CORNELL UNIVERSITY THE Flower Veterinary Library FOUNDED BY ROSWELL P. FLOWER for the use of the N. Y. STATE VETERINARY COLLEGE 1897 This Volume is the Gift of aid ee: a Peta 5077 | Cornell University Library _ SF 887.W72v an | 31924 021 949 296, Date Due WANs eed” f) ae @© PRINTED | IN U.S. A. Cornell University Library The original of this book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924021949296 VETERINARY OBSTETRICS INCLUDING THE DISEASES OF BREEDING ANIMALS AND OF THE NEW-BORN By W. L. WILLIAMS Professor of Surgery and Obstetrics in the New York State Veterinary College at Cornell University PUBLISHED BY THE AUTHOR AT ITHACA, N. Y. 1909 an Nod ys COPYRIGHT BY WwW. L. WILLIAMS 1909 SF 667 WT7XN PRESS OF ANDRUS & CHURCH ITHACA, N.Y. PREFACE. Whatever apology may be due the American veterinary pro- fession for the imperfections of this volume, the author does not deem it necessary to apologize for considering desirable a treat- ise upon Veterinary Obstetrics, and the diseases and accidents intimately associated therewith. In American veterinary colleges, and largely in the veterinary colleges of the world, obstetrics is the most poorly and ineffi- ciently taught of all the major subjects in the veterinary curri- culum. The available obstetric literature in the English language is very unsatisfactory. ‘The author believes that the chief ques- tion affecting this treatise is not the need for a comprehensive volume upon veterinary obstetrics and the closely related sub- jects, but the efficiency of the volume to partly supply that need. We have felt warranted in introducing features which are not usually included in treatises upon obstetrics. We have devoted a chapter to the ‘‘ Accidents and Injuries of Coition.’’ A yet greater space has been devoted to the ‘‘Infections of Coition’’, especially to the specific venereal infections. Still more em- phasis has been placed upon the subject of sterility. The writer desires to heartily express his sense of profound obligation to the various authors and publishers upon whose publications, with their kind permission, free draft has been made for illustrations and material for the text. It has been aimed, at the proper places, to give due credit for the source of the material used. Special mention is due to the authors and publishers of the treatises on Embryology by Bonnet, Heisler and Marshall; the Obstetrics of St. Cyr and Violet, Harms, Franck, DeBruin, and Fleming ; the Teratology of Gurlt ; and the Handbook of Surgery and Obstetrics by Bayer and Frohner. The author is under specially deep obligations to Professor Doctor E. Hess, of the Berne Veterinary School, for his courtesy iv Preface in permitting the insertion in our text of his extensive and ad- mirable contribution relating to sterility in cows. With a keen sense of the many and serious imperfections, this volume is submitted to the veterinary profession of America, hoping that it may awaken new interest in the practice of obstetrics, and extend some aid to those veterinarians engaged in obstetric work. W. L. WILLIAMS. Cornell University, June 1, 1909. CONTENTS. PAGE TN TPRODUCTORS (toe ei oly Be he Ne te I OBSTETRIC ANATOMY.______-___----- ee eee 3 A. THE ACCESSORY ORGANS OF REPRODUCTION ______-_-__--_ = 3 LHe, “PelViSo2, 2226 ao Sa ee a a 3 B. THE GENERATIVE ORGANS -_-___ ------ ----------------------- II The ‘Oyanies cess aeanseeeded Scenes ene ae ie ck IL The Miillerian Ducts ; the Oviducts, Uterus and Vagina._____ 19 OBSTETRIC PHYSIOLOGY. ..-__ 2-2-2. oo 2 eee ee neces eee 4o Reprodilctiow 225-552 226 oe ta pt OS, 4o OMIA OT so cee Se i eae a ee sees 44 HAS} ob 60 ae ee Sane ee nena Ue Se wea ee nee e Sek 9p Oe eT TEO NS RPA PILE men TRY 48 Spat EN Baa a a le ah ih at ete 49 THE DANGERS AND INFECTIONS OF COITION ____-_---_-____- 50 Phiysieal InjurieSss222<-- 22.2 cssccceesdcacess, jbaeeceees 50 GENERAL INFECTIONS OF COITION___---_----__-~------ -_---. --- =e 64 Contagious Cellulitis____--_-_---_--------+---- -------------- 68 SPECIFIC INFECTIONS OF COITION____-------------- ---------------- 73 IDOUTING: 3.252 55 eo Shas es eee 73 Genital Hose: POs pth wi a tet e eeel g2 Venereal Diseases of Cattle______ ____ -----__----------------- 95 Vesicular Exanthem____________--___-----_------ ~~. 95 Granular Venereal Disease (See also Appendix I page 1075)__ 97 Venereal Disease of the Dog-_____-_------------------------ 104 Venereal Disease of Sheep (See also Appendix II page 1114)_ 108 Venereal Disease of Rabbits__________-----_---------------- IIo Venereal Diseases of Swine and Goats..___. -------------__- IIo OTHER INFECTIONS OF GENITAL ORGANS_------___--_------------- III Bursattee of the Penis and Prepuce_____.-_-_--._-------_---- III Actinomycosis of the Genital Organs -_______..--.----------_ 113 MENSTRUATION. .2cscceceu ss Sete cote se case scesenee ees scees 114 PBRTIMIZATION jee eee poe os Bee eee SuSE ses 115 THE RELATION BETWEEN ESTRUM, OVULATION, FERTILIZATION AND IVI NS TRU ATION: Ss = 2-7 dso es se ee ee 116 STERTGULY 2225-22225. cs coss ies sesesda cesses sess tees ey IIg Sterility of the Male Animal___________ eehoestts teem bere ss 121 Pe Sterility of the Rémalé.o2<. -22.2 22 22sse sess ess sans 153 NostTRUMS AND PANACE AGAINST STERILITY ___------------------ 272 ARTIPICIAT; IMPREGNATION.__- 9222 cseseoese Se eee eee ene 278 BMBRYOUO GYs. 2secc2bee5c2 oseest sue oes ee bse 2 os 281 Germinal: ayers so -cccewe cess se co 52 atk aSe se cess eae kee The Primitive Streak Formation of the Embryo_ ._---_---------------------------- 286 vi Contents DEVELOPMENT OF THE ORGANS OF SPECIAL SENSE----~------------- 296 The Olfactory Organs__-_-------------------_-----+------ ---- 296 Whe: By @ isto oye See aSe eee eaeeensaase4 298 PHC MAR oe ela eer ete eae emeee ae’ 300 FORMATION OF THE DIGESTIVE APPARATUS -_-----. ----------------- 304 "The Wyungs). 322 eo as ns ese eS oek eo eee cee 310 HE eS thss 2226, 26 wee eect i oe Re ee ee os eo 311 TT Gla Vets sos a ee oe ore yas ae ee ee 318 The Pah Chasen 2ceansese se re aes ee ere eeo esse 318 "THR CIRCULATORY SYSTEM 22.2 -o ceo ese se Se Scse nese senccceeneeas 319 THE DEVELOPMENT OF THE URINO-GENITAL SYSTEM-__-_------------- 332 ‘The Weolfiant Diets: 2. apy ee Ss ee a 332 The Kidneys, Ureters and Bladder___---_ ---_------ .--------- 334 THE REPRODUCTIVE ORGANS._.--__---------------- ---------------+-- 335 HSER SaUMBS) os Sse oe eae See cec bse ca ct teee ous cagueceEsineeoee, 341 THE FRTAL MEMBRANES ..2-.5-2eeseeesec554-sses See ee cote neaee 347 The Vitelline, or Yolk Sac____________-___--_.--__---------- 347 hes Au miOn, 2c ioc ee esa ceee oe cee oe ees 347 he Allantois. ei se etc ene on esa coset uae eee 353 Wes CROTON wk sere ah pe eer et ee, 355 Whe: Placenta 835 ie pa a ee 358 The Umbilie Gord, ---.2--- =. 22252. e223 225--25554s555-4-45 364 TE RAT OMG 2225226 5uees ss Geil seem eS Bak a eer bees 367 PREGNANCY OR GESTATION_-_---_--_--_.. ---- ------------------ 369 The Form of the Pregnant Uterus-______--_----_ -------_----- 375 The Position of the Fetus in Uterus____._--__ --___-__________ 379 SIGNS‘OF PREGNANGY <<. -svuicscosecsecesseeceseubiiceeeses 6-4-8 384 The Duration of Pregnancy____-_-_..--------------------- 395 HYGIENE OF THE PREGNANT ANIMAL.___---_----------_ | 404 ANOMALIES IN FECUNDATION AND GESTATION-____-.________ 413 Supertecundation, 0.0.25. csseeeesssecoscssttess. sen clk 413 Extra-Uterine Pregnancy________-__. -.-------e ee Le 415 DISEASES OF THE PREGNANT ANIMAL.________-__- ee 421 Ostecimalacio nc ose eeid a rete a ne tt oe Ye 423 Dropsy of the Amnion and Allantois_________._______-._______ 424 Dropsy of ‘the: Uterus. oo ee eee ences 430 Paraplegia, 220. spc) tee os 2 ee ee ee 431 PTAUTOSIS( ins Ain ine he ee DS al a Rt oat Senet 435 Rupture of Prepubian Tendon___-____________-_-e 436 Heérniaot: the: Uterise sass gh tee ee eee 445 Rupture of the Gravid Uterus__-________-___-- ee 447 Ante-Partum Prolapse of the Vagina__.____-__---_-._ 449 MMetrorrhagi acs os alent la Seca 457 DISEASES OF THE FETUS AND ITS MEMBRANES____._____ 460 Death Of the: Petus: o.oo ee 460 Maceration or Putrid Decomposition of the Fetus____.________ 463 IBORMDION. 2222s. es Se eee ee a 466 Contents vii Enzootie Abortion... - 5 os. coce cc co eceeecoeacseeceeecees 473 Infectious Abortion_____________..---_---_ eee 474 NORMAL PARTURITION _______-___-_---- ee eee 509 EXPULSION OF FETAL MEMBRANES, AND INVOLUTION OF THE UTERUS 529 PRESENTATIONS AND POSITIONS OF THE FHTUS__---_..-------------- 530 MANAGEMENT OF NORMAL PARTURITION. __-_~-_-------~------------ 538 THE CARE OF THE PARTURIENT ANIMAL AND OF THE NEW-BORN-__-- 550 DW Si-O Kal Ase 3 coe ee aaa eo ee eee ase eaenea aS 568 EQUIPMENT FOR OBSTETRIC WORK._______--_--------------- 576 Condsiand! (Band's. he reer ee ee ees 476 Plalters: 25-9 o5 2 ee ea se 577 POreépSisa'-ce-22 2 Sb ce ces esc eoeelce ces ewe cent eee 582 “BACON 2c 52 ecco bene ee peta nbaaal Ben SAE Naa Se 586 Repellérsatid. Répulsidis.5-5 22 oo ese ne eeeeeces 595 INSTRUMENTS HOR: 'SHCTION 222204 se cote essa eee ce eeee eee eee 599 GENERAL OBSERVATIONS UPON THE CONSTRUCTION OF OBSTETRIC INSTRUMENTS) <9 20 22). ose ceoreeecec yee eee eee meeneees 608 OBSTETRIC OULBITS- = 2225.55 5052465- sce eet eee eee ee 611 ‘THE DRESS OF THE OPERATOR_-_---------------- ------ -----. ------- 613 POSITION AND CONTROL OF THE PATIENT____-~-~------.------------- 615 ( THE PREVENTION OF INFECTION DURING OBSTETRIC OPERATIONS___ 620 THE EXAMINATION OF THE PATIENT ___-__------------------------- THE GENERAL HANDLING OF DYSTOKIA____---.---- ---------------- Vv OBSTETRIC OPHBRA TIONS ocwe ess: ose soee Soe seay oseee tee eS Mutations... 25). 5- 225 sesesne Sodees weceeezeesseeeeces Forced. Extraction: ------- 42-0. 5 29s ales ee cee Mitibry ObOm yess ote dete soc ccéeesecsssycen ess eet ac Exercises in Mutations and Embryotomy Céessarian Sections. cee so Sao eo pt neat cas MATERNAL, DYSTOKIA..._...-+-- 2 eos se essences sccse se newsscses Inadequate Expulsive Powers_______----- ------ ------------- Pelvic Constriction’ .-.-5-nsesceeee-ses2 Sse seesdssee cus Rigidity or Spasm of Cervix Uteri__----------------- -------- Induration of Cervix Uteri__-.------------------------------ Malignant and Other New-Growths of Genital Passages___-__-- 690 DYSTOKIA DUE TO DISPLACEMENTS OF UTERUS-_--_---------- 692 Herniaiof Uterus. 22505- a sen se ese esse esse eeeeeeeeseseee 692 Deviation of Wtérus_ ce wscee sees ses ceecs cscs eciecae sess 692° ‘Torsion.6f Uterus__-~ =... -<2sssspeeseseeceeeetetsiessseees ss 693 FETAL DYSTORKIA..2022-2<..22---2-----3-5---sesessessssesesssess 714 Development of the Fetus in an Abnormal Position in the Uterus 716 Bicornual Pregnancy or Transverse Development of the Fetus 716 ABNORMALITIES IN THE DEVELOPMENT, OR DISEASES OF THE FETUS__ 727 Excess of Volume of the Fetus______._--------- .--. ---------- 727 Hydrocephalus -_-~ ------------- ----------------- ---------- 736 Ascites and Hydrothorax -__- -----------~---- ---- ----.-------- 739 Anasarca ___. -------- -------- ---------------------- -------- 740 Cysts and Cystic Degeneration of Fetal Organs___..---------- 740 Vill Contents TUMORS OF THE FRTUS.-22.2-- -2 223-222. 25-s+scseseeensssessas sees 741 ANOMALIES AND DISEASES OF THE FETAL MEMBRANES------_---- --- 742 ABERRATIONS AND ANOMALIES IN THE DEVELOPMENT OF THE FETUS_ 744 Campylorrhachis: i229 acces Sones eee ete 744 Schistocormus Reflexus_____________. ---_ ---- --------------- 744 Contractions of Extremities_....__...-._._.-_--_------------- 746 Double and Triple Monstrosities______-____--.---------------- 748 THE DVSTORIA OF TWINS. o252s2scc cee sese nse sco seus ass -sseeRe 752 ABNORMAL PRESENTATIONS AND POSITIONS OF THE FETUS 753 DYSTOKIA IN THE LONGITUDINAL PRESENTATIONS-___--------------- 753 DYSTOKIA IN THE TRANVERSE PRESENTATIONS ___------------------ 786 PATHOLOGY OF THE PARTURIENT OR PUERPERAL STATE_-. 791 PATHOLOGY, OF ‘THE PLACENTA .nccess cu ses Hee seeks ub eee eS 791 Retention of Fetal Envelops.____-----.---------------------- 791 WOUNDS AND INJURIES TO THE GENITAL AND NEIGHBORING ORGANS. 812 Post-Partum Hemorrhage______---._-_-_.--~_------------------ 812 Rupture of the Uterus and Vagina____.___-___-_------------- 814 Rupture of the Bladder______-__----_-___--------------------- 820 IU Ptuine-Of thes Ntestines 2.2 eo eo eee ed 820 Rupture of the Diaphiagin 2.25 oss cee esse cas 821 Rupture of the Sacro-Sciatic Ligaments____-_-_-_----_---_--_- 821 Prolapse of the Intestines through the Ruptured Walls of the Wtertishon Vasina: 22222. e bso eee 2h Stee eon cae se 821 Prolapse of the Bladder through a Rupture in the Vagina_ ___ 822 Uterine: Prolapse 2. eho eos cee et ese coca 823 Eyersion Of Vabiila... Wo weiiccocec ee Soot see 848 Prolapsé of the Rectwim_._...2 22+ 4-4 ene ete e sees cee csee 854 Hyersion ofthe Bladdetec... cee y eins poe eee ee ec Les 855 Ruptureof the Perinewm..0__--.....-.-----5-----+ elon oee 857 Vesico-Vaginal: Fistula 0... <= - 21 alone 8 ees ence 863 Hematoma of the Vulva______-_______-_____ ee 864 Relaxation of the Pelvic Symphysis__________ -.___.---_______ 866 Contusion of the Lumbo-Sacral Nerves -_.______.______-______ 866 Contusion of the Gluteal Nerves_______ .-__ -.-.2------ ee 867 Contusion of the Obturator Nerves__________ 5 868 PUERPERAL, INFECTIONS..-.---05--25-4-<.c222es ecco ose 871 ACUTE ME DRVIIS) 2-202 5520 oo aS Se oe oe tee 872 Acute Endometritis in the Mare_____________________-___ 874 Acute Metro-Peritonitis in the Mare__________ ---- =e 877 Acute Metritis and Metro- Peritonitis in the Cow______________ 878 Acute Metritis in the Smaller Animals______.______ --_-___ 884 CHRONIC METRITIS, PYOMETRA_____-____-__-_ eee 885 Chronic Metritis in the Mare__________-____-_-_ eee 885 Chronic Metritis in the Cow___.--______---e ee 894 Pyometra in the Bitch and Cat_________. --_- ee 895 Uteriie SA DSCOS9 een es eta 8s Ss Sn 896 Contents ix OVS UTES oS pee Oe eS he BETS ole ALA h ht i goo PERI-VAGINAL ABSCESSES______________---_-____-_______________ gol PYRMIC INFECTION. 3 20205 soennwsenieweteemneteccotece; cesses go02 PUERPERAL SEPTICHMIA.___---__ eee 905 PUERPERAL LAMINITIS_____-___-- ee 907 PURRPERAT, ‘TETANUS 2222222 pe es 909 PUERPERAL ECLAMPTIC DISEASES.___________------ ee gil Parturient Eclampsia in the Mare__________________-________- 914 Parturient Paresis in the Cow _.. _______-_-_-_____ ---__ eee 920 Puerperal Eclampsia in the Sow____-____________.____-____. - 936 The Milk Disease of Sheep__________________-____----- eee 937 Puerperal Eclampsia in the Bitch ____ ..__________ 1 -_-._ 938 DISEASES OF THE MAMMARY GLANDS._________--_ oe 939 Mammitis in the Cow__________________- ee 940 Acute Mammitis: . 2.222522 eco os ee ese een 941 Infectious Mammitis of Cows______-_________.__-.----_-__-.---- 965 \yienntheaia of the Udder Infectious Gangrenous Mammitis of Ewes____________________ 976 Infectious Agalactia in Goats and Sheep____.________________- 977 Mastitistin: Swine@ieeece. ees ec 978 Mammitis in the Bitch____________ Saeee seek cece t eee te 978 Edema.of the Udder. .- ---2--nescensecnecs cecestienesesce 979 Tumors of the Mamme____________---__---- ee ee 981 Hemorrhages in the Udder_____---___-___.------_-_----______ 983 Mike Histulae ss. opto oe ee sts os ee es 985 Fy GUO g G21 es | [eee eea nen seer Re eee te a eR 987 Pendulous Udder ___...-.---------2-2---4-2 sees cccenncen ee 988 Dermatitis of the Udder____------___-__-___--_---_----------- 988 Furunculosis of the Udder______----------------------------- ggo % Wounds of the Teats and Udder_____.____-.-.-------- = 991 Warts onthe eats 2. seus cncssee sede ss agceeeeseseseseseses 992 ™ Stricture or Atresia of the Teats___.---___-_-----__--.----__-- 993 DISEASES OF THE NEW-BORN..-____- -_-_-_-_------------------ INFECTIONS OF THE NEW-BORN_-__---------- ------------------ ------ ~) Omphalo-Phlebitis__._.._-.---.----------------------------- xy Tetanus: Neottatortiniicsjsssccct es cece ear caue ~ Dysentery of the New-Born______-___-_-__--_-_-------------- Sporadic Dysentery of the New-Born Infectious Diarrhea of Calves Septic Pleuro-Pneumonia of Calves________-___-_---. -------- 1032 Calf Septiceemia\ so sccsce ee ee ee ee soe 1033 BACteT Seta see ee es ee ha ee 1033 x Contents Non-INFECTIOUS DISEASES AND DEFECTS OF THE NEW-BoRN-------- 1035 Asphyxia. 2.22: -.cschsec-leseseveesepoussis eee eeseessecee 1035" Umbilic Hemorrhage_____.-------------- ------------------ 1037 Persistéiit UrachtS...2<. 25.2540 22-420-5L seeeesetee se 1039 No Retention of the Meconium en ee ETC R Te eyes Rn 1041 ANATOMICAL DEFECTS OF THE NEW-BORN-_-_-_----------------------- 1046 \Uin bilie’ Hernia... oe ee ee ee Se aoe es au ee esau 1046 Scrotal Hernia. 06 oe es pews seen Ske eee see 1059 Im'perforate Anus. q+ -- 2-22... 24 seeestese eee secdee nto 1064 Imperforate Viulya2s22--5225..i240 cote soe see ee 1064 Atresia of Posterior Nares____ .-____ --_---_-_-___ ------------- 1065 Atresia of other Body Openings______-__--- Peoreatenc sewn ets 1066 Fissure of the Palaté.oo2ccnc2ccee) esses cogcseeseessceseence 1067 Persistent Foramen:-Ovale.....-....2..-..-.----+ -sssss6-=++= 1068 BRO Tig Ue Cis ot etal ale he ae were ete AES 1069 Hernia Gerebrit, 2-2-3 o2 ee a eh ct ee ree 1069 Odontomesso2 26526 as es Se ee i 1069 RUPTURE OF THE EXTENSOR PEDIS TENDONS IN THE ANTERIOR LIMBS OF THE NEW-BORN _____--------------..------.------------- 1070 APPENDIX I The Granular Venereal Disease of Cows____---_- ------ 1075 APPENDIX II The Venereal Disease of Sheep____---.---_---------- 1114 I chciaa wacko dectanin ya ore os aaah ak teen “sa ahem A cat cistern ccs IlI4 VETERINARY OBSTETRICS INTRODUCTORY Veterinary obstetrics, in its most restricted sense, is a consid- eration of the necessary or advisable oversight or aid during the act of parturition in domestic animals. Birth constitutes one of the most prominent epochs in mammalian existence, marking the boundary between intra-uterine or fetal development, in which the young animal is nourished and protected within the maternal .body by the mother, and the extra-uterine life, when the young animal must assume more or less independence and responsibility, partly or wholly secure its own food and provide for its safety. The giving of birth to young is the culminating act of a series of complex and interesting phenomena, the perversion or inter- ruption of any one of which may lead to the defeat of reproduc- tion, and when the act has been completed and living offspring produced, there are still incidents immediately following, which are essentially dependent upon parturition and which may jeop- ardize the life or usefulness of either the mother or her young. The subject is one of intense scientific and economic impor- tance as it lies at the very foundation of livestock husbandry and largely determines the ultimate success or failure of this great industry. It is necessary to have a full comprehension of each corollary process in order that we may effectively grasp the significance of the phenomenon itself. Successful parturition occurs only when the prospective mother is normal in the structure and physiologic development of all her organs of reproduction and of others which may have an essential relation thereto ; and the fetus must undergo a normal development ere it can be born in a viable state. We consequently habitually include under veterinary obstet- rics all factors which necessarily precede and lead directly to par- turition and all immediate consequences of birth which affect the health of either the mother or the young. In this wider signifi- cance veterinary obstetrics may be defined as the study of the I 2 Veterinary Obstetrics dangers and diseases occurring in the process of reproduction in domestic animals and our means for avoiding or overcoming them. Under this conception we necessarily include : 1. A study of the anatomy of all those organs having a vital relation to the act of reproduction either directly or indirectly : Obstetric Anatomy. 2. A study of the physiologic functions of the reproductive organs, including such phenomena as sexual desire or estrum, ovulation, menstruation, copulation, fecundation, the origin and development of the fetus and the birth of the young: Odstetric Physiology. 3. The pathology of breeding, including the accidents and dis- eases dependent upon coition or interfering with fecundation. 4. Aberrations in the development of the embryo: 7Jeratology. 5. Accidents and diseases of the mother and fetus during pregnancy; Pathology of Pregnancy. 6. Difficult birth : Dystocza. 7. Accidents and diseases of the mother occurring as a sequence to parturition: Pathology of the Puerperal State. ; 8. Diseases and accidents of the new-born acquired during intra-uterine life or refetable to the exigencies of birth. OBSTETRIC ANATOMY Each organ or part of the body contributes directly or indi- rectly toward the function of reproduction, but, in many of them, the influence is so remote that their relationship to breeding does not require special consideration, while some organs or parts, de- signed primarily to serve other ends, incidentally perform impor- tant accessory offices in the act of birth, as in the case of the pel- vis, while other organs, like the ovaries, uterus, vagina, vulva and mammez are devoted exclusively to the procreation of the spe- cies and are designated reproductory or generative organs. A. The Accessory Organs of Reproduction. THE PELVIS. The pelvis constitutes an accessory organ of generation of fundamental importance because the fetus must traverse its canal in the process of birth, and success or failure may be decided by the amplitude of the pelvic channel in relation to the size of the fetal body. It consists of a bony girdle forming the posterior body wall, into which extends the posterior prolongation of the peritoneal cavity, and the terminal portions of the digestive, urinary and generative systems. Our chief obstetric interest in the pelvis is in its internal face, constituting the walls of its cavity. The pelvis is composed of the sacrum and coxae or ossa inno- mifata, with their ligaments, and the first two or three coccy- geal vertebree may be regarded as participating somewhat in its formation as they constitute a part of the pelvic roof. The sacrum consists of a series of anchylosed sacral verte- bre, varying in number in the different species of domestic ani- mals ; in the horse and ruminants five, in the pig four, and in carnivora three. In sagitttal section it presents the form of a truncated cone with its base articulating anteriorly with the last lumbar verte- bra and its apex posteriorly with the first coccygeal bone, In cross section it is triangular, with its base inferior. The lateral surfaces offer roughened facets for articulation with the 3 4 Veterinary Obstetrics coxae. ‘The inferior surface contributes to the formation of the pelvic roof, is concave from before to behind, essentially plane from side to side and shows transverse lines of demarcation be- tween the individual vertebree in the form of ridges varying in prominence with species, age, breed and individual. It is alleged that the sacrum varies according to sex, the articular elevations being, it is claimed, less prominent in the female. We have not been able to verify this claim by the study of specimens. Fic. I. SAGITTAL SECTION OF THE PELVIS OF THE MARE, SHOWING LUMBO-SACRAL NERVES. S, First sacral vertebra. L, Last lumbar vertebra. A, Last lumbar nerve, passing passing oyer lunibo-sacral eminence. E, Gluteal nerves. O, Obturator nerve entering foramen. The spinal canal extends through the sacrum and is occu- pied by the terminal nerves of the spinal cord. The inferior sur- face of the bone shows a series of paired openings, through which the sacral nerves emerge to take a prominent part in the forma- tion of the lumbo-sacral plexus. Most of these emerge in such a The Pelvis 5 manner as to render mechanical injury to them during parturi- tion very improbable, while others, especially the anterior gluteal and obturator nerves from the last lumbar pair, Fig. 1, have to pass over a promontory marking the lumbo-sacral articulation at A, in sucha manner that they may be, and not rarely are, crushed between the bony ridge and some unyielding part of the fetus during its passage through the pelvic canal. The ob- turator nerve may also be injured in a somewhat similar manner as it enters the obturator foramen, as shown in Fig. 140. (See Contusions of Lumbo-sacral Nerves. ) The two coxae or ossa innominata are elongated, flattened bones, widely expanded at each extremity, where they are com- posed chiefly of cancellated tissue, and constricted in the center, where they partake more of the structure of long bones. Above and anteriorly they are briefly separated from each other by the intervening ‘sacrum, with which they articulate by means of an almost immovable joint ; behind or below they converge to form the pelvic floor, in which, on either side of the median line and about midway from behind to before, occur two large oval open- ings, the foramina ovale. They unite on the median line to con- stitute the ischio-pubic symphysis and, becoming anchylosed early, serve, with the aid of the well-nigh immovable sacro-iliac articu- lation, to complete the pelvic girdle. Near the middle of each coxa, on the infero-external face, occurs the acetabulum or coty- loid cavity for articulation with the femur. Each coxa is composed of an ilium, ischium and pubis, which constitute separate bones during early fetal life, but become fused together prior to birth to constitute a single bone. The general direction of the ossa innominata is obliquely back- wards and downwards from the sacrum, the two coxae curving * at first outwards and later inwards to unite on the median line and, with the sacrum, to complete the oval pelvic inlet. The ilium, the largest of the three, is flat and triangular in outline, its supero-external face being concave and occupied by the gluteal muscles, the infero-internal face being occupied largely by the articulation with the sacrum inwardly and by muscular insertions laterally. Ihe postero-inferior angle of the bone is contracted and rounded to form the iliac shaft and ends by con- curring with the ischium and pubis in the formation of the ace- tabulum. The two ilia extend obliquely downwards and back- 6 Veterinary Obstetrics wards from their sacral articulation, their inner borders being concave. They attain their greatest distance from each other soon after leaving the sacrum, near the great sciatic notch, at the point where the flattened anterior portion merges into the shaft, from whence they converge slightly as they approach the cotyloid cavities. The ilia form the major portion of the lateral walls of the pelvic inlet. The ischium is an irregular triangular, flattened bone, consti- tuting the most posterior portion of the pelvis and concurring with the pubis in the formation of the pelvic floor. It occupies an almost horizontal position in the horse and most domestic ani- mals, but, in the cow, its posterior portion is directed upwards and backwards and compels the fetus, during its expulsion, to pass obliquely upwards and backwards, instead of horizontally back- wards. Anteriorly, it constitutes internally the posterior bound- ary of the foramen ovale and, externally, concurs in the formation of the acetabulum, where it articulates with the ilium and pubis ; on the median line it unites throughout its anterior part with the corresponding bone of the opposite side, constituting the pos- terior portion of the pelvic symphysis. The postero-external angles of the ischia are tuberous, consti- tuting the ischial tuberosities and between these is the receding angle known as the ischiatic notch, which depends largely upon the extent of the tuberosities for its depth while its width is fixed by the degree of divergence of the two bones. This triangular notch varies greatly with species and individ- uals and some authors contend that it is wider and more ample in the mare than in the horse. The latter contention is not well established and, if it exists, is not sufficiently marked to consti- tute a means for differentiation between the sexes. The ischium is of little obstetric significance in domestic ani- mals, except possibly in the cow, where the notch may be very deep and narrow and the tuberosities, being very prominent and directed sharply upward toward the coccyx, tend to limit the di- mensions of the pelvic outlet and constitute a barrier to the pas- sage of the fetus. The pubis is a flattened bone placed transversely at the anter- ior border of the pelvis, articulating on the median line with the corresponding bone of the opposite side to constitute the floor of the pelvic inlet. It articulates posteriorly with the ischium and The Pelvis 7 concurs with the ilium and ischium in the formation of the ace- tabulum. In the mare there frequently appears a sharp elevation on the median line at the anterior end of the symphisis pubis, surmount- ing the pubic brim and projecting upwards into the pelvic cavity in a manner to endanger the integrity of the vaginal or uterine walls when impinged between this sharp elevation while the body of the fetus is passing over it under great pressure. See Fig. 113¢. The relations between the pelvis and the spinal column are maintained by a series of ligaments and muscles. The sacro-iliac articulation is very rigid, the two bones being closely applied to each other by means of roughened surfaces and maintained by short and very strong inter-osseous ligaments. The integrity of the sacro-iliac articulation is further preserved behind by the sacro-sciatic ligament and in front by the pre- pubian tendon and the muscles contributing thereto. The great sacro-sciatic ligament arises from the transverse spinous ridge of the sacrum and,commencing immediately behind the sacro-iliac articulation, extends to the posterior extremity of that bone ; passing downwards, it is attached along the supero- external border of the ilium and ischium from the sacro-iliac articulation, backwards to the ischial tuberosity. The two liga- ments thus form wide aponeurotic sheets, which constitute the greater portions of the lateral pelvic walls and occupy all that area comprised between those portions of the ‘sacrum and ilium posterior to the sacro-iliac articulation and the external bor- der of the ischium to the summit of the ischial tuberosity. This broad and powerful ligament serves to prevent the posterior portion of the pelvis or ischia from receding downwards from the sacrum and affords a strong and somewhat flexible and yielding wall to the pelvic cavity. It is sufficiently extensible that, under the pressure of parturition, it yields enough to permit the con- stricted outlet to equal in dimensions the larger bony inlet to the pelvis. The powerful prepubian tendon arises from the pubic brim and, through the linea alba and the contributory muscles, finds attachment in front to the ensiform cartilage of the sternum and prevents the pubis and ischium from passing upwards and back- wards toward the sacral termination when the body weight is thrown upon the coxo-femoral articulation, which lies behind the 8 Veterinary Obstetrics ilio-sacral joint. It plays. avery important part in the large herb- ivora, especially in the mare, where it sometimes ruptures during advanced pregnancy, resulting ina hernia of the gravid uterus and destroying the normal relation of the pelvis to the spinal column. (See Rupture of Prepubian Tendon, and Figs. 82, 83, 84 and 85.) In addition to these ligaments, the great dorsal and psoas muscles serve an important function in maintaining the re- lations between the pelvis and spine. The pelvic cavity is somewhat conical in form in its antero- posterior diameter, with the base of the cone presenting forwards so that the pelvic inlet is somewhat larger than its outlet, a dif- ference which is counter-balanced fully by the fact that the inlet is really the only non-extensible portion of the pelvis so that, in practice, other things being normal, if a fetus can enter this por- tion it can pass through the outlet by causing its dilation. This distensibility is dependent upon the yielding character of the sacro-sciatic ligament, as mentioned above. In woman, the rela- tions between the sacro-pubic and bisiliac diameters of the pelvis are inconstant, resulting in a tortuous passage, which leads toa rotation of the fetus on its long axis during parturition in order to keep the greater dimensions of the fetal body in harmony with those of the bony girdle through which it is passing, while, in our domestic animals, the cavity is rectilinear and the fetus is expelled in a direct, instead of a spiral line. In cross section, the pelvic cavity is oval in outline, departing but little from circular, its perpendicular usually being slightly greater than the transverse diameter, though these relations may be reversed. The relations between the perpendicular and transverse diameters do not vary materially between the inlet and outlet, the former being usually the greater for the entire length of the passage. ‘The pelvic channel is direct and almost horizontal but usually directed more or less obliquely upwards and back- wards from the inlet to the outlet. This is especially nota- ble in the cow,where the pelvic floor is quite oblique and concave from before to behind and is further emphasized by the promi- nent ischial tuberosities, placed so closely together that, for prac- tical obstetric purposes, the summits of these may, in some cases, virtually mark the floor of the pelvic outlet because they are too close to each other to permit of the ready passage of the fetus between them. In the mare the pelvic floor is almost level and The Pelvts 9 the ischial tuberosities so small and wide apart as to be of little significance. The measurements of the pelvic cavity vary widely in different species, breeds and individuals so that it is virtually impossible to make any general statements as to the dimensions of the pelves of our domestic animals. The variations in size among domestic animals are extreme, owing to artificial selection for the production of giant and dwarf animals, which are widely sep- arated in stature. In the horse it is not rare to find animals weighing 250 Ibs. or 2500 lbs., or a ratio of 1:10, and there is naturally a corresponding variation in the measurements of the pelvic passages. In the dog the variations are even greater in size, the ratio in weight being at times as great as 1:100. It is, therefore, quite impossible to give a reasonably approximate measurement of the pelves of the different species of domestic animals. The most important diameters of the pelvis of the mare to be considered by the veterinarian are the supero-inferior, extending from the lumbo-sacral articulation to the anterior point of the pubic symphysis; a vertical diameter of the inlet from the symphysis pubis to the middle of the sacrum; anda transverse from the most concave point of one ilium to the corre- sponding point on the opposite side. For the outlet, usually but two diameters are considered ; a vertical, from the ischio-pubic symphysis to the sacro-coccygeal articulation and a transverse, from one ischial tuberosity to the other. The measurements vary considerably in the experiences of different authors, the supero-inferior for an average horse being 9 to 10 inches accord- ing to Baumeister & Rueff; 9.5 by Carsten-Harms; 9 by Ar- loing and 8.75 by Saint-Cyr. The same authors make the trans- verse diameters 11 to 12.5; 9.2; 9.2 and 8.1 in. respectively. These authors have evidently secured their measurements from different classes of mares. In the cow, the average diameters of the pelvic inlet as given by various authors range between 8% and 10% inches trans- versely and 634 to 734 perpendicularly, with an outlet somewhat smaller in each of its measurements. The ewe and she-goat show a perpendicular diameter of the pelvis averaging about 4.7 in. and a transverse measurement of approximately 3.1 in. The bitch shows a very wide variation in pelvic measurements, ranging from 2 to 2 1-3 in. in the sacro- fe) Veterinary Obstetrics pubic and 1.2 to 2 in. in the transverse diameter. Similar varia- tions occur in the measurements taken by the various observers of the other diameters of the pelvis of the mare and of other ani- mals, the differences being so wide as to render the measurements of questionable value. Some investigators have attempted to establish rules for determining approximately the diameters of the pelves of living animals, but, thus far, have been unable to turn pelvimetry to practical account in veterinary obstetrics, in contrast with human practice, where it acquires fundamental im- portance on account of the frequency of pelvic deformities, which often render normal parturition impossible. These deformities rarely occur in our domestic animals, partly because the osseous system is far more mature at birth than is observed in man and still more because a pelvis weakened by disease is subjected to no such strain in quadrupeds. The horse bears only 45 % of his total weight upon his posterior feet and this is largely made up by the weight of the limbs themselves and the muscles connect- ing them with the trunk so that the actual weight resting upon the pelvis in domestic animals is inconsequential and represents probably less than 25 % of the total body weight, while, in man, it needs endure the entire body weight, except the legs themselves. The pelves of domesticated animals are sometimes seriously deformed as a result of fractures, tumors and dislocations, which may render parturition difficult or impossible. Pelvimetry in domestic animals is impracticable usually in the two chief groups of cases where the size of the pelvis has to do with dystocia. When the pelvis is deformed as a result of tu- mors, fractures, dislocations or rickets, the constriction is rarely recognized until the veterinarian is called because of dystocia ‘and he faces the question of overcoming it and must determine his method of procedure by a rough comparison of the size of the fetus as related to the capacity of the pelvis, as estimated by man- ual exploration. He is then in a position to advise the owner in reference to the future of the patient, whether she should be again used for breeding purposes, turned to some other available use, or destroyed. When dealing with such injuries in non-preg- nant animals, it is clearly the duty of the attending veterinarian to warn the owner against breeding the animal unless careful examination makes it clear that the patient may normally give birth to young. The Generative Organs II In a second group of cases, excessive volume of the fetus, pelvimitry fails the veterinarian as he can not recognize, even if called to do so, this over size, until he is brought face to face with the consequent dystocia, and that fact alone demonstrates the disparity in size between the pelvic canal and the fetus, which is to traverse it. Nor does this occurrence, even when safely overcome by the obstetrist, furnish any safe criterion for future action except possibly suggesting a change of mating. Subse- quent fetuses may be of normal size. It has moreover been asserted that sexual differences exist in the pelves of domesticated animals, especially in the horse. This we have been wholly unable to verify. It is claimed that the pelvis of the mare is more ample than that of the stallion or gelding, that its foramen ovale is larger, that the ischiatic notch is broader and shallower, that the sacrum has less prominent articu- lar ridges ; in other words, that the pelvis of the mare is specially constructed as an organ of reproduction in a manner to facilitate the passage of the fetus at the time of parturition. We have critically examined a number of equine pelves and find among them those of stallions or geldings fulfilling the description given as typical of the mare in every regard and, vice versa, a mare pelvis fully meeting all the alleged characters of the male. So far as we have been able to determine, it is impossible to differen- tiate the sex of any species of domestic mammals by the form or size of the pelvis. B. The Generative Organs. The genital system of the mammalian female consists of the ovaries, oviducts, uterus, vagina, vulva and mamme. Writers variously divide them into internal and external, essential and subsidiary, genital or copulatory ; each, however, is influenced by the other and each is essential to normal reproduction. 1. THE OVARIES. In the protozoa, reproduction is effected by the division of a single nucleated cell into two parts, alike in form and size, the completion of the division establishing two individuals which ‘supplant the parent. Reproduction in the higher forms of animal life proceeds in a somewhat similar manner from a single specialized cell, the ovum, 12 Veterinary Obstetrics which, however, only divides after conjugation and fusion with the male cell, the spermatozoon, while the parental body remains unchanged after the separation and casting off of the male or female reproductive cell. The ova-producing bodies, the ovaries, appear early during embryonic life, varying in date according to species—usually at about one month in those of long gestation periods. The first traces of the ovaries are the genital ridges, which arise as longitud- inal eminences along the median borders of the Wolffian bodies and consist of a proliferation of the peritoneal epithelium at this point, by which several layers of cells are formed. The ridges appear in the human embryo at about 35 days or one-eighth term, in the rabbit at 11 days or a trifle after the first one-third, and in the sheep at 42 days or nearly one-half term. Connective tissue grows up into the genital ridges from the underlying mesoblastic cells to form the skeletal frame-work and tubules from the Wolffian bodies grow into the ridges to consti- tute the tubular tissue of the ovary, but they play no known essential part and are said to have nothing to do with the forma- tion of the ova. For a time the genital ridges are alike in both sexes, so far as can be determined, forming the indifferent stage, during which the male and female organs cannot be differentiated, As the genital ridges develop, the differentiation in sex becomes established and, in the female, the ovary soon assumes the charac- teristic form of the adult, varying with the species. While it is held that all ovarian tissues are of mesoblastic ori- gin, the genital epithelium, arising from the peritoneum, the skeletal connective tissue from the sub-peritoneal mesoblast and the tubular portion from the mesoblastic Wolffian bodies, we meet with in various animals, especially in the horse and human fam- ily, dermoid cysts and well defined tooth tissues in the ovaries and testicles. These abnormalities are variously explained by pathologists and teratologists. Since dermal structures and teeth are derived normally from the epiderm, it may be well to recall in this connection that the gubernaculum testis of the male and corresponding round ligament of the female extends from the ex- ternal skin in the scrotal region of the male and the cotrespond- ing parts in the female through the inguinal canal and ring into the peritoneal cavity, where it proceeds to a point contiguous to, if not continuous with, the testicle or ovary. Embryologists do The Ovaries 13 not make it clear whether epidermal cells may thus reach this region or not, nor whether the presence of this gubernaculum accounts for the occasional inclusion and development within the genital glands, of epidermal structures. It is also alleged by some embryologists that the Wolffian ducts are of epiblastic origin and are formed from a longitudinal in- vagination of epiblast. In the outermost layer of genital epithelium, the cells are columnar while, deeper, they are cuboidal in form. Inthe deeper parts, the skeletal stroma divides the cuboidal or spherical cells into clumps or groups known as egg columns, among which are to be seen, usually one or more in each nest, cells of large size with prominent nuclei, the primitive ova, which continue to form until near the close of intra-uterine life. Primitive ova are present as soon as the genital ridges are well formed and Nagel claims that these are not confined strictly to the genital ridges, but occur here and there in the region of theducts of Mueller in the thickened epithelium. This observation of Nagel is highly suggestive in reference to the operation of ovariotomy in females. We frequently find reportsof cases where females have been castrated and later have shown signs of estrum, and it has been held by many practitioners that certain of our domestic animals continue to show signs of estrum after they have been properly castrated. In our own experience, we have seen estrum recur in an aggravated form— nymphomania—in the case of cows, where we were sure that we had removed the ovaries completely. Operating a second time, we have found cystic Graafian follicles at the point of removal of the ovary. It would consequently seem that not only may these ova exist in the tissues somewhat outside the ovary, but, when the gland itself has been surgically removed, they are capable of developing ovisacs, especially in a cystic form which will later produce all the symptoms of estrum, but probably have no living ova in them. These facts suggest to us that, in performing ovariotomy, the operation should not be confined to removing the ovary, but should include a large part, if not all, of the oviducts, with the contiguous tissues, so as to be sure that the ova and ovisacs are all removed. It is contended by Nagel that there are differences in the geni- tal ridges of the sexes in the human embryo at as early a period 14 Veterinary Obstetrics as 32 or 33 days, those of the female containing primitive ova, while in the male there appear the tortuous cords, which are to become the tubuli semeniferi and, in these columns are found primitive sperm cells. Nagel doubts if there is any truly indif- ferent stage in the development of the sexual organs, but be- lieves that they can be distinguished at a very early date and that probably they are at no time exactly alike. The primitive ova pass inwards toward the center of the gland and, as they do so, undergo a progressive development, at first having granular nuclei of indistinct outline, which soon enlarge, becoming very distinct and of a regular spherical form, having a double-contoured wall, fluid contents and a nuclear reticulum with one or several nucleolar enlargements at the nodes. The whole egg also increases greatly in size, its protoplasm becomes granular and, between the ovum and the follicle or capsule, there is formed an elastic investing homogeneous layer known as the zona radiata. Having undergone this development, they are known as er- manent ova. The smaller germinal cells arrange themselves in enveloping layers about the permanent ova in the form of a hollow sphere, from the walls of which, usually near the bottom, a discoid eminence of small granular cells, the dzscus proligerus, appears and, resting in this, is the ovum, while, between the discus prolig- erus and the follicular wall, is the follicular liquid. Outside the cellular wall the follicle is furnished with a fibrous, investing tu-. nic from the stroma of the gland and, when contiguous to the sur- face, has, in addition, a covering of ordinary peritoneum. ‘To- gether these structures constitute Graafian follicles or ovisacs. Of all animal cells, the duration of life of the permanent ova is best known. Unless they mature and are discharged into the oviducts upon the rupture of the Graafian follicles, they remain permanent from the date of birth, or soon thereafter, until the re- productive powers of the animal have ceased as a consequence of age. They remain in an unchanged state in the mare, for example, for 20 to 25 years, capable at any time during that period of becoming discharged into the oviducts, and, when im- pregnated, of developing into a fetus. In all our domestic ani- mals, so far as known, all permanent ova are developed at, or very soon after, birth and hence, whenever such of these as are The Ovaries 15 capable of impregnation have all perished through ovulation or other means, the fertility of the animal is at an end. Since the ova are formed from. specialized peritoneal cells known as the genital epithelium, while the vessels and skeletal tissues are derived from the sub-peritoneal mesoblast we are pre- pared to anticipate the occurrence in the ovary of two somewhat definitely marked zones, the cortex and medulla. The peri- pheral cortex contains the essential ovarian cells, the ova, em- bedded in prolongations from the central or medullary portion, composed of skeletal connective tissue, vessels, nerves and pale muscles. The multiplication of the ova and ovisacs in the cortex causes it to outgrow the medulla and results generally in the formation of a well marked hilus, where the vessels and nerves enter, at which point ova are usually absent. The skeletal tissues present an area of increased density at the periphery, where they constitute a firm, dense envelop, the tunica albuginea, over which the peritoneum extends. As the ovisacs develop, they tend to pass centralwards toward the me- dulla, and, continuing to grow as the amount of follicular liquid within them increases, finally occupy the entire thickness of the cortex and, in some species of animals, bulge out beyond the surface as more or less prominent, hemispherical masses or even protrude quite beyond the tunica albuginea as spherical out- growths. As they mature, the external wall of the ovisac atro- phies and finally ruptures at the time of estrum and the ovum is discharged into the pavillion of the oviduct or fimbriated end of the Fallopian tube. (It is claimed that in rare instances in mam- malia the ova are accidently discharged into the peritoneal cavity.) Usually a Graafian follicle contains but one ovum but in some cases two have been recognized. The total number of ova in the ovaries of our domestic animals has not been deter- mined. In woman, the number has been estimated at about 70,000, nearly all of which must undergo retrograde changes and not mature. ‘The ova mature in cycles, varying according to species, climate and degree of domestication. In some well housed and fed domestic animals which are not pregnant, ovula- tion occurs every three or four weeks throughout the year. During oestrum the ova are discharged either singly, as in the mare and cow ; two or three, as is frequently observed in the 16 Veterinary Obstetrics sheep and goat; or in varying numbers, as in the carnivora and rodentia. It is estimated that the ovaries of a child two years of age are fully developed so far as the new formation of ova is con- cerned. Ovogenesis must cease much earlier in our domestic ani- mals, all of which may reach sexual maturity within one year from birth and are in most ways more mature when born than is the child when two years old. In old animals which have ceased to breed or to show sexual desire, the ovaries are much atrophied and contain degenerate ova incapable of fecundation, signifying that the supply of fecunda- ble ova has become exhausted during the span of sexual life. This suggests that any estoppel of ovulation, like pregnancy, where the cycle is longer than that of ovulation, as in all our larger animals, will tend in some degree to conserve the num- ber of ova capable of further development. In harmony with this thought, we find that mares which are regularly bred tend to retain their reproductive powers to a later period in life than those which are not permitted to breed until aged, but here other factors, probably of greater importance, are at work. The rupture of the ovisac leaves a lesion which usually be- haves differently according to whether the discharged ovum be- comes impregnated and undergoes development into a fetus or, failing of fecundation, perishes. The ruptured sac becomes filled with lymph, blood or other products of the disturbances of the tissues. Should the ovum perish, the ruptured ovisac tends to heal rapidly, with a faintly yellowish cicatrix, which soon disap- pears entirely so that no visible trace exists of the ruptured sac. The temporary scar is known as a false corpus luteum. ‘The per- sistence of a corpus luteum, especially if over size, in a non- pregnant animal, inhibits ovulation and induces sterlity. (See under ‘“‘ Sterility.’’ ‘‘ Persistent Corpus Luteum’’). Should the ovum become fecundated and undergo normal de- velopment, the scar resulting from the ruptured ovisac normally attains greater dimensions, is markedly yellow in color, projects beyond the ovarian surface and persists nearly or up to the time of parturition, and is known asa true corpus luteum, We thus note a bond of functional sympathy between the ovary and the fate of a discharged ovum, a harmony shown constantly between the various organs of the reproductive system. An important The Generative Organs 17 fact in relation to the persistence of the true corpus luteum during pregnancy is a well marked tendency to abortion when the ovaries are removed from a pregnant female, or the corpus luteum is forced out of the ovary by crushing or otherwise. The size and form of the ovaries differ greatly according to species, age and individual and even the two glands in the same animal are not ordinarily alike and may vary greatly in size. The ovary of the mare is much the largest seen in the domes- tic animals, reniform, very dense owing to its thick tunica albu- ginea, with a smooth surface which is elevated here and there in many cases by the presence near the surface of cystic Graafian follicles. It attains its maximum size at the age of two or three years and begins to atrophy at ten to fifteen years, to finally become very small as age advances. The ovary of the young mare is usually 3% to 4 inches in its greatest diameter and weighs about 4 ounces, while, in the aged, it may shrink to 1% inches in its greatest diameter and its weight to % ounce. The ovary of the cow is much smaller, being about one inch in its greatest diameter, weighing but 1% to % ounce; it is ob- long in form, more regular in outline and its tunica albuginea is less dense. The ovary of the sow is very large comparatively and the numerous ovisacs appear prominently on its surface to such an extent that the most superficial of them stand out entirely be- yond the general ovarian line in such a manner that they are attached to the body of the organ by a somewhat constricted neck. : The ovary of the cat is very small, oblong, with pointed ex- tremities and of a bright scarlet color with the ovisacs standing out thickly over the surface in a way to suggest a mulberry. The ovary of the bitch is very small, dark livid in color, even in outline, and, unlike that of other domestic animals, is com- pletely enveloped in the pavillion of the oviduct, except for a minute oblong opening of so small size that the ovary cannot be exposed to plain view through it. Forming in the fetus, beneath and on either side of the notochord just posterior to the kidney, and above the perito- neum, the ovary descends into the peritoneal cavity, carrying with it the peritoneum, which thus forms a double layer behind 2 18 Veterinary Obstetrics it which serves to preserve its attachment to the sub-lumbar region, and, between the two folds, the vessels and nerves pass to the gland. The location of the ovary in the adult varies much with species but, apparently, the size of the gland has little or no in- fluence upon its position. It rests upon the superior surface of the anterior border of the broad ligament, naked in most animals but closely invested in the bitch by the pavillion of the oviduct. The pavillion of the oviduct is attached at one point of its margin 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. ‘The ovary is further 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 passes up through the inguinal ring and above the peritoneum to became attached to the uterine cornua or oviduct not far from the ovary. ‘The latter tends with these attachments to follow a line of descent comparable to the testicle but normally becomes arrested in its movement 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 behind the kidney ; in the mare, its movement is arrested early and it remains rather firmly suspended not far be- hind the kidney and above the middle of the posterior part of the abdominal cavity, while that of the cow lies loosely alongside the vagina just by the internal inguinal ring. In the sow, the ovary floats quite freely in the peritoneal cavity and at times passes out through the inguinal ring and comes to rest in the perineal region corresponding to the scrotum of the male. The same displacement is said to occur rarely in bitches and it is possible in any species. In general we might say that in the elongated uteri of multi- parous animals the ovaries are situated further forward than in the uniparous or biparous species. The location of the ovary is further modified by the pregnant state, the gravid uterus dragging it downwards and forwards in its own descent. The Muellerian Ducts 19 The Muellerian Ducts; the Oviducts, Uterus and Vagina. 1. THE MUELLERIAN Ducts. Early in embryonic life, before the genital ridges have become well marked, about the second month in animals with extended durations of pregnancy, the ducts of Mueller develop as two ridges beneath the peritoneum near to, but outwardly from, the Wolffian ducts, from which they are said to arise as outgrowths, and extend forwards from near the cloaca to or beyond the Wolffian glands. Appearing first as solid rods, they later become excavated to constitute tubes, which end blindly at their posterior extremity for a time but later open into the cloaca or common vent of the digestive and urino-genital systems. As soon as hollowed out, each vessel opens anteriorly into the peritoneal cavity through a large funnel-shaped mouth, the future pavillion of the oviduct of fimbriated end of the Fallopian tube. At this time there are in this region, lying parallel and near to each other, three separate ducts; the ureter, the Wolfhlian duct to become the excretory duct of the male genital gland and the Muellerian duct to become the genital tract of the female. The posterior ends of the Muellerian ducts are in close contact at first and later, at'about the time of their opening into the cloaca, they fuse together for a variable distance forward, their median walls disappearing, resulting in the formation of a single tube as far as the fusion extends. The Muellerian ducts later become differentiated into three essentially separate segments through specialization of their development, each having its distinctive function. The anterior segment constitutes the oviduct or Fallopian tube with its ampulla, or pavillion, which serves to receive the ovum from the ovary and bear it, fetilized or unfecundated, into the uterine cornu, or uterus; the second or middle portion of the genital tube constitutes the uterine cavity, in which the fetus may find lodgement, attachment, nutrition and protection during its devel- opment ; the third or posterior segment, the vagina, extending from the uterus to the vulva, serves first as an essential copula- tive organ and later as a passage for the fetus at the time of birth. The distance to which the fusion of the: Muellerian duct ex- tends forwards and the extent of the specialization of the different 20 Veterinary Obstetrics areas, modifies greatly the form and relations of the various segments. Arrests in the development of the genital tube may occur at any point, which may interfere more or less with its form and functions. ‘The fusion in the utero-vaginial region may be partly or wholly arrested, resulting in a more or less completely double uterus or vagina or the Meullerian ducts may fail to develop as such but remain as two dense solid cords, as is seen in Fig. 51 where no uterus or vagina exists. A study of Fig. 51 shows that the uterine cornua and ovaries were apparently well developed, the cornua contained consider- able cavities which were distended with fluid, the ovaries showed Graafian follicles and a corpeus luteum. The anterior, or oviduct segments of the genital tubes are widely separated from each other and are not commonly the seat of arrest of development. The Muellerian ducts in the male commence to disappear at about the middle third of pregnancy, but small vestiges may re- main in the adult male as the hydatids of Morgagni, which, in some species of animals constitute small pedunculated bodies between the testis and the head of the epididymis., They are supposed to come from the anterior end of the ducts and are more prominent in man than in our domesticated animals. At the posterior end of these ducts, where they unite together, they are by some supposed to form the so-called uterus masculinus, a small sinus which ex- ists in the superior wall of the urethra between the seminal vesi- cles, at the point of emergence of the vasa deferentia. The entire genital tract, having a common origin, has a gen- eral type of construction, characterized chiefly by each having three separate coats ; peritoneal, muscular and mucous. The peritoneal layer, which invests the genital tract almost completely, is derived from that of the body wall, behind which the ducts of Mueller originate. At the anterior extremity the genital tract opens, through the pavillion of the oviduct, into the peritoneal cavity, the continuity of the peritoneum being interrupted at this point to be succeeded by the mucous mem- brane of the oviducts. As the broad ligament consists of two peritoneal layers, re- sulting from the departure of the genital tube from its seat of origin behind the peritoneum, it follows that, along the line of its attachment to the genital tube, the investment is interrupted to The Broad Ligaments 21 the extent of the area between the two folds, occupied by the vessels and nerves. At the posterior extremity of the genital tract, where it opens into the cloaca of the embryo, the peritoneal investment isinterrupted and its place taken by the intrapelvic connective tissue so that, eventually, the peritoneum covers, in addition to the oviducts and uterus, only the more anterior por- tion of the vagina; the fusion of the two Muellerian ducts more- over, to form the vagina and uterus, eliminates the peritoneal covering on the median plane of each separate tube as far as they coalesce, and, following this, occurs the atrophy and disappear- ance of the muscular and mucous walls connecting the two, and the adjacent tubes become a single canal. The muscular portion is composed of transverse and longitu- dinal layers of pale fibers, varying greatly in the different sections of the tract and also according to whether the animal be pregnant or not. The mucous coat of the genital tract offers the greatest possi- ble variations and assumes widely differing and highly import- ant functions, according to the particular area occupied. 2. THE Broap LIGAMENTS. Since the Muellerian ducts have their origin outside the peri- toneum, it follows that in moving away from the abdominal walls they must carry with them their peritoneal covering. As soon as they drop away from their point of origin the investing folds of peritoneum tend to meet behind to constitute a double perito- neal fold, between which the vessels and nerves, along with pale muscle fibres pass to and from the ovaries and genital tube. These expanses of peritoneum, with invested vessels, nerves and muscles, constitute the broad ligaments of the uterus, or more cor- rectly speaking, of the genitalcanal. ‘The ligaments act as a sus- pensorium for the genital tract, maintaining its connection with the abdominal walls and also furnishing a support for the ovaries, thereby fixing these organs, under certain limitations, in a defi- nite location. The broad ligament varies greatly in its form and amplitude according 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 throughout the life of the animal, as far forward as or anterior to, the posterior border of the kidney, the broad ligament maintains its anterior attachment 22 Veterinary Obstetrics to the abdominal wall at or near the point of origin of the ovary just behind the kidney ; in the cow, where the ovary and the an- terior end of the uterine cornua are turned backwards to the im- mediate vicinity of the internal inguinal ring, the attachment of the anterior border of the ligament likewise moves backwards for a considerable distance so that the middle of the recurved cornu tends to project anteriorly beyond the anterior margin of the ligamentous attachment even when non-gravid. When the uterus of a quadrupedal mammal becomes gravid the weight of the fetus drags the occupied portion downwards and forwards 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. Since the anterior attachment of the broad ligament is more posteriorly situated in ruminants than in other domestic animals, it tends to favor the revolving of the gravid uterus on its long axis in front of the anterior attachment. This disposition attains an important clinical significance in the study of uterine torsion (which see) in which it is observed that the tendency to torsion increases as the anterior extension of the attachments of the broad ligaments to the abdominal walls recedes. The genital tube is further maintained in its position by its at- tachment posteriorly to the-vulva and also by the round ligament of the uterus, which we have already described on page 18. 3. THE OvipucTs. The oviducts, formed from the anterior or ovarian extremities of the Muellerian ducts, are two long, tortuous tubes, varying in length and other characters according to species. Their length is several times the distance from the anterior extremity of the uterine cornu to the ovary, thus throwing it into folds. ‘The distance between the anterior extremity of the cornu and the ovary is fixed by the utero-ovarian ligament and not by the ovi- duct. In some animals the oviducts are naked and clearly visible while, in the bitch, they are hidden in the fat of the broad liga- ment and the utero-ovarian ligament is very short so that the anterior end of the uterine cornu is virtually in contact with the ovary while the oviduct, some 3 to 4 inches in length, is. thrown into numerous folds to terminate about %4 inch from its uterine end, so that casual observation, without dissection, might lead to the assumption that the Fallopian tube was well-nigh The Oviducts 23 absent in this animal, whereas it is very similar in actual length to that seen in other species. When divested of any concealing coverings of peritoneum, fat or other tissues, the oviduct appears as a very tortuous, firm white cord about .1 inch in diameter, of variable length in different species of animals. It is very firm to the touch and gives a sensation much like its analogue in the male, the vas deferens. After dissecting it out from the sur- rounding tissues and carefully eliminating its numerous abrupt curves, a very fine sound, like one of the tail hairs of a horse, may be inserted at one opening and passed through its entire length. The opening is therefore very narrow and being remarkably tor- tuous in its disposition it hecomes difficult to pass either a solid object like a sound or even a liquid through it. While, techni- cally, the oviducts complete a communication between the peri- toneal cavity and the exterior, it seems virtually impassable except to ova and spermatozoa and does not, under usual conditions, permit even the forcing of liquids through them when intra- uterine injections are made under comparatively high pressure. Clinically, they are also well-nigh proof against the passage of bacteria unless we except some special organisms like those of gonorrhea in woman. Occasionally, however, after abortion, retained placenta, nodular venereal disease, etc., in cows and other animals, infection extends along the oviducts, causing dis- ease of them or, reaching the ovary, induces abscess or other disease causing sterlity. The intimacy of contact between the peritoneum and oviduct varies according to species, the investment being very close in ruminants and the sow so that they are readily seen without dis- section, while, in the mare, it is surrounded by much connective tissue, which serves to conceal it from view until the peritoneal and fibrous coverings are dissected away ; and in the bitch the concealment is further accentuated by large amounts of adipose” tissue. The oviduct opens anteriorly through the ostium abdominale into the pavillion 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 consistency, and its paleness, which amounts almost to translucency. 24 Veterinary Obstetrics The superficial layer of the mucosa of the oviducts consists of ciliated columnar epithelium, with the cilia vibrating toward the uterus. The oviduct is the most rigid and undilatable portion of the genital tube and has for its office the conveyance of the ovum, fecundated or otherwise, from the ovary to the uterus, in which function the cilia apparently play an essential part. The duct also provides passage for the migration of the spermatozoa of the male, which, advancing from the uterus toward the ovary, meet the ovum within this narrow passage and fecundate it. In rare cases the fecundated ovum lodges in this duct and undergoes par- tial development, to constitute tubal pregnancy (which see), but its undilatability serves as a rule to cause a rupture of its walls and leads to the escape of the fetus from the duct into the ab- dominal cavity to either cause sudden death of the animal from hemorrhage or constitute extra-uterine or abdominal pregnancy (which see). 4. THE UTERUS. The uterus is a musculo-membranous sac designed for the re- ception, attachment, nutrition and protection of the ovum and finally aids in the expulsion of the fetus at the time of birth. Derived from the ducts of Mueller, it varies greatly in form and disposition, partly dependent upon the degree of fusion between those two structures. There are generally recognized a uterine body and two cornua, each having essentially like functions in varying degrees. In the rabbit, there exists no uterine body, but two distinct tub- ular uteri opening separately into the vagina. In the bitch, cat and sow the uterine body is limited in extent and physiologically unimportant, rarely containing even a portion of a fetus except in transit at the time of birth, while the two cornua are exten- sive and in them develop virtually all the fetuses so that, physio- logically, they represent the two separate uteri of the rabbit. In ruminants, the uterine body becomes markedly greater in size and assumes far higher importance physiologically, while the cornua remain relatively large. In these animals the one, two, or more fetuses habitually rest almost equally in the body and cornua so that they represent a middle point in the transition between the double uterus of the rabbit and the single uterus of woman, physiologically devoid of The Uterus 25 cornua. In the mare the uterine body becomes relatively more important than in the ruminant. The relative importance of the cornua to the uterine body sus- tains a close relation to the number of young brought forth at a given birth. In multiparous animals, there are two uteri, as in the tabbit, or the two extensive cornua with functionally unimportant uterine body, as in the bitch, cat and sow. In ruminants, which are largely bi-parous, the uterine body and cornua become ap- proximately equal in extent and function. In the normally uniparous mare, the cornua are smaller than the body, while, in woman, the uterus is virtually without cornua in size or function. 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, consisting superficially of columnar cells, while, embedded deeply within it, 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 establish- ment of its intricate connection 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 phys- ical and physiologic bond between the mother and fetus during the span of pregnancy. The uterine mucosa apparently exerts a distinct bactericidal power and ordinarily prevents the gaining of a habitat by bacteria in the uterine cavity. In the non-gravid uterus, as is common with distensible hollow organs, the mucous membrane is thrown into numerous longi- tudinal folds, which permit of prompt and extensive dilation of the cavity without violence to this membrane. The muscular coat consists of two somewhat differentiable groups of longitudinal and circular pale muscle fibers which in- crease in size, number and activity during pregnancy. The proportion of the longitudinal to the circular fibers varies, the latter being much more prominent in the region of the cervix, 26 Veterinary Obstetrics where they serve specially as occlusive agents to establish a sep- aration of the uterine from the vaginal cavity. The peritoneal layer of the uterus is derived from that of the abdominal walls and completely envelops the organ except at the points of continuity with the oviducts and vagina and the inter- stice between the two peritoneal sheets of the broad ligament at their points of uterine attachment. The broad ligaments have already been described on page 21. Those portions of the Muellerian ducts from which the uterus. is later developed are formed early in embryonic life behind the peritoneum and later leave the abdominal walls, to float freely within the abdominal cavity, suspended by the broad ligaments. or, in the gravid state, to rest upon the abdominal floor. The uterus is further retained in position by its continuity anteriorly with the oviducts and posteriorly with the vagina. 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 abdom- inal ring and thence to the cornu or oviduct is functionally of little or no interest. The uterus of the mare, with its cornua, constitutes a some- what crucial-shaped organ, the horns leaving the body laterally at right angles or somewhat recurved. It is located immediately beneath the rectum with its two cornua passing obliquely out- ward and upward on either side. The uterine body is oblong, flattened somewhat from above to below, varying from 5 to 8% inches in length and 1% to 2% inches wide. In the non-gravid organ, the mucous surfaces of its walls are normally in contact with each other. Posteriorly, its cavity is continuous with that of the vagina through the medium of the cervical canal, a con- stricted portion of the genital tube which serves to fix a bound- ary between the two cavities and to, in a measure, close the uterine cavity to the exterior. This canal is a somewhat. elongated and tortuous channel, dependable for its length upon that of the cervix uteri, which it traverses, and for its width upon the development and degree of contraction of the circular muscle fibers of the latter. The cervix uterd consists of a constricted area of the uterus in. which the circular muscle fibers are comparatively much more numerous than in other portions of the organ. Posteriorly the The Uterus 27 cervix projectS into the anterior end of the vagina for a distance of 1 to 2 inches in the form of an obtuse cone varying in its transverse diameter, but approximating its longitudinal dimen- sions. At the summit of this conical projection is the os uteri or os externum, with its mucous membrane thrown into conver- gent longitudinal folds, suggesting the appearance of a radiating flower, fleur epanoute. Fic. 2. NON-GRAVID UTERUS OF MARE VIEWED FROM ABOVE, WITH RIGHT CORNU LAID OPEN. O, O, Ovaries. Ov, Oviduct. U, Uterus. UC, Uterine cornu. BL, Broad ligament. V, Vagina. Vu, Vulva. Cl, Clitoris. H, Hymen. 28 Veterinary Obstetrics The origin of this-projection of the cervix into the vagina seems somewhat analogous to intestinal intussusception, a partial invagination of the anterior portion of the genital tube into the vaginal cavity. At the time of parturition this projection and the cervix as a whole becomes obliterated and the uterus and vagina temporarily indistinguishable except in the character of their mucosa. The dimensions and dilatability of the os wer? and cervical canal vary widely in individuals and at different times. Nor- mally, the mucosa of the circumference of the os xfer¢ should be in contact. Inthe mare it should permit of the ready intro- duction of one or two fingers through it and along the canal of the cervix into the uterine cavity. At the time of estrum the os becomes more dilated and, fre- quently, readily admits three or four fingers or the entire hand. It is not unusual to find cases where the os u¢ert of the mare is abnormally dilated and flaccid to such a degree as to interfere with fecundation. More rarely in the mare the os uter? may be closed or the cervix very much constricted in a manner to render the passage of spermatozoa into the uterine body uncertain and thus tend to induce sterility. Anteriorly, the cavity of the uterine body of the mare is con- tinuous with that of the two cornua, without a distinct line of demarcation beyond an abrupt turn at right angles or a slight recurvation to its long axis. This peculiar relation of the cornua to the uterine body and to each other renders bi-cornual preg- nancy (which see) possible in the mare (see Figs. 2, 120, 121). Each cornu is much like the body and the combined length of the two surpasses the latter in extent. They end obtusely, not far from the ovary, and present, on their interior, conical pro- jections in which there is an opening, the os u¢erinum, or uterine orifice of the oviducts. In the cow, and other ruminants, the uterine body is less pro- nounced in size when viewed exteriorly and yet more so upon section, while the cornua are much longer, tapering and more ample than in the mare. The two cornua separate at a very acute angle and for a time extend forwards almost parallel to each other and then, becoming somewhat more divergent, curve down- wards, outwards, backwards and then upwards to end above the The Uterus 29 broad ligament against the brim of the pubis and the infero- lateral wall of the vagina. The uterine body and cornua of ruminants are much more dense, narrower and more cylindrical than in the mare, the cer- vix is longer, intensely rigid, almost cartilaginous to the touch, while the cervical canal is longer, narrower, more tortuous and interrupted by transverse, as well as longitudinal ruge. It is very difficult and sometimes well nigh impractical to insert one finger through the cervical canal into the uterus. During estrum the os utert and cervical canal become more dilatable. The broad ligament of the uterus of the mare arises anteriorly from the abdominal wall in the sublumbar region not far poster- ior to the kidney and its parietal attachment passes from this point obliquely downwards, backwards and medianwards, along the median side of the inguinal ring and thence into the pelvic cavity where its two layers of peritoneum become reflected from the vagina upon the bladder, rectum and pelvic walls. As com- pared with the broad ligament of other domestic animals it is re- stricted in extent in the mare, especially transversely, resulting in a comparatively rigid fixation of the uterus and, since its anterior attachment is approximately in a direct line with the long axis of the cornua, the entire organ is held well forward in the abdo- minal cavity in the form of a cross, in marked contrast to the disposition of the organ in ruminants. As compared with the mare, the broad ligament of ruminants is much more ample transversely, while, in an antero-posterior direction, it is much less extensive. Its anterior point of attach- ment to the abdominal parieties is much farther back than in the mare. ‘This variation in disposition and relations of the broad ligament produces two well marked clinical differences obstetric- ally. * In the non-gravid uterus of the cow the anterior parietal at- tachment of its broad ligament is already posterior to the ante- rior curvature of the uterine cornua, which, in the gravid uterus, becomes sharply accentuated, almost the entire organ resting an- terior to its ligamentous attachments to the abdominal parieties. Thus the broad ligaments become largely powerless in prevent- ing the pregnant organ from revolving upon its long axis, so that torsion of the uterus (which see), becomes quite common in the cow and ewe, while in the mare, the more rigidly fixed organ, 30 Veterinary Obstetrics Fic. 3. GENERATIVE ORGANS OF BITCH IN SITU. TT, Two posterior teats. B, Bladder. V, Vagina. U, Uterus. LUC, LUC, Left uterine cornu with a portion of its broad ligament, BL, lying across it. RUC, Right uterina cornu with its broad liga- ment, BL’, turned outwards exposing the full length of the cornu, OO, Ovaries. R, Rectum. K, Left kidney. AA, Dotted lines in- dicating level of the external ilial tuberosities. The Vagina 31 with the anterior parietal attachment of the ligament much farther forward, renders the accident comparatively rare. The comparative amplitude of the ligament in the cow, with its most anterior point of parietal attachment but little forward -of the pelvis, permits more readily of inversion and prolapse of the uterus and vagina (which see) than obtains in other animals. In multiparous animals the broad ligaments are necessarily very extensive and uniformly have their anterior point of attach- ment to the abdominal walls far forward in the post-renal region. In the bitch, the ligament at its anterior border is very short so that the ovary and ovarian end of the cornu is closely fixed in the sublumbar region just posterior to the kidney and tends to stretch the cornu between this anterior, sublumbar at- tachment and the vagina. The ligament being exceedingly ample except at the anterior border, it is much longer than the distance from its parietal attachments to the position of the cornu, resulting in a large antero-posterior fold which drops down on the median side of the cornu and covers it in this double fold of broad ligament. (Fig. 3). Unlike in other domesticated animals, the broad ligaments of the bitch are uniformly the seat of extensive deposits of fat, -which causes them to strongly resemble the gastric omentum in general appearance. 5. THE VAGINA. The vagina is a musculo-membranous canal, formed from the fusion of the posterior ends of Mueller’s ducts and extending from the uterus to the vulva. Limited anteriorly by the os uterz externum, it ends posteriorly at the position of the hymen, just anterior to the meatus urinarius, where the vulva succeeds it. In the mare it is 8 to 12 inches in length and capable of lateral distension to the full size of the pelvic cavity. 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 surfaces at all times moist and which become especially active during sexual excitement and at the close of pregnancy. The muscular coat does not differ fundamentally in arrangement from that of the aiterus though less in volume. 32 Veterinary Obstetrics The peritoneal covering extends backwards from the anterior extremity three to five inches in the mare, where it becomes re- flected upon the rectum, bladder and pelvic walls. In the poste- rior portion of its course the vagina is surrounded by the loose pelvic connective tissue, which permits comparatively free move- ment. The function of the vagina is chiefly copulative, receiving the penis of the male during coition ; and during parturition it affords a passage for the fetus from the uterus to the vulva. In the mare, the organ has the power of ‘‘ ballooning ’’ or in- flating under sexual excitement or physical excitation. In this state it expands to such a degree that it fills the pelvic cavity completely from side to side and from floor to roof, presenting a vast cavity with smooth, rigid walls, which laterally are in close contact with the bony or ligamentous pelvic walls, while, superi- orly they lie against the sacrum except in the area where the rectum intervenes and inferiorly with the pubis except for the urinary bladder. The physiological nature of this ‘‘ ballooning’’ has not’ been. determined ; apparently it is of an erectile character. It prob- ably increases the safety of copulation by rendering it impossible for folds of the vagina to become caught by the penis and injured. This power of ballooning differs largely from other hollow organs of the body. The vagina of the cow has a similar ballooning power but of a less degree and it is possibly a general function, though less marked, in the vagine of other animals. The ballooning of the vagina of the mare is easily induced by intravaginal manipulation, by the injection into the organ of bland, tepid fluids or by various other means. The phenomenon. is especially marked and easily induced by introducing the moist hand into the organ at the time of estrum when the inflation at once occurs. The hymen is a transverse membranous expanse stretching across the genital canal marking the boundary between the: vagina and vulva. It represents the partition between the term- ination of the hind gut and the proctodeum of the embryo, which has failed to disappear in the lower or genito-urinary division of the cloaca. Generally it atrophies and completely disappears in our domesticated animals before their birth but at times it per-- The Vulva TR sists,either as perpendicular shreds or in a broad expanse closing one-half or more of the genital canal. We have met an instance in a filly where it prevented copulation until after surgical inter- vention occurred, and cases are recorded of imperforate hymen which caused an accumulation of utero-vaginal secretions. 6. THE VuLvaA. The vulva, located immediately beneath the anus, constitutes the posterior termination of the genital canal and, instead of being derived from the mesodermic Muellerian ducts, as in case of the preceding organs, its epithelial covering originates from the epi- derm of the embryo. It opens externally by means ‘of a verti- cally elongated slit, bounded upon either side by the labize vulve, which meet above and below to form the superior and inferior vulvar cotmmissures. The vulvar labize are covered by a very fine skin, in which the growth of hairs may be inconspicuous, as in the mare, while in others, like the cow, there is a prominent tuft of hairs about the inferior commissure. Since the parts are so scantily haired, their color, which, as a rule, is simply that of the adjacent skin, becomes very conspicuous. In mares with white faces, eyes and feet, the cutaneous covering of the vulva tends also to be devoid of pigment. The prominence of the pigmentation of the skin of this part serves as an aid in the clinical diagnosis of the venereal diseases. of horses (which see), in which important discolorations occur. The muscles of the vulva are chiefly circular and are divided into two groups, the posterior and anterior constrictors. The posterior constrictor is situated within the vulvar lips and con- stitutes a true sphincter, analogous to those 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 downwards to become lost in the skin and other tissues on the inside of the thighs. The office of this group comprises the usual function of a sphincter, their coutrac- tion bringing about the closure of the vulvar opening. The an- terior group of muscle fibers invests the vulva in the region of the hymen, just anterior to the meatus urinarius, where, by their 3 34 Veterinary Obstetrics contraction, they produce a constriction on the vulvo-vaginal border line. The mucous membrane, continuous with that of the urinary bladder and the vagina, is covered with squamous epithelium and contains numerous mucous glands, which are largely dis- placed near the labial margins and about the clitoris by sebace- ous follicles, the secretions from which are odoriferous, especially during estrual periods, when the odor becomes very marked in a manner characteristic of the species. Within the vulvar cavity are to be noted the meatus urinartus, clitoris and vaginal bulb. 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 in the mare. The urethral canal passes obliquely downwards and forwards through the vaginal floor to the urinary bladder. In most animals, the meatus urinarius is comparatively small and inextensible while, in the mare, in general harmony with the large and freely dilatable os uteri and genital passage, it is quite ample. One, two or more fingers are readily passed through it into the bladder and it is not rare to find the opening, in heavy, lymphatic animals, sufficiently large to admit, without great diff- culty, the entire hand. The dimensions of the meatus urinarius in the mare are of special significance clinically as they favor eversion and prolapse of the bladder, an accident not particularly rare in this animal, while extremely so in others. In the cow the narrow meatus urinarius is further guarded by a valvular membranous fold directed from the posterior border forward in a manner, it is claimed, to prevent the penis of the bull from acci- dentally entering it and wounding the bladder as a result of the violent copulative thrust of that animal. Nevertheless we have one instance recorded (see under ‘‘ Accidents of Coition ”) in which a fatal rupture of the bladder was caused in copulation. The clitoris is an erectile organ, analogous to the male penis and having in general the same tissues, form and attachments. It is two or three inches in length and arises, like the penis, by two crura from the ischial arch and passes upwards and back- wards to protrude from the vulvar floor just inside the inferior commissure and is the principal element in maintaining the form of this part. The Mamme or Udder 35 Its free end is lodged within a depression in the vulvar floor and over it extends a mucous fold, the prepuce of the clitoris. The clitoris and its prepuce are covered by a pigmented mucous membrane in which the mucous glands are displaced by sebaceous follicles, and the characters of the surrounding mucosa are absent. 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 our observation upon a large number of sows from which the clitoris had been removed by an empiric, it had no influence upon oes- trum or fecundation and all bred normally. In the mare it is frequently removed for the relief of nymphomaniac vice, but the results are in controversy. 7. THE MamMai OR UDDER. The mamme are essential organs of generation ; they are nor- mally excited to activity only by parturition and constitute a necessary source of nutritive supply to the new-born animal. Under domestication, the activity of the milk glands has been highly developed in the cow and goat to provide the important food supply to man of milk and its derivatives: cream, butter and cheese. The milk glands originate from the epiblast by an invagination into the subjacent parts from which is finally elaborated the es- sential secretory structure and the excretory apparatus, They are located symetrically on either side of the median line of the ventral surface of the body, varying in numbers approx- imately in accordance with the number of young usually pro- duced at a birth. Usually the number of mammee is in excess of that of the young born at one time, but rarely the relation- ship is reversed. Each mamma consists of a glandular parenchyma with excre- tory ducts traversing a conical nipple or teat, from which the young may obtain the secreted milk by sucking. The glands are covered with a very soft, almost hairless skin,containing numer- ous sebaceous follicles and are closely invested by a firm, fibro- elastic capsule derived from the abdominal tunic. 36 Veterinary Obstetrics The mammez belong to the acinous type of glands and con- sist fundamentally of the milk cells or acini, where the polyhe- dral or spherical epithelial cells form the active secretory units, and, from these, the milk is poured out through the small execre- tory ducts into more extensive canals which serve as a common outlet for a group of acini, constituting a lobule. These ducts continue to unite and form yet larger canals, which are few in number and, according to species, empty either into one, two or more milk cisterns or reservoirs in the teat, or, in the absence of these, traverse the length of the teat to open by separate orifices at the apex. Through these excretory ducts the milk is drawn normally by the new-born animal by sucking ; artificially, in dairying, it is forced out by compression with the hand or other means in a manner closely analogous to the suck- ing by the young. Mammary Pit Cutis Wall ‘Glandular Area& = AS M3 3 . Areolar Zone —______y. vac - Primary Lacteal Bud Secondary Lacteal Bud Bloodvessels Fic. 4. Section through the mammary pit of a 20 cm. long fe- male swine embryo after Profé. Magnified about 200. (Bonnet). The secretion of milk and its discharge from the udder bears some analogy to the behavior of erectile organs. It has been as- sumed by some that the milk is largely secreted and stored in the galactophorous sinuses and cisterns during the intervals between milking, but thisis for the most part erroneous. The milk is chiefly stored in the epithelial cells of the milk acini until, under excita- The Mamme or Udder 37 tion of sucking or milking, it is poured out into the milk cisterns and teats and thence is readily extracted by the sucking of the young or by the various milking processes. In some cows, mares and other females the sight of their young causes an involuntary Teat Pit Muscles Glandular Area Primary Teat Cuticular Wall A Milk Duct Milk Cistern Glandular Outgrowths ‘Secondary Teat Muscles of the Areola Milk Cistern ______— Glandular Outgrowths Fic. 5. AandB. Two schematic illustrations of the mammary -pit, showing the different forms of teats. A, Primary teat of the cow. B, Secondary teat of woman. (Bonnet. ) 38 Veterinary Obstetrics discharge of milk from the udder, or, when the young is sucking one teat, milk flows freely from the others or, even, when a milk- man is drawing milk from one cow, a neighboring one has an in- voluntary discharge of milk. Under the influence of anger, fear or other disturbances, the flow of milk, in the process of milking, abruptly ceases, the ani- mal ‘“‘ holds up’’ her milk and it cannot be withdrawn. One milker can abstract from an udder a greater amount of milk than another, yet each will withdraw with equal care all the milk which reaches the teat. The flow of milk is not directly subject to the control of the lactating animal, but involuntary on her part, subject to external influences over which she exerts but very imperfect power. In the mare, there are two hemispherical mamme, flattened from side to side, situated in the inguinal region and each closely attached in the region of the external abdominal ring, through which their chief vessels and nerves pass. There are two or more milk cisterns in each gland, from which corresponding excretory ducts pass to the apex of the teats to escape by separate orifices ranged one behind the other in the broad, antero-posteriorly flattened nipple. In ruminants, the mamme are also inguinal. In the cow, the right and left halves of the udder are quite distinct from each other although lying in contact, their fibro-elastic envelopes being completely separated by areolar tissue. ach lateral half is divided into two intimately connected ‘‘ quarters,’’ an anterior and posterior, with separate excretory ducts and teats. Each quarter has but one milk cistern, and this is of great size, into which all lacteal sinuses lead and from which a single excre- tory duct opens through the apex of the teat to the exterior. There are generally one or two rudimentary glands with teats behind the posterior quarter, which frequently function very slightly immediately after calving, while, in some cases, they , secrete a noticeable amount of milk. In one cow observed by the author each lateral half of the udder consisted of asingle gland or ‘‘quarter’’ with but one teat like that of the ewe or goat. In the bitch and cat there are eight to ten mamme and, in the sow, ten totwelve. In the mamme of the sow there are two or more small milk cisterns to each gland, each of which opens at the apex of the teat by a separate orifice. The mamme of car- The Mammae or Udder 39 nivora possess no milk cisterns, each of several large milk canals opening separately at the apex of the teat. Rudimentary mammary glands ‘occur in male animals in har- mony with the general rule that the sexual organs of each sex tend to be repeated or to possess an analogy in the other. In rare cases, the mammee of males become functional and he-goats and bulls have been known to yield milk. In the female the secretion of milk normally becomes estab- lished only as a result of pregnancy and the milk appears ordi- narily only near its termination, within a few days of the birth of the young, and reaches its greatest activity generally shortly after giving birth. This is not constant. If abortion is threat- ened in a pregnant animal, especially a mare, when the normal period of pregnancy is not nearing its close, the secretion of milk is liable to become suddenly established. In some animals the mammezee become excited, swollen and even function during estrum. Such was the case with a mule observed by the author, from which there was a very profuse and annoying flow of milk, keeping the legs constantly wet during the spring of the year, when she was in estrum much of the time. If a fetus perishes within the uterus of a uniparous animal without decomposition, its continued presence in the uterus fails to excite lactation and tends to prevent by its presence the occur- rence of estrum. OBSTETRICAL PHYSIOLOGY Reproduction. 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, its expulsion after a cer- tain degree of development and its further nutrition for a time after birth by milk from the mamme, until the young has ac- quired sufficient development to enable it to lead a wholly inde- pendent existence. The two sexes in mammalia are normally wholly distinct so that, before conception can take place, a con- jugation of the male and female, coition or copulation, must oc- cur. In all mammalia there are more or less apparent vestiges of each part of the genital apparatus of the opposite sex in each individual, but they naturally become arrested in their develop- ment in the embryonic stage and remain wholly functionless ; rarely do we meet with anomalies (hermaphrodites) in which the analogous organs of both sexes develop more or less completely ; less rarely we observe the development of some’ of the male or- gans (testes) and others of the female (uterus and vagina) in one individual. These animals partaking of a bisexual nature are, so far as we have observed, uniformly sterile. In other instances (freemartins), all genital organs may be arrested in the embry- onic stage and the animal remain virtually asexual. Before reproduction becomes possible the breeding animal must have reached the period of puberty or sexual maturity, the period when ova and spermatozoa mature and are discharged and sexual desire is established, up to which 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. Much depends upon the food supply and rapidity of growth. It quite uniformly occurs in both sexes prior to the completion of growth. There seems to be a tendency towards early puberty in short lived species and late in those which normally have a long span of life, but the rule is in- constant. The normal duration of life in the cow is approxi- mately twice that of the bitch, but the former tends to become sexually mature at an earlier age than the latter. 40 Reproduction 41 The rate of reproduction varies greatly in different species and is dependent chiefly upon three factors; the age of puberty and duration of sexual competency, the number of young brought forth at a given birth and the frequency of parturition. Uni- parity, or single births, is the rule in the larger animals; the smaller ruminants are to a great extent bi-parous, while the smaller classes of animals are quite uniformly multiparous and bring forth from three or four to twelve or more young at a given time. The frequency of parturition varies greatly and the minimum between two births is fixed by the duration of pregnancy, which, among our domestic animals, finds its extremes between the four weeks of the rabbit and the 21 months of the elephant. The fre- quency of partuition is further influenced by a dormant period in reproductive activity between the giving of birth to young and readiness to again conceive. In some species the nursing of young tends to inhibit the power of breeding, as is sometimes seen in the mare and is said to be yet more marked in the ele- phant. In all our larger animals there is usually an interval be- tween the birth of a fetus and the power to conceive, pending the recurrence of estrum and ovulation. In the mare this inter- val is very brief, frequently but eight or nine days, while in the cow it is longer. In these larger animals there is a tendency toward one parturition each year and in the mare the resumption of the power of conception after foaling needs be very prompt or annual breeding becomes impossible, since the duration of preg- nancy is about eleven and one-third months, exceeding 12 months in some cases, leaving an average of but about three weeks, in which pregnancy may recur, and a second foal be born within a year. Under such conditions it is natural that the mare does not usually produce a foal each year over an extended period. On the other hand, in the rabbit, conception normally recurs within a few hours after giving birth to a litter of young, so that she may breed each month. In nature, and still more in the domesticated state, conceptions fall far short of the maximum possibilities and the births are relatively much below the assumed number. Mares used especially for breeding purposes produce ordinarily but two foals in three years or even less, and elephants are said to pro- duce young but once in three to four years. Exceptionally, we 42 Veterinary Obstetrics meet with mares breeding anuually for ten, twelve or more con- secutive years. Neither do all animals born reach maturity. Their growth and development after birth is predicated upon the available food supply and their immunity from predatory animals and from diseases and accidents. Speaking generally we might safely say that in the wild state the probabilities of maturity are in inverse ratio to the rapidity of reproduction. In those which reproduce slowly, like the mare, with less than one young per annum, which, in turn, needs live about three years before giving birth to young, the new-born animal is born in a well matured state and is quickly able to travel long distances for food or water and to flee rapidly from pursuing predatory animals and enjoys, in addi- tion, highly efficient maternal protection. On the other hand, the young of the rabbit are born in a state of utter helplessness against enemies or of procuring food independently, while the mother is not competent to afford effective protection against foes. ‘Thus, in a state of nature, where there is neither room nor, food for all the young which might be born, agencies which modify the birth rate and the percentage of young which shall successfully mature serve to maintain a balance in animal life. The rapidity of the increase of a species is also modified by the available nutritive surplus of the mother. Generally speaking the larger the animal the lower the nutritive reserve. The greatest drain upon the nutritive supply is that upon the muscles for locomotion. Large animals need move over a more extensive area in order to obtain sufficient food and, the greater the body, weight, and, especially, the greater the height, the greater the drain upon the nutritive supply within the body. Among domesticated animals, where food and protection are provided by man, the control of the numbers of animals is brought about through such agencies as slaughtering the immature ani- mals for human food (ruminants and swine), the direct control of numbers by killing the surplus new-born (carnivora), castra- tion and the prohibition of breeding by sexual segregation. The maintenance of nutrition of the body of the parent must necessarily take precedence over the reproduction of young, and the latter be limited constantly by the nutritive reserve within the parent after the necessities for her own existence have been supplied. The drain upon the maternal system in the reproduc- Reproduction 43 tion of young is very great in all mammalian animals but differs widely according to species. In a mare weighing 1,500 pounds, the new-born foal may weigh about 125 pounds, or 8 % of her body weight, to which must be added an additional demand of the young, in the form of milk as food, covering a period of five, six or even more months after birth. The nutritive demands of the fetus of the mare extend over a long period, comprised of eleven and one-third months of preg- nancy and five, six or more months of nursing, or a total period of about one and one-half years. And her average rate of producing young is reduced to approximately one in two, or two in three years. In the cow there is a greater nutritive excess or reserve and, while the young is somewhat larger as related to the size of the mother than obtains in the case of the mare, or about 10 %; the intra-uterine term of existence is shortened from about eleven and one-third to nine and one-third months; and the period of sucking is also reduced somewhat, thus materially decreasing the demands upon the maternal system, with a corresponding increase in repro- ductive power and the rate of increase of the species. In the natural state, fewer of the young reach maturity. In multipara the young are relatively smaller, but parturition occurs more frequently. In the sow, parturition occurs about twice annually and the number of young may reach ten or more at each birth. A sow weighing 300 pounds may thus give birth to twenty pigs in a year, each of which may weigh two, or a total of forty pounds, equal to 13 % of the maternal body weight. The character and abundance of food exerts a well defined influence upon the number of young produced, a highly nutri- tive and well balanced ration with other favorable environment tending to greatly increase fecundity. The completeness of development of the fetus at birth varies widely and the demands upon the nutritive reserve of the mother correspond to the degree of embryonic evolution at- tained by the young prior to birth. The uew-born rabbit, after four weeks of intra-uterine life, is a very immature animal, inca- pable of locomotion, its eyes not open and its body almost naked of hair; the young Guinea pig, after the same duration of intra-uterine existence, is born with a dense coat of hair, with eyes open and its locomotory apparatus so completely developed that it can move about with almost the same celerity as its dam. 44 Veterinary Obstetrics The young of carnivora are born in a very immature state, while those of ruminauts and solipeds are well developed and early ready to follow their dams at will. In each case, there are probably advantages to the mother and offspring. The rabbit must depend wholly upon flight for pro- tection against foes and would evidently suffer a serious disad- vantage from a greatly increased body weight due to the presence in the uterus of a number of very large fetuses; the bitch, in the natural state, must depend upon the chase for her food, and she too would be hampered by a great weight due to well devel- oped fetuses. Reproduction is a complex physiologic process, accompanied by or associated with phenomena which bear an important relation to each other. In approximately the following order, we observe the maturation of the ovisacs or Graafian follicles: estrum,copula- tion, rupture of the Graafian follicles, fecundation and possibly menstruation. The chain of phenomena is finally completed by pregnancy, parturition and the nutrition of the new-born. Maturation of the Graafian Follicle-—Ovulation. Recounting briefly our previous allusion on page 11 to the forma- tion of the ovaries and their specific function, the formation of ova, there is observed very early in embryonic life the two genital ridges forming along the median side of the Wolffian bodies. Con- sisting at first of a mere thickening of the peritoneum, chiefly due to an elaboration of its epithelium, the external cell layer be- comes columnar in contrast to the surrounding squamous cells, while the deeper strata assume a more or less cuboidal form, to- gether constituting the germinal epithelium. This continues to thicken and certain of the cells become distinctly larger than the others, to constitute the primitive ova, while the deeper epi- thelial layers are being 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, shortly after _ birth in the immature young like that of the rabbit, some of the primitive ova become materially changed, to constitute permanent ova. In the process of development the connective tissue stroma throws out a thin layer, the tunica albuginea, parallel to the sur- Maturation of the Graafian Follicle 45 face of the ovary and serving to divide the germinal epithelium into a superficial, columnar layer and a deeper one broken up into irregular columns or clumps of spherical or polygonal cells. In these cell masses the permanent ova, developed from the przm- zttve ova, become much larger, while the nucleus or germinal vesicle enlarges and its enveloping 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 en- large to constitute the nucleoli or germinal spots. The neighbor- ing germinal cells become arranged about the ovum in a manner to completely enclose it in a follicle, which has at first a single layer of cells. Later a second layer of cells forms about the ovum within the first. Fic. 6. Section through part of the ovary of an adult rabbit. The section is taken vertical to the surface of the ovary, and shows one fully formed Graafian follicle, and others in various stages of development. X 50. GA, Follicle cells surrounding an ovum. GB, outer layer of Graafian follicle, or ‘‘tunica granulosa.”’ GC, inner layer of Graafian follicle or ** discus proligerus.’’ GK, Cavity of Graafian follicle. ; . OE, Outer layer of columnar epithelial cells, investing the ovary. OW, Ovum. OY, Primitive Ovum. OZ, Nests of Epithelial cells derived from the deeper layers of the genital epithelium. (Marshall. ) 46 Veterinary Obstetrics The cells of the follicle multiply rapidly and, the growth of the external layer being more rapid than the inner, there results a separation between the two, except at the point of attachment of the ovum, revealing upon section, a cresent-shaped cavity which is filled with fluid. Fully developed, this constitutes the. Graafian follicle, which consists-of the outer layer of follicular cells or tunica granulosa, the inner mass of granular cells or discus proligerus and the ovum, attached within or upon the inner cell mass. The cavity of the follicle is occupied by the follicular fluid. The ripening egg sacs lie at first deeply in the ovary ; as the size of the follicle increases they approach more and more nearly to the surface and even pro- ject beyond in varying degrees dependent somewhat upon species. They vary greatly in size. In the mare they are not readily observed upon the outer surface owing to the dense, heavy tunica albuginea and to the fact that they ripen and rupture in the con- cealed hilus instead of upon the free surface as in most other species. The exposed surface of the ovary is frequently occupied by massive cysts, or over-distended follicles. In the cow, the ripe follicles are prominent upon'the evarian surface while, in the sow, they project entirely beyond and main- tain their connection by a constricted neck. As the follicle be- comes more and more distended it ruptures at the weakest part of its wall and discharges its ovum or ova, with the follicular fluid and portions of its inner cellular layer, upon the surface of the ovary, where the ovum is normally taken up at once by the pavillion of the oviduct and conveyed toward the uterus. In some cases, the ovum is not discharged promptly or even at all from its follicle, but may become fecundated and developed there, constituting ovarian pregnancy (which see), while in other in- stances it possibly escapes free within the peritoneal cavity. During this period of maturation and rupture of the ovisac, the ovum itself undergoes important changes and, prior to its dis- charge from the follicle, its nucleus leaves its center and passes toward the periphery; a definite vztelline membrane is formed within the zona radiata immediately about the egg : the nucleus becomes indistinct and, while the yolk or vitellusjretracts 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, soon after which the Ovulation 47 Tupture of the ovisac occurs with the escape of the ovum into the pavillion of the tube and, following this, while the egg is moving along the oviduct, before impregnation has taken place, the second polar body is supposed to be cast off. The exact relation of ovulation to estrum and menstruation has not been determined with complete satisfaction, and conflic- ting views are held. In my personal experience in spaying cows, it has been constantly found that one in estrum has,in one ovary, a ripe Graafian follicle which is ready to rupture and usu- ally does so on being removed, while, if estrum has occurred on the previons day, a fresh corpus luteum is present. This indicates that, for the cow, estrum normally signifies the presence in the ovary of a mature Graafian follicle, about to rupture, and that copulation with the male usually takes place prior to the dis- charge of the ovum from its ovisac. Later, menstruation may occur if impregnation has not taken place. Observations on rabbits are similar. When young are born, there already exists, in the ovaries of the doe, a crop of ovisacs, fully matured and ready to rupture. Estrum follows at once upon the birth, copulation occurs, and it is not until after eight to twelve hours have elapsed that the ovisacs rupture and dis- charge their contents into the pavillion of the oviduct, there to become fertilized by the male cells already present. Such is probably in a large measure the rule with other animals. There are reasons for believing that ovulation is favored and at times possibly hastened by coition, but there is no definite relation and the ovulation regularly occurs in the absence of sexual contact. Ovulation occurs in more or less fixed cycles and is modified somewhat by climate, season, food and housing. In the mare it usually takes place at intervals of about four weeks during spring and early summer, is less frequent and more irregular during autumn and may be quite absent during winter, except she be well fed and housed. The cow ovulates with considerable regu- larity about every three weeks and, if well housed, the cycle is not liable to interruption during the winter months. In the ewe, ovulation apparently occurs every two or three weeks, but its existence is not very evident, except in the pres- ence of the male. In carnivora ovulation ordinarily occurs semi- annually in late winter and early autumn. 48 Veterinary Obstetrics In all animals ovulation is normally suspended during preg- nancy, but exceptions to this rule occur. In some cases the Graafian follicles become over-distended with follicular fluid, their walls are abnormally resistant, the ova tend to perish, while the enlarged ovisacs persist and grow, and ovu- lation does not occur. The presence of such ovarian cysts gen- erally inhibits the ripening and rupture of other follicles and, thus, not only causes sterility (which see) but exerts a profound influence upon the behavior of the animal, tending to cause nym- phomania, or sexual insanity. 2. ESTRUM. Reproduction among higher animals is fundamentally the re- sult of an irresistible sexual desire occurring simultaneously in the male and female and leading to coition. The condition is known as estrum in the female and, as related in the preceding section, occurs immediately prior to or concur- rently with ovulation. It finds expression in various ways with different species of animals. In general there is a nervous excit- ability, the external genitals are swollen and vascular, there is an increased secretion of mucus from the vulva and vagina. In the mare there are frequent emissions of urine in small quanti- ties, especially in the presence of other horses, most of all of a stallion, the vulvar lips are frequently opened and the erected clitoris protruded. In ruminants and the sow the female imitates the copulatory act of the male by mounting other animals of its species. In certain pathologic cases, the cow, especially, does not confine her expressions of sexual desire to her own species, but when affected with nymphomania. may attempt to mount other species of animals and we have known instances where they have even attempted to mount man and subjected him to very serious, danger. In all animals there is a tendency for the female to wander from home during estrum. This is most noticeable in carnivora, which, if not securely confined, regularly disappear and tend to wander long distances and remain away during a large part or all of the estrual period. In all animals there is a more or less apparent odor characteristic of estrum and peculiar to the species. Copulation. Cottion 49 3. COPULATION. COITION. Natural reproduction in higher animals can only occur asa result of copulation, which, in its turn, is brought about by the irresistible desire of the female, which we term estrum, and the corresponding sexual excitement of the male. Artificially im- pregnation is possible and has been practiced to some extent by breeders, by injecting the seminal fluid of the male into the uterus of the female. During the act of copulation the semen from the male is in- jected into the vagina of the female, possibly in part into the uterus. We have no definite data as to where the semen is deposited during copulation. It is thought by many that most or all of it is ejaculated directly through the cervical canal into the body of the utérus, the urethral opening of the male coming in direct contact with, or entering, the os uteri. Harmis, quoting Duranton (Journal de Lyon, 1888) cites a case of rupture of one of the cornu of the uterus of a cow during copulation. owing to the entrance of the penis through the cervix. On the other hand, as related below, in case of the mare, with a far more dilatable cervical canal, injuries from too long a penis occur in the vagina and not in the uterus. We have also known of a stallion with a considerable portion of the penis amputated which was quite as fertile after as before the operation, although it would seem that the stump of the organ could not well reach the os uteri. The essential condition to fecundation, so far as the male is concerned, is that physiologically perfect spermatozoa shall gain the cervical canal, traverse the uterus and oviducts and meet theovum. From among the countless myriads of these sperm cells in one discharge of semen, but one of them is essential for the fertilization of an ovum. THE DANGERS AND INFECTIONS OF COITION. Injuries and dangers to animals during copulation or prepara- tory thereto, involving both sexes, are not uncommon and are fre- quently of a serious character. They include physical injuries to both male and female, the transmission of infectious diseases of a general character and that of specific venereal disorders. 1. PHYSICAL INJURIES. In the wild state, severe and fatal battles between rival males are not infrequent and the same prevails to some degree among domesticated animals, although, as a general rule, if several males are kept together with a number of females they lose much of their combativeness without, however, completely eradicating it. The author has seen an instance of a fatal fray between two rams which had been regularly kept together. When a strange male wanders into a herd or group of females with which a male is regularly consorting there is at once a de- termined fight between the two, which ends onlv with one or the other becoming vanquished. In these battles, injuries of the most diverse character occur, according to species and chance. Their only prevention depends upon the proper confinement of male animals. In most countries there are laws against the running at large of male animals but, by custom, these are not enforced against carnivora, an exception which should be overcome by the con- finement of all females. There are further dangers, chiefly to the male, of injuries in attempting to escape from or break into enclosures in order to reach females, especially with horses and cattle. The appear- ance of a female in estrum near by the enclosure of a male is a signal for him to make violent attempts to escape from his con- finement and reach the female. It is consequently of importance that enclosures intended for the confinement of male breeding animals should be especially secure and, as far as possible, all elements avoided in their construction which would endanger the animal in an effort to escape. 50 Physical Injuries 51 In the preparations for copulation there is little danger except in case of horses. Breeding customs and conveniences bring into the procedure a period of ‘“ trying’’ or ‘‘teasing’’ of the mare by the stallion, both for the purpose of determining the existence of estrum and bringing about the desired degree of sexual excitement before permitting an attempt at copulation. In this act there are numerous dangers, especially to the stallion. It is desirable, if not frequently essential to safety, that special conveniences for restraint be provided for this purpose. They should consist ordinarily of a strong, solid wall about three feet high and ten to twelve feet in length with a rather broad and rounded top. Thechief object of the structure 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 accident and sufficiently resistant that the mare cannot kick through it. The use of 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 also 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 and, unless properly built, serious injury is liable to occur. ‘To this end the wall should be low enough that, either animal, getting upon it by rearing or kicking, may readily free itself without injury. In one instance the.author attended a stallion, which, becom- ing impatient, had passed beyond the control of the groom, reared to mount the mare and became impaled upon a projecting post at one end of the structure, causing a serious hernia and almost eveutration. 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. When this preparatory period has been passed and copulation 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 52 Veterinary Obstetrics 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 coun- teracted by vigorously drawing her head toward the stallion, thus turning her heels from him. After coition has been completed and the stallion is dismounting the same rule should constantly be applied and the mare brought at once 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, a rope of sufficient length attached to each, and the two free ends are carried forward between the forelegs and securely tied to a strong collar or the ends may be carried upwards on either side of the neck and tied on the top sufficiently tight to prevent the mare from kicking backward for any important distance. By the second plan, the hobbles are attached to the hocks instead of the pasterns. In this case, each hobble is double and one portion of each is attached above, the other below the hock of each hind leg and by ropes or straps are fixed forward the same as in the preceding. The latter possesses some points of superiority. The mare is not so liable to become entangled in the ropes and injure herself and the stal- lion is probably also exposed to less danger of getting his foot caught in the securing apparatus. Whatever the form of breed- ing hobbles or other confining apparatus, they need be secure and strong. Nothing can well be more dangerous for the breeding stallion than insecure hobbles which lead toa false feeling of security and throw the otherwise careful stallion groom off his guard. Ina recent instance the author 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 unex- pectedly cross and at a critical moment when the stallion was attempting to mount she commenced to kick and 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 strong that no mare can break them and always allow a safe margin of strength beyond that Physical Injuries 53 considered essential and the fastenings should be secure in every detail and beyond the possibility of slipping or accidental detachment. If accidents are to be avoided, it is also 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 stal- lion 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 stalliou has safely mounted her. In breeding mares to jacks, it is customary to place the mare ina 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 ouly gives an advantage to the comparatively small male by affording him an elevation, but also secures him against kicks from the mare, a highly essential precaution because the mare ordinarily resents copulation with the ass, so that the act is largely in the nature of rape. False copulation, or entrance of the penis into the anus in- stead of the vulva, is possible in almost any of our domestic ani- mals and Harms records it as occurring in the mare, cow and sow. ‘The author has observed it only in the mare and, in all, four times, though he has known of numerous other instances. It is by no means rare and is highly dangerous. Its causes are various but it is probably largely due to some resistance on the part of the mare asa result of not being properly in estrum or otherwise becoming excited and attempting to kick or move about. Coition is safe only when estrum is present in the proper de- gree. The mare has ample power to close the vulva against the ready entrance of the penis and thus cause it to glide upward and forwards against and into the anus, which opening may be ‘more readily forced. The accident is also invited in aged cows or mares with pendu- lous abdomen in which the anus is retracted and, drawing the supe- rior commissure of the vulva with it, causes the vulvar opening to approach the horizontalinstead of the perpendicular and the penis to glide forward and slightly upward over the oblique vulvar opening to strike against the inferior surface of the tail and be deflected into the anus. It may be purely accidental. Harms 54 Veterinary Obstetrics thinks it may result from smallness of the female. All cases we have observed have been in mares of medium or large size, whether viewed actually or comparatively as related to the size of the stallion. The extent of the injury varies. Apparently, the accident may cause little or no injury in some cases, though, in 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 and form of the penis, the violence of the copulatory act and the quantity and character of the feces in the posterior por- tion of the rectum. Should the rectum be quite empty or filled only with pultaceous feces, as in a cow, or in the mare on green food, the penis may force its way along in the bowel unless it is ‘caught in thefolds. 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 tis- sue. Inthe former case in the mare, the opening is so great that feces at once drop into the peritoneal cavity and cause pro- 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 as if tympanitic. The symtoms resemble in many particulars those of rupture of the stomach. The diagnosis is readily made by manual explor- ation per rectum, the hand easily passing out through the rup- ture into the peritoneal cavity. In one of our 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 our observation, in an old brood mare, no his- tory of injury was obtainable and apparently it had not occurred during the several years of ownership by her last proprietor. She died under symtoms of colic and an autopsy revealed a large intra-pelvic sac, opening into the rectum, which had been habit- ually filled with feces but, becoming over distended, had obstructed the bowel and caused arupture of the sac into the peritoneal cav- Physical Injuries 55 ity. It was almost certainly the result of a long-standing penial wound. grrr In another case to which the author was called the accident was recognized at the time of its occurrence, blood and feces were voided, the perineal region was swollen. Manual explora- tion revealed a large rent through the rectal walls into the peri- proctal connective tissue six to eight inches from the anus, con- taining a mass of feces equal to about. two liters 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, re- peated twice daily, along with restricted, laxative diet and com- plete rest, brought about a prompt recovery with little sacculation. According to Harms, false copulation in the sow is usually fol- lowed by no more serious consequences than a swollen anus, accompanied by a bloody discharge. In the mare the accident is preventable by ordinary precautions on the part of the stallion groom, whose duty it is to see that the penis is guided into the vulva or, at least, not permitted to enter the rectum. ‘To this end, it is best not to attempt service in case of a mare not certainly in proper estrum. It isa part of the busi. ness of the groom to see and to know that the penis of the stal- lion is properly entering the vulva of the mare. If the mare is kicking or otherwise violently resisting the stallion, he should be promptly withdrawn, since copulation under such circumstances is unwarrantedly dangerous for both animals. Such violent re- sistance of the mare is sometimes offered by the groom as an excuse for his failure to see and know that the penis of the stallion was being properly entered 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 perpen- dicular. In the cow and sow, the accident is not usually pre- ventable. The prognosis of penial injuries to the rectum must be based largely upon the position and extent of the injury. When the lacerations perforate the peritoneum and cause escape of feces into the peritoneal cavity the injury is essentially fatal, veteri- 56 Veterinary Obstetrics narians having not yet succeeded in successfully handling such lesions’ When the rupture of the rectal wall occurs behind the peritoneum or otherwise does not perforate it, the prognosis is good if timely surgical aid is given, though, after a long period of time, serious or fatal results may follow the impaction of feces in the sac formed in the pelvic connecting tissue. The pressure of the feces escaping 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 connective 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 ona very scant, laxative diet during the treatment, which should be continued until the rupture is quite healed as it is highly important to guard against extensive sacculation in the part, which can only be done by avoiding the accumulation of feces in it. In some instances, the injuries to the rectum from the entrance into it of the penis are comparatively trivial and consist merely of wounds of the mucosa and somewhat 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 for the damages to the mare, since the acci- dent is preventable with proper care upon the part of the groom. Such were the findings in the only case which we have seen tested in the courts. Harms, quoting Hinrichsen, mentions an instance in which a cow had her tail fractured at the base during copulation. The vagina, especially of the mare, is not infrequently lacer- ated or ruptured by the penis of the male. The size of the penis of the stallion does not bear a constant ratio to the size 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. Some-| times it is merely a slight laceration in the mucous membrane, Physical Injuries 57 ‘which may cause limited hemorrhage and some straining ; some- times the lacerations in the mucosa and muscular walls are ex- tensive and induce marked symtoms of wound infection in the vagina with tumefaction, discharge and straining ; while, in other cases, the vaginal walls are completely ruptured, with great dan- ger of fatal peritonitis. In one instance investigated by us a series of injuries was caused by a recently imported 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 wasa fatal rupture. Inspecting the horse, he was found to be an overgrown, coarse, leggy grade draft stal- lion about eighteen hands high and with an enormous penis which would have been dangerous with heavy draft mares, while, in his neighborhood, most animals were of small roadster or com- mon stock. When such injuries occur, there is observed an abnormal amount of straining immediately after copulation, with, perhaps, some dis- charge of blood from the vulva. Later, swelling of the vulva and a muco-purulent discharge may occur. If the wound penetrates the peritoneal cavity, septic peritonitis 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 and pass- ing 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 the prevention of the entrance of the entire length of the penis will unfavorably affect the results of copulation, as general obser- vations show to the contrary. In constructing this roll or pad an ordinary surcingle may be used and a tube made of sheeting or other sufficiently strong material and this, open at each end, slipped over the surcingle. Padding of cotton, oakum or other material is then.to be inserted into the tubular covering 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 abdomi- nal 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 . 58 Veterinary Obstetrics 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 remembering constantly that this organ reacts strongly to irritants and that thorough dis- infection should be brought about largely by mechanical flushing rather than by heroic attempts to destroy the micro-organisms in position. Lacerations of the vulvo-vaginal canal during copulation some- what rarely occur because of pathologic changes due to prior diseases, especially to adhesive inflammations leading to impor- tant stricture or occulusion. In one instance coming under observation, in a mare, there were old adhesions of the vaginal walls in their anterior portion. An attempt to breed her caused such injury as to lead to violent expulsive efforts, by which she iorced the urinary bladder, covered by the vulvo-vaginal floor, out through the vulvar opening—vesico-vaginocele—which persisted in spite of trusses, sutures and other expedients and was only controlled by producing prolonged and deep anaesthesia with chloral. In cows,adhesions of the vaginal parietes may occur as a result of infectious vaginitis and naturally render coition unsafe if not impossible. 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. Duranton (Journal de Lyon, 1888) records a casein which the uterine cornu of a cow was ruptured about 3.5 cm. anterior to the os uteri, supposedly by the penis of the bull during copula- lation. Weconsider the record open to question and would think it more probable that the rupture had occurred from other causes. , Injuries to the bladder by the penis of the male have been recorded, though very rarely. Harms, quoting Nebele (Reper- torium) mentions one case in a cow in which the bladder was ruptured owing to the entrance of the penis through the meatus urinarius. The probability of such an accident seems especially remote in the cow because of the small valve arising from the Physical Injuries 59 floor of the meatus and extending forwards. In the mare, this accident would seem quite as possible because of the very wide, valveless meatus, through which several fingers may be passed, but the penis of the stallion is much larger and the glans very broad. In one instance, a somewhat coarse two-year filly, weighing 1700 pounds was presented for service to a 2400 pound stallion with a large penis. Upon mounting her,the stallion entered his penis into the vulva a short distance, where an obstruction was apparently encountered, and after a time he dismounted. After repeated unsuccessful efforts the author was asked to examine her and found a persistent hymen across the lower portion of the vagina, sloping upward and backwards which had directed the penis downward against the meatus urinarius, through which the hand could be easily passed, but no injury from the penis could be detected at the time or later; on the other hand when the penis encountered the obstruction, the stallion desisted from further attempts at copulation. Injuries to the female because of great weight of the male are not rare though far less common 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 their weight and yet escape injury entirely. In the smaller species of animal, like 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. Ordinarily, a cow or mare can readily withstand copulation with a male weighing 150% more than herself, or a cow or heifer weighing 800 pounds can be safely bred to a bull weighing 2000 pounds or slightly more. When this point has been greatly exceeded,danger arises and increases in proportion to the variation in weight. In one instance a heifer of about five months and weighing about 400 pounds was served by a bull weighing 2000 pounds and suf- fered a fracture of the pelvis, though not sufficiently serious to prevent her giving birth in due time to a calf from the service which caused the injury. In another instance, a sucking filly was ridden by a large stallion, causing dislocation of the sacro- iliac articulation on one side and fracture of the iliac shaft on the other, rendering her useless for labor and, after having been 60 Veterinary Obstetrics bred at two years, necessiating her destruction at three years, because of irremediable dystokia. It is, therefore, 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 disparity 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 im- mature young as in the foregoing case, with serious or fatal results. In the mare, injuries to the neck and withers are also liable to occur from bites by the stallion during coitus. This is probably most common among heavy draft stallions, some of which are very rough and cause more or less serious lacerations or contu- sions, at times leading to fistulous withers. There seems to be no means for breaking the stallion of the vice and the only ef- fective method of control with which we are acquainted is the application of a muzzle during coition. Injuries to the male because of over-size of the female also oc- cur, especially in the bull. When young bulls of small size at- tempt copulation with mature or large cows, they are liable, at the moment of the violent copulatory thrust to take their feet off the ground to such a, degree that in coming down they miss their footing, their hind feet glide forwards and they fall heavily backwards, sometimes causing fracture of the spine or other serious injury. It is to be avoided by guarding against too great a disparity in size and by placing the small male in as advantageous a position as possible both as to slope of ground and security of footing, especially avoiding damp, slippery ground. In one case brought to our attention a similar accident oc- curred to a cow, which being in heat, mounted one of her mates slipped, fell and fractured her spine so that she had to be de- stroyed. Injuries to the penis of the male during copulation are by no rare. The penis of the stallion is most liable to injury from kicks by the mare, the avoidance of which we have considered above while discussing the subject in a general way. These contusions of the penis during its great vascularity in the breeding season are very difficult and refractory to handle. The stallion needs be kept quiet, free from sexual excitement, the penis retained at Physical Injuries 61 rest within the sheath by means of a suspensorium and the re- sulting local inflamation ameliorated by the application of cool- ing astringents such as lead acetate, hamamelis, tannin, bella- donna, etc., combined in cases of necessity with antiseptics. Gen- erally the patient may have quiet walking exercise, a restricted laxative diet, saline laxatives or in case of serious disturbance, prompt cathartics of the hypodermic alkaloidal group. Lesser injuries to the penis of the stallion are caused by the pushing of tail hairs of the mare into the vagina by the glans penis. These being drawn tightly across the penis, cut the organ. This is to be prevented by the stallion groom by drawing the tail of the mare aside at the commencement of the copulatory act or better by means of a bandage about the base of the tail extending low enough to secure any hairs that might be caught upon the glans penis or by braiding the upper hairs of the tail upon the dorsal surface. In bulls and other male ruminants, the penis occasionally be- comes 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 other- wise cAusing serious injury. 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, or that portion beyond the point of injury does not become erected, which renders him useless as a breeder (see Sterility) or the injury causes balanitis or inflammation of the prepuce which leads to adhesions so that the organ cannot be protruded. The prevention of such injuries is more important and practica- ble than their handling. They are most liable to occur in confined males which are suddenly brought in contact with fe- males in estrum, 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 yet have reached its fullness or has begun to decline so that she will not stand well and, asa result of 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 on the avoidance of these and other dangers. In cows especially, it is important that they be properly in estrum, that the enclosure in which copulation is to occur ig reasonably even and the footing secure. Zschokke 62 Veterinary Obstetrics commends (Der Unfruchtharkeit des Rindes, Page 66) service stocks consisting 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 anteseptic douches and the avoidance of sexual excitement, combined with such lo- cal 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 serious character, chiefly to swelling and inflamation of the parts, occasionally accompanied by para- phymosis. These injuries are not usually observed under proper breeding arrangements but are generally seen where bitches are permitted to run at large and a large number of dogs to congre- gate, with the resultant fighting. The handling of such injuries to dogs consists of essentially the same methods as in the bull, chiefly of disinfection. If para- phymosis results, it should be overcome. A solution of eucaine, with perhaps some adrenalin, may be applied to the swollen glans penis, after which, by the application 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 suffi- ciently to permit the penis to return. Copulation is one of the most common causes of strangulated inguinal hernia in the stallion and the accident is occasionally induced in this way in other male animals. When the stallion mounts the mare, his position subjects the inguinal region to increased pressure from the weight of the abdominal viscera, the position of the abdomen having been changed from horizontal, or a declination downwards and forwards from the inguinal ring towards the diaphragm, to almost the perpendicular, with the entire weight of the abdominal viscera pressing downwards upon the pelvic inlet and inguinal opening. The pressure is further augmented by the abdomen of the stallion becoming forcibly com- Physical Injuries 63 pressed against the buttocks of the mare, as well as by the vigor- ous contraction of the abdominal muscles during the act and all combine to increase the intra-abdominal pressure and tend to force a small section of intestine through the inguinal ring, where it quickly becomes strangulated unless it promptly returns to its proper position when the stallion dismounts. In such case, soon after dismounting, in 15 to 30 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 excruciating and constant, increasing in intensity, the sweat becoming 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, 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 fluctuating 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. Examination per rectum usually gives more definite results, and the incarcerated intestine can be felt and grasped, making the diagnosis definite and final. The handling needs 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 pro- hibit the attempt, the operator may insert his hand per rectum and grasping the incarcerated intestine, drag gently and cau- tiously upon it and thus attempt its replacement. At times this succeeds. Should this fail, the animal is to be cast in dorsal recumbency with the hind legs sharply abducted and the inguinal region freely opened. ‘The dragging on the incarcerated bowel per rectum may now be repeated, accompanied by digital manipula- tion or compression externally with the other hand or by an assistant. If the hernia is not promptly reduced, chloroform anaesthesia should be induced, which further relaxes the parts, and replacement may yet succeed. Failing in these efforts, herniotomy should be performed with the least possible delay. After thorough disinfection of the re- gion, proper sterilization of hands and instruments, and covering 64 Veterinary Obstetrics the adjacent parts, including the hind feet and legs, with aseptic or antiseptic towels or napkins, the scrotum is to be freely and cau- tiously incised down to the incarcerated intestine, after which the carefully disinfected and moistened index finger is to be passed up along the anterior side of the herniated bowel to the point of incarceration in the internal ring. Using the finger as a guide, a herniotome, probe pointed bistoury, scalpel, or such other instru- ment as the exigencies of the situation afford, is introduced through the ring at its antero-external angle and the tissues are sufficiently divided in a direction forwards and outwards to per- mit the incarcerated intestine to return. Sterile or antiseptic gauze is then introduced into the wound and packed closely against the internal ring in a manner to avoid all danger of a re- currence of the hernia and the scrotal wound is closed by sutures. The tampon may be omitted and deep sutures taken in the inter- nal ring, closing it against future hernia. Twenty-four to forty-eight hours later the antiseptic gauze may be removed, the wound disinfected and closed and thereafter left undisturbed or handled according to indications. 2. GENERAL INFECTIONS OF COITION. Coition brings the involved animals into such intimate contact that it offers special facilities for the transmission of infectious disorders from one to the other, regardless of the natural avenue of entrance of the microorganism. In their sexual maraudings animals make close approach to each individual of their species with which they meet and thereby tend to contract any conta- gion which may be extant in the neighborhood or, having such disease, to distribute it everywhere in its path. Thus, the author recalls an instance of a boar pig, wandering from the farm, to re- turn later and, sickening from hog cholera, spread the malady to the entire herd, causing the death of more than 100 animals. The dangers are little less at times among breeding animals kept confined. A young foal with strangles accompanies its dam to the breeding place, scatters the infection about the prem- ises where other colts may later come in contact with it or the stallion, being young and non-immune, contracts the disorder and transmits it to susceptible animals coming in contact with him, thus disseminating the infection over a wide area. Bierstadt (Woch, fur Thierheilkunde) records the transmission of stran- Physical Injuries 65 gles by a supposedly convalescent stallion to mares, apparently through the genital canal, as abcesses formed in the pelvis about the rectum and vagina. While abcesses occur in these parts from the usual mode of infection, the observations of B. are highly significant and interesting. In the infections cellulitis or ‘‘ pink eye’’ of the horse (see page 68) with the prevailing orchitis in the stallion, the malady is very liable to be transmitted through coition. In contagious abortion, coition is quite generally regarded as one of the most fruitful sources of dissemination, it being assumed that the spe- cific microorganism is carried directly into its native habitat and most favorable position for growth, upon the penis of the bull. In one instance the author has seen actinomycosis of the uterus and broad ligaments of a cow, resulting in her sterility, without other discoverable actinomycotic lesions, which suggested the probability of the infection having been lodged in the genital canal by copulation. The dissemination, of general contagions through sexual contact applies especially to males kept for gen- eral breeding service and serving females coming from a wide area; the arrival of females from so many different points tends to carry any contagion to the breeding place, thence to be dis- seminated by him to every part of the territory involved. If a healthy male escapes from an enclosure, wanders from home and contracts a disease, he carriesit back and exposes the other animals of his species; if diseased and he wanders into a neigh- boring healthy group of breeding animals, he carries the infec- tion tothem. Similarly a female, especially when in estrum, may prove an important disseminator of contagion. It is, therefore, well to consider the breeding place as one of the most important of distributing points for contagious diseases of animals and the veterinarian should constantly regard it as such and be in a position to direct capably how the dangers may be reduced to a minimum. When a breeder has an adequate number of females to warrant the keeping of a breeding male of the desired quality for his own use, it is good economy to do so, to breed all his females to the one male and to accept no females from outside for breeding. This is only rarely practi- cable. When breeding males are kept for public service, the females offered for breeding should be rigidly scrutinized. Not only 5 66 Veterinary Obstetrics. should they show no sign of disease but they should come from a herd where no contagion is known or believed to exist. The manager of public breeding animals should keep himself thor- oughly posted upon the prevalence of infectious diseases in his area and should carefully investigate any reported appearance of such diseases. When infectious maladies appear in the com- munity he should ascertain as clearly as possible the extent of dissemination, the location of each center of infection, and then take such measures as are necessary to prevent the contraction of the disease by the breeding male or his transmitting it to other females. Here the general rules of disinfection should be rigidly carried out and, if necessary, isolation and the suspension of breeding be applied. * The exclusion from the breeding pen or place of males, females or suckling young affected with con- tagious diseases, however mild or convalescent, should be rigid- ly enforced, the place should be kept clean, disinfected if con- ditions suggest, and, whenever warranted (perhaps it always is), the penis and prepuce of the male should be disinfected before or after each service. This isa matter of but a few momentsif prop- er conveniences are arranged and would frequently avoid seri- ous outbreaks of contagious disease. The arrangements for the disinfection of the genitals of male breeding animals should be simple and thoroughly convenient and effective. A pail or other vessel of copper, galvanized iron or tin fitted with lid and bail and having a capacity of one to two and one half gallons will readily serve the purpose. At or near the bottom of this vessel have inserted a small horizontal tube, curved downward at the external end, over which the end of a piece of rubber tubing six to ten feet long is slipped and secured. After the disinfecting solution is placed in the vessel, the latter is to be elevated by means of a cord attached to the bail and " passing over a pulley or beam, until a sufficient height is reached to supply the desired force by gravity. Usually a height of three to six feet above the part to be treated suffices. The distal end of the tube may then be inserted into the sheath of the penis, the opening of the sheath grasped and held closed for a time and the entire cavity distended with the antiseptic fluid ; or the tube may be pushed far back to the posterior end of the sheath and the current of antiseptic fluid be depended upon to reach every part. General Infections of Coition 67 Another very simple method for flushing out the penial sheath is to use an ordinary pure gum horse catheter for a tube, its rounded distal end offering an ideal shape for introduction into sheath, while a small funnel, inserted into the other end, affords facility for pouring the antiseptic fluid through the tube into the sheath and the funnel, held as high as the length of the catheter will permit, affords sufficient force of gravity for the purpose de- sired. The entire apparatus is cheap, compact, withstands steri- lization by boiling and is efficient. Any reliable disinfectant will answer the requirements but those which tend to dissolve, or are miscible with fats are best, especially about the preputial opening and the surrounding skin. Among these, lysol and carholic acid take a high place. The antiseptic solutions should preferably be used warm and, in dis- infecting the skin adjacent to the preputial opening, soap should be added. ‘The strength of the disinfectant introduced into the sheath should not be great, % to 1% of lysol or carbolic acid being as strong as the naked mucosa of the penis, especially of the bull, will readily tolerate. CONTAGIOUS CELLULITIS. EPIZOOTIC CELLULITIS. PINK EYE. RHEUMATIC INFLUENZA. MUCO-ENTERITIS Bibliography—Williams, Epizootic Cellulitis; Principles and Practice of Veterinary Medicine, 4th edition, 1888, p. 251. Cave, Pink Eye: Vet- erinary 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 Eye from Apparently Healthy Stallions to Mares; ibid., Vol. XIV, p. 159 and Vol. XV, p. 97. Contagious Cellulitis isa highly contagious acute fever of the horse, which has been generally ignored except by British veter- inary writers, although it seems to be widely distributed in vari- ous countries. It is common in parts of America, but fre- quently confused with influenza or catarrhal fever, although wholly distinct. We insert an account of this disease here because of its inti- mate bearing upon the question of horse breeding, which it affects chiefly in three distinct ways. It is frequently spread from apparently healthy stallions to mares through copulation, in which respect it approaches the character of a venereal disease, although, as a general rule, this is not the method by which it is transmitted from animal to animal. It has a relation to sterility because it causes an orchitis in the stallion, which frequently leads to a permanent loss of func- tion in these glands. It is related to abortion in that it very frequently causes the death of the fetus in utero when affecting the pregnant mare. ' Symptoms. Thesymptoms of the disease consist primarily of an elevation of temperature, sometimes accompanied by chills, dullness and other phenomena, which belong in general to acute contagious fevers. The fever appears very suddenly, usually ranging from 103 to 105° F. although it may exceed this. Gen- erally speaking, the temperature is higher than in influenza and lower than in the contagious pneumonia of the horse. ‘The pulse is hard and full and somewhat quickened, while the res- piration is not very greatly disturbed. Some cough is present, though this does not constitute a very prominent symptom of the affection. 68 Contagious Cellulitis 69 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 accompan- ied by a cracking sound in the joints. After a time the legs be- gin to swell, commencing at the feet and extending upward until at times it reaches the body. 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, there being a very marked tendency to constipation at first, in which the feces are covered with large quantities of mucus and their color considera- bly altered. Defecation causes some pain and straining. Later there is a tendency to diarrhoea, which is easily and often fatally intensified by the administration of purgatives, especially of aloes. ‘The conjunctiva is markedly altered in color, becoming a bright, pink hue, swollen and edematous. At times the con- junctivee are so badly swollen that the eyelids become somewhat everted and the edematous membraue 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 interrupted. There is some tendency toward pleurisy, pneumonia and other pulmonary complications. ; From an obstetric standpoint, the chief interest lies in the complications of the genital organs. In our experience, the breeding stallion shows a great tendency to suffer from orchitis. We have seen in large importing stables 50 to 75% of the stall- ions 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 dis- ease have largely disappeared. In some instances we have seen permanent sterility result so that the breeding value of the stallion was completely destroyed. In other cases we have noted that stallions apparently re- covered from the disease have quite uniformly transmitted it, 70 Veterinary Obstetrics during copulation, to susceptible mares. These observations are entirely in harmony with,those of Reeks, who records an instance where an apparently sound stallion transmitted the disease to susceptible mares almost uniformly over a period of two years. This observation is a not uncommon experience. It is notable also that, when the disease attacks a pregnant 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, re- lates 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. In our experience, in an extensive horse breeding district, the dis- ease quite uniformly leads to abortion in pregnant mares. Although highly contagious, the affection is of short duration, usually runs a favorable course, in from four to six days, and leaves the animal but little altered, except in those used for breeding. The eyes also may become permanently weakened and invite later attacks of disease. In some unfavorable cases the pulse becomes weak and there is a general depression, which is liable to be followed by sudden death owing, it appears, to heart failure, in which case there are usually found large thrombi in the cardiac cavities. No specific treatment has been discovered. In our experience the greatest benefit is to be derived from the administration of diffusible stimulants, like nitrous ether or carbonate of ammonia, along with quinine. Purgatives are to be avoided, aloes being especially dangerous. The bland oils might be used in some cases as aperients, or very small doses of eserine, arecoline or other alkaloid hypodermic cathartic, taking care to make the dose sufficiently small to induce no harmful degree of excite- ment and barely sufficient to induce gentle purgation. ‘There is naturally much divergence of opinion among veterinarians in reference to the treatment of this affection, but in its general handling we are not specially interested. From an obstetric standpoint, we are chiefly concerned in the question of the spread of the malady from the breeding pen and its tendency to induce sterility and abortion. . When the disease appears in a breeding area it should be han- dled with the greatest rigor as to quarantine, and breeding quar- Contagious Cellulitis 71 ters should receive special consideration. Diseased mares or mares coming from infected premises should on no account be admitted to the breeding place. Should the malady become gen- eral in a neighborhood, as it usually does when an outbreak oc- curs, breeding should be suspended until the disease is extermin- nated. 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 overcoming the linger- ing 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 needs be placed at rest, physically and sexually. The usual high feeding of breeding stallions should at once be displaced by a very light laxative diet, such as grass, rootsand bran, with an abundance of salt. If these measures do not induce a prompt unloading of the alimentary tract the bowels 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. Pend- ing the advent of the disease, the animal should have regular daily exercise, great care being taken, however, not to continue it after the advent of the first symptom of the malady, fever, has become established, as indicated by thermometry. At- tacked without these precautions, similar measures should still be adopted, the ration reduced and confined to laxative foods, while the bowels are promptly and cautiously evacuated. The patient is to be guarded jealously 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. If orchitis appears, as it frequently does, in addition to the foregoing measures, including the internal administration of nitrous ether and quinine, local applications to control the in- flammation in the glands should be applied. First among these in the early stages is local refrigeration by the application of cold 72 Veterinary Obstetrics -water or ice. Probably the most efficient means is the applica- tion of broken ice by means of a suspensorium, which serves the double purpose of refrigeration and supporting the weight of the pendant glands. This treatment should be constantly and faith- fully applied until the crisis of the malady has passed, since the effective handling of these glands may determine whether the ani- mal is to be of further value as a breeder or not. Such remedies as belladonna and camphor, applied locally, tend to relieve con- gestion and overcome the inflammation, but, in a critical case we believe the refrigeration superior. Later, when the acute symptoms have passed, chronic infection 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 possible. For this purpose an extended course of potassium iodide at the rate of 4% ounce per day for each 1,000 lbs. of body weight is, in our judgment, the safest remedy. By some veterinarians, fears are entertained that the prolonged administration of this drug may induce a harmful atrophy of the testicles, but we consider this quite imaginary and without foundation. We would con- tinue the drug for three or four weeks, or longer if necessary. Abundant time should be allowed to elapse, after the disappear- ance 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 season, 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 susceptible mares. When a stallion which has suffered/from pink eye shows evidences of sterility, careful examin- ation of the genitals and of the semen should be made and, should any restoration of the breeding powers seem possible, appropriate measures undertaken but usually, in our observation, the sterility following pink eye is permanent and irremediable and the animal must be removed from the stud and, with or without castration, used as a work horse. SPECIFIC INFECTIONS OF COITION Venereal Diseases. Venereal diseases have been described in nearly, if not all of our domesticated animals, especially in horses, cattle, sheep and dogs, with briefer references in our literature to such diseases in goats, swine and rabbits. In horses we recognize two well defined venereal affections, Dourine or Maladie du Coit and the Eruptive Venereal Disease or Genital Horse Pox; in cattle the Vesicular Venereal Disease and the Jnfectious Granular Venereal Disease ; in the dog the Venereal Granulomata; and in sheep an Ulcerative Venereal affection. , 1. DOURINE OR MALADIE DU CoIT. BESCHALSEUCHE. EQUINE SYPHILIS. Bibliography. Baldrey; Jour. Comp. Path. and Therap., 1905, Vol. 18, p. 7; de Does, Jahresbericht, 1902. Hutyra und Marek; Spezielle Pathol- ogie and Therapie. Thanhoffer; Ueber Zuchtlahme. W. L. Williams; Report Illionois State Board of Live Stock Commissioners, 1887. Dourine of the horse is the most serious venereal disease known among domestic animals, both on account of its wide geograpical distribution and the mortality and loss caused by it. It is widely dissemminated in Europe, Asia, Africa and North America. It has been recognized for more thaf\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 Wa- pella 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 appreciated so that it was not until 1887 that vigorous measures were undertaken for its control and eradication. Inthe meantime, numerous animals had been sold from the infected area and widely disseminated over the country in a manner which made it impracticable to effect- ively trace them to their ultimate destination. When the im- portance of the malady became recognized it was promptly placed under control and was so completely eradicated that up to the 73 74 Veterinary Obstetrics present time, a period of twenty years, it has not reappeared in that territory. Since that time the affection has been recognized in Nebraska, South Dakota, and in the province of Alberta, Canada. In these areas of infection the disease has not been definitely traced to its source. The outbreak in Illinois was believed to have been in- troduced by stallions imported from France, a conclusion which, although unproven, time has not served to change. The affected area in Illinois produced considerable numbers of grade draft stallions and mares, which were sold to go to the West and North- west for breeding purposes, and, although it cannot be clearly shown, there is good reason to conclude that this outbreak furn- ished the infection for the others which have occurred in Amer- ica. It has now become so widely disseminated, its eradication from among range animals is so uncertain, and the possibility of fresh importation so apparent, that the malady is of great importance to the horse breeding industry of America, since it may, possi- bly, manifest itself at any time in any breeding district. TShese facts render it important that veterinary practitioners, in horse breeding districts, should be on the alert and ready to recognize the disease in the early stages of an outbreak, ere it gains a wide distribution and its eradication is rendered difficult and uncertain. Nature. Dourine isa highly infectious venereal disease trans- mitted naturally by coition only. Experimentally, it may be trans- mitted by innoculation and to other animals than solipeds. It is. due to a protozoan parasite belonging to the trypanosoma group. This parasite, the ‘rypanosomum equiperdum, was discovered by: Rouget in 1896 and its rélation to the disease clearly demonstrated by Schneide: and Buffard in 1899. The trypanosome of Dourine isa one-celled organism provided with a flagellum at the anterior end. It is about 18 to 26 microns in length and, when observed in the living state, is highly motile. It occurs in the blood, spinal fluid, the discharges from the genital organs, in the plaques of the skin and perhaps in other tissues and fluids of the infected animal. It multiplies by longitudinal 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 dis- Dourine \ 75 covered in recently formed plaques. Baldrey says, in reference to the appearance of the trypanosomia 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 these plaques, so that it is dificult or impossible to find them after twenty-four hours. They may be found in the discharges from tLe vagina or urethra of the infected animal, but it seems that their existence here is not so uniform as in the fresh plaques. Some investigators believe that they are quite uniformly present in the spinal fluid. It is frequently very difficult to discover them in the blood. 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 aninsect. For laboratory uses it is generally cultivated in dogs. Symptoms. The period of incubation following natural in- fection 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 im- portant groups ; the local lesions of the genital organs and the contiguous parts; those of the skin and other mucous mem- branes than that of the genital organs ; and the symptoms 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 after eight or ten days, subsequent to infection, a swelling of the penis and prepuce, with some degree of protrusion of the penis from the sheath, still covered by the prepuce. The prepuce shows a tense, elastic swelling and has a smooth, glistening appearance. If the uretha 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 progresses, the tumefaction of the prepuce and penis increases and extends to the sheath and scrotum, which may eventually become enorm- ously swollen and remain in an indurated condition for one to 76 ; Veterinary Obstetrics 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 en- tirely out of the prepuce and hanging flaccid and fully exposed. The discharge from the urethra may become somewhat ichorous and, with the general, soiled condition of the penis and surround- ing parts, may lead to ulcerations or erosions upon these. Later in the course of the disease, the weakened condition of ‘the tissues of the part may lead to purulent infection and the forma- Fic. 7. DOURINE. Arab pony at beginning of the second stage of the malady, show- chiefly the enormously swollen sheath and penis and depressed as- pect of the patient. (Baldrey. ) Dourine 77 tion of abscesses in the sheath, scrotum and inguinal region. (See Figs. 7 and 8). 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 until they rest high up in the inguinal space, where they can not be readily felt. No vesicles or pustules occur upon the genitals 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 depig- mentation begins 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 Fic. 8. DOURINE IN FINAL STAGE. English Thoroughbred stallion showing paralysis and edema of penis. (Baldrey. ) 78 Veterinary Obstetrics on the penis, but this is regular in outline, whereas in dourine the depigmentation spreads out in patches. In the mare, about eight to ten days after infection there ap- pears a well marked swelling of the lips of the vulva. The mucous membrane of the vulva and vagina is intensely injected and swollen and from the vulva there escapes a more or less pro- fuse discharge of a mucous or muco-purulent character, which soils the tail and surrounding parts. The mare urinates fre- quently 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 may be, to some degree, misleading, depending largely for its expres- sion upon the frequent urination, rather than upon genuine sex- ual desire. As the disease progresses, the volume of the discharge tends to increase, in some cases, assumes a dirty grayish character and may become fetid. The swelling of the vulva increases, the la- biz become much enlarged, are tense, elastic and glistening. Their margins stand somewhat apart, so that the vulva is partly open, especially at its lower commisure. Within afew 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 depigmentation begins along the margins of the vulva, without prior vesicular or pustular eruptions, as simple, white patches, and thence extends onward in irregular lines, or spots, until it may involve the entire vulva, perineum and anus. The white patch, or patches, have irregu- lar borders and are of various shapes and sizes. ‘They persist for several months, and, in case of the recovery of the animal, they tend, finally, to disappear; fading first at the periphery, while upon the margins of the vulvar lips they persist for six months ora year. (See Fig. g). Of even greater 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, it becomes visible, ordinarily, without mechanically parting the labiz. The secretion of sebum in the prepuce of the clitoris apparently ceases, and the swollen organ seems dry and glistening. Depigmentation of the clitoris and its prepuce occurs early and persists for one to two years Dourine 79 in those mares which apparently recover and is the last symp- tom, in our experience, to disappear. The swollen, depigmented clitoris, with gaping vulva, constitutes one of the most uniform and persistent symptoms of the malady, and gives to a young mare the appearance of extreme old age, in this part. Following closely upon the first appearance of local lesions, ‘within a few weeks after infection, there appear pectiliar and pathognomonic cutaneous eruptions in the form of placques, Fic. 9. DOURINE IN MARE. Depigmented spots on labize vulvee and extreme emaciation. (Hutyra and Marek.) 80 Veterinary Obstetrics elliptical elevations or ‘‘talerflecke.’’ These eruptions appear suddenly, largely about the flanks, neck, shoulders, sides and thighs as more or less circular elevations, one to several inches in diameter. The margins of these are very abrupt and stand up above the level of the healthy skin like’ the eruptions of urti- caria, the hairs upon them being erect. They appear suddenly, not, usually, in great numbers, but only one to five or six ata time, remain a few days and disappear without leaving a mark, to be succeeded by a newcrop. It is claimed that, in these placques, the trypanosomes are very abundant during the first stages of their existence, but as the eruptions grow old the para- sites rapidly disappear from them. It has been stated that these placques may cause intense itch- ing and lead the animal to bite or rub the part and that they sometimes suppurate. None of these symptoms have been observed by us. It is not uncommon to observe in the latter 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 membrane may rarely be present. These erosions, when present, have no specific charac- ter in appearance and suggest rather a necrosis of a greatly de- bilitated tissue as the result of an irritant applied 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 itself clearly in lesions of the skin. Any wound of the part heals tardily and, if the animal is so weak that it is recumbent a large part of its time, it suffers from extensive decubitis gangrene. The symptoms, which are largely referable to the nerv- ous system, appear at about the same time as the placques or not long afterward. The first:and most pronounced of this group is usually a progressive paresis, which is chiefly observable in the hinder parts. At first there is an unsteady gait, the animal bring- ing 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 Dourine 81 a flexed position or somewhat knuckled over. This knuckling over, whether standing or during progression, is a rather common symptom in trypanosomic, if not protozoan diseases generally. This imperfect control may appear in one or both hind limbs or may alternate between the two and is subject to great varia- tion from day today. Sometimes this 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 decidedly lame in the joint. As the disease advances, the paresis tends to increase until there is such com- plete paralysis that the animal 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 compli- cations. In other cases, after being recumbent for days or having had to be assisted in rising for weeks, the animal improves and eventually recovers. With, and even before, the advent of the paretic symptoms, there appears a very rapid emaciation, which is especially prom- inent in the posterior parts of the body. This emaciation is noticeable from the fact that it occurs in spite of a good appetite, and the allowance of abundant food with apparently good diges- tion. It seems that both the paralysis and emaciation are largely dependent 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 symptoms of the dis- turbances of the nervous system are not confined to any portion of the body, and there is frequently observed a paralysis of an ear or eyelid or of the lips or nose. In the stallion there is fre- quently a well marked change in the voice so that he can not whinny naturally. The sexual desire may remain unaffected throughout the dis- ease, and, 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 other cause, the stallion fails in many cases, to effect coition, and, late in the course of disease, the same inability may arise from loss of power in the penis or from extreme paralysis of the posterior parts. 6 82 Veterinary Obstetrics The effect of the disease upon the powers of reproduction is very profound. In the earlier stages, the stallion may be capa- ble of impregnating mares and, failing to infect them with the disease, they 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 so, aborts so early that the conception is not observed. In the Illinois outbreak, it could not be deter- mined that a living foal had been born among roo diseased mares. Some writers claim that, occasionally, a diseased mare will pro- duce a living foal. Recovery may, and does, occur even after extreme 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 recovery, either apparent or real, take place at any intervening time. Pathological Anatomy. Inanimals 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 con- nective tissue, in the mesentery, and 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 mes- entery presents a pale saffron color, thickened by a gelatinous 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 found somewhat enlarged, very pale and edematous. The genital organs fail to exhibit the extraordinary changes one would naturally expect to find. Autopsies made by us on several stallions, all diseased for one and one-half to over two years, showed the general conditions above indicated, while, in addition, in some cases the genitals showed marked changes and, in others, there were only very Dourine 83 slight deviations from the normal. One very bad case, an im- ported French draft stallion, showed very great enlargement of the scrotum, which was hard and unyielding to the touch. The skin of the scrotum was enormously thickened and of a pale yellow color. The inguinal glands of the right side were the seat of an extensive abscess, opening at the upper part of the scrotum. A large abscess, occupying 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 in color, 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 in color, with- out any appearance of ulcers. The seminal vesicles and enlarged portions of vasa deferentia contained thin, grayish, purulent accumulations. The left testicle was normal in size, with cover- ings firmly adherent at every part. No appearance of ulcers was found in the urethra or upon the penis of either of the several stallions examined. Investigators have observed inconstant changes in the nervous system, principally of injection of the coverings of the brain and spinal cord, softening of the lower part of the cord and occa- sional extravasation of fluid into the ventricles of the brain. Thanhoffer describes extensive degeneration of the nuclei of the nerve cells in the spinal cord. The nasal mucous membrane usually shows catarrhal inflammation. Differential Diagnosis, Few contagious diseases of animals have been so confusedly described by veterinary writers. At first there was a very general confusion between Dourine and Genital Horse Pox, a condition which still continues in many descriptions of the malady. According to our observations, the most reliable local symp- toms for the diognosis of Dourine in the stallion consists of the doughy, elastic swelling of the prepuce, with varying degrees of penial paralysis, the penis hanging somewhat out of its sheath, usually retained within the prepuce. The urethral opening is usually inflamed and, from it, a slight discharge escapes, but there is nothing visible to the naked eye to mark this as differing from lesions of these parts due to other causes. 84 Veterinary Obstetrics 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 symptoms for purposes of diagnosis consist of thedoughy, edematous 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 uniformly 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 dis- charges or from the accumulations of filth about the genitals, accompanied by low vitality in the cutaneous tissues ; but such eruptions are devoid of diagnostic value, their relation to the disease, so far as we know, being quite secondary. Specific eruptions of vesicles or pustules upon the genitals do not occur. When abundant and specific eruptions occur on thé genitals of the horse, they indicate Genttal Horse Pox, not Dourine. Dourine and Genital Horse Pox may readily coexist and thus add confusion in diagnosis. In the outbreak of Dourine in Illinois in 1886-7, we were in great doubt for a time as to our diagnosis in the case of a young stallion showing abundant pustules and vesicles on the penis, prepuce and sheath. The urethral meatus was inflamed, dark livid in color; from it there was a thin grayish discharge; the prepuce and sheath were swollen. Though the animal was within the zone of infection, no exposure could be traced. He. transmitted Dourine to no mares, and recovered completely and permanently in a few days. Had it been possible to connect him in any way with the outbreak, it would have been difficult to attribute the eruptions to anything but Dourine, and, had he been actually affected with that malady, we have no reason to believe that it would have prevented his becoming simultaneously in- Dourine 85 fected with the far more common Genital Horse Pox. In the table on page 88 this animal is designated as No. XI. Some writers, in describing Dourine, accept the presence of de- pigmented areas about the vulva and anus as conclusive evidence of precedent ulceration, but depigmentation of the skin does not necessarily follow vesicular or pustular eruptions nor does its presence indicate that eruptions have occurred. We had excel- lent 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 vesicles, papules or ulcers. It was a depigmentation without ulceration. Fleming, (Veterinary Sanitary Science and Police); Williams, (Principles and Practice of Veterinary Medicine); Law, (Veter- inary Medicine); Moore, (Pathology and Diagnosis of Infectious Diseases) and numerous other writers place emphasis upon the presence of specific eruptions in Dourine, but fail to describe their characters, and do not intimate that they have personally observed them. The only definite assertion by any author,so far as we have been able to find, that he has personally observed ulcers, papules or vesicles is that of Thanhoffer, who records instances of mares with eruptions about the perineum and inside the thighs and presents illustrations of cases; but there is nothing in their char- acter of diagnostic value and it does not appear that the diag- nosis in these cases was verified. In the extensive Illinois outbreak, which was under our per- sonal charge, among more than 100 cases of the disease, not an instance of eruptions was observed nor could the most diligent inquiry among owners reveal any history of such in any animal. In this outbreak, the cases were observed daily for some months, and we were especially careful to search for these eruptions in recent and old cases because, relyitig upon the descriptions of va- rious writers, we expected to find them, and were disappointed and confused when we did not. European writers are generally inexact in reference to vesicu- lar and pustular eruptions and white spots upon the genital or- gans. One of the first writers to point out the distinction be- tween Dourine and the Genital Horse Pox and to assert that the former was without eruptions, was Rodloff. Baldrey, after an 86 Veterinary Obstetrics extensive experience with the malady in India, fails to record the occurrence of vesicles and pustules. In the United States of America, there have occurred approxi- mately 300 cases of the disease, and so far as we can determine, no vesicles or pustules have been observed in any instance. Hutyra and Marek describe eruptions but, on page 464 of their Spezielle Pathologie und Therapie, they present the illustration, (Fig. 9), of a mare with depigmentation about the vulva, which they attribute to prior ulceration, but they do not illustrate any of these ulcers and the appearances in the picture are identical with the depigmented spots observed in America, which occurred without the prior existence of vesicles, pustules, ulcers or other visible destructive processes in the epithelial surface of the skin. In the Jahresbericlit for 1902, de Does is quoted as having observed the depigmentation of the skin of the external genitals without precedent vesicles or pustules and regarded this loss of pigment as a marked symptom of the affection. It seems to us that the apparent differences in observation and view in reference to vesicles, pustules and loss of pigment is due to the constant confusion of the two wholly distinct venereal diseases and to accepting the erroneous conclusion that depig- mentation indicates prior pustular or vesicular eruptions. It should be further remarked in reference to the alleged oc- currence of eruptions that the character of the micro-organisms said to cause the disease is contradictory to the appearance of such lesions. Trypanosoma, in general, have little or no tend- ency to produce eruptions or suppuration, and it would seem unique to expect that, in this one disease, alone, of this great group, there should occur characteristic vesicles or pustules. The elliptical swellings or ‘‘talerflecke’’ 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. 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 ; accompanied by other lesions and symptoms it is pathognomic, while the peculiar jerky movements in the hind limbs during progression, Dourine 87 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. Finally, the finding of the ¢rypanosomum equiperdum in the blood of the animal serves to definitely establish the diagnosis. In many cases it seems to be very difficult to find the parasite in the blood of the animal and, consequently, this proof of the character of the disease is not always readily produced. 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 ruins the industry for a time be- cause its character is so insidious that it is exceedingly difficult to trace in it all its ramifications. The mortality among the affected animals reaches 60 to 80 %, which places it among the most fatal of infectious diseases. Those which’ recover do so very slowly and the time consumed before they are again fit for work is so great that it almost destroys their value. We have no data to show that an animal once affected can ever be bred again with safety, however completely they nfay have apparently recovered or how long a period may have elapsed. The tabulated list on next page of affected stallions in the Illinois outbreak, copied from the author’s report upon the disease, is of interest, as showing the transmissibility and mortality of the malady. Control and Eradication. There is no specific treatment known for the disease and, at present, the most that can be done is the securing of rest with favorable food and environment. Complications may be handled according to circumstances. Some investigators have obtained apparently favorable results from the administration of arsenic and other antiseptics but there is no definite evidence of specific action of these, though they are worthy of trial. Inthe Illinois outbreak, some animals recovered their general health after having been so completely paralyzed that they constantly required assistance, for several weeks, in getting up. 