Part 55

VAGINITIS. LEUCORRHŒA.

Inflammation of the vaginal mucosa is usually a concomitant of metritis and like that follows parturition. It will however occur independently from direct injury or infection or from the presence of neoplasms. In dourine and horsepox, vaginitis is a common symptom, to mare, cow and bitch infection is conveyed by coition. Dieckerhoff quotes old chronic cases, also acute ones which extended to the peritoneum and proved fatal in a few days. The common symptom of muco-purulent discharge having a heavy or fœtid odor is together with the discharge from the womb known by the common name of leucorrhœa. The frequent irrigation of the whole passage with antiseptic solutions is usually successful in putting a stop to the affection, unless in case of constitutional infection, or the presence of some neoplasm.

TUMORS OF THE VAGINA.

The vagina is the seat of different forms of neoplasms in the various domestic animals. Thus cystoma, lipoma, adenoma, fibroma, fibro-myoma, sarcoma and epithelioma have been noted. They are essentially surgical and to be dealt with as such. They are mainly important in this connection as inducing a leucorrhœa, which in the absence of careful examination might be mistaken for that of uterine or vaginal infective inflammation.

PARTURITION FEVER (COLLAPSE). MILK FEVER. PARTURIENT APOPLEXY. CALVING FEVER. PARTURITION PARESIS.

Definition. Predisposing causes: genus, breed, great milking capacity, heredity, mature age, vigor, high feeding, powerful digestion and assimilation, sudden plethora, drying up of milk, parturition, easy delivery, warm season, chills, idiosyncrasy, cardiac hypertrophy, contraction of womb, emotional excitement: Supposed causes: absorption of toxins from womb, colostrum, Schmidt treatment its significance, microbian infection and intoxication, effect of change of stable. Microbiology. Nature: Theories of nervous explosion, vaso-motor cerebral anæmia from exaggerated excitability of the uterine nerves, or from dilatation of the portal system and womb, metro-peritonitis, cerebral anæmia from congestion of the rete mirabile, etc., palsy of the ganglionic nerves, plethora, intracranial arterial tension, narcotic poisons from leucocytic or microbian source. Lesions: variable, cerebral and spinal congestion, pulmonary congestion, collapse, septic inhalation, bronchitis, dessication of ingesta in omasum and large intestine, black thick blood, yellowish gelatinoid exudates in cranium and spinal canal and under spine, glycosuria. Symptoms: time, post parturient, plethoric subject, sudden onset, comatose and violent forms, discomfort, restless movements, inappetence, moaning, mental dullness, unsteady walk, muscular weakness, compulsory recumbency, retained urine and fæces, drowsiness, somnolence, unconsciousness, stertor, venous pulse, tympany, sudden recovery, complete, with paralysis, fatal cases, violence, tossing head, trembling, cramps, convulsions, temperature. Mortality. Prevention: bleeding in plethoric, heavy milkers, purging, low diet, exercise, comfort, milking, blisters, sucking by calf, disinfection, iodine solution in udder. Treatment: in early stages bleeding, purgatives, peristalsis stimulants, antiseptics, injections, stimulants, rubefacients or cold sponging, elevation of the head, udder massage, milking, iodine injection of the mammæ.

Definition. A nervous disorder which develops suddenly in plethoric cows, heavy milkers, after calving, and is characterized by loss of senses, of consciousness and of muscular control, by hypothermia or hyperthermia, convulsions, coma, and mellituria.

Causes. While one cannot speak positively as to the essential cause of this disease, certain conditions are so constant and prominent that they must be given a high value as predisposing causes.

Genus and Breed. Milking Capacity. This is essentially a disease of cows, probably largely because of all domestic animals, cows only have been long and systematically bred to secure the greatest power of digestion and assimilation and the highest yield of milk. It is the disease not only of cows, but of milking breeds, and preëminently of individuals that give the most abundant dairy product. It is rare or unknown in scrub or common herds, while common and fatal in the best milking breeds, in advancing ratio about as follows: short horn, red polled, Normand, Swiss, Ayrshire, Flemish, Dutch, Alderney, Jersey, Guernsey, and Holstein. Heredity may be claimed, as the special predisposing qualities are hereditary.

Age has a marked influence, but this is subsidiary to the milking qualities. The disease rarely attacks a cow after the first or second calving when the system is as yet immature, and the milk yield has not reached its maximum: nor one that is past its prime and already failing in vital energy and milking qualities. The following table is from statistics compiled from veterinary records in Denmark and Bavaria:

Age, yrs Cases —3 —8 4 21 5 65 6 160 7 171 8 202 9 117 10 124 11 44 12 70 13 78 and over.

