Part 38

GRANULAR VENEREAL DISEASE (INFECTIOUS GRANULAR VAGINITIS).

The affection to which the foregoing names have been given is a chronic, mild, and apparently contagious disease of cattle, characterized by an inflammatory condition of the mucous membrane of the vagina and the development of nodules upon its surface.

This disease is very widely spread, but from an economic point of view it does not appear to have great significance. Williams, who investigated it, asserts that it is difficult to find a single herd in this country which is free of this disease. He considers it of great importance, claiming that granular vaginitis has a vital relation to abortion. This view, however, is not substantiated by other investigators, it being now generally accepted that the disease is only rarely responsible for abortion, and further, that it exerts no apparent ill effects on the health of the animal and that it has no effect on the milk yield.

Symptoms.--Natural infection may take place either by direct contact of animals or at the time of service. Most of the cows in the affected herd contract the disease, but the bulls are rarely or very mildly affected. The inflamed condition of the membranes of the vagina results in a catarrhal exudate, and this discharge, which soils the external genitals and the tail, and the uneasiness and sometimes the straining of the animal, are the first and most prominent symptoms observed. Upon examination, small, hard, grayish nodules can be seen and felt upon the inflamed membranes. This acute stage may last for three or four weeks, then it gradually subsides and assumes the chronic form, only to flare up again as the animal comes in heat.

These nodules are sometimes found on the membranes of the uterus, and some investigators have argued from this fact that it was responsible for abortion and sterility. Others, however, deny this and point out that the bacillus of abortion can be demonstrated in nearly every case. The importance of the disease is therefore in dispute and the decision must be left to future investigation.

Treatment.--The exaggerated importance which has been attached to this disease resulted in the exploitation of the most varied kinds of remedies for its treatment. It is true that with a protracted and laborious treatment it is possible to effect cures in from one to three months, but with our present knowledge of this disorder it is advisable to limit the treatment to animals which show an acute inflammatory condition of the vagina and vulva with a discharge as a result of the granular affection. The treatment should be local and confined to the application of antiseptic washes in the form of irrigations. For this purpose a 0.5 per cent solution of the compound solution of cresol or of Lugol's solution has been found satisfactory.

PARTURITION (CALVING).

SYMPTOMS OF CALVING.

In the cow the premonitions of calving are the enlargement of the udder, which becomes firm and resistant to the touch, with more or less swelling in front, and yields a serous, milky fluid; the enlargement and swelling of the vulva, which discharges an abundant, stringy mucus; the drooping of the belly, and the falling in of the muscles at each side of the root of the tail, so as to leave deep hollows. When this last symptom is seen, calving may be counted on in 24 hours or in 2 or 3 days. When the act is imminent, the cow becomes uneasy, moves restlessly, leaves off eating, in the field leaves the herd, lies down and rises again as if in pain, shifts upon her hind feet, moves the tail, and may bellow or moan. When labor pains come on the back is arched, the croup drooped, the belly is drawn up, and straining is more or less violent and continuous. Meanwhile blood may have appeared on the vulva and tail, and soon the clear water bags protrude between the lips of the vulva. They increase rapidly, hanging down toward the hocks, and the fore or hind feet can be detected within them. With the rupture of the bags and escape of the waters the womb contracts on the solid, angular body of the fetus and is at once stimulated to more violent contractions, so that the work proceeds with redoubled energy to the complete expulsion. This is why it is wrong to rupture the water bags if the presentation is normal, as they furnish a soft, uniform pressure for the preliminary dilation of the mouth of the womb and passages, in anticipation of the severe strain put upon them as the solid body of the calf passes.

The cow often calves standing, in which case the navel string is broken as the calf falls to the ground. If, however, she is recumbent, this cord is torn through as she rises. The afterpains come on 3 or 4 hours later and expel the membranes, which should never be left longer than 24 hours.

NATURAL PRESENTATION.

When there is but one calf the natural presentation is that of the fore feet with the front of the hoofs and knees turned upward toward the tail of the dam and the nose lying between the knees. (Pl. XV.) If there are twins the natural position of the second is that of the hind feet, the heels and hocks turned upward toward the cow's tail. (Pl. XVIII, fig. 1.) In both of these natural positions the curvature of the body of the calf--the back arched upward--is the same with the curvature of the passages, which descend anteriorly into the womb, ascend over the brim of the pelvis, and descend again toward the external opening (vulva). Any presentation differing from the above is abnormal.

OBSTACLES TO PARTURITION.

