GIFT OF Prof. E.J .klckson MAIN LIBHARY-AOWICUl-TUWC DETT \.f-U> I v^ A TEXT-BOOK VETERINARY OBSTETRICS INCLUDING THE DISEASES AND ACCIDENTS INCIDENTAL TO PREGNANCY, PARTURITION, AND EARLY AGE IN DOMESTICATED ANIMALS. toil!) Q^mo ^nniixch anh ^mcivc illustrations. GEORGE FLEMING, VETERINARY SURGEON, 2D LIFE GUARDS ; ' FELLOW, MEMBER #F COUNCIL AND OF THE EXAMINING BOARD, OF THE ROYAL COLLEGE OF VETERINARY SURGEONS ; FELLOW OF THE ROYAL GEOGRAPHICAL SOCIETY, ANTHROPOLOGICAL IN- STITUTE, AND OF THE ANTWERP, NEW YORK, MONTREAL, CENTRAL, AND LIVERPOOL VETERINARY MEDICAL SOCIETIES; CORRESPONDING MEMBER OF THE PARIS CENTRAL VETERINARY SOCIETY, ETC. kor of " Travels on Horseback in Mantchti Tartary,'- ^^Horse-shoes and Horse Shoeing," A >!imal Plagues" "■ Practical Horse-shoeing,''^ '■'' Rabies and Hydrophobia,^^ '^' The Contagious Diseases of A nitnals,'' " Manual of Veterinary Sanitary Science,^' Translator and Editor of '^ CJiauveaii's Comparative Anatomy of the Domesticated Animals," Editor cf the " Veterinary Journal,^'* id/ NEW YORK: ALBERT COGSWELL, Publisher 24 Bond Street. 1879. G f= C^ > T UWIA»IY-AG«*CU, ,TUIIE DEPT TO THE MEMBERS OF THE VETERINARY PROFESSION AND STOCK BREEDERS IN ALL ENGLISH-SPEAKING COUNTRIES, THIS CONTRIBUTION TOWARDS THE IMPROVEMENT AND PERFECTING OF A VERY IMPORTANT BRANCH OF VETERINARY AND AGRICULTURAL SCIENCE, AND THE PRESERVATION AND DEVELOPMENT OF A SOURCE OF NATIONAL WEALTH, Js reepcrtfulb lUcbicateii bg tl)c Author. Regent's Park Barracks, London, November, 1877. 520<>^Mr PREFACE When we consider the vast and yearly increasing amount of animal wealth we possess, the great skill, attention, and expense bestowed on the perfecting of the most important of the domesticated creatures, which are daily becoming more essential factors in our progressive civilization, it is somewhat remarkable, and rather discreditable, though not alto- gether inexplicable, that nothing in the way of a work devoted to the parturition of animals, and to the diseases and accidents incidental to that period, has yet appeared in the English language. For very many years the Anglo-Saxon race has devoted itself most assiduously and praiseworthily, and with the greatest measure of success, to the multi- plication and full development of those qualities which more particularly enhance the value and utility of animals. This has entailed unwearied efforts, the closest and shrewdest observation, and all the judgment and practical and scientific knowledge which generations of men could afford. It might therefore be considered that every thing relating to the repro- duction and rearing of these creatures must, from a materialistic point of view alone, be of great moment not only to breeders and stock-raisers, but to the entire community. Great loss may be, and far too often is, quickly sustained among animals during the pregnant or parturient period, and this loss may not only prove very serious to individuals, but make itself gravely felt by the general public. A treatise which might aid, to however small an extent, in pointing out how these losses may be averted or remedied, must surely, then, prove a welcome boon to those who are engaged in breeding and raising animals, as well as to all who are in- terested — and few are not — in their multiplication and welfare. At the commencement of this century a book was published, entitled " A Prac- tical Treatise on the Parturition of the Cow, or the Extraction of the Calf; and also on the Diseases of Neat Cattle in General." The author was Edw^ard Skellet, " Professor of that part of the Veterinary Art ; " but that and other parts of this art were certainly in a very crude, meagre, and elementary condition in the days when Skellet ventured to touch upon them ; and yet his book may be said to be the only attempt which has been made in this direction in England. Papers on obstetricy — some of them of much value — have appeared from time to time in pro- fessional journals ; but while in other countries many treatises have been produced, no one in this country has undertaken the task of supplying what has, for very many years, been an urgent want — a text-book of Obstetrics worthy of modern Veterinary Science. The necessity for such a guide has been felt more particularly by the Veterinary practitioner at the commencement of his career ; for only too frequently he has had to rely entirely upon his own resources, and to painfully acquire, at the expense of his employers, that knowledge of the subject which was either very imperfectly or not at all taught at the Veterinary Schools, and could not be found elsewhere. To deliver one of the larger domesticated vi PREFACE. animals in a case of difficult parturition requires special knowledge and aptitudes ; and even those practitioners who are fortunate in possessing these will be the first to confess that to attempt delivery in many cases is really a work of the Danaides. To the members of the Veterinary profession, therefore, no apology can be necessary in offering for their acceptance the present book. Every endeavor has been made to make it a standard work, representative of the most advanced views relating to this department of Veterinary Medi- cine. Animated by the desire to present my colleagues in English- speaking countries with a text-book at least equal to the best of the many which have been published on the Continent — a list of which is appended — every likely source of information has been made available, and no labor or pains have been spared to render my onerous and very difficult task as complete and as useful as possible. A glance at the references and illustrative cases will testify to the correctness of this statement. It has often been a matter for regret by the accoucheur of women, that the parturient period of animals was one upon which they could obtain but little, if any, information ; and its relations and importance with regard to this and the puerperal period in the human species has frequent- ly been insisted upon. I trust that this cause for regret may be at least partialK'' removed, and that the text-book may prove of some service to those medical men who are anxiously striving to advance human obstet- ricy, and a knowledge of those pathological processes around which there is still doubt and uncertainty. My best thanks are due to Professor Saint-Cyr, of the Lyons Veterinary School, for allowing me to use many of the drawings which illustrate his excellent treatise on the same subject, and to which I have often referred with much advantage. I am also greatly indebted to Mr. W. A. Cart- wright, of Whitchurch, Salop, for his kindness in looking over the proof- sheets containing the more practical portion of the subject ; his long experience and skilful practice, combined with careful reading and study, rendered his assistance particularly valuable in this respect. In this first attempt to deal with a very serious task, omissions and defects will doubtless be discovered. But in the circumstances in which I was placed they were unavoidable, and perhaps, after all, they will not interfere with the utility of the work. Now that certain principles in animal obstetrics have been laid down, and a commencement has been made to establish the practice of the Veterinary Obstetrist on a sound scientific basis, it is to be hoped that rapid progress will be made in rendering it more perfect. Humanity is perhaps as deeply concerned in this direction as in many others, and it must always be an important object with the Veterinary Surgeon to spare animals pain, and to abridge their sufferings as much as possible. GEORGE FLEMING, Second Life Guards. Regent's Park Barracks November, 1877. CHRONOLOGICAL LIST OF WORKS ON VET- ERINARY OBSTETRICS PUBLISHED UP TO THE PRESENT TIME. France. Rainard. Traite Complet de la Parturition des Femelles des Animaux Domestiques. Paris, 1845. Saint-Cyr. Traite d'Obstetrique Veterinaire. Paris, 1875. ♦ Germany. ydrg. Anleitung zu einer Rationellen Geburtshiilfe der Landwirthschaft- lichen Thiere. Leipsic, 18 18. Binz. Theoretisch-praktische Geburtshiilfe fiir die Haussaugethiere. Freiburg, 1830. • Thomas. Kenntnisse, Erfahrungen und Hulfsleistungen bei den Geburten der Pferde. Glogau, 1832. Seyffert. Die Geburtshiilfe bei den Kiihen, 1838. . Ziller. Kurzgefastzter jedoch moglichst griindlicher Unterricht tiber die Geburtshiilfe der Grotzeren landwirthschaftlichen Hausthiere. Sch- leusingen, 1838. Dieterichs. Handbuch der Praktischen Geburtshiilfe bei den Groszeren Hausthieren. Berlin, 1845. Baumeister-Rueff. Die Thierarztliche Geburtshiilfe. Ziini. Handbuch der Thierarztlichen Geburtshiilfe. Leipsic, 1863. Kehrer. Beitrage zur vergleichenden und experimentellen Geburtskunde. Geissen, 1864, Thomas. Versuch einer Anweisung zur Geburtshiilfe der Pferde. Mar- burg, 1866, Harms. Lehrbuch der Thierarztlichen Geburtshiilfe. Hanover, 1867. Franck. Handbuch der Thierarztlichen Geburtshiilfe. Berlin, 1876. Belgium. Delwart. De la Parturition des Principales Femelles Domestiques. Brussels, 1839. , viii LIST OF WORKS ON VETERINARY OBSTETRICS, Eherhard and Gunther. Verhandeling over het Verlossen der Koeyen. Amsterdam, 1793. Sweden. SJosfedf. Handbok i Forlossnings Konsten for Veterinarer och uppfodare af Husdjur. Stockholm, 1875. Austria. Henkel. Die Geburtshtilfe bei den Kiihen. Vienna, 1840. Poland. Seifert and Tenneker. Lehrbuch der Pferdearztlichen Geburtshtilfe. Prague, 1820. Kahlert. Praktische Anleituijg zu einer naturgemaszen Geburtshtilfe der landwirthschaftlichen Hausthiere. Prague, 1830. Italy. Cataneo. Manuale di Obstetricia Vererinaria. Milan, 1845. LanziUotti-Buonsanti. Manuale di Obstetricia Veterinaria. Milan, 187 1. England. Skellet. A Practical Treatise -on the Parturition of the Cow, or the Extraction of the Calf ; and also on the Diseases of Neat Cattle in general. London, 1807. TABLE OF ILLUSTRATIONS. FIG. PAGE 1. Pelvis of the Mare Baumeister and Rueff 7 2. Pelvis of the Cow . . . .Ibid 10 3. Pelvis of the Sheep Ibid ii 4. Lateral Ligaments of the Sacrum and Pelvis. Leyh 12 5. Ligaments of the Lumbar Vertebrae, Sacrum and Pelvis Ibid 13 6. Longitudinal Section of the Mare's Pelvis. . . .Saint-Cyr 16 7. Longitudinal Section of the Cow's Pelvis. . . .Ibid 19 8. Median Section of the Horse's Pelvis Franck 20 9. Median Section of the Mare's Pelvis Ibid 20 10. Pelvis of Mare Saint-Cyr 25 11. Pelvis of Horse Ibid 25 1 2. Generative Organs of Mare in situ Ibid 27 1 3. Lobule of Mammae Virchow 34 14. Section of Cow's Teat Guibourt 34 15. Generative Organs of the Mare, isolated Chauveau 36 16. Utricular Gland of a Pregnant Goat Franck 42 17. Utricular Gland of a Pregnant Cow Jbid 42 18. Horizontal Section of L^erine Glands. . . ... .Ibid 43 19. Uterus, Oviducts, and Ovaria of the Sheep. . .Owen 44 20. Ovary opened Vertically Saint-Cyr 48 21. Portion of the Ovary of a Pig Ibid 48 22. Graafian Vesicle in Mare's Ovary Franck 48 23. O vulum of Mare Ibid 48 24. Formation of the Ovisac in the Bitch's OYzry. Bischoff". 50 25. Graafian Vesicle and Ovum. . . Barry 51 26. Escape of Ovum from Ovisac Thomson 51 27. Successive Stages in Formation of Corpus Luteum Poiichet 52 28. Ovum from Oviduct of Rabbit Bischoff. 64 29. A more advanced Ovum ibid 64 30. Ovum from Uterine Half of Oviduct Ibid 65 31. Ovum from Uterine End of Oviduct Ibid 65 32. Blastoderm and Primitive Trace Saint-Cyr 66 X TABLE OF ILLUSTRATIONS. FIG. TAGE 33. Ovum from Twenty to Twenty-five Days old. .Saint-Cyr ... 68 34. Ovum about a Month old Ibid 69 35. Chorion of Mare at Mid-term CoUji 70 36. Foetal Membranes of the Cow at Mid-term Ibid 71 37. Foetal Membranes of the Goat at Full Time. . .Ibid 72 38. Foetus and Foetal Membranes of Cat Buffon 73 39. Foetus of Mare and its Envelopes Chauveaii 74 40. Plan of Foetal Envelopes in Mare Saint-Cyr 'j'] 41. Portion of Chorion with Placentulae : Cow. . . .Gurlt 81 42. Maternal and Foetal Cotyledons of the Cow . . . Colin 83 43. Cotyledon of a Cow's Uterus Pettigrew 84 44. Foetal Circulation in a Transition State Saifit-Cyr 97 45. Foetal Circulation : Advanced Period Colin 99 46. Male Foetus of the Mare Franck 1 03 47. Genito-urinary Organs of a f^oetal Sheep Midler 104 48. Female Organs of a Fcetal Deer Ibid 106 49. Female Foetus of the Cow Franck 106 50. Genital Organs of a Hermaphrodite Goat Leicckart 107 51. Section of Maternal Cotyledon during Gesta- tion Franck 121 52. Gravid Uterus of a Multiparous and Uniparous Animal Thonison 1 24 53. Twin Pregnancy : Cow Saint-Cyr 152 54. A Mole Zundel 169 55. Hydated Kyst Boivin 1 72 56. Cow in the Act of Parturition : Standing Posi- tion Original 222 57. Mare in the Act of Parturition: Recumbent Position Bauvieister .... 223 58. Vertebro-sacral Position of the Foetus Saint-Cyr 229 59. Lumbo-sacral Position of the Foetus Ibid 230 60. Right Cephalo-ilial Position of the Foetus Ibid 231 61. Cephalo-sacral Position of the Foetus Ibid 232 62. Sterno-abdominal Position of the Foetus Ibid 233 63. Mammary Gland and Milk Cells Virchow 253 64. Completely Deformed Pelvis Saint-Cyr 271 95. Exostosis of the Pelvis Ibid 273 66. Fracture of the Pelvis Ibid 274 67. Uterine Hernia : Mare Ibid 280 68. Incomplete or Simple Torsion of the Uterus. .Zundel 295 69. Multiple Torsion of the Uterus Gurlt 296 70. Diagram of Uterine Torsion Saint-Cyr 304 71. Left Uterine Torsion Gurlt 305 72. Right Uterine Torsion. Ibid 305 73. Right Uterine Torsion : Manipulation Saint-Cyr. . . 306 74. Left Uterine Torsion : Manipulation. Ibid 306 75. Left Uterine Torsion in situ Rossignol 308 'jd. Darreau's Uterine Retroversor Darreau 316 TABLE OF ILLUSTRATIONS. xi FIG. PAGE T]. Barnes's Uterine Dilator Original 346 'jZ. Skull of a Hydrocephalic Calf Saint-Cyr 380 79. Skull of a Hydrocephalic Calf Rueff—Baumeister . . . 380 80. Skull of a Hydrocephalic Foal Saint-Cyr 381 81. Calf Affected with Hydrocephalus Rueff—Baumeister . ... 381 82. Head of a Hydrocephalic Foal Original 382 83. Extraordinary Development of the Cranium of a Hydrocephalic Calf Original 384 84. Deformed Head and Neck of a Foal Fratick 391 85. Ectromelian Monstrosity : Horse Zimdel 402 86. Ectromelian Monstrosity : Goat Rueff—Baumeister . . . . 402 ^T. Symelian Monstrosity Ibid 403 88. Celosomian Monstrosity Ibid 403 89. Ectopia Cordis Hering 404 90. Pseudencephalian Monstrosity Ibid 404 91. Cyclopian Monstrosity : Ram Ibid 405 92. Cyclopian Monstrosity : Ass Gurlt 405 93. Acephalian Monstrosity - Ibid 406 94. Schistocephalus Fissilabrus Rueff—Baumeister . . . . 406 95. Camylorrhacchis Contorta. Ibid 40^ 96. Monomphalian Monstrosity Ibid 408 97. Skull of Syncephalian Monstrosity Franck 408 98. Monocephalian Monstrosity Rueff—Baumeister . . . . 409 99. Sysomian Monstrosity Ibid 410 100. Monosomian Monstrosity *. . . . Original 411 1 01. Polymelian Monstrosity Rueff—Baumeister .... 41 1 102. Double Parasitic Monstrosity Zundel 412 103. Sysomian Monstrosity Saint-Cyr 418 104. Celosomian Monstrosity : Lamb Youatt 421 105. Twin Foetuses in Different Presentations. . . .Saint-Cyr 428 106. Solid Repeller Original 435 107. Jointed Repeller Ibid 435 108. Jointed Repeller: Open Rainard 435 109. " " Closed Ibid 435 no. Anterior Presentation: Fore-limb Crossed Over the Neck Saint-Cyr 442 111. Anterior Presentation: Fore-limbs Bent at the Knees^ Ibid 444 112. Anterior Presentation: Extending the Fore- limb Franck 445 113. Anterior Presentation: One Fore-limb Com- pletely Retained Saint-Cyr 447 114. Anterior Presentation : Both Fore-limbs Com- pletely Retained Ibid 448 115. Anterior Presentation : Downward Deviation of the Head Ibid . 452 116. Anterior Presentation: Extreme Downward Deviation of the Head Ibid 453 xii TABLE OF ILLUSTRATIONS. FIG. PAGE 117. Anterior Presentation: Lateral Deviation of the Head Towards the Shoulder Saint-Cyr 456 118. Anterior Presentation: Lateral Deviation of the Head Towards the Abdomen Ibid 457 119. Straight Porte-cord Original 459 120. Bent Porte-cord 459 121. Finger-hook 459 122. Short Blunt Hook 459 123. Long Blunt Hook 460 1 24. Serrated Forceps 460 1 25. Binz's Porte-cord 461 1 26. Nelson's Blunt Forceps 462 127. Long Sharp Hook , 463 128. Anterior Presentation : Deviation of the Head Upwards and Backwards Saint-Cyr 465 129. Anterior Presentation : Deviation of the Head Upwards and Laterally Ibid 465 130. Deviation of the Hind-limbs in the Pelvis in the Anterior Presentation Ibid 468 131. Hind-limb Deviation : Anterior Presentation. /^r^iw^--^ 469 132. Lumbo-sacral Position of the Foetus Saint-Cyr 474 133. Hock Presentation : Calf Franck 478 134. Diagrams of the Hind-limbs in Hock Presen- tation Ibid 478 135. Hock Presentation : Hock Corded Saint-Cyr. .". 481 136. Thigh and Croup Presentation Ibid 483 137. Thigh and Croup Presentation: Thigh Corded Ibid 484 138. Thigh and Croup Presentation: Body Cord- ed Franck 485 139. Transverse Presentation : Right Cephalo-ilial Position — Side View Saint-Cyr 490 140. Transverse Presentation : Right Cephalo-ilial Position — Upper View Franck 490 141. Transverse Presentation: Vertical'^ or Ce- phalo-sacral Position Saint-Cyr 491 142. Sterno-abdominal Presentation, Head Re- tained : Calf Ibid 495 143. Sterno-abdominal Presentation, Head and Feet Engaged : Foal Franck 496 144. Darreau's Olive-shaped Repeller , 497 145. Traction Cord and Band, and the Manner of Applying them Banmeister 502 146. Schaack's Traction Cord Saint-Cyr 502 147. Cartwright's Porte-cord 504 148. Darreau's Porte-cord 504 149. Gunther's Bent Porte-cord 504 1 50. Darreau's Bent Porte-cord 504 TABLE OF ILLUSTRATIONS. xiii FIG. PAGE 151. Binz's Simple Head-collar Baiuneister 506 1 52. Rueff's Head-collar, No. i Rueff. 506 153. Rueff's Head-collar, No. 7.*. Ibid 506 154. Binz's Forceps-band Baumeister — Rueff. . . . 507 155. Schaack's Forceps-halter Saint-Cyr 508 156. Manner of Placing Schaack's Halter Ibid 50S 157. Schaack's Halter Placed on a Calf's Head. . .Ibid 509 158. Short Blunt Crotchet Original : .. 510 159. Blunt Finger Crotchet 510 160. Short Sharp Crotchet with Round Point 511 161. Short Sharp Crotchet with Broad Point 511 162. Long Blunt Crotchet 512 163. Long Pointed Crotchet 512 164. Long Pointed Crotchet : Darreau's Pattern 512 165. " " " " " 512 166. Schaack's Crotchet. .... 514 167. Simple Short Crotchet-forceps 516 168. Long Simple Crotchet-forceps 517 169. Gunther's Long Crotchet-forceps. . ." 517 170. Jointed Crotchet-forceps 517 171. Nelson's Blunt Crotchet-forceps 518 172. Nelson's Serrated Crotchet-foroeps . 518 173. Tallich's Short Bent Crotchet-forceps 518 174. Andre's Crotchet-forceps 519 I "j^. Bitch Forceps 520 I "](>. Weber's Forceps 520 I TJ. Defays's Forceps 520 178. Defays's Wire-extractor with the Torsion-rods 521 179. Defays's Wire-extractor Applied ■■ 522 180. Breulet's Tube and Noose. , . 522 181. Breulet's Noose Fixed on the Foetus 523 182. Diagram of the Pelvic Axis Saint-Cyr 524 183. Obstetric Pulleys Ibid 528 184. Baron's Obstetric Machine Ibid 529 185. Straight Embryotom Original 534 1 86. Curved Embryotom 534 187. Gunther's Embryotom : Improved Pattern 535^ 188. Scalpel Embryotom ^ 535 189. Gunther's Long-handled Embryotom .... 536 190. Cartwright's Subcutaneous Spatula 536 191. Carsten-Harms's Spatula < 536 192. Ungefrohrn's Spatula 537 193. Cartwright's Bone-chisel 537 194. Cartwright's Bone-saw , 537 195. Swedish Bone-saw 537 1 96. Pad Pessary Saint-Cyr, 593 197. Ring Pessary Ibid 594 198. Cup and Ball Pessary. .*. .Ibid 594 xiv TABLE OF ILLUSTRATIONS. FIG. PAGE 199. Labial Sutures Zundel 597 200. Loop of Delwart's Truss Franck 598 201. Delwart's Truss Applied Saint-Cyr 599 202. Renault's Truss Ibid 600 203. Leather Truss Franck 601 204. Lund's Truss Iron 602 205. Lund's Truss Applied Saint-Cyr 603 206. Parturient Apoplexy : Cow Armatage 658 207. Teat-syphon Original 710 208. Ringed Teat-syphon 710 209. Luthi's Perforating Sound 718 210. Armatage's Umbilical Truss Armatage 726 211. Wooden Clam for Hernia Ibid 730 212. Iron Screw-clams for Hernia Ibid 730 TABLE OF CONTENTS. I'AGE Introduction i Preface v PART FIRST. EUTOKIA. BOOK I.— OBSTETRICAL ANATOMY....' 5 CHAPTER I.— THE PELVIS . . 5 Section I.— Bones of the Pelvis 6 1. Os Innominatum 6 Ilium «..., .„. 7 Ischium 8 Pubis 8 2. Sacrum 9 3. Ooccyx 10 Differences in the Bones of the Pelvis of other Animals 10 Cow 10 Sheep and Goat 1 1 Bitch and Cat 1 1 Pig " Section II. — Articulations of the Pelvis 12 1. Sacro-lumbar Articulation 12 2, 3. Sacro-iliac Articulations 12 4. Ischio-pubic Symphysis 13 5. Sacro-coccygeal Articulations . . 14 Differences in the Pelvic Articulations of other Animals 14 Cow . . ~ . . . ...... 14 Sheep and Goat • • 14 Bitch and Cat 14 Sacro-sciatic Ligament 14 Section 1 1 1.— The Pelvis and its Cavity 15 Mare ^5 External Surface IS Anterior Opening or Inlet 17 TABLE OF CONTENTS. PAGE Posterior Opening or Outlet 17 The Cavity of the Pelvis 18 Differences in other Animals 18 Cow 18 Sheep and Goat 19 Pk 19 Bitch and Cat 19 Section IV. — Capacity of the Pelvis or Pelvimetry... 20 Differences in the Pelvis according to Sex 25 CHAPTER II.— FEMALE GENERATIVE ORGANS 27 Section I. — External Generative Organs 27 The Vulva. 27 Differences in the Vulva of other Animals 30 Cow 30 Sheep 31 Pk 31 Bitch and Cat .... 31 Section II. — The Mammae 31 Differences in other Animals 33 Cow 33 Sheep and Goat ... 34 Pig 35 Bitch 35 CHAPTER III.— INTERNAL ORGANS OF GENERATION.. 35 Section I. — The Vagina 35 Differences 37 CoWy Sheep, and Goat 37 Pig 38 Bitch and Cat 38 Section 1 1. — The Uterus 38 Differences 41 Cow 41 Sheep and Goat 43 Pig 43 Bitch and Cat 43 Development 44 Section III. — Fallopian Tubes or Oviducts 45 Differences 46 Cow, Sheep, and Goat 46 Pig 46 Bitch 46 Section IV. — The Ovaries 47 Differences , 49 Cow, Sheep, and Goat 49 Pig 49 Bitch and Cat 49 Development 49 TABLE OF CONTENTS. xvii PACK BOOK II.— OBSTETRIC AL PHYSIOLOGY 53 REPRODUCTION 53 CHAPTER I .—Section I.— Puberty ; . 55 Section II. — CEstrum or Menstruation 56 Section HI. — Maturation of the Graafian Vesicles... 60 CHAPTER H.— FECUNDATION 61 CHAPTER III.— STERILITY 62 CHAPTER IV.— CHANGES IN THE OVUM 64 Section I. — Development of the Embryo 66 Section 1 1. — Annexes of the Fcetus 70 Chorion yi Differences 73 Ruminants 73 Pig 73 Bilc/f^ and Cat 74 Amnion 74 Liquor Amnii 75 Differences in the Amnion of other Animals ♦. 76 Ruminants 76 Pig 76 Bitch and Cat. ...... 76 Allantois 77 Differences 70 Ruminants 7q P'S V 79 Bitch and Cat. 70 UmbiHcal Vesicle , . , 70 Differences go Ruminants and Pig go The Placenta go Differences gi Cow . . , gi Sheep and Goat g4 Pig ^S Bitch and Cat Z^ Functions 85 Umbilical Cord 86 Differences ^y Ruminants • 87 Pig ^7 Bitch and Cat 88 Section III. — Development of the Fcetus 89 The Nervous System u^is. ' Ilium. — The ilium, hip, or haunch bone (os ilium), gives its name to the region it occupies. It is the largest of the three bones, as well as being that which is most elevated. In shape it is irregularly triangular and flat, and is directed obliquely downwards, inwards, and backwards, and has two faces, three borders, and three angles. Its external or superior face or dorsum is marked by some muscular imprints, and is curved in its widest part to form a concave space — the external iliac fossa — which lodges the gluteal muscles. The internal or inferior face, or venter, offers Pelvis of the Mare. A, Tlium ; B, Pubis ; C, Ischium ; D, Foramen Ovale ; E, Tuberosity of the Ischium ; F, Cotyloid Cavity. a smooth external portion — the iliac surface — into which is implanted the iliac psoas or iliacus muscle; and an internal roughened, ear-shaped, irregularly diarthrodial surface, most apparent from behind — the auricu- lar facet — for articulation with the sacrum. The anterior border, or crest oj the ilium, is slightly concave, and bears a rugged lip for muscular insertion. The external border is thick and roughened, and grooved for the passage of blood-vessels ; inferiorly it has three nutrient foramina. The internal border is thin and concave, espe- cially in its posterior part, where it constitutes the great sciatic notch; it affords attachment to the sacro-sciatic ligament. The spine or ridge of the same name partly belongs to it. The external angle, antero-superior spinous process, or point of the hip, is a wide, thick, and flattened portion, bearing four tuberosities affording attachments to muscles. The internal or antero-internal angle or supero- posterior spinous process, is a rough tuberosity curving upwards and back- wards to form an angle with the corresponding portion of the opposite ilium — the summit of the croup. The inferior, posterior or cotyloid angle (concurring in the formation of the acetabulum) is very large and pris- matic in shape. Posteriorly, it offers a concave articular surface (acetab- ular), and above this cavity is the supra-cotyloid ridge or crista Hit : an elongated eminence passing backwards, sharp at its summit, smooth 8 OBSTETRICAL ANATOMY. internally, and roughened externally, which is continuous anteriorly with the inner border of the bone, divides its iliac and articular surfaces, becomes lost on the anterior margin of the pubis, and laterally limits the anterior circumference or border of the pelvic cavity — the linea ilio- pectinea. The ilium is therefore united to or in contact with the sacrum supe- riorly, and inferiorly and posteriorly with the two bones next to be described. Ischium. — The ischium {os sedentarum of man) is next in size to the ilium, and the most posterior of the three bones. In form it is flat and irregularly quadrilateral ; and is composed of a thick solid portion — the body, and a narrow part — the neck. It has two faces, four borders, 2iV\dfour angles. The upper face is smooth and nearly flat, and forms part of the floor of the pelvic cavity. The lower or exter?ial face bears some rugged imprints, particularly towards the symphysis. • The anterior border is thick and concave, and posteriorly circumscribes the obturator or oval foramen. The posterior border is straight and di- rected obliquely forward and inward, composing, with the corresponding border of the opposite bone, a large notch — the pubic or ischiatic arch. Throughout its extent it exhibits a roughened depressed lip which pro- jects on the lower face — this is the spine. The external border is thick and concave, affords attachment to the sacro-sciatic ligament, and forms the small sciatic notch. The internal border joins its homologue of the opposite side to complete the ischio-pubic symphysis. The external or cotyloid angle is the most voluminous, and shows : an excavated diarthrodial facet, forming part of the acetabulum ; and the posterior extremity of the crista ilii, limited by a small transverse fissure which separates it from the external border of the bone. The antcro- internal angle ]o\ns the posterior angle of the pubis. The postero-external angle is the most important in an obstetrical point of view, as it consti- tutes what is commonly named the point of the hip ; with the correspond- ing bone of the opposite side, it forms the ischiatic tuberosity {tuber ischii) : a thick, up-curved prismatic mass which is continued by a prom- inent ridge elongated from before to behind, the thin margin of which is curved outwards and downwards. The distance between the external tuberosities of the two ischii gives the width of the ischial arch, and al- lows an estimate to be formed of the transverse diameter, of the posterior opening of the pehds. The postero-internal angle constitutes, with that of the other ischium, the summit of the triangular notch or space named the " ischial " or " pubic arch " in some species. Pubis. — The pubis {pecten or share-bone) is the smaller of the three, and is situated between the ilium and ischium. It is irregularly triangular, and is described as having two faces, three borders and tliree a?igles. The tipper face is concave and smooth, and concurs in forming the floor of the pelvis. In the pelvis of many Mares it has a more or less marked depression, apparently produced at the expense of the anterior portion of the bone, which is thin ; while in the Horse it is generally much thicker at this part, and instead of a depression the surface may be plane or even convex. The lower face is rough and traversed on its whole length by a wide groove which reaches the bottom of the acetabulum, and lodges the pubio-femoral ligament and a very large vein. THE PEL VIS. 9 The ajiterior border is thin and uneven, and is curved like the arc of a circle ; it concurs in forming the anterior circumference of the pelvis. The posterior border is thick and concave, and in front circumscribes the oval^ sub-pubic ox obturator foramen. It is channeled, near the acetabulum, by a fissure that passes obliquely downwards and inwards. The internal border joins that of the opposite pubic bone in the middle line, to form the anterior portion of the ischio-pubic or pelvic symphysis. The external ox cotyloid angle is the thickest, and constitutes the largest portion of the roughened depressed surface at the bottom of the ace- tabulum. The internal angle is united to the corresponding angle of the opposite bone. Tho. posterior angle is fused at an early period with the anterointernal angle of the ischium, to form the inner boundary of the obturator foramen. The pubis does not alter much in form with age, but retains its convex shape, while the part around the acetabulum is of considerable thickness : a circumstance which tends to diminish the pelvic cavity to a notable depfree. During life, the pubic bones gradually lose their spongy tissue, and to such an extent that in old age it has almost disappeared, and the parts are translucid. It may also be well to note that the compact tissue is most abundant in the vicinity of the acetabulum, that cavity being the point where the impulsive efforts communicated to the body by the posterior limbs are concentrated ; at this part, also, ossification commences. 2. Sacrum. The sacrum {os basilare of man) may be said to terminate the vertebral spine posteriorly, and results from the fusion of five vertebrae into a single, voluminous, pyramidal or triangular mass. It encloses the pelvic cavity above, and articulates in front with the last lumbar vertebra, behind with the first coccygeal or tail-bone, and laterally with the ossa innominata. It has an upper 2iX\d a lower face, two lateral borders, 2l base or anterior extremity, sutiimit or posterior extremity, and central cajial, ThQ upper face shows the supra-spiyious processes or supra-sacral spine (though the processes only meet at their base). On each side of this spine is a channel in which are four openings — the supra-sacral foramifia, which communicate with others on the inferior face. The lower face is smooth, and slightly concave from before to behind ; this is the roof of the pelvic cavity, and shows traces of its being composed of five bones, as well as offers four foramina for the passage of the sub-sacral nerves. The two lateral borders are thick and concave, and posteriorly show a rugged lip. In front is an irregular oblique surface for articulation with the ossa innominata ; this is divided into two portions, the lower of which, slightly uneven and diarthrodial, is the auricular surface ; the upper is for the insertion of the sacro-sciatic ligament. The base, or anterior extrefnity, is articulated by a slightly oval and con- vex surface with the last lumbar vertebra, and forms with the spine a salient angle looking down towards the abdominal cavity, named the sacro- vertebral angle. Laterally, it is united with the two coxae, between which it is fixed like a horizonta/ wedge. In front it shows the opening of the spinal canal. The summit or posterior extremity likewise offers the opening of the spinal canal, and a surface for articulation with the first tail-bone. The central ca7ial\s a continuation of that in the other vertebrae, for the passage lo OBSTETRICAL ANATOMY. of the spinal cord. In this bone, however, instead of being circular, it is triangular, and diminishes in width posteriorly. The position of the sacrum is more or less inclined downwards from before to behind, according to the breed of the Mare. 3. Coccyx, The coccygeal or tail-bones are a series of small, cylindrical, or irregularly prismatic pieces, from fifteen to eighteen in number, behind the sacrum, the first three of which may be said to belong to the pelvis. They form the base of the tail. Differences in the Bones of the Pelvis of other Animals. In all the domesticated animals, the coxai are nearly horizontal, and the ilium has a vertical direction. Cow. In the pelvis of the Cow, the space between the coxae is no greater before than behind ; they are not so solid nor voluminous, comparatively, as in the Mare. This is more particularly the case with the iliuffi, the iliac Pelvis of the Cow. A, Ilium ; B, Pubis ; C, Ischium ; D, Foramen Ovale ; E, Ischiatic Spine ; F, Cotyloia Cavity ; G, Tuberosity of the Ischium. concavity of which is not so wide. It is more vertical than in the Mare. The ischiu7n, though thinner than in the Mare, has a much wider surface, and is more curved from before to behind and from side to side ; while the ischiatic spine or supra-cotyloid crest is very prominent and thin. Three tuberosities are observed on the postero-external angle. The pubis is wide and thin ; it has no channel on its inferior face, and the upper face is ^rery concave. The foramen ovale is large, and its margin thin. The symphysis is ossified earlier than in the Mare. The sacrum is longer, and more curved and voluminous than that of the Mare. The lateral borders are sharp and directed downwards. It is composed of the same number of vertebrae as in the Horse. The articular surfaces for union with the coxae approach the vertical direction. THE PELVIS. II The coccygeal bones are stronger and more tuberous : they are from sixteen to twenty in number. The pelvis of the Cow is therefore more developed than that of the Mare, and has more extensive bony walls. We shall see that it also differs in its form and direction, and that this has a notable influence in the mech- anism of parturition. Sheep a?id Goat In the Sheep and Goat, the bones of the pelvis greatly resemble those of the Cow. The ischium, instead of being curved in a longitudinal direction, however, is nearly rectilinear, and the external iliac fossa is divided into two portions by a small longitudinal crest. * The pelvis, on the whole, is more horizontal and longer. Bitch and Cat. In the Bitch and Cat, the lateral diameter of 'the pelvis is greater be- fore than behind ; the ilium is almost vertical, and its external face is Fig. 3. Pelvis of the Sheep. A, Ilium ; B, Pubis : C, Ischium ; D, Foramen Ovale ; E, Cotyloid Cavity. much depressed. The space which forms the pubic arch only occupies the inner moiety of the posterior border of the ischium, which is very broad ; between the arch and the ischial tuberosity is a roughened lip, which is directed downwards. The sacrum is somewhat quadrangular and com- posed of three bones, which are anchylosed at an early age, and the lateral surfaces for articulation with the ilium are turned outwards and almost vertical. There are only three vertebral foramina. The coccygeal bones are strong and tuberous, and the first five or six are as perfect as the true vertebral bones. Pig- The pelvis of the Pig resembles that of the Sheep. The crest of the ilium is convex, and there is no external protuberance on the symphysis pubis. The /«^/j- is narrow; and the ischium, m?>\.&d.d of a crest, has a tuberous prominence. The sacrum is formed by four vertebrae, which do not become fully consolidated for a long time, and it is sometimes difficult to discover where the sacrum ends and the coccyx begins. The spinous processes are absent; and the neural arch being deficient on each side, the spinal canal is open above. There is nothing particular to note in the coccygeal bones. 12 OBSTETRICAL ANATOMY. SECTION II. — ARTICULATIONS OF THE PELVIS. The bones of the pelvis are united by articulations and ligaments, as well 48 fibrous bands, which are complementary, A knowledge of these is of some importance to the obstetrist. The articulations are five in number: (i) the sacro-lumbar, (2,3) the two sacro-iliac, (4) the ischio- pubic symphysis, and (5) the sacro-coccygeal articulations. The ilio-sacral and sacro-sciatic ligaments complete the subject of this section. I . Sacro-lumbar Articulation. The sacro-lumbar articulation is formed between the anterior face or base of the sacrum, and the last lumbar vertebra j the union takes place by five articular surfaces and thick fibro-cartilages, and numerous strong ligaments bind the two bones closely and very firmly together, so as to allow only a minimum amount of movement between them. It would appear that these bones, though so limited in their movements on each, yet are never anchylosed through old age, nor yet by accident, even if all the other vertebrae in this region should happen to be consolidated. This arrangement is particularly remarkable in the Mare, on which it confers great strength and solidity. It is not present in the Cow ; con- sequently that animal is liable to a kind of incomplete luxation, which may at times become an obstacle in parturition. We have already alluded to the salient angle formed by the union of the last lumbar vertebra with the sacrum {sacra-vertebral angle), and which looks downward into the abdominal cavity.* 2, 3. Sacro-iliaC Articulations . The sacro-iliac articulation of each side establishes the union of the pos- terior limbs with the spine, and is formed by the sacrum and ossa ilii ; it Fig. 4- Lateral Ligaments of the Sacrum and Pelvis. A, Superior Sacro-iliac Ligament ; B, Sacral Ligament ; C, Lateral Sacro-iliac Ligament ; D, Sacro-sciatic Ligament ; E, Small Ischiatic Notch ; F, Great Ischiatic Notch. belongs to the arthrodial class of joints. The two surfaces which come into opposition have been already described, and it only now remains to point out that the sacrum is fixed between the antero-superior extremities of the * This angle is much more marked in woman, and is immediately at the entrance to the pelvis ; for these reasons it is frequently a cause of difficult parturition in her, while, from its less development and distance from the pelvis, it offers no obstacle in animals. THE PEL VIS. 13 ossa ilii, like a horizontal wedge or the keystone of an arch inverted : the transverse diameter is greater below than above — the pressure it has to resist being from below. The oblong roughened surfaces on the sacrum and ilium have a layer of cartilage between them to diminish shock and facilitate movement, which is further promoted by each articulation being provided with a synovial membrane, though the amount of synovia secreted is very trifling. The union of the bones at this part is strength- ened by three powerful ligaments : the sacro-iliac — superior and inferior, and the sacro-iliac proper. There is also the sacro-sciatic or sacro-ischiatic to be noticed hereafter. Though the movements of this articulation are very limited, but still useful in locomotion and parturition, yet it rarely, if ever, becomes consolidated. The diarthrodial union between the bones appears to be chiefly, if not exclusively, intended to obviate the fractures which must occur had they been united in a more solid manner ; while the two articulations being the centre towards which all the impul- sive efforts of the posterior extremities converge, a great degree of mobility would not be compatible with their solidity. 4. Ischio-pubic Symphysis. The symphysis pubis, as it is sometimes termed, is the amphiarthrosis formed by the union, inferiorly, of the two ossa pubis and ischia. The articulation is consolidated by means of a layer of fibro-cartilage be- tween the margin of these bones, and which becomes ossified more or less completely and rapidly according to species ; and by a layer of white ligamentou fibres — short and compact — which pass across above b Fig. 5- Ligaments of the Lumbar Vertebr/E, Sacrum and Pelvis, seen from below. A, Intertransverse Ligament of the Lumbar Vertebrae ; B, Capsular Ligament of the Spinous Process of the fifth and sixth Lumbar Vertebrae ; C, Capsular Ligament of the Sacrum ; D, Inferior Sacro-iliac Ligament ; E, Obturator Ligament ; F, Transverse Ligament of the Ischio-pubic Symphysis. and below, the latter being the strongest. The movements of this ar- ticulation are very limited, and depend solely upon the elasticity of the interosseous cartilage ; they are abolished when ossification occurs. This happens in the majority of Horses before adult age ; though some- times the posterior portion is cartilaginous after this period. # 14 OBSTETRICAL ANATOMY. 5 . Sacro-coccygeal Articulations. These resemble those of the vertebras in general : there being a thick disc of fibro-cartilage placed between each tail-bone, the first of which is joined to the posterior extremity of the sacrum. Their solidity is further assured by a common fibrous sheath which completely envelops them, but without interfering with their mobility. This mobility greatly favors parturition ; but it must be noted that not infrequently the first coccygeal bone is completely ossified with the sacrum, and as this necessarily limits the elevation of the tail, it diminishes the supero-inferior diameter of the posterior opening of the pelvis, and may in this way prove an obstacle to the expulsion of the foetus. Differences in the Pelvic Articulations of other Animals. In all the domesticated animals other than the Equine species, the sacrum is joined to the last lumbar vertebra by three diarthrodial sur- faces only : the head of the body and two transverse processes ; these latter on the vertebrae not being in immediate contact with the base of the sacrum, an interosseous ligament unites them. Therefore it is that, in the Cow more particularly, there is greater mobility in the sacro-lum- bar articulation, and the possibility of a greater increase in the supero- inferior diameter of the pelvis when it is subjected to such eccentric pressure as the passage of the foetus would produce. Cow. In the Cow the ischio-puhic symphysis is longer than in the Mare, not rectilinear, and much curved downwards in the middle ; across this con- cavity on the floor of the pelvis, the foetus passes during parturition. In the Cow ossification of the symphysis is less complete, and does not take place until much later than in the Mare, though it may in some instances be found entirely accomplished in old animals. Ossification, according to Saint-Cyr, commences in the Cow at the ischial arch, and proceeds forwards, while in the Mare it begins at the pubis and extends back- wards. The same authority remarks that this symphysis in the Cow has often a salient crest projecting *into the pelvic cavity, and which, if it does not offer a very considerable obstacle to the passage of the foetus, may nevertheless greatly fatigue the obstetrist when his hand is engaged between it and the young creature, during the straining of the mother. Sheep and Goat. In these animals the. ischio-pubic symphysis is rectilinear; the inter- posed cartilage is not ossified until very late in life, and almost never in those which have had many young. The same remarks are applicable to this symphysis in the Pig. JBitch and Cat. The symphysis in the Bitch and Cat scarcely ever ossifies ; so that these animals, when advanced in age, still have a notable degree of mobility in this region, and the diameter of the pelvic cavity may be proportionately increased. Sacro-sciatic Ligament. The sacro-sciatic ligament (Fig. 4, d) transforms the pelvic cavity into a complete canal by filling up the space on the side of the pelvis, between THE PELVIS. ,5 the sacrum and coxae. It is a wide membranous expansion, composed of white fibrous tissue — the fibres crossing each other in different directions, and serves rather to enclose this portion of the pelvic space than to main tain the solidity of the sacro-iliac articulation. It is irregularly quadri- lateral ; its superior dormer being rectilinear, and attached along the rough crest on the side of the sacrum, as well as to the first two or three coccy- geal bones. It anterior border is irregular, and not well defined, but it is inserted above into the base of the sacrum, and below into the inner border of the ilium, circumscribing in its middle the opening which has been named the great ischiatic notch, through which the gluteal vessels and nerves, as well as the sciatic nerves, pass, and to the compression of which against the bones of the pelvis during pregnancy may be due cramp of the posterior limbs, or even more or less persistent paralysis ; the inferior border is attached to the spine of the ischium, as well as to the ischiatic tuberosity, and between these insertions, and immediately behind the cotyloid cavity, it forms the small ischiatic notch, the opening through which the obturator internus muscle passes j while the posterior border^ not well limited, completes the posterior circumference of the pelvic cavity, and divides into two layers, between which lies the semimembra- nosus muscle, and above it is mixed up with the enveloping sheath of the tail muscles and bones. The inner face of this wide ligament is covered by peritoneum to the extent of one-third in front ; a-nd behind it is in direct relation with various organs contained in the pelvic cavity, by means of an abundant loose connective tissue. Its external face is traversed by the sciatic nerves and covered by muscles. SECTION III. THE PELVIS AND ITS CAVITY. Having now studied the individual pieces which compose the pelvis, as well as the manner in which they are united, it remains to consider this region in its entirety, and with regard to its general conformation, dimen- sions, axes, and other important features. This study is of much moment in an obstetrical point of view, and for the full comprehension of the mechanism of parturition. We will first notice the pelvis of the Mare and proceed to compare it with the other domesticated animals. ^ Mare. Considered in a general manner, the pelvis of the Mare represents a slightly cone-shaped, bony cavity at the pdsterior part of the trunk, completing or continuing the abdominal cavity ; the base of this conical excavation, intersected obliquely downwards and backwards, is anterior : its axis forming, with that of the abdomen, a very wide angle, the sinus of which is inferior. The summit or narrowest part of the cavity is pos- terior. With regard to conformation, it offers, for convenience of de scription, an external and internal surface and tivo openings. External Surface. — This surface may be considered as consisting of four regions, planes, or faces. The superior region or croup is the narrowest, and is slightly oblique downwards and backwards : the degree of obliquity varying not only in different breeds, but also in different animals of the same breed and species; In the Mare it is indicated by the droop or slope of the croup, which is generally greater than that of the Cow. It is 1 6 OBSTETRICAL ANATOMY. more conspicuous in common than in well-bred horses, in which the croup is almost horizontal, and the tail nearly on a level with its highest point. The width of this region also varies not only with the height and volume of the animal's body, but also according to breed : the draught or coarse- bred horse having a wider croup than the thorough-bred one. This region is constricted from before to behind, and shows, on the middle line, the spinous processes of the sacrum and the first coccygeal vertebrae ; and on each side the channels into which open the four sacral foramina. The inferior region is nearly horizontal, and is slightly convex. Formed by the pubic and ischial bones, it offers in the middle the symphysis pubis, on each side the subpubic channels, and the obturator foramen, and outwardly the cotyloid cavities through which the pelvis rests on the posterior limbs. The lateral regions are more extensive than the others ; they are in- clined downwards and inwards, and are wider before than behind. On each are observed the crest of the ilium and the two anterior iliac spines, the external iliac fossa, the great sciatic notch, the spine of the ischium, the small sciatic notch, and the tuberosity of the ischium. The internal surface, as has been already mentioned, is formed partly of bony and partly of ligamentous walls, and circumscribes the pelvic cavity, which is a continuation of that of the abdomen, and with which it communicates by a wide osseous circle — the anterior opening or i7ilel of the pelvis. A transverse section of this canal shows that it is oval- shaped, the largest portion being towards the pubis, and the narrowest to the sacrum. The internal surface is more regular than the external, but it cannot be divided into two portions like the human pelvis, the inner aspect of the ilia not being excavated to form an anterior cavity. It may, however, be considered as having four co7icave planes^ an anterior opening or inlet^ and 2t. posterior opening ox outlet. Fig. 6. Longitudinal Section of the Mare's Pelvis. The superior, sacral, or rectal plane, or roof of the pelvis, is formed by the lower face of the sacrum, and is in contact with the rectum, subsacral vessels, and sympathetic nerves. It is slightly concave longitudinally. The inferior plane, or floor of the pelvis, is constituted by the upper surface of the pubic bodies and ischia. It is rectilinear from before to side to side. The symphysis pubis occupies THE PELVIS. 1 7 the median line ; it is salient, and varies in length according to the size of the animal, being usually about six or seven inches. In front, at the pubis, is a depression more or less marked, in which the previously- emptied bladder may be lodged during the passage of the foetus. On each side is the obturator foramen, which is partly closed by the internal obturator muscles, and through which the obturator vessels and nerves make their exit. The two lateral planes are formed by the inner surface and spine of the ischia, and in great part by the sacro-sciatic ligaments; the sciatic notches belong to them, and they are traversed from before to behind by the obturator vessels and nerves, and pierced by the gluteal and ischio- muscular vessels and nerves, the internal pudic, and the great and small sciatic nerves. As has been stated, it is the compression of these nerves by the uterus and its contents which cause the cramps pregnant animals experience towards the termination of gestation. The lateral planes are readily dilatable during parturition. Anterior Opening or Inlet. — This, which may also be designated the bri77i^ afiterior circumference, ftr abdominal opening of the pelvis, is nearly circular, or slightly oval, the widest part corresponding to the symphysis pubis. It is a little obliquely inclined downwards and backwards, and is limited above by the anterior border of the sacrum and its articulations with the lumbar vertebra and ilia ; below, by the anterior border of the pubic bones ; and on each side,-by the ileo-pectineal crest and a portion of the inner aspect of the ilia. Owing to this circumference being entirely bony, and to the solidity of the articulations between the different bones, the inlet of the pelvis cannot be dilated to any appreciable degree, even under the most violent efforts, and supposing the sacro-iliac and ischio- pubic ligaments to become softened and relaxed before pregnancy — a change which must be indeed rare in the Mare. It is by the inlet that the foetus enters the pelvic cavity, and a knowl- edge of its dimensions is therefore of much moment to the obstetrist. These dimensions are ascertained by taking the diameter of the opening at several points, but two diameters are generally recognized : a supero- inferior and a trafisverse. The sicpero-inferior, or sacro-pnbic diameter, is the width between the sacro-vertebral angle and the symphysis pubis. This is generally the largest diameter, though exceptions are met with now and again ; it is the diameter which should receive the widest part of the foetus when it enters the pelvis. It varies with the size of the Mare, but is usually between eight and ten inches. The transverse diameter is measured from one ileo-pectineal crest to another, and is generally less than the supero-inferior, though sometimes it may be equal, or even greater. It is from seven to nine inches. Posterior Opening or Outlet. — This is also sometimes named the perineal circumfereftce, or recto-urethral openifig; it includes in its contour the rectum and vagina, and is related to the vulva and anus, which are external to it. Owing to the horizontal direction of the Mare's pelvis, this outlet is limited above by the apex of the sacrum and the base of the coccyx ; below, by the ischial arch formed by the junction of the two ischia ; and, laterally, by the upper face of the ischia and posterior border of the sacro-sciatic ligaments. The opening is oval. The diameters are ordinarily much less than those of the inlet — perhaps 1 8 OBSTETRICAL ANATOMY. one-fifth ; but this circumstance has rarely any influence in parturition, as the opening is very dilatable, owing to the relaxation that takes place in the sacro-sciatic ligaments during the later months of pregnancy, and the great mobility of the sacrum and coccyx, which may allow the supero- inferior diameter to be increased considerably. The Cavity of the Pelvis. The cavity of the pelvis is the space between the inlet and outlet. In the human female, it lodges nearly the whole of the uterus, and in the early days of pregnancy the foetus also. This is not the case with the domesti- cated animals, owing to their different attitude, until the act of parturition carries the progeny there.* With its two openings, the pelvic cavity is capable of more or less increase in capacity in every direction, through relaxation of the pubic and sacro-iliac articulations and sacro-sciatic liga- ments. The yielding of the latter is very noticeable in the larger animals immediately before parturition, as well as the elevation of the coccyx by the body of the foetus in its passage outwards. It is also a fact of daily observation that the pelvis permanently widqfis in animals which have had young frequently ; this accounts for the peculiar rocking gait they exhibit in progression, which, in some of the domesticated creatures at least, is no doubt due to persistent relaxation in the articulations above men- tioned. It may be again observed that the anterior margin of the flopr of this cavity is nearly straight, and its posterior border is deeply cut into by the ischial arch, while the floor itself often offers some diversities. For in- stance, it may be convex in front and concave behind, or vice versa, the concavity being separated from the convexity by a transverse ridge, which may also be represented by a series of small conical eminences ; or the floor may be a smooth plane sloping upwards from before to behind, with a kind of raised border surrounding the anterior contour of the ob- turator foramen. Differences in other Animals. Cow, In the Cow, the pelvis is longer than in the Mare, and less vertical ; the ischio-pubic symphysis is also longer, and instead of being straight is very curved ; so that the floor of the pelvis is concave in every direction. The ischial arch is more deeply cut at the symphysis, and the posterior borders of the ischia join at an acute angle or V-shape, the opening being supero- posterior. The external border of these bones is higher, and the sciatic spine or supra-cotyloid crest is thinner and more elevated. So that, alto- gether, the bony parietes of the Cow's pelvis are more extensive, com- paratively speaking, than the Mare's. The sacral surface is more concave, and the sacro-sciatic ligaments wider, though shorter. The pelvic cavity of the Cow is also less wide, when compared with its height. The diameters of the inlet — which is more oblique than in the Mare — are very unequal \ the difference between the sacro-pubic and the transverse, according to Saint-Cyr, being one-third (nine and six incli^s). The dimensions of the outlet are more equal, and are about those of the * Girard thought that, in the Bitch, one of the young in the body of the uterus might occupy this space ; but Rainard could not verify this, all his examinations of pregnant animals which had died before bring- ing forth their young proved the body of the uterus to be quite empty. THE PELVIS. 19 transverse diameter of the inlet. It therefore results that the pelvis of the Cow is more cylindrical and less conical than that of the Mare ; but this fea- ture does not render parturition any easier, for though the outlet is a little larger than in the latter animal, yet this advantage is counterbalanced by the length of the pelvic cavity, the greater extent of its bony walls, and the very marked curvature of the symphysis. So it is that, while it rarely happens that the foal experiences any difficulty in passing through the pelvis, once it has fairly cleared the inlet, it is not at all infrequent for the calf to become fixed in the pelvis, and to remain there unless removed by artifical means. It is also to be noted that the floor of the pelvic cavity is on a much Fig. 7. Longitudinal Section of the Cow's Pelvis. higher level than thaj of the abdomen ; so that a kind of steep step has to be ascended by the calf before it can enter this passage ; consequently, it often remains fixed against this upper level at the inlet. Sheep and Goat. With these animals the pelvis does not differ to any notable extent — except, of course, in size — from that of the Cow. The symphysis is nearly rectilinear in its direction, and its ossification occurs at a very much later period than in the Cow or Mare ; this allows the diameters of the pelvic cavity to be increased during parturition, and accounts for the rarity of difficult births in the Sheep and Goat. Pig. The general conformation of the pelvis in the Pig is not unlike that of ruminants, except that the sacro-vertebral angle, or "promontory of the sacrum," is more salient, the canal longer, the plane of its anterior cir- cumference more oblique, and the direction of the ischio-pubic symphysis perfectly rectilinear. The /^ in. Vertical Transverse 6/5 in. lYz in. 9 to 9>^ in. 14 hands Supero-inferior Vertical Transverse 9% to ^}i in. 8/5 in. 8/5 to 9 in. Vertical Transverse 6 to 6>^ in. 6to to 7 in. 8/5 in. 12 hands Supero-inferior Vertical Transverse 8T='iT to SiV in. 7:fir in. lYz to7i%in. Vertical Transverse 4fij to 4t5 in. 5iff to 5^ in. ih to 7>^ in. Ass Middle size Supero-inferior Vertical Transverse 7-h in. ST'ain. ^ 4/5 in. Vertical Transverse 415 in. 3x^5 in. 3/0 in. Cow Middle size Supero-inferior Vertical Transverse 8/s in. 7 A in. 7t*5 in. Vertical Transverse ■]-?Ti in. 7K in. 415 in. Sheep Ordinary size Supero-inferior Vertical Transverse 415 in. 21*5 in. 3^ in. Vertical Transverse 3>^ in. (varies) 21% in. 2 in. Goat Middle size Supero-inferior Vertical Transverse 4|^ in. Length from snout to tail, 54^ in. Supero-inferior Vertical Transverse 4 in. 3ft in. l^ji in. Vertical Transverse 2fS in. 4 in. 4 in. Dog Large Supero-inferior Vertical Transverse 2Kin. 2 in. 2 in. Vertical Transverse 23^ in. 2 in. 2 in. Small Supero-inferior Vertical Transverse 2 in. rfs in. I A to 1/5 in. Vertical Transverse 2 in I h in. IiIj in. Cat Ordinary size Supero-inferior Vertical Transverse 2Kin- 2 in. iT% in. Vertical 21^ in. Transverse 1/0 in. 1 10 in. Some veterinarians, however, who have made this subject an ahnost special study, only specify two diameters, the stcpero-ififerior or sacro-pubic, and the transverse or bis-iliac. The following are the measurements fur- nished by four of these authorities : — THE PELVIS. MARE. 23 iJiameters. Daumeis- \z\- nr.d Rucff. Carsten- Harms. Arloing. Saint- Cyr. Remarks. Inlet. Inches. In. In. In. Supero-inferior Diameter 9 to 10 9% 9 8^* *The average of 28 meas- urements of Mares vary- ing from l^y^ to 1 6- 1 hands in height. Transverse Diameter II to 12^ 9\ 9\ 8rVt tThe average of 25 meas- urements as above. Outlet. Supero-inferior Diameter 9 to 10 jyi 7 — Transverse Diameter 9 (>Vz 7% — COW. 1 Baumeister Diameters. i ^^^ j Rueff. Carsten- Harms. Arloing. Saint- Cyr. Remarks. Inlet. Sujjero-inferior Diameter Transverse Diameter Outlet. Supero-inferio Diameter Transverse Diameter Inches. 9 to9>^ 6| Urachus, the expansion of which forms the Allantois ; 6, Pedicle of the Um- bilical Vesicle. The inner, or amniotic layer, is so loosely united to the amnion, that a slight dissection or inflation will readily detach it. When inflation is practised, the separate membrane presents a wavy appearance, from the presence of numerous cellular attachments it has with the amnion ; as the inflation is forced these bands tear with a noise like the crackling of parchment, and with care the whole of this portion, which is equal in extent to the amnion, may be removed. The chorial allantois adheres much more firmly, and in some parts it can scarcely be dissected away. Infla- tion, however, demonstrates its existence and continuity with that on the amnion ; for if, after opening the allantoid sac by cutting through the chorion and the layer covering it, we introduce a tube between the two membranes — which is easily done near a large vessel, a slight inflation causes the air to penetrate between the allantois and chorion, though only in the track of the vessels of a certain size, where the adherence is slight ;• a more powerful inflation will cause the air to follow the smaller 78 OBSTETRICAL PHYSIOLOGY. vascular ramifications, and render the membrane still more apparent, but not at the points where the vessels have almost become capillaries. If, instead of forcing the air towards the ramifications, it is sent in the contrary direction, it will be seen to pass to that portion of the membrane covering the umbilical cord, and insinuate itself between the amnion and the layer of allantois covering it, thus proving the continuity of the membrane. As has been stated, the cavity of this sac is in communication with the interior of the bladder by means of the urachus : a narrow canal in the amniotic portion of the umbilical cord, and which widens at the origin of the allantoidean portion, where its walls are continuous with the amniotic layer of the membrane, as well as the chorial layer^ after being prolonged as a sheath around the cord. These arrangements show the allantoid cavity to be a kind of urinary reservoir or dependency of the bladder, the fundus of which is prolonged in an infundibular manner as far as the umbilicus, to constitute the urachus, which follows the umbili- cal vessels in the amniotic portion of the cord, and ends by forming the allantoid cavity. The structure of this membrane is slightly fibrous, with a layer of epithelium ; it is thin and pellucid, and appears to be destitute of vessels at a late period of foetal life. It bears on its surface the umbilical vessels, from the umbilicus to the chorion. The allantois contains a fluid — the allantoic liquid — the quantity of which, like that of the amnion, is greatest at an early period. It is then colorless or slightly turbid ; but with the growth of the foetus it gradually assumes a yellowish Jiue, until near parturition, when it is brown. It presents somewhat the same physical properties as the liquor amnii, and contains albumen, osmazone, a nitrogenous mucilaginous matter insoluble in alcohol, a particular principle named allantome, which appears to be the urate of urea, with lactic acid, lactate of soda, and phosphates of soda, lime, and magnesia. Allantoic acid is not found in this fluid in solipeds. In addition to the large percentage of water, there is a notable proportion of sugar at an early epoch of foetal life ; this, however, gradually and finally disappears towards the termination of gestation. It is probable that before the foetal circulation is fully established, the allantoid fluid serves to nourish the young creature, but that towards the end of gestation it is a product of the urinary secretion of the foetus. It is certain that as gestation approaches its termination, the renal excretion of the young animal passes from the bladder along the urachus, and deposits near the allantoic orifice of that tube a thick fluid of reddish color, and possessing an urinous odor ; it contains uroerithrrin and hip- puric acid. The fluid contains, besides, whitish filaments, and small oval or discoid masses of a brownish color from the size a pea to that of a hen's Qgg, either floating about in the cavity or attached to the allantois by a narrow pedicle. Sometimes they are very numerous, and at other times there is only one. From the fanciful notions attached to them in ancient times, they were named the '''' hippomanesy Usually they have the consistency and elasticity of gluten, are flattened, and are thinner at the border than the centre. Those attached to the allantois are generally pyriform, and their pedicle is narrower as they are more developed : proving that the loose bodies in the fluid were originally appendages of the allantois. It is not improbable that they are inspissated parts of the allantoic fluid CHANGES IN THE OVUM. 79 which were originally deposited upon the membrane. They contain much oxalate of lime. Differences. Ruminants. In Ruminants the allantois is different to that of the Mar^, being less complex. It represents a very elongated cavity, the middle portion of which is not extensive, and receives the insertion of the urachus ; while its extremities, which are unequal, are prolonged into the cornua of the chorion, where they are attached by a small ligament. This sac is in reality an expansion of the urachus ; it is always thrown back on one of the sides of the amnion. In the completely developed foetus, even at birth, the allantois still communicates directly with the bladder by means of the urachus. Frequently in the Sheep this membrane exceeds the chorion, and in the case of twin embryos, although the two chorial sacs unite by one of their cornua, there is only a simple external union between the two allantoid membranes, the cavities remaining isolated. , Laminated deposits, like the hippomanes^ are found in the allantoic fluid of ruminants, though not very frequently. These deposits are less dense, smaller, and of a lighter color. Pig. In the Pig the allantois does not offer any marked difference from that of ruminants, except that it is less sacculated, and shows at the extremity of each cornua a small portion projecting beyond the chorion, which it seems to pierce, while it is strangled by a kind of rings formed by that envelope. In the gelatinous tissue connecting the allantois to the chorion, are numerous, small, white, spherical bodies, each possessing a distinct capsule ; they are composed of multitudes of circular cells, the size of lymph corpuscles, and quantities of granular particles — being, in fact, histologically the same as the hippomajies., with which they are probably homologous. Bitch and Cat. In the Bitch and Cat it is disposed in the same fashion as in solipeds. Its external layer adheres less closely to the chorion, except at the part corresponding to the placenta, where it is more intimately united. Umbilical Vesicle. The umbilical vesicle^ saccus intestinalis, or vesicula alba, is a small fusiform or pyriform pouch lodged in the infundibulum at the extremity of the umbilical cord. Its fundus adheres to the chorion, while the oppo- site end is prolonged to a certain length in the substance of the cord, being even continued, in the very young foetus, to the abdominal cavity by a narrow canal that communicates with the terminal portion of the small intestine. This pouch has a red color, due to its great vascularity, its walls receiving a special vessel from the anterior mesenteric artery ; the ter- minations of this vessel give rise to a corresponding vein that terminates in the vena portae. These are the two omphalo-mesenteric vessels. The umbilical vesicle in solipeds is constantly present as a normal formation in the earlier months of foetal development, being formed from the extra- foetal portion of the internal layer of the blastoderm. It is connected 8o OBSTETRICAL PHYSIOLOGY. with the intestinal canal of the foetus ; being in reality the vitellus surrounded by the blastoderm upon which the embryo is first formed ; and it bears a perfect analogy to the yolk of the &gg, except that it is not ultimately enclosed within the foetal abdomen, It is a transitory organ, and in the last months of foetal, though in solipeds traces of it continue until parturition, it is always more or less atrophied, its cavity has disappeared, and nothing is left of it but a small reddish-brown cord, adhering to one of the sides of the infundibulum. Its vessels also atrophy in the same manner, the artery being nearly always found reduced to the dimensions of a thread. Its use is evidently to contain nutriment for the foetus, before the development of the placenta ; though it may also serve other purposes. It is the first organ which elaborates and supplies blood to the foetus. In some instances the chorion has been found perforated at its junction with the umbilical vesicle, which was therefore in communication with the cavity of the uterus. Differences. Ruminants and Fig. In Ruminants and the Pig, the umbilical vesicle is longer than in solipeds ) it also bulges in the middle, and its ends terminate in a canal. It is longest about the twenty-fifth day, and disappears very early ; no traces of it can be observed between the second and third month, after the abdominal parietes have been formed. BiUh and Cat. In the Bitch and Cat, however, it remains very developed up to the time of parturition, and in form resembles the allantois of the Pig. It is a transversely elongated sac (Fig. 38, ^), extending into the pointed cornua (^) comprised between the amnion, the inner layer of the allan- tois (h), and the placenta {U) ; it is provided at its middle part with a narrow pedicle (^), which is prolonged into the umbilical cord and has very vascular walls. The Placenta. The //d;^/?^/^ varies extremely in different species. In solipeds it is constituted by a multitude of short villosities or filiform papillae, which are spread in a uniform manner over the whole external surface of the chorion {diffused villi or placenta, constituting a chorion fro?idosum) ; though there is sometimes observed a tendency to bare patches, one especially being noticed opposite the os uteri, where there is no mucous membrane for the villi to penetrate. These villi are received into cor- responding depressions or follicles in the lining membrane of the uterus. The villi are very red in color, and consist, like the chorion itself, of an epithelial and a vascular layer, they being, in fact, the terminal rami- fications of the vessels of the umbilical cord. They are slender and easily torn ; and each is composed of a small quantity of delicate nu- cleated connective tissue, covered by a simple epithelial layer, enclosing the capillary vessels, which are arranged in loops made up of a principal . arteriole and two veins, there being generally only a single, or at most, a double, capillary loop. The villosities of the foetal placenta, penetrating the newly formed CHANGES IN THE OVUM. 8i crypts in the uterine mucous membrane, bring the capillary systems of mother and foetus into the closest relationship : only the very thin coats of the vessels and the epithelium intervening in the two circulations. There is no fusion, vascular continuity, or direct communication be- tween the maternal and foetal systems, as was at one time taught \ all the important changes that occur taking place through the walls of the capillaries by virtue of osmotic force. The function of the placenta, then, is to administer to the nutrition and development of the foetus by means of its intimate relations with the uterine vascular system, until the time has arrived for the expulsion of the young animal. Notwithstanding their close apposition, the ad- herence of this papillary layer of the chorion with the inner surface of the uterus is so slight, that this organ can scarcely be opened w^ithout more or less destroying it. A small quantity of a brownish fluid is found between the two. At an early stage of gestation there is no placenta \ a temporary mass of albuminoid substance accumulating around the ovum in the uterus, affords material for its nourishment until the vascular intussceptive re- lations between the chorion and uterine lining is established. When gestation is terminated, the placenta becomes remarkably rigid, the ves- sels are obliterated and transformed into fibrous tissue, and the external face of the chorion is wrinkled and withered-looking. I Fig. 41. Portion of Chorion with Placentul.*: : Cow. 1, Chorion ; 2, Placentulse. DiFFERENOeS. Cow. In Ruminants, there is an important difference m the arrangement of the placenta from that just described. In the Cow, the villi of the chorion are developed and agglomerated in large numbers at certain points of its surface, to constitute a multiple or tufted placenta, which is composed in this way of from sixty to oXghty placentulcz, or "foetal coty- ledons." These are of a bright red color, of various sizes, and gen- erally oval in shape ; they correspond to the prominences on the lining 6 82 OBSTETRICAL PHYSIOLOGY. membrane of the uterus from which the deciduous maternal parts of the placenta grow, and which have been already described as the " maternal cotyledons " or " placentae ; " into these latter the foetal processes are received. The maternal cotyledons are nothing more, as has been stated, than appendages or thickened points of the mucous membrane, whose utricular follicles, more numerous than elsewhere, have become enormously enlarged, and crypts have been formed. They are perma- nent, as before conception they are certainly present on the inner sur- face of the uterus, and traces of them may be already found in the fcetus of four or five months ; observation also appears to have demonstrated that they may be increased in number, or regenerated, when accidental circumstances render those in existence insufficient* They have been discovered in the foetus in process of formation, and regularly disposed, beside the ordinary cotyledons. When gestation has commenced, the surface of the maternal caruncles, previously smooth, becomes convex, and is covered ^yith reticulate pro- cesses which border the crypts, and give it a finely cribbled appearance. * In the Jdurnalde Mid VHerhiaire de Lyon, M. Strebel, of La Tour, Switzerland, gives an instance in which there ^yas absence of the uterine cotyledons in a Cow, and the placenta was like that of the Mare. Conception took place, gestation went on favorably, and parturition was normal. Chauveau's experiments have proved, that after all these placentulse have been extirpated from the uterus of the pregnant Cow, sterility does not necessarily follow ; but if, on the contrary, the animal sur- vives the operation, it is still capable of breeding. In such circumstances, accessory cotyledons are de- veloped upon the surface of the uterine mucous membrane, where previously none existed. Chauveau has also stated, in the same journal for 185 1, that during pregnancy the number of cotyledons is in- creased ; and Colin, in his Physiologie Comparee, makes a similar statement. Professor Franck, of Munich, in his dissections of the gravid uterus of bovines, has found, in a large number of instances, a more or less abundant quantity of accessory caruncles (karunkeht) on the mucous membrane, and which had no corresponding relations with the chorion. In one instance the ordinary cotyledons were entirely absent in an unimpregnated cornu, and in their stead were thousands of the accessory processes grouped together in small clusters. The whole of the lining membrane of this cornu had a peculiar mossy or vel- vety appearance. In a number of instances Franck has observed, in the immediate neighborhood of the OS uteri, where cotyledons proper were absent, groups of the so-called accessory cotyledons, in their form r&\)X&%^r\.\AW%7i placenta preevia. Certainly, this VmA oi placenta pravia in cattle has not the disadvan- tages it offers in woman ; for although a premature delivery may occur, a sufficiency of the placenta always remains to maintain the nourishment of the fcetus. Serious hjemorrhage is likewise little to be apprehended in such cases ; and even the disconnection between the placenta foetalis and the placenta uterina in the Cow, causes no injury. This is not the case with the human female and the Bitch. Small haemorrhagic streaks at the summit of the finer tufts, or on their upper surface, are often noticed in the uterus of Cows which have been slaughtered and bled. Birnbaum attributed these streaks to a plethora ex vacuo {Untersuchu7ige7i iiber de7t Ban der Eih'dute der Saugethiere, p. 90). The accessory placentulae are, both in shape and situation, as well as in development, different from the cotyledons propei; for while the latter, and of course also the foetal cotyledons, are arranged in four regular rows, in the gravid uterus, through the rapid increase of the amnion towards the poles of the ovum, they lie somewhat closely together, and the accessory processes are placed between these rows in an irregular manner. In their highest development, the latter are so disposed as to constitute a variable- sized felt-like patch ; the largest and widest are usually observed behind the ordinary cotyledons, and their form is very irregular, but normal. As a rule, the largest are not so big as a walnut, and they are widest at their base. In structure they resemble the ordinary cotyledons, their blood-vessels being ar- ranged in the same manner, while they are covered externally by a sheath of epithelium. In the early period of pregnancy — about the second or third month— they are found in largest number on the entire upper surface of the chorion, also likewise on the parts between the ordinary cotyledons and the finest caruncles. It may here be mentioned that the ovum of the Cow, in the first week of pregnancy, is smooth. Franck has never been able to discover the vascular semi-detached caruncles which are after- wards developed through the prolongation of the blood-vessels ; though they are found in the canine species. He has, however, observed definitely-formed vascular chorion-cotyledons between the fourth and sixth weeks of pregnancy. The interposed cotyledons observed by Franck have been noticed by other anatomists. Birnbaum mentions them, but he is in error with regard to their development, inas- much as he believed that they arose from the uterine glands, which is certainly not the case. The chorial tufts penetrate the uterine mucosa by four digitations, fixing themselves in the so-called simple follicles, according to Franck {Deutsche Zeitschri/t fur T/iiermedicin). This excellent authority also points out, with regard to this circumstance, that in the vicinity of the uterine glands there are found small follicles which are nearly always unobserved. The connection between these chorial tutts and the uterine mucosa is extremely slight. At a later period of pregnancy, there appear other caruncles tn the torm ot toeta/ tutts ana cotyledons, which the previously developed and prominent maternal cotyledons and caruncles lie opposite to and in contact with. The reason tor this tact is to be sought tor in the circumstance, that the tcetal caruncles pass into the most developed uterine cotyledons, and in consequence bring the larger tutts ot the allantois into contact with the opposite parts ot the chorion. The intermediate caruncles become entirely wasted. Nevertheless, with isolated tufts, sometimes in a great many, we find an increased development, wllich gives rise in the corresponding uterine mucosa to a similar formation, and a close co-aptation, or even an inter-penetration ot these accessory tcetal and maternal cotyledons. CHANGES IN THE OVUM. 83 The largest are found in the body of the uterus, and they become smaller as they approach the extremity of the cornua. They spring from the uterine surface by a somewhat narrow pedicle, through which they receive their blood-vessels, and their color is nearly always dark yellow ; alto- gether, in shape, hue, and general appearance, they are not unlike a morel mushroom. The "foetal" or "chorial cotyledons" repeat the disposition of the maternal cotyledons. They are bright-red concave patches, each exactly fitting into the sinuses of the corresponding uterine processes, with which they strikingly contrast in hue ; on their surface they offer a multitude of long, conical, ramifying or branched villi, measuring from 4 to 6-ioths ^B MM HI ^^^^^^^^9 ^m ■■HH i^^^l ^^^^^H^ y^i^^^^^jfi'MS&' ^^^H i^BI B ^9 ^H B^aMH ^b ^^P ^H ^ ^ Hi Fig. 42. Maternal A>fD Fcetal Cotyledons of the Cow. A, Pedicle of the Maternal Cotyledon ; BB, Maternal Cotyledon ; C, Foetal Cotyledon ; Placental Villi ; E, Chorion. D, of an inch, which are received into the depressions of the maternal cot- yledons. This ramifying or racemose disposition of the chorial villi is peculiar to the bovine and ovine species. The chorial cotyledons are attached to the chorion by a very short, thick, and vascular pedicle ; between them and the maternal cotyledons there is always to be found a small quantity of thick, white, milky-looking fluid — the so-called " cot- yledonous " or "uterine milk." According to Schlossberger, this uterine milk should be considered as a fluid analogous to milk or chyle. It contains 88 per cent, of water, I "5 of fat, 07 of salts, and 9*6 of a protein substance. In the cotyledo- 84 OBSTETRICAL PHYSIOLOGY, nal fluid, as well as in that on the surface of the uterine mucous mem- brane of a Mare towards the end of pregnancy, Ercolani has demon- strated the presence of albumen ; in the same fluid he has also proved the existence of amidon, dextrin, and sodium chloride.* The reticulated surface of the maternal cotyledons is hornologous with the decidua serotina or other mammals ; but it possesses a firmer texture, and usually remains attached until the termination of gestation — allowing the foetal villi to be withdrawn from it at birth ; it is afterwards shed or disappears in some obscure manner, and the caruncle again assumes its smooth surface. As in solipeds, there is no direct vascular communication between the maternal and foetal cotyledons, the villi of each being distinct, though in close contact ; being only separated at points by the lattescent fluid just alluded to. This fluid, which is present in all the domesticated animals, can be readily discovered by carefully withdrawing a chorionic tuft from the alveolar cavities of the uterine cotvledon. Pig- 43- Cotyledon of a Cow's Uterus. aa, Surface of Foetal Chorion ; bb. Blood-vessels of Foetal Chorion ; cc. Surface of Uterine Mucous Membrane ; dd. Blood-vessels of ditto ; /, Secretion from Utricular Glands — Cotyle- donous Milk — between Maternal and Foetal Vessels, and which is necessary to the Mutual Interchange of Gases, and Nutrient, Effete, and other Matters between Parent and Offspring. Sheep and Goat. In the Sheep and Goat the arrangement of the placenta is essentially- the same as in the Cow, except that the maternal cotyledons are deeply concave or cup-shaped in the middle, and into this cavity the foetal placentula is received and closely retained. This placentula is not so wide as that of the Cow, though it is thicker and the villi are more ♦ We must not overlook the fact, that the existence of the " uterine milk "in the living pregnant animal has been denied by M. CoWn (Traite de Fhysiologie Comparie des A nimaux, 1872, vol. II., P- 870), who states that this fluid is simply a product of cadaveric decomposition, and is not found during life ; as he has assured himself in the most evident manner, by opening the uterus of a pregnant Mare and Cow. It is not found immediately after death, as he has demonstrated on m^ny occasions, in Cows and Sheep slaughtered in the abbatoirs at all periods of gestation ; it is not even observed six, twelve, or twenty-four hours, or longer, when the surrounding temperature does not favor decomposition. It is only when the placentas spontaneously separate, or are disunited by slight traction, at a greater or less time after death, according to circumstances, that the white or yellowish-red colored fluid appears between the chorion and uterine mucous membrane. In proportion as decomposition has advanced, the fluid is abun- dant. Colin therefore concludes that it is a product of softening and progressive dissolution of the uterine mucous membrane and its cotyledons, as well as the placentae themselves. CHANGES IN THE OVUM. 85 -delicate. The mode of termination of the placental vessels in the Sheep is villous ; in the Goat it is pilose. Pig. In the Pig the placenta maybe designated as "diffused," not " polycot- yledonary " as in Ruminants; though the tufts do not form a continuous layer as in the Mare, the papillae being collected in small but closely- grouped clusters, which give the chorion a mottled aspect. When unin- jected they appear as white masses or spots scattered over the external surface of the chorion, thus giving it a mottled aspect, caused by the presence of feebly vascular and non-vascular areas ; but when the allantoic veins are filled, these are seen to form plexuses in the centre of each spot. The uterine veins have a corresponding disposition, and the arterial capillaries form a fine network, the meshes receiving the villosities which carry the fcetal arterial capillaries ; whence it might seem that the nutri- tion of the fcetus was effected principally at the points of contact of the foetal with the maternal venules, while the respiratory process took place at the surface of contact between the foetal and maternal arterial capil- laries. The chorion is destitute of these villosities at the extreniities, which are in contact with the chorion of others foetuses in the uterus. Bitch and Cat. In the Bitch and Cat the placenta forms a thick annular band or zone, about one or one and a half inch wide, passing round the middle of the chorion ; it is therefore said to be " zonular." This zone is concave within, of a mixed grey-and-red color when uninjected, livid or dark brown during gestation ; its foetal surface is lobulated, and the zone is limited at each side by a dark green border, the coloring matter of which can scarcely be removed by repeated washings. The placenta is studded with ramified villi of a leaf or plate shape, which are implanted in the uterine mucous follicles. The mucous mem- brane in which these are situated, and which corresponds to the placenta, presents a kind of vascular fungus development that appears after parturition, but which at an early stage of pregnancy has a quantity of fluid along its margin; the maternal placenta, ovserotine decidua, is present during gestation, and can be separated as a distinct layer. There cannot be a doubt that the uterine mucous membrane in car- nivora secretes a kind of plastic lymph, which forms this caducous lining or membrana decidua ; but it is only present at a certain period of foetal life, and forms the base of the uterine placenta. Functions. The functions of the placenta are obvious: it is the nutrient and respiratory apparatus during a portion of intra-uterine existence ; and for the accomplishment of these functions it must rely upon its intimate and healthy relations with the uterine surface. The special and temporary processes of development being completed and the task of providing capillary superficies being terminated, whether on the part of the mother or foetus, the placenta of the latter disappears, as well as the decidua ; though they may not be thrown off together, and the maternal decidua may not be shed all at once, but in successive portions. Th# long period of gestation necessary to endue the young of defenceless hoofed animals with sufficient strength before birfh, is perhaps a reason for the firmer 86 OBSTETRICAL PHYSIOLOGY. texture, better organization, greater extent, and more persistent character of their " deciduous " formations. The comparative study of the disposition of the different kinds of placentae, may furnish valuable indications as to the procedure which ought to be adopted in artificial delivery ; the surgical manipulation necessarily varying with the extent and arrangement of the points of union existing between the uterus and the foetal envelopes. It has, therefore, been thought useful to arrange the domesticated animals into two groups ; those with a single placenta, and others with a multiple placenta ; the first group being again subdivided according as the placenta is " diffused " or " localized." This arrangement and subdi- vision may be expressed as follows : — Single Placenta Multiple Placenta Diffused Horse. Pig. Cow. Localized -^ Sheep. Goat. S Zonular Dog. Cat. UiTBiLicAL Cord. The umbilical cord^ funis ^ or navel-string, is a collection of vessels which forms the means of communication between the mother and foetus, during the uterine existence of the latter, and which loses its functions when birth occurs. It is visible at the earliest period of pregnancy, and is formed by the vessels which convey the blood between the foetus and its envelopes — chiefly the placenta. It is divided, for facility of description, into two portions : an amniotic, the longest, always twisted on itself like a rope, and covered by the amnion, which passes along it to become con- tinuous with the skin at the umbilicus ; and an allantoic portion, much shorter, less twisted, and covered by the sheath that continues the two layers of the allantois until it is inserted into the upper wall of the chorial sac, between the two cornua. Three vessels enter into the composition of the cord : two arteries and a vein, which are embedded in embryonic connective tissue ( Whartonian gelatine^ that makes them appear more voluminous than they really are. This " Gelatine of Wharton " consists of a mucus basis, in the substance of which is fibrillar tissue. The umbilical arteries arise from the internal iliac artery, and pass along the sides of the bladder ; reaching the umbil- icufs, they pass through it and arrive at the terminal extremity of the amniotic portion of the cord, where they give off some branches to the amniotic sac, and then continue to the end of the allantoic portion, where they terminate by an expansion of placental branches. The amniotic divisiojis of these arteries are extremely flexuous and few in number ; they are included between the allantoic layer and the membrane of the amniotic sac, within which they are prominent. The placental or chorial divisions are infinitely more numerous and larger, and starting from the terminal extremity of the cord, pass in every direction bftween the chorion and the external layer of the allantois, beneath which they can be seen. By their anastomoses they form a beautiful network, whence proceed the capillary vessels that form the CHANGES IN THE OVUM. 87 placental villosities. As we have already stated, these capillaries have no direct communication with the maternal vessels, but after attaining their finest dimensions pass into the veins which finally constitute the UMBILICAL VEIN. This vessel, then, owes its origin to the capillary radicles of the placental villosities; which radicles, by their union be- tween the chorion and amnion, form a voluminous network whose rich- ness is even greater than the arterial arborization. Two chief trunks finally issue from this plexus, and these soon join to form a single trunk, which accompanies the two corresponding arteries in the cord. On reaching the umbilicus, this vessel, now the tujibilical van, bends forward on the inner surface of the abdominal wall, where it is covered by peri- toneum, and on gaining the liver enters that organ to open directly into the vena portai. Owing to this junction, it happens that the two vessels compose, in the interior of the liver, a single canal, from which proceed the hepatic veins. In other animals than solipeds, this single canal sends off a particular vessel of considerable size — the ductus venosus — that passes directly into the posterior vena cava. The umbilical vein has no valves. Besides these three principal vessels, the cord contains, in its amniotic portion, the duct of the umbilical vesicle, the urachus, and the omphalo- mesenteric vessels, as well as the extremity of the foetal intestine at an early period. The urachus is an irregularly bulging canal, continued from what is eventually the fundus of the bladder, and on reaching the umbilical opening it passes between the chorion and the amnion to form the allantois. After birth it rapidly contracts, especially at the fundus of the bladder, until it is quite closed, and nothing is left but the fold of peritoneum that sustained it, and which now becomes the middle ligament of the bladder. It sometimes happens, however, with the foal, but more fre- quently the calf, that it persists, the urine in this case escaping by the umbilicus. The omphalo-meseiiteric vessels are an artery and a vein. The first is given off from the anterior mesenteric artery, and passes to the amniotic extremity of the umbilical vesicle \ while the vein arising from this vesi- cle terminates in th^ vena portse. These two very thin vessels become obliterated with the vesicle. DIFFERENCES. Rumijiants. In Ruminants, the two veins passing from the chorion remain separate in the umbilical cord until they enter the umbilical ring, where they become one vessel. There are, therefore, two veins and two arteries ; the latter unite at the umbilicus, the resulting vessel entering the vena cava and vena portae, between which it establishes a communication by means of the ductus venosus. The chorion and the amnion being in immediate contact over a wide surface, the umbilical vessels are re- flected over the inner face of the first-named membrane on their leaving: the amniotic sheath ; they do not have a fold of allantois, as in solipeds* No traces of the omphalo-mesenteric vessels have been found. Fig. In the Pig the arrangement of the cord is the same as in ruminants. 88 OBSTETRICAL PHYSIOLOGY. Bitch and Cat. In the Bitch and Cat the cord resembles that of solipeds, in having an allantoic portion, but it is extremely short, and enveloped in a large fold of allantois. The omphalo-mesenteric vessels are very apparent until the end of gestation, and are proportionately larger than in solipeds ; this is due, in all probability, to the persistence of the umbilical vesicle. These are an artery and a vein ; the former arises from the anterior mesenteric, descends in nearly a direct line to the umbilical opening, and is expended in the umbilical vesicle. The vein originates from the terminal divisions of the artery, passes towards the abdomen, and ter- minates in the vena porta. The dimensions of the umbilical cord vary with the species of animals. Compared with that of the human foetus, it is short in solipeds and ruminants. At the commencement of gestation in the Mare and Cow, it is not so long as at a later period, though it is thicker ; towards the termination of gestation, it is at least as long as the young animal is tall. Its length in the Mare has been variously estimated. Immediately before birth it has been found to measure three feet four inches long, and three and a half inches in circumference (three-fourths in diameter). Daubenton found it to be in one instance, from the umbilicus to the am- nion, eighteen inches, though the period of gestation is not mentioned. Bourgelat gives it as about two and a half feet ; Blaine, from two^ to two and half feet. Goubaux found it to measure, when untwisted, at six months' pregnancy, thirty-four inches ; but it was so very twisted (twelve turns) that in this state it was only twenty-nine inches in length. In the Cow, Vitet gives it as from nine to ten inches ; but Goubaux, in a Cow at the eighth month of pregnancy, found it to be about sixteen inches ; while Colin, in another Cow at the same period, gives eighteen inches. In the Sheep, at two months' gestation, it has barely measured one inch ; Rainard, at the end of gestation, gives it at from three-fourths to one and a quarter inches. Daubenton says it is two inches at parturition. In the Pig it is comparatively very long, sometimes stretching the whole length of the Pig. Daubenton found it to be one incli^in length in a foetus measuring three inches, and three lines from nose to anus. In the Bitch and Cat it is very short, and measures from one to two inches at birth ; or about two-fifths of the length of the body. In the early days of foetal life, the cord contains a portion of the intes- tines, but as the cavity of the abdomen is formed and closes, the viscus is retracted within it. Very rarely, however, this retraction is not com- plete, and hernia of the intestines exists at birth, or even some time after that event. With regard to the curious torsion of the cord on itself, it has been held by some authorities that this is only accidental, and depends on the movements of the foetus during the latter stages of gestation, or the dis- placement it undergoes on leaving the uterus; consequently, that the spiral twisting of the vessels is not normal. Examination of non-dis- placed foetuses jDroves that it is far from being constant. At birth, the umbilical cord is usually torn or gnawed through, at a short distance from the umbilicus of the foetus ; the remaining portion drying up, dying, and falling off in a few days. CHANGES IN THE OVUM. 89 SECTION III. DEVELOPMENT OF THE FCETUS. Having studied the conception and partial development of the young ■creature, and described the envelopes which surround it, we will proceed to notice the various changes which occur in it until gestation is com- pleted and parturition is about to take place. This division of our subject is of much importance in several respects, but more especially with regard to the relation it bears to teratology — the branch of science which treats of congenital malformations and mon- strosities. The transition from the condition of the embryo, when the young an- imal has scarcely assumed a definite form, to that of the foetus, when it presents the lineaments of the species to which it belongs, is very gradual. The dorsal cord, as has been stated, is a cylindrical body developed above the primitive furrow, with slightly attenuated extremities, and at each side small opaque quadrangular masses, the vertebral lamincE, which are in reality the protovertebrce, or first rudiments of the vertebrae. Each of these masses is perforated by a small opening, and is resolved into three portions : theprotovertebral cavity, the miisctilar la7nma,si\M2i\.ed2ihovQ the cavity, and the protovertebra placed below the cavity. The muscular lamince, increasing in volume, are inflected upwards and at last unite on the median line of the back, chiefly forming the muscles of the vertebral furrows ; they also send off prolongations downwards, which concur in the development of the intercostal and abdominal muscles, as well as those of the limbs. The protovertebrce bend upwards and downwards on each side, so as to enclose the protovertebral cavity or spinal canal, and the dorsal cord ; the upper ring represents the rudiments of the annular portion of the vertebrae ; while the lower ring and the dorsal cord consti- tute the vertebral bodies and the discs uniting them. The lateral la7}iince arise from the portion of the middle layer of the blastoderm placed on each side of the vertebral laminae. In the region of the trunk, these laminae are separated for a certain time from the lat- ter ; but in the cephalic region they are always adherent to them, and at this part they are usually designated the cephalic lamince. The proper lat- eral lamiiKB are divisible into two layers, external and internal, united by a.middle layer; they comprise between them a space which becomes the pleuro-peritoneal cavity, after the formation of which the lateral are joined to the vertebral lamina. The internal or Jibro-intestinal layer envelops the deeper portion of the blastodermic layer or intestinal furrow, the um- bilical vesicle, and the allantois ; it constitutes the fibrous and vascular parts of these membranes, and carries the vessels to the inner face of the chorion. The external or cutaneous layer is developed in two ways : above, it glides between the muscular laminae and the foetal portion of the exter- nal layer of the blastoderm to form the cutaneous envelope on the back j below, it separates into two leaves, which receive between them the pro- longations of the muscular laminae destined to constitute the intercostal, abdominal, and other muscles of this part of the body. Of these two secondary leaves, the external forms the skin of the trunk, and the inter- nal the parietal layer of the peritoneum. The cutaneous laminae also fur- nish an extra-fcetal prolongation — the fibrous layer of the amnion. The middle or tnesenteric lanwice join at the median line, and in their substance are developed the Wolffian bodies, or antecedent deciduous kidneys, and the principal vessels of the trunk. go OBSTETRICAL PHYSIOLOGY. The cephalic lamincB always remain adherent to the vertebral laminae^ and are inflected inwards with them to form the anterior part of the cephalo-intestinal cavity, which is divided into two compartments — the pharyngeal and oesophageal cavities. The pharyngeal cavity opens exter- nally by the mouth, and is partly enclosed on the sides by the pharyngeal arches. The oesophageal cavity soon shows a diverticulum, which is not long in communicating with the pleuro-peritoneal cavity, and subse- quently contains the heart ; it is therefore named the cardiac cavity. The cephalic laminas also form the derm of the cranium, and the fibrous layer in which are developed some of the cranial bones. The Nervous System. The development of the nervous system comprises the growth of the brain, spifial cord, and nerves. The initial steps in the development of the brain and cord have been already indicated. At each extremity of the medullary cavity, which is a modification of the median furrow, is a slight bulging. From the posterior, or rhomboidal sinus, the sacro-lumbar nerves are given off, v/Iiile the anterior gives origin to the brain. This anterior enlargement appears as three successive dilatations, named the cerebral vesicles or cells, which are distinguished as anterior, middle, and' posterior. They are filled with fluid, and the middle slightly surmounts the other two, which gives the whole the figure of a small triangular mass. The vesicles increase irregularly in volume, and their walls, in develop- ing, form the nervous tissue ; while their cavity persists and becomes the space observed in each portion of the encephalon. The a.fiterior vesicle^ represents the cerebral hemispheres, the thalami optici and the lateral ventricles. The middle vesicle forms the crura cerebri, corpora quadrigem- ina, and the aqueduct of Sylvius or middle ventricle. The. posterior vesicle gives rise to the medulla oblongata, pons varolii, cerebellum, and fourth ventricle. The middle vesicle increases more rapidly in volume at first than the others, but it soon stops and allows the anterior cell to develop ; from this time the encephalon assumes its oval shape, with predominance of the anterior part. Towards the end of their first third of intra-uterine life, nearly all the parts of the encephalon are distinct ; the two hemispheres are separated by the development of the septufn lucidem, and the convolutions are ap- parent on their surface ; while the corpora quadrigemina and crura are well defined. At a later period the cerebellum is seen, as well as the pons varolii, corpora restiformia, and corpora pyramidalia. With regard to the development of the spinal cord, we have observed that the medullary canal is the first trace of this part. It occupies the whole length of the vertebral stalk, and its cavity communicates anteri- orly with the fourth ventrical. When the spine is developed, the cord only increases longitudinally to a certain degree, and appears to ascend in the canal \ it stops at the middle of the sacrum in the equine foetus, but ascends higher in the other species. During this apparent ascensional movement is developed the Jilum terminale, and the nerves of the tail of the Horse {cauda equina). The parietes of the medullary canal are at first very thin, but increase in thickness with the appearance of the ner- vous substance of the cord, and soon divide into two layers : an internal,, the epithelium of the central canal ; and an external, the grey substance of the cord. Gradually the canal contracts, and the cord shows longitudinal furrows. At the end of the first month the inferior roots of the nerves CHANGES liY THE OVUM. ^X are in existence, as well as the spinal ganglia, which are developed at the expense of the protovertebrae ; the superior roots are not distinguishable for some time after. The envelopes of the nervous centres are furnished by the protovertebral laminae, and are developed after the sixth week, fol- lowing the formation of the parts they are destined to cover. The fierves are not so definite in their development, and some obscurity prevails with regard to them. It would appear that the motor roots origi- nate in the cord, but that the ganglia are formed separately in the proto- vertebrae, and perhaps become the point of departure of the sensitive roots. The nervous ramifications grow from elongated ramified cells, which are joined by their extremities. The nuclei of the cells, joined to the periphery, become the nuclei of the sheath of Schwann, and the nerve tissue is afterwards deposited gradually between the axis-cylinder and the envelope. The great sympathetic nerve is perceived at an early date as a nodulated cord ; it is probably developed in the same manner as the other nerves. The Organs of Sense. The principal portion of the organs of sense belong to the nervous sys- tem, and are, of course, developed with it ; the other portions belong to the external epithelial layer, and to the derm or germinative layer. With regard to the organs of vision, two tubulous prolongations arise from the anterior cerebral vesicle and passing forward terminate in the primary ocular vesicles, traces of the ocular globes ; the hollow prolongments forming the optic nerves, and the vesicles furnishing the choroid and retina. The crystalline lens, vitreous body, cornea, and sclerotica are derived from the external blastodermic layer. The part of the integu- ment not required to form the lens constitutes the envelope of the globe. The latter forms the sclerotica and cornea ; while the epiderm furnishes the epithelium to the latter, which becomes distinct from the sclerotica in about the fourth month. A slit occurs at the lower part of the fibrous envelope of the globe ; this is related to the development of the vitreous humor, a prolongation of the derm passing through this slit and enter- ing between the lens and the anterior wall of the secondary ocular vesi- cle which appeared shortly before. There this prolongation becomes developed and transformed into the vitreous humor, which at one period is surrounded by vessels, but shows none immediately before gestation. It exhibits in its centre a transverse canal, which lodges a branch of the arteria centralis of the retina. The optic nerve is developed in the pedicle connecting the ocular vesi- cle with the anterior cerebral vesicle, and the reti?ia is formed by the in- ner la3^er of the secondary ocular vesicle ; it extends to the lens in chang- ing its character in front. The choroid coat is constituted by the posterior layer of the ocular vesicle ; it extends as far as the lens, and is then in- flected in front of that body to form the iris. The borders of the pupil embrace the vascular envelope of the lens, and the anterior face as well as this pupil are covered by a very vascular membrane, the membrana pupillaris ; behind it is the equally vascular covering, the membrana cap- sulo-pupillaris, that passes through the pupil to the lens to envelop it in a kind of sac that disappears towards the end of gestation. Previous to this time this aperture is very wide ; but as the iris is developed the pupil contracts, and the vessels of the vascular or pupillary membrane dimin- ish in size and number, until at last only a few are seen crossing the transparent membrane. 92 OBSTETRICAL PHYSIOLOGY. The protective and motor apparatus of the eye are gradually developed around the globe. The eyelids are small cutaneous folds which are formed in the first third of uterine life, and grow and unite by their mar- gins until a short time before or after birth, according to the species, when they separate. They are maintained closed by a thin membrane, which disappears in solipeds, ruminants, and the Pig, before birth ; but in carnivora it remains until some days (eight or ten) after that event. So long as the lids are closed, the conjunctiva is only a sac communicating with the lachrymal canal. The crystalline lens in the foetus and new- born animal distinctly shows the three septa peculiar to it ; three diverge from each pole at angles of 120°. The lachrymal gland is an appendage of the epithelial layer which is intruded above the globe ; at first com- pact, it becomes gradually excavated into cavities, from which arise the excretory ducts. The auditory apparatus, consisting of the internal ear, auditory nerve, and middle ear, is developed separately. The labyrinth appears in the form of a vesicle which is not in direct relation with the posterior cere- bral cell, but is constituted by a depression of the epidermic layer — the auditory fossa — that becomes more and more marked until it is finally a closed cavity. At this time the wall of the labyrinth is only a simple epithelial membrane ; but this is soon increased externally by a connec- tive membrane which vascularizes it, and then gives rise to three layers ; an internal, which adheres to the epithelium to form the membrane of the labyrinth ; an external, that lines the labyrinthic cartilage ; and a middle, whose soft embryonic connective tissue disappears and is re- placed by a fluid, the perilymph. At the same time that these changes of structure are taking place, the vesicular shape of the labyrinth is mod- ified, and shows the cochlea, semicircular canals, utriculus, and sacculus. The middle and external e^r are formed by the first pharyngeal slit, which is never completely closed, while the others disappear. At first there is a cavity communicating externally by the pharynx ; this cavity contracts, then divides into two portions by a septum in its middle ; this septum becomes the tynipa?ium, while the inner cavity forms the middle ear and Eustachian tube ; and the external portion the external auditory canal ox meatus. The ossicula audittis are at first cartilaginous, and appear to- wards the third month ; after which they gradually ossify, and have nearly assumed their definitive shape at birth. The co?icha is developed beneath the integument after the second month. The 07'gans of sinell begin by two depressions in the epidermic layer, analogous to the crystalline lens and auditory fossettes. These two olfac- tory fossa appear below the ocular vesicles, and, becoming deeper, their depth is further increased by granulations which spring up on their bor- ders. Behind, they communicate with the pharynx, and the formation of the palate separates them in front from the buccal cavity. From this time the nasal fossae are constituted and completed by the development of the bones of the face. The olfactory lobes and nerves are at first tubular, and are related to the anterior cerebral vesicle. In the young foetus the nos- trils are formed by a collection of mucus and epithelium ; they open towards the middle period of gestation. The Skill and its Appendages. The skiji and its appendages, which might be designated the tactcle ap- CHANGES IN THE OVUM. 93 paratus, are developed by the epidermic and middle layer of the blastoderm. The cutaneous laminae, by the modification of their elements, form the derm^ in which vessels are readily seen after three months. In the epiderm it is not long before the mucous and horny layers can be distinguished ; in the first, pigment cells are observed at the commencement of the fifth month in the larger quadrupeds. The epiderm is easily detached from the derm ; it forms a peculiar, white, completely-enveloping pellicle on the surface of the latter, apparently separated from it by the growing hairs. Frequently we find the integument covered by a special coating that looks like varnish (the varnix caseosd) ; this would appear to be intended to protect the epidermic epithelium from the destructive solvent action of the alkaline amniotic fluid. It is very abundant on the human foetus at all periods, but is not found on that of animals so long as the skin is gla- brous. As soon as the hairs begin to appear, the epiderm is partially de- tached in the form of the thin pellicle just alluded to, and the decomposi- tion of which gives rise to an appearance like varnish. It is best seen in the foetal Pig, the hairs on the skin appearing all at once over the body; in the other domesticated animals they are only developed success- ively, and consequently the shedding of the epiderm occurs partially and in patches, which are insensibly confounded with the normal epidermic layers. Microscopically, these flakes off^er the same characters as epider- mis removed by a vesicant ; the points where the hairs have passed appear as regular infundibuliform openings. When the foetus increases in volume, the epiderm desquamates and the debris floats in the amniotic fluid. In the third month, the hairs are perceptible on the foetus of the Mare and Cow. Hair follicles have been observed in embryos of the Pig which did not measure more than two inches in length. They first appear about the eyebrows, lips, and joints of the limbs, and the whole of the body is covered at the sixth or seventh month ; they are usually observed in the foetus of the Mare and Cow, around the lips, towards the eighteenth week of gestation. The hair maybe shed and renewed before birth ; for it has' been found in the amniotic fluid and in the stomach of the foetus. Each hair is developed in a prolongation of the epidermic layer which is im- bedded in the substance of the derm : which prolongation is constituted by a bottle-shaped mass of cells. In the centre the cells are modified and heaped up, so as to form a small cone whose base covers the grow- ing papilla ; this cone elongates, until it touches the superficies of the epidermis, when it becomes bent in the effort to push itself through ; but finally it issues beyond the surface, where it may grow freely. The sebaceous and perspiratory glands are developed in a similar man- ner, at the middle period of uterine life. The horny productions, such as the claws, hoofs, ergots, and chesnicts, are apparent at an early stage. To- wards the end of the second month there can be perceived in the foetus of the Cow, at the extremity of each digit, a small, pale, and transparent conical tubercle ; this is the rudiment of the claw. The hoofs of solipeds appear towards the twelfth week, and about the commencement of the fourth month they are more developed ; their texture has become firm and opaque, whereas before it was gelatinous and transparent, and has assumed a fine yellow tint. They are always soft, however, until birth, in order to guarantee the integrity of the foetal envelopes. At mid-term, brown or black patches appear in it, if the coronet is provided with pigmentary stains ; but it is not until about the end of gestation that the horn begins to show the greenish tint proper to it when destitute of pigment ; though 94 OBSTETRICAL PHYSIOLOGY. the remainder of this production, particularly its lower part, preserves its yellow color until the young animal is born. In solipeds the chesnuts are seen at mid-term, in the form of thin brownish plates, which soon be- come darker. The structure of the hoof is not tubular until after birth, when the foetal hoof, gradually disappearing, the horn that replaces it is fibrous and tubular, and much more consistent. The corneous substance is developed at the expense of the blastema which the capillaries of the modified derm throws out on its surface. In this material appear nucleated cells which, pressing against each other, become at first polygonal in shape and flattened, then lose their nucleus and are confounded with each other. At a later period, cells of a new formation are moulded on the papillae of the coronary cushion and plantar surface of the foot of solipeds and ruminants, giving it that fibrous ap- pearance which is so striking during extra-uterine life. The Locomotor ^ Apparatus. The development of bone, and with it the locomotory apparatus in gen- eral, next demands our attention. Bone is developed in the blastema or primitive basis — a transparent glairy mucus matter containing numerous minute corpuscles. This progressively acquires increased firmness ; some- times assuming a membraneous or ligamentous condition^ usually a gristly consistence, before its conversion into bone. The change into cartilage is noted by the appearance of minute nucleated cells, which increase in number and size, and are aggregated in rows, with intercellular tracts where the ossification is about to begin. These rows, in the cartilaginous basis of long bones, are vertical to its ends ; in that of flat bones they are vertical to the margin. The cells furthest from the seat of ossification are flattened and in close contact ; nearest that seat they become enlarged and separated. The first appearance of bone is that of minute granules in the intercellular tissue. Canals are next formed in the bone, by absorption ; these ultimately receive blood-vessels, and become the "vascular canals." The immediate nutrition of bone is provided for by the production of minute " plasmatic canals," " lacunae," or " bone-cells " from the vascu- lar ones. Ossification begins at the centre of round bones, and proceeds towards the surface ; in flat bones it extends between two membranes, and from a central point towards the periphery ; in short bones, towards the circumference ; and in long bones, from a central point or diap/iysis, towards another centre — the epiphysis, situated at each end. Particular parts or processes are furnished with a separate centre of development, named the apophysis. Length occurs at the extremity of the diaphysis, and bulk by deposition on the surface, the medullary cand of certain bones being due to internal absorption. The spinal stalk is the first portions of the skeleton observed in the embryo, it being represented by the chorda dorsalis, which is composed of a mass of cells in the interior of a transparent sheath. The proto- vertebrae appear on each side of the cord, and ultimately enclose it and constitute the spinal canal ; in this way results the external sheath of the cord, and the superior uniting membrane. The vertebral stalk now exists as a membraneous axis, but not for long ; as it becomes segmented in order to form the vertebrae, and these segments are gradually converted into cartilage. Each persisteiit vertebra does not correspond to a proto- vertebra, the latter dividing into two portions to constitute two vertebrae. The body of the veirtebra is developed more quickly than the spinous CHANGES IN THE OVUM. 95 portion ; at the end of the second month all the vertebral bodies are car- tilaginous, while the laminae are yet in a membraneous condition. In the third month ossification commences, and during this process the dorsal cord disappears, except between the vertebras, where it is developed to form the intervertebral fibro-cartilage. The /^ A, Placentulae; Bi Bi, Umbilical Veins, with their Common Trunk, B ; D, Vena Portse, and its Anastomosis, C ; E, Ductus Venosus ; F, Posterior Vena Cava ; G, Right Ventricle of Heart ; H, Pulmonary Artery ; J J, Aorta ; I, Ductus Arteriosus ; K, Umbilical Arteries, with their Anastomosis at the extremity of the Umbilical Cord. plied with pure blood, but with a mixture of arterialized and venous blood ; this mingling taking place through the foramot ovale, in the aorta by the ductus arteriosus, and in the liver by the ductus venosus. The head and neck receive the purest blood, a circumstance which probably explains the predominance in size of the upper to the lower parts of the body of the foetus. At birth the conditions of existence being suddenly changed, very marked modifications occur in the circulation. The lungs then become loo OBSTETRICAL PHYSIOLOGY. the organs of respiration, and rapidly increase in capacity, while the thorax enlarges in a commensurate degree ; the pulmonary artery also dilates to admit the increased flow of blood, and the ductus arteriosus is obliterated to prevent the mixture of arterial and venous blood. The ductus venosus also aids in the isolation of the two kinds of blood by becoming atrophied, as does also the occlusion of the foramen ovale. This opening, however, not infrequently remains intact in young animals ; though, as a rule, this does not greatly affect the circulation, for when the heart contracts the auricles are isolated by the narrowing of the orifice and the elevation of a valve. The Respiratory Apparatus. There is an absence of unanimity as to the mode of development of the respiratory apparatus, and particularly the lufigs. Some assert that the latter are derived from two little distended cellular masses attached to the anterior part of the intestinal tube, and which afterwards become perforated with numerous ramifying cavities, that communicate with the trachea ; while others describe them as commencing by a median enlarge- ment, which is hollow, and opens into the cesophagus. The walls of the orifice of communication with the digestive passage become considerably lengthened, and afterwards form the trachea and larynx ; while the vesicle or enlargement representing the lungs divides into two pyriform sacs, each of which is greatly subdivided to constitute the pulmonary lobes, with their vesicles and infundibula. The trachea is completed through the formation of the cartilaginous rings in the tube that attaches the lungs to the oesophagus ; the larynx is developed in the same man- ner, at the pharyngeal opening of the tube. This organ, however, is not very distinguishable during foetal life, and only assumes its definitive form and volume at puberty. Up to birth the placenta retains the function of the lungs, which, though ready to act, only come into play when the creature is born. Previous to this event they are of a dark red color, firm and compact, heavier than water, and apparently destitute of alveoli ; though these latter exist, but are filled with embryonic elements, and their walls are in contact. A moderate insufflation is sufficient to distend the air-vesicles, when the lungs become crepitant and enlarged, have a rosy color and spongy appearance,, float in water, and the air cannot be completely expelled from them. The same change immediately occurs in these organs when the young creature is born alive ; the external atmosphere, acting upon the surface of its body, causes it to inspire deeply, the chest dilates, the air rushes into the lungs, and respiration commences, only to cease with life. This alteration in the color, texture, and specific gravity of the lungs enables, us to decide, in certain cases, whether or not an animal has been born alive. The thymus gland first appears towards the second month, as a growth from the respiratory mucous membrane, near the larynx ; it then descends gradually along the trachea until it reaches the thorax, where it is situated between the layers of the anterior medianastinum. It increases in size until birth, after which it remains stationary for a short time ; then it gradually diminishes and disappears at a period which varies according to species, and even individuals. Exceptionally, it has been found in horses three years of age. It is a gland in structure, though it has no excretory canal. Its uses are unknown, though it is surmised that it plays CHANGES IN THE OVUM. loi a part in the nutrition and haematosis of the fcEtus and young animal. It may be that, like the spleen, it assists in converting the white corpuscles of the blood into red corpuscles. The Digestive Apparatus. The development of the digestive apparatus comprises the formation of the alimentary canal and the organs attached thereto. The alimentary canal begins to appear after the first outlines of the nervous centres and the vascular apparatus have been manifested. We have already described the manner in which the intestinal cavity was formed from the inner lamina of the blastoderm. This cavity, for convenience of description, may be divided into three portions ; the anterior iyitestine, which originates the pharynx and oesophagus ; the middle intestine, which becomes the stomach and intestines proper; and the posterior intestine, which constitutes the rectum. The chief, or middle intestine, is at first a cylindrical uniform tube, the diameter of which is afterwards modified to constitute the organs comprised between the oesophagus and rectum. The mouth begins by a depression or cul-de-sac, which is limited by the maxillar}'- tubercles ; it increases as it dips towards the pharj'-nx, from which it is only separated at last by a thin membrane ; this is eventually absorbed, and the mouth then communicates with the commencement of the digestive canal. Towards the third month the mouth is confounded with the nasal fossae, but after this the palatine bones appear, and finally isolate the two cavities. The to7igue is at first only a small protuberance from the maxillary tubercles, but is completed by the addition of a little growth from the second branchial arch. Its ephithelium and glands are derived from the external layer of the blastoderm ; they are apparent at the third or fourth month. The pharynx and oesophagus lengthen and widen as the foetus grows ; the latter at first communicates with the trachea, but it gradually closes, and ends by separating entirely from that tube. The stomach is formed by the dilatation of the anterior part of the mid- dle intestine. This dilatation is fusiform, its larger axis being longitudi- nal ; but it soon curves on itself, and then this axis becomes transversal. In ruminants the stomach is single when it first appears, though it is not long before furrows are observed on its outer surface ; while inter- nally the particular septa are seen as in adult life. In the foetus the stomach is small, but its volume increases rapidly after birth, when the animal commences to take solid food. During the sucking period in ruminants, there is a predominance of the fourth over the other gastric compartments; but as soon as the young animal begins to consume fibrous aliment, the rumen increases rapidly, until it is by far the largest cavity. The intestines are at first of uniform calibre, though in a short time it is easy to distinguish the different sections of which they are ultimately com- posed. In hoofed animals the caecum appears very early ; it is situated near the omphalo-meseraic duct, which is detached from the extremity of an intestinal loop that is drawn towards the umbilical ring ; while the latter is becoming obliterated, this loop ascends in the abdominal cavity. The intestines are quite smooth on the inner surface during the first, two months, and towards the third month show the villi and glands of Lieb- erktihn ; the Brunnerian glands and the follicles are only seen later. I02 OBSTETRICAL PHYSIOLOGY. The rectum arises from the posterior intestine, and is developed like the other portions. With regard to the anus, there is observed towards the caudal extrem- ity of the foetus a depression analagous to the buccal cul-de sac. This becomes deeper, and joins the rectum and genito-urinary organs ; later, it separates from the last, and then belongs exclusively to the alimentary canal. The ANNEXES OF THE ALIMENTARY CANAL are the salivary glands, teeth, liver, pancreas, and spleen. The salivary glands are developed in a solid cellular tubercle, which is connected with the epithelium at the upper part of the digestive apparatus. With the growth of this tubercle, it is converted into a series of cavities having the form of glandular culs-de-sac. The submaxillary gland appears first, and it is entire in a foetus of only twelve lines in length ; the parotid gland is the last formed. The teeth are developed in the interior of a cavity called the "dental follicle " or "sac," by means of the elements of three germs correspond- ing to the anatomical constituents of the teeth — enamel, ivory, and cementum. The follicle is an oval cavity whose wall comprises two layers : an external fibrous sac, and an internal gelatinous lining, at the bottom of which is the ivory p nip or germ. This is a prominence detached from the bottom of the sac, and has exactly the shape of the tooth. It is composed of a mass of delicate cellular tissue provided with vessels and nerves, and on the surface a layer of elongated cells. At the sum- mit of the follicle, facing this pulp, is the enamel pulp, which fits accu- rately on the dental pulp like a cap. This is made up of a small quantity of mucous cellular tissue, covered by a layer of cylindrical cells connected with the buccal epithelium by the gnberfiacnlnm dentis. The cement orgati manifestly exists in the foal, being found at the base of the ivory germ, though it disappears quickly after having performed its function. It is unnecessary in this place to enter into a consideration of the develop- ment of the teeth. The liver commences to be formed at an early period in all animals, appearing at the surface of the duodenum in the shape of one large tu- bercle or two small ones, according to the number of lobes in the organ of the adult. To these external tubercles, corresponding internal ones arise from the intestinal epithelium ; the first increase and enclose the omphalo- meseraic vein, while the second ramify in their interior and form the biliary ducts. The liver grows rapidly, and when about one-third of the period of ges- tation has elapsed, it nearly fills the abdominal cavity. At a later date this increase is less marked, although when gestation is nearly terminated, the gland is -proportionately more voluminous than in the adult. The pancreas, like the salivary glands, is first seen as a solid cellular tubercle, which is subsequently hollowed out by ramescent cavities. The spleen is developed about the second month, on the great curvature of the stomach ; it would appear to be formed at the same time as the pancreas, in a band extending from the stomach to the duodenum ; but it is separated from the pancreas and becomes attached to the stomach, where its elements assume the character of splenic tissue. The Genito-urinary Organs. The genito-urinary organs are related to each other in their develop- ment, and have some parts in common. Immediately after the formation CHANGES IN THE OVUM. 103 of the intestines, these organs are anticipated by the Wolffian bodies or primordial kidneys. These are glandular organs extending in front, or one on each side, of the vertebrae, from the heart to the pelvis. They are composed of small transversely disposed tubuli filled with a white fluid, and opening into a common duct running parallel to the spine, which again enters, inferiorly, that portion of the allantois which becomes the bladder. The duct is formed before the tubuli, and is one of the earliest developed structures in the embryo. Placed behind the perito- neum, the Wolffian bodies are attached by two folds of serous membrane : one, the anterior, named the diaphragmatic ligament of the Wolffian bodies ; and the other, posterior, the lumbar ligament of the Wolffian bodies. These organs secrete at first a fluid resembling wine, though their function is soon greatly modified, as they are not long in becoming atrophied ; then a portion serves for the development of the genital organs, while another gives rise to organs whose use is not exactly known, such as the Rosen- miiller organ, which is very developed in the equine foetus, and the canals of Gaertner visible in the Cow Male Foetus of the Mare at Five-and a Half Months: the Abdomen opened and Testicles exposed. I, Thighs ; 2, Penis, neither Scrotum nor Prepuce are yet foj-med ; 3, Bladder, with the two UmbiHcal Arteries ; 4, Abdominal Parietes ; 5, Douglas' Foramen, with the two Afferent Canals, 3, i5i ; 6, Kidneys ; 7, Supra-renal Capsules; 8, Rectum ; 9, Mesorchis or Spermatic Cord ; a, Gubemaculum Hunterii ; «i, Intenial Inguinal Ring ; b, b. Efferent Ducts ; c, c, Testicles ; d, d, Pampiniform Plexus. With regard to the urinary organs, we have mentioned how the allantois was derived from the terminal portion of the intestine ; it only now remains to add that the urinary bladder is derived from the abdomi- nal portion of the allantois, which is merely a dilatation of that sac. During fcetal life, the bladder is extended by the urachus to the umbilical ring ; but after birth this canal is obliterated, and the bladder retires to the bottom of the pelvic cavity. The kidneys appear a long time after the Wolffian bodies. They show themselves in the form of two culs-de-sac, constituted by the upper wall of I04 OBSTETRICAL PHYSIOLOGY. the small vesicle of the allantois. These small cavities become ramified, and are ultimately replaced by solid tubercles, in whose interior are developed the tubuli uriniferi and the Malpighian tufts. According to some observers, the kidneys only subsequently communicate with the ureters, which are developed separately in the middle lamina of the blas- toderm, and terminate in the pelvic portion of the allantois. The genital organs of the male -xr^d. female offer, at the commencement of their development, the greatest analogies. For a certain time it is impossible to distinguish the sexes ; so that some authorities propose to term this the " indifferent " state of the genital organs. Afterwards the sexes become defined, and at this stage the organs may be studied as internal and external. The indifferent stage begins about the sixth week, when there appears on the lower face, and near the inner border of the Wolffian body, a small white cord, which, in keeping this position, in- creases in volume. This is iht genital gland, which is fixed to the body by folds of the serous membrane, and is composed of a collection of young cells enclosed in an envelope. The development of this gland is coincident with the formation of Muller's duet or the genital canal, which lies inside and in front of the Wolffian duct. Miiller's duct is at first a solid cellular column, but is afterwards hollowed out into a cavity ; it terminates in a cul-de-sac at its upper extremity, and opens below into the bladder, near the Wolffian duct. From these modifications of the genital gland and the ducts of Miiller, it results that the testicle arises from the gland, which shortens and widens a little, while its tissue is transformed Genitourinary Organs of a Fcetal Sheep. a, a, Rudimentary Kidneys ; b, Ureters ; c, c, Testes ; d, d. Wolffian Bodies ; e, c, Excretory Ducts of Wolffian Bodies or Sperm Ducts ; ^, Oviduct with its openings/",,/ into the tubuli seminiferi^ The head or globus major of the epididymus is formed by the middle portion of the Wolffian body ; the tail or globus minor, the vas deferens, and the ejaculatory canal, are derived from the Wolffian duct. Lastly, the vesiculce seminales and the commcjtcement of the urethra are formed by the posterior extremity of the ducts of Miiller, which joins the urogenital sinus — the very short canal communicating between the bladder and the cloaca. The developed testicle remains in the abdominal cavity, maintained there by a peritoneal fold, the plica gubernatrix ; or descends by the inguinal canal into the scrotum. This descent is preceded by the appearance of a preparatory structure — the gubernaculum testis — consisting of a central axis of soft gelatinous sub- stance containing many nucleated cells and surrounded by fibrous tissue, which soon exhibits the striped characteristics of voluntary muscle. Some of these fibres spring from the bottom of the scrotum and traverse CHANGES IN THE OVUM. 105 the abdominal ring, while others arise from Poupart's ligament : the whole, enclosed by connective tissue and connected by a fold of perito- neum to the. psoas muscle, extending to the testis. This gubernaculum, in shrinking or contracting, draws the testis below the kidney to the abdominal ring, where it rests for a brief space ; after which it reaches the scrotum, where it is found after birth with the remains of the scrotal part of the gubernaculum. The iliac and the pubic portions of the mus- cular tissue now become the " cremaster," muscle, while the sac of per- itoneum carried down with the testicle is converted, by obliteration of the neck, into the tunica vaginalis testis. In solipeds the testicles do not usually descend into the scrotum until six months after birth ; when one or both do not appear, as sometimes happens in the male domesticated animals, and remain in the abdominal cavity during life, the gubernaculum, or what corresponds to it, is reduced to a small thin cord, without a trace of cavity, and showing only some few pale fibres of the atrophied cremaster muscle. In the foal they are voluminous, and somwhat reddish in color ; they are occasionally found in the scrotum at birth ; but they soon ascend into the abdomen, to redescend during the first year. With some animals, however, as has been already mentioned, and far more frequently with the Horse and Pig than any others, the testicles remain in the abdomen during life, or only one descends to its natural situation. When they remain in the abdominal cavity, the animal is said to be " anorchid '' or *' cryptorchid \ " and it has been shown that, although such animals have the sexual pro- pensity well marked, yet they are unproductive j their semen does not contain any spermatozoa. When one testicle has migrated to the scrotum, leaving one iij the abdomen, the Horse is " monorchid," and possesses the jDower of repro- duction unimpaired. In ruminants the testicles are small, and are in the scrotum at birth, where they remain. Sometimes there is a strange malposition of the testicles, and especially in the Pig ; they having been found beneath the chin, in the flank, and elsewhere. In the female, the ovary is derived from the genital gland, whose anatomical elements are disposed so as to form the stroma, Graafian follicles, and the ova. In foetal solipeds the ovary is of an immense size, especially about the middle of gestation, and its stroma is red and extremely soft. In other animals, and particularly ruminants, this disproportion is not ob- served. The Fallopian tube and its pavilion are formed by the anterior portion of Miiller's duct, the extremity of which presents a small linear orifice. The uterus and vagifia arise from the posterior part of these ducts, which approach each other, and finish by amalgamating posteriorly to form a single canal. This fusion originates the vagina and body of the uterus, the two diverging portions of the ducts comprised between the point of union and the Fallopian tubes forming the uterine cornui. The uterus and vagina are at first continuous and without any sign of demarcation, but towards the sixth month the neck of the uterus begins to become apparent. The external organs of the female in their indifferent state, demand notice. The intestine terminates in the cloaca, a cavity into which not only this tube but also the bladder enters, through the urogenital sinus. io6 OBSTETRICAL PHYSIOLOGY. This arrangement ceases somewhat suddenly, by the development of a transverse septum that divides the cavity into two portions : the anal opening, and the urogenital orifice. At the lower end of the latter Fig. 48. Female Organs of a Fcetal Deer. a, Uterus ; b, b, Comua ; c, c, Oviducts ; d, d, Ovaries ; e, e, Wolffian Bodies. appears the genital tubercle, the rudiment of the penis or clitoris, and which is surrounded by cutaneous ridges — the genital folds . This tubercle increases in size, and is traversed by a groove or fissure passing from behind forward. Up to this time the sexes cannot be distinguished. i Fig. 49' Female Fcetus of the Cow (Natural Size). I, Heart ; 2, Lungs; 3, Diaphragm; 4, Kidneys: a, Wolffian Body; 3, Germinal Gland; c. Wolffian Duct ; d, Miillerian Duct ; di, Uterus and Vagina ; dii, Abdominal Opening of the Oviduct ; f. Clitoris ; g^ Round Ligament of the Uterus. The male sex is marked by the rapid development of the genital tubercle, which becomes the penis, whose extremity is enlarged to con- stitute the "glans." The furrow or groove is closed behind, and forms the urethra ; while the genital folds, meeting each other below the penis, join to complete the scrotum. Owing to these changes, the digestive are separated from the urino-genital organs, and the urethral canal is con- nected with the bladder and the excretory ducts of the testicle. CHANGES IN THE OVUM. [07 The organs in the female also soon indicate the sex. The urogenital sinus forms the vulvular cavity or vestibule of the vagina^ so marked in the lower animals. The genital tubercle becomes the clitoris — the homo- logue of the penis. The cutaneous folds constitute the labia of the vulva ; while the genital groove is closed at one part of its extent to form \\\Q. perifieum. The mammce^ appendages of the generative organs, appear in the early months of uterine life, and the teats are perforated very soon. They are also seen very distinctly in the male foetus in the early months. In certain malformations of the generative organs, more or less of their primitive conditions are retained ; the most frequent of these mal- formations is hermaphrodism. Examples of this are by no means un- common among the lower animals, and the annexed drawing gives a good example of the organs of a hermaphrodite goat, with the male parts predominating. , s I Fig. so. Genital Organs of a Hermaphrodite Goat, the Male Parts predominating. a, a, Testas ; b, h, Combination of Epididymis with Abdominal Ends of Miillerian Ducts ; d, d, Vasa Deferentia ; e, Body of Uterus and Vagina ; f, y", Uterine Cornua : ^, g, Fallopian Tubes. SECTION IV. PERIODS OF DEVELOPMENT. Thus far we have traced the development of the young creature in the uterus ; but as our description may appear a little confused from our having described the growth of individual organs, rather than the foetus as a whole, it may be advisable to adopt the plan of dividing this bodily development into periods, which will also give an approximate idea of its age. From conception to maturity, utero-gestation may therefore be divided into seven periods or stages, as follows : — First Period. — Towards the second week after conception, the ovum or germ has passed from the ovary into the uterus ; it is then about a line in diameter (one-twelfth of an inch). Io8 OBSTETRICAL PHYSIOLOGY. Second Period. — In the third and fourth weeks of gestation in the Mare, Ruminants, and Pig ; the third week in Carnivora ; there appear the first traces of the embryo, and the head, body, and limbs can be distin- guished. Towards the twenty-eighth day, the embryo of the Mare meas- ures about six lines, and that of the Cow four lines ; that of the Sheep at twenty-five days is four and a half lines ; and the Bitch at eighteen days two lines. Third Period. — This is from the fifth to the eighth week with th^ Mare and Cow ; the fifth to the seventh with the Sheep and Goat ; and the fourth to the sixth with the Pig. The embryo of the Mare has acquired a length of rather more than 2 inches ; that of the Cow i^ inches ; that of the Sheep and Goat i^^ inches ; that of the Pig i^ inches; and that of the Bitch 11 to 12 lines. Fourth Period. — This is from the ninth to the thirteenth week with the Mare ; the ninth to the twelfth with the Cow ; the seventh to the eighth and ninth with the Sheep and Goat ; the sixth to the eighth with the Pig ; and the fifth week with Carnivora. The length of the fcetus of the Mare is 6 inches; that of the Cow 5^^ inches ; that of the small Rumi- nants 3^1^ inches ; that of the Pig 3 inches ; and that of the Dog 2j^ inches. Fifth Period. — This extends from the fourteenth to the twenty-second week in the Mare ; the thirteenth to the twentieth in the Cow; the tenth to the thirteenth in the Sheep and Goat ; the eighth to the tenth in the Pig; and the sixth week in Carnivora. At this stage the foetus of the Mare is about 13 inches long ; that of the Cow 12 inches ; that of the Sheep and Goat 6 inches ; that of the Pig 5 inches ; and that of the Bitch 3^ inches. Sixth Period. — From the twenty-third to the thirty-fourth week in the Mare ; the twenty-first to the thirty-second in the Cow ; the thirteenth to the eighteenth in the Sheep and Goat ; the eleventh to the fifteenth in the Pig ; the seventh to the eighth in Carnivora. The fcetus of the Mare in this period has acquired a length of more than 2 feet ; that of the Cow is about the same dimensions ; the fcetus of the Sheep is more than a foot ; that of the Pig about 7 inches ; and that of the Bitch 5 inches. Seventh Period. — From the thirty-fifth to the forty-eighth week — up to parturition, in the Mare ; the thirty-third to the fortieth in the Cow ; the nineteenth to the twenty-first in the Sheep and Goat ; the fifteenth to the seventeenth in the Pig ; the ninth week in the Bitch ; and the eighth in the Cat. A newly-born foal measures about 3^ feet long ; a calf 2 feet ; a lamb i^ feet ; a pig about 9 or 10 inches ; a puppy 6 to 8 inches ; and a kitten about 5 inches. In this study of the evolution of the young animal in utero, one cannot fail to be struck with the slowness with which development progresses for a certain period, and its rapidity afterwards. The slowness in growth may be accounted for by the extreme minuteness of the ovum at the moment of impregnation, and its containing within itself alone the ele- ments upon which the primary steps of evolution depend, there being at first no direct connection between the embryo and the uterine vessels. The parts which in reality grow most rapidly in the early period of ges- tation, are the enveloping membranes and the fluids they contain. In CHANGES IN THE OVUM. 109 the Sheep, towards the end of the first quarter of gestation, the mem- branes alone weigh from five to nine times more than the fcetus ; while the allantoic and amniotic fluids are from eight to ten times as heavy. These fluids increase in an absolute manner from the commencement, until within perhaps a short time of parturition. Rapid at first, towards the middle period their secretion abates, and then begins the more active development of the foetus, with a relative diminution in the proportion of the fluids ; until about the end of the fourth month they only repre- sent something like a third of the weight of the fcetus. In the Sheep a few days after the fifth month, or about birth time, they are a sixth of the weight of the young animal. The development of the foetus is so tardy at first, that the foetal lamb at the fortieth day has scarcely acquired the 300th part of the weight it has at birth ; at two months it has only a 60th, but now it grows more rapidly ; so that at the expiration of the fourth month, the foetus has gained more than one-third of its total weight.* The inequality of the growth of the different organs is also very no- table ; those whose functions are most required, such as the nervous centres, liver, etc., attaining considerable proportions very quickly. The brain, for instance, soon acquires a marked predominance over the other organs. In the fcetus of the lamb at the fifty-seventh day, the proportion of the entire brain to that of the body in weight is as i to 15 ; at the seventieth day it is as i to 55 ; and at birth as i to 65. At mid-term with the calf, its weight is to that of the body as i to 53, and at birth as I to 120. The spinal cord does not follow the same progression in growth. In the calf at mid-term it is only the 421st part of the weight of the foetus, and at birth the 470th part. In the lamb at birth, it is equal to the 340th part of the body. The heart, which appears so early, is more voluminous in the embryo than towards the termination of gestation and after birth. The heart of a calf at mid-term equals 125th of the weight of the body ; that of a lamb at birth the 120th ; in the adult bull it is only the 264th part. The lungs have, relative to the total bulk of the foetus, a variable weight according to age. In those of the Sheep at fifty- seven days, they are equal to a 20th part of the weight ; in a calf at mid-term, the 33d ; in another at eight months, the 34th ; and at birth, the 35th and 55th ; in a foal a little more than eight and a half months, they were the 33d ; in lambs and goats at birth, they averaged from the 24th to the 6ist part of the w^hole weight. The development of the thymus gland also varies considerably accord- ing to age and species. In a calf at mid-term, its weight was the 137th part of the body ; in another at seven months, it was the 197th ; in a foal at birth, the 200th; in a goat at the same period, the 130th ; and in a lamb eight days after birth, the 228th part. It is always proportion- ally more voluminous in ruminants than solipeds, and in them and the Pig it extends in front nearly to the larynx. In the Dog it does not get beyond the anterior mediastinum, and is small, though more persistent. It has in rare cases been found in Horses more than three years old, but as a rule in the adult animal it is only represented by a small and vari- able quantity of adipose tissue. The liver is extremely voluminous in the early period of the embryonic and foetal life, but decreases proportionately as gestation approaches its no OBSTETRICAL PHYSIOLOGY. close. In the foetus of a lamb at the fifty-seventh day it has been found equal to i-6th of the body in weight ; in calves at mid-term and birth to i-29th ; with the foal at birth 1-2 ist, and i-24th in lambs at the same period. In the adult horse it has been found to represent i-75th of the total weight, and i-83d in the ox. The intestines, during fcetal life, do not grow in length so as to attain the proportionate dimensions they offer in adult life. In an equine foetus of eight or nine months, the small intestines measured about 15 feet, the caecum 6 7-10 inches, and the large intestines 3)^ feet, or a total of about 20 feet : about i-5th of their length in after life. Shortly after birth they acquire i-3d the length to which they attain when fully devel- oped. The calf at mid-term has only i-ioth the length of the adult intestine : being only sixteen times the length of the body, instead of twenty times. The lamb and kid at birth have i-3d of their intestines complete : their length is seventeen to eighteen times the length of the body, instead of twenty-seven times in adult life The general proportions of the body, and especially those of the skel- eton, are not in foetal life what they are after birth. The bones are, relatively to the other parts, more voluminous as a whole, and notably at their extremities, than in the adult. The limbs in particular, and this more so in solipeds and ruminants, have attained a length which is not at all proportionate to that of these parts when their growth is completed. And several bones of the limbs, such as the radial, tibial, metacarpal, and metatarsal bones, are almost fully developed in their dimensions at birth. The following interesting table exhibits the comparative weight of the different bones in the foal and the adult horse. The weight is given in grammes (15*432 troy grains). Species. 1 1 £ ■rt 11 1 I 3 i i 3 i g i i i s 2 iS h 11 u M J m m ^ P4 CJ ^ ■A 1X4 h H >i u grs. grs. grs. grs. grs. grs. grs. 1 grs.; grs. grs. grs. grs. grs. grs. grs. grs. 315 370 390 35° no 135 383 "26 I9S 190 159 t88 243 250 224 59 40 238 240 2l8 139 131 227 245 232 254 223 ?6? (S6 271 275 255 17 173 Foal at Birth 205 170 -•Ro 6-> Foal two days old 246 3/0 3x0 36 45 240 170 450 390 360 7° 280 180 SECTION v. PHYSIOLOGICAL PHENOMENA IN THE FCETUS. With regard to the physiological phenomena which occur during foetal life, we cannot presume to speak in detail in this place. It is, however, interesting, and perhaps necessary, to allude briefly to several of the most important, in order to complete this portion of our subject. Nervous Functions. The development of the nervous functions is one of these phenomena worthy of attention. It appears certain that the young creature is CHANGES IN THE OVUM. m formed and developed without the direct intervention of the nervous influence of the parent, as there is no communication between the nerves of the uterus and the foetal envelopes ; and it has not been shown that there are nerves either in the latter or yet in the umbilical cord. The progressive animation of the new creature cannot, therefore, be derived from immediate nervous propagation or direct extension of the nervous activity from the mother to its offspring ; and we must look upon this animation as originating in the embryo, and becoming developed under the influence of inappreciable causes. At the very commencement of embryonic life, the nervous system, which, in extra-uterine existence, holds under its control the organic functions, appears now to have no possible influence on the phenomena that gradually manifest themselves. The primary changes in the ovum ocdur before the earliest traces of the nervous system are apparent ; .and while its rudiments are forming, those of other parts are also being developed. Even when the nervous system has attained a somewhat considerable growth, it does not appear to have assumed those controlling powers with which it is so largely endowed at a subsequent period. In the homogeneous plasma of the ovum, in the common blastema, coincidently or successively, a multitude of different parts are being formed independently of each other, as if each contained within itself the why and wherefore of its formation and ulterior perfecting. The nerv- ous system itself seems to be submitted to the same general laws : it does not appear to be dependent upon any other part, neither does any part depend upon it ;.even when it is fully formed, the phenomena per- taining to growth are evidently effected without its stimulating interven- tion. Besides, it is well known that the monstrosities which are some- times seen destitute of brain and spinal cord, may yet reach the end of their fcetal development. True, certain facts have appeared to de- monstrate that the formation of parts was dependent on nervous action. In certain monstrosities, organs have not become developed when the nerves which should have been distributed to them were absent; in others, several organs have become fused together when their nerves were similarly aggregated \ while an organ has been divided into frac- tions corresponding to the accidental development of its nerve. The muscles of the posterior part of the body of the foetus of the Cow and Pig have been observed to be absent when the corresponding portion of the spinal cord was, with its nerves, very imperfectly developed. But these facts do not prove that the absence of the nerves was the cause of the non-development of the muscles ; for in such cases there is a correla- tion between the non-formation of the nerve and the absence of the muscle ; the same cause which has hindered the formation of the one in a certain part of the body has also prevented the growth of the other in that part. And the same, to a certain point, with the relative develop- ment of vessels and the increase of the parts to which they are distrib- uted. In the original homogeneous plasma, there were developed the diverse elements of an organ at the same time as its vessels, and the force which created the connective, nervous, and muscular tissues, crea- ted also the elements of the vessels — arteries, veins, and capillaries : they are closely related to each other, and their growth goes on concur- rently. If the vessels do not carry a sufficient supply of formative mate- rial, the development of the part is tardy or ceases ; and, on the other hand, if the latter from some cause becomes feeble and cannot assimilate 112 OBSTETRICAL PHYSIOLOGY. this material, tlie vessels gradually cease to carry it -, consequently both become atrophied when they cease to grow. When the nervous system has arrived at a certain degree of develop- ment, it begins to assume its functions ; though the first manifestations of its activity are very obscure, and probably limited to mere tactile im- pressions, evinced by movements more or less appreciable. It is well known that in the pregnant Mare and Cow, after their ingestion of a large quantity, of cold water, the foetus, towards the end of the second third of gestation, and more particularly in the later months, executes move- ments which are at times so marked that they can be felt if the hand is applied to the abdominal parietes, or even seen in the region of the flank. It is very probable that these automatic or reflex movements may produce torsion of the umbilical cord, and in this way become a predis- posing cause of abortion. Colin, having had occasion to lay open the abdomen of a living pregnant Mare within two or three months of par- turition, saw the foetus, immediately after the incision in the abdominal walls, jumping about in the uterus in a very lively manner without any external stimulus being applied ; it moved the whole of its body, or with- drew its legs or head when pinched through the uterus and the envel- opes. In a quarter of an hour after removal from these and the mother, it no longer moved. The human foetus at five months has been seen to flex and extend its limbs when removed from the uterus. Towards the termination of gestation, there can be no doubt that the fcetal movements are somewhat energetic, for at this period the foetus changes its position preparatory to passing through the pelvis. Thus the young soliped, during the whole of its intra-uterine existence, lay with its abdomen turned upwards and the posterior limbs lodged in the largest of the two cornua ; but it now turns over on its belly, with the legs downwards, and the umbilical cord passing across one of its sides. The movements connected with deglutition also appear to be performed at an early stage of development, for some of the hairs which are so often observed in notable quantity floating in the amniotic fluid, have been discovered in the foetal stomach. Absorption. The phenomena of absorption play a considerable part in the develop- ment of the young animal. As soon as the microscopic ovule reaches the uterus, its vitelline envelope or pellucid zone becomes studded with deli- cate, hair-like prolongations — villosities without vessels — which, steeped in the fluid thrown out on the uterine surface, transmit this to the laminae of the blastoderm. At first this absorbent surface is very small, and the growth of the embryo is consequently slow ; nevertheless, this trifling absorption is sufficient to increase. the ovule to forty or fifty times its original volume before the blastodermic laminae and the germinative space are completed. Later, when the umbilical vesicle is formed at the expense of the vas- cular and mucous laminae, its vessels absorb the soluble matters that are added to the mass of elements necessary for the growth of the em- bryo. And, finally, when the chorion is at last organized, and furnished with its myriads of vascular papillae in the form of disseminated or ag- glomerated placentulae, absorption goes on with exaggerated activity over the whole uterine surface and texture, in order to supply all the nutrition required for the now rapid development of the foetus. CHANGES IN THE OVUM. 113 The nutritive elements are absorbed by the vessels of the placental villosities, transformed into blood, and conveyed to the young creature by the umbilical veins. The extra-fcetal absorption is supplemented by that which is taking place in the fluid of the envelopes, and also in the organs and tissues of the foetus itself. It is certain, however, that the placental absorption is by far the most important, and that the rapid development of the fcetus is mainly, if not altogether, due to the nutritive elements obtained there ; while it is not improbable that the amniotic fluid found in the stomach and intestines may act as a dilator of these, modify the action of the bile accumulated in the latter, and perhaps yield a small amount of nutriment : though it must be remembered that it does contain much of the nutritious elements, and that the foetus, which is unprovided with a mouth, and therefore cannot swallow, is neverthe- less as well developed as one that does ingest this fluid. Nutritioji. It has been shown that the foetal vascular system is quite distinct from that of the mother, the isolation of the two systems being .complete, and only brought into contact at the placenta or placentulae. There the mater- nal blood is conveyed by certain arteries into particular sinuses or recep- tacles of the uterus containing the ultimate radicles of these vessels, which emerge into veins ; while the foetal vessels, extremely attenuated, dip down into these receptacles, and are bathed in the blood of the parent, as the " gills " or branchiae of aquatic creatures are in the water in which they live. But the actual blood of parent and offspring never meet : they are only brought into indirect contact ; and between them are the thin coats of vessels, basement membranes, and cells. This indirect contact is sufficient to permit the venous foetal blood to become arterial, by en- abling it to part with its carbonic acid, and also to get rid of excrementi- tious matter derived from the different processes connected with the growth of the foetus, and whose retention in the blood of the young crea- ture would doubtless be a source of injury to it. This arrangement of the two systems of vessels also, as has just been said, allows certain nu- tritious elements of the maternal blood — its fluid portion only — to be taken up into the system of the foetus. In this way, as has been pointed out, these vascular rootlets of the placenta closely correspond to the villi of the mucous membrane of the intestines ; and the analogy is rendered more complete when we know that the nutrient material is selected and prepared by two sets of cells, one of which — the maternal — transmits it to the other — the fcetal — in the same manner as the epithelial cells of the intestinal villi seem to take up and prepare the nutrient matter that is destined to be again assimilated by the cells which float in the circula- ting fluid. No other communication between the two vascular systems exists ; and the fact that the blood corpuscles of each are diflferent in size, conclusively demonstrates that they must be distinct. Nevertheless, the special function of the placenta, and the intimate relation existing, through it, between the fluids of parent and offspring, renders it evident that the maternal blood may become impregnated with substances, or impressed with attributes, which will affect the development or modify the constitution of the fcetus ; while pernicious matters generated in the latter, may prove more or less noxious to the mother. 8 114 OBSTETRICAL PHYSIOLOGY. Ciradation. In order that the nutritive matters absorbed by the placental villi may reach the foetus and be circulated in its body, it is necessary that a deter- mining and regulating power should be brought into play at an early period in the existence of the foetus. This power appears with the formation of the contractile organ which has been named the heart. From the mo- ment when this important organ appears in the form of a cylindrical tube at the commencement of embryonic life, it dilates and contracts alter- nately, first to receive the venous blood, and then to propel it into the arteries. The fluid which is at first received and propelled by the heart is trans- parent, colorless, and destitute of morphological elements, and the organ itself exists in its most primitive form. As has been stated, the situation of the heart and the course of the principal trunks of the vascular area, are early visible, and are marked by the peculiar disposition of the aggre- gations of cells from which these organs are to be developed. It was shown that whilst the outer portions of these aggregations were trans- formed into the walls of the respective cavities, the inner portions ap- peared to deliquesce, and partly to remain as isolated cells floating in the resulting fluid. These isolated cells are supposed to be the first blood corpuscles. They are large, colorless, vesicular, spherical cells, full of yellowish particles of a substance like fatty matter. Many of these parti- cles are quadrangular and flattened, and have been called stearine-plates, though their composition is not ascertained ; each cell has a central nu- cleus, which is not at first very distinct, and the development of these embryo-cells into the complete form of corpuscles is effected by the grad- ual clearing-up, as if by division and liquefaction, of the contained particles, the acquirement of blood color and of the elliptical form, the flattening of the cell, and the more prominent appearance of the nucleus. In tracing the development of the red-corpuscles of the blood, it is found that at first their nuclei have no envelope, but contain nucleoli ; that they present all the characters of pale elementary cells, w^hilst they are so nu- merous as to give the blood a whitish hue. When more fully developed they acquire a cell and a reddish tint, and at a later stage are circular, thick, and disc-shaped, full-colored, and about 1-2 500th part of an inch in diameter ; their nuclei are central, circular, very little prominent on the surface of the cell, and apparently slightly granular or tuberculated. When the liver begins to be formed, the multiplication of blood-cells in the entire mass of the blood ceases, and in a short time all trace of the development of the red from the original colorless formative cells is lost, whilst, on the other hand, there takes place in the vessels of the liver a new production of colorless nucleated cells, which are formed around free nuclei, and which undergo a gradual change, by the production of coloring matter in their interior, into red nucleated cells. This new for- mation of blood corpuscles in the liver continues to take place during the whole period of foetal life ; but whether these nucleated cells themselves undergo transformation into the non-nucleated discs which constitute a gradually increasing proportion of the corpuscular components of the blood during the latter period of embryonic life, or whether these are formed only by the metamorphosis of lymph-corpuscles, has not yet been- determined. From the manner in which the circulation is carried on during foetal CHANGES IN THE O VUM. i j 5 life, and which has been adverted to, it is seen that the chief propelling power is centred in the right side of the heart ; the force of the left heart being mainly spent in effecting a due supply of blood to the head and upper extremities. And the structure of the heart proves this to be the case, for the walls of the right ventricle have been found as thick as those of the left ; while the walls of die right auricle are even thicker and more muscular than those of the left auricle : a condition which persists for a short time after birth. The isolation that exists in the two circulatory systems, might lead to the inference that there was no relation between the contractions of the heart in the foetus and those of the maternal organ, and experience proves this to be the case. Naegele has noted that there is no relation between the beats of the heart of the human foetus and those of its mother's heart. By auscultation he was able to distinguish the two sounds of the foetal heart, and found it beat on an average 135 times per minute : never more than 180, nor less than 90; and he remarked that the beats were sensi- bly the same from four and a half months, when they are first perceptible, until birth. And Hollmann, in resorting to the same mode of investigation in Cows, ascertained that, in one which was advanced eight and a half months in pregnancy, and whose pulse was 64 per minute, the foetal beat was 124 ; in another Cow, but which was ill, the pulse was from 70 to 112, while that of the foetus was 113 to 128. Colin opened a living Mare which had been pregnant for nine or ten months, and a Cow whose gestation dated about three months. When the uterus of the Mare was opened, and the contained envelopes incised to extract the foetus, the latter moved actively and respired deeply, though at rare intervals. The umbilical arteries and vein yielded some blood, from the small punctures made through their walls ; the first throbbed with a certain amount of force, and the pulsations were rapid. When the cord was divided and tied, the foetus appeared to be dead : there were no more spontaneous movements, and the respiration had ceased. The tho- rax and the abdomen were now thrown open, and it was observed that the heart contracted spontaneously arid strongly, and the pulsations of the aorta and umbilical arteries could be very distinctly felt. At first the contractions of the auricles regularly alternated with those of the ventri- cles, as in a normal condition ; but soon, as occurs in expiring animals, the auricles contracted several times for one contraction of the ventricles, as if it required several systoles of these to fill the ventricular cavities. At each contraction the auricles diminished much in volume, became nearly empty, and looked very pale, but assumed their reddish-violet color again during their diastole. At last the rhythmical movements be- came altogether perverted ; the auricles and ventricles contracted simul- taneously and quickly, but more and more feebly, and finally ceased alto- gether half an hour after the thorax had been opened. The Cow in which the foetal circulation was studied, had its flank wddely incised, and one of the cornua of the uterus withdrawn through the opening. Some of the placentulae were removed with difficulty from their cotyledons, and both bled a good deal. When the umbilical cord was exposed, the beat- ing of its very tense arteries could be distinctly felt ; and when com- pressed, these enlarged between the foetus and the point where the pres- sure was applied. On removing the foetus from the uterus, it did not make any perceptible movement, but then it was only three or four months old. The thorax having been opened, the action of the heart Ii6 OBSTETRICAL PHYSIOLOGY. was observed to resemble that of the other foetus ; there were 31 pulsa- tions in the first minute, 18 in the third, 11 in the fourth, and 21 in the fifth. The beats ceased in about twenty-five minutes. In these two ex- periments, as well as in others made on smaller animals, M. Colin found it impossible to perceive any difference in color between the blood of the umbilical arteries and that of the veins, both fluids showing a tint inter- mediate to that of the arterial and venous blood of the adult. Secret io7i. With regard to secretiofi in the fcetus, it is worthy of remark that several glandular structures at an early period and during foetal life exhibit a re- markable degree of activity; and more especially is this the case with those of the stomach and intestines, the liver, the mucous membrane of the air-passages, and the kidneys. The glands of the mouth and oesopha- gus only furnish the mucus that covers the membrane lining these parts, but it is not long before the stomach is filled with a white or colorless viscid fluid, in which is a large proportion of epithelial cells and nuclei. Colin has found as much as 229 grammes of this fluid in the stomach of a foal at birth, from 150 to 180 in lambs at the same period, 200 to 300 in calves towards the middle of gestation, and 500 to 600 in those at birth. It is neutral or slightly alkaline, and contains, more especially in the foetuses of solipeds and ruminants, a very large proportion of sugar, with mucine and salts. This fluid can scarcely, however, be looked upon as a gastric secretion, but rather as a mixture of this with the amniotic liquid swallowed by the fcetus ; and it appears certain that though the mucous glands are active, yet that those which elaborate the pepsine are inactive. The stomach of a foetal calf twenty weeks old, digested for eight days in milk at a temperature of 20 degrees (Cent.), transformed that fluid into a gelatinous mass, but did not coagulate it. The secretory function of the pancreas is so obscure, that it has not yet been determined. The biliary secretion soon appears, and is remarkably abundant. In the foetus of the Cow at birth, a small quantity of clear bile having a slight greenish tint is found in the gall-bladder ; and at the fourth month of gestation, the large intestines of this creature and the foetus of solipeds are filled with meconium, which is recognizable through the walls of the tube by its green hue. The foetal bile becomes thicker and deeper-col- ored as birth approaches ; it is insipid and alkaline. M. Lassaigne ana- lysed that of the foetus of a Cow six months old, and found two coloring matters, mucus, the carbonate and chloride of sodium and phosphate of lime, but no picromel. Mixed with the fluids thrown out by the intestines and the other mat- ters entering them, it forms the meconium, which is composed, according to Simon, of cholesterine 16,00 ; extractive matter and biliary resin 10,40 ; caseous matter 34,00 ; picromel 6,00 ; green coloring matter, 4,00 ; and epithelium, mucus, albumen 26,00. This meconium is scanty in the first periods of foetal life, and has been found to be white in foetuses destitute of a liver, as well as in others whose intestine was obliterated below the en- trance of the biliary duct. It is very consistent and plentiful in the in- testines at birth. In those of a foal whose stomach contained 229 grammes weight of the white viscid fluid above mentioned, there was found 216 grammes of greyish meconium in the small intestines, and 559 of green in the large intestines. This product is frequently expelled in CHANGES IN THE OVUM. 117 certain quantities towards the end of gestation, and is found in the liquor amnii, which owes its yellow color to its presence ; it is swallowed with this fluid, and is then observed in small masses in the stomach. The liver appears to be engaged, during foetal life, in the depuration of the blood, as appears from this accumulation of meconium, which is chiefly altered bile ; but at the same time, as has been stated, it is serv- ing as a blood-making organ, and this is probably its principal function before birth. The secretion of urine is somewhat active during intra-uterine life, and appears to be effected by the Wolffian bodies before the kidneys begin to act. It is not, however, until the end of gestation that a notable quantity of urine is found in the bladder, and urea in the allantoic fluid of the Cow. It is certain, however, that this fluid is not altogether the urine of the foetus, as its proportion is relatively larger at an early epoch of foetal life, and the communication between the bladder and allantois is more limited towards parturition. With regard to the function of the thyroid and thymus " glands," as they have been termed, and the spleen and supra-renal capsules, during foetal life, there is but little positively known. It appears, however, to be admitted that the office performed by these ductless or vascular glands, is to restore to the circulating current any substances which they may withdraw from it, and that their action is subsidiary to the process of sanguification \ being exercised, perhaps, chiefly upon that portion of the nutrient materials which did not pass through the absorbent system when first introduced, but was taken up directly by the blood-vessels. SECTION VI. WEIGHT AND DIMENSIONS OF THE FCETUS AT BIRTH. The various phenomena connected with development having been completed, so far as uterine existence is concerned, it may be useful to note what has been ascertained with regard to the weight and dimensions of the foetus at birth; the latter being of much importance from an obstetrical point of view, though it is a subject which has not received all the attention it merits from veterinary obstetrists. With regard to weight, we find, as might be expected, that this varies considerably, according to the size, breed, and condition of the parents, and other circumstances which more or less influence growth. For the Horse species, Boussingault estimated that foals from pa- rents weighing from 400 to 500 kilogrammes, weighed at birth 51 kilo- grammes.* According to a table drawn up by Saint-Cyr, it appears that a foal at birth may vary in weight from 30 to 60 kilogrammes, according to breed and individual peculiarities ; though between 38 to 42 kilo- grammes may be accepted as the average weight. With regard to the Bovine species, Tisserant has stated that calves weigh at birth from one-thirteenth to one-sixteenth of the weight of the Cow ; whereas Riedesel gives it as one-tenth. Magne mentions that calves vary between 20, 25, 45, and 50 kilogrammes. Saint-Cyr alludes to the observations made at the Agricultural School of Saulsie, France, where Cows of the Ayrshire breed were chiefly kept. The animals were maintained in good condition all the year round, and though they were only middle-sized, their weight varied between 400 and 650 kilogrammes. The Cows were regularly weighed, as were the calves immediately after * The kilogramme is equal to 2*205 pounds avoirdupois. ii8 OBSTETRICAL PHYSIOLOGY. birth, and the register for 1868 gave the following results. The weight varied from 31 to 35 kilogrammes — the average being 32^ kilogrammes. The males were a little heavier than the females. In twenty-eight instances, the average weight of the calf compared with that of the cow was as 2 to 31. The average weight of one hundred lambs weighed at the Alfort pens, is given by Magne as about 4 kilogrammes for both sexes. The males were heaviest. With regard to dimensio7is^ Saint-Cyr justly regrets the paucity of obser- vations which have been made on this important point. It is of course well known that, in a general wa}^, the foetus is larger than the pelvic opening through which it has to pass at birth, but we have to ascertain how much larger it is than that canal, and what is the amount of reduc- tion in volume to which it has to submit in passing the outlet of the pelvis. Rainard merely states that some measurements he had made, gave the diameter of the thorax of calves, from withers to sternum (verti- cal) as from 1034^ to 11 inches; and the diameter from side to side (transversal) as 63^ to 7 inches. Saint-Cyr, anxious to arrive at some definite conclusion in the matter, in order the better to understand the mechanism of natural parturition, as well as to gain a knowledge of how to surmount the difficulties of protracted labor, undertook some researches in this direction. His object was to ascertain the depth and width of the chest, and width of croup of the foetus', these being the dimensions which it is most important to compare with the different diameters of the pelvis of the mother, so as to understand how the former may accommodate themselves to the latter. He gives the name of sierno-dorsal line to the verticle measurement taken from the summit of the highest dorsal spines to the sternum, and biscapulo- humeral line to the distance measured from one scapulo-humeral artic- ulation to the other ; while the bicoxo-femoral line is the measure- ment of the croup from one coxo-femoral articulation to the other. From the measurements in the Horse species, we find that a Mare measuring a trifle over fifteen hands in height, and whose pelvis was nearly nineteen inches in width, brought forth a foal weighing slightly less than thirty pounds, and whose sterno-dorsal measurement was nearly twelve inches, biscapulo-humeral line 7^ inches, and bicoxo- femoral line nearly 8 inches. The other measurements of Mares and foals yielded similar results, and give an idea of the expulsive efforts the uterus must make to expel the foetus. In the case first cited, it may be admitted that the pelvis of the Mare had, approximately, the following dimensions : inlet of the pelvis — sacro-pubic diameter, 9 inches ; inlet of the pelvis — bi-iliac diameter, 8^ inches. In comparing these dimensions with those of the' foal to which it gave birth, it is obvious that the bi- scapulo-humeral and bicoxo-femoral diameters of the latter could be easily accommodated by the bi-iliac diameter of the mother, as they are less by 1 34^ and ^ inch ; but it is not the same with regard to the sacro-pubic diameter, which is less by nearly three inches than the sterno-dorsal line of the foetus. It is therefore evident that in order to pass through the pelvis, this line must be diminished at least by three inches. . With regard to the Bovine species, nine Cows were tabulated. The first, the smallest, was 11 3^ hands high, and the width of the croup 18^ inches ; the weight of the foetus was about sixty-two pounds, the sterno- dorsal diameter 10^ inches, the biscapulo-humeral 6iV inches, and GESTATION. ' 119 the bicoxo-femoral 7t'o inches. Another Cow was i2>^ hands high, the width of croup iSy^ inches ; the weight of the foetus was about seventy-three pounds, the sterno-dorsal diameter 103^ inches, the bi- scapulo-humeral 6 inches, and the bicoxo-femoral 8Vo inches. With a Cow \2Y^ hands high, and croup 18 inches in width, which had experi- enced a protracted accouchment in consequence of the size of the calf, and which had aborted the previous year, the weight of the foetus was sixty-six pounds, the sterno-dorsal diameter 15 inches, the biscapulo- humeral 7^ inches, and the bicoxo-femoral 8^^ inches. CHAPTER V Gestation. Gestation, or pregna?icy, comprises the period during which the female animal carries its young while this is undergoing development. Its con- sideration is of much moment, and we will, with regard to it, study it in this chapter from a normal physiological point of view : noticing the anatomical and functional alterations attending.it, the mode of recogniz- ing it, its duration in various species of animals, and the exceptional departures from the usual law, with respect to the number of young pro- duced. SECTION I. MODIFICATIONS IN THE UTERUS DURING PREGNANCY. With the development of the foetus, the uterus undergoes important anatomical and physiological modifications, while the system of the mother also participates more or less generally in the phenomena which mark the period of gestation. The modifications and phenomena are worthy of attentive notice, not only from the importance they hold with regard to the reproduction of animals, but also from the practical issues involved in the study. The anatomical changes in the uterus are those relating to its volume, structure, form, situatmi, and direction. Volume. W^th regard to volume^ we have seen that during and after copulation the uterus is congested, and that, when conception has taken place, the thin pulpy secretion corresponding to the decidua of the human female covers its' internal surface. The vessels, distended with blood, gradually enlarge to a great size : from the smallest to the largest forming most intricate and beautiful plexuses on and in the texture of the organ. The coats of the arteries are thickened to compensate for their distention, and the additional labor they have to perform ; wdiile the veins are still more enlarged in calibre. The lymphatics are likewise augmented in number and dimensions ; and the nerves, which were comparatively small in the unimpregnated state, enlarge and anastomose so freely as to compose a network similar to that of the vessels — the increase taking place in the nerve termina, not in the nerve substance. I20 OBSTETRICAL PHYSIOLOGY. Structure. These changes add to the thickness and density of the uterus ; but there are others still more remarkable. While the organ is increasing in volume, becoming rounder, acquiring a greater capacity, and its cervix widening, its proper structure is exaggerated to an extraordinary degree. This exaggeration, however, does not occur equally throughout ; it is most marked in the cornua of multiparous creatures at the points where the young are fixed ; in ruminant animals at the situation of the cotyle- dons ; and in solipeds at the part of the body of the uterus corresponding to the foetal placenta. So that, at least in the early months of pregnancy, it is thinnest towards the cervix. The increased thickness of the organ, however, never equals that observed in the human female, compared with which the walls of the uterus of the domesticated animals are thin. The firmness or density of the organ is always most conspicuous in the cornua, and in the operation of " spaying," or castration of the female, this serves as a useful guide in enabling the operator to distinguish be- tween the cornua and the intestines, which they so closely resemble in appearance. But during pregnancy this density seems to diminish, as the organ becomes more vascular, and the cervix assumes a much softer condition than usual. For instance, in the fcetal cornu of a Cow advanced three months in pregnancy, the thickness of the wall was only 2-5 millimetres, while in the other horn it was four millimetres. In another Cow at five months, it was two millimetres in the foetal horn and five millimetres in the vacant one. The mucosa is thicker, redder, more pulpy and vascu- lar, than before impregnation ; the longitudinal rugse it then exhibited gradually disappear ; the epithelium covering it usually loses its .colum.nar form ; the utricular glands enlarge — they are longer and their orifices wider, and their secretion, as well as that of the other glands, is increased ; the interglandular tissue is largely and rapidly augmented by multiplica- tion of the cells of the surface epithelium, and proliferation of the cor- puscles of the sub-epithelial connective tissue, so that the glands are more widely separated ; while the uterine cotyledons grow quickly, and there can be no doubt that new ones appear, Rainard speaks of exam- ining the uterus of several calves and lambs, and finding only thirty or forty cotyledons ; while after parturition he has ^counted more than a hundred ; and more recent observers have testified to this fact. In the uterus of a six months' pregnant Cow, Franck found that the horn con- taining the fcetus had forty-seven cotyledons and weighed 3,54zollpfund ; while the other horn had only forty-two placentae, and weighed no more than 0,22 zollpfund. In addition to these supplementary appendages of the mucous mem- branes, a new glandular apparatus, of which no trace was to be found previous to gestation, now makes its appearance in the form of a large number of small openings in the mucosa, each leading into a depression which was for a long time regarded as the dilated mouth of the tubular or utricular glands, but which is really a " crypt " formed in the hyper- trophied tissue of the uterus — a kind of open follicle placed in the inter- glandular part of the mucous membrane. These crypts are new struct- ures, formed during pregnancy, and are for the lodgment of the villi that project from the chorion of the foetus — being, in fact, the maternal coty- ledons or maternal portion of the placenta. They are small straight GESTATION. I2i depressions, lying more or less closely together throughout the whole of the uterine mucous membrane of the Mare, their cavity being lined by a layer of tessellated epithelium, and a very fine capillary network surround- ing each. In the Cow, these crypts are assembled on the surface of the projections designated cotyledons, of which they constitute nearly the entire mass during pregnancy. In the Bitch, they are only developed where the ovule is fixed, forming then a glandular layer occupying the contour of the uterine cornu. The utricular glands do not open directly into the crypts^ nor is their secretion poured into them, but on a definite surface of the mucous mem- brane between the crypts, the size and areas of which correspond, of course, to the size and arrangement of the foetal tufts. Between the foetal and maternal placentae, there is always a layer of Vertical Section through a Portion of the Uterine Cotyledon of AN Early Stage of Pregnancy. Cow in a, Serous Membrane; 3, Section of Longitudinal Muscular Layer; c. External, andfi, Internal Layers of the Circular Muscle ; d, Submucosa, with vessels ; e, Adenoid Tissue of the Cotyle- don ; f. New Tissue of the Placenta Uterina ; g, Section of the Mucous Layer of the Cotyle- don, with the Interspaces into which the Foetal Cotyledons are inserted ; h k, Utricular Glands passing under the Side of the Cotyledon; i i, Large Cotyledonal Vessels; k, Uterina Mucosa; //, Epithelial Layer of the Cotyledon. epithelial cells of varying thickness, which represents the membrana decidua or serotlna of woman. If not during parturition, at least after- wards, all placental mammals are " deciduate," more or less. With the Cow and Sheep, for example, large quantities of cells, possessing the character of epithelial cells of the pits and crypts of the maternal cotyle- dons, have been found, mingled with the villi of shed foetal cotyledons, in the fluid extruded during and after parturition : showing that a portion of the maternal structure is carried away at this time. The crypts possess structural characters of secreting organs ; and, indeed, we cannot but look -upon the maternal placenta and the remarkably modi- fied mucous lining of the uterus as a great secreting organ. In addition to the mucous membrane, the outer or serous membrane is 122 OBSTETRICAL PHYSIOLOGY. also hypertrophied, the broad ligaments are increased in every direction, but especially in length, and muscular fibres are abundantly developed between their layers, in order to give them sufficient strength to sustain the weight of the uterus. In the Cow, the fibres even form very distinct intercrossing fasciculi. The greatest increase of all noted in the texture of the uterus, occurs in the middle or muscular tunic. There appears to be a vast multiplica- tion of the fusiform nucleated fibres going on during pregnancy, as well as an immense increase in the volume of those already existing. This tunic gradually becomes redder as well as thicker, and the muscular fasciculi more distinct, and visibly more numerous. The inner layer, composed of circular fibres, is most conspicuous in the cornua of carni- vorus animals, and there they contract in the interspaces between the young, so as to form well-marked constrictions. The connective tissue which unites the muscular fibres also increases during pregnancy, and becomes markedly fibrous. Sensibility. With the increase in volume, w-eight, and capacity, the uterus likewise acquires a higher decree of sensibility^ doubtless from the development of its nerves. So that between the cervix, the body, and the cornua, there is established a sympathetic relation that is sometimes not advan- tageous ; for irritation of the cervix, howsoever produced, may bring on violent contractions of the whole organ, and lead to the premature ex- pulsion of the foetus. This expulsion, as is well known, sometimes fol- lows copulation ; though, as a rule, animals usually do no seek to copulate during pregnancy if left to their own natural instincts. It may also be a consequence of manipulation by the hand of the explorer. This contractility of the uterus is sometimes evidenced before parturi- tion, when animals have been killed and quickly opened. Colin has wit- nessed well-marked movements in the ut^Tus of a Cat which contained five young — three in one horn and two in the other ; these contractions were most energetic at the constricted spaces between the foetuses. The same talented veterinary physiologist has seen similar phenomena in Sheep at different periods of gestation ; the cornua contracted and dilated alternately, approached or withdrew from each other or the body of the uterus ; the movements persisting sometimes for forty or fifty minutes after the animal's death. In a pregnant Cow opened when alive, the same contractions were noted ; they became more active and stronger under the influence of a slight irritation ; the cornua changed their form in contracting ; they shortened sensibly, and became twisted on them- selves at their anterior extremity. In a Mare identical contractions were seen. Haller had long ago remarked that, even in the unimpregnated animal, these uterine contractions were present — though they were most energetic in the pregnant Bitches, Cats, and Rabbits he opened, the movement being spontaneous and peristaltic, like that of the intestines, and that it con- tinued in the organ, even when it was removed from the body. Those veterinarians who have had occasion to insert their hand into the uterus of one of the larger animals, to adjust the foetus or for any other object, must have been astonished, and frequently embarrassed, at the firmness with which the arm was grasped at the cervix during the expulsive efforts the creature made. { GESTATION. 123 These uterine contractions are very powerful, and in all probability their rhythm is analogous to that of the intestines j extending from the extremity of the cornua towards the cervix in a peristalic manner, par- ticularly in those animals which, like the Bitch and Pig, have very long cornua, and the young arranged one after another in them. This increase in sensibility, which the uterus acquires during gestation, must be considered as the organic cause of its contractions ; the sensi- bility and contractility gradually diminishing after parturition, during which it reaches its apogee. Its contractility, which signifies also its retractility, enables it to .contract on itself after delivery, and to nearly obliterate its cavity. This rapid diminution in the capacity of the organ closes the orifice of the vessels which open on its internal surface during the act, and thus prevents fatal haemorrhage. Its main function, however, appears to be concerned in the expulsion of the foetus, and then, as at other times, it is entirely independent of the will. Besides, its intensity is not always related to the strength of the animal ; pain deadens and paralyzes the contractile force, as is seen in primiparous creatures. When the contractions have been vigorous, the uterus rapidly diminishes ; but if they have been slow and weak, the organ slowly contracts on itself. When -it does not contract quickly after delivery it is said to be inert, and the cause is to be found in the expend- iture of its contractile power, either through excessive distention, a delivery too prompt or too slow, or general w^eakness of the maternal system.. By long exercise, like voluntary muscles, those of the uterus become weakened ; so that when the act of parturition has been pro- tracted, the contractions of the organ become slow and feeble, or cease altogether. Opiates and narcotics generally produce the same effect, and are therefore successfully administered when the contractions are too energetic or painful during delivery, or before abortion. The con- tractions are stimulated by irritation of the cervix or body of the uterus : such as ,is produced by retention of the whole or a portion of the placenta, titillation of the cervix by the finger, frictions on the belly, the applica- tion of cold to this part, or the administration of ergot of rye. Form. The uterus, after conception, begins to change inform as well as in volume and structure ; this alteration, like the others, proceeding pari passu with the develepment of the fcetus. The body becomes round, and in the carnivora, as already described, the cornua elongate and show the alternate dilatations and constrictions due to the presence of the young in their cavities. In the Mare, Cow, and Sheep, if there is but one foetus, a single horn is enlarged — usually the right — to contain the posterior limbs, and the other is relatively smaller and contracted, and looks a mere appendage. When a carnivorous animal contains only one foetus, it is developed in the horn, and not in the body of the uterus, and it is not until parturition commences that it descends into the latter ; should the creature die before delivery, the offspring will be found there. In this species each horn generally contains one or more young ; should there be only two, one occupies each cavity ; but when there is only one foetus, it is then in one of the cornua. The changes taking place in the cervix of the uterus during pregnancy have not been accurately ascertained in the domesticated animals ; as in the smaller species there is usually no occasion or necessity to make an 124 OBSTETRICAL PHYSIOLOGY, examination ; and in tlie larger the risk of injury to the examiner, and of abortion in the animal, militates against such an investigation. It is only known as a fact, that it widens at the termination of gestation, and loses it cervical character, as well as its longitudinal mucous folds. It may also be noted that, from being firm and dense at ordinary times, its texture becomes gradually soft and elastic ; while it diminishes in length, its projection into the vaginal cavity is lessened, and indeed at a late Fig. 52. The Gravid Uterus of a Multiparous and Uniparous Animal. A, Multiparous Uterus; «, ai, Ovaries ; 3, bi. Fimbriae of Fallopian Tubes, c, c'i ; d, t^ days or nine weeks. Baumeister and Rueff state the shortest period to be 55 days, and the longest 70 — the average being 60 days. The Cat is pregnant from 50 to 60, 62, or even 64 days, the average being 55 clays or eight weeks. SECTION V. GEMELLIPAROUS, PLURIPAROUS OR MULTIPAROUS GESTATION. Among the domestic animals there are species which are naturally uni- parous — produce only one at a birth ; and others which, in a normal or physiological manner, bring forth two, three, or more at a time, and are therefore designated g3meUiparous or tnidtiparoiis, gestation being known as double, triple, quadruple, etc. As examples of uniparoiis animals, we may give the Mare, Ass, Cow, and Sheep ; while we may cite the Pig, Bitch, and Cat as imiltiparous creatures. As multiparity is normal with the latter, we shall not refer to them, but will allude to those creatures which, naturally uniparous, sometimes bring forth more than one descendant at a time. It is seldom that twins are produced by the larger domesticated animals, and particularly by the Mare and Ass, though instances are recorded of these ; while in the Cow, Sheep, and Goat the occurrence of twins, triplets, or even more young creatures at a birth, are not so rare. The causes of multiparity are not well ascertained. It may be due to simultaneous ripening of two or more Graafian vesicles, which, rupturing at the same time, allow the escape of the ovules they contain, and which may become impregnated at a single coitus. Or a Graafian vesicle may contain two or more ovules, as Bischoff has witnessed in woman ; and these arriving together in the uterus, may be fecundated at one time. Or it may even happen that the vitelline membrane contains two yolks, as sometimes occurs in the fowl's Qgg ; and as the vitelline mass is the essential part of the ^gg, it is evident that when this contains two of these masses, they ought, if fecundated, to produce two embryos. In the first case, as Saint-Cyr points out, each foetus has ordinarily all its annexes distinct and completely independent ; or it may be that the two chorions are fused together, in which circumstance the two fcetuses will then have a common envelope. In the second hypothesis, this fusion of the chorions appears to be the rule, although the envelopes may also be independent ; and in the third case — that of the two vitelluses con- tained in the same vitelline membrane — not only the envelopes, but also the foetuses may become united more or less closely, and thus give rise to double monsters, Finally,_it is also possible that two ovules may become detached from the ovarian cluster, though not simultaneously, but successively ; and be fecundated, one after another, at two consecutive copulations within a brief period. Occurrences of this kind, by no means rare, have beer wrongly adduced as instances of superfoetation. Mare. Of all the domestic animals, the Mare is the one which least frequently brings forth more than a single creature at a birth ; and Saint-Cyr has only been able to collect fourteen instances, though we have been more fortunate. Rueff admits that one case of gemellar gestation may occur in this animal in every 250 normal cases; but that the young are nearly 144 OBSTE TRIG A L PH YSIOL OG Y. always born dead, or die soon after birth. In the register of a stud, only one instance of twins was found in every 236!- births. Demoussy, cited by Saint-Cyr, observed an example of double gestation ; but the foals, though alive when born, perished soon after. Lemaitre gives a similar instance ; only that one of the foetuses was expelled at four months, while the other was retained, was foaled alive at the usual time, and survived. Trelut has seen a Mare which, at the tenth month of pregnancy, cast two well-formed foals. She had been put to the stallion five times — on April 23, May 4, 16, and 25, and June 5; she aborted on March 15. Her abdomen was enormously large, and some time before abortion she had received a kick in the flank. A fourth example of double gestation is related by Goux. The two foals — a colt and a filly — were alive when born, and continued to thrive. Saint-Cyr's father, an agricul- turist, witnessed an analogous occurrence, the progeny also surviving ; and Saint-Cyr himself saw a twin birth in a Mare, one of the foals, which was born dead, weighing 25 kilogrammes ; the other, which lived, weighing nearly 26 kilogrammes. In the Veterinarian are found a number of instances of twin foals in this country. Mr. Millington (vol. iv., p. 424) gives three cases of this kind, the foals being born alive. In vol. ix. (p. 450) an account is given of a Mare which died of hydrops uteri, in which were twin foals ; in vol. xii. (p. 288) is another account of two born dead, and in vol. xvii. (p. 177) a similar instance. A most unusual case of twin-birth is related in the North British Agricnlturist for May 17th, 1876 : — A Mare, the property of Mr. Chapman, farmer, Halnaby, gave birth to a colt and filly foal on the 2d March, 1875, both living. On the i6th March, 1876, she brought forth two filly foals, thus giving birth to four foals — one colt and three fillies — in less than thirteen months. The Field (May 10, 1873) reports a Mare in Devonshire, which produced twin foals three times within three years. The Mare went full time in each instance, but only one foal (they were all colts) lived for any length of time. According to the Liverpool Mer- cury (July 23, 1845) ^ Mare at Abringhall, fifteen years old, brought iorth/our colts in the space of fifteen months ! Raabe, in 1852, witnessed a triple birth in a five-year-old Mare ; the three foals were born alive, and were completely developed, but they soon died. Two instances of triple birth are given by Saint-Cyr, the most remarkable being that recorded by Paugoue. This occurred with a Mare which, put to the Ilorse only once, on February 17th, 1843, aborted during the night of September 27-28, two foals being found in one chorion; on the 25th of the following February, it produced a third foal, perfectly formed, and which lived. In the second case, related by Devilliers, the Mare had been put to the stallion several times in May, June, and July. On March loth it produced three properly-formed but dead foals, one having apparently ceased to live some days before. In the Veterinarian for 1875 (P- 334) allusion is made to an agricultural Mare in Nor- folk, eight years old, and not known to have been previously bred from, producing three foals at a birth. The first was dead, and appeared to have been so for several days. The second was born alive immediately after the birth of the first, but only lived about half an hour. The third was born dead seven hours after the second, but its condition showed that at the time parturition commenced it was alive. The foals were all of the same color — bay — and were perfectly formed. The Mare made a good recovery. In the same journal for 1867 (p. 595), Mr. Newman, of Havant, reports the birth of three fine, well-developed foals, two of which were born alive and lived. The Mare, of the cart-breed, had gone the full period of pregnancy. The most numerous instances of twin or triple gestation in the Mare are, however, to be attributed to two successive fecundations, of which Saint- Cyr has collected eight examples. In all of these, strange to say, the Mares had been put to a stallion of the equine and asinine species in suc- cession, and brought forth each a foal and a mule. In the majority of these instances, the two fecundations were within a brief period — the one succeeding the other immediately, or, at any rate, within the same day ; though in one instance there was an interval of fifteen days. Which was the elder of the two foals in these births — the one first born or the one first conceived ? Though in the human species such a question might have some importance, with animals it has only a physiological interest; GESTATION. 145 but the order in which they were born would, nevertheless, be the only- rational assignment. The female Ass more frequently brings forth twins than the Mare ; but even in this animal such an occurrence is rare. In an average of thirty she- Asses, kept for the production of milk by a man at La Chapelle Saint- Denis, only four had twins in a period of seventeen years. Cow. Double, and even triple, births are not so unusual in the Cow, the for- mer being far from uncommon. Indeed, it is so frequent in some breeds, and with individuals, that it has been suggested to produce by selection a breed of Cows which would habitually have twins. Mr. J. Macgillivray, of Banff, in an excellent little " Manual of Veterinary Science and Practice," published in 1857, writes : — " A neighbor of mine, Mr. Peter Low, had a Cow, a splendid animal, of the cross breed, which had twin calves yearly for six suc- cessive years. Two of her female progeny have had. twin calves repeatedly. Mr. Low kept one of her male twins, a bull ; to him two Cows have had twin calves, and there are a number of Cows in calf to him just now. From this and other similar cases, I think there is no doubt but, by oroper selection and management, a race of twin-bearing cattle might be established." ' And again he says : — " From a paper now lying before me, I shall record what I believe to be a unique case of a calf-producing Cow. I am indebted for the particulars to Mr. James Stephen, Balfluig Cottage, Alford. ' Memo- randum regarding a small Cow of the black Polled breed, which belonged to the late Mr. Alexander Stephen, Farmton, Alford :— Year. Number of Calves at a birth. 1842 I — first calf. 1843 3 — came to maturity. 1843 4 — °"^ ^\^di ; seven in one year. 1844 • • • • •• - — came to maturity. 1845 3 — c^rne to maturity. 1846 6 — died prematurely. 1847 2 — came to maturity. 1848 4-' " Rueff says that, with the Simmen thaler breed of cattle at Hohenheim, during an interval of ten years, there were four per cent, twin births. Triple gestation is of course much more uncommon, but the instances on record are numerous. Dupuy mentions a very unusual instance of fecundity in a Cow which, at three births in successive years — 1817, 1818, and 1819 — brought forth nine calves, only two of which were not reared by the mother ; these calves afterwards had only one offspring at each birth. Rainard speaks of one of his pupils delivering a Cow of three calves in the neighborhood of Lyons ; and Roche-Lubin gives two similar instances. In one of these the first two calves were born alive and reared by their mother, but the third, which was in a bad position, was removed dead six days later. In the second instance, the Cow, after producing a living and properly-developed calf, continued to strain and make fruit- less efforts to get rid of the other foetuses, until she died five days afterwards, when two calves attached to each other by the sternum were found in the uterus. Sperling records the case of a Dutch Cow which produced three calves; the first was a male, the second a heifer, and the third a heifer in a wrong position In England Mr. Snowdon has seen a Cow which brought forth a living calf some hours after a dead one, and in a few minutes an anidian monster. In the Ipswich yournal for October, 1875, mention is made of a Cow which produced six calves in twentv months, all living : first three fine calves, then one, and again two. The Liverpool Mercury (April 9, 1847) mentions a Cow which produced sixteen calves in eight years — two calves at six births, three at one birth, and one at another birth. The Mark Lane Express (May ii, 1852) alludes to a Cow which brought forth three calves at a birth — making eleven calves before she was seven years old. The Chester Chronicle (February 18, 1865) reports the birth of three full-sized calves by a Cow, all of which did well ; and the Shrewsbury Chronicle (July 5, 1844) gives a similar instance, 10 146 OBSTETRICAL PHYSIOLOGY. but the calves, born during the night, were found dead in the morning. In the Field for June 17, 1876, the birth of three calves — a Bull and two Cows — is reported. They were alive and doing well. Quadrigemellar gestation is also sometimes observed in the Cow. Rainard gives two instances ; and Hamon mentions a little Breton Cow which, in 1858, produced four calves — two male and two female, the last two dying soon after birth. Gelle gives a remarkable instance of a Cow which, in 1837, had three calves, in 1838 two, in 1839 two, in 1S40 two, and in 1841 four ! One of the last was a heifer ; all were well-developed and successfully reared, and the last four, at five weeks old, weighed about forty-five pounds each. The Vetermartan (vol. xiii., p. 579) gives an account of a delivery, with assistance, of four dead calves. This journal also (vol. xiv., p. 15) records a case in which, with assistance, a Cow was delivered of four calves — two dead at birth and two alive, though these soon expired. They were properly developed, and appeared to have been healthy up to parturition; they weighed, respectively, 25)^, 24, ij^, and 1734:' lbs. From rhe structure of the placenta, it was concluded that each foetus had been contained in a separate membrane and fluid. The birth was premature by two months and nine days. In the same journal (vol. xvii., p. 424) another quadruple birth is described ; the calves were well-developed and all born alive, though they soon after died. According to the Chester Chronicle (March 5, 1847), ^ Cow brought forth three calves, and in three days a fourth. All died soon after. The /vV/o' (December 7, 1872) de- scribes the birth of four calves by a Cow about four years old, and which had twins at a previous calving. One calf died, but the others did well. The Liverpool Mercury (March 28, 1845) reports a Cow as having produced four calves — full-sized, but dead. Eddow's Shrewsbury Journal (July 29, 1846) alludes to a Cow which gave birth to four bull-calves, three of which livecf. Mr. Cart Wright, of Whitchurch, gives an instance of four calves at a birth. The Cow and calves died soon after. The Revue Vcterinaire of Toulouse (February, 1876) gives a case of quadrigemellar parturition in a Durham Cow, aged twenty-two months, near Rochefort. Birth occurred naturally in an hour ; two cow-calves were first born, then two males ; three did not live beyond an hour, the other survived thirty-six hours. • Quintuple pregnancy is very rare in the Cow. In the Giornale di Veterinaria for June, 1855, Professor Lessona, of Turin, describes a quintuple birth in a Cow in Piedmont. The animal was twenty days from its full time. The abdomen was very voluminous, but beyond the premature delivery there was nothing unusual attending the birth. The progeny consisted of three females and two males, and each weighed about 37}^ pounds. They were healthy and fully de- veloped ; but the mother, either through her premature delivery or from age, was unable to suckle them, and they were put to another Cow whose milk proved unsuitable for them, as they had an attack of indigestion, and in about eight days after birth all were dead. Lessona thinks two were lodged in the same envelope in each horn, and that the fifth foetus with a single placenta, occupied the body of the uterus with its proper envelopes. A singular fact was their being all presented for delivery in a normal posi- tion — a very extraordinary circumstance. The Cow had produced twin calves the pre- ceding year. In the Veterinarian (vol. xxxii., p. 200), Mr. Forbes, of Reigate, mentions a Cow, six years old, which at her third calving produced — three weeks premature — five calves at a birth — four bulls and one cow. Three of the calves died in a few hours, the fourth in a day, and the fifth two days after they were born. Still more remarkable is the case recorded in this journal, by Mr. Garrard, as having occurred at Repton. A Cow, cross- bred and eleven years old, and which had never previously brought forth more than one calf at a birth, produced five living healthy calves, all of which, when he wrote some days afterwards, were alive and vigorous, and had every appearance of continuing so. They were all nearly of one size, and were larger and stronger than might have been supposed. Four were bull-calves, and during parturition the first four presented in a natural position, but the fifth was a breech presentation. The Chester Chronicle (February 11, 1854) reports a Cow, between ten and eleven years old, producing five calves — four males and one female — all of which lived The calves were nearly of the ordinary size, and were strong and lively. In Eddow's Shre^vs- btiry Journal (September 9, 1874), mention is made of a Cow which had been purchased as barren, but which in due course produced a dead calf, on the following day another, and so on until four were born. The Cow then died, and on being opened a fifth calf GESTATION. 147 was found. Mr. Litt, of Shrewsbury, in the same journal gives the particulars of the case of a Cow which died within a fortnight of calving, and on being opened no fewer than five fully-developed calves were found in the uterus. They were nearly uniform in size, and with the exception of one, which was rather emaciated, they were in a remarkably well-nourished condition. They consisted of four females and a male, and were very little smaller than ordinary calves at birth, being about the usual size of twins. Mr. Litt was of opinion that, had they been born at the proper time, they would have lived. The Cow had not thriven so well as its companions for some time, but up to the morn- ing of the day previous to decease, it appeared to be in perfect health. Death was probably due to the excessive drain upon the animal's system produced by so many voung. Schumann, in 1854, reports a quintuple birth — all males, and dead-born. Rueff re- cords another, in which all the calves lived — and one which occurred at Havingen, in a five-year-old Cow. Baron also refers to a similar instance. Mr. Garrard, of Ticknall, however, has a more favorable report of a birth of this kind. In 1854 a Cow gave birth to five living healthy calves, all of which were, when he wrote (a week after birth), alive and vigorous, and likely to continue so. They were nearly all of one size, and larger and stronger than could be supposed. Four were bull-calves. The Cow, by no means a large one, was eleven years old and of a mongrel breed, and had never produced more than one calf at previous gestations. She did not manifest any unusual symptoms of exhaustion ; the first four calves presented naturally ; the fifth was a breech presenta- tion. Kurds speaks of a Cow which aborted seven foetuses ; while Kleinschmeid {Magazin fiir Thierheilku7tdc. 1857) mentions having found fifteen embryos in the uterus of an animal of this species ! Sheep. With the Sheep, twins are a very common occurrence ; and it is a say- ing that in a good flock there should be as many lambs as Ewes, the double births compensating for the losses. Instances of extraordinary fecundity are also by no means rare, and would appear to pertain to particular breeds. Daubenton states that, in the counties of JuUiers and Cleves, every Sheep brings forth two or three lambs twice a year — five Sheep producing twenty-five lambs in twelve months. In French Flanders, according to Magne, who cites Corneille as his authority, there is a very prolific breed of Sheep, each ordinarily producing three, sometimes four, five, and six, rarely seven lambs, at two births during the year. Tessier, speaking of this breed, while admitting that twin lambs are not an ordi- nary occurrence with Sheep, assures us that in a flock composed of 371 Ewes, there were 22 double births ; and he mentions having seen a Sheep that was twenty years old, which had bred every year. A Ewe at Hohen- heim, in 1845, brought forth one lamb, the first ; in 1846, two ; in 1847, five ; in 1848, four; 1849, three; 1850, two — in all seventeen lambs at six births. Four of these were males, and thirteen females. In England such fecundity is not very uncommon. For instance, in the Chamber of Agriauture Joiirnaliox March, 1871, there is a notice of extraordinary prolificacy related by Mr. Angus, of Lowthorpe, Hull, who says : — " Last year one of my Ewes of the Lincoln breed brought forth six lambs, all living. I had great difficulty in persuading my neighbors to believe this, although the fact was quite clear and we'll attested. I gave her a private ear-mark, and last Michaelmas a separate red mark also. As we saw this spring that she was getting heavy, we kept her quite separate from the rest of the Ewes, and last Thursday she produced another six lambs. Some of these will not survive, as they were a few days before their proper time ; but all are complete and well formed, and the Ewe is now suckling one lamb." " The especial wonder about this woolly mother," adds the editor of the journal, " is that she belongs to a breed in which it is rare for a Ewe to drop more than three lambs, while good luck among the Lincoln flocks is ' one-half pairs,' with occasionally a three." The Carmarthen Jourttal (March, 1844) alludes to four Ewes in that county, which in one week yeaned fourteen lambs ; one had five lambs, and these all did well. The Chester Chronicle (May 25, 1867) mentions that a little Welsh Ewe at Birkenhead had 148 OBSTETRICAL PHYSIOLOGY. two lambs in the spring of 1864 ; in 1865 three, all alive ; i866 four, all living ; and in 1876 five, four of which lived, and were in good health, BelVs Weekly Messenger (June 29, 1844), states that a farmer in Kent had a Ewe which dropped the extraordinary num- l)er of six lambs, four of which it reared, and the other two were brought up by hand. The previous season the same Ewe produced four lambs, all of which were reared and turned out well. According to the Chester Chro7iicle (April ii, 1868), a farmer at Otley, Yorkshire, had a Ewe, five years old, which had produced fifteen lambs. When one year old it had two, at two years four, at three years two, at four years four, and at five years three. The Salopian (April 6, 1872) speaks of a Ewe at Wem, Salop, which gave birth at one time to five lambs the i^revious year, and these were all reared, and in this year six were born, five of which lived. The Chester Chronicle (April 19, 1873) alludes to a Ewe which produced an annual average of three lambs for seven years ; the animal itself was one of three. The Shrewsbury Chronicle (June 26, 1874) reports that a Shrop- shire Ewe lambed twice in six months, producing twins each time; and the Field (May 12, 1873) gives an instance of a Ewe having five lambs, one of which died in a few days, l)ut the others did well. The Oswestry Advertiser (October 2, 1872) instances a Ewe which gave nine lambs in two seasons — three and six — all fine lambs and in perfect health. And in the Cambrian newspaper for the same month, it is mentioned that " Mr. J. M. Harding, of the Town-Hill Farm, Swansea, has just had an extraordinary piece of good luck in lambing. From a small flock of seventeen Ewes, he has had no less than thirty-seven lambs, all alive and doing well. Every Ewe has brought ' doubles,^ and three have brought ' triplets.' It is not only the number of lambs, but they are all strong and healthy. . . . There is no reason to doubt that the remainder of the flock will be equally prolific." In the A^ottingham yournal for 1846, it is stated that a Ewe in that locality brought forth five lambs at a birth, all alive and likely to continue so. Mr. Litt, already quoted, mentions the case of five Ewes which had been attacked with symptoms of brain disorder shortly before lambing, and soon died. Each, when opened, was found to have four lambs, making twenty in all. The Lytm Advertiser for February, 1872, states that a Ewe in that locality lambed on the nth of that month, the lamb living twenty-four hours : again on June 28th, and on January 21st, 1872, bringing forth twin lambs on the last occasion. The Ewe thus lambed three times in a year and ten days. In 1875 ^^- Robert P. Greenhill, of Elmbridge, near Droitwich, was in possession of a Ewe, seven years old, which had produced no fewer than 20 lambs — a small flock. In the first year she gave birth to 2 ; in the second, i ; third, 3; fourth, 3 ; fifth, 4 sixth, 4 ; and seventh, 3. And at Shaftesbury, it is recorded in May, 1876, that a farmer had some Ewes fatting, and a neighbor's ram got with them; consequently, 13 of them proved to be in lamb, and produced no less than 31 lambs, all born alive (a few dead since), as follows : — I single .... .... .... .... .... I -8 twins .... .... .... 16 3 threes .... .... 9 I five 5 13 ewes. 31 lambs. Other and similar instances might be quoted. It may be remarked, that extraordinary fecundity in Sheep is seldom observed in the highest-bred races, which are usually uniparous ; it ap- pears to pertain more to the common breeds. Not only this, but certain years are more remarkable than others for double, treble, and quadruple births in" this species. Goat. The Goat is generally considered a uniparous animal, but it would ap- pear that this is a mistake, as double and triple births may be said to be the rule ; not at all unfrequently four are produced. But usually with the three or four at a birth, one or more are feeble or born dead. It is looked upon as exceptional for only one kid to be produced at a birth. J GESTATION. 149 The question has been much discussed as to whether these multiple births in animals ordinarily uniparous, are the result of one or successive copulations. The majority of the authorities in such matters are certainly of opinion that a single copulation will suffice to fecundate several ovules, and they doubt if, after a fruitful copulation, it is possible for the sperma- tozoa to reach the ovary, supposing a second ovule to be developed, unless the second impregnation takes place very soon after the first, and before the fertilized ovule had descended into the uterus. The well-authenti- cated instances of superfoetation, though rare, nevertheless rather militate against this opinion ; and it would appear to be impossible to explain why one animal among several hundreds, perhaps thousands, should alone bring forth " doubles " or " triplets," while all the others, placed in the same hygienic conditions, have only one offspring. It is a fact, however, that wdth certain breeds of Sheep an abundance of nourishment and plen- tiful years dispose to these multiple births. What has been said of uniparous animals does not at all apply to those which are multiparous ; for although the latter may be impregnated at a single copulation, and bring forth several young, yet, as a rule, they are fecundated more than once, and in fact do not cease to seek the male until after several copulations. In these cases of multiple gestation in creatures naturally uniparous, one of .the fcetuses occupies the ordinary situation of single gestation : the head towards the cervix uteri, the larger portion of the trunk in the body of the uterus, and the hind quarters and limbs in one of the cornua. The second foetus occupies the whole of the other cornu ; with the head turned back, or, as occurs not infrequently, in the opposite direction, and so on. The duration of gestation in these cases is generally shorter than that of single pregnancy in the same animal, probably in consequence of the unusual distention, as well as derangement of the principal functions in the mother. The weight of the young, individually, is usually less than the average ; but, collectively, it may be very much greater than that of one young creature produced at a birth. Thus in the quadruple birth re- corded by Magdinier, each foetus weighed ten to eleven kilogrammes ; in that by Bouchard they only weighed from eight to nine kilogrammes ; in the quintuple birth described by Cassina, each calf weighed seventeen kilogrammes, or eighty-five for the entire birth — an enormous weight. Lignana, another Italian veterinary surgeon, mentions that in a double birth in a Cow, one of the calves which was born dead, though at full time, weighed twenty kilogrammes ; and the other calf, which was alive, weighed forty-three. In the double birth observed at Saulsaie, in which both calves were born alive, one was twenty-eight kilogrammes and the other thirty -one. Free-martins. A curious fact in connection with this subject in the bovine species, is that when the young are of both sexes, the female is in general unproduc- tive. This fact is well known in many countries, where the female calf receives a particular designation : as " Free-martin " in Britain ; in Hol- land, " Queenen ; " in Germany, "Zwitter," or "Zwillingj" in Swabia, " Zwicker ; " in Piedmont, " Mugn^ ;" in France, " Loures," " Taures," etc. The old Roman agriculturists knew these animals as "Taurae." It is very rare, indeed, that the male is infecund. Baumeister, however. ISO OBSTETRICAL PHYSIOLOGY. gives an instance in which a Bull — a twin — was put to a hundred cows, none of which produced a calf. In Switzerland it is the belief, that when the cow-calf is born first, it will not be sterile ; and that when, on the contrary, the male is born before the female, it will be unproductive. The female twin is generally a hermaphrodite, and in form more of a male than a female ; the vulva is excessively contracted, and the vagina a ciil- de-sac. The mammae are also feebly developed, sometimes appearing as a mere trifling fold of skin, at others as a voluminous sack. The animal is usually long-legged, with muscular hind-quarters. Internally, in some instances the uterus is undeveloped ; in others, the ovaries are absent, and instead of them there are testicles. With others, again, there is no trace of a uterus, the vagina ending in an infundibulum : a condition which is readily ascertained in the living animal by introducing the finger. The clitoris is sometimes enormously developed, and not unusually the urine is expelled powerfully backwards. Ordinarily the " free-martin " does not evince any sexual desire.* The rule does not always hold good, however, as to the infecundity of this twin calf, as instances are on record in which it has bred. For in- stance, in the Veterinaria?t (vol. ix., p. 22) there is an authenticated case in which the female of a twin birth, when five months old, became preg- nant, and in due course produced a calf. The next birth was twin calves. Diagnosis of Multiple Pregnancy. The diagnosis of multiple pregnancy in animals ordinarily uniparous, is not very certain. It is usual to say that the signs are only those indica- tive of a single foetus, but exaggerated. The belly is more voluminous than when there is but one, especially in the early months ; the respira- tion is more than usually embarrassed ; the animal lies frequently, and soon moves lazily and heavily, while the posterior limbs become oedema- tous. These signs, it will be remarked, are obscure, as a large foal or calf may occasion the disproportionate size of the abdomen and altera- tion in breathing ; so that at best they only afford a vague presumption as to the condition of the mother. It is also said that the belly is larger on the side on which it is usually least enlarged — the left ; in others, both sides are enlarged at the same time, and there the movements of the young are most evident. But this sign, in addition to being far from constant, depends upon the relative position of the progeny ; as when there are two one may occupy the body, the other the cornu, of the uterus. Neither does an examination per rectum or vaginum afford any certain indication of a multiple gestation ; as the number of young, supposing there are more than one, cannot be sufficiently distinguished. * One of the latest recorded examinations of these creatures is given in the CEsterreichische Viertel- jahresschrift for 1875 (p. 78), and was brought to the notice of the Gresnter Land and Forest Society of Austria, the veterinary surgeon to which furnished the anatomical details. The Society purchased the calf three and a half years previously, and it had never exhibited any signs of sexual instinct during that period. It was therefore killed. It was in good condition, and of the Miirzthaler breed. The head and physiognomy had a most sins^ular appearance, resembling that of a monkey, though the horns were strongly developed. The udder was little and hard, and the vulva small and contracted, although normal ; en opening the labia, no trace of a clitoris could be found. The vagina was nine to ten centimetres in length, and instead of extending forward to the cul-de-sac, which is often very dilated in Cows, it termi- nated abruptly in a funnel-shaped aperture, and here the genital organs ended ; for the cervix uteri was absent, as was the uterus and Fallopian tubes, and it vras only in the vicinity of the external angle of the ilium that were found small ovaries closely and curiously enveloped in fat, so that they could scarcely be recognized. The glands of Bartholin in the vagina were almost as large as an egg, and were full of blood ; instead of the valve in the vieina there was a small impermeable opening. On incising the mammae the gland substance was found to be absent, and in its stead was fibrous and adipose tissue. In fine, this twin was destitute of uterus and oviducts, and the vagina was short and constricted. GESTATION. i^i Auscultation, if it could be successfully applied to the larger animals — which are usually uniparous — would doubtless greatly aid in diagnosing whether a gestation was single or multiple. The distinct pulsation of the foetal hearts, especially if at a distance from each other, and if the num- ber of pulsations were different in the respective situations, should be conclusive proof of multiple pregnancy. It would, of course, be important to note the different situations of the pulsations, as the action of the foetal hearts might be at times synchronous. Care would also have to be observed not to confound the beating of the maternal heart with that of a fojtus. Position of the Foetus in Multiple Pregna7icy. The relative position of the young in the uterus in the cases already briefly alluded to, is important to remember. With regard to each other, it may be said that they usually occupy four different positions : i. Each foetus may be isolated and enveloped in its own proper membranes ; 2. If there are two foetuses they have a common envelope in the chorion, and otherwise have a second separate sac ; 3. Both may be developed in the same cavity and the same amniotic fluid, their membranes being com- mon, and no partition existing between them ; 4. One foetus may be con- tained within the other by" inclusion," as in some of the monstrosities of which we will speak hereafter. It may be necessary, however, to state that the included foetus may be contained in the abdominal cavity of the other individual, constituting deep and abdominal inclusion ; or it may be enveloped in a subcutaneous tumor — when it is superficial and cutaneous. In the first variety of gestation, the envelopes, where they are in con- tact, adhere together by means of a fine connective tissue ; the placentae are often confounded (in ruminants), or united by a kind of membranous connection, though their circulation remains distinct. In such a case the young may be expelled from the uterus together — a frequent occurrence in the Goat, according to Rainard ; but more commonly, after the birth of the first foetus, the uterus contracts on itself, enclosing the remaining progeny, which may not be born until some days after — long enough sometimes to give rise to the belief that it is a case of superfoetation. This apparently prolonged retention of the second foetus is generally due to the fact, that the first is expelled prematurely, because of the excessive distention experienced by the uterus ; this organ, having thus got rid of its embarrassment, and become relieved, can then maintain the second foetus until the usual time expires. An illustrative case is given in the Memoires de la Societe du Calvados for 1831-32. A Mare gave birth to a dead foal after four months' gestation, and at the ordinary time a living foal. If one of the foals dies in the uterus, the other being contained in a separate envelope, may continue to live and grow. In somewhat rare cases, the dead foetus remains in the uterus, becomes desiccated, and is not expelled until the birth of its companion at the usual period ; or, which is more common, it acts in the uterus as a foreign substance whose presence is irritating, and by inducing contractions of that organ it is extruded, while the living foetus is retained and grows until the normal time for delivery. The foetus that has died during gestation may be kept in the uterus for a long time, through close adhesions existing between that organ and the placenta. A case is on record in which a foetus was retained in this man- 152 OBSTE TRIG A L PHYSIOL OG Y ner for two years. Rainard gives an instance of a. Mare which retained a dead foetus for a year ; the animal was then fecundated again, but hav- ing perished while pregnant with the second foal, an examination of the Uterus was madS, and the two young creatures were found — the first being mummified. Death of the foetus in these multiple cases appears to be due either (i) to the stronger vitality of the one which lives, and which, by attracting to itself a larger share of nutriment, starves the other ; (2) to the too con- siderable increase in volume of one foetus, which compresses and atrophies the other ; (3) or to the separation of the foetal from the maternal placentae, which, of course, causes an interruption to the circulation of the young animal, and a suspension of nourishment and the decarbonization of its blood. In the second variety of gestation, in which the chorion is common to the two foetuses, but which are yet separated by the amnion, there is only one placenta ; the two having a circulation in common, through their Fig. 53. Twin Pregnancy ; Cow. placentae and the umbilical vessels communicating by their vascular rami- fications. In this case the expulsion of one foetus necessarily brings about that of the other. This also occurs when both are contained in the same envelopes. I believe only two instances are on record of inclusion : that of the first mentioned variety, in which one foetus was found in the abdominal cavity of the other, Bartholin, the celebrated anatomist, at the com- mencement of the seventeenth century described the case of a Mare which brought forth a mule, in the abdomen of which was found another ; and Gurlt {Magazin fur Thierheilkunde, 1869, p. 347) mentions an instance in which one foetus was developed within the abdominal cavity of a calf, and consisted of an incomplete left hind leg» a membraneous J HYGIENE OF PREGNANT ANIMALS. 153 organ representing the uterus, and the skin and some vessels. It may be remarked, however, that Rainard witnessed an instance of this abdominal inclusion in a goose. The egg was double the ordinary size, and it had another inside of about the ordinary dimensions ; each- had a perfectly formed shell. The subcutaneous tumors of young animals, containing either a whole foetus or Dortions of a pre-existing one, are common in animals. CHAPTER VI. Hygiene of Pregnant Animals. The hygienic measures to be observed in the management of animals during gestation are, in general, those which should prevail always, irre- spective of this condition. But besides these general principles, there are a few particular precautions to be attended to, in order that this period may be safely and successfully passed through, and these precautions are all the more necessary as the period of birth approaches. Unlike the human female, pregnant animals do not require those careful, numerous, and minute attentions so essential to her health and the welfare of her offspring ; indeed, too much nursing and pampering, by removing animals further from their natural condition, is unnecessary, and likely to do more harm than good. When an animal is believed to have been fecundated, it should not be allowed near the male again ; as in the artificial state in which domesti- cated creatures are usually kept, attempts at coitus may do harm ; though it must be confessed that among Cows the bull often remains in the same pasture with them, and they calve as regularly and as safely as if they were not so exposed. With those animals which are employed in labor — as the Mare, and sometimes the Cow — it is well not to work them severely nor fatigue them much, and particularly as pregnancy is advanced ; and, on the other hand, absolute repose is pernicious. Exercise is most beneficial, and the most difficult cases of parturition occur among animals to which this is denied. The pregnant Mare will accomplish ordinary and accustomed work, par- ticularly if it be slow, without any harm, perhaps with benefit, until the seventh, eighth, or ninth month, when more care must be observed ; but moderate exercise should always be allowed up to the period of parturi- tion. Harness is preferable to saddle work for pregnant Mares ; and fast trotting, galloping, jumping, travelling over broken ground, or severe and sudden exertion, injuries, or shocks of any kind, are to be avoided — in fact, extremes should be guarded against. If the animal must be employed for riding, the use of spurs should be interdicted, because of the sudden contraction of the abdominal muscles which their application induces, and which may lead to abortion. Should the animal not be usefully employed in this way, then it ought to be regularly exercised in hand, or placed in a paddock provided with shelter from inclement weather. The Cow, if employed in labor, may be worked moderately until the sixth or seventh month. If kept for milk production, the milking should also cease about this period ; though with well-fed Cows it is often pro- longed until near parturition. Nevertheless, there can be no doubt that 154 OBSTETRICAL PHYSIOLOGY. this practice is prejudicial to the foetus, by arresting or retarding its de- velopment, through diverting into the mammary glands the materials which should be disposed of in the uterus. Exercise at pasture is beneficial to all animals, even the Pig and Bitch are greatly benefited by movement. T\iQ.food oi pregnant animals is an important consideration. Creatures in this condition should be well fed, and especially if they have to accom- plish a certain amount of labor or yield milk. The appetite is generally increased, and there is, as has been already observed, a tendency to fatten. This tendency should be somewhat guarded against, as it may prove troublesome ; particularly if it is allowed to proceed to an extreme degree, when it may retard the development of the foetus, induce abortion, cause difficult parturition, or give rise to serious after-consequences. This pre- caution is more to be observed in the second than the first half of preg- nancy, when the food should be plentiful, but not in excess, and flesh more abundant in the animal than fat. The food should also be of good quality, very nutritive, easy of diges- tion, and not likely to induce constipation. Indigestion should be carefully guarded against, and unaccustomed, hard, damp, bulky, fermentable, mouldy, or otherwise hurtfully altered food, should be avoided, as it is likely to prove indigestible, occasion tym- panitis, and produce other injurious results. Grazing on pastures is favorable to the pregnant condition of herbivor- ous animals, and especially if the land is not too broken, or sloping, and the herbage is good ; as they take their own exercise, and breathe a purer atmosphere than that of stables or sheds. But it must be remembered that they should, if possible, be protected from damp, fogs, cold rain, stormy weather, etc. If the herbage is not sufficiently abundant and nutritive, it should be supplemented by an additional allowance of food. In connection with food, it may be well to observe that, besides the ordinary saline matters which it is beneficial to add to the ration, espe- cially when it is prepared for the animals, in those regions where inflam- mation of the joints of young creatures, and other morbid conditions, due to the deficiency of certain mineral constituents in the economy, are noted, it may be necessary to add these constituents to the food of the pregnant animal. * The phosphates so necessary for the formation of certain tissues of the body, for instance, may be deficient in the herbage ; and this may be com- pensated for by giving, in addition to bran, meal, oil-cake, etc., and even properly-prepared bone-dust. The water should be pure, and plentiful at all times ; as then the ani- mals will drink only moderate quantities, and when necessary. A point to be particularly attended to, is not allowing pregnant animals to drink very cold water, nor eat food at a low temperature. We have seen that the foetus is extremely susceptible to the action of cold, and abortion is by no means unusual through the operation of this suscepti- bility. Very cold water, frozen food — such as roots, or herbage covered with white or hoar frost — should therefore be withheld from pregnant animals, as they are likely to induce abortion, metritis, and other serious accidents, either through their direct action upon the foetus, or indirectly through the derangement they may set up in the digestive apparatus. With regard to dwellings^ the hygienic rules which should always be HYGIENE OF PREGNANT ANIMALS. 155 L observed in buildings in which animals are kept, ought to be rigorously enforced with regard to those in which pregnant creatures are lodged. Cleanliness is, above all things, necessary to be observed. Near foaling time — three weeks or a month — the Mares should be kept apart in a roomy loose-box, and when convenient, within sight of the other horses with which it has been accustomed to associate. The Cow is usually al- lowed to remain in its ordinary stall in the cow-shed ; but overcrowding and want of space should not be allowed, and every Cow, towards the end of gestation, ought to have plenty of room in its stall, if a separate stall cannot be allotted. Stables, sheds, and loose-boxes should have wide doors, to prevent injury to the females. With stalls, the floor should slope very little indeed, from before to behind ; as if the inclina- tion is at all marked, the weight of the gravid uterus is thrown back- wards, and this may lead to abortion, prolapsus of the vagina, and even eversion of the uterus. The cow-shed ought to be kept very clean and free from bad smells, and have plenty of fresh air. The stalls should have plenty of litter, so as to prevent the Cows soiling themselves. Should a case of abortion occur in a stable or shed, among pregnant Cows, the one which has aborted ought to be removed at once, and the place it occupied thoroughly cleansed and disinfected, every trace of the accident being most scrupulously obliterated. Cows which afford indications of approaching abortion, ought also to be removed from the vicinity of other pregnant animals, and kept apart from them so long ai there is any vaginal discharge ; the same precau- tions which must be adopted with regard to thorough disinfection and cleansing, are likewise necessary here. It is not advisable to have Cows bring forth among others, whose period of gestation has not arrived. The cleanliness of the animals themselves is not to be overlooked ; as neglect of grooming and freeing the skin from dirt, must operate per- niciously not only on the mother, but on the foetus. ^ Mental and physical tranquillity are essential conditions of successful gestation. Harsh or cruel treatment on the part of grooms, cow-keepers, shepherds, and others, should be sternly suppressed ; and fear, generally produced by young dogs hunting the animals, and particularly pregnant Sheep, is especially to be averted, if possible. It is not wise having animals of other species in the same field or pasture with those which are pregnant, more especially towards the period of parturition. With an irritable or timid primipara of the larger animals, it is well to be gentle, and to accustom it to manipulation, particularly about the ud- der, in order that it may the more readily allow its progeny to approach it without danger. Surgical operations, and medication in general, should be proscribed as hurtful during this state, unless they are urgently needed for the cure of disease. Above all, it is necessary to guard against the use of drastic purgatives, or even laxatives, for the relief of constipation which may not exist ; as with some animals these agents, by increasing the peris- taltic action of the bowels, indirectly excite contraction of the uterus. If there is constipation, suitable diet is a safer remedy than purgatives. Powerful narcotic, sedative, and other medicinal agents, if they do not injure the mother, may imperil the life of the fcetus. We have no sufficiently trustworthy facts to prove that female animals are amenable to those mental influences which, in the human species, and known as " maternal impressions," have such a marked effect on the development or characteristics of the foetus. 156 PA THOLOG Y OF GESTA TION. BOOK III. PATHOLOGY OF GESTATION. Tu'E. pathology of gestation may be said to include those diseases and ac- cidents which constitute deviations from the regular or normal series of physiological phenomena characteristic of this condition. These devia- tions are somewhat numerous and various, and we will follow Saint-Cyr in classing them under three distinct heads : anomalies, diseases, and acci- dents. We will study these in this order. CHAPTER I. Anomalies in Gestation. ^The anomalies occurring in gestation are superfcetation, extra-uterine pregnancy, and spurious pregnancy. SECTION I. — SUPERFCETATION. The term superfoetation {fo'Jus super fcetutn — one foetus on another) has been employed to designate those cases of conception in which an ani- mal, already pregnant, has been supposed to conceive a second time be- fore the termination of the primary gestation. In ordinary double or triple gestation, the same copulation has produced the young at once ; but in superfoetation they are supposed to be formed at a more or less wide interval of time, and of course by different copulations. The belief in the possibility of such an occurrence in woman was com- mon among the old writers, and cases are adduced in support of this view ; but its correctness has been much disputed by some recent au- thorities. Aristotle admitted the likelihood of superfoetation taking place in woman, because during pregnancy she was always with her husband ; but he denied its possibility in the Mare, although he was aware that it might receive the male several times. In all probability, he imagined that the instinct of the Mare would repel the stallion after impregnation. The naturalists and hippiatrists who succeeded him, have also denied that such an abnormal occurrence could take place in the Mare ; be- cause, they declared, after conception the orifice of the uterus is closed, so that the semen of the male cannot be introduced ; every double birth, they also maintained, was due to two ova being impregnated at the one copulation. But numerous facts recorded by competent authorities, would go to prove that superfoetation is not only probable, but possible ; and that if, generally, there is only one successful copulation possible, on the other hand there are instances well vouched for, in which two successive copu- lations have been followed by two independent impregnations. In unip- arous animals such cases have been frequently observed, the most con- vincing of which is the production of a mule-foal and a horse-foal by the same Mare at one birth. An occurrence of this kind is mentioned in the Memoires de VAcademie Royale des Sciences for 1753 ; a Mare at Chatillon-sur-Sevre brought forth a horse and a mule foal. A NOMA LIES IN GES TA TION. i ^ 7 Demoussy speaks of a M. Mail lard, a wealthy farmer and breeder of horses, who had occasion to observe a similar occurrence. In the Journal Veterinarie Pratique for 1826, there is an account of a Mare which, covered on the same day by a male-ass and stallion, brought forth in eleven months a well-formed, though weak mule foal, and a full-developed, but dead horse foal. In the same journal for 1836, there is another case of this kind recorded. A Mare had been put to an Ass stallion at St. Maixent, and was shut up in an enclosed space; into this, however, a Horse stallion, two years old, broke, and covered this animal several times in the course of the same day. The Mare obstinately refused to be covered when afterwards put to the Horse, according to custom. At the usual period of parturition it produced two foals, one evidently belonging to the equine species, and the other a well-characterized mule. These two young creatures, when three months old, were presented to M. de Vaublanc ; they were then being suckled by the Mare, and were in perfect health. The fact was verified by the Mayor of the Commune, and communicated to the administration of the Stallion depot of St. Maixent. In Moll and Gayot's " Connaissance General du Cheval," Ayrault states that in Poitou, France, a Mare was put to a stallion Ass on March 7, 1855, ^'""^^ ^'"^ ^he 28th, being still "in season," was put to a Horse. The following year, during the night of April 14-15, this Mare produced a colt foal at eight o'clock, and a filly mule at eleven o'clock ; so that the oldest foetus was born three hours after the youngest. In the Journal des Vetirinaires dii Midi for 1859, Dr. Chabaud relates that in the Commune of VernioUe (Ariege), a Mare was put to a stallion Ass. As oestrum con- tinued, it was put to a stallion fifteen days afterwards. Nothing unusual occurred during gestation, and when parturition took place, a fine healthy foal was born, and after ten minutes' straining, to the astonishment of the owner, a good well-formed mule. The Mare suckled the two, and they did well. In the Journal des Veterinaires du Midi for 1864, M. Gilis gives a similar account of a Mare that had been covered by a stallion, then some minutes afterwards by an Ass, and in twelve months had two foals, perfect in their conformation — one, a mule, died, soon after birth, and the other, a horse foal, did well. Lanzillotti-Buonsanti mentions a Mare which, on March 28, 1851, was put to an English stallion, and on April 5, to a Barb; on February 28, 1852,11 produced two foals, each resembling one of the stallions. Lessona speaks of a Mare which was put to a Horse in 1852, and sixteen days afterwards to a Persian stallion ; at eight months' pregnancy it dropped a horse foal, and in two hours after a mule foal* In the Veteritiarian (vol. xxx., p. 78), Mr. Evans refers to a Mare which was put three times to the Horse, about six weeks intervening between each time. Two months prior to the ordinary period of parturition from the last coitus, two foals were produced, one alive and full grown, the other so immature that it died immediately. The same journal (vol. xxxix., p. 444) contains another instance, in which a Mare was put to a Cart-Horse on May 20, but showing symptoms of oestrum subsequently, was again put to him on June 19. At the commencement of the following April, two foetuses were born, each being in a different stage of development, and one of them apparently a month older than the other. The same Mare had aborted the previous year. In the Journal Veterinaire Pratique for 1828, there is an instance given of what was supposed to be superfoetation. A fine-woolled ewe, impregnated at the usual season in 1823, evinced in the following year, at the period of parturition, the ordinary signs of giving birth ; but these subsided without any produce being born, and the animal quite recovered. The foetus was in the abdomen, -and could be easily felt. In 1824, this ewe was again impregnated; in the early days of March, 1825, the mammae contained milk, and soon after the symptoms of parturition became manifest; but, as before, they dis- appeared without any result. The animal then lost condition, became gradually weaker, and was not long in succumbing. On opening it, a perfectly developed lamb was found in the right horn of the uterus, and in the left another well-formed foetus of the male sex was discovered. The latter, with its envelopes, as well as the uterine cavity, were normal, except that a portion of the fluid had escaped and the foetus was dead; -the cervix uteri, however, was constricted by the presence of a newly- formed mass of * All these instances are paralleled in the human female, by various authorities. Buffon, quoted by Foder^ and Churchill, mentions a woman at- Charleston, South Carolina, who, in 1714, was delivered of twins within a very short time of each other, the one being black, the other white. On examination, the woman confessed that on a certain day, immediately after her husband had left her, a negro entered her room, and by threatening to murder her in case of refusal, obtained connection with her. Dr. Moseley alludes to the case of a negro woman who brought forth two children at a birth, both of a size, one of which was a negro and the other a mulatto. On being interrogated upon the cause of their dissimilitude, she said she perfectly well knew the cause of it ; which was that a white man belonging to the estate came to her hut one morning before she was up, and she suffered his embraces almost instantly after her black husband had quitted her. Similar illustrations are quoted by De Bouillon. Trotti. Guerarde, Delmas, Dunglison, and others- 158 PATHOLOGY OF GESTATION. matter, which was so hard that it could scarcely be cut through — a circumstance that appeared to explain the impossibility of delivery. Hering [Repert. fiir Thierheilkunde, Jahrgang ix., p. i), alludes to instances of super- foetation in the Cow and. Sheep. In the Memotres of the Veterinary Society of Calvados, vol. ii., M. Lemaitre describes the case of a Mare which aborted on December 2, and on the following June brought forth a foal which continued to live. Trelut, in the Jourttal des Velerviaircs diK Midi for 1844, mentions a Mare, eleven years old, which was put to the Horse on April 23, on the 4th, 6th, and 25th of May, and again on June 5, 1845. ^^ December this Mare received some kicks on the belly and flank from a Horse, but this did not impair her health. On March i it slipped up, and on thei 5th it aborted two foals without suffering any ill effects. The first foal had the tongue protruding from the mouth, the mucous mem- branes were very pale, the hair of body and mane and tail were present, the eyes were closed, the skin was colorless and looking as if macerated, and the hair was easily removed ; the blood-vessels only contained a few drops of pale blood ; and the muscles, pale and flaccid, did not show any signs of decomposition. The second foal had the skin smooth and shining, but no trace of hair ; the eyes were open ; the mucous mem- branes bright red ; the muscles firm and red ; and the heart and vessels filled with red blood. Cauzit, in the yoiirnal de Med. Veterinaires de Lyoti for 1859, gives an instance of super- foetation in a Mare, fecundation having occurred at an interval of eight days ; and Cha- baud, in the Journal des Vet du Midi for 1859, mentions another case, in which fecunda- tion must have occurred at fifteen days' interval. One of the most recent cases is reported from the United States of America. On the 20th of February, 1876, a five-year-old Mare belonging William Driesbach, of Sparta, N. Y., foaled a dead colt, fully developed and otherwise promising in those points which go to make up a good Horse. The Mare appeared to be well, and to the surprise of her owner, on the 2d of April following, six weeks after the birth of her foal, gave birth to another colt, which was sound, healthy, well developed, and in all respects as promising a colt as could be found in the state. From the facts already accumulated it may, then, be concluded that superfcetation in the Mare may occur, and indeed has occurred, several times. It has been argued against these facts that superfcetation is im- possible, because a Mare that has once conceived would be exceedingly liable to abortion if submitted to a second copulation ; but it is more than doubtful that abortion should be the inevitable consequence of re- peated copulation ; and we have the human species to adduce in proof of the comparative innocuousness of sexual intercourse during pregnancy. So far as researches have gone, however, it must be confessed that these double conceptions have only occurred in uniparous animals by successive copulations on the same day, or within a few days ; and we are therefore without any indication that this could occur in them at longer intervals. This, it will be evident, is no very strong, proof of superfcetation having taken place ; for in the case of the mule and horse foal, it only proves that a double conception may occur from intercourse with two different animals within a very short period. If a longer period — say three or four- months — intervened, then superfcetation would be admissible, and would perhaps be undeniable, provided there was nothing abnormal in the uterus — such as a double organ. Rainard remarks that torsion of the neck of the uterus in the Cow, though preventing the birth of the foetus, may nevertheless permit new conceptions. With inversion of the uterus and torsion of the cervix, parturition is impossible ; so that instead of attempting to deliver by a sanguinary and dangerous operation, the success of which is very doubt- ful, the animal, if not killed for consumption as food, is generally left to ANOMALIES IN GESTA TION i^g the efforts of nature ; should the season be favorable it is allowed to re- main at pasture, and frequently after some suffering the creature regains its condition, even becomes fat, and may then be advantageously sold to the butcher. Towards the spring-time, such an animal might conceive again without having been delivered of the first foetus. In multiparous animals there can scarcely be a doubt that superfoeta- tion may take place, and perhaps of all those which have been domes- ticated the Rabbit furnishes the most striking example. With this creature a new fecundation may occur in the middle of pregnancy. This, of course, can be accounted for by the anatomical disposition of the generative organs, the two cornua of the uterus opening into the vagina independently ; so that a primary fecundation may occur only from one ovary in the corresponding horn, the other remaining open and unoccu- pied. In the Bitch, many observers have assured themselves that superfoeta- tion is by no means unfrequent. Rainard, Blaine, and others speak of it. Blaine says, " I am disposed to think that Bitches are capable of super- foetation ; that is, they conceive more than once. If this is the case, a Bitch may copulate to-day, and become impregnated, that in a day or two she may copulate again, and again become impregnated. This is not frequent, I believe ; but it certainly does happen, or we could not account for the different periods at which the progeny sometimes appear. I have known a week, and in one case even ten days, intervene between the puppings ; but one or two days is not at all uncommon. As a still more convincing proof, the whelps often appear of different kinds." It must be remembered that the Bitch remains in " heat " for three or four days, and will seek for repeated intercourse with the male during that period. It must, therefore, either be concluded that the last inter- course was the successful one, or that one or more ova were impregnated at each copulation. So far as our knowledge at present extends, we can neither positively negative, nor absolutely admit, the possibility of superfoetation in the larger domesticated animals. The cases recorded have not been sufficiently investigated to convince those who deny the likelihood of two conceptions taking place after a certain interval ; and it must be admitted that a true explanation of such a singular occurrence has not yet been offered. A lapse of time occurring between the birth of two animals is no strong proof of a second impregnation during conception ; for, as we shall see hereafter, when twins are conceived from the same intercourse, it may and does happen that one ovum does not attain maturity so soon as the other, and is either rejected or retained after a more or less lengthened interval — a circumstance which might mislead. And again, with regard to the size of twins, it is not at all unusual to find one larger and more developed than the other, though both were produced at the same period. Putting aside the question of superfoetation in animals, the anatomical disposition of whose generative organs evidently permits such an occur- rence, a little consideration will show that usually there are physical obstacles which offer an insurmountable barrier to a second impregnation, after conception has been achieved for a short time. Soon after that event has taken place, the entrance to the uterus is closed by the shut sac enveloping the embr\'o, and which adheres closely to the inner surface of the organ throughout its entire extent — covering the orifices of the os uteri and Fallopian tubes. In addition to this, the canal of the cervix is i6o PATHOLOGY OF GESTATION. during gestation rendered still more impervious by the thick viscid mucus secreted by its glands. Such being the case, it will be obvious that a second impregation cannot occur, if it be necessary for this purpose that the spermatozoa pass into the uterus, or even to the ovaries ; for the whole is hermetically sealed after a certain time. For a second impregna- tion to be accomplished during conception, fecundation must take place before this closing-up of the uterus and Fallopian tubes — an interval too brief after the primary impregnation to make much difference in the respective developments of the young animals. In cases in which there is a double uterus, or in which conception occurs in only one horn, super- foetation is possible, and one parturition may not be followed by another for some considerable time. SECTION II. — EXTRA-UTERINE PREGNANCY. In studying the development and progress of the ovule, after its escape from the ovary and impregnation by the spermatozoa of the male, we saw that a peculiar arrangement existed in the presence of the fringed border at the extremity of the Fallopian tube, which grasped the ovule and per- mitted it to be conveyed into the canal on its way to the uterus. From certain causes which are not yet clearly understood, it sometimes chances that the ovule, instead of taking this its normal course, either remains in the ovary, is arrested in its progress through the tube, or, escap- ing the fimbriated extremity of the latter, falls into the peritoneal cavity, or glides between the folds of peritoneum constituting the broad ligament, or between the serous and mucous membrane of the uterus ; in all of which situations nature makes an effort to afford space and nutrition for the embryo, and thus supply the place of the uterus. This effort, however, as might be anticipated, is only partially successful, and after attaining a more or less imperfect development, the fcetus perishes from lack of nourishment. This abnormal deviation from ordinary gestation, happily very rare in the domesticated animals, has received various names : such as Extra- uterine pregnancy, Exfoetation, Conceptio vitioxa, etc. The first is that usually employed ; and the different varieties are commonly designated from the situation the ovum occupies. Thus we have (i) Ovarian foetation when the ovum is detained in the ovary ; (2) Ovario-tubal, when lodged partly in the F'allopian tube and partly in the ovary ; (3) Tubal, when the tube is the situation j (4) Inte7-stitial, when the ovum enters the parietes of the uterus at the termination of the tube, but is arrested between the fibres before it can reach the cavity of that organ ; (5) Utero- tubal, a compound of the two, the ovum being partly in the tube and partly in the uterus ; (6) Utero-tubo-abdominal, when the foetus is in the peritoneum, the umbilical cord passing through the tube to the uterus ; (7) Tubo-abdominal, when the foetal envelopes are fixed in the tube, but the foetus is developed in the peritoneal cavity ; and (8) Ventral or abdominal fostation, when the embryo is formed and develops in the abdomen. Extra-uterine pregnancy is not at all common in the domesticated animals, and appears much more rare in them than in woman ; and several of the varieties just enumerated have never, to my knowledge, been observed in them. This may be fully accounted for by the different disposition of their generative apparatus, the much less tendency of these ANOMALIES IN GESTA TION i6i to disease, functional disorder, or deformity, and also, doubtless, to their function being only that of reproduction. With regard to anatomical arrangement as averting, to some extent at least, this misplaced gestation, we may point out that of the Mare as typical — though the same indica- tion is applicable to the case of the other large animals. In this creature, the escape of the ovum into the abdominal cavity can only occur through some malformation or anomaly in the conformation of the fimbriated extremity of the tube, which, in the normal condition, is applied to the base of the ovary, and envelops it during the genital excitement. Neither is it likely that its course through the cavity of the tube can be checked, as this is short and direct ; and the comparative thinness of the uterine walls almost precludes the probability of the ovum lodging itself in them. Ovarian fcetatton has seldom been observed, so far as my researches have led me ; though its occurrence in the domesticated animals is far from being impossible. It has been divided into two kinds ; internal ovarian^ when the embryo is developed in the Graafian vesicle or interior of the ovary ; and external ovarian^ when the ovum has left the vesicle and grows beneath the envelope of the ovary. The only instances on record are given by Rohlwes, Gurlt, and Plot. The first observed this rare form of gestation in a Mare which had been pregnant twenty-one days. The ovary w^as greatly enlarged, and contained a small embryo in a vesicle. Plot observed it in a Cow, and also in three Sows. Tubal foetation^ in which the embryo is developed in the Fallopian tube, is also exceedingly rare, if the paucity of cases reported is any criterion. Rohlwes mentions having found the bones of a foetus in the left Fallopian tube ; and Carus says this form has been noted in the Rabbit. Car- sten Harms speaks of it causing fatal internal haemorrhage, by rupture of the tube, through the incapacity of the latter to distend sufficiently for the development of the foetus. In interstitial foitation, the embryo is developed between the membranes forming the walls of the uterus ; the muscular fibres, at the point where this occurs, are separated, and the cyst containing the embryo is situated between the serous and mucous membrane. This variety has not been noted in the lower animals, I believe ; neither have the remaining forms, except the abdominal^ some very rare cases of which are on record. Abdominal or ventral foetation, may present two varieties ; the ovum may !;"^it itself, after escaping from the ovary, directly in the* cavity of the abdomen, and there be developed ; or it may be developed at some other point — the ovary, Fallopian tube, etc., and fall into the abdomen after rupture of the pouch which contained it. In the first instance it is WdiXSi^A primary, and in the other secondary abdominal foetatio7i. Extremely rare though both varieties are in animals, yet perhaps the first variety is less frequent than the second. The following cases of abdominal fcetation are given as examples : — M. Mollard, in the Rccueil de Med. Veterinaire for 1838, gives the case of the foetus of a Goat, which was found in the abdomen of its parent by a butcher. The uterus was perfectly intact, and did not exhibit any trace of gestation ; the foetus itself was attached to the umbilical region of the mother by vessels and very short ligaments, and was enclosed and much compressed by an envelope somewhat resembling the omentum ; this membrane was adherent, throughout its extent, to the skin of the young animal. In this instance there is an absence of anatomical details which detracts from the inter- est and certainty of the case. In a more recent, and perhaps the only sufificiently attested instance of primary abdominal fcetation on record, we find these details very satisfactorily furnished by the able director of the Belgian Veterinary School at Brus- II 1 62 PA THOL OG Y OF GESTA TION. sels, M, Thiernesse, in the Bulletin de P Academic Royale de Medecine. A third year veterinary student was at home with his parents in April, 1871, when a fat Pig was killed for food. On its abdomen being opened, there were found, floating among the convolutions of the intestines, two foetuses, which were detached from the lumbar region, where they were each suspended by a vascular peduncle about three inches long, behind the great mass of the intestines, and between the two cornua of the uterus. These were sent to Professor Thiernesse immediately, with the information that the Pig had been at least two years old, and in September, 1S70, had given birth to three well-formed young ones ; after which, in con.sequence of being considered a bad breeder, through having brought such a small litter, it was laid up for fattening. Until it was killed it exhibited no signs of functional derangement, and manifested the usual indications of rutting every three or four weeks ; being kept apart, however, it had no opportunity of satisfying its desires. It was certain, then, that these two foetuses were of the same con- ception as those born in September, and they must have lived until their parent was sacrificed ; as they did not show the slightest alteration. They were closely contained in a complete membranous envelope of an ovoid shape, provided at one point with a vascular pedicle whose extremity, detached from the abdominal parietes of the mother, resembled a red spongy cord not unlike the ovary in form, and which Thiernesse believed it to be, fancying that the impregnated ovum had fixed itself there and grown. This was not the case, however ; for dissection proved it to be a simple vascular paren- chyma — a kind of cotyledon organized on the peritoneum of the young creature ; and the student had seen the two ovaries in the Pig, after the removal of the foetuses. This vascular body at the extremity of each foetal pedicle was therefore a new formation, formed at the same time as the foetus, and by a hsematosic elaboration necessary to the latter Consequently, there was here a case of primary abdominal extra-uterine gesta- tion, concomitant with a normal uterine gestation. On examining the foetuses, they were found to be females ; the least developed weighed about 23^ ounces, and measured, from the snout to the base of the tail, about 12 inches ; and from the dorsal spine to the distal extremity of the thoracic limb, 5 inches. The other was a little larger, weighed 29^ ounces, and was 14 inches long and 7 inches high. Their conformation was symmetrical, and development complete. Each had four teeth well grown up in each jaw — the canine and lateral incisors ; and in the largest foetus the middle incisors of the lower jaw were equally developed, while the two first hiolars were being cut in both jaws. Those two foetuses were, then, even a little beyond the ordinary development of those whose natural gestation is about to terminate. Each was attached by an umbilical cord to the membranous sac containing it ; which sac, applied immediately to the velvety skin, and even adhering to it at some points, was composed of a thin chorion, provided, for a small extent of its external surface, with a very thick vascular placenta, and responding by its inner face to a complete amnion, as well as a very small allantois whose cavity was' like that of the latter, destitute of fluid, but communicated with the bladder by a very distinct urachus. All the organs of these creatures were fully formed, and there was nothing anomalous observed. On this case Thiernesse rem'arks, that it would appear that the glandular arrangement of the uterus is not indis- pensable to the formation of the embryo, and that absence of these glands may be effi- ciently compensated for by an organ developed on or in any other in the abdominal cavity whefe the impregnated ovum may graft itself ; that under the stimulating influ- ence produced by tlie contact of the ova, this new organ constitutes a kind of extra- uterine cotyledon analogous, up to a certain point, to the maternal placenta resulting from the hypertrophy of the uterine mucous membrane, and which acts very well as such, though with less functional energy. This is evidenced in the development of these two foetuses, which required about ten months to bring them to their present growth — a period more than double that of ordinary gestation in the Pig.