c; -■;"■:' ^v-'rc:,,'._'',i!r>t-7-'r.:."''-.r".":5.^ _;/■ ■:-;''^:."-: .;.' ■ ■■';!:'. '■*.:V-n.-•-",,T.:^v{•^^'!«'*■'■''"■'■■■■"'^-■■^''•-•'^■• - •■:.:.•,••..,:;•- ii-^l'T!* I; ■;•>:•;.: A ^ '^^^ >^ xO°. '-^^ v^^ X^^r .v^" .0 o , ^- ,-0 ^ qV - ^» ■=: c5 -i i ■ .V" O ^ ,0' • ^i- '' ' A ■;% V- '^^ « "^^ v^ a^^ * 8 . °A '^c> * 9 I \ ■* 0> ■■^, •^r .-^^ " <• ..^^^ '^r. ■■--■■■ OO » F,'-"^:;' ,. ■■ " ''^ • -- ^ r'^ " "^ "^ '^^^' O a.' "'^^•\^ vV' > o. ^ .%'>^7 A^^ c ° ^ ' The Diseases of the Genital Organs of Domestic Animals BY W. L. WILLIAMS PROFESSOR OF OBSTETRICS AND RESEARCH PROFESSOR IN THE DISEASES OF BREEDING CATTLE IN THE NEW YORK STATE VETERINARY COLLEGE AT CORNELL UNIVERSITY WITH THE COLLABORATION OF W. W. WILLIAMS, B.A., D.V.M. SPRINGFIELD, MASS. Published by the Author ITHACA, N. Y. . 1921 ^5 Copyright by W. L. WILLIAMS 1921 Press of ANDRUS & CHURCH Ithaca. N. Y. m 13 1921 ©0.4614436 PREFACE No attempt has been made heretofore to describe system- atically the genital diseases of domestic animals. The path- ologic processes acting within the genital organs and inter- fering with the ideal production of young are chiefly hidden from view. Only certain phenomena caused by them be- come apparent. Of these the most striking phenomenon is the observed expulsion of a fetal cadaver, which is desig- nated abortion. The observer is generally forewarned of impending death of a born animal because it is commonly preceded by visible injury or illness, but abortion produces a profound impression because the death of a potentially valuable unborn animal has occurred unseen and is re- vealed only when the cadaver is seen to be expelled. This tends to draw a veil of mystery about the event. If the spermatozoon, unfertilized or fertilized ovum, or the small embryo perishes, the dead cell or body is not observed and therefore excites little or no comment. In the early history of medicine, certain striking phe- nomena were regarded and described as diseases. When the science of pathology became established, a rearrangement of medical literature became necessary and the phenomena became grouped about their causes, so far as known. It followed that various phenomena which had been regarded as distinct diseases were in some cases due to a common cause. In other cases a phenomenon classed as a disease has been split up because the phenomenon was inconstant in its cause. In primitive veterinary literature glanders and farcy were described as distinct affections, but later it be- came known that the two supposed diseases were merely separate phenomena resulting from one cause. Nasal gleet occupied a prominent place in primitive veterinary litera- ture, but as veterinary science advanced the phenomenon of nasal discharge was split up, assigned in each case to the disease of which it constituted one symptom, and nasal gleet disappeared from the pages of veterinary literature. iv Preface The pathologic processes occurring in the genitalia of animals have been almost wholly described under the primi- tive method, each striking "phenomenon being elevated to the dignity of a disease. Consequently a certain infection, by causing a wide variety of outstanding phenomena, in- jected into veterinary literature numerous alleged "dis- eases" each due to a single infection. It was unavoidable also that a given phenomenon, such as fetal death, which may be due to numerous different infecting agents, should be known as one disease. Thus abortion, metritis, retained fetal membranes, epididymitis, semino-vesiculitis, and dys- entery of the new-born, all of which in a given series of cases may be due to an identical infection, have been de- scribed as six distinct diseases and scattered from end to end of veterinary literature. The re-casting of the genital diseases of animals into a systematic treatise is a formidable task, the first effort at which must be very imperfect. In 1909 I published "Vet- erinary Obstetrics; Including the Diseases of Breed- ing Animals and of the New Born", in which many of the diseases of the genital organs were included under the primitive plan. It was abandoned at the exhaustion of the first edition. In 1917 I published "Veterinary Obstet- rics" and began the preparation of the present volume. The two treatises have been designated "companion volumes" because they are closely allied in subject matter and may be profitably studied together. The present treatise appears at a critical period in the history of the diseases of the genital organs of animals, when an old, firmly entrenched belief is slowly crumbling and a modern one is struggling for recognition. Abortion has long been regarded as a specific infectious disease, due in a given species of animals to one bacterium and to one only. If an exception arose and a given abortion or group of abortions was apparently due to an infection other than that specified for the species of animal concerned, it was not infectious abortion but merely abortion due to infection. The belief in a specific irifectious abortion has occupied Preface v the central position in the literature upon genital diseases in animals so long, that anyone attempting to write a sys- tematic treatise in this field must either make infectious abortion the cornerstone or reject it wholly. While in this treatise it is held that all abortions in animals (except those induced surgically) are due to infection, it is denied that such infection is specific, as that term is commonly under- stood in medicine. It is denied as a principle in pathology that conception, parturition, birth, or other physiologic act draws across the path of life an impenetrable barrier to dis- ease. It is held that any infection competent to invade a female may likewise invade a male ; if able to invade a preg- nant animal, it may also invade the same animal when non- pregnant ; if it can gain a habitat in the pregnant female, it may persist after parturition ; if it can invade and imperil the life of an embryo or fetus, it may continue through birth and affect the new-born, or may attack the new-born from external sources. Any infection which can invade and injure or kill a post-natal animal, may cause the same in- jury to it while intra-uterine, provided that contact is made. If tuberculosis or syphilis exists in the pregnant uterus, the infection may invade the embryo. There is no evidence to show, and no reason to believe, that any acute infection may not attack and destroy the embryo if the virus is brought into contact with it. It is true that acute infections, when attacking a pregnant female, rarely if ever pass the intact placental filter and reach the embryo. It does not follow that the embryo is immune to the infection, but merely that it is in a hermetically sealed sac, so isolated that the virus fails to acquire contact. Although the placental isolation of the embryo is efficient against filterable viruses, the supporters of the "specific in- fectious abortion" theory hold that certain comparatively large bacteria defy this important law, invade the pregnant female, pass directly to the existing embryo, and cause its death and expulsion. But in invading the pregnant female, presumably through the mouth, the infection is alleged to reach the endometrium and embryo without leaving behind vi Preface any lesion in its path or causing any disease or sign of dis- ease. This treatise is built upon the belief that abortion is only an incident in the ravages of infections existing within the pregnant uterus at the date of conception, or deposited with the semen at coitus. The infection is not specific, is not limited to one species of bacterium, invades organs other than the uterus, and involves both sexes and all ages. This general infection causes a long list of phenomena or lesions. The basic conflict of view with the majority of investiga- tors will inevitably draw much unfavorable criticism. In order to justify the views stated, controversial matter has been included. This is regretted because it increases the size of the volume, and because some highly esteemed col- leagues may erroneously regard such statements as personal reflections. The conflicting views have served to delay publication. A belief so long and thoroughly entrenched as that of specific infectious abortion can not be overthrown quickly. Neither would the overthrow of what I believe an error be a gain unless a foundation were ready upon which a more valuable structure could be erected. I made the first open attack upon the specific infectious abortion theory in 1912, and that has been followed periodically from various angles. But external attack has not been as effective as internal disinte- grating forces. The champions of a specific infectious abor- tion have admitted that at least several different species of bacteria may and do cause abortion in a given species of animal, and that the lesions caused by the several bacterial forms are not differentiable clinically or macroscopically. A most serious drawback to the theory has been its failure in practical application. It was announced twenty-five years ago that, since the cause of infectious abortion had been proven, it could be controlled. The twenty-five years which have elapsed have seen no progress in the control of abortion based upon the specific theory. The prevalence of abortion is greater today than at any prior date in history. During the past decade there has been developing gradu- Preface vii ally another view which appears more logical, is in harmony with the general principles of pathology, and is in full ac- cord with all data recorded by the believers in specific in- fectious abortion. That portion of the volume designated "The General Genital Infections" must be regarded as the cornerstone ; if the principles it has been attempted to estab- lish there break down, it fails as a systematic treatise. The principles which it is attempted to establish place the com- mon and most destructive genital infections upon a plane analogous to wound infection. Various bacteria exist in the genitalia of both sexes of all ages and species. The virulence and variety vary at different times and in different indi- viduals. They are modified by general health, coitus, preg- nancy, parturition and other critical incidents in life. The belief in a specific infectious abortiofi logically de- mands for the control of the disease the isolation of the pregnant female from all possible carriers of infections ; in this treatise it is held that physiologic reproduction is based upon coitus between two sexually healthy animals. The first is a hypothesis of despair, confirmed by lamentable failure over a period of twenty-five years : the latter a doctrine of hope, supported by success. Before publishing this treatise it was regarded as essential that the principles should have been tried thoroughly and proven successful in the crucible of practical clinical application. This has been a difficult task requiring unbounded and infinite patience under great discouragements and against opposition. The treatise is inevitably very imperfect in every part, and those who are inclined to criticise will have excellent opportunity. But the volume was not made to cause or to avoid criticism. It is a first effort in a new field which, it is hoped, may be helpful to some and which may serve to awaken a new interest in the diseases interfering with re- production in animals. The call of the hour to veterinarian and breeder is for increased efficiency of each domestic ani- mal. The room for animal numbers is decreasing, while the demand for service in the production of milk, meat, labor or other products is increasing. Most of the great animal viii Preface plagues which imperil the lives of adults have been brought under measurable control, but those infections involving the safety of the embryo are constantly gathering force. Yet it must be remembered that the sexual health of those animals desired for reproduction is the first basic need in animal husbandry. Reproductive efficiency in purebred cattle, swine, and horses, so far as can be estimated, has dropped below 60 per cent, of the ideal and continues to descend at a discouraging pace. The condition can be relieved only through conscientious and skillful work by veterinarians and breeders. The problem is difficult and the duration of the task infinite. It calls for the adoption of a permanent policy of guarding sexual health in animals — not of "cur- ing" established lesions. The advancement of reproductive efficiency in the best animals is at present the greatest eco- nomic problem in veterinary medicine. In a higher realm the study of genital diseases in domestic animals may be made of incalculable value in the elucidation of the basic principles of genital diseases in man. Aside from the specific venereal diseases of man, the genital infec- tions are probably analogous to, and possibly identical with, the general genital infections of animals. What is true of the intra-uterine infections of the embryo in domestic ani- mals is presumably equally true in principle of the human embryo. The veterinarian has opportunities for the study of the infections of the genital organs and embryos of ani- mals wholly denied to practitioners of human medicine. The veterinarian has freely available in the abattoir the genitalia in health and in disease of thousands and millions of freshly slaughtered cattle, sheep, and swine of all ages and of both sexes. The females are pregnant and non-pregnant and the embryos are of all ages, diseased and healthy. Clinically the veterinarian can palpate the genital organs of the cow and mare freely per rectum and read the anatomical lesions of ovaries, oviducts and uterus as the blind read braille. The fetus can be manipulated, its movements in response to me- chanical stimulation studied, and its physiologic function of swallowing its amniotic fluid recognized. Preface ix The new-born animal can be studied freely regarding the infections carried from the uterus, can be fed experimen- tally, and may be destroyed at will for examination. If the veterinary profession is fully to live up to its opportunities and discharge its obligations to the state, it must contribute its share to the advancement of the knowledge of disease. Nowhere else can it contribute more, nor as much, of value, as in the basic principles of the physiology, pathology and hygiene of reproduction. Purely a clinician, I have been dependent upon others for bacteriologic and histologic facts. • In this field Drs. W. A. Hagan and C. M. Carpenter have rendered invaluable aid. Working first in my department and later in the de- partment of pathology and bacteriology, they have extended every possible assistance. Similar help has been given by Dr. Herbert L. Oilman, at present in my department. The reader should undertsand the difficulty of securing knowl- edge regarding genital infections in animals. In general bacteriologists have not studied the genitalia of animals for infections, but for one specific infection, and have left un- recorded and unstudied all others. If the bacillus thought by the investigator to be the cause of infectious abortion was recognized, that was deemed final proof of it, and no other, caused the disease. Drs. Hagan, Carpenter, and Oilman have so far as practicable studied all bacteria found in the genital organs and their significance in the problem of re- production. My collaborator. Dr. W. W. Williams, has contributed greatly to the value of the treatise. Having devoted his en- tire energy for a number of years to the handling of genital diseases and the advancement of reproductive efficiency in purebred cattle, he has demonstrated with unusual clearness the value of the scientific handling of this group of infec- tions. He has contributed especially the sections upon the surgery of the cervix and the genital infections of bulls. W. L. Williams. Cornell University Ithaca, N. Y. April, 1921 TABLE OF CONTENTS PART I DISEASES AND DEFECTS NOT ATTRIBUTABLE TO INFECTION PAGE CHAPTER I THE ANATOMY AND PHYvSIOLOGY OF THE GENITALIA . . The Genital Organs of the Male ... i The Testicles and Their Excretory Ducts ...••.... i The Vesicula vSeminalis, Prostate, and Cowper's Glands ... lo The Penis 14 The Sheath and Prepuce , 15 The Genital Organs of the Female 18 The Ovaries 18 The Muellerian Ducts 22 The Oviducts 25 The Uterus 26 The Cervix 33 The Vagina • 36 Gartner's Ducts 39 The Vulva .... 41 The Physiology of the Genitalia 44 The Ripening of the Ovisac and Ovum 44 Estrum 47 Ovulation 49 Menstruation ' ' . . . 51 The Corpus Luteum of Estrum 52 Copulation .... 53 The Ejaculation of Semen 53 The Migration of Spermatozoa 54 Fertilization 55 The Migration and Implantation of the Ovum 55 The Corpus Luteum of Pregnancy 56 The Fetal Membranes 58 CHAPTER II THE CLINICAL EXAMINATION OF THE GENITALIA 73 The Clinical Examin.'^tion of the Male Genitalia ... 73 The Testicles 74 The Epididymis 75 The vSeminal Vesicles, Pro.state, and Cowper's Glands .... 76 The Semen and Spermatozoa 77 xii Contents The Clinical Examination of the Female Genitalia ... 79 The Examination of Vulva and Vagina 84 Rectal Palpation ' 89 The Examination of the Cervical Canal and Douching of the Uterus 99 ■The Diagnosis- OF EsTRUM iii The Diagnosis OF Pregnancy 113 CHAPTER III ARTIFICIAL INTERFERENCES WITH REPRODUCTIVE FUNCTIONS 140 The Induction of Estrum 140 Artificial Insemination 143 Artificial Abortion 146 CHAPTER IV ARRESTS AND ABERRATIONS IN GENITAL DEVELOPMENT 151 Asexual or Bisexual Aberrations 151 Neuters or Freemartins 151 Hermaphroditism 157 Arrests in the Development of the male Genitalia . . . 160 Arrests and Aberrations in the Development of the Testes . . 160 Cryptorchidy r6o Aberration in Position of Scrotal Testes 161 Arrest in Functional Development of Scrotal Testes, Fetal Testes 161 Aberrations in the Development of the Penis 163 Congenital Defects of the Female Genitalia 163 Uterus Unicornis 165 Double Uterus, Double Cervix 165 Persistence of Median Walls of Muellerian Ducts in Vaginal Area, Double Vagina 167 Imperforate Hymen, Persistent Hymen 169 CHAPTER V MISCELLANEOUS DEFECTS AND DISEASES INTERFERING WITH FERTILITY 172 Umbilic Hernia 172 Ventral Hernia 174 Horizontal Vulva 174 Stricture of Vagina and Vulva 175 Diseases of the Feet and Limbs 177 Paralysis, Plumbism * * 179 Torsion of the Testicle 180 Traumatic Orchitis 181 Tubal Pregnancy 185 Vaginal Hernia 185 Torsion of the Uterus 189 Pelvic Tumors and Calluses 190 Contents xiii CHAPTER VI SYSTEMIC DISEASES AND DERANGEMENTS INTERFERING WITH REPRODUCTION 192 Physical Overwork 192 Starvation 193 Obesity 194 Idleness and Overfeeding 196 Sexual Excess 200 Onanism or Masturbation 203 CHAPTER VII COITAL INJURIES 205 Kicks and Fractures 206 False Copulation, Rectal Injuries ... 210 Laceration and Rupture of the Vagina 214 Coital Rupture of the Uterus 216 Coital Rupture of the Urinary Bladder 217 Vaginal Hemorrhage following Coitus 218 Urethral Hemorrhage in Stallion 218 Contusions of Neck and Withers 219 Penial Injuries 219 Rupture of Prepuce 223 Strangulated Hernia 225 CHAPTER VIII PARTURIENT INJURIES 228 Lacerations of Perineum 228 Recto-Vaginal Fistula 229 Lacerations of Cervix 229 CHAPTER IX SODOMY AND SADISM 231 PART II TUMORS OF THE GENITAI^IA CHAPTER X MALIGNANT NEOPLASMS 239 Malignant Tumors of the Male Genitalia 239 Amputation of the Penis 245 Malignant New-Growths of the Female Genitalia 250 CHAPTER XI BENIGN TUMORS OF THE GENITALIA 253 Benign Tumors of the Male Genitalia 253 Benign Tumors of the Female Genitalia 257 Ovariotomy 263 xiv Co7itents PART III INFECTIONS OF THE GENITAL ORGANS SECTION I. THE GENITAL INFECTIONS OF CATTI.E CHAPTER XII THE SPECIFIC VENEREAL DISEASES 278 The Vesicular Venereal Disease of Cattle 278 The Nodular Venereal Disease 283 CHAPTER XIII NON-VENEREAL INFECTIONS WHICH INVADE THE GENITAL ORGANS • 317 Genital Actinomycosis 317 Genital Tuberculosis 319 CHAPTER XIV THE GENERAL INFECTIONS OF THE GENITAL ORGANS ... 356 I. INFECTIONS OF THE GENITAL ORGANS OF BULLS . . 358 Orchitis 375 Degenerative Orchitis. Destruction of Spermatogenetic Epi- thelium in Calves 375 Orchitis in Adult Bulls. Abscessation and Necrosis of Testicles 379 Epididymitis ■ 385 Degenerative Epididymitis of Calves 385 Arrest in Development ... 385 Chronic Indurated Epididymal Abscesses of Calves 386 Epididymitis of Adult Bulls 388 Infections of the Glands of the Pelvic Urethra 389 Spermato-Cystitis 389 Diseases of Prostate and Cowper's Glands 393 Balantitis. Balano-Posthitis. " The Granular Venereal Disease" 393 II. GENERAL INFECTIONS OF THE GENITAL ORGANS OF HEIFERS AND COWS Diseases of the Ovaries. Ovaritis 394 Atretic Follicles 395 Cystic Degeneration of the Ovaries, Nymphomania 395 Intra-FoUicular Hemorrhage 409 Post-Ovulation Hemorrhage into the Follicular Crater. ... 411 Hemorrhagic Corpus Luteum . . 412 Cystic Degeneration of the Corpus Luteum 413 Hypertrophy of the Corpus Luteum 418 Persistent Corpus Luteum .421 Central or Embedded Corpus Luteum. The Corpus Luteum of Pyometra and of Retained Fetal Cadaver 422 Contents xv Abscess of Ovary 424 Corpora Nigra 425 Par-Ovarian Cysts 425 TuBAiv Infections 426 Salpingitis, Pavilionitis, Adherent Ovary 428 P^-osalpinx. Tubo-Ovarian Abscesses 445 Hydrosalpinx. Dropsy of the Pavilion 448 Cysts in the Mesosalpinx 452 Uterine Infections 453 The Diseases of the Uterus of the Heifer Calf and Virgin Heifer 453 Intra-Uterine Infection and Endometritis .... 453 Pyometra 458 The Infections of the Gravid Uterus 462 Apical Eudometritis with Necrosis of the Fetal Sac 462 Diffuse Endometritis, with Atony of Uterine Walls. Dystocia 464 Cervical Endometritis 465 Uterine Gangrene 467 Placentitis 469 Peripheral Placentitis with Necrosis and Dehiscence at the Periphery of the Cotyledons 469 Inter-Placental Hemorrhage with Desiccation of the Fetus. IMummification 470 Incarcerating Placentitis 474 Necrosis of Cotyledons. Necrotic Placentitis 474 Adventitious Placenta 475 Calcification of Placenta 476 The Infections of the Ovum, Embryo and Fetus 476 The Death of the Fertilized Ovum . 476 The Death of the Embryo, with Survival of the Embr3-onic Sac. Cystic Mole . . 477 Death and Maceration of the Embryo or Fetus 480 The Pyometra of Fetal Decomposition 480 Abscessatiou of the Gravid Uterus 484 Emphysema of the Fetus 487 The Observed Expulsion of the Fetal Cadaver. Abortion . . 487 The History of Abortion 488 The Prevalence and Frequency of Abortion 49 i "Accidental Abortion" 495 "Food Abortion" 496 The Biology of Abortion 498 The Colon-Like Bacillus and the Micrococcus of Nocard 498 The Nodular Venereal Disease of Isepponi 499 The Bacterium Abortus of Bang 499 The Paratyphoid Bacillus of Moussu 511 The Spirillum of Smith and others 511 Miscellaneous Bacteria 511 xvi Co7itents The Nature of Abortion 511 The vSymptoms and Diagnosis of Abortion 517 The Date of Invasion 518 The Control of Abortion 519 Diseases of the Puerperal Uterus 538 Uterine Hemorrhage. Uterine Hematoma . ; 539 Endometritis 546 Septic Metritis 554 Placentitis, Cotyledonitis. Retained Fetal Membranes . 560 Puerperal Tetanus 584 Puerperal Laminitis 585 Puerperal Meningitis 585 Post-Puerperal Uterine Infections 586 Endometritis 589 Pyometra 594 Uterine Abscess 601 Abscessation of Uterine Submucosa , . , , 604 Sclerotic Metritis 605 Pelvic Adhesions. Parametritis 606 Pyemia, Pyemic Arthritis 609 Pyemic Abscesses 609 Cystic Degeneration of Uterine Walls with Hydrometra . 611 Infections of the Cervix 614 Cervicitis 614 Retention of Menstrual Debris, Cystic Uterus 640 Retention of Fetus from Cervical Adhesions 641 Retention Cysts of Cervix 642 Cervical Prolapse 642 Infections of^the Vagina 645 Vaginitis. The^Nodular Venereal Disease 645 Gangrene 647 Perivaginal Phlegmon 648 Cysts and Abscesses of Gartner's Ducts 649 The Infections of the Vulva 650 III. CONGENITAL INFECTIONS OF CALVES Dysentery Neonatorum, Cai,f Scours, White Scours, Cai.f Pneumonia, Arthritis, Pyemic Abscesses 651 The Problem of the Genital Infections of Cattle as a Whole] 687 The Assembling of Herds and the Addition of Cattle to Existing Herds 688 Equipment 694 The Systematic Handling of Herds for the Control of Genital Infections 697 The Genital Infectious of Cattle as an Economic Problem 708 Conte7its xvii The Genitai. Infections of Cattle in their Relation to Human Health . . 709 SECTION II. THE GENITAL INFECTIONS OF SHEEP AND GOATS CHAPTER XV THE SPECIFIC VENEREAL DISEASES 713 The Nodular Venereal Disease 713 CHAPTER XVI NON-VENEREAL INFECTIONS WHICH INVADE THE GENITAL ORGANS 713 Necrotic Disease of the Genital Organs Associated with Lip- and-Leg Ulceration 713 CHAPTER XVII THE GENERAL GENITAL INFECTIONS OF SHEEP AND GOATS 717 Abortion Associated with a Vibrio or Spirillum 717 Retained Placenta in Ewes 717 SECTION III. GENITAL INFECTIONS OF SWINE CHAPTER XVIII SPECIFIC VENEREAL INFECTIONS 736 The Nodular Venereal Disease 736 CHAPTER XIX NON-VENEREAL SPECIFIC INFECTIONS INVADING THE GENITALIA OF SWINE 736 Tuberculosis 736 CHAPTER XX THE GENERAL INFECTIONS OF THE GENITALIA OF SWINE . 738 Metritis, Death and Maceration of Embryos, Abortion .... 738 SECTION IV. GENITAL INFECTIONS OF HORSES 752 CHAPTER XXI THE SPECIFIC VENEREAL DISEASES OF HORSES 752 Dourine 752 Genital Horse Pox 766 CHAPTER XXII NON-VENEREAL SPECIFIC DISEASES WHICH INVADE THE GENITALIA OR AROUSE INFECTIONS ALREADY EXISTING WITHIN THE GENITAL TRACT 770 Infectious Cellulitis. "Pink Eye." 770 Bursattee 775 CHAPTER XXIII THE GENERAL INFECTIONS OF THE GENITAL TRACT. " CON- TAGIOUS ABORTION." 778 INFECTIONS OF THE GENITAL ORGANS OF STALLIONS ... 782 Orchitis and Epididymitis 782 Diseases of Seminal Vesicles, Semino- Vesiculitis 785 xviii Contents II. GENERAL INFECTIONvS OF THE GENITAL ORGANS OF MARES Diseases of the Ovaries. Ovaritis 788 Atretic Follicles 788 Cystic Degeneration. Nymphomania 788 Uterine Infections 793 Infections of the Gravid Uterus, Ovum, Embryo or Fetus. Abortion 793 Diseases of the Puerperal Uterus, Retained Afterbirth, Reten- tion of Non-Gravid Horn of Chorion, Endometritis, Puer- peral Laminitis 799 Metritis. Metro-peritonitis 803 Post-Puerperal Infections 805 Endometritis 805 Uterine Abscess 806 Pyometra S07 Cervicitis 810 Vaginitis . . 811 Vulvar Gangrene 8^3 III. CONGENITAL INFECTIONS OF FOALS 814 Septicemia of the Foal 814 Retention of the Meconium 814 Dysentery 815 Arthritis. Pyemia 815 Re-Opening of Urachus 820 Rupture of Tendons 824 SECTION V. THE GENITAL INFECTIONS OF CARNIVORA 828 CHAPTER XXIV SPECIFIC VENEREAL DISEASES The Venereal Tumors of Dogs 82S CHAPTER XXV THE GENERAL INFECTIONS OF THE GENITALIA Prostatitis of Dogs. Abortion, etc 831 CHAPTER XXVI VENEREAL DISEASE OF RABBITS 833 < u c X ° to < o Oh :3 D o > U •-■ « cs c« 5 T3 _ 01 • ^ «^ *i o i-J , . c/5 ^-»-r ^^ j^ yJ C O >-> -u t- . _C o a; ^ "tr o o ^ -c _. JJ O ^ O Ji -^ - o ■^ >^ " O 3 a X =" O bfl J, >- TO (U a, 3 O lu --^ ^:g s-5 • ^ I « J. s 3 _c O 3S 2 ^ii-5b > u O <" ~ w ^ -c . „ •- >S -T3 ^ X rt •^ -1-1 rt ,^ 4. 'o M uj aj o .H o c In *^ O C _' S iJ c ~ — .— ^ "rt "- £ ° o S =" r- ID gj o _^ ii ^ ^ -^ ~" c/3 3 C O OS bfl 3 tJ -^ C O _ « c o .is v^ ^" -n 3 c »- o -:3 t^J S L - Sb o ^ ij ^ £ . = J t; PART I DISEASES OF THE GENITAL ORGANS NOT ATTRIBUTED TO INFECTION Chapter I THE ANATOMY AND PHYSIOLOGY OF THE GENITAL ORGANS A. The Male Genitalia The male genital organs consist of the testicles, epididy- mes, vasa deferentia, vesiculae seminales, prostate and Cowper's glands, and the penis with its sheath and prepuce. Prior to the disappearance of the Wolffian bodies in the embryo, there appear near their anterior end at their median side, two parallel thickenings in the peritoneum designated the genital ridges, which by an elaboration of their epithel- ium ultimately form the genital glands. At first they can- not be differentiated, but they quickly assume definite sex characters and can be recognized as male (testicles) or fe- male (ovaries) glands. 1. The Testicles and their Excretory Ducts a. The testicles at first lie against the vertebral column, in close proximity to each other, between the anterior ends of the Wolffian bodies. The essential structures of the testicles, the tubuli seminiferi and the specialized cells ela- borating the spermatozoa, are formed from the peritoneal cells of the genital ridges. The contiguous peritoneal areas draw over the genital ridges, perpetuating the general peri- toneal surface while the glandular mass of the testicle lies outside or above the peritoneal cavity. The Wolffian bodies soon disappear as independent struc- tures. The anterior end of each Wolffian body later forms the head of the corresponding epididymis, becoming continu- ous with the proximal end of the testicle, upon its lateral 2 Diseases of the Geyiital Orga^is side. The Wolffian duct, after the virtual elimination of the Wolffian body, undergoes elaboration to constitute the body and tail of the epididymis and the vas deferens. The artery of the testicle derived from the posterior aorta, is at first very short, but with the descent of the gland into the scrotum, it becomes one of the longest unbranched arter- ies in the body. The artery with its satellite vein, nerves, and lymphatics, and the investing peritoneum, constitutes the vascular or spermatic cord, one of the three fundamental connections of the testicle with the body walls. A second attachment of the testicle to the body wall con- sists of the fibrous, cord-like gubernaculum testis. It is formed at about the same date as the genital ridge and ex- tends from that part of the external integument, which is to constitute the fundus of the scrotum through the inguinal space, internal inguinal ring, and thence outside the peri- toneum, upward, forward, and inward across the tail of the epididymis to the posterior end of the testicle to which it is attached. As the testicle increases in volume and weight, it drops down into the peritoneal cavity towards the internal in- guinal ring. In its descent the three attachments of the testicle, the vascular or spermatic cord (artery, vein, nerves, and lymphatics), vas deferens, and gubernaculum testis, each drags with it the peritoneum which furnishes to each structure a double fold, thus maintaining the continuity of the visceral with the parietal peritoneum, resulting in three double peritoneal folds, as shown in Fig. 1. When the testi- cle descends into the scrotum, the gubernaculum shortens throughout its course. In solipeds the tension of the guber- naculum, prior to the complete descent of the testicle, exerts a degree of traction upon its scrotal attachment sufficient to cause a depression or dimple in the scrotum. The approach of the testicle to the internal inguinal ring is accompanied by an evagination of peritoneum through it anterior to the gubernaculum, to constitute the processus vaginalis, which eventually forms the parietal peritoneum of the scrotum. When the testicle descends, it and the spermatic cord carry The Male Genitalia 3 down their peritoneal fold which extends from the guber- naculum below the origin of the spermatic artery in the lumbar region. It is attached anteriorly to the spermatic cord and posteriorly to the scrotal wall, to form the mesor- chium which constitutes a membranous median partition in the posterior part of each scrotal sac from the fundus to the internal inguinal ring, as shown in Figs. 2, 3, and 4. The processus vaginalis, in everting, pushes before it on the lateral side the as yet invisible cremaster which quickly de- velops when the testicle descends into a bright red, highly functioning muscle. The scrotal sac thus consists of two distinct groups of tissues, the general integument composed of the skin and dartos and the intra-abdominal portion con- sisting of the parietal peritoneum and the cremaster muscle with the intervening fasciae. The two groups of structures remain easily separable throughout life. The surgeon in performing the ''covered operation," when castrating ani- mals with scrotal hernia, avails himself of this distinction Fig. I. — The Testicle and its Attachments. Right inguinal region and testicle of 24 hrs. colt. P, Processus vaginalis sur- rounded by a dotted line and containing a curved sound, .S" ; G, first portion of gubernaclum testis ; G^, second porlion of gubernaculum testis extending to the epididymis,^ ; £, epididymis ; G^\ gubernaculum extending from epididymis (globus minor) to the testicle ; 7] testicle ; A, testicular artery ; F, F, vasa deferentia ; B, urinary bladder ; C/A, umbilical arteries. 4 Diseases of the Getiiial Organs and readily separates the two groups between the dartos and cremaster so that he may ligate the structures of intra- abdominal origin just at, or near to, the internal inguinal ring. In domestic animals, except the elephant, the descent of the testicles into the scrotum is a prerequisite to fertility; otherwise, spermatozoa are not formed. In the descent of the testicle, the gubernaculum shortens, the processus vaginalis develops, and the tail of the epididy- mis with the caudal end of the testicle traverses the inguinal ring followed by the body and head of the epididymis and cephalic end of the testicle. The descent of the epididymis and testicle of ruminants is directly downward. The gland comes to rest with the tail of the epididymis and that portion of the testicle which was, in the embryo, the posterior end directed downward. The long axis of the testicle is perpendicular to the spinal column. The epididymis thus rests upon the postero-lateral face of the testicle, its head directed toward the internal inguinal ring, its tail at the distal end of the testicle. The vas de- ferens passes inward across the lower margin of the mesor- chium and turns upward on the postero-median surface of the testicle closely applied to it. The epididymis and vas deferens are thus parallel and separated from each other by the mesorchium or peritoneal fold connecting the visceral and parietal layers. It is important to remember this ar- rangement of structures when examining clinically the testi' cles for evidences of disease. In solipeds the cutaneous attachment of the gubernaculum testis is farther posterior and higher than in ruminants. This draws the tail of the epididymis upward and backward causing its head and the corresponding end of the testicle to tilt forward. The gland revolves through 90 degrees on its short axis and comes to rest with its long axis parallel to the spinal column. The vas deferens, instead of doubling back along the postero-median surface of the testis as in the rumi- nant, leaves the horizontal testicle immediately at the tail of the epididymis and passes obliquely upward and forward, to come in contact with the vascular cord in the inguinal canal. The Male Genitalia Fig. 2— Testicles of Bull. Section through the posterior scrotal wall of the bull. The left testicle is fully exposed, tiie right is covered by the cremaster muscle and fascia and by the scrotal peritoneum. C, Cremaster muscle divided longitudinally ; S, sper- matic cord ; E, head of epididymis ; E' , body ditto ; E", tail ditto. 6 Diseases of the Genital Organs The gubernaculum of carnivora has its cutaneous at- tachment higher and more posteriorly than that of solipeds, the testicles are drawn further backward and upward so that they rest between the posterior portions of the thighs, and the glands are tilted so that their long axes are obliquely downward and forward from the tail of the epididymis. Finally, in swine, the cutaneous origin of the gubernaculum testis is located high in the perineal region just beneath the anus, and the tail of the epididymis with the lesser extrem- ity of the testicle is caught and held at that point with the head of the epididymis and greater end of the testicle pre- senting almost perpendicularly downward. Its direction in the scrotum is almost the reverse of the testicle of the ruminant. b. The epididymis, Figs. 2, 3, 4, is formed in part from the tubules of the Wolffian body and partly from the Wol- ffian duct. That portion of the epididymis derived from the tubules of the Wolffian body leaves the anterior or cephalic end of the embryonic testicle as a series of greatly coiled tubules which constitute an enlarged mass designated the head, or globus major, of the epididymis. The tubules all converge to become the single tubule representing the Wol- ffian duct. The latter, greatly coiled, forms the enlongated body of the epididymis which is equal in length to about three-fourths of the long diameter of the testicle. At the caudal or tail end of the testicle the single tube becomes greatly coiled to constitute a second enlargment, the tail, or globus minor. The tube then becomes less coiled and finally straight to constitute the vas deferens. The head of the epididymis, through the tubules, the vasa deferentia, is continuous with the tubular structure of the testicle, and through these the spermatozoa escape from the gland and reach the single tube of the body and tail of the epididymis which in turn is continued by the vas deferens. Only the head of the epididymis, therefore, is continuous with the tissues of the testicle, while the body and tail lie closely moulded against the gland and attached to it through the agency of peritoneum and connective tissue. The tail and The Male Genitalia 7 body of the epididymis are, therefore, only loosely attached to the testicle and these permit, under some circumstances, of wide separation from the gland. Thus in cryptorchidy in the horse, the gubernaculum, as shown in Fig. 1, crosses the tail of the epididymis and is closely attached to it. In enter- ing the inguinal ring, the tail of the epididymis, with the gubernaculum, must lead and physiologically the tail of the testicle must accompany it. But sometimes the caudal end of the testicle becomes caught at the ring, the tail of the Fig. 3 — Cross Section through Scrotum and Testicles of Bull Calf. /, 7, Body of epididymis ; 2, 2, vas deferens on the anterior side of the mesorchium. epididymis, followed by the body, and even the head, passes through the ring, the testicle turns upon its transverse axis, and its head becomes incarcerated in the inguinal ring, its caudal end remaining within the abdomen. The inexperi- enced surgeon attempts to castrate the cryptorchid, en- counters the epididymis in the peritoneal pouch and am- putates it from the testicle under the impression that he is castrating the animal. Later a second operation is neces- sary and within the abdomen there is found a "third testicle." 8 Diseases of the Genital Organs A study of Fig. 1 will show that in the descent of the testicle and attached structures, a broad peritoneal sheet, the mesorchium, is formed, extending from the spermatic artery, A, to the gubernaculum, G. Midway in this a sec- ond peritoneal duplicature leaves the broad expanse to en- velop the vas deferens, V. The ruminant testicle descends directly and in doing so, the first section of the gubernacu- lum, G, passes through the inguinal ring followed by the tail Fig. 4~Cross Section through Scrotum of Young Bull viewed from Posterior Side. /, /, Body of epididymis ; 2, 2, vas deferens. The right testicle has revolved on its long axis so that the epididymis and vas diferens with the mesorchium between them rest upon the postero-external surface of the gland. of the epididymis, E, with the caudal end of the testicle, and when this point reaches the fundus of the scrotum and the basal point of the attachment of G to the dartos, the descent is completed. The testicle of the bull descends in a direct line and when it comes to rest upon the bottom of the scro- tum by its caudal end, it remains upright, with the epi- didymis lying against its median side on the outer side of the mesorchium, and the vas deferens upon its median side. The spermatic artery, A, instead of leaving the gland per- The Male Genitalia 9 pendicular to the long axis, shifts its course and leaves the head end of the testicle in a direct line parallel to the long axis of the gland. This causes the vas deferens to turn ab- ruptly at E and follow the mesorchium on its median sur- face along the testicle until at the cephalic end of the latter, it joins the artery to contribute to the spermatic cord. In the bull the gubernaculum is anchored in the median wall of the scrotum with the result that both the epididymis and vas deferens are normally applied against the postero-median side of the testicle, as shown in Figs. 2-4, the epididymis behind, and the vas deferens in front of the mesorchium. The head of the epididymis of the bull begins superiorly upon the lateral surface of the cephalic end of the testicle, passes across the posterior surface upward, medianward, and then downward, in the form of an arc. It is flattened against the surface of the testicle and is not materially en- larged to form a "globus major" as in the horse. The tail of the epididymis, or globus minor, on the other hand, is large and prominent. It projects definitely beyond the cau- dal end of the testicle and lies chiefly on the postero-median surface where it is readily palpable and visible through the scrotum. It is the dominant seat of infection in the epi- didymis, with or without abscessation, and as such merits special attention. The descent of the testicle of the horse is at first funda- mentally the same as that of the bull but upon reaching the scrotum, the head end tilts forward and finally comes to rest with its long axis parallel to the spinal axis. The epi- didymis consequently lies upon the dorsal surface of the testicle, lateral to the mesorchium, and the vas deferens, in- stead of turning forward along the median side of the mesorchium, is free from the gland and upon leaving the tail of the epididymis, passes directly upward and forward to join the artery near the external abdominal ring. This results in a very marked difference in relation and subjects the testicle of the horse to the possibility of torsion. After the vas deferens has joined the spermatic artery, its behavior is essentially alike in all species. It accompanies lo Diseases of the Geyiital Organs the artery through the inguinal ring, parts there from it and, curving upward, inward, and backward, finally ap- proaches its fellow from the opposite side, passes above the neck of the urinary bladder between or beneath the seminal vesicles, and enters the urethra from above. It is reaily palable per rectum in the horse and bull. 2. The Vesiculae Seminales, Prostate, and Cowper's Glands The subsidiary sex glands and appendages to the sex organs of domestic animals show wide variations. Each vesicula seminalis is formed as an outgrowth from the vas deferens. In most animals the vesicle consists of a long, intricately folded, coecal tubule which, when incised, ap- pears like an acinous gland. In solipeds the structure as- sumes the form of a vesicle similar in outline to the urinary bladder. The two vesicles in the horse are oblong, about six to eight inches long by two inches in diameter, their anterior ends round. The posterior ends taper sharply to their outlet. They lie side by side above the neck of the urinary bladder and the termination of the vas deferens. Their walls are thick and their mucosa richly supplied with glands. The vesiculae secrete a thin mucoid fluid, presumed to dilute the semen at the time of ejaculation. Ordinarily the vesicle contains a small amount of this secretion, and occasionally a few spermatozoa make their way into the cavity, but the organ does not serve as a seminal reservoir in any domestic animal. In the gelding the vesiculae some- times suffer from catarrhal accumulation. When attempt- ing to catheterize geldings, the catheter sometimes passes into the dilated orifice of the vesicle and lodges, rendering it diflficult, and sometimes impossible, for the operator to pass the catheter into the urinary bladder. In ruminants the vesiculae seminales are composed of greatly elongated tubules so coiled as to give to the structure the appearance of an acinous gland. In the bull (See Figs. 5, 6, 7) the seminal vesicles are two oblong, nodular bodies varying with the size of the animal from two to three The Vesiculae Seminales II Fig. 5 Fig. 6 Grlands Attached to Pelvic Urethra of Bull viewed from above. Fig. 5. A^ Accelerator iiriuae muscle sectioned horizontally ; C, C, Cowper's glands ; W, Wilson's muscle ; P, body of prostrate ; S, S, seminal vesicles ; D, D, vasa deferentia ; U, ureter ; B, urinary bladder ; /, ischio-cavernosus muscle. Fig. 6. A transverse section has been made through the posterior part 'of Wil- son's muscle and the urethra and a median section through the accelerator urinae muscle and Gowper's gland. A, Accelerator urinae nmscle ; C, Cowper's gland just above the urethra. Other lettering same as in Fig. 5. 