With a well-formed cow and calf and a natural presentation as above, calving is usually prompt and easy. Obstacles may, however, come from failure of the mouth of the womb to dilate; from twisting of the neck of the womb; from tumors in the vagina; from dropsy in the womb or abdomen; from overdistention of the rectum or bladder; from undue narrowing of the passages; from excess of fat in the walls of the pelvis; from the disturbance of a nervous cow by noises; from stone or urine in the bladder; from wrong presentation of the calf, its back being turned downward or to one side in place of upward toward the spine of the dam; from the bending backward of one or more limbs or of the head into the body of the womb; from presentation of the back, shoulder, or croup, all four limbs being turned back; from presentation of all four feet at once; from obstruction caused by an extra head or extra limbs, or double body on the part of the offspring (Pl. XIX); from dropsy or other disease of the calf; from excessive or imperfect development of the calf; from the impaction of twins into the passages at the same time; or at times it may be from the mere excessive volume of the fetus.

GENERAL MAXIMS FOR THE ASSISTANT CONCERNING DIFFICULT PARTURITION.

Do not interfere too soon. "Meddlesome midwifery is bad" with animals as with women. After labor pains set in, give a reasonable time for the water bags to protrude and burst spontaneously, and only interfere when delay suggests some mechanical obstruction. If there is no mechanical obstruction, let the calf be expelled slowly by the unaided efforts of the cow. Bruises and lacerations of the passages and flooding from the uncontracted womb may come from the too speedy extraction of the calf. When assistance is necessary, the operator should dress in a thick flannel shirt from which the sleeves have been cut off clear to the shoulders. This avoids danger of exposure and yet leaves the whole arm free and untrammeled. Before inserting the hand it and the arm should be smeared with oil, lard, or vaseline, care being taken that the oil or lard is fresh, neither salted nor rancid, and that it has been purified by boiling or rendered antiseptic by the addition of a teaspoonful of carbolic acid to the pound. This is a valuable precaution against infecting the cow by introducing putrid ferments into the passages and against poisoning of the arm by decomposing discharges in case the calving is unduly protracted. When labor pains have lasted some time without any signs of the water bags, the dropping in at the sides of the rump, and the other preparations for calving being accomplished, the hand should be introduced to examine. When the water bags have burst and neither feet nor head appear for some time, examination should be made. When one fore foot only and the head appear, or both fore feet without the head, or the head without the fore feet, examine. If one hind foot appears without the other, make examination. The presenting limb or head should be secured by a rope with a running noose, so that it may not pass back into the womb and get lost during the subsequent manipulations, but may be retained in the vagina or brought up again easily. In searching for a missing member it is usually better to turn the head of the cow downhill, so that the gravitation of the fetus and abdominal organs forward into the belly of the cow may give more room in which to bring up the missing limb or head. If the cow is lying down, turn her on the side opposite to that on which the limb is missing, so that there may be more room for bringing the latter up. Even if a missing limb is reached, it is vain to attempt to bring it up during a labor pain. Wait until the pain has ceased and attempt to straighten out the limb before the next pain comes on. If the pains are violent and continuous, they may be checked by pinching the back or by putting a tight surcingle around the body in front of the udder. These failing, 1 ounce or 1-1/2 ounces of chloral hydrate in a quart of water may be given to check the pains. If the passages have dried up or lost their natural, lubricating liquid, smear the interior of the passages and womb and the surface of the calf, so far as it can be reached, with pure fresh lard; or pure sweet oil may be run into the womb through a rubber tube (fountain syringe). In dragging upon the fetus apply strong traction only while the mother is straining, and drag downward toward the hocks as well as backward. The natural curvature of both fetus and passages is thus followed and the extraction rendered easier.

LABOR PAINS BEFORE RELAXATION OF THE PASSAGES.

Any of the various causes of abortion may bring on labor pains before the time. Straining comes on days or weeks before the time, and there is not the usual enlargement, swelling, and mucous discharge from the vulva. There is little or no falling in by the sides of the root of the tail; the abdomen has not dropped to the usual extent, and the udder is less developed and yields little or no milk. In spite of the pains no water bags appear, and the oiled hand cautiously introduced into the vagina finds the neck of the womb firmly closed, rigid, and undilatable. If it is known that the cow has not reached her proper time of calving, the examination through the vagina should be omitted and the animal should be placed in a dark, quiet place by herself, and be given 1 to 2 ounces laudanum. Viburnum prunifolium (black haw), 1 ounce, may be added, if necessary, and repeated in three hours. The pains will usually subside.

In some instances the external parts are relaxed and duly prepared, but the neck of the womb remains rigidly closed. In such case the solid extract of belladonna should be smeared around the constricted opening and the animal left quiet until it relaxes.

DISEASED INDURATION OF THE MOUTH OF THE WOMB.

From previous lacerations or other injuries the neck of the womb may have become the seat of fibrous hardening and constriction, so as to prevent its dilatation, when all other parts are fully prepared for calving. The enlarged, flabby vulva, the sinking at each side of the rump, the full udder, and drooping abdomen indicate the proper time for calving, but the labor pains effect no progress in the dilatation of the mouth of the womb, and the oiled hand introduced detects the rigid, hard, and, in some cases, nodular feeling of the margins of the closed orifice which no application of belladonna or other antispasmodic suffices to relax. Sponge tents may be inserted or the mechanical dilator (Pl. XX, fig. 6) may be used if there is opening enough to admit it, and if not, a narrow-bladed, probe-pointed knife (Pl. XXIV, fig. 2) may be passed through the orifice and turned upward, downward, and to each side, cutting to a depth not exceeding a quarter of an inch in each case. This done, a finger may be inserted, then two, three, and four, and finally all four fingers and thumb brought together in the form of a cone and made to push in with rotary motion until the whole hand can be introduced. After this the labor pains will induce further dilation, and finally the presenting members of the calf will complete the process.