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In the case of each stall- ion which showed symptoms of the disease or which had served a diseased mare or a mare which had later become diseased without other known exposure, his breeding record was examined in detail and each mare which had been bred to him was placed under quarantine and subjected to repeated observation. All animals which were found diseased were either destroyed and the owners compensated, or they were placed under a strict quar- antiné for life, by the terms of which they were allowed to be worked, but not to be bred, sold or exchanged. Under these conditions, almost all the affected mares were killed and the few remaining ones were closely watched. The affected stallions were all destroyed. The mares which had been exposed to the disease, but had not become affected, were kept under quarantine for a year or more and subjected to rigid in- Spection from time to time and were finally released when it seemed perfectly clear that they were not, and had not been, dis- eased. The effect of these measures has been highly satisfac- tory and no recurrence of the disease has come to light during the twenty years which have elapsed since the outbreak. At that date the ‘rypanosomum equiperdum was unknown and its presence or absence could not enter into the question of diag- nosis or control, physical symptoms alone being relied upon. Upon one occasion, during the early stages of control work, the owner of a stallion, who doubted the diseased condition of his animal, clandestinely permitted him to serve a mare, which became infected. The destruction of all affected stallions shortly thereafter put a stop to such accidents. It is of primary importance in all outbreaks of the disease to provide early for the entire cessation of breeding, or, we might more strictly say, of copulation or attempts at copulation between animals. In this respect, it is important that colts which are reaching the breeding age should be properly castrated or other- wise made secure. Stallions of breeding age, which have become affected, should be destroyed promptly, or placed under safe quarantine, since they constitute the greatest source of danger. Destruction of the affected animal is highly important, since in go Veterinary Obstetrics many cases the owner is not fully convinced of the dangers from the disease and may carelessly violate any quarantine regulations imposed. There is the additional danger that employees of the owner, or others, may violate the quarantine without his knowledge or con- sent, and thereby start the disease anew in a way which may be exceedingly confusing, or might work serious injustice to the owners of healthy stallions. The feeling between competing stallion owners in a community is not always of the best, and they may seek to do a rival a very great injury. The castration of stallions does not insure inability to spread the disease. It isa well known fact that such castrated animals, which have previously been used for breeding purposes, will con- tinue to copulate with mares which are in estrum and may, thereby, spread the disease. It has been recorded that geldings have contracted the malady and it is perfectly reasonable to suppose that the accident occurred in this manner. The castra- tion of stallions is, consequently, not wholly safe and, if it is at all allowed, it should be accompanied by other safeguards which would prevent any accident. If such stallions are removed from breeding areas to city stables, where they are put to work, in case they have sufficiently recovered, they may cease to be dangerous so long as they are under reasonable supervision. The castration of mares has not been largely applied to the control of this disease, but may prove of important police value. If a mare has been exposed, but apparently not infected, there may still linger a question of her safety, even though she has not shown symptoms of the disease and, unless she is highly val- uable for breeding purposes, it may be better, in some cases, to completely exclude her from breeding by causing her castration. Since this operation is comparatively safe upon the mare and is ‘readily carried out by an ordinary operator, it might well be largely employed in these outbreaks, and the animal then put to work. Diseased mares should, in the present state of our knowledge, be destroyed. They occasionally recover their general health and ability for work but, as already stated, we have no data to show that such mares ever become entirely safe as breeding «ani. mals and the danger to the horse breeding industry, as compared o the small value of the few apparently recovered mares, is so Dourine g!I overwhelming that it would seem poor policy to take the risk of a violation of quarantine regulations and the breeding of these animals by the owners. In the Illinois outbreak the opposite course was pursued and a small number of mares was allowed to live and used for work purposes under strict quarantine against breeding or disposal. Though the plan has not been followed by any disaster, it was ainsafe and necessitated prolonged vigilance. In the community where they were, however, each neighbor knew the history of each of these previously diseased mares and would probably have reported any open violation of the quaran- tine very promptly. It is needless to say that careful watch should be kept over the breeding animals, especially the stallions, in the infected area for several years and prompt and rigid in- vestigations made upon the slightest suspicion of a recurrence of the malady. 2. 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 vesicular or pustular and rupture, leaving small erosions on the mucosa. From the vulva, there occurs a more or less copious, muco-purulent dis- charge, 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 externa 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 this, in turn, pustular and assumes a yellowish-white color; these mature quickly and soon rupture, to be followed by tough, yellow scabs, % to 4% inch in diameter. After a few days, the crusts drop off and leave be- hind white scars very slightly depressed. These depigmented spots are circular in form and, in very severe cases, may coalesce somewhat. They tend, however, to remain distinct 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 examina- tion, there may be eruptions in every stage. , Accompanying these eruptions, there is 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 violently rub the tailand vulva. Although we have personally observed a number of outbreaks, we have not seen this symp- tom in any case. Neither have we been able to find in the literature upon the subject any case where such a symptom has been recorded as a personal observation. g2 Genttal Horse Pox 93 In the stallion, the symptoms are virtually parallel. Erup- tions, of the same character as described upon the vulva and anus of the mare, appear upon the penis, prepuce and sheath of the horse. The openthg 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 constitutional symptoms in either animal, there is no loss of appetite nor appreciable emacia- tion and the general condition of the animal remains undisturbed. In one case observed by us, there remained a year afterward an extensive 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, its mucosa greatly thickened, the urinary salts were deposited over its inner surface and its cavity was largely oblit- erated. The meatus urinarius was open and the urine dribbed away involuntarily, so that the tail and thighs were kept con- stantly befouled 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 in- creasingly certain. The nature of the disease is not precisely known. A given outbreak is not usually traceable to any definite source of origin, but seems to become established in a community without having been imported by a diseased animal. Once it becomes estab- lished, 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. Experiments have shown that the vesicles and pustules contain the element of contagion in a virulent form. Handling. ‘The handling of the disease depends essentially upon disinfection and a temporary cessation of breeding. 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. From our experience we have come to prefer an antiseptic wash composed 94 Veterinary Obstetrics of about 1 ounce of carbolic acid with 2 ounces of tannin and 6 ounces of glycerine in 1 gallon of warm water. After washing the penis and prepuce thoroughly with soap and water, this solu- tion 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. The extent of disease in the urethra has not been investigated. We only know that there is a urethral inflammation and dis- charge and that it is infective. The mere washing of the penis and prepuce cannot, therefore, bring about effective disinfection, but the urethra needs be included. The urethral injection is best made by means of a rubber bulb syringe or a gravity ir- rigating apparatus. The syringe or irrigator nozzle is’ insert- ed into the urethral opening and retained there while the an- tiseptic solution is forced upward as far as is deemed necessary. Should some of the fluid reach the bladder, it will not prove dangerous but it would be well not to overfill the urethral pass- age at first so that the infective discharges may be largely ex- pelled before taking the risk of forcing them up into the bladder by an excess of the solution. 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 excite- ment, but should be allowed gentle exercise, along with a re- stricted, laxative diet. The stallion may be returned to the stud as soon as all evidences of disease have disappeared but, for a time, it might be advisable to continue the disinfection, especially after each service. . The handling of the mare should be along the same general line and should be persevered in until all symptoms have disap- peared. Asa general rule, she will recover sufficiently 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 on page 83. There is little need for police control of this disease, since its symptoms are so prominent that laymen promptly note it and voluntarily withdraw the affected animal from breeding until re- covery has occurred. Should there at any time be a negligent tendency shown, the affected animals should be promptly quar- antined until all danger has passed. VENEREAL DISEASES OF CATTLE 1. VESICULAR EXANTHEM. APHTHOUS VENEREAL DISEASE. The vesicular venereal disease of cattle is one of the most com- mon and wide-spread of the entire group of venereal diseases of animals. It is a highly contagious malady, transmitted ordin- arily by copulation. The Symptoms are very similar to those of the Genital Horse Pox, already described. The first evidence of the disease in the cow is an intense vaginitis, in which the mucous membrane of the vulva and vagina become greatly injected and swollen, soon followed by dark red points or petechize, which quickly develop into vesicles of very small size. These are at first transparent, but may later become pustular, although they largely rupture while yet in the vesicular stage. From these, very shallow ul- cers result and give rise to a muco-purulent discharge, which col- lects upon the tail and neighboring parts in the form of dry crusts. In severe cases, the ulcers may acquire considerable depth, with irregular borders, and, in healing, may temporarily leave a stellate scar, though there is usually no prominent mark. In any case, they tend to develop completely in a short time. The cow expresses pain and irritation by stepping to and fro with the hind feet and by movements of the tail. The act of urination is painful and causes straining because of the irritant effect of the urine upon the denuded mucous membrane. In some instances there seems to be an excessive estrum. When very severe, the cow may show some difficulty in moving, owing to the tenderness of the inflamed organs. Manipulations of the swollen vulva cause very evident pain and the inflamed mucous membrane bleeds very readily. The discharge from the vulva is somewhat parallel to the degree of ulceration in the vulva and vagina. If excessive, it may become irritant and cause ex- coriation of the parts with which it comes in contact. In very severe cases, patches of the mucosa may become necrotic and slough away. The infection may or may not prevent impregnation and, when affecting a pregnant cow, it rarely causes abortion. The general 95 96 Veterinary Obstetrics functions of the animal are not usually affected, the temperature and appetite remaining very nearly or quite normal. The affec- tion may lead to chronic catarrh of the vagina; or it may result in adhesions between the walls of the vagina, more or less com- pletely closing that canal. In the bull, the penis and sheath are inflamed, swollen and. tender. Eruptions of the same character as we have described in the cow appear also upon the penis, first as papules, which ‘develop into vesicles, to be followed by ulcers. The urethra is. similarly involved, as expressed by a muco-purulent discharge- This is further shown by the urine being frequently voided in small amounts, with appearances of pain. The swelling of the penis and its sheath tends to produce phimosis. Erection of the penis causes bleeding and this is especially evident immediately after copulation. Kampmann records a case of extensive necrosis of the penis with a permanent de- formity. The duration of the disease is usually brief and gener- ally ends in spontaneous recovery in from one to four weeks. An outbreak in a stable may continue for a long time by being transmitted first to one and then to another animal. One attack apparently confers little or no immunity and, when an animal has almost recovered, the disease may be renewed through copulation. This affection should be differentiated from the granular ven- ereal disease of cattle. Inthe latter, vesicles and pustules are absent throughout and it runs a far more chronic and virulent. course. We find no record of the latter affection in America, while the vesicular venereal disease is widely distributed. The prognosis is highly favorable and it is only rarely that. material loss follows. The control of the disease must rest fundamentally upon the isolation of the affected animals. It is highly essential that the two sexes should be kept entirely apart. Even steers should not be allowed in an enclosure with cows, because they sometimes. attempt copulation and may thereby serve to transmit the disease. A diseased cow should uot be permitted to stand in close proximity to healthy ones because the infection may be transmitted from one animal to the other through the medium of the tail, by soiled bedding or other means. Affected animals. should on no account be bred until they have fully recovered. Granular Venereal Disease of Cattle 97 Thorough disinfection of the stalls and of the diseased and soiled parts of the animals contributes materially to the control of an outbreak and the shortening of its duration. The treatment consists of the disinfection of the copulatory organs and those parts which become soiled from the discharges. The choice of a disinfectant is not of essential importance. Thorough mechanical cleansing by washing constitutes a highly important part of the handling. The disinfectants used should constantly be of such a character as to cause little irriation to the highly sensitive parts. One of the chief dangers to be an- ticipated is adhesions between contiguous mucous surfaces of the vagina or of the sheath of the penis. If the walls of the vagina or vulva adhere, because of the denudation of epithelium, breed- ing may be prevented, owing to the narrowing of the canal to such an extent that copulation cannot occur. Inthe bull, the penis may become adherent to the sheath so that it cannot be protruded, and coition thus be prevented. Such untoward results may be best anticipated, and recovery hastened and assured, by douching thoroughly with such mild disinfestants as 1% % solution of carbolic acid, 1% alum solution or .1% permanganate of potash, repeated twice daily. The so- lution should be used at about the body temperature and intro- duced into the vagina or sheath by means of an irrigator, until the cavity is"well distended, when it should be allowed to escape. Should the patient give indications, by straining, that the douche is painful, it should be reduced in strength until it is well borne. 2. GRANULAR VENEREAL DISEASE OF CATTLE. INFECTIOUS VAGINAL CATARRH. VAGINITIS VERRUCOSA Bibliography: Zschokke, Die Unfruchtbarkeit des Rindes; Hutyra und Marek, Spezielle Pathologie und Therapie ; Hess, Schweitzer Archives f. Tierheilkunde, Band XLVIII, S. 351; Thoms, Monatshefte fur Praktische Tierheilkunde, B. XVII, 5. 193. In many portions of continental Europe there exists a widely spread and highly contagious venereal disease of cattle, which causes very serious losses in dairies. So far as known, it is purely venereal, transmitted clinically, generally, if not always, by coi- tion, though capable of being transferred by other means. 7 98 Veterinary Obstetrics We have seen no record of its existence in America, but its wide dissemination in Europe, the chronic and somewhat insid- ious course of the disease, which may render it difficult of detec- tion at ports of entry, render it possible of importation. The want of any record of its presence, in this country, is not final proof of its non-existence, as it may be confused with the far less serious eruptive venereal disorder described in the preceding chapter. The malady has been recognized for twenty years and has been observed and described by numerous veterinary authors in Switz- erland, Germany, Italy, Denmark, Austria and other countries, from some of which America imports large numbers of dairy cattle. While not of importance, as related to the life of the affected animal, it becomes in other respects a very serious malady as affecting the dairying interests. It is highly contagious, involv- ing, in the infected zones, as high as 80 to 90% or even more of the total number of cows. Hutyra und Marek, citing Mueller, states that in East Prussia alone the disease involved 30,000 dairy cows, while, in Switzerland and other countries, it has ac- quired a similarly extensive dissemination. It is a fertile cause of enzootic abortion. ‘Thoms states that more than 50% of cows affected abort. In one outbreak, involv- ing 300 cows, about 70% aborted ; in another group of 296 cows there were 48 live calves. After the malady has prevailed in a dairy herd, a large proportion of cows become sterile, partly because of cystic ovaries, accompanied by nymphomania. In fact, this malady appears to be one of the common exciting causes of nymphomania with ovarian cysts. It may also lead to sterility in other ways. During the course of the malady and asa result of the direct irritation from the abortion and other interruptions, there is a great loss of milk. Thoms estimates the average losses upon each cow at 30 M. ($7.:0). According to those authors who have had extensive experience with the malady, it deserves to rank amongst the most serious of dairy plagues. Etiology. According to Ostertag and Hecker, the affection is due to a streptococcus consisting of 6-9 cocci, which are held together by a delicate capsule. Granular Venereal Disease of Cattle 99 In artificial cultures, either alkaline or acid, and at the body or room temperature, the organism grows vigorously. It does not liquefy coagulated blood serum or gelatin nor coagulate milk. It forms neither gas nor indol. . The disease is readily induced in healthly cows by vaginal in- oculation with pure cultures or by discharges from the vagina of a diseased animal. Attempts at experimental transmission to other species of animals have resulted negatively. Naturally, the infection is transmitted almost wholly by copu- lation, an affected bull infecting almost all the cows with which he copulates. A bull which has recently served a diseased cow may transmit the malady to a sound one without becoming dis- eased himself. Sometimes the transmission occurs through ordi- nary contact, without sexual intercourse. It may be accidentally transmitted to heifers or calves. The streptococci, having gained the vagina, penetrate the mucosa and are found between the epithelial cells and deeply within the papilla. The organisms have also been identified in nodules in the uterus, in the uterine mucosa and in the ovaries which have undergone cystic degeneration. In this way, apparently, they cause the very frequent sterility, while the wide area of distribution of the organisms and their depth within the tissues render disinfection and cure a complex and difficult problem. Symptoms. According to Ostertag, a vaginal catarrh be- comes established within 2-3 days after artificial inoculation, while, by natural or coital infection, one or two more days elapse before the catarrh becomes apparent. Raebiger observed va- ginitis and catarrh in 24 hours. The first symptoms of the malady to be noted consist of swell- ing of the labie of the vulva and a diffused or streaked reddening and swelling of the vulvo-vaginal mucosa, with tenderness of the parts. The inflamed area is covered somewhat by a muco- purulent discharge. A day or two later there develop in the vestibule of the vulva along the floor and sides about the clitoris numerous small nodules qs to % inch in diameter, which are at first dark red, later be- coming lighter in color. These nodules are smooth and of very 100 Veterinary Obstetrics firm consistence and are somewhat regularly a in parallel rows, as shown in Fig. 10. FIG. 10. INFECTIOUS GRANULAR VAGIITIS. Mucosa of the vestibule after three months duration of the dis- ease. (Hutyra and Marek, after Ostertag.) Granular Venereal Disease of Cattle IOI The nodules consist essentially of hypertrophied papillary bodies. If the vulva is held open and reflected light thrown into the cavity, the nodules can be readily distinguished ; they are also readily recognizable by the sense of touch. The mucous membrane is swollen, red and sensitive, bleeds easily upon manipulation and is covered by an inodorous mucous or muco-purulent secretion, which, flowing from the vulva, soils the labize, tail and adjacent parts, where it dries in brown crusts or, if in larger amounts, may flow from the vulva in long, ropy masses. The denudation of the mucosa renders it quite sensitive to the passage of urine over it, and the pain and irritation in the part tends to cause urination with abnormal frequency. When the disease extends into the cavity of the gravid uterus, which appears to be alinost the rule, abortion occurs, while, in the non-pregnant cow, nymphomania and sterility are common results. The acute stage of the malady continues for 20 to 30 days, when the swelling and tenderness abate and the nodules lose their red color to become somewhat yellowish or grayish, perhaps some- what transparent ; but the discharge and the granules persist for go to 100 days, or more. Vesicles, pustules or ulcers do not ordinarily occur, though ul- cers and phlegmon have been very rarely recorded. Bulls show a comparatively high resistance to the infection, and, though they constitute the chief vehicle for the contagion, apparently suffer slightly, if at all, in most cases. When affected, they show analogous symptoms to those observed in the cow. ‘The penis is studded over with nodules, like those of the vagina, which are easily seen when the organ is extruded. Erection, copulation or manipulation of the penis causes bleeding. There is a muco-purulent discharge from the sheath of the penis, which adheres to and soils the parts. Treatment. ‘The handling of the malady consists essentially of local disinfection, and, as in other localized infections, there should be a thoroughness in application conformable to the in- tricacy. We have stated above, that the cocci are found deeply insinuated between the epithelial cells, and yet deeper within the papillary bodies, that they may extend to the mucosa of the os uteri, to the oviducts and even to the ovaries. Safe recov- ery includes the successful destruction of the organisms in all 102 Veterinary Obstetrics these organs and tissues. The disinfectants used must not be too irritant to the highly sensitive mucosa of the genital passages, since they induce straining, inflammation, adhesions and other dis- agreeable consequences. Disinfecting douches, ointments, pow- ders and tampons have been commended, all having a common aim. Among douchesthere have been suggested 2 to 244% solu- tionsof lysol, creolin and similar drugs; .5% silver nitrate, .1% potassium permanganate, 5% ichthyol, etc. Likewise, with pow- ders, a wide variation is available, such as zinc sulphate, alum, tannin and others, reduced by mixing with starch or other inert powder. In this group, we should also mention iodoform, be- cause of its local anaesthetic action, its weight, which would cause it to drop into the depressions between the elevations of the mucosa, and its comparative insolubility, causing it to re- main in position for 24 and more hours, presumably to be slow- ly converted into iodine. It has one very serious objection in the dairy, its odor, which is at all times liable to taint the milk. If it is to be used, great care should be taken in its application, some, person other than the milker applying it, since his hands inevitably become somewhat saturated with the drug. It may be best introduced by means of a gelatine capsule, to be later broken and the powder liberated. Other drugs, like lysol and creolin, require cautious handling in the dairy, to avoid the contamination of the milk. Inthe use of tampons, the vulvo-vagi- nal cavity may be packed with gauze or cotton saturated with a ‘ disinfectant. Usually animals resist the presence of a tampon in the vulva or vagina and tend to expel it. Some experienced practitioners praise antiseptic ointments very highly. They may vary greatly in composition and consist of well nigh any disinfectant, incorporated with a heavy fat, like cocoa butter, wax or tallow. The latter is very cheap and may have added to it a little wax in order to give it the proper firm- ness. Along with the desired antiseptics, the mixture may be placed over a fire and brought to the melting point, when all in- gredients are mixed, and, while still soft, may be molded into suppositories, say in form of a candle, about one-half to one inch thick by five to eight inches in length. Such suppositories are very readily introduced through the vulva, and, unless containing highly irritant antiseptics, are well borne by the patient. Granular Venereal Disease of Cattle 103 Affected bulls are to be handled along the same general lines as described for cows. The prophylaxis and control of the malady is bighly impor- tant and, in a general way, demands the enforcement of the usual regulations for the control of contagious diseases. Of the first importance is sexual isolation ; coition must be prohibited until ' the disease has wholly disappeared in the two animals to be mated, not alone because a diseased animal will quite surely transmitit by copulating with a sound one, but because coition tends constantly to arouse the disease to new and increased ac- tivity. In addition there needs be general isolation of the dis- eased from the healthy, with thorough and efficient disinfection of the stalls and all portions of the stable. In a suspected herd, the penis and sheath of the bull should be thoroughly disinfected by means of a reliable douche, both immediately before and after copulation. This is easily accom- plished by placing a barrel or other container, filled with a relia- ble antiseptic, in a convenient elevated place, from which the fluid may flow by gravity, and attaching to it, by means of a faucet, a piece of rubber tubing 10 to 15 feet long, the free end of which may be inserted into the opening of the sheath and the cavity thoroughly douched. In regions where the malady exists or is suspected, efficient quarantine should be enforced against the entrance into the herd of diseased or suspected animals. VENEREAL DISEASE OF THE DOG. VENEREAL GRANULAMOTA. LYMPHO-SARCOMA In the dog, there is observed a specific venereal disease con- sisting of granulomata upon the genital mucosa. The disease is somewhat wide-spread in Great Britain and continental Europe. It is observed in various portions of the United States, largely in dogs recently imported. It seems most common in large cities. In the male it affects chiefly the penis and prepuce and some- times invades the adjacent tissues. Metastatic disease of the inguinal glands may follow. In the female it involves primarily and chiefly the vulva. It is naturally transmitted by copulation only, but may be otherwise spread by artificial or accidental inoculation. Fic. 11. INFECTIOUS VENEREAL GRANULOMA OF Doc. (C. A. White.) Symptoms. The first symptom usually noted is a bloody dis- charge from the prepuce or vulva, accompanied by tumefaction 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 base of the penis where the penial mucosa passes over to the sheath or, 104 Venereal Disease of the Dog 105 at times, upon other parts of the mucosa. These tumors are soft and friable and bleed freely upon being touched. ‘They may be sessile or somewhat pedunculated, resembling warts. The affection is of a chronic character and seems to have no definite limitation, the vegetations’continuing to increase in size month by month and Fic. 2A. INFECTIOUS VENEREAL GRANULOMA OF BitcH. (C.A. White. ) finally become firm, lobulated masses, so intensely injected that they assume a dark color. 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 appearance as already noted in the male. These appear chiefly along the floor of the vulva and, when very large, may protrude externally. The dis- charge from the vulva is usually fetid. According to French, 106 Veterinary Obstetrics males sometimes show an aversion to mating with affected females. Beebe and Ewing (Jour. Med. Research, Sept., 1906, do. Vet. Jour., July, 1907) record the presence in these tumors of spi- rocheete in one out of a series of cases, but failed to connect their presence with the cause of the malady. Fic. 12B, INFECTIOUS VENEREAL GRANULOMA OF BiTcH. (C. A. White. ) Later, Mettam (Veterinary Journal, February, 1907) records the discovery of an organism in this disease belonging to the group of spirochzte, which he believes to be the specific cause. 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 inflammatory or other disease changes. The disease has been repeatedly transmitted experimentally by inoculations in the genital mucosa and other tissues. Venereal Disease of the Dog 107 In clinical and experimental cases the neoplasms may not re- main 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 in 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 sutured. It is well to place the animal under general anesthesia for the operation, which should be repeated within one to three weeks if necessary, and in some cases, cautery may be resorted to. In inveterate cases it may be necessary to amputate the penisand prepuce. Hobday states that the disease may be favorably affected by castration. VENEREAL DISEASE OF SHEEP. Flook (Jour. Comp. Path. and Ther., Vol. XVI, p. 374) records an outbreak of a venereal disease among sheep which came under his observation. 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. Soon after pur- chase, the two rams were taken from the band with which they had been purchased and placed with a small flock of old ewes. After one week F. found nine of the old ewes showing great swelling of the vulvz, with raw, bleeding sores upon the mucous and cutaneous surfaces of the lips of the vulva. An examination of the rams revealed ulcerating sores in the sheath of one and eruptions upon the upper lip of the other. The general health of the animals was not apparently disturbed. The rams had been marked with color upon the breast between the forelegs so that each ewe which was served could be identified and, by this means, it seemed to be determined that two of the latter had contracted the disease without coition. F. suggests that, in these two, the disease may have been transmitted by the ram which had the eruptions on his upper lip, through smelling of the vulve of these two animals, or that it might have been caused by flies bearing the disease from one animal 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 recovered. On the following page of the same journal, Sir John McFad- yean contributes observations made by himself upon an out- break which he considers identical with that described by F., which he also observed. He saw twelve ewes affected in one flock, showing intense inflammation, swelling and tenderness of the vulva. The vulvar mucosa was inflamed and some ulcers were present, 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 returned to his owner six days previously, McFadyean failed to see the 108 Venereal Disease of Sheep 109 animal. McFadyean attempted to produce the disease experiment- ally 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, in the wether, a swelling of the sheath was apparent two days after the inoculation. This was still further increased on the 4th day and accompanied by a slight discharge. The swelling, at this time, was sufficient to make the exposure of the penis impossible. The symptoms continued over a period 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 artificially transfer the disease from this animal to another wether and ewe failed. McFadyean did not succeed in isolating any organism which he believed to be the cause of the disease. While both outbreaks here mentioned have been comparatively mild in their course, McFadyean remarks that it is worthy of careful observation and that newly purchased rams might well be exaniined with a reference to this affection before being used for breeding. G. H. Williams (Vet. Jour. Vol. XVII, p. 64) records two more 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 used chinosol and zinc sulphate, in solution, to the parts and they recovered in about two weeks. In his second outbreak, three rams and forty ewes, in a flock of fifty, showed the same symptoms as described by Flook and M’Fadyean. In one ewe, eruptions occurred upon the nostril. In some of his cases, the vulva was greatly swol- len and distorted and, in others, there were extensive granu- lations of a dark color, which protruded out through the vulva. The graulations and ulcers were penciled with silver nitrate and the entire parts were washed with a solution of zinc sulphate and chinosol. 110 Veterinary Obstetrics 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 some twelve of them had eruptions about the lips and and noses, but no genital affection was present. A second ram, in this lot, escaped the disease, so far as seen. In the larger 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 breed- ing was resumed without recurrence of the disease, and, in due time, the ewes dropped healthy lambs. INFECTIOUS VENEREAL DISEASE OF RABBITS Friedberger and Frohner (Spezielle Pathologie und Therapie, 190}, page 501), describe an infectious disease of rabbits which was transmitted chiefly, or wholly, through copulation. The af- fection appeared in an extensive breeding establishment of rab- bits, and consisted of an inflammatory disease of the organs of copulation. It was transmitted by coition from buck to doe, and vice versa. There were extensive swellings of the genital or- . gans in both sexes, accompanied by a muco-purulent discharge. The disease was finally eradicated by injections of a solution of sulphate of copper, 1 to 2%, extending over a period of some weeks, VENEREAL DISEASES OF SWINE AND GOATS Hutyra und Marek mention the occurrence of venereal disease in swine, and Friedberger und Froehner state that it occurs rarely in swine and goats, but neither of these authors record any de- finite observations upon either malady. x OTHER INFECTIONS OF THE GENITAL ORGANS Bursattee of the Penis and Prepuce. Genital bursattee presents characters suggesting, to the inex- perienced, a venereal disorder, and constitutes an annoying dis- ease in breeding stallions. It is not infrequent in those countries where this malady prevails in other portions of the body. Inour experience, bursattee shows a distinct tendency to attack the penis and prepuce of breeding stallions, especially of heavy draft animals. The infection is, persumably, not coital but is trans- mitted by other means: accidental wounds, flies or other carriers. The usual symptoms of penial bursattee, when first observed by the groom or owner, is the presence about the urethral open- ing of an angry-looking fungoid growth, which bleeds upon the slightest touch and is generally observed to bleed immediately after coition ; or, during erection, blood will drip from the tumor. Another fungoid mass of similar appearance exists at the prepu- tial ring upon the inferior 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 itssheath. 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 ex- tend from the seat of infection to neighboring parts. In one instance, we observed the disease beginning upon the scrotum. If the new growth is closely inspected, it is usually possible to recognize readily with the naked eye the small yellow concre- tions or ‘‘kunkurs’’ characteristic of the malady. In some cases, the penial bursattee is accompanied by infections upon the feet or other parts. So far as we have observed, the disease is not transmitted to mares through copulation, though, clinically, it behaves as an infectious malady and it seems not impossible that danger of transmission to the mare through the vagina may exist. The micro-biology of the disease has not been fully deter- mined, some attributing it to nematode worms, others to the presence of a fungus. 1tl 112 Veterinary Obstetrics Like bursattee of other parts, it is active in temperate coun- tries only during the hot season and undergoes apparent spon- taneous recovery upon the advent of winter, to remain dormant until the return of warm weather. It thus 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 palpably diseased. Furthermore, the sexual excitement incidental to breeding greatly influences the disease and adds to its virulence, each erection of the penis, with the consequent congestion of the organ, causing the bursattee growth to bleed. The handling of the disease consists of the destruction or re- moval of all infected tissues and the avoidance of venereal excite- ment. If undertaken early, the disease is usually confined to the urethral tube, filling it and protruding beyond the navicular fossa, and may extend up higher in the urethra. Whatever the extent, the diseased tissues are to be excised or curetted away and the parts well cauterized with silver nitrate or the thermo- cautery, after which the wound may be dressed with iodoform, which apparently exerts a very beneficial influence upon the course of the disease, should any remain. - 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 handling demands the with- drawal of the animal from the stud and the prevention of sex- ual 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 withdrawn, the secondary bursattic growth is more amenable to management. Here the operator can freely excise the diseased tissue without. danger of unpleasant deformity. After excision or destruction of the diseased tissues, the parts. should be kept scrupulously clean, to which end it is advisable to- wash the penis, prepuce and sheath twice daily, with soap and. water, to which % @ 1% of carbolic acid may be advantageously 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. Actinomycosts of Genital Organs 113 Actinomycosis of the Genital Organs. In cattle, actinomycosis of the external or internal genital or- gans may occur in such a manner as to suggest venereal infec- tion or, by their presence, may interfere with coition or fecund- tion. In a Galloway bull, we observed an actinomycotic tumor weigh- ing about two pounds, which was located in the elongated naked prepuce and prevented the protrusion of the penis. There were also similar actinomycotic new-growths present in the inguinal lymphatic glands. In another case, to which we shall again have occasion to refer when considering sterility, actinomycotic ab- cesses occurred in the broad ligament of the uterus, without ac- tinomycotic lesions in other organs. This would suggest that the infection had been introduced into the vagina during coition. MENSTRUATION In all domestic mammals, there occurs in those females of breeding age, at the time of estrum, an excitation of the genital tract with increased activity of the mucous glands, especially of the vagina and vulva, which leads to a more or less pronounced discharge of mucus. In addition to this increased production of mucus, there occurs in some animals, during or immediately subsequent to estrum, an evident discharge of blood from the vulva, which, mixed with mucus and epithelial debris, is known as the menstrual fluid ; the process, as menstruation. The phenomenon is not so con- spicuous in any of our domestic animals as is ordinarily observed in woman, and, for the most part, usually passes unobserved, if present. It is quite commonly noted in the cow and bitch. It has been recorded in the mare by Fleming (Veterinary Obstet- rics) and Kaiser (Magazine, 1859). Many regard estrum and menstruation as synonymous. While they are intimately re- lated, we prefer to regard them as two separate phenomena, as observed among domestic animals. While estrum is common to all mammalian animals of breed- ing age at the breeding period, menstruation, or a muco-sanguin- ous vaginal discharge, is not observable in most species at all, and, in the cow, where it is most conspicuous, it ordinarily does not occur during, but subsequent to, her very brief estrual period. In the bitch, the relation is not so well determined, the estrual and menstrual phenomena being of greater duration and over- lapping or occurring simultaneously. In the cow, there is very frequently noted at or near the close of the period of sexual de- sire a well marked discharge of blood from the vulva. The amount varies greatly, usually being limited to a sufficient quan- tity to plainly stain the tail and surrrounding parts so that they are distinctly bloody, but sometimes there is a large amount of blood of a bright red color,mixed with mucus,seen hanging from the inferior vulvar commissure. In a few cases we have observed guite a voluminous discharge of blood, amounting at times to several ounces and accompanied by some constitutional disturb- ance, consisting chiefly of decreased appetite and a loss of milk. This sanious discharge in the cow continues usually for only a 114 Fertilization 115 very brief period of five to twelve hours. During this interval the cow may copulate but estrum is not well marked. In the bitch the discharge appears during estrum and continues for some days without usually being very profuse. Fertilization. Fertilization is the successful union of the male generative cell or spermatozoon with the female egg or ovum, by which the re- sulting cell acquires the power of segmentation and is enabled to develop into an embryo. According to Marshall and other embryologists, fertilization in the rabbit occurs in from eight to twelve hours after copula- tion. This interval is not due to the time required for the mi- gration of the spermatozoa from the posterior portion of the. genital canal to and through the oviduct, but to the fact that the ovaare not discharged from the ovary until eight to twelve hours after copulation. In the rabbit, the spermatozoa are found to travel the length of the uterus and oviducts in from fifteen minutes to two hours and, in the ordinary course of events, are already in the pavillion of the tube, awaiting the discharge of the ova. The doe rabbit copulates with the buck immediately after giving birth to young, the interval between estrual periods being the same as the duration of pregnancy. We are not aware that any exact observations have been made in our larger domestic animals demonstrating the length of time elapsing between copulation and fertilization. In spaying cows, we have regularly observed that one which is in estrum has ripe ovisacs, which generally rupture the moment the ovary is grasped. If the cow has been in estrum on the previous day, we have found the Graafian follicle freshly ruptured. This would indicate to us that in the cow, as in the rabbit, ovulation occurs late in the estrual period or just at its close so that, under normal conditions, copulation would precede ovulation and hence that, in the cow, as in the rabbit, ovulation and fertilization occur some hours after the act of coition. In the rabbit, fertili- zation usually takes.place immediately after the eggs enter the oviduct, which is probably the general rule in mammalia. If eggs be taken from the upper portion of the oviduct, sperm- atozoa will usually be found imbedded in the zona radiata or 116 Veterinary Obstetrics lying in the space between the vitelline membrane and the egg. The exact process of fertilization has not been fully determined in our higher animals. It is generally held that.a single sperma- tozoon fuses with the female pronucleus. The Relation between Estrum, Ovulation, Fertilization and Menstruation. The relationship existing between the phenomena of estrum, ovulation, fertilization and menstruation has not been clearly determined. Owing to the very brief duration of estrum in the cow, she offers a specially favorable opportunity for study. As already related in our personal experience in the spaying of cows, it has been found that estrum is the first of these phenom- ena to present itself and that, if the ovaries be examined dur- ing the estrual period, it is found that there is an enlarged, mature Graafian follicle ready to rupture and that the walls give way under ordinary manipulation allowing the follicular con- tents to escape. If the ovaries be examined during menstruation, it is found that the ovisac has ruptured and its contents have escaped. It seems, therefore, that, in the cow at least, the chronologic order of these phenomena is estrum, ovulation and menstruation, pro- vided that this cycle is not interrupted by copulation and ferti- lization, when the order would be estrum, copulation, ovulation, fertilization. If successful copulation ensues early in estrum, it is the general observation that menstruation does not occur. Thus, its advent would seem to indicate the death and expulsion of the ovum along with some of the epithelium of the uterus, accompanied by hemorrhage in a manner to correspond in a way to the lochial discharge of parturition. It would appear that, in our higher animals, the phenomenon of menstruation is analogous in a way to parturition itself. In animals having a duration of pregnancy greater than the in- terval between two estrual periods, estrum becomes interrupted during gestation, except in rare pathologic cases. The follow- ing table by Simons (Graduation Thesis, Library of New York State Veterinary College, 1903) shows some interesting observations in reference to the relationship existing between this group of phenomenona and brings out especially the influ- ence of impregnation upon the occurrence of estrum. In those Relation between Estrum, Ovulation, Fertilization, etc. 117 animals where menstruation occurred, it is indicated by +. while, in those in which no sanious discharge could be recognized, the fact is indicated by —. RELATIONSHIP BETWEEN ESTRUM, OVULATION, FERTIL-— IZATION AND MENSTRUATION. g g $8 2) 3 me | ¢ S oy . _ tt 2 vo fo) wos on B og iu Be . Be) ge a ae z so | Ee 3 nn gS 8 ga Z a ) D A |e re I 8.00 A.M. ; 6.00 P.M 10 - fe) 6-14 6-14 | II 5.30 A. M. 5.00 P. M I2 - fo) 6-16 6-16 III | 3.00 P.M. 5.30 A. M. 15 _ ° 6-16 6-17 IV | 800 a.m 4.00 P. M 32; 4+ July 8 6-17 6-18 V | 6.00 A.M. 6.00 P. M. 12 - fo) 6-17 6-17 VI | I12.004.M 9.00 A M aroo+ July 12 6-20 6-21 | VII | 5.00P.M.] 5.00A.M 12. = fo) 6-20 6-21 : VIII | 3.00P.M./ 9.00P.M 6 5— ° 6-23 6-25 IX | I1.00 A.M. | 9.00 P. M II | = fo) 6-25 6-25 x 5.00 P. M. 9.00 P. M 4 | + August 8 6-27 6-28 | XI | 4.00P M.| 8.00A.M 1 | — oO 6-29 6-30 XII | 6.30P.M 5.30 A.M i — fo) 6 29 6-30 | XIII | 5.00a.M 6.00 A. M 210- ° 7-2 7-2 XIV | 12.00A.M 7.00 P. M. Fi — fe) 7-5 7-5 XV | 5-30A.M 6.00 P. M 13 - fe) 7-8 7-8 XVI 4.00 P. M, 9.00 P. M. 5 - fo) 7-12 7-12 XVII 5.30 P. M 7.00 A.M 13 _ fo} 7-24 7-25 XVIII | 5.00 4.M. | ---~------ 34 5 + 7-25 7-13 5 XIX | 8.00 A.M. | ---------- 4o | + 7-27 7-6 XX | 10.00 A.M. | ---------- 23 + 7-31 7-12 118 Veterinary Obstetrics ‘In cases IV and V, two heifers subject to the same condi- tions, the second was bred early during estrum, while the other was allowed to go until menstruation was well established, then served and, as a result, was not fecundated. Nos. VI and X were handled in the same way as No. IV and they also failed of fecundation. These cases were taken from a number for the reason that they were the most typical. They show that after service, which, in the successful cases, occurred before menstrua- tion, the latter did not take place. Instead, the animal quickly returned to its normal condition and continued as before estrum was present. Cases Nos. IV, VI and X, at the end of 21 days or thereabouts, were again in estrum with the same regularity as though they had not been bred, when they again were served, but this time before menstruation began, and became fecundated. Some observations were also made upon the length of time be- tween successive periods of estrum. ‘This occurs quite regularly in cycles of from 20 to 25 days, usually about 21 days being given, though this is, of course, subject to variation.”’ A careful study of this table would indicate that, in the breed- ing of cows, it should be the constant aim to cause copulation to occur somewhat early during the period of estrum. ‘Whether it is possible for it to occur too early after the establishment of estrum is not very clearly determined, but it would seem that, ordinarily, it should take place in the cow within twelve hours from the beginning of the period. In the twenty cases observed by Simons, the longest duration of estrum prior to successful copulation was sixteen hours in case XI. ; In abnormal or pathologic conditions of the genital organs, these relations become somewhat varied and unreliable. In a typical instance related by Simons of a nymphomaniac cow which was in estrum each eight to twelve days, repeated service was ineffective. The removal of the ovaries showed them to be about double the normal size and cystic. This cystic condition prevented alike ovulation and impregnation. Other conditions serve to interrupt the normal order and lead to variations in the cycle of estrum and menstruation. These observations, although brief and fragmentary, suggest that successful impregnation prevents the occurrence of menstru- ation and that, consequently, its presence, in a cow after breed- ing, may be accepted as important evidence that fertilization has not taken place. STERILITY Standing at the threshold of success in livestock breeding, is the question of the capability of the animal, set aside chiefly or wholly for the purpose, to reproduce living young. Without this capacity, pedigree and individual excellence count for noth- ing. From a practical standpoint, it matters little to us whether the failure to reproduce its kind depends upon a want of impreg- nation, a failure of union between the ovum and spermatozoon or if it be due to the death of the embryo or fetus while yet in the uterus, or even to its premature expulsion from the uterus in such a defective state of health or development that it cannot continue to live ; each results in a defeat of the aim of the breeder and practically constitutes sterility. We shall here limit our consideration to the failure of the ovum to become fertilized by a spermatozoon. The question of the life of the embryo and fetus and the birth of the latter in a state which will favor its development into a mature animal, we-shall consider under the head of abortion and related subjects. Great variations are noted in reference to the prevalence of sterility in our domestic animals, it being, apparently, more com- mon in the larger species. There is a somewhat general belief also that it is more common in high bred individuals but this may be largely erroneous. It certainly increases in all animals as domestication and close confinement increases, so that it is most common in those animals which are kept closely housed and, in this way, it becomes highly important in so intensely used as dairy cows. With many of our domestic animals, sterility does not attract much attention, especially with females, because it makes com- paratively little difference to the owner whether they breed, or go to the butcher. We are, therefore, most interested in steril- ity when it appears among animals in which their principal or sole value depends upon their reproductive powers. Among these, failure to breed may prove a great financial disaster. If a large harem of valuable brood mares, kept exclusively for breed- ing, is mated for a year with a sterile stallion, no foals are pro- duced the following season and a total loss of anticipated income results. In addition to this loss,each mare has deteriorated 119 120 Veterinary Obstetrics through her increase in age and, having been idle for a year, has, probably, become very fat, the sexual system somewhat weak- ened and the tendency to sterility intensified. In dairy cows, the results of sterility may be equally, or more, disastrous. The production of milk is an essentially sexual func- tion, enduring, as a rule, but for a year or two, when it may be re-established or reinvigorated only by bringing forth young. Hence, in a dairyiug establishment, a failure to breed causes not only the loss of the value of the young, but, generally of far more importance, a serious diminution in the amount, or total loss of the milk. The sterility of a large part of, or an entire herd, isa not uncommon observation in the experience of breeders and veter- inarians, and, while such instances are very impressive, they do not equal in the aggregate, the widely disseminated and oft re- peated individual cases. If a highly valuable dairy cow fails to produce a calf in a given year, the fact is somewhat masked by the success with other portions of the herd, but the loss occurs and, add these individ- ual instances together, the total cost to breeders becomes enor- mous. Ifa given cow fails to breed for several years in succes- sion, she becomes far more than a total loss, because the owner retains her, year after year, in the hope that she may yet breed before he sends her to the butcher, where, at best, her value is usually trivial. ; The function of reproduction being exceedingly complex, the causes leading to sterility are correspondingly varied. In higher animals, reproduction can only occur as a result of union under favorable conditions of a spermatozoon, or male cell, with an ovum, or female pronucleus ; the first elaborated b¥ the testicles of the male, the second by the ovaries of the female. Anything which may interrupt normal coition of the two sexes, or the physiologic activity of either male or female, may end in sterility. We consequently meet with sterility in both sexes but, in the female, the genital apparatus is more complex and sterility more common and widely diffused though intrinsically of no greater importance than in the male. The function of the male parent ends with the ejaculation of healthy semen into the uterus or vagina of the female. In the female, there is still to occur the migration of the male cells through the uterus and oviducts until Sterility of the Male Animal L2t they meet the ovum and, after the fusion of these two cells to constitute fertilization, the female organs must protect,and afford nutrition to, the embryo for a long period of time. While there are certain analogies between the causes and nature of sterility in the two sexes, it is desirable to consider them sep- arately. A. STERILITY OF THE MALE ANIMAL. In order that a male animal shall be fertile, it is essential that living, virile spermatozoa shall be secreted and that the animal be competent to copulate with the female and give effective emis- sion to the normal semen. The testicles constitute the basis of the male genital system, since they produce the male cell or spermatozoon. In mammalia, the testicles are two in number, a right and a left, variably located according to species. In all our common domestic ani- mals they are normally located in adult life outside the abdomen in the scrotum, which is situated, according to species, in the in- guinal or perineal region, the testicles passing through the inguinal ring in order to reach the scrotal sac. In the elephant, the testes are normally retained within the abdomen throughout life. The testes vary somewhat in form and, necessarily, in size in the different species and present some marked differences in their relations. ‘Their general form is oblong or spheroidal and, when they come to rest in the scrotum, their long axes may be perpen- dicular to the spinal axis, as in the bull, or parallel, as in the horse. In, addition to its peritoneal coverings, the testicle consists of its fibrous framework, the proper or secretory tissue, excretory ducts, and the vessels and nerves. The fibrous framework forms externally a very firm, inelastic capsule, the tunica albuginea. This serves to render the func- tioning testicle one of the most dense, incompressible glands in the body, the very firmness of which bears an important relation to fertility, since any disease causing swelling of the gland tends to seriously affect the proper glandular tissue by the severe compression. From the tunica albuginea, fibrous septa pass toward the center of the gland and divide the secretory tissue into small lobules. s 122 Veterinary Obstetrics Somewhat near the surface, toward the epididymis, the connect- ive tissue stroma becomes very prominent in the central portion. of the gland to constitute the corpus Highmori. The glandular tissue proper consists of numerous convoluted tubules, ¢ubulé semeniferi, which, commencing in a cul de sac, terminate in a central system of canals. These, passing through the corpus Highmori empty into the vasa efferentia, which fin- ally converge to form the vas deferens. The tubules consist of a basement membrane lined with an epithelium of three or four layers of cells. The deeper ones are polygonal in form while, more superficially, occur the spermatic cells or spermatoblasts, from which, finally, the spermatozoa are elaborated, the nucleus constituting the head, while the tail con- sists of protoplasm. The interlobular connective tissue stroma affords passage for the vessels and nerves to every portion of the gland and, within it, are numerous interlobular cells, which are believed by some to serve as nutritive agents for the ¢buli semenifert. The seminal canalculi are lined with ciliated epithelium, which disappears in the seminal duct, to be succeeded by a single layer of epithelial cells. The vesicule seminales of the stallion consist of two commo- dious pouches situated above the urinary bladder and the vasa efferentia, communicating with the latter. They have been. thought by some to act as seminal reservoirs. Hence their name. However, it is generally considered that such is not the case and that their sole function is the elaboration of a mucoid or watery secretion, which becomes mixed with the semen while being ejaculated. Fleming (Chauveau’s Anatomy) asserts that they serve as seminal resevoirs, but investigators, apparently, uni- formly fail to find spermatozoa in them. The seminal vesicles of the bull have the character of ordinary acinous glands. Zschokke has been unable to find spermatozoa in them. They have only a very small cavity. In the boar, the vesiculz seminales are very large acinous glands, secreting a watery fluid and not containing spermatozoa. The vesiculee seminales are absent in the dog and cat. The prostate glands of the horse are ‘situated above the ure- thra, at the neck of the bladder. They are acinous in type, and secrete a transparent viscid fluid, which becomes mixed with Sterility of the Male Animal 123 the secretions of the other glands. In the pig, there are ‘two pros- tates, while, in the dog and cat, there is one large gland com- pletely surrounding the urethra. Cowper’s glands are also acinous in character. Chauveau states they are absent in ruminants, but Zschokke claims they are pres- ent. They are absent in the dog, but present in the cat. The physical characters of the secretions from the seminal ves- icles, prostate and Cowper’s glands varies somewhat, is chiefly of a clear, watery character, that from the Cowper’s glands being somewhat more viscid. They are neutral in reaction. The function of the secretions from these subsidiary glands has not been very accurately determined, but they apparently serve a useful purpose as lubricants and, still more, they dilute the secretions from the testicles, adding volume to the semen and giving a wider dissemination to the spermatozoa. Furthermore, it is believed that their presence invigorates the spermatozoa. The semen, at the time of ejaculation, consists of an admixture of the secretions from these accessory glands, with the spermato- zoa and accompanying fluids from the testicles. It is a whitish, viscid fluid of feeble alkaline reaction, and has a specific odor. The spermatozoa in this fluid show very vigorous motion, in- duced by the contractions of the tail, which cause a progressive movement comparable to that of a fish or an eel. Hensen states that they may move 1.2 to 3.6 mm. per minute. Their vigor-is greatest at about the body temperature and is decreased or stop- ped by heat or cold or by the addition of water, acids, metallic salts, etc., while the vigor of the movements is increased by the addition of weak alkalies, blood serum and estrual discharges. The commencement of the secretion of spermatozoa marks the age of puberty in the male and is expressed by the appearance of sexual desire. Its advent varies greatly according to species, in the horse from 10 to 18 months, in the bull from 8 to 10 months and in most other species, at an earlier date. The amount of semen ejaculated during a single coition has not been well determined. In the bull, it is 5-6 c m.* (Zschokke) and contains more than 60,000 spermatozoa per mm.” In order that successful copulation may occur, it is essential that the testicles, excretory ducts, urethra, penis and accessory glands be normal in structure and function, and that the locomo- tory apparatus be sufficiently normal to enable the male to mount ° 124 Veterinary Obstetrics the female, and otherwise to perform the physiologic essentials of copulation. Sterility of the male may be outlined as follows : I. AZOOSPERMIE. a. Congenital Defects of Testes. Anorchidy. Congenital Malformations and Tumors. Cryptorchidy. Hybrids. Hermaphrodites. Qe Nn b. Acquired Diseases of the Testes and Scrotum. Tumors. Orchitis and Epididymitis. Spontaneous Degeneration of Testicles. . Hydrocele. Torsion of the Testicles. OMRWNH c. Azoospermie from Systemic Disease or Debility. Debilitating Systemic Diseases, Overwork. Idleness and Overfeeding. Excessive Sexual Use. . Onanism or Masturbation. bBwWNH IJ. DEFECTIVE SECRETIONS OF ACCESSORY GLANDS. III. INABILITY TO PROPERLY COPULATE. 1. Arrested Development of the Penis. 2. Tumors, hernia, etc., near the penis, which serve to mis- direct it and prevent its entering the vulva. 3. Tumors of the Penis and Prepuce. 4. Penial Paralysis. 5. Excessive Erection. Spasm of Penis. 6. Broken or Curved Penis. 7. Inflammation of Penis. 8. Adhesions of the Penis to the Prepuce. g. Constriction of the Preputial Opening. Phymosis. 1o. Paraphymosis. 11. Lumbar or General Paralysis. 12. Painful Diseases of the Posterior Limbs and other Parts. 13. Size of Male. , 14. Age of Male. IV. INFECTIOUS DISEASES. A zoospermie 125 I. AZOOSPERMIE. In the rearing and selection of male breeding animals, it be- comes of importance to determine at the earliest possible date whether they may prove efficient sires or not and it is essential, first, to know whether they possess normal testicles capable of producing vigorous spermatozoa. Although these organs, derived from the Wolffian bodies, are formed in the sublumbar region, they normally descend into the scrotum in all our domestic animals except the elephant and are, consequently, with the one exception, quite freely available for physical examination. In our large herbivorous animals, these organs normally de- scend into the scrotum prior to birth, so that, when one of these is born without this having occurred, that fact may well become an object for suspicion. 1. Anorchidy. In some cases these organs are entirely want- ing or have been arrested in their development so that they are wholly insignificant and devoid of physiologic power. Such ani- mals fail to develop sexual desire in the least, do not acquire the usual characters of the male in conformation, head, neck, horns, voice, or other attributes, but remain neuter or asexual in char- acter save in respect.to the penis and sheath and even these may be defective. “No testicles are present in the scrotum and none are distinguishable by rectal exploration. On post-mortem ex- amination, one may find within the abdomen a mass of tissue which, by its attachments and relations, is identifiable as the rep- resentative of the testicle, but devoid of any tissue of a true geni- tal character. Such are the findings in some twin calves, as well as in some single births, and the same conditions are met, far more rarely, among other animals. 2. Congenital Tumors. In other cases, instead of the normal glandular tissue, the male animal is born with a tumor represent- ing the genital gland, which may be either teratologic or patho- logic. Among the teratologic, the most common are dermoid cysts, containing hair, teeth and epithelial debris, along with more or less fluid. A possible mode of origin of these structures has already been discussed on page 12. In other animals, the primitive gland may become the seat of 126 Veterinary Obstetrics calcareous deposits, which invade the entire primitive gland and efface every trace of glandular tissue, inducing a state equivalent to anorchidy. In yet other instances the primitive testicle be- comes the seat of a malignant neoplasm. In one case, we ob- served in a cryptorchid pig a testicle which was the seat of a ma- lignant new-growth which had contracted firm adhesions with adjacent loops of intestine. Each of these conditions serves or- dinarily to prevent the descent of the testicle into the scrotum. The affected organs are necessarily and incurably sterile. Ex- cept in cases of malignant disease of the glands, castration is not ordinarily demanded. Fic. 13. DERMOID Cyst oF TESTICLE Showing dental tissues. Horse. (Hinebauch. ) 3. Cryptorchidy also constitutes'a uniform cause of sterility when both testicles are retained within the abdominal cavity. We speak of abdominal and inguinal cryptorchidy but, ordi- narily, only the former may exist asa permanent condition, while the latter is a transitory state, in which the gland is descending from the abdomen into the scrotum, which it will eventually reach. It is only very rarely that inflammatory adhesions or other conditions may permanently arrest a testicle in the inguinal region during its descent. Typically, cryptorchidy is an arrest in the development of the testicle, the organ being small, flaccid and soft. Histologically, it partakes of the character of the fetal testicle and no sperma- Hybrids. Hermaphrodites 127 tozoa are formed by it. Ifsuch a testicle descends and passes from the abdomen through the internal inguinal ring, it tends to at once develop normally and become fertile. However, it is essential that the gland itself shall descend. In some cases, the epididymis descends into the scrotum, while the gland remains in the abdomen, the testicle retaining its typical cryptorchid character and remaining sterile. While the typical abdominal croptorchid testicle is regularly sterile, it nevertheless induces a sexual reflex, causing the development of the ordinary male at- tributes, such as the characteristic head, neck, horns and voice and usually a sexual desire of an intense and more or less per- verted character, in which vice assumes a prominent role. If only one testicle is retained in the abdomen, the other being normally located and developed or even having undergone com- pensatorial hypertrophy, the animal may be fertile, that is, the normally developed gland is capable of performing its function regardless of the presence of the sterile gland within the abdo- men. The perverted sexual desire, akin to nymphomania of the female, persists so long as one testicle is in the abdomen, even though one has descended into the scrotum, and functions. The defect is of further interest to the breeder because of it: perni- cious hereditary transmission from parent to offspring. The con- dition is beyond practical remedy. While it is surgically possible to procure the descent of the testicle into the scrotum and thereby cause the gland to so develop that it will perform its normal function, this would not prevent the transmission of the defect to the offspring. 4. Hybrids, chiefly the mule, are regularly sterile, the testi- cles partaking of the fetal type histologically, though normal in position, form and volume. In this animal, the sexual desire is well developed. In rare cases, well authenticated, the female has bred, but we do not recall instances of recorded fertility in the male, although they probably occur. The opportunity for the demonstration of such power in the male is generally excluded by castration. 5. Hermaphrodites. In all species of domestic animals we meet, occasionally, with hermaphroditism in which the two sys- tems of sexual organs are each found more or less developed in the same animal. They incline to assume a prevailing type ac- cording to species. 128 Veterinary Obstetrics In the horse, hemaphroditism tends, generally, towards the de- velopment of testicles, which are largely retained within the ab- domen and attached and located the same as ‘the ovaries, but may descend into an imperfect scrotum ; the vulva, vagina and uterus may develop almost perfectly, as in one case occuring in the clinic of this college (Fig. 54), where the vulva and vagina were sufficiently developed that the animal was castrated through the vagina in the same manner as mares are spayed. The rudimentary penis, or enlarged clitoris, usually ends either in the vulva or in the vicinity of the ischial arch, with the urethal opening directed backwards. In other cases, this organ is pro- longed down between the thighs, but, still, as a rule, is directed backwards at itsextremity. The mamme are usually moderately developed in these animals and, upon casual examination, have the appearance of the mare, although, as in one case operated upon by us, there were, just above these rudimentary glands, small scrotal pouches containing the imperfectly developed testes. These animals present chiefly the sexual characters of the crypt- orchid horse with all his deranged sexual desire and tendency to viciousness. In the case illustrated by Fig. 54, the head, neck, voice and disposition were those of a cryptochid horse, and the vulva, vagina and uterus were those of a normal mare. When castrating the animal, the vagina underwent the customary bal- looning, which indicated functional activity. The erectile organ occupied a middle place between the clitoris of the mare and the penis of the horse. In Fig. 14 is shown the generative apparatus of a pig, in which the hermaphroditism is of quite a different character, one of the glands having developed into a typical ovary, the other a testi- cle, the two sides of the genital apparatus thus representing the two sexes. Sections of these genital glands show one to be a typical crypt- orchid testicle with tubuli semeniferi, the other a primitive ovary with scattering Graafian follicles containing ova. The Muellerian ducts have developed into typical oviducts, uterus and vagina, and, from the Wolffian ducts, have formed typical vasa deferentia and the penis is normal in form and extent. We have found no records of fertility in hermaphrodites of the equine or other species. Acquired Diseases of the Genital Organs 129 Fic, 14. HERMAPHRODITISM. Pig. T, Testicle. O, Ovary. P, Penis. CC. Uterine Cornua. B. ACQUIRED DISEASES OF THE TESTICLES AND SCROTUM. 1. Tumors. We have already referred on page 125 to con- genital tumors of the testicles. Malignant tumors of the testicles are occasionally seen in the stallion and other adult male breeding animals. When the tes- 9 130 Veterinary Obstetrics ticle is in its normal position, such a new growth reveals itself as a very tense swelling, inclined to be more or less nodular, not very painful, but does not tend to cause any marked swelling of the surrounding parts. The affected gland becomes sterile as soon as the glandular tissue is generally invaded and, probably, in a large proportion of cases, as soon as any increased pressure is exerted upon the parenchyma of the gland. When tumors of any kind involve the testicle to a marked de- gree and determine its loss of function, it should be promptly removed for general curative reasons as well as to anticipate any unfavorable influence which it may exert upon the other gland. The prognosis in case of maglinant tumor of the testicle is good if the gland be removed early, because the disease tends to be confined closely to the gland itself for a considerable period of time. The fertility of the normal gland may thus be pre- served for an indefinite period. 2. Orchitis and Epididymitis are not readily distinguishable clinically as distinct affections. So far as we are aware, they are due to essentially the same causes, present similar symptoms and have like dangers for the fertility of the animal. Judging from the standpoint of post-castration observations, it would ap- pear that, in the stallion at least, epididymitis is more common than orchitis. .(See Fig. 15). Inflammation; of the testicle and epididymis arise from a great variety of causes. In all animals, external wounds are liable to cause inflanimations of the gland especially when occurring dur- ing the active breeding season. Scrotal wounds, especially those peuetrating the peritoneal sac of the testicle are very liable to terminate in an inflammation of the glandular tissue. Contusions of the testicles without wounds of the skin are more or less common in domestic animals and may at all times lead to orchitis. In ruminants, and especially in the ram, where the scrotum is sometimes large and very pendulous, the testicles are bruised by coming in contact with obtacles or by being violently struck by one of the hind limbs and thence thrown against the other during rapid progession In the stallion, es- pecially in trotters used for track purposes, there is a well marked tendency for contusion of the testicles to occur by being thrown from one thigh to the other when the animal is going at Orchitis and Epididymitis © 131 arapid pace. When the horse is employed at this work, the testicles become more pendulous than when used for breeding. Contusions of the testicles of the stallion, and of a very danger- ous character, also occur occasionally from kicks by the mare at time of service. Orchitis and Epididymitis occur, in some cases, independent of any history of traumatism, as an apparently idiopathic malady. By some, this is ascribed to excessive venery, or coition. We have no definite data to show that it so occurs. It is not improb- Fic. 15. EPIDIDYMITIS. STALLION. T, Testicle. E, Epididymis. 132 Veterinary Obstetrics able that such untraced cases are due to infection of some char- acter passing through the vas deferens into the testicle, as sug- gested by Zschokke. This may be favored by excessive coition or by any debilitating influences. In other cases, the disease is directly traceable to an infectious malady. In the stallion, we meet, not infrequently, with stran- gles abcesses in the testicle or about it. In these, the ordinary symptoms of stranglés are usually present in other portions of the body, such as intermaxillary abcesses, with the other general symptoms. In the contagious cellulitis, or pink eye, as we have already stated on page 68, orchitis is the rule. Orchitis in the stallion has been recorded also as result of glanders. In the bull, orchitis occurs as a result of tuberculosis. Zschokke (Unfruchtbarkeit des Rindes) records tuberculous orchitis as the most common form of inflammation of the testicle in the bull, and has observed it both uni- and bilateral. It assumes a chronic course. The tubercular nodules are generally disseminated throughout the glandular tissue and may extend to the tunica albuginea and to the serous membrane. The tubercles present their usual characters, with an increased amount of connective tissue and greater density of the organ. If the nodules are super- ficial, there are adhesions between the two serous coverings. Tubercular deposits may also exist in the epididymis and spermatic cord. The clinical diagnosis of the tuburcular orchitis must chiefly rest upon the enlargement and hardening of the testicle, its adhe- sions, thickening of the spermatic cord and tumefaction of the inguinal glands. Other symptoms of tuberculosis are usually pre- sent and the diagnosis may be verified by the tuberculin test. While the sound areas of tuberculous testicles may generate normal spermatozoa, it should be remembered that the semen emanating from such a testicle will, probably, also carry tubercle bacilli, and thus be capable of directly transmitting the disease from the bull to the cow. Ehrhardt (Schweizer-Archiv fur Tierheilkunde, Vol. 38, p. 79) records a case of orchitis in a bull due to the vesicular vene- real disease of cattle. Wallruff (Reperotorium, 1846, p. 206) records an epizootic of inflammation of the testicles in horses, cattle and goats, accom- panied by the formation of abscesses. Others record inflamma- Orchitis and Epididymitis 133 tion of the testicles as a result of the presence of nematode parasites. The anatomy of the testicle is of such a character as to render acute inflammation very serious for its functional life. The tunica albuginea constitutes the most dense and inextensible capsule possessed by any gland in the body. When the volume of the contents of the capsule is augmented by engorgement or inflammation, the pressure exerted upon the encapsulated gland tissue is very great and at once threatens its functional activity or life. It is, consequently, very common for orchitis to per- manently destroy the integrity of the gland. Sometimes, the inflammation ends in a total necrosis of the organ. From whatever cause orchitis may arise, it should always be treated as a very serious disease, in so far as the reproductive powers of the animal are concerned, and should be handled with the greatest possible promptness and care. As with all diseases of the sexual organs, it is especially true of those of the testicles that the fundamental principle in their handling should be the removal, as far as possible, of all sexual excitement. The animal may be exercised aid, possibly, benefited thereby, but it should be done in a manner to avoid any sexual stimulation. In most stallions the application of the stud bridle is in itself a sexual suggestion because the animal constantly associates it with service. So far as possible, a breeding male affected with disease of the genital organs should be removed from sight or sound of any female of his kind, especially from those which are in estrum Every arousal of sexual appetite intensifies any existing irrita- tion or disease in the sexual organs and successful handling of these accidents and diseases demands, first of all, sexual quietude. Wounds to the scrotum of male breeding animals should have very careful surgical attention. Strict antiseptic precautions should be taken from the very outset and continued until all danger to the glands has been safely passed. If the wound is penetrant, infection of the peritoneal sac is to be very carefully avoided by thorough disinfection and closing of the wound. If there is a want of good drainage, this should be freely provided and no accumulation of wound discharges be permitted. The food should be of a light, laxative character. 134 Veterinary Obstetrics Contusions of the testicles should be avoided by the removal of the causes. Rams with very large and pendulous scroti should be confined in enclosures free from rough elevations and from obstacles against which the testes may strike when the animal is moving about and should be guarded against being chased by dogs or otherwise compelled to run. Injuries from contusions of the testicles of trotting or pacing stallions are effectively obviated by the use of a stallion suspensorium. The protection of the testicles of the stallion against kicks or other contusions during service has already been considered on page 51. Purgatives should usually be administered in cases of acute orchitis unless contra-indicated by some general systemic disease like pink eye. Even then, it would probably be desirable to prescribe such hypodermic cathartics as arecoline or eserine, combined with pilocarpine, which will act quickly without caus ing any great depression or inducing super-purgation. They should he given in small doses and may be repeated, if necessary, in one hour. In such animals as have pendant testicles, it is advisable to apply a suspensory bandage, which favors the circu- lation within the organs and tends to overcome the congestion. Locally, cold water may be applied to the testicles, or, when this cannot be continued, it may be advantageous to use an oint- ment or liniment consisting of camphor, belladonna and olive oil, applied with abundant and repeated massage. Febrifuges may be used to lower the temperature in event of fever, but, since any elevation “of temperature will usually sug- gest, if not indicate, the presence of infection in the gland, in- ternal medication should be chiefly directed toward the elimina- tion of the infecting element itself or of the products of infection. For this purpose, eserine and pilocarpine and, to a much less degree, the slower acting cathartics, exert a beneficent influence. Potassium iodide in full doses not only serves to favor the elimi- nation of bacterial products, but tends to exert a distinct bacter- icidal action. Some writers advise against its use lest it cause atrophy or degeneration of the testicles but, so far as we are aware, there is no evidence of such action of the drug in domestic animals. Hoffman recommends compression of the testes of dogs by means of strips of adhesive plaster over the scrotum, thereby tending to support the circulation in the part. When abscesses Spontaneous Degeneration of the Testicles 135 occur ip the organ, they should be promptly opened, the pus evacuated and the cavity treated antiseptically. Castration is always to be considered in case of orchitis, whether acute or chronic. In cases of acute orchitis or epididymitis in- volving one gland only, there is a constant tendency for the other to become involved. If the life of the animal is threatened by the intensity of the inflammation, if the function of the gland is apparently wholly and permanently destroyed, or if there appears to be danger of the sound gland becoming involved, the removal of the affected testicle should occur without delay. In chronic recurrent orchitis of both testicles, especially if examination of the semen indicates the absence of spermatozoa or if the animal has proven sterile in the stud, total castration should be per- formed and such salvage obtained from the animal as conditions may permit. In animals affected with acute orchitis, there is some hesitancy at times about castration lest the patient cannot well endure the operation but, in our experience, it is a most efficient therapeutic agent and the operation at once improves the general well-being of the animal. When orchitis is present as a complication of an acute infectious fever, like ‘‘ Pink Eye,’’ we should regard cas- tration as unsafe, until the acute stage of the malady has run its course and the disease has become chronic and located chiefly or wholly in the testes. Since, in orchitis, there are usually intimate and extensive adhesions between the peritoneal layers, it is safer and more convenient to castrate by the covered operation. The removal of one of the testicles, providing the other is sound, does not interfere with the reproductive power of the animal. 3. Spontaneous Degeneration of the Testicles. Zschokke re- . cords spontaneous degeneration of the testicles as a not uncommon cause of sterility. He attributes it largely to the action of toxines upon the secretory cells of the organ, thus causing their destruc- tion. He assumes that these toxines reach the glands through the blood or lymph, during the course of some systemic disease, in which the deleterious poisons are generated, and that the effect of these toxines will be most noticeable upon those tissues which are most sensitive, among which are the secretory cells of the testi- cles. When these toxines act upon the spermatoblasts, their first effect is the destruction of their physiologic function. If the toxicity is slight and temporary, the cells soon recover their 136 Veterinary Obstetrics function, but, if intense and continuous, it leads to disease changes and death of the cells. The anatomical changes observed by Zschokke under these conditions in the testicles of bulls, without apparent external cause or symptoms, accompanying the sterility, were now and then, sclerotic connective tissue degeneration ; fatty infiltration ; and the formation of bone, or the total calcification of the sem- inal tubules. He asserts that calcification is not at all rare and that it is easily recognized upon a microscopic examination of the excised gland, the white, calcified tubules being easily visi- ble and evident to the touch. The diagnosis of this condition cannot be made by palpation in the living animal with the or- gans in position, or by other means than histologic examination of the excised gland, except by examining the semen and deter- mining the absence of spermatozoa, which would point with con- siderable certainty to a degeneration of this character, It is evi- dent that no method of handling can result in any restoration of the breeding power, under such conditions, and castration is in- dicated. 4. Hydrocele, or dropsy of the scrotum, in which there is an accumulation of fluid inthe scrotal sac between the two peritoneal layers, probably, exerts an unfavorable influence upon the af- fected glands and tends to produce sterility. If the accumula- tion of fluid in the sac is the result of a general dropsy of the peritoneal cavity, ascites, the systemic debility of the animal would usually determine sterility. When the affection is local, as is usually the case in the stallion, and depends upon a chronic inflammation of the scrotal peritoneum with the accumulation of the secreted fluids in the sac and involves but one organ, it may not induce complete sterility, but affect the formation of. spermatozoa in the diseased testicle only. The symptoms of hydrocele consist of a painless enlargement of the scrotum, appearing gradually and usually without recogiza- ble cause. The general health of the animal is not usually in- volved. The swelling is even, soft and suggillating, indicating that it consists of fluid. It is to be differentiated from tumors and orchitis by the firmness of the latter; it may be distinguished from hernia by rectal exploration, determining, thereby, the presence or absence of a segment of the bowel in the internal in- guinal ring. Its diagnosis may be further established by intro- Azoospermie from Systemic Disease 137 troducing an exploratory trocar and withdrawing a portion of the contents. The handling of hydrocele is not usually highly successful. Sometimes good results may be had by aspirating the fluid and injecting tincture of iodine or Lugol’s solution into the cavity. When these measures fail, a radical cure of the local disease may be brought about by castration, the covered method being used. When the hydrocele is dependent upon a general constitutional malady, with dropsy of the abdomen, there is, usually, no suc- cessful method of treatment. 5. Torsion of the testicles, it is claimed, operates at times to cause their atrophy and inhibit the formation of .spermatozoa because of interruption of their nutritive supply. The reversal of the testicle of the stallion, so that the tail of the epididymis is turned forward, is alleged to interfere with fertility. Such a result from this slight and common displacement is, probably, purely mythical. It is well known that emasculation can he produced in ruminants by the process known as double subcu- taneous torsion, in which the testicles are twisted and turned upside down in a manner which interrupts their vascular supply and induces atrophy, with disappearance of sexual desire and power. c. AZOOSPERMIE FROM SYSTEMIC DISEASE. 1. Debilitating Diseases and Overwork. Any constitu- tional disease which produces profound depression of the general system is usually accompanied by suspension of the powers of reproduction. Most serious constitutional disorders not only de- stroy the sexual desire for the time being, but also prevent the formation of spermatozoa and thus lead to essential sterility dur- ing the period of the existence of the disease. In some acute fevers, the sexual powers are not in complete abeyance and male animals affected with a disease accompanied by a high fever may be fertile. In one case, we observed a stallion affected with brustseuche, with a temperature of 107° F., which, in spite of the very high fever, served a mare and successfully impreg- nated her. In chronic debilitating diseases, there is sometimes seen a tendency to sterility, especially in the. constitutional bone dis- 138 Veterinary Obstetrics eases, like osteoporosis, rickets and in other chronic disorders which depress the general vigor of the animal. Overwork serves to inhibit the breeding functions, so that animals subjected to severe work are strongly inclined to be sterile for the time. In animals which are severely, but not over- worked, as in stallions which are being trained for the turf, there is usually a 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 repro- ductive energy during this period. Starvation has a like effect upon the reproductive powers so that any animal which does not receive sufficient food to main- tain the general vigor of the system and afford a moderate re- serve for reproductive energies tends to become sterile during the period of want. The remedies for these conditions are suggested by the causes, they are usually but temporary and run a parallel course to the causes themselves. Whenever these are removed or naturally cease, the reproductive powers become spontaneously restored. 2. Idleness and Over-feeding. Impotence of the male is frequently expressed chiefly by an absence of sexual desire, without any changes of the sexual organs which can be detected. The male shows but slight sexual desire or none at all in the presence of females which are properly in estrum. At one time he may pay some attention to the female, with a more or less complete erection of the penis, and 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 alleged to be an individual psychic in- fluence which prevents the male from copulating with a certain female. This is alleged to be especially true of some stallions, to which certain mares seem to be repulsive, and they refuse to serve 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 by improper handling. It is almost, if not always, erroneous to attribute this trouble to the caprice or idiosyncracies of the male by which a female of a certain type or color becomes Results of Idleness and Overfeeding 139 repulsive to him and fails to arouse his sexual appetite ; the real cause lies in bad management. In some cases, there is a general depression of the sexual de- sire, especially in those animals which are lethargic or of a phlegmatic temperament. In very active, nervous animals this peculiarity is rarely seen. It is most common in draft stallions, but is observed in bulls, especially of the beef breeds, and in all kinds of male breeding animals. The tendency to loss of vigor on this account increases with the age of the animal. It 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 con- fined, highly fed and not properly exercised. It tends to disappear promptly upon a correction of the method of keeping, providing that it be applied sufficiently early. The most careful search fails to find any anatomical reason for the difficulty, and it seems to be of a purely functional character. The difficulty should be prevented by not forcing the young male designed for breeding purposes too rapidly in his development, but by allowing him only a moderate diet, with plenty of exercise and freedom, and, whenever practical, permitting him to consort with females dur- ing his period of growth. Upon the appearance of these defects in the mature animal, much can be done, if handled opportunely, by restricting the diet and causing an abundance of exercise. In our experience, a healthy draft stallion 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, we re- duced his food ration one-half and prescribed eight miles exercise, daily, ata brisk walk. Within a few days, his sexual desire 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 habit- ually worked, the bulls are largely kept in breeding condition by moderate draft service. It might be well to imitate this plan in America, where they are not habitually used for work purposes, but could readily render considerable service, while being greatly benefited by the vigorous exercise which would be secured in this way. Under general conditions, it is perhaps the best pos- sible and most economic manner in which we can insure sufficient 140 Veterinary Obstetrics exercise for these animals. Incidentally, it should be noted that such exercise or work tends very strongly to prevent that vicious- ness in bulls and other breeding males, which renders them dan- gerous to their keepers. Zschokke emphasizes the value of the proper selection of food for the purpose of arousing a sexual desire and especially insists that the hay should be of an aromatic character, as should also the oats. Not only should they be well cured and sweet smelling, but he believes that the admixture of certain stimulants like calamus, pepper, powdered mustard, and even powdered canthar- cides, are advantageous. He recommends that these remedies should be fed with cut hay and should be allowed for two or three days in succession and then omitted for a like period, when they may be given again. We doubt very greatly the value of aphrodisiacs, or sexual stimulants, in breeding animals. Sexual instinct is so normal a phenomenon and so universal in animals of breeding age and proper health that we fail to see the value of exciting sexual de- sire artificially. The function belongs normally to every male or female of breeding age and, if it is absent, it is because of some depression in the general vigor of the animal, which cannot read- ily be removed 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, while copulation merely serves to transfer these fecunding cells from the testes of the male to the vagina of the female. Copu- lation is in vain without vigorous spermatozoa and we have no data to show or suggest that any drug may directly cause or favor their development. Certainly, we must admit that tonics, alteratives, or other drugs which are capable of favorably influencing the restoration of a diseased animal to a healthy state must also improve its re- productive powers by restoring the equilibrium of the body and enabling it to better perform all its normal functions, 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, which constitute the first essen- tial in the fertility of the male animal. Results. of Idleness and Overwork 141 Zschokke further remarks that there is sometimes an absence of sexual desire in young bulls which have not previously served cows. This seems to bean absence of the sexual instinct and he suggests that such animals should be turned loose with cows which are in estrum. Under these conditions, they soon become sexually awakened and learn to serve females. This difficulty is not so prominent in other domestic animals, though the same condition is observed to some extent in young stallions. Under normal conditions the sexual desire of healthy young animals is awakened and intensified by the presence of the opposite sex. Breeders of pedigreed stock recognize this fact and cautiously keep young males of some species entirely away from females which may be in estrum, lest their mere presence awaken the sexual desires of the immature male and thereby interrupt his growth. The preparation of breeding animals for the show ring is always very dangerous for the sexual vitality of the individual. In order to get them in high condition, they are frequently closely con- fined in the stall and fed in such a manner as to produce the greatest amount of fat, in order that they may make a better showing and more certainly win a prize. It is an unfortunate fact that many of our most richly bred animals, which are de- signed for breeding purposes and which capture the most coveted prizes at the livestock fairs, have their breeding powers either temporarily or permanently destroyed in the process of feeding them for the show. There is no effective method for overcoming 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 attention to the amount of fat and more to the form and general 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 preparing 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 direc- tion and continue to breed regularly, while others are very sus- ceptible and soon become temporarily or permanently sterile. Once this sterility is established, the only thing that can be done is to correct errors in care by moderating the diet and enforcing 142 Veterinary Obstetrics vigorous exercise, which will, as a rule, though not always, re- store the sexual powers. In a general way, the food of a breeding male needs be rich in protein, as compared with the amount of hydrocarbons and car- bohydrates. The most common foods, when well grown and cured, are the best for the breeding animal, such as bright, aro-, matic 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 stimulant like pepper or mustard. 3. Excessive Sexual Use. The number of services which a male animal can effectively render is an important question for the breeder. It probably varies greatly with different indi- viduals. Naturally, the power of a male does not rest so much upon the number of females which he is expected to serve as. upon the number of copulations essential to cause fertilization. It has been determined by careful investigation 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 en- tirely, 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 regu- lated by the breeder but, if allowed to consort with the cows at pasture, not more than 50 should be allowed. In the western range country of America, the allowance 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 season, the bulls have not yet fully recovered their vigor from the long and trying winter with scant food sup- ply. 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. In the stallion, similar rules as to numbers and conditions are applicable. The total number of females, however, may be greatly increased over that suggested by Zschokke, if the service is distributed throughout the year, and noted stallions have been known to serve successfully, and without apparent injury, two Onanism or Maséurbation 143 or three hundred 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 se- men, which will answer for a series of copulations. There is no reservoir in the animal body for such purpose, and all semen which may be secreted and not used in copulation soon disinte- grates and is expelled or absorbed. On the other hand, he points out that, perhaps, the glands undergo some atrophy from long” inactivity and that their function is best preserved by moderate use. Excessive sexual use is largely a comparative term and indica- tive rather of a relative over-use under surrounding environment. There is no question that a breeding male may be readily over- done, nor that such is not a frequent occurrence, but, more com- monly, the use becomes excessive under bad management, where proper handlirg of the male would enable him to make the num- ber of services demanded, safely and efficiently. Zschokke also draws attention to the very important fact that moderate work during the breeding season is not injurious, but favorable, to fertility and that permanent confinement in the stall tends contantly to a decreased secretion of semen and con- sequent sterility. It is a constant observation that a male breed- ing animal which is regularly exercised is capable of rendering a greater number of effective services than one which is closely confined. The feeding has much to do with the breeding capacity of the male. In quality, some writers condemn such foods as oil cake and malted grain and prefer the various forms of grains and, es- pecially, of 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 essential as a part of the food supply for breeding males, but may aid in maintaining a good state of digestion and thus contribute to the general vigor. The feeding of salt has long been regarded as important in reference to fertility, but it is not known whether it acts directly or merely serves to favor fertility, indirectly, by aiding digestion and assimilation. 4. Onanism or Masturbation. Masturbation, as a cause of sterility, is observed chiefly in the stallion and bull. It is very 144 Veterinary Obstetrics common in improperly kept stallions. Spinola (Handbuch der spec. Pathol. 1858, II Bd.) records this vice in the bull. The stallion has an erection, the penis is moved up and down, imitating coitus, until finally an ejaculation of semen occurs. In the bull, the ejaculation is induced by an erection and the alternate protrusion and withdrawal of the penis. This is largely seen in idle males which are closely confined, over fed and sparingly used for breeding and in track stallions when sexual debility is brought about by hard work. It is a question whether the Onanism causes the impotence or the sexual weaknesses induces the masturbation. Corrections may be brought about by such feeding, exercise and other care as will maintain the general vigor of the animal and, as far as possible, he should have something to divert his atten- tion and exert a favorable psychic influence. Moderate work or exercise and judicious feeding, or, in animals which cannot be worked or artifically exercised, the allowance of freedom in a commodious paddock, or, still better, in a properly enclosed past- ure, and especially in company with pregnant females, 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 and thus prohibit erection. It is to be constantly viewed as a vice of idleness and debility, and it must be remembered that any and all remedies must fail in their aim until the return to normal vigor is attained. II. DEFECTIVE SECRETIONS OF THE ACCESSORY GLANDS. Bass and Furbinger (Deutsche Zeitschr. f. Th. Med. B. XX.. page 147) claim that the absence of the prostate secretions leads to an immobility and loss of vigor in the spermatozoa. The gen- eral belief of investigators is that the secretions of all the acces- sory glands—the seminal vesicles, the prostate and Cowper’s glands—when added to the semen, tend to stimulate the move- ments of the spermatozoa, invigorating them and prolonging their life, thus acting as an important accessory in the phenomenon of fertilization. How often sterility may be due to disease or im- proper function of these glands is not known. III. Puvstcat INaBILITy TO CoPULATE. 1. Arrested Development of the Penis, which we have al- Tumors. Paralysis of the Penis 145 ready noted on page 127 as occurring frequently in hermaphro- ditic animals, especially in the horse, is not rare in foals which are otherwise apparently normal, and similar defects may occur in other animals. In these animals, copulation may be impossible, either from the smallness of the organ or its misdirection. The defect is usually not subject to correction, nor is it desirable to correct it, lest the malformation prove transmissible. 2. Tumors or Herniz situated about the opening of the sheath may tend to push the penis aside as it is protruded and thus to so misdirect the organ that copulation becomes uncertain and difficult, if not impossible. 3. Tumors of the Penis or Prepuce in male breeding ani- mals are not rare, and constantly tend to interfere with, or pre- vent, copulation. We have already, on page 104, alluded to the znfectious granulo- mata or lympho-sarcoma upon the penis of the dog ; on page 112, to bursattee of the genttals of the horse and, on page 113, to actino- mycosts of the genitals of the bull. Various types of tumors, both benign and malignant, involving the penis or prepuce, are not rare in the stallion, bull and other males. They are quite largely of papillomatous type and, as soon as they attain a moderate size, prevent copulation. Their usual seat is upon the glans penis, where they are easily diagnosed by examining the exposed organ. In all cases, their removal should occur early, ere they involve the organ to such a degree that their ablation will result in its serious mutilation. In the stallion, the glans penis may be am- putated and the copulatory and procreative powers fully retained. In the bull, with the long, tapering glans, amputation is not practical, since copulation is thereby rendered difficult or impos- sible. In breeding males, the early ablation of penial tumors consequently becomes very urgent, if their breeding powers are to be retained. 4. Paralysis of the Penis occurs in all animals, but espec- ially in the stallion. It is usually of central origin and frequently occurs as a symptom of a constitutional affection, like the so- called cerebro-spinal meningitis, dourine, etc., and is a common accompaniment of lumbar paralysis, or of injuries to, or diseases of, the internal pudic or great sympathetic nerves. It is rarely 10 146 Veterinary Obstetrics remediable, and depends for its recovery upon the removal of the cause. In other cases, the paralysis is local and more or less tem- porary in character. Any injury to the penis which causes swel- ling and inflammation tends to induce paralysis, both directly through the disease of the tissues and indirectly as a result of the dragging on the organ due to its increased weight. Rough handling by the groom or violent strains of the organ during copulation may also lead to paralysis. Large tumors on the penis, by their weight, tend to cause paralysis and prolapse of the organ. In penial paralysis, the protruded organ is further exposed to wounds, abrasions and, in cold weather, to freezing. The handling of penial paralysis in breeding males should be prompt and energetic. The paralyzed organ should be at once supported, in order to overcome the injurious results of pend- ency. In recoverable cases, the longer the penis protrudes, the greater the danger that the prolapse itself may lead to permanent paralysis of the organ. 5. Excessive erection of the Penis (Spasm) sometimes occurs in the stallion and possibly in other animals. It is ac- companied by a peculiar interruption of copulatory power, closely analogous to the vaginismus of the female. We have personally observed one case in the stallion and have known of a second, both imported French draft horses. ‘These stallions were very amorousand would quickly get an erection, the glans penis becom- ing excessively large. They would promptly mount mares, intro- duce the penis momentarily into the vulva for a short distance, suddenly withdraw it and dismount with the penis still fully erected and without the ejaculation of semen having occurred. Repeated efforts were unavailing and constant and prolonged failure to copulate resulted. Zschokke records the case of a bull (Unfruchtbarkeit des Rindes, page 58) in which the symptoms were somewhat similar. Careful examination fails to reveal any anatomical defect or pathologic changes. The difficulty appears to be wholly functional. No remedy is certainly known. Vigorous work on a light, laxative diet may be tried. We attempted to overcome the nervous irritability by means of potassium bromide, but failed. Possibly we did not give a sufficient quantity. The horse passed Broken Penis. Inflammation of the Penis 147 from our observation before we had an opportunity to fully investigate. 6. ‘‘Broken Penis.’? When the penis becomes violently and abruptly bent while erected, the tissues at the point of cur- vature become severely injured, inflammation and swelling occur. the erectile tissues become infiltrated and undergo sclerosis. Aitter a tardy recovery, distortion remains ; the penis is bent or curved. In addition to the deformity, there is sometimes an in- terruption of the vascular or nerve supply to the portion of the penis distal to the seat of the injury and, in this part, erection may be wholly wanting, while normal in the proximal portion of the organ. The deformity and want of erection in the distal portion serves to prevent copulation. Treatment is usually impracticable. The defects cannot, as a rule, be remedied and generally occur too high to perniit of successful amputation from a breeding standpoint. In some cases of broken or curved penis, where copulation was still pos- sible, sterility is claimed to have resulted because the semen ejaculated from the bent organ was thrown laterally against the side of the vagina instead of forwards against the os uteri and the spermatozoa failed to enter. The difficulty in such cases was apparently overcome by artificial insemination, the semen being collected from the posterior portions of the vagina and introduced into the os uteri. 7. Inflammation of the Penis may arise in a variety of ways. We have already referred to the Venereal Infections which generally lead to more or less inflammatory disease of this organ. In addition, inflammation occasionally results from physical injuries during coition, from kicks in stallions, from lacerations when breaking from enclosures while the penis is erected, from the tail hairs of the mare becoming caught by the penis and cutting it, by the ‘‘ hanging fast’’ of the dog during copulation and in many other ways. The effects of inflammation of the penis upon copulatory powers varies greatly. Some males, like the bull, affected with one of the venereal diseases, may copulate in spite of the fact that the process causes profuse hemorrhage from the penis, which must be accompanied by pain. The stallion with bursattee of the urethra proceeds to copulate regularly, although he bleeds 148 Veterinary Obstetrics freely after each service. In this case, as in bursattee of other parts, there is usually, no evidence of pain. At other times, moderate inflammation of the penis may cause a male to desist from coition, although the sexual appetite is unimpaired and erection occurs; in others, the inflammation inhibits erection. Inflammation of the penis should be promptly and energet- ically handled, not only that we may thereby cause its eventual subsidence, but also to anticipate and avoid deformities and par- alysis. In general, the handling is to be based upon antisepsis, combined with astringents and cold, not neglecting to effectively support the organ, retaining it within the sheath if possible. The patient should be removed from sexual excitement and any internal medication which conditions suggest applied. Should the inflammation be acute and the swelling great, no time should be lost in inducing prompt catharsis by means of eserine, areco- line or other drugs of this group; delay in awaiting the action of aloes or oil may prove serious. 8. Adhesions between the Penis and Prepuce are especially liable to occur in the bull and other male ruminants, and constitute very serious obstacles to copulation. Resulting usually from some chronic inflammation of the penis and prepuce, the contiguous mucous layers, their protective epithelium having been destroyed, adhere in sucha inanner as to prevent protrusion of the penis. We have observed such a case in a valuable bull. Where possible, the adhesions should be surgically overcome and’ their recurrence prevented but, as a rule, they are not subject to remedy. g. Phymosis occurs in various animals as a result either of tumors or enlargements of the glans penis, which prevent its passage through the normal preputial opening ; more generally, the preputial opening becomes narrowed by inflammatory pro- cesses, possibly intensified by the deposit of urinary salts and epithelial debris. Naturally, it is most liable to occur in the ruminant and the dog, with narrow preputial openings. It is rare in the horse, where the opening is very ample. In the bull, it is liable to ensue from the deposit of urinary concretions in the sheath, as a complication of intense preputial inflammation, with great swelling. It is readily recognized by the pain, heat and swelling of the parts, and the very fetid pre- putial discharge. Paraphymosis. Lumbar or General Phymosis 149 The handling of phymosis consists essentially of the control of the infection which has caused it. The prepuce and sheath need be thoroughly and repeatedly douched with a warm antiseptic solution, not too powerfully irritant, such as a % % solution of potassium permanganate, or a1 % solution of carbolic acid or creolin. The solution should be used in large volume so that the sheath and prepuce are repeatedly filled until the entire cavity is thoroughly cleansed and disinfected. In the bull, the preputial tuft of hairs should be removed in order to facilitate cleansing. When the preputial opening is too greatly constricted, espe- cially in the bull, so that cleansing the cavity through the normal opening is difficult or impracticable, the sheath is to be freely opened, either by surgical enlargement of the preputial opening or by a perforating incision through the inferior wall of the sheath at its posterior extremity. The latter method affords ex- cellent facility for thoroughly cleansing the narrow, elongated sheath of the bull. With the latter plan, the antiseptic fluid can be injected through the preputial opening and allowed to escape through the incision at the posterior extremity of the sheath. 10. Paraphymosis, or the protrusion of the penis through an incarcerating preputial opening, interferes with normal erection and copulatory power. The incarcerated glans penis becomes en- gorged, swollen and inflamed so that it is too painful to permit of “copulation, and functionally incompetent. Observed chiefly in the dog, it more frequently follows than prevents copulation, but, having occurred, prevents coition until remedied. It is to be remedied by a reduction of the paraphy- mosis. ‘The incarcerated glans penis is, usually, greatly swollen and exceedingly painful and cannot be readily returned to its position. After cleansing with tepid water, to which a little lysol or soda bicarbonate has been added to render the parts unc- tuous, the enlarged glans is to be decreased in volume by digital compression and finally pressed back through the preputial ring. Failing in this, the preputial opening needs be dilated by a small incision with a probe-pointed bistoury, enlarging the opening just sufficiently to permit the return of the glans. This may be followed by antiseptic dressing. 11, Lumbar or General Paralysis, as a bar to copulation, 150 Veterinary Obstetrics is most frequent in the stallion, but is possible in all males. We have already referred to the paresis of Dourine as rendering the stallion unable to mount the mare. Usually, when any marked lumbar or general paralysis is pres- ent, the male is unable to mount the female and, hence, fails to copulate. In many cases, paralysis of the penis, to which we have already referred, accompanies these affections and also serves to inhibit copulation, even if the animal be able to mount the female. Usually this group of affections is not subject to cure or allevia- tion and can be successfully handled only in those extremely rare cases where the cause is removable. 12. Painful Diseases of the Feet and Limbs or of other parts, which may cause great suffering during coition, serve to render copulation uncertain or to prevent it. Diseases of the bones, like osteoporosis, spavin, ringbone, or painful diseases of the hind feet, such as wounds, quittor and others, serve to cause great and even unendurable pain when a male, like the stallion, is compelled to bear his chief weight on the two posterior mem- bers while mounting the female. Aside from this difficulty, in some of these there is a decreased formation of spermatozoa as well, owing to constitutional disturbances and loss of general vigor. 13. Diseases or injuries along the inferior part of the chest or abdomen, so situated that they come in contact with the fe- male during the act ina way to cause great pain to the male, tend to cause him to desist from attempts at copulation. Their prognosis will vary greatly according to cause, being favorable where the latter can be removed, unfavorable and per- manent where the causes are fixed. The handling is along general surgical lines according to con- ditions. 14. Over Size of the male apparently acts as a bar to copula- tion in some cases. An old bull may become so heavy and fat that it becomes difficult for him to mount cows. Zschokke also suggests that overfilling of the rumen may so weight a bull as to render his mounting acow exceedingly difficult. The nature of the condition, itself, indicates the rational method of handling. 15. The Age of the male, especially as related to size and maturity, may affect his ability to copulate. We have already Infectious Diseases. Examination of the Male 151 referred to the danger to small or young bulls in attempting to serve mature cows of large size. If this disparity in size be too great, copulation may be not only unsafe but even impossible. With an undersized young male, care should be taken to give him an advantage in the breeding place. The hind feet of the cow should rest upon lower ground than that upon which the bull stands and the ground should be dry and of a character to afford secure footing. The breeding stocks recommended by Zschokke and briefly described on page 61 may here be used with benefit. IV. InFEcrTIous DISEASES. In describing the venereal diseases, (page 73) we have already recorded their tendency to the production of sterility, especially in the dourine of the stallion and infectious granular venereal disease of cattle. On page 68 we have alluded to the tendency of epizootic cellulitis, or pink eye, to cause sterility in the stallion. THE EXAMINATION OF THE MALE IN RELATION TO SEXUAL EFFICIENCY. The ultimate test of sexual efficiency in the male is the regu- lar production of young. ‘This test is not always before us nor is it always essential. Such conditions, as abdominal cryptor- chidy, chronic orchitis with enlargement and induration of the testicles and numerous other conditions. require no physiologic test, but the anatomical conditions alone warrant a verdict of sterility of an incurable kind. When he fails in the test, the question arises as to the cause of sterility, its prognosis and handling. An animal may be highly fertile at a given time, be fatted for the show ring or sale and, a few months later, may prove to be wholly and irrecoverably sterile. In our examination, we need first secure from the owner or caretaker a history of the animal as a breeder, the breeding anamnesis. The veterinarian should determine the presence or absence of sexual desire by bringing the male into the presence of a strange female and observing his actions. A careful distinction should be made between an ab- sence of sexual desire and a failure of erection of the penis. In the presence of sexual desire, his ability to mount the fe- male and copulate should be tested. It should be determined 152 Veterinary Obstetrics whether ejaculation occurs or not. The act of ejaculation may be observed by watching over the course of the urethra for the wave-like movements caused by the propulsion of the fluid through the channel. If ejaculation has not occurred, when the male dismounts, the penis is still erected, probably more than at the commencement of the effort. This is especially notable in the stallion. In some.animals, especially the mare, a large portion of the semen is at once expelled from the vagina and may thus or other- wise be readily secured for further observation. The manual exploration of the sexual organs needs be careful and complete. The testicles should be normal in size, form, location and density and free from adhesions. Their surfaces should be smooth and even and the spermatic cords normal in size, soft, movable and regular. The accessory glands—vesiculae seminales, Cowper’s and prostate—and the vasa deferentia may be examined manually in the larger males and digitally in the smaller, and any disease or marked abnormality noted. For this purpose, the veterinarian in a breeding district should make him- self expert in the palpation of the internal genital organs by rec- tal exploration. The novice can draw no safe conclusions by rectal palpations, which acquire diagnostic value only by re- peated application in practice. The penis needs be completely exposed for proper examina- tion, when diseases and deformities may be readily detected. The urethral opening should be carefully inspected and, if neces- sary, explored to any desired distance with a sound or catheter. The quantity and quality of food should be carefully deter- mined and the amount of exercise or work permitted or enforced should be learned. Finally, much may be learned, if the animal copulates, by an examination of the semen. While the seminal fluid can be pre- served for hours and carried a long distance, it is preferable to examine it at the breeding place. Immediately after service by the male, semen should be taken from the vagina and placed in a watch crystal or on a slide with a cover glass and examined under a low power microscope. If this is not practicable and it is desired to make the examina- tion at a point distant from the breeding place, freshly ejaculated semen may be placed in a flask, which should be immersed in Sterility of the Female 153 water at about 100° F. and maintained at this temperature until the examination can be made. This should be done with as little delay as practicable. The spermatozoa should be abundant and show very vigorous movements. Even then, it is at times difficult to judge exactly. We have examined semen from stallions of very low fertility, which contained abundant motile spermatozoa. The low fertility apparently depended upon a want of vigor or virility in the sper- matozoa, not distinguishable under the microscope. But the presence of abundant living spermatozoa leads to the valuable conclusion that the glands are functioning and that the fertility may be heightened or perfected by bringing about a higher de- gree of bodily vigor of the male through properly regulated food, work and other agents and the virility and fecundating power of the spermatozoa themselves raised thereby to the normal. B. STERILITY OF THE FEMALE. The consideration of sterility in the female may be outlined as follows: I. DISEASES AND DEFECTS OF THE OVARIES. Congenital Defects. Oophoritis. Tuberculosis. Tumors. Edema. Cystic and Fibrous Degeneration of the Ovaries. Nym- phomania. 7. Persistence and Hypertrophy of the Corpus Luteum. 8. Senile Atrophy. 9. Debilitating Diseases, Emaciation, Overwork. DAO pm Il. DeFEcTS AND DISEASES OF THE OVIDUCTS, UTERUS, VAGINA AND VULVA. Arrests in Development. Salpingitis and Occlusion of the Oviducts. Metritis. Edema of the Uterine Walls. Tumors of the Genital Tract and of the Broad Ligaments. Qeo px 154 Veterinary Obstetrics 6. Occlusion of the Os Uteri. . Atony and Dilation of the Cervix Uteri. . Loss of Cotyledons. . Vaginitis. . Persistent Hymen. . Vulvo-Vaginal Adhesions, and Constrictions. . Horizontal Vulvar Opening. . Rupture of the Perinzeuim and Recto-vaginal Fistula. . IMPEDIMENTS TO COPULATION AND FECUNDATION REFER- ABLE TO NERVOUS DISORDERS. . Excitability. . Vaginismus. . Violent Expulsive Efforts following Coitus. IV. EXTREME VARIATIONS IN SIZE OF MALE AND FEMALE. V. INFECTIOUS DISEASES. I. DEFECTS AND DISEASES OF THE OVARIES I. Congenital Defects of the Ovaries. The fundamental basis of fertility in the female is the living, fertilizable ovum, which must be elaborated by the ovary, dis- charged therefrom, canght up by the pavillion of the oviduct, met and fertilized by the spermatozoa of the male and, migrating along the oviduct, reach the uterine cavity and establish intimate relations with the uterine walls, by which it may secure nourish- ment. The function of the ovary is fundamental in character, elabo- rating the ovum and discharging it when the ovisac ruptures. This completed, the direct function of the ovary ceases and its relation to fertilization and the maturation of the fetus is chiefly at an end. Still, it exerts an influence. If the ovaries of a pregnant animal are removed, there is a definite tendency toward abortion and it seems that it is not the ovaries as a whole which exert this influence upon the fetus, but the corpus luteum, which remains at the seat of the ruptured ovisac, from which the im- pregnation has resulted. According to Hess, if the corpus luteum is forced from the ovary of a pregnant cow, she will abort. Very rarely also the fertilization of the ovum occurs while it is yet in the ovisac, but presumably only after its rup- ture, while the egg remains adherent to the walls. Eventually this causes the exceedingly rare phenomenon of ovarian preg- nancy. The completed function, therefore, of the ovary includes ovulation, since it is immaterial how many ova the gland con- tains until, by discharge, they become available for fertilization. The causes of non-ovulation are numerous and may consist either in the failure of the ovaries to produce mature ova or of the intervention of some obstacle to the rupture of the ovisac and escape of the egg. Arrest in development or absence of the ovaries occurs with approximately the same frequency as the analogous condition of the testicles, with the exception that the female gland does not fail to attain functional maturity because of defective location, its normal adult position being within the abdomen, not widely separated from the point of embryonic origin. 155 156 Veterinary Obstetrics In rare cases, the ovaries are displaced by passing beyond their normal adult position and, escaping through the abdominal ring, come to rest in the region corresponding to the scrotum of the male. However, this false position does not interfere with their function, like the abdominal retention of the testicles. Freemartins. In bovine twins, we meet, frequently, with an interruption in the sexual development of one of the pair, which is generally known by the term ‘‘freemartin.’’ The general be- lief among breeders is that when both twins are of the same sex they are normally developed but that, when one is a male and the other a female, the latter undergoes an arrest in development aud becomes a freemartin. As a matter of fact, this is not always true and a pair of twins representing both sexes may be com- pletely developed and capable of breeding, but very largely the rule holds that a freemartin is one of a pair of twins, the other of which is a perfect male. The origin of this peculiarity has not been well determined. While similar arrests in development are seen occasionally in all species of animals, whether twins or not, there is no other in- stance where such a condition is expected with such regularity. It is a quite possible that the defect is due to the fact that, in such cases, we have todo with homologous twins which have originated from the division of a single ovum, after impregnation, and that one of these has suffered from an arrest in sexual devel- ment. Why the other should be always, or usuallv, a male has not been discovered. The character of these animals is generally quite uniform In form, voice, behavior and other attributes they are frequently asexual. ‘The head and neck partake neither of the character of the cow nor bull, but remind one more of an animal which has been castrated very young and has developed no sexual charac- teristics. The horns are fine, usually straight and not very large. The head and neck are fine. They behave and feed like castrated animals, and usually show no trace of sexual desire. Examined externally, they usually show at the ordinary loca- tion of the vulva a small urethral opening, having the general appearance of that organ, though very diminutive. Examined internally, the genital organs are generally found to have been arrested in the indifferent stage of development where the sexual characters are not yet far enough advanced to Congenital Defects of the Ovaries 157 state whether it be male or female. ‘The vagina and uterus may be somewhat developed but are very rudimentary, while the es- sential glands may resemble more or less the testicle or the ovary but, as a rule, can scarcely be classified as either but simply as a genital gland in the indifferent state. Freemartins are frequently spoken of as hermaphrodites and, in a certain sense, they may be so regarded but, since they fre- quently have neither sexual desire, character, nor power, it would be better to speak of such as neuters. It is sometimes important that it be determined as early as possible after the birth of twin calves if one of the pair is a free- martin or not. At an early age the question may sometimes be satisfactorily answered by observing the size and form of the vulva, especially by comparing it with a normal calf of similar age and size. If the vulva is normal, it is probably a normal heifer ; if small, it is probably a freemartin. In a freemartin, the cavity of the vagina is frequently absent, which may be recognized by the inability to introduce a sound or a finger beyond the meatus urinarius. As the age of puberty approaches, the differentiation between heifers and freemartins becomes greatly facilitated. . The vulva does not grow or it might better be said that a vulva does not exist, but rather a urethral opening in the perineal region, very narrow, constricted and scarcely admitting of the insertion of a man’s finger. No clitoris is recognizable. The animal fails to develop sexual characters in form, voice or be- havior. In some cases there is present a definite vulva into which two, three or more fingers may be passed. Rectal explor- ation may reveal ovaries and uterus or cornua in varying degrees of perfection and estrum may occur. Hermaphroditism habitually leads to an arrest in the devel- opment of the ovary, by which it retains more or less of its fetal character and fails to function. In mules and other hybrids the ovaries fail to produce fer- tilizable ova as a rule, to which there are rare exceptions. In these animals there is usually a well marked or even exaggerated sexual desire, presumably due to the development of imperfect ova, followed by ovulation. Like the testicles, the ovaries are sometimes the seat of der- moid cysts, which may contain hair or teeth. They are neces- sarily congenital and may attain indefinite size. Usually involv- 158 Veterinary Obstetrics ing the gland to such a degree as to compromise the formation or persistence of normal ovarian parenchyma, ovulation from the affected gland does not appear and sexual desire is not induced by the presence of such glands, though, if one be normal and the other has undergone aberration, estrum and even fertiliza- tion may result from the presence of the one normal ovary. Calcareous degeneration of the ovaries may occur as a con- genital defect, the gland assuming a variable form and size and consisting essentially of a mass of calcareous matter devoid of proper ovarian tissue. The condition leads to sterility and ab- sence of sexual desire. In many cases of arrested development of the ovaries, the sex- ual desire and attributes are wholly absent. In most instances of the undeveloped ovaries, except in hybrids, the condition may be suspected by the diminutive size of the vulva. In cases of dermoid cysts and congenital calcification of the ovaries, the con- dition may, usually, be determined by rectal or vaginal explora- tion. This group of affections is essentially incurable, from a breed- ing standpoint. When the ovaries are so defective that they in- duce no sexual desire and cause no inconvenience to the patient, no interference is demanded. When dermoid cysts or other de- fects induce undesirable conditions, the removal of the involved gland is indicated. In all those cases where nymphomania, or perverted sexual desire, is present, castration is indicated. Oophoritis. Inflammation of the ovaries is rare in the domestic animals and the symptoms are, usually, not recognized during life. Upon post-mortem examination, it is not rare to find the ovaries, especially of cows, studded over with fibrous tufts, point- ing to an inflammatory origin, or the glands adherent to the pavi- lion of the oviduct. Adhesions of the ovary to the pavilion of the oviduct is sometimes recognizable by manual exploration per rectum, but the condition is not subject to remedy, so far as breeding is concerned. Such animals may be castrated and pre- pared for the butcher. 3. Tuberculosis of the Ovaries is observed in cows as a cause of chronic oophoritis and sterility and may occur, more rarely, in other animals. Zschokke denies that tubercular ovaries consti- tute a common cause of sterility, and records that among 110 sterile cows but 2 % were referable to ovarian tuberculosis. Tumors of the Ovaries 159 According to this authority, ovarian tuberculosis does not, as a rule, cause nymphomania or produce other symptoms during life beyond sterility, which may be further identified by palpa- tion of the glands, when they may be found enlarged and nodu- Jar. A further aid in diagnosis may be secured by the tuber- culin test. The affection is beyond remedy. 4. Tumors of the Ovaries are somewhat rare in domestic animals bnt are found, occasionally, in all species. They may be malignant in character and tend to acquire large size before their presence is suspected or discovered. ‘There are sometimes seen adenoid tumors of great size. In the museum of the New York State Veterinary College is an adenoid ovarian tumor from a sow, weighing 38 pounds. Becoming sterile, she was fatted and upon slaughter the immense tumor was dis- covered. Cystic tumors are occasionally seen of immense size, especially in the mare. Ovarian tumors tend constantly to cause sterility with or with- out nymphomania. “A tumor of one ovary constantly tends to inhibit ovulation from the other gland. It is usually either the sterility or accompanying nymphomania which attracts attention to the animal and leads to an examination per rectum or vagi- nam, which discloses the presence of the tumor. Tumors of the ovary are to be identified by their location, the absence of the normal ovaries and the presence of the tumors to which the corresponding uterine cornua lead and are attached. The ovarian tumor may contract extensive and firm adhesions with the walls or viscera of the abdomen or pelvis and thus com- plicate the question of diagnosis. Its true character is then to be determined by tracing along the uterus, cornu and oviduct to the ovary and thus indentifying it by its relation to the uterus. We have observed the tumor displaced by such adhesions, so that it occupied a quite abnormal location. If essential to a cor- rect diagnosis, an exploratory incision may be made through the vaginal walls in the mare or cow or through the abdominal walls in the smaller animals. If discovered while it is of operable size, it should be promptly removed. When involving one ovary only, the successful removal of the tumor will usually re- store to functional activity the remaining normal gland. 160 Veterinary Obstetrics 5. Edema of the Ovaries is described by Zschokke as occur- ring, in his experience, in old, nymphomaniac cows. ‘The ovaries aré somewhat enlarged and contain a few small follicles but no corpora lutea. Upon incision, the dropsical fluid is easily pressed out from the cut surface. The cut surface is grayish red in color and shows the usual characters of edema, which is confined to the gland itself. The abnormality is to be differentiated chiefly from cystic ova- ries and persistent corpora lutea. Examining the glands care- fully per rectum, the touch reveals the somewhat large, soft, yielding ovary in contrast to the firm fluctuating and sharply defined cysts of cystic degeneration or the prominently enlarged and comparatively firm, non-fluctuating persistent yellow body. The dependent sterility is usually beyond remedy and, in case of nymphomania, ovariotomy should be performed in order to cure the vice and permit the cow to be fatted for the butcher. CYSTIC AND CYSTO-FIBROUS DEGENERATION OF THE OVARIES OF COWS. NYMPHOMANIA' The most frequent and important disease of the ovaries is cystic degeneration, to which Zangger was the first to draw at- tention, in the Schweitzer Archiv. fiir Tierheilkunde, Volume XXII, 1859, page 280. It is essential to a proper comprehension of the subject that we have in mind a brief outline of the formation, rupture and oblit- eration, or astresia, of the Graafian follicles and that we recog- nize the significance of the formation and degeneration of the corpus luteum for the further deyelopment of ovisacs and the origin of ovarian cysts, in which we follow the highly scientific and meritorious investigations and contributions of our anato- mist, Professor Doctor Rubeli. It is known that the reproductive cells originate from the germinal epi- thelium; which sinks down into the stroma of the ovary in the form of cell tubes. The formation of ova in hoofed animals is generally completed at the time of birth. According to Bonnet, there may, in exceptional cases, be a possibility of a new invagination of the germinal epithelium upon the margin of a ruptured ovisac. The primitive ova in the young ovary either lie somewhat scattered, as in ruminants and swine, or arranged in groups in the peripheral layer of the ovary. When the germinal epithelium has ceased its invagination, the tunica albuginea is formed as the outermost zone of the stroma, over which the ovarian epithelium extends. The primary eggs then becomes arated from each other by the ingrowth between them of the ovarian stroma, which pushes in between the cells and leaves each ovum surrounded bya single layer of smooth cells, constituting the primary follicular epithelium. Heitz (Archives fiir Wissensch. u. Prakt. Tierheilkunde, Vol. 32, 1906) recog- nizes that, in the ovaries of calves, the epithelium may consist of a single 1 In the following pages, (161-234) so far as they deal with sterility and nymphomania due to cystic or cysto-fibrous degeneration of the ovaries, to persistent corpora lutea, or to pyometra in cows, we have, with his permis- sion, inserted, essentially entire, the admirable report of Prof. Dr. E. Hess of the Bern veterinary school, entitled ‘‘The Sterility of Cows’’, presented at the Annual Convention of Swiss Veterinarians at Freiburg the 19th of October, 1905, and appearing in the Schweizer Archiv. fiir Tierheilkunde, No. 6, 1906, page 351. The illustrations and some brief additions, in [ ] are our own. i 161 162 Veterinary Obstetrics layer of endothelium-like cells or of a concentrically arranged double layer. From the primary follicular epithelium there develops from the cells a cy- lindrical epithelium, which thus forms several layers. Regarding the origin of the follicular cells, opinions vary. While, in the lower vertebrates, these cells certainly originate from the germinal epithelium and this source for the mammalia is accepted by many investigators, K6lliker, Rouget and Biihler believe that, in the formation of the follicular epithelium, the me- dullary fibres, or genital portions of the Wolffian bodies, play an important part, or, indeed, in the case of the dog, cat and fox, constitute the exclusive source of these cells. Heitz observed in the calf, in the neighborhood of an ovum surrounded by so-called primitive follicular epithelium, a group of granulation cells, which so increased at that point where the ovum was located that an excavation took place and, thereby, completely encom- passed it. The granulation mass either already contained the ovum before the development of a follicular cavity or else acquired this cavity after the egg was completely surrounded. One of the foregoing conditions appears, from these observations, to be the ordinary course in the calf. As soon as the follicle has acquired a certain size, it ruptures and dis- charges the egg and the follicular fluid. There is still a division of opinion as to the cause of the rupture of the follicle. It is highly probable that there occurs a sudden augmentation of follicular liquid owing to vasomotor irritation of the nerves and, consequently, a greater pressure on the part of this fluid, along with simultaneous thinning of the follicular walls at that part of the vesicle where it is to rupture. Ho6lzl, on the other hand, com- pares the rupture with that of the formation of an abcess, in that, between the granular membrane and the ¢heca fol iculi there occurs an important ac- cumulation of migratory cells which form the so-called /heca folliculi interna. Under the pressure of this infiltrated cell mass, the contents of the follicle are expelled in the direction of least resistance, that is, upon the external surface. Zschokke holds a similar view, though he does not attribute the rupture to the infiltration of the migratory cells, but to the multiplication of the cells of the theca itself at the base of the follicle. From the view-point of these two investigators, the thickening of the theca interna at the base of the follicle and the thinning of the wall upon the surface of the ovary has a special importance. However, it is essential to remember that the unequal thickness of this membrane must be referred to the con- dition of the blood supply since, indeed, the vessels become atrophied in that part of the follicle where the rupture is to occur, and, hence, the nutrition of this part of the theca becomes deficient. If now the mem- brane increases in thickness on one side and decreases on the other, so will the follicular contents be massed against the thin portion of the wall. The rupture of the follicle, consequently, does not become inevitable except there occurs a simultaneous increase of the intra-follicular pressure and an atrophy of the wall at the most prominent point, where it is to be ruptured. If the latter were not the case, there would necessarily occur more or less hemorrhage when the follicle breaks, which, however, Zschokke himself denies for the cow. Against the Holzl-Zschokke view there is, first of all, the occurrence of Cystic Degeneration of the Ovaries 163 atresia of the follicle, since, in this case, indeed, the theca interna becomes extraordinarily thickened yet does not lead to rupture of the follicle be- cause, in that case, the follicular fluid becomes decreased and the pressure, as a consequence, is lessened. Zschokke believes that a simple increase of the follicular fluid can not occur through hyperaemia because artificial or inflammatory hyperaemia does not cause ovulation ; on the contrary, it is to be observed that a local hyperaemia which affects the ¢heca folliculi alone evidently exerts a differ- ent influence from an artificial or inflammatory hyperaemia which involves the entire ovary. It is, moreover, to be remarked that the pressure of the follicular fluid in follicles of different sizes is variable in degree because the amount of fluid evidently varies with the size of the follicle, whereas the intrafollicular pressure alone can have the power to rupture the follicle. Zschokke believes also, a conclusion based upon personal observation, that ovulation often occurs in the beginning of estrum and that it is, conse- quently, to be held that the rupture of the follicle occurs, in some cases, before estrum has reached its zenith. We hold, on the one hand, from facts known for many decades, that ovulation, which is to be regarded as the manifestation of vaso-dilation, ushers in estrum ; we might however, on the other hand, emphasize the fact that the most evident normal clinical symptoms of estrum are not to be regarded as occurring at the same moment as the highest degree of ovarian hyperaemia. It seems to us far more probable that hyperaemia of the ovary precedes that of the uterus and vagina and that such a view is more plausible and correct. One argument for this view lies in the fact that, when cows, especially those in pasture, are bred at the beginning of estrum, they become pregnant. In regard to ovarian cysts, we have-found-small cystic follicles in ovaries of calves, ten to _twe lays. old, which-were investigated by Heitz. These toscabiesttnn vowed feet Go Pct the ovaries of -eows-contained.cysts at least 3 mm. in diameter. In wumerous cases, the cysts had a diameter of over 10 mm, and four times they reached 13 mm. Often there occurred in certain of these ovaries one or more cysts so greatly developed that the proper tissue of the ovary appeared as an unimportant appendix. By micro- scopical examinatio were recognizable a8 internal follictes7—The granulosa exhibited no ma ; S degenerative processes existed in the egg. These follicles do not rupture spontaneously, since nowhere could there be seen yellow bodies or other evidences, like scars or fibrous tufts, which indicated ruptured follicles. Many of these follicles retrograde, many, perhaps, become cysts, because they show absolutely no decrease in size, in spite of the fact that the egg has already undergone serious degeneration. Cysts are not infrequently observed even before the first pregnancy. Also, in new-born calves and heifers, one meets, according to Waldeyer1 and others, with follicles as large as peas, containing normally developed ova. The same is true for various.other species of animals. On the 1Waldeyer in Hertwig’s Handbuch der Entwicklungsgeschichte, p. 374. rd 164 Veterinary Obstetrics whole, these are rare exceptions in other animals, while, in the calf, they are extraordinarily common. It is readily understood that the prematurely appearing follicles do not rupture, for there is wanting, at this time, the hyperaemia of estrum, through which, after the advent of puberty, the intrafollicular pressure in adults becomes increased. Heitz could further determine that all follicles existing in calf ovaries had emanated from simple primordial follicles and had no relation to sheath follicles or ovarial adenoma. According to Simon! the large, distended, degenerated granular cells appearing so numerously, lying in the inner zone against the inner walls of the cyst, play an important role in the genesis of these cystic follicles. The most convincing argument of all would be the recognition of an ovum in such cysts. This evidence it has thus far been impossible for us to adduce, since the cysts, in the preparation of the material, were incised or ruptured, permitting most of the contents toescape. Zschokke has searched many cysts for ova but was unable, in a single case, to detect any. Accord- ing to this author, it is well nigh impossible to secure the entire follicular contents and adequately search them microscopically. The exact contents of these follicles in the cow need be fully determined. I believe it is possible to explain the cause of the existence of cysts directly by the structure of their walls, without taking into consideration the forma- tion or nonformation of the corpora lutea, which view, however, as is made clear by the preceding quotations, is by no means established in a manner free from objection. , If we study the delicate tissues which make up the Graafian follicles of the ovary, we are at once impressed with the thought that the least general or local pathologic changes must serve to interfere with the nutritive pro- cesses in them. If the contents of such a follicle perish as a result of these changes, the theca, which no longer receive adequate nutrition, cannot fill the cavity and thus obliterate the existing defect. This may be seen in follicular atresia, in which a fine-meshed connective tissue network grows out into the follicular cavity from the ¢heca interna. Through transudation from the few existing vsesels, the /iguor folliculi becomes increased and the follicular capsule then surrounds a cavity filled with a fluid poor in cell contents. Contemporary with the destruction of the follicular contents, there occur changes in the follicular wall. It becomes markedly poor in cells and ves- sels. The previously round cells assume a polygonal form and show polar outgrowths, which establish connections with neighboring cells. There are now observed, in relatively large numbers, round cells appearing scatter- ingly amongst the polygonal ones. The inter-cellular substance, at first fibrous, becomes more homogeneous in the outermost zone, which is al- most wholly devoid of cells, and stains intensively with eosin. The vessels 1A. Simon, Anatomisch-histologische Untersuchungen der Ovarien von 95 Kastrirten Kithen, Berner Inaugural-Dissertation, 1904. Cystic Degeneration of the Ovaries 165 ultimately atrophy completely, except upon the margin of the external zone, where there are still seen a few vessels. It is precisely this non-vascularity which is generally typical of the cyst walls investigated by us and, according to our view, constitutes the best in- dication for the explanation of the development of cysts from Graafian fol- licles. After the follicle has ruptured there occurs, in its place, the residual body, corpus luteum. It isa more or less spheroidal body, attaining a variable size, according to whether impregnation has occurred or not. In the first in- stance, it becomes extraordinarily large. It may exceed by several times the volume of the gland itself and persists throughout the period of pregnancy, to disappear only after birth. We have in this instance to deal with the cov~ pus luteum vera, or the yellow body of pregnancy. In the latter instance, it remains smaller and disappears a few weeks later; here we have to do with a corpus lutea spurium, or the yellow body of estrum. Among the alleged causes of the formation of these larger corpora lutea and their longer duration, are increased or decreased blood supply to the ovary during the period of pregnancy. Schulin sees the cause for the greater growth of the true corpus /utewm in the decreased supply of nutri- ment to the ovary. In this connection, from observations made in path- ology, he emphasizes the fact that soft granulation masses persist, not in vigorous, but only in feeble, sickly men. Bonnet states explicitly that the disappearance of the yellow body is delayed because the ovary becomes anzemic owing to the fact that, during pregnancy, the hyperemia of estrum becomes stable in the uterus, vagina, etc., as he has been able repeatedly to demonstrate to his personal satisfaction. H6lzl takes directly the oppo- site view. According to him, the ovaries should receive a larger amount of nutrition during pregnancy owing to the increased flow of blood to the genitals. He believes that, during pregnancy, the ovaries hypertrophy, whereas a badly nourished organ does not. According to his view, the true corpus luteum persists for a longer period because, during pregnancy, there is a regular diapedesis and hemorrhage into the yellow body so that one finds, in gravid animals and those in the puerperal state, yellow bodies, which are greatly enlarged as a consequence of hemorrhages into them and have in their center a well-defined blood clot, completely enclosed. Similar observations have not yet been made in the cow since, in this animal, hemorrhage into the follicular cavities is unimportant or wholly absent. Hence the alleged causes for the longer continuation of the yellow bodies which have been observed in woman are not present in cattle. The corpus luteum consists of a brownish-yellow or ochre-yellow capsular layer, which contains lutein cells, and a soft, gray, transparent nucleus, which consists of newly formed connective tissue containing few cells and supplied with blood vessels; sometimes there exists blood debris derived from cells which have undergone disintegration or fatty degeneration, per- haps mixed with cells, connective tissue fibres, etc. As the yellow body undergoes retrograde changes, there develops a form of connective tissue, which contracts to constitute the corpus fibrosum albicans. The remnant then represents merely the contracted nucleus of the yellow body, corpus 166 Veterinary Obstetrics fibrosum simplex; or it may contain a large amount of blood pigment, corpus nigrum, Regarding the formation of the yellow body, there is still much difference of opinion. According to Bischoff, Schrén, Pfliiger and others, this struc- ture emanates from the membrana granulosa; von Baer, Kolliker, His, Spiegelberg, Paladino and others consider that it is formed from the tunica interna folliculi. Warge spheroidal, polygonal lutein cells occur within the fine fibrous connective tissue stroma of the yellow capsule wall and contain large spherical nuclei, nucleoli, nuclear debris and a finely granular pig- ment (lutein lipochrome) permeating the protoplasm. According to Sabotta, in the mouse and rabbit, and to van Beneden and Honoré, in rabbits, these certainly arise from the membrana granulosa. The same origin holds good, according to Giacomini, and also Mingazzini, for reptiles and birds. Van der Stricht saw these cells derived, in part, at least, from the granulosa in vesperugo noctula, On the other hand, Clark, Nagel, Buhler and Stokel are of the opinion that the lutein cells are derived from the cells of the tunica interna folliculi. Zschokke speaks in much the same way of the origin of the yellow body in cattle. He says, ‘‘I have for a long time thor- oughly studied and sectioned dozens of ovaries of various animals and am fully convinced that they are derived from the unica interna,’’ He found a distinction in the nuclear staining of the granulosa cells and those of the tunica; the first was more intense. He further observed that the debris of the granulosa could be differentiated by their form from the growths ema- nating from the ‘unica interna. It is impossible, however, for one to deter- mine these differences in the illustrations in Zschokke’s work and to recognize which tissue one is observing because the magnification is too feeble. The destiny of the yellow bodies is chiefly that they shall occupy the cavity which occurs as a result of the rupture of the follicles. According to Bohn, who agrees with Frankel and Cohn, the yellow body consists of a substance secreted by the system, being derived from the blood through the influence of the attachment of the egg to the uterus. Closely allied to this, also, is the view that the yellow bodies, through these secretions, exert a restraining influence in a certain way upon the ovary and the further development of follicles. In relation to the latter point, perhaps, the simple pressure of the yellow body upon the ovary is partly responsible for the result. Zschokke asserts that, where large cor- pora lutea exist, as a general rule, large, ripe follicles are wanting, while, at the same time, in these animals, estrum is usually absent. Other veteri_ narians have, on the other hand, observed that the existence of yellow bodies does not always prevent the occurrence of estrum. In reference to the number of ovarian cysts occurring in one animal, we have found in ovaries secured by castration or after slaughter that one gland may be nermatawhite-the-ether has uh- dergone cystiedegeneration i inan eames maga Very frequently both ovaries suffer, § equally, but far more Cystic Degeneration of the Ovaries 167 commonly in a different degree. Not infrequently one observes in an ovary, both superficially and deeply, one to four cysts; in other cases, one large cyst. Ovaries containing two to three large and two to four-smel—eysts—are—by—ne-.means rare. While, under normal conditions, the ovary of the cow varies in size between a bean and a large hazelnut, the gland which is affected with cystic degeneration shows, upon-its-nodularsurface, varying numbers of stellate, radiating or linear scars. The special position of the cysts, which always develop from the follicles, is the stratum par- enchymatosum and especially the stratum vasculosum. In the former, the location of the cyst is more superficial or peripheral, while, in the latter, it is central, oe for walls, are found located, as a_rule, at_the inferior -or-su generally 3 mm. from the mesovarian or ligamentous border and ‘I-Io mm. from the free border. Cystsalso occur imediately upon the free border, especially in the middle of the organ. It is, moreover, quite common to find in the center of the ovary, one Fic. 16. NORMAL AND CYSTIC OVARIES OF Cow. A, B, B’, Cystic ovaries, B’, Section of B, showing it to consist of two large cysts and one corpus luteum with no visible ovarian tissue. C, Section of the normal ovary, D, showing ovisacs and one corpus luteum. One-half size. 168 Veterinary Obstetrics to four follicles of the size of a pea or small hazlenut. These do not project beyond the surface of the gland, but occupy the place of the vascular stratum, around which the external part of the ovary continues to form a tissue capsule 3-8 mm. in diameter. In isolated instances, also, the ovary may undergo atrophy because of the formation of abnormal follicles, until it becomes merely a remnant, in which only a few small follicles can be distinguished. Many times, in the sound portion of the surface of the ovary, there are observed numerous follicles. In regard to the extremely variable thickness of the walls of peripheral cysts,it-iste_be-emphasized that, in many cases, their walls are as thin as paper, consisting of a very delicate cuticle, ich is i re; in-other- ecases,-on—the contrary, t i ickness. of 6-8.mm.,. which-explains the 2o aero eer may-oceur-or that a variable degree of force may-be-neeessary in_order to crush it. Analogous to the variations in the strength of the exterior walls, there are also differences in the thickness of the sheath walls of the ovarian tissue of the cyst in one and the same ovary, ranging from 1-8 mm. According to the anatomo-histologic investigations of Simon, already quoted, under the direction of our esteemed colleague, Rubeli, in the Veterinary Anatomy Institute of this college, the average volume and weight of the ovaries of 95 castrated cows was as follows: Right Ovary. Left Ovary. Maxinilim Weight. 222. sscesceenoec254 “Baeceecececs 20.3 -gr. Medium weight_._____.___---------- 14¥330 2h kena, 10.11 gr. Minimum weight. -__.-._---------. 6.8 gr_.________- 5-2 gr. Maximum length_________---_______ FEO Cts ease = een 5.1 em. Medium length_______-_-__--_-_-__- 4.3 CW aosecesce, 3.71 cm. Minimum length. ____-_--_--------_ 1.0 cm__.________ 2.1 cm. Maximum width______-_____.------- 4:0 (CMssec5 soe 3.8 cm. Medium width__-___-_-_-----.___-_- 2:8) @iio 2-2-2 2ee 2.36 cm Minimum width_____.._____________ ao) | a 1.6 cm Maximum thickness____-_-_________ 80: Cie ene 3.9 cm. Medium thickness-________-_-_-_____ 2,53 CMe socsexcawn: Qe 15. CMs Minimum thickness___________-_____ 153) (Ctiese case sa 1.30 cm. According to these tables the right ovaries are, on the aver- age, greater_ thas” than the—leff—both_in_ weight and ud “volume, a-fact which, « concerning the size, can be readily determined by rectal Cystic Degeneration of the Ovaries 169 exploration. This indicates a probable greater functional ac- tivity of the right organ. According to Zschokke, the ovaries of medium sized animals weigh approximately 14-19 gr. The dimensions of the ovaries of healthy cows vary between 42 and 47 mm. in their greater, or longitudinal axes, and 12-15 mm. in their transverse diame- ters; in heifers they are approximately 23-27 mm. and in aged cows 31-36 mm. It is to be observed that the weight and size of the ovaries is, in a large measure, dependent upon prior physiologic occur- _rences, such as estrum, conception, etc. There is frequently observed upon - ~the.surface of the ovar linear Or stellate scars, the most prominent-linear-scars’ of which we tbute to rure-of_cysts because these occur especially in those ovaries in which we—have crushed various cysts. The stellate scars are referred by Zschokke and Simon to the rupture of follicles in which the corpus luteum does not, as is the case in most instances, project beyond the surface. Aside from these cicatrices, there is often found upon the sur- faces of many ovaries fibrous tufts as much as 1.6 mm. long which possess no clinical importance, and which, according to Simon, consist of numerous capillaries and embryonal wavy, connective tissue fibres with a few small spindle cells and elastic fibres and often arise from the margins of old yellow bodies. We have personally found that in cases of cysto-fibrous de- generated ovaries, which had been vigorously crushed two or three times within a few weeks in consequence of cystic degen- eration in the deeper parts of the organ, not only an evident enlargement of the gland, but that, after castration or slaughter, there as present on the surface of such ovaries a great number of intensely red, fresh, thick tufts, partly in sheet-like groups, partly as solitary projections. ETIOLOGY. According to the teachings of our extensive statistics, here omitted in order to save space, cystic degeneration occurs © most frequently in highly bred, early maturing valuable breeding. and miloh Sonat TOM ve © eight years of age. a and in well kept heifers of 1% to 3 years. However, ovarian cysts, in young calves and in aged animals, are not at all rare. We have also 170 Veterinary Obstetrics observed ovarian cysts in mares, sheep, goats and swine, always in the latter animals without nymphomaniac symptoms. (vid. Post Mortem Findings 7 and 8), [We have operated for nympho- mania due to ovarian cysts in the bitch. ] In regions with very intensively forced cattle-breeding and dairying, upon estates where large quantities of artificial ferti- lizers are used, artificial foods are employed, and where pedi- greed breeding animals are overfed, especially on rye, distiller’s grains, malt and, in addition, are constantly stabled, the disease is indigenous, while, in animals more naturally and moderately fed and kept much at pasture, the disease is far more rare. . Aside from the fact that nymphomania is especially common in highly fed, stabled cows and in certain establishments it is also apparent that there is a casual connéction in the frequency of its appearance according to the character of the season, the change from grass to hay feeding and in connection with parturition. On the other hand, there is not sufficient evidence to warrant the conclusion that ovarian cysts are directly inherited, although, in some cases found among cows of the same family. Neverthe- less, we believe that the disposition to the formation of cysts is hereditary and that this tendency becomes emphasized through intensive feeding, constant stabling, deep milking, frequent breeding and througl{ attacks of the nodular venereal disease. The tendency to cystic degeneration may also be favored by all conditions by which certain uses, like milking or breeding, be- come hereditarily emphasized, or the vital energy is greatly depressed, that is, a predisposition is established for diseases of the milk glands, ovaries and uterus. The primary causes of the formation of cysts are, as yet, un- known. Among other causes which have been suggested, we may mention that proposed by Giovanoli,’ who believes that it may be due to cerebral disease. According to the investigations of Simon, the occurrence of ovarian cysts cannot be referred toa chronic oophoritis with secondary thickening of the albuginea because he failed to find in any such ovaries a thickening of this tunic, although they were generally cystic in a high degree. 'Giovanoli. Schweizer-Archiv. fur Tierheilkunde, 1897, page 77. Cystic Degeneration of the Ovaries 171 In how far the frequently occurring ovarian cysts in new born calves and the presence, in ovarian follicles, of the coccidium ovt- forme, first recognized by Professors Rubeli and Guillebeau and Dr. Simon, exert an influence upon the cystic degeneration of the ovary, requires further investigation. A disease which, according to our view, certainly possesses great etiologic importance is the granular venereal disease (va- ginitis et metritis follicularis infectuosa) because the relative fre- quency of diseases of the ovary and uterus is much greater after the appearance of that plague than before ; likewise, one finds, in cows and heifers affected with diseases of the ovaries, extraordi- narily severe symptoms of vaginitis ef metritis follicularis tnfectuosa. In one case we observed primarily, in a cow, a prolapse of the vaginal portion of the uterus and, four weeks later, a large cyst in each of the ovaries. Undoubtedly, also, the normal occurrence of birth and unilat- eral castration exerts an important influence upon the formation of ovarian cysts. It is highly interesting to note that the data drawn from over 200 nymphomaniac animals observed by us during the year 1905, among which were three heifers, show that 92% were affected with cystic ovaries and, among these, were found 4 head which had aborted and later suffered from retention of the placenta, while all the others, aside from the 3 heifers, had completed the normal duration of pregnancy. Of the 92 % above mentioned, 5 cows had suffered from de- layed expulsion of the after birth and secondary septic endome- tritis, 4 from torsion of the gravid uterus and 7 from parturient paresis. So far as we could determine, these cows, which later became nymphomaniac had given birth to approximately the same number of male and female young. It is worthy of record, also, that, in one case, there was found a follicle as large as a hazelnut in the left ovary of a cow which had been slaughtered during the sixth month of pregnancy be- cause of agalactia, she being fat. . SYMPTOMS. For decades past, the symptoms induced by ovarian cysts have been designated by the terms budling or nymphomania. In the 172 Veterinary Obstetrics latter term, we recognize a true or erethetic nymphomania and the so-called dumb estrum (stillochsigkeit), in which latter, re- gardless of the existence of the sinking of the great sciatic liga- ments, symptoms of estrum are either entirely wanting or are only of a very feeble character. A. Nymphomania. GENERAL SYMPTOMS. Under normal conditions in non-pregnant cows, estrum occurs every three weeks and, if the milk secretion is not too intense, it begins from 6-8 weeks post partum. Vascillations of the estrual periods between 21-28 days must still be regarded as normal, while less than 21 or more than 28 days, as for example, estrual periods of 6-9 weeks, according to our statistical observations ex- tending over several years, can no longer be viewed as normal because experience teaches that animals with reduced or pro- ‘longed estrual periods either fail to conceive, or do so only with difficulty. On the whole, we have observed that the normal duration of estrum in the cow is 15-24 hours and that its pro- longation to 30-36-48 hours, DIQEIereiven diminishes the proba- bility of conception. The probability of sanucaric is also decreased if the duration of estrum is very brief or if it is excessively intense or goes to the opposite extreme and is very weak, as well as when there is a marked or abundant sanguineo-mucous vaginal discharge after the cessation of estrum. Only in exceptional cases have we ob- served conception to occur at the first service in well nourished cows, which, at times, remain in vigorous heat for fully 48 hours. All the varied deviations from the above described normal estrum fall within the designation of ‘‘ bulling’’ or of ‘‘dumb estrum’’ and especially do we designate as nymphomania those cases in which the estrum is excessive and irregular or is of too permanent a character. In reference to the relation between estrum appearing at the normal period, the anatomical character of the ovaries and the sinking of the broad ligaments of the pelvis, we may relate the following details in cases presenting the common characteristic that they fail to conceive. Quite exceptionally we met with cystic degeneration of the Nymphomania 173 ovaries in cows which were in estrum regularly every 21 days and showed constant slight sinking of the broad pelvic ligaments. In one instanée we recognized a small cyst in the right ovary and a large one in the left, in one case a cysto-fibrous degenera- tion of the left ovary, in another animal enxdometritis catarrhalis chronica, and in a third, an endometritis purulenta chronica. The usual case of nymphomania runs a chronic course without fever and shows, among its complex symptoms, many variations. Often one scarcely notes any disturbance of the general health ; in other cases, it is clearly linked with nervous symptoms. ‘The pulse varies between 60-66 per minute, the respirations from 12— 24. The state of nutrition varies widely according to the age, environment, feeding of the animal, and the duration of the malady, While nymphomaniac heifers and young cows which are handled early are generally in a good state of nutrition with glossy coat and soft skin, in aged breeding and milch cows the condition is only moderate or even bad. The live weight of large nymphomaniac Simmenthaler cows, according to our records, varies between 400-800 Kg. (1 Kg. = 2.2 lbs.) pre: oo ean rT nymphomania, is the failure of the milk yield to increase during the few days following—par- turition and the_ so-called ““hidebound”’ condition. ofthe -ani- mal, which maintains well nigh constant connection with the for- mation of ovarian cysts in conjunction with slight exdometritis catarrhalis acuta and more rarely rests exclusively and wholly upon exdometritis catarrhalis acuta and is characterized _by_a vyi- cious and restless behavior of the cow, nervous movements, with glassy eyes, the eyelids opened wide, the animal easily terrified, Staring, wild, vicious expression and dry hair. Sooner or later there appears, also i ition_aud decreased lactation. The animal feeds more and more erratically, becomes agitated without visible cause, the agitation not unfrequently amounting to a veritable storm, accompanied with pawing, low- ing and bellowing (bellowing disease. ) Should the latter symptoms develop during the night, other cattle in the same stall are made to suffer and even the people of the house may be disturbed. In some cases the diseased animal may escape from its fastenings, and opportunity be given for the fracture of the external angle of the ilium, the pelvis, etc. Hand in hand with these symptoms goes sexual excitement of great 174 Veterinary Obstetrics intensity but_not—identical_with normal-estrum ; sometimes it follows a very slight estrum, in other cases it is brought to light only when a cow standing beside the diseased ohe comes into heat and very often is first observed when the animal is out at pasture. Sexually excited_cows seldom lie down and only for brief periods. 7 Tee eae | aggressive behavior, attempt to rub their posterior parts upon other cows or objects, elevate the tail, urinate frequently, less frequently exhibit vaginal straining and neither drink deliberately nor even graze quietly. In the pasture these animals graze badly, run about, annoy the herd, and tear up the earth with horns or hoofs. If the nymphomania is intensely developed the animal becomes very vicious toward surrounding objects, especially strange persons or glistening bodiesin bright colors and falls upon them, as we have repeatedly observed, in maniacal fury. In some cases of nymphomania, the affected animals attempt to mount neighboring cows, bulls, oxen, and even persons and continue to ride the former for a long in- terval; on the other hand, they permit bulls and also other cows to mount them constantly. [The viciousness of nymphomaniac cows and _ thej encyto_ mount persons when not—on their i er RR Ret arene eae who come in-contaet-with them,.as we have had occasion to per- er ne In one instance observed by us, a previously kind cow became dangerously vicious toward women and would attack them furiously at every opportunity. | There occur nymphomaniac cows with cystic ovaries, however,— which, on_th ry,-resist_all attenmrpts of bulls or of other ea After a variable duration of the malady the affected cow, which has already become markedly unthrifty, shows an elevated croup, a forward sinking of the anus and vulva, lordosis, stiffness of the loins, associated with an upright direc- tion or knuckling-over of the hind fetlock, ‘‘ kuhhessige ’’ posi- tion and often a slightly staggering gait. That a nymphomaniac cow may suffer simultaneously from other diseases, such as capped knee, pelvic fractures, foul in the foot, etc., is to be regarded merely as a coincidence and that old, oft recurring cyst forma- tion may lead to an exaggeration of all the symptoms described is readily understood. According to the duration of tine between the last parturition and the advent of the nymphomania, there is a somewhat corre- Nymphomania 175 sponding variation in the character of the udder and milk. In most of the cases observed by us, the udders were large and finely developed and yielded, before the advent of nymphomania, 8-12 liters of milk per milking and only in a dozen cows were we able, in the year of 1905, to recognize a small and flaccid udder and in but a single animal a fleshy udder and, in harmony therewith, a yield of but 2% to 6 liters of milk per milking. In nymphomaniac cows which had been in milk for a. long period the milk from one or more of the quarters was, in some cases, white and without coagula but usually somewhat alkaline or bitter. Occasionally there was a ‘‘ holding up of the milk ”’ during one milking, a phenomenon which we attribute to vaso- motor paralysis and debility of the vascular muscles of the teats. SPECIAL SYMPTOMS. Among the special apparent symptoms of ovarial nymphoma- nia, sinking of the broad ligaments of the pelvis takes the _first place. Although not pathognomonic, it is constant. This symp- tom may reveal itself in varying degree and it is necessary for its proper observance that the animal be stood in a normal position on even ground: Concerning the relaxation of the great sciatic ligaments, Goubaux first suggested that it was the result of a serous infil- tration of these structures, leading to their elongation and de- creased tension. In a similar manner Franck expressed the opinion that, in addition to this cause, the gravid uterus exerted an influence by dragging the anus and vulva downward and for- ward, thus pulling the sacro-sciatic ligament inwards into the pelvic cavity. Berdez* was the first to describe the sinking of the sciatic ligaments as a purely mechanical result of a flexion of the pelvis at the sacro-iliac articulation by which the ligaments be- came relaxed, permitting them to sink inwards. He constructed a highly ingenious model for that purpose, by which he showed how the weight of the gravid uterus upon the abdominal floor served to stretch the sacro-sciatic ligaments. Shortly prior to birth the uterus contracts, the load—fetus, fetal membranes and waters—is lifted from the abdominal floor and is largely supported iBerdez, Schweitz Archiv. fiir Tierheilkunde u. Tierzucht, vol. 4, 1882, page 188. — 176 Veterinary Obstetrics by other agencies, such as the mesometrium, vagina, diaphragm of the pelvis, ete. The pelvic ligaments are thereby relaxed and sink inwards. ‘This very simple and plausible theory of Berdez is opposed by Zschokke because, according to his investigations, drawing in the direction of the rectus abdominis muscle does not produce the effects described nor can the unilateral sinking frequently observed in practice be explained by that theory. What effect the contraction of the rectus abdominis muscle exerts is not stated by Zschokke. Fuhrimann’ was enabled for the first time, in our ambulatory clinic, to recognize that sinking of the sciatic ligaments occurs in various diseases of the genital organs, as well as of. the milk glands, and is not at all confined to diseases of the ovaries. He was further able to induce sinking of the broad ligaments of the pelvis experimentally by inserting kelp pencils in the cervix uteri. From these data it follows that.any sufficiently powerful irrjta- ee sinking of the broad ligaments of the pelvis. ‘The previously -accepted theory of infiltration of the ligaments must, therefore, be abandoned. The measurements taken by Fuhriman on the prepared pelvis have further indicated that the stretching and relaxation of the pelvic ligaments through flexion of the ilio-sacral articulation may be induced, as claimed by Berdez, and that these movements are greatly favored in the cow because of the extraordinary mobility of the lumbo-sacral articulation, especially by the sink- ing of the loins. It is recognized that a mild grade of physio- logic sinking of the broad ligaments of the pelvis occurs often during normal estrum, also in a normal manner 8 to 15 days before calving or, under some conditions, such as high feeding and having to lie on sloping floors, it even occurs 4 to 6 weeks ante partum, and normally disappears inside of 8 to 12 daysafter parturition. In cases where the relaxed condition of the pelvic ligaments persisted on one or both sides throughout the entire duration of pregnancy and at times even embraced several consecutive preg- 1 Fuhrimann, Uber die Senkung der breiten Beckenbander beim Rinde. Berner Inaugural-Dissertation 1906 und Archiv. fur wissentschaftliche und praktische Tierheilkunde, Bd. 32, 1906. Nymphomania 177 nancies, in many instances to a marked degree, we observed now and then—and these cases afford striking evidence—that sinking of the hips and pregnancy are not incompatible. We also now and then see the so-called false estrum, especially during the second half of pregnancy, probably as the result of active hy- peraemia of the genital canal. We have observed this false estrum continue throughout the period of pregnancy and, accord- ing to our observations, it is very similar to the normal estrum of non-pregnant cows. In one cow in which there was sinking of the right broad pelvic ligament throughout pregnancy there was a constant sexual excitement, as evidenced by her mounting other cows. We here recognized a salpingitis of the right oviduct, which had not prevented conception. In another case, a cow five months pregnant had to be returned home from the mountain pasture because she constantly permitted the bulls to copulate with her. We recognize the abnormal sinking of the broad ligaments in the following diseased conditions: in 92% of the cases of ovarial cysts as well as in advanced fibrous degeneration of the ovaries, in hydrops tubarum (cystic distension of oviducts) with sound ovaries, in acute and chronic catarrhal and purulent metritis, pyometra, prolapsus of the vaginal portion of the uterus, vaginal prolapse, infectious nodular metritis and vaginitis, septic me- tritis, tubercular metritis, severe traumatic vaginitis and collitis, large retention cysts in Bartholini’s glands, severe mastitis 40 hours after its development, bacterial pyelo-nephritis, orchitis and, in old, heavy nonpregnant cows and in one breeding bull from over fatigue from transportation on foot. We have now and then observed a slight sinking of the broad ligaments of the pelvis in cows which, in spite of regular estrum, do not conceive and in which the cervical canal remains open as a consequence of chronic catarrh. A similar condition is also seen in profuse milkers 2-3 weeks after parturition due to a gen- eral debility and atony of the genital organs in connection with insufficient uterine involution, especially a slight catarrhal metritis. In reference to the date of the advent of the sinking of the broad pelvic ligaments in newly calved cows,a study of those cases in which data upon this point have been secured and 12 178 Veterinary Obstetrics which include but a very small percentage of the total number of cases of nymphomania recorded by us, it appears that, in 12 cases out of 120 observed during the first six months of 1905, a complete return to the normal elevation of the hips or recovery in tone of the broad ligaments did not occur within the normal period after calving but that the sciatic ligaments retained their relaxed condition during the first 12 days or increased somewhat after 3-7 days. In 100 cases the normal tension of the broad ligaments was reestablished within 12 days after calving which, however, after the following periods of time, again became re- laxed, namely : In 2 cases inside of 16 days post partum “e 7 ce “6 3 weeks ae ind ins 4 ce ins 4 “ce ins ce oe 6 “ce ce 5 oe iss “ce ae 5 ae “et 6 ins “et “ “ 5 ce ce ej ce at iz3 e I4 oe “ce 2 months oe “é 6c oe “e “e iad e 12 3 r “e Io m3 cay 4 ce Lay “ce ae 7 ce ce 5 oe 4c ing “eo 9 “ “e 6 oe ee “ “se 3 oe oe - ing “ce 6c oe 3 ce 6c 8 “cr ee oe oe 2 ec a3 9 ae “e se ce 4 ce “ec Io 46 “ “se “ 5 ae “ce 12 ing “ce ae “ I “6 «ec 14 ce “e “ee ing I ce ing 15 “es “ et According to these exhihits, the relaxation of the broad liga- ments of the pelvis occurred during the period of most intense lactation, the first 4 months after calving furnishing 77 cases, as against 35 cases at a later date, or about 2:1. In regard to the relation between the sinking of the broad lig- aments and nymphomania, the 120 cases cited above furnish the following clinical data : The 120 cases of nymphomania showed in 112 cases a sinking of the broad ligaments, and in 8 cases no sinking. Of the 112 cases, the sinking of the sciatic ligaments was as- sociated : 8 times with regularly recurring estrum every three months, which was very intense and was prolonged for 3-4 days ; ‘ Nymphomania 179 14 times with irregular estrum ; 59 times with nymphomania. In 31 cases estrum failed to occur at all, or occurred but rarely and was very slight. In 13 cases the sinking of the ligaments was slight. In 36 s A x ‘‘ moderate. In 63 = is es te ‘« severe. The 8 cases of nymphomania, without sinking of the ligaments, occurred wholly in vigorous cows, in high condition, partly in animals yielding a heavy flow of milk. The group included 4 cows with bilateral ovarian cysts as large as hazelnuts; one cow which showed irregular estrum and, in addition to a cyst as large as hickory nut in the right ovary, exhibited a chronic catarrhal metritis; another cow which had a cyst as large as a hen’s egg and a corpus leutum in the right ovary ; another showing in the right ovary, a cyst of the size of a hen’s egg, in the left a small yellow body, and, in addition to these, a slight catarrhal endome- tritis, and in the last cow we found in the right ovary a cyst as large as a hickory unt. The failure of the ligaments to sink when ovarial cysts exist depends, apparently, on the one hand, upon the slight individ- ual susceptibility, and on the other, upon the evidently vigorous constitution of the patient. As to the relation of the sinking of the sciatic ligaments to the presence of ovarial cysts, our statistics revealed the following : In the 112 cases of sinking of the broad ligaments it was found that : in 32 cases, there was a bilateral sinking of the broad liga- ments accompanied by bilateral ovarian cysts ; in 24 cases, the sinking was bilateral and the formation of cysts unilateral, in the right ovary ; in 10 cases, the sinking was bilateral and ovarian cysts occurred only in the left ovary ; in 4 cases the sinking and ovarian cysts were alike found on the right side only ; : in 3 cases the sinking and cysts were found on the left side only ; in 1 case the sinking was bilateral, the right ovary cystic, the left had undergone fibroid degeneration ; 180 Veterinary Obstetrics in 2 cases the sinking was bilateral and only the left ovary had undergone fibrous degeneration ; in 1 case the sinking was bilateral, the right ovary showed fibrous degeneration and the left was cystic ; in 1 case the sinking was bilateral, while only the right ovary showed fibrous degeneration ; in 2 cases the sinking was bilateral ; the right ovary contained 2 yellow bodies and the left, one cyst ; in 7 cases the sinking was bilateral and both ovaries had un- dergone fibrous degeneration ; ' in 1 case the sinking was bilateral ; the right ovary appeared normal, and the left contained a cyst as well as 2 yellow bodies ; in 1 case the sinking was bilateral; the right ovary had un- dergone cystic and fibrous, and the left, fibrous degeneration ; in 3 cases the sinking and cystic degeneration were bilateral and accompanied by prolapsus vagine ; in 4 cases the sinking was bilateral while the cystic degenera- tion, accompanied by prolapsus vagine, affected the right ovary only ; in 3 cases the sinking was bilateral, while the cystic degenera- tion, accompanied by frolapsus vagine, involved the left ovary only ; in 1 case the sinking was bilateral and the ovaries normal, but prolapsus vagine existed ; in 1 case there was bilateral sinking; the right ovary was tuberculous, the left cystic ; in 1 case the sinking was extreme, with bilateral cystic de- generation, to which was added fibrous degeneration of the right ovary ; 7 in 1 case the sinking was severe and bilateral ; the right ovary was cysto-fibrous degenerated ; the left only cystic ; in I case the sinking was severe and bilateral ; the left ovary was cystic ; the right ovary contained a greatly hypertrophied yellow body ; in 1 case the sinking was bilateral; there was revealed a cyst and a yellow body on the right, and a cyst on the left ; in 1 case the sinking was bilateral ; the right ovary contained a cyst, while in the left there was a yellow body the size of a hickory nut ; : Nymphomanta 18I in 1 case the sinking was bilateral ; the right ovary contained 2 large cysts, the left was normal ; in « case the sinking was bilateral ; the right ovary contained a cyst the size of a hen’s egg, the left was normal : in 1 case the sinking was bilateral ; the right ovary normal ; the left contained a yellow body as large as a man’s thumb and to this was added the complication of a chronic purulent metritis ; in 1 case the sinking was bilateral and also there was present cystic and fibrous degeneration of both ovaries and prolapsus vagina ; in 1 case the sinking was bilateral; the right ovary, of the size of a hickory nut, was cystic and had undergone fibrous degenera- tion ; the left contained a hypertrophied yellow body; the os uteri was open and chronic purulent endometritis present ; in 1 case the sinking was bilateral ; the right ovary contained a cyst the size of a goose egg ; the left was normal. This tabulated summary indicates that sinking of the hips generally indicates some affection of the sexual organs, especially of the ovaries, and that a good, firm_tension of the broad liga- ments of the pelvis constitutes excellent evidence of sexual sound- ness in the cow becatisé, between the character of the tension of these sciatic ligaments and the specific sexual organs, there exists a relationship quite analogous to that in man between the pos- terior portion of the eye and cerebral disease. It further appears that the relaxation of the sciatic ligaments does not always indicate bilateral cystic degeneration of the ova- ties, that in individual cases it may occur in the absence of cystic degeneration and that the right ovary was found cystic twice as frequently as the left. In general, we have determined that, when the relaxation of the sciatic ligaments is unequal, the ovary on the side of the greatest relaxation is the one which has, most probably, undergone cystic degeneration. On the other hand, now and then, the broad ligament is appreciably more relaxed on the side of the sound ovary than upon that of the cystic gland and, in the bilateral formation of the cysts in the periphery of the glands, the greater sinking tends to occur on that side where the cyst or cysts is the larger, firmer and older. Also, in unilateral sink- ing of the sciatic ligaments, cystic degeneration may likewise be unilateral and involve only that ovary on the side corresponding 182 Veterinary Obstetrics to the relaxed ligament, and this presumption is not changed by the presence of fibrous degeneration in the other gland. Finally, in fibrous degeneration of the ovaries, the sinking of the hips is only slight or moderate, never severe. In one nymphomaniac cow, the right sciatic ligament was slightly sunken ; the left one, very markedly. The right ovary showed a cyst the size of a hen’s egg, with slight increase in cir- cumference of the right uterine cornu ; the left ovary was of the size of a hazel nut and the left cornu the thickness of a man’s arm. The question if, probably, the size and age of the cysts exert a definite influence upon the degree of the uni- or bilateral sinking of the broad ligaments must be answered in the negative. Our observations teach that small, and especially the very small cysts in heifers, often cause a very marked sinking of the ligaments, and vice versa; furthermore, now and then, the sinking on the side corresponding to the smaller cyst is materially greater, and in cases of cysts varying greatly in size in the two ovaries, the sinking in of the hips may yet be alike on both sides. From the standpoint of age, it seems clear, from our observa- tions, that cows with old and large cysts, because of the chronic reflex irritation upon the sexual organs, through which the re- laxation of the broad ligaments is caused, generally show also a greater degree of sinking than those with newly formed cysts. When the sinking of the broad ligaments does not occur im- mediately after calving, the anamnesis usually indicates that the affected animal had already been in estrum several times at too short intervals and too intense in character or continued for an abnormally long period, without conception occurring. The degree of the sinking of the hips, which is sometimes more marked at the the posterior border, and sometimes upon the flat. surface of the hips, but is usually equally evident in both areas, is, as already stated,. extremely variable. The sinking is. very greatly emphasized by a high croup, which has no real influence upon the sinking of the ligaments and has, under normal conditions, merely the value of a blemish. In exag- gerated cases, the sunken broad ligaments of the pelvis con- stitute an almost flat surface beneath the tail and, at the sides. of the root of the tail, cause cavities the size of a fist. Nymphomania 183 Out of the 120 nymphomaniac cows of our statistics, 47 ex- hibited more or less evident changes in the vulva, consisting of an edematous swelling of variable intensity, exceptionally greater on one side, and an elongation and widening of the vulvar com- missure. In 12 cases there was a slight active hyperaemia evi- denced by a redness of the labize of the vulva, referable to a pressure upon the vasodilatorsin the ovaries. Ina few cases, where prolapse of the vagina coexisted, there was an evident wrinkling, either chiefly in the superior half or involving the entire circum- ference of the vulvar lips, as well as invagination, that is, an entropium of the vulvar lips. It is of symptomatic significance that, in heifers suffering from dumb estrum (stillochsigkeit), the variable edematous swelling of the vulva, under some conditions, constitutes the only notable external symptom which, omitting the abnormal findings in the ovaries, can not at all be explained. Among our 120 cases there existed in 42 a very variable vaginal discharge. In 30 cases, this was slight, vitreous and slimy; in the other 12, on the contrary, muco-purulent or, when it had to do with old purulent metritis or pyometra, whclly purulent. In a combination of nymphomania with prolapse of the vagina or of the vaginal portion of the uterus, there was found a muco- purulent discharge mixed with fecal particles, which were later drawn into the vagina by the spontaneous reduction of the pro- lapse when the cow assumed the standing position. If vaginal discharge exists, the hairs of the vulvar tuft are matted and the ventral surface of the tail, next to the vulva, soiled. The vaginal mucosa, in 15 % of the cases of nymphomania, is reddened, injected and swollen, the latter especially marked when prolapse of the vagina or vaginal portion of the uterus coexists. Very often one finds the symptoms of chronic infectious nodular vaginitis (nodular or granular venereal diseases of the cow ), suchas a yellowish hue of the vaginal mucosa in those parts no longer inflamed, blanched vesicles and nodules no longer sur- rounded by inflamed areas, either grouped in one part or dissem- inated over the entire vaginal mucosa. More seldom, the mucosa is superficially eroded as a result of therapeutic efforts. A comparatively frequent finding is retention cysts of the glands of Bartholini, varying from the size of a hazelnut toa fist and, 184 Veterinary Obstetrics more seldom, vaginal polypi. There also occurs, quite exception- ally, at the line of demarcation between the vestibule and vagina or in the roof of the vagina about a hand’s breadth posterior to the mouth of the uterus, a thin walled fluctuating retention cyst the size of a large fist, containing a grayish sero-mucous, odor- less fluid. ‘The location and character of these cysts may best be determined by simultaneous examination per rectum et per vagt- num and through causing the former viscus to glide over the tumor. To the symptomatology of nymphomania also belongs the oft observed extraordinarily great relaxation and widening of the vagina, which here and there shows evident, horizontally di- rected scars and a very notably increased facility for palpating this organ, now so much more roomy. Very seldom one finds by the os wterz externum an abcess as large as a hen’s egg containing thick, white pus and now and then beneath the os uteri? externum as many as 6 polypoid growths varying in size from a pea to a pigeon’s egg, or one to several ‘fluctuating, spherical, cordiform retention cysts of Gaertner’s ducts as large as a small hen’s egg. Not at all rarely, there is found the vestigial remnants of the incompletely resorbed median walls of the Muellerian ducts, which we have already described', that is, there exists immediately behind the vaginal portion of the uterus, perpendicular bands 1-3 fingers in breadth and 1-3 cm. thick. They are easily en- gaged by the index finger, elastic, nonvascular and, in non-gravid animals with a thoroughly mobile uterus, are readily drawn far back into the vagina. These evidently may interfere, under cer- tain conditions, with the ejaculation of the semen into the cervical canal. Contrary to the views of Zschokke, who holds that, in nympho- mania, the os uterz is closed, we are able to state that the nym- phomania resulting from ovarial cysts is intimately related to the abnormal dilation of the mouth of the uterus and of the cer- vical canal and that it is only very rarely, and chiefly in cases of small cysts occurring soon after calving, that nymphomania ex- ists without dilation of the os uteri. 