* A few other instances of abdominal foetation will. complete what we have to offer in the way of illustration of this abnormal pregnancy. The 'first case is reported by M. Simon, of Yonne, France. A celebrated sheep- breeder in his canton had a Sheep which, though carrying a dead lamb for two years, yet produced another at the end of this period, and which lived. It appears that the Sheep was seven years old, and had been put to the ram with the others of the flock to which it belonged. At the usual period of lambing, the animal made attempts at deliv- ery, but was unsuccessful ; and an examination made by a veterinary surgeon proved that the foetus could not be extracted ; it was therefore predicted that the Sheep would for the future prove sterile. At this period the mammae were enlarged for five or six days, and fever was present ; then all the general symptoms of this condition gradually disappeared, the appetite returned, and the animal was well. The foetus could be felt at the lower part of the belly. Two years afterwards, to the great astonishment of the * " Anuales de M^d. Vdt^rinaire de Bruxelles," 1871, p. 420. ANOMALIES IN GESTA TION 163 owner, the Sheep brought forth a lamb, which it suckled, and which grew up. The mother was then put by for fattening, and when ready for the butcher it was examined by M. Simon. By taxis, he distinctly felt, a little to the right of the lower part of the abdomen, an elongated, hard, irregular, insensible tumor, slightly curved shape, and presenting along the curvature very prominent asperities, which were distinguished as those of the vetebral column of a dead foetus. The animal being killed and opened, the uterus was found contracted, and situated in the upper region of the abdomen ; it offered no signs of gestation. The intestines were then removed and the right side of the rumen lifted up, when the tumor was discovered which had been felt externally ; it was firmly attached to the abdominal wall, and consisted of a pouch containing the foetus. No particular mention is made of the condition of the walls of the uterus, and the foetus and its envelopes having been sent to M. Renault, then directorof the Alfort Veterinary School, unfortunately no report as to the anatomical peculiarities of these was published. The case would, however, appear to be one of primary extra-uterine abdominal foetation.* ^ The second case is given by S. Della-Rovere, veterinary surgeon of Angliano {Archivio della Veterinai'ia Italiani, 1868), who was called to give his attention to a Cow in parturition, and which had been already in the hands of an empiric for some time. It was aged 14 years, and was very emaciated. By a vaginal exploration the os uteri was found completely closed, so that torsion of the uterus was at first apprehended ; but it was soon discovered that such was not the catse. During the examination the expulsive movements continued, and Della-Rovere felt under his hand the limbs of a foetus pressing against the margin of the vulva. Withdrawing his arm, by palpation along the floor of the vagina he satisfied himself of the presence of the two fore-limbs and head of a foetus. An incision was consequently made through the vaginal wall at the point corresponding to the foetal limbs, and by the opening so made he extracted a living healthy calf, which was given to another Cow to rear. Some minutes afterwards, the straining persisting, another exploration was made, when a second calf, much smaller and dead, was removed. The Cow died three days after this operation. Unfortunately, the veterinary surgeon could not make a careful examination, as when informed of the death of the 'animal, it had already been cut up ; so that he was unable to ascertain by what means the foetuses were nourished, and how the umbilical cords were attached. The uterus was quite contracted and small, with numerous folds in the inte- rior, as if the animal had not bred for several months ; on the left side of the organ, at its lower third, was a long irregular cicatrix, with a small round opening at its inferior extremity, through which a goose quill could scarcely be passed. From inquiry, it was ascertained that the Cow had been overturned by another while at pasture during the early months of gestation ; but it never showed any signs of inconvenience from this accident, and was regularly worked in the plough.! This is an example, probably, of the second form, the foetuses having escaped through the walls of the uterus by a tear made in that organ. Other instances of the variety will be given hereafter. In the Veterinarian (vol. vii., p. 606), Mr. Berry mentions a. Cow which, being preg- nant, exhibited all the signs of approaching parturition at the usual time ; and after showing symptoms of fever and uneasiness from distended udder for some days, was at last examined /^r z/a^/ww;/, but no calf was found in the uterus, though it could be " touched" above the flank. Being satisfied that it was a case of extra-uterine gesta- tion, the Caesarean operation was performed; but the animal was so exhausted that it died before the business was completed. The operation brought to light "a mass of fungous matter, weighing not less than seventy pounds, in the centre of which lay a remarkably fine heifer calf, fully matured, and evidently a very short time dead. The most minute examination was instituted, but no connection appeared between the womb and the part enclosing the calf, except by external adhesion." In the same journal (vol. xiii., p. 66) Mr. Metherell, of Spalding, describes a foetus which was found in the lumbar region, behind the left kidney of a Sheep, and attached to the peritoneum. In this journal also (vol. xv., p. 103I, Mr. Green, of Fareham, writes of an examination he made of the body of a full grown Ewe. On making an incision along the linea alba, through the abdominal and recti muscles, there was presented to view a foetal lamb in the cavity of the abdomen, wholly deprived of its membranes, its back lying on the abdominal muscles, the support or attachment being formed on the off-side, and effected by means of intervening bands of lymph from the cheek, and continuing backwards to the antero-spinous process of the ossa innominata, wholly enveloping the off-fore ex- tremity. The union formed between the foetus and the peritoneal covering, at the inner surface of the right abdominal muscles in the umbilical regionj was its head, the pos- * " Recueil de M^d. Vet^rinaire," 1857, p. 298. t "Journal des V^t^rinairesdu Midi,'' 1869, p. 1S9. 1 64 PA THOL OG Y OF GESTA TION. terior parts extended as far back as the ensiform cartilage, and the uniting medium was very firm. The left side, from the third cervical vertebra to the tail, was imbedded in the omentum. The hind extremities were firmly fixed to each other, also to the abdo- men : being, in fact, quite immovable. The fore extremities were attached to each other as far down as the carpus, and thence by bands of lymph to the lower surface of the neck. The nose of the foetus was twisted to one side ; there were no eyes ; the ears were small, and fixed to the occiput, being in texture like the parotid gland; the spine was curved, and the tail fixed between the hind legs; the anterior maxillary bones were alone covered with wool ; the abdominal muscles were very thick ; the spleen, pancreas, kidneys, and bladder, as well as the rectum, were all absent, and the sex could not be distinguished. It weighed within an ounce of five pounds. In the Ewe, the cervix of the uterus was obliterated by small excrescences, " of the character and appearance of the inner surface of that organ. The animal had never exhibited any unusual symptoms, except that she had proved barren in the previous spring, having been with the ram before then." The same journal (vol. xxix., p. 344) alludes to a good-sized, fully-formed lamb, found in what appeared to be a tumor or bag attached to the rumen of a fat Sheep killed for food. The skin of the foetus was covered with wool where it had not been torn in pro- cess of removal from its adherences. The uterus of the Ewe was small, and there was no evidence of rupture. Gurlt (Pathol. Anatomic, 1831) describes an instance of abdominal gestation in a Sheep, in which the maternal placenta was attached to the mesentery ; and Plot alludes to a similar occurrence in a Bitch, the foetal membranes adhering to the mesentery and kid- neys; while Fornari mentions a placenta formed on the rumen of a Goat. Below gives a detailed description of a mummy (/////(?/^fl'/£'«) weighing 1870 grammes, which was found in the abdominal cavity of a Sheep. A very interesting notice, one of the most recent, is given by Baillet [Rectieil de Med. Veterinaire, 1875, p. 26). As inspector of the abbatoir at Bourdeaux, his attention was called to the carcase of a six-year old Cow, in very fine condition, which had just been slaughtered. On opening the abdomen, an ovoid mass, not unlike in appearance the manyplus of the stomach, appeared at the anterior part of the right sac of the rumen ; it had formed adhesions with the omentum, rumen, diaphragm, liver, and right hypo- chondrium. When detached it measured 18 by 14 inches in diameter, and weighed 45 pounds. It was of a nacrous white hue, and provided with numerous firm, membranous prolongations of a red color ; a hard rounded body could be felt within it. When cut, it was found to be a sac, the wall of which was about one-fifth of an inch thick, and firm and resisting. No trace of vascularization could be made out on its inner surface, which adhered to a dead foetus so tenaciously, that some degree of force was required to destroy the intimacy existing between it and the hair on the dorso-lumbar region of the calf. A small quantity of turbid, yellow, colorless fluid, in which floated some debris of horn and some hairs, occupied the bottom of the sac. There were no proper foetal envelopes, and the creature appeared to have been grafted on the inner face of this fibrous cham- ber. It was a full-time foetus ; though by its general development it looked as if arrested by the limited space in which it had been enclosed. Bent longitudinally, its head was fixed between the fore legs. The surface of the body was covered by slightly humid hair, which was easily removed, particularly within the arms and thighs, where the skin was cf alight yellow color. The compression it had undergone had produced a general flattening of the muscles; the eyelids were quite distinct, though there w^as not a vestige of eyes ; a shred of umbilical cord, black and withered, still remained. There was no unpleasant smell, even when the body was opened. Thevicera were dry and looked as if macerated ; the muscles were pale, but firm ; and the bones were intact, their extremi- ties being provided with a cartilaginous covering. The uterus of the Cow, though care- fully examined, offered no evidence in explanation of this abnormal gestation. Some corpora lutea \td to the supposition that it had been bred from, or at least that its ovaries had been the seat of the process which accompanies fecundation. There was nothing in the condition of the Cow's carcase to indicate that this strange state had caused it any suffering or inconvenience. Professor Stockfleth, of Copenhagen, describes another instance ( Tidsskrift for Ve- terinitrer, 1875) of a Cow in which, after it had been slaughtered for food, a large round tumpr Avas found in the abdominal cavity. This tumor was attached by a cord to the abdomen, and it contained a foetus covered by a dense white membrane, through which the dark-brown epidermis retaining the hair appeared, but which came off with the covering. The calf lay rolled up with its head and feet together, and was in every respect normal. The uterus of the Cow was contracted in a natural manner, and one of the ovaries, which was somewhat larger than usual, contained a corpus luteum. There was no connection between the uterus and the membranes surrounding the foetus, neither had the membranes any cotyledons. ANOMALIES IN GESTA TION. 165 The length of time during which these extra-uterine foetuses may be re- tained, varies according to circumstances. In the human species, a case is recorded in which the foetus remained in the abdomen for fifty-six years ; and a great many instances are published in which retention has continued from three months up to the last-named period. In animals, this retention of the misplaced foetus may also continue for a long time \ and though death usually occurs if delivery is delayed much beyond the the usual period of pregnancy, yet development appears to progress in the ordinary manner, and subject to the laws of normal gestation. It is indeed astonishing to find the ovum fix itself, and become developed into the embryo and foetus, by drawing nourishment in "the strange situation in which it chances to fall : the placenta, cord, and envelopes being pres- ent just as if it had found its way into the natural receptacle. It does not appear to be quite decided whether the ovum, in primary abdominal foetation, receives an additional covering analogous to the decidua ; though it is very probable that it does, and that this membrane may per- form a similar office in the nutrition of the foetus. The part of the ab- dominal or other surface to which the ovum adheres, receives an in- creased vascular supply for the occasion, its vicarious function being as actively carried on as if it were the lining membrane of the uterus. Not unfrequently, retention is brought to a termination by the death of the parent, through the disordered state of health induced by the living foetus, or through absorption of the septic matter it engenders, if putre- faction sets in after its decease. On other occasions, and these are com- paratively not very unfrequent in the lower animals, an effort is' made by nature to get rid of what really in time becomes a foreign body by arti- ficial openings. In these cases the foetus may be passed whole or by fragments through the abdominal parietes, the intestines, or the vagina — in almost every case the former, owing to the quadrupedal position of ,the domesticated animals. Several occurrences of this kind are to be found in the literature of Veterinary Science ; but we will notice only the following in this place : M. Drouard [Recueil de Med. Veterinaire, 1842) reports that a Sheep -which had lambed the preceding year without any accident, was, at its second gestatron, seized with sudden but unavailing throes of parturition. Nothing appeared ; the os uteri re- mained closed, and the waters did not escape. The animal continued in this state for three or four days, after which the symptoms subsided, and in a month they had disap- jeared. About this time, however, the appetite became lessened, rumination began to irregularly performed, the strength was diminished, and the animal often lay for a )ng time. For fifteen days it remained in this state, very dull, the eyes sunk. in their orbits, the respiration frequent, and the pulse almost imperceptible. An cedematous swelling appeared beneath the belly, and the skin at this part was cold and brown col- ored. Scarifications made in it permitted the discharge of a foul-smelling sanguineous fluid, indicative of gangrene. Finally, ulceration set in over this swelling, and soon a foetus covered with wool showed itself : this was extracted after enlarging the opening. It was in an advanced stage of decomposition, and in the abdomen of the mother it lay with the head and fore limbs towards the pelvis, the croup being inclined towards the diaphragm. It was extracted by the fore part of the body, and the opening was closed by suture, leaving only an orifice for the escape of the pus • a retaining bandage around the body to support the sutures, applications to the skin, and diffusible stimulants in- ternally, was the treatment. As the appetite did not return for eight days, tonic and nourishing draughts were administered. After this period it rallied, but there was an abundant discharge of pus ; the orifice through which it flowed enlarged, and at last gave exit to the after-birth, as well as a portion of the omentum, which was of a deep reddish- brown tint, and had to be excised. The gangrenous condition of the wound also de- manded attention ; the margins were pared, and new sutures employed. By attention and careful nursing the wound had cicatrized by the forty-fifth day, and in six months 1 66 PA THOLOG Y OF GESTA TION, the animal was fat again. Unfortunately, it was sold to the butcher without the veteri- nary surgeon being allowed the opportunity of examining its carcase after it was killed ; as it would have been interesting to note whether this was a case of primary or second- ary abdominal foetation. Probably in this instance peritonitis was averted by adhesions being formed around the part to which the foetus was attached — the whole mass becom- ing encysted immediately over the abdominal surface where ulceration took place. Coquet [Instructiojts Veteri7iaire,vo\. ii.), so long ago as 1784, mentions that a farmer at Neufchatel bought a Cow that appeared to be ill, in the hope of being able to cure it. Instead of amending, however, it became worse, and a profuse diarrhoea set in of serous and putrid matters. It was soon noticed that these ejecta contained hard substances, which were recognized as bones. The farmer brought several of these to Coquet, among which was a cannon-bone, a calcis, several ribs, a portion of a lower jaw, several fragments of the knee anc^ hock, and a maxillary bone. Coquet thought at first that these could only come from the uterus ; but the owner positively assured him that they were passed with the faeces. As the case appeared to be hopeless, the animal was let alone ; it died in about a month, and the following lesions were noted : the colon was much enlarged from its last flexture to the commencement of the rectum — about two and a half feet, and its walls measured more than an inch in thickness ; they were very dense, dark-colored, inflamed, and gangrenous ; the inferior surface was perforated ; and the intestine contained at that part a considerable quantity of bones, similar to those which had been voided, but more voluminous and irregular, like the pelvic bones and those of the spine and head. The uterus was a little larger than in the non-pregnant state, but its fundus, which corresponded to the diseased and perforated intestine, was likewise engorged, indurated, and very thick, though there was no appearance of a cica- trix. The cervix was so contracted that a stylet could not be passed into it, and its cavity, which was empty, could scarcely be discerned. The peritoneum and mesentery in the neighborhood of the affected parts were swollen and inflamed ; while the serosity effused into the pelvic cavity was sanguinolent and putrid. The other viscera were healthy. Haubner reports a case recorded by Janke, of a Cow five years old, when in its sev- enth month of pregnancy, gradually losing its appetite, while the size of the abdomen increased. It was supposed to be affected with ascites, and was therefore killed ; when a foetus, contained in its envelopes, was discovered in the abdominal cavity. The uterus had the same appearances as in the non-pr^nant state. The same author mentions the case of a Sheep which had not lambed at the usual time, but which, two months afterwards, exhibited a tumor on the abdomen in which the fore limb of a lamb could be felt. The tumor was opened, the. lamb extracted, and the wound closed by suture. The Sheep recovered and remained in good health. Beiiz and Bagge, of the Copenhagen Veterinary School, found in the abdomen of a little Bitch, aged thirteen years, a foetus which appeared to occupy the mesentery of the- small intestines. All the soft parts of the creature had disappeared, and it looked like a skeleton. The Bitch did not show any signs of suffering during life. Saussol {Recueil de Med. Veterinaire, 1828) reports that a Ewe, three years old, had been with the Ram like the other Ewes, but never exhibited any signs of preg- nancy. About two months after being with the Ram, the shepherd observed a hard tumor about an inch behind the umbilicus, and which gradually increased in size, until, fifteen or sixteen months after it was. first seen, Saussol was called in. The tumor was then the size of a goose's egg, and felt like an abscess. It was punctured, when a quan- tity of pus escaped, and with it the bones of a foetus. These bones were separated from eaeh other, and were discolored ; the head, however, was entire, ^nd less altered than the other parts. The first incision being enlarged, it was found that the abdom- inal muscles were nearly double their ordinary thickness, and at this particular point formed a pouch in which the foetus was lodged, but covered only by the skin. No com- munication existed between the pouch and the abdominal cavity. The opening was closed by suture and soon healed, but the animal did not thrive and was sold. Dickinson, in the Veterinarian (vol. xxviii., p. 196), relates the case of a Sow which he was called in to attend. The animal had been ill for some time, and its period of gestation had expired four weeks previously; though as no indications of approaching parturition were noticeable, it was supposed a mistake had been made in the date. The symptoms were : loss of appetite, obstinate constipation, a peculiar or painful grunt, and lying on the left side with a limb extended, as if to relieve the abdomen from the weight. When standing it would support itself by leaning against the wall, and then gradually drop down as easily as possible. A hard mass could be distinctly felt on manipulating the abdomen, especially towards the left side ; the pain on pressure was intense. Medical treatment was of no avail, and on the fourth day it succumbed. _ At the autopsy, the peritoneal membrane was found to be inflamed, the visceral portions being most affected. The uterus had been seriously injured, evidently by the operation A NOMA LIES IN GESTA TION r 6 7 of "spaying." The right horn and its ovary, with a portion of the body of the uterus and vagina, were absent. A mass about the size of a man's head, enveloped in false membranes, was situated in the left iliac region, and connected with the left horn of the uterus, which was still continuous with its ovary and the vagina. On dissecting the tumor, the osseous remains of seven Pigs were discovered, enclosed in separate cavi- ties. Seven heads and all the bones were collected. They were, however, denuded of all soft parts, as if they had been subjected to maceration. Symptoms, Course, a?id Termifiations . We have already to some extent indicated, in recording the history of several of the most interesting cases of extra-uterine pregnancy mentioned in veterinary literature, the character of the symptoms, and the termina- tions which mark this accident. The symptoms are generally those of conception and gestation. The ovum grafts itself on some part with which it chances to be in contact ; an embryo results, the placenta being attached to the neighboring textures and developing with the increase of the young creature ; these changes being accompanied by the ordinary external signs of uterine pregnancy. In the majority of cases, tl^^e par- turition should occur in the usual course, the premonitory indications of that phenomenon are very slight or altogether absent ; though the animal may now and then make expulsive efforts, which continue perhaps for a few days, and then subside gradually, or recur at intervals. In the most favorable cases, when the fcetus perishes, it becomes enkysted and mum- mified ; the fluids and soft parts are absorbed, and the remaining por- tions become dry and parchment-like ; or the creature may undergo a process of calcification by the deposition of carbonate and phosphate of lime in its tissues, which preserve its shape, and convert it into a " litho- paedion " or " osteopjedion." In this condition the foetus may remain for an indefinite period in the abdomen of the mother, without causing much, if any inconvenience : indeed, a most perfect state of health may exist, and the animal become remarkably fat, or it may conceive and bring forth as favorably as if nothing abnormal existed ; the indications of anomalous gestation being only discovered by chance when the animal dies from some disease which has no relation to this accident, or is killed for food. Such a happy result of the accident is, however, very far from being % the rule, and the chances are many that fatal termination will be the consequence of extra-uterine gestation. Expulsive efforts or other causes, may lead to rupture of the kyst in which the foetus is contained ; and this, with the fluids and deh'ts of membranes, falling into the abdominal cavity, may give rise to such a severe form of peritonitis that death will ensue in one or two days. In other instances the kyst inflames, and suppuration is established, with putrefaction and partial solution of the fcetus ; and if the mother does not at once succumb to pyaemia or septi- kaemia, adhesions and communications are formed between the kyst and neighboring organs, and the remains of the yopng animal, chiefly the bones, are expelled either directly, as by ulceration of the abdominal I walls after the development of an abscess, or indirectly, as through the intestine, etc. After the foreign matters have been completely, or even only partially, eliminated in this way, the fistulous openings by which they escaped ciatrize after a variable period of suppuration, and the female recovers — as has been observed in Sheep and Goats. More frequently, however, it loses condition, becomes emaciated and feeble, and perishes in a state of marasmus ; or it succumbs to hectic 1 68 PA THOL OG Y OF GESTA TION. fever, septikaemia, or one of the many accidents which the presence of such a body may produce. The course of external ovarian gestation, which has been stated by Gurlt to occur in the domesticated animals, appears to be as follows : the envelopes of the ovary rupture towards the second or third month of the embryo's development, when the latter falls into the abdominal cavity, where it constitutes what we have termed '• abdominal " gestation, leaving only a cicatrix on the ovary. With regard to internal ovarian pregnancy, the ordinary termination is rupture of the organ, and fatal haemorrhage. Diagnosis and Treatment. There is absolutely nothing in the early, or even in the later stages of extra-uterine pregnancy, especially ovarian and tubal, to indicate the ex- istence of any deviation from normal gestation ; and when at length the animal exhibits indications of approaching parturition, there may be grave doubts as to the actual state of affairs, though the absence of cer- tains signs may give rise to suspicion. The animal is uneasy and strains, yet the vulva is not enlarged, and the flow of mucus observed in the pre- liminary stage of ordinary parturition is not apparent. Exploration of the cervix uteri by the vagina, will prove the absence of induration or morbid tumefaction, as well as dilatation or contraction of the os, not- withstanding the length of time that has elapsed and the expulsive efforts. Palpation and inspection of the abdomen may also furnish certain infor- mation with regard to volume, and the situation of the enlargement. C ireful exploration of the abdominal cavity by the rectum, will be found advantageous in cases of abdominal gestation uncomplicated with uterine pregnancy. Not only can the condition of the uterus be satisfactorily determined, but perhaps a tumor independent of that organ may be dis- covered, and in which a foetus, or parts of one, can be felt. In such a case, efforts must be made to check the attempts at parturition, though it must be confessed that they are not likely to be successful. Sedatives, large doses of opium, chloral, hot water applications to the abdomen, and other measures of this kind are indicated. If the diagnosis is well estab- lished, and the animal can be utilized for food, it is generally better to have it destroyed if in fair condition. In cases in which the period of parturition has passed, and when the animal has been unwell for some time, exhibiting loss of appetite, with marked depression, quickened pulse and increased temperature, and nothing else to account for these symptoms, then we may suspect the existence of extra-uterine gestation and putrefaction of the foetus. In the smaller animals — such as the Sheep, Goat, Bitch, etc., abdomi- nal palpation can be readily resorted to, and often with most satisfactory results. When elimination of the foetus has commenced in any of the modes just described, active interference may or may not be necessary, according to circumstances. The fistulous openings which may be occasioned by the eliminative process, must be dealt with as ordinary fistulae. Should the foetus chance to be alive, it is scarcely possible that it can be removed by operation without greatly endangering the life of the mother. If in abdominal gestation a tumor, simulating an abscess, forms on any part of the abdomen, this may be carefully opened, and the foetus extracted with a successful result. The accessory treatment, such as careful nurs- ing and hygienic measures, must not be neglected. ANOMALIES IN GESTA TION 169 SECTION III. SPURIOUS OR PSEUDO-PREGNANCY. Spurious pregnancy is a designation applied by veterinary obstetrists to certain accidents, characterized by the development of special patho- logical productions, which may probably be due to a previous conception, and which, more or less, simulate normal pregnancy. They are far from common, and the principal of them are described as moles, uterine kysls, and hydrops uteri* These we will allude to. Moles. Moles, or more correctly speaking perhaps, anidian monsters, are more or less voluminous fleshy masses constituted by a blighted embryo, the membranes of which have continued to perform their function, and to nourish the abnormal growths. They are, as a rule, met with only in ruminants, and especially the bovine species, though Roell mentions their occurrence in the Mare ; and in nearly every case they appear to be one of twins, the development of which has been arrested at a certain period. The mole {mola cruentd) is more particularly characterized by the per- sistence of an umbilical cord which, though degenerated, yet seems in the majority of cases to maintain relations between the tumor and the uterus. With regard to the tumor itself, it is generally easy to distinguish the dis- torted remains of an embryo — such as skin, bones, muscles, and even * I am not aware that the curious and obscure form of pseudo-pregnancy occurring in woman and Aq' sx^xviAzA. pseudo-.-yesis by the late Dr. Simpson, has ever been observed in animals. 1 7 o PA THOL OGY OF GESTA TION. organs of sense in some cases. These anidian monsters have not at- tracted much attention ; so we will venture to give a short analysis of some instances recorded in the annals of Veterinary Science. In the Rectieil de Med Vetirinaire for 1828 (p. 370), Saussol describes the case of a Cow three months in calf, and which, when harnessed to a carriage, fell on its abdomen with great force against a stone. After this accident it lost condition, pined away, and at last died. When opened, instead of an ordinary foetus, there was found an oval- shaped consistent fleshy mass, of a reddish violet color, floating in a rusty-tinted fluid, and which had obtained its nourishment by means of a single cord — no doubt emana- ting from some cotyledon. This tumor contained the skeleton of a fcefiis, the bones of which were normal and not displaced, being held together by means of ligaments. Leaux ( Journal de Med. Veterinatre de Lyon, 1846) states that a Cow seven months pregnant, after two days' violent straining, ejected a dead foetus and a large tumor, and died immediately afterwards. The tumor weighed five kilogrammes, was of no par- ticular shape, was reddish-brown in color, soft but very vascular and covered by a fine, apparently pseudo-membranous, envelope. No trace, of peduncle or uterine adhesion could be detected. The whole mass was of a fibrous texture, and composed of a mul- titude of small vesicles containing an amber-colored serqsity. The Reciicil de Med. Veterinaire for 1858, contains the description of an anidian monster found in a sheep which had given birth to a dead lamb, and was sacrificed. This monster had neither head nor tail, was about two feet long, and sixteen -inches broad at the widest part. The limbs were rudimentary, without any trace of digits, and there was neither anus, vulva, or scrotum. A protuberance took the place of the neck and shoulders ; while in the centre of the mass was only a cavity filled with serum, in which floated a rudimentary stomach and intestines. There was no trace of liver, spleen, kidneys, diaphragm, heart, or lungs, and there were a few bones, sup- posed to be misshapen ribs; the remainder was composed of infiltrated connective tissue. Mr. Snowdon, in the Veterinarian for 1856 (p. 218), states that on January 30th a Cow produced a healthy female calf. _ Nothing unusual was observed during the day, but about six p.m. the animal appeared to be in pain, when Mr. Snowdon was called. He found a membranous sac hanging from the vagina, to nearly as low as the Cow's hocks. This was punctured, but only a small quantity of fluid escaped, though a mole appeared, which was attached to the placental membranes by an umbilical cord. This was divided, and the animal continuing in pain, an examination was made/^r vaginam, when another calf was found in the uterus. This was delivered, when it was discovered to be a male calf, well developed, but dead. The Cow did well afterwards. The anidian monster was in shape a flattened ovoid, about two inches in thickness, and six inches by four in size. It was covered with long red hair ; though at the border, where the umbilical vessels enter, was a hairless spot. On the opposite border was ' the rudi- ment of a lower jaw, containing four well-developed incisor teeth, three of which had cut the gum. Above this was a small cartilaginous ear, and near it something like an eyelid. Several bones were contained in the mass, one of which had the shape of the bones of the skull ; though, as a whole, it felt spongy and elastic. Its weight was fourteen ounces. In the Annales de Med. Veteriiiaire for 1859, May mentions having delivered a normal calf, and afterwards the Cow expelled an oval mass the size of a child's head, covered with a fine velvety skin, and showing at one point an umbilical cord. This skin en- veloped a vascular spongy tissue, mixed with muscular and glandular portions, and in its centre was a small soft bone about an inch in length, Lavocat {Journal de Vet. du Midi, 1866) relates that having delivered a Cow of a well-formed calf, and before the removal of the membranes, a kind of downy ball was expelled, which was only attached to the latter by a vascular prolongation, comparable to an umbilical cord. The mass was oval in shape, as large as a lamb's head, every- where covered with hair, and at the middle was what appeared to be a regularly-formed umbilical cord. At one of its extremities was a shallow cavity terminating in a cul- de-sac, the irregular margin of which bore the incisor teeth projecting beneath the gums. There was no trace of thoracic or abdominal cavities or organs ; neither was there brain, spinal cord, or nerves. Some bony fragments were found, among which were the rudiments of a lower jaw bearing the teeth already mentioned. The remainder of the tumor was made up of very vascular cellulo-adipose tissue, the meshes of which were filled with serosity. In the Veterinarian (vol, xliv., p. 275), Mr, Creswell describes an anidian monster produced by a white short-horn Cow, two hours after delivery of a healthy and well- developed bull-calf of a roan color. This monstrosity was round, and about the size of A NO MA LIES IN GESTA TION 1 7 1 the crown of a hat (?). It weighed eighteen ounces some time after it had been found, but was much larger and heavier when first expelled; it was thickly covered with long fine lo/iiie hair, which was longest and thickest on one side ; at the part where it was thinnest there was a nude spot at the point of attachment of the placental membrane, and near the external border other two bare places which were deeply concave and red colored, one having a slight eminence in the centre. The entire mass was soft and pulpy, as if the interior was composed of cells containing fluid. No traces of bone could be felt, and as it was decided to keep the specimen intact, nothing more of its structure was reported. Rainard and others mention having found fibrous moles {mola racc- f/iosii) in the uterine cornua of the Bitch, Pig, and some other multiparous animals during gestation ; and most frequently in the last dilatation of one horn, rarely in both ; and sometimes between two of the dilatations which contain living foetuses. They are spheroidal, soft, irregular in shape, and look like flesh ; they appear to be composed of fibres run- ning in every direction. In the dilatation of the horn containing them, traces of a zonular uterine placenta have been observed. Rainard was of opinion that they were embryos whose development was checked by disease. Demoussy states that the presence of a foetal mole in the Mare gives rise to the same phenomena as real pregnancy — enlargement of the ab- domen, sinking of the croup and flanks, sluggish gait, and altered respira- tion ; and that the diagnosis is the presence or absence of movement in the foetus. Uterine Kysts. Uterine kysts are pathological productions, somewhat analogous to the vesicular degeneration of the human placenta, in which the placental villi are distended with fluid, enlarged, elliptical, transparent, and loosely con- nected, while their vessels become obliterated and disappear. This con- stitutes what has been designated a " vesicular mole." Liautard (Journal de Med. Veterinaire de Lyon, 1859) was to called to assist a Cow in parturition, on January 28, 1854. The animal was eight months old, and its abdomen had, within the previous eight days, assumed unusual dimensions ; while the very vio- lent expulsive efforts it made were followed by no result. When the hand was intro- duced into the vagina, the os was found to be moderately dilated, and in it was found a fluctuating tumor which was at first thought to be the bag of the waters. At each ex- pulsive effort this tumor was much protruded, but labor did not progress. Another more thorough exploration resulted in pushing the tumor back, and passing the hand through the os into the uterus ; then it was discovered that the tumor was not formed by the foetal envelopes, and that it adhered by one of its extremities to the inferior surface of the uterus, at the point where the mucous membrane entered the os. Its shape was oblong, and in size it was as large as an ostrich's egg ; it was a uterine kyst. While this obstacle was being pushed forward, a sudden effort made by the Cow carried into the os, then into the vagina, and at last externally, the bag of the waters, which on rupturing exposed the fore feet of a foetus ; this was withdrawn by a few gentle pulls, but it was dead, and appeared to be about seven months developed. On the hand being re-introduced into the uterus, the kyst was soon found ; it had been compressed during delivery, but now it had assumed its original size, and was lying in front of the internal orifice of the os. Exploring still farther, two other, but smaller and more cir- cumscribed, tuniors of the same character were felt in the middle of the body of the uterus. In consequence of this discovery, the owner of the animal was recommended to have it sold to the butcher as soon as it had recovered sufficiently. This advice Avas not followed, however, and the Cow appeared to be quite well soon after, yielding, as it did, twelve litres of milk daily. In two months it was put to the Bull, and in time was supposed to be pregnant, as the abdomen gradually became more voluminous. Never- theless, it remained emaciated, its quantity of milk diminished, there was tympanitis at intervals, and this appeared to be relieved only after an abundant emission of urine. When eleven months had elapsed since the previous abortion, and the period for par- 17' PATHOLOGY OF GESTATION. turitiou had arrived, it was so wasted that Liautard was again called in. It was then observed that the Cow almost every instant brought its limbs together under the body, arched its back very mach, and made feeble but long-continued expulsive efforts, which were immediately followed by the escape of a small quantity of odorless seruin. From time to time, also, there appeared in the right flank a variable-sized tumor, which did not look unlike the transient prominences the foetus makes during the later period of pregnancy ; this appearance was accompanied each time by 2. glott gloti sound. Abdom- inal exploration did not discover the foetus in this tumor; but direct exploration, which was easily made, proved that the kyst recognized eleven months previously had become considerably increased ; while the rupture of some fibrous bands during this l'"ig- 55- Hydatid Kyst or Mole; Human. The Kyst, which filled the Uterus, has been opened, and gives exit to a number of Hydatid Vesicles. The Section shows two Membranous Layers, the first of which, a aa,\% external, and is analo- gous to the Epichorion or Decidua ; while the second, b b b,\sz. fine transparent Membrane, apparently the remains of the Chorion, c c c, Granular Vesicles; d d d. White Vessels, some of which appear on the Surface as Granulations, and ot hrs act as Pedicles to the Globules at their extremity ; e e e. Oblong Vesicles which appear to be Constricted or Dilated Vesicles ; fff, Budding Vesicles. investigation, allowed the escape of some dozen litres of fluid. No foetus could be dis- covered in the uterus, but there were numerous kysts, some agglomerated, others iso- lated, and which made the interior of the organ feel lumpy at various points. Several of these kysts were doubtless ruptured during the manipulation, for when the arm was withdrawn there was an emission by the vulva of another dozen litres of fluid. This condition of the uterus accounted for the apparent pregnancy. No treatment was at- tempted, and eight days afterwards, the Cow having died, an examination was made of the carcase, when the following lesions were noted : On removing the digestive organs the uterus appeared as an enormous irregular mass, measuring from the cervix to the extremity of the horns three feet seven inches ; an incision made in its lower ) ANOMALIES IN GESTA TION. 173 face gave exit to about fifteen litres of fluid. There was no foetus : the mucous was separated from the muscular layer by the infiltrated connective tissue, and the knife had opened four large kysts, the most voluminous of which was situated towards the middle of the body of the organ, and was as large as the head of a child. All the kysts contained an abundant serous fluid, and they all offered the same organization : being formed by strong septa into several compartments, which were in reality so many smaller kysts enclosed by a common envelop — the mucous membrane. On the upper wall of the uterus were three more kysts, all resembling the others, though they were less voluminous. The cotyledons were abnormally developed. This is a good example of uterine kysts producing the appearance of pregnancy, and also offering an obstacle to parturition. In January, 1807, Rodet {Rectteil de Med. Veterinaire, 1824) was called to see a Mare which was believed to be pregnant, and which appeared to be suffering from tedious labor ; and the symptoms — among which were those of violent colic, and energetic expulsive efforts — might certainly have afforded good reason for the supposition. Rodet's first attempts to relieve the Mare having proved unsuccessful, in three hours he made an exploration per rectum, and discovered'that the uterus was as largely developed as at the full period of gestation, though its contents did not feel like an ordinary foetus. Making a vaginal exploration, he was astonished to find, instead of an unformed foetus or mole, several somewhat large excrescences moving about in the uterus, the interior of which they appeared to fill. Thinking that these were true polypi with a wide base, and covered and maintained by the mucous membrane, he submitted the animal to medi- cal treatment. This was attended with good results ; the animal recovered, and during the three months it was under observation there was no relapse ; after that period it was lost sight of. Hydatid kysts have been mentioned as occurring in the domesticated animals, and simulating pregnancy ; but the authorities who allude to these instances have not offered any details. They appear to be related to conception and pregnancy, and in some instances they may be a de- formed embryo. The Veterinarian (vol. xx., p. 187) gives an interesting account of an immense tumor in the uterus which, in the living animal, led to the belief that the Mare was in foal. Hydrops Uteri or Hydwmeira, Hydrops uteri, as the designation implies, is a collection of fluid in the uterus ; though it may not be of a serous character in every case, but may sometimes be purulent. There are many instances of this condition recorded in British and foreign veterinary literature, as occurring in the Mare and Cow — the animals which most frequently receive attention, though the Sheep and Bitch sometimes suffer from this disease. This condition appears to be related to gestation ; it is allied to mole pregnancy, and sometimes closely simulates real pregnancy. It may also be due to injury to the uterus. Rainard says: "When this collection is forming, the abdomen gradually enlarges as in ordinary gestation ; the animal looks healthy, and there is scarcely any difference between this state and that of pregnancy before the second-third, or even the second-half of gestation. It is rare that these collections persist more than five or six months without being evacuated at least once, and it is usual to see this evacua- tion take place every month, or at least every two months. The fluid is greyish-colored, and it is often as much as an ordinary bucketful." Saint-Cyr, in alluding to the cases recorded since Rainard v/rote these lines, remarks that it is usually after a copulation which is supposed to 174 PATHOLOGY OF GESTATION. be successful that these collections form. The collections are gradually- developed, and are accompanied by all the signs of ordinary ges- tation, with the exception, of course, of the movements of the foetus. Then, at a certain time, there appear the precursory indications of parturition or abortion: expulsive efforts — certainly less energetic, painful, or prolonged, as a rule, than those of natural parturition, and rather resemble those of micturition or defecation. The cervix uteri slowly enlarges, though the hand introduced into the vagina discovers it — the OS — to be almost impervious, and neither fcetus nor membranes can be felt ; when it is dilated, there. is at once a gush of fluid, the aspect and c^ality of which varies. It is often greyish-colored, thick, and more or less foetid ; though it may also be clear and serous. Its evacua- tion may occur at very variable periods — as at one hundred and eighty days, five and a half months, thirty-two weeks, or forty-six weeks, after the supposed successful copulation, according to the various writers who have described these cases. Many instances are on record (see the Veterinarian, vol. xlvi. p. 562) ; but we will only quote one, which is the most recent : — Suchanka {GLstcrr. Vierteljahr. f. Wissenshaftliche Veterindrkunde,, i^j ^, p. 76) was summoned, on February 11, to give an opinion as to whether a certain Cow was in calf. The animal was five years old, and had been put to the bull on Aprd 21, 1874; it should therefore have already calved. Many persons had declared that it was in calf ; but the owner was doubtful, and as the animal was unprofitable, he determined to kill it. Suchanka explained that, according. to all experience, the Cow should have calved long before, and that it would be impossible for him to give a decided opinion unless the owner gave his consent to an examination of the Cow, which entailed some. risk. This consent being given, the examination was made. The general health of the animal was not disturbed ; oestrum had ceased ; the abdomen was distended, and the tem- perature was normal. On " touching " the lower part of the right flank, there was a perceptible rebound, and on percussion a hollow sound was elicited ; there was slight swelling of the vulva, with other indications which might lead one to expect that a calf would soon be dropped. On making an exploration per rectum, the uterus was discovered to be much distended in the right flank and fluctuating; but nothing of a foetus could be detected. On examination per vagitiam, that cavity was found to be filled with a yellow gelatinous matter, which on being removed permitted the open os uteri to be felt. The latter syrry^tom, the fluctuation, and the absence of any trace of a foetus, led Suchanka to doubt whether the case was one of normal pregnancy, and to believe that he had to deal either with an abnormal embryo or disease of the uterus. He recommended that the Cow should be killed. This being done, the uterus was found to be of enormous size, and more especially towards the right cornu : this dis- tention being due to the presence of twenty-five to thirty litres of a thin, reddish- brown, but somewhat glutinous fluid. There was nothing solid in the uterus, the walls of which were very thin and flabby, and the cotyledons flatter than in health ; the mucous membrane was smooth, though thickened in the left cornu, of an unhealthy color, and covered with a watery mucus. This was the first case of the kind which fell under Suchanka's observation, and in the absence of' any thing to show that it was the result of abortion, he was of opinion that it was an instance of hydrops uteri. There are two forms of hydrometra — cedematous hydrometra and ascitic hydrometra. The former exists when the walls of the uterus are in- filtrated with serum, and may acquire a thickness of four or five inches ; the latter is an accumulation of fluid in the cavity of the uterus. Hy- drometra has been observed in the Mare, Cow, and Bitch ; rarely in the Sheep. Recovery has often followed the evacuation of the fluid, when it has been in the uterine cavity ; in some cases the condition has become so aggravated as to cause death, or necessitate the destruction of the animal. * DISEASES OF THE PREGNANT ANIMAL. 175 The diagnosis is arrived at by manual exploration, and by the absence of some of the most characteristic indications of pregnancy. When the condition is diagnosed, and there is reason for interference, the indications for treatme?it are plain : carefully dilate the os, evacuate the contents of the uterus, and inject astringent and antiseptic lotions (as carbolic acid i to 20) at intervals into its cavity. Give gentle laxatives frequently ; guard against retention in the bladder, from which the urine may be removed by means of a catheter, if necessary : and give nourish- ing food, with tonics. CHAPTER II. Diseases of the Pregnant Animal. Owing to animals being kept in a more natural state, generally, than the human species, when pregnant they are much less exposed to the risks and inconveniences of that condition than woman. The difference in the attitude of the body may also tend much to obviate those serious acci- dents, and prevent those unpleasant consequences, which so often attend gestation in the human female. Nevertheless, notwithstanding this immunity, pregnancy in animals brings about certain modifications in the female organism which may sometimes call for serious notice, either when it leads to a morbid predis- position, or in its influence on the progress of certain diseases already ex- isting at the time of conception, or which have developed during gestation. There are also maladies which are peculiar to this condition, some of them of great importance. SECTION I. — INFLUENCE OF GESTATION ON ORDINARY DISEASES. The influence of pregnancy on the course of the ordinary diseases of animals has not yet been well ascertained, though it has long been ob- served that such an influence exists, and has often been productive of marked effects. And these may have been due, directly or indirectly, in some cases at least, to the condition of the blood in the female, the red globules of which are greatly diminished, and the proportion of albumen is also notably decreased, w^hile the serum, on the contrary, is much above the normal standard. The amount of fibrine likewise varies, though this variation is neither so constant nor so uniform as in the other constituents ; but it generally increases towards the termination of pregnancy.* Owing to this decrease in the solid portion of the blood, and particularly in the red globules, the pregnant female is more anaemic than plethoric. It is none the less exposed to inflammatory attacks, however, owing to the excess of fibrine \ but as Saint-Cyr justly remarks, these phlegmasia^ assume a particular physiognomy, and run a very different course, to those observed in ordinary conditions, and more especially with regard to depletive measures, which have to be carefully resorted to — or, we might say, abstained from. * In woman, it has been noted that the normal proportion of red globules is from 125 to 127 per 1000 and that durint; pregnancy this proportion falls to 120, 115, 95, 90, and even 87 per 1000 of the total mass of the blood ; while the albumen descends from an average of 70J4 to 6'9, 66, and 62 per 1000. 176 PA THOL OG Y OF GESTA TION. The mechanical effects of the foetus, and the immense volume of the uterus, must also produce disturbance of most essential functions, and more especially those of the abdominal and thoracic organs. Therefore it is, that during pregnancy such affections as indigestion, colic, tympani- tis, enteritis, or pneumonia, are so frequently followed by abortion and slow convalescence, or death of the animal. Chronic diseases have in general but little influence on gestation. It has been imagined that " broken wind " in the Mare is much relieved during pregnancy ; but some observations would go to prove that it is rather aggravated — though the troublesome cough does not appear to militate against the foetus reaching its full period. Acute aiseases are more serious, and especially those of an epizootic kind, which often cause abortion or induce premature labor. Contagious pleuro-pneumonia of cattle, for instance, often produces abortion, and death is more frequent as pregnancy is well advanced. Sheep-pox is also more serious, more often fatal in pregnant Sheep, and most frequently followed by abortion. A number of observers — among them Saint-Cyr, Bouley, Roll, Lafosse, and Reynal — have remarked that the cattle-plague does not appear to have any very particular influence on gestation ; and the same have been said of eczema epizootica ("foot-and-mouth disease"). But this Conti- nental experience does not harmonize with that relating to these two diseases in our own country. Abortion has been a notorious sequel of both maladies, and more especially of "foot-and-mouth disease," in which the losses from this cause have sometimes amounted to twenty, thirty, fifty, and even more, per cent. Painful and nervous diseases are also more serious during pregnancy than at other times. It would, however, seem to be an error to attribute the non-appearance of certain disorders during gestation to the influence of this condition ; as Spinola has done, with regard to rabies, etc. SECTION II. DISEASES PECULIAR TO PREGNANCY. As has been already stated, the diseases peculiar to the pregnant con- dition are fewer, not so frequent, and usually much less serious in animals than in the human female. The chief maladies or morbid conditions which have been noted in animals are cramp, pica or malacia, constipation, oedema, hydrops amnii, paraplegia, and amaurosis, cough, and albuminuria. Cramp. Cramp — by which is meant a tonic, involuntary, and extremely painful contraction of one or more voluntary muscles — is sometimes observed in the Mare during the second half of gestation, the muscles of the thigh, and chiefly the principal extensor of the metatarsus, being almost exclu- sively involved. When effected, the animal either suddenly or rapidly flexes and extends the limb — striking the ground hurriedly and energeti- cally with the foot, as if a fly had settled on the leg, or the whole limb is gradually and rigidly elevated without flexure of the joints, except those of the phalanges, which are half-fixed, the anterior aspect of the hoof being directed towards the ground ; at the same time the muscles of the leg are hard, tense, and painful to manipulate, and the animal b«trays the torture it experiences by its expression and attitudes. This manifestation is increased if the Mare is compelled to walk, its first steps being extremely DISEASES OE THE PREGNANT ANIMAL. ijy difficult ; while "the limb is maintained in a perfectly rigid condition, and the indications of pain most marked. In a short time these symptoms disappear, and movement js restored. The cramp may pass from one hind limb to another alternately, and appears to be due to the compression exercised on the sciatic nerve in its course over the sacro-ischiatic liga- ment. This cramp has much analogy, in its symptoms, to luxation of the patella ; from this it may be distinguished, however, by the latter occur- ring most frequently in young animals, by the displacement of the patella, and by the total inability to flex the limb until the patella has been re- placed. Cramp is of no moment, and can be relieved by walking the animal for a few paces, or by smart friction. It disappears altogether after par- turition. We have already noted that the appetite of pregnant animals is some- times depraved, and that they will ingest foreign matters : such as plaster licked from the walls, wood gnawn from their stable-fittings, earth, etc. When depending on derangement of the digestive functions, this depraved appetite may be corrected by the careful administration of tonics, antacids, and attention to the quantity and quality of the food. The herbivora should be allowed common salt in their food or to lick. Constipation. Constipation is, of course, due to many causes, some of which have no relation to pregnancy. This condition, however, is not at all'rare, par- ticularly in the carnivora during gestation ; and in all animals it may be largely remedied, or altogether removed, by suitable diet and exercise. Purgatives should be avoided, and only mild laxatives resorted to if neces- sary. For the Bitch, which appears to suffer most frequently from constipation, Saint-Cyr recommends the administration, every day for eight or ten days, of five to eight grammes of white mustard. Castor or linseed oil, or even boiled linseed, answer well for the larger animals. CEdema. The infiltration of serosity into the connective tissue of certain parts of the body of pregnant animals — almost exclusively the Mare — is some- what allied to the anasarca serosa of woman. The period at which it is manifested depends much upon breed, conformation, and individual tem- perament, as well as upon the season and hygienic conditions. With common-bred, lymphatic Mares deprived of sufficient exercise, it appears at an early period — from the eighth month of gestation, and sometimes earlier — particularly in the winter. With better bred animals it is later, and in summer may not appear at all in those which are well-bred. It commences usually at the inferior part of the hind limbs, gradually ascending to the hocks, or higher -, the fore limbs are also attacked, though not so markedly ; and the swelling extends to the lower surface of the abdomen. Here it commences by a soft tumor in front of the udder ; this increases in size and spreads over that gland, as high as the vulva, down the inner surface of the thighs, and towards the chest, ster- num, and fore-arms. It readily disappears or diminishes with exercise, and is probably due to the pressure exercised by the foetus on the pelvi- crural vessels, as well as, perhaps, to the anaemic condition of the system. The exemption of the Cow from oedema has been ascribed to the great 12 178 PA THOLOG Y OF GESTA TION. development of the mammary veins in this animal, and their free commu- nication with others, which permits a ready return of the blood from the hind limbs. There is nothing serious in this cedema of pregnancy, as in nearly every case it can be counteracted by exercise or hand-rubbing, and it disappears in a day or two after birth. If it causes inconvenience, frictions with soap or turpentine liniments, bandaging, or even slight scarifications, may be employed ; but the occasions for these must be very rare indeed. Hydrops Amnii. When there is an unusual secretion of the amniotic fluid, it constitutes what has been termed " dropsy of the amnion " {hydrops amjiii or hydramnios) : a condition which, when very marked, is serious for the mother as well as the foetus. A number of cases have been recorded, and Saint-Cyr has enumerated thirteen, ten of which occurred in the bovine, two in the equine, and one in the caprine species. Gierer, who has published an interesting account of several cases, observes that it is most frequently met with in poor, badly-fed animals — and particularly in Cows, in which improper hygiene has produced a morbid excitement of the generative organs ; the result of which is that the act of exosmose and endosmose does not take place equally through the walls of the placentae and placentulae. Symptoms. — It is not until the fifth or sixth month of pregnancy, or even later, that indications of this condition are evident. Then the abdo- men rapidly enlarges, especially to one side — generally the right ; and in a short time it has acquired a greater volume than it has towards the end of gestation. At this period the health becomes deranged, and colic, with or without tympanitis, is not unfrequent. General debilit}' is so marked, that the animal can scarcely, if at all, stand ; the appetite is lost, rumination is suspended, defecation and micturition are irregular, oedematous swelling of the limbs and abdomen ensue, with dyspnoea, which increases so quickly in intensity that asphyxia is often imminent. The muscular parietes of the abdomen have in some cases been ruptured, and the entire mass of the uterus, with its contents, has formed a subcu- taneous hernia. The ordinary period of gestation may be completed ; or abortion may occur at the seventh or eighth month, when all the indica- tions of such an occurrence are present. The uterine contractions, owing to the relaxed condition of this organ, and its distended and paralyzed fibres, are weak, the pains feeble and unsustained, the os does not dilate, and the act of parturition is consequently tediou^. Diagnosis. — The state of the abdomen might lead to the supposition that the case was one of tympanitis or twin pregnancy. Abdominal percussion, and the " touch," as well as auscultation, should aid in diagnosing this condition. Rectal examination will reveal the immense size of the uterus, which forms a great globular mass in the abdominal cavity, and almost completely fills the pelvis, though nothing of a foetus can be detected ; while vaginal exploration discovers the cervix uteri effaced, the os closed, and the posterior part of the uterus projecting more or less into the vagina ; pressure on this prominent portion proves that it contains fluid, though usually no foetus can be felt, as it is beyond DISEASES OF THE PREGNANT ANIMAL. 179 the touch, and almost lost in the small ocean of fluid surrounding it. In rare cases the os is partially dilated, and the fcetal membranes protruding more or less into the vagina ; usually, however, scarcely one or two fingers can be introduced into it. Results. — The occurrence of hydrops amnii is nearly always fatal to the foetus. In none of the thirteen cases aHuded to by Saint-Cyr was it alive ; in a certain number it appeared to have lived up to the period of parturition or abortion ; in others it had been arrested in its development, and was dead for some time. In a Goat, the two foetuses were in a state of general anasarca, and completely infiltrated. The mother may or may not survive. Of the above cases three perished from the disease ; one was killed as incurable ; another recovered after a long time ; one was subsequently sold for food ; five got well so rapidly and completely as to be bred from again. The results have, as a rule, been more favorable as assistance has been prompt and early. After death the uterus is found excessively dilated, pale in texture, with ecchymoses on its surface. The fcetal membranes vary, sometimes being thickened and dense, and other times attenuated and friable. The liquor amnii has been found contained in alveoli, or cells, formed by the processes uniting the allantois to the amnion ; so that the membranes might be torn in several places without all the fluid escaping — in this respect resembling the vitreous humor of the eye. The liquor is usu- ally limpid and transparent, or of a pale citron color, with a slightly sweetish taste ; its quantfty, as has been remarked, is always considera- ble : as much as 50, 70, 100, 120, 150, and even 180 litres having been found. One example of this condition will suffice. It is given by Mr. Cartwright, of Whit- church, and the subject was a thorough-bred racing Mare, whose extreme " size " while pregnant was ascribed to the presence of twin foetuses, and also, it would appear, to an excessive quantity o£ fluid in the uterine cavity. The period for parturition arrived without any signs of milk-secretion or relaxation of the pelvis, and the abdomen meas- ured thirteen feet in circumference. Symptoms resembling slight colic appeared, which were not relieved by medicine, and the abdomen became so tense and hard that it was feared the muscular parietes would give way ; strong bandages were, therefore, placed round the body, though through these having been fastened too tight, the Mare fell apparently asphyxiated. However, on their being loosened recovery took place, and her sufferings subsided so much that food and water were taken, and general amendment seemed to have set in. Next morning, however, the unfortunate creature was found with an extensive rent in the right iliac region, from which the small intestines escaped. It was destroyed, and on opening the abdomen the uterus alone, with the exception of some portion of the small intestines, was the only organ visible, it being of extreme dimensions, and very pale and flaccid ; it contained about twelve gallons of serous fluid, as well as two dead, but perfectly developed, colt foetuses. These were of such a size, that it was surmised parturition could not have been safely accomplished, even had there been no dropsy. Indications. — The chief indication is to evacuate at least a portion of the fluid, by rupturing the membranes, as medical treatment has always "proved inefficacious. It must be remembered that the fcetus is always pdead ; and even if alive, with the view of saving the life of the mother, it should be sacrificed. Though opening amniotic sac, and removing a certain quantity of the liquor, need not necessarily compromise the exist- ence of the foetus ; as a case has been published by Lhomme {journal de Veterinaire du Midi, 1869), in which a portion of the foetal membranes, ■protruded beyond the vulva, was excised without interfering with the i8o PA THOLOG Y OF GESTA TION. ordinary progress of gestation ; as when parturition occurred three months afterwards, a well-formed mule was born and continued to live. The chances of success are greater as intervention takes place early, and before the abdomen is excessively distented, the respiration not seri- ously affected, and debility not great. The evacuation should be effected through the vagina, though it has been made through a puncture in the flank. If the membranes are in the vagina, they may be ruptured by the fingers there ; if not, and the os is sufficiently dilated for the admission of the hand, they may be ruptured in the uterus ; if it is closed it should be gently dilated, and the envelopes punctured, if necessary, by means of a trocar and canula. As soon as the membranes are pierced, a gush of fluid takes place, the abdomen diminishes in volume, the uterus becomes retracted, and in this retrac- tion the foetus and membranes are sometimes expelled. Should this expulsion not take place soon, they must be removed in the ordinary way. Afterwards, the animal is to be carefully attended to and gener- ously fed. Paraplegia: Paralysis of the posterior extremities during gestation, is not rare in the Cow, especially when near parturition, and often even v/hen that act has commenced ; it is also witnessed in the Sheep and Goat. Generally, however, it appears six, eight, ten, or twenty days, rarely a month or six weeks, previously, and attacks animals in the most diverse hygienic conditions — those which are well fed and tended, as well as those which receive the opposite treatment. As Saint-Cyr remarks, it is not rare to observe, in a cow-shed, two or three cases occurring a short dis- tance from each other, and even in a locality we may, in certain years, meet with a number of cases; then several consecutive years may elapse without any being noted, though it would be a manifest exaggeration to say that it was either an epizootic or enzootic malady. It must not be con- founded with what has been termed " parturient fever," in which we have paralysis, but from which it differs greatly, as the symptoms and results will show. The paralysis of gestation generally appears suddenly and without any premonitory symptoms, manifesting itself with the same intensity at the outset as at a later period ; though in rare cases, the animal shows a weakness and unsteadiness of the posterior part of the body and hind limbs for a short time before it drops, and the tail hangs disjointedly and flaccid. When paralysis has really set in, the Cow is forced to lie, but it does not appear to puffer ; the decubitus is natural, the head carried as usual, the eye bright and clear,, the muffle damp and cool, and the rumination in the majority of instances is not suspended ; the pulse, respiration, and appetite are unaltered, and sensation does not seem to be impaired, even in the hind limbs — it may even be exalted. Consti- pation is frequently present. It is only when the animal attempts to rise that its condition is evident ; the fore limbs and neck can be moved to accomplish this, but the hinder extremities are powerless. Ordinarily, the paralysis persists until parturition, when it disappears ; though Saint-C5T mentions an instance in which a Cow became paralyzed twenty-eight days before that event, and lay on the litter for two days after calving, without being able to move its hind extremities, but which arose spontaneously on the third day, and did well. The same authority. DISEASES OF THE PREGNANT ANIMAL. i8i however, states that he has occasionally witnessed the paralysis persist for a longer time after calving, and either cause death or necessitate slaughter. I have seen a sheep which eventually died from the ante-par- turient paralysis. The cause is somewhat obscure, but is supposed to be due to compres- sion, or rather straining, of the nerves and vessels of the posterior extrem- ities by the heavy uterus. In five or six cases there has been found on post-mortem inspection, infiltration of the dorso-lumbar and gluteal muscles, and discoloration of the muscular fibres. The spinal canal has also con- tained a large quantity @f serum, and the membranes of the spinal cord are injected. From the rapidity with which recovery generally takes place, it is obvious that the lesions cannot be serious. Treatment. — In the majority of cases, and especially before parturi- tion, but little treatment is necessary. The principal indication is to avert or get rid of constipation by means of laxatives and enemas, and pay attention to the diet and cleanliness, while enjoying quietude. Should the paralysis continue for any length of time after parturition, then more energetic treatment may be adopted. In these cases, the subcutaneous iniection of strychnine is nearly always attended with sliccess. Artificial removal of the foetus is not to be recommended, except in very exceptional circumstances. Amaurosis. The only instances of amaurosis occurring in connection with preg- nancy, are two given by Riss {Recueil de Med Veterinaire^ 183 1). A Mare, nine years old and in good condition, when advanced in pregnancy became blind. On the eyes being examined by Riss, the humors and lens were found to be quite healthy, but amaurosis was complete. A blister was applied to each cheek, and other treatment adopted, but without success. The day following- parturition, which occurred about a month after, vision was perfectly restored. A seven-year-old Mare, when near parturition, and which had never exhibited any thing the matter with its eyes, suddenly became blind from amaurosis. Remembering the other case, Riss abstained from treatment. The Mare foaled in thirteen or fourteen days after loss of sight had been noted, and on the third day after this occurrence it was able to see as well as ever. Cough. We have mentioned hydrops amnii as a cause of disturbance m the respiration, the obstacle to which is often a marked symptom of that condition. But even without the existence of this kind of dropsy, the breathing is not unfrequently impeded in pregnant animals, and this obstruction is sometimes accompanied by a very harassing nervous cough, which, in the larger animals, and particularly in the Mare, may lead to in- jury. For the relief of this cough, Zundel recommends the cyanide of potassium. Albuminuria. Ihe existence of albuminuria in pregnant women has long been ^ known, and Zundel gives it as one of the complications or accompani- ments of gestation in animals ; though he does not look upon it as a pathological condition. Saint-Cyr, on the contrary, thinks that this is a matter well deserving further investigation ; for as various kinds of paralysis — eclampsia, paraplegia, amaurosis, etc. — are probable conse- quences of albuminuria in the human female, there is no reason why they may not be so in animals. i82 PATHOLOGY OF GESTATION. CHAPTER III. Accidents of Pregnancy, Though a distinction between the diseases and accidents of pregnancy cannot always be readily drawn, yet for convenience we follow Saint-Cyr, in allotting to a separate chapter those conditions or diseases which may be due to accidental causes, operating either externally or internally. These are prolapsus of the vagifia, hernia of the utei'us, rupture of the uterus, tnetrorrhagia, abnormal retention of thefeetus, and abortion. Ante-Partum Prolapsus of the Vagina. Prolapsus vagince, or inversio vagitice, has only been observe^, so far as I can ascertain, most frequently in the Cow and Sheep ; rarely in the Mare or Bitch. It consists in the protrusion of the vagina by the uterus and its contents during pregnancy, the tumor it forms appearing between {inversio vagince. incompleta), or external to {iJiversio vagina co77ipletd), the labia of the vulva. It must not be confounded with post-partum pro- lapsus. This accident is peculiar to pregnancy, and may occur in well- shaped Cows, but whose tissues, and especially those of the genital organs, are soft and relaxed : animals of a lymphatic temperament, good milkers, with a wide pelvis, and which are fed on an abundance of bulky but innutritions food. Keeping such Cows on a floor sloping too much to the rear, as well as falls, injuries of different kinds, distention of the rumen, fatigue, etc., are all likely to lead to this accident in such ani- mals, when pregnant. It is observed, though very rarely, in primiparae, and occurs most frequentl}'' after the third or fourth gestation, the period of its appearance during that state varying : in certain Cows manifesting itself so early as the fifth month (though this is rare), and oftenest at the end of the seventh or eighth month, and even so late as twenty or fifteen days before delivery. The occurrence of the accident is made known by the appearance, at the vulva, of a circular, bright-red tumor, depressed in the centre, and of a variable but gradually increasing size, as gestation advances, or the exciting causes remain in operation — from the volume of a fist to that of the head of a child or man, or even larger. At first it is only visible when the animal is lying, and disappears when' it gets up ; but when of considerable volume it never entirely vanishes in the latter attitude, and even when reduced by the hand the vulva remains larger than usual. This prolapsus, in the majority of cases, does not appear to cause the slightest inconvenience to the animal, and offers no obstacle to par- turition — indeed, it has been noted that such Cows calve more easily than others ; neither does it predispose to chronic eversion of the vagina, as has often been supposed. After calving, the vaginal tumor disappears without any treatment being required. With some young, fidgety Cows, however, when the tumor is volumin- ous, often recurs, and the animal is feeble, expulsive efforts increase its size and irritate it ; and thus give rise to more or less derangement of health, constituting a serious accident. Loyer has noted three deaths in thirty-six instances recorded by him. According to Cox ( Veterinary journal, vol. i., p, 267), Sheep, when heavy in lamb, frequently evert a double fold of the vaginal mucous mem- ACCIDENTS OF PREGNANCY. 1 83 brane. This happens when they are in a recumbent position, and it is in some animals of such frequent occurrence as to cause excoriation and ulceration. Treatment.— The first thing to be done, if the floor of the stall is lower behind than in front, is to level it, or even raise it a little behind. This may be readily accomplished by means of the litter. The diet may also require attention, giving that which contains sufficient nutriment in small bulk ; constipation should be guarded against or remedied. This treatment will be sufficient in the majority of cases. In others, a bandage, to be hereafter described, may be required, and especially if the tumor is liable to become soiled and irritated when the animal is lying. In serious cases, when the tumor is large and the Cow strains, and spontaneous reduction does not occur in the standing position, the mass must be returned. This is readily enough accomplished ; but it some- times happens that reduction does not prevent a continuation of the straining, and even with the bandage the everted vagina again appears. This is due to the mucous membrane, which, not having been properly smoothed down when introduced into the pelvic cavity, is ridged, and these rugae give rise to an uncomfortable sensation, and induce expulsive efforts. It is necessary, therefore, in reducing the part, to smooth the vaginal mucous membrane by gentle pressure forward as far as the cervix uteri, in order to efface any folds which may excite uneasiness. After this the bandage may be applied with a view to keeping the vulva closed, until its labia have retracted somewhat. Wire sutures through these have been recommended, but they are very rarely required. In very exceptional instances, we may have not only complete prolap- sus vaginae, but also partial protrusion of the uterus itself. Then the case is very serious, owing to the weight and bulk of the foetus, which has to be returned beyond tli^e inlet of the pelvis. Death is often the re- sult of such an accident ; and to prevent a fatal termination, it has been suggested that artificial delivery should be effected without delay. Pre- mature delivery has been counselled in those cases in which the Cow continues to strain and evert the vagina, notwithstanding bandages, sutures, and other means, and when grave consequences are likely to fol- low ; more especially is this advice to be adopted when pregnancy has reached the 260th day, and the calf is alive. With Sheep, according to Cox, it is a common custom" to return the partially prolapsed vagina, and to tie the wool across the vulva ; on other occasions a truss, similar to that used for cattle, is employed. Both methods frequently fail, and in these cases nothing answers so well as the ring-shaped pessary. Hernia of the Uterus (Hysterocele). Hernia of the uterus is not uncommon in the domesticated animals, and has been observed in the Mare, Cow, Sheep, Goat, and Bitch. In the latter animal the organ is often displaced before conception, and the foetus is developed in the hernia ; but with the, larger creatures the empty uterus in too far removed from the abdominal parietes to escape from the cavnty ; and it is only when its volume is increased as gestation advances, that it may form a hernia, should there exist an accidental opening in the 1 84 PA THOL OG Y OF GESTA TION. muscles which enclose the cavity. In the Bitch the hernia may be in- guinal ; in the other animals it is always accidental and ventral, and usu- ally towards the inferior part of the abdomen, on the right or left side, or in the pubic region. Its ordinary cause, when accidental, is due to the natural or spontane- ous relaxation of the abdominal aponeuroses ; or to traumatism, as con- tusions or strains, the viscus being generally only covered by the skin. It is rare in young animals. In the Cow it is not at all unusual to observe the hernial tumor in front of the pubis, towards the attachment of the recti muscles, and near the udder ; here it may be of a great size, extending as low as the hocks, pushing the mammary gland to one side, reaching as far forward as the floating ribs, and containing, in addition, other of the abdominal viscera than the uterus and its contents. This tumor impedes movement ; the hind limbs are kept widely separated, and the animal is much inconve- nienced. With the Bitch, ventral hysterocele has been noted in two regions — above the mammae, where it might be mistaken for a scirrhus tumor ; and in one of the labia of the vulva, beneath the skin. In the larger animals, the foetus may sometimes be felt in the tumor, and its movements may be noticed ; though, owing to its being so low, it cannot be reached from the rectum. Very often, excepting the inconvenience to the female, hysterocele does not interfere with gestation, nor give rise to any serious symptoms ; though, in some cases, it may render parturition laborious and protracted, if not impossible. In other cases this act may be accomplished without difficulty or extraneous aid ; Cows which have been ruptured from the perineum to the ribs have calved easily enough ; and Leconte alludes to Mare which had a uterine hernia nearly as extensive as this, and yet brought forth four living foals in succession. Nevertheless, it is somewhat of a risk to attempt to breed from such animals. When treating of difficult parturition, we shall have occasion to return to this subject. In the mean time, it is only necessary to say that in order to obviate serious consequences, the hernia should be sup- ported by a wide bandage until the uterine contents are expelled. Should circumstances render it necessary, abortion may be artificially induced, or hysterotomy may be performed. Ante-partum Rupture of the Uterus. Rupture of the uterus may happen before and during parturition, or in attempts to reduce the organ when inversion has occurred during that act. This accident is not very common before gestation has terminated, and the symptoms by which it can be diagnosed are not very reliable. Spontaneous rupture of the uterus usually occurs at the anterior part of the organ, between the two cornua, or even in the cornua themselves ; the direction of the rupture generally depending on the direction of the mus- cular fibres — being sometimes diagonal, at other times transversal, and more rarely longitudinal. The size of the rupture also varies considerably ; though it must be remembered that in the dead animal ruptures only ap- pear in their original dimensions when the uterus had lost its contractility before death, and immediately after their production ; when the organ has contracted after the accident, the extent of the laceration is much dimin- ished. The lips of the wound are in some cases thin and ragged, in ACCIDENTS OF PREGNANCY. i8S others swollen and inflamed. The texture of the uterus itself, in the vicinity of the rupture, may be quite healthy, or it may be inflamed, soft- ened, or gangrenous ; while the peritoneum is normal or inflamed. The blood effused into the abdominal cavity may be in large quantity or scarcely noticeable, and it may or may not be decomposed. According as the tissue of the uterus is more or less completely torn, the ruptures have been divided into those which are " complete " and "incomplete." In the first, the cavity of the organ communicates freely with that of the abdomen ; while in the second, the peritoneum, or some- times a portion of the muscular layer, is intact. Symptoms. — The symptoms of rupture of the uterus are not well de- fined. If there has been straining, in the majority of cases this ceases altogether or diminishes ; sometimes blood or blood-colored fluid flows from the vagina, though this symptom is rare. The physiognomy of the animal changes ; at the same time it becomes restless, often the limbs are cold, the pulse small or imperceptible ; a cold perspiration covers the body ; the animal sighs or moans, is affected with dyspncea, is greatly agitated, and intense debility sets in. The symptoms are violent and marked as the accident is sudden and severe. If the foetus has passed into the cavity of the abdomen, it may be felt there ; and there may also be an alteration in the shape of the abdomen. Vaginal exploration generally reveals alterations of a distinctive character — sometimes even the rupture may be detected, and the absence of the foetus from the uterus noted. When the rupture is small and takes place gradually, the symp- toms are sometimes little marked, and a diagnosis is more difficult. Results. — Rupture of the uterus is sometimes followed in the gravid state by fatal haemorrhage, peritonitis (particularly in the Mare), or the results described in extra-uterine gestation. Recovery may occur either by surgical interference, or by the aid of nature alone. When the organ contracts the dimensions of the rupture are reduced, and tears in the upper portions are very much less serious than those in the lower surface, for obvious reasons. Saint-Cyr has given an analysis of some published cases, to which I have added others more recent. 1. In 1808. Anfri [Correspondence sur les Animatix Domestiques,-\^-xr Fromage de Feugre, vol. iii., p. 179) was called upon to attend a Cow which had. been attempting to calve for two days. When he saw it, its efforts had ceased, and it was greatly pros- trated ; the hand introduced into the uterus could not discover the foetus. Death occur- red on the night of the third and fourth day, without any thing having been detected which could have prevented delivery. On examination of the body, the foetal fluids were found in the abdominal cavity, as well as the foetus itself. They had escaped by a large oblique rent in the fundus of the organ ; while the left cornu'was also torn for one half of its length. The cause of the mishap could not be ascertained; the animal had been straining violently for two days, and a quack had attempted to deliver it. 2. Vatel [Journal Pratique de Med. Vet., 1827 ) reports that a Cow in a very bad state, was sent to the Alfort School on April 25. It could scarcely walk, and there escaped from the vulva glairy, blood-colored, odorless matter ; the condition of the animal was serious. On manipulating the abdominal wall, there was felt a hard resisting body. The Cow did not strain, and gradually became weaker until the night of the 28th, when it succumbed. The abdomen was found to contain about 15 litres of blood-tinted serosity ; the omentum was g^t^.\\y t\\\Qk.&nQ.d., and adhesiojis were observed on its visceral surface corresponding to the processes of the placenta ; the peritoneum showed traces of intense inflammation; while the' foetus lay on the floor of the abdomen, from which it 1 86 PA THOLOG Y OF GESTA TION. was only separated by the omen^tum and its own membranes, which were not ruptured. Two large unaltered clots of blood were discovered between the anterior extremities of the fcEtal membranes. The uterus maintained its natural situation, but it was con- tracted, and rent from its cervix to the middle of its left cornu. The borders of the rupture were red, swollen, and rounded : but the interior of the organ did not exhibit any trace of inflammation. The cause of the accident was unknown, 3. On June 8, 1843, Arnal {Joiirnal dcs Vet. du Midi, 1843, p. 331) was summoned to attend a Cow which had been ijl since the previous evening, when, about half an horn- before it was noticed to be unwell, it had playfully jumped a wide ditch, though it was advanced in pregnancy. Soon after it voluntarily returned to its stable, covered with perspiration. In consequence of there being no straining, the case was supposed to be merely one of " chill," though the creature was very ill indeed-. Next day it was worse ; the vulva was swollen, and there was slight straining. The hand introduced into the vagina discovered the " water-bag," in which the head of a foetus could be readily distinguished. On the membranes being ruptured, only about half a litre of fluid escaped ; the foetus was alive, and in a vertebro-pubic position, the limbs being doubled on the chest. These were placed in a favorable direction, and by means of moderate traction the calf was born alive. The Cow appeared to be much better, and it was hoped that recovery would' ensue ; but all at once its condition became most serious, and in spite of every measure it per- ished on June 1 1. When opened, the abdomen was found to contain about ten litres of sanguinolent serosity, and the peritoneum was much injected ; while the uterus, whose walls were considerably thickened, showed at its lower surface, near the cervix, a rup- ture four centimetres in circumference, the border of which was red and violet in color, and greatly tumefied. The uterine mucous membrane was reddish-brown, and studded with ecchymoses. The vagina and vulva did not offer any thing unusual. 4. Presseq {jfourjial des Vet. dti Midi, 1849, P- 35^) saw a Cow on March 4, 1846, which the owner said could not calve. There was nothing, however, to indicate that partu- rition was near : the vulva was not swollen, the gluteal muscles had not sunk, the abdo- men was round, the flanks were full as high as the transverse processes of lumbar ver- tebrae ; and when the hand was introduced with some difficulty into the vagina, the os uteri was found to be hermetically closed. Presseq concluded that the animal was not near calving, and promised to see it again next day. It died during the night. At the autopsy, the first thing which attracted Presseq's attention, on opening the abdomen, was a foetus, with its envelopes, lying on the walls of that cavity, and but recently dead, as the hair was intact and adherent, and the liquor amnii very limpid. On examining the uterus, he noticed only a small perforation about four centimetres in diameter, the margin of which was so completely cicatrized, smooth, and even, as to give it more the appearance of a natural than an accidental opening. The body of the uterus was con- tracted, and had lost much of its capacity. Presseq learned that, two inonths pre- viously, this Cow and another had drawn a load of barley to the neighboring market, and in passing a stall they took fright and ran away, and were not stopped until the cart was upset. But the animal did not appear to be any the worse until this illness set in. The other Cow gave birth to a fine calf. To this accident, two months before, Presseq attributed the rupture of the uterus, and the escape of the foetus into the alDdominal cavity. 5. "Boizy {Recueil de Med. Veterinaire, 1863, p. 272), called to see a Cow on February 8, 1863, noted the following symptoms : general tremors, colic, incessant pawing, slight tympanitis, inappetence, frequent groans, and faeces very hard and covered with mucus. He diagnosed enteritis, complicated with indigestion. By suitable treatment the ani- mal appeared to recover, but on March 8 it had a relapse ; the more urgent symptoms were allayed by similar treatment, but it never quite recovered, and lost condition. On the 28th of the same month this Cow, whose time for calving was April 4, evinced the first signs of parturition. On the 29th, Boizy found it straining must violently, and a portion of the foetal membranes extruded from the vulva. Exploring the vagina, no calf could be felt, and supposing it had been already born, search was made for it among the litter and in the shed, but without success. Boizy again examined the vagina and uterus, and was struck by a circumstance which he had not before remarked : the in- ternal capacity of the latter organ was not one half what it should have been had de- livery occurred only a short time previously. He began to separate the maternal and foetal cotyledons on the lower surface, an^ on I'eaching the upper part, a little to the right, he \vas much astonished to encounter a sinuous ring the size of a fist, directed obliquely forwards and from right to left, and measuring about twenty centimetres in length ; 'to this the chorion was attached in the closet fashion, and the membrane ex- tended from it in a folded manner, like a half-open fan. This was the opening by which the foetus had passed into the abdominal cavity. The removal of the membranes was ACCIDENTS OF PREGNANCY. 187 given up as useless, and the abdomen was examined externally. The " touch " of the right flank did not reveal any thing, but that of the left discovered a hard voluminous body, which was surmised to be the missing foetus. The Caesarean operation was pro- posed by Boizy, but the owner would not allow it. The Cow died and was buried, but Boizy had it exhumed three days afterwards ; though the autopsy was not so satis- factory as he could have desired, owing to this interval. He could only note that the foetus was in the abdomen, and that, notwithstanding this change of domicile, there were indications that it had continued to live as long as the Cow ; it had long frizzled hair, two incisors were apparent, and the horn of the hoofs was of a greenish color. The cause of the accident could not be discovered. 6. Dupont [yournal des Vet. dii Midi, 1849, P- 497) informs us that a farmer bought a pregnant Sheep, which soon after purchase showed signs of abortion, though the foetus was not expelled. In two months, a considerable tumor formed a little to the right of the umbilicus ; this suppurated, and from the abscess the four limbs of a foetus, minus the pasterns, were expelled ; then the wound cicatrized. Three and a half months later, another tumor appeared at the same place, and this likewise opened, but it only gave exit to faeces. The Sheep was then given to Dupont, who kept it for some time, then had it killed in order to study the lesions. On opening the abdomen, the caecum was found to be verj' much enlarged, had somewhat the shape of a horse's stomach, and was closely adherent to the abdominal muscles ; it offered four openings, the first of which was at the middle of the lower part, corresponding to the opening in the abdo- men, and from which the faeces were passed. Two other openings were in the intestine only, but the fourth communicated with the right cornu of the uterus, which adhered in the most intimate manner to the caecum. The uterus contained aL small quantity of greyish-colored foul-smelling fluid, in which floated some small bones, chiefly the first phalanges of the fore limbs. The vagina was completely twisted from left to right, and Dupont was of opinion that this was the cause of the lesions described. The cause of- the vaginal torsion, however, could not be ascertained. 7. Legrain (Annales de Med. Vet. de Bruxelles, 1865, p. 124) relates that a laborer having quarrelled with his employer, revenged himself on a poor she-goat which was pregnant, by kicking it violently on the belly. In consequence of this injury, the animal lost its appetite, passed blood per vagittam, was ill for ten days, and then all the phe- nomena of gestation disappeared ; the milk was suppressed, there were alternations of appetite and inappetence, and the creature became terribly emaciated. Neverthe- less, in six months the health was so far re-established that oestrum appeared. It was put to the male, though without result, and it did not again manifest "heat." A year subsequent to the accident, Legrain was asked to look at it, as " it had a hole in front of the teat." There, undoubtedly, was a circular opening about ten contimetres in width, through which this veterinarian extracted two incomplete foetuses in process of decom- position. A sponge steeped in cold water was introduced into the sac whence they had been withdrawn, the wound was cleaned and dressed in the same manner on the follow- ing days, and in three weeks the animal had recovered, though the udder remained atrophied. 8. Schmelz [Annales de Med. Vet. de Bruxelles, 1859, p. 382) mentions the case of a Cow which was eight weeks beyond the period of calving, and was constantly lying, without making any attempt to get up. It was killed, when all the viscera were dis- covered to be healthy, and a fully-devdoped foetus, surrounded by its membranes, lay in the abdomen. The uterus was completely detached at about six centimetres from the cervix, and the margin of the wound was already cicatrized. The foetus, envelopes, and detached uterus exhaled a most offensive odor, and were putrefied. There was no tract of liquor amnii. The reason for this rupture of the uterus could not be discov- ered. 9. On May 21, 1874, Vernant [Recueil de Med, Veterinaire, 1874, p. 924) attended a Cow eight years old, which had arrived near the termination of gestation, and could not eat, groaned constantly, and was tympanitic. It lay on the right side in a natural way ; the belly was enormously large laterally, but the tympanitic distention was on the left ; loss of appetite, continual groans heard at some distance, eyes sunk, pulse imper- ceptible, and the skin and limbs hot ; the foetus felt at the lower part of the abdomen on the left side, but no movement perceived in it ; constriction of the cervix uteri, which, in consequence of the tvmpanitis, was only about four inches from the vulva ; the animal could not get up. Fifteen days previously it had been treated for supposed indigestion by quacks, but it gradually became emaciated and weak, and lost its appe- tite. A few days before Vernant was called in, the owner was astonished at the ap- parent, but gradual, descent of the foetus in the left flank, and this, coupled with the condition, caused him to think that calving was about to take place. Seeing that the tympanitis was producing serious effects, the rumen was punctured and a quantity of gas escaped ; the animal was relieved, but the groaning did not cease, and the pulse i88 PA THOLOGY OF GESTA TION. did not appear. Another exploration per vaginam, proved that it was impossible to induce parturition, as only one finger could be introduced into the os. Twenty-four hours afterwards, another exploration was made, when Vernant was surprised to find the OS so dilated that he could feel some cotyledons, which led him to believe that he could effect delivery. On introducing his right arm deeper, however, he was aston- ished to discover it enveloped by the membranes only, without meeting with any trace of the foetus ; exploration of the horns did not discover it, and it was only by a most careful investigation that he satisfied himself that the membranes were displaced, tense as if something was hanging to them, and that there was no liquor amnii ; while the cavity of the uterus itself would scarcely contain a man's head. Vernant then surmised that this was a case of extra-uterine gestation ; though he was not quite satisfied, as the presence and development of the foetal membranes rather proved the contrary. In order to solve the enigma, the inextricable mesh of membranes was torn, and the cavity of the uterus reached; then, at the part which offered most obstacles, he contrived to pass a finger, and then his hand, into a diverticulum or rent, through which the mem- branes passed. Following these, the hand went into a large cavity in the left flank, where nothing could be felt. Turning over the animal on the right side, with external assistance he managed to feel the head, a fore limb, and then the abdomen of the foetuS; which was in a transverse position — the head in the left flank of the Cow, and the belly at the pelvic inlet. He drew the head and limb towards him, but could not reach the other fore leg ; to do this would have required an arm four or five feet long. Diagnos- ing a rupture of the uterus, and seeing that the Cow was about to succumb, the butcher was sent for. Next day the carcase was examined. There was an enormous male foetus, weighing 65 kilogrammes, and as large as a two-months' old calf, with an extraordinary large head, neck, and belly, and deformed pelvis ; in its stomach was about 20 litres of clear fluid like water, and odorless ; the abdomen contained a con- siderable quantity of sanguinolent serum, and putrefaction was commencing in the viscera. The uterus of the Cow was remarkably contracted, and at the commencement of the left horn, near the body of the organ, the outer border showed a somewhat regu- lar rent more than three inches long, with red infiltrated edges. The cotyledons ap- peared to be healthy, and were everywhere covered by their placentulae. The origin of the accident was ascribed to the large size of the foetus, which, lodged in one of the horns, deranged the digestion, and the walls of the part becoming thinner, at last rup- tured to a slight extent ; the weight of the foetus gradually dilated the rent, through which it slowly passed, until it fell into the peritoneal cavity, carrying with it the foetal membranes, which maintained their relations with the maternal cotyledons. The uterus must have retracted immediately, and thus masked the rupture during the exploration. The foetus, too, must have lived for some time after its change of location ; though it is not improbable that, in its struggles, it swallowed a large portion of the liquor amnii. 10. In the Veterinarian (vol. vii., p. 39) Mr. King describes a case of rupture of the uterus, and the escape of the foetus into the abdominal cavity. The cause of the rup- ture was supposed to be the swollen and "puffed-up " condition of the foetus. 11. In the same journal (vol. xix., p. 624) Mr. Cox states that he visited a Cow in a serious condition ; there was a peculiar heavy groaning, particularly when the animal was lying ; tympanum of the rumen and abdomen ; the faeces were liquid, black, and offensive, and voided with tenesmus ; mouth cold, and rigors ; mucous membranes pal- lid. The animal died, and when opened the calf was found among the intestines, the uterus ruptured, and the peritoneum inflamed. It was within five weeks of calving ; the foetus was healthy and well developed, and appeared to have been alive up to the time of the rupture. No cause could be discovered for the accident. The same veter- inarian alludes to a similar accident occurring in a Mare, through unusual exertion in draught when within a month of foaling. She died in twelve hours from internal haem- orrhage. 12. M.-AC%\\X\six?i^ (Veterinary yotcrnal, 1876, p. 249) was requested to visit a two- year-old Cow in the seventh month of pregnancy, which was very uneasy, and showing slight calving pains, He found immense distention of the abdomen, with a slight but thick reddish-brown discharge from the vagina. From the symptoms, it was supposed that a dead calf was about to be expelled, and a vaginal examination was accordingly made. ' The os was slightly dilated, and a portion of the foetal membranes as large as the fist lay in the vaginal canal ; on rupturing and removing this, it was discovered to be part of the chorion with two placentulae attached. Very little fluid escaped, and the *•' pains " were scarcely at all present. The os only admitted three fingers, and it could not be dilated ; one finger pushed through it came in contact with a foetus. Explora- tion of the cervix afterwards did not produce any straining, and the os remained rigid. The case being deemed hopeless, the animal was killed. When the abdominal cavity was laid open, an extraordinary quantity of a nearly transparent and slightly yellow- colored fluid escaped. There was an immense rupture in the fundus of the uterus, to- k A CCIDENTS* OF PREGNANC Y. 1 89 wards the left cornu. One foetus had escaped from the uterus altogether, and was found, destitute of membranes, in the right hypochondriac : another fcEtus was yet in the uterus — towards the right cornu, and part of the intact amnion enveloping it pro- truded through the rupture. The two foetuses did not appear to have been long dead, as there was no putrid smell about them or the membranes. The walls of the uterus were apparently healthy ; the external surface of the liver and intestines was bleached, and near where the disengaged foetus lay the peritoneum was blanched. Macgillivray was of opinion that hydrops uteri must have existed for a .considerable time, as the animal had been large-bellied and uneasy for some days ; though three or four days before he was calle^ in, it was supposed that she had sustained an injury from another Cow, and that then or afterwards the rupture had occurred. Saint-Cyr refers to what the Italian veterinarians designate as semi- mobile uterus, and which he believes to be allied to rupture. This is a condition in which the uterus has been completely divided across, either at the body or the cornua, and remains floating in the abdominal cavity, being only suspended by the broad ligaments. The most singular fact connected with these cases is, that although the uterus is torn in this manner, its contents — the fcetus and membranes — do not escape ; the section cicatrizes, and the organ appears as a large kystoid tumor. ErcoLini, Veterinary Professor at the Bologna University, has met with four instances of this extraordinary accident, the pathological specimens being deposited in the museum of that institution. Their history and description are as 'follows : 1. The uterus of a Cow which contained in one of the cornua a foetus beyond its term, and in the other horn such a great quantity of mucus that, so far as volume is concerned, it would be difficult to say which cornu was the largest. This uterus is completely divided at the cervix and floats in the abdominal cavity, being attached only by the broad ligaments, which are thin and distended. The detached portion of the uterus has a globular form, and its perfectly smooth surface is everywhere covered by peritoneum ; where the separation has taken place, the organ is closed by the cicatri- cial union of the border of the rupture. The mucous membrane in the left cornu of this portion is loose, and shows numerous radiating cicatrizes ; the foetus in the right cornu is indurated, and appears to have lived beyond the ordinary period of gestation, to judge by the hoofs, as well as the teeth, which are cut. The nose did not corre- spond to the opening of the cornu, as the head was* doubled on the left side of the neck. The vertex and occiput were turned upwards, and closed a vast circular opening result- ing from the destruction of the partition separating the two cornua. The head ad- hered to the entire border of this opening — unequal and ragged as it must have been ; and all that portion which projects into the left cornu presents a large tonstcre, where not only is the skin absent, but even the periosteum itself. Lying flat on one of its sides and curled up, the limbs twined towards the head, and the muffle placed between the thighs, the fcetus represents a kind of great discoid bod}-. .^ 2. Cornu of the uterus of a pregnant Cow, containing a completely developed foetus, markedly indurated. This cornu, perhaps ruptured during parturition, is detached, and hangs almost free in the abdomen ; while the rupture has cicatrized, and there is formed a large kyst, everywhere closed, and containing the foetus. The walls of the uterus are for the most part fibrous, and the foetal envelopes coriaceous. Like the preceding case, this specimen was found in a Cow which had been slaughtered by the butchery the cornu fell on the ground, after some few fibrous bands which attached it to the sub-lumbar region had been cut through. 3. The uterus of a Sheep arrived at the termination of pregnancy ; the organ has been torn in the vicinity of the vagina, and remains free in the abdominal cavity. In this instance, also, the uterus forms a completely closed kyst, which contains a very much indurated lamb. In detaching this organ, an irregular cicatrix is seen, which leads to the supposition that the accident was due to torsion of the cervix. 4. Posterior portion of the body of a Guinea-pig, which shows the right horn of the uterus detached and cicatrized where separation has occurred. This horn, whicli was half free, was filled with fluid blood ; the distention caused by the blood has been so great, that the horn is ruptured in the middle and the foetus must have died from haem- orrhage. J 190 PATHOLOGY OF GESTATION. With regard to these curious and very interesting cases, Saint-Cyr is of opinion that, to allow the foetus to remain in the detacJied portion of the uterus, the separation must have taken place slowly and gradually, and that cicatrization must have been going on in the portion already separated — the work of union and disunion being simultaneous. Treatment. — When it is possible to diagnose rupture of the uterus, the indications are obvious : extract the foetus as promptly and easily as possible, and if need be by gastro-hysterotomy. We shall refer to the treatment of these cases when describing this accident as a consequence of parturition. Metrorrhagia. Accidental haemorrhage from the uterus during pregnancy, appears to be rare in animals, judging from the paucity of instances recorded. Carsten Harms {Lehrbuch der thierdrztlichen Gcburtshillfe, p. 60) has ob- served this accident in cattle ; it was accompanied by a small discharge of blood from the vagina, particularly during micturition, and resulted in the death of the foetus. Other observers have not noticed this discharge ; the blood always, remaining in the uterus, where it has been sometimes found, as a clotted mass, to the amount of more than four gallons. In the majority of cases it would seem to be occasioned by a spontaneous separation— more or less extensive — of the placental capillaries from the uterine surface. Zundel has seen it occur in an animal which showed signs of oestrum while pregnant. The following cases may, to some extent, illustrate this accidental uterine haemorrhage. Egli was called to see a Cow which staggered about in walking, and did not eat. He found it lying, and had great difficulty in getting it up ; when it kept alternately lifting the hind legs. The pulse was slow and very weak, and the heart's beats were loud. There were no other symptoms. It was bled, but during the operation it staggered and trembled; the bleeding was stopped. It then lay down without appearing to suffer, and was dead in a few minutes. At the autopsy the uterus was observed to be considerably distended and of a violet color, and an enormous quantity of blood was effused between the muscular and serous layers, so that the wall of the organ was about six inches thick ; there was no extravasation, either in the abdomen or the cavity of the uterus. No cause was ascribed for the accident. Ziindel {yotirital de Med. Vet de Lyon, 1861) describes the case of a Mare which sud- denly presented the followi!ig symptoms during pregnancy: Anxious countenance, drooping head, rigidity of the loins, staggering gait and lameness of the left hind leg, as if from a sprain ; the respirations 36 per minute, and pulse 60 and small. Treatment was of no avail ; prostration gradually set in, the animal appeared extremely anxious, soon it could net stand, and when it fell, death ensued almost immediately without much agony. There were never anv symptoms of colic or discharge of blood per vulvain. On examination, a five months' old foetus was discovered iii the right cornu, and the placenta was detached nearly throughout. The left horn was the seat of sub-acute inflammation, and its volume exceeded that of the right ; an enormous blood-clot, measuring about four gallons, occupied this horn and the body of the uterus. The blood-vessels were nearly empty. Zundel asks whether the lameness, which had already been noted as a symptom of metrorrhagia by some German authorities, may not be explained by the arrangement of the lumbar plexus, which sends nerves to the limbs and the generative organs. In a pregnant Mare, Schmidt [Antiales de Med. Vet. de Bruxellei, 1862) witnessed the following symptoms : Sudden inappetence ; head low and " beneath the manger; " reeling gait ; extreme feebleness, and hind limbs widely separated ; looking first towards one flank, then the other ; pulse iic, regular but sinking; heart's beats quite audible, and venous pulsation in neck ; mucous membranes very pale, and the body temperature low. Dark-colored blood flowed in a passive manner from the uterus. The Mare died on the same day, and an autopsy revealed all the organs, except the uterus, almost blood- A CCI DENTS OF PREGNANCY. 1 9 1 less ; that viscus was found to be considerably distended with blood — nearly two pails- ful — which was partly coagulated. It contained, in addition, a seven months' foetus sur- rounded by the liquor amnii, and entirely separated from the uterine walls. When there is no escape of blood externally, the diagnosis of this acci- dent is most difficult ; but when the haemorrhage is apparent, then arti- ficial delivery should be attempted, and the same treatment adopted as iox post-partwn haemorrhage {which see). • Abnormal Retention of the Fcctus. It was remarked, when speaking of the normal period of gestation, that this varied within considerable limits, and that the fcetus might remain in the uterus for a comparatively long period beyond the ordinary time, with- out any serious inconvenience to itself or its bearer. But when, from any special' cause, delivery cannot take place, then very grave results may, indeed nearly always, follow. Cases of abnormal retention of the fcetus were observed in the last cen- tury by Boutrolle {Le Parfait Bouvier, 1776),* Gervy {Instructions Vet- erinaire, vol. iv., p. 256), and Huzard, senior and junior ; the latter exhibited to the Society of the Faculty of Medicine of Paris, in 18 15, the uterus of a Sheep containing a fcetus which had been there for three years. Since that period the literature of the subject has become very extensive, nearly forty instances being recorded in English veterinary journals alone. All the domesticated animals are exposed to this abnormal retention of the foetus, but the Cow far more than any other creature : the frequency in this animal being as twelve to one in the Mare, and ten to one in the Sheep. Symptoms and Terminations. — The symptoms at first are, of course, those of pregnancy, until the period of normal parturition, or even during pregnancy when abortion is about to take place. At this period we have nearly all the signs of parturition : enlarged mammae, swollen vulva, pen- dulous abdomen, restlessness and anxiety. Then straining begins, but the OS uteri remains closed, and no fcetus appears. This condition may persist for only a brief period, and be so little marked as to pass unob- served in some cases ; in others it may continue for two, three, or four days, the expulsive efforts gradually diminishing in force and frequency until they altogether disappear. The animal then regains its ordinary state, and, if a Cow, the secretion of milk goes on as if there was nothing the matter. Health may never be impaired from this cause, and the condition of the animal may not be suspected until, if a Cow or a Sheep, it has been fattened and slaughtered by the butcher for food, when the foetus is discovered. It has been observed that oestrum does not appear in such animals, as a rule. The exceptions are rare ; but Rossignol mentions a Cow which retained its foetus for twenty-seven months, but which yet gave an abundance of milk, often exhibited oestrum, and went to the bull, and was at last killed because it became too fat ! * Boutroile writes : " There are Cows which are not ' open,' that is to say, which have not sufficient passage for the calf, which remains in the Cow and becomes dried-up hke a ball. The Cow does not die for all this, if it is well cared for ; but many perish when, instead of drying-up, the foetus becomes a mass of corruption. The Cow which carries its dried-up calf in the uterus does not seek the Bull. ... It is necessary to take care of these Cows for ten months or a year, and to feed them well, especially when the calf dries, for they eat little and become extremely emaciated for fifteen days. In about ten months or earlier, if there is any herbage, these kind of Cows are put out to pasture, and they fatten like others ; the butchers find the calf dried up in the calf-bag." 192 PA THOLOG Y OF GESTA TION. In other instances, after the ordinary period of gestation has been exceeded by several months, signs of parturition are again manifested, and delivery may then be safely accomplished, either without aid, which is rare, or by careful manipulation ; the young animal may even be born alive if too long a period has not intervened since the normal time of deliv- ery.* Parturition in these cases is generally difficult ; and the favorable termination of such a copdition is due to the membranes of the fcetus re- maining intact, and the os sufficiently contracted and close to exclude the atmosphere. Even under these circumstances, as Saint-Cyr points out, the retention of the foetus may not have so fortunate an ending. Very often, after fruitless straining, the animal continues unwell ; it has little or no appetite, languishes, becomes feeble : hectic fever appears ; it falls into a state of marasmus, and dies after a more or less prolonged period of misery. When, at the usual time of parturition, the straining of the animal has ruptured the fcetal membranes, and the liquor amnii escapes, air at the same time obtaining access to the uterine cavity, the case is in nearly every instance very serious. The foetus soon perishes and begins to putrefy, and in a short time the decomposing mass causes inflammation of the uterus (metritis), accompanied by frequent and exceedingly severe straining ; low fever supervenes ; a foul-smelling putrescent fluid escapes from the vagina, and the creature finally succumbs to metritis and putrid infection. In other instances the termination is not so rapid. The ani- mal remains unhealthy ; the secretion of milk is suspended ; horribly fetid discharges are passed per vaginam, containing pus, broken-up decomposed tissues, and even bones of the fcetus ; these discharges are increased by the straining which sometimes takes place at intervals. In the mean time, the creature loses condition, emaciation becomes extreme, and death ensues from debility and marasmus. With the Cow we may, nevertheless, have a vaginal discharge, due' to the presence of a putrefying foetus, and foe a long time, without any such serious result. Figuier, quoted by Saint-Cyr, removed from the uterus of a Cow the entire skeleton of a foetus which had been there for more than five years, without giving rise to any other symptoms than a very disgust- ing intermittent vaginal discharge. The animal quite recovered. Thierry reports the abortion of a Cow at the fifth month of gestation, and the retention of the putrefied foetus for more than three months afterwards, without any harm ensuing ; Gervy also removed the head of a fcetus which had lain in the uterus of a Cow for eighteen months, with- out the animal suffering much inconvenience during that time. In the Veterinarian (vol. ix., p. 454) there is an instance of a Cow carrying a decomposing calf for two years with impunity ; and another (vol. xxix., p. 577) for ten months. It is not the same with the Mare, as death has been the usual termina- tion \ but it would appear that retention of the foetus is very unusual indeed in this animal, the best recorded instances being one by Hamon, * In the Newcastle Journal for January i8, 1840, there is the description of a calf which was born on the 365th day (fifty-two weeks and cue day). It was alive when dropped, but died soon after. It was of great size, though bom without assistance ; it was a male. Strange to relate, in the Verierinarian for 1850 (p. 148), a Mr. Tatam, of Homcastle, records a case of abnormal gestation in a Cow in his locality, in which not only was the period the same (fifty-two weeks and a day), but the calf was a male, as extraordinary in size, and excited a similar degree of wonder as the above ! Mr. Tatam saw the calf : had he seen the other one ? . I have some instances of 300 days' gestation, the calves being born alive. In the Mare, prolonged gestation is not so frequent, though it sometimes occurs, the foetus being retained a month, or even a little longer, without prejudice to the foal's existence. ACCIDENTS OF PREGNANCY. 193 in which death took place after seventeen months' pregnancy; and another by Hammond, when the same result followed after twenty-two months. The period during which a foetus may be retained in the uterus varies from a few months to five years. We have mentioned that in these cases of retention, the foetus may live for a certain time, provided the membranes are not ruptured when the symptoms of parturition first manifest themselves ; it may even continue to develop, as is evidenced by its size, its bony framework, hoofs, teeth, etc., which often cause it to look like an animal which has been born for two, four, or six months. But in other cases, there can scarcely be a doubt that the foetus perishes when the first ineffectual expulsive efforts are made by the mother, or even at a period anterior to the ordinary occurrence of parturition ; as is proved by the absence of hair, and the small size and weight of the creature ; while, again, it may live for some hours after rupture of the membranes, provided it can breathe, or the placental connections are intact. In all cases, as a rule, if the air does not obtain access to the uterine cavity, putrefaction does not ensue ; and when the uterus is examined after death, it is found to be closely contracted on its contents, its mucous membrane healthy or slightly ecchymosed here and there, with the cotyledons pale, wasted, and separated from the placentulae. Some- times between the inner surface of the uterus and the chorion there is a gelatinous mass, which covers the foetus and conceals the placental cotyledons, these being decayed, spongy, and sometimes completely destroyed. The liquor amnii has also been absorbed ; so that the mem- branes are in close contact with the foetus, and may even have become adherent to it in places. The foetus itself is dessicated by absorption, and its skin is hard and dry as if tanned, or it is wrinkled and shrivelled ; while the flesh, if any remains, is either perfectly white, or pale and faded- looking in color, and emits a kind of rancid odor. Other organs are pale and bloodless, and more or less undergoing fatty degeneration. When the retention has continued for a long time, all the soft textures may dis- appear, and nothing remain but the bones ; in other instances the foetus and its membranes become the seat of calcareous infiltration, and con- stitute what has been termed a lithopcedian. It is sometimes extraordinary how perfectly a foetus is protected from decay in the uterus. For instance, in the Veterinary journal (July, 1876), Mr. Taylor mentions one which had been retained for seven months beyond the normal period ; and yet with the exception of absorption of the eyes, it did not present indications of having passed more than a few days in excess of the usual term in the uterus. When the envelopes have been ruptiired, however, and the liquor amnii has escaped, w^e have a different pathological condition. Then, through the partially dilated os the air has been admitted, and if immediately before this the foetus was alive, it may then die and rapidly submit to the putrefactive process, its soft parts decomposing and macerating and form- ing a most foul-smelling mass ; so that when the uterus is opened, we discover a grey or greyish-rd^l fluid emitting a most disgusting odor, and containing portions of matter resembling adipocere, and perhaps bones which may yet be covered by soft parts and held together by ligaments, or entirely disunited and decaying, The uterus itself shows evidence, in the majority of cases, of chronic metritis ; sometimes abscesses have been 13 194 PA THOL OG V OF GESTA TION. formed in its texture, or it has become adherent to other organs — as the intestine, or tissues — as the abdominal walls, with which it has established fistulous communications, and through which portions or the whole of the fcetus may be passed. Causes. — Various causes have been assigned for the retention of the foetus, several of which are no doubt quite sufficient to offer an obstacle to normal parturition. Among these causes may be cited : a diminution or loss of contractile power in the uterus itself to expel its contents, and the absence of assistance when attempts are made ; adhesions of an un- usual character between the uterus and. placenta ; malposition of the foetus ; displacement of the uterus ; deformed pelvis ; fibrous induration or spasmodic contraction of the cervix uteri ; torsion of the uterus, or adhesion of its ligaments, etc. The following cases are given as examples. Mr. Cartwright ( Veterinarian, vol. x., p. 243) refers to a Cow that was at full time of calving in May, and showed signs of parturition, the udder being of great size, and two of the feet of the fcetus being seen in the vagina. As the animal could not be" assisted just then, a day or two was allowed to elapse, when exhibiting no signs of uneasiness a further interval ensued. But no indication of calving was again noticed, the Cow only moaning for a few days. Four or five days afterwards she was milked, though the yield was scanty at first, and only became moderately plentiful at a later period. It was sold in October, though it had not appeared to be quite well for some time after the proper period of calving had passed, and there was no oestrum. At the first the abdomen was very large, and then gradually subsided. The calf could be felt all the time. The same excellent obsers^er relates ( Veterinarian, vol. xi., p. 16) that a farmer, at shearing time, discovered that one of his Sheep, a fine four-year-old Cheshire Ewe, had not lambed, and that the foetus was "coming out at the bottom of the belly." Mr. Cartwright's examination revealed the existence of an opening at the umbilicus, sufficient to admit two or three fingers, from which hung a little hair, and matter oozed. The fcetus could be distinctly felt at the lower part of the abciomen, and seemed hard. Many pieces of the hair and skin, also one fore leg as high as the shoulder, and a por- tion of another limb, were removed. No more could then be got through. The wound gradually closed, and the animal improved in condition until about six months after- wards, when, being exposed to much wet weather, it began to decline, and it was deemed advisable to send it to the butcher. The abdominal wall in the region of the wound was thickened, and portions of bones projected from and pressed around the orifice, which was the width of a finger. The vagina and os uteri were pervious and natural ; but in front of the cervix the uterus, for a foot in length, was no thicker than a thin pipe stem, and very similar in appearance and structure to one of the ureters ; it would only admit a probe. Then it became wider and more muscular, and divided into two passages, in which were contained a few small bones. From this part the body of the uterus expanded to half the size of a man's head (the Iwo short cavities opening into it), and was attached anteriorly to the diaphragm, and laterally to the abdomen, for several inches around in every direction ; it contained the remains of a fine foetus, now reduced in a great measure merely 4;o bones and a little putrid matter. The sac thus formed by a part of the uterus was, inside, in an apparently diseased state, being necessarily of a darkish color in consequence of the uterus firmly clasping the bones, and becoming injured by their rough projections, as it was completely wedged full. There were attachments formed on its peritoneal layer with the small intestines and thin mesentery, but they were sound. The Ewe should have lambed two years pre- viously, at which time it showed uneasiness. The owner thought it would have done so had it been assisted. M. Caillier [Reaieil de Med. Veterinaire, 1847. p! 690) was called to attend a seven- year-old Mare, which had been put to a stallion Ass. The animal's abdomen was very large and pendulous, there was loss of appetite, the surface of the body was cold and skin unhealthy, membranes pallid, frequent yawnings, often looking back at flank, head continually agitated, sinking of the hind "quarters, and unsteady gait. The foetus appeared to be dead. The Mare had been ill for two days, though it had not been ex- posed to any thing likely to cause abortion ; its period of gestation had expired and ACCIDENTS OF PREGNANCY. 19. the movements of the foetus had been lately observed. On the previous evening the usual signs of approaching parturition were noted ; there were expulsive efforts, a discharge of glairy matter, considerable dilatation of the vulva, filling of the udder, and sinking of the abdomen. An exploration /(?r ra?-/«-'zw discovered the cervix uteri to be rigid and the os completely closed, which gave rise to a suspicion of the existence of scirrhus. Three days afterwards glairy discharges had been passed, but the udder and abdomen appeared to be diminished in size. Another examination proved that the index finger could not be introduced into the uterus, but was opposed by a hard tumor. The owner not assenting to an operation for the relief of the Mare, affairs were left to take their course ; for two months there was no amendment; then the animal was put to pasture, when improvement began, and on the return of the season it was put six times to a Horse. Ten days afterwards it died. Examined immediately after death, the uterus was fouiid to be a hard voluminous mass, which, when opened, was discovered to contain the body of a well-formed-mule in a perfect state of preserv'ation, the hair evenbeing quite firm. The nose was fixed in the os, and it had become elongated and the nasal cavities obliterated. There was nothing unusual about the uterus itself or the membranes, except at the cervix, the texture of which was yellow, swollen, and scirrhus, and so hard that it was with difficulty cut. The Mare had gone twenty-three months with foal, and the retention was due to the diseased condition of the cervix uteri. At the Obstetrical Society of Edinburgh, in 1872, the mummified foetus of a Cow was exhibited ; it had been expelled, without any effort, two years and three and a half months after insemination. In July, 1S65, this Cow, which was of a celebrated breed, was put to the Bull ; but in December it was attacked with the rinderpest, when no doubt the foetus died, though the mother recovered. There were no signs of labor when the foetus perished, nor yet at the ordinary period of parturition. The animal was fedior the butcher, and on October iS, 1867, in the course of the extreme fattening which it underwent, the almost forgotten pregnancy was brought to recollection by the expulsion, probably due to the accumulation of fat in the omentum and elsewhere, of the lithopaedian. In the Veterinarian (vol. xli., p. 88) Mr. Wilson describes a case of what he desig- nates "retention of a foetus" in a Cow, which was evidently some time beyond the usual period of parturition. On being killed and opened, all the viscera of the pelvis and posterior part of the abdomen were observed to be bound up en masse by more or less thin, transparent, and loose tissue. Removing this, the left tibia, fibula, and patella of a foetus were found within a double of the intestine. The bones were fullyformed, but black, and matted with short hair. The intestine of the Cow presented no morbid appearances, but the contents were liquid at that part only. The animal had been artacked with transient diarrhoea three days previously. The body of the uterus was affected with anasarca, and in the cavity of the organ was another lot of bones of the same appearance as the others. The cotyledons were entirely absorbed, and the tex- ture of the walls was like basil leather. There were three distinct tubular passages between the fundus of the organ and the colon, the largest of which was not less than three inches in diameter, and through this the bones in the intestine must have passed. The Fallopian tubes appeared to constitute two of these ducts. The cervix uteri was cartilaginous, and no os could be found. A very interesting case is recorded in the Veterinarian (vol. xlii., p. 391) of a Cow which had aborted towards Christmas, 186S, and until the following May had been in thriving condition ; when in that month it began to lose appetite, and commenced to strain. Then the vagina becamediscolored, and a peculiar offensive discharge flowed from it. On examination /fr rectum nothing could be discovered, but on exploring the generative organs it was found that the os uteri would admit the index finger, and that the dis- charge, which was faecal in character, was proceeding from the uterus ; hence it was surmised that the irritation and straining at the commencement of the animal's illness, might be accounted for by the large quantity of faeculent matter escaping by the vagina. The diagnosis was that a communication existed between the uterus and bowels, prob- ably as the result of abscess. The Cow was destroyed, and on cutting down on what appeared to be an enlarged portion of intestines, some of the bones of a calf were come upon ; it was also noted that several communications existed between the uterus and bowels. The uterus appeared to possess three, instead of two, cornua ; and in one of these, and partly covered by a thick layer of the mucous membrane, several bones of a foetus, including some belonging to the head, were found. An adhesion existed on the outer side of the cavity containing the foetal remains, and the peritoneal surface of the intestines. The continuous pressure of the sacculated bones had led to the production of fistulous openings into the bowels, through which, apparently, several of the bones had ultimately passed into the intestinal canal. This Cow may have been pregnant with twins, and only one had been aborted. 196 PA THOLOG V OF GESTA TIOJV. Treatment. — The treatment of fcetal retention must greatly depend upon circumstances. Wlien the owner of an animal that has reached the termination of gestation and begins to be in labor, perceives that the efforts are weak and irregular, and not sustained, so that birth does not take place after twenty-four, thirty-six, forty-eight hours, and even when the S3^mptoms of colic are slight and the condition of the creature other- wise satisfactory, the attendance of the veterinary surgeon should not be delayed. The latter will inform himself as to the history of the case, and also its present condition by careful external examination and internal exploration. By the latter he will ascertain, in all probability, the charac- ter of the obstacle to parturition, and be in a position to decide whether delay is necessary, or if he is to promote immediate delivery. In some instances it will be difficult to arrive at a decision. Some practitioners of note recommend abstention from interference, and the adoption of expectant treatment, so long as the os is not sufficiently dilated or the foetal membranes are not ruptured ; and they insist on this course, even when there is a material obstacle present — such as torsion of the uterus or degeneration of the cervix — which renders spontaneous or natural delivery impossible. This treatment is based on the relative innocuousness of the foetus in the uterus, even for a very long period, so long as the liquor amnii has not escaped and the air has not penetrated. This course is no doubt most judicious in some cases, and is followed by successful results. All that has to be done is to keep the animal very quiet, in a darkened place if possible, and to administer opium or chloral in full doses, both in draught and enema if need be. But Saint-Cyr is of opinion that in the majority of cases, if not in all, it is mor^ preferable to resort to active measures. The expectant method, he says, was all very well when art found itself disarmed in the face of certain accidents, such as torsion of the cervix, which rendered spontane- ous delivery impossible ; but it cannot be urgently insisted upon now, when we are in possession of methods which enable us to overcome these accidents. Therefore he thinks that, as a rule, it is the duty of the obstet- rist to terminate as soon as possible the act of parturition, when it has once cpmmenced. In compliance with this advice, the veterinarian, after informing himself as to the nature of the obstacle opposed to delivery, should act according to the rules applicable to each particular case — rules which will be alluded to hereafter. When the membranes are ruptured, then delay may be out of the question, and intervention might require to be prompt^ if serious conse- quences are to be averted. Attempts to effect speedy delivery should be resorted to at once, in the majority of cases, if not in all. Nevertheless, even here we find excellent practitioners recommending abstention, at least for some hours, according to circumstances. For instance, Dupont, of Bor- deaux (Arc/lives Veterinaires, June, 1876), a good authority, does not at all agree with the generally received opinion that death of the foetus must necessarily immediately follow rupture of the membranes, as he has met with many cases in which it has lived for a long interval — twenty- four to thirty-six hours — after the escape of the liquor amnii ; and he does not hesitate to affirm that respiration commences with, and is con- tinued after, the evacuation of this fluid, especially if the young creature is in a natural position — the fore-limbs and nose in the os. He will not say so much for all the positions of the foetus, though he has effected delivery ACCIDENTS OF PREGNANCY. 197 in them fifteen to twenty hours after escape of the liquor, and the crea- ture has respired and lived. He thinks that the popular opinion is due to the fact, that the attention of the obstetrist is solely directed to preserving the life of the mother, and that the foetus is killed through the violent compression it sustains in a narrow pelvis, from the powerful contractions of the uterus, without the intervention of other causes. When some time — days, for instance — has elapsed since this stage in parturition was reached, and labor has completely subsided, the case is difficult, and it will again depend upon circumstances whether expec- tant or active treatment shall be adopted. An exploration should certainly be made, and if it can be ascertained that the membranes are not ruptured, while there is no straining and the condition of the animal is satisfactory, then it will be advisable to wait until indications of labor are once more manifested. If the state of the animal is not so favorable, and delivery is decided upon ; should the os be impermeable, or not sufficiently dilated to allow the passage of the foetus, then it must be opened either by careful manipulation, uterine douches, the uterine dilating bag, or other modes which will be alluded to when treating of dystokia. When a long period has intervened, and the general and local disturb- ance in, the animal necessitates active interference on the part of the veterinary obstetrist, then of course the first and most urgent indication is to remove the cause — the putrefying foetus — from the uterus. When the OS is not sufficiently open to admit the hand and the withdrawal of the foetus, then the case is one of difficult labor, complicated by the death of the foetus and its state of decomposition. If the os should chance to be contracted, it must either be dilated by the means we have named, or if these do not succeed (though they often do), then the cervix must be incised. In very exceptional cases, gastro-hysterotomy has to be performed if the foetus or its remains are to be got rid of ; and in some instances, owing to the emphysematous condition of the foetus, its shape or size, or the deformity of the genital passages of the mother, embryotomy is called for. When the uterus is emptied of all the matters, solid and fluid, it con- tains, it may be thoroughly cleansed by repeated injections or washings with tepid water, and finally with some anti-putrescent fluid — weak solu- tions of chloral, or carbolic or salicylic acids. General treatment may also be necessary, and this must be regulated according to the indications. In all the manipulative operations subsequent to delivery, it will generally be found that care and patience, and, above all things, an absence of undue haste, are commendable, and particularly with regard to the removal of the membranes, especially in primiparae. The danger of septic infection may be largely averted by intravaginal emollient douches, and serious consequences may often be avoided by abstaining from pre- mature and violent interference. When portions of the foetus are expelled through fistulous openings, even then surgical interference might be successfully invoked. ABORTION. When pregnancy is interrupted by the expulsion of the ovum, or of the foetus at a stage when this has not attained sufficient development to live external to its parent, abortion {partus immaturiis) is said to occur. But 198 PATHOLOGY OF GESTATION, when the foetus is expelled before the ordinary period for parturition, yet with all its organs sufficiently perfected to enable it to exist for at least some time in the external world, this is designated //'^/^^////'^ birth (^partus prcEinaturtis). In the first instance, the young creature is either dead when expelled from the uterus, or dies immediately afterwards ; and in the second it may be weakly and immature, and succumb after a variable period ; or it may continue to live and thrive. In practice, there is no accurately defined limit between abortion and premature birth, and especially when the latter has been brought about by some of the causes which produce the former. Abortion may be said to take place in solipeds, when the foetus is expelled forty days before the normal period ; in the bovine species, thirty-five days ; in the Sheep and Goat, twenty days ; in the Pig, fifteen days ; and with the Bitch and Cat, seven days. Saint-Cyr says that it may be acknowledged that abortion has taken place, when the foetus is expelled in the Mare before the 300th day of gestation, in the Cow before the 200th, in the Sheep before the 140th, and in the Pig before the looth day. There is not the same tendency or readiness in all the domesticated animals to abort. The Bitch and Cat rarely do so, even after serious injuries ; and the Pig retains its foetuses almost as tenaciously \ but the Sheep and Goat are rather liable to this accident. The Cow and Mare, but more especially the former, most frequently lose their foetus. In what proportion abortions occur is not ascertainable from any document- ary evidence. For the Cow, Baumeister and Rueff state that in France, in a dairy containing Durham Cows, and numbering 100 pregnancies, there were 17 abortions ; and at Hohenheim, from a register kept for thirty years, it appears that one-fifth of the Cows aborted. Among 5864 Sheep of various breeds at the same establishment, there were only 26 abortions, or o'433 per cent. Abortion may occur at any period of gestation within the limits above named, though it is much more frequent during the first than the second half of pregnancy, and especially with the Mare. When this accident occurs at a very early stage, it may produce no appreciable disturbance of health in the female, iind the ovum escapes intact, and often unper- ceived. The accident is more serious when it happens at a late period ; as it then not only causes the loss of the young animal, but may compro- mise the existence or value of the mother. Abortion may be either sporadic or eiizootic or epizootic. When cases occur here and there over a wide extent of country, without any relation- ship as to causation, they are sporadic or accidental abortions ; and though they must be reckoned as losses, yet they rarely attract much attention from the damage they inflict, and because of their isolated, and by no means unusual, occurrence. But when, on the contrary, the pregnant animals — say Cows, Ewes, or Mares — on a farm, in a village, or over a large district or country, miscarry in large numbers, and the mishap is evidently due to the same cause or causes, then it is indeed a grave misfortune, as it entails serious damage — present and prospective — to the interests of agriculture. This is enzootic or epizootic abortion : an occur- rence far from uncommon, and the etiology of which has attracted the attention of the most distinguished European veterinarians for many years. ACCIDENTS OF PREGNANCY. 199 Sporadic Abortion. Causes. — The causes of sporadic abortion are very numerous ; they may act eitlier directly or indirectly, and produce their effects in an evi- dent or an obscure manner. They may be ranged as extertial ox internal. I. External Causes. — Atmospherical influences, bad weather, or irreg- ular seasons, have been cited as causing abortion. There can be no doubt whatever that cold, and especially when suddenly applied to the skin, may produce this result, and hence it is that the abrupt setting in of cold weather is often marked by miscarriages among animals exposed to it. Many observers have noted that the continued and severe cold of winter is far less frequently productive of abortions than when one cold wet, or frosty night in autumn succeeds a fine warm day. Cold rain is sometimes very damaging in this respect. With regard to food and ingesta in general, there can be no doubt that here we often have an undoubted cause. Food of bad quality, indiges- tible, or containing injurious ingredients, is well known to be dangerous. After unfavorable seasons, when forage has not been well dried and made, abortions are far from uncommon. Indigestible food, or that which has a tendency to collect or ferment in the stomach, may, by exerting pressure on the uterus, produce this accident.* On the other hand, too great an abundance of easily-digested and stimulating food, by inducing plethora, and consequent congestion of the uterus and looseni-ng of the placentas, has been set down as another cause. Frozen food or water, when taken in immoderate quantity, and especially if the digestive organs are nearly empty, as well as forage or herbage covered with snow or frost, are also injurious in this respect to all the larger animals when pregnant, and abortion often follows immediately-t Filthy putrid water has also very frequently a pernicious influ^ince on gestation. Some plants-— such as the horse-tails {Equisetacce), sedges {Cyperacece)., etc. — and the leaves of beet-root, readily induce abortion, according to several autlior- ities. Rue, savin, ergot of rye, and other ecbolics will, of course, cause expulsion of the foetus more or less readily ; and toxical substances, such as cantharides, which act upon the uterus, will do the same. Purgatives, especially those of a drastic kind, are a fertile cause ; and opium, digitalis, and some other drugs have to be administered with caution. Food or herbage altered by the presence of cryptogamic vegetation, has long been * Delwart hns given a good illustration of this. '* For t\yenty years all the Cows in a herd of thirty aborted each year, and if by chance one calf reached its term, it was so puny and deformed that it died in a few days after birth. The cause of these abortions appeared to me to lie in the too large quantity of grains and balls of cereals with which the animals were fad ; the rumen and second compartment of the stomach formed a compact mass which weighed on the foetus, prevented its development, and ended by killing it. These Cows were put under our care, and submitted to a different kind of alimentation ; roots replaced the innutritions food previously given, and which gave rise to permanent indigestion. This regime was seconded by the administration of a decoction of linseed, five or six bucketfuls \\\ the day, and a draught of a pound of sodium sulphate to each Cow. . . . Success was complete ; the destructive scourge entirely disappeared, and twentj'-eight healthy calves were born at the proper time." t Saint-Cyr mentions that Gelle has witnessed nearly one-fifth of a flock of Sheep abort immediately after drinking from a pond, the ice on which had to be broken to water them. Audoy reports an exactly similar occurrence ; and Delorme, who has also observed analogous accidents, adds that they are most likely to happen when the Sheep have been deprived of water for several days. Huvellier mentions a rich grazier of Merlerault who owned ten brood Mares, one half of which aborted every year, because they were sent three times a day to drink cold water. Often, after quenching their thirst, they trembled, were seized with colic, and aborted. The regime was changed ; the Mares received water at morning and mid- day in the stable, a handful of bran being put in the water ; and only in the evening were they allowed to be watered outside, after the stable-doors had been opened for an hour. The abortions ceased. Flandrin relates similar accidents occurring to the Mares belonging to the Prince of Conde, and from the same 2 oo PA THOL OG Y OF GESTA TION. known to cause abortion. Ergotized grasses and grains have often pro- duced wide-spread losses from this accident.* Excessive muscular exertion and unusual travelling, and especially if there is a predisposition to abortion, is very likely to produce it ; if the exertion is sudden and severe, or even moderate, but coming after a long period of rest, it is all the more certain. Contusions to the abdo- men by kicks or falls, or squeezing through a narrow doorway or passage, railway or steamboat travelling, blows and shocks, keeping the animals in stalls with very inclined floors, are all so many causes. A case came under my observation recently, of a little Bitch, extremely fat, which aborted at a late period of gestation, through frequently ascending and descending a steep staircase. Access of the male not unfrequently produces a miscarriage ; and exploration per vagtJiam by the expert, has also been blamed, as well as surgical operations performed on pregnant animals — bleeding, for in- stance, or throwing an animal down to be operated upon.f Carrying a rider, in the case of the Mare, and especially if spurs are used, is attended with much risk. Excitement, fear,t sudden surprise, or anger, are also causes. Heavy thunder has sometimes been serious in this way ; and the fear produced by Dogs leads sometimes to heavy losses among Sheep — foxhounds run- ning near or among pregnant Cattle or Sheep often cause considerable damage, especially among nervous animals. Certain odors are said to cause abortion, and contagion is supposed to play an active part. 2. Internal Causes. — Badly-fed and neglected animals sometimes mis- carry, but not nearly so frequently, perhaps, as those in the opposite con- dition and extremely fat. It is generally admitted that with some animals there is a special predisposition to abort, and that a very trifling cause, and sometimes no appreciable cause at all, will induce this acci- dent ; while other animals never lose their foetus, though exposed to the influence of apparently most powerful causes. This predisposition is not manifest externally, and sometimes it disappears as age advances. A more constant and potent cause, however, is to be found in the presence of grave diseases, and especially those which aifect the system generally, producing more or less derangement of all the functions. The various serious epizootic maladies, enteritis, and all those abdominal disorders which give rise to restlessness, tympanitis, cough, and those diseases which induce cough — as bronchitis, pneumonia, asthma, etc. — pleurisy and other affections and injuries accompanied by great pain ; * The Veterinary Journal (vol. i., p. 422) alludes to an occurrence of this kind in New Zealand in 1875 It appears that this accident was comparatively rare in that colony until the introduction of rye-grass on the pastures, after which it was common, and a cause of great loss when the rye became ergotized. The same journal (vol. ii-, p. 5;) contains an account of serious abortions among Mares in Germany, due to rust {Trichobasis riibigo) ov\. the straw on which they were fed. In Animal Plag'ues (London, 1871) many interesting notices are given of similar occurrences. Haselbach reports that in a cow-shed where maize infested with its parasitic iungxis (l/slilaj^o mdidis) was given to the cattle, eleven aborted within eight days. The food was changed at once, and the other Cows escaped the accident. A certain quantity was administered to two pregnant Bitches, and they both expelled their young. t Professor Bouley performed the operation of castration on three pregnant Cows ; they aborted in two days after, and one died. Nevertheless, Chanel has seen a castrator operate on a Sow about two months pregnant. Three foetuses, the size of the middle finger, were removed with the portion of cornu in which they were contained. The poor beast lost much blood, and was very ill for six or seven days ; yet in more than two months afterwards it brought forth five young pigs, which it suckled. J The Cat rarely aborts, and instances are on record in which they have fallen from a considerable height without this accident occurring. Nevertheless, they are liable to miscarry, and a friend who lives near Chatham had a favorite Cat heavy in kitten, that aborted immediately after being pursued by a strange Dog, which, however, did not seiie it. The accident in this case was evidently due to fear. ACCIDENTS OF PREGNANCY. 201 as well as nervous or convulsive derangements — such as tetanus, epilepsy, vertigo, etc., are all set down as causes. Disease of the uterus will, of course, be very likely to lead to the premature expulsion of the ovum or foetus. Metritis, abnormal conditions of its mucous membrane, as well as new formations — such as fibroid and carcinoma, and other alterations by which the enlargement of the organ is hindered — as enormous tumors in the abdomen, ovarian dropsy, etc. — will predispose to or excite abor- tion, as will also every condition which leads to hyperaemia of the viscus. Abortion has not unfrequently been ascribed to some defector other influence in the male, though in what these consist has not been ex- plicitly stated ; unless they are to be found in the debility arising from too frequent usage, or other causes related to the animal's state of health. There is strong and abundant evidence that a male enfeebled by too much use, is very likely to be a cause of abortion in the females to which he has been put. This accident has also been said to occur frequently when the male was larger and more powerful than the female. Various injuries and diseases of the foetus or its envelopes, may lead to the same result. External violence may not only injure the uterus itself, so as to produce abortion, but the foetus even may sustain damage. Cauvet, cited by Saint-Cyr, has remarked in a case of miscarriage in a Mare brought about by kicks on the abdomen, that the foetal membranes exhibited at the corresponding point an enormous ecchymosis, and behind the shoulder of the foetus, which was in relation to this extravasation, was a large brown-colored exudation. Another observer has witnessed an ad- hesion between the skin on the cranium of a foetus and the foetal mem- branes, as well as depression of the cranial bones — all evidently due to external violence. In acute febrile diseases of the mother, the foetus may perish from the abnormal accumulation of heat ; or chronic or acute anaemia in the female may prove fatal to the foetus, by causing asphyxia in it. Certain virulent disorders affecting the female may likewise cause the death and expulsion of the young creature iti utero. The foetus of a Cow affected with contagious pleuro-pneumonia, has been found with its lungs affected in a similar manner ; * and to prove that the transmission of these diseases can be effected in this way. Sheep which were in the uterus when their dam was affected with variola (sheep-pox) were found to resist inoculation with the virus of that very malignant malady. Hydrocephalus, ascitis, anasarca, and chlorosis, may also lead to the death of the foetus, which in nearly every case is not only the most fre- quent predisposing cause of abortion, but is almost a certain determining cause of its expulsion. Hydramnios, and other morbid conditions of the foetal membranes, or faulty formation or relations between the placenta?, are other causes ; as well as congenital malformations of the foetus, malposition, or exaggerated volume. The presence of several foetuses often leads to abortion in uniparous animals. Symptoms. — The symptomatology of abortion is extremely varied; being in some cases so trifling that, as already said, the accident may be unperceived, so far as the female is concerned \ while in others the sym- * Barrier describes an abortion epizobty among Cows, in which nearly all the calves were expelled alive at the fifth to the seventh month, but died within eight days afterwards. The principal symptoms were a more or less loud rale, the discharge of rusty-colored mucus from the nostrils, and constant loud bellow- ings. At the autopsies the " lungs were tumefied, red, and fleshy, and the brgnchia filled with the saffron- tinted fluid that flowed from the nostrils." 202 PA THOLOG Y OF GESTA TION. toms indicate a very serious condition. This usually depends on the period of gestation at which the accident occurs. Generally, abortion takes place without any premonitory indications, and the animal may be as well and lively as usual up to the moment when the foetus is expelled ; and the expulsion itself is so sudden, so prompt, and accomplished with so little visible effort or disturbance, that* the acci- dent in most cases receives very little, if any notice. It often occurs during the night, and wonder is often expressed at finding in the morning the aborted foetus, generally contained in its intact envelopes, lying behind an animal which, on the previous evening, looked perfectly well, and even now is so cheerful and unaltered, and its functions so unimpaired, that it can scarcely be believed that it has been the subject of such a mishap. Even the sentiment of maternity, which is so strongly developed in ani- mals, as Saint-Cyr justly remarks, is not awakened in favot of the expelled foetus, and the mother shows the utmost indifference to it, even treading on it as if it were in no way related to her. When this simple abortion has taken place during the day, it has been noted that the flanks fall in a little, the abdomen descends, the vulva and vagina slightly dilate, and there escapes from them a glutinous, sometimes sanguinolent, fluid, with which the foetus is passed almost without effort. We have said that the ovum or foetus is generally expelled in its intact membranes ; this more frequently happens at an early stage of pregnancy. Sometimes, however, the amnion ruptures at the commencement of the abortion, and the embryo or foetus escapes with a small quantity of liquor amnii, the envelopes being rejected soon after, or in some instances they may be retained in the uterus, and thus constitute a source of danger, the animal not making any effort to get rid of them. This complicated abor- tion occurs more frequently at the later stages of pregnancy, and more resembles normal birth than j-/w//(? abortion, which is more often witnessed in the first half of gestation. Nevertheless, we have the latter happen so late sometimes as the seventh or eighth month in the larger animals. It is observed more particularly in those which are debilitated from any cause ; but, at the same time, animals which appear in the very best health are often the victims of simple abortion. So little disturbance does this kind of abortion cause, that the animal can be treated in every way as if nothing had happened ; though it is more judicious to give it a little extra care for some hours at least. In what has been termed laborious, difficult, or complicated abortion, which is often due to external causes, such as injuries, the precursory symptoms are generally well marked, and vary somewhat according as the foetus may be dead or alive. The animal suddenly appears dull and peculiarly dejected \ or it is restless, uneasy, and continually moving about ; if pregnancy is advanced and the foetus is alive and strong, its movements are, on watching the abdomen attentively, perceived to be frequent, violent, and disordered, but they soon become feeble and un- frequent, and cease altogether when the foetus has succumbed. The appetite is lost, a plaintive neigh in the Mare, moan in the Cow, or bleat in the Sheep, is emitted every now and again ; the pulse is quick, small, and hard as in haemorrhage ; progression is difficult and unsteady ; the physiognomy is anxious, and respiration hurried. When the foetus is alive there is perhaps less prostration ; and, more particularly with the Mare, there appears to be much abdominal pain. The animal often looks anxiously towards the flanks, paws with its fore feet and stamps with its ACCIDENTS OF PREGNANCY. ^ 203 hind ones, moves from side to side, perspires at the flank, breast, and elsewhere, lies down and gets up again, whisks the tail incessantly, and exhibits every indication of increasing restlessness. At the ^ame time the abdomen loses its round shape, and drops ; if the animal is in milk, the mammae become soft and diminish in size more or less rapidly, while the secretion diminishes ; but if it is not yielding milk, then, on the con- trary, they enlarge and become turgid -, the vulva is tumefied, and from it escapes a tenacious mucus, serous, or sero-sanguinolent, and, if the foetus is dead, more or less foetid fluid, according to circumstances. Then follow symptoms analogous to those which characterize normal parturition : the uterus begins to contract, and the expiratory muscles act simultane- ously with it \ the expulsive efforts, or " labor pains," acting more or less energetically and continuously, according to the suddenness of the abortion and the strength and health of the animal. The first result of this straining is the evacuation of the bladder and rectum ; the next is the dilatation of the os uteri and protrusion of the membranes into the vagina, then through the vulva, where they appear externally as the " wateT-bag ;" this may rupture and the liquor amnii escape, and the pains becoming more powerful, the foetus is at last expelled either nude or covered by the membranes. This act occupies a variable period — from a few to many hours, according to the strength of the animal ; and it may even require human intervention to bring it to a successful termination. In other instances, however, the foetus is not expelled immediately after it is dead, but after many of the premonitory symptoms just described have been manifested j with the cessation of the movements in the foetus the animal regains its ordinary tranquillity, appetite, and liveliness, and all the symptoms disappear for one or more days, when they again set in, and the foetus may be rejected without any apparent effort, or after much straining. And in some cases of what might be termed " violent " or *' acute abortion," when it suddenly sets in, and nothing being prepared for its being carried to a successful termination, neither on the part of the foetus nor of the mother, the latter is exhausted hy ineffectual efforts, and soon passes into a critical condition. Abortion differs from normal parturition chiefly in the state of the cervix uteri. Towards the termination of pregnancy, this part of the. uterus becomes gradually shortened and softer ; but in abortion we do not have these progressive changes which are so favorable to the passage of the foetus from the uterine cavity outwards ; the cervix is long and rigid as in the non-pregnant condition, and its dilatation is therefore slower, more difficult, and more incomplete than when gestation has reached its termination \ and especially as the muscular fibres of the uterus have not acquired either their full development or contractile force. To counter- balance this, there is the small size of the foetus, which does not require so much space for its passage as if it were full grown; so that the diffi- culty in removing it is less on this account, though the other difficulties the obstetrist has so often to encounter in parturition may all be present. Results. — Abortion is always a serious accident, if only from the loss of the foetus. It is frequently complicated by haemorrhage, which may primarily have been the cause of uterine action 3 it may also result in rupture of the organ, from the efforts the animal makes to overcome the resistance offered by the cervix \ indeed, we may have the usual compli- 2 04 PA THOL OG Y OF GESTA TION. cations that attend parturition. But in many cases the complications are few and trifling, the animals scarcely experiencing any inconvenience, and retaining ^^11 their useful qualities unimpaired. When the accident occurs in the Cow at an early period — before the fifth month — the secretion of milk is generally interrupted, often for a year, as the mammas have not had time to experience the reflex or sympathetic influence which stimu- lates them into activity ; when, however, it takes place in the last half of .pregnancy the secretion may be established, though the yield is usually diminished, and the glands do not furnish their ordinary quantity until the next pregnancy. Abortion may produce prolapsus of the uterus and vagina, and some- times even of the rectum. At an early period of gestation, as we have mentioned, when the foetal and uterine attachments are not very close, the ovum or foetus may be expelled with the whole of the membranes ; but as the process has advanced, this result is less probable, and particularly with the Cow. The membranes are frequently retained, wholly or par- tially, when the foetus comes away ; and owing to the condition of the cervix and its rapid contraction, they are included in the uterine cavity and constitute what is termed *' retention of the placenta : " often a serious complication of abortion in the Cow after the first third of pregnancy, the membranes decomposing and giving rise to putrid infection and other alarming pathological conditions. In the simplest cases, oestrum appears in the Cow in from one to two weeks after the miscarriage, as after parturition, and conception may occur then ; but not unfrequently impregnation does not take place until after several returns of this condition, and often a whole year elapses. In other instances, oestrum does not appear until the full interval of regular pregnancy has elapsed, and then the animal conceives almost as readily as before the mishap. Another very common result is a more marked disturbance in the generative functions, in which there is a tendency to abortion after every conception ; and with other animals there remains an excitability of the generative organs, which is manifested by an almost persistent state of oestrum, giving rise to nymphomania, and accompanied by sterility. Pathological Anatomy. — The lesions occasioned by abortion are varied, according to circumstances. In the majority of cases, and espe- cially when pregnancy has been well advanced, the maternal organs are in a similar condition to that observed after normal parturition. The os is dilated or closed, but in general the cervix is a little softer than in the unimpregnated state. The uterus is more or less contracted on itself and looks congested, its vessels being voluminous, varicose, and filled with blood ; its cavity contains a certain quantity of blood-colored mucus, and often all the characteristic indications of placental retention and decomposition ; its mucous membrane is red and thickened, and there may be traces of inflammation in it and the cotyledons, as well as evidence of the cause which profluced the accident, if due to injury. The appearance of the, foetus varies also, according to the period at which it is expelled, the cause or causes which led to its expulsion or death, as well as the period of its decease. At page 107 we have enu- merated every thing known that is likely to lead to a knowledge of its age. Whether it is expelled or is found in the uterus on examining the carcase of an animal that has died or been destroyed, the body of the foetus may ACCIDENTS OF PREGNANCY. 205 be in a more or less perfect state of preservation. If it has perished re- centl}'-, it is little if at all altered ; its skin is firm, white, elastic, and even ; and its flesh white, rather firm, and odorless. But when death has taken place some days previously, and the air has had access to the uterine cav- ity, then there are indications of putrefaction — all the more marked as the interval is prolonged since death occurred. The foetus is swollen and emphysematous, and exhales a putrescent odor, while. the hairs, and even the hoofs, are easily removed. When the air has not entered the' uterus, the foetus may present a withered, wrinkled, mummified appearance. Saint-Cyr draws attention to a fact which we have already alluded to on several occasions, but which is worth alluding to again. It is that, as a general rule, the death of a foetus brings about its expulsion in a short time ; and not its own expulsion alone, but also, in multiparous animals, that of all the uterus may contain. This rule, however, is far from being absolute. We have already seen that a dead fcetus may be retained for a very long time ; and at the autopsy of such multiparous creatures as the Bitch, Cat, and Sow, which have died or been killed while pregnant, it is not rare to find, between two perfectly healthy and well-developed foetuses, one which had been arrested in its growth, and has evidently been dead for a long time, and yet its presence has occasioned no disturbance. Besides, Bitches and Sows, and even the uniparous Mare and Cow, at the usual period of parturition will bring forth, along with well-developed and living young, one or more dead foetuses whose general appearance testifies that they have ceased to live for a long time. These facts prove that the diseased condition, or even the death, of one or more of the foetuses in an animal does not always prevent gestation from following its regular course. Diagnosis. — The diagnosis of abortion, easy in some cases, is in others difficult and complicated ; and as an error in distinguishing this accident may result in serious consequences to the veterinary obstetrist, no less than to the animals confided to his care, as Saint-Cyr properly remarks, it is well that it should receive attention. This excellent authority judi- ciously presents the problem in three different aspects : i. Prognosticate a possible, but not yet imminent abortion ; 2. Distinguish an abortion taking place from other accidents or diseases with which it might be con- founded ; 3. Recognize that an abortion has taken place. I. Prognosticate an Abortion. — Suppose the owner of a pregnant animal asks such a question as, *' Will this creature carry its young the full time V this must be answered by another question, " What leads you to think it will not ?" For there can be no doubt that, as has been already asserted, there is a special predisposition in certain animals to abort from the most trifling cause, and indeed without any evident cause at all ; and yet they offer no visible indication of this tendency. In this aspect of the ques- tion, it is always judicious to remember certain maxims, the most important of which is that relating to several previous miscarriages, before giving an opinion as to the probability of such an accident ; and this opinion should be based on exact knowledge of the cause capable of compromising the issue of pregnancy to which the animal has 4Deen or is then exposed. The inquiry should be as complete as possible, and then an opinion ought to be carefully given ; as many of the causes of abortion are so very imper- fectly known, and so many circumstances may modify the predicted result, that in the majority of cases it is only permissible to hazard pre- sumptions which, after all, are more or less uncertain. 2 o6 PA THOL OG Y OF GESTA TION. 2. Recognize an Actual Abortioti. — Here we have to distinguish an abortion in process of accomplishment; and at first sight nothing would appear more easy, and, in fact, nothing is so easy if time be allowed until all the characteristic symptoms attending the expulsion of the foetus are plainly developed. Biit when the obstetrist is consulted at the com- mencement — during the premonitory period, it may be very embarrassing to give a decided opinion. In many cases, indeed, impending abortion is only announced — even for some days — by such vague signs as an indefinable malaise^ a peculiar dulness, inappetence, laziness, perhaps a little fever, with pawing now and again, agitation of the tail, and symp- toms which might be taken for those of slight colic. Saint-Cyr has known many good practitioners deceived by these signs, and who have diagnosed either indigestion, gastro-enteritis, or some other malady which disappeared — after the expulsion of the foetus ! Such a mistake is unfortunate for the reputation of the veterinarian, as well as for the owner of the animal, whose interests suffer; as if a miscarriage had been diag- nosed in proper time it might have been prevented, and pregnancy allowed to run its normal course. To prevent such an error, it is well to know that a mistake is possible ; so that if called in to attend an animal offering some of the above- enumerated symptoms, the first inquiry should be as to whether it is pregnant ; then the external organs of generation — the vulva and mammae — ought to be examined with the greatest care, and the actual symptoms thoughtfully analyzed. This being done, it will often be found that this is a case of threatened abortion ; and that, when taken in time, the accident can be averted by rational treatment. 3. Recognize that an Abortion has taken place. — It may happen that information is required as to whether abortion has occurred in an animal ; though this information is far less likely to be sought from the veterina- rian than the human obstetrist. In the absence of the foetus or its envel- opes, such a question is not easily answered with regard to animals ; and the difficulty is increased if the foetus is developed, and a long interval has elapsed since the presumed date of the suspected abortion. Saint- Cyr is of opinion that, as a rule, it is impossible after fifteen days to assert with absolute certainty that such an accident has occurred, the generative organs having at that date resumed their ordinary physiologi- cal condition. For it is only by an early inspection of these that we can enlighten ourselves as to what may have taken place. In this inspection is included that of the mammce , which are always a little tumid, hard, and painful, and often yield a small quantity of milk after a recent abortion ; the tail, the hair of which is soiled and matted by blood, mucus, and the liquor amnii ; the vulva, which is swollen and dilated, and the mucous membrane of which often presents, in addition to its uniform and more or less deep-red color, ecchymoses due to the rubbing or bruising it experiences during the passage of the foetus. On careful vaginal exploration, if the cervix is found to be softer than usual and the OS partially open, and, better still, if the hand can be introduced without much difficulty into the uterine cavity, and a quantity of sanguinolent or sanious fluid, or remains of membranes is discovered in it, it may be concluded that a foetus has been recently expelled. Treatment. — The treatment is preventive ?ix\d remedial. With regard to preventive treatment, this must mainly depend upon a knowledge of the causes which produce abortion — which we have seen are numerous, A CCIDENTS OF PREGNA NCY. 207 and. care in avoiding or modifying these. This pertains to the chapter on the hygiene of pregnancy (p. 153). With regard to animals wiiich have a predisposition to abortion they should not, if possible, be bred from. Should it be desired to breed from them, if they arebovines, they must not be put frequently to the male, and certainly not before eighteen months or two years have elapsed since the last miscarriage. If the accident has been due to irritation of the generative organs, then these should receive appropriate treatment. When pregnancy has again oc- curred, every precaution should be observed to continue it to a success- ful termination, by avoiding or removing those causes which previously induced the accident, and attending to the general health — combating ple- thora on the one hand, or anaemia on the other ; guarding against constipa- tion by administering mild laxatives, and against irritation, whether general or uterine, by doses of chloral of opium given by mouth or by rectum ; and allowing only gentle exercise towards the end of gestation. Wlien abortion appears to be imminent, active intervention generally becomes necessary in order to avert it ; and therefore it must be accu- rately diagnosed. We have already alluded to the symptoms and means by which this accident may be distinguished. If the veterinarian is fortunately called upon in good time, and he is able to assure himself that the foetus is still alive, that the membranes are not ruptured, and labor pains have been few and not severe, the accident may be checked or prevented by the administration of narcotics, and keeping the animal in the most perfect quiet possible — alone in a darkened place, with doors and windows closed, if convenient. The narcotic may be opium (in the form of tincture if desirable), chloral hydrate, or chloroform. Saint-Cyr recommends laudanum (one or two and a half drachms for large animals) administered every half-hour or hour, in very small enemata (not more than a wineglassful at once), which he thinks preferable to draughts, but which may, nevertheless, be employed concurrently. Zundel prefers chloroform, which, he asserts, has yielded extraordinary results in his hands in these cases, by suddenly arresting the straining. He gives it in doses of about three drachms to the Cow, in the form of draught in oil or mucilage, repeating them every hour. Carsten Harms recommends camphor, or camphor and opium, and Rueff assafoetida. The abdomen should be gently rubbed for some time, and the stall well littered ; and if the animal will eat and drink, easily-digested food in small quantity, and gruel, may be given until all danger has passed — generally for one or two days — -when it may be gradually put upon ordi- nary diet, and allowed to resume its usual occupation. When abortion is inevitable — indicated by rupture of the water-bag and escape of the waters — and there is no means of preventing the expulsion of the foetus — the object must then be to favor the latter in some cases as speedily as possible, and remove the membranes, should there be any likelihood of their being retained in the uterus. In the majority of cases, active intervention is of little value here, and is only to be recommended when the labor is tedious, and the animal is becoming exhausted by fruitless straining, or when the labor is altogether suspend- ed after rupture of the membranes. Then, having emptied the rectum, the oiled hand is to be cautiously introduced into the vagina, and if the OS is contracted or not sufficiently open, it must be gently dilated by the index and other fingers, until the interior of the uterus can be reached, 2o8 PA THOL OG Y OF GESTA TION. )jvhen the foetus is to be seized and removed in the usual way ; should it be in a wrong position, or should there be any obstacle to its egress, then we must proceed according to the directions given for overcoming such obstacles when they occur at the normal period of parturition. In abor- tion or premature labor, however, the foetus being smaller, the difficulties are less. If it should happen that the sphincter of the cervix is contracted, and shows no sign of yielding to gentle manipulation, then after a sufficient time has been allowed measures should be adopted to relax it. Bel- ladonna ointment (one part to four of lard), introduced into the vagina and applied around the cervix by the hand or any suitable instrument, may be used with advantage. Mr. Cox, of Ashbourne, also recommends rugs dipped in hot water and applied over the pelvic region. Injections of mucilaginous fluids or glycerine into the vagina, may be resorted to if the passage has become dry after the escape of the amniotic fluid ; and, internally, extract of belladonna, chloral, or aether or alcoholic draughts should be administered, particularly if the animal is exhausted ; when gruel, beef-tea, milk, or other strengthening fluids may likewise be required. The ergot of rye is of little value in these cases occurring in the larger animals, and its use is rarely to be prescribed. If the membranes come away with the foetus, there is little more to be done ; but in the contrary case, which is by no means unfrequent in abortion or premature birth, the membranes are strongly adherent to the uterine placentae, and their retention, particularly in cattle, is often trouble- some. Some practitioners in these instances prefer to remove them im- mediately and mechanically by the hand, carefully separating the placen- tulae one after another ; and though this is easily enough done so long as the OS is dilated, which it usually is for three days after delivery, yet others are content with some simple precautions, and then prefer to wait. When they find the membranes firmly adherent, and their separation from the uterus likely to be attended with inconvenience, they only partially detach them, then collect and twist them into a rope-like form, and leave this mass in the vagina ; so that should the cervix contract, it may not be imprisoned in the uterus. Others tie them together with a piece of tape, which is allowed to hang out of the vagina. In a short time the placenta has become loosened, and can then be wholly removed. A few experienced obstetrists rely on internal medication for the sep- aration of the foetal placenta. Zundel, for instance, has long and suc- cessfully administered powdered laurel berries in an infusion of fennel, giving I ^ ounces three times a day, with an ounce of sodium bicarbonate in half a pint of fennel infusion. The membranes always come away on the second or third day, particularly if plenty of mucilaginous fluid has been given in the interval. Rychner employs a decoction of the meal of linseed-cake in doses of about twelve pints a day, when this result ensues about the ninth day. An animal which has aborted requires attention after the delivery of the foetus. It should be kept clean, fed on gruel and easily-digested food, though not in excess, kept from draughts of air, particularly in cold weather, and otherwise nursed for some days. The complications which sometimes accompany this accident will be alluded to hereafter, as they are usually those of ordinary parturition. The animal should not be allowed to become impregnated at the next oestrum, nor yet perhaps at the succeeding period. ACCIDENTS OF PREGNANCY. 209 Relaxation of the genital passages in the Bitch generally follows im- mersion in a warm ba'th (112° to .114° Fahr.) for a few minutes ; it must not be prolonged after the respiration becomes hurried or the animal looks distressed j and the creature should be well dried and kept com fortable. Epizootic, Epizootic, or Infections Abortiofi. What has been named epizootic or enzootic abortion, but which we have designated " infectious," differs in its etiology and some other features from abortion occurring in isolated or sporadic cases, but more partic- ularly from its attacking all, or nearly all, the pregnant cattle (for it is more particularly observed in Cows, seldom in Sheep, and more rarely among Mares) on a farm or pasture, in a village, over a wide district, or even throughout an entire country, for perhaps a succession of years — thus constituting itself a veritable scourge to agriculture ; and more especially as it only too frequently defies all precautions to prevent its occurrence, and eludes the most careful search for its exciting cause. Epizootics of abortion have been recorded from the earliest times ; * but it was only towards the end of the last .century, when Flandrin, Bar- rier, Pele, and other French veterinary authorities undertook their inves- tigation, that we discover the damage they inflicted. The observers in this century are very numerous, but space forbids our alluding to them ; it may be sufficient to state that Continental authorities are agreed as to the destructiveness of this accident or disease, as well as to the obscurity which attends its development. For instance, Heuze mentions that in the Nievre (France) in 1869, the loss to certain agriculturists amounted to 30, 40, and even 50,000 francs ; in South Germany, in 1851-52, accord- ing to Rueff, it was very serious ; Zundel mentions that it is frequent in North Germany ; and, according to Harms, it is very prevalent in Han- over. Causes. — If we attempt to study the causes which have been alleged as operating in the production of epizootic abortion, we are baffled among conflicting statements and opinions. Many authorities hav^e adduced those causes which have been already enumerated as producing sporadic or accidental abortion ; while others hav^e taken into consideration those influences which may give rise to the accident, as well as those which may propagate the disorder. Among the latter is Zundel, who has made a conscientious study of this important subject, and throws considerable light upon it. With regard to general causes, it is remarked that the disease is most frequent, enzootic, in wet years, as it was in South Germany in 1852, when inundations were common (Rueff), and in Haute-Saone frequently (Trelut), and in other countries, when it is probably due to anaemia, as well as to forage damaged by moisture, ergotized, or otherwise altered. This adynamic condition of animals, brought about by the weather and food, is, in the opinion of Zundel, particularly favorable for the multi- plication pf microphytes, micrococci, and bacteria in the genito-urinary mucous membrane, and these have been spoken of as the principal local * Those occurring up to a.d. 800 are described in Animal Plagnei. We need only allude in this place to the human "Abortus epidemicus" of b.c. 278 ; to that observed in Germany in 1777, in which Cows and Pigs were involved ; and that at Chalons in 1784, in which nearly all the Cows and Mares aborted. 14 2 1 o PA THOLOG Y OF GESTA TION. cause of this kind of abortion. He also adds that it is possible that, • among the fungus or parasitic elements which infest forage in wet sea- sons, there may be some which act, like the ergot of rye, directly on the uterus. But in addition to the influence of seasons, there is also an influence of locality — the disease fixes itself in particular places and spares others. For instance, Heuze remarks that in the department of the Nievre, France, abortions are very few in the arrondissement of Clamecy, while in other arrondissements there is scarcely a calf. With regard to local conditions or causes, it is certain that the regime to which animals are subjected cannot be abduced as in operation ; for the abortions occur under every kind of regime, and as frequently with poor as with lean stock, and irrespective of age, breed, or constitution. So long ago as the end of the last century, contagion or infection was believed to play the principal, if not the sole part ; for it was observed that when a Cow aborted in a place where other pregnant Cows were kept, these would abort in succession until all, or nearly all, had mis- carried. Not only this, but it has often happened that a newly-purchased Cow-in-calf has been introduced into a farm where the Cows had always calved favorably at the proper time ; and when the stranger has aborted, first one, then another, then a third, and so on, of the others have experienced the same misfortune, and the malady has persisted in the place for consecutive years. It is not always the pregnant Cows next to the one which has aborted that are first seized, but rather animals some distance from it. Again, when pregnant Cows which were living in a place where the disease had not existed, have been introduced into a stable where it pre- vails, those that are at the end of gestation calve regularly and normally soon after arrival ; while if they are a certain time in the infected stable before this period is reached, they abort like the others. So that the presence of an infecting element, if not absolutely proved, is at least admissible, after the very numerous observations of the most competent veterinarians — especially of Darreau, Cruzel, Felizet, Bouley, and Lafosse in France ; and Rueff, Haubner, Franck, and Roloff in Germany. The insalubrity and bad hygiene of cowsheds and stables appear to have no influence in the pathogenesis of the accident, as it appears quite as severely and readily in those which are well ventilated and cleansed as those in the opposite conditions ; in fact, nothing can explain the occurrence of enzootic abortion except the presence of a contagtujn or a miasmatic infection. The existence of a contagium would appear to be proved by the result of an experiment performed by Franck, of the Munich Veterinary School. It has been established by microscopical investigation, that on the lining membrane of the vagina and that of the vulva, there is constantly found, as on the buccal mucous membrane, a minute fungus mixed with the mucus, in every respect similar to the Leptothrix buccalis, which, according to Hallier, is only an allotropic condition of the ordinary moulds, such as the Penicillium glaucmn or Aspergillus — being, in fact, a kind of bacterium. Towards the period of parturition, these bodies become extraordinarily abundant, and they appear to concur in !^ decom- position of the foetal membranes and their expulsion ; when the mem- branes are retained and putrefy in the uterus, they are extremely numerous, as are the micrococci. Franck has sho^n that, by smearing the vaginal canal of a pregnant animal to a certain depth with the A CCIDENTS OF PREGNA NCY. 211 matter from the expelled membranes of one which has been delivered, abortion can be induced. So that, says Zundel, it is sufficient to introduce into the vagina micrococci or bacteria, which multiply there, and, penetrating to the uterus, commence their work of decomposition, of which abortion is the consequence.' Roloff has also ascertained that abortion is due to something which finds admission to the uterus by the vagina ; that a certain amount of . redness and tumefaction of the lining membrane of the latter always precedes this accident ; and that this viruliferous or miasmatic matter is found on the articles soiled by the delivery of a Cow which has aborted, as well as in the drains of the stable, on the litter, etc. It has been remarked that, in general, the foetal membranes are liable to be retained in Cows which abort, and that when not removed artificially, they only come away when decomposition sets in. The influence of these putrefying membranes has been noted by several veterinarians — Pele, Barrier, Cruzel, Bouley, Rychner, Haubner, and others — who imagined that the putrescent emanations infected the economy of the animals breathing them ; but Zundel thinks it more probable that direct infection takes place by the genital mucous mem- brane. In support of this opinion, he quotes the observations of Roloff, who asserts that he always saw the disease or accident developed in stables where the distance between the mangers and drains was.small, or where the drains did not have sufficient fall, whereby the hind quarters of the cattle were readily soiled by the excreta in them. Without, then, going further into the question, and without taking into consideration other agencies which may cause extensive abortion — such as ergotized grasses — it may be concluded that this kind of miscarriage is transmissible through the medium of some infectious or virulent principle, which is really specific in its nature : for it is not necessarily allied to putrefaction of the foetal membranes ; and it always produces the same effect — abortion — without any other apparent efficient cause being in opertion. Symptoms. — It is rare that this kind of abortion occurs before the third or fourth month of gestation ; more frequently it is at the fifth, sixth, or seventh month, or even later. There are no premonitory symp- toms, except perhaps a trifling uneasiness for a few hours previously, with sinking of the flanks and descent of the abdomen ; the animal generally looks well and hearty, and yields its supply of milk as usual ; and soon after the foetus is expelled, apparently without any effort or inconvenience, and along with its membranes, if these are not ruptured, with or without them when they are. It is rare, however, that the rup- tured membranes are rejected immediately after the foetus ; as a rule they are nearly always retained, particularly when gestation is advanced ; and they putrefy in the uterus, being got rid of only in shreds at intervals. Then the animal loses its appetite and condition, goes off its milk, and sometimes perishes, as a consequence of this placental re- striction. If it recovers, oestrum appears unnaturally often, though con- ception is unfrequent and sterility common ; and on the other hand, there are some animals which expel the membranes quickly, conceive •soon after, but agaii* abort as readily — perhaps three times in the course of a year. 212 PA THOL OG Y OF GESTA TION. The foetus is usually dead, though when it is expelled (in the Cow) after the fifth month it may be alive ; but it is weakly and soon dies, even when born near the termination of pregnancy. Barrier mentions that these calves make a rattling noise when breathing, accompanied by the discharge of a rusty-colored mucilaginous fluid from the nostrils ; that they bellow continually, and are always emaciated and flabby, the gums and palate being pale, and the umbilical vessels livid and withered- looking. The dyspnoea and great weakness evinced by them shows that they are not properly organized. Those which are dead when expelled exhibit indications of having ceased to live a short time previously. As has been stated, all the animals on a pasture or in a shed where the disease prevails, do not abort at the same time, but at intervals. When one aborts, another — its neighbor perhaps — appears to prepare for the event, which occurs in about eight days ; then some days after this it is the turn of another, and so on until two-thirds, or perhaps even all, of the pregnant Cows beyond three months' gestation have miscarried. It has also been mentioned that it is only after being some time in sheds in which the disease is present, that newly-purchased pregnant Cows are attacked ; those which have passed their eighth month and near calving escaping abortion. Darreau alludes to instances in which a pregnant Cow, leaving a shed in which abortions prevailed, and transferred to another where the acci- dent had aiot been seen, would remain all right for some time, then sud- denly miscarry, and in the course of fifteen days other abortions would occur in this shed, testifying to the danger of keeping pregnant Cows in contact with or in proximity to those which have miscarried in this way. It has also been stated that an animal which miscarries has always a ten- dency to do so again. But it has been observed that if cows are well fed, the period of gestation after each abortion is often longer; so that if a Cow aborts the first time at six months, it will do so again at the seventh month, and the third time a little before the ninth month, reaching its full period in three pregnancies. Treatment. — If the malady is suspected to be due to any one partic- ular cause, or if there exist predisposing causes, then the indications for the prevention or cure of the diseased condition are obvious. The atonic state which seems to favor the occurrence of infectious abortion in or after certain rainy seasons, should be remedied by good food and tonics — and especially preparations of iron. Tonics are particularly serviceable when abortion is due to ergotized food ; though Zundel recommends the inter- nal administration of carbolic acid. If, however, we admit the most common and efficient cause to be infec- tion — that abortion is due to the presence of an agent transmissible from an affected animal, or something that has belonged to it, to another in health — then the first and fundamental indication is to remove or isolate the source of the mischief. When, therefore, abortion occurs, and there is reason to believe that this accident is in its nature infectious, the foetus and all pertaining to it should be removed as promptly and completely as possible from the shed or place in which the animal is located. The Cow itself should also be removed, and kept altogether isolated, or at least away from all other pregnant cattle, with a special attendant employe^! to look after it ; this, attendant should not go near the unaffected cattle, and the excreta from the cow should also be carefully kept out of their way. A CCI DENTS OF PREGNA NCY. 213 The shed from which the cow has been moved, and which contains other pregnant cattle, ought to be immediately cleared of all manure and other matters of an objectionable kind, the drains and the floor — partic- ularly that of the stall which had been occupied by the Cow — being thor- oughly swilled with water, and sprinkled with some good disinfectant ; a good layer of straw may then be laid down, and the cattle replaced. The shed should be kept clean and well ventilated for a number of days, and the drains well flushed and disinfected. The animal which has aborted must also be at once attended to. If the membranes have not been discharged — which is most frequently the case — they should be removed as early as possible, and not allowed to pu- trefy ; their removal should be affected by the hand, and a weak solu- tion of carbolic acid, permanganate of potass, or salicylic acid ought to be injected into the vagina and uterus. The membranes themselves should be destroyed or buried, and the Cow should not be allowed to go near others which are pregnant so long as there is any discharge /^r viil- vam : for safety, the period of isolation should extend to from eight to fifteen days. The animal may require good nursing in the mean time ; and it should not be put to the male until every trace of irritation in the generative organs has disappeared. When Cows show any symptoms of impending abortion, they ought to be promptly removed from the vicinity of others which are in calf. When this accident continues in a stable or shed, Saint-Cyr thinks it necessary to recommend disposal of all the Cows therein, and before in- troducing others into it, to thoroughly cleanse and disinfect it by removing all excreta ; renewing the soil or flooring, washing and scraping the man- gers, racks, and walls and wood-work, making more air-apertures if neces- sary, and leaving it empty, with the doors and windows open, for a month or six weeks. Should epizootic abortion be traced to the food — ergotized or other- wise damaged fodder, of course the use of this must, if possible, be pro- hibited, and a change resorted to. If the pasture grasses are ergotized, then the pregnant animals must be removed from them, and placed in more favorable conditions with regard to food. Ergotized or mouldy dry forage may be rendered safe for consumption by scalding it with boiling water or steam, or pickling it in salt. Whenever or wherever the accident occurs — whether at pasture, straw- yard, or in shed — it must not be forgotten that the greatest po^ible care should be taken to isolate the animal, if it is with other pregnant creatures of the same species, and to bury every thing — foetus, membranes, etc., as well as to destroy all traces of discharges from the patient. 214 ' NORMAL PARTURITION, BOOK IV. NORMAL PARTURITION. Normal, natural, physiological or spontaneous parturition or birth, is the expulsion of the foetus at term from the uterus, through the maternal pas- sages, by natural forces, and when it is sufficiently developed to live ex- ternal to its parent. This act is designated " foaling" when occurring in the Mare, "calving" in the Cow, "lambing" in the Sheep, "pupping" in the Bitch, etc. It receives the designation of "normal," "natural," etc., when it is accomplished in a manner favorable to the parent and offspring without extraneous assistance, and by natural forces alone ; and "abnormal," "pathological," or "difficult," when it cannot be so accomplished, and when the aid of man is required to relieve the parent and release the progeny. Though eminently a physiological act, it is nevertheless one of the most difficult ; the interval between normal and pathological parturition is sometimes extremely brief, the one being often transformed into the other in a remarkably short time. It is also said to be " premature " when it occurs before the usual period, and the young creature is born in a viable condition ; while it is " prolonged " birth when pregnancy extends beyond the ordinary term. We have already spoked of these terms, and alluded to their diversity ; and we have only now to note that these variations do not appear to have any influence on the physiological act of parturition. CHAPTER I. Physiology of Parturition. The act of parturition, notwithstanding its special object, is distinguished from all other physiological acts or functions by certain peculiarities ; for while the latter are normally accomplished without disturbing in any way the well-being of the individual, parturition, on the contrary, even when natural, is accompanied by pain, general disturbance and uneasiness, and violent efforts. And during birth nature does not appear to obey those immutable laws so strictly as in the accomplishment of the other physio- logical acts, but makes frequent and wide deviations ; though these do not often compromise the final result. We never find two births exactly alike, but each offers something peculiar when attentively observed. We need only refer to the duration of the act as a whole, as well as to each of its periods or stages. Sometimes it only occupies a few minutes, in other instances days are required to complete it ; in some cases the first stage is long and the second short, and in others it is the reverse. The labor pains, or contractions, present as notable differences with regard to intensity, duration, and frequency, as well as in the pain they cause and the influence they exercise on the other parts of the body ; while the amount of allantoid or amniotic fluid is as variable, though no ill effects may result from this. And, finally, the foetus may present itself for expul- sion in a variety of positions, which, though they may not impede birth, yet prove that parturition is an extremely variable act. PHYSIOLOGY OF PARTURITION. SECTION I. — CAUSES OF PARTURITION. 215 Though parturition only occurs, at the end of pregnancy, nevertheless this act is being prepared for from an early period in the development of the ovum, as we have shown when speaking of the anatomy and physiol- ogy of the generative organs. During the evolution and development of the ovum, the uterus increases in a corresponding manner, and its mus- cular layer is proportionately augmented. When, towards the termination of gestation, the ovum has reached maturity, and the organs necessary for the independent existence of the foetus are completely developed, certain alterations occur, both in the uterus and the foetal connections with it, which bring about the expulsion of the young creature. These alterations would appear to consist in a gradually increasing fatty degeneration of the decidua, by which the organic connection that had existed between the peripheral portions of the ovum and the uterus is gradually destroyed, by a regressive process in the cells lying between them ; while the blood which was sent to the organ is now diverted towards the mammae, for the secretion of milk. The exchange of mate- rials between the uterus and foetus is lessened, and the latter becomes like a foreign body in the cavity of the former. At all the places where the cell degeneration has reached a certain stage, the terminations of the nerves are irritated. But to obtain a reflex action, and consequent con- traction of the uterine muscles, as Schroeder observes, a certain amount of continuous irritation is necessary. This sum once obtained, a reflex action takes place in the form gf a contraction, which, however, is slight at the beginning. Then a pause follows, until the sum of the irritation is again sufficient to cause, a contraction. By the increase in intensity of the contractions, the uterine wall is removed from the envelopes, and this separation becomes a new source of irritation to the uterine nerve-fibres. The reflex action, in the form of labor-pains, becomes more and more powerful, until these follow at last in rapid succession and complete the expulsion of the ovum. This irritability of the uterine nerves progres- sively increases with the advance of pregnancy, and explains the regular setting in of labor, as well as the not unfrequent retardation of the pains in cases where the separation of the membranes has been premature. The sympathetic nerve is in all probability that which is most concerned in the uterine contractions, as it is the motor nerve of the organ ; and its influence is called forth by the irritation just mentioned as being pro- duced on the terminations of the nerves on the inner surface of the uterus by reflex action, the irritation being transformed into involuntary motor activity. It is surmised that the sacral nerves are merely inhibitory. SECTION II. THE EXPELLING POWERS. The expulsive force by v/hich parturition is effected resides in the un- striped muscular fibres of the uterus, which cause the organ to contract in a rhythmical and somewhat peristaltic manner, the contractions of the abdominal muscles and diaphragm being merely auxiliary. These con- tractions of the uterus may take place although the organ does not con- tain a foetus, and have been noted in extra-uterine pregnancy, when they probably occur through sympathy. They have been observed in the false gestation of the Bitch which has not really conceived, but whose mammae enlarge, and which makes its bed and exhibits other indications of ap- proaching labor; us well as in pregnancies prolonged beyond their ordi- narv limit. ,^^ - 2i6 NORMAL PARTURITION. As the uterine contractions which lead to expulsion are usually ac- companied by a painful sensation (duQ to the pressure exercised on the terminations of the nerves within the muscular fibres), they are in com- mon parlance designated "labor pains" {dolores ad partuni)\ while the resistance they have to overcome is centred in the foetus and its envel- opes, as well as in the passages these have to traverse in order to reach the external world. Expulsion is not effected by one contraction, but by a series of con- tractions ; between each of these there is an interval of apparent repose, during which the organ seems to be gathering strength for a new effort. As in almost all unstriped muscular fibres, the reflex action following upon an irritation is slow and gradual, and, according to the degree of irritation, of varying intensity and duration. ; At the commencement, corresponding to the slight irritation, the contraction is feeble and short, and the time required to obtain the necessary sum of the persistent irritation for a new reflex action as comparatively long ; through the uterine walls are not relaxed on their contents, but are maintained in a certain state of con- traction by the tonicity of their muscles. When the pains are regular, there is also a certain gradation in each individual contraction. Feeble at its commencement, it gradually increases, the uterus becoming harder until the maximum of contraction has been reached ; this persists for some time, and then as gradually subsides. As parturition progresses, and the separation between the uterus and foetus increases, the irritation becomes stronger, and the intervals between the contractions shorter, while these latter augment progressively in inten- sity and duration. The necessity for these intermissions, particularly in the early stage of parturition, is obvious. They allow the animal time to recover, to some extent, from the exhaustion they occasion, and permit the genital passages to become gradually prepared for the exit of the foetus through them ; while the latter can also recover from the inconveni- ence it may suffer from the interruption between it and the uterus during the pain, and especially towards the termination of the act. During each regular pain the whole of the uterus contracts, though the fundus does so most energetically ; and the longitudinal fibres of the organ are more particularly brought into play at the initial and middle stage of parturition. The cornua likewise contract, are twisted on themselves anteriorly, are shortened through the action of the longitudinal fibres, and are brought nearer the body of the uterus, which is also shortened ; and as this shortening is always taking place in the direction of the cervix, it is here that the sum total of the expelling force is centred ; and it is this force, commencing to operate at the fundus of the organ, and exerted on the incompressible liquor amnii, which gradually opens the os for the extrusion of the fcetus. The latter, with its envelopes, first acts as a stimulus to the uterus, but they soon begin to play quite a mechanical part in the di- lation of the already greatly shortened cervix. The latter becomes thin- ner as the contractions force the bag of waters against it; so that the os is gradually widened, and the cervix becomes a part of the uterine cavity. As soon as the os is slightly opened, the bag of waters enters it and acts as a mechanical dilator ; then the lower parts of the fore limbs, succeeded by the head of the foetus, are introduced, and from their combined shape act like a wedge, until, by the eccentric pressure, the chest is passed in, and the cervix being drawn over the presenting parts, the os is of the same diameter as the vagina, which then, with the uterus, constitutes one PH YSrOL OG Y OF PAR TURITION. 2 1 7 common cavity. Every part of the cervix being acted on by the longitu- dinal fibres, the aperture of the os is perfectly circular at this stage ; as is observed in the Cow and Goat when the uterus is pushed back, and its orifice is visible at the vulva. Irregularity in the contractions, however, and particularly when they are rendered so from a transverse position of the fcetus, delays the dilatation, which is otherwise rapid according to the force and frequency of these contractions. At first the dilatation occurs very slowly, especially in primiparse ; when the foetus presents by the croup, or when the body of the uterus inclines too much downwards, causing the cervix to bend up towards the sacrum, it is also very tardy. As soon, however, as the mechanical action of the water-bag and fcetus come into operation, it makes rapid progress in natural parturition. If the uterus of animals usually uniparous contains two foetuses, the two cornua are about the same size, each having a foetus in the same position as if there was only one in the uterine cavity. In general, the two foetuses present anteriorly ; although it sometimes happens that the second, or the first, or even both, present posteriorly ; not unfrequently the second makes a malpresentation. When there are twins, parturition is more difficult and slower than when there is only one : possibly because the great distention of the uterus diminishes its contractile power, an- other feature in twin pregnancies is that parturition often occurs before the ordinary time ; and even when this has been reached, one or both foetuses are smaller and weaker than when there is only a single fcetus. When twin parturition sets in, the uterine contractions commence almost simultaneously in both cornua, which are much less apart than in the non-pregnant state ; but as the two foetuses cannot be born together, that which is most advanced is delivered first, the other, which is behind it, mechanically aiding in its expulsion. In the Mare, the interval between the birth of twins is rarely more than ten minutes ; with the Cow it may be one or two hours ; and with the Ewe half an hour. When the position of the second foetus is favorable, it is usually expelled more rapidly and easily than the first ; and when they are of a different size, the largest is ordinarily born before the other. W^hen the number of foetuses is greater, they are also expelled successively at intervals of some hours. In cases of superfoetation, if such an occurrence can take place in animals other than in those the cornua of whose uterus opens into the vagina, the uterine contractions must be limited to the cornu containing the fcetus whose period for birth has arrived ; otherwise, the other foetus would be expelled at the same time, and there would then be a birth and an abortion. With the small multiparous animals, in which the foetuses are expelled one after the other, it may be admitted that each fraction of the uterus corresponding to a fcetus contracts in its turn — at first the segment of one of the cornua nearest the cervix, then the next segment, and so on until the one in proximity to the ovary is reached, so as to get rid of all succes- sively : one cornu expelling a foetus alternately with the other ; the uterine contractions, although general, being most energetic at the portions in- termediate to the foetuses. The uterine contractions-are very powerful, as any one can testify who has had occasion to introduce his hand into the uterus during parturition ; and the^r force is not always related to the general physical power of the animal ; though they are always more energetic in the Mare than the Cow, 2i8 NORMAL PARTURITION. as well as more continuous. Not unfrequently they are more powerful in weak-looking animals than in those which are robust and vigorous ; and their energy depends evidently upon the development of the muscular structure of the uterus, and the potency of the sympathetic ganglia which stimulates it. Their energy and frequency also often depend upon the duration of the pains, and the existence of mechanical obstacles to the birth of the foetus. After the complete dilatation of the os, the third stage of delivery begins, and the manner in which the uterus contracts is modified. The resistance is no longer at the cervix, but in the uterus itself, being due to the presence of the foetus ; and now the circular as well as the longitudi- nal fibres come into action simultaneously, in order to diminish the uterine cavity and quite expel its contents. In this they are greatly aided by the abdominal muscles and the diaphragm, which until now could assist but little ; though the participation of these does not appear to be absolutely indispensable, for birth may take place without it. Neverthe- less, it is a fact that in diminishing the abdominal cavity, and pressing on its contents, these muscles concur in pushing the foetus in the direc- tion in which least resistance is offered — towards the pelvic cavity ; and as their contractions are effective, so do those of the uterus, which are coincident with them, become increased in power and frequency. The animal "strains," as in defecation or micturition, but with all its force; and these throes, which are involuntary to a great extent, and in which nearly all the muscles of the trunk share, soon bring the act to a termi- nation. The foetus itself has been sometimes regarded as the chief agent in parturition, from the fact that this act is Jonger and more difficult when the creature is dead, and that it has been expelled after the mother has ceased to live. But it must be remembered that the movements of the foetus are very trifling, and of little importance when compared with the resistance to be overcome at birth ; so that the young creature must remain almost, if not quite passive during the act. And if this act is tardily accomplished- when the foetus is dead, the delay maybe due to the absence of stimulation or irritation in the organ, to the uterus not having a fixed point to act upon, or perhaps even to a local septosis or paralysis from the decomposition of the foetus. With regard to expulsion of the foetus after the death of the mother, it must also be remembered that all the organs do not cease to live at once, and that many continue to contract for some time after the mother's heart has ceased to pulsate. Leroux has felt this organ contracting a quarter of an hour after death, and after gastro-hysterotomy on the dead human body it has been seen to contract as in the living woman ; Haller has witnessed the contraction of the cornua of the Cat's uterus, even when the organ was detached from the body; and Colin states that he has observed the uterus of Sheep to contract for forty and fifty minutes after death. As we have said, the resistance which the expelling forces have to overcome is constituted by the foetus and its membranes, and the genital passages — the os uteri, vagina, vulva, as well as the pelvis and soft parts covering and lining it. The foetus participates in the resistance by its volume, its form, its manner of presentation, its position, the conforma- tion and texture of the tissues which unite it to the mother, etc. ; while the genital passages offer resistance from their form, width, extensibility, PHYSIOLOGY OF PARTURITION. 219 and softness. The faeces accumulated in the rectum, or urine in the blad-'' der, sometimes increase the resistance to be overcome. In order that birth may be possible, the expelling force must be greater than the resistance, and it is upon the relation between these that the manner in which the foetus is expelled will more particularly depend, as well as the difficulty attending its expulsion and the time required for the act of parturition. We have only now to allude to the influence of the expelling force on the fcetal membranes. We have seen that these, which we may now, with their contents, designate the "water bag," assist in dilating the os, and that the uterine contractions propel them farther into the vagina in the form of an elongated bladder partly filled with fluid. This soon appears between the labia of the vulva as a round distended tumor, at the moment a pain occurs, but flaccid in the interval ; and not long after- wards as a somewhat voluminous pediculated tumor, to which each pain adds a little more fluid, until at last the membranes cannot resist ihe strain, and rupture, when the allantoic, and then the amniotic fluids escape from them, leaving a variable quantity in the uterus ; some of this is discharged into the vagina at the termination of each pain, and assists in lubrifying the mucous membrane and aiding in the passage of the fcEtus. It may be remarked that numerous causes influence the period when this rupture occurs. In the Mare the membranes are thicker, more re- sisting, and much less adherent to the uterus than in the Cow ; so that rupture is later in taking place, and it not unfrequently happens that the foal is born in them ; though the calf, I believe, never is. But there are individual differences in this respect even, and in some instances it will be found that rupture takes place at the commencement of parturition, in others towards the end ; though when this takes place late it is more favorable than when it occurs early, as the amniotic fluid preserves the foetus from undue compression by the uterus, while it powerfully aids in the progressive and regular dilatation of the os and vulva, and lubrifies the passages, thus diminishing friction and protecting the maternal organs from injury. When rupture occurs too early, and before the foetus has been sufficiently expelled, the parts become dry, and labor is always longer, and more painful and difficult for the mother, while it is often fatal to the foetus. SECTION III. SYMPTOMS AND COURSE OF PARTURITION. The physiological phenomena just alluded to, and by which the foetus is born, are collectively designated as " labor." The entire period of labor is, for facility of description and study, divided into a certain num- ber of stages or periods — usually three or four. These are: i. Prelimi- nary stage ; 2 . Dilatatio?i of the os uteri ; 3 . Expiilsioti of the fcstus ; 4. Expulsion of the membranes. I. Preliminary Stage. — Various precursory signs announce the ap- proaching termination of pregnancy and the advent of labor. These may be observed some hours, sometimes even for days, before that event occurs. One of the most important signs is the enlargement and increased sen- sibility of the mammae, to which the excess of blood no longer required in the uterus is directed. These glands become voluminous, hard and 220 NORMAL PARTURITION. tender ; and this phenomenon is more particularly remarkable in those animals whose milk is not utilized after the young have been weaned. The mammary glands then become soft, flaccid, and small, and cease to secrete. In such animals as the Mare and Ewe, these glands, ordi- narily small and scarcely perceptible, before parturition become so re- markably developed as to cause alarm in people who do not understand the cause. With the Mare especially, the development of the mammae is sometimes so considerable, that the engorgement extends beneath the abdomen and simulates oedema, or it ascends between the thighs as high as the vulva as a prominent ridge, while the skin in this region is red- dened. At a later period, the teat yields a serous fluid on pressure, or this constitutes a crust around it ; this fluid afterwards becomes some- what lactescent, and finally appears as the "colostrum " or first milk. Another premonitory sign is the tumefaction of the vulva, increase of the space between the labia, which become soft and flabby^ while their lining membrane is reddened, and a viscid glairy mucus covers it. This mucus, derived from the vaginal lining membrane, soon becomes so abundant that it is discharged in long filamentous streams, particularly in the Cow, and soils the tail and hooks j it is destined to lubricate the genital pas- sages, and facilitate the extrusion of the foetus. With these changes, the abdomen falls, or rather becomes more pen- dent ; the croup looks hollow, as do the flanks, due to the relaxation of the broad ligaments. The spine, particularly in the lumbar region, be- comes more horizontal and rather inclines downward, as if yielding to the weight of the abdomen. The haunches appear to be wider apart, and the gluteal muscles to subside, owing to the falling in or modification of the sacro-ischiatic, as well as the sub-ischiatic, ligaments, from serous infiltration. The animal walks sluggishly and unwilingly, and if grazing with others, does not appear to care about following them. Sometimes, as has been mentioned, there is swelling of the limbs, particularly the hind ones. If very careful vaginal exploration be made at this time, it will be found that the cervix uteri has become a part of the uterine cavity, and is almost completely effaced, being reduced to merely a thin circular ring ; its tissue is soft, and the os is slightly open in l^iose animals which have previously had young. As parturition draws nearer, these phenomena are more marked. The animal also begins to be restless, and continually agitated ; if feeding, it stops for some moments, as if listening to some sound only audible to itself, or as if experiencing some strange internal sensation for the first time, and which may certainly be the preparatory or commencing contrac- tions of the uterus. Not unfrequently the animal lies down and gets up again, as if suffering from colic. Some are quite mute, though anxious and uneasy ; while others, in addition to exhibiting restlessness and dis- tress, utter a half-stifled cry of pain. The Mare whisks its tail, the Cow bellows, the Ewe bleats, the Bitch often whines, and the Cat emits a low cry as if in suffering. If the animal is at liberty, it seeks a remote quiet place in which to bring forth its young ; while some — such as the Bitch, Cat, Sow, and Rabbit — prepare a special nest. 2. Dilatation of the Os Uteri. — The limit between this stage and the former is not so well marked as our division would indicate. Neverthe- less, it is meant to imply that the stage of dilatation of the os terminates PHYSIOLOGY OF PARTURITION. 221 pregnancy and ends with complete extension in width of that uterine passage. It is marked by increasing uneasiness of the animal : pawing, lying down and rising frequently in a kiud of objectless fashion, while the expression of the physiognomy betrays suffering. When the uterine con- tractions really commence, the creature suddenly stops, as if surprised by the pain ; its eye looks animated and expresses anguish ; the skin is hot, pulse quickened, visible mucous membranes injected ; the abdominal walls are rigid and contracted, the flank is tense, and very frequently fasces or urine are voided. During this pain, if the cervix uteri is ex- plored, it will be found that its attenuated border has a tendency to be- come hard and prominent. When the pain has passed, calm succeeds ; the cervix becomes thick and elastic, and the os is markedly enlarged. Each pain lasts for some seconds to two or three minutes, the interval of quiet continuing to about fifteen minutes at first ; though it diminishes when the contractions become more frequent, more energetic, and more prolonged, and dilatation of the os progresses. Then the fcetal membranes begin to be detached from the inner surface of the uterus and enter the OS, whence they pass into the vagina and between the labia of the vulva, where they appear externally as the "water-bag." In the mean time, the fore limbs and the nose and head of the foetus enter the os, and dilate it to its fullest extent, when the cavity of the uterus forms a canal continu- ous with the vagina. 3, Expulsion of the Foetus. — The pains become more severe, frequent, and sustained, and to the uterine contractions are added those of the diaphragm, and abdominal and other muscles. If the animal is stand- ing, it brings all its limbs under the body, arches the back, elevates the tail, slightly flexes the hocks, makes a deep inspiration, closes the glottis to imprison the air in the chest, and by a powerful contraction of all the muscles of the trunk, it brings such an amount of pressure to bear on the foetus as to propel it into the pelvic cavity, and rupture the chorion. At leach contraction the " water-bag," formed by the allantois and amnion, ^protruded beyond the vulva, increases in volume. It varies in different fanimals ; being in the Cow about as large as the bladder of a Pig, and tin the Bitch the size of the carp's swimming bladder. When it is very [large in advanced parturition, it is reckoned a good sign ; though it may [not indicate a good presentation of the foetus, nor an easy birth. The water-bag soon ruptures, and its contents partly escape ; that [behind the thorax of the foetus being retained, and voided only in small ^quantity as the uterus contracts. When the membranes are thinner and ^weaker than usual, they may rupture before the os is completely dilated, , tand then the fluid escapes in a small quantity at a time \ this frequently ^happens with primiparae, though it is sometimes observed in protracted [labor, which is the most painful. In general, however, no harm results ^from this premature rupture if parturition is not too long delayed ; indeed, iin some cases it may be useful, as when the uterus is over-distended with puid in hydramnios, when its discharge allows the organ to contract more ^freely. In other instances the membranes are remarkably strong and iresisting, and withstand the contractions for a long time after they have [been extruded beyond the vulva ; their artificial rupture may even be trequired. Sometimes they do not rupture at all, and the foetus is born in them, or even after them, as has occurred in the Cow. The rupture lusually occurs at the most dependent part of the bag, at the uterine orifice, towards the os, or in front of it. Then succeeds a brief interval of quiet 222 NORMAL PARTURITION. — the foetus being meanwhile retained in the uterus — during which the organ is closely applied to the body of the foetus, and is preparing itself for a final effort, which is soon made. The contractions are most energetic and rapid, and every time they are made the waters flow in small quantity, moistening and relaxing the parts ; the foetus passes on until the fore feet and muzzle, forming a kind of cone, appear at the vulva, the orifice of which is opened by them. When the head has cleared the vulva, there is usually a short pause, as if to allow the tissues of this region to become accustomed to the distention, and to prepare them for the still greater strain which is yet to be imposed on them. The thorax and shoulders of the foetus have now arrived at the inlet of the pelvis, and as they form the deepest and most difficult part of the young crea- ture's body, the contractions which ensue for its complete expulsion, though most powerful and continuous, only impel it slowly towards the outlet, on arriving at which a more energetic and painful effort than all the others pushes it through. The act may now be said to have termi- nated ; as to expel the croup requires only a few comparatively weak throes, and the weight of the anterior part of the body of the foetus, hanging beyond the vulva, greatly aids them. It is rare indeed that the croup offers a serious obstacle to expulsion. During this act the creature betrays evidence of pain, especially if it be a primipara ; and this is particularly marked when the head of the foetus passes through the still incompletely dilated os, and still more so when Fig. 56. Cow IN THE Act of Parturition : Standing Position. the chest and shoulders distend the tissue of the vulva and perineum to the utmost. Then the pulse is hard and frequent, and the skin hot — sometimes covered with perspiration — or the body is rigid. The Bitch and Cat often utter a cry of pain as the head and chest pass through the vulva. After the young animal is expelled, the umbilical cord is torn, and the liquor amnii remaining in the uterus escapes, accompanied or followed by a little blood resulting from the sudden separation of the placentas. The position assumed by animals during parturition is somewhat varia- ble. The larger animals which usually only bring forth one at a birth, such as the Mare, Cow, and Sheep, ordinarily do so standing ; and this position has the following advantages ; the vertebro-sacral angle is effaced, PHYSIOLOGY OF PARTURITION. 223 and the obstacle that its projection might offer to the passage of the foetus into the pelvis is diminished ; the auxiliary muscles — abdominal and diaphragmatic — can act more energetically ; the young creature, being sustained by the umbilical cord when it has cleared the vulva, glides gently on the half-flexed hocks of the parent, and so reaches the ground without injury (Fig. 56). Such an attitude, however, is far from being constant with these animals ; and very often, especially with the Cow, they bring forth in a reclining position — maintained from the very commencement of the act, and only rising when birth is completed (Fig. 57). These cases, which are quite natural, though debility maybe present, offer nothing particular in the position of the female ; it being merely that assumed on ordinary occasions, though, of course, parturition is more difficult. The animal rests on the sternum, the body inclined to the right or left side, the fore limbs flexed beneath the chest, and the hind ones beneath the abdomen. In this attitude labor is carried on somewhat as when standing. The creature reclining on the breast and partially on the quar- ter, arches the back in straining, slightly raises itself on the hind feet, and drops again when the pain has subsided. f Fig. 57. Mare in the Act of Parturition : Recumbent Position. It is rare indeed that these animals lie full length on one side of the body during parturition, and when it does occur it nearly always indicates a long, difficult, exhausting labor. Multiparous animals — as the Bitch, Cat, and Sow — always assume the recumbent position, and lie reclining on one side, with the body disposed in a semicircular fashion, the head towards the tail. This position appears to be very favorable to birth, the sacro-vertebral angle being effaced, and the young being spared the risk of falling ; in addition, each fcetus as it issues from the vulva is within reach of the mother's mouth -, so that it can, without disturbing itself, remove the membranes from it, divide the umbilical cord, clean it with its tongue, put it in a proper posi- tion, and even direct its head towards the teat, in order to get it soothed while another is born. It may be remarked that, with the Sow, the creature is expelled with such force from the vulva, that it often turns a somersault. It may also be observed, that with the small multiparous 224 NORMAL PARTURITIONr animals the "water-bag" usually only appears with the first of the litter, the others being preceded or followed by their ruptured membranes. The total duration of parturition is, of course, extremely variable, not only according to accidental circumstances, individual peculiarities, and species, but even in the same animal at different births. With the Mare it is usually brief, and is ordinarily accomplished in about ten minutes, sometimes in five ; though it may extend to a quarter or half an hour, rarely more. This rapidity appears to be due to the fact that the placenta is detached from the uterus during the early pains, and consequently the foetus cannot live long after this occurs — three hours being supposed to be the limit — unless it can breathe by the lungs. The duration in the Cow is, on the average, one to two hours ; though it may only be about half an hour, or be extended, without injury to the calf, to one or two days. With Cows at pasture or which do no work, it is sometimes only fifteen minutes. With the sheep the period is also brief, being about fifteen minutes. If there are several lambs, there is usually an interval of fifteen minutes to two hours between them : the second and succeeding births being always quicker than the first. With multiparous animals — Sow, Bitch, and Cat — there is ordinarily a period of ten or fifteen minutes, half an hour, an hour, or even more between each birth. Not unfrequently the Sow brings forth ten young ones within the course of an hour. We have mentioned thsif with those animals which are delivered in a standing position, the ummical cord is ruptured when the young creature reaches the ground, and usually close to its abdomen. If the mother is recumbent when the offspring is born, the cord is torn as she gets up, which is usually immediately after parturition. The circulation in and by the cord being incomplete shortly before and during labor, its texture appears to undergo a kind of softening that favors rupture ; while owing to the vessels being reduced in size, and the way in which their rupture occurs, haemorrhage is trifling. Sometimes, however, the cord is suffi- ciently strong and elastic to resist spontaneous rupture, and the young creature is born with the membranes attached to it by means of this bond of union. The mother then, by a remarkable instinct, in cleansing the young creature with its tongue, gnaws through the cord and sets free its progeny. The Mare and Cow have been known to do this at times ; otherwise, it is usually done by the carnivora. Whether the cord be ruptured spontaneously or gnawn through by the parent, there is nothing to be feared from haemorrhage from either the foetal or placental end ; for, contrary to what is observed in the human species, the blood has very little tendency to flow from the umbilical vessels, and the laceration and cold soon check any slight escape. But it may sometimes happen that it is necessary to divide the cord at a short distance from the umbilicus, and this is usually effected either by scrap- ing, torsion, or cutting directly through it by the bistoury or scissors. Even here there is little to apprehend from bleeding. Rainard, in thirty years' experience, and other authorities, have never observed any harm to result ; and the cases in which there was danger are certainly very few. Rainard quotes-from Brugnone, that Be'ranger of Carpi has seen Horse and Ass foals perish from haemorrhage through the cord having been cut and no ligature applied ; and Peuch has witnessed a case of umbilical haemorrhage in a new-born calf from which, notwithstanding a thread tied round the cord, the blood escaped in drops ; another ligature placed PHYSIOLOGY OF PARTURITION. 225 above the other did not check this escape, and it was necessary to fix a compress, steeped in perchloride of iron, along the course of the cord before the haemorrhage could be checked. It must be borne in mind that similar accidents are possible, if a ligature is not applied an inch or so from the umbilicus. Whether it be tied or not, the portion remaining attached to the umbilicus soon becomes dry and withered, and falls off in a few days after birth ; the other end most frequently hanging to the fcetal membranes, which immediately after parturition protrude from the vagina. 4. Expulsion of the Membranes. — The expulsion of the fcetal membranes, or "afterbirth," as they are sometimes designated, may occur at birth, immediately after, or be delayed for a variable period : this depending not only upon accidental circumstances and individual peculiarities, but also upon species, and, consequently, the placental connections. Immediately after the foetus is expelled, the uterus contracts energeti- cally on itself, and its internal capacity rapidly diminishes ; consequently, the placental villosities are detached from their alveoli, the uterine and chorionic surfaces become wider apart, and the placenta is ultimately separated from the uterus. The same contractions which loosened them, are also instrumental in forcing the membranes through the gaping flaccid OS into the vagina ; and the auxiliary muscles, being again stimulated by their presence here, as they were by the head of the foetus in the same passage, add their powerful contractions ; so that these new pains, aided by the physical weight of the extruded portion with its appended umbili- cal cord, soon bring the whole mass away. The contractions of the vagina have probably little, if any thing, to do with this expulsion, which is rarely followed by hemorrhage in animals; though in woman, oVvingto the inertia of the uterus, this accident is not at all uncommon. Some- times the expulsion of the membranes is expedited by the young creature, as it descends from the vulva. With the Mare, owing to the disseminated placenta and the slight adherence of the placental villi, the separation of the membranes takes place rapidly ; indeed, the foal is not unfrequently born in the intact, envelopes. But generally only a few minutes elapse before the afterbirth is detached. Retention of the placenta is therefore exceedingly rare in the Mare, though it is very dangerous ; as in attempting to remove it there is great risk of haemorrhage. With the Cow, because of the multiple placentulae, the number of which may be over a hundred, the adhesion between the uterus and foetal mem- branes is very intimate ; while the small volume of the cotyledons offers but little surface for the uterine contractions to act upon. So that while it happens that the calf is never born in its intact envelopes, it also occurs that the afterbirth is only slowly and tardily extruded : two, four, or more hours, or even days, being required ; and, indeed, it is not at all rare for retention to take place in this animal, and the envelopes require to be removed artificially. Multiparous animals get rid of the envelopes as they expel the foetuses, the birth of the first being followed in a very brief space by its mem- branes ; after which comes the second foetus, then its envelopes, and so on ; so that only those of the last foetus may be retained — an accident which sometimes occurs. In these animals, the membranes appear to be expelled without any difficulty ; the Bitch, for instance, runs into a corner, and assuming a position as if about to micturate, expels the 15 2 26 NORMAL PARTURITION. secundines of the last puppy, devours them, and returns to the other puppies. With animals usually uniparous, but which sometimes bring forth two or mqre young, the envelopes of each foetus are expelled immedi- ately after it is born, so long as they do not offer an obstacle to the passage of the next foetus ; so that in a double birth in the Cow or Ewe, a foetus being lodged in each horn, the second may be born without the envelopes of the first having been discharged. We may here note the strange instinct which impels not only carnivor- ous and omnivorous, but also herbivorous animals — Bitch, Cat, Sow, Cow, and even sometimes the Mare — to devour the membranes as soon as they are expelled, if they are not quickly removed from beyond their reach ; at times they even devour them as they are being extruded, and the work of delivery is thus hastened. However unnatural and disgusting this propensity may appear, and though the cause for it is unknown, it does not occasion any visible inconvenience to the creature. It has been already remarked, that when the young creature is expelled in its intact envelopes, the mother, if at large, frees it from them by gnawing them through ; more rarely does the progeny release itself by its own efforts. If the mother should chance to be tied up, as in a stall, assistance may be required to cut the umbilical cord and extract the young animal from its imprisoning membranes, as it may become as- phyxiated. This peculiarity is most frequently observed in the Mare, with which birth is always rapid, and the chorion strong and easily de- tached from the uterus. Rueff states that it is not unusual in the Sow. CHAPTER II. Presentations of the Fcetus and Mechanism of Parturition. In addition to, and to a certain extent independent of, the physiological phenomena of gestation and parturition, there are in the latter certain physical and mechanical acts which have been, as Saint Cyr truly re- marks, hitherto very imperfectly studied in veterinary medicine, but whose consideration is, nevertheless, very important in a practical point of view. These acts are related to the manner in which the foetus presents at the pelvic inlet for passage through the outlet, and the way in which this passage is effected; they belong, in fact, to the presentations and posi- tions of the foetus, and the mechanism of parturition. The presentations and positions of the foetus during parturition, as well as the mechanism of that act, are of much practical importance to the veterinary obstetrist, and demand careful consideration. We have re- peatedly alluded to the position of the foetus in the uterus during gesta- tion, and have stated that this position is changed as parturition draws near. What the agency or influence may be which induces this change, has not been ascertained ; but it has been surmised that it is due to an instinctive tendency of the fcetus to assume, towards the termination of pregnancy, the position most favorable for its exit through the pelvic cav- ity ; though it is indeed very questionable whether the instinctive facul- PRESENTATIONS OF THE FCETUS, 227 ties of the young creature are already sufficiently developed to bring about this result, which may, after all, be due to some reflex action. However this may be, it is certain that the foetus is very far, from being always in this favorable position, and that the resources of art are often needed to remedy the false positions the young creature may have as- sumed at the termination of gestation. In studying the various positions and attitudes the foetus assumes at birth, and the consequent presentations it offers towards the anterior opening of the pelvis, there is to be considered (i) the region of its body which is first presented to the pelvic inlet, and (2) the relations of, or correspondence between, this region and the shape and dimensions of the pelvic cavity itself. The first has been designated \\i^ presentation, and the second i\\& posi- tion of the foetus • and the inlet, instead of the outlet, of the pelvis is con- sidered in this respect, because it is the most important in practice, and the position may be altered either spontaneously or artificially during labor ; indeed, this alteration has often to be effected by the obstetrist in order to render birth possible, SECTION I. PRESENTATIONS, The presentation results from the part of the foetus which first offers itself at the pelvic inlet — that region of the young creature \vhich the hand of the obstetrist immediately meets on being passed into the os, and which is directly opposite the inlet. In this sense the head, fore feet, hind feet, croup, etc., are said to be presented, according as one or other of them first offers itself on exploration. These presentations are extremely variable, as any part of the foetus may occupy this situation ; though so far as description and compreli^n- sibility are concerned, their study can be greatly simplified. As Rainard says : " The foetus, when covered by its envelopes, is oval shaped, or like an olive, which it is desired to pass down the neck of a bottle, and which may be presented to this in three ways — either by one of its two ends or by its middle." These ends are the anterior part of the chest in front, and the croup behind ; and it is these parts on which the classification of 'these presentations is based. This classification gives two longitudinal, and an anterior and posterior presentation ; and as the foetus may also offer itself across the long axis of the uterine cavity, we have a transverse presentation, which^ may again be dorso-himbar or sterno-abdominal, accord- ing to the side of the foetus which presents. These four fundamental presentations are, therefore : 1. Anterior Presentation. — The chest of the foetus presents towards the [inlet, and is preceded, accompanied, or followed by the head and fore limbs: the situation and direction of which may vary without altering the I essential features of the presentation. 2. Posterior Presentation. — The croup or breech is facing the inlet, and the presence or absence of the limbs there only constitute varieties of the presentation. 3. Dorso-lumbar Presentation. — Any portion of the upper part of the (body opposite the inlet. Lecoq and Rainard admit presentations of the withers, back, loins, shoulder or haunch, as distinct presentations ; but I agree with Saint-Cyr in declaring the distinction to be practically useless. On exploring the pelvic cavity, no matter what part of the back is first 228 NORMAL PARTURITION. touched, the hand always encounters the spine of the foetus, either di- rectly in the axis of the pelvis, or obliquely and at some distance from it. All these varieties may, therefore, be reduced to the one now named, and which may be either direct or oblique, according as the case may be. Sterno-abdo7mnal PresentaHo?t. — The limbs in this are in reality first touched, and we may have all four, or only three or two ; these, however, are not the fixed point of the presentation, which is the inferior part of the body — or sterno-abdominal region — hence the designation. These four principal presentations may be divided into natural ox nor- mal, in which spontaneous or unaided birth is possible ; and into rmnat- ural ox abnormal., in which parturition is impossible without the interven- tion of man. The longitudinal presentations alone comprise the first, although they are not always tiortnal : as a wrong direction of the head or limbs may prove an obstacle more or less difficult to overcome, and may require the aid of art. So that, taking this view into consideration, the presentations may either be simple, or more or less complicated, accord- ing to circumstances. SECTION II. — POSITIONS. The presentation being determined by the part of the foetus which offers at the pelvic inlet, it must be evident that this part, whichever it may be, may vary considerably in its relations to the circumference of that passage. If, says Saint-Cyr, the chest of the foetus first enters it, the attitude of this region may be very different in different cases ; in one the withers may correspond to the sacrum of the mother, and the sternum to the pubis, or the reverse may happen ; in another the foetus may be lying on the right side, the sternum n:orresponding to the right branch of the mother's ilium, and the withers to the left ilium, or vice versd. So that here are four different positions in the same presentation — the anterior ; and it will readily be understood that it should be the same, or nearly the same, for the other presentations. The position has accordingly been defined to be the relation of a de- terminate point on the surface of the foetus, to an equally determinate point of the pelvic circumference. The points, so far as the mother is concerned, may be determined once for all, and they will always remain the same for every presentation ; they may be, for instance, the sacral region above, the pubic below, and the two ascending branches of the ilium at the sides. If, with the foetus, we select any region — say the withers — and put this part in relation with any of th^se four points of the pelvic circumference, we shall have four successive and easily recog- nized positions. If, therefore, we first give the name of the region in the foetus, and next that of the pelvic circumference with which it is in relation, we have a ready means of designating the positions : describing the foetus to be in a vertebrosacral position, for instance, when its vertebral region is in relation with the sacrum of the mother. The fixed points may be invariable in the latter ; but they cannot be so with the foetus, as they will vary with each presentation. With regard to the anterior and posterior presentations, Rainard has selected the fixed points as follows : for the first, he has taken the spi- nous processes of the dorsal vertebrEe in the region of the withers ; for the second, the lumbar vertebrae. For the positions in the other two pre- sentations, he has not been so fortunate in a designation, in the opinion PRESENTATIONS OF THE FCETUS. 229 of Saint-Cyr, who has very judiciously proposed others which are more exphcit and comprehensible. The latter gives the various positions which should be recognized in each presentation, as follows : — A. Anterior Position. — The chest of the foetus is at the pelvic in- let, and it is desired to make known what relation this part has to the pel- vic circumference. The determinate point on the foetus is the vertebra? of the withers ; and these may be in relation with the sg,crum above, the pubis below, the right ascending branch of the ilium on the right side, and the left ditto on the left. From this we have four positions, named by Saint-Cyr as follows : — I. Vertebrosacral position (J^ig. c,8). — This is the most favorable and the most frequent of all, and is said to be the only natural position. The vertebrae of the foetus correspond to those of the mother, its withers touching the sacrum of the latter, the belly corresponding to the abdom- inal parietes, and its sternum to the pubis. This is sometimes named the _^rst anterior position. Fig. 58. Vertebro-sacral Position of the Fcetus. 2. Vertebro-pubic Position. — This is exactly the inverse of the first : the foetus lying on its back, its withers towards the pubis, and the sternum opposed to the sacrum of the female. This is also named the second anterior positio7i. 3. Left Vertebro-ilial Position. — The fcetus lies in the right flank, its head to the left side of the mother, the neck being in the same direction, and, when passing through the pelvic cavity, touching the ascending branch of the left ilium. The feet, when they are not in the pelvis, must, of course, be sought for on the opposite side, towards the right flank of the mother. 4. Right Vertebro-ilial Position. — This is exactly the reverse of the last- described position, the withers corresponding to the right ilium. The two last are sometimes named the lateral positions. They are less frequent, as primary positions, than the first two, and are sometimes met 230 NORMAL PARTURITION. with as secondary positions after the reduction of a mal-presentation — chiefly the dorsal or ventral. B. Posterior Presentation. — In this the cioup or breech first pre- sents at the pelvic inlet. The lumbar region of the foetus, which is the determinate point, may be directed towards the sacrum, the pubis, or the right or left branch of the ilium of the female. Hence we have four positions, as in the preceding presentation. These are : — I. Lumbosacral Positioti. — The foetus is in what some authorities have called a '' natural " position, but which is asserted by others to be unnatu- ral. The loins are towards the sacrum of the mother, the right coxo- femoral articulation towards the right ilium, and the left articulation towards the left ilium. This is sometimes named the first posterior posi- tion. Fig. 59. LUM BO-SACRAL POSITION. 2. Lumbo-puhic Position. — Some practitioners designate this the poste- rior reversed position. The foetus, in fact, is lying on its back, its croup and loins corresponding to the pubis of the mother, while the limbs are towards the sacrum, against which they are more or less pressed. This is sometimes termed the second posterior position. 3. Left Lumbo-ilial Position. — The fcetus is lying' on its left flank, its croup and loins opposite the ascending branch of the left ilium of the female, and the limbs towards the right flank, where they must be sought for if they do not present in the pelvis. 4. Right Lumbo-ilial Position. — This is exactly the reverse of the pre- ceding position. C. Dorso-lumbar Presentation. — Here the foetus is presented across or transverse^ and it may lie on one or other of its sides, its head towards one of the maternal flanks, and the body curved like that of a PRE SENT A TIONS OF THE FCETC/S. 231 Doo" asleep. In this we have two distinct positions, according as the fcetus lies on one side or the other. But it may also assume a third and almost vertical position — the croup on the floor of the abdomen of the mother, and the creature in the attitude of a Dog sitting. The important consideration m these three positions is related to the situation or direction of the head ; as if this is known, we may easily infer that of the other parts of its body, and thus appreciate the indica- tions for delivery to be followed in this pathological presentation. Ac- cording to the direction of the head, the three following positions are described ; — I. Right Cephalo-ilial Position. — The fcetus is on its right side, which rests more or less directly on the abdominal walls of the mother, the head in the right flank, the croup towards the left flank, the body more or less curved, and the dorso-lumbar region towards the pelvis, in which it presents (Fig. 60). Fig. 60. Right Cephalo-ilial Position of the Foetus. 2. Left Cephalo-ilial Position. — This is the reverse of the preceding. 