Chapter XII: Part 12

In case of abscess an opening by the side of the anus is preferable to one by the urinary passages or rectum, and will obviate the danger of rupture into the peritoneum. A pasty or fluctuating swelling in the perineum should be incised until the pus flows. A tense elastic fluctuating prostate may be transfixed by a cannula and trochar from the side of the anus, guided by the hand or finger in the rectum. When the pus has been evacuated a drainage tube may be inserted through the cannula and left in place when the latter is removed so as to allow free drainage at all times and frequent antiseptic injections. Punctures and even incisions have been made from the rectum, but they make badly infected wounds, and a rupture into the urethra, determines infection on that side, without any possibility of any effective antiseptic injection or perfect drainage. As injections may be used permanganate of potash 1:10000, or boric acid, a saturated solution. Poisonous agents must be eschewed or used with the greatest circumspection.

CHRONIC PROSTATITIS.

Causes. Follows acute. Same causes less potent. Lesions: as in acute,
or sclerosis, and abscess. Symptoms: delayed urination, last glairy or
purulent, constipation, defecation followed by urethral discharge,
little genital ardor, rectal palpation, tenderness of prostate to hand
or catheter, atony of hind limbs. Treatment: open air life, idle, milk
or succulent diet, saline laxatives or enemata, avoid generative
excitement, castrate, check masturbation, iodine, camphor, antiseptic
irrigations.

_Causes._ The acute disease often subsides leaving an indolent chronic inflammation of the organ. Apart from this, the causes are essentially those of the acute, but acting with lessened force or on a less susceptible system. Thus indoor life and overfeeding, with constipation and urine of a high density, calculus, irritant diuretics, the frequent incautious use of the catheter, infection from the catheter or otherwise, intense and frequent generative excitement, and exposure to cold are all occasional factors. Old age is a common concurrent cause.

_Lesions._ As in the acute form these indicate three successive, independent or concurrent forms, follicular, interstitial and suppurative.

With the distinctively =follicular= form the gland is usually enlarged and of a deep red color, but soft and friable, and when compressed exudes from its follicles and gland ducts a whitish muco-purulent glairy liquid. With the =interstitial= changes, which are often an advance on the follicular, the organ may be enlarged or shrunken, but the connective tissue has undergone a thickening and sclerosis which renders the mass firm and resistant, and which may have extended to the tissues in the immediate vicinity. In the =suppurative= form or stage, foci of suppuration are found throughout the gland substance, bulging out on its surface and even encroaching on surrounding tissues.

_Symptoms._ These are by no means obtrusive. There may be some delay in the discharge when the animal attempts to urinate, and the last drops of the urine, white and purulent or glairy, may be passed with evident pain. There is a tendency to constipation with painful straining to defecate. Compression of the prostate during defecation presses out its muco-purulent contents so that there is a greater urethral discharge following this act than at other times. This is also more abundant from the compression of the abdomen when the animal is lying down. This discharge is easily distinguished from semen by the absence or almost complete absence of spermatozoa and _the abundance_ of spermatic crystals, precipitated by ammonia phosphate. In the earlier stages there may be undue generative excitement, erections, and even seminal discharge, with or without the movements of masturbation but in advanced cases genital ardor is usually defective or there may be practical impotence. Conclusive evidence is obtained by rectal exploration, when the enlarged, or irregularly shaped and tender prostate can be easily recognized. If a sterile catheter is passed the pain caused as it touches the prostate is significant.

In the dog the affection may last for years, and tends to advancing atony of the hind limbs. A temporary arrest of the affection is often misleading, though the urine may be clear and normally discharged, yet manipulation may show a gradually advancing abscess, and when this bursts, usually into the urethra, all the symptoms become aggravated and cystitis, urethritis and general infection are to be dreaded.

_Treatment._ This is far from satisfactory yet in certain purely follicular or catarrhal cases it may prove successful. An open air life, without exertion, and a milk and farina diet are desirable, yet any tendency to costiveness must be obviated by saline laxatives and enemata. The avoidance of generative excitement must be secured, not only by restraining stud animals from service, but by keeping them well apart from all females of the same species. Even castration may be sometimes resorted to with advantage. Stallions given to masturbation must be restrained by net or otherwise. Any disease of the rectum, anus, urethra or bladder should be corrected, and undue exposure to cold prevented. Lafosse advises to slaughter butcher animals for food. Hertwig recommends iodine ointment on the anus and perineum of affected dogs. It must be borne in mind that the affection is maintained by infective microbes yet it is difficult to reach and deal with these thoroughly and effectively.

As an anaphrodisiac may be given camphor, or camphor bromide, ergot or potassium bromide, along with the mild stimulating antiseptic eucalyptol or copaiba. But the irrigation of the urethra, bladder and as far as possible the prostate with such antiseptic solutions as potassium permanganate (1:10000) or silver nitrate (0.5 to 1:100) or zinc chloride (1:100) is desirable. These should be injected into the urethra so as to reach the bladder, the contents of which they will render antiseptic and thus protect the organ against the transported microbes of the prostate. In man iodoform, europhen, and ichthyol are made into a bougie with gum, palm butter or other soluble liquifiable agent and inserted in the urethra as far as the prostatic part. Similar agents are used as suppositories or enemata. Hertwig’s iodine ointment on the perineum may be advantageously replaced by sinapisms.

HYPERTROPHY OF THE PROSTATE.

In old dogs. Causes: age, overfeeding on albuminoids, rectal impaction
or irritation, calculus, cystitis, urethritis, productive
inflammation, trophic derangement when function declines. Lesions:
hypertrophy general or partial, hard or soft, condensed or with sacs
of pus, red or pale. Infective cystitis. Calculi. Symptoms: straining
before urine comes, small or weak stream, sudden check, last part
purulent or mucous, incontinence, triple phosphate, ammoniacal odor,
crystals and dark color imply calculus. Diagnosis: by rectal
exploration, and catheterization. Treatment: palliative, moderate,
farinaceous, laxative diet, warmth, correct contiguous troubles,
iodine, castration, extirpation of prostate.