3 Approximately two to three times, annually we find an accumu- ' Schweizer-Archiv. fur tierheilkunde, 1896, page 252. Nymphomania 185 lation of urine in the vagina [urovagina ( Vagina urinalis)). This malady attacks old, feeble, nymphomaniac cows with large, wide vagine and uni- or bilateral ovarian cysts. The quantity of urine found in the vagina varies between 500 and 750 grammes, is feebly slimy and shows with the Nessler reagent within 12 hours after its removal a marked ammoniacal reaction, and after a few hours standing a very marked ammoniacal decomposition, which undeniably points to cow urine and excludes the sugges- tion of its being some injected fluid or an excretion discharged from the uterus. The accumulation of urine in the vagina is explained by the low pressure of the urinary stream while the animal is standing and the low lying, excavated vaginal floor about the urethral opening. ; The external os in cases of nymphomania in cows which have recently calved, also in all prolonged and well developed cases of nymphomania, is constantly penetrable for a lead pencil, little finger, index finger or, in cows very recently calved, for two fingers, and it was only in very recent cases of nymphomania and along with the existence of acute and severe chronic infec- tious nodular vaginitis (and especially when the latter has been handled with powerful irritants) that the os uferd was found closed in spite of the existence of cystic degeneration of the ovaries and sinking of the broad pelvic ligaments. Frequently the external os is penetrable for one or two fingers while further forward it is much narrowed or entirely closed. Under normal conditions, in non-pregnant cows and heifers which are not in estrum or have not been for a few days, as well as in those nymphomaniac cows in which the internal os is closed, there is found on the external os only a very small clot of a clear, tough mucus, while, in all cases of nymphomania with completely open os wterz, there is as a rule a hypersecretion. The exudate discharged from the cervical canal and ostZum ex- ternum and accumulating first in the vaginain varying quantity consists usually of vitreous, transparent, tenacious mucus; more rarely of slimy, whitish, or yellowish white, thick or thin liquid pus, which, in cases of prolapse of the vagina or mouth of the uterus, may in addition be mixed with fecal particles. If closed, the os uterz is small, not at all or but slightly swollen, and is often recognizable merely as a small rosette, which may be moved backwards or forwards and projects but little beyond the 186 Veterinary Obstetrics surrounding tissues, with which it is continuous. In case of an open cervical canal, the lips of the os uferz are enlarged, smooth, velvet-like, infiltrated. In many instances, especially when there exists a prolapsus portionis vaginalis uteri due to recurrent cystic disease of the ovaries, there are one or two flaps which are readily recognized in the vagina as bodies as thick as the hand, broad and long, tongue-shaped and often infiltrated with blood, upon the surface of which one may recognize, by palpation, the os uteri. Now and then there exists, as a result of chronic irritation in connection with the pathologic dilation of the cervical canal and the swelling of the vaginal portion of the uterus, in cows suffer- ing from cystic or fibrous ovarian degeneration, an enlargement and conspicuous firmness of the cervix uteri, sometimes slight, sometimes the thickness of the forearm or arm, and without any increase whatever in the size of the cornua. Passing to the changes in the uteri of nymphomaniac cows and heifers, recognizable by palpation, it is to be pointed out that the size of the organ in quite recent and not severe cases must now and then be regarded as normal. So, for example, we observed in one mild and very recent case of nymphomania in a cow which had aborted at the end of the fourth month of pregnancy, eight weeks after the abortion, a bilateral sinking of the broad pelvic ligaments, a large ovarian cyst in the right ovary, normal volume of the uterus and closed uterine os. However, in the great majority of nymphomaniac cows, the patients show a very variable degree of increased volume of the uterus, either zz foto or chiefly only in one horn. Often the uterine body at the point of origin of the cornua is only slightly thick- ened, the size of a child’s arm; in other cases, as thick as a man’s arm. Simultaneous with the increased circumference, there occurs also a varying elongation of the uterus to the extent of 2 to 3 times its normal length, whereby its anterior end projects far into the abdominal cavity. In asymmetric uteri the right horn is greater in 75% of cases and only exceptionally is one horn found to be normal while the other is importantly increased in circumference and length. The consistence of the uterus, which is never abnormally sensitive, Nymphomania 187 is uniform, soft-elastic, more seldom tense-elastic, and then dur- ing the existence of estrum. From the above facts and the post mortem findings yet to be related, it is indicated that cystic and cysto-fibrous degeneration of the ovaries almost uniformly lead to a non-infectious chronic catarrhal endometritis and only seldom to chronic muco-purulent endometritis or to chronic purulent endometritis, which makes it self evident that an impregnated ovum could not become attached to the uterine wall to undergo development into a fetus. Rela- tions analogous to those existing between cystic and cysto-fibrous ovarial degeneration and the sinking of the sacro-sciatic liga- ments hold good also between the former and the enlargement of the uterus. In bilateral cystic degeneration of the ovaries there exists no definite relation between the size of the cysts and the increased circumference of the uterus, which is usually symmetric, rarely asymmetric. In cases of unilateral formation of cysts the entire uterus-is frequently uniformly larger and longer or, on the other hand, the enlargement may be confined to the cornu leading to the affected ovary. Finally, it must be conceded that, as a general rule, the symp- toms of nymphomania are referable to the ovaries themselves, which are the chief and almost exclusive seat of the anatomio- pathologic changes, and that diseases of the uterus and vagina, without involving the ovaries, can only very rarely lead to symp- toms of nymphomania. On the other hand we have observed, and verified our diagnosis by post mortem examinations, that in both uncastrated and castrated cows, cysts in the broad liga- ments and in the oviducts, and hydatids in the oviducts or am- pullze can cause well marked nymphomania. As abnormalities of the ovaries which we have definitely recog- nized and verified in connection with nymphomania in cows we may relate: 1. ‘The formation of cysts or vesicles of the follicles—hyper- trophy of the ovisacs. According to Zschokke three genetic forms of these may be differentiated : a. Those which spring from the Graafian follicles and are to be designated as hydrops folliculorum. 188 Veterinary Obstetrics b. Those which emanate from the Pfliiger sheaths or from yellow bodies. c. Cysts which originate in hemmorrhages or colloid degenera- tion of cells, especially in malignant neoplasms. Because subclasses 6 and ¢ produce nymphomania only very rarely and consequently possess no great clinical importance, the subject, as related to these, will not be pursued further here. We will simply remark that not every ovarian_disease_in- duces nymphomania and that an ovary, under some. conditions, may possess: a-tumor-as large as the fist- without_producing symptoms of nymphomania ; indeed a cow may have a badly degenerated ovary, as we found in one particular case, and nevertheless show normal estrum and become pregnant. We have also repeatedly observed that, when but one ovary has undergone even severe cystic degeneration, estrum may be normal and impregnation occur. Undoubtedly, the most important and common disease of the ovaries leading to nymphomania is the cystic degeneration, which may be confined to only one or two ovisaes and then be desig- nated as solitary cyst formation, in contradistinction to multiple cyst formation, in which numerous Graafian follicles become hy- pertrophied in equal or unequal degrees. In regard to the formation of solitary cysts and fibrous degen- eration of the ovaries, we would here make the supplementary statement, or more properly, repeat that the right ovary is more frequently found diseased than the left, a fact which stands in an intimate relation with the greater functional activity of the right gland and the more frequent occurrence, approximately 70%, of impregnations in the right horn. It is also interesting to note the fact, amply verified by us, that large cysts, which, it is to be assumed, have required a longer period of time for their development than do smaller ones, cause no visibly greater symptoms of nymphomania, but that the volume of the cyst stands in no constant relation to the intensity of the symptoms. The size of the solitary cysts varies from that of a hazelnut to a hen’s egg or a goose egg or even as large as a fist. In this relation, it should be here remarked that, in cattle, Graafian fol- licles measuring 1.5 cm. and upwards in diameter are to be re- Nymphomania 189 garded as cysts, since, in these, according to Rubeli, (vid. pages 163 and 164) no ova are ever found. They are located either comparatively peripherally or centrally and lead, in both instances, to atrophy of the ovarial paren- chyima, which, under the pressure of the cysts, may completely disappear. By rectal palpation, the peripheral, solitary cysts, which are frequently thin walled, may be diagnosed by the en- largement of the ovary, upon which they appear as elastic, tense, smooth, fluctuating eminences. In thick walled peripheral cysts the gland feels more firm and elastic. More difficult than the diagnosis of solitary peripheral cysts is the recognition of the solitary central cysts, which are common and lead to every grade of nymphomania. One or two of these may be located in the center of the gland, never project above its surface and are surrounded by a layer of ovarian tissue as much*as 8 mm. thick. Here, the diagnosis is to be based upon the size of the ovary, the increased tension, the less readily com- pressed, elastic surface and the non-crushable character of the gland per rectum and especially per vaginam. It is an interesting observation that, in a cysto-fibrous de- generated ovary, there is now and then found one, rarely two large solitary cysts, after the crushing of which there still re- mains an abnormally large, firm, solid ovary. We have also found that after vigorous crushing of a cysto-fibrous degenerated ovary in exceptional cases there develop, after the lapse of a few weeks, cysts from the size of a hickorynut to that of a small hen’s egg and that, by periodic compression and massage, the de- velopment of small central cysts may be accelerated, as a con- sequence of which they may then approach the periphery. Another finding, to which we have already referred and which admittediy occurs rarely in nymphomaniac cows, consists in the formation of multiple cysts by which several ovisacs in various . parts of the ovary hypertrophy and acquire the dimensions of large peas, owing to which those most peripherally located pro- ject slightly beyond the surrounding surface of the ovary. The disseminated arrangement of the numerous follicles of approxi- mately uniform size, as well as the general, though not constant, absence of corpora lutea, indicates multiple cyst formation and that they are not normal, ripe ovisacs. 2. A quite frequent—cause of nymphomania consists of the 190 Veterinary Obstetrics formation of multiple cysts, accompanied—by_connective tissue hypertrophy-or-seelerosis-of the ovaries, in which a cut surface reveals several Graffian follicles, very small, up to as large asa pea, embedded in much firm, white connective tissue. Such ovaries vary in size from that of a hickory nut to a hen’s egg, are firm and hard, can not be crushed, and, now and again, there are still present yellow bodies. Contrary to the deductions of Zschokke and Simon, we were in a position 14 times during the last year to recognize with cer- tainty the presence, sometimes of large, at others of small, corpora lutea in cystic or cysto-fibrous degenerated ovaries, and, indeed, one, two, or even three of them in one ovary, (vid. post mortem findings in Nos. 2 and 3.) On the whole, there is nosubstantial ground for the opinion that, in intermittent nymphomania in cows, yellow bodies may not still be formed. Definite sclerosis of the ovaries (sclerosts ovariz) in which all appearances of ovulation cease, such as normal Graafian follicles and fresh corpora lutea, never determines nymphomania, but leads, according to our observations, when bilateral, to absence of estrum, though, when one ovary remains normal, the animal may conceive. Selerotic and cicatricially contracted ovaries are the size of a hazelnut to that of a hickory nut, smooth, and of a uniformly firm or hard, nodular consistence. 3. Yet another disease of the ovaries, which, however, leads to ‘« Stillochsigkeit ’’ or dumb estrum consists of the development of ovarial cysts containing yellowish, sero-fibrinous, pap-like fluid or of blood cysts. ‘The first mentioned formation, which is very rare, varies in size from a hen’s egg to a fist and feels like a sac filled with quicksilver. When these are crushed in living cows a granular, thick, gravy-like mass escapes. 4. In aged, good milk cows there occurs in rare instances, as a cause of nymphomania, ovarial dropsy (hydrops ovarii). In this disease the ovaries are soft, flabby and flattened. 5. A very rare cause of nymphomia in cows, not to exceed 0.5 % in our clinic, so far as we could determine, is tubercular ovaritis (oophoritis tuberculosa).* These cases run their course with and without symptoms of nymphomania and sinking of the sacro-sciatic ligaments. 1. Hess, Schweizer-Archiv. fiir Tierheilkunde, 1891, page 161. Nymphomania 19! In one cow with ovarial tuberculosis, which led to abortion in the sixth month of pregnancy, the left ovary revealed one cyst the size of a hazel nut and one yellow body. The right ovary in the living cow was the size of a child’s head, uneven, nodular, slightly mobile and adherent to the right horn of the uterus. In another case, each ovary was like a large, hard bunch of grapes, covered over with firm round nodules from the size of a pea to that of a hazel nut. Both oviducts were as large as the index finger, serpentine, rigid and likewise invaded by hard nodes from the size of a pea to a hazel nut. Finally, as further causes of nymphomania there occur very, rarely : oophoritis, abscesses in or near the ovaries, angioma of the ovary, hydrosalpinx or dropsy of the oviducts, perimetritic abscesses following perforation of a uterine horn, and cysts in the broad ligaments of the uterus. As a result of retention of the placenta and consequent septic metritis there follows adhesion of the ovaries and uterine horns to the surrounding parts, which may cause nymphomania, and the ovaries become sohidden by the adhesions that they are scarcely, if at all, recognizable by rectal palpation and are but very slightly mobile. Ina great many cases, in addition to these changes, the ovaries undergo cystic or cysto-fibrous degeneration, and attain the size of a hickory nut or hen’s egg; at times, although quite seldom, the septic metritis, in addition to the ad- hesions, leads to the formation of abscesses in the ligamentous apparatus of the ovary and in the ovary itself, which latter con- dition from a therapeutic standpoint warns one to be cautious. In a 3%-year-old, valuable premium winning cow, which had suffered from retained placenta following abortion and later from purulent endometritis, there developed, as a result of rough handling of the vagina by the owner, which irritated the uterus, an extensive adhesion of the va/vula vaginalis and, within a few days thereafter, there occurred an extensive accumulation of pus in the vagina (fyovagina) amounting to fully 3 liters. After opera- tive withdrawal of the very fetid pus, an examination of the sexual organs revealed an open cervical canal, which permitted the passage of the little finger. There was also present purulent metritis ; the right ovary was the size of a hazelnut and in the left uterine horn there was a tumor (abscess) as large as one’s 192 Veterinary Obstetrics fist, round, smooth and fluctuating. The cow showed normal estrum 14 days after the operation. 6. Supplementary to the foregoing, we shall here submit, through the courtesy of Professor Dr. Gillebeau, the appended postmortem findings relative to cystic degeneration of the ovaries: 1. A cow which had been handled by us for a long time was castrated on December 3, 1903. The right ovary weighed 20 grammes and contained in its center 2 follicles the size of peas; the one had the ordinary contents, the other was filled with clotted blood, evidently the result of preceding severe crushing. Otherwise, the ovary was in a state of advancéd fibrous degener- ation. The walls surrounding the follicles were 7 mm. thick. The left ovary, weighing 30 gr., was as large as avhen’s egg, 4cm. in diameter and contained 6 peripheral Graafian follicles, as much as 5 mm. in diameter, and one central Graafian follicle, 1 cm. in diameter, with yellow walls and contents consisting of a yellowish-red fluid serum and blood clots, which was likewise referable to the previous crushing of the organ. Otherwise, this ovary also showed extensive fibrous degeneration. Anatomo-pathologic diagnosis: sclerosis of the right ovary and cysto- fibrous degeneration of the left. 2. A 6-year-old cow. Six months previously, ovarial cysts had been crushed for the first time; later, they recurred. The patient suffered also from vaginal prolapse. Slaughtered on the 21st of December, 1905. The vagina was decidedly wide, the mucosa covered with much tenacious mucus. The habitually prolapsed portion was intensely hyperaemic, the lips of the os uteri swollen, the cervical canal penetrable for one finger. Weight of uterus 900 grammes, as against a normal weight of 600 to 700 grammes. The exaggerated weight is referable to the hypermaemia of the cervix. Uterine cavity normal. Left ovary somewhat enlarged, tissue dense with one follicle of the size of a pea and 2 yellow bodies. The right ovary con- sists of a cyst the size of a hen's egg, with clear contents, a moderately large yellow body and a vestige of normal ovarian parenchyma. Diagnosis: Chronic colpitis and cystic degeneration of right ovary. 3. A 2% year heifer, which had not been pregnant, was first handled on May 8, 1895, because of a cyst in the left ovary of the size of a hen’s egg. On the 28th of the same month there was recurrence of a cystin the same ovary, and 4 weeks later a recurrence of cysts in both glands. She was slaughtered August roth, 1895. Anatomo-pathologic findings : The dorsal vaginal arch is dispropostionately deep, so that the os wleri externum is not directly toward the vulvar opening but downwards against the vaginal floor. Above the os externum there lay a broad lip, which, in the usual condition, scarcely covered the os, but when hyperaemic certainly must have covered it completely. Uterus and oviducts were normal. The right ovary weighed 110 grammes. Its length was 3.5 cm., breadth 2.5 cm. and thickness 1.5 cm. At various points on the surface \there ap- peared yellow bodies 3-7 mm. broad. Through the dense fibrous tissue of Nymphomania 193 the gland there could be seen several Graafian follicles. The contents of one cyst of the size of a hickory nut were bloody. The left ovary weighed 55 grammes. Its length was 3.3 cm., its width 2.3 cm. and thickness 1.3 cm. The periphery was smooth, Upon section, this ovary was found to have undergone extensive fibrous degeneration and it contained a few follicles. Pathologico-anatomical diagnosis: indurative cystic ovaritis of right ovary, and indurative oophoritis of left. 4. In an aged nymphomaniac cow which was slaughtered on the 12th of November, 1904, the mouth of the uterus was penetrable for one finger, the lips of the os were slightly swollen, the uterus somewhat enlarged, the right uterine horn was empty. To it was suspended an abscess in the form of a pedunculated tumor. The right oviduct was dilated, its ovary the size of an apple and affected with two cysts as large as hickory nuts. The left uterine cornu contained some mucus and was adherent to the anterior extremity of the bladder: The left oviduct was as thick as a man’s finger and contained some pus. The left ovary was small and contained some pea-sized follicles. Pathologico-anatomical diagnosis: encapsulated abscess of right uterine horn, adhesion of left uterine horn to the urinary bladder, left pyosalpinx and cystic degeneration of both ovaries. 5. A three year old cow, which had not been pregnant, had shown normal estrum for 3 months but had not conceived; ovarial cysts and nympho- mania then developed. Post mortem examination on December 13th, 1905 revealed: the lips of the os uteri externum small, the cervical canal closed. In the cervical canal there was some viscid mucus. Weight of uterus 375 grammes. Uterine cornua very small. Uterine mucosa pale. Cotyledonal nodes normal. Right ovary, weighing 6 gr., contained several small yellow bodies and 6 pea-sized follicles. Left ovary weighed 11 grammes and was normal. Pathologico-anatomica) diagnosis: Multiple formation of cysts. 6. Acow which had been nymphomaniac for ten months, with marked sinking of the broad ligaments of the pelvis, revealed the following upon post mortem examination: lips of os uteri somewhat swollen, injected clear mucus in the cervical canal, in the walls were very hard areas sug- gestive of cancer. The uterus somewhat enlarged, peritoneal surface smooth. In the right horn was an intensely pigmented area, 3 x I cm. in ex- tent. Right oviduct dilated, its walls thin, its ampulla adherent to the ovary and distended into a thin walled, pear-shaped cyst 15 x9 cm. in size, filled with a clear, serous fluid. The ovary, concealed in the adherent ampulla, was normal in size and contained yellow bodies. Left oviduct also dilated. Fimbriated end adherent, leading to the ex- istence of an hour-glass-shaped sac 12 cm. long and g cm. broad at its widest point. It was thin-walled and filled with a clear yellowish serosity. The left ovary was normal in size, concealed in the ampulla and contained one large corpus luteum. The arteries of the broad ligament were some- what large and inflexible. 13 194 Veterinary Obstetrics Pathologico-anatomical diagnosis: bilateral serous salpingitis with oblit- eration of the opening of the ampulle through adhesion of their margins to the surface of the ovaries. 7. A yearling goat which had not shown estrum at all, nor nympho- mania, was slaughtered on October 26th, 1905. The post mortem examination revealed: uterus symmetric, its body 3 cm. and its horns 7cm. long. From the right ovary there hung by a pedicle 6 cm. long a spheroidal, free-swinging tumor 8 cm. in diameter. This 2 celled tumor contained a freely flowing yellowish fluid with numer- ous fibrin floccules. The left ovary was likewise enlarged, 3 cm. broad, fluctuating, three chambered, the cavities containing a clear, pap-like fluid. Pathologico-anatomical diagnosis: congenital ovarial cystic degeneration. 8. A 2 year old brood sow, apparently perfectly sound, which had already borne two litters of pigs, being fat, was slaughtered on May 8, 1906, and revealed the following : The ovaries were each as large as a fist and weighed together 500 grammes. Each consisted of numerous thin-walled fluctuating cysts, varying in size froma nut to an egg, the contents consisting of a transparent serum. In the right ovary there was a yellow body as large as a pea. ; Pathologico-anatomical diagnosis : cystic degeneration of both ovaries. * * * * * * The contents of solitary ovarial cysts usually consist of a watery, transparent fluid having an alkaline reaction and con- taining albumen; less frequently the contents are yellowish, reddish or bloody. It has been recognized for several decades that the thin walled peripheral ovarian cysts tend to recur. ‘The recurrence involves largely for a long duration of time the same ovary; at other times it alternates, first one, then the other; or both may be- come involved simultaneously or in rapid succession. It is worthy of note that, strictly speaking, the symptoms of nympho- mania resulting from recurrent ovarian cysts are frequently more marked and intense than those accompanying primary cysts. Exceptionally in cows which have developed “ stillochsig- keit,’’? or dumb estrum, asa result of ovarial cysts, and these have been crushed, intense erethetic nymphomania may occur 8-14 days later because of the recurrence of the cysts. Anadditional, though very rare, observation included three cows which were handled because of recurrent cysts, after which concep- tion followed but, during the entire span of gestation, sexual desire was easily excited so that they would neither graze quietly nor could they be turned out with other cows to drink and, even on the day before calving, attempted to ride other cows. In two of Nymphomania 195 them (the third was sold )the ovaries felt normal a few days after parturition and contained no yellow bodies; four months after parturition both animals showed bilateral cystic degeneration of the ovaries and again well marked nymphomania. The length of interval between recurrences is very variable in different individuals and ranges between a minimum of 3 and a maximum of 120 days, between which occur periods of 8, 12, 14, 16, 20, 27, 30 and 60 days. Often we find, in heifers and young cows, at the beginning, long and regular intervals ; later short and irregular, or the reverse. So, for example, we dbaened the: first formation of cysts 110 days after calving, in both ovaries; second formation of cysts 120 days after calving, in the right ovary ; first formation of cysts 60 days post partum, in both ovaries; second formation of cysts 120 days post partum, in right ovary; and third formation of cysts 160 days post partum, likewise in right ovary. One three year old cow which had not yet been pregnant showed cysts in the left ovary three times in succession at intervals of one month each. ‘Three months later, both ovaries had undergone cysto-fibrous degeneration and estrum now re- curred every 8 days. In another three year old cow which had not been pregnant, estrum recurred at first every 28 days and lasted 2 days; later the patient, suffering from recurrent bilateral ovarian cysts, was in estrum every 12 days. A 2% year old heifer, which had not been pregnant, showed at first a small cyst in the left ovary, eight days later a cyst as large as a hazelnut in the same gland, and, further, 15 days later, a cyst in each ovary the size of a large hazlenut. When the period elapsing between the recurrence of cysts is comparatively long, there frequently occurs one or two normal estrual periods, the cow appearing in all ways normal but failiug to conceive. The frequency of recurrence is extremely variable. In 50% of ‘the cases, after the cysts have been crushed, they do not re- cur until after the next calving. In individual cows, the forma- tion of cysts occurs almost immediately after each calving, and rel- atively such animals very frequently conceive after proper hand- ‘AIp pouiny “pojza1qZue[s sea ‘WOTIpuod) poos ur Suraq Mod ayy|—~~-E1j--- 7" 339d ‘ep sad yr szoqzy S| ,, ron teen “ih gee Aes te sjsXo [[BUIS WIM yuu 410 AI1Y JO azis ATeAO| Ai oS x RS [PPE AONE ‘ep tad [Lut Jo s1azI] g) C,, ie Nees ee #8 gad Westen 889-238008 Se peyersttesap snoiqy aSiel se ysho YyM 412A) qnu Aro Rory Jo azis AteAQ)~~~-1£|-- po “eIneu SEOISE A. 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The recurrence of cysts for 3-6-10-15 times is not rare ; it then frequently leads to atrophy and a fibrous thickening of the ovary (vid. table). The size of the cysts and thickness of their walls stand ina certain relation to the intervals of recurrence, in that in shorter intervals the cysts are small and thin walled, in longer intervals they are usually larger, their walls thicker and their rupture more difficult. The post mortem findings in the case detailed in the table upon the opposite page were as follows: Inthe right ovary there were recognizable four scars and a very thin-walled cyst the size of a hen’s egg which, in consequence of the for- mation of partitions, was separated into three sections. Of real ovarian tissue only a trace remained. The left ovary, also exhibiting four well defined scars, was the size of a hickorynut and contained a hazelnut sized cyst. The slightly enlarged uterus weighed 1 kilogram and contained some mucus. It is an interesting fact that all the cysts could be ruptured per rectum, that, further, there was constantly a restoration of the tension of the broad ligaments of the pelvis after 4 days; the quantity of milk increased and the prolapse again vanished four to ten days after the operation. B. ABSENCE OF ESTRUM Dumb Estrum. “ Stillochsigkeit.” We have already related that sinking of the broad ligaments of the pelvis, in connection with cystic or cysto-fibrous degenera- tion of the ovaries, is not necessarily associated with nympho- mania or abnormal sexual excitement but that there occur cases in cows in which there is an absence of, or only aslight degree of, sexual excitement. In these animals, absence of sexual excite- ment does not interfere with their feeding and they constantly tend to become fat. Accompanying this difficulty, there is usually present the same sinking of the hips as in nymphomania. The history of the animal is about as follows: after calving there is an entire absence of estrum or the broad ligaments of the pelvis recover their normal tension in spite of the ex- istence of the light, clear, albuminous discharge from the vagina ; noestrum appears. After 3-5 weeks fost partum there appears, and remains constant, a sinking of the broad ligaments of the pelvis although, during 4-6 months after calving, the cow ex- hibits no signs of estrum. Or, in other cases, estrum has oc- curred for the last time 6-8 months previously, at which date the cow was bred and, because of the non-recurrence of estrum and the general beliavior of the animal, it has been supposed that she was pregnant. This, in spite of the absence of a vaginal discharge, was evidently an erroneous view. The condition is generally due to acystic degeneration of the ovaries, in which the cyst wall is not usually so tensely stretched as in nymphomania but is more flaccid ; atrophy of the ovary; connective tissue degeneration (cicatricial degeneration, ovarial sclerosis) and, in a few cases, to parturient paresis, that is, as a result of the consequent changes taking place in the ovaries after parturient paresis. In such cows we were repeatedly able to. recognize, after many weeks, a persistent yellow body with ab- sence of estrum or a cystic, or more especially a cysto-fibrous degeneration of one or both ovaries, with sinking of the sacro- sciatic ligaments, the os uteri open toa degree to admit the passing of a finger, and the uterus enlarged asa result of mild chronic catarrhal endometritis. Seven times we recognized ovarial cysts. 198 Absence of Estrum 199 in cows which had previously suffered from parturient paresis and then showed dumb estrum with sinking of the broad pelvic ligaments. In one instance these phenomena were associated with a persistent yellow body in the right gland. In five of these cases, in spite of extreme sinking of the broad ligaments of the pelvis and marked bilateral cystic disease, there was not a trace of estrum to be seen. In one dumb estrual cow, presumed to have been 6 months pregnant and showing extreme sinking of the broad ligaments, there was present in the right ovary a large cyst and, in addition, an extensive pyometra with purulent discharge. In another dumb estrum cow, affected with extreme sinking of the broad ligaments, the two ovaries hung far down in the peritoneal cavity and each contained a large cyst, in addition to which there was a perivaginal abscess present. A fat young cow, a féw hours subsequent to normal parturition, exhibited sexual excitement and attempted to mount the milker. The broad ligaments resumed their normal position very promptly but sunk again to an extreme degree on the sixth day and re- mained permanent thereafter, while estrum failed entirely to recur. Inthe right ovary there was recognized a cyst the size of one’s fist, in the left a cyst the size of a large hazelnut. One observes now and then, in fat cows or deep milkers which are kept stabled, a marked sinking of the broad ligaments of the pelvis with large cysts in the ovaries without any symptoms of nymphomania. The latter tends to appear first after the animal has run at pasture for several weeks. In addition to the symp- toms of cystic degeneration already related, the following phe- nomena are of great clinical interest. C. PROLAPSUS VAGINA. There occurs with relative frequency in non-pregnant cows, seldom in heifers, far more frequently in dumb estrual cows, an habitual prolapse of the vagina. According to our investiga- tions, extending over a number of years, at least 50 % of the cases of prolapse of the vagina occur in nymphomaniac animals, which must generally be referred to the persistent occurrence of small or large ovarian cysts, seldom to cysto-fibrous degeneration of the ovaries or to ovarial cysts in combination with chronic catarrhal or purulent endometritis. We have good proof that 200 Veterinary Obstetrics the existence of the prolapse of the vagina in non-pregnant cattle is due toa chronic, permanent irritation of the genital organs owing to the presence of diseased ovaries, because, if we can bring about anormal state of the ovaries, the sinking of the broad ligaments, the swelling of the vulvaand the flaccidity of the vagina all cease in from seven to twelve days, while the milk flow in- creases. Furthermore, if ovariotomy be performed upon these animals, the prolapse of the vagina disappears in 95 % of the cases, thus demonstrating the co-ordination between the cysts and the vaginal prolapse. We should not underestimate, as a cause of continued or newly occurring prolapse of the vagina during the first two to six weeks after birth, an acute or chronic catarrhal or purulent endometritis due to the relaxed state of the pelvic diaphragm. As prodromata of vaginal prolapse due to ovarian cysts, there is observed a sinking of the sacro-sciatic ligament and a swelling of the lips of the vulva. As a general rule, the prolapse does not occur at the same time as the formation of the ovarian cysts or the sinking of pelvic ligaments, but follows these some days or weeks later. It often appears simultaneously with a well marked erethetic nymphomania. ‘Now and then the quantity of milk sinks one-half and along with it sometimes occurs a ‘“‘ holding up’’ of the milk. In rare cases, some time after the appearance of prolapse of the vagina there also appears a slight prolapse of the rectum. In one such case we identified on the right side an ovarian cyst the size of a hazelnut and in the left ovary a greatly hypertrophied corpus luteum. The prolapse often involves only the superior wall of the vagina. The swollen lips of the vulva are clearly sunken forward and ap- parently small; in many cases they hang loosely; in the superior half of the vulva they are folded and wrinkled. The wrinkles extend regularly from above and outward, downward and in- ward, and are almost wholly caused by the muscular contraction of the walls of the vestibule of the vagina or possibly are a result of the flaccidity of the radiating muscle of the vulva and common fibers of the sphincter ant externus and constrictor cunnt, causing an invagination of the lips of the vulva, that is, an entropium vulvae spasticus, from which, in place of the normal mucous margins of the vulva, two haired cutaneous surfaces come in contact. The last related symptoms (wrinkling and en- Absence of Estrum 201 tropium formation of the vulvar lips) are, from a diagnostic, pathonogmonic and superficially visible standpoint, of much im- portance. Moreover, the vulvar opening is frequently much elongated, the vestibule of the vagina markedly enlarged and flaccid, so that, in individual cows, air may readily become aspired into- the enlarged vaginal cavity, which may become greatly distended, so that, upon palpation per rectum, the vagina may be found tensely inflated with air, in order to evacuate which it is necessary to apply pressure and backward massage to the vagina, per rectum.’ If, in addition to the prolapse of the vagina, there is also en- dometritis, the os uteri is found sufficiently open to admit the index finger: out of it flows a mucous or muco-purulent exudate and the uterus shows an increased size. In cows which have suffered from prolapse of the vagina dependent upon ovarial cysts and have not been treated for these, but have had vulvar sutures applied to overcome the condition, there is now and then violent straining and pressing, on which account practitioners who are not experienced replace the vulvar sutures by a vaginal bandage or truss in order to give the prolapse more room.’ It is scarcely necessary to suggest that, in order to determine the etiology and rational therapeutics in each case of prolapsed vagina in non- pregnant cows, palpation per vaginam and per rectum should be employed and that these rules are constantly applied in this clinic. D. PROLAPSUS PoRTIONIS VAGINALIS UTERI.’ Quite analogous, from the standpoint of .cause and curative means, to the prolapse of the vagina is the prolapse of the vaginal portion of the uterus. In very great flaccidity of the genital organs this prolapse can be brought about artificially by drawing backward upon the os uteri. : E. PROGNOSIS. Cystic degeneration of the ovaries offers a favorable prognosis in general, since, in our statistics, certainly 70% of nympho- [1 In this relation it needs be borne in mind that the vagina possesses the power of ballooning, much as related here. ] 2, Hess, Schweizer Archiv fiir Tierheilkunde, 1886, p. 74: 1890, p. 212 and 1896, p. 228. 202 Veterinary Obstetrics maniac cows have been restored to fertility and again become pregnant. The remainder were mostly rendered at least temporarily quiet. The prognosis is the more favorable when the veterinary handling is begun early and the animal is not fed too intensely. The prognosis becomes doubtful in fat heifers which have never been pregnant, in old, deep-milking cows with depressed regenerative powers, as well as in cases of old standing and those in which the cysts have recurred six or more times. Estrum and pregnancy do not occur in cows whose ovaries have undergone senile atrophy or which have suffered atrophy from the rupture, by compression, of ovarian cysts. Itshould be noted, however, that a very small remnant of ovarian tissue may possess much regenerative power because there may form within six days in some cases either large corpora lutea or one or two cysts; as our collections very well show. A spontaneous recovery or rupture of the cysts has been ob- served by us in a few cases of cows which had calved normally two to six weeks before. And it is well to observe in our present state of knowledge that it was not the use of posset or sillabub that caused the rupture of the very thin walled cyst any more than the extreme filling of the rumen, which pressed upon the ovaries while the animal was lying down on a slanting floor, or to severe pressure of feces. Nymphomaniac cows which are not handled tend to become emaciated, wasted and, finally, to succumb to cachexy. In reference to the prognosis of prolapsus vaginze of non- pregnant cows, experience teaches that, in so far as the causes can be removed, and the atony of the pelvic diaphragm is not extreme, the prolapse disappears within twelve to twenty days or, if the cysts recur, the prolapse likewise returns. In hydro- and pyometra, the outlook needs be based upon the duration of the affection, the volume of the collection, and chiefly upon the facility with which the ovaries may be reached and restored to their normal condition through rectal or vaginal manipulation ; if these can be corrected, the results are often excellent. THERAPY A. MEDICINAL. We cannot undertake to discuss all the remedies which have been proposed by veterinarians of early times for the relief of nymphomania in cows, nor those which have actually been put in use and have from time to time won high repute in those regions where inner palpation of the genital organs of nympho- maniac cows is very rarely practiced. To these belong venesection, magnesium sulphate and sodium sulphate, in combination with amaris, aromatics and etherial oils, as: Rad. Gentian, Herb. Centaur minor, asafetida, Rad. Angelic, Rhiz. Calamit, Cantharid. pulv., Fol. Menth. Piperit., Fruct Foeniculi, Fruct Junpert, Piper Nigr. pulv., Rad. Valerian ; also such depressant drugs as Camphor, Potassa Bromid, etc. Slight sinking of the sacro-sciatic ligament dependent upon atony of the genital organs frequently recovers promptly after the use of the following :— R Magnesium Sulphate 300 grams P. Gent. Rad. ‘* Cinchonae Cort. aa 150 grains ‘* Cascarilla ‘ 100 grams Aq. font. q. s. ut fiat decoct. ad. colat. 8000 cc. Sig :—One pint internally 2-3 times daily. Sulphate of iron, 5-10 grams dissolved in 4 liters of water or camomile tea, is used for the same purpose. A yet greater reputation for influence upon the relaxed sacro- sciatic ligaments and genital organs is accredited to resinous and balsamic substances, especially Ol. Terebinth. The latter may be given in doses of 15-20 cc. in % liter of milk three times daily. Turpentine, camphor and asafetida has each the disad- vantage that, when given for several days, it imparts an unpleas- ant flavor to the milk, and, although we have prescribed turpen- tine or myrrh frequently, we have never been able to observe the disappearance of ovarian cysts as a result of its use. In earlier times, they bathed the loins and sunken sacro- sciatic ligaments daily with cold water or applied with massage 203 204 Veterinary Obstetrics spiritous, feebly stimulant drugs or even volatile liniments, ol. turpentine, rape oil 1:5, or compound cantharides ointment. Fric- tions over the sunken pelvic ligaments are merely of theoretic interest. The value of medicinal handling is doubtless frequently over- estimated ; nevertheless, it constitutes, in many cases, when applied alone, a valuable method, which is not to be underesti- mated, and in many other cases, a highly important adjunct in combination with operative handling. In those cows where estrum appears shortly after parturition and the uterus has not undergone normal involution and is flaccid and slight catarrhal en- dometritis arises without being caused by any recognizable anato- mical changes in the ovaries, but resulting rather from a depres- sion of the vital energy, stimulants and tonics exert a very beneficial effect. In catarrhal, muco-purulent or purulent endometritis, in addi- tion to internal medication, it is advisable to douche out the vagina daily with astringent and disinfectant decoctions or solu- tions, such as sol. plumbi. subacet. 15:1000, alum ust, 0.5-1%, Zinc Sulph. 0.25-0.5%, Creolin 0.5-1%, Lysol 0.25-1%, etc. Under all conditions, the beginning veterinarian has to behave, in the handling of nymphomaniac cows, so far as he will not seriously injure his repute or practice, with some respect toward ancient customs and psychologicconsiderations and, in opposition to views recently expressed in veterinary periodicals, endeavor to express himself frankly, tactfully and without reserve to the owner. B. OPERATIVE HANDLING OF OVARIAN CYSTS. The operative therapeutics of ovarian cysts should always be preceded by a painstaking-consideration of the anamnesis and a thorough examination of the special reproductive apparatus, as well as the other organs of the body. The proper arrange- ment of the data derived from the study of the case absolutely demands the entrance of all notes in a special journal. The investigation and examination is best conducted, from the standpoint of light and cleanliness, outside the stable, in which case the numerous simple and cheap stocks very common in this region serve an excellent purpose. Should this be wanting, the cow should be closely secured to a Operative Handling of Ovarian Cysts 205 ring in the wall or to a wagon, by means of a strong halter or horn rope. The position of the examiner should not be too low, and should be clean and dry. Cows which are sensitive about the handling of their genitals should be secured so that they can not move very freely, by forming a triangle by means of a wall with a wagon placed obliquely against it, the cow being tied short in the apex of the triangle so that she can neither move forwards ' nor backwards, while lateral movements are controlled by pushing the heavy wagon toward the wall and closing the base of the triangle. In very cold weather or when flies or gadflies are numerous, the animal may be secured and examined in a horse stall. Prior to the examination, the external genitals, anus and vagina should be well cleansed by means of a clean handtowel. If the right hand is to be used by the examiner, the tail should be turned to the right and held by an assistant standing on the left side of the cow, and reversely. The proper examination of the special genital organs requires a blouse to protect the cloth- ing and two, or better three assistants, much patience, at all times great cleanliness, removal of all finger rings, thorough oiling of the hand and arm, as well as closely trimmed nails. The evacuation of the rectum, especially in winter and in ani- mals not greatly excited sexually, is most conveniently brought about by inserting the fingers, up to the metacarpus, in the anus and, spreading the digits apart, permitting air to enter the rectum, upon which defecation usually occurs spontaneously ; otherwise the rectum needs be evacuated with the hand. A special flush- ing out of the rectum with the addition of anaesthetics we deem unnecessary. In order to avoid as far as possible the troublesome arching of the back and pressing upon the rectum, which renders the ex- amination and handling difficult and, especially when upon green food, becomes very disagreeable, it is recommended to gather the skin in folds just behind the withers, to pinch the skin of the back between the fingers, to press upon the anterior dorsal region by means of a round beam, and to strike sharply upon the horns with a small stick. [A wooden beam 5 to 6 feet long placed across the back and borne down by a man on either side, is, in our experience, the most effective plan for preventing straining. ] In locating the ovaries it is to be first remembered that the normally involuted, symmetrical, unimpregnated uterus, weigh- 206 Veterinary Obstetrics ing 600 to 700 grams, may be grasped in the open hand and car- ried relatively far-backwards into the pelvic cavity. Asa result of estrum, the uterus is normally quite hyperaemicfor three days, abnormally for four to six days, so that it is consequently larger, denser and firmer, which condition causes it to be readily felt just beneath the rectum. It is to be noted that the uterus frequently does not lie exactly on the median line but either to the right or left, and indeed far more frequently to the right side. The find- ing of the ovaries and their identification, which for the be- ginner is often very trying and sometimes accompanied by errors leading to fatal consequences, requires much training. The latter increases, however, the self-confidence in the proper examination and handling of the case and renders inner palpa- tion, in the course of time, more and more easy, until it finally be- comes no longer disagreeable. In case of veterinarians with limited experience, the ovary is most safely discovered by first grasping the uterus and thence palpating along the uterine cornu on the concave side until the apex is reached, from whence, slightly laterally, the ovary is loosely attached in the anterior border of the broad ligament, where it can be picked up. More experienced practitioners search directly for the ovary on the anterior border of the broad ligament and draw it backwards. In cases of pregnancy or pyometra the ovaries are carried far forward and downward into the abdominal cavity and thus render it difficult or impossible to reach and detect them. They are also frequently difficult to locate and grasp when the animal strains violently and the rectal walls are tensely stretched and also where the ovary is enclosed within the ovarian sinus, that is where we have to do with a so-called encapsulated ovary. In such cases it avails nothing, even if the os uteri projects into the vagina far enough to be grasped, to draw upon the cervix, either with the naked hand or with it wrapped in a small clean towel. In case of slight filling of the uterus with pus or other liquid, the ovary lying beneath the uterine horn may be made accessible by turning the uterus on itslong axis or the hand, with which the palpation is being made, passed underneath it, but not by elevating the abdominal floor by means of a beam. The examination of the ovaries includes the size, form, character of the surface, consistence of the tissues and presence Rupturing of Cysts per Rectum 207 or absence of pain on manipulation. Normally, ovaries without fresh corpora lutea, according to the age of the animal, as already related on page 168, are the size of a pea, bean or large hazelnut, ovoid and of firm-elastic consistence. Large, ripe follicles vary in size from a pea to at most the size of a hazelnut and are recognizable as soft, elastic, fluctuating spots, slightly elevated above the surface. Corpora lutea, when fresh, vary in size from a hazelnut toa hickorynut, project beyond the ovarian surface as slightly elastic, wart-like outgrowths; older and partly re- sorbed and persistent corpora (corpora albicantia and persisten- tia) are only the size of a pea to that of a hazelnut, protrude less, and are of a more firm and solid consistence. In the handling of ovarian cysts we have for many years re- lied upon the following methods in this clinic: 1. The rupture of the cysts by compression per rectum. The rupture of the cysts by compression per vaginam. The puncture of the cysts through the vaginal roof. The injection of disinfecting liquids into the ovaries. Unilateral or bilateral castration. nab wihns 1. RUPTURING THE CYSTS PER RECTUM. By this process, which was first described by: Zangger, the cystic degenerated ovary is grasped through the rectal wall, and the cyst ruptured, either by compression with the entire hand or by grasping it between the volar surfaces of two fingers and the thumb bent at a right angle or by pressing it between the hand and the ilial shaft or border. Care is to be taken that the bowel contains no feces, and it is to be remembered that the operation is more difficult in freshly fed cows on account of the more abundant defecation and, therefore, when practicable, should be undertaken during the afternoon, which has the further ad- vantage that, in case of the advent of fatal hemorrhage, the emergency slaughter need not be undertaken until the following morning, instead of during the night. Ina large proportion of cases, moderate pressure suffices to bring about the rupture of the cysts, the accomplishment of which is to be recognized by a sudden collapse of the ovary in the hand. In reference to the possibility of rupturing the cysts, those which are solitary, thin walled and of recent formation are: uni- formly most certain and easiest. In our experience with many 208 Veterinary, Obstetrics thousands of cases of cystic ovaries, we find the recent and easily rupturable ones chiefly in heifers and in cows which have recently calved and indeed with equal certainty whether the duration of pregnancy has been normal or not. The same is true of nymphomaniac cows which have only recently become affected, and of cases previously treated, in which the cysts have recently recurred. By mere accident apparently, in certain herds in which the cows and heifers run at pasture the entire summer and where they receive very little artificial food, the cysts are generally thin walled and easily ruptured. If the peripheral cysts be of long standing and possess a thick, tough capsule, earnest warning need be given, before the rup- ture of the cysts per rectum is undertaken, against the accom- panying dangers of severe maiming or tearing of certain, or of all the tissues of the rectal walls. It makes a bad showing if—in cases where the operation has been very difficult, as for example, where the patient is very resistent, shows great uneasiness and strains violently, or great sensibility in the ovaries which have already been sub- jected to the crushing of cysts several times, or difficulty in locat- ing and grasping them, etc.,—the operator withdraws from the rectum a bloody hand, since these unfavorable appearances do not tend to increase the esteem in which the operation is held, nor the standing of the operator. In peripheral cysts of varying ages, a cyst in one ovary may be easily crushed while, in the other gland, one of equal size will be very difficult or impossible of rupture. In cases of two or more cysts in one ovary, first one cyst and then the other is felt to rupture, after which there is recognizable a minute fragment of the ovary, which, however, amply suffices for inducing the occurrence of normal estrum, although the remnant consists merely of an empty, collapsed capsule ; asmall, empty, flat bag. If, in addition to one or two cysts, a corpus luteum is found, the latter usually becomes ruptured or pressed out first and then the cysts often burst spontaneously ; however, it sometimes occurs, as shown by our collection, that the cysts rupture while a small corpus luteum remains =.-iact in the ovary, and for its i dislodgement a still greater pressure is necessary. Rupturing Cysts per Vaginam 209 2. THE RUPTURE OF THE Cysts PER VAGINAM. For a long time we have, in addition to the rupturing of ovar- ial cysts per rectum, also practiced rupturing them per vaginam, an experience devoid of danger throughout, easily accomplished and accompanied by excellent results. The operation per vaginam is to be recommended in all those cases where ovarial cysts cannot be easily and safely ruptured per rectum. In this regard it is to be preferred in all those cases of peripheral cysts with thick walls, such as usually form in dumb bullers, ‘‘stillochsigkeitt,’’ and also in old, recurrent, thick-walled cysts, as well as in multiple and central cysts. Like- wise, it constitutes an excellent method for dislodging very firmly embedded hypertrophied corpora lutea which require removal. The operation is uniformly possible in cows of the spotted and brown breeds so long as the vulva and vagina are free from strictures and also in large two-year-old heifers with sound vag- inze it succeeds almost without exception if certain precautions are observed. Palpation per vaginam is difficult or impossible in heifers with fresh vagindtis follicularis infectiosa, in heifers and cows which have been handled for this disease with power- fully irritant or caustic remedies; also in animals with strictures or adhesions of the vagina, to which there is almost uniformly a well marked tendency after vaginal injections of a 2% pyoktanin solution in a vagina affected with infectious nodular disease ; and finally in two or three-year-old animals which have aborted dur- ing the first half of pregnancy or have suffered from placental retention aud whose vaginze have been irritated and lacerated by palpations by inexperienced and incompetent persons. Besides the customary precautions, palpation of the genital organs demands a thorough oiling of the vulva and the hand. The hand, usually the right, which is naturally the stronger, is then gently pushed through the vulva with a rotary motion until it reaches the os uteri externum. After the right hand has been succéssfully introduced, the left can then readily be in- serted without special difficulty. After completing the examina- tion of the vagina, the manual displacement of the ovary is car- ried out. Following the grasp: of the cyst per rectum it is then pushed backwards with tue right hand and held down- 14 210 Veterinary Obstetrics wards. First the diseased ovary is firmly grasped and drawn as far backwards as possible. ‘The left hand, carefully prepared, is then inserted with the greatest caution into the vagina and the ovary, now held in the right hand per rectum, is grasped firmly with the left through the roof of the vagina. Should the ovary escape because of sudden straining, search for and grasp it again with the right hand, per rectum, for which purpose it is best to partly withdraw the left until the gland is again located and secured. By lifting and pushing the rectum aside, the ovary is freed from the bowel and lies now surrounded only by the superior vaginal wall. Grasping the gland, either between the thumb, index and middle finger, or in the entire left hand, it may then be pressed and ruptured with all the force at command without any important injury to the vagina. In one exceptional instance, indeed, in a case of sclerotic ovary, the albuginea was ruptured, which was followed by no ill conse- quence. Should the left hand for any reason whatever become exhausted, it should be withdrawn and the right used in its stead. The bursting of thick-walled, large cysts is recognizable by the sudden disappearance of resistance and is now and then evi- denced by a slight cracking sound. It is highly advantageous that the rectal straining generally exerts no, or in other cases, only very slight influence upon the fixation of the ovary per vaginam, as a consequence of which the final compression is very much easier and more possible than by fixation of the ovary through the rectum. The thinner and more flaccid the superior vaginal wall and the farther the ovary can be drawn backwards, the easier the operation, and vice versa We have attempted to rupture central cysts through the supe- rior vaginal walls by a specially constructed instrument similar to the lithotrite of Weiss, but without result, as it was impossible to secure the affected ovary through the superior vaginal wall even though ample and flaccid. In cows with large, wide, relaxed vaginze we have also at- tempted to secure the ovary through the superior vaginal wall by means of an ecraseur chain and then to rupture or puncture the cysts, but we have found it a very exhausting task, which rarely succeeds, and our experience has not warranted recommending it. In cystic degeneration with adhesions of the ovaries to neigh- Puncturing Cysts through the Vaginal Wall 2X1 boring parts so that they cannot be pushed backwards per rectum, as well as in cases of abscess of the ovary, it is good policy to abandon manual handling and, instead, to castrate the animal by intra-abdominal ligation. And, finally, in cases of encapsulated ovaries which cannot be detached and which resist attempts to rupture them in their sinuses, there only remains castration with ligation of the ligamentary apparatus. 3. THE PUNCTURE OF THE Cysts THROUGH THE SUPERIOR VAGINAL WALL. This operation is indicated in cases of very thick-walled pe- ripheral or central cysts which cannot be ruptured per vaginam. It may be carried out with a very small concealed bistoury or with equal facility by means of the 5.5 cm. long intestinal trocar without canula such as we have used for some years and is made by Hauptner in Berlin. The strictest possible antisepsis of the external genitals, of the hand introduced into the vagina and disinfection of the instruments, is essential. The operation is simple and is not followed by important sequelz. The affected ovary is grasped and fixed with the right hand per rectum while the instrument, carried into the vagina with the left, is passed through the superior vaginal wall into the cysts. The puncture of the cyst causes a disappearance of resistance and by light pressure complete evacuation is readily induced. The ovary then consists essentially of an empty capsule. If the first effort is unsuccessful, draw the trocar back into the vagina somewhat and insert it at a different point in the ovary. In this operation, owing to the fact that the ovary is fixed by the hand in the rectum, it occasionally happens that the intestinal wall is wounded, but this is of no consequence since the muscles, being both circular and longitudinal, promptly close the small wound and prevent any escape of contents. This occurrence may be avoided in old cows with roomy vagine by grasping the ovary through the vaginal walls with the left hand and holding it far backwards, and then passing the right hand, armed with the instrument, alongside the left and making the puncture with entire safety. When the ovary can be drawn far backwards we have been enabled to make the puncture with the intestinal trocar by 212 Veterinary Obstetrics merely inserting the fingers of the right hand into the vestibule of the vagina. 4. INJECTION OF DISINFECTANTS INTO THE OVARIES. Quite analogous to emptying the ovarian cysts by puncture is the injection of them with disinfecting and dispersing agents. This was first recommended by Bertschy (Schweitzer-Archiv. 1906, p. 155) in cases of cystic ovaries, especially those under- going fibro-cystic degeneration or containing central cysts. We use for this purpose a Dieulofoy syringe fitted with a special rubber tube from the syringe to the canula, through which we inject a 1:10 Tr. Iodine solution. The practical results of puncture of cystic degenerated ovaries, as well as the intra-ovarian injections, according to our statistics, are evident only in rare cases, a fact which supports our teach- ing throughout that, when cystic ovaries cannot be restored to their normal condition and function by rupturing the cysts by compression, either through the rectum or vagina, the last and only rational resort is the uni- or bilateral castration of the animal. When the cysts are successfully evacuated early, there is re- covery from the nymphomania in from two to eight days. First the sexual excitement abates ; the animal becomes more quiet in from 12 to 24 hours, more docile and can again be turned with the other cows to water or pasture. The sunken sacro-sciatic lig- aments become normal, the vulva smaller and firmer, the vulvar opening and vagina narrower and the vaginal entropium ceases. Because of the contraction of the uterus and closure of the cervical canal, the slimy mucous discharge ceases. ‘The heretofore wild expression of the eyes becomes again normal and docile, and in a short time there is distinct improvement in the body nutrition, besides a qualitative and quantitative improvement in the milk secretion, changes which clearly increase the worth of the patient. Within about twenty days after the operation another notable result appears—the disappearance of the prolapsus vagine, or pro- lapsus portionis vaginalis utert. It is to be observed in reference to the latter that the recovery occurs without vulvar sutures and without the notable vulvar cicitrization, which decreases the value of the animal. Only in old cases with debility are vulvar sutures demanded. Furthermore, inabout three weeks the normal estrum Seguele of Crushing the Ovaries. 213 appears, when it is advisable to allow the animal to be bred. The custom, in some regions, of causing the cow to be served immedi- ately after the operation is not favorable to conception according to our observation and raises the question whether this premature copulation and excitation of the genital system does not really do harm and tend to cause the recurrence of the cystic degener- ation. Especially in well nourished heifers and in deep milking adult cows, ovarian cysts sometimes recur again and again so that they may be ruptured three to fifteen times, which puts a heavy tax on the time and energy of the veterinarian. It is interesting to note that exceptionally in cases of dumb estrum, after the cysts have been ruptured, normal estrum fol- lows or erethetic nymphomania with a recurrence of the cysts. Further, in rare cases, thick walled cysts, present at a first exam- ination and impossible of rupture, are readily ruptured under mod- erate pressure two or three weeks later. We have also noted rarely that fibrous degenerated ovaries, after vigorous vaginal pressure and massage, sometimes develop, in the course of fourteen days, cysts as large assmall hen’s eggs. In general the rupture of ovarial cysts, when carefully under- taken, is easy of accomplishment and without danger, and only requires after attention in the exceptional cases already men- tioned. Serious or fatal sequelee have not followed the rupture of ovarian cysts or the dislodgement of persistent or hypertro- phied corpora lutea in this ambulatory clinic in spite of the many thousands of cases operated upon, but we have had the fortune to observe such accidents elsewhere. . Among the sequelee we may mention : A. GREAT HYPERESTHESIA OF THE RECTUM AND GENITAL ORGANS. Now and then one meets with a cow which has been rudely pal- pated per rectum several times by an inexperienced person ; or affected with a chronic intestinal catarrh or intestinal tubercu- losis; adhesions of the uterine cornua and ovaries to the sur- rounding organs ; abscesses in the ovarian ligament; or, from handling for grariular venereal disease, has become uncommonly sensitive and strains violently, accompanied by the inspiration of air into the rectum. The straining may be somewhat controlled ‘by pinching or nipping the dorsal spine for 30 to 60 minutes, 214 Veterinary Obstetrics while the inspiration of air into the rectum may be obviated by pressure on the anus or, still better, by covering the anal opening with a folded hand-towel. Heifers and cows which have been previously handled for in- fectious granular venereal disease, with irritant remedies, or are still suffering from the malady, are frequently so irritable and afraid of the handling of the vulva or vagina that they are very resistent and require very careful and close securing and, even in the stocks, may either lower the hind quarters, rear, or throw themselves down and thus render the examination very difficult. Asa general rule the Lyperesthesia of the rectum and vagina disappears spontaneously after eight to ten weeks. B. KINKING OF THE LUMBO-SACRAL SYMPHYSIS. By this term we understand a sudden and rapidly alternating elevation and depression of the lumbo-sacral articulation, with a cracking sound. It occurs in young, timid animals and now and then also in animals suffering from a serous infiltration of the superior vaginal wall. As soon as, or just after, the hand is passed into the rectum or vagina there occurs a sudden elevation and depression of the symphysis, which painfully injures the operator’s arm and causes him to let go the ovary, which has already been grasped. This very annoying symptom usually ceases spontaneously in a few minutes but disappears more promptly by tapping the horns, pressing upon the back and leaving the arm wholly passive in the rectum. C. SEROUS INFILTRATION OF THE SUPERIOR WALL OF THE VAGINA. This condition is rarely seen except as the consequence of re- peated rude palpation of the vagina or as a result of the injec- tion of irritant remedies, especially in the treatment of granular venereal disease. As a result the vagina becomes as much as 5 em. thick with extensive serous infiltration, is sensitive, and the folds are obliterated so that grasping of the ovary through the vaginal wall is exceedingly difficult, if not impossible. By suspending the vaginal palpation, recovery occurs sponta- neously in 4-6 weeks. D. THE DETACHMENT OF THE OVARY. In the operation of securing the ovary per rectum preparatory- Seguele of Crushing the Ovaries. 215 to rupturing cysts or detaching persistent hypertrophied corpora lutea, it has happened to us in four cases in high bred, excitable heifers and young cows (never. in adults), owing to sudden straining or the sudden dropping of the lumbo-sacral articulation, . that the grasped ovary, attached to the fine, tense ligament, is unexpectedly torn away from its attachments and remains in the hand, to later fall into the abdominal cavity. The same misfor- tune can occur by drawing the ovary too far backward when grasped per rectum or vaginam. In all such cases, the ligament- ous apparatus should be immediately and carefully examined in order that hemorrhage, if present, may be controlled by compres- sion. In two of these cases we clearly felt per rectum the pulsa- ting, bleeding ovarian artery, which we compressed, as well as possible, for twenty minutes. Of the four cases, one failed to again show estrum, but the other three all conceived. It is well to bear in mind that, after the total ablation of an ovary, as also after the pressing out of large, fresh corpora lutea and vigorous after-compression of the ovary, the animal now and then shows, for 30-60 minutes, slight colic symptoms (castration colic), such as uneasiness, suspension of feeding, elevation of the tail without tympany, which symptoms spontaneously disappear in a short time. F. LACERATION OF THE RECTUM. This accident occurs mostly in delicately built heifers with a narrow rectum, or in good milch cows in which the rectum pos- sesses very slight resistant power and, even by very slight pres- sure, is lacerated. ‘These rather frequent lacerations, due con- stantly te improper palpation, may involve only the mucosa or include the muscular, and even the serous coats. While scratches’ and lacerations in the mucosa of the pelvic portion of the rectum from too long finger nails is as a rule inconsequential, extensive lacerations of the mucosa and muscu- laris lead readily to rectal strictures and to adhesions of the rectum to the surrounding parts. Small penetrant wounds in the pelvic rectum, which quickly close, lead to extensive suppuration or septic phlegmon in the peri-rectal or peri-vaginal counective tissue and thereby cause compression of the rectum with long continued straining and pressure upon the feces, marked narrow- ing of the rectum and vagina, adhesions of the rectum to its sur- 216 Veterinary Obstetrics roundings, slight pyaemic fever, emaciation, lumbar weakness and septicaemia. Now and then the abscesses break into the vagina, following which complete recovery may occur. Severe penetrant wounds of the rectum lead to fatal hemorrhage or septic peritonitis. G. Fata, HEMORRHAGE FROM THE OVARIAN ARTERY. (Hemorrhagia arterie ovarice. ) The most to be dreaded and certainly also more common sequel of ovarian operations than generally believed, is the slow bleed- ing to death from the ovarian arteries. Because of the non- vascularity of the capsule in peripheral ovarian cysts, hemorrhage does not occur from them, but serious or fatal hemorrhage is at times observed after the dislodgement of corpora lutea by com- pression, after severe crushing and laceration of the ovaries, and is possible also after the inadvertent tearing away of the ovary from its attachments. In ovaries affected with angioma and blood cysts, fatal hemorrhage may readily be caused. In the last case, which is very rare, the ovary feels soft, elastic, flabby, spheroidal, varies in size from that of a man’s fist toa child’s head and, in case of an angiom, possesses a spherical or slightly nodular character. Upon pressure, the angiom dimin- ishes in size but when the compression is removed the refilling of blood soon restores it to its former dimensions. We have twice had the opportunity of observing cows in which ovarian angioma had been lacerated through improper handling, followed by severe, though not fatal, intra-abdominal hemorrhage. The symptoms which serve to indicate ovarian hemorrhage and which appear a few hours after the operation are as follows: decreased or wholly suspended appetite, fullness in the upper flank, weariness, weakness, quickening of the respiration, violent heart beat, feeble pulse, muscular tremblings, cold horns, ears and feet, anaemia of the visible mucosa and the skin of the udder. Death usually follows 15-36 hours after operation. Aside from these fatal hemorrhages, others of a less serious character occur and become spontaneously stopped. The condi- tion may cause a more or less complete loss of appetite and rumin- nation for one or two meals and a varying degree of fullness in the upper flank region. After 24-96 hours the animals recover Sequele of Crushing the Ovaries. 217 their normal health. Evidently, fatal hemorrhage may also ac- company more or less extensive lacerations of the rectum. In one cow we ruptured by compression on two occasions, April and August, 1906, what we believed to be thick-walled ab- scesses the size of a hen’s egg in the right ovary, which was fol- lowed in each case 24 hours after operation by symptoms of se- vere peritonitis, which persisted for 14 days, so that our view was supported that in this case we were not dealing with a cyst, but with an ovarian abscess. With a view to prophylaxis of fatal hemorrhage, we believe the chief danger lies in too hasty, too careless operations, and in a too loose generalization of cases. If, therefore, each case is judiciously considered separately, as is undeniably demanded, there is no fear of after-hemorrhage. The careful, experienced practitioner will tind cases of diseased ovaries which it is injudi- cious to handle. From a prophylactic standpoint, it is desirable, in all those cases where it is not perfectly certain that it is a cyst which is being ruptured, that digital compression should be applied to the ovary for 10 to 20 minutes after the operation, or, this being impractic- able, the compression may be applied per rectum or per vaginam to the ovarian artery, which lies just beyond the apex of the uterine cornua. While the after-compression carried out per rectum has the disadvantage of being rendered difficult by the straining, and is more certain, reliable and easier per vaginam, either is efficient and trustworthy. In addition, the owner or milker should keep the patient under observation, whether day or night, for some fifteen hours after operation. 5. CASTRATION This final therapeutic agency, the last resort, the indications for which have become constantly more precise during recent years, and the worth of which in certain cases is unquestioned, is also to be considered here. The reasons for castration, as revealed by our numerous obser- vations, are as follows :— a. Recurrent peripheral cyst-formation in one or both ovaries, accompanied by nymphomania, when, in spite of frequently re- peated rupturing of the cysts, a restoration to the normal condi- tion cannot be effected. These conditions apply especially to aged cows yielding more than three liters of milk per milking, in which, in spite of repeated rupturing of cysts, a slight sexual ir- ritation, such as a slight falling in of the broad ligaments of the pelvis and swollen vulva, persist. On the other hand, we have not castrated any young breeding cows for years, because of peripheral cysts, until after we had ruptured the cysts 6-8 times in an attempt to bring about recovery, and in several cases it was not until after the cysts had been ruptured 8-12 times that normal estrum and pregnancy resulted. 6. Central or multiple cysts which cannot be broken by com- pression nor evacuated by puncture. c. Finally, ovarian edema and ovarian abscesses. The operation is contraindicated : a. In dumb estrum, loss of estrum due to atrophy and sclero- sis of the ovary ; 6. In ovarial tuberculosis ; c. In cancer of the ovary ; d. In nymphomania dependent upon disease of the oviducts, the ovarian ligaments, the uterus or the vagina, such as serous salpingitis, cystic formation in the ligamentous apparatus of the ovary, tuberculosis and cancer of the uterus and vaginal polypus. e. In tuberculous, poor, cachectic animals. , f. In cows with too narrow vaginee due to vaginal stricture.* (*The author apparently has in mind only the vaginal ovariotomy which the pathologic condition prevents, but which could not influence the flank operation. ] 218 Castration 219 From the foregoing it will be seen that the indications for castration have been reduced to a more limited compass than during earlier years, and there can be scant objection thereto because of the present enormously high price of breeding cattle, so that it becomes one of the greatest duties of the practicing veterinarian to resort to every possible means to preserve to the utmost the breeding power of well bred and valuable animals. We hold therefore that the wholesale castration of nympho- maniac cows without first resorting to earnest attempts at curing, the malady, robs them of their parturient function in a manner contrary to the interests of science, veterinary practice and stock- breeding. . According to veterinary authors cows may be castrated by : a, The flank incision ; 6. The vaginal incision ; c. Ligation of the ovary through the inferior rectal wall (Ex- perience of Trachsler-Berdes, Koch’s Encyclopaedia der gesamm- ten Thierheilkunde und Tierzucht). For a number of years we have endeavored to perfect the method of castrating cows. We have made the following in- vestigations upon cows designed for slaughter : a. Castration by tearing the ovaries from their attachments. In heifers with thin, weak ligaments the detachment of the ovaries per rectum or vaginam is comparatively easily and quickly effected, while in old animals with strong broad liga- ments the operation becomes impossible even per vaginam. The character of the lesion after division by tearing the ovary away in young animals is analogous to that induced by the ecraseur, while, in old cows, the ligamentous apparatus of the ovary tears very irregularly and sometimes involves the uterine cornua. The danger from fatal hemorrhage may be excluded by after compression, the artery being compressed between the thumb and fingers for a few minutes, but in one case we observed in the abdomen, one hour after castration, about one liter of blood. We have further found that the power of ovarial regeneration in the heifer is astonishing and that if a fragment of ovarian tissue as large as a pea or even a pinhead is left on the ligament it may rapidly develop and within 9-10 days contain one or two large corpora lutea or a cyst. [Upon the western plains of 220 Veterinary Obstetrics America where removal of the ovaries by linear tension or tear- ing away is practiced in the spaying of heifers for fattening, estrum and nymphomania are reported common, surely as a result of leaving behind some vestiges of ovarian tissues. ] 6. Castration by torsion of the ovary from the rectum or vagina. While, in the cadaver, the detachment of the ovary by torsion requires 6-10 complete revolutions, we failed in every case to bring about its removal by this means in the living animal because of the firmness of its attachment to the broad ligament and the smoothness of the ovary, which caused it to inevitably slip away. c. Equally impracticable to the two preceding methods have proven our attempts to ligate the ovary through the superior vaginal wall, including the latter with strong silk or elastic liga- ture, which was attempted by us in old cows with wide, flaccid vaginae. Apparently our failure was due to the violent strain- ing following the operation. d. On the other hand, the method of castration which we have regularly applied in our work and which has yielded excellent results is based upon the modern surgical principle that only the diseased part is to be removed, so that for some years we have practiced unzlateral castration by vaginal incision. This operation is indicated in valuable pedigreed animals with only one ovary involved in cystic degeneration, of a character which can not be removed by manipulation and which is causing nymphomania or sterility. Its success depends upon the sound- ness of the remaining ovary, which can be readily verified by direct palpation through the vaginal opening during the opera- tion. ‘The practical results of this operation, showing its great economic value, we are able to show from our experience that, if the remaining ovary is wholly normal, estrum ensues in three weeks after castration and that, after another three weeks, the ani- mal can be successfully served and impregnated. On the other hand we freely confess that the one sided castration, by increasing the nutritive supply to the remaining sound ovary, may lead to ifs cystic degeneration, and that experimentally we may cause the development of cysts by unilateral castration. If the remaining ovary is only slightly enlarged, the increased nutritive supply to it resulting from the removal of the diseased organ causes the regular occurrence of peripheral cysts in from 2-4 weeks after Castration 221 the operation. The repeated rupture of these by compression is indicated, but the constant tendency is toward an eventual sclerosis of the organ. More seldom the operation is followed at first by an exaggerated estrum with a large corpus luteum and, after its dislodgement by compression, solitary or multiple peripheral cysts appear and the ovary becomes sclerotic. Should the changes in the ovary seem incurable and be accompanied by nymphomania, the castration needs be completed. In a very valuable Simmerthal cow which had been under treatment for nymphomania for nine months, we found the left ovary the size of a hen’s egg and affected with multiple cysts. The right ovary was divided into two spherical parts, which were separated about 4 cm. from each other and possessed a dumb-bell formin miniature. Inthis patient the left ovary was completely removed with an emasculator and, from the right organ, only one of the two spherical masses was removed with the chain ecraseur. Examination of this mass showed it to be a large, round, firm cor- pus luteum permeated by connective tissue. Tendayslater the cow showed nymphomania, from a cyst formed in the right ovary, and eight weeks later it became necessary to completely remove the remainder of the right ovary because of extensive cystic disease after the cysts had been ruptured eight times in vain. e. The results of complete castration are similar in many respects to the successful handling by rupture of the cysts. The animals become quiet, sexual excitement disappears completely and the sa- cro-sciatic ligaments resume their normal position. As a result of the decreased vascularity, the uterus, vagina and vulva become distinctly smaller, prolapsus vagine or prolapsus utert portio vagin- alis disappears and nutrition isincreased, that is, the animal is more readily fatted and, while the animal yielded but about three liters of milk per milking before castration, by inhibiting the sexual functions and reflexes, the milk is materially increased in quan- tity and the ‘‘ holding up”’ of the milk is stopped. The influence of castration upon the course of tuberculosis—whether it amelio- rates the disease and tends to cure it or not and what general influence it exerts upon soundness and vigor, as indicated by cardiac and muscular power—it would be interesting to determine by further experiment. The sequelze of castration as observed by us in the course of 222 Veterinary Obstetrics years are by no means of so harmless a nature as many would have us believe and there is good room for differences of opinion as to its value in many cases. Among these unfavorable results are to be counted severe or fatal hemorrhage, in connection with which it might be urged that, in the castration of cows, the most rigid antiseptic precautions should be observed and that the pre- vention of even the slightest hemorrhage from the ovarial arteries is of very great importance in relation to infection, because any hemorrhage, with the resultant formation of hematoma or blood coagula, tends to favor the development of severe complications, the blood clots serving asa culture medium for bacterial growth. Hemorrhage from the ovarian artery also tends to induce ichorous-purulent and sero-fibrous peritonitis, indigestion and gastric catarrh, accompanied often by a permanent reduction of the milk secretion ; also serious phlegmon in the periproctal -vaginal and -vesicular connective tissue, complicated by difficult urination ; abscessation in the stump of the ovarian ligament, with or without rupture into the rectum; pelvic abscess, with rupture into the vagina or later into the peritoneal cavity ; encapsulated intra-peritoneal abscesses, leading to great emaciation ; cysts as large as the fist forming in an ovarian ligament, leading to emaciation ; as well as incomplete removal of the ovary, leading to the recurrence of cysts and nymphomania. Young and old castrated cows in a moderate or good state of nutrition, according to our observations, fatten well; but when slaughtered the flesh is yellowish, spongy, coarse-grained and not to be called prime in quality, for which cause in this region old, fat castrated cows are not sought after as first-class butchers’ stock. It is, however, to be remarked, as we have frequently observed, that thin, castrated cows are largely sold fraudulently as dry, farrow animals. II. COLLECTIONS oF PUS IN THE UTERUS. Pyometra. Hydrometra. By pyometra or hydrometra we understand the collection of a varying amount of pus or muco-purulent, (pyometra) or sero- mucoid fluid (hydrometra) in the uterus. This is comparatively common in the cow, more rare in the goat, and is accompanied or succeeded by various diseases of the genital organs It oc- Pyometra. 223 curs chiefly in 4-8 year-old cows, mostly in breeding and good milking cows, seldom in farrow animals. It is largely caused by abortion, premature birth, retained placenta, catarrhal or purulent endo-metritis, maceration of the fetus and, according to our observations, very often by the infectious granular venereal disease. Although the symptoms vary somewhat they show a notable constancy. First of all, contrary to our literature on the subject, our numerous clinical records teach that cows with abnormal col- lections in the uterus do not longer come in estrum, which con- dition, in cases where the pyometra had been preceded by estrum and coition, very often leads to the false assumption of pregnancy. Furthermore, the condition of the broad ligaments of the pelvis, the size of the vulva, the extent of the vulvar and vaginal canal, are ordinarily normal or but slightly altered, and only very sel- dom is there a marked sinking of the sacro-sciatic ligaments. Vaginal discharge is frequently absent in spite of the fact that the uterus is greatly distended and the cervix uteri is open sufficiently to permit the passage of a pencil, the little, or even the index, finger. Now and then there is seen in the stall, especially in the morning, a mucous, muco-purulent or flocculent purulent vaginal discharge behind the recumbent animal. This may be temporary or constant and variable in amount. It is also ob- served that the opening of the uterine cervix sufficiently for the passage of a pencil or of the little finger, and especially the vaginal discharge, tends to recur about every three weeks and persist for 2-3 days, or after about the same interval of time that estrum should normally recur and enduring for about the length of time that estrum should continue. In connection with the open cervical canal, the cervix and uterus are slightly en- larged or increased to the dimensions of a man’s arm. ‘The en- larged, painless uterus, which is not to be confused with preg- nancy, is either symmetric or now and then asymmetric, the one horn, most generally the right, being somewhat more distended. The size of the diseased horns varies between three and six inches in diameter and naturally their length and thickness vary greatly. If each horn does not contain to exceed a few liters of contents the point of bifurcation of the horns is very evident as is also the arching and curvature; one may also grasp the 224 Veterinary Obstetrics curvature of the uterus per rectum and draw the former back- wards and, what is of still greater practical value, may rotate the uterus 90° or { revolution on its long axis, by which means the ovaries may be grasped and examined. Every collection in the uterus causes a displacement in the ovaries, they being drawn downward, forward and toward the median line, beneath the distended uterine cornu, so that finding and recognizing them, especially in cows which strain hard, is rendered very difficult, and in the presence of great filling of both horns becomes wholly impossible. The uterine horns are smooth and of varying degrees of dis- tension, at one time being relaxed and flat, at others more tense, rounded and sugillating. The contents consist of a thin or thick liquid, which is white, whitish-gray or grayish- yellow; either sero-mucous (myxometra), or, more often, purulent or muco-purulent, odorless or fetid (pyometra). According to its etiology, one may find fragments of fetal envelops, a macerated fetus or individual bones, which latter one may distinguish by careful palpation. The ovaries are usually normal and thereis found, what should not be underrated from a therapeutic standpoint, in one of them, one, two or three various sized persistent corpora lutea firmly imbedded in the organ, their presence depending upon the failure of their physiologic atrophy to take place. ‘The other ovary has undergone fibrous or cystic degeneration and is from the size of a hickory nut to that of a hen’s egg. Therapeutics of Pyometra. At variance with the general practice and the teachings of ob- stetric authors concerning the handling of pathologic collections in the distended uterus, we have for years followed a course of treatment which has yielded good results in 50 % of all our cases and has been accepted by many of our colleagues as a reliable method. Each practitioner well knows that the therapy proposed in our literature for this disease, the prognosis of which is often unfa- vorable, consisting of the injection of astringent and antiseptic agents into the diseased uterus, has a higher theoretic than prac- tical value because, with the closed or but slightly opened os uteri, the sufficient dilation of the cervical canal and the subse- Pyometra 225 quent introduction through it into the uterus of the douching tube, is accompanied by enormous difficulty and great loss of time. The therapeutics of the malady is not faciliated, either, by the fact that, after the completion of the first dilation, there follows several hours of severe straining and pressing, with loss of appe- tite, which leads the owner to become dissatisfied and desist from further treatment. With a view to facilitating the dilation of the cervical canal and rendering it easy, as well as avoiding the afterstraining, irri- gation of the vagina with water warmed to 39°C. is recom- mended before and during the mechanical operation. The evac- uation of the pus is brought about by depressing the funnel attached to the end of the rubber tubing, which acts as a siphon. Now and then, though very rarely, one evacuation followed by flushing with lukewarm water suffices to bring about recovery and cause the recurrence of estrum. The treatment employed by us consists of the pressing out of the corpora lutea and the per rectum stroking or massage of the uterus from before to behind. As already related, the elimina- tion of the yellow body is only practicable when the uterus con- tains only a few liters of pus, that is, so long as the ovaries can be grasped and fixed perrectum. The detachment of the yellow bodies is brought about by compression through the rectum or vagina. The ovary is grasped between the volar surfaces of the thumb and two fingers or between the thumb, index and middle fingers and thus compressed. In old standing cases of pyometra— when the animal is irritable and strains violently, the rectum is very tense, and the corpora lutea are not very large or prominent and are solidly bound by connective tissue, that is, almost com- pletely encapsulated—the operation becomes very difficult, in which case it is our practice to not press out the yellow bodies, but to vigorously massage and rub the ovary between the fingers. If a voluminous collection exists in the uterus and, in spite of drawing it backwards, the ovaries cannot be brought in reach, the cow should be at once fed for early slaughter. After dislodgement of the corpus luteum, contraction of the uterus follows, the os uteri opens from before backward and the uterine contents are evacuated ; in approximately 18-72 hours 15 226 Veterinary Obstetrics after the operation there is observed, especially when the animal is recumbent, an astonishingly abundant, purulent vaginal dis- charge. It should be seen that this drains away promptly and that the floor, where the cow lies, and the gutter are well disinfected. As soon as the discharge ceases, which is usually after a very brief time, the uterus is small and empty and estrum often appears as early as the 4th day, still more commonly between the 4th and 1oth days, after the dislodgement of the yellow bodies, and tends afterwards to recur regularly. Upon the second return of estrum it is advisable to permit her to be served and conception usually follows. Exceptions to the type of cases described are seen in those cases in which, after the dislodgement of the corpora lutea, the patient shows pain. evidently the result of uterine contractions, and, for the first six hours after the operation, shows loss of appetite and slight tympany. With the advent of the vaginal discharge, these symptoms promptly disappear. In more tardy contraction of the uterus the profuse vaginal discharge extends beyond a week and, in the place of the dislodged yellow body, a second fresh one as large as a hickorynut develops which, in the interest of the evacuation of the uterus, is again to be eliminated and indeed this operation should be repeated as long as is needful and until the volume of the uterus returns to, and remains, normal. In other cases, as a consequence.of the prolonged treatment with repeated massage of the ovaries and uterus, pain and chronic purulent endometritis (whites) are shown by the patient, accompanied by slight emaciation. Nevertheless normal estrum eventually appears and conception takes place. In one cow with recurrent pyometra and dense ovaries with- out yellow bodies, we crushed the right ovary per vaginam, upon which, after 18 hours, a complete evacuation of the uterus oc- curred and, after 8 days, normal estrum followed. Besides the dislodgement of corpora lutea, the kneading and massage of the ovaries and the gentle pressure and stroking of the uterus, I have, upon the advice of my colleague, Anderegg, in Meringen, administered internally for pyometra, bicarbonate of soda in doses of 150-200 grammes a day as an emmenagogue. The results from this plan were indeed superior to the irriga- tions but not so prompt as by operative interference. After a few days our cows showed a profuse vaginal discharge and evi- Dislodgment of the Corpus Luteum 227 dent decrease in the size of the uterus. Recovery or the recur- rence of estrum occurred in one cow 4 weeks after the com- mencement of the treatment. When symptonis of soda poisoning appears such as weakness and diarrhoze, the administration of the sodium bicarbonate must be suspended for a few days. Ill. THE DIsLopGMENT OF THE Corpus LUTEUM. According to our observations, extending over many vears and including a large number of cases, we have reached the conclu- sion that this operation has not yet received the deserved atten- tion. When carefully carried out it is not dangerous, causes little pain and the succeeding straining rapidly disappears. Aside from the fact that the elimination of the yellow bodies by inducing an active hyperaemia of the uterus, which awakens its contraction and increases the auto-antiseptic power of the geni- tal canal when affected with pyometra and thus serves a funda- mentally useful purpose in this direction, we have also been led to apply this new therapeutic measure to other cases with now and then good results. It has proven useful in chronic purulent and catarrhal en- dometritis when combined with massage of the uterus, provided that the condition was not dependent partly upon tuberculosis or malignant neoplasms. It has also proven valuable in the induction of artificial abor- tion in young heifers which have been impregnated too early, and in cows with large callus formation in the pelvis which would prevent parturition at full term. The expulsion of the fetus accompanied by the membranes follows in from 24-72 hours after the operation. This plan of handling, at least so long as the ovary can be reached and grasped, is far preferable to the use of drugs de- scribed in our literature as competent to induce labor pains. The elimination of corpora lutea, in combination with gentle massage, is ineffectual in cows in which a mummified fetus is lodged in the uterus, a fact which must be attributed to the con- dition of the uterine walls themselves. The fact that estrum does not appear while the yellow body persists is of great scientific and practical interest. The condi- tion that, so long as a corpus luteum persists, estrum does not 228 Veterinary Obstetrics recur and that, if it is removed, the estrum promptly reappears, has long been known. Upon this point our statistics teach some important lessons. In addition to the persistent absence of the symptoms of estrum, such animals show the normal tension of the sacro-sciatic ligaments as well as a normal uterus and vagina. There is regularly found, in those cases which have not yet been handled, in one ovary a yellow body varying in size from a pea to a hazelnut or small hickorynut, sometimes inconspicuous, sometimes prominent and firm, often easily detached and many times removable only with difficulty or even not at all, especially when completely encapsulated in connective tissue. In rare cases, in addition to the foregoing, there may exist in the same gland a cyst the size of a hazelnut to a hickorynut; conse- quently the ovary is enlarged, smooth and fluctuating on one end, while at the other it appears lumpy. It is to be observed in the dislodgement of the persistent yellow bodies per rectum or per vaginam that, when these co- exist in both ovaries, the elimination of the larger corpora lutea as a rule suffices, and, when both a corpus luteum and a cyst exist in one and the same ovary, the cyst should first be ruptured if possible and then the yellow body pressed out. In this con- nection, we have noted at times that, after rupturing the cyst, the yellow body, which could be clearly recognized but could not be dislodged, soon became absorbed and, after a time, estrum spontaneously recurred ; on the other hand we have also seen under like conditions, after an operative elimination of the cyst and with the presence in the same ovary of a persistent yellow body which failed to be absorbed, that the cyst only very rarely re- turned. If the yellow body is small and not detachable, there is yet hope for bringing about estrum through invigorating the ova- rian circulation and causing the resorbtion of the corpus luteum by the application of vigorous massage to the affected gland. After squeezing out the corpus luteum, it should never be neg- lected to apply after-compression to the ovary for 10-20 minutes. If possible, the tip of a finger, either per rectum or per vaginam, should be pressed into the cavity from which the corpus luteum has been removed. In the walls of either the rectum or vagina the pulsation of an artery is occasionally to be felt, which is not to be confounded with the ovarian artery. Hypertrophy of the Corpus Luteum 229 The artificially aroused estrum is identical with that occurring normally and the percentage of impregnations is as high as in spontaneous heat. The artificially aroused estrum appears in 50 % of the cases on the evening of the third day or on the morn- ing of the fourth, in 20 % from 4-10 days, and in 10 % from 10-28 days after the operation. In 20 % of the operated animals, estrum failed to appear. At the point from which the persistent yellow body was dislodged there often develop, but not always, one or several new corpora in the course of a few days, which, in case estrum fails to appear, should again be pressed out. IV. HYPERTROPHY OF THE CoRPUS LUTEUM. In this region there is observed not rarely a condition which, up to the present, has not been considered in veterinary litera- ture as a cause of sterility in cows, the same consisting of a hypertrophy of the corpus luteum. The animals which have been affected with this lesion have been young cows and heifers, which have in all cases suffered, a few weeks to 2 to 4 months previously, from infectious granular vaginitis and, after recovery, in spite of estrum having recurred regularly and normally every three weeks or in rare cases every 19-20 days and having been regularly bred to healthy bulls, first to one and then another, yet fail to conceive. All animals affected with hypertrophy of the yellow bodies show as a rule a shortened estrual period of 12-15 hours duration. Rarely, it is normal or persists for 48 hours and is too severe, and asa rule these animals show for 2-4 days after estrum a voluminous dis- charge of sanious mucus, which is always prognostically bad for conception. Examination reveals normal tone and tension of the sacro-sciatic ligaments, constant traces of infectious granular vaginitis, constricted vulva, normal os uteri and uterus. . One of the ovaries, and indeed almost ‘always the left, appears normal; the other, even when examined only a few days prior to the appearance of estrum, is found affected with one to three greatly hypertrophied corpora lutea, and presents prominent, deeply fissured, clearly defined outgrowths, as thick as one’s thumb and as much as 4m. long, spherical, papilliform or wart- like, at times soft, in other cases firm, elastic in consistence. Our method of handling consists either of administering daily for 6-10 days before breeding, 25-40 grammes of powdered 230 Veterinary Obstetrics myrrh in a liter of water, or, what is more rational, the complete elimination of the yellow bodies, followed by compression when possible of the remnant of the ovary with three fingers or the entire hand, through the vaginal wall. In pressing out hypertrophied yellow bodies, it occurs excep- tionally that the ovary or enlarged yellow body splits into two portions, which remain loosely attached to each other. In such cases each portion, which is soft and elastic and consequently consists only of tissues characteristic of the yellow body, is to be removed. After the operation the animal shows for from 20 minutes to three hoursa slight arching of the back and elevation of the tail, at first slight straining and very rarely a diminished appetite at the next feeding time. At the point where the corpus luteum has been pressed out, one to several fresh corpora, less developed, generally form within 3-12 days and indeed we have observed two new corpora in the left ovary nine days after operating and three in the right organ after twelve days. The normal duration of estrum is not affected by this operation but in those cases where it was previously abnormally short it tends to become normal and our clinical records indicate clearly that 95 % of animals so handled conceive at the first service. The hypertrophy of the corpora lutea, like so many other phe- nomena in the sexual life of cows, is referable to the irritation to the sexual apparatus due to the prior attack of infectious granu- lar venereal disease. Finally, not only with reference to the indications for castra- tion but also from the view point of butter and cheese production, we should consider the influence of nymphomania and castration upon the quality of the milk. Prof. Dr. Schaffer, Canton Chemist in Berne, has favored ns with the following milk analyses and explanatory text with ref- erence to the influence of nymphomania and castration upon the character of the milk : Our literature is contradictory to a marked degree regarding the influence of sexual excitement of milking animals upon the quality of the milk. While Fleischmann (Landw., Jahrbuch 20, Erganzungsband II. S. 192) found a marked diminution of butter Influence ot Castration Upon Milk 231 fat, Wryssmann and Peter (Schweiz. Milchztg. 1902, No. 30) found the milk of cows in estrum, in general, somewhat richer in cream. They showed especially in several cases that the per cent of fat was decidedly higher for one or two days before estrum than during it. Also G. Schroeder (Milchztg. 1874, No. 104) and F. Schaffer (Mitteil. d. Naturf. Ges. in Berne 1884 u. Milchztg. 1885, S. 151) found that the milk of cows in estrum showed a high percent of fat. In the same publication the latter mentions a case of continued nymphomania, in which the per cent. of albu- minoids and solids was very high, and the rising quality.of the cream markedly weak, for which two reasons were suggested, on the one hand the increased density, on the other, the want of large fat globules. The influence of castration upon the milk, and especially in cases of nymphomania, is, according toall the above investigators, favorable. Stillour literaturecontains but few contributions upon the matter. Dieulafait (Journ. d’Agric. Pract. 1864 I., P. 519, ff. ), as well also as L. B. Arnold (Milchztg. 1873, 5S. 337) has ob- served, by castration experiments, that the solid contents of milk increased and the flavor improved, but the quantity decreased. The analyses made by these investigators vary in their contents within the boundaries of normal milk. Since castration, espec- ially in nymphomaniac cows, is very common in Switzerland, the analysis of the milk from these appealed strongly to us. For the investigations, milk was taken from nymphomaniac and castrated cows. On the whole, the experiment animals under our control were constantly in good general health, the udders completely sound and the milk macroscopically normal. As experiment animals there were used the cows, Stor, Reh and Graf; Stor and Reh during nymphomania, and Stor and Graf after their castration. Cow No. I, Stor, Simmerthal breed, about 10 years old, in medium condition. The cow calved the last time on June 24, 1903, and still yielded in January, 1904, three liters of milk per milking, and weighed 620 Kg. Since early in December, 1903, she had shown well-marked nymphomania, but on account of the experiment was not handled. Castration occurred on Feb- ruary 18, 1904, and the results were favorable. The first milk taken for chemical analysis, after castration, was on May 3, 1904. 232 Veterinary Obstetrics Cow No. II, Reh, Simmerthal breed, was about 12 years old and weighed 610 Kg. ‘The cow calved the last time on May 25, 1903, and still gave 3.5 liters of milk per milking, in January, 1904. The first signs of nymphomania occurred late in October, 1903, and the neglected disease became very severe in January, 1904. Cow No. ITI, Graf Simmerthal type, 7 years old, in good gen- eral condition. She calved last on the 23rd of February, 1903, became highly nymphomaniac during the summer of 1903, and was castrated on the 3rd of the following December. [Early in January, 1904, she weighed 800 Kg. and on January 13, yielded 5.5 liters of milk per milking. The analysis gave the following results : A. MILK OF NYMPHOMANIAC COWS. Milk of Cow, No. I. Milk of Cow, No. I. Jan. 13|Jan. 26|Feb. 15| \Jan. 13/Jan. 26! Feb. 15 04 04 , OF "04 04 04 Specific pay at 15° C. _| 1.0342} 1.0346] 1.0347/| 1.0340] 1.0358] 1.0342 Solids). 97. cn cccuneice ers) 13.18 [13.83 [13.88 13.56 |14.43 |13.75 Fat, Qso--sseseseueseeses 3-55 | 3.98 | 4.05 3.88 | 4.3 3-95 Albuminoids, ee 3.86 | 4.03 4.03 3.86 4.12 4.07 Salts: Ofna nett one a) 0.75 0.75 0.78 0.76 0.80 0.79 Chlorine, % of the ash___-] __ [12.08 {11.48 -- |14.59 |15.09 Phosphoric acid % of the ASH ee -- |29.18 /|29.21 26.25 |25.32 |26.18 Nciaity of the milk (after Soxhlet, in 100 cm')__' 7.0° 9a? 6.9° || 6.3° 8.4° 7.0° | The reaction to rennet was not remarkable in any test made. The milk coagulated under the casein test in 9% to 13 minutes. The coagulation was in no test abnormal. ‘Tests of the behavior of the milk in the incubator likewise showed normal characters. On the other hand, the tests showed, on the whole, a defective rising of cream in that, at a temperature of toto 12° C., no evi- dent line of demarcation between cream and milk appeared. Meas- ured by the micrometer, the fat globules, in the milk of cow I, showed a diameter of 0.0022 to v.0104, and in cow II, of 0.0017 to 0.0104 mm. Influewce of Castration Upon Milk 233 B. MILK OF CASTRATED COWS. Milk of Cow III. Milk of Cow I (Castrated on Feb. 18, (Castrated on Dec 3, 1903.) 1904 Jan. 13 | Jan. 26 | Feb. 15 | May 3 May 3 04 04 04 04 04 Specific Gravity at 15 C._| 1.0325] 1.0329,‘ 1.0329| 1.0320 1.0337 Solids, % ~------------_. 13,08 12.98 13.11 13.02 13.28 Fat, % ~-.--------------- 3-95 | 3.80 3.88 3-75 3.40 Albuminoids, % ----.-___ 3.88 3-43 3-45 3.53 4.01 Salts, % -----.---__. .__. 0.70 0.68 0.70 0.70 0.77 Chlorine, % of the ash___| 12.76 12.64 13.17 13.47 ~ bis ai acid, % of the: Se oe Soe rea 29.37 29.97 28.80 27. 29.31 ett of the milk vafter om as oS Soxhlet, in 100 cm*)_! 7.0° 6.7° 6.8° ; 7.0° | 8,0° The behavior toward rennet was not abnormal in any case. In the casein test coagulation occurred in 11-13% minutes. The behavior in the incubator was also parallel to that observed in any good, fresh milk. The rising of cream showed nothing ex- traordinary in the milk from either cow. The measurement of the fat globules in the milk of cow No. III, showed a diameter of 0.00135 to 0.0193 mm., while that of Cow No. I, gave a meas- urement of 0.cor1g to 0.0149 mm. If we now compare the data under tables A and B with each other we first observe a higher specific gravity in table A and a larger amount of solids than in table B. It is thereby indicated that the milk of nymphomaniac cows is not only somewhat richer in its contents than that of normal, but also of castrated milk animals. In castrated cows, it approaches more nearly the char- acter of normal milk. In conclusion, it should not be forgotten that a thorough clin- ical examination and a rational handling of diseases of the genital apparatus of cows, in spite of the many disagreeable features con- nected therewith, belong nevertheless among the most important, prominent and appreciable duties of veterinary practice, and not alone contribute to the increase of the national resources and dissipate errors and discontent in agricultural industries, but also add to our knowledge of the cause of sterility, and, not the least, add to the well deserved standing of veterinary science. In reply to the question as to how we might increase veterinary authority and efficiency in this regard, we would unqualifiedly answer that, in order to reach this plane with security, a great 234 Veterinary Obstetrics advance can be made in the teaching of veterinary students by the institution of a new and absolutely indispensable course, for inexperienced veterinarians, to be known as ‘‘ Palpation Course of the Genital Organs of Cows’’ and earnestly endeavor to give them an extensive practical discipline along this line. Many a momentary deep regret and complaint would be spared to our younger, enthusiastic veterinarians in agricultural practice, and they would be led to say: ‘‘ Labor omnia vincit improbus.’’’ Cystic oR CySTO-FIBROUS DEGENERATION OF THE OVARIES, WITH NYMPHOMANIA, IN OTHER ANIMALS THAN THE Cow. On page 194 we have recorded the occurrence of cystic de- generation in the ovaries of a goat and of a sow. While nymphomania is not extremely rare in all domestic ani- mals, it is preeminently commion in the cow, not so much ina specific sense but rather in the closely housed and high bred, fed and milked dairy cow. In economic importance, nymphomania in the mare assumes the place next to that of the affection in the dairy cow while, in other animals, it is not of great economic importance. NYMPHOMANIA IN THE MARE. Nymphomania in the mare is rare in some sections of the country, while in others it is quite common and possesses much economic importance, not so much because of the failure of the affected animal to breed, but because of its decreased value for work purposes, owing to the unusual development of disagree- able or dangerous vices. The symptoms of nymphomania in the mare are, in many re- spects, analogous to those observed in the cow. ‘There isa fund- amental difference, however. The mania in the cow presents an obvious relationship to sexual excitement and is expressed chiefly by sexual signs, however erratic, but, in the mare, the sexual signs tend to assume secondary importance, while the primary place is occupied by maniacal symptoms not so readily connected with sexual excitement. Nymphomania in the mare is most commonly met with in those 1 See foot note on page 161. Nymphomania in the Mare. 235 animals which are kept closely confined and are not bred. It is more rately observed in mares regularly worked and is well nigh unknown in those which are free, and is most commonly seen in young or middle-aged mares, rdrely in aged. It is quite uncom- mon in mules, though in one instance, we observed the disease in so marked a degree as to render the otherwise valuable ani- mal worthless. The symptoms of nymphomania in the mare usually appear just prior to estrum or during that period. As in the cow, so in the mare, estrum may occur with comparative regularity, about every four weeks but, in some cases, is apparently more frequent, while the duration of the period may be so prolonged that the intervals of calm between the periods of sexual mania may be- come very brief. In general, the first symptom of nymphomania, usually ap- pearing a few days prior to estrum, consists of excitability and irritability of temper, though in some cases this is absent. 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. If working with a mate she may con- stantly attempt to bite or kick it. Very frequently the patient will crowd against the pole of the wagon or other vehicle and perhaps lie down upon it in an effort to reach her mate and in- flict 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 mere 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, may kick, rear or run away. Toward persons her disposition is equally disagreeable and, indeed, often decidedly dangerous. Upon entering the stall to groom, harness, unharness or otherwise handle the animal, she is liable to kick, bite or trample upon 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 patient may show her vice by kicking the sides of her stall, striking 236 Veterinary Obstetrics 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 of the consequences to herself and would frequently and repeat- edly kick one leg viciously with the other. Her eyes were wild and staring and her whole appearance and behavior one of violent insanity. If her owner or other person entered the stall she became calm, began eating or fondled the person with her nose and appeared in every way rational and docile. Turned in a paddock, she behaved normally. Hitched in the usual manner to a single wagon, she behaved perfectly. The duration of the mania and its intensity had increased for some months until the degree we have described had been reached and the attacks con- tinued during 7-10 days. Ovariotomy was followed 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 discharge from the vulva. Urination is frequent, while the clitoris is erected and frequently protruded between the vulvar lips. The irritability of the vulva and vulvo-anal région is markedly increased and the animal fre- quently violently resents the handling of these parts. This is especially true, in many cases, of the tail, the animal resenting the raising of it in order to apply the crupper or remove it. While driving, should the patient either accidentally or inten- tionally get her tail over the reins, she 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 projection of the clitoris, making her unfit for driving purposes simply from repulsiveness. In most cases, however, the patient is unreliable or dangerous and cannot be depended upon in moments of emergency. During the periods of nymphomania she is very liable to be unsteady in Nymphomania in the Mare 237 draft work and may at any moment balk and tax the patience of the driver very greatly. Periodical at first, nymphomania or the vices such as kicking, balking and gripping of the reins by the tail, tend to become constant and permanent and the animal degenerates into an in- curable rogue, falls into the possession of low dealers and finally finds her way into some inhuman hands, where she succumbs to brutal work. FIG. 17. CySTO-FIBROUS DEGENERATION OF OVARIES. From insane mare. Cc, C, C, Cysts. C, L, Corpus luteum. One-half size. Fic. 18. Cystic DEGENERATION OF OVARIES. From Nymphomaniac Mare. A, Sclerotic Ovary. B, Cystic Ovary. Examined macroscopically, the ovaries are usually large and contain one to several cysts, varying in size from 14-2 in. or more in diameter and containing a clear, faintly yellowish 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 of quite large cysts that they project conspicuously beyond the general surface of the gland. In some cases, the ovarian tissue proper vanishes 238 Veterinary Obstetrics almost completely under the pressure of large cysts, so firmly compressed within the enveloping tunica albuginea (see Figs. 17 and 18). Inrare instances the cysts become enormous, reaching 4-8 inches and even more in diameter. In other instances of nymphomania we have found, in ex- tremely bad cases, small, atrophied, fibrous ovaries, very hard and dense, like fibro-cartilage. The examination of the ovaries of the mare is to be made upon essentially the same basis as that already described for the cow. ‘The examination is to be made upon the standing animal, due precautions being taken, according -to circumstances, to avoid injuries to the veterinarian from kicks and to overcome any probable annoyance from movements of the animal. Usually a single stall, with the animal tied short in it, will suffice, but vicious animals should be secured in stocks, the twich 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 well cleansed and soft- ened by warm water, and disinfected, and the rectum of the ani- mal should be emptied of feces, usually by introducing a warm soda bicarbonate solution into the rectum. The finger nails of the operator should be trimmed close and the hand and arm thoroughly lubricated with warm oil, lard or liquid paraffin, and then gently introduced into the rectum. Usually little progress, if any, can be made while the hand is in the posterior or pelvic rectum, but it becomes necessary to push the hand gently forwards into the free portion of the rectum, which can then be carried to the right or left, up or down, and forwards or backwards. The mare often strains somewhat, which should always be accepted as a signal to the operator to cease his palpation until the expul- sive effort ceases, but without withdrawing his hand. Care upon this point decreases the straining and does much to avoid lacera- ation of the rectal mucosa, associated with hemorrhage. With the palm of the hand directed downwards, the cervix uteri and uterine body, about the size of a man’s wrist, may be traced forward to the point of bifurcation, where the cornua, al- most as large as the body, are given off at approximately 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. Nymphomania in the Mare 239 The normal gland in the young or adult mare is elastic, smooth, firm, oblong and about 214—3% inches in its greatest diameter, by 114—2 inches in its lesser diameter. The diagnosis of cystic or fibrous degeneration of the ovaries of the mare and the rela- tionship between these diseases and sterility is not always clear. Nymphomania in the mare, is, unlike in the cow, most frequently observed in those animals not used for breeding purposes at all, rarely in those used in constant daily work, and chiefly in those more or less contantly stabled, irregularly worked and not at all bred. How many of them would conceive if bred, we do not know, but we do know that many nymphomaniac mares breed and that the nymphomania usually disappears during the span of preg- nancy, to recur with some degree of regularity after foaling. The condition of the ovaries in such cases is unknown. It is highly essential therefore that, in examining a mare for sterility, a diagnosis shonld be made only after the most careful examination, not only of the ovaries but of all other generative organs as well. At the same time, we must have due regard for the clinical history of the case and the general condition and handling of the patient. ‘TREATMENT. Since the ovisacs in the ovary of the mare normally rupture only in the hilus of the organ and the tunica albuginea is ex- ceedingly thick and tough, as compared with that of the cow and other domestic animals, the rupture of cysts by rectal compression is practically excluded in all cases. The ovary is attached so far forwards that it cannot be drawn back and com- pressed per vaginam, as in the cow. It is possible to puncture the cystic gland by meaus of a long trocar, while the ovary is grasped per rectum ; or a vaginal in- cision for ovariotomy may be made, one hand introduced into the the peritoneal cavity and the organ directly grasped while, with the other hand, a long trocar is carefully inserted, and the cyst punctured. When but one ovary is affected, unilateral ovariotomy. may of course restore the breeding powers and, in properly selected cases, becomes desirable. 240 Veterinary Obstetrics The question of overcoming sterility due to cysts or other ovarian disease, with a view to the restoration of the breeding powers in valuable brood mares, has been quite neglected and attention turned chiefly toward the amelioration or cure of the vice attending the malady, as symptoms, and thus restoring the work value of the animal. Since nymphomania in the mare is largely observed only in those not used or desired for breeding, this tendency in handling is natural and quite sufficient in this class of cases. It is only when involving animals desired for breeding purposes that we are specially concerned from an obstetric point of view. When our aim to restore fertility is frustrated by insurmountable obstacles, the duty of the veteri- narian yet remains to preserve to the owner, as far as possible, any work value which the animal may possess when relieved of the nymphomania. Three plans for, the surgical relief or amelioration of nympho- mania in the mare have been more or less advocated > I. CLITORIDECTOMY. Because some regard the clitoris as the chief seat of irritation, from which the nymphomaniac symptoms are reflected, the re- moval of this organ has from ‘time to time found advocates. In our experience it has not proven its efficiency, though we must confess that, owing to our skepticism of its value, we have not tested the operation sufficiently to warrant our condemning it. We can not, however, admit that the clitoris is of sufficient importance as a center of sexual reflexes, to warrant the belief that its surgical removal will generally suffice to eliminate sexual mania unless first it be shown that it is in some way organically or functionally diseased. We freely admit however that clitori- dectomy may, and does at times, overcome vice akin to nympho- mania in some respects, but, in part, this may be attributable to the physical punishment of the animal under confinement. Nymphomania being a reflex nervous disorder, physical punish- ment may at times possibly exert a curative influence. Holling- worth' records a case in the mare where he obtained relief from nymphomania by clitoridectomy, the operation being performed under complete chloroform anaesthesia, in which case the cure 1 Veterinary Magazine, Volume I. Nymphomania in the Mare 241 could not be attributed to physical punishment so far as the operation proper was concerned and it seems questionable if it could be properly referred to the casting and confinement prior to the anaesthesia. The relationship between the clitoris and sexual desire is by no means clear. While disease, functional disorder or irritation may arouse sexual desire, it is equally true that the excision of the organ does not abolish it nor interfere in the least with breeding, as we once witnessd, where some hundreds of sow pigs, from which this organ was removed by a travelling im- postor who asserted that it destroyed sexual desire and fulfilled all requirements of castration, proceeded to copulate as usual and bred as freely as though they had not been operated upon. As above stated, the nymphomania of the mare most fre- quently has its basis in cystic or cysto-fibrous degeneration of the ovaries, so far as we have been able. to determine in this clinic, where we have performed ovariotomy in more than fifty nymphomaniac patients. In such cases, excision of the clitoris could apparently overcome the nymphomania only by curing the ovarial degeneration and it would be difficult to understand how such result could be expected. We consequently believe that the alleviation of nymphomania by clitoridectomy occurs chiefly in those cases in which ovarial origin may be doubted and in which the disciplining of the patient through casting and securing and, if anaesthesia is not induced, the pain caused by the operation effect the alleged cure. The operation is simple and free from any notable danger. The animal may be cast or secured on the operating table or in the stocks and the operation may be performed under general or local anesthesia or without either. The vulvar lips may be held apart with tenacula or retractors and the clitoris seized by means of a tenaculum or tenaculum forceps and, being well drawn out, excised with a scalpel at the point of attachment of its crura to the ischiatic arch. Quite as conveniently, a longitudinal incis- ion may be made from below upwards through the floor of the vulva and the organ then excised, after proper dissection from surrounding tissues. The hemorrhage is unimportant and may be controlled by 16 242 Veterinary Obstetrics compression for a few minutes by means of forceps. The incision through the floor of the vulva may be sutured except a small area for drainage. 2. CAUDAL MYECTomy. In dealing with the symptoms of nymphomania in the mare, we related the very common and vicious habit of gripping the reins with the tail. Following the seizure of the reins, the nymphomaniac mare may lean heavily against the pole, kick viciously or, turning abruptly, break or upset the vehicle and run away. ‘This vicous habit constitutes one of the most danger- ous features of nymphomania in the mare, endangering alike property and the life of the driver or other persons and of the patient herself. Its amelioration or eradication, consequently, becomes important. The power of the animal to grip the reins may be overcome by myectomy, but this involves ordinarily no other effect upon the nymphomania. As practiced in this clinic, the animal is confined in the stocks or upon the operating table and the tail secured, firmly stretched dorsalwards. Under proper antiseptic precautions and after the application of an elastic ligature at the base of the tail, two par- allel incisions are made directly over the center of the two de- pressor coccygeus longus muscles, commencing close against the ligature and continuing for a distance of 6-8 inches, through the skin and caudal aponeurosis, laying the muscles bare. The muscles are dissected away from the surrounding parts and the entire exposed portion is excised, after which tampons of anti- septic cotton, approximately the size of the excised muscles, are laid in the cavities and, over these, an antiseptic bandage applied with sufficient firmness to control hemorrhage, after which the elastic ligature is removed. Properly carried out, the operation leaves the patient with an efficient tail in all respects except the power to forcibly grip the reins. This power being inhibited, the reins may be easily freed by the driver. The vice is thus, in many cases, greatly amelio- rated or wholly relieved, but the ovarian irritation presumably remains the same, and only the one important symptom, and those associated with it, is affected. Amputation of the tail, with or without knicking, brings about the same result, with the disadvantage, or otherwise, of the loss Nymphomania in the Mare. 243 of the tail. Neither clitoridectomy, caudal myectomy nor ampu- tation affects in any way the possibility of breeding. 3. OVARIOTOMY. O6PHORECTOMY. When nymphomania referable to ovarian disease is present and can not otherwise be effectively overcome, castration is indicated. 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, so that castration in these cases at once presents itself as the most reliable and enduring remedy. The operation is comparatively simple and not highly dangerous. It may be performed either in the standing or the recumbent position and with or without anaesthesia. In case of a valuable pedigreed. mare desired for breeding purposes, with but one ovary diseased, the operation is to be limited to the affected gland. In the standing position, without anaesthesia, the patient is secured in stocks, or otherwise, in a manner to prevent lying down, kicking or any extensive movements. The vulva and vagina, as well as contiguous parts, are well washed and disinfected, avoiding always the introduction into the vagina of irritant antiseptics. After the proper antiseptic precautions have been taken, the vagina should be partly filled with a sterilized, warm 1 % soda bicarbonate solution, which will cause the vagina to dilate or balloon. This condition having been brought about, the vaginal walls are tense and firm and the operative area is above the os uteri externum and standing perpendicular to the long axis of the vagina. Through this a stab wound is to be made, directly forward, large enough to admit one or more fingers into the peritoneal cavity and the opening thus made forcibly dilated by the fingers until the entire hand is passed through and the ovaries reached. The ecraseur is then carried in, the ovary caught in the loop of the chain and the gland promptly detached by ecrasement. ‘This usually takes place, so far as we have been able to determine, without important hemorrhage. However, in one case, when the instrument was too sharp, fatal hemorrhage followed. Possibly there is usually a greater amount of hemor- rhage than we ordinarily suspect, and it is well to take care that the instrument is sufficiently blunt, as indicated by the force re- 244 Veterinary Obstetrics quired to crush off the gland, lest serious or fatal hemorrhage occur. Uuder anesthesia the animal is confined in lateral recumbency, preferably upon the operating table, the hinder parts being ele- vated, to cause the abdominal viscera to drop forward out of the way. Under anesthesia the vagina does not balloon. The in- cision is made at the same point and in essentially the same manner. The recognition of the ovaries and their removal is the same as in the standing operation. The patient is to be kept quiet for 6-8 days on a light, laxa- tive diet. Ifthe viciousness continues, the animal should be turned out and left without annoyance for several weeks; if docile, she may be put to work. In some cases the viciousness may continue without visible abatement for a while and later wholly disappear. Too much should not, however, be expected from spaying. If a mare is fundamentally vicious, little good is to be anticipated from the operation, nor is a cure to be confidently expected if the opera- tion has been delayed till the vice has become habitual instead of periodic. Much depends too upon the driver and his method of handling the patient ; gentleness, firmness and a display of good judge- ment are demanded. The work should be regular and moderate, the animal well fed and her general health well guarded. Nymphomania and cysts in the ovaries of the smaller animals are not common. In the foregoing pages, Hess records instances in the sow and goat. We have observed nymphomania in a sow without determining the cause. We have also seen a nympho- maniac bitch, which was castrated in our clinic and in which both ovaries were the seat of enormouscysts, as shown in Fig. 19. The diagnosis of cystic ovarian degeneration in the smaller animals can only be made by the subjective symptoms of nym- phomania, to be verified by laparatomy and direct examination of the ovaries. The best treatment is castration, though, in the bitch and sow, it is indeed quite possible, in cases where the pedigree renders the patient highly valuable for breeding pur- poses, to crush or puncture the cysts and return the ovaries into the abdomen or, if only one gland is involved, it may be removed and the sound one retained, in order that the animal may breed. Senile Atrophy of the Ovaries. 245 Fic. 19. NORMAL AND CYSTIC OVARIES OF BITCH. A, Cystic ovary. B, Normal ovary with the pavilion of the oviduct turned back to ex- pose the ovary, o. C, Normal ovary covered by the pavilion of the tube, showing the meatus, M, of the ovarian sac, by which it communicates with the peritoneal cavity. One-half size. 7. SENILE ATROPHY OF THE OVARIES. In aged females, senile ovarian atrophy occurs to mark the cessation of the power of breeding and the advent of the brief old age of our domestic animals. ‘The advent of this period varies greatly with species and individuals. Fertility usually persists longest in animals regularly bred and well kept, while senile ovarian atrophy tends to occur earliest in those animals which are not bred and are badly kept or overworked. The disease is not to be distinguished, by palpation or macro- scopic appearances of the ovaries, from fibrous degeneration in adult animals, as already described, except by their very small size. It does not induce nymphomania, is not subject to remedy and definitely marks the end of the breeding powers of the animal, 246 Veterinary Obstetrics 8. SYSTEMIC AND PAINFUL DISEASES. Severe systemic affections and painful diseases, which depress the general vitality of the patient, tend constantly to prohibit ovulation and fertilitv. It is very rare that the evidences of ovulation and estrum occur during the existence of febrile dis- orders of any character. Chronic diseases—especially those of a systemic character, like rachitis, osteoporosis, and such severe bone diseases as are frequent in horses in many regions, and are expressed largely by the appearance of multiple spavins, ring- bones, navicular disease, lumbar anchylosis, spontaneous frac- tures, etc.—tend constantly to induce sterility, due apparently to non-ovulation during the active course of the disease, which may continue for 2-3 years or more. ; The remedy in these cases evidently lies in the direction of overcoming the constitutional malady itself, which is usually followed by a restoration of the normal reproductive powers. Il. DEFECTS AND DISEASES OF THE OVIDUCTS, UTERUS, VAGINA AND VULVA. I, ARRESTS IN DEVELOPMENT OF THE OvipucTs, AND UTERUS. : When dealing with arrests in the development of the ovaries, on page 155, we necessarily alluded to the concurrent arrests in the development of the genital tube. While arrests in the for- mation of the genital glands and of the oviducts, uterus and vagina are not necessarily parallel, they are quite frequently closely associated in the same individual. In Fig. 51 is shown the genitalia of a cow, in which the uterine body and the vagina are wanting and are replaced by two adherent, parallel cords representing the Miillerian ducts. In freemartins and herma- phrodites, arrests in development of the uterus and oviducts are common. In one instance occurring in our clinic, a filly “was presented, with the history that she had an annoying mucous discharge from the vulva. Palpation revealed that that portion of the ducts of Miiller which should have formed the uterus had instead developed the characters of a vagina. A slight con- striction denoted the location of the cervical canal but, beyond this, the tube had all the characters of the vagina itself; its mucosa was identical with that of the vagina so far as the sense of touch revealed and the function of the tube was also vaginal in character, ballooning promptly upon palpation, wholly unlike the uterus. While aberrations in the development of the oviducts and uterus are somewhat rare, the possible variations in such aberra- tion are extreme and their character must be determined by palpation, either through the rectum or the vagina. Such aberrations in development are rarely, if ever, subject to remedy, and their diagnosis and the determination of the character of the sterility, whether it be permanent or removable, is the chief question to be decided by the veterinarian. 2. SALPINGITIS AND OCCLUSION OF THE OVIDUCTS. Inflammation of the oviducts, accompanied by suppuration, ab- scessation and occlusion, is somewhat rarely recognized in veter- 247 248 Veterinary Obstetrics inary practice, partly, perhaps, because it is quite rare, probably largely owing to the fact that its occurrence usually passes un- recognized. The oviducts, when felt per rectum in the cow, are somewhat difficult to distinguish, as very small, dense, tor- tuous cords, extending from the apex of the uterine cornua, toward the ovary, in the anterior portion of the broad ligament. They are about ;4 of an inch in diameter. In dealing with diseases of the ovaries on pages 177 and 193, reference has been made to recognized pyosalpinx, or abscess of the oviducts. Abscess of the ovaries, which we have mentioned on page 217, is presumably due to the passage of pyogenic bac- teria from the uterine cornua, through the oviducts, to the ovaries, there to find lodgement and multiply. In thus travers- ing the ducts, a more or less pronounced salpingitis would tend to occur and this is verified by sufficient clinical and post mortem observations. The causes of salpingitis, so far as determined, are largely, infectious granular vaginitis in the cow, and retained placenta, especially following contagious abortion in the cow, and other animals. In tuberculosis and some other affections, the ovi- ducts may rarely become inflamed and enlarged so that, accord- ing to Zschokke, they sometimes attain the size of a lead pencil. The symptoms have usually passed unobserved, except as re- lated to sterility, the disease leading rarely to nymphomania. Its diagnosis can rest only upon palpation per rectum or va- ginam, by which the ducts may be found enlarged, and their consistence altered. They may be either soft or hard, and may contain abscesses or contents of variable character. The prognosis of salpingitis and pyosalpinx is always grave. The disease may abate and the organ recover, but the possibility is a remote one, since any extensive inflammation is likely to lead to adhesions and occlusion which determine permanent ster- ility. If but one tube is involved, it may be surgically removed and the patient rendered capable of breeding. 3. METRITIS. Metritis tends in all cases to induce sterility in all animals, sometimes temporary, frequently permanent. The malady occurs under a variety of forms, due to a multitude of causes and having Metritis 249 a varying significance for the fertility of the animal. The chief varities to be considered are: a. Acute metritis occurring in all species of animals, follow- ing closely upon parturition or abortion and resulting from infec- tion entering the uterus as a result of manipulations during parturition, or from retained, decomposing afterbirth or related causes. The malady is necessarily considered later among the ‘* Puerperal Infections ’’, to which the reader is referred. 6. Chronic metritis, pyometra or myxometra.—Chronic purulent metritis (pyometra) and muco-purulent metritis (myx-. ometra), as related to ovarian disease, have already received con- sideration on page 222, and need not be repeated here. These affections occasionally follow parturition, especially when accompanied by dystocia, or when parturition is succeeded by retention of the fetal membranes. This type, like acute metritis, is necessarily considered among ‘‘ Puerperal Infections ’’ and, accordingly, need not be repeated here. c. Chronic metritis, or pyometra, also occurs in non-breeding females, so far as we know, wholly independent of ovarian disease and nou-puerperal in character, as it may appear in an animal which has never bred or in one which has not recently bred. This type of cases isso like those in the preceding class in symptoms, prognosis and handling that they may be most profit- ably and concisely dealt with in the same chapter. Closely allied to chronic metritis, also, is ‘‘ Uterine Ab- scess,’’ which, following usually some puerperal infection, is naturally dealt with in that group. All these forms of disease inevitably cause, during their course, sterility, which may be rendered permanent by the changes re- sulting in the organs involved. Salpingitis, pyosalpinx and occlusion of the oviducts are constantly threatened in the course of these maladies, while ulcerations and erosions of the uterine mucosa may lead to adhesions between the uterine walls and ob- literation of the cavity of the cornua, uterine body or cervix. But such is not always true. ‘The author recalls delivering a cow after ten days of dystocia, with a badly decomposed fetus, intense metritis and enormously thickened uterine walls. A few months later she conceived. Since all these forms of disease have been, or will be, con- sidered in other chapters, it suffices to mention them here as 250 Veterinary Obstetrics important maladies in reference to sterility. The prognosis in these cases depends upon the promptness and efficiency of the handling, questions which are fully discussed in the chapters already mentioned. 4. EDEMA OF THE UTERINE WALLS. In very rare instances, edema of the uterine walls has been recorded, the edematous enlargement being so great as to simu- late pregnancy. Necessarily, it induces sterility and, so far as _known, the condition is incurable. 5. TUMORS OF THE UTERUS, VULVA, VAGINA AND OF THE BroaD LIGAMENTS. Tumors involving the uterus of the domestic animals are not at all common and play no very important role in the question of sterility. Zschokke claims that the most common tumors af- fecting the uterus of the cow are fibroma and lipoma. Tumors of the vagina and vulva are more common than those of the uterus. Perhaps the most common place for the occur- rence of benign tumors is on the line of demarcation between the vulva and vagina, that is, at the site of the hymen. ‘They usually originate from the mucous membrane and, when located in the vagina and vulva, tend to assume the polypoid form and may vary in color according to their vascularity. The fatty tumors arise in the pelvic connective tissues and press upon the vagina in a manner to more or less narrow it. Occasionally we meet with enlargements along the floor and sides of the vagina, due to a collection of secretions in Gartner’s canals. These present themselves as elongated, fluctuating tumors, which begin near the meatus urinarius and extend, ina divergent manner, obliquely forward and upward along the sides of the vagina. These retention cysts are easily diagnosed. When very large, they cause some narrowing of the vagina and may interfere with coition or parturition. Tumors of the vulva and vagina which have pedicles are easily and quickly removed with the ecraseur. When the tumors are sessile, it is necessary to use the scalpel or scissors for their re- moval. ‘These operations should be carried out under strict an- tiseptic precautions and, so far as possible, perforation of the peritoneal cavity should be avoided. If proper aseptic care has Tumors of the Uterus, Vulva, ete. 251 been taken, perforation is important only because of possible prolapse of the intestines or other viscera. The prolapse may be prevented by appropriate sutures. Where the possibility is foreseen, the tumor, with a section of the vaginal wall, may be removed by ligature. Retention cysts of the genital passage may be laid open freely with the scalpel, under strict asepsis. Diseases of the broad ligaments are rare. Yet, they occur with sufficient frequency to merit attention. So far as we are aware, they occur chiefly in the cow. Various writers refer to tubercular deposits in the broad liga- ment, which cause them to become thickened and, upon palpa- tion, to give the ordinary characteristics of tubercular invasion. In addition, there are also symptoms of the disease in other parts of the body. In one very interesting case of sterility, in a highly valuable pedigreed Holstein cow which we attended, it was found that the broad ligaments were the seat of eight or ten large abscesses with very dense capsules. The uterus and broad ligaments were adherent, over a large part of their surface, to the rectum and surrounding organs, and the ligament was invaded by multiple abscesses containing from two to five or six ounces of pus each. The contents of the abscesses were of a yellowish, granular character, which seemed strongly suggestive of actinomycosis. This impression was fully verified by microscopic examination. Although a careful search was made, no signs of actinomycosis were found elsewhere within the body. The case suggests that the infection probably occurred through the medium of copula- tion. Tuberculosis of the uterus has been alleged to be a frequent cause of sterility, but we have few data in support of the pre- sumption. Angst' records that, out of 34 sterile cows, 31 were affected with uterine tuberculosis ! Actinomycosis and tuberculosis of the uterine ligaments or walls, are usually not subject to remedy. Limited actinomy- cosis might possibly be relieved by the internal administration of potassium iodide. 1 Deutsche Tierartzlichen Wochenschrift, 1898. 252 Veterinary Obstetrics 6. OCCLUSION OF THE OS UTERI. Except during the time of estrum or at the period of birth, the os uteri externum is normally closed in all animals to such an extent that the folds of ‘the mucous membrane of the cervix are firmly pressed together, so that some degree of force is required to pass any object of size through it. The degree of closure varies greatly in the different domestic animals, being most marked in the cow and the least soin the mare. In the cow, the cervical canal is long and tortuous and the cervix itself is thick and firm, apparently almost tendinous. The circular muscle fibres of the cervix of the cow and other ruminants are very numerous and powerful and maintain the closure of the canal in a very effective manner. In the cow, the mucous membrane is thrown into the numerous longitudinal folds common to the uteri of all animals, and, in addition, there are two or three transverse ridges of mucous membrane surrounding the canal in such a manner that it becomes exceedingly difficult to pass a sound through it, from the vagina, into the uterine cavity. The physiologic dilation of the cervix during both estrum and parturition is not well understood, but seems to be due to a nervous reflex. We have already related, on page 32, that the vagina has an inherent power of dilating under sexual excite- ment. This is seen most marked in the mare and less so in the cow. Zschokke attributes this spontaneous dilation of the vagina of the cow to the contraction of the longitudinal muscle fibers, and to the action of the ischio-vaginal muscles upon those fascize which extend deeply into the vagina. He suggests that it is possible that this dilation of the vagina acts upon the mouth of the uterus and tends to widen it. As already stated, we con- sider that the reasons advanced by Zschokke are open to question, since the contraction of the longitudinal muscle fibers should tend rather to bring the walls together than to separate them. The explanation for the ballooning of the vagina requires further study, but we agree with Zschokke that it probably has an influ- ence upon the dilation of the os uteri. The closure of the cervical canal must be referred to the firm contraction of the circular muscles of the part. In the cow, the density of these muscles is so great, and their contraction so firm, that, except during the periods of estrum and parturition, it Occlusion of the Os Uteri 253 is exceedingly difficult to insert even the little finger through the canal into the uterus. Ina perfectly normal uterus of the cow, it usually requires half an hour to one hour of hard work to dilate the part sufficiently to insert an index finger. The cervix of the cow is so hard that it frequently leads the inexperienced veter- inarian to diagnose sclerosis when it is perfectly normal and thus lead to,an error in reference to the cause of sterility and an equal mistake in applying remedies for the sterility. Zschokke has searched in vain for cartilaginous tissue in the cervixes of cows, but has occasionally met with an excess of connective tissue which has led, in his judgment, to some sclerosis. Even this, he admits, isveryseldom. Zschokke, in his extensive experience, has never met with a case of atresia of the os except as a con- genital affection, and even then only very rarely. It is very evident that, if the mouth of the uterus is completely closed, neither the penis nor the semen can enter, because of the anatomical relations, which have been already discussed. It is, accordingly, an old custom in all countries to examine the cervix uteri in cases of sterility to determine if it is open or not. The frequency of occlusion of the os uteri is a question which admits of much discussion and which is differently answered by different practitioners. In the judgement of some veterinarians, it constitutes the chief cause of sterility, while by others it is re- garded as a very rareand more or less mythical condition. Hess passes over the question of occlusion of the os very lightly, while Zschokke considers it of much importance and of comparatively frequent occurrence. Bass deems it one of the great causes of sterility in the cow. It is dificult to harmonize these conflicting views. It is con- stantly to be remembered that an os uteri is not closed, so far as conception is concerned, so long as the canal will admit of the passage of a small probe. There is no essential reason why the os uteri externum should be any wider than the canal of the oviducts, which barely admit the passage of a large horse hair. The anatomical character of the cervix of the cow renders it ex- ceedingly difficult to determine if such a passage exists or not, until the os has been sufficiently dilated to permit the passage of a finger into the uterine cavity. According to Zschokke and others, the occlusion of the os, or a harmful stricture, has been met with in animals which have recently given birth to young 254 Veterinary Obstetrics and has been followed by a vaginal discharge, presumably due to endometritis. In other cases, it occurs without any preceding disease. We have indeed very little in our veterinary literature to thoroughly demonstrate the closure of the os uteri, as verified by post mortem examination, and the diagnosis has usually been based upon the difficulty of introducing a finger through the cervix into the uterine cavity. This, as we have already stated, is well-nigh impossible, at most times, in the normal uterus of the cow. In the mare, closure of the os uteri is stated to occur, and doubtless does, but in our experience we have never seen such a case except in some disease of the uterine cavity itself, such as pyometra or: uterine abscess, in which the cervix becomes sclero- tic and in which, sometimes, as observed by us clinically, a com- plete closure of the canal results. The diagnosis of closure of the os uteri is very difficult in the cow, still more so in the small domestic animals, but there is no difficulty ordinarily in the mare. If the uterus of the mare is normal, the index finger can readily be passed through it, even when she is not in estrum. During estrum, it is not at all rare to find the os of the mare so open and flaccid that the entire hand may readily be introduced through it. In the cow, we should preferably examine the animal for sus- pected closure of the os uteri during the period of estrum, be- cause the canal is naturally more dilated and dilatable at that time. The best method for examining the cervix is to grasp it per rectum with one hand, so as to fix and hold the cervix in a direct line, and then test the patency of the cervical canal with the index finger of the other hand or with a sound. One of the great difficulties in passing either the finger or the sound is the aforementioned transverse folds of mucous membrane, which tend to obstruct the passage and may lead to the conclusion that the canal is closed when, in fact, the sound or finger has simply been caught in one of these folds, and the cervical canal is wholly normal. Another serious difficulty is that, unless the cervix is fixed per rectum, as suggested, the pressure neces- sary to force the finger or sound through the canal causes the cervix to bend acutely, or even at right angles, and thus cause the finger or sound to be forced against the wall of the cervix, Occlusion of the Os Uteri 255 which has now become .perpendicular to the long axis of the finger or sound. In this way, we have known the operator to force his finger through the walls of the cervix into the peritoneal cavity while attempting to ‘‘open’’ a cervical canal which was not ‘‘closed’’, but perfectly normal. The diagnosis of occlusion of the cervical canal, as already suggested, is all too frequently mythical and based upon un- scientific grounds. The occurrence of the condition is freely admitted and verified by clinical and post mortem examinations, but the frequency of pathologic occlusion, of a degree to actually constitute a fertility destroying closure, is a debatable question of great significance. When is the os uteri closed to a degree to interfere with or prevent fecundation? Few will answer it alike. If we knew better the exact relation of the organs during copulation, the answer might be more specific. Some claim that, during copulation, the glans penis enters the os uteri. As proof, they cite uterine laceration or perforation alleged to have resulted from copulation, but can adduce from the pages of veterinary literature but one or two cases. ‘The records are not wholly convincing in the one case we have found recorded. Even if it occurred, as alleged, the fact of serious or fatal injury would indicate rather that it was due to abnormal copulation. It is fair to assume that manual exploration of the vagina in estrual animals induces conditions somewhat analogous to those obtaining during copulation and there is certainly little therein to suggest that the penis enters the cervical canal. The os uteri, while distinctly dilated as compared with the condition observed during the interval between estrual periods, is never- theless closed too firmly to make the entrance of the penis into it comprehensible. It is to be further noted that, when the so- called ‘‘impregnators’’ are used in the mare and inserted in the os uteri externum immediately prior to service, the apparatus is not dislodged by copulation, as would inevitably occur should the penis enter, or even press hard against, the os. In the cow, the canal is too small and tortuous to permit the penis of the bull to enter it, especially with the sudden and violent thrust made by that animal. The same holds true for other ruminants. 256 Veterinary Obstetrics Others maintain that, during copulation, the meatus urinarius of the male penis is pressed against the os uteri externum of the female at the moment of ejaculation and that the semen is in- jected directly into the uterus through the cervical canal. Little evidence exists in favor of such assumption and much against it. In the mare, it is especially notable that large quantities of semen are expelled from the vulva immediately after the completion of copulation, which would signify that it had probably not passed beyond the vagina. If the vaginal cavity is examined immediately after copulation, large quantities of semen will be found in it, apparently the normal volume dis- charged at a single copulation. If this is largely expelled from - the vagina immediately after ejaculation, it would scarcely appear that it was first thrown into the uterine cavity or cervical canal, but that it was discharged agdinst the anterior wall of the vagina, especially the os uteri externum, and that only a very small proportion of the fecundating cells pass beyond the vagina to assume any important part in the process of fertilization. Some of the spermatozoa pass through the cervical canal, uterine and cornual cavities, reach the oviduct and meet the ovum or ova, where ove male cell serves to fecundate each female cell or ovum, while the other spermatozoa perish. Most of the sperm- atozoa are expelled from the vagina immediately after copulation. Occlusion of the os uteri, as a fundamental cause of sterility, con- sists of such complete atresia, or closure, of the cervical canal as to render the passage of the microscopic spematozoa improbable or im- possible. In the oviduct with a canal admitting a large horsehair, the size of the channel is abundant for purposes of fecundation and, so far as we can determine, a like opening through the cervical canal fulfills all demands for impregnation. According to this view, the smallest recognizable opening ~ through the os uteri and cervical canal constitutes a reproduc- tively zormal condition and, ere we can diagnose occlusion of the os, we need to determine that the passage of microscopic sperma- tozoa, endowed with vigorous motile power and in their normal element, is impracticable. Hence, in our judgement, if the smallest sound, possessing adequate rigidity to render its insertion practicable, can be passed through the cervical canal without undue force, the diagnosis of occlusion of the os uteri is not warranted. Occlusion of the Os Uteri 257 When closure of the cervical canal has been definitely di- agnosed, it becomes evident that the most direct and only hopeful method of dealing with the consequent sterility is by its artificial dilation. The manual dilation of the os uteri should be carried out under the strictest aseptic precautions in order to avoid an inflammation of the parts, which must be more or less injured during the pro- cess. In the cow, the dilation must be very gradual and its accomplishment requires much patience. As suggested above, it is best, where we wish to use force in penetrating the cervical canal, to first grasp the cervix uteri per rectum with one hand and then carry out the dilating operation with the other hand in the vagina. The operator should have the finger nails well trimmed and perfectly smooth, the hands clean, disinfected and well softened. The hand should be oiled or should be moistened with some unctuous substance, like a solution of sodium bicarbon- ate or a weak solution of salt at a temperature of about too° F. The index finger should be pushed gently into the os with a rotary motion and advanced until resistance disappears and the finger tip enters the uterine cavity. After persisting in the effort for a considerable period of time, until the finger becomes tired and the animal considerably irritated, it may be best. to desist for a while and renew the operation some hours later or upon the following day. Zschokke condemns the use of wooden or metallic sounds in bringing about this dilation because he considers them dangerous. We hold, on the other hand, that they are quite as safe as the finger, providing, always, that the precaution is taken to first grasp and fix the cervix with one hand per rectum, in which case the progress of the sound may be constantly determined and the operator can know exactly if it is following the central line, that is, the cervical canal, and may determine when it has reached the uterine cavity. We even regard a metallic sound as distinctly safer, easier to manipulate, and more effective than the finger, in dilating the os or diagnosing its patency, because it can be much smaller and more even than the finger. For the cow, this instrument should be of well tempered, plated steel, ;3, to } inch in diameter at the point, 18 to 20 inches long and furnished with a handle con- 17 258 Veterinary Obstetrics venient for manipulation. Some writers advise a curved point, but the canal it is to penetrate is direct and the instrument should be straight. An interesting question in the dilation of the cervical canal is that in relation to the use of local anaesthetics, such as cocaine, stovaine and others. We find no records of the use of these drugs for this purpose. It would seem to us, however, that two very marked advantages might result. First, the use of these substances might diminish the resistance and straining, by obviating the pain incident to the process, and thus do away with one of the chief hindrances in the operation. In the second place, we have found that stovaine, especially, paralyzes motor nerves and it would appear to us that, if injected into the walls of the cervix, it might inhibit the muscular power and render the dilation of the canal easy, if not in itself accomplishing the desired end. The smearing of the cervix of the uterus with belladonna and other similar substances, with a view to relaxing the parts, has not been followed by success, according to our observations. Having already indicated our skepticism concerning the scien- tific basis for attributing a large percentage of instances of sterility to occlusion of the os uteri, it is essential to discuss freely the prognosis of dilation in the presence of this alleged cause. Numerous contributions appear here and there, in which excellent results are recorded from ‘‘ opening’’ the uterus and it is a common practice among stallion grooms to ‘‘open’’ the os in mares which fail to conceive at the first or second service. It becomes an exceedingly difficult and delicate task to differentiate between fact and fancy, between science and mysticism. Except we have first learned positively that a barrier to- fecundation, not spontaneously removable, exists, we are not prepared to say that a given coition will or will not prove suc- cessful because preceding copulations, be they one or many and distributed over months or years, have failed. Without ‘‘ open- ing’’, without mystical concoctions, without interference of any kind, we have observed the sudden and unexpected appearance of fertility after barrenness, in mares, from maturity up to the age of Io or 12 years or more. In such cases, the reasons for the final conception and prior sterility remained equally impene- trable enigmas. Occlusion of the Os Uteri 259 So, if a series of females which have failed to conceive are ‘‘opened’’, are drugged with this or that nostrum, have yeast injected into their vaginz, have ‘‘impregnators’’ applied, or resort is had to artificial impregnation, some of them, possibly all, may conceive. It is possible, though, we believe, highly improbable, that the forcible dilation of the cervical canal may indirectly favor fecun- dation. The discharge of viable ova into the oviducts is a reflex act. We know too little of the causes of the maturation and rupture of the ovisacs and the part played therein by reflexes from the other portions of the genital apparatus. It is believed by many breeders, and apparently not without reason, that sexual excitation tends to hasten and even determine ovulation and hence some breeders practice forced service, at times, in order to hasten or insure estrum and ovulation. It is common experience and observation that the proximity of a male stimulates sexual appetite in the female, and we have good reason to assume that, with it, is associated the stimulation of ovula- tion. If this be true, we are not in a position to deny that the manual or instrumental dilation of the cervical canal may stimu- late normal ovulation and hence indirectly favor conception. We cannot, however, in the present state of our knowledge, place scientific reliance upon dilation of the os uteri as an effect- ive remedy for sterility, except in isolated cases. On the other hand, there is much in the ordinary ‘'‘ opening of the uterus’’ which is in violation of all surgical principles. Time and again we have watched the stallion groom, without any precautions whatever, proceed with his operation. Some dirty water in a filthy stable pail, to which is added some irritant laundry soap, is used as a lubricant for the dirty unwashed hands of the groom, while the long and rough finger nails, con- cealing abundant filth, receive no attention. The rough, dirty hand is forced through the vulva and vagina with scant regard for their delicacy, and is then rudely forced onwards through the cervical canal, tearing the tissues and inducing extensive hemor- rhage so that the hand, when withdrawn, is covered with blood. The character of the uterine cervix of the cow renders such an operation less practicable and it is virtually impossible, within a reasonable time, to force the entire hand into the uterine cavity. 260 Veterinary Obstetrics We have known, however, a veterinarian to force a finger through the cervical walls into the peritoneal cavity. Sober consideration must convince anyone that such rough methods are not only antagonistic to the production of the desired result, but actually dangerous for the well-being of the patient and profoundly repulsive from a surgical standpoint. A rudely dilated os uteri means hemorrhage into the cervical canal, with consequent blood coagula in the-parts, which, if the animal is at once served, would seriously impede, or prevent, the passage of spermatoza through the canal. At the same time, the pain from the physical injuries will cause straining and tend to result in an unusually and injuriously complete expulsion of the semen. If time is permitted to elapse after the operation before serv- ice is permitted, the injured parts become inflamed and swollen, and the closed os more tightly closed than before the operation. Infection almost inevitably contributes to the dangers to the life of the spermatozoa. These conditions not alone tend to prohibit impregnation, but endanger the health of the genital passages, by planting infec- tion in the injured tissues and, in our clinical experience, chronic pyometra has followed ‘‘ opening’’ so closely in some cases as to point to the rude operation as the probable basic cause of the malady. di Others, especially veterinarians of excellent repute, instead of resorting to these rude and barbarous means of dilation, apply, the more scientific and far less dangerous expedient of intro- ducing, into the cervical canal, sponge or kelp tents, which, through the absorption of fluids, swell up and gently dilate the canal. Admittedly they are far milder and safer. But they are only applicable in those cases where the canal is already permea- ble, as they cannot otherwise beinserted. As above suggested, when the canal is penetrable, the further dilation is, in our judgment, unnecessary, if not wholly unwarranted. Nor is the danger from infection wholly obviated. Any foreign body, unless it be permanently aseptic or antiseptic, invites infec- tion in the part and, when the dilating body is removed and the infection left behind, it remains as a menace to all spermatozoa which must pass through the infected tract on their way to con- jugation with the ova. Atony of the Genital Tract, ete. 261 On the whole, therefore, we consider that the manual or mechanical dilation of the cervix uteri should be strictly limited to those cases where the sterility is traceable to a definite ob- struction in the canal, which it is possible to overcome by the operation. Hypertrophy of the Os Uteri.—Aside from the closure of the os uteri, Zschokke, Hess and others have observed hyper- trophy of the cervix as a hindrance to impregnation. In these cases, the os uteri externum projects far into the vagina, and is enlarged and firm. Zschokke has found this condition only in old cows which had repeatedly given birth. Hess believes that this condition may be transmitted to the offspring. The condi- tion consists chiefly of a hypertrophy of the mucous membrane and the folds may reach ten times their normal size. Some veterinarians have recorded tuberculosis of the cervix uteri. Zschokke alludes also to the formation, about the os uteri externum ‘in cows, of mucous membrane flaps as much as 6 cm. long, which, in his judgment, might act as a hindrance to the migration of spermatozoa through the cervical canal. In the mare this con- dition is very common in conjunction with general atonic condi- tions of the genital tract, which we consider below, where we shall deal with the problem of handling. The general handling of hypertrophy of the os uteri, or vaginal portion of the cervix uteri, must usually be coupled with an unfavorable prognosis. If the condition is static, if no active disease processes are present, and it is believed that parturition could be safely accomplished, artificial insemination may be successfully applied, if a small- caliber syringe nozzle can be introduced throughthe hypertrophied organ. If active disease processes are present, appropriate remedies should be applied for their cure. In general, however, the condition is beyond remedy. f 7. ATONY OF THE GENITAL TRACT AND DILATION OF THE CERVIX UTERI. In contrast to constriction or occlusion of the os uteri externum, we more commonly meet in the mare with an abnormal dilation of the passage. The os uteri is unusually wide open and flaccid and readily admits of the entrance of several fingers or of the entire hand. 262 Veterinary Obstetrics There is present a general flaccidity of the genital tract, the mucosa are somewhat injected and there is an increased secretion of mucus. The malady occurs usually in adult or old brood mares, but we have observed it in fillies. Asaruleitis observed in idle, highly-fed animals which have grown over-fat. The condition of the genital tract is simply the result of the general atonic state of the animal, caused by injudicious management. Along with this condition, the mucous membrane about the os uteri externum becomes hypertrophied and developes exten- sive flaps of mucous membrane, which hang down over the os like curtains. These may mechanically interfere with insemina- tion, as they act somewhat as valves and may possibly tend to deflect the spermatozoa from the cervical canal. The handling of sterility due to these causes must be directed primarily to the removal of the causes themselves and secondarily to relief from the changes which have occurred in the genital canal. 5 First, the patient should be so handled as to restore the normal systemic tone. Idleness and obesity are to be supplanted by ex- ercise, or by work of such a degree as to restore the general tonicity. This is not always easy of accomplishment in a harem of mares used wholly for breeding. In some manner, exercise should be enforced. When at pasture, the food supply should be reduced, by restricting the area or increasing the number of animals within the enclosure, to such a point that the mare must exert herself to a reasonable degree in order to secure the amount of food necessary to maintain good physical condition, and thus overcome the obesity and want of tone. A quiet mare, especially of the draft breeds, will not exercise unless compelled to do so in order to obtain food, water or shelter. The mere provision of a sufficient area, in which exercise may be taken, by no means assures exercise, except it is made necessary. If abundant food and water are close at hand, the animal will move far enough to procure these and generally stop, content with these. Even greater care is essential in order to secure adequate exercise in winter. If abundant food and water are supplied at the stable, the animal is often too content to remain idly near the stall, even though a large enclosure is open to her, where vigorous exercise could be had. Loss of Cotyledons 263 If the food supply is limited, and an extensive field is open to the animal, in which some food can be procured only by more or less vigorous exertion, she will promptly take this exercise in order to provide the additional food, for which the system craves. Best of all is work. Mares moderately, or even hard, worked are always among the most regular breeders. It is not rare for mares, which have long been sterile, to breed after being placed at steady work for a long enough time to bring them into good working condition, with a general vigorous tone. Locally, something may be done ,to restore the genital tract to its normal tone. The congestion and atony may be largely alleviated by astringent douches, such as solutions of alum or tannin. Should there seem to be important infection, adequate disinfection should follow. Powdered tannin and iodoform may be introduced into the uterine cavity in gelatin capsules, and these crushed or opened so that their contents may at once escape. The curtain-like flaps of mucous membrane may be snipped off with long scissors or removed by other convenient means. In all such cases the ovaries, oviducts and cornua should be carefully searched for abnormalities, and should any be found, appropriate measures applied. 8. Loss oF COTYLEDONS. It has been assumed by some that the loss of the cotyledons in ruminants serves to cause sterility, but Chauveau and others have experimentally removed all the cotyledons which could be recognized, without inducing sterility. New cotyledons were formed to maintain the functions of the uterus. Clinically, the pathologic destruction of the cotyledons does not necessarily lead to sterility. In retained afterbirth, placen- titis frequently follows; the cotyledons may be surgically re- moved in order to overcome the disease; or they may become necrotic and slough off and yet sterility not ensue. We have removed all recognizable cotyledons in order to overcome grave sepsis due to their necrosis, after which the patient bred promptly. The complete necrosis and sequestration of the cotyledons in retained placenta is not rare in cows. We have observed the sloughing off of, so far as we could recognize, all the ‘cotyledons, the greatly enlarged structures lying in a mass in the uterine cavity, still attached to the secundines. Following their re- 264 Veterinary Obstetrics moval and the disinfection of the uterine cavity, fertilization occurred in due season. Very frequently, when a retained fetus has undergone purulent decomposition and is later removed surgically, it is found that the cotyledons are all necrotic and, dropping off, are expelled along with, or following, the fetus. In due time the cow again conceives. The loss of the cotyledons does not lead to sterility; the septic metritis or other disease accompanying the retained placenta may cause sterility by in- ducing salpingitis followed by occlusion of the oviducts. Other anatomical changes may occur, rendering the patient sterile. Our attention is to be directed to measures which may prevent the loss of the cotyledons, or, if they have sloughed away, to a restoration of the uterus to its normal health. g. VAGINITIS. Though the normal secretions of the vagina are feebly alkaline, any disease which may affect this organ and induce purulent or other disease discharges tends to change the reaction of these, through bacterial influence, and render them acid, a condition which is inimical to the life of spermatozoa. It is held that, normally, the copulative tract of domestic animals contains more or less bacteria, the number and variety being quite abundant in the vulva, but decreasing both numerically and in variety as the os uteri is approached. Generally, also, it appears that the pathogenic power of bacteria diminishes as the os uteri is ap- proached so that, in the anterior portions of the vagina, the bac- teria present are largely saphrophytic. The bactericidal power of the vaginal walls gradually increases toward the anterior ex- tremity, to become complete in the normal organ in the cervix uteri, beyond which the genital tract is normally free from bac- teria. When, however, the copulative tract becomes invaded by pathogenic bacteria, their products, coming in contact with the spermatozoa, tend to destroy the latter and thus induce sterility by the destruction of the male cells before they have reached the uterine cavity. It therefore becomes essential that, in cases of inflammatory disease of the vagina, the infection should first be controlled and eliminated before copulation is permitted. Not only should this be done from the standpoint of the fertilization of the ovum, but Persistent Hymen 265 re also because of the danger of the transmission of disease to the male and, through him, to other females. In purulent vaginitis, sterility is the rule, if not constant. Perhaps the disease causing the vaginitis itself also involves other organs and, independent of the vaginitis, induces sterility. So it is with the granular or nodular venereal disease of cows and other venereal infections. The handling of these has al- ready received considération on pages 73 to 107. During the puerperal period, acute vaginitis may arise, caus- ing sterility for the time, or, becoming chronic or leading to adhe- sions of the vaginal walls, the sterility may become more or less permanently fixed. The overcoming or avoiding of sterility as a result of this affection is considered under ‘‘ Puerperal Infections.”’ 