It will be noted that it is in the period of the most vigorous, mature life, from the 6th to the 10th year inclusive that the great majority suffer. In a judiciously managed dairy it is the best cows that are carried at these ages, and although the very best are kept on into old age they show a steadily decreasing number of cases as they begin to fail. The disease is all but unknown in primipara.

High Feeding. Heavy and rich feeding prior to calving and immediately after, is a most prominent cause of the affection. This is so well known to owners of milking breeds, that they usually hold to the principle that the cow that is a heavy milker, should be all but starved for a fortnight before calving and for a week after. In herds where this rule is acted on the disease is rare and may be altogether unknown, and when it is neglected the malady is often very destructive.

Plethora. High Condition. Heavy feeding and high condition usually go together, and the majority of the victims are fat or in good flesh, yet a certain number are actually thin. The predisposing condition is plethora rather than fat or flesh, and this may be present in the comparative absence of flesh. The cow that is from a stock famed as heavy milkers, does not tend to lay on flesh, but, on succulent diet especially, the greater part of the nutritive matter assimilated goes to the production of milk, and she remains thin in flesh no matter how heavily she may be fed. Many such cows never go dry, but give a liberal yield of milk up to the day of calving, and if measures are taken to dry them up, it is done at the expense of a sudden plethora, as the milk giving system does not at once accommodate itself to the laying up of fat and flesh.

The drying up of the milk secretion sometime before calving in a cow which is normally a heavy milker is therefore a potent factor.

Parturition is an almost indispensable factor as the disease occurs one to seven days after that act, and only in rare and somewhat doubtful cases before it.

Easy Delivery with little nervous outlay or loss of blood, and no exhaustion is a special feature. The attack almost never occurs after a difficult parturition with considerable loss of blood and much nervous exhaustion. This should to a large extent exclude such alleged factors as shock or wearing out of nervous energy. The nervous prostration which figures so prominently in the disease, seems to be less the result of wear and tear, than of the supply of an excess of blood, which is either over-enriched, or charged with some injurious toxic matter. At the same time there is a manifest susceptibility at the parturient period which is not present at other times, and the plethora or toxin takes occasion to operate when this predisposition renders such an attack possible. The Warm Summer Season has been claimed to induce a greater number of cases, and doubtless exposure to continuous heat, tends to prostrate the nervous system and predispose to congestion, this fails to take into account the still more important element of the rich spring and early summer pastures, where the already plethoric animal is left to feed without stint, or the tempting red clover, alfalfa and other fodder crops, rich in albuminoids, which are fed liberally in a succulent condition.

Chills in cold winter weather have been similarly invoked as driving the blood from the surface to collect in internal organs, including the brain. That chills do act in this way cannot be denied, but there is no demonstration that any number of cases have been materially affected by cold.

Idiosyncrasy. Constitutional Predisposition. This must be allowed, inasmuch as that it covers all those individual conditions, functional and structural, which belong to the heavy milker, or the animal with extraordinary powers of digestion and assimilation. The same shows in the predisposition to a second attack of an animal which has survived a first one. The structural changes in the nerve centres, which occur in the primary attack, leave traces, which render these parts more susceptible at the next calving. In my own experience the violence of the disease is liable to increase with successive attacks, so that a second or third cannot be hoped to be as mild as was the former one.

Cardiac Hypertrophy. Cagny draws attention to the fact that in man and beast alike the heart undergoes hypertrophy during gestation and, above all, during its later stages. In improved breeds of cattle, and especially in milking breeds, a great development of the whole circulatory system is seen, and a large heart is a constant feature of this. This implies an increased force of cardiac systole, an increased blood tension in the arteries and capillaries, a condition which tells with special force on the soft tissues of the brain, as the violent abdominal compression in the expulsive efforts of parturition, tends to drive the blood from the great vascular viscera situated back of the diaphragm.

Parturition and the subsequent contraction of the womb and expulsion of the great mass of blood, must be accorded a prominent place among causative factors. The disease is almost restricted to the first week after parturition, and its gravity is greater the more it is related to the parturient act. Cases occurring in the first three days are usually fatal. The gravid uterus contains a very large amount of circulating blood, and when the womb contracts, the greater part of this is suddenly thrown upon the general circulation, already plethoric to an undue extent. As yet the mammæ are congested and there is no free depletion through that channel, so that there is a marked temporary plethora and vascular tension, before the system can establish free elimination and, as it were, strike a healthy balance. In this period of transient plethora there lies a source of great danger to the general system and, more particularly, to the brain.