12 Diseases of the Genital Organs inches in length, one to one and a quarter inches in width, and approximately one half inch in diameter from above to below. They are readily palpated per rectum, by which means they are recognized as oblong bodies meeting poster- iorly on the median line where their ducts empty into the urethra, while anteriorly they diverge and drop down upon a level with the urethra. They can be partially picked up and give to the examiner a sensation of a nodular, acinous gland. In swine the seminal vesicles are very large and similar in character to those of the bull. The structures are absent in the dog. Physiologically they appear to be of fundamental im- portance in those animals where present since they ap- parently furnish a thin, mucoid secretion which contributes the greater volume of the seminal fluid. In those animals where it is not present, its place appears to be taken by an increased volume and activity of the prostate gland. The prostate glands, lying across the urethra just behind the posterior ends of the seminal vesicles, are small in the horse. The prostate of the bull is of about the same volume as either of the seminal vesicles. The body of the prostate is a small, yellowish, transverse band lying across the urethra just behind the termination of the seminal vesicles and in front of the anterior end of Wilson's muscle, as shown in Fig. 6. Posteriorly, it extends to the vicinity of Cowper's glands. It surrounds, but lies chiefly above, the urethra. On cross section it shows a U-shaped structure with the urethral canal lying in the bottom of the U. Below and at the sides, it is heavily covered by Wilson's muscle, and above, the aponeurosis of the muscle stretches across from side to side so that this, the more voluminous and important portion of the gland, is completely hidden from sight and touch. Only the body, or that portion not covered by Wilson's muscle, is palpable per rectum. The gland is of moderate size in the boar. In carnivora the prostate glands are large and apparently perform the functions of the absent vesiculae seminales. It is virtually The Vesiailae S em in ale 13 Fig. 7. Same as Figs. 5 and 6 with same lettering. The left hand figure is from a bull calf. In the right figure a median section through the posterior part of the urethra has been made exposing to clear view Cowper's gland, C. 14 Diseases of the Genital Organs only in the dog, amongst domestic animals, that the prostate gland assumes pathologic importance. Cowper's glands are present in solipeds, ruminants, and the cat. They lie on either side of the urethra in the perineal region above the ischial arch. They have little or no known pathologic importance. The glands are absent in the dog. 3. The Penis The penis of domestic animals is normally completely hidden, when at rest, within the sheath, and the glans penis has a second covering, the prepuce. The soliped and dog ordinarily protrude the penis out of both prepuce and sheath during urination. The protrusion of the penis dur- FiG. 8 — Penis of Calf with Preputial Sac Unopened. S, Sheath ; (J, urethra ; P, prepuce, not yet free from the glans ; G, glans. Be- tween the prepuce and the glans is soft embryonic tissue. /% fornix ; C, C, corpus cavernosum. ing coitus or sexual excitement is brought about by its erection and by the relaxation of the retractor penis muscle. In solipeds and carnivora, the retractor muscle is closely applied throughout its length to the ventral side of the penis, so that the length of the retractor muscle from the tuber ischii to its penial insertion is identical with the length of the penis from the ischial notch to the muscular insertion. In ruminants and swine, the muscle is not closely applied to the ventrum of the penis but passes directly across the postero-inferior mouth of the curvature of that organ without following its course so that the length of the muscle is only about one-half that of the penis from the ischial notch to the muscular insertion. The Penis 15 Thus it occurs that the protrusion and retraction of the penis are brought about in a different manner in the horse from that observed in ruminants and swine. The penis of the soliped is protruded chiefly through an elongation of the organ itself in the process of erection ; the penis of the ruminant is protruded largely through the elimination of the S-curve and temporary lengthening of the retractor penis muscle. Fig. 9 — Penis of Calf with Sheath forcibly Everted showing Unopened Preputial Sac. x 3. Ps, Preputial sac. Other lettering same as in Fig. 8. 4. The Sheath and Prepuce Veterinary anatomists commonly use the words "sheath" and "prepuce" as synonomous terms. When studying the diseases of the genital organs, it is preferable to different- iate the sheath and prepuce as two separate structures of different embryologic history. It will simplify the study of the pathology of these structures if the prepuce is regarded as that sac which reaches from the fornix, or base of the glans, to its apex when the organ is at rest. The sheath begins at the apex of the penis, when the organ is at rest, and extends forward to the exterior opening where it be- comes continuous with the general integument. The pre- i6 Diseases of the Genital Orgam puce is wholly free from hairs; the sheath at its external opening contains numerous hairs. In the bull these are greatly developed to constitute the preputial tuft. The pre- putial sac of solipeds forms and opens early in embryonic life, but ruminants and swine are born without this struc- ture. The new-born male soliped can readily protrude the penis and commonly does so when urinating. The young ruminant and porcine male cannot protrude the penis, as is shown in Figs. 8 and 9, and necessarily urinate in the sheath. With the advent of puberty, the frail layer of em- bryonic tissue, serving to bind the prepuce to the glans, Fig. 9a— Penises of Steers showing- various degrees in the development of the Prepuce. The left hand figure .shows in the glan.s a few elevations from the granular venereal disease. The Sheath and Prepxue 17 slowly yields and the preputial sac opens, after which the penis may be protruded. If the young animal is castrated early, the formation of the prepuce is held in abeyance at varying stages. The animal must then urinate within the sheath throughout life and is subject to special diseases not observed in entire males. In the young lamb, the urethral orifice at the tip of the vermiform appendix of the penis opens into the fundus of the sheath, the tip of the vermiform appendix accordingly indicating the line of demarcation be- tween the sheath and the eventual preputial sac. Fig. 10 — Sheath, Prepuce and Retracted Penis of Bull. F Fornix ; G, glans ; P, prepuce ; S, sheath. The epithelial coverings of the glans penis and the pre- puce of solipeds are corneous and highly protective. They produce a moist sebum in the sinus about the urethral open- ing, but over the rest of its surface the sebum is normally dry and forms gross masses of crusts which are readily detached. In ruminants, swine, and carnivora, on the con- trary, the preputial sac and glans penis are covered by a very delicate mucous membrane which normally secretes sufficient mucus to keep the parts constantly moist. The prepuce of ruminants and of swine is accordingly more vulnerable to abrasions and infections than that of solipeds, and affects quite profoundly the type of lesions observed in the two classes. The preputial secretions are not as a rule markedly odoriferous. The sheath of all domestic animals secretes a smegma having a specific odor. The boar has two culs-de-sac in the superior wall of the sheath which may contain as much as a i8 Diseases of the Genital Organs pint of highly fetid urine and smegma. In the barrow these cavities are much smaller but contain a similar fetid material. When the penis is protruded as in copulation, the glans penis pushes its way out of the prepuce and that membrane becomes everted to constitute the covering of the penis from the fornix backward for a distance approximately equal to Fig. II — Sheath, Prepuce and Protruded Penis of Bull. Lettering same as in Fig. lo. the length of the glans. The further protrusion of the penis requires the eversion of the sheath by which it becomes the visceral covering of the base of the penis. It thus transpires that the prepuce and sheath, the epithelial surfaces of which face inwardly while the penis is at rest with a cavity be- tween them and the penis, become reversed when the organ is erected and constitute its immediate covering with its epi- thelium facing outward. The general plan is indicated in Figs. 8-11. B. The Female Generative Organs The genital system of the mammalian female consists of the ovaries, oviducts, uterus, cervix, vagina, and vulva. 1. The Ovaries The ovaries are the essential reproductive glands of the female. They perform the fundamental generative func- The Ovaries 19 tion by elaborating the ovum, or ^%%, which, after being discharged from the ovary and fertilized by the spermato- zoon, becomes a distinct, but in mammalia not immediately an independent, being. The fertilized ovum is still depend- ent for a time upon the oviducts for its transportation to the uterus, upon the uterus for its nutrition and protection dur- ing pregnancy and its expulsion at fetal maturity, and upon the milk from the udder of the mother as food immediately after birth. The size, form, and location of the ovaries of domestic animals differ greatly according to species, breed, age, and individual ; even the two glands in the same animal are not ordinarily alike and may vary greatly in size and form. The ovary of the mare is much the largest seen in the domestic animals, reniform, very dense owing to its thick tunica al- buginea, with a smooth surface which is elevated here and there in many cases by the presence near the surface of cysts varying from less than 0.25 inch to 2 or more inches in diameter. The gland attains its maximum size when the animal has reached the age of three or four years, and be- gins to atrophy at ten to fifteen years, to become very small and fibrous as age advances. The ovary of the young mare is usually 3V2 to 4 inches in its greatest diameter and weighs about 4 ounces, while in the aged it may shrink to II/2 inch in its greatest diameter and in weight to 1/2 ounce. The ovary of the cow is much smaller than that of the mare, varying in its greatest diameter between 0.25 and 2 inches and weighing about 0.25 to 0.5 ounce ; it is oblong and gen- erally regular in outline ; its tunica albuginea is only moder- ately dense. The ovary of the sow is comparatively very large. The numerous ovisacs appear prominently on its sur- face in such a manner that the most superficial of them stand out entirely beyond the general ovarian surface at- tached to the body of the organ by a somewhat constricted neck. The ovary of the cat is very oblong, with pointed ex- tremities, and of a bright scarlet color, with the ovisacs standing out thickly over the surface in a way suggesting a mulberry. 20 Diseases of the Genital Organs The ovary of the bitch is very small, livid in color, even in outline, and, unlike those of other domestic animals, is completely enveloped in the pavilion of the oviduct, except for a minute oblong opening of so small size that the gland can not be readily exposed to plain view through it. The location of the ovary in the adult varies much with species. The size of the gland, when normal, has little or no influence upon its position. It rests upon the superior surface of the anterior border of the broad ligament of the uterus, naked in most animals but closely invested in the bitch by the pavilion of the oviduct. The pavilion of the oviduct in the mare is attached by one of its fimbria to the ovary near its hilus, and its connection with the uterus is further maintained by the utero-ovarian ligament, com- posed largely of connective tissue and pale muscle fibers. In the cow one of the fimbriae of the pavilion is adherent to the outer or lateral end of the ovary. The ovary is also influenced in its position by the round ligament, which is analogous to the gubernaculum testis of the male. Arising like the latter from the skin and dartos at the point where the fundus of the scrotum of the male normally appears in the given species, it extends up through the inguinal ring behind the peritoneum, to become attached to the uterine cornu or oviduct, not far from the ovary. Its attachments tend to cause the ovary to follow a line of descent compar- able to that of the testicle, but normally it becomes arrested in its migration at some point between its place of origin and the internal inguinal ring. In the bitch, it remains closely applied to the sub-lumbar region, immediately be- hind the kidney, virtually at its point of origin. In the mare, its movement is arrested early and it remains rather firmly suspended not far behind the kidney and above the middle of the posterior part of the abdominal cavity. The ovary of the ruminant lies loosely in the pelvis, alongside the cervix uteri or the base of the cornu, behind the in- ternal inguinal ring, or just in front of the pubic brim, somewhat below it, resting upon the abdominal floor.. The ovary of the sow floats quite freely in the peritoneal cavity The Ovaries 21 and abnormally at times passes out through the inguinal ring and comes to rest in that part of the perineal region corresponding to the scrotum of the boar. The same dis- placement of the ovary occurs rarely in bitches. It is possible in any species. In general it may be said that in the elongated uteri of multiparous animals the ovaries are situated further forward than in the uniparous or biparous genera. The location of the ovary is further modified by the pregnant state. The gravid uterus, in its descent, drags the gland downward and forward. It is also drag- ged downward and forward by any increase in weight due to disease of the uterus, oviducts, or ovary, such as pyome- tra, tumors of the uterus, oviducts and ovaries. The functional activity of the ovary modifies its size and form. During the breeding life of the animal the cortex, or peripheral area, of the ovary is largely composed of egg columns, or masses, consisting of germinal cells arranged in the form of a hollow sphere. Resting upon an intruding mass of genital cells is a specially developed cell, the ovum. The spheroidal hollow mass of cells contains a fluid, the follicular liquid. When an ovum, or ova, matures and an ovisac ripens, the female is in estrum or "heat." The ovisac becomes distended with follicular fluid, presses aside the superposed ovarian tissues, and attenuates or destroys the tunica albuginea at the involved point. In most ani- mals the active ovisac pushes its way above the general ovarian surface as a hemispherical cyst with very thin walls. In the mare it regularly protrudes at the hilus of the gland, where it is not readily apparent. The ripe ovisac — or ovisacs — ruptures at the close of estrum, producing a lesion, which usually behaves differently according to whether the discharged ovum becomes fertilized and un- dergoes development into a fetus or, failing of fecundation, perishes. The crater resulting from the rupture of the sac becomes filled with lymph, blood, or other products of the disturbances of the tissues. Should the ovum perish, the lesion tends to heal rapidly, the blood and lymph in the crater are resorbed, and from its walls there forms a char- acteristic tissue, known as the corpus luteum of estrum. 22 Diseases of the Genital Organs In the cow and in most other animals it is identical in form, consistence, and volume with the corpus luteum of preg- nancy, but its color differs. In the non-pregnant cow it is chocolate-colored. Prior to the next estrum it atrophies. Should the ovum become fecundated and undergo normal development, the corpus luteum forming in the crater is al- most always markedly yellow, lemon, or orange. It pro- jects beyond the ovarian surface. It persists regularly up to the time of parturition or abortion and for a varying length of time thereafter. It is known as a true corpus luteum. Pathologically, it sometimes atrophies during pregnancy and is one of the causes of estrum in pregnant animals. While in unipara the corpus luteum regularly atrophies soon after the termination of pregnancy, the atrophy is ordinarily dependent upon the expulsion of the uterine contents. If the fetus perishes, but is retained and desiccates or macerates, the corpus luteum remains. In the sow (and presumably in other multipara) the number of corpora lutea almost always exceeds the number of fetuses, both living and dead, registering the fact that not all ova discharged at a given estrum successfully mature. When very few pigs are born in a litter, it indicates that numerous ova or embryos have perished, rather than that few ova were discharged. The size and form of the ovary are accordingly modified by the presence of a ripe ovisac or ovisacs or of a corpus luteum. In the cow the corpus luteum is frequently larger than the remainder of the ovary — approximately % to % inch. 2. The Muellerian Ducts The beginning of the genital canal in the embryo con- sists of two parallel rods, which later become excavated to form tubes — the ducts of Mueller — extending from near the posterior body opening, upward and forward to the re- gion of the ovary. Eventually the two ducts fuse at their posterior ends, producing a single tube. The ducts become differentiated, through specialization in their development, into four essentially separate segments, each having its distinctive function. The anterior segment constitutes the The Muellerian Duds 23 oviduct, or Fallopian tube, dilated at its anterior end to form the ampulla, or pavilion. The oviduct constitutes a conduit through which the spermatozoa of the male may pass from the vagina and uterus to the ampulla, there to meet and fertilize the freshly discharged ovum. It serves later to transport the ovum, fertilized or unfertilized, to the uterus. The second, or middle portion of the genital tube constitutes the uterine cavity, including the cornua, in which the fetus may find lodgment, attachment, nutri- tion, and protection during its development. The third segment consists of the cervix, which acts as a barrier be- tween the uterus and the vagina. The fourth, or posterior segment — the vagina — extending from the uterus to the vulva, serves first as an essential copulative organ and later as a passage for the fetus at the time of birth. The degree of the fusion of the Muellerian ducts and the extent of the specialization of the different areas modify greatly the form and relations of the various segments. The entire genital tube, having a common embryonic origin, has a similar structure, characterized chiefly by three coats — peritoneal, muscular, and mucous. The peritoneal layer, which invests the genital tract almost completely, is derived from the peritoneum of the body wall, behind which the ducts of Mueller originate. At its anterior extremity the genital tract opens, through the pavilion of the oviduct, into the peritoneal cavity. The peritoneum stops at the mar- gin of the pavilion, to be succeeded by the mucous membrane of the oviducts The genital tract is supported by the broad ligaments, which consist of two peritoneal layers resulting from the departure of the genital tube from its seat of origin behind the peritoneum. Along the line of their attachment to the genital tube, the peritoneal investment is interrupted to the extent of the area between the two peritoneal folds occupied by the vessels, nerves, pale muscle, and connective tissue fibres constituting the body of the ligament. At the pos- terior extremity of the genital tract, where it opens into the cloaca of the. embryo, the peritoneum is reflected upon 24 Diseases of the Genital Organs neighboring organs and the genital tube is surrounded by the intra-pelvic connective tissue, so that eventually the peritoneum covers, in addition to the oviducts and uterus, only the more anterior portions of the vagina. The fusion of the two Muellerian ducts, to form the vagina and uterus, destroys the contiguous median w^alls of the tubes as far as they coalesce, and the adjacent tubes become a single canal. The broad ligament of the uterus varies greatly in its form and amplitude acording to species and the functional activity of the genital tract. In the bitch, cat, and sow, in which the anterior extremities of the uterine cornua remain through- out the life of the animal about as far forward as the post- erior border of the kidney, the broad ligament maintains its anterior attachment to the abdominal wall at or near the point of origin of the ovary just behind the kidney; in the ruminant, where the ovary and the anterior ends of the uterine cornua are turned backward to the immediate vicinity of the internal inguinal ring, the parietal attach- ment of the anterior border of the ligament likewise moves backward for a considerable distance so that the middle of the recurved cornu tends to project forward beyond the an- terior margin of the ligamentous attachment. When the uterus of a quadrupedal mammal becomes gravid, the weight of the fetus drags the occupied portion downward and for- ward until the organ comes to rest upon the abdominal floor in front of the anterior point of fixation of the ligament to the abdominal wall. The genital tube is further maintain- ed in its position by its attachment posteriorly to the vulva and also by the round ligament of the uterus. The muscular walls of the genital tube are composed of circular and longitudinal layers of pale fibres, varying greatly in the different sections of the tract and also accord- ing to whether the animal be pregnant or not. The mucous coat of the genital tract offers the greatest possible variations and assumes widely differing and highly important functions, according to the particular area con- cerned. The M^iellerian Duds 25 a. The oviducts, formed from the anterior or ovarian ex- tremities of the Muellerian ducts, are two long, tortuous tubes, varying in length and other characters according to species. Their length is much greater than the distance from the anterior extremity of the uterine cornu to the ovary. This distance is fixed by the utero-ovarian liga- ment. In some animals the oviducts are naked and clearly visible. In the bitch they are hidden in the abundant fat of the broad ligament. The utero-ovarian ligament in the dog and cat is very short, so that the anterior end of the uterine cornu is virtually in contact with the ovary, while the oviduct, 3 to 4 inches in length, is thrown into numerous folds, to terminate in the immediate region of its origin, so that casual observation, without dissection, might lead to the assumption that the oviduct was well-nigh absent, whereas it is very similar in actual length to that of other species. When divested of any concealing coverings of peritoneum, fat, or other tissues, the oviduct appears as a very convo- luted white cord about 0.1 inch in diameter. It is very firm to the touch and gives a sensation much like its analogue in the male, the vas deferens. After it is dissected out from the surrounding tissues and its numerous abrupt curves are carefully eliminated, a very fine sound, as one of the tail hairs of a horse, may be inserted at one opening and passed through its entire length. While technically the oviducts complete a communication between the peritoneal cavity and the exterior, the tubes are ideally impassable, except to ova and spermatozoa. They do not under usual conditions per- mit the forcing of liquids through their canal when intra- uterine injections are made under comparatively high pres- sure. Clinically, they also offer valuable resistance to the passage of bacteria. Frequently, pathogenic organisms, such as those involved in abortion and retained placenta in cows and other animals, travel along the oviducts, causing disease of them or, reaching the ovary, induce abcess or other disease, causing sterility. The intimacy of contact between the peritoneal covering of the oviduct and the muscular walls varies according to 26 Diseases of the Genital Orgajis species. The investment is very close in ruminants and the sow, so that the ducts are readily seen without dissection. In the mare the duct is surrounded by much connective tissue, which serves to conceal it from view until the peri- toneal and fibrous coverings are dissected away. In the bitch the concealment is further accentuated by large amounts of adipose tissue. The oviduct opens anteriorly through the ostium abdomi- nale into the pavilion of the tube and posteriorly into the uterine cornu through the ostium uterinum, which usually projects somewhat as a small eminence into the cavity of the cornu. The muscular coat of the oviducts is characterized chiefly by its density, which gives to it an almost cartilaginous con- sistency, and its paleness, which amounts almost to trans- lucency. The superficial layer of the mucosa of the oviducts consists of ciliated columnar epithelium with the cilia vi- brating toward the uterus. The oviduct is the most rigid and undilatable portion of the genital tube. It provides passage for the migration of the spermatozoa of the male, which, in spite of the movements of the cilia in the contrary direction, advance from the uterus toward the ovary, in virtue of their inherent power of movement, meet the ovum in the pavilion, and fecundate it. Later the oviduct conveys the ovum, fecundated or not, from the ovary to the uterus. In this function the cilia play an essential part. In rare cases the fecundated ovum lodges in the duct and under- goes partial development, to constitute tubal pregnancy, but the undilatability of the duct serves, as a rule, to cause a rupture of its walls and leads to the escape of the fetus from the duct into the peritoneal cavity, either to cause sudden death of the mother from hemorrhage or to constitute extra- uterine, or abdominal, pregnancy. b. The uterus, see Figs. 12, 13, a bifurcated, musculo- membranous sac, designed for the reception, nutrition, and protection of the ovum, finally takes the initial part in the expulsion of the fetus at the time of birth. The uterus varies greatly in form and disposition, dependent partly The Mvellerian Ducts 27 upon the degree of fusion which has occurred between the two tubes. There are recognized in domestic animals a uterine body and two cornua, each having essentially like functions in varying degrees. This is in sharp contrast to the uterus of woman, where the uterine body constitutes es- sentially the entire functional organ and the cornua are un- important appendages. In the rabbit there is no uterine body, but two distinct tubular uteri opening separately into the vagina. In the bitch, cat, and sow the uterine body is limited in extent and physiologically unimportant, rarely containing placental attachments and only a small portion of one fetus except while in transit at the time of birth. The two cornua are extensive, and in them develop the fetuses, so that physiologically the horns represent the two separate uteri of the rabbit. In ruminants the uterine body is larger and assumes higher importance physiologically, while the cornua remain relatively large. The one, two, or, very rarely, more fetuses are habitually located almost equally in the body and the cornua, so that they represent a middle stage in the transition between the double uterus of the rabbit and the single uterus of woman, physiologically devoid of cornua. In the mare the uterine body becomes re- latively more important than in the ruminant. The relative sizes of the cornua and of the uterine body bear a close relation to the number of young brought forth at a given birth. In multiparous animals, there are two uteri, as in the rabbit, or the two extensive cornua with functionally unimportant uterine body, as in the bitch, cat, and sow. In ruminants, which are largely biparous, the uterine body and cornua become approximately equal in ex- tent and function. In the normally uniparous mare, the cornua are smaller than the body. The uterus and its cornua, within the above limitations, are uniform in their plan of structure and function. They consist of three coats : mucous, muscular and peritoneal. The mucous coat constitutes the essential physiologic basis of the organ. The mucous epithelium is very elaborate, con- sisting superficially of columnar cells, embedded deeply with- 28 Diseases of the Genital Organs in which are numerous tubular structures of a glandular character, the utricular glands, believed to secrete the so- called uterine milk, which is presumed to play an important role in the nutrition of the ovum pending the formation of the embryo and the establishment of its intricate connection O Fig. 12— Non-gravid Uterus of Mare viewed from the Dorsal Surface. O, (?, Ovary ; 0:\ oviduct; [/, uterus ; f/C, uterine cornu ; BL, broad ligament ; / ', vagina ; I'n, vulva; C/, clitoris ; //, hymen. with the mucous membrane through the chorion. Yet more important, it is through a special elaboration of the uterine mucosa that the highly intricate and essential maternal placenta is formed, to constitute a physical and physiologic The Mtiellerian Ducts 29 bond between the mother and fetus during the span of preg- nancy. The uterine mucosa is presumed to exert important bactericidal powers, but a majority of uteri of cows, both pregnant and non-pregnant, contain bacteria, several of which appear competent to induce important disease (steril- ity, abortion). In the non-gravid uterus, as is common with distensible hollow organs, the mucous membrane is thrown into numerous longitudinal folds, which facilitate prompt and extensive dilation of the cavity without violence. The muscular coat consists of two somewhat differentiable groups of longitudinal and circular pale muscle fibers which increase during pregnancy in size, activity, and, it is be- lieved, to some extent in number. The proportion of the longitudinal to the circular fibres varies. The peritoneal layer of the uterus, which is derived from that of the abdominal walls, envelops the organ completely except at the points of continuity with the oviducts and vagina and the interstice between the two peritoneal sheets of the broad ligament at their points of uterine attachment. The uterus is retained in position by its broad ligaments and by its continuity anteriorly with the oviducts and pos- teriorly with the cervix. The round ligament of the uterus, arising from the skin, or dartos, in the region normally constituting the fundus of the scrotum in the male, and passing up through the inguinal canal and abdominal ring and thence to the cornu, or oviduct, is functionally of scant interest as a ligament of fixation. The uterus is located immediately beneath the rectum, with its two cornua pass- ing obliquely outward and forward on either side. The uterus of the mare, with its cornua, constitutes a somewhat crucial organ : the horns leave the body laterally at right angles or somewhat recurved. The uterine body is oblong, flattened somewhat from above to below, varying from 5 to 8 inches in length and IV2 to 2 1/2 inches in width. Anteriorly, the cavity of the uterine body of the mare is continuous with that of the two cornua, without a distinct line of demarcation beyond an abrupt turn at right angles or slight recurvation to its long axis. Each cornu is much 30 Diseases of the Genital Organs like the body. The cavity of each is essentially equal to that of the body, and the combined length of the two is greater than that of the body. They end obtusely not far from the ovary. Each presents at its apex a conical pro- jection in which there is an opening, the os uterinum, or uterine orifice of the oviducts. Fig. 13 — Ovaries, Oviducts, Uterus, and Cervix of Cow. /, Os uteri externum ; 2, right cornu; j, ovary ; 7, ovarian ventricle ; 5, ostium abdominale of the oviduct, 6. The Muellerian Ducts 31 The peculiar crucial form of the uterus of the mare — the two ample horns with the bases of their cavities directly opposite, so that they have a common long axis — renders "^"^^ Fig. 14— Genital Organs of the Bitch. T, T, Posterior teat ; B, urinary bladder ; V, vagina ; U, uterus ; LUC, left uterine cornu with a portion of the broad ligament, BL, lying across it ; RUC, right uterine cornu with its broad ligament, BU , turned outward exposing the full length of the cornu ; O, O, ovary ; R, rectum ; K, left kidney. 2,2 Diseases of the Ge?iiial Orga^is bicornual, or transverse pregnancy so easy that it occurs not infrequently, resulting in a variety of transverse presen- tations and causing some of the most serious dystocias known to the veterinary practitioner. In ruminants the uterine body is less pronounced in size, when viewed exteriorly, and even less upon section, while the cornua are much longer, quite tapering, and compara- tively more ample than in the mare. The two cornua sep- arate at a very acute angle, for a time extend forward al- most parallel to each other, and then, becoming somewhat more divergent, curve downward, outward, backward, and finally upward, to end alongside the cervix within the pelvis. The uterine body and cornua are much denser, narrower, and more cylindrical than in the mare. The cornua taper gradually from their bases at the uterine body to their apices, where they pass almost insensibly into the oviducts. The broad ligaments of the uterus of the mare arise from the abdominal walls in the sublumbar region, begin- ning not far posterior to the kidneys and extending from this point obliquely downward, backward, and medianward into the pelvic cavity, where the two layers of peritoneum become reflected from the vagina upon the bladder, rectum, and pelvic walls. Compared with the broad ligaments of other domestic animals, they are limited in extent, especial- ly transversely, causing a comparatively rigid fixation of the uterus, and, since their anterior attachment is approxi- mately in a direct line with the long axis of the cornua, the entire organ is held well forward in the abdominal cavity. The broad ligaments of ruminants, as compared with those of the mare, are much more ample transversely, while antero-posteriorly they are much less extensive. Their an- terior point of attachment to the abdominal parietes is much farther posterior than in the mare. This variation in disposition and relations of the broad ligament produces two well-marked clinical differences. In the non-gravid uterus of the cow, the anterior parietal attachment of its broad ligament is already posterior to the anterior curva- ture of the uterine cornua, which in the gravid uterus be- The Miiellcrian D^icts 33 comes sharply accentuated, so that almost the entire organ rests anterior to its ligamentous attachments to the ab- dominal parietes. In the cow and ewe, the broad ligaments become largely powerless in preventing the pregnant organ from revolving upon its long axis, so that torsion of the uterus becomes quite common, while in the mare the more rigidly fixed organ, with the anterior parietal attachment of the ligament much farther forward, serves to render the displacement comparatively rare. In ruminants, the com- parative amplitude of the ligaments, with their anterior point of parietal attachment but little anterior to the pelvic inlet, permits more readily than in other animals inversion and prolapse of the uterus and vagina. In muciparous animals the broad ligaments are neces- sarily very extensive and uniformly have their anterior point of attachment to the abdominal walls far forward in the post-renal region. In the bitch, the ligament at its an- terior border is very short, so that the ovary and ovarian end of the cornu are closely fixed in the sublumbar region, just posterior to the kidney, tending to stretch the cornu be- tween this anterior, sublumbar attachment and the vagina. The ligaments are exceedingly ample, except at the anterior border, and are much broader than the distance from the parietal attachments to the position of the cornu, resulting in a large antero-posterior fold in the ligament, which drops down on the lateral side of the cornu and covers it in a double fold of broad ligament (Fig. 14). Unlike other do- mestic animals, the broad ligaments of the bitch are uni- formly the seat of extensive deposits of fat, which cause them to resemble the gastric omentum in general ap- pearance. c. The cervix, or neck of the uterus, consists of a power- ful, sphincter-like segment of the genital tract, serving to separate anatomically and physiologically the uterus from the vagina. It is continuous anteriorly with the uterine body and posteriorly with the vagina. It is a tubular organ having walls very much thicker than those of the uterus or vagina and very dense and rigid. In the cow especially the 34 Diseases of the Genital Organs walls are intensely rigid and hard like cartilage. In rigid- ity the cervix is closely analogous to the oviducts. In func- tion, too, they are analogous : the one acts as a pow^erful guardian of the anterior, or peritoneal opening of the uterus; the other of the posterior, or vaginal portal. The cervix varies in size in the diiferent genera and in individ- uals. The posterior end of the cervix projects into the vagina as an obtuse cone, II/2 to 21/2 inches in the mare and \ Fig. 15 — Cervices of Virgin Heifers opened from above on the median line exposing the Annular Folds of the Mucosa. /, First or vaginal fold ; 2, j, 4, the second, third and fourth folds respectively, the cow. The cow has the longest and most powerful cervix: it is 3 to 5 inches antero-posteriorly and 2 to 3 inches transversely. Its muscular walls are so rigid, and its circular muscle fibres so contracted that it is exceedingly difficult to dilate the canal mechanically, but it dilates freely under the influence of estrum and parturition. The cervix of the mare is shorter than that of the cow and the walls far thinner and more pliable, rendering its canal readily dilatable. 77/1? Miicllerian Ducts 35 The cervical mucosa is very complex. It is thrown into deep and ample longitudinal folds, which upon cross section (See Figs. 16 and 17) are seen to radiate centralward from the basal mucosa, the summits of the rugae converging to meet at the central axis of the cervical canal. The cervical mucosa of the ruminant is also thrown into very ample cir- FiG. i6 (Above) and Fig. 17 1 Below). Transverse section of the cervix between the Annular Folds. Fig. 16 — Viewed from the uterine eiid. From left to right they represent the first, second, third, and fourth annular rings respectively. A, Cervical canal ; M. muscular wall of cervix. Fig. 17 — .'Annular folds viewed from the vaginal end. 36 Diseases of the Genital Organs cular folds, with their summits, or free surfaces, directed vaginalward. In the cow these circular folds measure one- half to three-fourths of an inch from the base to the free summit, and in disease may become elongated to several inches and protrude into the vagina to constitute large polypoid masses. The cervical mucosa is rich in special mucous glands, which during pregnancy elaborate the uterine seal — a very tough, firm, adhesive structure com- pletely sealing the cervical canal from the uterus to the vagina and constituting a highly elaborate and efficient bar- rier against invasion of the pregnant uterus by infection from the vagina. The cervical canal, elaborately barri- caded by mucous folds and by the firm contraction of the circular muscles, is extremely narrow, and in the ruminant is besides exceedingly crooked (See Figs. 40, 41). This disposition of the cervical mucosa has given rise in the past to the fiction of "closure of the womb" and led to the belief in "opening the womb" as a panacea in sterility. Anterior- ly, the cervical canal opens into the uterine cavity by the os uteri internum ; posteriorly, at the summit of the conical projection into the vagina by the os uteri externum. During estrum the muscular walls of the cervix relax and the cervical canal dilates somewhat. When parturition en- sues, the cervix, as such, becomes temporarily obliterated, and the canal dilates sufficiently for the passage of the fetus — that is, until its cavity is co-extensive with the pelvic cav- ity and with the cavities of the uterus and vagina. At this time it becomes virtually non-recognizable ; all the posterior segments of the genital tract — uterus, cervix, and vagina — become one continuous tube of virtually uniform calibre. In that type of cystic disease of the ovaries causing nymph- omania, the cervical canal undergoes pathologic dilation. In the sow the cervix is not so well defined and no elaborate uterine seal forms. Instead, the vagina and cervix extend as an irregular tube up to the bifurcation of the essentially double uterus. d. The vagina is a musculo-membranous canal, formed from the fusion of the posterior ends of Mueller's ducts and The Mnelleriaii Diccts 37 Fig. i8. Vulva and Vagina of Cow showing Gartner's Ducts. A, Os uteri externum ; /, meatus urinarius ; 2, the outlets of the two ducts of Gartner. The arrows point to small openings from the duct into the vagina, apparently from ruptures of small cysts or abscesses, 38 Diseases of the Genital Organs extending from the cervix to the vulva. It begins at the os uteri externum and ends posteriorly at the position of the hymen, just anterior to the meatus urinarius, where the vulva succeeds it. In the cow, incomplete fusion of the Muellerian ducts in the vaginal segment is evidenced oc- casionally by a muscular column of varying size stretching from the roof to the floor of the vagina on the central line, just against, but free from the vaginal end of the cervix. The vagina of the mare is eight to twelve inches in length and capable of lateral distension to the full size of the pelvic cavity. It is lined with squamous epithelium. Its mucosa is thrown into longitudinal folds, which, when at rest, lie in contact with each other. The mucous membrane of the vagina has in its deeper portions numerous mucous glands which serve to keep the surface at all times moist and which become especially ac- tive during sexual excitement and at the close of pregnancy. The muscular coat does not differ fundamentally in arrange- ment from that of the uterus, though less in volume. In the mare, the peritoneal covering extends backward from the anterior extremity three to five inches, where it becomes reflected upon the rectum, bladder, and pelvic walls. In the posterior portion of its course, the vagina is sur- rounded by the loose pelvic connective tissue, which permits comparatively free movement. The function of the vagina is chiefly copulative, receiving the penis of the male during coition. During parturition, it affords a passage for the fetus from the uterus to the vulva. In the mare and the cow the vagina frequently becomes ballooned during manual exploration of the organ, owing to an inflow of air at the moment of inspiration. During ex- ploration the vulva is propped open by the hand or arm of the operator, permitting the air to flow in, distending the vagina so that it fills the pelvic cavity completely from side to side and from roof to floor, presenting a vast cavity with smooth, rigid walls, which are in close contact laterally with the bony or ligamentous pelvic walls, superiorly with the The Muellerian Ducts 39 sacrum except in the area where the rectum intervenes, and inferiorly with the pubis except for the urinary bladder. The ballooning of the vagina of the mare or the cow is readily induced by intra-vaginal manipulation, by the in- jection into the organ of bland, tepid fluids, or by various Fig. 19. Vulva and Vagina of Cow Showing' Gartner's Ducts and Bartholin's Glands. /, Meatus urinarius ; z, j, cystic areas in the right duct of Gartner ; 4, cervical canal laid open ; C, small cyst in Bartholin's gland. other means. When the moist hand is introduced into the organ at the time of estrum, marked inflation generally oc- curs at once. e. Gartner's Ducts. The Wolffian ducts of the embryo do not wholly disappear in the female but persist in varying 40 Diseases of the Genital Organs Fig. 20. Vulva and Vagina of Cow. /, Meatus urinarius ; 2, 2, enlarged openings of Gartner's duct in which a wire loop has l)een inserted ; j, opening of Barlliolin's gland ; 4, cervix. The conrse of Gartner's ducts is indicated by arrows upon slight ridges. slightly as they pass forward to disappear to the right and left of the cervix. As a result of vaginitis, their orifices occasionally become occluded and the structures assume the character of cylindrical or spindle-shaped retention cysts. (See Figs. 18, 19, 20, 21.) degrees as essentially functionless structures. The caudal ^ ends of the ducts persist as recognizable structures along the floor of the vagina in the co-w. They end posteriorly just in front of the meatus urinarius where they lie near together. They consist of very fine tubes which diverge The Vulva 41 3. The Vulva The vulva, located immediately beneath the anus, consti- tutes the posterior termination of the genital canal. In- stead of being derived from the mesodermic Muellerian ducts like the preceding organs, the vulvar epithelium origi- nates from the ectoderm of the embryo. Anteriorly, the boundary between the vagina and the vulva is