Chapter XII: Part 12

Fig. 1. Long embryotome with joint.

Fig. 2. Long, sharp hook. This instrument is about 3 feet in length, including the handle. Hooks of this kind, both blunt and sharp, are applied directly to the fetus to assist in delivery.

Fig. 3. G¸nther's long-handled embryotome. This instrument and that represented in Fig. 1 are of special value in cutting through muscular tissue and in separating the limbs from the trunk when the fetus can not be removed entire. These embryotomes are usually 30 inches long, but may be made either longer or shorter.

Fig. 4. Jointed cord-carrier, used in difficult parturition to carry a cord into regions which can not be reached by the arm.

Fig. 5. Instrument used to rotate or turn the fetus, known as a rotator.

Fig. 6. Dilator of the neck of the womb, used when conception can not take place owing to a contracted condition of the neck of the womb.

Fig. 7. Repeller. An instrument from 2 to 3 feet long, used to force the fetus forward into the womb. This operation is generally necessary when the presentation is abnormal and the fetus has advanced too far into the narrow inlet to the uterus to be moved.

Fig. 8. Cartwright's bone chisel. Including the handle, this instrument is about 32 inches in length; the chisel portion is a little more than 2 inches long and 1 to 1-1/2 broad. Only the middle portion is sharp, the projecting corners are blunt, and the sides rounded. This instrument is used for slitting up the skin of a limb and as a bone chisel when it is necessary to mutilate the fetus in order to effect delivery.

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PLATE XXI. Instruments used in difficult labor.

Fig. 1. Embryotome, an instrument used when it is necessary to reduce the size of the fetus by cutting away certain parts before birth can be effected. This instrument may be long or short, straight or curved.

Fig. 2. Also an embryotome. The blade can be made to slide out of or into the handle. The instrument can thus be introduced into or withdrawn from the genital passage without risk of injury to the mother.

Fig. 3. Schaack's traction cord. This is merely a cord with a running noose at one end and a piece of wood at the other, to offer a better hold for the hand.

Figs. 4_a_ and 4_b._ Reuff's head collar for securing the head of the fetus.

Fig. 5. Curved cord-carrier, used in difficult parturition to carry a cord into regions which can not be reached by the arm.

Fig. 6. Blunt hook, used in difficult parturition.

Fig. 7. Short hook forceps, used in difficult parturition.

Fig. 8. Blunt finger hook.

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DISEASES FOLLOWING PARTURITION.

By James Law, F. R. C. V. S.,

_Formerly Professor of Veterinary Science, etc., in Cornell University._

FLOODING (BLEEDING FROM THE WOMB).

Though not so common in the cow as in the human female, flooding is sufficiently frequent to demand attention. It may depend on a too rapid calving and a consequent failure of the womb to contract when the calf has been removed. The pregnant womb is extraordinarily rich in blood vessels, especially in large and tortuous veins, which become compressed and almost obliterated under contraction, but remain overfilled and often bleed into the cavity of the womb should no contraction take place. Cox records cases in which the labor pains had detached and expelled the fetal membranes, while the calf, owing to large size or wrong presentation, was detained in the womb, and the continued dilatation of the womb in the absence of the fetal membranes led to a flow of blood which accumulated in clots around the calf. Other causes are laceration of the cotyledons of the womb, or from an antecedent inflammation of the placenta, and the unnatural adhesion of the membranes to the womb, which bleeds when the two are torn apart. Weakness of the womb from overdistention, as in dropsy, twins, etc., is not without its influence. Finally, eversion of the womb (casting the withers) is an occasional cause of flooding. The trouble is only too evident when the blood flows from the external passages in drops or in a fine stream. When it is retained in the cavity of the womb, however, it may remain unsuspected until it has rendered the animal almost bloodless. The symptoms in such case are paleness of the eyes, nose, mouth, and of the lips of the vulva, a weak, rapid pulse, violent and perhaps loud beating of the heart (palpitations), sunken, staring eyes, coldness of the skin, ears, horns, and limbs, perspiration, weakness in standing, staggering gait, and, finally, inability to rise, and death in convulsions. If these symptoms are seen, the oiled hand should be introduced into the womb, which will be found open and flaccid and containing large blood clots.

_Treatment._--Treatment consists in the removal of the fetal membranes and blood clots from the womb (which will not contract while they are present), the dashing of cold water on the loins, right flank, and vulva, and if these measures fail, the injection of cold water into the womb through a rubber tube furnished with a funnel. In obstinate cases a good-sized sponge soaked in tincture of muriate of iron should be introduced into the womb and firmly squeezed, so as to bring the iron into contact with the bleeding surface. This is at once an astringent and a coagulant for the blood, besides stimulating the womb to contraction. In the absence of this agent astringents (solution of copperas, alum, tannic acid, or acetate of lead) may be thrown into the womb, and one-half-dram doses of acetate of lead may be given by the mouth, or 1 ounce powdered ergot of rye may be given in gruel. When nothing else is at hand, an injection of oil of turpentine will sometimes promptly check the bleeding.

EVERSION OF THE WOMB (CASTING THE WITHERS).

