CHAPTER IV. Genital Apparatus.

GENITAL APPARATUS.

=Semiology.= The examination of the genital apparatus properly so called is easy in animals of large size, whether male or female, but is more delicate and difficult, and is sometimes partially impossible, in small creatures.

In male animals it comprises the examination of the testicles by inspection and palpation, of the vas deferens, and of the intra-pelvic genital organs (vesiculæ seminales, prostate, etc.).

Inspection and palpation of the scrotum reveals hypertrophy, atrophy, œdematous or sanguineous infiltrations, inflammation of the tunica vaginalis, and tumours of the testicle. Intra-pelvic examination partly covers the same ground as examination of the pelvic portion of the urethra, and, provided the anatomical relationships of the different organs encountered are known, there is no difficulty in detecting the position of possible lesions (Fig. 226).

In small male animals, such as he-goats and rams, rectal exploration is confined to the use of one or two fingers.

In female animals examination comprises inspection, intra-vaginal examination, and rectal examination.

Inspection reveals lesions of the vulva and clitoris.

Vaginal examination with the hand establishes the condition of the walls of the vagina, the neck of the uterus, and the vaginal culs-de-sac.

If a lesion is detected, its character can easily be ascertained by means of a speculum, which exposes the base of the vagina, the prominence formed by the uterus, or any particular part of the vagina itself. Examination with the speculum is the only useful method in young female animals, heifers in particular, on account of the narrowness of the genital tract.

In small female animals, such as she-goats, ewes and sows, the fingers alone can be employed.

As regards examination of the uterus, the direct method gives little exact information, and examination by the rectum is to be preferred. By passing the arm into the rectum and gently pressing downwards towards the base of the pelvis, the hand can be brought in contact with the body of the uterus, which can be moved and displaced from right to left; the horns of the uterus can be felt and followed from the body of the uterus as far as the Fallopian tubes and the ovaries. By this means the state of the uterus, its degree of sensitiveness and mobility, as well as the state of the Fallopian tubes and of the ovaries, can all be ascertained. The examination also reveals the existence or non-existence of gestation, during which the uterus becomes hypertrophied and is displaced in a forward direction towards the right flank, at the same time descending in front from the base of the pelvis over the abdominal wall and under the mass of the intestinal convolutions.

VAGINITIS.

Inflammation of the vaginal conduit may be primary or secondary. It usually follows difficult parturition, but may occur under various circumstances. From the clinical standpoint three varieties are distinguished: simple or contagious acute vaginitis; croupal vaginitis; and chronic vaginitis.

ACUTE VAGINITIS.

=Causation.= Deep-seated genital injuries leading to metritis, excessive and prolonged strains due to painful labours, accidental injuries caused by obstetrical operations, etc., are followed by more or less acute vaginitis.

Suppurative inflammation of Gartner’s canals, irritant and caustic injections, and foreign bodies likewise cause local irritation, which may become complicated by infection and eventually produce vaginitis. The infective organisms may be numerous and varied.

=Symptoms.= The vagina being closed to external inspection, the symptoms are not very apparent. At first, acute vaginitis is suggested by swelling of the vulva, pruritus, and dysuria. The lips of the vulva are œdematous, injected, sensitive and of a brownish-red or violet-red colour on the internal surface. Sometimes they are excoriated and torn.

The period of full development is accompanied by the escape from the vulva of a serous, mucous, muco-purulent or purulent discharge of varying odour. Urination is painful and defæcation difficult. Examination of the vagina by means of a speculum shows the mucous membrane to be excoriated, ultra-sensitive, ulcerating or suppurating at certain points. The parts are hot.

The general symptoms are little marked, and without importance. The usual termination consists either in recovery, which may be spontaneous, or in passage to the chronic form.

The =diagnosis= is easy, and the =prognosis= favourable, provided the vaginitis has not been caused by severe mechanical injuries, capable of setting up cellulitis or the formation of deep abscesses of the pelvis.

=Treatment.= One of the principal reasons why vaginitis persists is the retention of morbid products in the vaginal culs-de-sac. Treatment ought therefore to aim chiefly at removing these by soothing, astringent, and antiseptic injections. Soothing injections should first be tried. They consist of lukewarm water at body temperature, decoctions of black-cherry bark, poppy-heads, linseed, etc. After a few days, when the excessive sensibility has disappeared, antiseptic and astringent solutions may be used, such as crystallised alum, 150 grains to the pint; sulphate of zinc, 75 grains to the pint; carbolic acid, lysol, cresyl, etc., 150 grains to the pint.

Injections of permanganate of potash of the strength of 150 grains to the pint and of solutions of iodine at a strength of 1 in 2,000 are more active, but require more careful handling. Hydroxyl diluted with from 3 to 5 parts of water is also of great efficacy. Strong solutions should never be used, because they cause irritation and expulsive efforts.

All these injections may be made without difficulty by passing a simple perforated drainage tube to the end of the vagina, and connecting it with a syringe, or, better, with a small cistern hung from the wall, which allows the required pressure to be obtained.

When there are deep and severe wounds, the parts should be washed out once or twice daily and the vagina should be packed with surgical wool and iodoform gauze. The septic liquids are absorbed by the dressing, which acts continuously. This dressing is renewed until recovery takes place.

CONTAGIOUS VAGINITIS.

