Part 45

DISEASES FOLLOWING PARTURITION.

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

Formerly Professor of Veterinary Science, etc., in Cornell University.

FLOODING (BLEEDING FROM THE WOMB).

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

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

EVERSION OF THE WOMB (CASTING THE WITHERS).

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

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

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

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

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

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

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

EVERSION OF THE BLADDER.

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

RUPTURE OF THE BLADDER.

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

RUPTURE OF THE WOMB.

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

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

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

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

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

CLOTS OF BLOOD IN THE WALLS OF THE VAGINA.

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

RETAINED AFTERBIRTH.

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