Like flooding, this is the result of failure of the womb to contract after calving. If that organ contracts naturally, the afterbirth is expelled, the internal cavity of the womb is nearly closed, and the mouth of the organ becomes so narrow that the hand can not be forced through, much less the whole mass of the matrix. When, however, it fails to contract, the closed end of one of the horns may fall into its open internal cavity, and under the compression of the adjacent intestines, and the straining and contraction of the abdominal walls, it is forced farther and farther, until the whole organ is turned outside in, slides back through the vagina, and hangs from the vulva. The womb can be instantly distinguished from the protruding vagina or bladder by the presence, over its whole surface, of 50 to 100 mushroomlike bodies (cotyledons), each 2 to 3 inches in diameter, and attached by a narrow neck. (Pls. XII, XIII.) When fully everted, it is further recognizable by a large, undivided body hanging from the vulva, and two horns or divisions which hang down toward the hocks. In the imperfect eversions the body of the womb may be present with two depressions leading into the two horns. In the cases of some standing the organ has become inflamed and gorged with blood until it is as large as a bushel basket, its surface has a dark-red, bloodlike hue, and tears and bleeds on the slightest touch. Still later lacerations, raw sores, and even gangrene are shown in the mass. At the moment of protrusion the general health is not altered, but soon the inflammation and fever with the violent and continued straining induce exhaustion, and the cow lies down, making no attempt to rise.

_Treatment._--Treatment varies somewhat, according to the degree of the eversion. In partial eversion, with the womb protruding only slightly from the vulva and the cow standing, let an assistant pinch the back to prevent straining while the operator pushes his closed fist into the center of the mass and carries it back through the vagina, assisting in returning the surrounding parts by the other hand. In more complete eversion, but with the womb as yet of its natural bulk and consistency and the cow standing, straining being checked by pinching the back, a sheet is held by two men so as to sustain the everted womb and raise it to the level of the vulva. It is now sponged clean with cold water, the cold being useful in driving out the blood and reducing the bulk, and finally it may be sponged over with laudanum or with a weak solution of carbolic acid (1 dram to 1 quart water).

The closed fist may now be planted in the rounded end of the largest horn and pushed on so as to turn it back within itself and carry it on through the vagina, the other hand being used meanwhile to assist in the inversion and in pushing the different masses in succession within the lips of the vulva. In case of failure, resort should be had at once to a plan which I have successfully followed for many years. Take a long linen or cotton bandage, 5 or 6 inches wide, and wind it around the protruding womb as tightly as it can be drawn, beginning at the free end and gradually covering the entire mass up to the vulva. By this means the greater part of the blood will be forced out of the organ and its bulk greatly reduced, so that its reduction is much facilitated. An additional advantage is found in the protection given to the womb by its investing bandage while it is being pushed forward into the vagina and abdomen. In manipulating the exposed womb there is always danger of laceration, but when the organ is covered with a sheet it is next to impossible to tear it. The subsequent manipulation is as in the other case, by pushing the blind end forward within itself with the closed fist and carrying this on through the vagina into the abdomen with the constant assistance of the other hand. Often it will be found convenient to use the edge of the left hand to push the outer part of the protruding mass inside the lips of the vulva, while the right hand and arm are carrying the central portions forward through the vagina. An intelligent assistant, pushing with the palms of both hands on the outer portion of the mass, will also afford material assistance. As the womb is turned within itself the wrapping bandage will gradually loosen, but once the great mass has entered the passages it is easy to compel the rest to follow, and the compression by the bandage is no longer so important. When the womb is fully replaced the bandage is left in its interior in a series of loose folds, and can be easily withdrawn. It is well to move the hand from side to side to insure that the two horns of the womb are fully extended and on about the same level before withdrawing the arm and applying a truss.

When the womb has been long everted and is gorged with blood, inflamed, and friable there is often the additional disadvantage that the animal is unable or unwilling to rise. When lying down the straining can not be controlled so effectually, and, even in the absence of straining, the compression of the belly is so great as to prove a serious obstacle to reduction. The straining may be checked by 2 or 3 ounces of laudanum or 2 ounces of chloral hydrate, or by inhalation of chloroform to insensibility, and then by raising the hind parts on straw bundles the gravitation of the abdominal organs forward may be made to lessen the resistance. If not successful in this way, the cow may be further turned on her back, and if return is still impossible, the hind limbs may be tied together and drawn up to a beam overhead by the aid of a pulley. In this position, in place of the pressure backward of the bowels proving a hindrance, their gravitation forward proves a most material help to reduction. In seeking to return the womb the sponging with ice-cold water, raising on a sheet, and wrapping in a tight bandage should be resorted to. Another method which is especially commendable in these inflamed conditions of the womb is to bring a piece of linen sheet, 30 by 36 inches, under the womb, with its anterior border close up to the vulva, then turn the posterior border upward and forward over the organ, and cross the two ends over this and over each other above. The ends of the sheet are steadily drawn, so as to tighten its hold on the womb, which is thus held on the level of the vulva or above, and cold water is constantly poured upon the mass. The reduction is further sought by compression of the mass with the palms applied outside the sheet. Fifteen or twenty minutes are usually sufficient to cause the return of the womb, provided straining is prevented by pinching the back, or otherwise.