During the past few years certain observers have described a disease which has been termed “contagious vaginitis,” in consequence of the facility with which it is transmitted.

This vaginitis may be transmitted by copulation, the bulls then serving as propagators of the disease. The bulls themselves are usually affected with balanitis.

The causative agent of the disease is unknown.

This contagious vaginitis is characterised by all the symptoms of acute vaginitis, and it is only from the fact of its appearing in all the animals served by one bull that its contagious character is established. A short time after service the vulva appears swollen and extremely sensitive; at the same time general disturbance appears, viz., diminution of appetite and of milk secretion, slackening of rumination, etc.

Vaginal exploration, which is somewhat difficult, reveals a papulovesicular eruption, accompanied by a muco-purulent discharge.

This vaginitis is easy to diagnose. It may disappear spontaneously, and the treatment differs in no respect from that of ordinary acute vaginitis.

CROUPAL VAGINITIS.

Croupal vaginitis is a form of acute vaginitis, from which it is distinguished by the formation of false membranes resembling those of diphtheria over the whole of the vaginal mucous membrane.

It was described by Baumeister. Moussu has only seen one case, and that at a period which rendered recovery out of the question.

=Symptoms.= The external symptoms are those of acute vaginitis, with greyish, fœtid, purulent or sanguinolent discharge. On examination, the mucous membrane is found to be covered with yellowish, greyish false membranes, and with vegetations of a greyish, dirty, verrucous appearance. The entire extent of the vaginal mucous membrane may be attacked, together with the neck of the uterus. In Moussu’s case the uterus itself was entirely invaded.

These false membranes and vegetations are very adherent, and bleed freely at the slightest touch. They are apt to extend by degrees.

The cause of this infection has not yet been determined. It appears to obtain access to the parts during parturition, and develops insidiously for a week or two, when widespread lesions have already formed.

=The diagnosis= is extremely easy.

=The prognosis= is grave, for the lesions have a tendency to extend towards neighbouring organs. Moreover, the general health is severely affected; there is rapid wasting, loss of appetite, and continued fever and death occurs from exhaustion, intoxication, and possibly infection.

=Treatment.= The treatment suggested for the ordinary acute forms appears to be useless in this condition. The new membranes show too many folds, depressions, and accidental culs-de-sac for simple injections to have any real effect. Better results might be expected from packing with antiseptic gauze or from the use of antiseptic ointments applied after washing out the cavity with permanganate of potash solution or hydroxyl.

Curettage, followed by the use of gauze dressings, might also be tried; considerable difficulty must necessarily be anticipated in operating in a cavity which has become inextensible and partly filled with vegetations and false membranes.

CHRONIC VAGINITIS.

Chronic vaginitis usually represents the last stage of some form of acute vaginitis, though it occasionally develops in a slow and progressive fashion as a primary condition in consequence of some deep-seated genital lesion. There is usually a constant discharge of irritant material.

The symptoms are not very striking, and are purely local.

Externally all that can be detected is a continuous or, much more frequently, an intermittent muco-purulent discharge from the vulva, which occurs only on urination, defæcation, coughing, etc.

Locally, examination with a speculum discloses the fact that the mucous membrane is of a greyish colour, thickened, less yielding than usual, and in places sclerosed. The entire thickness of the mucous membrane is affected, as also at times the muscular tissue, chronic irritation having caused sclerosis.

The =diagnosis= is very simple, and the =prognosis= of no particular gravity, because the animals can always be fattened. The condition is only grave as regards animals intended for breeding.

=Treatment= is often very successful, but, as in all chronic diseases, it extends over a considerable time. Practically it is not often attempted. It does not differ greatly from that of ordinary acute vaginitis, but the best results seem to follow the use of astringents.

METRITIS.

Infectious or traumatic diseases of the uterus are of the greatest importance in bovine pathology, both on account of their frequency and gravity. They comprise septic metritis, acute metritis, and chronic metritis.

SEPTIC METRITIS.

Septic metritis is also termed “metro-peritonitis” and “parturient septicæmia.” It may be compared with puerperal fever in woman.

These terms are sufficiently explicit to indicate that if at first the metritis is typical it frequently becomes complicated with peritonitis, and too often also with true septicæmia.

=Causation.= The disease only appears after parturition or abortion, and during the few days immediately succeeding delivery. Parturition may occur spontaneously in a perfectly regular and easy manner, and nevertheless be followed by fatal metritis as a consequence of infection. Usually the labour has been difficult, and the after-birth, or portions of the fœtal membranes, have been retained. Septic metritis then develops in consequence of their putrefaction.

Infection with microorganisms is therefore the essential cause, and the only one of importance. None of the conditions formerly invoked can do more than favour or check the course of this infection.

Moreover, the subsequent complications are entirely due to the special character of the infective agent.

These infective agents may be of various descriptions. They have been the subject of numerous investigations, on account of the gravity of puerperal fever in woman. Pasteur, Colin, Chauveau and Doléris were the first to take up this question. In veterinary medicine several inquiries have been instituted, but a great deal remains to be done. The most frequent agents are varieties of streptococci, of the colon bacillus, and of putrefactive bacteria.

Septic metritis may occasionally be purely accidental and only affect one animal, but infection of stables by a primary case is an obvious cause of propagation. Moussu has seen six animals successively die of septic metritis in one year, and in a stable which had not been disinfected after each death.