10. PERSISTENT HyMEN. As already stated on page 32, the hymen is a membranous expansion, stretching across the genital canal between the vulva and vagina, and represents the remnant of tissues existing be- tween the proctodeal pit and the posterior extremity of the embryonic gut. In domesticated animals, this membrane regu- larly atrophies and disappears wholly, or nearly so, before birth. Exceptionally, it remains until adult life. The persistence is most comimon in the mare, so far as recorded in veterinary literature. In a large proportion of cases, the remnants con- sist of one or more narrow bands stretching across the genital passage from above to below, not far from the median line. The lower end is attached to the vulvo-vaginal boundary just anterior to the meatus urinarius and, from that point, slopes upward and more or less backward to the roof of the vagina. In other cases, the hymen persists to a much greater degree and, in one instance, we observed a broad sheet stretching from above to below and completely closing the left half of the vagina. In this mare the hand could be passed along the right side of the genital tract until it had reached the vagina and then, by causing this organ to balloon, the hymen could be felt as a broad membranous expanse about 7-or 8 inches in its perpen- dicular diameter and 5 or 6 inches horizontally, the entire membrane tensely stretched. In another instance we observed a two-year-old filly with the 266 Veterinary Obstetrics hymen persisting entirely across the inferior portion of the vagina and extending upward and backward toward the vaginal roof, but not reaching it. On attempting to breed the filly, it was found that the stallion could not copulate on account of some obstruction. As soon as the penis reached the region of the hymen, progress was stopped and the stallion dismounted. After several vain attempts at breeding, we were asked to ex- amine the filly. We soon discovered that there was an opening through the hymen at the superior portion and consequently advised the stallion groom to see that the penis was pushed upward along the roof of the vagina, by the hand. By this means, copulation was successful and impregnation took place. In other cases which have been recorded in the cow, the hymen has completely closed the genital passage and caused an accumulation of uterine discharges in the vagina. In all such cases, copulation is evidently impossible until the membrane is ruptured. Bands of a similar character are also found, at times, represent- ing the embryologic median walls of the fused Miullerian ducts, (see page 19) which have failed to atrophy and disappear com- pletely, as is normal in the region of the vagina when the ducts fuse properly. They may persist so completely as to constitute essentially a double vagina. In all cases where copulation is interrupted in such a manner as we have described, a careful search of the genital canal by the veterinarian isdemanded. In making this examination one is to keep constantly in mind the embryologic development of the organs and look carefully for persistent hymen, which may con- stitute a transverse partition, as well as for bands representing the persistent median walls of the ducts of Muller, in the form of longitudinal septa. ‘These conditions should always be clearly differentiated from any acquired disease or deformityof the parts. They are to be handled on general surgical principles and as a rule offer but little difficulty in overcoming them. ‘The narrow bands representing either of these embryologic structures rarely interfere with copulation and it is only when they are quite ex- tensive that the process of coition is stopped. They may, asa rule, be destroyed by rupturing with the hand or by severing with a scalpel. Adhesions of the Vaginal Walls 267 11, ADHESIONS OF THE VAGINAL WALLS. ATRESIA VAGINA We have already stated on page 95, while describing the venereal diseases of the cow, that adhesions sometimes occur between the vaginal walls, as a result of these affections. This seems to be especially true of the vesicular venereal disease in thecow. We have observed one case of adhesion of the vagi- nal walls in the mare, but were unable to procure a history of the case or otherwise determine its cause. In another instance in the mare, the vaginal adhesion resulted from vaginitis follow- ing puerperal infection. In all cases of firm, extensive adhesions of the walls of the vagina, copulation becomes impossible and more or less serious injuries are liable to occur to the female, and possibly also to the male, from any attempts at coition. One mare which we ob- served was bred to a stallion during estrum and, on account of extensive vaginal adhesions, the vagina was somewhat lacerated and greatly irritated. The severe irritation caused violent straining, which brought about a prolapse of the floor of the vagina and, with it, the urinary bladder (vesico-vaginocele). This prolapse persisted for some time in spite of all efforts to over- come it. At first we attempted to overcome the prolapse by means of a rope truss. This failed and we resorted to vulvar sutures, but the straining was so violent that they were being torn out and were consequently removed, in order to avoid extensive: lacera- tions. The straining was finally controlled by producing deep anaesthesia with chloral hydrate, for a period of four or five hours, during which time the local irritation subsided. As a general rule, these adhesions of the vagina are: beyond surgicalaid. In handling cases of vaginitis, from whatever cause, highly irritant antiseptics, which might injure or destroy the external layers of the mucous membrane, should be carefully avoided, in order to anticipate such adhesions of the parts, which may permanently prevent breeding by making copulation impossible. 12. VULVAR ATRESIA. In some cases of inflammation of the genital tract from vener- eal diseases, as well as from traumatic injuries or other diseases in the parts, the opening of the vulva may become so constricted 268 Veterinary Obstetrics as to prevent the entrance of the penis. In one case which we observed in a mare, a foal became impacted in the passage during the night and remained until the following morning. The pres- sure upon the vulva was so great that gangrene of the vulvar lips ensued, resulting eventually in such a constriction of the vulvar opening that copulation was impossible. We may rarely be able to overcome such strictures by surgical means, but as a rule they are not subject to remedy. ‘The possi- bility of such stricture should always be borne in mind in dealing with inflammation of, or injuries to, these parts in female breed- ing animals. 13. HORIZONTAL POSITION OF THE VULVAR OPENING. * When breeding females, especially cows and mares, become aged and their abdomens enlarged and pendulous, the pelvic orgaus drop forward and downward, and, dragging upon the anus and vulva, cause a more or less deep excavation in the perineal region. At the same time the posterior dorsal and lumbar portions of the spinal column become depressed, producing what might be termed senile lordosis, or ‘‘ sway back.’’ The lumbo-sacral articulation becomes involved in the change of position of the parts so that it becomes depressed along with the sacro-iliac articulation, which brings about a relative eleva- tion of the ischiatic tuberosities and a more nearly horizontal position of the pelvis. These changes in anatomical relations modify the direction of the vulvo-vaginal canal so that, instead of the vulvar opening being approximately perpendicular, as in the normal, it ap- proaches closely to the horizontal. In copulating, the penis tends to approach the vulvar opening in a direction acutely ob- lique, or well nigh perpendicular, to the long axis of the vulvo- vaginal canal, thus rendering successful copulation uncertain, since the penis tends to glide forward and slightly upward over the vulva, against the anus, tail, or other parts. We have already drawn attention on page 50 to the danger of physical injuries, against which we should guard, but it is also important to bear in mind that, whether such injury occur or * Zschokke, die Unfruchtbarkeit des Rindes, page 134. Rupture of the Perineum and Recto-Vaginal Fistula 269 not, the abnormal position constantly invites sterility by causing a failure in coition. The difficulty may be overcome in most cases, and copulation rendered safe, by means of standing the female with the posterior feet somewhat lower than the anterior and having the male stand upon ground approximately level with, or higher than, the ground upon which the anterior feet of the female rest. This position of the female tends to bring the vulvar opening somewhat nearer the perpendicular and consequently renders copulation more certain. In the mare, also, the penis of the stallion may be largely directed by the groom in a manner to avoid accident and render copulation more secure. 14. RUPTURE OF THE PERINEUM AND RECTO-VAGINAL FISTULA. Rupture of the perineum or of the wall between the rectum and the vagina is not rare in the mare as a result of some por- tion of the foal, such as the head or a foot, pushing up into the rectum and appearing at the anus, while the other parts enter the vulva, when, unless prompt relief is given, a few violent ex- pulsive efforts on the part of the mare forces the foal out and tears the perineum asunder. If the attendance is prompt, the misdirected head or foot may be pushed back into the vagina, after it has entered the rectum, and complete rupture of the perineum averted, but, as a result of the accident, a fistula gen- erally persists, leading from the rectum into the vagina. In either case, fecal matter drops from the rectum into the va- gina and maintains a constant irritation of the mucosa of the vagina, with catarrhal discharge. When the perineum is ruptured, the deformity of the part is such that copulation cannot usually be successfully performed, and, even if it can be, the presence of fecal matter in the vagina, with the consequent inflammation and catarrh, generally prevents fertilization. Sterility due to this cause can only be removed, with any de- gree of certainty, by bringing about a recovery from the fistula or rupture. In some cases of this-kind the sterility may be overcome by means of artificial impregnation. The more or less befouled vagina may be flushed out with a warm saline solution or even with weak antiseptics, after which semen, preferably 270 Veterinary Obstetrics obtained from the vagina of a healthy mare immediately after copulation, is to be injected into the cervical canal or into the uterine cavity of the patient. The question of surgical treat- ment of these accidents is discussed under ‘‘ Accidents of Parturition.”’ III Impediments to Copulation and Fecundation Referable to Nervous Disorders. 1 Excitability and Timidity. In young heifers, especially if the animal is very timid and is approached by a strange male, there is a tendency to avoid coition if possible, although the female is properly in estrum. In such instances the behavior of the male has much to do with this state and, so far as possible, he should be caused to approach the timid animal quietly. A mare having a young foal at her side is sometimes much excited and resists the stallion because of the maternal instinct, by which she fears some injury to her young. It is usually de- sirable to keep the foal as near as possible to the mare’s head, where she can see it and recognize its safety. 2 Vaginismus. In the cow there is occasionally observed a peculiar contraction of the vulva, when attempts at copulation are made, which is referable to a spasm of the sphincter muscles of that organ, due to hypersensitiveness. In this af- fection the vulva becomes so firmly closed that the penis of the male can not enter and, consequently, copulation can not occur. We have seen no records of this difficulty in the mare and have observed no cases where copulation failed because of it. In one case of nymphomania in a mare we found, upon inserting the arm for the purpose of spaying, that the sphincter of the vulva contracted so powerfully that it caused great pain by crushing our arm, and so injured it that it was lame for eight or ten hours after the operation had been completed. The condition might have interfered with ‘copulation. Vaginismus is probably most generally connected with ovarian disorder. Its cause is to be carefully determined by examination. If the malady is of ovarian origin, those glands must receive atten- tion. If the condition appears to be wholly local, attempts may be made to overcome it by inducing fatigue in the animal, by the internal administration of narcotics or by the use of local anaes- thetics applied to the vulva. Extreme Variations in Size 271 3. Violent Expulsive Efforts Following Coition. In the mare and the cow we occasionally observe very violent expul- sive efforts immediately following copulation. It is apparently due, in some cases, to an irritability of the animal. If there has been some pre-existing disease of the part, which has caused a stricture of the coital canal, injury may follow the coition which produces pain and is naturally accompanied by straining. We observe the same results when the penis of the male is compara- tively large and the copulation causes laceration or rupture of the vagina. It is, consequently, most common in those cases where the female is young or is of small size and the male is large, and especially where the penis is of very large size or of ex- cessive length. In other animals the expulsive efforts are ap- parently due entirely to individual irritability. In such cases, immediately following coition, there is severe straining, which causes an immediate expulsion of a large part, or all, of the semen and may result, according to Zschokke* and others, in sterility. In all such cases, the cause of the irritation should be discov- ered and removed. We have already suggested a plan for pre- venting injury from the penis of the stallion under, ‘‘ The Dangers and Infections of Coition’’ on page 50. We have also pointed out the danger of permitting copulation when the vagina is inflamed. If the expulsive efforts are due to excessive irritability of the animal they may be overcome or ameliorated by causing her to move about constantly, or otherwise attracting her attention for some time after copulation. IV. Extreme Variation in the Size of the Male and Female. Under ‘‘ The Dangers and Infections of Coition,’’ on page 50, we have considered the question of the variation in the size of the male and female with reference to accidents. Closely allied to these accidents is the question of sterility due to this same lack of correspondence in size. In all cases where accidents are liable to occur because of this difference in size, sterility is likely to result for similar reasons. If the female is comparatively either too large or too small, sterility may ensue as a result of imperfect or incomplete copulation. The nature of the cause suggests the *Zschokke, Die Unfruchtbarkeit des Rindes, page 137. 272 Veterinary Obstetrics remedy. Artificial insemination, as described on page 278, may be indicated in some cases. V. Infectious Diseases. Infectious diseases, as a cause of sterility, have already re- ceived attention on pages 68 to 110. The venereal infections naturally tend to produce sterility, though in markedly varying degrees. In addition to these, there are various infections which tend to cause the death of the fetus, and which ‘we shall discuss in the chapter upon Abortion. While abortion is not identical with sterility, the results of it, by causing the death of the fetus prior to its expulsion, are essentially identical, from an economic standpoint, with a failure of fertilization itself. : NOSTRUMS AND PANACEZ AGAINST STERILITY. Few departments of veterinary practice offer so inviting a field for the plying of the sale of nostrums and the application of more or less mythical proceedings, as sterility. To the average layman, ovulation, fertilization and the development of the embryo are as a mysterious sealed book, which gives to the quack an open field for plying his method of chicanery. Some- times the remedies are not devoid of merit in proper cases, but lose their value by being applied uniformly in ad/ cases of sterility, regardless of the cause at work in a given case. Veterinarians in America indirectly support this chicanery by failure to extend scientific aid. Science and charlatanism are incompatible and, whenever the veterinarians of breed- ing areas study and understand sterility and intelligently advise owners of: sterile animals, quackery in this respect must cease. ‘The veterinarian is helpless in combatting sterility until he first learns well the normal structure and functions of the genital system; he must first comprehend /evtzlzty ere. he can understand sterility. Not only does he need have a theoretic knowledge of normal breeding, but he must have a clinical knowledge. He must be able, by manual exploration, to locate and recognize the various internal generative organs in our larger domestic animals and to determine by such examination whether they be normalor abnormal. Thisdoes not come by the reading of books nor by making post mortem examinations. The knowl- edge does not come to a man in an hour oraday. Itis to be learned by a conscientious study upon the living animal and competency is attained only by long and faithful work. When ability has been acquired, and the veterinarian can say that an ovarian abcess is present, and speak with authority upon the point, the intelligent owner will not resort to nostrums, nor cause the os uteri to be dilated. He will not try impregnators nor resort to artificial insemination. So, in each case, when the veterinarian is able to point out the difficulty with authority, the owner will desire the application of a remedy which will reasonably tend to remove the cause. As already stated, a pre- viously sterile animal may suddenly and unexpectedly conceive. 18 : 273 274 Veterinary Obstetrics Should an alleged remedy have been applied shortly before, it is probable that it will be credited with a cure, though the actual cause of the sterility may have been of such a character that the remedy applied could in no conceivable way have affected it. In addition to many secret nostrums which are placed upon the market and vigorously advertised by their promoters, there are various remedies, which are not secret, but which have been lauded as sovereign against sterility, regardless of the underlying cause ; or, possibly, we should say they are regarded as specifics against all cases of sterility, the causes of which are unknown to the parties concerned. Dilation of the Os Uteri. We have already had occasion to refer to this procedure while considering ‘‘ Occlusion of the Os Uteri.’’ Dilation of theos uteri has a direct value, and is the only scientific method of handling an occlusion of the os uteri externum. ‘This much granted, it has been seized upon by many as a universal remedy. We have also related‘ that the cervical canal of the cow is so narrow, so tortuous, and its mucous mem- brane thrown into so many folds, that it is difficult to passa finger or a sound through the canal. This difficulty is made greater by the vigorous contraction of the powerful circular muscles of the cervix. So it is easy to say that the os uteri is closed, much easier for a careless veterinarian to make the statement than to prove its untruth by passing a sound through into the uterine cavity. Of course some females, previously sterile, will breed after ‘‘opening’’ the os, which was not closed: so might the same animals have bred had their tails been split, or their horns bored. Impregnators, A few years ago there was an an extensive interest shown in impregnators as a soverign remedy for sterility in mares. Some prominent American practitioners, deeply im- pressed with the idea, bent their energies to overcome sterility in this manner and devised and patented impregnators of various types. Generally they consisted of hollow tubes of soft rubber, 3 to 4 inches in length, having an opening of variable size, usually % to 34 inch. ‘The outside of the tube was constricted in its center, and the posterior end was armed with a broad flange to prevent its falling into the uterine cavity. This ap- paratus was inserted in the os uteri externum just before the stallion mounted. The theory of use was that the ‘‘impregna- o Nostrums and Panacee against Sterility 275 tor’’ held the canal open and that, during ejaculation, the semen was thrown directly into the uterine cavity, the urethal opening of the penis coming into direct apposition to the open tube. Evidently the os uteri was open, as, otherwise, the ‘‘ impreg- nator ’’ could not have been inserted. The advocates of its use have not shown why semen passed through a rubber tube should have its virility increased. But mares, which had been sterile pre- viously, conceived at the first service, and statements to that ef- fect, by owners of mares, were freely used by makers of ‘‘im- pregnators ’’ to show their infallibility. What influence, if any, was exerted by the ‘‘impregnator,’’ is not wholly clear, but gen- erally it may be regarded as a harmless diversion, which ordina- rily will not prevent conception. In rare cases, they may be of actual value. Incidentally, experience with ‘‘impregnators’’ teaches that, contrary to the views of some, the penis of the stallion does not enter the cervical canal of the mare during normal copulation. If it did, the ‘‘impregnator ’’ would inevitably be displaced into the uterine cavity. Injections of Yeast Solution into the Vagina. Another method of handling sterility in cows, which acquired, for atime, a favorable reputation, was the injection into the vagina of a solution of yeast or the introduction, by other means, of yeast into the vaginal cavity. Cows previously sterile, in some cases, promptly conceived and these cases were naturally reported. Those which did not conceive after the treatment were generally not mentioned. There may be conditions of the vagina, chronic infections of the mucosa, or other disease, which the application of yeast may overcome, but this has not been determined. It is inconceivable, in our present state of knowledge, that yeast introduced into the vagina could overcome cystic degeneration, sclerosis or abscess of the ovaries, or, indeed, many of the conditions named in the preceding pages as causes of sterility. Aphrodisiacs. Yohimbin Spiegel. For many years numerous drugs have been credited with the power of arousing the sexual appetite and, through this agency, the sexual powers. Among these drugs are: cantharides, turpentine and the balsams and resins and, more recently, a new drug, yohimbin, has been 276 Veterinary Obstetrics introduced to overcome sterility. In large doses, these drugs induce more or less irritation of the urino-genital tract and stimulation of the sexual desire. To what extent aphrodisiacs stimulate ovulation and spermato- genesis has not been determined. It is possible that indirectly, through irritation of the genital-tract, they stimulate the ripen- ing and discharge of ova and spermatozoa but, from all data at hand, they merely arouse the sexual appetite without increasing the sexual 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 appe- tite is intense aud the breeding power almost nil. Sexual ap- petite, without normal ovulation in the female and the forma- tion of normal spermatozoa in the male, has no value for breed- ing purposes, but is rather a harm, frequently leading the owner astray and diminishing the value of the patient for other purposes. Yohimbin has recently acquired a high repute, in some quar- ters, as a remedy against sterility, both in human and in veterinary practice. It has been commended chiefly for arousing the sexual appetite, when absent in either sex. Its efficacy is in vigorous controversy and the cost of the drug is at present pro- hibitive except in unusually valuable animals. Holterbach (Berlin Tierarztliche Wochenschrift, No. 9, 1908), in an exhaustive article, champions the use of the drug. He used the drug in 37 cases of absence of sexual desire: 22 cows, g 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 normally in June, 1906, but estrum did not follow. All other drugs, in- cluding cantharides, proved useless. In August, 1907, 14 months after calving, 16 tablets of yohimbin chlorid, each con- taining 0.1 gram of the alkaloid, were prescribed, one tablet to be given three times daily in the drinking water. On the third day there was excitement, bellowing, uneasy stepping about, frequent urination and decreased 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 Nostrums and Panacee against Sterility 277 swollen and hyperaemic, 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, developed estrum 1o weeks later, was bred and the owner ‘“‘ believed ’’ her to be pregnant. Frubinger (D. M. W. No. 7, 1907) condemns the drug as worthless and attributes the alleged cures in man to suggestion. Muller (Arch. Internat. Phar. et de Therap. Vol. XVI, p. 81) considers it an erratic aphrodisiac, acting differently on different individuals. Daels, quoted by Holterbach, experi- mentally caused menstruation in a bitch already in estrum, but bitches usually menstruate at this time anyhow. In another, not in estrum, but date of probable normal estrum ,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 the drug. Autopsy showed enlarged, congested genital canals, prominent ripe ova, etc. In experiments with young bitches, less than nine months old, the drug, in fatal toxic doses, failed to cause reactions in the genital organs. So far as we have been able to determine, the drug has not induced estrum in any case where estrum may not have occured without it, nor impregnation where such a result was not per- fectly possible without the drug. The alleged estrum induced was of doubtful character. Swell- ing of the vulva occurs without estrum. A bloody discharge from the vulva may not be menstruation. The bloody feces following the administration of the drug might be called men- struation with equal right. Further authentic data are essential to a reliable conclusion. Until these are at hand, the administration of the drug should be regarded as a very expensive experiment of exceedingly doubtful value. It has a possible value in cases where sterility exists as a consequence of the absence of sexual desire without organic disease of the genital glands. ARTIFICIAL IMPREGNATION. Undoubtedly efficient in some cases, artificial insemination has been advocated as a widely applicable remedy for sterility, ap- parently upon the theory that sterility is usually based upon mechanical impediment. Artificial insemination is an easy and successful operation in fertile mares and other females with readily penetrable os uteri. It is difficult of application in the cow because of the narrow, tortuous, obstructed cervical canal. It is a valuable remedy in cases due to physical impediments to natural insemination, in so far as obstacles are surmountable by this means. It is incon- ceivable, in the present state of our knowledge, how the opera- tion can otherwise exert a favorable influence upon sterility, unless we admit that in some cases, owing to nervous causes, insemination without copulation, by avoiding the nerve-reflexes of that act, may favor fertilization. This has not been shown. Some exaggerated statements have been made regarding its efficiency. It has been asserted that 50 %, 60 %, or more, of mares, taken in large numbers, regardless of the presence, near- ness or remoteness of estrum, will be fertilized by this process. Upon its face, the contention is absurd. There isa belief, to which some embryologists have- lent weight, that spermatozoa will.live for days and weeks in the genital tube awaiting the ap- pearance of anovum. We have found no convincing data, how- ever, to indicate that, in a fertile animal, coming regularly in estrum and artificially inseminated shortly after a normal estrual period, the spermatozoa have remained in the genital canal until the next ovulation and induced fertilization. If the mares are fertile and the artificial insemination is carefully made at the proper time in relation to ovulation, there is no reason to doubt that 60 % or 100 % may be fertilized. In occlusion of the cervical canal, in deformities and defects of the os uteri, which may inhibit or render uncertain the passage of the spermatozoa into the uterine cavity, artificial insemination constitutes a rational and valuable remedy. In some diseases of the vagina and of the vaginal portion of the uterus, artificial insemination offers possibilities which should not be ignored. In recto-vaginal fistula and in rupture of the perineum, where Artitcial Impregnation 279 copulation is rendered difficult or uncertain, the operation is in- dicated. The limitations of artificial impregnation as a remedy against sterility should be fully recognized, and the value of the process should not be discredited by its application in improper cases. It has been urged, and with some reason, in cases of deformity of the penis in stallions, by which the semen is ejaculated in some other direction than forwards, that the fertility of the male may be greatly heightened by artificial insemination added to the imperfect copulation. There is a commercial feature, in connection with artificial in- semination, which interests the breeder rather than the veterin- arian and has no relation to sterility. Throughout nature there is a superabundance of male fecundating cells. Ina normal ejac- ulation of a healthy adult male, there are sufficient spermatozoa to fecundate innumerable females. It has, consequently, been proposed to extend the procreative power of a valuable breeding male by artificial insemination—by collecting some of the semen from the vagina of the female just served and transferring it, un- der proper precautions, to the vaginze of other females, to cause one copulation to answer for several or many fertilizations. The operation of artificial insemination is simple. It may be practiced as an adjunct to copulation. In such case, the male is permitted to serve the female, and promptly thereafter the operator inserts his hand into the vagina, picks up some of the semen and introduces it into the cervical canal. This may be done with the aid of a short spoon, in which the semen may be picked up and inserted through the os. A syringe, of almost any type, may be used to pick up the semen and then inject it into the uterus. The operator may simply use his hand. Even one finger immersed in the seminal fluid and pushed into the cervical canal would, ordinarily, carry sufficient spermatozoa to accomplish the purpose. This plan of insemination is applicable in those cases where some physical hindrance to natural insemi- nation exists,of a character surmountable by the artificial method. A second method of artificial insemination is the transfer of the semen from the vagina of a female, with which the male has recently copulated, to another female. If the two females are 280 Veterinary Obstetrics in close proximity, the operation is readily carried out by means of any of the impregnation syringes, or otherwise. It is essen- tial merely that the transfer be made promptly and without se- rious damage to the seminal fluid. By this method, females incapable of copulation may be im- prégnated, such as those suffering from ruptured perineum or other obstructions in the vagina or vulva. It may also be re- sorted to in order to avoid the dangers of copulation between animals in which there is too gross a variation in size, either the male or the female being too large to safely copulate with the desired mate. The chief essentials in artificial insemination are cleanliness (asepsis), reasonable promptness, the protection of the semen against extremes of temperature and its secure lodgment in the uterus or cervical canal. \ The hands, vessels and apparatus are to be made clean—asep- tically clean—and every precaution taken against the transfer of dangerous infection. ‘The possibilities of transferring infec- tious diseases by this means should not be underestimated. The duration of the vitality of the spermatozoa has not been fully determined. They can be kept alive in a warm saline so- lution for days, but it is doubtful if their fertilizing power can be maintained, with practical certainty, for a long period of time. The transfer should consequently, in the interests of efficiency, be made as promptly as possible. While, experimentally, artifi- cial fertilization may be induced after carrying the semen a long distance and keeping it many hours, the intervening time sub- jects it to many unfavorable circumstances. If to be carried, it may be placed in a rubber bag or wide mouthed bottle, the ves- sel being immersed in water at a temperature of about 100° F. and maintained at about this temperature until the semen has been used. EMBRYOLOGY. SEGMENTATION OF THE EGG We have already suggested in a preceding chapter that fertili- zation of the egg, under normal conditions, occurs in the oviduct, immediately after the rupture of the ovisac and the discharge of the egg into the tube. The observations upon this point have been carried out largely upon the rabbit as a repre- sentative of mammalia and it is assumed that the phenomena oc- curring in this animal are largely typical of the entire mammalian group. In the observations upon fertilization in the rabbit, cop- ulation has generally ensued immediately after the doe has given birth to young and from 8-12 hours prior to the rupture of the Graafian follicles. Under these conditions, when the ovisacs rup- ture,the spermatozoa have already passed through the uterus and the oviduct and have reached the ampulla of the tube, so they may at once meet the egg when it is discharged and fertilization im- mediately follow. The spermatozoa may even have reached the ovum while yet in the ruptured ovisac, before its discharge into the Fallopian tube as shown in Fig. 20. \ Fic. 20. A fully formed ovum of the Rabbit shortly before its discharge from the ovary. Marshall after Bischoff. Fic. 21. Ovum of Rabbit from the upper end of the oviduct after ex- trusion of the two polar bodies. Marshall after Bischoff. MO, Spermatozoon. N, nucleus or germinal vesicle. NU, Nucleolus or germinal spot. PB, Polar bodies. Z, zona radiata. This rule is probably true in our larger domestic animals, but it is possible that copulation may sometimes be delayed until after the rupture of the ovisac and the discharge of the ovum into the tube so that, before it meets with the spermatozoa, it 282 Veterinary Obstetrics may have travelled some distance along the oviduct toward the uterus. In the typical fertilization of the ovum in the rabbit, where the spermatozoa have already reached the anterior end of the oviduct when the Graafian follicle ruptures, the ovum undergoes segmentation or division during its passage toward the uterus. According to Van Beneden, the segmentation of the ovum begins 10 or 12 heurs after fertilization or 18-24 hours after copulation and continues for the next two days or until about the end of the third day, at which time the ovum reaches the uterus and its segmentation has been completed. At this time it is about the same size as the original ovum or possibly somewhat smaller, but has acquired, during its passage through the oviduct, a layer of albumen on its exterior, which increases the total size very considerably. Fic, 22. A rabit’s ovum from the middle of the length of the oviduct, about 22 hours after copulation, showing division of the ovum into two cells. > 200. Marshall after Bischoff. CB, Blastomere, or segmentation cell, MO, Spermatozoon imbedded in the zona radiata. N, Nucleus. Z, Zona radiata. The length of the time required for the passage of the ovum from the ovary to the uterus has not been determined for most animals, but, reasoning from other data in embryology, it would appear possible that, in the larger animals, it may require a longer period of time for travelling through the tube than in small ones like the rabbit. If we are to judge of the time re- quired for the passage of the ovum through the oviduct by the appearance of estrum and menstruation, we would be led to assume that, in the cow, it is quite as rapid as in the rabbit. Some Segmentation of the Egg 283 authors estimate that in woman the period is probably five to eight days, but we are aware of no definite data upon which to base this assumption. About 10-12 hours after the fertilization of the egg of the rabbit, the ovum undergoes cleavage, by which there arise two spherical cells, which are essentially alike in all respects except that some observers believe that the one is slightly smaller than the other. See Fig. 22. Each of these two cells, after a brief pause of a few hours, divides again into two cells, constituting a mass of 4 ovoid cells, which again subdivide to constitute a group of 8 cells, those de- rived from the larger of the two first cells being now more clearly larger than the others, the larger ones grouped together cen- trally, while the smaller rest upon them as acap. Later the segmentation of the small cells proceeds somewhat more rapidly than that of the larger and they tend to grow around and enclose the latter. According to Marshall, when the ovum of the rabbit Fic. 23. A rabit’s ovum from the lower end of the oviduct, about the middle of the third day; showing the morula stage, shortly before the completion of segmentation. 200. Marshall after Bishoff. Fic. 24. A rabbit’s ovum seventy hours after copulation, taken from the lower end of the oviduct just before entering the uterus and showing the condition at the close of segmentation. > 200. Marshall after Van- Beneden. has reached the 7oth hour after fertilization, its segmentation has been completed and it passes from the oviduct into the uterus. At this time it is a spherical mass consisting of an exterior layer of small, nearly spherical, transparent cells, enclosing almost completely the group of larger, more granular cells ; it has reached what is known as the morula or mulberry stage. See Figs. 23 and 24. 284 Veterinary Obstetrics At this stage the external layer, consisting of the smaller cells, and the internal mass of larger ones -are firmly attached to each other at one point only. The segmented ovum is still surrounded by the vitelline membrane, the zona radiata and the layer of al- bumen which it had acquired during its progress through the oviduct. Within a few hours after entering the uterus the ovum has be- come greatly enlarged, owing to the accumulation of a fluid be- tween the external layer of small cells and the mass of larger in- ner cells, except at the point of attachment between the two, so that the inner mass occupies a comparatively small area at the superior pole of the ovum. This stage in the development of the ovum is known as the dlastodermic vesicle. ‘The vesicle con- sists of an outer wall of flattened, polygonal cells, which have been formed from the outer cells of the previous stages, to which is attached, at one of its poles, the small mass of large cells. Separating the two layers of cells, except at the polar point of at- tachment, isa relatively large quantity of fluid, which greatly dis- tends and increases the size of the vesicle. ‘The mass of inner cells is flattened out in the form of a disk, consisting of severa] layers of somewhat spherical cells at the center, which is known as the embryonal or germinal area, while, at the pheriphery, they are but one or two layers in thickness. As the vesicle in- creases rapidly in size the vitelline membrane disappears, while the zona radiata and the albuminous layer become greatly at- tenuated by being stretched out. During this stage of development, which continues in the rab- bit to about the seventh day, the ovum lies free within the uter- ine cavity and, in case of multiparous animals, the ova, which enter the uterus almost simultaneously, tend to distribute them- selves at more or less uniform distances apart throughout the or- gan and assume the positions which they are to retain through- out their period of intra-uterine development, the location of each being early indicated by a bulging of the uterine walls. GERMINAL LAYERS. Toward the close of the developement of the blastoderm, im- portant changes take place, by which there are established three distinct germinal layers, each of which is destined to take a spe- The Primative Streak. The Primative Groove 285 cial part in the formation of certain tissues of the embryo. These changes affect chiefly the embryonal area or that point in the blastoderm at which the various layers are united, and the inter- nal cells are massed. The exact method of the formation of the germinal layers is not wholly free from controversy. In the embryonal area, which is a circular or discoid patch, three layers of cells may be recog- nized : an upper or external layer of pavement cells, the epiblast ; a middle layer of larger, cuboidal cells, the mesoblast ;-and a lower stratum of pavement cells, the hypoblast. At the margin of the embryonal area, the walls of the blas- todermic vesicle consist of two layers of cells representing the external and internal germinal layers, while, passing slightly be- yond this, the remainder of the blastodermic vesicle, constituting about 34 of its total surface, consists of a single layer of cells, the epiblast. According to Rauber and Kolliker, the uppermost layer of the blastodermic vesicle, the primitive epiblast, disappears from the embryonal area, to be succeeded by a new epiblast arising from the mesoblast so that, according to these, the entire embryonal area is ultimately derived from the inner hypoblast, which, in the morula, consisted of the larger, granular, slowly multiplying mass of cells. Late in the blastodermic stage, the embryonal area becomes pyriform, its greater diameter corresponding to the long axis of the blastodermic vesicle, which has now assumed the eliptical form. The broader end of the embryonal area may be desig- nated the anterior, or head, end and the narrower the posterior, or tail, end. THE PRIMITIVE STREAK. ‘THE PRIMITIVE GROOVE As the blastodermic vesicle approaches the completion of its development, there appears the primitive streak, consisting of an axial thickening of the epiblast, at the posterior, or tail, end of the embryonal area. This thickening extends longitudinally and finally equals about two-thirds of the length of the area and hasa faint longitudinal depression known as the primitive groove. A cross-section of the primitive streak shows it to consist of a multiplication of the deeper cells of the epiblast on the median 286 Veterinary Obstetrics line. From the deeper layers of this thickened, dense, primitive streak, the cells grow out in lateral plates between the epiblast and hypoblast, to constitute the permanent mesoblast. See Fig. 25. Fic. 25. A transverse section across the hinder part of the em- bryonal area of a rabbit embryo at the end of the seventh day, the section passing through the primitive streak. 80 Mar- shall after Kolliker. E, Epiblast. H, Hypoblast. M, Mesoblast. PG, Primitive groove. PS, Primitive streak. FORMATION OF THE EMBRYO The embryo is formed in the embryonal, or germinal, area. A longitudinal depression known as the neural groove is formed immediately in front of the primitive streak, the long axes of the two structures being parallel. The neural groove is bordered on the sides by the neural folds, which grow upward from the epi- blast and then approach each other to become united into a tube, in which, eventually, the central nervous system is formed and soon shows, in its anterior or head-end, the brain vesicles. By an infolding of the walls of the blastodermic vesicle about the margins of the embryonic area, the latter becomes con- stricted off from the rest of the vesicle, which then constitutes the vitelline, or yolk sack. The yolk sack of the mammalian embryo is small and of little consequence, as it contains no ap- preciable amount of nutriment for the embryo, but simply a quantity. of a presumably inert fluid. After this constriction forms, dividing the embryo from the yolk sac, the dorsal surface of the embryo grows much more rapidly than the ventral, which causes it to bend ventralwards very rapidly, so that the head-end is soon at right angles to the remainder of the embryo. ‘The head-end of the embryo, by becoming flexed, is bent downward The Celom or Body Cavity 287 into the yolk sac and pushes the walls of the latter before it. The different parts of the brain soon become recognizable and the nose, eyes and ears are also quite apparent, while, upon the sides of the head and neck, the visceral arches and clefts are seen. THE Ca@LoM or Bopy Cavity On the eighth or ninth day after fertilization in small animals, perhaps somewhat later in the larger ones, the ccelom, or body cavity, is formed as a cleft or rearrangement of the cells of the mesoblast, by which an extensive cavity is formed, radiating outwards from the region of the notocord, to pass beyond the embryo itself and extend outward in the walls of the blastoderm to near the margin of the mesoblastic area. This change serves to divide the mesoblast into two layers, the external of which is closely adherent to the epiblast, the two constituting the somata- pleur, while the inner mesoblastic iayer and the endoblast, with which it is intimately related, constitute the splanchnopleur. From the epiblast arise finally the epidermis, the hair, nails, hoof, horns, etc., and the cerebro-spinal nervous system. From the mesoblast arise the muscles, bones, connective and other skeletal tissues and the deeper layers of the skin. The mesoblast of the splanchnopleur gives origin to the heart and the muscular portions of the digestive, respiratory and urino- genital organs and, in a general way, to the pale, or unstriped, muscle fibers, while the somatopleuric mesoblast forms the striped, or voluntary, muscles. The endoblast of the splanchno- pleur forms the epithelium of the digestive and respiratory tracts. The origin of the various tissues from the three embryonic layers is of great interest in the study of medicine and surgery and numerous functions can only be understood by recalling the em- bryonic origin of certain tissues in the adult. A wound of the epithelium can be repaired by epithelial tissues only. Cells originating from the mesoblast have not the power to repair the epiblastic injury. Ere the blastoderm can proceed far in its development, new provision must be made for its nutrition, which, in mammalia, must be derived from the mother through an intimate relation between her uterine mucosa and special organs of the fetus, the fetal envelops, especially the placenta. , 288 Veterinary Obstetrics At a very early period, this nutritive relationship between the mother and the fertilized ovum is established by two outgrowths : one of the extra-embryonal somatopleur, to constitute the am- nion; the other from thesplanchnopleur, to constitute the allan- tois, both of which we shall describe later. THE NERVOUS SYSTEM We have already intimated that the zeural groove of the blas- toderm marks the beginning, location and direction of the future cerebro-spinal nervous system. Consisting of thickened epiblast, the neural folds increase in prominence, while the groove between them deepens and the summits of the folds approach each other as segments of an arch, to finally meet and fuse above the groove, converting it into a closed tube which, lined with ciliated epi- blastic cells and filled with fluid, is to persist throughout the life of the animal as the central canal in the spinal cord and as the ventricles of the brain, while, from the deeper epiblastic cells in the walls of the tube, are to dévelop the nerve cells and fibers of the cerebro-spinal axis. Under normal conditions, the neural groove grows rapidly in length and depth and, in the rabbit, its lips have met and fused to constitute a complete tube by the end of the ninth day. At this time one can distinguish the spinal cord, the fore-brain, the mid-brain and the hind-brain. The cerebro- spinal nervous system of mammalian animals con- stitutes the central organ, about which the other portions of the embryo develop in more or less complete harmony. Any inter- ruption in the normal development of the cerebro-spinal axis in- terrupts or vitiates the proper growth of other parts of the body. Should the neural groove become branched and double at its anterior end, there forms in the embryo two heads instead of one, constituting a double-headed monster or bicephalus; (See Fig. 35) or the fission may extend more posteriorly to constitute double neck or chest. Should the posterior end of the neural groove undergo division into two parts, we have a monster in which the posterior parts of the body are double, while the anterior may remain single and normal. Should two neural grooves form side by side and in intimate contact with each other, there may result a double monster, of two more. or ‘less separate bodies as in Figs, 126 and 127. Finally, the division between the two neural grooves may be complete and two The Nervous System 289 embryos form which are wholly separate, but have common en- velops and umbilic cords. In the cow not rarely we find one of the two embryos so aberrant i in form as to constitute a well nigh shapeless mass like Figs. 26 and 27, known as amorphus, acardia, or a ‘‘mole.’’ Fic. 26. ‘‘MOLE,’’ OR ACARDIA. FRomM Cow. M, Muzzle. SM, SM, Superior maxilla, showing white denticles. IM, IM, Inferior maxilla showing denticular masses (grinders). BM, Buccal mucosa showing papilla. T, Tongue. I, Incisors. One-half size. The fusion of the lips of the neural canal may become inter- rupted at various points and the canal may remain open even to the time of birth, to constitute spinal bifida. An instance of this occurring in the dorsal region (dorsal spinal bifida) is shown in Fig. 28, in which the superior wall of the spinal canal is want- ing from the dorsal region, backward. A similar persistence of the neural groove may occur at any point in its entire length, producing cervical, dorsal, lumbar or sacral spinal bifida, accord- ing to location. 7 19 290 Veterinary Obstetrics vee Fic. 27. SAGITTAL SECTION OF Fic. 26. I, Incisors. T, Tongue. M, Muzzle. B, Bone (skull?). B', Bone (sternum?). B’, Bone (pelvis ?). L, Lung. R. Rumen and reticulum. U, Umbilicus. 0, Omasum. One-half size. Fic. 28. SPINA BIFIDA WITH SPINAL FLEXURE. CV, CV, Cervical vertebree. R, ribs. SC, Spinal cord ending in anterior dorsal region. DLV, Dorso-lumbar vertebra. S, Sacrum. IPS, Ischio-pubic symphysis. The Brain 2Q91 THE BRAIN. The brain commences to form and is recognizable before the neural canal has been completed. It consists at first chiefly of a series of vesicles which are known as the fore-brain, mid-brain, and hind-brain. The anterior cerebral vesicle, or fore-brain, gives rise very early in its development to the optic vesicles, as lateral outgrowths, which are ultimately converted into the essential parts of the eye. Normally, there are two of these outgrowths, which, under aberration in development, may fuse or grow out as single pro- jections on the median line, to constitute the one-eyed monster, Oo Oc~ aS Fic. 29. SKULL, OF CvcLops. FOoat, Oc, Occiput. O, Single orbital cavity, MP, Coronoid process of inferior maxilla. SM, Superior grinders. SI, Superior incisors fused into a single organ. IM, Inferior grinders. T, Tongue. II, Inferior incisors. 292 Veterinary Obstetrics or cyclops. In case of this fusion of the optic vesicles, the de- velopment of a single vesicle on the median line, there is a ten- dency towards the inhibition of the development of the olfactory vesicles. Fic. 30. Cycriops. Lams. A, Head and neck, seen from below. B, Sagittal section. M, Mouth. Ea, Ear. N, Nostril. P, Dilated pharynx. ON, Olfactory nerve. OpN, Optic nerve. Ep, Epiglottis. O, Gsophagus. The Brain 293 The cerebral hemispheres are developed first as a median pro- longation at the anterior end of the fore-brain, which later be- comes divided into the two hemispheres by its anterior wall growing back into it from the front. ‘These two hemispheres appear first as large vesicles with very thin walls and these cavi- ties persist throughout life as the lateral ventricles of the brain, which communicate, through the foramina of Munro, with the third ventricle. See Figs. 41 and 60. Fic. 31. HyprocEPHALus. CaF. (After photograph). In some cases the fluid in these cerebral hemispheres becomes enormously increased, to constitute the fetal disease of hydro- cephalus as indicated in Fig. 31. In other instances the cerebral 294 Veterinary Obstetrics hemispheres grow rapidly and the walls of the skull fail to close over them, so that they protrude, to constitute heruza cerebri, as shown in Fig. 32. From these cerebral hemispheres, there grow out early in their development the olfactory vesicles, which are later to develop into the olfactory lobes, from which the olfactory nerves pass to the nose. These sometimes fail to appear if the optic vesicles are represented by a single vesicle, toconstitutea cyclopean monstros- ity as shown in Figs. 29 and 30. Fic. 32. HERNIA CEREBRI. PIG. Lateral view of brain, seen from the left. A, Segment of skin covering the herniated portion of the brain, B. CC, Cerebrum. D, Cerebellum. E, Medulla oblongata. THE SPINAL CorRD. As already suggested, the spinal cord develops from the pos- terior portion of the neural groove. The neural folds grow up- ward and their borders approach each other, to finally fuse at their margins, leaving a cavity within, which constitutes the central cavity of the spinal cord, and persists throughout the life of the animal. The neural canal is lined by columnar, cili- ated epithelium which persists throughout life, to constitute the: epithelium of the central canal. The deeper layers of epithe- The Spinal Cord 295 lium about the spinal canal go to form the skeletal frame-work and the nerve cells grow out into these deeper parts from the col- umnar epithelium which lines the cavity. These nerve cells, or neuroblasts, are at first spheroidal in form and.show upon their surface one to several prolongations, which are later to constitute the polar elongations, or axis cylinders, of the nerves. The spinal nerves develop first by the formation of the spinal ganglia, which appear in the neural folds at a very early period, and from the inner sides of which there grow out nerve fibers into the spinal cord, to constitute the superior, or dorsal, roots of the spinal nerves. They become the centripetal, or sensory, roots of the nerves. ‘The ventral, or motor, nerves arise very early as small outgrowths from the lower part of the sides of the spinal cord, in the position they occupy during adult life. These ventral roots grow outward to meet the dorsal roots just beyond the ganglia and fuse with them, after which they again divide into dorsal and ventral twigs, which are mixed nerves. DEVELOPMENT OF THE ORGANS OF SPECIAL SENSE A The Olfactory Organs. THE NOSE. The olfactory organs appear early in embryonic life as thick- ened patches of epiblast upon the antero-inferior part of the head, which patches soon sink inwards to constitute the olfactory pits, into the bottom of which the nerves of smell grow out from the olfactory bulbs of the brain. Fic. 33. The under surface of the head of a human embryo, let- tered by Professor His, Hn, and estimated as about twenty-nine days old. x 73%. From Marshall after His. BS, Cerebral hemisphere. DS, Stomatodeum. FO, Processus globularis, or lateral portion of fronto-nasal process. HM, hyo- mandibular cleft. MN, Mandibular arch. MX, Maxillary arch. OC, Eye. OK, Olfactory pit. The olfactory pits are at first incomplete, their lower borders being deeply notched, and communicate with the stomatodeum, somewhat as an extension of that cavity. The olfactory pits and the stomatodeum are connected by a urrrow isthmus, bordered inwardly by the processus globulares of tne fronto-nasal process and externally by the maxillary processes of the maxillary arch. Soon the maxillary processes approach and fuse with the processus globulares anteriorly, to complete the circumference of the olfactory pits and, by separating them from the mouth, to constitute the nostrils. For a short distance anteriorly, as faras to the incisive foramen of the adult, the processus globulares send projections inwards to constitute the anterior portion of the palate, while, behind the foramen, the maxillary processes send out shelf-like projections, which meet on the median line to 296 The Olfactory Organs 207 constitute the posterior portion of the palate and, from their fus- ing borders, send projections upward to eventually reach and fuse with the lower surface of the fronto-nasal process, to constitute the nasal septum, dividing the nasal chamber into two distinct cavities. The nasal passages are at first very short but, as the FIG. 34. SCHISTOCEPHALUS BIFIDUS. (Gurlt). nose elongates, the palatine processes from the maxillary arch grow backward and, fusing on the median line, completely separ- ate the oral and nasal cavities so that the latter finally open posteriorly, through the posterior nares, into the pharynx. The upper lip is formed by a fusion of the fronto-nasal pro- cesses with the maxillary arch. Aberrations in the development of the anterior nares and upper lip are not rare, especially in bo- vide, where, in some instances, the processus globulares fail to fuse with the maxillary processes, constituting hair lip (Schisto- cephalus fissilabrus). In other instances as in Fig, 34, fis- sion on the median line through the fronto-nasal process occurs, so that the maxilla is divided, with the mandible curved up- 298 Veterinary Obstetrics ward between the two lateral halves, to constitute schistoceph- alus bifidus. In dealing with diseases of the septum nasi, its origin should always be recalled and it should be remembered that, in some forms of disease, fluids may collect or new tissues may develop be- tween the two laminz, from which the septum takes its origin. Fic. 35. CLEFT PALATS. Foay. (From photograph). In some cases these margins fail to fuse and result in a cleft palate, as shown in Fig. 35. In other instances the fusion ex- tends too far backward aad, passing across the pharynx, com- pletely separates the nasal chamber from the mouth and pharynx, constituting atresia of the posterior nares, by which arrest in development the animal is unable to breathe through the nostrils and must respire entirely through the mouth. With the greatly elongated soft palate of the horse, which renders oral breathing extremely difficult, the animal can not liveif both posterior nares are closed, while, if the atresia affects but one nostril, the animal can breathe readily when not severely exerted, but, if put to hard work, shows extreme dyspnoea as a result of the restricted breathing room. THE EYE. The eyes originate partly from the optic vesicles of the brain and partly from the optic pits in the epiblast upon the sides of the head. The optic nerve develops from the optic vesicles, which ap- pear as lateral outgrowths of the fore-brain early during em- The Eye 299 bryonic life, varying apparently in species from 10-20 days after fertilization. The optic vesicles appear first as tubular out- growths from the forebrain, but the distal end of each soon becomes enlarged, while the connecting stalk remainsa narrow tube. Later, the enlarged distal end becomes invaginated within itself to con- stitute the optic cup, which is later to form the retina and within which the vitreous body develops. The lens develops somewhat later, first appearing as a pit in the epiblast upon the side of the head. This pit gradually sinks deeper and its mouth narrows, until it finally closes to constitute the vesicle of the lens. The vesicle sinks into the optic cup and the margins of the latter come in close contact with it except at one point on the ventral surface, where there is a distinct groove, the choroidal fissure. Within the vesicle the /ens becomes elaborated from the enclosed epiblastic cells. The vitreous body is derived from an ingrowth of mesoblast, which enters the optic cup through the choroidal fissure. As the lens becomes invaginated and separated from the external epiblast, a layer of mesoblast extends across between the vesicle and the external epiblast, constituting the cornea, the tissues of which become transparent, ‘The choroid and sclerotic coats develop from the mesoblastic tissues surrounding the optic cup; the iris is formed by a forward growth of the margins of the opticcup ; and the anterior chamber appearssomewhat later asan excavation between the cornea and lens. The eyelids are the last structures to form in connection with the eye and consist of folds of the skin from above and below. ‘These extend over the eyeball to finally meet and become fused together, without adher- ing to the surface of the cornea, so that they create a closed sac, the lacrymal sac, between their internal surfaces and the cornea. In the rabbit and carnivora, the eyelids remain closed for a short time after birth, while, in ruminants and solipeds, the eyelids open somewhat prior to birth. The membrana nictatans, or third eyelid, is formed froma fold of skin in a similar manner to the two ordinary eyelids and ex- ists in all domestic mammals. The lacrymal duct is formed in the groove existing between the external nasal process and the maxillary arch. In the domestic animals, we occasionally meet with aberrations in the development of the eye. Sometimes the eyelids have be- 300 Veterinary Obstetrics come so intimately fused that they fail to open at the proper time, a condition which is not usually subject to remedy. In other cases, the cornea fails to undergo the normal transforma- tion into a transparent body, but remains opaque. In yet other instances, there is seen growing from the neighborhood of the lacrymal duct long hairs, which irritate the eye but which are, at times, subject to surgical removal. In still other instances, there is a contraction of the inner, or mucous, layer of the eye- lid or a comparative overgrowth of the external skin, by which means the eyelids are inverted, producing entropium. THE Ear. The first traces of the ears consist of open pits opposite to the hind-brain at an early period in the life of the mammalian em- bryo, usually at about ten to fifteen days. These pits sink in deeply until they come in close contact with the hind-brain and early acquire a communication with the auditory nerves. The mouths of the pits soon close and the invaginated portion be- comes separated from the external epiblast, to constitute the auditory vesicles, in which the essential parts of the ear, the semicircular canals, vestibule, cochlea, etc., are developed. , The Eustachian tube is formed from the hyomandibular pouch, which extends out from the pharynx as a diverticulum. At one time it pushes out against the epiblast and is separated from the exterior by a very thin membrane consisting of epiblast exter- nally, in immediate contact with the inner layer of hypoblast, with no mesoblast between. Later, a layer of mesoblast grows in between the epiblast and hypoblast and the three constitute the tympanic membrane. This pouch does not normally reach the surface at any time during fetal life, but occasionally opens abnormally in various mammalian animals, to constitute gill-slit fistula, which rarely persists at the time of birth in a manner an- alogous to the open gills of fishes and other similar animals. In the solid ungulates, there is a large infundibulum formed in con- nection with the Eustachian tube, which is known as the guttural pouch, or air sac. The slit-like communication of this guttural pouch with the pharynx is sometimes abnormal in the new-born foal, which causes air to become impacted in it (tympany of the guttural pouch), which may so press upon the larynx as to strangle the young animal. The Ear 301 The formation of the external ear, or pinna, has not been so well studied in domestic animals as in man. The conchal carti- lage arises from the mandibular and hyoid arches, which bound on either side the hyomandibular cleft. As shown in F ig. 36 in the human ear, the concha consists of a series of tubercles with deep fissures extending between them. We have no data to show that the early stages of development of the concha in our domestic animals are precisely parallel, but they are presumably Fic. 36. The left ear of a human embryo, lettered by Professor His, Br. 2, and estimated as thirty-five days old. From Mar- shall, after His. > 20. 1, tuberculum tragicum. 2, tuberculum anterius helicis. 3, tuberculum intermedium helicis. 3 and 3c, cauda helicis. 4, tuber- culum anthelicis. 5, tuberculum antitragicum. 6, tubercu- lum lobulare. essentially so. By observing Fig. 36, it will be seen that be- tween 1 and 2 there is a deep fissure which, in the ear of the horse, is apparently marked by an important ridge inside the concha. It is interesting, in connection with this fissure, to ob- serve that foals are frequently born with a deep invagination of the epiblast at this point, causing a long, narrow fistula which extends downwards from about the middle of the internal border of the concha to near its base, and from which there exudes a viscid mucus. In other cases, this invagination extends more deeply and penetrates the squamous temporal bone and, in the development of the osseous tissues, the invagination is inter- rupted and a closed sac formed at the distal end, in which, ordinarily, one or more teeth are formed (ear teeth) which resemble more or less closely the molars of the horse and may grow to almost any size, projecting far above the external sur- face or growing inward, causing an inward bulging of the skull into the cranial cavity. (See Figs. 37A and B.) Various authors 302 Veterinary Obstetrics ascribe these formations to outgrowths from the buccal mucous membrane. A glance at the figure, prepared from a clinical case, indicates otherwise, and that it arises from the epiblast of the conchal region in a manner parallel to the formation of the teeth within the mouth from the stomatodeal epiblast. A Fic. 37 A. The Ear 303 “ = ee WW-----~-% t ' 1 U ' i 1 J | 1 1 ! 1 t an 4 Fic. 37 B. EC, Epiblastic cavity. D, Tooth. ST, Squamous temporal bone. ST’, ST”, Incarcerating outgrowths of squamous bone tending to isolate Petrous temporal or ear bone, which constitutes a separate bone in the horse. AM, Anditory meatus, MA, Maxillo-mandibular articula- tion. 304 Veterinary Obstetrics FORMATION OF THE DIGESTIVE APPARATUS. The alimentary canal of the embryo at first consists of that portion of the blastoderm which is included within the embryo in the process of infolding and finally becomes constricted off from the yolk sac by the gradual folding inward of the embry- onal area at its margins. For atime the alimentary tract con- tinues to communicate with the extra-embryonal portion of the blastoderm, or yolk sac, by means of the yolk-stalk or vitelline duct. In some species of animals, this tube remains open until a comparatively late period in embryonic life and traces of it may be found in some of them in the umbilical cord at the time of birth, but it does not normally retain its relation with the intestines. The intestinal tract, during the early life of the embryo, is divided into three sections, known respectively as the fore-, mid-, and hind-gut ; the first comprising that portion anterior to the communication with the yolk-sac, the second, the middle portion of the area occupied by the yolk-stalk and the third portion, or hind-gut, that which projects from the yolk-stalk posteriorly. In the fore-gut there early appear two dilations, the pharynx and the stomach. The gut is at first closed both anteriorly and posteriorly and the communications with the exterior become established later. The anterior end opens first. There appears, in that region of the embryo which is later to constitute the mouth, a depression known as the stomatodeal pit, by which the epiblast sinks inward in the direction of the pharynx until finally the two cavities are separated merely by a thin layer of epiblast and one of hypoblast, the intervening mesoblastic tis- sues having been absorbed. Eventually, the thin membrane, gives way and the mouth communicates with the anterior end of the fore-gut, or pharynx. The pharynx shows a marked dilation in comparison with the other parts of the digestive tube. In sagittal section, the inter- nal surface shows the prominent visceral arches, between which extend the visceral pouches. Among these visceral pouches, the hyomandibular and first branchial are the most prominent and have, on the outer surface, corresponding visceral grooves, which do not normally open upon the exterior, but the hyomandibular groove becomes very thin and ultimately forms the tympanum, 305 westive Apparatus zon of the Di, Format “SOLVLSODR ENS SI'IVOASUMOCISSI SOWUYODOLSIHOS “gf ‘oI 306 Veterinary Obstetrics or eardrum. Rarely the hyomandibular gill-slit opens com- pletely upon the exterior to constitute gill-slit fistula of the new born. The embryonic line of demarcation between the stomatodeum and fore-gut is not perfectly known in the adult, but is in the immediate vicinity of the soft palate, the buccal mucosa and the teeth being derived from the stomatodeal epiblast, the tongue growing forward from the hypoblast of the floor of the fore-gut. Later in the life of the embryo, varying according to species, there appears, opposite the posterior end of the hind-gut, a dis- tinct depression in the epiblast, the proctodeal pit. The invagi- nation of this pit is of a similar character to that of the stomato- deum and soon extends sufficiently toward the hind-gut that only athin membrane.remains between them, consisting exter- nally of a layer of epiblast and internally of hypoblast. Nor- mally, this pit soon opens into the hind-gut and the alimentary canal now communicates with the exterior, both anteriorly and posteriorly. Various aberrations in the development of these parts occur. The most common is an arrest in the development of the hind- gut, by which a portion of it is wanting and it consequently does not become connected with the proctodeal pit and does not open exteriorly. In such cases, the young animal is born devoid of arectum. In other cases, the membrane between the proctodeal pit and the hind-gut fails to disappear and the young animal is born without an anus, as shown in Fig. 42. In still other in- stances, as recorded by Gurlt, the intestine ceases at the vitelline stalk, passing out through the umbilicus, where it ends blindly. A highly interesting aberration involving the digestive tract, and spinal column, is that recorded by Gurlt and illustrated in Fig. 38, which he designates as Schistocormus fissi-dorsualts subecostatus and describes as a cleft in the dorsal wall of the body, beneath the spinal column on the left side, through which the stomachs and other abdominal viscera prolapse. Gurlt remarks that the aberration is very rare, he having known of three instances, one in the calf, two in lambs—all in ruminants. We have observed a single case, resembling that of Gurlt in many respects but showing important differences. Figs. 39 and 40 delineate briefly its character. In this instance, the omasum, Formation of the Digestive Apparatus 307 M, and the spleen, S, are protruding from a crater-like open- ing in the head, through the occiput. The rumen and reticu- lum are wanting in the specimen, fragmentary shreds indicating that they had been torn away accidentally or eaten away by some animal before the specimen came into our hands. In this case, the prolapse of the alimentary tract is not lateral, but dor- sal, immediately upon the median line, obliterating for a distance the cerebro-spinal axis. FIG. 39. SCHISTOCORMUS FISSIDORSUALIS. Showing crater-like opening in the occipital region. Since the notochord becomes established prior to the formation of the gut, it would seem improbable that the prolapse would occur through that organ, but rather that it would pass in front of it, and this is apparently what has occurred. A study of Fig. 41, NV and PT, shows that, just anterior to the end of the noto- chord, there is an infundibulum growing down from the thala- mencephalon, or midbrain, while, just opposite, growing upward from the posterior border of the stomatodeum, is the pituitary pouch, which later becomes the pituitary body, the two infundi- buli coming into immediate contact with each other. ‘The fore gut has pushed forward and upward, to escape through this area of low resistance, upon the back of the head. ‘The fore-gut escaping, no neck has developed, and the sternum, S7, extends forward beneath the pharynx, FP, and the basi- occipital bone, BS. The illustration from Gurlt likewise indi- cates a virtual absence of neck, though less pronounced. At first the alimentary canal is of the same length as the body and forms immediately beneath the notochord, but later it in- Veterinary Obstetrics 308 ‘useiqdeiq ‘dC ‘HOT}JE[MOTAY [esoes-oquin’y ‘S’T “‘TANIOST ‘st ‘siqng ‘nd "snotiqmg §0 ‘ssuwy ‘3’T snmAy, “EL “IOAVT "7 ‘pues [eueipy ‘V “Aoupra “A “aunjseq] ‘T ‘Olea 120d ‘dA ‘aportjuea 1ySTy ‘AW ‘ ‘man dI1931S 4S “eoqoery, ‘IJ, -xudreyd ‘d 6€ ‘OL AO NOLMLOUS IVILIOVS “pues prorA4q} sassoro ouL’T siopsiday ‘da ‘jndps0 Jo pus ‘js0d ‘/O ‘yndia.0 jo pua ‘jay ‘O “qtr ysi YO ‘WoeMoys pay, “TW ‘tanyuaMI orMaTds-o1}8eH ‘D ‘uaatds ‘S ‘ov ‘OI ‘ato proweyds ‘as ‘ammsstutur0s 9dO ‘DO ‘urerq 310.7 ‘qt “s]]oo plow ‘DA ‘ono plowing “A ‘souog payeniqnyzy, ‘gq, “BI [IXeUL IOLIAJUY ‘WT ‘anSuoy, ‘I, Fic. 41. A median longitudinal, or sagittal section through a rabbit em- bryo, at the end of the twelfth day. The section is a strictly median one except in two respects, the cerebral hemisphere of the left side has been introduced in order to render the figure more complete ; and the Wolffian body and ureter of the right side. The terminal portion of the tail has been removed. BF, Cavity of fore-brain or tbalamencephalon. BH, Cavity of hind brain, or fourth ventricle. BL, Cerebellum. BM, Cavity of mid-brain. BS, Cavity of cerebral hemisphere, or lateral ventricle. CH, Notochord. GP, Post-anal gut. IN, Finger-like process of infundibulum. KC, Wolffian duct. KD, Ureter. KM, Wolffian body. LE, Epiglottis. LG, Lung. LR, Trachea. PN, Pineal body. PT, Pituitary body. RS, Sinus venosus. RT, Truncus arteriosus. RV, Ventricle of heart. TI’, Glottis. TA, Stalk of allantois, cut short. TC, Cloaca. TA, Thyroid body. TO, CHsophagus. TP, Pharynx. W, Liver. WD, Bile duct. YK, Volk stalk, cut short. (Marshall). 310 Veterinary Obstetrics creases in length far more rapidly than the body and drops away from the dorsal portion of the body cavity to float freely, con- fined in position only by the mesentery, which it has derived from the superior wall of the abdomen and carried with it in its descent. At first the posterior gut of the embryo represents jointly the intestine and the genito-urinary passages and constitutes a sin- gle dilated chamber, or cloaca, but later there grows back, from the angle between the stalk of the allantois and the gut, a parti- tion which serves to separate the digestive tube from the genito- urinary tract. This partition is sometimes incomplete, especially in the female when the proctodeal opening fails in the upper portion and causes a closed anus, when the feces from the intestine drop into the vagina, to be expelled through the vulva, as indicated in Fig. 42. Fic. 42. ATRESIA ANI. LAMB. R, Rectum. P, Closed proctodeal pit. C, Cloaca. Ur, Urethra. U, Uterus. B, Bladder. V, Vagina. THE LUNGS. The lungs are formed as an outgrowth from the floor of the pharynx in the region of the first to third branchial arches and begin as a longitudinal groove, which soon develops into a blind pouch. This evagination extends backward beneath the pharynx and at its distal end soon splits into right and left halves, to con- stitute the two lobes of the lungs. The growth continues back- The Teeth 311 ward beneath the oesophagus and above the heart and the distal ends of the two lobes become enlarged and commence dividing into small lobes. ‘The lobes elongate greatly and give rise to buds which end in somewhat enlarged ampullz, which continue to subdivide in this mauner, the terminal infundibuli constitut- ing the air cells, while the tubes leading from them are the bronchioles, the larger ones are the bronchii, the original tube leading from the floor of the pharynx becomes the trachea, and the slit which first appeared in the bottom of the pharynx forms the glottis. THE TEETH. The teeth appear very early in the life of the embryo and orig- inate from the epiblast of the stomatodeum in the form of a lon- gitudinal invagination of thickened epithelium along the border of the jaw, which eventually sinks down into the substance of the jaw as a continuous ridge, known as the common enamel germ. Later, the ridges become enlarged at intervals, to consti- tute the individual enamel organs, while the portions between Fic. 43. Three successive stages in the development of a tooth- germ of a pig embryo (after Frey and Thiersch):’, a, b, c, layers of thickened oral epithelium, showing dental groove on sur- face in 3; e, enamel organ; f, dental papilla; g,h, internal and external layers of follicle wall; i, blood-vessel; k, maxilla; d, epithelial ingrowth, the end of which expands into the enamel sac. (Heisler). 312 Veterinary Obstetrics these enlargements tend to atrophy and finally to completely dis- appear. . Each enamel organ soon consists of a flask-like vesicle of epi- blast with a narrow neck, which is still continuous with the epi- thelium of the mouth by a cord-like constriction, while the distal end, or fundus, of the flask is enlarged and spherical. Beneath this enamel organ, there soon forms, from the meso- blastic connective tissue, the dental papilla, which pushes up into the sac, causing an invagination of its base. The enamel sac now invests the top of the papilla asa cap and soon takes on the form of the future tooth. The enamel organ is then in the form of a flattened sac, the distal end invaginated, so that the two walls are brought into close proximity. See Fig. 43. Upon the external surface of the dental papillze, odontoblasts arise, from which the dentine of the tooth is formed. ‘The enamel prisms are formed from the epithelium of that part of ‘the walls of the enamel sac which lie in immediate contact with the dental papilla, while the superficial wall, i. e. that portion con- tinuous with the neck-like mass of epithelial cells still maintain- ing connection with the mouth cavity, disappears without tak- ing any recognized part in the formation of the enamel tissue. The dentine, forming from the odontoblasts upon the apex and sides of the papilla, soon invests these portions in the hard ivory substance, while the base and center of the dental papilla con- tinue as the tooth pulp. The base is at first wide open, but, as the tooth develops, it gradually contracts and finally, in some teeth, there grow out projections or septa of dentine, to consti- tute the roots or fangs, which divide this cavity into two or more distinct openings, according to the individual tooth or species, and, through these apertures, the blood vessels and nerves pass to the pulp of the tooth. See Fig. 44. As the enamel organ sinks down into the jaw, there occurs a condensation of the surrounding mesoblastic connective tissue to constitute a capsule, the tooth follicle, which closely invests the enamel organ and papilla. When the bony tissue of the jaw forms, the follicle serves as periosteum for the tooth and alveolus, while, from its inner layers, the external tooth tissue, the cement, is developed. The origin of the dental tissues is then: 1, the enamel from the invaginated epiblastic cells; 2, the pa- pilla, vessels, nerves and dentinal tubules from the mesoblastic The Teeth 313 connective tissue, and, 3, the cementum and dental and alveolar periosteum from the mesoblastic dental follicle. WoT FIG. 44. Sagittal section through an inferior grinder of an equine embryo, 4 inches long. ect, ectoderm of mouth cavity ; mes, mesoderm; eo, enamel organ; ec, enamel cells; d, den- tine ; eb, embryonic bone. The enamel cap is at most points detached from the dentine papilla. The section through the tooth follicle is so made that the plicee of the enamel cap have split each of the dentine papillze so that there are four instead of two. When the bony jaws form later, the teeth are at first in con- tinuous grooves, but transverse osseous partitions later extend between the tooth germs and finally constitute separate compart- ments, or alveoli, foreach. The permanent teeth are developed as outgrowths from the enamel organs of the temporary set in those cases where they are preceded by such; in the others they are formed the same as the temporary teeth from a backward growth of the common enamel germ. The teeth of domestic animals, and especially of the horse, are subject to many aberrations in development. The mesoblastic connective tissue follicle, under disturbances, may undergo seri- ous aberration during its developmental stages. There may bea 314 Veterinary Obstetrics large amount of fluid formed within the follicle, which may cause the destruction of the tooth germ and may become enormously increased, to the extent of one, two or more pints of fluid and, when in the upper jaw, may cause serious distress to the animal by projecting into the sinuses and interfering with respiration. Fic. 46 B. FIG. 45. Fic. 45. Sagittal section of superior molars of adult horse show- ing on the left, normal development, on the right, arrested de- velopment of the cement area. Fic. 46. A, Crown, and B, Longitudinal cross section of a super- ior grinder of adult horse showing absence of cement in central infundibulum and erosion of the enamel and dentinal plates. C, External cement. C’, Central cement area. E, External enamel layer. E’, Central enamel. E/’, Ex- ternal enamel at point of contact between adjacent molars. The adjacent enamel laminze project above the surround- ing tissues, have no cement between them and are so ar- ranged as to prevent the impaction of food particles be+ tween. D, Dentine. Er, Erosion area. Er’, Erosion canal penetrat- ing the tooth fang. P, Pulp cavity. S, Superior maxillary bone. These aberrations we know as follicular cysts. In other cases, the walls of the follicle form an abnormal amount of cement, which causes a very great accumulation of this substance, to constitute what we know as a cement tumor, or cementoma. The Teeth 315 Sometimes there isa distension of the follicle with fluid, ac- companied by a growth of cement upon its inner surface, giving rise to what we know as compound follicular cysts. At other times the walls of the tooth follicle become greatly thickened by an abnormal growth of connective tissue, to con- stitute what is known as a fibrous odontome. Finally, in the horse, and to a less extent in other animals, where there are deep invaginations from the sides or. upon the crown of the enamel organ into the dental papilla, there is normally formed in the grinders a sufficient amount of cement to completely close the spaces between the infolded layers of enamel. In some instances this formation of cement is in- complete and an opening is left through the central portion of this substance, from the grinding surface of the tooth down to the bottom of the infundibulum, in close contact with the enamel. Through this cleft, food particles pass and, becoming lodged in the deepest part, undergo bacterial decomposition, which causes a solution of the enamel and dentine and, finally, a perforation of the pulp cavity, leading to a purulent inflamma- tion of the tooth pulp and a destruction of the life of the organ, with many complications of a highly important character. See C’ Figs. 45 and 46. The enamel organ is subject to aberrations in its develop- ment by which a tumor is formed, which may prevent the eruption of the tooth and lead to what is known asa multilocular cyst. Fic. 47. Cross section of molar of adult horse. C, External cement. C’, Cen- tral cement. EK, External enamel. E’, Central enamel. P, Pulp cavity surrounded by dentine. ; The dental papilla may undergo two important forms of fetal aberration or arrest in development. First, there may be an ex- cessive development of the dentinal substance to constitute an 316 Veterinary Obstetrics ivory tumor, or radicular odontome. Occasionally such tumors in the horse reach a weight of five pounds or more. There is frequently an arrest in the development of dentine at the wearing surface of the tooth. In the grinder of the horse, where the enamel dips down into the body of the tooth, it serves to bring two lamelle of dentinal substance into close contact. Fic. 48. A and B. Table surface and section of inferior molar of adult horse, showing non-fusion of dentinal lamelle, followed by infection and purulent pulpitis. C, External cement. C’, Central cement. E, External enamel. E’, Central enamel. P, Pulp cavity surrounded by dentine. In the complex grinder of the horse, the papilla or radicle of the tooth, d, Fig. 44, splits up into several sharp elevations which push their way up into the enamel organ. The dentine forms from the ondontoblasts upon the exterior of these pro- jections, and the soft tissues, or tooth pulp, occupy the interior of these elevations so that at their apexes the inner, or pulp, surfaces of the dentinal plates come in immediate contact. Normally the opposing faces of these two plates should fuse at the grinding surface and hermetically seal the pulp cavity as The Teeth 317 shown between Cand C’ in Fig. 46B, and at Din Figs. 45 and 46 A, before the time when the tooth comes into wear, and the dentinal summit is worn away. In some cases, as shown in Fig. 48, this fusion fails to occur and results in an opening into the pulp cavity, with food particles passing through between the laminze into the pulp, causing a purulent inflammation of it, with destruction of the tooth and other important complications. Thus, in the early stages of embryonic life, aberrations in the formation of the tooth germs serve in a variety of ways to in- duce defects in these organs which lead to their early disease and destruction, accompanied by an endless variety of com- plications of more or less serious importance for the well-being of the animal. The mammalian tooth, the hardest tissue in the body, is nor- mally a product of epiblastic growth from the stomatodeum, which has become invaginated into the bones of the maxilla and mandible, but tooth tissues are not confined to these parts. We have already related on page 301 that tooth tissue, histo- logically and anatomically, is also formed in the squamous por- tion of the temporal bone of the equine embryo, but here the conditions closely simulate those obtaining in the oral cavity itself, that is, epiblastic cells are invaginated into the deeper layers of mesoblast. From the mesoblastic bone, the squamous temporal is formed, while the incarcerated epiblast, as in the jaws, develops into enamel tissue. From these considerations one might be led to state that the invagination of epiblast into embryonic tissues which are later to form bone leads to the development of teeth and that this condi- tion is essential to their origin. This, however, is not wholly true. Somewhat rarely in horses, and yet more infrequently in other animals, we meet with dental substances in the ovaries and testi- cles, and here the condition of the invagination of epiblast into mesoblast, with the incarceration of the former in mesoblastic tis- sue which is to ossify, does not occur. Possibly, here, the epiblast becomes invaginated through the gubernaculum testis or the cor- responding ligament of the ovary into the mesoblastic genital gland, or it may reach the genital gland through the Wolffian duct, which, according to some embryologists, arises by a longi- tudinal invagination of the epiblast, and, while the tissues of the 318 Veterinary Obstetrics gland do not ossify, the very dense tunica albuginea affords a degree of compression of a somewhat analogous character. We may then state that, so far as we know, teeth are always liable to result whenever limited sacs of epiblast become invagi- nated into mesoblast, and become incarcerated and separated from the general epiblastic layer, while the surrounding meso- blast is converted into bone or is bound down by firm layers of unyielding connective or other dense tissues. THe LIVER. The liver of the embryo appears about the end of the second week as an outgrowth from the inferior wall of the intestine just beyond the dilation which marks the future stomach. The for- mation of the liver resembles in many respects that of the lungs, the outgrowth becoming enlarged at its distal end, while the proximal portion becomes narrowed to constitute the bile duct. The liver is the most conspicuous of all the glands in the embryo and, at the time of birth, constitutes the largest and heaviest portion of the internal viscera. In volume and weight, it is equal to the entire intestinal tract, with the lungs and heart added. THE PANCREAS. The pancreas arises at about the same time as the liver, as an infundibulum from the anterior wall of the duodenum, and is lodged in the tissue of the mesentery between the intestine and dorsal wall. The gland quickly divides up into lobules, from which the acini and ducts are formed. THE CIRCULATORY SYSTEM. During the second week in the life of the embryo, the heart is recognizable as two symmetrical and distinct halves, which con- sist at this time of two straight tubes, lying along the head-end of the embryo between the yolk-sac and the neural folds and connected at their posterior ends with the vitelline. vessels. These two tubes soon unite to form a single one, which becomes twisted upon itself and forms a prominent swelling on the ventral surface of the embryo in the region of the pharynx. It is twisted in an S-shaped loop and is free in its middle portion, while the ends are attached anteriorly and posteriorly to-the ventral surface of the fore-gut. The posterior, or dorsal, portion of the heart represents the future auricles and is separated by a somewhat marked constriction from the ventral portion, which is to become the ventricles. The anterior end of the.loop is somewhat enlarged to constitute the ¢runcus arteriosus, which is attached to the fore-gut in the vicinity of the mandibular arches. The heart increases rapidly in size and, within a week from the first traces of its formation, the constriction between the au- ricular and ventricular portions has become very narrow, the auricles have assumed their ear-like form, and the ventricular portion lies transversely across the body, shaped somewhat like the adult stomach. THE SINUS VENOSUS. The blood is returned to the heart by three symmetrical pairs of veins: the Cuvierian vein from the body of the embryo, the vitelline vein from the yolk-sac, and the allantoic vein from the placenta. These three pairs unite to constitute the sinus veno- sus, lying transversely across the body and opening into the auricular portion of the heart. The séwuws venosus ultimately becomes a part of the auricle and disappears as a separate structure. The auricular chamber becomes imperfectly divided into the two auricles, at an early date, by outgrowths from the walls, which finally separate the two chambers. The septum between the two auricles does not become complete during fetal life, but closes normally at the time of birth; abnormally, it may persist 319 320 Veterinary Obstetrics . after birth, giving rise to the affection known as persistent fora- men ovale, or cyanosis of the newborn, by which the blood. re- mains mixed, asin the serpent, giving a bluish color to the skin and mucous membranes, usually ending in the early death of the young animal. . The constriction between the auricular and ventricular por- tions gradually develops to form the septum between these cavi- ties and, from these also, the auriculo- ventricular valves: are formed. The ventricular cavity becomes divided into two somewhat unequal halves toward the close of the first month. There also forms in the ¢runcus arteriosus, ta, Fig. 49, a median partition, which, growing backwards, divides the vessel into two parts, which are to represent in the future the common aorta and the pulmonary artery. The septum between the two ventricles is for a time incomplete and both the aorta and pulmonary artery are connected with the right ventricle only, so that the left cavity communicates with the arteries only through the opening in the ventricular septum. THE ARTERIES. A series of aortic arches, see between va and da, Fig. 49, arise early in the third week of embryonic life from the anterior extremity of the truncus arteriosus, one for each of the visceral arches, the more anterior appearing first. At first there are two wholly separate aorte, which run parallel to each other through- out the length of the body just beneath the notochord, but they soon become fused posteriorly to constitute the dorsal aorta, from which is given off the vitelline arteries to the vitelline sac. Further back it divides into the two allantoic arteries, which carry the blood to the allantois. The aortic arches pass from the floor of the pharynx up through the visceral arches on either side and open into the aorta. They are soon complete, five, or, according to some authors, six pairs, being present, one for each branchial arch, and all connected above with the dorsal aorta. The attachment of the truncus arteriosus begins to shift back- ward along the floor of the mouth and divides into two branches, the anterior of which maintains connection with the mandibular and hyoidean aortic arches, while the posterior is connected with the three, or four, remaining vessels. The Arteries 321 Fic. 49. Reconstruction of human embryo of about 17 days (His): oy, optic vesicle, ot, otic vesicle; nc, ne’, notochord; hdg, head gut; vs, vitelline sac; 1, liver; v, ta, primitive ven- tricle and truncus arteriosus; va and da, ventral and dorsal aorte ; aa, aorticarches ; jv, primitive juglar vein ; cv, cardinal vein; dC, duct of Cuvier ; uv,ua, umbilical vein and artery ; al, allantois; uc, umbilical cord. (Heisler). 21 322 Veterinary Obstetrics The aorte continue forward beyond the aortic arches and run alongside the brain, to constitute the internal carotid arteries. Changes now begin to appear, looking toward the foundation of the adult plan of circulation. The middle portions of the aortic arches in the mandibular and hyoidean arches disappear ; the connection between the truncus arteriosus and the aorte, through these arches, ceases to exist and the proximal ends of these vessels remain as the external carotid arteries. The third aortic arch remains and retains its connection with the anterior portion of the aorta and its proximal end or stem constitutes the common carotid artery. The connection between the portion of the aorta posterior to the junction with the third aortic arch and anterior to the fourth disappears, thus separating the carotid system from the aortic vessels. Vagus nerve External carotid » Internal carotid Vertebral artery Common carotid —— j Arch of aorta Recurrent laryngeal nerve (right) Right subclavian Left subclavian Ductus arteriosus Innominate artery Ascending aorta Luli onary trunk Fic. 50. Diagram illustrating the fate of the aortic arches. (Modified from Heisler. ) The left fourth aortic arch persists, to eventually become the aorta, while the ‘fifth, or, according to those authors who re- cognize six aortic arches, the sixth, arch ultimately becomes the pulmonary artery. See Figs. 49 and 50. The Arteries \ ‘ \ 323 At approximately the fifth or sixth week of embryonic life, the heart leaves the region of the pharynx and passes backward, while the neck becomes elongated and the head extended for- ward, which causes a great lengthening of the common carotid Fic. 51. ARRESTED DEVELOPMENT OF THE UTERUS AND VAGINA. Cow. O, Ovary. CL, Corpus luteum. UC, Uterine cornua. U, Cordiform Mullerian ducts representing the uterus. Va, Vagina. H, Hymen. V, Vulva. MU, Meatus urinarius. During the formation of the cranial nerves, the inferior laryn- geal divisions of the pneumogastric nerves cross behind the fourth, or permanent, aortic arches between the aorta and truncus arteriosus, to reach their destination in the muscles of the larynx. As the heart recedes toward the chest and the head grows forward, the laryngeal nerves are necessarily caught and dragged along with the aortz into the chest cavity, thus bringing about their recurrent course. While the heart is moving backward, the right aortic, or sys- temic, arch becomes smaller and finally disappears. As a result, the right laryngeal nerve is released from the dragging of the aorta but still passes around the right subclavian artery, while the persistence of the left arch, with its increased size, to become the common aorta continues the dragging upon the left recurrent nerve, which, throughout the life of the animal, must pass into the chest, around the aorta, and retrace its way back to the larynx. This essential difference in the course of the two in- ferior laryngeal nerves is by some presumed to have a funda- mental relation to the fact that, in the affection of ‘‘ roaring ’’ in horses, itis regularly the left nerve which becomes degenerated, 324 Veterinary Obstetrics Fic. 52. Frissicounis. CERVICAL, EcropraA CORDIS. (Gurlt. ) CERVICAL ECTOPIA CORDIS IN AN ADULT STEER. A, Ectopic heart. (Kansas City Veterinary College. ) The Arteries 325 though the essential relation of this to the disease is unknown, nor is there any explanation why the recurrent character of the nerve should cause disease im the horse and not in other animals. Fic. 54. EcTopra CorpbIS; SCHISTOCORMUS FISSISTERNALIS. After Hering. It should be noted here also that the heart sometimes becomes arrested in its movement backward and remains in the cervical or pharyngeal region. It thus occurs, especially in bovide, that the young may be born with the heart just beneath the pharynx or at any point between this and the first rib, as shown in Figs. 52 and 53, thus graphically reminding one of the normal ‘shifting of the location of the heart from its first position along the floor of the pharynx, in the embryo, toward the posterior portion of the body, to become lodged within the chest cavity. In other cases, the aberration in the location of the heart may occur in connection with a fissure of the sternum, through which the heart becomes herniated, asin Fig. 54. The fifth aortic arch gives off a branch, before joining the aorta, to go to the lungs and constitute the pulmonary, artery. In the right vessel, the arch disappears between the pulmonary artery and the aorta, while, in the left, it continues up to the close of fetal life, as the ductus arteriosus, which, up to the time of birth, maintains the indirect communication between the right ventricle and the posterior aorta, and persists throughout life as a fibrous cord, the Ugamentum arteriosum, 326 Veterinary Obstetrics THE VEINS. When the mammalian embryo is about three weeks old, there are three pairs of veins : the Cuvierian, the vitelline and the allantoic. The first of these return the blood from the embryo itself and are formed by the union of the cardinal veins. The vitelline veins are formed in the walls of the yolk-sac and carry blood from it along the vitelline stalk to the heart, while the third pair return blood from the placenta along the stalk of the allantois. The vitelline veins df mammals are naturally small, since the vitellus, or yolk, contains essentially no nutriment and, hence, affords small opportunity for any important functions in these veins, so long as they merely carry blood from the yolk-sac to the heart. They are situated in the mesoblast of the splanchno- pleure, enter the embryo at the umbilicus and, passing forward along the sides of the alimentary canal, empty into the sinus venosus. In growing out from the intestine, the liver surrounds the vitel- line veins before they empty into the sinus venosus. Here theveins break up into a series of capillaries, converging later to form the efferent hepatic vessels. In this way, the capillary system of the liver is formed and we have a vein dividing up into capillaries in the same way as arteries usually do, and converging again to form a second venous trunk. At about the same period that the vitelline veins are breaking up to constitute the functional circulation of the liver, they become connected with each other just before their entrance into that gland, by three communicating branches, two of which pass beneath the duodenum. and one over it, and thus form venous rings surrounding the intestine. From the anterior ring, there arise veins which carry the blood into the liver. The right and left vitelline veins soon unite to form a single trunk, which, a little later, is joined by veins returning blood from the intestine, after which it is known as the hepatic portal vein. The veins which previously established the communication between the right and left vitelline veins disappear in part in such a way that the remaining portions, which constitute later the direct trunk, are twisted about the duodenum in a manner similar to that seen in adult life. The Veins 327 The allantoic veins are at first paired, but they undergo a variable extent of fusion in the different species of animals; in our domestic animals they are usually united into a single vein within the body of the fetus at an early date, while externally, in the umbilical cord, they usually remain separate. These veins, arising from the placenta, pass along the sides of the allantoic stalk, or urachus, and eventually reach the sinus venosus and empty into that cavity. Later, they lose their connection with the sinus venosus, the right vein becomes smaller and finally disappears, while the left increases much in volume and gives off some vessels as it nears the liver, which enter it directly, while the main portion of the vessel joins the hepatic portal vein prior to its entrance into that gland. Ata slightly later date, when both vitelline and allantoic vessels have ceased to empty into the szzus venosus, all the blood from these two vessels must pass through the capillaries of the liver before it can reach the heart. At this period, a communi- catién, the ductus venosus, is established between the right hepatic and portal veins, by which the blood may pass from the vitelline and allantoic vessels across to the hepatic vein, without passing through the capillaries of the liver. This ductus venosus grows rapidly and affords a commodious and direct path, through which the blood may pass at once from the placenta to the heart, without going through the liver. It becomes obliterated in the foal some time prior to birth so that, in this animal, all blood from the allantois must pass through the liver. The posterior vena cava does not acquire much size until the hind limbs begin to form and the iliac veins unite to constitute its principal branches. It enters into the ductus venosus near its termination in the hepatic vein. The anterior and posterior cardinal veins unite to form the Cuvierian veins. ‘The anterior cardinal vein persists in some of our adult domestic animals, such as the cow, as the external jugular vein. The posterior cardinal vein disappears in its middle and the posterior end becomes the iuternal iliac vein, while the anterior portion of the right posterior cardinal vein persists as the vena azygos. The anterior vena cava represents the right anterior Cuvierian vein, while the left vein disappears completely, with the possible exception of the coronary sinus of the heart. 328 Veterinary Obstetrics THE FETAL CIRCULATION. In the earlier stages of the fetal circulation, all the blood re- turned to the heart, whether from the embryo, the placenta or the vitelline sac, is emptied into the sinus venosus, from which it passes into the cavity of the common auricle. In this way a complete mixture of the blood from all sources necessarily occurs. This mixed blood is then forced out by the auricle, through the truncus arteriosus, toward the head of the fetus. The sinus venosus later becomes a part of the auricle and into it empty the Cuvierian veins and the posterior vena cava. ‘The septum between the two auricles is gradually formed, but there remains the foramen ovale, through which the blood can pass with more or less freedom. The posterior vena cava opens very near to the foramen ovale and a small valve at this point tends to cause the blood to flow from the posterior vena cava to the left auricle, by way of the foramen. In this way, considerable admixture of blood from the three different vessels still ensues. Later, as the lett Cuvierian vein disappears, the blood from the head and anterior limbs is all returned through the right vein, or anterior vena cava, so that there are now only two vessels, both of which empty into the right auricle. At this period, the blood which enters the auricle from the anterior vena cava, com- ing from the head and both fore-limbs, is entirely venous in character, while that from the posterior vena cava is chiefly arterial, or red, blood coming irom the placenta, with a small portion of venous blood added from the posterior limbs and other parts of the body. By an elaboration of the valve in the foramen ovale and a valvular fold at the opening of the posterior vena cava, the blood from this vein is finally all carried directly across the right auricle into the left auricular chamber. The right auricle now receives blood from the anterior and posterior vena cave and a small amount from the coronary sinus. The blood comes respectively from the head and fore- limbs, from the hinder part of the body, the placenta, the intes- tine and the liver and from the walls of the heart itself. The blood entering the heart through the posterior vena cava de- serves special consideration. The right allantoic vein disappears early in fetal life, while the left persists and enters the body The Fetal Circulation “ 329 through the umbilicus, to pass forward to the posterior border of the liver, where it unites with the hepatic portal vein, so that the combined vessel now carries blood from the intestine, from the vitelline veins of the earlier period and from the placenta. For a period of time, generally extending to the date of birth, the blood may pass either through the capillary system of the liver or, entering the ductus venosus, may pass directly to the posterior vena cava without going through that gland. The blood which is carried to the heart by the posterior vena cava is largely arterial in character, that is, it has given up its carbon dioxide and other waste material in the placenta and has derived, from the blood of the mother, oxygen and nutritive materials, which these veins carry to the heart. Into this posterior vena cava, there also enters the blood which has been to some degree favorably modified by passing through the kidneys and the liver, in which glands certain deleterious substances have been removed. The blood from the posterior vena cava consequently presents a marked contrast to that from the anterior vessel, which returns only the blood sent through the arteries to the head, neck and anterior limbs after it has performed its nutritive office to those parts and, consequently, comes back charged with waste materials, without having received in its course any additional nutrient matter or having undergone any purification in passing through the tissues or organs. The blood brought by the anterior vena cava passes into the right auricle and thence into the right ventricle, from which it is driven along the pulmonary artery. Since the lungs are not yet functioning, only a small portion of it enters these organs and virtually all of it passes through the ductus arteriosus to the dorsal, or posterior, aorta. Connecting with the latter at an acute angle, the blood is directed backward toward the posterior part of the body, whence it largely passes to the placenta, through the umbilical arteries, where it is relieved of its waste matters and, in exchange, receives oxygen and nutrient material. On the return of this arterial blood from the placental capillaries, along the umbilic veins, with its small admixture of venous blood along with that which has been somewhat modified by passing through the kidneys and liver, it re-enters the right auricle, to at once pass over into the left auricle and thence into 330 Veterinary Obstetrics the left ventricle. From this latter cavity, it is driven along the common aorta until it reaches the carotid and subclavian arteries, through which it is carried almost wholly to the head and an- terior limbs. While the aorta is freely open from the heart along the poster- ior aorta toward the posterior portions of the body, it seems that very little of the blood from the left ventricle passes backward. This is largely because the blood from the right ventricle, which, at this period, is as strong as the left, has already filled that portion of the posterior aorta posterior to the juncture of the ductus arteriosus with that vessel. Consequently, the blood pressure in the two portions of the vessel is approximately equal, so that there is as great a tendency for the blood from the right ventricle to pass forward from the ductus arteriosus as for that from the left to pass backward from the opening of the ductus arteriosus when propelled through the common aorta. In some cases, it has been found that the aorta has become obliterated during embryonic life at a point just anterior to its juncture with the ductus arteriosus and posterior to the fourth aortic arch, so that all the blood to the posterior end of the fetus must pass through this vessel. This condition of independent anterior and posterior circulations has not interfered with the development of the fetus, but, at the time of birth, the circulation is at once blocked to all the posterior portions of the body, so that the new-born young must promptly perish. The plan of the fetal circulation is in a measure the reverse of that after birth, the purified or red blood coming from the pla- centa along the posterior systemic veins to the right auricle, thence passing largely to the head, neck and anterior limbs through the right ventricle, ductus arteriosus, carotid and sub- clavian arteries. This would suggest that the head received purer blood of higher nutritive value and that, consequently, the head end of the fetus should develop most rapidly. In the earlier stages of fetal life, this apparently holds true but later, in the larger herbivora at least, the development of each of the two ends of the body becomes approximately equal. Throughout fetal life, the blood of the entire body is of a mixed character, the red blood of the umbilic veins becoming mixed with venous blood before reaching the heart. 33! Prior to birth, the vitelline vessels have disappeared except in so far as they have persisted as portions of other vessels within the body. As soon as birth takes place and the umbilical cord is ruptured or the placenta detached from the uterus, the allantoic circulation must abruptly cease, while the pulmonary circulation must be promptly established because the respiratory functions have been shifted from the placenta to the lungs. As soon as the animal begins to breathe, the lungs must at once commence to function and, while, prior to birth, no blood of any note has passed through the pulmonary arteries and capil- laries, they must now promptly become active. In order that the blood from the right ventricle shall pass through the pulmon- ary arteries to the lungs, instead of through the ductus arteri-- osus into the aorta, it is essential that the latter becomes promptly obliterated. The rupture of the umbilical cord finally interrupts the pla- cental circulation and renders useless all those vessels within the fetal body whose sole office was dependent upon the fetal circu- lation. ‘To this end, the intra-fetal portion of the umbilical vein, with the ductus venosus, needs to close and disappear. Vestiges of the umbilical vein persist, but its channel becomes occluded within a very few days after birth, unless interrupted by disease processes. The allantoic, or umbilical, arteries must likewise undergo a partial degeneration and complete loss of function. When ruptured in the natural way, they usually part just outside the. abdomen, though some writers (Carsten- Harms) allege that these arteries occasionally rupture within the ab- dominal cavity, especially in the cow. This is not wholly clear and is somewhat difficult of proof. In the foal, where it is generally admitted that they divide outside the abdominal cavity, the torn ends promptly retract within the body and, dragging with them the connective tissue surrounding their’ walls, normally retreat from the surface in such a manner as to pre- clude the possibility of hemorrhage and to greatly diminish any danger from infection in these vessels. (See Fig. 56.) A little later their ruptured ends retract to the vicinity of the anterior portion, or fundus, of the urinary bladder, from whence they may be traced throughout life as connective tissue cords, passing from this point to the internal iliac arteries to constitute the round ligaments of the bladder of the adult. THE DEVELOPMENT OF THE URINO-GENITAL SYSTEM. The urinary and genital systems are closely allied in their origin and are both preceded by the Wolffian bodies and ducts, which for a time perform the excretory office of the kidneys and finally take prominent parts in the origin of both the urinary and genital organs. THE WOLFFIAN DucTsS AND WOLFFIAN BODIES. The Wolffian ducts are claimed by some embryologists to orig- inate, as a pair of longitudinal grooves, in the epiblast on the ” Jateral surface of the body, at about the level of the notochord or somewhat below. ‘The invaginations of epiblast continue to sink inward into the mesoblast of the somatopleure until they attain the inner surface of the body cavity, in contact with the peritoneum. Other investigators, and apparently the majority, hold that the Wolffian ducts are wholly of mesoblastic origin, though at first lying immediately against the epiblast, as solid rods, which later become excavated in their center to constitute their cavity. For a time the Wolffian ducts end blindly be- hind, but later they open into the cloaca. The Wolffian bodies are first recognizable, during the third week of the embryo, as longitudinal thickenings in the dorsal surface of the body cavity, there being one of these ridges on either side of the mesentery.. They develop rapidly and become greatly elongated so that they soon reach from the posterior por- tion of the cervical region back to the end of the lumbar region. The essential tissues of the Wolffian bodies appear to develop, independently of the Wolffian ducts, from the mesoblast, in the form of rods and cells. The rods coil somewhat upon them- selves and become excavated to constitute tubes and, growing toward the Wolffian duct, empty into it at one end, while the other end becomes dilated, and then invaginated, to constitute the Malphigian bodies, or glomeruli. Into these glomeruli, branches of the aorta penetrate to furnish the functional blood supply. The veins from these glands empty into the posterior cardinal veins. 332 FIc. 50, A, B,C. PAROVARIAN TUMOR OF MARBP, INCARCERATING RECTUM. A, View from right side with a tumor, ‘T, almost hidden by the con- striction caused by the pedicle. B, View from left side, the tumor ex- posed by cutting away part of mesentery. C, Schematic illustration of method of incarceration. I, Intestine. M, Mesentery, ©, Ovary. T, Parovarian tumororcyst. P, Pedicle of tumor. R, Rectum, 334 - Veterinary Obstetrics Later the Wolffian bodies commence to degenerate and atrophy and finally the essential tissues of the organs almost wholly disappear and the Wolffian bodies, with their ducts, become concerned in the origin of accessory portions of the reproductive apparatus. In the female, the Wolffian bodies play no important part in the formation of the ovaries, but they send some outgrowths into these glands, which persist for a time without playing any essential part. Some remnants of the Wolffian bodies persist, however, as the parovarium, or organ of Rosenmueller, and from these vestigial portions of the Wolffian body the large peduncu- lated cystic tumors, occasionally seen in the mare, appear to arise. In rare cases these pedunculated par-ovarian tumors be- come looped about the rectum, inducing fatal incarceration, as shown in Fig. 55. In the female, some traces of the Wolffian duct may remain at its anterior end. In its posterior portion we do not observe remains of this duct in most animals, but, in the cow, they usually persist as Gaertner’s canals, which sometimes become blocked at their mouths to constitute retention cysts. ‘These present themselves as elongated sacs, arising close to the meatus urinarius on either side and extending upward and forward along the walls of the vagina. When they become very greatly dis- tended, they serve to interfere with copulation and, if very large, possibly with parturition. The Wolffian bodies largely disappear in the male but take a somewhat prominent part in the formation of the testicles and thus in part persist throughout life. Tubules grow out from the Wolffian tubules in the anterior part of the Wolffian bodies and finally enter the substance of the testicle to constitute the vasa efferentia, which eventually become connected with the seminal tubes. The coni vasculosi are derived from the anterior Wolffian tubules and the Wolffian duct is finally converted into the epididymis and vas deferens. THE KIDNEYS, URETERS AND BLADDER. Before the disappearance of the Wolffian body, there appears toward the posterior end of the Wolffian duct an outgrowth or diverticulum, which is later to constitute the ureter and which, passing backward toward the cloaca, finally acquires an inde- pendent opening a little way behind that of the Wolffian duct. The Reproductive Organs 335 At the anterior end, this infundibulum grows forward beneath the Wolffian body and dilates to form a sac which is to constitute the pelvis of the kidney, while, from its walls, a number of branching tubules grow out to constitute the uninary tubules and, at their ends, they enlarge to constitute the glomeruli of the kidney. At the point of communication between the ureter and the allantois the latter tube becomes dilated to constitute the urinary bladder. Behind, the allantois is constricted to constitute the urethra, while, in front, the narrowed portion which passes out through the umbilicus is known as the urachus. During the life of the fetus, the urine chiefly passes through the urachus, which opening normally closes at the time of birth. THE REPRODUCTIVE ORGANS. The development of the reproductive organs of the female has already been described on page 11, to which the reader is re- ferred. ‘They undergo many aberrations in their development, due to arrests, some of which have already been noted on page 247. Fig. 51 on page 323 illustrates an interesting form of arrested development of the uterus and vagina, in which these organs are represented by enlarged, solid cords. THE MALE REPRODUCTIVE ORGANS. THE TESTICLES. The testes form, like the ovaries, in the genital ridges and in the earliest stages the mode of origin or development can not be differentiated in the two sexes. Later the differentiation occurs through the development of some parts of the undifferentiated genital gland and the atrophy of others. The Wolffian bodies and ducts play an important part in the development of the ex- cretory apparatus of the testicles. In the indifferent gland the mesoblastic cells become grouped in cords containing small cells, along with the larger and more numerous primitive sexual cells. These sexual cords are formed from the roundish masses of cells, separated from each other by connective tissue sheaths. They eventually become elongated and hollowed out to constitute the seminiferous tubules. From the Wolffian bodies, cell cords grow out and fuse with the semeniferous tubules to constitute the vasa recta and rete 336 Veterinary Obstetrics ¢ testes and the latter, by further growth, form the head of the epididymis. The upper, or anterior, end of the Wolffian duct is modified to constitute the body and tail of the epididymis, while the posterior portions form the vas deferens, seminal vesicle and ejaculatory duct. Early in fetal life, the developing testicle shifts its location from its primary lumbar position toward its final normal resting place, in most animals in the scrotum. Formed in the per- itoneum of the body wall in the sub-lumbar region, the gland is outside or behind the parietal peritoneum and, as it shifts its po- sition and descends into the cavity of the abdomen toward the in- ternal abdominal ring, it necessarily carries with it a peritoneal covering and remains attached to its point of origin by a double peritoneal fold, mesentery or mesorchon, between which its vessels and nerves pass. In the formation of the Wolffian body, there arises, in con- nection with it, the inguinal ligament, which passes from the fundus of the scrotum through the inguinal ring up to the Wolffian body. When this atrophies and disappears, the cord persists and maintains a connection with the testicle, as the gubernaculum testis, or with the ovary, as the round ligament. The gubernaculum testis consists of connective tissue and un- striped muscle fibers, surrounded by peritoneal coverings. Since the testicle, the gubernaculum testis, and the vas deferens, origi- nating from the Wolffian duct, form outside of or behind the peritoneum, as the organ descends each of the three structures must drag with it a double peritoneal fold, so that finally there appear three peritoneal folds, as shown in Figs. 56 and 57 : one for the testicle and its artery, A ; one for the vas deferens, V, anda third for the gubernaculum testis, G, G’, and G”, all of which are continuous. , As.the organ continues to descend toward the inguinal ring, the peritoneum of the abdominal floor, which stretches across the ring, evaginates through it as the processus vaginalis at P. in Figs. 56 and 57, into which pouch the epididymis, E, descends, followed later by the gland, T. The testis having formed on the median side of the Wolffian duct, which later forms the epididymis, the two structures maintain this original relation throughout and, when the testicle comes to rest in the scrotum, The Reproductive Organs Bai the epididymis hes upon its external face, above the gland. The relation as to elevation between the testicle and epididymis be- comes reversed. In the abdomen, processus vaginalis and in- guinal canal, the epididymis is dezeath the testicle and precedes it in the descent but, when the testicle finally reaches the bottom of the scrotum, it performs a partial revolution forwards on its long axis, which reverses the relation and brings the epididymis Fic. 56. Genito-urinary system of a foal, 24 hrs. old, to illustrate descent of testicles and behavior of ruptured umbilic arteries. The central portion of the abdominal floor has been partly excised and laid back. Seen from below. T, Testicle. A, Artery of testicle. G, Gubernaculum testis. V, Vas def- erens. B, Bladder. UA, Ruptured ends of umbilic arteries retracted within abdomen. P, Processus vaginalis. UV, Umbilic artery. 22 338 Veterinary Obstetrics above the testicle in the horse. In ruminants, this reversal of relation does not occur, as the long diameter remains perpendicu- lar. The processus vaginalis remains normally open throughout life in the domestic animals, but in the adult it is so narrow that abdominal viscera may not escape through it. When the testicle has descended into the scrotum, it is attached posteriorly at the bottom to the fundus of the sac by the guber- naculum and upwards along the posterior wall of the scrotum and inguinal canal by the frenum, consisting of the peritoneal dupli- cature between V and G in Fig. 57; above, the gland is connected by means of the testicular or spermatic cord, consisting of the vas deferens, arteries, veinsand lymphatics covered by peritoneum. In the foal, pig, and more rarely in other species, at the. time of birth, we frequently meet with a hernia (congenital scrotal hernia) of intestines or omentum through an abnormally large processus vaginalis, alongside the spermatic cord. FIG. 57. RIGHT INGUINAL, REGION OF FOAL, 24 Hrs. OLD Illustrating descent of testicle, viewed from below, the testicle lifted upwards to reveal attachinents. P, Processus vaginalis, surrounded by a dotted line and contain- ing a curved sound, S. G, Gubernaculum testis emerging from the internal inguinal ring and reaching to the larger portion, G’, which extends to the epididymis, E, and is succeeded by the final or third section of the gubernaculum, G/’’, reaching from E to the testicle, T. A, Artery of testicle. V, Vas deferens. B, Bladder. UA, Um- bilic arteries. a The Reproductive Organs 339 In some instances, the epididymis, E, Fig. 57, descends into the scrotal:sac, while the gland remains in the abdomen or in- carcerated in theinternal ring. Far more frequently, both gland and epididymis are retained within the peritoneal cavity to con- stitute cryptorchidy. The successful castration of cryptorchid animals depends fundamentally upon a practical knowledge of the track and mode of descent of the testicle, and of itsattachments, through the medium of the gubernaculum testis, vas deferens and testicular artery. The Wolffian ducts open early, at their posterior ends, into the terminal portion of the allantoic stalk, which is later to consti- tute the urethra, which, in the male, elongates backward to ex- tend to the distal end of the penis. The penis of the male and clitoris of the female arise alike as outgrowths from the ischial arch ; in the female it stops short in its growth as a non-essen- tial erectile organ, without acquiring any relationship with the urethra, while, in the male, it becomes greatly elongated and, curving downwards and then forwards, passes between the thighs to end in a special sheath and prepuce. The urethra extends throughout its entire length to open at the extremity of the glans penis. Arrests or aberrations in development of the penis occur, con- sisting usually of an abbreviation in its length, suggesting a graduation in extent between a normal penis and clitoris. Sometimes the defective penis is directed more or less backwards, leading to a backward direction-of the urinary stream. In other instances, the formation of the urethra is aberrant and it opens at the ischial arch or lower down along the penis, to constitute hypospadius or epispadius. Defects in the development of the penis and clitoris are largely associated with aberrations iu the essential genital organs them- selves, partaking more or less of hermaphroditism or bi-sexual character. Hermaphroditism varies greatly in character and extent and tends largely to follow certain types for each species of animals. In the horse, it is not rare to meet with an animal having a well.developed vulva, vagina and uterus, the vulva and vagina functioning, the latter ballooning under manual ex- ploration, asin a normal mare. No ovaries are present but, instead, typical cryptorchid testicles producing the ordinary ‘SINH AUVINAWIGAY ONIAMOHS ‘HSHOH AO WSILIGONHAVWUHH-OGAHSG ‘gS “OMT The Limbs 341 cryptorchid sexual reflex, a male voice, form and behavior. Such a case was readily castrated by us through the ample vagina in the same manner as spaying a mare. (Fig. 58). The elongated clitoris, which projected 2 or 3 inches beyond the vulva, was amputated. The udder was well developed. In other cases in the horse, we have observed well developed mam- mz with testicles resting just above and to the outer side of them, an abbreviated penis and no vulva. Between these types various gradations appear. In a boar, as shown in Fig. 14, we found a male gland (testicle) on one side and a female, (ovary) on the other. THE Limes. In a rabbit embryo of about the tenth day, the mesoblastic cells on either side of the notochord become grouped into cuboid- al masses, divided from each other by transverse lines, which are known as somites or primitive segments. ‘The first pair ap- pears in the cervical region prior to the closure of the neural tube and additional somites appear, extending forward toward the head end and backward toward the tail. From these somites siz < _ | d of jie hb ie yd Fic. 59. Rabbit embryo of the ninth day; seen from the dorsal side (after Kolliker.) X2I. stz, Stem zone.. pz, Parietal zone. In the stem zone 8 pairs of somites appear on either side of the chorda dorsalis and neural tube. ap. Area pellucida. rf, Medullary groove. vh, Fore-brain. ab, Eye vesicle. mh, Mid-brain. hb, Hind-brain. uw, Primitive segment. h, Heart. ph, Pericardial portion of body cavity. vd, Margin of entrance to foregut. af, Amniotic fold. vo, Vena omphalo-mesenterica. (Heisler). 342 ma Veterinary Obstetrics Fic. 60. HuMAN EMBRYO OF ABOUT 28 DAYS. SHOWING LIMB BUDS. (His). Ito V, Brain aeSioles, 117 ft, Cephalic, cervical, dorsal and lumbar flexures. op, Eye. ot, Otic vesicle. ol, Olfactory pit. d, Maxillary and mandibular processes of first visceral sp, Sinus precervicalis. h!,h?, Heart. 1, 1, Limbs. als, Allantoic stalk. ch, Villous chorion. (Heisler. ) The Limbs 343 Feromelus aus Fic. 61. PEROMELUS APUS. (Gurlt). Fic. 62. PEROMELUS ACHIRUS, FOAL. later arise the vertebral column, the skeletal muscles, tendons and ligaments and the corium, or deeper layer of the skin. The formation of the limbs begins as small buds, or outgrowths, arising from the mesoblastic somites soon after the third week in the human embryo, earlier in the rabbit and probably in most of our domestic mammals. The limb-buds each represent several mesoblastic somites, as indicated by the fact that the nerves pass- ing to each limb are formed by the union of branches from sev- 344 Veterinary Obstetrics eral intervertebral nerves, each vertebra representing a somite. The buds lengthen to constitute the limbs, the bones arising from the connective tissue, while the muscles develop from the muscle plates of the mesoblast. The segments of the limbs are brought about by transverse grooves where the joints are later to form and the digitations begin as longitudinal grooves, which deepen into clefts. Various aberrations in the development of the limbs occur in our domestic animals. Merely the buds may appear and, within them, rudimentary bones representing the scapula and pelvis or, more or less also, the humerus and femur, but the other parts may fail of development. Any one, or all, of the limbs may be wanting. Fig. 61 represents the skeleton of a bovine fetus without limbs (Peromelus Apus), while Fig. 62 represents a foal, in which the two anterior limbs are wanting (Peromelus Achirus.) In such cases the defect is apparently due to an arrest in the development of the limb-buds during the first month of pregnancy. Between this absence of limbs and their normal development occurs every gradation of arrest in the development of limbs, as peromelus micromelus or dwarf limbs. Rarely a limb may undergo amputation during its early stages of development by becoming involved in a loop of the umbilical cord. A more common aberration in the limbs and feet is abnormal fission, by which the entire limb or its digitations become multi- plied. Most commonly, only the digits are involved, resulting in one or more extra digits, as shown in Figs. 63 and 64. Sometimes a greater part of the limb is involved in the ab- normal fission. Rarely normal fission fails in those animals nat- urally provided with two or more digits or, after their more or less complete fission, fusion occurs between them and the animal is born with less toes than normal. Rarely, in the development of the limbs, a tendency is shown toward the addition of an element not normally present in the genus but regularly occurring in some other genera, asis illustrated in well developed clavicles in the pig, as shown in Fig. 65. The Limbs. Fic. 63, M&GALOMELUS PERISSODACTYLUS. Pic. Fic. 64. . MEGALOMELUS PERISSODACTYLUS. FOAL. Fic. 65. HUMERI OF PIG, WITH CLAVICLE-LIKE OUTGROWTHS. 346 Veterinary Obstetrics FIG, 66 A Wine, (ls 18}. Fic. 66. A, Foal with bent anterior meta- carpal bones, show- ing extreme dorsal flexion of metacar- po-phalangeal arti- culations. B, Bent metacarpi from A. The limbs are furthermore subject to a variety of contractures, sometimes involving a misdirection of the limb due to deformity of the articulations, at other times to a bend in the bone itself, as shown in Fig. 66 A and B. THE FETAL MEMBRANES AND THE PLACENTA. The maintenance of the intra-uterine existence of the fetus, and its development to a degree which will enable it to maintain a more or less independent existence at the time of birth, requires that effective means be established for the exchange of nutritive and waste materials between the mother and her young, not alone for the basic purposes of nutrition and excretion, but also that the embryo may be moored or fixed at a given point in the maternal organ, where its position can be maintained throughout the duration of pregnancy in such a manner as to best protect and insure its life and normal growth. To this end there are formed three structures from the blastodermic vesicle, which undergo changes to finally constitute the fetal membranes and placenta. 1.. THE VITELLINE, OR VOLK Sac. When the embryo commences to develop, the embryonic area folds inward at its borders, leading to a constriction between this area and that part of the blastodermic vesicle which lies beyond, and they finally become separated except by a narrow neck, the vitelline duct, while, beyond, there exists the comparatively large vitelline or yolk sac. This vitelline, or yolk, sac plays but a minor part in the development of the embryo and tends to more or less completely disappear, according to species, while in some it persists as an embryonal vestige to the time of birth. In the mare, the yolk sac is very inconspicuous early in fetal life and disappears almost completely at a very early stage. In Fig. 74 this general plan is suggested at the twenty-eight day of pregnancy, while in Fig. 75 it is indicated that, at five months, it has well nigh disappeared. In the sheep, as shown in Fig. 76, it assumes a wholly differ- ent form and undergoes great elongation. In other of our domestic animals there are variations in the form which this sac assumes, but, in each alike, it is of apparently little importance except during the very earliest stages of embryonic life. 2. THE AMNION. The amnion commences to form as soon as segmentation has been completed and the ovum has passed through the oviduct and reached the uterus. This occurs at about the 13th or 14th 347 Veterinary Obstetrics 348 Primitive groove. Beginning amnion fold. Parietal — Mesoderm. layer of mesoderm. “Entodermic lining Ectoderm,. of gut-tract. Visceral layer of mesoderm, Entoderm. Transverse section of the embryonic area of a fourteen-and-a-half-day (Heisler, after Bonnet). Amnion. FIG. 67. ovum of sheep. Medullary Jurrow. So. <3 = ra , oe 2, s = ngs 22? Cay “ad A Paya itt Lining of pV? J Pericardial Extension plates, of celonm. nleSOderen, Lleuropericar- dial cavity. Transverse section of a sixteen-and-a-half-day sheep-embryo. (Heisler, after Bonnet). day of gestation in the embryo of the sheep and is soon complete. The date of its appearance in other domestic animals is approxi- Fic. 68. mately the same. The amnion arises from the extra-fetal portion of the somato- pleure, which folds upward around the margin of the embryonic It forms a double area beneath the zona pellucida, or prochorion. The Amnion 349 membrane which, by continuing to grow upward and converge, finally meets above the dorsal surface: of the embryo and fuses. By the fusion there is formed a double sac which envelops the fetus completely except at its point of origin at the ventral surface, where it takes part in the formation of the umbilicus. The inner of these two membranes constitutes the true amnion, while the external one forms the external or false amnion which, fusing with or re- placing the prochorion, forms the primitive chorion and later, when the allantois grows out, blends with it to contribute to the formationjof the permanent, or allantois-chorion. This outer, or Medullary Uncleft a m. Jurrow.. Ectoderm., A Parietal mesoderm. Celon. Visceral mesoderm. Notochord. Somite. Gut entoderm, Fic. 69. Transverse section of a sixteen-and-a-half-day sheep-embryo with six somites. (Heisler, after Bonnet). false, amnion is merely a portion of the external wall of the blastodermic vesicle, without its relations having been changed exteriorly. The space between the amnion and the fetus con- stitutes the amniotic cavity and is filled with the amniotic fluid. As the amniotic cavity becomes filled with fluid and enlarges, it closely invests the vitelline stalk and the allantoic cord in its passage through this cavity. The amount of liquor amnii varies greatly in different animals and at different periods of pregnancy, but it is generally most abundant at about the middle of gesta- tion. In the cow and mare the amount of amniotic liquid varies from 5-6 liters, while, in the sheep, according to St. Cyr and Violet, it varies between 100 and 500 grammes. In woman, the amount is said to be about 1% liters. 350 Veterinary Obstetrics Amniotic JSolds i i\ i\ Coelom H \ q q | Kitelline Duct ; Vitelline Sac 1 \. Cutaneous Navel Placental Tufts Amniotic Chorton Allantois "N Vitelline Duct *?>s, ExtraSetal Coelom Vitelline Sac Schematic longitudinal section of fetal annexes of At the points indicated by + the skin is con- (Bonnet). FIG. 70. mamuunalia. tinuous with the amnion. The Amnion 351 An increase of this fluid constitutes what is known as dropsy of the amnion, which accumulation, in the cow, may sometimes reach the enormous amount of 20 or more gallons and prove so burden- some as to prevent the patient from arising when down, because of the great weight of the accumulated fluid. (See Dropsy of the Amnion. ) : : In some cases, especially in the embryo of the cow, the amnion apparently becomes contracted during the early stages of its formation and causes an eversion of the somatopleuric portion of the embryo, resulting in the condition which we know as Jissura ventralis or schistosomus reflexus. In this deviation, no body cavity is formed and the internal viscera, derived from the splanchnopleure, lie free within the chorion. In other words, the constriction and infolding of the splanchnopleure to constitute the intestine proceeds. The constriction which should ex- ternally mark the division between the fetal and vitelline por- tions of the somatopleure, to constitute the umbilicus, fails to develop; the amnion contracts; the spinal axis of the embryo bends ventralwards, in a way passes out through the non-con- stricted umbilic area and the embryo, so to speak, turns inside- out. The spinal axis of the fetus becoines sharply doubled dorsally and the somatopleuric portions lie as a partially everted sac with its peritoneal surface presenting externally. This ab- normality constantly causes serious difficulties at the time of parturition and frequently taxes the resources of the obstetrist to overcome them. This will be more fully considered when dealing with dystocia. See Figs. 71 and 72. Other interesting defects in the development of the amnion occur, one of the most frequent being adhesion of this membrane to the epiblast of the fetus, largely upon the head, by which, at the time of birth, the fusion between the skin of the fetus and its membranes offers an important or serious obstacle to its ex- pulsion. The liquor amnii contains albumin, sugar, urea and other ele- ments of urine and, in many cases, especially in the foal, also some massesof meconium. ‘The avenue by which each of the fluid substances reaches the amniotic cavity has not been fully shown. Some hold that the fluid transudes into the cavity from the amnion itself, coming indirectly of course from the blood of Fic, 72. Schistocormus reflexus, after partial embryotomy to over- come dystokia. E, Left ear, above which is seen the radial portion of the left carpus. F, Right anterior foot. R, Ribs. S, Sternum. PL, Laverated area where posterior limbs have been torn away. The Allantots 353 the mother. It is obvious that the meconium observed in the amniotic fluid of the foal has been expelled from the intestine through the anus and that, the anterior end of the alimentary tract opening also into this cavity, any discharge of secretions or debris from the mouth or nostrils falls at once into the amniotic cavity. It is also clear that urine may he readily and freely ex- pelled into this cavity and that the urinary salts found in the amniotic fluid are derived from the fetal kidneys and discharged into the amniotic sac through the urethra. The amnion consists, on the embryonic side, of a thin layer of epiblast, while, on the outer side, it is formed from the somato- pleuric mesoblast. | The external surface of the amnion is in contact throughout more or less of its extent, varying according to species, with the inner wall of the allantois. THE ALLANTOIS. The allantois arises as an evagination from the hind gut just posterior to the vitelline duct and grows outward and backward between the two amniotic layers, and, in the mare and carnivora, finally envelops the amniotic sac completely, so that, in these animals, there occur two complete envelopes to the fetus, each of which is eventually filled with fluid. (See Figs. 74, 75.) Tracing the allantois from its origin in the hind gut, there is a slight constriction which is to constitute the urethra, followed by a dilation from which the urinary bladder is to develop, then an elongated, narrow tube, the urachus, which extends from the fundus of the urinary bladder out through the umbilicus and along in the umbilical cord across the amniotic cavity. In structure, the inner layer of the allantois is of hypoblast derived from the inner layer of the hind gut, while the external layer consists of mesoblast, in which the allantoic vessels are formed to constitute the vascular layer. In all our domestic animals, the allantois constitutes a great sac, which is filled with a liquid, the allantoic fluid, which con- sists largely of the secretions from the kidneys, augmented per- haps by transudation from the blood vessels of the walls of the sac itself. The allantoic fluid contains albumin, grape sugar 23 Veterinary Obstetrics Vitelline. Veins Vitelline Artery Areolar Ridge Sinus Terminalis Vitelline Area B Vitelline- Artery Rent in the Wall of the Ovum Fic. 73. A, Embryo of the horse in its membranes. 4.2 cm. in its greatest diameter. Twenty-eight days after fecundation. B, The same seen from the other side. (Bonnet). The Chorion 355 and urea and is, consequently, similar in character to the amniotic fluid, except that no meconium can reach this cavity since only the urinary tract communicates with it. In the fetus the urinary secretions may pass either backward through the urethra into the amniotic cavity or forward through the urachus into the allantoic cavity and, consequently, through this tract the two cavities communicate throughout intra-uterine existence. In the human embryo there is virtually no allantoic sac except for a very brief time early in pregnancy, the walls of the allantois soon coming in immediate contact. Collectively, these membranes, with the addition of the vesti- gial remains of the vitelline sac, constitute the fetal membranes, or after-birth. THE CHORION. The external or vascular layer of the allantois, with the ex- ternal or false amnion, constitutes the permanent or allantoic chorion. In the brief interval elapsing between the formation of the amnion and the allantois, the external or false amnion per- forms temporarily the functions of the placenta by throwing out placental tufts which acquire intimate attachments with the mucosa of the uterus, maintain the attachment and fixation of the embryonic mass in its position and provide an avenue for nutrition and excretion. Later, when the vascular layer of the allantois spreads over the inner surface of the false amnion and fuses with it, the allantoic tufts push out into the existing amniotic structures, acquire intimate relations with the uterine mucosa and lead finally to the displacement or effacement of the amniotic chorion. The form, extent and relations of the allantois in different animals present the greatest variability. In the mare, as indicated in Figs. 74 and 75, the allantois grows completely around the amnion and constitutes a complete double envelop, except for the area occupied by the vestigial yolk sac. It thus completely separates the amnion from the false amnion or amniotic chorion, its sac being filled with the allantoic fluid. Its internal surface is lined with endoblast from the enteric canal, while its exterior layer is of splanchnopleuric mesoblast. A study of Fig. 75 shows that the somatopleuric mesoblast, or outer layer of the true amnion, is in contact with the splanchnopleuric mesoblast of 356 Veterinary Obstetrics the allantois: these, though separable, adhere somewhat in- timately, the two together constituting the sac usually designated as the amnion. Similarly, the external wall of the allantois presses against the mesoblastic layer of the amniotic chorion or false amnion, fuses with it and constitutes the allantois-chorion. Amniotic Chorion fy y Allantois Chorton Sinus Terminalis Circular Ridge Border Zone Central Portion of Vitelline Area Fic. 74. Schematic illustration of fetal annexes of the embryo of the horse, 28 days after fecundation, as in Fig. 73. Perpendicu- lar section through the embryo and its envelops. The embryo in black. — Hetoblast. .... Vitelline layer. — - Parietal mesoblast. — — -— Visceral mesoblast. (Bonnet). In ruminants and swine, unlike the globular or spheroidal blastoderm of the horse as shown in Figs. 73 and 74, it becomes very greatly elongated, as shown in Figs. 76 and 77, longer even than the uterine cavity, necessitating its folding wpon itself. This elongated *sac does not persist, but soon atrophies and almost wholly vanishes long before birth. "The formation of the allantois follows more or less the plan of the blastoderm and its yolk sac and in these animals becomes much elongated. In swine the apices of the allantoic sac are destitute of placental The Chorion 357 tufts, as shown in Fig. 77. In ruminants, Fig. 80, the allantoic sac becomes much elongated, while its apex, along with the amniotic chorion, finally undergoes necrosis, as shown on the right of the figure, or the apex of the amniotic chorion alone be- comes necrotic without the allantois having penetrated it, as shown at the left. In case of single pregnancy, the allantoic sac of the ruminant occupies both cornua. The arrangement of the allantois in ruminants differs greatly from that of the horse. ‘The allantoic sac does not completely surround the fetus but, lying along its ventral side, greatly elongated, only partially encloses the amnion. Amnion J] -Epithelial Thicken tugs =A of the Amnion = a ~ Amniotic Chorion Ss. “ASS 4 ES Chorionic ; Ly . : \ mul! seal Layer of |. uter) Allantois ine Sac FAllantotc Portion of aad : a4} 78 paxety squiry (¢) | ‘sqiary ‘SMOGTH 94} 38 paxaTyT squiry (2) i TOMSUY “‘PeaH 34} 1810 passo1d yaa,q (1) ‘salpIsoljsuoy_ a[qnoq °* ‘SUOTLNIIVAY jo sasojAqouy ° *€ ; ‘quamdojaaaq [eja{ Ul saljemouy pue suonermeqy ‘2 =| a ‘prod Iq [emsouqy ‘Pv ‘sloyuel[eIp B ot o ce go. er 38 J int Oo wn ic} B of . 5 4 snjaq aq} Jo suontsog pue snoneuasearg jeuiouqy ‘9 ‘SOXOMUY SH pue snjzaq oq} jo yuamdoyaacq aq} Ut sat} -T[euliouqy Io ‘Jo sasvasiqy ‘g ‘sn.13}{] 94} Ul WoTTIsog [emM1ouqy Ue UI snja,J aT} Jo juemdopaaq “Ww A. DEVELOPMENT OF THE FETUS IN AN ABNORMAL POSITION IN THE UTERUS. BICORNUAL PREGNANCY OR TRANSVERSE DE- VELOPMENT OF THE FETUS. The uteri of domestic animals are so definite and characteristic in their form that they usually admit of the development of the fetus in but one position, in which the long axes of the uterine cornu and the fetus must be parallel. In uniparous animals the two cornua usually leave the rather ample body at an acute angle, and the single fetus is almost inevitably developed in a longitudinal position, somewhat equally in one of the cornua and in the uterine body. In multiparous animals the inconspicuous uterine body is usu- ally empty, and the fetuses are developed almost wholly in the extensive cornu, in a longitudinal position. In the mare, however, the form of the uterus is such that it may lead, as we have already stated on pages 28 and 379, to a bicornual or transverse development of the fetus. The earliest account we have found of this abnormality is by Pauli, who, in Gurlt and Hertwig’s Mag., 1842, Vol. 8, p. 196, records attending in 1837, with two colleagues, a mare which they could not deliver. Autopsy revealed a transverse fetus, dorsal presentation, head, neck and anterior limbs in right horn, hind feet in left horn, abdomen and chest occupying the uterine body. So far as we are aware, definite attention was first drawn to this anomaly by us, in an article entitled ‘‘ Transverse Develop- ment of the Fetus in the Uterus of the Mare’’ in the American Veterinary Review, Vol. 13, page 298. Later occurred a de- scription of apparently the same anomaly by Anton Tapken, Official Veterinarian in Varel, in the Monatshefte fiir Praktische Tierheilkunde, Vol. 18, page 148, of which a translation by us appeared, with added comments, in the Veterinary Journal, Vol. XLII, page 148. Bicornual development of the fetus is made possible in the mare because of the unique direction in which the two uterine cornua are given off from its body. Instead of leaving the uterus at an acute angle, as in ruminants and carnivora, they 716 Bicornual Pregnancy 717 depart from the body at right angles, or slightly recurved so as to give the entire organ, consisting of the body and cornua, a crucial form. It thus becomes possible for the fetus to develop in such a position that the long axis of its body corresponds to the combined long axes of the two uterine cornua; that is, the fetus develops partly in each of the two cornua, with its body ° crossing the uterine body at its anterior extremity, so that the fetus fundamentally occupies a position with its long axis trans- verse to that of the mare. How often this may occur in the mare, we do not know. In our contribution above quoted, we recorded four cases, to which we may add the four case reports of Tapken and one of Pauli. It is a well known fact, to all who have had extensive obstetric practice in mares, that it is not rare for the foal to present trans- versely. This is in sharp contrast to cattle obstetrics, where transverse presentation is very rare. Among these presentations, except those cases which we now, have defisaitely under con- sideration, it is impossible to determine how many of them may have developed transversely, and consequently at the time of birth presented transversely. While veterinary obstetrists may deny the posssibility of bicornual development, our cases, fully verified by post mortem examination, show that it actually occurs, and not very infrequently. The established facts do not forbid our assuming that some of the other fetuses which present trans- versely may have been developed in the transverse position. In the cases now under consideration, the embryo apparently forms in each case in the transverse presentation, with its ventral surface presenting toward the os uteri, and later revolves upon its long axis, so that it finally rests in a dorsal transverse presen- tation instead. In its earlier stages, the embryo curves very markedly ven- tralwards, and this ventral curvature continues to a consider- able degree throughout gestation. Since the cornua of the uterus leave the body at right angles or slightly recurved, the embryo may well develop with either its dorsal or ventral surface facing the os uteri, although, so far as investigations upon this point carry us, only those cases have been recognized as bicornual development which have begun their development with their ventral surface presenting toward the pelvis. 718 Veterinary Obstetrics If the embryo commences to form in the uterine cornua, with its ventral surface directed toward the os uteri, and the fetus curves ventrally, it would naturally follow that, as it attains weight, the central portion of its body would tend to drop downward, while its two extremities would point upward toward the oviducts. Later the fetus would tend to descend until the convex dorsal surface would come in contact with the abdominal floor and thereby assume an unstable position. Since the anatom- ical conditions prevent its revolving upon its long axis in the di- rection of the pelvis, it may acquire stability only by its ex- tremities passing forward and downward to come to rest upon the abdominal floor. In accomplishing this movement, the fetus revolves upon its long axis; and in doing so its dorsal surface turns toward the birth canal, pushing the uterine floor back- ward beneath the vaginal floor, and stretching the roof of the vagina forward. In this transverse position, the fetus must necessarily drop well forward and remain wholly in front of the pubis, thus stretching and elongating the vagina to a remarkable degree. We have attempted to indicate this change in the position of the fetus in Figs. 120 and 121. Symptoms. This anomaly in development naturally passes unobserved during the entire period of gestation, and is not dis- covered until an examination is made in order to determine the cause of dystokia. The symptoms are then unique and diagnos- tic. Before the obstetrist is called, the os uteri has become dilated, the water-bag has appeared and ruptured, and probably some of the fetal membranes lie in the vagina or protrude from the vulva. The labor pains are weak in character. The fact that no portion of the fetus, or at least no considerable portion of it, can usually be forced into the vagina, tends to inhibit any well marked expulsive efforts. Such would necessarily prove futile, and dangerous to the integrity of the uterus. When the obstetrist inserts his hand, he is first struck by the extremely elongated and narrowed vaginal passage, which is nearly twice its ordinary length, although very much decreased in its transverse diameter. No os uteri or cervix is distinguish- able as such. If the obstetrist follows the roof of the vagina, the hand glides along it almost as far as the arm can reach; or perhaps he cannot reach the anterior end of the roof, where it Bicornual Pregnancy 719 finally turns down in a gradual curve, without any recognizable line of demarcation between it and the uterus. If he follows the floor of the vagina and palpates carefully as his hand passes along, he will discover to his astonishment a hard body lying beneath it, which upon careful manipulation he may recognize as portions of the fetus, lying directly against the vaginal floor, and impressing him very strongly at first with the idea of extra-uterine pregnancy. If he will follow the uterine floor further, to the extent of nearly the entire length of his arm, his hand suddenly passes downward into the uterine cavity, and he finds that the floor which he has been following bends abruptly backward to constitute the roof of the uterus, immediately beneath which the fetus lies transversely with its dorsal surface presenting toward the pelvic inlet. Fic. 120. TRANSVERSE OR. BICORNUAL DEVEL- OPMENT OF THE FETUS IN THE MARE. V, Vagina. U, Uterine cavity, which is later to blend with the vagina to constitute an elongated tube. UC, Uterine cornu. 720 Veterinary Obstetrics In some cases the obstetrist may find one or more feet project- ing from the uterus into the vagina, which may be readily reached and grasped. Ina large proportion of cases, however, no portion of the fetus projects into the vagina, and before the operator can bring his hand into immediate contact with any por- tion of the fetus he must reach far forward and then, bending the hand downward.and backward, touch the ventral portion of the fetus or some of the extremities which are folded along it. In order to accomplish this, he reaches clear over the body of the fetus, passes beyond its ventral line and then, after passing the point of version where the floor of the vagina ends, turns the hand downward, and more or less backward, into the uterine cavity. These peculiarities serve to differentiate this condition from any other known in veterinary obstetrics. y t ‘gs ; ot he: Fic. 121. BICORNUAL PREGNANCY. Second stage, the fetus having made one-half revolution on its long axis. (Schematic), V, Elongated vagina and uterine body. UF, Floor of uterine cornua, now become the roof. UR, Roof of uterine cornua, now become anterior wall. BL, Broad ligament. Bicornual Pregnancy 721 Prognosis. The prognosis in this condition is always highly unfavorable. We have no record of any case in which the life of either mother or fetus has been saved. Tapken says, ‘‘ De- livery is always difficult. If no part of the fetus can be reached, delivery is evidently impossible. In each of the four cases which I append, the result was fatal for both mother and foal, and such was also the result in another case, which, owing to oversight, was not included in the foregoing table. In the latter case of dystokia, two experienced colleagues had already tried in vain to deliver the mare before I had been called. It was barely possible to touch the metacarpus of one leg with the finger tips, when the arm had been introduced completely to the shoulder.’’ ‘The case of Pauli also ended fatally for both mare and foal, despite the efforts of three veterinarians. In our own experience we have been equally unsuccessful, and have encountered great and even insurmountable difficulties in delivery. In one of our cases the mare survived the operation some days, but finally succumbed to metritis. In that one case it would seem possible that, had we had a better understanding of the conditions and given closer attention afterward, she might have been saved. We would not, therefore, advise the veterin- ary obstetrist to refrain from attempting to deliver a mare in this condition. However, in undertaking it, it would be well in our judgment to advise the owner of the highly unfavorable prog- nosis of the case, so that he may be forewarned of the probable outcome. Method of Handling. Each case must be dealt with, in detail, according to circumstances. In general, it is well to se- cure any of the extremities which may lie within reach and cord them, so that force may be exerted upon them at any time that, it may become desirable. If all four feet can be reached, it is usually advisable to amputate the two anterior limbs, either subcutaneously or at the humero-radial articulation, and then attempt to convert the presentation into a posterior one by drawing carefully upon the hind legs. The position of the animal is important. Fig. 121 suggests that, if we turn the mare upon her back, the version of the uterus will tend to disappear and the fetus will be brought nearer to the operator, so that parts which previously had not been in reach 46 722 Veterinary Obstetrics may now be grasped. Placing the mare upon her back also re- laxes the projecting floor of the vagina and, by tending to over- come the version of the organ, renders traction upon the fetus less dangerous to the floor of the vagina and the roof of the uterus. Various positions of the mare may be tried in an effort to overcome the difficulty. It must be remembered that it is ex- ceedingly exhausting to the mare to remain for a long period of time upon her back, and this position should not be continued beyond the absolute necessities of the case. If the work can be done nearly as well with her standing upon her feet, this position should be preferred until the critical time arrives for extracting the fetus by force, when we believe it would be best in all cases to turn the mare upon her back for.this brief period and thereby relieve the vaginal floor aud uterine roof. The position of the fetus and its relation to the uterus render most forms of embryotomy exceedingly difficult or impossible. In our experience, we have been limited to the possibility of the amputation of the limbs. The decrease in the size of the fetus, were we able to bring about embryotomy, especially evisceration, would favor its delivery. After the extraction of the fetus, if the obstetrist has been so fortunate as to accomplish this without fatally injuring the uterus, unusual care should be taken to guard against sepsis. Fig. 121 shows that the form of the uterine cavity is extremely unfavorable for adequate drainage, and suggests that this be over- come as far as possible by careful and repeated irrigation of the uterus and siphoning out of the contents. In view of the fact that we have been unable to save the life of either mare or foal in any case, and, so far as we have been able to determine from recorded cases, no mare or foal has been saved by other practitioners, it would seem to us that the veterinary obstetrist is fully warranted in early resorting to gastro-hysterotomy in a way to possibly save the life of his patient. While we have not attempted this operation in the mare, we believe that it offers the greatest hope for success in these cases. Evidently there is nothing to lose. In one of my cases, as in one of those recorded by Tapken, delivery through the birth canal was wholly impossible, and under such conditions clearly the only plan remaining is hysterotomy. Presumably there is never an opportunity to save the life of- Bicornual Pregnancy 723 the foal; it is ordinarily dead before the obstetrist is called. We have outlined the technic of hysterotomy on page 663. The following cases illustrate the variations and difficulties to be overcome, and suggest, more forcibly than anything else well can, the seriousness of the anomaly. Cases 1 to 3 are quoted from the contribution by Tapken; cases 4 to 6 are from our personal experience. 1. Anold mare, which had already foaled regularly a number of times, showed symptoms of colic in the evening after the normal duration of preg- nancy. Later, mild labor pains appeared and some of the fetal waters were expelled. Upon examination, at 8:30 A. M., the mare was comfortable, ate some, no labor pains recognizable. At times there was a discharge of fetal fluids. The cervix uteri was dilated. Portions of the ruptured chorion ex- tended into the vagina. The uterine walls were stretched and thrown into folds similar to torsion of the uterus, but nearer to the body of the uterus. The fetus could barely be reached with the finger tips, after the arm had been introduced up to the shoulder. During the exploration there were only feeble labor pains. An attempt to modify the position of the uterus, by rolling the mare, failed. While in the recumbent position, however, strong labor pains ap- peared. Asaconsequence of these violent pains, the tightly stretched uter- ine wall was pressed into the pelvis to such an extent as to threaten rupture. The neck of the bladder was also dilated to such a degree that four fingers could be introduced into it. During the violent pains, the urinary bladder was from time to time forced out into the vulva, where it was visible asa whitish mass about the size of a man’s fist. A second veterinarian was called in consultation. At 4 P. M. the further handling of the case was undertaken by T., in company with his colleague K. After a prolonged effort, the lower end of the tibia was grasped, and a cord attached above the hock. By means of a vigorous pull by four persons, the tarsus was brought to the pelvic inlet, and the tendo-Achilles divided, partly with a knife and partly with shears. Both arms were inserted in the genital canal, and finally the leg was drawn out so far that it could be amputated at the hock. The second leg could not be grasped. Traction was applied to the tibia of the amputated leg, and, with the force of six persons, the skin and muscles torn asunder without any incisions having been made, and the leg tore away at the hip joint and was drawn out. The other tarsus could then be grasped, and was handledin the same way. Upon the application of powerful traction by six persons, the fetus was extracted. It was large, but normally formed. In the uterus, near the neck, there existed a perforation. The mare died a few hours later. 2, An eight-year-old mare, which had repeatedly foaled in a normal manner, showed, after eleven months pregnancy, weak labor pains and un- rest for a period of two and one-half hours. An examination revealed one fore-leg, presenting in the normal position and direction, inthe pelvis. Be- 724 Veterinary Obstetrics neath the advanced limb, the uterus and vagina formed a projection, under which one could distinguish parts of the fetus, especially the head. These parts were time and again forced to the middle of the pelvic cavity during the labor pains. Beneath the presented foreleg one could feel, through the uterine wall, other parts of the foal, which later were found to be the second anterior limb flexed at the carpus. After mounting a stool, so that the arm could be inserted as far as possible, he succeeded in reaching the point of flexure of the uterus. It was not possible to grasp any other part of the fetus. The anterior limb was corded and drawn out by three persons, until the forearm was visible. The other anterior limb was then released from the folds in the uterus and brought into the genital canal, but it could not be extended. In order to secure room, the extended limb was detached. The division of the skin was incomplete, and could only be extended to the elbow joint. As a re- sult of this, it required the combined power of six or seven persons to draw the limb away. The head, which was clearly recognizable at the beginning of the opera- tion, became displaced in such a way that it could no longer be reached. There remained, consequently, no other recourse than a forcible extraction of the fetus, which was accomplished by the traction of six or seven persons. ‘The mare lay exhausted and listless. After half an hour the pulse was 60, strong and regular, which indicated that no great amount of internal hemorrhage was occuring. A small amount of blood flowed from the vulva. By a manual exploration of the uterus, no labor pains were induced. After three and one-half hours the mare arose, staggered somewhat at first, but soon partook of food. In the following days the appetite was fairly good, then failed. Four days later the mare was again examined. The pulse was 70, the appetite poor, and now and then there were expulsive efforts. Upon ex- amination of the parts, there was found a great gaping rent in the superior wall of the uterus, so that it was easy to introduce the hand directly into the peritoneal cavity. The animal died on the sixth day. The autopsy revealed a rent in the uterus about 25 cm. long, also diffuse peritonitis. 3. A young mare, at full term, had shown labor pains for several hours. Fetal waters had appeared. Upon inserting the hand as far as possible, only fetal membranes and the uterine wall could be felt ; through these walls, however, in the reflexed uterus, parts of the fetus could be recognized. An empiric, with the consent of the owner, had made an examination and had torn through the wall of the uterus, which he had mistaken for the fetal membranes. The mare was destroyed. 4. In 1887 the writer was called to attend an imported Percheron mare, because the keeper believed her to be in labor, although in some way the symptoms appeared to him unusual. Upon examination no expulsive efforts could be observed, and when manual exploration of the vagina was made there was marked narrowness of the passage at the usual location of the os uteri, which was mistaken for it. Lying beneath the vagina, a fetus was felt, apparently with all its membranes intact. Non-interference, with close watching, was advised. Bicornual Pregnancy 725 The mare continued fairly well and quiet for about 48 hours, when we were recalled and, upon making a second examination, found the fetal mem- branes protruding from the vulva. Upon careful examination it was found that the part, which was previously supposed to be the os uteri, was merely the narrow vagina, beneath which the fetus lay. The presence of the membranes permitted us to follow them along their course uitil the opening into the uterus was reached, when it was found that nothing resem- bling the normal os uteri was present. The vagina was extremely long and narrow. Far to the anterior, barely within reach, the canal opened abruptly downwards and backwards into the uterus. Posterior to this opening, and beneath the vagina, lay the body of the foal, in a transverse position, readily felt through the vaginal and uterine walls. Though beyond reach through the os uteri so long as the mare was standing, when she was recumbent the hind limbs could with difficulty be reached. After patient and exhausting work, the hind legs were secured at the tarsus by means of cords, but it was impossible to bring them into the passage until the feet were amputated through the lower tarsal articulation. We then had the two hocks presenting with the ossa calces directed up- wards, while beneath the vagina could still be felt the main volume of the fetus. Firm traction applied tothe hind limbs finally brought the fetus into a posterior presentation, and accomplished its extraction after about five hours of very trying labor. Examination immediately after delivery revealed an enormous rupture of the uterus and inferior wall of the vagina. The animal was destroyed, but no autopsy made. 5. A large French draft mare in excellent condition, which had pre- viously bred successfully. The fetal membranes were found protruding, but no well-marked labor pains. Exploration revealed an exceedingly long, narrow vagina, which, at its anterior extremity, barely within reach, opened abruptly downwards and backwards. The usual conformation of the os uteri was wanting. While the mare was standing, no portion of the fetus could be touched by passing the hand into the uterus. There seemed to be a great cavity to the right and left and posteriorly. By following the supe- rior walls of the vagina up to the uterus, we found this bent abruptly down- ward to become the anterior wall, which could be followed as far as the hand could reach without coming in contact with any portion of the foal. Posterior to this opening and beneath the floor of the vagina, the fetus could be plainly felt. By passing the hand through the uterine opening, drawing its posterior margin firmly backwards, and then reaching down- ward and backward as far as possible, a portion of the fetus could be barely touched, but not grasped. : After casting the mare and placing her upon her back, one hock was se- cured, corded, and with great difficulty brought into the passage. Then one anterior limb was secured and amputated. Later the other hind leg was secured, and with strong traction the fetus was brought away after eight hours of exhausting labor. The mare succumbed 24 hours later, and no autopsy was made. 6. The writer was called in consultation, in case of dystokia in a large 726 Veterinary Obstetrics draft mare which had bred repeatedly before without difficulty. The vagina was abnormally elongated and narrow, and its anterior end opened abruptly downward and backward without resemblance to the usual osuteri. The fetus could be plainly felt through the floor of the vagina, posterior to the opening into the uterus. It lay with its back against the pubis of the mare. By passing the hand through the opening into the uterus, and then down- wards and backwards, the elbow of one fore-leg could be touched with difficulty. After long and arduous labor this one limb was secured and brought into the passage, but we were wholly unable to secure any other limbs or parts of the foal, either by raising the abdomen with a sling or by casting the mare and turning her upon her back. Though my colleague was an experienced obstetrist and a large and powerful man with very long arms, it was impossible for either of us to secure other parts of the fetus. The one limb which we had succeeded in cording was in such a position, in relation to the uterus and vagina, that traction could not be applied with any _ safety orefficiency. After a long and fruitless effort, the mare was destroyed, and a post-mortem examination immediately made. The foal, very large and well matured in every respect was lying upon its right side with its dorsum against the pubis of the mare. The head was located in the right uterine cornu, and the hind legs and buttocks in the left. The body lay in a thoroughly transverse position across the abdominal cavity, posterior to the opening between the vagina and uterus. One fore- leg was flexed at the carpus, and the other, which we had secured, was drawn backward over the neck of the fetus, into the vagina. The two cornua were developed equally, and their long axes were perpendicular to that of the mare. The vagina, because of the transverse position of the fetus and the peculiar version of the uterus, was much elongated and narrow. The opening from the vagina into the uterus was abruptly down- wards, the superior vaginal wall suddenly losing itself by turning abruptly downwards to become the anterior uterine wall. Thus that portion of the uterus which had originally constituted the roof or superior wall had now become its anterior wall. The inferior wall of the vagina, or floor, terminated anteriorly abruptly, in a thin margin; what had previonsly been the floor of the uterus was turned abruptly backwards against the vagina, thus becoming the superior uterine wall. * *K a * * ok * While the bicornual development of the fetus seems to be naturally limited almost wholly to the mare, because of the peculiar conformation of her uterus, rare exceptions are recorded. Cuillé, Revue Vet. 1905, records a case of bicornual pregnancy in the bitch, which caused insurmountable dystokia. The autopsy showed a fetus, lying with its head and fore legs in the right horn and its croup and hind legs in the left. In another case of dystokia, in the bitch, C. extracted the fetus by traction on one fore foot, and believed that this also was a case of bi- cornual pregnancy. B. ABNORMALITIES IN THE DEVELOPMENT, OR DISEASES OF THE FETUS. a, EXCESS OF VOLUME OF THE FETUS. Excess in the volume of the fetus is a comparative term. It is the relation existing between the size of the fetus and the di- mensions of the birth canal of th emother, rather than definite abnormality in volume. Such comparative excess in size is not rare in domestic animals, and is frequently a more or less serious obstacle to the expulsion of the fetus. The causes of this comparative excess in fetal volume are not clear. The excess may be confined to one part of the body, or may apply to the entire body. Prolonged gestation is sometimes believed to increase the volume of the fetus. In the cow and mare there are great variations in the duration of gestation, ranging from 30 to 90 days or even more. During this period the fetus is presumably constantly growing, and, if carried for 30 to 60 days beyond the briefest duration of pregnancy, it would be but reasonable to ex- pect that it may be larger because of this longer period of intra- uterine development. Nevertheless it has not been possible to verify this suggestion by clinical observation. Prolonged gestation does not commonly result in such a growth of the fetus as to cause any serious ob- stacle to its delivery. It is true that those fetuses which are born after a comparatively short duration of gestation, prema- ture births, are usually very small, but they are also correspond- ingly immature. When they reach the average duration of intra-uterine development they seem to be as large as though carried for a much greater length of time. In one instance which we noted, where the duration of gestation in a mare ex- ceeded 12 months, the foal to which she gave birth wasa pigmy about half the size which would naturally have been expected in harmony with the size of the sire and dam. " Neuman (B. T. W., 1909, p.702) records delivering a cow, 413 days pregnant, of a putrid, emphysematous calf, weight 110 lbs. long hair, female, form of male. The impression is given that the large size was due to prolonged gestation. The fact 727 728 Veterinary Obstetrics that the fetus was dead and emphysematous destroys all evi- dence of prolonged gestation. The fetus may have perished at 280 days. In 1908, Frost, instructor in the N. Y. State Veteri- nary College, delivered a Holstein-Fresian cow of a calf weigh- ing 147 lbs. The duration of pregnancy was normal, the calf was normal, and was alive, but died during delivery. Calves weighing over 100 lbs. are not rare in this breed. It is con- sequently unwarranted to conclude that, because a fetus is un- usually large, the duration of pregnancy has been excessive; or that, because pregnancy is being prolonged, dystokia from ex- cessive volume of the fetus must occur. While rare exceptions may occur, according to our observations the largest fetuses are usually encountered in those cases where the full duration of what we regard as normal pregnancy has merely been reached. It appears, from all that we can learn of the subject from a clinical standpoint, that the retention of the fetus in the uterus, beyond the average duration of time, is not dangerous from the standpoint of causing dystokia by excess of volume, but rather that other complications may arise which may be more or less dangerous for the well-being of the mother and fetus. In multiparous animals, like the bitch and sow, it is frequent- ly noted that when the number of fetuses is below the average they tend to grow larger because of the increased nutritive supply, and in this way tend to cause difficult labor. Excessive size of the male animal, as compared with that of the female, has been alleged to cause an excessive size of the fetus, but this we have not been able to verify clinically.. We have had occasion to observe the results of crossing small mares of 700 to 1000 pounds with large draft stallions weighing from 1800 to 2500 pounds, or approximately three times the weight of the mare. Yet we did not observe a case of dystokia, in such mares, attributable to excessive volume of the fetus. 5 Fleming cites several authors to show that such crosses do re: sult in difficult labor, especially in the ewe and bitch. On. the other hand, Saint-Cyr states, in harmony with our personal -ex- perience, that he has repeatedly seen large Percheron stallions crossed with small mares, without any resulting difficulty in foaling, because of size. It appears from clinical observation that the size of the female, not that of the male, chiefly fixes the size of the fetus, and L£ixcess of Volume of the Fetus 729 that the variation in the size of animals because of cross-breed- ing occurs during extra-uterine life, and not during gestation. On the other hand, our observations indicate that the male in- fluences the form of the fetus and the comparative volume of certain portions of its body. This variation is noticed chiefly in the size of the head. It has been observed that the crossing of ewes with rams of certain breeds having larger heads may lead to dystokia because of the comparatively large size of the lambs’ heads. In one instance we observed that many of the cows bred to a certain bull, which had a very heavy head and neck, re- quired assistance because of the voluminous heads and necks of the calves. When the domestic cow is crossed with the buffalo or American bison, with his very heavy head and neck, there is very liable to be difficulty in giving birth to the young, because of the large head and chest of the hybrid fetus. The breeding of immature females constantly tends to produce dystokia because of the comparatively large size of the fetus. The fetus itself is actually smaller as a rule than the same female would produce later in life, but the birth canal, and especially the pelvis of the very young female, is not yet developed to a degree which will render birth easy or practicable. It is acommon experience, therefore, that young heifers, which give birth to calves when only 1% years old or even younger, may require some degree of assistance in order to expel the fetus. The same is noted in immature sows, and to some extent in other animals. In one instance which we noted, the owner of a number of fillies allowed a stallion colt to run with them at pasture, and several yearlings became pregnant. Before the end of gestation contagious abortion broke out, so that they all aborted, and sev- eral of them required assistance in order to get rid of the very im- mature fetuses. Judging from these observations, it would seem probable that, had they carried their fetuses to the normal close of gestation, there might have been difficulty in expelling them. Clinical observations apparently show that the fetuses are larger if the mother has been well fed. But this does not seem to in- terfere greatly with birth, because, while the fetus is compara- tively larger, the expulsive powers of the mother are also greater and the birth as a rule is easier. If, however, an animal is very 730 Veterinary Obstetrics fat, her young is not as a rule so large as the young of an animal which is simply well nourished. , Diagnosis. Excessive volume of the fetus is difficult of accu- rate determination, prior to its entrance into the pelvic canal. Various means have been suggested for determining this excess in volume, but they are necessarily unreliable. Some have sug- gested an unusual size of the abdomen, but this may depend upon twin pregnancy, an excessive number of fetuses, or hydramnios or other cystic disease. In many animals we note an enormous abdomen as the result of the character of the food or of individual peculiarity. Along similar lines, some veterinarians have suggested that the excess in size may be anticipated owing to increased weight of the animal. Its final determination must occur when, with a normally di- lated cervix and normal genital canal, labor sets in and the ex- pulsive efforts are vigorous, and, although the fetus is normal in form and position, little or no progress is made in its expul- sion. If, under these conditions, the veterinarian examines the patient, he is enabled to judge that comparatively the size of the fetus is too great to pass readily through the birth canal. How- ever, this opinion does not depend upon any definite measure- ment which he is able to make of the dimensions of the pelvis. The principal obstacles to birth, in most of these cases, are the head and chest. The obstruction caused by the head is especially notable in the bitch and cow. In the bitch the difficulty most fre- quently occurs in those breeds, like the bull-dog, which have short muzzles and consequently present a blunt extremity to pass through the undilated canal. In the mare, the head of the foal is small and elongated and rarely offers any serious obstacle to birth. Generally it is only when the chest or croup arrives at the pelvic inlet that serious difficulty arises because of volume. We have already noted in the preceding pages that the dimen- sions of the chest of the foal are greater than those of the pelvis of the mother, and that it is only by some displacement of the parts, especially of the shoulders, that the chest of the foal is capable of passing through the birth canal. When the dimen- sions of the fetus are such that it is impracticable for the diminu- tion by displacement to be sufficiently great to permit it to Excess of Volume of the Fetus 731 pass through, we meet with a more or less serious obstacle to parturition. Prognosis. The prognosis in case of excessive volume of the fetus must depend largely upon the degree of excess, and still more upon the duration of the dystokia. In the mare the outlook for the foal is always bad, because the delivery cannot be greatly hurried with safety to the mother and cannot be delayed with safety to the fetus. In fact, as already repeatedly stated, the foal is usually dead when the obstetrist is called. The prospects for the mare may be said to be usually good, but it should be remarked that dystokia in the mare, refer- able to excess in the volume of a living fetus, is exceedingly rare and does not constitute a formidable question. In the cow the outlook is usually good for the mother, and if the excess of volume of the fetus is not too great to permit of delivery by forced extraction the prognosis for the calf is also favorable. Unfortunately, however, we have met with cases in the cow where embryotomy was necessary because of the excess of volume. The comparative excess in volume of the fetus in multiparous animals where embryotomy is possible, is in many respects more serious than in the larger species. In a large proportion of these the head of the fetus does not enter the pelvis, and conse- quently traction cannot be applied because the head cannot be secured. Asa result, the veterinarian is forced to resort to Ce- sarian section in order to bring about delivery, and this operation, while not necessarily fatal to either mother or fetus, must con- stantly be considered as grave. Handling. 