In old and aggravated cases, with the womb torn, bruised, or even gangrenous, the only resort is to amputate the entire mass. This is done by tying a strong, waxed cord around the protruding mass close to the vulva, winding the cord around pieces of wood, so as to draw it as tightly as possible, cutting off the organ below this ligature, tying a thread on any artery that may still bleed, and returning the stump well into the vagina.

Retention of the returned womb is the next point, and is most easily accomplished by a rope truss. Take two ropes, each about 18 feet long and an inch in thickness. Double each rope at its middle, and lay the one above the other at the bend, so as to form an ovoid of about 8 inches in its long diameter. Twist each end of the one rope twice around the other, so that this ovoid will remain when they are drawn tight. (Pls. XXII and XXIII.) Tie a strap or rope around the back part of the neck and a surcingle around the body. Place the rope truss on the animal so that the ovoid ring will surround the vulva, the two ascending ropes on the right and left of the tail and the two descending ones down inside the thighs on the right and left of the udder. These descending ropes are carried forward on the sides of the body and tied to the surcingle and to the neck collar. The ascending ropes proceed forward on the middle of the back, twisting over each other, and are tied to the surcingle and collar. The upper and lower ropes are drawn so tightly that the rope ring is made to press firmly all around the vulva without risk of displacement. This should be worn for several days, until the womb shall have closed and all risk of further eversion is at an end. Variations of this device are found in the use of a narrow triangle of iron applied around the vulva and fixed by a similar arrangement of ropes, surcingle, and collar (Pl. XXIII, fig. 3), a common crupper similarly held around the vulva (Pl. XXII, fig. 1), stitches through the vulva, and wire inserted through the skin on the two hips (Pl. XXIII, fig. 2), so that they will cross behind the vulva; also pessaries of various kinds should be inserted into the vagina. None of these devices, however, present any advantage over the simple and comparatively painless rope truss described above. Such additional precautions as keeping the cow in a stall higher behind than in front, and seeing that the diet is slightly laxative and nonstimulating may be named. If straining is persistent, ounce doses of laudanum may be used twice a day, and the same may be injected into the vagina.

If the womb has been cut off, injections of a solution of a teaspoonful of carbolic acid in a quart of water should be used daily, or more frequently, until the discharge ceases.

EVERSION OF THE BLADDER.

A genuine eversion of the bladder is almost unknown in the cow, owing to the extreme narrowness of its mouth. The protrusion of the bladder, however, through a laceration sustained in calving, in the floor of the vagina and its subsequent protrusion through the vulva, is sometimes met with. In this case the protruding bladder contains urine; this can never be the case in a real eversion, in which the inner surface of the bladder and the openings of the ureters are both exposed outside the vulva. The presence of a bag containing water, which is connected with the floor of the vagina, will serve to identify this condition. If the position of the bladder in the vulva renders it impracticable to pass a catheter to draw off the urine, pierce the organ with the nozzle of a hypodermic syringe, or even a very small trocar and cannula, and draw off the water, when it will be found an easy matter to return the bladder to its place. The rent in the vagina can be stitched up, but as there would be risk in any subsequent calving it is best to prepare the cow for the butcher.

RUPTURE OF THE BLADDER.

This has been known to occur in protracted parturition when the fetus finally passed while the bladder was full. The symptoms are those of complete suppression of urine and tenderness of the abdomen, with a steady accumulation of liquid, and fluctuation on handling its lower part. If the hand is introduced into the vagina it is felt to be hot and tender, and perhaps slightly swollen along its floor. As a final test, if the lower, fluctuating part of the abdomen is punctured with a hypodermic needle, a straw-colored liquid of a urinous odor flows out. The condition has been considered as past hope. The only chance for recovery would be in opening the abdomen, evacuating the liquid, and stitching up the rent in the bladder, but at such a season, and with inflammation already started, there would be little to hope for.

RUPTURE OF THE WOMB.

When the womb has been rendered friable by disease rupture may occur in the course of the labor, but much more frequently it occurs from violence sustained in attempting assistance in difficult parturition. It is also liable to occur during eversion of the organ through efforts to replace it.

If it happens while the calf is still in the womb, it will usually bleed freely and continuously until the fetus has been extracted, so that the womb can contract on itself and expel its excess of blood. Another danger is that in case of a large rent the calf may escape into the cavity of the abdomen and parturition become impossible. Still another danger is that of the introduction of septic germs and the setting up of a fatal inflammation of the lining membrane of the belly (peritoneum). Still another is the escape of the small intestine through the rent and on through the vagina and vulva, so as to protrude externally and receive perhaps fatal injuries. In case of rupture before calving, that act should be completed as rapidly and carefully as possible, the fetal membranes removed, and the contraction of the womb sought by dashing cold water on the loins, the right flank, or the vulva. If the calf has escaped into the abdomen and can not be brought through the natural channels, it may be permissible to fix the animal and extract it through the side, as in the CÊsarian section. If the laceration has happened during eversion of the womb it is usually less redoubtable, because the womb contracts more readily under the stimulus of the cold air so recently applied. In case the abdomen has been laid open it is well to stitch up the rent, but if not, it should be left to nature, and will often heal satisfactorily, the cow even breeding successfully in after years.