=Symptoms.= The first symptoms occur between the first and fourth days after parturition, when the uterine mucous membrane is still tender, discharging and bleeding, and the lochial discharge is abundant. The disease rarely appears after the first week. The earliest symptoms are dulness, depression, loss of appetite, and general weakness. The animals appear exhausted, the secretion of milk is diminished or altogether suspended, and all the chief functions of the body are interfered with.

The temperature varies in a peculiar and significant way. In some forms, due to infection with streptococci or to mixed infection, it rises to 104° or 105° Fahr.; in others it remains stationary or falls below normal. It might be thought that in these latter cases, which are usually due to infection with the colon bacillus, the general condition was not grave. This, however, would be a very serious error, for in such cases death follows as rapidly as in the others.

The patients, or some of them at least, have slight colic and peritonism when the infection extends to the peritoneal pockets at the entrance to the pelvis. At a later stage they appear prostrate, remain lying, and seem to be suffering from paralysis of the hind quarters.

None of these general symptoms are in themselves significant, and to appreciate them at their true value the local signs must be taken into account.

The external genital organs are moderately swollen, the vagina is infiltrated and sensitive, and is soiled by exudate of varied character.

The neck of the uterus is sometimes prematurely contracted after the first or second day, constituting a troublesome complication both in examining the parts and in treatment. When, however, it is dilated and the hand can be passed, it is found that the uterus itself is not contracted or is only half-contracted, and that it is filled with a reddish-grey liquid of putrid appearance, sometimes without smell, at others fœtid or even putrid.

The uterine mucous membrane is infiltrated, thickened, and extremely fragile, partially destroyed, and breaks at the slightest touch. The cotyledons may become loosened by necrosis, and accumulate in the depression formed by the gravid horn of the uterus; otherwise they may be detached without difficulty.

When the neck of the uterus is prematurely contracted direct exploration gives no result, but rectal examination reveals a much enlarged uterus, filled with liquid or distended with putrid gas.

If, however, the after-birth has not come away, fragments of fœtal membranes may be removed from the deeper portions of the uterus or the surface of the cotyledons.

Death is inevitable unless treatment is early initiated. The animals succumb to infection produced by germs entering the vascular apparatus. When the infection extends by contiguity of tissue to the peritoneal cavity the immediate causes of death are infection and intoxication. In cases where the infection remains localised within the uterus the animal is poisoned by the absorption of toxins through the uterine mucous membrane.

The condition may prove fatal in from four to six days in the cow, but in a shorter period in the goat, ewe, and bitch.

=Lesions.= The uterus is excessively fragile, and can be torn at will. The mucous membrane in which the microorganisms more particularly develop appears necrosed in places. Large areas are sloughing or ulcerated.

The vessels are thrombosed, and extensive portions of the organ may be affected by true capillary phlebitis.

The lymphatics are dilated and distended with pus in animals which have resisted for some days.

If there is peritonitis, the entire floor of the abdominal cavity is affected, and sometimes the peritonitis is generalised.

The lesions in the other tissues and viscera are similar to those found in septicæmia and in general intoxication, such as injection of the capillary system, and interstitial extravasations of blood in the pleura, pericardium and other tissues.

=Diagnosis.= The diagnosis of septic metritis is not very difficult, though something more is required than simple observation of external signs. From the clinical standpoint it is of no great importance to distinguish between the various forms or to determine the responsibility of microorganisms for the infection. In every case the practitioner must utilise all the means at his disposal.

=Prognosis.= The prognosis is extremely grave, and death almost invariably occurs when treatment is not early undertaken.

=Treatment.= Treatment should be prompt and energetic. Infection of the genital organs being the cause of the symptoms, it is against this that remedies should be directed. The parts should first be thoroughly washed out with boiled water at the body temperature. A stiff drainage tube about 6 feet in length is passed to the base of the uterus and connected at its free end with a reservoir of liquid, which can be raised so as to obtain sufficient pressure. During this operation the animals should be placed with the front limbs higher than the hind.

When the liquid injected returns perfectly clear, antiseptics may be employed. Strong solutions containing mercury, carbolic acid, lysol or creolin should be avoided, partly because of their toxic action, but principally because they cause irritation and violent expulsive efforts.

A 25 per cent. hydroxyl solution gives surprisingly good results. A 1 in 2,000 iodine solution (iodine 15 grains, potassium iodide 1 drachm, warm water 4 pints) is also of very great service.

As the first irrigations are difficult to carry out thoroughly, it is often advisable to cleanse the parts directly by means of a large disinfected sponge, which should be passed over the whole surface of the mucous membrane and into the depressions of the uterus, thus directly removing septic liquids. Thereafter irrigation will be easier and more efficacious.

This method, however, of cleansing the parts is dangerous for the operator unless he takes the antiseptic precautions necessary in every case of delivery.

When the neck of the uterus is prematurely contracted, the difficulties become much greater, and are sometimes insurmountable on account of the impossibility of dilating it. It then becomes necessary to use metallic canulæ or uterine sounds made of aluminium in order to pass through the neck of the uterus. Liquids can be evacuated by compressing the uterus through the wall of the rectum, but the method is very troublesome.

This local treatment should be practised twice a day at least until all danger is over, and may be completed by the administration of diffusible stimulants, such as alcohol in doses of 6 to 10 ounces, acetate of ammonia in doses of 2 drachms, wine, coffee, and diuretic decoctions. These may be given with food or drink to whatever amount is considered necessary if the animals still retain their appetite. The food should be light and easily digested.