3. Cephalo-sacral Position. — In this position the foetus is presented by [the back, and in an almost vertical attitude : the croup resting on the [floor of the mother's abdomen, the head more or less depressed, and [directed forward towards the sacro-lumbar region — the creature being ^seated, as it were, on the udder of its parent (Fig. 61). D. Sterno-Abdominal Presentation. — In this presentation the foe- [tus offers the abdomen to the inlet of the pelvis, and on exploration the mand first meets this part, and two or more of the limbs, but always at lleast a hind and fore one. The head may be found, or it may be out of Freach. The sternum and other parts on the lower surface of the body ^can also be felt. In this presentation there are two principal positions : — I. Left Cephalo-ilial Position. — The foetus lies on the right side, th6 [head towards the left ilium of the mother, and the croup to the right milium (Fig 62). 232 NORMAL PARTURITION. 2. Right Cephalo-ilial Position. — This is the reverse of the preceding. Saint-Cyr, who has mainly followed Rainard in the definition of these presentations and positions of the foetus, insists on the necessity for studying them carefully, as by so doing those who commence the prac- tice of obstetricy will be greatly enlightened as to the diffiGulties they may encounter, and the readiest and most scientific way of overcoming them ; while this study will enable the skilled practitioner to describe his interesting cases with more clearness and precision. To render what has just been stated more convenient, the following table is given, in order to show at a glance the different presentations and positions. Fig. 6i. Cephalo-sacral Position of the Fcetus. Presentations and Positions of the Fcetus. Anterior Positions . . Posterior Positions . . Dorso-lumbar Positions . Sterno-abdominal Positions 13 Vertebro-sacral. Vertebro-pubic. Right Vertebro-ilial. Left Vertebro-ilial. Lumbo-sacral. 6. Lumbo-pubic. 7. Right Lumbo-ilial. 8. Left Lumbo-ilial. 9. Right Cephalo-ilial. 0. Left Cephalo-ilial. 1. Cephalo-sacral. 2. Right Cephalo-ilial. Left Cephalo-ilial. SECTION III. mechanism OF PARTURITION. Under normal conditions, it may be said that the pelvis itself does not offer any obstacle to the passage of the foetus, and that it is the soft parts alone which oppose its exit. PRESENTATIONS OF THE FOETUS. 233 Of the different presentations we have enumerated, the anterior — in which the fore feet, head, and chest present simultaneously — is the only one we may designate as " natural," especially with the larger animals and primiparae. Fromage de Feugre was the first to point this out, though Ramard was of opinion that the posterior presentation should also be looked upon as normal ; while Desplas gave three natural positions— head and fore limbs, head onlv, and hind limbs only ; and Delwart gives four normal position-^. But experience abundantly proves that the first we have described is that which alone merits the designation, as it is the one in which birth can take place without artificial aid. It is true that birth is possible when Fig. 62. Sterno-abdominal Position of the Fcetus. the foal or the calf presents posteriorly at the pelvic inlet ; but this is a rare presentation, and under the most auspicious circumstances it is much less favorable, and more difficult for the mother, while it is very often death to the young animal (especially in the Mare). In the majority of cases, without assistance expulsion proceeds no further than the hocks, and the fcetus dies ; and even sometimes with assistance much force is necessary to deliver. Whereas, in the anterior presentation, the cases are exceptional (and these chiefly in primiparge) in which even slight traction is necessary. We will follow Saint-Cyr in first studying the mechanism of parturition in this presentation, in which, of the four positions pertaining to it, the vertebrosacral is by far the most frequent and favorable. This we will now notice. I. Mechanism of Parturition in the Anterior Vertebra- sacral Position. — In this position it has been stated that the fcetus presents simultaneously with the head and fore limbs, the back directed to that of the mother and 234 NORMAL PARTURITION. the withers towards the sacrum. When perfectly natural, the head and fore legs first enter the inlet ; the head is extended, forehead looking upwards to the sacrum, chin towards the pubis, nose forward, the lower jaw resting on the outstretched limbs, the feet of which extend a little beyond the nose. Then comes the neck, and after it the chest and shoulders, which arrive at the inlet w^hen the nose and feet show them- selves at the rulva. In this course it will be observed that, so far as the head and limbs are concerned, there is no difficulty, as the pelvic diameter readily admits them when the soft parts are sufficiently relaxed. With the chest, how- ever, there is difficulty, as its diameter is greater than that of the pelvis ; and the question is, therefore, how it is got through the canal. In 1870, Saint-Cyr saw four well-bred harness and saddle Mares give birth to foals at tiie Lyons Veterinary School. Gestation had been regular, and par- turition, which was easy and favorable, did not exceed the ordinary dura- tion. In taking the diameters of the maternal pelvis by the method al- ready described, and those of the foetus (dorso-sternal, biscapulo-humeral, and bicoxo-femoral), it was found that in these four instances the biscap- ulo-humeral diameter — the largest in the chest — was easily accommo- dated in the bis-iliac diameter of the female pelvis, which was greater by 42, 45, 48, and even 52 millimetres (from i^^ to 2 inches) ; while the sterno-dorsal diameter of the young creatures exceeded that of the sacro- pubic region in the mothers by 28, 85, 87, 88 millimetres (from i to 3^ inches). This part of the body of the foetus had, therefore, to undergo a corresponding reduction in a vertical direction before it could clear the inlet; and even if we take into account the excess of the lateral diameter of the pelvis, it will be found that the thorax and withers of the foetus still notably exceed in size the opening through which they must pass. That they do pass through it, and with ease in the majority of cases, wdthout injury to the mother, or the young creature, is a matter of daily experience ; but the mechanism by which the reduction is effected has been much discussed. Lafosse endeavored, in the last century, to describe it, and came to the conclusion that the head once through the inlet, the shoulders of the foal, which exceed the withers, pass by their upper part in front of the neck, thus forming a kind of channel which glides along the maternal sacrum ; also that the spinous processes of the withers, wdiich are almost cartilagi- nous, bend back on each other, and to right and left of the spine, thus preventing too great compression of the chest. Altogether, he concluded, that the foal, in its passage, becomes moulded in such a manner that the chest has the form of the keel of a ship gliding on the stocks, and in every way corresponds to the mother's pelvis, whose internal contour it assumes. Rainard, however, takes a slightly different view of this matter ; for while admitting' with Lafosse, the inclination backward of the dorsal spines as a first cause in diminishing the vertebrc-sternal or perpendicular diameter of the thorax, he cannot admit that the upper border of the scapulae lie against the neck, but states that the shoulders, on arriving at the pelvic entrance, come in contact with the ascending branches of the ilium, and are thrown back somewhat, leaving the front part of the chest free, and thus diminishing its diameter. He also adds that the withers first enter beneath the sacrum ; that the sternum below is pushed back by the anterior border of the pubis, and the chest in this way submits to a process of elongation which notably diminishes its vertical diameter. PRESENTATIONS OF THE FCETUS. 235 Saint-Cyr agrees with Rainard in this interpretation of the real mech- anism of parturition in the Mare. The sternum in being carried back- wards, also pulls back the ribs attached to it, and this not only diminishes the chest in a vertical, but also in a horizontal direction, as is witnessed in studying the mechanism of respiration in the living animal, in which, during expiration, the chest decreases in width and depth. When the chest is so altered during parturition, the foetus becomes, as it were, elon- gated by this part being depressed : an alteration which occurs all the more readily, from the bones composing the thorax being soft and supple, and the organs they enclose (the lungs) not being so developed as they are immediately afterwards ; so that a moderate amount of pressure, provided it is not too long continued, may be borne with comparative impunity. In the larger animals, the pelvis cannot undergo any sensible increase in size during the passage of the deepest portion of the foetal body through the inlet, which is, in the Mare, an absolutely inextensible bony girdle. Lafosse has sawn through the pubis of Mares about to foal, and he found that during parturition there was only a space of two lines be- tween the sawn margins. So that it is the body of the foetus which has to accommodate itself to this part of the passage at this stage of delivery. When, however, it has passed through the inlet, extensibility of the maternal tissues can, and does, take place, and permits an enlargement of the canal. The wide sacro-ischiatic ligaments which enclose the pelvis laterally, are softened and more elastic during birth ; the sacro-iliac and sacro-lumbar articulations are increased in mobility ; and even the pos- terior part of the ischio-pubic symphysis may become slightly relaxed. So that when once approaching the outlet the progress of birth is more rapid, and this progress may be aided if, as is pointed out by Lafosse, the tail of the animal is well elevated. A slight check to expulsion is observed (especially in the Mare) when the croup arrives at the inlet, as this part nearly corresponds in diameter to this opening, being, if any thing, slightly less. However, notwith- standing this, in consequence of the croup being less susceptible of diminution than th'e chest, and although the bones may yield to some extent, friction will occur, more particularly if the croup is largely devel- oped, which it is in some foals. One haunch may pass into the inlet before the other, however, and thus facilitate the passage. With the Cow, the mechanism of parturition in this presentation is similar to that in the Mare. Saint-Cyr shows, from actual measurements of Cow and foetus, that the head of the calf can easily pass into the inlet, owing to its less diameter ; and that the principal difficulty is encountered by. the foetal thorax, which is slightly larger in every sense than the inlet.* The bicoxo-femoral diameter of the croup slightly exceeds the bis-iliac diameter of the pelvis ; but it is possible that the pelvis of the calf being more cartilaginous and supple than that of the foal, may be submitted to a slight temporary compression. It is to be remarked, however, that the progress of the calf through the pelvis must be more protracted than that of the foal, owing to the greater length of the maternal pubic symphysis, and the more considerable extent of the pelvic walls, as well as the pecu- liar curve in the floor of the pelvis ; though these disadvantages are * Saint-Cyr in these observations measured the thorax after the birth of the young creatures, and when the lungs had become expanded. He does not appear to have made any allowance for this expansion, which of course makes a difference in the size of the thorax after birth. 236 NORMAL PARTURITION. somewhat compensated for by the greater mobility of the sacrum. And, as we have seen, such is really the case, the duration of parturition being shorter in the Mare than in the Cow.* With regard to the other animals, the same, remarks will apply. We may just note that with the common-bred Bitch, which has a more or less elongated muzzle, when fecundated by a Dog of the same conformation and size, and which in due course brings forth from five to eight young, there is usually no difficulty in delivery. The conical form of the muzzle of the puppies, and the softness of their tissues, permits their entering the inlet in this presentation, and passing easily through it under the in- fluence of the uterine and abdominal contractions. But when the Bitch is of small size, and is fecun^dated by a young, vigorous, and larger Dog, and especially if the muzzle of either or both parents is short, then the head of the puppies is usually large and round, with the forehead high, and the presentation offers grave, and frequently insurmountable difficul- ties. This is more especially the case if the puppies are few in number, when they are usually .larger. This will be alluded to again when we come to treat of difficult parturition. 2. Mecha?iism of Parturition in the Anterior Vertebro-pubic Position. — In this position, the same diameters of the foetus correspond to those of the maternal pelvis ; though in practice it is found that this position is less favorable, and that delivery is always more difficult and longer than in the first anterior position. This appears to be due to the fact that in the latter the dorsal spines, or withers, the most prominent part of the foetus, glide along the vertebral column of the mother in the kind of channel formed by the psoas muscles, and is naturally directed towards the pelvis ; while in the vertebro-pubic position, it comes against the brim of the pubis, where greater, more frequent, and more continued con- tractions are needed to raise it to this kind of step leading to the inlet. And when it has cleared this obstacle, the foetus still passes with difficulty through the canal, as the curve of this passage is exactly the reverse of that offered by the body of the foetus ; all the articulations of the ver- tebrae, but particularly that of the atlas with the occiput, and those of all the limbs, being flexed downwards, or in a contrary direction to the curve of the sacrum. Consequently, in order to accommodate themselves to this curvature, all diese articulations must be forcibly extended — an un- favorable condition ; while the pressure and friction must be consider- able. And not only is progress through the pelvic canal slower and more difficult, but the* maternal organs are also exposed to injury, and some- times receive serious damage : the feet of the foetus having a natural tendency to be carried upwards, may squeeze the vagina against the sacrum, or press against the perineum, etc., when we may have lacera- tions of the vagina, vulva, perineum, or other part. 3. Mechanis7n of Parturition i?i the Anterior Vertebro-ilial Positions. — These lateral positions — two in number and symmetrical — are, according to Saint-Cyr, rarely primary, but, as Rainard remarks, are sometimes found as secondary positions, due to the reduction of some mal-presenta- tions. The latter authority asserts that spontaneous birth is impossible in these positions, because the chest of the foetus presents its greatest diameter to the smallest diameter of the pelvis of the mother. This, however, is an exaggeration, as Saint-Cyr points out that the bis-iliac * The fact that parturition is more quickly performed in the Mare than any other quadruped was well known to Aristotle : Equa, omnium quadrtipedem,facillime, parit. PRESENTATIONS OF THE FCETUS. 237 diameter is sometimes equal, or even superior, to the sacro-pubic diame- ter ; so that it is not always absolutely impossible for delivery to occur spontaneously in these positions ; though it is very true that it is always more difficult, and so?netimes impossible, if the position is not altered. Independently of the disproportion between the diameters of the pelvis and the corresponding diameters of the foetus, here also we find the two salient parts of the latter — the sternum and dorsal spines — jamming against the two resisting parts of the pelvic circumference — the ascending branch of each ilium, and it will be readily seen that in some cases these will prove an insurmountable obstacle. Nevertheless, as a general rule, this obstacle may be easily turned by merely causing the body of the foetus to rotate on its axis, in such a manner that its greatest diameter will be brought opposite the oblique diameter of the inlet, which extends from the ileo-pectineal ridge to the sacro-iliac articulation on the opposite side. Then its entrance into the pelvic cavity, and complete expulsion, is rendered possible. 4. Mechanism of Parturition in the Posterior Lumbosacral Position. — Of the four positions in which we may have a breech or posterior presenta- tion, only one, in the opinion of Saint-Cyr, is compatible with spontaneous delivery — the lumbosacral ; though even this is denied by other author- ities. The foetus is presented by the breech, the loins towards the sacrum of the mother, the hind limbs in complete extension and entering the inlet, so as to open the passage for the body -, and though this position may appear to be favorable for the expulsion of the young creature, yet it is far less so than the first anterior position. The croup of the foetus is a rounded voluminous mass which does not admit of much compres- sion, and the diameters of which — particularly the transverse — are neatly equal to those of the pelvis ; it is, therefore, not well disposed for passing through the latter, and, in addition, its upper part presses against the sacro-vertebral angle ; while the stifles, which are salient, press against the edge of the pubis, and the hip joints against the branches of the plium. Entrance into the inlet must therefore be slow, difficult, and pain- ful for the mother, and when this first obstacle is overcome and the croup is in the pelvic cavity, the chest has to follow, and to submit to the same compression at the inlet as in the anterior presentation. But this part of the foetus is much less favorably disposed for such a reduction of dimensions in this position ; as the resistance offered by the walls of the maternal pelvis has a tendency to erect the dorsal spines, and to carry the ribs and sternum forward — ail this going to increase the diameter of the foetus in every direction. It is only, then, by direct compression or crushing, that the necessary diminution in the diameters of the young creature can be effected, and not by a kind of physiological decrease, as in the anterior presentation. There is also the obstacle offered by the hair of the foetus, the " set " of which is against the direction of movement ; and this obstacle will be greatly increased if the fluids have escaped for some time, and the parts are more or less dry. Taking all these considerations into account, it will be seen that in this position, even when birth is possible with extraneous assistance, labor must be long and exhausting, and that the young creature incurs the greatest danger. Labor, however, is more likely to be successful and less tedious if the haunches of the foetus present one after the other at the inlet ; so that a slight obliquity in the presentation makes a great differ- 238 NORMAL PARTURITION, ence ; and it is just possible that when birth takes place in this position without aid, this obliquity may have been present. In the Cow, the calf is more frequently born alive in this position than the foal, and birth is easier ; a circumstance which is, in all probability, due to the smaller dimensions of the croup in the young of the bovine species. CHAPTER III. Necessary Aid in Normal Parturition. Although, as a rule, parturition is generally effected in animals in what v/e have designated a " spontaneous '' manner (without the intervention of man), and without danger or prejudice to the mother or offspring ; and although these do not require that minute and scrupulous attention be- stowed on woman, even when birth has been easy ; yet from the nature of this act and the unfavorable consequences which are sometimes noted, certain precautions should be observed by the owner of the animals at this period, and especially if these should happen to be valuable and very artificially kept. These attentions and precautions should be entrusted for their carrying out to competent persons selected by the owner ; as it is seldom that the veterinarian is called in unless something serious has occurred. The mother as well as the offspring require watching, and more or less nursing. • SECTION I. ATTENTION TO THE MOTHER. With the smaller animals, except perhaps the Bitch, but little prepara- tion is needed, and the act of parturition is accomplished without any trouble. But with the larger and more valuable creatures — such as the Mare and Cow, and even the Sheep — certain precautions should be adopted. With the Mare and Cow particularly, this function is accom- panied by pain, restlessness, and a certain amount of excitement, which necessitate attention. For instance, an animal tied up in a stall among other animals of the same or different species, is more exposed to acci- dents than one which is in a place by itself, or which is at liberty in a pasture or meadow. Therefore, the Mare about to foal should be allowed a roomy loose-box, well supplied with soft litter ; and the Cow should, if possible, be similarly provided. If either animal must be kept tied, then the fastening should' be of such a kind that it can readily be undone when required. The Sow should have a separate sty, and even the Sheep may need a separate allotment. If kept in a dwelling, the temperature should be comfortable and the ventilation good. A. During Labor. — When parturition commences, it is rare indeed that any thing requires to be done during at least the two first stages — those of preparation and dilatation of the os. Therefore, the animal should be allowed perfect quietude ; and if the light in the stable is too bright, it may be partially excluded. A trustworthy person may remain with it, in order to avert accidents ; but he should keep himself out of sight, and meddle with the animal as little as possible. Some creatures, and partic- NECESSARY AID IN NORMAL PARTURITION. 239 I ularly primiparas, are rendered peevish and fidgety if they see any one present during parturition. Unless something irregular or abnormal occurs during this act, all should be left to nature. The irregularities are few in number, the princi- pal h^xwg hurried and protracted parturition^ they being only modifications of natural labor; the difficult cases coming under the head of dystokia, to be treated of in another division of this volume. Whether called in to a case of irregular or abnormal parturition, the first care of the veterinary surgeon will be to assure himself as to the state of the animal and the progress made in the act. In this direction, it must be remembered that for the accomplishment of this function in a physio- logical manner — i.e., by the force of nature only — and without prejudice to the mother or offspring, there is required a definite action, proportionate to the constitution of the former, of the forces destined for the expulsion of the latter. The labor-pains should be normal, the act should be neither hurried or abrupt, nor yet too slow; and the mother should not exhibit any constitutional weakness or physical debility. In addition, the foetus should be normal as well as its membranes ; and the genital passages of the mother ought to be in a properly formed and healthy condition. The fcetus should be alive and natural in form and size, particularly with regard to the volume of the head and thorax; and it ought to be in such a posi- tion that it can be expelled without assistance. The foetal envelopes should possess a certain degree of thickness and resistance, so that they may not rupture too soon, nor yet resist the action of the uterus too long. The pelvis of the mother should have a convenient shape and capacity ; the genital passages soft and elastic ; the os, vagina, and vulva properly formed and extensible ; and the other pelvic organs in a normal state. If the act of parturition is not sufficiently advanced, and the soft parts through which the foetus has to pass are not enough dilated, time should be allowed for this to take place. As a rule, there should be no hurry to interfere with the progress of the case, as a somewhat long period is often required for preparation ; and if this is accelerated by the intervention of art, accidents are more likely to occur than if the labor had been long and protracted. Vitulary or parturient fever has been remarked as more common in Cows which have calved quickly or abruptly ; and in such instances it has also been noticed that the uterine contractions do not sufficiently de- tach the foetal membranes. In parturition, there is as much wisdom shown in remaining a specta- tor sometimes, as in interfering at other times when circumstances require it. It is only when obstacles, insurmountable by the natural efforts of the animal, offer themselves that aid must be rendered. So long as the course of parturition remains normal, nothing should be done, under or- dinary circumstances. With the Mare, however, delay should not be pushed too far, as the foetal placenta is very easily detached from the uterine surface, and the foetus may perish of asphyxia or inanition. The intelligent owner of an animal which is about to bring forth, should himself be able to ascertain the position of the foetus, and decide as to whether parturition may terminate in a natural manner, or if the ex- isting obstacles are easy to overcome. If they are not, he certainly should not venture to attempt delivering the animal himself, or to pull about the mother or foetus ; as this may only tend to aggravate the accident, and 240 NORMAL PARTURITION. render relief more difficult. The veterinary surgeon should be sent for, as his knowledge and practised manipulative skill will, in the majority of cases, bring the most complicated labor to a prompt and happy termina- tion — preserving the mother, and often the produce. This appeal to the veterinarian is not always made, however, until the owner, his servants and neighbors, or the empiric, have done great dam- age, and caused the loss of valuable time ; then he is sent for, but now the case may be one of extreme difficulty or hopelessness, from exhaus- tion or injury. We shall only notice in this place what has been designated abrupt^ tumultuous, disordered, or false labor {^partus prcecipitatus) , and protracted labor; both due to anomalies in the expelling forces. 1. Tumultuous Labor. — In this kind of labor the act of parturition is deranged and precipitate ; and though the pains are excessive and fre- quent, yet no progress appears to be made, the parts not being prepared, and the cervix is often in a state of spasmodic contraction, rigid, and painful. Otherwise the maternal organs are well formed, the passage roomy enough, and the foetus in a good position. Sometimes the uterus itself is in a state of contraction, the contractions assuming the opposite direction of those occurring in healthy labor, — commencing at the cervix they pass towards the fundus of the uterus. This condition, in which the phenomena are at first alarming, is most frequently observed in young, well-fed, vigorous, irritable animals, and especially primiparae, which are excited and troubled at the first pains, and give themselves up to violent expulsive efforts which hinder the natural course of parturition. In the majority of cases, amendment is ensured by diverting the ani- mal's attention, in walking it about for a short time, wisping.the abdomen gently, and keeping it in a quiet and dark place. If, however, the pains are violent, and the agitation great and persistent, other measures must be resorted to. Some authorities recommend bleeding, but this should, if possible, be dispensed with. Blankets steeped in hot water should be applied to the loins and abdomen, warm enemas should be administered, and, if deemed necessary, chloroform, aether, opium, or chloral given in draught or in enema — the latter being generally preferable. Not unfre- quently good results are produced by injecting tepid water into the vagina, and raising the animal's hind quarters ; and at other times, when the cervix is in a state of spasm, relief is soon obtained by applying a little extract of belladonna to it. With small animals, a few drops of laudanum, either in draught or enema, and a warm bath, are usually sufficient. Quiet, soothing, and simple treatment wall generally bring about a nor- mal state of affairs ; the agitation and irregular straining subside, and easy parturition occurs in six, twelve, or twenty-four hours. 2. Protracted Labor. — Protracted labor, due solely to the inability of the uterus to expel its contents, or to pathological weakness of the expel- ling forces, is rare, except in those cases in which exhaustion results from violent and long-continued attempts to overcome some material obstacle to birth. Then, most commonly, the membranes have ruptured, the wa- ters have entirely escaped, and the uterus, in a state of general tonic contraction — tetanus uteri — is closely applied to the foetus, but makes no effort to expel it. This usually, if not always, happens when the foetus is dead. But primary inertia, as Saint-Cyr remarks, due to constitutional weakness, and in the absence of any material obstacle to the extrusion of the foetus, is not common. NECESSARY AID IN NORMAL PARTURITION. 241 It is observed, nevertheless, in emaciated, puny, and frequently old animals, which are debilitated from lack of sufficient and good food, pro- longed lactation, overwork, or worn by chronic wasting diseases. It may also be due to congenitally feeble development of the uterine muscular fibres, and to diminished contractility of these by over-distention of the uterus during pregnancy, or by disease. The symptoms in the Mare and Cow are : comparatively shallow and repeated inspirations, feeble and unfrequent straining, weak pulse, rest- lessness and symptoms of suffering, extremely slow progress in birth, — parturition in the Cow being extended to twenty-four, and even forty- eight hour's, though the foetus may be in a good position, of ordinary size, and the passage clear. If the hand is introduced into the vagina, it will be discovered that the uterine contractions are weak. There is no urgent danger to the mother in this condition ; though the life of the foetus is often imperilled, as the placenta may be detached more or less from the uterus, and this may lead to fatal consequences. An examination is of course necessary, in order to ascertain whether there is any obstacle to parturition. Should such not be found, then stimulants may be given ; and such ecbolics as rue, saffron, savine, and particularly ergot of rye, have been recommended by various writers. These may be useful, but it will generally be found that, active interven- tion is preferable, and more especially as there is little, if any thing, to prevent the toetus being easily reached ; for should the os be insufficiently dilated, it may readily be made wide enough for the hand to be passed into the uterus. Moderate and judicious traction on the parts which pre- sent, when the mother makes expulsive efforts, will bring the foetus into the pelvic cavity, and through the vulva. Death of the Fcetus. — When parturition is retarded, it is often a question whether the foetus is dead or alive, and to answer it correctly is sometimes difficult. Auscultation in the larger animals cannot, as it may in the human species, furnish any certain evidence in this respect. The foetor of the liquor amnii has been held to prove the death of the fcetus ; but though it is a good, yet it is not an infallible sign. When decompo- sition has, however, well advanced, and the foetus is emphysematous and its hair easily removed, then there can be no doubt as to its being dead. The coldness of the parts external to the vulva of the mother, when well marked, is also a sign of death. Of course, so long as the fcetus displays active movements, it is alive ; but the absence of these is not an absolute proof that it no longer lives ; for sometimes when it is partly in the pelvis and the waters have escaped, so that the uterus encloses it firmly, though still living it remains immovable, and cannot be stimulated to movement. Should the presentation be anterior, then passing the fingers into its mouth and titillating the tongue will prove a test of its vitality, as the jaws and tongue are almost certain to move if it lives ; but the absence of movement will not be infallible, though it will constitute very prob- able, evidence of death. If the umbilical cord can be reached and seized between the thumb and index finger, slight compression will discover whether or not the arteries pulsate. The absence of pulsation affords a strong, but not in every case a sure, presumption that the fcetus is dead. Gelle, many years ago, gave an empirical test which, he asserted, was constantly successful ; though it is difficult to say why it should be. This method consists in passing a blanket or sheet under the belly of the Cow, 16 2 42 NORMAL PARTURITION. and lifting it up by assistants at each side. If the foetus is not dead, the Cow exhibits dislike of the pressure ; but if dead, then it rests on the shee . Another authority states that, with the Mare, the expulsive efforts cease for the time being as soon as the foal is dead, and if it has not entered the pelvic inlet ; if it has passed into this, the pains continue as usual. The causes of death of the fcetus during parturition are not numerous, and may be enumerated as follows : — i. Ktiots on the umbilical cord, which, though not unfrequent in the human fcetus, appear to be ver}^ rare in animals ; 2. Twists of the cord around the body, neck, or limbs of the foetus, and which may be sufficiently tight to interrupt the circulation in the umbilical vessels ; 3. Premature nipture of the membranes and escajDe of the whole of the liquor amnii, which, if parturition is not soon com- pleted, exposes the foetus to great danger from immediate pressure of the uterus upon it ; 4. Distmio?i, moro. or less complete and extensive, be- tween the uterus and foetal envelopes, by which the vital connection be- tween the mother and fcetus is interrupted, and if the latter is not quickly expelled it must die from asphyxia. Owing to the difference in the pla- centation of the various animals, it happens that this foetal asphyxia is not equally common in all; a fact which experience and clinical observation have abundantly demonstrated. Many veterinarians, and among them Saint-Cyr, have been struck by the fact, that no matter how soon they were called in to a case of difficult parturition in the Mare, nor how trifling the difficulty might be and rapid the delivery, a living foal was never produced ; while in cases in Cows, though incomparably more difficult, and requiring manipulation for more than an hour, living calves were the rule. So common is this experience, that a very distinguished French veterinary surgeon — Donnarieix — has laid it down as a maxim that the foal does not live more than three hours, often less, in the uterus, after the first expulsive efforts ; while the calf in the same conditions can live much longer-^-sometimes for several days — after the commencement of labor. The explanation he gives, and which we think is correct, is based on the manner in which the foetal pla- centa is inserted into the uterus. In the Cow, the placentulae, multiple and independent of each other, adhere firmly and closely to the uterine cotyledons, so that the placental circulation may persist for a long time, notwithstanding the energy of the uterine contractions ; while in the Mare, the placental apparatus being everywhere distributed over the chorion, adheres but feebly to the uterine mucous membrane, and gives way as soon as labor commences, so that fcetal asphyxia is imminent if bii'th be not prompt. It was, and still is, believed by many that the foetus plays an active part in delivery, and particularly in rupturing its membranes ; while others consider that its death increases to a marked degree the difficulties of parturition, because it does not then stimulate the contractions of the uterus, and its flaccid tissues do not afford that resistance to the uterine muscles which they do when it is alive. But Saint-Cyr denies that the death of the foetus renders parturition slower or more difficult ; though he admits .that if, at the commencement of this act, there may chance to be any trifling irregularities in presentation or position, these may be rectified to a certain extent by the automatic or more or less instinctive movements of the living foetus. He concludes, that though the death of jyecessa ry aid in norma l par TURITION. 2 43 the foetus has certainly a great importance, so far as the interests of the breeder are involved, as well as with regard to obstetrical operations in difficult cases ; yet it has little or none so far as parturition itself and its results to the mother are concerned. In the expulsive period, or third stage in parturition, it is usual to consider such matters, as when to rupture the water-bag, and when to use traction on the foetus. We will follow this custom, and notice these points. Rupture of the Water-bag. — This should not be artificially ruptured too early ; indeed, in the Cow, it should never, as a rule, be opened artifi- cially, as it is always spontaneously ruptured at the proper time, and not unfrequently sooner than it might be. Besides, the want of tenacity in the membranes, their thinness, and the firmness of their adhesion to the uterus, renders this non-interference all the more necessary. With the Mare, however, matters are different. In this animal the foetal membranes are thick, firm, and feebly adherent to the uterus ; so that the foal is sometimes born completely enveloped in them. It is, therefore, well to incise them when the water-bag appears as a large tumor beyond the vulva ; until this happens nothing should be done, unless the os is completely dilated, and the head and feet of the foetus are well in it. The membranes may be torn by the fingers, or cut by scissors or a knife, care being taken not to injure the foal. When the water-bag is ruptured too earh^, the uterus contracts on the foetus, as has been said, and becomes moulded on it; this is opposed to birth. Besides, the genital passage becomes dry and adherent, and this is an additional obstacle. To remedy this, recourse must be had to injections into the vagina of mucilaginous fluids, milk, glycerine and water, oil, lard, bran and water, or even simple tepid water, which may be introduced by a funnel, the Cow's hind quarters being slightly raised. Traction on the Foitus. — When the membranes are once ruptured, the natural expulsion of the foetus should be waited for. In some instances, however, this expulsion may be conveniently assisted by judicious trac- tion on the foetus. If it is in the anterior vertebro-sacral position, gentle traction may be made on the pastern of each fore leg when these and the head have cleared the vulva, the tractions coinciding with the throes of the mother, which they should supplement, but must not supplant. They ought to be made in a slightly oblique direction downwards, towards the hocks of the mother, so as to allow the body of the foetus to follow the curve of the pelvis ; inclining the traction a little to the right and left, will also aid in passing the shoulders and afterwards, the haunches. The head and neck, when they are clear of the vulva, should be supported. If the foetus is in the vertebro-pubic position, the direc- tion of the feet must be watched and directed, as they have a tendency to press against the sacrum, and may seriously injure the passage. They should therefore be seized while the}'- a^:e yet in the vagina, and brought gently outside the vulva along with the head, when traction may then be employed. This should at first be made upwards, so as to clear the withers from the brim of the f>elvis, against which it sometimes /jams. When this is effected, then the same procedure as in the other case is to be adopted. In the vertebro-iliac positions, it is always useful, when they are recog- nized in time, and before the chest has entered the pelvis, to attempt to 244 NORMAL PARTURITION. modify them by converting them into one of the preceding positions, and particularly the vertebro-sacral ; though this modification requires the manipulative skill of an experienced veterinary surgeon. If the foetus is already in the canal, delivery must be attempted according to the prin- ciples already indicated : directing the feet towards the centre of the passage and outside the vulva, and employing moderate traction on the limbs. When the foetus presents posteriorly, in the lumbo-sacral position, with the croup towards the maternal sacrum, the only way in which birth can be effected naturally is when the feet of the hinder extremities lead and dilate the os. This position is recognized by the coronary and pastern joints being bent upwards, and by the hocks, which are deeper situated, are flexed in the opposite direction, and are distinguished by their broad flat sides and the blunt point of the calcis, which points in a contrary direction to the flexure of the joint. In this position, the two limbs are to be seized at the pastern, and traction exercised at first slightly upwards, in order to carry the stifles over the brim of the pubis, which sometimes checks them ; then downwards, to bring the croup below the sacrum ; and lastly, an alternate movement from right to left and left to right, to free the haunches, one after the other. It is well to see that the tail of the foetus is in a right direction before traction has been much practised. The other positions will be referred to in the second division of this work.^ We mav remark, however, with regard to gemellar parturition, that this kind of pregnancy is not usually recognized in uniparous animals until birth takes place. The escape of only a small quantity of liquor amnii, and the small size of the creature first delivered, when compared with the size of the mother's abdomen, are not infallible indications that more young will be produced. Soon, however, another water-bag appears, and another foetus presents at the vulva. Not unfrequently, when the position of the two foetuses is natural, they present one after the other successively, and without any assistance being required. This is the case more particularly with the Sheep and Goat — animals which so often produce twins. But sometimes, and especially with the larger animals, the two foetuses present themselves simultaneously at the pelvic inlet, and neither can pass through. In such a case, which it must be confessed is rare, it is necessary to push back the one least favorably presenting, and to keep it away until the fore limbs of the other are engaged in the pas- sage. If the two foetuses chance to be in an unfavorable position, the anterior extremities of one should be sought for (recognized by the knees, and to a certain extent by the pasterns), or the hind limbs (recognized by the pasterns and hocks) if they are convenient for the purpose, and traction exercised as in the case of a single foetus, and according to the directions given above, taking care to keep the other foetus out of the way. Should it not be possible to extract this foetus, it may be that cer- tain parts of the other stop its progress, or that the expulsive forces are expended on the latter, although it is farthest from the os. It is then necessary to push back and turn the former, and endeavor to extract it by the extremity opposite to that which was first tried. But if the fore limbs have been got into the passage, as well as the head, the position need not be changed, the procedure being then the same as for a foetus disproportionately large. NECESSARY AID IN NORMAL PARTURITION. 245 Another remark is with reference to the operator. In exploring the genital passages, gentleness and tact should be scrupulously observed, and the hand and arm should be well oiled, the nail of the fingers being cut at least moderately short. It requires some experience to be able to ascertain, by the sense of touch, what parts of the foetus present, and those which are an obstacle to birth ; as well as knowledge to guide one in placing the parts in a favorable position, and particularly in one which approaches what we have designated the " natural " presentation. The time chosen for exploration should be the interval between the labor pains, and care must be taken not to rupture the membranes, should they still be intact. The exploration may be made while the animal is stand- ing or lying ; both positions have certain advantages, though the first is generally preferable, and is certainly less fatiguing. It must not be forgotten that, when traction is required, this should be slow and moderate, and only applied when the animal itself makes ex- pulsive efforts. In many cases the resistance to be overcome is often very slightly superior to the forces exerted by the parturient animal. Violent and sudden traction is to be deprecated, as it may inflict serious injury, while doing little, if any thing, in aiding delivery ; and even should this be effected, it must be remembered that the contractile power of the uterus is deranged when the contents of the organ are attempted to be , suddenly and forcibly removed. The simplest and safest traction is that made by the hands of the operator — for both hands may, in some cases, be introduced into the vagina. Should he not have sufficient strei^th or purchase, an assistant may clasp him around the chest and pull at and with him — gradually and steadily during the throes. But we shall recur to this subject again. B. After Labor. — The attention to be paid to the mother after par- turition will differ not only according to the species to which it belongs, but also according to its temperament, strength, and the kind of labor which it has undergone. When this has been natural, and the animal is vigorous and not much fatigued, simple hygienic measures are all that is necessary. It should be kept comfortable, with plenty of pure air, but away from draughts. If it has been perspiring, the body, and particularly the belly, should be well wisped if it is a larger animal ; indeed this fric- tion is always to be recommended, as it often allays the restlessness which sometimes persists after delivery, regulates the circulation, and appears to hasten the retraction of the uterus. It may be necessary to cover the body with a blanket, as the animal is very susceptible to cold at this period. A gallon or so of nourishing, tepid gruel, or even soup, may be given ; after which the diet should be moderate and easily digested. Clean dry litter should be plentifully supplied, and the animal left alone for half an hour or so, after which it may be visited, offered more gruel, and the offspring assisted to the teat, if it has not already found it. From three to eight, or even fifteen days' rest should be allowed, according to circumstances ; and in order to permit lactation to be fully established, and the animal quite recovered. When parturition has been protracted, and the animal has suffered much, and especially if the generative organs have been bruised and in- flamed, nursing should be continued longer, and greater precautions adopted. Every care ought to be taken to prevent metritis or metro- peritonitis ; and with this object in view tepid vaginal injections, to which 246 NORMAL PARTURITION. may be added a little per-manganate of potass or chloral, may be em- ployed : warm cloths being applied to the loins, the animal allowed light diet, with small doses of sulphate of magnesia, and kept clean in a good stable, and in a pure atmosphere. When the animals are old, weak, or exhausted by protracted labor, or if there has been haemorrhage, stimulants should be administered, and strengthening food. Sometimes the debility is so extreme, that the animal scarcely gives any indication of life. There is then all the more need for careful nursing and quietude. Friction to the surface of the body, clothing, and a good bed are particularly necessary ; and as lactation is established with difficulty in these cases, this *inust be attended to. It must be borne in mind that cold and damp are dangerous immediately, and indeed for some time after parturition. Therefore, when turned out to pasture, care should be taken to afford protection in bad weather, and damp cold localities should be avoided. With regard to Ewes, if the weather is mild and the situation favorable, protection is not required ; but if cold winds and wet prevail, then shelter is necessary. When more than one lamb is likely to be produced, the first should be kept warm and receive a little Cow's milk diluted with water, until the Ewe has finished lambing. Twin lambs may easily be reared by a strong mother, if supplied with a sufficiency of suitable food ; but, as a rule, if there are more than two, they should be put to another Ewe or reared artificially. In order to overcome the repugnance so oftei^pmanifested by the Ewe to a strange lamb, if its own lamb has died, the foster-lamb may be rubbed with the skin of the dead creature, or ihe two may be placed together during the night, or even put into a dark shed along with a Dog, which will induce the Ewe to protect and take to the lamb. The Goat is more exposed to long and difficult parturition than the Sheep, and not unfrequently requires assistance. The same care is ne- ' cessary as for the Sheep. The Sow generally suffers from weakness and prostration often parturi- tion, and requires plenty of nourishing and easily-digested food. When this is given there is less likelihood of the animal not devouring its young, and all the more so if it is not irritated by the presence of people. The Bitch should not be allowed to rear too many puppies, and warmth, a dry abode, and good food must not be withheld. Bitches do not readily take to strange puppies ; sprinkling these with some of its milk has been sometimes successful. Constipation is not unfrequent after parturition, and this may be removed by castor-oil or manna. SECTION II. ATTENTION TO THE OFFSPRING. No special rules can be laid down for the management of new-born animals, as this must vary more or less according to the species. How- ever, there are some general rules which it may be well to observe, and these we will refer to. With regard to the foal or other creature which may be born in the foetal membranes, it is evident that it must be freed from them immedi- ately, or it will perish from suffocation ; as through having no longer any communication with the mother by means of the umbilical cord, the blood cannot be oxygenated. If the umbilical cord is not ruptured, it may be double ligatured about two inches from the umbilicus, and then NECESSARY AID IN NORMAL PARTURITION. - 247 divided between the ligatures ; or it may be severed by scraping it through with a jagged knife. Immediately after delivery, and having removed the mucus which some- times clogs the mouth and nostrils, and hinders respiration, the young animal should be examined to ascertain whether it be strong or weak, whether all the natural apertures exist — such as the eyes, mouth, anus, vulva, urethra — and if any of them chance to be absent, to make artificial ones soon, if possible, by a kind of puncture, enlarging afterwards by the knife and sound, and preventing union by pledgets of lint, etc. Suspended Animation. — Whenever the connection with the mother is interrupted by rupture or occlusion of the umbilical cord, the young creature must breathe, respiration being now carried on by the lungs, through the nostrils. The establishment of respiration is a purely reflex act. The foetus, hitherto maintained at a certain and always uniform degree of warmth in its liquid bed in the uterus, is suddenly ushered into the cold and dry air of the outer world ; and this transition operates chiefly on the skin, producing a peculiar impression — such as we ourselves experience in being suddenly immersed in cold water ; this impression is at once transmitted to the cerebro-spinal centre, whence the reflex influence of the spinal cord is called into play, and the respiratory muscles are excited to movement by the centrifugal nerves issuing therefrom. All these muscles contract simultaneously, the chest is dilated, and the air rushes into the air-passages and lungs, distending the air-cells in the latter, and instituting the process of respiration, which is only to cease with the death of the creature. This reflex act may also be produced by pressure on the umbilical cord, or any thing which hinders the oxygenation of the blood in the foetus ; hence it has been inferred that the excess of carbonic acid in the circulating fluid acts as a stimulus to the medulla oblongata. It sometimes happens that the young creature is in a state of syncope when born, or very soon after, and gives no sign of life ; and observers have distinguished syncope from weakness, in which the animal is cold and does not breathe, the mucous membranes being pale and the body flaccid ; and syncope from plethora or cyanosis, when the inucous mem- branes are of a livid blue tint, the lips and tongue swollen, and the eyes injected. In the first form, resuscitation is to be attempted by pouring cold water on the head, beating the body with a cloth dipped in cold water — particularl}- about the face and chest — dry-rubbing the limbs, titillating the nostrils with a feather, puffing tobacco-smoke into them, imitating the respiratory movements, as in a case of asphyxia, and inflating the lungs by means of a pair of bellows, acting through the nostrils. So long as the heart pulsates there is a probability of restoration to life. In the second form, allowing a little blood to flow from the umbilical cord, and even cutting this or fomenting it with hot water to induce haemorrhage, is very useful, in conjunction with cold water to the head and cold water enemas. But, as a rule, death is always imminent in these cases of syncope. General Care. — With the larger animals, the newly-born creature should be placed before the mother, if it is not near her; and it generally follows that she instinctively licks off the viscid matter which covers its 248 NORMAL PARTURITION. skin ; and in doing this the cutaneous circulation is excited, and, by sympathy, the other organs of the young animal. Consequently, it becomes revived, soon endeavors to get up, and though it may fall several times, yet it generally quickl}'- succeeds in maintaining itself on its limbs, and instinctively seeks the maternal teat. It is very rare that the mother does not voluntarily, and at once, commence to cleanse its progeny ; nevertheless, there are exceptions, chiefly among the primip- arae, and especially when the labor has been long and painful. But it will generally be found that sprinkling the young animal with a little flour, bran, or salt will excite the attention of the mother and induce the cleaning process. Should it not do so, then the creature must be well dried and rubbed with a sponge, hay-wisp, or a cloth, and kept warm. This is more particularly necessary when the mother is indifferent to it, which sometimes happens with primiparae when people are present. Indeed, some Mares become quite savage after parturition, and will not allow their foal to come near them, and will even kill it; though this most frequently happens when they are tormented by spectators. Other Mares, vicious before parturition, sometimes become remarkably quiet when they have a foal by their side. When they exhibit any aversion to their progeny, it is well to leave them quietly together for some time. If the foal or calf is weak, and cannot reach the teat within half an hour or so after birth (for in uniparous animals the mammae are inguinal, so that the young are always suckled in a standing posture), it will be found necessary to assist it by bringing it to the mother, and applying the teat to its mouth, at the same time caressing and soothing the parent if disinclined to it by temper or painfulness of the udder. This coaxing and handling should be performed by some one accustomed to the animal. It may be necessary to have a second person at hand to hold the Mare by the head or lift up its fore foot. Sometimes from weakness or inexperience of the foal, and temper of the Mare, the former runs the risk of perishing from starvation. The Mare should be safely secured, and two persons ought then to push and support the young animal behind by joining one of their hands, while the other hands are employed in directing it towards the teat, which it should be allowed to use for two or three minutes. After one or two attempts of this kind, the foal begins to find its way to the udder by itself, while the Mare becomes reconciled to it. When the foal exliibits great debility, it may be preferable to feed it for a day or two with the milk of the Mare, which has been drawn by hand. With the Cow, these difficulties are seldom present, and if an animal will not take to its calf this is generally transferred to another Cow, or it may be artificially reared. The foal may even be reared in this manner, though not so easily as the calf. The milk of the Cow or Goat will suffice, and there is generally little difficulty in teaching it to drink it by at first pouring a little into its mouth while the finger is inserted therein ; or a piece of cloth steeped in milk, or even a bottle and tube may be used. Calves are often harshly treated after birth ; they are not allowed to suck, even for a number of days, for fear of damaging the Cow, but are kept apart and fed on drawn milk. Calves intended for slaughter may be artificially fed, and especially if nutritive substances are added to the milk ; but for those intended to be reared, it is a mistake to separate them' from the Cow during the early days of their existence. NECESSARY AID IN NORMAL PARTURITION. 249 Lambs, when able to stand, and if they do not readily find their way to the teat, should have a little milk from it pressed into their mouth. With twin lambs, if the Ewe is in good condition, the udder well filled, and the weather and pasture favorable, both may be suckled ; in the opposite conditions it maybe necessary to remove one. If the Ewe does not yield sufficient milk, this may be largely remedied by giving a liberal supply of good food.' Multiparous animals, such as the Bitch and Sow, usually lie when suckling their young j so that there is seldom any difficulty with them. The only care generally required in the case of young pigs, is to prevent their being crushed by the Sow in the act of lying down or moving. If the litter is large, plenty of good food is necessary. It is well to remember that if a Sow has more young in the litter than teats, unless watched the weakest wiM die of starvation. Each young pig has its own particular teat, to which it is persistently attached ; and if the creature is ill and does not suck, or if there is not a claimant for the teat, the gland there will cease secreting milk. The pectoral teats and glands are the largest and most active, and the weakest of the litter should be put to them. In general, a Sow should not be allowed to rear more than ten in a litter. Cleanliness and warmth are required for young pigs. Puppies do not require any special care beyond a warm, clean, and dry abode. After the first milk has been taken, there is usually an abundant evacuation of black resinous matter — meconium — from the intestines of the young animal, caused by the " colostrum," as this milk is named ; and it is well to notice if this evacuation occurs, as when it does not, serious constipation may ensue. With new-born animals which, for some reason or another, are deprived of this colostrum, a mild laxative — such as castor-oil, or. honey and water — should be administered to obviate this condition. At birth the feet of hoofed animals are covered with a soft yellow horn, which in some countries it is the custom to remove, from a belief that this removal hardens the succeeding horn. Tt is unnecessary to state that this is a popular fallacy, and that it is really injurious to deprive the foot of this temporary protection. The young, with their parents, should be kept apart from others — for some time at least, and especially the equine species ; and it must not be forgotten that a mild dry temperature is most favorable for all young creatures. Gentle exercise is as necessary for the foal or calf, as it is for their parents, a few days after birth. Therefore it is that a meadow is pref- erable to a stable, as, in addition to the more favorable nature of the food, sufficient exercise is afforded. Indeed, with the Mare light and regular work may be imposed a short time after foaling, and with much benefit to it and the foal. The latter will follow its dam, provided the pace is not too fast, and a halt be frequently allowed for it to get to the teat. It is astonishing sometimes to observe how well foals travel soon after birth, even over bad roads and during inclement weather, and for great distances, provided the journey is short each day. Huzard has seen buffalo calves, born during the night, follow their mother next day, and make a daily journey of six or eight leagues without appearing fatigued. 250 NORMAL PARTURITION. It is not rare to find newly-born animals, particularly when parturition has been laborious, injured more or less, from the manipulation of the obstetrist during birth, the lesions being more or less serious. The most frequent injuries are those due to obstetrical instruments and appliances. The wounds may be dressed wath cold water, with slightly alcoholized water, or some dilute tincture — such as that of arnica ; but salts of lead, or other poisonous salts, should not be employed. Abrasions, which are generally superficial, may be treated with glycerine and water, to which a very little carbolic acid has been added; or by lard, or any mucilagi- nous substance. Sprains should have cold water irrigation if possible, refrigerant lotions, or friction with soap liniment. Wounds and lacera- tions, if very severe, must have appropriate surgical treatment. . CHAPTER IV. Sequelae of Parturition. We have stated that gestation and parturition are physiological processes, and we may now add to these \\\^ puerperal state. But though in one respect eminently physiological, the puerperal condition is marked by special features, which distinguish it from other physiological states, and which, occurring under other circumstances, would be more allied to pathological changes. We refer now more particularly to the functional and organic alterations which take place after delivery. True, we do not have in animals such important, nor so many, sequelae as are noted in women at this period, some of which are really pathological. Neverthe- less, we have certain phenomena occurring during the return of the econ- omy and the generative organs to the condition they were in previous to pregnancy, which are not only very characteristic, but are worthy of seri- ous attention. These phenomena have been divided into fimdmial and organic. SECTION r. FUNCTIONAL MODIFICATIONS. The functional modifications include the afterpains^ lochia, 7nilk-fever, and lactation. I. After-pains. — These are the painful sensations in the abdomen, indications of which are frequently observed in animals, and which per- sist after the expulsion of the foetus and the secundines. They are due to the contractions of the uterus, which go on for some time, and which eventually reduce the organ to its ordinary volume and diminish its cavity. After an easy labor, there are generally few or no symptoms of these pains ; and when they are present the only indications are whisking of the tail, at which time, according to Saint-Cyr, the abdomen appears to be harder. They seldom continue longer than twelve or twenty-four hours in these cases, and do not require special treatment. In other cases, however, and particularly when birth has been very sudden and rapid, they persist longer and are more severe. The animal paws and exhibits suffering ; it also stretches as if trying to micturate, arches the back, contracts the abdominal muscles, and strains. The SEQ UEL^ OF PA R TURITION. 251 access of these attacks is not regular ; and when they are frequent, se- (^ere, and continue beyond twenty-four hours, we may apprehend the reten- tion of a portion of the foetal membranes in the uterus, or commencing inversion of that organ. This will necessitate an exploration, in order to discover the cause ; which, when ascertained, should receive appropriate treatment, to be hereafter described. 2. Lochia. — The term lochia has been giv-en to the sanguinolent, sero- sanguinolent, and muco-purulent, and finally mucus vaginal evacuations occurring after parturition, and generally persisting until the uterus has regained its ante-pregnant condition. The existence of this evacuation, so marked in woman, has often been denied in animals ; but there can be no doubt whatever as to the fact of its presence. It has been wit- nessed by several veterinarians in the Mare, Cow, Sheep, and Bitch, and we have noted it repeatedly in the Sow and Cat. But it is considerably less in these animals than in woman, and does not flow continuously as ih her, but at irregular periods ; the discharge accumulating in the uterus, and only escaping when the animal undergoes exertion, and in defecation or micturition. In the Cat, however, we have witnessed this discharge — very slight — flowing constantly for four days after parturition ; and with the Bitch we have a sanguinolent, then a mucus discharge persisting al- most continuously for several days subsequent to that event. In the larger animals, this discharge can be seen about the inferior commissure of the vulva ; it sometimes accumulates about the thighs and tail in flakes and patches, as well as on the litter ; and when the animal has been lying it forms small pools on the ground. When we remember that the uterus has for a long period nourished one or more foetuses, we can scarcely wonder that it cannot all at once cease its secretory function, and that its mucous membrane should con- tinue in a hyperaemic condition until the lacteal secretion in the mammai is fully established. As much as seven to eight quarts of sero-sanguino- lent fluid have been removed from the uterine cavity of a Mare which had foaled three days previously. When not mixed with blood, this discharge is albuminous and chylous- looking ; it is rarely purulent, and then probably only from traumatic causes ; neither does it have a bad odor, unless the uterus or vagina is the seat of some pathological process, or a portion of the placenta is retained. According to some authorities, the average duration of the discharge is from two to three weeks ; but Saint-Cyr believes that when it is prolonged beyond five to eight days, it is no longer a physiological, but a pathological process. This is about the period which is necessary, in the larger animals, for the return of the vulva to its normal dimensions and ordinary form. Of the importance of the lochia there can be no doubt. By them the uterus is relieved from its physiological hypertrophied condition, and of the excitement of which it was the Seat during pregnancy and parturition. But it can not have the same importance as innvoman, in whom the lining membrane of the uterus is thrown off pretty nearly after every delivery. It is not so with animals, as we shall see hereafter. One or two veterinary authorities have attached so much importance to the lochia in animals, that to their suspension or suppression they attrib- ute such serious results as : sanguine plethora, articular rheumatism in the Cow, laminitis in the Mare, metro-vaginitis, cystitis, nephritis, peri- -S' NORMAL PARTURITION. tonitis, mammitis, inflammation of the intestines or spinal cord, coryza, vitulary fever, etc. But tliere is evidently exaggeration in this ; and we are inclined to think that, at the most, the untimely cessation of this dis- charge can only cause, as has been stated, dulness, indifference of the mother to its progeny and surroundings, inappetence, suppression of milk, slight fever, with dry erect coat, and constipation. To avoid this untimely cessation of the lochia, it has been recommended that, with the larger animals, before and after parturition the food should be sound and nutritive, but moderate in quantity, and such as will not predispose to plethora or congestion; not" to travel or fatigue animals towards the end of pregnancy ; to shelter them at this period ; not to hurry labor, and only to render assistance when necessary ; and after delivery to attend to the removal of the secundines, which are sometimes retained in the Cow for an abnormal period, but should not be allowed to remain longer than four or five days. 3. MiLK-FEVER. — In woman the establishing of the lacteal secretion after delivery — generally forty-eight hours — is usually accompanied by a general febrile condition, in which this fluid changes from colostrum to ordinary milk. This is tlie so-called " milk-fever," a pathological condi- tion said by some authorities to be present in animals, and denied by others. The latter assert that, when parturition has been quite normal, there is only observed a little dulness, lassitude, the pulse fuller and quicker than usual, and less appetite for the first day — all consequences of the suffering undergone during even the easiest parturition. In a day or two, however, all this has disappeared, except perhaps a little weak- ness, which soon vanishes also. But when parturition has not been altogether natural, and complications arise, then there may certainly be fever, though this has nothing to do with the change of the colostrum to milk — a gradual process ; indeed, when traumatic fever sets in this secre- tion is diminished or suspended. Saint-Cyr is disposed to deny the existence of this so-called " milk fever '' in animals, and he quotes eminent accoucheurs, who are inclined to doubt the existence of this fever in woman as related to the lacteal secre- tion, but as due rather to traumatism from injury to the genital organs during child-birth. His own observations on Cows are certainly not favorable to the existence of this fever in these animals ; and even among those who believe in it, there are many who admit that it is scarcely per- ceptible. Rainard, for instance, accounts for its being so little marked in animals, by noticing that in woman the uterus receives its blood from the ab- dominal (mferior) aorta, but the mammae from the pectoral (or anterior) aorta; but in animals, uterus and mammae are supplied by the posterior aorta. In woman, when lactation is established, there is an alteration in the circulation, and consequently a general disturbance which has been ' hitherto designated "inflammatory" or " angiotenic fever;" but in animals this change in the' circulation does not occur. Therefore, this '• angiotenic fever " should not be present. 4. Lactation. — Before parturition, preparation for the secretion of milk is already being made in the mammary glands, and shortly before thnt event a thin serous or milky fluid can often be expressed from the teat ; while immediately after delivery, the oedematous tumefaction which SEQUELS OF PARTURITION. 253 had been observed in these glands for some time, begins to disappear as they increase in volume, become firmer, tenser, and more sensitive, and receive a larger quantity of blood. Then their activity is suddenly brought into full operation, and their secretion reaches its maximum. At the same time this fluid is modified in quality in a notable but gradual manner, so that it is very different three or four days after parturition from what it was on t^ie first or second day — being colostrum at the early period, and milk subsequently. Colostrum. — The first milk, or "colostrum," secreted after delivery is a viscid, dirty-white, or yellowish fluid, sweet, though unpleasant to the taste, and of a greater density than that of ordinary milk, being in the Cow I "063. It is very rich in solid elements, these varying according to individuals, and even breeds. The fat globules are present only in com- paratively small number, and are less in size than in milk at a later period ; l3ut there are numerous colostrum corpuscles — bodies of a large size, spherical or ovoid in shape — of ten agglomerated in masses by a tenacious viscid matter, and among them many leucocytes endowed with movement. Boussingault gives its composition in the Cow as follows : — Water 75-8 Albumen and casein ... 15 'o Butter 2-6 Milk-sugar 3-6 Salts ...... 3'o Dumas gives the colostrum of various animals as below : — Water - Fat Albumen Mucus - Sugar Cow. Ass. Goat. 803-3 8284 641-0 260 1"^ 1 160 520 1507 245-0 20-0 70 300 traces. 43"o 32-0 It is admitted that milk is due to a fatty degeneration of the epithelial cells of the gland follicles, in which they are greatly multiplied and developed during lactation. These cells rupture, and nothing remains but the fat globules of the milk. Fig. 63. Mammary Gland during Lactation. A, Lobule of the Mammary Gland filled with Cells; B, Milk or Fat Globules; C, Colostrum. a, Ceil filled with Fat Granules and with a visible Nucleus ; b. Cells from which the Nucleus has disappeared. But in the colostrum the epithelial cells have not undergone this [change ; their wall is intact, and they still contain their oil granules, ^and consequently constitute the colostrum corpuscles. Colostrum is 254 NORMAL PARTURITION. coagulable by heat, and it may be said that the albumen takes the place of casein ; but soon after parturition the former disappears and the latter is present. Towards the end of lactation, however, if the animal is preg- nant, the milk again loses its casein, and becomes very albuminous ; consequently, coagulable by heat. Its sugar also diminishes or disap- pears altogether. The leucocytes seem to be increased in number in the colostrum, as the animal is disturbed or its health deranged ; and as the young creatures are often attacked by diarrhoea, this is ascribed to the presence of these particles. Milk. — Towards the fifth or sixth day, or even longer, after parturition in the Cow and Mare, earlier with some of the other animals, the colos- trum disappears, and then we have the ordinary milk. This is an opaque, pure white, or slightly yellowish fluid, possessing a sweet taste, and a faint odor somewhat resembling that of the animal from which it is obtained ; it is unctuous to the touch, has an average density of 1032 to 1 041, according to the species and other circumstances;* and is com- posed of three essential parts — water, butter, and casein. We hav^e in addition albumen, milk-sugar, and mineral matters. The three principal constituents are easily separated — the fat or cream by allowing the fluid to stand at rest for some time ; by pressure the casein is separated in a solid mass ; and the remaining portion contains the water. The milk varies considerabl}'-, as has been said, according to species, breed, age, food, the period of lactation and milking, climate, state of health, etc. In herbivorous animals it is generally alkaline ; in carnivo- rous, acid. Vernois and Becquerel give a comparative table of the composition of the milk of various animals, as below : — Specific Gravity Weight of Water - Weight of Solid Parts Fat ----- - Casein and Extractive Matters . - - . Milk-sugar - - - ■ Salts (by incineration) Woman 1032-67 889-08 110-97 26-66 Cow. Goat. Sheep. '033-38 864-06 135-94 36-12 1033-53 844-90 155-10 56-87 1040-9S 167-6S 51-3' 39-24 43*64 1-38 IP 6-64 55-M 36-91 6-18 69-78 39'43 7-16 Camel. 1033-74 904-30 134-00 95-70 36-00 24*36 40-00 58-00 33-35 32-76 5-23 Ass. Sow. 1034-57 _ 890-12 854-90 109-88 145-10 1^-53 19-50 35-65 84-50 50-46 30-30 5-24 10-90 Bitch. 1041-62 772-08 227-92 87-95 116-88 15-29 7-80 Doyere furnishes us with another interesting analysis, which we cannot omit publishing here : — * Constituents. Woman. Cow. 87-60 Goat. Sheep. Llama. Ass. Mare. Water- - 87-38 380 87-30 8 1 -60 8660 89-63 91-37 Fat - 2-20 4-40 7-50 310 1-50 0-55 Casein 0-34 300 350 4-00 3-00 060 0-78 Albumen - 1-30 I -20 i"3S 1-70 0-90 135 140 Sugar - - . - 7-00 4-70 3-10 4-30 5-6o 640 550 Salts - 0-18 070 0-35 ■ 0-90 080 0-32 0-40 * Cow's milk of good quality, according to Voelcker, has a specific gravity of about 1030 ; Woman's lilk, 1020 ; Goat's and Eve's milk, 1035 ; Ass's milk, 1019. SEQUELS OF PARTURITION, 255 The salts contained in the milk varies with the character of the food, and also according to the time that has elapsed since parturition ; this fluid being particularly rich in inorganic elements during the first third of the period of lactation. According to the analyses of Haidlen and Furs- tenberg, there is in it 1000 parts of ash ; 475 phosphate of lime, magnesia, iron, etc. ; 219 carbonate of lime and salts, which are more especially combined with the casein ; 343 of sodium salts, with traces of sulphur and flouride of calcium. Milk also contains such gases as carbonic acid, oxygen, and nitrogen, in solution. In the Cow the flow of milk becomes very plentiful in about a week after calving, but after a month or so it gradually diminishes in quantity for about ten months, when the animal, as a rule, " runs dry." In the first and second months after calving, when the yield is abundant, it is generally more watery than after the fourth or fifth month ; and the fur- ther the diminution in quantity proceeds, the better it becomes in quality, other circumstances being equal. It will be seen from the above table, that the milk of the *Cow closely approaches that of woman, and this accounts for the readiness with which it can be substituted for the latter without injury to the child. It is, when compared with that of Solipeds, more rich in casein and fat. The milk of the Goat is the most nutritive, and contains more casein ; but it is viscid and has a peculiar odor, something like that of the cutaneous transpira- tion of this animal, and particularly during the rutting season; this odor is not so powerful in white goats, nor in those without horns, if they are properly kept. The milk of the sheep contains more fat than that of the Cow and Goat, while the casein is in larger quantity, but is also viscid. It has less water than that of the Cow, and altogether is particularly rich, especially soon after lambing. This is well seen in the subjoined analysis, and it will explain the difficulty which is experienced in bringing up a lamb when the Ewe has died soon after parturition : — Water - Fat - - - Casein - - - Milk-sugar - Mineral Matters (Ash) Ewe's Milk \ Ewe's Milk Three Weeks [ Six Weeks after Lambing. ' after Lambing. 75-00 8670 1278 3-67 658 4-44 4-66 400 •98 119 loo-oo I GO "00 The milk of the Mare appears to contain the largest portion of ^yater and the smallest quantity of fat, the milk of the Ass coming next to it in these constituents. This contains little casein, scarcely any fat, and a small quantity of ash. On the other hand, it is comparatively rich in milk-sugar, which is, according to Voelcker, a very digestible material and a good aperient, particularly for children. But of all animals, the carni- vora have the richest milk ; the casein and fat being particularly abun- dant, and no other food will at all compare with it in these constituents. Solid butcher's meat contains less real nutriment and more water than this description of milk. This explains at once the extreme difficulty of 256 NORMAL PARTURITION. bringing up a puppy by hand. No kind of food is sufficiently concen- trated adequately to provide for the nourishment of a puppy, strong beef- tea being perhaps the best substitute for that purpose. The milk of carnivorous animals has another peculiarity, in the very small proportion or entire absence of milk-sugar. This substance is very abundant in the milk of herbivorous animals ; and when carnivorous creatures are put on more or less of a vegetable'diet, it appears in their milk, and increases as this diet is increased ; whereas, by feeding them entirely on flesh, the sugar vanishes. The proportion of salts is also comparatively large.* According to the richness of milk in fixed constituents, Colin classes that of animals in the following decreasing order : Bitch Sow Woman Ewe Cow Ass Goat Camel Mare. Milk is a typical food, and when healthy and in sufficient quantity, contains all the constituents for the maintenance and growth of the young creature. t This is particularly noted immediately after birth, and before it begins to seek at all for other food. It is at this period, also, that growth is most rapid ; and it has been observed that puppies double their initial weight in six days only. Colin has stated that, in thirty days, ten •puppies — reduced to nine on the twenty-fifth day — living on the milk of the mother alone, except for the last ten days, showed a total increase of 35/^ lbs., the entire weight having been trebled since birth. A simi- lar increase may be observed in other young creatures while being suckled. When, from some cause or another, the progeny cannot obtain milk sufficient in quantity or proper in quality, it is necessary that this be remedied. A calf can be readily artificially reared in an ordinary estab- lishment, if it has had one or two days colostrum : or a substitute for the mother in another Cow may be procured. It is not so with the fo^l, which is much more difficult to rear, and another Mare, even if procured, will not alwa3's readily play the part of nurse. Nevertheless, many animals can be reared by judicious and patient management, and if arti- ficial food must be resorted to, this should come as near as possible, in chemical composition, that furnished by nature. In some instances, the mammary secretion may become a source of embarrassment, or ev-en of danger, when it is too abundant or is not with- drawn when secreted. This happens more particularly with the Bitch, Cat, Mare, or other animal which is suddenly deprived of its young by death, or for special reasons ; and the retention of the milk is often a cause of discomfort and disturbance, culminating not unfrequently in inflammation of the gland. In such cases the milk should be withdrawn until its secretion is diminished or altogether ceases, and mild diuretics or purgatives may be administered to hasten this end. Camphor, in small and frequent doses, has been recommended with this object, as well as an infusion of walnut-leaves and powdered white agaric. * According to a French medical journal, Montbrun-les-Bains, in the Drome, is celebrated for nurses, who continue to give the breast for two years and more. When one of these women loses her nursling, she takes a puppy-dog instead, which then becomes one of the family. But it has been observed that all these dogs become affected with rickets, and this has led a medical man to conclude that woman's milk is deficient in some principle contained in dog's milk, and that consequently the latter might be a cure for rickets. An observation published by him would seem to confirm this view. t The mammary secretion may be present in animals without these being in the pregnant or parturient state, or even having been so. We have already alluded to Bitches yielding milk without having puppies. Rabbits have done the same without having been fecundated, and have reared the young of other Rabbits : Bitches have done the same. Virgin or barren Ewes have also yielded milk, as have likewise Mares — Mule and Horse — and Fillies. SEQUELS OF PARTURITION. 257 Whatever general treatment may be adopted in such instances, local treatment must not be overlooked ; and in addition to removing as much of the contents of the mammary glands as possible, these may be kept healthy, or cured when congested or inflamed, by suitable treatment. Soothing liniments or embrocations should be timeously applied by fric- tion to the skin covering them. SECTION II. ORGANIC MODIFICATIONS. Gestation and parturition being completed, it is necessary that the genital oigans should return to their non-puerperal state. Indeed, this return to tneir ordinary physiological condition is commenced in the uterus even during labor, and remarkable modifications occur more par- ticularly in the uterus and its membranes then, and for some time after- wards. Theses changes are connected with the diminution of the uterus in volume, alterations in its mucous membrane, and the reforming of its cervix. The powerful contractions of the uterus during parturition, undoubtedly tend to use up the contents of the cells of the non-striped muscular fibre composing its middle coat ; the simultaneous compression of the capil- laries and afferent vessels preventing the expended protoplasm from being replaced. After the expulsion of the foetus and its membranes, this wasting or oxidation of these fibres continues : the uterus still contracting at intervals, and producing those sensations known as the " after-pains," — the contractions being slow, gradual, and continuous, and lasting until the whole of its inner surface is more or less in contact, and its cavity has regained its ordinary dimensions. In this process the muscular fibres continue to undergo alteration, the contractions of the organ diminishing in force as this change goes on ; and this change is essentially related to the conversion into fat of the albuminous substance of the protoplasm of which their cells are composed. The fibres become degenerated and absorbed, and it is some time before they are replaced by others which have much smaller cells. The bloodvessels of the organ also undergo similar alterations, after the uterine contractions have more or less sus- pended the flow of blood in their interior. They become wrinkled and sinuous, and gradually less permeable to the circulating fluid, and the walls of the veins and capillaries are attacked by fatty degeneration, and are absorbed in large numbers. This gradual interstitial absorption occurring after parturition, brings about a considerable reduction in the weight and volume of the organ. Thus the uterus of the Cow, which, immediately after delivery, will weigh from thirteen to fifteen pounds, will be no more than seventeen to twenty- one ounces when this process is completed ; and the uterus of a Ewe will be found reduced to a twelfth or thirteenth of its weight at parturition. At the same time, the mucous membrane lining the organ is undergoing corresponding, but perhaps less profound, modifications to those observed in woman after the uterus has got rid of its contents. When treating of the physiology of gestation, we described the manner in which this mem- brane* became enormously thickened, either wholly or partially, to con- stitute a most important glandular and vascular structure" for the develop- ment of the young creature. But after parturition, fatty degeneration attacks this structure and completely destroys it, and this destruction 258 NORMAL PARTURITION. takes place in a remarkably brief period in some animals. With the Bitch, Cat, and Rabbit, as with woman, the whole of the glandular layer of the membrane corresponding to the insertion of the foetal placenta — the decidua vera — is completely detached and eliminated. In Ruminants the cotyledons, which had gradually acquirec^uch large dimensions during pr*egnancy, shrink, their follicular receptacles contract so as to be scarcely visible to the naked eye, and many of these maternal placentse even appear to subside altogether, or to be reduced to exceed- ingly small proportions. With Solipeds and the Sow, which have a diffused placenta, the follicles which received the placental papillae of the chorion also disappear; and the membrane, greatly thinned, assumes its ordinary ridged appearamce, though the ridges or folds are larger and more numerous than before conception. In a Mare killed eighteen or twenty hours after parturition, Ercolani found the maternal portion of the placenta reduced to one-half its thickness ; its color, instead of being a dull red, had become yellowish ; the follicles, from being one to two millimetres in length, were reduced ta one and half a millimetre, and the capillary network around them was no longer visible. The evacuation of the detached elements is accompanied by an ap- parently large mucous secretion, which, often sanguinolent, constitutes what we have described as the "lochia." Finally, a new^ epithelium is formed in the place of that which has been shed, and the uterine interior presents the appearance it had before im- pregnation. According to Friedlander, the formation of the new mucous membrane takes place in the following manner : — All that has remained behind of the cellular layer richly infiltrated with blood, as well as the upper portions of the glandular layer, gradually exfoliates and is dis- charged in the lochia. The flatly compressed glandular tubes situated close to the muscular coat are opened up, and their cylindrical epithelium forms the new mucous epithelium of the internal surface of the uterus. The connective tissue situated between the tubular glands, accordingly proliferates, and becomes reorganized. In consequence of the increase in thickness of the mucous membrane, the previous shallow depressions of the epithelium are deepened, and in that way the uterine glands are also reformed in the new mucous membrane. Coincidently with this return to small proportions, the uterine cervix also regains its former shape. During the passage of the foetus, in process of dilatation the os and vagina form a continuous canal without any inter- ruption, and the cervix is effaced. Immediately after the fcetus has passed through, however, the .latter reappears, the os is closed, and the uterus and vagina are again separated by the sphincter-like ring which the uterine neck exhibits in the cavity of the latter. The cervix is at this time soft and flabby, and the os, not entirely closed, is readily dilated by the fingers. But it gradually contracts and closes, as its texture becomes firmer, and in doing so it elongates towards the vagina, into which it pro- jects, until it has regained its natural form and consistence ; though it is always shorter and less regular in shape, particularly attheos, in animals which have had several young, than in those which have never been pregnant. The uterus itself does not completely assume the dimensions it had in non-pregnant animals, but is always larger after it has contained one or more foetuses. It may be noted that the broad ligaments of the uterus become short- ened after parturition, and consequently raise the organ towards the SEQUELS OF PARTURITION. 259 lumbar region, and in the direction of the pelvis ; while their muscular fasciculi undergo fatty degeneration and absorption. Such are the organic modifications the genital organs undergo after labor, when everything occurs regularly. But it sometimes happens that the muscular layer of the uterus appears to be struck with paralysis soon, or even immediately after birth ; so that it remains "distended and its cavity so large that the arm can easily be introduced into it. This inertia is not so much to be dreaded in animals as in woman, though it is often troublesome and sometimes serious in them. The debris of the decidua vera, and other effete matters, accumulate in its cavity, and the os being always more or less patent, the air obtains admission, putrefaction com- mences, and grave results may follow. An exploration will discover a variable quantity of sanious, and more or less foul-smelling, matter in the cavity of the organ ; and until this is removed, and the organ made to contract on itself, danger may be apprehended. PART SECOND. DYSTOKIA. GENERAL CONSIDERATIONS. In studying the physiology of parturition, we saw that a favorable ter- mination of labor depended on two factors, one of which was a proper degree of activity of the expelling powers, and the other a normal condi- tion of the obstacles to be overcome by these powers. When these are out of proportion to each other, then we have difficult parturition or Dystokia (o''>'^ difficult ; roxoc, birtJi). Difficult parturition may be due to too feeble pains, or to an obstacle which the unaided efforts of the animal cannot surmount except after an unusual period of labor, or not at all. We have already alluded to the nature of and variations in the expel- ling forces, and also to the causes of protracted labor. We have now to treat of the difficulties attending parturition, with their consequences — proximate or remote, and the means to be adopted for overcoming, pre- venting, or remedying these. This involves a study of the necessary ob- stetrical operations, the accidents attending or following parturition, and the diseased conditions more or less related to the puerperal state — all of which may be included under the head of " pathology of parturition." The difficulties attending parturition depend upon the resistance op- posed to the expelling powers, and this is determined by the relation of the object to be expelled — the presenting part of the foetus — to the mater- nal genital passages. Consequently, an exaggerated resistance may be due to abnormal conditions of the parturient passages, or to some un- natural condition of the young animal. In the first we have Maternal Dystokia, and in the second Fcetal Dystokia. These necessitate particular operations, some of which demand much study, address, and manipula-' five power on the part of the obstetrist. In addition, we have dangerous accidents sometimes occurring during parturition, which, if they do not happen to interfere with the mechanism of that act, may nevertheless require the highest degree of surgical skill to remedy. And, finally, there are the maladies which accompany the parturient state, some of them being serious, and needing great clinical knowledge for their successful treatment. These difficulties, accidents, and diseases do not occur with the same gravity, nor with the same frequency, in all the domesticated animals ; indeed, with regard to the latter, some species appear to be altogether exempted from at least one or more of them. Cases of dvstokia are much more frequent in the bovine species than in any other ;* and least so, perhaps, in the equine species. These tvvo * The Camel, and particularly the Bactrian, which is characteristic of Mongolia, appears generally to require assistance during parturition. At least we may infer this from the statement of Colonel Prejevalsky, who, in speaking of the Mongolian Camel, says:— 'The males become vicious during the rutting season, which is in February, and they will then fight with one another, and sometimes attack mankind. The GENERAL CONSIDERATIONS. 261 species are those which the obstetrist is generally called upon to attend during protracted or difficult parturition ; and every practitioner who has had any experience in this matter, will testify that for one case in the Mare or other animal there will be at least ten in the Cow. Two Danish veterinarians, Nielsen and Tallich, have estimated, that while they have had ten cases in the Mare, the first has had 190, and the second 159 in the Cow ; and yet these writers practised in a district where more Horses than Cows were reared. We have already said that the Mare is, of all quadrupeds, the one which brings forth its young most easily — a fact noted by Aristotle. But this remark only applies to normal parturition in that animal ; in abnor- mal cases there is, as a rule, more urgency and danger than in the Cow, as well as more difficulty in affording relief. Indeed, a very able veterin- arian, Donnarieix, who has had an extensive experience in obstetricy, de- clares that obstetrical operations in the Mare are a labor of Hercules ; while in the Cow they are, comparatively, child's play. This experience will not quite accord with that of every practitioner ; as in both animals difficul- ties in parturition will be sometimes encountered, which baffle the skill of the most competent, and often prove insurmountable. One of these difficulties in the Mare is related to the difference in the vitality of the foal and calf when parturition has commenced — a difference which we have before pointed out as due to the particular arrangement of the ma- ternal and foetal placentae in each species, and which it is of great impor- tance to remember in choosing the means to be employed in overcoming obstacles to parturition in either the Mare or Cow. The following com- parison has been drawn by Donnarieix, between parturition in the Mare and Cow, and fairly accounts for the differences in each animal : — Mare. Cow. 1. Delivery is often followed by i. Delivery always terminates insuccess. favorably. 2. A wound inflicted on the geni- 2. A wound of these organs tal organs is generally fatal. rarely causes death. 3. Inversion of the uterus is 3. Inversion of the uterus is often nearly always irremediable. curable. 4. Mares nearly always succumb 4. This accident is not generally to penetrating wounds of the abdo- fatal in Cows. ^ men during parturition. 5. Delivery of the most simple 5. Delivery, even in the most kind is occasionally followed by bad complicated cases, generally proves results. In abnormal and laborious comparatively easy, and obstetrical parturitions not unfrequently Mare operations successful. and foal succumb. 6. Difficult parturition proves a 6. Such parturitions are not of Herculean task to the operator. much account to a practitioner skilled in the necessary operations. interference of man is needed to bring the sexes together. The period of gestation is thirteen months, at the expiration of which the dam gives birth to one, or, as an exception, two, foals. Human assistance is also required at the time of parturition. The new-bom Camel is the most helpless creature nnaginable ; it must be lifted by hand and placed under the mother's teats ; but as soon as it can walk, it follows her about everywhere, and the latter is so attached to her offspring, th.at she cannot bear to be separated from it. The female Camel is granted its liberty for a whole year after parturition ; so that it only foals every other y&2,x." —Mongolia, the Tangtit Country, and ike Solitudes of Northern Tibet, vol. i., p. 124. London, 1876. 262 DYSTOKIA. Ma re — continued. 7. The duration of the life of the fcEtus in a case of abnormal labor, does not extend beyond the fourth hour, on account of the young ani- mal having to maintain its inde- pendent existence, as if already born. 8. The neck of the foal being very long, the head is usually found deeply buried in the flank when- ever it is turned backwards. The operatQr has very great difficulty in reaching the head with his hand ; indeed, it is often impossible to bring it into its natural position. The loop slips off the neck of the lower jaw, and has constantly to be replaced ; it is scarcely possible to fix a cord there, this portion of the jaw being so short and the foetus having no teeth. 9. When once the amniotic fluid has escaped, the introduction of the hand is difficult, owing to the geni- tal organs becoming dry \ this dry- ness causes an efflux of blood to the mucous membranes. The re- sistance made by the foetal mem- branes to manipulation, when made to ascertain either the position of the foetus or for correcting the po- sition, together with the struggles and violence of the Mare, which now and then drops as if dead, are all difficulties to be overcome. Cow — continued. 7. Under the same circumstance the calf may live four or five days in' utero, as life is maintained by the placental connections. These differences are explained by the mechanism of foetal life in the two species of animals, as well as by the anatomy of the uterus and foe- tal membranes. 8. The neck of the foetus being shorter and thicker, the head is less twisted, and the operator can with greater ease bring it back into its normal position. In addition, there are teeth in the lower jaw, the neck of which is narrow ; so that the slip-knot does not leave it, and straightening of the head and neck becomes an easier affair. 9. The genital organs are con- tinually lubricated by a mucus fluid which, while it facilitates the in- troduction of the hand, renders easy any necessary correction of position, and favors parturient ope- rations. Besides, any movement made is not, in general, of much consequence. Presentations which, in the Cow, owing to its phlegmatic tempera- ment, intervals of quietude, and more gentle and tractable nature, are common, and as a rule adjijstable, are yet most difficult in the Mare, and if not quickly attended to, rapidly lead to a fatal termination. With re- gard to difficult parturition in the other domesticated animals, the Goat and Ewe come next to the Cow in the order of frequency ; though cases of dystokia are not so often noted in them as in that animal. It is to be remarked, however, that assistance is not so easily rendered them, owing to the introduction of the hand into the uterus not being always possible. In the Goat the act is sometimes very prolonged, though on account of the multiple placentae the foetus may live as long as in the Cow. With the Ewe the same occurrence is observed, but in this creature it is some- limes possible to introduce the hand into the genital passages. It is rare indeed that the obstetrist is required to attend upon the healthy Sow, GENERAL CONSIDERATIONS. 263 this animal appearing to be almost exempt from difficulties in parturi- tion. In cases of raciiitism, however, there is sometimes so much de- formity of the pelvis, that aid is required. Notwithstanding the narrow- ness of the passage, the hand or fingers may be passed into them. Cases of dystokia are not unfrequent in the Bitch, and particularly if it is of small size, or belongs to a breed with a large round head and short nose. Numbers of Bitches perish every year from non-delivery of their puppies ; these latter may also succumb before the decease of their parent, as it often happens that the death of one entails destruction on the others. Cats are sometimes subjects of difficult parturition, from the same causes as Bitches. A very great disadvantage under which the veterinary obstetrist labors in cases of dystokia, is the late period at which his services are gen- erally called into request, and often after serious and even irreparable injury has been done by unskilful hands ; and this in instances in which a little scientific manipulation and some surgical knowledge would have, perhaps, made all right and safe in a few minutes. Saint-Cyr justly says, in commenting on some remarks made with regard to the services a veterinary surgeon may render in difficult parturition, that these can be beneficial only on the absolute condition that he is present in good time. Called upon too late, when the " waters " have escaped for a long period, and the neighboring empiric has exhausted his science, aggra- vated a bad presentation, irritated the generative organs by manipula- tions, tractions, and violent means ; then all the ability of the most ex- perienced practitioner may be useless. He will find the passages dry, burning, swollen by inflammation, the fcetus more or less advanced into the pelvic cavity, where it is, it may be said, " wedged," or like a nail driven into wood ; with the uterus spasmodically contracted on itself, and so closely applied to the body of the fcetus that it is almost impos- sible to pass the hand between them. How is it possible to manipulate in such a place — how change the vicious position of a fcetus which the greatest efforts can neither make advance or retire ? How can a sharp instrument be carried into the uterine cavity, and used with safety, when the hand alone can scarcely be made to enter it .-• It is in these circumstances that a practical knowledge of obstetricy is most valuable, and renders he who possesses it a very great acquisition to an agricultural or pastoral district. And this knowledge may be said to be special ; for obstetricy is not like the other branches of veterinary surgery, in forming a portion of every veterinarian's practice. On the contrary, it is rarely practised in towns or cities, but is almost exclusively limited to animal-rearing localities ; there alone is to be found the school in which the practitioner may be initiated into all the difficulties of this complex art, and the best and readiest means of surmounting them. And it must be confessed that the practice of this art is not particularly allur- ing, and is attended with many more inconveniences, hardships, and dif- ficulties than fall to the lot of the human obstetrist; indeed, we know of no more arduous and anxious occupation than that of the country prac- titioner in a cattle-breeding district, and he requires physical endow- ments which are certainly not needed by the attendant on woman. Veterinary accouchments are generally difficult and perplexing, as well as fatiguing, says Zundel. Long and powerful arms are necessary, as well as much address in using them and the fingers ; bodily activity is above all essential, in order to go about an animal, to place one's self in 264 DYSTOKIA. the most favorable position for exploring and operating, and to avoid injury from the creature. The veterinary obstetrist should also be gifted with presence of mind, coolness, and fertility of resource; so as to take into consideration all the circumstances of the case, devise his method of procedure, and carry it out promptly. The conditions under which the veterinarian has to perform his task are not favorable or encouraging. It is any thing but easy to practise the necessary manipulations in the larger animals — such as the Mare or Cow — in such a great cavity as the abdomen, and in the uterus which lies deep in it, and contains a voluminous foetus. In practising these manipulations, the operator has to contend with the struggles and dis- ordered movements of the animal, which sometimes, in the midst of its sufferings, does not hesitate to use its feet, horns, or teeth as weapons of defence, or to crush its medical attendant against the adjoining wall. In addition, the violent contractions of the uterus, and especially of the cer- vix, fatigue the operator extremely. Sometimes these manipulations are continued for hours, until the various obstacles to delivery are successively overcome, or the creature is doomed to perish. Add to this, that Cows and Mares during parturition often inhabit close foul stables, with a poisonous atmosphere, destitute of light, and perhaps also cold and damp. Here the veterinarian must do his duty — cold, wet, and dirty, exposed to draughts and every kind of discomfort. Most frequently, too, he is left to his own resources ; for it is rare that intelli- gent and obedient assistants can be found in such places. And all this after driving long distances, often at night and in bad weather. How different to the accoucheur of woman ! All the inconveniences, risks, and hardships of the veterinary obstetrist do not end here. After manipulations, sometimes long continued, in a uterus containing infective matter resulting from retention of a dead foetus, or fcetal membranes in process of decomposition, he is exposed to the most serious septic diseases, and may even lose his life. A cutaneous eruption indeed often appears on the arms of the operator, only through having manipulated for some time in genital organs, the mucous mem- brane of which was only irritated and inflamed, or simply swollen and bruised — no putrefaction or suppuration being present. Most frequently the disease is merely local, and is sometimes a simple, limited, erythe- matous redness which disappears in tweni^y-four hours ; at other times it is a trifling eczema without pustules, but with intense itching ; frequently it is a pustular, sometimes confluent, ecthyma, the crusts on which are occasionally not detached for months ; in other cases there are furuncles, abscesses on the arm, or even over the body. In the majority of cases, the affection is accompanied by fever, anorexia, great uneasiness, and pains so acute that sleep is impossible ; there may also be tumefaction of the axillary glands. The course of the disease is generally irregular, relapses are common, and it is a long time before its effects pass off. Death sometimes occurs, and amputation of a portion of the arm has been necessary.* Such are the difficulties and risks of the veterinary accou- cheur. We will now refer more particularly to his line of conduct in practice. . Proprietors of animals should, in their own interests, suffer no delay to occur in sending for the veterinary surgeon as soon as they perceive that parturition is not progressing regularly; and they should carefully abstain * Veterinary yournal, vol. ii., p. :!i8. GENERAL CONSIDERATIONS. 265 from any violent handling of, or traction on, the foetus which might render irremediable a difficulty often easy to surmount at the commencement, by anv one sufficiently acquainted with obstetrics. <3n his part, the veterinarian should not lose time in giving his services ; as every minute's delay may render the case more difficult, and tend to compromise the life of not only the young animal, but also that of the mother, as well as the interests of the owner and his own reputation. It is essential that he should be provided with certain instruments, as obstet- rical operations are partly performed by means of these, as well as by the unarmed hand, which is, after all, the most perfect instrument, and should always be preferred to instruments when possible. Some opera- tions, however, can only be undertaken with instruments, and it is there- fore necessary that the obstetrist be provided with at least those which are most useful and indispensable : such as one or two knives, cords, hooks, Schaack's head-collar or some other pattern, etc., and these should be so portable as to be carried in a leather or canvas bag, or a small box. On reaching the patient, all information concerning it should be gath- ered at once, and an examination immediately made into its condition. The period when labor commenced ; if the " water-bag " has ruptured, and when ; if the animal has gone its full time, or exceeded it ; if it is a primipara, or, if not, if its previous parturitions were favorable ; all these and other useful points in its history should be obtained. The examination should comprise : the general appearance of the animal ; whether weak or strong ; the character of the pulse ; and the nature, frequency, and intensity of the expulsive efforts ; as well as the condition of the mammae, and external genital organs. After this, if further examination is necessary, direct exploration of the internal genital organs should be made. We have already described the mode of procedure to be adopted in this exploration ; but because of its importance, we will again notice it. If possible, the Mare and Cow should be examined in a standing atti- tude, as this is the best. If, however, the animal is lying, and from exhaustion or paralysis it cannot get up, then of course the examination must be made in this position ; indeed, it may be advantageous to examine in both positions. When standing, it should be approached gently and coaxingly, and rigorous restraint is seldom necessary ; for the pains of labor usually render the most vicious animals tractable. With the Mare it generally suffices to have one of the fore feet held up by an assistant, while the examination is made ; if young and dangerous, it may be necessary to employ a side-line on a hind pastern, or hobbles on both hind pasterns, and perhaps a twitch on the nose. With the Cow, a strong man holding the animal's head is sufficient to make it stand quiet. Lateral movements may be prevented by placing the animal against a wall or partition on one side, and a powerful man at the other side ; or a man at each side. The operator must be on his guard against the animal suddenly dropping, which would expose him to serious injury. When the floor inclines from the tail towards the head of the animal it is most favorable for an exploration, as the mass of intestines is thrown forward against the diaphragm ; so that they do not press on the uterus, which is then more free and better adapted for manoeuvres in its interior. When the operator has to explore in the lying position, he finds it much 266 DYSrOKIA. more fatiguing and difficult, as he has then to kneel, and to accommodate himself to the animal. In the decubitus, it is still more necessary that the croup should be higher than the front part of the body, in order to get the digestive organs out of the way ; the lateral pressure of the viscera should also be diminished by having the spine higher than the limbs ; and it must be borne in mind that the more an animal is raised above the ground when it is lying, the easier is the manipulation. For the same reason, the smaller animals should be raised as high as the operator's hand : the Sheep, Sow, and Goat on several bundles of straw ; the Bitch and Cat on a table covered with straw or a cloth. The two latter animals must be so secured that they will not bite or scratch the operator. To compel a Cow to get up, Schaack recommends that a small Dog be introduced into the stable, and made to bark at and excite the animal. The coat must be removed, and the shirt-sleeve rolled as high as the shoulder ; indeed, with large animals, when there is a likelihood of much manipulation being required with the cavity of the uterus, it has been recommended to remove the shirt and underclothing from the arm and shoulder altogether. My friend, Mr. Cartwright, of Whitchurch, employs a large, thick, and long woollen sleeveless vest that buttons close up around the neck ; this is ver}^ suitable for such cases, as it not only admits of the shirt being removed, but, besides keeping the operator's clothes clean, it prevents him catching cold. Other operators wear a long gown, like a dissecting- room gown. The back of the hand and arm should be well smeared with oil, grease, or even butter, not qnly to render their introduction into the genital pas- sages more easy, and less irritating to the lining membrane, but also to some extent to prevent the operator becoming infected. It is scarcely necessary to add that rings should not be worn on the fingers. The right hand is usually introduced, but it is well to be able to use both hands ; certain manipulations being more easily executed with the left than the right hand ; and, besides, in protracted operations one hand relieves the other. Before commencing the examination of the genital passages, it is well to empty the rectum, and if possible the bladder. While emptying the former viscus, useful information may be gleaned in ascertaining the con- dition of the uterus through its walls, as well as of the pelvis and pelvic cavity. The fingers being gathered together in a cone-like form, the hand — which should not be cold — is inserted carefully into the vagina at a moment when the animal is not straining : the outer margin (little finger) being downwards, thumb towards the rectum, and pushed gently inwards by a slight rotatory movement ; but the advance of the hand must be momentarily checked if the straining is at all sevefe, or until the animal, if irritable, has become reconciled to it. When once through the vulva, more room is found in the vagina, and the hand and fore-arm can then penetrate with ease as far as the cervix uteri. The object of exploration being to ascertain, in the first place, the con- dition of the genital passages, as well as the state of the pelvic cavity in general, the operator has to satisfy himself whether the vagina is empty, or if it already contains some portion of the foetus or its membranes, and what these are ; if there is any abnormal condition or contraction of the vagina, or any tumors either within or external to that canal, as well as GENERAL CONSIDERATIONS. 267 the seat of these, and if possible their nature. He has also to satisfy himself that the pelvis is wide, regular in form, or more or less deformed and diminished in size from exostoses, fractures, or other causes. The state of the soft parts will likewise engage his attention, and he must learn whether the vulvo-uterine canal is dry, or contains suffi- cient mucus to facilitate manipulation or delivery, as well as its tempera- ture. Having satisfied himself on these points, the fingers are again brought together, and their extremity pushed as far as the cervix uteri, the condition of which is carefully studied. The chief points to be noted are : whether it still projects into the vagina, or if it is completely effaced ; whether the uterus has descended on the floor of the abdomen, or is yet in its ordinary position ; whether the os is closed or open, and the extent of its dilatation ; whether the texture of the cervix is hard or soft, healthy or altered by morbid degeneration, and if it lies in the axis of the vagina or deviates therefrom, or is more or less twisted. Passing the hand into the uterine cavity, if necessary and possible, and with all care and gentleness, the explorer will meet with the " water- bag," if it is not already ruptured, and the foetus, if he has not already encountered it; at the same time the energy and frequency of the labor pains can be ascertained. If the membranes are ruptured, the hand must be passed into them in order to discover the situation of the foetus — the kind of presentation and position, the manner in which the limbs are dis- posed, and any complications which may be present. If the membranes are not ruptured, and it is deemed necessary to open them — which not unfrequently happens when an exploration has to be made, and labor is advanced, the pains being well marked, the os dilated, and the water-bag in the vagina — the hand may be passed between them and the uterus, the palm being towards the foetus j or it may not be required to pass so deeply. When the membranes are tense, pressure against them with the end of the index finger during a throe is usually sufficient to open them ; if, how- ever, they are flaccid, a portion is seized between ^he thumb and middle finger and torn by their nails, or by the nail of the first finger against that of the thumb. Sometimes the fingers alone are not sufficient, as when the envelopes contain but little fluid ; then a pair of scissors, a small trocar, or even an ordinary pen will effect this object. In examining for presentation and position, each region of the body of the foetus should be familiar to the touch, as it can be distinguished by its own proper characters. Under ordinary circumstances, the hand of the operator first meets with the limbs of the foetus ; if they are the ante- rior limbs, and the plantar surface of the feet is turned downwards, then the foetus is in the natural or vertebro-sacral position, anterior presenta- tion ; but if the plantar surface of the feet is inclined upwards, and they really belong to the fore limbs, then it is in the vertebro-pubic position. To distinguish the fore from the hind limb, the shape of the joints and their mode of flexion must be taken into account — the fetlock and knee of the former bend in the same direction, while in the latter the fetlock and hock flex in opposite directions ; the knee, in addition, is large, round, and rather flattened in front, while the hock is flattened on each side, and offers the calcis as an unmistakable guide. There is also a difference in the shape of the feet. The explorer should take time to assure himself of the real state of affairs, and conduct his examination with all the care, attention, and i68 DVSTOKTA, gentleness possible. The foetus may present in a variety of positions, in which hind and fore limbs may offer first, either alone or together ; and in the case of twins or monstrosities, the limbs of different creatures may be encountered at the same time. If the presentation is anterior, the heacl will be met with, and this is distinguished by the presence of the mouth, eyes, and ears ; if it is a posterior presentation, then we have the rounded croup, tail, hocks, and external genital organs. In other presenta- tions, the neck is recognized by the mane, if it be a foal, in addition to its shape, whether foal or calf ; the shoulders by the acromion processes and withers; the chest, by the ribs and intercostal spaces ; and so on. In addition to all this, the obstetrist should judge at the same time of the volume of the foetus and its proportions. This is particularly necessary in the case of monstrosities ; and in some instances it is most difficult to decide what the hand may light upon in such an examination. Kopp alludes to the case of a Mare which he examined during parturition, when he found a foetus affected with hydroceusphal to such a degree that for a long time he thought its head was the thorax. It cannot be too strongly impressed upon the minds of those who are commencing obstetric practice, that such an examination should be so complete as to furnish all the requirements of a sound diagnosis, on which the indications for affording assistance can be readily based ; and this exploration can only be said to be complete when the obstetrist is as well acquainted with the position of the foetus and the obstacles to its birth, as if he had scrutinized the whole with his eyes. Then he can decide as to the measures which are indicated by his diagnosis, in order to bring the young creature into one of the best posi- tions for delivery — either natural or artificial — so that this may be effected with certainty and rapidity. These measures being decided upon, a methodical procedure is as necessary in carrying them out, as in exploring the vagina and uterus. The required assistants should be selected, and to each should be allotted his share in the operation, in which he ought to be instructed briefly and clearly; the instruments, cords, and other apparatus ought next to be placed in readiness ; and then the task may be begun. When this is once commenced, it should be conducted with prudence, and yet with decision, all irrational and unnecessary manoeuvres being avoided ; while every precaution being at the same time observed, there should be no fear of irritating the organs or textures by manipulation, as they appear to be endowed with a greater amount of tolerance at this than any other time. In such cases, the operator should bear in mind that his task consists in. removing or overcoming every thing which suspends, hinders, or inter- feres with the natural course of parturition, and to bring this as near as possible to a normal termination. He should understand and appreciate the part Nature plays in this act ; only seeking to second her efforts so long as she is competent to attain the desired end, by removing any obstacles in the way. When Nature's efforts cease to be effective, they should be imitated as closely as possible ; and no more ought to be attempted than Nature herself would have accomplished under more favorable circumstances. Art should never undertake what Nature can effect ; and remembering this, the obstetrist will not only seek to learn and appreciate the powers of Nature, but will be in a better position to calcu- late how far he should himself interfere. GENERAL CONSIDERATIONS. 269 Whatever is necessary to be done should be accomplished without de- lay, so as to spare the animal pain and exhaustion. Sometimes parturition is difficult because of the insufficiency of the expelling forces, as we have already noticed, and this may be remedied by hygienic and therapeutic means ; but more frequently, while the expulsive efforts are normal, there is undue resistance. To increase the expelling forces in the latter in- stances would evidently be unwarrantable and injurious, and we must attack the resistance by various means, according to its character. Obstacles in the genital passages must be overcome either by altering the position of the foetus by manipulation, in changing the position of the mother, or by other means ; and it often happens that we must combine extraneous force with the expulsive efforts of the mother, in order to ex- tract the foetus artificially. At other times the size of the foetus must be re- duced by embr3^otomy, and in extreme cases an artificial passage has to be made for it by hysterotomy ; though these dangerous operations may be occasionally averted by causing artificial abortion, at a period when the foetus is sufficiently small to be safely expelled through a contracted pelvis. There is no occasion, in veterinary obstetrics, to hesitate in sacrificing the life of the foetus in serious cases ; and in this respect the practitioner is in a different position to \\\^ accoucheur oi woman-kind. With animals there is only a material loss to be looked at, and the foetus must always be greatly inferior in value to the mother ; therefore, in order to save the latter, it is more profitable to sacrifice the former. Such are the general principles which we believe to be applicable to all cases of dystokia. These cases, as Saint-Cyr observes, are numerous and various — more varied even in animals than in woman ; and in order to study them beneficially, it is advisable to classify them in a methodical manner. We will follow that authority in arranging and studying them in the order given below. Synoptic Table of Causes of Dystokia in the Principal Domesticated Animals. Dystokia Maternal Foetal. Pelvic Constriction. Displacement and altered relations of the Uterus. Morbid alterations of the Maternal Organs. T J A ^ c{ Excess in Volume. ^ Independent of | r):_„„e„ .he Presenta..! ^'o'^-^.i,,. ^Of the Foetus. t,ons,by: [ Multiparity. Dependent on f interior. tSePre^enta. P-^J-bar. tions : Sterno-abdominal. 270 MATERNAL DYSTOKIA. BOOK L MATERNAL DYSTOKIA, The pathology of parturition, as has been mentioned, includes disturb- ances produced by excessive or tumultuous pains and too feeble pains, and derangement caused by too great an obstacle to birth. We have sufficient- ly described the first ; and \Ve have now to deal with the second, in so far as the mother is concerned- The maternal obstacles to parturition are related to the too great resistance offered by the parturient passages, either in their hard or soft parts. These obstacles have been grouped in the preceding table under the head of pelvic constriction^ displacement or change in relations of the uterus, and morbid alterations of the maternal organs. CHAPTER L Dystokia by Pelvic Constrictionu Dystokia from constriction of the pelvis is sometimes observed in ani- mals ;* though less frequently, perhaps, than in woman, in whom con- stitutional causes and the different position (vertical) of this region, operate largely in producing diminished dimensions of its cavity. Any alteration in the dimensions or shape of the pelvis, whether general or partial, is a more or less serious cause of dystokia, and in some cases may render delivery absolutely impossible, A pelvis generally reduced in all its dimensions is sometimes noticed in the large, as well as the small do- mesticated animals. On the Continent of Europe, this has been observed more particularly among some of the small common breeds of cattle — such as the Bretonne, and certain of the grey Swiss breeds, as the J^ribourgeoise. These cattle have the ischia pointed and the tail attached high above them. Leconte has observed this conformation in animalslhe produce of a cross between large Norman Mares and pure-bred Horses — animals with a sharp croup. There is often a relative narrowness of the pelvis in animals of small size which have been put to larger males. This has been witnessed in the Mare and Bitch ; and as the young are proportionately larger than the pelvis can accommodate in parturition, we have here a cause of dystokia. An abnormal inclination of the pelvis has been supposed by some writ- ers to exercise an unfavorable influence on parturition, but this has been denied by others. Provided the other conditions of normal parturition are present, no difficulty should be experienced in delivery ; but if, added to this state, there is a narrow pelvis, then obstetrical operations would certainly be rendered more serious- Deformities which occasion irregular constriction of the pelvic cavity, * A naturally wide pelvis— or rather an esecess in width— observed more particularly in animals of a lymphatic temperament, and especially in Cows, along with an extraordinary suppleness and laxity ot the soft parts in this region, has the inconvenience of rendering parturition too easy, it would appear. Por this facility is supposed, and not without reason, to bring about such complications as eyersion ot the vagina and uterus, placental retention, and even predisposes, according to some authorities, to vituiary fever in the Cow and metritis in the other animals- DYSTOKIA BY PELVIC CONSTRICTION. 271 are various. They may belong to the bones of this region, or to its con- nective tissue ; and they always more or less diminish one or more of the dimensions of the parturient canal, and offer an obstacle to the passage of the fcEtus. These cases, however, are somewhat rare ; they are gen- erally found to be due to complete deformity of the pelvis., exostoses., fractures ^ or tumors. Complete Deformity of the Pelvis. As has been observed, complete deformity of the pelvis is very rare among animals. When due to rachitism, it is most frequently noted in the Pig. In this animal the pelvis is sometimes greatly distorted, and not unfrequently there is accompanying deviation in the vertebral spine. This condition is seldom seen in other creatures. Saint-Cyr informs us that in the Museum of the Lyons Veterinary School, there is the pelvis of a Mare and another of a She-Ass, which Fig. 64. Completely Defok.med Pelvis: Mare.. present a very remarkable degree of general constriction, and which must have offered a very serious obstacle to parturition if the animals had ever been pregnant. That of the Mare (Fig. 64) is singularly depressed on both sides, the ischia, and especially the pubis, being atrophied with re- spect to size. The oval foramina and cotyloid cavities are close together, the floor of the pelvis is extremely contracted and angular, and the pu- bic arch is hypertrophied. In this specimen there is a very notable diminution in the different diameters of the pelvic cavity ; the supero-in- ferior, instead of being about 8^'^ inches is only about 6, and the bi-iliac diameter is but dt% instead of being 7^ to 8 inches. According to Saint-Cyr, the diagnosis of this deformity should not be difficult, especially when it is so marked as in this instance. Vaginal ex- plorations should soon discover it, and the diminution in size may be ap- proximately determined by spreading the fingers, and in this way measur- ing the two diameters. The diagnosis may not be so easy, however, when the canal is partly or wholly occupied by the foetus. 272 MATERNAL DYSTOKIA. Denoc gives the following case of a Cow, which had been four days making fruitless attempts at delivery [Recueil de Med. Veteriuaire, 1845, p. 9). The os was dilated and the fcetus in a good position; the head and feet could be brought into the passage, but the creature could not be extracted. In exploring the cavity, after pushing back the foetus, it was discovered that there was liypertrophy of the symphysis pubis, and an ab- normal rugged production thereon, forming a kind of ossified ridge which extended beneath the bladder. Forceps proved useless, as this ossific deposit was an insurmount- able obstacle ; so the animal was killed for food. On examining it afterwards, in addi- tion to the bony alterations, there was a double twist of the uterus. Gelle has published a case in which the narrowness of the pelvis appears to have been the sole cause of difficulty in parturition ; there did not seem to be any appreciable deformity, and probably the youth of the animal — two years old, and a pri'mapara — and a large calf, occasioned the non-delivery, as the fcetus was extracted by embryotomy. The Cow did well afterwards. Another kind of deformity which has been described by several author- ities, consists in a depression of the sacrum (lordosis), which is recognized externally by an abrupt hollow existing towards the posterior third of the croup. By rectal exploration, the sacrum is found to constitute a pro- jection in the roof of the pelvis, at the lower face of the bone, and this diminishes the supero-inferior diameter of the cavity to an extent corre- sponding to the protuberance. Schaack gives an account of two cases of dystokia in Cows, arising from this defor- mity. In one, the fcetus was of ordinary size and making a good anterior presentation, but it was wedged between the floor of the pelvis and the exostosis above. It required the united efforts of four men for half an hour to extract the calf, and at the moment when the most voluminous part of its body was being dragged through the depressed point of the sacrum, a noise was heard similar to that produced by breaking a bit of dried wood. When the calf had been got through, it was then perceived, by the mobil- ity of the end of the sacrum and the root of the tail, that the Cow had sustained a frac- ture at this part. The Cow recovered, and was again sent to the bull at the ordinary period. Wlien next it calved, Schaack had to assist it in a laborious parturition, but a living calf was pro(Juced. In the second case the calf perished, and the Cow was sent to the butcher. Canu {Recueil de Med. Veieritmire, 1837) reports that in May, 1831, he was sent for to see a Mare which, for seven nr eight hours, had been vainly attempting to foal. The fore limbs were properly presented, but when it was observed that the head did not fol- low, those who had been endeavoring to assist the animal ceased to pull at them. The animal was seven years old ; it was continually straining, was covered with per- spiration, and appeared to be much distressed. Canu introduced his arm, but could not find the head of the foetus, as a hard round mass closed the pelvic inlet, and compelled him to withdraw his hand. Shortly afterwards, however, he made another attempt, and with more success. Having contrived to insert the whole of his arm in the direction of the obstructing mass, he at length touched the tip of the ears of the foetus with the extremity of his fingers. It was in vain, however, that he attempted to change the po- sition of the head or to turn the neck in the slightest degree, as the fingers could not be introduced between the latter and the shoulder. The owner was then informed that he must not reckon upon the foal being extracted alive, and that the Mare itself was in im- minent danger. Not seeing any way of saving the mother but by extracting the foal by force, the owner's consent was obtained to this ; a cord was placed on the fore limbs that were presented, and three assistants were posted at this, while two others, with a girth placed between the thighs, held the Mare, which was in the recumbent position. The assist- ants at the cord were then ordered to pull, and by exerting all their strength the foetus was extracted dead, with the neck bent to one side on the ribs. All attempts to have brought the head into the natural position must have proved unavailing, according to Canu, as the right side of it, flattened, and even crushed, perfectly fitted a concavity in the right flank. The vulva was a little torn at its upper part; it was much swollen, and its lining membrane was extremely congested. The Mare lay during three days before attempting to get up ; but by appropriate treatment it eventually recovered. It was subsequently ascertained that, although only seven years old, the animal's D YSTOKIA B V PEL VIC CONSTRICTION. 273 croup had become altered in form; it was depressed, and the attachment of the tail was low, while the ligamento-cartilaginous substance which united the sacrum to the ossa innominata had been partially torn, causing the croup to approach almost two inches nearer to a horizontal position. Exostoses. Exostoses on the pelvic bones, and particularly when they project into the pelvic cavity, or encroach on its openings, may become a more or less serious obstacle to the passage of the fcetus. Favre, of Geneva, states that bony tumors situated beneath the croup, at the inner and upper surface of the pelvis, render parturition difficult, even if they are not large and near the root of the tail. He adds that such cases are not rare in old Mares. Fractures. Like the exostoses, more or less completely consolidated fractures of Fig. 65. Pelvic Exostosis. the sacrum or coxae, which have been united by an irregular callus, may, for the same reason, prove an obstacle to birth. As animals suffering from a fracture of any of the bones of this region are often destroyed, laborious parturition from such a deformity is not so frequent as from some other causes ; nevertheless, it does occur now and again. It must be remembered that fractures of the pelvic bones are some- what frequent in animals, and may occur at any part. The most common seat of fracture is perhaps the external angle of the ilium ; and the least frequent, the posterior part of the ischium and the pubis. Fracture of the sacrum and the internal angle of the ilium is also very rare. Simul- taneous compound fracture of the two coxal bones has been observed in two cases by Lafosse ; in one case by Crepin, and in another by Philippe. 18 274 MATERNAL DYSTOKIA. D'Arboval has witnessed a fracture of the pubis in a Dog ; and Carsten Harms alludes to fractures of the ischium occurring in the Mare and Cow. The latter authority has likewise found the two iliums of a Goat united at their posterior angle by a mass of bone as thick as a finger. Professor Ercolani has well described twelve important cases of pelvic fracture exhibited in the Pathological Museum of the Bologna Univer- sity.* The first of these is a compound fracture of the ossa innominata, the solution of continuity involving all the border of the foramina ovale in the pelvis of a Mare j the second is a fracture of the left ilium near its neck, and extending to the cotyloid cavity, also in the pelvis of a Mare ; the third is a compound comminuted fracture of the left innominate bone in a Mare, the piece being div-ided into six principal portions ; the fourth is a compound fracture of the right ilium of a Mare, extending to the arch of the pubis on the left side ; the fifth is a longitudinal fracture of the right ilium of a Filly ; the sixth, a fracture of the external angle of the right ilium and the left ischiatic tuberosity of a Mare ; the seventh is a slightly oblique fracture of the ilium extending to the cotyloid cavity of a Mare ; the eighth is a compound fracture of the pelvis of a Mare, involving the internal angle of the ilium, the external part of the ischial tuberosity, the arch of the pubis, and the union of the pubis with the Fig. 66. Fracture of the Pelvis. ischium ; the ninth is a fracture of the superior and posterior crest of the ilium of a Mare ; the tenth is an oblique fracture of the neck of the left ilium of a Mare ; the eleventh is a compound fracture of the right coxa of a Mare, the cotyloid portion being completely isolated from the is- chium, ilium, and pubis ; the twelfth is a fracture of the external angle of the ilium. Lanzillotti-Buonsanti states that the Pathological Museum of the Milan Veterinary School contains a coxa, which shows a fracture of the neck of the ilium, with overlapping of the disunited portions; and also a pelvis in which the pubic portion of the symphysis has sustained a comminuted fracture. * Descrizione Metodica dei Preparati del Museo di Anatomia Patologica Comparata della R. Universita di Bologna. Meraoria I. Bologna, 1867, p. 38: — Fratture della Pelvi. D YSTOKIA B Y PEL VIC CONSTRICTION. 275 Much will depend, of course, upon the nature and the seat of the frac- ture. When it is only the outer angle of the ilium (point of haunch), and even when the fractured bone is displaced by the action of the small oblique muscles of the abdomen and the fascia lata, producing great external deformity, no great effect can be produced on the act of partu- rition, as this part has nothing to do with the pelvic cavity. But when the whole of one side of the haunch is lower than the other, delivery is then undoubtedly interfered with, and perhaps to a most serious extent; inasmuch as some one of the parts which concur in forming the pelvic cavity is implicated in the fracture, and consequently the external defor- mity corresponds to an internal diminution and irregularity in its diame-: ters, from displaced fragments of bone, overlapping of fractured ends,* the approach of the sacrum to the pubis, and consequent lessening of the inlet of this cavity, as well as to the more or less voluminous deposit of bone around the fractured portions. Many cases are on record of difficulty in parturition from this deformity. Gohier {Mem. stir la Chiriirgie et la Med. Vetirinaire) mentions a Ewe which was I^rought to him, and which for twelve hours had been making ineffectual attempts to give birth ; the cause of delay appeared to be narrowness of the pelvis. Traction on the fore limbs of the foetus only resulted in tearing them away from the thorax. De- livery being impossible by the natural way, Gohier performed the abdominal Caesarean operation, but the animal died next day. On examination, it was di'scovered that the pelvis was very narrow and irregular, in consequence of an old fracture of the ilium. The coxa of that side was at least half an inch shorter than the other from the cotyloid cavity to the sacrum, which gave a very marked obliquity to this part ; and it was this, as well as the, slight exostosis protruding there, which prevented the top of the lamb's head from passing through. Chretien {Journal Prat, de Med. Veterinaire, 1826, p. 225) was called to attend a Cow which could not calve. Two legs of the foetus protruded, but nothing more could be extracted. By exploration it was found that there was a hard tumor between the vagina and uterus, which filled up one-third of the pelvic cavity. On inquiry it was ascertained that the animal had been treated, a year previously, for a fracture of the ilium, near the coxo-femoral articulation, and that the fracture had united, though the Cow remained lame, and rested this side of the body more than the other. Delivery being impossible, the calf was removed by Csesarean operation. The Cow recovered, and on being killed by the butcher some time after, Chretien examined the pelvis, when he found a very voluminous bony tumor or callus, and noted that the inierior part of the ili^um had not united fairly, but projected a good deal inwards. Rainard speaks of a large Anglo-Chinese Sow which died during parturition, its owner being unable to extract any of the young. Two months previously it had sus- tained a fracture of the ascending branch of the ilium, near the cotyloid cavity, from which it had always been lame. When Rainard examined the pelvis, the callus was not yet solidified ; it formed a considerable prominence within the pelvis. Fractures of the pelvis are by no means unfrequent with animals, and are due to falls, crushing, blow.s, or other causes ; and, as the above in- stances testify, they may prove insurmountable obstacles in parturition. Female animals which have sustained an injury of this kind, should not be employed for breeding purposes, unless a careful examination has shown that it has not altered the pelvic diameters in such a way as ren- der delivery difficult. Such an alteration may be diagnosed by depression of the haunch or croup, and lameness to a more or less appreciable extent ; while rectal or vaginal exploration will discover the presence of a variable-sized hard tumor forming part of the bone, and projecting into the cavity. The previous history of the animal may also aid in confirming the diagnosis; Fractures of the pelvis may also take place during parturition, and 2^6 MATERNAL DYSTOKIA. Rueff mentions two instances in which they have occurred spontaneously during very violent labor pains. In the latter instances, there may have existed a predisposition due to a diseased condition of the bones — a predisposition not uncommon in breeding animals. Tumors in the Pelvic Cavity. Tumors of various kinds, in addition to those of a bony character due to injury — such as fibromata, melanotic, and cancerous tumors — may prove a cause of dystokia \ abscess may also co-exist with pregnancy, and be a source of difficulty in parturition. But that form of melanosis which appears in grey animals, and particularly manifests itself in the form of tumors at the root of the tail, around the anus, and in the connective tissue of the pelvis, should offer the most frequent obstacle to delivery. One case has occurred in my own experience, in which an aged Mare, nearly white, belonging to a friend, was, on my recommendation, taken by a farmer, who attempted to breed from it ; but at the termination of pregnancy, and during parturition, it died with- out giving birth to a foal. When opened, it was found that delivery could not take place, owing to great masses of melanotic deposit in the pelvic cavity. When given to the farmer there were only a few small nodular masses observed about the tail and vulva. Leconte [Mem. de la Societe Ccntrale de Med. Veterinaire, vol. v., p. i8o), was con- sulted with regard to a Mare, about twelve years old, and about five months pregnant, which had such a large melanotic deposit around the anus that defecation was impossi- ble without assistance. Rectal exploration discovered a very voluminous tumor sit- uated at the left side of the pelvis, in the centre of which a slight fluctuation could be perceived. With a view to accelerate the maturation of the tumor, vesicatory agents were applied to the left flank and croup ; five days later the tumor was larger and more fluctuating, and it was punctured, when about two pints of a dark, purulent, but almost odorless fluid escaped. On the hand being introduced into the softening mass, a por- tion was found about the size of two fists, and partially detached ; this was removed, and weighed nearly seven pounds. In twelve days the wound had cicatrized ; and in five and a half months, gestation being nearly completed, another melanotic tumor, sit- iiated somewhat deeply towards the right side of the pelvic cavity, was also removed. Cicatrization took place rapidly, and delivery occurred without any difficulty. Indications for Surgical Treatment. The surgical treatment of those cases in which dystokia is due to any of the causes just enumerated, will greatly depend upon circumstances, not only with regard to the kind of treatment, but also as to its expediency at all. For instance, if total or partial deformity of the pelvis is present to such a degree as to endanger the life of the animal during parturition, or if there exist obstacles due to fractures oi tumors, and which cannot be removed, then it may be advisable, if the animal be fit for food and in good condition, to send it to the butcher ; or if it be pregnant and in in- ferior condition, to produce abortion at a sufficiently early period. But if parturition has already commenced, then, of course, surgical or obstet- rical treatment must be had recourse to ; and the nature of this will de- pend upon the constriction of the pelvic cavity, and the kind of obstacle which causes the diminished space. The indications are : to forcibly ex- tract the foetus through the narrowed passage ; to 7mden the passage ; to dimin- ish the size of the fxtus ; or to make an artificial passage. But as artificial abortion may be necessary during pregnancy, should the veterinarian be D YSTOKIA B Y PEL VIC CONSTRICTION. z'j'j consulted, and from examination be led to conclude that parturition will be dangerous or impossible, we shall include this as one of the indica-- tions, and commence with it. 1. Artificial Abortion. — Artificial abortion may be rendered neces- sary not only during pregnancy, when the condition of the pelvic cavity leads to the supposition that delivery at full term is dangerous or impos- sible, but also in metrorrhagia, serious inversion of the vagina, hydram- nios, debility, or exhaustion, etc. Artificial abortion may be produced in several ways, and is generally more successful with the Mare than the Cow, because of the greater ex- citability of the cervix uteri, and the readiness, with which it can be di- lated in that animal. Three modes of procedure have been adopted with the domesticated animals, each being attended with success, and each offering special advantages in particular cases. These are : irritatiofi of the cervix uteri by the hand ; puncture of the envelopes ; and vaginal irrita- tions. Digital Irritation of the Cervix Uteri. — This is accomplished in the fol- lowing manner : The hand is introduced into the vagina, and first one finger, then two are insinuated into the os by a semi-rotatory movement, and finally the whole hand is inserted, as the part dilates. If the opera- tion is repeated several times, labor pains soon ensue. As the manual exertion is rather fatiguing, the sponge tent, elastic bags, or other dilators of the OS uteri may be employed. A better and more successful mode is the introduction of a long elastic catheter, strong pieces of catgut, or even a quill, between the foetal membranes and the uterus. Labor maybe promoted by passing the hand through the os, and separating the mem- branes from the uterus. This procedure is to be recommended for Mares, the uterus of which is so irritable that abortion sometimes occurs after manipulations in the rectum for some time. In ordinary cases, the expulsion of the foetus oc- curs in from six to twelve hours. It is not applicable to cattle, Harms having once manipulated a Cow in this manner for a whole night without producing any result ; neither is it to be recommended for smaller ani- mals. Puncture of the Foetal Envelopes. — The envelopes are punctured by pushing a long, and more or less pointed, sound through the os uteri, into the " water-bag ; " the liquor amnii soon escapes, and the uterine contractions begin. Expulsion of the foetus follows in from twelve to forty-eight hours. This method is particularly efficacious with cattle. Vaginal Irrigations. — Irrigation of the vagina with cold water (or water at a temperature of about 90^ Fahr.),- made by means of a syringe or in- jection-tube, and continued for a quarter of an hour every three hours, will induce labor pains about the fourth injection, and effect the expul- sion of the foetus towards the second, third, or fourth day. This method is more particularly adapted for the smaller animals ; though it will also succeed with the larger. The only danger to be apprehended from it is an attack of metro-peritonitis. 2. Forcible Extraction. — As Saint-Cyr well remarks, the first' im- pulse which presents itself when the foetus meets with any obstacle to its passage through the pelvis, is to " force it through ; " and it is this im- pulse which is carried into execution by unscientific people. Too fre- 278 MATERNAL DYSTOKIA. quently, however, it happens that by this procedure some portion of the foetus is so tightly wedged in the pelvis that no amount of force is capa- ble of moving it farther, and renders absolutely impossible those other operations which might be the means of savisg at least the mother or offspring, or perhaps both. For this reason it is, that the owner of an animal in this condition should not himself, nor suffer others to, pull at the foetus, or attempt any similar manoeuvre, until the arrival of the veter- inarian. And the latter has a difhcult task before him iji solving the problem, as to whether he ought to extract the fcetus forcibly, or resort immediately to the other measures prescribed. This will render a care- ful examination necessary, in order to ascertain the nature, seat, and de- gree of constriction. The animal is making excessive, nay violent, efforts, and the foetus may be in a favorable position, but it does not advance through the pelvis. The creature is restless and sighs deeply ; the flanks are covered with perspiration, and sometimes, through sheer exhaustion, it falls, utterly prostrated by its efforts. As the uterine contractions generally increase in violence in the presence of obstacles to birth, there is the gravest danger to mother and offspring. In such a case, the veterinarian, having introduced his hand into the pelvis in the ordinary way, endeavors to discover if the obstacle is there. With this object in view, he closes his hand to try if he can move his shut fist about in every direction, and with ease. Then stretching out the thumb, he can approximately judge the distance which intervenes between opposite points of the pelvic circumference, and in this way appreciate to a certain degree whether a moderate-sized foetus could pass through. For if the pelvis is so contracted that the closed hand can scarcely move about in it, it. will be needless to attempt forcible extraction, as the foetus cannot be brought through. Saint-Cyr has calculated that the closed hand of an adult man repre- sents an irregular mass measuring between three and four and a half inches in diameter; but the head of a calf, in its supero-inferior diameter, measures from seven to ten inches, and four to five inches in transverse diameter. It is therefore obvious that the head of a calf could not pass through an aperture in which the hand cannot move freely ; and much less the chest of a foal, which is at least twelve to thirteen inches in depth. It is also necessary to take into consideration the cause of dystokia. If this is due to a complete deformity of the pelvis, then the case is serious, and there is little hope of traction alone overcoming the diffi- culty. If it is due to a tumor, and localized, then it must be ascertained if this is of a bony character, arising from an exostosis or fracture ; or if it is movable and independent. If the latter, the case is not so serious, and especially if the tumor is connected with the sacro-sciatic ligament; as it may be pushed out of the way of the foetus and birth take place. As Saint-Cyr insists, all these considerations should be weighed before deciding to terminate parturition by mechanical traction ; for if the impos- sibility of accomplishing it by this means is discovered when too late, the other operations are rendered more difficult and dangerous, in conse- quence of the ineffectual attempts at forced extraction. If extraction of the entire foetus is discovered to be practicable, and the position is favorable, then there should not be much difficulty in effect- ing delivery, which may be achieved as in ordinary circumstances. It 1 D YSTOKIA B Y DISPLA CEMENT. 279 will be much facilitated, should the foetus and the passage be dry and tenacious, if these are smeared with oil or soapy fluid. If, however, the foetus has become wedged in the passage and cannot be pulled through, it may be useful to push it back a little into the uterine cavity, and then lubricate it and the vagina with some oily matter to assist movement, before another attempt is made. 3. Enlargement of the Passage. — This is nearly always impossible in practice, unless the cause be a tumor which can either be excised, or moved temporarily out of the way so as to effect delivery. 4. Diminution of the Size of the Fcetus. — With the domesticated animals, as we have repeatedly said, there are no moral considerations to oppose us when it comes to a question of sacrificing the foetus to save the life of the parent. And with the Mare there should be no hesitation in this direction, when a careful examination has proved delivery of the living or entire foetus to be impossible ; and particularly when we remem- ber that the young creature soon perishes. With the Cow, however, the case is somewhat different, as when delivery is unsuccessful this animal may be killed and utilized as food. Embry- otomy is, nevertheless, often resorted to before the case is considered hopeless ; and not at all unfrequently with good results, so far as the Cow is concerned. We shall treat of embryotomy hereafter ; but it may be useful to men- tion here that, in an anterior presentation, removal of one or both of the fore limbs at the scapula of the foetus will often allow the remaining portions to be removed by traction. With a- posterior presentation, exci- sion of one hind legis frequently sufficient to permit the body of the foetus to be drawn through the passage. 5. Establish an Artificial Passage for the Fcetus. — When all the preceding means have been recognized as impracticable or too danger- ous, there yet remains another, which, though it ma}'^ place the life of the mother in great jeopardy, and should be considered only as a last and a most serious expedient, may be resorted to : this is the C^esarean sec- tion, or gastro-hysterotomy — an operation to be described hereafter. It may only be noted in this place, that a formidable operation, such as this is, should be resorted to early, and before the female is much exhausted by inefficacious manipulations and impotent labor pains. CHAPTER II Dystokia by Displacement or Changed Relations of the Uterus. Delivery may be rendered difficult by displacement or altered relations of the organ containing the foetus — the uterus, either from heriiia of that organ through a natural or accidental opening in the abdominal parietes ; from deviations in the direction of the uterus, whereby the os is no longer in the axis of the pelvis ; and torsion of the organ, which is due to its having made a revolution or become twisted on its own axis — a singular displacement that well merits attention. 28o MATERNAL DYSTOKIA. Hernia of the Uterus — Hysterocele. Every description of ventral hernia may be viewed as more or less tending to dystokia, from the important share the abdominal muscles assume in the act of parturition ; and when there is a tendency to hernia of any of the organs in this cavity, or when a hernia really exists, this is likely to be increased during labor, and may complicate delivery. But the case is generally all the more serious if the displaced organ is the gravid uterus itself. Hernia of the uterus is certainly not a very common accident ; never- theless, it is far from being rare, if we are to judge by the instances recorded in veterinary literature, and it has been observed in the Mare, Cow, Sheep, Sow, Goat, and Bitch — in all the more important domesti- cated animals, in fact, and has often proved a very serious obstacle to parturition. Fig. 67. Uterine Hernia: Mare. A B, Hernial Tumor ; C, Teat carried down by the Tumor. Origin and Symptoms in Ufiiparoiis Animals. The symptoms and other features of this accident rather differ in uni- parous and multiparous animals. In such uniparous creatures as the Mare and Cow, hernia of the uterus is generally not observed until preg- nancy is pretty well advanced — towards the eighth or ninth month, or even later in the Mare, and the seventh or eighth month in the Cow. This delay is evidently due to the circumstance, that in the non-pregnant animal the uterus is small, and closely fixed by its ligaments to the sub- lumbar region ; so that if there is a breach in the abdominal walls, it is either the intestine or omentum which passes through it. When, how- DYSTOKIA BY DISPLACEMENT. 281 ever, pregnancy is advanced, the great size of the organ, together with its weight, brings it in contact with the parietes of the peritoneal cavity, and if there happens to be a weak part or a rupture, however slight, the heavy uterus gradually forces itself through, and may in time escape altogether from the abdomen, along with other viscera. It would appear that laceration of the abdominal walls may occur in other ways than through external traumatic influences, or any appreciable occasional cause ; and it would also appear that, in some animals, there is a kind of predisposing relaxation or softening of the abdominal muscles, which leads to their being unable to support the gradually increasing strain thrown upon them by the heavy uterus, and its oftentimes very lively and energetic inmate. The muscles are stretched and attenu- ated, their fibres are separated and some of them may rupture, and in this way is formed a rent, which gradually enlarges from the increasing pressure. Then a tumor appears externally and towards the lower part of the abdomen, though always a little to one side — usually the left in' the Mare, the right in the Cow, and not unfrequently in front of the pubis in the mammary region. This tumor, when first noticed, is about the size of a child's head, and not clearly defined ; but it rapidly enlarges, and in a few days may acquire prodigious dimensions : descending as low as the hocks, or even nearly to the ground, pushing the mammae to one side or carrying them with it, and extending almost as far forward as the sternum, giving to the abdomen a singular appearance (Fig. 67). These extraordinary herniae are most frequently witnessed in Cows, though several veterinarians — among others, Lecoq, Binz, Leconte, Serres, Lafosse — have seen them in Mares. In very many instances they are due to violent efforts, kicks, blows, and other external injuries. When the hernia is recent, and especially if it occurs in the mammary region, it is generally surrounded by a considerable cedematous swelling. This swelling disappears after parturition, though the hernial tumor itself does not diminish in volume, the digestive organs having occupied the space previously held by the foetus. Then the animal has a still more singular appearance, perhaps ; for owing to this emptying of the abdom- inal cavity, the belly is wonderfully retracted, and the flanks are so drawn together that the fingers may be made to touch through them on each side. Before parturition, palpation of the tumor enables the foetus to be distinguished, the head, limbs, and body being felt, while its movements are perceptible to the eye or hand. As a rule, and contrary to what might be surmised, this uterine hernia does not appear to cause any loss of condition or inconvenience except in progression, which it interferes with, and causes the animal to move with its hind legs wide apart. Aptitude for labor is also somewhat impaired, as may be imagined. Origin and Symptoms in Multiparous Animals. As has been mentioned, uterine hernia is observed in multiparous ani- mals, but its manner of production, according to Saint-Cyr, would appear to be different to what it is in uniparous creatures, this taking place in the intervals between gestations. The length and mobility of the cornua in such an animal as the Bitch, together with their close proximity to the abdominal walls, sufficiently explain how they may pass into an opening in 282 MATERNAL DYSTOKIA. these. There is formed, at first, a small tumor, the size of a pigeon's or hen's Qgg ; this tumor is soft, indolent, more or less easily reduced, and which, attracting perhaps little or no attention while the animal is unim- pregnated, remains stationary. After impregnation, however, it daily acquires larger dimensions ; one or more ovules have descended into the hernied portion, localized themselves there, and become developed into foetuses without the Bitch showing much, if any, disturbance. The usual seat of the hernia is in the mammary region, to the right or left of the linea alba, though it may be also inguinal, or even vulvular. An example of inguinal uterine hernia will be given hereafter ; we will now briefly allude to a case of vulvular uterine hernia described by Rain- ard. In this instance, the uterus, which had been apparently carried through the inguinal ring, was pushed backwards through the connective tissue, and appeared as a tumor at the vulva. The owner of the animal, not knowing what the swelling contained, opened it by means of a pen- knife ; in this way there was formed a fistulous wound from which a viscid fluid escaped. Rainard incised this fistula, and found beneath the skin a second membrane having some analogy to it, and which afterwards proved to be the uterus; to the inner face of this there adhered a reddish- brown vascular network, which was the placenta, and which was easily detached by the finger, and within it appeared a transparent bladder — the amnion — already slightly perforated, and looking like the envelope of a kyst. Having opened this, there escaped a quantity of fluid, and a foetus apparently three or four weeks old. The Bitch died next day. When the hernia occurs in*the abdominal region, it usually appears as an indolent tumor, the skin covering it being destitute of redness and not attenuated in any way ; the tumor itself being soft and fluctuating at dif- ferent points where the liquor unmii \'i, but firm and resisting at others where the foetus chances to be. It may be noted here, that we may have other herniae of the uterus than ventral. For instance, Gelle describes a case of hernia of one of the uterine cornua, which contained a calf, and which had passed through a rent in the mesentery. And Rainard has observed several cases of this kind in the Bitch. Diagnosis. The diagnosis of uterine hernia in the larger animals is not difficult in the great majority of instances, and especially if labor has commenced. In the first place, it is usually known to the owner that the animal is pregnant ; and in the second place, if parturition has begun there can scarcely be any mistake made as to the nature of the expulsive efforts. Besides, there is the abdominal tumor with its peculiar characteristics, and by manipulating which the foetus can be detected. It will also be discovered that the tumor does not adhere to the abdominal parietes, and that it may be reduced by taxis. But it may be necessary to ascertain the presentation and position of the foetus, and if it cannot be born, what the nature of the obstacle is which prevents delivery. In such a case vaginal exploration must be resorted to ; and from it we may learn that the os is not dilated from one of several causes to be hereafter discussed ; or the non -dilatation may be due to the uterine contractions not pressing the foetal mass directly against the cervix, in consequence of the altered direction of the uterus, DYSTOKIA BY DISPLACEMENT. 283 or the margin of the hernial opening strangulating the foetus and hindering its advance. These obstacles must be combated by appropri- ate measures. In consequence of the foetus lying so far below the pubis, the hand introduced through the os cannot feel it, even when the whole length of the arm is inserted ; in which case, if the animalis standing, the abdomen may be raised by means of a sheet or blanket, so as to bring the foetus within reach. If the animal is recumbent and cannot rise, then it should be placed on its back and secured in that position, the croup being raised by bundles of straw. The tumor may then be examined by external palpation, as well as by rectal and vaginal exploration, and the position of the foetus determined. As a rule, the position is never completely normal. In the most favor- able cases, the head is found to be directed backwards and near to the pubis — sometimes partly in the pelvis, with the face upwards and slightly forwards ; the fore feet being more or less doubled back against the body, which lies deep in the tumor, the buttocks resting on the mammae of the mother — the foetus being altogether in the recumbent female in the posi- tion of a sitting dog. The state of the borders of the hernial orifice should be carefully ascertained, and their rigidity and tension, together with the degree of constriction they exercise on the body of the foetus, noted. This impor- tant examination should be made before any traction is exercised on the foetus ; for on the information gained by it will depend the choice of means to effect delivery. With the Bitch uterine hernia is frequently most difficult to diagnose, and errors are far from unfrequent : the most common mistake is fixing on jthe tumor as a cancerous mass. But mammary tumors are very dif- ferent to that of hernia ; they are generally nodulated, very hard, and the skin is closely adherent to them ; whereas the uterine hernia has not the fluctuation of a kyst or abscess, neither has it the resistance of a carci- noma, fibroma, or adenoma, while the skin covering it is smooth, supple, perfectly natural, without ulcerations, discolorations, and other signs which mark the presence of mammary enlargements. The uterine tumor can also be reduced by taxis or manipulation, while the fissure in the abdominal wall can be felt. This, together with the fact that it is only developed rapidly after impregnation, and without any local or gen- eral inflammatory symptoms, or disturbance of the general health, should settle the question. However, should any doubt yet remain, or if it is desired to ascertain the exact state of affairs, a more careful examination will be necessary, it being always born in remembrance that his hernia in the Bitch appears in different regions. Vaginal exploration cannot be resorted to with this animal because of the smallness of the pelvis — unless the Bitch is a large one, and then the fingers are too short to explore to any depth. An external examination must, therefore, be relied upon, and this is easier and more certain than with the larger creatures. By it the size of the abdominal rent will be ascertained, and also whether the foetus can be passed through it into the abdomen ; though this is rarely possible, owing to the hernia occurring when the uterus was empty, and when it could pass through an opening which will not be sufficient for a foetus when fully developed. All manipulatory operations on the Bitch should be practised with as 284 MATERNAL DYSTOKIA. much tact and gentleness as possible, as the young are readily killed, whil§ the female itself is very liable to metritis. Indications. Animals suffering from uterine hernia sometimes bring forth their young spontaneously, and without any bad results to themselves or their progeny ; thus proving that the uterine contractions alone will expel the foetus, and that the aid of the abdominal muscles is not absolutely necessary. And more especially is this the case with the larger animals. Leconte mentions a Mare whose career he traced for five years, and which, notwithstanding the existence of this condition, brought forth four living foals; three without assistance, the forth being in a wrong position. Cows which had most alarming herniae, have even brought forth twin calves spontaneously. But, as a rule, with these larger uniparous animals, parturition is always more protracted and difficult than in ordinary circumstances, and the assistance of the veterinary obstetrist is needed to effect delivery ; and this, after all, is in some instances impossible, and the mother and off- spring are lost. This is more particularly the case with multiparous ani- mals, and especially the Bitch, in which it is generally all but impossible to reduce the hernia or remove the foetuses by the natural passage. Roll has, nevertheless, described the case of a Bitch suffering from uterine hernia, which brought forth its progeny in a natural manner ; and Prange, in 1844, published the history of another Bitch that, unaided, gave birth to three puppies which had been lodged in a hernia of this kind. Kopp, as we will see presently, removed three puppies by gastro- hysterotomy from a uterine hernia, which he afterwards reduced, when another puppy was borne naturally. And Chanel reports that a sow brought forth young after a portion of one of the uterine cornua contain- ing two foetuses, and which had been hernied, was amputated. Notwithstanding these instances, however, the assistance of the obstet- rist is necessary to effect delivery, for which a careful examination, as in diagnosis, will indicate the means. Previous to parturition, the hernia should be supported, when possible, by a truss or retaining bandage, and care should be taken to prevent over-exertion or straining. With the larger animals, delivery by the natural passages is, of course, the chief object to be attained. In certain cases, the simplest measure, and which is sometimes all that is necessary, is to elevate the hernia by means of a sheet or blanket passed under it, and raised by an assistant at each side of the animal. Manipulation per vaginam may supplement this support, and in the majority of such cases may even be absolutely necessary to complete delivery. In other instances, however, the foetus cannot be removed from the hernial sac without placing the female in a recumbent posture. Either lateral or dorsal decubitus maybe resorted to, according to circumstances ; but the preference is usually given to the latter position \ though when lateral decubitus is tried, the animal should be placed on the side oppo- site to that in which the hernia exists. In the dorsal position, the weight of the foetus and uterus is removed from the floor of the abdomen ; consequently, the abdominal muscles are relaxed, and the borders of the hernial opening are not so tense ; while DYSTOKIA BY DISPLACEMENT. 285 the uterus 'and its contents, by their own weight, have a tendency to escape from the hernia and fall into the abdomen ; at the same time the foetus is more accessible to the hand of the obstetrist. Should the os be contracted, it must then be dilated by the hand ; if the membranes are intact, they are to be ruptured ; should the foetus make an unfavorable presentation, which is not very frequent in these cases, this can be rectified ; and if the creature is dead, which is nearly alwavs the case when assistance has not been rendered sufficiently early, and the membranes are ruptured, it can be all the more easily removed. When the foetus presents anteriorly and the head can be seized, this should be brought into the pelvic inlet, and cords attached to the lower jaw, or Schaack's head-collar forceps (to be hereafter described) may be employed ; then having secured the head, the fore limbs are sought for, and brought into the passage one after the other, where they are also secured by cords around the pasterns. Sometimes these limbs cannot be found, owing to their being bent back against the body of the foetus, and this will certainly render delivery more difficult. Should the foetus present posteriorly, the case is more unfavorable ; though if the hind limbs can be found and brought into the vagina, then delivery may soon be effected if there are no other complications. Cords being fastened to the pasterns, sufficient and well-directed trac- tion should be employed on them, the hand of the operator remaining in the pelvis if necessary, in order to guide the passage of the foetus. Saint- Cyr suggests that an intelligent assistant may at the same time be directed to make methodical pressure on the hernia, in order to complete its reduction, which is effected when the contents of the hernia are returned to the abdomen. At times this reduction is easy, and at other times it is extremely diffi- cult. In the latter instances, all the more care is necessary that the ex- ternal manipulations are not too forcible, if it is desired to have a living foetus. Should the resistance prove greater than the means which may safely be employed to overcome it, then a surgical operation must be determined on. When the muscles of the abdomen prove an obstacle to the escape of the foetus from the hernial sac, and produce a kind of strangulation, an incision may be made through them in the most con- venient part, as in the operation for strangulated hernia of the intestine. In other cases the Csesarean operation may have to be resorted to, and speedily, if the mother or progeny, or even both, are to be saved. Recourse to this formidable measure will only be had in particular instances : as when the mother or foetus are valuable, and other means have failed or are not likely to succeed. And in uterine hernia this operation is undertaken in far more favor- able condition, than in some other circumstances which necessitate its adoption. In this accident only the skin, and perhaps also occasionally the tunica abdominaiis, has to be cut through to expose the uterus, which has not to be sought for among the mass of intestines and labo- riously withdrawn from their midst ; indeed, it generally occupies the whole of the hernial tumor, and so closely, that there is no danger of the intestines escaping during the operation. A simple incision — no larger than is necessary — through the organ, a larger one through the foetal membranes, and the prompt extraction of the foetus therefrom, pretty nearly complete the task. If the Caesarean operation is timeously resorted to, the chances are 286 MATERNAL DYSTOKIA. greatly in favor of delivering a living foetus ; with the Cow, as Saint-Cyr has stated, a living and perfectly viable calf is almost certain to be obtained, even a long time after labor is commenced and the " water- bag" has ruptured. And even with the Mare it is not at all impossible to rescue a living foal, if the operation is resorted to before rupture of the membranes. The chances in favor of the mother are, of course, fewer than with the foetus ; for under the most favorable conditions, after removal of the progeny, there will still remain the great hernial sac, which it will be most difficult to keep the intestines from occupying, and still more diffi- cult to cure in a radical manner : judicious trussing and bandaging being nearly all that can be done to palliate the effects of the accident. All these considerations should, of course, be duly estimated by the veterinary surgeon in undertaking the treatment of such a case ; and it is scarcely necessary to say that, with the Cow more especially, the butcher will frequently have to be called in when the question of risk and ex- pense has been fairly discussed. It need hardly be pointed out that it is generally very injudicious to attempt to breed from an animal affected with hysterocele, or an abdom- inal hernia of any description, notwithstanding the fact that this condition may not militate against gestation and parturition in every case. With the smaller animals, and especially the Bitch, the Caesarean ope- ration has usually to be resorted to for various reasons, the chief of which are the small size of the creature, the difficulty in reaching the foetus or foetuses and extracting them by the natural passages, as well as the irreducible nature of the hernia, which is often extremely constricted at the neck, and attempts at reduction are often followed by death. Besides, the Bitch withstands very serious operations in the abdominal region better almost than any other animal, the entire uterus having been frequently removed by abdominal section without a fatal termination. In this animal the operation is also very simple, and demands only ordinary care and manipulative skill. Every thing is therefore in favor of gastro-hysterotomy in the uterine hernia of the pregnant Bitch ; but in order to ensure whatever success may be possible, it must be performed early, and before serious injury has been done by attempts at reduction or delivery in other ways. It has been argued that it might be preferable to open the sac, divide the con- striction which prevents reduction, and return the gravid uterus to the abdomen, when delivery might be effected in a natural and spontaneous manner. And it has been shown that this mode of operating is rational and possible, and may be followed by success should there be no adhesions between the misplaced uterine cornu and the hernial pouch. The expe- rience gained in such cases, however, does not testify very markedly in favor of this procedure, and the evidence is certainly in favor of the Cae- sarean operation, and particularly when adhesions exist. The dangers to be apprehended from gastro-hysterotomy are inflamma- tion and strangulation of the imprisoned cornu and of the uterus, which at this time is so vascular, impressionable, and particularly susceptible to the influence of the air on its internal surface. To avert these dangers, it has been proposed to remove the uterine horn altogether ; 'and we are certainly of opinion that, in certain cases, the proposal is worthy of a trial. We will describe the Caesarean operation in another place. DYSTOKIA BY DISPLACEMENT. 287 At a recent meeting of the Medical Society of Strasburg, M. Kopp {Gazette Medicale de Strasbourg, 1875) exhibited the uterus and its appendages belonging to a Bitch upon which he had operated in order to extract a foetus which was lodged in one of the uterine cornua. The animal had been restless for some twenty-four hours when Kopp was called in to examine it ; he found every indication of approaching pafturition, but not- withstanding these, and the considerable volume of the abdomeji, tne os uteri was almost closed — a circumstance which decided him to wait. During the night the Bitch gave birth to a dead puppy, and on the following day the diminished distention of the abdo- men enabled him to discover, beneath the skin, the presence of three fa-tuses. On inquiry, he ascertained that for some time the animal had been suffering from an inguinal hernia on the left side, and this information led him to adopt active measures. The skin was incised over the isolated hernial sac, as far as the inguinal canal ; then, after largely opening the tumor, as well as the uterine cornu it contained, he was able to remove the three dead foetuses and their membranes. The prolapsed uterine portion having been carefully cleansed, was closed by suture and returned to the abdominal cavity, and a strong ligature placed round the sac. The inguinal canal had been widely incised ; but notwithstanding this, the reduction of the uterus and its annexes offered some difficulties, in consequence of the great mass of fat in and upon the broad ligaments surrounding them. Every thing appeared to be going on favorably until the ninth day, when the ani- mal suddenly succumbed. Death was attributed to purulent absorption, produced through the agency of a small abscess on the broad ligament, which had been abraded during the operation of reduction. There were no traces of metro-peritonitis, and the wound in the uterus, as well as in that portion of the sac which had been ligatured, was cicatrizing most satisfactorily. According to Kopp, this was an instance of intra and extra-abdominal pregnancy at the same time ; and in proof of this, he pointed to the narrowness of the inguinal canal, and the presence of the uterine hernia previous to im- pregnation. Three of the foetuses were developed in the cornual hernia, and the fourth in the body of the uterus. Pathological Anatomy. The pathological anatomy of uterine hernia is not without interest to the obstetrist ; and as it has been studied in animals which have died during attempts at parturition, or have been slaughtered after that act, the evi- dence is as plentiful as it is reliable. According to Saint-Cyr^ the chief and essential lesion is of course to be found in the abdominal parietes. The fleshy or tendinous fibres of the oblique muscles may be merely separated, especially at the commence- ment ; though most frequently some of them are ruptured. The great rectus muscle always shows a solution of continuity, the rupture being sometimes as clean and sharp as if it had been made by a knife ; though at other times it is irregular and lacerated. In every case there results a variable-sized opening, more or less circular, oval, or triangular, its larger diameter corresponding to the axis of the animal's body \ Rodet has seen an opening of this kind measure nearly twenty inches. The seat of the rupture varies ; sometimes the rectus muscle is perfor- ated at its pubic insertion, as Favre has seen it ; in other cases it is else- where, but in every instance it is inferior, posterior to the umbilicus, and to the right or left of the linea alba. The latter structure is at first never involved ; but when the hernia increases largely in size, it may in its turn give way ; so long as it remains intact it forms a kind of cord extending from the pubis to the sternum, and by partially dividing the tumor^ gives it a bi-lobular appearance. In a few cases the tunica abdominalis resists the strain imposed on it, being only extended, and in this way the hernia has another covering, in addition to the skin ; but in many instances it tears like the muscles. Delplanque has shown that the peritoneum may escape rupture, stretch and, accompanying the descending viscera, constitute a serous tunic to 288 MATERNAL DYSTOKIA. the hernia ; most frequently, however, it gives way, the uterus passes through it, and then there is no hernial sac. In a recent hernia, the connective tissue surrounding it is greatly ecchy- mosed and infiltrated, and the muscular fibres broken-up and separated ; the tendinous fibres are also separated and torn, and numerous red and partly discolorized blood-clots lie among their interstices. At a later period no extravasated blood is found between the skin and the uterus, but the parts are uniformly red ; and, later still, attempts at repair are evi- denced by cicatrization of the borders of the rupture, which have then a rounded, thickened, and fibro-tendinous aspect, and are dense and resist- ing. The connective tissue beneath the skin is condensed into a kind of smooth membrane, continuous with the margin of the rent, and forms a second tunic to the hernia. Before parturition the hernia is occupied exclusively, or nearly so, by the gravid uterus, which is wholly or in part lodged in this accidental di- verticulum. After delivery, however, the uterus often, though not always, ascends into the abdominal cavity ; but whether it does so or not, other viscera — such as the rumen with the Cow, and the colon and small intes- tine with the Mare — find their way into the pouch ; Rodet has even found the uterus and the entire intestinal mass included in it. Deviation of the Uterus. By the term deviation^ when applied to the uterus, is meant a change in the direction of the organ, by which the cervix and os no longer corre- spond to the axis of the vagina. This change of direction in the vaginal opening of the uterus may be productive of more or less difficulty in parturition. Changes in the position of the uterus are somewhat common in woman, whose vertical uterus may easily deviate in any direction, producing those flexions and versions which not unfrequently offer serious obstacles to de- livery. With quadrupeds, however, in which the uterus is horizontal, the veterinary obstetrist has but to deal with one kind of deviation of the uterus, the only one possible — that of inferior obliquity^ which appears to be extremely rare, and corresponds to the anteversion of the human fe- male. According to Schaack and Garreau, who have more particularly studied it, this change of position may, in certain circumstances, become a very serious cause of dystokia. The accident has, up to the present time, only been observed in the Cow \ and this circumstance is believed to be explained by an interest- ing feature in the anatomy of this animal, which has been recently brought under notice by Professor Goubaux, of the Alfort Veterinary School. It would appear that, in bovines, the abdominal muscles are not at- tached to the anterior border of the pubis as in solipeds, but are inserted into a thick ligament found at the external and inferior part of the pubic bones, and which strengthens the symphysis pubis. It consequently hap- pens that, at this border of these bones, the floor of the abdomen is on a lower plane than that of the pelvic cavity ; so that there is a kind of step between the two cavities, the height of which varies in different animals, but has been found to be as much as three, four, and even five inches. Dissection has demonstrated that the peritoneum lining the lower sur- face of the abdominal cavity, on arriving at the pubis ascends this step, DYSTOKIA BY DISPLACEMENT. 289 in covering it like a carpet, to line the upper surface of the pubic bones and the pelvic cavity. From this anatomical peculiarity, it may happen that the fundus of the gravid uterus, instead of being directed forward, will incline directly downwards and lie on this pelvic step, not passing beyond the umbilicus, behind which it may even rest sometimes. At the same time, and as a consequence of this arrangement, the other end — the cervix — is tilted upwards in the direction of the sacro-vertebral angle, and it may even compress the rectum against that part. It will be obvious that, through this great deviation in the direction of the cervix, the os no longer cor- responds to the axis of the vagina, the canal following, of course, the same oblique ascending line as the cervix. Such an alteration in the position of the uterus entails a similar change in the attitude of the foetus, which, instead of being placed almost horizontally, is now more or less vertical — the head towards the sacrum, and the buttocks resting on the pubic step. During parturition, as Saint-Cyr points out, we may easily understand how affairs are changed with regard to the performance of this act. The uterine contractions are no longer directed towards the cervix ; the os only dilates slowly or not at all, according to the degree of uterine ob- liquity ; the animal is exhausted with ineffectual attempts to expel the foetus ; and if assistance is not rendered, it may succumb without being delivered, or the uterus may rupture. Garreau has observed that labor may be suspended altogether- ; the foetus dies, becomes mummified, and is retained for perhaps a very long time. Diagnosis. The diagnosis of this deviation does not appear to be attended with much difficulty. The long duration of labor, and the inutility of the expulsive efforts, prove that some obstacle to delivery must be present. Consequently, vaginal exploration is resorted to, and when the hand is passed into that canal it reaches a kind of imperforate cul-de-sac, at the bottom of which is a large round tumor into which no opening can be found. This tumor is the lower face of the uterus which, pressed against the corresponding wall of the vagina, projects into the pelvic inlet. Raising the hand towards the sacrum, the os will be discovered much removed from its normal position, and situated above in front of the uterine tumor just alluded to. Sometimes the os is completely closed, in other cases it may be more or less dilated. When in the latter condition, there is frequently formed at this point a kind of membraneous transverse fold, raised in the form of a valve which has been compared to a fleshy band analogous to that which forms the sacculations of the large intestine ; this band is stretched across the lower part of the os, and it has to be surmounted before the hand can touch the foetus. The latter is lodged in a kind of pouch or excavation situated beneath the band, and constitutes the tu- mor met with at first at the bottom of the vagina. Complicatio7is. To Saint-Cyr, Garreau, and Schaack, we are indebted for our descrip- tion of the condition we have been describing, and to the two latter are also due the knowledge we possess of certain complications which are worthy of notice. 19 290 MATERNAL DYSTOKIA. Garreau has found the cervix in this uterine deviation, thickened^, indu- rated, and the os closed. Delivery was impossible, and the foetus re- mained for three months in the uterus without causing any great incon- venience to the Cow. At the end of this period the calf was extracted by Caesarean section, and with perfect success ; as the Cow quite recov- ered, and was sold at a good price eight months afterwards. In one of the cases described by Schaack, the foetus was in the verte- bro-sacral position, and the limbs and head having been secured by cords, delivery was accomplished by strong traction. In a quarter of an hour afterwards, however, the Cow lay down, trembled all over, the muscles of the limbs and the eyes contracted in a convulsive manner, and death rapidly ensued. At the autopsy, which was made six hours after death, a quantity of blood, in the form of a large clot, was found in the abdomen, and the textures about the pubis were infiltrated with that fluid. The uterus had resumed its ordinary form, and its mucous membrane was intact ; but at the inferior part of the organ, there was a large triangular tear, about six inches long and four wide ; and it was noted that this laceration had caused the rupture of two good-sized arteries, which of course led to the haemorrhage that caused death so rapidly. Indications. The indications for treatment in this deviation are simple : raise the fundus of the uterus, lower the cervix, and bring the os on a line with the vagina. When this is accomplished, the uterine contractions will act directly on the cervix, and if this is healthy, dilatation of .the os will soon take place ; then the foetus, pushed towards the vagina, instead of against the sacrum, will enter the passage, from which a little judicious manipu- lation will in all probability remove it, and thus complete delivery. Several modes of procedure have been recommended for adoption in carrying out these indications. Indeed, Saint-Cyr states that when the deviation is inconsiderable^ and the valvular band we have mentioned as obstructing the os is not present, reduction is often spontaneously effect- ed by mere decubitus. This, in pushing upwards the fundus of the uterus, brings down the cervix to its normal position by an easily under- stood tilting movement. Schaack has noticed this to happen in two in- stances. In such cases, says Rainard, if the animal persists in standing, it naay suffice to raise the belly by means of a folded sheet or blanket, or even a plank held by an assistant on each side of the Cow ; or the creature may be gently thrown down on a thick bed of straw. In difficult cases, however, these measures will not be sufficient, and Garreau recommends the following procedure to be adopted. Introduce the right hand into the rectum and the left into the vagina ; with the first press on the head of the foetus, and push back its body (the vaginal tumor) with the second, tilting, as it were, the young creature into its natural position. This will bring the uterus into its normal situation, and consequently the os opposite the vagina. Saint-Cyr, nevertheless, gives the preference to the method recom- mended and practised by Schaack in these troublesome cases, inasmuch as it is more simple, and experience has demonstrated its efficacy. This method consists merely in throwing down the Cow most carefully, plac- D YSTOKIA B Y D ISP LA CEMENT. 291 ing the animal on its back, and keeping it in that position by bundles of straw. The weight of the foetus carries the uterus down towards the spine (inferior) ; the fundus of the organ is depressed, and the cervix raised towards the pubis (now superior) \ the obliquity of the uterus is thus got rid of. Schaack has on two occasions resorted to this mode of reduction, and in each case the abnormal valve disappeared, and parturition was ren- dered easy. Professor Peuch, of the Lyons Veterinary School, states that in a case of this description, he employed Schaack's method ; when the Cow was placed on its back the obliquity disappeared spontaneously, and with the greatest facility. Torsion of the Uterus: Contorsio Uteri. Torsion, or " twisting " of the gravid uterus on itself — and which often involves not only the cervix of the organ, but also the vagina — is an ac- cident unknown to the pregnant human female, but for anatomical rea^ sons may occur in animals, and particularly in the Cow, in which it has been most frequently observed. This accident is rare in the Mare ; it has been observed in the Sheep and Goat, as well as i« the Cat ; but though in the Sow and Bitch the uterine cornua may become displaced and twisted on each other, and even become hernied by the broad liga- ments, yet torsion of the uterus has not been noted in them, so far as can be ascertained. We will first study the accident in the Cow, and afterwards in the Mare and other animals. History. Though torsion of the uterus is now recognized as a serious, but not insurmountable, obstacle to parturition, yet its existence may be said to be of recent discovery ; for though it was clearly and explicitly indicated in the last century by Boutrolle {Far/ait Bouvier, 2d edition, 1766), yet it was not until after much observation and discussion in this century that such a condition was proved to be possible. Boutrolle wrote: "If it is possible to pass two or three fingers into the os {veliere), the hand and arm may be forced through ; but if, on the contrary, a finger cannot be passed into it, and the opening is found to be turning, it is a sign that the OS is twisted — thai it has fnade a half-turn on itself- — and it is impos- sible to enter it." Though Veterinary Science had gained a sound footing in France soon after the publication of Boutrolle's " Perfect Cawherd," yet its students do not appear to have paid any heed to the amateur's description of the spiral twist of the cervix uteri, the difficulty in penetrating the os, and the impossibility of birth taking place through it. Indifference or incredulity may have prevailed ; and it was not until painful experience had awak- ened attention to the existence of the accident, that the veterinarians of this century began to notice it. Nevertheless, in France Boutrolle's " Cowherd " appears to have been carefully read and usefully studied by those for whom it was written — the countr}^- folks or cowmen, or he may have gained his knowledge from these ; for, according to Saint-Cyr, one of their great problems in cases 292 MA TERN A L D YSTOKIA . of difficult parturition — a problem not confined to the cowherds of France only — was to discover if the calving Cow was not " barre'e " (obstructed), if it had not the torche^ veliere, or portiere torse, torte, or tordue (cervix twisted), terms employed according to the localities and dialects, and which signify what Boutrolle has distinctly described. At the commencement of this century, however, we are informed by Rainard that Maurin of Cantal, and Vieillard of Brioude, two of his pu- pils, had witnessed this form of dystokia. " On January 13, 1823," says Maurin, " I was called upon to attend on an eight years old Cow which was calving. This animal, which had an enormous belly, had remained lying for four or five days, without appetite, and the pulse quick. It should have calved towards the end of the previous December ; and indeed on the 26th and 27th of that month, it exhibited symptoms of pain similar to those of labor, though the ' waters ' did not escape. " These symptoms having disappeared, and every thing being tranquil, the proprietor of the Cow thought that he had been deceived as to the precise period at which the animal should have calved, and believed that the pains were merely due to accidental colic, and had no relation to parturition. I endeavored to assure myself as to whether the foetus was alive or dead, by strong pressure on the abdomen, in order to excite it to movement if it chanced to be living ; but not succeeding in this, I was convinced that it was dead. On trying to introduce my hand, I experienced my first difficulty in passing the bulb of the vagina, which was so constricted that I was compelled to dilate it. Hav- ing reached the e«d of the canal, I was able to assure myself that the cervix uteri offered salient folds; as the index finger, with which I endeavored to penetrate the os, found it contracted and plicated. As it appeared to me that the Cow must die, I recom- mended the owner to sell it to the butcher. " On opening it, I found the small intestines in the vicinity of the uterus reddened for a considerable extent. The uterus itself was turned round from right to left, and the suspensory ligaments of the cornua were interlaced in one another. When the uterus was opened, the calf was found with its back towards the right flank of the Cow. its limbs being towards the left flank ; the cervix formed two very salient spiral turns, which undoubtedly prevented its dilatation The body of the foetus did not present any traces of putrefaction, although the ' waters ' had a foetid odor." Vieillard was able to distinguish this accident in a more evident manner than Maurin, and during the life-time of the two Cows he was called in to see. These animals had the uterus prolapsed, the cervix being external to the vulva, and the posterior part of the organ showed three markedly-spiral folds. In Frarjce, other veterinary observers afterwards published similar cases, the first in order being Lecoq, of Bayeux, who in 1837 '^^*^ occasion to note this accident. In a Alemoire sur le part laborieiix {Comptes Rejidus de la Societe Veterinaire du Calvados et de la Manc/ie, 1838), he expresses his surprise at the silence prevailing among veterinary authorities with regard to this condition, which was met with from time to time, and was well enough known to breeders. In describing the symptoms he had noted, Lecoq says : " The hand having been introduced into the vagina, and pushed as far as the neck of the uterus, encountered a kind of valve obstructing the entrance to the latter. I was beyond the part I had taken for a valve, and had got into a narrow canal which had the form of a screw {ayant la forme d'une vis). The Cow died on the following day without having been delivered, and at the autopsy it was found that the uterus was completely turned upside-down — the superior face having be- come the inferior — and that this version had taken place from right to left." The first Veterinarian, we believe, who observed — or, rather, who de- scribed — a complete rotation of the uterus (the previous cases recorded were only those of half-rotation), was Mazure, whose description is one of the best we possess. It is published in the same periodical which DYSTOKIA BY DISPLACEMENT. 293 contains Lecoq's account. From his narrative, it appears that he was consulted by one of his colleagues with regard to a Cow, the cervix of whose uterus was so twisted that a finger could not enter the os. Mazure gave an unfavorable prognosis ; but, notwithstanding, it was attempted to reduce the torsion by making an opening in the right flank in order to reach the uterus. The attempt failed, though it demonstrated that there was a quantity of foetid serosity and fibrinous flakes in the peritoneal cavity ; that the uterus had a rupture in its left posterior border, the rent being rounded in form and had a diameter of from twenty to twenty-four centimetres ; and that the foetus was dead, as had been suspected. As nothing more could be done with the Cow, it was destroyed, and it was then discovered that the uterus had made a complete revolution on its axis j while towards the part adjoining the cervix, there were found five spiral twists, two of which, more voluminous than the others, were of a greyish color and hard in texture. Throughout the whole extent of these twists in the uterus, the connective tissue, infiltrated with serosity, formed a swelling which rendered the dilatation of the posterior part, and the passage of the calf through it, most difficult. The foetus was perfectly developed and intact, and did not appear to have been dead more than two or three days. Another Norman Veterinarian, Pouchy, describes four cases, about the same period. These Cows merely suffered from loss of appetite, great distention of the abdomen, unhealthy-looking coat, a foetid and sanguino- lent vaginal discharge, and suppression of milk, for six to eight weeks ; when submitted to treatment, and turned out to pasture, they recovered sufficiently to become fit for the butcher. In Germany, about the same time, torsion of the uterus had been the subject of investigation and treatment by Dieterichs and Schmidt of Bavaria, Vix of Giessen, Fricke of Hanover, and Irminger and Schenker of Switzerland. Fricke cured a case by fastening the feet together, two by two, and rolling the animal in a contrary direction to that in which the uterus was twisted. In Britain nothing appears to have been noticed of this accident until 1840, when Mr. Carlisle, of Wigton, under the head of " Csesarean Opera- tion " ( Veterinarian^ vol. xiii., p. 407), describes an undoubted case of torsion. The circumstance which rendered the operation necessary, was a severe injury the animal had received two days previously, since when it had manifested symptoms of parturition ; but though several attempts had been made to extract the foetus, delivery could not be accomplished owing to the uterus being twisted. Caesarean section having delivered the calf and its membranes, the Cow only lived a short time. The uterus was found to be " completely rotated, even to the termination of the vagina." After this period, torsion of the uterus attracted a large share of at- tention among the most accomplished Continental Veterinarians, and particularly after the observations published by Denoc, in France, in 1845. It formed the subject of animated and interesting discussions at the Belgian Socie'te de Medicine, the Socie'te' Central de Med. Ve'terinaire of Paris in 1853 and i860, the Veterinary Society of Wurtemberg in 1854, and that of Denmark in 1855 ; and memoirs on it have b.een published by Bordonnat, Rossignol, Gaven, Bouley, Canu, Lemaire, Chambon, Goubaux, Chauveau, Weber, Liautard, Dagoureau, Lessona, Ollivero, Ercolani, Lafosse, Chuchu, Goron, Obig, Heu, Rocco, Marlot, Gourcy, 294 MATERNAL DYSTOKIA. Coquet, and many other foreign Veterinarians ; while it is alluded to with more or less detail in the treaties of Rainard, Baumeister and Rueff, Ziirn, Harms, Lanzillotti-Buonsanti, Cruzel, Saint-Cyr, etc. In this country it has not received much attention, if we are to judge from the paucity of allusions to it ; though there can be no doubt that the accident frequently occurs. Beyond a few notices from the pen of Car- lisle, Cartwright (of Whitchurch), Woods (Wigan), Bennet, and Captain Russell, little more is recorded. These observations only refer to torsion of the uterus in the Cow. No observer in this country has noticed its occurrence in other animals, except Cox. With the Mare, in which the accident is nearly always fatal, it has been witnessed by Belhomme, Elsen, Delwart, Hamon, Noll, Devaux, Canu, Leconte, Schmidt, and Cox. In the Cat, it has been observed by Vivier. Nature and Freqiieficy. Before proceeding to describe the symptoms and other features of this curious accident, it may be well to inquire into its nature and frequency. As the designation indicates, the accident consists in a rotation of the uterus on its axis, by which its upper surface may successively become lateral and inferior ; and lateral on the opposite side and superior, when the revolution is complete. This revolution may take place in two opposite directions ; the upper face may at first be left lateral or I'ight lateral — the first constituting left torsion, the second right torsion. I'orsion may be incomplete or cofnplete. There may be quarter-torsion^ half -torsion, three-quarter torsion, or complete torsion, according to the degree of rotation the uterus has experienced. In those instances in which the organ has made two complete turns, we have a double torsion. The consequences of this rotation are easily seen. The vagina and its prolongation — the cervix uteri — because of their attachments, cannot follow the uterus, and therefore become twisted in a cord-like manner ; whence arises stricture of the os — the constriction being all the greater as the rotation is complete — and utter impossibility to effect delivery of the foetus unless the uterus is replaced in its normal position, or its contents are removed otherwise than through the os. Incomplete torsion is by far- the most frequent form encountered in practice. It is often so slight that it might rather be classed among the deviations of the uterus already alluded to. For instance, very frequently there is only a trifling displacement of the cornu containing the foetus, and this may carry the uterus with it, giving rise to a condition which bears a certain analogy to the uterine obliquity met with in woman, in which the organ is inclined laterally. Schaack, Rainard^ Weiss, and Zundel have often noted these cases in animals ; and the latter states that they occur in largest proportion among the larger lymphatic Cows. In other instances, the torsion consists in a quarter or half-turn, the upper face of the uterus having become lateral or inferior ; sometimes the gravid cornu comes to occupy the inferior region of the abdomen ; and at other times, making a ,wider rotation, it is lodged in the opposite flank. There are scarcely any means in practice by which we can estimate, with mathematical exactness, the degree of torsion to which the uterus may have been submitted ; as what we have designated a quarter-turn or revolution only signifies that the organ has made a rotation of 90°, while D YSTOKIA B Y DISPL A CEMENT. 29s the half-turn is scarcely 180^. Nevertheless, an approximation is all that can be looked for, and, indeed, is all that is necessary. As we have already mentioned, Mazure, in 1842, had a case of com- plete rotation of the uterus on its axis ; this was remedied by causing the organ to turn completely round in the opposite direction. Other writers have spoken of a complete rotation in some cases, but it may be sur- mised that it was only a half-turn. Double, triple, and even quadruple twists have been described ; because there have been found two, three, or more spiral ridges or doubles, close together, hard, and resisting, and usually parallel to each other. But, as Zundel points out, these multiple plies are only what a somewhat long and supple cylinder makes when it is twisted. Fig. 68. Incomplete Torsion of the Uterus. I, Body of the Uterus ; 2, 3, 4, Spiral Twists directed from left to right ; 5, Cervix Uteri and Vagina; 6, Suspensory Ligament; 7, Pelvis. To account for these multiple ///V«, which have erroneously been taken for so many complete turns of the uterus, we have only to accept the illustration offered us by Delafond, who, comparing that organ to a long stocking, puts a weight in the foot of the latter, and gives it a turn in the middle, keeping the open or upper end fixed. Or a small body, to repre- sent the fcetus, may be enclosed in the middle of a handkerchief — the uterus — so as to make a sac. If the end containing the body be turned or twisted on itself, the neck of the sac will have a first ply, representing one-fourth of a complete twist ; a second ply will represent the half of a complete twist or turn, and will cross the other ; so that when a complete turn has been made, it will be found that there are at least four plies or strands. Notwithstanding this illusion, however, jt is certain that double and even multiple tol-sion of the uterus may ex'ist ; but then the body of the organ and the vagina are close twisted like a cord. This multiple tor- sion is discovered on making the autopsy of an animal which has died or been killed because of non-delivery. In such a case, it requires two 296 MATERNAL DVSTOKIA. or more turns of the uterus to bring it to its normal position. Such a complicated condition would appear, however, to be very rare. An important question is that relating to the possibility of such an accident occurring to an organ like this, which is attached to the pelvis by its continuation — the vagina — suspended to the vertebrae in the lum- bar region by broad ligaments, and maintained in situ, in addition, by the neighboring viscera, and more especially by the rumen in the Cow — the animal in which uterine torsion is observed by far the most frequently. This question can be answered by a reference to what we have stated with regard to the anatomy of this portion of the generative apparatus, at Fig. 69. Multiple Torsion of the Uterus. . I, Body of the Uterus; 2, 2, 2, Torsion, involving the Body of the Organ ; 3, Rectum; 4, Bladder ; 5, Vagkia ; 6, Symphysis Pubis. pages 38, 40, and 44. We have seen that, in the Cow, the concave curvatures of the uterine cornua look downwards, and that it is to these concavities the broad ligaments are attached ; so that if the uterus be considered as freely suspended in the abdomen, the extremity of each corml is turned outwards and upwards, while its base, near the body of the organ, although drawn in the same direction by the ligaments, yet retains its position, being firmly maintained in it by the body of the uterus, which also receives the insertion of the broad ligaments on its lower face. This insertion causes the uterus to project above the ligaments, which are very broad, particularly at their anterior border, and widely separated from one another in front, near their lumbar attachment. The ligaments suspend the uterus loosely in the abdomen, and allow it to become fully developed during pregnancy. At this period, too, they DYSTOKIA BY DISPLACEMENT. • 297 become greatly increased in substance and length. As gestation ad- vances, nearly the whole of the great size of the uterus is due to the development of the one horn in which the foetus is situated ; and as the other horn retains its normal size, the twisting of this around its ligament, and consequent torsion of the cervix, can be readily understood. Such in the explanation of the accident given by Chauveau ; but Gou- baux does not quite assent to it. According to him, it is not because one horn of the uterus is developed more than another, neither is it owing to one of the broad ligaments being longer than its fellow ; it is in con- sequence^of the development of the cornua during gestation, and their projecting greatly beyond their means of attachment or suspension,' the broad ligaments being thrown altogether back. During pregnancy the cornua are considerably lengthened, while the ligaments do not increase in breadth, their points of attachment to the inner face of the flank or the ilium remaining invariably the same. This projection of the gravid cornu beyond the broad ligament supporting it — and which may be as much as nearly two feet — must render the production of the torsion remarkably easy. We have shown that the uterus is suspended in its ligaments as in a hammock, and if these ligaments increased in width as the gravid organ is developed in size, so as not to be overlapped by the cornua, then it might to a certain extent roll about in the hammock, but could not twist around it. Even if the uterus was suspended at the extremity of the ligaments, as in the Mare, it would be far less liable to torsion, and would swing in the abdomen like a kind of pendulum. As it is, the projection of the gravid uterus beyond its means of suspen- sion, the peculiar attachment of the broad ligaments to the lower face and concave border of the cornua, and a large proportion of the weight being situated high above and in front of these ligaments — all this makes us comprehend how a shock of any kind may throw the organ off its ham- mock, and produce incomplete, or even complete, torsion in the pregnant Cow without rupturing the hammock itself. , Rueff and Ercolani have witnessed cases in which the torsion was con- fined to the gravid cornu ; and Stockfleth mentions its occurrence in the body of the uterus, in front of the cervix. Most frequently, however, it involves the vagina, as well as the cervix and body of the organ. In certain cases, alluded to by Zundel, the accident has been accom- panied by rupture of the ligaments ; and instances are recorded by Dense and Albrecht in which the rupture has extended to the uterus itself. Rueff alludes to a case in which the foetus had even escaped into the abdominal cavity from a uterus thus ruptured, and, developing in the peritoneal sac, constituted an extra-uterine pregnancy. With regard to the direction of the torsion, several authorities have maintained that it takes place from left to right. Others, however, have found it to be in the contrary direction, and there appears to be no reason why it should occur in one way more than another, as the foetus is devel- oped in either cornu irrespectiveh'. Reynal, however, believes that the obliquity of the inner face of the rumen might dispose the uterus to torsion towards the right. Chauveau is, we think, justified in asserting that torsion always takes place inwards and upwards — the foetus slipping off its hammock causes this to swing round either to the right or left. The relative unfrequency of this occurrence in the other domesticated animals, is undoubtedly owing to the different arrangement of the uterus and its suspensory ligaments. 298 MATERNAL DYSTOKIA With regard to \h.Q: frequency of the accident, this depends upon several circumstances, the chief of which, perhaps, are related to the nature of the country in which the animals are reared, as well as to the manner of rearing them. This will explain, partly or wholly, why veterinarians in one locality are familiar with the accident, while others with as extensive experience never witness it. Leconte states that he has observed it about a dozen times, in between three and four hundred cases of difficult parturition. Lemaire has met with it seven times in four years ; and Rocco speaks of having witnessed about thirty cases of uterine torsion during forty years' practice. Etiology. Torsion of the uterus ordinarily occurs towards the termination of preg- nancy — about the eighth or ninth month, and its causes appear to be very diverse, if we are to accept the numerous opinions which have been offered on this point. The cause which, of all others, appears to operate most frequently in producing this condition, is a slip ox fall, and particularly on the hind quarters — croup or hocks. For this reason, uterine torsion is oftenest witnessed among Cows at liberty in pastoral countries, where the ground is broken, intersected, or hilly. Therefore it is, also, that the accident is not at all uncommon in Switzerland and the hilly parts of South Germany; while it is almost un- known on the plains, and is ve^y rare indeed among Cows kept in sheds. Sometimes the Cow has slipped upon its hind-quarters and tumbled over, through coming in contact with another. Marlot and Liautard have seen it arise'from a horn thrust in the flank by a companion Cow, the blow throwing the foetus and the uterus round to the opposite side. It has occurred in a Cow which was often butting with others, Chambon has noted it in a Cow which was in the habit of rolling like a horse ; Dagou- reau reports it occurring in a pregnant Cow which leapt on others like a bull, and Liautard in another that used to get its fore feet in the manger. Rocco states that it is produced in shoeing at the forge, when pregnant Cows are either thrown down or put in the travis to be shod ; and Rueff mentions a case in which it happened through casting a Cow for the pur- pose of performing an operation on it. In other instances it has been ascribed to falling when jumping a ditch, or slipping up when descending a steep hill. Reynal, Mignon, Chambon, Weber, and others, appear to consider meteorism as one of the most certain and most frequent causes of uterine torsion, through the displacement of the viscera which the distension occasions. Either the expansion of the rumen induces unusual and inordinate movements on the part of the foetus ; or it acts directly on the uterus, and produces displacement of the organ through the changes in situation and relations imposed on the other . abdominal organs. Mr. Cartwright, of Whitchurch, is of opinion that great distension of the stomach may, either of itself, or especially in connection with a fall, cause the uterus to be forced on one side, or twisted. Other authorities, among whom we find Ercolani, attribute the accident to severe toil when Cows are worked — as in draught ; others, to deformity or malposition of the foetus ; and others, again, think it may be mainly, if not exclusively, due to the spontaneous and energetic movements of DYSTOKIA BY DISPLACEMENT. 299 the foetus in utero, towards the termination of pregnancy. It is well known that these movements are sometimes very lively and powerful, and especially when induced by sudden jerks or blows inflicted on the pregnant animal, or when the abdomen is compressed, after the ingestion of cold water, etc. There can be no doubt that the movements which the foetus executes in order to get rid of uncomfortable sensations or avoid unpleasant positions, gives rise to those various attitudes and mal-presen- tations which so frequently render birth difficult, if not impossible ; and their occurrence may also explain how the young creature may be the means of causing the cornu in which it is contained, to roll and twist around the vacant cornu on the opposite side. In this way Colin endeavors to account for those cases in which the uterus has made several revolutions on itself when the movements persist — a very rare accident, it is true ; while he admits that the quarter or half revolutions — which are, after all, most frequent — may occur without the active intervention of the foetus, or even of the uterus, and may take place through falls or slips. Torsion from the above cause, Colin thinks, is all the more feasible, as at the end of gestation the amniotic and allantoic fluids are diminished in quantity, and the membranes and uterus are therefore applied closer to the foetus, and may follow its movements more readily. Chambon and other veterinarians are of opinion that the irregular and often violent movements which the pregnant animals — and especially primiparae — manifest when the labor pains commence : lying down and getting up again, throwing themselves first down on one side, then on another, and sometimes even rolling, are the most frequent cause of torsion which, according to them, only takes place at parturition. The latter opinion is supported by a case described by Landel, in which, when he made a first exploration of the genital passages at the com- mencement of birtii, there was no obstruction ; but soon after, on again exploring, he found that torsion of the cervix uteri had occurred in the interval. Lessona and a few others believe that the accident may be due to the thabit that certain Cows have of rolling themselves alternately from right |to left when they are lying. On the sternum they may do this; but though among solipeds and other animals rolling on the back is a per- fectly natural movement, yet it is rarely if ever witnessed in the bovine species. Sternal or abdominal rolling could scarcely produce displace- lent of the uterus. Rupture of one or both of the broad ligaments has been indicated by ^econte as always present in torsion ; but this is an error, as such a lesion is found to be exceedingly rare after death. But rupture of either )r both of these important suspensory bands may take place when )regnancy has well advanced, and there is a severe strain upon them, 'hen it can be readily understood how the uterus, rolling about among the digestive viscera and mainly retained by the cervix and vagina, may twist and twine on itself, and thus effectually occlude the os. Torsion of the uterus has been witnessed by Pouchy, subsequent to a )irth, in which there was eversion of the vagina and this organ. In all likelihood, the stretching of the broad ligaments, through re- sated pregnancies, predisposes to it ; though this cannot be the sole :ause, as torsion is often met with in primiparae. Displacement of the uterus by the pressure of a diseased kidney, has 300 MATERNAL DYSTOKIA. been recorded by Rueff. The kidney was of great size, and weighed more than thirty-three pounds. Symptoms. We have stated that this accident always takes place towards the termination of pregnancy — from the eighth to the ninth month. But Wegerer, Benzie, and other veterinarians, assert that they have witnessed it so early as the fifth month. Without disputing the correctness of their observations, it must be admitted that, during the early periods of gestation, the means by which the uterus is retained in its situation are sufficiently powerful to prevent any displacement of this kind ; and that it can only be at a late period, when the foetus is fully developed, and, with its membranes, has attained its maximum size and weight — so far as uterine life is concerned, that such an occurrence is likely. And the existence of torsion is generally only discovered when the time for the expulsion of the foetus has arrived ; though it has been said that partu- rition takes place earlier when torsion is present. As a rule, there is no particular indication of inconvenience or suffering at the moment when torsion of the uterus has taken place, if it has occurred before parturition ; and it would appear that gestation may go on to its termination without any appreciable symptoms being noted, or any thing like functional disturbance observed. Even in the initial stage of parturition, when enlargement of the udder, sinking of the croup, swelling and dilatation of the vulva, etc., have become manifest, there is no sign which can be relied upon to prove the existence of torsion. Only in some instances it has been remarked that the tumefaction of the vulva is not so great as in ordinary cases, and that it remains dry, and appears to be buried more deeply between the ischial tuberosities. Occasionally some difficulty in micturition is observed before parturi- tion, should torsion have occurred : the urine escaping only in small quantity at a time \ or there may be total suppression. This interference with the discharge of the urine is due to the compression the bladder experiences from one of the twists in the uterus. The first labor pains, which soon appear, are usually feeble and separated by a comparatively long interval of quiet, during which the animal appears to be nothing amiss. Nevertheless, as time goes on, symptoms of colic are evinced now and again, and though the labor pains succeed each other more rapidly, and become more energetic, yet birth does not seem to advance; the "water-bag" does not show itself, and nothing appears externally. This condition may persist for six, twelve, twent3'-four, or even forty-eight hours ; when, if not before, the veterinarian is perhaps requested to attend. In other instances, however, the symptoms are more marked and severe during this first period. The animal appears to suffer from the pain of intense uterine and abdominal spasms, marked by violent straining, which comes on at longer or shorter. intervals ; it moves about anxiously ; paws energetically now and again ; attempts to lie down ; rests on its chest or sits like a dog on its hind-quarters ; springs up suddenly, and often with a bound. The pulse is quickened, the skin becomes alternately hot and cold, moist and dry; and the expulsive efforts, though so violent, are of course futile. D YSTOKIA B Y D ISP LA CEMENT. 301 In many instances, after a period varying from twelve to lorty-eight hours, these symptoms may disappear, and the animal seems to have recovered, for the time at least, its ordinary health. To such an extent does this occur, that it might be believed the period of birth had not ar- rived, and that the symptoms were only those of "false pains." In the course of from one to six days, however, this normal quietude is interrupted by the recurrence of the labor pains, and in so urgent a form that there can no longer be any doubt as to real attempts at delivery. But still the efforts are not succeeded by any tangible evidence that birth is making progress. As some obstacle to the expulsion of the foetus now evidently intervenes, a manual examination will probably be made by the veterinarian, if he has chanced to be called in, and after he has heard the history of the case and noted the general symptoms. The oiled hand, on being introduced into the vagina, meets at first with no obstacle in that canal ; but on advancing into it, the fingers soon en- counter one or more folds or rugae, which render the passage more and more constricted towards the cervix uteri. Towards the termination of the vagina, the fingers reach a kind of cul-de-sac, formed by the mucous folds, and which at this part converge in a spiral manner, their direction being either to the right or left. Although at first there appears to be no passage, yet it will be found that by turning the hand in the same spiral direction as the cavity winds, or rather the rugae incline, the fingers will be able to penetrate to a certain depth ; and if one of the most prom- inent ridges be followed in this way, it will be discovered that it has a cork-screw-like course. This is the pathognomonic or distinctive symptom of torsion of the uterus, and it is not found in simple deviation or obliquity of the organ. In the latter condition there is no spiral twisting or rugae, but merely a fold of mucous membrane passing from behind forward, in an oblique manner ; while the hand can be passed with little difficulty to the cervix, the OS of which is usually found dilated. It is only this fold of membrane, in uterine deviation, which prevents the passage of the foetus through the OS, by hindering uniform pressure on the cervix. The kind of spiral infundibulum into which the hand penetrates in torsion of the uterus, varies in dimensions according to the amount of torsion. In the quarter-turn or revolution, it may be possible to get the hand into the constriction, though with difiiculty, and to reach so far as ^to touch the neck of the uterus, which may be more or less dilated, and How the position of the foetus to be ascertained. In accomplishing this lanoeuvre, the fingers can feel a large salient spiral ring which becomes rider as the hand enters deeper into the organ, and which terminates in le cavity of the latter in a wide membranous, fan-like manner. If the torsion is to the left, this ring inclines to the right, and the membranous Jxpansion in the uterus is directed obliquely from right to left towards Hhe fundus of the organ. The spiral twist is in the direction of the tor- iion, and the uterus is carried towards the left flank. In torsion to the ight, the arrangement is the reverse of this. In the half-turn or revolution, occlusion is so marked that the fingers in scarcely be. made to enter the obstacle, and the cervix cannot be Reached unless the torsion is beyond it. There are always two prominent rings — two mucous folds which cross each other, but which, as they recede Erom the torsion, become wider apart and spread like a fan. We shall investigate the character of this twist hereafter. 302 MATERNAL DYSTOKIA. In the complete turn, the occlusion is such that only one finger can penetrate to a very slight depth in the spiral stricture, and the direction of the rugse is very baffling, as they seem to intersect each other, and to run in opposite directions. In some instances, when the mucous membrane of the vagina is in- volved, the spiral ridge may be distinguished in the roof of that canal, and even near to its commencement. When the hand can be introduced into the uterus, it is generally found that the foetal membranes, as well as the foetus, are intact, and particularly in the half and complete degrees of torsion. In the quarter revolution, the membranes are sometimes ruptured and the waters discharged for a considerable period. The foetus is usually alive soon after the first labor pains ; but it quickly perishes, and its death is almost certain to have taken place within forty-eight hours after parturition has commenced. The period of its decease, however, will greatly depend on the intensity of the " pains." The position of the foetus varies, according to circumstances. Some- times when the twist is slight and the passage sufficiently large, it partly enters the pelvis, where it may not only be felt, but seized by the parts first presenting. At other times it is entirely lodged in the abdomen ; and at others, again, it may be felt towards the pubis, in a kind of pouch or sub-vaginal tumor, formed by a duplicature of the uterus beneath the inner opening of the os. In the latter case, torsion is complicated with obliquity of the organ, and the tumor not unfrequently considerably ele- vates the bladder and meatus urinarius. The form of the abdomen is sometimes characteristic. The foetus can generally.be found higher in it, towards the flank, on the right or left side. This change in the position of the foetus may also be recognized by ex- ploration /^r rectum, which may also possibly allow the torsion of the uterus to be distinguished, as well as its direction. The uterus can be felt through the wall of the rectum as a tense hard mass, while the broad ligaments may be discovered as hard funicular bands. It may be noted, also, that occasionally the rectum itself is displaced and drawn towards the entangled uterus. If the animal is not relieved, the symptoms above indicated persist with variable intensity, according to circumstances. The straining and at- tempts at spontaneous delivery continue either feebly, and with long intervals between, or they are violent and almost incessant. The animal soon ceases to eat and ruminate ; it becomes dull and dispirited ; fever sets in, and the pulse and respiration are hurried ; rigors and grinding of the teeth are remarked from time to time ; the lacteal secretion which had commenced is now suspended ; the mammae become soft and small ; the eyes sink in their orbit ; and extreme prostration ensues. The creature, unable to get up, constantly lies ; the pulse becomes imperceptible, while the heart's beats are loud and tumultuous ; and death generally occurs from the third to the tenth day after the earliest symptoms were ex- hibited. Many authorities are of opinion that death is the only result that can be looked for when assistance is not rendered, and the animal is accord- ingly left to its fate ; and, contrary to what Rainard has stated, they do not admit that the foetus may become mummified in the uterus and the Cow live and thrive. But we have the evidence of the old French au- thority, BoutroUe, as well as that of Ercolani, Lessona, Rocco, Gurlt, DYSTOKIA BY DISPLACEMENT. 303 Liautard, Pouchy (already quoted), and others, that this happy termina- tion is quite possible ; and indisputable cases are recorded of Cows with unreduced uterine torsions, which have perfectly recovered and fattened, and in the uterus of which, after slaughter, the dessicated or mummified foetus has been found. But yet these must be looked upon as exceptional cases ; and while they only prove that spontaneous recovery is possible, it must be admitted that, in the great majority of instances, death is not long in appearing in torsion of the uterus, if the organ is not restored to its normal position. Diagnosis. The diagnosis of this accident, and the direction and extent of the torsion, are of great importance in an obstetrical point of view. We will therefore consider (i) The presence of torsion ; (2) The direction of the torsion; and (3) The degree of torsion. » I. The Presence of Torsion. — To recognize the existence of torsion of the uterus is not attended with much difficulty ; and in describing the symptoms we have, to a certain extent, shown the manner in which the accident manifests itself to the obstetrist. It has been stated, that when the hand is introduced into the vagina of an animal the subject of this displacement, it is soon discovered that there is something in the way, and that this appears to be a narrowing of the passage. Passing on, the constriction seems to be increasing, until at the end of the canal there is only a very small opening into which the fingers may pass w^ith difficulty ; when inserted there, it is found that they cannot be pushed straight forward, but have a tendency to deviate to the right or left, and finally to assume a spiral course. We have also stated that this peculiarity in the constriction is markedly characteristic and distinctive of uterine torsion, and this statement holds good in the large majority of cases ; so that it is scarcely possible to make a mistake. In very exceptional instances, however, the torsion may have occurred in front of the cervix — in the body of the uterus ; and then the cervix may be easily reached, while the os may even be penetrated, without dis- covering any indications of the accident. Such occurrences have been recorded by Stockfieth, Ercolani, and Rueff ; and these excellent authori- ties have also witnessed the torsion limited to the cornu containing the foetus. Here we have neither the constriction of the vagina, nor the spiral involutions of its lining membrane, to guide us to a conclusion, and we must mainly rely on rectal exploration. Fortunately, such cases are all but unknown in practice, and probably in ninet3'-nine per cent, it will be found that the twisting has taken place at the cervix, when we have the infallible distinctive sign — the spiral rugae in the vagina. 2. The Direction of the Torsion. — It has been demonstrated that the uterus may revolve on itself in two different directions, and that in order to make a complete revolution, its upper face may become right lateral, then inferior^ then left lateral, and again superior ; or if it revolves in the oppo- site direction, it will become successively left lateral, inferior, right Literal^ and once more superior. We have casually indicated how the direction of the twist may be dis- covered when it has not made a complete revolution. But as Sainl-Cyr 304 MATERNAL DYSTOKIA. remarks, the manner of discovering to which side the gravid uterus has inclined, has been one of the most debatable in the history of this accident, and has occasioned much controversy and the most contradictory interpre- tations ; up to the present time, in fact, the problem has not met with a satisfactory solution. The confusion prevailing with regard to what appears such a simple matter, is well exemplified in the discussion which took place in i860, at a meeting of the Central Veterinary Medical Society of Paris, at which the most opposite notions were promulgated. And yet next to assuring one's self that torsion does exist, the ascertaining of the direction it follows is of supreme importance, as on this alone depends our being able to rectify the malposition of the organ without delay. The disputation appears to have arisen solely from a confusion of terms — from ne^ecting to define what was meant by torsion from left to right, or right to left ; and Saint-Cyr praiseworthily endeavors, and with success, to settle the question by repairing the omission. "When," he says, "in its revolution the left cornu of the uterus passes above the right cornu, the upper face of the organ becomes successively right lateral, then inferior, then left lateral and again superior — thus con- stituting a complete revolution ; the torsion is then from left to right, or simply right torsion." A B Fig. 70. A, Cord Twisted to the Right ; B, Cord Twisted to the Left. The reverse movement constitutes torsion from right to left, or, better, left torsion. In other words, the passing of the left cornu over the right produces right torsion ; that of the right over the left cornu, left torsion. Hence we have the simple, and easily remembered and understood terms, of right torsion and left torsion, which arc synonymous with torsion from left to right and torsion from right to left. This being decided upon, the next question is how to distinguish, from a purely objective point of view, a right from a left torsion ; and this also, it appears, has been a source of difficulty and debate, from neglecting to define terms. Saint-Cyr again has come to the rescue, and his efforts to put the matter in a clear light must be looked upon as eminently satisfactory. DYSTOKIA BY DISPLACEMENT 305 Glancing at Figure 70, we see two pieces of cord, the strands of which exactly, but more clearly, represent the spiral plicae of the twisted vagina or cervix uteri. It will be observed from the course of the strands, that the pieces are twined in opposite directions : cord A being twined to the right, and cord B to the left. This disposition of the strands of a rope being generally recognized as exact in the technical language of mechanics, as well as in speaking of the spiral inclination of the thread of a screw, the same-application of the terms should hold good in such a mechanical deviation of the uterus as that now under consideration. These different torsions can be imitated by the handkerchief, as has just been pointed out ; and they are well represented in Figures 68 (left Fig. 71. Left Uterine Torsion. . Body of the Uterus ; 2, Cervix Uteri Twisted to the left ; 3, Rectum ; 4, Blad- der ; s, Symphysis. Fig. 72. Right Uterine Torsion. , Body of the Uterus ; 2, 2, 2, Torsion of the Cervix Uteri to the right, involving the Body of the Organ ; 3, Rectum ; 4, Blad- der ; 5, Vagina ; 6, Symphysis. torsion), 71 (left torsion,) 72 (right multiple torsion), and 75 (left tor- sion), which illustrate simple and multiple, as well as right and left tor- sion. This being fully understood, we have now to demonstrate how the different torsions may be distinguished in the living animal, by vaginal exploration. In doing so, we will follow the remarkably lucid directions furnished by Saint-Cyr, to guide obstetrists in forming a diagnosis. Supposing the right hand introduced in a state of pronation (palm down- wards) into the vagina of a Cow supposed to be suffering from uterine torsion, it is evident that, in order to follow the direction of the spiral folds met with, it must execute a kind of rotary or screw-like movement on the 20 3o6 MATERNAL DYSTOKIA, wrist. If this movement is such, that the cubital border of the hand, to the right at first (Fig. 73, position A), becomes inferior (little finger downwards — position B), then internal, so as to arrive at a state of supina- tion (palm upwards — position C), then the torsion is to the right. On the contrary, if the hand, in following the spiral folds in the vaginal canal, rotates in the opposite direction, of course the torsion is to the left. For instance, as in the other case,- the hand is introduced in a state of Right Uterine Torsion: Manipulation. Fig. 74. Left Uterine Torsion; Manipulation. pronation (Fig. 74, position A), but instead of the thumb turning upwards and round to the right, it inclines downward to the left (position B), the little finger ascending until it is uppermost, and the palm of the hand is turned outwards (position C). This is a very simple matter, apparently ; and yet in practice it may be very important. It may be sufficient, then, if we impress upon the young obstetrist the fact, that when the palm of the hand turns to the left, or inwards, the torsion is to the right ; and when it inclines outwards, or to the right, then the twist is to the left. 3. The Degree of Torsion, — To ascertain the degree of torsion is more difficult than to discover its existence or direction ; though every endeavor \ DYSTOKIA BY DISPLACEMENT. 307 should be made to satisfy one's self in this respect, as the " detorsion " will be easy as the torsion is slight, and vice versd. It has been stated that it may exist as a quarter, half, three-quarter, or a complete revolution ; and that it may even extend to a double, treble, or quadruple twist. But it must be always doubtful whether we can diagnose with certainty these different degrees of torsion which may be met with in obstetrical practice. It is evident, however, that the greater the amount of torsion, so the more will the vagina be constricted, and penetration by the hand ren- dered difficult. We have already, in treating of the symptoms, drawn attention to the condition of the vagina and cervix uteri in the more simple cases. When, for instancy, the hand can be pas§ed without very much trouble as far as the cervix, and the os can be penetrated to such a depth that some parts of the foetus are felt, then it may be presumed that the organ has only made about one-fourth of a revolution on itself. But if the passage is more constricted, the spiral folds closer together, and the cervix can be reached with much difficulty, perhaps only one or two fingers entering the os, we may expect that the uterus has made a half or three-quarter revolution. In a complete rotation of the organ, we may expect to find the vagina completely occluded not far from the vulva, the fingers being only able to pass into the funnel-shaped infundibuluni but a very short distance, and cannot reach the cervix. The spiral folds will also be close and numer- ous, and for this reason their direction will be all the more difficult to ascertain Frognosis. With the Cow, torsion of the uterus must be looked upon as a serious accident ; for except in a few exceptional cases, when assistance is not rendered, the foetus and mother have always perished. Nevertheless, not- withstanding its grave character, modern veterinary science does not consider it beyond remedy ; and its records show that, by judicious inter- vention, mother and offspring may often be saved. But in order to attain this happy result, a careful disignosis must not only be made, and the direction and extent (if possible) of the torsioa clearly ascertained, but the proper mode of restoring the uterus to its 'lormal position must also be observed and skilfully carried out> A cautious opinion must always be given, but its favorableness will of course depend upon the brief duration of the pafturient symptoms, the legree of torsion, the condition of the animal^ and whether it has been iubjected to unskilful manipulation before the veterinarian has beea tiled in. Pathological Anatomy^ When the animal has been subjected to manipulatory manoeuvres to feet delivery, or when it has been permitted to live many hours after signs of parturition have appeared, the first important alteration noted m opening the abdomen is that due to peritonitis. There is a quantity )f blood-tinted serum effused into the peritoneal sac, in which float shreds )f fibrin ; and the lining membrane is reddened, deeply injected with >lood in parts, and particularly those which have been in contact with le uterus ; not unfrequently there . is a fibrinous exudate on its suface, md this may cause adhesion between it and the different orgams. 3o8 MATERNAL DYSTOKIA. On removing the intestines and the floor of the pelvis, the uterus and vagina are exposed, and the torsion is visible. This appears as a large, hard cord, composed apparently of a number of spiral strands of unequal size, the closest twined of which are in the middle of the strangulation ; this cord — formed by the termination of the vagina and the^ cervix and body of the uterus — opens out its strands as it recedes from the densely- twined portion towards the fundus of the uterus on one side, and to the vagina on the other. The broad ligaments are sometimes compressed between the spiral folds, which they concur to form, and with which they are so intimately connected that very often they cannot be recognized until the uterus has Body of the Uterus ; Fig- 75- Left Uterine Torsion ht situ. Twisted cervix uteri; 3, Vagina ; 4, Left Fallopian Ligament. been untwisted. In other instances, they merely envelop the twist in crossing it ; so that the extent of the torsion cannot be seen until the ligaments are detached from the ilium on each side. Rarely, as we have remarked, are these ligaments ruptured ; and though some veterinary authorities have maintained that torsion is impos- sible without one or both being torn, yet we know that this lesion is seldom witnessed. In the large majority of cases, they are tense and greatly stretched, tightly compressing the cervix and rendering occlusion of the OS all the more rigid ; but when the uterus is reinstated in its natural relations, they are found to be intact. If the uterus be seized at its fundus, and turned in a direction con- trary to that of the torsion, the strands of the latter gradually open, widen, and are effaced ; while the strangulation disappears, the cervix comes DYSTOKIA BY DISPLACEMENT. 309 into view, and the vagina assumes its normal length and width, as well as cylindrical form. So that the hand introduced into the vagina, per vulvam, no longer encounters the spiral plicae met with in the animal while alive ; but passes through the canal, and even into the uterus, without hindrance. The number of turns necessary to accomplish this will indicate the amount of torsion which had taken place. Most frequently only half a turn is necessary, showing that the uterus had made half a revolution on its axis — the upper surface having become the lower. Sometimes the quarter of a turn will suffice to adjust it ; while in other instances a com- plete turn, or even two, three, or four turns in the opposite direction to the torsion, may be needed before the obstruction to the genital passages disappears. At times the uterus and vagina exhibit signs of inflimmation, particularly towards the strangulation, and the indications of acute metro-peritonitis are frequently most marked. In exceptional instances we may hav^e gan- grene of the uterus, probably due to obstruction of the blood-vessels im- plicated in the torsion. As a complication, a more or less extensive rupture, complete or incom- plete, of the uterus may exist : possibly having been produced by the severe uterine contractions during the life of the animal. This rupture implicating the walls of the organ, is most frequently met with in its body, in the vicinity of the twisted portion, or at the junction of the gravid cornu with the uterus. The foetus has been at times found partly fixed in the fissure. With regard to the foetus itself, its condition varies with the length of time which has elapsed since it perished, and also whether or not the external air has had access to it. In some instances, even when it has been dead for a long time, it will be found in a state of perfect preserva- tion ; in others it is in an advanced stage of putrefaction, the hair and hoofs coming off readily, and the body swollen and emphysematous, while the odor emitted is disgustingly powerful and foetid. In rare cases the foetus is mummified, and this may even occur when it has attained its full development. Such is an outline of the pathological anatomy of this accident. Nume- rous illustrations of the various lesions met with after death might be furnished, but we will content ourselves by quoting two or three of the very few cases recorded in England, in addition to that published by Carlisle and already referred to. In Carlisle's case the following lesions were noted : On opening the abdominal cavity to its full extent along the linea alba, the pelvic region was found to be " completely crammed with the small intestines in a far advanced state of putrefaction ; as far as the anterior ridge (brim) of the pelvis at this place, the portion of intestine was completely strangulated. Anterior to this the bowels were free from inflammation, and the only abnormal appearance was the mesentery which attaches the small intes- tines to the spine, which was torn from the spine for a considerable length. The bladder was free from inflammation, and void of urine." On examination of the uterus, there was discovered an extensive rupture of the broad ligaments, near to the cervix uteri. " For about four inches there was a high degree of inflammation, clearly pointing out thepl^ce where it had been twisted. The other parts of the uterus were healthy. The vagina appeared inflamed throughout its whole length ; " this condition 3IO MATERNAL DYSTOKIA. v/as supposed to be due to the frequent and long-continued attempts to in- troduce the hand to extract the calf. The cause of all these lesions was " the Cow tumbling into a ditch, and remaining there for some time struggling very much." " The calf and uterus were turned or twisted in consequence of the lateral ligaments giving way, which would take place during the fall, as the poor animal completely turned over before she fell to the ground. The mesentery might possibly be torn at the same time, and the intestines forced into the pelvic cavity. That part of the gut which rested on the brim of the pelvis was strangulated, from the weight of the calf resting on it ; and the other portion, which was forced back, was continually under the influence of excessive pressure, from the poor creature's attempt to rid herself from pain." Mr. Bennett ( Veterinarian, vol. xlv., p. 925), called to see a Cow which had been suffer- ing from aphthous fever, but which on recovery began to exhibit symptoms of abdom- inal pain, found on examination that it was near the period of parturition : the pains, indicated by the symptoms, being somewhat allied to those of labor, but were unac- companied by any dilatation of the os uteri. The pulse was quick and tremulous, the breathing rapid, and the surface of the body bedewed with perspiration ; the faeces and urine were voided during the painful expulsory efforts. Supposing the foetus to be dead, and that in due course the os uteri would be dilated, diffusible stimulants were adminis- tered with the view of sustaining the animal's strength and assisting in the expulsion of the calf. Subsequently, on the same day, the pulse was rather more distinct ; though the eyes were more sunken and the general indications of suffering more marked. On the following morning it was much worse, being almost pulseless and evidently dying, and no signs of delivery. The Cow died soon after. On making -a post-mortem examination, the uterus was found to be much congested, its vessels being turgid with. blood, and its walls very much thickened. But what, in Mr. Bennett's eyes, was a very singular thing, was the presence of a " complete twist in the neck of the uterus ; so that the uterus must, calf and all, hav'e turned quite over in the abdomen." Whether this state of things arose from the Cow rolling or from any other cause, Mr. Bennett could not say ; though, from the appearance of the uterus, he imag- ined the accident might have occurred forty-eight hours. He adds that, " No doubt the strangulation would lead very quickly to the complete congestion of the vessels of the womb and to the speedy death of the calf." At a meeting of the Liverpool Veterinary Medical Association, held in 1875, M""* Woods described a case of " twisted uterus " in a Cow, the organ containing a fully de- veloped foetus, and the os having become hermetically sealed. The animal had been ill for some time ; but it gradually recovered, and was fed for the butcher. When killed the foetus was discovered to be quite perfect, but the membranes had disappeared through absorption. Captain Russell, M.R.C.V.S. {Veterinary Journal, November, 1876), relates that he was called to see a heifer described as " straining a good deal," and had been doing so for sixteen hours, as if attempting to calve ; but that " nothing was visible, nor was her time up for another month or six weeks." The Cow was lying, and evidently in great pain; it was straining violently ; the eyes were sunken; the pulse was very frequent, feeble, and almost fluttering ; with other symptoms denoting great exhaustion, and ap- parently speedy dissolution. On making an examination /('r vaginam in the usual man- ner, to ascertain if it was merely a case of mal-presentation of the foetus, the hand could only be introduced about six inches, the walls of the canal feeling as if coiled from left to right ; the mucous membrane seemed to be much congested, and felt " corded," hot and swollen. Twisted uterus was diagnosed, and reduction was attempted by turning the animal from right to left, but without any benefit. The symptoms being so urgent, and as the Heifer was in good condition, it was im- mediately destroyed. On opening the abdomen, the entire body of the uterus was dis- covered to have made a rotation from left to right, the upper having become the under surface. The torsion itself was much congested and strangulated, and the pelvic cavity between the walls of the vagina and rectum, and between the former and the floor of the pelvis, was full of effused serum of a jelly-like consistence — evidently the result of long- continued strmining. The foetus was well developed, and had apparently been dead for some hours, decomposition having set in. How or when the uterus became displaced in this instance, could not be discovered, DYSTOKIA BY DISPLACEMENT. 31, as the animal had been tiimed out to pasture with several others, and nothing had been observed amiss with it until the previous day Then it was observed to lie down and get up frequently, and to stand with the back raised and the tail elevated ; straining Very much in that attitude. Treatment. The successful treatment of torsion of the uterus had, to the great majority — indeed, to all — of the veterinary obstetrists of not long ago, evidently appeared hopeless ; consequently, the animal suffering from this accident was either left to die without succor, or was consigned to the butcher if its carcase could be utilized for food. In some few in- stances, as we have seen, the animal has not succumbed, but recovered from the effects of the torsion, and without reposition of the organ having been effected. After fruitless efforts, the labor pains have subsided, the foetus dies and becomes mummified ; the Cow is in an ailing condition, perhaps, for some time, but rallies, and may even regain its former con- dition, not unfrequently even yielding a certain quantity of milk. In other cases the Cow becomes emaciated and miserable looking, gives no milk, and generally succumbs, after a variable period, to chronic peritonitis. But in far more instances serious illness ensues at the very commencement, and we have metritis and peritonitis, gangrene of the uterus, putrefaction of the foetus, septikaemia, paraplegia, or other grave conditions which quickly terminate life. In British vetennary literature only two successful attempts have been recorded, and these by Mr. Cartwright, of Whitchurch, one being so late asa875. On the Continent, although many cures have been published, yet they only date from a comparatively recent day. Nevertheless, according to Rainard {Traite Coniplet de la Farturitioji., vol. i., p. 420), Vieillard long ago (1823) succeeded in one instance in saving a Cow and calf, through hav- ing recourse to vaginal hysterotomy. In this case there was inversion of the uterus, the cervix of which was extruded beyond the vagina, and fShowed three markedly-salient spiral rings. He experienced much diflfi- [culty in making convenient openings ; the extensive incisions he was compelled to make, in order to remove the foetus, became lacerations, and there was serious haemorrhage. Yet the animal made a good recov- ery. This formidable operation has not found an imitator, and does not require one : except perhaps in a similar case, and in which there is , aversion of the vagina, so that the parts to be incised are visible. The principal — indeed, the sole — indication for the relief of this accident [is to untwist the uterus ; in doing this the cervix and os are restored to Itheir normal condition, and the vagina rendered patent, while the uterus itself assumes its ordinary relations. Various methods — all of which have been attended with more or less juccess in practice — have been devised to accomplish this object. They are (i) Abdominal taxis; (2) Vaginal hysteroto7ny ; (3) Vaginal taxis ; (4) Denoc's procedure; (5) Darreau's procedure ; (6) Rotation of the yCoTv's body ; and (7) Gastro-hysterotomy, or Ccesarean section. I. Abdominal Taxis. — The idea of opening the abdomen, and thrust- ping the hands and arms into its cavity, in order to search for the twisted iterus, then to untwist it directly by turnmg it on its axis in a contrary ^direction to the torsion, in order to deliver the animal by th6 natural pas- >ages, is at first sight an eminently rational and practical procedure, and 312 MATERNAL DYSTOKIA. one which, occurring independently to several minds, has been resorted to by a number of veterinary obstetrists. But, however simple and feasible it may appear, yet it is very far from being an easy or always successful method, and this for several reasons. Among these may be cited the great weight of the gravid uterus — from 112 to 180 pounds — its immense size, its convex, smooth, and slippery surface ; the limited space there is in the abdominal cavity for manipulation ; and the obstacles the other viscera offer to version manoeuvres. " Nothing," says Mazure, after repeatedly trying this method, " appears more simple to the mind than to seize with the hand one of the sides of the uterus, and to swing it round, and especially as it is restoring the organ to its natural position. Yet no one whom I know is competent to perform this simple movement." " My confrere and I tried to swing round the uterus," writes Gosselin, " but it was in vain ; all our efforts could not even cause it to change its place." Bouley attempted this method in 1853, but did not succeed. After fail- ing in other manoeuvres to effect the detorsion of the uterus, in despair he made a large incision in the right flank, in order to try if he could not, by direct taxis on the organ itself, restore it to its ordinary condition. But he was disappointed : for the uterus, enormously distended, so com- pletely filled the abdominal cavity that the hand could scarcely be intro- duced between it and the walls of the abdomen ; while the surface of the uterus was so smooth that the operator's fingers could not cling to it. Notwithstanding, this operation — which, from having been performed in the region of the flank, has received the designation of " laparotomy " (from ka-dpa^Jlank or loins^ and rijjysiv^ to ait) — has been practised with variable success in Germany by Fausel (1849),* Epple (1852), Kohler (1853), Diccas (1867), Lechleuthner (1868), Obich (1869), Heichlinger (1869), etc. ; in France by Darreau, Garreau, and others ; in Italy by Santoni and Rocco ; and in Denmark by Stockfleth. We have said that the success attending laparotomy has been variable. This is exemplified in Obich's experience ( Wochenschrift fiir Thierheil- kunde, 1869). This veterinarian had three cases of uterine torsion, in which he resorted to this operation to replace the organ. Two of the cases were attended with complete success ; but in the third the uterus was of such an extraordinary size and weight, that he failed to restore it to its natural position. He proposed in future to facilitate the operation by using a looped cord with which to raise the organ, Heichlinger operated successfully on a Cow in the same manner, but the animal afterwards perished through gangrene of the uterus. It must be admitted that the operation has not been performed suffi- ciently often, and then sometimes in very unfavorable circumstances, to enable us to draw any satisfactory conclusions as to its value. Darreau, who has been fortunate in some of his attempts, writes : " Direct taxis by * It is worthy of note that the idea of resorting to laparotomy occurred to an excellent veterinary practi- tioner in Scotland, perhaps long before it did to Fause!, though for lack of opportunity it was not carried into effect. Mr. Cartwright, of Whitchurch, writing, m 1850, "On Torsion of the IJterus in the Cow" {Veterinarian, vol. xxiii., p. 248), and its treatment, and proposing to try rolling the animal, adds : " If I did not succeed in this way, I should proceed according to a suggestion given me by Mr. John Steel, of Biggar, Lanarkshire— viz., to make an incision between the ilium and the ribs on the right side, and try to untwist it (the uterus). If I succeeded, I should sew up the wound and allow the labor to take its natural course ; but if not, I am not aware that there is any other means but that of performing the Cjesarean operation. Mr. Sfeel, althou2:h he has not yet had an opportunity of testing its practicability, deserves the thanks of the profession for such a suggestion, and it is one which I think very likely to succeed. At any rate, if it does not, we can but perform the Cjesarean operation." DYSTOKIA BY DISPLACEMENT. 313 an opening made in the flank has had some advantages ; I have even thought for a moment after my first success that it would be the only means I should resort to for the future. But, unfortunately, new cases upset my predictions, and compelled me to seek for more efficacious means." And Faussel admits that the considerable weight of the uterus may sometimes prove an insurmountable obstacle. The dangers attending the operation, even if reposition of the uterus is effected, are as great as its difficulties. Several good authorities have • therefore recommended its abandonment, or at least its being adopted only in very exceptional circumstances. Operation. — Different operators have different modes of operating. Some prefer the animal in a standing position ; others throw it down. One selects the left flank ; another, and perhaps with more reason, in- cises the right flank. Diccas, whose procedure appears to be preferred by Saint-Cyr, operates as follows : The animal is led into a suitable place, and secured as if to be operated upon for internal hernia. The skin and muscles of the right flank are carefully divided for about five or six inches, the opening being directed downward and slightly forward. The cord fixing the hind quarters of the animal (which is standing) is slack- ened a little, and the hand is introduced into the abdominal cavity and pushed towards the left side, passing it above the uterus if the torsion is from right to left ; but towards the right side and below the uterus if the twist is in the opposite direction. The displaced organ is then seized, and endeavors made to bring it into its normal position by lifting and drawing it towards the incision. To prevent the hand slipping on the surface of the uterus, it is wrapped round with a piece of thin cloth. Two assistants are required, one of whom exercises a certain amount of pres- sure on the abdominal w^alls ; while the other finds out, by vaginal palpa- tion, the extent of replacement which the uterus undergoes. When reposition is complete, the hand is withdrawn from the abdomi- nal cavity, and the lips of the wound are brought together by four or five tape or wire sutures, aftd, if thought necessary, a pitch plaster may be fixed over it. According to Obich, within eight days the wound will have healed by first intention. 