Rupture of the floor of the vagina has been already referred to as allowing the protrusion of the bladder. Laceration of the roof of this passage is also met with as the result of deviations of the hind limbs and feet upward when the calf lies on its back. In some such cases the opening passes clear into the rectum, or the foot may even pass out through the anus, so that that opening and the vulva are laid open into one.

Simple, superficial lacerations of the vaginal walls are not usually serious, and heal readily unless septic inflammation sets in, in which case the cow is liable to perish. They may be treated with soothing and antiseptic injections, such as carbolic acid, 1 dram; water, 1 quart.

The more serious injuries depend on the complications. Rupture of the anterior part of the canal, close to the mouth of the womb, may lead to the introduction of infecting germs into the cavity of the abdomen, or protrusion of the bowel through the rent and externally, either of which may prove fatal. If both these conditions are escaped the wound may heal spontaneously. Rupture into the bladder may lead to nothing worse than a constant dribbling of the urine from the vulva. The cow should be fattened if she survives. Rupture into the rectum will entail a constant escape of feces through the vulva, and, of course, the same condition exists when the anus as well has been torn open. I have successfully sewed up an opening of this kind in the mare, but in the case of the cow it is probably better to prepare her for the butcher.

CLOTS OF BLOOD IN THE WALLS OF THE VAGINA.

During calving the vagina may be bruised so as to cause escape of blood beneath the mucous membrane and its coagulation into large bulging clots. The vulva may appear swollen, and on separating its lips the mucous membrane of the vagina is seen to be raised into irregular rounded swellings of a dark-blue or black color, and which pit on pressure of the finger. If the accumulation of blood is not extensive it may be reabsorbed, but if abundant it may lead to irritation and dangerous inflammation, and should be incised with a lancet and the clots cleared out. The wounds may then be sponged twice a day with a lotion made with 1 dram sulphate of zinc, 1 dram carbolic acid, and 1 quart water.

RETAINED AFTERBIRTH.

The cow, of all our domestic animals, is especially subject to this accident. This may be partly accounted for by the firm connections established through the fifty to one hundred cotyledons (Pl. XIII, fig. 2) in which the fetal membranes dovetail with the follicles of the womb. It is also most liable to occur after abortion, in which preparation has not been made by fatty degeneration for the severance of these close connections. In the occurrence of inflammation, causing the formation of new tissue between the membranes and the womb, we find the occasion of unnaturally firm adhesions which prevent the spontaneous detachment of the membranes. Again, in low conditions of health and an imperfect power of contraction we find a potent cause of retention, the general debility showing particularly in the indisposition of the womb to contract, after calving, with sufficient energy to expel the afterbirth. Hence we find the condition common with insufficient or innutritious feed, and in years or localities in which the fodder has suffered from weather. Ergoted, smutty, or musty fodder (Pl. V), by causing abortion, is a frequent cause of retention. Old cows are more subject than young ones, probably because of diminishing vigor. A temporary retention is sometimes owing to a too rapid closure of the neck of the womb after calving, causing strangulation and imprisonment of the membranes. Conditions favoring this are the drinking of cold (iced) water, the eating of cold feed (frosted roots), and (through sympathy between udder and womb) a too prompt sucking by the calf or milking by the attendant.

_Symptoms._--The symptoms of retention of the afterbirth are usually only too evident, as the membranes hang from the vulva and rot away gradually, causing the most offensive odor throughout the building. When retained within the womb by closure of its mouth and similarly in cases in which the protruded part has rotted off, the decomposition continues and the fetid products escaping by the vulva appear in offensively smelling pools on the floor and mat together the hairs near the root of the tail. The septic materials retained in the womb cause inflammation of its lining membrane, and this, together with the absorption into the blood of the products of putrefaction, leads to ill health, emaciation, and drying up of the milk.

_Treatment._--Treatment varies according to the conditions. When the cow is in low condition, or when retention is connected with drinking iced water or eating frozen feed, hot drinks and hot mashes of wheat bran or other aliment may be sufficient. If along with the above conditions, the bowels are somewhat confined, an ounce of ground ginger, or half an ounce of black pepper, given with a quart of sweet oil, or 1-1/2 pounds of Glauber's salt in at least 4 quarts of warm water, will often prove effectual. A bottle or two of flaxseed tea, made by prolonged boiling, should also be given at frequent intervals. Other stimulants, like rue, savin, laurel, and carminatives like anise, cumin, and coriander, are preferred by some, but with very questionable reason, the more so that the first three are not without danger. Ergot of rye, 1 ounce, or its extract, 1 dram, may be resorted to to induce contraction of the womb. The mechanical extraction of the membranes is, however, often called for; of this there are several methods. The simplest is to hang a weight of 1 or 2 pounds to the hanging portion, and allow this, by its constant dragging and by its jerking effect when the cow moves, to pull the membranes from their attachments and to stimulate the womb to expulsive contractions. It frequently happens that the afterbirth is only loosely adherent to the womb and its removal is effected if but a slight amount of traction on it is exerted. This can be determined by seizing the dependent part of the afterbirth between two sticks and rolling it up on them until they lie against the vulva; then, by careful traction, accompanied with slight jerking movements from side to side, the womb is stimulated to expulsive contractions and the afterbirth is wound up more and more on the sticks until finally its last connections with the womb are severed and the remainder is expelled suddenly en masse. It is quite evident that neglected cases with putrid membranes are poor subjects for this method, as the afterbirth is liable to tear across, leaving a mass in the womb. During the progress of the work any indication of tearing is the signal to stop and proceed with greater caution or altogether abandon the attempt in this way.