marked by the hymen, a transverse membranous expanse stretching across the genital canal, which represents the partition between the termination of the hind gut and the proctodeum of the embryo, in the lower, or genito-urinary, division of the cloaca. Generally it atrophies and almost or wholly disappears in domestic animals before birth, but at times it persists, either as vertical bands stretching across from the roof to the floor of the vagina or as a circular ex- panse largely closing the genital canal except in its center. Rarely in domestic animals the hymen persists as an im- pervious membrane. The vulva opens externally by means of a vertically elong- ated slit, bounded upon either side by the labiae vulvae, which meet above and below to form the superior and in- ferior vulvar commissures. The vulvar labiae are covered externally by a very fine skin. In the mare the growth of hairs is inconspicuous ; in the cow, there is a prominent tuft of hairs about the in- ferior commissure. The parts are so scantily haired that their color, which as a rule is simply that of the adjacent skin, becomes very conspicuous. In dark-skinned mares with white faces, eyes, and feet, the cutaneous covering of the vulva tends also to be devoid of pigment. The promi- nence of the pigmentation of the skin of this part serves as an aid in the clinical diagnosis of the venereal diseases of horses, in which important discolorations occur. The muscles of the vulva, which are chiefly circular, are divided into two groups — the posterior and anterior con- strictors. The posterior constrictor, situated within the vulvar lips, constitutes a true sphincter, analogous to those 42 Diseases of the Genital Organs about other body openings. Above, its fibers become lost in the perineum and the sphincter ani; below, some go to the base of the clitoris and some pass downward, to become lost in the skin and other tissues of the thighs. Their con- traction brings about the closure of the vulvar opening. The anterior group of muscle fibers invests the vulva in the Fig. 21. Vulva and Vagina of Cow. /, Meatus urinarius ; 2, 2, mouths of Bartholin's glands. The arrows point to very small cystic swellings in Gartner's ducts. region of the hymen, just anterior to the meatus urinarius, where, by their contraction, they produce a constriction on the vulvo-vaginal border line. Through the medium of the surrounding aponeuroses, the vulvar muscles acquire continuity with the ischium, sacrum, The Vulva 43 and postero-superior border of the sacro-sciatic ligament, thus affording the vulva a secure attachment to the posterior opening of the pelvis and furnishing a fixed base upon which the entire genital canal may act in parturition. This fixa- tion enables the uterus, when contracting, to force the fetus back toward and through the cervical canal, the vagina, and the vulva. It is this fixed base of attachment which enables the contracting uterus at the time of parturition to dilate and virtually efface the cervical canal, obliterating all its mucous folds and increasing its calibre sufficiently to afford room for the passage of the fetus. The vulvar mucous membrane, continuous with that of the urinary bladder and the vagina, is covered with squam- ous epithelium and contains numerous mucous glands, which are largely displaced near the labial margins and about the clitoris by sebaceous follicles, the secretions from which are odoriferous, especially during estrual periods, when the odor becomes very marked in a manner charac- teristic of the species. Within the vulvar cavity are to be noted the meatus urin- arius, clitoris, Bartholin's glands, and vaginal bulb. In the mare the meatus urinarius, or terminal opening of the urethra, is located along the floor of the vulva at a distance of three to four inches from the external opening. The urethral canal passes obliquely downward and forward through the vaginal floor to the urinary bladder. In most animals the meatus urinarius is comparatively small and in- extensible. In the mare it is large and freely dilatable. With patience, one, two or more fingers may be pressed gradually through it into the bladder, and it is not rare to find the opening, in heavy, coarse animals, sufficiently large to admit without great difficulty the entire hand. The am- plitude of the meatus urinarius in the mare is of special significance clinically, as it favors eversion and prolapse of the bladder, an accident not particularly rare in this ani- mal, though extremely so in others. In the cow the narrow meatus urinarius has beneath its vulvar opening a small sac, or infundibulum. The supero-anterior wall of the 44 Diseases of the Genital Organs sinus constitutes the inferior terminal wall of the ureter causing it to act essentially as a valve, rendering cathe- terization difficult. Bartholin's glands, (See Figs. 18, 21) like Gartner's ducts, are vestigial structures presumed to represent the bulbo-urethral, or Cowper's glands, of the male. In the cow they consist of small, glandular structures located be- hind the vulvo-vaginal or hymeneal border, about midway from floor to roof of the copulatory canal, backward, up- ward and outward from the meatus urinarius. Their in- terest lies largely in the fact that, like Gartner's ducts, their mouths become occluded as a result of infection causing, in the cow especially, retention cysts in the vaginal walls. The clitoris is composed chiefly of erectile tissue like that of the corpus cavernosum of the penis. The clitoris of the bitch, like the penis of the dog, contains a small bone. The functions of the clitoris are not important, although it is alleged to exert an influence upon sexual excitement. In observations upon a large number of sows from which the clitoris had been removed by an empiric, the operation had no influence upon estrum or fecundation and all bred normally. C. The Physiology of the Genitalia The specific function of the generative organs is the pro- creation of the species, including conception, the intra- uterine nutrition and development of the fetus, and its ex- pulsion after a certain degree of development. As the two sexes in mammalia are wholly distinct, before conception can take place a conjunction of the male and female — coition, or copulation — must occur. In each individual there are more or less apparent vestiges of each part of the genital apparatus of the opposite sex, but these naturally become arrested in their development in the embryonic stage and remain wholly functionless. Before reproduction becomes possible, the breeding ani- mal must have reached the period of puberty, or sexual maturity, which is marked by the advent of sexual desire. When this period has been reached, ova mature in the ovary The Vulva 45 of the female and spermatozoa in the testicle of the male. Up to this time, the reproductive organs are dormant in so far as their specific functions are concerned. Puberty, or sexual maturity, occurs at varying ages in different species, breeds, and individuals, depending upon the food supply and rapidity of growth. It occurs quite uniformly in both sexes prior to the completion of growth. Reproduction is a complex physiologic process, accom- panied by or associated with phenomena which bear an im- portant relation to each other. In approximately the fol- lowing order, there are observed the maturation of the ovisac — or Graafian follicle — estrum, copulation, rupture of the ovisac, fecundation, and possibly menstruation. The chain of phenomena is finally completed by pregnancy, par- turition, and the nutrition of the new-born. The ovaries consist at first of a mere thickening of the peritoneum, due to an elaboration of its epithelial cells. The external cell layer becomes columnar. The cells of the deeper strata assume a more or less cuboidal form, to con- stitute the germinal cells, and certain of their number be- come distinctly larger than the others, to form the primitive ova. The deeper epithelial layers are broken into irregular columnar masses, or egg columns, through the growth among them from below of blood vessels and connective tissue. Prior to birth, in those young which are born in a well developed state, and shortly after birth in the imma- ture young like that of the rabbit, some of the primitive ova become materially changed, to constitute permafient ova. In the cell masses the permanent ova, developed from the primitive ova, become much larger than the others, while the nucleus, or germinal vesicle enlarges and its en- veloping membrane becomes distinct. The contents of the nucleus become massed at one point and form a distinct reticulum, in which one or more nodal points enlarge to constitute the nucleolus, or germinal spot. The neighbor- ing germinal cells become arranged about the ovum in such a manner as to enclose it completely in a follicle, which has at first a single layer of cells. Later a second layer of cells ^6 Diseases of the Ge7iital Organs forms within the first, closely investing the ovum and con- tinuous at one point with the cellular layer of the wall. This mass of cells, bearing within it the permanent ovum, constitutes the discus proligey^us. The cells of the follicular walls multiply rapidly. The external enveloping layer extends more rapidly than the inner discus proligerus causing a separation between the two, except at the point of attachment of the latter. A sec- tion through the discus proligerus and follicle reveals a crescent-shaped cavity filled with fluid. Fully developed, this constitutes the ovisac, or Graafian follicle, which con- sists of the outer layer of follicular cells, or tunica granulosa, and the inner granular cells, the discus proli- gerus, embedded within which lies the ovum. The cavity of the follicle between the two masses of cells is occupied by the follicular fluid. The immature egg sac usually lies deep within the ovary. As it matures and the volume of follicular fluid increases, it approaches the surface of the ovary. In the cow about one-half of the ovisac protrudes finally beyond the general ovarian surface as a hemisphere, -''■•ile the other half remains below the general level of the gland. The ripe ovisac of the cow is about one-half to five- eighths of an inch in diameter. In the sow the ovisac grows completely beyond the ovarian surface and appears as a pedunculated cyst one-fourth inch in diameter. In push- ing toward and beyond the ovarian surface, the tunica al- 'buginea, or ovarian capsule, atrophies and disappears at the summit of the distended sac, and the peritoneum is pushed outward. The follicular wall becomes very thin. During rectal palpation in the cow, the ovisac often ruptures under very slight pressure. During the maturation of the ovisac, the ovum undergoes important changes. Before the ovisac ruptures, the nucleus of the ovum passes from the center of the egg toward its periphery ; a definite vitelline membrane is formed within the zona radiata immediately about the nucleus of the ovum; the nucleus becomes indistinct; and, while the yolk retracts slightly from the vitelline membrane at one point, the first polar body, a smalfmass apparently derived from an unequal division of the nucleus, is assumed to be extruded. Estrtun 47 When the egg has fully ripened and the ovisac has com- pleted its growth and is fully distended with fluid, estrum, or "heat", occurs. 2. Estrum Preliminary to reproduction, an irresistible sexual desire occurs, leading to coition. Estrum finds expression in various ways in different species of animals. In general there is a nervous excitabil- ity, the external genitals are swollen and vascular, and there is an increased secretion of mucus from the vulva and the Germinal Lpitkelium /^ ^TimaVY ToUicle ■•'*^>, ' • ■ ' ' •'■,,. '"''^ ..'■■ .. • V ■- %»^^ ;? -f^i^-l^!|^ Zona. I'iG. 22 — Section of ovary of cow showing a follicle, 0.6 mm., w^ith ovum. vagina. In the mare, when other horses — especially stal- lions — are present, there are frequent emissions of urine in small quantities, and the vulvar lips are frequently opened and the erected clitoris protruded. In the cow and the sow, the female imitates the copulatory act of the male by mount- 48 Diseases of the Genital Organs ing, or standing to be mounted by, other animals of its species. The ewe ordinarily shows little or no evidence of estrum except in the presence of the male. In certain pathologic cases (nymphomania) the cow especially does not confine her expressions of sexual desire to her own kind, but may attempt to mount other species of animals. In all animals there is a tendency during estrum for the female to wander from home. This is most noticeable in the bitch and the cat, which, if not securely confined, disap- pear, tending to wander long distances and to remain away during a large part or all of the estrual period. The sexual wanderings of domestic animals constitute an interesting chapter in the dissemination of infectious diseases. Fig. 23 — Section of ovary of cow showing a follicle ot 2 mm., w^ith ovum. The female exhibits sexual desire only for a compara- tively brief time, during the existence of a ripe ovisac or ovisacs in the ovary. The duration of the estrual period varies widely, according to species. It is shortest in the cow, ranging ordinarily between eighteen and twenty-four hours, or a trifle longer. The mare is usually in estrum for several days. The bitch is in estrum for ten to fifteen days. In healthy females, the estrual cycle is quite uniform. In the cow it is twenty to twenty-two days, usually twenty-one ; in the mare 3 to 4 weeks ; in the bitch ordinarily every six months. The frequency, intensity, and duration of estrum are profoundly modified by the state of nutrition, diseases of the genital organs, and by serious systemic diseases. Ovulation 49 3. Ovulation At about the close of estrum, in those animals where the phenomena have been studied, as in the cow, the distended ovisac ruptures and discharges the ovum. Prior to the rup- ture of the ovisac, preparation for the detachment of the ovum from the enveloping and supporting cells of the dis- cus proligerus has been made by the formation of numerous vacuoles in the mound, as shown in Fig. 24. The attachment of the ovum is rendered exceedingly frail, subject to de- tachment upon the slightest disturbance. The ovum is ap- parently maintained in situ chiefly, if not wholly, by the Corona raeliatai Zoiia. pelluciAa Hucleus Fjg. 24 — Section of ovary of cow with a nearly ripe ovum in an ovisac, 5x7 mm., showing vacuoles in the cumulus preparatory to ovulation. sustaining pressure of the follicular liquid. When the ovi- sac ruptures, the ovum, the follicular fluid, and some of the granular cells of the discus proligerus in which the ovum was embedded are discharged into the pavilion of the ovi- duct, which is at this epoch erected and closely applied to the ovary at that point where the ovisac is about to rupture. Here, if successful copulation has occurred, spermatozoa are already present, meet the ovum and a single spermatozoon fuses with each, to constitute fertilization. The precise period at which ovulation occurs, as related to estrum, has not been determined for all domestic animals. In the rabbit, which has given birth to young, copulation 50 Diseases of the Genital Organs occurs immediately following parturition. Ovulation fol- lows about twelve hours later — an interval sufficiently great for the migration of spermatozoa from the vagina to the ovary. In the cow, estrum persists ordinarily for but twelve to twenty-four hours, and ovulation occurs at about the close of this period. If copulation occurs early in estrum, better opportunity is afforded for the arrival of spermatozoa at the pavilion of the oviduct prior to the rupture of the ovisac and discharge of the ovum. In swine, carnivora, and to some degree in solipeds, the estrual period is prolonged, extending over several days. In these there are no accurate data of the epoch of ovulation. Probably ovulation occurs at a time corresponding to that observed in the cow — that is, at about the close of estrum. Fig. 25 — Diagram of ovary of cow showing comparative sizes of the follicles shown in Figs. 22, 23, 24 The number of ovisacs rupturing at a given estrual period corresponds as a rule with the maximum number of possible fetuses. It is said that rarely two ova are contained in one ovisac. I have been unable to verify this statement, and have in all cases of twins in the cow observed two corpora lutea, sometimes both in one ovary but most frequently one in each. Sometimes a single fertilized ovum divides to con- stitute two embryos, which form identical twins in man, but this is not known to occur in domestic animals, though it probably does so. In multipara, it is assumed that there are at least as many ova discharged, from as many ovisacs, as there are embryos. Ovulation 5f- Physiologically, estrum and ovulation are inhibited by pregnancy ; abnormally, they occur while the animal is preg- nant and the fetus alive and well. 4. Menstruation If a heifer or a cow fails to conceive, when estrum, copu- lation, and ovulation have occurred, or if copulation has failed, she regularly menstruates. If she conceives, she does not as a rule menstruate. Evidently the engorgement of the uterus during estrum is designed to fit the genital tract for the protection and nutrition of the fertilized ovum. Should fertilization fail, capillary hemorrhage from the placental areas follows. The volume of hemorrhage is suf- ficient that the blood is expelled through the vagina and vulva to stain the exterior vulvar region and adjacent parts. Upon the killing floor of the abattoir, heifers or cows having in their ovaries ripe ovisacs have engorged uteri with special engorgement of the placental areas. If the ripe ovisac has ruptured, and presumably fertilization has failed, the pla- cental areas are covered over with thin coagula of bright red blood. Later this is expelled, to constitute the menstrual fluid. The exact significance of menstruation is not fully determined. By my observations I have been led to the con- clusion that menstruation constitutes reliable evidence of a failure to conceive, so far as the estrum just past is con- cerned. Apparently there are exceptions to the rule. There is much controversy amongst embryologists and human obstetrists regarding the relationship between men- struation, ovulation, and conception. There is no outstand- ing estrual period in woman, and scant opportunity for the clinical study of ovulation. The cow offers the best available animal for such study. Her estrual period is sharp, clear, and brief; the ovary is conveniently palpated per rectum; the ripe ovisac is clearly recognizable by palpation ; and the crater of the recently ruptured sac is clearly palpable. The order of the phenomena is clearly and indisputably — maturation of the ovisac, estrum (with copulation, if oppor- tunity exists), ovulation, and fertilization, or, if fertilization 52 Diseases of the Genital Organs fails, menstruation. The cow is probably representative for mammalia in general. 5. The Corpus Luteum of Estrum Ovulation leaves behind a crater having the same diame- ter as the ovisac which ruptured. Into this crater, physio- logically, a small amount of blood escapes at once and quickly clots. The walls of the crater rapidly approach each other and within a few hours there remains a small, deep cavity, about one-eighth to three-sixteenths of an inch, filled with a blood clot. Ovulation has necessarily caused a lesion, com- parable in some respects to a wound, in which ordinarily the wound cavity is to a greater or less extent filled with coagu- lated blood, and like the wound in the body covering, the lesion offers an open avenue for invasion by any bacteria existing in the peritoneal cavity or within the oviduct. Such infection frequently interrupts the orderly physiologic pro- cesses and leads to a variety of pathologic lesions. Soon after the rupture of the ovisac and discharge of the ovum, there is elaborated from the walls of the crater a distinctive tissue designated the corpus luteum (yellow body) because its prevailing color in pregnant animals is yellow. The corpus luteum consists of a network of capillaries, some connective tissue, and essentially of special lutein cells emanating from the membrana granu- losa and theca interna of the ovisac. The method of growth causes the corpus luteum to repeat at first the form of the crater from the sides of which it originates. Originally it is a cup-shaped structure opening upon the surface and filled in its center by the small blood coagulum which formed in the crater of the ruptured ovisac immediately after ovu- lation. The corpus luteum pushes its way out somewhat through the rupture in the ovarian tunic and projects (in the cow) somewhat above the ovarian surface as a cylin- drical or conical mass of granulations, one-eighth to one- half inch in diameter. The cavity in the center of the cor- pus luteum of the cow is gradually eliminated by the growth of the lutein tissue and at the same time the epithelium of The Corpus Luteuni of E strum 53 the ovary draws over the naked granulating surface until at seven to ten days, the structure, if physiologic, has lost its central cavity, the blood coagulum has disappeared and the epithelium of the ovary has recovered its continuity. The corpus luteum of the cow is then five-eighths to three- quarters of an inch in diameter, usually spherical or ovoid, but subject to numerous variations, has an even contour and is firm in consistence. It is readily recognized in the cow by rectal palpation and usually easily dislodged by digi- tal compression. If the ovum discharged is not fertilized, or if the fertilized ovum perishes quickly, the corpus luteum of the cow is not yellow but with great uniformity is choco- late or liver-colored. Its size, contour, and consistence are essentially the same as in pregnancy. The volume remains virtually constant after its growth has been completed at seven to ten days until at a period of about three or four days prior to the maturation of the next ovisac, when it commences to atrophy rapidly, and when about one-fourth inch in diameter, a new ovisac ripens, generally in the oppo- site ovary, the animal is again in estrum and ovulates. The old yellow body has permanently ceased, so far as known, to exert any influence upon the reproductive processes. It continues to atrophy slowly. There are frequently visible in a single section in the ovary of the cow, three to five old corpora lutea, one-eighth inch or less in diameter, with white strands of connective tissue scattered amongst the nests of lemon or orange-colored lutein cells. 6. Copulation The male ordinarily exhibits little or no sexual desire ex- cept in the presence of a female in estrum, but the testes function constantly. The sexual desire may be activated at any time when a female in estrum approaches sufficiently near to be recognized, and copulation occurs when opportu- nity offers. During the act of copulation, the semen from the male is ejaculated into the vagina of the female, possibly in part into the cervical canal. The semen has as its essential con- ,54 Diseases of the Genital Organs stituent the spermatozoa, or sperm cells, elaborated by the testicles. Prior to copulation the spermatozoa lie chiefly in the epididymis and vas deferens, being exceedingly concen- trated in these tubules. At the moment of ejaculation, there is thrown into the pelvic urethra the liquid secretions from the vesiculae seminales, prostate and Cowper's glands which serve to dilute greatly the very dense mass of sper- matozoa and facilitate the forcible ejaculation of the semen. Chief amongst these glands in the bull, are the seminal vesi- cles. If these are removed, or are so diseased that their function is impaired or in abeyance, the bull copulates with difficulty apparently owing to the absence of the diluent fluid from these structures. Some think that most or all of the semen is ejaculated directly through the cervical canal into the body of the uterus and that the urethral opening of the male comes in direct contact with or enters the os uteri. Harms, quoting Duranton (Journal de Lyon, 1888), cites a case of alleged rupture in the uterine cornu of a cow during copulation, owing to the entrance of the penis of the bull through the cervical canal, but this must have been an error in clinical history. A study of the cervical canal of the cow, as delineated in figures 15, 16, 17, suffices to refute any alle- gation of the entrance of the penis into it. It is an anatomi- cal impossibility. In the mare, with a far more dilatable cervical canal, copulatory injuries from an unusually long penis occur in the vagina — not in the uterus. Male animals, after the amputation of a considerable portion of the penis, are quite as fertile as before, although the stump of the or- gan can not reach the os uteri. Clinically, a large part of the semen is ejected from the vulva of the female immediately after copulation, and quantities of semen are readily ob- tained from the vagina at this time. The condition essential to fecundation, so far as the male is concerned, is that physiologically perfect spermatozoa shall gain the cervical canal, traverse the uterus and ovi- ducts, and meet the ovum in the pavilion of the oviduct. Of the countless myriads of sperm cells in one discharge of semen, but one can take part in the fertilization of the ovum. The migration of the spermatozoa from the vagina to the Fertilizatio7i 55 pavilion of the oviduct involves a period of brief duration, probably varying in different species. Marshall estimates that in the rabbit, the' migration of the spermatozoa requires but fifteen minutes to two hours. Copulation occurs eight or more hours prior to ovulation so that the spermatozoa ordinarily arrive at the pavilion of the tube six or more hours prior to ovulation and lie in v^^ait preparatory to im- mediate fertilization. According to clinical observations in cows, ovulation occurs at approximately eight to twelve hours after the cessation of estrum. Ovulation is apparently hastened (and estrum abbreviated) by copulation. The in- fluence of copulation upon ovulation in higher animals ap- pears somewhat analogous to insemination in the frog, where the sexual embrace of the male apparently favors the ovulation. It appears from available data that the sper- matozoa of the bull traverse the twenty to twenty-five or more inches of the genital tube (cervix, uterus, and ovi- ducts) in two or three hours and are present in the pavilion of the oviduct some time prior to ovulation. In this manner the single ovum meets at once many spermatozoa so that its prompt fertilization is luxuriantly provided for. 9. Fertilization Fertilization, fecundation, or conception follows when a healthy female copulates naturally with a healthy male. Since copulation, in those animals in which the sequence is known, precedes ovulation, spermatozoa have already mi- grated through the genital tube and have reached the pa- vilion of the oviduct, where they await the discharge of the ovum. One spermatozoon penetrates each ^%% and traverses the zona radiata to the nucleus. The nucleus of the sper- matozoon fuses with that of the ovum. A beginning has been made for the development of a new individual. The animal has conceived. 10. The Migration of the Fertilized Ovum After the ovum has been fertilized in the pavilion of the oviduct, it must traverse the length of the tube, reach a 56 Diseases of the Genital Organs suitable location in the uterus, and become implanted there before it can advantageously receive ample nutriment for needed growth and development. The migration through the oviduct must occur with sufficient celerity that the ovum shall enter the uterine cavity prior to any noteworthy growth in volume for the reason that the lumen of the tube is so small that important increase in the size of the %%% would imperil its passage. It is probably owing to patho- logic decrease in its lumen that the ovum occasionally lodges in the oviduct of woman (tubal pregnancy), de- stroying the life of the embryo and greatly imperilling the life of the mother. The migration of the ovum, unlike that of the spermatozoa, is passive and is brought about by the action of the cilia of the tubal epithelium which wave toward the uterus, and probably by muscular action in the walls of the oviduct. The time required in domestic animals is not known but in the cow it is probably eight to fifteen days. 11. The Corpus Luteum of Pregnancy The formation of the corpus luteum of pregnancy is fun- damentally like that of estrum as described above. Its source of origin, its method of growth and its ultimate vol- ume is the same. It presents two notable characters which serve to distinguish it. The color of the corpus luteum of pregnancy in the cow is regularly of a bright lemon color, in contrast with the chestnut or muscle-colored structure of estrum. The color distinction is not universally present. Amongst approxi- mately 2000 pregnant cows and heifers, I have observed two corpora nigra, or black bodies, one normal in size, the other about double the normal volume. The rule of chestnut color for the corpus luteum of estrum and lemon or orange color for the corpus luteum of pregnancy appears at times to be reversed. Some have claimed that the corpus luteum of estrum is often lemon or orange-colored but I believe most of these reports are referable to error. That is, observers not familiar with their ground see in the abattoir an empty The Corptis Luteum of Pregnancy 57 a W) o s His " f3 M o <« ^ © t/l U5 ^•? ^, f^ b o 53 - Diseases of the Genital OrganT uterus and an orange-colored corpus luteum and consider the structure that of estrum. But there has been pregnancy and the corpus luteum has not yet disappeared. The duration, or life, of the corpus luteum of pregnancy presents a strong contrast in most domestic animals to the corpus luteum of estrum. The corpus luteum of pregnancy has as its minimum physiologic life the duration of preg- nancy. The simplest cycle in ovulation, pregnancy, and atrophy of the corpus luteum is in the rabbit where the dura- tion of the corpus luteum and of pregnancy are identical. The doe conceives, the corpus luteum forms, in four weeks she gives birth to young, the corpora lutea have atrophied, new ovisacs have matured and immediately after parturi- tion she copulates with the male and conceives. In the cow, the corpus luteum forms promptly after con- ception, attains its growth in seven to ten days and physio- logically remains static until thirty to ninety days post par- tum, or for a period of ten to twelve calendar months. Pathologically (retained corpus luteum, pyometra, macer- ated or desiccated fetus, etc.), the corpus luteum of preg- nancy may remain static indefinitely and inhibit estrum and ovulation. In the mare it appears that the corpus luteum of pregnancy atrophies promptly after parturition so that she is ordinarily in estrum at seven to nine days post par- tum, thus giving it a physiologic duration of about three hundred fifty-five days. In those animals which have short periods of pregnancy and are normally in estrum semi-an- nually, like the bitch, the corpus luteum appears to persist for a comparatively long period after parturition or estrum. 12. The Fetal Membranes After fertilization has occurred, the ovum passes through the oviduct, propelled largely by the cilia of the tubal epi- thelium, and soon reaches the uterine cavity. During its tubal migration, the ovum has undergone segmentation. The stored food material in the ovum is insignificant, so that it must be dependent upon the uterus for any nutrient material for the maintenance of life and development. The nutrition of the ovum, embryo, and fetus is throughout in- The Fetal Membranes 59 <& u to o o -a pi H u •1-1 a o •iH o O a o pT o O Cm O 03 P^ a o 'H o O be o QQ 6o Diseases of the Genital Orgayis direct: that is, when the ovum is discharged from the ovi- sac, its direct connection with the tissues of the mother is finally and permanently severed. The fertilized ovum at first lies free upon the uterine mucosa while nutrient fluids poured out by the endometrium are absorbed by the ovum to provide for its development. Thus far, the life of the Fig. 28— Fetal Cotyledon of Cow showing' primary and adventitious Placentae. Photograph. ovum has been supremely precarious, relying wholly upon a delicately balanced physiologic state of the oviduct and uterus and their contents. It has no known inherited power to resist the attacks of any bacteria contained within the tubo-uterine cavity and has no known power to maintain a given location. Clinical observation leads readily to the be- lief that the mortality of the fertilized ova during this period The Fetal Membranes 6i is the greatest occurring at any epoch in life. The death is unseen, and is necessarily designated sterility. The newly created individual needs greater fixidity in its place, more accurate protection against invasion, and especially a safe and abundant food supply. While the ovum lies free in the uterine cavity, any liquid nutriment available is in constant danger of being contaminated by any bacteria or other dele- terious substances present in the uterus. Such toxic sub- FiG. 29 — Maternal (bottoiiO and Fetal (top) Cotyledons of Cow partly detached. A portion of the uterine wall seen at bottom and of choriom at top. stances constitute a menace by threatening to invade the new individual mixed with nutritive substances, through a common portal, the external layer of the morula. The nu- trition needs to be more dependable, abundant, and imme- diate, and guarded as far as possible against contamination from every source. The uterine seal hermetically closes the cervical canal to direct invasion from the vagina. Since the ovarian end of the genital tube, though opening into the 62 Diseases or the Genital Organs peritoneal cavity, is very narrow and the peritoneal cavity is assumed to be physiologically sterile, the embryo lying in the genital tube between the tubal and cervical openings, once the uterine seal is physiologically formed, enjoys a high degree of safety in these directions. Two vital dangers Fig. 30 — Same as Fig. 29, showing- a different type of Placental Crypts with thickened, fibrous partitions possibly due to prior disease. remain. There is constant peril to the embryo from bacte- ria, already old habitants of the utero-cervical cavity, and there is a further threat of unknown potentiality from micro-organisms floating in the blood of the mother, which may invade the uterus from the blood stream. These dan- The Fetal Membranes 63 gers are obviated in part by the formation of the placenta. The placenta consists of two complementary parts — one due to a special development of the whole or certain areas of the uterine mucosa, or endometrium, of the mother, and the other to an analogous development from the chorion of the fetus. The embryo or embryos early become arrested and detained for the rest of intra-uterine life in a definite and comparatively fixed location. In unipara the rule is Fig. 31 — Chorionic Placenta of Ewe. The right hand figure includes a portion of the Chorion. that the embryo becomes located partly within the cavity of the uterine body, with the remainder of its body lying in that horn of the uterus from the corresponding ovary of which the ovum was derived. Pathologically, the fetus of a soliped, instead of growing into the uterine body, may ex- tend across the ovarian end of the uterine body cavity into the opposite horn, to constitute bicornual pregnancy. In multipara the embryos become halted at approximately 64 Diseases of the Genital Organs equidistant points in the cornu corresponding to the ovary from which the ova emanated. If but one embryo is pres- ent in a horn, it is ordinarily near its base, and very rarely may become, as in the mare, bicornual. When near full term, the fetuses may be very irregularly located, owing to the fact that one or several of them has perished and later has been absorbed. Fig. 32 — Left. Uterine Cotyledon of Ewe, from which Fetal Cotyledon has been removed, leaving a cavit}'. Right. Median section of Maternal and Fetal Cotyledon of Ewe, with portion of Chorion attached. At the point where a fertilized ovum becomes located within the uterus, the adjacent uterine walls promptly as- sume increased functional activity, become increased in thickness, and show heightened vascularity. The vital changes occur in the endometrium, and particularly in the placental areas. In ruminants with multiple cotyledonal placentae, the placental areas are already visible in the uterus of the female fetus as definite elevations in the uterine mucosa. When the existing placental areas or caruncles of The Fetal Membranes 65 the ruminant have been destroyed by disease, the former non-placental areas develop adventitious placental struc- tures, but in such cases want their multiple cotyledonal character and take on the simpler structure of a diffuse placenta. As soon as the embryo begins to form, its enveloping membranes commence to develop, first the amnion, followed closely by the allantois. The external allantoic wall fuses with the external amniotic layer (false amnnion) to con- FiG. 33^Fetal and Maternal Placenta of Cow. The chorionic or fetal placental tufts are shown above and to the left, projecting downward, and to the right, into the placental crypts of the uterus. X310 (Pomayer). stitute the chorion. In all domestic animals the amnion and allantois each constitutes a sac containing considerable vol- umes of amniotic and allantoic fliuids respectively. In uni- para, the allantoic sac normally pushes out to the apices of both uterine horns and to the os uteri internum, thus ac- quiring contact with the uterine mucosa throughout. In ruminants and swine, however, the tips of the allantoic sac early become necrotic in varying degree, as shown in Figs. 35 and 36. The necrotic portion retracts at times from the apex of the cornual cavity, leaving the lumen filled with pus and debris. In extreme cases, the entire non-gravid horn of the allantois of the cow becomes necrotic as shown in Plate 66 Diseases of the Genital Organs III. Sometimes, also, as shown in Plate II, the chorion be- comes necrotic where it passes across the os uteri internum. The common, small necrotic tips, shown in Figs. 35 and 36, are designated as "normal" by embryologists but these pass by imperceptible gradations into the degree of necrosis shown in Plate III which is clearly and grossly pathologic. The allantoic sac, fully distended with fluid, fills the uterine cavity in such a manner that violent movements of the mother cannot readily cause any material displacement be- tween the uterine wall and the chorion, but both are moved Fig. 34. Same as Fig. 33. x 900. (Pomayer). as a unit, obviating largely any dragging upon the placenta which might threaten to cause injury thereto. The fetus floats within the amniotic fluid and the amniotic sac, in turn, floats within the allantoic fluid. In solipeds, swine and carnivora, the amniotic sac floats freely within the allantoic fluid, except for the allantoic segment of the um- bilic cord ; in ruminants, the dorsum of the amniotic sac is intimately fused with the chorion, obliterating the allantoic cavity in this area. The fetuses of solipeds, swine, and carnivora may be expelled from the uterus through a rent in the chorion, with the more or less intact amnion envel- oping them, but in ruminants the adhesion of the amnion Plate II Fetal Sac of Cow at Abolt ioo Days A. Amnion. Al. Allantois. 1. Necrotic tip of non-gravid horn. 2. Necrotic isthmus between gravid and non-gravid horn. n-grav Necrot ntagioi with tl o g .8 - H o o 2 o ^' . u .s CQ 'iJll < o g ^ rt o O X (/I 6 ^ %^ o ■H Q > C « . o > I- cj C o S <; bfl ^ C oi J. "-^ O S3 o O c o t: u O XI -C 1 2 C 4J *-• b O O rt *-i o Ui X a»-^ fe- rt < Z £ aj ° t; bJ 3 -^ u oj ^ u u^ fe-S O < ■^ > ^jl c r 1 Q cl"^ S'c t-J o b. >< cP _ '^ _c o w l> t- rt "2 c^ • I, O _Q D C OJ _C ^ c^ XI rt 2 2 rt u i- D 1- '-4- c o o > ^- 3 5 < ^S g ^' "rt O -c (u '-?; - _ ,1J ■ ^ *-' r" ^ I- O O rt The Fetal Membranes 67 to the allantois detains the former within the chorion, leav- ing it an essential part of the afterbirth which may only escape with the chorion. The ruminant is, therefore, born naked. Fig. 35 — Necrotic Tips of Fetal Sac, Cow. /, /, /, Living allantois ; 2, 2, 2, necrotic tips ; j, chorionic placenta. The fetal placental structures, originating as outgrowths from the allantois-chorion, consist fundamentally of branch- ing, arborescent capillary tufts continuous with the great vascular network of the allantois. Regardless of placental 68 Diseases of the Genital Organs type, the fundamental structure is essentially the same in all species. In the cotyledonal placentae of ruminants, the tufts, longer and far more elaborately branched, sink cor- respondingly deeply into the placental crypts of the endo- metrium. The chorionic tufts have in detail their counter- part in the crypts into which they project. The ultimate Fig. 36 — Necrotic Tips of Fetal Sacs, Swine, /, /a, Necrotic embrj^os in totally necrosed fetal sacs ; 2, 2, normal embryos within amnion, the allantois having been opened ; 4, necrotic tip of allantois. chorionic tufts consist of capillary walls with a single epi- thelial layer, while the corresponding maternal crypt con- sists also of capillary loops with a single, delicate, epithelial layer. The fetal and maternal capillaries remain perma- nently separate and the two delicate epithelial layers perma- nently separate the maternal from the fetal blood. All nu- triment and waste products exchanged between the mother and the fetus must pass through these two epithelial bar- riers, which together constitute the placental filter. Through 4- C c.