This has been seen almost exclusively in old dogs, among the domestic animals.

_Causes._ Age and good living, more particularly on highly albuminous food, may be adduced as the most prominent. Perhaps even more important are continued irritation in adjacent organs such as the rectum, bladder and urethra. It is the old, pampered dog that above all suffers from atonic, overloaded rectum, proctitis, piles, calculus, cystitis, and stricture, and the constant local pelvic congestion caused by one or other of these tends to a hyperplasia of the prostate. Again atheroma which is especially a disease of the aged is regarded as a cause of both cystitis and prostatic hypertrophy. Chronic inflammation in the prostate has been claimed as a factor, but contested on the ground that inflammation never increases normal growth though it may cause degeneration. The exudate of inflammation, tends, however, on its temporary arrest, to undergo organization, and such organization inclines to assume the structure which is normally built up by the adjacent trophic cells. The products of inflammation may, therefore, well contribute to hypertrophy, and above all to the increase of the simpler tissue represented by the fibrous framework of the gland. The congestion attendant on excessive venery has also been incriminated, and this too has been denied on the ground that the hypertrophy is not found in the young animals and men in which the generative ardor is greatest and most frequently aroused and gratified. Thompson’s idea is that the prostate, like the ovaries and womb, is especially prone to morbid growths and developments at the time when in advancing age, the normal generative functions are undergoing a rapid decline. The two conditions may well be recognized without considering them as mutually excluding each other as causative factors.

_Lesions._ The enlargement is usually general, but it may predominate in the right, left or median lobe, the latter as a rule exercising greater compression of the urethra so that this is often marked in the worst cases. The hyperplasia may feel firm and resistant or it may be more or less soft from sacs of muco-purulent fluid imprisoned by the obstruction of the outlet canals. On the surface and on section the general appearance of the gland is pale, bloodless and uniformly solid. This comes from the great hypertrophy of the fibro-muscular stroma which has in many cases compressed the parenchymatous or secreting structure so as to cause its atrophy. The presence of calculi (mainly phosphatic) in the follicles is not uncommon.

The complication of infective cystitis is frequent, the congestion, redness, ecchymosis, maculation, puckering and thickening of the mucosa, the granular degeneration and desquamation of the epithelium, the exposure of a raw vascular surface, the discoloration of the urine by mucus, pus and blood, and the formation of ammonia and other products of decomposition, becoming marked phenomena. Vesical calculus is not uncommon, the slowness of the exit current of the urine retarded by the enlarged prostate, tending to prevent its impaction in the orifice and thus minimizing one of the most prominent symptoms.

_Symptoms._ Among the earliest symptoms, is some modification in the act of micturition. Straining a few seconds before urine comes, retention, incontinence and dribbling, discharge in a small or weak stream, and sudden arrest of the flow and the last few drops may contain muco-pus showing abundance of spermatic crystals, on the addition of ammonia phosphate. Impaction of the rectum tends to occur sooner or later, the animal making little effort to unload the viscus, and the overdistended organ becoming more and more atonic, congested and catarrhal and reacting injuriously on the urinary organs. Incontinence may be especially marked during sleep, the sphincter being sufficiently controlled by volition during waking hours. Retention may be at first temporary from excitement and later more continuous by reason of the greater compression of the neck by the enlarged and indurated prostate. With the advance of the disease the urine shows abundance of triple phosphates, and becomes ammoniacal and fœtid. A dark or bloody color of the discharge and the presence of crystals suggest calculus.

An accurate _diagnosis_ can only be had by rectal examination. The great enlargement of the prostate, in the absence of heat and tenderness is characteristic. Enlargement is usually uniform, though it may be concentrated on the right, left or central lobe. The passage of the catheter may be obstructed, but is not specially painful at the prostatic region as in prostatitis. From =vesical calculus= it is distinguished by the fixity of the swelling on the neck of the bladder as contrasted with the mobility of the stone inside that half-filled organ. From =stricture= it is differentiated by the fact that the obstruction offered to the catheter and the swelling of the prostate exactly correspond in position, that the stream is lessened in force rather than simply reduced in size, and that the history of the case shows no antecedent cause for stricture.

_Treatment._ This has been considered as mainly palliative. Special care of the general health and above all of the diet which should be moderate, farinaceous and laxative, protection against cold and wet, the correcting of any coexisting trouble of the urinary or generative organs, and the removal from all sources of generative excitement are important elements. Occasional small doses of Epsom or Glauber salts in draught or enema obviate rectal hyperæmia. Ergot, potassium iodide internally, and iodine or mercurial ointment to the perineum have had little good effect. Möller claims to have secured improvement from the injection into the prostate at intervals of fourteen days, of a solution of two parts each of tincture of iodine and iodide of potassium, and sixty parts of distilled water. A small hypodermic syringe is used and the injection is made through the rectum directly into the substance of the prostate. Glass has adopted the recent surgical alternative of castration, with the result of marked relief from the active symptoms in a number of cases, but with a more rapid advance through emaciation and marasmus to death in three or four weeks in others. We would suggest a careful antiseptic castration in such cases, to obviate any added trouble from absorbed toxins or sepsis.

For the human subject, Lydston strongly advocates removal of the enlarged prostate by surgical means in strong, vigorous subjects, with healthy bladder and kidneys. The difficulty of such an operation in the dog is greatly enhanced by the relatively greater length of the pubio-ischiatic symphysis, and the lessened diameter of the pelvic cavity. Yet with the comparative immunity of the dog from suppuration, and the hopelessness of the case without such radical measure, and with the rigid application of an antiseptic technic, the operation would appear to be fully justified. It would be contra-indicated in all advanced cases, in which the prostate was the seat of active suppuration with discharge into the urethra, in cases complicated by urethritis, cystitis or nephritis, in cases in which there is marked prostration from sepsis or absorbed toxins, and generally in old, worn out and cachectic animals.