The following method (that with the skilled hand) is the most promptly and certainly successful. For this the operator had better dress as for a parturition case. Again, the operation should be undertaken within twenty-four hours after calving, since later the mouth of the womb may be so closed that it becomes difficult to introduce the hand. The operator should smear his arms with carbolized lard or vaseline to protect them against infection, and particularly in delayed cases with putrid membranes. An assistant holds the tail to one side, the operator seizes the hanging afterbirth with the left hand, while he introduces the other along the right side of the vagina and womb, letting the membranes slide through his palm until he reaches the first cotyledon to which they remain adherent. In case no such connection is within reach, with the left hand gentle traction is made on the membranes until the deeper parts of the womb are brought within reach and the attachments to the cotyledons can be reached. Then the soft projection of the membrane, which is attached to the firm fungus-shaped cotyledon on the inner surface of the womb, is seized by the little finger, and the other fingers and thumb are closed on it so as to tear it out from its connections. To explain this, it is necessary only to say that the projection from the membrane is covered by soft, conical processes, which are received into cavities of a corresponding size on the summit of the firm, mushroom-shaped cotyledon growing from the inner surface of the womb. To draw upon the former, therefore, is to extract its soft, villous processes from within the follicles or cavities of the other. (Pl. XIII, fig. 2.) If at times it is difficult to start this extraction it may be necessary to get the finger nail inserted between the two, and once started the finger may be pushed on, lifting all the villi, in turn, out of their cavities. This process of separating the cotyledons must be carefully conducted, one after another, until the last has been detached and the afterbirth comes freely out of the passages. I have never found any evil result from the removal of the whole mass at one operation, but Shaack mentions the eversion of the womb as the possible result of the necessary traction, and in cases in which those in the most distant part of the horn of the womb can not be easily reached, he advises to attach a cord to the membranes inside the vulva, letting it hang out behind, and to cut off the membranes below the cord. Then, after two or three days' delay, he extracts the remainder, now softened and easily detached. If carefully conducted, so as not to tear the cotyledons of the womb, the operation is eminently successful; the cow suffers little, and the straining roused by the manipulations soon subsides. Keeping in a quiet, dark place, or driving a short distance at a walking pace, will serve to quiet these. When the membranes have been withdrawn, the hand, half closed, may be used to draw out of the womb the offensive liquid that has collected. If the case is a neglected one, and the discharge is very offensive, the womb must be injected as for leucorrhea.

INFLAMMATION OF THE VAGINA (VAGINITIS).

This may occur independently of inflammation of the womb, and usually as the result of bruises, lacerations, or other injuries sustained during calving. It will be shown by swelling of the lips of the vulva, which, together with their lining membrane, become of a dark-red or leaden hue, and the mucous discharge increases and becomes whitish or purulent, and it may be fetid. Slight cases recover spontaneously, or under warm fomentations or mild astringent injections (a teaspoonful of carbolic acid in a quart of water), but severe cases may go on to the formation of large sores (ulcers), or considerable portions of the mucous membrane may die and slough off. Baumeister records two cases of diphtheritic vaginitis, the second case in a cow four weeks calved, contracted from the first in a newly calved cow. Both proved fatal, with formation of false membranes as far as the interior of the womb. In all severe cases the antiseptic injections must be applied most assiduously. The carbolic acid may be increased to one-half ounce to a quart, or chlorin water, or peroxid of hydrogen solution may be injected at least three times a day. Hyposulphite of soda, 1 ounce to a quart of water, is an excellent application, and the same amount may be given by the mouth.

LEUCORRHEA (MUCOPURULENT DISCHARGE FROM THE PASSAGES).

This is from a continued or chronic inflammation of the womb, or the vagina, or both. It usually results from injuries sustained in calving or from irritation by putrid matters in connection with retained afterbirth, or from the use of some object in the vagina (pessary) to prevent eversion of the womb. Exposure to cold or other cause of disturbance of the health may affect an organ so susceptible as this at the time of parturition so as to cause inflammation.

_Symptoms._--The main symptom is the glairy, white discharge flowing constantly or intermittently (when the cow lies down), soiling the tail and matting its hairs and those of the vulva. When the lips of the vulva are drawn apart the mucous membrane is seen to be red, with minute elevations, or pale and smooth. The health may not suffer at first, but if the discharge continues and is putrid the health fails, the milk shrinks, and flesh is lost. If the womb is involved the hand introduced into the vagina may detect the mouth of the womb slightly open and the liquid collected within its cavity. Examination with the oiled hand in the rectum may detect the outline of the womb beneath, somewhat enlarged, and fluctuating under the touch from contained fluid. In some cases heat is more frequent or intense than natural, but the animal rarely conceives when served, and, if she does, is liable to abort.