TWISTING OF THE NECK OF THE WOMB.

This is not very uncommon in the cow, the length of the body of the womb and the looseness of the broad ligaments that attach it to the walls of the pelvis favoring the twisting. It is as if one were to take a long sack rather loosely filled at the neck and turn over its closed end, so that its twisting should occur in the neck. The twist may be one-quarter round, so that the upper surface would come to look to one side, or it may be half round, so that what was the upper surface becomes the lower. The relation of the womb of the cow to the upper and right side of the paunch favors the twisting. The paunch occupies the whole left side of the abdomen and extends across its floor to the right side. Its upper surface thus forms an inclined plane, sloping from the left downward and to the right, and on this sloping surface lies the pregnant womb.

It is easy to see how, in the constant movements of the paunch upon its contents and the frequent changes of position of the growing fetus within the womb, to say nothing of the contractions of the adjacent bowels and the more or less active movements of the cow, the womb should roll downward to the right. Yet in many cases the twist is toward the left, showing that it is not the result of a simple rolling downward over the paunch, but rather of other disturbances. The condition may be suspected when labor pains have continued for some time without any sign of the water bags, and it is confirmed when the oiled hand, introduced through the vagina, finds the mouth of the womb soft and yielding, but furnished with internal folds running forward in a spiral manner. If the folds on the upper wall of the orifice run toward the right, the womb is twisted to the right; if, on the contrary, they turn toward the left, it indicates that the womb is turned over in that direction. The direction of the twist must be known before treatment can be undertaken. Then, if the twist is toward the right, the cow is laid upon her right side with her head downhill, the hand of the operator is introduced through the spirally constricted neck of the womb, and a limb or other portion of the body of the calf is seized and pressed firmly against the wall of the womb. Meanwhile two or three assistants roll the cow from her right side over on her back to her left side. The object is to hold the womb and calf still while the body of the cow rolls over. If successful, the twist is undone, its grasp on the wrist is slackened, and the water bags and calf press into the now open passage. If the first attempt does not succeed, it is to be repeated until success has been attained. If the spiral folds on the upper wall of the opening turn toward the left, the cow is laid on her left side and rolled over on her back and on to the right side, the hand being, as before, within the womb and holding the fetus, so that all may not rotate with the cow. In introducing the hand it will usually be found needful to perforate the membranes, so that a limb of the calf may be seized direct and firmly held. Among my occasional causes of failure with these cases have been, first, the previous death and decomposition of the fetus, leading to such overdistention of the womb that it could not be made to rotate within the abdomen, and, second, the occurrence of inflammation and an exudate on the twisted neck of the womb, which hindered it from untwisting.

In obstinate cases, in which the hand can be made to pass through the neck of the womb easily, additional help may be had from the use of the instrument shown in Plate XX, figure 5. Two cords, with running nooses, are successively introduced and made fast on two limbs of the calf; the cords are then passed through the two rings on the end of the instrument, which is passed into the womb and the cords drawn tight and fixed round the handle. Then, using the handle as a lever, it is turned in the direction opposite to the twist. The hand should meanwhile be introduced into the womb and the snared limbs seized and pressed against its walls so as to secure the rotation of the uterus along with the body of the fetus. The relaxation of the constriction and the effacement of the spiral folds will show when success has been gained, and the different members at one end of the body should then be brought up so as to secure a natural presentation.

NARROW PELVIS FROM FRACTURE OR DISEASE.

In a small cow the pelvis may be too narrow to pass a calf sired by a bull of a large breed, but this is exceptional, as the fetus usually accommodates itself to the size of the dam and makes its extra growth after birth. When the pelvic bones have been fractured repair takes place with the formation of a large permanent callus, which, projecting internally, may be a serious obstacle to calving. Worse still, if the edge of the broken bone projects internally as a sharp spike or ridge, the vaginal walls are cut upon it during the passage of the calf, with serious or fatal result. In other cases, where the cow has suffered from fragility of bone (fragilitas ossium) the thickening of the bone causes narrowing of the long passage of the pelvis and the crumbling fractures poorly repaired, with an excess of brittle new material, may form an insuperable obstacle to parturition. Cows affected in any of these ways should never again be bred, but if they do get pregnant and reach full time a careful examination will be necessary to determine whether natural parturition can take place or if the calf must be extracted in pieces. (See "Embryotomy," p. 202.)

OBSTRUCTION BY MASSES OF FAT.