Short of this, in cases complicated by cystitis, antiseptics by the stomach and as injections into the bladder are desirable. Eucalyptol in doses of ten minims four times a day, or beta naphthol, guaiacol, or phenol have been used in man. As injections mercuric chloride 1:20,000; boric acid, saturated solution; or carbolic acid ·5:100 (Lydston) may be used warm several times a day.

TUBERCULOSIS OF THE PROSTATE.

This is a common seat of tubercle in generalized tuberculosis in cattle, and may give rise to the same urinary troubles as chronic prostatitis or hypertrophy of the organ. In a remarkable case recorded by Frauenholz the tuberculous prostate of an ox weighed 10½ lbs. and had contracted adhesions to surrounding pelvic organs. Section of the mass showed numerous centres of extensive caseous degeneration. In such cases the generalized tuberculosis is the important fact and the prostatic disease is only an unusually intractable complication. If less generalized, the implication of the testicle or epididymus is strongly suggestive, and examination of the urine may detect the tubercle bacillus, or the tuberculin test may develop the characteristic febrile reaction.

CANCER OF THE PROSTATE.

Lafosse records as colloid cancer a case of diseased prostate in an ox, in which the mass approximated to the size of the human head, and was made up of numerous cavities the largest not over 1½ inch in diameter, and all intercommunicating, and containing a gluey, or gelatinoid liquid with numerous small round cells and a few multinucleated giant cells. No evidence is given of the implication of even the adjoining lymph glands, so that the case was probably only an enlarged cystic prostate.

Fournier records a case in a three year old horse, which on necropsy showed a ruptured bladder, general peritonitis, and an enlarged prostate, involving Cowper’s glands. Nocard identified its cancerous nature by microscopic examination. Yet there is not a word of the implication of adjacent lymph glands.

Goubaux says prostatic cancer is common in dogs.

PROSTATIC CYSTS.

These are not at all uncommon as a complication of hypertrophy of the prostate, the ducts having become obstructed and the follicles indefinitely distended. The case described by Lafosse as cancer of the prostate of a bull is strongly suggestive of such retention cysts.

CALCULUS OF THE PROSTATE.

Two forms of calculi have been found in the prostate in domestic animals: 1st, small, round, angular or branched bodies made up in concentric layers and formed of organic nitrogenous bodies: and 2nd, genuine calculi of calcium phosphate or ammonia magnesian phosphate. These may cause pressure on the parenchymatous tissue and atrophy, but in the lower animals they are seldom the direct cause of prominent morbid symptoms. They must, however, be recognized as one of the causes of chronic irritation that contribute to prostatic inflammation and hypertrophy.

DISEASES OF THE FEMALE GENERATIVE ORGANS.
MALPOSITION OF OVARY AND WOMB. HERNIA OF THE OVARIES.

Inguinal or crural hernia of ovary or womb. Bitch. Long uterine horns,
loose broad ligaments; Sow; Ewe; Cow. Other openings. Symptoms: not
marked: strangulation: inflammation: abscess. Gravid hernial uterus.
Treatment: reduction: surgical means: Cæsarian section.

The most common displacement of the ovary in the lower animals is through the inguinal or crural arch. It is most frequent in the bitch doubtless for the reason that the horns of the womb are long, and widely separated from each other, and in any case of inguinal or crural hernia, or of undue dilatation of the openings they are liable to pass through. A relaxation of the broad ligaments is another condition of such displacement. The laxity of these ligaments in the normal condition in the sow favors ovarian hernia, and Dupont found the ovaries in the perineal region in five sows examined. Laux found the condition in ewes, and Müller in cows, one ovary lying on each side of the mammæ. With relaxation of the uterine ligaments the hernia might occur in any female mammal, and not only through the orifices named, but through any normal or adventitious opening in the abdominal walls.

_Symptoms._ In the bitch the hernia is often overlooked although an examination of the inguinal region will reveal the presence of a small nodule and vermiform body which may usually be returned into the abdominal cavity. In some cases it becomes strangulated by the gradual contraction of the neck of the hernial sac, followed by swelling, heat and tenderness of the hernial mass, which may go on to abscess formation. In exceptional cases impregnation occurs with the womb in this position and the steady nodular increase of the mass, and finally the automatic movements of the contained fœtuses become very characteristic.

_Treatment_ consists in passing the womb and ovary back into the abdomen, and if adherent or incarcerated, in exposing and releasing, and if necessary extirpating them. In case of advanced pregnancy with the gravid womb on the inner side of the thigh, a modified Cæsarian operation is required without the attendant danger of laying the peritoneal cavity directly open. Inflammation and abscess must be treated on general principles.

UNDEVELOPED OVARIES. ABSENCE OF OVARIES.

The absence of ovaries has been often noticed in twin heifers, and most commonly associated with deficiency or absence of the womb, and even of the anterior part of the vagina. The condition is especially common, though not constant as some have supposed, when the other twin was a male. Such females are known as _free martins_ and fail to breed. Even when the ovaries are present in such twins they remain undeveloped, and are no larger than a bean or hazel nut. These usually have a firm, fibrous structure, and though there may be interspaces filled with a transparent fluid, no true Graafian follicles are formed. In birds, the left ovary only is developed and physiologically active. The absence of ovary has been noted also in the ewe, and less frequently in the mare and other species, and appears to be more common in twins than in single pregnancy. In cattle only has the influence of the male on the female twin of the same pregnancy been specially noted.

It has been noted that females with ovaries undeveloped, tend to show many male characters, in head, horns, and neck in cattle, in plumage in birds, and in voice in both.

ATROPHY OF OVARIES.

This is observed as a physiological result of having passed the breeding age, and may also take place from disease and degeneration of the organ. The fibrous stroma is usually increased and the cell elements reduced, yet in some cases, a cystic development occurs, giving the appearance of hypertrophy, while the ovarian parenchyma has actually been diminished.

SUPERNUMERARY OVARIES.