1. Forced extraction of the fetus should be car- ried out in all those cases where, in the judgment of the veterin- arian, it can be accomplished with reasonable safety to the mother. Prior to its application, it should be determined that the fetus is in a correct position, after which the genital canal should be thoroughly lubricated with warm lysol solution or fat, and the traction then applied. In the mare and cow, and to aless extent in the ewe and goat, the traction may be exerted by means of cords applied to the presenting parts, as described on page 586. In the sow, bitch and cat, traction is usually best applied by means of forceps such as Fig. 93 on page 585, or the obstetric noose such as f and g, Fig. 91, page 578. Very largely, forced 732 Veterinary Obstetrics extraction is not possible or desirable in small animals, and Ceesar- ian section must be employed. 2. Embryotomy. In all instances, in the larger animals, where forced extraction is impossible or imprudent, the veterin- arian should diminish the size of the fetus by embryotomy, un- less the fetus is still living and possesses a very high value as compared with thatof the mother. This operation is necessarily limited in practice to the larger species of animals, and is virtu- ally excluded in the sow, bitch and cat because the size of the genital canal does not permit. of carrying out the necessary operations. In the ewe and goat embryotomy is at times practicable, de- pending chiefly upon the comparative dimensions of the genital canal of the patient and the hand of the operator. In the cow we have occasionally found that the head presented the chief obstacle to labor, and it was only necessary to perform cephalotomy, as described on page 643, in order to accomplish delivery. If this does not suffice, the diminution in the size of the fetus may be continued to any further degree required, as suggested under d, page 645; g, page 649; and c, page 658. 3. Ceesarian section will be found necessary or advisable in many cases of dystokia in the sow and carnivora due to excessive volume of the fetus. Forced extraction is difficult because of the smallness of the genital passages, and frequently unwise because the force which would be required for the extraction of the fetus would produce injuries to the soft parts, of a more serious character than would result from gastro-hysterotomy. For the same reason embryotomy cannot be applied, and the obstetrist must turn to Ceesarian section as his last resort. It is unfortunate in these cases to postpone the operation too long. The obstetrist should determine the necessity for Ceesarian section early, and carry it out as promptly as possible. If there is delay in operating, and one or more fetuses have perished and become emphysematous and putrid, the operation becomes very grave ; whereas in these animals Ceesarian section, when carried out upon a uterus which has not suffered from any previous insult and ip which.the fetuses are yet alive, is not highly dangerous. The operation has already been discussed on page 663. ‘ Death of the Fetus. 733 6. DEATH OF THE FETUS. FETAL EMPHYSEMA. Simple death of the fetus prior to or during labor does not con- stitute a very important cause of dystokia, though the move- ments of the living fetus probably tend to favor easy labor by overcoming any tendency toa false presentation. The dead fetus may undergo rzgor mortis, asin extra-uterine death, and this may tend to complicate its expulsion. When the fetus has been long dead, andemphysema or gaseous distension of the tissues occurs as a result of its decomposition, the fetal cadaver becomes very greatly increased in volume, and this may render its expulsion exceedingly difficult or impossible. ‘Not only is there an increased fetal volume in such instances, but the fluids escape and the hair of the fetus becomes dry and ad- heres closely to the uterine walls, so that it is difficult for the fetal cadaver to glide along the passages. [The emphysema intensifies dystokia by distending the uterine cavity and causing paralysis of the uterine walls, from fatigue; or it leads to infection of the uterine walls, with paralysis of function. The advent of emphysema occurring during dystokia is very prompt. If the cervical canal is well dilated, and the membranes are ruptured, emphysema may be quite pronounced within 24 hours, the fetal cadaver greatly enlarged, and the hair and epidermis readily de- tached. Within 48 hours the skeleton may begin to lose its integrity, the epiphyses of the bones readily separating. The diagnosis of emphysema of the fetus is readily made by the fetid odor, the enlarged puffy condition of the fetal cadaver, and the crepitus when the skin is pressed by the hand. The cause of fetal emphysema, fundamentally, is the death of the fetus, followed by putrefaction dependent upon the presence of gas-producing organisms. It is essential, ordinarily, that the os uteri is open or the tissues of the cervix are seriously dis- eased, as in torsion, and hence incompetent to ward off the exten- sion of the infection through the cervical canal to the fetus. Under other conditions, mummification of the fetus may occur instead. Clinically, fetal emphysema may be divided into two classes— primary and secondary. In the first, the infection and death of the fetus in uterooccurs prior to theadvent of labor or expulsive td 734 Veterinary Obstetrics efforts. Insome casesalmost no labor painsare observed through- out their clinical history, and the presence of the emphysematous cadaver is made manifest chiefly by the protrusion of the putrid fetal membranes and the advent of fetid vaginal discharges. In the second class, or secondary emphysema, are included those cases in which the fetus was alive, or at least not em- physematous, at the beginning of labor, and in which the em- physema follows the expulsive efforts because of some delay in the expulsion of the fetus as a consequence of dystokia. The first class might be termed the dystokia of emphysema; the second the emphysema of dystokia. Whatever the cause of emphysema, in addition to the decom-, position of the fetal cadaver, metritis, metro-peritonitis, pyaemia and septiczemia are more or less frequent and intense. The uter- ine walls become thickened, hard and unyielding. Sometimes the walls are one inch or more thick, dark colored, black, or necrotic-green. The uterine expulsive powers are absent or greatly enfeebled. The prognosis is grave. In the cow, the extraction of the fetus after two or three days, or even its complete decomposition and sloughing out through the abdominal walls or into the ali- mentary tract, sometimes occurs. In fact, after emphysematous decomposition of the fetus hascontinued for a few days, the uterus and system acquire marked powers of resistance. It is the recent case of emphysema which offers the grave prognosis. We have seen death from septicaemia and uterine gangrene, in the cow, within 24 hours after the owner had first observed signs of labor or disease. In these cases, apparently, the emphysema antedated any expulsive efforts, and the uterus quickly lost its expulsive powers. Handling. 1. Forced Extraction. In many cases it is ad- visable to bring about delivery by forced extraction, pages 586 and 640. When forced extraction is to be attempted, we should first correct any deviation or abnormal condition of the presenting parts and then, lubricating the passages thoroughly with warm lysol solution or fat, apply traction, as already directed. The traction should be judiciously applied, but may be quite powerful, because, in the emphysematous state, the pressure is very evenly distributed over every part of the genital canal. It should be remembered also that the operation should not be hastened be- Death of the Fetus 735 cause the gases tend to become gradually forced out when pressure is applied to the cadaver, so that those parts which are under greatest pressure become slowly but markedly decreased in size, because of the shifting or escape of the emphysema, and thus favor extraction. 2. Embryotomy, page 641, should always be preferred to forced extraction if the latter involves any serious degree of force. Embryotomy is easier than in an undecomposed fetus, because the tissues are so soft and friable that they are very readily separated. In the performance of embryotomy it should be remembered that extensive punctures and incisions of the skin will allow the escape of large volumes of gas, by which the size may be reduced. A much greater reduction in sizecan be had by evisceration, p. 658, because not only do the viscera and the body cavity contain large quantities of gas, but also those gases which are in the tissues elsewhere may largely escape from the open body cavity, thus greatly reducing the volume. Fleming cites Bosetto as having had a unique experience in one of these cases of emphysema, in which, upon withdrawing his hand after some manipulation, there was a rush of gas from the vulva of the cow, which was inflammable and, becoming ig- nited owing to the presence of a candle, caused a considerable flame, which burned for somé time, but which produced no ill consequences. 3. Cesarian Section, page 663, is usually indicated in the sow, bitch and cat ; almost never, if ever, in the cow and mare. In many of these cases, in the sow, bitch and cat, the handling becomes safer if the more radical operation of hysterectomy, page 669, is substituted. The prognosis is unfavorable. C. DISEASES OF THE FETUS. During intra-uterine life the fetus is subject to various diseases, either of the entire body or of parts, which, at the time of partu- rition, may cause more or less serious dystokia. These consist largely of dropsy of cavities or organs, by which means a portion of the fetus becomes greatly increased in size; or a general dropsy of the entire body, anasarca, occurs. 1. HYDROCEPHALUS. Hydrocephalus consists essentially of a distension of the lateral ventricles of the brain with lymph. ‘The fluid may be of any amount, and upon its volume depends the degree of dystokia Fic. 122.][ HypDRocEPHALUS. CALF. (HARMS). i which it may produce. In the calf and foal it reaches, in many cases, the amount of 4 to 5 gallons, and then constitutes a rather serious impediment to the expulsion of the young. The cerebral hemispheres are virtually absent, while the cere- bellum and medulla oblongata are usually present in an appar- ently normal condition. ‘The enormous distension of the lateral ventricles, with the prevention of the formation of cerebral Lydrocephalus 737 matter, leads ordinarily to the death of the fetus as soon as the umbilic circulation is suspended. The effect upon the skull is interesting, and has an important relation to the question of delivery. The bony skull is usually incomplete, and the principal portion of the tumor or enlargement is wholly devoid of any osseous covering, and consists merely of the skin and vestiges of the meninges of the brain. At the base of the tumor, the bones of the skull spread outward and then upward to constitute a chalice-like cavity with irregular borders. The cause of hodrocephalus in the fetus is unknown. It is observed in all animals, but is most frequently seen in the calf and somewhat rarely in the foal. The diagnosis is comparatively easy when the fetus presents anteriorly, but may become somewhat difficult in the posterior presentation. When the fetus presents anteriorly, the obstetrist usually finds upon inserting his hand that the cranium is abnor- Fic. 123. HyDROCEPHALUS. CALF. SKULL FROM Fic. 122. (HARMS). mally enlarged and soft or fluctuating. Somewhat rarely the hydrocephalic cranium is complete, the osseous walls completely enclosing the abnormal brain. At first there may be difficulty in identifying the head, because of the great disproportion and its soft, fluctuating character. The actual diagnosis can be made only by identifying some definite parts of the head, such as the mouth, nostrils, ears or eyes, and determining that the enlarge- ment has a definite relation to these. 47 738 Veterinary Obstetrics In the posterior presentation, the presence of hydrocephalus is not likely to be suspected until the entire fetus, except the head, has been extracted, when suddenly its progress is checked or completely stopped, and it becomes necessary to make an ex- amination in order to determine the cause. Handling. The indications in hydrocephalus are the destruc- tion of the tumor by opening the sac and permitting the liquid - to escape and then diminishing the size of the osseous portion by dividing the bone with the obstetric chisel. The incision into the tumor is easily made with the scalpel or ring knife, and the cranial bones are so thin and weak that they are easily broken down by means of the chisel, as described on page 643. In one case, in the mare, where the anterior limbs had not yet advanced into the canal, we opened the sac and allowed its con- Fic. 124. HYDROCEPHALUS. CALF. (After photograph). tents to escape, broke down the bones, drew the head through the birth canal and amputated it, after which we repelled the neck, secured the two anterior limbs and extracted the headless fetus. : When the fetus presents posteriorly, and hydrocephalus has been diagnosed, the handling is analogous to that for the an- terior presentation. As a general rule, it is not essential to decrease the size of the head very greatly, or, in some cases, to decrease it at all by arti- ficial means. Fig.124 represents a hydrocephalic calf, which was expelled without aid, the head-sac of which had a capacity of about 5 gallons. We had been called because of the dys- tokia, but, pending our arrival, the calf had been expelled. Upon examination, it appeared that the expulsive efforts had compressed the sac to such a degree that it ruptured through the Ascites of the Fetus 739 cribriform plates of the ethmoid bone, which allowed the escape of the fluid through the mouth, and the collapse of the pouch. 2. ASCITES AND HypROTHORAX. The peritoneal cavity of the fetus is occasionally the seat of very extensive effusions. It is said that in some rare cases the pleural cavity may suffer similarly. The causes of fetal ascites areunknown. Possibly some cases designated as ascites are due to cystic distension of the fetal kidneys, ovaries or other organs. The symptoms of ascites, and similarly of hydrothorax, are confined to the resultant dystokia. It occurs almost wholly in the calf. Upon examination it may be found that the fetus is pre- senting normally, and the advancing parts are of normal form and volume. If presenting anteriorly, there is no apparent ob- stacle to expulsion until the head and neck have passed the vulva, when progress ceases, and, although considerable traction may be applied, the fetus appears immovable. Upon examination the veterinarian finds that the abdomen is enormously enlarged, tense and fluctuating, and alone consti- tutes the obstacle to parturition. When the fetus presents posteriorly the symptoms are quite analogous ; the fetus in normal attitude advances until the hips enter the pelvic canal, where it stops. Inserting the hand along- side the fetal body, the distended abdomen may be felt and recognized. The handling of the dystokia consists fundamentally of re- leasing the fluid from the abdominal cavity. This may be done in a variety of ways. The operator may carry a finger-knife or concealed scalpel into the uterine cavity, andincise the abdomen of the fetus from without, thus allowing the fluid to escape into the uterine cavity of the mother. From the standpoint of safety to the mother and convenience to the operator, we prefer liberating the fluid through the chest cavity externally. The head and neck have already passed the vulva; it is the work of but a few minutes to remove one an- terior limb subcutaneously, as described on page 645; after which one or two of the exposed fetal ribs may be severed. The operator can then eviscerate, page 658, pass his hand through the chest cavity, and rupture the diaphragm, when the ascitic 740 Veterinary Obstetrics fluid promptly rushes out and escapes externally. Delivery readily follows. In the posterior presentation the fluid may be caused to escape through the fetal pelvis by an incision through the perineum. 3. ANASARCA. Somewhat rarely in practice the veterinarian meets with a fetus, theentire body of which is edematous, so that its diameter is greatly increased and it appears as a somewhat rounded, soft mass with its tissues filled everywhere with fluid. Like ascites, anasarca is seen almost, if not quite exclusively, inthe calf. In Germany this disease has acquired the designation wasserkalbe or speckkalbe. ‘The fetus affected with anasarca usually perishes at the sixth to seventh month, and is expelled. Uponexpulsion it appears as a rounded mass; the skin is hairless and looks somewhat leathery ; the limbs and neck seem excessively short because of the increased’ transverse diameter of the fetus; and everywhere through its tissues there is a vast amount of liquid, which freely exudes when the parts are incised. The causes of anasarca are not known, but some investigators have attributed the condition to an absence of the thoracic duct. Anasarca rarely offers any serious obstacle to parturition, and when it does so the dystokia is referable solely to the excessive volume of the fetus, which we have already discussed on page 726, and should be handled in the same way. 4. CYSTS AND CysTIc DEGENERATION of FETAL ORGANS. Cysts in various internal organs or in the subcutaneous con- nective tissue, which may so increase the size of a particular region of the fetus asto induce dystokia, are very rarely recorded. Among the internal organs, the liver and kidneys have been found affected with cysts of such dimensions as to constitute an obstacle to the expulsion of the fetus. Naturally these cysts cannot be differentiated clinically from ascites, and it is only upon post partum examination that the character of the diffi- culty may be fully recognized. The method of handling is the same as we have already suggested for ascites. Fleming, citing Ludke, records a cyst, in the subcutaneous connective tissue below the ear of a calf, which was more than a foot in diameter and contained 36 pounds of fluid. This had to Tumors of the Fetus 741 be punctured in order to permit the extraction of the fetus, but the exact nature of the disease was not determined. Was it a cystic thyroid or salivary gland ? Fleming cites Pflug, who was called to attend a goat in difficult labor and found a large cyst upon each side of the head of the kid, in the region of the parotid gland, which offered considerable impediment to the extraction of the fetus, which, however, was finally accomplished without puncturing the cysts. The same author describes the case of a foal with a cystic distension of the guttural pouch. The indications in this rare group of anomalies will depend somewhat upon the location and volume of the cyst. When very large they may generally be easily destroyed by puncture, which allows the contents to escape; or the tumor may be so adjusted in position that the fetus may be extracted without the destruction of the cyst. D. TUMORS OF THE FETUS. It must be very rare that a fetus suffers from a tumor in the true meaning of that term. Fleming speaks of tumors of the fetus, but includes under this heading those which we have con- sidered in the preceding section as cysts. Among his citations there is only one which might possibly be regarded as a tumor in the common acceptance of that term. Citing Rossignol, Flem- ing alludes to a fetus which had, in the neighborhood of the um- bilicus, a tumor which weighed 11 pounds and was composed of fibro-adipose tissue. The description of the tumor is very incom- plete, and its nature is not revealed. E. ANOMALIES AND DISEASES OF THE FETAL MEM- BRANES AND OF THE UMBILIC CORD. 1. Dense Chorion. It has been asserted that the fetal mem- branes may be abnormally thick and resistant in one case or abnormally thin and weak in another, and that these may result in more or less danger to the mother or fetus. Asa source of dystokia, only the abnormally thick and resistant membranes, the chorion, can produce any serious results. How frequently these abnormalties occur in veterinary obstetrics cannot be de- termined. We have found no records of cases where such a condi- tion was clearly proven. The toughness of the chorion or other membrane must be merely comparative, and its existence will largely depend upon the interpetration of the obstetrist in attend- ance. Should it occur, artificial rupture or incision is demanded. 2. Adhesions of the Fetal Membranes to the Fetus. Very rarely in veterinary obstetrics there are found adhesions between the fetal membranes and the fetus, which tend to in- terfere with birth. There is no part of the fetus upon which such adhesions may not occur. All the membranes may be in- volved—amnion, allantois and chorion—and cause more or less firm adhesions with the fetus, and may also extend to and involve the uterine walls. Fleming cites one instance where the adhe- sion took place upon the frontal region, and interfered with the expulsion of the calf. In other cases the adhesion has occurred upon the skin of the pastern and elsewhere. When such adhe- sions exist, and result in dystokia, they must be divided in order to bring about prompt delivery. 3. Hydramnois and hydrallantois. On page 424 we have already described the dropsies of the fetal membranes as causing more or less serious interference with the well-being of the mother during gestation, and have there discussed the action necessary to be taken in these cases. 4. Abnormalities of the Umbilic Cord. The umbilic cord of domestic animals is very rarely of an abnormal character, either in dimensions or inits tissue. It varies greatly, as we have already noted on page 364, in its length in various domestic ani- mals, but we are unaware that these variations in length have any special significance to the obstetrist. If very short, it natur- ally must rupture very early, perhaps before the fetus is completely 742 Diseases of the Fetal Membranes and Umbilic Cord 743 expelled. In the cow, the umbilic cord habitually ruptures while the calf is passing through the pelvic canal, and yet it is born as safely as is the foal, in which the cord usually does not rupture until after the complete expulsion of the fetus. As compared with the child, the umbilic cord in all domestic animals is short, and consequently does not tend to protrude through the vagina in advance of the fetus or to become en- tangled about the fetal neck or extremities. In very rare cases the cord has been found entangled about the neck, limbs or body of the fetus, but this has apparently never acquired any great significance. Even if the cord should become entangled about the fetus, it usually offers no important impediment to parturition, because it is comparatively easily ruptured in any of the domestic ani- mals, so that any powerful expulsive effort would quickly cause it to part. The chief danger is the strangling of the fetus through compression of the cord. When the cord is found en- circling a part in a manner to cause its compression, the ob- stetrist should obviate the danger as far as possible, by disen- tangling it or hastening delivery, according to the circumstances. F. ABERRATIONS AND ANOMALIES IN THE DEVEL- OPMENT OF THE FETUS. 1. CAMPYLORRHACHIS. We have met, in one case in the cow, a formof contracture, consisting of an abrupt lateral curvature of the spine in the dorsal region, by which the body was doubled upon itself in the middle in such a way that the two posterior feet lay with their ventral surfaces upward, alongside the two anterior feet, with their soles turned downward and the head resting upon them. The symptoms of this anomaly are peculiar and confusing. The head end of the fetus offers in the typical anterior presen- tation, dorso-sacral position, the anterior feet extended and the nose resting upon them, while alongside them, to the right or left, are the two hind feet with their plantar surfaces turned up- ward and the hocks and buttocks readily reached. The condi- tion at once gives the obstetrist the impression of twins, and the chief point in diagnosis is to determine whether the symptoms are due to twins or to deformity. In case of twins, one of the fe- tuses may be repelled while the other is advanced, but in this anomaly both the anterior and posterior portions must advance or recede simultaneously. It may be possible to reach and iden- tify the spinal curvature. The remedy is embryotomy. The most efficient plan is the subcutaneous removal of the two anterior limbs, by the method described on page 645, and evisceration of the fetus, as described on page 658, after which the head and neck are to be repelled, the now flaccid body of the fetus converted into a posterior presentation by traction upon the posterior limbs, and its ex- traction accomplished. The repulsion of the anterior portion of the fetus should be quite complete, and the operator should continue the process with his hand as long as it is possible to keep his arm in the vaginal canal alongside the advancing posterior portion. 2. SCHISTOCORMUS REFLEXUS. On page 351, while discussing the development of the embryo, we have stated that under certain conditions the amniotic fold contracts in such a manner that the spinal column is forced 744 Schistocormus Reflexus 745 down through the abnormally wide vitelline duct, and the somatopleur of the embryo is reflected so that it is virtually everted, as indicated in Figs. 71, 72 and 125. his anomaly occurs almost wholly in the cow, though a few cases have occurred in other ruminants. The viscera lie naked, in the absence of a fetal body cavity, while the other portions of the fetus constitute an irregular mass, presenting the pleuro-peritoneal membrane ex- ternally in the form of an inverted pouch, open at one end, through which all four limbs and the nose may more or less pro- FIG. 125. SCHISTOCORMUS REFLEXUS. (DE BRUIN.) trude. The four legs and the head and neck lie in an inextri- cable mass, asin a pouch of skin. The skin, with its coat of hair, constitutes the lining of the pouch, and lies in contact with the contained limbs and head and neck. The diagnosis of this anomaly depends upon the anatomical re- lations above mentioned. Usually the monster presents by its 746 Veterinary Obstetrics four feet and head, and consequently the operator at once comes in contact with several, or all four feét and the head. Following along the fetal extremities, the hand passes into a closely envel- oping pouch, lined with hair. Examining more externally, the operator’s hand passes over the fetal mass and comes in contact with the fetal viscera lying loose within the uterine cavity. If presenting by the reverse end, the operator should recognize the viscera lying free, and the exposed, bent spinal column and ribs, covered only by peritoneum. Usually the condition offers rather serious dystokia. In the cases observed by us, fetal death, putrefaction and emphysema preceded the symptoms of dystokia, so that upon our arrival the fetus has been found putrid. Forced extraction and embryotomy offer the chief suggestions in delivery. ‘The conglomerate, irregular outline of the fetal mass, with projecting ribs and other bones, renders forced extrac- tion too dangerous in most cases. Unless the pelvis of the cow is very roomy and the fetal mass very small, embryotomy is to be preferred. In performing embryotomy, the operator should have in mind the anatomical relations of the parts, and should first of all make a longitudinal incision through the skin pouch, so as to lay it freely open and render the limbs available for operation. He should then proceed to diminish the mass to a sufficient degree, preferably first by the subcutaneous amputation of the two an- terior limbs, page 645. This may be followed by the amputation of one or both hind limbs or of the head, as circumstances may suggest, until the remaining portion may be extracted without serious difficulty or injury to the soft parts. 3. CONTRACTURES OF THE EXTREMITIES. WryY-NECK. Various fetal articulations undergo deformation during intra- uterine life, and present at birth obstacles of a more or less im- portant character. The campylorrhachis, mentioned on page 744, may be regarded as belonging to this class. Abnormal flexion of certain joints of the limbs is not rare. The indica- tions, in case of dystokia due to flexures or contractures of the limbs, are to overcome such obstacles by forcible extension, or, if this fails, to amputate the offending part or relieve the con- Wry-neck in the Foal 747 tracture by tenotomy or myotomy, and remove the fetus in an otherwise normal manner. Wry-neck in the Foal. In the foal the abnormality known as ‘‘wry-neck’’ is comparatively common as a cause of dystokia. Wry-neck is usually described as a contracture, with the implica- tion that the deformation is induced by contraction or abnormal shortening of fetal muscles, but the actual cause is unknown. Usually the bones themselves are bent. The anomaly is possibly due to the anterior feet occupying one horn, into which the head has failed to enter and becomes reflected back along the fetal body in the body of the uterus, there to be held firmly. If the neck of an equine fetus becomes accidentally caught in lateral deviation, and is so held, the muscles on the concave side naturally shorten asaresult. This abnormality is most frequent, or practically confined to the foal, apparently because of the great length of its neck. Wry-neck constitutes one of the most common and formidable obstacles to delivery in the foal. In these cases the neck is bent abruptly backward at its base, and the head lies in the flank of the foal. The deviation has existed throughout a long period of time, as is shown by the curvature of the head upon its long axis. If the neck is curved to the left side of the foal, so that the head rests in its lett flank, then the left side of the head and face is concave and moulded to the surface of the body, while the right side is convex. In our experience, wry-necked foals usually present either an- teriorly, with the two forefeet more or less extended in the pas- sage and the head out of reach, or transversely, with the ventral surface of the body toward the pelvic inlet and several orall four of the feet extended in the vaginal canal. In the anterior presentation, the operator may not be able to reach the head because of its extreme deviation, favored by the great length of the neck. If he can reach the head, it will be found exceedingly difficult or impossible to bring it into the va- gina, because when the fetus is repelled the head recedes, instead of tending to become extended asin case of a normally developed head and neck, where the head has recently become deviated. If the head is secured by means of hook or cord or other device, it is still found exceedingly difficult to bring about its extension in the genital passages, because of the contraction of the muscles 748 Veterinary Obstetrics and the fact that the cervical spine has been long bent and is quite rigid. When the fetus presents transversely, with all four feet in or near the pelvic inlet, the head is usually. undiscoverable ; if it can be reached, it is difficult or impossible to bring it into the pelvic inlet. Fortunately we do not wish in these cases to ad- vance it into the inlet or otherwise secure it. The indications in instances of wry-neck vary according to conditions. These will be considered under Lateral Deviations of the Head in the Anterior Presentation, on page 765, and under Transverse Ventral Presentation on page 788. 4. DouBLE AND TRIPLE MONSTROSITIES. Double monstrosities occur chiefly in the cow and somewhat rarely in the smaller ruminants and the sow, while in the mare Fic. 126. GASTRODIDYMUS OcTIPES. (From a photograph. ) they are almost unknown. ‘They constantly offer more or less serious obstacles todelivery. The symptoms of double monstros- ities vary according to the particular abnormality and the presentation. Commonly, where a fetus is double at one extremity only, it presents by that extremity, and consequently the abnormal por- tion of the fetus is within reach and the diagnosis can be made by manual exploration. A double face, head, neck, or chest is Double and Triple Monstrosities 749 usually easy to differentiate by palpation. Double monstrosities in which the double condition affects the posterior extremity only, if presenting posteriorly, enable the operator to reach for- ward a sufficient distance to properly examine the point of bifurcation and diagnose the double character of the fetus. In those cases where the single end of the fetus presents and enters the pelvic inlet, the dystokia is not apparent until the double portion reaches the pelvic inlet and its progress is stopped because of the abnormal size. Then the obstetrist, in making an Fic. 127. TETRACHIRUS CHORISTOCEPHALUS. (GURLT). examination, should be able to pass his hand alongside the single portion of the fetus until he reaches the double portion, the character of which, especially the spinal bifurcation, should be recognized by the sense of touch. In the ccmplete double monster, like the thoracopagus and others of similar type, Figs. 126 and 127, the obstetrist finds the two corresponding portions of the body advancing simultaneously, and cannot repel or advance the one without moving the other in a corresponding direction. Moreover, as a general rule he will be able to reach that portion of the two bodies where they are connected, and thus determine the character of the anomaly with which he hus to deal. In the very rare pigodidymus aversus, Fig. 129, it would be ex- 750 Veterinary Obstetrics ceedingly difficult to diagnose the condition until the presenting portion of the monster, or we might say the presenting fetus, is completely withdrawn or at least its croup enters the pelvic inlet, when the breech of the second or posterior twin reaches the pelvic inlet, becomes impacted in it and stops further progress. If the operator will then examine carefully, he may be able to reach sufficiently far to determine the character of the monster with which he has to deal. The indications in cases of double monsters vary. In many instances they are comparatively small, so that the double con- Fic. 128. SCHISTOCEPHALUS. CALF. dition does not prevent their extraction entire without serious difficulty. In other cases it is necessary to resort to embryotomy in order to bring about delivery with safety to the mother. There are no specific rules for the operation of embryotomy, but the reduction in the size of the monster is to be carried out ac- cording to the general suggestions already made on page 641. It may be well to suggest that it is highly desirable, whenever possible, to divide the double monster into its two halves. ‘That Double and Triple Monstrosities 751 is, if there exists a double head and neck, we should, if possible, amputate one of the necks with the chisel or by other means, and remove it, and then proceed to extract the remaining portion of the fetus. So we would handle a posterior presentation where (GUILT). Fic. 129. PIGoDIDyYMUS AVERSUS. the posterior extremity of the fetus is double. Or we may re duce-the volume of the double body by evisceration, page 658, by the destruction of the pelvic girdles, or by amputation of the hind limbs, page 653. 752 Veterinary Obstetrics 5. THE DySTOKIA OF TWINS. Twins occasionally induce dystokia, and may at times cause confusion in diagnosis. The diagnosis of twin or triplet pregnancy, when dystokia oc- curs, is usually not very difficult, especially if the fetuses have not become impacted in the pelvic canal, so that they are immov- able. When they produce dystokia, it is usually because one or more extremities of each fetus has entered the pelvic canal. A little carelessness may lead to an error. If one fetus is pre- senting posteriorly and the other anteriorly, there may be present in the passages the head and one forefoot of one fetus and one hind foot of the other fetus. This latter may be mistaken for a fore-foot of the former, or other similar error be made if proper care is not taken. In other cases there may be such a deformity of a single fetus that it may be mistaken for twins. Especially is this the case in campylorrhachis, which we have already described on page 744. The differentiation between twins and double monstrosities is usually not dificult. In case of double monstrosities the two parts necessarily move in harmony; they advance or retreat together, and each movement that one is caused to make is at once accompanied by a corresponding movement of the other. This is not true of twins. The indications for handling dystokia due to multiparity are comparatively simple. The operator needs repel one fetus, or rather the presenting parts of one fetus, and advance the other. It is essential that the one fetus shall be repelled entirely into the abdominal cavity, and kept there until the pelvic canal is fully occupied by the fetus which is being advanced, after which it is delivered. The other is then brought into position, and also extracted. Deviations of the extremities of twins are subject to the same rules as those of single pregnancies. Twins are usually smaller than single young, and permit of easier handling and correction of position. pene a ee C. ABNORMAL PRESENTATIONS OR POSITIONS OF THE FETUS. I. ANTERIOR PRESENTATION. a. Dorso-ILIaAL OR Dorso-PuBIC POSITIONS. In the larger domestic animals, where the fetus normally lies ez arc or describes in its attitude the segment of a circle, the ventral surface concave and the dorsal convex, it is essential to the easiest delivery that the fetus should be in the dorso-sacral position. The body does not readily bend dorsalwards, because the inferior wall of the fetus is comparatively short and inextensible and, with the viscera in position, the rigidity of the fetal body is maintained. A further obstruction to its passage, in other position than the dorso-sacral, is that the greater diameter of its body does not correspond with the greater diameter of the pelvic canal. It is possible in some cases to bring about the extraction of the fetus in the dorso-ilial or dorso-pubic position, but this is chiefly in those cases where the fetus is comparatively small as related to the genital passages of the mother. When the fetus is so small that it can be brought out in this unfavorable position, its diminutive size permits the correction of the position to be made with very little labor. The indications are usually to rotate the fetus upon its long axis, and convert the dorso-ilial or dorso-pubic into the dorso- sacral position. Under special conditions it may be advisable or practicable to resort to forced'extraction. We have already dealt with the question of rotation on page 632, and of forced extraction on page 586. Both of these failing, it may be necessary to resort to embryotomy, consisting of the subcutaneous amputation of one anterior limb, page 645, and evisceration, page 658, followed by rotation. 6. DEVIATION OF THE ANTERIOR LIMBS. The anterior limbs of the fetus are subject to greatly varying deviations. While these may sometimes be unimportant in the smaller species, they become of fundamental value in the larger animals, such as the foal and calf. The long and rigid limbs and neck of these make it essential that each extremity should be fully extended in order to pass readily through the pelvic 48 753 754 Veterinary Obstetrics canal. Any deviation from this normal attitude is liable to result in more or less serious difficulty in the expulsion of the young animal., I. FLEXION OF THE ANTERIOR LIMBS AT THE ELBOW. ANTERIOR TymMBS INCOMPLETELY Ex- TENDED IN THE PELVIS. It is not very rare to meet with instances in the calf and foal in which the two anterior feet present in their normal position and appear at the vulva, accompanied generally by the nose, which is advanced to nearly the same degree as the feet them- selves. At first glance the position seems to be essentially normal, Fic. 130. INCOMPLETE EXTENSION OF ANTERIOR LIMBS. but, when the fetus has reached the point where the feet and nose are visible, its advance becomes checked and the expulsive efforts of the mother are quite unavailing to cause any further progress. The interpretation of this condition varies somewhat with dif- ferent writers. Fleming says: ‘‘ It is usually due to the shoulders not being closely applied to the chest of the fetus, and the elbows, Abnormal Presentations of the Fetus 755 consequently, thrown widely apart, coming in contact with the brim of the pelvis, thus proving an obstacle to the progress of the young creature.”’ We interpret it as purely a flexion of the humero-radial articu- lation, the consequent or coincident pushing of the shoulders backward upon the sides of the chest, and the impaction of the olecranon against the pubic brim. In this position, the trans- verse diameter of the chest of the fetus is greatly increased by the retention upon its sides of the entire volume of the fetal shoulders, including the scapula and scapular muscles, the hu- merus and the bulky anconean group of muscles. The perpen- dicular diameter of the fetus is also greatly increased, because it must represent the distance from the top of the spinous processes of the dorsal vertebree down to and including the olecranon, the latter projecting downward to constitute an unyielding obstacle which becomes lodged against the pubic brim. The condition naturally belongs to the dorso-sacral position. The diagnosis depends fundamentally upon two facts. While the two forefeet present normally and the nose is resting on top of them in a normal position, so far as it is independently con- cerned, there is an abnormal relation between the degree of ad- vancement of the feet and the nose. While normally the nose of the fetus rests about the middle of the metacarpus, in these cases it is advanced to the fetlock or even further. Under these con- ditions, if the obstetrist will introduce his hand along the ante- rior limbs until he reaches the brim of the pubis, he will find the olecranon tightly impacted against the pubic brim. The indications are simple and obvious, and consist merely in releasing the olecranon from its incarceration in front of the pubis and the proper extension of the limb in the birth canal. Little, if any repulsion is required. When both limbs are retained, each should be handled separately. The operator should insert his hand along the inferior surface of the limb, with the palm turned upward, until it has been forced between the pubis and the ole- cranon, so that the latter rests in the hollow of the hand. An assistant is then to exert traction sharply upward and backward, while the operator causes the olecranon to glide over the pubic brim and the anterior limb to become extended in the pelvic canal. ‘The same operation is carried out upon the other limb, after which the fetus is delivered under ordinary precautions in the dorso-sacral position. 756 Veterinary Obstetrics 2. THE FORE-LIMBS CROSSED OVER THE NECK. It is very rare that an anterior limb of the fetus becomes crossed over its head while passing through the birth canal in other animals than the mare, and even here it is not very com- mon. Such displacement in the foal offers a considerable ob- stacle to parturition, partly owing to the obstruction of the car- pus lying on top the fetal poll or neck, largely because it induces the same position of the shoulder and elbow as we have already described in the previous section. By this displacement the di- ameter of the chest is greatly increased and the olecranon, instead of being in a horizontal position, projects downward almost per- pendicularly, and thus constitutes a very serious obstacle to the advancement of the fetus along the birth canal. : There is the further very important danger that, when a foot is so misdirected, it is liable to become engaged in the roof of vagina and, perforating it, cause a rupture of the rectum or of the perineum. The false position of the deviated foot or feet is readily recog- nized upon examination. Handling. It is not difficult ordinarily to seize the misdi- rected foot with the hand and, while exerting some traction upon it, push it toward the side where it belongs, first somewhat up- ward to cause it to glide over the poll, thence in a lateral direc- tion and downward, and finally toward the central line to bring it beneath the head and neck. If both feet are crossed over the head, as it is alleged occurs in rare instances, that one which is uppermost, the one which is crossed over the other foot as well as over the head, should first be brought into position, after which the other is to be similarly handled. It is not essential to repel the fetus, unless the fore-foot has become engaged in the roof of the vagina and has pushed its way into it so far that the repulsion is necessary to its disengagement. In such cases the repulsion should be merely sufficient to enable the operator to bring about the necessary replacement of the foot. Should the replacement of the limb prove difficult, it is ad- visable to cord the foot and have an assistant exert traction upon it in such direction as the operator may indicate, while he guides and aids the reposition directly with his hand. After completing the replacement of the foot into its normal position, Flexion of Anterior Limbs at Carpus 757 the operator should take the further precaution to see that the elbow is completely extended, before any traction is applied to other portions of the fetus, because, until this is done, the position remains such that expulsion cannot readily occur. 3. FLEXION OF THE ANTERIOR Limps AT THE CARPUS. This obstacle to birth occurs chiefly in the calf and foal, and toa lesserextent in the lamb and kid, but in these cases it is very rare and of less significance. In carnivora and the sow the condition is not present, or not of moment as a cause of dystokia, because the limbs are short and may readily fold backward and permit the head to present alone. TO, ay Fic. 131. FLEXURE OF THE ANTERIOR LIMBS AT THE CARPUS. (St. Cyr.) In such cases the metacarpus is flexed upon the radius, the ra- dius upon the humerus, and the humerus upon the scapula, so that the entire limb is folded and the shoulders are pushed back upon the chest, thus greatly increasing the perpendicular and ‘transverse diameters of the fetal body in the region of the chest, and offering a very great obstacle to its expulsion, which is greatly heightened by the impaction of the carpus in the pelvic -canal, or in front of or beneath the pubic brim. 758 Veterinary Obstetrics Normally the fetus, until just prior to birth, lies somewhat up- on its side with all the limbs flexed along the ventral surface of its body, the radius upon the humerus and the metacarpus upon the radius in such a way that the very long limbs of the foal and calf occupy the least possible space in the uterus. Whenex- pulsive efforts set in, should the fetus be dead, the limbs may remain flexed during parturition, just as they were prior to the beginning of that act. Should the fetus be alive, it is quite pos- sible that, because of close investment by the fetal membranes, its feet may not become extended upon the carpus. Consequent- ly the fetus approaches the pelvic inlet with the limbs still flexed, in which case they almost inevitably become impacted in the pelvic cavity, or beneath or against the pubic brim, to constitute a more or less serious obstacle to delivery. Some obstetrists hold that the displacement may occur other- wise. They claim that at the moment when the limbs of the fetus enter the pelvic inlet they may not be fully extended, and the toes may become caught against the border of the pubis. As the fetus advances the limbs become flexed at the carpus, and later the metacarpus and phalanges become directed backward, and the folded limbs thus applied against the neck. If we study carefully the mechanism here proposed, we find it probable that, if it came about in this manner, when the parts became folded the carpus would be far advanced in the pelvis along the side of the neck of the fetus. This, as every obstetrist well knows, is very: rarely the case, but instead the flexed carpus is engaged against or beneath the pubic brim, a position which it could acquire only with the greatest possible difficulty, by the method which has. been suggested. Another objection to the theory of the flexion of the carpus. during parturition may be realized by the obstetrist when he at- tempts to extend the flexed member so as to bring about the extraction of the fetus. He finds at once that the length of the metacarpus exceeds the perpendicular diameter of the pelvis and that the limb has to be pushed completely back into the abdomen in order to beextended. If the mechanism of this flexion, as found in dystokia, is of the character here alleged, when the flexion is. coming about it would tend to become stopped by the carpus. abutting against the sacrum and becoming lodged in a perpen- dicular position across the pelvic inlet. Flexion of Anterior Limbs at Carpus 759 We consequently regard this deviation as being usually a per- sistence of the pre-parturient attitude of the limb of the fetus, and not as an acquired deviation of the part. Consequently we may well find both anterior limbs flexed at the carpus, and the ‘head of the fetus flexed ventralward, with its chin resting up- on the sternum. This attitude of the fetus is especially frequent in cases of abortion in the mare, where the dead fetus quite fre- quently presents by the poll and the two carpal joints. Sometimes one foot presents normally, along with the head ; sometimes the head only ; and sometimes one anterior foot only. Any one of these suggests at once that there is either a flexion of the carpus which checks delivery, or else that the anterior limb has been completely retained. It is thus essential to diag- nosis that a manual examination be made. In the mare and cow the retention of the anterior limbsat the car- pus usually constitutes an insurmountable obstacle to parturition, except artificial assistance is given. Saint-Cyr properly suggests that the dystokia does not result somuch from the flexion of the carpus itself asit does because all the long bones of the anterior limb are flexed upon each other and the entire mass of the shoulder and limb is pushed backward upon the chest walls, to abnormally increase the transverse and perpendicular diameters of this por- tion of the body and render it so gross that it cannot pass through the birth canal without the deviation being first corrected. The indications are to secure the deviated limb or limbs and to bring them into their normal position. The position of the fetus is usually dorso-sacral, but, should it be dorso-pubic or dorso-ilial, the same general rules for the correction of the de- viation apply in the main, and in many respects are actually easier than though the fetus were in the normal or dorso-sacral position. 1. Mutation. In order to bring about the extension of the limb or limbs, repulsion of the fetus is necessary. If the head of the fetus, with or without one anterior limb, has advanced only ashort distance along the pelvic canal, it may be quite practicable to push it back intothe uterus and acquire room for the correction of the de- viation in the abdominal cavity. If the fetus is verysmall, orthe pelvis of the mother quite roomy, it may be possible to repel the fetus after its head has passed completely beyond the vulva, but this generally proves very difficult, and frequently impossible. If the fetus is dead, which is generally the case with the foal, and 760 Veterinary Obstetrics the head has passed beyond the vulva or can readily be brought beyond it, the most desirable method of procedure is to resort at once to decapitation, as described on page 642, and then repel. The decapitation is a very simple procedure under these condi- tions, decreases very greatly the amount of labor required for repulsion and the time neccessary for the correction of the devi- ation, and thereby very largely increases the favorable outlook for the mother. When the head of the calf has passed beyond the vulva, its prominent and blunt poll makes its repulsion more difficult than that of the foal. Hence, if the head has protruded beyond the vulva and the calf is dead or is of little or no value to the owner, or if the conditions are such that the life of the mother will be greatly jeopardized by tedious repulsion, the obstetrist, as in the foal, should at once proceed with decapitation. Pronounced elevation of the posterior parts of the body greatly facilitates repulsion. In the ewe and other small animals, the patient may be almost or quite suspended by the hind legs in order to favor repulsion. Tepid unctuous fluids may then be introduced through the vulva into the vagina by gravity. The fluid lubri- cates the walls, rendering fetal movements more easy, and the weight of the liquid contributes toward repulsion. The repulsion may be aided by manual force. Having accomplished repulsion, with or without decapitation, as described on page 595, the obstetrist should first secure the anterior limb, or limbs, with the hand*or by means of cords. First, if practicable, lift the bent carpus from beneath the pubis and carry it up into the pelvic canal. Then place a cord upon the pastern as described on page 579. When this has been secured, the operator proceeds to extend the limb as described on page 636. As soon as the toe has been brought into the birth canal, the foot is quickly extended, and the entire anterior limb is brought into complete extension by traction. ‘The other forefoot, if retained, is handled in the same manner. If the head is also deviated, it is to be handled according to the directions given under C on page 765. After proper adjustment of the relations between the two anterior limbs and the head, the delivery is proceeded with in the usual manner. When this deviation occurs in the dorso-ilial or dorso-pubic Flexion of Anterior Limbs at Carpus 761 position, its correction is usually easier than when the fetus pre- sents dorso-sacrally, and is to be brought about in a corresponding manner. If the fetus is presenting in a dorso-pubic position, it will be necessary to press the carpus downward in the front of the pubis and bring the toe of the foot along beneath the sacrum in order to extend it. In the dorso-ilial position, the retained carpus is pushed outwards in front of the shaft of one of the ilia, while the toe is carried over the ilium of the other side and ex- tended in the birth canal. After.the limbs have been properly extended in the birth canal, the fetus is to be rotated upon its long axis, page 632, and brought into the dorso-sacral position. 2. Forced Extraction. Under certain conditions forced ex- traction may be advisable. Some obstetrists highly recommend it, especially in the case of a living foal. Naturally, it is only practicable in those cases where the bent carpus is already ad- vanced in the pelvic canal, or is in a position where it may be readily secured and brought into the pelvic canal in its state of flexion. In these cases, especially when a foal is living and prompt delivery is essential to the preservation of its life, the flexed carpus may be grasped by the hand, ora cord may be ap- plied to it. By exerting firm traction, the shoulder, arm and forearm are normally extended, the flexed carpus advanced, the entire body then advanced by the application of force, and the fetus delivered. 3. Embryotomy is rarely demanded except to the extent of the preliminary decapitation, which is desirable in order to facili- tate repulsion. It is rarely, if ever, essential or advisable to amputate the anterior limbs at the carpus. 3. COMPLETE RETENTION OF THE ANTERIOR LIMBS. Instead of the limb being flexd at the carpus, as in the pre- ceding instance, we meet with cases in which one or both anterior limbs are completely retained, and assume the position shown in Fig. 132. Under these conditions one or both carpal articula- tions project down deeply into the uterine cavity in front of the pubis of the mother, with the radius fully extended upon the humerus, so that those two bones constitute one elongated, rigid column. In this position of the fetus there can be no yielding in a posterior direction from the scalpulo-humeral articulation to the carpus. As a consequence of this deviation, the shoulders of 762 Veterinary Obstetrics the fetus are pushed back upon the sides of the chest so as to greatly increase its transeverse diameter, while the perpendicular diameter is still more profoundly increased by the rigidity of the limb, and now equals the distance from the fetal withers or back, to the carpus. The causes of this deviation may be two. When a fetus pre- sents at the pelvic inlet with one or both carpal joints flexed, these become impacted against the pubis, and, as the fetus con- Fic. 132. COMPLETE RETENTION OF THE ANTERIOR LIMBS. tinues to be advanced by the expulsive efforts of the mother or by traction, they tend to glide downward and finally backward in a way to convert the flexed carpus into complete retention of the anterior limb. It is quite possible that in many instances the fetus approaches the pelvic inlet with the limbs extended backwards, due to an arrest in their forward extension. With the anterior limbs of the fetus folded against the ventral surface of its body, a small amount of force, applied to the lower end of the radius, pushes it backward, and causes the fetus to offer at the inlet with the entire forelimb retained. The position is not abnormal for the smaller domestic animals. Complete Retention of Anterior Limbs 763 For the carnivora the position is more favorable for easy delivery than though the anterior limbs were extended beneath the head. It is only in the larger domestic animals that this position be- comes abnormal and interferes seriously with parturition. The diagnosis is comparatively easy. The condition permits the advancement of the head and neck to a further degree than when the limbs are flexed at the carpus. Consequently, as a rule, when the veterinarian is called the head has passed beyond the vulva. Upon examining with the hand, the differentiation between the complete retention of the anterior limbs and their flexion at the carpus is easily made. Handling. 1. Mutation. The indications are to correct the deviation of the anterior limb or limbs. The fetus must almost always be repelled, page 595. Before this can be accomplished it is best, unless the fetus is living, todecapitate, as described on page 642. With or without decapitation, the repulsion should be made backward and upward, assuming that the fetus has pre- sented in the dorso-sacral position. As the fetus is repelled, the forearm tends to come within reach, so that it may be grasped. The beginner especially should bear in mind that, the further upward and backward the fetus is repelled, the nearer the radius approaches to the pubis, and consequently the more readily it is reached. Without repulsion it is frequently quite impossible to reach the radius at all. As repulsion progresses and the radius comes within reach, a cord should be passed around it and a run- ning noose applied as low down toward the carpus as is possible. Drawing from time to time upon the cord with which the limb is secured, the operator should continue the repulsion and, with the aid of the cord and the operator’s hand, bring the limb into the position of carpal flexion described in the preceding section. From this point the operation is the same as described under that head. 2. Forced Extraction has been suggested by some. It is fre- quently practicable in the sheep and goat. In the mareand cow we consider it wholly unwarranted. It is said that some veter- inary obstetrists have succeeded in the forced extraction of the foal or calf in this position, but the records in the cases are not sufficiently lucid to enable the reader to determine whether they were dealing with'an average sized fetus or with an abortion at a comparatively early period in gestation. When a fetus is not 764 Veterinary Obstetrics fully developed, its limbs are comparatively much shorter and far more pliable, and consequently it may be forced through the passage in almost any conceivable position, dependent upon its size. When the fetus has reached its normal dimensions and at- tained the degree of rigidity regularly shown at the time of birth, the question of the correct position of each extremity becomes one of fundamental importance, and whenever we attempt to bring about forced extraction under these conditions we must as- sume an extraordinary risk. If a fetus can be drawn away by forced extraction when an anterior limb is completely retained, it must be because it is a very small fetus, in which instance there is no necessity for forced extraction, because the deviation is easily corrected. 3. Embryotomy, Except the amputation of the head, which we always advise, embryotomy is rarely demanded in this devia- tion. Fleming states: ‘‘ Amputation of the head will not always prove advantageous in retropulsion; indeed, it will often be found to be a disadvantage.’’ Upon what clinical facts such an opinion is based we are not aware, and cannot readily understand how amputation of the head could in any case prove disadvanta- geous in bringing about repulsion of the fetus. It is possible that sometimes further embryotomy may provedesirable. If the head has been removed, and, after repulsion, it is still impossible or impracticable to correct the deviation, especially in cases of emphysema of the fetus, it may become desirable to remove one ot both of the shoulders. This cannot be done by subcutaneous amputation, described on page 645; but it would be necessary to divide and detach the skin over the region of the shoulder and follow this by a division of the muscles which attach the scapula to the chest. These are chiefly the trapezius and rhomboideus, which would free the superior end of the scapula and permit it to be secured by means of a cord with a running noose. ‘Then should. follow the division of the latissimus dorsi and the pectoral muscles, after which the limb may be drawn out from the skin covering it, in an inverted manner. After the one limb has been removed, the chest of the fetus may be opened and evisceration, page 658, em- ployed. Further diminution in size of the fetus may be prose- cuted to any desired extent, and the remnant finally drawn away. Complete Retention of Anterior Limbs 765 ¢. DEVIATIONS OF THE HEAD AND NECK. In domestic animals, the tendency for the head to become more or less deviated at the time of birth varies greatly because of the differences in the length of the neck as compared to its transverse diameter. In the pig, where the neck is thicker than its length, it is very difficult for the head to become deviated, in marked contrast to the foal, with the very long and slender neck, in which these deviations are among the most common and serious forms of dystokia. Not only is the head of the foal very liable to deviation at the time of birth, but frequently the head and neck have be- come bent laterally at a very early date in gestation and have re- mained so throughout the development of the fetus, constituting a serious deformity—wry-neck. 1, LATERAL DEVIATION OF THE HEAD. The most common form of deviation of the head is the lateral, as it is in this direction that the neck is most flexible and the head most readily displaced. The deviation may occur with equal facility to the right or the left. - The causes of lateral deviation of the head are two. In the foal the deviation frequently occurs during an early period of gestation, to constitute wry-neck, so that when the end of gesta- tion arrives the head and neck have already been doubled back along the side of the foal for weeks or months, the parts have become thoroughly adapted to this position, and the head lies in the flank of the foal, where it is moulded to the convex surface of its body. That side of the head in contact with the body of the foal is concave, and the opposite side convex. The second, and except in the foal, perhaps the only cause of deviation, and the one which is most subject to remedy, is an accidental misdirection of the head at the time of the parturition. As the fetus, in an anterior presentation, is being forced along the genital canal, the nose or other portion of the head becomes somewhat deflected to the right or the left, and, becoming im- pacted against some projecting portion of the pelvis or genital canal or entangled in some way in the fetal membranes, is drawn farther to one side, until it becomes caught between the side of its body and the wall of the uterus or vagina. When this oc- curs it is highly improbable that delivery can proceed spontane- ously, but instead the head tends to become farther and farther 766 Veterinary Obstetrics deviated as the body of the fetus is pushed more and more for- ward. Finally the neck is doubled directly backward as far as possible from the shoulder, and the head lies far back in the flank. The diagnosis of this deviation usually offers little difficulty. It generally needs to be differentiated from only the two succeeding ~ forms of deviation, the downward and upward displacements. First, the operator must identify the two anterior limbs, one or both of which are ordinarily in the passages. Having accom- plished this, he is yet to determine whether the head is deviating upward or downward, or, if laterally, whether it be to the right or to the left. EZ yy ZZ. FIG. 133. LATERAL DEVIATION OF THE HEAD. (Srv. Cyr.) The determination of the direction is not always easy. If the head can be reached, that decides the question. When the head cannot be reached with the hand, the diagnosis becomes more dificult. Asa general rule it is only in the foal that the head cannot be reached and examined with the hand, and in the foal we are aided by the presence of the somewhat prominent mane. If the head is bent laterally and the operator passes his hand as far as possible along the presenting portion of the fetus, he will usually be able to identify the withers. From this point, turning Lateral Deviation of the Head 767 either to the left or the right and then backwards, he may trace the top of the neck, bearing the mane. At the lower margin of the neck, the operator will usually be able to identify the trachea. In one direction he can trace this to its point of disappearance within the fetal chest between the two anterior limbs, and in the other may follow it across the right or left anterior limb to later turn backward toward the patient’s head. In the upward and downward deviations of the head, the rela- tions of the trachea and the superior border of the neck or mane are wholly different, and serve to distinguish these displacements. In the upward deviation of the head, the top of the neck or the mane is out of reach, whereas the lower margin of the neck or the trachea is quite fully exposed, and ‘curves upward and then backward above the withers and disappears. When the devia- tion is downward, the trachea cannot be discovered, but the superior portion of the neck or the mane disappears downward between the two anterior limbs. The indications in lateral deviations of the head will vary greatly according to species and individual cases. 1. Mutation. In those cases where the deviation is recent, where wry-neck is not present, where the fetus is not emphy- sematous or there are no other evidences of insurmountable obstacles to the correction of the deviation, this is the conserva- tive and proper course. The cow-or mare should’ be operated upon in the standing position, with the hind parts elevated, or, if recumbent, should be placed in lateral recumbency on the side opposite to the fétal head, with her hind-quarters elevated. The operation consists, first, of repulsion, as described on page 595, which is to be applied to the chest of the fetus, directed obliquely backward and away from the misdirected head. If the head is deviated to the right side of the mother, the repulsion should be obliquely toward her left side, so as to tend to release the head and cause it to advance toward the pelvic inlet. After repulsion has been accomplished, the operator should secure and extend the head of the fetus by those means most available in the particular case, under the rules laid down on page 636. In many instances it is merely necessary to grasp some portion of the head with the hand or fingers, and give it a sharp pull, by which it is brought into its normal position. When the nose is pointing backward, that is, toward the anterior part of ‘ 768 Veterinary Obstetrics the mother, the nostrils and commissure of the lips offer a secure hold for the finger of the operator or for the insertion of a blunt hook, and this hold may prove of value until the head has turned somewhat. In the correction of this deviation it will often prove highly advantageous to place a repeller securely against the chest of the fetus and have an assistant maintain constant repulsion, thus keeping the body of the fetus pushed away from the pelvic inlet in a manner to insure to the operator the greatest amount of room for manipulating the head. In the bitch, cat and ewe, the patient may be more or less sus- pended by the hind legs, the vagina filled with a warm, unctuous fluid, and the fetus repelled, partly by gravity, partly by the pres- sure of the fluids, aided by shaking the animal, by pushing upon the fetal limbs or by means of a finger-tip placed against the chest. When repulsion has been accomplished, the operator may locate the fetal head through the abdominal wall, and by ex- ternal manipulation push it upward (the patient being suspended by the hind feet) toward the vulva, while a finger or fingers in- serted in the vulva aid in adjusting the head in proper position, after which traction may be applied. 2. Forced extraction has been advised in the mare by some veterinary obstetrists, and a few of them have reported good re- sults by this method. It has been suggested by some that by this means it is possible to save a foal, though we have been un- able to find a record of so fortunate an occurrence. The plan of forced extraction has already been described on page 640. We have not had occasion to apply this method of delivery in the mare or other animal, but we have observed a con-: siderable number of instances in which others have done so, and have learned definitely of but one instance in this country where the life of the mare has been saved, and none where the fetus has not perished. In European countries there are a number of rec- ords of successful deliveries of mares, in these cases of dystokia, by forced extraction. There was entered in our clinic a mare from which a fetus in this position had been extracted by force. Her perineum was completely ruptured, the afterbirth was retained, she was very weak and exhausted, and presented a repulsive and pitiable sight. The afterbirth was removed, and the ruptured perineum was dis- Lateral Deviation of the Head 769 infected. Ina few days she succumbed, and upon post-mortem examination there was found a small perforation upon the floor of the cervix uteri, which had caused a septic peritonitis. We consider forced extraction in this position in the mare as unnecessary, unsurgical and brutal. There is one possible ex- ception to this condemnation—if the foal is known to be alive, cannot be promptly extracted otherwise and its life preserved, and there is a possibility of saving its life by forced extraction. Under all other conditions we hold that embryotomy is far safer for the mare, requires little labor upon the part of the obstetrist, is on the whole one of the easiest forms of embryotomy with which the veterinary obstetrist is acquainted, and offers to him the most favorable prognosis. If a fetus is so small that it can be safely extracted by force, without correction of the deviation or embryotomy, then it is so small that it need not be extracted by force, because the deviation can be easily corrected or embry- otomy can be very readily performed. We consequently see no good reason’ for forced extraction, and consider that such a plan should be constantly and vigorously condemned. As the calf has a very blunt poll and a thick head, forced extraction becomes highly dangerous in the cow and should not be considered. 3. Embryotomy constitutes one of the most practical and favorable methods for overcoming dystokia due to the lateral deviation of the head in the mare and cow, if the displacement cannot be readily corrected. Nowhere in obstetrics has embry- otomy a more favorable application than in this deviation, especially in those cases of foals where wry-neck is present, which renders it extremely difficult, if not impossible, to bring about a correction of the vicious position. In all those cases where the fetus is dead and the head is deviated laterally to so great an extent that it cannot be readily adjusted, or even if the fetus is alive and of comparatively little value or if it is evident that its life cannot be saved, embryotomy should be proceeded with at once. While the veterinarian should not undertake embryotomy when the deviation can readily be corrected, he should be equally careful not to exhaust his physical powers in a vain endeavor to bring about a correction of the deviation before he resorts to embryotomy. The operation consists of the subcutaneous removal of one anterior limb, as described on page 645. The limb away 49 770 Veterinary Obstetrics from which the head is bent, and which is thereby fully exposed, is the one to be selected for amputation. After the removal of the anterior limb, the chest should be opened at the exposed point and evisceration carried out, as described on page 658. When this has been accomplished, and the fetal ribs have been severed, the size of the presenting portion of the fetus is re- duced to such a degree that it is now no greater with the head turned back than it would have been had it presented normally. It may then be drawn away with the head deviated, or what is usually better, the fetus has now become very flaccid and much room is gained, so that it may usually be very readily repelled and the head brought into position, so that the extraction may finally take place in a somewhat normal manner. Some operators advise, instead of subcutaneous amputation of the limb, the amputation of the head and neck, which we have described on page 644. We regard the amputation of the limb as an easier, quicker and safer opera- tion. Should the fetus be emphysematous, it is also more efficient. If the fetal body is normal, the accomplishment of either operation is efficient. 4. Hysterotomy, or Czesarian section, is uncalled for in the larger domestic animals, and usually in the sheep and goat. In the smaller animals, where the correction of the deviation fails, and embryotomy is not available because of the narrowness of the passages, Czesarian section, as described on page 663, is the only recourse, and offers a fair prognosis if undertaken at the proper time and under proper conditions. 2. DOWNWARD DEVIATION OF THE HEAD BETWEEN THE ANTERIOR LIMBS. In describing the lateral deviation of the head, we did not state the very evident fact that such a deviation may not be direct but may be variably oblique upward or downward. Such devia- tions from the direct lateral line are not materially important, and offer nothing unusual for our consideration. In other in- stances there is a downward deviation, in which the head passes downwards between the.two anterior limbs. We have stated, in considering the normal attitude of the fetus in the uterus, that it rests with its head and neck bent ventral- wards, with its chin in close proximity to or resting upon the sternum. It is easy to understand that in some cases the head may remain in this position, and the two anterior limbs become extended and enter the pelvic canal. The head, passing down between the anterior limbs, is tightly held in that position, be- cause the limbs are firmly pressed together over the back of the neck. Downward Deviation of the Head 771 There occur variations in the degree of the deviation, as in other cases, but they largely arrange themselves into two groups. The first group includes those of a minor character, in which, when the fetus advances along the birth canal, its nose catches against the pubic brim. As the fetus is pushed along, there is a constant tendency for the nose to turn more and more downward and backward, while the head becomes sharply flexed upon the neck and the poll passes into the pelvis, to constitute what is sometimes known as the poll presentation. From this position it has been assumed by some that the devi- ation may become more and more accentuated until it reaches that degree where the head passes completely downward between the legs. A study of the circumstances under which the devia- tion occurs tends to throw serious doubt upon this view. When the limbs are advanced in the pelvic canal, they are necessarily confined quite closely to each other, and it is only during the early stages of advancement, before the feet have yet approached the vulva, that the muzzle of the foal or calf can well drop down between the two anterior feet and become jammed against the pubic brim. As the two limbs advance further and further, they become applied more and more closely to each other, so that it would be highly improbable for the head of the fetus to pass com- pletely down between them to occupy a position beneath them. We hold, therefore, that the two positions are not differences of degree, but are fundamentally different in origin, and that one does not pass into the other by imperceptible gradations. The diagnosis by manual exploration is comparatively easy. In the first instance the head is found lying upon the anterior limbs, with the poll directed more or less upwards and forwards, while the nose projects down between the limbs and is caught against the pubic brim. In the second instance the head at first cannot be felt, but the limbs seem to be pushed somewhat apart as they near the chest. Careful manipulation will reveal the fact that the top of the neck or the mane disappears almost straight downward from the top of the withers, to finally recurve back- ward. By reaching around underneath the anterior limbs and fetal chest, some portion of the head will most likely be reached and identified. The handling of the downward deviation of the head offers some variations according to type. 772 Veterinary Obstetrics 1. Mutation is usually applicable in those milder cases where the nose is caught against the pubic brim, and the correction of the deviation constitutes the most rational and economic proced- ure. In such cases it is not difficult to repel, as described on page 595. ‘The operator should correct the deviation by insert- ing his hand between the pubic brim and the muzzle of the fetus, and, grasping the latter in the palm of his hand, lift it over the pubic brim and extend it in the pelvis. The case is then to be proceeded with in the ordinary manner of normal parturition. When the head has passed completely down between the legs, correction of the deviation may prove highly difficult or impos- sible. Itis essential to so far repel the fetus that the carpal joints pass into the abdomen and permit the limbs to part sufficiently to allow the head to pass up between them and resume its normal position. When the fetus has been sufficiently repelled to permit the carpal joints to be flexed and parted, the lower jaw may be corded as described on page 637, grasped with the hand or secured by a hook in the orbit, and lifted upwards between the legs. In the smaller animals the correction of the displacement is to be undertaken in the same manner as we have just related for the lateral deviation. 2. Forced extraction. Tapken strongly advises forced ex- traction in those cases in the mare where the nose of the foal is caught against the pubic brim, if there is any hope that the fetus is alive. He believes that he thereby greatly advances the inter- ests of the foal without materially injuring those of the mother. However, it is very rare that the foal is alive when the veteri- narian reaches the case, and there is rarely, if ever, any reason for precipitancy. 3. Embryotomy. Where the head is completely deviated downward and the two anterior limbs are closed over above it, and a reasonable effort demonstrates that the replacement of the head is improbable, or if it will apparently prove very difficult and the fetus is dead or comparatively valueless, we should pro- ceed at once with embryotomy. We prefer to remove one ante- rior limb .subcutaneously, according to the technic on page 645, by which process we relieve the incarceration of the head and permit it to be readily brought into position, after which the ex- traction occurs in the ordinary way. Interlocking of the Fetal and Maternal Pelves 773 3. UPwaRD DEVIATION OF THE HEAD. The upward deviation of the head is exceedingly rare in prac- tice, and is due to some accidental misdirection while the fetus is passing along the birth canal. In most animals, and especially in the foal, a primary upward deviation is so unstable that the head is very liable to drop off to one side and, revolving some- what upon its long axis, assume a more or less lateral displace- ment. Owing to the anatomical peculiarities of the head and neck, this displacement is perhaps most frequently observed in carnivora, where it may constitute a very serious obstruction to birth. The diagnosis is not readily made in the smaller domestic ani- mals. In the larger ones, where manipulation is practicable, the obstetrist finds upon the insertion of his hand that, though the position is dorso-sacral, the head is not readily grasped or touched, and that the trachea of the fetus, freely exposed and presenting toward the pelvicinlet, emerges from the chest and turns upward and then backward to disappear along the sacrum of the mother. The indications are analogous to those already related under lateral deviation. First we should consider the question of re- pulsion and correction of the deviation by methods already de- scribed. Second, before exhausting the strength of the opera- tor or of the patient, if the replacement is difficult, or threatens to be futile, embryotomy is to be recommended, and should be carried out upon the same basis as in the lateral deviation. Ceesarian section, page 663, necessarily constitutes a valu- able and available method for handling this deviation in the carnivora, where the hand of the operator cannot be inserted along the genital passages to correct the vicious position. As in other cases of hysterotomy, the operation should here be under- taken early, before the patient has become exhausted or the fetuses have perished and become emphysematous, and especially before the genital passages have been lacerated and infected in a vain effort to bring about extraction by other means. d. DYSTOKIA IN THE ANTERIOR PRESENTATION, DUE TO THE HIPS. INTERLOCKING OF THE MATERNAL AND FETAL PELVES. It not infrequently occurs, especially in the cow, that birth thas proceeded with more or less facility, with the fetus in an ap- 774 Veterinary Obstetrics parently normal position, until the anterior portions have passed beyond the vulva and the hips of the fetus have reached the pelvic inlet, when the progress is interrupted and the fetus re- fuses to move, even under vigorous traction. The interpretation of this condition varies with different obstetrists. Some hold that the dystokia occurs because the two stifles are in a state of abduction and thus, standing apart, catch upon the pelvic margin and stop the progress of the fetus. It is difficult to conceive of the possibility of such a condition, because there is nothing to maintain such abduction, but all the expulsive forces tend to promptly and effectively overcome it. According to our interpetation of this difficulty, the conditions are as we have depicted in Fig. 109, page 650, and consist es- sentially of the interlocking of the pelves of the fetus and mother in such a way that, if the traction is applied in a somewhat unfa- - vorable upward direction, the incarceration is emphasized instead of being overcome. During its development the embryo nies in the form of the seg- ment of a circle, and the ventral surface of the body is main- tained in a somewhat concave form. When the fetus begins its passage through the birth canal, it maintains this curved form until it has been completely expelled from the vulva. If this direction becomes interrupted, according to our observation, the pelvis of the fetus may become interlocked with that of the mother. If, when the chest of the fetus is passing through, or has passed beyond the vulva, traction is directed upward instead of downward, the external tuberosities of the fetal ilia are thrown. upward, and the prepubian tendon of the fetus, being rendered tense, draws the fetal pubis forward, flexes the fetal pubis upon the sacrum and increases the transverse diameter between the supero-external tuberosities of the fetal ilia. The tension upon the prepubic tendon, by advancing the fetal. pubis, increases greatly and dangerously the perpendicular diameter of the fetal pelvis. Normally the fetal pelvis leaves the spinal column at an acute angle, and, if traction is exerted on the spine, this angle is increased, the ilial tuberosities are low- ered, and the ischia and pubis pass backwards and upwards. If the traction is instead applied to the pubis through the prepu- bian tendon, the angle is reduced and the ilial shafts approach Interlocking of the Fetal and Maternal Pelves 775 the perpendicular to the fetal spine. The error in the direction of traction causes the fetal ilia to become firmly lodged against the anterior border of the maternal ilia, and the more violent the traction, the firmer the interlocking. When the fetal pelvis is large and the external ilial tuberosi- ties prominent, the hips may offer serious resistance in passing the pelvic inlet, even without the complication of misdirected traction. With misdirected traction we have twice seen cows tied firmly by the head to a post, with one or two horses hitched to the fetus and pulling their utmost in an attempt to bring away the calf, but without avail. The symptoms and diagnosis of this form of dystokia require but little consideration. The fetus, possibly rather large, gen- erally offers in the normal anterior presentation, and advances somewhat slowly until the hips have reached the pelvic inlet, when the progress is stopped and the fetus cannot be advanced by traction so long as it is applied in a direct line, parallel to the long axis of the body of the mother or somewhat upwards. If the operator can succeed in inserting his hand along the fetus into the uterus, he will find that everything is apparently normal, except that the pelvis of the fetus is firmly wedged against that of the mother and seems immovable. We know of but one con- dition from which we need to differentiate it,.and that is the double monstrosity known as pigodidymus aversus, Fig. 129. The indications in this form of dystokia are : 1. The Application of Traction in the Proper Direction. When a fetus is advanced without serious difficulty until it has reached the hips, and is in every way normal, there is no good reason why its extraction should not be readily completed, if care is taken to apply the traction directly downward toward the feet of the mother, according to the technic given on pages 586 and 640. Some suggest release by partial rotation. 2. Embryotomy. Failing to bring about extraction under moderate force, the obstetrist should at once resort to embryot- omy, consisting of the destruction of the pelvic girdle, as already described on page 649. 776 Veterinary Obstetrics é. DYSTOKIA IN THE ANTERIOR PRESENTATION DUE TO THE FORWARD EXTENSION OF THE HIND LIMBS BENEATH THE FETAL Bopy. In the mare, and possibly in other animals, we occasionally encounter a fetus presenting anteriorly, with the anterior limbs and head in an approximately normal position, and the two posterior limbs thrust forward in extreme extension beneath the body of the fetus, so that the two hind feet are lodged just in front of the maternal pubic brim, or have passed some distance along the pelvic canal. This places the fetal body in such a position that its progress becomes blocked when the neck or chest has appeared at the vulva. FIG. 134. FORWARD DEVIATION OF POSTERIOR ‘Limps IN ANTERIOR PRESENTATION. (ST. Cyr.) The nature of this presentation suggests to one that of the ventral transverse presentation, in which all four feet are present, but the head is wanting, whereas in this case all four feet and . the head offer at the inlet, and become more or less engaged in it. The fetus is ordinarily in the dorso-sacral position, with the proper relations existing between the two anterior limbs and the head and neck. However, when it has advanced sufficiently for the fore feet and nose to show at the vulva, its further progress becomes blocked. Inserting the hand beneath the body of the fetus, the operator encounters one or both posterior feet, either in the pelvic canal or just anterior to the brim of the pubis, where they are easily recognized, their soles directed downwards. The spinal column is jammed hard against the maternal sacrum. Forward Extension of Posterior Limbs 777 The prognosis is extremely unfavorable. Next to bi-cornual pregnancy, this is one of the most dangerous positions of the fetus encountered in the mare. The fetus is doubled up in such a manner as to cause very severe pain and violent straining, constantly threatening serious or fatal injury to the mother. The position offers unusual opportunity for damage by empirics, and invites violent traction by laymen without knowledge of the serious results which are almost sure to follow. When the two posterior feet are lodged against the brim of the pubis, the danger is perhaps greater than when the hind feet are well advanced in the pelvis, because the expulsive efforts of the mare, or traction applied by attendants, tend to force the two posterior feet through the floor of the uterus. It is also a position in which the layman and empiric may undertake embryotomy, and in one case at- tended by us they had performed detruncation through the dorsal region, but had failed to protect the genital organs from the sharp bones which they had left. As a consequence, the vagina was very badly lacerated and a chronic vagino-cystitis followed, from which the mare never recovered, although she survived. The method of handling varies greatly in the hands of different obstetrists. 1. Mutation. Some advise the adjustment of the misplaced members, but we find no data to show in what proportion of cases such a plan may succeed. ‘The directions given are to repel the two hind feet as far as possible into the uterine cavity and abdo- men, and then by traction to bring the fetus away. It must be evident that it is only in very favorable cases that such an oper- ation can succeed in the mare. With the anterior portion of the fetus and its body impacted firmly in the pelvic canal, the oper- ator cannot reach very far into the abdominal cavity, and cannot expect to repel the two posterior feet to any very great degree. The character of the position generally excludes all possibility of repelling the head and body of the fetus, and if the hind limbs are very far advanced in the pelvic canal it would seem impossi- ble to effectively repel them. Even when repulsion has suc- ceeded to a degree, it is impossible .for the operator to know if the two hind feet rest in a safe position where they may turn backward as the fetus moves forward, or not. It seems to us, from our clinical observation, that there would be constant danger 778 Veterinary Obstetrics of the hind feet being thrust through the floor of the uterus while traction is being applied to the anterior portion and the hips are advancing and passing over the bent limbs. We do not consider adjustment of the deviated posterior limbs. safe, practicable or advisable in the mare. Such an operation may be wholly feasible in the cow, but dystokia of this form has. not been observed by us in this animal. The deviation is generally observed in the mare. 2. Forced Extraction. Other obstetrists advise forced ex- traction. What success they have attained we cannot determine from the literature before us, but it would appear that the posi- tion is one which renders this operation specially dangerous. The plan of forced extraction is to secure the two hind feet with cords, advance them well under the body of the fetus, and then, applying powerful traction simultaneously upon the two hind limbs and the head, bring it away entire. Such a plan of delivery necessarily draws the pubis forward and forces the pelvis into that unfavorable position we have already described as ‘‘ Inter- locking of the Fetal and Maternal Pelves.’’ 3. Embryotomy constitutes, according to our view, the most desirable and rational method for handling these cases in the mare. In performing embryotomy, our chief operation would be that of detruncation, page 648, repulsion of the hips, and conversion of the fragment into the posterior presentation. In all cases of dystokia in this position, an unfavorable prog- nosis should be given, whatever the method of handling. Be- fore beginning his operation, the veterinarian should determine as far as possible if any rupture of the uterus "has been caused by the two posterior feet, or if they have wounded the large uterine vessels of this part, causing serious hemorrhage. In our practice, one mare died from uterine hemorrhage while we were preparing to attempt delivery, although the case was a very recent one and had not been greatly tampered with. In another case, to which we have already alluded, the owner and his neighbors had bisected the fetus through the thorax and left the vertebrae and ribs freely exposed, and had lacerated and torn the vulva and vagina in a very repulsive manner, so that, although we succeeded in detruncation at the proper point and the removal of the remnant of the fetus, the lacera- tions which had been caused by the owner were followed by a severe and chronic infection, which not only involved the vagina and vulva, but ex- tended into the bladder, causing a severe chronic purulent cystitis, from which recovery was very tardy and incomplete. Forward Extension of Posterior Limbs 779 We were called to attend a vigorous young mare suffering from this form of dystokia. The case was recent and had not been meddled with. Delivery by detruncation was prompt and easy. The mare died two days later from gangrene of the vulva and vagina. In a fourth case a foal was found one morning incarcerated in this position. Apparently the dystokia had existed much of the night. The delivery waseasy. Gangrene of the vulva with sloughing occurred, followed by vulvar constriction of such a degree that copulation was not possible. We have not had a satisfactory recovery in this form of dys- tokia. Il. DYSTOKIA OF THE POSTERIOR PRESENTATION. 1. DoRSO-ILIAL AND DoRSO-PUBIC POSITIONS. When considering the normal course of birth we had occasion to observe that a fetus presenting posteriorly, especially in the larger domestic animals, may pass quite readily through the pelvic canal, so long as it is in the dorso-sacral position ; but, whenever it deviates to any great extent from this, its passage becomes more or less difficult or impossible, depending largely upon the size of the fetus as related to the dimensions of the channel through which it must pass. The dorso-pubic position is the most unfavorable, because, owing to the curvature of the body of the fetus, the hind feet project upward against the roof of the vagina, so that they may readily become engaged in the vaginal walls and cause more or less obstruction to the progress of the fetus, and at the same time greatly imperil the integrity of the soft parts of the mother. When the fetus is lying upon its back, its buttocks drop down in front of the pubic brim in such a position that it is exceed- ingly difficult for the contraction of the uterus and abdominal walls to lift it up over the pubis and cause it to enter the pelvic canal. The indications in these positions are to bring about an ad- justment by rotating the fetus upon its long axis, as described on page 632. Some obstetrists hold that the fetus may pass through the canal somewhat easily when in the dorso-ilial or dorso-pubic po- sition, and that, in either of these positions, it may often be forcibly extracted without serious peril to the mother, but ac- cording to general experience such positions offer more or less serious obstacles to delivery, especially in the calf and the foal. If the fetus is very large, the amount of traction necessary to bring it away passes the limit of safety ; if the amount of force required is not great it is usually very easy to bring about rota- tion and delivery by the more natural method. ‘Thus, forced extraction has a very limited application in this form of dystokia. Embry otomy might be demanded in very rare cases, where, owing to firm impaction in the pelvic canal, rotation becomes impossible and forced extraction unsafe. 780 Flexion of the Hind Legs at the Tarsus 781 2. FLEXION OF THE HIND LIMBS AT THE TARSUS. We meet occasionally, especially in the mare and cow, with dystokia due to the tarsal articulations becoming flexed and either entering the pelvic canal or becoming caught just in front of the pubis. This displacement constitutes a formidable obstacle to the expulsion of the fetus, because it necessarily involves the flexion of all the articulations of the limb, and consequently greatly increases the diameteras measured from the fetal sacrum down through the folded limb. The femur is flexed upon the pelvis, the tibia upon the femur, the metatarsus upon the tibia, FIG. 135. RETENTION OF POSTERIOR LIMRS AT THE TARSUS. (FRANCK). and the phalanges upon the metarsus. We cannot extend one of these articulations completely until the others are ready to be simultaneously extended, and the folding of the limbs in this manner quite effectively prevents the passage of a fetus of normal dimensions through the pelvic canal. The diagnosis is comparatively easy. Upon inserting the hand, the operator may first touch the tail, or the ischiatic tuber- osities. Lying just beneath and in front of the pubic border, there is recognized the summit of one or both hocks. In some cases the flexed hocks extend into the pelvic canal. The fetus 782 Veterinary Obstetrics isthus lying in the position of ordinary sternal recumbency, with the hind feet closely doubled immediately beneath the body. The cause of this displacement is not far to seek. In discuss- ing the normal position of the fetus in the uterus, we have noted that it usually lies withits hind legs folded beneath its abdomen. When parturition occurs, the limbs should, under normal condi- tions, become extended, so that in a posterior presentation the most advanced part should be the two hind feet. When this ex- tension fails to take place, and the fetus is forced toward the pelvic inlet in the position in which it has previously lain, the points of the ossa calces naturally become caught against the pubic brim, or advance fora short distance in the pelvic canal, and stop further progress in the expulsion of the fetus. : Handling. 1. Thecorrection of the deviation should in all cases be undertaken if, in the judgment of the obstetrist, it can be properly accomplished. The overcoming of the deviation consists first in the repulsion of the fetus obliquely forward and upward, as described on page 595. The mother should prefer- ably be in the standing position, with the hind parts elevated. If unable to rise, she should be placed in lateral recumbency, or sometimes still better, in the dorsal position, still applying the rule of keeping the posterior portions of the mother higher. When the repulsion has been accomplished, the extension of the limbs is to be carried out as described on page 636. 2. Forced extraction has been suggested by some operators, although neither its advantages nor safety have been clearly demonstrated. As a general rule the so-called forced extraction in this position really involves partial embryotomy by the severing of the tendo-Achilles, which, by permit- ting dorsal flexion at the fetlock, ameliorates the dystokia. In our judg- ment forced extraction is never necessary, and rarely if ever justifiable, even with the severing of the tendo-Achilles. 3. Embryotomy occasionally becomes necessary or desirable. In case of a very large foal, or when the foal or calf is dead and emphysematous, and especially in those cases where the patient is unable or unwilling to stand, it may be impossible, or at least impracticable, to adjust the position, and consequently embry- otomy must be performed. Embryotomy in these cases is very simple, consisting merely of the amputation of the foot with the chisel, through the lower portion of the tarsus, as described on page 651. 4. Ceesarian section, page 663, may become necessary in the Complete Retention of the Posterior Limbs 783 smaller domestic animals, where the adjustment of the deviated limbs or embryotomy is not available. 3. COMPLETE RETENTION OF THE PosTERIOR LImBs. BREECH PRESENTATION. The breech presentation may be met with in any of the domes- tic animals, and probably acquires its greatest significance in the mare, where it constitues a very formidable cause of dystokia. It differs from the preceding deviation in that, instead of being Fic. 136. BREECH PRESENTATION. (ST. Cyr.) flexed at the hocks, the posterior limbs are flexed upon the pelvis, beyond which each joint is in rigid extension and the limbs are thrust forward beneath the abdomen and chest of the fetus. The causes are identical with those of the preceding, and probably in many cases complete retention follows flexion at the tarsus. ‘The flexed tarsus becomes caught against the brim of the pubis, and the expulsive efforts of the mother, pushing the fetal body along, cause the ossa calces to glide downward and then forward, and the tarsus to become extended, until finally the en- tire limb is pushed forward beneath the body. The operator, upon examining the case, usually meets first with the tail or buttocks 784 Veterinary Obstetrics of the fetus, and in many cases can only touch the tibia or other portion of the limb with very great difficulty. Sometimes no part of the hind limb can be grasped or recognized until after re- pulsion has taken place. 1. The adjustment of the deviated limbs is first of all indi- cated. ‘The fetus should be repelled,.as described on page 595, after which the tibia or metatarsus, as may be available, should be secured by means of cords, as described on page 579. By continuing repulsion, the position is to be converted into a hock presentation, after which the further handling of the case is iden- tical with that position which has already been described. 2. Forced extraction has been advised by some operators in these cases. As to how successful they have been our veter- inary literature is not very clear. They suggest a variety of ways for bringing about forced extraction. Some recommend that a cord with a running noose be passed around the loins of the fetus and secured, or rather that the cord be passed around each of the thighs and then passed through the noose at the top of the back, so that the loins of the fetus are secured and the operator is enabled to apply any degree of traction which may be desired. Others would apply traction by means of sharp hooks deeply imbedded in the flanks, like the flank hooks of Harms. Yet other obstetrists would incise the perineum of the fetus and, inserting the hook through the fetal pelvis, engage it in the obturator foramen or in front of the pelvis, and exert traction in this way. While forced extraction may be somewhat easier for the ob- stetrist, we do not consider it warranted by modern surgical prin- ciples. We have at no time found any need for applying forced extraction. 3. Embryotomy offers the most valuable method for over- coming this form of dystokia, especially in the mare, in all those cases where adjustment is impossible or difficult. Whenever the fetus is comparatively large or is dry or emphysematous, or for any other reason it is exceedingly difficult or impracticable to bring about an adjustment of the position, embryotomy is highly commended, and should be undertaken promptly, before the ope- rator and patient have become exhausted in fruitless endeavors. Various forms of embryotomy have been recommended by differ- ent writers, but we greatly prefer the intra-fetal amputation of the two posterior limbs, as described on page 653. Others prefer Complete Retention of the Posterior Limbs 785 to amputate the limbs extra-fetally, with the knife, Persson’s saw, or the Pflanz embrytom. 4. Ceesarian section, as described on page 663, is sometimes necessary in the smaller animals, like the sow and bitch, but is uncalled for in the cow and mare because embryotomy is always readily available. 50 III. TRANSVERSE PRESENTATIONS. a. DORSAL TRANSVERSE PRESENTATION. Transverse presentations are virtually confined to the unipa- rous animals, and among these the overwhelming majority occur in the mare. The fetus usually presents ventrally, except in those cases we have already described as Bi-cornual Pregnancy on page 716. When the dorsum of the fetus offers at the pelvic inlet in the right or left cephalo-ilial position, the position is usually uncom- plicated by any further deviation, so that, when the operator inserts his hand, it comes at once irito contact with the dorsal surface of the fetus, which is easily recognized. By extending the hand to the right or left, he may palpate and recognize the hips or the shoulders and neck. As a general rule the operator does not come in contact with the head or any of the feet, but only with the body, although in rare cases one or more of the feet may be more or less misplaced in their general relation to the body of the fetus, and project in such a manner that they may be felt or grasped by the operator. In one case in our ex- perience, one hind leg passed backward over the fetus into the pelvic canal. The causes of transverse presentations are not well defined. Most obstetrists hold that they are acquired positions, occurring during labor; but, as we have related, page 716, the fetus of the mare occasionally develops equally in the two uterine cornua, in a transverse position. In the anomalous development which we have described, the fetal body revolves upon its long axis in order to attain a stable position. We do not know that all fetuses developing transversely in the mare undergo this rotation, and we can readily conceive it as being wholly possible that no rotation should occur, in many cases, and consequently that the fetus may develop transversely and, without rotation, present transversely at the time of partu- rition. Handling. Version, as described on page 634, is usually the best and most effective method of handling. In almost every case it succeeds well. Should this fail, it may be necessary to perform detruncation in the lumbar region. The detruncation is to be accomplished chiefly with the chisel, severing first the 786 Transverse Presentations 787 spinal column. ‘The soft parts may be most conveniently sev- ered with the finger knife. Evisceration, page 648, should fol- low. The posterior half may be secured by means of a rope noose about the lumbar vertebrze, or by hooks or cords applied inside the pelvis. It may prove necessary to extend the embryotomy to include the destruction of the pelvic girdle, pages 661 and 649. In other cases, the posterior half of the fetal body may be repelled, and converted into a posterior presentation. Fic. 137. DORSAL PRESENTATION. (FRANCK). The anterior half is to be managed in a similar manner. After evisceration it may be desirable to sever the ribs, page 656, so as to permit the fetal chest to collapse. The remnant may now be extracted by securing the dorsal vertebrz by means of a cord and exerting traction upon it. In some cases it may be practicable or preferable to convert the anterior half into the anterior presentation. In one instance occurring in our practice, due to abortion in a mare, the fetus was in the dorsal transverse presentation, with its upper hind leg extended over its back into the pelvic canal. The leg could not be returned into the uterine cavity, and con- sequently detruncation was effected, after which it was easy to convert the posterior half into a posterior presentation, and the two pieces were readily removed. , 788 Veternary Obstetrics b. VENTRAL TRANSVERSE PRESENTATION. Most fetuses in the transverse presentation offer at the pelvic inlet by their ventral surfaces. ‘The head of the fetus is retained, all the feet offer in, or are somewhere near to, the pelvicinlet, and the fetus lies upon its side, more or less transverse to the spinal axis of the mother, with the fetal head resting in the region of one or the other of the maternal ilia—right or left cephalo-ilial position. Symptoms. In most instances some or all feet appear at or near the vulva, but no essential progress is made in the expul: sion of the fetus, although the animal may make violent expul- sive efforts, and neighbors and empirics may apply force. In a large proportion of the cases in the mare, wry-neck is present. If the wry-neck:is to the right the fetus usually lies upon its right side, and if to the left upon its left side, so that the head ina large proportion of cases is entirely out of reach, which. in many respects is fortunate. Upon inserting the hand, the obstetrist usually meets with, and can identify, all four of the limbs. In some cases it may be exceedingly difficult for him to differentiate between the different members, so badly are they entangled with each other, and so tightly impacted in the pelvic canal, This form-of dystokia is quite favorable for the mare, because the owner or empiric is usually balked at once in any effort to meddle with the case, and must consequently await the arrival of the veterinarian. Even more or less violent traction upon the fetus, as a general rule, produces little harm, because its position is such that any moderate force applied to the feet cannot wedge the fetal body in the pelvic inlet or force any projecting portion of the fetus against the soft parts of the mother. Handling. 1. Version. In the cow it may be practical and advisable to attempt adjustment without embryotomy, because the feet and legs are shorter and more pliable than those of the foal. If it is decided to perform version of the fetus, the two posterior limbs are to be corded at the pastern, and the two anterior limbs pushed away forward as far as the operator can reach, while an assistant advances the posterior limbs by exert- ing traction upon the cords, as described on page 634. The operator thus converts a transverse into a posterior presentation, after which the delivery is completed as such. Ventral Transverse Presentation 789 2. Embryotomy. In the mare we regard embryotomy as be- ing simpler and safer than version, without generally involving any great amount of labor upon the part of the obstetrist. Embry- otomy in these cases consists of the subcutaneous removal of the two anterior limbs, as described on page 645, followed by version of the fetal remnant, which is to be brought about by repelling the chest and applying traction to the two posterior limbs, in or- der to convert the transverse into a posterior presentation. This position is subject to a variety of complications, which may tax the skill and endurance of the operator. In the typical case in the mare, which we have described above, it requires only about one hour or one and a half hours to perform embryotomy Fic. 138. VENTRAL PRESENTATION. (FRANCK). and deliver the fetus as outlined. An expert operator may even accomplish the task in much less time, but in the presence of certain complications it may require very much more time. In one of my cases all four feet of the fetus had already passed through the vulva, and the four large, bony limbs were tightly impacted in the pelvic -canal, completely filling it, so that it was only-with difficulty that the arm could be inserted alongside or between them. I could reach neither of the shoulders to amputate subcutaneously, but was forced to amputate one at ‘the elbow joint, and the other with difficulty at the scapulo-humeral articu- lation, but these amputations served my purpose, and permitted delivery after some five or six hours of fatiguing labor. The case was further com- plicated by the viciousness of the mare, which persistently fought by kick- -ing, striking or biting at any one within her reach, so that it became neces- _sary to cast her and securely tie all four feet. The recumbency, with the 790 Veterinary Obstetrics cramped position of all four feet, induced extraordinary pressure upon the abdomen and greatly restricted the room for the work. Nevertheless she made a good recovery. In another instance the two anterior limbs were well advanced in the pel- vis, with the feet protruding beyond the vulva, while the two hind feet were jammed across the pelvic inlet. The upper hind foot crossed above the up- per forefoot in front of the pelvic inlet, and the toe was firmly caught in front of the shaft of the maternal ilium, while the hock lay immovably fixed against the iliac shaft on the other side. The lower hind foot passed be- tween the two anterior limbs, and was otherwise engaged in the same way as the upper hind foot. It was impossible to repel the fetus, and equally impossible to reach the uppermost shoulder to amputate the anterior limb, because of its being crossed by the metatarsus. With the chisel, we therefore amputated the up- per hind foot through the lower part of the tarsus, removed the foot, and secured the stump above the os calcis with a cord. The upper fore-leg was then removed subcutaneously. Next the lower hind foot was amputated at the tarsus, in the same manner as ‘the ‘first one, and the stump was secured with a cord. Finally the lower arferior limb was amputated subcutaneous- ly, after which the chest was repelled, while traction was applied to the stutips of the amputatéd hind limbs, and the remnant of the fetus was con- verted into a posterior presentation. PATHOLOGY OF THE PARTURIENT OR PUERPERAL STATE. Grouped about the act of parturition, there is a highly inter- esting and important series of accidents and diseases of the mother, which require close study upon the part of the veterinary obstet- rist. They occur in all animals, although one or another disease or accident may be far more frequent in one species than in an- other. ‘These diseases, injuries or infections usually have some definite time at which their foundation is chiefly laid, but there are wide variations as to the exact time of the advent of the symptoms. In some instances they may occur before parturition; in others, during or after that act. Many of them pass by im- perceptible gradations from one into another, which tends to ren- der their classification somewhat difficult, and subjects any plan which may be suggested to certain objections. For con- venience, this group of affections may be divided into five classes: Pathology of the Placenta ; Wounds and Injuries of the Genital and Neighboring Organs; Puerperal Infections; Partu- rient Eclamptic Diseases ; and Diseases of the Mammez. I. PATHOLOGY OF THE PLACENTA. RETENTION OF THE FETAL ENVELOPES. RETAINED AFTERBIRTH. In dealing with the question of birth, we have already had oc- casion to allude on page 516 to extra resistance of the chorion, which, it has been claimed, sometimes imperils the life of the fetus ; on page 742, to adhesions between the fetal membranes and the fetus as a cause of difficult labor ; and on page 525, to the rup- ture of the chorion and its expulsion with the other membranes, in advance of the fetus, leading thereby to fetal death. These conditions are rare, and relatively unimportant from an economic standpoint. Retained placenta constitutes one of the most common and serious maladies among the diseases of the puerperal state, espe- cially in the cow. In considering normal birth, we have noted that, as a consequence of that act and following closely upon the expulsion of the fetus itself, there should normally occur a separation of the fetal placenta from that of the mother and an 791 792 Veterinary Obstetrics expulsion of the fetal membranes from the uterus. If they remain, they inevitably undergo decomposition and cause more or less serious disease. When the fetus has been removed or has ceased to live, and the passage of blood through the umbilic cord has ceased, these membranes become essentially foreign bodies, highly subject to infection, which more or less seriously involves the uterus and the animal system as a whole. A study of the placentze of the domestic animals shows that the intimacy of contact between fetal and maternal placentz varies greatly in the different species. The placental tufts are very much longer and more complex in ruminants than in other domestic animals. In ruminants the placental attachments are not uniform over a large area, as in the mare and sow, but they are concentrated upon certain well-defined areas, where their attachment is all the more complex. It would at once be sus- pected, after a study of the anatomy of the placentz of various domestic animals, that ruminants, with their highly complex cotyledonous placentze and very complex placental villi, would be far more subject to retention of the fetal membranes than is any other animal. This suggestion, however, holds true for but one member of the group, the cow? Retained placenta may almost be said to be a disease of the cow, so far as the domestic animals are concerned. While the condition is met with in all domestic animals, and acquires importance in mares, there is no such number of instances in any other domestic animal,or in all others combined, as in the cow. See Fig.97, p. 361 and Fig. 139, p. 802. It is difficult to define in exact terms what constitutes retained placenta. The line between the normal and abnormal duration of retention of the placenta, after the expulsion of the fetus, constantly vacillates according to species and individual, so that the term is largely a comparative one. In the mare the chorion usually separates from the uterus within 10 to 15 minutes after the expulsion of the fetus, and if it remains over 30 minutes it might be very properly considered abnormal, although in all probability it may yet separate and come away spontaneously after a further trifling delay, and the case pursue an apparently normal course. In cows the fetal membranes usually do not become detached so quickly. Ina large proportion of cases they still remain at- tached to the cotyledons after one-half to one hour, and, not at id Retained Placenta in the Cow 7193 all rarely, in cases which are apparently normal, they remain from 4 to 12 hours or even more, before becoming detached and drop- ping away. However, if they remain for a longer period than ro to 12 hours after the expulsion of the fetus, especially if the latter has been carried for the full term, most obstetrists would regard the further retention as abnormal. In the smaller ruminants, the ewe and goat, the placenta is usually expelled with more promptness and uniformity than in the cow. In multiparous animals it is the rule, if not a necessity, that the placenta of each fetus shall become expelled prior to the expul- sion of the next fetus from the same cornu, and the last fetus is almost immediately followed by the expulsion of its membranes. I. RETAINED PLACENTA IN THE Cow. Although, among all the domestic animals, the cow is by far the most subject to retained fetal membranes, the causes of such re- tention have not been made wholly clear by veterinary writers, and in fact comparatively little investigation has been made, with a view to a scientific explanation of the pathologic condi- tion. ; By many it has been regarded as a disease of the membranes, by which they adhere with abnormal tenacity to the maternal placenta. While the tufts of the chorion are very long and nu- merously branched, and sink into the recesses in the cotyledons of the mother, they have no power within themselves of holding fast to the maternal tissues. It has already been stated that, at no time during fetal life, is there any direct communication be- tween the maternal placenta and the placental tufts of the cho- rion, but they are always normally separated by two layers of epithelial cells, the one maternal, the other fetal. It has long been believed and taught that, under certain dis- eased conditions, adhesions take place between the tufts of the fetal chorion and the corresponding septa of the maternal pla- centa, but no such adhesions have as yet been observed by his- tologic examination. While we are not in a position to deny the possibility of such adhesions, it is certain that, if they occur at all, they are so rare as to constitute no important element in the question as a whole. e 794 Veterinary Obstetrics Retention of the fetal membranes in the cow is due primarily to the incarceration of the tufts of the chorion within the crypts of the maternal cotyledons. Recently Pomayer,' in a very extended study, has quite well shown the principal causes of retained afterbirth by histologic research, and his findings and conclusions are in full accord with clinical experience. Pomayer holds that retained fetal mem- branes are due to inflammation and swelling of the maternal pla- centa, that is, placentitis or cotyledonitis. The lesions within the cotyledons may be of two classes, aseptic and septic. During pregnancy an animal may receive a blow, be gored by a cow, or meet with some other external injury which may more or less detach some portion of the chorion from the maternal pla- centa. Hemorrhage may take place to a limited degree, followed by a more or less extensive inflammation, with new formation of connective tissue between the mucous membrane of the placenta and the epithelial tufts of the chorion. Should the hemorrhage between the two parts become very great, it may cause so exten- sive a separation as to induce the death and expulsion of the fetus. If the hemorrhage is not so great, and the inflammatory processes already mentioned take place, the fetal membranes may become more or less incarcerated and held over a limited area, but there would be no general retention of the entire fetal mem- branes, or rather we would say that, in the cow, the fetal mem- branes would become readily detached from all the cotyledons save one or two which had been implicated in the injury during pregnancy. With this group of cases, we have little to do, and clinically it is virtually negligible. The important group, from the practitioner’s standpoint, con- sists of those cases in which infection plays the chief role and the retention of the afterbirth is finally maintained by the in- flammation of the maternal placenta. By observing Figs. 79 and 139, it will be seen how intimate is the relation between the chorion and the cotyledons in the cow, and it will be readily understood that, when the cotyledons become inflamed and swell, the very complex chorionic tufts may become more or less immovably fixed and held. 'Das Zurtickhalten der Nachgeburt beim Rind, by Dr. Phil. C. Pomayer. Retained Placenta in the Cow 795 The advent of cotyledonitis may vary in different cases. In many instances, the disease of the placenta precedes the expul- sion of the fetus, and consequently, at the time of the expulsion of the calf, the pathologic conditions which must result in reten- tion of the fetal membranes are already present, and fully devel- oped. This is especially true in contagious abortion, in which there is frequently more or less infection of the cotyledons, prior to the expulsion of the uterine contents. If the abortion occurs early in pregnancy, before the chorionic tufts have become de- veloped, the fetal membranes are regularly expelled along with the aborted fetus. Later in pregnancy, after the chorionic tufts have become more developed, with corresponding complexity of the maternal placenta, retained afterbirth becomes very common, and is referable to the existence, at the time of the expulsion of the fetus, of a distinct inflammation of the maternal placenta, which incarcerates and holds the chorionic tufts of the fetal pla- centa. In other cases, also, inflammation has already advanced - into the uterus, and brought about an inflammation of the coty- ledons, prior to the expulsion of the fetus. In the granular vene- real disease of cows, where the granular inflammation extends into the uterus, if the death of the fetus fails to be brought about, but instead its premature expulsion is caused, the cotyle- dons readily suffer, and the expulsion of the immature fetus may be followed by the retention of the membranes. When a pregnant animal has suffered fora long period of time from prolapse of the vagina and of the vaginal portion of the uterus, the uterine cavity is very prone to become infected, since the chief barrier to uterine infection, the healthy vagina, has been replaced by a diseased and infected organ. Similar conditions prevail when torsion of the uterus has oc- curred, because compression and stretching of the tissues have greatly decreased their power of resisting infection and permitted the infection to extend into the uterine cavity and involve the placenta. Any cause which. may operate in such a way as to permit the access of disease-producing organisms into the uterine cavity may at any time cause infection of the maternal placenta and bring about a degree of inflammation and swelling which will eventually cause a retention of the fetal membranes. In the other important group of cases, those in which the dis- eased condition occurs after the completion of birth, infection 796 Veterinary Obstetrics is favored in a quite different manner. The observations of Pomayer upon this point are very exact and convincing. If birth has been difficult, if the animal is weak and debilitated, or if the uterusis in a debilitated state from the expulsion of the fetus, retention of the fetal membranes is very probable. The expul- sion of the fetus has exhausted, in these cases, the contractile powers of both the uterus and the abdominal walls. In most cases of parturition, there is a definite and well-marked exhaus- tion at the completion of the act, and a period of rest at once follows. Later, when the animal system and the uterus have recovered from the exhaustion of parturition, contractions of the uterine and of the abdominal walls normally occur, and serve to -press out any remaining fetal fluids, and the afterbirth, and close the uterine cavity. If, for any reason, the exhaustion is abnormal and the con- tractions of the uterine walls do not recur promptly, infection takes place very quickly. Assoon as the navel cord is ruptured, the fetal membranes at once cease to live, and assume the signifi- cance of a foreign body. The entire mass of membranes is dead tissue, filled with fluid and containing portions of the fetal fluids which have not been thrown out. Taken together, the membranes and the fluids constitute a highly favorable breeding ground for disease-producing organisms. Usually the broken end of the navel cord hangs from the vulva, comes in con- tact with bedding, feces, urine and other substances reeking in micro-organismal life, and furnishes an excellent avenue along which the organisms may pass into the uterine cavity. Still more important, in many cases, micro-organisms of the most dangerous kind are introduced directly into the uterine cavity on the hands of laymen, or other persons who have inter- fered in cases of dystokia or have inserted their hands into the uterus immediately after the expulsion of the fetus. Thus there is abundant opportunity for infection of many kinds to gain access to the uterine cavity and, having reached that organ, find the conditions of heat, moisture, nutritive material and exclusion of air ideal for their tapid and efficient multiplication. If the exhaustion of the uterus continues for 10, 12 or more hours, the infection of the cotyledons has probably occurred, and within 24-48 hours the disease processes in the cotyledons may have so far advanced as to firmly incarcerate and hold the chorionic tufts. Retained Placenta in the Cow 797 The pathology of the retention of the fetal membranes is necessarily somewhat foreshadowed by the causes which have been related above. Inflammation of the cotyledons in the cow, or of the placenta in other animals, naturally follows the general course of inflammation of tissues, resulting from infection. It may abate in the course of a few days, and the swelling of the coty- ledons may decrease and result in the release of the incarcerated placental tufts, so that the chorion may finally come away, ac- companied by contraction of the uterus and prompt recovery from the disease. If, however, the infection is more extensive and virulent, the cotyledon may undergo total necrosis and slough away, still holding firmly incarcerated the section of chorion to which it is attached. We have observed this result in the cow repeatedly, and sometimes it has involved the necrosis and sloughing away of all or nearly all the cotyledons in the entire uterine cavity. The ravages of the disease do not always cease with the necro- sis of the cotyledons, but may extend to the walls of the uterus, involving the mucous, muscular and peritoneal coats more or less in their order, and extending beyond the peritoneal covering of the uterus, to involve the peritoneum in general. The fetal membranes undergo more or less rapid decomposi- tion, so that in 48 hours, as a rule, they become quite putrid and give off a very fetid odor. The inflammation of the uterine mu- cosa, endometritis, causes a more or less abundant excretion into the uterine cavity, which is usually very fetid and consists of a dirty, grayish, flocculent, semi-fluid or fluid mass, which may vary greatly in amount. Naturally it is mixed with shreds of afterbirthand placenta, and sometimes contains cotyledons which have sloughed away from their pedicles. In some cases, the uter- ine mucosa is covered over with diphtheritic membranes. Depending upon the degree of infection, the uterine mucosa or the entire uterine walls may be more or less thickened and changed in consistency. Sometimes the uterine walls are very firm and hard, as aresult of an exudative inflammation, especially if the disease is of somewhat long standing. At other times, the walls are very thick and soft, as a result of gangrene. When the inflammation of the uterine walls is virulent, and the pathologic changes serious, the uterus quickly loses all con- tractile power and lies as an inert organ. The pathologic secre- 798 Veterinary Obstetrics tions accumulate within the organ, until sometimes it may con- tain four or five gallons. Any expulsion of the contents of the uterus must now be brought about by the contraction of the ab- dominal walls, including the diaphragm, and even these forces are too frequently in abeyance, so that the uterine contents in- crease more or less rapidly, and in many cases flow away spon- taneously, especially when the animal is lying down, simply as a result of passive pressure upon the abdominal walls. The constitutional symptoms are usually parallel to the local changes in the organ. ‘The systemic disturbances will vary, however, according to the vitality of the patient and her power of resistance to bacterial products. Usually, when the inflammation of the uterus has extended to any considerable degree, there are more or less well-marked symptoms of septicaemia or pyaemia. These include inappetence, irregularity of the bowels, either in the form of diarrhea or of constipation, cardiac debility with a very weak or imperceptible pulse, great depression of the animal, cold extremities, rapid, shallow respiration, and any other of the long train of symptoms which may accompany septicaemia. The symptoms of retained placenta, in the cow, are variable, and include the symptoms of all the pathologic lesions which may result from the disease. Generally they are self-evident, and consist of the navel cord and portions of the chorion hanging from the vulva, while other portions are retained within the uterus. This is not always true. Sometimes the major portion of the chorion, and the navel cord, have dropped away, and the owner believes that the expulsion of the fetal membranes has been complete, but within the uterus there remain imprisoned more or less extensive portions of the afterbirth, which soon become infected and undergo decomposition. In other cases, the entire mass of fetal membranes, or essentially all, is retained within the uterine cavity, the os uteri has contracted, and no portions of the membranes protrude from the vulva, to reveal in that very apparent way the condition which exists. In addition to these usual visible signs, there are present symptoms of the pathologic changes which we have enumerated above. These may not be very marked, but the animal, soon after parturition, loses her normal vigor, and there are generally symptoms of ill health of a more or less serious character. In many cases, the retention of the membranes may be suspected Retained Placenta in the Cow 799 from the presence of a vaginal discharge, with the general appear- ances of ill-health. In other cases, there occurs a more or less evident prolapse of the vagina. When retention of the placenta is neglected, the membranes and cotyledons may slowly slough away, the os uteri contract, chronic metritis and pyometra become established, marasmus and emaciation follow, and the disease continue month after month, to finally terminate in death, or in recovery with sterility. Under such conditions, following within a few days or a few weeks upon parturition, it behooves the veterinarian, when called to attend the animal, to make a careful search of the uterus. If the os uteri is open, he may profitably make this ex- amination direct through the vagina, but, if the os be closed, the examination needs be made per rectum, when the enlarged uterus will be discovered and the nature of the disease understood. The handling of retained placenta in the cow calls for care- ful study, and the display of great judgment. Mostly the work has been undertaken in a haphazard way by the layman or the dairyman, and these methods have been largely copied by the veterinary practitioner. No practice in connection with our professional duties could be more unfortunate. As a general tule, the layman or the veterinarian removes the afterbirth by manual force, more or less completely, at a time which is arbi- trarily fixed, or when it may suit the convenience of the parties concerned. As a result of this haphazard and unscientific method of handling this very serious disease, the lives of many valuable cows are annually sacrificed, and many more are ren- dered useless for dairying or other purposes. In order to handle retained placenta successfully, the veterinarian must first under- stand the physiologic expulsion of these membranes and the pathologic conditions which occur in the course of the disease. Three different courses present themselves for consideration in the handling of each case of retained placenta in the cow, and the veterinarian must use good judgment in determining which of these three courses he should pursue. 1. The manual removal of the placenta. As early as 24 hours after parturition, the veterinarian should examine the retained membranes and determine whether or not they may be safely and completely detached by manual force, and, if practi- cable, should remove them. The precise time for this examina- 800 Veterinary Obstetrics tion cannot be definitely fixed. If the veterinarian attends a case of dystokia, and finds, after: the removal of the fetus, that he can follow with the removal of the placenta, without tearing the cotyledons and without causing hemorrhage, this should be ac- complished immediately. If there are any wounds in the uterus or vagina, there is greater need for the removal of the membranes, in order to prevent wound infection and injury to the parts. If the fetus has been dead and emphysematous, it is quite important to remove the afterbirth immediately following the removal of the fetus, and in such cases it is generally quite practicable to do so. The operation of the manual removal of the placenta should be accomplished in a careful and thorough manner. During partu- rition, the chorion has become separated from some of the cotyle- dons about the cervical canal, and the farther toward the horns we proceed the more intimate do we usually find the attachments of the membranes to the cotyledons. ‘The veterinarian should begin by detaching those cotyledons which are first recognizable posteriorly, along the top of the uterus, and then, gradually work- ing forward, eventually detach those from the bottom of the uterus and from the horns. The method of detachment should aim at the complete removal of all the chorionic tufts, without injury to the cotyledon or to its pedicle. The operator grasps the cotyledon with his thumb resting upon one side at the margin of the attachment of the chorion to the cotyledon and his index and middle fingers resting upon the opposite border of the organ. By pressing upon the chorion, between the thumb and fingers, the chorionic tufts are gradually detached and forced out of the cryptsin the cotyledons, while no force is exerted upon the stalk of the cotyledon, and consequently it escapes injury. After the fetal placenta has begun to be detached on the side where the thumb is located, the detached margin may be grasped between the thumb and in- dex finger, while the other fingers rest upon the opposite side of the cotyledon, and the detachment of the chorion gradually com- pleted. This process is to be repeated upon one after another of the cotyledons, until all are finally detached. The operator usually has difficulty in reaching the most distant cotyledons located in the two horns, especially those in the gravid horn. This horn turns downward, and then backward, and is " Retained Placenta in the Cow 801 longer than the reach of a man’s arm. The operator may bring these cotyledons somewhat nearer to him by having assistants lift upon the floor of the abdomen with a blanket or board, or in some cases, by gradually pulling backward on the curved horn, and thus drawing it toward the pelvis. If the uterine walls are not paretic, one may also cause a decrease in the size of the organ by filling the uterus with warm water and causing it to contract and expel the liquid. This causes a diminution in the size of the organ, and brings the most distant cotyledons more nearly within reach. Before beginning the operation, the veterinarian should wash and disinfect the vulva and tail carefully, and should irrigate the vagina. The operator should take precautions against infection of his arms and hands. For this purpose, we recommend the repeated immersion of the arms and hands ina reliable antiseptic fluid, and would especially recommend lysol, because of its unc- .tuous character. Some, like Pomayer, condemn antiseptics for this purpose, and recommend oils or fats instead, but our expe- rience has been that oils and fats are almost instantly dissolved by the fluids present and washed away. We also practice and recommend the irrigation of the uterine cavity prior to the beginning of the removal of the afterbirth. We would not use, for this purpose, a powerful disinfectant, which would tend to cause abnormal expulsive efforts, but would use instead soft warm water, with a small amount of disinfectant, like 144% carbolic acid, which, we find, tends to soothe rather than irritate the diseased uterus. If the uterus is too feeble to cause the expulsion of this liquid, and it is not accomplished by the abdominal walls, it should be siphoned out. For making the injections we prefer to use a rubber tube,, especially the pure gum horse stomach tube, which, to our mind, makes an ideal apparatus for the irrigation of the uterine cavity. To thedistal end of this, we may attach either an aseptible enema pump orafunnel. The funnel is cheaper, lighter to carry, and is highly efficient. If the operation of the manual removal cannot be carried to completion, or cannot be performed without injury to the cotyle- dons or causing hemorrhage, it should not, for the time being, be persisted in. 51 802 Veterinary Obstetrics The membranes should not be divided, but should be removed completely or left together attached to the uterus. One important element in the normal detachment of the membranes is the weight and volume of the chorion and umbilic cord. If the principal volume and weight of these is removed, the tendency for the Chorion—— Hy i} Fic. 139. PLACENTAL TUFTS FROM THE CHORION OF THE Cow. (Pomayer. ) remnant to continue to be retained is intensified. If the main body of the chorion is torn away, and the placental tufts remain imbedded in the cotyledons, the incarcerated portions lose the in- fluence of traction, which is so necessary to their eventual re- Retained Placenta in the Cow 803 moval. It isthe dead and putrefying placental tufts im- prisoned in the cotyledons, and not the other portions of the chorion, which constitute the element of danger in the disease. If we cannot remove these tissues, which con- stitute the fundamental danger in retained placenta, then we should not, under any conditions, remove those harm- less portions, which may later serve a highly necessary and useful purpose in withdrawing the imprisoned placental tufts. 2. Expectant Handling. When it is impracticable to manu- ally remove the entire mass of the chorion, including the tufts, the afterbirth should be allowed to remain in the uterine cavity with the detached portions hanging from the vulva. The at- tending veterinarian should attempt to control and alleviate the infection in the organ, and to retard, as far as possible, the putrid decomposition of the retained membranes by irrigating the uterine cavity with warm water, to which he may add a small amount of disinfectant, being careful not to use sufficient to cause any irri- tation of the uterus. One may use from %{ to %% carbolicacid, or an equal amount of lysol. If the animal does not throw out the injected liquid, along with the accumulated discharges in the uterine cavity, it should be siphoned out by means of a tube. It is wrong to leave this fluid in the uterine cavity, where it can work no good. We cannot disinfect the diseased tissues, because any disinfectant sufficiently powerfnl to pass into the tissues and destroy the micro-organisms must destroy the tissues before the micro-organisms are reached. It is of great use, how- ever, to remove from the uterine cavity the accumulated disease discharges or bacterial products. The washing should be re- peated at least once a day, and should be continued each time until the fluid, when expelled or siphoned out, is comparatively clear and free from odor. When this has been siphoned out, there should be deposited within the uterus some antiseptic which will tend to obviate any increase of the infection, without in- ducing any marked irritation of the diseased organ. In our judgment, the most reliable drug for this purpose is iodoform, which may be introduced into the uterine cavity in the powdered form, enclosed in a gelatine capsule, which the operator may leave to dissolve or may open and scatter the powder about in the various parts of the uterus. This plan has been carried out by 804 Veterinary Obstetrics us, and some of our colleagues, with very satisfactory results. Possibly other antiseptics, such as powdered boric acid, would prove of similar value, introduced in the same manner. The patient should be examined daily. If it is found that the inflammation in the cotyledons has abated, so that the chorion may be effectively detached, the manual removal of the membranes should be proceeded with. If they are still firmly held, the treat- ment should be repeated, and so, day by day, the case should be carefully watched, until finally it is possible to remove the chorion complete, including all the placental tufts. 3. Removalofthe Cotyledons. The preceding plans may fail and the disease proceed rapidly to the necrosis of the cotyledons. Sometimes this necrosis is very acute, and calls for prompt recog- nition and handling. We observed especially, in one case, where apparently infection had been carried into the uterine cavity by the operator, while overcoming dystokia, that placental gangrene was well established in about 24 hours. The cotyledons were enormously enlarged, very firm and tense. They were about four times their normal volume. The fetal placente could not be de- tached from the cotyledons, but it was found that the cotyledons themselves were very easily detached from the uterus, and this was not followed by hemorrhage or by any apparent pain. The cotyledons were, one after another, detached and with- drawn, with the chorion still firmly attached to them. No mate- rial hemorrhage followed. The uterus was immediately irrigated with warm water, to which about 4 % of carbolic acid had been added. ‘The cow, which had previously shown all the cardinal symptoms of septicaemia, accompanied by a very high tempera- ture, improved immediately after the operation, and within 24 hours her temperature, appetite, and general cendition were normal. She made an uneventful recovery, and in due time again became pregnant. In other cases of retained placenta in the cow, we have fre- quently found many or all of the cotyledons lying free within the uterine cavity, still attached to the chorion, Sometimes we have been able to distinguish these enlarged necrotic cotyledons when they were almost ready to drop off, and have removed them with good results. In one case, in a valuable cow which had been neglected, we found the os uteri rather firmly closed. In the uterine cavity lay the entire chorion, with the cotyledons still Retained Placenta in the Cow 805 firmly attached to it, but sloughed away from the uterine walls. The removal of the cotyledons and chorion, with irrigation of the uterus, was followed by uneventful recovery, without destroying the fertility of the cow. Because of these experiences with necrosis of the cotyledons, we hold in all those cases where the uterine walls are compara- tively sound and the cotyledons have undergone necrosis, that the veterinarian is not only warranted in removing them, but that their removal is clearly indicated as the proper surgical procedure. Such removal of the cotyledons in the cow is‘somewhat anal- ogous to the curetting of the placenta in woman. It produces, in proper cases, the same results. It removes the decaying frag- ments of the fetal membranes and the irrecoverably diseased maternal placenta. While thedecomposing chorionic tufts are incarcerated within the crypts of the cotyledons, and the cotyledons are yet alive but diseased, the diseased surface, from which bacterial poisons may be absorbed, is the superficial area of the mucosa of all the pla- cental crypts. When the cotyledou has been removed, the re- ceptive surface is reduced to the area of the cross section of the cotyledonal stalk—probably less than roooth part of the area of the placental epithelium. The collateral handling will vary greatly, according to cir- cumstances. Ifthe patient is not seriously depressed, if she is not straining abnormally, if her temperature and appetite are good, there is no call for general medication. When there are evi- dences of serious constitutional disturbances, such as fever and weakness, the patient should be supported and strengthened by easily-digested, nutritive foods, if she will take them, to which may be added stimulants and tonics. Alcohol is especially use- ful, and may be given in large and frequent doses. When symp- toms of septicaemia appear, it has been our practice to administer large doses of quinine, and in our experience the results have been good. Some have practiced and advised the administration of ecbolics such as ergot, savin and rue, but this is opposed by many and the clinical evidence of the value of this group of drugs is not clear. 806 Veterinary Obstetrics Others, and with more reason, advise and use carminatives and aromatics internally, such as anise seed, fenugrec, gentian, and camomile, or the gum-resins like camphor and others. They are probably of distinct value as adjuncts to the local handling, In many cases, great good may come from prompt catharsis, and for this purpose we prefer one of the hypodermic cathartics, such as eserine or arecoline. Owing to the feebleness of the heart, we would administer it in small and repeated doses, com- bined with strychnine, and continue it until the desired evacua- tion of the bowels has been brought about. This in itself fre- quently causes a great reduction of the temperature, and marked improvement of the general symptoms. The food should be easily digestible. Such highly nutritious food as linseed meal serves an excellent purpose, while roots are also valuable, because of their keeping the bowels more or less freely open. The prevention of retained afterbirth in the cow is an im- portant problem, which offers hope for success in numerous cases. It is highly important, from the standpoint of prevention, that, in all cases of dystokia attended by a veterinarian, the after- birth should be removed, if possible, immediately after the re- moval of the fetus, followed by irrigation of the uterus, bringing about its firm contraction. Itis also important that the owners of pregnant animals should keep them in vigorous condition, allowing plenty of exercise, air and light, with an abundance of good digestible food, for some weeks at least prior to parturition. A very important element in the prevention of retained pla- centa, and for which the veterinarian is directly responsible, is the question of handling in cases of dystokia. In discussing the general handling of dystokia on page 620, we have already em- phasized the value of aseptic precautions in all these operations. It is well to repeat here the duty of the veterinarian to take every possible precaution against carrying infection into the uterine cavity while he is dealing with a case of dystokia. To this end, he needs to follow out carefully the rules which we have already laid down regarding sterilization or disinfection of his clothing, his hands and arms, his instruments, and the exposed parts of the patient. As soon as fears of placental retention are entertained, the veterinarian can, and should, do much to obviate the disease. Retained Placenta in the Cow 807 Copious irrigation of the uterine cavity, within a few hours after calving, washes away placental debris, fetal fluids and retained blood clots, stimulates uterine involution, and greatly favors the spontaneous expulsion of the membranes. The irrigating fluid should be at least as warm as the uterine cavity, but not of appreciably higher temperature, and should be of soft water or softened by the addition of soda bi-carbonate, to which may be added 0.6% of salt. The irrigation should be begun as early as convenient after calving, and may be repeated every 4 to 6 hours. The irriga- tion is to be carried out under antiseptic precautions, and very gently. When the horse stomach tube we have advised is used for irrigation, the properly lubricated end can be pushed forward gently, and with some rotary motion, through the vagina and into the uterine cavity, usually without inserting the hand, thus avoiding the manual introduction of infection. The tube is rigid enough to be reasonably subject to external direction, and pliable enough to obviate any danger of wounding the genital tract. The prognosis of retained placenta is exceedingly variable, but must always be cautious. Whenever the afterbirth can be completely removed manually within 24-48 hours after calving, the prognosis is highly favorable. It must, however, depend upon the state of the uterus itself, and upon the general vigor of the animal. If the uterus is highly inflamed and paretic, the out- look is always serious. In our experience, the most serious cases have usually been those where some party has unsuccessfully attempted to remove the membranes, and has merely succeeded in tearing away the major portion of the chorion, leaving many of the fetal placentz still firmly attached to the cotyledons, and naturally leaving many of the cotyledons themselves more or less seriously injured. When this has been done, and severe straining follows, accom- panied by a high temperature and loss of appetite, we have found the disease highly fatal. On the other hand, the uterine walis may be very intensely inflamed, firm, paretic, and yet recovery occur. Pomayer has emphasized the value, in this disease, of the degree of leucocytosis in the uterine walls. It is, he says, the number of leucocytes which exist in the uterine walls, or 808 Veterinary Obstetrics which may be attracted to them, which brings about recovery. If the infection of the cotyledons and of the uterine walls is of such a character as to destroy the leucocytes, recovery cannot occur. 2, RETAINED PLACENTA IN THE MARE. Retention of the placenta is much less frequent in the mare than in the cow. Clinically, retention of the placenta in the mare is divisible into two separate forms, total and fragmentary. Total retention of the fetal membranes in the mare corre- sponds in a measure to the disease in the cow. It is, however, very rare, not only as related to placental retention in other ani- mals, but also as compared with the fragmental retention in this animal. The rarity of placental retention in the mare is explained upon various hypotheses. Most significant, perhaps, is the compara- tive simplicity of the chorionic tufts, so that any swelling of the uterine mucosa does not tend materially to incarcerate them and hold the chorion. It bears another important difference when compared with ruminants ; the placenta is diffuse. The chorion is thick, rigid, not readily compressible. When involution of the uterus occurs, the area of attachment in the uterine mucosa rapidly decreases, while the opposing chorionic attachments are not subject to like diminution in area and are consequently de- tached. The placentee of sheep and goats are essentially as intri- ate as those of the cow, and are upon the same general plan, but retention of the fetal membranes in these is very rare as com- pared with the cow. According to our observations also the dis- ease is less common in the ewe than in the mare. Hence the arrangement of the placental structures does not wholly control the probability of retention. The causes of total placental retentiou in the mare are analo- gous to those already mentioned in the cow, such as placentitis as an accompaniment of contagious abortion, and fatigue of the uterine walls during difficult labor, followed by infection. The symptoms of total placental retention in the mare usu- ally consist merely of the visible protrusion from the vulva of the umbilic cord and portions of the chorion. There is rarely any straining. If neglected, and infection occurs, asit does very quickly, a diffuse endometritis quickly follows, the chorion usu- Retained Placenta in the Mare 809 ally sloughs away, the uterine walls become paretic, voluminous excretions into the uterine cavity occur, and the cavity of the organ is soon occupied by two to five or more gallons of a dirty grayish, flocculent, stinking semi-fluid mass. Following closely upon these changes, perhaps even noted first, parturient lamini- tis occurs. The handling of total retained placenta in the mare consists of the manual removal, and should be undertaken at the earliest convenient time subsequent to parturition. In cases of dystokia, the veterinarian should remove the membranes as soon after de- livery has been completed as possible, allowing merely a few minutes for the animal to recover from her exhaustion. In removing the afterbirth of the mare it is to be remembered that ordinarily the chorion comes away everted, but when we desire to remove it artificially it should be done right side out. First the veterinarian needs locate the margins of the rupture in the chorion through which the fetus has been expelled. Neces- sarily this margin is detached for some distance from the torn border. Secure the torn border and carefully draw it out through the vulva. Insert the open hand or clenched fist between the chorion and uterine wall, and, while exerting enough traction upon the ruptured margins to keep the chorion tense, gently and cau- tiously push the hand along between the chorion and uterine wall. The process should be carried out almost equally around the entire circumference of the uterus, and the chorion gradually detached until the coruna are reached and included. In many cases of retention in the mare, it is not actually needful to insert the hand into the uterus. If the protruding chorion be carefully grasped, folds of it picked up first here and then there, and gentle traction exerted upon each area by turn, it will soon be found that drawing upon a given part of the chorionic sac causes dehiscence of the placenta and distinct advance is made. Section after section is cautiously tested, and gradually the entire chorion comes away with the placental side outward. If there has been no infection, if the operator has not inserted _ his hand, nothing further is demanded. If there is infection in the uterusor if the operator has inserted his hand, the uterus should be well irrigated with tepid water to which 0.5% carbolic acid may be added. This should be repeated as frequently as conditions démand. 810 Veterinary Obstetrics Fragmentary placental retention isin a way peculiar to the mare. It consists in the accidental transverse rupture of the chorion of the non-gravid cornu, followed by the chorionic mass from the gravid cornu and uterine body coming away, and leav- ing behind the small isolated fragment in the non-gravid horn. This fragment is usually 8 to 12 inches in length, and its lumen sufficiently large to admit of the insertion of a man’s hand into its cavity. The cause of this retention is not far to seek. The chorionic mass of the mare is very heavy, and she usually stands while the membranes are being expelled. The non-gravid cornu is last to expel its membranes, so that, before the chorion in the non-gravid cornu becomes detached, it must support the weight of the re- mainder of the membranous mass. At thistime the greater mass of the chorion hangs outside the vulva, and the umbilic cord drags upon the ground, where it may be stepped upon and the attached area of chorion torn off. Possibly the cord is still intact and the foal, in trying to rise, may partly do so and fall, giving a violent pull upon the cord, which is promptly transmitted to the still attached strip of chorion in the non-gravid cornu, and causes it to give way. Once this fragment becomes separated, the narrow horn has little or no expulsive power and the mechanical assistance ordi- narily afforded through the weight of the other portions of the chorion is wanting. , Infection of the isolated fragment quickly follows. In two to five days the chorionic fragment has become well decomposed, the uterine wall has become inflamed, the abdomen is very tender upon pressure, the infection has spread throughout the uterus (purulent endometritis), extensive purulent col- lections have occurred in the uterine cavity, the uterine walls are thick, hard and paretic, and parturient laminitis is present. : At about this time, if the veterinarian will carefully explore the uterine cavity he will be able to recognize by touch the re- tained segment of chorion, somewhat loosened and readily de- tached, putrid, fragile and extremely fetid. He will not always find the piece as it may have sloughed away and passed out. In one such case, as we approached the recumbent patient, she sud- denly sprang to her feet. As she ‘did so, there came a gush of pus from the vulva, in which was the tell-tale fragment of chorion. Retained Placenta in Small Animals 8II The handling consists fundamentally of a careful search for, and removal of, the retained chorionic fragment, followed by the proper handling of the resulting endometritis and laminitis. These we shall discuss later. This type of retention is subject to preventive measures. The veterinarian, when attending a mare in labor, or removing the fetal membranes when completely retained, should always carefully note whether the two horns of the chorion are complete. If not, the missing apex should at once be removed and the uterine cavity well irrigated. 3. RETAINED PLACENTA IN THE SMALLER ANIMALS. The smaller domestic animals do not suffer so frequently from retained placenta as do the cow and mare. The ewe and goat with cotyledonal placenta suffer occasionally. The sow and car- nivora suffer but rarely from retention. De Bruin records teta- nus infection in the ewe as a result of placental retention. Gen- erally the disease in the ewe has about the same danger as in the cow. The sow withstands the disease well. The handling is somewhat similar to that in the cow. If the genital canal is large enough to admit of the insertion of the operator’s hand, manual removal may be carried out as in the cow. Otherwise the uterine cavity is to be irrigated with warm normal salt solution, thus mechanically cleansing the organ, stimulating normal involution of the uterus and increasing pre- sumably the number of leucocytes in the uterine walls. De Bruin condemns the use of antiseptics in these cases. Should chronic metritis, with chronic vaginal discharge or with vaginal prolapse, follow, hysterectomy, page 669, may be indicated in the sow and carnivora. II. WOUNDS AND INJURIES TO THE GENITAL AND NEIGHBORING ORGANS. Post-PARTUM HEMORRHAGE. Post-partum hemorrhage is comparatively rare in domestic animals, and occurs chiefly in the larger species. In woman hemorrhage following childbirth is very common as a result of the highly developed and vascular placenta, but in domestic animals, in which there are generally more or less diffuse pla- centze of the disseminated or cotyledonous form, the conditions are such that we rarely observe spontaneous placental hemorrhage. In fact we have no definite records to show that serious placental hemorrhage proper, occurs in animals, although slight hemor- rhage from the placenta is quite commonly observed in the mare and cow, and to a lesser degree in other domestic animals. The hemorrhages which occur during or immediately subse- quent to parturition in domestic animals are generally due to traumatic injury which is more or less independent of the pla- centa, although it may naturally involve that structure. We have already had occasion to mention, on page 457, that in rare instances uterine hemorrhage occurs during gestation and may with extreme rarity prove serious. During the act of giving birth to young, serious and fatal hemorrhage is not exceedingly rare, especially in the mare, asa result of a rupture of the uterine walls involving some of the great vessels of the organ. Necessarily in the mare it involves in the lesion the placenta itself, since this is distributed over the entireorgan. After the expulsion of the fetus, whether in the mare or the cow, there frequently follows’ immediately a considerable discharge of blood, which may be placental in origin, but which is more probably due to the rupture of uterine vessels of con- siderable size. The point of origin and the exact character of such a hemorrhage is very rarely determined. After the fetus has been expelled, the rude removal of the fetal membranes by laymen or empirics frequently induces profuse hemorrhage, which may even end fatally. In the mare, if the chorion is very firmly adherent to the uterus and violence is used to bring about separation, the mucosa may be wounded to such a degree as to cause profuse hemorrhage. In some cases of re- Wounds and Injuries to the Genital Organs 813 tention it is impracticable to separate the envelopes at once be- cause of hemorrhage due to the uterine injuries. In the cow, when the placenta is retained and involution of the uterus has not yet occurred, and the layman or empiric attempts to de- tach the membrane, profuse and fatal hemorrhage is liable to result, which is greatly accentuated when the cotyledons are rudely torn away from the uterus. In one instance observed by us, anempiric attempted to remove the membranes from a cow immediately after calving, and, by tearing them away, brought on a hemorrhage which proved fatal to the patient in the course of a few hours. When we were called, the entire uterine cavity was filled with a great mass of blood; much blood had already escaped from the vulva ; the cow was down, and unable to rise ; the mucous membranes were blanched ; the animal was pulseless, and in a dying condition. In the mare we have observed fatal hemorrhage as a result of ruptures during difficult labor. Hemorrhage from the uterus occurs also in cases of pro- lapse or inversion, and usually of two types. There may be a general capillary hemorrhage from the entire mucous surface, or rather from the placental surfaces of the uterus, and there may also occur hemorrhage from wounds of the uterine walls or placentz involving large vessels. Symptoms. Generally there isan escape of blood from the vulva. The blood may, however, be largely retained within the uterus, and coagulate promptly. In case of rupture of the uterine walls, and especially of the uterine floor, when involving large vessels, a profuse and even fatal hemorrhage may occur into the peritoneal cavity, without any appreciable amount of blood escaping from the vulva. In these instauces of intra-uterine or intra-peritoneal hemorrhage, the symptoms, in general, are those of internal hemorrhage, such as the blanching of the mucous membranes, weakness of the animal, pain, anxiety and sweating. Death frequently follows quickly. The diagnosis must be made by these symptoms, in conjunction with a manual exploration of the uterine cavity. The indications in uterine hemmorrhage will depend largely upon the cause and origin. When due to extensive wounds of the uterine walls, involving the large vessels, and the uterus is in position, it is well-nigh beyond the obstetrist’s control, though 814 Veterinary Obstetrics it might be possible in some cases to secure the wounded vessel if it could be identified. Inthe milder forms of hemorrhage, where the quantity of blood is not great, it may not be necessary or even advisable to interfere, especially if the uterine cavity is in an aseptic condition. When the hemorrhage is dependent upon awant of involution, contraction should be encouraged by such means as we have at command. : If the organ is intact, we may hasten involution by the injec- tion into it of a tepid solution of an antiseptic or a normal salt solution, or we may attempt to favor involution by the ad- ministration of ergot or of stimulants. It may be also that the involution can be hastened in some cases by the introduction of cold water or of ice into the uterine cavity, and at the same time the hemorrhage somewhat checked by the cold. In hemorrhage from the prolapsed uterus, we can not hope to check that of a capillary character except by the reposition of the organ; while that from any torn vessels of importance can be readily controlled with the aid of forceps or by ligation or other means in common use. Digital compression, applied for some time, may bring success. When a quantity of blood has accumulated in the uterus and coagulated, it should be promptly removed and means applied to cause uterine involution. 2. RUPTURE OF THE UTERUS AND VAGINA. In all domestic animals, rupture of the uterus or vagina is liable to occur at any time during labor, and especially toward the close of the act, as the fetus is being forced along the genital passages. The organs are again subject to rupture because of their prolapse or eversion of the organs. The accident occurs in a great variety of ways. Frequently it occurs through the projection of some part or extremity of the fetus in an improper direction, so that it is forced through the wall of the organ because of a concentration of pressure upon a small area. Ruptures from this cause naturally occur most fre- quently in the mare and cow, where the fetus has long and rigid extremities, which are capable of inducing great injury when they become misdirected. In transverse presentations in the mare, when version is at- tempted without embryotomy, there is always danger of an Rupture of the Uterus and Vagina 815 extremity becoming so misdirected that, during the expulsive efforts of the mother, it may be forced through the uterine wall and bring about a perforating wound of the peritoneal cavity. In the anterior presentation, with the two posterior limbs ex- tended beneath the body of the fetus and lodged just in front of the pubic brim upon the uterine floor, the forcing of the fetus into the passage brings about a great concentration of pressure upon the uterine floor by the feet. The croup and thighs are rigidly and firmly pressed against the sacrum and lumbar verte- bree, while the extended limbs are forced, under enormous pres- sure, downward and forward against the floor of the uterus. Such pressure is constantly liable to cause the toes of the fetus to force their way through the uterine floor. When the fetus presents anteriorly in the dorso-sacral position, with a foot crossed over the head, or a foot misdirected upward from other causes, the misplaced extremity tends constantly to push upward and force its way through the roof of the vagina. So with other misdirections of the anterior or posterior ex- tremities. In the bicornual development of the fetus, as already described on page 716, extensive and fatal rupture of the uterus is very liable to occur when traction is applied in order to bring about delivery. In torsion of the uterus, as already related on page 704, trans- verse rupture is acommon result of the displacement, and follows regularly when the torsion has acquired an extreme degree. A further and not rare cause of uterine rupture is the attempt of the veterinarian to force a fetus through a constricted passage, or a fetus which is too large or presents improperly through a normal passage. In discussing the question of atresia or indu- ration of the cervex uteri, we related an experience in which, in a heifer, we attempted to force the fetus, normal in size and posi- tion, through a very narrow cervical canal, with the result that we ruptured the cervix for its entire length. Another, and highly important, way by which rupture of the uterus may be caused during traction consists in tearing and rupturing the walls of the organ by forcing it against some pro- jecting portion of the pelvis, as already described on page 676. We meet occasionally in the mare and cow with projections or eminences upon the pelvic inlet, which assume such a form that, if 816 Veterinary Obstetrics the uterine wall is forced against them, it is liable to become seri- ously injured or even punctured. Insome instances there occurs, first, severe maiming or contusion of the organ, of such a char- acter that its vitality is destroyed over a small area, the devi- talized area becomes infected, and eventually a small slough takes place, which establishes a communication between the uterine and peritoneal cavities. In other cases, when forced extraction is attempted with a fetus in an improper position, such as a deviation of the head, the uterine wall may be caught by some projecting portion of the fetus, and dragged along in such a way that it doubles upon itself and thus tends to bring about its rupture. Of all the ruptures of the uterus, the most embarrassing and unfortunate are those which are brought about by improper manipulation or accident upon the part of the obstetrist himself or through the meddling of laymen or empirics. In discussing the general subject of obstetric work upon page 623, we have already suggested that it is to the professional and legal interests . of the veterinary obstetrist to examine very carefully each case of dystokia to which he is called, and determine whether or not the animal has been subjected to injurious meddling before his arrival, and discover, if possible, any important injuries which may have taken place, before he attempts to handle the case. Again, in discussing the method or plan for overcoming dys- tokia or accomplishing obstetric work, we have urged on page 630 that the veterinarian should always use care and judgment and that he should especially husband his strength to conserve his efficiency. In one instance, in our own practice, we had labored long and ineffectively to correct a lateral deviation of the head, in a case of wry-neck, when we should at once have re- sorted to embryotomy. Finally, after becoming exhausted, we made an attempt to secure the head by means of a long, blunt hook, and in our exhausted condition failed to properly control the direction of the instrument, caught it in the uterine wall and tore a large opening, which at once demanded the destruction of the patient. Sometimes, in cases of prolapse of the uterus, the animal gets the prolapsed organ caught upon obstacles of various kinds and, dragging upon it, brings about a more or less serious rupture. It is not very rare for the prolapsed uterus to be torn and lace- x Rupture of the Uterus and Vagina 817 rated by other animals. Especially is this true of the cow when she suffers from eversion of the uterus in an enclosure where swine can get to her, as these animals at once pounce upon the prolapsed organ and begin to devour it, if itis within reach. In one case cited by Fleming, almost the entire organ had been de- voured. Just as the condition was discovered the cow got up, and the remnant of the organ suddenly returned to its place. The animal recovered. : At the normal time for parturition, or when abortion occurs, the uterus may become ruptured from emphysema of the fetus, or rupture may follow dropsy of the amnion. The symptoms of rupture of the uterus are perfectly obvious in the prolapsed organ. When the organ in its normal position becomes ruptured, the symptoms will vary according to the posi- tion and extent of the rupture, the degree of hemorrhage, and the character and volume of substances which may escape from the uterine, into the peritonealcavity. If the rupture is very exten- sive, and a large amount of liquids, especially if infected, escape into the peritoneal cavity, there is at once a profound collapse, under which the animal is liable to die very suddenly. If the rupture is extensive, and immediately after the extraction of the fetus the veterinarian is so unfortunate as to inject into the uterine cavity a large volume of antiseptics for the purpose of irrigating the organ, and these escape instead into the peritoneal cavity, the collapse is sudden and death may ensue in the course of an hour or two. When the rupture involves the division of voluminous blood vessels, the chief symptoms may be due to the hemorrhage, as already described in the preceding chapter. If the rupture oc- curs in the roof of the organ, or so high along the sides that it does not cause the escape of large volumes of liquids into the peritoneal cavity, there may be no symptoms presented at first, and it may pass undiscovered except through the medium of manual exploration. Later, infection may gain admission into the peritoneal cavity, through the rupture, and bring about a septic peritonitis, with all the symptoms of that disease. When the rupture is very small and amounts to a mere perfo- ration, or when a small area of the organ is so contused that it looses its vitality to later become necrotic, and the peritoneal cavity becomes secondarily opened, the definite symptoms, septic 52 818 Veterinary Obstetrics peritonitis and its accompaniments, are slow to become estab- lished. It may be several days after parturition before they be- come apparent, and the definite diagnosis may be made only upon post-mortem examination. In one instance occurring in our clinic, the owner of a mare had inhumanly drawn away a foal while the head was com- pletely deviated to the side; and, in doing so, had caused a com- plete rupture of the perineum. -When the mare was presented at our clinic because of this injury, the afterbirth was still re- tained. This was removed, and the ruptured perineum was reg- ularly cleansed and disinfected. Although we had examined the uterus carefully, we had failed to find any injury of its walls, and concluded that we had only to deal with the retained placenta and the ruptured perineum, but we were in error. The mare perished three days after entrance into our clinic, under symptoms of septic peritonitis. Upon post-mortem examination there was revealed a small rupture of the uterus along the floor, just anterior to the pubic brim and located upon the median line. The opening was barely sufficient to admit the passage of a pen- cil; its edges were necrotic ; and it could not be determined from its appearance whether the rupture had been direct or complete at the time of the dystokia or whether it had first consisted of a contusion, which had been later followed by gangrene and a sloughing of the uterine floor. Most probably it had at first con- sisted of a contusion, the result of impingement of a uterine fold between the fetus and a bony prominence of the maternal pelvis, during the inhuman forced extraction. In another instance occuring in our clinic, some stablemen had delivered a cow without any antiseptic or other reasonable pre- cautions, and the delivery was followed by retention of the pla- centa. Though we removed this carefully and, as we believed, judiciously, the cow exhibited the general symptoms of perito- nitis, to which she succumbed. A post-mortem examination re- vealed a small perforation of the uterine floor, just in front of the pubic brim, in the same position essentially as in the preceding case of the mare. Again it was impossible to determine if the perforation was immediate or secondary. In each case we were criticised be- cause of the death of the patient. These cases suggest the importance of care in examining the Rupture of the Uterus and Vagina 819 uterus in all instances where there has possibly been tampering before the veterinarian has been called, and should clearly im- press the practitioner with the importance of using all due pre- cautions in any manipulations which he undertakes. It must be evident to him that, when he is attempting to adjust a retained foot, he should be very careful not to bring excessive pressure upon this point of danger at the pubic brim, because of the con- stant possibility of causing a small perforation of the uterine floor. We have suggested that, in the extension of a foot which has been retained, the operator should always’ grasp the toe in the palm of his hand, and cause it to glide over the pubic brim without coming in contact with the uterine floor. This point is highly important, not only because it actually facilitates the ope- ration, but also because it affords a highly necessary security against serious or fatal injury to the organ. The handling of rupture of the uterus must be adapted to each individual case. When the uterus is in position, itis rarely possible to close a rupture by means of sutures or otherwise. It. should always be remembered that the involution of the uterus brings about a great decrease in the size of a rupture in its walls. When the organ is prolapsed and ruptured, it is comparatively simple to close the opening by means of sutures under proper aseptic precautions. The sutures should be of silk, and of the intestinal type, that is, the peritoneal surfaces should be brought in contact with each other while the wound margins project into the uterine cavity. Whentherupture is in the roof of the uterus or well up on its side, there is always a possibility of spon- taneous recovery, and every opportunity should be allowed for its occurrence. In all cases of uterine rupture it is clearly inadvisable to inject liquid antiseptics or other fluids into the uterus, and take the risk of their escaping into the peritoneal cavity. If it is essential to remove blood clots, fetal envelopes or disease excretions, this should be accomplished without irrigating the organ. The opera- tor may largely remove these with the hand, which can be used somewhat as a scoop, and the cleansing may be completed by means of a piece of gauze saturated with an antiseptic. Rarely it may be practicable to grasp a ruptured uterus, and by traction, with the patient under general anaesthesia, draw 820 Veterinary Obstetrics the ruptured part out through the vulva, where the injury may be properly sutured. When the ruptured organ is prolapsed, and the rupture is so extensive that recovery is very doubtful, the organ should be am- putated, which operation is described under ‘‘ Eversion of the Uterus.”’ 3. RUPTURE OF THE BLADDER. Rupture of the bladder during parturition is a very rare acci- dent. Fleming cites two cases, one by Furnivall (Veterinarian, Vol. 33, page 377), in which a mare died very quickly after the expulsion of the fetus, and a post-mortem examination revealed nothing pathologic except rupture of the bladder. In the other, recorded by Overed, the mare was not seriously unwell after foal- ing, but it was noted that she urinated more frequently than usual and the act was accompanied by pain. However, she was well enough that she was bred to a stallion on the gth day, and it was only after four weeks had elapsed that Overed was called to ex- amine theanimal. She later died under symptoms of peritonitis, and, upon opening the abdomen, a large quantity of fluid, said to be about 12 gallons, escaped, which was supposed to be urine. Diffuse peritonitis was present, and a rupture existed in the bladder, which communicated with the peritoneal cavity. It was assumed that the fundus of the bladder was injured during parturition, and that it later sloughed throngh. 4. RUPTURE OF INTESTINES. In raré instances, rupture of the intestines may occur during parturition, either because they are over-filled or weakened at the time, or because an intestinal loop becomes engaged between the pelvic inlet and an unyielding portion of the fetus as it ad- vances along the birth canal. Fleming cites Schaack as having observed one instance of a rupture of the intestine by its becoming compressed between the fetus and the pelvic bones. The symptoms of such an injury, especially in the mare, would be those common to rupture of the intestine, and would consist chiefly of collapse, with very feeble or indistinguishable pulse, trembling, and cold sweats. It is well-nigh impossible to make a positive diagnosis of this condition during the life of the ani- mal, and it can merely be suspected from the general symptoms. It is not possible to apply any effective method of treatment. Rupture of the Diaphragm 821 5. RUPTURE OF THE DIAPHRAGM. It has been claimed that rupture of the diaphragm occurs rarely as a complication or accident of parturition, in some cases of dropsy of the amnion or allantois, or from other causes which may induce extraordinary weight or volume of the gravid uterus. The few cases which are recorded are not very significant, and exhibit no definite symptoms by which the accident is to be diagnosed. The diagnosis has been made post-mortem. It is quite possi- ble that some of the cases diagnosed as rupture of the diaphragm asa parturient accident may have been post-mortem lesions, such as frequently occur an hour or two after death. 7, RUPTURE OF THE SACRO-SCIATIC LIGAMENTS. Fleming cites one case of rupture of the sacro-sciatic ligaments in the mare, during the expulsion of the fetus, but the symptoms which he relates are very vague in so far as establishing the character of the alleged injury is concerned. A filly was un- able to rise after parturition, and an examination led the attend- ing veterinarian, Naylor, to conclude that the sacro-sciatic ligament had been ruptured. We fail to see how a rupture of the sacro-sciatic ligaments could prevent an animal from rising or standing, or why the rupture should have caused an extreme atrophy of the muscles of the affected hip, as was recorded in this case. The symptoms recorded point rather to an injury of the gluteal nerves, to which we shall refer later. 8. PROLAPSE OF THE INTESTINE THROUGH THE RUPTURED WALLS OF THE UTERUS OR VAGINA. When a perforating woundor rupture of the walls of the uterus or vagina occurs at any point, it is possible for a protrusion of the intestines to follow. This prolapse, however, does not ordi- narily follow when a wound is made through the walls of the vagina or uterus in the non-pregnant animal. The prolapse is probable only in those cases where there is violent straining, as seen in parturition or immediately following it. In spaying the mare or cow through the vagina, though the veterinarian habitu- ally makes a more or less extensive wound, large enough in the mare to admit the entire hand, there, is virtually no danger of 822 Veterinary Obstetrics the protrusion of the intestine. In uterine or vaginal rupture in difficult parturition, where the intra-abdominal pressure is enor- mously increased by the straining, a portion of the intestine fre- quently passes into the uterus or vagina, and finally beyond the vulva. We have already noted that in some cases a rupture of the uterus is caused by the meddling of empirics, by whom some rude instrument is used, and that through this rupture the in- testines protrude, if the fetus is prevented from escaping. In one instance which we observed, an effort had been made to catch some portion of the fetus by means of a hooked stick, and in so doing a large rent had been caused in the wall of the vagina. The fetus was retained within the uterine cavity because of bad position. The expulsive efforts of the mare forced the floating colon through the rentin the vagina, so that upon my arrival the intestine had protruded beyond the vulva so far that it dragged upon the ground. The indications usually are to at once destroy the patient, since the prognosis must necessarily be extremely bad. ‘The protrusion generally occurs before the expulsion of the fetus, and it then becomes almost impossible to extract the fetus without incidental injury to the intestine and infection of the peritoneal cavity. If it be possible to return the intestines with hope of saving the life of the patient, this should be done, and measures taken to keep the intestines out of the way until the fetus has passed beyond the point of injury. After the fetus has been re- moved, it may in some cases be possible to suture the wound in the uterus or vagina in order to guard against further prolapse and decrease the danger of infection. g. PROLAPSE OF THE BLADDER THROUGH A RUPTURE IN THE FLOOR OF THE VAGINA. When the floor of the vagina becomes ruptured during partu- rition, there is a somewhat remote possibility that the urinary bladder may be forced out through this rupture and extend into the vagina or vulva. Necessarily such a prolapse involves the bending of the organ upon itself to an extent which tends to cause an obstruction to the passage of urine through the ure- thra, and thereby favors an accumulation of urine in the bladder. The accident is an exceedingly rare one, and has occurred only with sufficient frequency to establish the possibility. Prolapse of the Bladder 823 The symptoms consist of the presence of the prolapsed organ in the vagina or vulva, with its fundus turned backward toward the vulvar opening, or protruding through it, according to the degree of distension. The organ is right side out, and shows the peritoneum upon its surface. A careful examination of the floor of the vagina will reveal the presence of a rupture, through which the organ protrudes. In the mare or cow, a further test of the character of the injury may be made by inserting a finger into the urethra and passing it along that canal until it turns upward, to reappear again in the vagina inside the prolapsed organ. The indications in such cases are to return the bladder to its proper position, under aseptic precautions, and suture the wound in the floor of the vagina, bringing the peritoneal surfaces of the vagina in contact. If the bladder should be so greatly distended that it is exceedingly difficult or impossible to return it through the rupture, the urine may be drawn off by passing a small trocar or hypodermic needle into the distended organ and allowing the urine to escape. 