£ -W 4^ ! V. ■/■ - m^^£ i c jz •' c :/; <■ i c c £ 5xj 1 U 4- ■^ i b. c c 1 o > c '-^ 1 f- 'Z "-*- 7 u o c 1 h > / < < "5 -2 C U X « y. o '5 5 ijJ s E >< ^ c J2 -'-• o ai < ' z C Ah >■ o X U ch ^ 1— 1 I c . ■^ w oo C Tl- < sT L. J a K^ cu c O u >--. C- Q '-' o < ^ 75 t^ " ^ & Ci 5:; O *z c U c c! i^ O 5 c 5 _ Z < ^ rt B^ _3 y. c '^l" U C *c) u ^ ; z ^^ rt -3 i 5 ] ^ The Fetal Membranes 69 this filter, so long as it is healthy, no solids or other visible substances ordinarily pass. Bacteria are not known to pass this filter while it is healthy. Researches show further that rarely or never do the hypothetical antibodies pass this filter, so that a mother may be highly infected with a given bacterium and her blood react strongly by agglutination or complement-fixation to such organism, but the blood of her new-born fails to react. The contact between the fetal and the maternal epithelium is so intimate, that no infection nor foreign substance may readily exist between them. Hence in the placental area, so long as the structures are healthy, so far as known, infection can not pass from the mother to the fetus through the placental filter, nor can infection in- vade the fetus from the uterine cavity by passing between the two fetal structures, and thence gain the fetal cir- culation, without having first attacked and severely dam- aged the placental structures themselves. The Utero-Chorionic Space. There is, however, a more vulnerable area through which bacterial invasion of the embryonic sac may occur. There are about one hundred functioning cotyledons in the healthy gravid uterus of the cow. Each of these cotyledons, in the slaughtered animal (they are doubtless much thicker in the living animal while they are distended with blood) is one to one and one-half inches in its perpendicular diameter while the peduncle of the cotyledon measures an inch or more, thus tending to push the chorion away from the non-placental endometrium for a distance of two inches. The one hundred cotyledons with their stalks serve as a great colonnade producing a vast space between the non-placental areas of the uterus and chorion, designated the utero-chorionic space. At full term of pregnancy, the uterine mucosa offers an area of approxi- mately fifteen square feet. In this space, as in the non- gravid uterus, bacteria commonly exist and need only to in- vade successfully the thin non-placental chorion and adher- ent amnion to gain the amniotic cavity and fluid. With the fluid, the fetus swallows any bacteria present. But the bac- teria have other interesting portals of entry, the importance 70 Diseases of the Genital Organs of which is not at present known. At the apex of each cornu, the tip of the chorion is necrotic and is commonly sur- rounded by exudate or pus. It would appear that such an area would offer but little resistance to invasion and once the bacteria have reached the allantoic fluid, the very thin amnion offers scant barrier. Placental Hemorrhage. At the cervical end of the uterus there also exist conditions which apparently favor invasion of the fetal sac. Nearly always placental hemor- rhages exist at the os uteri internum and some of the cotyle- dons have separated. In this manner the placental areas, denuded of protective epithelium, and with important vol- umes of blood resting upon their surfaces, offer an inviting field for invasion. Uterine Sand. Such placental hemorrhages must be of very frequent occurrence. It would be supposed that such hemorrhage would be resorbed in a few days so that the regular meeting with them would seem to indicate that they occur almost constantly. The frequency of these is further suggested by the existence in the utero-chorionic space in essentially all cows in advanced pregnancy, of bodies I have designated uterine sand. These are free, spherical bodies generally about one-sixteenth inch, translucent and amber- colored. They are very hard, are insoluble in water and alcohol. They vary greatly in numbers and volume. By de- taching the fetal membranes from the uterus, washing both surfaces in a vessel of water, and then decanting it off, there remains behind a mass of uterine sand varying from half a dram to one ounce, feeling much like sand when grasped between the fingers. Its exact character and origin are unknown but it appears most probably due to disinte- gration of red blood cells, and if so, indicates frequent and important placental hemorrhages. In ruminants, therefore, with the immense utero-chori- onic space, the inter-cotyledonal area of the chorion offers the avenue of least resistance to the invasion of the fetus. In the soliped, where no non-placental area exists, any vul- nerable field must be created by the invasion of the placental The Fetal Membranes 71 structures. After such infection has destroyed the placental power of resistance, it is free to invade the fetus. The development of the placentae is a cumulative process from the time of the formation of the fetal envelopes until the pregnancy terminates. It has been stated that as par- turition approaches, the placenta undergoes fatty degenera- tion in preparation for dehiscence. That is untrue. The embryonic sac at first lies free in the uterine or cornual cavity without visible placental structures. Gradually the placental structures become macroscopically apparent but the embryonic sac can still be lifted out of the opened uterus without resistance. Gradually the chorionic tufts lengthen, become more branched, and sink deeper and deeper into the maternal crypts. In the abattoir, it becomes necessary, in separating the placenta, to use gradually increasing care and force as the duration of pregnancy advances. Early in pregnancy the chorionic tufts of the cow appear very much the same as the short, simple structures of the soliped, but they gradually become more complex as the close of preg- nancy nears. This is essential to fetal development, which gathers in force and rapidity from the time of fertilization up to the end of pregnancy. The force which maintains the contact between the fetal and the maternal placenta is not readily defined. It might be termed physiologic magnetism. This force continues so long as the fetus lives and the umbilic cord is intact. When birth occurs and the navel cord ruptures, the magnetism ceases. The blood in the fetal placental capillaries escapes through the broken umbilic veins. The capillaries in the chorionic tufts collapse, automatically fall away from the crypt walls and drop out. Thus, in preparing histologic sections of healthy placental structures one does not see the chorionic tufts lying in contact with the crypt walls, but quite detached therefrom, with the fetal and maternal epi- thelial layers widely separated, as shown in Figs. 33, 34. If, however, disease has invaded the placental tissues, the picture promptly changes ; the damaged fetal and maternal epithelia or their debris lie in contact, and placentitis with 72 Diseases of the Genital Organs retained or adherent placenta is present. The tendency to retention of the fetal membranes, when placentitis is pres- ent, logically increases as the size and complexity of the chorionic tufts advance. Thus retention of the fetal mem- branes is commonest and most severe in the cow, and in- creases in severity with the advancement in pregnancy. It rarely occurs during the first four months of pregnancy, but becomes increasingly common as the duration of pregnancy increases. The simple, short, chorionic tufts of solipeds tend to obviate retention of fetal membranes. Chapter II THE CLINICAL EXAMINATION OF THE GENITAL ORGANS A. The Clinical Examination of the Male Genital Organs The clinical examination of the genital organs of the stal- lion and the bull is, as a rule, best made with the animal in the standing position after necessary measures have been taken for the safety of the examiner. Most stallions stand well but exceptions are sufficiently numerous to dictate that the animal be securely confined. A few are safe when care- fully held by bridle or halter ; some are controlled by the ap- plication of the twitch or by holding up a fore foot; some are safe only when side lines or breeding hobbles are applied. Even with these the examiner must be on his guard. The side line interferes with examination from that side. If the examination is made from behind, the animal may forcibly lift his hind foot and give the examiner a bad blow with the summit of the os calcis. The stocks make an ideal method for confining, safe alike for examiner and patient. Very refractory animals may need to be cast or placed upon the operating table. The bull is to be confined preferably in the stanchion, re- sorting to the use of the leading or nose ring in lieu of the twitch. Sufficient precautions should be taken against crowding and trampling upon the examiner. Kicking with one foot may be conveniently prevented by securing a rope upon one metatarsus, carrying it once around the other meta- tarsus, and having a man hold the free end. The animal can be promptly released if he falls. When the animal is properly secured, the testicles of both stallion and bull are best examined from behind because both glands can be viewed simultaneously or palpated from the same point. The smaller ruminants are readily ex- amined standing; carnivora need to be securely controlled against scratching or biting. 74 Diseases of the Genital Organs 1. The Testicles The testicles are to be examined with reference to loca- tion, position, volume, consistence, clearness of outline, and evidences of heat, pain, and swelling. It is a well established clinical principle that, in order to be fertile, there must be one testicle in the scrotum. It is desirable that both glands be in the scrotum because when one is retained, owing to arrest in development, the progeny are liable to inherit the defect. The testicles of the foal and the calf should be in the scrotum at birth. The position of the testicle apparently matters but little; at least occasion- ally the testicle of the stallion is observed to be rotated on its transverse axis so that the tail of the epididymis presents forward, without apparent detriment. In one bull, the tail of the testicle was caught well up in the posterior part of the scrotal sac and the large end of the gland tipped forward to come to rest in the position of the stallion testicle. In volume, the two testicles of the horse are rarely alike. Usually the right gland is clearly the larger. In ruminants the two glands are more nearly alike. The size varies with the size of the animal, the breed, the age, and the individual. It is only when the glands depart widely from the average volume that their size becomes significant. Even then the size needs to be considered with the consistence. They be- come enlarged in orchitis, abscessation, etc. When arrest in development has occurred, they are usually abnormally small. The consistence of the testicle is highly important. Phys- iologically the gland is very firm and tense and its contour is clear and definite. The testicle may, from inflammation, become hard and unyielding, or in advanced abscessation, soft and fluctuating. In arrest in development the testicle is generally small and flaccid. This is commonly so in the ab- dominal testicle but is observed also in arrest in development of scrotal testicles. Such testes do not form spermotozoa but do (cemmonly, at least) induce sex reflex. If a healthy male of similar age and size is available for comparison, the examination may thus be rendered more accurate. The Epididymis 75 2. The Epididymis The epididymis and scrotal section of the vas deferens are also palpable. The commonest point for the lodgment of chronic infections is in the tail of the epididymis which should be examined accordingly with special care. In the stallion, bull, and perhaps other males, there is a tendency towards the obliteration of the peritoneal sac of the scrotum due to adhesions between the parietal and vis- ceral layers of peritoneum. This lessens or destroys the mo- bility of the gland within its peritoneal sac but the very loose areolar fascia between the cremaster and the dartos and skin leave the testicle, with the adherent parietal peritoneum and the closely applied cremaster, movable within the dartos. The adhesions between the two peritoneal layers are not very readily diagnosed and accordingly careful search should be made. The size of the penis is not generally of clinical import- ance, but it is occasionally so large in the stallion that it im- perils the vagina of the mare. This can be best determined by bringing a mare into the presence of the stallion and causing complete erection, when the examiner can make a reasonable estimate of the safety or danger when mated with a mare of a certain size. In some cases urethral hemor- rhage follows coitus so that it is essential to cause the ani- mal to copulate in order to render the examination effective. An examination of the relaxed penis of the horse may be made by passing the hand up through the sheath into the prepuce and grasping the glans firmly behind the corona. By exerting moderate traction, sometimes for several min- utes, the retractor muscle becomes fatigued and the penis can be completely exposed and examined. If the organ is moist and not readily grasped with the hand, the hold may be rendered secure by wrapping the penis in a dry towel or a piece of gauze. The S-curved penis of ruminants cannot ordinarily be ex- amined satisfactorily while the patient is standing. Copula- tion is virtually instantaneous so that only a hurried glance can be had at such times. The sheath is so narrow that the 76 Diseases of the Ge?iiial Org-ans glans cannot be reached and grasped with the hand. The animal is to be confined in lateral recumbency, with the an- terior limbs extended forward and the posterior limbs, back- ward, thus completely exposing the ventral surface of the body and giving the operator free and safe access to the parts. The bull is best extended by placing him between two strong posts or other solid points for attachment and stretching the limbs by means of two stout ropes, one ex- tending from the hind, and the other from the fore feet to the corresponding posts. The penis is then to be exposed by eliminating the S-curve and pushing the sheath backward. The elimination of the sigmoid flexure is accomplished by grasping the distal curve at the point of insertion of the re- tractor muscle and, pushing firmly upward and forward, fatigue the muscle until it finally yields and the glans penis moves forward. The tissues about the sheath opening are then to be pressed backward toward the scrotum, thus short- ening the sheath ; the two movements combined serve to ex- pose the glans. A piece of dry gauze wrapped about the glans enables the operator to grasp it firmly, and by the ex- ertion of moderate and prudent traction the retractor muscle may be kept in a state of fatigue and the penis fully exposed. It can then be examined leisurely and carefully. The com- plete exposure of the penis also exposes fully the mucosa of the prepuce and sheath which, as shown in Fig. 9, now con- stitutes the covering of the body of the penis from the glans backward. 3. The Seminal Vesicles, Prostate, and Cowper's Glands The abdominal vas deferens, the vesicula seminalis, and the prostate gland may be palpated per rectum in the stal- lion and the bull. The prostate may be palpated digitally per anum in the dog. In the stallion and the bull the vas deferens may be palpated as it emerges from the internal inguinal ring and passes upward, forward, and inward to reach the superior surface of the neck of the urinary blad- der, where it passes backward to disappear beneath the cor- responding vesicula seminalis. The Semen and Spermatozoa 77 4. The Semen and Spermatozoa The satisfactory examination of the male genitalia ordi- narily involves an examination of the semen. This is best accomplished by causing the male to copulate with a female and removing immediately some of the semen from the vagina. This may be conveniently attained by introducing a sterile swab, like that used in diphtheria, deeply into the vagina. Then withdraw the swab and from it make a smear on an ordinary slide, apply a cover glass and examine under moderate magnification. If the examination is made in a warm room and the preparation is kept moist by adding a few drops of physiologic salt solution, healthy spermatozoa continue to move vigorously during a period ample for study of the living cells. If the semen is kept warm and moist, it may be carried some distance and examined after several hours. It is best, however, to examine the semen as to mo- tility soon after ejaculation. The quantity of semen ejaculated is likewise of funda- mental importance in judging the fertility of a sire. While technically but one spermatozoon is necessary for the fer- tilization of an Q%%, there are physiologically many millions of spermatozoa for each ovum. The luxurious numbers serve as a safeguard against their total destruction during the hurried migration from the vagina to the ovary. Not only is it important that great numbers of spermatozoa shall be present in order to make it certain that at least one vigor- ous cell will reach the ovum, but great numbers constitute, under certain limitations, an indication of sexual health and vigor. The amount of semen needs to be determined by some form of approximate measurement. In horses and cattle the vagina of the female may be well washed out with sterile salt solution or with a 0.25% chlorazene solution which dis- solves the vaginal mucus, followed by the salt solution, and by inserting the well disinfected hand, the animal may be caused to eject all fluid or it may be ladled out with the hand. If the male is then caused to copulate with her, the contents of her vagina may be at once ladled out of the yS Diseases of the Genital Organs vagina, measured, and a fair approximation of the volume of semen ejaculated obtained. If the vagina has not been cleaned out immediately prior to coitus, no accurate idea can be had of the volume of the semen because there may be several ounces of thin mucus or other fluid lying in the vagina. Studied under this plan, the bull ejaculates as a rule 6 to 8 mils of semen at a copulation. The semen con- sists largely of the secretions from the seminal vesicles and prostate gland in which the spermatozoa swim freely. If the spermatozoa are dead immediately after ejaculation, that is conclusive evidence of sterility but does not reveal the cause of the sperm death. Living spermatozoa, how- ever abundant, do not afford final proof of fertility. Sperm- atozoa may be suffering from disease and their elements undergoing disintegration and death. Or there may be bacteria ejaculated in the semen capable of causing the death of most or all spermatozoa. It is accordingly essential to accurate diagnosis that the spermatozoa shall be so pre- pared by staining and otherwise that their structural de- tails may be carefully and effectively studied. The various parts need to be rendered clear so that any commencing de- generation may be detected. The degeneration of the spermatozoa and their capacity to fertilize is not the end of the question. There is striking clinical evidence that stallions, apparently in good general health, transmit venereally to mares the infection of epizoo- tic cellulitis or "pink eye" and at the same time prohibit fer- tilization. Some sterile bulls apparently render sterile the females which they have unsuccessfully served. It is important that the copulatory act be closely observed so as to determine whether it is normal — that there is the normal sexual desire and ejaculation, followed by normal relaxation. Any hesitancy in copulation should be carefully noted and its cause determined if possible. Imperfect coitus may arise from physical difficulty in mounting the female due to painful diseases of the hind feet or limbs, or to paral- ysis. The difficulty may be due to mechanical interferenceo with the protrusion of the penis. In other instances there is The Semcyi and Spermatozoa 79 such pain in protruding the penis or in ejaculating semen, that the animal fails to copulate properly. The examiner must reach a proper diagnosis regarding the group of causes under which a given case falls and search in detail for a defi- nite solution of the problem. B. The Clinical Examination of the Female Genital Organs The clinical examination of the genital organs of the mare and the cow reveals to the veterinarian data of great eco- nomic and scientific interest. The freedom with which the veterinarian may palpate the entire genital system per rec- tum in these animals gives to him a marked advantage over his confrere in human medicine in the examination of woman. In the small ruminants, with a rectum too small to admit the operator's hand and a tense abdominal tunic which well-nigh shuts out abdominal taxis, the veterinarian is placed at a serious disadvantage. The same holds true of the sow, with the thick skin and dense, abundant, subcu- taneous fat. The bitch and cat, with thin flaccid abdominal walls, offer a moderate opportunity for palpation of the genital organs, but far inferior to that enjoyed in the mare and cow. By means of clinical examination of the genitalia, espec- ially of the cow and the mare, the veterinarian is enabled to diagnose estrum, ovulation, pregnancy, and innumerable genital diseases. Most mares and cows will stand quietly for both rectal and vaginal examination, but the prudent veterinarian will take no unnecessary risks. The danger, usually greatest at the commencement of the examination, is far greater in the mare than in the cow. The chief danger is, of course, from kicks. The greatest resistance is generally offered when the hand is introduced through the vulva. As a rule of prac- tice, in examining the mare, one assistant should hold the head securely and well elevated, another should hold up one fore foot, and a third hold the tail out of the examiner's 8o Diseases of the Genital Organs way. Should the mare be restless, a twitch should be ap- plied, and upon the least show of viciousness, breeding hob- bles should be used and drawn up tight. Even then, the veterinarian should have care that she does not give him a blow with one or both os calces. The operator should look carefully to having abundant room, especially that the mare may not crowd him against a wall, and also that, when his arm is in the rectum, she shall not be able to move violently to the right or left and, by pressing her buttocks close to a post, crush his arm. The cow does not often kick during rectal or vaginal ex- aminations, but I know to my cost that exceptionally she kicks fiendishly and very dangerously. Next to the worst kick in my career was from a cow while I was attempting to examine her genital organs. Usually the cow can be con- trolled by a strong stableman grasping her muzzle firmly, or still better by applying a leading ring or pincers to her muzzle and pulling firmly. However, a few vicious cows need to be shackled by tying a rope or strap about one meta- tarsus, giving it a turn about the other, and then having a strong, alert man hold the end of the rope firmly, ready in event of a fall to release her. I have encountered a number of heifers which were exceedingly resistant to the instru- mental examination of the cervico-uterine cavity, and have found it necessary to lay them down and secure them. It is inadvisable to waste time on these obstinate patients, be- cause the longer one works the more resistant they become. Finally they exhaust the operator and then, if ever, he is liable under fatigue to injure the patient seriously. There- fore it is best, when the animal cannot be controlled in a manner to render both patient and operator safe and to avoid fatigue, that the animal be secured in lateral recum- bency. She may be cast in a variety of ways, but for con- venience of securing for the operation, the best method is that of stretching her between two posts. The head should be tied securely to one, with a second post or other fixed point for securing a rope about twenty feet or more behind her. A stout rope is then tied in a running noose about one Exayyiination of Female Genital Organs 8i metatarsus, and a half hitch taken about the other. Two or three strong men may then draw regularly and firmly upon the rope, gradually stretching the animal until she finally falls upon her side. The process is rendered easier by apply- ing a second rope to the anterior feet and having a man stretch these forward, but the cow may then fall harder and should be guarded against injury by an ample bed. The ropes drawing upon the metatarsi or metacarpi may cause pressure injuries unless the precaution is taken to pad the parts beneath the rope, which is conveniently done usually by wrapping the part with a grain sack before applying the rope. Finally the rope on the hind feet is to be secured to the rear post and that on the fore feet to the front post. The operator may now proceed deliberately, conveniently, and safely with his examination. The examination of the recum- bent heifer thus secured is easier and safer. In the well- behaved heifer the advantage of securing in lateral recum- bency is more than counterbalanced by the time and labor of securing and the peril of casting injuries. I have found it necessary to secure a heifer in lateral recumbency three or four times in succession for examination or treatment, until finally she yields and stands without resistance. The preparation of a special stall or stanchion into which all cows in an establishment may be led for examination is a great convenience. In some herds a sort of movable stocks, somewhat like a shipping crate, is prepared, which can be placed anywhere according to light or other convenience, or moved from one stable to another. The ready introduction of the hand into the vulva or rec- tum requires some form of lubrication. As a rule, the best is a warm salt solution of approximately 0.7 to 1 per cent. Many veterinarians resort to soap as a lubricant, but this is undesirable because even very weak soapsuds almost inevi- tably irritates both the rectal and the vaginal mucosa and causes tenesmus — the worst foe with which the examiner must contend. The addition of antiseptics to the water is much worse than the use of soap. No antiseptic can be used of such strength as to produce even very feeble disinfection 82 Diseases of the Genital Organs without causing much irritation and straining. The opera- tor may use antiseptics on his hands and arms to cleanse them, and may use moderately strong antiseptic solutions, if desired, about the exterior of the anus and vulva, but these should not, as a rule, be carried on the hand, even in small amount, into the rectum or vagina. Oils and fats make good lubricants, but when used they interfere very seriously with the sense of touch in the vagina, especially when one wishes to palpate for the uterine seal or to deter- mine the character of the mucus within the vagina. Some- times, however, lubrication of the hand with oil or fat is virtually necessary, especially when introducing it through a very narrow vulva. Powdered elm bark suspended in warm water has a lubricant value essentially equal to that of fats, and has the advantage that it is readily washed away with water without the use of soap. Vaseline and other heavy fats make very bad lubricants because of the difficulty of getting rid of them after using. The value of any examination of the genital organs rests absolutely upon the knowledge, skill, and care in every detail. The veteri- narian needs a thorough knowledge of the anatomy of the entire genital system. This cannot be had from books or lectures, nor in the anatomical laboratory of a veterinary college. These help form the foundation, but in order to get an accurate sense of the form, size, density, and other attributes of the living organs, the veterinarian needs to examine them promptly after death. The abattoir offers an ideal place for the study of the genitalia of cattle, sheep, and swine, and no veterinarian interested in the diseases of their genital organs should neglect to avail himself of this ideal opportunity for study. Here he can see and handle non- gravid uteri and uteri in every stage of pregnancy, and by approximate measurements may learn to recognize with fair accuracy the duration of pregnancy by the transverse dia- meter of the distended uterus. In the abattoir, the uterine seal, the corpus luteum, cysts, ripe and freshly ruptured ovisacs may be recognized and their character studied by sight and touch. No such opportunity for fundamental Examination of Female Genital Orgajis 83 knowledge exists elsewhere. By availing himself of the freshly slaughtered animal, the veterinarian makes the closest possible approach to the next logical step, the clinical examination. STERILITY-ABORTION ORIGINAL EXAMINATION Owner. _ _ Address. _ — Name or Herd Number of Animal Date of Birth Has animal been pregnant? If she has bred, state number of calves produced _ Date of termination of last pregnancy Duration of last pregnancy in days Was calf alive or dead ? If living, was it healthy? Did cow have retained afterbirth ?. or discharge from uterilS? If a heifer which is not known to have been pregnant, insert in chart the date or dates of service or in case of estrum or "heat" and not served write date in parenthesis ( ). In animals which have been pregnant, indicate the dates of service since calving or aborting and dates of estrum when not served, as in the heiTers. Year Jan. Feb. Mar. Apr. Mat June July Aug. Sept. Oct. Nov. Dec 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Character of estrum, regular or irregular.. General condition State of lactatiou. Date of Examination ... Right broad ligament.. Vulva Cervix Left broad ligament. Vagina Uterus Right ovary. . __ _ — - Right oviduct _ - - Left oviduct -.. - Diagnosis Prognosis Treatment applied — Treatment advfsed - - — Remakks : Fig. 37 — Examination Blank for Recording Findings in the Examination of the Genitalia of Cows. Reduced. 84 Diseases of the Genital Organs There is no field of veterinary practice where system and detailed permanent records are so essential to efficiency. The precise order of examination needs to be varied some- times according to the individual, but generally a definite order may be followed from beginning to end. I have found the examination blank, shown in Fig. 37, convenient in mak- ing a systematic and complete examination. After the iden- tity and the history of the animal have been satisfactorily recorded, any evidences of abnormality in the broad, or sacro-sciatic ligaments, such as their sunken condition in nymphomania, with external evidences of. vulvar disease are noted. 1. Examination of Vulva and Vagina It is generally advisable next to insert the hand into the vagina and carefully palpate and record findings in the vulva, vagina, and os uteri externum. Unless palpation reveals counter-indications, the twenty-inch uterine forceps should be introduced alongside the hand already within the vagina and the cervix grasped. This is best accomplished by pushing the index finger against or into the os uteri externum. With the forceps slightly open, push the one jaw into the os far enough to se- cure a firm hold upon its lip and then close and lock the forceps. In some heifers, the vaginal portion of the cervix forms such a sharp cone, and the cervical canal is so narrow, that the tip of the forceps jaw cannot be inserted sufficiently to grasp the cervix. In such cases the forceps should be opened wide enough to grasp the cervical cone at the side near its base. Moderate traction upon the forceps draws the cervix, uterus, and ovaries backward four to ten inches, stretches the uterus in its ligaments, renders its outline clearer, and brings the ovaries into a more accessible position. When an ovary is unusually large and the abdomen pendulous, the gland frequently drops forward and downward where the examiner cannot reach it or can do so only with great diffi- culty not devoid of peril to the rectal walls. The traction Examination of Vulva and Vagina 85 with the forceps usually draws the uterus, the apices of the cornua, and the ovaries up into the pelvis or against the pubic brim, where they are readily palpated. At about the 90th to the 120th day of pregnancy, the fetus is sometimes far forward in the gravid cornu and the uterus has fallen down in a pendulous abdomen, where it is difficult to palpate, making error in diagnosis easy. Here again the traction upon the cervix tenses the genital tube so that it may be readily followed and brings up within reach the gravid por- tion of the horn, where its volume may be recognized and the approximate duration of pregnancy determined. There are some important exceptions to this order of pro- cedure. In heifers with narrow vulvae, and perhaps with considerable hymeneal stricture, the force necessary in order to introduce the hand in attaching the forceps may arouse so great an irritation as to induce severe and obstinate strain- ing, which may render rectal palpation very tiresome, fre- quently inaccurate, and sometimes impossible, so far as any reliable findings go. With heifers, therefore, I generally prefer to postpone the vulvo-vaginal palpation and omit the application of the forceps to the cervix until after the rectal examination has been attempted. The very frequent in- tense straining may thus be avoided. The traction upon the cervix is by no means so important in the heifer as in the cow. The uterus of the non-pregnant heifer, unless long sterile, is of good tone, firm, small, and lies in the pel- vis within easy reach. If the heifer is pregnant, her uterus virtually always remains firm and retains its position with a portion of the distended organ within, or just in front of, the pelvis, where it is readily palpated and its volume recog- nized. In a large proportion of pregnant heifers, reliable and satisfactory diagnosis can be made readily by rectal palpation without applying forceps to the cervix or insert- ing the hand into the vagina, thus rendering these super- fluous. If the heifer is not pregnant and after several copulations her sterility is deemed serious or important, the vulvo-vagi- nal and cervical canals and the uterine cavity need to be ex- 86 Diseases of the Genital Organs amined in order to arrive at a reliable diagnosis. The vulva and vagina then need to be forcibly dilated. This is best done with the hand. After lubricating with warm oil, fat, or emulsion of elm bark, the fingers should be formed in a cone and, under gradual and firm pressure, the vulva slowly di- lated. In extreme cases the dilation may require an hour or two, or may demand repeated efforts on successive days. Any intelligent helper may, under proper instruction and caution, undertake the work, but it must not be unduly rushed. In some extreme cases I have inserted the uterine forceps into the vagina without inserting my hand, directing it on the median line, from side to side, inclined very slightly Fig. 38 — Bischoff' s Vaginal Dilator. downward, to the end of the vagina. Opening the forceps moderately and pressing them forward against the cervical end of the vagina, closing and locking them, and then apply- ing gentle traction, I have occasionally been able to draw the vaginal portion of the cervix back to the vulva, where it could be palpated by inserting one or two fingers and even- tually secured by guiding the second pair of forceps to the part by palpation. With both forceps applied to the cervix, the vagina may be visually inspected and the cervical canal and uterine cavity examined instrumentally. In some heifers, the vulva is constricted by the presence of a small band of connective tissue or aponeurosis, located about one-half inch from the margin of the lips, just beneath the vulvar mucosa. When vulvar dilation is attempted, the veterinarian encounters this firm, small, cord-like structure, which under the force employed cuts into his hand. I have observed this in one family of Holstein heifers, the members of which were unusually large and rugged, where the vulvae Examinatio7i of Vulva and Vaghia 87 were so constricted by this cord-like structure that a small hand could not be inserted. The difficulty was overcome by severing the cord at one or two points. I encountered one sterile Jersey heifer of breeding age, with so small a vulva that I could not insert my hand at all and so small an anus that I could not palpate her genitalia, per rectum, though the heifer herself was not extremely small. Vulvo-vaginal stric- tures occur from disease, rendering palpation of the anterior end of the vagina impossible. These will be considered later. Albrechtsen makes extensive use of the vaginal speculum in studying the vagina and cervix, but I have not found it of great value. When one pair of the uterine forceps is at- tached to the right and the other pair to the left lip of the OS uteri externum, traction exerted, and the forceps pressed apart, the vulvar opening is widely dilated and in almost all animals all parts of the vaginal mucosa and the vaginal por- tion of the cervix are brought into view more clearly than with the speculum. The visual examination of the vaginal end of the cervix may be further facilitated in cases of need by applying a third pair of forceps to the superior margin of the cervical border. In a few instances of a very narrow vulva or vagina, a speculum of sufficiently small size may be of great aid. The best speculum in my experience for this purpose is that of Bischoff' s Vaginal Dilator, shown in Fig. 38. In the manual examination of the vulva and vagina, the examiner should take note of all abnormal contents and of abnormalities of the vulvo-vaginal mucosae and of the peri- vaginal tissues and organs. Physiologically, the vagina of the cow at estrum and when nearing parturition contains an abundance of clear, rather fluid, highly lubricant mucus. The vagina of the non-pregnant cow in the interval between estrual periods contains a small amount of lubricant mucus. The vagina of the pregnant cow, except when nearing par- turition, contains a highly adhesive mucus. These physio- logic variations in quantity and quality of vaginal mucus need to be learned by actual clinical observation before the various pathologic contents may be readily recognized. 88 Diseases of the Geyiital Orgaiis The walls of the vagina are physiologically soft, pliable, and thin, but thia is largely comparative which the examiner must learn to appreciate by clinical study. In severe granu- lar venereal disease and in other chronic inflammatory con- ditions, the mucosa and entire walls become thickened and hard. In the acute vesicular venereal disease the vulva and vagina become highly sensitive and exceedingly painful to the touch. In order that these variations in the vaginal walls may be recognized by palpation, it is essential that the organ be flaccid. It is impossible to determine clearly the state of the vaginal walls while the patient is straining violently. A still greater impediment to palpation of the vaginal walls is the ballooning or inflation of the vagina with air. During inspiration, if the vulva, the anus, or the cervical canal is open, air may be drawn into the vagina, rectum, or uterine cavity respectively, and the involved organ become greatly inflated like a balloon. These inflations appear to be wholly involuntary, but the tendency for them to occur varies greatly in individuals. Once the vagina becomes inflated, the ballooned organ completely fills the pelvis ; the walls are hard and firm ; and, except for the rectum above, lie in imme- diate contact everywhere with the pelvis. The condition of the vaginal walls and of the surrounding tissues or organs cannot be determined by palpation through this tightly stretched, firm, unyielding structure. Sometimes, by mov- ing the hand rapidly and vigorously from side to side and slapping the tense walls, the cow or mare may be induced to contract the vagina and expel the air. If the cervix is seized with forceps and drawn backward, the vaginal cavity is largely eliminated and the air forced out. The air may be forced out of the vagina by exerting manual pressure upon the ballooned organ from the rectum. In many cases the evacuation of the air from the vagina is none too readily ac- complished, but it must be done before the palpation of the vagina and perivaginal structures can be accomplished. The veterinarian must, therefore, be patient and persevere until his object has been attained. Through the flaccid vaginal Rectal Palpation 89 walls, the examiner may recognize perivaginal abscesses of lymph glands, tumors, pelvic fractures, diseases of the uri- nary bladder, ureters, and other organs. In advanced preg- nancy in the cow, the head of the fetus commonly lies in the pelvis above the vagina, as shown in Plate I, possibly mis- leading the unwary veterinarian and causing him to suspect extra-uterine pregnancy. 2. Rectal Palpation The palpation of the genitalia of the cow per rectum is on the whole the most important part of the clinical examina- tion, because it reveals such an extended list of data. The essential preliminaries to rectal palpation of the genitalia are that the rectum shall be empty of feces, that it shall not be ballooned with drawn-in air, and that straining or tenes- mus shall not be present. Some have advised emptying the rectum by means of an enema, but the liquid is rarely all evacuated until after the operator inserts his hand, at which time the liquid feces are often forced out, causing unpleasant soiling. Hess recommends inserting the hand into the anus in the form of a cone, spreading the fingers apart and di- lating the anal ring enough to admit some air which is com- monly followed by defecation. But one must wait for a time and although defecation finally occurs, quantities of feces usually still remain in the rectum which must be in- vaded for successful palpation. It is essential that the rec- tum be emptied as far as the operator wishes to insert his hand and, in the end, this must be accomplished largely by the manual removal of the feces. The ballooning of the rectum is an annoying impediment to rectal palpation, holding the examination completely in abeyance so long as it persists. Rapid movements of the hand, as suggested for ballooning of the vagina, frequently suffice, causing the rectum to contract and expel the air. The ballooning generally involves but twelve to sixteen inches of the rectum at the anal end, and the operator may reach beyond into an empty section of the gut, cautiously engage his fingers in the intestinal folds, and, drawing the 90 Diseases of the Genital Organs anterior segment of the rectum analward, force the air out of the ballooned portion. Patience must be exercised until the ballooning is completely overcome. It is useless to at- tempt palpation while it exists, because the rectal walls are so stretched, hard, and firm that reliable operation is simply- impossible. Tenesmus, or straining, also inhibits, so long as it lasts, any reliable palpation of the genital organs. It has already been remarked that soapsuds, antiseptics, etc., must not be introduced into the rectum on the hand, arm or otherwise, since they may cause very annoying straining. It has also been noted that if force has been used in dilating the vulvo- vaginal tract of a heifer just prior to rectal exploration, the pain already caused in the genital tract will result in vio- lent, and frequently uncontrollable straining during rectal palpation. These causes must be avoided. But when the hand can be readily introduced into the vagina and the for- ceps fixed in the cervix, any moderate traction exerted tends to prevent rather than to cause straining. Gentleness and patience are the chief factors in controlling straining. Dur- ing straining the operator should always let his hand lie perfectly passive in the rectum. He must not even use force to retain a position already reached. If his fingers are in a saccule of the rectum and he holds his hand rigidly in position, the cow will rupture her rectum against his finger tips. Even with the greatest gentleness and patience, one sometimes encounters an animal which strains persist- ently and violently. One cow strained constantly during efforts at rectal palpation by my colleagues and myself, and although repeated attempts were made at different times, accurate palpation failed. Peri-anal injections of apoth- esene and moderate chloral enemas both failed. Not only accurate work, but the safety and life of the patient, are dependent upon the gentleness and prudence of the operator. It is virtually impossible sometimes to avoid injuries suf- ficient to cause hemorrhage from the rectal mucosa. In small heifers the anal opening seems unduly constricted and at some point the mucosa may tear and slight hemorrhage Rectal Palpation 91 result, but this is extremely rare. Injuries to the rectal mucosa from the palpation are far more common. Veteri- narians with very large hands and arms should not under- take rectal palpation of the genitalia per rectum in small heifers. As a rule, however, bleeding from the rectal mu- cosa is not due to a big hand, but to roughness, inexperience, or untrimmed finger nails. The nails are to be trimmed to the quick and carefully filed until they are as smooth as possible, softened in warm water, and then all possible care and gentleness must be used. Under no conditions is the rectum to be dragged upon violently. While it is ballooned or the cow is straining, no reliable palpation can be accom- plished, but severe or fatal injury is always impending. Even if the injury is not serious, hemorrhage is a dis- credit to the examiner. When he removes his hand, covered with blood, it looks bad to the owner, and to one who knows the subject it shows that the examiner has failed to attain his object, which is a reliable palpation, but has instead in- jured the rectum. The prudent veterinarian will, therefore, have care to reduce to a minimum the frequency and amount of hemorrhage from the rectal mucosa, and will always feel that he has erred whenever his hand, when withdrawn, is stained with blood. After other precautions to prevent straining have failed, it may sometimes be controlled by pinching the skin of the back, pressing over the spine with a rough stick, pinching the muzzle with the fingers and thumb in the nostrils, or applying a leading-ring to the nose. When the foregoing preliminary precautions against in- jury to the intestines have been made and other preparations for rectal palpation satisfactorily attained, the examiner is ready to proceed with the palpation of the genital organs per rectum. If forceps have been applied and slight trac- tion is exerted, the cervix of the non-pregnant, adult cow may usually be drawn back almost or quite to the vulva. There are occasional exceptions. In Shorthorn cows, the vagina is quite long and narrow and the uterus is held far forward by its ligaments so that in many individuals it is very difficult, and sometimes impossible, to draw the cervix 92 Diseases of the Getiital Organs far enough back to permit of visual examination or of de- sired manipulations. When the operator inserts his hand into the rectum, the logical starting point for the palpation is the cervix. With the forceps applied to the vaginal end, the operator may recognize the structure by following the instrument to its point of attachment. When the forceps have not been ap- plied, as in heifers, the cervix must be sought and recognized by its location, size, consistence, and attachments. Without traction with the forceps, the vaginal end of the cervix lies eight to twelve or more inches anterior to the vulva. In the non-pregnant heifer, it ordinarily lies not more than eight inches from the vulva; in old, pregnant cows, it may be dragged far forward out of the pelvic, into the abdominal, cavity. Similar displacement may exist in pyometra, hydro- metra, large ovarian and uterine tumors, and other patho- logic conditions. Not infrequently, portions of the small in- testines are