_Treatment._--Treatment with the injections advised for vaginitis is successful in mild or recent cases. In obstinate ones stronger solutions may be used after the womb has been washed out by a stream of tepid water until it comes clear. A rubber tube is inserted into the womb, a funnel placed in its raised end, and the water, and afterwards the solution, poured slowly through it. If the neck of the womb is so close that the liquid can not escape, a second tube may be inserted to drain it off. As injections may be used chlorid of zinc, one-half dram to the quart of water, or sulphate of iron, 1 dram to the quart. Three drams of sulphate of iron and one-half ounce ground ginger may also be given in the feed daily.

INFLAMMATION OF THE WOMB (METRITIS, INFLAMMATION OF WOMB AND ABDOMEN, OR METROPERITONITIS).

Inflammation of the womb may be slight or violent, simple or associated with putrefaction of its liquid contents and general poisoning, or it may extend so that the inflammation affects the lining membrane of the whole abdominal cavity. In the last two cases the malady is a very grave one.

_Causes._--The causes are largely the same as those causing inflammation of the vagina. Greater importance must, however, be attached to exposure to cold and wet and to septic infection.

_Symptoms._--The symptoms appear two or three days after calving, when the cow may be seen to shiver, or the hair stands erect, especially along the spine, and the horns, ears, and limbs are cold. The temperature in the rectum is elevated by one or two degrees, the pulse is small, hard, and rapid (70 to 100), appetite is lost, rumination ceases, and the milk shrinks in quantity or is entirely arrested, and the breathing is hurried. The hind limbs may shift uneasily, the tail be twisted, the head and eyes turn to the right flank, and the teeth are ground. With the flush of heat to the horns and other extremities, there is redness of the eyes, nose, and mouth, and usually a dark redness about the vulva. Pressure on the right flank gives manifest pain, causing moaning or grunting, and the hind limbs are moved stiffly, extremely so if the general lining of the abdomen is involved. In severe cases the cow lies down and can not be made to rise. There is usually marked thirst, the bowels are costive, and dung is passed with pain and effort. The hand inserted into the vagina perceives the increased heat, and when the neck of the womb is touched the cow winces. Examination through the rectum detects enlargement and tenderness of the womb. The discharge from the vulva is at first watery, but becomes thick, yellow, and finally red or brown, with a heavy or fetid odor. Some cases recover speedily and may be almost well in two days; a large proportion perish within two days of the attack, and some merge into the chronic form, terminating in leucorrhea. In the worst cases there is local septic infection and ulceration, or even gangrene of the parts, or there is general septicemia, or the inflammation involving the veins of the womb causes coagulation of the blood contained in them, and the washing out of the clots to the right heart and lung leads to the blocking of the vessels in the latter and complicating pneumonia. Inflammation of the womb and passages after calving are always liable to these complications, and consequently to a fatal issue. Franck records three instances of rapidly fatal metritis in cows, all of which had been poisoned from an adjacent cow with retained and putrid afterbirth. Others have had similar cases.

_Treatment._--Treatment in the slight cases of simple inflammation does not differ much from that adopted for vaginitis, only care must be taken that the astringent and antiseptic injections are made to penetrate into the womb. After having washed out the womb a solution of chlorid of lime or permanganate of potassium (one-half ounce to 1 quart of water), with an ounce each of glycerin and laudanum to render it more soothing, will often answer every purpose. It is usually desirable to open the bowels with 1-1/2 pounds of Glauber's salt and 1 ounce of ginger in 4 quarts of warm water, and to apply fomentation of warm water or even mustard poultices or turpentine to the right flank.

In the violent attacks with high temperature and much prostration, besides the salts agents must be given to lower the temperature and counteract septic poisoning. Salicylate of soda one-half ounce, or quinia 2 drams every four hours will help in both ways, or ounce doses of hyposulphite of soda or dram doses of carbolic acid may be given as often until six doses have been taken. Tincture of aconite has often been used in 20-drop doses every six hours. If the temperature rises to 106∞ or 107∞ F., it must be met by the direct application of cold or iced water to the surface. The animal may be covered with wet sheets and cold water poured on them frequently until the temperature in the rectum is lowered to 102∞ F. In summer the cow may be allowed to dry spontaneously, while in winter it should be rubbed dry and blanketed. Even in the absence of high temperature much good may be obtained from the soothing influence of a wet sheet covering the loins and flanks and well covered at all points by a dry one. This may be followed next day by a free application of mustard and oil of turpentine. When the animal shows extreme prostration, carbonate of ammonia (1 ounce) may be given to tide over the danger, but such cases usually perish.

In this disease, even more than in difficult and protracted parturition or retained placenta, the attendants must carefully guard against the infection of their hands and arms from the diseased parts. The hand and arm before entering the passages should always be well smeared with lard impregnated with carbolic acid.

MILK FEVER (PARTURITION FEVER, PARTURIENT APOPLEXY, OR PARTURIENT COLLAPSE).