Extra ovaries have been found in different cases in the human female, the additional organ being furnished with a fallopian tube, and in some instances an extra uterine horn. No facts are at hand concerning the lower animals, but the occurrence of gestation and the birth of a single puppy a year after careful castration, would seem to suggest that the condition occurs in the bitch. There is no embryological reason why the lower animals should not at times show this deviation from the normal.

IRRITABLE OVARY. NEURALGIA OF THE OVARY.

This has been noticed most commonly in the mare, which from a quiet docile animal, has become very ticklish, especially in the region of the flank, kicking on the slightest touch, or even when approached and showing an amount of nervous apprehension, that may render her useless, for work. The ovaries are usually found to be enlarged, diseased and very sensitive. Œstrum may be in some cases constant and excessive and in others entirely suspended. Such cases are difficult or dangerous to shoe. In one case recorded by Thierry, handling of the flank promptly induced an epileptic attack. Cows with nymphomania (bullers) are often victims of this condition. The only remedy is castration, which is best performed by the vagina. The shorter the period of the irritability the more perfect is the cure. In some old standing cases the vicious habit may have become so fixed, that it is continued in spite of the operation.

HÆMORRHAGE ON THE OVARY.

Mare and Cow: genital excitement, mechanical injury, diseased ovary in
unimpregnated, ovulation with bleeding, falls, slings. Lesions: old
degenerations, productive inflammation, varicosities, aneurisms,
torpid vessels, blood staining, clots, follicular or not, ruptures
into peritoneum, amount, microbes usually absent. Symptoms: obscure,
arched, stiff loins, colics, recumbency, large tender ovary.
Shivering, fever, anorexia, anæmia, surface coldness, unsteadiness,
blood from vulva, liquid in abdomen fluctuates. Treatment: cold, ice,
snow, on loins, cold acid drinks, tannin, iron chloride, matico,
gelatine, subcutem atropin, ergotin, viburnum, derivatives,
castration.

This has been seen in the mare and cow especially in connection with genetic excitement and mechanical injuries, and more especially pre-existing disease of the ovary. Trasbot notes that it has always been in the absence of pregnancy, a fact which we can easily explain on the ground that most active diseases of the ovary render the animal barren. Gestation like castration, calms the genetic instincts, and prevents the recurrence of œstrum with its vascular excitement, general and ovarian, which characterizes the unimpregnated condition. The normal rupture of the Graafian follicle and escape of the ovum is attended by some effusion of blood which passes through a series of changes preparatory to absorption. A more extensive bleeding, at the time of œstrum or otherwise, into a follicle or intrafollicular, and with or without rupture of the albugenic tunic constitutes the morbid hæmorrhage. Among mechanical causes may be named violent exertion, falls, and suspension in slings.

_Lesions._ Some cases in mares and cows show old standing lesions, to which the extravasation is secondary: a productive inflammation of the ovarian stroma; varicosity of the ovarian veins; aneurism of the utero-ovarian artery: the presence of emboli or thrombi. In the area of the effusion there is a general turgescence of the vessels, and blood staining of the stroma. Or there are distinct blood clots in the follicles or between them, a few lines or an inch in diameter, buried in the depth of the organ, or standing out in rounded swellings on its surface, and sometimes with a rupture two or three inches in length, and the escape of blood into the peritoneal cavity. This may be sufficient merely to stain the peritoneal fluid, or it may amount to one or two bucketfuls as in cases recorded by Barrow and Palat. In the absence of rupture the effused blood may completely surround the ovary, or may accumulate in one or several of its distended follicles. The effused blood is rarely septic, being usually free from microbes, and it may remain fluid in the peritoneum, or coagulate in the ovary. The enlarged follicle may contain a dark red fluid, in which floats a solid clot, varying in color from dark red to light yellow, according to age.

_Symptoms._ These vary greatly with the extent of the lesion, and are always somewhat obscure. With slight interstitial or intrafollicular effusion, there may be only some general disorder, with, it may be, arching and stiffness of the loins, colicy pains, a desire for recumbency, and enlargement and tenderness of the ovary on rectal examination. In more severe cases as noticed by Cordonnier, Saucour and Palat in mares, by Laponsée in the ass, and Renault in the cow, there were shivering, hyperthermia, respiratory and cardiac acceleration, congested mucosæ, dull colicy pains, and anorexia, followed by indications of anæmia, small, weak, rapid pulse, pale mucosæ, coldness of ears and legs (in cows, of muzzle and horns), violent heart action, indisposition or inability to rise, unsteadiness on the limbs when up, and in some cases the escape of blood from the vulva. By rectal examination the enlarged, tender, doughy ovary may be characteristic and the fluctuation of liquid in the peritoneal cavity, which may also be recognized by manipulation of the flank.

_Treatment._ This should be directed toward checking the hæmorrhage: Cold water or ice, on loins or flank: injections of cold water: cold water or acids or astringents by the mouth: tannic acid: iron chloride: matico: gelatine: atropine, ergotin. By way of quieting ovarian excitement, viburnum prunifolium or opium may be tried. Sterilized solutions of gelatine may be given subcutem. Mustard or ammonia may be applied to limbs or flank. In case of survival, castration will be indicated.

INFLAMMATION OF THE OVARIES. OÖPHORITIS. PERIOÖPHORITIS.

Mares, cows, sows, etc. Causes: traumas, œstrum, parturition,
leucorrhœa, pus infection, strangles, dourine, glanders, abortion,
tuberculosis, chill, poisons. Lesions: Ovary enlarged unequally, red,
congested, exudate, extravasation, fibroid, caseated, purulent,
abscess single or multiple, indurations, cretefactions, cysts,
blocking of Fallopian tube, adhesions. Symptoms: mare: genital
erethism, soiling of vulva and tail, colics, tender loins and mammæ:
fever, dullness, emaciation, decubitus, paraplegia, swollen tender
ovary: cow: bellows, paws. Sterility, anæmia, pyæmia. Treatment: Cold
to croup, mustard, anodynes to vagina, calmatives, antiseptics.
Castration.

This has been frequently seen in mares, cows and sows, but it may occur in any of the female mammals or even in birds.