pushed back in the recto-vaginal pouch, and must be dislodged forward before the cervix, uterus, or ovaries may be palpated. Ordinarily it is a very easy task to dislodge these by applying very slight intermittent pres- sure downward and forward. When the urinary bladder is empty, the cervix may lie upon the empty viscus, but it is generally slightly deviated to the right and rests upon the pelvic floor. When the urinary bladder is distended, the cervix (and uterus) is almost al- ways deflected to the right and lies in the furrow between the distended viscus on its left, and the right pelvic wall. Rarely the cervix and uterus lie upon the distended urinary bladder or, yet more rarely, may be displaced to the left. Sometimes the greatly distended urinary bladder, containing four or more quarts of urine, almost fills the pelvis, the cer- vix and uterus fall far down between the bladder and pelvis, and the bladder rolls or extends over to the right, virtually covering the cervix and uterus. The distended bladder then needs to be pushed to the left in order to palpate the cervix and uterus. Rarely I find it desirable, before satisfactory palpation may be made, to catheterize the bladder and evacu- Rectal Palpation 93 ate the urine. The small or extra-small Albrechtsen uterine catheter answers the purpose satisfactorily. Sometimes great care is necessary in order to avoid con- fusion on account of the bladder. It may give the impression at first of the distended pregnant uterus, and the examiner, off his guard, may fall into a very embarrassing error. His safety is assured only by the clear recognition of the cervix and uterus. When the urinary bladder is empty, it forms a flattened, pear-shaped body, palpable beneath the cervix, about three to four inches long, rather firm in consistency, and finely irregular, due to the wrinkling of the mucosa and contracted muscle bands. Then follows every gradation in size, up to four or more quarts of contents, when the dis- tended organ may fall over the pubic brim and hang down in the abdomen. The cervix is recognizable by palpation as a very firm, al- most cartilaginous, cylindrical organ, three to six inches long, and one to three or four inches in diameter. In heifers it is very small and firm, usually about three to three and one-half inches long, and one to one and one-half inches in diameter. With age, and yet more with disease, it increases in all its diameters. In health, owing to the amplitude of its broad ligaments, the organ may be picked up per rectum, and virtually its entire circumference freely palpated. In disease, it may be adherent in varying degrees and difficult of clear identification. Behind, the cervix is continued by the flaccid, empty vagina. Sometimes the inexperienced practitioner may be confused on account of the ballooned vagina, which has already been mentioned. The cervix is then pushed forward by the ballooning and the operator feels beneath the rectum, filling more or less completely the pelvic cavity, a moderately tense, inflated sac, which he may at first mistake for the urinary bladder or be otherwise mis- led. Traction upon the cervix with the forceps pushes the air out through the vulva, or it may be readily evacuated by gentle pressure from the rectum. a. The Uterus. Forward, the cervix ends in the usually somewhat broader and markedly softer uterine body. In 94 Diseases of the Genital Organs severe cervicitis, the cervix often has a far greater trans- verse diameter than the body of the uterus. Just in front of the cervix, the body of the bovine uterus is small and inconspicuous when compared with the size of the uterus as a whole. Externally it is ordinarily two to three inches long, but the originally separate Muellerian ducts are still faintly evident upon palpation, in the form of a slight antero-posterior depression on the dorsal surface. This depression gradually deepens into a distinct furrow, soon the bifurcation is reached and the two distinct cornua follow, constituting the chief volume of the uterus. Each uterine horn has about sixty per cent of the transverse dia- meter of the body. The examiner recognizes the non-pregnant uterus by its continuity with the cervix anteriorly, its bicornual charac- ter, and its firmness and evenness to the touch, each cornu forming the segment of a circle with its convex border pre- senting dorso-anteriorly. In the healthy uterus of the heifer, the uterine body and horns are very firm, smooth, regular, thus serving to differentiate them clearly from all other pel- vic or abdominal viscera. The cornu of the heifer is one- half to three-fourths of an inch in diameter at the base, and tapers gradually to a fine point at the ovarian end, where it passes almost imperceptibly into the oviduct. The examiner should trace each cornu separately, as it extends obliquely forward to the right or left, where it soon turns downward, thence backward and upward by a regular curved line, to end, the right cornu on the right side, the left cornu to the left, in close proximity to its base, thus describing an almost complete circle. The healthy cornu of the heifer is eight to ten inches long on its convex border, thus forming an in- complete circle two and one-half to three inches in diameter. The entire organ may, therefore, be picked up through the rectal floor and held in the hollow of the hand. The uterus of the cow is larger, is slightly uneven owing to longitudinal wrinkles, and may be slightly sinuous because the cornua are longer than their broad ligaments. That is, the uterus, once pregnant, never wholly returns to the original form, outline Rectal Palpatio7i 95 and volume of the uterus of the heifer. Estrum, pregnancy, and disease alter profoundly the volume, form, position, and consistency. Whatever the changes may be, the basic prin- ciples in recognition are the continuity with the vagina and cervix and the fundamental position, attachments, and re- lations. h. The Oviduct. The healthy oviducts are difficult of rec- ognition by rectal palpation, but under favorable conditions are recognizable. They are less than one-eighth inch in diameter, sinuous, very smooth and firm. Arising almost imperceptibly from the apex of the cornu, they pass lateral- ward, in front of and below the ovaries embedded in the ovarian ventricle or pocket of the broad ligament, as shown in Fig. 13. Passing beyond the outer or lateral extremity of the ovary, it bends inward, or medianward, so that the pavilion of the tube presents toward the antero-lateral surface of that gland, with one of the fimbriae of the pavilion attached to the lateral end of the ovary. When either pyosalpinx or hydrosalpinx is present, the tube becomes distinctly en- larged and usually readily palpable. The distension of its lumen or the thickening of its walls increases not only its transverse diameter but also its length. It then becomes readily recognizable by palpation per rectum in almost every case. Generally the infection involves the pavilion and also the ovarian pocket, causing them to become ad- herent to the ovary in varying degrees. c. The Ovary. The palpation of the ovaries per rectum logically follows the examination of the oviducts. The glands, which in the cow physiologically lie approximately in the position indicated in Fig. 13, are to be recognized by their size, form, consistence, and attachments. In the healthy, non-pregnant heifer or cow, the ovary usually lies lateral to and somewhat below the dorsal border of the base of the uterine cornu, between it and the ascending, lateral portion of the pubis. Usually it lies upon the pubic floor, near the brim, or just beyond in the abdominal cavity, at or slightly below the brim of the pubis. Pregnancy and dis- g6 Diseases oj (he Ge7iital Organs ease greatly modify the position of the ovaries. Anything which contributes a weight in excess of the physiologic, non- gravid uterus, oviducts, or ovaries causes the latter to drop downward and forward. The extent of the dislocation is further influenced by the degree of pendulousness of the abdomen. The ovary swings freely in its attachments, may be picked up per rectum and ordinarily moved freely for a distance of four to six inches or more. The healthy ovary sometimes lies hidden in the ovarian pocket (mesosalpinx), or drops over in front of, and down beneath, the broad ligament, so that manipulation is required in order to free it and render accurate palpation possible. Once it is disentangled from the pocket or other accidental covering, the outline of the gland is very free and the examiner may recognize clearly ripe ovisacs, the crater following the recent rupture of an ovisac, the corpus luteum in its varying stages of growth and decline, its abnormalities and diseases, its adhesions with the pavilion of the tube and diseases of the ovary, with concur- rent diseases of both ovary and oviducts. The ripe ovisac of the cow is a thin-walled, yielding, and readily ruptured cyst of three-eighths to one-half inch in diameter, standing well above the ovarian surface, usually upon the convex or greater border of the gland. The crater resulting from the rupture of an ovisac is a deep pit with somewhat irregular edges, three-eighths to one-fourth inch across its mouth. The fresh, growing corpus luteum is very soft to the touch. Its dome, which may project one-fourth inch or more above the general ovarian surface, is about one- fourth inch wide. Upon palpation, it feels like a small, atonic granulations tumor. Gradually it increases in diame- ter, becomes firm, and after about ten days has reached its full size of three-quarters to seven-eighths of an inch. The contiguous covering of the ovary grows over the corpus luteum. The latter is usually spheroidal, sometimes ovoid, with its base implanted in the body of the ovary. The yellow body may be somewhat dumb-bell shaped owing apparently to a constriction about its center, due to a narrow, firm open- Rectal Palpation 97 ing of the crater when the ovisac ruptured. The two ovaries are rarely symmetrical ; the left is usually the smaller — not rarely, minute, — no larger than a small pea. From such a minimum, the healthy ovary may be of any size, up to two, or even three inches in some large cattle. The corpus luteum modifies greatly the gross volume of the ovary. In the very small ovary, the corpus luteum, fully de- veloped, may increase the volume of the organ ten- to twenty- fold, while the development of a seven-eighths inch corpus luteum in an ovary of two inches, though actually adding the same volume, does not cause the great comparative increase in size. The healthy corpus luteum of the non-pregnant heifer or cow retains its maximum volume until about the sixteenth to eighteenth day after ovulation, when it atrophies rapidly for two or three days, and at twenty to twenty-two days, when it has decreased to one-fourth or three-eighths of an inch in diameter, estrum and ovulation recur. After the corpus luteum has formed as a solid mass, physiologically it remains solid throughout its history. It is solid, firm, and somewhat elastic to the touch. The corpus luteum of pregnancy does not differ (except in color, which is of no concern here) from the corpus luteum of estrum in its general characters, but in duration it phys- iologically continues unchanged throughout pregnancy and for thirty to sixty days thereafter, when it atrophies and estrum and ovulation recur. Pathologically, the corpus luteum may be grossly enlarged to even two or three inches in diameter, may undergo cystic degeneration, and other- wise depart from the normal volume, consistence, and char- acter. It may undergo rapid degeneration, with abnormally short intervals between estrual periods, may atrophy dur- ing pregnancy and cause ovulation and estrum, may shift its position and sink deeply into the body of the gland, and may persist at full size for month after month, even to years, in- hibiting estrum and ovulation. The ovary is subject to such a wide variety of pathologic changes that the veterinarian needs to study it carefully and abundantly both in the abat- 7 98 Diseases of the Genital Organs toir and clinically by palpation in order to be able to read every change in the gland with his finger-tips as unerringly as a blind man reads braille. The rectal palpation of the uterus, oviducts and ovaries of cows and of some heifers, is greatly facilitated by the appli- cation of the forceps to the vaginal end of the cervix and the exertion of moderate traction thereon. The traction draws the uterus, oviducts and ovaries backward and upward, tenses the uterine horns and renders their outline more dis- tinct, and enables the operator to study all parts of the geni- tal tract at a far greater advantage. The plan avoids many errors in diagnosis. Some veterinarians fear that the appli- cation of the forceps to the cervix of a pregnant cow and the exertion of traction is dangerous, but I have failed to observe any untoward results. Without the aid of forceps, I have seen colleagues mistake gross pyometra for pregnancy and make other regrettable blunders. As a rule of practice, therefore, rectal palpation of the genital organs should regu- larly be aided by traction upon the cervix with forceps. Cer- tain exceptions arise. It has already been noted that the genital organs of a heifer with a small vulva may be ad- vantageously palpated per rectum without the application of the forceps. In pregnancy of 30 to 90 days, one may gen- erally make a clear diagnosis without applying forceps. But in an old cow with a pendulous belly, the uterus in early pregnancy may be dropped too far forward and be entirely too flaccid to admit of safe recognition. To add to the difli- culty, the embryo in such cows may be located in the apex of a horn, quite out of reliable reach. Then the operator paws about unconsciously in an effort to drag the uterus back per rectum which is infinitely more dangerous and far less efl^i- cient than traction with forceps. The vaginal and rectal palpation, in addition to revealing an endless category of pathologic lesions, serves almost al- ways to determine the presence or absence of pregnancy. If pregnancy is diagnosed, the examination is ordinarily com- plete. If the animal is non-pregnant, instrumental search of the cervical canal and uterine cavity is necessary for the Examination of the Cervical Canai 99 complete assembling of available data for diagnosis and prognosis. During vaginal palpation, the operator logi- cally palpates the os uteri externum for the uterine seal as an indication of pregnancy. When a healthy heifer is preg- nant 30 days or more, if the examiner will press the tip of his index finger, without oil, vaseline, or other lubricant, against the os uteri externum for a short interval, and then carefully withdraw it, he is able to recognize in the os a small, highly adhesive seal. The seal grows and expands, be- coming more and more recognizable throughout pregnancy. Its presence is a warning against the invasion of the cervi- cal canal until ample evidence is at hand that the seal is spurious. 3. The Examination of the Cervical Canal and' Douching the Uterus Having applied the uterine forceps either to the lips or to the sides of the cervix, and satisfactorily determined that the animal is not pregnant, the operator may exert traction and draw the vaginal end of the cervix back to the vulva or as near thereto as is safe. Continuing a safe degree of traction and drawing the handles of the two pairs of forceps apart, he brings the vaginal end of the cervix into view. If there is good light from a window behind the cow, the parts may be satisfactorily examined visually or in the absence of efficient natural light, one may secure excellent illumination by using a reflecting electric lamp on an extension cord, or an ordinary flash light. The examiner should note the state of the mucous membrane at the os uteri externum. In the healthy heifer, the vaginal end of the cervix terminates in a sharp cone, at the apex of which opens the very narrow OS uteri externum with its mucosa everywhere in contact. The index finger cannot be inserted without violence. Usu- ally it will admit for a short distance, without resorting to force, a smooth sound, one-fourth inch in diameter. The vaginal mucosa envelops completely the entire cone of the vaginal portion of the cervix and invaginates slightly into the OS uteri externum. lOO Diseases of the Genital Organs After a cow has been pregnant, increasing with each preg- nancy, the relations of the cervical tissues become modified. The second annular fold of the cervical mucosa becomes en- larged, both elongated and thickened, and the antero-poste- FiG. 39— Instruments for the Examination of the Genitalia of Cows. /, 20''' uterine forceps ; 2, Palmer's uterine dilator, modified ; j, Bozeman's uterine dressing forceps ; 7, small uterine catheter. rior grooves become comparatively deeper, cutting the ring into a series of deep, pedunculated lobes. Eventually these push their way out through the vaginal ring or os uteri ex- ternum into the vagina. The vaginal ring now serves as a band surrounding the protruding second ring. The second ring then becomes the most posterior portion of the cervix. Examination of the Cervical Canal loi and in disease may project three to four inches beyond the original os uteri externum toward the vulva. In severe dis- ease the third annular fold may also force its way out through the vaginal ring. In disease these everted, swollen rings of cervical mucosa constitute large, cauliflower-like Fig. 40 -Median Longitudinal Sections of Cervices of Cows showing the "Windings of the Cervical Canal. /, The vagina ; 2, lip of the os uteri externum ; j, first annular mucous fold ; 4, second annular mucous fold. tumors. The healthy mucosa of the cervix is smooth, of a pinkish hue, paler than the vaginal mucosa. Its surface is moist, but should reveal no signs of pus. During estrum the cervical canal is dilated and filled with clear, highly lubri- cant mucus. The deeper portions of the cervical canal may be examined I02 Diseases of the Genital Organs 4'T~ Fig. 42. Rupture of Cervix by an Amateur in an effort to " Open the Mouth of the womb " followed by Chronic Abscess of Cervix. Cv., Cervix; A, abscess in inferior wall of cervix; O. O., approximate location of ovaries lying above the uterine ligaments ; Ov, Ov, cystic oviducts (hydrosalpinx) which were causing the sterility ; Cti., Cu., uterine cornua. Examination of the Cervical Canal 103 by means of dilator, catheter, or sound. The dilator (Fig. 39) is usually preferable. As will be seen in Figs. 40, 41, the cervical canal is extremely narrow, sinuous, and at times angular, and the free margins of its annular mucous folds, directed toward the vagina, offer serious obstacles to the prompt passage of an instrument into the uterus. The canal usually extends sharply downward and forward, very slightly to the right, for one to one and one-half inch ; then bends sharply upward and forward, and thence approxi- mately forward, with slight divergences, to the cavity of the uterus. The windings of the canal are difficult to follow and the free margins of the annular folds, directed toward the vagina, constitute deep culs-de-sac, into which the dilator tends to pass and its progress to be thus arrested. The operator is, therefore, to take these conditions into account and, without violence or force, retreat and advance at vari- ous angles, in his effort to follow the tortuous canal and evade the barriers formed by the mucous folds. Sometimes the free edges of the mucous folds appear to become pushed forward by the instrument into the lumen of the canal and occlude it, preventing for the time the passage of the instru- ment. In disease, the annular folds often become so hyper- trophied and their bases so sclerotic as to cause acute bend- ings of the canal and to close quite firmly its lumen, making it exceedingly difficult and rarely impossible at a given time to pass an instrument through the canal into the uterus. The operator needs to be patient here, as well as skilful. Any undue force may rupture the cervical wall and pene- trate the surrounding connective tissue, causing pelvic ab- scessation, as shown in Fig. 42, with extreme peril to the physical and breeding life of the animal. If the operation cannot be made to succeed at first effort, it should be sus- pended for the time and undertaken later. I have worked for an hour or two at a time, four or five times in succession, before finally succeeding in reaching the uterine cavity. However, it is always infinitely better to try repeatedly, and finally fail, than to use force and ruin the animal, not so much because of the breeding value of such an animal, since I04 Diseases of the Genital Organs that is always seriously impaired already, but because the rupture of the cervical walls, with the unpleasant conse- quences attending, leaves an ugly stain on the veterinarian's reputation. If the passage of the canal is very difficult, one should not, as a rule, work at it for more than an hour or an hour and a half, since by that time he will tend to injure the Fig. 43. Rupture of the Uterus with Uterine Catheter. Cow. v.. Vagina; /, lip of os uteri externum ; 2, first annular mucous fold ; J, instrumental rupture in the roof of the horn ; 4, instrumental rupture of the floor of the uterine horn ; 5, mesometrium enormously thickened and inflamed ; 6, cystic corpus luteum with adherent cystic oviduct to the left ; 7, median section through cystic oviduct. The veterinarian had killed the cow douching the uterus when the sterility was caused by the inoperable hydrosalpinx. tissues unwarrantably if he continues his efforts longer, and, still more important, he becomes fatigued. A fatigued operator is always a dangerous operator. If prudent, he will not accept the attendant risks which he inevitably faces when fatigued. When the examiner has succeeded in passing the uterine dilator, the catheter, or other instrument into the uterine cavity, he faces the danger of puncturing the uterine wall. Examination of the Cervical Canal 105 as shown in Fig. 43, and invading the peritoneal cavity. In order to avoid wounding the uterus, the operator needs to judge well the approximate length of the cervix and when the end of the instrument reaches the region of the os uteri internum, it should be directed slightly downward. That is, using a curved instrument, as is always most convenient and safest, the operator should at this time turn the instrument so that the concave side of the curve is directed downward. Ordinarily no metal instrument should pass far beyond the OS uteri internum. In the ordinary empty, non-pregnant uterus, the downward curvature of the uterus is so marked that there is great peril of puncturing the walls if the instru- ment is pushed more than one to two inches into the uterine cavity. In addition to this danger, if the uterus is flaccid or if the pushing of the instrument through the cervical canal requires some degree of pressure, the uterus bends sharply and the instrument catches in this and punctures the wall. If chronic cervicitis is present, it inevitably causes scle- rosis of the annular mucous folds of the cervix, and the hy- pertrophy of the sclerotic areas presses across against the opposite side of the cervical canal, bending it out of its course and narrowing its lumen. The sharp bendings of the canal, with the intruding sclerotic and hypertrophied masses, so impede the passage of the instrument that once it has entered the uterine cavity, the resistance of the uterine wall is not clearly recognizable if the instrument is pushed into or through it. When using the dilators, therefore, the ad- vancement of the instrument should cease when the uterine cavity is reached. The length of the cervix, if doubt arises, may be learned by rectal palpation. The same means may be used to learn when the dilator has passed the cervical canal. In all cases where the cervical canal is not freely open and sufficiently direct to permit the easy passage of the uterine catheter, it is prudent and advisable to use first the uterine dilator. I have found the Palmer uterine dilator of the human gynecologist, modified as shown in Fig. 39, the best instrument for this purpose. It is small and the curva- ture of its blades corresponds fairly well with the average io6 Diseases of the Genital Organs bendings of the cervical canal. The dilation of the cervical canal is essentially alike for diagnosis and therapy. When the canal is very narrov^ and is pressed upon by sclerotic en- largements in the mucosa, the passage of a catheter suffi- ciently large to permit of satisfactory douching either for diagnosis or treatment, is both difficult and dangerous. Even if it is accomplished, the cervical disease cannot be satisfac- torily handled until the canal has been freely dilated. Once the instrument has reached the os uteri internum, the gradual dilation of the canal should be undertaken by forcing the forceps jaws apart v^ith the thumb screw. The opening of the jaws should be very gradual and prudence used in the amount of force applied. In heifers especially which have suffered severely from cervicitis, and there is consequently well advanced sclerosis, the tissues may fail to relax under the strain but rupture instead. The instrument must on no account be pushed toward the uterus while the jaws are opened as there is great danger of pushing them through the uterine or cervical wall. There is great danger, while dilation is proceeding, if the operator pushes toward the uterus when the patient strains. At such times the in- strument must be permitted to move backward with the cer- vix. The process of dilation should be continued for a suffi- cient period of time to render the cervical canal of sufficient size to admit of the ready passage of a small uterine cathe- ter, uterine dressing forceps, or other desired instruments. Once the forceps blades are forced apart, the operator may cautiously exert traction upon them, eventually drawing the forceps out with the jaws widely separated. This presses the free borders of the annular mucous folds outward against the cervical walls and tends to cause them to remain out of the way temporarily while the uterine catheter may be introduced. It is best in case of a very narrow cervical canal to open and close the dilator alternately and while closed to revolve the instrument in varying degrees so that the direct pressure of the blades shall be exerted on all parts of the cervical walls. With patience, the pale muscles of the cervix gradually become exhausted and finally the canal at- Examination of the Cervical Carta I 107 tains a sufficient lumen so that a moderately large uterine catheter may be passed through it without difficulty or dan- ger. This having been attained, catheterization may be un- dertaken. The catheter used should always be of as large caliber as the cervical canal will readily and safely admit, because the greater the caliber of the catheter, the more effi- cient the douching of the uterus. If the operator has care- fully observed the windings of the cervical canal while using the dilator, he will better understand the direction which the catheter must take. The catheter selected as of proper dimensions should be introduced into the cervical canal very gently and advanced with great care. Force is at all times to be avoided. If the catheter will not pass without force, it should be laid aside and the dilators again used and this plan repeated until the dilation suffices. The uterine catheter, like the dilator, should not be pressed deeply into the uterus but merely far enough that the fenestrum of the instrument is free in the cavity of the uterus so that douching will be practicable. At the moment of entering the uterus, the concave side of the catheter should be directed ventralward and so maintained through- out douching. Occasionally blood escapes through the cathe- ter, indicating mechanical injury to the uterine mucosa, and this should cause the operator to beware of impending trouble. Once I misjudged the length of the cervical canal, pushed the uterine catheter too far, and caused an extensive antero-posterior laceration in the uterine mucosa along the dorsal surface with copious hemorrhage. I had been careful and could not identify the character of the injury and it was only later when she was slaughtered as a tuberculin reactor, that the cicatrix in the organ revealed the character of the lesion. In this instance the blood did not escape through the catheter but was forced out after the withdrawal of the in- strument. The cow suffered greatly, kicked at her belly, lay down and rose frequently, trembled, sweat, and breathed rapidly. The hemorrhage was not of sufficient volume to cause the symptoms directly from the loss of blood nor could the lesion in itself cause so much pain. Apparently the dis- tress was due to uterine colic, that is, the small, empty io8 Diseases of the Genital Organs uterus, not recently gravid, rapidly filled with blood and the cervix being firm, it could not readily escape but, being re- tained, aroused violent contractions like those seen when a volume of fluid is inadvertently left behind when douching. The difficulty passed in an hour or two and she continued ap- parently well. Whenever there is any question as to the course of the catheter or other instrument, the operator should cautiously palpate per rectum and determine if all is well. Not rarely, when the catheter enters the uterine cavity there is a sudden inrush of air by which the uterus becomes greatly ballooned, as has already been noted of the vagina and rectum under similar conditions. The inflation of the uterus sometimes proves annoying. It is difficult and some- times impssible to douche the inflated organ until a very large amount of fluid has been introduced because the liquid drops downward and forward to the ovarian end of the uterus while the air occupies the cervical end of the cavity which is highest. If left in the uterus, it may cause colic. It can be pressed out through the catheter by careful rectal manipulation. (Gynecologists apparently encounter the same condition in woman and some writers describe it as "acute dilation of the uterus".) When the catheter is accidentally pushed through the uter- ine wall and the peritoneal cavity is entered, there is gener- ally an inrush of air through the instrument. In this one regard the inflation of the uterine cavity through the cathe- ter and the flow of air into the peritoneal cavity are much alike but in general the rate and volume of air drawn in are greater in the latter. When an antiseptic fluid, like a two per cent LugoFs solu- tion, is introduced into the peritoneal cavity through the catheter, it immediately causes marked depression and un- easiness, with rapid breathing, trembling, sometimes lying down, and other evidences of distress. The cow tenses her abdominal walls, arches her back and visually appears to be bloated. If the uterus is clean and little or no infection is forced into the peritoneal cavity, lymph is soon thrown Rxamtnation of the Cervical Canal 109 out, which dilutes the Lugol's solution. Rapid absorption may follow and iodism result. The distress from the introduc- tion of Lugol's solution into the peritoneal cavity is of short duration and within one-half to two hours she seems as well as before. The uterine wound heals promptly and little or no harm follows. When coal tar disinfectants and others of a highly irritant character, especially those not freely solu- ble in the lymph, are introduced, the irritation is more se- vere and prolonged, with great danger of a severe peritoni- tis with serious peril to life. If death is avoided, the peri- tonitis may lead to extensive adhesions destroying the value of the patient. Some veterinarians have counseled the use of bicarbonate or chloride of sodium solution as a douche, but if this or other neutral fluid is used and a puncture of the uterus occurs with the fluids entering the peritoneal cavity, the danger is extreme because usually infection is borne from the uterus and sets up a violent and fatal peri- tonitis. In Fig. 43, is shown a uterus punctured by pushing a catheter much too far, a fatal peritonitis following douch- ing with, it was claimed, soda bicarbonate solution. Whether the infection was due to a dirty catheter, whether it bore infection from the cervix or uterus into the peritoneal cav- ity, or whether the soda solution itself was septic, does not materially alter the case. No antiseptic was present to de- stroy the infection. When pus is present in the uterus in large quantities and of high virulence, as is most frequently seen in the puerperal animal, a gross rupture of the organ is followed at once by very alarming symptoms which frequently prove fatal within two or three hours. The shock is especially pro- found when it is attempted to douche a large paretic uterus containing a great volume of virulent material and a great amount of water is introduced to add to the mass of liquid. A large rupture of the uterus releasing the great mass of infected liquid, which immediately reaches the total peri- toneal surface, produces prompt collapse. The abdominal walls at once become tense and fixed, the breathing being thoracic, rapid and shallow. The patient appears tympani- I lo Diseases of the Genital Organs tic, shows intense suffering and, as a rule, quickly succumbs. Some of them, however, after remaining in an extremely critical state for some days slowly improve but as a rule never regain condition and must eventually be destroyed as useless. Consequently in the instrumental examination of the uterus, as in that of the cervix, ample care is always to be taken to avoid rupture. Such care must be based upon ac- curate anatomic knowledge, surgical skill, patience, and the application of the invariable rule that, if the instrument can- not he passed without the use of force, the effort must be suspended. The cervical canal dilates during estrum, at which time an instrument may far more readily be passed into the uterus. If the operator desires, he may dislodge the corpus luteum and return after three days with reasonable assurance that he will find the patient in estrum and her cervical canal dilated. If he will then use the dilators pru- dently, he will leave the canal dilated and the angles modified in a manner to render catheterization of the uterus less diffi- cult if again undertaken in a few days. Aside from the diag- nosis of estrum and the advantage of the dilated cervix fa- cilitating the catheterization of the uterus, estrum is a very poor time to examine the genitalia, because vagina, cervix, and uterus are so filled with mucus, and the uterus so en- larged and engorged that many pathologic conditions may be so completely screened as to be wholly unrecognizable. When the catheter has entered the uterine cavity, the ex- amination is to be completed by douching. For this purpose I prefer a one to two per cent. Lugol's solution, rather than sterile salt solution or other neutral liquid, because, in my judgment, the disinfectant renders the operation safer, es- pecially when any minor injury to the cervical or uterine mucosa has occurred. The faintly brownish and clear fluid serves to form a contrast with pus or muco-pus rendering them more apparent. Physiologically the douche should re- turn clear and uniform except that in estrum there should first escape some clear mucus, and during the one or two days following estrum, some partly clotted menstrual blood. The Diagnosis of Estrtun 1 1 1 Admitting fully the dangers incurred in the manual and instrumental examination of the genital organs of mares and cows, it nevertheless remains that (1) such examina- tion is not in the ordinary sense necessarily dangerous and (2) the examination is absolutely essential to a safe diag- nosis. Accidental injuries to the genital organs of cows and mares in the course of examination are happily rare in the hands of competent veterinarians. At present there is much activity in the handling of sterility in cows and many veterinarians, some of whom have always blundered at each critical step, have plunged headlong into this field with neither the chart of anatomical knowledge nor the compass of ordinary prudence. Naturally they make many and seri- ous errors and bring undeserved discredit upon one of the most valued fields of veterinary service. The veterinarian who will not %\mq^ long and conscientious study to the sub- ject, has no moral right to attempt the work. The physical examination of the genitalia not only serves the necessary purpose of diagnosing disease but also serves to identify estrum, the period of sexual rest between estrual periods, and pregnancy. C. The Diagnosis of Estrum The diagnosis of estrum is of great practical importance because in numerous instances the ordinary clinical signs fail unless the veterinarian is able to apply a more technical and accurate method of determination. Without technical examination, the breeder may fail to recognize the condition and hence omit breeding. The cow or heifer commonly re- veals the presence of estrum by bellowing and restlessness, whether in stable or field. In the field or paddock with other cattle, the animal in estrum repeatedly mounts other cattle or stands to be mounted by them. Often there is a dis- charge of thin mucus from the vulva. In many cases cattle are not out in paddock or field daily so that the tendency to mount other cattle is not apparent. Some individuals show little excitement and do not bellow enough to attract atten- tion in the stable. Even when turned daily into the paddock 112 Diseases of the Gejiital Orgaiis or field, as is commonly done in winter for only a brief in- terval, a cow may pass through her active estrual period during the interval between two periods in the paddock. Not infrequently such unrecognized estrual periods result in expensive delay in breeding. The chief evidences of estrum revealed upon physical ex- amination are : (1) The vagina contains much thin, lubricant, clear mu- cus. In metritis, cervicitis, and vaginitis the mucus may contain floccules of muco-pus. The flow of the mucus of es- trum appears in the vagina twenty-four hours or more prior to the establishment of sexual desire and terminates about twenty-four hours after the cessation of estrum. If fertiliza- tion fails, the discharge of estrual mucus is displaced by the menstrual flow. (2) The cervix is relaxed and the canal more dilated and dilatable than in the inter-estrual period of rest. (3) The uterus is engorged. Prior to the full develop- ment of estrum, the uterus may be normal to the touch at first, but under palpation becomes engorged or erected. When estrum is at its height, the engorgement is constant. The diameter of the engorged uterus of estrum is increased about one-half, is much firmer than during the inter-estrual pause, and is smooth, even, and very firm. It is about the same size as the pregnant uterus at thirty to forty days, but is distinguishable by its firm, engorged character, in con- trast with the fluctuant, tense uterus of pregnancy. It is less hard, and smaller than the uterus of chronic sclerotic metritis with destruction of the uterine mucosa. (4) The corpus luteum of the preceding estrum is atro- phied to about one-half its ordinary diameter, or about three- eighths of an inch. (5) There is present, generally upon the opposite ovary, a mature ovisac, a thin-walled cyst one-half inch or a trifle more in diameter. (See Figs. 22-25.) If it is desired to breed the animal during the existing es- trum, the examiner needs to be very cautious in palpating the ripe ovisac since under very slight pressure it ruptures, The Diagnosis of Pregnancy 113 the ovum escapes into the peritoneal cavity, and conception is barred for that estrual period. Recent estrum is recognized : (1) By menstrual blood in the vagina or the soiling of the tail and buttocks with blood, about twenty-four hours after estrum has ceased ; (2) By engorgement of the uterus which continues during menstruation ; (3) By the rapid atrophy of the corpus luteum of the pre- ceding estrum ; (4) By the palpation of the crater of the ruptured ovisac. The diagnosis of estrum may be rendered more certain by concentrating the observations to a brief period. Thus, when the soiling of the tail and buttocks with menstrual blood is observed, if the breeder will watch the animal closely from the eighteenth to the twentieth day thereafter and take occasion to place the cow in paddock or field with the bull or other cattle, estrum will in all probability be recog- nized. The time during which close watch is to be kept may be even further concentrated by dislodging the corpus lu- teum when it is well formed and watching the patient from the third to the fifth day thereafter. D. The Diagnosis of Pregnancy The accurate diagnosis of pregnancy in the cow is a fun- damental necessity in the handling of diseases of the genital organs. The gravest and most embarrassing errors made in dealing with the genital organs are the failure to diag- nose an existing pregnancy and the erroneous diagnosis of pregnancy when the animal is sterile. The failure to recog- nize an existing pregnancy frequently leads to instrumental abortion or to the slaughter of a valuable pregnant animal which is wrongly believed to be sterile. The diagnosis of pregnancy, when the animal is sterile, leads often to months of expensive delay in breeding. The examination for preg- nancy of valuable animals which are for sale is gradually assuming scientific and economic importance. In some large herds placed in dispersal sales, all the cattle are ex- 114 Diseases of the Genital Orgaris amined in detail and certificates of pregnancy or non-preg- nancy by a skilled veterinarian issued for each female. Eventually, probably before most veterinary practitioners are ready to render highly efficient service, buyers of ex- pensive breeding cattle will demand reliable veterinary ex- aminations as to sexual soundness. In the female assumed to be pregnant, the prudent buyer will place first reliance upon the judgment of an expert veterinarian. The signs of pregnancy are many. Each has its value and each is subject to certain limitations : 1. The Failure of Menstruation After Copulation When conception follows coition, estrum is rarely followed by menstruation. If menstruation follows coition after 24 to 48 hours, the cow is probably non-pregnant. 