10. EVERSION OF THE UTERUS. INVERSION OF THE UTERUS. UTERINE PROLAPSE. Eversion or prolapse of the uterus is a common and formidable obstetric accident, especially liable to occur in cows, chiefly in those which are largely confined in stables for dairying purposes. It is possible in any domestic animal, though not common in the smaller species. The accident consists at first of an invagination of the anterior extremity of a cornu into the succeeding portion, essentially in the same manner as intussusception of an intestine. Should the invagination continue, the invaginated portion finally appears at the vulva, and, passing beyond, constitutes a prolapse or evagina- tion. When the eversion becomes complete, there is necessarily involved withit a prolapse of the vagina as well. In the incom- plete forms, and in the beginning of the displacement, there exists merely an intussusception or invagination of one of the horns to a limited degree, and it is only by the extension of this that the accident becomes complete. In wuniparious animals, only the gravid cornu becomes everted, but the non-gravid cornu is prolapsed along with the everted gravid one, hidden from view and recognizable only as a diverticulum extending inwards. 824 Veterinary Obstetrics In multipara but one horn is usually involved, because its prolapse through the body of the uterus prevents the other horn from becoming everted. Symptoms. ‘The inversion usually begins in one of the cornua, whether in a uniparous or a multiparous animal. When the displacement has proceeded to only a very limited degree, the chief symptom observed is that of expulsive efforts, which differ very little, except in intensity, from those of parturition. There is more or less uneasiness on the part of the animal, with some symptoms of colic, as shown by kicking at the belly and looking toward the side. These, combined with expulsive efforts, should direct attention at once to the uterus. In the larger domestic animals, where the uterus can be readily examined withthe hand, a careful search at this stage will reveal the gravid cornu occluded at some point in its length by a rather hard projection into its canal. Upon examining this projection it will be found that there is an opening in its center, and also that the fingers may be passed around between the tumor and the direct wall of the cornu. A further study of the conditions present will show the obstetrist that he is dealing with a begin- ning inversion of the cornu. If measures are not at once taken to remedy the displacement, the constant tendency is for the intussusception to extend toward and involve the body of the uterus and the vagina, and later ap- pear at the vulva, to soon pass beyond and project as a large bleeding mass. ‘The prolapsed uterus is characteristic in ap- pearance, and should not be mistaken for any other organ. It may still be covered by retained fetal membranes, which should be readily distinguished. In ruminants the cotyledons are very conspicuous, and serve to fully reveal the character of the accident. In the mare the mucous surface of the uterus has a dark red, velvety appearance, and is studded thickly over with the placental villi. To the inexperienced, the appearance of the chorion may cause confusion between this membrane and the mucous surface of the uterus. They are well-nigh identical in their general ap- pearance, and can be distinguished only by a careful examination. Especially is this true when the chorion is being expelled right side out, instead of being everted, as usual, during its expulsion. Eversion of the Uterus 825 In all cases, a careful examination reveals the exact character of the accident, by the fact that the protruding organ is continu- ous with the vulva and vagina. When the eversion is extensive and complete, it forms a characteristic tumor, varying in its ap- pearance somewhat according to species. In the mare and cow it constitutes an immense pear-shaped tumor, which, when the animal is standing, hangs down to the neighborhood of the tarsus. The mucous surface has become external, and capillary hemorrhage occurs upon its surface. Litter and other foreign substances may be adherent to its exterior. If the eversion has existed for a considerable period of time, the organ becomes dark, and occasionally covered with an exu- date, or, if itis of very long standing, with pus. It may be badly torn and abraded, or even gangrenous. The position of the uterus causes an intense mechanical con- gestion and an enormous increase in size. The general symptoms are by no means uniform, and one will occasionally observe a cow, with her uterus quite completely prolapsed, grazing or ruminating almost as though nothing had occurred. In some instances the condition produces such de- bility that the animal is unable to rise ; or perhaps in more cases it might be said that prolapse of the uterus frequently occurs in animals which are so weak that this additional disturbance weakens them to such.a degree that they can no longer rise. In other cases the animal is recumbent because the displacement constitutes one of the symptoms of parturient paresis, and not because of the presence of the prolapsed organ. When gangrene of the organ occurs, the extreme debility and collapse from the septicaemia may bring about a paralysis which prevents the animal from standing. The symptoms may be modified and complicated by the rela- tions of neighboring organs, which tend also to become displaced. The vagina has necessarily been involved in each case of com- plete prolapse, and even the vulva is involved to a degree because of the great weight of the protruding organ dragging upon it, so that in many cases in the mare or cow, if the hand is inserted into the vulva, it can scarcely reach the boundary line of the vagina until it comes in contact with the recurved wall of the prolapsed organ. Naturally the bladder and rectum are more 826 Veternary Obstetrics or less displaced, and tend to be drawn into the pelvic canal, to occupy a position somewhat in the center of that cavity, and the urethra becomes doubled upon itself in such a way as to interfere with the escape of urine, while inside the uterus one or more loops of the intestine may extend down to the fundus of the pro- lapsed organ. We have already referred, on page 816, to the danger of rupture of the prolapsed uterus in various ways. The interference with the circulation in the organ, and the irritation of the atmospheric air, constantly accentuate the ten- dency to congestion and inflammation of the organ, while its denuded surface offers an excellent avenue for the introduction of infection. ‘Thus we may observe uterine prolapse ending in gangrene, abscesses or tetanus. The usual form of infection which supervenes upon this exposure is that of metritis. Flem- ing, citing Funk, records an instance where, in the bitch, the prolapse of one cornu prevented the expulsion of fetuses which still remained in the other horn, necessitating Caesarian section for their removal. The prognosis of prolapse of the uterus is exceedingly vari- able, and must always be highly unfavorable except artificial assistance is given, since there is no possibility of spontaneous reduction. Fleming cites one case in a cow in which the organ was devoured by pigs, after which she recovered. Generally speaking, death is inevitable, unless the case has judicious at- tention. Even then the mortality is high. The rapidity with which death occurs will vary according to circumstances and complications. In ordinary cases the animal may live for several ........ days, while in special instances, as in parturient paresis in the cow, death may ensue within a very few hours, rather because of the paresis than of the prolapse. The prognosis depends very largely upon the promptness with which competent assistance is given. It is always unfavorable in neglected cases, and very much more favorable where prompt attention is given. The prognosis is very greatly influenced by species, being very much more favorable in the cow than in the mare. Flem- ing, citing Deneubourg, states that in an extensive experience he had not lost a case; and the same author cites Moens as hav- ing had 27 cases without a fatality. Other writers have lost Inversion of the Uterus 827 as high as 25 to 30% of cases in the cow. The statistics regard- ing fatalities in this accident are not reliable because, like in too many other instances, there is a tendency for veterinarians to record their successful experiences and remain silent regarding those where the termination has proven fatal. In the mare the accident is highly fatal. Saint-Cyr, from statistics given, re- cords a mortality of 74%, and Zundel of 50%. These figures are probably misleading, due to the fact that the successful and not the fatal cases have been recorded. In our own experience, prolapse of the uterus in the mare has been very rare. One or two instances occurred where the pro- lapse appeared immediately upon the expulsion of the fetus, when the mare was in a dying condition, and where death followed within a few minutes. In only one instance, in the mare, did pro- lapse of the uterus occur in such a way as to call for definite treatment, and this animal survived. She was unable to stand after the reduction of the prolapse, and required slings. Before she had become strong enough to warrant our removing these, tetanus set in, and the slings were retained until she recovered from that disease. Repeatedly after dystokia we have recognized a beginning in- version of the gravid cornu in the mare. Having given it imme- diate attention, we have been able to promptly correct the posi- tion of the organ, and the animal remained well. However we cannot count these as cases of prolapse, but simply as begin- ning cases, in which a certain degree of inversion had occurred. In the cow our experience on the whole has been unfavorable, because we have encountered a number of cases of this accident as a complication of parturient paresis, in which it has proven universally fatal. In other instances the results have been more satisfactory, with recovery in more than 80% of cases. In the smaller animals, inversion of the uterus is highly unfavorable, in so far as replacement is concerned, but they very largely recover after amputation of the organ. The relation of prolapse of the uterus to the breeding of the animal has not been very carefully studied. Asa general rule, if the organ is promptly returned it seems to have little or no in- fluence upon the fecundity of the patient so far as has been ob- served. 828 Veterinary Obstetrics Once the accident has occurred, its recurrence is probable at the next parturition, and when such animals are rebred they should be watched the next time they give birth to young. Causes. Prolapse of the uterus has been attributed to a variety of causes. The accident necessarily demands the presence of a freely dilated os uteri, and consequently occurs very soonafter parturition. It frequently appears immediately after the expulsion of the fetus, in both the cow and the mare. In some instances in the mare, the organ has followed the fetus, and has required immediate replacement. In these instances it seems that the closely investing uterine walls adhere more or less to the fetal body, and tend to be dragged out with it, so that, as the last portion of the fetus escapes from the vulva, the uterus, apparently adherent to it, follows immediately. In other cases in our experience, the foundation for the later prolapse is apparently laid at the time of the act of birth, by the apex of the gravid cornua becoming inverted. We suspect that many of the cases of inversion of the uterus have their foundation in such accident at the time of the expulsion of the fetus, and that, if the uterus were carefully examined at the time, the beginning of what is later to constitute a prolapse would be found, though the prolapse itself may not be complete until after one or moredays. Exhaustion of the contractile powers of the uter- us, and the expulsion of the fetus wholly through contraction of the abdominal walls, or with traction, tend to produce the prolapse. Aside from a derangement in the contractile power of the or- gan, by which a partial intussusception occurs in the gravid cornu, a very prominent cause is tardy involution of the uterus, with failure of the cervix to contract, consequently leaving the organ more or less open and flaccid. A further cause of prolapse of the uterus is the presence of an irritant in the body of the organ, such as infection or retained placenta, each of which may cause expulsive efforts, and at the same time may delay a proper involution of the organ. Closely allied to tardy involution is the question of the com- parative amplitude of the genital passages in the so-called roomy animal, and especially one of a more or less phlegmatic tempera- ment. In this relation we find general influences at work, such as close confinement with overfeeding, which is so often seen in Inversion of the Uterus 829 dairy stables, where the accident is far more common than in the field. In our experience, among cows which are kept for rais- ing beef cattle and constantly run at large, the accident is almost never seen. Anatomical peculiarities exert some influence upon the proba- bility of inversion of the uterus. We have already related, on page 29, that the broad ligaments of the uterus of the cow are attached to the abdominal walls more posteriorly than those of the mare, and hence the uterus is not held so far forward in the peritoneal cavity. When pregnancy occurs, the broad ligaments become greatly amplified, and when parturition occurs these bands are so greatly elongated that the uterus can readily become pro- lapsed, so far as these attachments are concerned, without their becoming ruptured or even very greatly stretched. In spaying the non-pregnant cow we can draw the ovary very nearly to the vulva. From this standpoint, the cow is more liable to prolapse than is the mare. On the other hand, the cervix of the uterus in the cow is more narrow and contracts more promptly than that of the mare, so that, if the contraction takes place normally in each, the mare would be more subject to the accident from this standpoint than the cow. We must constantly recognize, as a contributory cause of pro- lapse, anything which greatly debilitates the animal. Difficult and prolonged labor is so frequently followed by prolapse of the organ that it must be regarded as one of the causes of the acci- dent, although it by no means follows that dystokia should directly cause this displacement. We repeatedly see cases where powerful traction has been employed without inducing any dis- placement of the uterus. On the other hand, we meet with cases.of prolapse of the organ where the parturition has been natural and easy. When the fetal membranes are abnormally retained, and cause irritation and expulsive efforts, they are liable to cause a prolapse of the organ. Eversion is further facilitated by the fact that, in the presence of the membranes, the cervix of the uterus does not undergo its normal constriction. Very naturally, any injudi- cious traction upon retained membranes tends to cause prolapse of the organ. For example, when the chorion of the mare is separated from all parts except the apex of the gravid cornu, severe traction upon the membranesis liable to cause the beginning 830 Veterinary Obstetrics of an inversion of the horn, and the irritation causes a continua- tion of the displacement until the prolapse results. Parturient paresis acts as a distinct and not very rare cause of prolapse of the uterus. Apparently this cause has been over- looked by many veterinary obstetrists. In these instances we have the ordinary symptoms of parturient paresis, such as coma, coupled with a sub-normal temperature, and a general state of unconsciousness in the recumbent animal. In the cases which we have observed, three in all, we could not determine from their history whether the ordinary symptoms of paresis occurred first or the prolapse was the initial symptom. Naturally, when uterine prolapse complicates parturient paresis the animal is found in recumbency, usually lying prone upon her side. This induces tympany, by which the paresis is complicated and the replacement of the prolapsed organ is prevented. Handling. In all cases of dystokia, the obstetrist should ex- amine the uterus after the extraction of the fetus, in order to determine if the organ has assumed its proper position and rela- tions, and especially to determine if any inversion of the organ has begun. If such beginning inversion is present, as has re- peatedly been observed by the writer, the obstetrist should reduce the intussusception at once, by applying pressure upon the ad- vancing portion of the organ, either with the clenched fist or with. the ventral surface of the fingers of the open hand, taking care at all times not to wound or otherwise injure the organ. After the replacement of the organ, unless there are reasons to the con- trary, such asa rupture of the uterus, the obstetrist should inject into the uterine cavity a large volume of normal salt solution or a very weak disinfecting solution, by which means the uterus is cleansed from any irritants which may be present. The expul- sion of the liquids also causes energetic contractions of the mus- cular walls of the organ, which lead to a prompt and normal in- volution, after which the danger from prolapse is usually, if not always, eliminated. The same rules should be applied when the veterinarian is called to attend an animal because of retention of the fetal envelopes, and great care should be taken not to leave the organ partly everted after the removal of the membranes. In these cases, the position of the patient is not highly essen- tial; but it is very desirable that she should be in the standing position, with the hind parts higher than the fore parts. Inversion of the Uterus 831 The handling of complete prolapse or inversion of the uterus offers two different plans—replacement and amputation. The replacement of the organ, and its retention in position, is always the most conservative and desirable, and should be applied in the vast majority of cases, including all those in which it is pos- sible to replace and retain it, and in which the state of the uterus is such that the veterinarian may reasonably hope that it may re- cover from any injury or disease existing at the time of its pro- lapse or acquired as a result of the accident. : For the replacement of the organ it is important that the animal should be placed in the most favorable position pos- sible. In the larger domestic animals, where the prolapse has not existed for a very great period of time, the standing position of the animal is frequently preferred. Whether the animal is standing or lying, it is always to the advantage of the obstetrist that its body should be more or less sharply inclined from be- hind downwards and forwards, so as to throw the weight of the abdominal viscera against the diaphragm and away from the pel- vis, in such a way as to favor a spontaneous reduction of the pro- lapsed organ. When the prolapse is complete, the position of the body of the patient becomes of the very greatest importance. Though many veterinarians prefer to have the animal standing, those who have had extensive experience in very severe and difficult cases are very much inclined to prefer that the animal be placed in the recumbent position, but never in sternal recumbency. If the animal is to be handled in the recumbent position, it is desirable that it be placed upon its side. Some hold that it is even better to place the animal upon her back. The attitude of the patient should be borne in mind, in every case of uterine prolapse, because it modifies the difficulties to be overcome, to a degree which almost surpasses belief. We might well illustrate this fact by an occurrence in our practice, where we had worked long and hard to return the prolapsed organ inacow. We had worked with the patient in the stand- ing position, and several times had progressed far enough that almost the entire organ had been returned through the vulva. Then violent expulsive efforts would come on, and the cow would throw herself to the ground ard undo all our work. When this had occurred several times, and we had worked more than an 832 Veterinary Obstetrics hour, we had once more almost completely returned the organ, when the cow again threw herself violently to the ground. This time, by accident, she fell into an excavation, and lay with her head down hill upon as steep a bank as would permit her to re- tain her position without sliding downward. When we grasped the uterus and again attempted to return it, it fairly fell back into place after one or two minutes of work, and the operation, at which we had worked in vain for an hour or two, was completed. The smaller animals, when suffering from prolapse of the uterus, are regularly to be more or less completely suspended by the hind legs. Where extreme difficulty is encountered in the mare or cow, she too may be partially suspended with ropes and pulleys from a beam. Having secured the animal in a proper position for the return of the organ, or having made the necessary arrangements for placing the patient in the proper position, the obstetrist should proceed to put the organ in proper condition for its return into the normal position. If the placenta remains attached, this should be removed if at all practicable. In this everted state, the operation of the re- moval of the placenta is undertaken under the very best possible conditions, so that it is nearly, if not always, perfectly practi- cable and easy to remove it. It is needless to say that this shouid be done with very great caution, since any abrasions or lacera- tions of the uterus in this prolapsed state tends to produce very profuse hemorrhage. ; In almost all cases of prolapse of the uterus, the organ has be-. come more or less befouled with dirt of various kinds, and espe- cially with manure and bedding, bearing abundant and serious infection, which it is the province of the veterinarian to overcome as far as possible. In order to properly cleanse the uterus, the organ must first be protected from further contamination by being placed upon a clean sheet, tray, or other suitable apparatus. Having pro- vided ample protection, the operator should next proceed to cleanse the organ, chiefly by irrigating it with a tepid saline solution, so as to remove most of the dirt by mechanical wash- ing, without irritating the organ. We may use in this solution a very small quantity of carbolic acid, not to exceed 0.5%. The washing with this solution should be very abundant, and Inversion of the Uterus 833 should be accompanied by gentle.massage, which will tend to overcome the congestion of the organ, thereby decreasing its volume. It should be constantly ‘Gicete in mind by the ancien that. the position of the organ, as related to the body of the patient, affectsits size, and that, if the organ.can be held somewhat above the level of the vulva, or at least as high as that organ, the blood tends to pass back into the body, thus relieving to an appreciable degree the engorgement of the organ, and rendering its. replace- ment more practicable. oe ne if If the uterus has been torn or dbeeted: the wounds should be given proper attention. If.any perforations have occurred in the. organ, they should be: closed by means of sutures, in such a manner that the two peritoneal surfaces of the organ are brought in contact. Should any blood vessels .be wounded, they should be ligated or twisted, or the hemorrhage shouldbe otherwise controlled beforeit is attempted, to return:the organ to its position. In some cases.it may becomé necessary or desirable, before at- tempting replacement, to reduce the volume of the organ by removing a portion of the blood from it... Two plans for decreas- ing the volume of blood in the organ, and thereby lessening its size, have been proposed, «: i The most direct and. radical of these is souvifieation of the mucous surface of the organ. While:some writers upon veterinary obstetrics:recommend this, they do not seem to speak from the standpoint of experience, but rather theoretically. There can be no question but that these scarifications. will reduce the volume of the congested organ, but the safety of the operation does not seem so clear. .Saint-Cyr relates that early in his experience he applied scarification in a case of uterine prolapse in a mare, and she died from bleeding. This would seem to be a very natural consequence.of such an operation. It would be well-nigh im- possible to perform very extensive scarification without injuring vessels of large size, and when this is done in an organ which has become weakened by displacement the control of the hemorrhage would become difficult, if. not.impossible. Aside from the ques- tion of hemorrhage, however, scarification opens up an extensive avenue for the entrance of infection,and the conservative obstetrist would avoid making these wounds. Theextraction of the blood 53 834 Veterinary Obstetrics may not be advisable either, because ifa very large amount escapes, even though it does not result fatally, it tends to seriously weaken the animal. The scarification of the prolapsed organ is inadvisable. A second method of reducing the volume of the organ is by causing the blood to return into the vessels of the body. This may be accomplished by a variety of means. We have already sug- gested that the elevation of the organ above the level of the vulva, accompanied by massage during the cleansing of the organ, tends to distinctly reduce its volume. Others suggest that they get most excellent effects from immersing the organ in cold water, and still others advise the use of ice. While cold may re- duce the volume of the organ more than the application of a tepid solution, it also renders it somewhat more hard and firm, while the tepid solution makes it soft and pliable. Others recommend the application of pressure by means of a bandage, beginning at the fundus of the organ and continuing toward the vulva. The plan suggested below for reducing the prolapse also efficiently reduces the congestion and volume. The reduction or replacement of the uterus is next to be undertaken. We have already suggested that, when the inver- sion is incomplete, and consists merely of an intussesception of the apex of the gravid cornu into the succeeding portion, the operation is very simple and consists merely in placing the clinched fist or open hand against the advancing or central por- tion of the displaced mass, and pushing toward the apex of the horn, causing it to become unfolded and to resume its normal position. When the inversion is complete, and prolapse has occurred, the operation becomes far more complicated and difficult. If possi- ble, there should always be an abundance of help at hand to give any necessary aid to the operator. Fleming suggests that at least four assistants are necessary, but in our experience we have usu- ally succeeded with two or three persons, though admittedly in severe cases it is very much better if more persons are at hand in case of emergency. If the animal can stand, and will do so, and it is practicable to return the organ with the patient in this position, it is not essential to have very many assistants, but even then it is usually convenient to have as many as Fleming suggests. Fleming would place one attendant at the animal’s Inversion of the Uterus 835 head to hold it firmly, and in case of the cow to pinch the nasal septum in order tocontrol the movements of the animal and dimin- ish the straining. One man would stand upon each side of the animal and, with a sheet or other cloth, hold and elevate the or- gan while it is being returned. The fourth man would hold the tail away, and at the same time pinch the back of the cow so as to prevent her straining. Great assistance can be rendered by two to four assistants, in exerting pressure upon the prolapsed uterus. A piece of sterile muslin or other suitable tunicis passed beneath the tumor, and one or two assistants grasp each end as near to the organ as will per- mit the operator to work. They then lift the organ at least as high as the vulva, and press it firmly against the vulvar open- ing, thus tending at the same time to push the prolapse back in- to the vulva and to reduce the congestion and size by forcing the blood back into the body vessels. Different operators suggest different methods for returning the organ. The plan which we have uniformly followed is that of exerting pressure upon the extremity of the prolapsed organ, or as some would say, against its fundus. The pressure is thus made against that part of the organ which first began to evert, so that in replacing it the operator simply reverses the process by which the prolapse took place. In this operation the obstet- rist seeks that point in the gravid cornu where it has ceased to evert, a point which is recognized at the fundus or extremity of the mass, in the center of which there is an excavation or passage representing the apex of the gravid cornu, which has not become everted, but has prolapsed within the everted portion. Placing the clinched fist or open hand against this portion, the operator gradually and carefully pushes his hand forward, toward and into the vulva, as far as he can readily reach. Holding the advanced hand in this position, with the other he grasps the portion of the organ immediately surrounding the inserted arm and holds the uterus, while he withdraws the arm which has been advanced, and prevents the replaced portion from follow- ing his arm out. He now carries the other arm up to and through the vulva, pressing with it a succeeding portion of the prolapsed mass. He continues in this way to pass first one hand and then the other into the mass ofthe organ, and thence through the vulva, carrying with it the distal or ovarian end 836 Veterinary Obstetrics of the cornu, until finally the entire horn and body have been pushed in, and have thus become replaced in the order of the original displacement. It is essential in this operation that great care be taken not to lacerate or abrade the organ with the finger nails, push a pro- jecting finger through the walls of the organ, or otherwise injure it. Throughout the operation the prolapsed organ should be kept soft and pliable by frequent irrigation with warm water or saline solution. mo 4 Some have suggested that, instead of returning the apex of the gravid or everted horn first, the obstetrist should. begin at that part of the organ which is nearest the vulva, and by this means press the uterus back through the vulvar opening. .By this method the assistants hold the organ in the same position as the preceding, and the operator,.acting upon the proximal portion of the prolapsed mass, presses his hands on either side of the tumor, between it and the lips of the.vulva, and thus acts first upon the vagina; then upon..the cervix.and body of the uterus, and finally upon the everted cornu, until the replacement becomes complete. ne bo 4 ee A third method is that of Coquelet, although: it apparently does not merit the designation of being distinct from the two. preceding. It consists essentially of applying a pressure bandage of a peculiar form until the organ is considerably reduced in size, when one of the two preceding methods is applied for replacing the mass. .C takes a clean piece of cloth about one yard in length and 28 to. 30.inches in width, and passes this beneath the prolapsed organ up close to the vulva. Its lowerborder is carried up over the distal end of the.organ, and the ends are then carried up over the sides of the organ, until all are folded together on top of the uterus, completely enveloping it. While tepid water is kept constantly applied to the bandage, it is gradually tightened by: pressing upon the mass underneath and pulling the corners of the bandage tighter and tighter until the desired amount of re- duction has been brought about. The prolapsed organ is then replaced by the method described above, or otherwise. Other methods for reducing the size of the organ, due to some peculiar way of applying a bandage, have been described. After the uterus has been returned through the vulva, it is essential that the operation should immediately be continued Inversion of the Uterus 837 until the replacement is fully completed, since otherwise expul- sive efforts recur and the organ is almost certain to again become everted and prolapsed. When the uterus returns into the vagina, the operator’s hand should follow it and should trace out each part of the cavity. Especially should he clearly distinguish the two cornua of the organ and make a careful search of the gravid horn to see that the invagination of that part has been com- pletely overcome. Asa rule it will be found that some invagi- nation still exists, and this must be overcome by placing the clinched fist or the open hand against the invaginating mass and pushing upon it until the intussusception has been completely overcome. When the complete replacement has been accomplished, it is well to keep the hand in the cavity of the organ for a few min- utes, until straining and uneasiness cease, and the organ has un- dergone some contraction and begins to recover its . tone. Sometimes severe straining continues, with the probability of a recurrence of the prolapse. The most efficient means for overcoming these expulsive efforts is the introduction into the uterine cavity of a large volume of a warm 4% solution of cearbolic acid, which not only completes the replacement but also soothes the organ, washes away any blood clots or extraneous matter, and favors a normal involution of the organ. As soon as the uterine cavity is well filled, the fluid ex- cites expulsive efforts, by which the solution is thrown out, and the contractions aroused in the uterine walls cause each part to become properly replaced. If the straining is very persistent, after the organ has been re- placed as well as possible, and the measures above suggested have been carried out, it may be necessary to resort to the use of narcotics or anaesthetics. Among the various remedies to over- come the straining, we should not forget those which may act locally. The tepid saline solution or the very weak solution of carbolic acid acts as a local soothing agent, and tends to decrease the irritation and overcome the straining. Iodoform also acts well as a local anaesthetic, and at the same time tends to guard against infection of the uterus, and consequently becomes of very great importance in retaining the organ in position. The pow- dered iodoform should be introduced into the uterine cavity in a gelatin capsule, the capsule opened and the powder scattered thoroughly. 838 Veterinary Obstetrics Among the remedies which have a powerful influence in con- trolling the straining, chloral hydrate occupies an important place. It may be administered in a variety of ways; indraught, in enema, orintra-peritoneally. Some obstetrists have advised the use of ether as a general anaesthetic, while others have advised the use of opium as a narcotic. Morphine and opium are not reliable agents, however, in ruminants and solipeds, and may excite rather than soothe. Others advise large doses of alcohol to the point of inducing narcosis, and this we would believe use- ful, even though given only as a stimulant, thus arousing the contractile powers of the organ. In the smaller animals, where the uterus is so small that the hand cannot be introduced, the reposition of the prolapsed organ is rendered difficult and somewhat dangerous, and very frequently fails. To a certain degree, the finger may be used to replace the organ.in small animals, but cannot follow it to assure complete replacement. In order to bring this about, it may be necessary to use a sound, which needs be of large size and well rounded at the end in order to guard against puncture of. the organ. For this purpose a large instrument, like a horse catheter, may be used to push the organ into its position ; or, as Fleming suggests, one might useacandle, properly rounded at one end, for pushing the organ back into its place. If the small animal is suspended by its hind legs, and warm water poured into the vagina through a funnel, the weight of the water, with the position of the patient, tends to complete the replacement of the organ. In most cases when the prolapsed uterus has been promptly reduced and properly replaced, the animal becomes calm and ceases to strain, and a recurrence of the prolapse is not probable. This especially holds true in all cases where the animal can stand. Many obstetrists deem it essential, nevertheless, that some mechanical appliance should be used to prevent a recurrence of the eversion. However advisable this may be, it should not tend in any way to decrease the attention of the obstetrist to the measures: which we have already suggested for bringing about a thorough replacement of the organ in every detail, its proper cleansing and soothing by irrigation, and the stimulation of the uterus to normal involution. When these are done, and thor- oughly done, it is only in a minority of cases that any mechanical appliances are essential for the retention of the organ. Admit- Inversion of the Uterus 839 tedly, however, it is very unfortunate to leave an animal without adequate protection, and permit the recurrence of the prolapse after the obstetrist has left the premises. A variety of appli- ances for the retention of the uterus in position have been de- vised and applied, and are recommended or condemned by this or that veterinary obstetrist, largely according to his personal experience or prejudice. 1, Pessaries have long been used for the purpose of retaining in position a uterus which has once been prolapsed or threatens to become so. They consist essentially of an elongated and rigid shaft, which may be passed through the vulva and vagina into the uterus, and retained there by some form of external bandage or other mechanism, thus preventing the uterus from becoming everted. The uterine end needs be large and smooth in order to avoid possible injury to the uterus. They are constructed of a great variety of materials, and upon different models. The pad pessary is made of a stick of wood 20 or 25 inches in length, with a pad of as large a size as can readily be introduced through the vulva, fixed to the uterine end. This is firmly se- cured to the wooden stem, so that it cannot become dislodged, while through the other end of the shaft a cord is passed by which it can be fastened to a bandage, so that the instrument cannot be forced out of the organ. Others construct a pessary of metal, with a small ring upon the uterine end. This is introduced and retained in the same way as the pad pessary. A rude pessary is sometimes made by attaching a pig’s bladder, filled with water, to a round stick, thus producing an instrument similar to the pad pessary. Others have suggested a rubber bag, attached to a tube to act as the stem of the pessary, and inflated by air forced through the tube into it and retained by means of.a stop-cock. Still others take a large wine or beer bottle, fasten a stick in its mouth, intro- duce the large end of the bottle into the uterus: and retain it there with a bandage. The value of the pessary in veterinary obstetrics is very question- able. It almost inevitably causes discomfort to the patient, and tends to induce expulsive efforts. If for any reason the pessary -becomes disconnected, such as the pad slipping off the end of the shaft, the naked stem is liable to be forced through the uterine wall and cause serious injury. The most formidable objection to 840 Veterinary Obstetrics the pessary is from the standpoint of inducing uterine infection. It exerts a concentrated pressure upon a small area of the organ, which weakens the tissues and renders them more susceptible to infection, while the stalk of the instrument constitutes a high- way from the exterior to the cavity of the organ, along which bacteria may freely pass. It is no longer much used in any country, so far as we can determine, and has never acquired an extensive foothold in American. practice. From the standpoint of efficiency in preventing the recurrence of the prolapse, the pessary naturally occupies.a prominent place, but it seems that the dangers which surround its use tend to couipletely outweigh this one advantage. Sutures in a variety of forms have been recommended by veterinary obstetrists, and are generally preferred to the pessary. The sutures may consist of silk, linen, hemp or other vegetable fiber, or of metal. The metallic sutures may be in the form of wire, or special metal bands may be used. The sutures are usually passed directly through the lips of the vulva, but they may be in- serted through the skin near the point of the hip, thus avoiding the wounding of the vulvar mucosa itself. They must neces- sarily be strong and deeply inserted, in order to afford that amount of security which the obstetrist desires. The number of sutures to be inserted need not be great. Usually a single suture will suffice, if placed sufficiently deep in the vulva, and in no case need there be more than two deep sutures. Veterinary obstetrists are by no means agreed as to the com- parative merits of the sutures placed directly through the vulvar lips and of those passing over the vulva and through the skin of the hips. The former are known as labial sutures, and the latter as hipsutures. Some practitioners claim that the labial suture is painful; that the tissues, being infiltrated and swollen, may readily yield to expulsive efforts, tear out, and the prolapse recur; and that consequently the hip suture is preferable. The latter is applied by lifting up a piece of skin near the tuberosity of the ischium, passing the suture through this fold, carrying it across the vulva to the opposite side, and passing it through another skin fold at a corresponding point. Four to six of these sutures are advised, in sufficiently close proximity to prevent any portion’ of the uterus from passing out between them. Lnversion of the Uterus 841 The efficiency of sutures in preventing a recurrence of prolapse of the uterus is high, but not perfect. In our experience, if the straining of the animal is very violent, the sutures are ineffective and are promptly torn out by the great force applied by the animal. When there is little or no straining, they remain in position, and are effective; at least the prolapse does not recur. Perhaps this is partly because the sutures do not readily permit it, but largely because the animal does not strain. ‘This especially applies to the sutures through the lips of the vulva, which we have seen torn out very promptly, especially in the mare, under violent straining. The labial sutures have the further disad- Fic. 139b. ROPE TRUSS OF RAINARD. (de Bruin.) vantage that they produce wounds in the birth canal at a time when it is highly susceptible to infection, which may readily extend deeper and constitute a menace to the uterus itself. It is claimed that the hip sutures have a much higher efficiency in preventing the prolapse of the organ, and they certainly are highly superior from the standpoint of danger of causing infection to the uterus. ‘The sutures necessarily cause pain, and suture infection inevitably ensues. It must consequently be confessed that sutures, like the pessary, have objections, although not the same in each case. The bandage or truss constitutes a third method for retaining the uterus. These appliances consist essentially of some apparatus 842 Veterinary Obstetrics which can be held firmly against the vulva of the patient, ina way to compress the opening and to offer thereby a more or less effective obstacle against the protrusion of the uterus or vagina. They are made in a great variety of patterns, and of various materials. Usually they are constructed of cord. For this purpose two pieces of cord about % inch in diameter and 12 to 15 feet in length are used. Each is double in the center, and the two are united by a loop in their middle, in a way to leave an oval space somewhat in the form of a ring, which will sur- round and include the vulvar opening, but not completely close it. The two free ends of one of these cords are then passed downward between the hind legs, on either side of the udder, and thence forward to be attached to a collar placed about the neck. ‘The free ends of the other cord are carried upward, one on either side of the tail, and then forward along the back, and secured to the collar at the top of the neck. The cords are then drawn sufficiently tight to exert compression upon the vulva. Such a truss will remain in position better if another cord be passed around the loins, firmly attached to each of the longitudinal cords at the point of crossing, and then tied tightly around the body. Such a cord not only retains the others in position, but when drawn tight about the loins tends to stop straining. A second cord, passed around the chest in a similar manner, further aids in keeping the truss in position. Other forms of the rope truss are suggested in great variety by different obstetrists. Some construct a truss from a band of leather, in which they make openings corresponding approxi- mately to the anus and vulva. The appliance is retained in position in a similar manner to the rope truss. Other obstetrists prefer a metallic loop, through which compression is to be exerted upon the vulva. This apparatus is maintained in position by cords somewhat similar to the rope truss. With most veterinary obstetrists the truss holds first place as a means for retaining the uterus, after it has once been pro- lapsed. Its efficiency is somewhat questionable in so far as its direct influence is concerned. If the cord about the loins is kept quite tight, it may prevent the animal from straining, and consequently tend to obviate the prolapse of the organ. In our experience, if an animal strains severely the truss is wanting Inversion of the Uterus 843 in efficiency, and the prolapsed organ may push it aside and escape. According to our observations, trusses generally become relaxed and loosened when the patient arches her back in order to strain. ~ Should we desire to prevent this relaxation, it is advisable in our judgment to carry the two inferior cords upward and forward over the flanks, and cross them over the loins of the animal, from whence they are to be carried downward and forward along the sides of the chest to pass between the fore-legs, and attached in such a manner that, if the animal arches her back in order to make an expulsive effort, the tension upon these cords is increased rather than decreased. In any event, however, the most important point is to have the truss very carefully adjusted, and then to watch it very closely. The truss cannot prevent the inversion of the organ and its pass- age into the vagina and vulva, but can only tend to prevent its prolapse through the vulvar opening. This is equally true of sutures. While this truss is recommended by one and, that truss by another, the best one always is that one which is best applied. The actual value of the truss is not so great as many suppose, but after all it has an important influence from a senti- mental standpoint, and has none or few of the objections which can be raised against sutures and pessaries. Since the owner of an animal which has suffered from prolapse of the uterus is con- stantly afraid of its recurrence, it is good practice to apply the truss in the majority of cases simply to allay his fears, if it accomplishes nothing else. Should the truss become displaced somewhat, and the prolapse recur, the owner still considers that the veterinarian has at least attempted the retention of the organ. We prefer to show the owner how to apply the truss, should it become necessary, then have him watch the patient and so care for her that the truss will not be needed. We have in mind here the patient which is able to stand. If the patient is recumbent, the case is graver, and retention appar- atus usually imperative. She should be kept with her hind parts elevated and abdominal pressure reduced to a minimum. The handling of prolapse of the uterus, after the organ has been replaced and the precautions against a recurrence taken as sug- gested, demands little except to care for the general well-being of the animal. It is well to bear in mind that any increase of 844 Veterinary Obstetrics the intra-abdominal pressure tends constantly to force the organ backward. This may be largely avoided by unloading the alimentary canal with one of the prompt-acting hypodermic cathartics like eserine and arecoline. The abdomen should be kept somewhat empty, by allowing a.concentrated and laxative diet and avoiding bulky foods. If the weather is suitable, the animal will be more quiet, and will not show the same tendency to strain, if given its freedom in the pasture, where it can constantly move about in search of food. In many cases when the animal seems to be very much irritated and shows a great tendency to straining, if it is led about gently for a time and its attention attracted, the irritation may soon abate. This movement may further tend to bring about a more thorough adjustment of the organ, while it stimu- lates normal circulation and involution of the uterus. It is needless to say that any food which may tend to cause tympany should be carefully avoided, or that constipation should not be permitted to occur. If an animal becomes tympanic, that alone may suffice to bring about the prolapse of the organ, simply as a result of the increased intra-abdominal pressure. When there is reason to fear metritis following proldpse, its avoidance should be attempted by frequent antiseptic irrigations and the liberal application of powered iodoform in the uterine cavity. When metritis follows replacement and retention of the prolapsed organ, it should be handled according to the directions for handling that malady. The truss or sutures may be retained in position for one to three days, according to conditions, or, if straining continues, possibly for even a longer period of time. Amputation of the Uterus. When it becomes impractica- ble or impossible to return the prolapsed uterus or, after reduc- tion, to retain it in position, the question of its amputation arises with a view of saving the life of the patient, minus its power of breeding. ‘The reasons for resorting to amputation of the uterus are chiefly three. 1. The impossibility of bringing about a reposition of the or- gan. In practically all cases of eversion and prolapse of the uterus in large animals, it is possible to return the organ into its former position and retain it in place. It is claimed, however, that cases do occur in which reposition cannot be attained, and Amputation of the Uterus 845 this is especially true in the smallerdomestic animals with very long uterine horns. 2. In some cases of prolapse of the uterus, when the organ has remained extruded for a considerable period of time and has be- come more or less necrotic and seriously infected, its return into its usual position is followed by serious and even fatal conse- quences to the patient. Ifthe uterus has been prolapsed for a few hours only, it is not gangrenous as a rule, because the ever- sion of the organ does not wholly cut off the circulation in it, but only interferes somewhat by doubling the vessels in their course, so that the blood supply may be maintained for a long time, and in some cases almost indefinitely. As soon as the organ hangs down from the vulva in a complete state of prolapse, the inter- ruption to the circulation is important, since in addition to the doubling of the vessels there-is also the impediment of gravity, which causes the organ to become greatly engorged with blood and interferes.in an important manner with its circulation. If the organ has been seriously injured by rough handling during dystokia, has been prolapsed for a number of hours and has been bruised or crushed against the floor or wall, or has fora long time been greatly soiled. by highly infectious manure, gangrene is frequently inevitable, It. isinadvisable to return,such a uterus into position. The condition may cause a recurrence of the pro- lapse, in spite of any precautions to the contrary; or, if the organ is retained in its position, it may undergo gangrene, and cause the death of the animal. 3. Wounds of the uterus of large extent usually call for ampu- tation, especially when complicated with extensive infection of the peritoneal surface. When only a small wound, or even a large one which is moderately clean, occurs, amputation is not necessary. It is by no means essential that the entire uterus should be amputated because a small portion or even half of it has been more or less damaged. It is presumably just as safe to am- putate 4% or % as to amputate all of the organ, and it may at times be of fundamental importance that we should save a portion of it, if by so doing we may retain the power, of breeding. Con- sequently, when a wound is present and we can close it accurately by means of sutures, we have performed: an operation which is quite as safe as the ablation of the organ. The principal ob- jection to this is the fact that some infection will probably 846 Veterinary Obstetrics. occur at the seat of the sutures, which may: readily involve the general surface of the uterus. The prognosis of amputation of the uterus varies in different animals, and under different conditions. In the mare it is usually unsuccessful. In the cow it is a fairly successful operation, if undertaken in due season and carried out with proper care. In the smaller domestic animals it is usually quite success- ful, especially in the sow and carnivora. Technic. Before proceeding with amputation, the entire prolapsed organ is to be carefully cleansed and disinfected, and placed upon a sheet of sterile gauze or other material, where it may be well protected during the operation. As far as possible, the blood accumulated in the organ should be forced back into the circulatory system by compression with the bandage of Coquelet as, described on page 836, or by other means. Great care should also be taken that other viscera are not in- cluded in the operation. The bladder may extend out into the prolapsed organ, and be caught or damaged in the operation. Very frequently a loop of intestine projects out into the peritoneal sac of the prolapsed organ, and numerous instances have oc- curred where veterinarians have carelessly ligated the organ and included the intestine, causing the death of the patient. In order to safely determine whether any viscera extend into the cavity of the prolapsed organ, the veterinarian should incise the uterine wall under aseptic precautions, and insert a finger or his hand into its peritoneal cavity. Amputation is to be carried out by the ligation or suturing of the entire organ. Some operators advise that it be ligated in parts, while others strongly insist that the organ should be ligated in toto. The latter is the usual custom, and probably the best. The material for the ligature may vary according to availability in a given case. One of the best and most satisfactory materials is silk tape, which is soft and very strong, so that it will admit of being drawn very tight. Others use a heavy cord of almost any character, and some veterinary obstetrists advise the use of a moderately thick and strong pure- gum tubing. In the larger domestic animals, the ligature should usually be placed about the cervix of the uterus, near to the external os, while in the smaller multiparious animals, in which: generally Amputation of the Uterus 847 but one horn is involved, it may be placed as close as possible to the point of bifurcation. The ligature must be applied very tightly, and for this purpose powerful traction is required. ‘I‘he ligated portion necessarily becomes sharply plicated, and unless the ligature is drawn very tightly there will be an open avenue for infection to pass through the amputated stump into the peritoneal cavity. Unless very tightly ligated also, the partial disappearance of the engorgement loosens the ligature and per- mits the stump of the organ to slip away. The principle of the application of the ligature should be to apply it so tight that the nutrition of the portion of the stump beyond the ligature shall be completely cut off, so as to cause immediate necrosis and prompt sloughing away. The elastic ligature is highly efficient, because it continues to contract as the tissues of the organ give way, and so tends to continue tight instead of becoming loosened by the yielding’ of thetissues. In applying this ligature, a piece of stout cord should be placed lengthwise upon the uterus, and the ligature applied tightly around the uterus and over the cord. The cord is then tied over the ligature to hold it. The ligature may be passed two or more times around the organ, according to its strength in - comparison to the size of the uterus. When the ligature has been securely applied, the uterus may be cut off at a safe distance beyond it—in the cow usually about 3 to 4 inches. Care should be taken to leave a sufficiently large stump to insure the ligature against slipping when the vagina returus into its position. On the other hand, it is inadvis- able to leave an unnecessary amount of tissue, which must inevi- tably undergo decomposition and consequently prove a danger from the standpoint of infection. The ligature should come away ordinarily after 5 to 10 days, along with the necrotic stump of the uterus. Pending this time, the vagina should be irrigated daily with antiseptics. In the amputation of the organ, the veterinarian should aim, in all cases where practicable, to include the ovaries in order to ob- literate estrum along with the power of breeding. Closing the amputation wound by means of sutures is more surgical, and safer than the ligature. After thorough cleansing of the prolapsed organ, it should be grasped and extended by an assistant. A piece of heavy braided silk, about one yard long, 848 Veterinary Obstetrics should be armed at each end with a heavy straight needle. The suturing should begin at the top, that is, opposite the superior vulvar commissure, and the two needles inserted at approxi- mately opposite points, about %4 in. from the superior border of the organ, each needle emerging at the point where the other entered. By drawing firmly upon the ends of the ligature, the included portion of the uterus is strangulated. The needles are then turned back, and reinserted at a point about % in. farther down, and the process repeated until the inferior wall or floor of the prolapsed organ is reached and included, when the ends of the suture are firmly tied together. In this manner the circula- tion in the organ to be amputated, is aye cut off, and hemorrhage rendered impossible. The uterus may now be excised at. a point 2 or 3 in. . beyond the suture line, but the incision should not be at once completed. The incision may be begun at either end of the suture and ex- tended for a short distance, followed by the application of a second ordinary continuous suture, closing the margins of the new-made wounds. When the suture has: reached the point to which the excision has been carried, the cut may be.extended,, the attachments of the organ serving merely as a means for hold- ing the stump while it is being sutured. The excision could be completed at once, and the stump held with forceps. The same precautions are to be taken in this operation as in ligation, to not wound or include the urinary bladder, intestine, or other viscera. When the operation is completed, and all blood clots have been removed, the stump may be permitted to return into the vagina. Whether amputated by ligature or suture, the vagina should be kept as nearly aseptic or antiseptic as possible during the heal- ing of the wound. It should be irrigated daily and dressed with powdered iodoform. . EVERSION OF THE VAGINA. VAGINAL PROLAPSE. Prolapse or eversion of the vagina may occur in any domestic animal after parturition. We have already dealt with pro- lapse of the vagina, as related to sterility, on page 199, and as occurring during pregnancy, on page 449. The character of prolapse of the vagina after birth, in a large proportion of cases, is essentially different from that seen before or during pregnancy. Prolapse of the vagina consists of the displacement of some por- Eversion of the Vagina 849 tion or the entire circumference of the vaginal wall, backward into or through the vulva. According to some authors, the pro- lapse consists chiefly or wholly of a displacement of the upper or lateral walls of the vagina, but this does not always hold true. In many cases the entire circumference of the vagina is pro- lapsed in‘a way closely anatogous to the eversion of the uterus. Occasionally the vaginal prolapse includes also the prolapse of the vaginal portion of the uterus, exposing to view the os uteri externum. ‘ In other cases we have observed in the mare, cow and bitch the displacement of the floor of the vagina upward and backward until it protrudes through and beyond the vulva and carries along with it the urinary bladder, which becomes turned upon its transverse axis so that its fundus is directed upward and backward instead of downward and forward, to constitute vesico- vaginocele. Prolapse of the vagina occurs chiefly in ruminants, and largely because of anatomical peculiarities. The uterus of the cow is more readily pushed backward than that of any other animal, because its broad ligaments are attached more posteriorly, which permit a ready posterior displacement of the vagina. Prolapse of the vagina in ruminants is further favored by the fact that the organ is not so closely attached by means of the pelvic connective tissue, and especially by the fact that the prolongations of the peritoneum constituting the vesico-vaginal and recto-vaginal excavations extend more posteriorly in these animals than in others, so that a greater part of the vagina is covered with peritoneum, and it is consequently more free to move in any direction. In addition to these causes, the other essential conditfons which tend to determine the prolapse of the organ exist more frequently in ruminants than in other animals. Etiology. Various causes have been assigned to account for prolapse of the vagina. One of the very common and fundamental causes is a relaxation of the parts, which must be attributed partly to the manner in which the animal is kept, very largely to the debilitating influences of long-continued and close con- finement, with high feeding. The disease is far more common in closely-housed dairy cows and in closely-housed ewes than in any other domestic animals. 54 850 Veterinary Obstetrics In addition to these predisposing causes, there may occur in- filtration of the walls of the vagina and surrounding connective tissue, at the time of birth, which causes the vagina to become more readily displaced. The tendency is further heightened by increased intra-abdominal pressure, and especially by increased intra-pelvic pressure. Animals which are highly fed, especially upon bulky food, must inevitably suffer to some degree from the consequences of exalted intra-abdominal pressure, and if we add to this a floor sloping backward, upon which the animal is con- stantly kept, the pressure becomes most effective upon the pelvic organs, tending constantly to press them backward toward the vulva, and finally to cause their prolapse. A very fruitful cause of prolapse of the vagina following par- turition consists of some form of chronic irritation, either in the vagina itself or in the uterine cavity. The most important and common causé of post-parturient prolapse of the vagina is a chronic metritis, caused by retained placenta. Such irritation will cause expulsive efforts, which may produce prolapse of the vagina or uterus, or both. Symptoms. Sometimes the prolapse appears as a reddish, somewhat spherical tumor, between the lips of the vulva, which may be visible only when the animal is lying down or when, for any reason, she is making expulsive efforts. In other instances the prolapse is much greater, and the everted organ appears be- yond the lips of the vulva. In the larger animals, the prolapsed mass may be as great as 8 or 10 inches in diameter. The exter- nal covering consists of mucous membrane, which may be more or less disguised by the adherence of dirt or of blood clots. Its surface may be blackened asa result of long exposure, or ulcera- tion, suppuration or gangrene may be present. As the case progresses, the tendency is for the prolapse to be- come more and more constant, so that finally the displacement of the organ is continuous. The tumefaction and enlargement of the prolapsed organ may become so great that its replacement is difficult. The inflammation and swelling render the prolapsed organ more friable and easily torn, and contact with the tail, floor or walls tends to cause abrasions and lacerations. The patient may eat well and her general condition remain good, or there may be difficulty in defecation and urination, with more or less persistent straining. If the prolapse is de- 3 Eversion of the Vagina 851 pendent upon disease of the uterine cavity, the symptoms of general disease will depend upon the uterine affection rather than upon the prolapse of the vagina. In vesico- -vaginocele, the irritation is very great, and the difficulty in urinating tends to further complicate the course of the disease, leading as a general rule to more or less continuous and violent expulsive efforts. A manual exploration should be made by the veterinarian to determine the condition of the vagina, uterus and neighboring organs. Referring to differential diagnosis, de Bruin suggests the possibility of confusion between prolapse of the vagina, vaginal tumors, retention cysts of Bartholini’s glands, and in- version of the bladder. A careful examination, however, will reveal the characters of each in such a way as to bring about a differentiation. Tumors of the vagina are necessarily attached to some portion of the wall. Bartholini’s glands lie upon the lateral portions of the floor of the vestibule, and, when they become distended with retained contents, appear as fluctuating tumors. The prolapsed bladder may readily be recognized by its point of attachment, the drib- bling of urine from its surface at the point of opening of the ureters, and the absence of the urethral opening. ‘The prognosis of the disease is largely dependent upon the cause. Asa general rule it is not dangerous for the life of the animal, but when caused by chronic inflammation of the uterus, complicated by retained afterbirth, it should be regarded as serious. The condition has the further danger of consequent sterility. In some cases the patient may suffer from prolapse of the vagina for days and even weeks, with great swelling and ulcera- tion or necrosis of the mucous membrane, though with little danger for the life of the animal. One of the most unfavorable features of the disease is its tendency to recur. Handling. The first aim is the replacement of the organ, which should always be preceded by thorough cleansing and disinfection. In bringing about the cleansing of the prolapsed organ, care should be taken to decrease rather than increase the irritation present, in order that when it is returned the method of handling shall not cause pain, and thereby expulsive efforts. De Bruin advises the use of a 2 to 3% creolin solution or a 2% carbolic acid or alum solution, placing special emphasis upon the 852 Veterinary Obstetrics latter because of its cheapness and great astringency. In our experience so strong a solution of creolin or carbolic acid as suggested by this author tends to excite straining, and thereby to defeat the object in view. The replacement of the organ is to be brought about in a way somewhat analogous to the reduction of prolapse of the uterus: The position of the animal should bethe same. Great advantage may be gained by having the posterior parts more or less ele- vated. The smaller animals may be suspended by the posterior limbs. After having properly secured the animal and cleansed the organ, the protruded mass may be replaced by pressure with the open hands. The finger nails should be well trimmed in order to avoid abrading the organ, and the hands carefully placed in a manner to insure the parts against injury. After the return of the organ into place, the hand should be introduced into the cavity, and the walls straightened out and replaced carefully in detail. De Bruin recommends, in cases of long-standing prolapse of the vagina, after cleansing the organ, that a 2% alum solution should be applied to it for 10 or 15 minutes, after which a piece of cloth about 1344 by 2 feet should be applied to the prolapsed organ and wound about it as a bandage. Thisis to be kept saturated with the alum solution, while firm and careful pressure is applied to the outside of the mass with both hands, until finally the prolapsed organ is replaced. During reposition the animal often strains violently, and renders the operation far more difficult. It may be necessary or advisable ‘to take measures to overcome the expulsive efforts. An assistant can do much by attracting the animal’s attention or by pinch- ing the back so as to prevent the expulsive efforts. In the mare the straining may be overcome to some extent by the applica- tion of the twitch. Afterthereplacement of the organit is some- times of importance to move the animal gently for a. time in order to attract its attention and to overcome the tendency to straining. Where the prolapse is referable to irritation in the uterine cavity, ourefforts must be directed to overcoming it. The uterus should be thoroughly examined, and nointra-uterine infection or disease overlooked. After the reposition of the va gina, the Eversion of the Vagina 853 cervical canal should be dilated, and the uterus irrigated with antiseptics. Hess recommends in these cases in the cow that we search for and press out any persistent yellow bodies from the ovaries, and then apply massage per rectum to the uterus. By this method he reports excellent results. In other instances the prolapse is directly referable to some irritation in the walls of the vagina, and, before one may reasona- bly hope to overcome the straining and recurrence of the prolapse the irritation must be removed. On page 267 we have related a case of vaginal prolapse due to vaginal adhesions which could not be mechanically controlled but was cured by chloral narcosis. All the various means that have been advised for preventing recurrence of uterine prolapse have alike been suggested for that of the vagina. ‘The pessary is ineffectual, constantly irritates the organ, and tends toincrease rather than decrease the straining. Many veterinarians recommend vulvar sutures as already de- scribed for prolapse of the uterus. It is inadvisable to apply sutures until after the cause of the prolapse has been removed, since such a closure of the vulva can only result in harm in those instances where ovarian, intra- uterine or intra-vaginal disease is the cause. The application of the bandage, such as advised for prolapse of the uterus, has a very low efficiency in prolapse of the vagina, because the organ can readily be pushed out beneath the bandage whenever severe straining occurs. Whatever value any retention apparatus may possess, it is more important to overcome the cause of the prolapse than it is to force the organ back in its position and hold it there by mechanical means. If infection is the cause, and it usually is, then disinfection must constitute the basis of handling, and should be applied with that thoroughness which will secure efficiency. ‘The alum solution so strongly recommended by de Bruin and others is commendable, because it has high value as an antiseptic, is very astringent, and induces but little irritation. ‘Iodoform is a valuable remedy in such cases, because it possesses high efficiency as a disinfectant, along with a distinct local anaesthetic effect. Where the straining is very violent, because of great irritation in the vagina, it may be temporarily 854 Veterinary Obstetrics controlled by the aid of cocaine, eucaine or other local anaes- thetics. Where the irritation is acute and exceedingly difficult of con- trol, we may secure excellent results by complete chloral narcosis, extending over several hours. During this period of respite from severe straining, the organ may resume its normal condition. 12. PROLAPSE OF THE RECTUM. Prolapse of the rectum occurs rarely as a result of expulsive efforts during or immediately after the act of parturition. In the horse the anus becomes somewhat everted normally with each defecation, but returns at once to its position when the act has been completed. This peculiarity is regarded as a predis- posing cause of prolapse. In dystokia in the mare, the rectum tends to become everted on account of the violent expulsive efforts. In some cases, where difficulty in parturition has occurred and the animal is not con- stantly attended, the eversion or prolapse of the rectum may become very great, and seriously imperil the animal’s existence. In one case occurring in our practice, a valuable mare, suffer- ing from dystokia, was found with the rectum prolapsed to the extent of 3 feet, involving about 6 feet of the organ. With some difficulty it was replaced in position, and the extraction of the foal accomplished without material delay or visible injury to the rectum or genital organs, but the patient perished a few hours later. Extreme prolapse of the rectum is sometimes observed in the sow during parturition. During labor the obstetrist should take note of any threatened eversion of the rectum, especially in the mare, and should take all necessary precautions against its occurrence. This may be best accomplished by having an assistant press upon the anus with a towel or other cloth saturated with disinfectant. When the organ has already become prolapsed, it should be replaced as promptly as possible, and retained in position. It should be care- fully cleansed, but does not call for very thorough disinfection, since it must again become infected as soon as feces pass back into the portion which has been, prolapsed. It should, how- ever, be quite well cleansed, and preferably bathed in a normal salt or soda solution, and then returned into its place, followed Prolapse or Evorsion of the Bladder 855 by the hand to make sure that all parts of the walls are straight- ened out. The prognosis of prolapse of the rectum in the mare during parturition is highly unfavorable. In other animals the prog- nosis is more favorable. 13. PROLAPSE OR EVERSION OF THE BLADDER. Eversion of the bladder may occur in any animal, but has been noted chiefly i in the mare, though it has also been recorded in the cow and sow. ‘The very wide urethral opening of the bladder of the mare tends to make the eversion of the organ in that ani- mal more probable, because more room is afforded through which the organ may pass. The eversion of the bladder may occur at any time immedi- ately prior to, during, or following labor. When prolapse occurs prior to the expulsion of the fetus, the integrity of the organ may . be endangered during the passage of the fetus through the vulva. The accident does not constitute any great impediment to the expulsion of the fetus, but greatly imperils the integrity of the organ and the life of the patient if the fetus passes over the pro- lapsed organ. When eversion occurs after the passage of the fetus, the danger to the patient is less. The causes of eversion of the bladder are chiefly the exalted intra-abdominal pressure due to expulsive efforts, the relaxed and weakened state of the circular muscles of the urethra, and in the mare, the very large urethral opening. The symptoms of eversion of the bladder are of such a char- acter as to render diagnosis easy and clear in the majority of cases. A tumor appears, which is somewhat pear-shaped and has its attachment on the median line of the floor of the vulva, at the point where the urethra normally exists. In eversion the urethral opening has disappeared, ‘and its place has been taken by the everted organ. The tumor varies in size, according to its degree of congestion, which is largely dependent upon the duration of the eversion. If the eversion is recent, or if it has not protruded beyond the vulva to any great extent, or has not been seriously abraded or injured, it presents a fresh mucous surface, and upon either side near the neck of the tumor may be observed the two uretral openings, from which urine escapes drop by drop, or sometimes in small jets during an expulsive 856 Veterinary Obstetrics effort... If not much swollen, the bladder may remain almost or completely hidden, especially when the animal is standing, to become exposed when the patient is lying down or straining. It is to be differentiated chiefly from hernia of the bladder through a rent in the vaginal floor, and from hematoma or tu- mors in the vagina or vulva. In rupture of the vaginal floor with hernia of the bladder, the perztoneal surface of the bladder remains external, and the ureters, still emptying inside the organ, may cause it to become distended with urine. The rupture in the vaginal floor is recognizable. The urethra is present in its normal position on the vulvar floor, and through it the finger or a catheter may be passed into the herniated organ. The mucous surface of theeverted bladder, is external, and the ureters open upon the external surface. The viscus does not become dilated with urine, and the meatus urinarius is absent. In the handling of eversion of the bladder, the organ should first, be thoroughly cleansed by washing with a non-irritant fluid, such as a normal saline solution. The organ should be examined and proper attention given to any injuries. If any perforations of the walls of the organ exist, these should be carefully closed by means of sutures, so applied that the peritoneal surfaces of the lips of the wounds are brought into contact. If a portion of the wall of the organ has been severely lacerated or contused or has become so badly infected or otherwise damaged that its recovery cannot wellbe expected, the damaged portion should be removed and the edges of the wound brought together, thus amputating as much of the organ as may be necessary. In such an operation it is essential to preserve the outlet of each ureter. After due preparation the organ is to be returned into its normal position, through the urethral opening. The operation is usually not difficult, especially if the organ has not been long everted. Grasping the organ in the hollow of one or both hands, the operator should press firmly and evenly over the entire mass until it gradually returns into its position. The operation can- not generally be carried out hastily. Firm and evenly applied pressure with the hands gradually forces the blood out of the organ, and reduces its volume, until finally, when the engorge- ment has largely disappeared, the organ is usually returnable through the urethal opening. Rupture of the Perineum 857 After replacement, any irritation present may be ameliorated to some extent by irrigating the cavity with a warm saline solu- tion. If this does not suffice, local anaesthetics may be applied, such as cocaine with adrenalin chloride. General anaesthetics or narcotics, like chloral and morphine, may also be used in order to overcome the expulsive efforts, by which the replacement or retention of the organ is made difficult. The prognosis in prolapse of the bladder is usually favorable, if it is handled early and properly. 14. RUPTURE OF THE PERINEUM. Ruptures of the perineal tissues may consist of a rupture of the vulvo-vaginal roof and ano-rectal floor in front of the sphinc- ter muscles of these two openings, to constitute recto-vaginal or ano-vulvar fistula. The lesion may extend backward from this opening and involve a complete division of all the tissues com- prised between the floor of the anus and the superior commissure of the vulva, so that the two openings are converted into one cavity, into which the rectum, the vagina and the bladder empty in a common cloaca. In other cases it may consist of a more or less extensive rupture at the superior commissure or other part of the vulva, without involving the anus. The symptoms of a rupture extending from the vulva or va- gina into the anus or rectum, without involving the sphincter muscles, are not well marked externally at first, but may be fol- lowed soon by swelling. At the time of the accident the obstet- rist or attendant may observe that some portion of the fetus has passed from the vulva or vagina upward into the anus or rectum. Later feces occasionally drop from the vulva. The relative amounts of feces which may escape from the vulva and anus re- spectively will depend upon the size of the opening between the two passages. There is frequently an involuntary passage of flatus, especially when the animal is driven at a trot. When the rupture of the perineum is complete, and involves the floor of the anus and roof of the vulva, the symptoms are well defined and very evident. At first there is more or less hemorrhage from the lacerated tissues. The tissues are greatly lacerated and befouled with feces, which ‘drop into the wound, and thence into the vulva. ‘There is intense infection, followed by extensive swelling and suppuration, accompanied by necrosis 858 Veterinary Obstetrics of the lacerated tissues. After a time the lacerated wounds heal, with cicatricial deformity. There is no reunion of the divided parts, but each portion separately granulates and heals, leaving the perineum divided. The feces constantly fall into the vulva, from which they drop in an involuntary manner, after causing a chronic irritation and thickening of the mucous membrane. If the animal is moved at a rapid pace, there is an involuntary pas- sage of air in and out of the cloaca, which causes a repulsive sound, and as the air is involuntarily forced out it usually carries with it particles of fecal matter. The causes of rupture of the perineum may be divided into three important groups. 1. The misdirection of a fetal extremity, by which it becomes deviated upward and is forced through the roof of the vagina into the rectum, to eventually appear in most cases through the analopening. The other fetalextremities pass through the vulva, and thus, as the fetus is forced along by the expulsive efforts, the complete rupture of all tissues between the vulva and anus posterior to the perforation inevitably follows. When the owner or obstetrist 1s present, and notes the threatened injury in time, the diverging foot or head may be pushed back into the vagina from the rectum, and the delivery brought about in the usual way, leaving a more or less extensive tear in the recto-vaginal partition. Cases are recorded in which the entire fetus has passed into the rectum and been expelled through the anus, thus leaving a very wide and extensive rent between the rectum and vagina. he mare is far more liable to this accident because of her spacious rectum, often filled with large, hard fecal masses, and the tendency for the long and rigid feet of the foal or its long and pointed nose to become displaced upward toward the rectum, to be forced through the recto-vaginal wall. The mare is further rendered liable to this injury because of the stormy character of her labor pains and the rapidity of the passage of the fetus through the birth canal. The rupture of the perineum in this manner is therefore essentially an accident of the mare, and is rarely, if ever, observed in other domestic animals. 2. Rupture of the perineum may be caused in any animal by: overstretching of the parts as the result of forcing through the birth canal a fetus of too large dimensions, and especially a fetus with one or more extremities displaced, forming a projection and Rupture of the Perineum 859 abrupt increase of diameter, which may cause an increased tension to bear upon some portion, especially the superior com- missure of the vulva. We have seen complete rupture of the perineum in the mare, where the foal had been torn away by powerful traction exerted upon the two anterior limbs, while the head and neck of the foal were completely deviated to the side. The prognosis of rupture of the perineum depends chiefly upon the character and degree of the lesion. When the rupture results in a recto-vaginal fistula, the prognosis is favorable for the life of the animal, and moderately favorable as to her usefulness, but as a general rule the animal makes an objectionable noise when being trotted, owing tothe involuntary escape of flatus from the rectum through thevulva. Itis possible for such animals to breed, providing the fistula is of suchacharacter that the penis of the stallion will not become engaged in the opening during coition. The probability of bringing about a recovery in such cases, that is a complete recovery by obliteration of the fistula, is re- mote. We have made repeated efforts to bring about a closure of the fistula in two cases in the mare, aiid in each instance not only failed absolutely in our object, but left the fistula rather larger than smaller. A few cases of complete recovery from this injury appear to be recorded, but the failures are apparently left unpublished. When the rupture involves the complete destruction of the sphincters of the anus and vulva, and includes the floor of the rectum and roof of the vagina for some inches forward, the prognosis is again highly favorable in respect to the life of the animal. As in the preceding condition, there have ap- peared from time to time records of complete recovery follow- ing sutures, but here again there has been ominous silence in reference to the failures. How great the proportion of failures we do not know, but it must certainly be very, very high, probably more than 90%. Personally we have neither obtained a recovery nor had the privilege of observing one in the hands of other veterinarians. In almost all cases the wounds granulate and finally cicatrize, but the lips of the wound do not unite, and the anal and vulvar cavities remain one, with the feces dropping into the vulva. An animal with complete perineal rupture which has failed to unite, is usually sterile. The conditions are such that successful 860 Veterinary Obstetrics: copulation cannot readily occur, because the penis of the stallion becomes deflected upward into the rectum. As work, animals they are wholly worthless for purposes of pleasure, because of the repulsive sound of the involuntary passages of air in and out of the cloaca and the fragments of feces accompanying the ex- pelled air, which scatter in every direction. Unless complete recovery can be obtained, the value of the animal is virtually ruined except for the temporary purpose of nursing the foal should it be born alive. After this service has been rendered the mare usually passes into the hands of low dealers. Unless complete recovery can be attained, it is usually better for sentimental and humane reasons to destroy the animal. 3. The third group of lesions, which consists chiefly of the tear- ing of the lips of the vulva at or near the superior commissure or elsewhere, without involving extensively the sphincter of the anus, the prognosis is highly favorable. Under proper surgical attention, the animal should be completely restored to usefulness in the vast majority of cases. The handling of these very serious accidents calls for judg- ment and patience upon the part of the veterinarian. In the two first groups, in spite of the very unfavorable prognosis, attempts should be made to bring about complete recovery, always giving to the owner an unfavorable prognosis, and thus placing the operator in a proper position before the handling is undertaken. There is nothing to lose, and if success follows the effort, the gain is the value of the recovered animal. Views vary as to the most opportune time at which an opera- tion should be undertaken. Some recommend operating im- mediately after the injury, while others counsel delay until the lacerated tissues have sloughed away and granulation is estab- lished over the entire wound surface. In this the operator should be guided somewhat by circumstances. If called im- mediately, before a serious infection of the wound accompanied by great swelling has taken place, we consider it preferable to operate at once. If the operation has been delayed until the wound margins have healed, it becomes necessary to entirely denude them of epithelium. Prior to undertaking the operation, the alimentary tract should be thoroughly and completely evacuated,so that there Rupture of the Perineum 861 may be no necessity for the passage of feces over the freshly closed wound. Such unloading is best accomplished with re- peated small doses of eserine or arecoline. A mare of medium size may take 0.75 to 1 grain of either alkaloid, which should be repeated every 45 to 60 minutes until the intestines are appar- ently completely empty. The vulva, anus, perineum, buttocks and tail should be thoroughly scrubbed with hot water, soap and brush for half an hour or more and bathed thoroughly with ether to dissolve the fats in the skin. The parts should then be thoroughly scrubbed with a hot 1-1000 corrosive sublimate solution for 15 to 30 minutes. This should be completed before casting the patient or placing her on the table. The animal is to be placed in lateral recumbency, for which purpose the operating table furnishes by far the best means and places the patient in the best possible position. for the conveni- ence and efficiency of the operator. If a table is not available, the patient may be secured upon an improvised platform of boards or straw, and sufficient elevation acquired to render the operation field available. The patient is then to be placed under complete general anaes- thesia with chloroform or chloral. Local anaesthesia does not fully answer, because the animal will resist the confinement and interfere with the operation even in the absence of surgical pain. The vagina and rectum are to be thoroughly washed and dis- infected. The rectal and vaginal mucosa will not withstand concentrated disinfectants, without inducing an irritation which will later cause swelling and straining. The operator should accordingly do much of the cleansing by means of irrigations with warm normal salt solution, followed by copious irrigations with a 1% solution of carbolic acid, creolin or lysol. The weak- ness of the disinfecting solution needs be counterbalanced by careful and extended application. The tail should be completely enclosed in an antiseptic band- age, and securely tied out of the operator’s way. Antiseptic towels or cloths should be spread in abundance over the but- tocks and thighs, and secured in position by means of safety- pins. The table or floor just beneath the field of operation should also be carefully covered with antiseptic towels or gauze. These precautions having been taken, the vagina and rectum 862 Veterinary Obstetrics are to be carefully wiped dry with sterile gauze. If the opera- tion is upon a fresh case, any necrotic or maimed tissue fragments are to be carefully excised with scissors. If the case is an old one and the wound margins are covered with epithelium, this must be carefully and completely removed, The recto-vaginal cloaca is to be widely dilated by means of retractors, and the recto-vaginal walls upon either side of the wound grasped with double tenaculum forceps and drawn back- wards as far as possible, bringing them essentially external to the vulvar lips. The sutures may be applied by any reliable method. A good plan is to take heavy braided silk sutures about two feet in length, armed at either end with a full-curved needle. Carry one of the needles into the rectum and, if the operator is right handed, insert the needle into the right side of the recto-vaginal parti-- tion about 14 inch from the anterior end of the wound and an equal distance from its lateral margin. Pass the needle down to but not through the vaginal mucosa, carry it across, insert it in the opposite margin of the wound between the vaginal mucosa and muscular tissue, carry it up through into the rectum at a point opposite the entrance on the left side, and remove the needle. Insert the other needle in the same manner about 4% inch posterior to the first, and pass through the tissues and back into the rectum in the same way. ‘Tlie the extreme ends of the suture together, and have an assistant hold it upward out of the way. Apply a second suture in the same manner; and repeat until the posterior or external end of the wound is reached. Drop all the sutures along the floor of the rectum, or have an assistant hold them aside. -Divide the first suture by clipping away the knot, and then close the engaged portion of the wound by drawing the sutures gently and tying. Donot draw the sutures too tightly, lest they cause necrosis, infection, swelling and tearing out. Repeat the process with each succeeding suture. After the sutures have all been tied, and the ends clipped away, begin .at the anterior end of the wound, and apply a con- tinuous suture close to the margins to secure accurate apposition. The wound margins on the vaginal side should be closed by accurate continuous sutures in the same manner as the second suture in the rectum. Vesico- Vaginal Fistula 863 The external wounds are then to be closed by appropriate deep interrupted sutures. Because of’ the great danger from suture infection in this part, the sutures, before introduction, should be thoroughly saturated with a disinfectant, preferably by im- mersion of the sutures for a day in tincture of iodine. The ex- ternal sutures may be rendered safer by applying to each, after insertion, a drop of the tincture of iodine. When the suturing has been completed, the rectum and vagina should be carefully wiped with sterile cotton or gauze, and the wound line, especially in the rectum, liberally sprinkled with iodoform. When recto-vaginal fistula exists, the operation is analogous. The sutures are to be made in the same manner. The anus should be widely dilated with retractors, and the margins of the fistula grasped and drawn out through the anus. The after-handling of the wound is highly important. The chief concern of the operator is the prevention of the befouling of the wound by means of contact with the fecal matter, followed by swelling, infection and tearing out of the sutures. The ani- mal should not be allowed any solid food, but may have gruels or liquid foods, especially milk. The bowels may be largely blocked up, and the passage of feces into the rectum decreased, by small doses, 14 to 1 gr. of morphia repeated every 3 or 4 hours. The expulsion of such feces as may gain the rectum should be facilitated by injections of warm antiseptic solutions, especially of weak solutions of lysol or of a weak carbolized oil warmed to the temperature of the body. The handling of the third group of injuries to the perineum, the external lacerations which do not divide the sphincters, offers nothing special, and consists in the closure of the wound by means of sutures, in accordance with general surgical principles. 15. VESICO-VAGINAL FISTULA. Fleming, citing Dupont, records an instance of vesico-vaginal fistula, but fails to give exact data in regard toit. Rupture of the bladder in an ordinary case of birth, due to the passage of the fetus over it, is improbabie, since normally the bladder is completely emptied before the fetus enters the birth canal, and the empty organ lies in a depressed and smooth area upon the pelvic floor, covered over by the floor of the vagina. Should 864 Veterinary Obstetrics there be present, within the bladder, a calculus or tumor, the danger to the viscus would be very great. Should the floor of the vagina and the upper wall of the bladder become very severely contused, and the two adhere, there might well occur a sloughing of the injured portions, and eventually an artificial communication between the bladder and the vagina. -Chronic purulent cystitis, see page 900, which is not a very rare disease in the mare, fol- lowing vaginitis and other maladies, should not be mistaken for vesico-vaginal fistula. The handling of vesico-vaginal fistula should be based upon general surgical principles, adjusted to each individual case. The fistula cannot be overcome unless the urethra remains open. In such a lesion, as a general rule, there would be, in addition, a chronic, purulent cystitis, with an accompanying precipitation of the urinary salts upon the walls of the bladder, causing the latter to become very greatly thickened and paretic, while they give to the finger the sensation of being covered with fine sand which has formed into crusts. This condition needs be overcome by repeated irrigations with warm water, with possibly very mild antiseptics as recommended on page goo. 16. HEMATOMA OF THE VULVA. During or about the period of parturition, there occasionally appear in the vulva more or less extensive hematoma, due to the rupture of blood vessels, causing a hemorrhage beneath the mucous membrane in the loose connective tissue. The date of their appearance varies. In one instance we noted a hematom of considerable size in a mare, following parturition, in which no dystokia had occurred so far as was known. Ina second instance we noted the development of a hematom which contained about % pound of coagulated blood, in a mare not yet due to foal. In this animal there had been a somewhat severe colic, which had continued for 18 or 20 hours with some tympany, but she had not rolled violently and it was not known that she had received any injury. The owner had made a manual ex- ploration of the vagina, but apparently had done nothing which might cause the hematom to form. The great vascularity of the part just prior to parturition tends to favor such lesions upon very slight provocation. In one of these cases the hematom oc- flematoma of the Vulva 865 curred along the floor of the vulva near the median line ; in the other it was well up along the side of the organ. The symptoms are very characteristic when the blood has be- come collected in alarge mass, because it pushes the mucous mem- brane outward into the cavity of the vulva, so that the volume of the tumor projects beyond the surface of the surrounding tis- sues and may become pedunculated or pear-shaped. It may pro- ject quite beyond the lips of the vulva, especially when the ani- mal is lying down, and may usually be seen very well by parting the lips of the vulva with the hands. Upon palpation the tumor is comparatively soft and painless. When so situated that it can be seen, it is observed to be of very dark color, which indicates its character. It is important to make a clear differential diagnosis of hematoma. In one of our cases the tumor was distinctly pedun- culated, and so extensive that it protruded beyond the lips of the vulva whenever the animal was lying down, and it was so near to the median line and immediately in the neighborhood of the meatus urinarius that it was at first mistaken for the everted bladder. Further examination revealed the meatus, and estab- lished the fact that the bladder was in its normal position. In some cases there may be a very general extravasation of the blood into the tissues, over a large area. This we frequently meet with in practice, where dystokia has existed, especially if rudely handled by laymen or empirics, and the vulva and vagina greatly abraded and irritated by rough hands and apparatus, or with hard, rough cords. Such extravasations are not of a char- acter generally to cause serious trouble, but are after a time absorbed. The handling of hematoma usually consists merely of making a free opening through the mucous membrane and pressing out the blood clots, after which the vulva should be cleansed with an antiseptic solution. In our experience it is easy to thrust a finger through the mucous membrane, and thus produce an extensive opening, which will not adhere and retain discharges later. This method of evacuating the blood coagula has an element of safety in it, because there is no danger of wounding any blood vessels which by chance may be displaced because of the lesion. 55 ’ 866 Veterinary Obstetrics Fleming advises scarifications in cases of extensive extravasa- tions, though he admits that Cartwright had an unfortunate experience through the wounding of a large vein. Apparently in this instance he was dealing with a general extravasation of blood in the connective tissue, and here of course a single puncture or division of the mucous membrane would not permit the escape of the blood. As a general rule, in these cases, the extravasated blood will be safely resorbed by the tissues, if they are given that opportunity. Scarifications, on the other hand, open an inviting avenue for serious infection. ‘They had best be omitted and, in their stead, careful cleansing and disinfection maintained until resorption occurs. 17. RELAXATION OF THE PELVIC SYMPHYSIS. Fleming, citing Gillis, records one instance of what was diag- nosed as relaxation of the symphysis of the pelvis, as a consequence of parturition, but the diagnosis was not verified by post-mortem examination or by other conclusive evidence. In this case a cow had some difficulty in expelling a calf, after which she could scarcely rise when down, or walk when upon her feet, and her hind quarters swayed from side to side. The sacro-iliac articulations appeared to be tender. When the ani- mal was moved, there seemed to be some motion in the ischio- pubic symphysis. The condition remained permanent, and the animal was prepared for the butcher. 18. CONTUSIONS OF THE LUMBO-SACRAL NERVES. The lumbo-sacral plexus of nerves is so disposed, in domestic animals, that certain trunks are somewhat subject to impingment between the bony walls of the pelvis and prominent, unyielding portions of the fetus, by which they may become more or less seriously contused and their functions interrupted. The prob- ability of these nerves becoming injured during parturition is not alike for all the trunks, the gluteal and obturator nerves being especially exposed, where they pass over the articular eminence between the last lumbar and the first sacral vertebrze, while the obturator nerve again becomes exposed to injury as it rounds the margin of the obturator foramen. See Fig. 1, page 4. Contusion of Gluteal Nerves. Gluteal Paralysis 867 a, CONTUSION OF THE GLUTEAL NERVES. GLUTEAL PARALYSIS. We have observed, in two cases in draft mares, paralysis of the gluteal muscles, followed by atrophy consequent upon par- turition. In our observations. neither case was referable to dys- tokia, in the ordinary acceptation of the term, since birth took place without aid and, so far as known, without observable diffi- culty. The mares were in prime condition ; no injury or infec- tion was externally visible; there was no fever or loss of appe- tite or flesh. Yet, when the mare was down it was difficult for her to get up, and when up she walked with an unsteady gait. In one case the paralysis was unilateral, and consequently the difficulty experienced in rising was not great. When moved she had a very distinct paralytic limp in the affected limb. After a few days the muscles of the gluteal region commenced to atrophy rapidly, which continued to an extreme degree, but the paralysis soon subsided, although there was a certain deficiency in the strength of the part. After the lapse of several weeks the mus- cles began to recover their volume, but the recovery was very slow, and nearly a year elapsed before the parts resumed their normal appearance. In the second case the paralysis was very profound and notable, because both hind limbs were involved and it was necessary for a time to aid the mare_somewhat when she attempted to get up, although once she had gained her feet she could walk about with some difficulty. The paralytic symptoms subsided in the course of two or three weeks, while the atrophy was extreme and the restoration of the muscles was very slow, though eventually complete. The handling of contusion of the gluteal nerves must depend fundamentally upon the general care of the animal, since there is nothing very direct to be accomplished, nor is it probably nec- essary as a rule that anything definite should be done. The an- imal should not be permitted to struggle in getting up, or other- wise exert herself violently in a manner to increase the injury to the nerves and muscles, but should be watched rather closely and guarded against further injury. To this end she should have comfortable quarters, and her stall should be so managed that she will have the best footing possible in order to avoid any 868 Veterinary Obstetrics slipping in attempting to rise. Furthermore, it is desirable, as far as practicable, to aid the animal by lifting upon the tail whenever she wishes to get up, uulessshe can accomplish the act unaided with comparative ease and safety. Slings may be ap- plied should conditions require, but it is preferable to avoid them. Should indications warrant it, the veterinarian may apply electricity by placing one of the poles of the battery over the lumbar region and moving the other over the surface of the atrophied gluteal muscles. According to our observations, the prognosis is highly favor- able. The paralysis disappears in the course of a few days to two or three weeks. At the same time the atrophy is increasing, but from this the animal tends to recover completely in from 6 to 18 months, and in the meantime may do light work if desired. 6. CONTUSION OF THE OBTURATOR NERVES. OBTURATOR PARALYSIS. The obturator nerve is subject to injury from the fetus, at its point of passage over the eminence of the lumbo-sacral articula- tion and again at the point where it rounds the lip of the obtur- ator foramen. The symptoms of this accident are acute and unique. They consist essentially of a loss of power in the obturator group of muscles, which include all of thé adductors of the limb—the ob- turator externus, the adductors of the thigh, the pectineus and the short adductor of the leg. It matters not, so far as symptoms are concerned, if the nerve is injured at its point of emergence from the spinal canal or of its disappearance through the obturator foramen. If one nerve only is contused, the animal is able to progress with some diffi- culty, but the affected limb is held in extreme abduction, though the power of bearing weight or of advancement is not interrupted. In advancing the limb, it is brought forward in extreme abduc- tion, and is placed upon the ground some inches laterally to the normal point of bearing. If both obturators are simultaneously injured, the symptoms assume an entirely different phase. Both limbs now become sharply abducted, the animal is unable to support its weight, the two hind feet slip apart, and the animal drops uponits pubis. If assisted to its feet, and the hind limbs are held in adduction, the Contuston of Obturator Nerves. Obturator Paralysis 869 animal can stand without difficulty, but the moment it raises one foot the two slip apart again and the animal falls. In one case occurring in the clinic of the New York State Vet- -erinary College, a mare had foaled apparently naturally, but im- mediately afterward it was seen that in walking she carried the leg in extreme abduction, so that it was exceedingly difficult for her to walk. The condition had existed for about a year before she was presented at our clinic. We promptly diagnosed injury to the obturator nerve upon the affected side. She still walked with the affected limb in extreme abduction, while the muscles of the inside of the thigh were greatly atrophied. As we believed her incurable after so long a duration, she was destroyed, and a post- mortem examination revealed all the muscles supplied by the in- jured obturator nerve, very pale and greatly atrophied, so that their volume was only about 13 that of the corresponding muscles of the opposite side. The other muscles of the limb were normal. The obturator nerve was apparently normal, except at its point of disappearance in the obturator foramen, where there existed a very distinct enlargement, consisting chiefly of connective tissue, as shown in Fig. 140. Fic. 140. CONTUSION OF OBTURATOR NERVE. I, Ilium. Is, Ischium. P, Pubis. ON, Obturator nerve. O, Obturator foramen. 1, Inflammatory induration of obturator nerve. 870 Veterinary Obstetrics In a second case, observed in our private practice, an imported French draft mare, aged four years, had given birth to her first foal without difficulty, but was unable to get up. Having been called, we placed slings under the patient and helped her to her. feet, but she could not stand on the hind limbs because they im- mediately parted and she tended to drop upon her pubis. Ifa man would hold the feet in adduction, she could stand without difficulty. The slings were properly adjusted and the two hind feet tied together, after which she stood comfortably and with- out difficulty. After three days, upon the removal of the slings, it was found that she could walk with but little difficulty. She made a rapid and complete recovery. The handling of contusions of the obturator nerve should con- sist of the application of slings, and the feet should be tied to- gether to prevent abduction. Later, electricity may prove use- ful, one electrode being applied over the loins, the other to the inside of the thigh. PUERPERAL INFECTIONS. During the puerperal state, the great vascularity of the entire genital system, combined with the denudation of all that portion of the uterus occupied by the placenta, and the almost inevitable abrasions and lacerations of some of the parts, tends very strongly to lead to infections of a more or less serious character. "The de- tachment of the fetal from the maternal placenta leaves a vast denuded surface, which, in relation to infection, is somewhat comparable to a wound. If to this is added wounds, contusions and abrasions, of a more or less extensive character, the tend- ency to infection is still more increased. In the separation of the placenta there is inevitably some escape of blood and other fluids into the uterine cavity, which, if not promptly expelled, act as foreign bodies and invite infection in the part. If the placenta for any reason fails to become detached and expelled at the proper time, it inevitably undergoes decom- position and leads with certainty to a greater or less degree of in- fection of the uterus and vagina, with possible involvement of distant parts and the general system. Added to all this, when dystokia occurs and the animal is weakened, the genital organs are debilitated, do not contract and close as they should, and infection is directly carried into the uterus by the ignorant or careless operator, upon the hands, instruments or apparatus. It is consequently not so much to be wondered that infection frequently occurs during the puerperal state, but rather that such infection does not occur with greater frequency. Infections re- ferable to the puerperal state are consequently of the greatest possible variety in intensity, location, character and symptoms. It is difficult to draw definite lines between the various forms, nor is it possible to describe all forms of infection. We shall endeavor to describe only those of leading importance, which offer some special train of symptoms, and permit of classification. They all trace to the one common source—the entrance of infec- tion into some part of the genital tract during the highly sus- ceptible puerperal state. From the genital tract the infection may extend to neighboring or distant parts, or involve the entire system in more or less grave disease. 871 872 Veterinary Obstetrics 1. ACUTE METRITIS. Foremost among the puerperal infections, from the standpoint of frequency and seriousness, stand the acute infections of the uterus. The infection may involve simply the mucous mem- brane of the uterus, to constitute endometritis. When involv- ing only the mucosa of the organ, it may be largely or wholly confined to the placenta. In the mare, so long as the infection is confined to the mucosa, it is also limited -to the placenta, and might therefore be called placentitis with equal propriety. In endometritis of the cow, with her multiple placentz, the infec- tion may be confined chiefly or wholly to the placentze or that part of the mucosa which goes to elaborate the placentz. Here again we might justly apply the term placentitis, but in this instance it is probable also that those portions of the mucosa between the cotyledons may become involved to some extent, constituting more strictly an endometritis. If the infection is of such virulence that it passes beyond the mucosa and, penetrating the muscular walls, involves the peri- toneal surface of the uterus, thus including the entire uterine wall, we designate it as metro-peritonitis. The difference in designation is consequently one intended to indicate the degree of extension and the consequent difference in the gravity of the disease. The causes of acute metritis consist of any of those elements which may favor the introduction into the uterine cavity, and the growth there, of disease-producing bacteria. Standing at the head of causes of metritis, is the retention of the fetal envelopes. Whenever the normal period at which these should become separated and expelled has passed by, without such expulsion, they immediately constitute a source of danger for the well-being of the animal. They promptly cease to constitute a part of the living tissues, the circulation of blood within them ceases, and they furnish a favorable medium in which bacteria may multiply. In most cases the membranes extend from the uterus out through the vagina and vulva, where they become soiled with feces and other highly infected material, and consti- tute an open highway, along which the bacteria may rapidly travel as well as multiply, until they reach the uterine cavity. The presence of the membranes keeps open the cervix of the Acute Metritis. 873 uterus, and prevents toa large degree the normal involution of the organ. Added to this, the interference with the retained mem- branes, with a view to their removal, by laymen, empirics or other incompetent persons, serves to intensify the danger of infection by wounding and abrading the organ. In the mare, where endometritis is by far the most common form of puerperal infection, the disease is generally attributable to the fragmental retained placenta, already described on page 810. Another very fruitful cause of metritis is the introduction of infection into the cavity of the organ, upon the hands, instru- ments or apparatus of the veterinary obstetrist during the over- coming of dystokia or other manipulations of the organ. The frequency with which metritis following dystokia occurs in ani- mals constitutes a severe criticism upon the usual methods em- ployed by veterinary obstetrists. Wounds of the organ during manipulations of any kind greatly facilitate the entrance into the tissues of any infection which may gain admission to the uterine cavity. The presence of a dead fetus, which is undergoing putrid de- composition in the uterus, inevitably causes a more or less se- rious metritis. In some instances, where the death of the fetus is comparatively recent and the putrid decomposition has not pro- gressed far, the degree of metritis may be comparatively unim- portant, or may even pass unnoticed. In other cases, where the putrid fetus has remained in the uterus for a longer period of time and the decomposition has become quite complete, the in- flammation of the organ is correspondingly great and serious. After a long period of fetal decomposition, the uterine walls may finally assume the characters and functions of abscess walls. When the fetus dies in the uterus and does not become decom- posed, but undergoes mummification instead, it does not tend to induce inflammation of the organ. Tardy involution of the uterus constantly tends to invite in- fection. When the uterus does not promptly close, and its walls fail to quickly come in contact with each other, there is proba- bly a similar tardiness in the contraction of the vagina and vulva, so that the entire tract remains somewhat freely open, inviting infection. The debility of the organ, of which the tardy involu- tion is but a symptom, decreases its power of resisting the infec- 874 Veterinary Obstetrics tion. When the organ undergoes normal involution and contracts vigorously, that vigor in itself acts largely to prevent or over- come infection. Exposure tocold or wet has also been claimed to act as a causa- tive agent in metritis. It no doubt occupiesan important, though indirect place. Any sudden chill, or disturbance of the body in general, weakens and depresses the highly sensitive genital tract, and renders infection far more probable than though the animal were kept under more favorable conditions. For convenience the various types of metritis may be con- sidered separately. a. ACUTE ENDOMETRITIS IN THE MARE. Inflammation of the mucosa of the uterus may develop in the mare very promptly after giving birth toa foal. Should the foal perish and be retained in the uterus to undergo rapid putrid decomposition, there may be present within 24 hours a well- marked endometritis, which seriously complicates the handling of the dystokia. Many cases of endometritis inthe mare, do not follow dys- tokia, but result from the retention of a fragment of the fetal placenta in the non-gravid horn, as already described on page 810. Insuch cases infection quickly takes place, and, within 24 to 48 hours or slightly longer after the expulsion of the fetus and of the principal volume of the fetal membranes, there appears first of all a well-marked stiffness in the gait of the animal, with some disinclination to move and very marked tenderness of the abdomen upon pressure. The pulse may be normal or somewhat quickened ; the temperature is slightly elevated ; and the respiration is somewhat impeded because of the abdominal tenderness. The mare may assume the recum- bent position much of the time, or she may persistently stand. The appetite is variable, and sometimes remains fairly good, but is usually depressed. The lips of the vulva are usually swollen, and from the genital tract there issues a somewhat thin, reddish-gray, dirty, floccu- lent discharge, which may be more or less fetid. If the lips of the vulva are parted, the mucous membrane is seen to be in- jected and irritated. If the obstetrist will introduce his hand into the uterine cavity, he will usually find it filled with a dirty, Acute Endometritis in the Mare 875 flocculent discharge of the same character as that which is ob- served flowing from the vulva. The amount of the accumula- tion in the uterus is extremely variable ; there may be but two or three quarts, or there may be 4 or 5 gallons. The walls of the uterus are paretic, so that they are unable to force the ac- cumulated discharge out of the uterine cavity, and thus permit the great accumulation. Upon palpation, the walls are found to be dense, swollen and very thick, giving the examiner the im- pression of a diameter of % inch or more. Examining the non-gravid cornu carefully, the obstetrist will frequently identify in it a retained piece of the chorion ; or this retained membrane inay have become detached from the cornu and passed out into the body of the uterus, where it lies free in the accumulated pus; or it may have escaped through the vulva and disappeared. In alinost all cases of acute endometritis in the mare, there co- éxists parturient laminitis. The occurrence of this disease as a complication is so uniform that it might well be regarded as a part of the malady, but since it is usually described separately we shall follow that custom and take up its consideration later. As the disease progresses, and becomes more intense, the pulse, temperature and respiration become more markedly involved, and the discharge from the uterus increases in volume and becomes more fetid. Asthe laminitis increases, the animal becomes more and more unable to move, assumes either the recumbent or the - standing position, according to individual temperament, and per- sistently maintains such position. The handling of acute endo-metritis in the mare consists es- sentially. of the removal from the uterine cavity of any placental fragments and accumulated uterine discharges. Special search is to be made for the fragment of retained chorion so common in the non-gravid horn. The accumulated fluids are to be removed from the uterine cavity by copious irrigations with warm water, to which a small amount of antiseptics, like 0.25% carbolic acid, lysol or bacillol or 0.1% permaganate of potash may be added. This will not disinfect the uterine contents or uterus, but may serve the pur- pose of partially disinfecting the irrigating solution. Two, three ot more gallons of the solution may be introduced at one time, al- lowed to escape, and a like quantity again injected. The process 876 Veterinary Obstetrics should be continued until the water is expelled clear and odor- less. This may require a total of six to ten gallons. The plan outlined is mechanical cleansing, in contradistinc- tion to chemical disinfection. The enormous volume of viru- lently infective discharges is quite beyond the power of any or- dinary disinfectant to overcome. If the discharges can be me- chanically removed, the aim of the surgeon is fully accomplished in so far as that is concerned. The walls are stiil infected and inflamed, and will quickly secrete more discharges. We cannot disinfect the walls; any antiseptic capable of doing this would likewise irritate, injure or destroy the uterine tissues. The paretic uterine walls do not contract, and the fluid must either be forced out by the contraction of the abdominal walls or must be siphoned out through the irrigation tube. The uterine cavity should be left empty, except that 1% 0z. of powdered iodo- form may be introduced ina gelatine capsule, the capsule opened, and the powder scattered over the surface. The irrigation should be repeated one to three times daily, ac- cording to indications. Improvement is indicated by decreased discharge, disappearance of fetor, and a gradual change from the dirty-grayish, flocculent, semi-fluid mass to a transparent, odor- less mucus. At the same time the hard, thickened walls of the uterus soften and become thinner, the mucosa recovers its normal consistence, the walls contract, the uterine cavity decreases and the walls come in contact. These changes mark convalescence, and warrant the gradual cessation of irrigation. The strength of the patient may be advantageously supported by a free allowance of alcohol or nitrous ether in the drinking water. An ordinary sized mare may take two to four ounces of either drug, and the dose may be repeated frequently. She may take either of them at the rate 1% to 1 oz. per hour for 24 con- secutive hours. Quinine may also be administered in large (ounce) doses, once or twice daily if fever is present. The handling of the concurrent laminitis will be discussed while dealing separately with that affection. The prognosis of acute endo-metritis is highly favorable. Properly handled, over 90% recover promptly and completely. The mare usually remains fertile. Acute Metro-Peritonitis in the Mare 877 6, ACUTE METRO-PERITONITIS IN THE MARE. Acute metro-peritonitis in the mare is most frequently due to a perforation of the uterine walls during parturition, or to lacerations or contusions of the uterine walls, which soon lead to necrosis of an area, through which an avenue is afforded for the passage of infection from the uterine cavity to the peritoneum. The wounds which invite the infection and afford an avenue for the entrance of the organisms into the deeper tissues fre- quently occur just in front of the pubic brim along the utero- vaginal floor, and are apparently often due to the presence of a conical bony projection on the symphysis pubis, as indicated in Fig. 113b, page 677. The perforation may be direct, but proba- bly more frequently consists of an irrecoverable contusion and maiming of the uterine tissues between an unyielding portion of the fetus and the conical projection of the pelvis. The contu- sions may also be due toa portion of the fetus becoming impacted against the pubic brim and crushing the intervening uterine floor, especially during forced extraction with important deviations, as already related on page 818. It also results frequently from the intensity of infection of the uterine walls, from rough handling during dystokia, from the introduction of virulent organisms into the. uterine cavity upon the hands of obstetrists or others, the putrid decomposition of the fetus in the uterus, and other similar causes. The symptoms may be preceded by, or include in a measure, those of endometritis, already described. Laminitis, which is so often observed in endometritis,is not a common symptom. The pa- tient is stiff and disinclined to move. Pressure upon the abdominal walls induces severe pain. Fever and loss of appetite are marked. The vulva and perineum are usually swollen. Asa general rule, vaginal discharge is present, soiling the tail and neighboring parts. Manual exploration of the genital tract reveals its walls swollen, more or less paretic, thickened and painful to the touch. The uterine cavity may contain a variable amount of disease dis- charges, thick, flocculent and fetid, as already described in endo- metritis. The prognosis is extremely grave. Few mares recover from the disease, but usually succumb from gangrene and septicaemia in from three to ten days. 878 Veterinary Obstetrics Treatment is of little avail. Locally it should consist of irri- gations, as already recommended for endometritis on page 876. To the warm water may be added 0.5% carbolic acid, creolin or lysol. After thorough irrigation, iodoform powder may be scat- tered over the uterine floor. Internally, quinine, one ounce once or twice daily, or potassium iodide in ounce doses, two or three times daily, may be used; or the two drugs may be given simultaneously or alternately. The strength of the patient should be supported by large and repeated doses of alcohol or nitrous ether, and by repeated mod- erate doses of strychnine. If the patient will eat, ample food should be allowed of such variety asis usually indicated in serious febrile infections. c. ACUTE METRITIS AND METRO-PERITONITIS IN THE Cow. . Metritis in the cow ismost frequently dependent upon retained placenta, especially when such retention is neglected, or still worse, when improperly handled, as has already been discussed when considering the treatment of retained placenta on page 799. The infection is also frequently dependent upon perforating wounds, or ruptures, of the uterus due to accidents during par- turition such as have already been related on page 818 while con- sidering rupture of the uterus. It varies greatly in acuteness. In one instance, where an acute placentitis occurred within 24 hours after dystokia, apparently due to infection carried into the uterine cavity by the obstetrist, there was a sudden elevation of temperature to 106F., with the general symptoms of acute septicaemia, the cotyledons were enormously enlarged, tense and necrotic. This represents an exceedingly virulent type of metritis, more severe than the usuai form of the disease. As usually ob- served there is elevation of temperature, loss of appetite, absence of milk secretion, torpidity of the bowels, dullness, and the general symptoms of septicaemia. Locally there is observed swelling of the vulva, and upon in- troducing the hand, the vulva and vagina are found very hot to the touch and tender, and the mucous membrane swollen. There is frequent and severe straining, during which usually small quantities of a grayish-red flocculent pus are discharged. Acute Metritis and Metro-Peritonitis in the Cow 879 Mixed with the discharge from the uterus, there are frequently observed shreds of the fetal membranes, or necrotic cotyledons which have sloughed off. The straining is usually very intense, and in some cases well-nigh constant. The cow stands with her back arched and the abdomen compressed. She frequently grinds her teeth, and in almost all cases shows very great pros- tration. When the hand is introduced into the uterus, the straining is usually aggravated, and becomes very violent. As the disease progresses, the discharge may vary greatly in character. Always somewhat muco-purulent, it shows a constant variation of the proportion of pus to mucus and of the degree of admixture of blood, which induces a change in color and con- sistence. In some cases the discharge becomes diptheritic, and is expelled in large, tough grayish-white masses. As the disease progresses, the cow tends to assume the recumbent position, and ere long is unable to get up, as a result of the profound septi- caemia. ‘The rumen may become distended with gas. Terminations. The course of acute metritis in the cow is usually very rapid, and terminates in recovery or death within from two to six or eight days. In some cases the disease gradually passes into the chronic state, and continues for weeks, months or years unless properly handled. The mortality is high, exceeding 50%. Inthe placental me- tritis or placentitis, where necrosis of the cotyledons is followed by their prompt removal and the thorough disinfection of the organ, the prognosis in our experience is highly favorable. When, however, we have to deal with the usual type of metritis or metro-peritonitis, the prognosis is always exceedingly grave. The symptoms upon which our prognosis is to be based resolve themselves into two principal groups, general and local. The temperature of the animal is not always a reliable index as to the state of disease, since when there is extensive septi- caemia the body temperature is somewhat erratic and at times deceptive, so that, while a high temperature may always be re- garded as indicative of a serious state, a low temperature is not to be relied upon as indicating a favorable course. In cases of very profound septicaemia in the cow, mare and other animals, the temperature may be normal or subnormal, but when such is the case there is a general depression, coma, or collapse, which should place the veterinarian upon his guard and prevent him 880 Veterinary Obstetrics from misinterpreting the gravity of the disease by the body tem- perature. The general appearance of the animal is of more im- portance in determining the probable outcome than is the question of temperature. If the animal looks somewhat bright and maintains a fair appetite, or the appetite, having been lost, shows a tendency to return, such may be regarded as a favorable omen. Locally we usually can determine more exactly the course of the disease and its probable termination, by comparing the con- ditions from day to day. The tumefaction of the vulva and vagina, if it increases, indicates an unfavorable course of the disease, which is heightened to a degree if the mucous membrane of these passages becomes darker in color and necrotic. If, on the other hand, the swelling of the vulva tends to disappear and the mucous membrane to assume its normal color, the indications are favorable. Within the uterus itself we meet with still more definite signs as to the course of the disease. If the case is progressing favor- ably, the uterine walls are less firm and become thinner ; the mu- cous membrane gradually resumes its normal consistency and loses its hard and smooth character, to become soft and velvety. When the patient is improving satisfactorily, the uterine walls gradually regain their contractile power, and the uterine cavity conse- quently becomes smaller. The accumulation of disease products in the uterine cavity decreases in volume; the discharge loses its fetor and tends to become more and more mucous in character, until finally all appearances of pus cease, and the discharge is entirely of mucus, so far as the naked eye can observe. On the other hand, if the disease is progressing toward a fatal termination, the uterine walls become more swollen and paretic, while the discharge into the uterine cavity teuds to increase and become more purulent and fetid, and perhaps darker in color, owing to a larger admixture of blood. Pathology. When metritis progresses to a fatal termination, the post-mortem examination usually shows the chief lesions to be in the genital tract, very largely in the uterus itself. Accom- panying these changes there are general appearances throughout the body of a profound septicaemia, followed by very rapid decom- position of the body. In fact the decomposition has progressed to an unusual degree before death, so that, if an autopsy is made Acute Metritis in the Cow 881 immediately after the animal succumbs, the decomposition of the genital tract has already advanced to a very marked degree, and involves its peritoneal covering. The uterus is usually much thickened, dark colored, and more or less necrotic. The necrosis involves not only-the mucous membrane, but the muscular and peritoneal coats, and even adja- cent organs in the abdominal cavity, which have been in imme- diate contact with the diseased organ. In the vulva and vagina there are frequently encountered necrotic patches of a dark, dirty, or greenish color, and the entire tract and its contents are usually very fetid. The quantity of fluid in the uterus may be comparatively small, or may reach several gallons. The greatly thickened walls of the uterus are frequently highly emphysematous and very friable. Sometimes shreds of the fetal membranes are still retained, the cotyledons may be necrotic, and portions of the uterus may be covered with extensive dip- theritic membranes. The peritoneal covering of the uterus being involved, permit- ting the disease to extend thereby to other portions of the peritoneum, causes a more or less voluminous exudate into the peritoneal cavity. Abscesses may exist in the uterine walls, or in the surrounding pelvic connective tissue. Whenever metritis is highly virulent, thrombosis of the neigh- boring vessels is probable, as a result of the infection extending to and involving the veins and lymphatics. Such a condition is greatly favored in metritis, because of the fact that, only a few hours before, the vessels were very large and contained a great volume of blood. The large vessels, which no longer have their previous function to perform, become inactive and vulnerable to infection. The thrombi, breaking down and passing along the blood vessels, tend to cause embolisms in distant parts of the body, such as the lungs and the joints. In the latter position they may produce pyaemic arthritis. The general post-mortem appearances of the tissue and organs, other than the genital tract, are those of septicaemia or pyaemia. The blood is dark colored, and does not readily coagulate. The muscles are pale, friable and soft. The liver and kidneys are engorged and soft. The general appearances of the body do not offer any special differences from those observed in death from 56 882 Veterinary Obstetrics wound infection ; in fact we are essentially dealing with wound infection of a particularly virulent type. The infection is usually mixed in character, and offers no dis- tinction from that usually found in acute wound infection. Handling, The veterinarian should first of all observe care- fully those general rules which tend to prevent the infection. As in other operations of a surgical character, accompanied by wounds or destruction of the protective epithelium, we know that they may be caused without being followed by infection, if certain precautions can be, or are, properly applied. We have already urged, on page 620, that the veterinary obstetrist should rigidly apply the rules of aseptic and antiseptic surgery, and have there fully discussed the proper course to pursue. He should remember that the introduction of his hand into the genital pas- sages of a breeding female, just before, during or after parturi- tion, is always accompanied by more or jess grave possibilities of infection, and consequently that such manual exploration . should not take place unless there is ample reason for it. A retained and decomposing fetus should be removed from the uterus as early and carefully as possible, because it must other- wise eventually induce metritis. If the fetal envelopes are re- tained, they should be carefully handled along the lines which we have suggested on page 793, in order that their decomposition in the uterus, and the infection of the organ therefrom, may be avoided. When metritis and parturient fever have become established, the gravity of the disease calls for prompt, vigorous and intelli- gent handling. The first duty is the cleansing of the uterine and vaginal cavities. If there is a large accumulation of purulent material in the uterine cavity, its prompt removal is demanded. The septic material may be flushed out by overfilling the uterus with warm water, as described on page 875. . It is not essential what antiseptic is used, but highly important how it is used. Generally speaking, we desiré the highest effi- ciency with the least irritation. With the uterus in a highly in- flamed state, the irritation from antiseptics is not so great as in the normal organ, and consequently a comparatively strong solu- tion may be used. Howeve®, we must constantly rely far more upon the mechanical flushing out of the organ and the washing away of the micro-organisms and their poisons than upon de- Acute Metritis in the Cow 883 1 stroying them in the uterine cavity or in the tissues of the uter- us. Large volumes of weak antiseptic solutions are therefore preferable to smaller concentrated ones. During the entire pro- cess of irrigation, the operator may add small quantities of anti- septics, and thus exert some influence upon the septic condition. In our experience we have preferred less than a 1% solution of carbolic acid. We have likewise used a 0.1% solution of per- manganate of potash, with good results. After the irrigation of the uterine cavity has been completed and the liquid has been expelled or siphoned out, there may be deposited in the uterine cavity a liberal amount of powdered iodoform. The flushing of the uterus should be continued until the walls have recovered their contractile power and the purulent discharge has been replaced by mucus. Internally the treatment should consist chiefly of those reme- dies which support the strength of the animal, and tend to bring about either the destruction of the micro-organisms and their pro- ducts, or their prompt excretion from the system. The general rules of systemic medication in acute metritis in the mare apply also to the cow. Potassium iodide, being highly toxic for the cow, should be omitted or given in small doses. In metro-peritonitis, and other puerperal infections, various anti-streptococcic and other sera have been used and highly lauded by some veterinarians, but so far as we have been able to determine, the evidence of their value has been what we may term circumstantial. The rapid elimination of poisonous products may be greatly favored, when necessary, by prompt catharsis, but as a general rule this should be avoided except in very acute cases, and in- stead the excretion by the bowels should be favored ,by a light, laxative diet so long as the patient will eat. If, however, it is felt that prompt excretion is essential, our preference is decidedly toward the hypodermic cathartics, which will act within an hour, and thus not induce a prolonged depression or threaten to cause ' superpurgation. Among these remedies we favor moderate or small doses of eserine or arecoline, of such amount as to not cause great depression of the animal. 884 Veterinary Obstetrics d. ACUTE METRITIS IN THE SMALLER ANIMALS. In the smaller animals the causes and symptoms of acute metritis are in the main parallel to those observed in the cow and mare, varying of course in their expression, according to species. Most small animals, when suffering from acute metri- tis, tend to remain in the recumbent position. There is extreme prostration, with fever, tenderness of the abdomen and a puru- lent discharge from the vulva. The patient shows a disin- clination to move, and usually gives an outcry of pain when pressure is applied to the abdomen. Since in the smaller domestic animals the uterus is not so readily cleansed by flushing, considerable care is necessary in order to bring about disinfection, and even then the operation will not succeed so well as inthe larger domestic animals. In the smaller animals, like the cat and bitch, we may insert far into the uterine horn, a rubber human catheter, and through this inject the fluid ; or possibly a slightly bent metallic catheter might be used with even greater advantage, because of the possibility of directing it first into one and then into the other horn, and gently flushing these out with antiseptic fluids. In these animals, if the uterus cannot be disinfected by irriga- tion, it may be necessary to resort to hysterectomy, as described on page 669. 2. CHRONIC METRITIS. PYOMETRA. Allied to acute metritis, and frequently following it as a sequel, there occurs a chronic inflammation of the uterus, which is characterized by suppuration of the uterine cavity, with more or less accumulation of pus, constituting pyometra, or in case the cervical canal of the uterus becomes completely occluded a large volume of pus may be confined within the uterine cavity, to con- stitute abscess of the uterus. Chronic metritis or pyometra may occur in any domestic ani- mal, but has been observed chiefly in the mare, cow and bitch. It may appear at almost any period in the life of the animal, and its relation to parturition is variable. It occurs almost always in fe- males which have previously bred, but the duration of time elapsing between the last birth and the appearance of the disease is not constant. In some cases, pyometra or chronic metritis follows parturition after an interval of a few weeks, or there may be a more or less definite acute metritis, which partially recovers, to be continued somewhat indefinitely as a chronic, purulent in- flammation. Anything which may lead to an infection of the uterus, and permit it to continue for a long period of time, suffices to estab- lish the disease. Anything, therefore, which would debilitate the organ or the general system, or which would favor or lead to the introduction of micro-organisms into the uterus, would act as a cause of the malady. Prominent among the recognizable causes of this malady, are retained fetal membranes and any of those causes which operate to bring about acute metritis, as de- scribed in the preceding article. In many cases manipulations during dystokia appear to be the essential source of an infection, which, though not sufficiently virulent to bring about an acute metritis, nevertheless induces a chronic suppurative disease of the organ. a. CHRONIC METRITIS IN THE MARE. PYOMETRA. Chronic metritis in the mare has not received that attention, from writers upon veterinary obstetrics or gynzecology, which its importance deserves. The affection is not at all rare in the mare, and often proves very obstinate when handled by the 885 886 Veterinary Obstetrics methods which have been in vogue. ‘This affection is by far most frequently seen in those mares which have at some pre- vious time been bred, and have then been allowed to go without further attempts at breeding. It is consequently more common, according to our observations, in localities where few horses are raised, than in those districts where most mares are regularly used for breeding purposes. In addition to the general causes of chronic metritis, indi- cated above, it is not rare to observe chronic metritis in the mare, in cases where, because of apparent sterility, the stallion groom has attempted to ‘‘open’’ the uterus with a view to inducing the mare toconceive. ‘The groom has forced his dirty hand through the cervix of the uterus in a rough manner, wounding the organ more or less seriously and depositing in the lacerations or abra- sions, abundant infection from his dirty hand. The symptoms of chronic metritis in the mare consist usually -of a general appearance of indifferent or poor health, with some emaciation and want of power of endurance. Accompanying these systemic disturbances, there usually appears from time to time a discharge of pus from the vulva. This discharge is some- times constant, and dribbles away, especially when the mare is moved rapidly upon the road or when she is lying down. If it-is at all constant, the tail and thighs will generally be found soiled. In many cases the discharge occurs only at very wide intervals, and apparently proceeds from the over-distensidn of the uterus, which causes the cervix uteri to dilate and brings about the es- cape of a large portion of the contents. In these cases the dis- ease behaves somewhat as an abscess. The uterine cavity be- comes filled with pus, the cervical canal opens and permits the escape of the pus, then closes, and the abscess cavity again be- comes distended. Sometimes the evacuation of pus is preceded by symptoms of colic, and expulsive efforts. The amount of pus which may be discharged at one time varies between a few pints and four or five gallons. The contents usually present the ordinary appearances of pus from an abscess, with the admixture of more or less mucus. In many cases it is comparatively free from odor, while in others it is quite fetid. It is usually yellowish or bluish-white, or may be of a dirty, grayish color, and in one case was black, somewhat flocculent, Chronic Metritis in the Mare 887 and presented to the naked eye the appearance of a disintegrated melanotic tumor. Upon vaginal exploration, the vagina is usually found to be normal, though possibly the mucosa is somewhat irritated because of the presence of the pus from the uterus. - When the os uteri is reached, it is usually found closed, and it may prove exceed- ingly difficult or impossible to insert a finger. If the cervical canal can be passed, the uterine cavity is found filled with pus, and the uterine walls paretic and denuded of their epithelial cover- ing. Exploring per rectum, the operator finds the uterus very greatly distended, lying inert, and containing from one to several gallons of liquid, which fluctuates upon palpation. There are few affections which may be confounded in reference to diagnosis with chronic metritis. Occasionally we meet with a similar discharge from the vulva in case of a very large calculus in the bladder, accompanied by purulent cystitis. Other forms of purulent cystitis may cause like symptoms, as may also a malig- nant tumor of the bladder when breaking down. Chronic vag- initis may also be mistaken for this affection, until manual ex- Fic. 141. PYOMETRA IN MARE. O, O, Ovaries. UC, Uterine cornu. U, Uterus. CU, Indurated cervix uteri. V, Vagina. ploration is made. In Case 3 we record below an instance of ter- atologic development of the uterus, which induced symptoms of chronic metritis. The changes observed in the uterus consist chiefly of a thick- ened and sclerotic condition of the cervix uteri, with extreme 888 Veterinary Obstetrics narrowing of the os. The mucous membrane completely, loses its ordinary character ; ulcerating patches appear ; and, as shown in Fig. 141, the cornua become displaced from their normal po- sition at right angles to the uterine body, and push forward somewhat in the direction assumed by the cornua of the uterus of the cow. ‘The normal longitudinal folds in the mucous mem- brane are entirely obliterated, and in their place there appear numerous transverse ridges ia the muscular walls. The handling of chronic metritis in the mare must be based upon the problem of local disinfection, the principal obstacles to which are the sclerotic condition of the cervix uteri and the pare- tic state of the uterine walls. The fundamental duty of the practitioner is to bring about a thorough dilation of the os uteri to such a degree as to permit the insertion of the operator’s hand into the suppurating cavity. This requires much patience and hard work in many cases, but is of such great importance that it should be persevered in until fully accomplished. In some cases it requires patient endeavor, extending over several hours, to dilate the os sufficiently to insert a finger. When this has been attained, the uterus can be irrigated somewhat ineffectively by passing a tube through the os, injecting a large volume of anti- septic fluid,.and then siphoning it out by means of the tube through which it entered. But the further dilation of the os uteri must be completed before recovery can be assured. ‘This may be accomplished with the finger and hand of the operator, by repeated efforts upon succeeding days. The partially dilated os may also be tamponed with antiseptic gauze or other material, which, remaining in place for twenty- four hours, tends to cause a dilation or softening of the parts. A large and powerful uterine dilator may be of great service in forcibly dilating the os, rendering it very much easier for the operator. Once the os uteri is sufficiently dilated to admit freely the operator’s hand, he is in a position to proceed with the final pro- blem of disinfection. With good drainage, the question of a choice of disinfectants is not supremely important. Any reliable disinfectant will accomplish the end, but it needs be intelligent- ly applied, and by the veterinarian himself. It is needless to say that the disinfecting solution should be sufficiently volumin- ous to fill the uterus two or three times successively, so as to in- { Chronic Metritis in the Mare 889 sure the thorough cleansing of the cavity ateach operation. The flushing of the uterus should occur regularly as often as once a day, and should be persevered with until success is obtained. Among disinfectants, 1-1000 permanganate of potash solution is highly efficient. We have had good results with a solution consisting of carbolic acid, tannin, glycerine and water. We have varied the strength of this solution according to circum- stances, as related in the cases given below. It is important to make the solution as strong as will be borne without irritating the organ. It is well to remember that most disinfectants are quickly absorbed, and their action ceases. In this respect 1odo- form offers special advantages. After cleansing the suppurating cavity thoroughly with one of the foregoing disinfectants, a gelatine capsule containing 5 or 1o grammes or more of powdered iodoform may be carried with the hand into the cavity, opened, _and the powder scattered over the uterine floor. The specific gravity of the iodoform causes it to drop into the folds and irregularities of the mucosa, and prevents its being thrown out, while its feeble solubility causes a continued action for a day or more. At the same time it acts somewhat as a local anzesthetic, and tends to prevent straining. When local treatment is begun, there frequently occurs an increased systemic disturbance, ‘due apparently to an accelerated absorption of septic material. In order to counteract this it is well to administer tonics and antiseptics, such as nux vomica and iron, potassium iodide, hydrastis Canadensis, or other agents. Still more important perhaps, especially if the pus seems more fetid and abundant, the irrigations should be increased to two, three or more times daily if essential to cleanliness. When the disinfection becomes effective there is decreased sup- puration, any odor which may have been present disappears, the discharge becomes more and more mixed with mucus, the mucosa of the uterus becomes normal in consistency, the uterine walls become active and approach each other so that they lie in contact. The mare should be kept directly under the supervision of the veterinarian from the beginning of the treatment to its success- ful termination, and the handling should on no account be en- trusted to an ordinary layman. The treatment should not be stopped or relaxed until the recovery is complete. By following 890 Veterinary Obstetrics these lines of handling we have not met with an unsuccessful case, while we do not recall an instance where the treatment has proven successful when the application of the remedies has been entrusted to a layman. Upon the question of breeding after recovery we have no definite data, but there is the danger that the oviducts may occasionally become occluded during the course of the disease, and cause sterility. The following cases are illustrative : CaAsE 1.—A mare, aged 15, entered our clinic March 11, 1899, because of a vaginal discharge. An examination revealed a copious discharge of dirty, whitish pus from the uterus. The os uteri was constricted. The uterine cavity was first injected with warm water, and later with 1-5000 corrosive sublimate solution. On March 12, a horse catheter was introduced through the constricted os, and 1 gallon of pus siphoned out, after which the cavity was injected with 1-5000 corrosive sublimate solution. This line of treatment was continued until the 16th, when the os and uter- ine cavity were tightly packed with gauze saturated with creolin solution. On March 23 the os had become dilated, and the uterus had regained its power, so that the pack of gauze was expelled. There was no longer an appreciable amount of pus in the uterus. On March 25 the packing of the uterus was discontinued, and creolin solution was substituted for the corro- sive sublimate for irrigating. The suppuration had ceased, and the mare was discharged. The treatment had occupied a period of two weeks. CasE 2.—The patient was a mare aged 9g yrs., weighing about 1,100 lbs, She was entered on January 9, 1900, with the history of a vaginal discharge since June, 1899, or a period of seven months. She had been served in June, 1899, without result. Exploration per rectum revealed the uterus greatly distended with fluid. A rubber hose was passed into the uterus, and 5 gallons of pus were siphoned out. A weak solution of creolin was then injected into the uterus by gravity, and allowed to escape. The uterine cavity was then packed with three yards of cheese-cloth saturated with 2% creolin solution. On January Io the same treatment was applied, and 5 yards of cheese. cloth were used in packing. The same course was pursued on January11. On January 12 the uterus was washed with creoline solution, and packed with gauze saturated with carbolic acid solution, which was left in place until January 14, when it was re-dressed. On January 15 the patient seemed worse. In order to bring about a more complete dilation of the constricted os, a new plan of packing was adopted. A bag was made of sufficiently strong cloth, with a diameter of about 4 or 5 inches and a length of 3 feet. It was saturated with creolin solution, sprinkled with iodoform, and then oiled, and the closed end passed into the uterus. Through the open end there were then passed 3 yards of cheese cloth, partly into the uterus but largely in the canal of the cervix. Chronic Metritis in the Mare 891 There was given internally for the five following days 1 dram of pow- dered nux vomica and one-half dram sulphate of copper twice daily. A manual examination of the uterine cavity showed that the cornua, in their paretic state, tended to become reflexed upon themselves in a way to pre- vent good drainage. This difficulty slowly disappeared as the case pro- gressed. On January 17 the creoline injection was displaced by 1-2500 corrosive sublimate solution, and, in addition, iodoform powder was intro- duced into the uterus on January 20, 22 and 23. She now improved very rapidly. The‘internal treatment was continued. The mare was discharged on the 23rd, convalescent, after fourteen days of treatment. CASE 3.—A mare, aged 4, weighing about 1,050 lbs., was entered on Janu- ary 7, 1901, with the history that she had suffered from a vaginal discharge since one year old. The discharge was of a light color, and was dropping away continuously, keeping the tail and thighs badly soiled. She had not been bred, and had never shown signs of estrum. Upon making a manual exploration, it was found that the os uteri was open and the hand could be passed through it readily. The right cornu appeared normal, while the uterine body, with the left cornu formed a remarkably large, elongated cavity. The uterus and cornu had the peculiar property of ballooning, like the vagina, under the movement of the hand. . The case is inserted here because of its unique character. It offered the general external appearances of chronic metritis, except that the discharge was mucoid in character instead of purulent. The difficulty was evidently teratologic in character, and the uterus had developed like the vagina, and should physiologically have been considered a part of that organ. CasE 4.—An imported French draft mare, aged 23, and weighing about 1,350 lbs., was entered in the clinic on February 13, 1902, for chronic metritis. She had a copious discharge of a thick, fetid pus from the vul- va. The tail had a number of small melanotic tumors.. The uterus was washed with a weak solution of carbolic acid. On February 14 the dis- charge seemed somewhat decreased, and potassium permanganate solution was used for irrigating. The same was repeated on the 15th. Onthe 17th the uterus was packed with cheese-cloth saturated with iodoform and vaseline. On the 18th the pack was omitted, and the uterus was washed with a solution of carbolic acid and bi-carbonate of soda, which was con- tinued on the 19th and 20th. On the latter date there was but a small amount of discharge. Onthe 21st the discharge seemed worse. The uterus was washed as before. Following the washing, a suppository of iodoform, tannin, vaseline and beef tallow was introduced into the uterus. On the 22nd the uterus was washed with carbolic solution, and afterit had been expelled there was inserted into the uterine cavity, and allowed to remain, a solution con- sisting of tannin 1 0z., carbolic acid 1 dram, glycerine 4 oz., tepid water I pint. This treatment was continued daily until March 3, when the patient was discharged practically convalescent, with directions for the owner to continue the disinfection of the uterus for seven or eight days. CASE 5.—A farm mare, aged 11, was entered in the clinic on April 25, 1904. She had been owned by the party who presented her for three years. Elev- 892 Veterinary Obstetrics en months prior to entrance she had been taken to a stallion for breeding, and when the stallion groom examined her he thought that the os uteri was much constricted. After using considerable force he succeeded in passing one finger through the os. Immediately afterwards she was served, but did not conceive. Since that time she had regularly shown signs of estrum. Six months prior to entrance in our clinic, the owner observed intermittent discharges from the vulva, of a thick, white, muco-purulent character. At times while at work, she would discharge a large amount of pus, and then for several days the discharge would virtually cease. Examination revealed the os uteri rigidly contracted.. After repeated and laborious attempts we succeeded in passing two fingers into the uterus. We introduced a piece of rubber hose into the uterus, and withdrew seven quarts of a thick, grayish-white viscid pus. We then washed the cavity of the uterus repeatedly with 1-1000 corrosive sublimate solution, after which we introduced some two quarts of the solution into the cavity, and allowed it to remain. We then packed the os uteri firmly with gauze. Internally we prescribed copper sulphate I—1% oz., nux vomica 3 0z., potassium iodide 5 oz., mixed and divided into twenty-four powders, of which two were directed to be given daily in the food. During the forcible dilation of the os, the mare strained violently and offered considerable resistance. On April 26 the mare was straining a great deal, though not very violently. After removing the pack, it was found that the os had dilated but little. The rubber hose was again introduced into the uterus, and the cavity thoroughly washed out with a'solution of lysol. After repeated injections until the siphoned fluid canfe away clear, we introduced into the uterus a solution consisting of tannin I oz., carbolic acid 1 dram, glycerine 4 0z., water I pint. We then packed the os as tightly as possible, after which she strained very violently. She was given one ounce each of chloral and powdered ginger, which gave relief. On April 27 there seemed to be little progress in dilating the os by means of the pack. After thorough disinfection of the parts, the os was forcibly dilated until the hand could be passed into the uterus. The uterus and horns were found greatly dilated, with thickened, paralysed walls. After thoroughly irrigating the cavity with lysol solution, we deposited about 1 dram of powdered iodoform in each cornu, and injected, and al- lowed to remain in the uterus, the solution used upon the preceding day. We then inserted into the os a gauze bag, which had been smeared with iodoform and lard, and followed this by packing the bag as full as possible of surgeon’s cotton, saturated with corrosive sublimate solution. On the 28th we removed ‘the pack, and found no accumulation of “pus. The cavity was washed with lysol, after which the solution of carbolic acid, tannin and glycerine of the preceding days was repeated. On April 29 ex- amination showed that the uterine walls were resuming their normal condi- tion and contractile power. The treatment of the previous day was repeated. The same treatment was applied on the 3oth, and the case was left without interruption on May 1. Examination on May 2 showed a small amount of mucus in the uterus. The treatment of the previous days was repeated. Chronic Metrit’s in the Mare 893 Recovery was now rapid, and she was discharged fully convalescent on May 7, or thirteen days after the beginning of the treatment. CaSE 6.—A mare aged 14, weighing about 1,050 lbs., was entered in the clinic on October 6, 1904, for poll-evil. During the operation for poll-evil, under chloroform, there was a constant discharge of a very fetid black pus from the vulva. A rubber hose was inserted into the uterus, and 4 gallons of pus siphoned away. Upon the following day one and a half gallons of pus were removed, and the uterus was washed with a solution of potassium permanganate 1-500. Three of these injections were employed consecu- tively, each consisting of 2% gallons of the fluid. On the third day the amount of pus colleated in the uterus had decreased to one quart. The treatment of the previous days was repeated. The accumulation of pus in the uterus gradually decreased from day to day, and became lighter in color. On October 12 the pus had assume the ordinary muco-purulent character in colour and consistence, and was free from odor. On the first day there appeared to be some blood clots in the discharge, and the highly fetid pus had the appearance of broken-down melanotic tis- sue. Microscopical examination of the pus revealed streptococci, and a peculiar fungus which was apparently responsible for the color. From the beginning of our treatment the mare had received daily in her feed % oz. of iodide of potash and %{ oz. powdered nux vomica. On Octo- ber 18 the administration of potassium iodide and nux vomica was decreased one-half; the discharge was constantly growing lighter in color; and the pus was being replaced by mucus. During the entire course of treatment the os had been very much con- stricted, and each day forcible dilation was attempted, but it was not until the 2oth that it was practicable to insert the entire hand into the uterus. On the 22nd, the potassium permanganate injection was replaced by the car- bolic acid, tannin and glycerine solution described in the previous cases. On October 24 the same treatment was repeated, with the addition of one ounce of powdered iodoform deposited in the uterus before the injection of the disinfecting solution. On October 26 the os was well dilated, there was a small amount of mucus present, the uterine walls were contracting, and and the patient was convalescent. She was discharged on October 27, after twenty-one days’ treatment. CASE 7.—A mare. aged 7, weighing about 1,000 Ibs. was entered in the clinic on October 13, 1904, for chronic metritis. The owner related that she had had a very pendulous abdomen for some time and had shown an inter- mittent vaginal discharge. She had expelled a considerable quantity of pus on the day of entrance. A rubber tube was inserted into the uterus, and 5 gallons of thick, whitish pus withdrawn. The cervix uteri was hard and unyielding, and the os much constricted. The mucosa of the uterus felt much thickened. Only two fingers could be passed through the os into the uterus. The uterus was washed daily, up to October 20, with a solution of permanganate of potash. On October 20 the permanganate of potash was discontinued, and in its stead we injected into the cavity a solution consist- 894 Veterinary Obstetrics ing of tannin one ounce, carbolic acid one ounce, glycerine three ounces, and water one gallon. This line of treatment was continued until October 25. Throughout the course of the treatment, attempts had been made to dilate the os uteri, but had not succceded, and consequently on October 25 we in- serted a uterine dilator, and forcibly dilated the os uteri until the hand could almost be passed into it. The os was packed with gauze saturated with 2 per cent. lysol. On the following day there was a considerable ac- cumulation of fetid pus, and the os uteri was much swollen. The uterus was washed with 0.5 per cent. potassium permanganate solution, and the os was packed with gauze saturated with lysol solution. On October 27 we suc- ceeded in inserting the hand into the uterus. he treatment of the previous day was repeated, and continued until November 3, when the cavity was injected with corrosive sublimate solution, after which we deposited in the uterus half an ounce of iodoform and two ounces of olive oil. This line of treatment was now continued, and the case improved rap- idly until November 16, when the patient was discharged convalescent. CASE 8.—A farm mare, aged 21, was entered in the clinic on May 3, 1905, for chronic metritis, The owner related that a whitish vaginal discharge had been present to some extent for three years. She had given birth toa foal in the spring of 1904, since which time the discharge had been much increased. The os uteri was dilated so that the hand was readily passed into the cavity. The uterine walls were flaccid and thickened. The uterus con- tained a collection of fetid pus. The uterus was washed with a 1-2,000 cor- rosive sublimate solution. Owing to the paretic condition of the uterine walls, there was difficulty in expelling the fluid. She was given internally nux vomica and sulphate of copper. The case was discharged on the day of entrance, and the owner was directed to wash the uterus daily with 1-2,000 corrosive sublimate solu- tion. It was later reported that in the hands of the owner the treatment proved unsatisfactory and the animal was destroyed. 6. CHRONIC METRITIS IN THE Cow. Chronic metritis in the cow occurs chiefly in those animals which are closely housed, used for dairying purposes, and regu- larly bred. The causes appear to be chiefly retained fetal membranes or improper manipulations during dystokia. It appears to be especially common in the granular venereal disease, or granular vaginitis. Whether in these cases it results indirectly from re- tained placenta as a consequence of the disease, or directly from the extension of the disease into the uterine cavity, is not clear. The symptoms in the cow consist mainly of a chronic purulent discharge, of adirty gray color, accompanied sometimes by in: different health, with loss of condition and decrease of milk. In many cases, in addition to these general signs, thereis, in the i a i a iach aS Pyometra in the Bitch and Cat. 895 “cow, a tendency to prolapse of the vagina. Usually the dis- charge occurs while the cow is in the recumbent position, and the dirty reddish-gray accumulation is found lying behind the patient in the gutter. In cases where prolapse of the vagina occurs, the discharge from the uterus may largely pass un- noticed. In many cases of chronic metritis in the cow, the dis- charge from the uterus is intermittent, may be comparatively insignificant in volume, and therefore not readily observed. When such a discharge appears at the vulva, or the animal seems to be in indifferent health, or is sterile, it is well for the veterinarian to make a manual exploration of the uterus and de- termine its condition. If chronic metritis exists, the uterus will be found enlarged, according to the amount of pus retained within its cavity. The amount of liquid within the uterus may vary between one pint and 4 or 5 gallons. Theos uteri is firmly closed ; otherwise the imprisonment of the pus would not be so marked. Chronic metritis in the cow constitutes an im- portant cause of sterility. Handling. The handling of chronic metritis or pyometra in the cow must be based upon the same general principles as al- ready related in detail for the mare. In the disinfection of the organ one may follow the method already suggested for the mare, dilating the os uteri and injecting disinfectants into the uterine cavity. The problem of dilating the cervical canal in the cow is far more difficult than-in the mare, because of ana- tomical conditions. ‘The treatment consequently requires more time and effort than in the mare. A second plan for dealing with chronic metritis or pyometra in the cow has been proposed by Hess, and already described while discussing the subject of sterility on page 224. According to Hess, his plan of handling pyometra by pressing out the per- sistent yellow body of the ovary, and then applying massage to the uterus from before backward, has been followed by gratify- ing results. This plan has proven effective in our hands. c. PYOMETRA IN THE BITCH AND CaT. In the bitch and cat, pyometra seems most common in those animals which have been bred and later excluded from breeding, but may occur in animals which have not been bred at all. The symptoms are very similar to those already noted in the 896 Veterinary Obstetrics mare and cow, and include a general weakness and emaciation of- the patient, combined with a grayish-red discharge from the vul- va, which stains the bedding. When the uterus becomes much distended, the size of the abdomen may be augmented, and the enlarged, fluctuating uterus may be recognized by abdominal palpation. The handling of the disease in these animals is to be based upon the same general principles as in the preceding cases, modified by differences in the size of the patient and the form of the uterus. Owing to the smallness of the uterus, and its form, it is well- nigh impossible to effectively irrigate and disinfect its cavity. A catheter or other tube may be pushed along through the vagina into one of the horns, but it can scarcely advance to the apex or be introduced at will into the right or left cornu ; nor can the vet- erinarian determine, after it has entered one of the cornua, which one it occupies. The irrigation with antiseptics is consequently indefinite and unsatisfactory. Hobday (Vet. Jour., Jan., 1907, page 30) relates that he has had favorable results in rare instances by the administration of the extract of hydrastic Canadensis, while a solution of the same was used as an injection into the vagina. Hobday recommends, instead of antiseptic irrigations or inter- nal medication, the operation of hysterectomy, because as a gen- eral rule the more conservative measures ultimately fail to bring about recovery, while hysterectomy in his experience has been safe and efficient. The technic of this operation has been de- scribed on page 669. It is essential to carry out the operation under the strictest aseptic precautions, and to this end it is well that the operation be performed under general anaesthesia. 3. UTERINE ABSCESS. When chronic purulent metritis is complicated with atresia of the os uteri, there ensues a condition which may be best de- scribed as uterine abscess. The line of demarcation between chronic metritis or pyometra, described in the preceding article, and uterine abscess is not clear. In the former the evacuation of the uterine contents is sometimes constant and sometimes intermittent. The intermittent character may be due to a ee ee ee Uterine Abscess 897 temporary atresia of the os or the cervical canal, and the final discharge of the accumulated fluid may be the result of a breaking down of the adhesions in the canal, in a way which might be compared to the rupture of an abscess. In some cases, however, the atresia or closure of the os is more persistent, and brings about a state which cannot be better designated than as abscess. The causes of abscess of the uterus are similar to those of chronic metritis, and are very largely referable to infection fol- lowing manipulations during dystokia or to retention of the fetal membranes. The symptoms of uterine abscess differ from those which are typical of chronic metritis. The disease is observed chiefly in the mare. ‘The principal symptoms observed are those of general debility accompanied by some emaciation and general appear- ances of ill-health, with evidences of abdominal pain, which may be described as colic. Later, expulsive efforts appear. The uterine walls serve as abscess walls, and the tension within the cavity constantly increases, until finally the walls rupture in the direction of least resistance, and the contents escape. So far as we have observed, the abscess ruptures into the vagina, appar- ently through the occluded os uteri. Under these conditions a manual exploration per rectum re- veals an enormously enlarged uterus, very tense and fluctuating. The uterus may contain as much as 4 or 5 gallons of pus. ‘The organ loses its usual form, and becomes more or less spherical. Manual exploration per vaginam reveals a normal vulva and vagina ; but the os uteri is absent, and that portion of the uterus which normally projects into the cavity of the vagina has be- come wholly effaced. The anterior wall of the vagina appears as a tense partition, without any opening toward the uterus. Through this wall the distended organ may be readily felt, or rather we might say that the anterior vaginal wall, with which the hand comes in immediate contact, constitutes the posterior wall of the abscess cavity. In one mare we had considerable difficulty in overcoming dys- tokia. After the fetus was removed by means of embryotomy, the mare did not recover with that promptness and completeness which should be expected, and finally began to decline. Later 57 898 Veterinary Obstetrics she was presented for examination because of frequent colicky pains and expulsive efforts. Upon manual exploration per rectum, the uterus appeared as an immense spherical sac contain- ing 5 or 6 gallons of liquid. Upon introducing the hand into the vagina, the os uteri could not be definitely recognized, and there was no opening extending forward into the uterine cavity. - The owner hesitated about an operation, and after a few days, upon going to the stable in the morning, he found lying in the stall behind the mare some 5 or 6 gallons of thick and extremely fetid pus. Handling. The treatment of uterine abscess shoud be essen- tiaHy the. same as that for other abscesses. The abscess cavity should be freely opened, and its contents evacuated, followed by thorough disinfection. The point for opening the abscess is through the occluded os uteri. The opening may be made with a scalpel, or a finger may be thrust through the wall, if not too dense. ‘The opening should be sufficiently dilated that the hand may be passed through into the abscess cavity. The later treat- ment is the same as for chronic metritis. The prognosis in uterine abscess should be guarded. The life of the patient may usually be saved. The abscess tends to cause occlusion of the oviducts and consequent sterility. 4. VAGINITIS AND VULVITIS. Inflammation of the vagina and vulva almost inevitably ac- company acute metritis, because the passage of infected and irri- tant discharges from the uterine cavity must contaminate the mu- cous membrane of these organs in escaping externally. In such cases the vaginitis and vulvitis normally disappear when the me- tritis recovers. Aside from this we sometimes meet with inflam- mation of the vagina and vulva without the uterus becoming in- volved. Causes. Anything which may cause contusions, lacerations or. abrasions of the vaginal and vulvar mucosa tends to cause the dis- ease, if added to this there is favorable opportunity for infection. In dystokia, the manipulations of a careless obstetrist may do much to lacerate and abrade the vagina and bring about infec-. tion of the wounds. Laymen and empirics, as well as some vet- erinarians, frequently use old, dirty cords or ropes, made of very coarse, harsh material, for carrying out obstetric operations. 7 Vaginitis and Vulvitis 899 These lacerate and abrade the genital passages in a highly repul- sive manner, and simultaneously deposit the infection in the maimed tissues. Add to these, dirty hands of careless operators and the virulent infection from a putrid fetus or fetal metbranes, and a highly dangerous infection of the vagina or vulva is almost inevitable. Necessarily no differentiation can usually be made between inflammation of the vagina and of the vulva, since these two canals are continuous at the time of parturition, and the vagina cannot well be involved without the vulva sharing in the disease to a greater or less extent, and vice versa. Inflammation of the vagina or vulva may lead to suppuration, ulceration or gangrene. Necrosis of the lips of the vulva, or of the walls of the vagina, may lead to a rapidly fatal termination ; or, should the patient survive, the vulvar lips may slough away, and more or less atresia of the vulva or vagina result. While dealing with dystokia in the anterior presentation, due to the extension of the posterior limbs beneath the fetal body, we re- lated, on page 778, three cases in which serious vulvitis, vaginitis or cystitis followed, one case ending fatally. The lips of the vulva, and the mucous membrane of the vulva and vagina, become inflamed and swollen. If the lips of the vulva are parted, the mucosa is observed to be of a deep red or dark blue, or a necrotic greenish-black. Usually there are also visible lacerations or abrasions of the mucous membrane, with more or less suppuration. ‘The swelling and pain in the parts may cause difficulty in defecation or urination. The prognosis of vaginitis and vulvitis must be based upon the extent and virulence of the infection. Where the necrosis of the tissues is not extensive, the prognosis is usually good; but when there is extensive gangrene, accompanied by general septicaemia, a fatal issue may be expected.. In cases of more or less exten- sive ulceration or gangrene, without marked septicaemia, there may be highly important adhesions or constrictions, which may serve to prevent thereafter the breeding of the animal. The treatment of vaginitis consists essentially of disinfection, which needs be vigorous and thorough. The attending veteri- narian should guard with all possible care against septicaemia in cases of gangrene, by the administration internally of quinine, goo Veterinary Obstetrics potassium iodide or other similar remedies in large doses, in addi- tion to vigorous local disinfection. In all cases of dystokia where the obstetrist has reason to fear vulvo-vaginitis, he should apply strict ‘prophylactic measures, in the form of careful and repeated irrigations with warm antisep- tics, and the washing of the tail, vulva, anus and surrounding parts frequently with reliable antiseptics like 2.5% carbolic acid solution. 5. CYSTITIS. Septic inflammation of the bladder, as a result of puerperal in- fection, is not a very common malady in domestic animals. We have observed one case in the mare, which we have already briefly related at the bottom of page 778. After overcoming the dystokia, the vagina and vulva were cleansed as well as practicable, but the case was neglected and not seen by us again for some weeks, when we found severe vag- initis, vulvitis and cystitis. The cystitis was the most formid- able 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 over 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 kept these parts repulsively soiled and excoriated, and the tail constantly wet and filthy. The treatment of purulent cystitis consists essentially of the disinfection of the vagina, vulva and bladder. Somewhat mild and efficient antiseptic fluids, such asao.5% solution of carbolic acid, or, perhaps better, 0.1% permanganate of potash, should be injected into the cavity of the bladder. On account of the precipitation of the urinary salts on the walls of the blad- der, it might be well to slightly acidulate the fluids injected into the viscus, in order that the urinary salts may be dissolved, and hence the irritation caused by their presence overcome. ‘The disinfection of the vagina, vulva and bladder should be frequently repeated, at least once a day, and persisted in until complete recovery is assured. 2 5. ; Pert-vaginal Abscesses gol 6. PERI-VAGINAL ABSCESSES. In difficult labor, much of the violence to the genital tract is concentrated upon the vagina and the pelvic portion of the uter- us. These parts may be caught between unyielding portions of the fetus and the bony walls of the pelvis, and become more or less seriously contused, abraded or lacerated. In addi- tion to these injuries, the obstetrist may irritate the parts in some measure with his hands and arms, and with instru- ments and apparatus, especially with coarse cords or straps for the exertion of traction. Under these conditions the walls of the vagina are liable to become seriously infected. The septic material, finding its way deeply into the tissues, eventually in- duces the formation of abscesses in the walls of the vagina itself or outside in the pelvic connective tissue. More anteriorly, the infection of the vaginal walls may cause adhesions between the vaginal or uterine peritoneum and the wallsof the pelvis, and lead to the formation of abscesses between these two layers of adherent peritoneum or in the adjacent connective tissues. The abscesses occur with greatest frequency, according to our observations, along the floor of the vagina in the region of the bladder, and, when very extensive, press upon that organ and interfere with urination. They may so involve the walls of the bladder as to cause a rupture of that organ, either into the vagina or the peritoneal cavity. The abscesses may rupture into the vagina, rectum, or peritoneal cavity. The symptoms of peri-vaginal abscesses consist at first chiefly of a stiffness in the posterior portions of the body, with a disin- clination to move, accompanied by general febrile disturbances, including. elevation of temperature, loss of appetite and general dullness. The vulva is usually swollen, and upon separating the lips, the mucous membrane is usually found to be swollen and dark colored. Defecation is painful, if not difficult, be- cause of the extreme sensitiveness of the parts, accompanied by more or less extensive swelling. If the abscesses are forming between the pubis and the vaginal floor, the act of urination is almost inevitably accompanied by pain and difficulty. Upon manual exploration of the vagina, the parts are found to be very hot and sensitive, while at some point, most probably along the vaginal floor, extensive, hard swellings may be felt, go2 _Veterinary Obstetrics which, later in the progress of the disease, fluctuate. In amare we observed almost the entire floor of the vagina involved in a series of large abscesses, which extended forward as far’ as the pubic brim. The fluctuation could be readily felt. The ‘parts were exceedingly tender, and the animal moved with very great difficulty. ‘The prognosis of peri-vaginal abscesses must be based largely upon their location and the possibility or probability of their rup- turing or being opened into the vagina or rectum. The handling of peri-vaginal abscesses should be in accordance with general surgical principles, and should consist funda- mentally of opening the abscesses into the vagina or rectum at the earliest possible moment. Inthe instance which we have already cited, we hesitated too long to open the abscess, lest we might thereby open the peritoneal cavity, and hoped for a spontaneous rupture into the vagina, but our delay permitted the abscess to rupture into the peritoneal cavity instead. It is hazardous to delay opening the abscesses. Ifthey cannot be safely opened into the vagina or rectum, then fatal rupture into the peritoneal cavity is practically certain. Thorough irrigation of the vagina and abscess cavity should be applied daily or more frequently, according to circumstances. Internal antiseptics, such as quinine and potassium iodide, in full doses, are indicated. 