2. Vaginal Hysterotomy. — We have noticed that Vieillard, so long ago as 1823, removed the foetus from a twisted uterus by means of vagi- nal section. In 1856 Ercolani proposed vaginal hysterotomy, ih^o^^xixw^ being made through the upper wall of the vagina, for the reposition of the twisted uterus. The operation is of the same kind, and is conducted in a similar manner, as that for the castration of Cows, introduced by Charlier ; except that, instead of the ov^aries being seized, the uterus is grasped through the wound, and attempts made to untwist it. Rueff speaks in favor of the proceeding ; but we cannot find that it has ever been carried into practice, and serious doubts may be entertained as to the likelihood of its being successful, from the weight and size of the gravid uterus, and only one hand being employed to turn the displaced mass, unless the displacement should be very trifling ; in which case a simpler operation might succeed. * If attempted, not much risk may be apprehended from incising the vagina, as it has generally been found to be attended with little danger, and cicatrization soon takes place. 314 MATERNAL DYSTOKIA, 3. Vaginal Taxis. — All sanguinary and serious operations for the cure of uterine torsion^like the two preceding — should be avoided, if possi- ble, until the simpler means which modern veterinary science has indi- cated are tried. We allude more particularly to version, which rarely fails to bring the case to a satisfactory termination. That is, of course, on the assumption that this is resorted to sufficiently early ; for it must be remembered that nothing is gained by delay in this accident, and if relief is to be afforded it must be rendered promptly, and as soon as the existence of displacement is fairly established. When delay has been allowed to take place, more or less serious consequences must ensue to either the foetus or the maternal organs, or to both. In certain cases of very incomplete torsion — quarter rotation of the uterus, for instance — and when there is sufficient space in the vagina for the hand to pass through the obstacle and into the os or uterus, detorsion has been accomplished by seizing the most suitable parts of the foetus and exercising direct traction on it. Instances of success by adopting this course have been furnished by Chambon, Cann, Gaven, Darreau, and others. The mode of procedure may be as follows : — After ascertaining the direction of the torsion, the arm is to be introduced into the uterus as deeply as possible ; if the foetal membranes are yet intact, they must be largely ruptured, and the most convenient parts of the foetus sought for. In this respect it will be found that every part of the young animal does not offer the same advantages to the operator, for reposition of the uterus. The head is too large and does not afford sufficient hold for the hand ; the pasterns and knees are too much removed from the body and too round ; but the hocks and elbows are, of all parts perhaps, -those best adapted for this kind of manipulation. If one of them can be reached, it should be firmly grasped, and endeavors made by it to raise the body of the foetus, at the same time giving it a turning movement contrary to that which we would give the uterus in order to untwist it. Supposing, for example, that the torsion is to the right, and that the foetus, offering an anterior presentation, is, from the fact of the quarter revolution of the organ, in the right vertebro-ilial position ; then the object must be to place it in the vertebrosacral position. To effect this, the right hand, in a state of supination (knuckles down- wards, palm upwards), must be introduced be?ieath the foetus, and, if pos- sible, the left fore limb seized by the elbow ; then the operator, turning his arm round, raises the body of the creature, at the same time turning so that the withers describe the arc of a circle from right to left — from the right flank of the Cow towards the sacrum. Sometimes when the foetus is alive, at the moment this manoeuvre is being executed it makes a movement which greatly assists the efforts of the operator. If the dimensions of the vagina admit of it, the limbs of the foetus may be drawn into the pelvis, and even as far as the vulva ; and while the operator is acting as described on the upper part of one of the legs, an assistant presses on the free portion, and by thus aiding in the version considerably facilitates the task. By this procedure several ob^tetrists have been successful in re-adjust- ing the uterus, through the medium of the foetus ; the adjustment being ascertained by the disappearance of the spiral mucous folds from the vagina and the patency of the canal. DYSTOKIA BY DISPLACEMENT. 315 Nevertheless, it has been remarked that this operation is not so easy as one would be inclined to imagine it without testing it in practice. It requires much force to raise and turn the foetus in this way ; and the con- stricted and powerful uterine contractions are formidable obstacles to the exercise of that force. Some Veterinarians, as Meyer and Losner, have succeeded in adjust- ing a slightly twisted uterus by introducing the hands into the vagina, and aided by assistants, who manipulated either with their hands or by means of boards or sheets applied externally to the abdomen, so as to set the organ straight. Of course, such attempts must be greatly pro- moted if the foetus can be reached and used as an instrument in the manner just alluded to. 4. Denoc's Procedure. — Denoc appears to have been the first veteri- narian who attempted reduction of this torsion by the simple means stated above, but applied in such a manner as to merit the designation of " original." His procedure marked a great step in advance, so far as veterinary obstetrics are concerned. In 1845 he describes the case of a Cow {Reciieil de Med.- Veterinaire, 1845, p. 69) unable to calve, but whose os uteri was sufficiently dilated to allow him to pass his hand into the uterus, where the foetus lay in a good position, but from which it could not be expelled, owing to a wide membranous fold extending from the cervix to the fundus of the organ. His manner of getting rid of the torsion consisted in suspending the animal by a very narrow sack passed under its chest ; and two pulleys having been fixed in the wall on the right side — one corresponding to the fore limbs, the other to the hind ones — the fore legs were tied by a cord which passed through the corresponding pulley, while the hind ones were also secured by another cord running through the posterior pulley. Five men were posted to the distal end of each of these cords, and di- rected to pull. When this was done, the suspended Cow was swung into a dorsal position. Then two strong men, placed on the left side, were directed to push the animal's body to the right — a movement which caused it suddenly to rotate. An exploration with the hand led to the discovery that the uterus had changed its place, but that there was either a double torsion, or the in- version of the animal had only incompletely turned the uterus, as the duplicature was still present at the cervix. Another pull was given at the cords, and the previous manoeuvre re- peated, and this time with a good effect, as. it was found that the ob- structing fold had now vanished, and the uterus was in its ordinary posi- tion. The Cow was then left alone, to await the result of its own expulsive efforts ; but nothing having transpired after about an hour, a dose of ergot of rye was administered. Another hour had not elapsed until parturition was accomplished without the slightest difficulty, two calves being born. 5. Darreau's Procedure. — Denoc's method does not appear to have been much practised, either because it was lost sight of, or was only adapted for cases of very slight torsion ; and in view of the great diffi- culty generally experienced in vaginal taxis — which is, after all, the most reasonable, least dangerous, and perhaps the most convenient of all 3i6 MATERNAL DYSTOKIA. methods — several devices have been brought forward to render it more easy and effective. Of these none deserves more notice than that of Darreau, and which was brought before the Central Veterinary Medical Society of Paris in 1852. The improvement in vaginal taxis for this accident, mainly consists in the employment of what has been designated a " uterine retroversor " {iiterm retroverseur), an appliance which would appear to be very ingenious, if complicated. And, besides, it is only of service in those cases in which the hand can be introduced in the uterus and the feet of the foetus seized — a state of affairs, unfortunately, not always — nor indeed very often — present in torsion of this viscus. Liau- tard and some others, however, while admitting that the apparatus is not very easily applied, yet testify to its utility. The apparatus is composed of three rods (A, A', A" ; Fig. 76) ; of a ^^ M Fig. 76. Darreau's Retroversor. winch (B) ; of a screw, with a movable screw-nut (D), pierced by three holes ; and, finally, three cords (E, E', E") with a loop (F). The end of each rod (G), a little thickened, has a longitudinal hole (H) ; the other extremity (I) has a hole punched through it, and a shoulder (K). This end of the three rods is inserted into the three holes of the winch. The apparatus is put together for use in the following manner : — The cords are fastened by their loop (F) to the two pasterns and the lower jaw of the foetus, and serve as points of attachment as well as conduc- tors to the rods. With this object the obstetrist passes them, one by one, through the hole (H) in each rod ; then, by one hand, he seizes the extremity (I), and with the second hand the other end (G) ; directing the latter towards the part of the foetus to be pulled at, an assistant who keeps the cord tense passes this through the hole (I). This done, each D YSTOKIA B Y D ISP LA CEMENT. 317 rod is inserted in one of the openings of the winch, the screw (C) is pushed through the middle hole, and the cords are passed through the holes in the nut (D) of the screw (C), by means of which they are made as tight as may be necessary. The apparatus may be used either while the Cow is standing or lying on its back. By turning the handle of the winch in a contrary direction to the torsion, counter-torsion is at once effected without difficulty, and without causing the animal any fatigue. If the resistance is at all great, the operator entrusts the instrument to the assistant, passes his hand into the uterus, presses on the head of the calf, and in this way aids the ac- tion of the retroversor. Parturition then takes place naturally. 6. Rotation of the Cow's Body. — The methods of Denoc and Dar- reau are likely to be useful only in cases in which the uterus is slightly twisted ; and in these instances, and others in which the torsion is much greater, the method about to be considered is so simple, attended with so little danger, and hitherto has yielded such favorable results, that it is certainly to be preferred, unless vaginal taxis can be resorted to with every chance of speedy success. This method consists in rolling the ani- mal affected with uterine torsion, in such a manner that the twist which forms an obstacle to parturition is effaced, and the genital passages are open for the passage of the foetus. This method has been in vogue for a long time, and its introduction is due, according to Dieterichs, of the Berlin Veterinary School, to Fricke, a Hanoverian veterinary surgeon. At least this would appear to be the fact from what Dieterichs has stated with regard to Denoc's procedure in 1845 {R^cueil de Med. Veferinaire), when he says that not only had Schmidt, Vix, Irminger, and Schenker, — all German veterinarians — men- tioned the occurrence of torsion of the uterus ; but that Fricke, in addi- tion, cured a Cow of the accident by tying its feet, two and two, then rolling it, taking care to move it in a contrary direction to that in which the torsion had been produced. German, French, Belgian, and Italian veterinary obstetrists have prac- tised this method of reduction in a very large number of instances, and altogether with most gratifying results. Mr. Cartwright, in England, has been successful in two cases. As with Denoc's rotation method, this is a version of the uterus, and not of the foetus. The manner of rolling the animal varies somewhat with different au- thorities, but in principle all are agreed. The first step, after ascertaining the existence and the direction of the displacement, is to empty the udder of its milk as completely as possible, so as to prevent the gland being in- jured during the operation. While this is being done, a sufficiently roomy place should be got ready, and the floor covered with a thick layer of straw ; on this the Cow is thrown on the proper side, and with all possible care, the feet being fas- tened together. The hand and arm are then to be introduced as far into the vagina as its condition will permit. Should the os be accessible, and dilated, some part of the foetus must be secured, and more especially a limb; this must be firmly maintained in one position. If the foetus can- not be reached, then nothing remains but to make the wall of the vagina the point of resistance until a better can be made available. The assistants are then to pull at the ropes which secure the feet, so as to bring the Cow on its back ; then gently, and without jerking, allow it 3i8 > MATERNAL DYSTOKTA. to fall on the opposite side. This being done, the animal is raised on its chest, by the shoulder and quarter, and turned over on thQ side on which it was thrown. In this way it will have made a complete rotation. While the assistants are rolling the Cow, the operator, with his hand in the vagina or uterus, as the case may be, endeavors, by pressing in the opposite direction, to keep the organ fixed and to prevent its following the movement the body is undergoing. If the operation is well conducted, and the body of the Cow moved in the proper direction, the obstetrist will find, as rotation is carried on, that the genital passage is becoming wider and the obstacle disappearing, until, the spiral rings having become effaced, the hand can reach the cer- vix and penetrate the uterus if the os is relaxed. Generally a gush of the liquor amnii from the organ announces the termination of the operation. If, however, the hand is more strongly compressed by the spiral folds as the animal is turned on its axis, and the vaginal canal is diminishing in length, it is a proof that rotation is effected in the wrong direction. This is remedied, of course, by reversing the movement. Sometimes it is sufficient to make the animal execute a complete turn to bring the uterus into its usual position. More frequently, however, this rotation only relaxes the constriction and does not entirely efface the rings ; so that it is necessary to continue the turning — always in the same direction — until the desired result has been obtained. Then par- turition can be completed in the ordinary way. It will be seen from this description that the method consists simply in rolling the Cow as one would roll a barrel ; and the only point now to be discussed, is the direction in which it should be rolled. This point, strange to say, has given rise to as warm and as unsatisfac- tory discussions as some of the other points to which reference has al- ready been made. Some authorities have declared that, to achieve the reduction of the torsion, the Cow must be rolled in the same direction as it ; others assert thit the rolling should be contrary to the torsion ; while others, again, pretend that both procedures are correct, according as in one the uterus is maintained fixed, while in the other it remains free in the abdominal cavity. The confusion imported into the discussion was probably largely due to the manner in which each disputant looked at the question — or, rather,: to the position in which he mentally placed himself during the supposed; operation. For instance, one may have fancied an animal in a standing] attitude placed before him ; another, with a Cow lying on its back ; an- other stood in front of the beast ; another imagined he was behind it ; and; another stood at its right side, while a seventh viewed it from the left. Consequently, each discussed the torsion, and the mode of remedying it^ by rolling, from his own particular point of view j so that the terms they' employed in the discussion could not fail to be contradictory. Fortunately, in practice no great harm could result ; as in whatever* direction the torsion may have existed, and however baffling the spiral] curving of the vaginal rugae may have appeared in bad cases, the grand? test and guide was the effect produced by rolling. If, when the Cow was turned to the right, the vagina became shorter and more firmly constricted, then it was evident that the animal was being rolled in the wrong direc-; tion, and rolling to the left was indicated, when the constriction would be^ diminished and the vagina lengthened. The procedure might be empiri- cal ; nevertheless it was invaluable. DYSTOKIA BY DISPLACEMENT. 319 But there can be no reason why the remedy should be empirical, or why the confusion in terms which has, unfortunately, existed should be allowed to hinder the progress of science, and even throw obscurity on the practice of such an important operation in obstetrical surgery. Saint-Cyr had already explained as succinctly and clearly as possible the exact meaning to be attached to the terms "right torsion" and " left torsion ; " and he has set himself as diligently to demonstrate what should be understood by " rolling an animal to the right," and " rolling it to the left." He supposes an animal laid on its right side ; if it is desired to turn it on its left side, it is evident that this may be accomplished in two different ways : first, by rolling it on its back and allowing it to fall on the left side ; and, second, placing it on its sternum and pushing it over on its left side. In both cases the result is the same : the animal lying at first on the right side, finds itself at last on the left side. And yet it is perfectly obvious that the second movement is exactly the reverse of the first ; while it is not less evident that the creature in both movements has been turned from right to left : for this expression in its real sense simply means that the animal has been moved from its right to its left side. But in order to give to this expression a precise signification, a conven- tional interpretation is necessary. This, Saint-Cyr proposes, should be as follows ; — " It ought to be thoroughly understood that, in the move- ment of rotation impressed on the body of an animal, we should always commence by placing it on its back before bringing it on the side oppo- site to that on which it first lay." In this sense, "to turn or roll a Cow from right to left," means that the animal, " laid at first on its right side, was placed on its back, then on its left side, then on the sternum, and finally on the side from which it commenced — the right." The contrary expression of course means a precisely contrary move- ment : left side, back, right side, sternum, left side. From all this it must be admitted that, in order to effect detorsion of the uterus, the Cow should be rolled in the same direction the uterus followed during torsion ; and it is also clear that the uterus does not participate to the same extent as the body of the animal in the rotatory movement to which the latter has been subjected. Supposing, as Saint-Cyr has done, that the torsion has been recognized as left, and as is depicted in figure 75 (page 308). In such a case the animal would be cast on its left side, and turned suc- cessively on its back, right side, sternum, and left side — it would be rolled^ in fact, from left to right. If one complete rotation does not suffice, then the movement must be continued in the same direction until the hand can freely pass to the cer- vix and into the uterus. The soundness of these views of our estimable colleague is amply verified in the very numerous cases of torsion of the uterus which have been published during the last thirty years on the Continent, and particu- larly in France, of which he gives a few examples. I. Bouley, in a very interesting and complete observation communicated to the Cen- tral Veterinary Medical Society of Paris [Recuetl de Mid. Veterinaire, 1853, p. 469), makes us acquainted with the following features in a case of this description : The obstacle which his hand encountered in the vagina seemed to be a spiral infundi- bulum, the curves of which were directed from right to left and from above downwards — there was, in fact, left torsion. The Cow fell on the right side, and was fixed in this 320 MATERNAL DYSTOKIA. position ; the operator then, keeping the hand firmly fixed in the spiral turns, in order to make certain of his diagnosis, ordered the assistants to roll the animal /r^w right to left, turning it on its back. When this was done, he found his hand strangled, as it were, in the os. He at once ordered them to roll it in the opposite direction : and when the Cow, which was lying on the left side at the commencement of this second rolling, had been returned to her right side by being pivoted on its back, he had it further rolled by placing it on the belly, and then on the left side again. Then he discovered that he had attained his object, for his hand could enter the uterus freely, and a gush of sanguino- lent, but odorless, fluid announced that the communication between the uterus and va- gina was again established. Here the torsion was to the left, and when rotation to the left was at- tempted the twist became increased ; but when it was made from left to right, reduction was easy and complete. 2. Chambon has published a case of demi-torsion of the uterus [Reaieil de Med. Veter- inare, i860). The hand, on being passed into the vagina, reached a multitude of spiral folds of the mucous membrane, the upper of which were directed to the right and the lower to the left. The os could be penetrated with much difficulty, and a careful explo- ration led him to believe that the left cornu was higher than usual and more to the right ; while the right cornu, which contained the foetus, had become inferior. The diagnosis was torsion of the uterus to the right. The animal lay down voluntarily, at first on the left side, then rising with difficulty on its knees and hocks, it fell on the right side. Chambon immediately took advantage of this last position, and introduced his hand once more into the vagina, requesting his assistants to turn the animal over on the belly by raising the shoulders and haunch, and placing it on its left side. In doing this, he felt the constriction caused by the vaginal folds notably increased on his arm. Turning over the animal again to its original position on the right side, he had the limbs tied to- gether with cords, and then rotated the body : placing it on the back, then the left side, belly, and right side. This revolution made the detorsion complete. 3. Heu publishes three cases of torsion [Op. Cit., i860, p. 833), one of which will be sufficient for illustration. This was a Cow suffering from uterine torsion, as evidenced by the numerous duplicatures arising in the vagina, and which converged from left to right, downwards and forwards, radiating towards a common centre — the cervix uteri — where they formed a kind of spiral arrangement. Right torsion was diagnosed. The Cow was raised on the right side, and the limbs being gathered under the body it was turned on the left side by pushing on the withers, then on the right side by rolling on the back. The torsion increased ; so it was necessary to change the manoeuvre, and after a turn and a half in the new direction, the hand was no longer opposed by any ob- stacle, but was at once carried into the uterus, the " waters " escaping in gushes. 4. Liautard [Journal de Med. Vitiyinaire de Lyon, 1861) was called to attend a Cow suffering from torsion during parturition ; but too late, as it died a few minutes after his arrival. Nevertheless, he took advantage of the opportunity to enlighten himself ex- perimentally as to the procedure to be adopted in such cases. The hide having been removed, he made a large incision in each flank, through which he could easily intro- duce his hand to explore the uterus He then assured himself as to the direction of the torsion, and found, by vaginal exploration, numerous folds arranged in two fasciculi, one of which — the right — passed from right to left to form a spiral series running upwards from left to right ; the other fasciculus turned in the opposite direction. He noted, be- sides, and by means of abdominal exploration, that the left horn of the uterus, which contained the foetus, had passed over the right horn, and that the latter, which was empty, occupied the left flank. It was therefore clear that this was an instance of right torsion. The carcase was then rolled from the left side, on which it lay, on its back to the right side. In doing this it was observed that the plies became tighter and closer. It was moved in the contrary direction — from the right side, on the back, left side, and sternum to the right side. At the third turn in this sense the uterus regained its nor- mal position. 5. Chuchu [Recueil de Med. Veieriftaire, 1866, p. 705) publishes ten cases of torsion, one of which has been selected by Saint-Cyr for the purpose of illustration. In this case it is attempted to show the comparative merits of the two procedures. It was a demi-torsion /riw/ right to left — or a left torsion, in fact ; the right cornu, passing above the left, became the left. The Cow was laid on the right side, and rolled over on its back to the left side. But there was no change. It was then rolled in the contrary way ; detorsion was at once effected. DYSTOKIA BY DISPLACEMENT. 321 All the facts collected b}^ Saint-Cyr are unanimous in justifying the ac- ceptance of the precept which he has formulated in the following brief and distinct manner for application in these often-times difficult cases : Torsion I0 the left — lay the animal on the left side. Torsion to the right — lay the animal on the right side. Or the same precept might be formulated in this way : In torsion from right to left, roll the Cow from left to right ; and vice versA. Though this precept appears contradictory to what has been recom- mended above — in order to reduce the torsion, make the body of the animal execute an equal degree of movement, and in the same direction, as that executed by the uterus ; yet the contradiction is only apparent, not real. In fact, in this manoeuvre the movement of rotation does not really commence at the moment when the Cow, lying on its side, is turned on its back; but rather at the time when it is thrown on its side from the standing posture. If it is thrown on the left side for a left torsion, it really falls from right to left — or in the same sense as the uterine twist. Since the publication of these valuable remarks, further confirmation of their exactness has been afforded by various papers published in dif- ferent veterinary periodicals. Of these we will only select two — the most recent and interesting. I. Coquet [Journal de Med. Veterinaire et de Zootechnie, 1876, p. 66) relates that on May 21, 1875, he was sent for to see a Cow which for several days had been endeavoring to calve. On arrival he found the animal, which was eight or nine years old, lying on its left side in a sterno-costal attitude, the head bent on the neck and the muffle resting on the litter. The pulse was small and quick — about 62 per minute — the ears were cold, and the respiration plaintive. The Cow was not making any expulsive efforts; the udder was flaccid, though somewhat voluminous ; the vulva was not si.uollen, and there was no sign of secretion or discharge from it. The animal's condition was moderate. The Cow had been purchased twenty days previously, apparently in good health ; ' eight days afterwards symptoms of approaching parturition t)egan to show themselves. ; On the 1 6th, expulsive efforts began to be made : the animal pawed, lay down and got I up again several times, and appeared to be suffering from colic. In three or four hours i these symptoms subsided, the Cow became quiet, and all seemed well again. During i the following night there was some indication of colic, but less agitation than before, and the next there appeared to be nothing whatever amiss. On the i8th, the animal was dull, pawing, lying down first on one side, then on the other, making expulsive ef- forts at times. The attendants kept looking out for the '" water-bag," but nothing whatever appeared at the vulva. The Cow was still suffering on the 19th ; it remained lying the greater part of the day and refused all food. On the 20th it was in the same condition, making expulsive efforts every now and again. The prostration was great on the 21st, and there were no labor pains ; the appetite was lost, and the moans were constant. On obtaining this information. Coquet proceeded to examine the genital organs. Oil- I ing his right hand, he introduced it into the vagina, where he found numerous spiral folds which converged towards the bottom of the passage, where they gathered so closely that he could pass his fingers no farther forward. In following these folds, his hand, introduced in a state of pronation^ rotated on the wrist ; so that the cubital border which was at first to the right, became inferior, then internal, so as to bring the hand into a state of supination, the elbow looking downwards. He therefore diagnosed torsion of the uterus to the right, the torsion being complete ; for notwithstanding all his efforts his hand could not reach the cervix. The prognosis was unfavorable, because of the long duration of the torsion, as well as its extent. Nevertheless, it was determined to effect reposition of the uterus if pos- sible ; and with that object five or six men were sent for, ropes were procured, and the other articles necessary for such an operation were provided. A.n attempt was first aiade to raise the Cow, but this was unsuccessful, and it remained lying on the left ;ide. In this position-its legs were tied together by means of a rope, and an assistant having 3een placed at its head, the others were told off to roll it on the litter, turning it first on 21 322 MATERNAL DYSTOKIA. its sternum, then on the right side, back, and so on. While this was being done. Coquet, with his hand in the vagina, endeavored to fix the uterus ; and as the rotation move- ment went on, the cervix was reached, then the os was felt to open, and when a com- plete turn had been made, two fingers were introduced. When two rotations of the body had been completed, the obstructing folds had disappeared, and the hand could enter the cavity of the uterus with ease. Then the membranes were ruptured, the fore limbs of the foetus were seized — the calf being in an anterior presentation and vertebro- sacral position. Notwithstanding the dilatation of the os, energetic traction had to be employed, as the Cow made no attempt to assist in parturition ; five men had to pull with all their strength at the cord fastened to the limbs of the foetus before delivery could be effected. A living and well-developed calf was extracted ; but the Cow lay extended on the litter, perfectly exhausted apparently. Immediately after the extraction of the calf a stream of blood issued from the vulva, which necessitated plugging of the vagina by means of cloths steeped in cold w^ater. This arrested the haemorrhage, but the animal continued to lie motionless and perfectly indifferent to everything going on around it. Stimulants were administered, the next day it was able to eat, and soon after it perfectly recovered, regaining condition and suckling the calf. 2. On May 26, 1875, M. Dus, of Mehun [Renieil de Med. Veterinaire, September, 1876), had to attend a young Cow of small size, which had arrived at the termination of its second pregnancy, but was unable to calve, though it had been attempting to do so for about fifteen hours. For some months the animal, although well fed, had been losing condition, and was unwell; it had not quitted the cow-shed since winter, except to go to the watering-place, a short distance away, and access to which was easy. When seen by Dus, it was lying on the sternum, a little inclined to the left. From time to time it made slight expulsive efforts which had no result. The "waters " had not es- caped, and nothing was to be seen at the vulva, which was much dilated and oedema- tous, through the manipulations of an empiric who had been previously called in. The udder was very large, and milk flowed from the teats. The appetite was lost. The Cow was got up, and a vaginal exploration made; when it was immediately dis- covered that there existed at the bottom of the canal a duplicature of the mucous mem- brane, which was directed from left to right and downwards and forwards, leaving be- low an aperture through which the cervix uteri could be reached. The os uteri was dilated, but the hand could only be introduced into the organ with extreme difficulty. When so introduced, however, the feet of the foetus could be felt, but the arm was so severely compressed by the vaginal duplicature that delivery was considered to be utterly impossible. Torsion of the uterus from left to right was diagnosed, and attempts at re- duction were at once made. The animal was laid on the right side by tying its limbs together and pushing it over. The hand was introduced into the uterus to fix it as much as possible by means of the fore limbs of the foetus, which was in a normal position. The assistants present were then told to raise the Cow's limbs, so as to turn it on its back and to the left side. After this half-turn of the body, it was found that the arm was not so compressed ; and on continuing the movement of rotation on the sternum and right side again, the animal's body having now made a complete revolution, the uterus was discovered to be completely untwisted, and the " water-bag " immediately passed through the os without rupturing. The Cow's limbs were then unfastened and it was led to its stable, where delivery was effected in a natural manner ; though not without assistance, the animal being so prostrated from the previous ineffectual efforts. In a few days recovery was complete, and Cow and calf subsequently did well. There is not much to add with regard to this " rotation " treatment of torsion. We have recommended that if the animal can be moved from its stall, and time permit, it should be thrown down on litter in a roomy place ; all the limbs may be tied together at once ; or first the two fore and then the two hind legs, these being fastened together afterwards, but not allowed to cross. For an ordinary-sized Cow five assistants are nec- essary ; one of these is to be placed at the animal's head to hold it, and make it follow the movements of the body ; the second should keep the limbs as close to the belly as possible, when the Cow is rolled over on them. It is very important during the operation that the hocks be kept flexed as much as possible, in order to prevent the udder being damaged, and also to avoid muscular injuries to the upper part of the hind limbs. DYSTOKIA BY DISPLACEMENT 323 The other three assistants should lift and roll the Cow, and aid the second in pulling at the hind legs when the animal is being placed on its back. We have already described how, and explained why, rotation should be made either in one direction or the other. The operator need not endeavor to render the uterus perfectly immov- able during the rolling, as it turns a good deal with the body of the animal, and particularly when the mass of the rumen presses with all its weight on the organ. This is also the reason why, according to Zundel, a half or even quarter torsion requires for its reduction at least a com- plete revolution of the body- It often needs a number of turns to reduce the torsion, but generally two, three, or four are sufficient. There is, therefore, no pressing necessity for maintaining the uterus absolutely fixed while the Cow is being rolled ; indeed, as a rule, it is no easy matter to keep it at all near the desired position, there being a great difficulty to find a part to cling to. The hand should rather be employed to discover the effects of the version, and to find when the genital pas- sage is patent. An important precaution in this operation has been notified by some practitioners ; and that is to roll the Cow on a slightly inclined floor, if possible. It may be observed, however, that while Wegerer and others recommend that the hind quarters of the animal should be the highest, Chambon and Liautard maintain that they ought to be lower than the rest of the body. And we can scarcely be in doubt as to the correctness of the latter opinion ; for in the position indicated, the uterus falls towards the plevic cavity, and this favors relaxation of the torsion, and the more easy introduction of the hand through the obstacle in the vagina, if it is desired to attempt to fix the organ by the hand while roll- ing is taking place. Wegerer's position — the hind quarters raised — is nevertheless to be preferred if it is sought to fix the uterus by its own weight, when the hand cannot be passed into the vagina or cannot act advantageously there. As in the majority of cases there is only incomplete torsion, and all that has to be done is simply to replace the foetus, or rather the uterus, on its bed or hammock, reposition can sometimes be effected by merely rolling the animal on its back. In some instances, when slow steady rolling will not suffice, a quick or jerking roll may be successful j in other instances it has been found advantageous to place the animal on its back, and roll it from side to side. Wegerer, Sacchero, Rueff, and some others, have combined rolling with abdominal manipulation and compression, so as to fix the foetus and uterus, or to push them in the desired direction for effecting detorsion \ at the same time rotation is practised according to the directions laid down. Numerous practitioners are content to roll the Cow without attempting to fix or manipulate the vagina or uterus, and many successful cases are recorded by them. But this success appears to have been obtained at the expense of the Cow or its foetus, as the rotation had to be carried on for a longer time than if the organ had been fixed ; several turns may be necessary where one would suffice with the hand in the vagina. If detortion does not take place so soon as anticipated, there is no [^^4r MATERNAL DYSTOKIA reason to despair. If the direction of the twist has been exactly made out, the rotation may be continued. Weber, Wannovius, and Fischer mention instances in which the Cow has been rolled from fifteen to twenty turns b'efore success crowned their efforts. It is even mentioned that the roll- ings in some cases has occupied an hour or more. Weber writes : — " The Cow is often rolled for more than an hour. The operation is laborious,' sometimes painful, to the operator ; it demands an expendi- ture of strength which the most vigorous can scarcely boast of, and it needs a good deal of amour-propre Xo undertake such a task. The efforts required to complete it are so great, that often when a successful result has been obtained the operator is out of breath and exhausted." Happily, these extreme and baffling cases are rare, and they have generally been observed with Cows in which the foetus was dead. It is a common remark, that reposition is easier when the foetus is alive than when it is dead. Unfortunatel)-, cases will be met with in which replacement of the uterus, and, consequently, delivery of the foetus, is impossible by this method of rotation, and these are more particularly cases of multiple torsion. Rueff says that they are sometimes accompanied by decompo- sition of the foetus, when the gases which are developed in the uterus inflate the organ, and prevent its being untwisted. In other instances there is plastic adhesion between the spiral folds, or between the uterus and other abdominal viscera, or even the parietes of the abdomen. It has often been predicted that the rotation procedure may give rise to serious accidents — such as volvulus of the intestines, hernise, etc. But we cannot find any notice of such accidents having occurred. ' If the diagnosis is co'rrect, the nature and direction of the torsion well ascertained, and the animal not too much exhausted nor the parts involved seriously injured, a successful result may be anticipated in the large majority of cases, if the treatment above indicated is carried out. When the uterus is replaced in its normal position, the genital passages patent and in a proper state for delivery, the Cow not much exhausted, and the foetus in a good attitude for birth, time maybe allowed for Nature to effect the expulsion of the young creature. Birth is generally not long delayed under such circumstances, and the operator has the satisfaction of knowing that he has been the means of saving the Cow, and very often its progen}^, with but trifling inconvenience to both. The after conse- quences, so far as the Cow is concerned, are of no more importance than those of ordinary parturition. But not unfrequently, deceived by the slight symptoms of indisposition the Cow at first exhibits, the owner does not send for the veterinarian until too late to save the foetus, and even the Cow. In some cases it will be found that birth cannot take place after repo- sition of the organ, from inertia or paralysis of its muscles : due either to the great extension the fibres have experienced, the interrupted circula- tion of blood in the organ, or injury to its nerves. In such cases stimulants should be given, and friction applied to the abdomen and loins.. Ergot of rye is recommended by Continental veteri- narians. Should uterine action not speedily ensue, and particularly if the OS is dilated and the membranes are ruptured, the foetus must be removed by traction. If the os is impervious, and atony of the uterus continues, then steps must be adopted toMleliver artificially. • When the torsion has been in existence for some time, the liquor amnii DYSTOKIA BY DISPLACEMENT. ^25 expelled, and the uterus closely applied round the foetus, then extraction is difficult and laborious, and prolapsus uteri is not unlikely to follow. The genital canal should be lubrified with glycerine, injections of tepid water may be thrown into the uterus ; and when the secundines are removed, it may be necessary to inject some antiputrescent substance, if there are foul-smelling discharges or any apprehension of septikaemia. In serious cases, after reposition of the uterus and delivery of the foetus, grave complications may ensue — such as metritis, metro-peritoni- tis, etc. It may also then be discovered that a rupture of the viscus exists. These complications must be treated according to their indications. 7. Gastro-hysterotomy, or Cesarean Section. — This operation has been recommended, when the other measures described above have failed, with the object of saving the foetus, if it is still alive, or to preserve the life of the Cow. Laparotomy may be resorted to sometimes, instead of abdominal section towards the linea alba. Rocco {II Medico Veteri?iaria, 1863) has twice successfully performed the Caesarean section in torsion of the uterus, and delivered living calves. Lemaire {Recueil de Med. Veterinaire) relates a case of torsion and rup- ture of the uterus, in which recovery was hopeless. The Cow was killed, the abdomen immediately and widely opened, and the foetus extracted from the uterus with all haste. The Calf was alive, and did well. We shall describe the operation hereafter. Torsion of the Uterus in the Mare. Torsion of the uterus in the Mare is a rare accident. This is doubt- less owing to the direction of the uterine cornua, and the manner in which the broad ligaments are attached to them, which renders rotation of the organ very difficult, unless there is some anatomical anomaly in the parts. Nevertheless, undoubted instances of this displacement in the preg- nant Mare are on record. Belhomme, in 1850, was the first to describe the accident ; he was followed, in 1852, by Elsen and Delwart ; in i860, by Hamon ; in 1861, by Canu ; in 1863, by Schmidt ; in 1866, by Jan- sen ; in 1870, by Gierer ; and in 1875 ^"^^ ^^11^ by Cox {Veterinajy yournal, vol. i., p. 263, vol. iv., p. 28). Serious doubts having been entertained as to the possibility of such an accident in this animal, the fact that it can take place was experi- mentally demonstrated by Goubaux in 1864. Causes. The cause of uterine torsion in the Mare are not well ascertained. It is not improbable that some of the causes which produce it in the Cow will also be effective, in certain circumstances, in the Mare. Wolff mentions that he has witnessed it in a Mare which had suffered from attacks of colic four days previously, and whgn so affected had thrown itself down and rolled violently. In Cox's case, a few weeks be- fore parturition, the Mare had an attack of colic, and rolled over several times. The accident has only been seen in Mares whose period of gestation had nearlv terminated. In Elsen's case the Mare had been ten months 326 MATERNAL DYSTOKIA. pregnant ; in Hamon's case the ordinary period had expired ; and the Mare which was attended by Schmidt was within a few days of foaling. Symptoms. The general symptoms appear to be similar to those observed in the Cow. The local symptoms, however, differ somewhat, the torsion being generally Iriore forward in the body of the uterus; so that the spiral vaginal folds are often not so distinct, and, from Goubaux's experiments, may even not be felt at all. Rectal exploration is recommended by Saint-Cyr in these cases, the torsion being felt as a thick, short, and hard cord. Schmidt easily in- troduced his hand into the rectum as far as the abdominal margin of the pubis, and there he felt under his hand an obstacle which prevented further progress, as only three fingers could be introduced beyond this. The body under his hand was hard, resisting, and immovable ; whereas the contents^ of the colon were soft and easily indented by the fingers. The posterior portion of the floating colon, as in this instance, may be obstructed in the Mare by the twist formed by the uterus and the broad ligaments, and this obstruction will, of course, prevent expulsion of the faeces. Prognosis and Treatment. This accident must be considered more serious in the Mare than the Cow, for some of the reasons already alluded to as influencing parturi- tion and its results in these animals. The treatment must, of course, be similar. Belhomme succeeded, by powerful traction, and without previous reduction of the twisted uterus, in extracting a dead foal in what he describes as a case of " demi-tor- sion." It is probable that the torsion could not have been so great, for when it exists to this degree delivery by traction is impossible. Elsen and Delwart succeeded in reducing the torsion in their case, by rolling the Mare in the manner we have recommended to be adopted with the Cow. In this instance, however, every thing was against the success of the operation, for the foetus had already been two months be- yond its time in the uterus ; it was dead and in a state of putrefaction, and had to be removed piecemeal. The Mare died from septic infec- tion eleven days after the operation. In Canu's interesting case the result was favorable. The Mare had been endeavoring to foal, it would appear, for ten days, and was evi- dently about to succumb. Canu, recognizing torsion of the uterus, was proceeding to open it by force, when the animal fell with great violence, and the shock her body received had the unlooked-for result of com- pletely untwisting the organ, so that parturition, though difficult, became possible. The foal was dead, as might have been predicted ; but the Mare was saved, and continued to recover sufficiently to be put to light work, when, on the thirtieth day after the operation, it was attacked with metrorrhagia which nearly killed it. It eventually got well. Hamon, in France, and Schmidt, in Germany, endeavored to effect re- duction of the torsion in their cases by rolling the Mares first in one direction, then in the other ; but without success, as both animals died without being delivered. Gierer observed two cases of complete torsion in Mares, in both of which the accident was complicated by a large rupture at the base of the uterus, through which the foetus had escaped into the abdominal cavity. MORBID ALTERATIONS IN THE GENITAL ORGANS. 327 Cox ( Veterinary yournal, 1875, p. 264) found the head and fore legs of the foetus protruding through the inferior wall of the uterus. Explora- tion discovered the vaginal passage beyond these parts, but it suddenly terminated ; though a small rpgose opening, barely admitting two fingers, was found. The Mare died in two hours ; and on examination there was noted a double twist of the cervix uteri, with rupture of the uterus and vagina. Torsion of the Uterus in other Animals. We need not allude to this accident in the other animals mentioned as liable to the accident, as it is scarcely possible to diagnose its existence, owing to their small size. Besides, it appears to be extremely rare in them. We may, however, refer to a case of uterine torsion in the Cat, which is, we believe, unique. Vivier {Archives Veterinaires, Sept., 1876, p. 424) had a fine large Cat, two years old, and just dead, brought to him. A few hours previously it had been apparently quite well. The owner, suspecting it had been poisoned, wished a post-mortem examination to be made. Vivier found the muscles almost bloodless when the skin was removed ; and on incising the abdominal parietes, he was surprised to find one of the uterine cor- nua suddenly escape from the opening. This cornu was deeply congested ; indeed, it was almost of a violet tint, and the veins were gorged with dark-colored blood. The other cornu was less voluminous, but offered the same lesions. It was evident the Cat was pregnant. When the abdomen was completely opened, it was discovered that the uterus had made two turns on itself, the tivists being to the right and left ; the cervix presented the spiral appearance characteristic of torsion ; the broad ligaments were intact, and had followed the uterus in its revolution. The two cornua being opened lengthways, they were found to contain a large quantity of black blood mixed with clots ; in this fluid were five foetuses (three in one cornu, and two in the other) contained in their membranes, and probably about fifteen days old. This was, therefore, a case of double torsion of the uterus, and it was most probable that death was immediately due to the considerable haemorrhage. Nothing could be learned as to the cause of the accident. CHAPTER HI. Dystokia from Morbid Alterations in the Genital Organs. Following the arrangement adopted by Saint-Cyr, we will in this chapter study the obstacles to parturition which are due to (i) Tumors developed in, /)r in the vicinity of, the genital organs of the female ; (2) Rigidity of the cervix uteri ; (3) Morbid dege?ierations of the cervix uteri ; and (4) Oblitera- tion of the os uteri. I. Uterovaginal Tumors. The tumors met with in the vagina and uterus differ much with regard to their nature, origin, structure, and influence on the act of parturition. Sometimes they are contained in the interior of the genital organs : in the uterus or its cornua or cervix, and on the walls of the vagina, as well as on the labia of the vulva ; at other times they hav^e their seat in the neigh- boring parts or organs: in the bladder, rectum, or pelvic connective tissue. They may be constituted by degenerations or displacements of these parts, or by heteroplastic products developed there. 328 MATERNAL DYSTOKIA. Their volume, form, and consistence are very diverse ; and they may either adhere closely or loosely to the adjacent parts, being fixed in the one case and movable in the other. Some are attached or implanted by wide bases, others are pediculated or retained by a more or less narrow pedicle. • Tumors of the soft parturient passages are rather rare in the domesti- cated animals, and their occurrence has only recently been brought under observation. The first instance is probably that recorded by Jeanroy, in 1828 {Recueil de Med. Veierinaire, 1828, p. 639). Since that period a number of cases have been recorded by veterinarians in this and other countries, and as some of these are very interesting, we will give them a brief notice hereafter. With regard to parturition, these tumors may be considered in a gen- eral manner according to their {1) Seat ; (2) Mode of attachment ; and (3) Consistence. 1. Seat. — The situation of genital tumors — whether in the vagina, on the cervix uteri, in the os uteri, body of the uterus, or cornua — will make a very great difference in the act of parturition. Those tumors which are developed in the uterine cornua may, by alter- ing the structure of the walls of the uterus, hinder the amplification of the organ, impair the nutrition of the foetus, and even cause it to be expelled prematurely. If, however, they do not interfere with the regular course of gestation, birth may take place in a natural manner and without inter- ruption. If the foetus is situated behind the tumor, towards the body of the uterus, of course it meets with no obstruction in its passage out- wards j and if it should happen that labor is longer and more difficult than usual, this can only be attributed to the alteration the pathological production has effected in the muscular structure of the uterus, an-d which may produce a diminution in its contractile or expelling power. When, however, the tumor is between the foetus and the genital passages, the case is much more serious. If it is fixed directly on the cervix, it may prevent dilatation of the os to the necessary extent, or perhaps altogether. When it is situated in front of the cervix, towards the body of the uterus, but in the immediate vicinity of the former, and is movable to a certain extent, it may be carried into the dilated os, occupy it to a greater or less extent, and render the exit of the foetus impossible, unless the tumor is moved out of the way. If the tumor occupies the vagina, it will prove a more or less formidable obstacle, as it is large or small, hard or soft, and consequently diminishes the calibre of this outlet for the foetus. 2. Mode of Attachment. — The manner in which these tumors are attached to the membranes from which they spring, has some influence on their action as obstacles to birth. They have either a wide basis of attachment, or they are sessile or pediculated. Those tumors which have a very wide base are generally of- a malignant character ; and though they may prove very serious, so far as the female is concerned, yet they do not often prove a cause of difficult parturition, provided they are not situated in the vagina or on the cervix. Animals so affected do not generally breed, though they may regularly exhibit oestrum ; if, however, they should chance to conceive, and pregnancy has terminated, with these exceptions parturition may not be delayed in its course. The circumscribed sessile tumors are generally more serious than those MORBID ALTERATIONS IN THE GENITAL ORGANS. 329 which are pediculated ; as the latter may be more or less easily displaced when they are in the way, and delivery rendered as easy as usual. Or if the pediculated tumors cannot be temporarily removed from the path of the foetus, they may easily be altogether got rid of by a simple opera- tion, particularly if their base is very attenuated. 3. Consistence. — The hardness or softness of the tumors has an impor- tant bearing on their obstructiveness. Such tumors as the fibroids are so dense and inelastic, that the strongest compression will scarcely diminish their volume or alter their shape ; while others — such as the condyloma- tous or papillomatous tumors^ — readily change their form and dimensions when submitted to pressure. We will allude to each of these morbid productions more fully here- after. Diagnosis. The diagnosis of these tumors is not always so easy in the domesti- cated animals as in woman. In the latter, as Saint-Cyr truly says, the surgeon may sometimes have to discover the existence and to determine the nature of such growths during pregnancy ; and he may, consequently, be prepared beforehand to overcome the difficulties which will present themselves at a later period. But with the veterinary obstetrist's patients this is not so ; and it is only and always during parturition, in the midst of the trouble which inevitably accompanies a difficult birth, that he is called upon to give an opinion. But as some compensation for this disadvantage, in animals direct explo- ration is easier than in woman ; while the entire hand can be introduced into the genital passages of the larger creatures with facility, and explore every part \ so that if the period is late for acquiring information with regard to the existence of tumors, yet these facilities enable the obstetrist to obtain most valuable notions with regard to diagnosis, prognosis, and treatment. But this exploration should be complete and intelligent ; as errors in diagnosis are easily committed, and may lead to serious consequences. Here the hand, not the eye, must be the guide, and just as the sense of touch is well developed in this organ, so it will all the more readily distin- guish between a tumor, the " water-bag," or some part of the foetus which is covered by or denuded of its membranes ; as well as discover the exact seat, volume, consistence, and mode of attachment, besides some- thing of the nature, of such pathological productions as we are now considering. Treatmejit. The indications for the treatment of these obstacles to birth will, of course, depend upon a variety of circumstances, the majority of which have been referred to. Sometimes we may be able to act directly on the tumor, and remove it from the genital passages ; in other cases, from its situation and nature, it may be beyond the reach of direct action. When in the vagina and not far from the vulva, and particularly when pediculated, it is occasionally extruded as the foetus is expelled from the uterus, and may then be readily seized by the hand or forceps, and taken out of the way. In such a case the tumor may be either drawn outside the vulva, pushed to one side so as to clear the passage, or extirpated. If it is situated beyond the os, and is sufficiently movable, it may be 330 MATERNAL DYSTOKIA. pushed in front of the pelvic inlet, and the parts of the foetus which pre- sent be immediately brought therein : so that the tumor may be kept out of the track of the latter. Should the growth be of the nature of a kyst or abscess, merely punc- turing it by means of a bistoury, scalpel, or trocar, will evacuate its fluid contents, when it will collapse and birth be rendered possible. When it is a pediculated tumor like a polypus, it may be got rid of at once by extirpation, if the pedicle is easily accessible. To this end the pedicle may be simply ait through ; but this measure, though the most expeditious, is not always the best ; as there may ensue internal haemor- rhage, which will be all the more troublesome as haemostatic agents are difficult of application to the wound. The pedicle may certainly be ligatured, either in mass or partially previous to extirpation, in order to obviate the disadvantages attending simple excision. This means has been successfully employed, and though perhaps a longer and more difficult operation, it is to be preferred when possible. Saint-Cyr recommends, before all other measures, linear ecrase?ndnt, should Chassaignac's or any other ecraseur be available. This ecrascme7it should be no more difficult than simple excision, and so far as haemorrhage is concerned, it is as safe as the ligature, while its consequences are much more trifling. Cartwright has most successfully removed a vaginal tumor by the ecraseur. When the base of the tumor is very small, and has but a slender attach- ment to the textures from which it springs, and when, in addition, it is beyond the application of a ligature or the use of the ecraseur, it may be torn off, or removed by the finger-nail. The most difficult tumors for treatment are those which are hard and sessile, and to which the foregoing measures are not applicable. It some- times happens, however, that these formations have only a very loose connection with the subjacent tissues, and it is often possible to remove them either wholly or in part, by making incisions through them, and enucleating the divided portions by means of the fingers. It is rare that these neoplasms developed in the labia of the vulva offer any obstacle to birth ; should they chance to do so, however, it is easy to remove them by means of the scalpel or bistoury. If the subse- quent oedema of the labia has not disappeared when parturition com- mences, and if it hinders exploration by the hand, or the expulsion of the foetus, it may be combated by scarifications. These, however, should only be made during parturition. There may occur cases, nevertheless, in which, either from the nature, mode of attachment, or situation of these tumors, their removal is not possible, and birth cannot be effected. In such cases it will be for the obstetrist to decide whether he will have recourse to embryotomy or the Caesarean section : this decision being arrived at after duly weighing all the circumstances and facts relating to them. Having completed these general considerations on utero-vaginal tumors as a cause of dystokia, and offered the above indications in the way of treatment, we will now proceed to notice each class of these formations, in so far as they have been recognized as obstacles to parturition in animals. MORBID ALTERA TICK'S IN THE GENITAL ORGANS. 331 CANCEROUS, CARCINOMATOUS, OR SARCOMATOUS TUMORS. Cancer of the uterus, and other organs of generation, would appear to be rare in animals, and very few veterinary writers allude to it. Even those observations which have been published have but little interest for the obstetrist, as nearly all of them have no relation to difficult parturi- tion. Some cases, however, have been recorded in which cancer of the cervix uteri has produced contraction of the os, and necessitated opera- tive interference in order to effect delivery ; and one or two instances are noted in which cancerous tumors have elsewhere proved an obstacle to parturition, and even when that act has been accomplished have proved dangerous from the haemorrhage they occasioned. When the cancer is situated at the cervix, and the os cannot be dilated by the foetus, then treatment must be directed to effect sufficient dilata- tion for its passage through the canal. In nearly every instance this must be accomplished by free incision of the cervix. CONDYLOMATOUS, PAPILLOMATOUS, AND LIPOMATOUS TUMORS. These tumors are met with most frequently in the generative organs of the Cow and Bitch, and particularly in the vagina. They seldom prove a serious obstacle to the passage of the foetus. They first appear as soft, fungoid, cauliflower-like vegetations, which bleed from the slightest contact, and are readily crushed or deformed. In the Bitch they sometimes completely fill the vagina, and give rise to a constant sanious, and most offensive discharge from the vulva. Lipomatous tumors are also most frequently noticed in the vagina of the Bitch ; and in two instances observed by Oreste and Falconio, one tumor was the size of a filbert, the other of a large walnut. The general indications for treatment are applicable to these growths. FIBROID AND MYOMATOUS TUMORS. Fibroids are not at all uncommon in the generative organs, and are frequently the cause of difficult parturition. They have been observed in the uterus and vagina of the Mare, Cow, Sow, Goat and Bitch. In structure, it would appear that the fundamental portion of these tumors is composed of connective tissue, which may present the histologi- cal characters of areolar, mucous, or tendinous tissue, the fibres of which, more or less closely interlaced, have connective tissue corpuscles or cells lying between them, and are cemented into a solid mass by an inter- elementary, more or less abundant, amorphous substance that greatly contributes to increase the consistency of the neoplasm, giving it a dull white or nacrous appearance, as if composed of cartilaginous tissue. The connective-tissue corpuscles composing these tumors are sometimes considerably enlarged and hypertrophied, and this is more particularly observed in the fibroids of the uterus. This arrangement has been found to exist in the uterine fibroma of a Cow examined by Ercolani in 1855 ; cartilaginous transformation of the structure has even been detected. The fibroids are developed from the submucous or subserous connec- tive tissue, or from the muscular texture of the uterine parietes. When the latter, the tumor is rarely pediculated, but nearly always remains ses- sile. The uterine fibroma of submucous origin is certainly at first 332^ • MATERNAL DYSTOKIA. sessile, and is covered by the mucous membrane ; but as it grows it becomes pediculated. The fibroids of the uterus, as well as those of the vagina, are some- times covered by the mucous membrane, and at other times grow beyond it. They are sessile or pediculated, and of v^ariable volume and consis- tency ; their surface is either smooth or irregular, as if composed of a number of smaller tumors. Franck mentions that the pathological museum of the Munich Veteri- nary School contains the uterus of a Cow, one of the cornua of which is occupied by a myomatous tumor, springing from the muscular layer of the part, and as large as a man's head. Sometimes the pediculated fibroids of the uterus, in consequence of the elongation of their pedicle, extend beyond the os into the vagina, and even in some instances pass through the latter and the vulva, and remain suspended between the thighs. A case of this kind has been observed by Granaveri and studied by Ercolani.* As we have observed, the presence of fibroids has a variable influence on the process of parturition, according to their situation. Of course, the larger, and particularly the submucous interstitial fibroids, only very exceptionally allow successful fecundation to take place ; though in some instances, when this occurs, absorption follows. During labor they may predispose to rupture of the uterus, from the alteration they have pro- duced in the texture of the organ. Submucous or superitoneal fibroids, when situated towards the fundus of the uterus, or when only of a moderate size, very frequently offer no particular obstacle to birth, and interfere but little with labor. It is only when they are very large, and situated towards the cervix or vaginal canal, that they may become a serious impediment to delivery. Those with short pedicles, and which are designated "polypi," maybe projected backwards before the advancing fcetus, and be mistaken for some part of the latter by the unobservant obstetrist. Sometimes the tumors soften towards the termination of gestation, so that during parturition they may be sufficiently compressed and flattened for the foetus to pass over them. If they have an elongated pedicle attached to some parts which is easily displaced, they may be pushed beyond the vulva by the fcetus, or the pedicle may be ruptured by the latter, and the parturient passage thus left unobstructed. The recognition of these tumors is not very difficult when they are within reach of the hand. To prevent their being mistaken, during manual exploration, for some part of an ordinary or deformed fcetus, their nature and mode of attachment must be attended to. With this object, the hand should be carefully passed between them and the uterus and vagina in every direction, so as to find their pedicle, and thus be assured that they do not belong to a foetus. With regard to the treatment, we must refer to the general indications already given. We may only add that, when the tumors are not very large, it is better not to interfere until Nature has done what it can in overcoming the obstacle ; for in these Instances, as in so many others, it sometimes effects surprising results. If they are pediculated and can be reached, they may be incised, ligatured, or removed by the ecraseur ; should the base not be attainable, or very extensive, they may be par- tially extirpated. * Oreste and Falconio. Stiidii sulle Neoplasie a Massa distinta degli Animali Domestici, p. 58. MORBID ALTERATIONS IN THE GENITAL ORGANS. 2>IZ If, after parturition, there appears any thing like a serious haemorrhage due to this extirpation, this may be suppressed by plugging with lint or fine tow, which may be steeped in perchloride of iron. The following selected observations will illustrate what has been said with regard to these fibrous tumors : 1. The first case on record is that published by Jeanroy {Recueil de Med. Veterinaire, 1S28, p. 639). In this instance the Cow was in parturition, and being unable to calve an empiric had been called in ; this man, though the foetus was in a good position, tore off the head. Jeanroy found the Cow to be suffering from ascites, and on puncturing the abdomen more than two gallons of fluid escaped. On exploring the uterus, he discov- ered a large pplypus occupying the upper part of the organ. With a probe-pointed bis- toury he removed a large portion of it by incision, and extirpated the remainder by enucleation. The operation was completely successful, as when the polypus was re- moved the calf could be easily extracted, and two months afterwards the Cow had com- pletely recovered. The animal subsequently produced three calves. 2. Leaux mentions the case of a Cow, seven months pregnant, which had been exhib- iting violent expulsive efforts. On examinadon the vagina was found to be unobstructed, but the OS uteri was so contracted that a finger could not be introduced. Nothing was done. Next day the animal was found lying dead, and behind it was a foetus in its envel- opes, as well as a tumor which had been expelled at the same time. This tumor was of a reddish-brown color, %oft, and weighed about eleven pounds ; it appeared to be of a fibrous nature, and was perforated by cavities which contained a serous fluid. 3. Corbet ( Veterinarian, vol., vii. p. 78) alludes to a Cow — " a large roomy animal " — which had occasionally exhibited symptoms of colic while pregnant, and discharged copiously from the vagina. It had been gored by other cattle, and had also sustained some heavy falls while in calf. Being unable to calve at its full time, Mr. Corbet had to attend; but he could not deliver the calf, though it was small, and was preparing to re- sort to embryotomy when the Cow died. A polypus weighing upwards of six stones was found in the'uterus. The greater part of the tumor was composed of matter closely re- sembling coagulated blood, the smaller end which lay towards the bladder being more highly organized and of a bluish color. The mass was easily torn. 4. Horsburgh (Ibid., vol. xiv., p. 604) was sent for to attend a Mare which had been at- tempting to foal for some time. He found the animal very weak from long-continued straining, and discovered in the vagina a yellow-colored mass, the size of a man's head. This mass projected considerably beyond the vulva whenever the "pains" returned, and had " been forcibly kept back by a stout fellow every time these labor pains came on." The Mare, having been lying, was got up in order that a better examination might be made, and then a firm hard body was found beyond this substance, and which was surmised to be the head of the foal. A pain coming on, Horsburgh did not hesitate to cautiously make an incision through what he then discovered to be a " substance resem- bling coagulable lymph." On enlarging the incision, the head of the foal presented itself, covered by the foetal membranes, and the creature was then extracted alive. Soon the placenta was removed, and then the obstruction was examined. It was found to be firmly adherent to the os uteri, was about two inches in thickness, and when removed weighed nearly eight pounds. At the previous parturition, about twelve months before, it had appeared a little. The Mare quite recovered. 5. Dick [Ibid., vol. xix., p. 458) relates the case of a Cow at the full period of preg- nancy, and which was straining for many hours without being a1)le to calve ; the os had at last to be dilated, when the calf was removed with much difficulty. Uneasiness contin- ued for two days afterwards — indeed the animal was quite ill, and no faeces or urine were passed. A tumor was then observed in the vagina ; it was about eight inches in length and the same in circumference, and was loosely attached, its anterior extremity being fixed near the meatus urinarius ; it was not covered by the mucous membrane, which was distinctly ruptured at that part of the vagina to which it was attached. No pain was evinced on pressing the tumor, into which the fingers could be easily passed without much bleeding ensuing ; it had all the appearance of imperfectly organized lymph, and did not possess the usual characters of a polypus. As no harm seemed likely to arise from its removal, it was excised. Soon after this micturition was easily effected. The Cow was recovering when it was attacked by pleuro-pneumonia, and had to be killed. 6. Lewis (Ibid., vol. xxv., p 184) attended a Cow which had gone a week beyond its time, and could not deliver itself. The os uteri was sufficiently dilated to admit two fingers, but it appeared to be so indurated that further dilatation was deemed impossible, the constriction being so great that it felt as if a ligature had been passed around the cervix. Next day nevertheless, a calf was with difficulty extracted ; and on the animal 334 MA TERN A L D YSTOKIA . lying down soon after, the uterus became completely inverted. The broad ligaments were torn, and the organ was so much injured that amputation of it was attempted. The Cow, however, succumbed, and on examination it was discovered that the os uteri was " torn into fragments," and " had a large excrescence in a schirrous state around its neck, which had evidently acted as a strong ligature.' The broad ligaments were ruptured as was the uterus itself ; likewise the vagina, through inversion, and also the rectum. 7. Howell {Ibid., vol. xlii., p. 97) describes a tumor which had formed beneath themu- cous membrane of the vagina of a pregnant Cow. The animal was aged, and exhibiting symptoms of parturition for some time without any visible progress being noted, an explo- ration was made per vagmam. This revealed the existence of an immense tumor filling up the vaginal canal and firmly pressing against the cervix uteri. With much difficulty the OS was reached, when it was found that although the fcEtal presentation was natural, delivery was impossible. The Cow was consequently slaughtered. The tumor, which was ovoid in form, with slightly flattened sides, measured fifteen inches in its long and ten in its short diameter — having a circumference of twenty-five inches at its largest part. Its surface was smooth and unbroken, and covered by the vaginal mucous mem- brane ; while its color was but little different from that of the adjacent parts. Its at- tachment, which was just above the os uteri, was broad and thick ; in this respect it dif- fered greatly from ordinary vaginal polypi. Its weight was a little under twenty-one pounds. Histologically, its fibres were closely arranged in a network, and their meshes contained exudation corpuscles. 8. Cartwright {Ibid., vol. xlv., p. 203) gives an account of a vaginal polypus (lipoma- tous) in a Cow, and which was removed by means of a coppir wire ligature. The tu- mor, which was pendant from the vagina, was pear-shaped, about nine inches in length and five across its widest part ; its surface was uneven. The ligature was applied around the pedicle and tightened on the fifth day. Three days afterwards the tumor was ex- cised close to the ligature, and the remaining parts returned. The animal did well. It was not pregnant. 9. A case similar to the foregoing is mentioned by Lemaitre {Memoires de la Soc. Vet. du Calvados et dc la Manche, No. iii., p. 109). This was a non-pregnant eighteen months old Mare, which showed febrile symptoms, had frequent attacks of colic, made expulsive efforts, and reddish-colored matter escaped from the vulva. When the hand was intro- duced into the uterus, it encountered a fleshy mass fixed by a narrow pedicle to the left side of the organ, in the vicinity of the cornu. The tumor was removed by twisting and pulling it. It weighed about four and a half pounds. The Mare had quite recovered in seven days after the operation. 10. Delhaye [Anttales de Med. Veterinaire de Bruxelles, 1853, p. 549) reports the case of a Cow which was in labor for twelve hours. On a vaginal exploration being made, an unusual-sized polypus was found obstructing the os uteri in which it was fixed. A kind of incision was made, which allowed Delhaye to introduce his hand between the cervix and the substance of the polypus, and then, by a brief manipulation, he was able to isolate the mass from the subjacent tissues and remove it altogether. Ten minutes afterwards parturition was accomplished spontaneously, and the Cow and calf did well. 11. Delwart {Ibid., p. 550) describes a polypus growing from the floor of the vagina near the cervix uteri, and which, while the animal was straining in parturition, was pushed beyond the vulva. At first sight it looked like a case of inversion of the vagina ; but on exploration its true character was detected. It was easily removed, and normal delivery afterwards took place with ease. 12. Leconte {Memoires de la Soc. Centrale de Mid. Veterinaire, vol. v., p. 153) ob- served a heifer, two years old, and advanced in pregnancy, in whose vagina were a num- ber of polypi, some of which were so large that they projected beyond the vulva when the animal was lying. The largest measured from four to five inches in diameter and its pedicle was as thick as a finger. Nothing was done until parturition commenced, when the mass was removed by incision and enucleation. 13. A heifer, about twenty months old was, according to Fabry {Annales de Med. Vet. de Bruxelles, i860, p. 415), making violent expulsive efforts without any assignable cause. Exploration revealed the presence, on the upper wall of the vagina, of an oblong fluctu- ating tumor as thick as a man's arm, and which so filled up the passage that the finger could scarcely be introduced beyond the meatus urinarius. No treatment was adopted and the animal was killed for food. On the carcase being dressed, it was observed that this tumor extended to the neck of the uterus, and that it contained a dark-colored fetid pus, enclosed in a dark-tinted kyst. The walls of the uterus were extraordinarily thickened by a massive exudate — the product of a previous inflammation. 14. Fleury {Recueil de Med. Vetirinaire, 1863, p. 259) has given a very interesting history of a Cow which was in labor for nine hours, and with which, at each pain, there appeared between the labia of the vulva, at the same time as the fore-feet of the fcetus, a volumi- I MORBID ALTERATIONS IN THE GENITAL ORGANS. 335 nous round tumor. In order to make an examination, it was necessary to push the tumor as far forward as the uterus, and then it was ascertained that the head of the foetus was turned towards its back, the nose being directed to the sub-lumbar region of the mother. The head was brought down, a cord was passed behind the occiput and the ears, and on this being pulled at the head and neck were put straight. Then the left hand of the operator keeping the tumor in the interior of the uterus, in front of the pelvic inlet, the assistants pulled at the cords, and without much trouble — owing to the large size of the pelvis and smallness of the foetus — brought away a living and well-formed calf. • Parturition being thus happily accomplished there remained the tumor, which was found to be attached by a short, but very thick pedicle within and almost on the lower border of the os, to the left side. Owing to the mobility of the uterus, the tumor could be withdrawn outside the vulva, and there it was fixed by the hands of two assistants, while Fleuiy passed a long sacking-needle, furnished with a long and very strong thread, through the middle of its pedicle, and in this way enclosed this portion in a tight double ligature. By tv>'o cuts of a bistoury the pedicle was then divided a short distance from the ligatures, and these, with the mucous membrane dragged out by the tumor, being immediately put back in the vagina nothing was seen of ihe operation save the ends of the thread which were purposely left outside the vulva. In twelve days after the operation the Cow was discharged as cured. The tumor was oblong, irregular on the surface, hard and resisting, and divided into two unequal lobes by a deep fissure ; it was covered by mucous membrane, though this was only loosely adherent to it. In its largest diameter it measured more than ten inches, and it weighed over twelve pounds. It grated when cut into by the bistoury, as if it was an unripe apple, and a yellow serous fluid escaped from its interior, which was hollow near the end opposite the pedicle. Around this cavity the fibrous tissue — soft and rose-colored — yielded by pressure a greyish opaque fluid which was miscible in wa- ter, and was not found in any part of this growth. Seven-tenths of the mass was com- posed of a dense dull-white fibrous tissue disposed in irregular striae or in concentric tufts. Watson (F'^^'<'r/«rt:r/a«, vol. xlv., p. 174) gives the history of a sheep-dog which had been in labor for a day, but could not deliver itself because of what the owner called the " pup-bed " coming out. This had been frequently returned, though it caused the poor animal great pain, which was only relieved when the mass was again extruded. On examination, a tumor as large as a hen's egg was found protruding from the vagina. " At first sight it had every appearance of an everted bladder," but on manipulation it was discovered to be a firm fibrous tumbr, v/ith a long pedicle extending into the vagina. A ligature was applied to the neck of the tumor, and this was removed by the scalpel : tincture of opium enemata were administered, and in about an hour three puppies were born. The bitch afterwards did well. 15. To Barbenoire and Arloing [Journal de Med. Viterinaire de Lyon, 1868, p. 76) we owe our last example of this kind of tumor. A Cow thirteen years old, which had calved in a natural manner fifteen months previously, and was supposed to be again about five months pregnant, was suddenly taken ill. Suspecting abortion, Barbenoire introduced his arm into the uterus, the os of which, strongly contracted, had to be pre- viously incised ; there he found an enormous hard tumor, which he vainly endeavored to extirpate. The animal died next day, after suffering for four days ; the cause of death appeared to be due to metrorrhagia. The tumor, on a post-mortem examination, was discovered to be entirely confined to the uterus, with the exception of a somewhat voluminous " appendice," which was found to be strangulated at the origin of the left cornu. into which it was prolonged. Arloing examined this morbid production and described it as follows : An oval, uneven surfaced tumor, traversed by grooves or fissures, one of which deeper than the others, limits the appendice mentioned by Barbenoire as extending into the left horn ; and studded by small fibro-vascular prolongations by which, no doubt, it grafted itself on the uterine walls. Its longitudinal diameter measures 35 centimetres (nearly fourteen inches), transversal 20 centimetres (nearly eight inches), audit weighs about 6,610 kilo- grammes (about fifteen pounds). The tissue of which it is composed is hard, resisting, and grates under the scalpel : it has a fibrous aspect ; its density is pretty much the same throughout ; and its color is in general a dull white or nucrous tint, with here and there light red down to carmine and violet points, according to the degree of vascularization. This vascularity is very considerable on the surface of the tumor, but diminishes as the centre is approached. Examined miscroscopically, the neoplasm is found to be formed, throughout the whole of its mass, of fine long parallel fibres, on whose course are seen dark-colored dilatations corresponding to the nuclei which the caustic soda has rendered visible. These fibres are joined in bundles, which cross each other in various directions. 336 MATERNAL DYSTOKIA. There are found, in addition, cells or fusiform bodies, as well as somewhat irregular globular bodies with dark contours. From the histological characters, Arloing came to the conclusion that the tumor was a fibroid. THROMBUS OR HEMATOMA, Thrombus or haematoma of the -vagina or vulva, usually appears most frequently after delivery. Pfirter, however, has recorded the case of a Mare in which a large blood tumor, or haematoma, was caused by the rup- ture of blood-vessels and the escape of blood into the connective tissue around the vagina. It formed a great swelling on the sides of the vagina and vulva, the infiltration of blood extending to the perineum. This tumefaction proved an obstacle to parturition ; so that it was necessary to remove it by opening it freely, and taking away the clots of blood which had formed. The haemorrhage which ensued was checked by the injec- tion of a solution of perchloride of iron. Saake has observed these blood-kysts most frequently in Swine ; death from haemorrhage has sometimes resulted from their rupture. The application of ice or cold water, or perchloride of iron, or even the actual cautery, and plugging the vaginal canal, will generally arrest the bleeding. SEROUS KYSTS. Kopp, Hering, Ayrault, Lafosse, Liautard, Miiller, and others, have observed serous kysts on the vaginal mucous membrane, and even in the uterus, of the Mare and Cow. The vaginal kysts are of variable size, but most frequently as large as a pear, which they are generally not unlike in shape. They are attached to the mucous membrane by a very narrow pedicle, and in some instances appear between the labia of the vulva when the animal is reclining, but disappear again into the vagina when the standing posture is assumed ; though occasionally they are so large that they cannot return without assistance. The kyst is smooth and transparent, and contains a clear limpid serosity, in which albuminous flakes are often observed. Not unfrequently, the glands of Bartholin in the vagina of the Cow are greatly distended with mucus, serum, or even pus, as a result of inflam- mation. Such kysts are not likely to retard parturition, and if they should, their treatment is very simple j as a lancet puncture suffices to evacuate the fluid they contain, and the walls readily adhere and cicatrize. Hering has seen them occupy the vagina and extend into the uterus ; and in the latter organ their presence may be more serious than when they are -limited to the vagina. We have given an instance of this, furnished by Liautard {see p. 167), and which shows that they may prove troublesome obstacles to delivery, as well as dangerous to the animal in whose uterus they may have formed. When the kyst is attached to the cervix or its neighborhood, it may pass into the os and obstruct it, and thus prevent the foetus passing through. When very large it may so closely simulate the " water-bag," as to be mistaken for it — though the mistake need not lead to grave results ; indeed, if ruptured the kyst immediately collapses, and can no longer prove a barrier to the expulsion of the foetus. If the kyst is MORBID ALTERATIONS IN THE GENITAL ORGANS, 337 situated towards the os, and if puncturing it be deemed inadvisable, pushing it beyond the pelvic inlet out of the track of the foetus will be sufficient to overcome the obstacle. Vaginal kysts may be mistaken for an everted bladder : a mistake which we are assured if often committed, from the external aspect of the tumor, its oval shape, and its color. Of course, this mistake would prove most unfortunate, should the treatment we have recommended be adopted ; but a careful examination should always be made before any active interference is attempted, and this examination will obviate such an error. • Hernia of the bladder through the ruptured v/alls of the vagina, may also simulate a vaginal kyst ; and if this viscus is punctured in this posi- tion, it will lead to the same lamentable results, in all probability, as in inversion. This accident we will now notice, and point out the signs by \vhich it may be distinguished. HERNIA OF THE BLADDER INTO THE VAGINA : VAGINAL CYSTOCELE. Dystokia from the existence of a vaginal cystocele is a somewhat rare accident, and only a few instances are recorded as having been observed in the Mare and Cow during parturition. Inversion of this viscus may occur in two ways : — i. When empty, it may, by a spasmodic contraction of its walls, evert itself — the mucous membrane becoming external and the peritoneal coat internal — and thus turned outside-in, it may pass through the meatus urinarius into the vagina ; 2. It may, without being everted, escape into the vagina by an old or recent fissure in the floor of the passage. Most of the cases occur during parturition, and when the animal is straining violently, whereby a portion of the contents of the abdomen and uterus are pressed against the bladder, and may thus produoe its inversion. It is not at all improbable that the viscus may, in consequence of the pressure it occasionally receives, be in a spasmodic state, or the cervix may be dilated and relaxed at times (Cartwright). In the Mare and Cow the urethra is short, straight, and wide ; and this no doubt renders the bladder liable to inversion. Zundel states that it may, during parturition, acquire such dimensions from retention of urine that it will entirely fill the vagina, and protrude externally during the expulsive efforts of the animal. However this may be, it is certain that the cystocele will present a different appearance in the vagina according as its peritoneal or mucous membrane is visible : i.e., everted or non-everted. In the first case we find a somewhat hard, red tumor with a corru- gated surface, and attached to the floor of* the vagina by ^ short narrow pedicle. Examining the lower wall of the vagina attentively, the meatus urinarius cannot be found, but on the soft pulpy surface of the tumor will be observed two small openings — the apertures of the ureters — from which a fluid continually escapes, and which may be recognized by its odor as urine ; this fluid may even be thrown out with a certain degree of force during the labor pains. These characters should be sufficent to indicate the nature of the obstacle. In the second variety, the bladder escapes through a rent in the wall of the vagina, and this rent may only involve the muscular layer — the' 22 338 MATERNAL DYSTOKIA. vaginal mucous membrane remaining intact ; or, which is more frequent, the muscular and mucous tissues may be ruptured. In either case there is found in the vagina a round, sm'ooth, and fluctuating tumor, attached to the floor of the canal by a pedicle more or less wide, and beneath which the meatus urinarius can be seen or felt. The most striking pathognomonic feature of this kind of tumor is its rapid growth, in consequence of the accumulation of urine in the interior of the displaced bladder, the fundus of which is towards the vulva and the neck directed forwards — its position being the reverse of normal ; the fundus, by pressing on the urethra — which is doubled on itself — prevents the urine from escaping, and we have in this way a rapidly increasing vaginal tumor. In a case recorded by Violet {Recueii de Med. Veterifiaire de Lyon, 1862, p. 371) the tumor had acquired, within eight hours, a diam- eter of from eight to ten inches. Such a tumor must, therefore, con- stitute a more or less serious obstacle to parturition. We have pointed out the necessity for a careful examination of the tumor, in order to avoid making a mistake, as the cystocele resembles other tumors, and especially the kysts we have already described, or even the " water-bag," and an error in diagnosis may lead to grave consequences. Such an error is recorded by Charcot {yournal Pratique de Med, Veterinaire, 1826, p. 165), who, being called upon to attend a Cow which had been attempting to calve for three days, found on sepa- rating the labia of the vulva a whitish, tense, and fluctuating tumor. Thinking that this was only the " water-bag," he punctured it ; when the color and odor of the fluid which escaped quickly undeceived him. When the bladder had collapsed, he then recognized the tear in the vagina through which the viscus had passed. The Cow being in a dying condition and the foetus still alive, Charcot had recourse to the Caesarean section ; the calf was saved, but the mother died. As the diagnosis of this accident is of so much importance, we will notice the symptoms in greater detail. Protruding through the opening of the vulva, or immediately within the labia, will be discovered a tumor of a pyriform shape, and varying in size and color, according to the duration of the accident. Sometimes this tumor will be seen hanging from within the vagina by a kind of peduncle, for at least eight or nine inches, and will contain two or three pints of fluid. At times, the protruded part will be nothing more than a thickening of the bladder, produced by strangulation and inflammation; and it will be changed from its normal color to that of an inflamed surface, or, if it has been hernied for some time, to a darker hue. Sometimes it will become gangrenous and slough ; at other times its surface appears rugged and plicated, and on occasions a large quantity of blood has exuded from its surface. Should there exist any doubts as to the nature of the tumor, the meatus urinarius must be looked for ; if that cannot be discovered, then the greatest circumspection should be exercised. The attachment and situation of the protrusion should be noted, and also whether it is continuous with the vagina. The nipple- shaped prominences which mark the openings of the' uterus into the bladder should also be looked for, as their presence will at once denote the case as inversion of this viscus, as will the escape of urine from them. Treatment. The chief indication in vaginal cystocele is reduction, or reposition of MORBID ALTERATIONS IN THE GENITAL ORGANS. 339 the displaced viscus. This, however, is not always, if ever, an easy task. In a case of simple hernia, the bladder is soon distended by the urine, and owing to the increase in size, it cannot be returned by the opening through which it passed when it was empty. Compression of its walls will not suffice in the majority of cases to evacuate its contents, because, as has been shown, the weight of the organ lies upon the doubled urethra. To empty the bladder a catheter must be employed ; the shoot of an elder tree deprived of its pith has been successfully used for this purpose on an emergency. Once emptied, according to Saint-Cyr, the bladder easily resumes its normal situation. Puncture of the organ has been practised when catheterism was not tried ; a fine trocar been inserted obliquely into the upper part of the viscus — which was now of course the inferior part — so as to make it pass for a certain distance between the membranes before entering the cavity of the sac, in this way imitating the entrance of the ureters. The opera- tion was completely successful, as the bladder had been little more than half emptied before the hernia was spontaneously reduced. Cartwright says, with regard to treatment : " Provided we are called to the case at an early period, and before a thickening of the parietes of the bladder and sphincter has taken place, we most probably will succeed. We should, with the left hand, press gently upon the sides, and with the right hand the fundus of the iDladder, until we feel it gradually receding from us ; after which we may carefully introduce a pessary or catheter, so as fairly to force it into its natural situation. If there should be violent straining at the moment w^e are employing the taxis, we had better desist for a time until we have abstracted four or five quarts of blood, or give a dose of opium in solution, to allay any irritation or spasm. But if we cannot succeed in this way, I think a far more preferable plan will be to get a stick with a round blunt point that will pass through the sphinc- ter, and force it against the base of the protruded fundus. A very excellent instrument would be a female catheter, such as is used for the Cow or Mare, as it would have the necessary curve. In thus trying to rein vert it, we may use considerable force without rupturing it ; though, of course, we must be cautious in our pressure." Should the distended cystocele be immediately in the track of the foetus, and the expulsion of the latter urgent, if the bladder cannot be returned before birth, it must at least be emptied, to allow the young creature to get through the vagina. As the latter passes over it, the viscus should be protected from injury by the fingers. We will return to a consideration of this condition when treating of the accidents occurring as a sequel of parturition. In the mean time, we will give one or two illustrative cases to show the importance of exercising care in diagnosing, g.nd skill in treating, this accident. Youatt [Cattle, p. 522) relates that a Cow had been three days in labor, and little ad- vance had been made. It was lying on the right side, exhausted, and at intervals lowing mournfully, and making violent efforts to expel the foetus. A round, fibrous white tumor presented itself; it was evidently distended with some fluid, fluctuation being detectable on the slightest touch. Not dreaming that it could be any thing but the mem- branous bag that contained the natural uterine fluid, he punctured it, and found that what escaped was urine. It was the bladder which had protruded through a rent in the vagina, adds Youatt, and which he might have recognized by its smaller bulk and firmer texture, and by the ease with which the neck would have been discovered on a slight examination. Baker ( Transactions of the Veterinary Medical Association, vol. ii. p. 57) records a case of inversion of the bladder in a Mare while in the act of foaling. It was replaced three 340 MATERNAL DYSTOKIA. times within two hours, and there was little difficulty in doing so ; probal^ly owing to unusual width of the urethra. Littler ( Veterinaria7t, vol. xxxvi., p. 273) was sent for to see a Mare which was^ unable to foal. He found the animal being led about in a straw yard, in order to avert or miti- gate the violent throes of parturition which had been present for two and a half hours. Protruding from between the labia of the vulva, during each throe, were the Mare's urinary bladder and three foetal feet. The bladder was completely inverted, and '* from its elastic or yielding nature apparently contained gas on its peritoneal surface, distend- mg it to the size of an inflated Sheep's bladder." It was not observed to have been in- jured either by exposure to the air, or by the repeated and forcible compression to which it had been subjected by the foetal extremities during the parturient paroxysms. Its mucous membrane was not in the least discolored, being clean and shining, and without the slightest trace of congestion. The foetus was lying on its left side, the head and neck thrown back and extending along the floor of the uterus, from the right to the left flank of the Mare. The fore-feet were beyond the vulva, and the right or upper hind- foot was in the vagina. Reposition of the displaced bladder was the first thing attempted, and this was readily effected by equable pressure being exerted by the hand on the surface of the viscus, " when the elastic matter was speedily expelled, and the collapsed body easily passed through its widely dilated neck, which was relaxed to such a degree as to admit of the free introduction of the three middle fingers." Though so easily returned, however, it was as readily inverted again, every expulsive effort bringing it into the vagina; and the frequent attempts made to prevent its pro- trusion, by the operator placing his arm firmly on its cervix, while his hand was engaged in rectifying the position of the foetus, were perfectly ineffectual, and even the applica- tion of the hand of a strong assistant over the meatus was equally unavailing. Delivery of the foetus, which was dead, had therefore to be effected over the cystic hernia ; this was accomplished without any visible laceration of the bladder by the violence to which it had been subjected ; its mucous membrane, however, was thickened and congested throughout its whole extent, and the effusion of blood on its abraded surface gave it the appearance of a " spherical mass of coagulated arterial blood." After being washed, it was readily placed in its natural situation by gentle pressure, when its cavity was explored to " correct local deviation." No subsequent displace- ment occurred. The operation occupied thirty-five" minutes. Suitable treatment was adopted — chiefly the administration of opiates, clothing the body and limbs, with mashes and infusion of linseed as diet ; thick dark bloody urine was passed for some days ; there was also much difficulty in moving the limbs. In six days recovery was complete. fi This was one of three cases of inversion of the bladder during parturition, which this veterinary surgeon had met with in his practice. TUMORS IN THE VICINITY OF THE GENITAL ORGANS. Tumors in the bladder, when of large size — as polypi, steatomous growths, etc., as well as calcareous concretions, may hinder parturition, or even render it impossible. Even an excessively distended bladder may offer an obstacle to the accomplishment of this act, either in check- ing the advance of the foetus, or by sympathetically disturbing the uterine contractions. The indications here are obvious. Tumors of various kinds may be developed in the connective tissue of the pelvic organs, and especially between the vagina and rectum, and more or less obstruct labor. Ovarian tumors may "also prove trouble- some, as may likewise multiple abscesses and kysts in the neighborhood of the genital passages. In some cases these may be successfully punc- tured ; in others extirpation may be possible ; while in others, again, the obstetrist can only choose between embryotomy and the Caesarean sec- tion. Distention of the rectum from an accumulation of faeces may prove a cause of dystokia — particularly in the Mare ; but this should be easily discovered, and readily removed. Tumors in the immediate vicinity of the anus are rarely a cause of difficult parturition. We have already alluded to melanotic tumors. MORBID ALTERATIONS IN THE GENITAL ORGANS. 341 2. Rigidity of the Cervix Uteri. /Rigidity or spas7n of the cervix uteri is a condition notunfrequently met with among animals — most frequently in the Cow, next in the Goat, and less often in the Mare. It appears to be more common with nervous, irritable animals, and especially primiparce, than others ; though it is sometimes noted in emaciated and debilitated animals, and even in those which are old, and which have previously brought forth without any trouble. Without any modification in the structure of the cervix, but merely by a kind of rigid contraction of its fibres, the os remains closed, and can- not be dilated by the efforts of the parturient animal. '^The cervix is not soft and elastic, as in the normal condition, but feels prominent and rigid, and shows less sensibility than usual ; while the os will not admit a fin- ger, or if it does, it grasps it most powerfully. The majority of veterinarians admit the existence of spasm of the cer- vix, while others maintain that rigidity and' spasm are synonymous terms, in so far as this conditioh is concerned. The first are ready to confess, however, that spasm is not always present, because very often the " pains " are feeble and few, and the absence of dilatation appears to be due rath- er to something abnormal in the contractility of the uterus, as a whole, than of this part in particular ; whereas, when there is spasm, it has usually been observed that there are inordinate and disordered contrac- tions of the organ. In short, it has been attempted to prove that in rigidity of tlie cervix there is a purely passive condition of this part, while in spasm there is an active contraction of the organ. In reality, there is no marked distinction between the two conditions, at least so far as ob- stetrical practice is concerned ; and this form of dystokia, in its more salient features, might be looked upon as merely an exaggerated mani- festation of that derangement which we have designated tumultuous or irregular parturition, or '"false \dhor " {metripercinesis, 2iS distinguished from ?netracinesia, or feebleness of the uterine contractions), in which the contractions are irregular or partial. We have pointed out that there are two sets 6i muscles in the uterus — the circular and longitudinal, and that there exists a marked antagonism between the circular fibres of the cervix and fundus of the organ, and the longitudinal fibres. So that if the first are more active than the sec- ond, and the latter cannot, as a consequence, overcome the resistance they offer, the os remains closed and labor cannot advance. This is, we think, the true explanation of this condition. Symptoms. The symptoms vary somewhat. In one case there is at first nothing unusual to be noted, the pains being manifested with their usual regu- larity and intensity, and the animal is in noways distressed. The only thing that is likely to awaken suspicion, is the unusual duration of partu- rition, which may extend over two, three, four, or more days, if assistance be not afforded. As the period is prolonged, the animal may in some instances lose condition, exhibit indications of exhaustion and suffering, and gradually sink ; or it may appear ill for some days, then rally and assume its ordinary appearance — constituting a case of " missed birth.'' * * We may here call attention to certain signs presented bv Cows, and which have been described by Biot {Rectteil de Mid. VHirinaire, September, 1876, p. 1007) as essentially pathognomomic of uterine 342 MATERMAL DYSTOKIA. In other instances, the creature manifests an unusual amount of ex- citement at first ; there is agitation, straining, and symptoms of colicky pains ; the abdomen is frequently looked at by the animal, which lies down but soon gets up again ; the pulse is full, strong, and frequent ; the conjunctivae are injected ; the skin is hot ; faeces and urine are passed at frequent intervals ; there is thirst and anorexia \ and sometimes during the throes the vagina is protruded beyond the vulva, and appears as a large red mass. A vaginal exploration is necessary, in order to learn the cause of ob- struction. This should be carefully and gently made — the latter pre- caution being most important to observe during the throes. It may be necessary, if the mucous membrane is dry, to inject some emollient fluid into the vagina, or introduce it by a sponge. When the hand is passed through the vagina, the os will be found more or less contracted, so that scarcely one or two fingers can be introduced into it, owing to the spasmodic resistance it offers, while the cervix pre- serves its elongated shape. In the Cow, Saint-Cyr has frequently found the cervix and vagina filled with a tenacious gluey matter, which sticks to the fingers like bird-lime, and which, by glueing together the margin and walls of the os, doubtless increases the resistance the canal offers to dilatation. If the finger can be introduced into the os, it will be found that there is neither deformity nor morbid induration, and that the constriction is due to the fibres of the cervix alone. Saint-Cyr points out that, contrary to what we have state'd above, the cervix uteri is sometimes completely effaced ; the bottom of the vagina being occupied by a kind of smooth-surfaced ball, in the centre of which is a narrow opening, and through which the foetus can be felt. The con- vex body is the posterior segment of the uterus which, pressed by the hand or some other part of the foetus, is pushed into the vagina ; while the small aperture is the os — partially effaced and undilated. This trace of the OS, instead of being in the centre, is at times more or less to one side, and occasionally it can only be found with much difficulty. * Diagnosis. From the symptoms enumerated, there should not be much doubt or delay in diagnosing this cause of dystokia. As in so many other in- stances, however, the necessity for a correct diagnosis is imperative, as on its accuracy will depend the success of treatment. If the exploration has been carefully made, the state of the cervix will dt once explain the delay in birth. Perhaps the only other condition of the cervix with which it might be confpunded is " induration ; " but in spasm this part is hot, tense, and painful, and neither hard, lumpy, nor deformed, as in the latter. disturbance in these animals, and for this reason have been specially designated as uterine. These signs, upon which he places the greatest diagnostic value, are observed when the sick Cow is approached or touched in any way. The animal then "suddenly elongates the neck, extends the head, yawns, protudes the tongue, and emits at the same time a kind of aull moan, but which is rather a powerful expiration than a real moan." When these signs are present, Biot asserts that the corps delit — the disturbance — is in the uterus, and never elsewhere. Laborious or protracted parturition, mal-positions of the foetus or monstrous conformation, occlusion or induration of the cervix uteri, hydramnios, torsion of the uterus ; and after par- turition, inversion of the uterus, retention of the plecenta, and vitulary fever with or without paralysis ;— all these may give rise to the manifestation of this singular piienomenon, which he has never witnessed in any other affection — not even in chronic diseases of the uterus. MORBID ALTERATIONS IN THE GENITAL ORGANS. 343 Prognosis. Simple rigidity or spasm of the cervix uteri, provided there is no alter- ation ill its texture, is not in itself of very much consequence. In many cases Nature overcomes the obstacle, and in the course of twenty- four, forty-eight, or seventy-two hours of more or less severe and exhaust- ing labor, delivery is effected spontaneously, and the animal and its progeny are none the worse after a short time. This delay has been most frequently observed in the Cow and Goat ; in the Mare it is rarely so prolonged. But, as a rule, it is not advisable to allow so much time to elapse after labor has commenced, without, at least, ascertaining the nature of the obstacle which delays birth • as during the longer intervals especially, complications may arise which might lead to serious results. The foetus may die, or it may assume a wrong position in the uterus, which may afterwards prove troublesome to the obstetrist ; the mother may become exhausted and the uterus paralyzed, so that the foetus cannot be expelled when the os is dilated ; or, still more serious, the energetic contractions of the uterus may produce rupture of the organ. So that a prognosis must be based on these considerations ; and both the owner of the animal and the veterinarian must bear in mind the fact, that while premature and too active intervention in such a case is to be deprecated, too long delay in affording assistance is to be equally guarded against. Trcatmefit. As this condition of the cervix uteri is, at the commencement, of no great importance, and merely retards natural delivery, active interference is forbidden for some time. When the first signs of parturition do not extend beyond some hours — one or two for the Mare, five or six for the Cow, according to Saint- Cyr ; when the obstetrist, by vaginal exploration, has assured himself that the genital organs, as welf as the pelvis, are not in any way de- formed or altered ; that the animal is all right otherwise ; and that rigid- ity of the cervix is alone the cause of delay in birth ; then he ought to wait, while being prepared at the same time for any emergency. The glutinous matter which has been mentioned as occupying the vagina and OS and covering the cervix, should be removed as much and as gently as possible from these parts, so as to permit dilatation to take place when the spasmodic condition begins to yield. If, however, labor appears to be unduly prolonged without any pro- gress being made in parturition, and if the "pains" are energetic, while the animal's condition is not so satisfactory, then intervention may be counselled. But this intervention should be of the simplest and mildest character ; and in the majority of cases it will be attended with entire success. Injections jz>^r rectum or vagmam, of emollient or oily fluids, to which tincture pi opium or extract of belladonna has been added ; the ointment or extract of belladonna smeared around the cervix or intro- duced into the os ; blankets or sacks steeped in hot water and applied over the loins of the larger animals, or warm water baths for the smaller ones ; and, in certain cases, the administration of draughts containing some soothing medicament — such as chloral, chloroform, or opium j— these are the means to be adopted. 344 MATERNAL DYSTOKIA. Bleeding has been advocated by some authorities — particularly on the Continent ; but we quite agree with Saint-Cyr that, unless something very unusual in the general condition of the animal demands it, the abstrac- tion of blood is of very questionable value. Opium is of much service, from the influence it possesses in controlling the uterine spasms ; it is therefore to be recommended when the "pains " are severe and frequent. It may be given in large doses, both in draught and enema, and frequently. Chloral hydrate and chloroform, particularly the former, are of great utility, and possess advantages over opium as soothing agents. For a very long time, belladonna has enjoyed the reputation — and ap- parently with justice — of being one of the best agents for combating spasm of the cervix uteri, and permitting dilatation of the os. Occasion- ally its efficacy has been contested, but the great balance of evidence is in its favor, and its employment is almost a matter of course with every veterinary obstetrist. It is generally applied in the form of extract around the cervix, about a drachm or so being required for one application — it is rare that a second application is needed. Time sliould be allowed for its action. Sometimes it is attempted to dilate the os uteri by manipulation — the fingers and hand being the dilators ; but this means should not be adopted until milder measures have failed, and until time and patience have been exhausted over them. The hand and fingers well oiled, or smeared with extract of belladonna, should be introduced in the form of a cone, towards the os ; if they cannot be passed into the canal in this shape, then the insertion of one finger may be attempted, followed by a second, and so on until the hand has been pushed through. Very frequently this cannot be accomplished at the first trial, nor yet at the second ; but with patience and judgment it rarely fails, and if con- ducted with the care and gentleness which all operations of this kind should receive, such manipulation may be attempted without the least danger at intervals of a few hours, until crowned with success. The condition of the os should be ascertained, after a certain period has elapsed since the last attempt, every precaution being adopted to prevent injury ; and an entrance to the os ought only to be effected when the re- sistance has greatly diminished, and can easily be overcome. A fairly typical case of this condition, and one which illustrates the evil results of undue haste in attempting to effect delivery, is given by Cartwright ( Veterinarian, vol. XV., p. 371). A Cow, three years old, when within about two days of calving, was found straining violently, and had protruded a portion of the vagina and rectum. The os uteri was not in the least dilated, but the Cervix felt larger and harder than usual, and projected a good deal into the vagina. The head and feet of the calf could be felt by examination -per rectum, and were not far from their natural position ; but when the an- imal strained, they were forced with such violence against the rectum that it was feared they would penetrate it, and large swellings were formed at the anus and vulva. Blood was abstracted, and opium given in solution. In threfe hours the symptoms were not so urgent, and more opium was given. During the night an amateur had repeatedly examined the os uteri, had tried to dilate it, pulled out portions of hard lymph there- from, and got. the fore-feet and head of the foetus into the passage ; afterwards, four or five persons had been pulling at the latter with ropes, but could not get it away. Cart- wright found the calf properly presented, but counselhd abstention for an hour or so, as the OS was not sufficiently dilated. Two hours afterwards, it was attempted to ex- tract the calf by three persons pulling at the cords attached to it, while the operator tried to dilate the os. While traction was being made, the cervix protruded about five inches beyond the vulva, and was excessively tight around the calf s head ; but from the force of pulling, the " stricture " ruptured to the extent of four or five inches. The calf MORBID ALTERATIONS IN THE GENITAL ORGANS. 345 then immediately came away, and the uterus became inverted. The placentulae were removed and the organ was returned. The annnal continued to strain for about a week, and nineteen days after delivery a fireat quantity of putrefying matter was removed from the inner surface of the uterus by manual exploration ; in four days after this, the creature being in a helpless state, it was killed. The uterus was found to be quite contracted, and contained about a pint of matter. There was a distinct cicatrix, about four inches long, over a portion of the cervix and vagina, where probably the laceration had occurred. " Taking the cervix uteri, uterus, and vagina all together, there was little amiss with them, more than after an ordinary case of parturition. The cervix uteri was a little rigid, but perhaps scarcely more than usual," Mechanical dilatation of the os by means of the sponge tent has been much, and most successfully, employed in human obstetrics for a long time, and the method has recently been greatly simplified and perfected by Sims and Joulin, Saint-Cyr thinks that it is perfectly applicable to animals, and we are of the same opinion. The tent can perhaps be pur- chased at any druggist's, but if not it is easily made, Joulin makes those he uses \w the following manner : — From a somewhat fine and dry sponge of inferior quality, he cuts two long conical pieces, one about three and a quarter inches in length, about an inch wide at the base, and one-third of an inch at the apex ; the other five or six inches in length, two and a half inches at the base, and one-third of an inch at the apex. Of course they would require to be larger for animals. These cones are then prepared for use by wrapping them closely round in twine, the circles of which should be so near each other as not to leave ridges on the sponge. By this pressure the tents become extremely com- pact, and look like a thick bougie. When required for use, the twine is removed — this should not be done until the tent has been prepared for at least two or three hours, when it will have acquired sufficient rigidity. A piece of cord should be attached to its base, so as to allow it to be withdrawn when inserted in the os ; but before this insertion takes place, the apex must be covered with a little lard, cerate, or extract of belladonna. The sponge is passed into the OS as far as possible, either by the fingers or forceps, and until the base of the tent is close to the margin of that opening. The narrow and slightly flexible apex of the tent allows of its passage through the os into, the uterine cavity ; but in order to be successful the operation must be quickly performed. Otherwise, the sponge rapidly absorbs mucus and loses Its rigidity. No plugging or other means are necessary to retain the tent, as the portion which projects into the uterus quickly increases in size from the absorption of moisture ; so that, after a few minutes, a certain amount of force is necessary to withdraw it therefrom by means of the cord. The sponge-tent acts in several ways, and simultaneously: i. It detaches the membranes, and this is often sufficient to induce labor; 2. It acts as a foreign body in irritating the posterior segment of the uterus, which reacts by contracting ; 3. It dilates the inner opening of the os \ 4. It also dilates the entire length of the os, by swelling through imbibi- tion of the uterine mucus. To obviate the risk of softening before it is inserted into the os, Joulin prepares the tent in the following manner. Instead of wrapping it round with twine while it is in a dry state, he saturates the sponge in a solution of gum Arabic, and then having rolled the twine round it, leaves it to 3 46 MA TERN A L D YSTOKIA . dry for some days. After this treatment it preserves a certain degree of siippleness, but may remain for a minute or two in contact with the mucus before imbibing it. Barnes' procedure for the dilatation of the os uteri in woman, has also proved of great service in human obstetrics ; but to our knowledge it has only once been tried with animals, though there is no reason why it should not be successfully employed, not only in producing abortion in those cases to which w^e have previously alluded, but also in the morbid con- dition now under consideration. This procedure -consists in dilating the os by means of fiddle-shaped india-rubber bags, which for women are of three different sizes ; but the very largest of them would probably be required as the smallest size that could advantageously be used for the Cow or Mare.* Fig. 77- Barnes' Uterine Dilator. The bag, in an empty condition, is introduced into the os by means of a whalebone sound or director, which fits into a small pocket at the side ; it is pushed through the canal until the pocket end projects into the uterus j then water is steadily injected into it by means of the tube at- tached to the other end. When filled with water the bag remains in the OS, in consequence of the middle portion being narrower than the two ends. This dilator produces the same results as the sponge tent, over which it has some advantages. The only drawback to it is, perhaps, the thick- ness of its substance ; as it cannot be passed into the os unless this is permeable to two or three fingers. The instance to which we have alluded as that in which this dilating bag has been tried, is recorded by West ( Veterinarian, 1876, p. 384). On February 9th, 1876, lie saw a very valuable Cow, the winner of several first-class prizes, which should have calved in the previous November, but had showed no signs of doing so. It was, in fact, a good example of the condition which we are now treating of, and which has been vulgarly designated a " horned-up " os uteri. The animal was apparently healthy, the pulse and temperature being normal, and there being no offensive discharge from the vagina. An examination /^r rcctian revealed the presence of a foetus in the uterus, while exploration per vaginam proved that the os uteri was nearly closed, and that the end of a finger could not be inserted. Belladonna was applied, and the cervix patiently manipulated for a long time, but the constriction could not be dilated to the smallest extent. From * These bags are made by Weiss & Son, surgical instrument makers. Strand, London. When ordered, the animal for which they are to be used should be mentioned. MORBID ALTERATIONS IN THE GENITAL ORGANS. 347 the time that elapsed since the period of gestation had expired, this was evidently a case of "missed birth." It was proposed to incise the cervix, so as to allow the hand to be introduced, but this was objected to by the owner, as it would probably render the Cow useless for breeding purposes. The case was left as hopeless, and as it was decided that the ani- mal should not be killed, it was kept as a " pensioner." About the end of April it was proposed that Barnes' infiating india-rubber bags, as used for women, should be tried, As might have been foreseen, it was soon discovered that, though suitable for the human female, the bags in ordinary use were neither suffi- ciently long nor strong enough. Special bags were therefore prepared, and the smallest was introduced into the os by means of the whalebone director, though with the greatest difficulty. It was then gradually filled with warm water by the india- rubber syringe and tube attached to it. In about ten minutes this bag had sufficiently dilated the os to admit that of the next size, and in rather less than an hour the largest bag was filled, when the passage was so widened that the decomposed fcetus was re- moved with very little trouble. The uterus contained a large quantity of horribly foetid fluid ; this was removed, and the cavity thoroughly cleansed and syringed out with a dilute solution of Condy's fiuid. The animal quite recovered. A simpler contrivance than that of Barnes, and which will perhaps be found useful on similar occasions, is that designed by Schnakenburg, and named the " Sphenosiphon." It is merely the bladder of an animal tied to a syringe, and which, when water is injected into it, mechanically dilates the cervix. For veterinary purposes, the bladder might be attached to a piece of india-rubber tubing, which again could be fixed to the nozzle of the syringe. It and Barnes' dilator act in the same manner as the natural " water-bag," formed by the fcetal membranes and liquor amnii. Another means which might be successfully employed in such cases, as it is simple and without danger, and at the same time effective in pro- ducing premature artificial delivery in woman, is the uteri?ie douche intro- duced into obstetrical practice in 1848, by Kiwisch of Dresden. This is generally known as the " ascending uterine douche," and consists of a jet of water at a certain temperature directed against the posterior uterine segment for some minutes, and repeated, if necessary, at intervals of two or three hours. It is often resorted to in woman to favor the dilata- tion of an e?itirdy closed os, and to prepare it for the application of an- other method, which may be either Barnes' or Schnakenburg's. Saint-Cyr proposes to adopt this method to animals in the following manner. The apparatus may consist merely of a bucket, or barrel with one end out, such as may be found in almost every stable or cow-shed, and a long piece of india-rubber tubing about half an inch in diameter, which can be procured easily and cheaply. To one end of this tubing is fitted the pipe of an ordinary syrfnge — either enema or garden ; the other end is immersed in the barrel or pail, which should be filled with tepid water at a temperature of about 40° Cent. (104° Fahr.), and placed sufficiently high to yield a pretty strong jet. In order to set the water flowing, the tube must be exhausted of air by suction with the mouth, and the end provided with the syringe pipe carried into the vagina and directed towards the cervix uteri. Each douche should continue for about ten or fifteen minutes, or longer ; and it may be repeated every two or three hours, or even at short intervals, according to circumstances, until the desired effect has been produced. Cazeaux speaks highly of this method of dilating the cervix in woman, and for the following reasons : I, The uterine douche prepares the act of premature birth with the greatest possible gentleness, by means of the softening and the necessary dilatation of the inferior searment of the uterus. 348 MA TERNAL D YSTOKIA . 2. By this means all preparatory treatment is needless. 3. This procedure is easily employed, and not at all disagreeable to the woman, as the injection of warm water does not produce any discom- fort. 4. It does not require much time. 5. Its action can be graduated at the will of the obstetrist, who may, according to requirements, increase or diminish the duration of the douche and the temperature of the water, as well as vary the parts of the cervix on which he directs it. 6. Finally, it can never occasion lesions of the genital organs, nor yet injure the foetal membranes or the fcEtus. We deem this uterine douche well worthy of notice, and though there are only, so far as we can ascertain, three cases on record in which it has been tried with animals, yet as these were most successfully treated by it, it may be assumed that it will be found a most valuable means of not only dilating the os uteri, but also of controlling the action or relieving certain morbid conditions of the uterus itself. Quivogne communicates to Saint-Cyr {Traite de Obstetrique Veter- itiaire, p. 373) the following three instances of the successful application of the douche. 1. In 1859, a Cow, aged five years, and seven months pregnant, was purchased, and two days afterwards it jumped over the fence of the meadow in which it had been placed. In a few hours it began to exhibit symptoms of colic. A vaginal examination was made, and it was discovered that there was complete occlusion of the os, so that the extremity of the little finger could not be introduced. Quivogne deemed it the best course to wait before interfering. Some hours having elapsed, however, labor pains became frequent and energetic ; though the cervix was in the same state as before. Still later, towards the evening, the condition of the animal was more aggravated, and penetration of the os was altogether impossible. All the measures that might be adopted in such a case were passed in re- view, but none of them could be decided upon. Here was a cervix anatomically healthy ; to resort to incision appeared to be imprudent, and too dangerous an operation. Irriga- tions with tepid water were then thought of, and it was resolved to try them. In order to apply them, Quivogne had recourse to a small garden syringe, to which was already attached an india-rubber tube. The irrigations were commenced and con- tinued until the morning, at first under the direction of Quivogne, then by the people be- longing to the house. The next morning at six o'clock the patient was lying quietly and was being douched without the slightest manifestation of displeasure. Then an explo- ration was made, and it was found that the os had sensibly dilated, as the whole of the fingers of the hand, gathered together in a cone-like manner, could be inserted, and by a slight pressure the whole hand was passed through. The douches were resumed, but only for a short time, as the " water-bag " was not long in appearing, and very soon after delivery was effected. 2. In i860, the same veterinarian was called ^pon during the night to attend upon a Goat, which was showing symptoms of abortion. Vaginal exploration, although difficult, on account of the smallness of the pelvis, nevertheless satisfied him that this was another case of rigidity of the cervix. He at once decided to have recourse to the uterine douches. For lack of better apparatus, he was compelled to use a horse syringe, with which he directed, as well as he could, frequent jets of tepid water on the cervix. Here again, notwithstanding the imperfect apparatus employed, the result was favorable ; as delivery was effected without any trouble at one o'clock next morning. 3. In the same year, Quivogne was again requested to see a Goat which was about to abort. The obstacle to the passage of the foetus was, in this case also, the rigidity of the cervix and occlusion of the os uteri. Having already succeeded twice with the douche, he was determined to give it another trial, though in a modified form. He placed a washing-tub on a table, into the plug-hole of which he fitted a sufficiently-long india-rub- ber tube ; having filled this vessel with tepid water, he immediately commenced the vaginal douches, and these were productive of complete success in five hours. Rougher treatment for the dilatation of the cervix than that which has MORBID ALTERATIONS IN THE GENITAL ORGANS. 349 been described, is sometimes resorted to, either through impatience, ignorance, or in cases which demand prompt action ; as the other measures require a certain amount of time, from the slowness of their operation — though perhaps this is rather an advantage than otherwise. Forcible dilatation of the os uteri has been practised in human obstetrics, and special instruments have been devised with this object. Such dila- tors have been constructed by Osiander, Busch, Mende, and Krause, but they have not been much used, as milder measures are far more prefer- able. The same remark is applicable to veterinary obstetrics, in which there is only too often a tendency to imagine that because the patient is an animal, so all the more force and brusqueness should be resorted to. Forcible dilatation of the cervix, which is not to be recommended, except perhaps in very exceptional instances, has its advocates, and two cases re- ported by Oschner, a Swiss veterinary surgeon, prove that it may be suc- cessful, notwithstanding its disadvantages. In these cases, every other known means had failed ; so Oschner procured a pair of large fire tongs used by blacksmiths, and wrapping their jaws round with tow which was smeared with grease, he introduced them, closed, through the os j then an assistant gradually opened the shanks or handles of the tongs, and so produced the desired widening of the passage. The inflammation set up by this manoeuvre was dissipated by the employment of soothing reme- dies, after fifteen days' treatment. It is obvious that such a mode of dilatation should not be practised, unless there is something most unusual in the case ; as it is a most pain- ful operation, and likely to produce -contusions and lacerations of the cervix, which may require much tijne and attention to repair. Incision of the cervix {vaginal hysterotomy) is another operation which can scarcely ever be required for rigidity or spasm of this part, and ought to be reserved for more serious conditions. At any rate, it should not be practised until the other measures we have enumerated have been fairly tried, as it is an operation not without risk of ill consequences. In some cases, in which the spasmodic action of the uterus is irregular, and leads to occlusion of the os, it might be advisable to resort to anaes- thesia, produced by the inhalation of ether or chloroform. Of course the anaesthesia should not be pushed to complete insensibilit}^, but be limited to semi-consciousness or " obstretrical anesthesia." This is more particularly to be recommended for the smaller animals. In the majority of cases, when the rigidity has been dispelled, or the spasm relaxed, birth will take place without further assistance being required ; though it may be well that the obstetrist assure himself that the foetus is in a favorable position for delivery. If there appears to be atony of the uterus, or the mother is exhausted, or if the foetus is dead or in a faulty position, then it will be necessary to afford aid in parturition by adjustment and traction. In very many instances, it must be remembered, that this rigid condi- tion of the cervix is due to malpresentation or malposition of the foetus in the uterus ; and even when the os has been sufficiently relaxed, the young creature cannot pass through until it has been properly placed, and not unfrequently aided through the genital canal. 3. Induration of the Cervix Uteri. Induration of the cervix is the term applied to this part when its tex- ture is altered in any way — whether the alteration may be fibrous, sar- 35° MATERNAL DYSTOKIA, comatous, or cancerous — so that its elasticity being destroyed, and its structure inextensible, it offers an obstacle to parturition. This alteration, or " scirrhus," as it has sometimes been designated, is not at all unfrequent; but it has only been observed, it appears, in the Cow, and would seem to be almost, if not quite, peculiar to that animal.* The reason for this partiality has been variously accounted for, but prob- ably Bouley, in an unpublished note to Saint-Cyr, has afforded the most satisfactory explanation. He remarks that " irritation produces in the bovine species phenomena of induration much more durable than in any other species ; in proof of this, witness the plastic engorgements — so ad- verse to suppuration, and so slow to disappear — which are caused by a seton introduced beneath the skin of an ox ; witness, also, the enormous swellings observed as a consequence of inoculation for pleuro-pneumonia (bovine), and those indurated tumors vulgarly designated osteo-sarcoma- tous, so frequent on the maxilla, and which repeated irritation produced by the prick of a needle are sufficient to produce. This seems to be a general organic fact, of which induration of the cervix uteri is only a par- ticular instance." This induration must not be confounded with the dense, fibrous, though normal, consistence of the cervix of the Cow's uterus, which, there can be no doubt, has often been mistaken for a diseased condition, and particu- larly when in a rigid or spasmodic state. The distinction between what we may term the functional dera?igement an-d the pathological alteration of this part is of great importance from an obstetrical point of view ; as the first maybe remedied by the- mild and innocuous measures enume- rated, while the second can only be overcome by a more or less serious surgical operation. In some cases, perhaps the induration is congenital ; but it must be admitted that, as a rule, it is due to the influence of disease or injury — past or present — in the textures. It may, therefore, be expected to be more frequent in old animals, or those which have already been bred from, than in those which are young or are pregnant for the first time, though these do not appear to be exempt. Rancon assured Rainard that morbid induration of this part was wit- nessed more frequently in the ancient Brian9onnais, where he practised for thirty-six years, than in other regions of France. We are not aware whether the influence of breed or locality has been observed to influence its prevalence in other countries. Symptoms. Owing to the situation of the cervix, the nature of the tissues entering into its composition, as well as to the slowness with which the pathologi- cal alterations take place, this condition may be in existence for a long time, without any appreciable change being observable in the animal's health. Therefore it is that Cows which are so affected do not exhibit any thing, during the whole period of pregnancy, which might lead any one to suspect the existence of uterine disease. * I can only find one case mentioned as occurring in any other animal, and that happened in a Ewe. It is reported by Shentone ( Veterinarian, vol. xxix. p. 36), who says that the creature had been in labor since the previous night, but had made no progress, and was very much exhausted. " It was a case of scirrhous os uteri- 1 told him (the owner) I would divide the stricture as the only means of saving her, but in her <;ase it was almost a 'forlorn hope.' However, I did divide it, cutting in"two places, parallel to each other, and with a good deal of difficulty extracted a large lamb that had, from its appearance, been dead for some time." The Ewe recovered. MORBID ALTERATIONS IN THE GENITAL ORGANS. 351 In some cases, however, towards the termination of pregnancy there has been remarked a lisllessness or gradually increasing debility, which has been so great at last that the animal assumed the recumbent position : and could not get up without assistance. This general weakness has been mistaken for paraplegia, and has sometimes been supposed to be due to lumbago ; but it may have been merely a symptom of generalized cancerous infection, the part itself being the seat of cancer. But in the great majority of cases, the existence of induration is not suspected until parturition sets in, when the labor pains, which may con- tinue for a long time, attract more than ordinary attention, as birth does not take place. And not unfrequently during the pains, and more espe- cially when the animal is lying, a livid, irregular-shaped, and nodulated kind of tumor appears between the labia of the vulva ; this is the undi- lated cervix uteri. In other instances, however, nothing is observable externally, and a vaginal exploration is necessary. The cervix is then discovered to be more or lass protruded into the vagina, and to form a voluminous, irregu- lar, nodulated tumor which in some cases feels as hard as wood, and in others it has a rugged, soft, and ulcerated surface. Some veterinary obstetrists have described transverse rugae, composed of a solid, unyield- ing, fibro-cartilaginous material, in the os. The OS is not always easily found, and it is sometimes so contracted, that one finger cannot be introduced into it ; at other times it is not so constricted, and the foetus may be felt through it. But in every case it is irregular and deformed, deviated from its usual direction, and its walls are greatly thickened, perhaps corrugated. Its degree of hardness and thickness will indicate whether, and to what extent, it can be dilated ; and this condition may not only involve the whole of the cervix, but also the walls of the uterus itself, as w^ell as those of the vagina. When the cervix is ulcerated, the hand will be found covered with blood after the examination. Diagnosis. The diagnosis or this condition must be left, to a large extent, to the tactile impressions derived from a vaginal exploration. In some cases an ocular inspection of the cervix may be possible, and the previous his- tory of the case may also be useful in this direction. Prognosis. The influence of the induration on the act of parturition, will depend upon the degree and extent of the alteration. If this is not very serious, and does not implicate the organ very much, and particularly if the in- duration is localized in some unimportant part, parturition, though pro- tracted, may nevertheless be accomplished without assistance. Often, however, the results are troublesome ; one of these being laceration of the cervix, from its unequal dilatation. Though there is a great difference, pathologically speaking, between the various alterations — for example, between simple fibrous transforma- tion and cancerous degeneration — yet it is admitted that the most benig- nant alteration' is infinitely more serious, from an obstetrical point of view, than simple rigidity of the cervix, either in its immediate or remote 352 MATERNAL DYSTOKIA. results. This Saint-Cyr has proved to be the case in nineteen recorded observations. Of these, seven were more or less unfortunate in their re- sults ; in three instances, the mother and foetus succumbed ; in other three, the mother died, but the progeny was saved ; and in the seventh, the calf died but the Cow lived. This is a very high rate in mortality, and yet Saint-Cyr is not quite certain that in these nineteen observations there were not some which were rather cases of simple rigidity than indura- tion of the cervix. For as Rainard remarks — and the remark would also apply to the observations recorded in English veterinary literature — it is not always easy, for lack of sufficient details, to discern clearly to which category belongs such or such an observation given by writers under the title of" indurated cervix," " scirrhous cervix," " stricture of the os uteri." In arriving at a prognosis in a case of this description, the immediate results are not alone to be taken into consideration ; as pregnancy and the manipulatory operations necessary to effect delivery — which is always tedious and difficult — give to morbid alterations of these parts — even when quite benignant in their nature — an exceptional gravity ; so that many animals, even after a comparatively easy delivery, succumb soon after- wards to the diseased condition. The uterus may be ruptured through the efforts at delivery. Pathological Anatomy. The lesions found after death are generally alluded to as "fibrous de- generation," " scirrhus," or " cancer " of the cervix ; and it is usually mentioned that this part was " hard and like cartilage," " creaking under the knife like cutting an unripe apple or a turnip ; " or that there was "scirrhus " or " cancer," " nodular and hard like cartilage." Macgillivray states that when the contraction of the os uteri is the re- sult of prior disease, it will generally be found of a hard fibroid nature ; while, on the other hand, where the contracted parts are soft and very much thickened, acute disease will commonly be found accompanying the stricture. " In hard stricture, the transverse rugae or folds appear gener- ally to be transformed into a compact, unyielding fibro-cartilaginous ma- terial ; in one very serious case I found six of these hardened unyielding transverse rugae or folds between the os tmcce and os mternum. In soft stricture, without any actual disease being present, the contraction is generally confined to the os and the vaginal portion of the cervix uteri. In cases of complicated stricture, or, in other words, stricture accompanied by some active disease, it will often be found that the stricture is merely the concomitant effect of the disease, and such causative disease will al- most invariably prove to be either ulcerative, scirrhous, really cancerous, or fungous in its nature. . . . Deposits of a fibrinous nature are only too common in patients of rheumatic constitution." Lecoq, GelM, Horsburgh, Berger, Bruckmiiller and Macgillivray have each recorded autopsies of animals which died from, or were killed be- cause of, this condition. These are all the writers, to my knowledge, who have done so. I. Called upon to assist a Cow which could not calve, Lecoq [Journal Pratique de Med. Veterinaire, 1828, p. 88), on inti'oducing his hand into the vagina, found that the neck of the uterus was thickened and hard, and the os quite closed; that a round body of the same density was present at the upper part of the vagina, and was prolonged to- wards the anus. When he withdrew his hand it was stained with blood. MORBID ALTERATIONS IN THE GENITAL ORGANS. 353 Dilatation of the os being deemed impossible, and the animal being nearly dead, Lecoq had it destroyed ; at the autopsy he discovered the following lesions : " The lining membrane of the uterus was of a dark-red color, which became black towards the cervix ; while the os was so contracted that the finger could scarcely be passed into it. The walls of the cervix presented a yellow scirrhous engorgement, so hard that it creaked under the scalpel ; its thickness varied from one to two inches, and in its centre were several small purulent centres the size of a cherry-stone. A cylindrical body of the same character, about five inches in length, and gradually diminishing in volume, was lodged at the upper part of the vagina. ' 2. In a Cow w.iich had died about three weeks after parturition, but which, it appears, had hien suffering for fifteen months, and had succumbed to the effects of calving, Gelle [Pathologie Bovine, vol. iii., p. 618) found the following, among other lesions: "The vagina was in its normal condition, but the neck of the uterus was invaded by an enor- mous hard, unequal, and lobulated cancerous tumor, softened at several points, and from several openings in which escaped a pultaceous, greyish-white cerebriform matter, mixed with blood-streaks, and which blackened the silver probe. A little of this matter flowed into the vagina; but in the cavity of the uterus there was a large quantity, which was also more colored by the blood that had passed with it through the fistulous openings in the tumor. The large violet and slaty-colored patches on the lining membrane of the uterus, testifv to the chronic character of the inflammation. 3. Horsbu'rgh relates ( Veterinarian, vol. xiv., p. 605) the case of a Cow in labor, which had been very ill for two days, and which had been attended by an old shepherd. When Horsburgh saw the poor animal it was dying, and the os was completely con- tracted and undilatable. He attempted to incise the cervix, but this caused so much pain that he desisted, and awaited the death of the animal, in order to perform the Cae- sarean section and extract the calf. In a short time the Cow succumbed and the opera- tion was performed, but the fcetus was dead. On examination, the latter was found in a natural position, but the uterus was much inflamed. A stricture of the os, about four inches in length, existed ; this was " corrugated longitudinally, and of a cartilaginous hardness — so much so that I could not force a passage with the finger, but found a blunt- pointed stick to answer the purpose. I removed the uterus by dividing the vagina about four inches posterior to the stricture, and, with the hooked bistoury, made an incision longitudinally through one of the sides of the cartilaginous substance. The parts were immediately dilated, until I could with ease introduce my hand. On making the incis- ion on the other side, the corrugations gave way." 4. Macgillivray [Ibid., vol. xlv., p. 718) attended an aged Cow, almost reduced to a skeleton from the effect of a rheumatic fever. The animal had not been able to get up for three weeks, and was now in the pangs of impotent labor. " On examination, I found this a case of hard stricture, the worst case I ever met with, there being no less than six transverse hardened bands, each completely encircling the cervix uteri. The OS uteri was also firmly rigid. I found it utterly impossible to complete the incisive ope- ration in this case, and only succeeded in cutting through three of the transverse rugae or hardened bands; and as the Cow was evidently a worthless subject, and there being no doubt that the Calf was alive, I proposed performing the Cassarean operation, in order to save the life of the latter. The owner at once consented, and appeared highly delighted with the Calf, which was alive and ultimately did well. The Cow was killed immediately after the operation. ^ Treatment. The condition of the cervix uteri being ascertained, there should be no delay in resorting to active measures, as it is impossible for delivery to be effected, in the great majority of cases, without such interference. Here the necessity for a correct diagnosis is, as we have already insisted, of the greatest moment ; for if the obstacle to birth is only rigidity or spasm of the uterus, this can generally be overcome by mild measures and with- out risk or injury to the animal ; whereas, in induration, these measures would be ineffective, and valuable time would be lost in trying them. Delivery, in induration of the cervix, must be effected by one of two serious operations. This must be either vaginal-hysterotomy or gastro- hysterotomy. We shall again allude to, and describe these, in speaking of obstetrical operations. It may only be necessary in this place to say that vaginal-hysterotomy 23 354 MATERNAL DYSTOKIA. — by which is meant incising the cervix, either completely or partially, in one or more places — does not offer any very dangerous consequences when the textures are healthy; though when they are much degenerated, the operation may be followed by troublesome, if not fatal results. Nev- ertheless, dilating the cervix by incision is rarely so serious for the mother as the Caesarean section ; though the foetus may incur more risk, as, after the cervix has been relaxed, it is often a tedious and difficult op- eration to effect delivery, and strong traction may even be necessary. As this measure offers a chance of saving both mother and foetus, it should, as a rule, be preferred to gastro-hysterotomy ; and this preference is still further warranted by the fact that the life of the mother is of more value than that of the foetus, and if one must be sacrificed, it should be the latter. Should the foetus happen to be dead, then there is an addi- tional motive in preferring incision of the cervix. When the os has been considered sufficiently dilated for the introduc- tion of the hand and arm into the uterus, then the foetus should be placed in position for extraction — the most favorable being, of course, the verte- bro-sacral, with the head and fore limbs towards the os. Should it be found impossible to engage these in the passage, then more incisions may be made in the cervix, and this can be done without displacing the foetus. It is well to remember that it is very much better to dilate the os by incision than by laceration, through unduly forcing the foetus into it. At the same time, judicious traction should be made during the maternal efforts. Aubry, Van Dam, and some others, have witnessed fatal haemorrhage resulting from the incisions ; while metro-peritonitis has also been re- ported as an equally unfortunate sequel. But these cases are exceptional. Those veterinary obstetrists in this country and on the Continent, who have had most experience in the op- eration, are unanimous in asserting that, provided certain precautions are adopted in making the incisions, no such results are likely to follow. Donnarieix states that, in thirty years, he has performed vaginal hys- terotomy in sixteen cases of schirrus, and other kinds of induration' of the cervix leading to occlusion of the os uteri, and of these only one died, though the cause of death was not ascertained. Recovery is the rule and death the exception. Of course recovery must always be doubtful if the disease of the cervix is of a malignant nature, as the operation and the irritation caused by the extraction of the foetus will, in all probability, hasten its progress. In some rare instances it may be advisable to have recourse to the Caesarean section at once. When, for example, labor has been severe and prolonged — when some days have elapsed since parturition com- menced, and the veterinary surgeon is not sent for until amateurs have exhausted their efforts and the animal is sinking ; or when, from a va- ginal exploration, it is ascertained that uterine or vaginal disease is so extensive and advanced that the mother cannot live much longer, and the foetus is alive ; then this formidable operation should be adopted without delay. Though very many cases of induration of the cervix, with stenosis of its canal, are recorded in Continental veterinary literature, yet we do not find lialf-a-dozen instances in English journals. Of these we select the following : MORBID ALTERATIONS IN THE GENITAL ORGANS. 355 1. Hall [Vetcrbiarian, vol. xxviii., p. 272) attended a Cow which had been in labor for twenty-six hours, and was so much exhausted that the labor pains had almost sub- sided. The OS uteri was found to be impermeable. Stimulants and ecbolics were ad- ministered, but they produced no effect pn the uterus. It was then " determined to cut through the ligaments or bands which encircle the inner margin of the os uteri, and having done this with great difficulty, it afforded only slight relief; for it was more like cutting bone than elastic tissue. I could even now only get three fingers in ; but this giving me more room to work, with a curved knife fitted to my finger I made four inci- sions — one above, another below, and one at each side. With great caution I had to proceed, for the Cow was now making violent throes ; but I had more room, and with the assistance or five men I brought the calf into the world alive." The Cow recovered. 2. Macgillivray (Ibid.,\o\. xlv., p. 717) was called to a seven-year-old Cow which had been trying to calve for twenty-four hours. The foetal membranes had ruptured, but an amateur who had been interfering could only succ'eed in passing one finger into the os uteri. The labor pains were tolerably severe, and the entrance to the uterus was found to be quite rigid and closely contracted, admitting only two fingers with great difiiculty. The cervix was soft, but within the os were three transverse bands, exceedingly firm and unyielding, and no manipulation could relax them. It was resolved to cut through these apparently cartilaginous rings ; but as the cervix could not be brought sufficiently back into the vagina to be seen and manipulated externally, cutting through it was diffi- cult and required extreme care. A partially covered knife was, however, introduced into the os, and two lateral incisions, " up and out," were made through the transverse bands. " The effect was wonderful, the whole parts relaxing almost instantly, and the fore-legs of a foetus made their way into the vagina ; but it required considerable trac- tion to get the head, and subsequently the whole body, away. There were twins pres- ent, and both were born alive and did well. Very little assistance was required in bringing the second calf away. There was scarcely any haemorrhage." 3. The same writer mentions the case of a two-year old Cow in its first pregnancy. This animal had been unwell for some days ; there was anorexia, and occasionally se- vere labor pains. " The whole uterus and its contents were seemingly at times forced into the pelvic cavity, and at such times the walls of the vagina became inverted." On exploration, the cervix was found firmly contracted, the os only admitting a finger. Di- latation by " emollients" and other means having been tried, an interval of twenty-four hours was allowed to elapse before incision was attempted. The operation was per- formed as in the other instance, and delivery was effected. " In this case, however, the calf was of great size, and it required a tremendous amount of traction to effect a sep- aration between the mother and foetus. The calf was alive and did well ; and the mother, notwithstanding much unavoidable laceration, with good nursing and treatment came all right." 4. Another case alluded to by Macgillivray as one of " soft stricture," was also that of a primiparous two-year-old Cow which had occasionally been seized with labor pains during five days. These were at times so severe as to bring the cervix uteri into view, when " it presented a very inflamed appearance, was extremely ragged in outline, and considerable fungous excrescences had become developed around the margin. . . . The cervix was quite soft, and attended with much inflammatory action and. surrounding thickening." Vaginal hysterotomy was performed as in the previous cases, and with much difficulty a living calf was extracted. But the mother was so " frightfully torn," owing to the large size of the foetus, that it was deemed advisable to have it slaughtered. The owner would not then consent, but after the creature had lingered for ten days, it had to be killed. 5. Migliano {II Medico Veterinario, 1875) is the latest writer who treats of dystokia from induration or stenosis of the cervix uteri. The first case of dystokia recorded by him occurred in a Cow three years old, which had already produced a calf without any difficulty. When seen by Migliano, the animal was in the act of parturition : it was lying on the right side, manifested indications of uneasiness or pain, and a small quan- tity of a slightly fetid fluid escaped from the vulva. The proprietor stated that the Cow had eaten a little food, but much less than usual. To inform himself as to the position of the foetus, Migliano made a vaginal exploration, when he encountered an ob- stacle that prevented further investigation, in the form of occlusion and rigidity of the cervix uteri. In presence of the collective symptoms in this case, he thought it better to wait. On the following day, another attempt at exploration proved the existence of the same obstacle, the character of which it was now determined to ascertain. Migliano found it possible to assure himself that it was composed of three dense fibrous rings, each the thickness of the little finger, very slightly elastic, disposed transversely, and so firmly closing the uterine opening as to render every effort to introduce the hand futile. 356 . MATERNAL DYSTOKIA. The diagnosis Migliano arrived at was the existence of new formations of a fibrous nature, arranged in a circular form around the cervix uteri; and he asked if the quasi atresia might not by chance be due to a spasmodic contraction or torsion. It did not appear logical to attribute the condition of the uterus to spasm, because of the long duration of parturition without any interval of relaxation in this insurmountable obstacle, which would scarcely allow two fingers at most to be introduced ; and torsion could scarcely be admitted, because in that condition the ridges are never transversal, but always spiral or oblique. For these reasons, and seeing that the efforts of the animal could not overcome the obstacle, it was proposed to cut through the fibrous rings by means of a probe-pointed bistoury. But the owner would not consent to this operation, and obtained the opinion of other two veterinary surgeons ; these recognized the presence of the impediment, but did not share in the opinion given as to its nature, attributing it to mere hyperaemia, with erethismus of the cervix; they bled the animal thrice at short intervals, and prescribed emollient drinks. Migliano retired from the case, and he afterwards learned that the owner, alarmed at the illness of his Cow, and not having any one at hand who could promptly relieve it, sought the assistance of a milkman, who, notwithstanding the prostration of the animal because of a second sanguine emission, attempted to operate by force. With the aid of his hails he lacerated the primary obstacles, with his hand destroyed the fibrous rings, and succeeded in producing a tear of some four or five inches in the left side of the cervix, and another of less importance on the right side. The hand could then be introduced into the uterus, and the Cow was delivered of a live calf. An hour afterwards the placenta came away, followed by clots of blood weighing nearly seven pounds, evidently derived from the lacerations. The dilatation which was thus accomplished irrespective of the rules of surgery, rendered parturition possible ; otherwise this could not have taken place. Some months subsequently, this veterinarian encountered the same anomaly in an equally young Cow, which, the first time also, brought forth a calf without any difficulty. In this instance, the calf had been dead in the uterus for forty days at least, according to the history elicited from the proprietor. But here the fibrous rings were incised, and by their resistance and inextensibility they bore a great resemblance to those found in the other Cow. The fcetal membranes being ruptured, the foetus appeared ; but it was so distended by gas developed beneath the skin, and in the thorax and abdomen, that long and deep scarifications had to be made in it. When reduced to a smaller volume in this way, it was in a short time, and by means of gentle traction, withdrawn from the uterine cavity without occasioning any great amount of suffering to the Cow, and without producing the slightest haemor- rhage. It is to be observed that in this case recovery took place in fifteen days, and that, in the preceding instance, it required a month. On the twenty-fifth day the animal was sent to pasture, but could not be sold in perfect health until a month and a-half after the extraction of the foetus. The author thinks it well to relate these facts, with a view to demonstrate that, in the bovine species, there sometimes really exists constriction of the os uteri by new- formations of fibrous or cicatricial tissue, notwithstanding the opinion of those who pretend that it is only due to a simple spasm, which may be cured by belladonna or the forcible introduction of the hand ; and also that probably in the two cases narrated above, the constriction may have been consecutive to the lesions produced in the cervix in the preceding parturition of the animals, which were too young for breeding with safety. 4. Complete Obliteration (Atresia) of the Os Uteri. Congenital atresia of the os uteri may at once be admitted as an impos- sibility in obstetrics, as if this canal is completely closed impregnation cannot take place. But between fecundation and parturition, certain alterations may occur which, by leading to more or less persistent closure of this passage, will prove an obstacle to birth. These alterations may, indeed, exist at the period of fecundation, but then the uterine opening ,must be only partially closed ; and, in fact, at parturition the os may be superficially, and partially, as well as completely occluded. This condition been has observed in the Mare, Cow, and Sheep. MORBID ALTERATIONS IN THE GENITAL ORGANS. 357 Causes. This occlusion may be due to agglutination of walls of the os, the for- mation of fibrinous membranes or bands, the development of cicatricial tissue from wound or injuries sustained in previous pregnancies, etc. Symptoms. The symptoms are, of course, the usual external symptoms of retarded parturition. Internally, the hand, on being introduced into the vagina and pushed towards the cervix, comes in contact with a round, smooth, and tense but fluctuating tumor at a variable distance from the vulva, or even between its labia ; the foetus can be felt through this tumor, and this might lead to the supposition that this is the " water-bag." But on passing the hand to the base of the tumor, instead of finding the bor- ders of the OS — as we should do if it was the foetal membranes — there is discovered a circular furrow, one side of which is the extremity of the vagina, and the other is continuous with the tumor — which is the pos- terior segment of the uterus pushed into the vaginal canal. On the sur- face of this tumor may be found a small imperforate depression ; in other instances there is a kind of prominent ring, like the top of the neck of a bottle, but without an opening ; this is the cervix. In other cases no trace of the cervix or os can be distinguished. Results. If relief is not aflEorded, the mother may die from exhaustion or rupture of the uterus ; or a rupture may occur through which the foetus and its membranes will pass, and the mother survive for a longer or shorter period, constituting a case of extra-uterine pregnancy. Or neither of these results may happen, but after a certain time the labor pains and the other indications of parturitipn subside, the dead foetus is gradually dessicated as the fluids surrounding it become absorbed, and the animal does not appear at all amiss ; its condition being perhaps only accident- ally discovered, either when it dies or is killed long afterwards, or when the remains of the foetus begin to be expelled in a vicarious manner. Diagnosis. The diagnosis of this condition must be based on the signs just alluded to. The only other anomal}^ perhaps, with which it might be confounded is deviation of the uterus, in which the cervix may be tilted up towards the vertebro-sacral angle, even almost beyond the reach of the hand. The position of the cervix and os tincae should be the guide in diagnosis. Treatment. As in induration of the cervix, so in atresia delivery must be effected by incision, or puncture if the os is found to be obstructed by superficial fibrinous bands or membranes. For the latter object, the extremity of the finger or a metal catheter may suffice, the pressure being gradual and the movement semi-rotatory. The bands may, in rare instances, be rup- tured by means of the finger-nails or divided by scissors. If, however, the resistance is too great, and the os is closed either through the produc- tion of cicatricial tissue or other morbid alteration, then it will be neces- sary to incise it as for induration, and in the way to be hereafter described. 358 . MATERNAL DVSTOKIA. But if the osis obliterated and tlie cervix cannot be found, then the portion of the uterus which protrudes into the vagina must be incised, and the fcetus removed by this artificial opening. With this object, Hubert recommends a convex bistoury, the blade of which is covered to within a few lines of its point. The instrument is to be directed to the part where the os is supposed to be ; then the coats of the uterus are to be carefully incised to a small extent — layer after layer, until the escape of the liquor amnii announces that the foetal membranes are opened. The small slit thus made is to be enlarged by a probe-pointed bistoury — the enlargement being either crucial or T-shaped. Then the foetus is to be extracted. Hubert has performed this operation once on a Sheep, and a shepherd by his direction also performed it on another Sheep, and in both cases the result was favorable for mother and offspring. The number of instances of atresia of the os uteri are extremely few, and Saint-Cyr has only been able to mention three. These are as follows : 1. Lecoq [Mem. de la Societe Veterinaire du Calvados et de la Manche, Nos. v., vi.), called to attend upon a Cow in parturition, had much difficulty in finding the place where' the cervix uteri should be, the os being only a slight depression without any opening. The Cow could not calve, and Lecoq therefore decided to perform gastro-hykerotomy. A living calf was extracted, but it was so weak that it died on the same night, and the Cow also succumbed next day. Unfortunately, an autopsy could not be made. 2. In 1844, Leconte {Mem. de la Societe Centrale de Med. Veterinaire, vol. v.) met with a similar case to the last The Cow had been in labor for twelve hours, and on explor- ing the vagina and uterus he felt a kind of " septum " which, examined in every way, only offered a vestige of the os. " On the uterine wall of the vagina," he writes, " was a kind of cervix, a sort of ring, hollow in its centre and similar to the mouth of a bottle. The opening did not seem to be more than one-third to three-quarters of an inch in depth, and about an inch in width, the bottom being closed by a solid membrane which resisted every effort to force it. The fcetus could be distinctly felt through the walls of the uterus, but no issue could be found for it except this rudimentary os. Vaginal hysterotomy was practised, and the fcetus was easily extracted ; but it was dead, arid the Cow died in an hour and a half after the operation. Nothing is said as to an autopsy having been made. « 3. Hubert, a Belgian veterinary surgeon, has published three observations on this condition {Annales de Med. Veterinaire de Br nx'elles, 1856, p. 143). The first refers to a Mare, the other two to Sheep. Doubts are entertained, however, as to the correctness of his diagnosis, and particularly with regard to the Mare, from the fact that this animal gave birth to a living foal, and without operation, after violent and repeated straining. What is remarked as still more extraordinary, perhaps, is the statement that no un- favorable results followed birth, and that in the succeeding year the Mare brought forth another foal without any assistance. CHAPTER IV. Other Causes of Maternal Dystokia. There are some other causes of Dystokia which, though comparatively rare, yet deserve attention from the Veterinary Obstetrist, and will com- plete our notice of the maternal obstacles to parturition. These are : (i) Anomalies of the placenta ; (2) Morbid adhesion between the fostus and uterus; (3) Stricture of the uterus by external bands ; {^\) Persistent hymen ; (5) Vaginal and vulvular atresia. Anomalies of the Placenta. We are but little acquainted with the morbid alterations of the foetal membranes of animals, and of those changes which lead to the more or OTHER CAUSES OF MATERNAL DYSTOKIA. 359 less permanent adhesion of these to the foetus and to the uterus. The subject appears to have received very little attention, and the observa- tions are so few that Saint-Cyr makes no mention of these adhesions as a cause of difficult or impossible birth. It is very probable that animals are less subject to disease of the uterus and the placental membranes than the human species, and this will no doubt account to a certain extent for the absence of notices of such occurrences. Nevertheless, that animals are disposed to metritis, endom- etritis, and perimetris. no one can deny ; and that we may also have such anomalies as hyperplasia of the chorion, as well as myxomata of that membrane, in addition to new formations of the placenta and placentitis, might be expected. But, as we have observed, there is indeed but litde direct evidence to prove that any of these morbid conditions ever exist, though some of them at least may lead to abortion, while others give rise to obstacles which may retard or altogether prevent birth. Scirrhous Chorion. According to Cox {Veterinary Journal, Februar}-, 1877), scirrhous chorion is occasionally met with in animals, and proves an obstacle to parturition. The membrane is found to be separated from the uterus, and envelops the foetus, as it were, in a leather bag, no part of the creature being dis- tinguishable. This is probably the condition known in woman as 7nyxoma fi'ibrosum placentce. The labor pains are seldom violent, though the foetal membranes (water-bag) cannot be expelled into the vagina, even when the os uteri offers no obstacle. An early examination is necessary, as the foetus soon perishes. An incision must be made through the chorion, and the foetus extracted. Morbid Adhesion between the Fcetus and Uterus. Adhesion between the uterus and its contents maybe due to inflamma- tion of a portion of the mucous membrane, to hyperplasia of the chorion, or to disease of the ovum or placenta, by which the two latter are brought into direct contact with the interior of the organ. Or it may be owing to a deficient quantity of liquor amnii when- the foetus begins to be formed ; for if the amnion, in the course of its development, is not separated from the growing foetus by a sufficient quantity of fluid, connection between them is almost certain to be established either in isolated spots (Simon- art's " bands "), or over a wide surface. Adhesion between the amnion, chorion, and lining membrane of the uterus, is then not only possible but probable, and in this way the foetus is brought into a solid union with the maternal organ. It will readily be understood that such an occurrence will prove a very serious obstacle to birth, and greatly endanger the life of the mother. Rainard {Traite Cojnplet de la Parturition, vol. i., p. 461) furnishes us with two observations, a writer in the Veterinary Journal (" Nemo '') with another, and Naylor with two. These are the only illustrations I can find in veterinary literature. I. Two pupils of the Lyons Veterinary School — Patusset and Chabral — were, in 1840, sent to attend a Cow, between seven and eight years old, which, according to the cal- culations of its owner, was ten days beyond its ordinary period of gestation. It was in 360 MATERNAL DYSTOKIA. fair condition, and up to a recent date had been in apparent good health. At the usual time of parturition, it exhibited a few symptoms of labor ; but they disappeared, though only to manifest themselves in eight days — the evening previous to the arrival of the pupils. For more than twenty-four hours the animal lay on its litter, straining so vio- lently and continuously, that it was then nearly exhausted. There was anorexia, the pulse was small without being quick ; and the mammae, which had previously been dis- tended with milk, were empty and flaccid. Palpation in the right flank, as well as an examination /^r r^^ Veterinary Review, vol. ii, p. 285) in which there was a vertical band across the os uteri that prevented ^ birth. This was divided, parturition took place, and the animal did well. 8. Goubaux {Recueil de Med. Veterinaire, 1873-74, Archives Veterinaire, November, 1876, p. 562) has drawn particular attention to the existence of these bands as a cause of dystokia in the domestic animals, but particularly in the Mare and Cow. He refers more especially to the two following instances : Rolland, in 1874, attended a Cow, a primipara, in which there was a vertical septum, three centimetres wide in the middle, between the vulva and vagina : this prevented birth, and the Cow calved when the band was incised ; the specimen is now in the Museum of the Alfort School. In May, 1867, Colme was called to assist a three years old Heiferwhich could not calve ; the two fore-limbs of the foetus only presented. An exploration discovered a fibrous band, three centimetres broad, its extremities attached horizontally to each side of the cervix uteri, the OS being perfectly dilated; it divided the latter into two openings, through each of which one of the foetal limbs had passed. The band was divided, scarcely any haemor- rhage resulted, and birth took place in the ordinary^vay, and without any troublesome consequences. Goubaux also gives some interesting details of a post-mortem examination of a Cow which had a similar band immediately behind the cervix, and sums up as follows: Some of these bands are situated between the vulva and vagina, and are vertical ; others are placed at the bottom of the vagina, close to the cervix, and may be vertical and hori- zontal ; they are very strong and resisting. They may not constitute an obstacle to copulation, whatever their situation, but they may prove an obstacle to parturition; their division does not occasion haemorrhage or any serious result, and this operation allows parturition to take place in the usual manner. It may be that some of these bands are nothing more than the hymen, alluded to below. With regard to the treatment of these cases, but little can be said. When the bands are in the vagina, their division is the principal object, after which, if no other obstacle is present, delivery can take place. When, however, the uterus is constricted by an external abdominal band — though this condition will be difficult to diagnose — then no course can promise any thing like a successful result except the Caesarean section. 364 MATERNAL DYSTOKIA. Persistent Hymen. At page 29, we have described a wide duplicature of the lining mem- brane of the vagina, which covers the meatus urinarius, and which looks like, while it acts as, a valve (valvida vagince) to that opening. This membrane, which stretches across the passage and separates the vulvular from the vaginal canal, is the analogue of the hymen of woman ; and, as in her, it may persist after the impregnation of primiparae — having escaped rupture during coitus — and becoming abnormally rigid, may prove an impediment to birth in some instances — though it must be confessed they appear to be exceedingly rare. This cause of dystokia should be very much less frequently met with in the equine and asinine species than other of the domesticated animals, in consequence of the size and conformation of the male organ of copulation, from which the membranous vaginal partition can scarcely escape rupture when it is present, which is only occasionally.* With the bovine, caprine, ovine, and porcine species, however, the case is different ; as the penis, from its volume and shape, is far less likely to lacerate the hymen ; and it is in the bovine species alone that the persistence of the latter at par- turition has been found — at least so far as published observations show ; and in all the instances the animals have been young and primiparae. It is just possible that in many animals of these species, the hymen may be more or less intact until parturition sets in, when the foetus, in its passage through the vagina, ruptures and effaces it without much delay resulting, or other cause which might attract attention. But in others — few though they be — the membrane would appear to offer a rather serious amount of resistance to the expulsion of the young creature, and demand the services of the obstetrist. The cases recorded are exceedingly few, and none are to be found in English Veterinary literature. I. On March 28, 1863, Mignon [Recueil de Med. Veterinaire, 1863, p. 767) attended a two and a half years old Cow in an advanced stage of pregnancy, and which exhibited all the signs of approaching delivery, with the exception of the labor pains, which were not yet manifested. They however appeared on April ist, and continued for about fifteen hours, but without any progress being made towards birth. On the 2d, Mignon endeavored, by abdominal taxis, to assure himself if the calf was still alive, but this failing he had recourse to vaginal exploration, when, to his surprise, his fingers met an obstacle almost at the vulvular orifice. He was soon convinced that this obstacle was nothing more than a wide band — a real duplicature of the mucous membrane — placed at the entrance to the vagina, which it incompletely closed as a vertical septum, being attached by its extremities to the walls of the canal. This vaginal band — a veritable hymen — was flattened on both sides, wider at the ends than in the middle, and had curved borders ; it measured two and a third inches in length, three-quarters of an inch in depth at its extremities, but only about one-third inch at its central portion. The calibre of the vagina was considerably diminished by this band ; the canal had two * The hymen appears to be only exceptionally present in the Mare, though it is an error to assume that it is always absent- Not only is it sometimes to be found, and occasionally of large size and extraordinary tenacity, but it may even become a source of trouble in unimpregnated Mares. Of this we have an example by Mr. Thomson, of Beith {Veterinarian, vol. vii., p. 147). That Veterinarian was called to see a young Mare, said to have inversion of the bladder. On his arrival, he saw protruding from the vulva a membranous sac containing about a quart of fluid in its cavity. An examination proved the sac to be a simple membrane, extremely vascular and much inflamed. It was easily pushed back into the vaginal cavity, where it was found to be attached to the posterior part of the urethra and all around the vaginal canal, so that the passage to the os uteri was completely obstructed ; the membrane could not be pushed so far forward as the cei-vix. On romoving the hand, it again protruded whenever the Mare made an effort. In another instance — a year and a half old Filly — Mr. Thomson observed an intact hymen, but there was a small opening in it, immediately behind the urethra. OTHER CAUSES OF MATERNAL DYSTOKIA. 365 orifices — an inferior and a superior, and nearly of equal dimensions ; three fingers could scarcely be passed into either of them. This obstacle to birth having been recognized, the necessity for removing it by inci- sion was apparent. It was divided in the middle by a bistoury, and the constricted vagina then became widely dilated, when a well-formed living Calf was soon produced, 2. Hermann, a Swiss Veterinary Surgeon {Journal de Med. Veterinaire de Lyon, 1851, p. 73), met with a similar case in 1849. In a quey, he found a thick resisting membrane in the vagina, which offered an obstacle to parturition, and which partitioned that canal into two portions. When incised, delivery took place. 3. Hamm [Magizinfiir Thierheilkimde, 1842, p. 185) attended a Cow which had gone nine days beyond its time for calving, when it commenced to show symptoms of that act. With the early labor pains, there appeared at the vulva a round tumor as large as a man's head, and which appeared to be covered by the vaginal mucous membrane. On pressure, this tumor fluctuated, and on a careful examination it was perceived that the membrane covering the tumor was the hymen. On incising this, a large quantity of mucus, which had collected between it and the cervix uteri, escaped. The os was con- tracted at this time, but it soon dilated, and birth occurred without any trouble. 4. Vincenzo-Luatti [Recueil de Med. Veterinaire, 1859) alludes to a Cow — a primipara and three years old, which, otherwise in good health, was affected by complete proci- dence of the vagina. On examining the parts, this Veterinarian found a white ligamentous band, two or two and a half inches wide, and the third of an inch in thickness, very strong, and attached above and below to the walls of the vagina, so as completely to' occlude the canal — at least so far as exploration was concerned. Both surfaces were quite free. Luatti introduced a straight probe-pointed bistoury as high as possible between the band and cervix, and at a single cut divided the former to near its inferior insertion. Then the prolapsed vagina was reduced, a retaining bandage was applied, and the labor pains, which had not yet shown themselves, were waited for. In six or seven days, Luatti was informed that the Cow had calved, and that it and the offspring were well. TreatmeJit. The indications for treatment, when the hymen is present and an obstacle to birth, are obvious : divide it at once. This division may be made in the middle of the membi;ane, and does not demand any particular care or surgical knowledge ; though it is well to make a close examination before the incision is made, in order to avoid making a mistake should the membrane appear as a tumor. Vaginal and Vulvular Constriction or Atresia. Stenosis and Atresia of the vulva and vagina have not unfrequently been recorded as either delaying, or altogether preventing, parturition in animals, according as the obstruction is incomplete or complete. This condition may exist previous to impregnation, and to such an extent as to offer no obstacle whatever to that act ; or it may become developed in the interval between impregnation and parturition. Of course, if atresia is complete, and of such a character that the spermatic particles cannot pass into the os uteri, impregnation cannot take place, and the animal remains sterile. The condition may, therefore, be congenital or acquired. Incomplete congenital stenosis of these passages is not at all uncommon in young ani- mals, in which the vulva and vagina are often so constricted and inelas- tic, that during copulation they are injured, and this injury tends still more to diminish their calibre and dilatability during pregnancy. Con- genital stenosis to a very abnormal degree may sometimes exist, how- ever, without any apparent traumatic influence. A recent case of this description is recorded by Macgillivray ( Veterinary Jotirnal, December, 1876). Called in to see a two-year-old Heifer which was reported to be suffering from constipation of the bowels, he found the creature very uneasy, straining every few minutes, and voiding small pellets of dung. The urine was natural ; abdo- 366 MATERNAL DYSTOKIA. men hard and tense ; breathing much hurried; pulse 75 beats per minute, and tempera- ture 104°. The straining being a suspicious symptom, inquiry was made as to whether the animal had been put to the bull, but the reply was in the negative. On separating the labice valvce, nothing abnormal could be detected ; and it was therefore concluded that obstruction of the bowels was really the cause of illness. Treatment was adopted accordingly. During fire days there was no alteration, though the bowels had acted freely ; but on the filth day, on attempting to explore the vaginal passage, it was dis- covered that the hand, or even a finger, could not be got beyond the vulva. Thinking it might be merely an extra tightness at the ostum vagince, considerable force was used, but only one finger could be made to penetrate about an inch. No vaginal canal existed, and its walls seemed to have grown firmly together. The Heifer was now straining so violently, as to leave but little doubt that irritation about the generative organs was the sole cause of the illness. Continuing patiently to exert steady force, two fingers were finally pushed some four or five inches through where the vagina should have been, when there all at once escaped a dark-brown fluid which had a most repulsive odor. This fluid came away in variable quantity every time the creature strained. Next day, after great difficulty and laceration, from vulva to uterus, the os of the latter was reached ; the operation was like " forcing one's hand into a piece of raw firm muscular tissue." " The os uteri was fully dilated, and the uterus itself had seemingly been pretty much distended by the imprisoned fluid." As the case was considered hopeless, and the animal was in good condition, it was killed. An examination of the vagina and uterus could not be made. Macgillivray was of opinion that this case goes to prove the existence of a menstrual discharge in the brute female, analogous to that in the human female, the symptoms of retention being somewhat similar. " The cestral products — however many times the Heifer had been in * heat ' — had evidently never found exit from the uterus, and the re- sult was the immense collection of a most abominably-smelling serosanguineous fluid, which escaped after the forcible opening up of the hitherto impervious vaginal canal." A very similar case is recorded by West ( Veterinary Journal, February, 1877), but in this instance the animal recovered. Acquired Stenosis or Atresia is generally the result of certain diseases, or injuries, such as inflammation, suppuration and ulceration, and lacera- tion, often due to difficult parturition. These may lead to hypertrophy and density of the tissues, hard resisting cicatrices, solid adhesions, or partial or complete obliteration. Malposition of the vulva may also lead to atresia. I witnessed a case of this kind in an Arab Mare of high pedigree in Syria. The vulva was partly below the ischial arch. In primiparae, cases of abortion, cases in which birth occurs in a hur- ried manner, as well as when the water-bag is ruptured too soon, or in those breech presentations in which the hind legs are bent forward and only the hocks offer — in all these the narrowness of the vulva and vagina, from lack of preparation, is often an obstacle to parturition, their tissues being "hard." But with patience and warm emollient injections, as well as careful and gradual manual dilatation, this obstacle may be overcome. When birth is taking place too hurriedly, Rainard recommends closing the animal's nostrils and opening its mouth, pulling out its tongue, and pressing on the loins to prevent its arching the back and straining. It is very rare that the resistance is serious, and in the great majority of cases birth occurs spontaneously, or with trifling assistance. Some authorities, however, have met with instances in which it was necessary to dilate the vulvular orifice by incision, in order to prevent this part being lacerated, and to spare the animal pain and subsequent deterioration. When the dystokia is due to disease or a traumatic cause, birth is more difficult ; and this difficulty is increased as the pathological alteration is extensive. OTHER CAUSES OF MATERNAL DYSTOKIA. 367 1. In the Zeitschrift fiir Thierheilkunde imd Viehzticht (Band 7), there is the descrip- tion of a case in which the wall of the vagina was some inches thick, and the diameter of the canal only one and a half inch. This was the result of disease. 2. Leconte (Mern. de la Societe de MJd. Veterinaire, vol. v., p. 185) has furnished us with a very interesting case of this description. He attended a Mare in parturition, which had previously, and while at pasture, re- ceived an injury from the horn of a Cow ; this injury was inflicted in the region of the perinaeum, and the vulva had been torn as far the recto-vaginal septum. The cicatrices, still visible, proved that the laceration had been very extensive, and the vulva was so deformed and contracted that the hand could scarcely be passed into it. The vagina, cervix uteri, etc., appeared to be all right. The Mare was making frequent parturient efforts ; the liquor amnii had escaped — it was not known how long before ; and the foetus soon presented itself in a good position at the vulvular orifice, the head resting on the two fore limbs. At this part, however, the foetus met with serious resistance to its outward progress. Nature might have sur- mounted this obstacle, perhaps, and birth might consequently have taken place without assistance, but there must have occurred considerable lacerations. Leconte, therefore, preferred facilitating the exit of the young creature by operating as in vaginal hysterotomy. He made two lateral incisions — one above the other — on each side of the vulva, about an inch and a half apart, and about an inch in length ; these incisions allowed sufficient space for birth to take place. Parturition was completed without an accident, and the incisions, treated as simple wounds, cicatrized in a few days. The treatment of stenosis of the vulva and vagina must be," of course, surgical, and will vary according to the cause producing the constriction. But it will chiefly consist in incisions carried to a depth and extent com- mensurate with the exigences of each case, and modified according to the anatomy of the part which forms the seat of stricture. It will be found that lateral incisions are, when they can possibly be practised, preferable to those made either superiorly or inferiorly, as they are less likely to be followed by inconvenient alterations and unfavorable consequences ; while, with regard to the vulva, the textures at the sides of that orifice have more vitality, and therefore cicatrize more rapidly, than at the superior commissure. 368 FOETAL DYSTOKIA, BOOK II. FCETAL DYSTOKIA. Though the obstacles to parturition offered by the maternal organs are somewhat considerable in number, yet it is found in practice that those due to the foetus are far more frequently met with, and are much more numerous ; though all of them may not constitute real or serious obstacles, some being easily removed or overcome, when birth takes place without any difficulty. , The obstacles which the foetus may offer to birth are, for convenience of study, divided into two natural groups, according as they result from some physical condition of the young creature itself, or from the more or less irregular manner in which it is presented at the pelvic inlet. Each of these groups, again, it is needless to add, embraces a certain number of varieties of obstacles ; but though grouped and classified in this way, we must remember that difficult parturition due to the foetus may not be owing exclusively to any one of these obstacles in every case, but in some instances may result from a combination of two or more of them. But this combination does not preclude us from studying them sep- arately ; indeed, their separate consideration is absolutely necessary, as it is only by analyzing them that we can realize their influence in hin, dering birth, either when alone or combined. As will be seen from the following synoptic table, these obstacles are very numerous and -varied, and require careful consideration from the obstetrist : opening, as they do, a wide field for investigation and reflec- tion, as well as practical deduction. The two groups referred to consist (i) of the obstacles independent of presentations and positions, and (2) of the malpresentations and positions of the foetus, and the difficulties resulting from them. Synoptic Table of Fcetal Dystokia. Excess in Volume of the Fa:tus. Anomalies in, and Diseases of the Postal Membranes Abnormal Quantity of Placental Pluid. Anomalies in the Umbilical Cord. Q^ Independent of the Pre- sentations. Diseases Resulting from the Presenta- tions. Death. Monstrosities. Multiparity. ' Anterior - - Posterior. - • Transverse • ' Hydrocephalus. Ascites, Anasarca, and Hydrothorax. Emphysema. Polysarcia. Contractions. Tumors. Incompletely Extended. Crossed on the Neck. Flexed at the Knees. Completely Retained. Bent Downwards and Backwards. Bent Laterally. Bent Upwards and Backwards. Hind Quar- j Forced Abduction of the Limbs. ters - - - I Croup Bent Under the Body. Lumbo-pubic and Lumbo-iliac Positions. Flexed at the Hocks. Completely retained. Dorso- lumbar. Sterno-abdominal. Limbs Head and neck - Limbs - EXCESS IN VOLUME OF THE FCETUS. 369 GROUP I. OBSTACLES INDEPENDENT OF PRESENTATIONS AND POSITIONS. In this group, the maternal organs of generation and those parts imme- diately concerned in parturition may be perfectly healthy, and the foetus itself may be in a favorable position for expulsion ; yet birth is either protracted, or rendered impossible without assistance, because of the ex- cessive volume of the fcetus, anomalies in, or diseases of its enveloping membranes, an abnormal quantity of placental fluid, anomalies in the umbilical cord, or from disease or malformation of the young creature, or a plurality of foetuses in animals ordinarily uniparous. CHAPTER I. Excess in Volume of the Fcetus. Excess in volume of the foetus, due to normal or abnormal development of either the whole or only a part of its body, is far from constituting an unfrequent cause of dystokia in the domesticated animals ; rendering spontaneous birth more or less difficult or altogether impossible, notwith- standing the healthy condition of the maternal organs, and the regularity and energy of the uterine contractions. Causes. Several causes may be in operation to lead to excessive development of the foetus — either wholly cr partially. Among these we may cite the following as the principal : Prolonged Gestation. It has been shown that the foetus may be retained without injury for several weeks beyond the period usually allotted for its expulsion, and there can be little doubt that during this interval its development is continued. This extra development being unprovided for in the dimensions of the genital passages of the mother, leads of course to protracted or difficult parturition. There are instances recorded of the foetus of the Cow and Mare weigh- ing 117, 165, and 189 pounds. It may, therefore, be readily understood that the greatly exaggerated volume which this weight represents, must meet with much resistance in passing through a canal which, in ordinary circumstances, gives exit to a foetus weighing from 56 to 80 pounds. Instances of this exaggerated development, through prolonged retention, are far from uncommon. We will therefore only give one example. A correspondent in the Veterinarian (vol. ix., p. 453) was called to see a Heifer, three years old, and which was supposed to be long beyond its time for calving. On examin- mg it, the os uteri was found to be closed, so that the hand could not be introduced in- to the organ, though the fcetus could be felt. It seemed to be so enormous in size that he had no hope of extracting it. An examination per rectum confirmed the suspicion that the calf was larger than the passage would, admit. The animal was killed, and the autopsy verified the opinion as to the impossibility of delivery taking place. Reduced Number of Foetuses. — With multiparous animals, when the 24 370 FCETAL DYSTOKIA. number of foetuses is smaller than usual — as with the Bitch which has only one or two, instead of five or six — the excess of nutriment they receive increases their bulk to an abnormal degree ; and as almost every breeder of dogs knows, this often leads to serious results in parturition. Disproportion i?i Size Between the Male and Female. — There can be no doubt that a disproportion in size between the male and female, in many instances, exerts a marked influence in this direction. More especially is this the case in crossingwith different breeds^ or in attempting to breed from too young females. Delorme, quoted by Rainard(vol. i., p. 474), says that he has known a certain number of Camargue Ewes die every year through non -delivery, they having been put to Dishley Rams, which were much larger than the native Sheep. The case of' small Bitches crossed by larger dogs is familiar to all dog-breeders. There appears, indeed, to be a natural tendency in some small-sized Bitches to seek intercourse with dogs much larger than them- selves, and this preference not unfrequently leads to fatal consequences in parturition. But in many instances dystokia is due to exaggerated development of some particular region of the foetus, and more especially of the head — a peculiarity derived from crossing, or breeding from a male possessing this character. Indeed, some authorities deny that crossing small female animals with males which are generally larger is likely to prove a source of difficult parturition, provided there is nothing unusual in the proportion of any region of the latter. It is pointed out that, in the human species, small women are very often married to very large men, and yet their accouchments are more or less easy. It has also been remarked that Melingie, in order to form the breed of Sheep known in France as the race de la Charmoise. coupled the small Berrichonne Sheep with the great New Kent Rams ; and yet in two thousand births only one was difficult. A German veterinarian surgeon, Nathusius, mentioned by Rueff and Baumeister, asserts that in the cross between the small Merino Sheep with the huge English Rams, he has observed fewer difficult births than in flocks composed solely of Merinos. And Saint-Cyr states that he has often seen little " Bressanne " Mares, which were put to big Percheron or Anglo-Norman Stallions, foal without difficulty at the ordinary period. We might also adduce the small female Ass coupled with the Horse- Stallion, and which rarely suffers during birth. Abortion or premature birth may be more frequently the consequence of such " mesalliances." Though certain facts could be opposed to the above conclusions, yet it must be admitted that the wiiformly exaggerated development of the foetus is not a very common cause of dystokia, and is, as a rule, only so when the pelvis of the female is smaller than usual. So that we must look rather to special conformation than exaggerated development. And so far as conformation is concerned, we find that excessive development of the croup, chest, or head, have the principal influence. With regard to the head., it is indisputable that of the three regions this most frequently proves an obstacle to parturition. In the Bitch this is more particularly remarked. But it is also noted in other animals. Price, in his book on Sheep, mentions that a grazier in Appledore em- ployed Leicester Rams for several years, and obtained a breed with very small heads and " kindly disposition ; " but he did not approve of them, because they were not sufficiently large, and did not fetch a good price in EXCESS IN VOLUME OF THE FCETUS. 371 the market. He therefore, in the summer of 1804, hired some large Kentish rams, in order to give size to his flock. In the following lamb- ing season he lost twelve Ewes, from the immense size of the lambs' heads, and he was obliged to " draw " (extract artificially) nearly all his Ewe lambs. In 1806 he had the same difficulty, and lost nine Ewes in a flock of two hundred and fifty from this cause. Mr. Cartwright (Whitchurch) casually states that he has frequently known of some bulls " getting calves with very large heads, and causing great difficulty in calving; and the owners, finding what trouble there was at calving-time, and the danger of losing their Cows, have sold them, and obtained others whose breed had not this objection." Rueff and Baumeister {Op. cit., p. 247), in alluding to this subject, re- mark that in the bovine species it is nearly always the head which forms the chief obstacle to birth ; and they refer for proof of this statement to the small native Cows of Wurtemberg, which, when crossed by the Origi- nal Simmenthalern Bull, have often difficult labor, as the latter breed has often a large head. And Schaack writes to Saint-Cyr, stating that for thirty years the Cows in the district of Lyons were all put to a Bull remarkable for its massive framework. The head especially was very developed, and as the animal transmitted this conformation to nearly the whole of its progeny, the size of the head of the foetus very often rendered parturition difficult. Breeding from immature undeveloped animals is almost certain to pro- duce laborious births ; and the reason for this is not difficult to find : the genital canal, and particularly the pelvis, is not sufficiently developed for the passage of the foetus. A very striking instance of this, as well as of very remarkable precocity in the bovine species, is given by Mr. Barker (^Veterinary jFournal^ November, 1876). We will give the case in his own words : " On the 14th of May, I was requested by the bailiff of Greenshills Farm to go and assist or deliver a young Cow of a calf, this Cow being the property of J. T. Wharton, Esq. " On arrival, I found the smallest animal to be a mother that ever T witnessed or heard of. This creature, a black-polled Scot, nine days short of one year old, had made per- fect preparation for parturition, and there was one fore-foot of the foetus projecting about two inches from the vulva. " On inquiry, the bailiff told me that she had been accidentally ' bulled ' when she was ten weeks and five days old, while sucking her mother ; the Bull of the same breed going with the herd of Cows, the calves of which were all allowed to suck their mothers so long as they chose. " The above statement to many may seem incredible, as it did to a neighboring eye- witness, who was asked to give a little assistance in pulling the calf away ; for although he saw the calf's foot projecting, he remarked that he could hardly believe his own eyes, and asked me if I did not think that the Bull (the father of the mother) had got two calves at once, one within the other — as the mother was only a calf herself. " On examining her, I found the other fore-foot and head back in the uterus, and the calf dead. I therefore corded the projecting foot and thrust it back, and, with difficulty, corded the other foot and brought it forward as far as I could ; then I returned both feet and corded the lower jaw. After manipulating a short time, I succeeded in getting both fore-legs and head straight, when I met with a great obstacle — viz., the pelvic orifice being by far too small to admit the legs and head together, one leg filling the vaginal canal almost completely. I at once allowed the head and one leg to fall back, and introduced an embryotomy knife, with which I skinned the leg, and divided it from the trunk with the scapula. I then brought the next one, and divided it in the same way, except having to leave the scapula, owing to so little room to work in ; and the calf having only died about an hour before, the muscles, etc., were very strong and difficult to sever without using very great traction. After the above reduction, I again corded the lower jaw, which tad slipped, and essayed to bring the head forward ; but 372 FCETAL DYSTOKIA. this I found could only be done as far as the eyebrows the entrance into the bony canal of the mother's pelvis refusing admission of the bulky parts of the foetus's head. But after manipulating the head, and using gentle traction, I succeeded in getting the whole of it into the passage, and ordered the men to pull simultaneously with her throes. The pelvic brim and inferior surface of the vertebrae here again refused egress to the sternum and anterior dorsal vertebrae of the calf; and very strong but steady force was employed to move the foetus, but this failed. I therefore made an incision through the skin in the calf's throat, and subdermically cut a hand-way into the thoracic cavity, which I emptied of its contents. We then continued traction during her throes, and, as with the head, the most bulky part of the body passed over the brim of the pelvis with a sudden jerk, and entered the vagina. " It again stuck obstinately at the pelvis, but was overcome by perseverance — the calf and placental membranes coming away in toto. It was a well-nourished and full- grown calf ; and had not Nature endowed the mother's pelvis with great flexibility and elasticity of its ligaments, nothing short of the Caesarean operation would have suc- ceeded in delivering it. " I was not very much surprised at the incident, as last year I delivered some of the same herd in a similar way, and these exactly one year old on the day they calved. I may add that about a teacupful of 'beastings ' {Colostrum) were in the udder of each Cow when parturition occurred, but no more was secreted in any of these precocious creatures." Influence of Food. — There is no convincing proof before us that the manner of feeding or kind of food has much influence on pregnant ani- mals, so far as excessive volume of the foetus, and consequent difficult parturition, is concerned. Cox ( Veterinary journal, vol. i., p. 265) says : " The size of the foetus depends considerably upon the condition of the parent and the kind of food given to it. Fat animals, and those emaciated from the continuous use of food of a poor nature or insufficient in quantity, bring forth a small foetus. Where the debility is the result of pregnancy, and food has been given of a nutritious character and in sufficiency during that period, the; foetus will be disproportionately large, the extra nutriment having been diverted to its growth. Green food, or ' depasturing,' causes the foetus to grow rapidly and attain a great size ; but Nature compensates for this by giving with such diet greater relaxation of the tissues of the dam, and an increase of the placental fluids to lubricate and assist at delivery." Diagnosis. The diagnosis of excessive volume of the foetus is difficult, and can only be established, as a rule, at parturition ; for we do not possess any certain means of appreciating the dimensions of the foetus i7t iitero before its enveloping membranes have ruptured and the os is dilated. An un- usual size of the maternal abdomen towards the termination of pregnancy, is an uncertain and very often deceptive sign. Nasse, a German Veterinarian, imagined that this excess in develop- ment might be ascertained by weighing the animal during gestation. With regard to the Bitch, he thought there was danger when the weight was increased by two-fifths during this period, the normal increase being only one-third. But it is evident that an inordinate increase in weight may be due to other causes than the foetus or foetuses — such as an unusual num- ber of these, an excess of amniotic or allantoic fluid, greater obesity of the Bitch, etc. Otherwise, if this test could be applied to the Bitch with practical results, the conclusions derived from it could not be made ap- plicable to the other animals. N The only circumstance which might give rise to suspicion, is the pro- EXCESS IN VOLUME OF THE FCETUS. 373 longation of gestation beyond its ordinary period ; though this suspicion, as we have seen, will not always, nor yet very often, be confirmed. It is only, then, at parturition that this obstacle on the part of the foetus can be ascertained. If at this time, in spite of energetic and sustained uterine contractions, labor is protracted and does not advance, and if on exploration the pelvis and genital organs are found to be well-formed and normal, the os dilated, the foetus in a favorable position and not malformed, it may be suspected that the obstacle to birth is dependent on the large size of the latter. A closer examination will probably con- firm this suspicion. With the Bitchy the principal obstacle, as has been already said, is gen- erally with the head of the puppy, which, when it is large, is lodged at the entrance to the pelvic inlet, where it can be touched/*?/- vaginam. The common-bred Bitch, with muzzle more or less elongated, when fecundated by a male of the same size and conformation, and bringing forth from five to eight young, has usually no difficulty in pupping. The tapering or conical form of the muzzle of the puppies allows it to enter the passage and pass easily through, under the influence of the uterine and abdominal contractions. But when the Bitch is of small size, and has been impregnated by a larger and young vigorous dog, and especially if the muzzle of either or both of the parents is short and the cranium brachycephalic — as in King Charles' spaniels, pugs, and bull-dogs — par- turition is oftentimes extremely difficult, as the forehead in these breeds is very large and cylindrical. This difficulty, as has been mentioned, is increased as the number of puppies is small, as then the latter are more developed. With the Cow, the head of the calf may also be the chief impediment, and provided the young creature is otherwise in a favorable position, the muffle may pass through the inlet, but the remainder of the head re- mains fixed like a wedge in the long and almost undilatable bony canal. The head is often so firmly wedged at this part that it can scarcely, even with much force, be advanced or pushed back, and this " wedging " is always one of the most serious difficulties which the obstetrist has to overcome. With the Mare, the head of the foal is smaller, longer, and more taper- ing than that of the calf, and meets with much less resistance in passing through the comparatively short and wide canal. But as Saint-Cyr points out, and as we have previously shown, in the equine and bovine species the young creature finds more difficulty when the anterior part of its body — chest and shoulders — begins to enter this part ; and from their respec- tive dimensions it is evident that, even under ordinary conditions, the anterior region of the foetal trunk must submit to a certain degree of diminution in order to pass the pelvic inlet of the mother. The limits within which this diminution is compatible with physiologi- cal parturition, are not yet perfectly ascertained ; though there can be no doubt whatever — for we have facts to prove it — that the development of the young creature may be so exaggerated that sufficient reduction cannot be effected to allow of its being born. Mignot, of the Agricultural School at Saulsaie, France, furnished Saint- Cyr with the following notes and measurements which he made of a case of protracted parturition due to this cause. An Ayrshire Cow, aged three years and ten months, i'30 metre high, and weighing 374 ^ FCETAL DYSTOKIA. 460 kilogrammes, had just brought forth its second calf. The previous year it aborted ; this time it went its full period. The calf was in a favorable position — anterior ver- tebro-sacral — it was born alive and well, but birth was laborious because of the exces- sive size of its chest : so that powerful traction had to be exercised to complete deliv- ery. The calf was poor, and weighed immediately after birth 30 kilogrammes. Its dimensions were as follows : — Metres. Supero-inferior diameter of the head - - - . . 0237 Bi-temporal " - - - -- - -OT18 Vertebro-sternal " of the chest 0'385 Bi-scapulo-humeral diameter " 0-197 With the Cow, the maximum pelvimetric elements were : — Metres. Height - - - I -030 X 0-182 =Sacro-pubic diameter - - 0-236 Width of croup - - 0-456 x o-428=Bi-iliac diameter - - - 0-195 These figures clearly show the difficulty to be overcome in parturition in this instance. It will be noticed that the head itself could scarcely pass through the pelvis, because its vertical diameter was about equal to that of the pelvic cavity ; that the thorax had to submit to a considerable reduction, as its vertebro-sternal diameter (0*385 metres) exceeded by about 15 centiitietres the corresponding diameter (0-236) of the pelvis ; while the two transverse diameters were about equal. If the circumfer- ence of the thorax be compared with that of the pelvic canal, it will be found that the large circle (the foetus) had to pass through the small circle (the pelvis). But the result proved that this can be done in these con- ditions, and without injury to the mother or foetus ; though, as Saint-Cyr justly says, this, ccr very near it, must be the extreme limit of possible physiological reduction, and that beyond this limit the life of the foetus at least must be seriously compromised. In other instances, and especially with the foal, the passage of the croup presents the greatest obstacle, and the difficulty may even be serious. Progfiosis. In such cases as those we are now studying, in which birth is delayed through undue development of the foetus, it generally happens that the membranes have ruptured, and the liquor amnii has escaped, at an early stage ; consequently, the maternal passage is dry and tenacious, and per- haps swollen and irritated ; while the foetus, no longer protected in its hydrostatic bed, is directly exposed to the uterine contractions, and in proportion as these are energetic, so does it the more rapidly succumb. The mother, in turn, becomes exhausted through unavailing efforts at expulsion, and if judicious assistance is not opportunely rendered, is not long before it also perishes. It will, therefore, be seen that a prognosis in such cases of dystokia cannot always be of a favorable kind, as very often the death of the foetus, if npt of the mother, has to be taken into consideration. More particularly is this the case with the smaller animals — and especially the Bitch, though, as has been shown, the larger females, if they do not die so frequently, yet are not exempt from danger. Indications. The indications for the treatment of these cases are similar to those given for constricted or contracted pelvis: (i) Extraction of the fcetus entire by manipulation \ (2) Removal by embryotomy. EXCESS IN VOLUME OF THE FCETUS. 375 1. Extraction of the Foetus entire. — If the " waters " have escaped for any length of time and the parts are dry and viscid, warm emollient fluids should be injected into the vagina, and if necessary the portions of the foetus presenting may be lubricated with glycerine, oil, unsalted lard, or any other lubricant. The hand should then adjust the foetus, if this is requisite, and attempts made to extract it by judicious traction, cords, and other accessory means to be hereafter described, being employed as occasion demands. The degree of traction will depend upon the amount of resistance to be overcome ; it being carefully borne in, mind that a medium degree of force well directed is often more effective than severe traction misdirected and inopportune. For this reason it is that a careful adjustment of the foetus should be made before any force is resorted to, the " wedged " portions being " eased " and well smeared. It not unfrequently happens that a very trifling displacement of the foetus will allow it to pass gradually through the pelvic canal, and lead to the successful termination of a case which otherwise many would consider impossible to deliver. 2. Embryotomy. — When forcible extraction is deemed impossible, or dangerous for the mother, and when the latter has ceased to aid in expel- ling the foetus, then the only alternative is embryotomy, which, entailing as it does the destruction of the progeny, yet affords the only chance of saving the parent. The operation will be described hereafter. Anomalies In, and Disease of, the Fcetal Membranes. It is very rare indeed, so far as published observations are evidence, that anomalies in, or disease of, the foetal membranes prove an obstacle to birth. That they may sometimes do so, however, is evident from what we have previously described. As Franck justly remarks, it is not un- likely that the retention of the foetal membranes after birth is due, in many cases, to inflammation of the placenta (placentitis). A not unfre- quent condition of the membranes is congestion of, or extravasation into, the placenta, rupture of the capillaries {capillary apoplexy), and haemor- rhage between the placenta materna and placenta uterina. Partial sepa- ration of the two placentae is also not very uncommon in the Mare ; and metrorrhagia may be due, at times, to placenta prcBvia. Such haemorrhage, when it occurs in the uterus, and the blood mixes with the uterine milk, gives rise to a chocolate-colored fluid between that organ and the foetal membranes, and in the asphyxia and intra-uterine respiration (pulmonary) of the foetus, this reddish-colored fluid is often present in the lungs. Hartmann describes a case in which the chorion papillae of an aborted foal were small, pale, hard, and cartilaginous ; and Broers (Canstatt's yahresbericht, 1861, p. 53) describes two foetuses in the uterus of a Cat, and on the inner surface of the membranes of one were numerous vesicular extravasations, while the other could scarcely be recognized. It may be surmised that many abortions or fcetal deaths are due to dis- ease of the placentas. The foetal membranes may be too thick and resisting, or too thin and friable. In the first condition, they resist the labor pains too long, and after the os uteri is completely dilated they may be found intact outside the vulva ; the fcetus may even be expelled in them. Such tenacious membranes may, to a certain extent, hinder delivery, though seldom, if ever, produce dangerous consequences, except to the foetus. 376 FCETAL DYSTOKIA. Very thin membranes may, on the contrary, not resist the uterine con- tractions for a sufficient length of time, and therefore rupture before the OS is sufficiently dilated. The consequent escape of the " waters " will render labor longer and more difficult. The utero-vaginal canal is dry and retentive, and the contractions of the uterus are weaker and much less effective. The treatment for both of these conditions has been already indicated. At page 359 we alluded to adhesions between the foetus, its membranes, and the uterus, as a cause of protracted or impotent labor. We have now to refer to adhesion of the membranes to each other, or to the foetus only, as a cause of difficult labor. These adhesions are generally of the nature of fibrinous bands passing between the membranes, or from the surface of the young creature's body to the interior of its envelopes, due to the development of some local in- flammation. Such cases are certainly rare, but their occurrence must nevertheless be taken into account. One of the most interesting instances of this occurrence is given by Millot, and quoted by Rainard {Op. cit., vol. i., p. 492). The animal, a Cow, was eight years old, and had been in the pangs of labor for eight days. Some months before it had received a kick on the abdomen from a horse, which caused it to show all the symptoms of impending abortion. After eight days suffering, the symptoms subsided and the appetite returned ; but emaciation persisted until the period for parturition. When this occurred the an- imal was quickly exhausted, and Millot found it lying on the left side ; the eyes sunken ; the visible mucous membranes pale ; the pulse frequent, small, and weak ; the respira- tion hurried and plaintive ; the labicc vulvce tumified and the mucous membrane ecchy- mosed, while a reddish-colored and foetid serum escaped from this opening. The fore- feet of the calf presented, and on opening the vulva the head could be perceived. As every attempt to make the Cow stand on its feet had proved useless, it was de- cided to remove the foetus while the mother was in the recumbent position ; but the debility was so great that three bottles of hot wine had to be administered before ex- traction could be attempted. And even then the Cow gave but little assistance, as the pains had nearly subsided. Traction having proved ineffectual to advance the foetus, the hand was introduced to discover the obstacle which hindered its progress. In pass- ing it over the anterior surface of the head, a kind of flattened cord was felt passing be- tween that part and the membranes. Nothing else being met with, this cord was cut, when the foetus, which was dead, came away immediately. An examination of the calf showed that death had not occurred recently, as the hair came off readily, and there was a foetid odor. The subcutaneous connective tissue of the head was infiltrated with a yellow serosity, which greatly increased its size. On the left frontal region — that to which the cord was attached — there was an indentation ex- tending to below the orbit, and the bone was thickened ; while the corresponding part of the brain was diminished in volume, the ventricle being nearly effaced, and the cere- bral tissue had the color of yellow wax and the consistence of suet. No alteration was noticed on the other side of the head. There was no doubt as to these lesions having been produced by the kick from the horse a month previously. The cord attaching the head of the foetus to its envelopes, showed a peculiarity worthy of attention in an anatomo-pathological point of view. It had the aspect of the skin, and was covered with hair for more than an inch in extent, beyond which it was composed of the normal layers of the envelopes. Where it was inserted into the head, the skin was notably attenuated in a horse-shoe-like form. It seemed probable that a shred of skin had become detached by the injury, and contracted adhesions with the foetal membranes ; in this way constituting the cord covered with hair, which proved so serious an impediment to birth. Vincent describes a very interesting case, in which the skin covering the joints of the first and second phalanges of the right fore-leg of the foetus had contracted close and strong adhesions with the envelopes, and these with the uterine mucous membrane — in a somewhat similar manner to that recorded by " Nemo," at page 360. These adhesions opposed a EXCESS IN VOLUME OF THE FCETUS. 377 serious obstacle to birth, which could not be accomplished until they were broken up by the fingers. A curious case is given by Lhomme {journal des Veterinaires dii Midi, 1868, p. 372) which shows, among other things, that adhesion of the membranes to the uterus does not always prove an obstacle to sponta- neous delivery. This Veterinarian was called to attend a pregnant Mare, reported to be suffering from colic. The animal was lying extended on the ground, breathing heavily, struggling, and making expulsive efforts. A portion of the foetal envelopes was observed to protrude beyond the vulva, which led to the belief that abortion was about to take place. The colic was allayed by medicines, hygienic measures were recommended, and Lhomme re- tired, persuaded that the expulsion of the foetus would soon occur. Two days passed, however, and he was again sent for ; as although the pains had disappeared and there had been no abortion, yet the membranes still hung from the vulva. An examination proved that the foetus was still alive, and that the os uteri was firmly closed on the extruded envelopes, so that a finger could not be introduced. There ap- peared to be a veritable strangulation of the membranes which, having undergone change, irritated the vagina, and made the Mare restless. By means of curved scissors, these extruded membranes were removed as close to the cervix uteri as possible. The Mare was immediately relieved, as the pawing, stamp- ing, and whisking of the tail ceased. No opinion could be given as to the result, the case being so unusual. It was certain that the embryonal sac had, by this operation, been opened ; but then there was no escape of liquor amnii, owing to the closure of the OS on the remaining portion of the envelopes. But the question was whether the fluids would yet escape, or whether this would be prevented by cicatrization of the membranes on the distal side of the strangulation. It was still three months to the time for partu- rition, and the owner of the Mare was recommended to report whenever the slightest sign of illness appeared ; and if abortion should take place, he was requested to keep the foetus and membranes for Lhomme's inspection. The animal continued to enjoy perfect health, however, and at eleven months and twelve days — three months and two days after the operation — it brought forth a strong and perfectly-formed mule. The foetal envelopes were carefully examined, and a cica- trix was discovered which corrugated and united them together ; from this part they were in plaits to the extent of several inches, and these plaits were destitute of villi. The opening in the membranes through which the foetus had passed was between two and three inches from the cicatrix. xA.dhesions, when they exist and are a cause of dystokia, and when they can be reached, must be broken up or cut through. In the majority of cases, the fingers will suffice ; if not, then a bistoury must be used. Difficulty in parturition in the Cow is sometimes experienced from the envelopes being torn in several places, and the head or limbs, or both, passing through these fissures. In such cases the entangled parts of the foetus must be sought for, re- leased, and brought into a favorable position by tearing or cutting through the obstacles. Frornage de Feugre {Cours Complet, vol. i., p. 87) reports an observation furnished by Lacueille. A Heifer was in labor for five hours, and was much exhausted by the manipulations of amateurs. The calf presented the head and one fore-leg. Lacueille, instead of acting with precipitation, allowed an interval to occur between each of his attempts at extraction ; but an hour elapsed before he could discover the elbow of the other fore limb, which was entangled in the torn envelopes. Delivery was soon after effected, and the membranes came away with the calf. Abnormal Quantity of Placental Fluid. We have already described the condition known as " hydramnios," and have pointed out that when it exists abortion nearly always takes place. When the accumulation of fluid interferes with parturition, labor is slow 378 FCETAL DVSTOKIA. s and delivery difficult, owing to the great distention of the uterus and the pendulous state of the abdomen. The indications for treatment have been given at p. i8o. An unusually small quantity of the liquor amnii, when it is not due to premature rupture of the envelopes, has not, to my knowledge, been men- tioned as a cause of dystokia ; though there is no reason why this de- ficiency should not lead to protracted labor, if we call to mind what has been said as to the uses of this fluid. The indications will be the same as for those cases in which the fluid has escaped prematurely. Anomalies in the Umbilical Cord. Anomalies in the umbilical cord are not a very common cause of dystokia. The cord may be unusually short; but this deficiency does not appear to operate prejudicially in parturition, as the natural twist in it admits of its elongation to a certain extent, while during the act of expulsion the walls of the body of the uterus approach the cervix as the foetus advances into the vagina. Even if the cord happened to be too short, it is ques- tionable whether it would constitute a serious obstacle to birth, as it would most probably either rupture or the placenta would separate from the uterus. If by chance the foetus should not be expelled until it was discovered that the cord was not sufficiently long, this might easily be cut in the vagina, as far as possible from the foetus, the ends being compressed by the fingers and ligatured after delivery. In the domesticated animals the cord is never so long as to occasion what has been designated in human ohsietxics prolapsus of the cord, i.e., its descent into the os, vagina, or outside the vulva, after rupture of the membranes, and alongside the presenting part of the child : an accident attended sometimes with great danger to the latter, from compression of the funis. The comparatively short cord of the domesticated animals also ex- empts them to some extent from another frequent cause of difficult labor met with in woman : the coiling of the funis around some part or parts of the foetus. Nevertheless, this coiling has been observed in animals — more often with the Mare than the Cow. Havon, Delwart, Hurtrel D'Arboval, Rueff, and Sacchers have seen it coiled around the neck, and more especially when the foetus was in a wrong position — bent towards the flanks, near the cord. Gaven has found it round the loins ; and numerous observers have noted it encircling one or more of the limbs. Daubenton had remarked the frequency of leg coils in Sheep. Coiling of the funis around any part of the foetus is not in itself a com- mon cause of dystokia, although it may render delivery protracted and fatiguing. It is more likely to induce asphyxia in the young creature, from the stretching and diminished calibre of the blood-vessels composing it, and consequent check to the flow of blood. Rainard is of opinion that the obstacle to parturition from coiling, is less serious in the Mare and carnivorous animals than other creatures, because of the readiness with which the placenta is detached in them. The dangers of strangulation are also much less when the foetus pre- sents anteriorly ; when the presentation is posterior, there is risk of suffocation, because it is difficult to ascertain the situation of the cord DISEASES OF THE FCETUS. 379 in order to divide it ; and the uterine contractions, as well as the artificial traction, tend to tighten the funis around the neck. In the human species, it has often been remarked that children are sometimes born with their limbs deficient, and the spontaneous amputa- tion has been attributed to the constriction produced by this coiling or twisting of the umbilical cord around the part, during the development of the foetus. Vrolig, Hillairet, and Goubaux have recorded similar muti- lations in animals. Indications. When coiling of the funis is ascertained to be the cause of difficult parturition, the indications are to uncoil it ; or if this cannot be effected, then it must be divided either by the fingers, scissors, or a probe-pointed bistoury — hastening delivery as much as possible afterwards. There is not much to be feared from haemorrhage after section of the vessels, as they seldom bleed. CHAPTER II. Diseases of the Foetus. While in the uterus the foetus may be affected with disease, which, causing its death, will lead to abortion or premature expulsion, or perhaps undue retention. Other abnormal conditions, more or less allied to disease, may give rise to vicious conformation or excess of volume, generally or locally, and thus prove a cause of difficult parturition These conditions may produce hydrocephalus, ascites and anasarca, em- physema, polysarcia, muscular contractions, and tumors of various kinds. Hydrocephalus. As the term implies, " hydrocephalus " signifies dropsy of the brain, the dropsy being constituted by the accumulation of a more or less considerable quantity of fluid in the cranium of the foetus, leading to a proportionate enlargement of that region. This diseased condition is not at all uncommon in the bovine and equine species, and some of the specimens of craniums found in mu- seums are wonderfully deformed, through the accumulation of fluid in their interior. Pathological Anatomy. This diseased condition is recognized by a more or less exaggerated development or volume of the cranium, the vault of which has been elevated and distended by the fluid collected in the brain ventricles. In some cases, the distention has been so slight that the frontal bones are not much raised ; while in others the collection of serum has been so great that these and other bones of the cranium are displaced, and the forehead, rising almost at right angles to the face, suddenly reaches an extraordinary height, giving the creature a startling appearance. The hydrocephalic tumor varies in figure as well as in volume. It is some- times quite globular, and protrudes so high and so much over the face as to give the physiognomy a strangely human appearance (Fig. 81) ; in rare cases it is narrow, but excessively protuberant, involving only a part 38p FCETAL DYSTOKIA, of the cranium (Fig. 83) ; at other times it is bilobular, and the divisions may be either alike or unequal in volume. Not unfrequently the diam- eter of such a tumor in the calf measures more than a foot. The tumor is soft and depressible in parts, hard and resisting in others, owing to the bones of the cranium being altered and separated in places. These bones — and particularly the frontal, temporal and parietal — are, as a rule, considerably deformed and thrown out of their natural direction, and in places so expanded and rarefied as to be i\o thicker than tissue-paper ; Fig. 78. Skull of a Hydrocephalic Calf: the Cranial Bones are partially destroyed and defective. when the internal distention has been very considerable, their borders do not meet as in their normal condition, but are often widely separated, leaving between them vast fontanellae occupied only by a thin translucid membrane — the dura mater — which is in immediate contact with, and adheres closely to, the skin. In some instances — especially in the calf — the bones in their upper part do not join at all, and the roof of the cranium, or, rather, of the cranial tumor, is entirely absent (Fig. 79). In other instances, and particularly in the foal, a kind of bony arch extends from the nasal to the occipital bones, in the direction of the saggital suture, with only here and Fig. 79. Skull of a Hydrocephalic Calf: the Roof of the Cranium is absent. there, on each side, small osseous patches from the parietal or temporal bones, and adhering to the dura mater. The tumor is always entirely covered by intact, though sometimes very thin skin, to which the hair is ordinarily attached, and is indeed at DISEASES OF THE FCETUS. 381 times longer than usual, especially at the sides. This often makes the animal appear as if it wore a high fur cap (Fig. 81). Owing to the great development of the forehead the upper jaw appears to be shorter than usual ; and, indeed, it will be found that it is really so (Fig. 78). Fig. 80. Skull of a Hydrocephalic Foal: the Cranial Roof is Deficient at the Sides. When the cranial cavity is opened, and the dura mater incised, there is found a quantity — varying with the dimensions of the tumor — of limpid, colorless, or slightly yellow or greenish serum. The quantity of fluid varies considerably, but it is generally from two Fig. 81. Calf affected with Hydrocephalus: its Skull is represented in Figure 79. to four pints in the foal and calf. Rainard estimated the quantity of fluid that had been contained in the skull of the Calf sent to him, at two and a quarter litres — the largest quantity he had met with. Drouard, how- ever, in 1842, published the details of a case of a foal whose cranium held four and a-half litres (about eight imperial pints). Figure 80 represents a Foal's skull, now in the museum of the Lyons Veterinary School, and which from its dimensions, Saint-Cyr calculates to have contained eight litres (about thirteen pints). Kopp not long since exhibited the head of a Foal before the Veterinary Society of Alsace, >3«2 FCETAL DYSTOKIA. the diameter of whose dropsical cranium was fourteen inches, and which it was computed would contain about twelve litres of fluid (more than two and a-half gallons). And Quesnel has also shown a skull of about the same dimensions, to the Veterinary Society of Calvados et de la Manche. Mr. Olver ( Veterinarian, 1874, p. 481) describes the cranium of a hydro- cephalic Foal which measured thirty-six inches in circumference, ten inches from one orbit to the other, and twenty-seven inches from the occipital crest to the nasal bones. At least twelve pints of fluid were contained in the cavity, and the cerebral substance remaining was quite disorganized, the durmater being much thickened. The cranial cavity was almost wholly surrounded by bone ; the only portion which was solely enclosed by skin was a space about four inches in circumference at the top. In the Museum of the Munich Veterinary School is a skull, the cranium of which measures nine by eleven inches in diameter. Professor Lombardini {Giornale di Veterinaria, 1873) speaks of the head of a Calf, the cranium of which was more than fourteen inches high ; it was eight and a-half inches long, and four and a-half broad. This Calf, with two others, well-formed, was aborted at six months, without any injury to the Cow, which was six years old. There can be no doubt that if the full period of pregnancy had been reached, this Calf would have proved troublesome to extract. But these latter are quite exceptional instances, and are three or four times larger than those usually met with. This accumulation of fluid takes place in the ventricles of the brain, as has been ascertained from dissection by Rainard, Taiche, Chouard, Fig. 82. Head ok a Foal affected with Hydrocephalus. Axe, and others, who have found the tumor formed externally by the skin, and internally by the membranes of the brain, to which adhered a thin layer of cerebral substance. The spinal cord, plexus choroides, and cerebellum, have been generally observed to be intact, and ou\f the cerebral hemispheres are destroyed more or less completely. Though this alteration, or rather destruction, of the brain is of so serious a character, and though it must have begun at an early period of uterine life, yet it does not appear to have much influence on the development of the foetus, as this is usually found to be full grown, its skin covered with hair and well-formed everywhere except in the head. Exceptional cases DISEASES OF THE FCETUS. 383 occur, however, in which development is arrested ; as in some mentioned by Lecoq, of hydrocephalic Calves, in which the limbs were atrophied and the bones of these cartilaginous. If intra-uterine existence can be maintained by the hydrocephalic foetus until the period of parturition, it generally perishes during birth or soon after — usually after one or two respirations. In some exceptional cases, however, such creatures have lived to the eighth day after birth, and, as Saint-Cyr remarks, they might survive even longer if the dropsy is not very extensive. In the most favorable cases, nevertheless, there is little profit to be expected from keeping such animals alive, as they are ordinarily week and thrive badly ; they can rarely stand, and they refuse the teat, being usually in a semi-comatose state ; if the tumor chances to he pressed upon, the young creature becomes completely unconscious and lies in convulsions. Very few cases of recovery, even in the mildest form of the malady, are recorded. Dystokia. The obstacle this congenital condition of the foetus presents during birth, must, of course, depend upon the volume of the cranial tumor. The birth of a hydrocephalic fcetus often takes place spontaneously, though perhaps only after much straining. If the cranium is not very large, and provided the labor pains are sufficiently energetic and the position favorable, the tumor yields, and the head becomes elongated in its passage through the os and the pelvis, or it may rupture internally and the fluid escape by the ears, nostrils, and eyes. When extremely large, the cranium may offer an invincible obstacle to spontaneous de- livery, notwithstanding the most powerful labor pains. And, besides, the mechanism of parturition in such cases varies with the presentation — anterior or posterior. The head of the hydrocephalic foetus being more or less spherical — instead of conical, as in the normal condition — it results that this part, when the young creature is pressed upon by the uterus, no longer acts as a wedge to gradually dilate the os uteri. The head certainly commences the work of dilatation, but in a very incomplete manner, and when the jaws — particularly the upper one — have cleared the os, further progress is checked by the voluminous .forehead. If the hand is introduced into the vagina, the cervix uteri is found to be contracted on the nose or jaws of the foetus ; and the delay in further expulsion depends upon the size of the cranium, the protrusion of the uterus into the pelvic cavity, and the exhaustion of the organ by futile contractions. In the posterior presentation, birth takes place in the manner already described ; the hinder extremities advance through the os, then the body and neck, and birth is apparently takin'g place satisfactorily until the head reaches this aperture, when further advancment is stopped — the resistance to expulsion being in proportion to the volume of the head. Not unfrequently, with such a condition of the fcetus, we have also a malposition to complicate matters. Diagnosis, In the anterior position, there is not riiuch difficulty in diagnosing the presence of hydrocephalus : as the hand can feel the voluminous spherical 384 FCETAL DYSTOKIA. cranium beyond the muzzle and eyes, with the ears on each side, and its unequally resisting surface — hard in some parts, soft or fluctuating in others. When, however, there is a malposition of the foetus, then it is sometimes more difficult to discover the hydrocephalus j and often this cannot be done until the position is remedied. The head should be sought for in every case, and it will be recognized by the mouth, eyes, and ears ; after which the size, consistence, and form of the cranium can be estimated by passing the hand over it. In the posterior presentation, hydrocephalus has been recognized while the foetus was still in the uterus. The greatly enlarged head may be felt per rectum, or even through the abominal walls. But, as a rule, it is only at an advanced period of labor, and when the body of the young creature is already beyond the os, and perhaps without the vulva, that a difficulty is discovered and the cause sought for. Fig. 83. Extraordinary Development of the Cranium of a Hydrocephalic Calf.* In such a case manual exploration is necessary, and this should be effected, if possible, by passing the hand between the foetus and the wall of the vagina. This is difficult if the body is still in the passage, and it may be requisite to have recourse to traction to withdraw it therefrom. If, however, it is beyond the vulva, then the hand can be easily passed along the neck as far as the head, when the real state of affairs can be discovered. Indications, , The indications for treatment in cases of dystokia from hydrocephalus alone, without reference to such a complication as malposition of the foetus, are simple and few. When the hydrocephalus is not considerable, judicious traction will often accomplish delivery \ and several cases are on record in which foals and calves whose cranium was of large size and full of fluid, have been delivered by this means, some of them alive, and in the posterior as well * For the photograph oi Figs. 82, 83, and 99, I am indebted to my friend, Mr. Shipley, M.R.C.V.S., of Yarmouth. DISEASES OF THE FCETUS. 385 as the anterior presentation. In such a case, suppose the fore feet pre- sent, these should be secured by cords> the ends of which may be given to an assistant ; then the hand should be introduced into the vagina, and if necessary the os should be dilated sufficiently to allow of another cord being fastened on the upper, or, perhaps better, the lower jaw, which is often wider. Traction can then be made during the throes of the mother. When, however, traction will not effect delivery, because of the size of the head, and the mother is becoming exhausted, the cranium must be punctured — an easy operation when the presentation is anterior, but more difficult when it is posterior. The puncture may be made by means of a bistoury, a scalpel or ordi- nary knife, or, which is preferable, a somewhat large trocar and canula, curved if possible. The most fluctuating part of the tumor should be penetrated, and the fluid having escaped, the cranial parietes collapse, or give way to pressure; the head is thus greatly reduced in size, and' de- livery can be completed. Rainard recommends the puncture to be made on the side of the cra- nium ; and should it be necessar34 to still further reduce the size of this part by bone-forceps or other means, the side of the cranium will be found most suitable. In the posterior presentation, the back of the head may be punctured, and the weight of the young creature's body, hanging be- yond the vulva, will sufficiently steady the head for this purpose ; but in the anterior presentation, traction should be made by means of the cords while the cranium is being opened. Rainard informs us that Conte, being called in to assist a Mare in foal- ing, found a posterior presentation, and having diagnosed hydrocephalus, he was able by version to convert it into an anterior presentation, when the head was easily punctured. Embryotomy has been recommended in such cases ; but, beyond re- ducing the size of the head, if that is the only obstacle, there is no neces- sity for resorting to further breaking up of the body of the foetus. In- deed, it will be found that, in ordinary cases, patience and judicious manipulation will often enable the obstetrist to dispense with craniotomy. This is well exemplified in the following instance. Drouard {Renieil de Med. Veterinaire, 1842, p. 40) was requested to attend a Mare laboring under difficult parturition. The animal was nine or ten years old, in good con- dition and well-formed, and had produced and reared three or four foals. The presen- tation was posterior, with the hind legs bent forward under the body. The breech oc- cupied the passage, and could not be moved forward to allow the hand to seize the thighs and so bring up the legs ; the labia of the vulva were becoming swollen, and the Mare, being exhausted by fruitless straining, was in a dangerous condition. There ap- peared to be only two methods of delivering the animal : by practising embryotomy, or forcibly extracting the hind extremities. For this purpose a strong hooked instrument was fixed in the right hip of the foetus. Six or seven persons pulled energetically at this instrument, while others supported the Mare and prevented her falling. As soon as the skin and muscles began to give way, the femur became disarticulated, and was drawn out. After this it was thought that' the other parts of the foetus might be ex- tracted by ordinary means ; but tumefaction of the parts increased so rapidly that the other extremity had to be removed in the same way. A hook was then in.serted into ' each of the acetabular cavities, and the body of the foetus was easily drawn into the vagina when, the head having arrived at the pelvic inlet, all further progress was stopped. The hand was introduced into the uterine cavity, and a monstrous head was recognized ; in this considerable fluctuation could be detected, and hydrocephalus was diagnosed. Drouard was preparing to puncture the head, when the assi.stants, taking advantage lOf an effort of the Mare, pulled all together so stronglv, that they extracted the trunk 25 386 FCETAL DYSTOKIA. and head of the foetus — a cranium of such monstrous size had scarcely ever been seen before. The foetus altogether was small and emaciated, but the enormous head was larger on the right side then on the left. On the slightest displacement, the fluctuation of the contained fluid could be both seen and felt. Macgillivray {Veterinary yournal, January, 1877) attended a Cow which had been showing symptoms of calving for some hours, the waters having escaped, etc. He found parturition further advanced then was expected, for a pair of feet were protruding from the vulva. Observing that the soles of the two feet were shown uppermost, he concluded that it was a hind-leg presentation, or something worse. It proyed to be a hind-quarter presentation, and very slight traction sufficed to bring away the foetus as far as the fore-quarters, but there it came to a complete standstill. He introduced his arm into the passage, expecting to find a fore-leg turned back ; but could discover no such obstacle — his hand slipping quite easily all round the body of the foetus. He now attached cords to the hind-legs above the fetlocks, and with the assistance of five or six people drew away a living foetus. The cranium was of an immense size, and precisely similar in shape to Fig. 78. What rendered the extraction of the foetus so difficult, and the case so uncommon, interestingj- and complicated, was that one of the fore-legs passed right over the top of the, enlarged cranium (from occiput to muzzle), and was. in fact, partially imbedded in a groove during its whole course along the abnormally large foetal cranium. This mal- positioned leg must have been there for months, as the bones of the cranium were quite firm and unyielding ; and the erratic leg persisted in keeping its cranial \>o?h\!\o\\ even after delivery. This malpostured foetal monster remained alive for a few minutes only ; which the farmer's wife thought a very lucky cfrcumstance, as she was just asking him to make away with it when it went away of itself ! Every case, however, does not terminate successfully. Olver ( Veterinarian, vol. xlvii., p. 481), in a case of difficult parturition in a cart Mare, found, on examination /^r t/(2^/«a;«, the fore limbs of the foal in the passage, with the head turned back out of reach. The presenting limbs being detached from the body of the foetus, an enormously enlarged head was discovered, the enlargement being surmised to be due to hydrocephalus. Attempts were made to puncture the cranium, but unsuc- cessfully — though the reason for the failure is not stated ; consequently the Mare was killed. We have given the dimensions of the cranium at p. 382. Ascites, Anasarca and Hydrothorax. " Ascites " (fluid in the abdominal cavity) and " Anasarca" (fluid be- neath the skin), either partial or complete, do not appear to be such fre- quent diseases of the foetus as hydrocephalus. The cases recorded are comparatively few. Anasarca has been observed in the foal, calf, and kid, and ascites chiefly in the calf. These pathological conditions have generally been confounded. With regard to ascites, it appears that in all the recorded observations, the foetus was in what we have designated the " natural presentation and position ; " though twice these were complicated : the head being turned back on the left side in one, and in the other all the limbs presented with the head, the left fore-limb being contracted. Sometimes the foetus has ceased to live before the full period of preg- nancy has expired, and is expelled from the uterus ; at other times it reaches maturity, and living through a few of the early pains, it succumbs before parturition is completed, either from the effects of protracted la- bor or from the manoeuvres adopted to extract it. None appear to have been born alive ; nor would they be likely to live if by chance they were extracted before death seized them. In addition to the abdominal cavity, the scrotum is often enormously enlarged through its communication with the latter, of which it is only a kind of diverticulum. Hydrothorax is often combined with ascites. DISEASES OF THE FOETUS. 387 With regard to anasarca, Noyes (Rainard, Op. ctt., p. 476) has witnessed a number of cases of general anasarca in the course of a year, in the nfeigh- borhood of Mirepoix, France. He states that the calves were born at least three weeks before their time, and always dead. The connective tissue of the entire body — from the head to the croup — was infiltrated with serum, the young creatures being double or treble the size of ordi- nary calves ; the head especially was enormously large. During preg- nancy the abdomen of the Cows was so developed, that their owners thought they were bearing twin calves. Que'tier has published details of analogous cases of general infiltra- tion, in which the foetus was at least twice its natural size. This condition has been witnessed in the foetus of the Mare by Pauli (Gurlt and Hertwig's Magazin, vol. viii.), and by Lehnhardt {Ibid., vol. ix.) and Herran {Journal de Vet. du Alidu 1864) in the Goat. The lat- ter authority made an autopsy of a Goat which had died from injuries in- flicted on its head, and found in it twin foetuses, whose body was com- pletely infiltrated. Cause. The cause of this dropsical condition is not well ascertained. In some cases it may be due to uterine dropsy of the mother or to constitutional hydraemia ; but in other instances it cannot be so, as the mother is in good health, and it would then appear to be owing to derangement of the foetal circulation, and particularly of the venous system — probably conges- tion of the umbilical cord. At times, disease of such organs as the kid- neys may produce it. Arloing informed Saint-Cyr [Op. cit.^ p. 544) that Guilhempey, veterinary surgeon at Cologne (Gers), met with tliree cases of foetal ascites which proved a cause of dystokia in the Cow. The foetus in each case was in the normal position (vetebro-sacral of the anterior presentation) ; but though the feet were in the vagina, delivery could not be effected, notwithstanding the most skilful and energetic traction. In the first- cases, after many difficulties and much examination, it was ascertained that the abdomen of the foetus was enormously distended; and at the moment the mother strained, or when trac- tion was made, this region seemed to divide into two masses, separated by the spins of the young creature. Recognizing it as a case of ascites, the abdomen was punctured by means of a long knife, the blade of which was guarded with tow except at the point ; a great quantity of fluid escaped, and the mother then straining violently, delivery was effected. The second case was of a similar character, and in the third case, though puncture diminished the difficulty, yet it did not permit it to be entirely overcome, as in the others. This was because, in addition to the ascites, there was hypertrophy of the liver and kidneys. One of the latter weighed nearly eighty-two ounces (2,300 grammes), the other about seventy ounces (1,990 grammes) ; the liver weighed ninety-two ounces. The peritoneum was thickened, and showed traces of chronic inflammation. One of the kidneys sent to Arloing for examination weighed only fifty-six ounces, but a large quan- tity of blood had escaped from it into the vessel in which it had been carried. It ap- peared to be five or six times larger than the kidney of a calf ready for the butcher, and its surface still allowed its usual lobulated arrangement to be seen. Its proper capsule, covered by its thickened peritoneal envelope, was easily removed, and beneath it ap- peared a great number of somewhat translucid greyish points. On section through the middle, the two structures of the kidney were distinguishable, but their tint was pale ; everywhere, but more particularly in the cortical substance, were observed the greyish points, the contents of which could be readily removed, leaving a small cavity in their place. After hardening in chromic acid, sections were made, when the greyish points, on being submitted to microscopic examination, appeared to be so many kysts filled with the d}bris of epithelium from the uriniferous tubes. The connective stroma was also hypertrophied, and particularly abundant in the neigh- borhood of the papillae. This \vas evidently a case of kystoid degeneration of the kidney, from atresia of the papillse — a kind of degeneration observed in the human species, and described in Vir- chow's " Pathology of Tumors." 388 FCETAL DYSTOKIA. Franck remarks {Handbuch dcr Thierdrztlichen Geburtshiilfe, p. 429), that the fact that sometimes a Cow will for a number of years bring forth these dropsical calves ( Wasserkdlher) in succession, while other Cows in the same shed produce healthy calves, shows that there is probably, in these cases at least, some anomaly in the uterine vessels ; the fact, also, that sometimes along with general anasarca and ascites, there are rhachitic alterations of the bones, points to mal-assimilation, or deficient supply of the protein substances and phosphorus salts, the deficiency being presum- ably due to disease on the part of the mother, or to some anomaly in the composition of the uterine milk. Dystokia The amount of difficulty met with during delivery in these cases will depend upon the quantity of fluid effused into the abdominal cavity, chest, or superficial connective tissue. Sometimes delivery is possible with the aid of traction. But in the great majority of instances, when the head and fore-feet have passed through the os, further progress appears to be impossible. In these cases we have extreme distention, but even in some of them delivery by traction is not hopeless. Cazeaux Traite Theoretique et Practique de VArt des AccoHchmenis, p. 659) says of this condition in the human foetus : " The abdominal parieteshave been observed to yield in such a way that a large portion of the tumor remained above the inlet, while the trunk gradually descended into the pelvis ; and when once a part of the abdomen had cleared the passage, the fluid escaped into it and towards the point where there was least resistance, the volume of the part still in the pelvis pro- gressively diminishing, and delivery beingfinally accomplished naturally." Saint-Cyr is of opinion that it is probable delivery has been effected in a similar manner, in those cases in which the dropsical foetus of animals has been extracted without operation or mutilation. Sometimes the walls of the abdomen give way, as in the case recorded by Courjon (Rainard, Oj>. cif., p. 485). This veterinarian attended a Cow, three years old, which was in the act of parturition. The foetus was in the natural position, and the head and fore limbs were external to the vulva. Strong traction was employed to extract 'it, during which the abdomen ruptured, and it was estimated that more than twenty litres of fluid escaped. The Cow was in great danger for a month afterwards. Diagnosis. The nature of the obstacle can only be ascertained by vaginal or uterine exploration, though an examination per rectum may assist in leading to a correct diagnosis. In vaginal exploration the great size of the abdomen in ascites, the dis- tention of its parietes, and the fluctuation on pressure, should reveal the state of affairs. Not unfrequently, however, the body of the foetus so com- pletely blocks up the passage that it is impossible to pass the hand, and it may be necessary to remove the protruding limbs by embryotomy in order to diminish its volume. Hesitation in resorting to this operation is usually unjustifiable, as the foetus is nearly always dead, and if alive it cannot exist after birth. It has been recommended, in addition, to remove the two first ribs, in DISEASES OF THE FCETUS. 389 order to allow the hand to explore the interior of the foetus. If the ob- stacle is due to ascites, the convex condition of the diaphragm, and the fluctuation of the fluid on the abdominal side of it, will be remarked. When the dystokia is owing to anasarca^ this will be distinguished by the general roundness of the surface of the body, owing to the subcuta- neous fluid, which effaces all the prominences, and to the oedematous sensation communicated to the fingers by pressure. Indicatmis . When the condition of the foetus is once ascertained, the principal indication, if delivery by traction cannot be effected, is to diminish its volume, by producing the evacuation of the fluid which distends it, as promptly and effectually as possible. In ascites, puncture of the abdomen through the parietes of that cavity, if they can be reached, or puncturing the diaphragm through the chest, if they cannot, must be practised. In the first, a bistoury or any kind of convenient knife, or a trocar, will suffice j in the second, a long trocar or long-bladed knife, wrapped round with tow to near the point, will answer the same purpose ; or if the hand can be introduced into the thorax, the fingers alone will rupture the diaphragm. As the fluid escapes, the abdomen collapses, and delivery is then easy. When anasarca is present, the fluid must be got rid of by deep incisions through the skin wherever the hand can reach. The mechanical extrac- tion of the foetus should then be easy. In a case reported by Anacker, however {Thierarzt, 1868, p. 85), the foetus was so large that it had to be removed by gastro-hysterotomy. 1. In 181 5, Rouchon communicated the following case to Rainard {Op.cit., p. 484). He was called to see a Cow, ten years old, and which had always until then been in good health, and had calved four times : but the belly had never been so large as during the pregnancy with the calf which it was then attempting to get rid of. It was ex- tremely feeble, and before anything could be done towards assisting it, a stimulant had to be administered. No portion of the foetus was visible, but on Rouchon introducing his hand into the uterus, he found the fore limbs and the head ; the creature was in the dorso- lumbar position, and on the fingers being passed into the mouth, it was discovered that it was dead. The limbs and jaw were corded, and on traction being patiently but forci- bly exercised, the head and fore limbs were extracted, though it was impossible to remove more than these. With very great difficulty the hand was again passed into the genital passages, and it was found that the abdomen and scrotum of the foetus were of an enormous volume. The abdomen was punctured with a bistoury, and Rouchon estimated that from seven to eight litres of a yellow, oily-looking fluid escaped there- from. The extraction of the calf was immediately effected, and soon after the Cow expelled nearly three-fourths of a bucketful of the same kind of liquid. 2. Courjon, according to the same authority, saw a Cow, three years old, the foetus of which, in the same position, had the head and fore limbs protruded ; in the attempts to extract this foetus, its abdominal parietes were ruptured, when it was calculated that twenty litres of fluid escaped. Soon after, this veterinarian had to puncture the abdo- men of another calf foetus with a bistoury, then to enlarge the incision with the fingers and hand, in order to permit the escape of the fluid therein, which was supposed to amount to twenty-five litres. The foetus had also anasarca of the hind limbs. Schvvarz, according to Franck, describes the case of a calf affected with hydrops universalis, which an empiric had been trying for twelve hours to extract, and the four feet of which had been drawn into the vagina. Schwarz incised the kystoid swelling about the neck, after which the calf could be removed. 