2. The Cessation of Estrum If a cow or heifer has been regular in her estrual periods, and estrum fails to recur at the normal date, the animal is quite probably pregnant. The probability is accentuated if menstruation following coitus failed. The sign is of little value in irregular estrum. The estrual period may be com- paratively short or long, but in order to be of value in judg- ing conception, the periods need to be alike. That is, one animal may have an estrual cycle of eighteen, and another of twenty-two, days but an animal having once an interval of eighteen days and at another time a cycle of twenty-two days offers suspicion of ovarian disease. The failure of an estrual period in such an animal is not a good index of con- ception. In healthy cows and heifers there is little varia- tion in the estrual cycle in the individual ; the variation rarely exceeds twenty-four hours. It is important alike for the breeder and the veterinarian that accurate records be kept for each heifer and cow. Estrum does not always cease with conception. In my judgment, one to two per cent, of pregnant cows and heifers show estrum. In some of these, the estrum recurs at vary- ing intervals up to the seventh or eighth month, but as a rule The Cessatio7i of Est nan 115 it ceases to recur after the third or fourth month of preg- nancy. Sometimes the recurrence of estrum is regular, re- peating the cycle prevailing in the individual prior to con- ception, but usually the cycle is irregular. So far as I have observed, the estrum of pregnancy is not followed by men- struation. In fact, menstruation is not ordinarily possible, owing to the uterine seal blocking the cervical canal and preventing exit. Estrum not infrequently fails to recur after copulation although conception did not follow. Sometimes the failure of estrum to recur is due to retained corpus luteum, some- times pyometra (without discharge) follows estrum and coitus, inhibits estrum and misleads the caretaker. Poverty serves to prevent alike ovulation and estrum. The failure of estrum to recur in non-pregnant, and the recurrence of estrum in pregnant animals render it clear that the pres- ence or absence of estrum does not furnish secure ground for diagnosis relative to pregnancy. The evidence must be supported by other facts in order to be reliable. The estrum of pregnancy has been little studied. In one case which I had the good fortune to examine while the ani- mal was in estrum, the corpus luteum of pregnancy had atrophied and a ripe ovisac was present on the non-gravid side, I think it more than possible that the estrum of preg- nancy is generally due to this cause. The corpus luteum of pregnancy, for some unknown reason, atrophies, loses its inhibitory power upon the maturation of ovisacs, and es- trum, so far as the ovaries are concerned, appears in the or- dinary manner. It is of scientific interest to note here also that the estrum of pregnancy, with the atrophy of the corpus luteum and the ripening of an ovisac upon the opposite ovary, is the possible foundation for numerous errors regarding the migration of the ovum. It has been claimed that finding a fetus in one horn and the corpus luteum in the alternate ovary is proof of the migration of the ovum, and that the fertilized ovum has dropped into the peritoneal cavity, been transported to the pavilion of the opposite oviduct and penetrated it, or that ii6 Diseases of the Genital Organs the ovum has passed down the horn corresponding to the ovary from which it emanated, thence across the uterine body cavity and up the opposite horn. My observation makes it perfectly clear that the alternating of the fetus and the corpus luteum is not proof of migration. The abnormality of estrum (and coitus) appears to have no serious peril for either the pregnant animal or the fetus. It is clear evidence of a pathologic state, but many cows and heifers show frequent estrum and copulate freely without showing any marked tendency to abort or for the pregnancy to terminate unfavorably in any marked respect. Some of them abort, it is true, but I have been unable to learn that their tendency to abort is greater than in pregnant cows which do not show estrum. A few cases have occurred under conditions which have led some to believe that coitus caused abortion almost immediately. Thus I recall one cow which came in estrum in the sixth month of pregnancy, copulated, and the next day aborted. In other instances, a cow carry- ing a desiccated fetus develops estrum, copulates, and a few hours later expels the mummy. I think it reasonably certain that the facts have been misinterpreted, and that, instead of the coitus causing the expulsion of the fetus, the corpus luteum has atrophied, an ovisac has ripened, estrum and coitus have occurred, and because of the atrophy of the corpus luteum, not because of coitus, the uterus contracts and expels the fetus. That is, instead of the estrum and copulation causing the abortion, the disease has brought about the changes in the ovary, the estrum, the copulation, and the expulsion of the fetus. The problem merits further study. Menstruation following estrum in pregnancy is incom- patible with the life of the fetus, because the menstrual blood consists of a hemorrhage emanating from the pla- cental areas (cotyledons) of the uterus. Menstruation would, therefore, result first of all in a hemorrhage between the maternal and fetal structures which would force the two structures asunder (compare "Desiccation of the Fetus"). The Uterine Seal 117 3. The Uterine Seal If the vagina and cervix are healthy, the cervical canal is well sealed at from thirty to forty days after conception and it may be felt clearly upon palpation per vaginam. In order to recognize this, the finger tip must be pressed carefully and gently against the external os uteri and then cautiously withdrawn ; if the seal is present, it is readily revealed by its adhesiveness. In the earlier stages the seal is very small, only one-eighth to one-fourth inch across, and does not pro- FiCx. 44— The uterine Seal in Early Pregnancy in Heifer. t\ Embryo % inch loiit^ in the embryonic sac ; S, uterine seal in cross sec- tion ; O, ovary with corpus lutem of pregnancy ; A, uterine seal protruding from the vaginal end of the cervix. ject into the vagina. It is distinct, however, and adheres clearly to the finger tips. It continues to grow and soon bulges out into the vagina. The uterine seal involves the cervical mucosa only. As stated earlier, however, the annu- lar folds of the cervical mucosa push out into the vagina in the cow which has calved and especially when she has suf- fered from cervicitis. The protruding portions of the cervical ii8 Diseases of the Genital Organs mucosa function as though they remained in the canal so that in such animals the uterine seal proceeds from, and covers over, the mucosa protruding into the vagina. In the mare, in advanced pregnancy, the uterine seal projects into Fig. 45— The Uterine Seal of an Adult Cow in Advanced Pregnancy. Cross seciions through the cervix at various points. The larger seals are near the vaginal end. the vagina as an adhesive, somewhat cylindrical body, one, two, or more inches in length. Its size and protrusion in- crease until just before the close of pregnancy, when it softens, changes to lubricant mucus, and strings from the vulva. During pregnancy the mucus secreted by the vagina becomes exceedingly sticky, having much the same charac- ter as the uterine seal. The Uterine Seal 119 Sometimes a false uterine seal forms, as a result of dis- ease, as in retained corpus luteum and in cervicitis. The uterine seal persists when the fetus dies and desiccates, and when the embryo dies and the embryonic sac remains to con- stitute a "mole". The uterine seal may fail to form or it may break down when the cervix is badly diseased and abortion is imminent. Consequently the presence of the typical seal not only gives reliable evidence of pregnancy, but adds to that a certain feeling of security, suggesting not only that the animal is Fig. 45a — The Uterine Seal in Longitudinal Section. Cow. /, Os uteri externum ; 2, os uteri internum ; j, base of second annular cervi- cal fold ; 4, uterine seal extending throughout the length of the canal. pregnant, but perhaps safely so. In severe purulent vagini- tis or purulent cervicitis of the vaginal portion, the uterine seal may exist in the uterine end of the cervical canal and be displaced by pus in the vaginal portion. The seal may then be recognized by palpating it with a metallic sound, uterine catheter, or dilator introduced cautiously along the cervical canal. While the uterine seal is one of the most important evidences of pregnancy, it has its limitations in diagnosis and, like most signs, needs to be considered in conjunction with other findings. I20 Diseases of the Genital Organs 4. The Corpus Luteum of Pregnancy (See Fig. 26) Physiologically, a corpus luteum develops after each es- trum, and is of the same form, size, and consistency, whether the animal be pregnant or not. In sterility, however, the corpus luteum is one of the most common sufferers from pathologic changes. The bovine corpus luteum of preg- nancy is normally five-eighths to three-quarters of an inch in diameter, somewhat oval in form, usually even in con- tour, and firm in consistency. Forming, as it does, within the crater left behind when the ovisac ruptures, it is at first naked. That is, it is not covered by the tunic of the ovary and it protrudes somewhat beyond the surface of the gland. If the animal conceives, the tunic of the ovary soon draws over the surface of the yellow body and leaves it smooth and firm. The wound is healed. Sometimes a considerable projection remains, even though the tunic has drawn over the yellow body. In sterility, however, the wound in the ovisac frequently fails to heal and the yellow body remains for a long period of time protruding and naked. The pro- truding dome feels soft upon palpation, like the exuberant granulation of an unhealthy ulcer. The corpus luteum of sterility frequently undergoes cystic degeneration in its center. It becomes soft and more or less fluctuant, accord- ing to the degree of degeneration. Finally, as the degenera- tion extends, the lutein tissue disappears and a cyst remains. When one can recognize these conditions in the ovary, he can with very rare exceptions rest assured that pregnancy has not occurred through fertilization of the ovum which was discharged from the ovisac in which the diseased yellow body develops. He must not be deceived, however, because of the presence of a cyst or cysts in an ovary. The typical corpus luteum of pregnancy almost always exists in a preg- nant animal, but cysts may co-exist. Accordingly, while the absence of a corpus luteum of a normal type is fairly con- clusive evidence that the animal is not pregnant, the co- existence of a large cyst in the same or other ovary is not final proof, though it is strong evidence that the animal is The Corpus Liiteiu)i of Pregnancy 1 21 non-pregnant. When a typical corpus luteum of pregnancy is present and other findings are in accord, the evidence it affords is of the greatest possible value. Amongst thousands of ovaries which I have examined, I have seen but one cor- pus luteum of pregnancy which departed markedly in volume from the normal. The one exception was more than one inch in diameter. In cows which, though pregnant, nevertheless show estrum, the corpus luteum disappears, at least some- times. Hence a cow may be pregnant and no corpus luteum present. The corpus luteum of pregnancy persists throughout pregnancy and for thirty to sixty days after its close. The corpus luteum of estrum is a temporary structure, which be- gins to disappear rapidly at about eighteen days after es- trum, so that at the average period of twenty-one days it has become so far resorbed that it no longer inhibits the matur- ing of a fresh ovisac. It is at this period that the corpus luteum becomes of special significance in the diagnosis of very early pregnancy. If estrum has been regular and the animal is not pregnant, it is very certain that at about twenty-one days the animal will again be in estrum and that the corpus luteum of the previous estrum will have decreased to a small size. At the same time, if estrum is near, the uterus is engorged, the cervical canal is dilated, and the vagina contains the lubri- cant mucus of estrum. Hence, if the practitioner examines a cow at about eighteen to twenty-one days after breeding, if she is pregnant, there is almost invariably a typical corpus luteum ; if she is not pregnant, the corpus luteum is definitely atrophied. This is one of the best times for making a diag- nosis, and a highly important date, because if the animal is not pregnant, immediate measures may be taken, such as disinfecting the uterine cavity, preparatory to breeding when the approaching estrum has become established. 5. The Uterine Arteries The uterine arteries afford definite evidences of preg- nancy. As soon as the fertilized ovum has become implanted 122 Diseases of the Ge7iital Organs in the uterus, all vessels leading to that organ awaken to a wholly new activity. There are three pairs of arteries con- cerned, the utero-ovarian, the uterine, and the vaginal. In the healthy non-pregnant cow or mare each of these is clearly palpable per rectum, approximately one-eighth inch in diameter and, being but lightly covered, yields a clear, though not strong, pulsation. The utero-ovarian artery, analogue of the chief artery of the testicle in the male, arises from the aorta near the ori- gin of the small mesenteric, and, passing downward, back- ward and inward between the peritoneal layers of the broad ligament, divides near the ovary into two branches, one go- ing to the ovary, the other supplying the oviduct and the apex of the uterine horn. Readily palpable in the non-gravid animal, it is soon dragged so far forward that rectal palpa- tion is rendered inconvenient. The two other pairs, which are readily reached, suffice in virtually all cases, and conse- quently the utero-ovarian artery is commonly ignored. Its palpation becomes of great importance in the diagnosis of ovarian tumors. The middle or chief uterine artery arises usually from the posterior aorta near its division into the iliacs, or from one of these, and is easily recognized as it leaves the arterial trunk, at almost right angles, in the region of the anterior border of the shaft of the ilium. It curves backward, me- dianward, and finally, in the form of an arc, forward, to dis- appear in the uterine walls at or near to the base of the uterine horn. During this course it lies between the two peritoneal layers of the broad ligament of the uterus, is much longer than the broad ligament and is thrown into nu- merous S-shaped coils. It is readily picked up per rectum and palpated in the non-pregnant animal and in all stages of pregnancy. With the advent of pregnancy, the artery quickly enlarges and the pulsation becomes strong and bounding. The arterial stream feels as if impeded and there is a sensation of grating not encountered in other healthy arteries. The artery is about one-quarter of an inch in diameter at 120 to 150 days ; at eight months it is one-half Paipatio7i of the Uterus per Rechun 123 inch or over; and in a large cow closely approaching full term it may be nearly three-quarters inch, full and bounding. The posterior uterine or vaginal artery is given off from the internal pudic, approximately opposite the apex of the angle between the sacro-sciatic ligament and its point of at- tachment to the sacrum, and passes across the pelvic cavity in the broad ligament of the vagina to the vagina and cervix. In the healthy non-pregnant cow it is almost as large as the main uterine artery. It is easily picked up per rectum and palpated. Like the middle uterine artery, it enlarges very rapidly as soon as pregnancy is established but attains no such great dimensions as the former. It reaches ordinarily the size of a lead pencil. The examiner, in the course of his work, should acquaint himself with these various changes by studying animals pregnant for a known period. In this manner he becomes familiar with the clinical findings and is able to reach a closer approximation of the date of pregnancy of females whose history of conception is wanting. 6. Palpation of the Uterus per Rectum The palpation of the uterus of the cow and mare per rec- tum affords the most valuable means which we possess for the diagnosis of pregnancy. After conception the uterus undergoes prompt and marked changes in volume, form, consistence, and location. When estrum occurs, there is a marked engorgement. The organ is hard, tense, and smooth. The condition is most notable in heifers. If conception oc- curs, the engorged, undulatory character continues for a time and in heifers the organ remains almost static in size for fifteen to twenty days, after which it gradually en- larges. In cows which have calved previously, these symp- toms do not become so apparent and the enlargement is not pronounced until thirty to sixty, or even seventy, days. Then the uterus becomes larger, most markedly in the gravid horn. Owing to the great variations of the size of the uterus in adult cows and mares, due partly to individual peculiarities and partly to the health or disease of the organ, one has 124 Diseases of the Genital Organs sometimes to await a quite definite increase in volume before this becomes of distinct value in determining pregnancy. The same may be true of heifers which have been sterile for a long period and in which the uterus has undergone en- largement because of chronic endometritis. As a general rule, however, heifers which have conceived at all promptly show distinct and characteristic enlargement of the uterus within twenty to thirty days after conception, and cows at any time from thirty to sixty or seventy days. The enlargement of the uterus as a result of conception is very characteristic. The organ may be enlarged from a great variety of causes, but the enlargement due to other in- fluences than pregnancy differs materially and clearly in al- most every case. In pregnancy the uterus is smooth and even in outline, firm, tense, and fluctuating. Except in case of twin pregnancy, the pregnant horn is much larger than the other and regularly corresponds with the corpus luteum of pregnancy. While the corpus luteum is regularly palpable in early pregnancy in the cow, it is not so in the mare be- cause it is hidden deeply in the hilus of her ovary. At the region of the internal os uteri, the superior uterine wall of the pregnant cow rises up suddenly like a terrace instead of sloping forward gradually as is observed when pus or lymph distends the organ. The firmness of the uterine wall is in marked contrast also to its character when the organ is dis- tended with pus or lymph. In pregnancy the uterus is dis- tinctly firm and exhibits to the touch a sense of vigor and life. When lymph distends the uterus, the walls may be thin as in pregnancy but they are almost always soft and flaccid and the horns are usually somewhat equally filled. In rare instances, owing to compression of the cervical canal due to sclerotic swellings in the cervical walls associated with cer- vicitis, menstrual debris is retained, distending the uterus quite firmly and giving a tension much like that of preg- nancy, but the two horns are alike and there is but one cor- pus luteum. Usually in such cases no uterine seal is pres- ent. When the organ is distended with pus, the contents do not move as freely as the fetal liquids. The uterine walls Palpation of the Uterus per Reduvi 125 are soft and flabby with a moderate amount of thickening, or they are tense and at some place an abscess may point, or the organ is very dense, with thick, hard walls. As pregnancy advances, additional evidences appear. The uterus becomes very greatly enlarged, the walls are tense, and the fetal fluids are quite readily recognized as such. Later, cotyledons are palpable through the uterine wall and when pregnancy has reached four to five months one will occasionally recognize the fetus itself floating in its fluids. The fetus becomes increasingly easy of recognition as preg- nancy advances. In some cases, however, both fetus and uterus fall forward into the abdomen and may be beyond the reach of the examiner. In such cases there is still good evidence of pregnancy. The vagina is drawn far forward, the cervix has been dragged anterior to the pubis, and the vaginal end of the uterus constitutes a large, thick, firmly stretched band passing downward and forward beyond the examiner's reach. This of itself does not indicate preg- nancy with absolute certainty, because the same displace- ment of the uterus also occurs from the presence of large uterine or ovarian tumors, from extensive pyometra, or from other pathologic conditions which would cause an increased weight of the organ. The application of the uterine forceps to the cervix, followed by traction on these, thus drawing the uterus upward and backward, to or into the pelvis, as already advised, is of supreme importance in making an accurate diagnosis in these cases. No other means alone can afford so great assistance and security. In this emer- gency, however, other signs appear to aid the examiner in making his diagnosis. As a general rule, the diagnosis can be verified by the presence of the uterine seal,- by abdomi- nal ballottement, or by palpation of the enormously en- larged uterine arteries. In some instances it is practicable to diagnose the physical well-being of the pregnancy. It is easy to diagnose desiccation of the fetus from the time when the interplacental hemorrhage occurs. When the metritis of pregnancy is so far advanced that abortion is not very distant, it may be diagnosed by vaginal and rectal 126 Diseases of the Genital Organs palpation, even though the fetus be yet alive, but this is not as easy in the cow as in the mare. In the latter I have been able to pass my finger through the wide, short cervical canal, from which the uterine seal had disappeared, palpate the suppurating, necrotic area of the chorion about the os uteri internum, and, beyond, touch the active fetus. In the cow this is impracticable, but one may recognize by vaginal examination the disease or destruction of the uterine seal or portions of necrotic chorion in the cervical canal or pro- truding into the vagina. By rectal examination, one may recognize clearly the paretic uterus of metritis, its want of tone, its flaccidity at the cervical end, and the thickened wall. By these means I have been able to make the diag- nosis "Pregnant, but unsafe" and, to the astonishment of the breeder, have my diagnosis verified in a few weeks by the cow aborting. The dead and macerating or emphyse- matous fetus and such displacements as torsion of the uterus without clinical symptoms are clearly diagnosed by rectal palpation. The palpation of the pregnant uterus per rec- tum has, therefore, a very wide range of usefulness and is capable of important advancement by further study. Much fiction has been indulged in regarding the dangers from palpation of the gravid uterus per rectum. While some persons are bungling enough to rupture the rectum in this procedure, that is not the fault of the operation, but merely the ignorance, stupidity, or carelessness of the ex- aminer. The idea that abortion may be caused by a pru- dent rectal palpation is no better founded, if as well, than the unavoidability of rupturing the rectum. A stupid ex- aminer might rupture the gravid uterus, or possibly roll it over and cause torsion, but that is not abortion, and does not lead to abortion. I might illustrate the safety of the examination by a typical incident to which reference will be made later. I was examining for pregnancy a cow which had been bred 145 days previously. The findings were ex- ceedingly confusing. I palpated the uterus for one-half hour before I finally recognized the presence of torsion. The cow was left for about twenty hours, then was cast, The Diagnosis of Twin Pregnancy 127 rolled over several times, released and caused to get up, then thrown and rolled again. In all, she was rolled com- pletely over six times, thrown twice, and the gravid uterus palpated with considerable vigor. She calved easily and without assistance, at 280 days. Both mother and calf were healthy. Thus, she endured severe uterine torsion, violent rolling, and prolonged palpation per rectum, without visible disturbance of the course of pregnancy. Some veterinarians are afraid to apply forceps to the cervix of a pregnant cow or mare and exert traction. The proper application of the uterine forceps to the cervix does not cause any material disturbance to the uterine seal and causes only the most trivial wound of the cervix. The trac- tion applied to the cervix by any veterinarian of very ordi- nary prudence is not so great as the tension caused upon the same parts when the animal is lying down or getting up. Generally life can be recognized in the fetus by rectal ex- ploration long before it can be by auscultation of the heart or by other means. When the cow has been pregnant four or five months, the fetus, eight to twelve inches long, when touched, generally reacts to the impact and moves in a clearly recognizable manner. 7. The Diagnosis of Twin Pregnancy The diagnosis of twin pregnancy can be made only by rectal examination and is especially easy in the cow at 90 to 120 days, when the entire uterus may generally be palpated, as well as the ovaries. At this time, if the twins are bicor- nual, as is the rule, the diagnosis is very simple. The two horns are equal in size, and, as discussed in the following paragraph, there is a corpus luteum of pregnancy in each ovary. With all cardinal symptoms of pregnancy present, the two elements mentioned make the diagnosis very reli- able. Later, when the uterus becomes greatly enlarged and . passes far forward in the abdomen, the diagnosis is more difficult and less secure. The corpora lutea cannot then be felt, as the ovaries are out of reach and the uterine horns cannot be well compared. The diagnosis of twins must then 128 Diseases of the Genital Org arts rest upon the palpation of two fetuses, and there is no cer- tainty whether they are to present ahke or alternately. Generally they alternate; one presents cephalically and the other caudally. In campylorrhachis and schistocormus re- flexus, however, we meet with a single fetus presenting both by its cephalic and caudal ends. Double monsters may also be met, confusing the examiner. In unicornual twins, the examiner faces great difficulty. Almost, if not always, they lie end to end — either head to head or tail to tail — caus- ing an enormous elongation of the gravid horn which reaches, at the close of pregnancy, double the length of the antero-posterior diameter of the abdominal cavity, necessi- tating the doubling of the uterus upon itself, as in the bitch. Then the fetuses lie side by side, with two uterine walls be- tween them and their contact ends lying against the dia- phragm of the mother. Their free ends — two heads or two tails — lying side by side, are directed toward the pelvis. The basal fetus presents on a line with the long axis of the cervix ; the fetus occupying the ovarian end of the horn lies lateral to the basal fetus, on the side of the ovary of preg- nancy. That is, if unicornual twins are in the right horn, the basal fetus presents with its head or tail towards the cervix, and on the right of this lies the other fetus, present- ing by the same part but lying to the right of the cervix. The ovary may now be pushed toward the pelvis and its two corpora lutea should be palpable. On the left the non- gravid horn would be palpable. In one cow about 60 days pregnant, unicornual twins were quite securely diagnosable by the presence of two typical corpora lutea in the ovary on the pregnant side. That does not make twin birth neces- sary. One embryo may perish and be absorbed but the diag- nosis is still important because the other embryo may be a "freemartin", or neuter, though born singly. If a good diagnosis of twin pregnancy has been made, a single birth follows, and the offspring is apparently a female, its sex may well be doubted. Diagnosis of the Duration of Pregnancy i 29 8. Diagnosis of the Duration of Pregnancy It is highly important that the veterinarian shall be able to diagnose with reasonable accuracy the duration of an ex- isting pregnancy. As already related, the heifer or cow sometimes comes in estrum and is re-bred perhaps repeat- edly after conception. It is then desirable to be able to state, approximately, the stage of pregnancy in order that it may be determined at about what period parturition may be anticipated. When heifers or cows are bred in pasture so that the date of conception is practically unknown, the determination of the duration of pregnancy is at times sought by the owner. In pedigreed cattle, when pregnant females come in estrum, the bull is sometimes changed and confusion of pedigree results, which may often be satisfac- torily solved by physical examination to determine the dura- tion. Sometimes conception occurs unexpectedly and a de- termination of the stage of pregnancy aids in determining how it occurred. Thus in one instance, in a cow supposed to be non-pregnant which showed no estrum, examination led me to say that she was pregnant four months. The owner was certain she had not been served, but it was finally recalled that four months previously a bull, supposed to be too young to copulate, had been with her at pasture. In another instance a pure-bred Holstein cow purchased a year previously as pregnant six months, had not calved, had not been in estrum so far as known, and, according to his- tory, had at no time been where a bull could copulate with her unknown to the custodian. In addition, her vagina con- tained a quart or more of highly fetid pus. In spite of such a history, I pronounced her pregnant six months and the fetus alive. She calved true to diagnosis. When the custo- dian saw clearly that the cow was to calve soon, he recalled that she had, at the date indicated, escaped to the premises of a Shorthorn breeder, though it was not known that she had copulated with the Shorthorn bull. During the first five or six months, the stage of preg- nancy in cattle is to be determined by the transverse diame- ter of the pregnant horn of the uterus. During the latter 9 130 Diseases of the Genital Organs stages, the duration is to be determined by the volume of the palpable part or parts of the fetus, the volume of the uterine arteries, and to some extent by the volume of the uterine seal, the dilation of the cervical canal, the enlarge- ment of the udder, and the sinking of the pelvic ligaments. In a heifer of medium size, pregnant thirty days, the gravid horn is about one to one and one-quarter inches in diame- ter. When forty-five days pregnant, the gravid horn has increased to one and one-quarter or one and one-half inches. At sixty days, it has reached about one and three-quarters inches; at ninety days, two to two and one-half inches; at one hundred to one hundred and twenty days, three to three and one-half inches. At one hundred and fifty days, the gravid horn is four and one-half to six inches, and at one hundred eighty days, seven to eight inches. In the cow, during the first sixty days, the uterus is somewhat larger than in the heifer, and later is not quite as tense as in the latter, but there is no recognizable difference in size. At about one hundred fifty to one hundred eighty days, the fetus is generally palpable. Frequently it is palpable at a much earlier date even when only six to eight inches long, but recognition of the fetus at this time is not at all certain in any given case. Even when the fetus is recognized at this early date, it is of little or no advantage, as a means for determining the stage of pregnancy, over the transverse di- ameter of the gravid horn. Once the fetus is palpable, its age is to be judged by the volume of the extremity palpated. The length of the fetus cannot be determined. The parts usually palpated are the head or the anterior feet when in the anterior presentation, or buttocks when in posterior presentation. ' The size of these will vary with the size and age of the pregnant animal and with breed. The Holstein fetus is the largest commonly encountered and has large head and feet. The Jersey pre- sents the other extreme. The examiner is to bear in mind individual variations in size of fetuses also. The determina- tion of the stage of pregnancy by physical examination is evidently only approximation but, with the breeding history, Diagnosis of the Duration of Pregnancy 131 may be rendered very exact. Thus when a cow or mare has been bred but twice with an interval of two to four months between and the two dates definitely known, the veterinarian can then positively state by which service the animal is pregnant. Depending upon the value of the animal and the skill of the veterinarian, the rectal palpation of pregnant animals may be made of wider use to breeders. The trained human obstetrist examines his patient at intervals during her preg- nancy in order to determine if all is well and, if possible, to recognize any impending danger to mother or fetus. So in animals there is an interesting and useful opportunity for service. Thus in the cow with torsion of the uterus, to which reference was made above, the statement is quite jus- tified that this examination of an apparently well cow saved the lives of herself and fetus. In mares and cows the pos- terior presentation of the fetus is as a rule a definite peril. In many instances definite assistance is required during par- turition. If the presentation were known in advance, close watch might be kept and veterinary aid more promptly sum- moned. Perhaps one of the most striking instances where the diagnosis of the presentation of the fetus would prove of tremendous value to the breeder, is in the transverse or bi- cornual development of the fetus in the uterus of the mare. In the commonest of these, the ventral transverse presenta- tion, virtually every foal is lost, since the sacrifice of its life in the performance of embryotomy is essential to any hope for the life of the mare. Nevertheless, the mortality in mares from this presentation is appalling. When the con- dition which I have described in Veterinary Obstetrics as "compound rotated bicornual pregnancy" is encountered, no foal or mare, so far as recorded, has emerged from the ordeal alive. It seems to me that the most hopeful outlook for such cases would be to diagnose them as early as mid- term, and either bring about artificial delivery while the fetus is yet small, or resort to Caesarian section some time during the eleventh month. 132 Diseases of the Genital Organs There lies before the veterinarian an interesting, and as yet wholly undeveloped field of usefulness in watching preg- nant animals and guarding them against important perils. 9. Palpation of the Fetus per Vaginam Palpation of the fetus per vaginam generally succeeds only during the last months of pregnancy. At this time, in many cases, some portions of the fetal body, usually the head and two anterior feet, rest upon the vagina posterior to the OS uteri externum, occasionally giving the inexperi- enced examiner the impression of extra-uterine pregnancy. 10. Abdominal Ballottement After the sixth month of pregnancy, in the cow, the but- tocks or other portions of the fetus usually lie in close con- tact with the abdominal floor of the lower right flank re- gion. If the hand is placed firmly against the abdominal wall, a somewhat vigorous thrust made upward, and then suddenly the force released, but the hand kept in contact with the parts, the adjacent portion of the fetus is pushed upward in its fluids, floats for a moment, and then drops back against the examiner's hand with a recognizable im- pact. This is a good sign of pregnancy, but not always re- liable. Sometimes no portion of the fetus chances to lie in sufficiently close contact with the abdominal wall to render the test eflficient. On the other hand, a tumor or a very large and heavy intestinal calculus might mislead the ex- aminer when the animal is actually sterile. 11. Auscultation of the Fetal Heart In the advanced stages of pregnancy it is frequently possi- ble, by careful auscultation of the abdominal walls over the region of the fetus, to detect the beat of the fetal heart, which is usually at least twice as rapid as the beat of the maternal heart. The abdominal ballottement and the auscultation of the fetal heart are of minor value to the skilled veterinarian, be- cause when these can be successfully applied the other signs The Abderhalden Reaction 133 which have been enumerated should have decided the ques- tion long before. 12. The Abderhalden Reaction Abderhalden (0 announced in 1912 the discovery of a highly interesting method for diagnosing pregnancy by a laboratory test. A test fluid is made from placental tissues, to which is added serum from the animal to be tested, and the mixture is placed in a dialyzing tube. If the animal is pregnant, portions of the ferments existing within the blood serum dialyze into surrounding distilled water, in which they may be recognized by a delicate purple coloring, upon the addition of ninhydrin followed by heat. It is claimed that the placental ferments appear in the blood as early as eight days after conception and disappear within fourteen to twenty-one days after the expulsion of the placenta. In the larger domestic animals it is more than eight days be- fore any placental tissue commences to form. It is not easy to understand how a test for placental elements can act until placental tissues exist. The statement that a reaction may occur as early as at eight days is probably based upon re- searches upon some small rodent, where the placenta de- velops much earlier. Since the preparation of the test material and the test it- self are very complex, requiring delicate laboratory appara- tus and highly technical skill, the test is expensive as com- pared to its value in the veterinary field. Even in human obstetrics and gynecology, where the cost is not as great an element and where an accurate physical examination is not nearly as practicable as in the mare and cow, the test is not regarded by many of the foremost authorities as effi- cient. J. Whitridge Williams (-) states, ''While I consider that the method should be regarded as one of the important recent contributions to medicine, I do not believe that it is destined to come into extensive practical use for several reasons : First, its technic is so complicated that it can be ^ Die Serodiagnostik der Scliwangerschaft, Deutsche med. Wochenschr. , 1912, No. 46. ' Obstetrics, 1917. 134 Diseases of the Genital Orgayis satisfactorily employed only by especially trained labora- tory workers. Second, even its most enthusiastic advo- cates admit that the results fail to correspond with the clini- cal findings in 5 to 10 per cent, of cases, and thirdly, that it is available only in normal pregnancy, as it gives uncertain results in inflammatory conditions and uterine myomata, or when the pregnancy is complicated by nephritis or tox- aemia." Graves (0, speaking of this test, states, "Opinions dif- fer as to the present value of the Abderhalden test for preg- nancy, some regarding it as too inaccurate to be of much clinical value, while others consider it reliable and practical (McCord). The test requires much skill and care, there be- ing numerous chances for error. For that reason it has not yet come into general practical use." Thus for woman, where accurate diagnosis is most im- portant, leading authors either condemn the test as unre- liable or seriously question its value in the present state of knowledge concerning it. Zell(-') concludes that the test is very reliable, but when questioned admits that the serum of a cow may react for twenty or more days after abortion, that many tests are valueless because of slight errors in drawing the blood or decanting the serum, and that various diseases nullify the value of the test. Finally, he admits that the test is not at all sufficient or complete within itself and must always be considered in conjunction with — not as a substitute for — physical examination. In 78 clinical cases summarized, the test was erroneous in 5 animals — or 6.4 per cent. Any fairly good diagnostician can be more accurate by physical examination. Some have claimed a place for the Abder- halden test on the ground that, in the cow and the mare, physical diagnosis is impracticable in the first half of preg- nancy and in the second half physical examination imperils the pregnancy. Neither of these assumptions is true Should the test become simplified and its accuracy be ad- ' Gynecology, Graves, Wm. P., 1917. '■'C. A. Zell, The Abderhalden Test for Pregnancy in Animals, Jour. Am. Vet. Med. Assn., Oct., 1917. New Series Vol. 5, No. i, page 39. The Abderhalden Reaction 135 vanced, it may prove valuable in sheep, goats, swine, and carnivora, where rectal palpation is not practicable, but in these a diagnosis is rarely of sufficient importance to war- rant the cost. It is claimed that the test is highly valuable in cases of sale and warranty, but at the same time it is admitted that the blood of a cow which has recently calved, and presuma- bly also of one which has recently aborted, gives a positive reaction for a somewhat indefinite period. Accordingly, even though a test is positive and no error in technic has been made, the Abderhalden test can at best show only an alternative result — that is, the animal either is or has re- cently been pregnant. Just how recently, we do not know. In this respect it is inferior to physical diagnosis, because the latter shows that the animal is actually pregnant at the time of examination and in many cases gives valuable in- formation as to the safety of the pregnancy. In another direction the Abderhalden test is very de- fective. In examining cows for sterility, the examiner must decide upon the spot whether a cow is pregnant. In many cases the whole value of his work in relation to ster- ility depends upon a prompt and accurate diagnosis without resort to laboratory methods, with the accompanying de- lays and difficulties. For example, when called to examine a cow which has proven sterile, at about the time for a re- turn of the estrual period, the practitioner needs to make a prompt and accurate diagnosis and apply the proper handl- ing immediately. If he cannot make a diagnosis and take prompt action, if the cow is nearing estrum, he must lose one period without having made any material progress. At present it seems highly improbable that the Abderhalden test for pregnancy is destined to attain a prominent place in veterinary medicine. The physical diagnosis of pregnancy is not dependent upon any one sign, but rather upon a summary of all signs, all of which are in close accord and are available to the careful examiner. We have dealt with these individually. They should always be considered individually, and later 136 Diseases of the Ge7iital Organs collectively. For example, if an animal has been bred for thirty days, if estrum has not recurred, if the uterine seal is present and definite, if one of the horns is larger than the other, and on the same side with the enlarged horn there is a typical corpus luteum of pregnancy, the cow is pregnant, and the diagnosis is as accurate and secure as any diagnosis which we can make. Other signs exist which may aid us and add to the security when any one of these fundamental signs is absent or in some manner clouded. With experi- ence and care, any veterinarian can learn to make a safe and accurate diagnosis of pregnancy by physical examina- tion. Certain other signs of pregnancy frequently relied upon have a minor value. One of the commonest physical signs of pregnancy is a change in the volume and form of the ab- domen. However, this is not in itself dependable. Many non-pregnant animals have greatly enlarged abdomens, and many in advanced pregnancy show but little enlargement of the abdomen. In a heifer, gaunt from advanced tuberculo- sis and believed non-pregnant, I diagnosed twins, to which she gave birth a few weeks later. The enlargement of the mammae is generally a reliable sign of advanced pregnancy, but some cows do not show marked' enlargement. In other cases sterile heifers lactate freely. I saw one, which was not and had not been preg- nant, yield twenty pounds of milk daily. 13. Confusing Findings in Examination for Pregnancy While engaged in rectal palpation, one sometimes en- counters conditions which confuse the examiner, at least temporarily. a. The left kidney, in all cows, is displaced somewhat to the right and appears quite pendulous. It is much larger in the living than in the dead animal. It contains a great vol- ume of blood. In some cases, it hangs very pendant, and an inexperienced veterinarian, coming in contact v/ith it for the first time, may for a moment think it a tumor. Conftising Findings in Examination for Pregnancy 137 Fig. 46. Lipoma of Mesenteric Fat of Large Intestine. Cow. /, /, /, Large intestine ; 2, 2, 2, cross sections of loops of large intestine, surrounded by fat tumor. 