From 8 to 12 pints of physiological salt solution may be injected intravenously every day, the temperature at which this fluid is injected being varied according to the degree of fever. (Physiological salt solution consists of chloride of sodium 9 parts, sterilised water 1,000 parts.)

=Prophylaxis.= Should a case of septic metritis occur in a byre containing other cows about to calve the building should be disinfected.

ACUTE METRITIS.

The term “acute metritis” is used to indicate a variety of inflammation of the uterus of a sufficiently grave character, which, however, does not prove fatal in twenty-four or forty-eight hours.

=Causation.= In domestic animals acute metritis develops exclusively after difficult parturition and as a consequence of the tearing of tissues or accidental post-partum infection.

At one time it was the rule to recognise a traumatic form consequent on wounds by embryotomy hooks, crutches, cords, etc., etc. There is no reason for maintaining this distinction, because the essential condition for the development of metritis is the infection of the injuries.

Acute metritis follows non-delivery, incomplete delivery, or accidental infection.

=Symptoms.= The external signs are very few, and must be carefully studied, in order that wrong conclusions may be avoided.

Certain of these external signs suggest general disturbance such as one finds in all acute visceral inflammations, viz., loss of appetite, progressive wasting, irregular slight fever, diminution or cessation of the secretion of milk, dulness, etc.

The others are purely local. The discharge from the vagina is mucoid, muco-purulent, sanguinolent or fœtid, according to circumstances. It is small in quantity, and occurs only when the animal lies down or makes expulsive efforts. Examination with the speculum reveals the existence of slight secondary vaginitis and more intense inflammation of the neck of the uterus, which remains half open. Rectal examination shows that the uterus is abnormally large and more difficult than usual to displace. If acute metritis has existed for some weeks, the uterus is painful to the touch, and sometimes fixed in position in consequence of the development of parametritis and of slight pelvi-peritonitis, the occurrence of which is always indicated by temporary tympanites.

Cases of acute metritis may recover spontaneously, but they rarely do so. The condition usually tends to become chronic or to be complicated with peri-uterine diseases which may prove fatal.

=Diagnosis.= The diagnosis can be established without difficulty by rectal examination and direct examination with a speculum.

=Prognosis.= The prognosis is grave, because the patients are temporarily or permanently incapable of becoming pregnant, and because acute metritis may be complicated with pelvi-peritonitis, phlebitis of the intra-pelvic veins, etc.

=Treatment.= The uterus, and particularly the uterine mucous membrane, being affected, all our efforts should be concentrated on that organ. A careful study of the lesions shows that the glandular follicles are infected, and with them the entire thickness of the mucous membrane. The object to be attained, therefore, is the perfect disinfection of this tissue. The parts should repeatedly be washed out with warm water at blood-heat, followed by antiseptic injections containing 4 drachms of chloral per pint; a 1 in 2,000 iodine solution or 20 per cent. to 25 per cent. hydroxyl solution, etc. Despite such injections, the inflammation disappears slowly and with difficulty, and when the neck is sufficiently open it might perhaps be possible, as in human medicine, slightly to curette the mucous membrane of the uterus and plug the cavity with iodoform gauze.

Where, however, the neck of the uterus is so far contracted as no longer to admit a sound or canula for irrigation, the difficulties are very great. Nothing effectual can be done until the neck of the uterus is dilated, an exceedingly troublesome operation.

In the forms termed “post-partum traumatic metritis” antiseptic injections must not be made with any considerable pressure, because of the danger of rupture; plugging the cavity with antiseptic gauze is preferable.

CHRONIC METRITIS.

Chronic metritis is often the termination of acute metritis, though inflammation of the uterine mucous membrane may assume the chronic form from the first. All post-partum infections with pathogenic microbes may give rise to chronic metritis, as may the various forms of cystitis, vaginitis, rupture of the vulva, etc. Tuberculosis also leads to chronic metritis, which is easily diagnosed by a simple bacteriogical examination of the discharge.

=Symptoms.= Chronic metritis is accompanied by bad general health and persistent local disturbance. The animals show a permanent muco-purulent discharge varying in amount, or simply an intermittent discharge, which is then more abundant and only lasts some hours or some days, but reappears after irregular intervals. On examination the neck of the uterus is found to be half open, slightly hypertrophied, sometimes sensitive, and covered with vegetations.

Examination through the rectum may show the organ to be considerably hypertrophied, sensitive, and comparatively immobile. Cases are numerous, however, in which the examination reveals nothing very striking.

In other cases, vaginal examination by means of the speculum reveals nothing, except that the neck of the uterus is completely closed, and yet on rectal examination the uterus is found to be of large size, tense, uniformly fluctuating, and in exactly the position to be expected were the animal pregnant. This clinical form was formerly termed “hydrometritis,” but it would be better named “pyo-metritis,” inasmuch as it depends on chronic metritis. The neck of the uterus remains contracted, and the morbid products accumulate in the body and uterine horns, which are gradually dilated. Then suddenly the uterus is seized with reflex contractions overcoming the resistance of the neck and expelling the contents in one jet. The discharge may continue for some days, after which the neck again closes and the disease enters on a new phase.