3. Voigtlander (Sachs. Jahresbericht, 1861, p. 67) also mentions a similar case, in which the fore limbs had to be extracted, and the chest and abdomen opened, before birth could be effected. The Cow was saved. 4. Miiller {Oesterr. Vierteljahresschrift, 1868, p. 36) likewise describes a dropsical calf. 390 FCETAL DYSTOKIA. the fluid in the kysts being clear and yellow, with whitish flakes; they had the form of echinococcus kysts, and were formed by a thin serous membrane. The lungs were very small, and the chest contained a quantity of water; the heart was large, and the right chambers much widened. 5. Gierer [Ibid., 187 1) alludes to an ascitic calf which, when being forcibly extracted, ruptured internally, and a stream of fluid gushed from its mouth and nostrils; The same authority writes of another calf in the same condition, which ten men had extracted as far as the withers, but could get it no further. Gierer contrived to make an opening in the abdomen, when a great quantity of fluid escaped, and the young creature was then removed. 6. Dinter [Sachs. Jahresbericht, 1867, p. 87) relates a case in which five men had ex- tracted the calf as far as the shoulders, when it remained fast. It was punctured by a trocar and canula, and eight to ten quarts of blood-tinted serum escaped, When ex- amined after it was removed, about half a pailful of fluid was still in the abdomen. 7. Binz [Geburtshiilfe, etc., p. 241) gives the case of an ascitic calf, the head and one fore limb of which had passed through the os uteri. The chest and abdomen were opened through the breast, the fluid was evacuated, and delivery effected. An extremely rare cause of dystokia is due to congenital occlusion of the urachus, which leads to great accumulation of urine in the bladder, and consequent distention of the abdomen. A very good example is given in the yearly report of the Veterinary School of Hanover, for 1872. This condition will be diagnosed in the same way as ascites, and the same indications for extraction of the foetus are to be observed. Emphysema. Emphysema of the foetus is sometimes found to be a cause of dystokia. Leconte mentions that he has met with a case in which a living foetus was partially emphysematous, the head and neck, as far as the shoulders, being involved. This case is exceptional, however, as this condition is, as a rule, ob- served only after the foetus has perished in the uterus. It sometimes happens that during parturition the water-bag is ruptured before the young creature has made sufficient progress, or it may be in a bad posi- tion. The uterus then closely contracts on it, over the whole of its sur- face, and it soon succumbs. In the course of two or three days its tissues have become softened and decomposed ; the subcutaneous con- nective tissue becomes distended with gases, the result pf this decomposi- tion, and in a short time the entire carcase of the young creature is inflated. This inflation indirectly distends the uterus, and the foetus sometimes increases so immensely in volume as to cause rupture of the walls of that organ. The hair on the skin of the foetus is. loose and easily removed ; the skin is often dry, and the fluids small in quantity. Gases are not unfrequently disengaged in the foetal membranes, and particularly in the amnion. Bossetto {Gior?iale di Veterinaria Practica., 1859) mentions a curious case of this description, in which, after rupturing the membranes of a foetus that had been dead in the uterus for some time, on withdrawing his hand from the vagina there was a rush of carburetted hydrogen ; this became ignited by the flame of a candle held some distance from the vulva of the pregnant animal. The flame, ten to twelve inches long, burned for some time, and the Cow did not appear to suffer. Indications. The dryness of the skin and the large volume of the foetus, as well as the inertia of the uterus, are the obstacles to extraction. Consequently, DISEASES OF THE FCETUS. 3^1 version and retropulsion cannot be beneficially resorted to here ; but deep incisions may be practised on the surface of the body of the foetus as far as the hand and knife can reach. The maternal passages, as well as the foetus, should then be well lubricated with some fatty agent, and if the carcase is in a favorable position traction may be tried — cords and hooks being employed in a manner hereafter described. If the position is not favorable, then it must be corrected. Should mechanical extraction fail, then embryotomy must be practised. After the foetus has been removed, thorough cleansing of the uterus will be necessary POLYSARCIA. German authors only, so far as I can ascertain, make mention of this condition, in which there are abnormal accumulations of adipose matter in the subcutaneous connective tissue ; so that at birth these fat deposits often cause the calf to weigh more than a hundredweight. They are designated in Germany "lard calves " {Speck-kdlber). Fig. 84. Deformed Head and Neck of a Foal, due to Contraction and Pressure in the Uterus. Indications. The indications for the extraction of these lardaceous calves are, as might be presumed, the same as those for over-developed foetuses in general. Contractions. This designation has been given to the permanent contraction or retraction of certain muscles — and we might add tendons and ligaments — which, in becoming hard and rigid, are at the same time reduced in length and thickness, so as to form inextensible cords which deform the part they are attached to, and prevent its assuming its natural positions. This state of contraction and rigidity only 'takes place slowly and pro- gressively, and it chiefly, though not exclusively, affects the muscles of the 392 FOETAL DYSTOKIA. ■ neck and fore limbs, giving these a vicious direction which it is very difficult to change, and which at parturition may become a rather trouble- some cause of dystokia. The cause of these deviations, which bring about actual alterations in the structure of the bones and muscles themselves, are very obscure. Bouley is of opinion that the lesion is solely due to X^a^ passive influence of a false position, which the foetus assumes and maintains for a long time, and to which the muscles and bones finally accommodate them- selves. . Rainard thought the cause might be of a mechanical nature, and due to the pressure exercised on the foetus by the colon — particularly its pelvic portion — when filled with hard faecal matters, the residue of ligneous provender. He also considered it possible that it might be of a convulsive kind, owing to disease of the nervous centres. When the neck is affected, it is bent round to the side, the nose being buried in the flank, or ^ven resting on the hind quarters of the foetus ; and so rigidly is it curved, that not only does it resist all attempts to straighten it in the uterus, but even when extracted and the foetus is dead the neck cannot be made to assume a rectilinear direction. The period of gestation at which this deviation occurs is, of, course, difficult to arrive at ; but Rainard and Saint-Cyr are of opinion that it takes place early, as the bones of the head and neck are more or less deformed in some cases, the head being more especially distorted and curved laterally, and moulded, so to speak, to the parts on which it has rested during intra-uterine existence. This distortion appears to be more frequent in monodactyles, the neck of which is longer than that of ruminants or other domesticated animals ; and according to French writers, it appears to be more common in some localities than others, and to be frequent in certain years — particularly in those of scarcity or bad forage. Houssard reported that in Franche- Comte he had seen the majority of brood Mares abort near the termina- tion of pregnancy, or experience great difficulty in foaling, from this ab- normal distortion of the neck. Courjon, another Veterinary Surgeon practising at Meyzieux, Isere, has remarked on the frequency of this ac- cident, under the influence, it was presumed, of the same causes. Schaack informed Saint-Cyr, that in his long experience he had met with several cases of this kind, one of which was in a Calf that nevertheless lived, notwithstanding the deformity. Contraction of the limbs also appears to be more frequent in Foals than Calves, and varies in degree : from slight bending at the knees, which generally more or less disappears after birth, and as the animal acquires strength, to extreme flexion, so that ligaments must be ruptured, and perhaps bones broken, before the distortion can be corrected. The accident is alluded to by Favre {Le Veterinaire Campagfiard, p. 290), Gaven {journal de Med. Veterinaire, 1850, p. 201), Lemaire, {Recueil de Mdd. Veterijtaire, 1858, p. 444), Veret {Ibid. 1837, p. 289), and Cartwright. Veret's case, alluded to by Saint-Cyr, is somewhat remarkable and deserves notice. On exploring the uterus of a Cow in obstructed parturition, he recognized that the foe- tus was alive, and that it was presenting with the head and all the feet together. The left fore leg was very thin and had only one claw ; it was bent at three angles at 25° to 30^^, and it was impossible to straighten it without tearing the skin, as well the flexor muscles which, by their retraction, had produced these angles. One of the angles was at the fetlock, the other at the knee, and the third at the elbow. The foetus was at the same time affected with ascites. Delivery was very difficult, but it was effected after the two fore limbs had been removed and the abdomen punctured. DISEASES OF THE FOETUS. 393 The foetus, in addition to the defective conformation of its left fore leg, had a very short and thick neck, and the xiphoid cartilage vi'as about eight inches long and curved upwards. The calcis of the right hock did not project, and the femur of the same limb was bulging Cartwright gives two instances — the only ones in English literature — both of which are interesting and instructive. In one case ( Veterinarian, vol. xx. p. 385), the Calf had been extracted by an empiric, who had ruptured the uterus of the Cow, so that it had to be destroyed. The hind parts of the Calf were much contracted and diminished in size ; the anus was impervious. The hind extremities were fractured in extraction, but they must previously have been lying under the belly or against the sides, and the ligaments of the patellcB af»peared to have become shortened, as " the femur and tibia formed almost a straight line, there not being the least flexure at the stifle joints." " The stifle, hock, fetlock, and pastern joints were so firmly braced together, that they were completely fixed and immovable, and would not bend backwards, sideways, or for- wards in the least. On examining these joints, not the slightest union of the cartilages or bones had taken place ; only a shortening of the ligaments of the joints generally, not permitting the usual flexure of the parts. From the cont-raction at the stifle joints, the legs were almost straight, forming only a curve by the metatarsal and pastern bones being drawn a little anteriorly." The other instance {Ibid., vol. xvi., p. 487) was in a Cow six years old, which could not calve. The presentation of the foetus was posterior, and as the hind legs could not be drawn into their proper position by hand, it was attempted to do this by force with cords. But the limbs proved quite rigid ; one limb at last broke off below the hock, then the other, and the foetus was at length extracted by powerful pulling. It was then noticed that " the stifle joint lay forward, high up against the posterior ribs, and was held firmly there by the great contraction of the skin over the parts." " The extensor muscles underneath were very much shortened. The tibia was also bent unusually backwards, as the os calcis came almost in contact with the hip joint. The muscles here were in the same state of contraction and shortening as those attached to the patella, etc. The part of the limb below the hock was nearly in its natural position, being only a little more flexed upon the tibia than usual. The stifle and hock joints were also firmly held together in their altered position, by the shortening of some and lengthening of other of the ligaments of the joints ; and when the muscles were cut through, the joints could not be brought to'their natural positions without rupturing some of these ligaments. Both hind legs were in this state." The Cow had to be de- stroyed next day, as the neck of the uterus was ruptured. Indications. The indications for delivery are the same as those which will be given for extraction of the foetus in malposition of the limbs and head. Not unfrequently recourse must be had to embryotomy ; and the limbs more particularly require attention in this operation, as by dividing the muscles, tendons, or ligaments of those which are contracted, they may be straightened and delivery effected. A careful examination should be made of the presenting limbs in all cases in which they are found to be flexed, in order to discover whether the joints are movable ; and great care ought to be exercised in using traction before they are straightened or removed by the knife ; as rupture of the uterus, or severe laceration of the other soft parts, may be the result. Tumors. Tumors of various kinds, situated either externally or internally, may prove an obstacle to birth ; though the cases recorded are very few. Some of the former are kysts which, in some instances, may be looked upon as due to a second undeveloped ovule which has grafted itself on the foetus. Hygromata are not very uncommon, and some of these are often rup- tured during birth. I. Binz {G eh arts half e, p. 244) describes an immense kyst in the liver, which rendered parturition diflicult ; and we have already alluded to enormously enlarged kidneys pro- ducing ascites. 394 FCETAL DYSTOKIA. 2. Liidke mentions an enormous kyst on the neck of a calf, as entirely opposing natural delivery. The kyst was situated in the subcutaneous connective tissue, below the ear on the right side, and measured more than a foot in diameter ; it contained thirty- six pounds of fluid, which was yellow-colored, and in which were some flocculi of lymph. During labor it lay against the fore limbs, which were advanced into the pelvis, and it had pushed the head so far back that this could not be found. The nature of the tu- mor having been ascertained, Liidke punctured it ; this rendered delivery possible, and saved the Cow. 3. Rossignol (yournal de Med. Veterinaire de Lyon, 1864, p. 400) gives a very interest- ing account of a case of this description. Making an exploration in a case of protracted labor, he found that the foetus, which was dead, was in the anterior presentation, with the head turned back and out of reach. It was decided to remove it by embryotomy, in order to rescue the Cow, which was greatly exhausted. The fore limbs were removed o«e after the other, and this allowed a cord with a running noose to be passed round the neck, which was then straightened and the head brought into the vagina, from which the foetus was extracted by moderate force. Birth was then supposed to be finished, but to the surprise of Rossignol and his four assistants, who pulled with all their might, the calf could make no further progress. The case was an embarrassing one, and necessitated another examination ; this was rendered easier from the fact of the fore limbs having been removed. Passing the hand beneath the thorax of the foetus, it soon came in contact with a large, solid, round, and smooth tumor, but no trace of ears or jaws could be felt. It seemed to be firmly attached in front of the umbilicus, though it was slightly movable. Deciding that, whether it was the head of another foetus or whether it was a tumor, the union should be broken by the increasing traction, a rope was passed round the hind quarters of the Cow and held by assistants at its head, and the pulling at the foetus recommenced. This at last brought away the whole of the body, but the tumor was left behind in the uterus. All these manipulations did not last longer than half an hour. The foetus, though large, was remarkably emaciated. Towards the umbilical region there was a" place as big as the hand, which was denuded of skin ; the latter had been torn off, leaving the tunica abdominalis exposed ; this, around the margin of the wound, showed long fibrous shreds. The umbilical cord was somewhat long, but did not appear to have had any connection with the tumor. Search was about to be made for the latter, when the Cow lay down; the labor pains again commenced — at first feebly, but gradually increasing — and at length, without any assistance, a large white tumor was expelled, and soon after the foetal envelopes. The tumor was spheroidal in shape, white, hard, and nodulated, and appeared to be composed of fibro-adipose tissue. It was covered by a thin, smooth, but resisting membrane, beneath which were blood-vessels. On one side was a net-work of veins, and there were also some fibrous bands indicating where it had been attached to the foetus. It weighed a little over eleven pounds. The Cow quickly and completely recovered. 4. Pflug {Zeitschrift fiir Thiermedicin, etc., vol. i., p. 367) was called to attend a Goat in difficult labor, and on manual exploration discovered that the first foetus was in a normal position, but that on each side of the head, in the parotideal regions and towards the larynx, were too large swellings (congenital scrofula) which prevented the passage of the young creature. By manipulation, pressure on the tumors — which were as large as a small fist^ — first on one side, then on the other, with gentle traction, the kid was released. Two other kids which were in proximity to the first, were also artificially delivered. 5. Schliepe (Gurlt and Hertwig's Magazin, 1863) describes the case of an unborn foal which had, behind the lower jaw, towards the neck, a kind of scrofulous tumor. On examination, this was found to be a distension of the Eustachian pouch, which con- tained six Berlin quarts of yellow but somewhat coagulated serum. Indications. The indications will depend upon circumstances. In the examples given, the course there followed may be again adopted. Puncturing the tumor if it contains fluid, removing it if it is accessible and solid, and embryotomy if neither of these operations is likely to be successful, are the only measures which can be recommended. DEATH. Many practitioners are of opinion that the death of the foetus renders MONSTROSITIES. 395 parturition difficult. In certain circumstances it may do so, but, as a rule, provided it is in a proper position and properly developed, its death has but little inflifence on this act. We have already alluded to the death of the foetus at page 241. •CHAPTER III. Monstrosities. The designation "Monster," " Monstrosity," or Zz/i-z^j iV^/wr^ (French, Monstre, Monstniosite ; German, Missgeburt ; Ita.\ia.n, Afos/ro ; Spanish, Motistruo)^ is generally applied to a creature which exhibits some vice in conformation, — some remarkable anomaly or organic deviation in form or structure, or both, in one or more parts of its body. Monstrosities have been conveniently divided into two kinds : those which are anatomically so, and those which are so by reason of their vicious conformation. The first present no modifications externally, and there is no disturbance of function, but merely a change in the number or position of certain organs — a change only discoverable hy post-mortem examination. The second includes those defects or deformities which more or less seriously impair the value of the young creature, either by destroying the symmetry of its shape, or rendering it more or less useless by the absence or incompleteness of certain organs. The term " monstrosity," however, is usually reserved for a creature which presents the most serious kind of organic alterations, and which involve one or more organs — external or internal — these being modified in form, structure, and relations. In this class we may have a deficiency in one or more limbs, head, part of the head or trunk, or fusion more or less incomplete of two or more individuals, etc. It must be admitted, however, that the limits between these groups of anomalies or organic deviations are not well defined, and that they merge into each other imperceptibly ; so that it is not always possible to say where the one class ends and the other begins, and we can only fix upon the types of each of these artificial groups. In ancient times the appearance of monstrosities was ascribed to the influence of enraged gods, and they were regarded with fear or horror ; or they were looked upon as prodigies or freaks of Nature, and described as marvels or curiosities. Indeed, it was not until the end of the eighteenth and commencement of this century that they began to be studied in a scientific spirit, and their anomalies shown to be only simple modifications or irregularities in the development of organs. Haller and Meckel commenced this new era, but it was not until the philosophical study of this subject had been pursued by Etienne and Isidore Geoffroy Saint-Hilaire, that the science of Teratology was founded on a true basis. Then it was clearly demon- strated that monstrosities themselves did not escape the general laws of organization, but own their sway and prove their universality, and that Nature, in its widest divergencies, never ceases to be faithful to the decrees whi::h the Creator imposed upon it at the commencement. In 1827, E. G. Saint-Hilaire proposed a scientific classification of mon- strosities — those beings which had hitherto been looked upon as combina- 396 FOETAL DYSTOKIA. . tions of different characters or individuals ; and on this basis was raised the science of Teratology by his son Isidore. The labors of these men have been largely supplemented by the researches of such authorities as Meckel, Gurlt, Otto, Bischoff, Leyh, Martin-Saint-Ange, Forster, Dareste, Panum, Lombard ini, and others. The labors of these investigators are unknown to English veterinary literature — indeed the entire subject is nowhere mentioned f it will, therefore, be our duty to notice it somewhat fully, not only from its novelty in this'respect, but also from its import- ance ina physiological and obstetrical point of view. Classification. Various classifications of monstrosities have been proposed at different times by investigators, who generally based their classification either on the notions they entertained as to the mode of formation of these crea- tures, or on some physical peculiarity presented in their organization. Buffon divided them into three classes — i, monstrosities by excess ; 2, monstrosities by defect ; 3, monstrosities by irregularity in structure or situation of parts. To these classes Meckel added a fourth, which included the hermaphrodites. Martin-Saint-Ange divided them into — i, monsters by excess, comprising the union of several foetuses — double monsters, in fact ; 2, monsters by excess of growth ; 3, monsters by ab- sence of one or more parts ; 4, monsters by general defect, as dwarfs ; 5, hermaphrodite monsters. The two classifications which have generally been adopted by conti- nental veterinarians are those of Ciurlt and Geoffrey Saint-Hilaire ; that of the former — the eminent Berlin veterinary professor — being preferred by the Germans, Italians, Dutch, and Danish, and that of the latter by the French. Gurlt's classification and nomenclature are good and explicit, and in some respects to be preferred to Saint-Hilaire's ; while those of the latter offer advantages which might lead us to give them the preference, apart from the fact that it is they on which the science was based. Gurlt t separates monstrosities into two classes — Simple and Co77ipound. The first comprises eight orders, twenty-six genera, and seventy-three species ; the second includes six orders, twenty-six genera, and fifty-nine species. As some veterinarians may prefer Gurlt's classification to that of Saint- Hilaire, and particularly for its practical utility, we give it here. CLASS I. SIMPLE MONSTROSITIES. This class is occupied with a single individual, and refers to an absence of or addition to parts, exaggeration of them, or alteration in their form or position. It comprises 8 Orders, 26 Genera, and 73 SPEcms. ORDER I. — Simple Monstrosities through Absence of Parts : — 1. Amorphus. — Absence of conformation ; i species : A. globosus. 2. Acephalus. — Headless ; 2 species : A. untpes, A. bipes. * a monstrosity is generally only alluded to as such, or as a Lusus Naturce ; their scientific classification has never been attempted in this country. t Pathologische Anatomic, Berlin, 1833. Article: '■'■ Missbildungen-" also '■'■ Ueber Thierische Miss- geburten" Berlin, 1877. MONSTROSITIES. 397 3. Perocephalus. — Head defective; 7 species : P. pseiidocephalus (ap- parently without a head), P. aprosopus (head without a face), P. micro- cephalus (small head), P. agnathiis (head without a jaw). Varieties : a^ P. agnatJiwi hypostojnus (mouth a longitudinal fissure beneath the ordinary situation) ; b, P. agnathiis microstomns (small mouth) ; r, P. agnathus astomus (without a mouth), P. brachyrhy?ichus (short face or nose), P. anomatus (without eyes), P. aotus (without ears). 4. Perosomus. — The whole of the body defective ; 4 species : P. hemi- cephalicus (body defective and head absent), P. horridiis (horrid defor- mity), P. ehunbls (loins absent), P. pseiidoscelus (body defective, with posterior limbs incomplete). 5. Perocormus. — Trunk defective ; 3 species : P. oligospondylus (de- fective vertebrae), P. ecaudatus (without tail), P. anacdoca (without external generative organs). 6. Peromelus. — Limbs defective ; 6 species : P. apus (without limbs), P. achirtis (without anterior limbs), P. vionochirus (with only one anterior limb), P. ascelus (without posterior limbs), P. monoscehis (with only one posterior limb), P. micromelus (limbs shortened) ; with the varieties, P. micromelus microchirus (anterior limb short), P. microtnelus microscelus (posterior limb short). ORDER II. — Simple Monstrosities through Smallness of Parts : — 7. Nanosomus. — Limbs and trunk small — dwarf ; 2 species : N. pyg- cemus (short and low, but without disproportion of parts), JV. caticeps (cat-faced dwarf). 8. Nanocephalus. — Small head ; 3 species : N. micrommatiis (eyes too small), N. brachyotus (ears too short), N. brachygnolus (lower jaw too short). 9. Nanocormus. — Short trunk ; 2 species : IV. rectus (vertebral col- umn straight, but very short), N. curvatus (vertebral column short, and curved to one side). 10. Nanomelus. — Limbs short; 5 species: N. brevipes (all the limbs short), N. brachychirus (anterior limbs too short), N. campylochirus (anterior limbs short and crooked), N. chiropterus (anterior limbs short, with cutaneous folds resembling wings), N. compyloscelus (posterior limbs short and crooked). ORDER III. — Simple Monstrosities through Abnormal Division OF the Body : — 11. Schistocephalus. — Division of the head ; 5 species : S. hemiceph- alus (cleft in the middle) ; with the varieties : a, S. hemicephalus partialis, or hydrencephalocele (partial hernia of the brain, with hydrocephalus) ; b, S. hetnicephahis totalis (absence of all the cranium) ; c, S. hemicephalus complicatus (cleft cranium, face defective) ; 6". bifidus (face divided), S. fissipalatinus or rictus lupinus (cleft palate), S. fissilabrus or labium lepori- num (cleft or harelip), S. megolostomus (wide mouth). 12. ScHiSTOCORMus. — Divided trunk; 6 species: S. fissicollis (neck cleft), 6*. fissisternalis (sternum divided), S. schistepigastrico-sternalis (di- vision of the sternum and anterior portion of the abdomen), .S". exom- phalus (divided umbilicus), S. fissiventralis (the whole of the abdomen divided), S.fissispinalis or spina bifida (division of the spinal column). 398 FCETAL DYSTOKIA. 13. ScHiSTOSOMirs. — Division of the head and trunk ; 3 species : S. reflexus (division of the body and inversion of the spinal column), S. contortus (division of the body and torsion of the vertebral column), S. microchiriis (division of the body and anterior limbs shortened). 14. Schistomelus. — Cleft limbs j 2 species : S. fissimafms (division of the anterior limbs), S. fissimgulus (division of the phalanges). ORDER IV. — Simple Monstrosities through Absence of the Natural IDivision of Parts : — 15. Atretocephalus. — Absence of openings in the head ; i species : A. ast077ius (mouth absent). 16. Atretocormus. — Absence of the natural apertures in the body ; 2 species : A. aproctus (anus absent), A. atmrethra (urethra absent). 17. AscHiSTODACTYLUS. — Phalanges undivided ; i species: A. solidun- gulus (absence of division of the phalanges and claws in those animals which usually have them divided). ORDER V. — Simple Monstrosities through Fusion or Coali- tion OF Organs: — 18. Cyclops Monophthalmus. — One eye in the middle of the face, and a proboscis in addition ; 3 species : C. megalostomiis (large mouth), of which there are two varieties : a^ C. megalostomus rhynchcBUus (large mouth and proboscis), b, C. megalostomus archynchiis (large mouth, but no probo- scis) j C. prostomus (irregular mouth), in which are two varieties : a, C. prostomus arhynchus (irregular mouth and no nose) ; b^ C. prostoimis rhynchcenus (irregular mouth and nose) ; C. astomus (without mouth), with two varieties : a, C. astomus arhynchus (mouth and nose absent) ; b, C. astomus rhynchcznus (proboscis present, but mouth absent). ORDER VI. — Simple Monstrosities through Abnormal Position AND Form of Parts : — 19. Campylorrhinus. — Curvature of the nose ; i species : C. lateralis (lateral curvature of the nose). 20. Camylorrhacchis. — Curvature of the vertebral column ; 2 species : C. scoliosa (lateral curvature of the spine), C. contorta (torsion of the spine). ORDER VII. — Simple Monstrosities through Excess in Forma- tion : — 21. Megalocephalus. — Head abnormally large ; 2 species : M. hydren- cephalus (with hydrocephalus), M. polycerus (head with large horns). 22. Diphallus. — Double penis ; i species : D. imperfectus (double penis, incomplete). 23. Megalomelus. — Limbs with supernumerary parts ; i species : M. perissodactylus (with supernumerary digits). ORDER VIIL — Hermaphrodites: — 24. Hermaphroditus. — Double sex, with predominance of organs be- longing to one sex ; 2 species : H. lateralis (genital organs to one side), in which there are two varieties : «, H. lateralis masculinus (with predom- inance of the male organs) ; ^, H. lateralis femininus (with predominance MONSTROSITIES. 3^^ of the female organs) ; H. iransversalis (the external generative organs belonging to one sex, and the internal to the opposite sex), including two varieties : a^ H. iransversalis masculimts (external genital organs male, internal female) ; b, If. iransversalis femininus (external genital organs feminine, internal male — often imperfect). 25. PsEUDO-HERMAPHRODiTUS. — False hermaphrodites ; 4 species : P. megalomasihus (male with large mammae), P. micruphallus (penis unusu- ally small), T'. hypospadiaius (with the urethra divided interiorly), P. feminimis (false feminine hermaphrodite). 26. Androgynus. — Double hermaphrodites, the male and female organs existing in a single individual, one sex being incomplete and the other predominating ; 2 species : A. masadimis (the external organs are masculine, with a small penis, the internal organs being male and female — though the one set is more complete than the other), A. feinininus (the external organs are feminine, with abnormally large clitoris, the internal being male and female, with predominance of the one over the other). CLASS II. TREBLE AND DOUBLE MONSTROSITIES. In these monstrosites there is a union of two or three individuals, neither of which is complete, but which are united at various points : often wnth a completely developed body is united a portion of a second individual. It comprises 6 Orders, 26 Genera, and 59 Species. ORDER I. — Trigeminal Monstrosities, in which are united one or more parts or organs of three individuals : — 1. Cephalotridymus. — Three heads united to a single trunk ; i species : C. unicorporeus (with a single body). 2. Cormotrtdymus. — Posterior part of the trunk triplicate, with more than four limbs ; i species : C. iricaudaius (three croups with three tails, but only one anus and four posterior limbs). 3. Melotridymus. — Posterior part of the body double, and rnore than eight limbs ; i species : M. decapus (ten limbs of unequal length). 4. Somatotridymus. — Triple body ; i species : ^. siertialis (three chests united). ORDER II. — Monster with Two Heads — Cephalodidymi : — 5. DiPROSOPus, — Double face ; 3 species : D. sejuncius (the two faces separate), D. disians (the two faces diverging), including three varieties; «, D. distaiis disiomus (a mouth in each face) ; b^ D. disians monostomus (a mouth in one face only) ; r, D. distonia hemicephalicus (without a cranium) ; D. conjimcius (two faces united) has two varieties : a, D. con- junctus disiomus (double mouths) ; b, D. conjimcius monostomus (with one mouth). 6. Monocranus. — Single cranium ; 4 species : M. mesognaius (the lower jaw included in or united to the other from the commencement of the branches), M. dignaius (lower jaw double), M. heieroprosopus (diverse faces), M. bimandibularis (upper jaw double). 7. Heterocephalus. — Double heads, one of which is complete, the other very incomplete ; 2 species : H. i?iterposiius (between the two branches of the lower jaw of the complete head is interposed the lower jaw of the incomplete one), H. opposiius (the lower jaw of the complete head is depressed in front, and on its upper surface — anterior extremity 400 FCETAL DYSTOKIA. — it is united to the corresponding part of the second jaw, with which it forms an acute angle). ORDER III. DOUBLED-HEADED MONSTROSITIES, WITH THE TrUNK WHOLLY OR PARTIALLY DOUBLE : 8. DiCEPHALUS. — Two separate heads ; 7 species : D. biatlaniiciis (double head and two atlases), D. subbicollis (double head with apparently two necks), D. bicollis (double head and two necks), with two varieties : D, bicollis omocephalus (both heads alike), Z>, bicollis heterocephalus (one head perfect, the other imperfect) D. subbidorsnalis (double head, with apparently a double back), D. bidorsualis (double head with double back), D. bilumbis (double head and double loins), D. bispinalis (double head and vertebral column) has two varieties : a, D. bispinalis quadnipes (with four limbs) ; b^ D. bispinalis achirus (without anterior limbs). 9. DiCRANUS. — Double cranium ; i species : D. bispinalis (cranium and vertebral column double). ORDER IV. — Monstrosities with a Single Head, but the Trunk OR Limbs more or less Completely Double — Conno-melo- didymi: — 10. Dipygus. — Double croups ; 3 species : D. bidorsualis (double croup and back), D. subbidorsualis (double croup, with half the back doub- led), Z>. biliitnbis (croup and loins doubled), containing two varieties:. a, D. bilumbus teleocephalus (with head regular) ; b^ D. bilumbis cacoceph- alus (with head irregular). 11. Heterodidymus. — Unequally-developed twins, the body of one being large and regularly or irregularly formed, the other being small and slenderly attached to some part of its fellow ; 3 species : H. octipes (with eight feet), containing two varieties : a, H. octipes emprosthochirophoriis (the anterior limbs of the parasitic twin situated in front) ; b^ H. octipes pleiirochirophorus (the anterior limbs of the parasitic twin situated at the side) ; H. tetrasulus (with four posterior extremities), also containing two varieties : a, H. tetrasulus monopygus (with one croup) ; b, H. tetrasulus dipygus (with a double croup) ; H. triscelus (with three posterior limbs). ORDER V. — Monstrosities with a Single Head and Trunk, and more than Four Limbs — Melodidymi : — 12. — Opisthomelophorus. — An animal regularly formed, but which bears on its back or croup a supernumerary limb or limbs \ 3 species : O. trichirus (with an anterior limb on the back), (9, tetrachirus (with two anterior limbs on the back), O. tetrascelus (with two posterior limbs on the croup). 13. Emprosthomelophorus. — With a supernumerary limb or limbs on the neck, thorax, or beneath the pelvis ; 5 species : E. octipes (with four supernumerary limbs beneath the thorax), E. trichirus (with an anterior limb on the thorax), E. tetrachirus (with two anterior limbs on the neck), E. triscelus (with a posterior limb beneath the pelvis), E. tetrascelus (with two posterior limbs beneath the pelvis). 14. Pleuromelphorus. — With a supernumerary limb or limbs situated on the side ; 4 species : P. octipes (with four limbs on the side), P. tetra- chirus (v/ith two anterior limbs on the side), P. trichirus (with an anterior supernumerary limb), P. triscelus (with a posterior supernumerary limb). MONSTROSITIES. 401 ORDER VI. — Monstrosities with the Head, Trunk, and Limbs MORE OR LESS COMPLETELY DouBLE — Somatodidymi : 15. Octopus. — With eight limbs; 4 species: O. Janus (two faces placed opposite each other, and eight limbs), O. quadriauritus (eight limbs and four ears), containing two varieties : a^ O. quadriauritus monoprosopus (with a perfect face) ; b, O. quadriauritus aprosopus (face absent) ; O. biauritus (eight limbs and two ears), O. syfiapheocephalus (eight limbs, and the heads joined externally only by the skin). 16. Tetrachirus. — With four anterior limbs ; 2 species : T. symphyo- cephalus (four anterior limbs, two lateral and two incomplete, on the back, and heads joined), T. choristocephalus (four anterior limbs, and heads separate). 17. Tetrasculus. — With four posterior limbs ; 2 species : T.symphyo- cephalus (four posterior limbs, and heads united), T. bifacialis (four pos- terior limbs, and the two faces separate). 18. Gastrodidymus. — Twins united at the abdomen ; 3 species : G. quadrupes (twins united at the abdomen, and furnished with four limbs), G. tetrachirus (with four anterior limbs), G. octipes (with eight limbs). 19. Gastro-Thoracodidymus. — Twins united at the thorax and ab- domen ; I species : G. thoracodidymus octipes (with eight limbs). 20. Epigastrodidymus. — Twins united at the thorax and epigastrium : I species : G. octipes (with eight limbs). 21. Thoracodidymus. — Twins united at the thorax; i species: T. octipes (with eight limbs). 22. ScHELODiDYMUS. — Twius United at the posterior extremities ; i species : S. heptamelus (with seven limbs, the posterior pair being united into one, the next pair at the side, and the other four in front). 23. IscHiODiDYMUS. — Twins United at the pelvis ; i species : /. examelus (with six limbs, four anterior and two posterior). 24. Omphalo-Chronodidymus. — Twins united at the umbilicus and the head ; i species : O. disomatus (the bodies separate). 25. Pygodidymus. — Twins united at the croup ; i species : P. aversus (bodies united at the ischii and sometimes at the buttock, and in opposite directions). 26. Cryptodidymus. — Inclusion of one twin within the other ; 2 species : C. abdominalis {twin included in the ^hdomtn), C. subcutaneus (\x\covs\- plete foetus included beneath the skin of the complete one;. Such is the classification adopted by Gurlt, and it will be seen that it is very complete, while the nomenclature scarcely leaves any thing to be desired. Nevertheless, as Saint-Hilaire's classification and nomenclature are also employed, and are in some respects advantageous to know, we will now allude to them, though not in such detail as we have done those of Gurlt, and following the summary given by Zundel. Saint-Hilaii^ separates the Monstrosities from the vices of conformation, which he dis- tinguishes as Hemiteries, or simple and trifling organic anomalies, and Ifeterotaxies, or mere changes in the situation of organs, and nearly always without alteration in relative position and connections. For the Hermaphrodisms — due to the union of the sexes or some of their characters in the same individual — he forms a separate class, which he again divides into two subclasses, according as there is an absence or excess in the number of parts ; he distinguishes male hermaphrodism, female her- 26 402 FCETAL DYSTOKIA. maphrodism, and neutral hermaphrodism ; mixed ; complex — masculine or feminine ; and bisexual — perfect or imperfect. The Monstrosities — properly so called — exhibiting anomalies which are more or less serious, either because of the injurious influence they exercise on the functions of the individual, or the vicious conformation they give rise to — are divided into two classes : Simple Monstrosities and Composite, Double^ or Triple Monstrosities. The first class comprises three orders : i. Autositic Monstrosities (adroq. Fig. 8s. Eciromelian Monstrosity (Saint-Hilaire) ; Nanotnelus Campylochirus (Gurlt) : Horse. self, G'iToz.^ nourishment) — whose organs are capable of maintaining them for a variable period after birth. Only one or more regions of the body are involved, the majority being little, if at all, different from the normal standard ; the circulatory apparatus is always more or less complete, particularly the heart ; the lungs, nearly all the digestive viscera, and at least a portion of the head, are present ; and all the anatomical and physiological characters are manifested externally by the general con- formation, which, in the greater part of the body, remains symmetrical Fig. Eciromelian Monstosity (Saint-Hilaire) ; Nanomelus Campylochirus (Gurlt) : Goat. and almost normal. 2. Omphalositic Monstrosities {diitpakoq^ umbilicus, and (TtToz, nourishme?it)—r\hosQ which live imperfectly, being maintained by the nourishment derived from the mother through the umbilical cord, and dying as soon as the cord is ruptured. These omphalosites are deficient in a large number of organs, and those which are present are MONSTROSITIES. 403 generally very imperfect ; externally all the regions appear to be anomalous, and the symmetry is imperfect or even effaced. 3. Parasitic Monstrosities — the most imperfect of all, and generally inert, irregular masses, composed of bones, adipose tissue, etc., destitute of umbilical cord, and attached to the generative apparatus of the mother, at whose expense they maintain an obscure parasitic existence, by means of a vascular pedicle. The double monstrosities are divided into autositarian and double par- Fig. 87, Symelian Monstrosity (Saint-Hilairk) ; Perosomus pseudoscelus (Gurlt): Pig. asitic. The first are composed of two individuals more or less intimately united, and somewhat equal in development ; this inequality indicating that they both have been equally nourished, and that their functions have been alike complete. The second are composed of two distinct individ- uals, very unequal in development, the smallest being the most imperfect ; testifying that it, like a parasite, has lived at the expense of the other, [It would appear that the triple monstrosities have not been met with in jufficiently large numbers to establish a trustworthy classification. Celosomian Monstrosity (Saint-Hilaire) ; Schistocorntus Jissiventralis (Gurlt) : Calf. Each of the orders of Saint-Hilaire, like those of Gurlt, contains several families, subdivided again into genera and species, according to their iffinities, and which include all the monstrosities he had met with. With regard to these families, it may be mentioned that among the single lautositic monstrosities, there are the ectromelians {iV-pdu)^ to make abort, i/oc, limb) in which we have a more or less complete deficiency in the levelopment of the limbs, either anteriorly or posteriorly, and involving me or more of these (Figs. 85, 86). 404 FCETAL DYSTOKIA. The Symelian Motisirosities {ao-j^ with, >j.ikoq^ limb) are those which Guilt includes in his first Class and Order, there being an absence of parts, with fusion of others (Fig. 87). The Celosomian Monstrosities {yjjlr^, hernia, aw'ta^ l^ody), more frequent perhaps than any others, are those which Gurlt places in his third Order Ectopia Cordis '. Schistocormus fissisiernalis — Schistocormus, and are chiefly characterized by the absence, more or less complete, of the abdominal parietes, and the abrupt curvature of the sjDine backwards, downwards, or to one side ; so that the pelvis and pos- terior limbs are directed forwards, to one side, or over the back, while the Fig. 90. Pseiidencephciliaii Monstrosity ; Perocephalus pseudocephalus, Gurlt. abdominal cavity bemg open, allows its viscera to float about unprotected. There are many degrees of this deformity. Sometimes the abdominal cavity is open, the thorax being undeformed and closed in posteriorly by the diaphragm, and the ribs attached to the sternum (Schistocormus fssi- ventralis, Gurlt, Fig. 88). Sometimes the posterior end of the spine is curved forward to the middle of the back {Schistocormus reflexus^ Gurlt) ; the ribs follow in the same direction, but instead of bending: downwards MONSTROSITIES. 405 to enclose the chest, they spring upwards towards the dorsal spines ; the sternum is absent or divided throughout its length {Schistocormus Jissister- nalis — Gurlt, Fig. 104), with evisceration of thoracic organs — most frequent- ly the heart {Ectopia cordis, Fig. 89) ; the diaphragm is not present, the chest is as widely open as the abdomen, and the viscera of both cavities Fig. 91. Cyclopean Monstrosity; are external to the body {S. Schistepigastrico-sternalis), At other times the spine is twisted, and the body and head divided {Schistosomus con- tortus) ; or other deformities of a similar kind, and more or less complex, may be found. The skin follows the displacement of the various regions Fig. 92. Cyclopean Monstrosity ; Cyclops niegalostomus archynchus (Gurlt) : Ass. — the external surface being generally in contact — while the lining mem- brane of the chest or abdomen, or both, becomes external ; sometimes to such an extent is this inversion of the body carried, that it is turned, as it were, outside in : the skin forming a kind of internal sac — the hair to the interior — and containing the head and limbs of the foetus. With such a deformity, of course other serious malformations or displacements co-exist : distorted pelvis, wasted or undeveloped limbs, atresia of the anus, more or less complete absence of the generative organs, etc. 4o6 FCETAL DYSTOKIA. This kind of monstrosity will have to be specially noticed hereafter, the eventration of the viscera of the foetus often considerably baffling the Fig- 93- Acephalian Monstrosity; A.perosomus Iiemicephalicus (Gurlt). obstetrist \ while the frequent distortion of the spine and limbs renders deliver)^ very difficult. The Exencephalian monstrosities, belonging to Gurlt's third Order in the first Class, are those which have the brain defective, deformed, and external to the cranial cavity — itself more or less imperfect. Fig. 94. Schistocephalus Jissislabruf of labmm leporinuvi (Hare-up). MONSTROSITIES. 407 The Pseudencephalimi monstrosities belong to the third Order of Gurlt's first Class, the encephalon being absent and replaced by a variable-sized bright red tumor, composed of a multitude of small blood-vessels \ this tumor rests on the base of the cranium, the roof of which is absent (Fig. 90). The Anencephalian monstrosities — Gurlt's first Order, first Class — are destitute of the encephalon or any thing to represent it, and the roof of the cranium is entirely absent. The Cyclocephalia?i monstrosities (joyj^oz, circle, /.zodXr^, head) — Order five, Class first of Gurlt — are characterized by the approximation, or more or less complete fusion of the eyes into one organ, with absence, displace- ment, or deformity of the nose and mouth ; but the ears are usually in their natural position, or perhaps are lower than usual. Not unfrequently the nose is absent and the mouth greatly enlarged, while the fusion of the eyes may not be complete (Fig. 91, 92). The Acephalian monstrosities — Gurlt's first Class and first Order — are more or less destitute of head, and sometimes of neck, thorax and tho- racic organs (Fig. 93). Fig- 95. Camylorrkacchis contorta. The Anidian, or zoomylian monstrosities, we have already described at page 169 : so we need not again refer to them. The Schistocephalian monstrosities (Gurlt) have the head or face cleft : most frequently the face, the division being sometimes limited to the nose and upper lip. Those monstrosities which are characterized by the abnormal situation and form of different parts — and which are included in Class first, Order six, of Gurlt — are not exceedingly rare, and in some instances are proba- bly due to muscular contraction, or mal-position for some time in the uterus (Fig. 95). Saint-Hilaire divides the double monstrosities into two orders : Auto- sitaric and Parasitic; the former being constituted by individuals more or 4o8 FCETAL DYSTOKIA. less intimately united and somewhat equally developed, each concurring to the mutual existence j while the second is made up of those, monstros- Fig. 96. MoNOMPHALiAN MONSTROSITY: Cepka »-cormodidytnus (Guklt). Fig. 97- Skull of Syncephalian Monstrosity. MONSTROSITIES. 409 ities which, though united, have one being more or less complete — being reduced in fact to a limb, jaw, or other fragment of a body implantsed or subsisting on an individual which is fully developed. iThese are included in Gurlt's second Class. In the autositaric order we have the Eusomphalian and Monophalian monstrosities : these have the common character of two heads and four pairs of limbs ; the first have, however, a distinct umbilical cord to each of the united foetuses ; while in the other — the Monophalian — there is only a single umbilical cord and umbilicus. The Eusomphalian monstrosity consists, then, of two pretty equally de- veloped foetuses, each with its own umbilical cord, the two being usually joined together by some soft part at any region of the body ; so that they may be separated by a surgical operation without the existence of either being compromised. This is included in the third Order of Gurlt's sec- ond Class. With the Monomphalian monstrosity, on the contrary, there being only one umbilicus and one cord, the foetuses are joined at the ventral surface, and have usually several organs in common — notably the liver, to which the umbilical vein passes (Fig. 96). The Sy?tcephalia7i monstrosities have two bodies either completely sep- arated, or only divided above the umbilicus, and surmounted by a more or less incomplete double head : the two heads being fused, as it were, into one {Dicephalus heterocephalus of Gurlt — Fig. 97). The Monocephalian monstrosities, as the name implies, differ from the last in having only one head but a double body, the separation of the two usually taking place below the umbilicus (Fig. 98). The Sysoinian monstrosities (Fig. 99) have two heads on apparently a single body though a closer investigation will prove that the unicity is merely superficial, and that at least some parts are double. Gurlt describes a full-grown Sysomian lamb he ex- amined, and which had, apparently, a single body and only four feet, but two necks, two heads, and two tails, and the skin normally covered with wool. The trunk, though somewhat small, gave no indica- tion of its duplicity. It had, nevertheless, two ver- tebral columns, the inner ribs attached to each being shortened and fused together, while the ex- ternal ones were attached in the usual way to the single sternum. The viscera were generally double, though they were confounded at certain points. A single heart sufficed for two pairs of lungs, one pair of which, however, were only rudimentary. The two livers were combined into one, and in some parts the intestines merged into a single tube, again to become double, and finally to terminate in one rectum. The Monosomian monstrosities have, in reality, only a single body, the duplicity generally com- mencing towards the neck, In the cervical region, not unfrequently at the atlas, and sometimes as far as the facial region (Fig. 100). Among the double parasitic monstrosities, we may mention Saint-Hi- Fig. 98. Monocephalian Mon- strosity : Corttio-Me- lodidymi (Gurlt). 4IO FCETAL DYSTOKIA. laire's Heterotypians, in which the smallest of the foetuses is attached to the »nterior part of the body of the other, at or near the umbilicus ; the Heteraliafis, in which the parasitic foetus is very incomplete, and perhaps reduced to a single region — as a head without a body — attached some distance from the umbilicus ; the Polyg7iathia?is, in which the parasite is reduced to the mere fragments of a foetus — the jaws and some cer*haiic Fig. 99. Sysomian Monstrosity: Dicephalus bicollis (Gurlt). remains adhering to the jaws of the other foetus. All these are included in Gurlt's classification, which we would advise the veterinary obstetrist, as a rule, to employ. The Polymelian Qj.iXo';, limb) monstrosities — Gurlt's Melodidymi — com- prise those creatures which are so frequently exhibited in public, and in which there is only a single body and head, but supernumerary limbs. Fig. 100. MoNosoMiAN Monstrosity : Dicephalus hi-atlanticus (Gurlt) : Calf. These limbs may vary in number, and be attached to various parts of the complete foetus ; there may also be present, in addition to the supernu- merary members, an unformed kind of tumor resting on the back or shoulders, which in one case has been recognized to be composed of the ' MONSTROSITIES. 4„ heart and lungs of a second fcEtus (Fig. 102). In other instances, the tumor is alone observed, without the additional limbs.* The Endocymian monstrosities are those double foetuses of which one, or part of one, is included within the other. They are the Cryptodidymi of Gurlt's Second Class. Origin of Monstrosities, and the Laws of Teratology. The causes which operate in the production of what we have desig- nated " monstrosities," appear to be numerous. Putting to one side, as unworthy of notice, the superstitious ideas which long prevailed with regard to the formation of these monstnosities — because they can all be explained by the laws teratology — we come to the period when Regis started the hypothesis that the germs of these must have been originally produced with those of normal beings, and that Fig. 10 1. PoLYMELiAN MONSTROSITY: EtnprosthromelophoTus (Gurlt): Calf- they w^ere developed in the ordinary course of generation. This hypoth- esis, or something like it, was accepted by Winslow, Duvernoy, Haller, and others, up to the time of Meckel. Geoffroy Saint-Hilaire, however, successfully combated it, and demonstrated that these anomalies in or- ganization are not primary, but accidental ; that embryos which, had they been placed in ordinary circumstanc'es, would have been developed in a normal manner, and which had, in fact, begun to be so developed, only became anomalous and monstrous because their development was dis- turbed. Therefore these anomalies did not exist previous to impregnation, but were the result of some perturbation occurring during the development of the embryos, which were at first perfectly normal. The opinion which at present prevails with respect to these malfor- * It is not improbable that the "Nadeah" bullock of India is an animal with a parasitic monstrosity attached to it. A bull of this kind has been described, by an amateur, as having " an excrescence of skin, covered with white hair, hanging from the top of the hump, about seven inches long and of a soft nature, in appearance resembling a child's stocking, dangling from side to side as the animal moved, butin noway unsightly or repulsive to look at." Such animals are worshipped, and not put to any work ; they are usually exhibited, covered with a kind of earth-colored cloth trimmed with cowrie-shells, and the owners derive a livelihood by exhibiting them. The "fakeers," or holy mendicants, usually obtain possession of them. These double or polymelian mon- strosities receive their sacred designation from the god Mahadeo, who is believed by the Hindoos to have ridden upon a bull called " Nadeah," which was capable of changing its shape, and producing as many legs or horns for offensive or defensive purposes as it might find necessary. Thus it happens that any animal with unnatural or extraordinary marks, is supposed to have some affinity to the great " Nadeah " of Mahadeo, the founder of Hindoo teratology. 1 412 FOETAL DYSTOKIA- maticMis, is to the effect that the embryo or fcetus has been submitted to some kind of alteration in uiero, and that this has been produced during the interval between conception and birth. It is a matter of ordinary- observation that sometimes a fall, blow, sudden fright, or a' powerful mental impression will, in woman, disturlD the ordinary course of preg- nancy, and give rise to more or less unusual symptoms, and even prema- ture birth of an imperfect fcetus. It has been attempted to explain the action of these influences, by supposing that the sudden physical or men- tal shock produces an abrupt contraction of the vascular system and, co- incidentally, of the uterus ; and that the foetal membranes are thus all at once constricted, and slightly lacerated. Consequently, a part of the liquor amnii escapes (as has been frequently observed), and this is suc- ceeded by adhesion of the margin of the laceration in the membranes to the corresponding part of the body of the embryo ; and thus are formed those layers or bands which, whether temporary or permanent, disturb Fig. 102. Double Parasitic Monstrosity; Polytnelian notomelus ; Cow. more or less the development of the young creature, either by prevent- ing organs from occupying their natural cavities, hindering the union or fusion of parts, or opposing or delaying the formation of those which should afterwards appear. That this opinion is not improbable may be at once conceded, when we remember that during the early stages of development the ovum is little more than a semi-fluid mass, and that its constituent parts are extremely impressionable. But the formation of mcxistrosities is more particularly due to what has been designated the theory of retardation or arrested development ; the de- viations from the normal standard being the effect of disturbance and arrested supply of nutriment during the period of intra-uterine growth. G. Saint-Hilaire has proved experimentally, by means of eggs artificially hatched, that the production of monstrosities is due to the interruption or accidental suspension of development which had commenced in a regular manner; while Meckel has shown the striking analogy there ex- MONSTROSITIES. , 413 ists between many anomalies and various transitory conditions of em- bryonic organization. It has been well remarked that the majority of the malformations due to defect in the higher animals, represent, in a more or less perfect man- ner, the normal conformation of the inferior classes. For instance, the imperfection or absence of limbs is the natural condition of fishes and some reptiles ; the heart is not present in zoophytes ; when it has but one cavity in the higher mammalia, it only resembles the single heart of crustaceae ; and when the auricular septum of the heart remains patent, it is like the reptilean heart. All this is explained by the fact, that the embryo of the domesticated animals, in arriving at its ultimate develop- ment, appears to pass through all the degrees of organization which mark the different types in the zoological series. And by means of the knowl- edge we possess of the organization of these types, we are sometimes able to say when a particular monstrosity began to deviate from the normal condition, the nature of the deviation, and its cause. An excess of general development is less frequent than the opposite condition : partial excess of an organ or region is not unfrequent ; while excess of parts is far from rare, and may be noted in the vascular sys- tem, in internal organs, and externally : more particularly is it remarked in the extremities, when we have in some species "polydactylism," and in others " hvperdactylism." It is often obseVved that an excess in development in one part coincides with defective development in an- other, as if the balance in formative organization must be maintained throughout the body. With regard to double monstrosities — the result of two foetuses being accidentally joined together, and fused, as it were, into each other — G. Saint-Hilaire proposed a special law which he designated the law of sim- ilar imion or of mutual affinity. The result of this law is the production of symmetrical development in a double monster in as perfect a manner as in a single and normal individual ; the two creatures which, by their union, form either a partial or complete double monstrosity, are always joined by the homologous faces of their bodies — side to side, front to front, or back to back. And not only are they united by their homolo- gous surfaces externally, but internally they are allied by homologous organs : each part or viscus of one corresponding to a similar part or viscus of the other ; so that each vessel, nerve, or muscle on the plane of union of one, notwithstanding the apparent complexity, is joined to the corresponding vessel, nerve, or muscle of the other : just as the two moieties of a single and central organ, originally distinct and lateral, be- come naturally fused together at a certain period, and in obedience to the laws controlling their formation and development. A double mon- ster IS, therefore, only a being composed of four more or less complete moieties instead of two, as in the single individual. With regard to more complex monstrosities, we find that, instead of two moieties, as in the normal condition of an individual, or the four moieties as in the double monstrosity, we may have six, eight, or even more ; but yet the law of similar union prevails, and the moieties com- bine m twos. Therefore it is that a triple monstrosity is only a double monstrosity doubled, and a quadruple one a triple monstrosity doubled also — all the phenomena of the compound monstrosity being accounted for on the same general principle. The formation of double monstrosities has given rise to some digcus- 1 414 FCETAL DYSTOKIA. sion, and at present there are two chief theories which are worthy of notice. According to one of these, there have been originally two ova, which may have been derived from one or from two Graafian vesicles or follicles rupturing at the same, or nearly the same time, and passing down the oviduct together, towards the cornu, become fused by pressure in their passage. The other theory supposes the existence of only one ovum, by whose division or cleavage the double monstrosity is formed. The first view is that which has found most favor, though quite re- cently it has been considered as quite exploded by Dittmer {Reichert and Dii Bois-Reymond's Archiv., 1875), who is inclined to adopt the latter theory, and believes that the double monster is only an instance of bi- lateral symmetry carried too far. According to him, in the primitive germ of the normal embryo a longitudinal groove is formed, which after- wards represents the middle line, the two lateral parts developing sym- metrically. But if this groove is too deep at one or both ends, the two halves will there be separated ; and the separated extremities have the power of producing the wanting lateral half of each. The separation of the two halves may occur at one extremity or at both, and it may extend to any depth. According to these differences, we should have the vari- ous forms of double monster — from such creatures as the Siamese twins to cases of a small supernumerary leg. There may even be a further stage of this process. One of the separated halves may present a sim- ilar exaggeration of bilateral symmetry, if it again separate into two halves like the original germ. Thus may be explained monsters with three heads or three tails. Some objections might be raised to this theor}^ but this is not the place to enter upon their discussion. We may, however, point out that it will scarcely apply to included monstrosities, in which we have one creature, more or less perfectly developed, contained within another. We can scarcely doubt of the existence of two ova, the included one being the oldest, and that this inclusion has probably been effected at a very early period of germ development. To return, however, to the long-accepted theory. If we descend from the complex phenomena of double monsters to single ones, and from these to simple anomalies, we find again that every anomalous union be- tween organs takes place by homologous parts. What have been desig- nated " Symelian " monstrosities are characterized by the fusion of their more or less atrophied abdominal limbs ; in the " Cyclocephalian " mon- sters the eyes are more or less fused into one organ of vision ; while with the " Otocephalians " the ears themselves are joined, and often inti- mately confounded. The union of the kidneys, testicles, cerebral hemi- spheres, and other double organs, is often observed in creatures otherwise normal in conformation ; and all these anomalies occur under the reign of the same law — that of " similar union " — which for organs, as for en- tire individuals, operates on homologous parts. With regard to the remote or proximate causes which lead to the pro- duction of monstrosities, it is very probable that the most prominent are irregularity or inequality in the nutrition of the foetus, physical injury, undue pressure, alterations in the membranes, or diseased conditions of the young creature. G. Saint-Hilaire and Valentine, by disturbing the development of the embryo of the fowl during the early stage of incuba- tion of eggs — through shaking, jarring, and pressing them, perforating the shell, or covering it with w^x — could almost create monstrosities at will. MONSTROSITIES. 41 5 And, as Zundel remarks, an accident during gestation — a blow, a fall, a displacement of the uterus — will produce the same results in animals. And Lafosse observes that it is perhaps because of the pressure to which the foetus of ruminants is exposed, owing to the accumulation and fer- mentation of food in the rumen, that must be attributed the greater fre- quency of anomalies in the species of this order than in the other domes- ticated animals. The quantity and quality of the food, and the work to which the mother is subjected, have an undoubted influence on the nutri- tion of the embryo. A circumstance which appears to have some influence in the produc- tion of anomalies in animals, is the great disparity in size between the male and female. Lafosse endeavors to prove this by showing that the frequency of certain vices of conformation — such as hypospadias, umbili- cal hernia, want of proportion between the jaws, etc. — is most notable in the mule. We are also convinced that excessive consanguinity (breeding " in and in ") likewise leads to the frequent production of monstrosities ; we have witnessed some startling instances in the Cow and Pig. Weakness of the procreative powers may also tend to the development of monsters. A too small uterus may likewise act mechanically in distorting the fcetus j while the health or disease of the organ, or of the foetal mem- branes, must exert a powerful influence on its development and conforma- tion. It is not improbable that the Celosomian monstrosity {Schistosomus reflexus), observed only in the bovine species, is due to the form of, or pressure in, the uterus ; and to the same cause may also be ascribed the greater frequency of double and triple monstrosities in this species than in any other. The amputation of limbs, or portions of them, may be due to the action of the umbilical cord, which, in the Mare at least, is perhaps sufficiently long for this purpose. Hereditary influence is here undeniable. In the human species it has often been remarked, and scarcely less frequently in animals. Hornless cattle, double-headed puppies, tailless cats, and other anomalies, are commonly reproduced. Franck* mentions the case of a Mare which con- stantly had foals whose lower jaw was so short that they could not suck ; consequently they died. Gurlt alludes to a Bitch \Wiich brought forth four litters of puppies ; the first litter consisted of six, two of which were minus their fore feet and were hare-lipped ; there were five in the second litter, four of which were monstrosities ; in the third litter there was the same number, and the fifth puppy, which was otherwise normal, had a hump in the middle of its back ; four puppies were produced in the fourth litter, three of which were anomalous. A psychical or mental influence has often been invoked to account for certain monstrosities, and the vulgar opinion since Old Testament times is certainly entirely in favor of its existence j but, on the other hand, it has often been denied. While there can be no doubt that the popular mind has greatly exaggerated this influence, yet it would appear from the interesting observations collected by Trehonnais, as well as the curious instances recorded by Buhler, Weber, Herbst, Bagge, Rueff, and others — and which we regret we have not space to quote — that it does operate to some extent in animals ; fear especially, as has been already said, will react on the embryo or foetus. * Handbuch der thierarztlichen Geburtshiilfe, p. 434. 1 41 6 ^ FCETAL DYSTOKIA. Disease of the foetus itself, or maladies transmitted from the mother, may play an active part in the production of anomalies and monstrosities. Frequency of Monstrosities. Monstrosities are far from being rare in the domesticated animals, but they do not occur with the same frequency in all the species. Gurlt* tabulates 740, which shows the proportion furnished by the different ani- mals. This is as follows : — Ass 3 Mule 3 Goat 24 Mare 56 Cat 71 Bitch 78 Sow 87 Ewe 179 Cow 239 Baumeister and Rueff mention that in the King of Wurtemberg's pri- vate stud, of 2340 foals produced, there were only nine monstrosities, or one abnormal to 260 normal foals. In the Hohenheim dairies, among the Cows the monstrosities were only one-half per cent, (i per 200) ; swine came next in frequency, then goats and sheep. Among the latter there was only one monster in 768 lambs. Saint-Cyr collected 49 instances (not including hydrocephalic mon- sters), which were apportioned in the following manner : — Cow 27 Sheep and Goat - - - - 13 Sow - 4 Cat ------ 4 Bitch ------ o Mare - i Though monstrosities are not rare m animals, yet all do not give rise to difficult parturition ; for in some cases the deformity.does not interfere at all with birth ; in others in which the deformity is of such a nature as would impede delivery, birth often occurs prematurely when the foetus or foetuses are small and soft ; while even when fully developed, double and triple monstrosities have been occasionally born without assistance. Nevertheless, there is ample proof that triple, double, and even single monstrosities, often require to be removed artificially, and may be pro- ductive of serious consequences to the mother. These we will now allude to. Distorted Monstrosities. The distorted monstrosities which Gurlt \i?is dQs\gx\2itQd Camyiorrhacchis contorta, and which are characterized by abnormal situation and form of different parts (Fig. 95), may occasionally, from their crooked shape, prove a source of difficulty during birth. The distortion may be due * Pathol. Anatomic, vol. ii., p. 5. MONSTROSITIES. 4 1 7 either to muscular contraction in the foetus, or to extraneous uterine pressure, and if we glance at the figure which illustrates one variety of this malformation at page 407, we will readily perceive that the obstetrist may indeed have a serious task before him if he is required to remove such a misshapen foetus. The remarks we have made with regard to dystokia from muscular contraction are applicable to this form of mon- strosity ; and in the majority of instances, it will be found that embry- otomy, or even the Cassarean section, must be resorted to. The following are illustrative cases. Wilson ( Veterinarian, vol. xl., p. 770) attended an aged Cow which had been in labor for more than twenty hours. The abdominal viscera of the foetus were hanging from the Cow's vagina, and as much of the pudendum as could be seen was livid and flaccid. Introducing his arm, he discovered what afterwards proved to be an irregularly-round bony mass, too large apparently for birth. The presenting substance was a portion of a malformed foetus. Nothing resembling a calf could be discovered, though what seemed to be a kyst was found ; this was punctured, but with no evident result. Embryotomy was out of the question, as it was not known how to proceed ; so it was decided to draw the mass into the genital passage, in order to extract it. Tracing the connections of the fostal viscera, what 'was supposed to be the oesophagus was found in the middle of the hard mass. Four or five inches within this orifice, a strong iron hook, to which a cord was fastened, was inserted. Smearing the foetus well with soft soap, and giving the cord to an assistant, with in- structions to pull steadily and gently, after some manipulation the mass was carried into the OS uteri, and by continuing the efforts delivery was effected. On examination, the bony mass felt within the uterus was found to be composed of all the bones of the trunk, except the cervical vertebras, " jumbled and thrown together." " Projecting from one side of this were the fore legs, and in the middle of these the head and neck, all fully formed and well haired." The part mistaken for a kyst and punctured, was discovered to be a large piece of perfect skin growing from the bony lump, and falling round the whole mass. The Cow recovered in a short time. The same writer {Ibid., vol. xli., p. 606) attended another aged Cow which had been irt labor for a day. Two or three j^ersons had felt for the calf, but could not understand its presentation, which was very peculiar. The head and fore legs were in the natural position, but the two hind feet were also in the passage — one resting on the spine and the other against the right shoulder of the calf, each leg with its posterior part superior. Wilson, at first believing two calves to be present, endeavored to return the hind legs into the uterus, but they were immovable, and the presentation could not be changed. Embryotomy was, therefore, resorted to, and each hind leg was detached at the stifle joint ; after which the Cow calved without much difficulty. An examination of the foetus showed that the position of the hind legs depended upon a twist in'the loins. The Cow perfectly recovered. Cyclopean Monstrosity. A Cyclopean Monstrosity would not, so far as the visual deformity is concerned, give any trouble to the obstetrist ; but in conjuction with this condition we not unfrequently find other anomalies existing, as in the following instance : — Wilson { Veterinarian, vol. xli., p. 607) mentions the case of a Cow which was nearly fifty-five weeks pregnant when parturition commenced. The presentation of the foetus was natural, but the limbs were excessive in size. Eventration had to be effected before delivery was completed, the calf having been in the genital passage for more than two hours, notwithstanding the efforts of three or four men, who pulled at it from time to time. The calf was not larger than the female calf usually is, but the nasal bones were entirely absent, as well as the nasal openings — the skin in this situation being elongated as a simple but well-haired flap. On the under part of this flap, which was about three inches long, the lower jaw, mouth, and tongue appeared to be properly formed. " The foetus was a cyclops, as only one eye existed, and this in the centre of the forehead. The eye was very imperfect, and the eyelids were much contracted and ran parallel to the longitudinal suture. The external ears seemed to be perfect in form, but the meatus auditorius was closed in both of them." 27 4i8 FGETAL DYSTOKIA. This, it will be seen, was a variety o£ Gurlt's cy clops. Youatt gives a good descrip- tion of the head of a cyclops foal in the V^eterinarian (vol. vii., p. 434). Pseud ENCEPHALi AN Monstrosity. The head of the foetus may prove a cause of protracted or difficult par- turition, as we have seen when treating of hydrocephalus as a source of dystokia, as well as in other kinds of anomalies, when it is either greatly deformed or double. We are cognizant of only one instance in which a pseudencephalian monstrosity {Ferocephalus pseudocephalus, Gurlt) gave rise to difficulty in birth. Maw ( Veterinarian, vol. xxxiii., p. 450) attended a Cow in calf for the first time, and which had been violently in labor for six hours. A shepherd had been attempting de- livery, and found the fore legs of the fcetus presenting, the head being turned back ; the latter was adjusted, but yet, notwithstanding considerable force, the calf could not be removed. By skilful manipulation Maw succeeded in extracting it, when it was discovered to have " a protuberance on its head about the size of a child's head, with hair on it, and the tongue protruded from the mouth like a man's hand, withthe thumb and fore fingers. On all the four feet were four digits, and the hind quarters and tail were like those of a dog ; the legs were about six inches long, and there was no roof to the mouth — this aperture freely opening into the nostrils. The Cow was much exhausted, but ulti- mately recovered. Fig. 103. / SvsoMiAN Monstrosity: Dicephalus bicollis (Gurlt). Double-headed (Monosomian and Sysomian) Monstrosities. The occurrence of double-headed monstrosities is more common, per- haps, than any other anomaly ; they are observed more particularly in rumi- nants, though instances are recorded of their appearing in the Pig, and even in the Gat species. We have collected reports of some three dozen cases, the large majority of which refer to this anomaly in the Calf, and not one to the equine or asinine MONSTROSITIES. 419 species. Only two of these cases appear in English literature. We have already shown, in the classification of monstrosities, the kind and degree of division there exists between the heads, and we have only now to deal with this anomaly from an obstetrical point of view. It may be observed that many of these creatures have been born alive, and have continued to live for some time. Canu mentions a double- headed Calf which survived its birth fifty days, and Bert gives a good description of another which he examined when it was fifteen months old ; but in the latter instance the anomaly was limited to the lower part of the head, the jaws only giving evidence of duplicity. The existence of this anomaly renders birth more or less difficult, or even impossible, according to the size of the heads, their point of junc- tion — whether at the face or cranium, or towards the neck, and also ac- cording as the presentation of the foetus is anterior or posterior. In very many of the cases recorded, the mother died or had to be killed, while in others birth occurred without assistance and with but little difiiculty : rather a matter for wonder, considering the width of two foetal heads joined towards tne upper part of the neck. In this respect the Monoso- mian must prove more troublesome sometimes than the Sysomian mon- ster. In the majority of cases the presentation is anterior. An examination will reveal the existence of this condition, when the obstetrist will adopt the measures necessary for extraction. In very many of the cases embryotomy will have to be resorted to, or even the Csesarean section. Decapitation of one or both heads may sometimes suffice. In other cases, judicious manipulation and well-timed traction will effect delivery. When the heads are united at the cranium (as in Figs. 97 and 100), and it is impossible to decapitate, the obstetrical saw, chisel, or bone forceps may be usefully employed to disunite them at their junction. With double necks, amputation of one head and neck should be ef- fected as low down as possible, 1. Wilson ( Veterinarian, vol. xlii., p. 407) describes a Monosomian monster ; the heads were of equal size and fully developed. With the exception of the atlas and dentata, the bones were natural in shape. The dentata did not differ much from the normal form ; but the ring or body of the atlas was curved from below upw^ards, at its anterior and middle part, and had attached to the extremity of this curved portion an extra piece, which was carried with a sweep upwards and backwards to join the body of the bone superiorly. This interposed portion of bone contributed, on either side, to the formation of the concavities for the attachment of the two occipital bones. The spinal cord was not bifid, as only a common but enlarged cavity existed in the atlas. The presentation of the fcEtus was posterior, and delivery could not be effected until the greater part of the foetus was removed by dissection. This was the fourth case of double head this veterinarian had met with in twenty-five years' practice. The first (a calf) was delivered alive, but only lived about half-an-hour ; the next two were born dead. 2. Shipley [Veterinary Journal, March, 1877) gives details of the case shown in figure 100. The mother was a medium-sized Cow, which had been in labor for about twenty- four hours, during which an empiric had exerted all his skill for several hours to effect delivery. Shipley found the genital canal dry and swollen from the severe treatment. With difiiculty the fore-legs of the foetus were reached, and then a malformed or double head. The lower jaw of each head was smashed, and the incisors pulled out or hanging from the gum. This damage had been done during the attempts at extraction ; unsuc- cessful efforts had also been made to amputate the head. With much trouble and labor, the fore limbs were pushed forward as far as possible into the uterus, and a strong cord passed over the back of the heads behind the ears ; then, with the aid of some men who pulled at this cord, and in manipulating the two noses of the foetus — first to one side, then the other, gradually drawing each forward — 1 42 o . FCETAL DYSTOKIA. the heads were extracted, and cut off at their junction with the atlas. The neck was now pushed back, the fore limbs lifted up, and with a little assistance the body of a well-de- veloped calf was extracted. The creature was alive at an earlier period, and Shipley had no doubt that it could have been delivered more easily than by cording the lower jaws and using a halter over the head. The spinal cord was single ; the cerebrum on each side was fairly developed; the cerebellum was only "semi-double;" the two tongues were nearly perfect. 3. Canu {Mem. de la Soc. du Calvados, etc., p. 362) mentions that a double-headed calf was found behind a Cow one morning, and it was not known how delivery had been ef- fected. It was alive, and sucked by either mouth. 4. Rainard {Op, Cit., vol. i., p. 486) gives a very interesting account of a double-headed kitten, which made a posterior presentation in the lumbo-sacral position. The body having been extracted, the greatest difficulty was experienced in removing the head, M'hich the finger introduced into the uterus discovered to be double. It was finally re- moved by traction — first on one side of the body, then on the other — the young creature dying during the manipulation. 5. Forster (Franck, Op. Cit., p. 441) delivered a Cow of a double-headed calf, which was affected with prolapsus cerebri ; no cutting was required — only manual assistance. The calf lived for about sixty hours ; when it sucked by one mouth the milk escaped from the other mouth. The junction of the heads took" place at the temporal bones, immediately behind the orbit (Fig. 97). The Cow was a frequent bearer of twins. Franck gives a number of examples of this form of monstrosity, from German veterinary literature. Celosomian Monstrosities. Those creatures which are more or less destitute of abdominal and thoracic parietes, and otherwise deformed in various degrees, would ap- pear to be somewhat frequently met with by the veterinary obstetrist. The above designation for them will be recognized as that bestowed by G. Saint-Hilaire, the name proposed by Gurlt being Schistosomas 7'eflexus or contortiis (Fig. 88). They also are found more often in the Cow than in other animals, the Sheep being next in the order of frequency. Of forty-nine monstrosities referred to by Saint-Cyr, twelve belonged to this order, and of these eleven were calves, and only one lamb. Our own figures place the proportion of calves much higher. Perhaps this relative frequency, as Saint-Cyr remarks, is at least partly due to the fact that the singularity of thfe malformation is so striking that observers are more ready to publish cases of this kind ; while parturition being always more or less laborious, empirics who may chance to be called in cannot understand the anomaly, and the veterinary surgeon has at last to be sent for. Diagnosis. The diagnosis of this malformation is not difficult to the practised obstetrist. If the fcetal intestines are apparent at the genital orifice of the mother, their small size indicates at once that they are those of the foetus, while an exploration of the vagina and uterus will discover the distorted body, with the viscera unprotected and floating freely about. When nothing is visible externally, of course the diagnosis is more diffi- cult ; and this difficulty is increased with certain presentations and posi- tions of the foetus. When, for instance, this is anterior, and the spine is greatly distorted, the hand will first meet the head, and around it all the feet ; and it will be in vain for the obstetrist to attempt to separate these, and to push back the posterior limbs in order to put the foetus in a good position, as the rigidity of the crooked spine prevents this being accom- plished. In other cases the presentation may be abdominal or posterior, MONSTROSITIES. 421 and then the hand encounters a confused, soft, floating mass of viscera, the nature of which is not easily ascertained. However, the/^ Fig. 116. Extreme Downward Deviation of the Head. When, however, through delay or unskilful attempts at delivery, the nape of the neck is firmly engaged in the inlet, there is no room to ad- just the head, the lower part of which is jammed against the maternal pubis below, and the vertex against the sacrum above. In such a case delivery has been effected by passing the running noose of a cord round the nose or the upper jaw of the foetus, and while an assistant pulled at this, the operator, by pressing strongly against the top of the head, made this swing backwards, the nose rising into the passage ; birth was then accomplished in a few minutes. And ev^en with this degree of head deviation, delivery of the foal with- out adjustment is not impossible : for Lecoq, quoted by Saint-Cyr, gives an instance in which the upper part of the head and poll jvere so firmly 454 FCETAL DYSTOKIA. fixed in the pelvis, that it was impossible to push the foetus into the uterus. This was attempted, however, by squeezing the head closer to the neck, the hand being passed alongside the cheek and the nose grad- ually raised ; at the same moment the Mare strained doubly hard, and gentle traction being applied, the foal was expelled with its head in this position, but without injuring the perineum of the mother. The latter soon recovered, but the foal, as is usual in such cases in the equine species, was dead. In this degree of deviation, as well as in the others, great assistance will be afforded by raising the hinder parts, of the mother to the extent of one, two, or more feet. Lecoq, Rueif, and others have recommended placing the animal on its back. It is perhaps better, however, to elevate the hind-quarters, and to resort to retropulsion either by tne hand or the crutch ; then after injecting warm water or oleaginous fluids, to either ex- tend the head, or to attempt forced extraction. The blunt hooks fixed firmly in the orbits of the foetus, will be found most useful in the latter operation. When the upper part of the neck alone presents, reduction is still pos- sible, provided no great delay has occurred, nor mismangement by un- skilful people allowed. But when the " waters "have been long expelled, the legs pulled at by amateurs, and the uterus closely applied to the body of the foetus, the case is most difficult j as then manipulation and retro- pulsion cannot effect much in many instances. The doubled neck is too voluminous to enter the pelvis, and the longer the pains continue, so the farther is the head pushed forward from the in- let, and therefore away from the reach of the obstetrist. The contractions of the closely applied uterus also render attempts at delivery almost impossible, by their paralyzing the hand and arm. Large quantities of warm lubricating fluids must be injected, retropul- sion attempted by one or two crutches applied to shoulders of the foetus — not to the neck ; while the hand manipulates, aided, if need be, by the finger-hook (Fig. 120). A blunt hook (Fig. 121) inserted on each side of the lower jaw — when this can be reached, towards the root of the ear, or into the orbits ; a cord round the neck — if it can be passed ; and other devices may be tried. If they all fail, then the animal should be thrown on its back ; indeed, the success which has attended this change of atti- tude in so many recorded instances, would incline the obstetrist to adopt it without much delay. Very often the altered position of the mother at once disengages the head of the foetus from its deviation ; if this does not happen, then the other means may be tried as in the standing position. Pelvic version may be resorted to in some cases, the anterior presenta- tion being converted into a posterior one. When reduction cannot be effected, and delivery of the entire foetus cannot be accomplished, then the obstetrist has no other course left open to him but the adoption of embryotomy. The head may be amputated through the presenting part of the neck, or the fore-limbs removed sub- cutaneously at the shoulders — the latter is to be preferred in the majori- ty of cases, at least before incision of the neck is begun. This gives more room for manipulating the body, and effecting extraction. In all these amputations and incisions, care must be observed in pre- venting the maternal organs being injured either by instruments or ex- posed bones ; and when traction on the limbs, or what remains of them, is resorted to, it should be applied to both alike — not to one, as this would be worse than useless. DYSTOKIA DEPEXDIXG ON ANTERIOR PRESENTATION. 455 Lateral Deviation to the Right or Left. Hie lateral deviation of the head to the right or left side of the body, whereby the left or right side of the neck presents at the pelvic inlet, is a very serious obstacle to birth, and is only too frequently one of the most difficult to be overcome. It is also one of the most frequent deviations, Saake observing it in 39^ per cent, of his cases of dystokia ; and it occurs far more often in the Mare than the Cow or other animals. With regard to its origin, as well as to its adjustment, a wids distinction must be drawn between it as it exists in the foal and other young creatures. The cause of lateral deviation of the head is not well ascertained in all cases. It is not improbable that, in very many instances, it is due to precipitate or tumultuous birth, when the os is either imperfectly or not at all dilated. In such circumstances, the uterine contractions propel the head of the foetus, otherwise in a good direction, towards the pelvis ; but as the os is not open, and as the impelling force continues, the body of the foetus pushes the nose against either the pelvis or the occluded os ; this subsequently yields to one side, and then the deviation becomes in- creased with every contraction. Premature rupture of the fcetal mem- branes and escape of the " waters," spasm of the cervix uteri, torsion of the uterus, and other anomalous conditions, may all more or less occa- sion it. As with the downward deviation, if the nose is not in the axis of the pelvis, or indeed of the os, even though the latter may be partially dilated, misdirection may occur, and all the more rapidly should the fore- limbs chance to pass into the vagina. The accident appears to be most frequent with primiparag. In 108 cases of lateral deviation of the head, Saake found 84 — or 78 per cent. — in animals pregnant for the first time. The remainder were noted in animals which had previously brought forth, but in which labor was pro- tracted through imperfect or tardy dilatation of the os. This deviation is more serious when the foetus is dead than when it is alive ; and when the deviation is only slight, the head fitting into the concavity on the side of the neck, birth may even — though indeed rarely — occur without assistance, particularly with rhe foal, which has a longer and thinner head than the calf. Some authorities have remarked that the deviation is more frequently to the right than the left side, and others the contrary. In some instances there can scarcely be any doubt that the deviation has taken place some time before gestation is completed, and is the result of a long-continued malposition of the fcetus. In many foals, at birth, the neck cannot be straightened, and the head is distorted from being pressed against the neck or side of the body (Fig. 84), bones, muscles, and ligaments being involved. We have referred to these in describing '" Contractions " of the fcetus as a cause of dystokia. It is not difficult, as a rule, to distinguish the existence of lateral de- viation. Usually both fore-feet are in the genital canal, but birth does not progress. But an important fact to remember is that one limb — that belonging to the side to which the head is bent — is shorter, or rather less advanced, than the other. The hand, on being passed beyond these towards the inlet, comes in contact with a rounded mass, more or less occupying the whole of it, and rendering access to the uterine cavity dif- ficult. Patient exploration, however, discovers this to be the bent neck ; and if it be a calf, owing to the short neck, the head is soon found, and 1 4S6 FCETAL DYSTOKIA. recognized by the ears, eyes, and often the muffle turned towards the shoulder (Fig. 117) ; with this bovine foetus, in fact, the greater part of the head in the majority of cases hes against the shoulder. With the foal, it is only too often otherwise. The much longer neck of this creature, and the more violent uterine contractions of the Mare, generally results in the head being pushed towards the side of the thorax, the abdomen, or even the flank, where it cannot be reached. This diffi- culty is greatly increased if the abdomen of the mother is very pendu- lous. Occasionally this is also the case with the Cow, though it is rare that in this animal the ears, or even the eyes, cannot be reached by a fairly long arm (Fig. 118). If the animal, be it Mare or Cow, chances to be lying, and the deviation is only to the shoulder, it is most difficult to reach the nose of the foetus if it is inclined to the side on which the Anterior Presentation Fig. 117. Lateral Deviation of the Head towards the Shoulder. parent lies — i.e., if the Mare is on the left side and the deviation of the foal's head is to the right. The head may be raised as high as the back, or as low as the under part of the chest or abdomen. The foetus is usually in the first (or ver- tebro-sacral) position, though the deviation may'also occur in the second (vertebro-pubic) or third (vertebro-ilial) positions ; in the latter position the neck may be bent upwards, the head towards the maternal sacrum, or downwards, the head resting on the floor of the uterus. . This complication is not only a very frequent, biit, as has been said, a very serious one for the obstetrist, and it may be truthfully asserted that birth is not possible without his assistance ; indeed, it has been well re- marked that " it taxes all his strength, patience, and ingenuity." With the calf, the neck of which is comparatively short, the head is in most cases no farther back than the shoulder, though it may be as high as the withers or as low as the sternum. It is, therefore, possible to DYSTOKIA DEPENDING ON ANTERIOR PRESENTATION. 457 reach it ; and though its relatively large size is a great obstacle to reduc- tion, yet in the majority of instances this adjustment can be accom- plished, and especially if the young creature is alive, as its spontaneous movements aid the operation ; for this and other reasons already alluded to, the calf is more frequently extracted alive than the foal. As a rule, reduction of the displacement is indispensable in delivery, the head and neck, or -shoulder, forming too voluminous a mass to pass through the pelvic canal. With the foal the head may also not go beyond the region of the shoulder, and the case is then generally not so serious as with the calf, the head being smaller and the displacement more easily reduced. But, as has been pointed out, owing to the long and flexible neck of this crea- ture, the head is most frequently deeper in the uterine cavity : towards Fig. 118. Anterior PRESEN-TATio>f : Lateral DEVIATIO^J of the Head towards the Addomz: . the side of the chest, abdomen, flank, or even the croup. Here the hand cannot reach it, and reduction is nearly always impossible ; besides, the foetus succumbs soon after the commencement of the labor-pains : death being due in many, if not in all, cases to premature separation of the maternal and fcetal placenta. However, owing to the thinner and more flexible neck, and the smaller head, when the latter was lodged in the flank the foetus has been delivered by energetic traction. Mention is made that both in the Mare and Cow delivery has been effected, though the head has been bent back on the neck, side, or flank, without having recourse to embryotomy, and in a great measure by the expulsive efforts of the mother. Indications. The principal indication in this deviation is, of course, to get hold of the head, adjust it, bring it into a favorable position in the genital canal. 458 FCETAL DYSTOKIA. and then terminate delivery. But this indication cannot always be car- ried out, especially when the head is beyond reach ; neither is it always necessary that it should be followed implicitly, so far as the foal is con- cerned, though in the case of the calf it is an almost absolute require- ment. For the latter there are only two courses open — adjustment or embryotomy. With regard to adjustment, it is generally recommended that the lower part of the head should be secured, either by the hand or a cord passed round the lower jaw, and strong traction employed. But this necessarily produces twisting of the neck, which, in addition to rendering reduction very difficult, endangers the life of the foetus. The better plan, therefore, appears to be as follows : Cord the pre- senting fore-feet; push the foetus into the uterus, so as to clear it from the inlet ; pushing either on the flexed neck or chest, and not directly forward, but rather obliquely to the side opposite that to which the head inclines, so as to bring this round to the inlet. This retropulsion, Man- del asserts, has often alone brought the head into the. natural position. If it does not, then the operation must be continued. If the fore-limbs are in the way of the operator, they may also be pushed back into the uterus. The head is then to be sought for, and version applied to it in such a way as to bring its under surface uppermost. Schaack has communicated to Saint-Cyr his method of eifecting this : The extremity of the jaws is employed to straighten the head, not by lowering the chin and drawing it below the neck, but superiorly, after forcing the chin and lower jaw up and outwards — the foetus is supposed to be in the first position. In order to do this, as soon as the hand reaches the muffle the fingers are passed into the submaxillary space, and pressure is made on one of the branches of the lower jaw, so as to twist the head outwards and upwards. When this is done, it is an easy matter to put it in a good position by pulling at the nose, as traction then acts exactly in the direction of the atloido-occipital and other joints of the vertebrae ; whereas, if practised before this manoeuvre, traction tends to twist the neck, and renders reduction much more difficult. The head being twisted in this way, it has now to be extended and brought into the inlet. To eifect this, Bordonnat gives these directions : Place the palm of the hand beneath the chin, seize each side of the lower jaw by the fingers, the thumb being in the mouth behind the incisors. This ensures a solid grip, and the head is brought into a good position by direct traction towards the axis of the pelvis, this traction being ap- plied in jerks rather than continuously. 'i1ie hand must not relax its hold of the head, when at the inlet, until it has been corded, as it readily slips back again. If the hand cannot accomplish this, a cord should be placed around the lower jaw, behind the incisor teeth. This, however, is not always easy, as only too frequently the fingers are paralyzed by the uterine con- tractions. The porte-cord (Figs. 119, 120) maybe usefully employed in this direc- tion, and the jaw secured. But sometimes, and generally with the foal (which has no incisor teeth), the cord slips off when traction is applied ; it must then be given up, and other means tried. When, however, it does remain attached to the jaw, an assistant judiciously pulling at it will greatly aid the operator, whose hand is manipulating the accessible parts of the head. In this manipulation, even when the cord will not remain on the DYSTOKIA DEPEADIXG OX ANTERIOR PRESENTATION. 459 neck of the jaw, much benefit will be derived by using the finger-hook (Fig. i2i), which can be inserted into the ear, orbit, or angle of the mouth or jaw. In default of the cord round the jaw, recourse may be had to the short blunt crotchet (Fig. 122) — some obstetrists prefer the long blunt crotchet (Fig. 123) — which can be fixed in the angle of the jaw behind the chin, in the cheek, orbit, or ear, or on the under-side of the head — in fact, wherever Fig. 121. Finger-Crotchet. i c^ Fig. iig. Straight Porte-Cord. Fig. 120. Bent Porte-Cord. Fig. 122. Short Blunt Crotchet. the operator may deem most effective — the assistant pulling at the cord attached to it, according to the directions of the obstetrist, who guards the hook with his hand, or assists in straightening the head by judicious ma- noeuvres. The ear, or other convenient part, may also be secured by the serrated forceps (Fig. 124), and traction exercised by the cord passing through its eyelets. In all these attempts it is absolutely necessary that the foetus be kept 1 460 FCETAL DYSTOKIA. as far as possible from the inlet. It has been recommended in those cases in which the head, lying towards the flank, cannot be reached, that the fore-part of the mother be raised ; that the abdomen be elevated by a plank, sheet, or sack ; that the flank be pressed upon externally by an intelli- gent assistant ; that the animal be placed on its back ; that sharp hooks be implanted in the neck, occiput, or other part of the foetus, etc. Schaack, who has had a large experience in such cases, and appears to have made this subject a special study, points out that all these devices gain the proposed end with difficulty, and" have one capital defect — they do not act on the proper part. With regard to traction, he says that it is neither n> Fig. 123. Long Blunt Chrotchet. on the ears, occiput, nor even the head, that this should be applied in such cases, but on the point where the neck is bent. It is necessary, there- fore, to introduce the hand into this part, and, by repeated tugs or jerks, to widen the bend ; this done to some extent, the hand is moved to an- other point nearer the head, retropulsion being at the same time practised. By acting in this manner, he assures Saint-Cyr that he has always suc- ceeded in bringing the head sufficiently near to be able to manipulate it. Delafoy {Recueil de Med. Veterinaire, 1832, p. 313) many years ago described his method, which consists in carrying a good firm cord, about twelve feet long, and with a knot at the end to hold it by, by the hand into the uterus. The knot, held at the end of the fingers, is passed between the neck and chest of the foetus ; there it is left while the hand seeks for it at the other side of the neck, where it is seized, drawn through, and Fig. 124. Nelson's Serrated Forceps carried without the vulva, the double of the neck being included in it. The hand is again passed into the uterus, and the cord is pushed as near the head as possible ; and there it is held, while an assistant twines the two ends until they form one piece closely fixed on the neck — care being taken that the membranes are not entangled in it, or cotyledons, if it is a Cow. The hand is then placed on the point of the sternum or one of the shoulders of the foetus, and while this is pushed forward into the uterus, the assistant is told to pull steadily. If this movement is well managed, the head of the foetus is brought sufficiently near the os to. be secured and adjusted. Delafoy states that he has practised this procedure a great number of times, and always with success ; and others have been equally DYSTOKIA DEPENDING ON ANTERIOR PRESENTATION 461 fortunate. For instance, Lecoq gives the following testimony of his expe- rience to Saint-Cyr : " During my sojourn at Solre-le-Chateau, I was called one morning to a Cow which had been in labor since the previous evening, and which had passed the night in futile efforts, notwithstanding the more than probable intervention of the owner and his neighbors. I recognized immediately the position of the head, which was turned towards the flank, and so far round that my fingers could not seize the nose with sufficient firmness to bring it into its normal position. I, however, soon succeeded in doing so by a very simple procedure. I passed from above to below, in the concavity formed by the bend of the neck, a cord, the end of which, passed under the neck, was drawn outwards, and, with the other end, placed in the hands of an assistant. A moderate effort by the latter drew the fcetus backwards, and I was then able, with the great- est ease, to straighten the neck by getting hold ot the jaw. Birth took place immediately." One of the long bent porte-cords, such as is rep- resented by Fig. 120, that of Binz (Fig. 125), or those to be hereafter described, might be most usefully employed not only in carrying the cord or sling round the neck, but also in pulling at this part. In all these manceuvres, should the " waters " Fig. BiNz's Porte-Cord. time, and the genital canal and uterus be dry and ho have escaped for some frequent injections of warm water should be applied to them. In certain cases, when the head is adjusted, or even to aid in its adjustment. Nelson's blunt forceps (Fig. 126) will be found of great service in seizing the nasal septum. With regard to embryotomy, though instances are recorded in which forced extraction in the Cow has been successful,* yet it should never be resorted to by the humane practitioner (and we earnestly hope veterinary obstetrists are, above all things, humane). The great length and essen- tially bony structure of the Cow's pelvis, and the large volume and shape of the calf's head, prove such an obstacle to forced extraction in this lateral deviation, that, if persisted in, it will not only cause the death of the young creature in all probability, but also that of the mother, unless the fcetus is unusually small and the pelvis of the Cow very wide. In fact, those who have attempted it testify to its barbarity and fatality. With the Mare, the case is somewhat different. When the head of the foal is deeply buried towards its flank or croup, reduction is most difficult, and requires long and laborious manipulations, which so irritate the organs and exhaust the strength of the mother, that it not unfrequently dies from their effects. In most cases, too, the obstetrist is called in when the foal is dead, so that there is no necessity for scruples with regard to it. On the other * Franck {Op. cit., p. 373) gives an instance in which two empirics attempted to deliver a Cow that could not calve. They mistook this deviation for a breech presentation, as they could not find the head, and they thought the fore-feet in the vagina were hind ones. They consequently, other means failing, set about extracting the calf per force, and eight men pulled at the cords attached to the feet ; the young creature was removed, but it was dead. The Cow was unable to get up for eight days, but eventually recovered. 462 FCETAL DYSTOKIA. hand, as we have previously said, the long, thin, and flexible neck, and narrow and tapering head, readily allows the latter to become imbedded in the flank, and thus to offer much less resistance than with the calf ; while the wider pelvis of the Mare offers further facilities. Numerous in- stances are given, in which forcible extraction of the foal with the head so deviated, has been attended with complete success — Darreau had eight out of ten cases — and without much suffering on the part of the Mare. Indeed, so successful and prompt is it, that Donnarieix, who has devoted much attention to this procedure, says it should, as a rule, be adopted in these cases, as it is not possible to restore the head to its normal position ; delivery by vigorous traction is, if not easy, at least most frequently fol- lowed by success. Donnarieix operates as follows : The Mare is thrown down near the stable door, the thighs propped against the threshold, and a breech- ing and side-line, fixed to the wall or held by assistants, may be em- ployed to keep the animal in position. Each fore-limb of the fcetus is corded at the pasterns, the cords being confided to assistants, the number of which will vary according to the amount of resistance — four at least are necessary, and sometimes six or eight. On the word being given, Fig. 126. Nelson's Blunt Forceps. these men pull slowly, steadily and gradually, without jerking, but strongly, and equally on both cords. The foal enters the inlet, but it often happens that, at a given moment, it stops there, owing to the uterus forming a double or ring at this part and opposing progression. Traction must then cease, but the foetus is to be held firmly in the position to which it has been advanced ; the hand is to be introduced between the latter and the uterus — the back of the hand to the foetus, palm to the mucous mem- brane — the fold sought for, and dispersed by raising the back of the hand. Then the tractions are to be renewed, and in the course of fifteen, ten, or even fewer minutes, the foal is extracted. It is well to empty the rectum before commencing extraction. When practised with care and discretion, this forced removal of the foal may certainly be commended ; but we should prefer, when circumstances will permit, to give a trial to the methods already enumerated ; seeing that this procedure is not always successful, and may be followed by un- toward consequences. Eberhard, for instance (Gurlt and Hertwig's Magazin, 185 1, p. 269), gives a case in which forced extraction was at- tempted in a Mare, and was followed by rupture of the abdominal muscles, through the powerful tractiorf resorted to. With regard to embryotomy^ this must be looked upon as preferable to forced extraction — even in the Mare, but particularly . in the Cow; nevertheless, it must always be considered as an extreme measure. The D YSTOKIA DEPENDING, ON ANTERIOR PRE SENT A TION 463 operation will be described hereafter, but we may note in this place that the head or the presenting limbs, or even both, may be removed. Decollation is, however, a most difficult business when the head cannot be reached ; if it is accessible the operation can scarcely be necessary. The limbs should be removed subcutaneously, the most advanced being first excised, and with the shoulder if possible. Not unfrequently removal of one limb will be sufficient to allow the foetus to be adjusted — especially in the Mare ; or it may permit forced extraction, without adjustment, to be easily accomplished. With the calf, both limbs have usually to be removed. In this opera- tion, the long sharp crotchet (Fig. 127) will be of service. The parturient animal in which this head-deviation of the foetus occurs, has sometimes a very pendulous abdomen, and manipulation is greatly retarded by this conformation. Placing it on its back will generally give greater facilities for obstetrical operations of this kind. Fig. 127. Long Sharp Crotchet. ^ L Lateral deviation of the head is usually encountered when the foetus is in the first, or vertebrosacral, position. It may nevertheless be met with, though rarely, in the vertebro-pubic position, or in the right or left vertebro-ilial position, which is still more rare. These positions, however, do not modify the indications for extraction to any considerable extent, except that in the last, after correcting the deviation of the head, rotation should be practised, and the foetus placed in the verteBro -sacral position, if possible, before delivery is attempted. When the head is doubled beneath the body of the foetus in these lateral positions, in order to reach it, it will be found most advantageous to throw the mother down on the side that will ensure the head of the. young creature being uppermost. Version may be advisable in some of these positions. This lateral deviation of the head is liable to be complicated by misdirection of one or both of the fore-limbs, which may be flexed at the knee, entirely retained, or crossed on the sternum. Such a complication of course greatly adds to the gravity of the case, and renders it much more formidable. Here it will be necessary to adjust the limbs before interfering with the head ; though the latter, if it can be reached, and there is any benefit to be derived from doing so, should be secured by either a head-collar, or a cord round the neck or jaw. The feet should always be secured by cords, so that if it is requisite to push them into the uterus, they may readily be withdrawn again. Jones {Veterinarian, vol. xxx., p. 20), acting on a suggestion thrown out in the course of a lecture by Professor Varnell, divided the sacro-ischiatic ligament of a Cow whose foetus was in this position and could not be delivered. The calf was dead, its fore-legs protruding, and the head turned back towards the flank. The ear or orbit could not be reached, but with great difficulty the neck and fore-limbs were corded, and several per- sons pulled at the cords ; however, from " the size and unnatural presentation of the foetus, coupled with the narrowness of the pelvic outlet, " it could not be extracted. A 464 FCETAL DYSTOKIA. trocar (for lack of a better instrument) was introduced between the ischio-rectal fascia and the sacro-ischiatic ligament to form an opening, into which a probe-pointed bistoury was inserted; with the other hand on the outside, the ligament was quite divided — which was ascertained by feeling the point of the bistoury under the skin. Very little haemorrhage supervened, and the calf was removed with but little difficulty from the artificial opening thus made. A diffusible stimulant, followed by a laxative draught, was all the after-treatment adopted. The small orifice " was cicatrized over on or about the third day," and the Cow quickly recovered. This operation has not, so far as I am aware, been repeated. With the smaller animals — such as the Sheep and Goat — this deviation must be remedied by forced extraction or the short blunt hook or finger- hook, the fore-limbs of the fcetus being manipulated so as to push away the unencumbered shoulder into the uterus, and bring forward that round which the neck bends. The smallness of the genital passages in these creatures is an obstacle to manipulation, but an intelligent boy with a small hand may be of much service when acting under the direction of the obstetrist. With the Bitch and Sow these deviations are extremely rare. When they do occur it will be found that forceps will generally effect forced extraction ; or a piece of strong catgut or brass or copper wire may be passed round the bend of the neck. Traction on this will either remove the fcetus, or by cutting through the neck permit it to be extracted by the forceps hereafter to be described. Placing the Bitch in a warm bath for a few minutes, and then laying it on the side opposite to that to which the head of the puppy is inclined, will be found advantageous. Deviation Upward and Backward. The deviation of the head more or less upward and backward — the inferior borders of the lower jaw being vertical or turned up. towards the maternal sacrum — appears to be an extremely rare complication, and is chiefly met with in the Mare, in which it has led to rupture of the uterus and rectum, and delivery by the latter. The cause is probably the same as in the other deviations of this region. On exploration, in the vertebro-sacral position, the fore-limbs maybe found more or less advanced in the vagina, and beyond them, at the inlet, the hand meets the chest with its sternum, and above" it the front part of the neck with the trachea leading upwards to the head, which may be flexed more or less back on the withers or loins (Fig. 128), or inclined to one or other side of the foetus, the lower jaw always facing the lumbo-sacral region of the mother, or twisted slightly round (Fig. 129). Indications. Retropulsion is the first indication, and this alone will often bring the head into its normal position ; it should be practised on the sternum. Should the head not drop down to the pelvic inlet, then, still continuing the retropulsion, the hand may be introduced, the lower jaw seized i.nd brought towards the os, by carrying it downwards and a little to one side if necessary, by a slightly screwing motion. A cord on the lower jaw, or around the head, may be useful if it can be applied. Rueff recom- mends compression in the rectum, previously emptied, by the hand of an DYSTOKIA DEPENDING ON ANTERIOR PRESENTATION 465 assistant, while the operator manipulates in the uterus. If the animal is lying, it must be made to stand. Embryotomy is rarely necessary. Fig. 128. Anterior Presentation: Deviation of the Head Upwards and Backwards. In the smaller animals — at least in the Bitch — delivery has been effected without reduction of the deviation. Fig. i2g. Anterior Presentation : Deviation of the Head Upwards and Laterally. 1. Charant {Rcaieil de Med.Veterinaire, r85i, p. 895) attended a Mare in labor. With isome difficulty he was able to pass his hand into the uterus, and then found that the foal lad its head and neck reversed on the back, the throat pressing strongly against the ipper part of the maternal pelvis and a little to one side. There was also inversion of the bladder, with hernia of the intestines into it. Tlie head and neck were adjusted with lifficulty, and the foal extracted, but the Mare died from the above injuries. 2. Donnarieix describes a case of this deviation in the Cow, the head of the calf — 30 466 FCETAL DYSTOKIA. which was dead — being reversed on the back. Much time and patience were required to adjust the misplacement and extract the calf. The Cow did well. 3. Grad {Briefliche Mittheilung, Franck, Op. cit.,-^. 384) met a case of this kind for the first time. It occurred in a Mare ; the head and neck of the foal were thrown on the back, and only the sternum presented at the inlet. Three shepherds had been endeavor- ing to pull away the young creature, which was dead. The fore-limbs were in the vagina, and as it was decided not to exhaust the Mare by adjusting the head and neck, these legs were removed subcutaneously; then the head was sought for. The hand, pushed as far into the uterus as possible, encountered first the cervical vertebrae, then the right ear was at last reached and secured. It was now discovered that the head lay a little to the right side of the croup, the lower jaw being downwards. The task of reduction was a most difficult one, the arm being too short ; but at length the head was brought as low as the shoulder. The neck was not contracted, and a hook being inserted into the orbit, the head was carried into the pelvis, and delivery was then soon completed. 4. Saint-Cy (Op. cit., p. 472) reports the case of a Bitch which was forwarded to the clinic of the Lyons Veterinary School, having brought forth several puppies the previous evening, and continuing to strain. An exploration discovered a foetus firmly engaged in the pelvic canal ; two limbs could be distinctly felt, and beyond them a rounded surface which was at first supposed to be the croup ; the case was therefore suspected to be a breech presentation. The two limbs were seized and drawn outside the vulva," when they were recognized as fore-legs. The head could not be discovered; so traction was continued, though with every precaution, and at last the foetus was brought away. It was dead, and the head was bent back on the loins, in which it had made a considerable depression (Fig. 129). The Bitch did not suffer much, and soon was quite well. SECTION III. DYSTOKIA DUE TO MISDIRECTION OF THE HIND-LIMBS IN THE ANTERIOR PRESENTATION. Sometimes in the anterior presentation, when the head and fore-limbs are normal and in a good position, an obstacle to birth is met with in a wrong direction of the posterior parts of ^ the young creature's body, and especially the limbs. The anterior parts may be engaged in the pelvis, and yet can advance no farther, owing to the hind-legs advancing at the same time with them into the canal, or, being widely abducted, the stifles come against the brim of the inlet on each side and prevent further progress. This cause of dystokia we will now consider, commencing with the latter deviation. Extreme Abduction of the Hind-limbs. In this deviation birth appears to be proceeding favorably, the fore- limbs, head, and body being normal and in the natural position, and well through the genital canal — these parts being even more or less outside the vulva, when, just as parturition is supposed to be completed, a check occurs ; and the redoubled strainings of the mother, and even powerful traction on the foetus, are unavailing in bringing it beyond a certain point. This cause of dystokia appears to be noticed only in the foal, the long limbs of which undoubtedly favor the occurrence of the deviation. It may be discovered by passing the hand between the foetus and the genital passage — between the fore-limbs and underneath the belly of the young creature ; when it reaches the pelvic inlet, the thighs of the foetus are found to be widely separated — the stifles turned outwards, so that the outer aspect of the thighs is nearly horizontal on the floor of the uterus, and these joints are pressing against the ascending branches of the ilium or the anterior margin of the pubis. DYSTOKIA DEPENDING ON ANTERIOR PRESENTATION. 467 Indications. The indications for extraction are the adjustment of the hind-limbs. This adjustment is all the more difficult as the foetus is well advanced in the pelvis, and energetic traction has been much employed. Retropul- sion must be resorted to, the hind-quarters of the foetus being pushed as far from the inlet as possible, so that the abducted limbs may be ad- ducted ; but retropulsion is not unfrequently very difficult, if not alto- gether impossible in some cases. Under these circumstances, a slight ro- tation of the foetus on its axis, so as to change its relations with the inlet, and allow the stifles to enter the pelvic canal, has been recommended and practised with success. Heu, quoted by Saint-Cyr, gives the following directions for this ma- noeuvre : A double cord is passed round the loins of the young creature, as near the vulva as possible, the two ends being tied and a stick passed through them. Two turns of the stick being made to tighten the cord firmly round the belly, the front part of the foetus is lifted to the level of the vulva ; then the body, as well as the lever — the stick — is rotated from right to left ; after a little manipulation the resistance is overcome. Heu has by this means been able to extract a living calf. Should this operation fail, embryotomy is the last resource. This may perhaps be best effected by removing the sternum of the foetus and the thoracic organs, so that the walls of the chest will readily fall together ; the hand and arm can then be passed between the foetus and the pelvis until the hind-limbs are reached ; these are seized by the upper and front part, and adducted one after the other. When this recommenda- tion cannot be carried into practice, the trunk of the foetus should be divided {see " Embryotomy "), the hind-quarters pushed into the uterus, and version effected, when delivery can be accomplished in the posterior presentation. In order to prevent injury to the uterus or genital pass- ages, as much of the skin as possible should be left to cover the divided end of the spine. This procedure, however, is not always successful. Peuch (Saint-Cyr, Op. cii., p. 475) was called at a very late period to attend a Cow which, during protracted parturition, had been subjected to very severe handling, violent attempts having been made to extract the foetus ; this was consequently so firmly wedged by the haunches and croup in the maternal pelvis, that Peuch could not pass his hand between the young creature and the uterine walls. Finding delivery impossible without embryotomy, he divided the foetus at the loins and tried to push the posterior part into the uterus, but unsuccessfully. Extraction was impossible, and the Cow was killed by the butcher for food. Deviation of the Hind-limbs in the Pelvis, the Anterior Part OF the Body Presenting. This malpresentation, known to the German veterihary obstetrists as the " vertical-abdominal" or " dog-sitting position" {Bauch-Vertikallage^ Hunde-Sitzige Lage), is not at all uncommon, and is one of the most for- midable, perhaps, which can be encountered. First described by Canu in 1837 {Recueil dg Med. Veterinaire, 1837, p. 444), it has been alluded to by a number of veterinary surgeons, and it has also been mentioned in every work on veterinary obstetrics published on the Continent. Since that time it has been met with in the Mare, as well as the Cow, and consists essentially in the advance of the hind-limbs of the foetus in 1 468 FCETAL DYSTOKIA. the pelvic canal, at the same time as the anterior part of the body, the position of the young creature being consequently more or less vertical and the body bent at the loins. As in the preceding deviation, nothing is at first known of the existence of the displacement. Parturition commences and appears to be going on favorably ; the foetus, in the vertebro-sacral position, arrives at the inlet, the head and fore-limbs in advance as in normal birth. Progres- sive expulsion may continue until the head of the young animal is beyond the inlet, and as far as, or even external to, the vulva — sometimes the head, fore-limbs, neck, and half of the chest hanging outside the vagina. But further progress is checked, and neither the most energetic straining on the part of the animal, nor the most violent traction by those persons who may be with it, can advance the foetus beyond this point. The obstetrist has great difficulty in ascertaining the cause of delay in birth : the difficulty varying, and depending upon the volume of .the Fig. 130. Deviation of the Hind-limbs in the Pelvis in the Anterior Presentation. foetus, and whether its body more or less completely fills the pelvic canal. The hand can generally only be introduced after much trouble and tact into the passage, and having got to a certain distance it encounters either under the body or head (Fig. 131), to one side of the neck or head, or even projecting upwards above the head (Fig. 130), first one, then a second foot or limb, which are recognized by a careful examination to be those of the hinder part of the body. Sometimes the feet and metatarsal bones have alone entered the pelvis, the other parts of the limbs being in the uterus (Fig, 131) ; in other cases the hocks may be in the inlet, or even well through 'the passage — depending upon the size of the foetus and the capacity of the maternal pelvis ; more rarely the stifles have cleared the inlet, and the hind-feet are arrived at the vulva. The more advanced the hind-limbs are, so the more is the body of the foetus bent on itself, and the greater is its resemblance to a dog in a sitting posture. It is needless to state that the foetus cannot be extracted in this malposi- tion, no matter what amount of force may be exercised ; and that violent measures are certain to lead to serious injury to the mother. The great- est care is therefore necessary, in order to ascertain the exact state of DYSTOKIA DEPENDING ON ANTERIOR PRESENTATION 469 affairs ; indeed, in all cases of dystokia it cannot be too often impressed on the mind of the young practitioner, that a careful examination is ab- solutely essential before attempting extraction. In this particular form of dystokia, the life of the mother may be pre- served by timely and rational intervention ; while violent and irrational interference, even at the earliest period, will undoubtedly be followed by serious, if not fatal, consequences. With regard to preserving the foetus, the prognosis must generally be unfavorable. The foal is, in every case perhaps, certain to perish at an early period ; and though the calf is more tenacious of life, and may con- tinue to exist for some time, yet in the majority of cases it succumbs, or it has to be sacrificed to save the mother. ^25««8^^1^BT^i^^l3™i«^^ v^-^:^^: 5<:, Fig. 131. Hind-limb Deviation : Anterior Presentation. Indications. In nearly every case the preservation of the mother is the first object [to be attained, the life of the foetus — if it be yet alive when the veterinary ^surgeon is called in — being quite a secondary consideration ; though it jmust be admitted that if he is present when it is still vigorous and not imuch engaged in the pelvic cavity, there is no reason why it should not ^be extracted alive. The indication is, of course, to rectify the deviation ^of the hind-limbs ; and if the foetus is not too far advanced in the gen- ital canal, this may be accomplished by pushing it, if need be, towards I the uterus, and introducing the hand between it and the wall of the vagina (often a most difficult matter), to carry the hind-feet back — one after another — into the uterine cavity, either by the hand or the aid of the repeller ; then the head and fore-limbs being in a good position, birth can readily be effected. In this manner Carsten, Harms has extracted a foal. And when the front part of the foetus has not advanced into the pelvis, and the deviation has been ascertained in good time, the anterior 1 470 FCETAL DYSTOKIA. presentation has sometimes been successfully converted into a posterior one, so that birth could take place. But such cases are rarely met with in practice ; and, as a rule, the vet- erinary obstetrist finds that parturition has made much progress, the foetus being fixed in the genital canal and occupying its entire diameter, and its hind-limbs well forward under the body, each labor-pain wedging it more firmly ; and the case is perhaps complicated and aggravated by the indiscreet manipulations of amateurs and busybodies. In such cir- cumstances, it is needless attempting to push the foetus towards the uterus, neither can the hind-limbs be thrust into the uterine cavity ; as no sooner are they carried from under the body for ever so short a distance, than a succeeding pain brings them into their former position. Indeed, it is sometimes most difficult to reach the hind-limbs to apply cords to them, and so by straightening to bring them parallel to the body. In a case of this description in the Mare, Obich ( Wochejischrift fiir Thierheil- kunde und Viehzuchi) succeeded in extracting the foal by cording the hind-feet (which were under the body), and pulling at them as well as the head and fore-feet. Donnarieix recommends pulling the posterior limbs forward beneath the body, the contents of the abdomen and chest having been previously removed to facilitate the operation ; then cording the hind-pasterns, to draw fir^t one, then the other, towards the vulva. He admits, however, that this is difficult, and one of his cases treated in this way occupied him for four hours ; he was even compelled to excise one of the limbs at the hock before he could straighten it. The Mare, however, lived. Canu {Op. cit.), in 1837, gives another method in which embryotomy may be carried out. The illustrative case was that of a Mare, the foal — which was dead — being born as far as the half of the chest. As it was not possible to push it back, the body of the young creature was divided as near the hind-quarters as possible, by making an incision from the sternum to the spine, behind the last rib on each side ; then the ab-- domen was emptied of its contents, and the spine cut through between the last dorsal and first lumbar vertebra, the amputation being facilitated by an assistant holding the lips of the vulva as far apart as possible. The Mare, which was very exhausted, did not offer much opposition when the croup was pushed into the uterus, and the hind-limbs being corded, version was very easy, and the operation soon finished. The Mare was at work within twenty days afterwards. Canu's method of extraction has often been practised, both in the Mare and Cow, by subsequent veterinary surgeons ; and it has been proved to be both rational and successful — so far as the mother is concerned. In practising it, the following directions have been given by Saint-Cyr, and their observance is important : I. Find the hind-limbs and secure them by cords around the pasterns; 2. Cord the head and fore-limbs, and pull these out as far as possible be- yond the vulva ; 3. Remove the abdominal viscera, and divide the spine as near the lumbar region as possible, taking the precaution to leave a good piece of skin attached to the loins, so as to cover the exposed bones and prevent the maternal organs being injured during the subse- quent steps in extraction ; 4. Obtain a solid bearing on the divided spine, either with the hand or the repeller, and push steadily and firmly against it, so as to direct it into the uterus, when the cords on the hind- pasterns being pulled by assistants, guided by the hand of the operator DYSrOKIA DEPENDING ON ANTERIOR PRESENTATION. 471 the remains of the foetus can be removed. This part of the operation is tlie most difficult and fatiguing for the obstetrist, as well as the most dangerous for the mother, and requires both strength and dexterity to push back the loins and pelvis of the foetus while advancing the hind- limbs, thighs, and croup towards the outlet ; 5. Nothing now has to be done but to exercise moderate traction, and terminate, in the lumbo- pubic position of the posterior presentation, a birth commenced in the vertebro-sacral position of the anterior presentation. Dietrich recommends eventeration of the fcetus, removal of one of the huid limbs, and the adjustment of the hinder parts through the abdom- inal opening ; if this cannot be effected, then these parts are to be drawn into the vacant cavity of the abdomen. When only one hind leg is in the pelvis, retropulsion of the body may be tried, the fore legs and head being corded, and the misplaced hind limb finally extended backwards in the uterus. If this cannot be accom- plished, the hind leg must be drawn forward and amputated at the hock or beyond, and the thigh then carefully pushed towards the uterus. Removal of the abdominal viscera favors these manoeuvres. 1. Cartwright describes the case of a Cow which showed signs of calving, and soon after the fore feet appeared, and subsequently the head. A variety of assistance had been called in previous to his arrival, but the calf could not be advanced farther than the loins. He found the Cow in a very exhausted state, with one-half of the foetus hangnig out. On examination it was discovered that the hind legs were in the pelvis ; '* thus preventing us, with all the strength we could muster, drawing the foetus away ; as the hind parts, together with the metatarsal and tibial bones, were doubled up, and thus completely blocked tlie passage. Of course, in trying to pull it away in this posi- tion, the femoral bones would be thrown up before the hind parts could pass." Cords were attached to the hind legs, the thoracic and abdominal viscera removed, as well as the protruding portion of the body, and the loins were then forced back, while assistants pulled at the hind legs and extracted the remainder of the body without any further dithculty. The Cow received stimulants, but died in a short time. The uterus was found to be ruptured at the cervix. 2. In the Edinburgh Veterinary Review, mention is made of a case in which only one hind leg m the pelvis proved an insurmountable obstacle to birth. The abdominal or- gans were removed, the leg in the pelvis drawn forward, and traction at the same time exercised on the hind and fore limbs. The foetus was in this way removed. 3. Gierer [Magazin von Giirlt unci Hertwig, 1865, p. 78) describes the case of a Mare, which six men attempted to deliver by dragging at the foal. Gierer found the latter hangmg dead from the vagina. Removing the viscera from the chest and abdomen, the hind feet were reached through the cavity of the body ; the abdominal muscles and skin were cut through, but the hind legs could only then be imperfectly pushed back- wards. With the help of five men pulling, however, the foal was extracted. There ensued much swelhng of the vulva, but the Mare eventually did well. 4. Marty (Journal des Veterinaires du Midi, vol. xiv., p. 400) attended a case in which the front part of the foal was born, but the hinder extremities were firmly retained, the hind feet beneath the body. Dividing the trunk, cording the hind pasterns, and push- ing the loins into the uterus while the cords were steadily pulled at, the Mare was de- livered and did well some time afterwards. 5 Walther (6'aV/^i-m Jahresbericht, 1861, p. 123) had a Cow in which all the feet of the calf presented. The fore limbs were corded, the hind ones secured and drawn to- wards the vulva. Suddenly the progress of the calf towards the outlet of the pelvis was checked, and on examination it was discovered that one of the hind feet had passed be- tween the fore ones. This state of affairs changed, however, and the foetus, in altering its position slightly, had both hind feet jammed against the pelvis, and the body pro- truded as far as the shoulder. Embryotomy was decided upon, and the viscera were removed from the fcetus, as well as the front part of the body ; the hind feet were corded, and traction soon removed them and the croup. 6. In the Repertoriumfiir Thier.heilkuttde (1875, P- -57) '■'' ^" account of a Mare which had been in labor for eighteen hours. The foetus was dead , both the fore feet were in advance and visible, one hind foot was fixed against the side of the mother's pelvis, while the other pressed against the inlet, the head being turned back to the left side. 472 FCETAL DYSrOKIA. The fore feet were corded, the hind ones attempted to be pushed back and the head brought straight ; but without success. Version was tried, but failed, and embryotomy had to be adopted. The Mare, however, died in an hour after the operation. The rec- tal mesentery was discovered to be ruptured, there was blood in the abdominal cavity, and two small lacerations towards the neck of the uterus. In a second case the head also complicated the deviation ; embryotomy w as resorted to, and the mother- survived. 7. Dus [Recneil de Med- Veterinaire, 1876, p. 11 50) points out that in those cases in which there is deviation of one or both of the hind feet in the pelvis and the head 'is turned towards the side, it is better, with the Mare, to attempt extraction by making the presentation a posterior one ; for though it may be possible to readjust the head and neck of a calf and afterwards extract it, yet with the foal there are great difficulties, and particularly in those cases in which the violent contractions of the uterus are op- posed to the introduction of the arm of the operator. He gives two instances, almost identical in their circumstances, in which he was able to deliver foals without very great difficulty, and also indicates how rupture of the uterus from amputated limbs may be prevented. His first case was a six-year-old Mare in labor only three hours. It was lying on its sternum, and making violent expulsive efforts from time to time. Getting it up and securing it, Dus found that the foal was in the anterior presentation, vertebro- sacral position, the fore limbs well placed and projecting beyond the vulva as far as the' knees ; the neck, however, was bent to the left and the head inaccessible to the hand ; one of the hind limbs had cleared the neck of the uterus, but lay alongside the left shoulder, and jammed against the right side of the vagina, the hoof being directed up- wards, backwards, and to the right. The uterine contractions were so powerful that the organ was closely moulded on the foetus, and it was impossible to introduce the arm beyond a certain limit. It was therefore determined not to attempt adjusting the head and neck ; though at first it was the intention to extract the foal by vigorous traction on the fore limbs by a large number of assistants, and to do this the' hind leg in the pelvis must at least have been pushed back. The latter operation, however, could not be ac- complished, as the limb was so rigid that, like a spring, it resumed its position as soon almost as it was displaced. It was then deemed advisable to resort to version, and to attempt delivery by the breech. After amputating the fore legs at the knee, and having pushed them into the uterus. — where they lodged in the right flank, not far from the pelvis, the end of the radius upwards, — they were kept in place by an improvised re- peller (a short blunt stable-fork), which pressed strongly against the nearest fore arm close to the shoulder, to the right and a little downwards ; several men at the same time pulled at the cords fixed on the pastern of the engaged hind leg. As the traction brought this limb outward, it turned first sideways, the hock to the left, then upwards, as in a normal presentation. The efforts ceasing, an examination was now made ; when it was found that the fore limbs were still towards the right flank, the stumps directed upwards, though the croup was much nearer the pelvis, so that it was easy now to trace the course of the hind limb which had been pulled be3^ond the vulva as far as the hock ; this was the right limb ; the left could be reached by the hand, and was nearly vertical, semiflexed, inclined to the right, the foot resting on the belly, towards the mammae. After several very arduous attempts, it was possible to seize this limb by the hock, and, pushing it forwards and to the left, to pass the hand to the shank •, but it was only after most fatiguing efforts that the foot could be reached. This was pulled into the vagina, and a cord being passed round the pastern, the limb was drawn alongside its fellow. The croup now being in the pelvis, nothing more remained to be done but to pull steadily on the two hind limbs, and birth was very easily effected. No sooner, however, had the foal been extracted than the Mare became dull and indifferent to every thing around it ; it would neither eat nor drink , the expression was anxious and the flanks greatly agitated. These .symptoms indicated an internal injury, and in a few hours the animal .succumbed after considerable haemorrhage from the uteru.s. There was a rupture of the organ, and Dus shows that this fatal injury was caused by the stump of the fore limb against which the repeller was pressed, and that it might have been averted had he amputated these limbs nearer the trunk, or if he had torn them off altogether after skinning the fore arm and dividing the pectoral muscles. In the following example, he testifies that when the hind limbs preserve their flexi- bility, it is not necessary to have recourse to this complicated operation to extract the foetus, without danger to the mother. He was called to see a Mare which had been for some hours attempting to foal. Three of the foal's feet were visible externally, but no head : two fore limbs protruded as far as the knees, and the hoof of a hind foot could be distinguished — the plantar surface being upwards — the other hind limb was found at the bottom of the vagina. D YSTOKIA DEPENDING ON ANTERIOR PRESENTA PI ON 473 The presentation of the foetus was anterior, the position vertebro-sacral ; the neck was bent on the body, the head beyond reach. The uterine contractions were extremely energetic. After amputating the fore limbs at the knees, they were put back into the uterus, where they were kept by Dus's hand ; while two assistants pulled at the most advanced hind limb by means of cords, and brought it out as far as the hock. Then the other hind limb was sought for and found at the inlet ; it was carried into the vagina, then externally by a cord round the pastern, while Dus prevented the fore limbs from passing through the os. This manoevre was completely successful in bring- ing the hind quarters into the pelvis, the croup upwards. Vigorous and well-directed traction on the two hind limbs, during the throes of the Mare, resulted in the birth of the foal without any further difficulty. In a few minutes after, the Mare was feeding heartily, and apparently none the worse for the operation. Dus notes that though labor had only been going on for scarcely three hours \r\ both cases, the foals were dead when he arrived. 8. Sparrow ( Veterinarian, vol. xvi., p. 130) saw a Mare which had been in labor for some hours, and had been subjected to rude treatment by amateurs The creature was in great agony, and the genital organs were so much swollen that much difficulty was experienced in making an examination. The labor-pains had ceased ; the fore legs of the foetus presented, one of the hind legs being between them, and this at first led to the supposition that there were twins. The young animal was on its back, and the head could not be reached. It was attempted to force the fore legs back and draw out the hind one, but this did not succeed. As the Mare was sinking from exhaustion, stim- ulants were administered, but death soon ensued. On post-mortevi examination, the head of the foetus was found lying under and across the withers, and was greatly dis- torted from pressure. 9. Younghusband [Ibid., vol. xxi., p 270) attended a Cow in labor, the head and neck of the foetus protruding to their full extent, and extremely tumiried, the creature being dead. Exploration was impossible, so it was decided to perform embryotomy. A circular incision was made round the neck,' close behind the ears, and the skin dissected as far back as possible ; then the vertebra; were divided, and the head and neck removed. The loose portion of skin being placed over the divided vertebra, this was pushed into the uterus, and the fore feet and legs were placed in a proper position. A crotchet being fixed into the upper and back part of the neck, the fore legs were corded, and the whole confided to an assistant. Owing, however, to the emphysematous condition of the calf, delivery was still impossible. A fore leg and shoulder were now speedily removed, but yet extraction could not be effected, from the immense size of the thorax and abdomen. The anterior ribs were excised and the contents of these cavities removed ; but as soon as the haunches of the calf reached the inlet, no further progress could be made, notwithstanding the most strenuous efforts. The lumbar-vertebras were divided, and the adjoining muscles separated, when there was more room for manipula- tion. The obstacle to extraction was found to be the hind feet and legs, "which had become impacted forward, and were pressing against the lower parts of the pelvis, in a manner resembling that of a dog sitting upon its haunches." By pushing the parts in jitero back, the hind feet were easily got hold of, and thus, as in a breech presentation, with the belly turned upwards, the calf was delivered. The Cow quickly recovered. CHAPTER II. Dystokia depending on the Posterior Presentation. When treating of the mechanism of parturition (p. 227), it was remarked that of the four positions in which we have a breech or posterior presen- tation, only one is compatible with spontaneous and natural delivery — the lumbosacral ; but that this is only possible when the hind limbs are fully extended backwards, and are the first to enter the genital canal, so as to gradually dilate the channel for the passage of the voluminous and rounded croup. Birth in this position, and without assistance, is more frequent in the bovine than the equine species, and the young creature is nearly always alive. V/ith the Mare, parturition is always longer and more laborious, and the foal quickly perishes after rupture of the mem- 474 FCETAL DYSTOKIA. branes. It therefore results, that even when the latter is in the lumbo- sacral position, posterior presentation, and every thing is favorable, yet delivery should hastened if it is desired to preserve the life of the young creature. The other three posterior positions — lumbo-pubic and right and left lumbo-ilial — are unnatural, and demand the intervention of the obstetrist. Besides, these positions, as well as the lumbo-sacral, may be compli- cated by a vicious direction of the limbs, which may lead to as great, if less varied difficulties, as those encountered in the anterior presentation. The varieties of dystokia met with in the posterior presentation depend : I. On the difficulties depending on the lumbo-pubic and lumbo-ilial posi- tions ; 2. Those due to a vicious direction of the hind limbs ; 3. Those arising from the head and fore legs. Some writers have alluded to dystokia from a wrong direction of the tail ; but this must be very rare indeed. Fig. 132. Lumbo-sacral Position. SECTION I. -DYSTOKIA RESULTING FROM THE LUMBO-PUBIC AND LUMBO- ILIAL POSITIONS. LuMBo-PUBic Position. In this, the posterior reversed position, the foetus is lying on its back, its croup and loins corresponding to the floor of the abdomen or the pubis of the mother, with the fe^ and belly towards the sacrum. As a consequence of this reversed position, the hind-limbs, which soonest enter the pelvis, are inclined upwards and backwards into the genital canal, and they are therefore the parts that first meet the hand in exploration. Saint-Cyr points out what might be a cause of error in this exploration, in the following terms : " As the anterior face of the hoof or claws is directed upwards and the plantar surface (sole) downwards, the explorer might be inclined to think that it was an anterior vertebro- DYSTOKIA DEPENDING ON POSTERIOR PRESENTATION. 475 sacral presentation ; but in pushing the exploration further, and follow- ing the cannon bone with the hand, the hock is met with — recognizable by lis fatness on each side, t\\Q pomt of the hock downwards, the /5^ \\\q Germans) is passed to the middle of the cord, and may then be introduced into the uterus, where, from its curvature and its shortness, it can be pushed behind or \ MECHANICAL EXTRACTION OF THE FCETUS. 505 between the limbs, in the double of a bent neck, etc. The hand seeks the one half of the cord on the opposite side of the part, and pulls it into the vagina ; the instrument is then withdrawn, and the part is ready to be pulled at by the cord left encircling it. Tyvaert (Annales de Med. Veterinaire, June, 1876, p. 320) has for a long time made profitable use of a simple porte-cord. This is composed of a somewhat short piece of iron wire, about the thickness of a goose-quill, and bent a little round, the length and curve varying with the part to be secured. One end is turned to form a small ring, while the other is bent to make a hook, a little longer than wide. A cord being attached to the ring end, the wire is passed round the part it is sought to seize ; the hook end remains free, and afterwards receives the traction cord, serving to form a running noose on the part. This porte-cord is very simple, and may be made on the spot when required ; it has proved most useful for securing the neck or hocks. Giinther {Handbuch der praktischen Veterindr Geburtshiilfe) has pro- posed a complicated porte-cord, not unlike a long " ball-gun," and pro- vided at the end with two jaws, which hold the cord, and release it when necessary by means of a spring at the handle. An ordinary walking-stick may, on an emergency, and by a little inge- nuity, be readily made to serve as a useful porte-cord — the bent handle of the stick being utilized as the curve. The straight porte-cord, when required to be used, has the cord passed through the eyelet at the end, the noose remaining beyond the end, and of sufficient size to pass over the foot, or around the neck of the lower jaw, as in Figure 144. One hand is introduced into the noose in either of the ways already indicated, while the other hand seizes the handle of the instrument, which is then introduced into the genital canal — the hand with the noose preceding it. When the foot or jaw is reached, the noose is slipped over it, and tightened by pushing on the handle of the porte- cord, Cartwright has employed his straight porte-cord (Fig. 147) to carry the cord over the head of the foetus and on to the neck. If the iron of the straight instrument is soft, it may readily be con- verted into a bent porte-cord (Fig. 149), and in this altered form render good service in the case of flexed limbs or bent neck, and in some mal- positions of the posterior presentation. The instrument is introduced in the same manner as the other form, but with only the loop — no noose — at the end of the cord ; the curved portion is pushed around the part to be secured, and the hand, leaving it, is passed to the opposite side of the part, where it searches for the loop or ring, which, when found, is drawn into the genital canal. The instrument is then withdrawn, the cord re- maining around the part ; the free end of the cord is passed through the loop or ring, and being pulled at, the limb, neck, body, or whatever it may be, is secured in the noose so formed, and traction can in this way be directly exerted upon it. Head-cord, or Head-collar. In addition to the limbs and other parts, we have stated that the trac- tion-cord can often be advantageously applied to the lower jaw. Indeed, in the anterior presentation, even when the fore-limbs are "corded," and the head is in a favorable position, it will generally be found very useful to apply traction to the head in addition, as not unfrequently pulling at the fore-limbs alone only fixes them more firmly in the passage. 5o6 OBSTETRIC OPERATIONS. We have also mentioned that the interdental space, or " neck " of the lower jaw, is the most convenient for the attachment of the cord ; but nevertheless it will be found in practice that this does not afford nearly so firm a hold as the limbs, and that if the noose does not slip off the jaw, which is often the case, should the traction be at all energetic, the bones will probably be smashed, the foetus, if alive, irreparably damaged, and an important accessory means to extraction lost. Should the head be turned back towards the side, cording the neck does not reduce the deviation, but only allows this to be brought, in a doubled condition, into the genital canal. It is therefore most important that means be at hand to secure the head firmly and solidly, either with a view to correct deviation when this part is in malposition, or to exercise traction upon it when it is adjusted, but the foetus remains immovable by pulling at the fore-limbs. Fig. isi. BiNz's Simple Head-collar. Rueff's Head-collar. No. I. Rueff's Head-collar. No. 2. We have suggested that the noose of the cord, sufficiently widened, instead of being placed on the lower jaw, should be first passed into the mouth of the foetus, then carried up over the head and behind the ears — the loop of the noose remaining, of course, tightly drawn in the mouth, as this must be the direction from w^hich the traction is exercised ; if pulled at from behind the ears, the noose would be drawn off. In plac- ing the noose in this position, the straight porte-cord — and especially Mr. Cartwright's pattern — will be found very useful. Instead of this simple noose, which can readily be made when needed, various kinds of head-stall have been proposed by veterinary obstetrists from time to time, and some of these possess certain advantages. Giin- ther, many years ago, pointed out the advantages of a head-band like that represented in Fig. 145, the upper part of which was passed behind the ears, while the lower part with the running knot lay between the MECHANICAL EXTRACTION OF THE FCETUS. 507 branches of the lower jaw. Binz soon after proposed a kind of head- collar, or halter, which could be adapted to different-sized heads (Fig. 151) : it has a long cord attached, which can be used by assistants to pull at. This halter is held between the thumb and index-finger by its upper part, and passed into the uterus, where it is put over the occiput of the young creature's head, and the sides applied to the cheeks ; the lower portion,"* which was open, is now closed by running the end of the cord through the loop, by which the head is firmly secured, as in the figure (151). Rueff has described two similar halters (Figs. 152, 153) which, having a long cord on each side of the head, must, of course, exercise more direct traction — sometimes an important consideration. Binz's halter is made by a cord which has at one end an eyelet or loop, and at a certain distance a loop-knot. When the other end of the cord is passed into the first eyelet, it forms a long semicircle, and when passed through the second, a circle which may be enlarged or decreased at will in pulling at this end. Rueff makes his halter in a similar manner, but instead of having the loop at the very end, it is placed some distance from it ; this of course gives a halter with two lead or traction ropes. I Fig- 154- Binz's Forceps-band. Binz has devised a special head-apparatus (Fig, 154), to which he has given the name of " Forceps-band " {Zangenbtmd). This is a band of flax, silk, or some other woven material, which is at its widest part about four inches broad, and in length it is about six or seven feet. At one end is a moderately large opening, while the other is divided into two portions to within some distance of the loop ; these last pass through a round, movable, cork-shaped piece of wood, metal, or leather. The head of the foetus is passed between the divided ends of this band, which are then tightened behind the jaw by running the keeper close up to the chin, the undivided portion being brought over the forehe,ad towards the nose. In this way powerful and direct traction can be made on the head, above and below, by means of the upper part with the hole at the end, and the two portions beneath. It has been found particularly useful in cases of hydrocephalus. Schaack, in 1848, introduced another kind of head apparatus, which he designated a " sliding head-stall " {tetiere a coulanl), but which is perhaps better known in France as a " forceps hTihev'' (licol-forceps),hY reason of its shape and use. It is composed of two doubled cords, one of which (Fig. 155, I, i) forms the head-stall^ while the other (3, 3) makes the nose- band. The two are united by a metallic runner (5), which allows the apparatus to be increased or diminished in size at will. The runner^ which forms the key of the apparatus, is a piece of brass or pewter a little more than an inch in length, about an inch in breadth, and half an inch in thickness. It is perforated by three holes, two of which are parallel and pass through the wider part of the metal, while the third, placed be- 5o8 OBSTETRIC OPERATIONS. tween them, runs through its narrower surface. The two ends of the head-stall loop go through the parallel holes, the cord composing this being nine or ten feet long and one-third of an inch thick, the loop itself being intended to lie behind the ears of the foetus. One side of the loop is fixed in the runner, by rings of waxed pack-thread above and below the hole ; this waxed thread being also run up on the loop, to give it a certain degree of rigidity. The other half of the cord is freely movable in its hole in the runner, and a knot tied near its end allows it to be dis- tinguished from the fixed half. Tho-nose-bafid (3, 3) is made of two strong but soft strips of leather sewn one within the other, and doubled in the middle to constitute a loop eight to ten inches long : the two portions being made into a single cord (4) between three and four feet long, and Fig. 155. Fig. 156, Schaack's Forceps-Halter. Manner of Placing 1, I. Head-stall ; 2, 2. Two Cords, its continuation ; Schaack's Halter. 3, 3. Nose-band ; 4. Single Cord forming a con- tinuation of the Loop constituting the Nose-band ; 5. Metal Runner, uniting the several parts of the Halter. which passes through the single hole across the runner. The middle part of the nose-loop has a kind of shield or button of thin leather, to prevent the loop slipping through the hole. This was the apparatus first devised by Schaack, but recently he has somewhat modified and simplified it, by dispensing with the nose-band altogether, as he found that the nose of the foetus could be better guided and held by the hand. Experience has proved that this simplification allows the halter to be more easily applied. The manner in which the original halter was employed is described as follows : — The head of the foetus being in front of the inlet and readily accessible to the hand, the nose-loop is pulled through the runner until stopped by the leather button ; while the head stall loop is made suffi- ciently wide. The middle of the latter is placed at the end of the middle- fingers, the movable part of the cord being between the middle and in- MECHANICAL EXTRACTION OF THE FCETUS. 509 dex-finger, the fixed side between the ring and little finger (Fig. 156). The apparatus is at first held by the index and middle-fingers against the other fingers, as well as by the thumb, which keeps both cords in the palm of the hand ; and, finally, by the left hand, which, drawing lightly on the three cords, keeps them sufficiently tight. The runner should be at the wrist, the button of the nose-loop towards the hand. The apparatus being so disposed, the hand is introduced sideways (little finger downwards) into the vagina, until it arrives at the head of the fcetus j then the nose of the latter is passed into the head-stall loop, which is pushed forward by one side of the face — say the right — towards the neck and over the ear ; the other half being now carried on the opposite side towards the left ear, and then the runner is seized below the jaw. In this way the hand has passed round the length of the head-stall from its fixed to its movable part — the latter readily allowing the loop to en- large and pass over the salient portions of the head, the loop being nev- ertheless kept sufficiently tense by the right hand pushing the runner up Fig. 157- Schaack's Halter Placed on a Calf's Head, the Right Fore-pastern being also Corded. towards the throat ; while the left hand, pulling at the movable cord (rec- ognized by the knot at its end — tightens it as much as may be necessary. The nose-loop is placed by introducing the index-finger of the right hand under the button, and drawing the loop through the runner to a sufficient length, the left hand keeping the other two cords tight ; the end of the nose is passed into the loop, which is lifted as high as need be. This done, the right hand is withdrawn from the uterus and vagina, along, while keeping tight, the three cords. These are tied together in a knot outside the vulva, and the head is thus securely and solidly fixed. Saint-Cyr and others highly recommend this apparatus of Schaack's, which in its modified form differs but little from that described by Binz some years previously. Saint-Cyr remarks that its extreme simplicity, its trifling cost, the facility with which it can be placed after a little prac- tice, its solidity, \vhich enables it to withstand any amount of traction, and its absolute innocuousness — all combine to render it one of the best and most precious instruments required in veterinary obstetricy. In the first place, when it is properly applied, it cannot slip, and all the amount of force necessary under the circumstances may be employed without fear; next, being formed of small and flexible cords, which are well oiled before use, it cannot injure the maternal organs in any way ; thirdly, 1 5IO OBSTETRIC OPERATIONS. from the manner in which it acts on the neck, the lower jaw, and the face, and the impossibility of its becoming tighter when once it is fixed, it is absolutely inoffensive, so far as the foetus is concerned ; and, finally, owing to the nose-loop, it always keeps the head in a good direction, pre- vents it from deviating, and compels it to follow the course most favor- able for its extraction : in the words of Schaack himself, " Without exag- geration, the forceps of the accoucheurs could not answer better for the human foetus." As an agent of prehension and traction — but particu- larly the latter, Saint-Cyr asserts that he does not know of any thing superior to this apparatus. Schaack's halter is more especially applicable to the bovine foetus, the head of which is so much larger and squarer than that of solipeds, and sometimes requires such energetic pulling at to remove from the pelvis. Crotchets or Hooks. Obstetrical crotchets or hooks are iron or steel instruments of variable dimensions, more or less curved at one end — which is blunt, sharp, or Fig. 158. Fig. 159. Short Blunt Crotchet. Blunt Finger Crotchet. pointed ; the other end having a ring or eyelet if short, a handle if long. The latter are from thirty to thirty-six inches in length (including the handle), and act directly on the foetus without any other appliance inter- vening ; while the short hooks have cords attached to them, or they may fit on the finger of the operator by means of a ring. Some sharp crotchets are jointed at the end curve, so as to permit them to be more readily and safely introduced into the genital passage by bringing the sharp point near the stalk, the curve being restored by a spring when the foetus is reached. But the advantages' of the joint hooks are very few, while their strength is impaired and their expense increased. In using the long or short pointed crotchets, risk of injury to the maternal organs may be obviated, if the hand is not found sufficient to guard the instrument dur- ing its intromission, by fixing the point in a piece of cork or soft wood, to which a long piece of twine is attached ; when the crotchet is required to be implanted in the foetus, this shield may be removed from the point, and withdrawn from the genital organs by pulling at the end of the twine outside the vulva. Blunt and sharp crotchets are much employed in veterinary obstetrics, and are very valuable. The blunt crotchets are more particularly resorted to when the foetus is alive, and it is hoped to extract it before it is dead ; they are most serviceable in correcting deviations of the head or limbs, and the long crotchet is especially useful in finding and straightening the latter. The curve should be about four inches wide. The finger crotchet may be usefully employed when the hand is fatigued or paralyzed by the uterine contractions. Blunt crotchets of a much smaller size than those required for the larger animals can be most successfully employed in delivering the Sow, Sheep, Goat, Bitch, or Cat. MECHANICAL EXTRACTION OF THE FOETUS. 5" Gunther's long porte-cord (Fig. 149) can be most effectively used as a blunt crotchet at the same time as a carrier of the cord, A German long blunt crotchet has a concealed sharp blade in the concavity of the curve ; by means of a spring in the handle, this blade can be projected, and the instrument wiil then do good work in embryotomy. With the sharp crotchet, the curve should certainly not be very wide ; the smaller it is, the more readily it can be passed into the genital pas- sage, and the less chance of injurv is there to the mother or operator ; it should not be greater than the hand can cover. At the same time, if the curve is too small, the crotchet does not obtain sufficient hold of the foe- tus, is readily torn out, and for this reason may be most dangerous. The point should be so bent as to penetrate readily into the part in which it is determined to fix it, and the angle of the curvature should be such that the more the crotchet is pulled at, the deeper and more firmly the point will enter. Fig. 160. Fig. 161. Short Sharp Crotchet, Short Sharp Crotchet, WITH Broad or Flanged Point. with Round Point. So it is that the point should not be turned round in a semicircular manner, but rather at an acute angle, as in Figs. 164, 165. There is rather a diversity of opinion with regard to the preference to be accorded to the crotchets ; some practitioners preferring the short ones, as they can be readily carried into the uterus guarded by the hand and moved about there, so as to be implanted in the most convenient part of the foetus ; while the cords attached to them allow traction to be made in the most favorable direction. Other obstetrists prefer the long rigid crotchet, which they affirm is more easily placed — one hand guiding the point though the passage, the other hand acting on the handle. These preferences depend very much upon whether the operator is more practised in the use of one or other of the crotchets, and also, doubt- less, upon circumstances peculiar to each case requiring the employment of such instruments. Both long and short crotchets are most useful, and the obstetrist should have several of each, and of various forms and dimen- sions, so as to be able to select that which is best adapted to meet the requirements of particular cases. It must be observed also, that many practitioners are not in favor of crotchets, and decry their use. But we are of opinion that there is some- thing unreasonable in this, and the experience of almost every day goes to prove that these instruments afford a simple and ready means of get- ting hold of the foetus in regions of its body which the hand cannot pos- sibly reach, or if it could, where it could do very little service either from the shape of the part, its slipperiness, or from the paralyzing effect of the uterine contractions on the hand and arm of the operator. They can also be profitably employed in cases in which cords and halters are use- less ; for not only will they serve in allowing traction to be made on parts which actually present at the inlet, but they can also be utilized in effect 512 OBSTETRIC OPERA TIONS. ing those mutations which are necessary in order to bring particular parts of the young creature in front of the pelvic opening, or though the genital canal, and which the hand could not seize or move. It is no doubt true that the sharp or pointed crotchets have certain dis- advantages which must not be lost sight of, and which impel us to give the preference to the cords or halter when they can be employed. In the first place, their introduction into the uterus is not such an easy matter as it might appear without trial or consideration ; for the contractions of iP^ Fig. 162. Fig. 163. Fig. 164. Fig. 165 Long Blunt Long Pointed Long Pointed Crotchets, Crotchet. Crotchet. Darreau's Pattern. this organ may paralyze the hand which carries the instrument, and causes the latter to escape, or its point to wound either the mother or the operator. Their employment often produces serious lesions in the body of the foetus, which are certainly of no importance when this is dead, but may be of much consequence should it be alive. Then, again, the tissues into which they are implanted are not very firm or resisting, so that only a moderate degree of traction can be expected from them, and which is often insufficient to overcome the resistance that prevents the birth of the foetus. In such a case, if, through forgetfulness or maladroitness, the tissues suddenly give way and the crotchet slips into the maternal organs. MECHANICAL EXTRACTION OF THE FCETUS. 513 serious, if not fatal injuries may be inflicted ; or the hand or arm of the operator may be the part torn by it. These are undoubtedly disadvantages of a weighty kind ; nevertheless, the veterinary obstetrist has always to contend with disadvantages in cases of dystokia, and must overcome them by prudence, patience, and skill. When using the crotchets the same qualities must be brought to bear. His hand must diligently guide them, and note their effects and* movements ; while, at the same time, he must vigilantly exercise his judgment in directing his assistants as to the amount and direction of the force they are to use, so as to proportion it according to the resist- ance of the tissues in which the crotchet is fixed, and to desist from traction as soon as there is a likelihood of the instrument breaking away or slipping. With the evidence before us as to the numerous and in- contestable advantages offered by these appliances, and the knowledge that their disadvantages can be overcome by intelligent watchfulness, we have every reason to recommend their adoption in those cases which call for their employment. '* In all cases where the head of the foetus is back," Cartwright writes to us, " I am very partial to using the long sharp-pointed hook in the orbit ; even if the head is at the extreme distance, with care we can insert it in the otbit and get the head in the passage. Of course, it requires great care in watching that the hook does not break loose and do mis- chief. I have found that we may pull by the hook in the orbit with great force, without tearing the skin of the calf, provided the latter is not in a decomposed state. From my experience, I can speak highly of the hooks ; indeed, you cannot get the head up without them sometimes." And in embryotomy the crotchets may be most usefully resorted to for many purposes. We will now briefly refer to the parts of the foetus upon which the crotchets can be most effectively employed, and the manner of employ- ing them. Parts into which the Crotchets may be Implanted — The parts into which the crotchets may be implanted are numerous, but those which are selected by the obstetrist will not only depend upon the na- ture of the malpresentation or malposition, but also upon the simplest indications for the adjustment of these. When the desirable part has been reached, the point of the crotchet is inserted in such a way that the instrument is directed towards the source of traction — the assistant. When blunt crotchets are employed, except in cavities, it will be neces- sary to make an incision through the skin before they can be inserted. Cartwright states that sometimes the sharp crotchets cannot be used without making these preliminary incisions ; but then the instruments must be rather blunt. The best parts for implantation are (i) the mus- cular tissues, (2) the head, (3) the spine, and (4) ihe pelvis. I. The Muscular Tissues. — These tissues are not advantageous for the employment of the crotchets, for although they are easily inserted, they are as easily torn out. Nevertheless, these instruments, when fixed in certain muscular regions, such as the croup, thighs, loins, and neck — more especially the latter, may render useful service in rectifying devia- tions, as the skin offers a good amount of resistance. But, from the fragile and yielding nature of the textures, it must be borne in mind that the hand of the obstetrist should never leave the crotchet while traction 2>Z 514 OBSTETRIC OPERATIONS. is made on it, and that its position in them must be most attentively noted, in order to guard against accidents arising from its tearing away. 2. The Head. — The head offers many good points for implanting the crotchets — such as the symphysis of the lower jaw, the palate, and the orbit, as well as the ear and angle of the inferior maxilla, on particular occasions. • It must be observed, however, that all these points are not of equal value. The maxillary symphysis is convenient, but not very firm ; mod- erately strong traction will rupture it, and damage may then occur. Still, there are times and occasions when this part may be advantageously seized by the crotchet, which may be inserted in two ways : the point of the instrument may be passed from below the chin into the mouth, or from the cavity of the latter through the mucous membrane beneath the tongue, to below the chin. The first is generally preferable. When traction begins, the operator must be on the lookout for tearing away of the two branches of the jaw. The orbital cavity is the best part of all the head for a solid hold. Some authorities have expressed doubts as to the propriety of fixing a crotchet in the ocular cavity of a living foetus, from a belief that the eye- ball must be damaged, and Rainard goes so far as to advise that it should only be done when the creature is dead ; though he adds that, if there is no other means of remedying a deviation of the head in the living calf, it is well to attempt it, " as it is better to have a living, if blind calf, than a dead one with both its eyes intact." But it is rare indeed that the eyes are seriously damaged by fixing the crotchet in their socket ; and innumerable instances testify that, if the foetus is alive, the ocular globe is retracted to the bottom of the cavity when the instrument begins to be inserted, and so escapes injury. Schaack, who has freely resorted to this mode of adjusting the head or neck — in the sheep and goat more particularly (the smallness of the pel- vis not allowing any other means to be employed) — describes Ibis manner of operating as follows : " The crotchet I use," says he, " is a solid (or long) one ; the point is blunt and slightly flattened (Fig. i66). When it is desired to pull at the head of the foetal goat or lamb, the left hand at first seizes the nose, and the crotchet is fixed in the right orbit ; with the right hand the other instrument is passed into the left orbit, the thumb of the left hand keeping the hook in the other orbit by pressing the stalk against the cheek. In this way I can pull wi^h the two hands on both orbits, so as to keep the nose in a good direction." He has never seen the point of the crotchet cause the slightest injury to the globe of the eye, although he has had, in the majority of cases, to pull ivery hard. The means has answered very well. And Cart- wright informs us that " it is astonishing how wounds heal up in the cheek where hooks have been in the orbit. I have had two or three men pulling at the rod (of the crotchet), and the hook did not break out." This immunity from injury, in the case of the living foetus. Fig. 166. does not, however, absolve the operator from exercising all Schaack's due care in fixing and pulling at the crotchet. The inner Crotchet, ^gp^^^j- q£ ^j^g orbital cavitv is thc most favorable, and if the foetus is alive, the blunt instrument must be first tried, the sharp-pointed MECHANICAL EXTRACTION OF THE FCETUS. 515 one being kept in reserve until this has failed, or it may be used at first when the young creature is dead. The. pa/atifte arch affords a very solid and useful point of attachment for the crotchet, and many obstetrists have successfully utilized it in ex- tracting the foetus ; some authorities — among them is Schaack — assert- ing that hooking this part is easier, and the results more certain and direct, than fixing the instrument in the orbit. The stalk of the crotchet is somewhat long ; the hook end is passed sideways into the mouth of the foetus, and over the tongue until it gets be3^ond the palate, when it is turned point upwards, and seizes the base of the vomer. According to Schaack and others, a very strong degree of traction can be made on this part without inconvenience to the young creature. It appears to be an excellent situation to plant the crotchet in the calf — particularly if it is de^d, and it is desired to effect extraction as quickly as possible. It may be also employed in the foal, the only risk being more or less dis- union of the palate, which may render sucking difficult or imperfect for a short time after birth. Of course, the head must be in a good position either in the inlet or in the genital canal, before the crotchet can be placed behind the palate. The traction must also be moderate and steady, and the usual precau- tions observed. 3. T/ie SpiJie. — When embryotomy is practised, or the foetus is dead, the vertebrae, their transverse processes, or the ribs, afford excellent hold for hooks, though care must be observed in placing them securely, and guarding them when they are being pulled at. 4. The Pelvis. — In posterior presentations, when cords cannot be em- ployed to the hind limbs, the loins, or the croup, or when they have not sufficient power, then crotchets must be resorted to \ and with this view the foetal pelvis offers several very advantageous points. After removal of one or both hind-limbs, the cotyloid cavities, by their depth and the hard- ness of their walls, are admirably adapted for receiving the hooks and withstanding energetic pulling. If both limbs are amputated from the hip joints, then a hook may be placed in each cavity ; if ablation of only one limb has been effected, then one hook will be most useful, The pubic arch and the oval foramina of the pelvis are likewise well suited for crotchet traction in the posterior presentation, when the foetus is dead. In some cases the sharp-pointed crotchet may be passed directly through the rectum, and pushed forward so as to seize the ante- rior border of the pubis, the margin of one of the oval foramina, the base of the sacrum, or the shaft of the ilium ; care being taken that the point does not pass through the skin. Or the crotchet may be passed from without inwards — the safest method — after the pelvic bones have been denuded as much as possible of their soft tissues. This is, perhaps, the most prac- ticable method, if the hind-limbs have been already removed. But if they have not, then Saint-Cyr recommends that all the soft tissues of the foetus from the root of the tail to the ischial arch, should be largely incised, and the hand passed through the incision into the pelvds, which is emptied of its viscera. The crotchet is then pushed into it, and planted either on the brim of the pubis, or in the oval foramen. It is always safer to pass the hook from without inwards, whenever this is possible, as the point is then in the pelvic cavity of the foetus. Forceps. The introduction of forceps into human obstetricy marked a new era in 5 1 6 . OBSTE TRIG OPERA TIONS. the accoucheur s art, and has been productive of the greatest benefits in difficult cases of parturition in woman. But they have not yielded much service to the veterinary obstetrist, except with the smaller animals , not- withstanding that Hurtrel d'Arboval, at the commencement of this century, asserted of the forceps that there are circumstances in which great advan- tages might be derived from them, that their use is perhaps the best means of completing parturition when it cannot be terminated naturally, etc. Attempts have been made at various times to introduce them into general use for the larger domesticated animals, and various models — more or less modifications of the human patterns — have been proposed, but with very little, if any, success. The forceps used by the accoucheur of woman are, as is well known, composed of two branches or blades, which are nearly or quite alike, and form levers of the first order ; they are united at the middle by a fixed or sliding joint, and one end — the "bow," or widest part — which is intehded to grasp the foetus, is fenestrated, or perforated by a wide opening ; at the other end is the handle. The reason why the forceps has never come into general use in vet- erinary obstetric operations — except with the smaller animals, as already said — is not so much from a prejudice against novelties and innovations, as because they are really not adapted for this kind of practice, unless in a very modified form, to be presently noticed. Rainard ( Op. cit., vol ii., p. 98) remarks : " Medical men will be astonished that I have not men- tioned the forceps, from which they derive such great advantages. This instrument, which can seize a round head, like that of a child — when each blade fits exactly throughout its whole length — will have much less hold on that of animals, which is elongated, flattened at the sides, and otherwise but little yielding. When the forceps is applied to the foal or calf, it slips and is useless. Otherwise, the readiness with which cords can be attached to the head and limbs, renders these in every way preferable to this instrument. What the forceps cannot do, the cords can ; and they have the additional advantage that they scarcely occupy any space in the pelvic canal. Tlie pelvis of our animals is nearly rectilinear ; with the cords we pull in a straight line ; what more could the forceps do } The Fig. 167. Simple short Crotchet-Forceps. entire hand can be introduced freely into the pelvis, and moved about easily. This cannot be done in human accouchements." And Saint-Cyr justly asserts that there is no known forceps capable of affording such a solid purchase, and at the same time one so harmless, as a good cord fixed on the pastern, or Schaack's head-stall properly placed on the head. Though an instrument resembling the human forceps is not at all adapted for extracting the foetus in such animals as the Mare or Cow ; and though in the cords and head-stall an excellent substitute is found ; yet modified forceps, which might be designated — if not from their shape, MECHANICAL EXTRACTION OF THE FCETUS. 517 at least from their 3.c\.\on~^crott/iet-forceps^ have been long employed by veterinary obstetrists, and with much advantage in certain cases. The simplest of these consists merely of two short crotchets, the points oppo- site each other, and a cord passing through both eyelets (Fig. 167). The hooks can be inserted near, but opposite to, each other, on each side of the spine, pelvis, head, flanks, etc., the cord, when tightened, bringing them closer together, and so concentrating the traction. A longer crot- Fig. t68. LoMG Simple Crotchet-Forceps. chet-forceps, with a wider curve at the points, is not unfrequently used with success in breech presentations with the hind limbs retained ; the points are inserted towards each flank, penetrating as far as the shaft of the ilium. Fig. i6g. Gunther's Long Crotchet-Forceps. Fig, 170. Jointed Crotchst-Forceps. Gunther has spoken highly in favor of a long blunt crotchet-forceps to answer the same purpose, but which has what is considered an advantage — a series of notches on each side towards 'the traction-rope, on which runs a clip that binds them together, and prevents their flying outwards while the assistants are pulling (Fig. 169). The two crotchets A B, C D, are brought together at A C by the cord C, which passes through their eyelets ; d is the clip on the ratchet, e e ; //, the curve of the crotchets ; and gg, their blunt points. To render their hold more secure, these crotchet-forceps are some- 5i8 OBSTETRIC OPERATIONS. times jointed ; and in this form they are preferred by some practitioners. Fig. 170 represents a very useful model, the points being sharp, and one point lying in a slight notch on the opposite one, to render their introduc- tion into the uterus more safe, and also to prevent accidents, should the tissues in which the points are implanted give way. A cord passes through eyelets at the extremities of the blades, as in the other models ; but sometimes the eyelets are in opposite directions, and the ends of the branches in which they are pierced are bent towards each other ; this variation is supposed to be accompanied by certain advantages, as in Nelson's blunt and serrated forceps (Figs. 171, 172), some of the uses of which have already been noticed. Fig. 171. Nelson's Blunt Crotchet-Forceps. Fig. 172. Nelson's Serrated Crotchet-Forceps. Some of the models of crotchet-forceps have a spring introduced be- tween the branches, and behind the joint, as in Tallich's short instrument (Fig. 173), the jaws of which are bent to one side, and toothed ; it is intend- ed to secure a hold of the foetus, and make traction on parts to which neither cords nor crotchet can be applied : as the skin of the cheek, or the nose or ear, when the head is thrown back towards the flank, in the anterior presentation. Another instrument of this description has been devised bv a Belgian Fig. 173. Tallich's Short Bent Crotchet-Forceps. veterinary surgeon, Andre', which he designated as 2. pi?ice-forceps or accro- che-foetus. This is not unlike the instrument fixed in the nose of a bull in order to lead the animal. The points of the jaws are bevelled to fit into each other, the bevel being grooved. In one of the jaws is a small hole, into which is fixed a string that passes through the eyelet at the end of the opposite branch, and which is pulled at when it is desired to open the jaws. The two branches behind the joint are very short, and through the eyelet of each passes a strong cord, the two ends of which soon unite into a single piece (Fig. 174). When this is pulled at the jaws close, as in the other jointed examples, and they remain all the more firmly closed as the traction is great. In order to use the instrument, it is passed by the hand into the uterus ; the jaws are fixed on the part to be drawn at, by first pulling, outside the vulva, at the string which opens them, pushing the points against or over the part, then, when this is be- tween the points, drawing at the single cord which closes them. This is MECHANICAL EXTRACTION OF THE FCETUS. 519 acknowledged to be rather an instrument for holding or fixing a certain region, and not for exercising tractile force upon. Andre has often applied it successfully to the lower and upper jaw, or the ear, to bring the head into a good position ; to the te7ido-Achilles in order to raise a hind limb, which the hand alone could not do ; to the fore-limbs, etc. With regard to the smaller animals, such as the Bitch, Sow, Sheep, or Goat, in them we may often use the crotchet, the ordinary forceps, or a small-sized model of the human forceps, with advantage. Various pat- terns are in use, some of them fenestrated, others not ; some resemble polypus-forceps, while others again are grooved, serrated, or toothed, at the ends of the blades. An essential which should not be lost sight of in the forceps for such small animals as the Bitch or Cat, is that the blades should be sufficiently long to seize not only the head, but much, if not all of the body of the fcetus. If they are short in the blades, they cannot be made to grasp sufficient of the foetus to remove it ; while the joint being close to the vulva, or even within the vagina, is likely to pinch the mucous membrane and cause them other considerable pain. Hill, of Wolverhampton, who has had extensive experience in this direction, uses a small and slightly modified form of the human forceps for Bitches ; there is a spring between the branches of the handle (Fig. 175)- Fig. 174. Andre's Crotchet-Forceps. Weber has proposed a forceps for these small animals, and it has been preferred by some authorities to the ordinary model. It is a modification of one for a long time employed by Leblanc, which again was fashioned after an instrument designed by Hunter. This is composed of an iron stalk about ten inches in length, with a wooden handle at one end, and two blades or bows at the other. On this stalk glides a long enveloping metal tube, which, near the handle, has a wide ferule or shield, that allows it to be pushed along by the thumb of the hand holding the instrument, and thus to bring the blades together. A nut or female screw, running on a screwed portion of the stalk near the handle, is intended to assist the pressure of the thumb, when this is insufficient (Fig. 176). A finger of the other hand introduced into the vagina guides the instrument, and allows the part of the fcetus to be seized, to be reached by the operator, either v/ith the view of extracting the young creature or changing its position, according to the indications. Defays concludes that the forceps employed by veterinary surgeons in the accouchement of the smaller animals should not be merely a reduc- tion in size of those employed in human practice, but ought to be some- thing like that of Palfin. It is most difficult, he truly says, to apply an instrument in shape like that of the accoucheur's ordinary forceps, owing to the neck of the ftus in carnivoraoe being so thick, and the difference in 520 OBSTETRIC OPERA TIONS. volume between it and the head far less than in the human foetus. So that, when the forceps is used, the bow of the blades presses on the BiTCH Forceps. Fig. 176. Weber's Forceps. Fig. 177- Defays' Forceps. neck, slips under the throat, and the head escapes from them. To rem- MECHANICAL EXTRACTION OF THE FCETUS. 521 edy this imperfection, he has made forceps with the extremity of the blades notched or hollowed out (Fig. 177), while the end of one of the branches has a piece of metal with a slot in it attached by a hinge, and which is intended to hold the blades together when the foetus is seized. Though this forceps has sometimes proved of service, yet cases occur in which it is not so useful. When the Bitch is large, or of moderate size, forceps may be employed with advantage, though they must be of various dimensions. But when the animal is very small, as is usually the case in difficult parturition in this species, the space oc- cupied by the bows of the forceps — if they are ever so thin — so increases the volume of the mass which has to pass through the pelvic canal, that this instrument cannot be used. As we pointed out when studying the anatomy of this region, the pelvis is cylindrical in carnivora, and if we sup- pose its diameter to be three inches, and that of the head of the foetus a trifle less, it will be seen that birth must neces- sarily be difficult ; and this difficulty will be increased if the vagina is narrow and rigid. When the forceps is used, the difficulty is further exaggerated ; for when the blades are passed on the head, the foetus is then augmented in size by a quantity equal to their breadth multiplied by their thick- ifess — the whole constituting a mass greater than the pelvic cavity will permit tp pass through it ; so that delivery be- comes impossible. Forceps, therefore, in small bitches, in- creases the difficulties of parturition, and these difficulties are all the more embarrassing as the animal is diminutive. Recourse to this instrument is consequently contra-indicated, and if delivery is to be effected, a means must be substituted which presents less inconvenience. As a rule, the loss of one or two puppies is not a matter of much moment, the principal object being to save the mother by bringing the act of parturition to a prompt termination. Tiie desideratum is to apply an apparatus which will exert its force behind the head of the foetus, as if the sum of the expulsive efforts was directed from behind ; or as if a new force had been devel- oped in the uterine cavity, which presses directly on the summit of the head. After much consideration, Defays finally produced an ap- paratus which fulfils these indications, and, besides its inge- nuity, is very simple and easily applied. It consists merely of two rather fine brass, or very pliable iron wires, which can be easily twisted, and are yet strong enough to with- stand a moderate amount of strain. The wires should be at least sixteen inches in length, and looped in the middle, so as to be applied to the foetus in t'lie following manner : The first finger of the left hand being passed into the vagi- na, serves to guide one of the loops towards the summit of and behind the foetal head ; and it then conducts the loop of the other wire beneath the head behind the jaw. This done, the two wires on each side are twisted by a little machine (Fig. 178) composed of a thin iron rod in a handle, the other end of which is thickened and pierced by holes running nearly parallel to the Defays' Wire- Extractor WITH THE Tor- sion Rods. 522 OBSTETRIC OPERATIONS. stalk. Into these holes the two wires of one side are passed ; the machine on each side is pulled up as close as possible to the head of the foetus, and then each being turned round three or four times, the neck is en- closed in a kind of noose or collar formed by the two wires (Fig. 179). The rods are now withdrawn from the latter, and the foetus can be ex- tracted by exercising traction on the ends of the four wires outside the vulva. By this contrivance, delivery is effected without injury to the Bitch, and, unless it is much decomposed, without separating the head of the foetus. We have tried Defays' apparatus, and can speak highly of it ; not un- frequently we have succeeded in extracting the puppy alive, and when the use of forceps would have been impossible. - Fig. 179. Defays' Wire-Extractor Applied. ^ A much simpler, readier, and perhaps more successful apparatus (so far as our experience enables us to speak), is that devised by Breulet, of Marche, Belgium, which meets every requirement in the accouchement of small Bitches, and might be successfully employed with Sows, Ewes, and Goats. This apparatus is the same in principle as Defays' wire-extractor, but there is only one wire. The principal part of the invention is a noose-tube, consisting of a tubular piece of round wood, from four to six inches long, and half an inch thick. The wire may either be of copper, Fig. I So. Breulet's Tube and Noose. brass, or iron, about sixteen int:hes long (we have generally used a piece of catgut, and prefer it) ; this is doubled, passed through the tube to a cer- tain extent, so as to form a loop or noose at the end (Fig. 180). When it is to be used, the first finger of the left hand carries the loop into the va- gina of the Bitch, and slips it behind the occiput of the puppy ; then the two ends of the wire are passed through the tube, and this is pushed into the vagina under the chin of the foetus ; the operator now tightens and secures the wire, by giving it a turn round the first finger of his right hand, placing his thumb at the end of the tube (Fig. 181). A little trac- tion then extracts the foetus, and without doing it or the Bitch the least damage. We now employ no other instrument in canine obstetricy, and our success has always been complete, even with the tiniest toy terriers. When our assistance has been sought for in time, we have generally managed, expeditiously and easily, to extract the puppies alive. MECHANICAL EXTRACTION OF THE FCETUS. 523 It will be seen that'the noose is not unlike the " fillet " used in human obstetrics. The Employment of Force in Dystokia. In connection with the foregoing obstetric operations, a rather impor- tant question to be considered is the employment oi force in the artificial extraction of the foetus. For, as we have seen, more or less energetic traction is very frequently needed to remove the fcetus from its parent, and those who do not understand, or are inexperienced in animal obstet- rics, are sometimes astonished, if not horrified, at hearing of the amount of pulling which the foetus has to undergo, and the parent to sustain, before delivery can be effected in some cases. Yet force is, as a rule, absolutely necessary ; and, though some of the various points with regard to it are not yet sufficently ascertained, and differences of opinion exist with regard to them, yet it is a subject well deserving the attention Fig. 181. Breulet's Noose fixed on the Fcetus. of the obstetrist, and especially the junior practitioner. Saint-Cyr has, with his usual ability, discussed it carefully ; and we will therefore, to a certain extent, follow him in noticing it. The direction, intensity, and nature or means of developing the force to be employed, have first to be considered, after which it will be desirible to compare manual with mechanical force, and point out their respective advantages and disadvantages from an obstetrical point of view. Direction of Traction. Since the forceps was introduced into human obstetric practice, the direction which the foetus should be made to follow in the pelvic cavity of woman has been continually discussed, and has been acknowledged to be a very difficult, as well as a very important problem to solve. This difficulty is mainly due to the fact that -the pelvic canal in the human female is not uniform in its dimensions, and that the head of the foetus must pass through it by always offering its greatest diameter to that of the cavity. Consequently, it must execute during its passage a rotatiofi movement in one or other direction, according to the presentation — a movement necessitated by the different planes of the cavity. In addi- tion, the canal is curvilinear, its axis not being represented by a straight, but by a curved line, whose form and direction are, besides, modified by those deformities of the pelvis wdiich are so frequent and varied in woman, and which constitute one of the principal indications for the use of the forceps. Therefore it is, that all the difficulty in the question is to de- termine, in a rigorous manner, the direction in which to exercise traction with this instrument ; though it is generally agreed that it should be made according to the pelvic axis. 524 OBSTETRIC OPERATIONS. With animals, the problem is, of course, much less complicated, as their pelvis is somewhat cylindrical ; and its axis — almost rectilinear — can readily be determined by a line passing from the centre of the an- terior circumference to the centre of the vulva, or somewhat towards the middle of the line uniting the two superior ischiatic tuberosities. Saint- Cyr justly points out that traction should be made in the direction of this axis (Fig. 182, A B) ; and that this line of traction, happily for the veterinary obstetrist, and thanks also to the flexibility of the cords which, in his practice, take the place of the forceps, offers no serious difficulty. At page 243, it has been shown that this direction may vary, and may be modified according to the presentation — and more particularly the position — of the foetus, and also according to the period of labor. Fig. 182. Diagram of the Pelvic Axis. Degree of Traction. When passing through the pelvic cavity, the foetus undergoes a certain amount of compression, proportionate to the uterine contractions or the external traction which determines its progression outwards ; at the same time, this compression produces a kind of reaction in the body of the foetus, and gives rise to an eccentric pressure against the walls of the passage, related to that which itself experiences. The question is, there- fore, limited to the amount of force necessary to overcome the resistance that prevents the onward progress of the foetus, without injuring either the latter or the parent. In veterinary obstetrics we have no fixed data to rely upon ; but the experiments of Joulin, Delore, and Poullet, alluded to by Saint-Cyr, may afford some idea of the resistance offered by the pelvic girdle to the eccentric pressure. These authorities found that if a rounded body — a ball for instance, to represent the head of a foetus — is attempted to be pulled through the pelvis of a woman, it requires a force represented by 375 to 441, and even as much as 635 pounds (estimated by the dynamometer), to produce such serious lesions as fracture in the bones or disunion of the symphyses. But it must not be concluded from this result, that such powerful traction can be practised with impunity in woman. In the first place, the child could not be extracted alive, for its existence appears to be compromised if the degree of traction by the forceps exceeds from 132 to 154 pounds ; and in order that the pelvis of woman could resist such pressure, certain conditions are required which we never meet with in ordinary practice: for instance, the pressure MECHANICAL EXTRACTION OF THE FCETUS. 525 should be equally applied to every part of the bony girdle in contact with the head of the foetus. But this does not take place with the ordinary forceps, which, even in the hands of the most expert accoucheur, not only acts as a traction agent, but at a given moment is unfortunately trans- formed into a lever of the first or second kind, whose power is incalcula- ble, and which, resting on two opposite points of the pelvic circumference, may burst it, without the dynamometer showing any thing more than a relatively feeble degree of traction. Otherwise, it is not only the bones which have to be considered, but also the soft parts, which, pressed between the foetal head and the hard pelvic circumference, may be bruised, contused, or lacerated to a variable degree, if the comparison exceeds a certain limit. This pressure, how- ever, is always considerable ; for, according to Chassagny, when a trac- tile force of fifty kilogrammes is exercised on the head of a foetus seized by the ordinary forceps, we may calculate that each square centimetre of surface of the pelvic walls sustains a pressure of 1800 grammes, even in the most favorable conditions ; though it may be as much as six kilo- grammes or more, according to circumstances. These observations, though doubtless valuable and significant for the ac- coucheur of woman, are only very indirectly applicable to veterinary ob- stetricy. Without taking into account the strength of the pelvic osseous girdle, which is so much greater in the Mare and Cow than in woman, several other circumstances allow us to understand why this bony circle may, in these animals, resist an amount of strain which would appear to be altogether unreasonable, if judged according to the principles which should guide the practice of the human obstetrist. But the veterinarian is in possession of means of traction which give him a great advantage in this respect — an advantage which the accoucheur has not yet been able to avail himself of : we allude to the cords the former so frequently employs as traction instruments, and which can never be transformed into levers, like the forceps. In woman, as with animals, the foetus, in passing through the pelvic cavity, is pressed upon by its walls, and in return it presses upon them, in the manner of a wedge, which tends to tear them asunder. But there is a great difference in woman and animals. On the one hand, it is a hard, bony, and little reducible region — the head — which presses against the pelvic walls, to which it transmits, almost undiminished, the pressure itself receives ; on the other hand, it is a bony cage — the chest — formed of numerous very movable parts, and which can submit without injury to much distortion, in addition to its being covered by soft and readily com- pressible tissues : consequently, we can easily comprehend how much in the latter case — that of animals — the eccentric pressure produced by the passage of the foetus should be attenuated. Besides all this, the head of the infant is spherical, and therefore comes in contact with the interior of the mother's pelvis by a circle or narrow zone ; the surface of the pelvis in contact with the foetal head has been estimated at sixty square centi- ^ metres, and it is to this limited space that the head transmits the pressure it sustains. Chassagny, from a series of experiments, estimates that, for a traction of sixty kilogrammes — exerted under the most favorable cir- cumstances by his forceps on the head of the human foetus — each square centimetre of the surface of the pelvis in contact with it should support a pressure of about 500 grammes ; in less favorable conditions it may even be much more. 526 OBSTETRIC OPERATIONS. From some measurements made by Saint-Cyr, the pelvis of the Mare and Cow, and which is nearly cylindrical, maybe reckoned at 1600 square centimetres (248 inches) of internal surface ; and it is on this expanse that is distributed, in a nearly uniform manner, the eccentric pressure which the chest of the foetus transmits to the walls of the genital canal, to which it is very closely applied during its passage outwards. If, then, it be admitted that the total of this eccentric pressure measures about one- half the tractile force expended on the foetus, it will be easy to find, by a simple calculation, the pressure on each square inch. Supposing the traction to be equal to 1540 pounds — the estimated strength of seven or eight men pulling with all their force at the cords — the pressure on each square inch would be about 73^ ounces ; or one half that exerted on the same extent of surface with a tractile force of 132 pounds, in woman ! Saint-Cyr does not pretend that these calculations give a rigorously exact measure of what really takes place during parturition ; but he be- lieves th^ may assist, up to a certain point, in explaining certain facts in comparative obstetrics which otherwise would remain obscure : how, for instance, natural birth, which is always so painful in woman, is compar- atively painless in the larger animals ; and why traction, the very idea of which frightens the accoucheur of woman, is, in the majority of instances, so well sustained by the veterinary surgeon's patients. It must be confessed, however, that we have as yet no certain data by which we can estimate the exact amount of force necessary, or which may be employed without danger ; and on this point the opinions of the best authorities are widely divergent. Some declare for moderate trac- tion — two, three, or four men at the most, pulling simultaneously at the cords with all their force, are, in their opinion, quite sufficient in all cases, if well managed ; and they assert that it is rash and dangerous to employ more. Others do not hesitate to have recourse to more ener- getic traction,, and are not afraid of employing the combined strength of six, eight, or ten strong men ; being convinced that the parent suffers more from protracted labor than powerful traction : and not unfrequently their success justifies their boldness. Donnarieix admits that three assistants are usually sufficient with the Cow : one at the head, another at the tail, and the third to aid the opera- tor ; while ten are needed for the Mare : one at the head, another hold- ing the rope which confines the limbs of the animal, and prevents its do- ing damage, a third to hold the tail, a fourth to assist the operator, and the other five or six to pull at the foetus when necessary. Zundel, how- ever, is of opiniori that these numbers are somewhat exaggerated ; very often more than three assistants are required for the Cow, and if more than six are needed for the Mare, it is better to have recourse to mechan- ical means ; as too many assistants hamper the operator, and are often in each other's way, while their united strength cannot be usefully ap- plied. The assistants should be strong, and have had some experience in handling animals ; some of them are to maintain the creature in a favor- able position, while the others aid the attempts at extraction, under the orders of the operator. The tractile efforts should be made simultane- ously, without jerking, but in a continued and energetic manner, and always in the direction of the axis of the pelvis — in a straight line behind the animal. The direction of the traction may, however, be a little down- ward in the anterior presentation, lumbo-sacral position, until the withers MECHANICAL EXTRACTION OF THE F^^TC/S. 527 have passed through the inlet ; as by this means the top of the withers is depressed, and this part enters the pelvis before the sternum. The operator stands behind the parent, his hands on the sides of the vulva, v.hich he depresses with the cubital border of one hand, while, with the back of it he separates the lips, and prevents their being abraded by the cords. It is better to engage only one shoulder of the foetus *at a time, if possible ; and when the sternum and one shoulder have been carried into the passage, then the other shoulder is brought forward by directing the assistants to pull a trifle towards the opposite side. By acting in this way, with care, and by slow though continued efforts while the parent is straining, delivery will be effected, if this be possible by traction. The operator must not act hurriedly or brusquely, and his hand should care- fully attend the advance of the foetus : facilitating its passage, and aiding the progress of the haunches by passing his open hand between them and the maternal pelvis. In the posterior presentation, when at least one assistant must be told off to each cord, the traction should be moderate, or even gentle at first, until the operator's hand has adjusted the foetus as much as possible. In addition, the latter, besides directing his assistants, must frequently him- self guide the traction by the disengaged hand, and personally exert him- self in the extraction of the young creature : separating the lips of the vulva, and pressing them towards the pelvis when they are pushed out- wards by the advancing foetus ; lubricating the latter and the genital canal when necessary, etc. Means of Developing the Necessary Force. Hitherto we have only been alluding to the employment of human or manual force in the extraction of the foetus ; and this, of course, is that which is generally resorted to at first. But it is not the only force w^e may employ, and especially if it is desirable to exercise very powerful traction. It is true that empirics and amateurs have often adopted the barbarous expedient of attaching the cords fixed on the foetus to a horse or ox, and by making the latter exert its strength, to tear the young crea- ture through the maternal passage. Rainard mentions that in the Ca- margue, those who have the charge of droves of Mares, not having the services of a veterinary surgeon, yoke another Mare to the cords they fasten on the foetus, and deliver the parturient animal in this cruel fash- ion. Being destitute of anatomical knowledge, they act blindly ; and not understanding how to adjust a malposition, the foal is nearly always extracted dead, and only too frequently the mother perishes. With the object of extracting the foetus by force when manual traction is not sufficient, the windlass, capstan, wheel, cart, and pulleys, have fre- quently been used, and with great benefit. Many veterinarians consider the employment of machines as equally barbarous with the ox or horse traction, but this opinion is scarcely just. They say such machines are blind instruments which cannot be directed at will, and they prefer in- creasing the number of men indefinitely rather than resort to them. But some of the most intelligent and experienced veterinary obstetrists — Lecoq,Gunther, Binz, Leconte, Rainard, Baumeister, Saint-Cyr, Franck, etc. — speak in the highest terms of the utility of these machines ; and some of them state that whenever the combined strength of six men is not sufficient to extract the foetus from the larger animals, they do not hesitate to employ one of these articles. Not only can a greater tractile 528 OBSTETRIC OPERATIONS. force be developed by them, but this force maybe diminished or increased at will, and as gradually as the circumstances may require. In this direction, though the windlass, capstan, or wheel may be utilized, yet, for convenience in application, portability, and steady graduated traction, nothing can approach the light obstetric pulley, the manner of using which is shown in the annexed drawing (Fig. 183). When very powerful traction is required, whether manual or machine, there is the risk — particularly if the animal is standing — of dragging it backwards until it falls, or doing it some injury, unless the precaution is adopted of fixing it in some way. It is obvious that there is great danger — indeed cruelty — in attaching it merely by the head or neck, and allow- ing these to bear all the strain. It is necessary to render the creature immovable, by passing cords, bands, or a sack behind the thighs and above the hocks, bringing the ends towards the animal's shoulders, and maintaining them there either by assistants, or to the manger or any other part sufficiently strong, in the direction of the creature's head. A Fig. 183. Obstetric Pulleys. wooden bar, placed behind the thighs, and secured to the stall-posts, is also serviceable ; as is also an ordinary harness breeching, the front parts being secured to rings in the wall or manger. In some cases, vigorous assistants, placing their back against the haunches of the animal, will offer sufficient resistance to its displacement. Many practitioners prefer throwing the animal down, if it is standing, in order to avoid the dangers of being dragged ; Schaack even asserts that the body lying on the ground increases the expulsive efforts, and keeps the foetus in the plane of the pelvis. Donnarieix is not afraid of seeing the animal dragged a little, and recommends that the traction should not cease in conse- quence. Nevertheless, during the decubitus, the operator is more quickly fatigued, besides being restrained in his movements ; the necessary manoeuvres are more difficult to perform, and the weight of the fcetus is often an additional obstacle. And even when the creature is lying, if the traction is very strong, it is often necessary to prevent the body being drawn backwards. All these inconveniences being recognized by Baron, in 1858 he intro- duced an obstetrical machine — an apparatus for producing sustained traction {appareil d tradmi soutenue) in the extraction of the foetus. This apparatus presses against the hind-quarters of the parturient animal, and owing to its construction it cannot only develop a very energetic extrac- tive force in the gentlest and most inoffensive way possible, but itself produces the counter-extension in an exacdy proportionate degree. MECHANICAL EXTRACTION OF THE FCETUS. 529 The principal parts of the machine are: a kind of horse-collar (Fig. 184, A) with three stalks (B, C, D) intermediate between this collar and a broad, fixed, female screw (E), which receives a movable screw rod (H) that bears a revolving hook and chain (K) at one end; the other end of the chain has also a hook to which the cord or cords fixed on the foetus are attached. The collar is made of several pieces of light wood superposed an^ bound together by an iron band applied to its pos- terior surface. This band is perforated by three screwed holes placed in a triangular position, and which receive the iron stalks. The anterior face of the collar is so fashioned as to fit closely on the hind parts of the animal, the space for the passage of the fcetus being about twenty inches in diameter. The intermediate stalks (B, C, D) serve to transmit to the collar the pressure exercised by the female screw ; they are about forty Fig. 1S4. Bakon's Obstetric Machine. inches long, and each is composed of two pieces, one of these being hollow (4, 5, 6), the other solid (i, 2, 3) : consequently, one fits into the other, and the end opposite the collar enters one of the openings in the flange of the female screw (E) ; a small thumb-screw (7, 8, 9) secures the two portions of the stalk. The female screw is of iron or copper, the flange being of wood, and its circumference provided with two handles to hold it firmly when the machine is in use. The male screw (H) is of iron, and screwed to the right ; one extremity articulates with the turning-hook(I) : it is screwed in the contrary direction to the principal portion, so as not to become unscrewed during the operation ; the other end has a four- branched windlass which can be removed at will. To use the machine, the animal is made to lie ; the cords are attached to the foetus in the usual manner ; the windlass handle is put on its place ; the screwed stalk (H) is introduced into the female screw to about as far as J ; the collar is applied to the animal's croup, and the three long stalks are fixed — one end in the collar, the other in th.e flange. An assistant 34 530 OBSTETRIC OPERATIONS. keeps the machine in equilibrium by placing one of his hands on one of the forked handles of the flange, while the other handle rests firmly on, the ground. Another assistant, the cords attached to the foetus being fixed in the hook at the end of the chain (K), slowly turns the windlass in such a direction as will bring the extremity of the stalk (I) towards the flange, while the operator superintends the extraction. It will thus be seen that a strong traction is exerted on the foetus, while a proportionate pressure is transmitted to the croup of the parent through the three long rods — the machine producing extension and counter-extension at the same time, while it also allows a sustained traction to be obtained — without jerks or checks, and as powerful as may be desired. This machine has been well tested in France, and has received the highest praise. Comparison between Ma7iual and Mechanical Force. The employment of machines which multiply force, for artificial ex- traction of the foetus, can be traced to a somewhat distant period ; and the use of the windlass, the wheel, and the cart, by rude Empirics is of ancient date. Resorted to byignor.ant people destitute of that knowledge which alone can ensure safety and success, these appliances must have been produc- tive of great injury and loss. It "was probably from witnessing these re- sults that the early French veterinarians were almost unanimous in their condemnation of their use, and designated them as " ciliel " and "mur- derous." "It is cruel," says Fromage de Feugre, " to tie a cord to a calf, and pull at it by the windlass or capstan, or by horses attached to it. It is much better, the Cow being tied by its horns, to make men pull at the cord, so that force may be employed with more precaution and man- agement." Hurtrel d'Arboval remarks : " There are people who would go so far as to pull at the cord wWch is attached to the foal or the calf by the windlass, the capstan, or pulleys ; this procedure is not only cruel, but its violence usually kills the foetus, and often causes lacerations, serious injury, and displacement of the uterus." Other writers have written in equally strong terms against the use of traction machines, and in favor of manual force — which, they argue, is an intelligent force, may be graduated at will, and its direction modified according to circumstances, so as always to act in the most favorable way — i.e., in the axis of the pelvis. Nevertheless, since 1838, when Lecoq spoke out in favor of mechanical appliances, many of the most experienced practitioners have expressed them- selves in their favor. " I propose the pully," says Lecoq, " because it afifords much more gentle and steady traction than that obtained by strength of arm. . . . This opinion is shared by the majority of the veterinarian sur- geons in our part of the world." " The employment of the moulinet,'" writes Darreau in 1852, "gives a more regular and sustained traction than that of assistants, no matter how vigorous and intelligent these may be ; in turning it slowly, we obtain a gradual and continuous traction ; the shoulders and the body of the foetus are elongated, the sides are flattened by the pressure, and delivery is effected in the majority of cases without an accident. ... By this procedure, we succeed in eight cases out of ten." Ayrault writes {Recueil de Med Veterinaire, 1857) : "I have decided to employ a means which \ have often very severely qualified when in the MECHANICAL EXTRACTION OF THE FCETUS. 531 hnndsof empirics, and which can be only barbarous and brutal by reason of the ignorance of those who apply it : I speak of the windlass, and wheel and axle. ... It is now amply demonstrated to me that this obstetrical means, so little enticing at first sight, is the first among all the means for producing traction which the veterinary surgeon has at his disposal — pro- vided always that he watches its operation with much attention .... so that no part of the foetus wedges against the sides of the pelvis ; for the windlass does not know of any obstacle which it cannot overcome." And Garreau, commenting on Baron's obstetric machine just described, re- marks {Report a la Soc. Centrale de Med Veterinaire, 1858) : " From what has been said, it results from an examination of every part of this apparatus : that the mechanism is simple, and works well and easily ; that its power is at least equal to that of the pulleys, windlass, or capstan ; that its action is based on mechanical laws ; that the traction it produces is so gentle, slow, and regular, that it is without danger for the mother ; that its employment altogether leaves behind all the other means used for the production of the necessary counter-extension in foetal extraction ; that the collar transmits, in a regular manner, and to the whole of the inferior and posterior parts of the maternal pelvis, the pressure it receives from the female screw ; that this pressure, disseminated over the entire hind-quarters of the female, is proportionally less severe and painful during traction of a given intensity." Many more references could be given to other very competent author- ities in favor of mechanical over manual traction ; but we will sum the evidence by stating that mechanical traction is preferable to that pro- duced by manual power, inasmuch as it is slower, more regular, its ac- tion is more sustained, and it is more powerful and efficacious, without imposing increased strain on the parent or foetus. Manual traction is unsteady and jerking, especially when several men are pulling ; all the men do not pull alike or at the same time, therefore even during traction, however steady it may aim to be, the strain varies ; men soon become fatigued, whereas the machine can maintain the traction for any length of time without increasing or diminishing it. One of the objections urged against machine traction, is that its direc- tion cannot be so easily varied upwards, downwards, or to one side or the other, as manual traction. But this is a very trifling objection, and it may be nearly, if not altogether, overcome by making assistants press against the cord or cords, so as to give them the necessary direction. When powerful traction is required, whether it be manual or mechan- ical, great attention is necessary in guiding the foetus through the genital canal, so as to prevent injury to the parent. The traction should cease in the intervals between the labor-pains, and the efforts ought not to be continuous ; the animal should bs allowed intervals of rest, and time be given for the genital canal to dilate and adapt itself to the passage of the foetus. Severe and injudicious traction may be productive of the most serious results. Even when tiae operation is nearly terminated, care will be requisite in order to prevent inversion of the uterus. This accident may be obviated by careful manipulation, and abundant injection of emollient fluids.* * While on the subject of mechanical traction in veterinary obstetrics, we may note that two distinguished French accoucheurs — MM. Chassagny and Joulin — have recently introduced an apparatus intended to replace mechanical for manual traction in the human female, botlj being unanimous with regard to the # • 532 OBSTETRIC OPERATIONS. CHAPTER II. Embryotomy. Embryotomy, or embryuicia, is the name given to ever}' operation which has for its object the reduction in volume of the foetus at parturition, by mutilating or dividing it ; so as to allow it to be extracted by portions, when it cannot be delivered whole. It is a generic term for a number of operations very different in their character, and performed on the foetus either while it is wholly retained in the uterus, or more or less engaged in the genital passage. These operations may be practised on various parts of the young creature : head, limbs, or body, and faciliate the removal of one or more parts, so that the remainder can be removed from the uterine cavity. Of course, the life of the foetus, if it be alive, is sacrificed in every case ; and this sacrifice is only made to prevent a greater loss — the death of the parent. But in resorting to embryotomy, the veterinary obstetrist is not hampered by those gr^ve considerations which, in a legal, moral, and re- ligious point of view, have so long embarrassed the action of the accou- cheur of woman. The question with the veterinary surgeon, should the foetus be living, is as to the respective value of parent and offspring, and which of these should be preserved in the interest of the owner. In nearly every instance the response is entirely in favor of the parent, this being of most commercial value ; and this fact^ together with the absence of legal and moral objections, will account for embryotomy being much more frequently practised in veterinary than in human obstetrics. Never- theless, the destruction of the living foetus in the case of domesticated animals should not be lightly entertained ; it is the duty of the veterina- rian, in the interest of his client, to preserve the life of the young creature as well as that of the parent, by every means in his power ; and it is not until these means have been fairly tried, or are deemed insufficient after due deliberation and without trial, that the necessary mutilation shquldbe undertaken. And it must not be forgotten that embryotomy is not always without danger for the parent ; on the contrary, it is nearly always serious, and its consequences have often to be dreaded, while to the operator it is in the great majority of cases a heavy and fatiguing task. When the foetus is not dead, then it is only the most urgent necessity that should impel the obstetrist to resort to embryotomy ; though when the creature has perished there is no need for hesitation, and the opera- tion maybe undertaken at once, if the operator is satisfied that extraction cannot be readily effected otherwise. We have already indicated the conditions which generally require re- course to embryotomy. These are deformities of the maternal pelvis — either congenital or acquired, constitutional or accidental — which prevent extraction of the intact foetus, this condition being, however, very rare in animals; hysterocele ; disproportion between the size of the foetus and the genital canal ; certain kinds of monstrosity ; particular malprese?itatio?is and malpositions^ as well as irreducible distortions of the foetus ; death of the superiority of the former over the latter. Chassagny gives his reasons for preferring the one to the other- (thev are the same as those which have been expresse'd by veterinary obstetrists for many years), in a well written article in the Gazette Medicale d^ Lyon for 1861 ; while Joulin, a year afterwards, in his work on midwifery {Traiti comf>let d' Accouchements, Paris, 1862), points out in the clearest manner the great advantages of his means of extraction. EMBRYOTOMY. 533 /(etiis, when its retention in the uterus has given rise to intense emphy- sema which hinders delivery ; certain diseases of the foetus^ as hydroceph- alus, ascitis, oedema, etc. Indeed, embryotomy is indicated in every case when parturition cannot be accomplished by the other measures already mentioned, without seriously compromising the life or future usefulness of the parent. We have stated that division of the foetus is a heavy and fatiguing task ; and we have only now to remark that, however easy it may be to lay down rules and give directions as to how the manuel of the operation should be conducted, those only who have had experience in this direc- tion can testify that it is much easier to write and to speak than to act, and that some of the manoeuvres so complacently recommended by those who have but little knowledge of the practical part of veterinary obstet- rics, cannot be carried out. The fact is, that embryotomy cannot be restricted to definite rules which shall be applicable to every case ; the operation must vary ac- cording to circumstances, and these are often of the most diverse kind. In very many instances, before the veterinarian is called in, rude and misguided hands have greatly complicated the case, 'and caused so much injury and swelling to the maternal organs that the difficulties of the operation are increased manifold. But, as in every thing else, there is a right way and a wrong way of operating — apart from the collateral difficulties of the operation ; and though no fixed rules can be laid down for every case which requires em- bryotomy, yet there are directions, based on the results of practical ex- perience, which afford a general and trustworthy summary of the most important points to be observed — by the young practitioner more particu- larly. These directions we will now allude to, in treating of the inci- sion, excision, or ablation of those parts of the foetus which are selected for operation — these being the head, limbs, and body. But we must first notice the instruments in actual use, or whxh are recommended for per- forming embryotomy. Embryotomy Instruments. The performance of embryotomy necessitates the use of surgical ap- pliances for the division, puncture, or removal of certain parts ; and as these operations have to be effected either in the genital canal or in the cavity of the uterus, the manipulation of cutting instruments in such a confined space, under all the disadvantages of distance from the opera- tor, the struggles and paralyzing straining of the mother, and the fact that only one hand can be employed, and that without the aid of vision to guide and direct it, renders the operations peculiarly difficult and dan- gerous. These difficulties and dangers have stimulated the inventive faculties of veterinarians for a long time, in devising instruments by which they might operate quickly and safely, and so obviate fatigue and danger to themselves, and exhaustion and risk to the parturient animal. It is needless to remark that many of these instruments have never come into general use, either because they did not fulfil the requirements claimed from them, or because they were too complicated or expensive. Sometimes, also, prejudice rather conflicts with the introduction of any novelty in this direction ; while long experience often enables the prac- titioner to achieve the desired end with instruments which would be useless, if not dangerous, in the hand of a less expert obstetrist. 534 OBSTETRIC OPERATIONS. So it is that, for nearly all the cutting operations, an ordinary pocket knife or bistoury is sometimes the only instrument employed ; the ope- rator being satisfied if the spring is sufficiently strong to prevent the blade shutting up in the handle when it is used in the uterus. Rainard preferred an ordinary knife with a blunt point and a convex cutting edge ; others use a bistoury cache. Even small pocket-knives of various sizes are utilized for this purpose, and one of Mr. Cartwright's embryotomy knives is not unlike a gardener's large pruning knife. In the use and preference for knives, much must depend upon custom and the expertness of the operator. Nevertheless, convenience, safety, and the absence of long experience, demand that proper instruments be devised for this operation ; and this requirement has long been present to the minds of veterinary obstetrists. One of the earliest to introduce a convenient and efficient embryotom was Giinther, who, in his work, published in 1830, figures an instrument which is fixed on the finger by a ring ; the cutting edge of the blade, about two inches long, being somewhat concave. This embryotom has been slightly modified in various ways by different practitioners — some- times having two narrow rings, so as to grasp more of the finger ; at other times having, in addition, a small button on the back of the blade Fig. 185. Fig. i86. Straight Embryotom. Curved Embryotom. for the finger to press upon ; while the blade itself has been made more curved, straighten longer, or like the blade of a fleam. This instrument is the prototype of the ring scalpel invented by Dr. Simpson, of St. An- drews, for opening the skull of the human foetus. Two of these embry- otoms which have been used in England, are shown in the annexed figures (185, 186). An improvement in this instrument is the having a hole at the opposite end of the blade (Fig. 186), through which a piece of cord or tape can be passed and tied round the wrist, to prevent the knife slipping from the finger and falling into the cavity of the uterus. Indeed, this is a wise precaution with all the short instruments introduced into the genital organs, as the contractions of the uterus, struggles of the animal, and the position of the hand, as well as the slipperiness caused by the presence of mucus, etc., only too often render the hold of the in- strument very insecure. The middle-finger of the operating hand is passed through the ring and the other fingers enclose the blade, which is in this way safely conveyed to the part of the foetus which is to be incised. The finger-knife is the most useful instrument in embryotomy. Giinther also at this time introduced another form of embryotom, which has likewise continued in use, and has been more or less altered or improved in shape. This consists of a blade, which can be made to slide out of or into a handle, by the thumb of the hand holding it. It can therefore be introduced into or withdrawn from the genital passage, without risk of injury to the maternal organs. The annexed figure (187) EMBRYOTOMY. .535 exhibits an improved model of Gunther's second embryotom ; the original pattern had double cutting edges. We may remark that Zundel and Saint- Cyr give Thibeaudeau the credit of inveniing this sliding bistoury ; but the instrument is only described by the latter in 183 1 {Rec. de Med. Vet- h'inaire, 1831, p. 152); where as an exactly similar knife is figured in Giinther's work {Lehrbuch der Practischen Veterindr-Gebiirtshiilfe), pub- lished at Hanover in 1830. Another kind of embryotom is one not unlike an ordinary large scal- pel, along one side of which glides a blade-guard, which can also be moved backwards or forwards by the thumb of the hand that holds it. This is a very convenient knife (Fig. 188). Fig. 187. GuNrHER's Embryotom: Improved Pattern. Embryotoms have also been proposed by Brogniez, Hubert, Contamin, Obermayer, and others, but they all are more or less imitations of the foregoing models. Giinther figures an embryotom fixed on a handle, and which may be of any convenient length — about thirty inches is recommended (Fig. 189) ; the blade is semicircular, the concave border and point being very sharp. This instrument is extolled foi" its usefulness in cutting through the mus- cles subcutaneously, and especially in separating the limbs from the trunk. The same authority gives the figure of a " Scheerenmesser," or " secator," as it has been termed. This is an instrument about thirty-six inches in length, composed of two branches, held together by two short sheaths, Fig. 188. Colin's Scalpel Embryotom. through which the one glides on the other. Each of the branches has a blade placed at a right angle to the stalk ; these blades are opposite each other, the opposing edges being sharp, and they are brought in contact by a ratchet arrangement and screw moved by a handle at the other extremity. This instrument is very powerful, and can divide bones as well as soft tissues. Subcutaneous embryotomy is at times very necessary, but after the skin has been incised great difficulty is often experienced in separating it from the textures beneath, by tearing through the connective tissue. This is found to be the case more particularly in amputating the shoulder, when the fingers become fatigued in trying to pass them beneath the skin. To facilitate this part of the operation, different-shaped spatulas have been devised, which do the work of the fingers in liberating the skin from the parts it covers. One of these spatulas has been used by Cartwright ; it is merely a thin but rigid blade of iron, about seven inches long and 536 OBSTETRIC OPERATIONS. one or one and a quarter inch wide, the edges being smooth and rounded, and one end fixed in a wooden handle (Fig. 190). Carsten-Harms employs a double spatula about three feet in length ; the blade at each end is about an inch wide and two inches long, the intermediate portion being simply a round rod about half-inch thick j one end is a little bent to one side (Fig. 191). This instrument can be used with both hands, and is more firmly held than a one-handed spatula. Fig. r8q. Gunther's Long-hakdled Embryotom. Fig. 190. Cartwright's Subcutaneous Spatula. ll Fig. 191 Carsten-Harms's Spatula. Ungefrohrn proposes another, but somewhat differently-shaped, spatula. This measures about twenty-five inches, the stalk being about three-eighths of an inch thick, and the blade two inches long and somewhat crescent- shaped ; the convex border is most useful in raising the skin, particularly in parts where the connective tissue is close and resisting. The blade must be pretty strong and slightly convex on one side, concave on the other. The other end has a wide eyelet as a handle. The section of bones, though not often necessary, is nevertheless some- EMBRYOTOMY. 537 times required to be made, and it is found to be no easy matter — wiiii the larger bones especially. For this purpose chisels, saws, and forceps have been proposed and employed. Cartwright has a model of an instru- ment for slitting up the skin of a limb, which may, on occasions, be made useful as a bone-chisel. Including the handle, it is about thirty-two « Fig. 192. Fig. 193. Fig. 194. Fig. 195. Jngefrohrn's Spatula. Cartwright's Bone-chisel. Cartwright's Bone-saw. Swedish Chain-saw inches in length ; the chisel portion is a little more than two inches long, and one or one and a half inch broad ; only the middle portion at the end is sharp, the two corners, which project a little, being blunt and rounded, as are also the sides (Fig. 193). 538 OBSTETRIC OPERATIONS. Margraff's " Stemmeisen," or chisel, is not unlike a joiner's chisel in shape \ the instrument itself is seven or eight inches long, and at its cut- ting edge (end), which is very sharp, is an inch to inch-and-quarter broad. The sides are well rounded, and the instrument gradualy tapers as it reaches the handle, into which it is fixed. This handle is a round piece of hard wood about three feet long and about two inches in diameter, with a ferule at the end into which the chisel is fixed, as in the ordinary carpenter's chisel. The cutting end of the instrument is carried by the right or left hand to the part of the foetus to be incised, while the handle is held by the other hand. The two hands can in this way be employed : that in the uterus guiding the movements of the chisel, while that holding the handle applies the necessary force. This simple instrument has been found most serviceable in dividing the vertebrae when the body of the foetus had to be bisected, dividing the head or, in double-headed mon- strosities, the two heads ; as well as slitting up the skin. It has been well suggested that if the cutting edge was made slightly concave the chisel would be more useful. For the same purpose a saw has been proposed. Such an article has been successfully employed when the occasion demanded it. Cartwright's saw is shown in the annexed figure (194). The stalk (of iron) is sixteen inches in length, the saw four inches long, and the handle six inches. The saw-blade should be of the same thick,ness throughout, the end and back being well-rounded and smooth. Sjostedt {Handbok i Forlossnings Konsten for och uppfodare af Husdjur) draws attention to the value of the ordinary surgical chain-saw, which a veterinary surgeon at Stromsholm had successfully employed. That which was recommended is about a foot in length, and an inch wide. Each end has a ring to which a cord is ^.ttached, and to the cord may be fixed a short, transverse wooden handle. The chain-saw has the advantage of being perfectly flexible, and can therefore be passed around bones, joints, etc., and the necessary movements performed in cutting through these — by pulling alternately at each cord — without endangering the organs of the mother. One hand of the operator must, of necessity, guide the saw and ascertain its progress.* Bone-forceps might be used advantageously, but we are not aware that they have been employed in veterinary obstetrics. They should be made with the jaws bent, so that the cutting edge would be concave, and they could be made sufficiently strong in jaws and handles to cut through the largest bones. A screw at the end of the handles would bring these together with sufficient force to divide the strongest pieces of bone. In the foregoing we have only alluded to the instruments which are generally approved of ; many more might have been described ; but no particular advantage could have been derived by doing so. A multitude of instruments can only be embarrassing to the veterinary obstetrist. Be- sides, it must be confessed that too little attention has been devoted to the perfecting of those already in use, or to devising others more simple and efficient to supplant them. There is here a wide field still open for those who desire to cultivate a most important department of veterinary surgery. Instruments necessary for particular operations will be referred to as these are described. * All the obstetrical instruments to which reference has been made in this work, are supplied by Mackey, Sellers & Co., Bouverie Street, Fleet Street, London. i EM BR YO TOM Y 539 Preliminary Arrangements for Embryotomy. There is not much to arrange before commencing embryotomy. The operator is supposed to have made an exploration of the genital passage, and to have ascertained the state of affairs ; he may even have attemp'ed every thing possible in the way of extraction, and failed. Being satisfied that nothing remains to be done to preserve the life of the parent, save removing the fcetus piecemeal, he has to decide, from the nature of the case, how this is to be effected. The necessary instruments he may have with him, or they may be devised on the spot ; if the case is more diffi- cult than usual, they may have to be sent for. But, as a rule, the opera- tor must utilize to the best of his ability whatever is to hand ; as he usu- ally finds his patient greatly exhausted, either from protracted labor or the mischievous meddling of untutored hands. The animal must be detached from the manger or rack, and kept, if possible, in a standing attitude : this position being the one best suited for such an operation, or it may be tied by the head to a stake, by a rather long head-rope. A rope, or, better still, a rug or blanket, should be passed round the hind-quarters, a little above the hocks, the ends being held by assistants standing towards the shoulders of the animal. This precaution is required to steady the creature, to keep it in a stand- ing position, and to assist it in resisting the traction generally employed in removing the foetus. It may be necessary, if the animal is much ex- hausted or suffering much pain, to administer a stimulant, meal or flour gruel, or an anodyne draught. Cephalotomy. Every operation which has for its object the diminution in size of the head, or rather cranium, when this part offers an obstacle to the passage of the fcetus, is designated by this name. Hydrocephalus is the condi- tion which most frequently calls for the operation in the larger animals ; though certain malformations and monstrosities, and even^an exaggerated volume of the head of the fcetus in the Bitch or Cat, may also require it. Cephalotomy comprises several distinct operations, which may be per- formed independently or simultaneously. These are simple puncture, in- cision, or crushijig of the cranial parietes. Puncture of the Cranium. In order to allow the escape of fluid from the cranium, as in hydro- cephalus, and thus permit the birth of the foetus, a simple puncture is often all that is necessary. The fluid having escaped, the thin fragile bones of the cranium readily collapse from the pressure they undergo in the pelvic cavity ; so that the head and body can be removed by traction. Supposing the presentation to be anterior, it is first necessary to fix the head, unless it is firmly wedged in the passage ; this fixation may be effected by using a head-stall, Schaack's head-stall forceps, or even a cord on the lower jaw : exercising sufficient traction on the cord to pre- vent the head from slipping from under the hand of the obstetrist during the operation. The head may be punctured by a scalpel, straight bistoury, finger-knife, or even the finger in certain cases. If a long-bladed instrument is used, 540 OBSTETRIC OPERA TIONS. there is sometimes a good deal of risk, so far as the maternal organs are concerned ; and it is advisable to wrap twine, tow, or tape, around a good portion of the blade towards the handle. The best instrument, if it is at hand, is a long, medium-sized trocar and cannula, the end of the latter fitting closely on the stalk of the trocar, which should be very sharp. It is introduced safely into the genital canal by drawing the point sufficiently far back into the cannula as to be entirely concealed. This end is then seized between the fingers and thumb in such a way that the index-finger extends a little beyond the ex- tremity of the cannula ; the other three fingers holding it in the palm of the hand, while the right hand sustains and guides the instrument. Should the trocar not fit the cannula tightly, the play between the two renders their indroduction somewhat difficult, and the point may glide through and wound the operator. The trocar may, in such a case, be pushed quite through the cannula, and the point fixed in a cork which can readily be knocked off by one of the fingers when the instrument has reached the head of the foetus. Having arrived at this part, the proper spot for puncture is selected, and then the instrument is applied to it — perpendicular to its surface if possible, to prevent slipping. The trocar is made to penetrate slowly by a slight rotatory motion from side to side, and when all resistance ceases the cranium is perforated. This perfora- tion should not be made at the sutures, if they can be avoided, as they overlap and close the opening. The cannula is now held firmly in its place by the left hand, the trocar is withdrawn by the right, and the fluid escapes. The instrument should be sufficiently long for the end to be near, or even outside, the vulva, when the point is on the cranium of the foetus. There is no difficulty in performing this operation when the head pre- sents first, even though it should not have entered the inlet, so long as it is easily accessible to the hand. With the posterior presentation, how- ever, the operation is troublesome ; as owing to the body of the foetus occupying the passage, it is extremely difficult to pass the hand armed with the trocar so far as the head. Nevertheless, it maybe accomplished in many cases by patience and tact. There is no reason why the trocar and cannula should not be passed through the mouth of the foetus in some cases, and made to penetrate the cranium at the base of the skull, when the frontal region cannot be attained. If the head cannot be reached in this presentation, then exsection of the body of the young creature must be practised, and the parts removed until the head can be manipulated. Craniotomy. Craniotomy or incisioJi of the cranium, is resorted to when puncture has not sufficiently reduced the size of the head. It is an operation of great antiquity in human obstetrics, and various instruments have been intro- duced to facilitate its performance ; but very few of them have been util- ized in veterinary obstetrics, and indeed for the larger domesticated an- imals they are of no use. A simple straight or curved bistoury. Gunthers sliding embryotom (Fig. 187), finger-scalpel (Figs. 185, 186). the long- handled embryotom (Fig. 189), scalpel embryotom (Fig. 188), bone-chisel (Fig. 193), or saw (Fig. 194), may one or all be employed, according to circumstances. It cannot be denied, however, that the operation is very difficult to execute, and not without serious danger for the parent. Even EMBRYOTOMY. 541 in woman, with all those advantages and appliances of which the veter- inary obstetrist cannot avail himself, craniotomy is always a formidable undertaking. The cephalotribe and craniodast, so useful in human obstet- ricy, cannot be employed with our animals, it would appear ; but there is no reason why modifications of these instruments might not be devised to answer the same end. Hurtrel d'Arboval recommends that craniotomy be performed with a convex probe-pointed bistoury (sharp on the convex border), the middle of the cranium being incised ; then the fingers compress the bones, and so effect delivery. Rainard advises two incisions on each side of the head, in the parietal region. Giinther mentions that if, after puncture, the operator cannot crush the bones of the cranium with the hand, they should be cut by his secator, and removed picemeal. Carsten Harms states that when the head is an obstacle, it should always be crushed, if possible, the bones being broken beneath the skin. Sometimes it is sufficient to re- move the lower jaw ; and in order to effect this, the jaw is first fixed by a cord, the skin is then cut through on each side — from the commissure of the mouth to the temporo-maxillary articulation, the masseter muscles and the ligaments being divided ; a transverse section of the skin is now made between the two joints, the finger separating it, and two or three assistants pulling at the cord, the jaw is removed. If it is the trans- verse diameter of the head which forms the obstacle, the division must be longitudinal, and great service may be derived from the use of the bone-chisel — either Cartwright's or Margraff's pattern. As much of the skin should be left as possible, in order to cover the jagged ends of the bones. With the smaller animals, puncture and craniotomy are not at all diffi- cult operations, the bones being fragile and easily perforated or crushed. Decapitation. Decapitation, an operation which consists in separating the head com- pletely from the body, so as to allow these parts to be removed one after the other, is not very often required ; and fortunately so, as it is not with- out great danger to the parent. More frequently the head is partially re- moved, the fore-limbs amputated, or evisceration of the chest or abdo- men, or both, practised, rather than resort to decapitation. Nevertheless, it is indicated when a double-headed monstrosity — mon- osomian or sysooiian — is presented, and in certain irreducible malposi- tions of the head or limbs — especially in heifers, when the head of the calf is in the genital canal, and can neither be advanced nor pushed into the uterus. The operation is more or less difficult, according to the situation of the head : if entirely in the uterus or fixed in the passage, or if it is or can be brought near or beyond the vulva. In the latter instance, it is easily accomplished ; although, except in the case of double monstrosi- ties, it is rarely very useful, as when the head is in this situation it is not an obstacle to birth, and its removal deprives the operator of a most powerful means of exercising traction on the parts which are firmly re- tained in the maternal organs. When wedged in the canal, however, the head may prove a troublesome obstacle to the performance of those manoeuvres necessary for the reduction of other parts ; as it may not be possible either to advance or repel it, nor yet to pass the hand between 542 OBSTETRIC OPERATIONS. it and the pelvic walls to search for a deviated limb, for example, or to bring this limb into a proper position. The passage must, therefore, be freed from the obstacle, and this can be accomplished in various ways, the most common of which is as fol- lows : The fore-limbs, if present, are corded and pushed as far towards the uterus as possible ; then the head is secured by cording the lower jaw, a pointed hook fixed in each orbit, or a head-collar over the head if it can be placed. Four or five assistants now pull at the head by these appliances, so as to bring it as near the vulva as circumstances will per- mit ; while another assistant keeps the labia apart, in order to expose as much of the head as he can, and prevent injury to the organs of the parent. The operator, with a convenient knife (the curved finger-scalpel is very useful), incises the skin around the neck — first one side, then the other — close to the occiput, passes his fingers between it and the muscles beneath, and pushes it well back on the neck — the assistants pulling at the head at the same time facilitate this separation. A few cuts now divide the soft tissues down to the vertebrae, and nothing more remains to be done than to produce disarticulation by vigorous traction, and a twisting movement of the head at the same time ; the ligaments gradually yield and tear, the head extends and at last comes away, and the body of the foetus recedes more or less suddenly into the abdominal cavity. If the limbs have been previously secured, they are brought into the passage by the cords attached to them \ or if they are not so accessible, they must be sought for in the way already indicated, and delivery completed : care being taken to cover the exposed bones of the neck by the surplus skin, while the foetus is being brought through the passage. Another method is to make an incision through the skin across the forehead, in front of the ears, and to separate it by means of the fingers or spatula as far as the occipital articulation. The knife divides this joint, as well as the soft tissues around it, and particularly the ligaments ; traction will bring away the head. The upper part of the neck is covered by the loose skin — which may be fixed there by ligature — and directed into the middle of the passage. Crotchets should now be placed on the bodies of the vertebrae, or even on the ribs if they can be reached ; as the limbs do not offer sufficient resistance if they alone are pulled at, neither do they bring the body fairly into the passage. Traction should be made on the sternum, not the withers, as the latter ought first to enter the inlet. A third method consists in removing the lower jaw, and excising the head from below. Or this excision may be practise<^ from the mouth, the chisel being used to divide the vertebrae, after the cheeks, masseter muscles, and soft tissues behind the lower jaw have been cut through. Decapitation, under the most favorable circumstances, is often a long and fatiguing operation, as the greatest care has to be observed in order to avoid injuring the parent. But this fatigue and anxiety are vastly in- creased, when the head is deeply buried in the passage or the uterus. Then, as Saint-Cyr truthfully says, the hand, moist with the fluids of the genital organs, embarrassed by shreds of the foetal envelopes, ham- pered by the presence of the limbs, compressed and paralyzed by the uterine contractions — the hand can then scarcely hold and guide the cutting instrument, or distinguish what belongs to the foetus and what to mother, and has no longer any strength to divide the tissues, which are all the more difficult to cut by reason of their softness and flaccidity. It will readily be understood how such an operation must be difficult for EMBRYOTOMY. 543 the operator and dangerous for the mother. It would almost be deemed impossible, if veterinarians had not attempted it and succeeded ; though the majority of them have said but little as to their mode of procedure. It is always preferable, if possible, to remove one of the fore-limbs, as this is easier, quicker, and less dangerous. But decapitation must sometimes be performed, and then the above instructions will be found useful. • In the case of double-headed monstrosities, the saw and bone-chisel, or a pair of strong bone-forceps, will be valuable. When the head of the foetus is retained in the uterus, and bent back towards the shoulder or flank, then it may be decided to amputate the head should it and the neck be distorted. Disarticulation may be commenced at the most con- venient part of the convexity made by the bend of the neck, cutting through the soft tissues down to the vertebra on that side, then on the other ; then sawing or chiselling through the bones, and afterwards using the crotchets carefully. Amputation of the Limbs. When the limbs are so deviated that they cannot be straightened, or when by their presence in the genital passage they prevent the necessary manoeuvres for the adjustment of other parts of the foetus, then it may be necessary to amputate or disarticulate one or more of the extremities. Some of the indications for the operation have been referred to on vari- ous occasions : they include all those foetal monstrosities which have su- pernumerary limbs that require removal before delivery can be effected ; those cases in which the foetus is exaggerated in volume, either normally, or through having become emphysematous after death in utero ; those complicated malpresentations, such as the abdominal, hock, thigh, etc., and certain deviations of the head and neck in the anterior presentation. Saint-Cyr points out that, in the latter, it is well to hesitate before de- cidiug to remove the limbs ; for if it is true that their ablation allows more space for manoeuvres, and more facility for adjusting the head, it is not less true that, should these manoeuvres fail, by the loss of the limbs we are deprived of a powerful means of traction when we are compelled, as a derniere ressource, to adopt forced extraction. Besides, it must not be forgotten that embryotomy is itself an extreme measure, to which we should only have recourse when every other fails or seems to be really hopeless. One or both of the fore or hind-limbs may be required to be ampu- tated, according to circumstances. In the earlier days of veterinary science, the obstetrist was content to pull at the limb of the foetus which he wished to remove, either by mechanical or manual power, until it was torn off by brute-force. Fromage de Feugre mentions that Texier had in this manner torn away the limbs of many foals which he could not ex- tract — the separation of the limb always taking place between the chest and scapula, by rupture of the muscles uniting these two parts ; and he asserts that by this procedure he was able to save many Mares — though he says nothing as to the suffering of these before the limbs could be torn from the body. Subsequently, it was discovered that the skin offered most resistance to this kind of avulsion — the muscles and ligaments being much more easily torn. Then the knife was employed to incise the skin, and thus get rid of the chief difficulty. On the Continent, in amputating a fore 544 OBSTETRIC OPERATIONS. limb, for instance, the skin and muscles were divided as near the shoul- der as possible, and the bones, united by their ligaments and covered by the skin, separated by traction. Skellet, in his crude and imperfect work {A Practical Treatise on the Parturition of the Cow), published in 1807, writes: "Take a sharp knife, and cut from the point of each shoulder of the calf to the muscular or thick part of the fore-leg ; then cut round it, so as to enable the operator to skin the upper part of the shoulder. A knife is then to be conveyed betw^een the shoulder and brisket, so as to cut the muscles which unite them. When so done, the leg and shoulder may be easily pulled off from its body. The other fore-leg, etc., is to be taken off in the same way." But the subcutaneous method of excision was greatly facilitated by the directions published in Gilnther's work in 1830, and also by the publication of the procedure of Huvellier in the same year {Recueil de Med. Vet^rinaire, 1830, p. 449); while the parent was protected from some of the dangers and pain which attended the old plan. Since the introduction of this method, it has been adopted by every obstetrist of note, who has either kept to the original manuel operatoire, or modified it to suit his own fancy or con- venience. Amputation of the Fore-Limbs. In order to amputate a fore-limb, it must be more or less advanced in the vagina, or even beyond the vulva. So that, if it is still in the uterus, it must first be removed therefrom and brought into the canal. If both limbs are to be removed, they must be secured by cords around the pastern in the ordinary manner, the cord of the one which is to be first excised being pulled at by two, three, or four assistants, so as to draw it as near, or as much beyond, the vulva as possible. Another assistant then keeps the lips of the vulva wide apart, in order to allow the opera- tor more room. The latter makes a circular incision above the fetlock — or, better still, the knee, taking care not to go deeper than the ^in. From this incision, gliding his hand into the vagina, along the limb, he gradually makes a longitudinal one, extending higher up as the leg be- comes elongated by the traction. Bome practitioners make this incision on the inner aspect of the limb, others on the outer side. On the latter there is perhaps less danger of wounding the maternal organs, and it may be more convenient for the operator. But this is a matter of minor importance ; it is more neces- sary to be careful in incising the skin over the articulations, so as not to divide the ligaments of these, as this might lead to the limb being torn away at the wrong place ; no such precaution is necessary with the muscles. This longitudinal incision having being made, the skin is separated from the structures beneath, either by means of the fingers or spatula : pushing it up towards the shoulder as it is detached, until at length, as the leg becomes stretched, the incision and the detached skin are as high as the shoulder. The dissection being then deemed sufficient, and the limb being only retained by the muscles which attach it to the thorax, the operator, either by his hand or the crutch, makes pressure on the foetus, while the assistants are ordered to pull energetically at the ^ cord on the pastern, and in a kind of jerking manner. Soon slight crack- ' ing sounds are heard, the muscles are rupturing and giving way, and in a very short time the entire limb — scapula and all — is removed. EM BR yq TOM V. 5 43 The removal of one limb usually leaves a considerable space in the genital canal, and this allows delivery to be completed. Sometimes, however, and particularly when the head is deviated towards the flank, it is necessary to remove the other limb ; and this, when effected, per- mits the head to be sought for and rectified, version accomplished, etc., according to the requirements of the case. Some practitioners operate in a somewhat different manner to the fore- going. Lecoq, for instance, commences his incision at the upper part of the shoulder, brings it down over the head of the humerus, on the side of the fore-arm, and as far as the middle of the cannon, where he makes his circular incision ; the skin is separated from this part upwards. In some cases this procedure may be preferable to the other, and it cer- tainly is less dangerous for the parent ; but it may sometimes happen that the shoulder cannot be reached. Giinther pushed back the foetus as far as possible by means of the crutch, then with the finger-scalpel divided the skin before and behind the scapula, then across — below and above ; cutting through the pectoral muscles, and then extracting the limb. Cartwright operates in a similar manner to Lecoq. He first has a leg drawn out, and divides the skin as far as possible ; or he introduces his hand, containing a knife, as high as he can on the side of the scapula, and makes an incision thence down the whole length of the limb to the pastern bones ; the skin is separated by the fingers or spatula as far as possible from the entire leg, and the trans- verse pectoral muscles cut through. The limb is then disjointed, either at the pastern or fetlock ; the foot being left attached to the skin, as it is afterwards found to be useful in the extraction of the body. Cords are fastened around the limb above the fetlock-joint and knee, and the Cow being firmly tied by the head, the necessary force is applied, and the whole limb drawn away. He writes, " I have known, in some of these cases, the limbs to separate at the shoulder joints, and yei; the foetus has been extracted — both from the Mare and Cow — with the shoulders attached, the points of the latter having, fortunately, not caught the edge of the pelvis. The great danger in these cases is, that the shoulder joints may catch against the pelvis and thus prevent extraction." Meyer recommends that the circular incision on the cannon be not made until the skin is detached above, as this facilitates avulsion. It is well to divide as many of the muscles uniting the limb to the chest as possible, and also to apply counter-extension by means of the arm or crutch placed against the chest or opposite shoulder of the foetus ; this also spares the mother much of the pain and exhaustion attending extraction.