This disease is not only peculiar to the cow, but it may be said to be virtually confined to the improved and plethoric cow. It further occurs only at or near the time of calving. Indeed, these two factors, calving and plethora, may be set apart as preeminently the causes of this disease. It is the disease of cows that have been improved in the direction of early maturity, power of rapid fattening, or a heavy yield of milk, and hence it is characteristic of those having great appetites and extraordinary power of digestion. The heavy milking breeds are especially its victims, as in them the demand for the daily yield of 50 to 100 pounds of milk means even more than a daily increase of 2 to 3 pounds of body weight, mainly fat. The victims are not always fat when attacked, but they are cows having enormous powers of digestion, and which have been fed heavily at the time. Hence the stall-fed, city-dairy cow, and the farm cow on a rich clover pasture in June or July are especially subject. The condition of the blood globules in the suffering cow attests the extreme richness and density of the blood, yet this peculiarity appears to have entirely escaped the notice of veterinary writers. I have never examined the blood of a victim of this disease without finding the red-blood globules reduced to little more than one-half their usual size. Now, these globules expand or contract according to the density of the liquid in which they float. If we dilute the blood with water they will expand until they burst, whereas if solids, such as salt or albumin, are added they shrink to a large extent. Their small size, therefore, in parturition fever indicates the extreme richness of the blood, or, in other words, plethora.

Confinement in the stall is an accessory cause, partly because stabled cattle are highly fed, partly because the air is hotter and fouler, and partly because there is no expenditure by exercise of the rich products of digestion.

High temperature is conducive to the malady, though the extreme colds of winter are no protection against it. Heat, however, conduces to fever, and fever means lessened secretion, which means a plethoric state of the circulation. The heats of summer are, however, often only a coincidence of the real cause, the mature rich pastures, and especially the clover ones, being the greater.

Electrical disturbances have an influence of a similar kind, disturbing the functions of the body and favoring sudden variations in the circulation. A succession of cases of the malady often accompany or precede a change of weather from dry to wet, from a low to a high barometric pressure.

Costiveness, which is the usual concomitant of fever, may in a case of this kind become an accessory cause, the retention in the blood of what should have passed off by the bowels tending to increase the fullness of the blood vessels and the density of the blood.

Mature age is a very strong accessory cause. The disease never occurs with the first parturition, and rarely with the second. It appears with the third, fourth, fifth, or sixth--after the growth of the cow has ceased and when all her powers are devoted to the production of milk.

Calving is an essential condition, as the disturbance of the circulation consequent on the contraction of the womb and the expulsion into the general circulation of the enormous mass of blood hitherto circulating in the walls of the womb fills to repletion the vessels of the rest of the body and very greatly intensifies the already existing plethora. If this is not speedily counterbalanced by a free secretion from the udder, kidneys, bowels, and other excretory organs, the most dire results may ensue. Calving may thus be held to be an exciting cause, and yet the labor and fatigue of the act are not active factors. It is after the easy calving, when there has been little expenditure of muscular or nervous energy and no loss of blood, that the malady is seen. Difficult parturitions may be followed by metritis, but they are rarely connected with parturition fever.

All these factors coincide in intensifying the one condition of plethora and point to that as a most essential cause of the affection. It is needless to enter here into the much-debated question as to the mode in which the plethora brings about the characteristic symptoms and results. As the results show disorder or suspension of the nervous functions mainly, it may suffice to say that this condition of the blood and blood vessels is incompatible with the normal functional activity of the nerve centers. How much is due to congestion of the brain and how much to bloodlessness may well be debated, yet in a closed box like the cranium, in which the absolute contents can not be appreciably increased or diminished, it is evident that, apart from dropsical effusion or inflammatory exudation, there can be only a given amount of blood; therefore, if one portion of the brain is congested, another must be proportionately bloodless; and as congestion of the eyes and head generally and great heat of the head are most prominent features of the disease, congestion of the brain must be accepted. This, of course, implies a lack of blood in certain other parts or blood vessels.

The latest developments of treatment indicate very clearly that the main cause is the production of poisonous, metabolic products (leucomains and toxins) by secreting cells of the follicles of the udder, acting on the susceptible nerve centers of the plethoric, calving cow. Less fatal examples of udder poisons are found in the first milk (colostrum), which is distinctly irritant and purgative, and in the toxic qualities of the first milk drawn from an animal which has been subjected to violent overexertion or excitement. Still more conclusive as to the production of such poisons is the fact that the full distention of the milk ducts and follicles, and the consequent driving of the blood out of the udder and arrest of the formation of depraved products, determines a speedy and complete recovery from the disease. This does not exclude the other causes above named, nor the influence of a reflex nervous derangement proceeding from the udder to the brain.

_Symptoms._--It may be said that there are two extreme types of this disease, with intervening grades. In both forms there is the characteristic plethora and more or less sudden loss of voluntary movement and sensation, indicating a sudden collapse of nervous power; in one, however, there is such prominent evidence of congestion of head and brain that it may be called the congestive form par excellence, without thereby intimating that the torpid form is independent of congestion.

In the congestive form there is sudden dullness, languor, hanging back in the stall, or drooping the head, uneasy movements of the hind limbs or tail; if the cow is moved, she steps unsteadily, or even staggers; she no longer notices her calf or her feed; the eyes appear red and their pupils dilated; the weakness increases and the cow lies down or falls and after that is unable to rise. At this time the pulse is usually full, bounding, and the temperature raised, though not invariably so, the head, horns, and ears being especially hot and the veins of the head full, while the visible mucous membranes of nose and eyes are deeply congested.