1 38 Diseases of the Genital Organs b. Mesenteric fat tumors of immense size occur now and then, chiefly in the mesentery of the large intestines, as seen in Fig, 46. I have seen these mostly in Guernseys and Jer- seys. They consist of great masses of necrotic fat, hard, marbled, and iridescent on section. They are quite movable in the abdomen. In my first case, I was greatly confused, and suspected that I had to do with an extra-uterine fetus. It was too far forward to permit of complete palpation. There is no occasion for such error. In extra-uterine preg- nancy the fetus is firmly moored by adhesions to the abdomi- nal floor. While I have no definite history, my museum speci- mens show the fetus, or fetuses, to be firmly encapsuled by adhesions, so that they are compressed into the narrowest space possible, but where and how they were attached I have no history. When the examiner is on his guard, the mesenteric fat tumors have in my experience admitted of ready diagnosis. Their relation to the intestines constitutes the chief guide. I have seen them in old, or at least adult, cows only. They may be of any size. In one case the entire abdomen appeared to be filled with these. c. Dislocation of the rumen is also a very disconcerting condition when first met. In one cow, to all external ap- pearances in perfect health, the rumen was extremely dis- located. The right sac had glided across the abdominal floor and had come to rest against the right abdominal wall, above the level of the pubis. The left sac of the rumen had de- parted from the left sub-lumbar region and dropped down until it lay only slightly above the pubis. The massive or- gan thus lay on the abdominal floor. Its normal left wall had become its floor; its right wall faced upward. The rumen occupied the entire abdominal floor in front of the pubis, and projected somewhat above it. The soft, pulta- ceous rumenal contents were readily recognizable. The or- gan could be clearly distinguished and traced. The genital organs, uterus, and ovaries passed directly forward and lay upon the dislocated rumen. The dislocation is apparently of no consequence, except for the confusion it may cause during rectal palpation. Confusing Findings in Examination for Pregnancy 139 d. Extensive pyometra has caused colleagues of consid- erable experience to diagnose pregnancy. In one instance, pregnancy had been diagnosed in a well-bred cow. She was sold at a high figure and shipped a long distance. She was finally returned by the purchaser at heavy cost. When I ex- amined her, I siphoned out 3 to 4 gallons of a thin, very fetid pus. In another instance, a heifer purchased as preg- nant, having gone beyond her supposed duration of preg- nancy, was examined and a macerating fetus diagnosed. I siphoned out about 13 liters of a very thin, odorless, yellow pus. In each case there was no observable purulent dis- charge, though the cervical canal was freely open. The uterus lay far forward (neither colleague had applied for- ceps and drawn the uterus back) and, finding it distended to the volume of six months or more pregnant, the colleague in each case erred and diagnosed pregnancy. The uterus was too flaccid for pregnancy and its walls were too thick. When traction was applied and the uterus drawn backward and upward until the entire organ was in reach, it was per- fectly clear no large fetus or fetal cadaver was present. It is true that often the gravid uterus drops far downward and forward, especially in old cows with pendant bellies, but fetal cotyledons are in reach even if the fetus is not. The veterinarian should also seek evidence from the uterine arteries. Pyometra cannot cause an enlargement of the arteries at all comparable with the enlargement of preg- nancy. e. Cystic Uterus. The uterus of the cow occasionally be- comes cystic and causes the veterinarian to err in diagnos- ing pregnancy. There may be five to ten gallons of lymph or thin mucus in the uterine cavity, the organ dropped far forward and very flaccid. There is no recognizable dis- charge. The cervical canal is usually free. In another group of cases, there is a blocking of the cervi- cal canal owing to one of the annular mucous folds acting as a valve to retain menstrual debris. This causes a tense filling of the uterus which is much like pregnancy, but the uterine seal is ordinarily absent, there is probably no corpus luteum typical of pregnancy, the arteries are not enlarged, and the two uterine horns are distended alike. Chapter III ARTIFICIAL INTERFERENCES WITH REPRODUCTIVE FUNCTIONS A. The Artificial Induction of Estrum The artificial induction of estrum has a wide application in cattle breeding and in dairying, but has not been rendered available in other species of animals. Aphrodisiacs. Yohimbin Spiegel. For many years nu- merous drugs have been credited with the power of arousing the sexual appetite and powers. Among these are canthar- ides, turpentine and the balsams and resins and, more re- cently, a new drug, yohimbin, has been introduced to over- come sterility. In large doses, these drugs induce more or less irritation of the urino-genital tract and, apparently, stimulation of the sexual desire. It has not been shown that aphrodisiacs stimulate ovula- tion and spermatogenesis. From all data at hand, they merely arouse the sexual appetite without increasing the re- productive powers. In the minds of some, vigorous sexual desire signifies exalted breeding powers, but this is a false assumption. In nymphomania, for example, the sexual ap- petite is intense and the breeding power nil. Sexual appe- tite, without normal ovulation in the female and the forma- tion of normal spermatozoa in the male, has no value, but is rather a harm, frequently leading the owner astray and di- minishing the value of the patient for other purposes. A few years ago vigorous propaganda brought into notice yohimbin spiegel as a magical sex tonic and a great weapon against sterility. The pathology of the cases where it was alleged to give relief was not recorded. It was used almost wholly in females which failed to come in estrum, but why they failed no intimation was given. Holterbach (Berlin Tierarztliche Wochenscrift, No. 9, 1908), in an exhaustive article, champions the use of the drug. He used it in 37 cases of absence of sexual desire — The Artificial Induction of Estrnm 141 22 cows, 9 bitches, 3 bulls, and 3 sows. In his observation, the drug has a greater affinity for the female than for the male genitalia, A five-year-old Simmerthal cow calved nor- mally in June, 1906, but estrum did not follow. All other drugs, including cantharides, proved useless. In August, 1907, fourteen months after calving, 16 tablets of yohimbin chloride, each containing 0.1 gram of the alkaloid, were pre- scribed, one tablet to be given three times daily in the drink- ing water. On the third day there was excitement, bellow- ing, uneasy stepping about, frequent urination and de- creased milk flow. On the fourth day there was a muco- sanguineous discharge from the vulva (menstruation?) and on the fifth day the owner noted expulsive efforts resembling labor pains. The external genitals were swollen and hyper- aemic, but no estrum was present. The uterus was large. The ovaries were enlarged, but not cystic. Six weeks later, the cow, showing violent estrum, was bred and the owner "believed" her in calf. Another cow, nine months post partum ,without estrum, and having cystic ovaries, was treated in the same way, de- veloped estrum ten weeks later and was bred. The owner "believed" her to be pregnant. So far as can be seen from Holterbach's reports, the evi- dence is not convincing. In no case was the cause of non- estrum explained, and no proof was submitted that the es- trum, following the use of yohimbin, was due to the drug. Frubinger (D. M. W. No. 7, 1907) condemns the drug as worthless and attributes the alleged cures in man to sug- gestion. Miiller (Arch. Internat. Phar. et de Therap., Vol. XVII, p. 81) considers it an erratic aphrodisiac, acting differently on different individuals. Daels, quoted by Holterbach, ex- perimentally caused menstruation in bitches already in es- trum, but bitches usually menstruate at this time anyhow. In another, not in estrum, but date of probable normal es- trum not named, menstruation occurred in four days. A third bitch showed a mucous discharge. Later, bloody feces were voided and the animal died from the toxic effects of 142 Diseases of the Genital Organs the drug. Autopsy showed enlarged, congested genital canal, prominent ripe ova, etc. In experiments on young bitches less than nine months old, the drug, in fatal toxic doses, failed to cause reaction in the genital organs. I used the drug experimentally upon several cows in which I had otherwise failed to induce estrum, but, like other efforts, it was without avail. In one cow there were ovarian adhesions ; in another, cystic degeneration of the ovaries, etc. The drug has dropped out of notice except for an occasional medicine vendor who adheres to "patent medi- cine" ideals. The failure of an adult, non-pregnant female to come in estrum at the proper time is due to some patho- logic condition, the removal of which is followed by estrum. But the removal of the cause of non-estrum must be the basis for action in each case. These pathologic conditions will be discussed in their proper places. In some cows es- trum is not very evident, or the keeper fails to recognize it. The animal may be healthy or unhealthy. It is important in some healthy cows to get definite track of the estrum. If, upon the examination of an animal in which estrum is not observed, the general health is good, the genital organs nor- mal, and a corpus luteum present, it is sufficiently clear that at some former date the animal had been in estrum and had ovulated. If the corpus luteum is dislodged by compressing it per rectum, the animal will quite certainly be in estrum in three or four days. In some cases it is desirable to interrupt the estrual cycle because several females are in estrum simultaneously and the service of all would overwork the herd bull. The vet- erinarian can, by dislodging the corpus luteum, adjust the estrual cycle at will. Healthy cows sometimes fail to ovulate promptly after parturition, thereby causing a delay in re-breeding. When a cow does not show estrum within sixty days after par- turition, if she is healthy, the corpus luteum of pregnancy is probably tardy in disappearing. It then becomes of im- portance to the dairyman that the yellow body shall be dis- lodged and the cow caused to come in estrum. Artificial Insemination 143 The veterinarian should constantly remember that es- trum and ovulation come as a matter of course in healthy females of breeding age and that when estrum fails it is because of general ill health or some other restraining cause. No drug has yet been discovered which can di- rectlj^ cause estrum or ovulation. The restoration of the general health, relief from distinctively genital diseases, and the surgical dislodgment of the inhibiting corpus lu- teum, when present, constitute the fundamental principles in regulating estrum and ovulation. B. Artificial Insemination. Artificial Impregnation Artificial insemination or impregnation has been advo- cated by a limited number of veterinarians and breeders. The advocacy has been based upon various hypotheses and facts, but the operation has not come into extended use. At present there are no indications that the scheme will ever occupy an important place in livestock husbandry. Artificial insemination is not difficult and there can be no question of its efficacy in fertilization. It has been advo- cated in two distinct fields — to conserve the sexual powers of valuable sires by causing numerous fertilizations from a single coitus and also to insure fertilization in a female otherwise sterile. The fertilizing of many females by a single coitus is of course technically possible, and has appealed very strongly to some owners of fashionable sires. Technically, in all ani- mals there are millions of spermatozoa ejaculated at each coitus, of which but one can take part in the fertilization of an %^%, and the millions of others must perish. Any at- tempt to conserve these millions of spermatozoa, when from a valuable sire, has much in it to appeal to some owners, and comparatively simple means are at hand for carrying out the operation. The prime essentials to possible arti- ficial fertilization are that the spermatozoa shall be obtained promptly after ejaculation by the male, kept moist, the tem- perature maintained at approximately that of the body (100 to 105 degrees, F.), and introduced into the genital 144 Diseases of the Genital Organs canal of the female with sufficient promptness that the spermatozoa shall have lost none of their vigor. In large animals (horse and cow) semen may be collected immedi- ately after coitus by introducing the hand into the vagina, using it as a ladle to gather up and withdraw the contents, and may then be placed in a wide-mouthed bottle or other vessel, immersed in water at a temperature of 100° to 105° F. The semen may then be diluted, if required, by adding sterile physiologic salt solution of body temperature. Di- luted or undiluted, the semen may be introduced into the vagina, cervical canal or uterine cavity of another female which it is desired to fertilize. The introduction may be made with a syringe, a funnel fitted with a tube, or other apparatus. Spermatozoa have been kept artificially in a motile state for many hours. In the healthy genital tract they presuma- bly retain their motility for days. Motility of the sperma- tozoa is not proof of fertilizing power, and no satisfactory data are at hand indicating how long after ejaculation sper- matozoa retain vigorous fertility. It is probably for a few hours only when in the healthy genital tract, where the spermatozoa unquestionably live longer than when kept out- side the body. In mares and cows, rape is occasionally in- duced by the breeder, under the belief that it will cause es- trum to appear soon. In other cases, the female has been in estrum, which, before opportunity for coitus has occurred, ceases and the owner hopes by belated coitus, under com- pulsion, to secure fertilization. Rape virtually always, if not always, fails of results. It is reasonable to assume that artificial insemination can be no more productive of results than rape. Mule breeding is based upon approximate rape, but the resistance of the mare is not because she is not in estrum but owing to her repulsion to coitus with the ass. It appears that artificial insemination must, therefore, ap- proximate the essentials of physiologic coitus. The sperma- tozoa need to be transferred promptly, during estrum. The suggestion that semen may be transported long distances and used successfully should be discounted liberally until Artificial hisemination 145 further evidence is adduced. The allegations of some en- thusiasts that artificial insemination succeeds whether the female is in estrum or not is without supporting evidence and appears absurd. Artificial insemination has numerous objectionable feat- ures. So far as I am aware, no livestock association offi- cially recognizes such fertilization for purposes of record of pedigree. The moral hazard in recording pedigrees is al- ready great and artificial insemination would open a new avenue to fraud. While the millions of spermatozoa ejaculated at each coitus are technically capable of infinite fertilizations, some are dead and some defective from the first, and most of them succumb to bacterial or other injury while en route from the vagina to the ovary, so that their numbers are greatly reduced before they have reached the pavilion of the oviduct. As soon as the spermatozoa are apportioned between two or more animals, the certainty of fertilization decreases. It is clearly impossible to keep the spermatozoa as well outside the body as within the genital tract, and slight error in technic may destroy completely the fertiliz- ing power. The chief menace from artificial insemination is the trans- fer of infection. In natural coitus, when the semen is ejacu- lated into the vagina, there may be present infection from both the male and the female genital organs. Most infec- tions, so far as known, are non-motile. This affords oppor- tunity for the vigorously motile spermatozoa to move away from the infection, elude the dangers ,and effect fertiliza- tion. Semen taken from the vagina of one female contains the bacteria from herself and the male and, when introduced into the vagina of a second female, carries for her a double danger. If, as is generally advocated, the insemination is made intra-uterine, the danger from infection is greatly in- creased. Artificial insemination has also been advocated as a remedy for sterility. When first proposed, atresia of the cervical canal was considered one of the chief causes of 10 146 Diseases of the Genital Organs sterility. Had that been true, the plan would have had merit. Later developments show clearly that cervical atresia is essentially negligible as a cause of sterility. Ar- tificial insemination has, therefore, only a very limited and questionable place in the treatment of sterility. Diseases of the vagina, cervix, and uterus which might cause sterility are more readily remedied by other means than by artificial insemination. Diseases of the oviducts and ovaries cannot be favorably affected by the operation. Artificial insemina- tion may have some value under exceptional conditions in extending the breeding range of highly valued sires, and in very rare cases may possibly have value in sterile females. Artificial Abortion Occasionally artificial abortion in animals becomes desir- able in the economic interests of the owner. When highly pedigreed females are accidentally permitted to copulate with common males or with pedigreed males of a different breed, the progeny is valueless and the span of the pregnancy becomes a loss to the owner in so far as the production of valuable progeny is concerned. Sometimes, also, a heifer calf of five to ten months unexpectedly comes in estrum, copulates with a bull, conceives, and, unless the pregnancy is artificially interrupted, is much damaged by repression of growth and development. No drug is known which is capable of causing a pregnant animal to abort. Ergot and other drugs have been cited as acholics or abortifacients, but there is no reliable evidence that any one of them is competent to cause abortion di- rectly. Ergot, given repeatedly and in large doses, finally poisons the pregnant animal, which, just prior to death, may abort. Such abortion is probably indirect; the toxic effect of the drug, by lowering the resistance of the body, may enable the infection present in the uterus to acquire new power and precipitate abortion. It is not known that any form of bacteria, living or dead, or any of their toxins or other products, possesses any di- rect ecbolic power, if by this term is meant an inherent Artificial Abortion 147 power to cause contraction of the uterus with the expulsion of its contents. Many veterinarians and research workers with the B. abortus of Bang believed for some years that this organism had the power to act directly as an abortifacient. Professor Bang made no such claim, so far as I have found, but in- stead contended that the abortion was the result of an endo- metritis for which he believed the B. abortus responsible. If the B. abortus could cause abortion by directly acting upon the central nervous system, it should be able to do so when the bacillus is multiplying elsewhere than in the uterus or fetus, but in all cases, when the aborter is promptly destroyed, metritis is present and bacteria are recognized as the cause of the metritis. Hence, so far as known, abor- tion can not be caused artificially by means of toxins or other bacterial poisons. Artificial abortion is quite certainly induced by breaking down the uterine seal, invading the uterus, and douching the cavity. The earliest date after copulation at which abor- tion can be induced by uterine douching is undetermined. Douching the uterus with a disinfectant immediately after copulation is quite certain to destroy all spermatozoa and prevent fertilization, but after the lapse of a brief time, certainly less than an hour in the cow, the spermatozoa, having passed into the oviducts, are beyond reach. Mar- shall, citing Hensen, states that in the rabbit the spermato- zoa travel from the vagina to the ovary in from fifteen min- utes to two hours. If that be correct, it is well-nigh im- possible to douche the uterus early enough after copula- tion to prevent fertilization. Marshall states that the fer- tilized ovum of the rabbit enters the uterus at about three days after fertilization. During this interval uterine douching can not interrupt pregnancy. In the larger domes- tic animals, the migration of the fertilized ovum from the pavilion of the oviduct into the uterus is believed to be slower than in the rabbit. Marshall (^ gives the duration of migration in the dog as eight to ten days. During this ' Marshall, A. Milnes, Vertebrate Embryology, 1S93, p. 47i- 148 Diseases of the Genital Organs interval, or about 16 per cent, of her span of pregnancy, the bitch can not be aborted by uterine douching. Bonnet beheves that in domestic animals generally the tubal migration of the fertilized ovum requires eight to ten days. The period is certainly no less, and I suspect that in the cow it is longer. In one cow, which had long been ster- ile, I douched the uterus freely with 2 per cent. Lugol's so- lution thirteen days after conception, without inducing abortion. There was moderate cervicitis present, and I douched from the cervical end of the uterus some mils, of pus, so that I possibly prevented, instead of caused, abor- tion. So far as known, artificial abortion in the cow can not be brought about by uterine douching until at least eight to ten days after conception, or, judging from my single experience, not until an even later date. There is greater assurance of success if douching is deferred until about the twentieth day. In douching the pregnant uterus, the veterinarian needs to be quite cautious. The catheter must be introduced very gradually and carefully through the cervical canal, since the very adhesive uterine seal dulls the sense of touch and renders mechanical injury possible. When the catheter has entered the uterus and douching is attempted, the instru- ment generally becomes blocked with portions of the uter- ine seal and no safe distension of the uterus with fluid will force out the sticky mass. The connecting screw between the outer and inner tubes needs to be loosened and the inner tube drawn back and forth until the plug of the uterine seal is dislodged and washed away. The amount of fluid introduced should be noted very care- fully, and great care taken not to use too much, because the pregnant uterus is vevij easily ruptured. In a recent publi- cation, a veterinarian records a case of "extra-uterine preg- nancy" in a cow, the uterus of which he had recently douched and ruptured, thus causing the fetus to become extra-uter- ine. It is to be remembered, since up to the fourth month the embryonic sac in the cow lies very loosely in the uterus, that the douching fluid pushes the maternal and fetal pla- centae apart. Then the detached sac, sucked into the fenes- Artificial Abortion 149 tra of the catheter, prevents the return of the fluid. If the catheter is removed, the detached embryonic sac blocks the cervical canal, the distended uterine walls contract, rup- ture takes place, and the fetus drops into the peritoneal cav- ity. Therefore it is safer to introduce a few ounces of fluid only, thus avoiding the peril of rupture. The fluid should be antiseptic, because, as a rule, the uterine cavity is septic and a neutral fluid stimulates the bacteria present. The fluid introduced must not be highly irritant. While the induction of abortion by means of the uterine douche is quite reliable in bringing about the expulsion of the uterine contents, it is neither the safest nor the best plan. Hess(0 was first to draw attention to the reliability with which abortion may be induced in heifers and cows by dislodging the corpus luteum of pregnancy. This operation possesses the great advantage over the preceding plan of causing the abortion in an approximately physiologic man- ner. That is, it acts directly, by removing the inhibiting power of the corpus luteum, and establishes uterine con- tractions closely simulating those of parturition and men- struation, without the intervention of any mechanical insult to the cervix and uterus. The abortion follows in one to three days. The operation is easy and safe in early pregnancy. As late as ninety to one hundred and twenty days, the operator can pick up the ovary of pregnancy per rectum with one hand, carry it back over the vagina, introduce the other hand into the vagina, grasp the ovary through its roof, and compress the base of the corpus luteum firmly between the thumb and fingers until the body is wholly dislodged. Sometimes the yellow body breaks up under pressure, so that only a portion is dislodged. The operator should be careful to press it all out. Later in pregnancy, the ovary can not be carried back over the vagina. In small heifers, the vulva may not permit the passage of the hand. Then it is essential to dislodge the corpus luteum by compression from the rectum. This must be done cautiously, since the • Hess, Professor E., Schweitzer Archives fur Tierheilkunde, No. 6, 1906, P- 351- 150 Diseases of the Ge^iital Orgatis rectal walls are but feebly resistant and are readily in- jured. With patience and care, the dislodgement can be carried out per rectum though not so safely as per vaginam. Artificial abortion is rarely advisable after the sixth month, especially for the purpose of terminating a funda- mentally undesirable pregnancy. It is safer in such cases, and the loss of time is little, if any, greater to allow the pregnancy to go full term and end in parturition. Should occasion arise for inducing abortion late in pregnancy, it would be necessary to resort either to breaking down the uterine seal and douching the uterus, or to performing lapa- rotomy, if the ovary of pregnancy has been dragged beyond reach per rectum. If the vagina is clean, vaginectomy may be performed as in spaying, the hand and arm inserted, and the ovary thus reached. However abortion is induced, once it has been completed, it is desirable to watch the progress of the case and determine by examination of the genital or- gans, including uterine douching, whether all is going well. Chapter IV ARRESTS AND ABERRATIONS IN GENITAL DEVELOPMENT A. Asexual or Bisexual Aberrations 1. Neuters, Freemartins So far as known, cattle lead in the production of asexual, or neuter individuals. This may be only apparent, since in cattle, more than in any other animal, the value of the fe- male of breeding age rests almost wholly upon its reproduc- tive powers, and any failure to breed attracts definite atten- tion. It may be that sheep and goats are as frequently neu- ter but that the condition is overlooked. In cattle the neuter is ordinarily one of a pair of twins, of which the other is a male and commonly fertile. The condition, so far as I know, has not been observed when the other twin is a female. Numerous theories have been advanced in an effort to ex- plain the origin of freemartins, or neuters, but the cause of the phenomenon has not been made clear. While ordinarily the neuter is twin to a male, I am unable to verify the gen- eral belief that this is universal. It has been my privilege to examine clinically several neuters which had been regu- larly registered in official herd books and sold as heifers. The rules of breeders' associations forbid the registration of an apparent female which is twin to a bull until the ani- mal has conceived. In some instances where the animal has not been sold, but has been bred by the party for whom the examination was made, I have had personal assurances that it was a single. Some of these cases may be due to fraud upon the part of the breeder. Other animals may be truly singles in so far as birth is concerned, but the conception may have been twin and one embryo may have perished and disappeared. I am inclined to believe that neuters rarely come from a single conception. Accordingly, when examin- ing a neuter which has been registered and sold as a breeder, 152 Diseases of the Genital Orgayis I always feel that fraud has probably been committed, though I believe that exceptions exist. In the most typical individuals, no distinctively genital organs exist, but traces of both Wolffian and Mueller's ducts are present and may be clearly traced. No ovaries or testes are present, but very tiny undifferentiated sex glands may be recognizable. Every gradation of development is encountered, from ab- solute neuter to complete female, but the direction of devel- opment in cattle, so far as I have observed, is always toward the female — never toward the male or toward hermaphrod- itism. Hermaphroditism, so far as I have noticed, is rarer in cattle than in any other species of domestic animal, but Fig. 47 — Arrested Development of the Genital Tract. Bovine. MU, Meatus urinarius ; V, vulva ; //, hymen ; Ta, vagina ; U, cordiform Muellerian ducts representing the uterus ; UC, uterine cornu, excavated and filled with fluid (menstrual debris) ; CL, corpus luteum ; C, ovary. cattle furnish by far the greatest number of asexual indi- viduals. The development of the genital organs in the embryo be- gins at the anterior, or ovarian end and progresses toward the vulva. In the typical asexual individual, the genital glands are represented by indifferent nodes, yellow in color, about the size of an ordinary grain of wheat. Both the Muellerian and Wolffian ducts are present and have attained considerable size. They do not become tubular, but persist as solid, fibrous cords. All four structures lie on a common plane, the Wolffian lateral to the Muellerian ducts and in close contact with them. The ducts of Mueller do not fuse Asexual or Bisextial Aberrations 153 in any portion of their length, but persist as contiguous, solid cords. The first suggestion of sex specialization is generally an excavation of the Muellerian ducts at the apices of the uterine horns, as shown in Figs. 51, 52. Paral- lel with this there may be some suggestion of ovarian de- velopment. The next observed stage of excavation of the apices of the uterine horns is the fusion and the excavation of the Muellerian ducts in the area of the uterine body. The cavity of the excavated uterine horns or body sometimes be- comes distended with lymph, usually thin and clear. Fig. 48— Arrested Development of Bovine Genital Tract (Freemartin. ) MU, Meatus urinarius ; //, hymen ; WD, Wolffian ducts ; DM, ducts of Mueller ; DM' cross section of Mueller's ducts ; GG, undifferentiated genital gland. The anterior ends of the Muellerian Ducts, DM, between the genital glands, GG, are excavated and distended with fluid. 154 Diseases of the Genital Orgatis Finally, in the individuals most advanced in development, the posterior portions of the cervico-vaginal segments show definite advances toward physiologic development. When this occurs, there is parallel development of the ovaries and the genital system functions more or less normally. Thus all conceivable gradations occur between the absolute neu- ter and the fully developed female sex system. Fig. 49 — Same as Fig. 48, with further Developruent of the Muellerian Ducts. Lettering same as in Fig. 48, except BL indicates broad ligament of the uterus and just above BL at DM, the ducts of Mueller are excavated and distended. I Asexual and Bisexual Aberrations 155 The vulva of the neuter frequently shows at birth a highly marked tuft of vulvar hairs, strongly suggestive of the pre- putial tuft of the bull. In the typical neuter no sexual de- sire develops : there is no estrum. The head and neck fail to develop that fineness of lines characteristic of the heifer and the body is generally somewhat gross. It has been stated that the head and neck are like those of the bull, but I have been unable to verify this. To me they seem more like those of a steer — a surgically made neuter. The horns are rather gross, straight, and thick. As soon as the rectum of the animal is large enough to admit the operator's hand, a reliable diagnosis is available. Upon rectal palpation, the urinary bladder is prominent, as in the bull ; there is no vagina or cervix, but instead there are two hard, fibrous cords the size of lead pencils or smaller, sometimes so closely bound together that they feel as one. In other cases careful palpation may identify all four cords. Wolffian and Muellerian ducts. The length of these cords varies greatly. Sometimes they are as long as a normal genital tract; sometimes very short and blunt. Frequently they end anteriorly in cystic dilations given off at almost /ight angles. Beyond the ends of these dilations, the operator may or may not be able to distinguish the un- differentiated tiny sex glands. In typical cases, the diag- nosis is easy, and fortunately most cases are typical. In some of the atypical cases, where the sex development has progressed to a considerable degree, the diagnosis may prove very difficult. Confusion is most probable in those cases where a large proportion or all of the uterine horns and body have become excavated but the cervix remains imperforate. The uterus and horns are then distended with lymph, sim- ulating pregnancy. As a rule, however, the examiner can recognize by palpation some fundamental defect in vagina, cervix, or ovaries which will make the diagnosis clear. The character of the distension itself, as I have observed it, serves readily to differentiate the condition from preg- nancy. The uterus is flaccid and the contents mobile. The horns are irregularly distended, broad at one point and 156 Diseases of the Genital Orgaris quite narrow at another. The fluid may sometimes be pressed from one horn to the other through the uterine body. This is in sharp contrast to the distended uterus of pregnancy, in which, if the pregnancy is healthy, the dis- tension is firm and the contained fluids fixed in the fetal membranes. If a careful record is made of the volume of the uterus, and it is re-examined thirty days later, the uterus of pregnancy will have enlarged markedly; distension of a uterus arrested in development would have remained essen- tially static. Fig. 50 — Same as Figs. 48, 49. /, Meatus uriuarius ; 2, 2, Wolffian ducts ; J. Muellerian ducts ; 4, 4, excavated and distended anterior (ovarian) ends of Muellerian ducts. The mole, or uterine cyst, may also confuse. Like the uterus of arrested development, the mole may remain static for months and the uterus may be flaccid. In this instance, however, the genital organs are anatomically sound, there is a corpus luteum of pregnancy, probably a typical uterine seal, and a distended uterus, static in size. It can finally be differentiated by sounding the cervical canal. The condi- tion is discussed later. As soon as the neuter character of the animal is recog- nized, it should be designated for slaughter, but whether the animal shall be kept until further grown, fattened, or slaugh- tered immediately will depend upon conditions. - Hermaphroditism 157 Forensically, if the animal has been sold as a female, the recognition of its asexual character arouses a suspicion of fraud, but by no means proves it because, as previously stated, single births are sometimes neuters, though possibly due to twin conception, the other twin having perished and been absorbed. Ethically, however, the result is the same. The animal is not a heifer or a female. Accordingly it has been sold for what it is not. If the purchaser has paid for a breeding female, he is ethically entitled to reimbursement. 2. Hermaphroditism Hermaphroditism, in which organs of both sexes are found in one individual, is observed in all domestic animals. Some have claimed that freemartins, or what I have desig- nated as "neuters", are in fact a type of hermaphrodite, but with this view I am unable to agree. Neuters, as they grade up toward sexuality, tend always toward the female — never toward the male or toward both. Hermaphrodites incline to assume prevailing types according to species. In the horse, hermaphroditism tends generally toward the development of testicles which are largely retained within the abdomen and attached and located the same as the ovaries, but may descend into an imperfect scrotum. The vulva, vagina, and uterus may develop almost per- fectly, as in one case occurring in my clinic where the vulva and vagina were sufficiently developed that I castrated the animal through the vagina in the same manner as mares are spayed. The rudimentary penis, or enlarged clitoris, usu- ally ends either in the vulva or in the vicinity of the ischial arch, with the urethral opening directed backward. Some- times it is directed backward at its extremity. The mam- mae are usually moderately developed and upon casual ex- amination, have the appearance of those of the mare. In one case upon which I operated there were, just above these rudimentary glands, small scrotal pouches containing the imperfectly developed testes. These animals present chiefly the characters of the crypt- orchid horse with all his deranged sexual desire and ten- 158 Diseases of the Genital Organs dency to viciousness. In the case illustrated by Fig. 52, the head, neck, voice, and disposition were those of a cryptor- chid horse, and the vulva, vagina, uterus, and udder were those of a normal mare. The erectile organ occupied a mid- dle place between the clitoris of the mare and the penis of the horse. In Fig. 51 is shown the generative apparatus of a pig, in which the hermaphroditism is of quite a different character ; Fig. 51 — Hermaphroditism. Swine. T, Testicle ; O, ovary ; P, penis ; UC, uterine cornu ; V, vas deferens. one of the glands developed into a typical ovary and the other into a testicle, so that the two sides of the genital ap- paratus represented the two sexes. Sections of these genital glands show one to be a typical cryptorchid testicle with tubuli seminiferi and the other a primitive ovary with scattering Graafian follicles contain- ing ova. The Muellerian ducts have developed into typical oviducts, uterus, and vagina. From the Wolffian ducts have formed typical vasa deferentia. The penis is normal in form and extent. Hermaphroditism 159 60 PI 73 o u A P4 i6o Diseases of the Genital Orgaiis I have found no records of fertility in hermaphrodites of the equine or other species. B. Arrests in the Development of the Male Genitalia 1. Arrests and Aberrations in the Development OF THE Testes Anorchidy, or complete absence of the testicles, except in neuters as described above, is exceedingly rare in domestic animals. That is, if some other portions of the male genital system are present in approximately normal development, the testicles, however aberrant or arrested in development, are regularly present. Anorchidy is repeatedly mentioned in veterinary literature, but the basis for the assertion is not quite clear. I have observed one horse, sold as a colt for breeding purposes, which showed no testicles or scro- tum, had no sexual desire, and lacked the form and voice of the stallion. The penis, prepuce, and sheath were fully de- veloped. Since no rectal or post-mortem examination was made, a positive diagnosis of anorchidy was not practicable. I doubt its occurrence. The testis is so fundamental in the genital system that, in its absence, I am inclined to doubt the formation of such accessories as penis, prepuce and sheath. Practical anorchidy does, however, occur, as in the horse just described. In castrating a cryptorchid colt, the hidden testis was represented by a small, calcareous node, render- ing him to all practical purposes a true monorchid. 2. Cryptorchidy Cryptorchidy, or the retention of one or both testes within the abdominal cavity, is common in domestic animals. It is commonest in horses and boars. As a rule — surely in 98 per cent. — cryptorchidy is due to simple arrest in develop- ment. Occasionally a dermoid cyst is at fault. I have seen a pig in which the cryptorchid testicle was the seat of ma- lignant growth. These new-growths will be considered un- der tumors of the genitalia. The typical cryptorchid tes- ticle is small, soft, and fetal in type, anatomically and his- tologically. Cryptorch idy 1 6 1 The cryptorchid testis does not produce spermatozoa. When one testis has descended into the scrotum, it under- goes compensatorial hypertrophy and functions freely. Monorchids, though the scrotal testicle functions freely, are not desirable as sires, because of the constant peril of the transmission of the defect to the progeny. The condition is beyond remedy in a breeding sense, since the involved testicle can not be induced to function. As a rule of practice, cryptorchid animals designed for meat should be slaughtered before sex maturity, if it can be done economically. If desired for work (horse) or as a pet (dog or cat) or if it is to be grown to maturity for meat, castration is indicated. In all domestic animals, cryptor- chidy constantly tends to produce nymphomania. The cryptorchid horse tends strongly to become dangerously vicious when four or five years old, and the viciousness grows with years. In the boar, since the cryptorchid tes- ticle, as soon as the animal reaches sex maturity, taints the meat beyond endurance for human food, castration is essen- tial. The operation of castration, falling within the do- main of ordinary surgery, need not be described here. 3. Aberration in the Position of the Testis in the Scrotum In one case I have observed the testicle of a bull caught in its descent before reaching the bottom of the scrotum, ap- parently because the gubernaculum became adherent two or three inches above the fundus of the scrotum or because of a shortness of the mesorchium. The result was that the testis tipped forward at its upper end, coming to rest with its long axis horizontal instead of perpendicular. Thus it lay in the same position as the testicle of the horse. The tes- ticle appeared in every respect physiological. It was of the same size and consistence as its fellow. The bull was fer- tile. No interference was believed desirable. 4. Arrest in Functional Development of Scrotal Testes. Fetal Testis An arrest in the development of scrotal testicles some- times occurs, in which they fail to acquire the fundamental 1 62 Diseases of the Genital Organs functional power of secreting spermatozoa. When the tes- ticles descend into the scrotum, they are normal in size and consistency. As the age of sexual function approaches, the testicles fail to grow to full size and remain soft. So far as I have observed, the sexual desire is normal, or perhaps slightly subnormal. The animal mounts the female promptly and apparently copulates naturally. Search for spermatozoa in the vagina, immediately following copula- tion, is negative. Physical examination shows the testicles to be not more than one-half to two-thirds the volume of testes of normal animals of the same age, size, and breed. Even more marked, in my experience, is the soft, flaccid character of the glands. In all cases observed by me, the di- minutive, flaccid testes have been symmetrical in size and form. The defect appears to be congenital or to originate while the male is yet a nursling. I have observed it only in young animals which were absolutely sterile from the first. The sterility has always been uniform and permanent. At first some of this type of testicles revealed upon histologic examination what was looked upon as a true arrest in devel- opment, like the typical cryptorchid testes. Later, in some cases, I have been surprised to find that the epithelium of the epididymal tubules has been destroyed and their lumen filled with cell debris instead of spermatozoa, the semeni- ferous tubules have largely lost their epithelium, spermato- zoa rare, and probably at no time viable. This leads to the conclusion that in such cases the condition is due to a highly destructive invasion of the epididymis and testicle by an in- fection which falls short of abscessation or suppuration but absolutely and permanently destroys the physiologic func- tion of the organ. The condition will therefore be more fully discussed under "Infections of the Genital Tract of the Bull." Forensically, I know of no instance which has been de- cided in a law court in case of sale. The sale of such an ani- mal for breeding purposes is rarely, if ever, fraudulent. The breeder, selling his young males usually without having used them for breeding purposes, does not discern the ster- Congenital Defects of the Female Genitalia ' 163 ility and takes no note of the diminutive size and flaccidity of the testes. Ethically, the buyer, having paid for a breed- ing bull, is entitled to remuneration, and in my experience most breeders very promptly reimburse the buyer. The condition is apparently hopeless ; no form of handling sug- gests itself. 6. Aberrations in the Development of the Penis In rare cases aberrations in the development of the penis incapacitate the male for copulation. I attended one young bull in which the penis was somewhat chisel-shaped and di- rected upward when protruded, instead of being acutely conical and directed slightly downward. A loose, baggy fold of skin about the umbilicus, caught by the penis, formed a pocket in which the glans lodged and prevented copulation. I removed a transverse gored piece of skin, about three by five inches, and drew the wound margins together by sutures. This overcame the mechanical diffi- culty. C. Congenital Defects of the Female Genitalia The occurrence of asexual individuals and the impercep- tible gradations between the neuter and the female have al- ready been described. Independent of these, brief reference was made to the non-development or aberrant development of certain portions of the genital system. The failure of one ovary to develop and function is ex- ceedingly rare, except in conjunction with other abnormali- ties. Usually the two ovaries are not equal in volume. The greatest disparity in size is seen in the cow, in which the left is almost always smaller than the right, frequently less than one-fourth the volume, but the small ovary neverthe- less functions. It has been claimed that the right ovary of the cow functions far more frequently than the left. I have the abattoir records on 1700 pregnant females, of which 55 per cent, were pregnant in the right horn and 45 per cent, in the left. In heifers, especially in Channel Island breeds, which regularly have very small ovaries, the left gland is 164 Diseases of the Genital Organs be n ^ oj c ■T3 !