Emotional Excitement connected with the removal of the calf is urged by Günther, Jaumain, Félizet and others as a prominent cause. This, however, must be rare, at the most; the disease does not attack the primipara that should be most susceptible to this influence, but the mature animal, at her third calving or later when she is already well accustomed to this treatment; it supervenes so quickly on parturition in many cases, that there was no opportunity for such emotion; it occurs also in cows, the calves of which have remained with them or have received no attention from them.

Absorption of Toxic Matters. The theory of a poisoning of the nerve centres is indicated in the familiar name of milk fever, suggesting an absorption, or poisonous condition of the milk. Lafosse charged the trouble on the uterine milk secreted in the cotyledons and reabsorbed in quantity. Abadie and Kaiser attributed it to the products of gastro-intestinal ferments, which acted on the nerve centres like a deadly organic alkaloid. Hartenstein incriminated the products of muscular contraction in the womb and systemic muscles during parturition. Ehrhardt invoked a similar auto-intoxication, going on before parturition and only reaching its climax in connection with that act.

Allemani and Gratia attribute the disease to the absorption of the first milk (colostrum), and there are several considerations that strongly favor this hypothesis. The disease sets in always in connection with the parturient development and congestion of the udder and the secretion of the first milk. In exceptional cases it may even appear just before parturition. Even upon the calf the colostrum operates as an irritant and purgative. Is it wonderful that, in the parturient cow, with a high state of plethora, a highly susceptible state of the nervous system, and the various concurrent conditions already referred to above, a direct poisoning of the nerve centres should appear? It is worthy of notice that the absorption from the mammæ takes place without any metabolic change, such as occurs in the stomach and liver in the case of materials digested. It is to be presumed that the hypothetical mammary poison is delivered in the brain in its pristine condition and possessed of its full force.

The doctrine is corroborated even more strongly by the successful results of treatment by the injection of a solution of potassium iodide into the udder. The iodide solution may presumably act in one or more of several ways. It is unquestionably an antiseptic, and would tend to arrest or control microbian growth and activity, thus preventing the further formation of toxins. It has a potent deobstruent action on glandular tissue, tending not only to dry up the milk, but to hold in check the leucocytic function of producing dangerous leucomaines. There is reason to believe that with regard to some poisonous ptomaines iodine acts as a direct antidote, probably uniting with these and forming new and comparatively harmless compounds. It manifestly acts in this way in the case of cryptogamic diuresis, and in cerebral congestions arising from spoilt fodder. The iodide tends further to act as a calmative to the nerve centres, and as a diuretic, serving to eliminate the poison that may be present in the blood.

Microbian Infection or Intoxication. The doctrine has been advanced that the disease is either a microbian infection of the nerve centres or a process of poisoning by the absorbed toxins of microbes. Of the two hypothesis the latter is the more acceptable, in view of the fact, that cows in a condition of coma will sometimes recover with extraordinary rapidity. This is more likely to occur in connection with the elimination or exhaustion of a transient narcotic poison, than with a deadly microbe colonized in the brain. This hypothesis is in full accord with the acknowledged success of the iodide injections; with the observation of Bissauge, which I can endorse, that certain villages and hamlets habitually furnish cases of parturition fever, while neighboring ones, with the same breeds and apparently the same management escape; and with the observations of Russell and Wortley Axe, that the malady will sometimes be suddenly prevented in a herd, by the simple expedient of having the cows moved to a new and previously unoccupied stable, for calving and the first nine days thereafter.

In support of the doctrine of a microbian origin is recalled the fact that the disease almost invariably follows parturition, which opened the way for the introduction of bacteria by the genital passages. This is somewhat invalidated by the fact that it follows the easy parturition, in which there was no chance for the introduction of germs on hands or instruments, and does not follow dystokia in which, without question, germs have been planted abundantly in the interior of the womb. Undue weight should not be given to this objection, as the essential accessory conditions of plethora, etc., are usually largely modified in cases of dystokia.

The microbiology of the affection leaves much to be desired. Coureur and Pottiez and later Van de Velde found a streptococcus in the blood. Trinchera, Nocard, and Cozette found the common pus cocci (staphylococcus pyogenes aureus, citreus and albus) a streptococcus and a colon bacillus in the liquid squeezed from the cotyledons, and in the liquid debris on the uterine mucosa. These microbes were not found in other organs. They grew readily in artificial cultures, but we lack the final proof of a successful inoculation on a susceptible parturient subject. The whole subject is therefore still a plausible theory.