_Causes._ The condition has been ascribed to blows on the flanks, pressure on the abdomen and the congestion of the ovary which attends on frequent œstrum in the absence of the physiological quiet which comes from conception. In a large proportion of the cases, however, the attack has followed on parturition, abortion, a preëxisting leucorrhœa or metritis, or a suppurating process in some other part of the body. These cases therefore, must be looked upon as secondary and infective, the microbes having been transferred from the womb, along the Fallopian tubes, or through lymph vessels, or peritoneal cavity, or finally through the circulating blood. In mares strangles, abortion, leucorrhœa, dourine and glanders, and in cows and sows abortion, metritis, leucorrhœa, and tuberculosis, may prove the starting point of the infection.

Sudden chills when heated, perspiring or exhausted and especially exposure in inclement weather just before or after parturition, have been regarded as effective causes, and doubtless these lower vitality and power of resistance, but back of these we must look for infection coming from the parturient womb.

Bivort records an extensive epizootic of oöphoritis in sows kept on waste ground which had been used for herding swine years before. He attributes the trouble to poisonous plants, without, however, attempting to identify them, and the probability is even more strongly in favor of infection left over from the former herds.

_Lesions._ The inflamed ovary is swollen slightly, or to a great size, in mare or cow like the fist or even an infants’ head. The swelling, however, is unequal throughout, and the surface may bulge in rounded masses at different points. In the early stages the organ is firm, elastic, red and on the cut surface bleeding, with here and there a distended follicle with bloody or gelatinoid liquid contents. The exudate into the fibrous stroma may become coagulated, and later may be organized into fibrous substance giving a hard resistant sensation to the finger (sclerosis). In some cases this may become partly cartilaginous. In other cases the distended follicles may have their contents coagulated and transformed into a caseous mass, while much of the stroma has become liquefied and absorbed. When suppuration has set in, the gland is softened at this point, the parenchyma giving way before the pus. The pus may be in multiple sacs, as if formed in the Graafian vesicles, or it may be in one undivided abscess. In the ovary of a cow, Eléouet counted no less than sixty-three separate abscesses. In cases complicated by ovarian glanders, tuberculosis or actinomycosis, the gross, microscopic, and mycotic characters of the lesions will afford the means of diagnosis.

In chronic forms indurations, cretefactions, cystic degenerations, caseations, and sclerosis may be met with.

Lesions in adjacent structures are common, such as thickening and stenosis of the Fallopian tube; congestion, thickening and puckering of the mucosa in the adjacent part of the womb; peritonitis; adhesions of the ovary to the abdominal walls or to an adjacent organ.

_Symptoms. Mare._ In many cases the early phenomena are those of excessive genital erethism: the animal is restless, feverish, whinnies to attract other horses, snuffs the males on their approach, contracts the vulvar muscles constantly, exposing the congested mucosa and clitoris, and ejecting a glairy liquid which soils the tail, hips, thighs and hocks. She strains frequently, passing small jets of high colored turbid urine, and rubs the tail and hips against available objects, twisting and breaking the hair and abrading and excoriating the surface. The croup may be alternately drooped and raised and the tail switched. These phenomena are not abated by copulation, nor by time, like ordinary heats, but will last for one or more weeks when a new set of symptoms set in. Meanwhile dull colicy pains cause restless movements, arched back, frequent moving from place to place, crouching by partial bending of the limbs, twisting of the hind parts from side to side. The loins are tender to pressure, and the middle of the flank to pressure or percussion. The mammary glands are usually hot, swollen and tender. The genital erethism may last from four to seven days. Then it subsides, with coincident improvement of the general symptoms and a recovery ensues. Relapses are to be expected sooner or later.

In fatal cases the erethism subsides, but fever, dullness and emaciation continue, the case becomes aggravated at intervals, weakness and exhaustion increase, decubitus may become constant or paralysis ensue. The patient dies in marasmus in one to three months.

In some the genital erethism is absent from the first. There is dullness, prostration, anorexia, fever, hurried breathing, small rapid pulse, colicy pains, tender abdomen, difficult defecation, coated dung, a glairy (perhaps reddish or fœtid) discharge from the vulva, hot, tumid tender mammæ, arched and sensitive loins, and stiffness of the hind limbs.

In all cases alike a rectal examination detects the ovary swollen and exceedingly tender.

_Cow._ The same general symptoms appear with characteristic modifications. Restlessness, bellowing, pawing, inappetence, arched, tender loins, swollen vulva with discharge, shiny and perhaps fœtid but without contractions, abdomen pendent and flanks hollow and tender, udder turgid, hot and painful, movements of the hind limbs stiff, halting, straddling. There is greater tendency to salacious movements of the croup. The diagnostic feature is palpation of the ovary through the rectum.

In _chronic cases_ more or less of the above symptoms are shown in a greatly mitigated form, but oftentimes there are long intervals of apparent health. Palpation through the rectum is the final test in this as in the more acute cases.

_Prognosis._ This is very uncertain. Unless complete recovery takes place in a few weeks, the inevitable consequence is sterility, or death from hæmorrhage, peritonitis, pyæmia, or marasmus.

_Treatment._ In acute cases Trasbot strongly urges bleeding in the larger races and leeching of the flanks in the smaller. Mustard plasters to the loins and abdomen, and cold or damp applications to the croup are in order. Vaginal and rectal injections of mucilaginous liquids, containing anodynes and antiseptics are indicated. Opium, belladonna, hyoscyamus, chloral, borax, acetate of aluminium may serve as examples. If needful to quiet the excitement, morphia, atropia or hyoscyamine may be given subcutem. Or the anodynes may be administered by the mouth. As a last resort, and by far the most radical treatment, castration may be performed. With small ovaries this is best done through the vagina in the larger animals, while with large and adherent ones the flank operation is imperative. If the peritoneum is involved, careful antisepsis of the cavity is desirable. In case of adhesions the operation may be risky, but if successful it will obviate secondary infections and establish a permanent cure. Complications must be treated according to their nature.

OVARIAN CYSTS.