- Amputation of the entire fore-limb, including the scapula, is a very useful operation in the most serious cases of dystokia ; but there some- times occur instances in which the whole leg need not be excised — as when the legs are an obstacle rather from their length than their volume. This happens, as has been described, in the abdominal presentation of the foetus, when the limbs so often render version difficult — all of them being perhaps in the genital canal, from which they cannot be advanced or pushed back. In these circumstances, disarticulation of the limbs at the knee or elbow joints is often practised — the latter being generally pre- ferred ; though it must be remembered that excision at this part can be but of limited value, and, in fact, is only useful in the presentation just alluded to, because it does not give so much room as removal of the scapula and humerus. 35 I 546 ■ OBSTETRIC OPERATIONS. In the abdominal presentation with four legs in the vagina, Donnarieix lays down the following procedure : Three pieces of supple twine are got ready, as well as a strong cord. With the twine the pasterns of three of the limbs are firmly bound, while the cord is fixed on the limb which is to be detached, and confided to five assistants, who pull at the cord while the other limbs are pushed towards the uterus. The knee, then the fore-arm appear, and the lips of the vulva being kept widely separated, the ope- rator makes a circular incision through the skin at this part ; traction is again applied, the muscles tear, and gradually the joint is reached. The tendons and ligaments are cut, and the leg being twisted as it is pulled at, another cut of the knife finally removes it. With the Sheep or Goat, amputation of the fore-limbs of the fcetus is very rarely indeed required, though, if necessary, it can be effected. The same remark applies to the Bitch and Cat. Amputation of the Hind-Limbs. When the foetus makes a posterior presentation, with the hind-limbs flexed at the hocks, and so firmly wedged in the canal that they cannot be extended backwards, nor yet sufficiently bent to permit delivery — which is far from being rare in the Mare — these joints are disarticulated. This is accomplished by passing a running noose round each leg, above the hock, and tying it firmly there. Powerful traction being made on one of the cords by four or five assistants, will bring the point of one of the hocks to the vulva, the lips of which are separated, while the operator divides the gastrocnemii tendons and the lateral ligaments of the joint, so as to produce complete disarticulation. The tibia is then pushed into the vagina, the other limb is amputated in the same way, and birth is accomplished by pulling at both cords, which remain attached to the lower end of the leg-bone. When the limbs are completely retained in the uterus in this presenta- tion, the procedure recommended at pages 486 and 515 must be adopted. We may remark that Carsten Harms recommends symphysiotomy to be practised on the fcetus, when the buttocks present at the inlet — the sym- physis pubis being cut through. By this means, the two borders of the symphysis can be made to overlap, and the transverse diameter of the pelvis thereby diminished. The finger-scalpel and spatula are the instru- ments he prefers. The saw might be advantageously used. In certain kinds of monstrosity in which the posterior parts of the foetus are double, or when the hind-limbs are in the vagina, and in consequence of the narrowness of the maternal pelvis, or width of the croup, or haunches of the young creature, birth cannot take place, them amputation of the legs at the trunk may be necessary. Such an operation can be rarely required, however. It is performed in a similar manner to that for removal of the fore-limbs — subcutaneously. A cord is fastened to each pastern, and, one after another, the limbs are drawn towards the vulva ; a circular incision is made through the skin above the hock ; then a longitudinal incision is carried as high as possible on the thigh, and the skin separated in the ordinary way by means of the spatula — always as- cending towards the croup ; the gluteal and other muscles attaching the thigh to the pelvis are cut across, and the limb is at last torn away by strong and sustained traction. Amputation of the hind-limb is a much more onerous and fatiguing EMBRYOTOMY. 547 operation than the removal of the fore-extremity. The skin adheres very closely to the subjacent textures, and more labor is needed to separate it ; the muscles attaching the limb to the trunk are more numerous and powerful, and when they are cut through there remains the resistance of the pubio and coxo-femoral ligaments (in the foal — the pubio-femoral ligament is not present in the calf). Harms estimates that if three assist- ants can pull away a fore-limb, four men will not in every instance remove a hind one. However, the difficulties are not always insuperable, and many cases are on record in which the operation has been successfully performed. After avulsion of the limbs, crotchets should be fixed in the cotyloid cavities or oval foramina, and delivery completed according to the direc- tions already laid down. Division or Detruncation of the Fcetus. When one-half of the body of the foetus has more or less passed through the pelvic canal, and the other half is retained, so that it is impos- sible to extract or return it, it is recommended to cut the trunk in two — division or detruncation. We have shown that this retention may be due to malposition or malpresentation, excessive development of, or deformity in the hind-quarters of the fcetus,. as well as ascites, anasarca, or emphy- sema {physometrd). If the hind-parts are retained, and the head and fore-limbs are not much beyond the vulva — if so far — cords should be placed on each pastern, and a head-stall on the head, and slow, gradual, but strong traction exerted on them, so as to expose as much of the body of the young creature as possible. This done, the operator, with a sharp bistoury, incises the body in a circular manner as close to the vulva as is convenient (the labia being kept well out of the way by an assistant) — the incision commencing below, which allows the elongation of the vertebral stalk ; then the skin and muscles on the sides are divided. When the vertebrae are reached, the bistoury is passed between them, and as close to the loins as possible ; slight pulling and twisting will then complete the bisection. It is a good plan to incise the skin at some distance in front of the place where it is intended to divide the spine, and to separate and push it back over the portion of trunk in the genital canal. When the divis- ion of the body is effected, this superfluous skin is pulled forward over the mutilated remaining part of the trunk and sewn together, so as to en- close the latter completely, and prevent injury to the parent during the subsequent manoeuvres. Should the hind-limbs be doubled under the croup in the passage, or should they still be in the uterus, they ought to be sought for and corded at the pasterns, the cords being given to assistants. Then vigorous pres- sure is applied to the divided end of the spine in the remaining part of the trunk, while the assistants pull until version is effected ; extraction is afterwards easy. In some cases it is not necessary, nor is it always possible, to secure the hind-limbs before the trunk is pushed into the uterus, version taking place merely by the retropulsion ; and sometimes, when one limb has been found, there is much difficulty in discovering the other. In such a case, and when version cannot be effected, Rain- iard recommends that the limb which has been secured be drawn towards 548 OBSTETRIC OPERATIONS. the vulva, and disarticulated ; this will enable the operator to find the other leg. The foetus, when wholly retained in the uterus, has been divided, ac- cording to the reports of several veterinarians, successfully ; but they have not, it would appear, furnished us with any details as to the pro- cedure they adopted. In particular circumstances it might certainly be accomplished, but we scarcely see the necessity for it. Evisceration. When it is desired to reduce the volume of the thorax or abdomen, or both, the organs they contain are removed. This procedure is generally adopted when, after removal of one or more of the limbs, the body of the fcetus still remains fixed in the genital canal ; by it we obtain a considerable diminution in the dimensions of these regions, and perhaps next to the removal of the limbs it is the most useful operation in embryotomy, and is to be highly recommended. As we have said, evisceration of either of the cavities may be practised, according to circumstances. We shall, therefore, describe the mode of reducing the volume of both — thorax and abdomen. Thoracic Evisceration. The chest is emptied of its contents first, when the anterior part of the foetus is in the passage. The head and limbs should be corded — if one of the latter is removed all the better ; if not, the cords should be pulled well upwards, in order to make more room. Should the head be an obstacle to the performance of the operation, it may be amputated ; but if it is back in the uterus, then it may be left there. A strong scalpel with a long handle, the finger-scalpel, or either of the two embryotoms shown in Figs. 187, 188, is the best instrument. It is passed carefully into the vagina until the hand reaches the breast of the foetus, when the blade is thrust deeply into the chest, between the two front ribs, and as close to the spine as possible, cutting down towards the sternum. The knife is now dispensed with, and the hand being re-introduced, the fingers are pushed into the foetal chest and the two first ribs removed, thereby allowing sufficient room for the whole hand to enter the cavity. The lungs and heart are torn away from beneath the spine, and, with the thymus gland, removed from the uterus. The chest collapses a good deal, but if the foetus cannot yet be extracted, the hand may be pushed through the diaphragm, and the contents of the abdomen carried away through the chest. Some operators, instead of opening the thorax in front, incise from two to five of the ribs close to the sternum, and pass the hand into the chest by the aperture so made. Others divide the ribs on both sides, and remove the sternum as well as the viscera. It will often be found that the contents of the chest and abdomen can be removed without cutting the ribs. Abdominal Evisceration. Evisceration of the abdomen may be effected, as just stated, through the thorax, by tearing away the diaphragm. But in the posterior or abdominal presentations, and indeed in any presentation or position in which this region is accessible to the hand. VAGINAL HYSTEROTOMY. 549 eventration can be performed. Nevertheless, it is not always easy ; on the contrary, it is sometimes most difficult and dangerous. Either of the embryotoms used for evisceration of the chest may be employed for the abdomen. The edge of the instrument is applied to the wall of the cavity, which is incised by drawing the hand towards the operator. Then the whole of the viscera are torn away, and, if need be, that of the chest also, through the diaphragm. This terminates what we have to state with regard to embryotomy ; and it will be remarked that nearly all the operations connected with it require much time, are fatiguing for the operator, and only too often very exhausting and serious for the parent. During the operations, the latter should receive the greatest consideration ; from time to time, an interval ought to be allowed for it to rest or to rally from the exhaustion which is always evident to the attentive obstetrist. It may even be necessary to give it a stimulant in the form of brandy, beer, etc., or nourishing drinks — warm or tepid if convenient. The greatest care should be observed in preventing injury to the maternal organs from the cutting instruments employed, or from the ends of divided bones CHAPTER III. Vaginal Hysterotomy. At page 349 we alluded to induration of the cervix uteri as a cause of dystokia, and described more or less fully the indications for overcoming the obstacle ; we also alluded to the manner in which these indications should be carried out. As we are now treating of obstetric operations for the extraction of the foetus, it is necessary that we describe more fully the operation and its consequences, as these are of much importance. Vaginal hysterotomy consists in incising the indurated and inextensi- ble neck of the uterus, in such a manner, and to such an extent, that it will allow the foetus to pass through its canal. For this purpose, the only instrument necessary is a strong probe- pointed bistoury, a bistoury cache, or one of the finger-scalpels or other embryotoms. When the straining of the animal has propelled the cervix uteri towards the vulva, with partial prolapsus of the vagina, the opera- tion is simple, as the eye can then aid the hand. All that has to be done is to glide the instrument into the os, and make the necessary number of incisions through the tissues composing the cervix : the situation and depth of the incisions depending upon the extent of the induration and the atresia. In other cases there is no prolapsus of the vagina, which is quite soft and elastic. Then the left hand may be passed into it, and the index- finger being introduced into the os, draws the cervix towards the vulva ; tlie labia of the latter are separated by an assistant, and the operator passes the blade of the instrument — guiding it by the index-finger of the other hand — into the os, where he gradually and steadily incises the tissues. 550 OBSTETRIC OPERATIONS. When, however, the walls of the vagina are involved in the induration, this retraction of the cervix cannot be effected, and the part must be op- erated upon in its ordinary situation : the knife being carried carefully into the vagina, passed to the necessary depth in the os, and the incision made. Perhaps the bistoury cache is the best instrument for such cases. It is rare indeed that one incision is sufficient; generally from two to four are required, and it is better to have a larger number than make them too deep ; they certainly must not pass through the entire thickness of the cervix. The situation of the incisions is a matter of some moment. The lower portion of the cervix should be avoided, in consequence of its proximity to the floor of the vagina, which is in immediate contact with the bladder and urethra ; should these be wounded, the results might be serious, if not fatal ; and if the peritoneum is cut or torn during the passage of the foetus, fluids and discharges will escape into the abdominal cavity, and give rise to peritonitis. There is less danger in incising the upper part of the cervix, as the rectum is not so near ; nevertheless, in induration there may be adhesions between them, and an accident is therefore pos- sible — though it must be rare. So that, if only two incisions are required, it is advisable to make one on each side of the cervix ; and if four are necessary, to have them at each corner. Horsburgh {^Veterinarian, vol. xviii., p. 215) recommends, if the atresia is complete, to pass the finger or a blunt instrument into the os, then in- troduce a stout, sharp-pointed, curved bistoury about four inches long — dividing the stricture laterally by two incisions — always drawing the bis- toury towards the operator ; after which he is to introduce both hands, with the palms towards each other, and press them apart. " He will find the part immediately dilate to the proper size, and labor may go on naturally ; or he may then proceed to extract the calf if labor has been protracted." The object in making the incisions only to a comparatively slight depth, and not through the entire thickness of the os, is to prevent extensive lacerations of the organ during the passage of the fcetus. It will gen- erally be found that these partial incisions will, with a little patience, admit the hand ; this being passed into the uterus, seizes the presenting part of the young creature, places it in a favorable position if necessary, and then begins to draw it gently into the os. Sometimes with primiparae in good health and strong, delivery is after- wards effected spontaneously, and this is the most favorable result ; but in the majority of cases labor has been going on for a long time — per- haps two days or more, the parent is exhausted, and the uterine contrac- tions are either suspended, or so feeble as to preclude all hope of their expelling the foetus. The head and fore-feet must then be corded, and delivery accomplished in the ordinary way. It is well to remember, however, that the traction resorted to must be judiciously employed. It should be moderate, gradual, and sustained, in order to allow the tissues of the cervix time to accommodate themselves to the eccentric pressure imposed on them by the advancing foetus. To act otherwise, is to incur the grave risk of lacerating the uterus beyond the possibility of repair, and is quite as reprehensible as making deep incisions. J VAGliVAL HYSTEROTOMY. 551 With regard to the consequences of vaginal hysterotomy, it must be admitted that it is not without danger, and that death not unfrequently results. We have no reliable statistics to guide us in estimating the amount of success or non-success following its performance, as not all — or perhaps not many — of the cases are published. Saint-Cyr has col- lected thirty-four cases — all those published in France and Belgium since the commencement of the century, an analysis of these gives the follow- ing results : Mother and progeny saved in 14 instances. Mother saved — fate of the progeny not mentioned — in - 9 " Mother alone saved in ------5 " Progeny saved, mother died, in - - - - - 6 " Mother succumbed — fate of progeny not mentioned — in 5 " Mother and progeny perished in - - - - - i " So that of 40 Cows operated upon, 28 survived, and 12 — or 30 per cent. — succumbed; while, with regard to the progeny, 14 calves were de- livered alive and continued to live, and 6 were dead ; nothing is said as to the other 14. In other words, of 80 lives more or less compromised, 18 at least — or 22^ per cent. — were not saved by the operation. And Saint-Cyr is inclined to think that if all the successful cases have been published, there is reason to believe that all the unsuccessful ones have not ; and he is apparently confirmed in this view by Bugniet {lie- cueil de Med. Veterinaire, 1873), who writes: "Distinguished veterina- rians have published very interesting observations on this important question in obstetrics^ but I am bound to say that these experienced practitioners have been more fortunate than myself, for I have had noth- ing but misfortune, and in the interest of science I do not hesitate to say so." Bugniet, after describing three cases in which he operated, and in which death of the mother followed, as evidence that his procedure was not at fault, remarks : '• Nevertheless, I acted with extreme prudence ; when the incisions were made, I proceeded to complete delivery with great care and deliberation. Incision, dilatation, birth, removal of the placenta — all conducted with knowledge and circumspection; and yet this did not prevent a fatal issue." But in opposition to this experience, we have that of other practitioners who have had a fair — indeed, a large — share of success. Donnarieix, for instance {Ibid., 1874, p. 511), com- menting on Bugniet's report, blames the latter for adopting expectant in- stead of active treatment, and asserts that he has taken the exception for the rule. From his own experience, extending over thirty years, during which he had performed vaginal hysterotomy in sixty cases with only one death (the cause of which was not apparent), he concludes (i) that incision of the cervix uteri is generally curable, and (2) that palliative measures are more injurious than beneficial, when their uselessness is demonstrated. Many instances of successful treatment by incision might be given, in addition to those already enumerated, but a few will suffice. I. Of several cases given by Donnarieix {Op.cit., 1874, pp. 512, 514) we will select two. In one case, atresia was so complete that the index-finger could not be introduced into the OS. and it was impossible to discover if there was a calf. The vagina was prolapsed beyond the vulva, and formed a tumor as large as a man's head. After evacuating the 552 OBSTETRIC OPERATIONS. bladder by replacing the vagina, hysterotomy was practised, and the fore-limbs of the foetus were seized and brought through the os, but the head was deviated ; so it was necessary to cord thefeet, return them to the uterus, and adjust the head. The opera- tion lasted for six hours, but the calf was extracted alive. In about half an hour, inver- sion of the uterus took place, with the membranes adherent. The latter were detached, reposition of the uterus was effected, and the organ retained by Renault's bandage — all in a few minutes. The Cow did not die, but lived, and subsequently produced more calves. The second case was one of occlusion of the os uteri. Vaginal hysterotomy occupied about ten minutes ; a bull-calf was born alive, and the Cow did not appear to suffer. The animal, of the Charolaise breed, was of great value, and was subsequently sold for a thousand francs ; after producing several calves without any difficulty, it was again sold, when aged twelve years, for six hundred francs. 2. Binz {Zeitschrift filr Wissenschaftliche Thierheilktinde, 1846, p. 365) describes the case of a Cow which for three years was unprolific ; but during oestrum, at the end of this period, the os was artificially dilated by the finger half an hour before the animal was put to the Bull. Impregnation resulted, but at the termination of pregnancy delivery could not take place. Binz, on exploration, found the cervix in a cartilaginous condi- tion, and the os completely and firmly occluded. With difficulty one of the fingers was passed half through the canal. The labor-pains were so extremely powerful, that it seemed as if the foetus would be expelled through the walls of the uterus or the rectum before the os would dilate. An incision in the cervix was then made by means of a probe-pointed bistoury, from the os, and upwards. The labor-pains continuing strong, the " water-bag " soon appeared; but the os did not dilate sufficiently to allow it or the fcetus to enter ; a second incision — also upwards — was therefore made in the cartilaginous cervix, which permitted the " water-bag " to pass through. This was opened, and it was found that the calf presented in the proper position in front of the opening. The incisions gradually widened, and in a few minutes a fine Cow-calf, weighing forty ffund, was born ; in half an hour afterwards the foetal membranes came away. Three or four times a day lukewarm water, with a decoction of chamomile flowers and tincture of myrrh, was injected ; the animal ate and drank well, and soon quite recovered ; it yielded a good quantity of milk, and in a year afterwards was sold to the butcher in fine condition. 3. The same excellent authority [Ibid., p. 368) performed the operation on a Cow, the cervix of whose uterus was so indurated that it was impossible to bring the calf through it. Birth then took place without assistance, and no ill consequences resulted. When oestrum again occurred, the worst fears of the owner were realized, in that the Cow, when put to the Bull, was not impregnated. Binz was consulted, and on examination he found that, at the part where the incisions had been made during the last calving, a hard cicatrix as thick as the finger had developed, but that the other parts of the cervix were sufficiently dilatable to allow him to introduce the finger into the os. The latter being rendered permeable in this way, the Cow was once more put to the Bull, conceived, and at the termination of gestation, with very little help, brought forth a fine calf. 4. Pflug [Wochenschrift fiir Thierheilkunde tend Viehzucht, 1863) was called upon to assist a heifer in calving. The labor-pains were strong, and the vagina, together with the cervix — behind which were the head and feet of the calf — protruded beyond the vulva. The calf was alive. Reposition of the vagina was effected, the upper part of the cervix was incised in one place, and the young creature extracted. The haemorrhage was not serious. The afterbirth was removed piecemeal, and in a few days the Cow regained its appetite. Suddenly it became unwell, and on examination it was found that the upper margin of the cervix was greatly swollen ; in a short time an abscess formed, pus was discharged, and the heifer soon recovered permanently. 5. Foglar {Oesterreichische Vlerteljahresschrift fiir Wissenschaftliche Veterincirhinde, 1876, p. 30), in referring to this " Scheidengebarmutterschnitt," as the Germans desig- nate the operation, makes some interesting observations. In the course of five years' practice he had performed vaginal hysterotomy on six occasions — partly on primiparae, partly on pluriparae. The incisions in the cervix were made, in two of the cases, in the outer margin of the dense cartilaginous ring, so as to allow the inner ring to be incised.* In the other four cases, the occlusion of the os was so complete that at most, only the tip of the little finger could be introduced. A passage to the interior of the uterus had to be gradually cut by means of the knife. The operation took from one and a quarter to one and a half hour, during which the animals were kept standing : two or three men were placed at the head and tail, and the left hind-leg was secured. The animals remained perfectly quiet. Foglar used the probe-pointed or button bistoury for the * Foglar, following the example of human anatomists, recognizes in the canal of the cervix an os uteri externum, and internum or "rings" iringen). VAGINAL HYSTEROTOMY. 553 operation, the blade being covered for one-half its length by a bandage. The instrument is carried in the hand, so that the forefinger covers the back of the blade, while the remaining four fingers firmly grasp the handle. The hand — well oiled — is passed into the vagina, and after the external ring of the cervix has been incised — right and left — to the depth of one-third to half an inch, towards the top, attempts are made, by careful manipulation, to further dilate the passage. This procedure has, as a rule, been attended with success. The iimer ring is reached, after this manipulation has been continued for some time ; and this is dilated, partly by incision, and partly by pressure or distention — though care is taken to avoid contact with the incisions already made. This happened, however, in his first case, in which the textures between the rings had to be divided. Sometimes the knife is dispensed with in the course of the operation, and the hand alone is made to trace the channel, which has often a devious course. During the '" pains " the knife is very liable to slip from the hand and injure the uterus — thereby causing unnecessary haemorrhage. In four cases, in which, after the widen- ing of the incisions, birth took place in a normal manner, the result was most satisfactory ; the animals operated upon recovered completely, and after only a brief indisposition. Two afterwards became pregnant, and calved without any difficulty. In the other two cases the results were not so favorable : the calves being too large to pass through the vagina, and the Caesarean section was objected to by the owners, and was certainly not deemed very, likely to be attended with success by Foglar. After parturition, the foetal membranes were either removed artificially, or left to nature ; and in no instance were any ill consequences noted. In the first case the "afterbirth " came away on the ninth day ; and in all the cases the subsequent treat- ment chiefly consisted, for the first two or three days, of cold applications to the loins, cold water pessaries in the vagina, gruel, and Glauber's salts, with, in particular instances, injection of cold water into the genital canal. 6. Macgillivray {Veterinary journal, 1S77, p. 149),. referring to the instances alluded to at p. 352, adds : " In the first case the subject was a seven-year-old Cow, on which I operated by incision (making two side cuts up and down), and extracted two living calves. Both calves and the Cow did well. Having made a speedy, good, and perfect recovery, the said Cow was in due course again served with the Bull, and the following season produced (without any uncommon disturbance) a living calf ! Thus showing that incision of indurated cervix uteri is no bar to future productiveness of a perfectly normal character." There is no doubt that, in the majority of instances, and in the hands of careful obstetrists, vaginal hysterotomy will be successful, and will prove a useful operation. As a rule, after the operation, and for a period of eight or ten days, there is a muco-purulent discharge from the vulva ; but the Cow eats, ruminates, gives the usual quantity of milk, and does not appear to be any more inconvenienced than after normal parturition. The unfavorable results, however, must not be overlooked. Serious injury to the neighboring organs by the knife, or by the extension of the laceration, is within the range of possibility. When the cervix is com- pletely divided, either by incision, or by subsequent laceration during the passage of the foetus, we may have intense peritonitis arising from escape of the liquor amnii or other fluids into the abdomen, and speedy death. Or excessive haemorrhage may lead to serious consequences. In every case, of course, there must be more or less bleeding from the incisions ; but, as a rule, this is of no importance, and it ceases after a time. In less frequent cases, however, it persists, and either brings on great debility, or, if excessive, will lead to a rapidly fatal termination. This result is most to be apprehended when the cervix is greatly degen- erated, and its tissue extremely vascular — as in carcinoma and sarcoma. It may also occur from rupture of blood-vessels, in laceration of the cer- vix or body of the uterus, during the passage of the calf through the incised os. When serious haemorrhage occurs, cloths or sponges steeped in cold water, astringent lotions, and styptics — as the perchloride of iron — 554 OBSTETRIC OPERATIONS. should De applied as close to the part as possible ; while cold water irrigation should be maintained on the loins. Another result is metritis, or metro-vaginitis, which is rapidly fatal, and in which we find the usual local lesions on making an autopsy. Sep- tikaemia is also to be apprehended ; and to prevent it, it is well to remove every source of putridity, or any thing likely to become putrid, and to use plentifully a weak solution of carbolic acid (i to loo) or the permanganate of potass in the interior of the uterus, and particularly about the incisions in the cervix — even for some days after the operation. CHAPTER IV. Gastro-Hysterotomy, or the Csesarean Section. Gastro-hysterotomy, the Ccesarean Section^ or abdommal hysterotomy, is an operation which has for its object the removal of the fcetus or foetuses from the uterus of the parent, when they cannot be doWvered per vias naticrales, by making an opening in that organ through the abdominal walls, and thereby extracting them. This is a formidable and a serious operation, whether it is practised on the human female or on animals. In the obstetricy of woman, it has been resorted to from a very early period ; the Greeks knew it as vffTspoToiJMToxiYj or i,ai3piosXxrj, though it is supposed that they only performed it after the mother was dead, and to save the child. Persons thus born were sacred to Apollo, and yEsculapius was designated the son of that god, because it was believed he had been delivered by gastro-hysterot- omy. Some strange notion appears to have been attached to this method of delivery ; as among these old-world people, the person who had been born by means of the operation was esteemed remarkable and fortunate. Hence Claudius Caesar, Scipio Africanus, Ca^so Fabius, Julius Caesar, and other more or less illustrious personages of old Rome, received the surname of " Caesones " from being extracted by abdominal incision from their mother's womb : " Quia caeso matris uteru in lucem prodiscunt." At a later period these persons were designated " Caesares," — a noble title ; though, as has been demonstrated, it is a mistake to assert that it owes its origin to Julius Ceesar — this being merely his patronym. Since these early times, abdominal hysterotomy has been often prac- tised on woman ; but when it was first attempted on animals we cannot yet be quite certain. Haller was led to believe that the Greek veterinari- ans — Apsyrtus and Hierocles — knew and performed the operation on the domesticated animals ; but this has been shown to be a mistake. Until we arrive at the time of Bourgelat — the illustrious founder of veterinary schools — in the latter half of the last century, we appear to have no evi- dence that such an operation was ever proposed for animals. And even Bourgelat only suggests it in cases in which the dam is attacked by a dangerous disease when the period of gestation has nearly or quite expired, and its life may be beneficially sacrificed in favor of its prog- eny, which is to be quickly removed from the uterus. {Traite de la Conformation Exterieure du Cheval, 1768.) In 1781, Brugnone {Trattaio della Razzi di Cavalli, p. 406) intimates that this operation may be per- GASTRO-HYSTEROTOMY, OR THE CESAREAN SECTION. 555 formed on Mares and other animals which could not bring forth ; but, like Bourgelat, he does not state whether he ever practised it. It was not apparently until 1813, that Morange, and in 1816 Gohier {Mem. sur la Chirurgie et la Med. Veterinaire^ vol. ii., p. 40), attempted it on the living animal, though unsuccessfully. Morange operated on a Cow, and it was to all appearance in a fair way to recovery, when it suc- cumbed to an attack of indigestion caused by improper feeding. About the same period, Rohlwes {Das Gauze der Thierheilkunde, 1822, p. 143) operated on a Mare. Since that time gastro-hysterotomy has been practised comparatively often, both in England and on the Continent ; and there can scarcely be a doubt that it was mainly indebted to its general introduction, as an obstetric operation, to the fact that the abdomen of animals could be opened with impunity in such operations as ovariotomy (spaying) in swine and other creatures ; as well as from the experience that, in abdominal hernia in the pregnant animal, the foetus had been often extracted in this way, and the mother did not succumb. Gastro-hysterotomy has been practised both on the large and small domesticated animals, but perhaps with most success on the latter. In 48 cases of this operation, Franck finds that 25 — or. 52 per cent. — had a fatal termination. Saint-Cyr, from a smaller number, makes the mortal- ity 71 per cent. Franck can only note three instances in the Mare, and they were all fatal, though the foals were saved. For the Cow he has 17 instances ; 6 of these recovered (one of them, however, was Morange's, which died from over-feeding fifteen days after the operation, and another was Sacchero's, which was sent to the butcher in six days). This gives 35 per cent, saved, and 65 percent, lost. In three Sheep there were no recoveries, and in two Goats, only one. With the Pig the operation ap- pears to have been wonderfully successful. In 8 instances all recovered : a result Franck is inclined to attribute to the different arrangement — or rather attachment — of the placenta, which renders this animal less liable to septic infection through injury to the uterus. With the Bitch, the mortal- ity is about the same as in the bovine species ; in 15 cases, 6 — 40 per cent. — lived. Franck thinks this percentage might be much increased if the operation was performed on the right side, and antiseptic treatment adopted, or, if necessary, even extirpation of the uterus ; as putrid infec- tion readily occurs in the Dog. With regard to saving the young, the operation is not very favorable. In nearly all the instances in which the parent recovered, the progeny has been dead, or died ; and in only 4 of Franck's list of cases were the parents, and one or more of the young creatures, preserved alive. Three of these cases were Bitches, and the other was a Sow. With the Cow, the Calf is often saved, while the parent dies. Of 7 in- stances, the calves were extracted alive in 6. With the Mare, the operation must be resorted to early in order to save the foal, as, for the reasons already given, it perishes quickly. It is only on a knowledge of the length of time the foetus may live during parturition, or after the death of the parent, that the operation can be undertaken with any prospect of success — so far as obtaining it alive is concerned ; and this is an important consideration with regard to the bovine species. Kehrers, in his observations on the Bitch, found that three minutes after death the foetus began to show symptoms of asphyxia, and in thirty-six minutes it was dead. In pregnant Cows and 556 OBSTETRIC OPERATIONS. Sheep which were slaughtered, the foetus moved about in a very lively manner for eight to ten minutes, but death ensued soon after. Sauer observed an unusual instance of fcetal vitality in a Bitch which could not be delivered, and was poisoned by cyanide of potassium. Eight minutes after death the foituses were observed to move in the abdomen, and this and the uterus being opened, they were extracted alive. After fifteen minutes, Franck has found in slaughtered Sheep that the foetus was usually asphyxiated ; and he concludes that during the first eight minutes after the death of the parent, the foetus can be extracted alive (if alive before the parent died) ; even towards fifteen minutes there is a chance of preserving it, but by that time it is usually dead. When extracted late, and in the first stage of asphyxia, though it may rally for a short time, yet it usually succumbs to inflammation of the lungs — through the amniotic fluid having penetrated into the air-passages during the convulsive gasps the young creature makes. There can be no doubt that much of the great mortality which follows the operation, is due to the circumstances amid which it is undertaken. It is, as a rule, never resorted to until every other means to deliver the animal has failed, and the creature, worn out by suffering, is already almost dead. In addition to this, the foetus itself — subjected to long- continued and severe manipulation — is either dying or dead ; indeed, it may have perished days before, and, becoming putrid, has already in- fected the parent." Death is usually due, when not immediate, to putrid infection — to peri- tonitis or metro-peritonitis. This is more particularly the case with the Bitch, in which, when the operation is performed early, and the young are extracted alive, recovery generally takes place ; though Franck remarks, that wherever the green coloring matter of the placenta imparts a simi- lar tint to the textures it comes in contact with, very often septic inflam- mation begins there. The same authority points out that there is no great reason otherwise why death should be a frequent result of the ope- ration, when we consider the hundreds of similar operations performed in the study of embryology, by Bischoff and others, on Bitches, Guinea- pigs, and Rabbits, the majority of which did not have a fatal termination. He also alludes to the success of Nature's Caesarean section, when we have mummification and maceration of the foetus, consequent on occlu- sion of the OS uteri, and the remains of the creature find their way out by another channel without much disturbance to the mother. The most dangerous cases for operation are those in which the foetus is dead, and more or less decomposed. Indications. The operation should only be resorted to in those cases in which de- livery by the natural passages — the foetus being alive — is altogether im- possible, or so difficult and dangerous that the mother incurs nearly as much risk as from gastro-hysterotomy itself, while the young creature must be sacrificed ; or when the owner prefers having the latter alive, in- stead of incurring the risk of losing both — the progeny being the most valuable. The operation is therefore likely to be demanded in those deformities of the pelvis produced by fractures, exostoses, etc.^ which considerably diminish its canal, intra-pelvic tumors, hernia of the uterus, GASTRO-HVSTEROTOMY, OR THE CESAREAN SECTION. 557 extra-uterine foetation, certain cases of uterine torsion irreducible by the methods we have described. Atresia of the os should be more advan- tageously overcome by vaginal hysterotomy, unless the owner is desirous of saving the foetus and sacrificing the mother. The operation is also indicated when an animal, near the termination of pregnancy, is so seriously ill or injured that it cannot live until, birth takes place. It may then be most judicious, if the progeny is valuable, to kill the parent and extract the foetus at once. If the parent has just died, or is dying, the operation may also be practised. In considering the adoption of the Caesarean section, the species of animal will, of course, weigh a good deal. Those which can be utilized as food, there need be no hesitation in operating upon, and sacrificing immediately afterwards ; the value of the carcase and the living calf or lamb diminishing very considerably the loss which would otherwise be sustained. With the Mare, as we have said, the foal may be very much more valuable than the parent. With the Bitch and Sow, there is much more prospect of a favorable result of the operation ; and, as difficult parturition in them is often so serious, it is advisable to operate in good time. Indeed, in all cases when the operation is once decided upon, no time should be lost in prac- tising it, if w^e desire to preserve the progeny, and guve the parent a chance. We have seen that the foal soon perishes when it cannot be born, and though the foetus of other animals retains its vitality longer, yet there is also a limit here. Besides, it must be remembered that the strength of the parent is an important factor in the case, and the longer the delay, so the less chance is there of a successful result. It is, therefore, most important that the obstetrist loses no time in making his diagnosis, and coming to a conclusion as to the course he must pursue. Embryotomy will, of course, present itself to his mind before gastro-hysterotomy, which is, after all, only to be an ultimate means of saving either mother or progeny, or both, in very exceptional cases. It need scarcely be pointed out that in irreducible uterine hernia, there need be no delay in deciding, and that this condition gives good hope of success — especially in the smaller animals. Operation. Looking at the Caesarean Section from a purely surgical point of view, there can be no doubt that, so far as the larger domesticated animals are concerned, it is one of the longest, most fatiguing, and most difficult, in veterinary surgery. There is also the great extent of the wound, as well as the opening of the peritoneum, haemorrhage, and escape of blood or liquor amnii into the peritoneal cavity, to be considered. Besides, the animal is, as a rule, in a state of extreme prostration, and the results of mischievous interfer- ence may be already apparent before the operation is commenced, or even before the veterinary surgeon is called in. The after treatment of the mother, too, often requires much attention, and is expensive ; and recovery requires a considerable period, as conva- lescence is only too often protracted. What, however, makes the operation so formidable, if the mother is to be saved, is the quadrupedal position of animals ; for, after section of the 558 OBSTETRIC OPERATIONS. abdominal parietes, the mass of intestines presses heavily on the part which has to be incised ; so that it needs much careful management and supervision to effect cicatrization, and to procure such a solid adhesion of the margins of the wound that hernia may not result. If the mother is alive, the operation is a painful one, and one of long duration in some cases, and the pain inflicted causes the animal to struggle ; this inconveniences the operator more or less, and — not to speak of the humane feelings which should ever be predominant on such occasions — induces him to avail himself of the advantages of anaesthesia, if they can be obtained. Perhaps no agent is so useful in this respect as the hydrate of chloral, though chloroform or aether may be administered in the usual way — by inhalation — and produce their effect. The objection to the two latter substances, however, is very great, so far as cattle are concerned ; as they taint the flesh, should it be necessary to kill the ani- mals, and utilize their flesh as food; whereas the chloral dydrate has not this objectionable action. The latter is perhaps best administered in enema ; for horses and cattle, the dose may be from fourteen to twenty- two drams ; about two or three drams for dogs (depending on the size), and three to six drams for pigs. It is best given in mucilage or bland syrup of any kind. In a quarter of an hour or so the animal is in a state of narcosis, and the operation may be commenced. Unfortunately, the drug only too frequently causes the death of the foetus — a matter of some importance when this is of more value than the parent ; but not to be considered when the life of the latter is to be preserved. When the parent is doomed to be killed — as in the case of a worthless Mare, or one suffering from an incurable disease or accident — and the young animal is to be rescued, the best course to follow is to pierce the medulla oblongata, and operate at once, as Vollmar has done with suc- cess. By this means insensibility has been produced, and the young creature extracted alive. Gtlnther recommends dividing the posterior aorta after removal of the foetus, as it is close to hand in the abdominal cavity, and death quickly ensues. For the operation but few instruments are needed. They consist chiefly of a scalpel, probe-pointed bistoury, scissors, forceps, muscle-hooks, and some common suture needles, pins, and sutures — silk or catgut. For the larger animals a strong suture needle, suture wire, and waxed carbol- ized thread or twine, teased oakum, tow, small pieces of wood or whale- bone for the sutures, and large pieces of linen are required in addition, as well as a body-bandage made by folding a linen or cotton sheet. If the parent is not to be preserved, or is already dead or dying, of course no such preparations need be made ; as a scalpel and probe-pointed bis- toury, or even and ordinary pocket-knife, on an emergency, and used with care, will suffice. The operation might, and should if possible, be performed under the carbolic-acid spray ; with the smaller animals at least, this antiseptic treatment can be adopted. The incision in the abdomen may be made in either of two regions — at the linea alba, or the right flank. If it is desired to preserve the parent, the flank operation is certainly to be preferred, with the larger animals and the Sow, as no sutures can resist the weight of the mtestines when the incision is at the inferior part of the abdomen. Even with the Bitch the flank operation should be adopted for the same reason, and also because wounding the mammae is avoided — an important consideration in more GASTRO-HYSTEROTOMY, OR THE CESAREAN SECTION. 559 respects than one. It is true that Bourgelat, describing how gastro-hys- terotomy ought to be performed in the Mare in order to obtain the living foetus, says that the animal should be carefully thrown, placed on its back, and there secured. " Then a crucial incision is to be made at the middle of the lower part of the abdomen, and it should be about a foot- and-a-half in length — terminating at the pubis. If the large intestine, forced outwards by the struggles of the animal, appears, it should be carried to one side, when the uterus will soon be seen ; then an opening, corresponding to the other, must be made with the greatest circumspec- tion, so as not to wound the foal ; the membranes are to be opened, the * waters ' they contain escape, and the young creature is to be im- mediately removed. The success of the enterprise depends upon the attention paid in order to prevent the death of the Mare j the more time lost, so the more is the foetus weakened ; the less time is there to spare if the Mare is dead, for then it is certain that the foal will not live longer than a few moments." The umbilical cord was to be liga- tured at four or five inches from the body of the foal ^ *' after which it is only a question of providing means for rearing the young animal, until it can attend to itself." But Rainard points out that nothing is said as to closing and bandag- ing the incision, or the after-treatment of the mare — thus indicating that preserving the foal only was in view. With the Mare or Cow, the operation is sometimes attempted in the standing attitude ; but it is obvious that there must be great inconvenience and danger in this. It is much better, therefore, to place the Mare, Cow, Sheep, or Goat, on the left side — right side uppermost ; either side suffices for the Bitch or Sow. If the animal is narcotized and insensible, then it is not necessary to secure the limbs ; but if it is only partially, or not at all unconscious, then means of contention must be adopted, for the safety of the animal as well as the operator. The right hind leg should be firmly fixed back- wards, so as fully to expose the region to be operated upon ; the other three limbs are secured together in the ordinary manner. A small animal can be held by one or two assistants. The incision, as has been said, is made in the right flank, rather below and in front of the anterior spinous process of the ilium, so as to avoid wounding the circumflex artery — an accident which might embar- rass the operator ; if this or any other artery is wounded, it must be tied immediately. If there is no great hurry, and the hair is long, this had better be clipped off. The incision should pass downwards and forwards, in the direction of the fibres of the small oblique muscle of the abdomen (no muscle should be cut across) ; it should extend through the skin to the muscles, and even if it passes into these, there is no danger to be apprehended. The length of the wound will, of course, depend upon the size of the animal : for the Mare or Cow, it may be from twelve. to fourteen inches. The layers of muscles are to be gently cut through until the peritoneum is reached, and into it a small opening is to be made, but in doing this the greatest care is to be exercised, so as not to wound the viscera. The two first fingers of the left hand are passed through this opening, the back of the hand downwards ; the blade of the probe-pointed bistoury is placed between these fingers, and carried along — cutting through the peritoneum and muscles until the opening is of the same length as that 560 OBSTETRIC OPERATIONS. in the skin. An intelligent assistant should be at hand to prevent the escape of the intestines through this large aperture. The arm of the operator is now pushed into the abdominal cavity in search of the uterus, which, when found, is brought opposite the incision, should it not be there at first. Two assistants compress the sides of the wound, so as to maintain them closely against the uterus ; this the operator cuts through slowly, layer after layer, using all diligence so as to escape wounding the fcetal membranes. Two fingers are insinuated between the walls of the organ and these membranes, and the bistoury is again employed to dilate the opening, as in the peritoneal incision, so as to give it nearly the same direction and extent of that in the abdominal wall. Should the membranes be still intact, they are to be torn, and the " waters " allowed to flow — but only ^7//- j"/V/(?the abdomen, if possible. The operator now, plunging his arm at once into the cavity of the uterus, seizes the first parts of the foetus that come to hand — fore-legs, head, or hind quarters, if possible — and removes it quickly ; the umjjilical cord is torn or tied, and the young creature given to those who will dry and rub it, wrap it in a warm blanket, and otherwise attend to it. The obstetrist immediately, if the parent is to be preserved, removes the fcetal membranes — an easy task comparatively in the Mare, much more tedious and difficult in the Cow, as all the adhering cotyledons must be separated one by one. Then, by means of a sponge, all the fluid remaining in the organ is to be cleared out, as well as any that may have escaped into the abdomen. It might be well to damp the interior of the uterus with a very weak solution of carbolic acid. . This accom- plished, the great wound is to be closed. Nothing is done to the uterus, as a rule ; the organ soon diminishes very considerably in volume, and it would appear that the wound in it is not long in cicatrizing. The borders of the wound in the abdomen, how- ever, must be speedily and solidly united. The best means of union is undoubtedly the quilled suture, which is to be applied according to the ordinary rules of surgery ; care must be taken to make the sutures enter at a good distance from the border of the wound, and to include the muscles as well as the skin. If the cord fixing the outstretched hind limb is slackened a little, it will facilitate closing the wound. A small corner should be left open at the lower end of the wound, to allow the products of inflammation and suppuration to escape. External to the wound, either a layer of fine tow or lint, slightly carbolized, or oakum, may be placed. Over this, long narrow strips of canvas covered with melted glue may be fixed, to support the sutures and retain the dressing ; then on these another thin layer of carbolized tow or oakum, and lastly, the wide body-bandage around the abdomen and loins of the creature. Though it is somewhat difficult to apply, yet it is essential that this bandage or compress be put on before the animal is allowed to rise. Afterwards, the bandage may be adjusted and tightened if necessary. When the incision is made at the lima alba the procedure is somewhat similar ; but, as we do not recommend it for the reasons above stated, we need not allude to it further. The after-treatment of the wound is that followed for all such serious traumatisms. Cold water, or ice, or very dilute carbolic acid, may be applied to the wound, if necessary ; but very often this requires only ordinary surgical management. The patient must not be allowed to lie down until the wound is united. GASTRO-HYSTEROTOMY, OR THE CESAREAN SECTION. 561 The diet should be light and sloppy for a short time, unless the animal is very feeble, when nourishing food must be given. With the smaller animals the treatment will be the same. For enlarg- ing the abdominal and peritoneal incisions, small sharp scissors will be found very useful and safe, the blade with the blunt point being intro- duced. The bad results to be apprehended from the operation are septic metritis, or peritonitis, or both ; abscess at the seat of the incision, or adhesion of the abdominal organs to this part. As the subject is particularly interesting and important, we shall en- deavor to give the first complete list of cases of gastro-hysterotomy which has yet been published. 1. Youatt [Cattle, 1834) states that he had twice attempted the operation, but in neither instance did he save either the Cow or Calf. 2. Berry {Veteriiiarian, vol. xii., p. 709) records a case of extra-uterine foetation, in which the operation was performed by a medical man, but the Heifer died. 3. Ellis [Ibid., loc. cit.) : Operation on a Sow which could not farrow because of the immense size of the foetuses, which were in a state of decomposition. The operation had been delayed too long, however, and the animal died. Ellis rnentions -that he had twice successfully performed the Caesarean Section on the Bitch. . 4, 5. Carlisle [Ibid., vol. xiii., p. 121) operated on a Sow (flank) which had been in labor for six days, and had gone ten days beyond the ordinary period of pregnancy. The foetuses, seven in number, were dead, but the Sow recovered. He states that, sixteen years previously (he writes in 1839), a farrier residing near Carlisle had per- formed the operation on a Mare, and with success. " The poor animal was sadly mutilated."' 6, 7, 8, 9, 10, II, 12, 13, 14. Hayes, in 1824 [Ibid., loc. cit., p. 267), had a kind of ex- perimental operation upon a Bitch, removing six puppies alive, but one died on the following day. The remainder, with the Bitch, did well. ' In 1825, he tried to remove a Calf by embryotomy (head very large, and deviated to- wards the flank), but could not succeed : gastro-hysterotomy was resorted to, and the Cow was doing well until the twelfth day, when it suddenly died. The diaphragm was found to be ruptured and gangrenous. A third case occurred in a very old Cow, that had 'exceeded the usual period of ges- tation about seventeen days. The foetus, could not be extracted by embryotomy ; the pelvis being too small. After the Caesarean section, no untoward symptoms appeared, and the animal was quite recovered in nine weeks. The same practitioner states : " Since that time I have operated successfully on two Cows and one Sow. Three other Cows on which I operated died, in three, six and eight days afterwards ; two of these were affected with severe peritonitis. 15. Carlisle [Ibid., loc. cit., 1^. spi) performed the flank operation for torsion of the uterus. The Cow died from strangulation of the intestines. 16. Bowles [Proc. of the Veterinary Medical Association, 1839 — 40) describes a case in which the parent was killed, and the foetus extracted by the Caesarean Section. 17. Younghusband [Ibid.) records the case of a Cow which had been in labor for some time, and the os uteri of which was completely occluded. The animal was extremely exhausted, and the foetus seemed to be dead. As the case appeared to be a hopeless one, it was resolved to spare the Cow further pain by killing it. This was done by blowing into the jugular vein, and at the moment the animal expired the foetus was seen to move strongly. The abdomen was at once opened by a long knife, the uterus incised, and a living'Calf extracted. This being well attended to, in two days it was able to drink milk wdthout assistance, and was afterwards reared successfully. i3. Morgan ( Veterinarian, vol. xxix., p. 698) attended a Sow which could not farrow [all her pigs — only two having been born. One was extracted /^r vaginam by the crotch- iCt, but as the animal was sinking, it was decided to resort to gastro-hysterotomy. The [■operation was performed in the right flank ; only one foetus remained, and this was ■taken away. The Sow recovered in a short time. The incision in the uterus was su- ; tared. When the animal was fatted and killed, two months afterwards, it was found that [adhesion had taken place between the organ and contiguous intestine, and that an [abscess had formed, from which a sinus could be traced into the intestinal canal. The fright ovary was destroyed. 19. Brooks and "Whitworth [Ibid., vol. xxxix., p. 33) relate the history of a Bitch, 36 562 OBSTETRIC OPERATIONS. which, while pregnant, had its pelvis injured by being run over by a carriage. When parturition had been going on fruitlessly for some time, an examination was made, and it was discovered that, owing to the fracture of the pelvis, 'just above the symphysis pubis, the dimensions of the canal were greatly reduced and altered in form, so that the finger could scarcely be passed. Chloroform was administered, the hair removed from the skin in the right iliac region, where the incision was made. Two puppies were re- moved, the wound in the uterus closed*by silver wire suture. In three weeks the Bitch was well. The puppies, put to another bitch, also lived. 20. ?>zcc\\&ro [Giornale di Med. Veterinaria, 1858) alludes to the case of a four-years old Cow, which had been in labor for tliree days, and every attempt to remove the Calf per vaginani had failed. The os uteri could not be dilated. So it was proposed to extract the foetus by the Cassarean section. The animal was cast and properly secured ; an in- cision was made in the left flank, when all the intestines suddenly rushed from the wound ; these were received on a sheet, which was kept moist with tepid water. The uterus was then exposed, cut into, and a dead Calf pulled out by the tail. The operation occupied less than twenty minutes. The parts were well cleansed by an affu- sion of warm water, intestines returned, incision closed by twisted suture, and covered with fine tow steeped in warm wine. A net was fixed round the body to support the sutures. After the opei-ation was completed, the Cow got up and fed. The case termi- nated favorably, and the animal was subsequently fattened for the butcher. 21. Braga (Archivio di Medic. Vetertna7-ia, June, 1S76) was called in haste to attend a Cow — a Primipara — which had been some time in labor, the " water-bag " having rup- tured, and the fore-limbs of the foetus were presenting ; but nothing more was advanced. Braga found the animal in tolerably satisfactory condition, but the vulva was twice its normal size, and was partly emphysematous. The mucous membrane of the vaginal ves- tibulum was of a deep red color, with small black points, showing advancing gangrene. The fore-limbs protruded from the opening, and in such a manner that their posterior surface was superior. An exploration of the vagina discovered the mucous membrane of this part, as well as of the cervix uteri, to be greatly swollen and extremely hot ; while it was also ascertained that the foetus was in the dorsal position — the sternum towards the maternal sacrum, and the withers on the symphysis pubis, with the head and neck deviated towards the back. Every attempt to adjust the position, or effect delivery, failed — notwithstanding the use of the cords, crotchets, amputation of the head, etc. Although it was now late, gastro-hysterotomv was proposed to the owner, and the operation was allowed. The Cow was laid on its right side, and the incision was made at the liriea alha. When the uterus was opened, the back of the foetus was encountered, and not being able to remove it in this position, nor yet change it without greatly enlarg- ing the uterine wound, the hind-limbs were disarticulated at the stifle, and the remains of the creature were at last extracted. The incision in the uterus was not closed, but left to itself ; while that in the abdominal parietes was united by twisted suture ; a wide bandage was applied round the body. A stimulant infusion was administered to the Cow, and aromatic injections thrown into the vagina. The fever ran high, though there was not much prostration; but towards the evening the proprietor became alarmed, and fearing to lose the value of\he animal, he sent for the butcher and had it killed for food. 22. Gohier {Mhnoires de Gohier, vol., ii. p. 40) mentions the case of a Ewe which had been in labor for about twelve hours. The fore-feet of the lamb protruded three inches beyond the vulva, and the head was bent back towards the withers. ' The foetus was placed in a favorable position, but the most energetic traction only succeeded in tearing away the fore-limbs. The Ccesarean section was then decided upon, and an incision, about five inches in length, was made below the right flank ; the intestines were lifted out, and the uterus exposed and cut into. The foetus was now extracted, and afterwards the placenta. The intestines were replaced; the abdominal wound closed by quilled suture ; a compress applied around the body, and several glasses of decoction of gentian administered to the Sheep. Death occurred next day, and it was then discovered that the iliu.ii was the seat of an old fracture which had become united, ; nd in doing so had produced an oblique deformity of the pelvis. The head of the lamb had been arrested and bent back against the callus, opposite the cotyloid cavity. 23. Morange (D'Arboval. Dictio)in. de Med. Chiriiro-. etc., Veterinnire) furnishes the case of a Cow which had gone beyond the ordinary period of gestation bv thirty-seven days. The cervix uteri was altered in texture, and the os undilatable. The calf was dead, and consequently gastro-hysterotomy was decided upon. When the abdominal walls were cut into, an enormous quantity of reddish serum flowed therefrom. The foetus was removed, as well as the placenta, and the wounds united by suture. After the next day the appetite had returned ; but in fifteen days the owner,'thinking the animal was suffering from hunger, inconsiderately gave it a large quantity of lucerne, and the Cow soon died from indigestion. 24. Chariot {Journal Prat, de Med. Veterinaire, 1826, p. 165) mentions a Cow which GASTRO-HYSTEROTOMY, OR THE CESAREAN SECTION. 563 was extremely weak from having been in the pangs of impotent labor for three days. There was a vaginal tumor, apparently fibrous, which had been mistaken for the " water bag," and punctured ; this was the inverted bladder! The neck of the uterus was indu- rated. The animal being now considered lost, the Caesarean section was practised in the hope of saving the Calf. The operation was successful ; a living Calf, which was afterwards reared, being removed from the uterus. The Cow died. 25. Chretien {Ibid., loc. cit., p. 221) describes a similar case ; the Cow having been in labor for three days, the cervix uteri indurated, and the genital organs greatly inflamed. The Cow being deemed lost, it was determined to sate the Calf by the Caesarean sec- tion. The right flank was opened about two inches in front of the anterior spinous pro- cess of the ilium, the Cow being in a standing attitude; the incision was about seven inches in length. The uterus presented at the wound, and was incised in turn ; the foe- tus was removed alive, and then the membranes. A portion of intestine escaped from the wound ; this was returned, and the uterine wound closed by continuous or pointed suture ; the blood which had escaped into the abdomen was carefully removed, and a double suture united at first the muscles, then the skin. The Cow died eight hours after the operation ; the calf appears to have lived. 26. The same author (ibid.) alludes to another Cow which was in labor for six hours. Some time previously it had been treated for a fracture of the ilium, which united ; but the animal remained lame, and the callus filled one-third of the pelvic cavity. The fore- limbs of the foetus were outside the vulva ; the head was retained and thrown over the back. It was brought into a favorable position, and energetic traction applied, but the obstruction could not be overcome. The Caesarean section was deemed indispensable, and was practised as in the previous case, except that a small opening was left at the lower part of the wound for the escape of discharges. The Cow recovered, but no men- tion is made as to whether the calf survived. 27. This authority (/(!5zV/.) gives another instance of a Cow which had gone twenty- seven days beyond its time for calving, and had been in labor for twenty-four hours. The foetus was a Celosomian monstrosity, which could not be extracted per vias natur- ales ; so in order to save time, and fatigue to mother and operator, gastro-hysterotomy was performed, and practised the same as above. The extraction of the monstrosity was difficult, and it had to be divided — the anterior half being first removed, then the posterior. The Cow was killed next day, as fears were entertained for the result of the operation. 28. Pradal {Recueil de Mid. Vetcrinaire, 1833, p. 195) attended a Cow which had been making fruitless efforts to calve for forty-eight hours. When the animal was lying, on separating the labia of the vulva the posterior segment of the uterus could be seen well advanced in the vagina ; but when it stood the tumor receded into the abdomen. The cervix uteri was swollen, indurated, and almost cartilaginous in consistence ; di- lation of the OS was considered impossible. The foetus was alive and strong, as its movements showed. The Caesarean section was adopted ; the right flank, then the uterus was largely opened; the foetus was quickly removed ; and the Cow immediately killed by the butcher. The Calf was reared by another Cow.* 29. Lecoq {Man. de la Soc. Vet. du Calvados, etc., No. vi.) refers to a Cow which had been straining fruitlessly for twenty-four hours, and was weak and exhausted, though the pains still continued. The os uteri was occluded. Without giving any reason for the preference, Lecoq decided on the Caesarean section rather than vagftal hvsterot- om)-. An incision was made in the middle of the right flank, downwards and backwards, for about seven inches; then the uterus was opened. The foetal membranes were so thick and resisting that it was necessary to divide them with the knife ; the foetus was then easily extracted, though it was difiicult to remove the placenta afterwards. The abdominal wound was closed by suture. Notwithstanding every attention, the calf, which was weak and ill when extracted, died on the same evening ; while the Cow succumbed next day — twenty-four hours after the operation. 30. 31, 32. T,y Rainard (Op. cit., vol. ii., p. 103) states that he had performed the op- eration four times — on the Sheep, Goat, and Bitch, and he was never successful in saving either the parent or progeny ; though he admits that the animals operated upon were always in a desperate condition — the long-continued efforts to remove the foetus by the genital passages having exhausted them. 34. Garreau [Rec. de Med. Veteriimire, 1854, p. 513) mentions the case of a Cow preg- nant with its fourth calf, and which had gone fifteen days beyond its time ; though at the ordinary period it had exhibited signs of parturition, which disappeared only to re- appear at the end of the fifteen days. * This would have been an excellent case for original hysterotomy, and offered a good prospect of suc- cess. The Cow might even have recovered from the effects of the operation practised on it. 564 > OBSTETRIC OPERATIONS. The uterus was deviated [see p. 288), and there was induration of the cervix. Gar- reau saw no other means of relieving the animal than by resorting to gastro-hysterot- omy; though he did not venture to operate. The animal was not interfered with until three nionths afterwards, when being in the same condition, Garreau was requested to perform the operation. This he did somewhat after the procedure already indicated ; the foetus was extracted, and the abdominal wound closed by quilled suture. Kept on very low diet, and receiving tonics for some days, the Cow completely recovered; eight months afterwards it was sold, because it did not exhibit any inclination for the Bull. 35. Macorps {Aimales de Medf Veterinaire de Bruxelles, 1862, p. 137) had under treat- ment a Bitch which had in the right flank, towards the last mamma, a tumor the size of a fist, and which had appeared six weeks previously in a very gradual manner. It was neither hot nor painful to the touch or on pressure. As it was supposed to be a mammary neoplasy, its excision was attempted. A large incision was made in the skin, and there immediately appeared a white saccular body which was at once recognized as a titerbie hernia. Instead of returning it to the abdo- men, as this appeared to be both difficult and dangerous, it was decided to extract the entire uterine cornu as far as the cervix uteri, apply a ligature round it there, and thus extirpate the organ. This was done ; a few sutures firmly united the skin incision ; the animal was kept quiet, the diet attended to, a few enemas'.administered, and in eighteen days after the operation, the Bitch — of a sporting breed — was out in the field with its master. 36. Thierry {Bulletin de la Soc. Cent. Veterinaire, 1873) gives an interesting case of a Cow, three years old, which suffered at an interval of three days from a double luxa- tion of the coxo-femoral articulations from some unknown cause. A rectal and vaginal exploration led to the discovery of a slight deformity of the pelvis, and Thierry satisfied himself that it was a case of osteomalacia — a diagnosis which subsequent events con- firmed. In fact, in a few days afterwards, another exploration found a fracture of the pelvis, which appeared to have occurred spontaneously. Finally, symptoms of par- turition showed themselves, but birth could not take place ; the fracture had so nar- rowed the pelvic canal that it was barely possible to introduce the hand. After several ineffectual attempts, the idea of extracting the foetus by the natural passage was given up, and the Caesarean section practised. A fine calf, which lived, was the result ; the Cow was immediately killed, and at the autopsy the fractures and luxations diagnosed during life were found, 37. Saint-Cyr [Op. cit., p. 579) gave his attention'to a Bitch which had been in labor since the previous evening. It had given birth to a puppy twelve hours before, but no more could be expelled. When Saint-Cyr first saw the Bitch, the labor pains had ceased ; by vaginal exploration he could scarcely touch the foot of the most advanced puppy — which was not in the pelvis — with his finger ; while the volume of the abdomen led him to believe that there were more than one in the uterus. The general condition of the animal was good; so it was decided to try the Caesarean section, incising the right flank, where the foetuses were most readily felt by abdominal exploration. Three foetuses were removed from the right cornu by a single incision ; two of these were dead, but one was still alive. The operation being completed, the cornu was returned to the abdomen, but not sutured ; and the abdominal incision closed by interrupted suture, a bandage being placed round the body. After the Ofseration the Bitch was very weak ; it died in eighteen hours. The autopsy showed a moderate degree of metro-peritonitis. 38. Ory, in a communication to Saint-Cyr {Op. cit., p. 577) states that he was called to attend a Cow, which, for seven or eight days, had been making impotent efforts to calve On his arrival he found it extended on the litter, and quite unable to get up. For eight days it had been suffering from complete paraplegia. The "waters" had only escaped about two hours previously, and the uterine contractions were feeble ; the Cow was fat, but nearly dead. Vaginal exploration discovered the foetus to be alive, in the anterior position, head on the withers, and the fore-limbs completely retained and deviated backwards. Attempts were made to rectify this malposition, and the two limbs were brought into the pelvis ; but the Cow was evidently sinking and death imminent. Ory endeavored to get the head rectified, but quickly saw that delay would only entail the sacrifice of the calf as well as the loss of the Cow. The latter was killed by the butcher ; then at once, by a single cut of the bistoury, he made a large opening in the abdomen, and by another incision threw open the uterus, from which the calf was taken. The latter was well-shaped and alive, and being reared, became an excellent Cow, which Ory had under observation for eleven years. 39. In 1870, the same veterinarian (Saint-Cyr, Op. cit., p. 578) had to attend an aged Mare in labor. The animal was pregnant with its eleventh foal ; it had been straining so violently for some hours previously, that the rectum had become everted. This ever- GASTRO-HYSTEROTOMY, OR THE CESAREAN SECTION. 565 sion having been reduced, Ory practised the "touch," and found the cervix uteri so contracted that he could scarcely introduce one finger. After long-continued efforts, he contrived to introduce three fingers, but it was im- possible to effect more. The cervix was excised, but a new difficulty then presented itself : the foetus filled the uterus so exactly, that the hand could not be passed between it and the foetus. However, it was ascertained that all the feet of the latter presented, and that the young creature was doubled on itself ; it did not exhibit any sign of being alive. Ory then came at once to the conclusion that delivery by the genital canal was impossible ; though, for conscience sake, he did all he could during two hours until, exhausted, he was compelled to cease. The Mare being very old and of little value, he determined to have it destroyed ; but before doing so he resolved to save the foal — if it still lived — by resorting to the Cassarean section for its extraction. The operation was easily performed, and in the same manner as in the previous case. But the foal was dead. Its head was on the left shoulder, the croup ott the head, — the creature being thus gathered in a threefold mass, not unlike a ball, to which the uterus was closely ap- plied. All the feet were directed towards the os. The Mare was killed as soon as the operation was concluded, and its uterus showed a somewhat remarkable disposition. The body of the organ alone had been developed during gestation, and it had a globular or spherical shape, not unlike that of a woman. The cornua were ver^' slightly developed, and formed, near the anterior part of the organ, two nearly equal appendages about three inches long. 40. Rohhves (Dieterich, Geburtshiilfe, p. 125), in 1822, refers to the case of a Mare which could not foal. He had the animal placed on its back, the fore-feet fastened to as many posts, and opened the abdomen at the linea alba. The foal was alive, and was extracted; it was reared by another Mare, its mother having died, and was afterwards a stud stallion. This is the earliest recorded case of gastro-hysterotomy we can find any notice of. 41. Lehnert {Sachs JaJn-esbericht, 1S73, P- ^5) performed the Caesarean section on a Cow which was dying from a lung disease, and extracted three living calves. 42. Feser ( Thierarztliche Mittheilungen der Munchener Schule, Part iii., p. 296) op- erated on a Bitch which could not pup, making the opening in the left flank, against which the uterus lay ; three puppies were extracted — one from each horn and one from towards the os uteri, the latter being dead, and from a deviation of its head it consti- tuted the obstacle to birth. The heads of the other two puppies were likewise deviated. The uterus and Fallopian tubes — every thing behind the cervix uteri — were extirpated by the ecraseur. The uterine and ovarian artery were ligatured. The incisions were closed by suture, and ice applied to the left side of the abdomen. The animal lost about three ounces of blood. An hour after the operation it had a shivering fit, but this soon passed off ; though it recurred three times a day for some time. In six- teen days the wound had healed and the Bitch was quite recovered. The puppies were reared artificially. 43. The same veterinarian [Ibid., p. 297) performed the Sedio Ccesarean on another Bitch two years old. The animal had been in labor for two days, and was extremely weak ; no puppies has been born. The section was made on the left side, and four dead puppies extracted. The uterus and ovaries were extirpated by the ecraseur, and the arteries ligatured. Frequent rigors appeared after the operation. In twenty-four hours death ensued, the fatal termination being apparently due to septikasmia. 44. Feser [Ibid., p. 298) relates another instance in which he performed the operation, extracting; four living puppies — two from each cornu ; the incision was made in the left flank. The uterus and ovaries were also excised in this case, the animal losing about five ounces of blood. Extreme prostration ensued after the wounds were closed, but this was combated by stimulants, and sprinkling sweet spirits of nitre over the body. The appetite was good, and with the exception of traumatic fever, no unfavorable symptoms supervened. In eight days the Bitch had recovered ; two of the puppies were reared artificially. 45. Adam [Briijliche Mittheibing) performed the operation on a Bitch, under chloro- form, making the section at the linea alba, behind the umbilicus, and dividing the tissues with the scalpel, the peritoneum with scissors; the cornua were opened by incision. After removal of the foetuses, the wound in the abdominal muscles was united by suture, then that in the skin. During the first day the animal was very depressed and feverish, but on the third day it was able to move about. The puppies, which were very large, were reared by hand. Eight months afterwards the Bitch again became pregnant, and, not being able to bring forth, died — no assistance having been rendered on this occasion, apparently. 46. Soerensen [Tidskrift for Veterinar.. 186S) gives the case of a Sow, the vagina of which was so swollen that it could not farrow after one foetus had been expelled. Soeren- sen operated as for ovariotomy ; first removing the bristles from the left flank where the 566 OBSTETRIC OPERATIONS. incision was made, A foetus was extracted from the left cornu, and through the same opening another was obtained. The hsemorrhage was unimportant. The ovaries wdre extirpated, and the uterus wound being left untouched, that in the abdominal wall was sutured. The Sow was fattened and soon after killed. The right cornu was found to l>e normal ; the left contained about a pint of pus at the part where the incision had been made. 47. Jensen [Ibid., 1869) relates an instance in which a Sow could not farrow ; the left cornu of the uterus had been previously removed. He incised the right flank, opened the right cornu, and extracted five foetuses — three of which were alive, and lived. The foetal membranes were entirely removed, and the wound closed by interrupted suture. The Sow recovered and became very fat. When killed there was a litre and a half of pus in the uterus. 48. This authority {Ibid., 1S73) had occasion to resort to the operation again in 1873. The subject was a Sow — pregnant for the first time — which had already brought forth three dead foetuses. Next day the abdomen was greatly distended, and fluid was dis- charged from the opening. In the left cornu was found only one very large foetus, and in removing it, the friable texture of this part was-torn. The abdominal wound was closed by suture after the extraction. The Sow recovered and was fattened. When killed, a well-marked cicatrix was observed in the left cornu with some tubercles ( Tuberkel) around its margin ; the cornu was somewhat contracted at this part — else- where it was normal. 49. Adam, sen. (Miindliche Mittheilung) relates that a worthless Mare became acci- dentally impregnated, and at the end of pregnancy could not foal, owing to a contracted pelvis. The case being hopeless, the Mare was killed, the abdomen and uterus imme- diately opened, and a living foal extracted ; this was kept alive for eight days. 50. Adam, junr., was called to attend a pregnant Mare which could not expel the foal. Attempts were made at extraction, but all failed. The animal was killed by a blow on the head, and the abdomen and uterus being opened, and the membranes incised towards the head of the foal, the latter was extracted. The entire operation did not occupy more than ten minutes. The foal lived for eight days. CHAPTER V. Symphysiotomy. Symphysiotomy, as the name implies, consists in dividing the ischio- pubic symphysis throughout ; so that, by allowing the bones to separate somewhat in the pubic region, the pelvic cavity may be enlarged, and the passage of the foetus through it rendered possible. But even in woman, with every advantage and appliance, and after a most serious mutilation, the separation procured between the bones is infinitesimal, and therefore can have but little influence on the progress of the foetus. And when we remember that in woman the mortality is more than 32 per cent., while among those which survive many are permanently disabled, and those which recover often require months before convalescence is established, it will be understood that the operation can never, with our present knowledge, be reckoned among those which the veterinary obstetrist must practise. It may be sufficient to notice the fact that, in animals, the symphysis pubis, as a rule, soon becomes ossified. The operation does not appear to have been resorted to in veterinary obstet- ricy, and it would require a bold operator to attempt it. RETENTION OF THE FCETAL ENVELOPES. 567 BOOK IV. ACCIDENTS INCIDENTAL TO PARTURITION. The accidents incidental to the act of parturition are rather diverse, and not unfrequently complicate those difficulties already alluded to as hin- dering natural birth. These accidents may occur either during par- turition, immediately after delivery, or within a few days subsequent to that event. In addition to the accidents, there are diseases which appear during the puerperal period : though the distinction between them and the former is not always easy to establish. Some of the complications just alluded to may succeed a perfectly nor- mal delivery, or an accidental abortion, as well as a difficult birth. The accidents consecutive to or accompanying parturition, may be enu- merated as follows : (i) Retention of the foetal etivelopes in the uterus and the consequefices ; (2) Post-partum hce7norrhage from the genital organs ; (3) Displacement or hernia of one or fnore of the i?iternal genital organs through the vulva ; (4) Trau?natic lesions of the ge?iital or neighboring orgafis. Some of these accidents are either very serious in themselves or in their consequences, and require the greatest skill to remedy \ or they are comparatively trifling, and easily repaired. CHAPTER I. Retention of the Fcetal Envelopes. The retention or the foetal envelopes, placenta, " secundines," or " after- birth," beyond a certain time after the expulsion of the foetus from the uterus, must be looked upon as an accidental or pathological condition which requires attention. We have already shown that the placenta is usually shed or expelled soon after the young creature is born, and par- ticularly with such animals as the Mare, Sow, and Bitch, the placenta of which is diffused or zonular ; indeed, with multiparous animals — as the two latter — the placenta of each foetus is extruded soon after its birth by the succeeding foetus ; so that, if retention occurs at all, it is only the last, or the two last placentae which remain in the cornua of the uterus. With ruminant animals, however, retention is far from rare ; though even in them there is a difference in this respect, according to species — this accident being much more frequent in the Cow than in the Sheep or Goat. This frequency in ruminant animals is doubtless due to the pecu- liar conformation of their placentae — the cotyledonal arrangement being evidently opposed to segregation. But if the Cow is the animal of all others in which this accident occurs, it is also the one which appears to be the least inconvenienced by it ; for, as Saint-Cyr correctly observes, it is not uncommon to see Cows which four, six, eight, and even ten or twelve days after parturition, have not got rid of the placenta, and yet are lively, the appetite is Unimpaired, and they continue to ruminate and give milk as if there was nothing amiss. 568 ACCIDENTS INCIDENTAL TO PARTURITION. Symptoms and Termi fiat ions. The symptoms are generally so marked that the obstetrist readily dis- covers the state of affairs. Nearly always there is a more or less consid- erable mass of the foetal envelopes — sometimes only the umbilical cord — hanging from the vulvar orifice, the labia of which are often swollen and injected. Occasionally the mass is so large as to reach below the hocks, with little bags of liquor amnii at the lower end ; it has, if recently expelled, a fresh tint, not unlike that of the intestines ; but if exposed for some time, and especially in summer, it is greyish-colored, somewhat adhesive, and generally soiled by faeces or litter, . In other cases nothing is noticeable, except when the animal is lying on its abdomen ; then the pressure on the uterus pushes the cervix into the vagina, and if any portion of the membranes is through the os, of course it is visible. And in others, again, nothing whatever is to be seen whether the creature is lying or standing, the whole mass b^jng retained in the uterus. After the third day of delivery the os is usually closed ; and unless a portion of the membranes chanced to be in the vagina be- fore this period, the entire placenta is imprisoned in the uterus, and a manual exploration will not always discover it. Sometimes only a frag- ment of the membranes is so retained. We have mentioned that, in many cases, the animal does not evince any uneasiness at first ; sometimes, when the portion of placenta hang- ing outside the vulva is large and heavy, when the creature is standing the meatus urinarius is pressed upon, and micturition is rendered diffi- cult. There may also be symptoms of abdominal uneasiness — whisking the tail,. stamping with the feet, and making efforts as if to defecate or micturate, with slight and brief uterine contractions, which may eventu- ally lead to the expulsion of the placenta. it often happens that when the os is not completely closed, owing to a portion of the membranes lying in it, spontaneous expulsion takes place, after a variable period. Deneubourg, a Belgian veterinary surgeon, asserts that it occurs at fixed intervals, which are almost regular "tertiary periods ;" that is, if expulsion does not ensue in the first twenty-four hours, it should take place on the third day ; and if not then, it will be either on the sixth, ninth, twelfth, fifteenth, or other tertiary interval — but most frequently on the ninth day. How far this assertion maybe correct, experience can alone decide ; what is more to the point, however, is the fact that, when once this spontaneous expulsion has been effected, there is little to be apprehended. It is not so when retention is accompanied by decomposition of the membranes. This occurs when the air has access to them ; and all the more rapidly does putrefaction progress as the temperature is high, and they are impregnated with discharges. The odor is most repulsive, and a sanious brown-tinted discharge, com- posed of debris of the membranes, and secretions from the irritated mu- cous lining of the genital canal, fiow from the vulva — soiling it, the tail, thighs, and hocks, and often excoriating them ; this discharge is most abundant when the animal extends itself to micturate, and it is then horribly fetid. The hand, on being passed into the vagina, is covered with the fluid, and it may encounter shreds of the placenta. In such cases, the hea'lth of the animal often suffers : there is dulness, RETENTION OF THE FCETAL ENVELOPES. 569 prostration, diminution in the secretion of milk, decreased appetite, re- spiration perhaps quickened, temperature increased, and other indica- tions of illness. The complications from placental retention are somewhat numerous. Contact with the decomposing membranes may so irritate the interior of the uterus as to occasion metritis, or even metro-peritonitis — a diseased condition which is always serious, and often fatal. There is also risk of septik^emia ; and even under the most favorable circumstances there sometimes remains a local irritation — a chronic vaginitis or metritis which leads to leucorrhoea. Some authorities have observed trismus, tetanus, metastatic arthritis, and chest affections, as seqicelce of placental retention. There is no danger when the retention has only lasted for two or three days, and particularly if a large portion of the membranes protrudes be- yond the vulva, and they have a fresh tint. Attention is necessary, however, when the placenta begins to putrefy, and a fetid discharge commences from the vulva ; though even so late as fifteen days after par- turition the membranes may be expelled spontaneously, without any in- jury occurring to the animal from the prolonged retention. The case is serious, however, when the animal begins to show symptoms of general illness, and, particularly if no portion of the placenta can be seen, or the OS be occluded. Plastic adhesion of the placenta to the uterus is also a grave complication, though happily rare. In these instances, the animal gradually becomes listless, weak, and emaciated, loses its appetite, and ceases to yield milk, until at length it falls into a state of marasmus, and perishes from septikaemia. Or in more rapid cases, with these general symptoms we have the lining mem- brane of the vagina of a deep-red color and intensely hot, a fetid sanguineo- purulent discharge from the vulva ; tremblings over the whole body, hurried respiration, intense fever, and all the other signs of metritis. Though retention is not, in the majority of cases in the Cow, a very serious affair, yet it should be attended to even in this animal. With other creatures it is much more to be dreaded, as they incur greater risks by prolonged retention. Saint-Cyr mentions the case of a fine Mare which died in less than eight days from metritis, due to the fcetal membranes being retained ; though the cause was not ascertained in time. Causes. Retention, it appears, occurs most frequently in cases of abortion, or when birth occurs some days before the proper time. It has also been re- marked that a Cow which has retained its placenta unusually long after the birth of its first calf, will do so at every succeeding birth. A protract- ed and laborious birth is also said by some authorities to favor retention, while other obstetrists declare that the converse is true. The accident is stated to be more frequent with old Cows, and especially when these are employed in draught — as in France and other countries. Abnormal adhesion between the maternal and fcetal placentae, of course, would be a sure caqse of prolonged retention, and we have given instances of such adhesion ; indeed, every obstetrist knows that at times there is much dif- ficulty in disuniting the cotyledons in the uterus. When the cervix uteri contracts rapidly after delivery, and the os is 570 ACCIDENTS INCIDENTAL TO PARTURITION. consequently firmly closed, the placenta, though non-adherent, will be retained. Rueff mentions that the accident is especially frequent in certain years. when the herbage and forage is not good, and particularly when the latter is mouldy ; it has long been known that these conditions favor abortion. He also alludes to a popular belief in Germany, which attributes this ZurUckbkiben der JVachegeburf, to allowing the calf to take the teat before the placenta has been expelled ; the irritation of the udder so produced reacts sympathetically on the uterus, which contracts at the cervix, and so retains the membranes. According to Baumeister, milking too soon, or giving cold water to drink, is supposed to act in the same way. Numerous other causes have been mentioned as influencing this reten- tion ; but we need not notice them, as there is really no proof that they do operate in this way. The accident occurs under all systems of man- agement, and all kinds of conditions ; it is, therefore, probable that sev- eral causes may produce it, and that some of these are still obscure. Treatment, The treatment of placental retention appears always to have been a subject on which diverse views and opinions have been held : many ob- stetrists maintaining that — with the Cow more particubvly — this reten- tion is never dangerous in itself, and that unless there arise complications, • the removal of the foetal membranes should in every case be left to the efforts of nature ; while there are others who assert that there is great risk in this retention, and that when it has exceeded two or three days after the birth of the foetus, there is need for active intervention. The experience of the majority of obstetrists will negative both of these opin- ions j for it is a matter of almost daily observation, that in many instances the placenta remains without inconvenience in the uterus for several days — six or eight — before it is spontaneously expelled ; while in other cases retention for the same period is marked by more or less serious symptoms. This difference undoubtedly depends upon circumstances, the precise nature of wjiich we cannot always fully ascertain or compre- hend. Nor can we venture to lay down positive rules as to when it is time to interfere, or when abstention will be the prudent course : — this can only be learned by individual experience and the tact of the practi- tioner. It may be remarked, however, that when parturition has been normal, when the Cow does not appear to suffer pain or inconvenience, when the " straining " is unfrequent and slight, the appetite good and lactation es- tablished, and particularly when, during a low or moderate temperature^ a portion of the membranes protrude beyond the vulva ; then there is no great reason for interference until a week or even more has elapsed. But if, on the contrary, the external temperature is high, the labor has been difficult, the genital organs irritated or abraded, and if fever, rest- lessness, and suffering are noted, with strong and frequent straining, and especially, if there are foul-smelling discharges from the vagina, then in- tervention is called for, no matter whether the time which has elapsed since parturition is long or short. When the envelopes form a somewhat large mass hanging from the vulva, it may be anticipated that early and spontaneous removal wall take RETENTION OF THE FCETAL ENVELOPES. 571 place ; though it sometimes happens, as we have pointed out, that the weight of the pendulous portion causes inconvenience in micturition ; while it fatigues and pains the animal by dragging on the uterus, and inducing expulsive but futile efforts. Schaack has shown that in nearly all these cases it will be found that a loop of the membranes has become twisted around the pedicle of some large uterine cotyledon ; and as this is the obstacle to separation, it is necessary to release the loop as soon as possible, in order to prevent accidents. It has also been remarked that, even when birth has been easy and favorable, primiparae are often irritable and impatient, and the presence of the secundines in the vagina and vulva exaggerate the restless, and occasion frequent and energetic uterine contractions. In such cases it will generally be found judicious to remove the membranes as soon as possible — on the same day, or the day succeeding deliver)^, if necessary. If, after the birth of the foetus, nothing is seen at the vulva except a thin cord, formed solely by the umbilical vessels, we may be almost cer- tain that there is a strong adhesion between the maternal and foetal placentae, and that the separation of the latter will be protracted — in all likelihood require to be removed artificially. But even in such a case there is no occasion for immediate interference ; on the contrary, it is more judicious to wait, and allow time for the placentae to soften and the adhesions between them to diminish : though the opportunity for complete detachment must not be overlooked. When nothing whatever is discernible externally, there is reason to surmise that the placenta is completely retained. But even in this case there is no need to resort at once to removal of the membranes ; though it may be necessary, in order to prevent imprisonment for sg>me time, through the closure of the os uteri upon them, to introduce the hand into the uterus, and if they are already partially detached, to extract them. If they remain firmly adherent, however, it is better to .gather as much as can be seized into a single mass, carry it through the os into the vagina, and tying it there by a long piece of cord, to leave the latter hanging without the vulva. In this manner the os is prevented from closing, while the cord will assist in effecting artificial removal at a later period, should such be demanded. Certain medicaments, more or less of the nature of emmenagogues — such as rue, savin, laurel, stramonium, carbonate of potass, etc. — have been for a long time credited with the power of hastening the expulsion of the membranes ; and their administration has been recommended be- fore resorting to manual force for the removal of the placenta. Some of the recipes for these potions are very antiquated, and others are quite modern, and lauded by the highest authorities. Zundel, for instance, extols laurel berries, and gives the following recipe : Laurel berries - - - - 120 grammes. Aniseed 60 " Bicarbonate of soda - - - 120 " These are infused in 4 litres of water, and given in two doses. It may be repeated the following day ; but, as a rule, the membranes are expelled within twenty-four hours after the last dose has been given. Zundel asserts that this infusion has rendered excellent service, succeed- ing in sixty per cent, of his cases of retention. Hering and Stockfleth 572 ACCIDENTS INCIDENTAL TO PARTURITION. also speak highly in its favor, and assert that it is always successful, pro- vided there is no mechanical obstacle to the expulsion. Baumeister and Rueff recommend carbonate of potass in the dose of 45 grammes daily, at three times, and in an infusion of chamomile or savin. Hummer pre- scribes 90 gramme doses for three consecutive days, and Hertwig, Lund, and others also prescribe it with the same object. Hering gives the fol- lowing formula : Carbonate of potass - - - 15 grammes. Savin leaves 30 " These are infused in 500 grammes of water, filtered, and administered tepid. The dose to be repeated every six hours. Garreau praises Caramija's uterine tincture, which he states always succeeds in producing expulsion of the membranes, even when they have been retained for two months after parturition. The formula for this tincture is given by Tabourin as follows : Powdered savin - - - 250 grammes. Treacle - - 190 Powdered cumin - - - 125 ' Essence of rue ) " savin j ^^ - 80 Alcohol - 2 kilogrammes. Garreau prescribes this tincture in doses of 100 grammes, given in 2 litres of savin infusion. Cruzel likewise has his favorite potion, composed of 30 to 40 grammes of green rue, or 10 grammes of ergot of rye and 20 grammes of powdered savin, made into a decoction in a litre and a half of water. Delwart, Rainard, and Schrader recommend ergot of rye, and Ungefrohrn stra- 'monium Seeds (30 grammes in two litres of water), which he believes to be specific in their action ; he advises that linseed decoction be given in the intervals, as it acts as a diuretic, and Rychner asserts that this sim- ple medication is particularly useful when the foetal membranes are so decomposed that they cannot be removed by the hand. The subcutaneous injection of ergotine or ergot of rye has also been advised. Extract of ergot of rye, one to three grammes, dissolved in glycerine and spirits of wine (fifteen grammes of each), has- been used for injection. Though medication has been so highly vaunted by some authorities, yet some others have not much faith in it. Deneubourg thinks its chief advantage is in making the owner of the animal exercise patience, until spontaneous expulsion is effected ; the least active measures being the best. Other obstetrists entertain the same opinion of these emmena- gogues. For a very long time, an empirical mode of removing the placenta when a part of it protruded beyond the vulva, was to exercise slight and continuous traction on it by attaching a weight to the pendulous portion : in France the farmers attach a " sabot " filled with gravel. Favre of Geneva, who notices this rude method, admits that a weight not exceed- ing two pounds may be suspended from the membranes, which are col- lected into a mass and tied with a piece of hemp. This method is, how- ever, objectionable from several points of view. RETENTION OF THE FCETAL ENVELOPES. 573 Manual traction is often employed when a portion of the membranes is visible. This is seized either by the hands, or by means of a towel, or wisp of hay or straw, and gently pulled at — particularly when the animal strains — twisting it at the same time, until the whole mass is re- moved from the uterine cavity. This traction is not likely to be productive of much injury to the Mare, Sow, or Bitch, as the adhesion of the placenta is .not great, and is usually limited to a few points ; it is, therefore, as a rule, generally and quickly successful in these animals. With the Cow, however, it is not so, owing to the numerous, and often strong attachments of the placentae, and the fragile texture of the mem- branes, which are easily torn if too much force is employed ; if they do not give way, and the traction is immoderate, then there is risk of irrita- ting the uterus, tearing away the cotyledons, or producing partial or complete inversion of the cornua, or even of the entire uterus. Should the membranes alone give way, this may lead to greater difficulty in re- moving what is left of them in the uterus. For these reasons, some practitioners discountenance this mode of ab- stracting the placenta ; but there can be no doubt that if the traction is moderate and judicious, the membranes not very adherent to the interior of the uterus, and a good part of them beyond the os, the operation is quite justifiable, and will be successful. When, however, the resistance is marked, or the membranes begin to tear, it is better to desist. Deneubourg recommends the following method, as better than employ- ing the hands : The protruding umbilical cord is seized between two pieces of wood, the length and size of an ordinary walking-stick, and rolled round them until they are close to the vulva ; there, by a slight and gentle circular movement, the portion engaged in the vagina produces a kind of titillation which induces the animal to stretch as in micturition — an act it nearly always accomplishes — and during this period the mem- branes are rolled round the pieces of wood as they are detached, which usually occurs in about six days, when the whole is removed. When any resistance is experienced, and any thing is found to tear or rend, it is evi- dent that adherences still exist, and the rolling must cease ; but then, by a kind of jerking movement from side to side, there are communicated to the uterus, by means of the adherent membranes, a series of shakes more or less energetic, according to the state of the organ. Deneubourg says that there need be no hesitation in employing a certain amount of force in practising these movements : " We may act strongly, but gently." Great success is said to have attended this method. But, after all, it is doubtful whether the more scientific and surgical, and old plan — that of direct extraction by enucleation of the cotyledons — is not preferable. This method consists in passing the hand into the uterus, and detaching, or enucleating the cotyledons, one by one, so as to destroy the adhesions between the maternal organ and the foetal envelopes, and extract the latter. When this extraction should take place will depend upon circum- stances. It will generally be found that it will not be successful beforie the third day, as the cotyledons are too closely and firmly united to allow their disunion without injurious force, which may bring about inversion of the uterus, or laceration of the maternal cotyledons, and consequent haemorrhage. About the third day is generally a favorable period, as the OS is still sufficiently relaxed to pass the hand through it into the uterus, 574 ACCIDENTS INCIDENTAL TO PARTURITION. while disintegration between the fcetal and maternal placentae has ad- vanced sufficiently to permit the hand to complete the disunion without need for violence. It sometimes happens, however, that extraction can be effected so late as the fifth or eighth day after delivery ; but then the membranes are extremely friable, and will scarcely withstand any degree of traction. Besides, the operator himself incurs great risk of infection, either Iccal or general, from the absorption of the putrid matters in the uterus by the skin of the hand and arm, which have been engaged in that cavity. An assistant holds the tail of the animal to one side, and the hand and arm, being well oiled, are passed into the vagina ; if a portion of the membranes is in this canal, then the operation is not so difficult, as the os will probably be more or less relaxed, and this portion lying towards the palm of the hand — the back of which is upwards — serves as a guide ; while the left hand pulls at it gently, as occasion requires. When, how- ever, nothing of the envelopes is to be found outside the os, and that opening is firmly closed — as happens four or six days after birth — then it may be very difficult to reach the interior of the uterus. One finger must be at first introduced, then two, and three, and so on, until the hand, in the form of a cone, and by a semi-rotatory motion, can be passed through. This operation is often long, troublesome, and fatiguing, and requires to be carefully managed, so as not to bruise, irritate, or wound the organ. When the hand reaches the interior of the uterus, it is pressed forward between the mucous membrane of the latter and the chorion — the palm towards the latter — separating them as it advances until it meets with the cotyledons. Some of these — the maternal — may be detached from the membranes, while others are still imbedded in them, as it were, through their fcetal cotyledons. These last have to be enucleated ; and to effect this, the cotyledon is gently pressed at its base between the thumb and index finger, and, if necessary, the fingers are moved over each other as if removing a buttoi-Afrom its button-hole. Other practitioners make pres sure on the summit of the cotyledon by the three first fingers, and thus destroy the adhesion. In this manner the hand passes from one coty- ledon to another, effecting disunion as rapidly, yet carefullv, as possible. At times a cotyledon will be met with which adheres so very firmly that it cannot be detached in the way just mentioned. Then the nail of the thumb or other finger must be gently insinuated at the border, so as to gradually raise it, and pass the finger over its entire surface. The tediousness of the operation will be inferred, when it is known that the number of adherent cotyledons may sometimes amount to more than a hundred ; and the fatigue is often so great that the right and left hand have to be employed alternately — a circumstance which has advantages otherwise. When a certain number of cotyledons are detached, the portion of en- velopes so released is carried into the vagina, and beyond the vulva, where the other hand, or an assistant, seizes it, and pulls gently on it. As the bulk of this increases by the detachment of more cotyledons, the pulling must cease, and the mass will require to be supported so as to prevent tearing of the membranes, or painful dragging on the fundus of the uterus. As the hand reaches the cornua, the cotyledons increase, and it be- comes difficult to reach them — particularly the cornu in which the hind- limbs of the calf were lodged — because o^ the insufficient length of the arm. Moderate traction, however, on the part just detached will bring RETENTION OF THE FCETAL ENVELOPES. 575 the others nearer, and facilitate the task ; but the traction must be judi- ciously managed, else tearing of the membranes, the adherent cotyledons, invagination of the cornu, or even inversion of the uterus, may result. So likely is this accident to happen, that some practitioners, instead of pull- ing at the membrane in this way in order to disunite the most distant cotyledons, %re content to await their natural separation, merely tying near the vulva the portion of the membranes separated, and cutting away the parts beyond — the separation generally occurring in from two to five days. To facilitate the traction, Gunther recommends that the abdomen of the animal should be well raised by a piece of wood placed under it, and held by assistants. It has sometimes been found, as already mentioned, that the greater part of the membranes has been expelled, when all at once expulsion has ceased, notwithstanding the volume and weight of the pendulous mass, which caused so much disturbance to the animal that it has refused to eat, persisted in lying, and when compelled to get up, has kept stamping its hind feet until it could lie down again. On introducing the hand into the uterus, it has been discovered that this unusual interruption to the ex- pulsion has been occasioned by one or two large maternal cotyledons be- coming entangled in the loop of a duplicature of the membranes. Some- times the drag on these cotyledons has been so great, that they have been brought as far as, or even beyond, the os. Relief has been given by cutting the membranes off by scissors, close to the vulva, and then releasing the cotyledons. When extraction of the membranes has been properly conducted, there is no haemorrhage ; if bleeding ensues, then one or more of the maternal cotyledons have been injured, or perhaps torn off altogether — an acci- dent not without danger sometimes, and all the more serious if a number of the cotyledons is involved. This injury may lead, in addition to he- morrhage, to uterine irritation, metritis, or uterine phlebitis. Still, such an untoward accident is not always the result o/ injury to the cotyledons, as instances are recorded in which great numbers, or even the whole of the maternal placentae, have been torn away by ignorant empirics, and yet the animals have survived — we have shown at the com- mencement of this work that fecundation and gestation may even take place after ablation of the cotyledons. Nevertheless, these cases must be looked upon as entirely exceptional, and must not be relied upon as evidence that these bodies can be injured with impunity. In order to be assured that the whole of the foetal envelopes has been removed from the uterus, it is well to make an examination of them. Knowing their conformation and extent, there should be no difficulty in ascertaining whether they are all present. After the removal of the membranes, there always remains in the uterus a quantity of thick, grumous, diversely-colored fluid, more or less unpleas- ant smelling, which is derived from the foetal fluids, the blood which has escaped from the umbilical cord, and the partly-decomposed envelopes. As the retention of this fluid is likely to do harm, particularly if there is any wound or abrasion of the mucous membrane, as much as possible of it should be removed by the half-closed hand. It is often advisable to wash out the interior of the organ with tepid water, and to inject a weak solution of carbolic acid, chloral, or permanganate of potass. When extraction of the envelppes has been effected in good time, and with the necessary precautions, the Cow bears the operation very well, 576 ACCIDENTS INCIDENTAL TO PARTURITION. and does not appear to be much inconvenienced, while but little after- treatment is needed. Gentle walking, if the weather is fine, in order to calm its restlessness and to allay the straining, if it is still present ; keep- ing in a well-lighted and properly ventilated stable ; a blanket over the body if the temperature is low ; a few enemas, if constipation threatens; and a light laxative diet, with bran, oatmeal, or linseed gruel,' are usually all that are necessary. When the envelopes have putrefied in the uterus, through delay in re- moving them, and an abundant and fetid discharge flows from the vulva, while the animal itself is unwell and feverish, then the case is serious, and requires instant and close attention. The uterus must be cleared, without delay, from its putrescent contents, and in order to accomplish this, the hand must be passed into the organ, and fevery thing removed which it can possibly seize. Before doing so, however, the hand and arm should be well and frequently smeared with carbolized lard, butter, or oil, to prevent septic infection ; if there are wounds or abrasions upon them, the greatest care should be taken in this respect — indeed, it is questionable whether they should be introduced at all if the skin is not intact. When every thing has been taken away which the hand can remove, then the interior of the organ should be thoroughly cleansed by the con- tinuous injection of tepid water from a large syringe and tube, until the fluid comes away perfectly clean. Very weak solutions of the before-mentioned antiputrescents should also be injected, but they need not be allowed to remain. Should the discharge continue, this treatment may be repeated daily until it ceases ; and tonics, stimulants, and antiputrescents (as the sulphite of soda) administered internally. Good food and cleanliness are also essentials in treatment. The hands and arms of the operator should be thoroughly washed as soon as passible after the uterus has been emptied ; for this purpose nothing is better than carbolized soap. On the slightest sensation of uneasiness in the arm, advice should be taken with regard to it, as an attack of Ecthyma parturitionis is often a serious affair, and has necessi- tated the amputation of fingers, and even the greater portion of the arm. It must be remembered that cleansing and detergent injections are absolutely required when the mucous membrane of the vagina or uterus is inflamed, abraded, or wounded, and has been in contact with putrid membranes of fluids. More particularly are they necessary in placental retention in the Mare — an animal peculiarly liable to septic infection. Indeed, so much is this the case, that it may be laid down as a rule that manual extraction of the membranes is always indicated in the Mare, when they are not expelled immediately after birth. The injection of warm water will materially facilitate the operation. With the Mare, however, retention of the placenta does not invariably lead to serious results, as several cases are on record in which it has con- tinued for two days, and even longer. Binz mentions an instance in which the membranes were not thrown off until the ninth day, owing to adhesion of the uterus to a hernial sac. POST PAR TUM HjEMORRHA GE. 577 CHAPTER II. Post Partum Haemorrhage. HEMORRHAGE from the uterus, or " flooding," after abortion, or the birth of the foetus at the ordinary term — an accident so frequent and alarming in woman — would appear to be far from common in the domesticated animals. This difference between the female of the human species and that of animals, is evidently due to the dissimilarity in organization of the uterine mucous membrane in them, particularly at the insertions of the placenta foetalis ; as well as to the absence of those immense vascu- lar lacunas which exist in the uterus of woman, the walls of which are so thin and fragile as to be easily torn when the placenta is detached, and which renders insufficient contraction of the uterus after delivery such a grave matter. Another reason for the unfrequency of metrorrhagia in the veterinary obstetrist's patients, is the great rarity of placenta pravia in them,* and which is a somewhat common cause of liEemorrhage either during or after delivery in woman. Nevertheless, whether owing to some anatomical or pathological pecu- liarity, to atony of the uterine walls, rupture of vessels during removal of the foetal placenta, or even during its spontaneous expulsion, almost every practitioner of any experience has met with cases of metrorrhagia of a more or less alarming character. So serious, indeed, is this hae- morrhage, that the mortality has been estimated as high as 73 per cent, of the cases reported. We have already, at page 190, alluded to metrorrhagia occurring dur- ing pregnacy. In what Cox has designated " pre-placental presentation " {Veterinary journal, March, 1877, p. 178), we may have haemorrhage en- suing. According to this authority, such presentations are rare, and if they occur at the termination of gestation, may be looked upon as un- favorable ; though they are most frequent in cases of abortion, and are then seldom followed by serious results. Metrorrhagia ensues when the usual period of parturition has been exceeded, and the " water-bag " has been presented and ruptured, the entire placenta foetalis coming away before. the foetus itself. " In some cases a considerable portion of the membranes envelope the fore-parts of the foetus, and occasionally to such an extent as to retard delivery ; this may be shredded off and re- moved without risk, but it will be found that the posterior part remains attached. The fatality attendant upon these cases is owing to neglect of examination and proper aid, and this negligence is owing to the absence of 'pains.' After the removal of the foetus, it is found that haemorrhage has taken place from the open vessels, and the quantity indicates that it *Yx?cnc\i{Handbtich de Thierarztlichen Geburtshiilfe, and Zeitshrift fur T/ieirmedictn)\\Z5 clearly demonstrated the occurrence of placenta prjevia in animals. Grey {Veterinarian, vol. xxvi., p. 12) gives two instances of what he believed to be this condition. A farmer, in passing through a field in which Cows were grazing, came upon a newly-expelled placenta, and knowing that one of the animals was in calf, and near parturition, he returned to his farm, and gave directions that the calf should be looked for, as he could not find it in the pastures. Nothing of it could be discovered, however, and the Cow was therefore driven home. While being milked, however, it began to show uneasiness, and to evince evident signs of approaching labor. Grey was sent for, and he states: "On examining my patient, I found a dead foetus with all four legs presenting, which was with the greatest difficulty extracted." The Cow lived. _ In the second instance, he was called to attend a Cow which had expelled the foetal membranes, and exhibited great uneasiness. " In this case, on making an exploration, I again found the foetus presenting in a false position ; but, after a little manual dexterity, I was enabled to remove a dead calf of unusually large size." The Cow survived. 37 578 ACCIDENTS INCIDENTAL TO PARTURITION commenced immediately after the separation of tlie placenta. I have seen these cases only in cattle." In certain instances, there can be no doubt that, as in woman, insuffi- cient contraction of the uterus is a cause of post partum haemorrhage ; and, according to Schroeder, this atony of the organ is especially observed after a rapid emptying of its cavity, whether artificially or naturally pro- duced, also after a previous and very considerable distention. It there- fore occurs after very rapid deliveries, too early turning, and extraction, in hydramnios, and twins. The haemorrhage is sometimes also due to general debility, and too feeble development of the uterine muscles (either congenital or depending upon previous very difficult labors). Partial adhesions of the placenta to the uterine wall, which, however, are rarely caused by real connective-tissue bands, may also give rise to profuse haemorrhage ; because the separated places in the vicinity of the adhesions can only imperfectly contract. Symptoms. The symptoms of post partum haemorrhage are not well marked, unless die bleeding is visible, though they are those of profuse haemorrhage in general. There is the quick, weak, running down pulse, which, becomes imperceptible as death approaches, and the throbbing, irregular contrac- tions of the heart ; the decoloration of the mucous membranes, rapidly increasing prostration of the animal, with the unsteady staggering gait on movement, and the difficulty of maintaining the standing position to- wards the end ; the haggardy^^/Vj-/ with chilliness of the surface, cold, clammy perspiration breaking out over the body ; and, finally, the re- cumbent position, convulsions and death. Sometimes there are indications of abdominal pain — indicated by paw- ing and looking anxiously at the flanks ; but these indications are only likely to be present when the haemorrhage is due to traumatic influences. When the haemorrhage / concluding that the bleeding was proceeding from the uterus, which, in consequence of the enfeebled condition of the animal, had not power to contract. I resolved to resort to the injection of cold water. Half an ounce of the tincture of galls was mixed with a quart of water ; but not more than the third of a pint was injected, before a sharp but low cry informed me that the agent had done its work. No more was injected ; but the haemorrhage ceased, and the Bitch seemed re- freshed." It recovered. 11. Cox {Ibid., vol. xxvii., p. 16) reports the Case of a Cow which, showing symptoms of calving the previous day, the owner examined it and found the calf in a wrong posi- tion, but with the help of a neighbor contrived to accomplish delivery. From that time the Cow became unwell, refusing all food, etc. Cox found the pulse quick and weak ; the mucous membranes blanched ; breathing quick and laborious ; constipation ; limbs cold and nose dry. Suspecting rupture of the uterus, he introduced his arm, and al- though very little blood had been discharged, the case was discovered to be one of "flooding," the uterus being full of coagulated blood; the Cow was evidently sinking. A sponge, impregnated with acetic acid and tincture of opium mixed, was passed into the uterus; stimulants were administered, with plenty of gruel; and cold water was constantly applied to the loins, vulva, etc. The animal recovered. There was no straining until the arm was passed into the uterus, and in all probability this stimulus to contraction was the principal factor in suppressing the haemorrhage. 12. Sarginson {Ibid., vol. xxx., p. 329) alludes to a Cow which was brutally maltreated by an empiric, who forcibly dilated the os uteri, and tore away a calf, which soon after died. Profuse haemorrhage commenced immediately, "the blood fairly spouting out."| The placenta had been extracted along with the calf. The os uteri and vagina were| lacerated to some extent ; the Cow was sinking from loss of blood. Cold water W3 continually applied to the loins for many hours, and dilute sulphuric acid given internally., This checked the haemorrhage, and stimulants and tonics, with good food, being allowed,| the animal in seven days was convalescent. 13. 14. King [Ibid., vol. xlii., p. 157) gives a description of two cases of post partunA uterine haemorrhage in the Cow, in which he succeeded in suppressing the bleeding bj slowly injecting cold water into the uterus. By furnishing himself with two bladders and holding each in succession — when filled with water — in contact with the large end of the pipe of an ordinary clyster syringe, and pressing the bladder with the other hand, hel was enabled to introduce the fluid very gradually and with little force. Three gallons of^ water were thus injected. The animals were freely supplied with stimulants at ii tervals. 15. Cox {Veterinary ymirnal, March, 1877) delivered a Cow of its calf without diffi- culty ; the placenta followed, and every thing appeared to be well until soon after, when| it was reported that the animal was - " parting with great quantities of blood. Thisf proved to be the case ; it was discharged in volume equal to an ordinary pump spout.! INVERSION OF THE UTERUS. 581 It was an urgent case. I soaked four or five double towels and a sheet in cold water, and passed them through the vagina into the uterus, and then blocked that passage up in a similar manner. From fifty to sixty cans of cold water were thrown on her, and a double cloth over her loins was kept constantly wet. Acetate of lead and opium were admin- istered internally, with alternate doses of laxative medicine. On the third day the cloths were eased by twisting them, and on the fourth day they were expelled. The ani- mal recovered, and was in usual milk in ten or twelve days." 16. The same veterinary surgeon {Ibid.) was sent for in great haste to see a Mare which had foaled, and was reported to be losing great quantities of blood. When he arrived, he found the animal so exhausted that it was staggering about. "In several places where she had stood for a short time^ were clots of blood the size of a man's head, besides much fluid blood that had been evacuated, and had sunk into the ground. I douched her with a great volume of cold water, and adopted the treatment before men- tioned. I did not introduce cloths into the vagina. The Mare recovered." CHAPTER III. Inversion of the Uterus. Inversion, procidence, prolapse of the uterus, or vagino-uteral inversion, sig- nifies a kind of hernia of the organ, consisting in its partial or complete turning inside out: the inverted fundus escaping through the os uteri {partial i?iversion), vagina, and vulva, and perhaps descending as low as the hocks {comptete inversion), where it forms a more or less voluminous tumor. When the inversion is very partial, nothing whatever is seen externally, and an exploration alone reveals the existence of the accident ; if more developed, the uterus appears as a round tumor between the labia of the vulva when the animal is lying, and especially if the floor is sloping back- wards, which causes the gastro-intestinal mass to press upon the organ. Sometimes the procidence is so very slight that there is merely a bulging inwards at the fundus of the uterus, or in one of the cornua. In complete inversion, we not unfrequently have prolapsus of a portion of the vagina ; and it is recognized as appearing in two forms or degrees, according as there is inversion of the body of the uterus, or inversion of the cornua as well ; sometimes it is only one cornu, which is then de- viated to the right or left of the vertical direction of the body of the organ, according as it is one or other of these parts. If both cornua are com- pletely inverted, they terminate inferiorly in the form of a cone ; but if they are only incompletely so, then they remain cylindrical at their lower end, and at the centre of the cylinder is a depression or caecal cavity. Inversion of the uterus is, of course, only possible when the os uteri is dilated ; consequently, it occurs either immediately before or after birth. Again, inversion is simple or complicated. It is simple when the viscus is intact, uninjured, and not accompanied by the extrusion or displace- ment of any other organ. When it is wounded or torn, or when there is accompanying hernia or protrusion of other viscera, then it is complicated. As we have said, ruminants are most liable to this accident : the Cow coming first, then the Sheep and Goat ; the Mare is less frequently affected, and the Sow and Bitch perhaps not so often as the Mare. In- version of the uterus has been observed in the Cat and Rabbit. With the Bitch and Sow, incomplete inversion of the uterus is far from uncommon, as is also simple inversion of the vagina, for which it might be mistaken. In uniparous animals, the whole of the organ is usually in- 582 ACCIDENTS INCIDENTAL TO PARTURITION verted ; while in multiparous creatures, generally little more than the por- tion which contained the foetuses is involved. •The accident has been observed in animals kept in houses and stables, as well as in those roaming about at liberty ; and it has been known from time immemorial. The Roman veterinarian, Vegetius, alludes to it, and recommends the employment of an inflated pig's bladder as a very good pessary. , Symptoms. The symptoms of uterine inversion vary with its extent. With uniparous animals, inversion always commences at the fundus of the organ, most fre- quently towards the largest cornu where the greater p^rt of the foetus was lodged. Under the influence of an irregular, and kind of spasmodic con- traction, this part is drawn, or pushed inwards, just as the foot of a stock- ing is inverted ; and this action continuing, the fundus or cornu is more or less rapidly carried towards the os, through which it passes into the vagina {incojnplete inversion), dragging after it the body of the organ, which also becomes inverted as it proceeds. It is rare indeed that inversion does not go beyond this; for the con- siderable alteration in position and relations which has already taken place, gives rise to sensations of discomfort and pain, and these react on the nervous system, and induce contraction of the uterine and abdominal muscles. Powerful and hurried expulsive efforts ensue, and soon the or- gan is pushed beyond the vulva, where its own weight carries it down- wards, and renders the ^rcAdt^isns comJ>kte — the lining or mucous membrane having become external. When inversion is complete, the uterus has the form of an enormous pear or calabash-shaped tumor, hanging between the posterior limbs : the wider and rounded portion being inferior, and sometimes extending as low as the ho.cks, the narrow extremity or pedicle being at the vulva, in the interior of which, and between the labia and the tumor, is a more or less deep and circular ctil-de sac, according as the prolapsus has in- volved a certain extent of the vagina. That the surface of the tumor is composed of the uterine mucous mem- brane, is easily apparent from its softness and color — which is sometimes m a bright red, at other times somewhat violet or brown, according as it is 1 much injected with venous blood, or irritated by the external air, or the litter, fqeces, etc., with which it may have come in contact, and which may be adhering to it. With the Mare and Sow, we can recognize the uterine placental villi, and the innumerable depressions for the reception of those of the foetal placenta ; in the Cow, Sheep, and Goat, we have the deep- red isolated fungiform eminences or cotyledons, and in the Bitch and Cat, the wide dark-brown zone. Sometimes we notice with the Cow, — more rarely with the Mare, — portions of chorion still attached to the placental surface of the uterus ; and nearly always are seen excoriations, more or less extensive ecchymoses, and even gangrenous patches, on the membrane — indications of the injury the organ has sustained, either during or after parturition. This mucous surface is not so sensitive as might be im- agined ; it is more or less hot, and bleeds at the slightest touch, though the haemorrhage may not be profuse ; at one side or the other may be noticed a kind of depression — the opening to the cornu which is not yet inverted. The longer the period which has elapsed since inversion occurred, so INVERSION OF THE UTERUS. 583 the larger is the tumor. This increase is due to the violent expulsive efforts of the animal, as well as to the increase in weight of the organ in consequence of the congestion and infiltration which has taken place in its textures : constricted — even strangulated — at its upper part, the cir- culation is maintained with great difficulty, and the capillaries become gorged with blood. The walls of the organ lose their elasticity, become thickened and dense, and darker tinted, until, from its increased volume and altered aspect, it can scarcely be recognized ; while its reposition is rendered extremely difficult, if not impossible. In consequence of the excessive hyperaemia, ulceration and gangrene usually supervene ; these are serious lesions, and may induce afatal termi- nation. * Such a grave accident as this, in which we have such extensive dis- placement, with severe straining at the suspensory ligaments of the uterus, and sometimes their rupture ; the irritation and perhaps abrasions or wounds of the mucous membrane ; the tension on the vagina, and the compression of various parts or organs — all this might be expected to produce general disturbance. And this is the case. From the very commencement, and even before any thing is apparent at the vulva, the animal is uneasy and anxious-looking; it paws with the fore, or stamps with the hind-feet ; switches the tail as if driving off insects ; lies down and gets up frequently, finding no ease in either attitude ; and strains more or less energetically at closer or wider intervals, thus adding to the extruded mass. Not unfrequently the Mare kicks at the prolapsed uterus, or endeavors to attack it with its teeth. At first there is no perceptible fever, and the animal, in the intervals of straining, attentive to what is going on around it, is solicitous about its progenx^, and may even eat. This state is not of long duration, however ; for soon after inversion is complete, indications of fever manifest them- selves : quickened pulse and respiration, elevated temperature, and an expression of anxiety and pain. The straining is more frequent and energetic, and soon exhausts the animal ; and the prostration, together with the great weight of the pendant uterus, compels it to assume and maintain the recumbent posture, in spite of attempts to make it get up. The organ assumes a gangrenous or intensely inflamed appearance," and the animal soon succumbs, either from the nervous prostration resulting from its sufferings, or from the condition of the uterus. In woman, sudden inversion of the uterus always leads immediately, according to Schroeder, to great general disturbance — the heart's action is deranged, and syncope, convulsions, vomiting, etc., may sometimes be caused by the sudden change in the position of the uterus. More fre- quently those symptoms depend upon acute cerebral anaemia, to which the sudden emptying of the uterus of its contents already predisposes, but which must be still greater when not only the contents of the uterus, but the whole organ itself, passes out of the abdominal cavity. .The blood then rushes into the vessels of this cavity, which are suddenly under a greatly diminished pressure, and the cerebral anaemia that en- sues is due to the scanty supply which the upper half of the trunk now receives. A similar condition is sometimes — though rarely — observed in animals, and particularly in the Mare. A good instance is that furnished by Peuch at page 579 (case 5). 584 ACCIDENTS INCIDENTAL TO PARTURITION Complications. ^One of the ordinary complications of this accident, is the adherence of the foetal placenta to the uterine surface ; though this is much more frequent with animals which have a multiple placenta — Cow, Sheep, and Goat — than with the Mare, Ass, Sow, Carnivorous animals, or the Rabbit. The inversion of the uterus — when complete — also brings about dis- placement of the vagina, as Hurtrel d'Arboval has remarked ; the deep- er portion of this part is found folded on the neighboring surface of the cervix ; the bladder and inferior wall of the rectum are drawn into the middle of the pelvic canal, and occupy the place the uterus has quitted -, the meatus urinarius is doubled on itself, and so compressed that no urine can flow through it ; while the ureters continuing to carry that fluid to the bladder, this reservoir soon becomes filled and greatly distended, without relief being possible. Hence results another source of suffering, and another cause of exhausting efforts which are added to those occasioned by the prolapsed uterus. In certain cases there may also exist prolapsus of the rectum, and displacement, or even inversion, of the bladder. The uterus may also be wounded or torn, either from bad management during parturition, or from injudicious attempts at reposition ; or the injury may be due to rats, cats, dogs, or pigs gnawing at the bleeding mass ; sometimes it is the creature itself, or a neighboring animal which inflicts the damage. The contact of the air, and particularly of foreign bodies, induces inflammation, which frequently runs on gangrene, and this to dissolution. Gangrene is readily induced in the Sheep. Sometimes perforation of the vagina or uterus, arising at times from sloughing of a gangrenous patch, has caused fatal peritonitis ; at other times pelvic abscesses have formed. After reduction has been effected, metritis and metro-peritonitis may appear ; this is not at all unlikely in the Mare. Lafosse mentions para- plegia also as a complication ; this may be a consequence of gangrene and septic infection. An exceptional complication is hernia of the intestines, through a rupture in the uterus. It may be noted that in prolapsus uteri in the Mare, it has happened that the colon has followed the fundus of the organ, and become invaginated in the inverted sac. Funk also mentions the case of a Bitch in which one of the cornua became inverted, and prevented the expulsion of the remaining foetuses from the other cornu -, thus necessitating the performance of the Caesarean section. Ayrault has, on three occasions, encountered an unusual complication after reduction of the prolapsed organ, in the form of severe lameness, with knuckling over of the two hind-fetlock joints, but without any artic- ular swelling. This complication disappeared as the animals recovered from inversion. T'rognosis. There can scarcely be any doubt that, if no assistance is rendered to an animal suffering from prolapsus uteri, death must ensue, and more or less speedily : as gangrene is inevitable, while spontaneous reduction is impossible. In some instances death occurs in less than twenty-four hours, but INVERSION OF THE UTERUS, 585 most frequently the animal may live from three to five days — very rarely longer. Sabini {younial des Vetir. du Midi, 1869, p. 175), an Italian veterinarian, cites a case in which treatment was not adopted until the seventh day ; but this is an altogether exceptional instance. Inversion of the uterus is generally fatal when owners of animals have neglected to procure assistance until too late, or who employ ignorant people to attempt reduction. If attended to sufficiently early by those who are competent, the number of recoveries is considerable, and, as Saint-Cyr truly observes, perhaps in no other pathological condition is the utility and power of art, when invoked at the proper time, better demonstrated. The prognosis is not equally favorable, however, in all the domesti- cated animals ; and between the Mare and Cow, for instance, the differ- ence is considerable. With regard to the latter animal, Deneubourg, who has often had to treat this accident, has never lost one of his patients. In one hundred cases, Donnarieix has only had three deaths. Moens, in twenty-seven cases, has not had a fatal termination. Guillaume, cited by Gelle, lost three cases out of forty-two : Loyer, of Nemours, nine out of twenty- seven ; and Mazure, Holland, one in four. With regard to the mare, Donnarieix had eight cases, and all perished ; Cruzel had three, and they also succumbed ; Schaack only saved one of two. In 249 cases of prolapsus uteri in the Cow, collected by Saint-Cyr, there were 30 deaths — or a mortality of 12 per cent. For the Mare he only found 19 cases, and of these 14 were fatal — a mortality of 74 per cent. A number of authorities quoted by Zundel give the percentage of re- coveries in the Cow as 97, and in the Mare as 50. It would, therefore, appear, and it is no doubt true, that this accident is much more fatal in the Mare than the Cow. Inversion in the Sow is nearly always fatal, unless amputation of the uterus is resorted to ; but this animal and the Bitch will live, in very rare cases, for two, three, or four days with the uterus prolapsed. It has often been stated that inversion of the uterus leads to infecun- dity ; but though it may do so- in some instances, yet it cannot be ac- cepted as a rule. Numerous cases are on record, and particularly for the Cow and Bitch, in which fecundation has taken place after this acci- dent. Though inversion is likely to recur after another pregnancy, or even during a succeeding gestation, yet even in this case it is not invariably so ; though to avert it care may be necessary. Causes. Inversion of the uterus is generally consecutive to parturition, and is most frequent in the Cow, w^iose uterine ligaments are so extensive and extensible. It usually occurs within two or three days after parturition, rarely later. With multiparous animals, in which each uterine cornu forms a kind of independent uterus, it can be understood that one of these may alone be inverted, the foetus contained in the other cornu being retained there for some time — though not without danger to its existence should this oeriod be much prolonged. 586 ACCIDENTS INCIDENTAL TO PARTURITION With uniparous animals, however, this cannot take place, it appears ; as the uterus cannot become inverted without the fcetus being expelled. Nevertheless, Aubry {Reaieil de Med. Veiermaire, 1859, p. 731) has pub- lished a very curious observation, in which it is mentioned that a Cow, affected with a prolapse of the vagina during pregnancy, had complete inversion of the left cornu at the end of that period ; but the calf, which was lodged in the right cornu, and which was alive and well developed, was retained there for two entire days. It was then necessary to inter- fere and effect delivery, which was followed by total inversion of the organ. This incident, which appears to be unique, does not, however, prevent us from accepting the rule as general, that inversion of the uterus is absolutely incompatible with the prolongation of gestation. In order that this inversion can take place, it is essential that the os uteri is more or less dilated ; consequently, the accident is only ob- served in breeding animals, and either during or soon after parturition or abortion. In order that it can occur, a certain degree of relaxation of the sub- lumbar uterine ligaments must be present ; there must also be some cause of irritation in operation after the expulsion of the fcetus, suffi- cient to excite the contraction of the muscles of the uterus and lead to inversion — though it is often difficult to ascertain what this ciuse may be. In very many instances gestation has gone on to its full term, the an- imal is strong and healthy, birth natural and easy, and there is nothing to indicate the advent of such an accident — when, suddenly, after a few expulsive efforts, the uterus is ejected in an inverted state. It has been attempted to explain the occurrence of the accident in such cases, by alluding to the lymphatic temperament of the animals, and their consequent laxity of tissue ; and it is often the case that Cows which are " soft," and kept on food that is better suited for the produc- tion of milk than flesh, are the most frequent subjects of inversion ; this sometimes occurring after each birth, and though parturition was perfectly normal. Inversion or retropulsion of the vagina during pregnancy, has also been accused as the cause of inversion of the uterus ; and it may be so in some instances, but it certainly is not s« in all. Indeed, excellent au- thorities maintain that there is no proof that this accident is more fre- quent in animals suffering from inversion of the vagina than those which are not. And it must be remembered, as already stated, that the os must be more or less dilated and dilatable for inversion of the uterus to occur — a condition which does not always, nor yet frequently, co-exist with vaginal inversion. The latter, indeed, is far from rare in non-preg- nant animals, and in those which have never been pregnant ; and it is not at all uncommon in those which are advanced in pregnancy, and yet do not suffer afterwards from this uterine displacement. Difficult and laborious parturition, when much manipulation and ener- getic traction on the foetus have been employed, has likewise been ac- knowledged as a cause of uterine inversion ; and it is certain that the efforts to remove a foetus which — whether from malposition, deviation of parts, excess of volume, etc. — cannot be expelled in a natural manner, are somewhat frequently followed by this accident. But on the other hand, how often do we find that the most vigorous — even painful and violent — traction, and long and complicated manoeuvres — are not sue- INVERSION OF THE UTERUS. 587 ceeded by inversion ; while, on the contrary, the easiest and most rapid birth sometimes is. The retention of the foetal placenta beyond the ordinary period, must also be taken into account as one of the exciting causes ; as it then acts as a foreign body, irritates the interior of the uterus, and so by a reflex action induces contraction of its muscular layer — thus giving rise to in- vagination of the extremity of one of the cornua, which is supposed to be the commencement of inversion. It is also extremely probable that injudicious traction on the foetal membranes may, for mechanical and physiological reasons, bring about this result in a flaccid and dilated uterus, when the cervix is also relaxed. More especially is this likely to happen if the placenta is adherent to- wards the fundus of the organ, or in one of the cornua. Much mystery appears to have attached to this inversion of the uterus, and though various causes have been assigned as operating in its produc- tion, yet as these were not present in every case, it has been admitted that a particular predisposition must have existed. We are much inclined to believe that several causes may be invoked to account for the accident. A flaccid, non-contracted uterus after birth, with a weak cervix and dilated os, and relaxed broad ligaments, we would certainly look upon as a predisposing condition ; and this is most likely to be present in lymphatic animals, or those suffering from atony, brought about by debility through disease, or bad or insufficient food, exposure to weather, etc. When this condition is present, it is easy to understand why inversion may occur from abdominal pressure at the cornua or fun- dus of the organ, or external mechanical force ; and we can also compre- hend why an antiperistaltic movement of one of the cornua, or a portion of it — ^just as happens in intussusception of the intestines — may take place sometimes, and lead to this condition immediately after birth, and before the cervix has had time to contract. Any trifling irritation may lead to this wrong movement, and once commenced it is far more likely to continue than to cease — as in the case of the intestines, when one por- tion becomes invaginated within another. We believe this will be found to be the correct opinion. ♦ Treatment. Whatever may be the cause of inversion of the uterus, the obstetrist must lose no time in remedying the accident ; as when interference is not prompt, a fatal termination, or, at the very least, most serious conse- quences rapidly ensue. In treating the inversion, several important indications are to be ob- served, but they may be classed as : (i) the imfjiediate ox preliminary mea- sicres which the local symptoms demand, (2) the reduction or reposition of the uterus^ (3) the retenfiojt of the organ, (4) the after-treatment ; or should reposition be impossible or contra-indicated, then recourse must be had to (5) excision or a7npiitation of the uterus. Preliminary Measures. The preliminary measures consist in combating the local and general symptoms. The animal is sometimes standing, sometimes lying down. If the lat- ter, it must be got up by some means or other, as the standing attitude 588 ACCIDENTS INCIDENTAL TO PARTURITION, is by far the best for reducing the inversion, there being more space in the abdomen when its walls are not compressed by the ground, and the obstetrist can operate more easily and quickly, while the downward in- clination of the lower surface of the pelvis and abdomen is favorable for reduction and retention. If the animal is not very feverish, but only debilitated, and there is otherwise no great urgency in the case, a strong diffusible stimulant may be administered, with the view to enabling it to get up. It may also be induced to rise by bringing a dog before it ; or it may be aided by a sack or sheet passed under its chest. If it cannot be made to get up, or is unable to stand when raised, then of course reposition must be effected while it is lying — fatiguing, and often troublesome, as the operation then is. This fatigue and difficulty may be somewhat diminished in raising the hind-quarters of the animal as much as possible, by means of bundles of straw placed under them, — all the litter being removed from beneath the abdomen, so as to relieve the viscera it contains from pressure as much as possible. Cosse, Tyvaert, Haubner, Andersen, and others advise placing the animal on its back, with the croup so raised ; while Viborg, Fassler, Bettinger, Ober- mayer, Hering, Merkt, Adam, and several other obstetrists, recommend raising or suspending the animal by the hind limbs, over a beam — a pro- cedure which, they assert, is most adv^tageous when reposition is possible or advisable. But as has just been said, the recumbent position, with the larger animals, is always to be avoided when possible, and every means should be tried to get them to stand. With the smaller animals — as the Sheep, Goat, Sow, Bitch, or Cat — it is convenient to place them on a bench or table, and lying either on the side or back, with the hind- quarters well raised. If the accident is recent — an hour or two, or even a little longer — the uterus may be returned at once \ but should a longer interval have elapsed, it is well to ascertain the condition of the rectum and bladder, and to empty them if necessary ; though it must be confessed that it. is often a most difficult task to accomplish evacuation of the bladder. It may be done, however, by causing assistants to raise the uterus, and to seek for the meatus urinarius on its lower surface, near the vulva, intro- ducing one or two fingers into that canal, or a catheter through it into the bladder. Should the fcEtal membranes still be adherent to the uterine surface — wholly or partially — then they must be carefully removed without injur- ing the cotyledons, enucleation being effected in the manner already described. If properly performed, this removal should not cause any haemorrhage ; and if any pulpy gangrenous cotyledons are found, it is better to remove them at once with scissors than kave them to be elimi- nated in the ordinary way ; though if they show any vitality at all they need not be interfered with. Torn or gangrenous portions of mucous membrane are also to be excised in the same manner. This done, the uterus should be cleansed from matters adhering to its surface — such as litter, mud, dirt, filth or blood ; and this may be effected by means of a fine soft sponge or cloth, the fluid employed being either cold or tepid water, milk and water, some astringent or soothing lotion, if there is much tumefaction or irritation, or a stimulating fluid— as the dilute tincture of opium — if the organ is much bruised and congested. Some practitioners immerse the entire uterus in a bucket containing either of these fluids ; and some particularly prefer cold w^ater, allowing INVERSION OF THE UTERUS. 589 the organ to remain in it for as long as five or ten minutes. By tliis means it is freed from extraneous matters and cleansed ; while the con- gestation is allayed and the mass considerably reduced in size.* Meyer, Pfirter, and others state that this immersion in cold water has an astonish- ing effect, and greatly facilitates reposition. Schnee even recommends the application of ice, which, he asserts, not only diminishes the volume of the protruded organ, but allays its irritability and contractions. When attempting to reduce the cornu or uterus, he holds a piece of ice in the hand he applies to the part. If from long inversion and consequent congestion, infiltration, or in- flammation, the volume of the uterus is so increased that it appears impossible to return it, scarifications may be made on its surface ; these often lead to a notable decrease in its size, and reduction may then be effected. If it is determined to scarify the organ, the greatest circum- spection should be observed in making the incisions ; they must be quite superficial, and only a few at a time. Should the hagmorrhage prove ex- cessive — which it sometimes does, when the scarifications are deep and numerous — then styptics must be applied. If the uterus is torn, it may be necessary to close the wound by the continuous suture — but this must not be drawn too tight ; mere apposition of the edges being all that is necessary. If the wound is not extensive, it need not be closed ; indeed, there are many cases on record in which wounds of the uterus have not been sutured — the organ having been merely returned to the abdominal cavity, and yet recovery has taken place. If hernia of the intestine or any other viscus in present, then, of course, this must be reduced before the uterus. Reduction or Reposition. When inversion of the uterus is incomplete — a very rare occurrence — and the organ has not passed beyond the vagina, reduction is compara- tively easy. It is sufficient, with the larger animals, to introduce the closed fist" into the vagina, and to push the uterus as far into the abdo- men as may be deemed necessary. When the animal strains, the opera- tor must not push, but maintaining what he has accomplished as well as he can, recommence as soon as the expulsive effort has ceased. Whether inversion is complete or incomplete, and if the animal is standing or lying, it is always well to have the hind-parts higher than the fore. When it is complete, then four assistants are necessary. One of these stands at the animal's head, and holds it firmly — if a Cow he may seize it by a horn with one hand and nasal septum by the other ; if it is a Mare, a twitch on the nose or ear may be required, and it may even be necessary to have a side-line on one of the hind-limbs. Another assistant holds the tail over the croup with one hand, and with the other he presses or pinches the loins in order to diminish the straining ; while a man stands at each side of the croup to aid in raising and returning the uterus. It is well to attract the animal's attention as miich as possible, as it then offers less opposition to the manipulations, and does not strain so vio- * A little care on the part of owners of animals would often prove of great advantage in averting serious consequences in such an accident as inversion of the uterus, beiore the arrival of the veterinary surgeon. This care should be mainly directed to keeping the animal in a standing attitude ; and preventing the uterus from being soiled, bruised or torn, as well as swollen. The or^an may readily and easily be preserved from injury by receiving it on a sheet or large cloth, or, better still, a basket or tray, and holding it well raised until prof.'ssional assistance arrives. 590 ACCIDENTS INCIDENTAL TO PARTURITION. lently. Pinching the nose and loins will be found very effective in this respect, and if a Cow, a dog may be introduced in front of it. Should the animal be much exhausted or unsteady, two additional assistants may be required to stand at each side. The uterus must be placed on a cloth or sheet in two or three folds and well moistened, the ends being held by the two assistants at the croup, so that the organ maybe lifted as high as the vulva. By doing so, there is neither traction nor compression on the mass, and as the circula- tion in it is thereby much facilitated, the tumefaction subsides to a cor- responding degree. It also allows the operator more freedom, as he could not sustain the weight of the prolapsed organ — sometimes as much as ICO to 140 pounds — and at the same time attempt its reposition. Indeed, some practitioners recommend that the two corners of each end of the cloth on which the uterus is placed, should be tied round the neck of the assistants, so that their hands may also be free to aid the operator in his manoeuvres : though this device must, one would imagine, have more disadvantages then conveniences. When the animal strains very severely and almost continuously — as sometimes happens during reposition — it is useful to constrain the chest as much as possible by a girth, so as to prevent its expansion. It may even be necessary to give a strong anodyne draught of chloral or opium. For effecting reposition, three methods are recommended, and these we will now notice : merely observing that whichever may be adopted, the operator always stands directly behind the animal, with the inverted organ immediately before him. First Method. — If the inverted tumor formed by the uterus, external to the vulva, is not very voluminous, and if by the application of cold water to it — should it be tumefied — it is reduced in size, then reposition may be effected by pressure on the fundus of the organ. This pressure is to be made by the closed fist against the central part of the tumor ; and in some instances, if it is well directed, and the inversion not serious, the organ may be returned to the pelvic cavity by one push, while another will carry it into the abdomen. Rainard and other practitioners approve of this method, and describe it somewhat in detail. The operator is to seek for the largest cornu — that which contained the foetus — seize it by the fundus, and reduce this by pushing it inwards, as we would the finger of a glove which has been turned outside in : continuing the reduction by successive portions until the pedicle of the tumor is reached, when more serious resistance is encountered from the os uteri. This being overcome, the body of the uterus is next replaced, either by the fist pressing against ^the widest part, or by using a pessary. The pressure is to be directed straight forward, though the vulva and pelvic canal, upwards and inwards. Great care is necessary in exerting the pressure, which should not be applied while the animal is straining. During expulsive efforts, the operator must be content to wait, merely keeping the parts where he has carried them, until the straining has ceased. The pressure must be steady and well-directed, so as not to bruise or lacerate the uterus. When a portion is got within the vulva, it is held there by one hand, while the other manipulates the next part to be returned. Reduction must be effected progressively, so that the organ may be completely replaced ; if it is not, then reinversion is certain to occur. Some practitioners employ the pad or cup-shaped pessary, to aid them INVERSION OF THE UTERUS. ' 5gi in this operation ; the round end is applied to the fundus of the uterus, and the pressure is made at the other end of the instrument by the chest or abdomen of the operator, whose hands are thus at liberty to direct the viscus into the vulva and vagina. Seco7id Method. — If the uterine tumor is voluminous, and hangs — a heavy mass — as low as the hocks, then the first method is dangerous, if not impracticable, and must not be attempted. The best method now undoubtedly is to return, first, the parts of the organ nearest the vulva, and not act directly on the fundus of the uterus until the greater portion has been replaced in the pelvis. In order to accomplish this, the assistants on each side of the croup raise the uterus in the manner already described, so as to bring it near the vulva, and opposite the axis of the pelvis. Then the operator gently presses with open hands on eacli side on the parts close to the vulvar opening, in order to force them gradually into it. By acting in this w^ay with care and patience, and preventing, as well as he can, the expulsion of those portions he has already reduced, the tumor by degrees becomes diminished, and may even be entirely returned. But it is not necessary to continue the method after two-thirds or three-fourths of the total mass has been conveyed into the pelvic cavity ; for it is then more expeditious, and quite as safe, to apply the closed fist to the extremity of the tumor, and push it directly into the vagina and abdomen. In some instances it will be found that, towards the termination of reduction, the organ itself returns to its normal position, and often quite suddenly, as if it had been thrown back by a spring. Sometimes a combination of the first and second methods is most useful : an assistant pressing; on the extremity of the tumor, while the operator manipulates near the vulva. Third Afethod. — This method was first brought to notice by Coculet i^Jounial dcs Vet. dii Midi, 1862), who, finding the previous methods long and laborious, set himself the task of improving it. This he has succeeded in doing by an ingenious procedure, which is described as follows. A dry and clean piece of linen, about a yard in length, and twenty-eight to thirty inches wide, is passed beneath the inverted uterus, and close up to the vulva ; its lower border is then lifted over the organ, one of the ends folded over it, and then the other end over this, so as to envelop the entire uterus — the four corners of the wrapper being uppermost. Tepid w^ater is now kept incessantly applied to this cloth, which is gradually tightened every minute, by placing the open hand beneath the mass, and with the other hand pulling at the upper end of the wrapper. This equable, gentle, and sustained pressure over the entire organ, soon (fifteen to twenty minutes) brings about a marked diminution in its size, and renders its reduction easier. The method has been most successfully employed on several occasions ; though some practitioners prefer immersing the protruded uterus in cold water at once, as being a quicker plan for reducing it, while also effecting the necessary cleansing process. Certainly cold water might frequently be substituted for tepid, and compression might commence at the lower extremity of the organ, par- ticularly if the bandage is elastic, on the Esmarch principle ; this would greatly expedite the operation, and would prevent injury to the uterus. Jensen (Hering's Repcrtorium, 1874, p. 183) describes a similar method to that of Coculet. 592 ACCIDENTS INCIDENTAL TO PARTURITION. When the uterus has been returned to the abdominal cavity, the oper- ator has then to ascertain if it is properly disposed. It sometimes hap- pens that the extremity of one or other of the cornua remains invaginated in itself to a certain extent, and thus renders reduction incomplete ; this will undoubtedly induce renewed straining, and in all probability bring about reinversion. It is, therefore, essential that the hand of the operator should carefully examine every part of the interior of the uterus and the genital canal, and particularly around the cervix. This is more especially necessary when, after reposition has been effected, straining continues — a sure indication that the parts are not in their normal position. The hand must then be again introduced, and if any abnormal folds of the mucous membrane — any commencing invagi- nation — is encountered, this must be gently smoothed down, or adjusted, and replaced — not forgetting, should ' the cornua be involved, the very dissimilar disposition of these in the Mare and Cow. When reposition has been finally accomplished, the straining ceases, and the animal soon appears to be quite easy : that is, if reduction is made early — on the same day, for instance — and provided there is no injury to the organ. It is generally advisable to keep the hand in the uterus for a short time until the latter begins to contract freely ; if this is not done, the flaccid organ may again become inverted. With the smaller animals, reposition is rendered difficult, because of the small pelvis not admitting the hand ; and with some, and particularly the Sow, reduction of the prolapsed cornu or cornua is often a serious mat- ter. The cornua must be reduced in the manner already indicated, the finger, or even a tallow candle, being employed to replace them, then the body of the organ should follow; a small pessary with a handle or retro- verter, may be used to complete the operation. Frick, a Swiss veterina- rian {Sc/iweizer Archiev.^ vol. xii., p. 249), has adopted a plan which has succeeded in his hands, and also with other obstetrists who have tried it. The inverted organ being reduced, the animal is raised by the hind limbs, and a quantity of mucilaginous fluid is injected into the vagiha and uterus, until they are filled. This fluid acts in a mechanical manner, forcing the uterus to distend and assume its ordinary form. In some cases, when reduction is attempted, the animal continues to strain so violently that it is almost impossible to operate, notwithstanding the adoption of the measures already recommended. In these cases bleeding has been advised and practised, but not always with success ; if the animal is not strong, it may do positive harm. Opium is not always a soothing remedy for ruminants, and if given in narcotic doses may lead to mischief. Ether has been employed to produce in- complete anaesthesia in the Mare, so as to diminish the expulsive efforts, and with success. Andelfinger, Rueff, and Baumeister, as well as Saint- Cyr, recommend this partial anaesthesia. Van Dommelen, a Dutch veterinary surgeon, gives the preference to a very strong dose of alcohol, so as to produce semi-narcosis. He has em- ployed it in a great number of instances of inversion of the uterus in which there was violent straining, and has never observed any accident. Chloral hydrate, either in draught or enema, should be found an excel- lent agent in such cases, as well as the subcutaneous injection of acetate of morphia. The injection of dilute tincture of opium into the uterus may also be found beneficial. It must not be forgotten that a tight surcingle round the chest or abdo- INVERSION OF THE UTERUS. 593 men or both, and raising of the hind parts of the animal as high as pos- sible, will greatly assist in diminishing the straining. , Cont£7itio7i or Retentiofi of the Uterus. Reduction of the inverted uterus having been accomplishecl, and every thing done to remove the slightest traces of invagination, the animal — unless serious injury has been inflicted on the organ — immediately begins to look easier and happier, and the inexperienced would suppose that there was no further occasion for interference. The experienced ob- stetrist, however, is well aware that certain precautions must be adopted against a possible recurrence of the accident. True, this recurrence is to a certain extent provided for by raising the croup of the animal as high as may be convenient, either by means of litter or boards, and keeping the forehand low. But this is not always a preventive, and veterinary obstetrists have therefore devised other means for retaining the uterus in its place until all risk of another inversion has passed away. These de- vices consist oi pessaries, sutures, and bandages. Fig. 196. Pad Pessary, Pessaries. — These are instruments of various forms, which are introduced into the genital organs, and kept there for a certain time, in order to prevent displacement of the uterus after its reduction. There are several described and used by veterinary obstetrists, T\-i^ pad pe^ssary (Fig. 196) is a round piece of wood, from twenty to twenty-five inches in length, with a hole at one end, through which passes a loop of strong cord six to eight inches long ; and at the other end a round pad, three or four inches in diameter, composed of tow or rags, covered by a piece of soft cloth, and firmly tied to the stalk by a piece of twine fixed in a small circular groove therein. In using this pessary, the pad is steeped in oil or melted lard ; it is then carefully introduced into the vagina, and placed against the cervix uteri, and cords from each side of the loop at the other end, attached to a surcingle round the chest, keep it firmly in its place. The pad por- tion of the pessary may be of wood, though the elastic material is to be preferred, A transverse piece of wood, with an eyelet at each end, and made to move up and down the handle by means of a screw, is some- times substituted for the loop of cord. This pessary may be most usefully employed as a repositor, in effecting reduction of the inverted uterus. The ring pessary (Fig. 197) is equally simple, and is preferred by some practitioners to the pad one. It is composed of a wooden, or better, an iron ring, about two-and-a-half inches in diameter, pierced by an elongated or mortised hole at opposite sides, and of a strong wooden stem about twenty inches long, cleft in two as far as the middle, where it is tied by a piece of twine or wire. The ends of the two branches (A A) are firmly tennoned in the mortises of the ring ; and the other end of the stalk (B) is flat, and passes through the central opening of a transverse piece (T T), 38 594 ACCIDENTS INCIDENTAL TO PARTURITION. which is about eight inches long, and has at each end an aperture (O O), in which are fastened the cords or straps destined to fix the apparatus. When required for use, the ring is wrapped in a narrow piece of fine linen, which is rolled round it in a uniform manner, so that it may not irritate the 'neck of the uterus, with which it has to come in contact. This part is well oiled, and being passed through the vagina, is so placed against the uterus that the cervix will be in the middle of the ring, which should make pressure on the cul de sac of the vagina. It is secured by means of cords or straps at the end of the transverse portion, in a simi- lar manner to the other pessary. The Cup-and-ball pessary (Fig. 198), invented, or first described by Fig. 197. Ring Pessary. Fig. Cup-and-Ball Pessary. Chabert, is not at all unlike the last. It is composed of a round iron or steel ring (A A), about the same in diameter as the other ; from this springs three stalks (B B B) which unite about six or seven inches from the ring into a single stalk (T T), which is screwed from a little beyond this union to the end. On this screwed portion moves a transverse piece (C C), by its middle opening, or female screw (E) ; this piece has open- ings (G G) at its extremities, which receive straps or cords. To use it, the ring and the three branches are dipped in melted wax, then cooled, and again and again dipped and cooled, until the instrument has acquired a sufficient volume, and the middle of the ring is reduced to INVERSION OF THE UTERUS. 595 about one and a half inch. This prevents its injuring the genital organs, when it is applied exactly in the same manner as the preceding pessary — thecervix uteri being in the centre of the ring. A rondelle pessary has been devised by Leblanc, and Rainard has in- vented a pessary (similar to Fig. 197) for small animals. A bottle pessary has frequently done good service, when nothing more suitable has been at hand. An ordinary glass bottle, with a deep con- cave and smooth bottom, has a long piece of wood fixed in the neck, and can thus be made to act like the other pessaries ; though its weight is objectionable, and there is also the danger of its breaking. A very ancient pessary — employed even by the Greeks of an early period — and one which has been most usefully resorted to by Tolney, Laubender, Willburg, and others, is the bladder of the pig or ox. When required for use, the bladder is steeped in warm water, then a long wooden tube, or a piece of india-rubber tubing, is fastened to the neck of it ; the bladder is introduced into the uterus and inflated, the tube being then closed. Rainard recommends that it be only placed in the vagina ; but the majority of obstetrists prefer it in the uterus. It has been allowed to remain there as long as ten and fourteen days. For valuable animals, it has been suggested that Gariel's air pessary might be employed. This acts on the same principle as the bladder ; in fact, it is an india-rubber bladder, which is inflated by means of a long tube with a stop-cock. This tube may be in connection with another bag and stop-cock, the former being already filled with air, which can be transferred to the other bag when it is placed in the vagina or uterus. The smaller animals rarely require pessaries of this description ; though there is no reason why, if necessary, modifications of the three first, and on a proportionately small scale, might not be employed. The ring might be made of india-rubber, or cork. For the Bitch, more particularly, the cuvette pessary, however, has been recommended and used. This is an imitation of that employed for woman, and is merely an oval, circular, or oblong piece, made of gum, india-rubber, gutta-percha, or ivory, one to two inches in diameter, and having a hole in the middle. When required to be introduced, this pessary is well oiled ; the narrow end is passed edgeways into the vulva, and the piece is pushed in beyond the bulb of the vagina. Then, by means of the index finger, it is placed ver- tically : the hole in the middle allowing the finger to fix it in the centre of the ^allva, its two fends being retained by the branches of the ilium, or at least in front of the ischium and the bulb. A spring, or elastic pessary, such as is now frequently employed for woman, and which can be more easily introduced into the vagina, might be useful with the smaller domesticated animals. Salt, of Birmingham, has introduced into human gynecology a new flexible annular pessar\', which might be advantageously employed by the veterinarian for the smaller animals. It consists of a watch-spring coiled spirally, with the extremities left free, and encased in caoutchouc ; it col- lapses for introduction, and when in situ, it expands to the circular form, or such other shape as may best accommodate its contact with surround- ing parts. The value of pessaries in inversion of the uterus in animals has been a good deal discussed. We are not aware that they have been much, if at all, employed in England j and in Germany they do not 596 ACCIDENTS INCIDENTAL TO PARTURITION. appear to have obtained much favor ; while in France, though they have often been resorted to, yet their use has been only limited, as their prac- tical utility has been questioned by many excellent obstetrists. It has been pointed out that if they can be supported without incon- venience by some phlegmatic unimpressionable animals, more frequently they irritate the organs in the pelvis, cause straining and uneasiness, and produce those relapses which their application was intended to prevent. Therefore it is that, nowadays, they are not made available to any thing like the extent of a few years ago. Saint-Cyr admits that if, in some exceptionable case, it is necessary to employ a pessary, the/z^V bladder deserves the preference for the larger animals. It is found nearly everywhere, requires no other preparation than merely softening its texture by pouring some tepid water into it, whilst its outer surface is well oiled. It is easily placed where desired, even in the uterus ; its soft, flexible walls cannot bruise or excoriate ; and, by inflation, it can be distended to the size necessary for each par- ticular case. Sutures. — The suture is generally preferred to the pessary, as being simpler, more easily applied, and having fewer inconveniences than the latter. Being inserted outside the genital organs, they do not irritate those which are most concerned in inversion, neither do they provoke ex- pulsive efforts on the part of the animal. The sutures may be of hemp or silk, or metal ; and they may be passed directly through the lips of the vulva, or include the skin towards the point of the hip, on each side. The first may be named the labial suture., the second the hip suture. The labial suture may be " interrupted," or " quilled," and is made ac- cording to the principles of surgery. A saddler's large needle, or a sack- ing-needle with a handle at one end and an eye near the point, is the most useful. Through the eye is passed a piece of whipcord, two or three strands of well-waxed thread, or a piece of cotton or silk tape, or moderately thick carbolized catgut. The needle is passed through one lip of the vulva — say the right — from the outside, and near the upper commissure ; it is then passed through the left lip, from within to with- out, towards the inferior commissure. The needle is then cut from the suture, sufficient of the latter being left for both ends to tie in the middle of the vulva. A second suture is then placed in the contrary direction — upper part of left to lower part of right lip — so that the two sutures cross each other obliquely, in an X fashion. The ends are now tied towards the centre of the vagina ; and, if thought necessary, a third suture, directly transverse, may be placed between these. It is more convenient than painless to pass the needle first through the tissues, then the suture through the eye of the needle, withdrawing the latter, which carries the suture with it. This labial ^\x\MX% is painful, as it is placed in textures already swollen and sore, and it does not always retain a sufficiently solid hold to pre- vent the uterus tearing it out when the straining is very severe and vio- lent. The hip suture has therefore often been resorted to in these cases, and with advantage. The needle — either the above, or a small seton needle — is passed through a fold of skin lifted up at the point of the hip or ischium, on a level with the upper commissure of the vulva, and carried across to the other hip. The next suture is a trifle lower, and the others INVERSION OF THE UTERUS. 597 below this : there being, in all, about four to six sutures, the ends of each being tied in the middle, or fastened to bits of round wood at each side. In this way, the vulva lies behind a number of strong cords — their strength and durability being in proportion to the width of skin they are made to enclose. . The sutures may be drawn more or less tightly, and they may either be transversely parallel, or cross each other obliquely. When the animal is not pregnant, the vulva is not nearly on a level with the ischial tuberosities. After parturition, however, the vulva is swollen and prominent, and stands beyond these parts. It will therefore press against the hip sutures, and may even become excoriated or cut by them ; so that, to avoid injury, and diffuse the pressure, it is well to place a thick pledget of tow, or other soft material, on each side of the vulva, on which the sutures may chiefly rest. Though good service has been obtained from these sutures, in a num- ber of instances, yet many practitioners prefer the metallic suture. This may be of lead, or iron wire softened. The needle is like that used for the other sutures ; a pair of wire-pliers is necessary, and two sizes of wire are recommended. The thickest size is cut into pieces of a convenient Fig. 199. Zundel's Labial Sutures. length, and an eyelet turned at one end, while the other is made into a hook. The left lip of the vulva is seized by the left hand, and the needle pushed through it from the outside, a little obliquely upwards, so as to bring it out above the superior commissure ; the wire is passed into the e3'e at the point, and the needle being smartly withdrawn, the wire is pulled through. The needle is introduced into the right lip in the same man- ner but downwards, and the wire pulled through it. The hooked end is now passed into the one with the eyelet, drawn sufficiently through, cut off, and the end bent also into an eyelet, the suture constituting an ellipse at this part, which is opposite the vulvar opening. Beneath this suture, one or two more are placed, and all are joined together by the thinner wire, which, doubled, is longer than the space occupied by the sutures ; each piece is passed into each eyelet of the upper suture, and firmly crossed and twisted as far as the two points of the suture ; the same is done with the second and the third suture — the whole being joined into a solid piece, which, according to report, does not interfere with the phvsiological functions of the animal. The same objection applies to w4re sutures through the vulva, as to vegetable sutures ; and there can be no doubt that they are less painful 598 ACCIDENTS INCIDENTAL TO PARTURITION and more effective when passed through the skin at the point of the hip. Two wires across are generally sufficient ; the ends are bent round by pliers after they are inserted, and through these eyelets on each side a vertical wire is passed (Fig. 199). This keeps the horizontal wires together, and in place. Other metallic sutures, in the form of pins, screwed at one end to fix into plates after being pissed through the labia of the vulva, and other contrivances of this description, have been described ; but in principle they are all the same, and there is no manifest advantage in their employment. In fact, it may be said of all the labial or other sutures, that they in no respect prevent the inversion of the organ internally, but merely prevent its escaping beyond the vulva ; and, as their integrity depends not only upon the material of which they are composed, but also upon the integ- rity, or power of resistance of the textures through which they pass, Fig. 200. The Loop of Delwart's Truss. it often happens that they either give way themselves, or they " tear out " prematurely, leaving oftentimes troublesome wounds or cicatrices. It must not be forgotten, too, that even under the most favorable cir- cumstances, these sutures, both during their insertion and their main- tenance, are a source of uneasiness and pain to the animal. Bandages^ or Trusses. — To dispense with the inconveniences of the pessary and suture, the bandage or truss has been proposed, and exten- sively employed ; and we must confess that, in the great majority of cases of uterine inversion, it should be adopted in preference to the other methods of retention. The truss or bandage may be composed of cords, surcingles, leather, canvas, etc., which are so arranged and disposed as to make pressure jy VERSION OF THE UTERUS. 599 I upon the sides of the vulva, and, by keeping it closed, prevent the extru- sion of the uterus, without interfering with defecation or micturition. There are several kinds of truss in use, and these vary somewhat in their details, though in principle they are the same. Some of them are fixed around the shoulders and neck^ others round the chest only, and others again round both regions-^most frequently to a collar, or sur- cingle. We will allude to those which are recognized as most useful. Two of the most useful and readily-made trusses are composed of light rope or thick cord — something like a clothes-line. One of these is termed "" Delwart's Truss," and is formed by cords united by a loop in their middle, in such a manner that an oval space {a. Fig. 200) suffi- cient to admit the vulva, and compress it laterally, is formed — the Fig. 201. Delwart's Tkuss Api'Lied. inferior commissure being left free, to allow the escape of urine, and uterine discharges, should there be any. The two portions of one of the cords {b b, Fig. 200) passing over the back, are secured to a collar or band round the neck or chest ; while those of the other cord {c c) pass between the thighs, and are tied to the lower part of the collar or sur- cingle, in the manner depicted in Fig. 201. The loop may be wrapped in tow or cloth, to prevent chafing to the parts under the tail. Another rope truss, described by Renault in the Maison Rustique du XIX Siede (vol. ii., p. 286), is perhaps more simple, and yet quite as, if not more, effective as the preceding. This is composed of a leather strap which buckles round the neck, and a rope from twenty-four to thirty feet long, and the thickness of the little finger, or a trifle less, according to the size of the animal. The neck-strap is not indispensable, though it is useful in giving more firmness to the truss ; it may be replaced by a thicker rope, or, in the case of the Mare, by an ordinary draught collar. 6oo ACCIDENTS INCIDENTAL TO PARTURITION. In order to apply the bandage, the neck-strap or collar is first to be put on j the cord is then to be doubled in equal parts, and put across the back, behind the withers, so that each portion may fall behind the shoulders, to be passed under the chest. In front of the chest, the two portions are crossed, the left passing to the right, and the right to the left. Each side is carried through the collar, and back, over the front of the shoulder, at the top of which both are tied in a simple knot, so as to be easily untied when required. At ten or twelve inches from this, a firmer knot is tied, then several others beyond it towards the loins — according to the length of the animal — and at neady equal distances, as far as the root of the tail, where a simple knot is tied. The branches of the cord then separate on each side of the vulva, and unite again by a simple knot below the inferior commissure ; again separating, each cord is carried between the hind legs, brought up by the flank towards the Fig. 202. Renault's Truss. loins on each side, and tied over the back to one of the loops there, as shown in figure 202. This truss can be made as easy or tight as may be necessar}^, and its simplicity is its great recommendation. Horsburgh [Veteritmriayi, vol. xiv. p. 490), describes a similar truss, which he applied to a Mare that had inverted the uterus three days after foaling. Giving the animal some extract of hyoscymus and gum opii, dissolved in a pint of warm water, to allay the straining, as soon as this dose began to operate he reduced the organ. This was done by securing the animal, sponging over the uterus with a little vinegar and water, and "taking hold of a clean towel in the left hand, doubled, and the corners of the towel falling back on the arm — made bare for the purpose. I then applied the doubled fist to the fundus of the uterus, with the assistance of the right hand in bearing it up by a moderate degree of force, and returned it to its place, slowly withdrawing the hand, and leaving the towel for a few minutes. I next proceeded to remove the towel, by intro- ducing the hand, greased for the purpose, into the vagina, taking it by the corners, turning it several times round, and at the same time bringing it out slowly. After which, I introduced the arm to the full length, in order to ascertain whether it was in its proper INVERSION OF THE UTERUS. 6oi position, using a little force on the further end, in order to stretch it. I then withdrew the arm, and proceeded to apply the necessary bandages. First, a strong girt, or sur- cingle was buckled tightly round the abdomen, to prevent the muscles acting with such force as again to expel the uterus. This is essentially necessary. I then took a small rope, or narrow web (the one used on this occasion was a cavesson for breaking horses in the menage), forming an eye (loop) in the middle, to be passed over the neck, as if for casting. I then passed the ends between the fore-legs and along the belly — one on each side of the udder, up between the hind legs — tying a single knot exactly at the inferior part of the vulva. Another was placed superior to the anus, carrying the ends up on each side the tail, fixing them securely and tightly to the loop round the neck, and on each side of the withers." This truss was a perfect success, and could be dispensed with in three days. Horsburgh condemns sutures passed through the labia pudendi. A very efficient and suitable truss is that made of a piece of stout leatlier, with a round opening in it above, corresponding to the anus, and an oblong opening beneath this, through which the vulva passes. The Fig. 203. Leather Truss. leather is so shaped as to embrace and lie close to the root of the tail and between the buttocks, extending for some distance below the \»ulva, as in figure 203. It is maintained in position by four strong leather straps — two above and two below — which pass on each side to a surcingle around the chest, which may again be attached to a collar or breast-strap, should the straining be violent. Anoiher kind of truss is formed by an ordinary crupper attached to a surcingle, and, if need be, this to a breast-strap or collar. From the part of the crupper under the tail proceeds two, three, or four narrow leather straps, which, passing over the vulva, are attached to the loop of a doubled rope in the perinaeum, each portion of the rope being passed between the hind-legs and tied to the lower part of the surcingle. Or a cord may be attached to the crupper at each side of the vulva, and carried forward between the hind-legs and underneath the belly in the same manner, two or three transverse narrow straps passing between the two, immediately over the vulvar opening. When there is much swelling, a soft cloth doubled several times, or a sponge steeped in cold water, may be placed over the vulva beneath the straps, though in such a way as not to interfere with micturition or defecation. 6o2 ACCIDENTS INCIDENTAL TO PARTURITION Various other trusses for the Mare or Cow have been proposed by veterinary obstetrists, but in principle they are all the same. We need only notice one of these, which has been proposed by Lund, a Danish veterinary surgeon, and which has been greatly lauded by Dieterichs and others for its cheapness, simplicity, and efficiency. The chief part of it is a narrow piece of iron, nine millimetres thick (about one-third to three- eighths of an inch), welded at its extremities, and turned into a triangular shape that enables it to include the vulva, while the loops at its three corners allow it to receive cords (fig. 204). The base of the triangle, which fits under the tail, is about two to two and a half inches wide, and the sides from five to seven inches long. The loopholes at the angles may be replaced by small hooks to receive the cords. Fig. 204. Lund's Truss Iron. This metal plate, which may be round iron, and convex on one side, concave oti the other, fits over the vulva and the base to the tail, the apex being below the lower commissure, while the convex side is towards the animal. Cords pass through the loops or around the hooks, one above, another below — as in figure 205 — and are fastened to a surcingle or collar, or both, like the preceding trusses. Any blacksmith can make the plate in a few minutes ; and from what has been said in praise of this cheap and simple method of retaining the uterus, there can be no doubt that it will be found most useful. All these trusses are intended for the larger animals, and cannot well be applied to the smaller creatures, with the exception perhaps of Lund's plate, which, much diminished in size and made of a piece of strong iron wire, might be serviceable for the Ewe, Sow, Goat, or large Bitch. For these smaller animals Rainard recommends a triangular bandage, made by folding a piece of strong cloth in a triangular manner. The base of this triangle lies over the loins, is carried down by the flanks to beneath the abdomen, where the corners are tied together; while the point of the triangle is passed over the croup and, vulva — a hole being made for the tail to pass through, and another for the anus, brought between the hind- INVERSION OF THE UTERUS. 603 legs, and either by means of' tapes attached to it, or, if sufficiently long, by splitting up the end to a short distance so as to make two strips of it, and fastening the piece to the ends already tied beneath the belly. It must be acknowledged that these trusses, no matter how skilfully they may be contrived or however well they may be adjusted, will not hin- der vaginal inversion of the uterus ; all they can do is to prevent the organ from being suddenly protruded beyond the vulva again, and so ex- posed to the air and the irritating effects of extraneous matters bef(fre it could be returned once more. This alone, however, is an important ob- ject achieved, and is a great step towards permanent retention. Be- sides, by maintaining the labia of the vulva in close apposition, the truss, if well applied, prevents the admission of air into the genital canal ; and thus does away with one source of irritation. And as the apparatus does not cause any pain or inconvenience to the animal, it is for these reasons to be preferred to any other means for maintaining the reposition of the uterus. Fig. 205. Lund's Truss Applied. With regard to the best kind of bandage, this is of secondary impor- tance to its proper application. • Simplicity and efficiency are the desider- ata, and these will be found, we believe, in the trusses we have described, and particularly in those of Renault and Lund. If reposition of the uterus is properly effected, and the truss well ap- plied, there is but little reason to apprehend a recurrence of the accident. After-Treatment. When the uterus has been returned to its natural situation, an antisep- tic injection or ''swabbing" of the interior accomplished if deemed ne- cessary, and precautions against a recurrence of the inversion adopted, little more remains to be done except to observe some simple directions, which are to be followed out for a few days after reposition. 6o4 ACCIDENTS INCIDENTAL TO PARTURITION If the weather is favorable, and little or no fever present, Saint-Cyr recommends that the animal — covered with a rug — should be walked about for a few minutes ; as this takes away its attention from the acci- dent, regulates the general circulation, and allays the expulsive efforts. If, however, there is fever, with the pulse quick, full and hard, and the animal is strong, he advises the abstraction of blood. In any case, the animal should stand with the hind parts well raised, and It ought not to be allowed to lie down for a day or so. Great attention should be paid to the diet, particularly in ruminants, from the tendency to tympanitis and constipation. Indeed, tympanitis may be sometimes considered a cause of inversion in the Cow and Ewe ; and the rumen is at times so distended with gases, and accordingly proves such an obstacle to reduction, that it has to be punctured in the usual way before reposition can be effected. For the same reason, this inflation of the digestive organs has to be guarded against in the after- treatment. For the first day only oatmeal gruel, with barley-water — both tepid — should be allowed in small but frequent quantities. Subsequently for some days, easily-digested sloppy food may be given, and if the appe- tite is fickle it should be tempted by choice portions of diet ; though the quantity must not be large at any time until all danger is past. Should there be a tendency to constipation, soap-and-water enemas may be administered. Micturition is rarely deranged ; but if no urine is passed within twenty- four hours after reposition, an examination should be made, and the bladder emptied in the usual manner. The different disposition of the urethral valve in the Mare and Cow will, of course, be borne in mind in passing the catheter. Nearly always these simple measures suffice to restore the animal to its usual condition in three or four days, in uncomplicated cases. In ex- ceptional cases, however, we may have metritis or metroperitonitis, or leucorrhoea follow the accident. The animal may go off its milk and fall into low condition, without exhibiting any acute symptoms ; or indi- cations of puerperal fever may supervene. Sometimes the animal re- mains sterile for a variable period. With the Ewe, chronic inversion of the uterus often leads to loss of the wool. In complicated cases we may have wounds, lacerations, rupture of the uterus, cornua, or vagina, lesions of neighboring organs or textures, etc. ; these we will refer to hereafter. A curious complication of uterine inversion has been mentioned by Ayrault {Recueil de Med. Vet'erinaire, 1857, p. 723), who has witnessed it in three cases. This consisted in great lameness in the limbs, without swelling of the joints, but with marked knuckling over in the hind-pasterns. This complication disappeared spontaneously as the patients recovered from the other effects of the inversion. Amputation of the Uterus — Metrotomy. Though it should be recognized as a rule, that, provided there is no serious complication and the obstetrist is called in good time, with pa- tience and skill reposition of the inverted uterus is possible, yet cases will occur in which the operator is baffled in his attempts at reduction, or when, at the first glance or after an examination, he has to recognize this as impossible or useless. " Since I have been in practice," says Schaack, INVERSION OF THE UTERUS. 605 " I have been often called upon to remedy this kind of displacement, and from what I have seen I am led to believe that the impossibility of reduc- tion is not so much due to the difficulties in the cases themselves, as to the hurtful manoeuvres which have been performed. Nevertheless, it must be acknowledged that the development of the hernia and the rigid- ity of the tissues are sometimes so great that it requires a certain amount of confidence in one's self neither to be disconcerted nor afraid. - . To be successful it is necessary to insist — to insist in spite of every thing — on applying one's self to seize each alternative point of relaxation ; to engage, bit by bit, the displaced organ in the vulva, in commencing with that which is nearest this opening, then successively all the remainder." This advice is judicious and sound ; but, as we have said, in certain cases the extruded organ is so injured, either by the unskilful attempts of ignorant men to return it, or from other causes, that it would be cer- tain death to the animal to replace it in the abdomen. We refer now to extensive lacerations and bruises, or when the organ has become softened and gangrenous. Lacerations and ruptures are always more serious, it must be remembered, in the lower than the upper wall of the uterus. In other cases, when reduction has not been complete, and one horn remains more or less invaginated, or the body of the d^'gan is not well adjusted, inversion will again and again occur in spite of all attempts at retention ; and this only too frequently leads to such grave injury, that there is no hope of the organ regaining its normal condition, even should reposition be at last successful. Indeed, its walls are so softened and friable that they cannot withstand the least pressure, but tear whenever an attempt is made to carry the uterus into the vulva. With certain animals, too— as Swine — reposition is extremely difficult, particularly when one or both cornua are inverted ; as the smallness of the organ, as well as of the pelvis, is a great obstacle to manipulation. In such exceptional circumstances complete extirpation of the uterus (^Metrotomy) has been recommended and practised. It is now many years since the operation was introduced into veterinary surgery, as Binz states that it was performed by Jenne, a German veter- inarian in Forchheim, so long ago as 1802. Though the operation is apparently a most formidable and painful one, and only to be ventured upon as a last resource, yet, on the whole, it is tolerably successful. Of twenty-five cases collected by Saint-Cyr, no fewer than nineteen recovered from the operation. Franck refers to thirty cases, eighteen of which recovered, and four (two Cows and two Goats) were killed, though not, it would appear, on account of the opera- tion. Of these thirty cases only one was a Mare ; 17 were Cows ; 3 Goats ; 4 Sows ; I Ewe ; 2 Bitches ; and 2 Cats. He remarks that of the unfor- tunate cases, there were probably some which died from other causes than the amputation ; while some evidently perished from septic infec- tion. We know that recoveries have taken place after the C^esarean sec- tion and excision of the uterus in the same animal, at the same time. The operation might be more successful did it not happen that it is late before it is resorted to, and very often the animal is already greatly exhausted. It is curious to note that it has been recorded by several observers, that some Cows which recovered have shown signs of oestrum — doubtless be- cause the ovaries were left intact ; while other Cows have yielded milk after the operation. Lecoq informed Saint-Cyr that he knew of a Cow .6o6 ACCIDENTS INCIDENTAL TO PARTURITION. from which the uterus had been remov'ed, and which gave an abundance of milk for two years afterwards. Operation. — Various modes of operating have been practised and recom- mended. With the larger animals, the hind-limbs should be secured — especially with the Mare — or the animals may be thrown down, or fixed in a travis if there is one convenient. Chloroform, chloral, or morphia may be administered to the animals about to be operated upon. It is also a good plan to tie the uterus up in a large cloth, so that it may be easier moved about by the operator or his assistants, and render the operation cleaner and less repulsive-looking. The oldest, and perhaps most popular, method is the ligature in mass. A piece of strong whipcord, well waxed and made into a running loop, is passed over the tumor as near to the vulva as possible, but without in- cluding the meatus urinarius. When evenly placed around the pedicle, it is then gradually, but firmly, tightened by pulling at each end so as completely to intercept the circulation in the mass. This done, the cord is tied in a knot. Though this method has been much employed, and with a fair amount of success, yet it has been condemned by some good authorities, on the plea that it is (fengerous to tie such a voluminous mass ; as all the parts cannot be sufficiently and equally compressed to become mortified at the same time. Those parts which have not been firmly bound still retain a certain amount of circulation, become inflamed, and occasion violent pain. Rainard therefore recommends tht double ligature. A long sacking or saddlers' large needle is armed with a somewhat long double piece of whipcord. This is passed through the middle of the pedicle of the tu- mor, from below to above, and the needle cut away from the cord. The pedicle is thus perforated by two pieces of cord ; one of these is very firm- ly tied round the right half of the pedicle, the other round the left, so as to include the whole in two separate ligatures. Claverie {Journal des Vdt. du Midi, i860, p. 535) reports a serious haemorrhage by this double ligature, after removal of the uterus, which necessitated the application of a ligature in mass above the others, as well as the application of the actual cautery to the cut surface. It is possible that the needle wounded some large vessel, which, of course, would not be included in either of the ligatures. The uterus of the Cow has been successfully deprived of its circulation by means of clams about an inch thick and ten inches long. They were applied close to the vulva, and the two ends fastened to- gether by twine. Saint-Cyr alludes to a successful case of amputation of the uterus in a woman, by means of caustic clams, or rather a clamp ; the operator being M. Valette of Lyons ; and he believes that the same procedure might be advantageously adopted by veterinary surgeons. He recommends the long curved clams used for hernia, and suggests that the groove be filled either with chloride of zinc, or with tallow powdered over with corrosive sublimate. By whatever procedure the pedicle of the tumor is rigidly compressed, the uterus has afterwards to be excised. Some veterinarians are of opin- ion that it is better to wait until it is completely mortified, or even until it sloughs away spontaneously ; and they allege, in justification of this INVERSION OF THE UTERUS. 607 opinion, the danger of haemorrhage when dealing with such a large and vascular organ as the uterus is at parturition. Others, dreading the dan- gers resulting from the retention of such an enormous mass suspended behind the animal, counsel its immediate amputation. The incessant traction it exercises on the vagina, the obnoxious odor it gives off, the contact with the absorbing surface of the septic products resulting from its mortification, expose the animal, they declare, to serious accidents, which can only be averted by at once cutting away the uterus. We quite agree with these authorities, and with Saint-Cyr, that these dangers are most serious ; and as the risk of hgemorrhage may be obvi- ated by sufficiently constricting the base or pedicle of the mass, it is cei'- tainly most advisable to amputate it at once, and at a short distance — from an inch to three inches — behind the constriction. Trasbot (^Bulletin de la Soc. Centrak de Med. Vetermaire, 1870) brings under notice the use of the ecraseiir in amputating the uterus. The case to which he refers was not successful ; but it is probable that this result was due to the imperfect or improper manner in which the instrument was used. With the kraseur^ the tissues should be slowly and gently cut through. The entire pedicle may be included, or the chain may be passed through the middle of it by means of a needle, like the double ligature. The elastic ligature (Dittel's) has been suggested as worth a trial, and if properly applied we think the result might be favorable. This consists in applying a long piece of india-rubber tubing around the pedicle, and tying it firmly there. The tissues are cut through by the continuous pressure, which causes obliteration of the vessels and cessation of nutrition. It has also been suggested that Esmarch's method of amputation by elastic compression of the part to be excised, might be most successfully employed in ablation of the uterus in animals. Considering the volume of the uterine tumor and its great vascularity, there must be an immense advantage in sending back into the circulation of the animal the larger part, or even the whole, of the blood contained in the organ, before sep- arating this from the body, and in addition performing a bloodless opera- tion. Coculet's method of reducing the volume of the inverted uterus by compression has been already alluded to, and is the same in principle. Esmarch's method essentially consists in winding around the part to be amputated — commencing at the distal extremity — an elastic band, so as to press the blood from this part into the body ; and above the band to tie firmly a piece of india-rubber tubing, so as to prevent a reflux of blood by the arteries. The elastic band is now removed and the part — pale and bloodless — is excised. When the uterus has been cut away, the portion of vagina or cervix re- maining should be returned as far as possible into the genital canal, and if there is any haemorrhage, injections of cold water will probably check it. Cicatrization generally occurs within fourteen days. If ablation of the uterus is not effected immediately after constriction of the pedicle, but is allowed to take place spontaneously, mortification and sloughing are completed in from six to ten days. In some cases, the animal does not appear to be much disturbed after the operation, in others it is very uneasy. Ledru describes an instance {Rec. de Med. Vet'erinaire, 1866, p. 115) in which the Cow operated upon was for an hour as if mad. It lay down, got up, rolled about, kicked and stamped, and climbed into the manger. Its eyes appeared to be starting 6o8 ACCIDENTS INCIDENTAL TO PARTURITION. from their orbits ; it flexed its hind limbs like a horse attacked with par- aplegia, and it was impossible to get near it. These symptoms appear to have been caused by the intense pain ; though they gradually subsided and the animal ultimately recovered. In many instances no unusual symptoms have been observed, and the mother has anxiously occupied itself with its progeny. This has been noticed with the Sow. After the operation the cows appear to have fatted well ; and when killed, in those which were examined large masses of fat have been found in the place of the uterus, and filling the pelvis. It may be remarked that in one case recorded — in the Cow — a portion of intestine had become prolapsed with the uterus, the interior of the sack of which it occupied ; another similar occurrence was noticed in a Bitch. Franck insists on this complication being always looked for in the Mare, and he recommends that this animal be always either narcotized by mor- phia or chloroform, so as to get rid of the violent straining to which it yields itself. An exploratory incision may then be made in the body of the uterus, and if any intestine is found in its interior, this must be returned to the abdomen before amputation is ventured upon. From among the many recorded cases, we select the following as ex^ amples : 1. Barker in 1841 ( Veterinarian, vol. xiv., p. 444), gives one of the earliest instances of this operation in England. The patient was a Sow, which, after producing nine young ones, had the uterus inverted. No attempt was made to replace it, and a ligature being tied tightly round its pedicle, the organ was cut away, leaving a small portion of it protruding. No haemorrhage followed. It soon after took some gruel and then ordinary food, suckled its young, and was recovering rapidly when it was attacked by aphthous fever. It ultimately did well, and became very fat. 2. Gregory [Ibid., vol. xvii., p. 422) amputated the uterus of a Sow, the organ being so torn after complete inversion, and the animal being so prostrate, that no other course was open. A ligature was applied to the " uterine vessels," and the uterus excised. An opiate dose was administered, and laxative medicine, and recovery soon took place. 3. Gardner [Ibid., p. 485) amputated the inverted uterus of a Ewe, as the organ was always extruded when returned. " I commenced as high as I could, tying the uterine arteries as I came to them, and stitched the cut edges together in order to prevent an effusion of the intestines. No more care was taken with her than usual, and in ten days' time she was caught for me to look at her, when I found that adhesion had taken place, and she was as well as ever." 4. This veterinarian {loc. cit.) had to operate in the same manner on a Cow, whose inverted uterus had been injured by rough handling, and the labia of the vulva torn by sutures. The animal recovered and fattened well. 5 Cleveland [Ibid., vol. xx., p. 378) attended a Sow which had farrowed four days previously. The entire uterus was inverted and the mucous membrane lacerated. " A ligature was applied as far forward within the vagina as convenient, including the ovaries ; and then, with a sharp knife, the whole of the protruded uterus was removed. The animal sickened for a few days ; then her appetite returned." Recovery was com- plete. 6. Dickens {Ibid., xxviii., p. 130) records the case of a fine sow which brought forth a litter of twelve, and inversion of the uterus soon ensued. The organ had been twice returned, and the labia sutured, but without avail, and it was rapidly becoming gan- grenous. Two strong ligatures were placed round the cervix uteri, and then the organ was excised. The creature was kept warm and carefully nursed. It soon partook of some milk and peas, and the mammary secretion gradually returned, so that the young family were all suckled. Afterwards the Sow arrived at great "bacon weight." 7. Leech {Ibid., vol. xxxix., p. 790) attended a pointer Bitch which had pupped several days previously, and the uterus had become inverted. It had been returned several times before he was called in, and the organ was so swollen that he could not replace it. " Upon careful examination, and after passing the catheter. I found that the bladder was included in the mass; therefore I made •'an incision in the body of the uterus, and INVERSION OF THE UTERUS. 609 found that therein was also a knuckle of intestine as well as the bladder. I returned the bladder and intestine into the cavity of the abdomen, and raised the hind jiarts of the Bitch, so as to keep them there whilst the operation was performed. This was done in the following manner : A needle armed with a strong ligature was passed through the neck of the uterus, behind the meatus urinarius, including one-fourth of its substance, which being tightly tied, the needle was again passed through another fourth and tied in the same manner ; then again through another fourth in the same way, leaving one- fourth up to this time fre^. The whole of the neck of the uterus was then included in one strong ligature, which closed the aperture ittto the abdomen?'' The parts behind the ligatures were then removed by the scalpel, and the remainder returned in the vagina. The haemorrhage was very trifling ; the parts were sponged with cold water ; a dose of opium was administered, and a good dry bed allowed. Next morning more opium was given, and the animal partook freely of bread and milk. No untoward symptoms intervened, and in about a fortnight the Bitch had quite recovered. This case demonstrates the necessity for a careful examination of the tumor before excision is ventured upon, as the inverted uterus contained both bladder and intestine, and if these had been included death was certain in a brief period. 8. Brown [Ibid., vol. xl., p. 845) partially amputated the uterus of a setter Bitch. The organ had a tumor upon it, and a ligature was passed round it near this tumor^nd the latter, with the distal portion of the uterus, cut away. There was considerable haemor- rhage, and the uterus was returned with some dilificulty. The ligature came away on the third day, and recovery was rapid. Before the operation the Bitch was in a very sorry condition ; after recovery there was a wonderful improvement. The case was complicated by a fracture of the ilium. 9. Barnes [Ibid., vol. xliv., p. 656) amputated the uterus of a Ewe which had lambed, and the inversion had occurred four hours before his arrival. The organ was so much torn and swollen, that it was impossible to effect its return. A ligature was firmly tied round the cervix, and the mass removed by a sharp bistoury, the arteries being ligatured as a further precaution against haemorrhage ; the vulva was likewise sutured, to prevent a protrusion of the remaining parts.. When the operation was finished the Ewe was in a sinking condition; but stimulants were given, and, with attention, in a week it was convalescent. 10. Olver {Ibid., vol. xlv., p. 98) removed the uterus of a Bitch by a ligature placed close to the vulva, and excising the body of the organ by the knife. There was little bleeding, and the remaining portion of the organ was returned. A stimulant was given, and good food, and recovery was rapid. If. Broad {Ibid., xlviii., p. 175) removed the inverted uterus of a Bitch by means of clams and the hot iron. " Bitches appear to suffer very little from the operation. . . In • all cases where it is possible to use the clams and hot iron I do so, as I find that liga- tures cause the animals much suffering ; besides which, there is a greater danger of blood-poisoning from absorption of the morbid products during the sloughing process." In all cases of cauterizing it is better to use the iron at a black heat. 12. Goffi (// Medico Veterittario, 1876) had to attend a Cow — primipara— for inversion of the uterus. The organ had been greatly contused and lacerated through the attempts of the owner and his friends to return it, and reposition was hopeless. After assuring himself that the extruded sac did not contain any viscera, he tied a strong ligature round it, near the vulva, then ampirtated it about two inches beyond the ligature. There was a slight haemorrhage, and when this was subdued the remaining portion was put back into the pelvis. Soon after, the Cow was very restless, and strained severely. It was bled and sedatives were given. On the fourth day there was acute traumatic fever, and inappetence ; small doses of carbolic acid were administered, and improve- ment took place ; but on the eighth day superficial oedema manifested itself. This was combated bv oil of turpentine itttus and extra. Gradually recovery took place, and about the thirteenth day there was so little amiss that the Cow was turned out to pasture. It never went off its milk, though the calf died on the fourth day. 13. Lorretta {Ibid., 1876) returned the inverted uterus of a Cow, and every thing ap- peared to be well until the fourth day, when the accident again occurred. During the owner's journey to request the attendance of Lorretta, a large Saint Bernard dog in the cow-shed devoured a large portion of the protruded uterus. On the arrival of the owner and veterinary surgeon, the Cow was lying on the floor inundated with blood, and apparently about to die. A knuckle of intestine protruded through a rent in the uterus. Nothing could be done but to amputate the organ. This was ligatured close to the vulva — after the intestine had been returned — by a well waxed and soaped cord, which Avas passed round it several times, being tied each time. Then by means of a convex bistoury, he cut through the mass about two inches below the ligature, applied an astringent lotion to the ligatured end, and Replaced it in the pelvic cavity. From 39 6io ACCIDENTS INCIDENTAL TO PARTURITION. the fourth day the Cow appeared to be quite well, seeking food and ruminating, and on the twelfth day it was cured. 14. Ledru [Recueil de Med. Veterinaire, 1866, p. 115) returned the inverted uterus of a Cow, and applied a truss. The owner removed the latter too soon, and inversion again occurred ; but this time reposition was impossible. Amputation being decided upon, a whipcord ligature was applied round the pedicle of the tumor, about two and a half inches from the vulva ; there was some haemorrhage when the uterus was cut away four or five minutes afterwards. For an hour the Cow was \'1*ry uneasy, but next morn- ing it was tranquil, and in a few days gave its usual quantity of milk and quite recovered. 15. Claverie [Journal des Vet. du Midi, i860, p. 535) reduced the inverted uterus of a three-year-old Cow with great difficulty, and attempted to retain it by sutures in the- vulva and a truss. All appeared to be going on favorably until the fourth day, when the organ was again prolapsed, tearing away the sutures and the truss. Excision of the uterus was considered the only means of saving the animal, and this was performed by double ligature — the needle being passed through the middle of the pedicle ; the body of the organ being amputated, the remainder was returned to the vagina. Much bleed- ing ensued, and the part had to be withdrawn, another circular ligature applied, and the hot iron used to close the bleeding vessels. Cooling lotions and charcoal were after- wards CTnployed ; for ten days the animal was dull, and the secretion of milk and appetite were diminished ; soon after this, however, it improved rapidly and completely recovered. 16. Turquet {Recueil de Med. Veterinaire, 1868, p. 20) relates a case of inversion in which, from the great infiltration and gangrenous condition of the uterus, reduction was impracticable ; so it was decided to amputate. The operation was performed by pass- ing a cord about two yards in length, and with a piece of wood at each end, around the uterus about two inches from the vulva — the Cow being held by two strong men ; while two other assistants pulled at the ends of the cord, so as to tighten it gradually around the tumor. Turquet kept^his finger on the knot, so as to judge of the amount of con- striction, and finding after a minute or two that it was sufficient to stop the circulation, the cord was firmly tied. There was scarcely any bleeding when the uterus was removed about two inches from the ligature, and the latter disappeared within the vagina. The animal was extremely uneasy, threw itself down, groaned and bellowed, and otherwise exhibited indications of pain for about ten minutes. Next morning it was ruminating ; the ligature came away in due course, the Cow suckled its calf and gave the usual quantity of milk, and in five months afterwards was fatted. 17. Schiiller {CEsterreich. Vierteljahress. fiir Wissenschaftliche Veierin&rknnde, 1858, p. 17) appears to be one of the few veterinarians who has attempted amputation of the uterus in the Mare. He was called to attend a seven-year-old Mare, which eight days previously had given birth to a dead foal, and soon after suddenly inverted the uterus. For eight days (!) was the swollen, gangrenous organ protruded, and when he saw it, the mucous membrane was greatly infiltrated and sodden, and covered by a yellowish exudation. The animal stood with its hind-legs wide apart, and looked dull and heavy ; the pulse was 65 per minute, the respirations 25 to 30. It still fed, except during the paroxysms of straining. No attempt was of course made to replace the uterus, and with the owner's consent amputation was resolved on. A twitch was placed on the Mare's nose, and a man placed at the head, while two others stood on each side to keep the animal steady and to assist in the operation when necessary. The upper part of the uterus, near to the vagina, was then freed from the discharge and exudation by means of the finger and tepid water, and the mucous membrane exposed. A strong, well- waxed ligature was tied round the pedicle, about two inches from the vulva, and the uterus excised by a sharp bistoury about half an inch from this part. The haemorrhage was unimportant, and the remains of the uterus disappeared in the vagina. A few sutures were passed through the vulva, and a pledget of tow put over it and retained by a bandage. Internal treatment was also resorted to. Next day the pulse was y^^ and the respirations increased ; micturition and defecation were normal. The vulva was greatly swollen, injected and hot. The straining was feeble, and only occurred at long intervals. On the succeeding two days the Mare was livelier, the appetite was better, and the straining had almost disappeared. The vulvar sutures had given way, and the bandage was removed. A small quantity of unhealthy, dirty-brown colored fluid escaped from the vulva. This was corrected by injections, and in three days the discharge was healthy. In fourteen days after the operation the Mare was discharged cured. 18. Moens (Annales de Med. Veterinaire de Britxelles, 1866, p. 591) was less fortunate with a Mare, six years old, which had the uterus inverted and hanging as low as its hocks. The organ had a large rent in it, and a jet of arterial blood flowed in such quantity that it was evident death must soon take place from haemorrhage. A ligature INVERSION OF THE VAGINA. 6ii was therefore at once applied around the cervix, and with the aid of several persons abla- tion was effected. The Mare died two days afterwards. 19. The same authority {Ibid.) practised the operation on a Cow soon after this un- fortunate case, and with the greatest success. In all, he had operated on eighteen Cows, without a fatal case ; and he is of opinion that total ablation of the uterus in this animal is incontestably more benignant than reposition. He remarks on the ease with which it can be executed, and that it requires no special dexterity : all that is needed is a strong ligature applied as close as possible to the vulva, and firmly tied round the part ; the organ being cut off about two fingers' breadth from the ligature. A little straining often occurs afterwards, but rarely any thing more serious. 20. De Ceuster [Ibid., p. 588), in attempting to reduce the inverted uterus of a Cow, ruptured the organ almost unconsciously — its texture was so soft and friable. Ampu- tation was decided upon. The opening was enlarged to discover if the sac contained intestines. A strong suture {forte suture) was placed at the base of the organ, close to the vulva, and in half-an-hour, when the uterus had become cold, it was amputated about two inches from the vulva, and the ligatured end returned. The following day there were a few expulsive efforts, and for twelve days a foul-smelling fluid was dis- charged from the vulva. Tar-water was injected. The animal fed well immediately after the operation, and gave an abundance of milk. De Ceuster is of opinion that the obstetrist should not hesitate in resorting to ampu- tation of the inverted uterus when he cannot return it, or when it is so damaged that, if returned, the animal's life may be endangered. Van-Hacken [Ibid., 1863, p. 259), Sulmon, and De Meester {Ibid., 1877, p. 158) record successful cases of ablation of the uterus in the Cow. CHAPTER IV. Inversion of the Vagina — Inversio Vaginae. Inversion., procidence, prolapsus, or fall of the vagina., is a hernia of this part through the vulvar opening, analogous to that of the uterus, and with which it may be complicated when inversion of the latter is extreme ; though in this case it does not add to the symptomatology or gravity of the accident. The accident may occur in other than pregnant or parturient animals, though rarely; it may also take place during gestation, particularly towards the termination of that condition, when the gravid uterus pushes it outwards. Most frequently, however, it is witnessed after parturition, and particularly when delivery has been difficult and protracted, and especially when force has been necessary to extract the foetus, and Uie expulsive efforts were severe. It often occurs when the " waters " have escaped for some time, and the young creature, lodged in the genital canal, is extracted without the precaution of lubrication. Its progress through the dry, tenacious passage causes the mucous membrane of the vagina to gather in ridges and folds ; the connective tissue beneath is torn, and this leads to inver- sion, which may occur immediately, along with the exit of the foetus, or when the animal afterwards strains — sometimes so long as four, six, or eight days subsequent to parturition. Fatigue, such as that induced by travelling, or severe exertion, imme- diately or soon after calving, or keeping the animal in a stall, the floor of which slopes too much backwards, are also likely to produce the acci- dent. It may also take place after abortion, and retention of the placenta. When inversion of the vagina occurs without that of the uterus, the latter is propelled backwards by the contractions of the abdominal muscles, pushing before it the walls of that canal until it has extruded 6i2 ACCIDENTS INCIDENTAL TO PARTURITION. them beyond the vulva, and itself occupies the cavity of the pelvis. During this extrusion, the connective tissue which attaches the vaginal mucous membrane to the pelvis is more or less lacerated ; and it is this laceration which, as Saint-Cyr justly remarks, constitutes, the serious character of the accident, and differentiates it from simple prolapse due to relaxation of the connective tissue, which is of no great moment, but which may precede it. The latter condition is not very rare towards the end of pregnancy, and under certain circumstances it may lead to com- plete inversion, Rainard mentions having seen a Goat which had inversion of the vagina fifteen days before parturition, and to such an extent that the mouth and nostrils of the foetus protruded through the half-open os uteri, so that it could breathe and lick the hand. But, as has been said, inversion of the vagina occurs far more frequently after abortion and parturition, though not so often as inversion of the uterus. Symptoms. Of course, the chief symptom of this accident is the presence of a tumor between the labia of the vulva, and which may hang for some distance below that opening. In this respect it resembles inversion of the uterus, though the difference is otherwise very marked. In the majority of cases the tumor is most voluminous when the animal is lying, and can then be best examined. It is circular in form, varies in size from that of an apple to a large melon, and is not unlike a thick sausage ; the surface is smooth, more or less of a deep red color streaked with darker patches, and covered by a thick white mucus, or a fibrinous exudate ; in other cases it is inflamed, excoriated by the tail or litter, and covered with foreign mat- ters. There are fio traces of cotyledons or placental follicles. On the under surface of the tumor is observed a longitudinal depression, or furrow, which leads to the urethra. At its end is a round opening, into which the finger can be passed as far as the os uteri, which will be found either completely closed or partially open. At the vulva the tumor is narrow, and exhibits longitudinal folds or ridges, due to the constriction caused by the vulva. Passing the finger between the tumor and the vulva, there is found a depression, or cul-de-sac, formed by its direct continuity with the vulvar mucous membrane. In certain cases, the cervix uteri can be seen in the middle of the tumor. Not unfrequently the tumor is not visible when the animal is standing ; though it may show itself when it lies down, riiicturates, defecates, or strains. When, however, the inver- sion has occurred to a considerable extent, or the case is chronic, the tumor often remains external to the vulva. There is generally more or less difficulty in micturating, arising from the pressure on the urethra ; and instances are recorded in which extreme distention of the bladder, from retention of urine, had occasioned serious symptoms, and led to paralysis, and even rupture, of that viscus. There may also be more or less straining — indeed, this symptom is nearly always present ; febrile symptoms may likewise be noted in some cases. When the mucous membrane has been long exposed to the air it becomes thickened and indurated, from the constant irritation giving rise to effusion and exudation ; it assumes a greyish tint, and is covered with a coriaceous epithelium, which gives it a leathery appearance. The local symptoms which we have indicated should sufficiently distin- guish between this accident and the presence of tumors in the genital INVERSION OF THE VAGINA. 613 canal. In the Bitch, inversion of the vagina has been sometimes mis- taken for a condylomatous tumor ; and cases are recorded in which tumors of this kind, protruding beyond the vulva, through insufficient examination have been mistaken for inversion. Inversion of the bladder has also b6en confounded with that of the vagina. The pyriform kysts which sometimes form in that canal, and contain a citron-colored fluid, have likewise been sometimes confounded with inversion of the vagina. To avoid errors which might have a serious tendency, a careful examina- tion must be made, and nothing should be attempted in the way of opera- tion until the state of affairs is exactly determined. Prognosis. Inversion of the vagina is not nearly so serious an accident as inver- sion of the uterus ; and Cows, Mares, and Bitches may often suffer from this condition for months without showing much apparent inconvenience. This is the kind of inversion that is liable to recur ; reposition may be readily effected, but no sooner is it accomplished than inversion again takes place through the animal straining. In other instances, however, the accident is much more serious. The mucous membrane of the vagina, exposed to contact with the urine, faeces, and litter, in addition to friction from the tail and other objects, as well as the attacks of flies, etc., becomes irritated, excoriated, abraded, and indurated, while it is greatly thickened from exudation ; a more or less foetid muco-purulent secretion covers its surface ; cicatrization of the torn sub-mucous connective tissue ensues ; new adhesions are formed which fix the part in its abnormal situation, and offer what is sometimes an insurmountable obstacle, if not to reduction, at least to retention, after that has been effected. If assistance is not afforded, the animal gradually loses condition and becomes emaciated ; hectic fever sets in, and it falls into a state of marasmus. At other times the extruded part becomes acutely inflamed, intense fever supervenes, and the creature succumbs to the effects of vaginitis — either simple or complicated with metritis— "-and almost as rapidly as from inversion of the uterus. Treat77ie?it. The more speedily treatment is resorted to after inversion has occurred, the more easily is reduction effected and likely to prove permanent, while the risks from injury are greatly diminished. The treatment is somewhat similar to that recommended for inversion of the uterus, the preli^ninary steps being the same in both accidents, and reduction accomplished according to the same rules. The part of the vaginal membrane nearest the vulva is to be carefully and gradually returned should the tumor be large ; if comparatively small, then it may be reduced en masse, by applying the closed fist to the centre of the most dependent part, and pushing it into the canal. When reduction has been effected, it is particularly necessary to observe that every part has assumed its normal shape and position ; as it often happens that the mucous membrane, particularly towards the bottom of the canal, forms a thick fold, which must be effaced if it is desired to obviate renewed straining and a recurrence of the inversion. All the folds and inequalities from one end of the canal to the other, as far as the cervix, should be smoothed carefully down by the hand or a soft damp cloth. If, after reduction, the 6 1 4 A CC IDE NTS INC IDE NT A L TO PAR TURITION. straining continues, it may be inferred that tlie mucous membrane is irritated by the existence of wrinkles or folds on its surface. The hand must then be introduced again into the vagina, and the ridges effaced either by passing the hand over them so as to carry the membrane onwards, or by gentle pressure entirely obliterating them. If the membrane is irritable and inflamed, astringents — such as acetate of lead, and anodynes — such as opjum, may be applied to it \ and as a matter of precaution, a truss may used for a few hours. When the foetal membranes are still in the uterus, some obstetrists recommend that they should be removed before reduction of the inversion is attempted ; but others — and among them Saint-Cyr — are of opinion that reduction should be accomplished first, and removal of the mem- branes afterwards, unless the latter are so lightly attached that they can be pulled away without introducing the hand into the uterus. In any case the membranes must be removed, as their presence is certain to cause expulsive efforts which will inevitably lead to protrusion of the vagina again. For the retention of the reduced organ, sutures are often passed through the labia of the vulva, and Harms and Schleg {Magazm von Gurlt und Hertwig, 1869, p. 13) have rings (ringehts) with this object. Schleg's ring is a thin flat band of steel, pointed at one end, and with a round hole and slot a little above the point : at the other end is a kind of button raised on the surface. The point is passed through the labia, and the band bent round so as to meet and button at the ends. This ring has been worn, according to Schleg, from a few days to more than five months. But in general, it will be preferable to employ a truss for the retention of the vagina, if the accident is recent. When the submucous connective tissue of the vagina has been much lacerated, and abnormal adhesions have taken place, then a recurrence of the inversion is to be apprehended. This recurrence is, of course, most likely to take place in chronic inversion, and all the skill and patience of the veterinary surgeon will be required in dealing with such a case. At times the accident has proved so troublesome, and retention has so baffled every attempt after reduction was effected, that amputation of the pro- truded portion has been practised, and with success. Rainard appears to have been the first to venture on this bold measure, and he practised the operation several times on Bitches. He ligatured the entire inverted mass close to the vulva, in one case ; but as this gave rise to intense fever, and, when cured, the animal suffered from inconti- nence of urine, he adopted another procedure. Instead of including the whole of the tumor in one ligature, he divided the pedicle into three por- tions, which he tied separately, so that each ligature only enclosed one- third of the mass. After tightening the ligatures, the Bitch was allowed to run at large, the only attention it received being the injection of emol- lient fluids into the vagina, and a smaller allowance of food. The pain was much less in intensity and duration than in the first case, and the tumor came away in five or six days, when recovery took place. Rainard, however, advises immediate excision of the portion of the mass beyond the ligatures, when these have been drawn tight. Daprey operated on a two-year-old filly in a somewhat different man- ner. Inversion of the vagina had been present for fifteen days, and the tumor was as large as a man's head ; it was cold, of a dark brown color, and the animal was greatly agitated and feverish. As gangrene was apprehended, it was decided to remove the whole mass. This was done INVERSION OF THE BLADDER. 615 by practising a kind of saddler's stitch around it, by means of two needles armed with a waxed thread ; and when sewn round, the two ends of the ligature were drawn so tight as to raise the enclosed sides of the tumor into plaits like the mouth of a tied sack ; they were then firmly joined. The filly was kept standing with the hinder part of the body raised, and the tumor was dressed with chlorinated water and vinegar. Between the seventh and eighth days the mass came away ; the discharge diminished in quantity and foetidness, and on the tenth day the animal was nearly well. Saint-Cyr mentions that Bernard operated upon a female Ass, which had the vagina inverted for more than a month, and every means- of retention had failed. Amputatipn was practised, by a circular incision around the base of the tumor. At the first cut of the bistoury, it was observ^ed that the mucous membrane was very much thickened, and easily detached from the other parts ; so that, instead of making a total ampu- tation, it was considered better to make it only partial, by dissecting away all that fissue to the extent of four or five inches. This was done, and the haemorrhage was inconsiderable ; but it persisted so long after- wards that the animal was seized with symptoms of syncope. However, these symptoms passed away, and the creature began to eat. A rope truss was applied, and for eight days there was a discharge of pus. At the end of that time, when the truss was removed, recovery was found to be complete. On exploring the vagina some time afterwards, a thick but dilatable ring, about the middle of the vagina, was found, through which first one finger, than two and three, could be passed. Beyond this ring the canal was normal in width. There can be no doubt, then, that the inverted vagina may be ampu- tated without much risk, when reduction is impossible or incomplete ; but whether an animal which has undergone this operation can be utilized for breeding purposes after\vards, we have no evidence to. prove. It is possible that the cicatricial tissue uniting the wound maybe sufficiently yielding to allow of gradual dilatation by manual or mechanical means, and thus not offer much impediment to impregnation or parturition. CHAPTER V. Inversion of the Bladder — Prolapsus Vesicae. At page 337, we have alluded to inversion of the bladder as occurring before parturition, and described the symptoms and treatment of this accident. The remarks we there made are applicable to the accident when it follows delivery. It is of somewhat rare occurrence, and is per- haps more frequently met with in the Mare than the Cow. We have jDarticularly insisted upon the necessity for a careful examina- tion of these vulvar tumors before adopting any surgical measures ; and this precaution is above all things necessary in this accident, as an inci- sion in this viscus is certain to lead to a fatal termination : of this we have given an illustration in page 339. Reduction must be attempted according to the directions given at page 338, and care, must be taken not to lacerate the organ, as this also will 6i6 ACCIDENTS INCIDENTAL TO PARTURITION. prove fatal. Elmue (Canstatt's yahresbericht, 1859) relates an occurrence of this description. In desperate cases, when reduction cannot be effected, or when the organ is so much injured that reposition is almost certain to be followed by death, amputation may be ventured upon with some prospect of suc- cess. With regard to the operation, Cartwright remarks : " It is to be observed that the ureters enter the substance of the neck of the bladder obliquely towards its sides, but their orifices are to be seen when the bladder is inverted, and the Cow or Mare is standing up, at the upper surface of the viscus, about half an inch apart. To detect them, we must draw the bladder sufficiently down, so that we may be able to in- spect the parts. Where they enter, the inner membrane (now the ureter) will have a soft and jelly-like protuberant appearance, in the middle of which will be detected two very small openings of a nipple-like shape. To be certain that we have hit upon them, we may introduce a probe, and pass it down towards the suspended fundus. Having discovered the orifice of the ureters, and passed a ligature around the neck of the blad- der below them, we have nothing more to do than occasionally tighten it, so as to effect complete strangulation and sloughing of the body of the bladder ; though, as soon as we find it dead, we may, to save time, cut it away with a scalpel. We should also, after having applied the ligature, puncture the distended fundus ; since its great weight may cause a dragging and inflammation about its cervix, or may force the ligature over the mouth of the ureters, which would occasion the death of the an- imal. After the separation has taken place, the remaining portion will contract within the vagina, and the cavity will be closed by the vulva. The urine will generally ever after run down the thighs, excoriating them ; though in other cases the fluid will accumulate within the vulva, and be from time to time ejected in large quantities." When excision is not resorted to, spontaneous amputation may take place. When the inversion or prolapsus is complicated by rupture of the floor of the vagina, then the accident is of the most serious character, though not invariably fatal in its results. » 1. Riviere {Journal de Med. Veterinaire de Lyon, 1867, p. 236) reports the case of a Cow which had a laborious delivery, in consequence of lateral deviation of the head of the foetus, and manual aid was necessary. The foetus was very large., and soon after it was extracted the envelopes came away ; but in about a quarter of an hour very violent straining ensued, and almost immediately a quantity of reddish fluid flowed from the vulva, followed by a tumor as large as a child's head. A careful inspection proved this tumor to be formed by the fundus of the bladder, and a manual exploration discovered, on the floor of the vagina, a long slit through which the organ had passed. When this laceration took place, was not known ; but the owner of the. Cow had attempted to de- liver it the previous evening, and had, as he thought, pierced the "water bag." The bladder was full of urine, so it could not be returned, nor yet could it be emptied by pressure on its surface. The contents were removed by a hastily-devised catheter, made of a piece of elder- tree deprived of its pith. When the urine was abstracted, reduction was easy, and the Cow recovered in less than twenty days. 2. Canu {Mem. de la Societe VetSrinaire dit Calvados, 1835) was requested to see a Mare that half an hour previously, had given birth to a foal without any difficulty. He found the animal lying on its left side, straining violently, covered with perspiration, and a membranous-looking substance hanging from the vulva, which led to the suspi- cion that inversion of the uterus or vagina had taken place. The owner said that he had been for a long time attempting to return this membrane, but had failed. Canu INVERSION OF THE BLADDER. 617 carefully examined it, but was unable to satisfy himself as to what it really was. He therefore caused the Mare to rise, which was done with difficulty, owing to weakness. The creature made repeated efforts to void its urine, from time to time ejecting it to a considerable distance. Canu did not even suspect inversion of the bladder, as he had never seen or read of such an accident. The tumor was red, thickened, and bloody, and an examination by means of a candle proved the vagina to be all right. P'oUowing the floor of that canal, however, the meatus urinarius could not be found, and the tumor commenced where that conduit should be ; at the same time the Mare violently expelled some urine, and it was now surmised that it was really the bladder that was depending from the vulva. A close scrutiny led to the discovery that the organ was torn at the fundus, through the owner's efforts to replace it ; he had used all his force, and the Mare at the same time struggled violently. After considerable deliberation, nothing was done, except abstracting a quantity of blood and reducing the diet. At the end of three days, the mammary secretion proving troublesome, the foal was restored to the Mare. The bladder was then swollen and black, and the thighs were excoriated from the constant flowing of urine. On the fourth day, in consultation with another veter- inary surgeon, it was decided to pass a ligature around the organ, behind the orifice of the ureter. This was done, and the owner was entrusted with the task of tightening the ligature every day. Next day the Mare showed symptoms of colic, and it was found that the ligature had slipped upwards for more than an inch, and closed the ureters — thus causing uneasiness from retention of urine in these ducts. The bladder being py- riform — the pedicle next the vulva — it was difficult to keep the ligature in its place. This was ultimately accomplished, however, by passing two small pieces of wood through the tumor behind the ligature, and attaching the latter to them. Every day the constriction was increased until the whole mass — weighing nearly six pounds, and very foetid — was held only by a narrow band ; this was divided without any haemorrhage. The remaining portion was immediately retracted as far as the meatus urina?-ius, when the lips of the vulva closed, leaving nothing to be seen. The urine, however, continually flowing through the ureters, accumulated in the vulva, whence it was frequently ejected, and running down the thighs excoriated them still more. Canu {hen determined to have a little projecting spout of tin made, with brass wires to attach it to the vulva. This was fitted below the inferior commissure of that open- ing the wires serving to fasten it to a crupper worn by the animal ; the hair of the tail was tied up so that it might not disarrange the apparatus. By this means the urine was thrown beyond the hocks, and a few emollient lotions healed the excoriations. The Mare was put to work six" weeks after the accident, and in three months it was sold at a fair. 3. Lecoq [Ibid., 1837, p. 252) mentions that a draught Mare, after difficult parturi- tion, and expulsion of the foetal membranes, without the slightest warning protruded a round dull-colored body as large as a fist, from the vulva. Next morning this had a fleshy appearance, was pyriform in shape, as large as a three-pint bottle, and eight or nine inches in length. It was soft, and only some small transverse rugae were apparent on its surface. On the hand being introduced into the vagina, it was evident that this body was continuous with it; and on separating the labia of the vulva, on the upper surface of the part, at a short distance from each other were two nipple-shaped bodies, the size of a pea, from the centre of which, at every effort made by the Mare, a faintly- tinged fluid was projected. It was therefore evident that the tumor was the inverted bladder. Reposition could not be effected, owing to the struggles of the Mare, the con- striction and engorgement of the sphincter, and the thickening of the parietes of the bladder ; so to save the animal, amputation was resolved upon. " Having prepared a strong waxed thread, many times doubled, and to the extremities of which we had at- tached two small pieces of wood to facilitate tightening the ligature, we passed it round the body of the bladder, an inch and a half below the orifices of the ureters, and drew the knot as tightly as possible. In exploring the bladder, we perceived that it con- tained some fluid, and on cutting into its fundus about a pint of light-red odorless liquid — the product of the exhalation from the utero-vesical portion of the peritoneum — es- caped." The Mare's health appeared to be scarcely affected by the operation. Three days afterwards the efforts to micturate were less violent; the bladder below the ligature was flaccid, livid, and like macerated flesh ; the parts above, and in immediate pro.ximity to the ligature, were red and inflamed. Every time the animal strained, a jet of urine escaped from the ureters, and in the intervals between these efforts it ran continually from the vulva, though without causing any apparent inconvenience. A new ligature, tightly drawn, was placed above the other, at which the parts were becoming gangren- ous. Six days subsequentlv, the t^ini or was excised an inch below the ligature, and the remaining part was well washed with camphorated spirit of wine. Suppuration speedily set in, and in another fifteen days the part had healed. The Mare was put to work in 6i8 ACCIDENTS INCIDENTAL TO PARTURITIOA a month, and did well ; inside the thighs was slightly excoriated for some months after- wards, and the salts of the urine had become deposited on the hair and skin. The urine trickled down these parts almost continuously. Nine months after the operation, the condition of the Mare was as follows : "The thighs are a little excoriated, the vulva somewhat swollen,. the urine runs only at inter- vals, but oftener than in a healthy state, and in a small quantity at a time. The Mare assumes the natural attitude in order to micturate, and discharges about half a pint of urine at each attempt. The hair below the vulva is thin and easily removed, on account of the flow of urine over the part." 4. Devaux [Ibid., p. 219) relates the case of a Mare which had eversion of the blad- der fifteen days after abortion. When he attempted to examine it, the animal struggled violently and threw itself down, and there ensued a violent distention and bruising of the tumor ; so that in the course of a few minutes five or six pints of blood escaped from it. Washing with pure vinegar checked the haemorrhage. The Mare being raised and tranquillized, reduction was affected by causing the mass to be supported by an as- sistant, and gently pressing on its sides with the fingers and hand ; it returned readily, and the hand was kept pressing on it for neaily half an hour. The animal was tied up during four days and completely recovered. 5. Baudson [Annales de Med. Veterinaire de Bruxelles, 1877, p. 153) refers'tothe case of a three-year- old Mare, which had inversion of the bladder for six weeks. Reposi- tion had been effected by an empiric, but inversion recurred almost immediately. The tumor presented the characteristic appearances, though it was greatly inflamed, owing to the rough manipulation to which it had been subjected, as well as the exposure. The animal was in much pain and strained violently. Reduction being deemed impos- sible, an iron clam was fixed behind the ureters, and gradually tightened until the eighteenth day, when the fundus and body of the organ came away. The remainder was spontaneously retracted, and the Mare went to work. 6. Decleene {Ibid., 1876, p. 147) furnishes an interesting case of retroversion or retro- flexion of the bladder against the floor of the vagina, which was inverted by the dis- placed organ. The amateurs who had tried to relieve the animal — a Cow which had just calved — thought the mass was the thickened foetal envelopes of a second foetus ; com- mencement of inversion of the uterus ; inversion of the bladder ; or hernia of the intes- tine. The animal was lying when Decleene examined it, and it was breathing quickly, as well as making violent expulsive efforts ; during which a round tumor, the size of a man's head, appeared at the vulva, and diminished in size when the straining ceased. The temperature of the tumor was low ; it was rather hard, and almost stony in consist- ence during straining ; when there was not straining, fluctuation could be detected. The surface was smooth and regular, except at its posterior part, where were some abrasions, due to the owner's attempts to tear through it, from an idea that it was the " water bag " of a second foetus. A vaginal exploration proved that the upper and lateral surfaces of the tumor were directly continuous with the vaginal mucous membrane ; and that the os uteri was partially dilated, but normal. Internally the hand could not advance far into the vagina, as at the meatus urinarius the mucous membrane was reflected on itself at a very acute angle. In order to pass the finger into the meatus it had to be bent, and even then it could only be advanced a short distance, in consequence of the inflexion of the neck of the bladder. Moderate pressure for more than five minutes was unavailing in replacing the organ, in consequence of the continuous straining of the Cow. The animal was incited to get up, and at the moment when its hind quarters were raised, the knees being bent, the pressure forward and a little upward caused the bladder to suddenly resume its normal position and relations. The animal quickly recovered. 7. Neale [Veterinarian, vol. xi., p. 410) states that a Sow had inversion of the bladder after bringing forth a litter of ten pigs. A butcher thought it was the uterus, and return- ing it into the vagina, put stitches through the lips of the vulva to retain it. It again protruded, however, and nothing more was done to it. It sloughed away, and the Sow did not suffer much ; indeed, in six months after the accident, it was killed for bacon. The bladder was found to have completely disappeared, and the ureters passed directly from the kidneys to a mass about the size of a lemon, lying in the vulva — the remains of the organ. 8. Leech {Ibid., vol. xx., p. 425) attended an aged Cart Mare which had foaled a few days previously, and was suffering from inversion of the bladder. On the supposition that it was the uterus which protruded, the owner had tried to return it, and had passed sutures through the labia of the vulva. On these being removed, it was ascertained that the bladder, which filled the vagina, was extensively and severely inflamed ; urine was ejected at intervals from the ureters. Attempts at reduction were made, but with- out success. The organ was then ligatured behind the ureters, and the ligature tight- ened every day. The animal received general depletive treatment. On the sixth day TRAUMATIC LESIONS OF THE GENITAL ORGANS, ETC. 619 the tumor was removed by the knife ; it weighed seven pounds. The Mare died three days subsequently, from inflammation of the vagina, neck of the bladder, and the ureters. Leech was of opinion that the inflammation was chiefly due to the weight of the mass after the ligature was applied, and he recommends immediate amputation. 9. Tailby {Ibid., vol. xliii., p. 23) attended a six-year-old Mare which had foaled three days previously, and soon after was observed to have a large mass protruding from the vulva. The animal was in great pain, pulse and res'piration much increased, tremors in the hind quarters, great difficulty in moving from side to side, and occasionally lying down and getting up again. The protruded viscus, supposed to be the uterus, was evidently the bladder : urine trickling from the orifice of the ureters, ana the hand could be readily passed into the vagina. The organ appeared to be in a gangrenous condition. Reduction was attempted without casting the animal, but it strained so violently that it had to be thrown down. The fundus and as much of the body as could be grasped, were seized, and gentle pressure was steadily applied with three fingers upon the entrance to the urethra ; during a struggle made by the animal, a large portion of the mass receded, and the hand of an assistant completed the reduction. The uterus, vagina, and bladder were then injected with solution of carbolic acid (i to 60). Anodynes and stimulants were subsequently administered, and the Mare recovered. 