7. Pyz#mic INFECTION. Aside from the strictly local infections of the genital tract, lesions of these organs afford a portal for the entrance of infec- tions of various kinds into the system. The infecting organisms may gain the lymph or blood circulation, and be carried to distant parts of the body, where they may become lodged to multiply and produce localized inflammation, with the formation of ab- scesses or other changes, to constitute pyeemia. Pyzmic in- flammations may involve any tissue or organ in the body, and consequently may produce a great variety of symptoms. In ob- stetric practice we observe chiefly, as pyeemic diseases belonging to the puerperal state, poly-arthritis or pyzemic arthritis, and metastatic inflammation of tendon sheaths. a, Poly-arthritis may be defined as an arthritis following par- turition, and generally involving several joints, especially the tarsal, carpal, and femoro-tibial articulations. No articulation is Pyemic Infection 903 immune. According to de Bruin the disease may have its origin in the articular serous membrane or in the bone marrow, and may be either serous or purulent in character. It is observed chiefly in the cow. pe Ob It is believed that the infection reaches the articulations pri- marily by being taken up by the veins from the uterus, probably in the form of small thrombi, which, passing to the heart and thence to the lungs, succeed in passing through the latter organs and gaining the systemic circulation, through which they event- ually reach the synovial membranes or marrow of the bone, where the micro-organisms lodge and multiply to induce arthritis. Asarule poly-arthritis follows some recognizable puerperal infection of the uterus, such as retained placenta, or other dis- ease, followed by more or less evident metritis or vaginitis. In some instances the disease follows an apparently normal puerpe- ral period, presumably because some very small wound of the mucosa of the genital tract, or other injury, has led to an infec- tion which has escaped notice until the arthritis appears. The symptoms of poly-arthritis usually appear at about 6 to 8 days after parturition, though they may be delayed for some weeks. They consist chiefly of stiffness in the gait, accompanied by more or less distinct lameness and difficulty in getting up. Pain is very evident, and the animal assumes the recumbent posi- tion for a large part of the time. There is well marked fever, with the accompanying symptoms of loss of appetite, cessation of rumination and a decreased secretion of milk. An examina- tion of the uterus may reveal the presence of retained placenta, or of a dark-colored fluid, which may or may not be fetid. The pain in the affected limb is so great that the animal de- clines to bear weight upon it so far as avoidable. The capsule of the joint is distended and tender. The epiphyses of the bones are sometimes swollen and painful. If more than one joint is simultaneously involved, the movements of the animal become exceedingly difficult and painful. The symptoms may be com- plicated by metastatic inflammation, or abscesses of some of the internal organs, which may cause edema of some of the depen- dent parts of the body. The prognosis is variable. If the arthritis is serous in char- acter, perhaps we might say if it is due to the irritation of the bacterial products in the part rather than to the presence of 904 Veterinary Obstetrics the bacteria themselves, the disease may run a favorable course, with complete recovery in a comparatively short time. When the bone marrow is involved, the disease becomes more serious, and a fatal termination is probable, as is also the case when the dis- ease assumes a purulent character and abscesses form in or about the articular capsule. Upon post-mortem examination the synovial membranes of the joints are found reddened and thickened, and the superficial epithelium destroyed. The synovia is of a dark yellow color, or purulent in character, while the tissues outside the capsule are infiltrated. Scattered here and there are small purulent cen- ters. The articular cartilage may be eroded and destroyed, and the epiphyses of the bones may have undergone purulent de- struction. ‘ Handling. Our first carein the handling of the disease should be the thorough and repeated disinfection of the genital tract, in order to prevent further absorption of septic material from the original source. If the fetal membranes, or fragments of them, still remain in the uterus, they should be removed. If some of the cotyledons are necrotic, and destined to slough away, the pro- cess should be hastened by their removal, and the organ thorough- ly irrigated with antiseptic solutions. Reliable antiseptics should be applied to the affected articula- tions by means of a large pack of cotton, jute or oakum, kept constantly saturated with the disinfectant. In some instances where the bone is extensively involved, it has been recommended to apply the thermo-cautery in small punctures. When ab- scesses form about the joint, they should be treated according to surgical principles, though as a general rule they cannot be suc- cessfully handled. Internally the animal may receive antiseptics, among which de Bruin especially recommends camphor and turpentine. 6. Metastatic Tendovaginitis. Under this title de Bruin describes an inflammation of the tendon sheaths of cows during the puerperal state, occurring chiefly in the great flexor tendons. The symptoms consist of a stiffness in the gait, with evidences of pain, accompanied by loss of appetite and of milk secretion, and a tendency for the animal to remain in the recumbent posi- tion. Examining the animal locally, the veterinarian finds the tendon sheaths hot, swollen and tender. The disease may co-exist Pyemic Infection 905 with poly-arthritis. The prognosis is fairly good if only one of the limbs is diseased ; but if all are involved, extreme emacia- tion is probable, along with extensive decubitis gangrene. These tend to greatly complicate the disease, and render the prognosis very grave. Even here, however, prompt and vigorous meas- ures may save the life of the animal. Handling. The general line of treatment is identical with that of poly-arthritis. The uterus should be cleansed and disin- fected. The affected tendon sheaths should be enclosed in anti- septic packs, which are to be kept constantly moistened. If the tendon sheaths undergo suppuration, they should be freely opened from end to end upon the median line, and the cavity packed with gauze saturated with tincture of iodine, in order to bring about at once a thorough disinfection of the parts. Over this there should be placed an ample pack of surgeon’s cotton or oak- um, saturated with a reliable antiseptic. 8. PUERPERAL SEPTICAMIA. Puerperal septicaemia signifies the entrance into the general system of septic products, accompanied or not by the bacteria by which these products have been formed. Technically a distinc- tion is made between septiczemia—by which pathologists under- stand the entrance of micro-organisms along with their products into the blood, and the continued multiplication of the bacteria in the body fluids—and sapreemia or toxzeemia—by which is understood the entrance into the blood of the bacterial poisons only. Clinically the differentiation between septiczemia, bacteri- zmia and sapreemia is not easily defined. Yet they present an essential difference in prognosis. The condition accompanies to a greater or less extent most forms of septic infection of the gen- ital tract during the puerperal state, but the intensity of the septiczemia is not necessarily parallel to that of the local disease. We meet clinically with very extensive septic inflammation of the uterus, resulting from a retained fetus undergoing putrid de- composition over a period of days, weeks or months, or from re- tained placenta undergoing rapid decomposition, during which the cotyledons may become necrotic and slough off, while the de- gree of septicemia or sapreemia may be very insignificant. On the other hand, there: may occur virulent septiceemia in the 906 Veterinary Obstetrics presence of comparatively slight discoverable disease of the gen- ital tract. The disease may follow dystokia or normal birth, and the port of entry for the bacteria may consist of wounds or abrasions or of the denuded mucosa, resulting from the separation of the pla- centa. The organisms may be introduced by the obstetrist or other persons upon the hands or arms ; by means of instruments or apparatus, or in various other ways. Symptoms. The symptoms of septicemia are acute. The disease is usually ushered in suddenly in from one to four or five days after parturition or after the death of the fetus, with open os uteri and decomposition of the uterinecontents. The symptoms consist chiefly of the general signs of fever, including elevation of temperature, cessation of feeding and of rumination, decrease in milk secretion, quickened pulse and respiration, with injection of the ‘visible mucous membranes. Locally there is swelling of the vulva, and when the dis- ease is very intense the vulvar lips may become greatly tumefied, cold to the touch and blue-black in color. The vulvar mucosa is swollen and dark colored, and may show wounds or ulcers. The contents of the uterus may consist of shreds of placenta, with accumulations of pus of variable color, which is usually very fetid. The patient generally shows extreme weakness and listless- ness. Most animals tend to lie down much of the time. The eyes soon become lustreless ; in the cow they may appear swol- len. Ruminauts may grit the teeth, and moan. The bowels are irregular, at one time showing constipation, at another a fetid diarrhea. If purgatives are given, especially saline, oleaginous or aloetic, superpurgation is highly probable. Acute puerperal septiczemia is usually fatal, generally ending in death within a few days. It sometimes runs a very stormy course. We have observed cases in the cow which have ended fatally in less than 24 hours after the advent of signs of disease. Pathology. The changes in the genital tract are not always in harmony with the profound effect upon the general system. A diligent search may fail to reveal very pronounced changes in the uterus or vagina. The blood is thin and does not coagulate, and the muscles are pale and have the appearance of having been cooked. There may be more or less evident metritis, with all the changes belonging to that affection. Pyemic Infection 907 The peritoneum shows here and there ecchymoses. Ente- ritis may be present. The liver, spleen and kidneys show well- marked degeneration, and are somewhat enlarged and friable. Handling. All attempts at therapeutics usually fail. De Bruin recommends camphor, turpentine and alcohol, but without having any faith in their bringing about a cure. He very prop- erly places the chief emphasis upon the question of prophylaxis. Especially is it important that the veterinary obstetrist should take due precautions against acting as a bearer of the infection through his person, instruments or apparatus. Any animal suffering from septic infection of the genital tract, or, for that matter, of any other organs or tissues, should be care- fully excluded from the stable and vicinity of parturient animals, and there should be no intermediary communication between them by which the transportation of infecting material from one to the other is rendered possible. : Whenever a veterinarian is called to attend a parturient ani- mal suffering from fever or other systemic disturbance, the genital tract, and especially the uterus, should first of all be thoroughly examined in order to determine whether it be the avenue of a serious infection. Should the examination reveal septic utero-vaginal disease, no time should be lost in thoroughly cleansing and disinfecting the genital tract. Time and again the careless veterinarian treats an animal, especially a cow, for indigestion, constipation, diarrhea or some other symptom of disease, without taking the trouble to examine the uterus and learn therefrom that the constipation, diarrhea or or other symptom which he is handling is dependent upon a serious puerperal infection, which demands prompt and vigorous treatment. ‘The handling of these conditions falls essentially under ‘‘ Retained Placenta,’ page 791, and ‘“‘Acute Metritis,’’ page 872. 9. PUERPERAL LAMINITIS. PATURIENT LAMINITIS. While describing endometritis in the mare we had occasion to refer to parturient, or puerperal laminitis. So far as we have been able to determine, parturient laminitis occurs in the mare only, though there is no reason why it may not occur in ruminants, where laminitis from other causes is not unknown. Flem- 908 ; Veterinary Obstetrics ing cites Roloff as having observed a peculiar inflammation of the feet of cows just after parturition, though the description which he gives does not fully identify it with laminitis. Parturient laminitis inthe mare is a well-nigh constant accom- paniment of endometritis. It is so common that it may be re- garded as an essential part of that malady. It is probably overlooked sometimes because there are present, in endometritis of the mare, two painful areas—the abdominal pain due to metri- tis, and the pain in the feet from the laminitis, each of which induces a stiffness in the gait which is very much like the other. The nature of parturient laminitis, so far as we have been able to observe clinically, does not differ in any essential respect from the laminitis due to irritation of the intestinal tract from indiges- tion. It appears to be a purely metastatic inflammation, depend- ent directly upon the irritation in the uterus as a result of en- dometritis, and the absorption from the uterine mucosa of the products of bacterial decomposition. The symptoms of puerperal laminitis are identical with the symptoms of the laminitis following indigestion. It usually occurs in those cases of endometritis in the mare which have their origin in a retention of the placenta in the non-gravid horn of the uterus. Asarule it follows an apparently normal birth, in which the placenta has been expelled promptly, and so far as the owner observes, completely, but that portion of it which has occupied the non-gravid cornu has been broken off and re- tained. In the course of 48 to 72 hours after parturition, there appear the general symptoms of endometritis, as already de- ‘scribed on page 874. Upon examination, the fragment of placenta may still be found in the non-gravid cornu. At the same time that the symptoms of endometritis are first observed, well-marked laminitis also usually appears. The disease may involve the two anterior feet, or all four feet. As in ordinary cases of laminitis, the animal moves with great difficulty, and places its weight upon its heels so as to relieve the sensitive laminze upon the anterior walls of the feet from pres- sure as far as possible. If the disease is very severe, the animal tends to persistent recumbency, or stands riveted to the spot and can hardly be induced to move. Examination of the hoofs reveals a distinct elevation in their temperature, varying of course according to the intensity of the attack. Throbbing of the arteries of the feet is very evident. Puerperal Tetanus 909 The prognosis of the disease is generally highly favorable, and is parallel to the prognosis of the endometritis. In fact the two diseases are inseparably bound up together, so that their prognosis and handling are essentially identical. Like laminitis from other causes, so puerperal laminitis is largely a disease of the draft animal. The prognosis will depend to a degree upon the size of the patient. The gravity of the disease increases with the weight of the animal. The handling of the endometritis we have already discussed | on page 874, and it is only essential at this time to consider the local treatment of the laminitis. There are two plans for hand- ling the inflammation of the feet, each of which has its devotees —hot and cold applications. We distinctly prefer the application of cold, either in the form of water or of ice, and that the application be continuous and ample. If the animal is recumbent or can be induced to remain recumbent, so much the better, because it relieves the feet from the weight of the patient. In the recumbent animal, cold water is not readily applied, and consequently one may most con- veniently apply ice poultices, renewing them frequently in order to maintain constant refrigeration. If the animal can readily stand, and will do so, it should be placed in a bath of cold water, the temperature of which may be reduced to a low point by the frequent addition of ice. ‘The cold water bath should extend up to or above the fetlocks, and the floor of the bath should be of some yielding substance, so that the entire plantar surfaces of the feet may contribute to the support of the weight. The shoes should be removed in order to prevent the sinking of the os pedis, or the dropping of the sole may be still better prevented by the application of special padded shoes, and the weight dis- tributed equally over the entire plantar surface of the hoof. The internal treatment and the handling of the uterus, which have already been discussed on page 875, are quite as important as the local applications to the feet. 10. PUERPERAL TETANUS. In discussing the question of retained placenta in the sheep on page 811, and of prolapse of the uterus on page 827, we have alluded to the rare occurrence of tetanus asa complication. We observed one case of tetanus following retained placenta in a cow. gIo Veterinary Obstetrics Tetanus infection may find entrance into the genital tract under still other conditions during the puerperal state, and induce typical tetanus. ‘The obstetrist or others may readily introduce the bacilli into the genital tract, during a case of dystokia or the removal of placenta. Having gained the susceptible genital tract, the organisms may there multiply and induce the disease. The period of incubation, symptoms, pathology and treatment are identical with those of cases of tetanus in which the micro- organisms have entered by other avenues. The number of cases of puerperal tetanus is small, so that the comparative prognosis is uncertain. In the case of prolapse of the uterus mentioned on page 827, the mare recovered successively from uterine prolapse and from tetanus. PUERPERAL ECLAMPTIC DISEASES. In domestic animals there occurs with considerable frequency a group of diseases characterized chiefly bya profound disturbance of the central nervous system, which express themselves either in tonic and clonic spasms or in coma. These diseases appear usually soon after parturition, but may occur during the act or shortly prior to that event. They all run a very rapid and stormy course, with a high mortality, except their course is in- terrupted by prompt and judicious treatment. The pathology of this group of diseases is unknown. Various theories have been propounded to account for the occurrence of these affections, but none of them have met with general accep- tance, and the correctness of none of them has been shown. Post- mortem examinations have revealed various lesions or alleged lesions, which may be regarded as results of, rather than ‘the cause of, the malady. They fail to reveal the true character of the disease. For example, there is frequently found in parturi- ent paresis of the cow a well-marked pneumonia, which we know is not a part of the disease, but an inter-current com- plication due to the inhalation of food particles or medicines. Hemorrhages upon the brain have been found; but this is not strange if an animal has thrown itself about violently for a number of hours, striking its horns with great force against the wall, floor or ground, and thus causing more or less injifty by concussion of the brain. Ina similar way we might account for other lesions which have been discovered upon post-mortem examination. In many instances the post-mortem revelations are zz/, and it would appear from such knowledge as has been gained up to the present time that in reality no lesion has been discovered which constitutes an essential part of the malady, and consequently that its true pathology is unknown. The causes of this group of maladies in domestic animals are unknown. It is difficult to arrive at a general conclusion, be- cause various reasons are assigned, and there is no general agree- ment as to what maladies should be included in the group. In woman there occurs a somewhat common and highly fatal disease known as parturient eclampsia, which some authors con- sider identical with the parturient paresis of the cow, while others strongly dispute the identity or analogy of the two. gli gi2 Veterinary Obstetrics The eclampsia of woman occurs most frequently, or in approxi- mately 50% of the cases, during birth. About 25% occur before parturition, and the other 25% after childbirth. The history of the date of attack of eclampsia in woman and of parturient paresis in the cow are somewhat alike in so far as the occurrence of cases before, during and after birth are concerned, but the percentages of cases during these various epochs are not at all alike. Very few attacks of parturient paresis occur in the cow during preg- nancy or labor, and almost all of them during the puerperal state. Eclampsia in woman is characterized by sudden and severe spasms, which endure for a few minutes, to be followed by a pause and later a recurrence of the spasms. The pause is some- times characterized by deep coma. The disease usually appears very suddenly, without warning, though in some cases there may be premonitory symptomsof unrest, headache and nervous twitch- ings. Then follows dilation of the pupil, with loss of conscious- ness accompanied by clonic and tonic spasms. The jaws are tightly closed, sometimes severely wounding the tongue. ‘The temperature is usually high, and tends to become more elevated as the spasms are more severe. Upon post-mortem examination, the changes which are ob- served can scarcely be considered as characteristic of the disease, or as indicating the essential pathology of it. The symptoms of parturient paresis in the cow admittedly differ widely in a general way from those seen in the eclampsia of woman. This leads Harms to remark that a comparison of the symptoms of eclampsia in woman with this malady would cause anyone who had ever seen a case of milk fever in the cow to at once conclude that they were two wholly distinct maladies. Other veterinary obstetrists believe that the two maladies are essentially identical, in which opinion we concur. The two maladies appear at a similar date as related to parturition, the true pathology of neither has been satisfactorily determined, and post-mortem changes which can properly be considered as the basic lesions of the disease are wanting. In some domestic animals, especially in the mare, bitch and sow, it is not rare to observe a parturient eclampsia which, in history, symptoms, course and termination, is quite parallel to that ob- served in woman. There are present similar tonic and clonic Puerperal Eclamptie Diseases 913 spasms, the well-marked trismus, the pirouetting of the eyes, the elevation of temperature, the stormy course and the high mortality. Though we usually observe profound coma instead of spasms in the parturient paresis of the cow, this does not prove the non- identity of it with the eclampsia of woman. ‘Tonic and clonic spasms are common in woman, and in some of the domestic ani- mals, from a variety of causes. Coma in some animals, like the horse, is exceedingly rare. In the cowcoma is a common symp- tom of disease, and occurs in many maladies. We see it in indi- gestion, especially from over-feeding, in which, in the horse, in man or in carnivora, we might see spasms. We observe coma in the cow as a result of infections from the uterus or udder, and along with these we may meet with a sub-normal temperature, just as we do in parturient parasis. Coma also appears at inter- vals in the eclampsia of woman, and tonic and clonic spasms ap- pear in the parturient paresis of the cow. The difference in symptoms is not basic, but rather a question of preponderance of spasms as related to coma, or vice versa, in the different patients. In one instance we observed a cow in which the general symp- toms of eclampsia were present a few hours after easy parturi- tion. The pupils were dilated, the eyes were rolled, there was grinding of the teeth with frothing at the mouth, there were clonic spasms, especially of the head and neck, and a general disturbance of consciousness, so that the animal looked and acted as if temporarily insane. The condition lasted for about two hours, when the symptoms passed into those of ordinary parturient paresis, with the profound coma and sub-normal temperature. In other instances of parturient paresis we have observed some- what similar, though less marked eclamptic symptoms in the earlier stages, but these have quickly passed into the character- istic symptoms of paresis. While our knowledge of eclampsia in woman and in the do- mestic animals remains so imperfect as at present, with our equal want of knowledge as to the nature of the parturient pare- sis in the cow, it is impossible to determine precisely what rela- tion they bear to each other. It would appear from the fore- going that, until some positive knowledge as to the actual causes of these diseases is obtained, they should be considered as con- stituting one great group dependent upon the same general 53 914 Veterinary Obstetrics causes. The disease is expressed somewhat differently by the various species of animals. Here and there a case occupies a middle ground between the symptoms recognized as character. istic of two different members of the group, constituting connec- ing links which serve to bind them more or less closely together into a highly interesting class of diseases. a. PARTURIENT ECLAMPSIA IN THE MARE. Parturient eclampsia in the mare is a disease which is closely related to the parturient state, and is expressed chiefly by violent tonic and clonic spasms, which run a very rapid course, and quickly terminate in recovery or death, without producing any lesions yet discovered which may be properly considered as fundamental. So far as we know, the first definite description of this disease was a paper presented by the author before the Illinois Veteri- nary Medical Association, which later appeared in the American Veterinary Review, Vol. 14, page 559. Since that time a few cases have been described which seem to be identical, and in various personal communications, practicing veterinarians have assured us of the occasional occurrence of this malady in their practice. Under the designation of trismus, Plaskett describes cases which appear identical with ours. (American Veterinary Review, Vol. 23, page 254.) There is a bare hint of eclampsia in the mare by Bigniay (Veterinary Obstetrics, p. 660), who, in speaking of parturient apoplexy of the cow, says, ‘‘It is worthy of notice that the first stage of parturient fever, viz., the stage marked by congestion, of the brain, is observed in the mare. It soon terminates in death, as is also sometimes the case with the cow, asa result of apoplexy. Such cases, though not sufficiently substantiated by, the result of autopsies, have been described by Gerard (Veteri- narian, 1874). The mares in question died during: parturition, or soon after.’’ Gerard’s cases were evidently essentially differ- ent from those here described as eclampsia. My first case occurred in an adult grade draft mare, which had at her side a healthy, vigorous foal, some ten days old. The mare had foaled naturally and easily at the ordinary time, and the very apparent vigor of the foal showed clearly that she had, been furnishing an abundant supply of milk. The owner re- Parturient Eclampsia in the Mare 915 ported that a few hours prior to my arrival the mare suddenly became strangely nervous, assuming a wild look, with staring eyes, restlessness, stiffness of gait, twitching of the muscles, occasionally lying down and getting up. The symptoms all very rapidly increased, until she lay prostrate on her side, unable to rise. In this position I found her, with the whole muscular system exceedingly rigid, breathing labored, convulsions con- stant, pupils greatly dilated, mucous membrane livid, firm tris- mus, and the muscles of her limbs so rigid that they could not be flexed sufficiently to raise her upon her chest. The second case was a high grade draft mare, used exclusively for breeding purposes, and aged six years. ‘The mare was quite large, very robust and had foaled ten days previously without difficulty. The foal at her side was very vigorous and well nour- ished. I found the mare lying apparently quiet on her sternum, show- ing no evidence of suffering and looking quite bright and healthy. Upon approaching her, however, she showed marked nervous- ness, and at once tried to get up, but appeared to have lost the power of co-ordination. Her efforts brought on clonic spasms of a severe character. Her hind legs knuckled at the pasterns, much as in azoturia. During my ‘stay she became more nervous and uneasy, making repeated unsuccessful attempts to rise. Respiration was rapid and laborious, and there were constant and severe cramps of the entire body, tremblings and profuse perspiration, all of which appeared to decrease in intensity when we would withdraw and permit her to become more tranquil. The passage of the catheter increased the convulsions quite markedly. There was appar- ently hyperaesthesia of the vulva, and of the body generally. I diagnosed azoturia, and prognosticated a favorable termina- tion. Later observations have shown me that mares with young foals do not contract azoturia ; moreover, the fact that the mare had been running at grass constantly, precluded the possibility of that disease. She died a few hours later. During the summer of 1889 an unusual number of cases oc- curred in rapid succession, showing every degree of intensity. At this date our rapidly developing horse-breeding interests had about reached their maximum in my locality, so that large numbers of mares were kept solely for breeding purposes. Favor- g16 Veterinary Obstetrics able weather during the season furnished exceedingly luxuriant pasturage. During that year I observed seven well marked cases, several of which offered favorable opportunities for observation throughout a greater part of the course of the disease. A well-bred road mare, in high condition, with a vigorous, well-nourished foal, eight to ten days old, at her side, was brought from the pasture preparatory to being bred. Soon after her arrival at the owner’s stable, it was noticed that the mare was restless and nervous, her eyes somewhat staring, and occa- sional muscular twitchings were present. Most noticeable of all was a peculiar, very well-marked throbbing of the chest, which shook the entire body. It seemed like an exaggerated heart- beat, and was quite regular in rhythm and force, but was not rhythmical with the heart-beat. The disturbance seemed great- est along the line of attachment of the diaphragm to the ribs, and the phenomena could be attributed to no other cause than clonic spasm of the diaphragm. ‘There was some trismus present, but not sufficient to prevent the patient from eating with relish and comparative ease. With quietude and moderate doses of belladonna and cannabis Indica, she made a good recovery in a few hours. In another case I was called to attend a half-blood draft mare, aged seven years, in prime condition and perfect health prior to the date of my visit. She had foaled ten days before without trouble, and the foal was vigorous and well nourished. She was then brought from the pasture for the first time, and placed in the stable. Within a few hours, symptoms of disease were manifested. I found the animal in great pain, very nervous, and easily dis- turbed by any movements or noise. She lay down quite fre- quently. While lying, she became more tranquil, and all the symptoms abated. While down, the animal lay on her sternum, and did not attempt to roll; in rising she did so with apparent ease. While standing there were constant clonic twitchings of the muscles of the entire body, spasmodic movements of the limbs, frequent changes in posture, trembling, profuse sweating, with the nostrils widely distended, and the movements stiff as in tetanus. There was no protrusion of the membrana nictatans over the eyeballs, but the eyes were staring, the pupils dilated, and the conjunctive dark livid in color.’ There was severe tris- Parturient Eclampsia in the Mare O17 mus, and the jaws were wholly immovable. As in the pre- ceding case, there was violent spasm of the diaphragm. She was bled freely from the jugular, and given large and repeated doses of belladonna and cannabis Indica. For nearly thirty-six hours the symptoms remained about the same, when they began to abate rapidly, and in 48 hours after the beginning of the attack the mare was in her usual health. On the same day, on a neighboring farm, I attended another grade draft mare with a similar history of recent easy parturi- tion, healthy foal at her side, etc. Prior to my arrival, she had shown a similar train of symptoms to those noted above; but the owner delayed calling me, so that upon my arrival I found the animal prostrate on her side, the whole muscular system thoroughly tetanized, the eyes set and insensible to light, firm trismus, well-marked opisthotomos, repeated severe convulsions of the entire body, readily increased by any sudden noise. Barring the want of protrusion of the membrana nictatans and the greater nervousness, the case closely simulated recumbent tetanus. ‘The animal succumbed after about twenty-four hours. In another case I was called to attend a full-blood draft foal, five or six days old, which was suffering from lameness. In order that the foal might be well attended, the mare was brought from the pasture and placed in the stable. The next morning I was hurriedly called to attend the mare, which I had seen the previous day in apparently perfect health and unusually robust and vigorous. Upon my arrival at the farm I found her greatly agitated, the whole body tetanized, with constant clonic twitch- ings, spasmodic movements of the limbs, hurried, labored respi- rations, nostrils widely dilated, visible mucous membranes of a dark livid hue, firm trismus and profuse sweating. When on her feet she could not stand still, but continually moved about involuntarily, and so very uncertainly that she could scarcely be approached with safety. The perspiration was so profuse that it streamed from the dependent parts of her body, the nose was poked out, the head elevated, the back arched, the tail erected, giving the entire body the posture assumed in severe tetanus; but the well-marked protrusion of the membrana nicta- tans seen in the latter disease was wanting. The animal would lie down frequently, usually on the sternum, in which position she became more tranquil and apparently obtained some relief. 918 Veterinary Obstetrics At other times she lay prostrate on her side, in severe convul- sions, the legs all rigid, so that the upper feet did not touch the ground, but projected in a straight line from the body. The spasm of the diaphragm was so violent that even when the mare was lying on her sternum her whole body shook violently at each diaphragmatic contraction. When the patient was standing fif- teen or twenty feet distant, a loud thumping noise could be heard, emanating from the chest, like violent palpitation of the heart ; but upon close examination it was found that the disturbance was not synchronous with the heart-beat. With great difficulty, owing to the uncertain convulsive move- ments of the animal, I drew about three gallons of blood from the jugular. This was followed by heavy and repeated doses of fluid extract of belladonna and cannabis Indica every hour. My prognosis was very unfavorable, as death seemed imminent. After twelve to fifteen hours the symptoms rapidly abated, and within twenty-four hours after my visit she was apparently in her usual health. In another case, a high-grade draft mare of vigorous constitu- tion, with a well-nourished healthy foal about fifteen days old at her side, was taken from the pasture for the first time since foal- ing and put to light farm work. Ina few hours she had devel- oped all the symptoms enumerated in the preceding cases, and when I arrived she was unable to regain her feet. She rapidly grew worse, and died the same day, within twelve hours from the time she was brought from the pasture in prime condition, and only five to eight hours after the beginning of the attack. Another case was that of a little imported pony mare in high condition, with a well nourished foal at her side, six or eight weeks old. The pony was brought from the pasture for the first time since foaling, saddled, and placed in the hands of children, who used her for a few hours in the morning. At noon the stableman found some difficulty in removing the bit from her mouth. This attracted no particular attention, but when the owner at- tempted to bridle her again after dinner, and failed on account of firmtrismus, it was evident that something serious was wrong. A veterinarian was at hand in a few hours, but the pony rapidly developed all the symptoms enumerated in the preceding cases. She was bled from one jugular on the first, and the other on the Parturient Eclampsia in the Mare 919 second day. In about forty hours after the beginning of the at- tack, the symptoms suddenly abated, and within forty-eight hours the pony was apparently as well as ever. We have here a series of cases presenting symptoms no more varied than we would expect to find in different individuals in different stages of the development of the disease, yet passing from oneinto the other by imperceptible gradations, all apparently due to the same cause. In the earlier stages, and in the very mild cases throughout, all showed the restlessness, the staring, pirouetting eyes, the clonic spasms, especially marked in the diaphragm. In propor- tion to the nervousness, the pulse and temperature are little altered. If unchecked, the clonic spasms are largely succeeded by those of a more tonic nature, trismus becomes a marked symptom early in the malady, the restlessness and convulsions increase in intensity, the respiration becomes more labored, the mucous membranes livid from partial asphyxia, the whole muscu- lar system extremely tetanized. The animal finally becomes unable to stand, or_to find relief in lying on the sternum, but lies prostrate on the side in constant convulsions until it succumbs from asphyxia. The history is quite uniform. The disease occurs wholly in vigorous mares, in high condition, of mature age, but not old. They have recently foaled naturally and easily, and have healthy, well nourished foals at their sides. The mammary glands are well developed and active in all cases. In nearly, if not all the cases I have related, the mares had been enjoying unrestricted freedom at pasture constantly since foaling, until taken up a few hours prior to the attack, which was suddenly ushered in without warning. It seems that a sudden change of surroundings, a change from freedom to the stable or harness, probably by causing maternal anxiety for the foal, has an essential influence in the immediate causation of the disease. ‘The symptoms indicate a grave dis- turbance of the central nervous system, expressed for the most part in convulsions and spasms of the striated muscles. The symptoms we have enumerated as occurring in the mare bear a close resemblance to those of eclampsia of other lower animals and of woman, as well as to the early stages of parturient apo- plexy of the cow. 920 Veterinary Obstetrics The disease in the mare is ushered in suddenly, runs a rapid course of twenty-four to forty-eight hours, and terminates as abruptly as it began, in complete recovery, or in death. The diagnosis should apparently be quite easy in all cases. The history of the case, so far as observed, seems of special value. The clonic and tonic spasms, the extreme trismus, and the peculiar spasms of the diaphragm, are quite characteristic. It may be confounded with : (a) Tetanus, from which it is distinguished by the sudden onset, the earlier and more compiete trismus, the peculiar spasm of the diaphragm, the greater nervous irritability and greater tendency to clonic spasms, the greater tendency to lie down, the dilation of the pupil and pirouetting of the eyes, the absence of the protrusion of the membrana nictatans, the absence of any antecedent wound, the far more rapid course and the usually more favorable termination. (b) Cerebro-spinal meningitis, from which it is to be separated by its history, its more sudden onset, its cramp unaccompanied by paralysis, its well marked trismus, rapid course and more favorable termination. 7 (c) Azoturia, from which it differs essentially in attacking animals not subject to that affection—that is, mares enjoying unrestrained liberty and having young foals. Aside from the fact that azoturia cannot be induced in such animals, the spasms are more general over the entire body, the trismus is character- istic, and the urine neither abundant nor highly colored. The treatment should evidently consist first of quietude and comfort. The foal should be allowed with the mare. In my cases, free blood-letting apparently alleviated the symptoms, if resorted to early. Fluid extracts of belladonna and cannabis Indica, in large and repeated doses, apparently allayed the excitability, and exerted a favorable influence upon the course of the disease. 6. PARTURIENT PARESIS IN THE Cow. MILK FEVER. PARTURIENT APOPLEXY. Parturient Paresis has long been known as an exceedingly common, and until recently highly fatal malady of dairy cows. It has apparently been known as long as dairying has been fol- lowed as a scientific pursuit, and cows have been bred especially for dairying purposes. Parturient Paresis in the Cow g2I Somewhat rarely it may attack cows belonging to the dis- tinctively beef breeds, but even then it is usually in those which are heavy milkers. The disease occurs usually in adult cows, rarely in the young or aged. Harms, citing Bavarian statistics, gives the following table of the ages at which 127 cows were attacked by milk fever. At the age OF ”.3 syearsee 82sec oo aes I “é ia AG ORES ain 2 eee aa el Sa “e 46 ing : St] See ee oe Eee 20 “ce ae 6 Ss secu et 4 ee Net Mee eae St tat ae? 14 ¢ ‘ ae 7 DU «ap a hel M ta cd Delta 22 ae 4e 8 OP ihe MS PL a see he Ea 18 oe 9 OP eosin Ge 22 ee “a 10 OO on a eee ee ee 12 uc a “ EXs So Zeeu steal ie be cebee ti 3 ce {2 Super Ear Seen Se, ENC ee ERENT BRAS 6 “ © 6 13 Be aia) eae PANS Th ein 2 “ 6c 14 “ I - “" SE ae te ee ae 2 Harms, quoting Haycock, gives the following duration of time after parturition, at which parturient paresis made its appearance. times immediately after calving. ‘« 20 hours a ee 5 8 5 os 23 af Scag 3 2 I “ 6“ 6c « 6c “ cc ag 88 “cc 36 “e 6 a ie « We have diagnosed parturient paresis, both before and during parturition. In these cases all the cardinal symptoms of the malady presented themselves, and the course and termination were identical with those usually observed. Harms, early in his career, diagnosed cases of milk fever before birth, during the act, and as long after parturition as 30 days ; but later he concluded that he had been in error and had been dealing with spinal meningitis or hydrocephalus, two diseases which he regarded as very difficult to differentiate from milk fever. According to his view, parturient paresis in the cow does not occur at all before the fetal membranes have been expelled. He cites other practitioners, however, among whom is Thomsen of Flemsbury, who had a cow fall with paresis while he was remov- g22 Veterinary Obstetrics ing theafterbirth manually, and Kohler, who found the detached membranes in the uterus in cases of paresis. Other observers have seen cases in which the malady has occurred under other conditions. We were called to attend a cow because of presumed dystokia, and found her standing with portions of the membranes hanging from the vulva. Upon ex- amination it was found that the fetus was in its normal position and alive, and that the cervix was fully dilated. All that ap- peared to be wanting was a moderate expulsive effort on the part of the cow, but this did not occur. She seemed well in a general way, except that she was unsteady upon her feet. The fetus was extracted under very moderate traction, without any aid from the mother. Some two hours later she fell, exhibiting all the symptoms of parturient paresis, and perished therefrom a few hours later. r In another instance in our practice, a typical case of paresis occurred, where the animal was down and comatose, and the placenta was still feebly retained in the uterus. The disease is one of well-nourished animals. It does not occur in those cows which have been starved or have been kept , upon food of very bad quality, and consequently are in poor condition. On the other hand, the excessively fat cow does not show so great a tendency to the disease as the one which isin good flesh. Itis a disease belonging to the highly-nourished animal, and not to the obese or the emaciated. In all those cases of parturient paresis occurring subsequent to parturition, and virtually all of them occur during this period, the disease follows an easy birth. Along with this, in almost every case, there is prompt expulsion of the fetal membranes. Symptoms. When the animal is under close observation, preceding the full development of the symptoms of parturient paresis there is usually first noted a staring expression of the eye, with dilation of the pupil and a wild look. The eyes may be pirouetted or rolled in their orbits. There may be occasional muscular twitchings or contractions, and a condition of unrest. In rare cases there are very distinct clonic spasms, especially of the neck, with grinding of the teeth and slobbering. The ani- mal acts as if affected with mania, and executes various move- ments with the head. In one case we observed that the cow would bite at her shoulder. If the cow is caused to move she Parturient Paresis in the Cow 923 does so with a more or less unsteady gait. She seems especially weak and uncertain in her hind limbs, and sways somewhat from side to side or knuckles over. She may show considerable un- easiness and nervousness, and lie down, only to get up again in a few minutes, and perhaps with some difficulty. As the disease progresses the animal goes down and is unable to rise. At first she lies upon her sternum, usually upon the left side, in a somewhat natural attitude, with the head up. Later she shows a tendency to rest the muzzle on the ground or the head in the right flank with the nose lying upon the ground. Still later she tends to lie prone upon the side. Early in the disease coma sets in, and the animal becomes more or less insensible. Convulsive struggles occur for a time, in which the patient throws herself about violently ; she may make unsuccessful and unconscious efforts to arise, and may suc- ceed in getting upon her knees and floundering about violently. She may throw the head from side to side with great violence, and in doing so may shift from sternal to lateral recumbency, and from time to time may resume sternal decubitis. As the disease advances, there is a constantly increasing tendency to lie flat upon the side. At first the pupils are dilated and the eyes have a wild and glaring look, but later they become dry and glassy-looking, probably because the eyelids are not closed frequently in order to distribute the tears over the cornea, and thus fail to keep it moist. An abundance of tears may flow down over the cheeks and keep them wet. From the mouth there is an involuntary flow of saliva, due rather to failure of the animal to swallow it than to any increase in the amount secreted. The temperature is sub-normal. Rarely in the earlier stages of the disease, accompanied by more or less violent muscular twitchings, there may be elevation of temperature. Later, when the disease has existed for some hours and there has been partial improvement, and a relapse occurs, not of paresis, but of inhala- tion pneumonia or other inflammatory complication, the tempera- ture may become elevated. The respiration is deep and slow as a general rule, though in some cases it may be rapid and shallow. There is sometimes a moan during expiration. The disturbances in the alimentary tract consist essentially of 924. Veterinary Obstetrics a profound paralysis. There is difficulty in deglutition, so that in former times many cows were killed in attempting to drench them with fluids, which, instead of being swallowed, passed into the lungs, causing fatal strangling or bringing about an equally fatal foreign-body pneumonia. The rumen is para- lyzed, and as a consequence tends to become filled with gas owing to decomposition of its contents. This is especially marked if the animal lies upon her side. This symptom is one of great danger for the animal, because the tympany tends to press the food up through the cesophagus into the pharynx, whence it drops into the larynx and is inhaled, to either cause fatal strangling or later a fatal foreign-body pneumonia. The in- testines are likewise paralyzed, and little or no defecation occurs. If the hand is introduced into the rectum, a small amount of dry feces is found. The kidneys cease to function, and little or no urine is poured into the bladder. Some veterinarians have urged that it is essential in the treatment of the disease for the catheter to be frequently passed in order to prevent rupture of the bladder. As a matter of fact, unless the bladder is distended when the disease comes on it does not become so until after the malady has ceased. The secretion of milk is wholly in abeyance. There may be a small amount of milk in the udder at the time that the cow goes down, and this may remain fora time, but there appears to be some tendency for it to become resorbed and the udder very flaccid. The pulse at first may be glow and weak, becoming later more frequent and irregular. The general sensation is much depressed. Early in the disease the eye seems somewhat sensitive to light or touch, but later the cornea may be touched without causing any reaction, and the skin may be pricked at any point with a pin or other sharp ob- ject, without producing any evidence of feeling. As the disease progresses, the coma and paralysis become more and more profound, and death may occur at any time without warning, or the coma may gradually deepen and the animal ap- pear almost lifeless for hours before death occurs. As the fatal termination approaches, the coma and paralysis become more and more profound, the breathing more shallow, and the pulse weaker and more irregular, while the temperature continues to sink. Parturient Paresis in the Cow 925 The course of the disease is rapid. Generally, the earlier the advent of the malady after parturition, the more rapid its course. The animal may die within 6 or 8 hours from the beginning of the attack, or the disease may be prolonged to two or three days. Complications of great variety may occur. In some especially stormy cases there is complete prolapse of the uterus as one of the earliest symptoms, and in these death usually ensues very quickly. In two cases in our experience, the animals perished within two or three hours after the advent of the first symptoms of the disease. One of the most common and serious complications observed in the course of the disease is that of foreign-body pneumonia, or of strangling owing to the inhalation of solids or liquids. A few years ago it was common to drench a cow with large vol- umes of oil or of solutions of saline cathartics or other medicines, which in many cases flowed directly into the lungs because of the unconsciousness of the animal and the paralysis of the pharynx. In other instances in the comatose animal, there is an involuntary passage of food from the rumen through the cesophagus into the pharynx, from which it is inhaled into the the lungs. In either case the animal may be quickly strangled by the blocking of the bronchial tubes from the food or medi- cines. It was formerly a common experience for the veteri- narian to give a large dose of medicine and have the animal perish before he could get off the premises. When immediate death from the inhalation of food or drugs does not ensue, the paralysis and coma may continue, and the symptoms of parturient paresis pass imperceptibly into those of pneumonia. In other cases the animal partially recovers, and seems brighter, and may even recover so far as to regain her feet and possibly take some food. After some hours, or even a day or more, she may show signs of pneumonia with elevation of temperature, and go down again to finally perish from the complication. Diagnosis. ‘The diagnosis is usually rendered clear by the period of the occurrence of the disease, the condition and char- acter of the animal, and the symptoms. In some cases, how- ever, the differential diagnosis may be exceedingly difficult, and afford abundant room for a conflict of opinion between practitioners. 926 Veterinary Obstetrics Harms very properly points out that the peculiar attitude of the cow does not always indicate parturient paresis, but that other diseases, like acute hydrocephalus, spinal myelitis and meningitis, may cause the animal to assume the same position. Harms considers these the only diseases which may be mistaken for parturient paresis, and suggests that puerperal mania, puer- peral fever, simple lumbar paralysis and fracture of the pelvis cannot deceive the scientific veterinarian. Harms points out that in his experience the diagnosis of milk fever may be ex- cluded in those cows which have not calved recently, which show loss of sensation in the hind parts of the body only, or have a normal or elevated rectal temperature. Cows which retain an appetite until they fall, or even after they are down and unable to rise, he does not regard as being affected with parturient paresis. On the other hand, he claims that hydrocephalus may be ex- cluded and milk fever diagnosed if the cow has calved within a few days, if the loss of sensation involves the entire body, if the rectal temperature is sub-normal, and the paralysis is so profound that the animal cannot rise upon its feet even with assistance. The relation of calving to the diagnosis of parturient paresis, in our judgment, cannot be relied upon, although it constitutes important evidence. While Harms believes that the disease occurs only after parturition, and we agree with him in the main, we are nevertheless forced to hold, from our personal observation, that the malady is not confined to the post-parturi- ent period, but may rarely occur before or during the act of parturition. The fact that a cow has recently calved does not prevent’ the occurrence, during this period, of other diseases which may closely simulate parturient paresis. Schmidt (American Vet. Review, Vol. 22, 1898) draws atten- tion to the fact that indigestion in the cow may very closely simulate parturient paresis. In one case which we observed, a cow went down in the past- ure with what strongly resembled parturient paresis in almost all essential respects, including paralysis, coma, and subnormal temperature, but she had calved six weeks previously. The disease was apparently due toa slight purulent mammitis. It is interesting to note, in connection with this case, that the in- jection of oxygen into the udder apparently led to a complete Parturtent Parests in the Cow 927 recovery. This would lead many to believe that the malady was really parturient paresis. Causes, While we do not comprehend the fundamental nature of milk fever in the cow, we nevertheless know fairly well the conditions which predispose or lead up to the disease. 1. Chief among the causes, stands the quality of the cow asa deep or profuse milker. Milk fever is pre-eminently a disease of the high-class dairy cow, and has herertofore stood as a perpetual menace against the improving of dairy breeds, because the more excellent the individual asa dairy animal the more vulnerable to the disease. On the other hand, cows belonging to the beef breeds, or poor milkers among dairy cows, are virtually immune. 2. The state of nutrition of the animal has a very marked and well known influence upon the occurrence of parturient paresis. This is a disease of the plethoric cow, and not of those which are emaciated or excessively fat. It occurs, we may say, in those animals which are in the highest possible condition, and apparently in perfect health up to the hour of attack. 3. Food and housing have been claimed to influence the tend- ency of the cow to parturient paresis, and this is in many re- spects very true. The malady is seen much more frequently in some seasons and in some communities than in others, which is variously attributed to the food or weather. ‘These questions are inseparable from that of nutrition. If the weather is bad, the food may be bad. Undue exposure may lower the condition of the animal, and thus prevent the high condition which predis- poses to milk fever. We observe the disease in the stable and in the pasture, and the relative frequency will vary according to.conditions. Par- turient paresis may occur chiefly during the spring or early summer, in cows which are upon very rich pastures ; or in other cases the disease may be seen most frequently in those animals which are kept in the stable. This will vary according to the comparative excellency of the pastures or of the food and feeding in the stable. 4. Abrupt changes in food, housing or other conditions may apparently influence the tendency to the disease. In the other members of this group of diseases we recognize very clearly the effect of psychic influences, such as removing the young from the mother or bringing the mother and her young into the pres- 928 Veterinary Obstetrics ence of strange animals or surroundings, thereby causing ma- ternal anxiety. This apparently has an effect in some cases in the cause of parturient paresis of the cow. 5. It is quite universally recognized that, when parturient paresis occurs soon after calving, at which epoch virtually all cases occur, the malady uniformly follows a very prompt and easy birth. No case has been recorded, so far as we can find, where parturient paresis in the cow has followed dystokia. Pathology. As already stated, the pathology of the dis- ease is unknown. Pest-mortem examination reveals changes of aninteresting character, which tend to throw some light upon the symptoms and course of the disease, without, however, making clear its exact character. Because of the well-marked coma and the general disturbance of the nervous system, the condition of the brain and the spinal cord become of great interest. The dura mater is apparently sound, though in some cases a serous exudate exists beneath it. The pia mater is said to be somewhat congested ; the veins, es- pecially, are distended with blood. The interpretation of the conditions in the brain varies with different observers. Some have found the brain substance anaemic, while others have con- sidered it congested. Hemorrhages are sometimes found upon the surface of the brain. Harms found emphysema beneath the pia mater and in the veins of the canal of the spinal cord. The heart is usually pale and distended with blood, and occa- sionally shows ecchymoses of varying size. The condition of the lungs is exceedingly variable. Harms found them edematous or emphysematous, but observed no foreign bodies in them. We have repeatedly discovered particles of food far down in the bronchial tubes, and in some cases of sudden death have found the larger bronchi completely occluded by food masses. In other instances we have been able to rec- ognize the presence of drugs in the bronchial tubes, which had been forced upon the cow in the form of a drench some hours previously. The alimentary tract, liver, spleen and urinary organs are usually comparatively normal. In the uterus there are no very remarkable changes. In harmony with the history of the disease, the uterus is not normally contracted. Like other organs of the body, the uterus is anaemic. : Parturient Paresis in the Cow 929 The theories regarding the nature of parturient paresis are in- numerable, and difficult of classification. These may be divided into four great classes, according to the belief veterinarians hold as to the organ or system from which the disease takes its origin. 1. Many hold that the disease has its origin in some essential change in the brain or spinal cord. ‘They believe the disease to consist of a congestion of the entire central nervous system, with overfilling of the veins of the brain and spinal cord. Other veter- inarians hold that the disease consists of anaemia and paralysis of the central nervous system. 2. Another group of veterinarians believes that the disease has its essential origin in the uterus. In this group each indi- vidual has an opinion of his own, which differs somewhat from that of each of his colleagues. Some of them believe that, from the uterine mucosa, there is absorbed into the system an amount of infectious material or the products of bacterial activity within the uterine cavity, which, acting upon the central nervous sys- tem, produce the disease. The character of this toxic substance has not been revealed, nor has any clear evidence been adduced to show that such exists. It has not been shown why, if the disease consists of the absorption of toxic substances from the uterus, cows which are very thin in flesh, are poor milkers or have suffered from dystokia should not just as readily suffer from milk fever as deep milkers which are in high condition and have calved easily. Others, like Stockfleth, hold that milk fever is the result of embolism of the veins of the uterus, the emboli escaping to other portions of the body. 3. A third group of veterinarians, including Schmidt of Kol- ding, holds that the disease arises from the mammary gland, and consists of a toxaemia due to the absorption of colostrum, per- haps incompletely formed, or other secretions which possess a highly deleterious character. 4. Harms holds that the disease is a form of aeraemia, or air in the blood. In his post-mortem examinations he found air in the veins of the brain, spinal cord, lungs and other organs. This view has not been generally accepted. As already stated, post-mortem examination has virtually failed to reveal anything definite regarding the actual cause or character of the malady. This and that lesion has been re- 59 930 Veterinary Obstetrics corded, only to have its existence or importance disputed by others of equal authority. One finds hyperaemia of the brain, and another anaemia of the brain, with the possibility that either or both may be correct.* Handling. 1. The essential therapeutics of parturient paresis consists of the inflation of the udder with atmos- pheric air or oxygen. So far as clinical experience reveals, it is not material which of these is used. As soon as the patient can be reached, and a definite diagnosis of parturient paresis made, a sufficient volume of oxygen or atmospheric air should be introduced into each quarter of the udder to quite thoroughly distend all parts of the gland. In order to avoid the escape of the air through the teat canal, it may sometimes be desirable to apply temporarily a soft ligature near the end of the teat, which is to be removed after the expiration of three or four hours. The ligature should preferably consist of a soft piece of tape, which should be tied around the teat sufficiently tight to barely prevent the injected air from escaping through the teat orifice. If tied too tight, and allowed to remain for several hours, necrosis of the teat follows. The ligature is to be closely watched, and promptly removed whenever serious injury to the teat is threat- ened. The danger might be very largely avoided if a long piece of.tape were used, and wound several times about the teat, from the apex upwards. Strips of adhesive plaster, applied directly over the teat orifices and extended upward along the teat, would probably fill all requirements and obviate pressure gangrene. The necessity for ligating the teat is very questionable. The amount of gas injected is subject to no fixed rule. The udder should be firmly distended. Usually the sphincters of the teats will retain sufficient gas and permit any excess to escape. Some believe that the greater the distension of the udder with air, the more prompt and effective the treatment. Occasionally this is overdone, and we have observed extensive emphysema of the udder, thighs and croup from rupture of the mammary epith- elium as a result of over-distension. No harm ensued. If the *For a full resumé and discussion of the various theories of the nature of parturient paresis, the reader is referred to the contribution of J. Schmidt, Kolding, Monatshefte fiir Praktische Thierheilkunde. Bd. IX., S. 241, a translation of which appears in the Am. Vet. Review, Vol. 22, p. 392, Sept., 1898. Parturient Paresis in the Cow 931 volume seems insufficient, if the response is tardy or feeble, more air or oxygen may be introduced at any time. Should the first inflation fail to produce the desired results after an interval of 3 to 6 hours, a second inflation of the gland should be made. We have no evidence that any harm may occur from repeated inflations of the udder with air or oxygen, so long as no infection is carried into the gland. Since the mamme are at this stage in a very highly vunerable state, it is essential to safety that due precautions be taken against introducing infection into the gland upon the portion of the apparatus inserted into the teat, or forcing it into the gland with the oxygen or air which is being introduced. The precautions to be taken are analogous to those for any surgicaloperation. They include the disinfection of the operator’s hands ; of the cow’s udder, especially the teats; and of the injec- tion apparatus, especially the tube which is to be introduced into the teats; and the protection of each of these parts from infection during the operation. The udder should be carefully placed upon a clean cloth sat- urated with a reliable disinfectant, or upon a clean tray, after which the entire gland, and especially the teats, is to be thoroughly washed and disinfected. The apparatus to be used for injecting the air or oxygen, especially the tube to be inserted into the teat, should be sterilized by boiling. Before inserting the tube into the teat, all antiseptics should be carefully washed away from the tube and the end of the teat with sterile water. The introduction of antiseptics into the milk gland upona tube or other instrument is as dangerous as the introduction of most forms of bacteria. The opera- tion is to be aseptic, not antiseptic. The mechanism by which the inflation is brought about is not essential, so long as the general rules of asepsis are maintained. Various forms of apparatus have been introduced for the purpose of avoiding infection, but few, if any of them are free from ob- jection. No difference what the particular type of apparatus, the general rules of aseptic surgery must be carefully applied by the veterinarian ; the apparatus is not sufficient in itself. Many of these devices consist of a rubber bulb, attached to an elongated tube, into which is inserted a filter of asbestos, cotton or other substance. Beyond this, the rubber tubing ends with an ordinary 932 Veterinary Obstetrics milk or teat tube, which is inserted into the milk canal. This form of apparatus is probably the most objectionable of any that has been devised, because the filter is difficult of steriliza- tion and, becoming befouled, acts as a constant menace to the udder of the patient. The simplest apparatus, the one which can be most readily sterilized by boiling, is the best. There is no great danger of the introduction of infection with the air which is introduced, if moderate care is taken not to stir up dust in the stall while the operation is in progress, and this danger may be eliminated in a variety of ways which are very simple. If a wash-bottle is con- structed, and the air be forced through the water, and thence into the udder, any floating particles of dirt.will be retained in the water, leaving the air free from infection. Laymen have used the ordinary bicycle pump for injecting air into the udder, and the process has been bitterly criticised by some veterinarians. Such a pump, or one on a similar plan, with very ordinary precautions, is safer than the apparatus usually sold for the purpose. A pump of this type, with sterilizable piston, can be made a very convenient and safe appliance. It may be enclosed in a sterilizable metal case, and kept sterilized ready for use. At time of use, a few layers of sterile gauze over the intake effectively filter the air. A very convenient and safe apparatus for the work is the oxygen, or compressed air tank. Under proper precautions, the tank may becharged by the practitioner with either air or oxygen, and is ready for safe use atamy moment. The tube for insertion into the teat may be carried in alcohol, so that it, too, is ready in a moment. A yet more convenient and safer apparatus for the inflation of the udder may be readily arranged by having a very small and strong compressed air tank, fitted with an opening armed with a stop cock. It could be made of the size of a pint bottle, and strong enough to contain sufficient air for the inflation of an udder. Two or more such tanks could be kept on hand so that one may always be charged and ready for use. ‘The detached tube may be enclosed ina sterilizable metal container and quickly prepared for use. The tank may be charged by the veterinarian, the air being filtered through sterile gauzé as it enters the pump. Thus Parturient Paresis in the Cow 933 charged, under suitable precautions, the apparatus is always ready, compact, light, easily applied, and free from danger of causing infection. The milk tube or other tube inserted into the teat should be very short, barely long enough to freely enter the milk cistern. A longer tube may wound the parts during unexpected struggles. It is apparently immaterial whether any milk which. may be in the udder is withdrawn before the injection or not. Some practitioners advise treatment supplementary to the in- flation of the udder, but they have not yet clearly shown by clinical data that any good has come from such additions. Gen- erally those who desire to add something to the udder inflation prescribe powerful heart stimulants, like strychnine or caffein. As a remnant of by-gone days, some veterinarians still advise and practice catheterization. The secretion of urine ceases with the advent of thedisease. Over-distension could not have existed in the healthy cow, and cannot occur in the paresis patient. A pint or a gallon of urine in the bladder can do no harm: catheterization may do much. The attitude of the patient is of very great importance. From the first she should be carefully and zealously guarded against assuming lateral recumbency, or this position promptly cor- rected if already attained. The cow, like other ruminants, promptly suffers from.tympany of the rumen whenever lateral recumbency is maintained for a prolonged period. ‘The disten- sion of the rumen, by its pressure upon the diaphragm, interferes seriously with respiration and with the action of the heart and other organs. The most serious danger from this position is that, in the paretic state of the animal, there is imminent risk of the involuntary passage of food from the rumen into the pharynx, and its inhalation into the lungs, to cause fatal strangling, or foreign-body pneumonia. It is consequently essential to keep the animal in sternal recumbency. ‘This may be facilitated by packing bundles of straw about the animal. In cases of violence it may be desirable to secure the two anterior feet in such a way that the limbs cannot be extended. This is best accomplished by attaching a short strap or cord to each anterior foot, carry- ing these upward over the withers, and tying them together in such amanner as to keep the anterior feet completely flexed upon the carpus. 934 Veterinary Obstetrics It is quite unnecessary to suggest that the animal be well bedded and otherwise made comfortable. The practitioner should be on his guard against the dangers of moving the recumbent animal from place to place. If the patient has fallen in a bad situation, out of doors or elsewhere, it may appear desirable that she should be conveyed to a stable or other suitable place for handling. In bringing about this transfer it is well-nigh unavoidable that she be placed in lateral recumbency, and that she must undergo a form of handling which will strongly tend to cause the regurgitation and inhalation of some of the contents of the rumen. It is therefore best, in all cases, to make the patient comfort- able, if possible, where she falls. Abundant bedding, blankets if the weather is cold, or an improvised tent or shed if the weather is hot or rainy, usually suffices as well as a stable and avoids the danger of transfer. When moving the recumbent animal is im- perative, she should be kept on her chest until all is in readi- ness, the transfer then made promptly, and the patient quickly replaced upon her sternum. When the practitioner is called to attend a case of parturient paresis, he should rigidly abstain from drenching the patient, and carefully enquire, before he takes charge, if any drugs or medicines have been given by the mouth. If cows suffering from parturient paresis have been drenched, the mortality is exceedingly high, because portions of the drench usually pass down the trachea into the lungs. It does not matter at what stage of the disease the attempt to drench the animal occurs, While she is still upon her feet, and merely beginning to stagger, she is nevertheless very liable to become strangled. There appears to be from the first an anaesthesia or paresis of the larynx and other parts, which prevents coughing or any other signs of strangling. Ifthe animal has received a drench, especially one which would be highly irritant to the lungs or could not be ab- sorbed from the respiratory mucous membrane, an unfavorable prognosis should at once be given, and the handling begun with a definite understanding that the animal will probably die from inhalation pneumonia as a result of the drench. * ok *« K * The history of the origin of the present plan for handling parturient paresis dates back to the investigations of Schmidt of Parturient Paresis in the Cow 935 Denmark, in 1897, when he introduced his plan of handling the disease by the introduction into the udder of a solution of iodide of potassium, commingled with atmospheric air. Later, various practitioners found that, failing to have the potassium iodide at hand, the distension of the udder by other liquids, such as very weak disinfecting solutions or normal salt solution, possessed a similar efficiency. Then oxygen was substituted for the potas- sium iodide solution, and its efficiency was found to be even greater. From this experience it was readily surmised that, in default of pure oxygen, the mixture of oxygen and nitrogen of atmospheric air might answer the purpose, and clinical experience early demonstrated this to be a fact. Today oxygen and atmos- pheric air are used indifferently, and with very great success. The discovery of Schmidt, with its gradual development, leading to the now universally accepted mode of handling parturient paresis, constitutes one of the most remarkable and beneficent advances in therapeutics in the history of veterinary medicine. It has transformed one of the most fatal of diseases into one which, when promptly handled, is almost robbed of its mortality. Prior to the investigations of Schmidt, parturient paresis was a great obstacle to the advancement of efficiency in dairy cows. As soon as a cow showed high efficiency, imminent danger to her life from parturient paresis at once arose, and the ranks of the best dairy cows annually suffered appalling losses. Under the treatment with air or oxygen, the mortality in parturient paresis in the cow has dropped from 60-75% to less than 5%, in those cases which are promptly attended and in which there has been no meddling by the administration of medicines by the mouth. From the standpoint of prophylaxis, the attitude of the pro- fession has been quite generally modified by the advent of the present method of handling. Formerly it was advised in many cases to withdraw a portion of the milk from the udder before the cow calved, and to keep her well milked immediately after calving, but this rule has been reversed, and it is now advised to leave the udder fully distended with colostrum or milk. It was formerly advised, also, that a purgative be given either just before or immediately succeeding parturition, in order to —o 936 Veterinary Obstetrics prevent parturient paresis ; but this has been generally discarded since the advent of the inflation treatment. It is now uniformly advised, in case there appears to be any danger of an attack of parturient paresis, that the udder be inflated at once with oxygen or air as a prophy- lactic measure. The history of the therapeutics of parturient paresis is exten- sive and interesting. Almost every form and character of treat- ment possible has been advised, and favorable reports of the use of each have been made. Purgatives long held a very high place, in spite of the fact that they were generally poured into the lungs instead of the rumen, and quite generally hastened the fatal termination. Stimulants, narcotics, sedatives, in endless profusion, were recommended by one, only to be condemned by others and finally to be discarded. Blood-letting was advised and abandoned. Hypodermic in- jections of strychnine, eserine, pilocarpine and many drugs were advised, with the great advantage that they did not get into the lungs and strangie the animal, but the results from their use were not satisfactory. External applications were used, such as stimulating liniments to the spine, and ice tothe head. Intra- uterine injections of solutions of alum or other substances were advised. In spite of all these innumerable methods which were recommended by this or that practitioner, the high mortality of the disease still held its sway. PUERPERAL ECLAMPSIA IN THE Sow. Hegel (Repertorium, Vol. 46,) de Bruin (Geburtshilfe bei den Kleineren Haustieren) and others, describe puerperal eclamp- siain the sow. ‘The malady is characterized, according to Hegel, by spasmodic movements of the neck, grinding of the teeth, con- vulsive movements of the facial muscles, inability to stand and elevation of temperature. De Bruin has usually observed the disease two to five days after farrowing and expulsion of the fetal membranes. Usually the birth has been easy. The symptoms are chiefly a more or less complete suspension of lactation, with paresis, coma, and in- testinal torpidity. The prognosis is good, and most cases tend to spontaneous re- covery after a few days. The Milk Disease of the Sheep 937 Hegel advises bleeding from the tail, cold poultices to head and back, purgatives, tobacco clysters, etc., and, if trismus per- sists, the application of chloroform and oil to the masseter region. De Bruin warns the practitioner against drenches, always dangerous for swine because of strangling. He advises the use of electuaries composed of 10 grammes sulphate of magnesia, 50 grammes powd. anise seed, and common syrup sufficient to make apaste. This is placed upon the tongue with a wooden spatula, and the entire quantity used during oneday. He further advises applying tincture of camphor over the body to arouse the skin secretions. THE MILK DISEASE OF SHEEP. PARTURIENT PARESIS IN SHEEP AND GOATS. De Bruin describes a malady of ewes, closely resembling the parturient paresis of the cow, under the designation of milk dis- ease. It occurs chiefly in ewes from which the sucking lambs have been removed after having lambed normally some six weeks previously. The disease appears usually 2-24 hours after the removal of the lambs from the ewes. The symptoms consist of absence of appetite, rumiuation or other digestive functions. ‘The ewe ceases to bleat or hunt for her lamb, becomes paretic, with glassy eyes, loss of corneal reflex, coma, and the general symptoms of parturient paresis of cows. The prognosis is good, and the method of handling it is the same as for parturient paresis in the cow. De Bruin describes, under a separate heading, a parturient eclampsia of sheep, goats and swine, regarding this malady as essentially different in etiology or pathology from the milk dis- ease described above.. The real ground for differentiation is not clear. In these cases the animals show definite tonic and clonic spasms. ‘The disease is usually acute and stormy. It appears ordinarily soon after birth, though it may occur ante-partum. There is present trismus, opisthotonos, and general convulsions, with pirouetting of the eyes, followed by coma. >? Chloral hydrate in enemas, and hypodermic injections of mor- phine, are recommended for handling, and good results are re- ported. De Bruin does not mention inflation of the mamme with air or oxygen ; nor does heintimate why this should not be quite 938 Veterinary Obstetrics as successful in the eclampsia of the sheep and goat as in the paresis of the cow. PUERPERAL ECLAMPSIA OF THE BITCH. Next to the cow, probably the bitch suffers most frequently from puerperal eclampsia or paresis. The malady has rarely been observed prior to, or immediately following parturition. Usually it occurs from 2 to 8 days after giving birth to young. Occa- sionally it occurs 10 to 14 days after parturition, and rarely as late as 30 days. Ordinarily it follows easy parturition. It is most frequently observed in highly bred nervous animals, and occasionally follows the psychic disturbance incident to removal of the puppies from the patient. The symptoms are analogous to the eclampsia already de- scribed in the mare, ewe, goat and sow. The first symptoms are those of anxiety, restlessness and uncertain gait. The patient falls in convulsions, the voluntary muscles being affected with severe tonic and clonic spasms. As in other eclamptic diseases, the body excretions are largely in abeyance, the bowels are torpid, the urinary secretions are suspended, and the mamme are flaccid and devoid of milk. During the convulsions, the patient remains conscious. Later the convulsions may be followed by coma and unconsciousness. During the convulsions, the visible mucosa are cyanotic. The affection greatly resembles strychnine poisoning, but De Bruin points out the important difference that in strychnine poisoning the patient is easily excited, while in eclampsia no hypersensi- tiveness is apparent. The course of the Disease, like in other members of the eclamptic group, is usually stormy, and, unless energetically handled, ends fatally in 24 to 48 hours. The prognosis is good when the disease is promptly handled. De Bruin strongly recommends 20-40 mg. (0.3-0.6 grains) of morphia hydrochlor, hypodermically, repeated in a few hours if necessary. Others advise chloroform inhalations or chloral hy- drate enemas. Some have recommended the administration of ether or chloroform syrup by the mouth; but, asin all diseases of this group, the powers of deglutition are uncertain, and there is constant danger from the introduction of medicines into the lungs. DISEASES OF THE MAMMARY GLANDS. In mammalia, the mammary glands constitute an essential part of the reproductive system, because it is through these that the new-born is enabled to live for a time after its birth, before it acquires the experience and power necessary to provide its own food. The mammez ordinarily come into function at the time when young are born. As soon as the young animals have acquired sufficient age and strength to lead an independent ex- istence, the glands cease to secrete milk, until their function is aroused anew at the next period of birth. Following the general rule of vulnerability of organs, the mammee are most subject to disease and accident during their period of activity, and rarely suffer during their interval of rest. The diseases of the milk glands may, accordingly, very properly be dealt with as a part of obstetrics, because they not only jeop- ardize the life and well-being of the mother chiefly during the puerperal state, but also have great importance for the life of the young at the beginning of its extra-uterine existence. Anatomically the milk glands of animals belong to the acinous type. The glands consist of numerous acini or glandular vesi- cles, lined with cuboidal epithelium. From each of these cells there emanate small milk canals, which finally unite with each other into common canals of larger size. ‘These may empty into a large cistern and thence through a common opening at the end of the teat, Fig. 5A, p. 37, or two or more cisterns form, each of which opens through a separate milk duct, or the milk canals may remain separate, without milk cisterns and open directly at the end of the nipple. There are consequently two great types of milk glands—the one with a cistern, in which a considerable volume of milk accumulates; and the other without a cistern, in which the milk canals lead from the glandular substance di- rectly to the end of the teat. Solipeds, ruminants and swine have capacious milk cisterns ; in carnivora milk cisterns are absent. The general anatomy of the milk glands has been briefly outlined on page 35. The variations in the structure of the milk glands in different animals are very interesting in relation to their tendency to disease. The highly-developed glands of ruminants, with a single large cistern and a very large excretory canal through the end of the 939 940 Veterinary Obstetrics teat, are subjected to very great danger from acute infection. In animals where extensive milk cisterns do not exist, like the mare, and in carnivora, which have no cisterns at all, the tendency to acute mammary infection is very much less. On the other hand, we find that in the carnivora, especially in the bitch, without any milk cistern, there is a pre-eminent ten- dency for the glands to become the seat of malignant new-growths. When infection occurs in the capacious single milk cistern of a ruminant, the entire quarter is almost inevitably involved. In those animals with two or more cisterns, or with numerous milk canals without cisterns, a single lobule of the gland may become infected and the others remain sound. For convenience of description we may divide the diseases of the udder into: (1) Acute Infections, (2) Chronic Infections, (3) Wounds and Injuries, (4) Neoplasms. ACUTE INFECTIONS OF THE MAMMA. MAMMITIS. MASTITIS. Mammitis consists essentially of an infection of the mammary gland, and, like the infections of other organs or tissues, may be extremely variable in character. The different species of domestic animals show yreat variations in their susceptibility to mammitis, and in the type or types which the disease may assume. By some authors, the inflammations of the gland have been divided into catarrhal, phlegmonous and interstitial mammitis. Others add to these, purulent and gangrenous mammitis. Until we understand better the exact nature of the various forms of mammitis, especially in relation to the bacteriologic cause of each, any classification which may be made is merely a matter of convenience for purposes of description, which may facilitate our understanding of certain more or less distinct types of disease observed. The various species of domestic animals show such marked differences in the prevailing type or types of diseases of the milk glands that it is advantageous to consider those of each species separately, although in many respects they may be identical. a. MAMMITIS OR MASTITIS IN THE Cow. The cow constitutes the chief dairy animal, for which purpose she has been specially bred for centuries, and has been brought Acute Mammitis 941 to a high state of perfection as a milk-producing animal. With this specialization of function, there has arisen a vulnerability of the milk glands to injuries and diseases, which surpasses that seen in any other domestic animal. We consequently meet with a great variety of inflammatory diseases of the milk glands in cows. These variations are due in part to the intensity of the infection and the comparative power of resistance of the gland, and are in large part due to the specific differences in the infec- tions themselves. Mamunitis in dairy cows has a wide economic and sanitary in- terest. The pathologic milk of mammitis is usually rejected as human food by the repulsive taste, smell or visible appearances. Pathologic milk, unrecognizable by the special senses, like that from a tubercular udder, may possess far greater danger for man. According to the avenue of infection, the inflammations of the mammary glands may be divided into two groups, very un- equal in size and importance : 1. The infections which gain entrance into the cavity of the milk gland from the exterior, through the milk orifice or orifices in the teat, or through some wound involving the tissues which constitute the walls of these cavities. 2. A lesser group of infections, which reach the tissues of the gland from some other portion of the body, through the medium of the lymph or blood channels, ¢. g., tubercular mammitis. 1. AcuTE Mammitis. ACUTE MASTITIS. Acute mastitis may be defined as an infection of the milk gland, due to the entrance into its substance of the micro-organ- isms ordinarily inducing wound infection. We might liken acute mammitis to wound infection itself, and regard the epithe- lial lining of the milk cisterns, ducts or acini, or all these areas combined, as representing the wound area which has become infected. As in wound infection, so in acute mammitis, the infecting agent may be of very diverse character. Investigators, in deal- ing with acute mammitis, have found virtually all the types of organisms which are recognizable in wound infection, such as diplococci, streptococci, staphylococci and bacilli. In accordance with the clinical history of wound infection, 942 Veterinary Obstetrics some have believed, with apparently good reason, that there are variations in the virulence of mammitis, somewhat in harmony with the species of the infecting agent. Asin ordinary wound infection, so in mammitis, streptococci apparently lead in viru- lence, while the staphylococci are believed to induce a milder form of inflammation. The avenue of entrance of the infecting organisms is regularly through the orifice of the teat. Their source of origin may offer great variety, but ordinarily the infecting organisms are abundant, and only require some favorable opportunity for pass- ing through the teat orifice and gaining the interior of the gland. The more abundant and virulent the micro-organisms in the imme- diaté environment of the cow, the more probable the infection. The bedding, floor and stall constantly afford more or less infective material, the virulence of which may be partly dependent upon the cleanliness of the stall, but in the main isnot understood. The dairyman may reduce the degree of filth, and hence of infection, to the minimum. Accidental conditions which we do not under- stand sometimes seem to cause a sudden increase of virulence or. volume of infection in the stable, which may express itself for a time in the form of enzootic mammitis. In a large proportion of cases, there are good clinical evi- dences of the source of origin of the infecting material. When- ever a suppurating wound exists upon a teat, or some adjacent part of the udder, and the pus has an opportunity to flow down the teat to come in contact with the teat orifice, mammitis al- most invariably follows, unless some adequate precautions are promptly taken by the veterinarian to bar the entrance of the infection through the milk canal. Retained and decomposing after- birth, or any putrid discharge from the uterus or vagina, always tends very strongly toinduce mammitis. The pus flowsdown over the thighs and udder, and thence along the teat, naturally the posterior teat, and, gaining the apex of this, the infection finds its way upward through the orifice in the teat, and mammitis at once results. Possibly more direct and effective is the infection. _ through the teat orifice, when a retained afterbirth hangs down so low that it comes in direct contact with the teat and is actually. pressed against the teat orifice. Or the tail, saturated with the discharges from the vulva, may be lashed against the ends of. the teats and force the infection into the teat orifice. Not only may Acute Mammit?s 943 such a cow bring about an infection of her own udder, but with her soiled tail she may convey the infection to another cow in an adjacent stanchion, or the neighboring cow may strike her tail against the soiled parts of the diseased animal, and thence carry the infection to her own udder. There is frequently convincing clinical evidence that a milker carries the infection to a healthy teat. He may get the infec- tion upon his hands from an animal which is suffering from mammitis, and may readily convey it to another teat of the same udder, or, without washing his hands, may carry it farther and deposit the infection upon the teats of a healthy cow, and induce the disease. It is not essential that the milker should get the infection from a diseased milk gland. He can as readily and as seriously infect his hands by handling a putrid afterbirth, or an aborted fetus, or an infected wound upon any animal, and, by negligence or oversight, carry the infection to the udder of a healthy cow. It has been suggested that, when cows lie down, straws from their bedding may be pushed through the orifice into the milk cis- tern and carry with them virulent and infectious material, and there have probably been sufficient observations upon this point to establish the fact that such infections really occur. Every veterinarian in dairy practice has probably observed numerous cases of infection by means of the milk tube. Laymen very generally believe that they can meddle with the inside of a cow’s teat with the same degree of abandon with which they may handle the outside, and many of them do not hesitate, upon the least excuse, to insert a milk tube, a sound, a wire, a knitting needle, or almost any implement, into the teat, and do not an- ticipate therefrom any serious consequences. Thus, in many ways infection of a virulent character may be forced through, or find its entrance into, the milk cistern. Once it has reached the milk cistern and milk canals, it is ina favorable environment for growth. The infection may then ex- tend according to virulence and the resistance of the tissues, along the larger, and thence along the smaller milk ducts, and may finally reach the milk acini and attack the secretory epithe- lium of those structures, and produce any symptoms or patho- logic conditions which the various forms of organisms are capa- ble of inducing in such tissues. 944 Veterinary Obstetrics The handling of parturient paresis by intra-mammary injection is a fruitful source of mammitis, as already related while discuss- ing that affection. Most infections of the body have been attributed to ‘‘ taking cold,’’ and it is assumed that mammitis may be caused or its establishment favored by exposure to cold, dampness or drafts. Perhaps these factors do depress the system and favor the advent of mammitis. Contusions exert an important induence by devitalizing the tissues and rendering them more vulnerable to infection. ‘Thus a very pendent udder, buffetted back and forth between the legs of a rapidly moving cow, may seriously contuse the gland and destroy its normal power of resistance. A rough milker may readily induce contusions of the udder which may do much to cause mammitis. It is unnecessary for the infection to be introduced immedi- ately from the outside. The teat orifice and lower part of the cistern already contain, in the milk, some bacteria, usually of a kind not pathogenic for the parts so long as the gland is not dis- turbed. Whenever the gland is contused, or other accident occurs to depress the vitality of the tissues, the hitherto harmless (sap- tophytic) bacteria, may become pathogenic. When the udder is overdistended, the tissues become weakened and infection is favored. ‘The whole udder projects very promi- nently in the cow, and is accordingly exposed to injury. The posterior teats are shorter than the anterior, are more rigid, and are directed more or less backward in a direction which renders them more susceptible to injury from pressure and from dirty bedding-straws being pushed through the orifice into the milk cistern. Symptoms. Mastitis occurs almost wholly in cows in full milk, and chiefly very soon after calving. It is at this time that the udder is most active, and consequently offers the great- est vulnerability to infection, and it is at this period that the udder is most exposed to virulent infections of various kinds. The maximum distension of the udder subjects the secretory tissues to a compression, which, if not promptly relieved by milk- ing, lowers the powers of resistance in the parenchyma of the gland. At the same time, the engorgement causes the udder to project farther, more directly and rigidly from the body walls, Acute Mammitis- 945 exposing the udder and teats to increased danger from contu- sions and abrasions; intensifies the danger of forcible contact of the teat orifice with infected objects; and favors the entrance into the teat of straws or other rigid infection-bearing bodies. The disease may occur, however, at any date during the period of milking, or in the dry cow. We have observed the disease in heifers, Usually only one quarter of the udder, most commonly a pos- terior one, is involved. The disease may simultaneously or con- secutively affect two, three or all of the quarters. ; The period of incubation in acute mammitis is brief. Experi- mental infection has induced the symptoms of mammitis in 12— 24 hours. We also observe a similar period of incubation clini- cally following operative interference of the mammz. ‘The forcible insertion of a milk tube; the inflation of the udder in milk fever; or the overcoming of atresia of the teat by incision or puncture is frequently followed by mammitis in 12-24 hours. Lameness is a common and early symptom of the disease. It is frequently the first symptom observed by the owner, though it may occur at any time during the disease. The lame- ness may be referable to three different causes. 1. In the first stages of the disease, the owner may observe lameness as the first symptom of mammitis. In such cases the lameness is apparently an expression of pain in the affected quarter or quarters. The lameness may be more severe whena hind quarter is involved than when an anterior one is affected, because, in progression, the posterior quarter is more severely compressed or contused by the hind leg as the limb is carried forward and weight placed upon it. Doubtless not all the pain and conse- quent lameness is due to the sensitiveness of the affected quarter, but must be largely referred to lymphangitis or phlebitis of the chief mammary veins and lymphatics in their course through the inguinal canal, where any tenderness causes intense pain dur- ing any movements of the limbs or body which may bring into play the surrounding muscles. When both sides of the udder are simultaneously inflamed, the disinclination to move becomes very strong, with evidences of very great pain. 2. Pyzmic arthritis may arise at any time during the affec- tion, as a complication of mammitis, and induce symptoms par- allel in all respects with the pyzemic arthritis already described 60 946 Veterinary Obstetrics on page 902 asa sequel to puerperal infection. Such arthritis cannot be differentiated from that arising from septic inflamma- tion of the uterus, except it occurs at a time when the uterine avenue of infection may be excluded. 3. Paretic lameness or paralysis occasionally accompanies manimitis, and appears in two somewhat distinct forms. a. Acute mammary gangrene with acute septicemia fre- quently causes rapid and complete paralysis of the posterior portions of the body. In particularly stormy mammitis with gangrene, complete par- alysis has sometimes been the first symptom observed by the owner. During the night, or other interval without observation,. other preliminary symptoms may have come and gone, and when first observed the cow is prostrate and unable to rise. 6. Mammary toxemia or pseudo-parturient paresis may occur in very mild, insidious cases of mammitis. Ere the owner or veterinarian realizes or suspects serious consequences, the cow goes down, is more or less completely paralyzed, her temperature may be sub-normal, and more or less marked coma may appear. Two facts serve todifferentiate this from parturient paresis. It occurs, or may occur, four to six weeks after partu- rition, perhaps in an animal not a good subject for parturient paresis, and a history of the case will reveal the existence of a more or less evident mammitis. According to our observation the mammitis in such cases has been of a very mild type, slight swelling, the disease apparently confined chiefly to the milk cistern and ducts aud accompanied by well marked, though not extreme, changes in the secretions of the affected quarter. The milk had for a few hours been thin, wheyey and flocculent, but not fetid. Apparently such paralysis is due to toxeemia from the absorp- tion of bacterial products from the diseased udder. In one case observed by us, inflation of the udder.with oxygen promptly overcame the paralysis and coma, and apparently also disinfected the diseased quarter. The local symptoms of mammitis consist essentially of the cardinal symptoms of inflammation, with the various conse- quences of inflammation in these tissues. Heat is usually a prominent symptom in the affected quarter, and is very readily recognized by the sense of touch, especially Acute Mammitis 947 when compared with an adjacent healthy quarter. The intensity of heat is not indicative of the seriousness of the inflammation within the gland. The inflammatory processes may be chiefly taking place in the central portion of the gland,and the skin may be but slightly involved. While the presence of heat may > aid in the diagnosis, it is of comparatively little value as an aid to prognosis. The pain in the inflamed gland shows every possible variation in intensity. Asin the case of heat, so the degree of pain does not reveal the seriousness or extent of the malady. As a general tule, the pain is most marked upon pressure when the disease is largely concentrated in or about the teat, that-is, when the disease most seriously involves the more superficial, sensitive portions of the gland. There may be a deep-seated inflammation of the gland, which may be freely palpated without causing evidence of great pain. When necrosis occurs in any part of the gland, sensation in that portion necessarily ceases., The redness of the tissues is usually in harmony with the de- gree of heat and pain. When the inflammation is at all super- ficially located, the redness is usually very intense, and in marked contrast to the color of the adjacent healthy quarters. When gangrene occurs, and involves the skin, that portion which is gangrenous assumes a necrotic-black or necrotic-green hue, and the epidermis may slip off upon touch, exposing the naked skin. Swelling constitutes one of the most prominent and important local symptoms. At the very beginning of the disease, the swell- ing is usually quite evident to both sight and touch. It becomes especially marked when the healthy quarters of the gland have been milked out. Upon manipulation, the diseased quarter is found to be more or less extensively enlarged, sometimes to double the size of the corresponding normal quarter when filled with milk. There is, however, a somewhat definite limit to the rapid swelling of the gland, owing to the very inextensible gland cap- sule. As the inflammation continues, the capsule may become slowly increased to an enormous size. There are variations in the character of the swelling, depend- ent somewhat upon the chief center of the disease and the viru- lence of the infecting agent. When the inflammation is deep- seated, the external appearances of swelling may consist very largely of edema, which appears subcutaneously about the upper 948 Veterinary Obstetrics part of the udder, and may extend forward along the floor of the abdomen toward the anterior limbs, and upward and backward between the thighs to the vulva and perineum. Sometimes the volume of the edema is very great, while at other times edema may be virtually absent. In other instances, the swelling assumes, instead, the character of induration, or we might say it is chiefly within the capsule of the gland, involving the glandular and interlobular connective tissues and, by causing parenchymatous engorgement, stretches the gland capsule tight and causes a firm compression of the contents within: Manipulation of the diseased quarter reveals great tenseness and hardness in the deeper parts of the organ. When suppuration appears, and pus is formed, there soon occur the cardinal symptoms of abscessation, with the prominent firm swelling, redness and pain, to be followed by fluctuation. Usually there is a single abscess involving much or all of a quarter. Rarely one, two or all the quarters become the seat of multiple recurrent abscesses, the udder enormously enlarged, with abscesses scattered here and there, discharging copiously a thick, fetid pus. When gangrene supervenes, the redness, pain and heat may disappear, the swelling may become softer, and, if the skin is in- volved, the surface becomes cold and the epithelium is readily displaced. When the disease continues for a long period of time, and ~ enters upon a chronic state, sclerosis, with absence of pain and heat, may follow, and the gland assume an enormous size. The disturbance of function in the gland is one of the most marked and important symptoms of mammitis. From the very first, there is a more or less marked decrease, or a total suspension of the secretion of milk in the affected quarter. At the same time, there usually occurs a more or less marked diminution in the amount of milk secreted by the apparently healthy quarters. The changes in the character of the milk are highly important, and reveal to a certain extent the virulence of the malady. The milk loses its neutral or faintly alkaline character, and. becomes somewhat acid. The casein becomes precipitated and flocculent. The clumpsof casein may be so tough and of such large size as to render it difficult or impossible for them to be forced out through the teat orifice. In many cases they probably remain incarcerated Acute Mammits 949 in the larger milk ducts, to add to the engorgement of the gland. The liquid portions of the milk are watery, and vary in color according to circumstances. Usually in the earlier stages the liquid portion of the milk is white, faintly bluish-white, or yellow. Sometimes it is streaked with blood, or merely somewhat tinged with blood, to give it a faint reddish color. When gangrene ap- pears, the liquid which may drip or be expressed from the teat has a tell-tale necrotic-red color, which at once reveals the con- dition of the deep-seated tissues. The albumen in the milk may be increased ten-fold ; the salts may be largely increased ; while the fat and casein almost dis- appear. Sometimes the contents of the milk cistern are princi- pally or wholly of pus. The milk may be either odorless or more or less fetid. In many cases, when the diseased liquid is pressed out from the teat and caught, it is found to be extremely fetid, giving off the odor of fetid pus from wounds. In gangrene, the typical gangrenous odor may be present in the fluid. The taste of the diseased milk shows every possible variation, usually is somewhat salty or may be bitter. Bacteriologically, the discharge from the gland may be highly variable, and include, as already suggested, various forms of diplococci, streptococci or bacilli, and other organisms char- acteristic of wound infection. The infection may be pure or mixed. The systemic disturbances of mammitis are not always in harmony with the extent and intensity of the local lesions. Usually, in severe, acute mammitis, there are well-marked sys- temic disturbances, consisting essentially of fever or septicemia. In very acute cases of mastitis, we have observed the tempera- ture rise suddenly, reaching 106° F. within twenty-four hours from the time of infection. Generally, when there is an ex- tensive inflammation of the udder, a more or less marked fever is present, with all the symptoms which that term usually includes, such as loss of appetite, torpidity of the bowels, dry muzzle, suspension of rumination and decrease of thirst. The urinary and other functions are decreased, and there is more or less profound depression. In the early stages of the disease, there may be chills, with staring coat. When the disease be- comes very severe, there ensues a loss of sensibility, and the 950 Veterinary Obstetrics patient ceases to care for her calf and becomes more or less un- conscious of her surroundings. When gangrene is threatened or present, there may be more or less complete paralysis, as already stated ; or a somewhat similar paralysis may occur sometimes as a result of intoxication owing to absorption from the udder of bacterial products, in comparatively mild attacks. Course and Termination. In a large proportion of cases the course and termination of the disease is tinfavorable. Even in those cases counted as recoveries, the glands are almost inevi- tably more or less damaged, and their function interrupted either temporarily or permanently. ‘The complete loss of one or more quarters by atrophy, indura- tion, abscessation or gangrene is common, resulting in a three-or two-teated cow of greatly diminished value. A three-teated cow may yield a high percentage of the normal amount of milk, but the diseased and functionless gland may constitute a menace to the adjacent quarters, and is unsightly and undesirable. When two quarters are‘lost, the decrease in the milk yield is so great that the value of the cow as a dairy animal is ordinarily at an end. The mortality from the disease is by no means insignificant. ‘The disease may terminate in resolution ; abscessation ; chronic mastitis, with atrophy of the glandular substance, which may be accompanied by hyperplasia of the connective tissue with indu- ration and enlargement ; gangrene ; pyaemia; or septiczemia. a Resolution may occur early in the attack, at any period from the third or fourth to the eighth or tenth day, or even later. +In very acute cases, resolution may follow in the course of a very few hours; in fact, in some very virulent cases resolution must occur very quickly or the animal necessarily perishes. When resolution occurs, the swelling and pain in the udder abate, the appetite returns and the milk secretion becomes re-established, while the general appearance of the animal improves in harmony with the local conditions. The milk may remain somewhat ab- normal for a time. The milk flow very rarely recovers its normal amount, but remains somewhat lessened throughout the involved milking period. The volume may or may not become fully re- stored at the next calving. Vennerholm agrees with Franck that resolution seldom follows, while Stockfleth estimates that resolution occurs in at least 50% Acute Mammttis 951 of the cases. In our experience resolution has been very rare indeed. Too frequently the acute disease passes into the chronic form. If the changes brought about by the disease are not too serious, the period of rest, while the cow is dry, may afford an oppor- tunity for the complete resolution of the gland, so that when she again calves she may yield almost or wholly her normal amount and quality of milk. If the gland has been once seriously affected, it is rendered so vulnerable to any subsequent infection that the disease may at any time recur. 6, Suppuration and the formation of abscesses may originate in any of the tissues of the gland—in the subcutaneous connec- tive tissue, the inter-lobular connective tissues, or the paren- chyma of the gland. In many cases we observe that the suppuration affects chiefly the epithelium of the milk canals and acini, to coristitute ca- tarrhal mastitis, in which case there may not be very extensive swelling, and the area of the disease may be more or less con- fined to the milk cistern and the larger milk canals, without in- volving seriously the acini themselves. Rarely an abscess forms in the milk cistern, without involving the parenchyma of the gland at all. Abscesses in the milk cistern are very liable to cause the destruction of the milk canals, by causing their com- plete atresia, so that they can never re-open. The formation of “ abscesses in the udder leads almost uniformly to the permanent destruction of the involved quarter, though in rare instances there may be a partial restoration of milk production after the next calving. Purulent mastitis may lead, in somewhat:rare instances, to pyzemia or to metastatic complications of the joints or tendon sheaths. Abscesses may become encapsulated, with indurated abscess walls which surround the pus, and continue as hard swellings in the affected part. c. Atrophy of the gland substance occurs frequently, with or without induration. Following many cases of acute mastitis, a chronic inflamma- tion remains, which causes, in addition to the atrophy of the substance of the gland itself, an extensive hyperplasia of the inter-lobular substance. The gland becomes indurated, hard, and incapable of secreting milk. The indurated gland may as- 952 Veterinary Obstetrics sume enormous proportions, and finally take the character of a connective tissue tumor, and, by its weight, drag the capsule of the quarter downward until it nearly reaches the ground. Insome cows the indurated udder is so enormous in size, and hangs so low, that it interferes greatly with locomotion. It is constantly subject to injuries during the animal’s movements, by coming in contact with obstacles of various kinds, which cause wounds and contusionsand bring about infections of the enlarged function- less gland which may give more or lessannoyance. _ At each birth period, also, indurated glands are liable to be- come congested and inflamed, and give rise to more or less serious complications. Such a gland is.always beyond restoration. d. Gangrene. Gangrene constitutes the most serious termi- nation of mastitis, because it destroys absolutely the function of all that portion of the gland which is involved, and seriously im- perils the life of the animal. It occurs usually as a direct result of the intense infection of the part, which leads to the destruc- tion of the circulation in the affected gland. It may appear very quickly, or may be somewhat delayed in its advent. Gangrene may involve the parenchymal and inter-lobular tissues alone, or may include the skin. It may be confined to one of the quarters or a portion of it, or may involve the half or all of the gland. The gangrenous portion may partially undergo purulent destruc. . tion. The surrounding parts may suppurate in such a manner that a sequestration of the necrotic tissue occurs, and the gan-* grenous portion is later thrown off. In the more acute forms of gangrenous mammitis, the course of the disease is entirely too rapid and virulent for a sequestrum to form or suppuration to take place, and the animal dies very quickly from acute septiceemia or pyzemia. Few diseases run a more stormy course than the more acute types of gangrene of the mammze. In one instance, which we observed, a cow was left apparently well at milking time in the evening ; when found the next morning she was down and unable to rise because of acute mammitis, which quickly advanced to gangrene of the organ; she died during the day. Other instances have been observed where the disease has pursued a similarly rapid course. Pathology. ‘The pathology of mammitis includes every pos- sible morbid change in an acinous gland, important changes in the milk secretions. and such systemic disorders as pyzemia and Acute Mammitis 953 septiceemia, which may emanate from the disease processes in the glands. An incision through a milk gland recently attacked by mam- mitis, reveals engorgement, injection and hemorrhages in the parenchyma. The milk canals contain abnormal secretions, usu- ally flocculent in character, due to clots of casein. ‘The groups of acini upon the cut surface appear as small yellow clumps. Serous or sero-sanguineous fluid may be pressed from the cut surface. If the disease assumes the catarrhal type, and limits its rav- ages chiefly to the epithelium of the gland, the milk cistern and milk ducts usually contain muco-purulent or purulent secre- tions. The accumulated secretions may be thin and watery with caseous clots floating in them, stringy and tenacious, or purulent and fetid. Sometimes the disease may be limited to the milk cistern, anda catarrhal inflammation ensue with discharge of the pus through the teat orifice ; or the teat orifice may become blocked, con- verting the cistern temporarily into an abscess cavity, which eventually ruptures by re-opening of the milk orifice, and the dis- charge of the accumulated pus follows. Such an abscess tends to cause permanent atresia of the larger milk ducts and, preventing the escape of milk into the cistern, produces engorgement of that portion of the gland from which the affected duct normally ‘Serves as an outlet. Later the engorgement destroys the secre- tory power of the part, and there may remain for a time an im- prisoned volume of milk—a ‘‘ milk cyst.’’ Catarrhal inflamma- tion of the milk cistern may lead to atresia or adhesions in any part of the cavity. Sometimes the entire milk cistern becomes occluded, the cistern walls adhere from the base to the apex of the teat, and even though the gland itself may escape destruc- tive inflammation, it is later doomed to pressure atrophy from the compression of the imprisoned milk. Such adhesions occur most readily in the dry cow or heifer, when the changes named are not interrupted by a constant flow of milk into the cistern. When the catarrhal inflammation extends to the smaller milk ducts and acini, the secretory epithelium is more or less injured or wholly destroyed, while the cavities of the acini become oc- cluded with exudate. Later the glandular tissue may undergo 954 Veterinary Obstetrics atrophy. The atrophy may be intensified and increased by hyperplasia of the inter-lobular connective tissue septa. Treatment. The treatment of mammitis is necessarily unsat- isfactory. The anatomy of the gland is such that when the tissues be- come infected there is no known method of reliable disinfection. Acute inflammation of the parenchyma at once causes the milk ducts and acini to become filled with exudate. Into these blocked passages we are powerless to introduce remedies, and from them we are alike powerless to extract the exudate. The gland is firmly bound down by its very tense fibro-elastic cap- sule, derived from the abdominal tunic. When the imprisoned gland becomes inflamed and swollen, great pressure is at once exerted upon its substance by the unyielding capsule, its circula- tion is impeded or suspended, and the infecting agent is afforded an excellent opportunity for rapid multiplication and destructive activity in the weakened tissues. Further complications arise from the dependent position of the gland, which interferes seri- ously with the return of the venous blood. As in all diseases where no specific method of handling has been devised, so in mammitis, an almost endless variety of means have been suggested, tried, approved or condemned. It is im- practicable to relate each method of handling, nor would it be profitable. The various forms of handling may be more or less definitely classified. 1. Disinfection. Since acute mammitis is referable to infec- tion, the most rational course for treatment, the one which technically appeals most directly to reason, is disinfection. Un- fortunately, as already stated, we have no efficient plan for bring- ing this about. Three plans for disinfection‘have been tried, and each has had its champions, possibly because each possesses some degree of efficiency. a. Intra-mammary injections of disinfectants have long been practiced and advised by some veterinarians, but the plan has never acquired general adoption. Nocard, Franck and other authorities have reported favorably. Vennerholm, Zschokke and other equal authorities have failed to secure benefit from this method of handling. In our hands, a 2@5% boric acid solution, injected into the udder by gravity, has not only Acute Mammitts 955 failed to reduce the infection and inflammation but has appar- ently intensified the disease. In the healthy udder, only a small amount of fluid can be introduced under a gravity pressure of three or four feet. We have succeeded in this manner in injecting little more than a pint into a quarter from which five to eight times that volume of milk had been withdrawn. This signifies that, in the healthy udder, fluids injected through the teat pass into the cistern and larger milk canals, but not into the smaller milk ducts and the acini. In the vast majority of cases of mammitis, the small ducts and acini, not the milk cisterns and larger canals, constitute the chief center of disease. Fluids injected into the udder usually reach the least important part of the gland only—the cistern and large canals. As a consequence, not much can be expected from this plan of handling. If the disease is largely centered in the cistern and large sinuses, disinfection by intra- mammary injections may prove highly efficient, but such cases are in the minority. The selection of a disinfectant for such purpose is not highly important, though certain principles may have clinical import- ance. Boric and other acids tend to coagulate any casein or albumen present. The same holds true of mercuric chloride, and the salts of the heavy metals generally. Carbolic acid, cteolin and allied drugs are highly irritant. Probably lysol, bacillol and other drugs of this group are most useful for injection. Whatever disinfectant is employed, it must be in very weak solution. Of lysol or bacillol, not to exceed 0.5% should be used. ‘The chief reliance should be placed upon the irrigation of the cistern and sinuses with the warm water, rather than upon the efficiency of the antiseptic contained. The various soluble silver salts have been proposed for this purpose, but have failed to secure a prominent place. 6. Disinfection by external applications is an old plan of handling. Probably in many cases, the practitioner has not had disinfection in mind when applying it. Camphor, iodine and mercury, in combination with various substances, have long been used in the form of ointments thoroughly anointed over the affected area. ‘Their value has been stoutly asserted by practi- 956 Veterinary Obstetrics tioners like Johne, Bang and Franck. They probably exert some favorable influence as disinfectants. It is possible, however, that the massage used in applying the ointment constitutes as great, or even a greater, factor than the absorbed portion of the ointment. The drugs named are also rubefacients, and may favorably affect the diseased gland by exciting increased vas- cularity with exalted leucocytosis. c. Systemic disinfection in mammitis has not yet received much attention. How effectively it may be employed remains to be determined. We know that potassium iodide exerts a some- what specific effect, when given internally, upon lesions of acti- nomycosis and botryomycosis—chronic infections which are not wholly unlike the acute infections of ordinary mammitis. Aromatics and gum resins, when given to healthy, lactating animals, are recognizable in the milk by the sense of odor and taste. Most of these drugs, like camphor, turpentine and the aromatic oils, are efficient disinfectants, and given in full doses tend somewhat to lessen infection in the mammary gland. 2. Modifications in the blood-flow to the udder have been claimed to affect the course of mammitis. In former times practi- tioners aimed to reduce the intra-mammary blood pressure by means of venesection. Local applications of camphor, belladonna and other drugs have been made, in the belief that they decreased the amount of blood sent to the udder, though the truth of this has not been clearly shown. On the other hand it is not impos- sible that they increase the blood supply and also the léucocy- tosis, through which the treatment may act favorably upon the diseased organ. Just as in the application of antiseptics, so here the massage incident to application may exert the chief favorable influence. Cold has been used and advocated by some, either cold water or ice being applied to the inflamed gland. It has not proven of any marked value. Its tendency is to cause decreased vascu- larity during the continuance, to be followed by increased blood flow and vascular engorgement as soon as the cold is withdrawn. Fomentations with hot water, to which vinegar and various ‘other drugs are added, have long been recommended, and with the accompanying massage, appear to exert a favorable influence. For this purpose, a sufficiently capacious vessel should be filled with as hot water as the patient can bear, and the vessel placed * Acute Mammitis : 957 directly beneath the udder. ‘The fomentation and massage are then applied, the bath being kept hot by repeated additions of hot water. It has been recommended also to modify the blood flow in the mammzee by suspension or compression of the glands. Some recommend that a three-cornered piece of cloth, of sufficient size to encompass the udder, be fitted with long straps, those from one corner passing up behind on either side of the tail, those from the other corners upwards along the flanks, and all tied securely over the loins. This may support the weight of the pendulous udder, exert some pressure upon it, and de- crease the engorgement of the gland. Some would cut holes in the suspensorium, through which the teats may project, so that the cow may be milked ; others advise that the teats be included in the bandage, and one corner detached while the cow is being milked. It has also-been proposed to strap the udder tightly with strips of adhesive plaster, and to thereby exert compression upon the gland, but the plan has not come into general use, presumably because it has failed to produce the expected results. The form, direction and location of the udder of the cow render suspension and adhesive strapping exceedingly difficult, and the efficiency of neither has been demonstrated. It may well be questioned whether the inevitable partial displacement of such appliances, when the animal lies down, does not induce injuries which more than counterbalance any possible good it is hoped to derive from the strapping or suspension. With the aid of the suspensory bandage, poultices were for- merly applied to the inflamed udder. They were highly com- mended by many, but their use has been largely discontinued. They are difficult of application and retention, and their value is very problematic. Instead of attempting to decrease the blood flow to the in- flamed gland, some would increase it. This is probably in a measure brought about by massage and by the application of stimulating liniments. Cupping has also been tried. A cup- ping glass of sufficient size is fitted over the teat of the affected quarter, and the airexhausted. This may cause the discharge of quantities of secretions which could not be withdrawn by milking, and stimulates increased nutrition in the diseased tissues. 958 Veterinary Obstetrics Modern therapeutics recognizes the value of increased numbers and activity of leucocytes ina diseased area. Cupping, massage, ‘repeated milking, fomentatious, and the application of stimulating liniments or ointments, all probably favor leucocytosis. It may ‘be that the chief value of each of these applications lies in this influence upon the abundance of lencocytes in the part. 3. It has been proposed to exert a favorable influence upon the course of mammitis by decreasing the flow of milk. In a way, this plan is closely allied to the decreasing of the blood supply to the gland. In considering the symptoms of the malady, we had occasion to note the inevitable decrease of milk secretion, or even its total suspension, as soon as mammitis becomes established. The artificial checking of the secretion of milk is usually quite unnecessary ; it becomes checked or suspended as an inevitable consequence of the disease. Not only is the secretion of milk decreased or suspended in the affected quarter, but also in the sound areas of the gland. Nevertheless many practitioners would have us decrease the milk secretion by the application of belladona or camphor to the exterior of the affected gland. Others recommend reduction of lactation by a reduced diet or by laxatives or purgatives. Whether or not these be of direct value in precisely the way in- tended, is possibly of no great consequence. Two essential thera- peutic principles are involved: 1. The maintainance of the vigor of the animal system—as a whole; and, 2. The placing of the diseased organ at rest. We cannot maintain the highest systemic vigor upon a too restricted diet, and it is equally injurious to overfeed. The forced feeding of dairy cows is highly inimical to the progress of mammitis, just as it is of any other serious organic malady. It is consequently important that, in mammitis, the food rations be adjusted to the needs of a sick animal, and this in itself will reduce the tendency to active lactation. For this pur- pose it is well to allow a restricted ration of bran, roots or grass, freely salted, to emphasize the laxative tendency. 4. Elimination of disease products from the system. Acute mammitis is inevitably accompanied by the entrance into the system of important disease products which more or less se- riously affect the general health of the patient. “These disturb- ances are reflected back to the affected organ, there to intensify the local disease. Not only is it important, for the progress of Acute Mammitis 959 mammitis, that the animal system be kept in the most vigorous condition possible, but it is equally important that the disease products shall be promptly eliminated. Whenever these fail to be promptly eliminated, they at once act unfavorably upon the system, inducing fever, with its important train of symptoms. With the advent of fever, the kidneys, bowels and other eliminating organs fail to perform their normal functions. Mastitis in ruminants is especially marked by great torpidity of the digestive system: rumination ceases, the bowels are tor- pid, digestion is. at a standstill, the aliment within the canal tends to undergo decomposition, and waste products: which are normally eliminated through this channel are retained within the system. It has accordingly long been the custom of veterinary practi- tioners to favor elimination by stimulating the alimentary tract to increased activity. This is partly accomplished by a laxative diet, which in mild cases frequently suffices. In the more serious . cases, the patient does not eat, or for other reasons a laxative diet fails to produce the desired results and the practitioner needs ap- peal to more radical measures. The administration of purgatives in acute mammitis has ac- cordingly become recognized by many practitioners as highly valuable. Most practitioners rely upon the administration of © magnesium, or sodium sulphate with various adjuncts. ‘They have the common defect of inducing a degree of nausea, de- creased thirst and inappetence, which combine to retard or prevent catharsis. At best they are slow of action. Oils are little, if any, more effective. In our experience, the hypodermic cathartics—eserine, areco-' line and pilocarpine, combined where advisable with strychnine— constitute the most reliable, prompt and efficient means for un- loading the alimentary tract. They save 12 to 20 hours in time, hours which may be of critical importance in the control of the malady ; they are safe and bear quick repetition when the dose proves too small; and they possess very high efficiency. In one case occurring in our clinic, acute mammitis of a very virulent type, in all four quarters, followed the iodide of potas- sium infusion in handling parturient paresis. The temperature was 106° F., the pulse very rapid, the muzzle dry, the animal 960 Veterinary Obstetrics extremely dull and weak and paying no attention whatever to her calf. The udder was immensely enlarged, hard and unyield- ing, and but a few drops of a thin, serous fluid could be pressed out of the teats. The general appearance of the animal indi- cated that the disease was progressing rapidly to a fatal termina- tion, and in our judgment the patient would not have survived many hours under the usual methods of treatment. We ignored the local handling of the organ, and instead iu- jected a full dose of eserine sulphate and pilocarpine hydro- chlorate hypodermically. The purgation and salivation were very ‘prompt and decided. The improvement in the condition of the animal was also prompt and remarkable. The temperature fell at once, and continued to drop at the rate of more than 1°F. per hour, until it reached normal. The muzzle soon became moist, and the cow renewed her attentions to her calf. The engorgement of the udder diminished rapidly ; the gland quickly became less tense and hard, and milk soon reappeared in the gland. The recovery was as prompt as had been the onset of the disease, which had shown unusual virulence from the beginning. | Vennerholm regards the repeated withdrawal of the milk or ‘excretions representing it, and thereby the removal of so much infectious material, as one of the most important elements in the handling of acute mammitis in the earlier stages. He recom- mends that the milk which accumulates in the cisterns should be withdrawn at least hourly so long as there is a hope of bring- ing about the resolution of the gland. He very properly re- marks that the infectious fluid should on no account be deposited upon the stable floor, but should be milked directly into a con- tainer partly filled with a reliable disinfectant. Too much reli- ance should not be placed upon the withdrawal of the small amount of fluid which has accumulated in the milk cistern. In most cases of acute mammitis, the amount of this is not large, although we know full well that it is highly infected, and may consequently look upon its retention in the cistern and sinuses as very undesirable. The important pathologic changes are tak- ing place chiefly in the acini, and not in the milk canals or cis- tern, and such influence as we may be able to exert upon the large milk canals and their reservoirs is not of fundamental importance. Our anxiety is centered upon the acini themselves. | Acute Mammitis 961 While the infection has admittedly entered through the milk cistern and the milk canals, nevertheless after the infection has traversed these parts and reached the parenchyma, the import- ance of these canals in the course of the disease has been largely eliminated. When considering the symptoms of acute mammitis we have referred to the advent of coma in rare cases, and have stated that in at least oneinstance the inflation of the udder with oxygen over- came the coma, and apparently at the same time eliminated the infection. In ordinary mammitis it would appear that inflation with air or oxygen would prove valueless. As in other infections, so in mammitis, it has been hoped that curative sera may be devised which may be turned to practical account. ‘The uncertain and usually mixed character of the in- fection constitutes a serious obstacle to serum therapeutics. Cows which are suffering from mammitis should be milked by | a person who does not come in contact with the other cows, or should be milked last, so that the milker may not pass from the diseased cow immediately to a healthy one, with the possible danger of transmitting the disease. The same rule should be applied to the healthy portions of the gland of an animal suf- fering from the disease ; the healthy quarters should be milked first, followed by the milking of the diseased ones. Disinfection of the udder externally is of very great impor- tance in the control of the disease. Before beginning to milk an affected gland, the entire udder should be thoroughly disinfected, and after the milking of the diseased gland has been completed it should again receive thorough disinfection. The milker should also very thoroughly disinfect his hands before and after the milking, and especially should always most thoroughly disinfect his hands after having milked a diseased gland before he milks or otherwise handles the udder of a healthy cow. The best dis- infectant for this purpose is 1-1000 corrosive sublimate solu- tion, because of its high efficiency and freedom from odor, so that if used in a stable where milking is going on, there is no danger of causing the milk to become tainted. In stalls where mammitis exists, great care should be taken to thoroughly cleanse and disinfect the floors and gutters, in order to prevent the spread of the infection from animal to animal. It 61 962 Veterinary Obstetrics is important also, as has been suggested in dealing with the causes of the disease, that the tails of neighboring cows should be kept disinfected, or, preferably, that a cow suffering from mam- mitis should not be kept so near to a healthy cow that a transfer of the infection from one to another, through the medium of the tail or otherwise, is probable. In wounds of the teats or udder, it is highly important that the disinfection ef these should be as complete as it is in the power of the practitioner to command, in order to avoid the en- trance of infection through the teat orifice into the gland. In dealing with metritis, or other disease accompanied by infective discharges from the vulva, which may flow down over and soil the udder and teats, the practitioner should exercise care in order to prevent the infection from gaining entrance into the teats. The surgical handling of mammitis consists in the opening of abscesses, the detachment of necrotic areas, or the amputation of the gland. The handling of abscesses of the mammae offers few special problems as compared with the handling of abscesses of other portions of the body. Following the general rule of procedure, they should be opened as early as fluctuation is clearly present ; the opening should be free and dependent as in other abscesses ; the abscess cavity should be thoroughly disinfected and any ne- crotic tissue lying within the cavity should be removed. In some instances of suppuration, the pus collects very largely in the milk cistern and is discharged through the orifice of the teat. In some cases this discharge of pus is not as free as should be, and it is occasionally advisable to amputate the end of the teat in order to secure a perfectly free opening. The question of the preservation of the teat is usually of no significance, because the quarter has lost its power of again secreting milk and is consequently useless. . In some instances of severe mammitis, with great enlargement of the udder and extreme tension of the capsule of the gland, the virulence of the disease may be largely overcome by long and deep scarifications, by which the capsule is incised at a number of places in such a manner as to relieve the compression of the gland. This may be followed by liberal bathing with warm antiseptic solutions. In this way gangrene of the gland may be avoided, and the inflammation largely overcome; but after Acute Mammitis 963 all no very useful purpose has been served, except possibly that the danger to the life of the animal has been lessened. The affected gland is destroyed, and consequently useless. Amputa- tion would generally be preferable. Whenever gangrene threatens the life of the animal; when the udder is the seat of enormous abscesses which must eventually destroy the integrity of the gland and cause prolonged disease and loss of condition ; when tumors of large size or chronic in. flammatory processes with great enlargement and pendulousness of the udder exist ; or when the gland is the seat of actino- mycosis or botryomycosis, the udder should be amputated. It is impractible to amputate one of the quarters of the cow, since the two quarters of one half are too intimately blended for separation. The cow is to be cast, and preferably secured in lateral re- cumbency. Vennerholm recommends dorsal recumbency, but this is constantly objectionable in ruminants because such posi- tion tends to induce tympany, and consequently should be avoided as far as practicable. The patient should be secured by means of two stout ropes, one of which is to be attached to the anterior, and the other to the posterior feet. The patient is then to be extended by attaching each rope toa post or other secure fasten- ing, sufficiently far apart to allow the animal to be fully stretched between the two points. The question of anaesthesia is one upon which practitioners are not agreed. Vennerholm recommends complete general an- aesthesia. In ourexperience general anaesthesia in the ruminant is dangerous, because of the probability of food being regurgitated from the rumen and inhaled,-to cause foreign body pneumonia. In one case of amputation of the udder in the cow, where the entire gland was removed, as it was completely gangrenous, the cow was in a comatose condition and required no anaesthetic, because, so far as could be seen, no sense of pain was induced in the animal during the entire operation. Neither is the opera- tion a very painful one in most cases, so far as can be judged by the character of the tissues involved. The principal pain is in- duced by the cutaneous incisions, and the ligation of the chief mass of inguinal vessels. The operator may consequently choose between general anaesthesia and iocal anaesthesia to the skin, followed by local anaesthesia to the vessels passing through the inguinal canal. 964 Veterinary Obstetrics With proper care in application, the local anaesthesia is efficient and ample from both humane and surgical standpoints, and is far safer than general anaesthesia in ruminants. : If the entire udder is to be removed, it is most easily accom- plished by amputating the two halves separately. If the skin is healthy, enough of it should be retained to readily cover over the denuded tissues, though most of it would best be removed with the gland. A curved incision is made around the half of the udder to be removed, at such a point that sufficient skin will remain to properly close the wound. The incision should extend ‘ only through the skin into the subcutaneous connective tissue. The skin is separated, by means of the fingers or the scalpel handle, Fic. 142. UDDER OF Cow, SHOWING PRINCIPAL BLOODVESSELS. (FURSTENBERG). @ Ext. pudicart.; 6 Ext. pudic vein ; ¢ Arterial twig to the lymph gland ; d Posterior mammary gland; e¢ Anastomotic twig of external pudic artery; & Larger venous trunk; 4 Posterior mammary vein; / Lymph gland ; m Milk vein; o Ant. mammary vein; 7 Lymphatic vessel; ¢ Nerve trunk (ilio-hypogastric and ext. spermatic). 4 Infectious Mammitis of Cows 965 from the fibro-elastic capsule of the gland. As this division ap- proaches the base of the gland, the operator encounters the sub- cutaneous abdominal vein and a branch of the external pudic ar- tery, which should be ligated, preferably with a double ligature, in order to prevent anastomatic hemorrhage. Posteriorly the operator encounters branches of the external pudic vein and artery, which require ligation. As the operation extends upward, the capsule of the gland needs be detached from the abdominal tunic, of which it constitutes a part, and when the region of the external inguinal ring is reached the operator encounters the chief vascular supply of the gland, as the vessels emerge from the inguinal canal. These should be carefully and securely ligated ez masse. Any failure to properly secure these vessels may lead to serious or fatal hemorrhage, as has been repeatedly observed. By properly dividing the connective tissue from these vessels, they may be readily bared for some distance, and a ligature passed around the group of vessels, which may then be divided with scalpel or scissors some distance beyond, leaving a sufficient stump to insure against displacement of the ligature. If these vessels are properly ligated, there can scarcely occur a serious hemorrhage from any of the others. If the other half of the gland is to be removed, the animal, if secured in lateral recumbancy, should now be turned to the op- posite side, and the operation repeated. The wound should then be thoroughly cleansed and disinfected, all blood clots washed carefully away, and all vessels which can be discovered properly secured, after which the margins of the wound should be trimmed in such a manner that they can be brought together in proper apposition, without being either stretched or flaccid. In the wound should be laid some anti- septic tampons, such as strips of iodoform gauze, in order to pro- vide drainage and secure antisepsis. 2. INFECTIOUS MamMiITIs oF Cows. INFECTIOUS AcaLactia. ‘‘GELBER GALT.”’ Messrs. Borgeaud, Nocard and Mollereau, Zschokke, Bang, Kitt and others, describe an epizootic form of mastitis in cows which sometimes occasions very serious losses. Zschokke asserts 966 Veterinary Obstetrics that some dairymen dread the malady more than foot and mouth disease, so extensive are the losses sometimes occasioned in affected dairies. The malady has been observed chiefly in Switzerland, where it has been extensively studied. We have seen no definite account of the existence of the malady in America, but its chronic, in- sidious character renders its importation easy. It probably already exists in this country, and merely awaits recognition and report of its presence. The disease consists of a catarrhal mastitis accompanied by slight or inconspicuous tumefaction of the affected quarter or quarters. The onset is somewhat insidious. The gland does not swell greatly, if noticeably. ‘There is little or no tendency to abscessation or gangrene, and no marked systemic disturbances. The milk from the affected gland diminishes in quantity and undergoes gradual changes in quality. It becomes serous, bluish, and more or less viscid or flocculent. Later the color of the milk may be reddish or brownish. It acquires a slight acid reaction, is odorless and has a salty taste. The affected gland, which at first was but little altered in size, consistency or temperature, begins after 2 or 3 weeks to atrophy, and the milk secretion largely or completely ceases. After 2 or 3 months the gland becomes extremely atrophied and shriveled, and the gland tissue so far disappears as to be almost unrecognizable by palpation. After the disease has run its course, the gland re- mains functionless at least until the cow calves again, possibly permanently. Ibel (Archiv. Tierheilk, vol. 30) found that the lacteal vesicles largely disappear, so that instead of 200-300 in a lobule, but 15-60 could be found. The diameters of the lacteal vesicles were also greatly reduced. The acini were sometimes empty, sometimes contained granular leucocytes or albumen coagula. The interlobular connective tissue was found somewhat thick- ened and sclerotic. Ibel concludes that ‘‘gelber galt ’’ at first consists of a comparatively mild parenchymatous mastitis, with the escape of leucocytes and albumen into the alveoli. The disease is highly contagious, and is readily transmitted from the diseased to the healthy glands of the same udder or from cow to cow, through the agency of the milker’s hands. The cause is a form of streptococcus, which can readily be ob- Infectious Mammitis of Cows 967 tained in pure cultures, and by which the typical affection can be _experimentally induced. Zschokke recognizes two types of the disease—-the curable and the incurable. The first is caused by a short streptococcus ; the latter by a long streptococcus. Apparently this is a variation in the virulence of the same organism; if very virulent it forms in long chains if milder in short chains. Zschokke insists that the microscopical diagnosis is practical, and fundamentally important. Not only would he differentiate microscopically between acute mammitis and infectious mammitis, but he would recognize, by the length of the cocci chains, the grade of virulence in individual cases of infectious manimitis. He considers the early bacterial diagnosis of the greatest import- ance in order that control measures may be properly instituted early in an outbreak. The handling of infectious mammitis or agalactia has proven unsuccessful. No method of treatment has been found which exerts any recognizable influence from an economic standpoint. Zschokke tried intra-mammary injections of potassium iodide, I-1000, and itrol (silver citrate), 1-gooo, but without result. He also tried, in vain, subcutaneous and intra-mammary injections of anti-streptococcus serum. Cantharides and other stimulating applications to the udder reduced the infection; but the milk flow was suppressed, the gland continued functionless, and the betterment was without economic value. The experiments of Zschokke convinced him that it is best to leave a milk gland, affected with infectious mammitis, wholly alone. If the milkis drawn from the gland, the free leucocytes are also extracted. If left alone, the leucocytes destroy the streptococci, especially those in short chains. If the milk, or mammary excretion representing it, is left in the gland, not only do the leucocytes tend to destroy the cocci, but the spread of the infection to other quarters of the udder or to other cows is obvi- ated. So long as the infected excretions remain in the udder, they do no harm to the gland, but the affected gland tends more to recovery than if the excretions were removed. The most important feature of handling the malady is the pre- vention of its spread from diseased to healthy glands. Diseased cows should be as well isolated as practicable, and should be 968 Veterinary Obstetrics milked by separate milkers, or, if by the same milker, they should be milked last. When the disease exists in a dairy, dis- infectants should be freely used on the milker’s hands and the cow’s udders, both before and after the milking of each cow. 3. EXANTHEMA OF THE UDDER. ‘THE MAMMITIS OF CoW-POX ” AND POCK-LIKE DISEASES. Pox of the udder is quite common in milk cows in some re- gions. Some hold that there is a true and a false pox, while others claim that the two alleged diseases are really identical and consist of the genuine cow-pox. Cow-pox is usually of a benign character, though at times it is severe and tends to produce mammitis. At the beginning of the disease there may be present the general symptoms of fever, including chills with constipation and a decreased flow of milk. This is followed in the course of a few hours by characteristic lesions of the teats and the parts immediately surrounding these, consisting at first of hyperemic areas, with swelling of the sur- rounding skin. The skin is tender upon handling, and the cow resists being milked. In the course of two or three days there appear distinct papules in the inflamed areas, which vary some- what in their appearance according to the color of the skin. If the integument is not too highly pigmented, the papules are” surrounded by a red zone, and become pitted or pocked in their center. ‘The contents of the papules are at first clear and lym- phoid in character, but later become cloudy and more or less purulent, and finally dry, to constitute a scab, which drops away in two or three weeks, leaving a reddish, depressed scar. Should the pustules be injured by careless milking or other- wise, and the crusts torn away, the disease processes become intensified, the ulcers extend, and perhaps those which are near together become confluent. The crusts forming over the surface are very extensive, and under repeated irritation the lesions tend constantly to grow worse. The eruptions do not all appear sim- ultaneously, but new cropsarise from time to time, so that there may be fresh papules alongside the old crusts or ulcers. While the course of cow-pox is usually benign, in severe cases there isa tendency to the occurence of mastitis of a severe type. It is not known that the mastitis is due to the entrance of the cow-pox organism into the udder. It is probable that the pox Exanthema of the Udder 969 lesions upon the teat and udder cause a purulent infection, which furnishes a supply of highly virulent pus, ready to induce infec- tion at any time that it may chance to find entrance through the teat canal into the milk cistern and thence into the milk canals. The source and character of the infection of the cow pox is unknown. In some cases, however, it is traceable to vaccination in man. The milker may have been vaccinated, or may have handled the vaccination wounds in children or others who have been vaccinated, and thus may bear the disease, upon his hands, to the teats of the cows while milking. Once the affection has gained entrance into a dairy stable, it is readily transmitted by the hands of the milkers from one cow to another. The handling of cow pox in dairy cows is chiefly prophylactic, and consists of the application of the fundamental rules of disin- fection. So far as is practicable, the affected cows should be isolated from the sound ones, and should be milked last. If the disease exists in a dairy stable, the hands of the milkers should be thoroughly disinfected before and after the milking of each cow. In our judgment the best disinfectant for this purpose is corrosive sublimate, because of its efficiency and absence of odor. * * * * * * We meet from time to time, in various localities, with other forms of exanthema of the teats and udder. In the vicinity of Ithaca, N. Y., there has prevailed from time to time a disease having the general clinical characters of an in- fection. So far as we have been able to observe, the disease is unaccompanied by the formation of vesicles, pustules or other lesions to definitely identify it with cow-pox. At first there appear small inflamed areas in the skin of the teat or contiguous parts of the udder. Later the areas become hemorrhagic, and finally necrotic, when they dessicate, turn black and constitute a large scab, which is exceedingly hard, tough and adherent. he number of these necrotic areas is usually limited to from two to five or six upon the entire udder and teats. They vary in size from ote-quarter to one-half inch, or even more, in diame- ter. Ordinarily the disease pursues a comparatively benign course ; but the diseased areas are sensitive and painful, so that the cow resists being milked. In some cases the disease is fol- lowed by a very destructive streptococcic mammitis, which usu- ally leads to the permanent destruction of the affected quarter 970 Veterinary Obstetrics or quarters. The danger of mammitis increases as the proximity of the lesion to the teat orifice increases. Sometimes the lesion occurs in the teat orifice itself, interfering promptly with the pas- sage of milk and leading quickly, in many cases, to infection of the gland. Apparently the mammitis is not the direct, but rather an indi- rect result of the presence of the eruptions. The infection of the gland takes place after the scabs have attained large size and more or less abundant suppuration has occurred around their bor- ders. It seems that the infection is attributable to the pus which thus forms, and later gains access to the milk cistern through the teat orifice. Our chief interest in the disease is the prevention of the mammitis by thorough disinfection. Whether this be genuine cow-pox or not, the disinfection should be careful and ample. The diseased parts should be thoroughly disinfected before and after milking, and the hands of the milkers should be well disinfected before and after the milking of each cow, whether diseased or sound. We recommend in this disease the washing of the udder of the cow and-the hands of the milkers with a 1-1000 corrosive sublimate solution, to be followed by the application of a disinfectant to the teats and adjacent parts of the udder, consisting of equal parts of tincture of iodine, tinct- ure of arnicaand glycerine. If the crusts become detached, leav- ing a raw sore, this may be carefully touched with stick silver nitrate, or with tincture of iodine. When the lesion is located directly in the milk orifice, vigor- ous disinfection should be instituted. The part should be pen- cilled with a fine cone of silver nitrate, or a drop of tincture of iodine inserted by means of a medicine dropper. 4. TUBERCULOSIS OF THE UDDER. TUBERCULAR MAMmMITIS. Tuberculosis of the udder is virtually confined to the cow. Although tuberculosis is very common among dairy cows, recog- nizable tubercular disease of the udder is comparatively rare. ' When it does occur it is regarded as especially important because of the highly infectious character of the milk. Symptoms. The symptoms of tuberculosis of the mammary gland consist usually of a tense swelling of the mamme, gener- ally of one quarter only, and most frequently one of the hind quarters. ‘The general condition of the animal is not affected by Tubercular Mammitis 971 the tuberculosis of the udder, and whatever constitutional symp- toms may appear are referable to the ravages of the disease in other parts of the body. ‘The mammitis is chronic in character, and increases very gradually in volume and hardness. After a time the affected quarter becomes very hard and extremely large. Franck records cases in which the udder has attained a weight of 30 to 40 pounds. The secretions of the gland depart from the normal very gradu- ally, and may retain the general appearance of milk for weeks or months, and then slowly become watery, filled with clots and perhaps becomes yellowish in color. The lymph glands on the proximal side of the mamme, the supra-mammary lymph glands, become swollen to such a degree that they may be felt or seen. The diagnosis of tubercular mammitis is to be made in con- junction with the general symptoms. The definite diagnosis must depend largely upon the tuberculin test. According to Bang the disease is characterized by the fact that, for some time after the advent of the malady, the secretions of the gland remain apparently normal in appearance and quantity, although in some cases the disease may be acute from the beginning, and conse- quently the amount of milk very much decreased. In compari- son with other forms of mammiitis, it is important to note that as a rule there is little or no pain in the tubercular portion of the udder. Tuberculosis of the udder occurs chiefly in very severe cases of tuberculosis. The course is comparatively rapid, and the animal may succumb to general tuberculosis in a few months. Upon post-mortem examination the swelling of the affected glands is usually diffuse, though in some cases it is nodular. Upon section, the swollen partsof the udderare found very firm, and the cut surface is even, while the affected portions are prominently separated from the sound parts by a clear line of de- marcation. There occur, throughout the diseased portion of the gland, more or less numerous yellow spots or tubercules, while the larger milk canals may contain yellowish caseous masses and the walls of the milk cisterns may show small tubercular elevations. In cases of long standing, the tubercular degeneration of the gland becomes more evident, and the tubercles may become 972 Veterinary Obstetrics widely disseminated through the glandular tissue without causing a very dense swelling. Microscopic examination of the caseous masses, the miliary tubercles, and the milk from the tuberculous udder, reveals an abundance of tubercle bacili. The feeding of such milk has produced tuberculosis in swine, rabbits, cows, cats, goats and other animals, and numerous in- stances are cited where fatal tuberculosis of man has apparently resulted from the ingestion of such milk, especially by children. Tuberculosis of the udder is incurable. 5. ACTINOMYCOSIS OF THE UDDER. Actinomycosis of the udder may occur in any animal which is subject to actinomycotic infection, but has been observed chiefly or wholly in the cowand sow. It closely resembles in many respects tuberculosis of the udder. Prior to the identifica- tion of actinomycosis, the disease was usually mistaken for tuberculosis. It may affect one or all quarters, but has a great tendency to remain confined to one quarter, because as a general rule, the source of the infection is local and not systemic ; whereas the opposite usually holds true in cases of tuberculosis. The malady usually reveals itself in the form of a chronic, slow-forming nodular disease of the gland, the nodules varying from 4% to4inches or more in size, and consisting of small abscesses surrounded by thick and dense connective tissue. ‘These small foci behave like actinomycotic abscesses occurring in other tissues of the body; they tend to rupture one after another, and leave small fistulous openings, which are somewhat retracted, and heal tardily. . Upon section, the actinomycotic lesions have the superfi- cial appearance of tuberculosis, and may at first be mistaken for that disease. ‘The section reveals abscesses of various sizes, sur- rounded by more or less dense connective tissue walls. If the abscess is large, and contains much pus, the wall is usually very thick and dense. If the abscesses are very small, or consist of very small suppurating areas, the walls are not so conspicuous, and the tissues invaded by the disease present a yellowish, gran- ular appearance, quite characteristic of the malady, and different from that of tuberculosis. In actinomycosis, caseation and calci- fication do not occur. ‘The diagnosis may be definitely made by Mastitts in the Mare 973 the microscopical examination and the identification of the acti- nomyces. bs The handling of the disease does not differ from the treatment of actinomycosis in other parts of the body. It depends essen- tially upon the internal administration of iodine, or the direct surgical removal or destruction of the diseased parts. Internally potassium iodide may be administered to the cow, in doses of 1 to 3 drams per day, while tincture of iodine or iodine ointment may be locally applied to the udder. In other cases it is best to extirpate the affected part completely with the scalpel. When large abscesses appear, they may he sloughed out by opening them and then filling the cavity with sulphate of copper crystals, and leaving them in position until they come away spontaneously. 6. MASTITIS IN THE MARR. Acute mastitis due to ordinary infection of the udder is rare in the mare. It is occasionally observed at about the time of foal- ing, or within a few days thereafter, and may run a similar course to the disease in the cow, though not usually so violent. Abscesses occur somewhat rarely, but are largely referable to other causes than ordinary wound infection, chiefly to strangles and botryomycosis. As in the cow, it is possible for the inflam- mation to pursue a chronic course. The prognosis in mammitis of the mare is more favorable than in the cow. The handling of the disease in the mare calls for nothing different from that in the cow. 7. MaMMARY STRANGLES IN THE MARE. When strangles attacks a mare which is nursing a young foal, the infection is very liable to involve the milk glands and cause abscesses of these or of the neighboring lymph glands. The ab- scesses are frequently very large, and are accompanied by exten- sive and virulent inflammation of the gland. The abscess may rupture externally, and escape over the side of the udder, or it may rupture within and escape through the teat with the milk. An abscess of the mammary gland, due to strangles, does not vary in any essential particular from a strangles abscess in any other portion of the body, but may at first be mistaken by the practitioner for an ordinary case of mammitis. Generally, how- ever, the abscess of the udder follows the formation of abscesses 974 Veterinary Obstetrics in the sub-maxillary glands or elsewhere, so that the practitioner is forewarned as to the character of the disease. The chief significance of strangles abscess in the mammary gland of the mare is in relation to the health of the foal. In our experience, when a young foal takes milk from a mare which is suffering from strangles, and especially when the strangles affects the udder itself in the form of abscesses, the malady has an unusual virulence for the foal, and it is very liable to perish. The handling of strangles of the mammary gland demands the same general measures as in other cases of strangles, in so far as the mare is concerned. The abscesses should be opened early, and the animal should receive internally reliable antiseptics, especially large doses of potassium iodide, in order to overcome the infection as early as possible. The foal should be removed from the mare, and fed upon milk from a healthy mare or from a cow, and should receive some preventive, treatment, such as the administration of potassium iodide in its milk, in order if possible to decrease the severity of the attack, which must almost inevitably occur. 8. BOTRYOMYCOSIS OF THE UDDER. There occurs occasionally in the mare a chronic, indurative inflammation of the milk gland, which is characterized by a very tense and hard enlargement of the udder, with chronic fistule and small recurrent abscesses. It is claimed to be due to a special form of micro-organism, known asthe botryomyces equi or micrococcus ascoformans. Some pathologists claim that this micro-organism is simply one of the pus-forming organisms, and that the peculiar characters of disease resulting from it, the new formation of sclerotic connective tissue, the formation of abscess and fistula are due, not to the special form of the agent causing it, but to the peculiarities of the tissues of the animal itself. The general character of botryomycosis of the udder of the mare is analogous in all respects to that of botryomycosis of other tis- sues and organs of the horse. Symptoms. The symptoms of botryomycosis of the udder in the mare are generally well developed before they attract any at- tention. The disease may occur in an animal which is nursing a foal, or in one which has been dry for months or years, or possibly has never bred. It is usually first observed by the owner when the Botryomycosis of the Udder 975 gland becomes much swollen because of the maturing of an ab- scess preparatory to its rupture. The gland may become so swollen, tense, and sensitive that the animal shows pain, ex- pressed by lameness in the hind limb of the corresponding side. There is usually some edema in the subcutaneous tissues of the udder and neighboring parts. As a rule, but one-half of the gland isinvolved. After afew days the matured abscess ruptures and discharges a small quantity of pus, and there remains for a period of time an inconspicuous fistulous opening, from which a very small quantity of pus exudes. The mouth of the fistula sinks deeply into the skin by retraction of its scar tissue. If a probe be inserted into the fistula, the canal is found tortuous, but one may be able to follow it for a distance of two to six or more inches. After atime the fistula heals, and later another small abscess forms in some other portion of the gland, and ruptures, to be followed by another fistulous opening. In some cases there may exist, at one time, two, three or more fistulous openings, from each of which a very small quantity of thick pus is dis- charged. The general health of the patient is not apparently affected. The diseased gland continues to grow, and may attain a very large size. The disease is chronic, and shows no tendency toward spon- taneous recovery, but rather continues from year to year. There is little tendency for the disease to pass beyond the capsule of the gland and involve neighboring tissues. Vennerholm states that it may extend to the thigh or perineum, and may thus cause marasmus and the death of the animal. The differential diagnosis sometimes offers difficulties. A gray “ mare, entered in our clinic, presented symptoms which made it difficult to determine whether she was suffering from botryomy- cosis, melanosis or a malignant new-growth. The affected half of the gland was enormously enlarged, and the animal showed a distinct cachexia and was very stiff in her movements. Explor- ing the pelvic cavity and posterior portion of the abdomen per rectum, we found that the growth extended up through the in- guinal ring into the peritoneal cavity. An unfavorable prognosis was given, and the animal was destroyed, whereupon it was found that the gland was invaded by a malignant melanom, and 976 Veterinary Obstetrics the liver weighed 72 pounds, it being likewise the seat of malignant melanosis. Generally the disease is easily diagnosed by the chronic course, the enlarged sclerotic gland, and the small abscesses and fistulze. The handling of the disease consists essentially of the early amputation of the gland, by the method which we have already described for amputating the udder of the cow. Asin botryomy- cosis of other parts of the body, so here we may cause improve- ment of the disease by the internal administration of iodide of potash. In our experience, however, we have never succeeded in bringing about the cure of botryomycosis, in any organ, by means of this drug. 9. INFECTIOUS GANGRENOUS MAMMITIS OF EWES. PUSTULAR ERUPTIONS OF THE LIPS OF NURSING LAMBS. We observed in our clinic an important outbreak of gangrenous mammitis in ewes, which proved uniformly fatal. The mammary affection began very suddenly, with intense inflamma- tion, engorgement and redness of one-half of the udder. The patient at once became very lame, much depressed, with loss of appetite and cessation of rumination. Within 24 to 48 hours after the advent of the attack, the apex of the nipple of the af- fected gland assumed a dark necrotic-black color, the teat was cold and its epithelium was easily detached and rubbed off. Paralysis and death rapidly followed. Searching for the source of the infection, we discovered that most of the lambs in the flock were affected with pustular eruptions of the lips. The pustules were located chiefly upon . the labial margins, were about 34 in. high, sharply conical and filled with yellow pus. Breaking, they left behind slow-healing ulcers. Apparently the disease of the lips of the lambs, and the gan- grene of the mammee of the ewes, were identical, and the nursing served to transmit the infection to the udders of the ewes and vice versa. Thorough disinfection of the lips of the lambs, with penciling of the labial ulcers with silver nitrate, was followed by a cessation of the mammitis in the ewes. Infectious Agalactia in Goats and Sheep 977 10. INFECTIOUS AGALACTIA IN GOATS AND SHEEP. There has been observed from time to time, in Italy, Switzer- land and France, an infectious disease of the mammary glands of sheep and goats, characterized chiefly by a gradual decrease in the volume of milk and an extreme atrophy of the glands. | Clinically the disease presents all the characteristics of an in- fection which is readily transmitted from animal to animal, and involves not only the infection of the mammary glands, but also the articulations, the tendon sheaths and the eyes. Vennerholm mentions one herd of 28 animals, in which, during the course, of six weeks, 24, including one buck and one kid, showed symptoms of the disease. The male animals suffered from the disease of the eyes and articulations. : The malady does not seriously affect the general well-being of the animal. The milk becomes greatly changed, is grayish-white and flocculent, and after standing there appears a precipitate of pus, which is separated from the normal milk by a sharp line of red, due to the presence of red blood cells, The milk acquires a bitter, saline taste; while the reaction is variable, sometimes feebly acid and sometimes alkaline. In verysevere cases the milk may be firmly coagulated and opaque. The quantity of milk may be decreased rapidly, to the extent of 90 to 95%. As in the agalactia of the cow, so in the disease of the sheep and goat, there are no marked evidences of acute inflam- matory changes, as exhibited by swellings or tenderness in the gland. The gland tends rather to become atrophied, and finally retracts to one-tenth of its original volume and becomes very in- conspicuous. Later in the course of the disease, without any evidence of pain, there may appear abscesses of a chronic or ‘“‘eold’? character in the udder, as well as in the parotid salivary glands and in the region of the stifle. These abscesses contain a thick yellow pus. Ina mannersomewhat similar to the forma- tion of metastatic abscesses, there also appear inflammations of the fetlock, stifle, hip, carpus and elbow, which in some instances constitute the only evidence of the disease, especially in males or in females which are not in milk. Tendo-vaginitis may also appear. In a large proportion of cases there appears a well-marked 62 978 Veterinary Obstetrics keratitis, in which there is either a local or a diffuse cloudiness and ulceration of the cornea, with increased vascularity and hemorrhages. Insome cases staphyloma, followed by rupture of ‘the cornea and hernia of the iris, has occurred. ‘The disease of the eyes continues fora prolonged period, and generally ends in recovery in from six to eight weeks, though white or pigmented spots sometimes remain upon the cornea. These changes in the cornea are accompanied by conjunctivitis. As a general rule the animals recover, and finally their power of milk production becomes restored. The cause of the disease has not been determined, and attempts to transmit it from one animal to another have failed. Isolation and disinfection are apparently indicated. 11. MAMMITIS IN SWINE. Inflammation of the mammez in swine is an exceedingly rare disease. It may involve one or several of the glands, and present the ordinary symptoms of mastitis, with swelling, pain and a general depression of the system. ‘The inflammation may end in resolution, induration or gangrene, and in the latter case may result in the death of the animal. The sow is so immune to ordinary wound infection that it is only under very great provo- cation that the glands become inflamed. The handling is accord- ing to the general rules already related for mastitis in the cow. 12. MAMMITIS IN THE BITCH. According to Vennerholm, mammitis is very common in the bitch, when her puppies have been prematurely taken away. As in the sow, so in the bitch, there isa high degree of immunity against invasion by the ordinary organisms of wound infection, except under peculiarly favorable conditions. In the bitch, as in other multiparous animals, inflammation of those glands which are not used is not usually observed. Ordinarily the number of glandsexceeds that of the young, each of which has its own teat, from which it obtains its milk supply. Any extra glands which the mother may have are allowed to atrophy, and cease to func- tion from the first, without apparently causing any marked de- gree of discomfort or danger; but, after a gland has been fully aroused toits function because of its use by the new-born animal, if the young is removed before the normal decline in lactation, mastitis is probable. Edema of the Udder 979 The symptoms of mastitis in the bitch are peculiar chiefly in the fact that the milk canals are swollen and distended, so that they feel like stretched cords. As no milk cistern is present, the mammitis tends to become lobular, being confined to the lobule of the milk canal into which the infection has penetrated. Otherwise the swelling does not differ materially from mastitis observed in other animals. The character of the milk is changed, becoming serous or purulent, and mixed with blood. The in- flamed gland is not especially painful. More or less edema may be present, in the early stages. The course of the disease is not so acute as that observed in ruminants, but tends rather to be- come chronic and to result in induration and atresia of the milk canals. ‘These changes in general take the character of adeno- . fibroma. In some rare instances the glands become rapidly gangrenous, but as a general rule this does not cause the death of the animal. The handling of the disease is essentially the same as in other animals, and consists of repeated massage and milking out, with the application of an antiseptic poultice. Later, if the disease becomes chronic, or should gangrene occur, the affected gland or glands may be amputated. 13. EDEMA OF THE UDDER. MAMMARY ENGORGEMENT. Clinically there not infrequently occurs edema of the udder, which may be of a more or less physiologic character and may consist largely of engorgement of the gland without the advent of inflammation. It may appear either during pregnancy or early after parturi- tion. In some instances, during pregnancy, the occurrence of engorgement and edema of the mammary glands may suggest the death, or some disease or disturbance of the fetus. Very fre- quently the symptoms are followed by abortion. ‘Toward the culmination of pregnancy, the mammary glands become more or less congested, depending somewhat upon the species and indi- vidual. Asa general rule, the congestion and edema are most marked in animals which have not previously given birth to young. : The symptoms in such cases apparently rest upon a physio- logic basis, depending upon the harmonious functioning of the uterus and the mammary glands. In some animals, especially in 980 Veterinary Obstetrics the bitch, edema of the mammee may occur at about the normal time for parturition, after the disappearance of estrum without impregnation. In these instances it seems that the functional activity of the glands becomes aroused without pregnancy having taken place at all, as the result of some organic sympathy be- tween the two parts of the generative system. We have also observed such edema of the udder, in the non- pregnant mare mule, accompanied later by the active secretion, of milk. In these cases the edema was related to the functional activity of the uterus and ovaries, and occurred during the breed- ing season only. In the cow, when for any reason the milk canals or the teats become blocked so that the milk cannot escape, there occurs a great distension of the gland, by the accumulation of milk within its canals, until the pressure within its cavity attains such a de- gree that the further secretion of milk is stopped. This condi- tion of over-distension brings about an edema of the gland, accompanied by retrograde changes in the milk and its final resorption, followed by atrophy of the gland. “When the young is removed from the mother while lactation is still active, a similar edema results because of the over-disten- sion of the gland. This very frequently leads to infection, be- cause the orifice to the teat is open, which permits the invasion of micro-organisms. Should the gland escape infection, the changes taking place pursue the same course as in those instances where the teat orifice is blocked and infection prevented. The symptoms consist essentially of a gradually increasing tension of the gland, which may be more or less painful and may involve a quarter or half or the entire gland, while the edema may extend forward anterior to the mamme, or upward and backward to the region of the perineum. The temperature is little or not at all elevated, and the secre- tions from the gland are not materially altered from the normal. The anatomical conditions, in cases of edema or congestion of the udder, consist essentially of vascular engorgement and con- gestion of the inter-glandular connective tissue. Unless the edema leads to infection, the disease pursues a favorable course and ends in spontaneous recovery after a few days. Especially is this true of the engorgement of the gland just prior to parturition. Tumors of the Mamme 981 It is not essential, usually, that any -active handling occur. As soon as lactation has become well established and the young sucks regularly, or the gland is well milked out, the edema spon- taneously disappears. If, however, the young dies or has been removed, and it is not desired to keep up the lactation for the production of milk, it is advisable and frequently essential that a portion of the milk should be withdrawn two or three times a day, until the activity of the gland becomes diminished. If less and less of the milk is withdrawn each day, the lactation gradually ceases, and the milking may be discontinued- gener- ally within five or six days. Most domestic animals are thus easily dried up, though in some instances there is considerable difficulty, especially in the milk cow. In some of the best dairy animals it is almost impossible to stop the secretion of milk with- out endangering the integrity of the gland. This difficulty is also observed at times in ewes, when weaning lambs, espe- cially if they are weaned somewhat early, before the milk glands have largely ceased their functions. In some of the larger breeds of sheep, which are very heavy milkers, it is well to carefully watch the ewes while the lambs are being weaned, and withdraw part of the milk from those which show very great distension of the gland with the consequent edema. 14. TUMORS OF THE MAMMA, Tumors of the mammary glands are very rare in domestic animals, with the exception of the bitch, in which they are com- mon. Ruminants are almost wholly free from any form of mam- mary tumor. In the mare we observe chiefly the botryomycotic udder, which has already been described upon page 974, and belongs distinctly to infections, not to tumors proper. The bitch suffers occasionally from a form of granulation tumor or adeno-fibrom, in which the general characters of adenoma and fibroma are combined. Such adeno-fibroma are usually the sequel of infection. he adeno-fibrom consists chiefly of an increase of the con- nective tissue between the lobules of the gland, which new-formed tissues press upon the acini and gradually bring about their de- struction, until there remains simply the epithelial debris sur- rounded by firm connective tissue. 982 Veterinary Obstetrics Malignant neoplasms of the mammz are very common in the bitch, and exceedingly rare in other domestic animals. In aged bitches mammary carcinoma are very common. ‘They assume various types, most frequently scirrhous, more rarely myxoma- tous, and in some rare cases are accompanied by calcification or ossification. ‘The cancer may break down and result in ulcera- tion, or the blood vessels may become eroded and causea hematom. The carcinoma usually originate in the substance of the gland, although more rarely they may have their beginning in the skin covering it. Asa general rule the development of the tumor is slow, although it may at times be rapid. In some instances the tumors remain quiescent for a long period of time, especially if not interfered with ; while in othercases, especially if the glands have been removed, metastatic tumors occur in the surrounding tissues, which pursue a very rapid and virulent course. In carcinoma of the mammez of the bitch, the affected gland or glands are enlarged and hardened. ‘The swelling is distinctly lobular, and usually commences near the base of the teat, extend- ing thence upward to involve the entire gland. Sometimes the disease is confined to a single gland, but frequently it involves. several, and in some cases virtually all of the glands, one after another. The extension from one gland to another may be very rapid. Sarcoma of the milk glands occur chiefly in the bitch and mare, as nodular and more or less soft swellings, which may reach very large proportions. In the mare the tumor may extend up- ward from the gland through the inguinal canal into the peritoneal cavity. : As in the adeno-fibrom and the carcinom, so in sarcoma, there may be a tendency to ossification, or cysts may form containing a variable quantity of fluid, which may resemble mucus, and con- tain detritis of cells, along with fat and crystals of cholesterine. Other tumors of the mammary glands, such as chondroma, lipoma and osteoma, occur in domestic animals, especially in the bitch. Very rarely large cystic tumors. form in the mamme, filled with a mucoid substance, while their boundaries may be cal- cified and sharply limited so that they can be easily enucleated. Rehmet relates the occurrence of echinococcus polymorphus in the udder of a cow. Numerous large firm nodules were observed, which were suspected of being tubercular in character; but,. Hemorrhages in the Udder 983 when examined after slaughter, were found to consist of very tense cysts, varying in size from a hazelnut to a hen’s egg, and containing a clear fluid and echinococci. There are also observed, in the udder, retention cysts. A milk canal leading from a portion of the gland becomes occluded, and consequently a quantity of milk is imprisoned until it causes a sufficient distension that it is readily seen and felt. It presents the characters of a fluctuating tumor, and, when opened, dis- charges ordinary milk. The handling of tumors of the udder consists essentially of their early enucleation, or the amputation of the entire gland. It is especially important, when malignancy is suspected, that the eftire gland should be removed early, and along with it should be included any neighboring lymph glands which are prob- ably or possibly involved. If the malignant tumor has existed for a long period of time, the probabilities are that its removal will but excite other disease foci in neighboring glands to in- creased activity, and that the disease will run a more virulent course than if left untouched.. 