=Lesions.= The lesions affect the mucous membrane, more particularly the glandular tissue and the interstitial tissue. From the anatomical and pathological point of view different forms are recognised, some with glandular and mucous atrophy, others with marked hypertrophy, the mucous membrane being covered in some cases with vegetations and fungus-like growths.

=Diagnosis.= From a clinical standpoint, it is only necessary to distinguish the ordinary forms from tuberculous metritis, which latter is of no clinical importance on account of the impossibility of treatment.

=Prognosis.= The prognosis is grave, as in all chronic diseases. Furthermore the animals are, for the time being, sterile and difficult to fatten.

=Treatment.= One of the fundamental conditions of treatment is to attack the disease locally, and it is necessary, therefore, that the uterine neck should be dilated.

If the neck of the uterus is pervious, the parts must be washed out daily with antiseptic solutions, after having lightly curetted the mucous membrane with a blunt curette. Boiled water is first used, and is followed by solutions of chloral, iodine, hydroxyl, or permanganate of potash.

When the neck of the uterus is contracted, it must first of all be dilated. In practice such treatment is sometimes considered too costly, so that the animals are slaughtered or recovery is left to chance.

Moussu has seen several animals suffering from metritis, and even from salpingitis, recover spontaneously after six to eight months at grass.

EPIZOOTIC ABORTION IN COWS.

This disease, which was carefully investigated, first by Professor Nocard of Alfort, and afterwards by Professor Bang of Copenhagen, may be regarded as a specific uterine catarrh, determined by a definite species of bacterium.

It often affects large numbers of animals in one district or on one farm, and causes very serious loss. It is conveyed from cow to cow either by the bull or by litter or utensils used in the byre which have been soiled by the uterine discharges of an infected cow. As in many other infectious disorders, one attack of the disease seems to confer a certain immunity, and although some cows become sterile after an attack and others continue to abort, a certain proportion after aborting two or three times acquire relative immunity, so that they conceive and carry their calves the full time. This is probably why epizootic abortion usually ceases after some years in herds which are kept isolated and do not receive fresh recruits.

The microbe of epizootic abortion is a very small bacterium which stains well with Löffler’s methylene blue. When massed together these bacteria resemble cocci, but isolated specimens are seen to be true bacteria containing one, two, or occasionally three roundish, elongated deeply-stained granules. They do not stain with Gram, and are non-motile.

These bacteria exhibit remarkable vitality. Bang relates cases which seem to prove that they may exist within the uterus for at least fourteen months, and in the uterine exudate outside the body for at least seven months, even at comparatively low temperatures.

On post-mortem examination one finds between the mucous membrane of the uterus and the fœtal envelopes an abundant odourless exudate, dirty-yellow in colour, somewhat thin, pultaceous, slimy, or lumpy in character. Under the chorion is found a thin, clear, gelatinous substance contained within the fine connective tissue lying between the chorion and allantois. The umbilical cord is often œdematous. All these exudates contain the specific minute bacterium.

The above exudate forms the peculiar dirty, reddish yellow, slimy, flocculent, pus-like odourless fluid which escapes from the vagina during or immediately after the act of abortion.

The results of infection of the uterus with Bang’s bacterium may be delayed for a considerable time. In two cases where he injected pure cultures into the vaginæ of pregnant cows no apparent local results had been produced at the end of thirty-three and thirty-five days respectively when the cows were slaughtered; but in the case of two other pregnant cows, inoculated three months after conception, signs of abortion became apparent, and one cow in fact aborted in about ten weeks; post-mortem examination revealed the characteristic local changes, and microscopical and cultural preparations clearly established the presence of the specific organism.

Although the sexual organs form the usual channel of infection, it seems possible that the organism may in some cases enter the body through the respiratory or digestive tract.

=The treatment= in this condition is chiefly of a prophylactic character. Bulls which have served cows belonging to herds known to be infected should not be allowed to cover healthy cows. They should undergo careful local disinfection, and for a time be withdrawn from the stud.

Cows which show signs of impending abortion should at once be removed to a separate shed. The fœtus and its envelopes should be buried or burnt, and the person who attends the diseased cow should be prohibited from entering the common cow-shed.

Where space does not admit of this the affected cows should be removed as far as possible from those still healthy and placed in a separate row. When they abort the after-birth should be removed by hand, and the uterus daily washed out with some non-irritant but effectual disinfectant. Even after apparent recovery a period of probation should elapse before the cow is again put to the bull.

The genital organs and vaginæ of the still healthy animals may also be irrigated with a disinfectant solution, in order, if possible, to ward off infection. For disinfecting the channels and floor of the stable quick-lime will be found clean, non-odorous, cheap and effective.

In dealing with this disease one must always bear in mind the great vitality of the bacterium, the relatively long time it may persist either in the animal’s body or in the infected sheds, and the considerable period which may elapse before its effects become evident.

The same or a similar organism seems capable of producing abortion in sheep and mares.

SALPINGITIS SALPINGO-OVARITIS.

This section will be brief, because the condition is very far from having been thoroughly elucidated. Moussu himself has only studied a single case of simple suppurative salpingo-ovaritis.

Salpingitis and salpingo-ovaritis, i.e., inflammation of the Fallopian tubes and of the ovaries, can only develop as a consequence of ascending infection, as a complication of acute or chronic metritis, by auto-infection during the course of tuberculosis, or as an accident during what is known as tubal gestation.