10. Robinson (Ibid., p. 78 1) relates a case of inversion of the bladder in a Mare, a sequel of parturition. It was attended with so much general prostration, as well as congestion of the bladder, that he thought it inadvisable to attempt reduction. The urine conveyed by the ureters filled tlie vagina, and was frequently ejected. The Mare was ultimately able to partially retract the organ within the vagina ! CHAPTER VI. Traumatic Lesions of the Genital and Neighboring Organs. Either during or after parturition, the genital and neighboring organs are exposed to injuries of a more or less serious character, according to their situation and extent. These we will now consider in the following order : i. Laceration and rupture of the uterus ; 2. Laceration and rupture of the vagina ; 3. Thro?nbus of the vulva and vagina ; 4. Relaxation of the pelvic symphyses ; 5. Rupture of the bladder ; 6. Rupture of the intestines ; 7. Rupture of the diaphragm ; 8, Rupture of the abdominal muscles ; 9, Rup- ture of the sacro-sciatic ligament. Section i. — Laceration and Rupture of the Uterus. Laceration and rupture of the soft parturient passages are very far from being unusual during parturition in the domestic animals, and par- ticularly in the Mare and Cow ; and of these the uterus and vagina are most frequently involved. Solutions of continuity of the uterus are often met with by the veteri- nary obstetrist, and they are either incomplete — when the organ is only partially torn or lacerated, or complete — when they penetrate through the entire thickness of the uterine wall, and perforate into the abdominal cavity. These solutions may occur either during pregnancy, during par- turition, or at a variable period after the fcetus has been removed from the uterus — when it is generally a complication of inversion of this organ. Antepartum rupture has been already fully alluded to at page 184, and we have now to study its occurrence during and after birth. Rupture during Birth. — Rupture of the uterus may occur spontaneously in a complete or incomplete form during parturition ; and though the ac- cident is perhaps not so frequent in animals as in woman, yet there are many cases on record in which it has undoubtedly occurred in them, and 62 o ACCIDENTS INCIDENTAL TO PARTURITION. it has been affirmed by highly competent authorities that it has been observed in Cows which had not received any assistance during parturi- tion. It can easily be understood why, if there is any material obstacle to the passage of the fcetus — such as induration or torsion of the cervix, or a malposition or deformity of the young creature — the violent contractions of the powerful muscular layer of the organ should overcome the resist- ance of some portion of its own fibres, and thus lead to a more or less extensive solution of continuity, which may involve the other tunics and produce complete perforation. Non-penetrating, or incomplete lacera- tions, in the majority of instances occur towards the cervix, and are usually longitudinal. Complete rupture may take place at any part of the organ. This accident is more likely to occur spontaneously when there chances to be an alteration in the texture, wholly or partially, of the uterus wall ; though this predisposing cause does not appear to be so often present in animals as in the human female, in which sudden per- forating ruptures never take place when the uterine tissue is healthy. Nevertheless, there can be no reason to doubt that in animals alterations in the tissue of this organ may and do occur ; and, as in woman, this may assume the form of anomalous development ; interruption of the normal tissue by interstitial fibroids or cicatrices ; separation of the muscular fibres by submucous fibroids, or by projecting thin parts of the foetus ; inflammatory softening of some portions of the parenchyma during preg- nancy ; or thinning of the wall at some part by pressiire. This pressure may arise from contact with the brim of the pelvis, or exostoses in or upon the bony canal. The exciting cause, however, proceeds from considerable mipediments to the progress of labor, and the accident is due to the energetic contrac- tions of the uterine walls and abdominal muscles, as well as to the pres- sure, direct or indirect, of the diaphragm through the fully dilated chest cavity. In such cases the rent may be so great, that the fcetus passes entirely through it into the abdominal cavity, enveloped or not in its membranes ; or only a portion of it has escaped through the tear, and it may be extracted therefrom with more or less dA^oxAiy per vias naturales, and in some recorded cases birth has taken place by the natural efforts, the existence of rupture only becoming evident when the uterus was acci- dentally extruded after birth. More frequently, however, the accident arises from artificial mechani- cal causes, brought into operation in the course of manoeuvres for effecting the extraction of the fcetus. The various instruments employed may either tear or incise the uterus ; or the organ may be lacerated dur- ing traction on the foetus when the " waters " have escaped, and its walls closely envelop the young creature ; or during retropulsion or version. The tenuity of the uterine parietes at this period, renders such an acci- dent as laceration one of easy occurrence ; and, however large the tear maybe during life, after death it usually appears much smaller, because of the contraction of the muscular tissue. In all these cases, when the organ remains /;/ situ, the diagnosis is diffi- cult, and generally it is only on post-mortem examination that the lesion is discovered. Nevertheless, certain clinical symptoms are often observed during life, which, if they were constant, might lead to a sus- TRAUMATIC LESIONS OF THE GENITAL ORGANS, ETC. 621 picioii of the existence of rupture. Thus, the expulsive efforts are very energetic and regular up to a certain period, when all at once they cease ; the animal begins to manifest symptoms of abdominal pain — lying down and getting up, stamping and pawing, looking towards its flanks, moving about uneasily, moaning, bellowing, neighing, or even screaming, when the rupture occurs. Non-penetrating lacerations do not, as a rule, give rise to very marked symptoms immediately ; though subsequently they may produce metritis or metro-peritonitis, or induce septic infection. Their presence is not easily diagnosed during life. In some few instances, the existedice of complete rupture has been ascertained by manual exploration of the uterus ; in others it has been discovered de visu in inversion of the organ. The pulse soon becomes feeble if there is much haemorrhage, and exhaustion quickly supeivenes. If death does not occur promptly, acute fever ensues, and symptoms of peritonitis or septic infection. The complications attending this accident are always serious, and ren- der the prognosis unfavorable in nearly every case. When, however, the laceration occurs at the upper part or sides of the uterus, the accident is not so grave as when the floor of the organ is involved ; if the os remains closed, so as 'to prevent the admission of air, the circumstance is still more favorable, though this can- rarely indeed be the case. The chief cojnplications are hcEmorrhage, hernia of the intestines, 2LXiA peri- tonitis. Death from direct hcemorrhage is less frequent than might be antici- pated, knowing the great vascularity of the uterus at parturition. This unfrequency is explained by the fact, that bleeding from such a laceration is less profuse than from an incised wound of the same dimensions. Nearly always, too, the foetus is partially or entirely expelled from the uterus into the abdominal cavity, or is born immediately after the acci- dent, and the organ then may firmly contract. Nevertheless, in some instances, the haemorrhage is so great that a fatal termination soon takes place, with all the symptoms already described at page 577. Hernia of the intestines ozcxxx^ when the rent is somewhat large, and the uterus, flaccid and uncontracted, allows these viscera to enter its cavity — they being propelled therein by the action of the abdominal muscles. In some instances the intestinal mass received into the uterus has been so large that they have passed through the vagina and vulva, reached the ground, and the animal has trodden upon them — thus has- tening death ; while in others, the hernia has been reduced and the crea- ture survived. Peritonitis may be primary or secondary. ^\\&n primary, it is due to the escape of blood, the foetal fluids or envelopes, or the foetus itself. When secondary, or consecutive, it may result either from the extension of the inflammation to the peritoneum, or the discharge of the lochia, pus, etc., from the interior of the organ. The escape of fluids from the uterus is, of course, more likely to take place when the rupture is inferior than when lateral or superior. Death is nearly always the result of peritonitis or metro-peritonitis. Treatment. The treatment of rupture of the uterus during parturition is generally 622 ACCIDENTS INCIDENTAL TO PARTURITION. very unsatisfactory. Very little can be done to check the haemorrhage, if it is great, and consecutive peritonitis is always a most serious complica- tion. If the fcetus remains within the peritoneal sac, a favorable termination can scarcely be hoped for ; though in some rare instances, if air does not obtain access to the cavity of the uterus or abdomen, it is possible that it may terminate in all the various ways of extra-uterine pregnancy. If the fcetus is extracted, the rent may heal up ; though this is very unlikely if the edges are much contused, and the animal will, in all probability, perish from consecutive purulent peritonitis. If the fcetus is still wholly or partially in the uterus, it and its envelopes must be extracted without delay, and as gently as possible ; as haemorrhage will probably only cease with the contraction of the organ. If the uterus does not contract, but remains flaccid after removal of the placenta, then it maybe stimulated to do so by introducing the hand into the interior for some time, after removing the coagula. If this fails, and the rupture is not in the floor of the uterus, small pieces of ice, cold water, or astringents may be introduced, and ergot of rye administered ; a jet of cold water should be allowed to play upon the loins, wherever the rupture may be. If there is hernia of the intestines, these, of course, must be promptly returned into the abdominal cavity, before any thing is done to the uterus. Some authorities advise that the uterus should be gently inverted and brought outside the vulva, in order that the rent maybe closed by suture, and then return it. But this course is not to be recommended, as it is very dangerous, and the wound will unite without sutures if the organ contracts and no complications follow. The cavity of the uterus should be swabbed with a weak solution of carbolic acid (i to loo, up to 250) ; and to prevent septic infection by admission of air, a pledget of carbolized lint or tow should be placed in the OS or vagina, and changed nov»^ and again. Straining must be subdued by doses of opium or chloral, or the subcu- taneous injection of morphia ; and the diet must be carefully attended to. If there is constipation, mild laxatives and enemas may be admin- istered. Consecutive fever and peritonitis must be treated by cold, and large doses of anodynes — such as opium, as well as counter-irritants. Metritis must be treated in the same manner, by the gentle injection of cold water ; or the introduction of small pieces of ice into the genital canal will be beneficial. Should symptoms of septic infection appear, stimulants, with small doses of carbolic acid and sulphite of soda, must be given. When the foetus has passed through the rent into the abdominal cavity, d^Mv^ry per vias natur ales is then impossible, and the Caesarean section must be resorted to ; unless it be decided to allow the animal to take its chance, and get rid of the fcetus as in extra-uterine foetation, should it survive the accident. Rupture of the Uterus after Parturition. Rupture of the uterus after parturition generally complicates inversion of the organ and is due to mechanical injury either on the part of amateurs, or even of the veterinary surgeon, when endeavoring to re- place it j sometimes it is produced by the animal itself, or by other TRAUMATIC LESIONS OF THE GENITAL ORGANS, ETC. 623 animals when the prolapsed organ gets in their way. In some instances it has been caused by jagged bones of the fcEtus in embryotomy, and in others by pessaries introduced into the genital canal to retain the inverted organ. In such instances the diagnosis is easy ; for if the uterus is still inverted the rent is visible, and its dimensions, situation, and gravity can be taken into account. It is somewhat remarkable that laceration or rupture of the extruded organ is much less serious than the same amount of injury to the uterus in situ, and it would appear that in inversion there is the greatest toler- ance of the most serious lesions. Why this should be has not been ex- plained ; but the fact is nevertheless patent, that in very many instances, when reposition of the uterus has been effected, the rupture has readily cicatrized, and union has been so complete and substantial, that the animals have afterwards been successfully bred from. Some authorities have closed the rent by suture ; but very many have not, and the termination has been as favorable in the one series of cases as the other. Unless the rupture is in the lower wall of the uterus, sutures are at least superfluous. Beyond the measures for reduction of the inversion, and the neces- sary antiseptic after-treatment, little more has to be observed. When the rupture is serious in inversion, and grave results are to be appre- hended should the uterus be returned, then it may be advisable to ampu- tate the organ. This may be accomplished in the manner already indi- cated. We shall notice a few of the recorded cases of rupture of the uterus. 1. Louis {Reaieil de Mid. Vetermaire, i?>6i) attended a Mare — a primipara — which had aborted, and soon afterwards the uterus was inverted, with the placenta adhering to it ; the organ was ruptured in the two-thirds of its antero-posterior diameter, i.e., laterally. It was the left side — probably the left cornu. The Mare was straining violently. The inverted portion was replaced, a cord truss was applied, and the animal had recovered in twenty days. 2. Darquie (Gelle', Pathologie Bovine, vol. iii.) was called in to reduce the inverted uterus of a four-year-old Cow, three days after parturition. Reduction was accomplished, and a truss applied. The straining continued, however, and on the fourth day after reduc- tion, one of the strands of the truss having been torn, inversion again occurred. On the arrival of Darquie, the uterus was found to be enormously swollen, and the mucous membrane hanging about it in shreds. He went for assistance, but forgot to close the door of the shed, and during his absence two large dogs had got in, and commenced de- vouring the organ. When he returned half an hour afterwards, the Cow was lying and covered with blood, and the uterus was destroyed nearly as high as the vulva. Fearing the results of the haemorrhage, Darquie was about to ligature en wajj^what remained of the uterus, when the animal suddenly jumped up, and all that was left disappeared in the pelvis. Nothing was done except to prescribe some acidulated injections into the vagina, low diet, and a few hygienic measures; in about fifteen days the Cow appeared to be quite well. 3. Eleout [Rec. de Med. Veterinaire, 1841) had to treat a Cow which produced a dead calf, and soon after showed complete inversion of the uterus. The latter was of a deep red color, and soiled. Reposition was attempted. " I commenced with the left cornu, which I readily returned, holding it by its base, and pushing it with my left hand until it disappeared. I proceeded in the same manner with the right cornu, which was likewise replaced. There was only a small portion that was not returned, when the Cow backed upon me with such force that the termination of the right cornu was ruptured, and my hand and arm penetrated into the abdomen. The uterus, finding nothing to resist it, was again expelled. My first thought was to unite the edges of the wound by suture ; but seeing that the animal was greatly debilitated, that the mucous membrane of the ut rus had been too long exposed to irritating contact with the air, that by this pro- ceeding I would protract the operation, and that in similar cases others had obtained a radical cure by excising a portion of the organ, I set about a second reduction of the 624 ACCIDENTS INCIDENTAL TO PARTURITION. uterus, which was returned into the abdominal cavity without difficulty." A pessary was introduced into the vagina, and the hind-quarters of the Cow elevated; emollient injec- tions were employed, and stimulating draughts administered. On the following day there was much fever and general disturbance. Blood was abstracted, febrifuge medi- cine given, and a poultice applied to the loins. On the fourth day the pessary was with- drawn, and a sanious fetid fluid escaped from the vulva. Vaginal injections were fre- quently resorted to. In twelve days the Cow was turned out to graze, evidently re- covered. 4. Franyois {Annales de Med. Veterinaire de Bruxelles, 1877, p. 157) describes a case of inversion of the uterus in a Cow, which was complicated by a rupture in the wall of the organ, about eight inches in length. This rent was closed by suture, the uterus was returned, and retained by a truss. The case did well. * 5. Obich ( Wocheiischrift fi'tr 'Ihierheilkwtde jmd Viehzucht, 1869, p. 349) describes the case of a Cow which, suffering from torsion of the uterus, had, during detorsion, a rent made in the upper wall of the organ ; this rent was so large that the outspread hand could be passed through it into the abdominal cavity. The animal was very ill for eight days, but it gradually recovered without any treatment. 0. Adam {Ibid., 1870, p. .411) mentions that a four-year-old Cow had a calf, and ap- peared to be quite Well until ten days afterwards, when haemorrhage from the vulva was observed; and on the following day there was loss of appetite, high fever, and greatly accelerated pulse and respiration, and the animal showed such serious symptoms that it was killed. On examination the uterus was found to be tolerably healthy, but in the right cornu, which had contained the calf, was found a quantity of partially coagulated blood, while the mucous and muscular coats were lacerated to the extent of nearly two inches — the laceration commencing at the base of a cotyledon. In the pericardial sac was some dark-red fluid, and the right endocardium was marked by large ecchymoses; while the fourth compartment of the stomach, as well as the small intestine, had their mucous membrane tumefied and very red, and that of the gall-bladder was ecchymosed. All this pointed to a sudden attack of septikaemia, resulting from the laceration. 7. Copeman ( Veterinary Record and Tra7tsactions,-\d\. v., p. 1 54) relates a case of rup- ture of the uterus in a Cow, occurring after protracted labor. The rent was nearly eight inches long, and about a foot from the os ; the small intestine passed through it into the uterus. These were replaced, and Copeman held the edges of the laceration to- gether for a quarter of an hour. No other treatment was adopted, and the animal re- covered. 8. Higginson {Veterinarian, vol. xiii., p. 395) was summoned to attend a Cow which had calved five hours previously. He found complete inversion of the uterus, and the fundus of the organ so lacerated as to allow a large portion of the small intestine to pass through. This rupture was probably produced by an amateur who had tried to reduce the inversion, but failed. The intestine was fir.st returned, and then the uterus, a truss being applied. Stimulants, opiates, and febrifuge medicines were administered, and in nine days the Cow was convalescent. This Veterinarian does not approve of sutures in the uterus. 9. At page 345 we have given an instance in which a rent in the uterus and vagina was discovered to have cicatrized perfectly. 10. Cartwright ( Veterinarian, vol. xv., p. 429) relates the case of a Cow from which a calf had been forcibly extracted by an amateur on the previous day. On examination, the uterus was found to be ruptured, and as the animal was evidently sinking it was killed. At the neck of the uterus was a rent sufficiently large to admit a man's head. The rectum was also torn. 11. The same authority {Ibid.) states that he was called to a Cow, from which the head, fore-limbs, and body of a calf had been removed. It was intended to extract the hind extremities by the application of greater force, but on the amateur introducing his arm they could not be found. Cartwright soon discovered that the uterus was ruptured to a very great extent, and through the opening the limbs had receded. The Cow lived for several hours after the accident, without evincing any pain or debility, and was ulti- mately destroyed. 12. This authority {Ibid., vol. xviii.) gives an account of a Cow which was most cruelly dealt with by amateurs, while trying to deliver it of a calf in malposition. The extrac- tion occupied two or three hours, during which time it was observed that the animal breathed quicker than usual, and groaned very much; it also strained violently, though this ceased immediately before delivery. It soon began to " breathe short, threw the head about, moaned, and was restless." Death took place in about twenty-four hours. The uterus was observed to be ruptured on its lower surface, to the extent of eicrhteen inches in a straight line from the cervix towards the fundus. The abdomen contained about two gallons of bloody serum, and the peritoneum was inflamed. 13. Cartwright {Ibid.) gives another fatal case of rupture of the uterus, due to attempts TRAUMATIC LESIONS OF THE GENITAL ORGANS, ETC. 625 to extract a calf in a false presentation. The Cow died. The peritoneum was inflamed, about two quarts of coagulated blood was contained in the uterus, and the floor of the latter, towards the fundus, was lacerated and ruptured in two places. One rupture was towards the posterior part of the fundus, extending in a circular manner nearly around it. The organ had contracted very much. 14. Younghusband {Ibid., vol. xxvi., p. 382) was sent for in haste to see a Cow which, three days previously, had calved, and was apparently quite well until that morning, when inversion of the uterus was discovered. He found the placental membranes ad- herent to the surface of the organ, which was greatly soiled. The hind-quarters were well elevated, the placenta detached, and the uterus cleansed by weak spirit and water ; on proceeding to return it, a large rent was found through which the hand could be passed, and which was supposed to have been caused by the next Cow having trodden upon the extruded mass. Reposition was attempted. " Judging I had got all the part into a right position, I made an attempt to withdraw my arm ; but in doing this the Cow immediately began to strain with such violence that it was with the greatest difficulty I could retain the part. But by a fortunate slip, her anterior parts were brought so near the ground that I now easily accomplished that which for a length of time I had found the gre'atest difficulty in attempting to do — getting the part into a right position, retain- ing it there, and withdrawing my arm without difficulty." The usual measures were adopted to prevent a recurrence of the inversion, an anodyne was given, and recovery soon ensued. The Cow had two calves afterwards. 15. The same veterinary surgeon (//^/^.) refers to the case of a Cow which calved without difficulty, and soon after had inversion of the uterus, the placen'.a remaining ad- herent. The owner took precautions against injury to the organ, and hurriedly sent for Younghusband, who on arrival detached the placenta, and readily replaced the uterus. Immediately, however, a portion of the small intestine appeared through the vulva, and a rent was soon discovered towards the fundus of the organ. The intestine was returned without much difficulty, and contraction of the uterus was brought about by applying tincture of opium and camphor. No truss was employed, and the Cow recovered. SECTION II. — LACERATION AND RUPTURE OF THE VAGINA Lacerations and rupture of the vagina are not at all unfrequent in the larger domesticated animals, and they are generally as serious as those of the uterus. These accidents may occur during copulation, as well as in parturition ; but they are more common in the latter. Trifling laceration of the vagina and vulva is often observed in primiparae, or those animals in which the soft parturient passages are narrow or rigid. The injury may be either spontaneous or accidental. The accidental in- juries are those produced artificially during assisted labor, and are due either to the instruments employed — hooks, forceps, knives, etc. ; the hand or the nails of the fingers of the obstetrist — the sharp exposed bones of the foetus when embryotomy has been practised, or from some salient part of the young creature during the uterine contractions. In the latter case, the feet generally cause the laceration or rupture. Deformity of the pelvis, or roughened nodules of bone in the vicinity of the genital canal, may also lead to serious lesions of the vagina. When the lesion occurs in what we may call a "spontaneous manner," it happens either that the vagina is lacerated along with the uterus, during natural labor and from continuity of texture, or when the os is amply dilated, but the vagina is overstretched by the foetus. In some instances such an accident as rupture of the vagina may be secondary : as when the textures which form its walls are much bruised and contused during the passage of the foetus. Then gangrene may supervene, and the mortified tissue be thrown off in a gradual manner, until complete perforation has taken place. The lesions arising from these different causes are extremely varied — from removal of the epithelium or simple abrasion, to laceration of the mucous membrane, or even thorough perforation of the vagina ; and they 40 626 ACCIDENTS INCIDENTAL TO PARTURITION. may be situated either towards the vutva or cervix uteri, on the sides, floor, or roof of the canal ; while they may only concern the vagina, or involve, at the same time, the neighboring organs and textures. Conse- quently, the gravity, as well as the symptoms of such lesions, vary con- siderably, according to their simplicity or complexity. Nevertheless, as we shall have to note hereafter, a very trifling abrasion may bring about very serious consequences ; while an apparently formidable injury maybe followed by no unfavorable indications. With regard to rupture of the vagina, and particularly with that which may be designated " spontaneous," it may be remarked that when the lesion occurs towards the cervix uteri, it is nearly always transversal, and, as has been before noted, the vagina may be completely separated from the uterus. In other instances, the form and direction of the rupture will differ considerably. Longitudinal rents often extend into the cervix uteri and body of the uterus. Of all the domesticated animals, the Mare appears to suffer most fre- quently from lesions of the vagina produced during parturition. The reasons for this liability we have already alluded to, and they may be chiefly referred to the length of the limbs of the foetus, and the energetic and rapid contractions of the uterus ; as \vell as the greater susceptibility of this animal to morbid influences — such as septikasmia. Nevertheless, in all animals these injuries are notoriously serious, and if the laceration occurs when the tissues of this part are bruised, chafed, and irritated by manipulations during a laborious delivery, they are all the more grave, ^ainard justly remarks that Bitches and Cats in which such a condition of the tissues exist, all succumb if there is the most trifling rupture of the vagina, even if there is no hernia. If the laceration is extensive towards the bottom of the vagina, the ab- dominal cavity will be opened, and the foetus, if it has not been expelled, may have partly passed through the rupture ; and in consequence of the walls of the passage being much less contractile than those of the uterus, the accidental opening is more pervious in the former than the latter, and thus all the more readily allows the intestines or bladder to pass through. Laceration or rupture of the vagina is more easily diagnosed than when this accident occurs in the uterus, as the vagina is much more accessible to the eye and hand ; though in some cases it is difficult to arrive at an exact knowledge of the situation or extent of the injury. With regard to progtiosis^ this will much depend upon circumstances, and the complications met with. Sometimes a mere abrasion of the mu- cous membrane, which produces a raw surface, or a laceration extending to the submucous connective tissue, may lead to septic infection. This is particularly to be apprehended should the foetus or membranes have undergone decomposition, or any putrid matter — as the lochia — allowed to remain in the genital canal, especially during hot weather. Wounds or lacerations on the floor of the vagina are generally more serious than those on the roof or sides, for the reasons mentioned with regard to rup- ture of the uterus. And even wounds or rupture of the sides or roof of the vagina are much more serious than the incisions made through its walls in ovariotomy, owing to the presence, during parturition and the puerperal state, of .fluids which may quickly become, or are already, putrescent. Hcemorrhage is generally not so much to be dreaded as in lacerations TRAUMATIC LESIONS OF THE GENITAL ORGANS, ETC. 627 of the uterus ; though occasionally it may be so serious as to endanger the life of the animal. Hernia of the intestine occurs when perforation of the vaginal wall, near the cervix, is complete, and the peritoneal cavity is opened. This is a serious complication, as is also hernia of the bladder, which may happen when the rent is adjacent to that viscus ; though in the case alluded to by Riviere (page 616) it was deemed a fortunate circumstance that cysto- cele was present, as the bladder effectually closed the rupture in the vagina, and thus prevented the escape of the lochial and other fluids into the abdominal cavity. Peritonitis and pelvic cellulitis are also very serious complications suc- ceeding laceration, and are a consequence either of the extension of vaginal inflammation to the neighboring tissues, or the escape of septic matters or inflammatory products into the pelvic connective tissue or the peritoneal cavity. So that if extensive laceration of the vagina does not produce rapid death, there are other grave dangers to be apprehended from either present or subsequent complications. The inflammation of the vagina and sub- mucous tissues, with suppuration and partial gangrene, may lead to the formation of fistula, or even of wide-spread destruction of the soft parts in the pelvic cavity, which sooner or later induce a fatal termination. Should this not occur, and some of the neighboring organs have been injured at the same time as the vagina, then we may have such important damage as to render the animal nearly valueless. We will refer to some of these injuries presently. The symptoms of injury to the vagina and neighboring organs will, of course, vary with their nature and extent. Much constitutional disturbance is generally only manifested when the lesions are serious, or when septic infection has taken place. Small rents may not give rise to any perceptible derangement, except, perhaps, a little fever and tumefaction \ but if they extend deeply into the con- nective tissue, then acute fever, infiltration, and other grave symptoms may supervene. With regard to treatment. This also must depend upon circumstances. When rupture of the vagina is recognized during parturition, delivery should be eftected as speedily as possible, and with every care, in order to prevent the laceration extending and the foetus passing into it. If, un- fortunately, some part of the latter has lodged in the rent, it must be re- moved therefrom with the utmost precaution, so as not to injure other viscera. The foetal membranes should also be extracted as soon as pos- sible. If there is heemorrhage from the vagina, this may be suppressed by ice or injections of cold water if the rent is superior or lateral ; if it is inferior, then a sponge or a cloth soaked in cold water should be placed in the canal. Should there be hernia of the bladder or intestines, these must be replaced at once. In all cases of wounds, abrasions, or rupture of the vagina, every pre- caution should be observed with a view to the prevention of septic infec- tion. With this object the greatest cleanliness must be observed, all decomposing matters, or matters likely to decompose, should, if possible, be scrupulously removed, and injections or " swabbings " with weak solu- tions of carbolic acid or other disinfectants, practised. If there is much danger of haemorrhage, a suitable tampon of lint or fine tow, saturated in these fluids, may be allowed to remain in the vagina for some time. fc 628 ACCIDENTS INCIDENTAL TO PARTURITION. 1. Petzold {Sachsen Jahresbericht, 1865, p. 73) relates that a Cow was delivered of its calf by manual force, though without much difficulty ; nevertheless, there ensued much swelling of the vulva, which extended to the right hock. On a close inspection being made, there was found on the right side of the vagina, about four inches from the vulva. a rent nearly three inches in length ; while the whole of the vagina itself was swollen, hard, and of a bluish-red hue. Fzeces and urine were voided with difficulty ; the animal was feverish, had lost its appetite, the respiration was hurried, etc. Injections of tepid aromatic infusions, with acetate of lead, were resorted to. From the third day all the more serious symptoms disappeared, and on the tenth day the wound had healed. 2. Field ( Veterinarian, vol. xxxi., p. i) communicates the case of a young Mare which, being expected soon to foal, was put into one of the bays of a barn with that view ; at the same time another Mare, due to foal two months later, was put into the opposite bay. Both were fenced off from contact with each other, and the breadth of the floor intervened. The Mares were visited by the carter at night, and there was nothing to attract his particular attention. When he looked in upon them early next morning, he found the Mare which had been expected to foal was dead, and that the other had aborted. The first had evidently been dead some hours, and on a closer inspection, its bowels were observed to be lying about its feet, bruised and lacerated, but there was no foal. An autopsy was made, and the foetus, full-grown, was found with its head bent on the chest and the fore-legs under the body. In the violent efforts made by the Mare to expel the foal, the intestines had been forced through a wide rupture between the vagina and rectum. The other Mare had aborted through fear or sympathy, or both. 3. Shipley {Ibid., vol. xxx., p. 383) attended a Mare which required assistance in par- turition. The animal was lying down and getting up frequently, straining, etc A very small portion of the foetal membrane was hanging from the vagina, the calibre of which was contracted, and the general appearance of the parts was not that of the parturient period. The liquor a?nnii had escaped. The foal was large and alive ; the fore-limbs were in the vagina, but the head was bent round to the right side. Attempts were made to adjust the latter, during which the hand came in contact with something, the character of which could not be detected from its being covered with the membranes. The Mare was very much exhausted, and threw itself down violently onCe or twice. Traction by means of cords was exercised on the foetus, during which the Mare sud- denly fell on the left side and violently strained, forcing from the vagina what appeared to be a portion of the single colon, covered by part of the cTiorion. The case being deemed hopeless for the Mare, even if the foetus was removed by embryotomy, it was shot, and a longitudinal incision being at once made along the li7tea alba, the uterus was exposed, opened anteriorly, and a fine healthy filly extracted. The young creature lived and did well. The wall of the uterus was found to be ruptured to the left of the upper part, and anterior to the os ; the rent was about five inches in length, and some- what oblique, a considerable portion of the single colon and rectum protruding through it. The meso-colon and meso-rectum were also ruptured to the extent of six inches. 4. Meyrick [Ibid., p. 503) alludes to a Mare he was called upon to attend which could not foal. The labor-pains had only commenced two or three hours previously, but there was no appearance of the foal. On introducing the hand into the uterus, the foetus was found to be so placed that there was no diffiulty in adjusting it. While, how- ever, attempts were being made to bring one of the fore-feet through the os, the Mare strained very violently. "This led to an immediate protrusion of a portion of the vagina in the form of a large bladder, close to my shoulder. Immediately afterwards the vagina burst, and a quantity o£ the intestines gushed out through the rent, the Mare falling down at the same instant. The mucous membranes of the mouth and nose be- came blanched almost immediately, and the pulse so tremulous and weak as scarcely to be felt." In about fifteen minutes death took place ; and on opening the abdomen a large quantity of blood was found in it, and which had escaped from a rupture, two or three inches in length, in one of the common iliac veins. Much blood had also poured from the rent in the vagina. The foal was dead. ^' 5. Galtier [Recueil de Med. Veterinaire, 1875, P- 47) '*^^^ summoned in the afternoon to aid a Mare which had been attempting to foal since the morning. It had lain on its side, making violent expulsive efforts, and Galtier was only sent for when it was noticed that the intestines were protruding from the vulva ; on his arrival the Mare was dead. The small intestine and floating colon, pushed through a rent in the vagina, were fully exposed externally, but not torn, and notwithstanding their expulsion, the abdomen was still considerably distended. As soon as the abdominal walls were incised, a large quantity of uncoagulated blood escaped from the cavity — the result of haemorrhage from the ruptured vagina. The foetus was in the anterior presentation, vertebro-sacral posi- tion, the lower part of the head pressed against the brim of the pubis and slightly in- clined to the right, although the Mare died when lying on the left side. The uterus and its contents occupied the right flank, and the small intestine and floating colon, more free TRAUMATIC LESIONS OF THE GENITAL ORGANS, ETC. 629 than the large intestine, puslied by the other portions of the intestinal mass by the efforts of the mother, had passed through a rent on the left side of the vagina, close to the cervix uteri which remained intact. The rent was irregular, and sufficiently large to admit the fist ; it extended lengthways, and its borders were ragged, ecchymosed, red, and thickened, with considerable extravasation of blood in the connective tissue. The stomach and large intestine contained a great quantity of alimentary matters, and Galtier is inclined to attribute the rupture to this condition, together with the faulty position of the foal and the .ecumbent attitude of the Mare. He points out that a trifling amount of manual skill in raising the head of the foetus would probably have prevented the accident; that the full condition and exaggerated volume of the first portions of the digestive tube may have contributed to bring about the misdirection of the foetus ; that when parturition is near, animals should not receive food in too great bulk ; that assistance should be sought for immediately the discovery is made that birth is delayed ; and that when the life of the mother is compromised, the Caesarear section should be practised without delay, in order to preserve the offspring. Complications of Ruptured Vagina. We have mentioned some serious complications of ruptured vagina, in which adjacent organs and tissues were involved. These are chiefly the rectum, bladder, and the perinaeum, one or more of which may be per- forated and torn, along with the vagina. These ruptures vary in extent and gravity, and while some of them are necessarily fatal, others are not so ; though they may lead to serious deformity and inconvenience, such as accompany chronic fistulae in important regions. We will follow the example of Saint-Cyr, and consider them under the head of recto-vaginal fistula, rupture of the perinaum, and vesico-vaginal fistula. Recto- Vaginal Fistula. — Injuries to the rectum are generally pro- duced through the wall of the vagina, during the passage of the fcetus. When the salient parts of the latter, and more especially the feet, are misdirected and pressed up towards the sacrum of the mother, and if the rectum chances to be distended with fasces, not only will the vagina, but this viscus also may be perforated, and some portion of the foetus will soon appear at the anus. If this accident is discovered in time, it may be possible to push back the parts thus misdirected into their natural outlet, and complete delivery by the vagina ; but, notwithstand- ing this happy termination, the communication between the vagina and rectum very often remains permanent, and we have a recto-vaginal fistula. The treatment of these cases is not always satisfactory, so far as a perfect cure is concerned. Sutures have sometimes been employed to close the wound in the rectum, when it was sufficiently accessible. But this surgical operation can rarely be resorted to, and all that can be done is to keep the lacerated parts clean, by frequent injections per vaginam and rectum, prevent constipation, and treat the injury on ordinary prin- ciples — not forgetting the free employment of antiseptics. If sutures are employed to close the fistula, they may be supported by a pessary or tampon placed in the vagina beneath the fistula. When the limbs, or other parts of the foetus, protrude through the anu^ it is nearly always advisable to amputate them, in order to effect the replacement of the remainder more easily in the vagina, and with less risk of further injury to the parent. Once in the genital canal, then the foetus can be extracted in the ordinary manner. Opiates should be largely administered. I. Cruzel {Journal de Med. Veterinaire, 1832, p. 153) l-.ad his attention directed to a Cow, which, after aborting, had a fistulous opening between the vagina and rectum, through 630 ACCIDENTS INCIDENTAL TO PARTURITION. which a portion of the faeces escaped. These caused a great and constant irritation in the vagina. The animal was in a state of marasmus, and was therefore killed. 2. Favre {Le Veterinaire Campagnard, p. 300) was shown a Mare, which the groom found with some pellets of faeces in the vulva. Removing these, others followed. There was no external lesion apparent, but, on examination, Favre discovered in the floor of the rectum, about five fingers' breadth from the anus, a longitudinal fissure from five to six inches in length, the borders of which were cicatrized, and came together when the rectum was empty. The roof of the vagina was fissured in the same direction, and the corresponding borders of the two fissures were adherent ; so that a free and direct com- munication existed between the rectum and vagina. The cause of the fistula was not known, and no treatment was adopted. t 3. Mongau {Annates de Med. Veterinaire^ 1856, p. 406) was called to assist a Mare in labor,^and found the foetus in a wrong position. The head, neck, and a fore-limb of the young creature had passed through the wall of the vagina into the rectum, while the other fore-limb protruded from the vulva. The parts in the rectum were pushed back through the rent, and the foetus was placed in its normal position, and extracted. In a short time the Mare was sufficiently well to be sold. Mongau adds that this was not the first time he had to treat such a case, and he remarks that when the parent lives, the tear in the rectum does not entirely close — there always remains an opening by which faecal matters pass into the vagina. 4. Dupont [Recueit de Med. Veterinaire, 1858, p. 105) was consulted about a Mare which the stud-groom at the stallion-station of ^Bordeaux declined to put again to the horse ; as at each attempt the latter had the penis covered with fasces when it was with- drawn from the vagina. Externally, there was nothing wrong noticed with the Mare ; but, on the hand being introduced into the vagina, there was found in the roof of that canal an opening into which the fingers could be easily passed. At that moment the animal passed f?eces, and, on the hand being withdrawn, it was soiled by excrementitious matters. The fistula was in the middle part of the canal, and was between two and three inches in length. When the rectum was empty, its borders were in apposition ; these were thick and irregular, from the presence of large, soft granulations, which bled readily. Dupont did not see the animal again after this examination. 5. Griois {Ibid., 1859, p. 411) relates that a farmer, in the vicinity of Amiens, was aroused during the night, owing to one of his Mares which was in labor. The foal was apparent, and he set himself to pull it away. The task was a long and difficult one ; but, aided by two neighbors, it was at length accomplished — the foetus being extracted, and the envelopes soon followed. It was not until late next day that it was discovered that the foal had been removed /^r rectum. Griois being then called in, made the fol- lowing observations : The anus, from which the debris of the foetal envelopes still hung, was much lacerated in every direction, but especially at its lower part ; it was also considerably swollen. The vulva, on the contrary, did not offer any thing unusual — not even the slightest infiltration. The hand, on being iTitroduced into the rectum, perceived, at about six inches from the anus, a rupture, eight inches long at least, with ragged margins, and corresponding to a similar rent in the uterus (vagina?). Through openings the hand could not only be passed into one or other of the canals, but also into the abdominal cavity, where the faces -which had escaped fr 0771 the recttmt cotdd be al- ready felt. The fissure in the rectum was sutured, and appropriate treatment adopted. In eleven days the wound in the intestine was cicatrized, and some months afterwards the animal was sold for a good sum. 6. Lecouturier {A7t7iales de Med. Vet. de Bruxelles, 1867, p. 268) was called upon to examine a Mare, which, two months after parturition, exhibited unsteady gait, rigidity of the loins, difficulty in rising, and pain in defecation, discovered, on rectal exploration, a tumor on the anterior part of the left side of the pelvis. An examination /^rz/a^/««z« led also to the discovery of a solution of continuity of the vaginal wall, at a point cor- responding to the tumor. From the bottom of this wound was removed the remains of a fibrinous clot, the whole of which could not be brought away, even after the opening was enlarged. It was then found that the recto-vaginal septum was perforated. Green food was prescribed, as well as emollient enemas, and slightly stimulant injections into the vagina. In six weeks the fistula was cicatrized. 7. Andre [Ibid., 1864, p. 175) reports that a Mare, four years old, strained very much during parturition when, all at once, the fore -limbs of the foal appeared — one by the vulva, the other by the anus. The owner, who was with the Mare, at once endeavored to push back the two limbs, and bring that which had entered the rectum into the va- gina ; having accomplished this, birth soon took place. Andre prescribed a soft diet, and the application of lard three times a day to the vagina. Cicatrization, without fis- tula, was complete by the seventeenth day. 8. Ory (Saint-Cyr, Op. cit., p. 662) had to give his attention to a Mare, five years old, which had foaled on the previous evening. For three weeks previously the animal TRAUMATIC LESIONS OF THE GENITAL ORGANS, ETC. 631 had exhibited, from time to time, and chiefly during the night, symptoms of colic, which gradually became more marked and frequent, until on the day of foaling it had seven actacks. On the evening of that day appeared the expulsive efforts, and soon the anus began to dilate in an extraordinary manner, until the two fore-limbs of the foetus ap- peared at the opening, and then the head showed itself. At last, under the influence of a violent effort, the anus, which seemed to have attained its extreme limit of dilatation, tore, and gave exit to a well-formed and lively foal. When Ory arrived, the poor Mare was in a state of great prostration. The sphincter ^z;// was lacerated to the extent of four inches; the rupture extending obliquely down- wards and outwards, and from right to left, passing through the skin, and exposing a portion of the left semimembranosus muscle, though the perinaeum was uninjured. On introducing the hand into the vagina, it was noted that this and the rectum formed to- gether one vast cavity, containing a certain quantity of well-moulded faecal pellets. The anus, which had been so violently dilated, remained wide and flaccid. Ory did not at- tempt to repair thes« enormous lacerations, but limited his treatment to removing, three times a day, and by hand, the faecal pellets which fell into the vagina ; to cleansing the cavity as thoroughly as possible, and to injecting a mixture of oil, carbolic acid, and an infusion of elder-flowers ; while the external wound was dressed with a decoction of oak bark, to which acetate of lead was added. This treatment was continued for fifteen days, and in about three weeks the external laceration was almost cicatrized ; the ani- mal's health was good ; but the vagina and rectum remained as a single cavity, and forming a kind of cloaca, where the faeces accumulated. The owner stated that, since the accident, the Mare could only be worked at a slow pace on the farm. As soon as it began to trot, a noise was heard, due to the air rush- ing out and in to the fistula. Then the animal became tympanitic, and evinced symp- toms of colic. Then, also, the urine and faeces were sometimes ejected simultaneously from the anus, which was always dilated ; but these i^assed by their natural channel when the Mare was at rest. 9. Schrader {Magazin fiir die Gesamtnte Thierheilkunde, 1837, p. 261) was requested to examine a six-year-old Mare, which had been purchased a few divs previously. When the animal micturated, faecal pellets came away at the same lime. A rectal ex- ploration, as far as the arm could be inserted, did not discover any thmj amiss, until, on withdrawing it with the fingers downwards, an opening has encountered, wliich led in an oblique direction from the rectum to the upper part of the vagina. A finger could be easily passed from the vagina into the rectum. The opening was about an inch in di- ameter, but it could be readily dilated ; its borders were even and smooth, and the ani- mal did not evince any pain when they were touched. The Mare had produced one foal. The fasces were tolerably well retained in the rectum, but flatus always passed through the vagina. 10. Hawthorn ( Veterinarian, vol. vii., p. 28) was sent for to see a Mare which was re- ported to have the foal " coming the wrong way." Hawthorn was struck with the sin- gularity of the case. " The foal was protruded as far as the middle of the chest, and the fore-legs were almost a yard asunder — one hanging down towards the thighs, and the other standing up above the tail. The body of the foal was lying on its off-side : of course it was dead. The left leg had, in the act of foaling, been forced through the rectum, and then through the anus." The Mare was cold and feeble ; the pulse was scarcely perceptible, and the animal appeared to be sinking rapidly. It was decided to extract the foetus by embryotomy. " The nearest place which was suitable for the opera- tion, was a barn a quarter of a mile distant, to which ^he was immediately walked ; and as I followed her, and witnessed her staggering gait, I felt as if she was going to execu- tion. She was thrown, and pulleyed up to a joist. The near leg of the foal was dis- sected off at the knee, and, by the right hand, forced back into the vagina, where it was received by my left hand, and drawn a little forward. As the only obstacle to the foal- ing was now removed, the remaining part of the operation was soon accomplished, and the Mare got on her legs. The wound through the rectum was terrific, as I had easily passed my arm through it. She was then walked home, and seemed much better." The animal was dieted on wet bran and clover for a week. The rectum was emptied manually two or three times a day, and the vagina washed out. " The faeces which es- caped through the wound into the vagina were not wholly expelled ; it was therefore necessary to cleanse the vaginal passage. The wound in the rectum healed very rap- idly, and' the Mare never exhibited any unfavorable symptoms after the extraction of the foal." The animal, soon after, was put to work, as if nothing had happened. ir. Morgan {Ibid., vol. xxviii., p. 397) was hastily sent for to see a Mare which was foaling, but the foal was "coming the wrong way." When he arrived he found the ani- mal lying down, groaning, and straining violently, and the head, neck, and one fore-leg of the foal through "the rectum, and the other fore-leg through the vulva. The Mare was induced to get up, hobbles were applied, and then the parts of the foetus protruding be* 632 ACCIDENTS INCIDENTAL TO PARTURITION. yond the anus were excised as close as possible. The sphincter ani was dilated, the parts in the rectum pushed through the rent in that viscus into the vagina, and with a little assistance the remains of the foal were extracted by the vulva. The Mare received opiate and laxative draughts, and soft diet. " Without entering into further details, the animal was under my care for about a fortnight, when she was sold to a builder for ;i^i8, and is at present working in a brick-cart, perfectly well." 12. Hudson {Ibid., vol. xlv., p. 409), called to attend a case of difficult parturition in a five-year-old Mare, with the first foal, found, on arrival, that the persons in attendance had delivered the animal, and that during labor the head and neck of the foal had pro- truded from the anus of the mother nearly as low as the hocks of the latter. When first observed, one foot of the foal was protruding from the vagina, " with the other foot pointing upwards towards the spine, and after pulling it downwards into position, the next pain sent the head into the place which the foot had previously occupied, and a sec- ond pain forced the head through the passage and out at the anus." The foal was alive, but to effect delivery the head was cut off, which allowed the neck to be pushed back into the vagina, and delivery to be accomplished. " The Mare looked anxious and un- settled. Her head was held high, and she was paddling with the hind-legs, and whisk- ing the tail occasionallv. The pulse and respiration were both somewhat quickened. On an examination being made/^^r vaginam, I was enabled to pass my hand through a large rent, and to touch the forefinger of the other hand, which I had passed into the rectum." An anodyne and aperient bolus was administered, the animal ordered to be kept quiet, the parts to be fomented and dressed with lard, and the fasces to be removed if they accumulated. Next day the rectum was emptied, and an enema of warm water administered. The injured parts were dressed with tincture of myrrh, and the mucous membrane lubricated with lard. The appetite remained good. Next day there were indications of congestion of the fore-feet, for which treatment was prescribed, and the rectum was emptied and cleansed as before. Two days afterwards a small quantity of fasces had passed into the vagina, and the following day there was much discharge, and a piece of dead tissue hanging out of the vulva. Thirteen days after the accident, some fascal pellets still dropped into the vagina, and this appeared to be the only incon- venience. " The rent in the rectum has contracted considerably, and seems to be partly arched over by a portion of the lining membrane projecting from the antero-inferior part of the laceration. Posteriorly, the edge of the lesion feels now only just within the anus, but there is not the slightest indication of union by healing." Soon afterwards the Mare went to regular work. Rupture of the PERiNiEUM. Laceration of the vagina is not at all unfrequently complicated with more or less extensive rupture of the perinaeum, and occasionally we may meet with rupture of the vagina, rectum and perinasum in the same ani- mal. Sometimes it is only the fourchette and superior commissure of the vulva which are involved ; in others the entire extent of the perinseum is lacerated, and the lesion only ends at the anal sphincter ; while in others, again, the sphincter and part of the rectum are included. If, in malposition of the foetus, assistance is not timely afforded — and particularly in the Mare — so as to correct the deviation, the young crea- ture is pushed outwards by the violent uterine contractions, and if it en- ters the rectum the anus is dilated ; while, if the expulsive efforts are con- tinued, the sphincter and all the tissues between it and the vulva are greatly stretched and strained until they tear. Then the foetus is finally expelled — sometimes dead, at other times alive — and there remain the most startling and immense lacerations which convert the rectum and vagina into one vast opening, into whose cavity, as Saint-Cyr observes, the termination of the digestive and genito-urinary organs open in com- mon. These ruptures, immediately after birth, appear two or three times larger than they are some days afterwards, when the distended textures have contracted somewhat ; the borders of the laceration are sometimes even, in other cases uneven, ragged and shreddy. TRAUMATIC LESIONS OF THE GENITAL ORGANS, ETC. 633 The consequences are variable, according to the extent of tlie injury. Moderate laceration does not usually prove very prejudicial j but if severe, serious inflammation of the perinasum, extending sometimes to neighboring tissues and organs, sets in. If the tear involves the anus and its sphincter, there will be involuntary escape of fcecal matters and flatus ; and in the most formidable cases — those in which the vagina and rectum form one wide gaping cavity — the mucous membrane is irritated by the free admission of air and excreta, inflammation and suppuration ensue, fistulas are formed, and the poor animal only too often presents a painful and repulsive spectacle. In other instances, partial recovery takes place, and the animals do not appear to be much affected or inconvenienced. They maintain good health, rear their progeny, if it chances to be born alive, and may even bring forth young again, though the laceration has not cicatrized. The treatment will vary, according to circumstances. If there is much hsemorrhage, styptics must be employed ; if the bleeding is slight, cold may check it ; but if severe, perchloride of iron must be used. The lacerated margins, if much torn, must be freed from shreds, which are likely to lose, or have already lost, their vitality. They must then be brought together by sutures — either of metal, or carbolized silk or catgut. Cold water dressings may then be applied; or styptic colloid, collodion, or carbolized glycerine may be employed. The parts must be kept as clean as possible, and the animal not disturbed or allowed to lie down until union has been effected. With this object a narrow stall is to be preferred. The sutured septum should be supported from the vagina by a tampon placed therein. This will tend to prevent the pressure of faeces tearing away the sutures in the floor of the rectum, and this result will also be greatly obviated by administering enemas frequently, and cover- ing the mucous membrane with lard. Sloppy food should be given as diet. Fever and other unfavorable complications must be treated accord- ing to their indications. Opiates will prove of great service ; and if there is much local disturbance or straining, suppositories of opium are to be recommended. There are not, so far as I can ascertain, any instances of this accident recorded in English veterinary literature. We shall therefore give a few derived from foreign sources. 1. Cruzel (Journal de Med. Veterhtaire, 1832) mentions that a Mare, ten months preg- nant, aborted a living Mule, one of whose limbs, during parturition, had passed through the rectum. A veterinary surgeon attempted to extract it, but not succeeding owing to the obstacle this limb presented, he prolonged the rupture to the anus. The Mare died next day. 2. The same authority saw a she-Ass which had the posterior third of the rectum ruptured, as well as the anus. It was not much inconvenienced. 3. Dupont [Recueil de Med. Veterinarire, 1858) relates that an empiric being called upon to deliver a Mare in parturition, seeing the feet of the foal protruding from the anus, knew nothing better than to pull at them, and thus extract the young creature through the rectum. Four days afterwards Dupont was sent for, and he found that de- fecation had not taken place for three days ; there was considerable tumefaction in the ano-vulvar region: from the anus to the vulva all the textures were torn and bleeding, and the external borders of the rupture overlapped each other in large swollen masses ; the inferior parts of the vulva were covered by the continual escape of the vagino-intes- tinal excretions. The injury-exhaled a very fetid odor. The rectum and vagina were emptied of the faecal pellets which encumbered the vast cloaca, and then the injury was seen to its full extent. From the cervix uteri to the roof of the intestine, the vagina and rectum formed one vasf cavity. The flica p.xhnata of the cervix were visible as thick dark-colored ridges, between which excrementitial debris was incrusted. Superiorly, the rectum appeared gaping, and aspiring the air like the piston of a steam engine. 634 ACCIDENTS INCIDENTAL TO PARTURITION The line representing the recto-vaginal septum divided the cavity, in the form of a small, red and irregular ring. The mucous membrane was ecchymosed and very congested ; the cervix was seriously inflamed. For fifteen days nothing was done but merely keep- ing the parts clean. At this time the inflammation in the borders of the external wound had disappeared, and repair was going on along the perineal rupture ; internally, the mucous membrane had nearly assumed its normal appearance, and scarcely any thing remained of the vagino-rectal diaphragm ; there was no suppuration or ulceration. Dupont then decided to resort to autoplasty to repair the serious damage, and fixed on the Indian method. "I slowly introduced my left hand into the vagina, and extended the canal by pressing strongly on its sides. The right hand, armed with long fine scissors, pared to the blood the edges of what remained of the septum. Then with a needle armed with a waxed thread, I commenced to bring these edges together by suture, the sutures being eight in number ... I then passed to the perineal laceration. With the scissors, I destroyed all the granulations as low as the skin. I then applied sutures, se- curing each by a distinct knot . , . covering the whole externally with a thick layer of collodion." Every care was taken to ensure success, and for eight days every thing appeared to be going on favorably ; but on the ninth day it was observed that some of the recto-vaginal sutures had given way, and that the wound had not united ; and in two days afterwards all the sutures had sloughed through, without the least union having been effected. Nothing discouraged by this failure, Dupont again resorted to sutures, and when the edges were once more brought into apposition by them, with a curved bistoury he cut through the vaginal mucous membrane parallel to the sutures, but at a few lines from the roof, in order to diminish the tension. For fifteen days all went on satisfactorily, and success appeared to be certain, when the same result ensued. Dupont then gave up the case, and the Mare, which had been in excellent health during the seventh month's trial, was set to work. 4. Andre [AnnalSs de Med. Vitirinaire de Bruxellcs, 1864) was summoned to aid in the delivery of a Mare, ten years old, whose foal was being expelled through the anus. "When he arrived it had been delivered, and did not appear indisposed; the foal was well and lively. The birth, which was spontaneous, appeared to have been very rapid ; for the servant, as soon as he saw the feet of the foal appear at the anus, ran for his master, and when he returned the foal was born. On examining the Mare, Andre found a complete rupture of the perinasum, and, consequently, a total absence of any septum between the annus and vulva — the rectum and vagina being merely one large open- ing. It was also, observed that this lesion involved the contiguous walls of these parts to some extent ; and on separating the labia of the vulva the cervix uteri could be seen. The faeces were passed by the vulva. No attempt at repair was made, and treatment was merely directed towards subduing inflammation. A month afterwards the wounds were cicatrized, but not united. The general heUlth was good, but defecation took place by the vulva more frequently than usual, and involuntarily. 5. Jouet {Rec. de Med. Veterinaire, 1873, p. 56) gives the detailed history of a Mare belonging to Prince Ney, of Moscow, and with which, during parturition, the foal could not pass through the vagina, in consequence of the narrowness of that canal ; it there- fore passed into the rectum, and was born through the anus. About eighteen months after this accident, the rupture, which established a communication between the rectum and vagina, was ten inches in length, and formed an infundibulum in which the faeces accumulated before being expelled by the vulva. The anus appeared to be inert, and did not act. The clitoris was hypertrophied. Notwithstanding this infirmity, the Mare lived for many years, and neither suffered in health or vigor. It was even fecundated without accident, and brought forth a foal with ease. When put to the stallion a second time, however, it received serious injury, lost condition, fell into a state of marasmus, and died. 6. Saint-Cyr {Op. Cit., p. 665) states that the internal clinic of the Lyons Veterinary School received a Mare, five years old, and a primipara, which had brought forth its ioz\per anum, under the following circumstances. Six days previously it exhibited the first signs of parturition. Soon the two fore-feet of the foetus appeared at the vulva, and quickly after the nose appeared, but at the anus. While the proprietor was in search of a veterinary surgeon, the foal was born without any assistance. It soon died, and when the surgeon came he saw an immen.se rupture in the Mare, comprising the perinasum and the whole of the recto-vaginal septum. Otherwise the Mare did not ap- pear to be much disturbed, but ate and drank heartily. The veterinary surgeon declared that he could do nothing for the animal ; consequently it was sent to the Veterinary School. When it reached there, nothing particular was observed except a slight swel- ling of the left hind-leg, which caused marked lameness. On raising the tail there was immediately observed a considerable tumefaction of the vulva and anus, then a complete TRAUMATIC LESIONS OF THE GENITAL ORGANS, ETC. 635 rupture of the perinasum — an irregular laceration rather to the right side, and which made the anus and vulva one long slit. When the great cavity was freed from the mass of faeces it contained, the half-open os uteri could be seen at the far end, while above were the remains of the recto-vaginal septum. The latter was destroyed throughout its entire length, so that the rectum and vagina communicated freely with each other for at least five inches, and their union formed a vast cloaca, in which the faeces gradually col- lected. The borders of the rupture had commenced to granulate. On the floor of the vagina, not far from the bulb, there were two other wounds of some length, which in- volved the mucous membrane throughout its thickness — one to the right, the other to the left — from which escaped a quantity of pus. Rather for the instruction of the pupils than in the hope of effecting a cure, the auto- plastic procedure adopted by Dupont was resorted to. The remains of the recto- vaginal septum were made raw, and united by the interrupted suture : six sutures being made without nmch difficulty ; so that, when the operation was completed, the margins of the rupture were in exact apposition and the septum re-established. This was the most difficult part of the operation, as the perineal sutures were easily placed. The rectal and vaginal cavities were thus once agam separated, as in the normal condition. During the day of the operation, the anfmal appeared to suffer and was restless ; it was unable to defecate spontaneously, and the rectum had to be emptied several times, dur- ing which manceuvre the sutures were interfered with, the tissues strained, and next morning it was discovered that several of the stitches had given way; so that the edges were not exactly in contact, excrement had passed between them, and it was necessary to again attempt the task of restoration This, however, was not ventured upon, and nothing was done but to keep the parts clean Cicatrization occurred without any note- worthy circumstance except the formation of an intermuscular abscess, which developed towards the middle of the right thigh, discharged a large quantity of pus, and healed slowly. In a month the animal had recovered, so far as general health was concerned, but the infirmity still existed, and rendered the creature almost valueless. Vesico-Vaginal Fistula. When the floor of the vagina is ruptured, it may happen that the neck or walls of the bladder are involved in the lesion, just as that viscus may, as we have seen, become prolapsed or hernied through the vaginal rent. When rupture of the bladder occurs in this manner, the case is indeed serious. The urine is no longer confined to its receptacle, but escapes through the laceration and becomes infiltrated in the pelvic connective tissue. Hence arises most serious complications : pelvic cellulitis and urine-ahscess, which rapidly lead to a fatal termination. In less, formid- able cases, the urine may escape by the vagina, but involuntarily ; so that the incontinence of urine not only proves a troublesome infirmity, but the constant passage of this fluid over the membrane lining the vagina gives rise to intense inflammation of the canal, and leads to the formation of a vesico-vaginal fistula. This fistula may also be produced by usure or bruising. When the foetus is very large it occasions over-stretching of the vagina, and if it remains for any length of time in the passage, this dis- tention weakens the vitality of the soft tissues ; so that the compression to which they are submitted between the fcetus and the floor of the pelvis will produce mortification, which may extend to the neck of the bladder. The resulting sloughing, should the animal survive, will establish a direct- communication between the vagina and bladder. An animal may live with a fistula of this description, provided urine- abscess, uraemia, or other serious complications do not result. The symptoms need not be specified. The chief is incontinence of urine. When this fluid is observed to be constantly dribbling from the vulva after parturition, the existence of the accident may be suspected, and an examination /^r vaginam will confirm the suspicion. Treattnent must be mainly palliative. 636 ACCIDENTS INCIDENTAL TO PARTURITION. bupont [Rec. de Med. Veterinaire, 1858, p. 1057) examijied a fine, well-bred, four-year- old Cow, which was in good condition. The animal emitted a very penetrating acid odor, which extended to some distance around it. The tail was entirely denuded of hair ; a vast ulcer occupied all the posterior regions, from the inferior commissure of the vulva down to the claws of the hind feet. After washing the parts well with chlori- nated water, the hand was passed into the vagina, and a large wound was discovered in the middle of the lower and posterior part of that canal, but it was partly concealed by large, ragged, and irregular vegetations. Pus, thick and plastic secretions, and a thin layer of salts, gave to the touch the sensation of a calcareous powder occupying the bot- tom of the wound, which was bathed by a permanent " sweating " of urine. When this part of the vagina had been well cleansed, it was observed that there was a considerable loss of substance, and that about three inches of the ischial symphysis was denuded. The irregular borders of what remained of the vagina, stood nearly an inch above the bony surface ; great movable, and spongy granulations partly covered the symphysis, and appeared to be the seat of an abundant suppuration. Beyond this the retracted bladder could be felt. The vaginal mucous membrane was of a bright-red color, and the whole of its inferior surface was ulcerated. The place where the hind-feet of the animal had stood during the few minutes' exploration was saturated with urine. No information as to the date or origin of the lesion could be procured. SECTION III. THROMBUS OF THE VAGINA AND VULVA. Thrombus or hcematoma of the vagina and vulva is sometimes observed after parturition, and is due to an infiltration of blood into the connective tissue of these parts, from the almost inevitable injury they sustain during laborious parturition. In such cases, when the foetus is very large, or in a wrong position, considerable manipulation and traction are often necessary to adjust and remove it ; and this leads to bruising of the soft parts against the pelvis, ana laceration and rupture of the blood-vessels and connective tissue. The blood-vessels are larger, and probably more numerous, during preg- nancy than at other times ; consequently, there results extravasation of blood, and considerable tumefaction of the genital canal, particularly in the vagina and vulva. Sometimes this tumefaction appears during par- turition, when it may form an obstacle to birth. The mucous membrane is raised into irregular masses, perceptible to the eye, and still more marked to the touch. The membrane itself has a blue, violet, or black tint ; the labia of the vulva are considerably swollen, and the engorgement may extend to the thighs and croup. If there is not much extravasation, the eflfused blood may be absorbed in a few days \ but if the thrombus is extensive, the blood becomes de- composed, gives rise to inflammation, may run on to gangrene, and septic infection may consequently ensue. As to treatment, scarifications are above all things to be recommended. wSamson, who has had much experience of such cases, says that the labia of the vulva should be well separated, and a bistour}'- plunged into the right and left walls of the vagina, as if to open an abscess, and the incis- ion should be large, in proportion to the quantity and situation of the clots ; pressure must then be made, so as to remove the latter. The operation appears to be quite innocuous ; though a case is re- corded by Cartvvright ( Veteritiarian, vol. xix., p. 386) in which a great stream of blood issued from one of the punctures, in consequence of a large vein being wounded. When all the extravasated blood has been removed from beneath the mucous membrane or skin, cold water injections and sponging, and weak solutions of carbolic acid, permanganate of potash, or other detersive and disinfecting fluids, should be resorted to. The same treatment is to be TRAUMATIC LESIONS OF THE GENITAL ORGANS, ETC. 637 adopted when suppuration has set in, only more attention must be paid to the disinfective treatment. SECTION IV. RELAXATION OF THE PELVIC SYMPHYSES. This accident, which is far from common in woman, is still more rare in animals j and there appears to be only one case recorded — that by Gilis. Gilis {Journal des Veterinaires dii Midi, 1858) alludes to the case of a Cow, eight years of age, which, nineteen clays beyond its time for calving, commenced to strain very much. All at once it ceased, bellowed, flexed its fore-limbs, lay down, and began to strain again. In a short time it brought forth a calf in a natural manner. From this time it lay almost constantly, and could only rise with great difficulty. Then it could scarcely move, and its hind-quarters swayed from side to side : the ilium of either side rising or falling, as the corresponding limb sustained weight or was raised from the ground. The hand passed into the rectum, found the sacro-iliac articulation painful on ])ressure. There was no abnormal sensibility in the ischio-pubic symphysis; but when ihe animal walked, the index-finger placed on one pubic bone and the medius on the other, felt an alternate movement of these bone.s, in harmony with that of each ilium. The sacro-pubic diameter of the pelvis appeared to be diminished, while the bi-iliac was slightly increased. The internal angle of the iliums forming the summit of the croup, projected more than four inches above the spines of the sacrum, which appeared to be as much buried between these angles. From these symptoms, Gilis diagnosed a partial disjunction between the pubic and sacro-iliac bones. Deeming the case incurable, he recommended that the animal should be fattened and killed. Some months after the examination, it was in the same condition. The accident was attributed at first to pregnancy, then to the ex- ertion the Cow made in draught until parturition, and finally to the act of parturition itself. SECTION V. RUPTURE OF THE BLADDER. Rupture of the bladder alone, during parturition, would appear to be an unusual accident, from the almost total absence of mention of its occurrence. That it may happen, however, is beyond dispute, and the cause of it is obvious. In the Mare the act of parturition is hurried and energetic, and if it occurs while the bladder is distended with urine, the pressure of the foetus during expulsion may rupture this viscus, and par- ticularly if the rectum above is also full of faeces, the fcetus large, and perhaps in a wrong position. The extravasated urine gives rise to peritonitis, and the animal will present the symptoms of that most painful inflammation. Death is inevitable. I. Furnivall ( F^/^r/war/Vj-;?, vol. x.xxiii., p. 377) was hurriedly called to attend a six- year-old cart Mare, which had brought forth in previous years' two foals, and had then foaled fourteen days before its anticipated time. Early in the morning the wagoner entered the stable where the Mare stood along with five other horses, and found the animal with a foal hanging from it, the hips being fast in the vagina. He removed the Mare at once to an empty stable, and went to inform the owner. During his absence, according to the statement of a boy who remained, it heaved violently and ejected the foal, which alighted on its head, dislocated the second and third cervical vertebrae, and did not move afterwards. The Mare then commenced throwing itself about and breath- ing quickly, striking at the abdomen with the hind-limbs, and, whqp up, reeling like an intoxicated animal. It appeared to be in the most terrible agony, and in a short time fell down as if shot, and died. This occurred before the arrival of Furnivall, who made an examination of the body. Every organ was found to be perfectly healthy both in the thorax and abdomen, with the exception of the bladder, which was ruptured to the ex- tent of three inches, and the urine it contained had necessarily escaped into the perito- neal sac. 638 ACCIDENTS INCIDENTAL TO PARTURITION. 1. Overed [Ibid., vol. xxxvii., p. 505) communicates a case of peculiar interest, ni which a Mare, twelve years old, had given birth to a living foal about four weeks pre- vious to his advice being sought. Assistance had been rendered by some farm-laborers, after which the Mare was observed to micturate more frequently and in smaller quan- tities, the effort being accompanied with pain. Put to the stallion nine days after par- turition, the symptoms became more aggravated, the desire to micturate being almost continuous ; but nothing in the way of advice was sought for until a later period, when being put into a pasture, the animal suddenly ceased feeding, trembled violently, lay down, rolled several times, got up, and after much straining voided only a few drops of urine, great pain being evinced, and the body was covered with perspiration. Faeces were freely passed. Great prostration was manifested next day ; there was straining at intervals, the anus and vulva were intensely swollen, the latter being much inflamed. The bladder was discovered to be quite empty and firmly contracted within the pelvis, and the finger passed into the urethra caused a spasmodic ejection of only a few drops of. urine. The Mare died during the evening of the examination. On opening the abdomen a large quantity of fluid — from ten to twelve gallons — escaped; this proved to be urine, with possibly a small quantity of serum, as the peritoneum exhibited slight traces of inflammation. The omentum was very dark in color, and covered with a thin sabulous deposit, some of which was also found adhering to the caecum, colon, and blad- der. The latter was inflamed, unusually thin at the fundus, in the centre of which was a rupture through which a finger could be passed in the contracted state of the organ — the rent would be much larger when the viscus was distended. The injury was sup- posed to have been inflicted during parturition, when probably the bladder was injured at the fundus, and this led to sloughing at the part where the rupture occurred. SECTION VI. RUPTURE OF THE INTESTINES. There are some instances recorded in which rupture of the intestines has occurred during parturition, Avithout the uterus or other organs being involved. The accident may have been due to over-repletion of the stomach and intestines with ingesta, and the energetic action of the abdominal muscles during the labor pains ; or from the animal throwing itself down violently, under the same circumstances. Schaack mentions a case in which rupture was due to a loop of intes- tine being compressed between the foetus and the brim of the pelvis, when the former was passing through the genital canal. Such an accident is beyond remedy. SECTION VII. RUPTURE OF THE DIAPHRAGM. Rupture of the diaphragm is a rare occurrence during parturition, and I can only find three cases recorded. They were probably due to the same causes as those which produce rupture of the intestines. Death resulted. 1. Molin {Recueil de' Med. Veterinaire, i^yj) vidiS consulted concerning an old Mare which was in foal, but nothing was known as to when fecundation had taken place. The extraordinary size of the abdomen and the movements of the foetus, left no doubt as to pregnancy, and as the period for birth had been exceeded, there were suspicions that it was a case of extra-uterine pregnancy. However, a few days subsequently labor pains set in, and after the animal had been very uneasy for some time they ceased. Two days afterwards, the Mare was again uneasy from time to time, and refused all food. These attacks once more subsided, but in four days a message was sent that the animal was voiding its bowels through the vagina. When Molin arrived, the Mare was dead, and a great part of its intestines were spread over the litter. An examination was made when the uterus was found to be of an enormous size, the body and cornua forming one vast sac ; it had entered the thorax through an enormous rupture in the diaphragm. "This probably had been produced by the violent straining, and was the immediate cause of death." There was a rent in the vagina near the symphysis pubis. The cervix uteri was extremely dense, and the walls of the vagina were also rigid. The os had not dilated. The foetus weighed 140 pounds. 2. Hayes ( Veterinarian, vol. xiii., p. 268) performed the Caesarean section on a Cow, TRAUMATIC LESIONS OF THE GENITAL ORGANS, ETC. 639 and for twelve days it appeared to be going on favorably, when it died in a, few hours. A rupture of the diaphragm at its central part, extending for three inches, and with much inflammation around it, was found. The wound -in the abdomen and uterus was healthy, but the vagina was very dark-colored and jelly-like. Death in this instance may have been due to septikaemia ; though Hayes was of opinion that it was owing to the rupture in the diaphragm. SECTION VIII. — RUPTURE OF THE ABDOMINAL MUSCLES. We have, at page 280, when treating of " Hernia of the Uterus " during pregnancy, explained under what conditions, and the manner in which, rupture of the abdominal muscles occurs. The accident can scarcely be designated as one consecutive to parturition ; but its treatment may nevertheless engage the attention of the veterinary surgeon, after ^ the uterus has been emptied of its contents. In the same section allusion has been made to the appropriate measures. SECTION IX. — RUPTURE OF THE SACRO-SCIATIC LIGAMENT. We can only find one case of this accident on record ; so that it must be extremely rare. It is given by Naylor ( Veterinarian, vol. xxxiii. p., 321), and the subject was a three-year-old cart Mare, which had a mal- presentation. The animal was down, and the fore-feet of the foetus pro- truded beyond th^ vulva, but the head was not visible, it being bent back to the side of the chest ; the young creature was dead. Embryotomy was resorted to, and one limb was about to be removed, when the uterus suddenly contracted with great violence, and half expelled the foal ; traction then removed it. " All attempts to get the filly up were ineffec- tual, and an examination showed that a rupture of the sacro-sciatic liga- ment on the right side, with other lesions, had taken place." Stimulants and laxatives were administered, and a mustard plaster applied to the loins. "In two days she was on her legs, and tottering about the yard. Suffice it to say that she ultimately recovered, and though for two years the off-quarter was less in size than the other, she ultimately got quite well, and had two or three foals." 640 PATHOLOGY OF PARTURITION. BOOK V. PATHOLOGY OF PARTURITION. Under the head of Pathology of Parturition, we intend to include those diseases which accompany or follow this act, and are more or less related to it. Some of these maladies are of great pathological interest and practical importance, and deserve the closest study. The parturient or, if we might use the term, puerperal period, is a very remarkable and critical one in the life of the female animal, and it becomes all the more so as the creature is submitted to the influences of domestication, and is rendered more and more artificial by skilful management and breeding. During pregnancy, a large amount of nutritive material has been ab- stracted from the parent to nourish and develop the foetus;, and when birth takes place this is retained until the lacteal secretion has been fully established. Consequent upon this reflux, there is established a kind of plethora, which, together with the nervous excitement and succeeding prostration induced by the straining and pain of labor, renders the animal more susceptible to the influence of morbific causes of various kinds. Hence we have maladies which are peculiar to the parturient state, or if common at other times, are at least much aggravated when they appear at this period. Though the parturient diseases of animals are not so numerous as those of the human female, yet they are neither unimportant nor few ; and it is possible that, with the advance of vet- erinary science, their number will be increased — so far as exact definition and differentiation are concerned. In this respect, the prominent part infection by septic material plays in the development of parturient diseases is to be remarked. It is but recently that this agency has been recognized as one well worthy of consideration in veterinary pathology; and the closer its effects are studied, so the more inclined are we to attribute diseases — and particularly those of the parturient state — to one common source, septic infection. Of course, there are other maladies or disturbances, chiefly of a local character, the etiology of which cannot at present be traced to septosis, and which merit notice in this part of our work. The diseases which we have to consider are: i. Vaginitis ; 2. Leucor- rhoea ; 3. Metritis, Metro-peritonitis^ and Parturiejit Fever; 4. Parturient Apoplexy; 5. Post-partum Paraplegia; 6. Parturient Eclampsia; 7, Ep- ilepsia Uterina ox Mania Puerperalis ; 8. Parturient Laminitis ; 9. Mam- mitis ; 10. Agalactia; 11. Injuries to the teats. CHAPTER I. Vaginitis. Inflammation of the vagina does not often exist independently, but is generally an accompaniment of inflammation of the uterus, or "Metritis," which, being the more serious evil, masks this malady. Nevertheless, vaginitis may occur independently of metritis, and is then generally due VAGINITIS. 641 to protracted and laborious delivery, which necessitates manipulatory efforts, the use of instruments, etc., the passage of a very voluminous foetus, the pressure of a pessary, or any other cause which may lead to irritation, bruising, or wounding of the mucous membrane. In very ex- ceptional instances, the inflammation may be indirectly due to the action of cold on the skin, or, as Saint-Cyr observes, the ingestion of very cold water — though this is more likely to induce metritis or metro-vaginitis. The inflammation may lead to, or be complicated with, ulceration, gangrene, or mortification to a greater or less extent. The labia of the vulva and the lining membrane are more or less swollen, the latter being of a deep or bright red, brown or livid hue ; there may be also patches of congestion and ecchymoses, with wounds or abrasions, and in rare cases we may»find phlyctaenae on the surface of the mem- brane. The temperature of the canal is also greatly increased, while its walls are dry and often adhesive. Micturition is generally painful and difficult, constipation is often present, and there is sometimes much itch- ing in the region of the vulva, which is indicated by the continued attempts the animal makes to rub the part. If the inflammation is severe and extensive, fever will be manifested. When the inflammation has existed for one or two. days, the mucus secreted by the membrane is greatly increased in quantity \ it is at first a serous limpid fluid, sometimes streaked with blood ; then it gradually becomes thicker and sero or muco-purulent, soiling the tail and the thighs and hocks, and sometimes becoming so acrid as to cause removal of the hair and excoriation of the skin. Simple vaginitis, of itself, is not a serious affection, and the inflam- mation often subsides spontaneously in the course of a few days, or rapidly yields to treatment. In some instances, however, it assumes a troublesome, if not a grave character. When gangrene ensues we may have infective inflammation in the surrounding parts, and large portions of the membrane, or even the skin of the labia, may slough, while the discharge is sanious and foetid. Baumeister describes a diphtheritic form of vaginitis which he observed in a Cow that had calved a few days before, and which died on the third day. At the autopsy, the vagina, as well as the uterus, was found full of pseudo-membranous productions. Another Cow which stood beside this one, and which had calved four weeks earlier, contracted the disease a few days after the Cow that died, and also perished — leading to the supposition that this form of vaginitis is contagious. The treatment of simple vaginitis does not merit much consideration. Cleanliness, attention to diet, and injections of cold or tepid water, or mild astringents, into the vagina, generally succeed in subduing the in- flammation. When, however, there is any tendency to acute inflammation and gangrene, or there exists ulceration, sloughing, or even abrasions, disinfecting treatment is advisable — a solution of carbolic acid (2 to 10 per cent.), permanganate of potass, or chlorinated or tar water, being perhaps the best local applications. General constitutional treatment may also be necessary, and especially if the fever runs high, and there are indications of septic infection. 41 \ 642 PA THOLOG Y OF PARTURITION. CHAPTER II. Leucorrhcea. vVhen inflammation of the vagina, and perhaps also of the Hning mem- brane of the uterus, becomes chronic, the more acute symptoms disappear ; but the vaginal discharge continues, and may even increase in quantity. Usually the fluid is of a white, glutinous, and odorless character ; or it may be purulent, muco-purulent, or even chocolate-colored and sour- smelling, or sanious at times. The secretion is mainly composed of mucus. Histologically, we find mucus corpuscles, an abundance of epithelial cells, probably some pus corpuscles, and at times micrococci, and»infusoria, particularly the Trichomonas vaginalis, which is also found in healthy mucus from the vagina. Sometimes the secretion is only manifest in an intermittent manner — as when the animal is lying down or in movement, or during micturition. It is more frequently observed in the Cow — particularly if lymphatic — than the Mare, and especially if there is bad hygiene ; it is somewhat rare in the smaller animals. The appetite is in many cases unimpaired, and the creature does not ap- pear to be inconvenienced in any way ; in other instances, with the in- crease in the discharge and the duration of the disease, there is loss of condition and appetite, the yield of milk is less, and it may be viscid ; signs of oestrum are more frequently present, but fecundation does not take place so readily as in health, if the os and uterus are affected ; if it does occur, the chances are that the full period of pregnancy will not be reached. When the discharge comes chiefly from the cervix uteri, it is more transparent and watery-looking than when derived from the vagina or in- terior of the uterus, and the os is usually more or less dilated when these parts are involved, while the uterus itself is not so firmly contracted as when in a sound condition. The mucous membrane of the genital canal is pale, relaxed and insen- sible ; in other cases it may be roughened by granulations ; and some- times it is tumefied and red. Vaginal catarrh in the Bitch is often as- sociated with, or dependent on, the presence of papillomata or epithelo- mata. In rare instances the tissues lining the canal become indurated and lardaceous, and its calibre diminished. Lafosse has even observed ad- hesions between the sides of the vagina in an old Mare. With regard to treatment^ if the disease is not of very long duration, it may yield to cleanliness and astringent injections — such as solutions of sulphate of zinc, alum, permanganate of potass, tannic acid, etc. When it has been in existence for a long time, however (it may continue for months and even years), it is generally very obstinate, chiefly from the relaxed condition of the membrane. The uterus or vagina, or both if affected, should be thoroughly washed out twice or thrice daily with warm water, which should be injected until it flows out quite clear. A solution of carbolic acid in warm water should then be injected. A so- lution of the sulphate of iron has likewise been successfully employed. Nitrate of silver has also been efficaciously employed in solution (i to 10) ; as has tannic acid (i to 70). Tonics should also be freely administered. If the discharge continues after two or three weeks' treatment, it may be found useful to apply a blister to the loins, croup, or thighs. METRITIS, METRO-PERITONITIS, ETC. 643 CHAPTER III. Metritis, Metro-Peritonitis, and Parturient Fever. Inflammation of the uterus {Metritis) may be limited to one or more of the internal layers of the organ {Endo-metritis), or it may extend to its outer covering — the peritoneum {Metro-peritonitis), and produce cer- tain symptoms ; while the introduction of septic matters into the blood, which is very often a result of this inflammation, will give rise to symp- toms of septikagmia. The latter cqjnplication, from the febrile indica- tions which accompany it, is appropriately distinguished by the name of " Parturient Fever " — a designation applied wrongly to another and very different malady of the parturient period — Parturient apoplexy or Eclamp- sia — and which we will study hereafter. It is true that we may have metritis and metro-peritonitis without sep- tikaemia — at least to any very marked degree ; but the symptoms of fever which accompany the former are generally more or less apparent, and it is often difficult to discover when septic infection has taken place — the high temperature and greatly accelerated circulation being the first no- table symptoms observed, and these often appear at an early stage of metritis. And we may have septic infection without metritis, when putrid matter obtains admission to the circulating fluids through a lesion in the uterus or vagina. Inflammation of the uterus and Septikczinia puerperalis occur in all the domesticated animals. The latter would appear to be very frequent in the Bitch ; but the Mare, Cow, Sheep, Goat, and Sow are liable to septic in- fection, either as a result of metritis, or the introduction of putrefying matter into the blood through an abrasion or wound. The inflammation, as well as the infection, varies in intensity from acute, sub-acute, to chronic. Symptoms. Inflammation of the uterus and parturient septikaemia may ensue very soon after birth — rarely before the second day with the Cow, and sel- dom beyond the eighth day. With the Mare and Bitch, according to Franck, the development of these conditions may be more retarded. Im- mediately after parturition the animal may appear to have quite recov- ered from the effects of that act, yields milk, takes care of its progeny, and there is nothing to indicate the existence of disturbance. The tem- perature in the rectum is normal, except in those cases — far from rare — in which birth has been difficult and the genital canal has been roughly treated and injured ; then the rectal temperature may be higher. The increase of temperature is the first indication of disease, and within twenty-four hours the rise may be as much as two de- grees. At the commencement of this rise, there are well-marked rig- ors j the animal becomes dull and loses its appetite ; if a Cow, rumina- tion ceases ; there is horripilation, and the pulse, small and hard, may increase in the Mare and Cow to 100 per minute ; the secretion of milk gradually decreases, and soon ceases altogether, while the udder dimin- ishes in size and is flaccid ; the respiration is hurried and shallow ; the mouth hot and pasty, and the visible mucous membranes injected ; while the horns and ears are very warm. The animal grinds its teeth, and betrays the existence of colicky pains 644 • ^^ THOL OG Y OF PAR TURITION. by lying down and getting up, stamping, striking at the belly, and turning the head towards the flanks, whisking the tail, and making more or less energetic expulsive efforts. Signs of pain or lameness in the hind-limbs become apparent. When the uterus is more inflamed, the animal does not lie down, because of the increase of pain produced by pressure on the abdomen. The smaller animals, however, maintain the recumbent position. A very marked symptom is the tumefaction of the vulva — the labia of which are separated — and the discharge therefrom of a fluid, at first serous, and either transparent or ha*^ing a yellow, chocolate, or reddish tinge ; then it becomes gradually thicker and more abundant, and be- comes modified according to the termination of the disease. Manual ex- ploration of the vagina discovers it to be very hot and sensitive, particu- larly towards the cervix uteri ; and when its lining membrane is exposed, it is observed to be swollen and reddened, and sometimes there are found diphtheritic ulcers and croupous deposits on the inflamed surface. In some cases, when the uterus is very much swollen, and particularly in lean, flat-sided animals, the inflamed organ can be felt on the right side, and pressure on the abdomen often, but not invariably, causes pain. Rectal exploration generally discovers the uterus larger than natural, and more or less distended by gas. Defecation is painful, and the faeces are hard. The Mare attacked by metritis or metro-peritonitis, generally maintains the standing posture, with the back arched and rigid, and marked indis- position to move : only lying down on the approach of death, or towards convalescence ; whereas flie Cow persists in lying, and this has been supposed to be due to paralysis of the hind-quarters, but it is more prob- ably owing to debility or prostration induced by the pain. In ruminants there is generally distention of the rumen with gas ; there are also acid eructations, and even regurgitations. When the temperature rises very high — and it may reach \2° Cent. — death is certain. When metro-peritonitis is present, there always occurs — and sometimes very rapidly — an effusion of serum into the abdominal cavity. When this is in large quantity, the abdomen becomes enlarged and rounded, as if the animal had been feeding freely. There is then dulness on percussion in the lower region of the abdomen, contrasting markedly with the tympan- itic resonance of the upper regions ; while sudden pressure by means of the open hand on one part while the other hand is placed at another point, will cause a perceptible movement of the fluid. Terminations. • The course of metritis, metro-peritonitis, and parturient septikaemia, is generally very rapid, and may not occupy more than a few days — usually three or four, rarely five or six days. In some cases a chronic form may be met with — and particularly in simple metritis, due to retention of the fcetal membranes, and sometimes to abortion. But these exceptions are few, and the disease or diseases just named may be designated as serious, when we learn that death carries off more than one-half of the number of animals attacked. Though so serious, however, in those animals which are about to re- cover convalescence ensues very rapidly, especially with the Cow. As Saint-Cyr observes, a few hours often suffice to bring about such a change METRITIS, METRO-PERITONITIS, ETC. 645 for the better, that one could scarcely believe it unless they saw it, and it might excite a doubt whether metritis had really been present. In the evening the animal is left in an almost hopeless condition, and next morn- ing one is astonished to find it up, the eye limpid, the physiognomy bright and cheerful, and caresses bestowed on the offspring which, previously, was unheeded or repelled. The animal is certainly not cured, but it is out of danger, and with a few days' care it may be on the way to conva- lescence. The decrease in rectal temperature is always a favorable sign. But, as has been said, death is the most frequent termination ; and this may occur in two, four, or six days from the commencement of the malady — rarely a little later. Then all the symptoms become aggravated. The tumefaction of the genital organs increases, and extends to the mammae and hind-limbs ; the vulva is covered with ecchymosed patches and becomes cold; the vaginal discharge is ichorous and brown in color, and emits a most fetid odor ; the temperature suddenly falls \ the surface of the body is covered by a cold glutinous perspiration — especially in the Mare — and the animal expires either in a state of profound coma, or in convulsions. In such cases death may be due to the violence of the inflammation and its extension to the peritoneum, gangrene of the uterus, or to septic infection by absorption of the putrid matters in the uterus, and general poisoning therefrom. Franck mentions that in three instances the disease manifested itself on the day after easy parturition, and it had become so severe that, on the second day, it was necessary to slaughter the animals. On the inner surface of the vulvar labia — which was of a dark- red hue — were one to three parturient ulcers, and in a few hours there had occurred an enormous tumefaction of the labia, which extended to the pelvic connective tissue and as low as the hocks, while the dependent parts of the body were also involved. Deep scarifications— which caused no pain — were useless, and were not followed by bleeding. On examination of the bodies after death, thrombi were discovered in the uterine and ovarian veins. In these cases the infection seemed to have been derived from an ad- joining Cow, which retained the placenta. Meyer refers to a case of this kind, in which death ensued during the evening of the day on which the disease manifested itself. He found a, large blood-clot in the uterus, and ecchymoses on the intestines. More frequently than rapid recovery, the malady passes into a chronic state. Then the more acute symptoms gradually diminish, the appetite returns, and the animal does not exhibit much suffering. But convales- cence is not established — the mammae remain flaccid, and the secretion of milk is either very scanty or altogether suppressed ; the swelling dis- appears from the vulva, but the discharge therefrom persists or is in- creased in quantity. This discharge is either of a white glairy character — leucorrhoea ; greyish and grumous, resembling clotted milk \ or red, brown, or sanguinolent. It is always more or less odorous, and some- times extremely fetid ; more particularly is this the case when, as often happens with the Cow, the discharge is mixed with or derived from the retention in the uterus of the foetal envelopes, or even the foetus itself. In some instances, the croupous exudates which have been formed on the mucous membrane become broken up, and are cast ofif with the discharges. Franck states that, in one case, a large croupous or false membrane, which had covered the greater part of the interior of the uterus, was shed in this way. In other instances the cervix uteri contracts, though the mucous mem- brane is still inflamed ; consequently, the muco-purulent secretions are 646 PATHOLOGY OF PARTURITION. retained for some time, and the discharge from the vulva ceases. But when the organ becomes distended, it contracts, or it is pressed upon when the animal lies down, or during micturition or defecation ; then the OS is forced partially open, and the accumulated fluid escapes in great abundance. Saint-Cyr mentions that Gohier, Chouard, and other veter- inary writers, give instances of this singular form of chronic metritis ; they have seen Mares which every forty days, every month, or at shorter inter- vals, expelled fourteen, sixteen, and even as much as twenty pints of pus, after exhibiting symptoms of colic, followed by more or less marked ex- pulsive efforts. In the chronic form of metritis, the animal does not appear to suffer at the commencement, but it soon loses condition ; the appetite is irregular, and the skin unhealthy-looking and clings to the bones ; the secretion of milk decreases, and finally disappears ; and though debility is present, oestrum may occur far more frequently than in health, yet fecundation is not possible. Marasmus sets in, with febrile attacks at intervals — pyaemic fever ; and though recovery is still probable, by skilful treatment and long- continued nursing, yet death is only too often the sequel. Even when recovery appears to be progressing favorably, relapses may occur, sometimes through the breaking up and diffusion of venous thrombi, which give rise to a pyaemic process, as in the case recorded by Con- tamine. On the morning after an easy parturition, the after-birth having also been expelled, the Cow began -to tremble very much ; the udder was small and flaccid, the back arched, the appetite was lost ; there was anxiety, with colicky pains, constipation, and pressure in the right flank caused pain ; the labia of the vulva were apart, swollen, and of a dark-red color. In three days the animal was much better ; but after three weeks there was a relapse. Petechiae formed on the conjunctivae, the hind- limbs became swollen, and bleeding ensued from the skin and nostrils, and there was cough. The Cow finally recovered. Occasionally during the sub-acute or chronic stages of metritis, metas- tatic formations occur in the lungs, liver, joints, and other parts ; not un- frequently there are caseous or pseudo-tuberculous deposits in the uterus, which may attain such a thickness in its walls as to simulate pregnancy. Pathological Anatomy. In those cases in which death has taken place and an examination of the body been made, the local and essential lesions are found in the gen- ital organs and peritoneum, and when puerperal septikaemia has been present, there are observed indications of general infection of the body. Decomposition sets in early, the tissues are dark-green* and foetid, and meteorism is largely developed. In simple endo-metritis we will not, of course, find such marked and general lesions, nor will the peritoneum be involved. In the more acute cases, and particularly those in which there has been septic infection, puerperal ulcers of a dirty greenish hue are generally met with in the vagina, often in the vicinity of the meatus urinarius and about the labia of the vulva. The mucous membrane is of a dull dark-red hue, and swollen in patches by diphtheritic infiltration, or covered in parts by crou- pous exudates. The bladder may also be implicated, though not to such a serious extent, and especially if the catheter has been employed. In the cavity of the uterus is constantly found a quantity of chocolate- METRITIS, METRO-PERITONITIS, ETC. 647 colored or greyish fluid, composed of effused blood, remains of foetal envelopes, the secretions of the mucous membranes — all in a more or less advanced state of decomposition, and emitting the most repulsive odor. This fluid contains quantities of epithelial and round cells, fat globules, and decomposition bacteria. The quantity of fluid varies considerably, according to circumstances — amounting sometimes to many gallons. The uterus itself is never contracted as in the normal condition, and it is often two or three times larger than it ought to be. The walls of the organ are thickened, friable, softened, intensely red, and infiltrated with sanguinolent serosity, inflammatory products, and pus globules. The mucous membrane is thickened, of a dirty-brown or dark- green tint, livid, softened, ecchymosed in places, and covered here and there with diphtheritic or fibrinous exudates and blood-clots, the latter being chiefly found — in the Cow — at the base of the cotyledons, which are, with the exudates and clots, in process of putrefaction, and are grey, pulpy, and almost detached. Sometimes portions of decomposed foetal membranes yet remain attached to the cotyledons ; and there are here and there gangrenous eschars, in the form of green or greyish spongy masses of a diphtheritic nature, and which are in process of softening and dissolution. In all these alterations — which are usually very notable in the cornu that contained the foetus — we have the characteristic fea- tures of Endometritis scptica. It is seldom, indeed, that the puerperal or septic inflammation is limited to the mucous membrane. Nearly always it extends to the submucous connective tissue {Metritis phleg77ionosd) which is infiltrated with an oede- matous transudation ; or it becomes the seat of acute inflammatory oedema, in which the tissue swells, becomes tumid, and its interstices filled with fluid, small cells, and a gelatinous, semi-solid material. The muscular tissue is swollen and softened, and a dark fluid flows from it. The sub-peritoneal connective tissue of the uterus may suffer in a like manner, and undergo necrotic softening and putrefaction j while the serous membrane itself becomes inflamed {Metro-perito?iitis) . When this takes place, the abdominal cavity contains a quantity of reddish, turbid, sanious serosity, in which are flakes of lymph. The lining membrane of this cavity, and especially that covering the uterus, is highly inflamed, and its surface is covered with pseudo-membranous layers of fibrin ; while adhesion may have taken place between the dif- ferent organs it covers. In some cases the inflammation of the peri- toneum is not so diffuse, and is more or less limited to the uterus and organs immediately adjacent. In other cases, again, the phlegmonous inflammation extends to the pelvic connective tissue {Parametritis), and we have diffuse acute oedema, infiltration with pus, or even abscesses. Indeed, in the uterine connective tissue we may have, in different parts, active cell-proliferation and abscesses, and if the animal chances to live beyond a certain period, these terminate in caseous inspissation, or even perforation into the abdominal cavity. A very important pathological lesion, and one which is not unfre- quently noted in parametritis, is thrombosis of the veins and lymphatics. Thrombosis of the uterine veins has been observed in animals : solid, white or yellowish thrombi adhering to the internal surface of the vessels, and extending towards the larger venous trunks — even as far as the pos- terior vena cava. Sometimes the breaking-up of these thrombi causes 648 PA THOL OG Y OF PAR TURITION. relapse, and embolic pyaemia of the lungs or neighboring organs. When septic infection does not occur, bruising of the soft parts during difficult parturition may give rise to thrombosis of the veins, with secondary pysemia. This may explain the occurrence of abscesses appearing at the joints, and inflammation of the feet supervening on parturition. Thrombosis of the lymphatics has rarely been observed in animals ; it is noticed within the inflamed spot. "The coagulated lymph either uni- formly fills the vessel, or gives the appearance of a string of beads. Sometimes, also, single larger dilatations of lymphatic vessels are seen. The thrombosis may be due to the direct influence of the infecting mat- ter, but more frequently it is caused by the inflammation of the connec- tive tissue around the vessel. The products also of the inflammation of this tissue have a tendency to coagulate, and the contents of the vessels participate in the process." Sometimes the lymphatics are filled with pus (Purulent lympka?igitis), and the neighboring glands are swollen and softened. This thrombosis of the lymphatics has been considered a favorable circumstance, since the occluded vessels are prevented from conveying the infecting materials : the inflammatory process being at least delayed at the nearest group of lymphatic glands. The lymphan- gitis is therefore considered an accidental change, which usually remains limited to the diseased part, and may disappear ; and it has been re- marked that it rarely extends further towards the thoracic .duct, unless there are other very considerable changes. Sometimes the thrombi in the vessels in the uterus soften ; so that, in cutting into the walls of the organ, these appear like small abscesses, varying in size from a pea to that of a nut. They can only be distin- guished from abscesses by their smooth walls, since the aff'erent and efferent vessels cannot always be found. In intense parametritis, with extensive infiltration of the subserous connective tissue, we may have other organs involved, and especially those which are directly connected by means of this tissue — such as the ovaries. The peritonitis may extend through the diaphragm to the pleurae, or the inflammation in both membranes may be due to ichorrhaemia. In those cases in which thrombi in the blood-vessels have become de- tached and broken-up, the masses may be carried in the circulation, and then give rise to embolism and haemorrhagic infarcts, or to metastatic abscesses, in such parenchymatous organs as the lungs, liver, spleen, kid- neys, etc. In the most rapidly fatal cases, in which death is due to septic para- metritis, there is no time for fibrinous exudation, and we have appear- ances not unlike those observed in splenic fever. The blood is dark- colored and non-coagulable, ecchymoses are found in various organs and tissues, and there is a marked tendency to rapid putrefaction. The ele- mentary structures of organs show the commencement of an acute inflam- matory process — the fine granular infiltration or " cloudy swelling," fatty degeneration, or even disintegration of cells. We have already stated that there is nothing specific in parturient fever, and so far as its pathological anatomy is concerned, the same al- terations are observed in non-parturient subjects. Parturition only predisposes the animal to its occurrence, from the fact that there are wounds and bruises inflicted on the soft tissues of the genital canal ; that there is present a quantity of matters — fluid and solid — either decomposed or decomposing ; and that the blood-vessels and lymphatics of the uterus METRITIS, METRO-PERITONITIS, ETC. 649 at this time are in a favorable condition for the reception and action of this septic material. In animals which have succumbed after the opera- tion of ovariotomy, similar pathological alterations are found. With regard to chronic metritis, various changes have been observed. In some cases the uterus has contained a considerable quantity of fetid pus, or muco-purulent matter of a white or grey hue ; while the mucous membrane has been grey or dark-colored, thickened, and softened, and the cotyledons infiltrated, softened, or even indurated ; the vaginal mu- cous membrane is also infiltrated and indurated in some cases. I. Robinson (Saint-Cyr, (?/. «V., p. 686) reports the case of a Cow which brought forth a calf, naturally and without assistance, three weeks after purchase, and the fcetal envelopes were expelled in the ordinary way at the usual time. The calf was strong and lively, but the Cow did not completely recover from the effects of parturition, but remained unwell, lost its appetite and condition, and soon discharged from the vulva — which remained swollen — a white fluid that, at a later period, v.as streaked with blood. When Robinson saw it, the animal was in the last stage of emaciation ; the pulse was small and 72 beats per minute, the surface of the body was colder than in health, and there was little appetite, though thirst was insatiable. By the vulva a purulo-sanguino- lent fluid escaped, and though the urine was ordinarily transparent, yet sometimes its mingling with this discharge rendered it turbid. Chronic metritis was diagnosed, and, in consequence of the condition of the animal, slaughter was recommended. This advice was not adopted, however, and the Cow died in a week afterwards. At the autopsy the whole mucous surface of the uterus was found ulcerated, and the walls of the organ considerably thickened, as were also those of the bladder and ureters — the latter particularly. The kidneys were enormous in size — nearly four times larger than in health ; in them were several abscesses, containing thick yellow pus mixed with a little blood. It is possible that, as Saint-Cyr thinks, there had been uterine phlebitis, and some fragments of the thrombus becoming detached from the inflamed veins and carried by the blood, had, by a reflux movement, reached the divisions of the renal veins. There they would give rise to capillary obstructions, infarct, inflammation, and all those acci- dents which accompany embolism. In this way the inflammation and abscesses in the kidney would be produced. 2. Gray {Veterinary yournal, ]\\\\e, 1877) describes the case of Cow two years old, which, some time after being put to the bull, strained at times and ejected small quanti- ties of blood. In two months the animal was observed to be in oestrum, and was again sent to the bull. The symptoms became greatly aggravated ; there was a continuous discharge from the vulva of a chocolate-colored fluid, which had somewhat the consist- ency of cream, and the animal strained frequently. Loss of condition ensued. On ex- amination the pulse was found to be more than 80 beats per minute, external tempera- ture normal, conjunctivae pale, and general expression excited and anxious. The blood- discharges increased in quantity and frequency, and in another month the anaemia and debility were so great that the Cow could not stand ; death took place soon after, v All the organs, with the exception of the uterus, were found healthy. This contained about two quarts of a sero-sanguineous fluid, and externally the organ presented the appearance and volume natural to the third month of gestation, and as if the fostus had been in the left cornu. The os uteri was dilated, and protruding from it was an elon- gated piece of blood-clot about an inch in diameter ; this was merely a portion of a very large clot, weighing more than twelve pounds, and lying in the cavity of the organ. This mass of clot was in many places firmly adherent to the mucous membrane ; at other points it was breaking up. It was surmised that abortion had occurred, and that this led to ulcerative endometritis and haemorrhage. Causes. The predisposing cause of metritis, metro-peritonitis, and purturient fever, is the parturient or puerperal state. It is true that septic infection, with its train of symptoms, may occur at other periods and from various causes ; but metritis and its complications are, as a rule, it may be said, observed only after abortion or parturition. The occasional causes of metritis, and therefore of metro-peritonitis and 650 PA THOL OG Y OF PA R TURITION. fever, are injuries to the genital canal or interior of the uterus, during or after birth. The manipulations necessary for the artificial removal of the foetus or its envelopes, and by which the mucous membrane is abrad- ed or wounded, are a frequent cause ; inversion of the organ, and es- pecially when it has been exposed for some time to the air and the action of irritating substances, or bruised or lacerated in returning it, is another cause. Retention of the foetus or fcetal envelopes has also been given as a cause of metritis. But other cases have been noted in which birth was easy and natural, and at the usual time ; and yet towards the second, fourth, or sixth day after parturition, the animal began to lose its appetite, the vulva became swollen, fever set in, and all the symptoms of metro-peritonitis became rapidly developed. In these cases, the occurrence of disease has been attributed to some imprudence in management, which brings about de- rangement in the functions of the skin or digestive organs — as exposing the animal to wet and cold out of doors, or draughts of cold air in stables, or giving it cold water to drink, or unsuitable food. Sometimes the disease occurs among such a large number of animals almost simultaneously, that it has been looked upon as epizootic, and due to a miasma. More particularly has this been the case with par- turient fever, but which must now be considered as due solely to' the absorption of septic matter, i.e., decomposing organic material. The production of parturient fever in animals, as in the human female, requires two conditions : i, a fresh wound by which the septic poison can enter. The wound need not be large, but it appears to be almost essen- tial that it is recent ; for suppurating or granulating sores do not absorb, so long as the infecting agent does not destroy the suppurating or gran- ulating surface. If the mucous membrane is intact and protected by its epithelium, absorption is also prevented ; 2, an active septic substance, either produced in the animal which is to be the subject of parturient fever — auto-infection, or introduced from without — external infection. Birth rarely takes place in animals without more or less laceration or abrasion of the cervix uteri, vagina, or labia of the vulva ; and those in- juries which are on the floor of the genital canal are more likely to be followed by septic fever than those which are on the sides or roof, simply because they are brought more directly in contact with the decom- posing material. Infection less frequently takes place from the interior of the uterus under normal conditions, as injury is much less likely to occur there from the passage of the foetus. Exceptionally, it may take place 'in the uterus through the cotyledons, when some of these are torn during the separation of the foetal membranes. As has been already mentioned, the parturient period is eminently favorable for the absorption of septic matters ; as the mucous membrane of the genital canal is exceptionally vascular, and the blood-vessels and lymphatics are greatly developed. Auto-infection occurs generally when there is a fresh wound, and when the foetus is dead, and, still retained in the uterus, has become decom- posed through the access of air ; or from retention and putrefaction of the envelopes. The ichorous putrefaction of wounds, or new growths in the uterus or vagina, may also lead to septic infection. PYanck gives the following illustrations which could be easily and largely supple- mented. METRITIS, METRO-PERITONITIS, ETC, 651 1. The foetus of a heifer was dead in the uterus, and much distended with gas. Em- bryotomy had to be resorted to, in order to extract it ; and this was accompUshed, ap- parently, without causing any noticeable injury to the vagina. On the third day septikae- mia became manifest, and the animal had to be killed. 2. A Cow gave birth to a calf in a normal manner ; but the hoof of the young creature, on its passage through the vagina, made a small wound. Twenty-four hours afterwards a second calf, in a state of putrefaction, was removed by manual force, but without in- juring the Cow. In two days the latter was attacked' with puerperal fever, and was killed. 3. Mombrini removed a dead calf from the uterus by embryotomy. Septic inflamma- tion of the uterus and peritoneum set in, and the Cow died on the seventh day. 4. It is well known that Bitches which retain the foetus in the genital canal for any length of time (eighteen hours or thereabouts), frequently perish from Septikcetnia i)uer- peralis. This appears to be due to the fact that the puppy so retained quickly dies ; owing to the shortness of the umbilical cord, the early separation of the placenta, and birth taking place in the amnion. The young creature also speedily putrefies, and the large raw surface formed by the -maternal placenta Is a ready inlet for the direct intro- duction of the septic material into the blood. Speedy death of the Bitch is the conse- quence. Embryotomy, when the foetus is decomposing, is a dangerous operation, if a wound chances to be inflicted during its performance. It is the same with the removal of the foetal envelopes. A* Cow retained the foetal envelopes for five days after parturition, when they were removed. The operator had evidently wounded a cotyledon or the uterine mucous membrane in doing so, as his hand was stained with blood. In three days the animal was affected with parturient fever and died. No injury to the uterus could be detected on post-mortem examination. With the Mare, removal of the foetal membranes does not appear to be dangerous. Retention of these is not usually followed by infection ; for it is not until the second or third day after parturition that their decom- position usually commences ; so that if small injuries have been pro- duced during birth, it is most likely that they will be suppurating or granulating by that time, and thus be proof against the passage of putrid matter. If, however, a fresh w^ound is made, or the granulations are in- jured by mechanical means, then removal of the putrid envelopes is full of risk. F»elen mentions that a Cow had a wound on the vulva, and this was infected by putrid membranes ; on the fourth day after, the an- imal died with all the symptoms of parturient septikiemia. External infection does not appear to be so frequent as auto-infection among animals. It takes place when septic materials are brought to the recent wounds or lacerations of the genital organs by any means — as di- rectly by the hand, instruments, sponges, straw, etc, or indirectly by means of the atmosphere, when the septic materials are suspended there- in — the so-called miasmatic infection. There is a dose relationship be- tween abortion and parturient fever — a Cow suffering from the latter being undoubtedly dangerous in a stable or pasture -where there are a number of pregnant cattle ; while a case of abortion or placental reten- tion occurring in a stable, might be considered nearly as serious among parturient Cows. A retained and decomposed placenta is undoubtedly a fertile source of parturient fever. Franck refers to three instances, in which the Cows calved in a normal manner and the foetal membranes came away in four hours after ; but a trifling wound existed in the mucous membrane of the labia, at the commencement of the vagina. In two or three days after- wards these animals showed very acute symptoms of parturient fever. 6^i PA THOLOG Y OF PARTURITION. They stood near another Cow whose uterus contained a decomposing placenta. The emanations from the vulva or discharges of this animal had, there can scarcely be a doubt, infected the three ; or the soiled straw may have been the means of conveying the septic matter to the vulvar wounds ; the tail of the Cow may even have been an active agent in throwing the vaginal discharges about, as it is generally much soiled by them. External infection may also be conveyed by means of cords, crotchets, and other obstetrical appliances, if they are soiled with septic matters : which they may be if previously used in the removal of a decomposing foetus ; and the operator himself may be the means of infecting. An in- stance of this kind is related where, in Switzerland, during 1861-63, in a large cowshed containing about 200 head of cattle, suddenly a number died of parturient fever, though they had no difficulty in calving. For a long time afterwards no other births took place, so no more accidents of this kind were observed ; but it was strongly suspected that the herds- man who attended the first sick animal, cleaned it, etc., in helping the others during parturition, had conveyed the infection to them. And it is quite possible that many serious and wide-spread outbreaks of partu- rient fever in cattle are due to an obstetrist who has been engaged in removing a dead foetus or a retained placenta. The same cause may^be in operation among Ewes during the lambing season, when, as is well known, parturition occurs in the flocks within a limited period, and un- der circumstances favorable to the spread of infection • and not unfre- quently large numbers of Ewes perish from parturient septikaemia (*' heaving pains "). We have mentioned that exposure to cold is supposed to be one of the causes of parturient fever. Franck, however, is of opinion that real par- turient fever cannot be so produced. With regard to the nature of the infective material, there is yet much to be learned. The active agent has been surmised to be the Microsporon septicum, which has some analogy to the Leptoihrix buccalis. In the putrid matters and fluids from the uterus, bacteria, are always found. But whether these organisms are really concerned in the genesis of septi- kaemia is still doubtful. Some authorities are inclined to believe that there is a chemical body — septin or sepsin — in such infective fluids, which possesses great putrefactiv'^e powers ; so that a very small quantity intro- duced into the blood may produce the most serious results. In favor of the latter view, it is to be noted that very often after rapid death from parturient fever, no bacteria or other similar bodies can be found in the blood. Another hypothesis is that these organisms are only the originators or bearers of the infective material. In the puerperal fever of woman, it is recognized that the infecting mat- ter may be derived from a great variety of sources. It is formed wherever organic compounds decompose; therefore it is derived from dead bodies, from suppurating wounds, disintegrating neoplasms, and especially from the secretions of diseased — and sometimes also of healthy — women. So it is that puerperal fever is looked upon as nothing more than poisoning with septic matter from the genital organs. The experiments of Weber, Billroth, and others, have demonstrated that septic matter has pyrogenetic and phlogogeneous properties, being capable of producing fever and local inflammation. METRITIS, METRO-PERITONITIS, ETC. 653 The theory therefore is, that in cases of acute septikaemia such a quan- tity of septic matter has been absorbed, that the blood has received phlogogeneous properties, and that it is able to produce inflammatory changes wherever it goes. Such a general inflammation of the whole or- ganism, and especially of those organs whose undisturbed function is ne- cessary for the maintenance of existence, must be capable of destroying life before marked pathological alterations have been developed in indi- vidual organs. Accordingly, in such cases functional disturbance of the drgans are alone observed during life, and after death only the com- mencement of parenchymatous inflanmntion of those organs — the " cloudy swelling " of the cell. In other cases the infection of the blood is not so intense ; fever is the only symptom of general disturbance ; the functions of the organs im- portant to the maintenance of life are not so disturbed that death must inevitably follow. If infective matter has only once been absorbed into the blood, the disturbances caused by it soon pass off, as shown in numerous experiments on animals ; the poison is rendered innocuous within the organism, or eliminated from it. Such is the case when putrid matter has been once injected into the blood. By infection from a wound, the absorbed matter has still another effe'ct. Locally, it sets up around the wound an inflammation progres- sive in character — the acute inflammatory oedema — with a tendency to extend along the connective tissue. In this inflamed spot, again, materials are produced by the disintegration of tissues, equally possessed of pyroge- netic and phlogogeneous properties. Continually small quantities of these materials are absorbed into the blood, and thus the fever is sustained. At the same time the blood, now possessed of phlogogeneous properties — though in a slight degree — may also cause inflammation in other organs predisposed thereto, either from their anatomical condition, or from the idiosyncrasy of the patient. Such organs are chiefly the large abdominal glands and the serous membranes, also the striped muscles and the. connective tissue. Whilst the process described as consisting of a uniformly acute degeneration of all the organs has been called " septi- kaemia," that just mentioned, where the process is more chronic and limited to individual organs, has been designated "ichorrhaemia." A specific difference between the two does not exist — it is only one of degree ; for where septikaemia has not quite an acute course it ceases to be a pure intoxication with the original infecting agent ; but the infection of the blood is now aided by the' absorption of the products of the local inflammation — which products, however, are not specifically different from the original agent. On the whole, septikaemia may be considered the acute, icorrhaemia the chronic, or rather sub-acute, septic infection. The whole organism may also be effected from the local disease by the occurrence of thrombus in a vein ; but this, properly speaking, is not peculiar to septic infection (Schroeder). General infection, then, in the majority of cases, is due to the presence of parturient sores or ulcers m the vulva, vagina, or uterus, and this in- fection is manifested externally by the high temperature and other serious symptoms. In other cases, when only a small quantity of septic matter has been absorbed, the symptoms have more of a local character ; they are less severe, and though the fever may be of a continuous character, yet it is not so acute, and indications of peritonitis are generally absent. 654 P^ THOL OG Y OF PA R TURITION. Indeed, we may have si.nple metritis without much constitutional dis- turbance. Prognosis. The prognosis of parturient fever must be, in the majority of cases, un- favorable, as the veterinary surgeon is only too frequently not called in until too late. When infection is but slight, or when the local inflamma- tion is not very severe, then careful treatment may restore the patient to health. It must not be forgoten, however, that what appears at first, a a mild form of metritis, may become a very grave attack of ichorraemia, or even septikaemia. Prophylaxis. From what we have said with regard to the causes ot parturient fever and metro-peritonitis, it will seen that in obsterical operations great care should be exercised, so as to avoid wounding the genital canal, and especially the interior of the uterus, the vagina, or the vulva. Should injury be unfortunately inflicted, cleanliness, and careful dressing with some such disinfectant as carbolic acid, should be enforced. This is especially necessary when extraction of a dead foetus or retained placenta takes place. No person who has been handling a creature suffering from parturient fever or any decomposing animal matters, should be allowed to assist animals in parturition \ and the same rule should be observed with regard to instruments and other obstetrical means, unless these have been thoroughly cleansed and disinfected. If a case of parturient fever should occur where there are other pregnant animals, or animals which have quite recently brought forth, these should be immediately removed. An animal which retains a decomposing foetus or foetal membranes, is also dangerous among these. The same remark applies to animals — such as Ewes and Cows — at pasture. The soiled ground should be most carefully disinfected with lime, and pregnant or parturient animals should be kept away from it. Treatment, Metritis, metro-peritonitis, and parturient fever being grave disorders, and rapid in their progress, demand prompt, rational, and energetic treat- ment. The first thing to be attended to is the condition of the uterus, and the removal of any infective matters it or the vagina may contain ; as well as the disinfection of any wounds or abrasions in these parts. The genital canal should be thoroughly cleansed by injections of warm water, and the wounds dressed with carbolic acid and olive oil (i to lo), applied by means of a brush or feather ; or salicylic acid, i part; spirits of wine, 20 parts ; warm water, 24 parts. After the interior of the uterus has been cleansed by injections of warm water, an injection of carbolic acid solution (i to 20-50) should be made every day, and the wounds, if accessible, must be dressed at the same time. Permanganate of potash (i to 50 of water) may be employed to inject into the genital canal, when the disease is less acute. With regard to constitutional treatment, this must be directed towards neutralizing the effects of the septic matter by the exhibition of antiseptic remedies, and reducing the high temperature ; as a long continuation of METRITIS, METRO-PERITONITIS, ETC. 655 this leads to rapid consumption of the tissues, and is fraught with danger to the system. There is no specific remedy with which to neutralize the action of the septic matters in the blood and tissues. The sulphites of soda and potash have been recommended, as well as sulphurous acid. These appear to have acted favorably in some cases. Carbonate of soda and permanganate of potash have also been well spoken of, as well as large doses of quinine. Carbolic and salicylic acids are now most in repute, and are given in small but frequent doses. If there is a tendency to constipation, a purgative may be administered ; indeed, unless special circumstances forbid it, a purgative may prove most serviceable in assisting in the removal of the septic matter through the intestinal canal. Dogs which have been poisoned by this matter, often recover after profuse and foetid diarrhoea ; and a purgative generally reduces the temperature. In acute cases, in order to obtain the more prompt action of antiseptics, it has been proposed to introduce them directly into the circulation by intravenous injection. Solutions of carbolic acid and iodine have been employed successfully ; and in woman a desperate case has recovered after the intravenous injection of liquor ammoniae (i to 3). As a last resource, and to substitute healthy for poisoned blood, trans- fusion has been also practised in woman, and with good results. The experiment is worth trying in the parturient fever of animals. With regard to the diminution of temperature, quinine has been highly lauded. Bleeding is certainly not to be recommended. If the tempera- ture continuously remains very high, then the application of cold water to the surface of the body is indicated. The cold water may be applied to the larger animals by means of cold wet sheets wrapped round the body, and kept cold for an hour or two at a time by pouring on water, at intervals, by means of a small vessel. Smaller animals may be put in a gradually- cooled bath. The skin must be well dried after the application of the cold water, and with the larger animals a dry blanket should be thrown over the body. The stable must be kept scrupulously clean and well ventilated. Tonics and good food must be allowed when recovery is taking place, and the sequelce of the disease treated according to their indications. Peritonitis may be combated by the exhibition of large and frequent doses of calomel. Van den Eide and Clement were successful in treating serious cases of metro-peritonitis, by administering calomel, and applying mercurial ointment to the abdomen. When the pain is very severe, mustard may be applied to the surface of the abdomen, and, in the case of small animals, linseed-meal poul- tices on which laudanum has been sprinkled ; while subcutaneous injec- tions of morphia may be freely resorted to. When great exhaustion or collapse is present, large and frequent draughts, containing diffusible stimulants, must be administered, with nutritious gruel. To the smaller animals milk or beef-tea may be given. In the chronic form of metritis, the same treatm.ent may be adopted, so far as the genital canal is concerned ; and if there is vaginal discharge, the treatment recommended for leucorrhoea will be suitable. If the uterus is not contracted, this may be promoted by the exhibition of prepara- tions of ergot of rye. In handling animals suffering from parturient fever, or in examining 656 PATHOLOGY OF PARTURITION. the carcases of those which have died, the veterinary surgeon should be on his guard against inoculation. More particularly is this necessary when exploring the genital canal of the living animal, or removing a putrescent foetus or foetal envelopes. The arm and hand should then be well smeared with oil or lard, and thoroughly cleaned with carbolic acid soap when the operation is completed. CHAPTER IV. Parturient Apoplexy. — Parturient Collapse. Few diseases affecting animals have received a greater amount of atten- tion, or given rise to more widely divergent opinions as to their nature, than the malady to which, chiefly for convenience, we have given the designation of parturient apoplexy or parturient collapse. Veterinary literature, since the commencement of the century, teems with descrip- tions and discussions relative to the disease, and the most eminent veteri- nary pathologists still appear to be far from unanimous as to its nature. The great number of names given to it — some of which either indicate the opinions prevalent with regard to its pathology or causes, or point to prominent symptoms — are evidence of the uncertainty which has pre- vailed, and now prevails, with regard to it. For instance, it has been ^&^- \gr\2i\.td puerperal fever, fiervous or paralytic form of puerperal fever, 77iilk- fever^ puerperal apoplexy, paraplegia, puerperal collapse, vitulary fever, vitu- lary apoplexy, vitulary paralysis, processus puerperal, puerperal typhus, calf fever, dropping after calving, eclampsia puerperalis., etc. The ordinary French name is " Vitulary Fever " (that given to it by Saint-Cyrand other veterinary authorities in France), while in Germany it is commonly known as "Calving Fever" (Franck and others). In England it is usually designated V Parturient Apoplexy," "Puerperal Fever," " Milk Fever," etc. The malady appears to have been known from an early period, but the first exact description of the symptoms we can find is that given by Skel- let (^Practical Treatise on the Parturitioii of the Cow, London, 1807), who names it " Milk Fever, or Dropping after Calving ; " in the following year it is alluded to by Jorg {Anleitung zu eifier rationellefi Geburtshulfe, e\.c.,fUr Thierdrzie), who evidently knew Skellet's work, as the latter's plates are copied. Some years after this period the disease began to attract much attention, as with the improvement in the breeding of Cat- tle, it gradually became more prevalent ; until now, the literature of the subject is very extensive. Without entering at this moment into a discussion as to the nature of the disease, it may be sufficient to say that it is a very serious and acute affection, peculiar to Cows in the parturient state — and especially to those of the improved Milch breeds, in which it is frequent ; that its invasion is sudden and its course rapid ; and that it is characterized by loss of con- sciousness and paralysis, seldom by convulsions. It is extremely fatal, death ensuing in a very short time ; or if recovery takes place, this is sometimes nearly as rapid as the attack was sudden. It has been con- founded with parturient fever, or considered to be only a nervous or paralytic form of that malady ; while Franck, who appears to have PARTURIENT APOPLEXY.— PARTURIENT COLLAPSE. 657 studied it very carefully, is of opinion that it is identical with the eclampsia of the human female, and considers that " parturient eclampsia " {^Ek- lampsie in Folge der Geburt) is the best designation for it. He asserts that to look upon it as a "fever" is a mistake, as a high temperature — the sure sign of such a condition — is not present ; while to name it " calv- ing-fever " is not quite exact, as it has been known to affect oxen and other domesticated animals — though seldom. We shall, however, revert to this question presently Symptoms, The disease sets in suddenly after calving, and without any premonitory symptoms. It may attack the Cow so early as twelve or twenty hours after parturition, but it is most frequent on the second or third day, and generally follows a rapid and an easy birth. It has, though very rarely, manifested itself before parturition, and also during that act. It is seldom that it appears after the third day ; though Harms says it may occur so late as the tenth day ; Hess records an instance on the fourteenth day, and a case has been witnessed in the fourth week ; while Gierer states that he saw a Cow which offered all the symptoms of the disease seven weeks after calving. In some instances, before the symptoms commence, the lacteal secre- tion is either diminished or suspended. Generally, however, the first indications are the Cow hanging back in the stall, or the head drooping ; there is uneasiness, whisking of the tail, striking at the belly with the hind feet ; the appetite is suddenly lost and rumination ceases ; the faeces are hurriedly expelledj and the animal becomes indifferent to its calf. There is often a shivering fit, but this is not followed by an increase of temperature. In a few cases, congestion of the brain appears to be pres- ent at the commencement ; as the Cow presses its head to "the wall or leans against the stall-post, it bellows, looks stupid, its mouth is hot, the eyes are reddened, and the eyelids wink, and it half unconsciously treads with the hind feet. The respiration becomes hurried and plaintive, though the pulse may be normal \ and if the animal is conscious, its physiognomy expresses anxiety and suffering. Unsteadiness and stagger- ing are manifested ; the animal can no longer stand, and it either lays itself down, or falls on the floor 9f the stall. Then it may remain tran- quil, merely moaning or bellowing, or striking with its feet at the belly as if affected with colic, and making convulsive movements. Congestion of the brain may be more or less marked ; the ears and horns may be warm- er than natural, and in addition to the redness of the eyes, tears may flow down the cheeks. All these changes may become developed in a very few hours; so that an animal which was left in apparent good health only a short time be- fore, is found lying, cannot get up, and is in a soporific condition. This is the stage of the malady at which the veterinary surgeon is usually sent for. Then he finds it lying tranquilly on its side, fully extended ; or, which is far more frequent, resting on the sternum, and the head turned round towards the shoulder or flank (fig. 206). This position of the head is supposed to be due to contraction or tonic spasm of the cervical muscles of one side of the neck. It is sometimes observed at the commencement of the attack, even while the animal is standing. The neck is so rigidly 42 658 PA THOL OGY OF PAR TURITION. bent that force cannot extend it, and the temperature is distinctly in- creased on the concave side — that on which the muscles are contracted. From time to time it may attempt to rise, but it cannot, as a rule, do so ; the knees may be flexed, but the hind parts of the body seem to be nailed to the ground. If assistance is afforded, it cannot avail itself of it ; or if it chances to be raised, it falls again as soon as let alone. It appears to be insensible to blows or pain of any kind, and if the head is lifted and let go, it drops an inert mass, or is again pressed round against the shoulder. The teeth are ground at intervals, and the stupor or coma becomes more marked. The animal pays no heed to surrounding objects ; the eyes are half-closed, and they either move convulsively in their orbits, or are dull and lustreless ; the hair is erect and dry, and flies settle on the surface of the body. The pulse does not vary much in the earlier stage ; it may number fifty, sixty, or seventy beats per minute, or it may be fewer than in health, but it is very full and soft. When coma is well advanced, however, and paralysis appears to be complete, it becomes small and quick. •««§& Fig. 206. Puerperal Apoplexy : Cow. The respirations may be increased to eighty or ninety per minute, and this occurs more particularly when there is pneumonia, due to the passage of foreign matter into the bronchia — an accident which is frequently noted in this disease. When the coma and paralysis are very marked, the re- spirations are often slow and deep, sighing or stertorous, at other times calm and regular. We may have all these variations in the same animal — the hurried, stertorous breathing succeeding the quiet and deep respi- rations in a very abrupt manner. As the pulse increases in frequency the breathing sometimes becomes slower. The temperature of the body is not increased, as a rule ; on the con- trary, it is very often below the normal standard — Harms and Adams have found it as low as 35° Cent. (95° Fahr.). The extremities are gen- erally icy cold, and the surface heat of the trunk is irregularly distributed. Sometimes, during the first stage, the temperature is for a very brief period slightly elevated. The mucous membrane of the mouth is pale, and saliva accumulates about or flows continually from it (hence the disease is sometimes des- PARTURIENT APOPLEXY.— PARTURIENT COLLAPSE. 659 ignated Abtropfeln aus dent Maide by the Germans). Food and water are refused, and indeed at an early period there appears to be paralysis of the deglutition organs, and if care is not taken the solids or fluids at- tempted to be administered may find their way into the air-passages, and if they do not quickly produce asphyxia, they will probably give rise to pneumonia. The functions of the rumen and digestive system are more or less suspended, and the peristaltic movement of the intestines de- creased. Hence we have tympany, eructations, and constipation. The eructations may carry fluid and food from the rumen into the pharynxj and even into the nostrils, and these may pass from thence into the trachea. So that we may have pneumonia from this cause alone, and without at- tempts having been made to administer food or medicine. Constipation is also a marked feature of this paralyzed condition. Micturition is also, as a rule, suspended from the commencement. Consequently, urine accumulates in the bladder and faeces in the rectum. The secretion of milk may be diminished or suspended, and sometimes very suddenly, even before the voluntary muscles are paralyzed; in other instances it may be uninterrupted. When the animal is about to recover, these symptoms may persist for some hours, or even for two, three, or four days. Then it appears to rouse up suddenly from the stupor into which it was plunged ; the tongue is moved about ; the head is raised ; attempts are made to get up ; it ele- vates the fore-part of the body, and after some struggles finally gets on its hind-legs and stands. The first favorable indications are elevation of the temperature, and resumption of the intestinal peristalsis. The latter is assured when the rectum is found to be filled with faeces, after it has been emptied. The animal's physiognomy changes, and becomes natural — though it may still look half-stupefied \ it drinks and seeks food, and is not long in commencing to ruminate ; its calf is caressed ; urine and faeces are passed ; and recovery sets in so promptly, and goes on so quickly, that in many cases it is scarcely possible to believe that the animal which, twenty-four hours previously appeared to be dying, is now not only recovering, but completely recovered. When death is about to take place, the more serious symptoms are bet- ter marked. The coUapsus — the coma — becomes more and more complete. The nose rests on the ground as if the animal could no longer support the head, and at times sways from side to side. The decubitus, instead of being sternal, becomes lateral, and the body is stretched out at full length on its side. The eye is glassy, and there is no movement of the eyelids when the cornea is touched ; the body and mouth are colder; the tympanitis increases ; the pulse becomes small, irregular, and intermit- tent, and very quick, until at last it is imperceptible ; the breathing is pufiing, slower, and more stertorous, and the animal dies without a strug- gle, or in the midst of slight convulsions. In some cases there are epileptiform convulsions, or there may be symp- toms of delirium : the animal throws its head about violently from side to side, or bends it rigidly backwards, struggles, bellows, groans, extends the limbs convulsively as if undergoing an electric shock, and appears to be unconscious ; the breathing is deep and spasmodic, and apoplexy — parturient apoplexy — seems to be the cause of death. 66o PA THOLOG Y OF PARTURITION. Duration, Terminatmis, and Complications. The duration of the disease is very brief. There are instances on record in which it has been less than twenty-four hours ; but two or three days is the ordinary term ; it has rarely extended to five or six days. If there are no complications, the terminations are death or recovery. The chief complications are broncho-pneumonia, milk-metastasis, amau- rosis, and temporary or permanent paralysis. Pneumonia is due to the passage of foreign matters — either food or medicine — into the air-passages during the period when the animal can- not swallow, or when it is comatose, and meteorismus, with eructations, are present. This is often a cause of death when the Cow has recovered from the parturient malady. Indeed, the animal may perish from suifo- cation alone when the quantity of matter that passes through the larynx is considerable. And not unfrequendy, when the creature has lingered for a few days, and is then killed, the existence of pneumonia from this cause will be discovered on making an examination^ of the body. Adam {Wochenschrift fur Thier/ieilkunde, 1870-71) believes that ten per cent, of the Cows which recover from parturient collapse eventually die of pneu- monia, due to extraneous matters introduced during the paralyzed condi- tion of the pharynx. Sometimes the animal appears to be almost recovered from the attack of parturient apoplexy, when symptoms of lung congestion or inflamma- tion are suddenly developed, and death soon occurs. Another complication of parturient apoplexy, is the so-called milk-me- tastasis, which does not appear to have been noted in England, but which is alluded to by Bentele, Born, and Franck in Germany, and Alle- mani in Italy. Occasionally there is observed, after an attack of the dis- ease, a white, milky-looking emulsion, similar to chyle, expelled as urine, or as a discharge from the nostrils ; and at one time it was imagined that this was the milk which, instead of being got rid of by the mammae, was absorbed or retained in the blood, acted upon the nervous centres, and was then expelled in this vicarious manner. Though no analyses appear to have been made of this fluid, Franck is of opinion that the fluid is only the normal secretions mixed with lymph. The milk-metastasis theory is untenable, as it is quite opposed to what we know of the lacteal secretion, especially during this disease. 1. Bentele {Wochenschrift fiir Thierheilktmde, 1857, p. 145) states that a Cow attacked by calving-fever lay for sixty hours in a state of lethargy. The urine, which was passed six hours afterwards, was milk (?) with clots — as if boiled — in it. The animal recovered from the attack, but some weeks later had to be killed in consequence of diseased lungs — probably pneumonia from foreign matters. 2. Born (Anacker's Thierarzt, 1871. p. 279) relates a case, in which milk flowed from the nostrils of a Cow that was affected with calving-fever. 3. Allemani (// Medico Veterinaria, 1870, p. 289) tells us of a Cow proprietor, who be- lieved one of his Cows passed milk instead of mine. The supposed milk — which was of a yellowish-white color — contained epithelium from the bladder, a large quantity of epithelium from the kidney, lymph-corpuscles, and albumen. After some days this condition disappeared. The fluid did not coagulate spontaneously. With regard to paralysis, this is not evident until the animal recovers consciousness, and begins to look bright and anxious for food, when it is found that it cannot be made to rise. The paralysis may be limited to one limb, to the two hind-limbs (paraplegia), or to one side of the body PARTURIENT APOPLEXY.— PARTURIENT COLLAPSE. 66i {hemiplegia). Saake says he has sometimes seen instances in which the fore-limbs were paralyzed, while the posterior ones could be moved freely. Afuanrosis is readily discovered, from the animal being blind. It is generally persistent. Breulet, Gabler, Dommelen and Festal have re- corded instances. Prognosis. The prognosis of parturient apoplexy is generally difficult, if not unfavorable; as a fatal termination occurs in a large proportion of cases. Of 721 cases treated by various methods, Franck states that 294 either died or were slaughtered — 40 8 per cent. Of course, no definite conclu- sion can be drawn from these figures ; as it is possible that some, if not many, of the cases may have been parturient fever, while of those killed probably a few recoveries might have been noted. Saint-Cyr, in 466 cases, gives 45 per cent, deaths ; while Stockfieth gives 50 per cent. Often cases which appear very trifling at first, have a rapidly fatal termination ; while others which commenced with alarming symptoms, quickly recover. Therefore it is, that perhaps in no disease with which we are acquainted is a reliable prognosis more difficult to be arrived at, not only in the earlier stages, but during the whole of its course. " There is no absolute fr/Z^r/w;;/," says Lanzillotti,- "by which we can positively say whether we can cure the case, or whether death will ^nsue ; and it often happens that the result contradicts the prognosis." And Allemani slates that he has seen cases which looked so favorable, as to lead him to believe they would recover, suddenly become aggravated without any apparent cause, and succumb ; while others which exhibited the gravest symptoms in all their intensity, and gave no hope of recovery, have been restored to health. This is probably the experience of every one who has had to contend with the disease ; it is in consequence of this uncertainty, and the fatality attending the malady, that the butcher is so frequently called in, and the animal is killed and its flesh sold as food. As to the propriety of util- izing the flesh in this manner, there have been different opinions; but provided the animal has not been drugged to any considerable extent before death, and it is killed early, we cannot see any objection to its flesh being consumed. We have no evidence whatever that there is any deleterious agent developed during the malady. With regard to using the flesh of animals which have been 2&Q.QXQA'^'Vi\i parturietit fever — a disease with which parturient apoplexy is so often, and has been for so long, confounded — that is quite another matter, as in this we have a blood poison, — sepsin. Though the prognosis is generally so uncertain, yet there are certain manifestations which may assist us, at any rate to some extent, in form- ing an opinion as to the probability of recovery or death. Thus, the earlier the attack occurs after parturition, the more serious the case may be considered ; while the longer its invasion takes place after that act, so is it less likely to be fatal. When it appears within twenty-four hours after calving, then it nearly always terminates in death. It is the same when the attack is very sudden and powerful ; when there is marked coma, rapid and general loss of h^at, great distension of the rumen (which may speedily cause asphyxia), violent convulsions, deep mucous rales in the trachea and bronchi, lustreless eyes, insensible to light or 662 PA THOL OG Y OF PA R TURITION. touch; paralysis of the digestive organs — indicated by meteorismus, tor- pidity of the bowels, so that the rectum remains empty when it has been evacuated ; as well as paralysis of the pharynx and oesophagus — shown by inability to swallow ; suspended lacteal secretion, relaxed sphincters, puffing breathing by the mouth and pendulous lower jaw, and total suppression of milk. The favorable indications are a maintenance of the normal tempera- ture in body and limbs, or the slightest elevation when this is low ; natural tint of the mucous membranes, expulsion of the urine either spontaneously or when the finger is introduced into the urethra ; and, according to Schaack, "a mode of respiration in which the animal retains its breath for an instant, then allows the air to escape by a long and slightly plaintive expiration." It is likewise a very favorable sign when the faeces are passed. A return to consciousness is also, of course, a happy omen, and particularly if the animal attempts to rise, desires food or drink, and the lacteal secretion begins to re-appear. In some cases, however, there appears to be slight recovery, and fatal relapse takes place. The pulse will also aid in forming an opinion as to the probable termination of the malady. The longer the disease continues, so the more hope there is of recov- ery ; though there is all the more danger of pneumonia from extraneous matters in the bronchia, if the coma or paralysis of the muscles of de- glutition lasts for some days. Weigand says that when an animal con- tinues lying for six to eight days, unless it can eat and drink, it should be killed. Causes. The unanimous opinion with regard to this disease is that it is peculiar to the parturient condition, and that it has a close relation to the state of the Cow previous to parturition — to a more or less marked race or zW/- 7V^z/^/ predisposition. So far as breed is concerned, it is a fact that the Cows most liable to be attacked are those in which the secretion of milk is abundant — " deep milkers " — and which are in a more or less plethoric condition. With the perfecting of Cows for the production of milk, this disease has become vastly more prevalent. Numerous observers testify to this fact. " Since in Algau," writes Bentele, " the Cow has been so largely utilized for the production of cheese — converted into a milk ma- chine, in fact — the previously unknown calving-fever has appeared." So it is, that in countries or districts where bovines are reared more for their flesh than their milk, parturient apoplexy is not a very common malady, and the losses from it are comparatively small. It is, therefore, a disease almost peculiar to the best breeds of milch. Cows. With regard to individual predisposition, there can be no doubt that even in these breeds there are animals which suffer from parturient apo- plexy more than others ; and instances are reported of Cows being attacked after several consecutive births. Plethora^ there can be no doubt, exercises a great influence in the produc- tion of the disease. Thus it is chiefly among the well-fed Cows, particu- larly those kept for milk, in the vicinity of large towns, and which seldom or ever leave their stable, and are abundantly nourished immediately before calving, that parturient apopfexy prevails most seriously and exten- sively. It is true that it may attack Milch Cows in moderate, or even in PA R TURIENT A POPLEXY.—PA R TURIENT COLL A PSE. 663 comparatively poor condition ; but then it will be found that their hygienic management is at fault. For instance, as Saint-Cyr observes, they are Cows which, having been scantily fed during a long winter, are abundantly supplied with food in the spring ; or they are Cows which, purchased in low condition, receive a large supply of food from their new owner. Kohne (Gurlt and Hertwig's Magazin, 1855) states that he had occasion 10 observe eighty cases of this disease at Kemper (Rhenish Prussia), and that the majority were Cows which, bought lean in Holland some time before parturition, had passed without any gradual transition from the Dutch pastures to the stables of the Rhenish feeders, where they received a large amount of food. Kniebusch {Ibid.) and others have made similar observations. It has also been remarked that a uniform, and ev^en abun- dant diet, is less dangerous than an abrupt change from scarcity to generous allowance. Permanent confinement to the stable also acts in a similar manner to abundant and stimulating food, by inducing plethora and laxity of fibre. Thus it is, that while the disease is prevalent in the cowsheds of towns, or in those from which the cattle are seldom driven out to graze or for exercise, it is almost, if not quite, unknown in hilly pastures. Age, or rather the development of lactation, has also a powerful influence. When the secretory power has reached a certain point, the Cow appears to become much more predisposed to an. attack. Thus it is asserted that parturient apoplexy has never been observed in a primipara, and very rarely indeed before the third calf, when the lactiferous system has almost attained its maximum development in the more precocious breeds. In twenty-nine cases reported by Haycock {Veterinarian, 185 1), 3 occurred after the third calf, 5 after the fourth, 16 after the fifth, 2 after the sixth, 3 after the eighth. After the third calf, or even previous to its birth, dairy-keepers are averse to purchasing the better-bred Milch Cows. Temperature is supposed to influence the production of the disease, and especially exposure to cold. The suppression of the cutaneous functions, and the determination of the blood from the surface of the body to the internal organs, must favor congestion of these organs. Therefore it is that currents of cold air, lying on cold ground, and cold fluids ingested immediately after parturition, have been looked upon as powerful occa- sional causes. Sanson thinks that the sudden expulsion of the blood so abundantly contained in the uterine mucous membrane and cotyledons — and which should be only slowly diffused — forces that fluid into the neighboring vessels, and surcharges them beyond measure; while Ayr- ault is of opinion that the cold air, entering the uterine cavity by its partially dilated os, drives the blood from the mucous membrane into the other viscera, suddenly checks the lochial secretion, and thus gives rise to the disease. This lochial secretion plays an important part in the genesis of the malady, according to several authorities. Other writers suppose that the disease is more common during warm than cold seasons. In fact, it prevails in the most diverse temperatures, and it is as serious in cold as in warm weather. Sometimes the number of cases is very great, without any reference to heat or cold ; then almost suddenly they subside, and no more outbreaks occur for some time. This has led to the supposition, again, that it depends for its development on a peculiar condition or epizootic constitution of the atmosphere, but in what this consists no one has attenfipted to explain. Kohne says: " It is certain that when one of these periods of vitulary fever prevails, a change 664 PA THOLOG Y OF PARTURITION. of atmosphere has occurred or is about to take place, though the con- verse is not true — for when an atmospheric change takes place we cannot predict an invasion of this fever. But if it happens that several cases of the malady follow each other immediately during a certain atmospheric constitution, we may assuredly predict a change in the weather. This change most frequently consists in a transition from settled to rainy weather, bringing about a duninution in the barometric pressure." Some veterinarians have ascribed the disease mainly to infection — assimilating the puerperal fever of woman to the ^^TiXixxn^Vii processus in the Cow, but of this there is little evidence indeed ; while others, as already mentioned, imagine that it is merely a nervous form of parturient fever, and due to blood-poisoning. Gtinther, very many years ago, and a few others more recently, fancied it was produced by a moral influence, and that this was the removal of the Calf soon after birth, which distressed the Cow. But it was forgotten that the malady sometimes occurs when the Calf is with the Cow, and sucking ; and that other creatures in which the moral faculties are more highly developed, and which exhibit great anxiety and distress on being deprived of their progeny, yet do not suffer from parturient apoplexy. Besides, the latter is no more prevalent in those countries or districts where the calves are taken away from the Cows at an early period, than where they are allowed to remain with them. Others also have attributed the occurrence of the disorder to mental excitement during the act of parturition ; but surely this excitement must be greater with the first calf or with the second — when the disease seldom or never appears — than with the third, fourth, or fifth calf, when it is so frequent. Not only this, but it is a notorious fact that parturient apoplexy, in almost every case, follows an easy and rapid expulsion of the foetus without assistance, and ejection of the foetal membranes at the ordinary time. Indeed, parturition is generally wonderfully easy and the opposite of abnormal. So much is this the case, that Kohne boldly asserts that a difficult or protracted delivery is never followed by this disease ; and another authority (Banderschieren) is no less positive in declaring that if a Caw has a difficult calving, or if the placenta is retained, there is little reason to apprehend an attack of the disease. The more rapidly the uterus contracts and resumes its normal size, so the more danger there is of parturient apoplexy ; while the longer it remains relaxed or the memoranes are retained in it, so the chances are diminished. In the examination of the bodies of Cows which have per- ished, the uterus is generally found very firmly contracted. Before the expulsion of the foetal membranes, the disease is exceptionally rare. In a very few cases, the attack has commenced during parturition, and in still fewer before birth, and then when the lacteal secretion has not appeared. Constipation and gastric repletion have been held by one or two writers to be causes, and others attribute it to over-feeding immediately before parturition. These are the chief causes which have been given as operating in the production of this grave affection ; and it will be seen that they are suffi- ciently numerous and diversified to prove that the nature of the disease is obscure — so far at least as its etiology is concerned. We shall only, therefore^ recapitulate what we have said with regard to the salient points of this question, by stating that parturient apoplexy, as a rule, attacks Cows within one to five days after parturition, and especially when that PARTURIENT APOPLEXY.— PARTURIENT COLLAPSE. 665 act has been easy, prompt, and natural ; and that the animals which are affected are those of the higher breeds, good milkers, in a state of ple- thora, and pluriparas. This brings us to a consideration of the patho- logical anatomy and nature of the malady. Pathological Anatomy. Notwithstanding the numerous, characteristic, and striking symptoms ;which mark this disease, \\\q post-mortem appearances, no matter whether the animal has been killed or allowed to die, are for the most part of a negative character. In the majority of the descriptions there is much confusion, the lesions of parturient fever being mistaken for those of parturient apoplexy, and vice versd, just as the two diseases are con- founded with each other. In this malady the generative organs are usu- ally little changed ; the uterus may be congested — which it always is immediately after parturition, or it may even be paler than usual ; it is generally firmly contracted. The digestive organs are also usually normal, or their blood-vessels are much distended — perhaps due to paralysis of the vaso-motor system of nerves. The rumen is distended with gas in many cases, and the third compartment of the stomach often filled with hard dry food between its leaves, while the intestines contain somewhat hardened faeces. The gall- bladder is sometimes much distended. The lungs are normal, perhaps slightly emphysematous ; at other times congested, or in different stages of pneumonia if foreign matters have obtained access to the air-passages. The examination of the brain has not yielded very satisfactory or con- stant results. Some authorities have not discovered any pathological lesions worthy of note, either in the brain, spinal cord, or their envelopes ; while others have found well-marked and important lesions. These va- ried from venous congestion to oedema, anaemia, and exudation. Bragard, cited by Rainard and Saint-Cyr, constantly found injection of the brain and its meninges. Saake and Festal have also witnessed congestion of the vessels of the encephalon, sub-arachnoideal effusion, extravasation, and blood-clots on the surface of the cerebrum and cerebellum. Lecou- turier has seen serous effusion in the lateral ventricles — traces of spinal meningitis ; while Binz has observed a sanguineous extravasation and gelatinous matter at the origin of the sympathetic nerve, and Fabry blood-clots at the base of the brain, with ser.iim in the cavity of the arach- noid. In one instance Schaack irlet with a clot, three-fourths of a line in thickness, covering the left side of the medulla oblongata, and serous effusion into the lateral ventricles ; and in anotiier instance an inflam- matory exudate on the right side of the cerebellum. Harms has found, in many cases, air in the cerebral blood-vessels ; and Noquet and others have reported alterations in the spinal cord, with was reddened, con- gested, more rarely covered with exudate — chiefly in its lumbar portion, and sometimes the sciatic plexus of nerves has been affected. Abadie {Recueil de Med. Vt'terinaire, 1873, P- 953) made a careful examination of a Cow which was attacked twenty-four hours after an easy delivery, and died in eighteen • hours. The rumen was filled with dry food ; the second compartment of the stomach was normal, but the third was distended with hard cakes ; the fourth was normal. The mucous membrane was leaden-colored, and in the pylorus and caecum he found a large patch of ecchymosis. In the uterus the cotyledons were shrivelled, whitish, and the lining membrane pale. The organ itself was well contracted, and there was no trace of 666 PATHOLOGY OF PARTURITION. after-biith or lochia : it was more dry than moist, and the cervix was covered by a small quantity of mucus. The color of the uterus contrasted strongly with that of the vagina, the posterior part of which was congested, and towards the vulva was a wide patch of ecchymosis. The upper surface of the lining membrane was dry. In the udder was plenty of milk of good quality. The kidneys and bladder were normal ; the latter was filled with reddish urine. The blood in the vessels was dark-colored and inclined to coagulate. There were a few ecchymosed spots on the surface of the heart, which was otherwise healthy. The lungs were normal, though full of dark blood, and emphyse- matous at the left anterior border ; the bronchial mucous membrane was of a livid-red hue, and without mucus ; out of the trachea, as well as from the nostrils, flowed a quan- tity of fluid mixed with food. When the head was cut off no fluid escaped. The dura mater of the brain was normal ; no fluid in the sub-arac^noideal space, but the arachnoi- deal membrane and pia mater appeared somewhat infiltrated and opaque. The brain- substance had a natural hue without blood-points {punda vasculosa) on section. There was no trace of fluid in the ventricles. The other organs were healthy. Nature. With regard to the nature or efficient cause of the disease, there has been, and is even now, much divergence of opinion, as already stated. With some authorities it is a fever — a nervous or paralytic form of par- turient fever, closely allied to the puerperal fever of woman, and due to a blood-poisoning : the two forms only differing in degree. But we have shown that there is no fever ; that the temperature is rarely above, but is generally below, the normal standard ; and that sometimes the animal recovers — all the symptoms disappear in a remarkably brief space of time, and leave not the slightest trace of either fever or inflammation.^ This theory is opposed to the most careful and exact observations, and is evidently based upon erroneous notions, or through mistaking metritis or metro-peritonitis, with its septic fever, for this disease. With other writers the disease is considered to be a grave form of gastric fever — this opinion being based on the circumstance that there is constipation, and impaction of the digestive organs with hard dry food. But impaction does not produce the symptoms of parturient apoplexy, neither does it cause death in such a brief period. Again, it is supposed that mephitic gases, generated in the digestive apparatus, enter the blood, alter it, and so produce disturbance and stupefaction in all the organs. But no proof of the existence of such a gas i^ given us. The increase in the proportion of white corpuscles in the blood to- wards the end of pregnancy and after parturition, has led some writers to imagine that the disease might be a kind of leucocythaemia. But it is evident that this cannot be so. Again, the disease has been considered as in its essence a cerebral or spinal congestion, encephalitis, myelitis, a meningo-cephalitis, or a cere- bral or medullary apoplexy, according to the nature or the scr.t of the lesions found after death. But some of these opinions are opposed by the fact, that many of the lesions on which they are based are not found in all cases of death, and that recovery is often quite rapid. With re- gard to cerebral congestion and apoplexy we shall have to refer hereafter. Many high authorities — such as Kohne, Carsten-Harms, Wannovius, Fusch, Roll, Baumeister-Rueff, Barlow, and others — have maintained that the disease is primarily a derangement or paralysis of the ganglionic nervous system, which affects, or is extended to, the spinal cord and brain during the course of the disease. The following explanation is offered in support of this opinion. A too easy birth throws out of play a certain amount of the nervous force destined to the accomplishment of this act. Hence, there is a disproportion between the polar tension of the PARTURIENT APOPLEXY.— PARTURIENT COLLAPSE. 667 force conveyed by these nerves and the muscular irritability, and conse- quently an obstacle to the conductibility of the nerves charged with the distribution of this superfluous portion of the nerve force. Barlow thought that this disturbance in the function of the sympathetic nerves produces arrest of secretion and general congestion, especially of the brain and spinal cord. Contamine is more or less a partisan of this theory, as he explains the origin of the disease by stating that a reserve of nervous influence which is not expended in the animals that calve easily, by a reflex movement acts at first upon the spinal cord, and afterwards on the brain. Another theory — that of Lafosse — is that the malady is due to the cir- cumstance that the milky fluid secreted by the cotyledons, and absorbed by the chorial villi for the nutrition of the foetus, being no longer sepa- rated from the blood after parturition, remains in the circulation and accumulates there until the mammary glands eliminate it. When these glands act promptly, the febrile movement is imperceptible or almost nil ; but if they are slow in secreting, the arises a more or less intense morbid disturbance, due more especially to then presence in the blood of a product foreign to its normal composition. Without commenting at any length on this theory, it may be sufficient to mention that in some cases of parturient apoplexy, the function of the mammary glands is not suspended. Others — among them Deneubourg — trace the commencement of the disease to milk fever, the intensity of which, originated by a rapid and easy delivery, is in proportion to the development and secretory power of the mammae. The resulting disturbance is spread over the entire economy, and favored by the repletion of the stomach and the pre-existing plethora — suddenly increased by the mass of blood which goes to the uterus dur- ing pregnancy — as well as by the state of the nervous system in general which the pains of labor have induced, excites grave disturbance in the important functions of digestion, circulation and innervation. Hence arise disorders, as much more sudden and serious as the repletion of the stomach and the plethora are great, the blood is rich and plastic, and the irritability of the nervous system — especially the ganglionic — is excited. Consequently, we have a general functional disturbance resulting from the " congesting " action of all the cerebro-spinal and trisphlanchnic or ganglionic nervous systems. For Sanson, the collapsus of parturition is the consequence of a sudden, disturbance in the physiological condition of the uterus after parturition, consisting in the sudden removal of blood which congested the organ at that time. ; as during gestation a large portion of the bl4)od is diverted towards the pelvic region, where the uterus is lodged. After parturition the mucous membrane and cotyledons of the organ have lost their func- tion, and the enormous quantity of blood they contained is suddenly thrown into the circulation, surcharges the neighboring vessels beyond measure, and produces collapse. In proof of this, at the autopsies he made, Sanson affirms that the mucous membrane and cotyledons were always found bloodless, and of a pale-yellow color. Wermer is of opinion that the vascular system is involved, — as mani- fested by the diminution in temperature and the lacteal secretion — as well as the ner\^ous system — shown by the general depression and loss of sensibility, inactivity of the spinal cord in the dorsal region, difficulty in digestion, quickened heart's action, and slowing of the respiration ; and 668 PATHOLOGY OF PARTURITION. the causes he believes to be a bad regime, and pressure of the foetus on the stomach and intestines, diaphragm, vena cava, and posterior aorta. A too rapid evacuation of the contents of the uterus brings about a fall of the abdominal viscera, dilatation of the posterior aorta, and slacken- ing of the circulation. This theory of Wermer's is somewhat analogous to that of Franck, who compares the disease to the parturient eclampsia of woman, and has done more to elucidate its pathology by calling to his aid modern physiological teaching, than any previous investigator. The great importance of the subject from a pathological and therapeu- tical, no less than from an ecomical, point of view, induces us to notice his statements at greater length than we have done those of other veteri- nary writers, as we think they go far to furnish an explanation of the phenomena of this disease. Franck {Woc/imschrift /iir Thierheilkimde, 1876, Nos. 21, 22) says that nearly all the theories set up have this in common, that their correctness or incorrectness has never been supported by experiments. If we con- sider the conditions which are present at parturition, as well as the symp- toms of the disease, we are led to attribute the origin of the latter to an acute ancemia (" Blutarmuth " — poverty of blood), and consequent sudden loss of brain power. With respect to this the following questions have to be answered : 1. Do the same symptoms appear in sudden brain anaemia as occur in calf-fever (" Kalbefiebers," the popular name for the malady in Ger- many) ? 2. Has brain anaemia any relation to calf-fever? 3. If so, what occasions this brain anaemia ? Now as regards the first question, it is an indisputable fact that the functions of the brain are in a great measure dependent on the state of the circulation. A large array of physiological facts tend to show that reduoed flow of blood in this organ, and consequent diminished oxidation' of the brain ganglia, lead to lethargy, lessened reflex action, loss of volition, and complete unconsciousness. Snakes, which seldom feed, but which on these occasions consume an enormous quantity of food, are known to be in this comatose state after one of their heavy meals ; they either move about sluggishly or not at all, are quite stupid, make no attempt to flee from danger, and can be then easily destroyed. This is due to a peculiar distribution of the blood. A large proportion of this fluid must necessarily be diverted to the stomach, in order to convert the enormous quantity of food into chyle ; consequently, the stomach has much more blo^d during the process of digestion than when this is not going on. The stomach having absorbed the blood, it follows that the brain and muscular system must suffer from a deprivation of it. Now there is a general physiological law to the effect, that organs cannot per- form their functions without a sufficient supply of the vital fluid ; and as the cerebrum is the seat of volition and of consciousness, these two func- tions are diminished in activity by sudden loss of blood, and if the depri- vation is very considerable, the brain entirely ceases to act. Remove the cerebrum from an animal (such as a pigeon), and the same symptoms appear; the animal is no longer conscious of what is going on ; it can no longer assert its will or control its movements ; it lies as if in a dream, but otherwise its health is unimpaired. It is different, however, if the whole of the brain loses much blood j then certain functional dis- I PARTURIENT APOPLEXY.— PARTURIEXT COLLAPSE. 669 turbances of the organ are manifest, which often terminate in total un- consciousness. In narcosis the brain is poor in blood and pale ; the action of cold on it produces contraction of the blood-vessels and anaemia, resulting in lethargy and, finally, unconsciousness. Even during sleep there is less blood in the brain than when awake. The fontanella of children collapse somewhat during sleep, and the upper surface of the brain itself becomes pale, as has been shown to be the case in animals by Durham, Strike a dog a severe blow on the muzzle, and it will at once become insensible, and perhaps quickly die. This is owing to the blow having affected the inhibitory filaments (in the track of the fifth cerebral nerve are a number of these filaments, which excite the contraction of the vessels), and caused them to bring about complete contraction of the small cerebral arteries, so that the brain becomes suddenly deprived of arterial blood ; hence unconsciousness and death. There is also the instructive experiment of Goltz, by which, when the heart's movements are made to stop at the diastole, the blood-vessels dilate, especially those of the portal system, and there is brain anoemia. All this tends to show that the same symptoms are common to anaemia of the brain and calf-fever. No doubt coma can result from deficient oxida- tion of the ganglion-cells of the cerebrum, from exclusion of air ; or blend- ing of matter or carbonic acid therein, which prevent the blood from pass- ing into the tissues, will readily induce coma. Another symptom must be referred to — paralysis. I'his symptom manifests itself in two ways — in single muscles or in groups of muscles. In the first, the nerve connected with the muscles, or its centrum in the brain or spinal cord, ceases to act. This is the commonest form of paralysis, and may be due to apo- plexy. In the second case, the paralysis may arise from functional inac- tivity of the volitional centre, located in the cerebrum. The animal, as a rule, makes no attempt to move, or cannot take the initiative in move- .ment ; and we might be inclined to designate it as a "paralysis of the will." Some of the symptoms of paralysis which appear at the com- mencement of calf-fever may certainly be traced to the latter form. Saake seems to be quite convinced of this, for he says that the paralysis is owing to a disinclination to move the hinder parts. In the second place, it is particularly interesting to note the frequent occurrence of epileptic attacks and spasms. The latter can be produced by sudden anaemia of the brain. The various centres in the medulla ob- longata can, according to Landois, be irritated by anaemia ; and sudden and acute anaemia of the medulla oblongata is most likely to occur in the fourth ventricle, above and behind the pons where the " spasm-centre " {^Kra77ipfezefitrmn) is situated. From this may arise convulsions which are very similar to, if not identical with, epilepsy. Epilepsy can, how- ever, in many instances be traced to anaemia of the brain and medulla oblongata, induced by reflex action of the vaso-motor centres, or direct influence of the inhibitory nerves. We may easily be convinced of this by watching an animal which is being bled to death after being stunned. When nearly all the blood has escaped, and reflex action through the cornea can no longer take place, insensibility and acute convulsions (Opisthotonos) then set in — the latter bearing the closest resemblance to those of epilepsy and calf-fever, and are assignable to the same cause. The comatose symptoms occur chiefly in distinct ansemia of the brain surface and cerebral ganglia, and when the medulla oblongata is involved convulsions prevail. It does not seem out of place to direct attention to 670 PA THOLOG Y OF PARTURITION. the Rosenberg-Traube theory as to the eclampsia of woman, which ap- plies equally to that of Cows. This theory can be summed up in the following sentences : i. The origin of the symptoms of eclampsia lies in the altered conditions of the brain circulation, and not in a uraemic blood-poisoning, as Frerichs, Listzmann, Braun, and others have main- tained ; 2. This altered circulation in the brain is brought about by in- creased aortic pressure, and perhaps also by direct reflex brain-stimulus. Owing to the sudden and violent contractions of the uterus, blood must be poured into the aorta, and the consequence will be hyperaemia, and afterwards oedema and anaemia, of the brain ; 3. The brain oedema and the anaemia resulting therefrom, are materially afifected by the aqueous- ness of the blood after parturition. This hydrsemia is undoubtedly in- creased during the last period of pregnancy, by the appearance of albu- men in the urine. This theory is all the more valuable, as its correctness has been ex- perimentally demonstrated on living animals. Bidder and Munk have made experiments with regard to eclampsia in animals. They first in- jected tepid water into the carotids; and as soon as the pressure of the water reached seven times that of the blood, coma and convulsions im- mediately set in. The dilution of the blood does not altogether account for the convulsions. Strong and momentary pressure had no effect ; but when the pressure was applied continuously, coma, spasms, or at least un- consciousness, resulted. Bidder came to the conclusion that increased blood-pressure alone would not produce eclampsia ; and that this fluid must be much more impoverished, and the pressure more durable, to in- duce this condition. Although it cannot be denied that the injection of warm water causes certain changes in the blood and unknown disturb- ances in the brain, and although we can arrive at no definite conclusion as to the extent of blood-pressure in the vessels of the brain, these ex- periments are of the utmost importance. The question now is whether, in calf-fever, changes in the brain occur,' such as are portrayed in the Rosenberg-Traube theory t This question must be answered in the affirmative. Nearly all those who have had op- portunities of dissecting Cows which died of calf-fever, mention that, ac- cording to the stage in which death occurred, hyperaemia of the brain, brain oedema, and exudation in the cranial cavity. As soon, however, as it reaches the degree of brain oedema, anaemia sets in. It may as well be casually remarked, that animals may suffer from arterial anaemia — and this is most likely to induce eclampsia — simultaneously with venous hyperaemia of the brain. The question may be asked. How is it that such a brain anaemia en- sues after calving, and what makes it so prevalent among cattle ? As a matter of fact, there are a host of conditions during, and particularly after, calving which are most favorable to an attack of eclampsia, from the Traube-Rosenberg point of view. It is also a fact that calf-fever sets in almost without any exception, during, or after, parturition, and simul- taneously with the involution period of the uterus. In many cases, the commencement of the malady corresponds with the "after-pains." Fur- thermore, the malady in question principally attacks Cows which are in good milk, and, as a rule, those which are best fed ; and these attacks generally follow easy parturitions. Consequent on the uterus contrac- tion and diminution, a great portion of the circulation is diverted from it. The blood is poured into the larger trunks and into the aorta. The PA R TURIENT A POPLEXY.—PA R TURIENT COLLAPSE. 6 7 1 quicker and more continuous the uterus contractions, the more consider- able is this flow of blood. Attention may casually be directed, to the fact, that the after-pains are much more severe and continuous after a speedy parturition, than after a tardy one. The blood forced back generally finds its normal outlet by the udder and skin ; and by watching every nor- mal parturition one can observe the acute swelling of the udder, which swel- ling varies in proportion to the number and violence of the pains. By this outflow into the udder and skin, and by which a collateral fluxion is es- tablished, the accumulation of blood already alluded to, which would be followed by aortic pressure,* is got rid of without detriment to the ani- mal. In cases, however, where this stoppage is sudden and violent — as happens after a chill to the surface of the body — the aortic pressure must undoubtedly be considerably increased. One consequence of the increased pressure — always easily observable after a little time, as will be shown presently — must, among others, be congestion of the brain. But the soft brain-tissue can only offer a slight opposition to the distention of the vessels ; consequentl}^, sudden effu- sion and, as a result, brain oedema, ensues. This brain oedema, on its part, causes contraction of the vessels and, in this way, arterial anaemia. Tlie whole process, which can be followed step by step, is greatly aided by {a) the heart's hyperplasia, {h) the increased flow of blood, and ('mpanitic, the heart's action fluttering, and the pulse almost undetectable, bleeding is calculated to do more harm than good, as the heart's action would now be further impaired, and the amount of arterial blood sent to the brain diminished. For it must be remembered that the cerebral conges- tion is now less due to an over-abundant supply of arterial blood than to pressure upon it by venous or capillary engorgement ; that, in fact, the brain — engorged as it may app'ear — is in an anaemic condition in regard to its arterial supply ; and when this is the case, paralysis of the heart is to be prevented, if possible, by the use of stimulants," A principal indication in the treatment of the disease, viewing it in the light we have done, is Xo favor the cutaneous circulation and stimulate the skin by every means in our power, and thus relieve those organs in which the blood-pressure is too considerable. With this object in view, the skin is to be well rubbed with straw wisps, and then warmly clothed. Or the course of the spine and for some distance on each side, may after- wards be stimulated with strong ammonia liniment. Some authorities recommend the application of a mixture of croton oil with oil of turpen- tine j others employ a thick layer of mustard, after the skin has been well cleansed with warm water and the hair removed ; others resort to sacks steeped in boiling water apiplied to the spine — sometimes after deep scarifications have been made. In addition to the applications of turpentine or mustard to the spine, they are often made to the limbs. In some cases, a hot iron — the laundress's flat iron — has been applied to the back in an "ironing" fashion, and at a somewhat high tempera- ture, a piece of flannel being interposed between it and the skin. The action of the skin can be greatly augmented by covering the body with a wet sheet, and above this a thick woollen one, surrounding the animal with plenty of litter. Cold water or ic6 may be applied to the head ; but this application re- quires care, as the resulting coryza and other complications may prove very serious, should the animal recover from the collapse. With regard to the tympanitis which is so often present as a conse- quence of the torpidity in the digestive organs, this should be combated in the ordinary way, by the administration of stimulants. These are most effective and rapid in their action when given in the fluid form, if the animal can swallow. If it cannot, then they may be administered by means of the stomach-pump or probang, or even in bolus. Williams rec- ommends giving carbonate of ammonia in bolus ; the hand being well oiled, is to be pushed as far as possible into the pharynx, when the dose " will slowly gravitate into the rumen." Should the medicine not act promptly, or should the tympanitis be so great that suffocation is to be apprehended, then the rumen ought to be punctured without delay. This may be effected by the ordinary trocar and cannula, the latter being allowed to remain in the rumen for some time. It may be closed by a cork, which is to be withdrawn when the gas accumulates. If care is exercised, fluid medicaments. may be introduced into the stomach through the cannula. 678 PA THOL OG V OF PAR TURITION. Even when the tympanitis is not extreme, but the animal is comatose and there is gastric regurgitation, it will be advisable to puncture the rumen ; as by this means the entrance of food into the trachea may be prevented, by allowing the gases to escape through the cannula, instead of by the oesophagus. Enetnas are as essential as counter-irritation. The rectum should first be emptied manually, and then either enemas of warm water, or those of a stimulant or laxative nature, administered. By the rectum enemas of linseed oil, common salt, sulphate of soda or magnesia, aloes, tobacco, oil of turpentine, camphor, etc., have been administered. The rectum forms a safe and convenient channel for the introduction of medicines, and especially those intended to act upon the torpid digestive organs, when the animal can no longer swallow. Powdered camphor in small quantities has even been introduced into the rectum to stimulate the in- testines, when drugs exhibited by the mouth have failed to effect this. Enemas may be given as frequently as necessary without danger to the animal, and with ease : advantages not available with the mouth admin- istration. , The urine should be frequently removed from the bladder, either by pressure on the viscus through the rectum, the introduction of the cathe- ter or no2zle of the ordinary injection syringe into the urethra, or even by passing the finger into that canal. The milk should be often removed, and the udder completely emptied. Even when there is no milk, the teats should be well and repeatedly stripped. ^ Purgatives are in nearly every case necessary, and they should be ac- tive, and given in larger doses, than in ordinary circumstances, constipa- tion being a constant and serious symptom ; while action of the bowels ■may be considered a most favorable sign. The most common are sul- phate of magnesia or soda, aloes, chloride of sodium, cream of tartar, linseed oil, castor oil, tartar emetic, ipecacuanha, croton oil, etc. In the great majority of instances these agents are not given alone, but are associated with other substances. A very favorite compound in Germany is that mentioned by Kohne, the composition of which is as follows : Nux vomica - - - - 8>^ drams. Tartar emetic - . - - 2 ounces. Sulphate of soda - - - 18 " Common salt - - - - 4^ " These are boiled together for about a quarter of an hour in four pints of water, and one-fourth given every hour or every two hours. Harms places great confidence in tartar emetic. He gives 8^ drams in about two pints of water, in four hours three drams in a pint of water, and in five hours two drams. In one serious case he gave as much as two ounces in fourteen hours. In thirty-seven cases of the disease, only two died. When it is desired to increase the activity of any of the ordinary pur- gatives, croton oil is generally added in the proportion of six to twelve — or even forty — drops, or oil of turpentine one or two ounces. Some practitioners extol nux vomica in tolerably large doses, to aid in rousing the action of the intestines. Stimula?its are often administered, and in conjunction with bleeding POST-PA RTUM PARALYSIS. 679 they may prove of the greatest service at the commencement 01 the at- tack, or they may be associated with the purgatives. If given alone, they should be exhibited in small doses and very often. Other medicaments have been employed — as aconite, bryonia, camphor, phosphorus, datura, quinine, gentian, digitalis, etc. — with varying suc- cess. When recovery commences, small doses of stimulants may be benefi- cial if there is much debilit}', and the animal can swallow readily. But in the administration of fluids when the animal is comatose, or deglutition is impeded, the greatest care is necessary to prevent their entering the trachea — -an accident which might prove fatal. To test whether the animal can swallow, a little cold water may be poured into the mouth from a bottle. If swallowing is difficult, then the only safe mode of ad- ministration is by the stomach-pump or probang, or directly into the rumen by the trocar and cannula. Large quantities of fluids are objectionable, and the amount in any single dose should not exceed a pint. It must also be remembered, that if it is probable that the animal will not recover, but will be killed and its flesh consumed as food, drugs of a poisonous kind, or likely to flavor the meat, should not be given. Many cases are recorded in which people have been poisoned, through eating of the flesh of Cows which had received large quantities of poisonous medicines before being killed by the butcher. Electricity has been employed with success, both in the comatose stage and when paralysis has remained after the attack. Neumann and Holden relate instances of recovery. The Leyden jar, or, better, the induction coil, may be employed. To sum up, the treatment of parturient collapse consists chiefly in re- lieving the congestion of the brain (at the commencement), restoring the functions of and stimulating the skin, promoting the action of the intestines, and jfcmoving the milk or stimulating the function of the mammary gland. All violent arfd heroic treatment should be avoided, as well as large doses of medicine. Consecutive congestion or inflammation of the lungs must be treated according to circumstances ; and paralysis will be best combated by stim- ulation to the loins, and the subcutaneous^ injection of strychnia, with diuretics and purgatives. Easily digested food in small quantities should alone be allowed im- mediately after recovery, and the animal must not be given any indiges- tible food, nor be permitted to eat hay or litter. It is judicious not to breed from a Cow which has suffered from partu- rient collapse, unless every precaution is taken towards the next calving period. CHAPTER V. Post-Partum Paralysis. In treating of the diseases peculiar to pregnancy, we alluded to paraple- gia (p. 180) as one of these. Paralysis of the hind-quarters is more frequent previous to birth than after that event, and is generally observed in the Cow. After birth, paralysis is comparatively rare, and may affect 68o PA THOLOG Y OF PARTURITION. nearly the whole of the body, or both or only one of the hind-limbs. The Cow is also the animal which oftenest exhibits post-partum paralysis. The affection may be due to parturient apoplexy or collapse — as already noticed ; it may also be a result of metritis ; or it may follow difficult parturition, and especially after the birth of a large calf, or if the latter has been in a wrong position. Franckhas often witnessed its occurrence after delivery, when the uterus has been half-twisted. Williams gives an instance in which paralysis appeared to be due to mental disturbance ! Symptoms. The symptoms are similar to those of ante-pa?'tum paralysis. The animal continues to lie, and one or both hind-limbs may be moved in a convulsive irregular manner, or they are completely incapable of movement. In the majority of cases, however, the animal is able to turn itself over at intervals from side to side — particularly during the night. Sometimes only one leg is paralyzed. Apparent paralysis is at times observed in Cows, which persist in lying after parturition, and though they can move their limbs readily, yet they will not attempt to get up ; their appetite is unimpaired, they exhibit no symptoms of disease, but yield plenty of milk, and the excretions are normal. • This condition may continue for weeks or months, and often animals have to be killed in consequence of it. Nature. Little is known as to the nature of this affection. Harms and othen thought it was due to injury inflicted on the sacral and other nerves dur ing difficult parturition. The sciatic nerves are particularly liable t( injury. Post-mortem examination, however, has on-ly furnished negativ; evidence of this. Franck thinks that injury to the cervix uteri may giv rise to reflex paralysis ; this has been witnessed in a Bitch ; and refie; paralysis of the legs has been seen in woman, and asq^ibed to uterine injury or derangement — when this was repaired the paralysis disappeared. It is not at all improbable that the same causes will produce the same effects in animals. We can easily understand how paralysis is induced in parturient apoplexy. Williams states that it is due to inflammation and red softening of the spinal cord in the lumbar region. Treatment. When paralysis is actually present, the animal must be kept clean and healthy. Blisters, or even the actual cautery, should be applied to the loins, and the subcutaneous injection of strychnia resorted to. The con- dition of the bowels and bladder must be attended to ; the former being regulated by feeding, and if necessary by laxatives, the latter by diuretics. Electricity may be useful in some cases, and particularly when only one limb is involved. In all cases, the state of the uterus should be ascertained, and if it is unsatisfactory, then remedial measures should be adopted with regard to it. When the animal cannot turn itself, this must be done by its attend- ants ; and if it is a valuable one, and the paralysis is likely to continue for some time, slinging for a short period everyday may be tried. With PARTURIENT ECLAMPSIA. 68 1 Cows, however, unless there are special reasons to the contrary, and if they are in good condition, it is often advisable to have them killed for food. 1. Williams {Op,, cit., p. 414) mentions that a she-Goat had its kids taken away when they were four weeks old, and in an hour afterwards it was completely paralyzed, moan- ing piteously, and evidently in great distress. It remained in this condition for several days — lying extended on its side and quite conscious, but powerless. It then gradually sank and died. 2. " Veterinarius " ( Veterinarian, vol. xii. p. 288) gives a case of parturient paralysis in a Mare, succeeding abortion. There were at first evident symptoms of metritis. It ultimately recovered. 3. Toll {Ibid., vol. xxxvii. p. 824) relates a case of parturient apoplexy from which the Cow recovered in three days, but could not reise until ten days afterwards, when it was discovered that one of the hind-limbs was paralyzed. The leg was drawn along, the foot being turned back. In a month extensive ulceration had occurred at the fetlock and hock, and there was a large abcess in the gluteal region. The Cow was eventually killed. 4. The same writer gives a similar instance, in which paralysis of a hind-limb followed parturient apoplexy. It recovered sufficiently well to walk about at pasture, and yielded a liberal quantity of milk. CHAPTER VI. Parturient Eclampsia. We have seen that Franck has compared the malady we have designated " parturient apoplexy " or " collapse," with the disease known in woman as " eclampsia," and has endeavored to establish their identity. To a certain extent we admit that he has been successful, but we are far from convinced that the eclampsia of woman and the malady of the Cow are identical ; though we do not dispute that the same or similar causes may be in operation in the production of both. In the first place, the eclamp- sia of woman is essentially epileptic or convulsive, the convulsions being of a tonic and clonic nature ; and though, in the disease of the Cow, convulsions are sometimes present, yet they are far from being a constant symptom. The symptomatology of the two diseases, indeed, is widely different. In the woman there are premonitory signs — such as uneasiness, headache, nausea, twitchings, sudden vertigo. Then the attack begins by rapid contractions of the muscles of the face, eyelids, and eyeballs : the latter rolling about in their orbits. These movements soon extend to the head, neck, and other parts of the body, and are rapidly replaced by tonic con- traction of all the extensor muscles either of the trunk or limbs. The respiration is stertorous or suspended ; the pulse — at first full and strong — is so weak that it is scarcely perceptible ; the tongue is protruded from the mouth, and often bitten ; foam appears between the lips ; uncon- sciousness is complete. The attack may last for twenty or thirty seconds ; then the tonic convulsions are replaced by those of a clonic kind, pre- ceded by a general state of rigidity. The movements are jerking, and so convulsive that they shake the whole body. The respiration gradu- ally returns, the pulse resumes its natural rhythm ; the jerking of the limbs and body subsides, perspiration appears, and in from one to five minutes all is tranquil ; the comatose condition which supervenes varies in duration, but the patient awakes greatly exhausted, and complaining 682 PA THOL OG Y OF PA R TURITION. of pain in the limbs. Exceptionally, there is only one attack ; generally there are several, which may succeed each other quickly, when the pa- tient may remain comatose between the pauses, and at the height of an attack death may take place from cedema of the lungs or apoplexy. In favorable cases the intervals become longer, the attacks tliemselves more imperfect and shorter, until they finally cease. Parturient collapse in the Cow has not the intermittent character of the eclampsia of woman, and there are seldom, if ever, real convulsions ; there is, on the contrary, loss of the cerebral faculties, and paralysis of the m.uscles, particularly of the hind-limbs : indeed, the most marked features of the disease are progressive paralysis, continuous course, absence of convulsions, and rapid death in fatal cases. But if we cannot at present admit that this bovine disorder and eclamp- sia of woman are the same, there is a malady which attacks not only the Cow, but also the Goat, Bitch, and Sow, and which certainly closely re- sembles the human disease. It has been studied chiefly by Hertwig, Zundel (who had only observed it in the Bitch), Mauri (who has studied it in the Cow, Goat, and Bitch), Harms (who describes it in the Goat), and Ellenberger, Seller, and Wostendorf (who have seen it in the Sow). It is possible that the disease is rare ; but it is more probable that it has been confounded with other maladies. We have only seen one case of it, the victim being a Bitch suckling too many puppies. Symptoms. With the Cow and Goat, the attack appears to come on soon after pj-r- turition, but in the Bitch it may occur in from two to thirty days after that event, and always during lactation. In the Sow, it usually begins between three to five days after parturition. With the Bitch and Sow it is not so serious as in the Cow, and with the latter the disease is far less fatal than in woman. It would appear that it is hereditary. In the Cow and Goat the malady closely resembles that in woman, the attacks being multiple, and sometimes accompanied by loss of consciousness ; though, as with the Bitch, the two periods of tonic and clonic convulsions are not well marked. The eclamptic attacks are not sudden in their invasion. They gen- erally begin with tremblings, anxiety, agitation, and very perceptible feebleness in movement. These symptoms progressively increase in in- tensity, until the animal can no longer stand. This, the first period, is not constant in its duration. When lying, the animal is seized with gen- eral convulsions of the voluntary muscles ; the limbs are extended and agitated as if by electric discharges ; the eyes pirouette in their orbit, or more or less squint ; the mouth is half open, the tongue pendent, and spumous foam flows from the commissures of the lips. The Bitch ap- pears to retain its consciousness, but the Cow loses its senses more or less completely. After a variable period of time — from a quarter of an hour to several hours — the convulsions cease, the patient rises, and after standing for a few seconds as if in a state of deep coma, it gradually re- gains its senses and ordinary condition. The attacks may be more or less numerous and intense, and conse- quently constitutes a disease of which the gravity is variable, according to Mauri. Hertwig, who was the first to describe the disease in the Bitch, and Zundel, give a similar account of the symptoms in that animal. The PARTURIENT ECLAMPSIA. 683 latter had never witnessed iDremonitory signs of the disease, though Hert- wig had. He says that with Bitches which are suckling, and particularly those kept in the house and well fed, it is not rare to observe a state of tetanic rigidity and incomplete paralysis, with the following symptoms : The animal suddenly commences to be uneasy and anxious ; the eyes are haggard, sometimes the nose is a little hot ; the respiration is very short and quick, though pressure on the chest or abdomen does not cause any pain. In a short time — about a quarter of an hour after the difficulty in respiration was observed — the animal cannot stand, but falls on its side, and lies with the limbs extended ; even when raised it cannot stand. The breathing becomes still quicker — from 60 to 100 per min- ute ; while the pulse is small, hard, and irregular, and beats 100. Con- sciousness appears to be retained, but the animal refuses food and drink, and the alvine and urinary excretions are suppressed. The mammary glands are, greatly engorged, hot, and abundantly provided with milk, the quality of which does not appear to be altered or injurious to the young, which usually continue to suck as before. This state continues for forty-eight hours, when death generally occurs from apoplexy and paralysis ; though by proper treatment the disease may always be quickly cured. Zundel's description is almost the same, except that he says there are tonic convulsions, with clonic contractions extending rapidly to the whole of the body ; that sometimes there is trismus, with grinding of the teeth ; constantly there is a white foam at the mouth and muscular trem- blings of the jaws ; the breathing is stertorous, and sensibility much di- minished ; that there are cases in which the eclampsia appears to be merely partial, affecting only the hind-limbs for instance, and the animal sits, with the head unaffected, and whining ; that the disease is continuous and without intermittences, the attacks last for one or two days ; and if no relief is afforded the creature dies from total paralysis, due to conges- tion of the meninges of the brain, or from asphyxia after a spasm of the glottis. In the Sow, according to Ellenberger and Wostendorf, the symptoms are not very unlike calf-fever in the Cow, with which disease it is de- scribed by Franck, In the cases Ellenberger {Gurlt and Hertwig's Magazin, 1869) had an opportunity of seeing, the animals were attacked from three to five days after easy parturition. The appetite was partially or totally lost, the young were neglected, and the animal seldom moved about ; soon it persisted in lying, and there was suppression of faeces and urine, with diminution or cessation of milk secretion. The animal lay on its side, the eyes closed, and the body temperature low ; at times there were feeble convulsions. The respiration was irregular, deep-drawn, and moaning ; the pulse 80 to 90 per minute ; and great loss of sensibility. Nothing was observed about the generative organs. After twenty-four to thirty-six hours improvement took place, faeces were voided, and the animal began to pay attention to surrounding objects ; the temperature rose ; the pulse and breathing became normal ; the appetite and milk secretion returned ; and in from three to five days recovery was complete. All the Sows survived the attack. In one case reported by Seller {Can- statfs Jahresbericht, 1862, p. 48), the symptoms were more of a convul- sive or epileptic nature. Nature, and Causes. This disease, it appears, never attacks any but animals in the parturient 684 PATHOLOGY OF PARTURITION. condition, and it has affected Bitches, especially those well-fed and in a plethoric state, after each parturition. With regard to the nature of the disease, much cannot be said, as there do not appear to have been many opportunities for post-mortem examina- tions. No albumen has been discovered in the urine, and uraemia has not been noted. The cause which has been attributed by Franck as operating in the production of parturient collapse, may be in operation in the development of eclampsia — viz., increased pressure in the arterial or aortic system, and brain anaemia. As occasional causes, Hertwig mentions for the Bitch, chills ; the loss of the offspring, and, consequently, " stagnation " of the milk ; mental emotions, and especially those due to loss of offspring or master. In the only case we have observed, which was in the Bitch, we attributed it to suckling too many puppies. Treatment. The disease does not appear to be at all serious, many cases recover without medical treatment. Hertwig recommends the abstraction of blood from the jugular, the quantity varying with the size and condition of the animals ; and he asserts that frequently all the symptoms diminish considerably, or even disappear, while the blood flows. After the bleed- ing, he administers a spoonful of tea every four or six hours, with small doses of nitrate of potass. If the bowels ar^ constipated, an enema is to be given. Zundel has been particularly successful with the syrup of chloroform, which, in small and frequent doses, keeps the animal in a state of semi-anaesthesia ; the cure being terminated by a dose of laxative medicine and one or two enemas. The syrup of ether produces the same effect as the chloroform, though less quickly and surely. In the case which occurred in our own experience, and which we believed to be due to hyper-lactation, some of the puppies — a large litter — were removed, and the bitch had a warm bath and a laxative ; recovery quickly ensued. 1. Boissonneau [Journal des Vetermaires dii Midi, 1858) relates that a Cow, three days after parturition, which had been natural and spontaneous, showed symptoms of an attack of metritis. The following day, a quarter of an hour after abstracting blood, the animal began to manifest great anxiety ; the respiration became laborious and hurried, like that of a Horse pris de chaleiirs ; the hmbs were wide apart, as if to prop up the body, and the head rested on the manger — the body being balanced by a kind of undulatory movement. Soon the Cow fell — an inert mass, the limbs rigid and immova- ble, the eyes turned backwards and fixed, the mouth half open and the tongue pendent. The animal bit at objects within its reach, and the foaming saliva flowed from the com- missures of the mouth. This fit, during which all the instinctive and sensorial faculties seemed to be in abeyance, lasted about twenty-five minutes, and five attacks occurred during the day. Next day there were three attacks, and the fourth day only two. The fifth day passed without any, and it was thought that recovery had set in, when, on the sixth day, the fits re-appeared with the same intensity as at the commencement. In the middle of one of these attacks, the Cow got entangled in the stall and was strangled. At the autopsy, dark blood was found in the lateral ventricles of the brain, the envelopes of which were congested and its texture softened. Death in this case was accidental, and the lesions may have been due to strangulation. 2. Mauri {Revue Veteri7taire, 1876, p. 65) describes the case of a Cow, four years old, and aprimipara, which had calved, and the placenta was expelled two hours afterwards. On the following morning the animal was seized with tremblings, refused all food, mani- fested breathlessness, and looked anxious. On being led to the pasture to give it more air, it was perceived that it was weak in the hind-quarters, and in the short distance it had to travel it fell several times. It was put in a shed with a northern exposure, and its calf being brought, it remained completely indifferent to it. At two o'clock it fell, and Mauri was sent for. He found it lying extended on the right side, the respiration PARTURIENT ECLAMPSIA. 685 appeared to be suspended, and it was difficult to perceive the movements of the flanks ; the pulse was imperceptible, but the heart's beats were strong. The tongue hung out of the mouth, and the air expelled during perspiration carried a large quantity of foamy saliva with it. The senses appeared to t)e completely abolished, and the eyeballs — turned greatly upwards — looked fixed in a remarkable rnanner. The limbs were rigidly extended, and they, with the trunk, jerked in such a violent manner, that the whole body was shaken without being displaced. The udder was not flaccid,'and milk of a good quality was readily obtained from it. Mauri thought it was a case of vitulary fever, and ordered the necessary treatment. After six o'clock in the evening, while preparations were being made to carry out his prescriptions, the Cow got up and stumbled towards the side of the shed where its calf was standing. During the night it ate and ruminated. Next morning at eight o'clock there was a new attack. The premonitory symptoms lasted for about half an hour, and the animal lay until half-past nine. At mid-day it did not present any signs of disease. It had no more attacks, but the owner, apprehensive of future danger, sold it two months afterwards, and Mauri lost sight of it. 3. Calmettes (Ibid., p. 67) mentions that a four-year-old Cow gave birth to a calf during the night in quite a natural manner, and during the following day it ate and ruminated as usual. Towards six o'clock in the evening it suddenly commenced to tremble, and to stagger in its hind-limbs, so that it could only walk with the greatest difficulty. At seven o'clock Calmettes noted that the hind-quarters were very feeble, the general sensibility appeared to be increased, pressure on the dorso-lumbar region caused much pain ; the skin was very hot, and the respiration deep and hurried ; the pulse was strong and quick, the mucous membranes somewhat reddened, and the muffle damp. Counter-irritants were applied to the hind-quarters, and draughts and emollient enemas administered. At one o'clock in the morning he was again called. The animal had fallen on its side ; the general sensibility was diminished, and the skin was very cold. From time to time it was remarked that all the extensor muscles of the limbs were convulsed, which threw the latter into rigid extension ; though, when seized by the hands, they could be flexed and moved about. The sensorial functions were completely abolished, and the skin could be pricked or incised without inducing the least movement ; the eye, which was generally fixed, pirouetted in its orbit from time to time, while it could distinguish nothing, and could be touched without betraying any sensation ; there was also loss of hearing. At this time the respiration was about normal — eighteen to twenty respirations in the minute ; the pulse was small and imperceptil)le ; the heart's beats strong ; the mucous membrane rather pale than red, and the muffle dry. During expiration there was a labial souffle, and an abundance of foamy saliva escaped from the mouth. The animal remained in this condition for six hours. Towards seven o'clock next morning, when about to send for a butcher, the limbs be- came rigid and were seized with convulsions, which extended to the entire body. As if by enchantment, the animal placed itself on its sternum, raised its head in the normal position, and finally got up, though with difficulty ; it remained in a somewhat deep coma for about an hour. In the evening it had a second attack, there being general agitation, with hurried respiration and weakness of the hind-quarters. Soon it fell, had numerous convulsions, and manifested the same general insensibility it displayed in the morning ; remain- ing paralyzed, however, for only three hours. Next morning it appeared to be quite recovered. Fifteen months previously, and eight days after parturition, this Cow had another attack when returning from pasture; being suddenly seized with tremblings, it staggered and fell. In half an hour afterwards it was completely insensible, and sensationless ; the respiration was almost normal, the pulse imperceptible, though the contractions of the heart were powerful, and all the symptoms already enumerated were present, but became more rapidly developed. The convulsions continued for two and a half hours. 4. Lafitte {Ilnd., p. 70) mentions that a Cow calved in the most favorable manner, and four hours afterwards became agitated and restless ; soon afterwards, there were convulsions of the muscles of the trunk and limbs, and so much weakness set in that the animal could not stand. The tongue was often projected from the mouth and foam flowed therefrom : the Cow coutd hear and see during the attack. The pulse was intermittent, and the respiration moderately increased. In about ten hours it arose and gradually recovered. Two days after, it had another and a final attack, which lasted for three hours, 5. The same writer {Ibid., p. 70) relates that a Cow, which had calved a few hours before, was seized with persistent convulsions and great general weakness, which ren- dered standing impossible — presenting, in fact, all the symptoms of the previous case. This attack continued for three hours, and another followed on the same day. Then an 686 PATHOLOGY OF PARTURITION. i interval of a day elapsed, when' the fits succeeded each other so frequently, and with so much intensity, that the animal died from asphyxia. 6. Lafitte [Ibid., p. 71) describes the case of a Goat affected with metro-peritonitis after parturition, and for which it was treated? Two days afterwards, the creature ap- peared to be agitated and restless ; convulsions were manifested in all the muscles, and particularly those of the jaws; the eyes rolled about; there was abundant salivation, etc. ; the animal could not stand. There was only one attack, which lasted for several hours. 7. Mauri {Ibid., p. 18) relates that a Bitch, four years old, and which had been ill since the previous evening, was sent to the Toulouse Veterinary School. Fifteen days pre- viously it had given birth to four puppies, which it suckled. That morning, about three o'clock, its owner was awoke by its plaintive cries and its restlessness. It was then anxious, its mouth was open, and it breathed as if it had been running fast on a hot day; it also appeared to be weak in its hind-parts. On its arrival at the school, it was lying on its side in a large hamper, with its four puppies, which were at the teat ; the respira- tion was very hurried, short, irregular, and noisy ; it was executed in a jerking, irregular manner ; the ribs appeared to be limited in their movements, as in a horse affected with tetanus. The mouth was half open, the tongue pendent, and the saliva flowing in a frothy, abundant stream. The animal convulsively closed its jaws, and withdrew its tongue from time to time, in order to swallow a portion of the saliva; the buccal and conjunctival mucous membrane was greatly injected ; the physiognomy expressed great anxiety rather than pain ; the eye was widely open, bright and animated, and the visual axis was not deviated. The limbs were kept extended and immovable, without tetanic rigidity. At intervals the animal attempted to get up, and managed to raise itself on its fore-limbs; but the hind-legs moved in different directions, and automatically, so that the Bitch could not co-ordinate them in a determinate manner. The joints could be easily flexed on each other, by seizing the bones like the branches of a pair of compasses, but when left to themselves they immediately became extended. The pulse was strong and quick. The senses were unimpaired, and when its name was called the animal directed its eyes towards its master, and attempted to move its tail. This did not always happen, however, for the creature generally appeared to be completely absorbed by its condition — a circumstance which might have led to the belief that its general sensibility was diminished. There was no appetite, and the excretion of faeces and urine was completely suppressed since the commencement of the disease. Mauri, never having had an opportunity of witnessing such a malady, was much troubled to give a name to the collection of symptoms. As, however, paraplegia ap- peared to be imminent, he ordered sinapisms to the limbs and the spine, and enemas of tepid water. In the evening the symptoms were ameliorated ; the animal, instead of lying extended on its side, was curled round as in health, and when excited it got up, staggered, and fell on the litter ; a deep coma had given place to the excitement observed in the morning, and on some bread and milk being offered, it slowly took a small quan- tity. Next day all the symptoms disappeared, and though the animal remained for five davs in the hospital kennels, no relapse occurred. S. Mauri, in another instance [Ibid.., p. 20) — that of a two-year-old Bitch, which had nursed two puppies for a month, and during that time seemed to be in perfect health, but which was suddenly seized with agitation and anxiety, appeared to be suffocated, could scarcely stand, and appeared to be paralyzed in its hind-limbs — noted the follow- ing symptoms : General agitation of all the muscles, anxious physiognomy, and all the characteristic features described in the preceding case. The respiration was very labori- ous, though the ribs were immovable. The gait was unsteady, and the hind quarters were feeble, as in confirmed rabies. The animal appeared to be impelled to move about incessantly, and if it stopped it fell ; then the limbs became rigidly extended. In the midst of its convulsions, it endeavored to rise, but could not co-ordinate its movements — it turned itself on its back, so as to lie alternately on the right or left side. After numerous attempts it sometimes succeeded in getting up, and commenced to walk, but only to fall again; it could only stand on its rigid paws by resting against a wall or tree. An hour after its arrival at the school, it could not rise unaided. Its senses did not ap- pear to be affected ; the appetite was lost, and there was neither defecation nor micturi- tion during the attack. The case in every respect appeared to be similar to the preced- ing. No treatment was adopted, and in the evening the Bitch had almost completely recovered, though it was rather sleepy and dull. Next day it was taken away cured. 9. The same authority [Ibid.., p. 22) records the case of a Bitch brought to the Toulouse' Veterinary School, and which caused anxiety about three hours previously by' its agitation, breathlessness, and anxious look. It had fallen, was seized with contrac tion of the limbs, got up, and staggered about in different directions, until at last it be- came so weak that it could not stand. When Mauri saw it, it was lying on its side, the limbs extended, and agitated from time to time with clonic convulsions. The animal EPILEPSIA UTERINA. • 687 could not be induced to get up, the head only being raised towards the shoulder. The symptoms were altogether similar to those observed in the two preceding cases. No treatment was adopted, and next morning all the symptoms had disappeared. 10. Lafitte {Ibid., p. 23) attended a Bitch which, two days previously, had brought forth two puppies which it suckled. It appeared to be very weak and staggered in walking. Soon after, the feebleness in the hind-quarters was extreme, and clonic con- vulsions affected all the muscles ; the eye-balls pirouetted in their socket, the jaws were incessantly moved, and saliva ran from the mouth continually ; hearing and seeing were unaffected. Two hours subsequently the animal could not rise. A belladonna draught was given, narcotic frictions were applied along the spine, and emetized enemata admin- istered. In the evening the Bitch was dull, weak, and stupid. In the morning every trace of the malady had disappeared. Next day there was another eclamptic attack of shorter duration, and on the fourth day another still briefer and weaker. The puppies were put to another Bitch, and in about eight days they had attacks similar to those of their parent, though shorter and less intense. One, a female, had three attacks on suc- cessive days, and then died — the other, a male, had only two attacks. 11. Laiitte [Ibid., p. 25) reports that a Bitch, four days after pupping, had clonic con- vulsions in all its muscles ; its jaws were agitated, it was much salivated, and respired with difficulty. Its expression was animated, but it could not stand, and was compelled to lie. During the night the convulsions ceased, and the animal, although, a little somnolescent, appeared quite recovered ; at ten o'clock next morning, however, it had another attack, and in the evening it died. 12. The same veterinarian {Ibid., p. 25) alludes to the case of a Bitch which, three days after pupping, had convulsions in the muscles of the trunk and limbs, and the hind-legs were so "feeble that it could not stand. Its gaze was unsteady, and at times the eyes rolled about in the orbits. The masseter muscles participated in the convul- sive movements of the other muscles, so that there was a continual champing of the jaws, and an abundant salivation. The senses were not impaired, however. An anti- spasmodic treatment was adopted. The attack lasted four hours, when recovery took place. 13. Mauri {Ibid., p. 201) reports another instance of this malady occurring in a Bitch, eight years old, and very fat. It had pupped twelve days before, and suckled four puppies. When brought to the Veterinary School it was lying on its side, though it could raise itself on its sternum — it panted much, its mouth was wide open and much saliva flowed therefrom — the tongue was pendent. The respiratory movements were much quickened, but very shallow. The eyes were wide open and slightly squinted to the left. Violent convulsions, as if produced by electric discharges, agitated the limbs, and threw them into a state of forced extension; if a group of extensor muscles — such as the patellar — were seized in the hand, the energetic contractions, rapidly repeated, could be easily felt. Nothing of the kind could be distinguished in the flexor muscles. The senses were not affected. The urine did not offer any trace of albumen. In the course of the day the symptoms disappeared, and the animal recovered. Mauri alludes to four additional cases of eclampsia — two in the Cow and two in the Bitch, all presenting similar symptoms to the foregoing CHAPTER VII Epilepsia Uterina. — Mania Puerperalis. A PECULIAR nervous affection, to which the designation of " Epilepsia Uterina " has been given by Storrar ( Veterinary journal. Vol. IV., p. 53), might be classed with the disease which, in the previous chapter, has been named " Eclampsia," did it not differ somewhat from it, and rather resemble epilepsy, or what Harms has called " Mania puerperalis." Until its exact pathology is better defined, we think it most convenient to retain Storrar's designation Symptoms, The disease appears to affect the Cow only, and is marked* by great agitation, sometimes fury. We cannot do better than give the symptoms in two cases, and then refer to Storrar's and Harms' evidence. 688 PA THOL OG Y OF PAR TURITION. 1. Rolls [Veterinary Journal, Vol. II., p. 17) was sent for in great haste to see a Cow, five years old, which had calved a fortnight previously, and had eaten the placenta. For two days before he was called in the animal had not been well, and its elf had been removed the previous night. It had a wild excited expression ; eyes staring ; ears warm ; pulse full ; rather strong and quick ; jaws continually moving, as if in the act of biting ; foaming at the mouth ; the under part of the tongue purple and livid-looking. The movement of the jaws could not be stopped by holding them together, and whem the animal was left to itself it was continually biting at its fore-legs, though without making a wound ; when interrupted it gnawed the manger, woodwork of the stall, or any thing presented to it. If hay was offered it would seize it, masticate it with the con- tinuous and violent movement referred to, and swallow it. It took some bran-mash and chilled water, and though it partook of nothing else, it looked full, and there was the peculiar sour odor often met with in cows suffering gastric derangement, and especially when it occurs soon after parturition. Blood was abstracted, and belladonna and linseed oil administered. In about three hours afterwards, the convulsive movements ceased and the Cow appeared to be much better. Next day the excited expression was still appar- ent. Under further treatment it recovered. Thirteen months afterwards it calved again, and when a fortnight old the calf was removed from it. Next morning it was found to be suffering from a similar attack : the jaws moving in the same convulsive manner, but not so violently. Rolls noted that the Cow looked wild and excited ; the pupils of the eyes were normal ; ears warm ; pulse eighty per minute, and full and strong; foaming at the mouth; under part of tongue livid ; grinding the teeth occasionally ; the fore-legs were wet and covered with saliva, from gnawing them. The animal was again bled and had opiates, and recovery soon took place. 2. Robellet [Rectieil de Med. Veierinaire, 1874) gives a similar instance, in which the symptoms closely resembled those of rabies. The Cow — four years old — calved four days previously, parturition being normal. On the day on which Robellet was sent for it had refused to eat at pasture, left its companions, and constantly licked its fore-legs. In the evening it was restless, and bit every thing about it. Robellet found that it had bitten the manger, rack, and food — allo'wing the latter to fall from its mouth without masticating it ; it also seized its breast and fore-legs, but without breaking the skin. The pulse was full and sixty per minute ; the eyes, unnaturally open, were red, fixed, and haggard, and the pupils dilated; the buccal mucous membrane was slightly inflamed, and a frothy saliva surrounded the borders of the lips ; the respiration was normal. At times the Cow stretched out its fore-limbs, bellowed, pawed the ground with the fore-feet, and seemed to defy an invisible enemy. The handle of a stable- fork being presented, the animal seized it in a frantic manner and bit it, shaking the head violently. The symptopis gave rise to the suspicion of rabies ; but no evidence as to inoculation could he obtained. The Cow was separated from the others, secured by a double chain, and an ounce and a half of chloral administered in two doses in tea — a quarter of an hour between each dose. Several minutes after the second dose, the Cow, which had continued to show the same symptoms, hung down its head, and without staggering, fell like an inert mass on the ground, then rose at once of its own accord. Ten minutes afterwards the same occurrence was again noted — the Cow once more falling and jump- ing up; it remained in the excited condition already described. Next day all the alarm- ing symptoms had subsided ; there was no fever or excitement — nothing except slight weakness and prostration. It had fallen a third time on the previous day, then became drowsy, and remained Iving for about three hours ; after which it arose, apparently quite well. Robellet's father had seen two similar cases. Storrar relates that, in one of his cases, so savagely did the Cow bite the timber fornjing the front of its stall, that with one desperate effort it broke all the incisor teeth, except one, entirely out of its jaw, and fractured the alveolar processes. Another Cow, some years before, so severely injured the lower jaw, that the incisors could not be employed for some time ; though the molars could be used when the food was placed in the mouth. Gunther {Geburtshulfe, p. 145) and Landel {^Repertorium^ vol. viii.) have observed similar cases. They describe the animals as extremely excited and violent, biting every thing around them — even people, climlDing into the manger, running against the wall, roused to fits of fury at the slight- PARTURIENT LA MINI T IS. 689 est noise, foaming at the mouth, and sometimes tossing the head and bellowing. The pulse is hard and quick, but the heart's action is weak. Cause. Rolls thought that in the case he describes, depriving the animal of its calf was the cause of the attack; Harms ascribes the symptoms to chills, which cause brain congestion ; while Storrar looks upon the malady as epileptic, dyspeptic, and uterine. " The animal affected has calved some few days previously — say from four to fourteen, or even more days ; she has been heartily eating her food ; giving milk very largely, or, more correctly, her milk has been remarkably rich, and throwing up, when left for a time, a very heavy layer of cream ; and the usual uterine lochial discharge has been suppressed. Or the case might be thus stated : An excessive drain upon the system by the mammary glands, causing, perhaps, the suppression of the uterine cleansing, with the pecu- liar smell about the animal, and more marked in her milk, which is referred to by Mr. Rolls, followed by a more or less severely developed attack of indigestion. These causes act upon the nervous centres, so as to produce the extraordinary excitement which has been described. The dyspeptic signs are the more prominently shown — such as a desire to eat any .thing unclean in preference to good food, or coarse straw in prefer- ence to roots or hay. The bowels becoftie torpid, and the supply of milk nearly ceases." We can scarcely bring ourselves to believe that this condition is due to psychical influences, and are rather inclined to attribute it to cerebral ir- ritation from some physical cause — either indigestion, constipation, or deranged circulation in the brain, and connected with the parturient state. Treatment. If indigestion or constipation are present, purgatives should be admin- istered, with stimulant or tonic medicines, according to the indications. When there is much fury or excitement, narcotics in large doses may be given — the best, perhaps, being choral hydrate. Great attention must be paid to the diet. Giinther abstracted blood in large quantity, and gave extract of stramonium. He, also, on the supposition that the brain was congested, applied strong stimulants to the back of the head and to the spine. CHAPTER VHI. Parturient Laminitis. With the Mare,* a few days after foaling or abortion, tnere has been sometimes observed an attack of congestion or inflammation of the feet, * It would appear that bovine animals are liable to a foot inflammation after parturition, as well as Mares. Roloff {Mlttheilungen aus der thierarztlichen Praxis in preuszischen Staate, 1865, 1866, p. 154) observed a jjeculiar inflammation of the feet of Cows, supervening on parturition. Some days after that event, the skin between the claws was observed to be reddened, swollen, and moist, and gradually the inflammation extended to the coronet and heels (Ballen) ; the skin became more tumefied and dense, and immediately above the claws was uniformly thick and red. In some cases abscesses formed at the coronet, the horn became separated, and finally the whole claw was shed. The mflammation extended to above and behind the fetlock, and the pain was so great that the animals ate but little, and, consequently, they soon lost condition. Tiie hind limbs were most frequently affected : first one, then the other, one being always more affected than the other. The Cows had only calved a short time previously. Roloff supposed that the disease was due to contact of the skin, towards the hind feet, with some substance which had escaped from the vulva after calving. He, therefore, insisted on the utmost cleanliness being observed ; had the stalls cleaned out, and sprinkled with chloride of lime every day, and the hind feet damped with chlorine water, particularly between the claws, and afterwards smeared with oil. By these measures, the extension of the disease was at once checked. 44 690 PA THOL OG Y OF PA R TURITION. which closely simulated the painful and serious malady known as *' Lam- initis," and appeared to be related to the parturient state. The disease does not seem to be very common ; though Obich ( Wochenschrift fiir Thierhei/kufide, 1869, p. 105) asserts that it and metritis are the most frequent sequelae of parturition in the Mare. It appears to have been first described by Tisserant in 1846 {J^ournai des Veterinaires du Midi, vol. ix., p. 347) ; since then it has been alluded to by Gloag and Smith in England {Veterifiarian, 185 1, pp. 14, 258), Fabry, Guilmot, Lecouturier, Windelinck, and Deneubourg in Belgium (Atmales de Med. Veteniaire de Bruxelks, i860, 1861, 18C8), Obich in Germany {Op. df.), and Ayrault in France {Recueil de Med. Veierinaire, 1866). At page 632 of this work, it will be found that Hudson alludes to this parturient laminitis as a com- plication of ruptured vagina. Symptoms. The symptoms of the disease are those of laminitis occurring under ordinary conditions. They are suddenly developed on the second or third day after foaling, or abortion, more rarely on the fourth day, and very seldom later. In a small number of cases, inflammation of the feet has been noticed either during or immediately after parturition. Excep- tionally, it has taken place within twenty-four hours after the contents of the uterus have been expelled. As a rule, there has been nothing re- markable in the case — birth having taken place naturally ; sometimes, however, parturition may have been difficult. The attack is either sudden, or only very indefinite premonitory indi- cations are present. The animal becomes unusually restless, and moves its limbs — the fore one especially — continually, while it exhibits signs of great suffering. There is fever, quick and hard pulse, hurried respiration, and all the other signs of this most distressing foot-inflammation, the most marked of which at this time is the disregard of the progeny. In other cases, the attack is more gradual ; there is loss of appetite, great thirst, depression, hurried respi^'ation, full, hard, and quick pulse, consti- pation, etc. — premonitory symptoms which may continue for two, three, or four days. The fore or hind feet may be affected. Tisserant and Guilmot say the former, Deneubourg the latter ; though in some in- stances all the feet may be involved. The position of the animal, if standing, indicates the feet affected, and they are found to be extremely hot, the plantar arteries throbbing, and percussion of the hoof causes intense pain. During the inflammation, the Mare evinces the greatest agony. If all the feet are implicated, standing may be impossible ; the expression is anxious and pinched ; the respiration is hurried, jerking and plaintive, and the nostrils widely dilated ; the skin is usually cov- ered with perspiration, and the production of milk is completely checked. Indeed, the rapid disappearance of this secretion has attracted the atten- tion of nearly every observer. In the evening, perhaps, there will be an abundant supply of milk, and in the morning mulsion or suction will only obtain a few drops of a transparent or reddish fluid, though the mammae may look as full and as well-developed as usual. This suppres- sion of its supply of food is soon testified to by the foal, which betrays its sensations of hunger by becoming less timid, and making itself familiar with those around it. The duration of the disease is from four to eight days ; Franck says from eight to fourteen days. The symptoms are certainly most intense PARTURIENT LAMINITIS. 691 between the fourth and eighth day. The termination is generally recov ery, if proper treatment has been adopted ; though in some cases the malady assumes a chronic form, with the accompanying deformity and disorganization of the feet. In rare instances, death may ensue from nervous exhaustion caused by the excessive pain ; or the inflammation may run on to suppuration, and a fatal result arise from pyaemia, with purulent deposits in the lungs, brain, or other organs. A favorable or unfavorable prognosis may, according to Guilmot, be drawn from the lacteal secretion. If this returns in the course of a few days, it is a good sign. Causes. The cause or causes of parturient laminitis are not well known. The predisposing C2L\1SQ is generally recognized to be the parturient state, though there is a wide divergence of opinion as to the way in which the disease originates. Tisserant believes that it is due to a disturbance in the func- tional equilibrium existing between the various organs. After parturition, and particularly after abortion, there is manifestly a disturbance of this kind ; there is, as Rainard correctly states, a general superabundance of blood, and consequently atende^ncy to disease until the equilibrium between production and consumption is restored. Guilmot thinks that the" space left by the foetus must necessarily bring about a series of exceptional phenomena, whose point of departure is perhaps the superfluous supply of blood thrown into the circulation after parturition. Deneubourg sees in this disease and the so-called vitulary fever of the Cow, two different " modes of expression " of the same disease ; and while recognizing the justness of the expression employed by the old hippiatrists that " the fever has fallen into the feet," he is inclined to think that the morbid localiza- tion is due to sudden suppression of the lochia. " The larger animals," he writes, " are not exempt after parturition from the depuratory process which takes place on the internal surface of the woman's uterus after delivery, and known as the lochia ; and its abrupt suppression gives rise to a disturbance — a fever^ which physicians designate * puerperal fever,' and veterinary surgeons ' vitulary fever.' The disease proper to the Cow is, in our opinion, sirnple vitulary fever ^ which, in concentrating itself on the tendinous, articular, and perhaps muscular tissues, may become a rhcuniatismal vitulary fever. That of the Mare, until now unrecognized, is evidently due to the same cause ; we cannot deny it the parent traits with the vitulary fevers which are witnessed in the Cow, and we propose to designate it by the name of vitulary laminitis, to distinguish it from essential laminitis.''^ Bouley, quoted by Saint-Cyr, is of opinion that parturient laminitis may be allied to that other form of laminitis which so commonly succeeds intestinal congestions from accidental causes, or from drastic purgatives ; and that both varieties may well be the result of a momentary paralysis of the vaso-motbr nerves of the keratogenous apparatus of the foot, under the influence of a profoundly depressing action. The occasional C2insts are quite as obscure. Tisserant asserts that none of the ordinary causes of laminitis are special in their operation here ; while Deneubourg adds that it equally attacks Mares without distinction as to age, constitution, condition, or hygienic circumstances. Guilmot, however, remarks that Mares which are submitted to moderate work, and which receive an allowance of food in proportion thereto, are not attacked 692 PA THOLOG Y OF PARTURITION. by this disease ; while those which are fed on oats have always been the subjects affected, so far as he has been able to observe. There is the same diversity of opinion with regard to the influence of parturition in the production of parturient laminitis. Tisserant has noticed it occurring, in the great majority or cases, in Mares which had aborted at a somewhat advanced period of gestation, or whose delivery had been laborious or very difficult, from the wrong position of the foetus, or from some maternal obstacle, Deneubourg, on the contrar}^, has observed it following parturition effected in the most favorable conditions, as well as after abortion or difficult labor ; with Mares which had expelled the foetal membranes, as well as those which retained them ; but never after a laborious parturition which required manoeuvres more or less pro- tracted and cruel ; though he adds that his brother had witnessed a case following laborious and artificial delivery. It may be noted that Gloag gives an instance (^Veterinarian^ 185 1, p. 14) in which it followed an abor- tion at three months. Obich attributes the disease to the action of cold upon the skin. Treatment, In the treatment of this disease, the rules observed in the ordinary attacks of laminitis are usually applicable. In the majority of cases the treatment need not, and should not, be heroic. If the fever runs high, sedatives — as the tincture of aconite — should be given ; and it may even be necessary to administer narcotics — as chloral or opium — if the pain is very great. Some authorities recommend the abstraction of blood, either generally or locally ; but we are decidedly averse to this treatment. The inflamed feet should be treated with the greatest care, and for sub- duing the inflammation nothing can equal cold applications — either cold water, cold poultices, or even ice. We prefer the continuous irrigation system ; the water being applied to the feet by means of india-rubber tubing, which carries the fluid direct from the water-tap to the foot. The latter is thickly covered with pieces of thick flannel or tow, so as to diffuse the water around it. The shoes should be previously removed, and the wall of the hoof lowered, so as to allow the sole and frog to sustain as much of the weight as possible. It is a good plan to litter the animal on saw-dust. Warm applications should never, on any account, be employed for the feet. When suppuration is apprehended or has set in, or even when the effusion or exudation are serious, an outlet may be made between the sole and wall, towards the toe of the hoof, for their escape. -Astringent and antiseptic lotions or foot-baths may then be useful. At the commence- ment of the disease, and sometimes at a later period, when it threatens to become chronic, stimulating applications — even blisters — may be applied with advantage to the limbs above the fetlocks. The diet should be light, and limited to mashes, grass, a small quantity of good hay, and nitrated water or gruel as drink. The body should be comfortably, if not warmly, clothed, and friction to^ the skin is often beneficial. The foal should be allowed to remarin with the Mare, as its frequent sucking is likely to hasten the return of the milk, which is, as has been already remarked, a most favorable sign. If constipation is present, laxatives should be administered, and emol- lient enemas are then, as well as at other times, most useful. MAMMITIS OR MASTITIS. 693 CHAPTER IX Mammitis or Mastitis. In treating of pregnancy, we alluded to the function of the mammae, and pointed out that this function — except in rare cases, when it may be in operation independent of pregnancy or the parturient period, and even manifest itself in the male sex — is in mammals peculiar to the period of parturition and rearing of the young. Some time before the progeny are born, the mammae begin to enlarge, to become pendulous, and their density increases ; they are more often vascular ; if not marked by dark pigment, their color is observed to have changed, and the teats are considerably developed. So that, at parturition, the glands have attained dimensions and offer appearances very different to those they exhibited a short time previously ; while the fluid — the milk — provided by Nature for the suste- nance of the young creature after birth, is secreted in more or less con- siderable quantity — generally in proportion to the development of the mammag. With the exception of some species — such as the Cow and Goat, some- times the Ewe and Ass (and also the Mare among the Khirgiz), in which the secretion is maintained artificially for some time beyond its natural duration, and, with the former animal especially, almost permanently — the function is essentially intermittent: being most active during the parturient or, if we may use the term, " puerperal " period, and ceasing ^when the progeny no longer require milk. It is during this period that the activity of the mammae exercise so much influence on the health of parent and offspring, and it is also at this time that these glands are most liable to derangements, which are more or less serious. Even their normal physiological development, when it occurs rapidly and considera- bly, under certain conditions, often occasions uneasiness and pain. The temperature of the glands is increased, and they are much more sensitive than usual. But this disturbance is usually ephemeral, and rarely con- tinues for more than a day or two. It may be relieved by " stripping " the teats — the importance of which, as a preventive of parturient apo- plexy in deep-milkers and plethoric Cows, we have already pointed out — rubbing the udder with olive-oil, or fomenting it with decoction of marsh- mallows. This might be termed the nor?na I ov physiological ewgoxgQVi\Q.nt of the mammae ; but there is also a pathological engorgement, to which attention has been drawn by various writers, and particularly by Ztindel, and to this we will now refer, as it is often the commencement of inflam- mation of these glands. Pathological Congestion of the Mamm^. Hyperaemia or congestion of the mammae is not very uncommon, and all female animals are liable to it ; though it is most frequently observed in the Cow, Mare, Ewe, and Bitch, in degrees varying rather with the causes which determine, than the phenomena that accompany it. Causes. Congestion of the mammae is due to various causes : among which may be cited injuries, exposure to cold air or water, or over-repletion — the stings of insects have also been blamed. There is generally a sympa- thetic excitement existing at this time, either from the animal having 694 ^^ THOL OG Y OF PAR TURITION. been immediately or recently delivered, or even when it is in oestrum. Most frequently, however, it occurs either when the progeny cannot empty the glands, when it has been removed from the parent, or when the latter has not been milked at the proper time. The tendency of the mammas to become engorged when the lacteal secretion is not removed, is often made available with a fraudulent motive, when disposing of Cows for milking purposes. The milk is not withdrawn for some time, the glands become greatly distended, and assume an excessive development ("over-stocking"), which may impose upon the unwary, and give rise to the belief that the animal possesses extraordinary lactiferous proper- ties. Franck is of opinion that this congestion may be due to obstruction of the circulation in the posterior vena cava, towards the end of pregnancy. It may also arise from obstruction in the milk ducts. Symptoms. When the congestion is due to accumulation of milk, the symptoms are, of course, only gradually developed ; but if arising from injury, then they may appear suddenly, a certain part becoming all at once swollen, hard, and tense, but without altogether losing its softness and elasticity. There is neither redness nor great sensibility j the swelling is not oedem- atous, and does not *' pit ; " there is but little fever, and the appetite is not much affected. An important consideration in these affections of the mammae, is that relating to their anatomy. As we have shown at pages 31-34, in the Mare, Ewe, and Goat, they are formed of two perfectly distinct glands placed together in the inguinal region ; while in the Cow they are com- . posed of at least four glands or "quarters " in close contact, and appar- ently forming one mass in the prepubic region ; and in the Sow, Bitch, and Cat, they are numerous and distinct from each other, and extend from the inguinal to the thoracic region. When we know that all the glands may become congested or inflamed, or only one — or even only a certain number of acini in each gland — we see at once that morbid con- ditions may give rise to very diverse symptoms, due to these anatomical peculiarities. With the Cow, congestion may, therefore, be limited to one gland or " quarter ; " though at the commencement the whole udder may be swollen, and localization only occur at a later period. The same is Observed with the Bitch and all the other animals with numerous mam- mae : there is always at first general engorgement, before it is finally localized. The tumefaction partakes somewhat of oedema, from its read- iness to pit on pressure, and there is often a doughy swelling around the udder, which, in some instances, extends to the other parts of the abdo- men. The latter symptom is most noticeable in Mares, in which, in the course of a few days, the mammary swelling altogether disappears, leav- ing only an oedematous tumor towards the umbilicus. The secretion of milk is diminished ; at first it may be normal in con- sistence, and exceptionally it may offer streaks of blood, which give it more or less of a rose tint. When this condition continues, however, its degree of fluidity is changed, and it becomes lumpy and clotted, being partially coagulated in the lactiferous sinuses and canals, and the coag- ula of casein are evacuated at the same time as the other portions of the milk, which is sometimes nothing but pure viscid, yellowish serum, hav- ing a sweet taste j sometimes these coagula — round or cylindrical masses MAMMITIS OR MASTITIS. 695 — obstruct the canals, and prevent the escape of the milk. Ftirstenberg states that he has sometimes found casts of epithelial cells in them, and that about the third or fourth day there are globules of colostrum. This alteration in the milk may be limited to that from the affected gland or quarter ; in the others the secretion may be healthy, though less abun- dant. This condition most frequently terminates by resolution, and very often without treatment — the tumefaction disappearing in a very brief time, or in the course of four to eight days ; though the milk may remain less plentiful for some time, and up to the eighth or twelfth day may still contain colostrum corpuscles. In other cases, the quantity of milk remains less than usual ; and when relief is not afforded, we may have inflammation supervening, and the formation of one or more abscesses. In the great majority of cases, it is probable that this condition com- mences in, or is limited to, the parenchyma of the gland, which receives an inordinate supply of food. This leads to a congested condition, and consequent diminished lacteal secretion, with serous infiltration into the interlobular connective tissue. According to Ftirstenberg {Milchdrusen der Kuhe\ the milk contains more particularly the solid elements of this fluid, and also the epithelium yet undergoing that change which should be completed in the acini. This condition has often been confounded with inflammation of the udder, though it must be admitted that it sometimes constitutes the in- itial stage of mammitis. It may be distinguished from the latter by the non-existence of general symptoms, and also locally by the absence of the peculiar density or hardness, and the extreme painfulness and sen- sibility, which mark the presence of the latter. According to Franck, this mammary oedema (or Floss) is peculiar to many parts of the Bavarian Alps, and he appears to consider it as in- flammation of the skin and connective tissue of the gland {E?itzundung der Ueberzuge des Enters und des Zellgewebes). It always appears some days, on occasions some weeks, before parturition, and the whole udder is involved ; though one side may be more affected than the other. The swelling sometimes extends as high as the vulva, and even beyond it. Sometimes the skin is reddened, tense, and shining {Eryt/iema mammil- arutn) ; in other instances it is normal The health is seldom unaf- fected, and this is a characteristic feature of the disease ; there is also rarely any pain, or alteration in the secretion — colostrum or ordinary milk flowing from the teat. When, however, the connective tissue is in- volved, there is swelling and " pitting " on pressure, the skin is red- dened, and the finger indentations last for some time ; there is also more pain. This latter condition has sometimes been designated the " ery- sipelatous " form of mastitis ; though it must be observed that the secre- tion of milk is unaltered to any extent. It continues for about eight days. When the skin is much inflamed, as in the erysipelatous form, Franck thinks it probable that a special cause — a kind of infection of the skin — is in operation. Treatment. This malady, in the greater number of cases, does not require any special treatment. If the animal eats well and is not much inconven- ienced, the mammae should be relieved of their contents either by al- 696 PATHOLOGY OF PARTURITION. lowing the offspring to suck, milking by hand every two hours, or drain- ing of the fluid by the teat-syphon. When the swelling is great and the skin tense, smearing with lard, butter, or olive-oil will often give relief, and aid in dispersing the tumefaction. When mammitis is apprehended, Ziindel highly recommends inunction with camphorated pomade, which, he asserts, is almost specific in its de- obstruent action. At the same time salines, and particularly the bicar- bonate of soda, are to be administered internally ; while a moderate quantity of easily-digested food is to be given. When the redness or inflammation of the skin has a tendency to be- come erysipelatous, Franck prescribes an ointment composed of sulphate of iron (one part) and lard (eight parts) ; or, a liniment of carbolic acid (one part) and olive-oil (thirty to forty parts). Inflammation of the Mamm^. All the domestic animals are liable to inflammation of the mammae ; and it is somewhat frequent after parturition, though it also appears after abortion. The Cow is oftenest attacked, and from the importance of the lacteal secretion in this animal, it is always more or less serious, especially as it may continue during the whole period of lactation, and generally affects the best milk-producers. It is not so common in the Goat and Sheep, and is still more rare in the Mare. It is seldom wit- nessed in the Bitch, Sow, or Cat ; though when it does occur in the former, it is liable to lead to the formation of neoplasms of different characters in the glands. Various kinds of inflammation of the mammary glands have been de- scribed — such as superficial or subcutaneous^ and deep ; acute and c/iro?tic, active and passive or latent, and a rheumatismal form j while Saint-Cyr gives a catarrhal. 