Part 46

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

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

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

INFLAMMATION OF THE VAGINA (VAGINITIS).

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

LEUCORRHEA (MUCOPURULENT DISCHARGE FROM THE PASSAGES).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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