Tuberculous salpingitis is frequent, and exists in a very large majority of cases of genital tuberculosis. Accidental salpingitis as a consequence of tubal gestation is extremely rare, and is usually overlooked or mistaken for some other condition.

From the clinical standpoint, therefore, we recognise two varieties of salpingitis—the one suppurative, the other tuberculous.

=Symptoms.= The external symptoms are similar to those of metritis, because salpingitis develops as a complication of metritis after parturition, abortion, or retention of the after-birth. The only external symptom is a discharge of varying quantity from the vulva. This may be intermittent or permanent, and it is accompanied by frequent expulsive efforts in no respect characteristic.

The nature of the lesions is ascertained by rectal examination, and as lesions of the uterus, of the Fallopian tube, and sometimes of the ovary often co-exist, the examination must be carried out methodically and gently in order to distinguish between the parts touched. The normal relationships may be modified by uterine lesions, inflammatory adhesions, local peritonitis, etc.

=Diagnosis.= The diagnosis requires care.

=Prognosis.= The prognosis is grave. The lesions are too deep-seated to be directly attacked, and, moreover, salpingitis may terminate in pyo-salpynx, i.e., in encysted abscess of the Fallopian tube.

=Treatment.= The treatment is similar to that of metritis. The natural opening of the Fallopian tube into the uterus allows pus and morbid products to escape, and when the metritis disappears the salpingitis may diminish and recovery may take place.

Treatment therefore is quite indirect, for in veterinary surgery it is useless to attempt to repeat on large domestic animals the brilliant operations of human surgery. The relations between uterine diseases and those of the Fallopian tubes are so close that this method of treatment gives excellent results. Moussu has seen a case of chronic metritis complicated with salpingitis recover after simple uterine treatment.

TORSION OF THE UTERUS.

Although torsion of the uterus is a condition more particularly pertaining to the domain of obstetrics, a few remarks on the subject may not be altogether out of place at this point.

The accident is commonest in the cow, but it has also been described in the mare, ewe, bitch and cat, and it probably occurs, though less frequently, in the other domestic animals. In the cow it is commonest during the last month of pregnancy.

Very little is known as to its cause, though the consensus of opinion—if any consensus can be said to exist in face of the existing divergent views—appears rather to indicate that it follows falls in awkward positions, sudden efforts, severe prolonged exertion, or tympanites.

In pregnant cows the uterus assumes the appearance of a pendulous organ the body and horns of which constitute the bob of the pendulum, whilst the ligaments represent the cords by which it is suspended. The fixed points are formed by the insertions of the two ligaments in the neighbourhood of the two external iliac angles.

The uterus, however, is also steadied in position by the vagina and by the cellular tissue surrounding it; in fact, in non-pregnant animals it can scarcely be regarded as pendulous, but rather as freely floating and readily yielding to the movements of the surrounding organs.

As soon as the uterus is occupied by a fœtus, however, the conditions become changed. In consequence of the increased weight of its contents the uterus exerts a pull on the broad ligaments and sinks lower in the abdominal cavity. The vagina and the surrounding connective tissue are rendered tense to a degree depending on the increasing weight of the calf. The uterus then more closely resembles a pendulum, the bob being represented by the fœtus and its envelopes. The suspensory apparatus can be divided into three parts, viz., the two broad ligaments and the tissue connecting the uterus to the vagina.

The pull on the vagina increases greatly as soon as the gravid uterus is twisted either to the right or left, for, torsion being attended with more or less extensive displacement towards the lower abdominal wall, the tension on the vagina must become more marked.

Considering now how the spiral folds and the constrictions which are of such importance in diagnosis are formed, we find that both structures, viz., the wall of the uterus and the ligaments, are implicated, though to different degrees. Whilst the spiral folds are more particularly formed by the wall of the uterus, the broad ligaments are chiefly responsible for the constrictions, though to some extent the spiral folds also contribute to their production. The spiral folds of the body of the uterus are formed solely by twisting of its own walls. This can easily be shown by taking any tubular organ whose walls are not too rigid, and twisting it round its horizontal axis.

The broad ligaments contribute less to the formation of the spiral folds, though they play a more important part in producing constrictions and thus in compressing the wall of the uterus.

=The symptoms= are ill-defined. Sometimes there is difficulty in micturition, but as a rule little evidence exists of any abnormal condition until the advent of labour pains. The first pains, which are usually feeble and separated by rather long intervals, are succeeded by colic. The succeeding efforts steadily become more violent and frequent, but the “water-bag” fails to appear, and in a period varying between twelve and forty-eight hours the pains subside. Rumination is at first suspended, the pulse and respiration are accelerated, and the surface temperature is irregular.

If treatment is not undertaken similar symptoms, but of exaggerated intensity, may again appear in from one to six days. Failing relief death always follows after a varying interval.

=The diagnosis= is not difficult, provided the maternal passages be examined. On passing a carefully lubricated hand into the vagina the operator discovers, at a varying distance from the os uteri, signs of collapse and twisting of the canal. In cases of quarter twist it is often possible, by rotating the hand so as to follow the spiral folding of the vagina, to introduce the fingers as far as the os uteri; but in half or complete rotation only one or two fingers can be passed so far, or it may be altogether impossible to reach the os.

In the Berliner Archiv for 1902 Lempen gave a summary of the extensive literature dealing with this disease and of the varying views held regarding its origin and treatment, particularly as to the direction in which the animal should be rolled in order to reduce the torsion.