7i phlegmonous, and 2i parenchymatous. The catarrhaliorm is — so far as its symptoms are concerned — allied to that which we have described as due to congestion, and consists in an inflammation of the mucous membrane lining the teats and lactiferous sinuses. This inflammation is generally caused by the retention of the milk in the gland ; this fluid becomes altered and coagulated, and the clots irritate the membrane and inflame it, the inflammation extending to the acini after a time. In the Cow the inflammation usually com- mences in one quarter or gland, and may remain limited to it ; or it may extend to the other quarter of the same side, and even to one or both of the opposite side — though this is rare — by an extension of the morbid process from the acini to the interstitial and interglandular connective tissue. When more than one-quarter is involved, then the disease in each varies in intensity. When limited to the mucous membrane, the inflammation induces a kind of catarrh or special galactorrhoea which, according to Gerlach, is not at all uncommon, and accounts for the serous or watery milk some- times given by Cows ; and the same agency may lead to the spontaneous coagulation of the milk, without any acidity being present. Symptoms. The animal does not at first appear to be much affected, and the swollen gland or glands are evidently not very painful, the pain being probably of a dull character. The skin is tense and shining, though perhaps not reddened ; the teat is greatly enlarged, hard, and somewhat MAMMITIS OR MASTITIS. 697 sensitive to manipulation. The swelling is rather ceclematous super- ficially, but deeper the tissue of the gland is found to be somewhat harder, and towards the teat rather lumpy, from the presence of coagula of casein. By mulsion, a rose or red-tinted fluid is obtained, which looks like decomposed clotted milk. With careful and frequent milking, and attention to diet and hygiene, complete resolution may take place within three or four days ; the secre- tion gradually becomes normal in quantity and quality, though for more days it may contain numerous colostrum and pus globules. If neglected, however, or mismanaged in treatment, the inflammation may become more serious, and attack the milk vesicles and their parenchyma — the real glandular tissues — giving rise to parenchymatous mammitis ; or it may remain localized, though increasing in intensity. Then the secre- tion of milk is greatly diminished in the gland, and what is withdrawn by mulsion is altered — containing, as it does, mucus, pus, and clots, all emitting a highly ammoniacal odor. This catarrhal condition may continue for a considerable time, and it may happen that the matter contained in the sinuses and ducts, becom- ing inspissated, escapes from the teat with difficulty, or not at all ; so that, in accumulating in these cavities, it forms deposits — half milk, half pus — which are oftentimes considerable. When they have acquired a certain volume, these deposits break up and escape, either through the teats, or by ulceration of the walls of the duct. When opened by means of the lancet, these "lacteal abscesses " discharge a large quantity of foetid matter. Then the general phenomena disappear, the tumefaction and sensibility diminish, the suppuration — though it may persist for some time — gradually decreases, and the normal secretion of milk is finally established. In other instances, all the symptoms disappear except the clotted character of the milk, and the tendency of this fluid to coagulate in the ducts and sinuses. There it may form solid masses or concre- tions of variable size — from a pea to that of a nut — which become dense as dried cheese, or hard almost as a stone. They are sometimes cylin- drical in shape, at other times elongated, being moulded by the part in which they are formed ; they are usually movable, and may be displaced in the operation of milking ; but they always constitute a more or less serious obstacle to the flow of milk. When situated at the lower end of the teat, they almost entirely obstruct the canal ; higher, they render the flow of milk more or less difficult, and in all cases they may give rise to extreme distention of the gland, and lead to the formation of abscesses or parenchymatous inflammation. The. phlegmonous mammitis described by Saint-Cyr, is always more seri- ous than the catarrhal form. It commences with several generally very well-marked febrile symptoms : the animal is dull, loses its appetite, and ceases to ruminate ; the temperature is elevated, the pulse becomes fre- quent and quick, etc. These symptoms of general disturbance, accord- ing to some authorities, may manifest themselves three or four days before the local disorder, and occasionally diminish considerably when the latter appears ; though Saint-Cyr correctly states that this rule has numerous exceptions. What is certain, is that there are rigors and un- mistakable indications of general febrile reaction at the very commence- ment of phlegmonous mammitis. In a very brief period the udder acquires a considerable, sometimes a 698 J'A THOL OGY OF PAR TURITION. great volume — in the Cow often reaching as low as the hocks, or even lower; the swelling is (Edematous, "pitting" deeply on pressure, but it is hot, inflammatory, and very painful, and extends beyond the gland — at times towards the vulva and umbilicus or sternum with the Mare and Ewe. Beneath the cedematory tumefaction, the gland texture can be felt hard, tense, and nodulated in places ; while the skin is red, stretched, and shining, and extremely painful to the touch. This painfulness causes an animal, at other times quiet and docile, to be irritable and fidgety, and averse to have the part touched, either for examination or milking. Progression, or even standing, is painful, the animal being evidently afraid of the hind-limbs coming in contact with the gland ; so that it either stands or walks with them wide apart, especially on the affected side of the gland. The creature, for the same reason, seldom, if ever, lies down ; when it does so, it is on the side on which the gland is least affected. There is often much restlessness and anxiety, and the Mare may show symptoms of colic. The secretion of milk suddenly ceases, and pressure on the teat only causes a small quantity of reddish-colored grumous fluid to flov/. All these symptoms may become aggravated in four, six, or eight days, when the malady may terminate by resolution, suppuration, gangrene, or induration, according to circumstances. Parenchymatous mammitis, or inflammation of the proper glandular and connective-tissue structures of the udder, is not, as a rule, so acute in its manifestations as the preceding, nor yet does it differ materially, so far as the general symptoms are concerned. The appetite is diminished, but not altogether suspended ; there is much thirst, and rumination is irregu- lar ; the physiognomy betrays suffering, though not of a very acute kind ; the pulse is full and quick, respiration short and hurried, and constipa- tion is frequently present, while the urine is less abundant and dark ; the temperature of the surface of the body is variable, and the muffle hot and dry; there are rigors, and muscular twitchings or tremblings, particularly towards the shoulders and flanks. The conjunctivae are in- jected, the skin more sensitive than usual, and the Cow manifests pain when the loins are pressed upon ; with the Mare the loins appear to be stiff and sore. There also appears to be lameness of the hind-limb of the affected side, due to the cause before-mentioned ; and when more than one quarter is attacked, the Cow seldom lies down. The swelling of the gland is very hard and hot, but not oedematous, as in the other forms, and the skin preserves somewhat of its natural hue, and is not thickened ^ the subcutaneous veins are much distended over the whole surface of the gland. The intense hardness of the inflamed mass is very characteristic, and is noted throughout the whole mammas ; though it is always greater on one side than another, and sometimes only in one quarter — most frequently a posterior one in the Cow, both mammaa in the Mare. When the inflammation is intense, and it has commenced in a particular part of the gland, it generally spreads rapidly until the whole quarter, frequently the entire mass of glands, is involved. From the commencement the secretion of milk is almost, if not quite suspended in the diseased gland, and much diminished in the others : mulsion only yielding a very small quantity of a red clotty fluid, mixed with blood ; in very acute cases almost blood alone may escape. In other cases the fluid is composed of transuded serum, and small pieces of coagulated casein. In a short time this fluid becomes of a purulent MAMMITIS OR MASTITIS. 699 character, at other times it is putrescent and foetid. Microscopically, it is found to be composed of particles of solidified casein, a few fat globules, epithelium from the milk-vesicles and ducts, but especially pus and red blood-corpuscles ; sometimes bacteria and micrococci are noticed to be in considerable numbers. When abscess forms and ulceration takes place, bundles of fibres of elastic tissue are often discovered in this fluid. Chemically, it contains but little casein, milk, sugai^ or fat, but much water and albumen. The progress of the disease is very rapid — more so than in either of the other forms ; in twenty-four, thirty-six, or forty-eight hours — some- times even in less than the first-named period — the disease has reached its greatest intensity. The attack is generally very sudden — the animal being apparently quite well when left for the night, and perhaps present- ing all the symptoms described when seen again next morning. When it has reached its culminating point, it may remain stationary for two, three, or four days before passing to one of its ordinary terminations. Towards the third or fourth day the vicinity of the gland becomes oedematous, and this oedema may extend to beneath the chest and as high as the vulva : in the Mare to the inside of the thighs, and down the hind-legs. Course and Terminations. The course and terminations of mammitis is a matter of much impor- tance. It, as we have seen, rapidly passes through its different phases until the fourth, rarely until the sixth day, when it terminates either by resolution — which seldom indeed occurs without prompt treatment; atrophy; induration; suppuration ; gangrene ; or even the death of the animal. Resolution is, of course, by far the most favorable termination. In the parenchymatous form it can rarely be rendered complete, even by the most rational and vigorous treatment, after the second or third day ; in the phlegmonous form it may occur so late as the fourth to the sixth day, but seldom after the eighth. It is marked by a gradual diminution in the intensity of the symptoms — general and local, and particularly in the pain, which first disappears, then the tumefaction and solidity. Saint-Cyr lays much stress on the decrease in density with regard to prognosis. If it persists beyond the time stated above : if after forty-eight hours in parenchymatous mammitis, or six days in the phlegmonous form, the gland has not, to any marked extent, lost something of its woody hardness, there is great reason to fear that resolution will not be complete, and that some portions will remain indurated, or that the mass will become either partially or totally atrophied. Though the subsidence of the fever and diminution of the swelling are in themselves favorable signs, yet they may be deceptive with regard to thorough resolution ; and it must be recognized as more favorable when the tissue of the gland resumes its softness and suppleness, rather than when the swelling subsides rapidly and the hardness remains but little altered. It is scarcely necessary to mention that the return of the normal secre- tion to the affected gland is a most favorable sign, though this does not occur very rapidly. For several days — from ten to twenty, or even more — the fluid obtained from the teat of the affected quarter remains watery, or rather serous, curdled, contains numerous colostrum cells, and is more albuminous than caseous — coagulating readily by heat ; it contains but 700 PA THOLOG Y OF PARTURITION, little cream or sugar. But it gradually recovers its usual composition and increases in quantity, until, at last, in amount and quality, it does not differ from that furnished by the other quarters of the mammae. It sometimes happens, however, that with regard to the lacteal secretion, though the gland regains its normal size and softness, it does not acquire its full functional activity until the next pregnancy and the next period of lactation. Complete recovery appears to take place during the period when the Cow is "dry." With the Cow, it generally requires four to five weeks before resolution is complete ; with the Goat the period is less, and it is still less with the Mare. Atrophy of the gland occurs generally when resolution is not complete. All the indications of that change are present, though they occur more slowly ; but the lacteal secretion does not return — recovery is not perfect. The glandular acini, obliterated by the proliferation of the interstitial connective tissue or the inflammatory exudate which took place in their interior, are no longer capable of performing their function ; and in proportion as these products of inflammation are absorbed after its subsidence, so does the diseased gland diminish in volume, the mammae become deformed and asymmetrical, the teat retracts and assumes an abnormal direction, and but little, if any, milk can be obtained from it. On manipulation, instead of the gland structure, nothing can be felt save a very firm, dense mass, which feels like indurated connective tissue, with, in its texture, some isolated nodules which appear to be, and really are, lobules of the gland which have remained intact and yet secrete the little milk that is yielded. The loss of a quarter of the mammas in Milch Cows is, of course, a somewhat serious termination, so far as the supply of milk is concerned, as this is materially diminished. Nevertheless, the other quarters sometimes partially compensate, by their increased activity, for the injury, and the animal is otherwise in good health. Induration is not at all an uncommon teimination of mammitis, especially in the Cow and Bitch, and is often the point of departure, in the latter animal, of various and serious degenerations of the glandular tissue. This termination is to be apprehended, in the Cow, when the inflam- mation persists in a somewhat acute manner beyond the sixth or eighth day. Then the general symptoms diminish, the animal suffers less pain, the appetite returns, as well as rumination, if any oedema was present it has disappeared, but yet the gland does not regain its healthy character. The inflammation has gone, the morbid products are partly absorbed, but in different parts of the substance of the gland there are more or less voluminous, well-defined, and rounded masses which have an almost stony hardness, and are apparently adherent to the surrounding tissues. These are evidently indurated lobules which have not undergone resolu- tion, and their secretory power is therefore lost. In other instances in which the inflammation has been very intense, recovery does not even proceed so far. The febrile symptoms disappear, and the pain in the udder to some extent diminishes, as well as the swel- ling ; though for a long time the local temperature is higher than usual, and the animal evinces uneasiness when it lies down. The induration of the swollen gland, often visible externally, instead of diminishing, appears to increase, owing to the progressive organization of the inflammatory products, and from the teat there can only be obtained a small quantity MAMMITJS OR MASTITIS. 701 of yellowish turbid serum, with perhaps a few coagula of casein, epithe- lium casts, and sometimes even veritable diphtheritic false membranes. In such a case, all the parts of the gland so altered are irrevocably destroyed, so far as the lacteal secretion is concerned. It is from this indurated condition that those degenerations and neo- plasms arise, which are met with in the mammae of animals, but especially the Bitch. These are the adenomatous, sarcomatous, carcinomatous, en- chondromatous. and fibromatous growths which have been described so often as found in the mammas of this animal ; but a consideration of which we cannot enter upon here. Suppuration — by which we mean the formation of abscess — is a rather frequent termination of mammitis, and particularly of the phlegmonous form. The abscess may be single or multiple, and vary in size as well as situation. Sometimes they appear immediately beneath the skin, and between it and the tunic of yellow fibrous tissue covering the gland ; in other cases they are formed in the interstitial connective tissue separating the glands, or even in the interlobular tissue ; while, though rarely, they may be found in the connective tissue between the mammae and the abdominal wall. Suppuration generally sets in from the eighth to the twelfth day, and is marked by an increase, instead of a diminution, in the symptoms — augmentation of the fever, swelling, and pain. If the abscess in process of formation is superficial, the pain and redness appear to be greatest at a certain point ; there the skin is at first of a bright red, but changes to a violet hue, and at the same time this part becomes more prominent and circumscribed. Soon there is fluctuation, and the other indication of abscess, and if not artificially opened this takes place spontaneously, and the contained pus escapes. Then the febrile symptoms diminish, and the general condition improves ; the swelling in the gland subsides, along with the pain ; pus escapes from the opening for two or three weeks, and finally ceases, the wound becoming cicatrized. Recovery has now been accomplished, and nothing remains, save perhaps a small mass of indu- rated gland where the abscess has been. This subcutaneous or superfi- cial abscess is not generally very injurious or serious. It is not so, however, when the abscess is developed in the intergland- ular connective tissue, or in that between the mammae and the abdomen. Here the pus is deep-seated, and burrows or spreads wherever the resist- ance is least ; in this way it leads to the formation of sinuses, sloughing of the skin over a wide surface, isolates masses of the glands — thus destroying their relations with neighboring parts, and causing their mor- tification and total destruction. This mammary suppuration is always serious, as, under the most favorable circumstances, it generally ends in the animal losing more or less of the gland ; while in some cases it may cause death from the violence of the inflammation and intensity of the pain, or through exhaustion from the long-continued and profuse sup- puration. When the abscess is situated in the interstitial or lobular connective tissue, the case is no better, but perhaps worse, Ow-ing to the nature and disposition of the tissues, which resist distention, the pain produced by the inflammation is most accute and distracting ; while the process of suppuration destroys a greater or less number of the aci7ii, and the pus, deep-seated, is long before it reaches the surface of the gland, caus- ing great havoc in doing so.- Sometimes the interstitial abscess, opens 702 PATHOLOGY OF PARTURITION. into a milk sinus, and partly escapes by the teat during milking. The pus is then mixed with the serum of the milk, and perhaps clots of casein and shreds of glandular tissue, the fluid having a highly ammoniacal odor. The pain is less, but does not cease, and it is generally necessary to make an external opening for the readier and more complete evacu- ation of the matter. There is generally much destruction of tissue, and cicatrization is difficult and tedious, particularly when there are lacteal fistulas. Not unfrequently the abscesses are multiple, and in some in- stances there are as many as there are inflamed lobules. In other cases one abscess succeeds another, owing to the presence of dead tissue in the mass of the gland. Even when the abscess opens externally, and the other quarters yield milk, the pus is, of course, liable to pass into it, an'd to render it most objectionable as food. So that during the whole of the suppurative period, the services of the Cow as a producer of milk are lost. Such milk has usually a greyish tint, and often a peculiar odor — sometimes similar to that of pus. Fiirstenberg has drawn attention to a cold abscess, often observed in the udder of Cows more particularly, and due to the spontaneous soften- ing of a chronic tumor or induration — the softening being the result of fatty degeneration. The tumor loses its hardness, and the softening process gradually extends ; the skin covering the mass becomes pulpy and thin, and often the tumor opens spontaneously and externally, a thick, yellowish kind of pus escaping; or it may evacuate its contents into one of the milk sinuses. The . secretory function of one or more quarters of the mammae may be quite destroyed — a serious result with valuable Milch Cows. Gangrene of the whole or a portion of the udder, is not an unusual termination of mammitis, and is, of course, the most serious one, except the death of the animal. It may be limited or diffused. The first fre- quently succeeds phlegmonous mammitis, and particularly when suppura- tion and diffuse or deep-seated abscess exists. In such a case the sup- purative process has isolated a large portion — say a quarter — of the mammae by the pus burrowing around it, and thils cutting off its nutri- tion — the blood-vessels being the last to give way to ulceration. The dead gland is encapsuled by its fibrous covering, and there it may re- main for some time unless removed by a large opening — though some- times the capsule gives way, and the mortified mass is found lying on the ground among the feet of the animal. In this way Nature gets rid of the diseased portion, and recovery becomes possible. The gangrene is generally limited by a dense band of fibrous tissue. In many cases sur- gical interference is necessary, when the mammae mortify ; and when this is judicious, and the animal is not too weak or exhausted, success is complete ; though, of course, the lacteal apparatus is mutilated and greatly damaged. When diffuse, gangrene of the mammae is generally fatal. All the domestic animals appear to be liable to gangrenous mammitis, but more especially the Cow, Mare, and Sheep, the latter being oftenest attacked. The symptoms are described as extraordinarily intense from the very commencement. There is great depression of strength, and the animal looks prostrated ; the appetite is lost, rumination ceases, the heart beats loud and frequently, and there is grinding of the teeth and convulsive tremors. At the same time the udder swells enormously, the tumefaction MAMMITIS OR MASTITIS 703 extending along the abdomen and up the perinaeum. At first oedematous, hot, and extremely painful, the swelling soon becomes emphysematous, cold, and insensible ; the skin, which was previously intensely red, as- sumes a violet, then a grey, leaden, or dark hue, and is cold and clammy — vesicles containing a limpid or reddish serosity appearing on its sur- face — the mammary gland can now be readily enucleated by making an incision through the skin. The general symptoms become more grave ; the animal appears to be completely exhausted, trembles continually, and the pulse becomes im- perceptible ; at last the creature falls extended on the ground and dies — sometimes within ten or twelve hours, rarely longer than a few days, after the commencement of the attack. Death sometimes occurs in phlegmonous and interstitial suppuration. Then the intense pain continues, or becomes still more excruciating ; the animal is continually moaning, lying down and getting up again, as the recumbent posture increases the agony, by making pressure on the mam- mae ; the temperature is elevated ; attempts to milk, which* cause the ut- most distress, only result in obtaining a few drops of reddish or semi- purulent fluid from the teat. All food and drink is refused ; emaciation sets in rapidly ; the animal is indifferent to every thing around it ; the expression is haggard and anxious ; the conjunctivas are livid ; the res- piration is quickened and often noisy ; the muffle is dry and sometimes cracked ; the pulse is thready or imperceptible, and there are constant tremblings ; the prostration is soon so extreme that the animal falls, per- haps turns its head towards its shoulder, and dies without a struggle. Ewes are very liable to mammitis during the "yeaning " or lambing period, and in very many instances it assumes an almost epizootic preva- lence, and the fatal gangrenous form. This is more particularly observed in large flocks, where gangrenous mastitis may be said to be the rule. Of this there are many instances to be found in veterinary literature, and particularly those given by Toggia, Yvart, D'Arboval, Roche-Lubin, and others. That recorded by Yvart, as occurring in the Alfort flock in 1833, is interesting. YjdX.^\vci2iWX\. (^Zeitschrift fiir die p. Thierheilkunde von Nebel afid Vix, 1836, p. 423) gives a very good description of the disease, as he observed it. In the majority of cases, he saw only one-half of the udder affected, and generally first around the teat, extending thence in every direction. The seat of the inflammation was in the substance of the udder — the gland parenchyma, the swelling being hard, and the skin covering it light red ; the pain was very great. Before the inflammation had reached its culminating point, a thin serous fluid {ftiilclnuasser) drop- ped from the teat, and when the latter was squeezed, curdled milk, or milk in firm clots, about the size of a pea, was obtained. The affected Ewe kept apart from its companions, did not eat, looked very dull, head and ears drooping, back arched, hind-limbs widely separated, and move- ment difficult, the hind-leg towards the inflamed side of the udder being most slowly and cautiously extended, as if lame ; when both mammae were affected, the gait was markedly straddling, and the steps short. When the lamb attempted to suck, the Ewe sank to the ground from pain, and could not rise again without assistance. Sometimes in the evening the quarter yielded good milk, and in the morning blood or reddish-col- ored serum would be found dropping from the teat. In twenty-four hours from the commencement of the disease, death not unfrequently ensued. If, in the first twelve hours, the malady did not yield to antiphlogistic 7 o4 PA THOL OG Y OF PAR TURITION. treatment, the skin covering the part and the hard gland, hitherto hot, became cold, painless to the touch, and assumed a dark-blue, glazed appearance. Then an oedematous swelling showed itself in front of the udder, and which soon extended to the umbilicus and sternum, along the side of the body, and down the thigh to the hocks. The development of this oedema was a sure sign that gangrene had commenced in the mass of the diseased gland, and the sanious fluid which could be drawn from the now insensitive teat was a further proof of this condition. When this change took place, the animal seemed to be much easier ; it looked livelier, began to graze and eat, and even to ruminate. But the dark- blue color of the udder, and the oedema extending therefrom, were un- mistiakable signs of approaching death, which usually occurred in thirty-six hours, when operations on the udder and scarification of the swelling did not avail. This form of mammitis attacked young and old, good and bad, among the Ewes, but more particularly those of the improved foreign breeds — the Ewes that reared weakly lambs which could not sufficiently empty the udder, and which were well fed. Kotelmann believed that this insufficient evacuation of the mammas, mechanical injury to the teat, etc., was the cause. Prognosis. The prognosis of mammitis is generally unfavorable, unless the inflam- mation is superficial and limited, not severe, and treatment is adopted early. When the inflammation, and particularly in the Cow, attacks the whole of the mammae, it is then most serious, and rarely indeed can a favor- able result be prognosticated. When the inflammation is localized and not likely to extend, and particularly w^hen the suppuration is superficial, the results may be trifling — provided always that judicious treatment is early adopted and energetically carried out. With cattle and sheep at pasture, mammitis is often a most serious disease, from the fact that its existence is generally not perceived in time to check it, and the causes which produced it are perhaps still in operation. The permanent in- duration or sloughing a way of one or more quarters of the mammae, are always to be apprehended when the inflammation is interglandular or interstitial, and especially when it is acute. Gangrene, and even death, may result ; indeed, the gangrenous termination of mammitis is fatal in nearly every case. Complications. With ruminants, the digestive organs are generally involved in the disturbance and require attention. Inflammation of the joints (arthritis) is a frequent complication of mammitis; any of the articulations may become affected, but the patellar and tarsal appear to be the most pre- disposed. Septic infection and pyaemia are grave complications, and appear when gangrene or extensive suppuration is present. There are also the degenerations and new formations in the mammae w^hich com- plicate the malady when chronic, or subsequently. Pathological Anatomy. In the majority of instances, the interlobular connective tissue is the principal seat of the inflammation, particularly when the disease has been neglected. The layers of this tissue enveloping the lobules and MAMMITIS OR MASTITIS 705 acini are swollen and infiltrated, and compress, or even efface, the proper substance of the gland, as well as the vessels of the part. It is this swelling and infiltration which causes the tumefaction of the mammie ; though the inflammation of the proper gland-tissue will bring about the same results. Retention of the milk is caused by the inflammatory in- filtration of the connective tissue surrounding the milk-ducts and canals. When inflammation has gone on to suppuration, we find, on section of the affected gland, the gland-tissue more or less occupied by large and small abscesses, adjoining healthy connective tissue ; these abscesses may be isolated, or communicate with each other and form one large irregular cavity. Sometimes there is necrosis of the ligamentous bands which form the principal septa between the glands, and in this way are produced fistulae or secondary abscesses, which may open externally or into the milk sinuses. These latter are generally lined with a large number of cylindrical epithelium ; in severe cases their walls are thick- ened and of a dark color, their cavity, as well as that of the teat, being dilated with the altered fluid. The matter in the abscesses varies ex- ceedingly in its composition. Along with cylindrical epithelium are blood-corpuscles, fat-crystals, fragments of yellow elastic tissue, colos- trum corpuscles, and an extraordinary quantity of micrococci of various shapes. The interlobular connective tissue is thickened, dense, and like ten- don or cartilage (sclerosis). The gland tissue itself has, instead of a yellow tint, a marbled aspect ; in chronic cases calcareous salts may even be found in the textures. When circumscribed gangrene has occurred, and elimination of the diseased part is accomplished, the dead mass may weigh as much as five or six pounds in the Cow ; it is somewhat regularly oval, but rather flat- tened and discoid in the Mare ; the color is a light or pale yellow, and in consistence it is pulpy but not elastic, and the finger cannot be easily passed into its substance ; traces of its lobulated structure can still be perceived, and if a section be made of it, all the characters of the mam- mary gland can be made out in its interior. In diffused gangrene, however, the glandular tissue is deep-red in color, softened, and filled with pulpy cavities ; the ducts and sinuses are filled or choked with coagulated milk, pus and serum, the whole .forming a diversely-colored fluid. In the veins are sometimes blood-clots, varia- ble in color and consistence ; gas and foetid fluids escape from the tissue on section '; and the oedema is found to be due to infiltrations of yellow serum in which are brown and greenish streaks. This fluid, examined microscopically, has much the appearance of that found in animals which have died from septikaemia. Shreds of necrotic tissue are also met with. Causes. Mammitis appears to be due to the most diverse causes. Among the principal predisposing causes, the first is lactation — the disease appear- ing immediately before or soon after parturition ; and those animals whose mammae are most active at this period, are those most frequently attacked. In the great majority of cases in the Cow — in which animal it is most serious — it follows within a month after parturition. It is true that, in certain maladies — as foot-and-mouth disease, cow-pox, sheep-pox, etc. — the udder may be affected at any time ; yet the lactation period, 45 7o6 PA THOLOG Y OF PARTURITION that when the mammae are at the height of their function, is the time when this inflammation is generally met with. With those animals whose milk is only utilised to rear their progeny, the sudden sej3aration of their young without any precautions is often noted as an exciting or predisposing cause. The great activity of these glands in the Cow, and the long time during which this activity is maintained, is, there can be no doubt, one of the chief reasons why this animal so often suffers from this affection. Mechanical causes may produce this inflammation — such as contusions, wounds,* injuries in milkingf or sucking, blows from the head of the young creature, etc. Parenchymatous inflammation of the gland may also be due, according to Franck, to a deep purulent wound in the canal of the teat, especially that produced in dilating this channel, or in the removal of papillomatous tumours from this part. Noquet [Reaieil de Med. Veterinaires, 185 1 ) alludes to a Cow in which, in con- sequence of mammitis, for six months the two posterior quarters of the udder lost their power of secreting milk. It afterwards calved, and the sinuses of these quarters were filled with milk ; but none could escape, owing to the teat-canals being closed. By means of a knitting needle, artificial passages were made, but these became deep purulent fissures. When Noquet first saw the Cow, three-quarters of the mammae were enormously swollen and gangrenous. Deep scarifications were made, and repeated dressings applied ; while camphorated draughts were administered internally. The three quarters were destroyed, leaving only the left anterior quarter. Half a year afterwards all had cicatrised, and there only remained a fistula. The animal was in good condition, and was therefore slaughtered. In these cases infection may occur from the wound itself, or through a ferment passing into the canals from without. In support of the latter view, which will be referred to again, we may mention that Viseur has attributed catarrh of the membrane lining the milk-ducts and sinuses to the too frequent employment of the teat-tube or syphon, which more or less paralyses the sphincter of the teat, and through the relaxed aperture the air, charged with germs, irritates and inflames this membrane. "Overstocking" of the udder with milk has generally been considered a very likely cause in the production of inflammation. The sudden removal of the young, imperfect milking, etc., have also been blamed. Franck, however, appears to doubt the influence of mammary distention, and some observations and experiments would tend to prove that this does not always cause inflammation. For instance, Cows which had suffered from mammitis, and had temporarily lost the function of one or two quarters of the mammae, were found at the next lactation period to have recovered the secretory power of these glands, but the excretory canal in the teat was obliterated. Consequently, great distention oc- curred, and this was not relieved by an artificial opening. Nevertheless, no inflammation ensued ; after the third day there was a marked diminu- tion in the turgescence of the quarters, and in about eight days they had assumed their normal volume. And Kehrer has experimentally shown that extreme distention may not cause inflammation, by closing two teats * Gotze (Sachs Jahresbericht, 1867, p. 92), quoted by Franck, mentions an instance in which the posterior part of the udder of a Cow becamed inflamed, and soon there was a severe attack of mammitis. When the animal was killed, a large abscess was found in the gland, and in it two common pins, which Gotze thought might have penetrated there from the rumen. t In those countries where the milk of Ewes is utilised like that of Cows, in the production of cheese —as at Roquefort, where cheese bearing this name is largely manufactured— mammitis appears to be very frequent, and has been attributed very often to the rough handling the teats and udder receive in milking. Roche-Lubin says that he has often witnessed shepherds acting so violently in milking that the Ewes could scarcely breathe, staggered in their hind-limbs, and sometimes fell from the pain and shock. MAMMITIS OR MASTITIS. 707 of a pregnant Bitch with collodion, and so securely that at birth the pup- pies could not remove it. The corresponding glands were much dis- tended with milk, but no inflammatory action was set up. The influence of cold and wet, and especially the former — particularly when animals rest with the udder on the ground — has also been largely ascribed as a cause of mammary inflammation, but probably there is some exaggeration in this ; as Cows which are seldom housed suffer less, perhaps, from this malady than those kept in warm cowsheds. Cold winds or draughts in cowsheds have been especially alluded to as op- erating powerfully in its production ; and though we are inclined to think that these and lying on cold ground do not produce the disorder so frequently as is imagined, yet there can be no doubt that while the udder is very active, and is in a state of almost constant hyperaemia, it will be more susceptible to alternations of temperature, particularly if the animal is rendered delicate by high feeding and an artificial existence. Certain atmospherical conditions — as electrical storms — have been supposed to exert some influence also ; and extensive outbreaks of mammitis have certainly been observed to coincide with these disturb- ances — the udder being attacked with a kind of phlegmonous erysipelas. Hygiene has been looked upon as aiding in the development of mammitis; filthy and badly ventilated dwellings being greatly blamed as tending to generate a miasma, which exerts a special influence on the udder. Plethora has been imagined to be, if not an exciting, at least a predis- posing cause, and so has hot weather. Bardy, quoted by Rainard and Saint-Cyr, gives a description of an epizooty of mammitis which was said to be due to the Cows consuming ranunculaceous plants, which were very abundant in the fields where the animals grazed. The people in the locality assured him that this always occurred when these plants were most plentiful in certain years. Mammitis sometimes complicates or accompanies vaginitis, metritis, peritonitis, etc., according to some authorities. There is much reason to believe that a particular form of mammitis is due to a putrid or septic infection, and Franck is one of the strongest supporters of this view. Indeed, he asserts that the majority of cases of mammitis are of septic origin ; and he has experimentally proved the correctness of his statement. For instance, he has repeatedly injected into the teats of healthy Cows, pus from the udder of those affected with mammitis, or fluid from putrid flesh, as well as putrid blood, and within twenty-four hours an acute inflammation of the corresponding quarters has been observed. This inflammation occurred with Cows whose udder was in active function, as well as those which were " dry." The unin- jured epithelium of the milk sinuses and vesicles are, therefore, not protective of the gland like the pavement epithelium of the vagina ; for it has been shown that when putrid flesh or blood-fluid was injected into the uninjured vagina of Ewes and Cows, no inflammation was set up. One of Franck's experiments is instructive. A Cow which gave only a small quantity of milk, had, on February 26, 1875, a quantity of fresh pus from the udder of another Cow suffering from mammitis, and diluted with ten times its bulk of water, injected into the teat of the left anterior quarter. Next day this quarter had all the appearance of being affected with parenchymatous inflammation. The other three quarters were generally intact. The secretion from the diseased quarter was yellow, creamy, and pus-like. It only contained pus-globules in great quantity, and these wei;e studdied with micrococci : 7 o8 PA THOL OGY OF PAR TURITION. there were also some epithelial cells, milk-globules and small masses of coagulated casein. On February 28, the inflammation had extended to the left posterior quarter. In another experiment he injected some putrid-flesh fluid into the milk duct of a teat. Next day this quarter of the udder was affected with acute parenchymatous inflamma- tion ; the milk was curdled, purulent, and contained large numbers of pus-corpuscles and micrococci. In a few days the adjoining quarter was likewise involved. The structure of the teat and arrangement of the milk-sinuses and ducts in the Mare, ruminants, and Swine, are, in the opinion of Franck, favorable for the reception of infection ; and this accounts for the read- iness with which parenchymatous inflammation of the udder occurs early in foot-and-mouth-disease, the virus of this specific malady finding its way from the surface of the gland into the teat. The wider prevalence of mammitis in close sultry weather during summer, than in cold winter weather, may be accounted for by the readiness with which organic mat- ters putrefy. By the way of infection, those extensive outbreaks of mam- mitis which occur among flocks of sheep may also be explained. Those cases of the disease which follow abortion, or accompany metritis or va- ginitis, may also be attributed to self-infection, instead of metastasis ; in- deed, in Franck's view those maladies which lead to the formation of putrid or septic matter — such as parturient fever, omphalitis in the prog- eny, retention and putrefaction of the after-birth, etc. — may all be pro- ductive of mammitis in this way. Disease of the progeny may also give rise to it, the infection being conveyed to the teat by the young in the act of sucking. The hands of milkers or others, or soiled litter or ground on which the animal lies, may also be the means of conveying the infec- tion. Franck believes that the column of milk in the sinuses and ducts is first tainted, and that this is effected through the milk at the end of the teat — a drop or two of which maybe suspended therefrom. A chem- ical change is thereby brought about in the milk, and this altered secre- tion leads to the inflammation, which is secondary. An alteration in the' character of the milk is, it w^ill be remembered, one of the first symptoms — if not the first — of mammitis. Consequently, "dry" Cows, or those to which the infection cannot obtain access, are not attacked by the mal- ady ; and " dry " Cows suffering from foot-and-mouth-disease never have parenchymatous mammitis. In the veterinary journal of the University of Y\%2>. [Giornale di Anatomia, etc.,dcgli Animali, 1875) Professor Rivolta describes a form of mammitis prevailing among sheep in the neighborhood of Pisa, towards the end of winter and commencement of spring, and to which he has prefixed the designation of " septic." He gives it this designation because, when it begins at a certain part of the mammary gland, there is noted a kind of putrefaction of the juices of the skin, as well as of the gland itself; and besides, in the sero-sanguinolent fluid in the connective tissue of the gland are remarked a very active element in the process of putrefaction, in the presence of micrococci and bacteria. The disease appears to be perfectly distinct from the gangrenous mammitis, and the gangrenous, or anthracoid erysipelas, described by various writers. It is a local malady which usually invades the gland, extending at a certain rate of progress, and most fre- quently proving fatal. It ordinarily commences in the neighborhood of, or in, one of the teats ; if the latter, it offers a circumscribed (Edematous tumefaction, while the sur- face of the skin thereon is intensely red. This red patch rapidly assumes a grey color, and finally becomes almost black.' Sometimes blood escapes from the affected teat. This cedematous swelling and discoloration gradually extend, and in a more or less brief period of time has invaded one-third or one-half of the udder — not even sparing the tissue of the gland. The whole of the affected part is then tumefied, doughy, somewhat consistent, slightly or not at all sensitive, and dark or black in hue. The line of demar- cation between the healthy and diseased portion is perfectly defined; the former being of a rosy color, and normal in size and consistency. The diseased condition spreads beyond the udder to beneath the abdomen, and when an ulcer appears on the gland, MAMMITIS OR MASTITIS. 709 discharging a foetid sanguinolent fluid, tlie animal then becomes depressed and feverish, debility and emaciation set in, and the creature succumbs to an attack of septikaemia. The numerous necroscopical examinations made by Rivolta confirm, in his opinion, the distinction he has established between this special malady and erysipelatous mam- mitis. With regard to the causes, the shepherds affirm that the malady attacks those sheep which are kept for a long time on a thick bed of litter ; others, again, assert that it appears when they are allowed to pasture in the open air, and are not confined. The same uncertainty prevails with regard to its contagiousness. The shepherds carefully isolate the affected animals : and it would seem that, by their doing so, the disease is limited to those first attacked. Rivolta is of opinion that this form of mammitis is produced and maintained by special micrococci and bacteria, which penetrate by the teats, or at some part of the skin covering the gland. Tuberculosis of the udder is sometimes a cause of mammitis, and in all cases, when severe, diminishes the secretion of milk. The mammae are gt-eatly enlarged, hard, and nodulated, and softening of the tubercular masses may give rise to isolated or diffused abscesses.* Several Italian authorities, and among them Brusasco, Oreste, Metaxa, and Provinzano, have drawn attention to a peculiar disease of Goats and Sheep, accompanied by the gradual loss of milk. Often lameness is observed, and within fourteen days the quantity of milk is reduced to one-fifth of the usual quantity. This fluid soon becomes sour. The disease appears to be contagious, for it could be produced by injecting the milk from affected Sheep into the teats of healthy Sheep and Goats. All the animals so experimented upon became affected, the period of in- cubation being six, twelve, fifteen, or twenty days. The secretion of milk ceases in from eighteen to thirty days. Treatment. However slight the attack or mild the form of mammitis may be, in view of the serious consequences which it may entail, treatment should be prompt and judicious ; as in two or three days alterations may be pro- duced in the secretofy apparatus of the gland, which medical skill may be unable to amend. When the udder or quarter is simply engorged with milk, nothing more has to be done than to thoroughly remove this fluid. This, of course, cannot be accomplished at once, and it maybe necessary to milk the ani- mal several times during the day — five or six times, or even every one or two hours. When this causes pain, the milking should be gently per- formed ; and if pressure on the teat causes so much disturbance that the fluid cannot be withdrawn by hand, then the teat-syphon (Fig. 207), well oiled, should be passed into the milk duct ; should it be necessary to re- tain it there, then the ring-syphon (Fig. 208) may be employed, its reten- tion being effected by a cord or tape through the rings and tied over the animal's loins. In all cases in which hand-milking causes pain, and is likely to increase the evil it is intended to avert, the teat-syphon should be resorted to.f It may be necessary to remove the progeny for a day or two, or allow it access only to the healthy quarters, if the animal * This tubercular affection of the udder is very important, when it is borne in mind that the milk of animals suffering from tuberculosis will, if experimental results be accepted as proof, produce the disease in those creatures who partake of it ; and that, when the mammag themselves are involved, the viruliferous qualities of this fluid may be greatly increased. Is the more and more frequent occurrence of the disease to be attributed to this cause ? , • . • • t Franck very properly draws attention to the necessity for thoroughly cleansing these syphons m boihng water or carbolic acid solution. The danger of conveying infection to other quarters of the mammae, or to the udder of healthy animals, is obvious unless this precaution is adopted. 7IO PA THOLOGY OF PARTURITION. is suckling ; and should it be required to lessen the secretion of milk until the gland has recovered its normal condition, this may be effected by a suitable diet, and perhaps a dose of laxative or purgative medicine. Saint-Cyr recommends applications of vinegar to the gland. Should the gland remain hard, tense, and painful, and the superficial veins be gorged with blood, much relief will be afforded by bleeding from the corresponding mammary or " milk " vein, if a Cow. The animal should not be exposed to cold or draughts, and it may be advisable to cover the body with a large blanket. If fever is apprehended, enemas may be administered, in addition to the exhibition of nitrated gruel. *iAfcKV.eeLLdi«i.H» ^ 1 Fig. 207. Teat-syphon. Should coagula or solid caseous concretions have formed, they must be removed. This may be accomplished by moving the masses up and down, when possible, by careful and gentle pressure. When it can be easily displaced, it may then be pushed down to the end of the teat, and pressed through. A coagulum or concretion of this kind, as large as a nut, has been extracted in this manner. When it is too voluminous, however, it may be necessary to introduce a sound carefully into the canal, in order to break it up ; or it may even be required to incise the teat, when the mass is too large and dense to be got rid of in this way. Retention of the milk is sometimes due to atresia or obliteration of the milk canal in the teat, and will then demand an operation which we will refer to presently. ^^aas (CKEY.StULEI Fig. 208. Ring Teat-syphon. When phlegmonous or parenchymatous mammatis is present, the treat- ment must be energetic, and adopted early, in order to prevent those serious alterations in the gland which take place so rapidly. In the Cow, bleeding from the corresponding mammary vein has been recommended by many excellent authorities, from the speedy relief it gives to the congested gland ; in the Mare, if bleeding is necessary, the blood must be abstracted from the jugular, though this can rarely be pro- ductive of much benefit. Leeches maybe most usefully employed, locally, for the smaller animals, and Bouley has even had recourse to them with great advantage in the Cow. • In inflammation of the gland, emptying it of its secretion or removing from it the products of the inflammation, must be scrupulously observed. Milking by hand must be persisted in for brief but frequent periods, even though only a few drops of serum be withdrawn each time. The teat- MAMMITIS OR MASTITIS. 711 syphon may sometimes be usefully introduced ; but its employment re- quires much circumspection when the inflammation is acute. With the smaller animals, as the Bitch, milkmg is not so urgent. The general treatment must depend upon the condition of the animal and the nature and degree of the disturbance, and must be, in principle, that of all inflammation. The local treatment is a matter of much impor- tance, and here we find the most diverse recommendations. Zundel, Baumeister and Rueff, Gillibert, and others, have lauded the advantages to be obtained from the application of collodion, particularly with small animals. With the larger animals, as Mares and Heifers, it has been most successfully employed by Zundel, who adds a few drops of castor-oil to the collodion, which is applied either over the whole gland or the inflamed quarter or quarters, commencing at the teat, the orifice of which must not be covered ; a second or a third application may be made. The evaporation of the ether produces a salutary degree of cold, while the continuous layer of cotton closely adhering to the surface of the skin, affords equable compression and support by its contraction when the ether evaporates. Astringent and refrigerant applications have always held a high place in the treatment of mammitis, and every authority has his own favorite ap- plication. In this way we have cold water, either alone or with the addi- tion of ice, acetate of lead, or Goulard's extract ; clay tempered with vinegar or salt water ; evaporating lotions of various kinds, etc. These applications may be usefully and safely employed when there is merely congestion, or at the commencement of slight inflammation ; but when the inflammation has become fairly established, and there is exudation, they increase the tension, and, without allaying the pain, promote indura tion. So that, as a rule, they are to be avoided until the inflammation has been greatly subdued, when they may be resorted to with some ad- vantage. Emollient applications, and especially when warm, afford more satis- factory results. In this direction warm fomentations and poultices ap- pear to be most grateful to the animal, and to dissipate the inflammation most readily. They must not be too hot, as the skin of the udder is so thin that it is easily injured by inordinate heat. Poultices of linseed-meal, oatmeal, marsh-mallows, dough, etc., covered with olive-oil. laudanum, opium, or extract of belladonna, are especially to be recommended, in preference to fomentations, which require much time ; and as they can- not be applied continually, the udder often suffers from the reaction — the change from heat to cold, though this may to some extent be ob- viated by drying the parts well, and smearing them with lard. An ex- cellent poultice is furnished by spongio piline, which, if covered externally by oiled silk, and holes made in it for the teats to pass through, makes an excellent and clean cataplasm when steeped in warm water and ap- plied to the udder. Williams recommends " spent " hops, which are very light, contain much moisture, are soothing, and do not irritate when they become dry. The drying of a poultice can be averted by placing it in a piece of waterproof material or oiled silk. Poultices and other ap- plications of this kind are best retained by a wide and tailed bandage, in which are holes for the teats, and which, passing upwards on each side at the flank, and back between the thighs, is secured over the loins and croup. This bandage is at all times beneficial in relieving the pain and congestion, by the support it affords the swollen organ. It should therefore be adopted early. 712 PA THOL OG Y OF PA R TURITION^ Lotions of belladonna, opium, tincture of camphor, poppy heads, etc., are convenient applications, and if warm do good ; but to prove effica- cious, they must be applied frequently, and at the commencement of the disease. A sponge, or rubbing in with the hand, are the best means of applying them. Ftirstenberg recommends continuous tepid alkaline lo- tions applied by the hand for twenty-four to thirty-six hours ; and Schaack, quoted by Saint-Cyr, asserts that, employed at the commence- ment, they have a remarkable effect — often arresting the inflammation in that interval, the swelling disappearing in one or two days. _ Rychner states that nothing can equal the success resulting from the employment of alkaline lotions. The owners of cattle in Switzerland are well aware of this, and as soon as they observe the slightest alteration in the milk of a Cow, they take a handful of wood-ashes, which they moisten with milk, and making a lotion of the mixture, they rub it on the udder. Rychner is of opinion that the potash in the ashes prevents the coagulation of the milk in the udder^this coagulation being, according to him, the point of departure or initial phenomenon of mastitis. For this reason he gives the following recipe, which has obtained more suc- cess than any other, when applied before the inflammation had attained its greatest intensity : Potass - - - - - I part. Water - - - - - • - 2 parts. . Olive-oil 5 " These are to be well mixed, and then four or five parts more water are to be added. Often, after five or six hours, during which nothing could ike drawn from the teat except a small quantity of thin curdled milk, there is obtained a whitish-yellow fluid, more like pus than milk, which is a very favorable sign. Ointments and embrocations of various kinds are also employed — as those of belladonna, henbane, morphia, camphor, laurel, etc. In Eng- land, the extract of belladonna is much used as an application to the in- flamed gland. Rychner recommends an ointment made with soft soap and this extract ; Hertwig gives his testimony in favor of camphorated pomade ; while some prefer simple lard. Strong mercurial ointment has been greatly extolled as an anodyne and relaxer of the tissues, and justly so. Its constitutional effects should be watched, and care must be taken that the progeny is not allowed to suck the teat. Stimulating applications should not be employed, unless the disease is in a chronic form, and then their effect must be noted. When suppuration appears to be inevitable, this process should be ex- pedited by every means, so as to concentrate the pus at one point, if possible. The warm poultice or fomentations should be continued, and it may even be advantageous to apply mercurial ointment, ammoniacal liniments, and such other "maturatives " as blisters. The abscess is to be treated according to general principles : it should be opened as soon as fluctuation can be detected, and for thi^i purpose the bistoury or lan- cet may be employed ; though some practitioners prefer the actual cau- tery, which, they believe, does not entail so much risk of haemorrhage, favors the exit of indurated parts, affords a better means for the escape of pus, and the resulting wound heals up more readily. When opened, the wound demands only ordinary treatment — cleanliness, detersive or stimulant dressings, carbolic oil or lotion, etc. To prevent the opening MAMMITIS OR MASTITIS. 713 closing too early — which it may do when the abscess has been opened by the bistoury, it will be necessary to introduce a small tent of lint or fine tow. Sometimes several abscesses are developed simultaneously or succes- sively in the tumor, and are separated from each other by thin septa. In such a case, having opened the largest abscess, it often happens that the pus from the others drains through the opening, converting it into a fistula. In such circumstances, a counter-opening must be made ; and if there is any necrotic tissue to be found, it should be removed. In all operations on the mammary glands, the incisions should be carefully made, and no larger than is absolutely necessary. When the abscesses are deep-seated in the texture of the gland or the connective tissue, it frequently happens that, in opening them, one or perhaps more of the milk ducts are wounded, and then we may have " lacteal fistulte." From these the milk escapes, and renders their cica- trization difficult and tedious, if the gland is active. The treatment must chiefly consist in the application of caustics to the walls of the fistulae, in order to hasten granulation — the nitrate of silver, chloride of zinc, tincture of iodine, or even the actual cautery, being generally resorted to. Soriietimes a cure cannot be effected until the gland hae become " dry." In some cases a pitch plaster or one of marine glue is useful, or the pressure of a broad elastic band when the fistula is situated at the base of the teat. The occurrence of gangrene is always serious, though of course it is not so grave when limited than when diffuse. It generally leads to the loss of one or more quarters, or even to the death of the animal from icorrhaemia or septikaemia. When limited, little can be done, and in some cases it is best to wait for the spontaneous elimination of the dead portion : waiting and watching the process, supporting the strength of the animal, accelerating the separation of the dead from the living tissues, favoring the free escape of pus and putrid matters, so as to hinder their absorption, making counter-openings, and applying antiseptic dressings — as chloride of zinc, carbolic acid, permanganate of potash. In other cases, it may be necessary to expedite recovery by excision of the mortified mass. In order to do this, it is sometimes, but not always, requisite to cast the animal, and to fix it as for castration. The opening by which the pus escapes is enlarged, and the tissues still adhering to the living parts of the gland are separated from it by the fingers, keeping clear as much as possible of the arteries, which should be ligatured, if injured. When the separation is complete, ligatures may be placed round the principal vessels — the ligature being a piece of narrow tape or ribbon, as their walls are fragile and easily torn. If any haemorrhage oc- curs, the actual cautery or perchloride of iron may be employed to sub- due it. The wound is then to be dressed with disinfecting and stimula- ting applications, until it ceases to give off a bad odor, and is throwing out healthy granulations. The animal must be well fed, and its strength sustained by stimulants and tonics if necessary. When the gangrene threatens to become diffuse, there must be no hesi- tation in resorting to deep scarifications, in order to limit its ravages ; these allow the escape of the septic fluids, which would impregnate the healthy tissues if permitted to remain ; and the isolation of the diseased parts may be still further secured by plunging the actual cautery deeply into them, and applying oil of turpentine, carbolic acid, perchloride of iron, 714 PATHOLOGY OF PARTURITION. or tincture of camphor to them and into the wounds. It is often advisable to trace a line around the gangrene, so as to circumscribe it. When it is surrounded by a ring of inflammation, then emollient poultices may be applied to hasten its separation ; indeed, if the part is quite dead, it may be judicious to cut into and remove as much of it as can be done — cau- terizing the wound well with the hot iron or perchloride of iron, and after- wards dressing it with chloride of lime, carbolic acid, and other antiseptics. At the same time, antiseptic medicines, tonics, and stimulants, should be administered internally. It migl>t be well worth trying the injection of antiseptic agents — such as carbolic acid, tincture of iodine, etc., into the gangrenous tissues, by means of deep incisions and a Pravaz syringe. Induration following mastitis can rarely be remedied, but it may be useful to continue the inunction of ointments which contain preparations of mercury — as the iodide — or iodine for a certain time. Armatage recommends the following ointment to be applied once a day, with smart friction : Soft soap - }^ lb. Mercurial ointment - - - - i oz. Camphor ointment - - - - 4 " Extract of belladonna - - - 4 drams. Or the following tincture : Tincture of iodine - - - - 6 oz. Tincture of opium - - - - 2 " Soap liniment - - - - - 4 " Frequent and gentle milking may also prove serviceable, as well as dry friction. As a preventive measure when infection is apprehended — as in reten- tion of the placenta, metritis or vaginitis, etc. — it is advisable to inject a weak solution of carbolic acid (2^ per cent.) or alum (2 per cent.), up the teat by means of a glass syringe, always after milking ; the fluid should be at a temperature of 95° Fahr. Franck has proved the value of this precaution, and also its utility as a remedial measure ; indeed, Armatage had previously recommended the injection of weak solutions of carbonate of soda or potash in mastitis. Franck has employed a ten per cent, emulsion of carbolic acid as an injection in artificially-produced mastitis (sixty grammes daily), and by this means suppressed the develop- ment of micrococci and bacteria in the milk, as well as prevented curd- ling of that fluid in the ducts and sinuses. Solutions of alum — ten per cent., 100 grammes injected daily — appeared to be also beneficial in this direction. Armatage recommends that animals suffering from gangrene of the mammae should be removed from those which are pregnant, " as great excitement will be produced by the odor of decomposition," and abor- tion is probable. CHAPTER X. Agalactia. " Agalactia," or absence of milk in the mammae, is not uncommon in animals, particularly the Mare and Cow, and more especially in those INJURIES TO THE TEATS, 715 which have not been bred from for a long time, or which have brought forth their first young, though themselves aged. This absence of secre- tion may occur, even though pregnancy has been normal and has reached its full limit. The udder is small and soft, and attempts at milking only result in the production of some drops of yellowish fluid, followed some- times by a few drops of white watery fluid. There appears to be a want of development in the lacteal apparatus, which various causes concur in producing. The principal of these causes are : previous or present chronic disease in the mammae ; atrophy of these glands ; exhaustion fol- lowing disease ; severe labor ; insufficient food, either during or immedi- ately after pregnancy; natural debility, emaciation, etc. In some in- stances the milk gradually appears some time after parturition, and a tolerable quantity is secreted ; but in the majority of cases it is either not produced at all, or only in very small quantity. This condition is very unfortunate for its young, which must suffer from hunger if not observed, and must either be artificially reared, or put to another animal to be suckled. The treatment of this condition must frequently prove unsuccessful. It must chiefly consist in giving good food, particularly of a leguminous kind, with aniseed and fennel, fennel-seeds, water fennel, Mcum mutel- linum, antimonials, and other agents which are likely to stimulate the secretory function of the mammae. Great attention must be paid to the digestive organs, and the teats should be frequently stripped and the mammae rubbed, either dry, or with some stimulating application. Macorps (Canstatt's jfahresbericht, i860) records a case in which the udder was rubbed with brandy, friction applied to the abdomen, and warm milk and fennel-seeds administered ; in two days the milk began to appear. When the absence of milk is due to disease of the gland, this must be combated according to the indications. CHAPTER XI. Injuries to the Teats. Fissures. The chief injuries to the teats consist of wounds, in the form of fissures or " cracks," which are most frequently witnessed in the Cow a few days after parturition ; and though apparently unimportant, they nevertheless may become very troublesome and serious if neglected, and even lead to mastitis and icorrhaemia or septikaemia ; while they render the animal fidgety and averse to being milked or suckled — the latter being especially inconvenient, particularly in the case of the foal. Causes. These injuries are generally produced by the powerful traction of the young creature on the teat while sucking, and mainly when the teat is empty, the milk scanty, and the skin very thin and fine — as in primiparas. Even when the milk is abundant, but the skin thin, these fissures may occur. The teat is alternately distended by milk — when it is covered and softened by the externally warm saliva and buccal secretions of the 7 16 PA THOLOGY OF PARTURITION, progeny, in the act of sucking — then retracted and corrugated when emptied. At the bottom of the folds, the epidermis is rendered soft, and its cells loose and swollen ; these finally, instead of forming a continuous layer capable of protecting the subjacent derm,' give rise to a whitish unctuous pulp, which accumulates at the bottom of the corrugations. When this is removed, a sore is left, and the development of this sore is hastened by cold, which still further corrugates the part, as well as by want of cleanliness, contact with dirty litter or manure, which irritate the organ, besides the act of milking or suction, which extend the sore in length and depth. It may be that certain conditions of the saliva in the young creature also lead to irritation. Cows with voluminous udders and long teats, are often the subjects of this injury. Symptoms. The sore appears as a more or less deep, narrow, and sinuous ulcer, running transversely around the teat, and having indurated, thickened, raised margins, greyish at the bottom, or very red and erythematous, and containing a variable quantity of the thick unctuous matter just men- tioned. The teat is apparently not much deformed — at least after milk- ing, when it is retracted ; and the fissures might readily pass unperceived. Then it is necessary to draw the end of the teat gently, in order to dis- cover them. When superficial, they are not so troublesome as when deep, irritable, and bleeding ; then they are extremely painful, and the animal refuses to be suckled or milked, while attempts to handle the teat cause the crea- ture to offer great resistance. These fissures have an almost natural tendency to increase in depth, so long as the young creature is suckled. Sometimes they form at the very extremity of the teat, and the sinus and milk ducts become inflamed, the viscid matter secreted becomes firm and blocks up the canal, which may ultimately be completely obliterated, causing retention of the milk, inflammation of the gland, and perhaps lead to a fatal termination. Treatment. Fissur-es in the teat should not be neglected, however slight they may appear to be. They might be prevented by cleanliness and care, and keeping the animal from draughts of cold air. It is a good plan, par- ticularly with primiparae, and especially the finer bred Cows, to examine and wash the teats for a short time after parturition, and if there is a tendency to sores, to dress them with some bland substance — as lard, glycerine, or olive-oil. When fissures are present, and especially when they are deep, an es- sential condition for their recovery is preventing the progeny from using the affected teat or teats. By this abstention, and the use of the teat- syphon (well disinfected every time) to empty the gland, recovery in the most serious cases is comparatively rapid, and sometimes even sponta- neous. P^mollient lotions are generally recommended, and the ordinary fluid is the milk drawn from the teat, which is frequently applied during the day, the part being well cleaned with a soft cloth after each application. This and other mild emollients may be useful when the injuries are very slight and superficial ; but when they are more serious, or a rapid recov- ery is important, then recourse must be had to more efficient remedies. INJURIES TO THE TEATS. yiy For this purpose, perhaps nothing is better than carbolized glycerine (i to 20), or, in very severe cases, to watery solution of silicate of soda. It may expedite recovery to touch the fissures lightly with nitrate of silver, and to cover the teat with an india-rubber capsule or ring. Obliteration of the Galactophorus Sinus. This may result from fissures, disease, or growths of various kinds, or it may be congenital (atresia), and is most frequently observed in the Cow. It may be either partial or complete. Symptoms. When due to fissures or disease, the symptoms are gradually developed ; but when the occlusion is congenital, they suddenly appear either imme- diately before or after parturition, when the gland becomes active. Then the udder is distended, but no milk issues from the teat; the distention increases, and if relief is not afforded, inflammation and suppuration may result. On examination of the end of the teat in congenital atresia, pres- sure, as if in milking, and if the skin alone be the obstacle, will cause a slight prominence where the opening of the sinus should be, the milk being felt in the sinus. Should the occlusion extend higher, and the whole or a portion of the sinus be obliterated, then this prominence will not be produced, and the obstacle will be discovered towards the base of the teat. Occlusion brought about by inflammation, hypertrophy of the mucous membrane lining the sinus, or the development of any growth — as a wart — does not occur suddenly ; and in milking it will be observed that the stream of fluid gradually becomes smaller, until at last it can only be drawn drop by drop, or its flow has completely ceased. Treati7ient. When the occlusion is only due to the skin — which is not uncommon in primiparae — a small crucial incision made through it by the bistoury or lancet, is generally ail that is necessary. The sinus of the teat is dis- tended with milk by pressure from the base, and the prominence at the end is then incised. To prevent the wound closing, a small bougie is in- troduced into the sinus for four or five days until the wound has cica- trized j it should only be taken out at milking time. Fiirstenberg states that he has seen the opening thus made remain permeable during the whole period of lactation, but close again when this period expired ; and a second operation had to be performed at the next calving. When the obstacle is in the sinus of the teat, at the narrow part of the canal, and immediately above the sphincter, a fine trocar or stocking- needle, previously cleaned in boiling water and dipped in carbolic acid solution, must be passed into it and through the obstruction, when the milk will flow. To prevent closure, the cannula of the trocar or a teat- syphon may be inserted for some days, the opening being closed by a cork except at milking-time. Or a solid gutta-percha sound may be em- ployed until an artificial mucous membrane is found, removing it when milking. When the canal is only partially obstructed, and the milk yet flows, the introduction of a small feather — pigeon's — or a piece of thick catgut, will, with a little patience, gradually effect dilatation. But should it not suffice, and particularly if a wart is the cause of obstruction, ao incision will be 7 18 PA THOLOG Y OF PARTURITION. necessary. Various instruments have been proposed for this operation, but Ltithi's sound is perhaps the best. This is an iron wire about eight millimetres long and two in diameter, having a ring at one end, and at the other a steel cone screwed on to it. This cone has a very sharp point, and both sides have cutting edges at the base or widest part. It is passed into the opening of the teat, pushed through the obstacle, and then gently turned round from side to side until no resistance is felt. Then it is withdrawn, and a bougie or teat-syphon, or a piece of thick earbol- ized catgut introduced. Zundel mentions that Ltithi and Strebel have been very successful by this method of operating. B Fig. 209, LuTHi's Perforating Sound. A. Half the Natural Size. B. Natural Size and Section of the Cone. In all cutting operations on the teat, every precaution must be adopt- ed for the prevention of mastitis ; and this must chiefly consist in follow- ing out the antiseptic method of treatment of the incisions as closely as possible. Fistula of the Teat. We have seen several cases of fistula of the teat which proved very troublesome to cure during the period of lactation. From injury or disease, an opening is established between the milk sinus and the side of the teat ; so that the milk, instead of passing through the canal in the extremity, escapes in a jet at the side, and its flow is nearly constant. This is a source of loss, and has often an unpleasant appearance. If it is decided to cure the fistula during the lactation period, and the opening is towards the middle of the teat, then the ring teat-syphon must be kept in the sinus for some time, and the fistula treated according to surgical principles. When the fistula is towards the extremity of the teat, how- ever, the case is more difficult, and the teat-syphon only too often renders it worse. Then it is generally necessary to wait until the Cow is " dry," when, with a little attention, the fistula is readily cured. A SPHP VIA OF THE NE W-BORN A NIMAL. 7 19 BOOK VI. DISEASES AND ABNORMALITIES OF THE YOUNG ANIMAL. The diseases and abnormalities of the young animal, gbserved immedi- ately after birth, are, many of them, of the greatest importance, and deserve far more attention than they have yet received in England. Their consideration forms an appropriate complement to what has been said as to the pathology of the parturient state of the female parent ; and a notice of them, however brief and imperfect it may be, is all the more necessary, as few, if any of them, are referred to in works on veterinary medicine or surgery. We will describe them in the following order : — (i) Asphyxia, (2) Umbilical Hcemorrhage, (3) Persistence of the l/rachus, (4) Umbilical Hernia, (5) CEdema of the Umbilicus, (6) Inflammation of the Umbilical Cord, (7) Arthritis, (8) Indigestion, (9) Diarrhoea, (10) Re- tention of Meconium, (11) Skiti dryness, (12) Imperf oration of the Anus, (13) Imperforation of the Vulva, (14) Imperforation of the Prepuce, {\^ Cyanosis. % CHAPTER I. Asphyxia of the New-born Animal. At page 247, under the head of " Suspended Animation," we alluded to asphyxia of the new-born animal — a condition similar to that of the new- born child, and briefly alluded to the measures necessary for restoration. We have likewise referred to the immediate cause of this condition. It has been recognized that when animals are submitted during pregnancy to insufficient food, to severe exertion, have suffered from chest disease, or from colic a short time before parturition, or when labor has been difficult and protracted, the young creature at birth is so exhausted that it lies apparently dead — all the tissues being pale and flaccid, the body low in temperature, and the heart's beats and the respiratory movements are very feeble or quite imperceptible. There may also be syncope or asphyxia from plethora or cyanosis ; asphyxia may likewise be due to interrupted circulation in the umbilical cord, and intra-uterine respiration. Apparent death, or suspended animation, must be treated in the manner indicated at page 247. The mouth and trachea should be cleared of mucus and amniotic fluid, if any of the latter has passed into the air passages, as it may give rise to pneumonia, should the creature be resuscitated and live for a short time. With the calf or foal, it is possible to pass an elastic tube or catheter through the nostril into the trachea, and by means of a syringe to remove much of the fluid there- from. Aspersion of the skin with cold water may also be useful in stimula- ting the respiratory nerve-centre, by the reflex action it induces. This is more particularly indicated when asphyxia is due to an excess of carbonic acid in the blood. Stimulation of the skin may also be useful in this direction. Direct electric stimulation of the phrenic nerve should be 720 DISEASES AND ABNORMALITIES. attempted. Artificial inflation of the lungs should not be tried until the mouth and fauces have been cleared of mucus ; this may be effected by suction, which has a very beneficial action otherwise. Indeed, some authorities prefer aspiration to inspiration or blowing into the mouth ; and Albert (Henke's Zeitschrift fur Staatqrzneikiinde^\o\. xxiii,, p. 279) has restored 41 out of 47 cases of apparently dead animals, by aspiration or Suction. Transfusion of blood by the umbilical vein might prove useful ; be- tween one-half and a litre of blood should be sufficient for a foal or calf, according to Franck. The fumes of ammonia or some other powerful volatile irritant may be applied to the nostrils. A few drops of brandy may also be poured into the nostril. CHAPTER II. Umbilical Haemorrhage. HEMORRHAGE from the umbilical cord does not appear to be a very common accident ; nevertheless, it does sometimes occur, and in some cases so copiously as to cause death. It rq^ay ensue immediately after birth, rarely after some days ; and it may continue for a short or long period — producing great debility, and even dissolution. The haemor- rhage is generally due to imprudence in cutting the umbilical cord too near the abdomen, or to laceration of the vessels of which it is composed during difficult parturition, when violent traction tears it close to the abdominal ring ; in very rare instances it may be due to a varicose con- dition of the vessels. Zundel alludes to a predisposition to umbilical haemorrhage — a kind of haemophilus. In one or two instances the bleed- ing has been induced by either the mother, the young creature, or its companions sucking or pulling at the remains of the cord. In the foal, the haemorrhage may take place from the artery, as that vessel is firmly attached to the umlDilical ring ; with ruminants it takes place from the vein, because of the existence of the Ductus Arantii, and the retraction of the artery within the abdomen. Treatment. When the bleeding is trifling and not likely to continue long, little, if any thing, requires to be done ; but when it is copious and continuous, active and prompt treatment must be adopted. When the cord is extremely short, astringents — as alum, tannic acid, etc., may be tried, or such haemostatic agents as the sesquichloride of iron, nitrate of silver, etc., or even the actual cautery in a fine point. If, however, the cord is sufficiently long, it is better to apply a ligature ; this will check the bleeding, and the cord will slough away in four or five days. In applying the ligature, however, the operator must be careful not to include a portion of intestine within it ; and when there is much infiltration of the cord, as sometimes happens, the serum should be got rid of, as much as possible, by squeezing with the fingers or sacrifica- tion, in order that the ligature may exercise sufficient compression after- wards. PERSISTENCE OF THE URACHUS. 721 Artificial respiration is sometimes required when syncope or asphyxia is present, and this alone often suppresses the haemorrhage. The transfusion of blood may be urgently demanded in extreme cases. CHAPTER HI. Persistence of the Urachus. In studying the development of the foetus, we described the urachus (pp. 77, 87), and pointed out that it was a canal formed by the middle portion of the allantois, which passed through the umbilical ring, and during fcetal life communicated with the bladder, from which it conveyed the urine into the allantoid sac. After birth this canal is obliterated, its walls become a thin cord, and the bladder is retracted within the pelvic cavity, the urine then passing through the urethra. It not unfrequently happens, however, that from accidental circumstances or some malforma- tion, the canal of the urachus is only partially or not at all obliterated after birth ; consequently, the urine continues to escape by drops or in a thin stream from the umbilicus or umbilical cord. This condition is far more frequent in solipeds than ruminants, owing to the urachus — like the umbilical artery — being firmly attached to the umbilical ring in the for- mer, and therefore not at oace withdrawn into the abdomen, as in the latter, when the umbilical cord is divided at birth. Therefore it is, that escape of urine from the navel is very seldom noticed in the calf ; while in the foal it is often witnessed, particularly when the abdominal ring re- mains very open, or the cord is excised close to the body. This condi- tion has, however, been seen in calves. It appears to be more frequent in male than female animals, and is most dangerous in the former ; in the latter, the discharge of urine by this abnormal channel often ceases spontaneously, only passing at first in drops ; whereas, in the male, it generally escapes in a stream, little or no urine being discharged from the urethra. Treatment, In some cases scarcely any treatment is necessary, the escape of urine ceasing in a few days after birth ; and when interference is demanded, a cure can generally be effected in a short time, if the urethra is pervious. Be'nard {Recueil de Med. Veterinaire, 1828) mentions an instance of this accident, in which death occurred two days after applying a ligature to the urachus ; it was then discovered that the urethra was imperforate, so that the urine could not be expelled at all. It is therefore necessary, before adopting remedial measures, to ascertain that the urethra is patent. When the urachus protrudes sufficiently from the umbilical ring, a lig- ature may be fastened firmly around it. When it is close to the abdominal ring, and consequently too short to be secured by the ordinary ligature, it must be secured by a curved needle. The foal is thrown on its left side, and the operator, holding the nejedle armed with the thread in his right hand, seizes the urachus, which is covered by the skin, between the thumb and index-finger of the left hand, and pulls it outwards ; the needle is then passed through be- 46 722 DISEASES AND ABNORMALITIES. hind the canal, induding as little of the skin as possible, and the ends tied. If there is any doubt as to the patency of the urethra, the ligature should only be partially tightened, until the nature of the obstruction is ascertained and removed. When this is done, then the ligature may be firmly tied when the urine escapes freely by the natural channel. In those cases in which the urachus cannot be secured by this pro- cedure, astringents or caustics — such as the sulphate of copper — may be successfully employed. Beneficial results have been obtained by the ap- plication of a strong vesicant around the umbilical ring, the tumefaction caused by it closing the opening. The actual cautery has also been most successfully employed, particularly in a fine point. In the foal this accident is not uncommon ; in the calf it is so. 1. Ercolani {Osservazioni di Anatomia PatJiolo^s[ica Cotnparata, Bologna, 1872) gives an interesting relation of this accident in a calf about thirty xlays old. 2. Cingolani {Gichrnale di Med. Fratica della Societa Vet. Torino., 1876, p. 214) relates that a Cow brought forth a well-developed female calf which, five hours after birth, was observed to pass its urine, not in the ordinary way, through the urethra, but in con- tinual drops from the navel. Cingolani examined the creature carefully, and could not discover any indications of atresia of the urethra; but nothing was done for fifteen days, during which time the urine escaped by the same channel, and the urachus protruded like a tap. A ligature was then applied, and the opening closed. On the succeeding evening serious symptoms ensued; the belly was much 'retracted, and great pain was 'caused by pressure ; there was intense fever, and the calf was comatose. The operation being suspected as the cause of these symptoms, the ligature was untied, but no urine now passed from the navel ; neither did any pass from the urethra, though on a catheter being introduced, between 100 to 120 grammes were Withdrawn. No relief was afforded ; the abdomen became greatly enlarged, and the pain increased ; the pulse was small, the extremities were cold, and tetanoid spasms were noticed. In two days the calf died. An examination revealed obliteration of the urachus by plastic exudation, the kidneys were hyperaemic, the ureters opened into a small cylindrical reservoir about 14 or 15 centimetres long, which contained only about 100 to 120 grammes of urine ; this appeared to be the bladder, and from it passed the urethra, while underneath was a wide opening into the urachus. In the abdominal cavity was about a litre of urine. The symptoms presented by the animal during life were evidently due to uraemia. CHAPTER IV. Umbilical Hernia. ExoMPHALUS omphalocele, or umbilical ox navel hernia is not at all rare in young animals, and is perhaps most frequently observed in foals and pup- pies ; it does not appear to be so common in calves, and in pigs and lambs it is seldom seen. It would seem to be more prevalent in some countries or regions than in others. Marlot states that in every score of foals or mules bred in France, one is so affected. The hernia or rupture may ap- pear at birth or some time after, and may continue during the life of the animal if no measures are adopted to cure it ; it may be congenital or ac- quired. The congenital form is produced during foetal life, when a portion of the digestive and biliary apparatus is contained in the umbilical cord, the anatomy of which has been described at page 86. The embryonic connective tissue or Whartonian gelatine, in which are imbedded the two umbilical arteries and vein (two in the calf and pig), is very abundant at the elliptical opening named the umbilical ring, through which also pass the urachus, the omphalo-mesenteric vessels, and a portion of intestine. After birth the u'mbilical cord withers, and the Whartonian gelatine be- i':::uLiCAL hernia. 723 comes condensed and organized, forming a fibrous membrane which closes the umbilical opening, and gradually contracting, brings the two edges together ; these unite, and soon nothing is left to mark the situa- tion of the opening, except a short lozenge-shaped fibrous cicatrix : the intestine had previously been retracted within the abdomen, and the urachus, becoming contracted after birth into a thin ligament, while the blood-vessels are obliterated. It sometimes happens, however, that the process of cicatrization is either prevented, retarded, or interrupted ; consequently, the umbilical ring remains more or less patent, and certain viscera either remain in it, or are pushed into it by an internal pressure, and lodged in the pouch formed externally by the skin. In this congenital hernia, the vein or veins and the arteries are separated by the misplaced viscera, the former being usually in front, the latter behind. The lesion may be observed at the moment the animal is born ; and after the cord is ruptured it may happen that the abdomen remains open, the viscera being exposed ; the creature then generally succumbs quickly. Acquired or accidental umbilical hernia usually appears soon after the cord has withered, or within a few months after birth. A true and false exomphalus have been described : the first being that just mentioned, in which hernia takes place through the umbilical ring ; while the second occurs through an accidental opening in the neighboring aponeurotic or muscular tunics of the abdomen, and is in reality ventral hernia — occurring, as it generally does, after birth and in adult animals. Various kinds of umbilical herniae have also been alluded to, according as the viscus is intestine or omentum, or both ; thus we have enter omphalus^ mesentero or epiplomphalus, and entero-epiplomphalus. The last is most frequently observed in carnivorous animals. Causes. We have just alluded to the cause of congenital hernia. Acquired or accidental hernia may be due to severe or sudden muscular exertion ; as when the foal or calf runs or jumps very actively during its gambols or when pursued, or in falls. It is sometimes produced when the young creature is separated from its parent, and being kept in an isolated place,, it rushes about and cries energetically. Umbilical hernia has also been known to follow an attack of colic, and after constipation or diarrhoea. There appears to be generally present, in umbilical hernia, a certain organic predisposition, due to the suppressed or imperfect organization of the Whartonian^ gelatine ; and it has been remarked that common-bred animals are more liable to it than those of the higher breeds. Neverthe- less, in all those in which it manifests itself — no matter what the breed may be — there is usually constitutional debility present, due in many in- stances to the mother having been ill-fed and badly cared for during- pregnancy. Zundel says that there are years in which the accident is usually frequent, and particularly ^vhen much rain prevails, as then the food of herbivorous animals is more aqueous than usual. Low, wet, marshy pastures are also believed to predispose to hernia ; as in them the tissues become soft and relaxed, and the digestive organs inordinately bulky ; foals and calves kept in these situations have the belly voluminous, and the extrinsic pressure v/eakens the abdominal walls. Benard, Hamon, Cruzel, Bouley, and others believe in heredity as a predisposing cai>se : 724 DISEASES AND ABNORMALITIES. Mares which were affected with umbilical hernia when young, have pro- duced foals which presented this lesion. Pathological Anatomy. The hernial pouch or sac is nearly always lined by peritoneum — the peritoneal investment being produced at the same time as the hernia. In some instances, however, the peritoneum gives way to the pressure of the viscera, and then the walls of the sac are composed only of connective tissue and skin. The latter is frequently so much stretched that it becomes thinner, and in puppies is generally quite transparent. Marlot says that the sac is usually composed of five layers : i. The parietal peritoneum ; 2. A very fine fibrous layer constituted by the fascia transversalis ; 3. A kind of dartos formed by the tunica abdomi- nalis ; 4. The panniculus carnosus muscle ; 5. The skin : the whole being connected by connective tissue. But this arrangement is far from being constant. The opening of the hernial sac corresponds to the umbilical opening, which is elongated, and measures in the foal from i^ to 3^ inches in length, its width being variable, but never exceeding two inches. The viscera contained in the sac are usually the small intestine, omentum, free colon, and the point of the caecum. Lanclot, Be'nard, Delafond, Hertwig, and others have sometimes found the urachus in the sac, as well as intestine ; but in congenital hernia, the urachus can scarcely fail to be absent, and we may also have the umbilical veins. It rarely happens that there is any adhesion between the hernied organs and the sac containing them, inflammation being rare ; the sac seldom indeed contains any serum, and is therefore in immediate contact with the misplaced viscera. When ascites is present, however, serous fluid may then be present, and constitute the diseased condition termed " hydro-enteromphalus." Symptoms. The symptoms of umbilical hernia are, as a rule, entirely local. There is a round or pyriform tumor situated in the region of the umbilicus or *' navel," varying in size in different individuals and species — from that of a pigeon's egg to a child's head, or even larger. The siz-e also varies in the same individual at different times, according as the digestive organs are full or empty, the attitude standing or recumbent, at rest or undergoing active exertion, or the duration of the hernia — the older it is, the larger the tumor. It is usually soft, fluctuating, easily depressed by the finger, and as readily resuming its ordinary size and shape ; when recent, however, it is often tense and not depressible. Sometimes it has a doughy feel and fluctuates much, and at other times it is flaccid, accord- ing as the portion of intestine which it contains is empty or filled with alimentary matters. It is nearly always indolent, and in the large majority of cases can be reduced by throwing the animal on its back, by manipulation externally, or by taxis internally. The tumor soon returns, however, particularly when the animal lies down or moves about ; closing the nostrils or causing the animal to cough, will also produce its imme- diate appearance. When the sac has been emptied by pressure or taxis, the opening in the abdomen can then be perceived. As a general rule, the volume of the tumor corresponds to the dimensions of this opening, which is sometimes elliptical, at other times nearly or completely circular ; in false or acci- UMBILICAL HERNIA. 725 dental hernia, it is usually irregular in outline. The borders of the opening feel tense and resisting. On applying the open hand against the tumor, the vermicular move- ment of the intestine can be ascertained \ careful taxis may lead to the discovery of a loop of intestine in the sac ; while auscultation may detect the rumbling of the displaced viscus. When the tumor is not reducible, this is generally due to the presence of an accumulation of f^cal matters or other substances in the intestine. Inflammation is rare, and is ordinarily due to contusions or other exter- nal influences. Strangulation of the intestine is likewise far from frequent. Prognosis. Umbilical hernia is not a serious condition in young animals, except in rare cases. Sometimes spontaneous recovery takes place ; in the great majority of instances a cure is easily effected ; and even when the hernia persists there is but little danger, health and utility being seldom inter- fered with. When the hernial sac is occupied by omentum only, and the abdominal opening is small, there is much less danger than when the intestine is involved, while spontaneous recovery is much more probable. In adult animals umbilical hernia is often a serious accident ; and its gravity generally depends on the volume of the tumor. Complicated hernia is always dangerous. Though not at all serious in itself, when affecting young animals, yet from their diminished value, and the expense of treatment, umbilical hernia may become a cause of much loss. Marlot estimates that in France this accident causes a loss of more than a million francs to French agriculture. We know nothing as to its prev- alence in Britain. Diagnosis. The diagnosis of umbilical hernia is not difficult, so long as it is uncom- plicated. If, however, the tumor is hot, painful, and oedematous, it may be mistaken for an abscess or a recent traumatic hernia ; it may also assume the appearance of an indolent fibrous tumor or a " cold abscess," when the contained intestine is filled with faeces. It is not easy to distinguish between enteromphalusand epiplomphalus, even when there is no complication. Causing the animal to cough may enable the expert not only to diagnose the presence of umbilical hernia, but also whether it is of the omentum or intestine, the effort producing enlargement of the tumor when the intestine is misplaced. Treatment. We have stated that umbilical hernia in young animals often disappears spontaneously ; and though there are several ways in which it can be remedied artificially, yet unless there are reasons to fear complications, or a cure is desired early, it may be well to consider whether it is not advisable to wait — at least for some time, to see if spontaneous recovery will take place. It is well known that during the lactation period, the small intestine, which is at this time the most developed portion of the alimentary canal — instead of occupying the left flank, lies immediately on the floor of the abdomen ; but as the young creature grows and its diet is changed from milk to the food on which it is for the future to subsist, this intestine is gradually removed from' the umbilical region by the 726 DISEASES AND ABNORMALITIES. development of the caeco-colic mass, which occupies its place. In this manner, the natural changes occurring in the digestive apparatus may bring about a spontaneous cure of the hernia. It may be, therefore, advantageous to wait for some time before resort- ing to treatment : allowing the young animals good tonic food, in small quantity at a time, to prevent undue development of the abdomen after weaning, and bathing the tumor with cold water or some mild astringent lotion. When treatment has to be resorted to, it is generally recognized that, for the foal and calf, autumn is the best season, as the animal is older and stronger, and less likely to suffer from the necessary operations. The methods of treatment comprise (i) bandaging, (2) topical applications, (3) constriction^ (4) operations for complications. I. Bandages. — A truss or retaining bandage for the cure of umbilical hernia, consists essentially of a wide girth or roller placed around the body, and by the aid of which there is maintained over the tumor, and against the umbilical opening, a pad intended to prevent the viscera from again descending, when the hernia has been reduced. By this means Fig. 2 10. Armatage's Truss applied for Umbilical Hernia. temporary mechanical occlusion of the opening is obtained, until the physiological and permanent closure of the latter can be effected, and its borders are firmly united. There are various bandages which may be usefully employed with this object — the chief desideratum being sufficient solidity, simplicity, fixity, and ease for the animal. Marlot has proposed a truss, for which he claims solidity, fixity, and elasticity. This consists of a kind of well-stuffed sad- dle, from the four corners of which pass leather straps, which are buckled to two girths — one of which is of canvas webbing, and passes round the chest ; the other, of india-rubber webbing, goes round the belly, and main- tains a pad against the umbilicus. This pad is a wide, but not very thick, cushion stuffed with horse-hair, and which a broad longitudinal band uniting the pectoral and abdominal girths prevents from slipping back- wards. In Italy, the Massiera truss is employed. This is also a kind of smajl saddle with two wide girths passing under the chest, and pressing against the sternum and epigastrium a plate of iron, the posterior ex- tremity of which, corresponding to the umbilical ring, and covered by a leather cushion stuffed with -horse-hair, is applied to the seat of hernia. UMBILICAL HERNIA. 727 In Germany, Strauss's apparatus is in vogue. This likewise consists of girths disposed in a similar manner, with a kind of martingale to prevent them gliding backwards. If a pad is used, Lafosse recommends that it should not be too convex or elevated in the middle. Armatage advises the employment of a similar arrangement or harness, which furnishes a compress at the proper part; it is merely a number of straps, capable of being shortened or lengthened, as may be necessary in order to fit animals of different sizes (Fig. 210). It usually requires from one to three months to effect a cure, the period depending chiefly on the size of the hernia. A tonic regime hastens re- covery. Some veterinary surgeons combine agglutinative agents with the use of the truss — employing, for instance, a pad steeped in a mixture of pitch and turpentine. Before the truss is applied, it is, of course, necessary to reduce the hernia, and place the pad exactly over the umbilical opening. Trusses are chiefly objectionable from the long time they must remain on the animal, and the tightness with which they must be applied in or- der to act beneficially. This inconveniences and often injures the young creature, and not unfrequently causes it to fret, impairs its appetite, and induces loss of condition ; and though highly recommended by Marlot, Lafosse, Perosino, Schreger, Strauss, Ungefrohrn, and many others, they are not always to be preferred to other methods of treatment. 2. Topical Applications. — Topical applications have been for cen- turies employed for the cure of hernia, Celsus having recommended the use of sulphuric acid, which was resorted to at a later period by the early hippiatrists : and since 1833, when it was brought to notice by Hertwig, it has been used in Germany, being applied to the tumor every two or three days. The subcutaneous serous infiltration, and the plastic exuda- tion in the hernial sac, drive the misplaced viscera into the abdomen, and in becoming absorbed afterwards, produce obliteration of the cavity and its opening. Blisters act in the same way ; and applications of alcohol, creosote water, and other agents, have been largely resorted to. But Gi- rard, D'Arboval, Benard, and Mignon have asserted that these topical ap- plications were very uncertain, and even dangerous, as the irritation they produced readily causes adhesion between the w^all of the sac and the or- gans it contained, and thus rendered reduction impossible. But in 1848, Dayot, and more recently other veterinarians, had drawn attention to the value of nitric acid cauterization in umbilical hernia. The acid is applied to the skin covering the tumor until at first an eschar is formed, and, finally, detachment of the cutaneous hernial sac is achieved. In order to effect this, the hair is removed from the skin, and by means of a spun-glass brush or cotton-wool fixed on a glass rod, nitric acid of commerce is applied around the base of the tumor at first ; then over the other part it is used in sufficient quantity, and with friction, so as to de- stroy the skin and ensure its speedy mortification and sloughing. Expe- rience has proved that the more profound the disorganization, the more certain is the beneficial action. According to Lafosse, it requires from 24 to 32 grammes of acid for a hernial tumor the size of a fist; and the friction, which ought to be as equable as possible over the whole surface, should be continued for three to five minutes — supposing the animal to be quiet and the rubbing not interrupted. A smaller quantity of acid 728 DISEASES AND ABNORMALITIES. and less friction, may be employed to herniae which are not so consider- able in volume, and are covered by fine skin. When the animal has to be thrown and placed on its back, the quantity of acid and amount of friction must also be diminished. Dayot recommends that the application be repeated once or twice in the hour, according to the thickness of the skin ; but it has been found that one application is generally sufficient, fifteen days being allowed to elapse in order to watch the result. If at the end of this time the skin is not destroyed, the application may be re- peated. The nitric acid produces a yellow eschar, which, if not dry on the first day, soon becomes soft, unctuous to the touch, and easily destroyed. With the formation of this eschar, there is much swelling, either immediately on the application of the acid, or soon after ; in some cases there is but little if any swelling. The tumefaction is due to the action of the nitric acid on the subcutaneous connective tissue, which is infiltrated, and causes a uniform pressure on the hernied mass ; this leads to the latter being pushed into the abdomen and kept there as if by a truss. The cedema- tous swelling established external to the tumor, is oblong and depressed in the centre, in consequence of the diminished elasticity of the central portion of the escharified skin ; in a few days it is gradually absorbed and becomes more consistent, while the skin in the centre becomes dry and hard, like parchment. Instead of the hernia, there is now only a newly-formed' mass of fibrous tissue, which is gradually lessened in vol- ume, condensed, and partly absorbed, like cicatricial tissue. At the same time the cauterized skin begins to be thrown off at the margin, the pro- cess of separation extending to the centre, where it takes a long time to be completed, because of the remains of the umbilical cord. When com- pletely detached, there is a granulating healthy-looking wound left, which may have some fibrous masses in its middle. This suppurates, dries, be- comes covered with a crust, and is gradually furnished with epithelium. In retracting, the wound contributes largely in closing the hernial open- ing, while the indurated skin which continues for some time to adhere to the abdominal walls, through the medium of the condensed connective tissue, contributes its share. In about a month cicatrization is finished ; the cicatrix remains destitute of hair and often of pigment. According to the testimony of Zundel and others, this mode of treat- ing umbilical hernia is prompt and speedy. There is generally no occa- sion to throw the animal down, and one assistant only is necessary ; it is rarely followed by accidents. These do occur, however, and the most serious and frequent is the escape of the intestines through the eschar, about eight days after the nitric acid has been applied. This unfortunate result has been attributed to excessive cauterization when the skin is thin and fine, though it may also occur from the animal rubbing or tearing off the sloughing cuticle when the pain or itching are troublesome. To ob- viate this accident, Rev, Lafosse, Legoff, and others recommend the em- ployment of a bandage, and quietude after the operation. Reynal has observed peritonitis as a consequence of nitric acid cauterization, and Lafosse mentions a case of tetanus due to this treatment. When the cauterization has not been sufficient, a relapse is likely to occur ; Lafosse has observed one in twenty successful cases. This in- sufficiency is generally noticed on the following day, in the absence or trifling amount of swelling ; but the cauterization must not be attempted again in less than two or three weeks. UMBILICAL HERNIA. 729 Hertwig, as has been mentioned, recommends sulphuric instead of nitric acid, and applies it in lines, night and morning, for two days, by means of a glass rod. CEdema soon sets in, and it may be increased by rubbing the cauterized surface with oil of turpentine and oil (one to two). The sulphuric acid, however, appears to be less prompt than the nitric. Strong blistering ointment applied at intervals of three days ; chromate of potass ointment (one to three) rubbed in once a day for five minutes at a time, on two consecutiv^e days ; solution of bichloride of mercury, and other topical irritants, have all been more or less suc- cessfully employed. Even the. actual cautery, in lines and points, has been resorted to j but the beneficial effect to be derived from it is uncer- tain, and at best it is very painful. Bouley {Recueil de Med. Veterinaire^ July, 1877) draws attention to Luton's method of subcutaneous injections for the cure of congenital herniae in infants, and believes it will be found more advantageous than any other treatment yet attempted 'for umbilical hernia in animals. Lu- ton's method consists in the subcutaneous injection of a few drops of common salt solution around the hernial tumor, by means of the ordinary subcutaneous injection syringe. Under the irritating influence of this injection, oedema sets in, and this mechanically repels the contained viscus, the margins of the abdominal opening come into apposition, and, with the connective tissue, are inflamed and soon unite. The needle of the syringe must not pass beyond the subcutaneous con- nective tissue. 3. Constriction. — Constriction of the hernial sac has been largely re- sorted to for the cure of umbilical hernia, with the view of destroying it by mortification, causing adhesion above the part where this has taken place, and inducing secondary cicatrization when the sac has sloughed away. The constriction is produced by ligature, dams, and suture. To apply these, the animal must, in nearly all cases, be thrown ; but before this is attempted, the tumor should be well examined, in order to ascer- tain if it is reducible, if there are adhesions, the extent of the abdominal opening, and the limits within which the constricting apparatus should be applied. The best position for reduction and constriction is the dorsal. The animal, if a foal, should be cast on a good bed of litter, and placed on its back. Very often the change of position reduces the hernia ; if not, gentle manipulation and pressure will effect this, and then the empty sac is pulled away from the body, and the operation completed. The oldest procedure is ligaturing the entire mass of the hernial sac by a piece of cord tied firmly round it, close to the body. This produces at first a merely mechanical occlusion, but subsequently this is physiologi- cal — exudation and organization of the plasma thrown out by the inflam- matory process set up, producing adhesion of the peritoneal surfaces. A piece of whipcord answers very well for this ligature, but it must be drawn very tight around the neck of the sac, in order to produce its im- mediate and consecutive effects. To keep the ligature in place, some practitioners pass one or two wooden pegs through the sac where it is encircled by the ligature ; these prevent the twine being displaced by the swelling which quickly super- venes. Sometimes a ring is employed^ which is less in diameter than the 730 DISEASES AND ABNORMALITIES. umbilical opening, and through which the hernial sac is passed before the ligature is made. Some authorities prefer a double ligature, made by passing a double cord through the base of the sac by means of a sacking-needle, and tying each separately or entirely round the sac. Sometimes the ligatures are multiple ; and Legoff has recommended the employment of several liga- tures passing through the sac from apex to base, each becoming tighter as the abdomen is neared. Ligatures are very simple and easily applied, but they have their draw- backs, and these have led to their disuse. Among their disadvantages are uncertainty in their action — which is sometimes too intense, at other times insufficient ; the sac often sloughs off before adhesion has taken Fig. 211. Umbilical Clam. place to such a degree as to sustain the weight of the abdominal viscera : and it has been pointed out that there is risk of including or wounding the intestine. Very favorable results obtained by the elastic ligature in castration, are recently reported by Guerin {Recueil de Med. Veterinaire, July 30, 1877) ; this ligature might prove very effective in umbilical hernia. The procedure by clams is often resorted to, particularly when the hernia is serious. The ordinary wooden clam (Fig. 211) may be employed, or one of iron, either hinged at one end or tightened by screws. To render the coaptation of the two branches of the clam more perfect, and to prevent the Fig. 212. Armatage's Iron Umbilical Clam. instrument slipping when tumefaction sets in, as well as to produce more prompt inflammation, adhesion, and gangrene, various contrivances are in use. Borhauer has used a clam, in the branches of which are a num- ber of holes placed opposite each other, and through which wooden or metal pins can be passed when the instrument is fixed on the sac. Other practitioners use a clam with toothed branches, the teeth perforating the walls of the sac. Armatage recommends an iron screw clam, one branch of which has a long deep groove, and into this fits a narrow projecting ridge on the opposite branch (Fig, 212). To apply the clam, he gives the folio\ying directions : " The animal is (EDEMA OF THE UMBILICUS. 731 secured and placed on its back. The skin over the rupture is drawn together by the fingers in a flat fold, corresponding with a central longi- tudinal line through the abdomen {linea alba), and elevated from the parts beneath, in order to cause the intestines or omentum to descend. The clam is then put over the skin, as close to the abdomen as possible, and the screws tightened. The pressure must not be too severe, or the parts will drop off too soon, and possibly the intestines may escape. The operation, therefore, requires to be carefully watched." Sutures are frequently employed, and there are various ways of using them. One method is the "twisted " suture, which is applied as follows : The hernial sac is included between two round pieces of hard wood or iron, which are drawn tightly together by whipcord passed round their extremities before and behind ; double sutures are then passed through the sac, one of which is tied to the piece of wood on one side, and the other to that on the other side — so that the sac is completely invested between the wood and ligatures, which divide it into two portions. Another procedure by suture is to make a thick longitudinal fold of the skin covering the hernia, to pass the suture needle — armed with a waxed thread or cord — as near to the muscles as possible, and about three to four inches from the ring, from before to behind, or one side to the other ; the needle is again passed through in the contrary direction, about half an inch from the first perforation, and the two portions of suture firmly tied, so as to draw the skin together like the mouth of a sac. Sutures are then passed through the sides of the pedicle and tied, so as to include the whole of the skin in the multiple loops. A cure by this procedure is usually effected in about fifteen days. The only objection to the opera- tion appears to be the danger of wounding the intestine by the needle. To obviate this, some operators, after reducing the hernia, pull the empty sac well away from the abdomen, and pass it through a partially split piece of lead which is applied close to the belly ; then the needle can be used without risk, as the lead — which is secured in situ — forms a shield as well as a truss, and prevents the descent of the intestine until adhesion has taken place. When the hernia is irreducible or strangulation has taken place, then it will be necessary to carefully open the sac. Should adhesion have taken place between the latter and the intestine, or between the skin and per- itoneum, this must be broken up ; if the umbilical ring has to be incised in order to return the viscus, this may be effected by a probe-pointed bistoury. The incision should be no longer than is absolutely requisite. The after-treatment of operation for hernia must be conducted on surgical principles, and according to the necessities of the case. CHAPTER V. CEdema of the Umbilicus. * Tumefaction, or rather " oedema " of the umbilical region, is not at all rare. Often it is simply due to an effusion of serum in the connective tissue of the umbilical cord, and sometimes to an infiltration of blood in this part and the surrounding connective tissue. This accident is usually produced by contusion and laceration during 732 DISEASES AND ABNORMALITIES, •birth, though at times it may also be caused by the young creatures, when two or more are together, sucking and pulling at the remains of the umbilical cord. It may also be due to chronic inflammation of this part, or the formation of abscess in the umbilical ring. The accident is readily recognized ; the swelling is often very consid- erable, and always cold to the touch. It often persists a long time in bovine animals ; and Zundel says that it then constitutes a grave defect in young bulls, which it mechanically prevents from copulating. When due to sclerosis of the connective tissue, it is usually persistent. Treatment. Cold applications and compresses have been recommended in the way of treatment, as well as lotions of arnica, camphorated spirits of wine, preparations of iodine, mercury, etc. These often fail, however, and it is generally better to resort to scarifications or leeches at once, to be succeeded by hot water fomentations. When the swelling is chronic, and due to a blood clot, which is sometimes the case, Baumeister recom- mends enucleation. CHAPTER VI. Inflammation of the Umbilical Cord. Inflammation of the umbilicus, or o?tiphalitis (the so-called " navel-ilV of shepherds), is a serious accident, and often terminates fatally. It con- sists essentially in inflammation of the umbilical vein, which sooner or later involves the adjoining tissues, and is often followed by suppuration and pyaemia, which causes the death of the young creature. It is rare indeed that the inflammation remains of a simple kind throughout its course. As a rule, it is not merely an omphalo-phlebitis, but involves the abdominal portion of the umbilical vein. There is a thrombus, which soon suppurates ; a fistula appears at the umbilicus, the umbilical vein is inflamed as far as the liver, to which the thrombosis extends, and the portal and hepatic veins may even be affected. As a consequence, the most serious accidents may arise. Embolic infarction of the lungs, liver, or other organs is likely to occur, with gangrene, septikaemia or pyaemia. Symptoms, The inflammation commences soon after birth. The remains of the umbilical cord, in the normal condition, quickly dries up and withers, as it were, within a few days after the creature is born. When inflamed, however, -the part appears to be moist, and projects from the abdomen as an enlarged, compact, and hard mass, from the centre of which flows a small quantity of thin, unhealthy, purulent-looking fluid that soils the surrounding skin. The peculiar tap-like appearance of the umbilical cord, its density and high tenaperature, with the discharge therefrom, will lead the careful observer to recognize the existence of omphalitis. A probe can bfe readily passed into the umbilical vein, which remains patent to a considerable extent. The local symptoms are often over- looked at the commencement, and the first general signs of omphalitis observed are usually dulness, arched back, indifference to the teat and INFLAMMA TION OF THE UMBILICAL CORD. 733 to surrounding objects, persistent recumbency, fever, and hurried pant- ing respiration wlien general infection takes place, and embolism of the lungs exists. As the malady progresses, great prostration is manifest ; there is swelling at the umbilicus, and intense pain on manipulation of that region ; the eyes are dull and injected, the mouth very hot and dry ; the pulse is so small and quick as to be scarcely perceptible ; the bowels may be constipated and the faeces scanty, or obstinate diarrhoea may su- pervene ; the urine is greatly diminished in quantity ; the mucous mem- branes often assume a yellowish tint ; soft, fluctuating swellings, contain- ing a yellow gelatinous fluid, often appear on various parts of the body; the creature refuses to suck; indications of colic or peritonitis are some- times manifested, with enterrorhagia ; and in the majority of cases death rapidly ensues. Not unfrequently the phlebitis is most intense in the internal abdom- inal portion of the vein, and the pus, instead of freely escaping from the external opening, accumulates in the canal to such a degree as to form a large swelling at the umbilical ring, which might be mistaken at the first glance for a hernia. When this swelling has been opened, about half a pint of pus has escaped in some instances. When a fatal termination does not quickly follow from septikaemia, or from embolism of some important organs, through detached portions of the thrombus being carried into them by the circulation, we may have chronic morbid conditions of a pyaemic character set up, which are char- acterized by metastatic inflammation of the serous membranes in various parts of the body, and particularly of the articulations. Indeed, it is now recognized by the highest continental veterinarians that the destructive arthritis or "^joint disease " of foals, calves, and lambs is attributable to omphalo-phlebitis. Inflammation of the joints — especially those of the hocks — has often been accidentally produced by the inflammation ex- cited through ligaturing the umbilical cord. Metastasis to the iris, choroid coat of the eye, diarrhoea, tumefaction of the lymphatic glands, abscesses in the muscles and other parts, and other accidents, have been observed as a result of inflammation of the umbilical cord. Pathological Anatomy. In animals which have died or been killed in consequence of this dis- ease, the walls of the umbilical vein throughout the course of the vessel, are much thickened, and the communication with the portal veili entirely interrupted by a blood clot. The vessel is filled by a yellow pulpy mass, foul-smelling in some cases, odorless in others ; while its ifitima is de- tached, and forms part of the contents. In the abdominal cavity we may find effusion, exudation, and adhesion of various viscera, with peri- toneal haemorrhagic spots. The portal and other abdominal veins often contain matter similar to that in the umbilical vein ; the liver is enlarged, in some cases atrophied, qlay-colored, and almost bloodless. The lym- phatics of the liver and mesentery are usually nodulated, swollen, and infiltrated. The lungs in many instances exhibit intense haemorrhagic infarction, lobular pneumonia and its consequence, and particularly pur- ulent broncho-pneumonia. In special cases, to be alluded to hereafter, the joints are swollen and inflamed, and their capsules contain pus. When the creature lives until it becomes cachectic, fatty degeneration of the muscles, with ecchymoses in various parts of the body, are nearly always noticed. 734 DISEASES AND ABNORMALITIES. Causes. The causes of omphalitis are numerous. They may be enumerated as follows : the admission of air or foreign matters to the interior of the umbilical vessels ; bruises or injury to the umbilicus, either during birth or afterwards ; irritation of this part either by the litter, manure, or urine ; the habit which certain females have of licking the umbilicus of their progeny, or of young creatures to suck the remains of the umbilical cord of each other ; rupture of the cord close to, or within the abdomen ; improper food given to the mother ; exposure to cold and wet ; and in- fection. Bollinger admits that in certain establishments, in consequence of over-crowding, the omphalitis of young animals may become erysipe- latous, and be due to an analogous infection to that which produces the oftentimes fatal inflammation of the umbilical cicatrix in the new-born children in maternity hospitals. Rueff asserts that omphalitis is more frequent in some years than others. There can scarcely be any doubt that, as Franck remarks, this inflam- mation is largely due to contact of the atmosphere with the umbilical wound, and to the ingress of germs which excite zymosis ; or to contact with filth or putrid matters. There can scarcely be a doubt, also, that the manner in which the um- bilical cord is divided at birth has an influence in the production of this inflammation ; indeed, this division or rupture of the cord necessarily produces a wound which is readily absorbent under all circumstances, until the remaining portion attached to the umbilicus becomes dry and shrivelled. The exposed umbilical vein and artery in the foal, the double vein in ruminants, also increase this readiness to receive infection, and consequent tendency, to phlebitis ; and these vessels are occasionally laid quite bare when the cord is divided close to the umbilical ring, and their protecting sheath is removed. Franck gives an instance of this accident, which was witnessed in the breeding sheds of the Munich Veterinary School. A Cow brought forth twin calves, one of which — A — had the umbilical cord ruptured in the usual way, while the other — B — had it torn asunder in a markedly abnor- mal manner. Alongside this Cow stood another which had recently calved, then was attacked with puerperal fever, and eventually succumbed to that disease. The aftef-birth of this animal was allowed to lie behind the Cow which had given birth to the twins ; so that there was no lack of infection-pro- ducing material — the floor, straw, implements, as well as the hands of the cowmen, being impregnated with it. The calf — B — which had the umbilical cord abnormally ruptured, be- came affected with omphalitis ; while the other — A — with the wound better protected, escaped infection and remained in good health. This cause of ompklialitis must be frequently and extensively in opera- tion among the lambs of flocks of Ewes, when abortions occur among these, or when putrid matters are discharged from the vulva, or even when gangrenous or septic mammitis is present among them. It is often remarked that omphalitis sometimes appears among a larger number of lambs on a particular pasture ; and it is extremely probable that careful investigation will lead to the discovery that many of these outbreaks are largely, if not entirely, due to septic infection of this kind. Franck has observed such occurrences in extensive cowsheds, when sometimes of ten INFLAMMATION OF THE UMBILICAL CORD. 735 to fifteen calves born within a few days of each other and kept together, half the number has become affected with this inflammation of the navel, and the remainder has escaped. . It must be remembered, too, that the discharge from one diseased um- bilicus may afford sufficient material to infect a great many newly-born animals, should circumstances prove favorable. Not only may contamination take place through actual contact with objects soiled or impregnated by such infective material, but the air itself, or flies, may prove media for its conveyance to the umbilical wound. There may also be a special infection, as a consequence of over-crowding in badly-ventilated dwellings — something analogous to the puerperal in- fection observed in certain maternity and other hospitals. A malignant and a benignant form of omphalitis have been described by various authorities ; but the distinction, if it really exists, is of no prac- tical importance, and it is perhaps advisable, in so far as treatment is con- cerned, to consider the disease always as malignant. It would appear to be fully ascertained that septic infection gives rise to a far more serious and destructive inflammation than that due to entrance of the air, or an aerial ferment, into the wound or open vessels of the cord. As has been remarked, this inflammation of the umbilical cord is more frequent in calves and lambs than in foals ; and the reason for this is probably due to the fact that in the former there is a dudics Arantii^ which is absent in the latter. There may also occur a kind of aspiration of air into the umbilical vein. However this may be, it must not be forgotten, when considering the etiology of omphalitis and its frequency in differ- ent species of animals, that putrid or septic diseases are much more com- mon in Cows and Ewes than Mares, and that the latter do not so often receive manual assistance during parturition ; so that they are less liable to parturient fever and other septic disorders which might involve their offspring. When the remains of the umbilical cord are once fairly dried and shrivelled, omphalitis is very seldom, if ever, v;itnessed. Ulrich {Canstatfs Jahresbericht, i860, p. 41) reports that he saw a wide outbreak of the disease in a flock of lambs, many of which died from abscess in the liver. He attributed the outbreak to feeding the Ewes on rape-cake. Changing the food to oil-cake, and administering Glauber salts to the Ewes checked the malady. Franck is inclined to think that infection may have had something to do with the outbreak. Treatment. T\i^ prophylaxis oiovc\'^\i2X\\\% or purulent phlebitis of the umbilical cord, is very important, and must be based on our knowledge of the etiologv of the malady. This we have just alluded to. Cleanliness is absolutely ne- cessary, and the young creature should be protected from every possible source of septic infection. The danger of infection may be greatly obvi- ated, if the extremity of the umbilical cord be dressed with a concentrated solution of carbolic acid, which destroys atmospheric germs, keeps away flies, and renders putrid matters innocuous, while it quickly shrivels up the cord itself. This preventive treatment is strongly to be recommended for lambs, and particularly when there have been abortions among the Ewes, retention of dead lambs or the placental membranes, or any other likely cause of putridity on a sheep-run or pasture. The same measure is appli- 736 DISEASES AND ABNORMALITIES. cable to the calf and foal, but in all care must be observed not to apply the acid to the parts surrounding the umbilicus. Curative treatment must be chiefly of a disinfecting and antiseptic kind. At the commencement it must be chiefly local, and the applications most likely to prove beneficial are lotions of carbolic acid, salicylic acid (par- ticularly if fever runs high), salicylate of soda, permanganate of potass, borate of soda, alum, or other astringent. If the umbilical vein is readily accessible, one of these lotions may be introduced into it, either by a fine bone probe wrapped round with lint, or by a syringe. Franck states that a five per cent, solution of carbolic acid may be passed in this way into the abdominal portion of the vein of small calves ; this vessel can be pene- trated to a distance of nearly ten inches. He does not approve of inject- ing the solution, because of the danger of injuring the portal vein. If the suppuration is superficial, the same lotions may be used, or the part may be cauterized with solid nitrate of silver. When the inflammation is very intense, several authorities recom- mend recourse to vesicating agents ; others employ ammoniacal liniment, and Rueff advocates tartarized antimony ointment. .When there is danger of general infection, or this has already oc- curred, then the internal administration of antiseptic agents must be resorted to. Franck recommends salicylate of soda in doses of about one gramme every hour. Carbolic acid, sulphite of soda, or other agents of this class may also be given with advantage. Constipation may be averted by castor-oil or a suitable diet — skimmed milk alternately with new milk. Preparations of iron may also be ad- ministered j and if the young creature is still at the teat, its dam should be well fed. Franck notes that, during omphalitis, the most serious complication is inflammation of the umbilical artery, the existence of which can gen- erally only be detected on a post-mortem examination of an animal which has died,' or has been killed because of the disease. This complication is more frequent in the foal than the calf, probably because the vessel is torn at the umbilical ring in the first, and in the abdomen in the second. The peripheral portion is thickened, and contains a reddish-colored thrombus, or is filled with a puriform breaking-up mass, and often the vessel is surrounded by, or imbedded in, an abscess ; a sharp line of de- marcation separates the inflamed from the healthy portion. General infection or pyaemia rapidly follows umbilical arteritis. CHAPTER VII. Arthritis. Disease of the joints of young animals, occurring soon after birth, has been for a long time recorded in districts or regions where breeding is largely carried on ; the animals affected belonging to the equine, bovine, and ovine species — much less frequently are dogs and pigs attacked. In France it is usually known as the " Arthrite " or " Paralysie des Jeunes Animaux," in Germany as the " Fohlenlahme," " Kalblahme," and " Lammerlahme," and in England — where it has evidently been but little ARTHRITIS. 737 studied, it lias been popularly known as " Joint 111," and technically as " Scrofulous Disease of the Joints," or " Specific " or " Constitutional Synovitis." The disease was first described, we believe, by Brugnone {Trattato delle Razze de Cavalli, Turin, 1781) ; then it was noticed by Roupp {Recueil de Med. Veterinaire, 1825), Lecoq in 1828, Strauss in 1831 {Darrsucht der Fohlen, Vienna, 1831), Benard in 1832 {Recueil de Med. ^ etc., 1832) Trager in 1839 {Fohlenkrankheiten^ Berlin, 1839), Noll in 1840, Darreau in 1842 {Recueil de Med., etc., 1842), Anker in 1848 {Kal- berldhme, Zurich, 1848), Roloff in 1865 {Fohlenldhme, Berlin, 1865), and Bollinger in 1873 {Zur Kentniss der Fohlenldhme, Virchow's Arc/iiv., Bd. 58, 1873), and in 1875 {Deutsche Zeitschrift fiir Thiermedicin, 1875). I" England, the most valuable description of the malady which has ap- peared, is to be found in a paper by Walley (" Joint 111 in Lambs," Vet- erhiary journal, 1876, p. 406). It has been more particularly described as it occurs in the equine race in Normandy, by Lecoq and Darreau, and in Poitou by Terai ; in North Germany by Trager, Bollinger, Strauss, and Roloff. In the bovine species, it has been portrayed as it prevails in Bourbonnais, by Benard and Gay ; in Switzerland by Anker, and in Bavaria by Bollinger. In the ovine species. Roll describes it as existing* in Hungary, Haubner in Saxony, Kuers in Prussia, and Chambert and Cauvet in the South of France. Walley alludes to its principal features, as it is witnessed in lambs in England. In some years it prevails very extensively, and appears to be almost enzootic in some portions of the above-mentioned countries. By some authorities it is supposed to be a constitutional disease, by others as scrofulous in its nature ; while others, again, consider it as essentially pyaemic, and a sequel of purulent omphalo-phlebitis. Roloff is of opinion that the affection is due to an alteration in the blood — to a diminution in the amount of mineral salts in that fluid — a veritable cachexia,' in fact, allied to rachitism or osteomalacia. In this view, the inflammation which attacks the joints and is symptomatic of the disorder, should be attributed, primarily, to a cachectic or scrofulous ' diathesis, and, secondarily, to the traction exercised by the ligaments, connective tissue, and periosteum imperfectly attached to the soft and unequally consistent bones, when the animal movies. Walley defines it as an inflammatory affection of the synovial mem- brane of the joints, of a specific character ; hence the terms " Specific Synovitis " and " Specific Arthritis." Causes. If there is some diversity of opinion as to the etiology of this joint disease of young animals, there is absolute unanimity as to its predis- posing cause — the period of youth, as it only appears during lactation. This fact disposes of its constitutional or hereditary nature, and has in- clined some veterinary pathologists to attribute its occurrence to an al- teration in the composition of the milk of the parent. Darreau believed that the malady is more frequent among foals which do not receive the first milk, which contains colostrum ; but this view is not borne out by other observers. Roloff has witnessed its advent in such a manner, that he thought it must be sometimes congenital. Walley states that the causes are entirely local, and can be traced to an impure or anaemic condition of the milk of the dam, as the result of improper 738 DISEASES AND ABNORMALITIES. systems of management, or giving food deficient in the necessary con- stituents of the blood. Hence, he asserts, it is seen when Ewes have been fed on an abundance of turnips, without a sufficient allowance of hay or corn, particularly if the turnips are decaying, or have been un- duly forced with artificial manures. It has also been remarked that it often occurs on heath lands which are much exposed, and have been top-dressed with marl ; but the ap- pearance of the malady only when the young creatures are at the teat, rather negatives the idea that exposure has any thing to do with it. It has likewise been noted, that when Ewes are fed on decaying turnips or mangold wurtzel, the lambs are frequently the subjects of effusions of lymph between the muscles — the effusion being arrested when corn is given to the Ewes. Walley insists upon an altered condition of the milk as the cause of the disease. '* That it is due to, and must be associated with, an altered condition of the mother's milk is proved by the fact that it only attacks young animals while sucking the dam ; that the Ewes coincidentally die from malignant paturient fever (though it must be borne in mind that it . is not necessary that the Ewe should exhibit any external symptoms of a diseased condition of the blood); and that it is frequently found to disap- pear on farms which have been heavily limed and drained, and also when a different system of management has been adopted. Again, the general post-mortem appearances bear a strong resemblance to those of distemper in the dog, especially of the hepatic form of the disease ; and the enlarged and softened state of the liver, where external symptoms have not been manifested, points to disease of a typhoid character, brought on by the imbibition of impure milk." He enumerates the exciting causes as "ex- posure ; cold, damp pastures (hence the more frequent localization of the disease in the joints); neglect at birth, allowing the young animals to be- come covered with mud and dirt, thus preventing the dam licking them ; excess of wet weather, etc." Roloff, as just mentioned, thinks the development of the disease is due to the insufficient ingestion of calcareous salts ; and as the malady is originated during intra-uterine life or the sucking period, it is evident, he adds, that it is in the regime to which the dam is submitted during gesta- tion, when the osseous system of the foetus is being developed, and when suckling, that the cause of the disorder must be especially sought for. Careful analyses have shown that the ash of the herbage or hay in the lo- calities where the malady makes the largest number of victims, does not contain more than six to eight per cent, of lime salts, while that of good quality should have from eleven to thirteen per cent. It is also remarked that this form of arthritis sometimes prevails in those places where the osteoclasty of cattle is frequent ; and this coincidence, it is affirmed, should indicate a common origin of the two affections — a defective sup- ply of calcareous salts, and particularly of the phosphates This defi- ciency is sometimes noticed when the food is relatively of a rich charac- ter ; though then the amyloid and proteic constituents are in excessive proportion. Bollinger, whose scientific and most valuable researches in compara- tive pathology entitle his opinions to the greatest consideration, enter- tains different views as to the origin of the malady ; and his anatomo- pathological investigations in this direction are of the highest interest and importance. His observations on this disorder commenced in 1869, ARTHRITIS. 739 at the Government Stud at Graditz, Silesia, where it prevailed enzootic ally and caused considerable loss. In that year forty-seven foals were attacked, and in 1870, twelve. Nineteen cases were not very serious ; but of the other forty, twenty-nine succumbed — a mortality of 72 per cent, of those affected. The foals were generally seized with it (75 per cent, of the cases) during the three weeks succeeding birth. Of the forty foals above alluded to, twenty were ill within the first eight days, ten in fifteen days, and the others in the fourth or sixth week. The period of the malady was, of course, related to the foaling season — April, May, and June. After an attentive study of the symptoms, and making postmortem examinations, Bollinger came to the conclusion that there is a complete analogy between the arthritis of foals — particularly in the "lesions observed — and the results noticed as a consequence of omphalitis in infants. In his opinion, this joint disease, with its complications, is due to metastatic pyaemia, which has its point of departure in the puru- lent omphalo-phlebitis described in the preceding section of this work. In a more recent publication, Bollinger returns to this subject ; and after alluding to his former opinion, founded on literary studies and clin- ical observations, that the lameness or disease of the joints which attacks foals and calves during the first weeks after birth, are due to primary al- terations in the apparatus of the circulation, viz. — inflammation of the umbilicus and umbilical vessels, he gives further evidence in support of this supposition. The autopsies of the calves which form the subject of his second communication, we will notice hereafter ; but we may men- tion that they afford indubitable evidence of the existence of puru- lent omphalo-phlebitis, and its consequences. As in foals, so in calves, he traces the origin of joint disease to violent inflammation of the um- bilical veins. He notes that in calves — which have a ductus venosus Arantii, and foals have not — the direct opening of the vessels into the posterior vena cava, as well as the general implication of the latter, causes a proportionately larger number of cases in them than in foals. The influences at work in the production omphalitis we have enumerated, but Bollinger lays great stress on the want of care, which is, as a rule, be- stowed on the navel in newly-born domesticated animals, and compares this neglect with the scrupulous attention -paid to that of infants, which is severed and bandaged immediately after birth ; while the former have to lie with an open wound in all kinds of filth, and are thus exposed in the readiest manner to inoculation with poisonous or injurious matters, which cannot be excluded even from stables built especially for the purpose, and kept thoroughly clean. If the navel wound of an infant was ex- posed to the filth which young foals and calves have to lie in, it would be quite as liable to blood-poisoning as animals, and to the consequent affection of the joints. Bollinger contests the influence of food in the production of the disease, as the strong, no less than the weak animals, are attacked ; and it appears when every kind of diet is given to the parent. He also denies that it is produced by chills, and attributes its advent chiefly to pyaemic or septic infection. He compares the enzootic appear- ances of joint lameness with the endemic outbreaks of pyaemia and septikaemia (or puerperal fever), and points out that the only real differ- ence between man and beast lies in the simultaneous appearance of puerperal fever epidemics with pyaemia in infants. One point is certain, he adds, and that is that there is a physiological and anatomical differ- 740 DISEASES AND ABNORMALITIES. ence between woman and the domestic animals. The anatomical struc- ture of the placenta and its villi, and its relations with the placenta mater- na, are of such a nature in these animals, as to prevent (on the normal detachment of the placenta) any rupture of the blood-vessels, and conse- quent haemorrhage. In other words, if delivery has been successfully ac- complished, no injury in the shape of wounds or abrasions is inflicted on the inner surface of the uterus ; and owing chiefly to this fact is the in- flammatory reaction and consecutive lochial fever reduced to a minimum among animals, and the introduction of poisonous matters (be they veg- etable organisms or other injurious substances) into the uterus is ren- dered much more difficult ; while we frequently find instances of the pyaemic process, due to inflammation of the navel and its vessels, among sucking animals, though with the parent — except in the case of the Cow — this process is rare. Symptoms. The symptoms of this form of arthritis are variously enumerated. The principal is extreme difficulty in moving which is often noticed with- out any other premonitory indication. The movements are painfully and reluctantly performed, so that the yoeng creature generally persists in lying. Around the epiphyses of the bones, and consequently near the articulations, there is swelling not only of the proper tissues of the joints, but also of the surrounding connective tissue ; with hot, oedematous, and very painful infiltration of the region. From the very commencement the symptoms are most acute, and similar to those of ordinary arthritis ; and they are rendered more marked by the least movement, the lameness being then extremely great, and generally all the joints are involved. T'he fever is extreme, the respiration hurried, and the visible mucous membranes highly injected ; sometimes, and especially with lambs, there are ^//^j-/-tetanic spasmodic contractions. The appetite is lost, but thirst is intense, and the suffering creature will often be observed dragging itself along the ground to reach water or the teat of its dam. Not unfre- quently there is at the same time a debilitating diarrhoea or dysentery, and sometimes in lambs a purulent nasal discharge. The progress of the disease is sometimes very rapid, death occurring in twenty-four or forty-eight hours after the manifestation of the earliest symptoms. This rapid course is, however, rare, and the animal may live for twenty or thirty days, or even longer. Recovery is also rare, and death is the usual termination ; it is quite exceptional that the disease becomes chronic. The malady usually ends in suppuration, which nearly always becomes general ; numerous abscesses forming around the joints, whose capsules contain pus, as well as purulent deposits in other regions of the body. Generally after the fourth day, when the joints are greatly swollen, the hair falls off in these parts, and a yellowish or citron-colored fluid, then pus, begins to exude through the skin, which sloughs away ; the ligaments are also involved in this sloughing process, and at last the articulations are completely disorganized. In some cases the limb is only retained by remains of tendons, the bones being exposed, the articu lar surfaces destroyed, and the odor almost insupportable. As complica- tions, we may have pneumonia, pleurisy, pericarditis, and the usual indi "cations of pyaemia. With foals, Bollinger noted, as the chief symptoms, a violent fever with very hurried respiration ; the animals did not suck so much as usual, and ARTHRITIS. 741 if lively and attentive at the commencement of the disease, they were quickly prostrated and extremely weak. They became emaciated, and the coat was harsh and lustreless ; often there was a nasal catarrh and discharge, tumefaction of the submaxillary lymphatic glands, sometimes capillary bronchitis, and generally diarrhoea. With the majority there was tumefaction of certain joints, and particularly of the hocks. In addi- tion to the swelling, there were heat and pain, with great lameness. Not unfrequently there were immense subcutaneous abscesses. Stupor event- ually set in, and the creatures looked as if half asleep ; coma was soon manifested ; there was dysenteric diarrhoea, the dejections being quite fluid, greyish-colored, and extremely foetid ; while the visible mucous membranes had often a yellowish tint, in consequence of the existence .of icterus. In lambs the symptoms are similar to those just enumerated. Walley describes them as follows : — A general febrile condition of the system, as shown by the injected state of the mucous membranes ; quick, irrita- ble pulse, irregularity of the bowels, hurried respiration, and refusal to suck. The animal persistently lies, and if made to move does so unwil- lingly and very stiffly, with the back arched, and placing as little weight as possible on the affected limb or limbs, which are usually flexed, even in recubation, to remove pressure — this persistent flexion ultimately lead- ing to contraction of the tendons and distorted limbs. If the disease continues, the muscles waste, causing the affected joint to appear larger than it really is. The characteristic swellings usually appear, in the hocks, knees, and stifles, though they are not by any means confined to these particular joints. In character, they are round, have a doughy feel, are intensely painful to the touch, very hot, immovable, and increase in size. Thus they are like, yet dissimilar to, rheumatismal swellings : like them in being located in the joints, and being hard, round, and tender ; unlike them in being stationary, and attacking the internal structures of the joints — the primary lesions in rheumatism being confined to the external ligamentous structures of these organs, and when attacking the interior of the joints formative processes are evidenced ; while in " joint ill " de- generative processes predominate. As the disease progresses, and life is prolonged, the animal becomes emaciated, diarrhoea sets in, the wool falls off, and a variety of changes are detected in the joints. Erysipela- tous inflammation makes its appearance in various parts of the skin of the body, especially at the external orifice of the urino-genital organs, at the postero-inferior part of the abdomen, and round the navel, in the latter position constituting " navel ill." Local dropsies are frequent under the jaw and other dependent positions — as the navel, which is said to ho. pocked. If blood is abstracted during life, or collected after death, and set at rest for a time, it deposits a peculiar dark-colored, grumous mass at the bottom of the vessel, composed, so far as can be seen by the microscope, of altered blood-cells. This deposit lacks the firmness of the other parts of the clot, and bears a close resemblance to half-fermented damson pulp. Bacteria are developed in the blood shortly after death, and long before any putrefactive odor can be detected. Absorption of pus into the blood — pyaemia — is indicated by elevation of the tempera- ture, foetor of the breath, diarrhoea, dark yellowish-red color of the mu- cous membrane, gnashing of the teeth, rigors, and hectic fever — the lat- ter being present also in ulceration of the joints. In the latter, the swellings become softer and more irregular in outline, 742 DISEASES AND ABNORMALITIES. from bulging of the more flaccid portions of the synovial membrane and skin ; and, from portions of the effused lymph becoming liquefied, fluc- tuation is produced — other portions remaining solid. The fluctuating swellings extend along the thecse or sheaths of the tendons — two joints often becoming in this way connected with each other ; finally, the skin over the most prominent portions of the joint becomes absorbed, ulcer- ates, and if not divided with the lancet or by accidental violence, bursts — allowing the escape of the contained fluids and semi-solid matters, and being followed by sinuous ulcers, caries, or abscess proper, of the joint. The sinuses may extend a considerable distance from the joint, and discharge an ichorous unhealthy fluid, accompanied by foetor if bony or ligamentous structure is involved. In some cases the exuded lymph simply becomes liquefied and absorbed, without any external opening being formed ; in others — /. e., when the lymph is plastic and the consti- tution strong — it undergoes healthy organization, and remains as a part of the joint, producing, however permanent thickening, distortion, and stiffness.. Prognosis. From what has been stated, it will be seen that the prognosis with re- gard to this disease must always be unfavorable, especially when the creature is very young. The mortality reaches as high as forty, fifty, sixty, and even more per cent. Indeed, Darreau states that eighteen out of every twenty foals die ; and Lecoq says that the breeders in Noi*mandy have an axiom, " Poulain boiteux, poulain perdu." Pathological A?iatomy, According to Roloff, the predominant lesions are the characteristic alterations of rachitism and periostitis. The cartilage uniting the epiphy- ses to the body of the bones, is soft from cellular proliferation, and in- jected in places by hsemorrhagic spots ; the periosteum is also thickened, injected, and here and there detached from the bones ; while towards the diarthrodial surfaces the bone tissue is greatly involved. There are, in fact, all the lesions of arthritis, but of a much more serious character than are observed in adult animals. The synovial membrane is highly in- flamed, and there is great infiltration of the connective tissue around the joints. Reynal has found in the intra-articular cavities of the joints, deep- yellow-colored clots, streaked with red, and elastic and firm, which are nothing more than false membranes that have had time to form in the short space of two to five days. Walley remarks that, in lambs, the post-7nortem appearances zxt general and loca,l. The general, in the earlier stages, are effusion of lymph be- tween the intercostal muscles, and beneath the pleura and into the lungs and other organs ; with hyperaemia or cngorge'ment of the small blood- vessels of the mucous membrane of the stomach (fourth compartment) and intestines. If the disease has existed for any length of time, erysipelatous exuda- tions will be found under and within the structure of the skin of depend- ent parts, or effusion of serum (dropsy) into the connective tissue, and into the various cavities of the body. The large blood-vessels — even those of the brain — are filled with dark grumous damson-colored blood ; the structure of the brain is dark : the liver is often enlarged, friable, and • ARTHRITIS. 743 full of minute abscesses, which give it a mottled appearance that is frequently mistaken for scrofula ; all the organs and tissues are tinged with the coloring matter of the bile ; the small vessels of the omentum are charged with blood, and the mucous lining of the fourth stomach is congested and black wherever the milk has lain in contact with it. In many cases, the urachus is black — a bluish-black hue extending some distance along the mucous membrane of the bladder. The umbilical vein is also black, and filled with a cheesy material — degenerated lymph, or coagulum of blood. The local appearances — i.e., in the jc^nts — are, in the first stages, in- flammation of the synovial membrane, which, in a short time, extends to the ends of the bones and ligamentous structures — the whole having an intensely scarlet hue, which in a few days diminishes. Coagulable lymph becomes effused into the cavities of the joints, forming perfect casts of their interior, and filling up the interspaces between the bones. In time, the exuded lymph commences to soften and break down. From the con- traction of the mass, the fluid portion is pressed out, and intermixes with the degenerated lymph. Fluid is also thrown out from the irritated vessels of the joint, and aids in the softening of the lymph. After a time, suppuration is thoroughly established, and pus cells are distinguished by the aid of the microscope. The sheaths of the tendons running over the fronts of the joints become excessively inflamed, and the blood-vessels of the ligamentous structures are filled with scarlet blood. The cartilage covering the articular ends of the bones becomes ulcerated and blackened, as also the cancellated structure of the bones ; extravasations of blood, from ulceration through the coats of the vessel, take place, the coagula either undergoing degeneration or healthy organization. In the latter case, distinct granulations are formed, which, on recovery of the animal, fill up the cavities formed by the lymph. The flakes of lymph which are found floating in the fluid contents of the joints or adherent to their sides, are often mistaken for scrofulous deposits. If animals have lived suffi- ciently long, multiple pyaemic abscesses are found in the various organs and structures of the body. Blood from diseitsed lambs introduced into the veins of a dog, gives rise to the formation of multiple hepatic ab- scesses. From this description of the pathological anatomy of the malady, there can scarcely be any doubt as to its pyaemic or septic origin, and this is further demonstrated by the following account of its morbid anatomy by Bollinger {Deutsche Zeitschrift fur Thiennediciti^ 1875) : — A male calf born at the Agricultural School of Strickhof, near Zurich, showed symp- toms, soon after birth, of inflammation of the umbilicus. As the joints began to swell, and there appeared to be no hope of saving the animal from the effects of the dreadful joint disease — " gelenkseuche " — it was destroyed eight days afterwards. The body was dissected an hour after death, but the examination was imperfectly made. The umbilical ring was discovered to be still open ; it formed a circular aperture about two centimetres in diameter, the sides of which were covered w^ith ulcers and a greenish- yellow pus. The umbilical veins and the joints had been thrown away, and therefore the investigation could not be continued. Projecting about the upper margin of both lungs were several cuneiform tumors of a daric-red color, and of a solid consistency. In the pericardium was a quantity of pale serum, in which floated loose stringy fibres. In the cavity of the heart were a few detached fibres and blood clots. Beneath the endo- cardium were various-sized patches of ecchymoses and blood extravasations. Nothing abnormal was observed in the liver and kidneys, except bloodlessness. Another calf was produced at the same establishment on February 6th. Its birth had been laborious, and the umbilical cord was divided in the ordinary natural manner. 744 DISEASES AND ABNORMALITIES. The animal did not appear to be as lively as it ought. About eight days after birth a swelling showed itself in the neigborhood of the navel ; this, however, disappeared after the application of poultices. Fourteen days after birth the calf could not stand, and painful swellings appeared on the inner aspect of the knee joints. Until this time, the creature had a good appetite, and had taken a plentiful supply of milk regularly every day. On February 27th the appetite entirely failed, and on the 28th the calf was killed, in order that the carcase might realize something. The most important organs were sent to Bollinger, and their examination yielded the following results : There via.?, purulent omphalo-thrombo-p/ilebitis, with thrombosis of the portal vein ; fibro- purulent gonarthritis of the stifle joints, afid purulent peri-arthritis ; ptirulent tracheo- bronchitis, embolic infarction of the lungs, conuneiicing endocarditis of the mitral valves, and getieralized icterus. The parts surrounding the stifle joints were of a pale-yellow color, infiltrated with sero-purulent fluid, and moderately thickened. In the cavity of the joints there was a tolerable quantity of dark-tinted serum, and on the synovial membrane more especially was a mass of yellowish-green, firm fibro-purulent matter, about two centimetres thick, which projected into the synovial cavity. The cartilages of the joints were covered with similar matter, and in some places they were quite rough. The entire capsule of the joint was inflamed, softened, and purulent. The trachea and bronchial tubes contained a quantity of muco-purulent fluid, which, in the latter, formed itself into one mass. The mucous membrane was paFe : the almost bloodless lungs had ecchymosed spots beneath the pleura, and in one place were two wedge-shaped masses the size of a pea, which, on being cut open, were found to contain pus in the centre. The heart and pericardium were normal, with the exception of the mitral valve, which showed alteration in being of a dark-red color, thickened, and exhibiting haemorrhagic infiltration in places; by means of the microscope, a notable cellular opening could be perceived in the connective tissue close to the haemorrhage. The spleen was of normal size, but pale and bloodless; the liver was enlarged, full of blood, icteric in tint; in parts were small subperitoneal haemorrhagic deposits. The umbilical vein was dis- tended throughout its entire length, its walls were considerably thickened, and the inner surface was of a dirty-grey color, rough, uneven, and studded with greyish-white puri- form deposits. This alteration in the umbilical vein extended as far as its junction with the posterior vena cava, which, owing to the closure of the ductus venosus, is not in direct communication with the umbilical vein. Where the umbilical vein enters the portal vein was a purulent cloaca, beyond which was a large thrombotic puriform mass that obliterated the cavity of the latter vessel as far as its bifurcation. As fatty degen- eration of the heart was suspected from its appearance, the tissue of that organ was examined microscopically, but it was found to be normal. The voluntary muscles in the vicinity of the diseased joints, and which appeared very pale to the naked eye, were only clouded with granular matter. The puriform contents of the umbilical vein con- sisted of fatty granular detritus, in which it was diflicult to detect pus corpuscles ; bacteria could not be found in any number. The liver offered indications of a violent icterus, and exhibited all the alterations of acute parenchymatous hepatitis, with marked granular degeneration of the hepatic cells. In the three autopsies of foals made by Bollinger at Graditz ( Virchozu's Archiv., 1873), he found double broncho-pneumonia of the anterior lobes of the lungs, pulmonary abscesses, purulent arthritis, intra-muscular abscesses, caries of the bones, and fatty degeneration of the muscles of animal life, particularly in the neighborhood of the affected joints ; fatty degeneration of the heart tissue, liver, and kidneys. In the in- testinal canal were lesions of catarrhal enteritis, accompanied by hyperplasia of the mesenteric glands. Neither in the animals when alive, nor at their autopsy, were there any of the signs of rachitism mentioned by Roloff. The umbilical cord was unfor- tunately not examined. On another occasion, the same excellent veterinary pathologist examined the bodies of two foals — one three weeks, the other five weeks old — which had succumbed to this malady. In these there was inflammation and thrombosis of the umbilical vessels, con- tinuation of the thrombosis of the umbilical vein (in process of suppuration) into the portal vein, which was also affected with thrombosis, as well as its hepatic ramifica- tions. In one of these cases there was likewise thrombosis of the pulmonary artery, double pleurisy with pericarditis, purulent arthritis affecting several joints, vast intra- muscular or subcutaneous abscesses, and cutaneous erysipelas. In the other case, there were pulmonary abscesses, circumscribe pleurisy, purulent irido-choroiditis, and, finally, in addition to general anaemia, there was great tumefaction of the bronchial and mesenteric glands. The result of these autopsies, together with the symptoms observed during life, led Bollinger to the conclusion that the development of the ARTHRITIS. 745 pathological process is solely as follows : inflammation of the umbilical vessels, notably the vein, its decomposed and softened thrombus which communicates with the vena portae, and forms the point of departure or the source of a metastatic pyaemia, whence embolism of the lungs is some- times directly originated ; or at other times, in consequence of the alter- ation in the blood, which is septic, and of the general character of the inflammations, there are metastatic inflammations of the serous and synovial membranes (pleurisy, pericarditis, "arthritis) of the lungs, iris and choroid coat of the eye, abscesses in the muscles and connective tissue — in a word, the entire series of clinical and anatomical alterations which constitute the complicated arthritis of foals.* * The great importance of this subject in a sanitary point of view, induces me to notice it so fully as I luve done. The septic or pyaemic nature of the malady has not, to my knowledge, been pointed out, or at least insisted upon, in England. And yet it is a matter of vital importance that this be recognized, wli2n we consider that very often the flesh of calves and lambs which have been affected with joint disease, ii utilized as food when the creatures have been purposely slaughtered, which is generally the case before tha malady has reached its worst stage. Doubtless such flesh, when well cooked or cleaned, is very much relished, and may often be eaten without any ill effect ; but, on the o.her hand, as Bollinger has pointed out, many cases of illness in human beings are due to its consumption. Poisoning from eating veal can often bi traced with great certainty to the pyjeaiic or septikaemic infection of the calf ; and that authority quotes an instanca in support of this assertion. The occurrence is communicated by Zann^er (Arckiv/iir ThierJieilkiinde, Band xxiv., S. 204, Zurich, 1871) to Zehnder's official report, and which, notwithstanding its urgent importance, has not been taken notice of by the medical journals. During ths epidemic of cholera in Zurich in 1867, in August, twenty-seven members of six families living at Fluntern (a suburb of Zurich), were attacked with diarrhoea, accompanied by varied cerebral disturb- ance. Ail tho32 who ware ta'.cen ill had eaten the fl3sh of a five days' old calf, which was the progeny of a diseased Cow, and which had yellow water (^rt'fcj ivrLsser)'m. the knee-joints. The Cow w.is suffering from a large dark swelling on the uddar, and which extended along the belly to beneath the breast. The milk from this Cow produced, in a number of people who consumed it, vomiting and diarrhoea. The calf at birth was smafT and weak, and had swellings o;i its joints and limbs. As soon as it was killed, its carcase wis sold and the flesh e^ten. No examination of the body was made. Chemical analysis was made of its re:nains for the detection of inorganic substances, as well as a microscopical examination for trichinae, but wit'i negative results. The outbreak, which was followed by fatal consequences, was ascribed to the cholera ; thou:;h it ensued within from twenty-four to forty-aight hours after eating the flesh. The diffarent mambers of some families — in one instance nine individuals — were seized within a few hours of each othar, and tha violence of the attack varied according to the quantity of the diseased veal they had eatan. Tha chief symjjtoms ware: vomiting a thin greenish matter, watery stools of the same color, great and CDntinued prostration, often preceded by shivering fits; stupor, combined with delirium; involuntary evacuations ; and, in the milder cases, headache and giddiness were observed. Convalescence was most tedijus. The vomiting lasted, as a rule, for several days, and when it ceased it left the patients very weak and prostrate. In some cases, cedematous swellings made their appearance, and of those who recovered, twalva individuals ware helpless for frjm two to four weeks. In one instance, in which death took place on the eleventh day, and in which the patient— a man fifty-two years of age, and who had eaten a compar- atively larga quantity of the partly raw, partly cooked liver — there were found petechix over the entire surfica of the body, in the epicardium, kidneys, stomach, intestines, and brain, as well as great oedema of the luags— all of which corresponded with the appearances presented during life, and which led to the conclusion that the alterations were due to intense blood-poisoning through putrid organic matter— the appearances closely simultating those often observed in poisoning by sausages {ivurstgi/t, " Botulismus"), through some change in the flesh of which they are composed, but the chemical nature of which is not yet ascertained. It may ba noted, however, that decomposition had not begun in the flesh of this calf ; as vaal is usually sold on the day on which the animal is killed, or on the following day, and at once eaten ; and that the craature was affected with septikaemia or pyaemia at birth. As, for various reasons, the existence of anthrax cannot ba accepted in this case, the illness of the calf may reasonably be compared to what in children is called " congenital pyjemia or septikaemia." Bollinger concludes his notice of the outbreak, by adding the following remarks.— " Although I do not wish to go into any further discussion on the sanitary aspect of our food supply, I may be allowed to give my opinion that the celebrated epidemy at Adelfingen (Greisinger, Handbuch der Speciellen Pathologie und Titer apie, Art. Ileotyphus), the nature of which, according to tha latest discoveries — and particularly those of Biermer — was not typhoid, but was to be attributed to a similar poisoning of the flesh eaten by the people, to that occurring in this calf. In this epidemy five hundred people ware seized with illness from eating diseased meat. Although the nature of the saptikae nic and pyjemic poison is not well defined, we are, I think, justified, after the numerous experiments made, in considering it identical with certain substances, be they of a chemical or vegetable nature, or in fact both chemical and vegetable. In other words, this poison belongs to that class of poisons whicli can multiply both in and out of the human body. In conclusion, the general remark may be ven- tured upon that, with regard to the etiolosy of the diarrhoea, and the multiple hsetnorrhagic and petechial aoDe-arances which marked the progress of the disease in the people attacked at Zurich, the dates given in Zeh-idar's report on the meat poisoning are of the P'reatest importance. If such cases occur sporadically — as, for instance, in large towns — it will always be difficult to discover their etiology. Anyhow, it is cer- tainly tha fact that, in the latest treatises on the subject, the occurrence of meat poisoning — with the excep- tion of poisoning from eating unsound sausages — is completely proved. To assert that, as a rule, such poisoning does not occur, seems to me to be scarcely right, and especially when one knows the numberless tricks of the meat-market in preparing the flesh for sale. On the other hand, it is an indisr utable fact that, notwithstanding the vast importance of our food supnly, for the so-called official and leeal meat inspection there is no proper basis to work upon. The cause of this deficiency, the repair of which must be of the greatest moment to huma# hygiene, can be traced to the complete neglect of the pathological anatomy and 746 DISEASES AND ABNORMALITIES. Treatment. Curative treatment of this form of joint disease being, under the most favorable circumstances, very unsatisfactory unless it is adopted at the very commencement, the greatest importance must be attached to pre- ventive measures, and especially if the malady is enzootic. On the Con- tinent, those veterinarians who adopt Roloff's view lay great stress on the necessity for preserving the young animals, and particularly the female parents, from the effects of improper feeding. These are to be well fed during pregnancy, and aliment rich in earthy salts is to be given. In addition, bone-dust may be mixed with their prepared food, or with bran, meal, or oil-cake. When it is continually prevalent in districts, it is recommended to im- prove the pasture lands, and to restore to them, by means of top-dress- ings, the mineral elements abstracted by the growth of forage, or the herbage consumed by the animals grazing upon them. Attention i-^> drawn to the fact, that in a hundred days a medium-sized Cow will remove from the soil about a kilogramme of phosphoric acid, which is present in the milk yielded during that period. If we have reason to believe that the malady is of septic origin, as Bol- linger and others are, from clinical and anatomical investigation, assured of, then the preventive measures recommended for omphalitis must be adopted. In all cases where the affection is enzootic, or even sporadic, every means should be resorted to, in order to discover tlffe predisposing and exciting causes, as on the successful removal or suppression of these must loss be mainly averted. And with modern means of investigation and clinical and physiological knowledge, there should be no difficulty in arriving at correct conclusions in this direction. Curative treatment, as has just been said, is generally unsatisfactory, and this not only from the comparatively small value of the animals affected, and the difficulty in applying remedies to them, but also from the very serious nature of the disease, and the character of the tissues involved. Even when the life of the creature affected with arthritis is preserved, only too frequently its health and condition are irretrievably impaired. Zundel remarks that counter-irritants to the joints augment the pain and increase the debility, and emollients have only a doubtful effect. In the hands of Strauss, refrigerants were productive of good results, the inflamed joints being enveloped afterwards in linen bandages. Anodyne lotions and embrocations have also been recommended,- in order to allay the pain and irritative fever ; as well as the application of tincture of histology of the domestic animals. The study of these subjects can alone place the onerous and responsible duty of the meat inspector on a surer footing. In connection with this subject, it may be interesting and important to remark that a very melancholy case of wholesale poisoning from the consumption of diseased meat, was reported from Wurzen, a small town in Saxony, in the summer of 1877. A local farmer, finding one of his recently-calved Cows to be suf- fering from puerperal fever (not puerperal apoplexy), with accompanying abscess and ulcers, and beyond all hope of recovery, employed the services of two neighboring butchers to slaughter the beast and dress the carcase ; after which the trio managed to dispose of the meat, partly in the form of sausages, and partly as joints. Among those who partook of it, at least 206 cases of illness occurred, and in seven in- stances such illness terminated fatally. The symptoms observed during life were analogous to those of Asiatic cholera, and in the fatal cases decomposition of the bodies rapidly set in. In six of these cases, post-mortem examinations were made, and in all were found most extensive inflammation of the mucous membrane of the stomach and intestines, with peculiar extravasations of blood in the mucous membrane, and marked swelling of the glands of the small intestine. The other sufferers recovered, though convales- cence was slow, and in many instances attended with serious relapses. Inquiries instituted by the author- ities clearly showed the origin of the outbreak ; and the heartless culprits, whose miserable cupidity had led to such sad results, were committed to prison to await their trial. • ARTHRITIS. 747 iodine, before the suppuration period. When suppuration is established, the abscess should be opened at the proper time. Tonics have been given with advantage, as well as cod-liver-oil, castor- oil, and even ordinary oils and fats. These not only aid in the assimila- tion of earthy salts and nitrogenous matters, but to some extent act as a laxative — a service of some importance. Small doses of sulphate of magnesia or soda, or aloes, may also be given with the last-named object, or even to produce continuous purgation for some time. With regard to the treatment of the disease in lambs, Walley advises that those affected be removed from the dam, and receive milk from healthy animals. The milk maybe mixed with beaten-up eggs, and good nitrogenized gruels may also be allowed. " Place in dry, warm houses, and give gentle aperients — as castor-oil — or better, a small dose of mer- cury with chalk ; follow up by febrifuges and diuretics, as nitrate of pot- ash and camphor, with nitric ether, or carbonate of ammonia ; if much pain is evinced, give small doses of opiates — Dover's powder being the best agent of this class ; or inject a small quantity of the solution of morphia underneath the skin of the joints. In the course of a few days^ tonic treatment should be adopted, as the administration of iron, alter- nated with iodide of potassium ; or mineral acids with cinchona, or other vegetable tonics j and allow a little wine, good old ale, or porter." The same authority recommends, as local treatment, the application of a strong blister — as the compound tincture of iodine ointment — all round the joint, at the commencement of the disease ; and when the subsequent inflammation has subsided, to keep the joints at rest and in their proper position by the use of light splints and bandages, leaving the joint exposed for further observation. As soon as any tendency towards "pointing" in suppuration is perceived, the joint is to be opened freely, the inflammatory products removed, and the interior washed out with a solution of carbolic acid in glycerine and warm water — one part of the first, two of the second, and forty or fifty of the last. Afterwards, pads of soft lint or linen and tow, saturated in carbolized oil (one to eight or ten) should be applied, leaving an aperture inferiorly for the escape of discharge ; the dressings are to be renewed every day. Mild caustics or astringent lotions are to be applied if granulations project above the skin. If the ends of the bones are carious, they must be scraped, and nitric or muriatic acid applied ; should sinuses have formed, they must be obliter- ated by the use of setons, or laying them open with the knife, and treat- ing them afterwards as ordinary wounds. " In treating the results of this disease, it must be borne in mind that in young animals the repara- tive processes go on very rapidly ; and that what appears to be a very formidable wound, is soon converted into a comparatively simple one. Animals, too, may, with a little trouble, be fattened and their flesh utilized ; few can be preserved for breeding purposes." As salicylic acid is unrivalled for its antipyretic properties, and partic- ularly in inflammation of the fibro-serous membranes, its internal admin- istration should be tried in the arthritis of young animals. The soda salt (salicylate of soda) is the best form, perhaps. The internal administra- tion of other antiseptic remedies — as preparations of carbolic acid, and boracic acid, sulphite of soda, etc., might also be tried in those cases in which the joint disease is suspected to be due to septikaemia as the result of omphalitis. 748 DISEASES AND ABNORMALITIES. CHAPTER VIII. Indigestion. Indigestion sometimes attacks young animals soon after birth, and is perhaps most frequently observed in calves, seldomer in lambs ; in foals, and the young of carnivora, it is rarely met with. Causes. The principal cause would appear to be too rich milk, or even milk difficult of digestion from its poorness, or its containing some extraneous ingredient to which the young creature is not accustomed. The quantity of milk may also prove as potent a cause as its quality. Therefore it often happens, that too copious sucking after abstinence will give rise to an attack, and among calves reared by hand, those which receive artificial food of improper quality or in undue quantity, are frequently the subjects of indigestion. An alteration in the milk of the Cow, produced by fatigue, or bad food or water, will also lead to the same accident ; while altered secretions in the stomach of the calf — as too much acidity — will undoubtedly cause coagulation of the milk, and, as a consequence, indi- gestion. Indigestion is often witnessed in high-bred calves which are unnaturally forced, in order to produce greater and premature development. Symptoms. The young animal looks dull and dejected, and evinces uneasiness or suffering ; the movements are torpid ; the coat is dry and staring ; it yawns now and again, and there are sharp gaseous eructations which cause the animal to elevate its head. Soon it refuses to suck or to par- take of food, and the nausea is more marked ; there may be vomiting of coagulated milk ; the breath has an acid odor, and the tongue is coated with a -white or greyish matter ; the abdomen is swollen and tympanitic ; and pressure made towards the upper part of the right side, as well as along the cartilages of the ribs, causes pain ; flatus is expelled when diarrhoea — the faeces being yellow and foetid — sets in, which is frequent — though constipation is not rare ; and at this period symptoms of colic are often noted, and the respiration is at times hurried. The diarrhoea is a means of cure ; though should it persist too long, inflammation of the stomach and intestines may ensue. Then there is emaciation, the abdomen is retracted and flanks tucked up ; fever is present ; great pain is manifested, and the dejections are small in quantity, and consists of a yellow glairy mucus, mixed with lymph or false membranes. Indigestion runs its course rapidly in the calf — in the majority of cases only occupying two, three, or four days. It may be considered a serious condition, as death often occurs. As it is frequently induced by causes- which remain in operation for some time, even when recovery takes place relapses are to be apprehended ; and at last the stomach and intestines become inflamed, and enteritis brings about a fatal termination. At the best, it causes loss of condition, and often retards growth. Treatment. Preventive treatment is to be based on the predisposing or exciting causes just enumerated. Over-repletion with milk should be guarded DIARRHCEA. 749 against, and if the animal is being reared artificially, great care must be paid to the diet. If at the teat, the food and water of the mother should be attended to ; and if the milk is too rich, this may be remedied by giv- ing less stimulating food. With Mares which are worked during the suckling period, the milk is often retained for a long time in the udder, and becomes altered ; on returning to the foal, the latter is ravenously hungry, and over-gorges itself with this unhealthy fluid. The preventive measures are obvious in such a case. Indigestion may be due to an insufficiency of oily matters in the milk of the mother ; here, the diet of the latter must be altered. The curative measures in mild cases are simple. Some French and Italian veterinarians recommend the administration of barley-water or very weak beef-tea, and if there is not speedy amendment, they prescribe a spoonful of rennet, which, they assert, readily effects a cure. When the indigestion is due to acidity, alkaline agents — as carbonate of potass or soda, lime-water, calcined magnesia, etc. — and afterwards castor-oil — are generally effective. A mild purgative — such as castor-oil, manna, cream of tartar, olive-oil, or a dose of glycerine in albuminized water — is very useful, even when diarrhoea has set in. Manna has proved an excellent remedy for lambs, and even calves. When constipation is present, enemata of soap and water may prove serviceable. Vegetable bitters — as tincture of gentian — and mild stimulants, are often beneficial ; and much success has attended the administration of a spoooful of very finely-powdered vegetable charcoal, given twice a day, mixed with water in which an Q.gg has been beaten up. When there is pain and uneasiness, chlorodyne will be found an ex- cellent medicine, particularly if diarrhoea has persisted for some time. Of course, a change of regime is generally necessary. In chronic indi- gestion of calves, Philippi omits all medical treatment, which he asserts is usually found to be inefficacious in these cases, and puts them to be suckled by Cows which have newly calved, dieting them carefully at the same time. CHAPTER IX. Diarrhoea. The peculiar diarrhoea which attacks young animals while at the teat, has for very many years attracted particular attention because of its specific nature, its almost incurable character, and the great mortality which attends it. Known by various names in different animal-rearing countries (as "White Scour" in England — the "Weisse Ruhr" of the Germans, and the " Diarrhee des Jeunes Animaux " of the French), it is generally acknowledged that calves are far more frequently attacked than other animals ; though it is also an extremely fatal disease among foals. Brugnone {La Mascalcia, Turin, 1774) long ago asserted, that it is one of the maladies which cause most destruction among the foals in breed- ing establishments ; and to our own knowledge, it is a most serious scourge among the young thorough-bred stock in England. It is also a fatal malady among young lambs \ and it is observed in piggeries and kennels as a very destructive disorder. It appears to be much more 750 DISEASES AND ABNORMALITIES. frequent among animals reared- in dwellings than those at pasture, and seems to be a malady due to the artificial way in which they are kept. It presents itself in somewhat diverse forms ; but in the majority of cases it arises from disturbance in the secretory functions of the intestinal mucous membrane, without any very marked anatomical alterations — being merely an intestinal catarrh. It is rare indeed, and only consecu- tively, that there is inflammation — unless the young creature is somewhat old, when we may have the ordinary lesions of gastro-enteritis, as it occurs in infants. The idiopathic mucous diarrhoea of young animals has a special character, seldom observed in the diarrhoea of adult creatures, and is therefore to be studied apart from those inflammatory conditions of the intestinal tract which affect young and old alike. The malady, though very common and fatal, does not appear to have been much studied ; but from what has already been learnt with regard to it, it appears to be one of the most dangerous and infectious disorders to which new-born animals are liable. The diarrhoea often manifests itself as an epizooty, and runs its course rapidly, death taking place within one to three days. It sometimes haunts breeding stables and cowsheds for years. It is extremely difficult of cure, and among calves is seen more frequently in some localities than others — low-lying districts being, perhaps, more often and severely visited than elevated situations. It is sqtid to be particularly prevalent in districts where the spe.nt grains of distilleries and breweries are generally used for feeding purposes. When a number of new-born animals are crowded together, if one is attacked by diarrhoea, all are likely to suffer. Syfnpfoms. The disease generally appears suddenly in a shed : an apparently healthy calf being seized all at once, and without any notable alteration in the food or hygienic management. The diarrhoea manifests itself most frequently during the first eight days after birth, though in calves it may not show itself until the tenth or fifteenth day. In many cases it is present almost immediately — within twenty-four hours — after the creature is born : and death ensues in from twenty-four to forty-eight hours — from the second to the fourth day after birth. In a number of instances, Franck has known the diarrhoea to appear immediately the calf was born, and before it had time to suck ; indeed, it never sucked, as it was dead before it could do so. As a rule, according to the same authority, the calf has two or three good meals before the acute diarrhoea sets in. The faeces are very fluid and mucus in character, they have a sour or foetid odor, are yellow-tinted and then whitish, or of a greyish-green hue, but most frequently light-colored. The evacuations are more or less numerous in a brief period — from five to fifteen or twenty in twenty-four hours, and the excreta are projected with some force. The first indica- tion of the presence of diarrhoea is usually the soiled condition of the tail, and the animal ceasing to suck. The creature seems suddenly to lose its strength, remains nearly always lying, and when it gets up it staggers about ; it is indifferent to surrounding objects ; the eyes sink deeply in their orbits ; saliva flows from the mouth, no attempt being made to swallow it, and it wets the throat and breast. Emaciation is astonishing- ly rapid, and the hair is dry and erect. Nevertheless, the belly is not painful to pressure, neither is meteorismus present ; no gas is mingled with the alvine evacuations, borborygmi are not heard, nor are symptoms DTARRHCEA. 751 of colic manifest. Tliere may be slight tenesmus, and the anus is dilated as if it were paralyzed ; while the air passing into the rectum produces a peculiar sound. Towards the end, the creature remains immovable, as if paralyzed, and dies without a struggle. Zundel and others state, that if the disease continues for any length of time, the diarrhoea is accompanied by congestion and ulceration of the intestinal mucous membrane, through the acridity of the secretions, as well as inflammation and excoriation of the skin around the anal opening. Then there is fever with its attendant symptoms, and the abdomen is very sensitive to pressure and becomes more and more retracted ; while the evacuations are increased in frequency, are more foetid, and finally become serous and sanguinolent. Brugnone has observed as a complication in the diarrhoea of foals, a kind of ophthalmia more particularly involving the anterior chamber of the eye, accompanied by tumefaction of the cornea and lachrymation.* A similar complication has been noticed in calves ; and in the diarrhoea of poultry this ophthalmia is often noticed. Zundel alludes to constipation alternating with the diarrhoea ; and also to the occurrence of convulsions, similar to those present in infantile diarrhoea. Rainard mentions consecutive pneumonia, with suppression of the diarrhoea, as a termination of the disorder. Pathological Anatomy. Rainard was of opinion that the diarrhoea of young animals is due to an irritation of the colon and rectum. There is a kind of atony, and a special catarrhal condition of this portion of the intestinal tract, with frequently pseudo-ulcerations due to an alteration in the follicles, but without any trace of inflammation. He never found any lesions in the small intestines or stomach. The lymphatic glands corresponding to the diseased intestines are voluminous, reddened, and infiltrated with a red- dish fluid. Zundel thinks these alterations are caused by microscopic entozoa, and he is of opinion that the malady is especially due to the influence of microphytes, which are developed in excess in the posterior portions of the intestinal canal, which the bile does not reach. This excessive development is simply owing to the superabundance of fluid in the tube ; and the growth of these minute organisms, again, still further increases the secretion of intestinal mucus. Billard and Valleix, a long time ago, announced that the diseased condition known as " thrush " {aphtha) of children is produced by a cryptogamous parasite, and that this, extending along the mucous membrane of the intestines, has been found in infantile diarrhoea. Hallier and Zurn have proved the presence of micrococci in the diarrhoea of animals. Franck is the most recent authority on this malady, and his observa- tions are of great importance, not only from the care with which he has studied it, but also from the scientific manner in which he has investi- gated its pathological anatomy. He examined a number of bodies of calves which had recently died of the disease, and always found the same characteristic alterations, of which the following are given as typical : * The following are the symptoms observed in the foal by Brugnone. " The diarrhoea commences two or three days after birth ; a yellow, acrid, sometimes purulent-looking fluid, is evacuated ; the foal becomes rapidly emaciated and is nearly always lying ; it is weak and staggers about, sucks little or none at all, and finally falls into a state of complete marasmus- During the first period it is not rare to observe a general ophthalmia occur; the humors of the eye are turbid, the eyes are painful, tears flow continually, the eye- ball becomes bnried in its socket and atrophied, and vision appears to be lost." 752 DISEASES AND ABNORMALITIES. A bull calf of the Algauer breed, which died on the third day after birth, the second day of the disease. Weight 37*4 kilogrammes. The remaining portion of the umbilical cord is perfectly dry. The hind parts are somewhat soiled by fasces, the eyes are deep in their sockets ; there is no meteorismus. Eight incisors are cut. There is a remarkable and general bloodlessness observed, and this is more particularly noted in the digestive organs, which look very white. (This anaemia was present in all the cases to the highest degree : so much so, indeed, that the tanner who bought the skins thought they were from calves which had been slaughtered in the ordinary way, /. ^., bled to death — "white veal.") The umbilical artery is, at the torn extremity, contracted, dark- red in color, and retracted towards the pelvic opening ; it is distended by a dark-red blood-clot, which extends as far as the aorta. The umbilical vein is not inflamed, but contains a Quantity of dark, small blood-clots(these were not always present) ; it had been torn through towards the outer half of the navel-ring, so that both divisions were visible. The urachus is rup- tured at the inner portion of the umbilical opening. Around the latter are a number of generally small ecchymoses. The abdominal cavity is filled with a dark fluid, which extends through the second and third compart- ments of the stomach, as far as the fourth compartment. This fluid is also found in the mouth and pharynx, as well as in the trachea ; though none is observed in the lungs. In the true stomach is discovered a greater quantity (about one and a half-litre) of curdled milk, in which were dirty- white masses of casein ; this fluid has an acid reaction — making litmus paper double-red : its normal condition. The mucous membrane of this portion of the stomach is cedematous, of a dirty yellowish-red color, with traces of post-mortem solution. In the third compartment are a number of isolated ecchymoses about the size of a pin's head. The intestines are quite empty, and their lining membrane is covered by a thin layer of puru- lent-looking matter, which has a feeble alkaline reaction. Peyer's glands are slightly swollen, somewhat injected, but otherwise normal. The caecum is remarkably void of solid or fluid contents, and is full of gas. The liver is very small, pale,cIay-colored, and bloodless ; the little gall-blad- der is completely empty ; the spleen is normal. The lungs are speckled red ; at some points the patches are reddish-brown ; the organs are perme- able to air. The cavities in both sides of the heart are full of dark coagu- lated blood, and beneath the epicardium are a number of small ecchymoses. Otherwise the heart and its valves are very healthy. The dura mater of the brain is strongly attached to the cranium. The sinuses are dark- colored, and full of coagulated blood. The brain is remarkably anaemic ; its lateral ventricles are distended by a clear serous fluid ; the rete mira- bile at its base, and the neighboring membranes, are also distended by co- agulated blood. Microscopic examination of the blood and the blood-clots in the heart, umbilical vein and artery, proved that these were perfectly normal. The red and white corpuscles in them were unaltered, and there were no special organisms ; the color of the blood was not diminished. All those appearances which are particularly noted in putrid diseases — as in puer- peral fever, and particularly in septikasmia, were absent. The liver-cells were certainly partly filled with fat granules, but there was otherwise no indication of fatty degeneration. A very special feature of the disease was always found in the micro- scopical examination of the contents of the true stomach and small intes- DIARRHCEA. 753 tine. In these were discovered great quantities of epithelium, and crowds of minule organisms. This purulent-looking matter appeared to be a kind of bacteria pulp {Bakterienbret). Besides innumerable micrococci, there were also immense numbers of vibratile staff-shaped bodies {scfnving- mde Stdbcheti). In the present state of uncertainty of the question with regard to minute vegetable organisms, Franck declines to give an opinion as to the species to which the last-'described bodies belongs. Causes, Zundel is of opinion that the most ordinary cause consists in a modifi- cation in the food of the young creatures, and most frequently in an alteration in the mother's milk, under the influence of some inscrutable agency. Brugnone admitted the existence in the mother of constitutional maladies — as mange, grease, and other skin affections — which might produce the disease in question in their progeny : just as Bouchut asserts that the herpetisme dartreux of woman may similarly affect the child. Dela- fond thinks that the more frequent causes are too rich food given to the mother, the use of highly nitrogenous aliment, too poor regime, innutri- tions food — and particularly that w'hich is in bad condition. In the milk of Cows fed in this manner, is a superabundance of white granular cor- puscles, which are particularly numerous in the colostrum, while the other constituents of the milk are relatively deficient. These colostrum corpuscles are supposed to be agglomerated, generally granular, leucocytes — the granules being probably nothing else than the spores of some mycoderm. These leucocytes are greatly increased in the milk when the Cow is excited or disturbed in any way, according to Zun- del ; and he fancies this may lead to the production of diarrhoea in the offspring. But he also insists strongly on the influence of unfavorable hygienic conditions, when the animals are fed without care, and lodged in unhealthy dwellings. The supposed causes of this form of diarrhoea Franck enumerated as follows : bad, deficient, or improper food ; an undue proportion of lime salts in the food ; milk too rich in fatty constituents, housing at night, chills, defective stabling, stable miasma (Roloff), or a volatile contagium (Obich). That the nature of the fodder or the milk, or even chills, will not induce the disease, Franck is certain ; and he points to the fact that ample stable room and good food is no safeguard against it. And he also alludes to what is another fact, that some time after birth, young animals are only exceptionally attacked, though the food and stables may be the same. Even when the food or the milk is changed, there is no differ- ence. The malady is most intense during permanent stabling ; and with the advent of grazing, when the cattle are driven to pasture it begins to dis- appear, and is no more heard of until the pregnant Cows are again stabled and begin to calve. All this would indicate, according to Franck, that there is an agent at work in the production of the disease, to which the des- ignation of " stable-miasma," for want of a better, may properly be given. This view as to the existence of an infecting agent, would seem to be borne out by the circumstance, that whenever one young creature in a large breeding-shed is affected, other cases soon follow. Obich ( Wochenschrift fur Thierheilkunde, 1865), who was the first to direct attention to the in- fectious nature of the malady, gives several strong illustrations, which not. only support this opinion, but would also tend to prove that the infecting 48 754 DISEASES AND ABNORMALITIES. agent can be spontaneously developed. Franck could not produce the disease spontaneously, however; for though he administered in milk, and to sheep, goats, and rabbits a quantity of the intestinal matter which swarmed with bacteria, no positive result was noted. This, however, can scarcely be deemed a satisfactory experiment ; and it would be better to try the effects of the morbid products on sucking calves or other creatures of the teat. If nothing is at present known as to the manner in which the contagium acts, or its origin, as little are we acquainted with its mode of transmission or its vital tenacity. We can only assert that such contagium must exist, from the manner in which the disease spreads, and from the other evidence already adduced. It is interesting to note in this respect, that a case is recorded in which, in an infected shed, of twin calves one was attacked with " white scour " and died, while the other remained sound. And when pregnant Cows are transferred from an infected to a healthy stable and soon after calve there, yet their progeny may still be attacked. But if the transfer has taken place so long as six weeks or two months before parturition, then there is indeed but little risk of the young creatures being seized with the diarrhoea. Roloff {Mittheilwtgen aus der Thierarztlichen Praxis, 1875, P- 1 19), from his experience of the disease, concluded that it was due to a " stable miasma." " The malady will suddenly appear in a cowshed, and vanish again after a time, without any alteration having been made in the feeding or management of the Cow. I was consulted in a case of this kind, where, in a large cowshed, during eight weeks every calf produced therein had perished. The calves were generally, about the second day after birth, uneasy, bellowed, appeared to be suffering from abdominal pain, had no appetite, rapidly lost condition, passed watery stools, and died within twenty-four hours. All remedies tried — among them, large doses of ojaium — were useless. Some of the new-born calves were fed on skimmed milk, others on boiled milk diluted with water, while others received no milk at all, but were fed on oatmeal gruel with which preparations of iron were mixed— but all to no purpose, as they died all the same. The feeding of the Cows was in every way good, and had not varied from that of other times, when this disease did not appear. Roloff therefore concluded that the mortality was due to a miasma in the shed ; consequently all the Cows which had not yet calved were removed to another dry and airy shed. In this they brought forth at various times, and the calves remained healthy." In a second instance, the malady broke out suddenly in a cowshed at the commence- ment of 1874. The calves were apparently healthy when born, but in about two days they became unwell and soon died in the usual way. As an experiment, some new-born calves were not allowed to get milk from their parent, but were fed on milk from Cows in other sheds where the disease did not exist. On the second day, however, the calves sickened all the same, and succumbed. The feeding of the Cows was modified, but without benefit. In a third instance, Roloff mentions that, for a long time, all the calves in a large cow- shed had perished in a similar manner, and though many of them had not received any of their mother's milk — some of them no food at all — yet it made no difference. This instance was particularly conclusive that the milk of the parent was certainly not the cause of the disorder. The Cows near their time for calving were moved from this shed into another some distance away, and the change was attended with the happiest results. With regard to the disease in lambs, we find Benedikt [Sdchsen Jahresbericht, 1871, p. 140) describing it under the head of " typhus diarrhoea in Sheep" [Typhbse Ruhr bei Schafen), He writes : " At the commencement of lambing-time, the lambs are observed, soon after birth, to be dull and dejected ; they do not care to suck ; there is great debility ; the eye is dull and sunken ; there are involuntary evacuations of a foetid, brownish-yellow color, which is ejected some distance ; and in three or four hours death ensues. In all the cases the lambs, when born, appeared to be quite healthy ; but in two or three hours after they began to exhibit these .symptoms, and during the first, seldom the second day, they perished. On examination of the carcase, bright-red spots are observed in the true stomach and intestines, which contain matter having an DIARRHCEA. 755 unpleasant odor. The Ewes remain healthy. With regard to the cause, this was prob- ably in the fodder, which consisted of damp oats, and also in the dwellings, which were hot and steamy. The Ewes in lamb were therefore fed with maize and good fod- der, sulphuric acid was put in the water they drank, and every week they received two draughts of a solution of sulphate of iron with vegetable bitters, the dwelling was changed, and the disease ceased. Prognosis. The prognosis of this disease is generally unfavorable. Nearly all the young animals seized with it perish ; and when a few recover, it is either through energetic and appropriate treatment, being attacked in a less severe manner, or from being endowed with greater vital tenacity. And even those which recover are usually so reduced in strength and condi- tion, and convalescence is so protracted and unsatisfactory, that there is little if any profit in rearing them. As a rule, all those born about the same period succumb ; but after the malady has prevailed for one or two years in a shed, it assumes a milder form, and more recoveries are recorded. When the disease appears in small cowsheds, where there are fewer calves and comparatively more space, it is much less to be dreaded. Sometimes it disappears from a cowshed for some months. Old calves are not so readily affected, and recover more readily. Weaned calves which are fed on fodder, appear to enjoy immunity from attack. Treatment. As with every other animal m3.]7idiy, preventive treatment is the most important, with regard to this diarrhoea of young animals. Attention to hygiene is very necessary at all times, and more so when the disease has shown itself in a stable or shed. It is much the safer plan, however, to remove all pregnant animals from the dwelling in which it has appeared, and the longer the interval which elapses between their removal and parturition, so the more likelihood there is of their progeny escaping. If moved three to four, or four to six weeks before parturition, their safety may be fairly assured. The stable or shed in which the malady has occurred should be well disinfected, and if possible left unoccupied during the grazing season. The floor particularly demands attention, as it is not at all improbable that the infection is retained there ; if possible, the floor should be renewed. Strong carbolic acid or chloride of lime-wash must be freely employed, and especially where the excreta from the sick animals have fallen. Thorough disinfection of the building with sulphuric acid or chlorine gas is advisable. With regard to curative measures, but little, unfortunately, can be said. The history of the outbreak may suggest the nature of predisposing causes, and furnish indications for their removal. In the Milch Zeitung for 1877, is a good paper on the malady in calves, by Kessel-Zeutsch, who says, with regard to treatment : " When only isolated cases occur among the sucking calves in a herd, they are usually of a mild and tractable form, and due to cold or temporary unsuitability of the mother's milk, or to a natural predisposition to weakness of digestion. The external symptoms generally observed are the frequent passage of slimy motions, marked tenesmus, and a disinclination to suck. Consequently the calves soon become weak, and the primary con- sideration is, therefore, to support their strength while treating the attack. To this end it is absolutely necessary that any calf having diarrhoea to an extent requiring medicinal treatment should immediately be placed with the mother, so as to benefit by the animal heat of the Cow, and by its own instinctive inclination to suck. Diarrhoea caused by over-sucking is rarely met with except when the calves have been separated from the mother shortly after birth, in which case they naturally feed too greedily when allowed access to the teat, and so overburden their still immature digestive apparatus. 756 DISEASES AND ABNORMALITIES. " The color of the motion is always an index to the cause of the diarrhoea, and, with this point established, its treatment by appropriate means can be rationally conducted. When the motion is yellowish-white, the diarrhoea is chiefly dependent on simple weak- ness of digestion, and in such cases a couple of raw eggs, with their shells, or the whites of two eggs with some chalk, may probably be of service ; or should this treatment not suffice for the cure, it may be followed by the administration of an infusion of oak bark, or peppermint root in starch. On the other hand, when the motion is of deep golden yellow color, slimy and tough, and the orifice of the anus irritated, the liver is at fault, and laxative and strengthening medicines are called for. These are best given in the form of rhubarb and Epsom salts, three or four times a day, in half a pint of linseed tea. Again, if the motion be slightly colored, and have no appreciable smell, but is still accompanied by pain in the passage, the diarrhoea is dependent on the inflammatory condition of the intestines, and is best treated by decoctions of linseed, or by infusions of marsh-mallow or of camomile flowers, either given internally, or admin- istered as clysters. A decoction of bruised bitter almonds (125 grammes in a pint of new milk) has also proved useful in such cases. In Switzerland, and in the Tyrol, diarrhcea dependent on inflammation is generally treated by camomile infusions, and that caused by weakness of digestion by coffee. In France the former class of cases is treated by mallow flowers, and the latter by broth made from mutton bones, or by rennet. In Holland and Oldenburgh the means chiefly relied upon are infusions of hops. " All the above methods are good if applied early, and if the cases are sporadic only ; but when the calves generally are attacked soon after birth, presenting such symptoms as diminished appetite, debility, constant passage of yellowish-white modons, and fits of cramp, they are generally of little avail. In such cases the calves are but secondarily affected, and the proximate cause of mischief must be looked for in the mother Cows, whose condition of blood will generally be found at fault. Till this fact is recognized, all treatment of the calves is but lost. Where diarrhoea is generally prevalent among the calves, the Cow's coat will usually be found in an unhealthy condition — the hair rough and dull, its roots colorless, and its skin covered with a crust or scale. The milk of such Cows, tested with litmus paper, invariably exhibits an acid reaction. To cor- rect this faulty condition of blood, it has been my practice to give them a lick-bit of bitter aromatics three or four times a week. The preparation employed is a mixture of equal parts of calamus root, juniper berries, and gentian in powder, to which a spoonful of salt is added A handful of rye meal is sprinkled over it, and the powder placed in a dry state at the bottom of the crib, food being withheld for an hour or so after the dose has been taken. At the same time, to promote an increased action of the skin, the ordinary curry-combing and brushing is supplemented by a vigorous rubbing-down of the whole body, more especially of the flanks, belly and back, with wisps of straw. In a few weeks such treatment proves successful, a healthy appearance of skin and hair gradually returning, while the milk regains its normal wholesome condition, and can be taken by the calves without danger of a return of diarrhoea. Of course, careful attention is also given to the diet, all injurious substances being scrupulously avoided. Such calves as fell victimsto the disease were examined after death, and in no case were any organic changes detected, but the stomach and neck of the bladder were invariably found swollen, the intestines inflamed, and the milk contained in them curdled. The rationale of treatment is to promote the secretion of bile, to neutralize the acidity of the mother's milk, and to support the strength. Powerful medicines are too drastic in their effects, and even if successful in checking the diarrhoea, bring on convulsions which often prove fatal. I have found the administration of small powders of opium and car- bonate of magnesia, given once, twice, or thrice a day, according to the severity of the attack, extremely useful. " To all bleeding and issues, often so strongly recommended, I am decidedly opposed, since they cannot possibly exercise any influence on organic disease, and simply serve to weaken the patients still further. As a preventive against diarrhoea, it is often recommended to place lumps of chalk in the rack for the calves to help themselves from. To this practice also I am strongly opposed. Though commonly eaten readily enough by young animals, chalk is far too irritating and constipating in its effects to be good for them. The occasional use of bicarbonate of soda is in all respects far pref- erable. " In many districts it is the practice to draw off by hand the first portion of milk found in the udder after calving, before allowing the calf access to the teat. Nature has, however, specially provided this peculiarly constituted milk for the benefit of the new- born calf, and many later ailments of digestion would undoubtedly be avoided if it were allowed this gentle natural purge. Any one who can overcome this prejudice against its use, and let Nature have her way, will be saved endless worry and trouble in the constant physicing of young live stock." DTARRHCEA. 757 Hertwig recommends the following as a specific remedy : Pulv. rad. rhei - - - - 4-0 grammes. " magnes. carb. - - - i* " opii pur . - . _ o*3 " This is to be given in 100 to 120 grammes of camomile tea or in fifty grammes of whiskey — the dose to be repeated in twelve hours if neces- sary. Obich gives a recipe which he speaks confidently of. It is the follow- ing : Decoct, rad. althag concis. - - 250 grammes. Tinct, opii simpl. - . _ 7-^0 " Two table-spoonfuls to be given every two hours, according to the size of the calf or the urgency of the symptoms. Sulphate of iron, nitrate of silver, phosphoric acid, hydrochloric acid, sulphate of zinc, opium and rhubarb, chalk, strong coffee decoction, etc., have all been recommended, tried, and failed, Beltz, Auloge, Rueff, and others recommend castor-oil or glycerine, or even magnesia, to which a little rhubarb or gentian has been added. Armatage gives the following as an astringent mixture for calves, lambs, and pigs : Powdered opium - - - - - 2 grs. Tincture of cardimoms - - - - 2 drs. Sulphuric ether 20 to 30 drops. Linseed-tea or starch gruel - - - 4 " 6 oz. Half an additional quantity is the dose for a calf ; half the above is that for lambs and pigs. He mentions that alum whey is in common use. This is made by mixing together half an ounce of powdered alum and two quarts of milk, and boiling them for about ten minutes. The mixture, after being strained and' cooled, is ready for use, and is given twice a day to calves, and proportionately to other animals. This com- pound is also useful as an injection, together with mixtures of starch or wheaten flour, and tincture of opium in water. Zundel speaks of enemeta of starch or dextrine, or water slightly carbolized ; and he particularly recommends those composed of a dilute solution of permanganate of potass (i to 2 to 100). Franck suggests the employment of tepid enemas of the neutral salicylate of soda (about ten grammes /^r^/z>»2), in doses of one or two grammes. The same medicament might be tried in draughts. Chlorodyne might likewise be most usefully resorted to. Careful attention, as has been stated, must be given to the feeding. Either from a cow, or in a bucket, the calf should have, three times daily, a small quantity of fresh milk — if possible from a recently calved Cow. In severe cases, it is recommended that the milk be supplied from the same Cow -, and where these precautions are not very ejffectual, each meal of milk is to be diluted with about a fourth of lime-water, which is said to prevent the formation of curd in the stomach. In more serious cases, milk should be withheld, and instead of it may be substituted well- boiled gruel made with wheaten flour, Liebig's farinaceous food, or even eggs and beef-tea may be administered. 758 DISEASES AND ABNORMALITIES. The patient should be kept warm and comfortable, warm baths have sometimes proved useful, as have also poultices of camomile flowers to the abdomen, when symptoms of pain are manifested. CHAPTER X. Retention of Meconium. — Constipation. The contents of the intestines — the meconium — are generally expelled immediately after birth, when the umbilical circulation is first interrupted. When the meconium is retained much longer it is abnormal ; and this occurs more frequently with the foal, perhaps, than other creatures. The prolonged retention of the meconium gives rise to constipation, and this is often a serious condition. The animals in which it occurs are gener- ally weakly, and not well developed. Cattses. Constipation is usually observed in foals which have been dropped in February or March, and whose dams have been fed exclusively on dry fodder during the winter. This result is still more likely to follow if the dams have been worked until near foaling-time. Their milk is then deficient in those purgative qualities which are so necessary for the new- born animal. It is the same with Cows which have been stall-fed all the winter with dry food ; and the calves are almost certain to suffer from retention of the meconium if deprived of the first milk of the Cow, no matter whether the latter may have been properly fed. ^ Symptoms. One or two days after birth, the foal appears to be uneasy, refuses to suck, has tenesmus, makes efforts to defecate, shows symptoms of colic, rolls on the ground, and often looks towards the abdomen ; the back is arched, micturition is suspended, pulse and respiration frequent, the eyes injected, and the teeth ground against each other. Enteritis sets in, and death takes place in struggles and convulsions. The symptoms are similar in the calf : the abdomen is very much re- tracted ; the respiration hurried ; back raised when the creature is stand- ing, though it generally persists in lying ; it moans continually ; refuses to suck ; and is very restless. Treatment. The preventive treatment consists in attending to the feeding and con- dition of the pregnant animal some time before parturition. The young creature should be fed on the first milk its parent gives. The curative treatment must be directed towards removing the meco- nium from the intestines. This may be effected by giving a soap or oil enema, or previously removing as much as is accessible to a well-oiled finger. That which is beyond reach of the finger, Franck recommends to be brought away by means of a flexible, but not too weak, noose of wire. The Cow should have an abundance of fluid to drink, and this may be rendered slightly laxative by the addition of cream of tartar or sulphate of soda. IMPERFORA TION OF THE ANUS, 759 If the constipation persists, purgatives may be administered. These may be castor-oil, manna, sulphate of soda, aloes, etc. Frequent enemas will aid the" action of the purgatives. Sometimes constipation is due to giving too rich food, and, in artificial rearing, to an excessive allowance of meal or flour. The treatment is the same. CHAPTER XI. Skin Dryness of the New-born Animal. Obich {Wochenschrift fur Thierheilkimde, 1869, p. 10/) is, to my knowl- edge, the only writer who has alluded to this peculiar condition of the foal at birth. He says : " In the case of some primiparous Mares, a fatal ac- cident often happens to their progeny. When parturition takes place without any one being present, the young creature, on being expelled from the mother, continues lying away from her until its skin is dry. The consequence is that the Mare does not care for it, does not lick or attend to it, and opposes all attempts to compel her to suckle it. For some days constraint is necessary, and much trouble and danger may be incurred before she .is accustomed to it. This may be averted if the new-born creature is rubbed over with the 'after-birth' (placental membranes). The instinct of the Mare impels her then to lick and fondle heroffspringj and to take to it kindly and in a natural manner." CHAPTER XII. Imperforation of the Anus. Imperforation of the anus is not a very rare occurrence in new-born an- imals, and this vicious conformation has been observed in foals, calves, pigs, and lambs. The latter appear to furnish the largest number of cases. This condition is, of course, very serious unless surgical aid is quickly afforded, and even then the young creature cannot always be saved. The meconium cannot be evacuated, nor yet the residue of the milk the animal may have ingested after birth ; whence results an accumulation of irritating matters in the intestines, which give rise to inflammation, and this quickly causes death. This occlusion or imperforation may exist in various degrees. There maybe merely a membrane covering and occluding the anal opening; the borders of the anus may be adherent to a greater or less extent ; the rectum may be more or less absent or incomplete ; or it may open into the genito-urinary passages instead of at the anus. Symptoms. When no faeces can be expelled, usually towards the second or third day after birth, uneasiness and symptoms of acute colic are manifested ; the animal does not suck, the abdomen becomes distended, expulsive ef- forts and pawing are observed, yet nothing is passed. The animal shows signs of great pain and misery, and if help is not afforded it dies in agony. 76o DISEASES AND ABNORMALITIES. Ill young female animals in which the rectum is absent, it often hap- pens that the intestine opens into the vagina, and the fasces are expelled by that canal. Rainard has witnessed this malformation in several fillies, and his attention was also drawn to four young pigs — males and females — in which the anus was absent. They were the litter of one Sow. It is therefore well to ascertain, in the case of female animals destitute of an anus, whether the meconium or faeces pass by the vulva. Treatment. The symptoms lead the veterinary surgeon to examine the defecating organs, and to discover the character of the obstruction. If there is only a simple membrane occluding the anus, this projects like a large vesicle through the pressure made upon it by the faeces. This membrane, which is really the skin, has usually a deep red tint, and is soft and thin, offer- ing but little resistance. The prominence it forms is altogether soft and pits on pressure. In such a case all that has to be done is to incise the membrane — in a crucial manner, if deemed best. Along, narrow, pointed bistoury is the most suitable. After well ascertaining the entrance to the rectum, the skin is punctured, care being taken not to allow the knife to pass too deep ; a director may be employed to complete the incision, and to guard the intestine from injury. No sooner is this incision made, than the meconium escapes ; then the crucial division may be made with a pair of sharp scissors. The index finger should be introduced as far as possible into the intestine, to make certain that all is right there. In order to prevent the opening closing by cicatrization, a suppository or tent may be introduced into the rectum, and withdrawn every now and again in order to allow the fasces to be expelled — injections assisting in the latter ; or the angles of the divided skin may be snipped off by scis- sors, so as to hinder their union. The lips of the wound are subsequently lubrified by a little oil or grease, and, provided inflammation does not set in, recovery is certain. When the prominence is not present, and yet there is complete occlu- sion, with all the symptoms above-mentioned, the operation is more dif- ficult. The perineal raphe is sought for, as on its track the anus should be found. This is carefully felt, when the prominence formed by the end of the intestine will be discovered. Then a short incision is made through the skin only on the middle line ; the subcutaneous tissues are dissected away until the bulging of the intestine is reached ; this is drawn outwards between the lips of the wound by forceps or a ligature, and an opening made into it, and the contents removed. The margins of the opening are then secured to the borders of the external wound by some fine su- tures, and attention is paid to the parts during the healing process, in order to prevent the artificial anus becoming too contracted. When the rectum is absent to a more or less considerable extent (in some cases it is reduced to a mere fibrous cord), then but little benefit can be conferred. In a few instances nature has effected a partial rem- edy, by establishing an artificial opening by ulceration through organs and textures, and the faeces have escaped by the fistula. Rainard mentions this natural colotomy as occurring in two young horses. An artificial opening may be made either in the perineal or ab- dominal region \ but it is rare indeed that the animal is worth the trouble and risk. IMPERFORATION OF THE ANUS. 761 In those female animals in which the rectum communicates with the vagina, Rainard makes the following remarks with regard to operation. As the part of the vagina which has the opening into the rectum is never very deep, a half S-curved sound is introduced by one of its ends into the normal track, and pushed into the rectum until it reaches the cul-de-sac in it. With a bistoury, an incision is then made where the anus should be ; the skin and subcutaneous connective tissue being divided, the index-finger is passed into the wound in search of the curved sound in the rectum. When met with, an assistant takes the sound, while the blade of the bis- toury is made to glide over the nail of the index-finger, and the intestine opened by it. The same finger is plunged into this new opening, and serves to guide the bistoury in dilating the incision as much as may be deemed necessary. After the skin and connective tissue is incised, a trocar of sufficient size may be employed to puncture the intestine. Landel [yournal Vetirinaire ^elge, vol. i., p. 95) met with a case of this kind in a Cow, aged one and a half year. On examining the creature, he found that the anus was occluded, and that the vagina contained fluid faeces which had passed into it by a nar- row opening leading to a canal communicating with the rectum. Landel decided to make an artificial anus. He made an incision in the perinaeum about two and a half inches in length, through which the faeces escaped. On the following days enemas were administered ; the margin of the wound tumefied slightly ; the recto-vaginal fistula be- came obliterated, and the young animal made a perfect recovery. From among many recorded instances of anal atresia, we select the following as illustrativ^e : 1. Rossignol (Rainard, Op. ciL, vol. ii., p. 492) states that a calf, soon after birth, did not offer any trace of an anus. Hoping that the ail-de-sac formed by the rectum was not too distant from the perineum, and that he might feel it when the calf attempted to defecate, he gave it a dose of almond and castor-oil. In a few hours violent colicky pains seized the creature, and nothing could allay them ; no bulging appeared at the perinaeum, and death soon ensued. At the autopsy, made next day, the rectum was found to be completely absent ; the colon terminated in a large dilatation the size of a hen's egg, in the neighborhood of the left kidney, and from it was a transparent liga- mentous prolongation which was attached to the commencement of the sacrum. The colon was congested and full of foetid gas and meconium. 2. Ammon {yahresbericht der Miinchener Zeutral Thierarzneischtde, 1846-47, p. 22) mentions that a new-born calf sucked for a day, when symptoms of constipation-colic were manifested. The enemas administered did not appear to penetrate as far as usual, and they and other treatment afforded no relief. In another day vomiting ensued, and in thirty-six hours from the appearance of the colic death ensued. The digestive organs were found healthy as far as the colon, which terminated in a cul-de-sac; the urinary bladder was absent, and the ureters terminated in what should have been the rectum. 3. Dinter (Sachsischer yahresbericht, 1873, P ^7) operated on a new-born sow which had atresia of the anus, but yet no faeces were passed. The creature died in eight weeks (?) after birth, without any defecation. ' The caecum and large intestine were found to be enormously dilated. 4. Hartmann [CEsterreichischer Vierteljahresschrift f. Wiss. Veterinarkunde, 1874) re- ports that some hours after birth, a foal was observed to have no anal aperture. Hart- mann was shortly after called in, and it was decided that an artificial opening should be established. An incision was made through the skin along the median line of the per- ineum, and the connective tissue separated, but the finger could not discover the ex- tremity of the rectum. Enemas were tried, but without success In the pelvis, at a . distance of about four inches from the incision, the finger came upon a sac with a con- vex extremity, and containing a faecal mass. The first longitudinal incision was enlarged by a second transverse one, and then the finger could explore three-fourths of the extremity of the sac. From it the meconium was passed in small quantity, but it was eventually completely evacuated by the acf ministration of enemas. Into the aperture, a bougie covered with lead ointment was introduced. On the fourth day the opening was nearly closed, and though various measures were 702 DISEASES AND ABNORMALITIES. essayed to re-widen it, it was necessary at length to have recourse to multiple incisions in the skin. But notwithstanding these incisipns, in spite of all attempts at dilatation, and although enemas were frequently given, no favorable change could be effected, and the foal succumbed on the sixth day. The autopsy demonstrated the existence of peritonitis, as well as a notable distention of the intestines. The rectum was about four inches shorter than is natural, and the surrounding connective tissue was ulcerated. 5. Siebenrogg {Repertorium filr Thierheilkunde, 1875, P- 5-) gives a case which de- rives its importance from the subject of it being a nine-months-old Sow. Defecation took place by the vagina, between which and the rectum there was a free communica- tion. So long as the faeces were soft, the recto-vaginal opening sufficed for their ejec- tion ; but when the animal began to be fattened with potatoes, etc., this did not permit defecation, and the contents of the intestine were arrested. The Sow was in the latter condition when seen by Siebenrogg, and the case was so urgent that he decided on making an artificial anal orifice. After removing the skin at this point and exposing the extremity of the rectum, the latter was incised to a sufficient extent to allow of its being emptied ; this afforded the animal immediate relief. The faeces afterwards con- tinued to pass through this surgical opening, as well as that between the rectum and vagina. In six months the Sow was slaughtered, and on examination it was found that the borders of the wound were cicatrized, and the opening into the rectum about two inches deep and large enough to admit the little finger. CHAPTER XIII. Imperforation of the Vulva and Vagina. Imperforation, atresia, or occlusion of the Vulva does not appear to be very rare in new-born animals, they being not unfrequently found after birth without any apparent opening into this passage, the hibia of which are adherent. The adhesion may be general or partial. In the former case the urine cannot escape, and is therefore retained ; or it may be expelled through the urachus, by the umbilical opening. When the retention is complete, the bladder soon becomes distended and ruptures. From this death soon ensues. Complete occlusion is always a serious condition, as there is no precise indication as to where the urethra opens, or even if it exists at all ; so that it is scarcely possible to make an artificial opening for the passage of the urine with perfect and permanent success. When the labia are merely adherent, then there is no difficulty, and not much danger, in the case. The adhesion being destroyed and the labia freed, the urine is no longer retained and the malformation is remedied : the only precaution necessary is to prevent their again becoming united — this is easily ef- fected by dressing the raw margi-ns with oil or grease, and, if need be, keeping them apart until healed. When occlusion is only partial, the interference of the operator may or may not be deemed necessary, according to circumstances ; but it will be generally most judicious to enlarge the opening to its natural dimen- sions before the animal becomes full-grown. Imperforate Vagina is much less frequent than imperforate vulva. Nevertheless, it is sometimes met with in new-born creatures. The dan- ger is the same as in the other malformation, as the external opening of the urethra is situated below the pubic symphysis, immediately anterior to the entrance to the vagina. Consequently, the urine may be retained, and the animal will soon perish from rupture of the bladder, peritonitis, etc. IMPERFORATION OF THE PREPUCE. 763 All that can be done in such a state of affairs, is to compensate for the absence of the natural canal by making an artificial opening, and to prevent it from closing by introducing a dilator, and keeping it there (removing it, of course, from " time to time) until there is no danger of closure. When the obliteration is only partial the case is not so serious, and provided the urine escapes at all freely, surgical interference may not be necessary — at least until breeding-time arrives. CHAPTER XIV. Imperforation of the Prepuce. IMPERFORATION of the prepuce of new-born creatures is apparently a very unusual occurrence, as it is scarcely mentioned in veterinary litera- ture. Brugnone notices it as occurring in foals, and he recommends that an artificial opening be made in the prepuce where the natural aper- ture should be ; the lips of the wound to be kept apart by any suitable contrivance, which may be secured z>z situ by attaching tapes to it, and passing these round the body, securing them over the loins. When this artificial opening is not made, the same grave results follow as in com- plete occlusion of the vulva. This operation is successful only when the urethral canal is patent throughout its length ; when it is occluded also, the operation will no longer be attended with benefit, and the operator must then endeavor to discover where the obstruction is, and either overcome it, or make an opening somewhere for the escape of the urine. In some instances, when the orifice of the urethra is occluded, the urine escapes by a congenital opening in some part of the canal. When this opening exists at its upper surface, the defect receives the name of epispadias., and when at its lower hypospadias. Such a malformation has been seen m the dog, lamb, and goat, and it is not of much importance, so far as the flow of urine is concerned. If the opening is near the end of the urethra, the urine runs into the prepuce, and passes thence ; but if it is more behind, between the scrotum and ischiatic curvature, it then flows over the skin, abrades it, and the dust and dirt accumulate ; this, together with the repulsive' odor of the decomposed urine, renders the case very unpleasant to the eye and nose. Treatment is only too often unsuccessful and always troublesome. It is least so when the opening is near the termination of the urethra, as then the defect is more accessible and easier remedied. There are other two regions which may suffer from congenital occlu- sion, but to the description of which we have not deemed it necessary to allot separate chapters : we refer to the visual and auditory. Occlusion of the eyelids has been witnessed in foals, calves, and other young animals. Of course we do not allude to the natural occlusion of the eyelids of puppies, kittens, and young rabbits, which prevents their seeing for some days after birth. This accidental occlusion of the eyelids presents itself in two forms. In one, the margins of the upper and lower eyelids are only adherent ; 764 DISEASES AND ABNORMALITIES. and in the other, the eyelids are, in addition, adherent to the eye itself throughout their entire surface. The first variety is alone curable, and in order to disunite the eyelids, the operator proceeds as follows : Securing the head of the creature in the hands of an assistant, the upper eyelid is elevated by another assist- ant by means of a pair of forceps. The operator himself seizes the lower lid by the same means, and pulls it as far as possible from the eyeball beneath ; then taking a pointed bistoury or sharp scissors in his right hand, a small puncture or notch is made between the margins of the lids, in such a manner as to injure neither, if possible, and much less to wound the eye. A grooved director is passed into the puncture in the direction of one of the canthi of the eye, and the bistoury or scissors run along it, separates the two lids; the director is then turned towards the other canthus, and the same procedure is followed. If the scissors are used, the director is not necessary. All that is required after the opera- tion, is to apply a little lard to the borders of the lids, should there be any tendency to re-adhesion. Occlusion of the auditory canal is much less rare than that of the eye- lids, and when it exists deafness is the consequence, as well as dumb- ness. It is the latter condition which most frequently attracts attention, and leads to the discovery that the real and serious defect is deafness. Then a small prominent tumor is detected in the place of the ear, or where the external auditory canal should be. This tumor is rather soft, and can be readily seized by forceps, when it may be punctured with a bistoury or a lancet, and a crucial incision made through it, or it may be resected by forceps and scalpel or scissors. When the membrane forming the covering of the tumor is removed, a quantity of grey cerumen is found obstructing the canal ; this can be removed by pressure, injections of tepid water, or a small scoop. To hinder the closure of the canal, a little morsel of lint or fine tow is placed in the ear, and retained there by a bandage round the head. With the dog, which is most frequently affected in this way, the bandage requires to be more carefully fixed than with other animals, as it uses its paws, and does not rest until it is removed. If both ears are affected, one only should be operated upon at a time ; and, as a rule, it is better to wait until the slight inflammation which fol- lows the operation subsides, before the other ear undergoes the same treatment. So far as hearing is concerned, the result is often negative ; indeed, Rainard confesses that of the large number of dogs he operated upon, not one recovered its hearing. CHAPTER XV. Cyanosis. At page 99, in describing the foetal circulation and the modifications which occur in it at birth, we mentioned that the lungs then become the organs of respiration, and rapidly increase in capacity, while the thorax enlarges in a commensurate degree ; the pulmonary artery also dilates to admit the increased flow of blood, and the ductus arteriosus is oblit- CYANOSIS. 765 eratecl to prevent the mingling of arterial and venous blood. It was also stated that the ductus venosus likewise aids in the isolation of the two kinds of blood by becoming atrophied, as does also the occlusion of the foramen ovale, though the latter opening not infrequently remains intact in young animals. Remarking upon the patency of the foramen ovale, it was said that, as a rule, this accident did not greatly affect the circula- tion ; for when the heart contracts, the auricles are isolated by the nar- rowing of the orifice and the elevation of the valve. Cases occur, nevertheless, in which, either from the persistence of the foramen ovale, with perhaps defective auricular contraction, or an abnor- mal disposition of the large blood-vessels at their origin, the arterial and venous blood is mixed, and we have the condition known as cyanosis or the " blue disease." Then there is a deep-blue or violet coloration of the visible mucous membranes, more or less debility and difficulty in respira- tion, especially during exertion, coldness of the limbs and surface of the body, and a great predisposition to haemorrhage. Cyanosis may occur in otherwise well-developed individuals, and be due to a congenital adhesion between the lungs and pleura or pericar- dium ; it is also a symptom of asphyxia, and is sometimes witnessed in colic in the horse, complicated with meteorismus ; it likewise accompanies certain forms of poisoning. When due to the first-named causes, this condition is manifested during, or immediately after, birth ; it is only in rare instances that it is developed at a later period. It is needless to mention that such a conformation is beyond remedy, though animals so affected will often live for a long time; Zundel has seen a horse seven years old which was in this condition. Vernant {Reciceil de Med. Veterinaire, 1877, p. 592) was called to see a calf which had been born the previous evening, and with such ease that it was found behind the Cow, no one being present at its birth. It was viable, in very good condition, fat, and so well developed that it looked as if fifteen days old. But it could not stand, and lay constantly in the sternal position, refusing to suck. ' The symptoms it presented were markedly those of asphyxia : the tongue was half protruded from the mouth, the eyes prominent, the respiration plaintive and hurried, and the flanks very agitated. When raised it could not stand ; its limbs were constantly and convulsively moved, and were unable to sus- tain the weight of the body. The animal was bled at the tail, but this afforded no relief, and in forty-eight hours after birth it died. The lungs were then found to be collapsed, and looked very con- gested. The anterior extremities of the lobules floated well in water, but the mass of the lungs was rather heavy. The foramen ovale was incompletely closed, so that the two auricles could communi- cate with each other ; the opening was as large as a five-franc piece, and the auricular septum was extremely thin. Another congenital malformation to which we have not devoted a special chapter, is ".tongue-tie " in young animals, and particularly calves. Tyvaert {Annales de Med. Veterinaire, June, 1877) has observed this condition on six occasions in calves. It is similar to tongue-tie in chil- dren and certain birds, and is characterized by the fraenum linguae being too narrow from above to below, and too much prolonged forward — some- times extending to the root of the incisor teeth. This anomaly greatly hinders the prehension of food and swallowing of fluids ; the calf, if drinking out of a bucket, vainly plunges its face into the fluid as far as the eyes. The teat is seized with difficulty, and the tongue is so limited in its movements that it cannot be protruded to lick the nostrils, as is the 766 DISEASES AND ABNORMALITIES. custom with bovine and some other creatures. The defect is often un- perceived, and the young creature loses condition, becomes weak, and eventually succumbs. The treatment is very simple. It consists merely in dividing the fraenum to such an extent that the tongue may recover its liberty of move- ment. Immediately after the operation, the creature protrudes its tongue to lick the blood which escapes, and it can drink with ease. The wound heals in a few days without any precautions. The End. INDEX Abdominal evisceration, 548. Abdominal foetation, 161. Abdominal taxis, 310. Abnormal quantity of placental fluid, 377- Abnormal retention of the foetus, 191. Abortion, 197. " artificial, 277. " epizootic, 209. " sporadic, 199. Accessory cotyledons, 82. Accidents of pregnancy, 182. Accidents incidental to parturition, 567. After-pains, 250. Agalactia, 714. Aid after labor, 245. Albuminuria, i8r. Alimentary canal of foetus, loi. " " annexes of, 102. Allantoic fluid, 78. Allantois,. 77, 78. " differences in, 78. Amaurosis, 181. Amnion, 74. " differences in, 76. Amputation of the limbs, 543. '' " fore limbs, 544. " " hind limbs, 546. " " uterus, 604. Anasarca, 386. Anatomy, obstetrical, 531. Anidian monsters, 169. Annexes of the foetus, 70. Anomalies in gestation, 156. " foetal membranes, 375. " placenta, 358. " umbilical cord, 378. Ante-partum prolapsus of the vagina, 182. " rupture of the uterus, 184. Anterior position, 229. Anterior presentation, 227. Anus, atresia of, 759. Apoplexy, parturient, 656, 669. Arthritis, 736. " causes of, 737. " pathological anatomy of, 742. " prognosis of, 742. " symptoms of, 740. " treatment of, 746. Articulations of pelvis, 12. " differences in, 14. " ischio-pubic symphysis, 13. " sacro-coccygeal, 14. " sacro-iliac, 12. " sacro-lumbar, 12. Artificial abortion, 277. Artificial passage for foetus, 279, Asphyxia of the new-born animal, 246, 719. Ascites, 386. Atresia of anus, 759. " OS uteri, 356. Attention to the offspring, 246. B. Bandages, or trusses, 598, 726. Bladder, inversion of, 615. CESAREAN section, 325. Cancerous, carcinomatous or sarco- matous tumors, 331. Capacity of pelvis, 20. Cephalotomy, 539. Cervix uteri, digital irritation of, 277. " induration of, 349. " rigidity of, 341. " structure of, 38, 39. Changes in the ovum, 64. Chorial cotyledons, 83. Chorion, 71. " differences in, 73, 74. Chorion, scirrhous, 359. Cleft palate, 95. Collapse, parturient," 656. 768 INDEX. Colostrum, 253. Complete deformity of the pelvis, 271. Complications cfc ruptured vagina, 629. Complications caused by deviation of the hind limbs of the foetus, 476. Condylomatous, papillomatous, and lipomatous tumors, 331. Constipation, 177, 758. Constriction of vagina and vulva, 365. Contorsio uteri, 291, 325. Contention or retention of the uterus, 593- Contractions of the foetus, 391. Cords and bands, 501. Corpus luteum, 51, 52. Cotyledonous milk, 83. Cotyledons, 83, 121. Cough, 181. Cramp, 176. Craniotomy, 540. Crotchets or hooks, 510. Cup-and-ball pessary, 594. Cyanosis, 764. D. Death of foetus, 241, 394. Decapitation, 541. Decidua serotina, 84, 85. Decidua vera, 258. Development of embryo, 66, 67, 68. " of ovaries, 49. Deviation of the uterus, 288. Diagnosis of multiple pregnancy, 150. Diarrhoea, 749. Differences in pelvis, 10, 25, Diffused placenta, 85. Digital irritation of cervix uteri, 277. Diminution in the size of the foetus, 279. Diseases of the foetus, 379. Diseases and abnormalities of the young animal, 719. Diseases of pregnant animals, 175, Diseases peculiar to pregnancy, 176. Distorted monstrosities, 416. Division or detruncation of the foetus, 547- Dorso-lumbar position of the foetus, 230. Dorso-lumbar presentation, 227, 228. Ductus arteriosus, 99. Ductus venosus, 99. Duration of pregnancy, 138. Dystokia, iii. 260. " general considerations^ 260. Dystokia foetal, 368, 260. " maternal, 260, 270. " due to anterior limbs incom- pletely extended in the pelvis, 441. Dystokia, head deviation upward and backward, 464. " " downward, 451. " displacement or changed re- lations of the uterus, 279. " dorso-lumbar uresentation, 489. " extreme abduction of head and limbs, 466, *' fetlock presentation, 477. " fore limbs, 441. " fore limbs completely re- tained, 447. " fore limbs crossed over the neck, 441. " fore limbs flexed at the knees, 443. " head, 450. " head and fore limbs in the posterior presentation,487. " hind limbs in the pelvis, 467. " hock presentation, 478. " lateral deviation, 455. " lumbo-ilial positions, 476. " lumbo-pubic position, 474. " lumbo-pubic and lumbo-ilial positions, 474. " misdirection of hind limbs in the anterior presentation, 466. " morbid alterations in the genital oi'gans, 327. " right or left vertebro-ilial position of the foetus, 446. " pelvic constriction, 270. " posterior presentation, 473. " sterno-abdominal presenta- tion, 494. " thigh and croup presenta- tion, 482. " transverse presentation, 488. " vertebro-pubic position, 446. " vertebro-sacral position, 443. Eclampsia, parturient, 681. Embryo, development of, 66, 67, 68. Embryotomy, 532. " instruments for, 533. preliminary arrange- ments for, 539. Emphysema, 390. Employment of force in dystokia, 523. Endo-metritis, 643. Enlargement of the genital canal, 279 Epilepsia uterina, 687. Epispadias, 763. Epizootic abortion, 209. Eutokia, iii. 5. INDEX. 769 Evisceration, 548. " abdominal, 548. " thoracic, 548. Evolution in dystokia^ 438. Excess in volume of the foetus, 369. Exostoses on pelvis, 273. External generative organs, 27. Expulsion of the foetus, 221. " membranes, 225. Extra-uterine pregnancy, 160, i6r. F. Fallopian tubes, 45, 105. " *' differences in, 46, 47, Fecundation, 61. Female generative organs, 27. Fibroid tumors, 331. Fistulae of teat, 718. " vesi CO- vaginal, 635. Foetal cotyledons, 83. " dystokia, 368. " envelopes, puncture of, 277. " " retention of, 567. " membranes, anomahes, and dis- ease in, 375. Foetus, abnormal, retention of, 191. " annexes of, 70. " artificial passage, 279. " death of, 24 [. " development of, 89. " " circulatory system, 96. " " digestive apparatus, loi. " " geui to-urinary organs, 102. *' " locomotory apparatus, 94- " " nervous system, 90. " " organs of sense, 91. " " respiratory apparatus, 92. " " skin and appendages, 92. *' diminution in size of, 278. *' diseases of, 379. '■'• forcible extraction of, 277. " mechanical means for extrac- tion of, 501. " periods of development of, 107, loS. " physiological phenomena in, rio. " " absorption, 112. *' " circulation, 1 14. " " nervous functions. III. *' " nutrition, 1 13. *' " secretion, 116. *' positions of, 228. " " in uterus, 128. " presentations of, 226. *' weight and dimensions of, 1 1 7. Forceps, 515. Forcible extraction of the foetus, 277. Fractures of pelvis, 273, Free-martins, 149. Frequency of monstrosities, 416. Functional modifications in parturi- tion, 250. Funis, 86. Galactophorus sinus, obliteration of, 717. Gastro-hysterotomy, 325, 554. Gelatine of Wharton, 86. Gemelliparous gestation, 143. Generative organs, 27. " external, 27. " female, 27. " internal, 35. Gestation, 107. " anomalies in, 156. " duration of, 138. " influence of, 175. " multiparous, 143, 144, 145. " pathology of, 1 56. " pluriparous, 143. Glandulae utriculares, 40. Graafian vesicles, 47. " " maturation of, 60. Gubernaculum testis, 104. H. HiEMORRHAGE from uterus, 626. " post-partum, 577. " umbilical, 720. Head-collar or head-cord, 505. Hernia of bladder into vagina, 337. " intestines, 621, 627. " umbilical, 722. " uterus, 183. Horizontal diameter of pelvis, 26. Hippomanes, 78. Hydatid kysts, 173. Hydrocephalus, 379. Hydramnios, 178. Hydrometra, 173. Hydrops amnii, 178. Hydrops uteri, 173. Hydrothorax, 386. Hygiene of pregnant animals, 153. Hymen, 364. " persistent, 364. Hypospadias, 763. Hysterocele, 183, 2S0. Hysterotomy, vaginal, 313. I. Imperforation of anus, 759. " prepuce, 763. " vagina and vulva, 762. Indigestion of young animals, 748. 770 INDEX. Induration of the cervix uteri, 349. Infectious abortion, 209. Inflammation of the mammae, 696. " umbilical cord, 732. Influence of food on the foetus, 372. " gestation on ordinary dis- eases, 175. Injuries to the teats, 715. Internal organs of generation, 35. Intestines, hernia- of, 621, 627. Intestitial fcetation, 161. Inversion of the bladder, 615. " " uterus, 581. " " vagina, 611. K. Kysts, serous, 336. L. Labor pains, 216. Laceration of uterus, 619. " vagina, 625. Lactation, 252. Laminitis, parturient, 689. Laws of teratology, 41 1. Left vertebro-ilial position, 229. Leucorrhcea, 642. Liquor amnii, 75. Lithopoedian, 193. • Lochia, 251, 258. Lordosis, 272. Lumbo-sacral position, 230. M. " congestion in, 693. " differences in, 33, 35, " inflammation of, 696. Mammitis, 693, 696. " parenchymatous, 698. " phlegmonous, 697. Mania puerperalis, 687. Manual and mechanical force com- pared. 530. Mastitis, 693, 695. Maternal cotyledons, 82. Maternal dystokia, 260, 270. " " causes of, 358. Maturation of Graafian vesicles, 60. Means for developing necessary force, 527. Mechanical means for the extraction of the foetus, 501. Mechanism of parturition 226, 232. Meconium, retention of, 758. Menstrual discharge, 57. Menstruation, 56. Metritis, 643. Metro-peritonitis, 643. Metrorrhagia, 190. Metrotomy, 604. Milk, 253. Milk fever, 252. Moles, 169. Monstrosities, 395. " classification of, 396. " distorted, 416. " double, 399, 424. " double-headed, 418. " frequency of, 416. " origin of, 411. " simple, 396. " treble, 399, 424. Acephalian monstrosities, 407. Acephalus, 396. Amorphus, 396. Androgynus, 399. Anencephalian monstrosities, 407. Anidian or zoomylian monstrosities, 407. Aschistodactylus, 398 Atretocephalus, 398. Atretocormus, 398. Autositic, 402. Campy lorrhacchis, 398. Campylorrhinus, 398. Celosomian monstrosities, 404, 420. Cryptodidymus, 401. Cyclocephalian monstrosities, 407. Cyclopean monstrosities, 417. Cyclops or monophthalmus, 398. Dicephalus, 400. Dicranus, 400. Diphallus, 398. Diprospus, 399. Dipygus, 400. Emprosthomelophorus, 400. Ensomphalian monstrosities, 409. Epigastrodymus, 401. Exencephalian monstrosities, 406. Gastrodidymus, 401. Gastro-thoracodidymus, 39. Hermaphrodites, 398. Heterocephalus, 399. Heterodidymus, 400. Ischiodidymus, 401. Megalocephalus, 398. Megalomelus, 398. Monocephalian monstrosities, 409. Monocranus, 399. Monomphalian monstrosities, 408. Monosomian monstrosities, 409. Nanocephalus, 397. Nanocormus, 397. Nanomelus, 397. Nanosomus, 397. Octopus, 401. Omphalo-chronodidymus, 401. Opisthomelophorus, 400. Perocephalus, 397. INDEX. m Monstrosities — continued, Perocormus, 397. Peromelus, 397. Perosomus, 397. Pleuromelphorus, 400. Pseudencephalian monstrosity, 407, 418. Pseudo-hermaphroditus, 399. Pygadidymus, 401. Schelodidymus, 401. Schistocephalian monstrosities, 407. Schistocephalus, 397. Schistocormus, 397. Schistomelus, 398. Schistosomus, 398. Symelian monstrosities, 404. Syncepnalian monstrosities, 409. Sysomian monstrosities, 409. Tetrachirus, 401. Tetrasculus, 401. Trigeminal monstrosities, 399. Thoracodidymus, 401. Morbid adhesion between the fcEtus and the uterus, 359. Multiparity, dystokia from, 427. Multiparous gestation, 143. Multiple pregnancy, diagnosis of, 150. " position of foetuses, 151. N. Necessary aid in normal patrurition, 238. Normal parturition, 214. " necessary aid in, 238. O. Obliteration of the galactophorus sinus, 717. Obliteration of os uteri, 356. Obstacles independent of presenta- tions and positions, 369. Obstetrical anatomy, 5. " operations, 500. -' physiology, 53. Occlusion of auditory canal, 764. " eyelids, 763. " uterus, 361. CEdema in pregnancy, 177. " of umbilicus, 731. CEstrum, 56, 57, 58, 60. Offspring, attention to, 246. " general care of, 247. Omphalo-mesenteric vessels, 87. Organic modifications in uterus, 257. Origin of monstrosities, 411. Os uteri, 39. obliteration of, 356. Os tincae, 356. Ovarian foetation, 161. Ovaries, 47. " development of, 49. " differences in, 49, 50, 51, 52. Oviducts, 45. Ovula Nabothi, 40. Ovulum, 48. Ovum, changes in, 52, 64, 67. Paralysis, post-partum, 679. Paraplegia, 180. Parturient apoplexy, 656, 669. " collapse, 671, 656. " eclampsia, 681. " fever, 643. " laminitis, 689, Parturition, 214. " accidents incidental to, 567. " causes of, 215. " expelling powers in, 216. " mechanism of, 232. " necessary aid in, 238. " normal, physiology of, 214. " pathology of, 640. " sequelae of, 250. *' symptoms and course of, 214, 219. Pathological congestion of the mam- mae, 693. Pathology of gestation, 156. " parturition, 640. Pelvic cavity, tumors in, 276, " cellulitis, 627. " openings, 17. " symphysis, relaxation of, 637, Pelvimetry, 21. Pelvis, 5. " articulations of, 12. " bones of, 6. " capacity of, 20. *' cavity of, 15. " complete deformity of, 271. " diameters of, 26. " differences in, 10, 25. " exostoses on, 273. " fractures of, 273. *' openings in, 17. Perinaeum, 31. " rupture of, 632. Peritonitis, 621, 627. Persistence of the urachus, 721. Persistent hymen, 364. Physiology of parturition, 214. Pica, 177. Placenta, 80. " anomalies in, 358. " differences in, 81. " functions of, 85. " praevia, 82. 772 INDEX. Placentas, 8i. Placental fluid, 75. " abnormal quantity of, 377. Placentulce, 81. Pluriparous gestation, 143. Polycotyledonous placenta, Z^. Polysarcia, 391. Porte-cord, 458. Positions of foetus, 228. " " in multiple preg- nancy, 151. " " in the uterus, 1 28. Posterior presentation, 227, 230. Post-partum haemorrhage, ^Tj. " paralysis, 679. Pregnancy, 119. " accidents of, 182. " course of, 167. " diagnosis of, 168. " diseases peculiar to, 176. " duration of, 138. " " in bitch, 142. " " cat, 143. " " cow, 141. " " mare, 139. " " sow, 142, " " sheep and goat, 141. " extra-uterine, 160. " signs of, 129. " symptoms of, 167. " termination of, 167. " treatment of, 168. Pregnant animals, diseases, of, 175. " " hygiene of, 153. Prepuce, imperforation of, 763. Presentations of the foetus, 226. Prolapsus of vagina, ante-partum, 182. " vesicae, 615. Prolonged gestation, 369. Protracted labor, 240. Pseudo-pregnancy, 169. Puberty, 55, 56. Puncture of cranium, 539. " foetal envelopes, 277. R. Reduced number of foetuses, 369. Relaxation of pelvic symphysis, 637. Reproduction, 53, 54, SS- Repulsion, 438. Retention, abnormal, of the foetus, 191. " foetal envelopes, 567. " meconium, 758. Retropulsion, 433. Right vertebro-ilial position, 229. Rigidity of the cervix uteri, 341. Rotation, 436. Rupture of abdominal muscles, 639. " bladder,. 637. Rupture of diaphragm, 638. " intestines, 638. " perinaeum, 632. " sacro-sciatic ligament, 639. " uterus, ante-partum, 184. " " post-partum, 622. " water-bag, 243. S. Sacro-sciatic ligament, 14. " " "■ rupture of, 639- Scirrhous chorion, 359. Sequelae of parturition, 250. Serous kysts, 336. Signs of pregnancy, 129. " " material, 131. " " rational, 129. " " sensible, 134. Skin dryness, 759. Sporadic abortion, 198, 199. Spurious or pseudo-pregnancy, 169. Sterility, 62, 63. Sterno-abdominal presentation, 228, 231. Stricture or occlusion of uterus, 361. Super-foetation, 156. Sutures, 596. Symphyses, pelvic, relaxation of, 637. Symphysis, ischio-pubic, 13. Symphysiotomy, 566. T. Taxis, abdominal, 311. " vaginal, 314. Teats, anatomy of, 31, 33, 35. " fistulae in, 718. " fissures in, 715. " injuries to, 715. Teratology, laws of, 411. Thoracic evisceration, 548. Thrombus or hasmatoma, 336. " of vagina and vulva, 636. Tongue-tie, 765. Torsion of the uterus, 291, 325, 327. " degree of, 303, 306. " diagnosis of, 303. " direction of, 303. " history of, 291. " in other animals, 327. '* pathological anatomy of, 307. " presence of, 302. " symptoms of, 300. " treatment of, 311. Traction on foetus, 243. " degree of, 524. " direction of, 523. Traumatic lesions of genital and neigh- boring organs, 619. Tumors, 393. INDEX. 773 Tumors, cancerous, 331. " condylomatous, 331. " fibroid, 331. " in genital organs, 340. " " pelvic cavity, 327. " " vicinity of genital organs, 340.' Tubal foetation, 161. Tumultuous labor, 240. U. Umbilical cord, 86. " " anomalies in, 378. " " differences in, 87. " " dimensions of, 88. " " haemorrhage from, 720. " " inflammation of, 732. Umbilical hernia, 722. Umbilical vein, 87, 98. Umbilical vesicle, 79. " " differences in, 80. Umbilicus, oedema of, 731. Urachus, 79, 87. " persistence of, 721. Uterine kysts, 171. Uterine milk, 83. Utero-vaginal tumors, 327. Uterus, 38. " amputation of, 604. " deviations of, 288. " differences in, 41, 42, 43. " direction of, 125. " form of, 123. " hernia of, 183, 280. " influence on neighboring or- gans, 126. " inversion of, 581. " laceration and rupture of, 619, 622. " modifications in, 119. " occlusion of, 361. " reposition of, 589. Uterus, rupture of, 184. " sensibility of, 122. " situation of, 125. " structure of, 120. " torsion of, 291, 319. " volume of, 1 19. Vagina, 35. " complications in rupture of, 629. " differences in, 37. " imperf oration of, 762. *' inversion of, 61 1. " laceration of, 625. " rupture of, 625. " thrombus of, 636. Vaginal constriction or atresia, 365. " cystocele, 337. " hysterotomy, 313, 549. " irrigations, 277. " taxis, 314. Vaginitis, 640. Venereal oestrum, 56. Ventral foetation, 161. Version, 437. Vertebro-pubic position, 229. Vertebro -sacral position, 229. Vertical diameter of pelvis, 26. Vesicle, umbilical, 79. Vesico-vaginal fistulae, 635, Vulva, 27, " differences in, 30, 31/ '* imperforation in, 762. " thrombus of, 636. W. Water-bag, rupture of, 243. Whartonian gelatine, 86. Womb, 38. Zonular placenta, '^i- UNIVERSITY OF CALIFORNIA LIBRARY, BERKELEY THIS BOOK IS DUE ON THE LAST DATE STAMPED BELOW Books not returned on time are subject to a fine of 50c per volume after the third day overdue, increasing to $1.00 per volume after the sixth day. Books not in demand may be renewed if application is made before expiration of loan period. iv.AV 20 19- Ml 7 /gcp JUN7 1962 2.'im-7,'25 ^m^Mp ^M]kL^;:^^LS': 52(>G()0 BIOLOGY UNIVERSITY OF CAUFORNIA LIBRARY