The cow may lie on her breastbone with her feet beneath the body and her head turned sleepily round, with the nose resting on the right flank; or, if worse, she may be stretched full on her side, with even the head extended, though at times it is suddenly raised and again dashed back on the ground. At such times the legs, fore and hind, struggle convulsively, evidently through unconscious nervous spasm. By this time the unconsciousness is usually complete; the eyes are glazed, their pupils widely dilated, and their lids are not moved when the ball of the eye is touched with the finger. Pricking the skin with a pin also fails to bring any wincing or other response. The pulse, at first from 50 to 70 a minute, becomes weaker and more accelerated as the disease advances. The breathing is quickened, becoming more and more so with the violence of the symptoms, and at first associated with moaning (in exceptional cases, bellowing), it may, before death, become slow, deep, sighing, or rattling (stertorous). The temperature, at first usually raised, tends to become lower as stupor and utter insensibility and coma supervene. The bowels, which may have moved at the onset of the attack, become torpid or completely paralyzed, and, unless in case of improvement, they are not likely to operate again. Yet this is the result of paralysis and not of induration of the feces, as often shown by the semiliquid, pultaceous condition of the contents after death. The bladder, too, is paralyzed and fails to expel its contents. A free action of either bladder or bowels, or of both, is always a favorable symptom. The urine contains sugar, in quantity proportionate to the severity of the attack.

In nearly all cases the torpor of the digestive organs results in gastric disorder; the paunch becomes the seat of fermentation, producing gas, which causes it to bloat like a drum. There are frequent eructations of gas and liquid and solid feed, which, reaching the paralyzed throat, pass in part into the windpipe and cause inflammations of the air passages and lungs.

In the torpid form of the disease there is much less indication of fever or violence. There may be no special heat about the horns, ears, or forehead, nor any marked redness or congestion of the eyes or nose, nor engorgement of the veins of the head. The attack comes on more slowly, with apparent weakness of the hind limbs, dullness, drowsiness, suspension of rumination and appetite, and a general indifference to surrounding objects. Soon the cow lies down, or falls and is unable to rise, but for one or two days she may rest on the breastbone and hold the head in the flank without showing any disorderly movements. Meanwhile there is not only loss of muscular power and inability to stand, but also considerable dullness of sensation, pricking the skin producing no quick response, and even touching the edge of the eyelids causing no very prompt winking. Unless she gets relief, however, the case develops all the advanced symptoms of the more violent form, and the animal perishes.

In advanced and fatal cases of either form the insensibility becomes complete; no irritation of skin or eye meets any response; the eye becomes more dull and glassy; the head rests on the ground or other object; unless prevented the cow lies stretched fully on her side; the pulse is small, rapid, and finally imperceptible; the breathing is slow, deep, stertorous, and the expirations accompanied with puffing is slow, the cheeks, and death comes quietly or with accompanying struggles.

_Prevention._--For such fatal disease prevention is of far more consequence than treatment. Among the most efficient preventives may be named a spare diet (amounting to actual starvation in very plethoric, heavy-milking cows) for a week before calving and at least four days after. A free access to salt and water is most important, as the salt favors drinking and the water serves to dilute the rich and dense blood. Iced water, however, is undesirable, as a chill may favor the onset of fever. A dose of Epsom salt (1 to 2 pounds) should be given 12 to 24 hours before calving is due, so that it may operate at or just before that act. In case calving has occurred unexpectedly in the heavy milker, no time should be lost in giving the purgative thereafter. A most important precaution in the fleshy, plethoric cow, or in one that has been attacked at a previous calving, is to avoid drawing any milk from the bag for 12 or 24 hours after calving. Breeders on the island of Jersey have found that this alone has almost abolished the mortality from milk fever. If Epsom salt is not at hand, saltpeter (1 ounce) should be used for several days. Daily exercise is also of importance, and, excepting in midsummer, when the heat of the sun may be injurious, the value of open air is unquestionable. Even in summer an open shed or shady grove is incomparably better than a close, stuffy stall. A rich pasture (clover especially), in May, June, or July, when at its best, is to be carefully avoided. It is better to keep the cow indoors on dry straw with plenty of salt and water than to have access to such pastures.

_Treatment._--Treatment of milk fever has been completely revolutionized, with the result that a former mortality of 50 to 70 per cent has been practically abolished. Formerly the most vigorous treatment was practiced by bleeding, purging, the increase of peristalsis by eserin or pilocarpin, enemas, cold in the head, counterirritants, aconite, tartar emetic, sponging, wet-sheet packing, etc. The gross mortality, however, was not materially reduced, and nearly all that were attacked within the first two days after calving perished.

The first step in the modern treatment was made in 1897, when J. Schmidt published his successful treatment by the injection of the teats and milk ducts with a solution of iodid of potassium (1-1/2 drams to 1 quart of water). This reduced the mortality to 17 per cent. Others followed this lead by the injection of other antiseptics (lysol, creolin, creosol, chinosol, common salt, etherized air, oxygen). These succeeded as well as the iodid solution. With the injection of gases, however, a fuller distention of the udder was usually secured, and virtually every case recovered. This suggested the full distention of the udder with common atmospheric air filtered and sterilized, and this with the most perfect success. With sterile air Schmidt-Kolding claimed 96.7 per cent recoveries in 914 cases.