Mare, cow, ewe, sow, bitch, hen. Forms. Histogenesis. Dilated
vesicles, egg tubes, blood obstruction. Lesions: Ovary large, smooth,
lobulated, vascular, size, connective tissue, epithelium, liquid
contents. Abscess. Symptoms: impaired portal circulation,
muco-enteritis, piles, intestinal torpor, impaction, constriction,
obstruction, congestions, inflammation. Urinary disorder.
Strangulation. Sterility. Abortion. Dystokia. Indigestion. Anorexia.
Colic. Genital erethism. Straining. Altered Urine. Peritonitis. Septic
infection. Collapse. Rectal palpation, enlarged, sensitive ovary.
_Treatment_: Castration. Tapping cyst. Rupturing cyst by compression.

These have been met with in all races of domestic animals, mare, cow, ewe, sow, bitch and hen. They vary greatly in their characters, being unilocular, multilocular, rounded or lobulated, serous, albuminous, colloid or hæmorrhagic, strictly ovarian or parovarian (in broad ligaments), in one ovary or in both.

_Histogenesis._ The source of these cysts has been much debated. Many have held with Spencer Wells that they have their origin in dilated Graafian vesicles, and the discovery of an ovum in the contents, by Rokitansky and Ritchie showed at least that this follicle had formed part of the cyst. On the other hand Foster, Rivolta, Klebs, Malassez and others, constantly failed to find ova or other distinct elements of the Graafian follicles, but did find epithelial elements, and note that the cysts are at an early stage connected with the surface of the ovary like the egg tubes. These embryonic tubules of Pflueger are therefore held to be the starting point for the cysts, which because of their mixed epithelial as well as liquid contents, seem allied to adenoma. From observations on the ovarian cysts of the lower animals Galtier, attaches great importance to vascular obstructions. Obstruction by pressure or otherwise led to hæmorrhages and transudation of blood, and the cavities formed in this way became the seats of epithelial growth, and liquid effusion. The blood remained for a time as distinct clots, and was later indicated by the pigmentation of the walls of the cyst.

_Lesions._ The enlarged ovary may be uniformly rounded and smooth, or it may be marked by irregular bosses, giving it a lobulated appearance. It is very vascular, and is often covered by a thickening of peritoneum. When multiple they are usually closely adherent and may even be included one within another. The individual cysts may be of the most varied sizes. The cystic ovary has at times reached enormous dimensions: in the mare 46 lbs. (Bouley, Rivolta, Thiernesse): in the cow 250 lbs. (Reynolds, Meyer): in the ewe 7 lbs. (Willis): in the sow 7 lbs. (Reyer): in the bitch 15 lbs. (Bovett). The walls of the cyst are formed of connective tissue more or less perfectly organized, arranged it may be in several superposed layers (Galtier) and lined or not by epithelial cells (cylindroid, nucleated, or of various forms). They may be reddened by hæmorrhages or pigmented from former blood extravasations. The liquid contents may be clear and watery, white, straw yellow, or of a deeper yellow, brown or red. Among other constituents there are alkaline chlorides and sulphates, albumen in solution or flakes, mucin, fibrine, fatty granules and cholesterine crystals. In some instances they contain pus cells (chronic abscess).

_Symptoms._ Small, tardily growing cysts may cause no appreciable symptoms. The larger ones or those that increase rapidly are liable to cause disorders of circulation, innervation and digestion. The mere pressure of a considerable cystic ovary may interfere with portal circulation so as to entail muco-enteritis, rectal congestion, piles, or intestinal torpor or impaction. Adhesions of the diseased ovary to adjacent intestinal viscera, tend to produce constrictions, obstructions and local congestions or inflammation. In adhesions to the womb or bladder, ureter or kidney, the symptoms will indicate disorder of these respective parts. The weight of the enlarged ovary causing extension of its ligamentous connections will allow of its winding around a loop of intestine and producing strangulation. In those unusual cases in which pregnancy occurs it may interfere with its completion, causing abortion or, failing in this, with parturition, by becoming imbedded in the pelvis. In the line of innervation, disorder is especially common in the digestive organs, anorexia, nausea, impaired rumination, and colicy pains resulting. Again, in many subjects the genesic instinct is stimulated, the patient is more or less constantly in heat, cows become _bullers_, and mares _switchers_, they cannot be impregnated, and under the continuous excitement undergo rapid emaciation. There is often urinary disturbance, frequent straining with the passage of a small quantity only of turbid or glairy liquid, colored, it may be, by blood, or fœtid. The colics are liable to be dull and slight, the patient moving uneasily, switching the tail, moving the weight from one hind foot to the other, pawing, looking at the flank, but seldom lying down or rolling. In other cases, with adhesions, impactions, obstructions, and congestions, all the violent motions of the most intense spasmodic colic may be shown. Where there has been rupture of the obstructed bowel, these symptoms may merge into those of peritonitis, septic infection, or collapse. When with these symptoms of intestinal disorder, there are tender loins and flank, abdominal plenitude and tension, genital excitement, frequent straining to pass urine, the discharge of a glairy or fœtid liquid, and when all these symptoms have increased slowly for weeks or months in a female, the ovaries may be suspected and a rectal examination should be made. Usually the outline of the womb can be made out with the enlarged and irregularly shaped ovary anteriorly and adherent to it through one of the broad ligaments; it may be sensitive to touch, tense, or even fluctuating. Difficulty may be encountered when the enlarged ovary is so great as to fill the whole region, or when adherent to or wound round the rectum, thus hindering the advance of the hand or the movement of the gut, or when it has become pediculated and displaced to a distant part of the abdomen. Even the obstructed and distended intestine, may prevent a satisfactory diagnosis. Yet in the great majority of cases rectal examination gives conclusive results.

_Treatment._ Medicinal measures are useless: surgical alone are of any avail. Castration is the natural resort, and in all recent cases, uncomplicated by adhesions, is to be preferred. In the large females it may often be performed through the vagina, but if the ovary is very large the flank operation becomes imperative. Sometimes the evacuation through a cannula of the contents of one or more large cysts will so reduce the mass as to allow of the safer vaginal operation.