In common with the majority of authors, Lempen rightly concluded that the rolling should be in the same direction as the torsion. He also proposed to describe the torsion as being to right or left, according to the direction of the spiral folds to be found on the upper wall of the dilated cervix uteri when the examiner stands behind the animal. This mode of describing the changes seems least likely to cause misunderstanding.

In describing the degree of torsion Haase takes as his index the upper wall of the uterus. Where this has moved through an angle of 90 degrees he speaks of quarter torsion; when through an angle of 180 degrees (in which case the upper wall will have become the lower) of half or semi-complete torsion; when through an angle of 270 degrees as three-quarter, and when through 360 degrees (the upper wall having then described an entire circle and returned to its former position) as complete torsion.

In forming a diagnosis, the extent to which the maternal passages seem fixed in position, the amount of resistance they offer to the hand, and the degree of tension in the spiral folds to some extent indicate how far torsion has proceeded. Where the spiral folds are very tense and the passages completely immovable, so that the operator cannot reach the fœtus, torsion is usually complete; in cases of less complete torsion (one-quarter to three-quarters) the cervix uteri is closed and displaced to a proportionate extent, and the resistance to the passage of the hand is in keeping.

=The prognosis= is very grave.

=Treatment= is difficult, and of the numerous methods suggested (laparotomy and direct abdominal taxis, vaginal hysterotomy followed by abdominal taxis, vaginal taxis, etc.) most have fallen into desuetude or are looked on as of so desperate a character as only to be justified in extreme cases. That which most merits attention and has been attended by most uniformly favourable results consists in the rotation of the animal’s whole body. The best results are said to be obtained by casting the animal, or causing it to lie down, on a sloping surface with the hind quarters higher than the fore and then to roll it down hill, in the same direction as the spiral twists discovered in the vagina. It is possible to follow the course of the manipulation by retaining the hand in the vagina, but failing this the vagina should be examined after each attempt. Even, though the first attempts fail hope should not be abandoned, for Haase has succeeded in effecting delivery after rolling the animal twenty times. The operation should be performed smartly and the animal’s body be rolled as a whole, the fore limbs turning along with the hind.

TUMOURS OF THE UTERUS.

The study of tumours of the uterus is still so incomplete that it would be impossible to give a precise description of them. This is to a great extent due to the fact that as treatment is difficult the animals are usually slaughtered as soon as an assured diagnosis can be given.

The general =symptoms= of tumours of the neck, body, or horns of the uterus resemble those of chronic metritis, viz., permanent or intermittent discharge from the vulva, wasting, expulsive efforts, dysuria and sterility. The position of the tumour, its form, point of insertion, size, consistency, mode of attachment, etc., can be detected by vaginal or rectal examination.

The diagnosis having been made, the only question is as to =treatment=. Should the tumour prove mobile, clearly delimited, and with a well-marked pedicle, it can be removed either by tearing away or by breaking into fragments, or again simply by dividing the pedicle and applying antiseptic pads to check bleeding. But if the tumour proves largely sessile and ill-defined and it extends into neighbouring tissues the animal should be slaughtered, as such patients can neither be fattened nor used for reproductive purposes.

TUMOURS OF THE OVARY.

We might repeat in regard to tumours of the ovary what has just been said as regards those of the uterus, though the former are much commoner than the latter.

Clinically, ovarian tumours may be grouped under two heads, solid tumours and cystic tumours—the first represented by the fibromata, fibro-sarcomata and epitheliomata, the second by uni- or multi-locular cysts.

All these tumours are dangerous; they may develop rapidly, and they rarely fail to produce disturbance, the animals presenting various genital troubles, among which may be mentioned sterility and nympho-mania.

The cystic tumours, which develop at the expense of epithelial invaginations of the peritoneal covering or at the expense of Pflüger’s tubes, and not, as was formerly believed, by the morbid development of the Graafian vesicles, constitute dangerous growths, true cysto-epitheliomata or cystic epitheliomata, capable of producing fatal complications (vascular disturbance, local or general peritonitis, compression of the ureters, etc.).

=The diagnosis= must be arrived at by vaginal and rectal examination. It is usually possible to distinguish the condition from disease of the kidney, bladder, or pelvic lymphatic glands.

=Treatment.= The only possible treatment is removal of the diseased ovary and of the ovarian tumour, but much depends on circumstances. If a large tumour has formed extensive adhesions, ablation may be impracticable or so dangerous that under the circumstances in which veterinary practitioners are forced to operate it cannot be undertaken. If, on the contrary, the ovarian growth is free and pedunculated, even though of large size, extirpation is possible.

The method is exactly similar to that of castration of the cow, and follows the same rules, but the vaginal incision has to be much longer, so as to allow the entire hand to be passed as far as the tumour. The pedicle is divided by means of the écraseur, which should be worked very slowly. In removing very large tumours, however, it is possible to operate from the flank.

GENITAL MALFORMATIONS.

IMPERFORATE VAGINA.

Many forms of genital malformation occur, but only those which produce sterility are pathologically important.

One alone causes very marked disturbance, viz., imperforate vagina. This condition may be accidental or acquired, and may follow either difficult parturition, with circular lesions of the vagina, or burns or cauterisation of the vagina, followed by adhesion of its walls.

It is generally of congenital origin, and the obstruction as a rule is in the region of the hymen, as a consequence of some anomaly in development, and not of abnormal development of the hymen itself.