15. HEMORRHAGES IN THE UDDER. Hemorrhages may occur in any part of the udder, either be- cause of trauma or exalted blood pressure, and may result in the formation of hematoma; or the blood may flow into the larger milk canals or milk cistern and be milked out. The symptoms necessarily vary greatly according to the loca- tion of the injury and volume of blood escaping from the vessels. A large volume of blood causes a distinct swelling of the udder. This is especially notable if a hematom occurs in the subcutaneous connective tissue. In pendulous udders the gland is constantly turned to and fro upon its long axis, during the progression of the animal, because at each step it strikes against the advancing hind limb, or it comes in violent contact with obstacles in the path of the animal, from either of which causes the udder may receive more or less serious injuries. In the normal gland, in- jury may ‘result from rough milking, from treads or other- wise. The milk from an animal suffering from) mammary hemor- rhage may {be mixed with blood, or pure blood may be drawn from the teat. If the hemorrhage is very extensive, the udder 984 Veterinary Obstetrics may hang very low because of the great weight of the large hematom which it contains. If an injury has caused hemorrhage into the udder, and the blood becomes mixed with the milk, the mixture is usually somewhat clotted. When mammary hemor- rhage is due to the passage of red corpuscles through the walls of the capillaries into the milk vessels, the blood is uniformly mixed with the milk, and may give it a reddish tinge, or may pass unobserved until the milk has stood for a time, when the blood, on account of its weight, sinks to the bottom and is very readily seen. The advent of blood in milk not infrequently indicates the commencement ofa chronic catarrhal mammitis, affecting chiefly the milk cistern and large canals. The bloody character of the milk may presently abate, but the catarrh persists, leading grad- ually to atresia of the teat. The atresia may mature dur- ing the milking period, or its completion be delayed until the dry period, and when the cow again comes into milk the atresia may be found complete. Special forms of infection sometimes cause a reddish tint of the milk, in the absence of blood or blood-coloring matter. Termination. In those cases of bloody milk due to exalted blood pressure in the gland, the duration of the condition is usually prolonged, so that it is a long time before the milk again becomes normal. As a general rule the result is very unfa- vorable, because the same condition tends to recur at each calving. If hematoma form, they are slowly resorbed, to leave cysts behind, or induration of the gland occurs, or the wall of the hematom gives way and its contents escape externally. Should the hematom become infected, mastitis results, usually followed by abscess. When a limited amount of hemorrhage occurs in the milk, the most that can be done is the careful milking out. This does not prove very satisfactory, as the milk is unfit for use, and the animal tends to give bloody milk again and again at the begin- ning of each milking. When hematoma form, an attempt may be made to check the hemorrhage, if still existing, by the appli- cation of cold, especially of ice by means of a suspensory bandage, or by hemostatics given internally. Generally this is not neces- sary. The hematom should be left alone for two or three days, until assured that the hemorrhage will not be renewed and that Milk Fistule 985 a somewhat resistant wall is formed around the escaped blood. The hematom may then be opened and the blood removed, after which the lesion is to be handled as an ordinary wound. 16. MILK FIsTuLa. A milk fistula consists of a communication of the milk cistern or one of the large milk canals with the exterior, through a canal other than the normal one. While such fistulé are possible in any animal, they occur, or are observed, practically in the cow alone. Their very rare occurrence in other animals is of little or no significance. The fistulae may be congenital, but generally they are caused by penetrating wounds of the milk cistern during the period of lactation. They arise from trauma of various kinds, and in some instances result from operative wounds, or from abscesses forming in the milk cistern or large milk sinuses and rupturing outward through the wall of the teat or udder. Symptoms. Milk fistule may open at any part of the teat, or of the udder near the teat base. They are most common in the teat near its base, though sometimes observed at the apex of the teat, within a very short distance of the normal opening. If the fistulous opening is very small, the milk may not flow from it except when the teat is being milked and greater pressure is consequently placed upon the fluid within the cistern. If the fistulous opening is large, the milk drops away continually when- ever the pressure of the milk in the cistern is sufficiently high. Fistulee of the milk canals tend to heal spontaneously in a com- paratively short time, while those of the milk cistern, and espe- cially those of large size, do not readily heal of themselves, and are liable to become permanent unless active intervention occurs. If the fistula forms somewhat early, during active lactation, its walls tend to become healed and covered over by a protective epithelium, so that they will not readily adhere. If the perfo- rating wound occurs while the cow is dry, or if she ceases to milk before the walls of the fistula become covered over with epithe- lium, adhesion of the wound margins, with spontaneous oblitera- tion of the fistula, is probable. Treatment. Perforating wounds of the milk cistern or canal should be handled as soon as possible after their occurrence. The handling should consist essentially of the thorough and careful disinfection of the wound, after which it may be neatly sutured 986 Veterinary Obstetrics and measures taken to protect the sutures during milking. It is highly important that strict antiseptic rules should be followed in order to prevent infection of the gland. It has been sugges- ted that the danger of disturbing the sutures should be overcome by the use of the milk tube, under very strict antiseptic precautions. Vennerholm advises that a rubber band may be placed over the suture to afford pressure, being careful not to apply it so tightly as to cause a disturbance of the circulation. One may do much also to prevent the tearing out of sutures, or even to overcome the necessity for their insertion, by applying a strip of adhesive plaster carefully to the part. The strip should be long and nar- row, and applied by encircling the teat several times, each course overlapping the preceding one, the whole forming a solid encase- ment, insuring the accurate and secure closure of the wound. In chronic fistula, in which the walls are covered over with ep- ithelium, it is essential that the protective epithelial layer be destroyed before adhesion can take place. The epithelium of the fistula may be most readily destroyed with a fine thermocau- tery point, by inserting it well into the fistulous tract and con- tinuing the cautery until the epithelium has been completely destroyed. In place of the thermocautery one may use a caustic, especially the nitrate of silver. If the fistula is at the apex of the teat and near by the normal opening, it may sometimes be best handled by the amputation of the teat just above the fistula. It is usually desirable that any interference with chronic milk fistula should be deferred until the cow is dry, in order to avoid as far as possible the danger of infection of the gland as a result of the injuries to the tissues during the operation. Supernumerary teats sometimes exist in a manner to con- stitute an annoyance in milking, because they are constantly in the way of the milker. Sometimes they act as fistule, through which milk escapes while the milking process is going on with the normal teats. Should they prove annoying, it is best to amputate them during the dry period, when the healing of the wound will usually cause an obliteration of the duct or cistern of the supernumerary nipple. When heifer calves are born with supernumerary teats, which may later prove annoying or unsightly, they may readily be re- moved by clipping them off with scissors. The teat should be well drawn out, and excised close against the gland. In healing, Milk Stones or Milk Calculi 987 any milk orifice traversing it will be closed and, if clipped closely, will not show when the animal is grown. When the heifer calves, the rudimentary gland may function temporarily, but soon ceases to secrete because of the pressure of the confined milk. Later the gland atrophies. There is a want of power in the teats of some cows to retain the milk within the udder, so that as soon as the gland becomes distended, the milk begins to escape involuntarily through the teat canal. This causes great waste by allowing a large propor- tion of the milk secreted to escape from the teats during the in- terval between milkings. Various plans for overcoming the dificulty have been suggested and tried, but none of them are very satisfactory. The cow may be milked very frequently, so as to prevent any great pressure of the fluid within the gland ; or the lumen of the teat canal may be closed by the application of a rubber band or a metal ring. Vennerholm suggests the possibility of bringing about a nar- rowing of the teat canal by the excision of a wedge-shaped piece of the teat wall, in the hope that, in healing, the teat orifice may contract sufficiently to hold the milk. He admits, however, that it isexceedingly difficult to determine the properamount of tissue to remove. If too much is included, the teat canal may become obliterated or excessively narrowed ; if too little is taken, the object is unaccomplished. Amputation of the apex of the teat may also cause narrowing, but the degree can not be foretold. 17, MILK STONES OR MILK CALCULI. ‘There are occasionally found, in the udder of the cow, con- cretions of the carbonate of lime, mixed with small proportions of fat or casein, and varying in size from that of a mustard seed to a large bean. They may occur singly orin large numbers. When very large they may readily be felt through the walls of the large milk canals or of the cistern, and may become lodged in the teat canal in such a manner as to interfere with the flow of milk, and cause pain to the animal during milking. When occurring in large numbers, they may cause a general sensitive- ness of the gland, accompanied by some stiffness and a straddling gait. They are to be differentiated from nodular enlargements in the teats. ‘The latter are immoveable and grow slowly, while the 988 Veterinary Obstetrics calculi are generally movable, at least during their early stages or until they accidently become incarcerated in the teat canal. Sometimes milk stones may be forced out through the teat canal without injury, but if too large for this to be accomplished, it is advisable to remove them by means of an incision through the walls of the gland, after which the wound should be carefully closed immediately. 18. PENDULOUS UDDER. The mamme of the cow, ewe and goat frequently become very pendulous, and hang down almost or quite to the ground. Such an udder is in constant danger of injury from being struck by the hind legs during locomotion, especially when the animal is forced torun. It may also come in violent contact with ob- stacles of various kinds in a manner to cause wounds, to be followed by infection. Sometimes a pendulous udder apparently results froma gradual yielding of the suspensory apparatus of a comparatively normal gland. Once the gland drops away from the abdomen fora short distance, its weight tends to cause it to drop lower until the pendulousness becomes extreme. In other cases the pendulous- ness is attributable to mammitis, followed by induration and enlargement, the increased weight overcoming the power of the suspensory apparatus and causing the gland to drop down away from the abdomen. We have no successful method for overcoming the pendulous udder. An ordinary animal so affected should be fitted for the butcher. In a pedigreed cow having a very high valueas a breeder, if the udder is much enlarged and indurated, is so pendulous as to constitute a constant and serious impediment to locomotion, or menace the health or life of the animal on aceount of repeated infections from injuries, the pendulous organ should be amputated according to the technic already suggested on page 963. 19. DERMATITIS OF THE UDDER. Inflammation of the skin of the udder is said to be caused at times from exposure to the raysof the sun inhot weather. ‘The effect is referable, according to Vidmark, to the action of the ultra-violet rays upon the non-pigmented skin, which leads to dermatitis and mummification. Dermatitis of the Udder 989 When cows are exposed to cold and damp winds, the skin of the teats and udder is liable to become inflamed and cracked. If the teats of the cow are bathed or moistened, preparatory to milking, and then left to dry in a cold draft, the skin is liable to crack and become very sore, so that in milking it bleeds and causes quite severe pain to the animal, which not infrequently leads to uneasiness and kicking. Dry gangrene of the skin of the teats is said to result in some cases from the feeding of cows upon potato refuse or ergotized fodder. Wounds or other injuries to the teat or glands may likewise cause dry gangrene. The symptoms of dermatitis of the udder are as variable as the causes which may induceit. There may be redness accom- panied by sensitiveness in the part, or there may be small fissures or excoriations from which blood exudes. When gangrene occurs there is swelling of the parts, a black or blue-black color, with usually a well defined line of demarcation. The sequestration of the mummified portion is usually very slow. In the Mississippi Valley and some other portions of the United States, there appears from time to time, usually in the late sum- mer or autumn, a disease affecting the feet, mouths and udders of cattle, which was at first mistaken by some for the contagious foot and mouth disease. It occurs almost, if not entirely, among animals which are upon the pasture. The disease first expresses itself by a stiffness in the gait, as a result of the sore feet; and a dribbling of saliva from the mouth, as a consequence of the necrosis of the buccal mucous membrane. Hemorrhagic areas occur in the skin of the feet, especially between the claws; upon the teats and udder of milk cows ; and in the mucous membrane of the mouth, especially upon the bars and pad of the upper jaw. Later the areas become necrotic and slough away, leaving painful ulcers, which heal in the course of a few days. Upon post- mortem examination, in fatal cases, hemorrhagic areas are found throughout the length of the alimentary canal. The character of the disease is not well known, though it has been described by Mohler as mycotic stomatitis. So far as we know, the disease of the udder has not proven annoying in any case, and simply constitutes an interesting symptom in the course of the more widely diffused disease. It calls for no special treat- ment, so far as observed. 990 Veterinary Obstetrics The prognosis is favorable, except for the danger of infection of the glandular tissue itself, leading to mastitisand a disturbance of the milk-secreting functions. ‘The handling of dermatitis of the udder should be specially de- termined for each case, according to the cause. Generally the treatment should consist of the application of antiseptics and protectives to the injured skin. When the teats are fissured and excoriated asa result of exposure to damp winds, or of wetting the teatsduring milking and not properly drying them, great care should be taken to thoroughly cleanse them with a warm antiseptic solution. Immediately afterward a protective antiseptic dressing should be applied. One will usually obtain excellent results by first cleansing the parts with warm antiseptic solution and then applying, after the completion of the milking, a mixture of one part each of tincture of iodine, glycerine, and tincture of arnica. Such a mixture should be sparingly applied, so as to constitute a thin coating over the part. Care should be taken to not apply so much as to make the parts sticky, and thereby cause dirt to adhere. Vennerholm suggests the applica- tion of a salve, consisting of tannic acid and oxide of lead, or other similar substances, but such applications cause dirt to adhere and keep the teat soiled, unless applied very sparingly. If gangrene of the skin is threatened, antiseptics should be applied more liberally, and it is suggested by some writers that the skin should be scarified, antiseptic poultices applied, and the udder supported by a bandage. If the gangrene extends into the deeper parts of the teat, it may be advisable to amputate it in order to hasten recovery. If the gangrene extends into the cistern, the glandular tissue is almost inevitably involved in mammitis, and the amputation of the teat affords excellent drainage for the gland and permits all excretions to drop away almost immediately. 20. FURUNCULOSIS OF THE UDDER. Johne has recorded a special form of disease of the udder of the cow, under the name of furunculosis. In the cases thus re- corded, there occurred swellings, which were one-quarter to two inches in diameter, chiefly above the base of the teat. The swellings were quite hard and painful for a time, but after some weeks fluctuated and finally ruptured, discharging pus, mixed Wounds of the Udder and Teats 991 with fragments of necrotic tissue. ater the abscesses healed, without serious interference with the secretion of milk. Johne did not determine the cause of the disease. Clinically it assumed an enzootic character, and appeared chiefly in stables where potato tops and mouldy straw were used for bedding. In the handling of the disease, the abscesses were opened and dis- infected according to general surgical principles. 21. WOUNDS OF THE UDDER AND TEATS. Wounds of the udder and teats present every possible variety in cause and degree. Cows which are kept in crowded stanchions frequently suffer from wounds to the teats caused by neighboring animals treading upon them. In many parts of the United States a very common cause of wounds to the teats of cows is barbed wire, especially where a fence has been badly built and cows have crowded through it or attempted to jump over it. If the cow is in full milk, so that the udder is tense and distended, the wounds from the barbs of the wire may be very severe and extensive. Wounds or contusions may also occur from rough milking. If a milker is careless in regard to his finger nails, the teats may be badly abraded by these. We have observed wounds, of a more or less serious character, inflicted by pigs or other animals in sucking. When pigs are allowed in the same enclosure with milk cows, and there chances to be a cow from which the milk flows involuntarily when she is lying down with the udder well filled, pigs, coming about, detect the milk and eat it. Following up the stream to its source, the pig finally acquires the habit of sucking the cow, incidentally wounding the teats with the teeth. In one case we observed a heifer, pregnant for the first time, ac- quire maternal attachment for a half-grown pig, which she persistently suckled. The sucking by the pig caused unimportant teat wounds. From wounds of such diverse characters, equally variable lesions follow, such as milk fistula, suppuration, ulceration and mammi- tis. Wounds of a quiescent udder usually heai well, but if the cow is in milk and the lesions involve the teats it may be exceed- ingly difficult to milk the cow without irritating the wound and delaying the healing process. 992 Veterinary Obstetrics As we have already stated in discussing the subject of mam- mitis, suppurating wounds of the active udder or teats possess great danger for the integrity of the gland because of their ten- dency to produce mammitis. Penetrant wounds of the milk cistern or deep wounds near the apex of the teat in milk cows are especially dangerous. In the absence of a penetrant wound, the pus flows down over the teat to the teat orifice, and thence the infection passes up into the cistern ; or the careless dairyman, finding the cow nervous or unruly because of the sensitive and painful teat, resorts to the milk tube for withdrawing the milk. The milk tube, probably already filthy from prior use, becomes contaminated further as it is being inserted, and carries infection up into the cistern. Such contamination is preventable only by the strictest possible precautions, consisting of the thorough disinfection of the teat- wound, the entire teat, and the hands of the operator; and the sterilization of the milk tube. Even then the teat orifice may contain virulent organisms to be pushed up into the cistern on the end of the milk tube. It would be far better to aspirate the milk from the wounded teat by means of a cupping glass. It would cause much less pain to the cow, and would permit far better asepsis. Vennerholm suggests that, when wounds of the teats are very sensitive, there should be applied to them a 5% solution of cocaine at milking time, in order that the process may be carried out without causing pain. The pain of milking can always be re- duced greatly by first bathing the part with warm water, to which has been added a small amount of carbolic acid. After milking, the wound should always be carefully dressed with the most re- liable antiseptics, for which purpose we recommend equal parts of tincture of iodide, tincture of arnica and glycerine. 22. WARTS ON THE TEATS. Warts on the teats are very common in milk cows, and differ greatly in form and size. As a general rule they are more or less polypoid or pedunculate in character, and have a very small neck, though they are sometimes conical or sessile. ‘They are especially common on the teats of young cows. ‘There may be 15. or 20 or even more on one teat, scattered over the organ from Stricture or Atresia of the Teats 993 the apex to the base, and spreading somewhat over the contiguous udder. Generally they are not particularly sensitive, but some of them are markedly so, and under certain conditions and situations, because of being pinched in the process of milking, they may be quite painful, and cause the animal to become uneasy, and resist milking by stamping or kicking. If the warts are causing no annoyance to the cow and are not in the way in milking, they should be left alone. If they are causing annoyance they may be very safely clipped off with shears, under local anaesthesia, or cauterized with silver nitrate or with the thermocautery, during the dry period. One of the most efficient and convenient remedies for warts is the application of strong nitric acid. The end of a small glass rod is dipped in the acid, and with this the surface of the wart is cautiously moistened. This may be repeated every two or three days, until the wart contracts and the small, hard eschar drops away. If carefully done, not too much of the acid applied, and none al- lowed to touch the normal skin, no pain will be caused what- ever. This is of importance as affecting the temper of the cow. In young animals they tend after a time to disappear spontaneously. They may also be caused to disappear in some cases by the internal administration of arsenic. 23. STRICTURE OR ATRESIA OF THE TEATS. In cows there not infrequently occurs stricture or atresia of the milk orifice, the cistern, or the milk canals, which may either render milking very tedious and difficult or completely prevent the withdrawal of the milk from the gland. While it is possible for similar lesions to occur in other animals, such as the ewe and goat, from an economic standpoint the condition is confined to the cow, where it exerts a very great influence upon the produc- tion of milk and offers an exceedingly complicated and difficult problem to the veterinarian, because in the present state of our knowledge the handling of this group of affections is exceedingly unsatisfactory. The teats of cows show as great variety in their internal structure and arrangement as they do in their external form and size. They may shew upon the internal wall of the cistern small gland-like prominences of a spherical form, but having no special 63 994 Veterinary Obstetrics influence upon the process.of milking. The teat walls may be very thick, leading to a small lumen of the'teat canal, accom- panied by difficult milking, but this condition cannot be regarded as pathologic. In addition to these there may be transverse folds of the mucous membrane projecting out into the milk cistern, which may possibly be normal, and yet may offer some obstruc- tion to the passage of the milk. Jensen records the occasional: occurrence of perpendicular par-: titions in the cistern of the teat, constituting essentially double teats. ‘There may be supernumerary cisterns, with small teat canals opening near the base of the teat, so that they behave as milk fistule. Vennerholm states that there. frequently occur, in the cistern, small papilloma, which interfere with the pas- sage of the milk by partially filling the cistern. Such papilloma may also become displaced. and, dropping into the teat canal, partially block it. The cause of these papilloma is presumably the previous occurrence of trauma. The stricture or atresia may occur at any point in the teat, from its apex to its base. Most of the lesions are found at the base of the teat or in the teat canal at its apex, while the capacious cistern remains comparatively free. The symptoms of stricture or atresia will depend acai upon the location of the lesion and its extent. If the stricture or atresia occurs in the teat canal, the teat promptly and read- ily becomes distended with milk, but it is exceedingly difficult or impossible to press it out through the teat orifice. When the milk is forced ont, it comes away in a fine stream. This condition should not be confounded with those instances in the cow where the teat canal is normally very narrow and the sphincter muscle surrounding it is very powerful, rendering milk- ing exceedingly dificult. In such cases, ordinarily, all four teats of the cow are alike, and merely require extra pressure in order to force the milk through the narrow canal. ' Such teats are normal upon digital palpation, and in other respects. By palpation of teats affected with stricture or atresia, one can usually recognize a hard, dense, cord-like thickening along the position of the teat canal, which indicates that the mucous mem- brane and sub-mucous connective tissue are thickened and indurated. In most cases in which the obstruction exists at the base of the Stricture or Atresia of the Teats 995 teat, it is found that the milk descends slowly or not at all into the teat, but, if it once descends into the milk cistern, is easily pressed out. When the cistern is emptied, however, it is slow in refilling, and consequently the milking process is ex- ceedingly tedious. In those cases of stricture where the upper part of the cistern is completely closed, the milk may readily be felt in the milk canals above, pressing down upon the obstruction, while the teat remains empty. Examining closely the base of the teat, one usually finds in the central portion of the teat base a hard, firm nodule, irregularly spherical in form and varying in size from ¥% to Y% inch in diameter. The pathologic processes which lead to a narrowing of the teat canal are usually referred to some traumatism, involving the epi- thelium, the mucous membrane, or the sub-mucosa of the teat canal. Lesions of this character are assumed to follow such in- juries as treads, blows or rough milking. Following these injuries, hemorrhages may occur into the sub-mucosa, ac- companied by exudation into the surrounding tissues. After the wounded parts have become infected and inflamed, and have later healed, there remains a cicatricial thickening and induration of the epithelium and sub-mucous tissue. In some cases the thick- ening involves almost the entire length of the teat canal, and ex- tends completely around it. In our observation, most of the cases of stricture and atresia of the teat occur at the base, without any history whatever of traumatism or preceding mammitis. We frequently observe the slow formation of a nodular enlargement of a very firm character at the base of the teat, usually almost directly in its center, at the point of entrance of the milk canals into the cistern. As the nodule begins to form, the milker first observes that the milking process is retarded. The milk is readily pressed out from the well-filled cistern through the teat orifice, but the cistern does not promptly refill. After waiting for a time, the cistern again fills and the teat becomes distended. Slowly and insidiously the difficulty in milking increases, and careful palpation reveals a firm hard nodule centrally located in the base of the teat. At first it appears about % inch or less in diameter, very firm, painless. It grows some, but does not attain a large size, usually not more than 4 inch. 996 Veterinary Obstetrics The teat remains empty, the nodule in the teat is very evi- dent, and above it are the milk canals, widely distended by the imprisoned milk. A chronic catarrh of the epithelium ap- parently exists with the new formation of dense sclerotic con- nective tissue in the form of a nodule. If left alone it has little tendency to cause marked mastitis. In a large propor- tion of cases, however, the use of the milk tube, sound, or other implement, creates a wound and deposits virulent infection in it, resulting finally in mammitis. If left alone the nodule finally causes complete atresia, and the milk is imprisoned until the intra- mammary pressure reaches the point at which milk secretion can- not be continued, after which the quarter commences to atrophy. The process is a chronic one, may continue to develop and in- crease week by week, but usually does not advance far enough to bring about complete atresia during the milking period when its appearance is first observed. After the cow is turned dry, however, the process continues, and leads usually to complete atresia, so that at the next calving, it is found that the affected teat is completely closed at its base, making it impossible for the milk to enter the cistern from the larger canals. The disease may affect but one teat, or may involve two, three, or allof them. It behaves clinically as a chronic infection, and appears to spread from one quarter of the cow to another, until each is involved and ruined. We have observed each of the four quarters of the udder ruined consecutively because of such nodu- lar growth at the base of the teat. After the cistern has been completely closed at the base, the disease extends down, and in many cases brings about a complete obliteration of the cistern and the teat canal. In many other instances the atresia has its beginning in an ulcer involving the milk orifice. First there arises difficulty in withdrawing the milk from the cistern. If the nipple is carefully examined, it will be found to have a small, hard, sclerotic mass at the teat orifice, usually not painful. If the milk orifice is care- fully inspected, there is frequently observed a red, angry ulcer, involving the milk meatus at the apex of the teat. Like the preceding disease, the course is chronic and insidious. There is, however, no limitation of the area in which thesclerotic enlargement may occur. While most of these changes are ob- Stricture or Atresia of the Teats 997 served either at the apex or the base of the teat, the intervening portion of the teat is nowhere exempt. The prognosis of atresia or stricture of the teat depends largely upon the position of the lesion. ‘The outlook is the more favorable as the lesion is situated nearer to the end of the teat, and becomes more serious as it is nearer the base, or when it involves an extensive area in the cistern or teat canal. There is little danger to the life of the animal if the disease is left to itself, especially if the atresia is complete. If surgical in- terference is undertaken, except under the most rigid precau- tions, there is great danger of mastitis, because the veterinarian cannot certainly prevent the invasion of bacteria. Handling. In many cases it is advisable, especially when there is complete atresia at the base of the teat, to allow the gland to atrophy rather than assume the risk of causing infection by an operation, thereby completely destroying the affected quarter, greatly diminishing the milk secretion from all the other g h i é Ls FIG. 143. a, Pomayer’s teat dilator. g, Holland teat knife and dilator b, Aluminum dilating sounds, combined. 5,6and 7 mm. h, Wessel’s concealed knife for ‘c, Teat sounds of Giovanoli. dilating teat canal. d, Concealed teat knife. i, Fraun’s perforator. e, Lance-shaped teat knife, with j, Teat reamer of Hug. probe point. American. k, Teat lancet of Hug. f, French teat dilator. 1, Teat dilator of Parmans. (Hauptner. ) 998 Veterinary Obstetrics quarters, and bringing into jeopardy the life of the animal. This is especially true of such operations, when 2, 3 or all the teats are affected and the number of operations required renders serious mammitis well nigh inevitable. After all the danger to the animal, the outlook for any definite improvement is virtually hopeless. Should the veterinarian decide to operate, the essential object to be attained consists of a dilation of the teat canal, or of the communication between the teat cistern below and the milk canals above. Any and all operations having such an end in view require the strictest possible asepsis. The hands of the operator, the teat and the instruments must be scrupulously clean, and the operations must be carried out without introducing into the teat any form of infection or irritant. Even after an opera- tion has been successfully performed, from the standpoint of asepsis, it is still a difficult problem to so instruct a caretaker that he will use the necessary precautions to maintain an aseptic condition in the part during the process of healing. Various methods for overcoming the stricture or atresia have been sug- gested, differing in detail, and belonging essentially to two classes —the bloodless and the bloody dilations. The dilation of the narrowed canal, without the division of the tissues, is attempted by means of bougies or sounds. ‘This method can only be applied in those cases where the lumen of the canal is narrowed, but not completely closed. Some advise the introduction of a piece of catgut about two to three cm. in length, bearing a head at the distal end, which will prevent it from slipping entirely into the teat. When this is introduced through the constricted portion, it swells by absorbing surround- ing moisture, and gradually dilates the constricted part. It may be inserted just after one milking, and remain in position until the next. Others advise the repeated insertion or prolonged re- tention of metallic teat sounds or bougies like 4. ¢, Fig. 143. Other forms of bougies have been suggested, such as one con- sisting of pure gum, whichexerts gradual pressure upon the part. and brings about dilation. These palliative measures have generally proven unsatisfactory, being accompanied by very decided danger, without any corre- sponding probability of permanent benefit. Stricture or Atresia of the Teats 999 The dilation of the canal or cistern by incision has been quite largely practiced for many years, and numerous instruments. have been devised and recommended for carrying out the operation. The stilette of an ordinary trocar serves the purposes of dilating the teat canal quite effectively, in so far as the immediate results are concerned. Various instruments, known as milk needles, and having a small caliber and the stilette of a trocar, have been devised for this purpose. Some operators have used a small lancet, a probe-pointed bistoury, or a bistoury cache. Various forms of the latter have been recommended, such as a and d, Fig. 143, and many other forms involving similar principles. The perforator of Fraun, Fig. 143i, has been highly recom- mended by some, because with it transverse membranes may be perforated, and the perforation enlarged by means of the four blades, which can be pressed out laterally after the introduction of the instrument into the constricted portion. In addition to these cutting instruments, one requires, for handling the teat after the operation, one of the ordinary forms of milk tubes, by which the edges of the wound may be kept apart, and their adhesion prevented during the process of heal- ing, and with which the milk may be drawn with the least possible injury. Itis highly important that milk tubes, or other instruments designed to remain in the teat, should be of pure silver, because the silver is antiseptic. The operative dilation of the teat may be undertaken upon the standing animal. The foot upon the affected side may be secured by passing a side line around it, and thence around the limb oppo- site, the end of the line being held by an assistant ; or the oper- ator may place himself upon the opposite side to the affected teat, under the assumption that the cow will kick with the foot upon the affected side. It is better, however, that the, animal should be cast, or still better, confined upon an operating table, where the antiseptic precautions can be more effectively applied. The instruments, hands and teat should be thoroughly disin- fected, and the cistern should be carefully washed out with sterile water. Some even recommend that the cistern be washed out with a 1-1000 corrosive sublimate solution, by means of a hypodermic syringe. The operator grasps the teat with one hand, above the point of obstruction if possible, presses the milk down against the obstruc- 1000 Veterinary Obstetrics tion, and then introduces the instrument through the teat canal until it reaches the point of disease. Bang directs that, in case a knife is used, the incision through the constricted portion should be backward in an anterior teat and for- ward in a _ posterior teat, in order that the resulting stream of milk may be favorably directed. This applies only to those cases in which the obstruction is in the teat canal and not in the base of the teat. When the teat canal is sufficiently dilated, the cow loses her power to hold the milk, and it flows away involuntarily ; but during the process of healing she regains the power of retaining it. The after-handling consists in frequent milking and in very careful disinfection and cleanliness of the parts. While healing is going on, it is desirable to insert a milk tube daily, and retain it in position for several hours in order to prevent adhesion during the process of repair. Even with this precaution, it is exceed- ingly difficult to prevent a recurrence of the stricture ; and finally, during the dry period, complete atresia is liable to occur. Strebel and others recommend that the thickened tissues which cause the stricture should be removed by curetting. They ad- vise,-as an instrument, a stilette with a sharp shield at the distal end, which may be pushed through the thickened part, and then forcibly drawn out, cutting away a portion of the diseased tissues. By repeated use, this instrument finally enlarges the canal toa sufficient size, after which the treatment is of the same general character as that already described after dilating by cutting. Others use a small curette in the same way, or even a very nar- row-bladed knife or scalpel. Others have suggested incising the teat from the side, cutting down upon the obstacle and removing it completely with the scalpel, and, under strict aseptic precautions, carefully suturing the wound. Later great care should be used in milking, so as to avoid the tearing out of the sutures and the consequent estab- lishment of a milk fistula. The operation has not come into general use, because it is almost impossible to carry out the operation and the after-treatment with sufficient care to avoid mamunitis. If the obstruction is near the end of the teat, the amputation of the obstructed portion immediately above the seat of the disease may afford satisfactory results. The operation is espec- Stricture or Atresia of the Teats 1001 ially favorable in those cases where the obstruction is quite near to the end of the teat, and the teat is so long that it will have ample length after amputation. ‘The teat is grasped with the fingers, and is amputated immediately above the point of obstruction, either with a pair of scissors or with a scalpel. As the teat is at the moment somewhat stretched, the stump assumes the form of a crater, which favors healing. Kiihn has constructed special forceps, Fig. 144, for holding the teat in such a manner that the excision is readily performed with the scalpel. Fic. 144. TEAT-AMPUTATING FoRCEPS oF KUHN. (Bayer and Frohner. ) After the teat is amputated, the milk flows away involuntarily, but later, as the healing process goes on, the opening narrows, and finally the milk is retained as before. Following the ampu- tation, there is little difficulty from hemorrhage, and if any occur it may be checked by a bandage or by a rubber band, placed around the teat, but not too tightly, lest it interfere with the life of the tissues. It may be well, for a time, to protect the wound against infection by means of antiseptics applied upon a cotton pack, which covers the wound and the teat generally and main- tains antisepsis for a few hours. This dressing may be retained in position by a ligature about the teat, or with strips of adhe- sive plaster. If it is desired to prevent the milk from escaping, it may be retained by the application of an elastic, or other ligature, near the end of the teat, sufficiently tight to close the milk canal, but not tight enough to interfere seriously with the nutrition of the part. Amputation of the teat is impracticable when the obstruction is located near its base. Vennerholm recommends that, when there are transverse mem- branous folds across the cistern, the teat should be as firmly grasped as possible above the obstruction, and then so vigorously pressed that the milk contained brings about a rupture of the 1002 Veterinary Obstetrics band, after which the affected teat is to be very frequently emptied forafew days. Others attempt to rupture these transverse bands by still greater pressure than can be applied by means of the hands, but the recorded results from the operation do not seem to: strongly commend it. Wherever these operations are under- taken, mastitis very frequently follows, and the cow eventually: becomes three-teated. In a somewhat extensive experience in the operative handling of the nodular obstruction at the base of the teat, we have had success in a small minority of cases; whereas, in the larger number, mastitis of a more or less serious form has been induced, which has usually ended in the loss of the affected quarter or quarters. Under these conditions it seems more judicious in many cases to allow the gland to atrophy and the cow to become. three-teated rather than to involve the risk of a dangerous infec- tion to be followed later by the destruction of the gland. DISEASES OF THE NEW-BORN ANIMAL. 1. INFECTIONS OF THE NEw-Born. At the time of birth there necessarily occurs a wound of the new-born consisting of a division of the umbilic cord. The division of the cord may occur just prior to the completion of the expulsion of the fetus, after a portion of the fetal body has passed beyond the vulva, as is usually the case in those animals having a very short umbilic cord, like the cow and other rumi- nants. In other animals, where the umbilic cord is long, as in the mare, the fetus is usually wholly expelled before rupture of the cord takes place. In any animal, though extremely im- probable in ruminants, the entire fetal placenta may follow the expulsion of the fetus immediately, and the cord remain intact. As a general rule this presages the death of the fetus in the larger animals, because the separation of the fetal from the ma- ternal placenta has advanced to such a degree before the expul- sion of the young that it disturbs the aeration of its blood and leads to its death by strangling. In multiparous animals, where the fetal placenta must necessarily follow each fetus before a succeeding one can be expelled, the fetal membranes very fre- quently remain attached to the fetus by the umbilic cord, which is divided by the mother with the teeth. In other young which may be born with the navel cord unbroken, its rupture very fre- quently results from the struggles of the young animal, or may be brought about by the mother. The point at which the navel cord divides is usually very close to the umbilicus—in the foal and calf from one to three inches— in which region the cord is normally smaller and weaker than at other parts. After the rupture, the normal course of events consists of the retraction of the two umbilic arteries and of the urachus, upward and backward into the peritoneal cavity, draw- ing with them, in their retreat, portions of the loose connective tissue which immediately surround them. In this retraction the walls of the vessels become thickened, while their lumen becomes correspondingly decreased, thus preventing the escape of blood from the arteries or of urine from the urachus. The escape of urine or of blood is further safeguarded by the connective tissue, 1003 1004 Veterinary Obstetrics which is continuous with the external layer of the vessel walls, adheres to the divided ends of the vessels, and becomes retracted along with them, serving to close over the broken ends and form a fibrous network which offers an impassible barrier for the blood or urine. The umbilic vein, having very thin walls, collapses at once after rupture, so that its lumen is closed and what blood remains within, being free from any cardiac or capillary pressure, soon coagulates and blocks the remaining cavity. The Whartonian gelatine included within the cord rapidly loses its fluid portion, which oozes away from the broken end; within a few hours the navel becomes dessicated to a hard, dry crust, which hermet- ically seals the surface of the wound, and aseptic healing occurs beneath the scab. Prior to the hermetic sealing of the wound by dessication, it is open to infections of an extended variety, which acquire special significance because of the vulnerability of the tissues involved. The tissues of the umbilic cord, including the urachus, veins and arteries, invested with connective tissue and Whartonian gelatine, become dormant when the cord ruptures, and possess little or no power of resistance against bacterial invasion. ‘The conditions prevailing at this epoch rather invite infection, as the tissues provide abundant moisture, nutrient material and warmth for bacterial growth. Opportunities for infection are not wanting. Even before the fetus has escaped from the vulva or the cord has ruptured, any infection existing in the vulvo-vaginal canal of the mother may have acquired a habitat on or in the cord. Nocard and others hold that the appallingly fatal infectious diarrhea of calves is due chiefly to navel infection, and that the infection is already lying in wait in the vulvo-vaginal canal of the cow when the calf is being born. Later, when the cord ruptures, the umbilic stump is readily brought in contact with the earth, bedding, dung, urine, etc., whence it may acquire virulent infections. The anatomy of the part permits the infection to reach the circulatory system by a short route through the inert, open umbilic vein, and to be carried thence to remote parts. Purulent Infection of the Navel 1005 1. PURULENT INFECTION OF THE NAVEL. OMPHALITIS. OMPHALO-PHLEBITIS. PyYO-SEPTHAMIA. Purulent infection of the navel is greatly favored by many of the circumstances attending the birth of the young animal. When it is born in a stable or barnyard, or in surroundings where filth and dirt are abundant and omnipresent, there is constant exposure to infection of the new-made wound. Whenever the animal lies down, especially in sternal recumbency, the new-made wound comes in direct contact with infected bedding, decompo- sing feces or urine, or with other filth which may chance to ex- ist at sucha point. The carnivorous, and toa lesser degree the herbivorous mother habitually cleanses the broken cord by licking, and thereby with- draws from it a large part of the Whartonian gelatine, thus favoring the early dessication of the stump. It appears that, in spite of the fact that the mouth usually abounds in pathogenic bacteria, the process of lickiny the navel is, according to clinical observations, comparatively safe and tends to protect the navel against infection. We observe infection of the navel most fre- quently in the foal, whose mother pays less attention to the navel than do other domestic animals. Purulent infection of the navel very frequently arises, also, as an indirect result of ligating the umbilic cord. The danger from ligating the cord consists usually of two principal elements—the infection of the wound by careless ligation, and the providing of a breeding ground for bacteria by the inclusion of the Whar- tonian gelatine. From a surgical standpoint, nothing can well be more danger- ous to the new-born animal than the careless or filthy ligation of the umbilic cord by a layman or a veterinarian with dirty, in- fected hands and an unclean ligature. Most ligatures applied to . the navel are placed there by laymen, who are ignorant of the fundamental rules and practices of surgery, and consequently pick up almost any kind of ligature, which they apply without disinfection or sterilization, and usually without disinfecting or even washing their hands. They thus bear directly to the cord abundant infection of a dangerous character. Even when a ligature is applied to the navel under some of the rules of modern surgery, other important ones are habitually 1006 Veterinary Obstetrics neglected, and the ligature is nevertheless wrongly and danger- ously placed. The exterior of the cord consists of the imper- meable amniotic sheath, which encloses within it the vessels sur- rounded by the Whartonian gelatine. If the cord is tightly ligated, the gelatine is firnily enclosed, and its fluid portions can- not escape readily and permit proper dessication of the stump. Even if the ligature has been applied under other antiseptic pre- cautions, but retains the Whartonian gelatine, the procedure is at once in conflict with surgical practice, because this substance constitutes an excellent medium for the growth of pathogenic bacteria and assumes the same surgical significance as extensive blood clots when retained in awound. The danger from infec- tion is further emphasized if the ligature is placed at a point too distant from the umbilicus, thus increasing the amount of tissue in the cord which must undergo dessication or putrefaction. The greater the amount of moist tissue, the more probable is putre- faction, and the less likely is dessication to occur. Ligation possesses yet another danger, in the possible incarce- ration of the two umbilic arteries and the urachus. If the ligature is applied very tightly before the cord is severed, the retraction of the arteries and urachus into the abdominal cavity may be prevented. Being retained in the navel, the open ends of the arteries and urachus are freely exposed, and rendered more subject to infection during putrefaction of the tissues. The possibility of either preventing or decreasing navel infec- tion by ligating the stump is by no means clear upon surgical grounds. When a living tissue is ligated, and the ligature so tightly appli¢d as to cause necrosis on the distal side, it appears clinically to cause a prompt protective reaction (leucocytosis) on the proximal side of the ligature, which largely serves to prevent important infection. But whena ligature is applied to adormant or dead tissue like the umbilic stump, no such reaction is caused, and the stump goes on to putrefaction or dessication, as circum- stances may favor. The application of a ligature about a mass of dead tissue cannot prevent infection of the necrotic mass on either side of the ligature, but may greatly favor putrefaction by confining fluids within the parts. When such bacterial infection and decomposition occur in the necrotic tissues of the cord, the more or less dormant vessels incarcerated in the decomposing tissues are seriously exposed to bacterial invasion. Purulent Infection of the Navel 1007 It is thus a common clinical observation that purulent infec- tion of the navel is greatly favored by the process of ligation, and the more improperly ligated the greater the danger. Ad- mittedly a navel cord may be safely ligated. If the cord is di- ‘vided at the proper point, the Whartonian gelatine thoroughly pressed out and the stump ligated under perfect aseptic precau- tions, followed by the application of an aseptic covering, and its retention in position and in an aseptic state (a very difficult task with domestic animals), the operation is safe. Another method by which infection apparently takes place is through the medium of flies, which are attracted to the cord while it is yet moist after birth. These filth carriers, having previously been in contact with infected wounds or putrid organic matter, carry the infection to the navel. Foals born during fly time very frequently suffer from navel infection. Symptoms. Navel infection occurs within a few hours after birth, and the danger is eliminated as soon as the cord is thor- oughly dessicated. Consequently, the danger period is during the first 12 to 24 hours after birth. The symptoms usually fol- low very promptly after this period, although in the initial stages of the disease, the malady may be overlooked or unrecog- nized by the owner or attendant. First there usually occur the general symptoms of local infection, modified by the peculiar structure of the navel. In the foal, Fig. 90 B, page 559, there is an extension of a hairless skin from the umbilicus, to con- stitute the cutaneous portion of the cord, beyond which,the cord is somewhat smaller, softer, more fragile, and covered with the amnion. It is just beyond this cutaneous area of the cord that it normally ruptures. When the umbilicus becomes inflamed, this projection of hair- less skin becomes intensely reddened, tense and glistening. Further examination will reveal the fact that, instead of the part having dessicated normally, there exudes from near the center of the cord a dirty, thin, watery, flocculent serosity, which may be grayish-white or tinged with blood. If the part is carefully examined with a fine probe, it will usually be found possible to pass the instrument upward and forward for a variable distance toward the liver along the course of the umbilic vein. If the infection has extended along the vein in its course through the peritoneal cavity, the probe can probably be passed for a distance 1008 Veterinary Obstetrics of two, three or four inches, or even more. If the infection has been arrested in the umbilic ring, the probe cannot pass be- yond it. The behavior of the case will depend primarily upon the degree of extension of the infection. It may be confined chiefly or wholly to the umbilicus itself, to constitute simple omphalitis ,- or it may pass beyond the umbilicus, in the lumen of the umbilic vessels, and the infecting agent and its products gain entrance into the blood stream, by which they may be carried to distant parts, to produce septic or pyzemic disturbances of a grave char- acter, which we recognize as omphalo-phlebitis or pyosepthaemta of the new-born. It is an important clinical fact that the gravity of navel infection is usually in inverse proportion to the local dis- turbances. If the local changes are great, inducing severe local omphalitis, the systemic disturbances are usually unimportant ; if the infection gains admission to the umbilic veins, and thence enters the general circulation, the local disturbances may be com- paratively insignificant, while the sepsis or pyzemia is exceed- ingly grave. When the infection remains localized in the umbilicus itself, the part becomes swollen, somewhat tender to the touch, and soon suppurates. Small abscesses form in and about the um- bilicus, which open-and discharge pus. ‘The abscesses may be followed by fistule of varying lengths, into which a probe may be passed for a distance of one, two or more inches. Sometimes the fistula may consist of the suppurating walls of the umbilic vein or artery. The swelling from local umbilic infection may be very great, sometimes offeriug a sharp, hemispherical swelling, 4-6 inches in diameter. The course of such local infection is usually chronic, continuing for week after week. A somewhat limited amount of pus is dis- charged, which is generally of an ordinary consistency, without odor. Such an inflammation does not involve the general well- being of the young animal ; it takes its food in the normal man- ner and amount, its digestion is undisturbed, it is playful, and its growth is usually unaffected. When the infection, instead of expending its virulence upon the tissues of the umbilicus, gains admission to the open umbilic vein and extends along its course toward the heart, and the Purulent Infection of the Navel 1009 bacteria and their products enter the blood stream, the symptoms are wholly different from those of the local disease. ‘The coagu- lated blood within the umbilic vein breaks up under bacterial invasion, liquifies, and may be partly discharged into the hepatic vein from the central end of the umbilic vein, and externally from the stump of the cord as a dirty, flocculent, reddish-gray liquid, consisting of the disintegrated blood clot mingled partly with pus. The entire lumen of the umbilic vein has become a suppu- rating cavity. The tissues about the umbilicus are slightly, if at all swollen, but the umbilic stump is swollen, tense, glistening, and projects out from the umbilic ring as an elongated cone, having in its center a very small opening, from which the dis- charge appears. This discharge may occur as early as the 3rd or 4th day after birth, and may continue for a period of one, two, or even more weeks, should the animal survive. During the continuation of the discharge from the umbilic vein through the stump, the hairs about the navel are kept befouled and moist. Usually the adjacent hairs become matted together, and may more or less hide the broken end of the stump. Later the be- fouled, matted hairsdropaway, leaving a depilated, naked surface. Soon after the commencement of suppuration in the umbilic vein, there frequently occurs also a corresponding infection in the broken end of the urachus, which results in the duct becom- ing reopened, with a consequent dribbling of urine from the navel, which adds to the moist condition of the diseased part and gives to jt the odor of decomposed urine. Usually this condition is attributed to ‘‘ persistent ’’ urachus, but according to our ob- servations, this designation is ordinarily erroneous, since the open condition of the urachus with dribbling of the urine is gen- erally secondary. In the more serious cases of navel infection, the local symptoms are so insignificant in a general way that they may wholly escape the observation of the owner or caretaker. The first ‘signs of disease which he notes are the more serious systemic dis- turbances, because of the entrance of the infection into the general circulation. When the young animal has reached the age of two to four days or somewhat more, there suddenly appears in many cases a high fever, with loss of appetite and extreme dullness. The udder of the mother becomes over-distended with 64 IOIO Veterinary Obstetrics milk as a consequence of the loss of appetite of the young. The coat of the young animal is staring and dull. There may exist either constipation or diarrhea. In many cases distinct chills are noticed as a symptom of the fever which is present. The young animal in many cases shows very great weakness, and may perish from the infection in the course of 24 to 48 hours after the first symptoms of disease are observed. The symptoms of general infection vary widely in intensity. Between the rapidly fatal septicaemia which we have outlined and those cases which for a time do not attract any notice, there is every gradation. In many cases the symptoms of fever continue for a day or two, with a decreased appetite and other general febrile svmptoms, disappear, and the young animal ap- parently regains its usual health, although it may not seem quite as vigorous as should be expected. In some of the very mild cases, no febrile symptoms appear of such a character as to attract the attention of the owner, and the early stages of the general infection pass unnoticed. This very frequently occurs, and it is only when the secondary symp- toms of the infection arise that the attention of the owner is at- tracted to the diseased condition of the patient. When the young animal has reached an age of from three to five or even ten days, and sometimes more, there suddenly ap- pear, without warning, acute septic or pyzemic inflammations of various parts or organs of the body. Pre-eminently there occur septic or pyezemic inflammations of the articulations. The young animal is left apparently well in the evening, and is found the following morning severely lame in one of its limbs—usually so lame that it will not bear weight upon the affected member. Upon examination of the limb, one of the prominent articulations is found swollen, hot, tense, and painful upon manipulation. The inflammation usually affects the more important articula- tions, especially the hock and stifle, and less frequently the elbow and carpus or other joints. The suddenness and intensity of the. arthritis usually leads the owner to believe that the dam has in- jured the joint of the young by treading upon it. The course of the inflammation of the articulation varies ac- cording to circumstances. In many cases it increases in intensity for a few hours in the articulation first involved, and then very suddenly abates, while another articulation becomes violently Purulent Infection of the Navel IOI inflamed. The inflammation may thus involve one after another of thearticulations, disappearing from one to reappear in another. This has caused the disease to be designated by some as rheu- matoid arthritis, and by others as foal lameness, calf lameness, etc. As the disease continues, there is a well-marked tendency for the arthritis to become fixed and permanent in a given articu- lation, and at the same time additional articulations become in- volved, so that in many instances two, three, or four joints are simultaneously diseased. We recognize two somewhat distinct forms of arthritis; the one a serous inflammation without the formation of abscesses, the other characterized by the presence of abscesses, the con- tents of which are usually mixed with synovia. The apparently serous arthritis, in which abscesses do not form, constitutes the most common type of articular disease. The inflamed articulation is greatly enlarged, tense, hot and painful. The distended synovial sac may offer some symptoms of fluctuation, but does not ‘‘point.’’ Later the articular tissues hypertrophy, the subcutem, synovial membranes and other parts thicken and become more or less sclerotic. At the same time the contents of the synovial sac may become increased, caus- ing severe distension, which may remain permanent. When in- volving the femoro-patellar articulation, the synovial disten- sion floats the patella upwards until it reaches the level of the top of the external femoral condyle, when the patella slips out laterally to constitute ‘‘ floating luxation of the patella : which may prove temporary or permanent. NY Less frequently the arthritis is of a purulent character, and the joint soon becomes the seat of an extensive suppuration} the pain is very severe, and the accompanying constitutional symptoms are exceedingly grave. After the lapse of a few days, the pus in the synovial sac becomes so abundant that distinct fluctuation is present. Unless opened surgically, the abscess ruptures and discharges a flocculent pus mixed with abundant synovia. In most cases, however, the sepsis is so acute and severe that the young animal perishes before the abscess ruptures-spontaneously ; or, if the abscess is opened, the animal soon succumbs from septiczemia. The abscesses are not confined to any particular articulations of the body. They are observed chiefly about the principal IO12 Veterinary Obstetrics articulations of the limbs, such as the tarsus, carpus, fetlock and stifle, but usually do not include the coxo-femoral or scapulo- humeral joints, though somewhat rarely these are involved. When the hip joint becomes affected, the symptoms are not so well defined, because of the depth of the abscess. The animal is excessively lame in the affected hip, and there is a general swell- ing of the gluteal region. The imprisoned pus finally approaches the exterior at some point, causes fluctuation if the young animal lives for a sufficient time, and may then rupture or be opened, and the true character of the disease becomes revealed. The severe lameness caused by the arthritis exerts an impor- tant influence upon the course of the disease, aside from the septicemia with which it is so closely associated. ‘The lameness interferes with the young animal securing proper nourishment, because in many instances it is unable to rise or even to stand while it sucks, and thus it suffers from starvation. In chronic cases, also, the young animal suffers greatly from decubitis gangrene upon various portions of the surface of the body, so that from these sores alone it may soon become a very repulsive and pitiable object. The formation of pyzemic abscesses does not confine itself to any organs or tissues, but may occur at almost any point within the entire body. Abscesses may form within the lungs and, rupturing into the bronchial tubes, cause death from an acute septic pneumonia. In other instances the abscess forms in the articulations of the vertebral column, and may extend in- ward to press upon the spinal cord, thereby inducing a more or less sudden and complete paralysis ; or the abscess may form in the spinal canal and bring about similar symptoms. Spinal paralysis, due to pyzemic abscess as a result of navel infection, may cause either sudden or gradual paralysis. If the abscess forms in the inter-vertebral space, and suddenly forces its way into the spinal canal to cause pressure upon the cord, the paralysis may be very sudden and unexpected, as we noted in one instance where a foal had been apparently well and very thrifty and vigorous until some 8 or 10 weeks old, when it was found one morning unable to rise. It,could not stand when helped to its feet, and presented all the appearances of a broken back. Upon post-mortem examination, there was discovered a Purulent Infection of the Navel 1013 small abscess at the dorso-lumbar articulation, which, rupturing into the spinal canal, had caused pressure upon the spinal cord. In another instance, in a calf, there appeared at the age of 6 or 8 weeks a gradually increasing paraplegia. The caretaker had not observed any disease or infection of the navel, but a careful inspection of the part revealed the presence of an’ old suppuration, the evidence consisting chiefly of dried pus upon the surrounding hairs, and a naked point at the navel, indicating that a limited infection of the part had existed. Being unable to account otherwise for the paralysis, we diagnosed spinal abscess as a result of navel infection, and finally, destroying the animal, we discovered upon post-mortem examination a large abscess in the spinal canal, pressing upon the cord, as shown in Fig. 145. Fic. 145. OMPHALO-PHLEBITIS. Spinal abscess, in a four-weeks-old calf. A, Inspissated pus in spinal canal, pressing upon the spinal cord, SC, causing paralysis of posterior parts. Pathology. ‘The disease is the result of the entrance, into the freshly broken navel, of pus-forming micro-organisms. So far as we are aware, the disease is not limited to any one form of infection. In one instance, where a foal had succumbed to the disease, bacteriologic examination of deep-seated pyaemic abscesses revealed the presence of a pure streptococcic infection. The local infection of the navel is a mixed one, as has been shown by Bollinger and others. Clinically we observe that, IOI4 Veterinary Obstetrics along with the general purulent infection, there may also occur a tetanus infection, inducing a virulent form of that malady. Nocard and others have shown that, in calves, along with other infections, or without them, there may enter through the broken navel cord the germs of infectious diarrhea. One organism or another may acquire precedence, and consequently modify the symptonis of the infection. The force of the infection is sometimes expended upon the navel and its immediate neighborhood, producing a type of dis- ease depending somewhat upon its virulence. In such cases it appears that a sufficiently resistant embolus forms in the um- bilic vein to constitute an efficient barrier against the centripetal progress of the infection and limit its ravages to the umbilic region. ‘The infection induces a more or less severe inflamma- tion, with swelling, suppuration, and the formation of abscesses and fistule. If the infection possesses a still higher virulence, gangrene or necrosis of the tissues may occur. If the infection extends beyond the immediate area of the navel through the lumen of the umbilic vein or other umbilic vessels, it quickly gains entrance to the general system, and induces septicemia or pyzemia. Upon post-mortem examina- tion in such cases, the navel vein is usually found filled with decomposed blood, mixed with a dirty-gray, flocculent pus. The umbilic vein is converted into a vast suppurating tube, opening at one end into the hepatic vein, at the other externally at the umbilicus. The purulent contents may escape outwards through the navel or inwards into the hepatic circulation. Once the infection reaches the hepatic circulation, it flows freely to the heart, passes through the pulmonary system and gains the systemic circulation. The gravity of the attack is dependent upon the amount and virulence of the infection entering the hepatic circulation, and the power of resistance (age and vigor) of the patient. In many cases the septiceemia is so acute and intense that the patient succumbs in a few hours, presenting essentially only the symptoms of high fever with very slight navel disease. In other instances the disease assumes the character of pyezmia, and the clumps of bacteria, passing into the general circulation, are forced through the pulmonary vessels, into the lungs, where they may lodgeto bring about pulmonary abscesses. * Purulent Infection of the Navel 1015 Passing through the pulmonary capillaries, and reaching the systemic circulation, the infection may become arrested at any point, and induce an acute septic or pyzemic inflammation. ‘The infection is especially liable to become lodged in the capillaries in or about the synovial membranes of the articulations or of the sheaths of tendons, and to induce therein either an acute serous or purulent inflammation. Fic, 146. ABSCESSES OF UMBILIC VEIN AND ARTERIES IN OMPHALO- PHLEBITIS OF FOAL. A section of the abdominal floor, including the umbilicus, seen from above. B, Bladder. U, Emergence of umbilic vein from naval cord into intra-peritoneal portion of that vessel. UA, Umbilic arteries retracted to the fundus of the.urinary bladder, B, I, I, Pus cavities in umbilic vein. 2, Abscess in right umbilic artery. 3, Greatly thickened walls of left umbilic artery. 4, A brief segment of apparently normal artery. 5, Thrombus in posterior aorta and iliac arteries. No tissue or organ of the body is immune against the ravages of the disease. The internal organs are by no means free from the dangers of pyzeemic infection. Abscesses of the liver, kid- neys and spleen are frequently found. We have frequently observed abscesses within the umbilic veins and arteries, as shown in Fig. 146, especially when these vessels have been caught and held as a consequence of the ligation of the umbilic cord. If the cord has not been ligated, and thearteries thus held, they quickly retract into the abdomen and are comparatively free from danger. “T@16 Veterinary Obstetrics Pyzemic arthritis is usually highly destructive to the affected articulation. When the focus of infection is within the articu- lation, the synovial membranes are found greatly thickened, intensely injected, and frequently necrotic. The articular cavity is usually distended with purulent synovia, as indicated at A A Fig. 147. The infection spreads rapidly to the surrounding tis- sues, causing extensive suppuration in the neighboring tendon sheaths, like at C, and in the subcutaneous tissues at B. /B AA a aaa Vt Fic. 147. OMPHALO-PHLEBITIS. FOAL. Sagittal section from carpus. Same case as Fig 146. A, A, Intra-articular abscess of carpal joint, communicating with an extensive subcutaneous abscess, B, and posteriorly with an empyzmic cavity, C, in the vaginal sheath of the flexor tendons. The articular cartilage undergoes rapid destruction, as shown at A and B, Fig. 148. In addition to the lesions already men- tioned, there may occur septic inflammation of the pleura, inter- muscular abscesses, opthalmia, leptomeningitis, catarrhal enteri- tis, pneumonia, myocarditis, bronchitis, etc. Fic. 148. OMPHALO-PHLEBITIS. Cross section of Fig. 147, showing lower row of carpal bones, seen from above. A, B, Purulent destruction of articular cartilage. At the upper part of the illustration is seen the pus cavity, B, of Fig. 147, in cross section. Purulent Infection of the Navel IO17 Prognosis. The prognosis is very grave in all cases of omphalo-phlebitis, that is, in all patients suffering from umbilic infection in which the infection gains the hepatic and general circulation. It is most hopeless in the foal, in which animal the mortality exceeds 95%. Of the few which ultimately sur- vive, the vast majority are comparatively valueless because of permanent changes in the articulations or in other parts of the body. In the calf the prognosis is somewhat more favor- able, but is still exceedingly grave. The greater the age of the young animal when the symptoms of the disease appear, the more vigor and strength it has acquired; the better the progno- sis. If the infection is so mild that the first evidences appear only after the young patient is 2 or 3 weeks old, the prognosis is fair. . When simple omphalitis is present and severe, and the local swelling and inflammation indicate that the entrance of the in- fection into the general system is barred by a resistant embolus in the umbilic vein, the prognosis is. good. Handling. The handling of the localized infection of the navel consists essentially of local disinfection. The navel should be thoroughly cleansed ,and ifa portion of the cord is still present and undergoing decomposition it should be cautiously removed, and any necrotic tissues should be excised or curetted away as far as is practicable. Abscesses in the navel should be opened promptly, under strict antiseptic precautions. It is highly essen- tial, also, that, before attempting to operate, one should care- fully differentiate between inflammation of the navel and umbilic hernia. [In some cases the two conditions coéxist, and become highly confusing, so that the hernia may be mistaken for an abscess, or vice versa; or a fistula may exist along with hernia. When attempting to lay open a fistula, the surgeon may open the peritoneal cavity and invite intra-peritoneal infec- tion, or a protrusion of the omentum or the intestine. Sup- purating fistule about the navel should usually be treated by the injection of antiseptics, such as tincture of iodine, rather than by opening, unless the more conservative method fails to produce the desired results. The selection of a disinfectant is not so important as the thor- oughness of its application, except that it should be one which will penetrate the tissues freely, We prefer the application of 1018 Veterinary Obstetrics the tincture of iodine or of other antiseptics in alcoholic solution. They have the advantage that the alcohol quickly evaporates and leaves the antiseptic behind in a dry state. It may be equally effective to apply a wet dressing to the part, in the form of an antiseptic pack, to be retained in position by means of a band- age. Ifthisis attempted, the pack needs be kept constantly saturated with the antiseptic and frequently renewed. When the infection has become general, and septiceemia or pyzmia has developed, all forms of handling become almost hopeless. In accordance with general surgical principles, we would promptly open abscesses, and disinfect their cavities. whether they involve the muscles or the articulations. Inter- naily there may be given various antiseptics, and we especially recommend large and repeated doses of quinine, or in the foal we may add to the quinine large doses of potassium iodide, or supplant the quinine by the iodide. Recent developments in opsonic and serum therapy have aroused interest, and in the minds of some, hope has been estab- lished that pyo-septiceemia of the new-born may be brought under control. As yet, the problem is undecided. Spencer (Proc. Am. Vet. Med. Ass’cn., 1908, p. 393) claims definite re- sults in severe cases, but the data submitted are not convincing. Most of his cases were comparatively old foals, in a fair proportion of which spontaneous recovery might have been anticipated. He gave 10 cc. of anti-streptococcic serum subcutaneously, daily. Noevidence is submitted that the foals had streptococcic infection. If the infection was streptococcic, we have no evi- dence that the serum was from the same organism. In about half his cases, S. used influenza serum instead of the antistrep- tococcic preparation. In one case he combined them. Were we to accept the conclusion that the sera acted specifically in these cases, we would be forced into the position that the charac- ter of the infection is unimportant, and all that is necessary is to buy some kind of serum from a manufacturer, administer it in any kind of infection, and get a speedy cure. It is to be sincerely hoped that investigations along these lines. may develop a safe and reliable remedy for umbilic infection of the new-born, but until we are supplied with more definite data regarding this or other remedies, the practitioner needs rely upon prophylaxis, not upon therapeutics. Purulent Infection of the Navel 1019 While the handling of pyo-septhzemia of the new-born is ex- ceedingly unfavorable and well-nigh hopeless, prophylaxis of navel infection is highly successful, and should be regularly ap- plied in stock-breeding, especially in horse-breeding. Franck recommends that, after the navel cord has been ligated, it should be penciled over with concentrated carbolic acid, but Vennerholm contends that this converts the covering of the cord into a parch- FIc. 149. SOHNLE’S NAVEL BANDAGE FOR FOALS. a, Elastic girth inserted in the suspensorium. (Bayer & Frdhner). ment-like membrane, which interferes with the escape of the tissue-fluids, and consequently with the mummification of the cord. He recommends instead the plan of Sohnle of Wurtem- berg, who uses a special navel bandage, as shown in Fig. 149. Vennerholm recommends that the surrounding parts be carefully shaved, in order to prevent the adhesion of dirt. The navel is then disinfected, and further protected by the application of the Sohnle apparatus. The leather surcingle, and other parts of this apparatus, are well padded, to prevent galling of the young ani- mal, and applied as shown in the figure. ‘The navel rests ina depression in the surcingle, in which there is placed sterilized cotton, upon which the disinfected navel rests. The parts are disinfected and redressed daily, until the navel stump sloughs away and granulation is fully established. The plan of Vennerholm and Sohnle is admittedly good if thoroughly applied, but it requires a very long and tedious course of procedure, with a somewhat expensive apparatus and no little annoyance to the foal. It isdangerous to entrust such a 1020 Veterinary Obstetrics method of handling to laymen, but the remedy demands applica- tion by the veterinarian himself. Unless properly applied, closely watched and carefully reapplied, the pad quickly becomes befouled and at once acts asa retainer and promoter of infection. In our judgment, so complicated a method of handling is alike needless and dangerous. In our experience we have had most excellent results by a far simpler method, which we believe safer and more efficient. We provide the breeder with a dessicating antiseptic powder for ap- plication to the navel cord as soon as the foal or other young animal is born. This powder may be variously compounded, according to the taste of the veterinarian, but should consist of reliable antiseptics having a distinct dessicating power. We would suggest, for such a powder, equal parts of iodoform, tannin, oxide of zinc and starch, all finely powdered and mixed. ‘The oxide of zinc might be displaced by calomel, or the latter might be added to the compound suggested. Quite as good, or per- haps even superior, is a powder consisting of equal parts of dessi- cated alum, gum-camphor and starch, finely powdered and thor- oughly mixed. The latter mixture is especially efficient in keeping flies away from the moist cord. For the application of such a powder, the owner or veterina- rian should first thoroughly cleanse and disinfect his hands. If the navel has become soiled, it also should be cleansed and dis- infected. The navel cord should not be tied. We have al- ready stated our objections to ligating the cord, on page 1005. If it is unruptured, the caretaker, after disinfecting his hands, should pull, tear or scrape the cord in two, under antiseptic pre- cautions, at a distance of about two or three inches from the navel, after which, with his thumb and finger, he should press out from the stump the Whartonian gelatine and fluids. After this has been well done, the powder should be dusted over the stump of the navel very freely and repeatedly, until the rem- nant of the cord has become completely dessicated and the navel hermetically sealed. If the application is repeated three or four times at intervals of one-half hour, the stump of the cord is well mummified with- in two to four hours and the danger from infection is eliminated. The horse-breeder should be impressed with the fact that the efficacy of the remedy depends wholly upon the early and Tetanus of the New-born 1021 thorough application, and that any delay or carelessness is liable to vitiate the result. Antistreptococcic serum has been heralded asa valuable prophy- lactic against this infection, but is wholly needless. Local cleanliness isample, and other means superfluous or worse. Few diseases of animals are more subject to safe, convenient and economic prevention than navel infection of the new-born. Its success calls for fidelity to cleanliness on the part of the owner, preceded by timely and intelligent advice by the veterinarian. 2. TETANUS NEONATORUM. TETANUS OF THE NEW-BORN. Tetanus of the new-born acquires special significance because of the avenue of entrance of the tetanus bacilli. While tetanus may appear in any new-born animal from the same causes which induce it in the adult, it is of especial interest to us when occur- ring asa result of navel infection. Owing to the method of infection, the malady acquires a distinctive name, though differ- ing in no essential respect from the ordinary disease, except per- haps that it is more virulent because the toxic substances enter more freely and directly from the umbilic vein into the general circulation. In domestic animals, tetanus of the new-born is chiefly confined to the foal. The symptoms of tetanus of the new-born are identical with those observed in the adult animal, except that in our observa- tion the onset is more sudden, the course more violent, and death more certain. We have not observed a recovery, but in the few instances which we have seen the course of the disease has been especially brief and stormy. Asa general rule the foal goes down and is unable to stand within 24 hours after the first symptoms are noted. If the navel is examined in these cases, so far as we’ have observed, there is found in each instance a well-marked purulent discharge emanating from the navel vein. The disease is handled the same as other cases of tetanus, but, so far as we have observed, is hopeless from the outset. Tetanus of the new-born may be safely and readily prevented by the same precautions which we have suggested in the fore- going article, for ordinary purulent infection of the navel. 1022 Veterinary Obstetrics 3. DYSENTERIA NEONATORUM. DYSENTERY OF THE NEW-BORN. WHITE SCOURS. In all new-born animals there may occur disorders of the di- gestive tract, which are expressed chiefly in the form of dysen- tery, due as a rule to the entrance into the alimentary canal, and multiplication therein, of various forms of bacteria which induce a catarrhal inflammation of the alimentary mucous membrane, accompanied by an acute diarrhea. While'the disease may affect the new-born of any species of animal, it is most common and fatal among calves. In this animal there is a distinctively infec- tious form, in which the disease becomes enzootic, and assumes the proportion of a very destructive plague in dairy herds. The calf is no more subject to digestive disturbances, aside from the infectious diarrhea, than are other new-born animals. In fact it may well be questioned if dysentery of the new-born ani- mal is not more common in the foal, when we leave out of con- sideration the specific dysentery of the calf. a. SPORADIC DYSENTERY OF THE NEw-Born. WHITE SCOURS. Dysentery of the new-born consists of a diarrhea which at- tacks the young animal, usually during the first few days of extra-uterine life. The disease appears occasionally among all species, especially among foals and calves. Symptoms. When the young animal has reached the age of two to ten days, symptoms of general illness of a more or less severe type appear. ; The feces are very fluid, and usually somewhat mixed with mucus. They are generally fetid, and vary in color, frequently being of a dirty yellowish or whitish tinge. They may partake of the peculiar coloring of the foods consumed, so that, in case the young animal partakes of green grass, the feces assume a tinge of green. The feces are usually mixed to some extent with gas bubbles, because of gaseous decomposition taking place within the alimentary canal, and the presence of these bubbles imparts to the feces a frothy character. The liquid feces are sticky, and the tail and buttocks soon become soiled by the adherent dis- charges. This constitutes one of the first noticeable symptoms of the disease. : Sporadic Dysentery of the New-born 1023 The evacuations from the bowels are frequent, and the feces are usually expelled with force. When the disease is well ad- vanced the feces are highly irritant, the amount of feces ex- pelled at a given time is usually very small, and the expulsion is accompanied by straining and other symptoms of pain. ‘The disease may cause symptoms of colic, as indicated by the whisking of the tail, kicking at the abdomen and looking at the flank. The patient becomes weak ; if the disease is very severe, it lies most of the time, and when it gets up, it staggers about in a _ very weak manner. The eyes become sunken, the animal very listless, and saliva may flow from the mouth. Emaciation is very tapid in the severe cases, and the coat is dry and rough. The measurement of the temperature is not very reliable, because in the weakened state of the animal the anus remains somewhat open. Moreover, the frequent passage of liquid feces tends to keep the rectal temperature somewhat depressed. As usually observed, the principal postmortem change is an irritated condition of the gastro-intestinal canal, which is largely concentrated in the colon and rectum. In these parts there is present a well-marked catarrhal inflammation of the mucous membrane, with a greatly increased secretion of fluids and mucus. ‘There is usually very marked anzemia and paleness of the tissues. The bacteriology of the disease has not been well determined. Usually there is a mixed infection. Various forms of micro- - organisms have been described by different writers, but it has not been definitely shown that the disease is due toany onealone. Causes. Sporadic diarrhea of the new-born depends largely upon the abrupt introduction of pathogenic organisms into the alimentary canal of an animal which is not inured to their presence. ‘The young animal has undergone a sudden transition from the uterus of the mother (which, with the placenta, has served as a barrier against most infections) to extra-uterine life, where it is subjected to the dangers incident to taking into the alimentary tract, food which is almost inevitably contaminated with microorganisms capable of inducing disease. Anything which may depress the general strength of the young animal, and which may supply a favorable breeding ground for the bacteria introduced into the digestive tract, serves ‘indirectly to favor the multiplication of the disease organisms. If too much food is taken, it over-taxes the digestive powers, 1024 Veterinary Obstetrics and thus invites the occurrence of disease. It is frequently observed that, when young animals are over-fed, and especially when they receive their food in too large amounts at a given period, they are liable to suffer from dysentery. Under natural conditions, where the young animal is constantly with the mother and has opportunity to suck as often as it may like, the danger from over-feeding isnot very marked. However, if the young animal is separated from its mother during long intervals, and thus becomes very hungry, it will eat voraciously when op- portunity is affordéd, and will partake of more milk than the state of its digestive organs warrants, thus tending to induce digestive disturbances. In mares it is frequently observed that the udder is greatly distended with milk at the time that the foal is born, and that the young animal shows a voracious appetite, attempting to take all the milk present, with disastrous results. An improper quality of milk is also dangerous for the diges- tive functions of the new-born. When mares or other mothers are hard-worked, and especially in warm weather, their milk is very liable to produce digestive disturbances in the young ani- mal, and all the more so because the foalis usually denied the opportunity to suck at frequent intervals, and becomes very hungry. Added to this condition, the foal of a work mare is occasionally compelled to follow her upon a long journey, the fatigue of which favors the occurrence of dysentery, and greatly aggravates the disease when it already exists. The adaptability of the food to the new-born is highly impor- tant. New-born animals sometimes show a depraved appetite, and soon after birth partake of food which they are not compe- tent to digest. In one instance we found upon post mortem ex- amination, in a case of fatal diarrhea in a foalthree or four days old, a tangled mass of straw in the stomach, weighing perhaps half a pound, incapable of digestion or of escaping from the organ through the pylorus, and acting as an irremovable irritant. It is very common to observe foals habitually swallowing bedding and other forms of rubbish or indigestible substances. It is a very common experience, when examining the feces in a case of scours, to find mixed with the intestinal discharges, undigested particles of straw or other similar substances. The eating of hay by very young animals frequently acts as a cause of persis- - tent dysentery. Sporadic Dysentery of the New-born 1025 Decomposing foods constitute a fertile source of diarrhea, and the disease is consequently very largely seen among young ani- mals which are artificially reared. Milk which has been allowed to partially decompose, which has begun to ferment or sour, is always dangerous as a food for the new-born; but even more dangerous is food which is contaminated with filth. In many instances the vessels, from which artificially-reared animals are fed, are exceedingly filthy and dirty, and contain particles of milk which have been allowed to remain and decompose day after day. Prognosis. The prognosis of sporadic dysentery in new-born animals is usually favorable. In those animals in which the disease appears very early, within two or three days after birth, the prognosis is less favorable than in those in which the attack is delayed until the animal has acquired some age and strength. The prognosis necessarily depends somewhat upon the cause of the disease, and the power of the veterinarian to overcome it. In such a case as that to which we have above referred, in which the animal had swallowed a large amount of straw which had become molded into a tangled mass in the stomach and was neither removable nor digestible, the termination could not be other than fatal. Handling. The prevention of sporadic dysentery in young animals is highly important. The food of the new-born animal should be as free as possible from pathogenic organisms, should be allowed in proper amounts and at sufficiently frequent inter- vals, and should be as readily digestible as circumstances will permit. If the young animal is allowed to suck the mother, it should be given such opportunity quite frequently ; at first the young animal should be allowed to be with its mother constantly. If the amount of milk in the udder is excessive, a portion of it should be withdrawn, so that the young animal will not be tempted to over-feed. This is especially true of the foal, since the mare sometimes has an enormous quantity of milk when the foal is born, and the latter is so voracious that it may greatly overfeed, if not prevented by the timely withdrawal of a portion of the milk. The objection has been interposed that the withdrawal of the milk removes the colostrum, which some have alleged is essential to the well-being of the young animal. 65 1026 Veterinary Obstetrics How true this may be, has not been definitely shown, but it is certainly true that many animals are well raised without having access to the colostrum. In many mares the milk has been flowing freely from the udder for days or weeks before the foal is born, and the colostrum has already escaped. Yet, so far as we have clinically observed, the foal does not suffer from this cause. When young animals are to be artificially reared, the task should be undertaken with a practical understanding and appli- cation of the rules of aseptic feeding. The food should be given frequently, and in small amounts, in harmony with the undevel- oped state of the alimentary tract, and it. should be as free as practicable from decomposition and from filth bacteria. The vessels from which the milk is fed to the young animal should be regularly cleansed and sterilized by boiling before each feeding. In some instances it may be desirable to Pasteurize the milk be- fore it is fed to the young animal, but this process reduces the digestibility of the milk to a degree, and is undesirable except in those cases where dangerous pollution cannot otherwise be avoided. The composition of the food should resemble as closely as pos- sible the normal milk of the species of animal to which it is being fed. When a young animal is being reared artificially, the milk should preferably be derived from an animal of its own species. The surroundings of the new-born should be scrupuously clean, and there should be a careful avoidance of any dangerous sub- stances which are likely to be swallowed. If the young animal exhibits a morbid appetite, such as a tendency to eat bedding, it is highly important to apply effective preventive measures. In some instances the young animal shows a marked tendency to eat fecal matter which has been voided by itself or other animals. The eating of bedding may be largely overcome by removing it and keeping the animal upon a bare floor, or still better, when the season and surroundings will permit, by placing the animal upon clean grass. In other cases, where the morbid appetite is marked and serious, we have found it necessary to apply a muzzle to the young animal so that it could not swallow rubbish. When the disease has become established, the precautions above suggested should be rigidly enforced, and in addi- tion, measures should be taken to remove, from the alimentary Sporadic Dysentery of the New-born 1027 canal, indigestible and irritant substances, allay the irritation in the parts, and disinfect such contents as may remain in the canal. First of all we strongly recommend the administration of an oleaginous cathartic, such as castor, linseed, or cotton seed oil. To the foal may be given one tablespoonful of castor oil, or two to three ounces of linseed or cotton seed oil. The oil is ad- ministered to gently evacuate the intestinal canal of its irritating contents, and at the same time to bring about a soothing of the irritated mucous membrane. Many practitioners have proceeded in an opposite direction, and have administered opium, tannin, catechu, alum and other astringent substances, which tend to retain within the canal the irritant substances which contain or bear the infecting agents. We have not been able to observe the benefits from this class of drugs, which have been claimed for them by many writers. The disinfection of the alimentary canal, after the removal of the infecting discharges so far as practicable, should receive close attention upon the part of the practitioner. Many drugs exert either a direct or an indirect influence upon micro-organisms in the digestive canal. Since the discharges are usually acid in re- action, many practitioners have strongly advised the use of alka- line carbonates, such as chalk or sodium bicarbonate. Others have had excellent results by the administration of powerful antiseptics, like corrosive sublimate or carbolic acid in appro- priate doses. Indirectly, excellent results have been obtained by the adminiscration of small doses of calomel, which, by ex- citing the functions of the liver, cause an increased amount of bile to be poured into the intestines, which acts as an antiseptic, increases the peristalsis of the bowels, and causes the expulsion as well as the destruction of the micro-organisms. Salol and other similar drugs have been used and recommended by some. Stimulants and carminates have also been used and highly commended by many practitioners. We have largely used the tincture of ginger, with apparently good results. Any of the carminates or aromatics may perhaps be used with benefit. Some of them have a direct antiseptic influence, while indirectly they all tend to disinfect the alimentary canal by arousing the normal peristalsis and secretions of the intestines, which in themselves control to a great extent the question of infection. There are probably few disinfectants which are superior in effi- 1028 Veterinary Obstetrics ciency to the normal peristalsis of the intestines and the corre- lated normal secretions of the alimentary glands. Stimulants strengthen the animal and help tide it over a crisis in the course of the disease. Alcoholic stimulants act also as antiseptics. Much good may sometimes be had from the administration of gruels or other substances which are at once nutritive and sooth- ing to the irritated mucosa. For this purpose one may use a thin gruel of elm bark or of starch, or may administer the whites of eggs, but care should be taken not to force too large an amount of these substances upon the young animal unless the conditions warrant us to believe that they will be digested, and not decom- pose to further complicate the disease. It is desirable toovercome as far as practicable the tenesmus due tothe irritation by the intestinal discharges in the rectum, for which purpose one may advantageously administer enemas of a soothing and aseptic character, such as a 0.5% solution of carbolic acid in starch or milk. Enemas of elm bark gruel, to which has been added salicylate of soda, may be used advan- tageously. . The surroundings of the young animal should be clean and comfortable, and any exertion upon its part should be carefully avoided, since this tends to greatly aggravate the disease. 6 INFECTIOUS DIARRHEA OF CALVES. There occurs frequently in calves a serious dysentery or scours, which is regarded as a specific infectious disease, differing mate- rially from the sporadic dysentery of the young animal. It ap- pears usually during the first few days after birth, but may appear almost immediately after birth, and, in fact, seemingly exists in some instances at the time that the young animal is born, so that it quickly perishes from the disease without having sucked the mother. The disease is highly fatal, and runs a very acute course. Causes. Franck was one of the first to describe diarrhea as an infectious disease, since which time many writers have verified his conclusions, that it isa highly contagious malady due to a specific cause. Nocard asserted the identity or close relationship between in- fectious abortion and dysentery of the new-born, but there seems to be no very good clinical grounds for such an assumption, Infectious Diarrhea of Calves 1029 though the possibility of the co-existence of the two maladies in one herd cannot be denied. Nocard believed that the infection usually enters the body of the calf through the umbilic cord, and consequently may occur during the passage of the fetus through the birth canal. It has been shown by Walther Schild that new- born animals have bacteria in the alimentary tract prior to the ingestion of food. Jensen does not accept the views of Nocard, but inclines to the belief that the infection is usually transmitted directty to the alimentary canal through the mouth, or at least that it may be so transmitted. Jensen found oval bacteria in pairs or short chains, in the mesenteric glands, spleen, liver, kidneys, heart, lungs and elsewhere. The organism is apparently closely allied to the bacterium coli communis and bacillus fetidi lactis, The findings of Jensen have in the main been verified by other investigators. He induced the disease experimentally, by admin- istering a culture of these organisms, with milk, to calves of sus- ceptible age. Symptoms. The symptoms of the disease appear usually in from one to two days after birth, but in some instances within a very few hours. The first symptom observed by the owner is usually tenesmus, accompanied by fluid evacuations which are at first of a yellowish color and stinking. At first the liquid feces are expelled with considerable force, but later the intestines largely lose their power and the evacuations take place involun- tarily, while the color changes from the normal yellow to a gray or whitish-gray, and becomes very thin. The young animal ceases to take food, and rapidly becomes weak and dull, with cold extremities. The course of the disease is usually very rapid, and death follows in from 12 to 48 hours. According to Fried- berger and Frohner, the mortality ranges from 80 to 100%. Sometimes the disease is accompanied by stretching, and at other times convulsions are present. In those cases where the calf sickens within a very few hours after birth, before it has sucked, the course is very rapid and fatal. This fact has supported the opinion of Franck and Nocard, that the infection occurs during the intra-uterine life of the calf or at the time of birth while the fetus is passing through the vagina. Upon similar grounds Friedberger and Froéhner are of the opinion that infectious uterine catarrh (granular venereal disease?) of the mother may 1030 Veterinary Obstetrics become transferred to the alimentary tract of the fetus and induce the diarrhea. Thus, according to one and another investigator, a relationship is suggested between several more or less serious maladies—abor- tion, diarrhea, uterine catarrh. At the present time the writer is handling a herd for severe granular venereal disease, in which abortion and diarrhea co-exist, but the relationship of the diar- rhea to the granular vaginitis is not clear. Upon post-mortem examination the chief changes are found in the alimentary canal and in the heart. The digestive mucous membrane is injected and hemorrhagic, and in some places shows a denudation of epithelium. ‘The irritation is largely concen- trated in the rectum, where the mucous folds are excessively hyperaemic. The mesenteric glands are enlarged and infiltrated, as are also the liver and kidneys. The spleen is apparently normal; the heart at times shows ecchymoses. In addition to these changes, there are present at times small areas of pneumonia. Handling. The therapeutics of this disease has constantly proven unsuccessful, and the chief attention is necessarily turned to preventive measures. More than a quarter of a century ago, Franck advised that pregnant cows be removed from infected stables four to six weeks prior to parturition, and that they be placed in clean and disinfected stalls. Others have advised that the posterior portions of the pregnant animal, the vulva, peri- neum, tail and buttocks, be carefully disinfected, that the vagina be irrigated with warm antiseptics shortly prior to parturition, and that the udder be washed with a 2% carbolic acid solution before permitting the calf to suck or before drawing milk from the udder to feed the calf. Morkeberg succeeded in reducing the mortality from 77 to 33%, by applying careful disinfection, fol- lowed by the immediate removal of the calf and feeding it upon clean milk. The udder was carefully washed with corrosive sub- limate solution before the milk was drawn for feeding the calf. Nocard advises that the navel cord should be ligated and ex- cised, and the stump carefully disinfected, because he believes that the disease is largely transmitted through the wound of the ruptured cord while the calf is passing through the vagina or while the freshly ruptured cord is yet in contact with; or moist- ened by, the vulvo-vaginal fluids. While we admit the proba- bility of the transmission of the disease through the navel wound, Infectious Diarrhea of Calves 1031 it would certainly be unfortunate to ignore other even more probable avenues of infection. If the infection exists in the genital passages of the mother, it may as readily gain the lungs and alimentary tract by entering the nostrils and mouth as it may enter the system through the umbliic wound. Itis therefore quite as important to guard these portals of entry, as itis the umbilic stump. Assuming the correctness of the view that the infection is already lying in wait in the genital canal when birth begins, antiseptic irrigations of the vaginal canal of the cow just prior to labor, and the immediate disinfec- tion of the nostrils and mouth of the new-born are indicated. As we have already indicated on page 561, we very greatly prefer, and strongly recommend, the application of dessicant antiseptic powders to the freshly ruptured navel, and would omit the ligature. We regard the dessication of the navel stump as more efficient, convenient and economic. Apparently those who advise ligation of the cord desire that it shall be done prior to rupture, but the cord of the calf is so short that it usually ruptures at the moment of expulsion, and immediately encounters the most crit- ical exposure in its history, if we accept the theory of intra- vaginal infection. A ligature, encircling the now dormant cord and presumably infected stump, cannot act as a barrier to the spread of the infection, but it may readily favor the extension of the infection in the necrotic stump by retaining the included Whartonian gelatin. The calf should at once be removed from the cow and from the infected stable. The removalis to be followed by the rigid appli- cation of the general rules of asepsis and antisepsis. These must include clean and comfortable quarters for the new-born, and strictly clean milk in proper quantity and at proper intervals. In applying these rules, the milk must be withdrawn from the cow under the strictest possible precautions to avoid its contamina- tion. Before the milk is drawn, the milker should carefully dis- infect his hands and the udder of the cow. The milk should be drawn in a sterile vessel. Ample precautions are to be taken against contamination of the milk between its withdrawal and feeding to the calf. The feeding vessels must be handled under’ strict aseptic precautions, being sterilized before each feeding. Care must be taken also that the infection shall not be borne to the. susceptible young by intermediary bearers, such as caretakers, 1032 Veterinary Obstetrics ‘animals, bedding or food. When the disease exists in a stable, it is of great importance that all fecal and other excreta from . the diseased calves shall be promptly disinfected. The buttocks and other soiled parts should be cleansed with a reliable disin- fectant, and the soiled bedding and floor should be given close attention. When the young animal has once become infected, the case is almost hopeless. Various antiseptics have been used and recom- mended, such as the tri-chloride of iodine, creolin, carbolic acid, salicylate of soda and others. Opium has also been used and recommended, in conjunction with powdered rhei radix. Opsonic and serum prevention and cure have been proposed, but at present do not warrant any relaxation in disinfection. c. SEPTIC PLEURO-PNEUMONIA OF CALVES. Under the name of septic pleuro-pneumonia, Poels has des- cribed a fatal disease of calves, complicated by inflammation of the pleura and lungs, and caused by specific bacteria which be- long to the colon group. Poels secured pure cultures of the bacteria, which caused a disease in experiment calves that could not be clinically distinguished from that in calves which had ac- quired the infection in the natural way. The artificially-grown bacteria also killed mice, rabbits and guinea pigs, and induced in swine a disease which appeared very much like swine plague. The bacteria were found, upon post-mortem examination, in the blood andinternal organs, and in the pleura and pulmonary exu- dates. It is believed that the infection may enter through the alimentary tract, the navel, the respiratory organs, or wounds upon the body surface. The clinical and bacterial differentiation between calf dysen- tery and pleuro-pneumonia in calves is not yet clear. Some hold ‘the two for identical ; others consider them as distinct diseases, due to wholly distinct micro-organisms. It is common in outbreaks of calf pleuro-pneumonia, to observe diarrhea. In some outbreaks of pleuro-pneumonia, diarrhea is the rule rather than the exception. The reverse is equally true. Pleuro-pneumonia is by no means rare in outbreaks of infectious dysentery. Certainly the two may coéxist. While the evidence for and against the idenity of Calf Septicemia 1033 diarrhea and pleuro-pneumonia is very confusing, their mode of origin, avenue of infection, prognosis and handling are essen- tially the same. Poels recommends that calves suffering from pleuro-pneumonia or diarrhea should be fed upon sterilized milk, from vessels which have been sterilized by boiling, and that great care should be taken to avoid infection passing to the young animal through the medium of dirty milk. Especially he recommends that great care should be taken in those cows in which there is a septic dis- charge from the vulva, which may thence be transferred to the udder and gain entrance into the milk, and suggests that in all such cases, the parts which are liable to be soiled, including the tail and udder, should be thoroughly disinfected. He further suggests that the navel should have antiseptic handling at the time of the birth of the young animal. d. CALF SEPTICEMIA. Jensen has described a fatal disease of calves occurring in Denmark, which is caused by ovoid bacteria, closely resembling those of swine plague, but in their pathogenic properties exhibit- ing some characteristic differences. Jensen considers this disease closely allied to the pleuro-pneumonia described by Poels, but it runs a more rapid course, without producing inflammation of the lungs. In Jensen’s observations the calves died in from 12 to 24 hours after the first appearance of the disease. The calves were attacked very suddenly, and became at once so weak that they could not stand, the temperature became elevated to about 41 C., and the patients quickly perished, with symptoms of diarrhea and dyspnoea. Upon post-mortem examination, Jensen found acute fibrinous inflammation of the pleura and pericardium, with ecchymoses in these two membranes, gastro-enteritis, enlargement of the spleen, and infiltrations about the larynx and pharynx. e. BACTERIZMIA OF TTHOMASSEN. ‘Thomassen has described a fatal infection of calves due to a bacillus of the colon group, which he could distinguish from the bacterium coli communis only by its greater virulence. He con- sidered the infection even more virulent than that of' diarrhea. According to Thomassen the calves are born sound, and show 1034 Veterinary Obstetrics the first symptoms of the disease within from 5 to 8 days, or even more, when they suddenly become weak and listless, remain recumbent, aud, when they are compelled to get up, habitually stretch themselves. Along with the dry muzzle, the respirations are increased to 50 or 120 per, minute, the pulse issmall, 100 to 150 per minute, and the temperature is elevated as high as 42° C. Some of the patients cough. ‘The appetite is greatly diminished, though the calf may continue to drink some milk. In these outbreaks. diarrhea is rare, and usually the feces are normal, while the urine is frequently voided in small amounts and contains epithe- lium from the bladder and tubular casts from the kidneys. In some cases cerebral symptoms are present, in the form of tonic and clonic spasms, to be later followed by paralysis. The disease has a duration of § or 6 days, and in the experi- ence of Thomassen is uniformly fatal. The pathologic anatomy consists chiefly of great enlargement of the spleen, which is 5 to 6 times its normal size and has a weight of about 500 grams. The pulp of the spleen is congested and chocolate color or black, and it sometimes shows an irregular form, being moreswollen at one point than another. In smear preparations of the spleen, there are found many bacilli. The kidneys are affected with a parenchymatous inflammation, and the mucous membrane of the bladder shows streaks or spots of a brown-red color. The mesenteric lymph glands are enlarged and show hemorrhagic spots. The mucous membrane of the fourth stomach, and to a lesser degree that of the small intes- tine, show numerous dark red petechia. The liver has under- gone parenchymatous degeneration. The endocardium is cov- ered with red petechiz. Thomassen administered various antiseptics to the diseased animals, such as carbolic acid, eucalyptol, trichloride of iodine, Lugol’s solution and others, but without any success. NON-INFECTIOUS DISEASES AND DEFECTS OF THE NEW-BORN ANIMAL. 1. ASPHYXIA OF THE NEw-Born. Asphyxia is not rare in the new-born, and may proceed from a variety of causes. If the mother has suffered fromsome malady which interferes with aeration of her own blood, just prior to parturition, the fetus must necessarily suffer in a somewhat simi- lar manner. For example, if a mare in advanced pregnancy is suffering from pneumonia, hydrothorax, or other disease which interferes with her respiration, the foal, during this diseased con- dition of the mother, necessarily suffers more or less for want of oxygen. If for auy reason the fetal placenta becomes detached from the maternal placenta before the fetus has sufficiently emerged from the genital tract to breathe, and parturition is in any way de- layed, asphyxia must necessarily result very quickly. Especially in the mare, where the adhesion between the fetal placenta and the uterus is very slight, the placenta may become partially or wholly detached before the fetus is expelled, and may even be expelled ahead of the fetus, causing in either case, a fatal asphyxiation. During parturition, if the fetus moves slowly through the birth canal, especially when in the posterior presentation, and the navel cord becomes tightly compressed between the wall of the fetal chest and the pelvis of the mother in a manner to interrupt the circulation, the delivery must be very quickly concluded or fatal asphyxia results. The navel cord may become entangled about one of the limbs or the head of the fetus, and the circula- tion thus be interrupted. In one instance of asphyxiation in pigs, we observed upon post-mortem examination a firm clot of mucus occluding the glottis and causing, immediately after birth, difficult respiration accompanied by dyspnceic sounds. It is only rarely that any efforts which the attending veteri- narian may be able to exert will successfully overcome suspended animation due to asphyxia of the new-born. Usually the asphyxia has proceeded too far before the extraction of the fetus, and any 1035 1036 Veterinary Obstetrics attempts at resuscitation will prove of noavail. If the heart still beats, there may be hope that the asphyxia can be overcome. The attendant should attempt to induce artificial respiration by such means as are at hand. In some cases, like those related above in the pig, there may be present in the larynx a clot of mucus, which should be removed. This mucus might be dis- lodged by drawing forcibly upon the tongue and then suddenly releasing it, and continuing this operation as long as may seem prudent. In the usual case of asphyxia, respiration may be favored by alternately compressing and relaxing the chest with the hands, or by extending the anterior limbs alternately forward and backward. It has been suggested that a tube might be passed through the nostril and larynx into the trachea, and amniotic or allantoic fluids drawn off which have beén inhaled prior to the expulsion of the fetus. Such suggestion is based upon anerror. If the fetus has inhaled amniotic fluid before its expulsion, it will be very quickly absorbed from the lungs and will cease to act as an impediment to respiration almost immediately, and consequently need not be taken into account in any measures for inducing artificial respiration. Suspending the asphyxiated young by the hind legs tends to stimulate respiration by inducing cerebral en- gorgement with venous blood, and incidentally any fluids in the lungs may freely escape. One of the most efficient means for inducing respiration is the alternating electric current, but unfortunately as a rule such ap- paratus is not at hand at the critical moment. In many instances a sharp blow upon the nose or other sensitive part tends to induce respiratory effort. It has also been suggested that dilation and irritation of the anus will tend’to produce inspiratory effort. In a similar manner one may stimulate efforts at breathing by dashing cold water upon the skin of the animal. It has also been suggested that respiration be stimulated by the inhalation of ammonia fumes; but the efficiency of this plan may well be doubted so long as no respiration is taking place, because the fumes cannot well be introduced into the nostril except with the aid of inspiration. It has also been advised that the lungs be inflated by means of bellows, applied to one nostril while the other is closed ; but this is not necessarily effective, because the larynx may be closed Umbilic Hemorrhage - 1037 and the lungs fail to become inflated. If one would be sure of the introduction of the air into the lungs, it would be best to in- troduce it into the trachea, and close the nostrils and mouth so that it could not escape in that way. In some cases, where the larynx seems to be occluded and it is impossible to induce free breathing through that organ, it might be well to perform tracheotomy, until whatever obstruction existing in the larynx may be removed. Ordinarily tracheotomy of the newborn involves great danger of tracheal collapse later, and is accordingly to be avoided as far as possible, and, instead, an incision made through the crico-thyroidean liagament large enough to admit the oper- ator’s finger 2. UMBILIC HEMORRHAGE. Umbilic hemorrhage in the new-born animal is very rare. We have not had occasion to observe this accident in any case, Under normal conditions, when the umbilic arteries rupture they retract within the abdominal cavity, as shown in Fig. 56, and in so doing withdraw with them, in an inverted manner, the con- nective tissue surrounding them, and thus form a net-work of fibers, which serves to cause the blood to coagulate and make hemorrhage extremelyimprobable. ‘The retraction of the arteries also causes a thickening of their walls, and a distinct decrease in their caliber, thereby so narrowing the lumen that it is exceed- ingly difficult for blood to escape from their divided ends. In addition to this, there is a general physiologic law that the blood pressure is decreased whenever the blood is no longer required by the tissues. Since the function of the umbilic arteries has ceased, the blood pressure within them becomes suddenly de- creased. Fleming states that hemorrhage may take place from these arteries in the foal, because they are firmly attached to the um- bilic ring. After repeated autopsies, we have failed to find an instance where such was the case, except the umbilic cord had been ligated, and the arteries thereby held so firmly that they could not retract. In addition to this, when the cord is ligated it is usually divided at an abnormal distance from the umbilic ring, so that its retraction is difficult. In all foals which we have examined, where the navel cord had been allowed to rupture normally, the arteries had promptly retracted to the 1038 Veterinary Obstetrics position shown in Fig. 56, on page 337. Fleming admits that this retraction of the artery takes place in the ruminant. The only difference, so far as we are able to observe, is that the cord of the ruminant is so short that it ruptures during birth, and ligation is consequently excluded. In the foal, the cord is very long and does not spontaneously rupture so promptly. It con- sequently affords an opportunity for mischief-making by at- tendants, who may so fix the arteries with a ligature that they cannot retract. Fleming claims that hemorrhage may occur from the umbilic vein in ruminants, because of the presence of the ductus venosus, although why this should predispose the animal to the accident is not made clear. Zundel claims that in some individuals a predisposition to umbilic hemorrhage exists. Fleming alludes to the possibility of hemorrhage occurring from the umbilic cord when the animal is several days old. Perhaps in this case he is dealing with secondary hemorrhage due to an infection of the artery, probably as-a result of ligation of the cord without proper antiseptic precautions. It is claimed also that hemor- rhage may be caused by the umbilic cord rupturing too close to the umbilic ring, though why this should be so does not appear. A neighboring veterinary practitioner related a case to us of fatal umbilic hemorrhage in a foal, in which case the cord had been ligated and later excised. So far as could be determined, it seemed that the hemorrhage was the indirect result of the liga- tion. The artery had been caught and held by the ligature, but, since it was not bound sufficiently tight to prevent hemor- rhage, remained stretched. The blood pressure was probably increased because of the ligation. Whatever the cause of umbilic hemorrhage, such cause needs be removed if possible, in order to control the escape of blood. If the cord is too long, and perchance has been ligated, it should be divided at the proper point by scraping or tearing. In the foal, the point for division is about two to three inches from the umbilic ring. After the division of the cord, the Whartonian gelatine is to be pressed out and the arteries permitted to retract into the abdominal cavity, when hemorrhage must necessarily cease. If for any reason the artery does not retract, it should be separated from the surrounding tissues and carefully ligated under antiseptic precautions. Should hemorrhage from the Persistent Uvrachus 1039 umbilic vein occur, it is advisable to search for the vessel and place a ligature about it. The ligation of the cord itself, as advised by some, is not sufficient, because the arteries or vein may not be included, as they may have broken at a point higher than that at which the ligature is applied. In such cases liga- tion would tend to favor, rather than prevent the hemorrhage, because it would simply prevent the blood from escaping from the amniotic covering of the cord, which has been converted into asac by the ligature, and must eventually become filled with blood, causing the ligature to be pushed off. In a general way we may best avoid umbilic hemorrhage by permitting the cord to rupture spontaneously, or by rupturing it at the proper point by linear tension, laceration or ecrasement. We should avoid dividing the cord by cutting. 3. PERSISTENT URACHUS. Prior to the birth of the young animal, in all those which have an allantoic sac, the urinary bladder has two openings, one posteriorly through the urethra into the amniotic cavity, and the other anteriorly through the umbilic ring and urachus into the cavity of the allantois. At the time of birth the narrow anterior canal, constituting a part of the umbilic cord, becomes ruptured, and under normal conditions behaves similarly to the umbilic arteries, and retracts with, or is retracted by the arteries, into the abdominal cavity. Thereafter the urine can escape only through the urethra. Some- what rarely the urachus remains open after birth; how rarely is not clear. Wehave not personally observed this condition. It is probably very rare. A more common condition is the re-opening of the urachus in cases of umbilic infection, owing to a destruction of the tissue which has occluded the ruptured end of the canal at the time of birth. This condition we have observed only in the foal. Flem- ing asserts that persistent urachus is most frequently observed in the foal, because the vessel is closely attached to the umbilic ring and does not become retracted. However, so far as we have observed, the urachus retracts promptly when the cord is ruptured, and does not protrude beyond the umbilicus except in those cases where the cord has been ligated and then excised. 1040 Veterinary Obstetrics Symptoms. The symptoms of perforate urachus may be divided into two groups, according to causes. 1. In cases where the urachus is for some reason abnormally open, or has become in some way abnormally divided, or if the meatus urinarius is constricted or absent, the young animal, in urinating, discharges a large part or all of the urine through the navel. If the urethra is closed, the entire amount must flow through the navel; while, if the normal passage is open, a part of the urine may flow from each opening. 2. When the urachus becomes secondarily re-opened, as a con- sequence of umbilic infection, the discharge of urine through the navel is not very great in amount, but dribbles away or flows in a very small stream during urination, and perhaps oozes some- what continuously from the navel, keeping the region soiled, moist and fetid. In such cases the navel is inflamed, and may be swollen, or the patient may show well-defined symptoms of pyo-septhzemia or inflammation of the umbilic vessels. In these cases the foal or other young animal has remained apparently well for some days after birth, and no discharge of urine from the navel has been noted during this period. After infection of the umbilicus takes place, perhaps three to five days after birth, the dribbling of urine from the navel appears. Thiscondition is by no means a rare one in foals, and in our observation has been most frequently seen when the cord has been ligated and cut long, causing the stump to undergo putrid decomposition and the urachus to re-open. Handling. The method.of handling pervious urachus must be based primarily upon its cause. If the opening is present at the time of birth, it must be regarded as a menace to the health of the patient, because it invites infection of the umbilicus by keeping the stump of the cord constantly moist and preventing its dessication. Ifitis due simply to an abnormally large or inefficient urachus, it may be closed by applying to the part dessicating and astringent antiseptics, which, at the same time, guard the umbilicus against infection. If the pervious urachus is dependent upon an imperforate urethra, the urachus must on no account be closed until the urethra has been satisfactorily opened, since otherwise a rupture of the bladder or other serious result must necessarily ensue. When the urachus becomes re-opened ‘as a consequence of Retention of the Meconium 1041 umbilic infection, its handling must necessarily be based upon disinfection of the part. If we can accomplish the disinfection by means of astringent remedies, we may aid materially in over- coming the difficulty. The prognosis in these cases must be based upon the severity of the umbilic infection, and follow the general prognosis of that malady. The prognosis of persistent urachus, in general, must be based upon its cause. If due to an imperforate urethra, the prognosis will be dependent upon the possibility of overcoming the urethral atresia. In one case, recently brought to our notice by a neigh- boring practitioner, the urachus was still open in a colt aged one year, and efforts to close it surgically, failed. RETENTION OF THE MECONIUM. During fetal life there accumulates, in the intestinal tube, a mixture of epithelial debris and secretions from the glands con- nected with the alimentary tract, especially from the liver, which excrement is largely retained within the alimentary canal until birth, though some of it is frequently found floating in the amni- otic fluid. The appearance of meconium, in color and consis- tency, varies somewhat according to species and individual. It usually varies in color between yellow and a dark green or greenish-black. In most new-born young, the meconium occurs as a pasty mass, but in the foal it is frequently hard and dry, and moulded into pellets by the floating colon and rectum. The mass is found chiefly in the rectum and floating colon, but may occupy the entire large colon and the ceecum. Since the meconium in most animals occurs in the form of a pasty mass, it is usually promptly expelled by the new-born without difficulty, and leads to no complications. In the foal, where it is hard and dry, it is not infrequently retained, and may induce more or less serious disease, which, if not promptly and efficiently handled, may lead to the death of the animal. Causes. Some claim that retention of the meconium usually occurs in foals which are weak or poorly developed, but this we have been unable to wholly corroborate, and have found it in foals which to all appearances were strong and vigorous at the time of birth, and would presumably have continued so had proper oversight been given them at the time. In our expe- 66 1042 Veterinary Obstetrics rience it has appeared that retention of the meconium is most common in foals whose. mothers have been kept continu- ously stabled and upon dry food prior to parturition. Mares which are regularly exercised, enjoy the freedom of the pasture, or are judiciously worked, as a general rule give birth to foals which do not have difficulty from retained meconium. It has been asserted that retention of the meconium is usually caused by the failure of the young animal to secure the colostrum or first milk, but this cannot properly be held, since the condition exists at the time the fetus is born, so that the colostrum could only act as a curative agent and not as a preventive. Symptoms. The symptoms of retention of the meconium appear very soon after birth, within 10 to 20 hours, but may be so slight as to escape observation by the owner until some time later. Usually within 24 hours after birth, very evident symp- toms of illness appear, consisting fundamentally of intermittent colic, with the general symptoms of impaction of the large colon. These consist chiefly of stretching, or standing in a position of extension, with the hind limbs extended far backward, the anterior limbs forward, and the back depressed much as if the animal were attempting to urinate; but the position differs from that attitude in that the hocks are not flexed and that there is no real effort being made to urinate. A close watch will, de- velop the fact that there is straining, as if to expel something from the abdominal cavity, but the impaction of the hard, dry meconium in the rectum prevents its walls from contracting, and hence the actions of the foal are wanting in the definite symptoms of an attempt at defecation. The colic present may be of any degree of severity. Usually it is quite mild at the beginning. The young animal will look at its flank and kick at the abdomen with its hind feet, will lie down and roll, and show a strong tendency to attempt to balance itself upon its back. After lying for some time it will get up, looking bright, and perhaps go to the teat and feed with an apparently normal appetite for a little time. It will then let go the teat and resume its stretched condition, perhaps standing in this attitude for 10 to 20 minutes at a time, occasionally looking somewhat anxiously at its flank ; it may then lie down and roll again. ‘Thus the symptoms may change more or less rapidly Retention of the Meconium 1043 between the stretching, or rolling as in colic, and the bright intervals when the foal again sucks. In one instance observed by us, in addition to these general symptoms there was a morbid appetite, which led the young foal to devour quantities of hay and straw, which added very much to the intestinal obstruction. The symptoms above related are characteristic, and in them- selves are well-nigh diagnostic, especially the peculiar stretching with the dropping of the back when the animal is standing. In almost all cases the diagnosis can be readily and completely veri- fied by inserting the index finger into the anus, where the hard pellets of meconium are readily felt and recognized. In foals, especiaily those of value, the caretaker should observe the new-born animal closely, and see that the meconium is ex- pelled within an hour. Should such expulsion not occur, the caretaker should at once take measures to bring it about. The best means for this is enemas of warm water, to which some soda bicarbonate or 1% of common salt has been added. Solutions of soap or other irritants should be carefully avoided, as they cause straining by the pain which they induce. It is not strain- ing that we wish to accomplish by the enema. Instead, it is de- sired to soften and macerate the dry pellets so that they will be easily expelled, and to this end it is important that only a small amount of a bland liquid shall be gently introduced into the rectum at a given time. We have usually found that one pint of the liquid at a time is ample, and sometimes even less should beused. The amount should be so gauged that the little patient will not throw it out immediately, but that it will remain in the rectum for some time in order to accomplish the maceration desired. Care should be taken, in administering enemas, to avoid in- juring the anus or rectum. It is especially desirable to avoid using a large metallic or wooden nozzle upon a syringe, because when the intestine is so firmly impacted with dry pellets of me- conium there is constant and serious danger of the rigid nozzle gliding to one side and rupturing the intestinal wall, inducing a fatal lesion. It is preferable to use some other apparatus than the ordinary enema syringe. A very convenient implement is the ordinary bulb syringe, or the fountain syringe used in house- holds. Sometimes it is desirable to introduce the enema deeply 1044 Veterinary Obstetrics into the intestine. For this purpose an ordinary soft rubber horse catheter may be passed into the intestine as far as possible, and the end fitted upon a syringe, or a small funnel may be in- serted into the catheter and elevated sufficiently that fluid poured into the funnel will gravitate into the intestine. If the catheter is used, it may be possible to pass it gently along the wall of the intestine, and, by keeping the fluid flowing through it, to push it beyond the pellets of meconium, so that the fluid is deposited behind them, insuring their being forced out at the first expulsive effort. In some cases we have supplanted the normal salt solution or soda bicarbonate solution with warm cot- ton seed, olive, or raw linseed, oil. Complementary to the enema it may be advisable to admin- ister cathartics. The choice of cathartics may vary with cir- cumstances. If the case does not seem at all urgent, a bland oil isthe best. An ordinary foal may be given 2 ounces of castor oil, or 4-ounce doses of raw linseed, cotton seed, or olive, oil. In other instances the practitioner may not feel disposed to await the slow action of oil, and may resort instead to the hypodermic cathartics in small doses, such as eserine sulphate or arecoline in doses of 1-20 to 1-12 grain, which may be repeated in 30 to 45 minutes. But with all this treatment, if the case has been neglected, it may be impossible to dislodge the pellets. They may be tightly impacted for a considerable distance along the rectum and float- ing colon. In one neglected case in our clinic, we could recog- nize the pellets of meconium, which completely blocked the rectum, at a distance of 12 inches from the anus. The hard pellets could be clearly felt with an ordinary gum horse catheter. The liquids injected directly against the obstruction were all to no purpose. Eserine failed to cause the expulsion of the meconium. The foal eventually perished, apparently from toxemia, since there was no enteritis present upon post-mortem examination. The conditions presenting themselves upon post-mortem examination, in this one case, suggested that, had we performed laparotomy and grasped the intestine, the pellets of meconium could have been pushed backward and finally forced out, or the intestine might have been opened and the pellets thus removed. But, in our experience, if the case has prompt attention no such opera- tion is demanded, and ordinarily the case is easily handled. Retention of the Meconium 1045 Some practitioners have devised and recommended meconium extractors, such as shown in Fig. 150, with which they have claimed good results. In default of these, a wire loop could be tried. We have observed but the one case which could not be relieved by enemas and oil. FIG. 150. a : MECONIUM EXTRACTORS. b O- a, Meconium extractor of Masch. ae b, Meconium extractor of Mensik- Babolna. In the handling of retention of the meconium, it is important always to determine when the difficulty has been fully and com- pletely surmounted. The expulsion of more or less meconium does not indicate that the difficulty has been completely overcome. The full accomplishment of the object has been only certainly attained when all the pellets have come away and there has been expelled some soft, pasty meconium. Whether looking at the affection from a preventive or a curative standpoint, our efforts should not be relaxed until we are fully assured that all pellets of meconium have been expelled. ANATOMICAL DEFECTS OF THE NEW-BORN. In tracing the history of the development of the embryo and fetus, we have had occasion to remark the occurrence of devia- tions from the normal course of development, which serve to render the animal abnormal at the time of birth. In many of these cases the aberration from the normal is so great as to cause what are known as monstrosities, in which case the young ani- mals are born so faultily developed that they usually perish im- mediately, or if they live, the deformity renders them useless, and they are consequently destroyed. The consideration of these belongs to the domain of teratology, and, as such, are of very great scientific interest. Quite frequently there exist, in new-born animals, various deviations from the normal, insufficient to immediately com- promise life, which may be spontaneously overcome, may be cur- able by surgical procedure, or may persist, and the animal yet be able to perform its functions without very great inconvenience. This group of minor deviations should be duly considered at the time of the birth, and handled according to the outlook for the ultimate value of the defective animal. It should be determined whether, by any means, the defect can be over- come, and to what extent its persistence will destroy the use- fulness of the animal. If it is irremediable, and its persistence destroys the value of the animal, it is highly important, in the interests of economy, that the patient should be at once destroyed. Still more important is the relation of these defects to the ques- tion of hereditary transmission. The majority of them tend strongly to become fixed as hereditary defects. Such animals showa constant tendency to reproduce their own defects in their progeny, even though artificially or spontaneously cured. Such animals are consequently unsuitable for breeding purposes. These defects accordingly assume a highly important place in the breeding of animals, whether viewed from the standpoint of surgery or of zodtechnics. ” 1. UMBILIC HERNIA. EXOMPHALUS. OMPHALOCELE. NAVEL HERNIA. Umbilic Hernia consists of the non-closure of the umbilic ring in the abdominal floor, while the skin closes over the region in 1046 Umbilic Hernia 1047 the normal manner. In tracing the development of the embryo on page 558, we noted that the somatopleur folds ventralwards and finally unites upon the median line, to constitute the um- bilicus, through which normally pass the allantoic stalk, in- cluding the allantoic or umbilic arteries and veins, the urachus, and the yolk stalk, surrounded by the amnion. During the earlier periods of fetal life, the abdominal cavity is comparatively small, while the abdominal viscera are so volu- minous that there is not sufficient room within the cavity to ac- commodate them. They consequently press, or grow outward through the wide umbilic ring into the navel cord, so that, in fetuses of an early age, a large part of the intestinal mass, omentum, and liver, may lie outside the abdominal cavity, lodged in the umbilic cord. As the fetus develops and approaches ma- turity, the abdominal cavity increases in size, while the umbilic ring gradually contracts, until finally the opening’ becomes virtually occluded and the margins of the ring adhere closely to the umbilic vessels. For reasons unknown to us, the normal closure of the umbilic ring may not occur, and when the young animal is born there persists a variable-sized opening through the abdominal floor, usually elongated from before to behind as an oval slit, wider at the anterior end. In some cases the open- ing is almost circular in form. The diameter of the opening may vary from so small a size as to be barely distinguishable, up to © six or eight inches. The resulting hernial sac corresponds in size. ‘The defect may be present in any species of domestic animals, though it attracts the most attention, and perhaps is most fre- quent, in foals, pigs and puppies. Some writers recognize a congenital and acquired umbilic hernia. Only the congenital defect is of interest tous. Some writers have claimed that an acquired or accidental umbilic hernia may be caused by severe muscular exertion of the new- born animal, in running or playing, but we find no records of cases in our literature to substantiate the correctness of such a view, and have not observed such an occurrence in actual practice. We have observed from time to time that umbilic hernize, which were comparatively inconspicuous at the time of the birth of the young animal, later became more conspicuous, and were in- creased in size to such a degree as to attract attention. When umbilic hernia exists at the time of the birth, anything which 1048 Veterinary Obstetrics may increase the intra-abdominal pressure, such as severe ex- pulsive efforts due to the retention of the meconium, or to con- stipation of the bowels, may cause a marked increase in the size of the hernial sac. ‘The same increase in size may be caused by the allowance of large quantities of bulky food. Fleming cites Zundel and others in support of his belief that environment, and especially the character of food, tends to in- duce the disease. He believes that the young of animals kept upon low and marshy pastures, or subsisting upon soft, luxuriant herbage during a rainy season, are especially subject to herniz. The majority of writers, with whom we are in full accord, consider the defect to be chiefly hereditary. We have repeatedly observed the strong hereditary tendency of this defect. In one instance a client purchased an imported French draft stallion for service in a valuable stud of pedigreed draft mares, in the progeny of which, umbilic hernia had previously been unknown. The first crop of foals showed about 50% of umbilic hernize. The stallion was promptly sold, and umbilic hernia did uot recur the following season or thereafter. We have noted the same heredi- tary tendency among swine, where a farmer has been careless in the selection of his breeding animals. In some cases we have observed an entire litter of pigs affected with herniz. It is in- teresting to note that, in the pig at least, umbilic and scrotal hernia seem to be interchangeable, so that, in a given litter of pigs, males may suffer from scrotal or umbilic hernia indiffer- ently, or even from both, while the females show only the umbilic defect. Symptoms. There is present, at the umbilicus, a tumor, which may be either spherical or pyriform or may be more or less elongated from before to behind. The size of the hernial ring varies greatly according to species and individual. In the puppy it may be % tor inch in diameter; in the foal 1 to 6 inches in diameter. The character of the tumor, as revealed by palpation, neces- sarily depends upon the contents of the hernial sac, and the question of their incarceration or freedom to return into the ab- dominal cavity. The contents of the hernial sac usually consist of portions of intestine containing liquid feces, or of portions of the omentum. Except these become incarcerated, a soft, fluctu- ating tumor results, which is usually readily pushed upward into Umbilic Hernia 1049 the abdominal cavity, rendering the hernial ring easily recog- nizable by palpation. Usually there is no pain upon pressure or manipulation. If the young animal is turned upon its back, the tumor usually disappears spontaneously. If the animal is caused to struggle, or its nostrils be closed for a time so as to catise severe respiratory effort, or it is made to cough, the hernia temporarily increases in size. In some cases the intestine occupying the hernial sac may contain hard, firm masses of feces, which render the hernia hard and firm. Such fecal matter is not readily pushed through the ring into the abdominal cavity. The contents of the hernia may become incarcerated or strangu- lated, and induce thereby symptoms differing very materially from those which have already been described. If the hernial contents consist of intestines, and strangulation occurs, the tumor at once becomes very tense and hard, and is more or less enlarged as compared with its previous condition, and the animal shows severe pain, expressed by violent colic. The hernia may also be sensitive to the touch. When the hernial contents consist of omentum, and it becomes incarcerated, the tumor becomes tense and indolent; cannot be reduced, and induces uo pain upon palpation. Diagnosis. Though umbilic hernia is not liable to become mistaken for other diseases, it should be borne in mind that there are possibilities of error in diagnosis. In one instance we at- tended an umbilic hernia complicated by the presence of umbilic fistula from infection at the time of birth. The enlargement present was attributed to the chronic infection alone. In opening the fistula we punctured the peritoneal wall of a small hernial sac, and caused a prolapse of the omentum. Abscesses may occur at the navel as a result of infection, and may lead to diag- nosis of hernia, but the abscess is irreducible, and may readily be tested, in cases of doubt, by aspirating with a hypodermic syringe. It is virtually impossible to differentiate between an uncompli- cated hernia of the intestines and hernia of the omentum ; nor is the differentiation of any great practical value. Strangulated umbilic hernia of the intestines is recognized by the hernial colic, the irreducibility of the hernia, and the firm, hard character of the tumor. Incarcerated umbilic hernia of the omentum, occur- 1050 Veterinary Obstetrics ring chiefly in pigs, “is recognized by the firm, irreducible tumor, unaccompanied by inflammation or pain. Prognosis. The prognosis of umbilic hernia is favorable. Many cases, especially small hernize in foals, recover spontane- ously, and the others may be surgically overcome with compara- tive certainty and safety. If left undisturbed, umbilic herniz rarely become incarcerated or otherwise interfere with the well- being of the animal. If the hernial ring is small, when the animal develops and the intestines increase in size, they can not pass through the opening. If the hernial contents consist of omen- tum, when the animal grows older, the omental expanse becomes comparatively retracted and no longer reaches the open umbilic ring. Although the ring may persist throughout the life of the animal, the hernial sac no longer becomes filled and is not notice- able. The greatest loss attributable to the defect, is the de- creased value of pedigreed animals for breeding purposes, because of the well-marked tendency to transmission. Treatment. Umbilic herniz in young animals disappear spontaneously so often that, in all cases where the hernial ring is very small, an opportunity should be given for a spontaneous recovery. However, when the hernial ring is large, such a re- sult cannot be reasonably anticipated, and it becomes desirable to use some means for overcoming the defect, except in those cases where the animals are intended for early slaughter, where handling may well be ignored in most instances. Before under- taking any operative treatment, it is desirable that the young animal shall have acquired some age and considerable vigor. It is generally preferable to postpone a radical operation until the animal is two to four months of age. However, it should not be too long delayed, because as the animal grows larger it is some- what more difficult to handle. When fatalities from an opera- tion occur, the loss becomes greater to the owner in proportion to the age of the animal. The chief plans of handling include : a. Bandages. Many writers have advised the application of a bandage or truss for the cure of umbilic hernia, apparently somewhat in imitation of the human surgeon. For this purpose a wide girth or surcingle is applied about the body, over the umbilic ring, and maintained in position by straps or bands. In a general way these bandages are similar to the Sohnle appara- tus, Fig. 149, page 1019. One or more straps pass forward Umbilic Hernia 1051 between the fore legs, and are attached to a band about the neck. Along the back, the position of the bandage is maintained by a back-strap, which extends forward to the neck-band, and back- ward to terminate in a crupper. Bandages or trusses are con- structed in great variety, but they all depend upon the common principle of compression of the umbilicus in such a manner as to push the intestines upward, toward or into the abdominal cavity, assuming that, in the meantime, the hernial ring will close and retain them there. Those who recommend a truss claim that it requires from two to three months to effect a cure. Even then it is not perfectly clear that a large proportion of the alleged cures may not have taken place spontaneously. It is to be constantly remembered that the truss or bandage cannot keep the intestine or other hernial contents within the abdominal cavity, but can only press them upward as far as the bandage pushes the walls of the hernial sac, leaving the hernial contents lying in the hernial ring. This tends to keep the ring open. If there is a projection upon the bandage, by which means the contents are pushed up into the abdominal cavity completely, the projecting portion of the ap- paratus is pushed into the hernial ring, and, in its turn, keeps it open and prevents healing. Serious objections to the truss are its expense, when well con- tructed, and the long period of time during which it must be kept applied in order that it may induce a cure. The apparatus requires much careful watching and oversight on the part of the owner of the animal, since it needs be readjusted frequently, be- cause the abdomen is constantly changing in size according to the amount of food taken. A very. formidable objection, also, is the question of injury and annoyance to the young animal. Its skin is tender, and great care is necessary to avoid galling and other injuries from pressure or friction. It must be constantly borne in mind that the veterinarian has no such opportunity for the efficient application of the truss as has the human obstetrist. The patient of the veterinarian either stands with the body horizontal, with the entire intestinal mass resting directly upon the hernial ring ; or, when lying down, it usually remains in the sternal position with the weight of the in- testines still upon the defective part. The human practitioner may keep his patient constantly upon the back, so that the ab- TO52 Veterinary Obstetrics dominal viscera do not bear upon the part. When the hernial ring is very large, hope of acure, through the agency of a band- age, is virtually excluded from the first. 6. Topical applications have been used for decades, for the cure of umbilic hernia. Various substances have been used for this purpose, among which may be prominently mentioned the application of the mineral acids, either sulphuric or nitric. The intent is to cause dry gangrene of the skin and hernial sac by the application of the acid thereto; and, by causing an intense local inflammation with much swelling, to induce closure of the hernial ring. For this purpose, sulphuric or nitric acid is applied over the hernial sac, by means of a glass rod, until the skin has been well saturated and an extensive necrosis of the tissues is assured. Prior to the application of the acid to the skin, the hernial sac may be shaved or clipped. The acid needs be applied quite lib- erally, in order that the death of the skin shall be complete and the resulting swelling extensive ; otherwise a cure is not certain, or even probable. Lafosse recommends the use of 24 to 32 grammes of nitric acid, applied over the whole surface of the hernial sac, followed by friction, to be continued for three to five minutes. The nitric acid usually needs be applied but once in order to produce the desired result, but, if the first application fails, it may. be reapplied in about 15 days. Zundel highly recommends this plan, although he admits that it is sometimes followed by accidents, the most serious of which is an extensive sloughing of the hernial walls, which finally in- volves the peritoneum and permits the intestines to become pro- lapsed through the opening. Reynal has seen peritonitis follow- ing nitric acid cauterization, and Lafosse has observed tetanus as a result. Hertwig prefers sulphuric to nitric acid, and applies it in lines with a glass rod, twice daily until four applications are made. He sometimes added an application of turpentine and oil to the part, inorder to increase the amount of swelling and edema. Other irritants have heen used and recommended in the treat- ment of this defect. Like the mineral acids, they are intended to induce an intense local inflammation and swelling, by which meansit is hoped to block up the open:umbilic ring. Blisters of various kinds act in this way. Some veterinarians have prac- ticed hypodermic injections into the walls of the hernial sac, near to the hernial ring, of irritants of various kinds, such as Umbilic Hernia 1053 oil of mustard, concentrated solutions of salt, and spirits of tur- pentine. Great care should be taken not to inject the irritants into the peritoneal cavity, as such an error would be exceedingly dangerous. c. Ligation. In umbilic hernia, where the ring is very large, there is little if any hope of succeeding by either of the previous methods. Consequently some method must be applied for bringing the margins of the hernial ring into close apposition, and retaining them in contact until they become adherent. This usually involves the destruction of the hernial sac. Numerous methods have been introduced for bringing this about, one of the oldest and crudest of which is the ligation of the entire hernial sac at its base, so tightly as to cause its death and sloughing away. Such a ligature, if well applied, decreases greatly or closes the hernial ring, by the tension exerted upon the walls of the hernial sac and the surrounding tissues. For the application of such a ligature, the patient is secured uponits back, and the hernial sac is firmly grasped. After the contents have been safely returned into the abdominal cavity, the sac is drawn up tightly, and the neighboring skin and skin muscle are brought together in such a manner asto tend todraw the margins of the umbilic ring nearer to each other. Then, around the base of the hernial sac, a stout ligature is tighty applied. The ligature may consist of a strong silk or linen cord, in harmony with the size of the hernia, or of an elastic ligature which may act more promptly than the others. Thelatter does not need tightening, because its elasticity causes a continuous compression until the tissues become des- troyed and the sac sloughs away. If there should appear to be any doubt about the security of the ligature, a suture or a skewer may be passed through the hernial sac below it, and any danger from its slipping thus obviated. The results from ligatures have not generally been satisfac- tory, and the method has largely fallen into disuse. They are uncertain in their action; they may cause a very tardy slough; the hernia may reform before the sac is completely destroyed ; or a very rapid necrosis may occur, resulting in prolapse. d. Clamps have been recommended very highly, by some practitioners, in the treatment of umbilic hernia. They do not differ materially, in their general character, from the clamps used in castration, and their application is upon a similar princi- 1054 Veterinary Obstetrics ple. Various types of clamps are listed by veterinary instru- ment makers, based upon the recommendation of practitioners who have used them and found them satisfactory; but no one possesses any special advantage, and the practitioner may readily make clamps from a stick of wood which will answer all essential purposes. The clamps are applied essentially the same as the ligature. The animal is secured upon its back; the contents of the hernial sac returned into the abdomen; the sac firmly grasped ; and the clamps applied antero-posteriorly, as close to the abdomen as possible, and fixed very tightly so as to cut off the circulation from the sac and cause its death. Two dangers confront the practitioner in the use of clamps. Some have found that, as with the ligature, the clamps may cause a very rapid gangrene, with consequent early sloughing and protrusion of the intestines. In our own experience we have found the clamps inefficient. After having applied them as close to the abdominal floor as possible, and secured them very tightly, we succeeded in producing necrosis and the destruction of the entire hernial sac. However, while this was going on the intes- tines were constantly pressing through the hernial ring, so that, when the sac, which had been included between the clamps, had completely sloughed off, it was found, to our disappointment, that the weight of the intestines from above had pushed the skin down- ward and a new hernial sac had formed, which, though somewhat less in size, was just as objectionable as the original defect and required further surgical attention. If clamps are to be applied, the operation should be carried out under antiseptic precautions, the area shaved and disinfected, and either general or local anesthesia induced. The hernial sac is to be grasped, drawn out as far as possible, and the clamps applied close to the ring, including all the tissues which can be drawn into them. The clamps are then to be closed by means of forceps, and secured with a cord. An abundance of antiseptic cotton or gauze is then to be packed about the clamps and over the in- carcerated sac, and over this a strong bandage is to be placed, and well secured in position in such a manner that it will hold the clamps tightly against the umbilic ring. By so doing, the hernial sac is held against the ring, and the inflammation caused by the necrosis of the sac induces inflammatory adhesion and closure of the hernial ring. Umbilic Hernia 1055 Strict antisepsisshould be maintained, and the necrotic hernial sac prevented from decomposing or becoming harmfully infected. Usually the necrotic sac drops away within seven to ten days. The atresia of the hernial ring may be furthered and rendered more secure by the continuance of the supporting antiseptic bandage for a few days after the necrotic sac has dropped away. e. Sutures constitute the most radical, and, in our hands, the most satisfactory method for handling umbilic hernia. The sutures may be applied by a great variety of methods. In very large hernize it is best to open the hernial sac freely, under general anaesthesia and strict asepsis, and, after denuding the margins of the hernial ring, to pass strong sutures through the margins of the ring and forcibly draw them together. In one instance in our clinic, a yearling filly had an umbilic hernia, the oblong ring of which measured approximately 4 by 8 inches. The animal was secured in the dorsal position upon the table, and anesthetized. With the aid of two assistants, the hernial sac was opened from end to end under strict aseptic precau- tions. By means of a strong needle, sutures were passed through the skin and other tissues into the muscular walls of the abdo- men, and then carried across from one margin of the ring to the point opposite, where they were finally brought out through the skin on the opposite side, some distance from the margin of the hernial ring. The suture was then returned in the opposite di- rection, at a distance of about % inch, a piece of rubber tubing passed between the closed end and the skin, and a second piece of tubing laid between the two free ends, which were now tied and drawn sufficiently tight to bring the two margins of the ring into immediate contact. A series of these sutures was applied, sufficient in number to thoroughly close the entire hernial ring from end to end, thus constituting essentially a quilled suture. The hernial sac was excised, and the margins of the skin brought together by ordi- nary interrupted sutures. A broad bandage was then passed around the body of the filly, and a large antiseptic pad securely attached to it, pressing upon the operative area. The pad of absorbent cotton was saturated several times daily with 1-1000 corrosive sublimate solution. There was little reaction from the operation, and the suppuration in the wound was trivial in 1056 Veterinary Obstetrics amount. After about two weeks the sutures were removed, and the animal was discharged, completely cured. In other cases, where the hernia was not so large, we have operated by cutting a hole into the hernial sac, through which an index fingeris passed in order to constitute a guide and insur- ance against the wounding of the viscera. A heavy needle, armed with a strong suture, is then inserted into the skin at a distance of two or more inches to the right or left of the margin of the hernial ring, and carefully guided through the abdominal mus- cles of the one side, and across the hernial ring, to penetrate the abdominal muscles on the other side of the ring, and through the skin, to emerge some distance from the hernial ring. The needle is then reversed, and thence returned at a distance of about % inch from the point of beginning, where the two ends are tied as in the preceding case. Other sutures are added until the ring is completely closed, as determined by digital examination. In small umbilic hernize a modification of this suture has been used by us, with very satisfactory results. The animal is secured upon its back, and the area is shaved and disinfected. The hernial contents are returned into the abdomen, and the hernial sac grasped with one hand and drawn out as far as possible. The hernial sac is then firmly grasped from side to side, between the thumb on one side and the fingers on the other,and the walls brought tightly together. In small herniz, if as much as possi- ble of the skin on either side is grasped in this manner, and the two sides brought together, the operation also draws the margins of the hernial ring together. A needle armed with a heavy silk suture is inserted immediately against the thumb and finger, be- tween them and the abdominal floor, soas to avoid any danger of wounding the intestine, and is forced through to the opposite side as shown in Fig. 151 A. Grasping the hernial sac anew, and reversing the needle and inserting it about 4% inch from its point of emergence, the operator carries it back to the opposite side parallel to the first suture, and ties the two ends together, as indicated in Fig. 151 B, so tightly as to close the hernial ring. A second suture is now inserted in the same way, at a point about 1% inch distant from the first, and the series of sutures is coutinued untila sufficient number have been inserted to prevent the escape of the hernial contents between or beyond the sutures. Care is to be taken that at either end the sutures extend beyond Umbilic Hernia 1057 the hernial ring, including all of the hernial sac, thus excluding the possibility of the intestine slipping out from behind or in front of the sutures. By this method the hernial sac does not become necrotic, and is not destroyed if the operation has been carried out under strict antiseptic precautions. Under this plan, Fic. 151. DIAGRAMMATIC ILLUSTRATION OF SUTURES FOR UMBILIC HERNIA. A, Cross section through the herniai ring and sac, showing relations of su- ture to hernial parts. 1, Peritoneum ; 2, Muscles of abdominal floor ; 3, Skin and subcutaneous tissues ; 4, Suture ; 5, Hernial opening. B, Diagram of hernial ring viewed from below, with hernial sac cut away to show plan of sutures, 1, Hernial ring; 2, Margin of the skin where hernial sac has been cut away ; 3, 3, Areas between the sutures in which the hernial sac is not strangulated ; 4, 4, 4, Areas in hernial sac which are included in the sutures but which still receive a vascular supply from areas 3, 3. according to our experience, the hernial ring closes more surely than with strangulation and necrosis of the hernial sac, and any risk from rapid or extensive sloughing is excluded. A broad, many-tailed bandage is applied around the body, and an antiseptic pack is applied over the operative area and repeatedly saturated with antiseptics until danger from infection has passed. The bandage is kept in place for five or six days, and the sutures are left in position for three weeks or longer, when they are to be 67 1058 Veterinary Obstetrics removed. The hernial sac remains as an empty pouch, but after a time this tends to disappear spontaneously, or may be clipped off. Others apply sutures in such a way as to constitute essentially a multiple incarcerating ligature, causing the entire hernial sac to become necrotic and slough away. ‘This plan has little if any advantage over the simple ligature. Ligatures, clamps and sutures have the common danger of in- fection, which should be avoided by the application of strict anti- sepsis. While it is essential that strict precautions be taken pre- liminary to and during the operation, it is just as important that the resulting wound be handled according to antiseptic methods. Thus, whether we use the ligature, clamps or sutures, an antiseptic dressing should be applied to the area of operation, and the part should be maintained in an antiseptic state from the completion of the operation until danger from infection has been safely passed, which is usually after about one week. When an intestinal umbilic hernia becomes strangulated, radi- cal measures should at once be taken to bring about acure. It is first essential to relieve the strangulation, which may be done in some cases by securing the animal upon its back and carefully manipulating the hernial contents, so that they may be pressed back into the abdominal cavity. This process may be greatly favored by general anaesthesia. If the contents of the intestines are liquid, the incarceration may be overcome by aspirating por- tions of the fluid contents by means of a hypodermic syringe ora small trocar, after which the prolapsed intestines may usually be readily returned. If these measures fail, the hernia should be cut down upon, the ring dilated by cutting, the strangulated viscera returned, and the margins of the hernial ring brought together by sutures, such as we have described above. When there exists a hernia consisting of omentum, and it be- comes incarcerated, the death of the strangulated portion pro- duces no general symptoms, but the hernial tumor becomes rather hard and unyielding. By such means, the hernia becomes sponta- neously obliterated, but the tumor remains. ‘This condition we have observed in several instances in the pig. The condition is not a serious one, and its only significance is the blemish, which can readily be removed by opening the hernial sac and excising the necrotic omentum, after which the ring and sac are to be closed under antiseptic precautions. Scrotal Hernia. Inguinal Hernia 1059 2. SCROTAL HERNIA. INGUINAL HERNIA. Scrotal or inguinal hernia may exist in any new-born domes- tic animal, perhaps most frequently in the foal and pig, rarely in ruminants and carnivora. Inguinal hernia is virtually a defect of the male, though very rarely it exists in the female. As shown in Fig. 57, page 338, there exists, early in fetal life, the internal inguinal or abdominal ring, through which passes the guberna- culum testis from the scrotum to the testicle. Later, as the male animal develops, there occurs an evagination of the peritoneum, the processus vaginalis, through the inguinal ring into the scrotal pouch, and the testicle ultimately descends, until finally the evagi- nated portion of the peritoneum forms the external or parietal layer of the scrotal peritoneum. As already related on page 336, the descent of the testicle occurs at a variable period of time, controlled largely by species. In solipeds and ruminants, as well as in swine, the glands are usually in the scrotum at the time of the birth of the young animal. In some cases the inguinal ring in the fetus is abnor- mally large, and the intra-abominal pressure during early fetal life may cause portions of the viscera to be forced out through the ring, and, remaining there, prevent the latter from normally closing, or narrowing to such a degree as to prevent the escape of viscera from the abdominal cavity. In all domestic animals, the inguinal ring normally remains pervious throughout life, and consequently inguinal hernia does not depend upon the abnormal existence of an opening, but merely upon its abnormal size. In new-born foals, especially among the draft breeds, scrotal hernia is very common at birth, but is usually of a temporary character, and spontaneously disappears. However, this does not always occur, and in some instances the internal inguinal ring is excessively large, so that portions of viscera protrude through it, which, by their weight, tend to render the abnormal dilation of the ring permanent and to cause the hernia to persist throughout the life of the animal unless surgically handled. In the pig, scrotal hernia is quite common, and usually tends to re- main permanent unless surgical interference takes place. The size of the hernial ring shows every possible variation. We have observed, in the foal, an internal ring four or five inches in diameter, through which virtually all the abdominal viscera, 1060 Veterinary Obstetrics whieh were not too closely retained by mesentery, dropped out into the hernial sac, descending to the level of the hocks. Such conditions inevitably persist unless surgical relief is applied, and the size of the hernia tends to grow, rather than decrease. It is not rare to see a stallion with a scrotal hernia extending down to the hocks, and with the internal ring so large that the veterinarian may pass his hand through the rectum, into and through the hernial ring, covered by the intestine, and down into the scrotal sac. ‘The contents of the hernial sac may consist of either in- testine or omentum. The symptoms of scrotal hernia in the new-born are usually very apparent, and consist essentially of an increased size of one or both halves of the scrotum. Upon manipulation, it is usually found that the herniated intestine or omentum can be readily re- turned into the abdominal cavity, especially if the patient is placed upon its back. After the contents have been returned, the enlarged ring can be discovered by digital exploration. Strangulation, orincarceration, of scrotal hernia is very rare in new-born animals. We have noted but one instance ina young animal, which occurred in a foal, some weeks of age. When strangulation occurs, the ordinary symptoms of strangulated hernia appear, consisting of severe and constant colic, with sweating and trembling. The volume of the hernial contents is increased ; the sac is tense, firm and painful. The course and termination of scrotal hernia vary, according to species and the size of the hernial ring. In most animals scrotal hernia tends to persist, and to increase rather than de- crease in size, as the patient grows older. In the foal, when the scrotal hernia is small, it tends to disappear spontaneously with age. In probably 90%, or even more, of foals born with scrotal hernia, the defect becomes spontaneously remedied, so far that they may be safely castrated by the open operation when one year old. The contents of scrotal hernia very rarely, if ever, become adherent, except because of some ineffectual surgical handling. The defect is markedly hereditary, and its existence in the young animal serves to render it of diminished value for breed- ing purposes. In the foal, it has yet another significance, from a clinical standpoint, in that, even though the defect may be apparently overcome in a spontaneous manner, it may yet Scrotal Hernia. Inguinal Hernia 1061 lead to serious or fatal accident in later life. If such an animal is castrated after apparent recovery, without unusual precautions having been taken, protrusion of the omentum, or still worse, of the intestine, is liable to occur, and lead to serious or fatal re- sults. If the animal is retained for breeding purposes, it may, at any time after reaching adult life, suddenly develop strangu- lated hernia, owing to some accident or exertion which may cause a sudden increase of the intra-abdominal pressure, such as jumping, rearing, or copulating with a mare. Handling. Since scrotal hernia in the foal usually recovers spontaneously during the first year, a reasonable opportunity for such recovery should be advised. If, however, the hernia is very large or tends constantly to increase in size, or if it threatens to become strangulated, a radical operation for its cure should not be long delayed. The new-born foal is usually wanting in the desired vigor to withstand such an operation, and whenever practicable the veterinarian should postpone surgical interference until the foal has acquired strength and the tissues have de- veloped increased powers of resistance. The surgical handling of scrotal hernia consists essentially of the removal of the testicle, and the closure of the ring or of the inguinal canal. The most common and preferable operation is that of ‘‘covered’’ castration. The animal is cast and turned upon its back. In case of the foal, general anaesthesia should be induced. Under thorough antiseptic precautions, the skin and dartos are incised down to the cremasteric fascia. The testicle is grasped, inclosed within the cremasteric fascia and peritoneum, and traction exerted upon it, while the dartos is separated from the cremasteric fascia and muscle by means of the fingers or scalpel handle. The separation is carried upwards to and beyond the external abdominal ring. In this manner the two groups of tissues of the scrotum are separated from each other. The skin and dartos derived fromthe external body wall, are separated from the cremaster and peritoneum, which have been carried down from the abdominal cavity with the testicle in its descent. A curved needle, armed with sterilized silk, is passed through the cremaster and spermatic cord, as high upagainst the internal ring as is practicable. After the needle has been removed, the 1062 Veterinary Obstetrics ligature is tied tightly around the entire cord. Having been passed through the cord, the ligature is insured against slipping. While catgut presents the advantage of being absorbed by the tissues, its use is excluded in this operation because it quickly softens and relaxes to such a degree as to permit hemorrhage from the spermatic arteries, or the ligature slips and prolapse of the intestine or mesentery occurs. In one case, where we ligated carefully with catgut, severe and dangerous hemorrhage occurred, although the ligature remained in position. “The cord had to be later ligated with strong silk in order to save the patient’s life. After the ligature has been securely placed about the parts, the ligated tissues may be severed with a scalpel, or preferably with scissors, at a distance of not less than 1 inch beyond the point of ligation. Great care should always be taken to leave a sufh- ciently long stump. The pressure of intestines or omentum above tends to pull a portion of the ligated inguinal wall out of the ligature, even though it has been passed through the cord and investing tissues. If the hernial ring is comparatively small, the wound through the skin and dartos may be allowed to remain open, but we be- lieve such a course inadvisable, and would recommend the closing of the scrotal wound by means of sutures. If the ring is very capacious, and the hernia very large, the cremaster muscle may be so much attenuated that it does not offer sufficient strength to render the maintenance of the weight of the viscera secure against prolapse of the intestine. In order to guard against this, it is essential that the scrotal wound be closed. If the sac is very large, the ligation of the cremaster and peritoneum, and the suturing of the wound of the skin and dartos, may not prevent the intestinal mass from breaking through to constitute prolapse. Asa further guard against the descent of the viscera, a portion of the scrotal sac may be removed, after which the suturing of the margins of the wound stretches the skin across the external abdominal ring and exerts some pressure upon the parts. This pressure may be accentuated, and rendered far more efficient, by inserting into the external abdominal ring, against the ligated stump of the cord and excised cremaster, a large mass of anti- septic gauze, so that, when the skin and dartos are brought to- gether and sutured over it, a distinct pressure and support is obtained. Other means for insuring ample pressure upon the Imperforate Anus > 1063 part may be used. The skin from the inguinal region may be drawn down tightly over the external ring, and sutures passed through it and the internal and anterior margins of the ring, so that the skin and dartos are thus firmly fixed to the deeper parts, and the external abdominal ring virtually closed. Or, with heavy silk, the margins of the external abdominal ring may be brought together. The operation upon the pig is carried out in a similar manner. The position of the scrotum in the pig renders it less difficult to retain the intestines within the abdominal cawity. After the performance of the operation, the patient should be allowed quiet and clean quarters. In the case of the foal, the parts should be disinfected several times daily, but otherwise should go undisturbed except in those cases where a pack of gauze or other material has been inserted, as above recommended, which should be removed in the course of 48 hours, when a sufh- cient swelling will have taken place in the part to prevent the prolapse of the intestine. Fora time the animal should be fed very lightly, in order to avoid distension of the abdominal cavity and unnecessary pressure upon the parts. Should the ligature about the cord become infected, a fistulous opening may result, and necessitate cutting down upon the cord at a later date, and re- moval of the ligature. Sometimes the ligature infection takes the form of botryomycosis or schirrhous cord, and necessitates the re- moval of the diseased cord. The age at which scrotal hernize should be operated upor. will vary according to circumstances. In the foal, unless there is some reason to the contrary, such as strangulation, or growth of the hernia, it should be postponed until the patient is eight to twelve weeks old, but it may be performed at any age when cir- cumstances may demand it. In the pig there is little, if any- thing, to be gained by delay; and the animal may as well be operated upon at the usual age of castration. 3. IMPERFORATE ANUS. In considering the development of the embryo, we have learned, on page 310, that at an early period in its history the posterior gut ends blindly, and, opposite to it upon the external surface, there appears a depression in the ectoderm known as the proctodeal pit, which gradually becomes deeper while the wall be- 1064 Veterinary Obstetrics tween it and the end of the gut becomes more and more attenu- ated, until finally it disappears and the gut opens posteriorly as the anus. In some cases the attenuation and disappearance of the walls of the proctodeal pit fail to occur, and as a result the young animal is born with an imperforate anus. In other cases, not only is there an arrest of the development inthis part, but the entire posterior gut, or any portion of it, may fail to form or may become obliterated early, so that there is an absence of both thé anus and the rectum. The diagnosis of imperforate anus is comparatively simple, since it depends upon the absence of that organ. Upon examin- ation no posterior opening of the gut is discoverable. If only the anus fails, the meconium may be pushed back against the thin membrane, to form a tumor in the anal region ; while, if the rectum itself is absent, no such tumor occurs. The handling of imperforate anus consists of making an in- cision through the skin of the part, down upon the accumulated meconium. If the rectum is absent, so that the accumulation of meconium in the anal region does not occur, the animal should be destroyed as valueless. In some instances in new-born females, there occurs an imper- forate anus, accompanied by an imperfect vulvo-anal partition, and the feces drop downward into the vulva through the defect- ive partition, and escape therefrom involuntarily. Such a case is illustrated in Fig. 42 on page 310. It may possibly be overcome by inserting the finger or a curved sound through the vulva up into the anus, and, directing it backward, cutting down in the anal region until the wall is perforated. The communication between the anus and vulva may then be denuded of its mucous membrane, and closed by sutures. However, because of the difficulty of bringing about the closure of an opening in this place, it would be better as a rule to destroy the young animal, unless it is of unusual value for work purposes. An animal with such a defect should not be used for breeding. 4. IMPERFORATE VULVA. Imperforate vulva is fundamentally referable to the same cause as we have already described as operating in imperforate anus. The vulva is formed in the same manner as the anus, that is, it originates from the lower portion of the proctodeal pit. The Atresia of the Posterior Nares 1065 atresia or closure may not end with the vulva, but may include other parts of the urino-genital canal. If the vulva is com- pletely closed, it prevents the discharge of urine through the normal channel, and forces it to continue to pass through the urachus. The handling of imperforate vulva cannot as a rule be suc- cessful, because it is difficult or impossible to discover the urethra and open it in a manner which will prove effective. The animal may continue to live indefinitely with an open urachus, but is of no value. When the vulva is only partially closed, and there is room for urine to escape readily, there is no occasion for surgical interference. Asa general rule, such partial atresia or absence of the vulva in reality depends upon an asexual state, as is observed in freemartins, so that the animal is incapable of breeding. Consequently, there is no object to be gained by any surgical attempt at dilating the vulva. 5. ATRESIA OF THE POSTERIOR NARES. In studying the development of the embryo on page 296, we noted that the nasal and oral cavities are at first one common chamber, which later becomes divided into two separate passages by the lateral ingrowth and fusion of the palatine plates, which eventually become ossified throughout most of their extent, to constitute the hard palate. In some cases it is found that this partition between the nasal and oral cavities continues backward to the base of the sphenoid bone, thus causing a more or less complete atresia of the posterior nares. The defect has been re- corded in man and in the horse. When involving but one nostril, the defect may escape detection, because, unless the young animal is caused to undergo severe exertion, the one free nostril answers all demands for respiration and no inconvenience ensues. If both posterior nares should be occluded, severe dyspncea re- sults, and oral breathing becomes necessary. When an animal, with atresia of one posterior naris, arrives at a working age, and is put to heavy draft or rapid travel, the de- fective respiratory passage becomes at once evident, and a dis- tinct roaring noise is present. In one case existing in a three- year-old in our clinic, there were no external evidences of dis- ease, such as bulging or inequality of the face, no nasal dis- 1066 Veterinary Obstetrics charge, no abnormal odor. One posterior naris was completely closed, and consequently there was unilateral breathing.