A less radical measure is the evacuation of the cyst with cannula and trochar and the injection of tincture of iodine. With a hand in the rectum the ovary may be held against the abdominal wall to facilitate the operation. The results, however, are not satisfactory, for, although re-accumulation of the liquid is delayed, it is not entirely prevented. Moreover, when the cysts are multiple, the punctures also must be numerous, or remain ineffective. Nor is the operation unattended by danger as deaths often occur from resulting inflammation, infection, or iodine poisoning.

Zannger, in 1860, introduced the method of rupturing the cyst without incision, and met with considerable success. With the hand in the rectum the cystic ovary is pressed against the wall of the pelvis or abdomen, until the attenuated wall of the cyst gives way, the fluid is left in the abdominal cavity, to be absorbed and many animals will afterward become pregnant. In a large proportion of cases in which the symptoms are marked, the walls of the cyst are sufficiently attenuated to allow of rupture by pressure, and, if the escaping contents are free from infecting microbes, no immediate harm comes to the peritoneum. It should be avoided in case of abscess, following perhaps on a shivering fit and constitutional febrile reaction, and when there is a fœtid discharge from the vulva, suggesting microbian infection likely to dangerously infect the serosa. In appropriate cases it is a resort of very great value, in restoring to use animals that are especially valuable for their progeny and which become utterly useless when rendered barren. According to different observers an average of 70 per cent. can be restored to usefulness in this way. Friedberger and Fröhner claim 90 per cent. Some febrile reaction may be noted for twenty-four hours, demanding rest, restricted, cooling, laxative food and sometimes laxatives and anodynes.

DERMOID CYSTS OF THE OVARY. PILOUS CYSTS.

Closed cutaneous sacs, with hair and sebum. Causes: enclosure of
dermoid tissue in embryo: aborted ovum: virgin gestation. Symptoms.
Treatment: Castration.

These are much less common than are simple cysts. They are closed sacs, lined by a tissue essentially representing skin, and containing sebaceous matter and hairs, some growing from the dermoid surface, and others detached and formed into a loose mass.

_Causes._ These cysts have been attributed to the enclosure, in the forming embryo, of the formative elements of dermoid tissue, which may or may not remain latent and inactive until maturity, or until the ovary becomes physiologically active.

Another theory is that an impregnated ovum has remained imperfect, developing only the elements of the skin, instead of the whole fœtal body. Many cases cannot by any possibility be included under this head, seeing that the cyst is found at much too early an age, and its bearer has never had sexual intercourse.

Another doctrine is that the dermoid cyst is derived from the normal plastic or formative powers of the ovary, and the product becomes suggestive of parthenogenesis or virgin gestation. The fact that these cysts are not confined to the production of skin and hair, but at times form bone, teeth, nervous and other tissues as well, corroborates this view. On the other hand we must bear in mind that dermoid cysts are much more common in other tissues than they are in the ovaries. Thus they are common in the subcutaneous connective tissue and between the muscles.

The _symptoms_ do not differ essentially from those of simple cysts and _treatment_ is mainly by castration. As the escape of the contents into the peritoneal cavity is especially provocative of infection, the greatest care must be taken to extract the mass whole, or to use the most thorough antiseptic precautions.

SOLID OVARIAN TUMORS.

These are much more rare than cystic tumors. They seldom maintain the character of perfect solidity, for whether fibrous, sarcomatous, melanotic, cretaceous, myomatous, cancerous, epithelial, tubercular, glanderous, or actinomycotic, they are usually associated with cysts to a greater or less extent. Not only are they liable to stimulate the formation of cysts, but the special heteroplasia may become engrafted on the walls of pre-existing cysts, as well as on normal tissues.

The _symptoms_ of the solid tumors are in the main, those of the cystic form, and _treatment_ resolves itself into extirpation by castration. Its success will vary according to the nature of the tumor, sarcoma, melanoma and carcinoma being especially liable to recur in the same or in distant situations, and the same is true of the colonizing with infectious germs (glanders, tuberculosis, actinomycosis) which are presumably already present in other parts of the body. Castration has, however, this recommendation, it secures the removal of the entire diseased organ, and if the morbid process or infection is confined to that only, it holds out the best prospect of recovery.

INFLAMMATION OF THE FALLOPIAN TUBES. SALPINGITIS.

This condition is met with in the female mammals of all species and mainly as the result of an infection extending from diseased womb or ovary. The results are degeneration of the epithelium, exudation into the mucosa with thickening, stenosis of the tubes, the formation of cysts along the line of the canal, with pink or straw colored contents, including fibrine, leucocytes, epithelium and granular debris. As in oöphoritis there may be blood extravasations and clots and abscess. In the cow they are at times calcified and create a suspicion of tuberculosis.

The _symptoms_ are essentially those of metritis or ovaritis, and as these are usually more prominent the attendant salpingitis is generally overlooked during life. Careful rectal examination may detect the enlarged, tender or sacculated tubes. _Treatment_ may be laxative, diuretic, derivative, and antiseptic toward the womb. Ablation of the ovaries, tubes and even the womb is often required.

DISEASES OF THE OVIDUCT IN BIRDS.

Imperforate tube near cloaca. Polypus: snare and twist off. Egg
impaction: from atony, inflammation, stricture, congenital smallness,
exhaustion, large eggs, thick end first, broken egg. Symptoms: mopes
alone, feathers erect, wing and tail drooping, large, solid swelling
around anus and abdomen. Rupture into abdomen. Treatment: oil cloaca
and oviduct, manipulate, turn, break egg and scoop out, incise and
extract, antiseptic oils. Excision of ovary.

_Imperforate oviduct_ usually occurs in the lower part of its course, the tube being connected with the cloaca by a short, fibrous cord. In the case of a very valuable bird it may be incised and the walls of the duct may be brought down and fixed to those of the cloaca.