This imperforate condition of the vagina is not attended by grave consequences during early life; but later, when the generative functions become active, all the products of secretion of the uterine and vaginal mucous membranes accumulate in the closed cavity, giving rise first to muco-metritis, then to muco-kolpitis, similar in its development to the hæmato-kolpitis of young girls. The uterus gradually becomes distended with liquid, the neck is dilated, and a portion of the vagina may attain enormous dimensions, so much so as to suggest pregnancy.

=Symptoms.= The symptoms become appreciable only after a time—about one year or fifteen months in heifers—and they seem to be associated with the appearance of œstrum. The animals make continued expulsive efforts, which when the genital canal is much distended may become extremely violent. There is also dysuria as a consequence of compression, together with uterine and vesical colic, loss of appetite and wasting.

=Diagnosis.= The diagnosis requires care, and can only be arrived at after examination of the vagina and examination per rectum. In young females this examination is extremely difficult, because of the narrowness of the genital tract and of the rectum. For vaginal examination we prefer to use a small speculum, which exposes the depths of the vagina or the transverse septum without necessitating other manipulation. On rectal examination the uterus and vagina are sometimes found to be enormously enlarged, and to contain a quantity of fluid, but no fœtus.

=Prognosis.= The prognosis is grave. Unless treatment is undertaken the animals die in consequence of exhaustion or secondary peritonitis.

=The treatment= is simple, and consists in aseptic puncture of the septum and evacuation of the contents. The operation is carried out with a long, large-sized trocar, which is passed through the centre of the most prominent portion of the transverse septum where it projects towards the vulva. Five, ten, or fifteen quarts of mucous fluid escape, and the constitutional disturbance disappears almost instantly.

Antiseptic precautions are necessary in order to avoid the development of secondary pyo-metritis. The artificial orifice can afterwards be gradually dilated to allow free exit to the discharges, but in practice, as the animals cannot be used for breeding purposes, they are usually fattened for slaughter.

NYMPHO-MANIA.

The term “nympho-mania” is employed to describe a special condition in female animals which is manifested by continual sexual excitement. The animals are almost always sterile. The disease is most frequent in cows.

=Causation.= This general condition may depend on one of many causes, but is rarely due to a true neurosis, as was once believed. Some morbid influence of genital origin is always responsible for the appearance of the symptoms.

Nympho-mania, therefore, often co-exists with lesions of the ovaries (simple ovaritis, cystic ovaritis, tumours of the ovary), with lesions of the Fallopian tubes and of the uterus (salpingitis, chronic metritis and tumours of the uterus), with chronic vaginitis and lesions of the clitoris (hypertrophy and tumour formation), and even with peri-vaginal or peri-uterine lesions (cysts or tumours).

In exceptional cases it may be found occurring as a simple nervous disturbance without genital lesion, and it would then appear to be due to some temporary genital affection having produced nervous irritation.

In short, nympho-mania may be considered as almost invariably the result of a genital lesion.

=Symptoms.= The symptoms are very clearly marked. They consist in persistence of the sexual appetite, which is quite abnormal in female domestic animals. The patients lose flesh, feed badly and irregularly, annoy their fellows, cause accidents, and sometimes become dangerous.

=Diagnosis.= The diagnosis of nympho-mania is so simple that the condition is generally recognised by the owners or cow-herds. The only difficult point lies in discovering the exact cause. Complete examination of the genital organs per rectum and per vaginam is absolutely necessary to settle this question.

=Prognosis.= From an economic standpoint the prognosis is generally grave.

=Treatment.= The treatment varies considerably, according to the nature of the lesion.

In mild cases where nympho-mania is due to some lesion of the clitoris (balanitis, hypertrophy, or tumour formation), the radical treatment consists in clitoridectomy. The operation is comparatively slight, the organ being removed with forceps and scissors, or with a bistoury after the animal has been hobbled or placed in a trevis. The hæmorrhage which follows removal of the clitoris is of little importance, and after-treatment simply consists in keeping the parts clean.

Animals so treated can sometimes be preserved for breeding.

When nympho-mania co-exists with, and is a delayed consequence of, either chronic vaginitis or metritis localised in the neck of the uterus, or, again, chronic metritis of the cavity of the uterus, etc., the treatment must be directed against these diseases, and the nervous condition may be sufficiently modified to render the animals useful for breeding, or at least for slaughter, while fattening is easy.

Similarly, when the nervous condition results from a lesion of the ovary, improvement will only follow removal of the diseased part. The operation is similar to that of castration of the female. It presents, however, certain added difficulties, in consequence of the size of the organs and of the abnormal adhesions which often occur. Nevertheless, these difficulties are seldom insurmountable.

In the case of peri-uterine disease operation is difficult, and it is better to slaughter the animal.

Finally, as may occasionally happen, should there be no congenital lesion capable of explaining the appearance of nympho-mania, the disease may be regarded as a neurosis, and may then be treated by such sedatives as the bromides of potassium, sodium and strontium, in doses of 2 to 3 drachms per day, divided into two or three portions. Bromide of camphor also gives excellent results by acting simultaneously on the nervous system and calming excessive genital irritation.

The above method of treatment is much preferable to performing clitoridectomy, or ovariotomy as a kind of panacea, although certain writers have suggested these operations without taking into account the special local conditions.