_Polypi of the oviduct_ may seriously impede laying, and start obstruction and impaction. The seat of the tumor having been ascertained, it may be seized and twisted off by a snare. An elastic wire is passed through a small metallic tube so that a loop protrudes large enough to pass over the polypus. When fixed around the pedicle, it is tightened, and the tissues twisted through.

=Egg Impaction in the Oviduct.= From weakness or lack of tone in the bird, by inflammation and loss of contractile power in the oviduct, by stricture of the duct as a sequel of inflammation or abrasion, by congenital narrowing, by weakening of the oviduct through constant laying, by excessive size of the egg, by double yolked eggs, by presentation of a large egg with its thick end first, or by an egg with broken shell, the oviduct may be rendered incapable of passing the egg on and out, and as others continue to press down from above an excessive and dangerous impaction ensues. The bird refuses food, mopes around with ruffled feathers and drooping head, wings and tail. The region of the anus and in front of it hangs downward and feels firm and solid, and the oiled finger introduced into the cloaca comes in contact with the impacted mass. The bird strains violently but ineffectually and rubs its anus on the ground. The swelling goes on steadily and rapidly increasing, and the bird becomes more prostrate and hopeless. Sometimes the overdistended and congested oviduct gives way and the eggs escape into the abdomen. Reul has counted as many as 24 eggs that had thus escaped into the abdominal cavity. Or without rupture of the oviduct, the soft eggs pack together into a solid, dry yolk-like mass, the watery parts having been pressed out or absorbed. In bad cases this may weigh 1½ lb. in the hen (Weber). In the way of _treatment_ the cloaca and oviduct should be thoroughly lubricated with a bland oil, which might be injected with a syringe, so as to pass it, if possible, around the impacted egg or mass. By careful manipulation the egg may now be brought away. If the thick end is presented it is sometimes possible to turn it so that the thin end will come first. Should all fail the egg may be broken and its contents together with the other impacted matter may be dislodged with a looped wire or small spoon. The oviduct should be lubricated for some time with a bland antiseptic oil (olive oil and boric or salicylic acid). In obstinate cases the abdomen and oviduct may be laid open and both evacuated of any egg matter that may be present. After suitable antisepsis the wounds in the oviduct and abdominal walls are to be sutured. If there appears to be danger of the further early descent of eggs into the weakened oviduct the ovary may be removed.

_Eversion of the Oviduct._ This appears at times as a result of the intromission of the penis (ducks) being shown immediately after copulation as a pink, lax membrane one or more inches long, dragging from the anus. In other cases it appears to result from the paresis that occurs in old birds from prolonged laying, or from inflammation and impactions. It may appear abruptly or gradually, and after a few hours becomes the seat of exudation, swelling and redness, forming a pyriform mass. In some cases it is carried out around an egg which does not glide through its canal and may be felt through its walls, and through its terminal opening. A partial eversion may take place as an invagination into the cloaca, without showing externally. When an egg is impacted, or when the protruded organ is inflamed and swollen, violent straining continues, which tends to aggravate the condition, and the bird gets rapidly exhausted, resting on its breast, later upon its back, and dying in convulsions.

In slight cases following copulation, the vermicular movement of the duct, of the cloaca and anus may serve to secure speedy spontaneous reduction. In the partial cases, of eversion into the cloaca, the free local use of oil, may secure the passage of the presenting egg and the return of the oviduct. If necessary the egg may be broken and its shell thoroughly extracted. This last method is imperative when the egg enclosed in the oviduct has already passed through the anus. The oviduct should then be cleansed in tepid water, and laudanum, oiled and returned.

_Inflammation of the oviduct_ is a common condition resulting from debility, from impaction of an egg or of egg-material, from scratching with the shell of a broken egg, and from microbian invasion. The frequent passage of large eggs is an accessory cause, and the egg becomes an important factor in the maintenance and aggravation of the inflammation. The mucosa becomes red, dry, infiltrated, thickened and friable, and the muscular coat increasingly paretic. The egg, becoming impacted, and subjected to constant pressure in the vain efforts at expulsion, hinders circulation and nutrition, and favors necrotic and ulcerative processes, and too often the fragile membranous walls yield, and the mass drops into the abdominal cavity. Short of this, the exudate at a particular point, the main seat of inflammation, contracting in undergoing organization, forms a distinct stricture, which renders the further laying of fully formed eggs difficult or impossible, and further impaction, inflammation and rupture may follow. Sometimes the irritation causes undue peristalsis in the anterior and less actively inflamed part of the tube, and the eggs are laid prematurely without albumen or without shell, yet with much effort and suffering. Or the bowels become irritable and a profuse diarrhœa sets in, hastening the exhaustion of the patient.

_Treatment_ should be applied early. A cooling diet of vegetables or slops, the careful removal of all irritating contents from the oviduct, and its frequent injection with bland oils medicated with mild antiseptics (boric or salicylic acid, or potassium permanganate) will usually serve a good purpose.

HYDROMETRA AND PYOMETRA.

Cause: chronic metritis, tumors, microbian infection. Symptoms:
ill-health, low condition, vulvar swelling or discharge, swelling and
fluctuation of womb. Rectal exploration. Treatment: evacuate liquid,
disinfect womb and passages, creolin, iodine.

As a rule these conditions belong to obstetrics and would not come under the scope of this volume, but when in chronic cases, with closure of the neck of the womb, the liquids accumulate and distend the uterus, they may deserve mention in a medical work.

The _cause_ is usually a chronic metritis, originating it may be at the time of a now distant parturition, or associated with tumors or microbian invasions of the womb. In the deadly cases that follow upon parturition and abortion streptococcus is usually present, in the more chronic forms the staphylococcus or other pus microbe.

The _symptoms_ are those of general ill-health, low condition, pallor of the visible mucosæ, sometimes swelling of the vulva with discharge, serous or purulent, lessened milk yield, enlargement of the abdomen with fluctuation felt in the right flank, or still better with the hand in the rectum. Rectal exploration will further detect the distended uterus connected with the vagina behind and dividing in front into two horns.