_ d yi ii "3 ^ ;-i Im nj y rt -; tD OJ v^ (U 02 tn ;i tn ^ •^ 0) >, -»3 I' o Uterus Lhiicornis 165 frequently no more than one-quarter inch in diameter, but it is anatomically perfect and of the adult type. Such an ovary functions. I recall meeting clinically with but one ovary of fetal type where the corresponding uterine cornu was developed ; this ovary was paired with the angio-car- cinoma shown in Fig. 66. In most cases of unicornual uteri which I have seen the ovary was of normal, adult type on the side where the uterine horn was absent. The absence of one ovary, or the fact that one is of fetal type, is of little consequence except that a second ovary serves as a reserve or alternate. So long as one good ovary is present and the corresponding oviduct and cornu are physiologic, the animal is fertile. 1. Uterus Unicornis Arrest in the development of one uterine cornu is not rare in cattle. In the abattoir I encountered six instances amongst a few more than three thousand females — nearly two per thousand. Five of them were, or had been, preg- nant; one was a heifer. The defect is apparently of little or no significance, except, as in the ovaries, the second cornu provides a reserve, in case of disaster to the other side. It is readily recognized by rectal palpation. The single horn projects directly forward from the anterior end of the cervix. No uterine body is recognizable. In the ex- amination of pure-bred animals for sale, the unicornual uterus should be classed as sound but defective, and the value of the animal as a breeder somewhat discounted. 2. Double Uterus. Double Cervix Double uterus is extremely rare in domestic animals. I have no specimen in my collection. In consultation with a colleague, I have seen one cow, which, so far as I was able to determine clinically, had two complete uteri and cer- vices but there may have been a communication (uterine body) at the anterior end of the two cervical canals. The two cervical canals were perfect and readily recognized. The cow was fertile. Diseases of the Genital Organs ■pir =;/i— Cervix of a Uterus Unicornis. . . The Cervix is ^^^^U^^- OB, Os uteri exteru,,^^ 0/ Os ulen -„- ternum CZ., Corpus luteum of pregnancy. U, Uterus, t,^. *-o^>^e donT" Between ^(?;5 and 0/ the cervix is greatly distorted and has vagrant partitions. Fig ss— Double Cervix. Cow. num : C' O' false median lips of os uteri. The Persistence of Muelleriaji Ducts 167 Double cervix is not at all rare. My collection contains several specimens, each having individual characteristics. It is interesting to record that a double cervix is occasion- ally associated with a one-horned uterus. The double cervix is readily diagnosed. The two cervices, lying side by side, have the normal cervical characters, are sealed in pregnancy, and penetrable with a sound when non- pregnant. The condition does not visibly affect fertility. It is objectionable merely as a congenital defect which may be perpetuated and accentuated in the progeny. 3. Persistence of the Median Walls of the Muellerian Ducts in the Vagina Occasionally, in vaginal palpation, one finds a perpendi- cular muscular column located against the os uteri exter- num, but free from its lips, which extend from the floor to the roof of the vagina. I have seen the structure varying in diameter from one-fourth to one inch. It is quite firm and covered by the vaginal mucosa. It serves at times to con- fuse the inexperienced veterinarian, who, by recognizing the OS uteri externum first on the right and then on the left of the fleshy column, may imagine that he is dealing with a double cervix. The defect is easily diagnosed. The operator can pass his finger across between the vaginal end of the cervix and the fleshy cord and, by bending the finger, com- pletely encircle the column. By exerting traction the mus- cular column can usually be drawn back into the vulva, where it can be clearly seen. Ordinarily the structure does not interfere with concep- tion. In some cases the structure seemed to me competent to cause difficulty in parturition because one of the ex- tremities might pass on one side of the cord and one on the other side. Then the column would need to rupture or be cut before parturition could be completed. After parturi- tion, the fetal membranes might very well become caught and detained by portions passing on either side. There- fore it is desirable to sever the column. I have hooked an index finger about the cord, drawn it well back, and then i68 Diseases of the Genital Orgayis Figs 56 57— Persistent Median Walls of Mueller's Ducts. Fig s6 (above). View of cervix from Va^nna. The persistent wall, /, gives an appearance of a double cervix which Fig 57. (below) shows in horizontal section, is false. The depression on the right is the mouth of the sin-le cervix, while that on the left constitutes a cul-de-sac Had the open- ing'' on the left ioined the true cervical canal, just m front of /, it woulrt have left the usual perdendicular muscular column. Had the persistent partition extended to the uterine cavity, U. a double cervix would have re- sulted. C False OS uteri. (^^ True os uteri. Persistent Hymen i6g severed it with a scalpel or with scissors. An insignificant hemorrhage follows. There is virtually no sensation in the structure and no material evidence of pain when it is severed. 4. Persistent Hymen In the development of the female embryo of cattle, the hymen regularly disappears as a complete membrane, but a series of fragmentary projections remains, marking the vulvo-vaginal boundary line. Upon the floor of the genital passage this line is located just in front (the ovarian side) of the urethral opening. The vestiges of the hymen consti- tute a well defined stricture between the vulva and the va- gina. In the manual examination of heifers, passing this stricture with the hand frequently causes a slight tearing accompanied by hemorrhage. In numerous cases, remnants of the hymen persist as fleshy cords, sometimes the dimen- sions of a lead pencil, extending perpendicularly from the floor to the roof of the passage, sometimes on the median line, but generally to the right or left of the centre. Sel- dom, if ever, do they cause difficulty of any consequence, but they should be cut or ruptured when encountered. Rarely, the hymeneal constriction forms a slight cul-de- sac in the vaginal floor, where debris accumulates and de- composes, to imperil conception. Sometimes the cul-de-sac may be overcome by dividing the stricture along the floor. Otherwise, the peril is to be obviated by frequent vaginal douches until conception occurs. Parturition will ordinarily eliminate the defect. The hymen sometimes persists as an imperforate mem- brane. I have observed but two cases, one in a heifer, the other in a ewe. In Great Britain, I am told, it is common in a certain strain of white cattle, so that it has become known as "the white heifer disease". I have been unable to get particulars about it. In any animal, imperforate hymen in- evitably leads to the accumulation of menstrual and other debris in the vagina, which becomes a great retention cyst. Estrum may be regular, but copulation is impossible, be- cause the penis of the male is prevented from entering the lyo Diseases of the Genital Or£a?is vagina. As soon as the vagina becomes fully distended, discomfort and pain result, causing colicky symptoms and expulsive efforts. During the expulsive efforts the hymen may be forced back into the vulva and become visible be- tween the vulvar lips. Palpation reveals a tense, mem- branous wall retaining a liquid beyond. On the floor of the passage, the membrane is attached just anterior to (on the ovarian side of) the meatus urinarius. The attachment of the membrane to the walls can be traced completely around the genital passage. Per rectum, the vagina is readily pal- pable as an elongated sac firmly dis-tended with fluid. In the one heifer which I observed, both uterus and vagina were distended greatly with thin pus. This caused much pain, with constant straining and loss of flesh. It is quite probable that the infection was carried to the genital tract by the blood early in the heifer's life and remained dormant until menstrual debris collected, when suppuration promptly ensued. The handling consists of the surgical destruction of the membrane, which should be punctured approximately in the center with a scalpel and the opening thus made ex- tended by cutting or tearing to a sufficient degree. It is especially important to extend the opening in the membrane downward to the floor of the passage, since otherwise it may serve to form a cul-de-sac leading to the retention and decomposition of discharges, thus keeping a pool of in- fected debris about the os uteri externum, interfering with conception. When persistent hymen becomes a race characteristic, as in the "white heifer disease" of England, it would appear best to eliminate the defect by careful selection. Imperforate hymen in the mare is apparently very rare. There occur a few rather vague descriptions of imperforate hymen in the mare from which the actual facts are unob- tainable. There occur in literature statements that in the pregnant heifer and filly imperforate hymen may exist at the time of parturition. Evidently that is impossible. A remnant of the hymen suflficient to complicate parturition may persist, but copulation cannot occur and leave the mem- brane imperforate. When imperforate, a distension of the Persistent Hymen 171 vagina with menstrual debris is inevitable. So far as I have observed, the imperforate hymen can not be ruptured by the male. It is imperforate and persistent because ab- normally thick and tough. I have observed in a filly a persistence of the lower por- tion of the hymen, constituting a cul-de-sac which ended at the anterior margin of the urethra and sloped upward and backward as a crescent-shaped partition open at the top. It was attempted to breed her to a very large stallion. After several unsuccessful efforts my advice was sought. Upon introducing my hand, I promptly encountered a broad band stretched transversely and sloping forward and downward. Pushing my hand along the lower surface of the membranous partition, I found that the urethral open- ing formed the fundus of a great cul-de-sac. The urethra was so greatly dilated that it readily admitted my hand. Apparently it had been dilated by the penis of the stallion. Searching higher up, I found the hymen was not imperfor- ate; there was a large opening at the vaginal roof. The groom was advised to be on the alert at the next effort at coitus and push the penis of the stallion upward just at it entered the vulva. The filly conceived. The case reports of persistent hymen which have inter- fered with parturition are probably largely based upon di- agnostic error. Instead of persistent hymen there was probably a persistent portion of the median walls of the ducts of Mueller, a condition just short of a double vagina. Such remnant is resistant enough to readily cause dystocia. Many appear to think erroneously of any band passing across the vagina as "persistent hymen". The persistent median wall is far more common than the persistent hymen. The condition has been discussed above. The persistent hymen which is perforate usually has but little significance. The imperforate hymen has little peril for the life and general health of the patient unless over- looked until the vagina is tensely filled with menstrual de- bris. When, as in the heifer described above, both vagina and uterus are greatly distended with pus, there is ground for serious fear that breeding life is at an end. Chapter V MISCELLANEOUS DEFECTS AND DISEASES INTERFERING WITH FERTILITY There are many defects and diseases of other than the genital organs which may render coitus physically difficult or impossible, although the animal is fundamentally fertile. Much has been said of the physical difficulty of coitus be- tween individuals representing extremes in size. This oc- curs only when the disparity in size is so great that mating is as a rule imprudent for other reasons. Extreme varia- tion in size may render coitus difficult or dangerous. In both horses and cattle it is not rare to observe successful coitus of a large male with a female 30 to 40 per cent, of his weight. The danger from such disparity is not great, but when a stallion has an extra large penis this may have great peril for the vagina of the mare. These injuries will be discussed later. When a very small male attempts coitus with a large female, failure is dependent ordinarily upon the shortness of the hind legs of the male, making it impossi- ble for him to reach the vulva. As a rule, however, the male of a given breed of animals is able, not long after he reaches puberty, to copulate with an adult female of his breed. In horses and dogs, where giant and pigmy breeds have been developed, coitus between these extremes is virtually im- possible. The variations in weight between Clydesdale horses and Shetland ponies, for instance, may be from 2400 to 200 pounds — or 12 to 1. In dogs the extremes reach nearly 100 to 1. Disparity in size does not enter prominently into the question of the physical possibility of copulating. A. Umbilic Hernia Umbilic hernia, especially in the bull, whenever of ma- terial size, inhibits copulation by deflecting the penis as it is being protruded. The defect is ordinarily not brought to Unibilic Hernia 173 the attention of the veterinarian, except in young bulls of high pedigree. If the bull is an ordinary grade, or of low pedigree, he is usually, and quite properly, sent to slaughter. However, when a bull is of high pedigree and potentially of great value, the owner often becomes anxious to have the difficulty overcome by surgical interference. Umbilic hernia is a congenital defect due to an arrest in the normal closure of the umbilic ring. As an arrest in fetal development, it has the same significance for the breed or family as other teratological defects. It signifies a fun- damental organic weakness always threatening to be trans- mitted to the progeny. Umbilic hernia is very difficult to handle in the bull. The breeder usually defers the operation until the rumen has attained a great weight. Then the sur- geon is faced with a weight, which it is virtually impossible to support by means of surgical appliances, bearing imme- diately upon the operative area. In umbilic hernia of the bull, the surgeon is denied his chief mechanical means of support — the bandage — because the opening of the sheath is immediately at the umbilicus, so that the bandage can not be effectively applied without involving and obstructing the sheath opening. As a result, when attempting to suture an umbilic hernia in a bull, the bandage must be omitted or in- effectually applied, and before healing occurs the sutures usually tear away and carry with them portions of the her- nial ring, making the opening larger than before. If the surgeon undertakes to clamp or ligate the hernial sac, by the time the incarcerated mass has sloughed away, the pres- sure from above has stretched the tissues and formed a new sac. If the hernia is operated on when the calf is but a few days old, before the viscera acquire insupportable weight, the surgeon may more readily succeed. Even then, however, the fundamental weakness of structure is there, and in my judgment the animal should not be used as a sire. 174 Diseases of the Genital Or^ayis B. Ventral Hernia Large ventral herniae, such as indicated in Fig. 58, also inhibit copulation, rendering the bull worthless as a sire. Fig. 58— Large Ventral Hernia preventing Coitus. C. Horizontal Vulva Horizontal vulva in the cow sometimes serves to render copulation difficult or impossible. In aged cows with pen- dulous abdomen and low back (lordosis, or sway-back) the superior commissure of the vulva is depressed and dragged downward and forward by the descent of the rectum and anus, so that the vulvar opening is directed upward. More rarely, the vulvar opening is directed upward in otherwise well-formed heifers, as a peculiarity in conformation. When the bull attempts to copulate with such an animal, the penis tends to glide over the vulva and strike against the anal re- gion. This is best avoided by causing the female to stand with her hind feet in a pit or depression, with the fore feet Strictures of Vagina and Vtilva 175 high, thus bringing the vulvar opening toward the perpen- dicular. Horizontal vulva also follows perineal laceration at the superior vulvar commissure. This is described under "Parturient Injuries". D. Strictures of Vagina and Vulva Strictures of the vagina, and more rarely of the vulva, are occasionally encountered in domestic animals, chiefly in the mare and the cow. They always result, so far as known, from some prior inflammation of these parts, but frequently the history of the disease is not available and the veterinarian encounters simply the result of the disease. In a mare which came under my observation, there was difficulty in parturition due to an anterior presentation in the dorso-sacral position, with the two hind feet pushed forward beneath the fold into the pelvis. The difficulty, oc- curring during the night, was not observed until m^orning. Delivery was promptly and readily accomplished by em- bryotomy, but the vulva had been so badly contused that more than half of its circumference became necrotic and sloughed away. The resulting constriction was such that the animal could not copulate. She might have been arti- ficially fertilized v/ithout material difficulty but, as she prob- ably would have been unable to give birth to young, no at- tempt was made to cause her to breed. I could see no pros- pect for success by any operation. The mare was conse- quently used for work. I observed one instance of severe stricture of the vagina in a mare, the origin of which was unknown. Without knowledge of the presence of the lesion, the owner attempted to breed her. This caused extensive lacerations of the va- gina with great pain and straining. She was placed under my care. The straining caused an eversion of the floor of the vagina and the urinary bladder (vesico-vaginocele). I attempted to keep the vagina and bladder in position with a truss, and later with vulvar sutures, but failed. Finally I controlled the straining and eversion by producing profound and prolonged chloral narcosis. 176 Diseases of the Gefiital Organs Stricture of the vagina in the cow is comparatively com- mon and of varying degrees. Occasionally one meets cases in which it is impossible to reach the cervix. Frequently the stricture is associated with long-standing sterility, where it is highly desirable to reach the cervix and handle the uterus. In my experience, stricture of the vagina has occurred most frequently in herds where the vagina has been douched with potassium permanganate. It is not certain that there is any connection between the potassium permanganate douching and the stricture. Stricture is very liable to fol- low douching with any powerful antiseptic, and very natu- rally might follow the use of a too highly concentrated per- manganate solution. There is another possibility with the potassium permanganate. As it is very heavy and dissolves rather slowly, laymen or careless veterinarians may inad- vertently introduce some crystals into the vagina. The liquid would be largely thrown out, and the heavy crystals remain behind. These would cause profound irritation with necrosis of the mucosa and stricture would naturally follow. Stricture is likely to follow any case of severe vaginitis, re- gardless of the cause. If the stricture is not too severe, the prognosis is good. If the condition of the vagina is such that copulation may be safely performed and there is not too great hardening, the vagina may largely recover its normal elasticity during the rest of pregnancy, so that the animal may go through parturition safely. If the uterus requires handling, it may be possible to pass the uterine forceps through the stricture and grasp the cervix without inserting the hand, or the for- ceps may be guided with one hand in the rectum. In other cases, one may be able to introduce the vaginal dilator (Fig. 37) and distend the passage sufficiently that the cervix may be seen and grasped. Whenever I have been able to grasp the cervix, it has been possible to draw it out through the constricted vagina and give to the cervix and uterus any at- tention desired. Diseases of the Feet and Limbs E. Diseases of the Feet and Limbs 177 Breeding bulls and, to a lesser degree, cows which are kept constantly stabled tend to become disabled owing to the fact that the growth of the hoofs is not counterbalanced by the normal wear of travel. The margins of the lateral and median walls tend to converge and, as they become elon- gated, to bend beneath, the soles, approaching each other as Fig. 59 -Overgrown Hoofs interfering with Coitus. Bull. S, Sole, which has been largely overgrown by the wall, \l\ growing for- ward from the heel. /, A shallow groove showing approximately the normal location of the margin of the wall. 178 Diseases of the Genital Orga?is shown in Fig. 59. The heel portion of the wall is directed acutely downward and forward, and, as this is not worn away by the idle animal, the superposed weight bends the free margin forward and inward until it lies flat against the sole, and continues to grow forward until the posterior, or heel wall finally reaches the toe, completely covering the sole. The bull then walks upon the elongated heel wall, be- tween which and the sole is a space, opening at the toe, in which gravel, dirt, etc., become impacted. Then follows un- equal pressure (by gravel, etc.) upon the sole, contusions of the sensitive parts, pressure necrosis, and other lesions. The bull soon becomes lame, and, unless the difficulty is promptly recognized, may be crippled permanently. Fre- quently I have seen bulls rendered incapable of copulation from this cause. The condition is best prevented by care- fully trimming the feet of all breeding bulls kept in stan- chions or stalls, at least twice annually. Once the difficulty has become established, the walls are permanently deformed and constantly turn in. Then the trouble can be palliated only by the frequent trimming of the feet and by keeping the bull well bedded on a clay or board floor. Stone, con- crete and gravel floors should be avoided. The trimming of the feet may generally be accomplished with hoof-cutting pincers, with the animal standing. When the bull is secured in a stanchion, two strong men can gen- erally hold up one of his hind feet and extend it backward while the operator trims it. The men should take a stout, smooth beam, preferably a round piece about six feet long, pass it between the hind legs in front of the tarsus of the foot to be raised, and, firmly grasping each end of the beam, lift it upward and draw it sharply backward, so that the flexure of the hock rests upon the middle of the beam. Most animals will struggle but little and the trimming of the hoof can be performed readily. If the animal is too re- sistant, he should be cast and secured the same as already recommended for examining the penis. Painful diseases of the posterior feet and limbs occa- sionally render a male incompetent or unwilling to mount Diseases of the Feet and Limbs 179 the female, thus throwing increased weight upon his hind limbs. Obviously any attempt at copulation aggravates the local disease. The male should, therefore, be held out of breeding until he has recovered. Sometimes it is wished to breed a female suffering from some local, non-genital disease which renders copulation difficult or dangerous for her because of the weight of the male which she is called upon to bear. Partial relief from the excessive weight may be secured in cows and mares by using a breeding rack so constructed that the female stands between two broad, sloping shelves of such height that, when the male mounts her, his fore feet rest upon the shelves and his weight is more or less completely borne by these. The shelves must fit closely against the sides of the female, in order to ob- viate the danger of the male's getting his foot between the shelf and the female, and should slope downward from the head of the female. The breeding rack does more than partly or wholly support the weight of the male. When it fits closely and a beam is placed securely in front of her sternum, her equilibrium is maintained and she can sup- port without increased danger probably twice the weight of which she would be capable otherwise. This is especially true of the violent copulatory thrust of the bull. Not in- frequently, when a cow is weakened and unsteady, or when a small heifer is mounted by a large bull, the thrust causes the cow or heifer to crumple up and fall headlong. It is unwise to breed a crippled or weak female unless it can be reasonably determined that the patient will promptly recover from the local disease. Otherwise, as soon as the increased weight of pregnancy has to be borne by the weak member, a new peril is encountered in the aggravation of the disease. Pregnancy may occur and parturition may be safely passed, but the progeny is rarely well nourished or valuable. F. Paralysis and Plumbism Paralysis sufficient to interfere with copulation may oc- cur in any animal, and from a great variety of causes. In i8o Diseases of the Genital Organs the stallion there occurs sometimes a paralysis of the pos- terior limbs. In one bull in my experiment herd, paralysis was due to lead poisoning caused by licking a painted board when but a few days old. He was completely paralyzed and unconscious for a number of days. For months he was quite severely paralyzed in his posterior parts, with some swelling of the joints and bones. He attained medium size, and was normally fertile, but was quite awkward and copu- lated with some difficulty. Stallions suffer occasionally from paralysis of the penis, the cause of which is generally unknown, largely associated with partial paralysis of the posterior limbs and not ordi- narily subject to remedy. G. Torsion of the Testicle Torsion of the spermatic cord, it is claimed, sometimes causes atrophy of the testicles and inhibits the formation of spermatozoa because of interruption of the nutritive sup- ply. It is well known that emasculation can be produced in ruminants by the process designated double subcutaneous torsion, in which the testicles are twisted and inverted in such a manner as to interrupt their vascular supply and in- duce atrophy, with disappearance of sexual desire and power. Occasionally in man torsion of the testicle appears to pro- duce painful and serious symptoms simulating incarcerated hernia with vomition. O'Connor (^) describes two cases and states that one hundred twenty-four cases have been recorded in man. I am not aware that disease has been traced to torsion of the spermatic cord in animals. In the stallion, with horizontal testes, the gland is frequently re- volved upon its transverse axis through 180 degrees, but this appears to be of no consequence. The horizontal posi- tion of the testicle permits it to revolve upon its transverse axis below the mesorchium. The displacement involves very slight damage to the spermatic cord. The freedom of 'Vincent J. O'Connor, Torsion of the Spermatic Cord. Surg. Gyn. and Obst., Dec, 1919, p. 580. i Torsion of the Testicle i8i the spermatic cord in the inguinal canal permits part of the torsion to occur within the abdomen, so that the twist need not be great at any one point. In man the torsion is said to occur frequently where the gland is caught in the inguinal canal. Just how it can revolve in the inguinal canal, I fail to understand. Inguinal cryptorchidy is familiar to veteri- narians, but torsion is rarely, if ever, recognized in these cases. I have observed but one instance of torsion which was of consequence. In an adult cryptorchid presented for castration, I quickly recognized a state of affairs new to me, finally recognized what I believed to be the vas deferens, traced this to what appeared to be the testicle, and then ap- plied traction in an effort to bring the gland out through the wound. Finally an attachment unexpectedly parted, and a large, livid-colored testicle was brought out. The spermatic cord was spiral, the circulation had been barred, and the cord and testicle were necrotic. The cord was so weakened at the chief point of torsion that it gave way at that point. O'Connor, cited above, believes the chief cause of torsion to be the irregular contraction of muscle bundles in the cre- master, but, in my case with the testicle in the abdomen, such an explanation can not be accepted, as the cremaster does not come into play or become visibly developed until the testicle descends into the scrotum. A study of Fig. 1 will show how a cryptorchid testicle could readily revolve upon its transverse axis. The testicle of the ruminant, moored throughout by the mesorchium to the wall of the scrotum, can not possibly, so far as I can see, revolve upon either of its axes. The possibility of serious torsion of the spermatic cord should be borne in mind. H, Traumatic Orchitis According to many veterinary authors, orchitis in animals is due largely to traumatism. Professor Hendricks'' empha- sizes the belief in trauma as a cause of orchitis and considers that most cases of inflammation of the testicles are due to mechanical injuries. It is an open question, however, to ^Handbuch der tierartzl. Chirurgie u. Geburtshilfe, III Band. 1 82 Diseases of the Geiiital Orga^is what extent such an opinion is based on experience and to what extent, upon legend. Personally I have not observed orchitis in any domestic animal where it was plainly due to traumatism except in one instance of an abattoir bull which had suffered from gunshot wound in the scrotum, two of the shot having lodged, one in the epididymis and the other in the testicle. This case is illustrated in Fig. 59a. Clnically orchitis is most common in the stallion, in which animal the testicles are unusually well protected against traumatism when compared with those of other domestic animals. The pendent testicles of ruminants are exposed preeminently to mechanical injury. In the ram and the he- goat, the testicles hang so low that in moving rapidly over rough ground, especially where there are stumps and high- projecting stones, the testicles frequently come in rather vio- lent contact with these foreign objects. In all ruminants the pendent testicles are thrown against the thighs repeat- edly whenever the animal is in rapid locomotion, and yet I have not observed orchitis as a result of this. In trotting stallions there is a general belief that, unless a suspensorium is used, orchitis may result from the constant striking of the testicles against the thighs during rapid locomotion, but I find nothing in veterinary literature to indicate that orchitis arises in this way. While it must be freely admitted that orchitis may arise in any animal because of traumatism, careful clinical ex- amination would indicate that the affection is very rare. It is difficult to determine clearly just what type of orchitis a mechanical injury may induce. It cannot by any con- ceivable means cause an abscess of the testicle unless there is first a destructive injury to the skin or a penetrant wound so that the trauma serves merely to open an avenue of in- fection rather than to directly cause orchitis. In Chapter XIV of this treatise, the question of orchitis as a result of infection is discussed at some length. By referring to this chapter, it will be observed that in nearly all cases of orchi- tis and epididymitis the disease is bilateral, which would in- dicate very strongly that it is due to some systemic infection Traumatic Orchitis 1S3 Fig. 59a— Gunshot Wounds of Testicles. Bull. .S", Gunshot embedded in right epididymis ; S^, gunshot embedded in left testis ; //, globus major of epididymis ; T, globus minor, do ; A, rough- ened surface from inflammatory thickenings. The orchitic peritoneum is generally roughened on account of traumatic peritonitis. 1 84 Diseases of the Geyiital Organs arising from the presence in the blood stream of pathogenic organisms having a distinct affinity for the genital organs. The lesions figured and described are distinctly those of in- fection and not of traumatism. Before diagnosing traumatic orchitis in any animal, one should give ample consideration to the facts as stated and should in addition know that there has been a severe trau- matism of the gland or glands. It is quite possible that mechanical injury plays a very important part in bringing about a crisis when infection is already present within the gland. That is the general rule in the etiology of disease in any organ of the body, and ap- parently applies with special force to the diseases of the genital organs. Thus Hendricks, to whom reference has been made above, states that excessive coitus serves as a fertile cause of this disease. Excessive coitus, however, cannot be regarded as traumatism. It must, instead, be looked upon as an overworking of a gland by which it be- comes weakened and its tissues lose their power of resis- tance toward disease-producing microorganisms which are already present in the part. When the veterinarian feels justified in diagnosing trau- matic orchitis, the prognosis will of course depend upon the nature of the trauma. The treatment also needs to be ad- justed to the general principles of surgery in harmony with the character of the injury. Speaking generally, care should be taken to obviate, as far as possible, the invasion of the gland by bacteria because of injury to the skin and other coverings. It is likewise important that the interferences with the circulation in the testicles should be anticipated and prevented, if possible, by the careful application of a suspensorium. In ruminants, in addition to the suspenso-^ rium, the testicles can be inclosed in a bandage of adhesive tape in such a manner as to exert uniform and gentle pres- sure upon the glands and thereby maintain the efficiency of the circulation. Sexual excitement should be strictly avoided. The bowels should be kept freely open as in any case of dis- ease where fever is likely to occur, and the diet should be properly adjusted. Tubal Pregnancy 185 I. Tubal Pregnancy Tubal pregnancy, comparatively common in woman, has not, so far as I know, been recorded in any domestic ani- mal, but it is quite possible and may be encountered by the veterinarian when he is examining the genitalia. The fact that extra-uterine pregnancy is now and then encountered in the abattoir renders it highly probable that tubal preg- nancy does at times occur in animals. The veterinarian does not have the means for diagnosis afforded in woman by the regular occurrence of hemorrhage from the uterus, since the cervix is too securely sealed, but he has a distinct advantage over the human obstetrist in the facility with which palpation per rectum may be applied. The condition would necessarily give rise to a cystic enlargement in the oviduct, associated with a typical corpus luteum of preg- nancy in the corresponding ovary, a typical uterine seal, en- largement of the ovarian artery, and an absence of estrum. If tubal pregnancy is diagnosed, the peril from rupture of the oviduct should be promptly removed by performing laparotomy in the upper flank on the involved side, followed by the amputation of the tube and ovary. If the other side of the reproductive tract is sound, the fertility of the ani- mal is not disturbed. After the oviduct has ruptured and the ovum has escaped into the peritoneal cavity, if the accident is discovered early and there are evidences of serious internal hemor- rhage, the animal, if of a species used for food and other- wise fit, should be slaughtered immediately. Should the veterinarian by chance diagnose an old-standing extra- uterine pregnancy, with the fetus securely anchored and enveloped, the fact is to be wholly disregarded, except that the animal is probably permanently sterile on the side where the pregnancy originated. J. Vaginal Hernia Vaginal hernia, or hernia through the vulvo-vaginal mus- cular wall, is not infrequent in cows. In the cases I have observed there was a rent in the lateral wall of the vagina 1 86 Diseases of the Genital Organs at the hymeneal ring. The symptoms consist of the ap- pearance between the vulvar lips, or projecting beyond them, when the patient is lying down, of a fluctuant, globu- lar mass, covered by the vaginal mucosa. When the cow is caused to stand, the hernial mass usually disappears spon- taneously, or, if it does not, readily disappears under gentle manual compression. Then the veterinarian can readily recognize a well defined hernial ring of variable size, ad- mitting the insertion of two fingers or the entire hand. The veterinarian should constantly be on the alert not to confuse vaginal hernia with prolapse. Prolapse of the vagina is not so frequent as vaginal hernia. I have seen colleagues err in diagnosis. The size of the hernial mass increases as pregnancy advances. The mucosa of the hernial sac be- comes somewhat befouled and inflamed by constant ex- posure to filth when the animal is lying down, but in the cases I have observed there has been no recognizable incon- venience. The hernia constitutes a repulsive defect not wholly devoid of peril to the animal. I have observed five cases of this hernia, all in pedigreed cows. With one ex- ception, all had been purchased as presumably sound by the parties owning them at the time of examination. The one owned by her breeder had developed a fibroma at the hymeneal ring, which protruded beyond the vulva. The veterinarian removed the tumor by ecrasement. Evidently the chain of the ecraseur included a portion of the muscu- lar wall of the vagina, thus causing an opening into the pelvic connective tissue, behind the peritoneum. The intra- abdominal pressure pushed portions of the small intestine against the peritoneum and forced it out through the vent in the vulvo-vaginal wall, to constitute a hernia. It is not impossible that the other cases I observed were caused in the same way, since the vestiges of the hymen are fre- quently the seat of fibroid tumors and the veterinarian, when called to remove them, resorts to the ecraseur, with- out thinking of the consequences. The tumors will be dis- cussed later. As I now recall, the hernia has been on the Vaginal Herjiia 187 right side in most of my cases. The initial injury must be as frequent on the left as on the right side, but the intra- pelvic content of the small intestine is greater on the right and would tend rather to develop a hernia in a weakened area. Fig. 60 — Sutures For Vaginal Hernia. The insert below at the left shows details of suture. Although I have not had an opportunity to operate upon a case, and thus can not speak from experience, the condi- tion should be amenable to surgical interference. The oper- ation could be done best upon the non-pregnant animal, al- lowed only a small volume of food in order to lower the in- 1 88 Diseases of the Geyiital Organs tra-pelvic pressure upon the operative area. It would be practicable to operate upon most cows under local anaes- thesia in the standing position. After carefully cleansing the vulva and vagina, an incision may be made through the vulvar mucosa of the hernial sac, down to the pelvic fascia. An index finger can be inserted through the incision and, palpating the hernial ring, act as a guide in suturing. A half-curve needle armed with strong silk should then be in- serted at a point on a level with the superior border of the hernial ring and about one-half inch posterior to the mar- gin. The needle is to be passed through the vulvar mucosa and the muscular wall ; carried forward, carefully guarded, across the hernial opening on the ovarian side of the ante- rior margin of the hernial ring ; and finally brought out into the vagina, through the muscular and mucous coats. Then the needle is to be reversed, carried downward about one- fourth inch, inserted, and a suture laid parallel to the first, emerging about one-fourth inch below the point of starting. The free ends of the suture are then brought together and tied tightly, with a view to inducing pressure necrosis in the tissues incarcerated in the loop. The sutures should be repeated every quarter of an inch, from the upper to the lower margin of the hernial ring. The ring will then be obliterated, and adhesion occur between the incarcerated tissues. The portions of tissue lying between the incar- cerated areas in the sutures serve to maintain function in the hernial sac, preventing it from sloughing away, and the possibility of prolapse of the intestine through the slough. When circumstances render it desirable to apply pallia- tive measures to ventral hernia pending parturition, the object is readily accomplished by means of vulvar sutures, as shown in Fig. 60. In the illustration, tape has been used for sutures. A loop has been tied near the middle of the suture, after which the needle is inserted about one inch lateral to the vulvar opening, somewhat below the superior commissure, carried downward nearly to the inferior com- missure, and brought out. The ends are then tied together Torsion of the litems 189 firmly, leaving sufficient free tape to reach across the vulva to the suture of the other side, to which it is tied by a bow- knot. The sutures can be untied at will while the vulva, vagina, and sutures are cleansed. The suture is better when made of heavy silver wire. It irritates the tissues less than the tape and is cleaner. It has the great advantage, also, that the ends of the wires crossing over the vulva may be fastened by merely bending them over the suture, so that, if parturition commences in the absence of an attendant the force will cause the wire hook to unbend and the vulvar lips to part. Similar pro- vision may be made with tape by using for the cross liga- tures, tape or cord of low tensile strength which, in case of labor pains, will break. Otherwise, there is danger of in- terference with parturition and special danger of lacera- tions of the vulva owing to pressure upon the sutures. K. Torsion of the Uterus Torsion of the uterus is generally considered only as a cause of dystocia at or near the full term of pregnancy. It has been quite fully discussed in the companion volume upon Veterinary Obstetrics. It is well to add that uterine torsion occurs quite independently from the near approach of parturition. In the cow it may be encountered when palpating the genitalia at least as early as the 145th day of pregnancy. It may cause colicky pains, or merely dullness, or for a time no symptoms at all. Therefore the practi- tioner may be called to examine the cow because she has shown signs of disease, or he may detect the torsion in the course of an examination of the genitalia as a part of the control of sterility and abortion. When a veterinarian is called to attend a cow showing oc- cult evidences of disease, he should always have in mind the important role played by the genital organs and make a careful examination. When the displacement occurs early, as in the cow already cited, there may be no manifestations of disease or discomfort. The torsion in the small and not igo Diseases of the Genital Organs fully distended uterus may occur so far forward that the usual spiral folding of the vaginal walls may be wanting. Therefore it may be stated as a law that rectal palpation is essential to a proper determination of the state of the uterus. When the uterus which has undergone torsion is palpated per rectum, it offers certain definite characteristics : 1. The posterior portion of the uterus can not be clearly palpated, because one of the broad ligaments is tightly stretched across the organ, completely covering it. Far for- ward, in front of the broad ligament, the examiner may di- rectly palpate the gravid uterus and the contained fetus. If the uterus has revolved to the left — that is, if in the begin- ning of the displacement the dorsal wall of the uterus has moved to the left, while the ventral or lower wall moves to the right — the right broad ligament passes over the vagina and uterus to the left, while the left broad ligament passes beneath the vagina and uterus to the right. Both ligaments are tensely stretched. 2. The chief uterine artery inevitably moves with the broad ligament, and is readily felt. In left torsion, the right uterine artery, tightly stretched, passes over the uterus to the left side, while the right artery is forced down along the pelvic floor and passes beneath the uterus and vagina, to the right. The torsion constitutes a for- midable obstacle to the circulation in the entire genital tract anterior to the turn, causing the arteries to become distended and the pulsation in them to be unusually full and bounding. These findings serve to identify the char- acter of the displacement. Moderate uterine torsion, with- out transverse rupture of the uterus or vagina, recognized in time, warrants a highly favorable prognosis. The chief indication is the rolling process already fully described in the companion volume, Veterinary Obstetrics. L. Pelvic Tumors and Calluses Occasionally, when examining the genital organs of mares or cows, one finds tumors in the pelvis between the Pelvic Ttiniors and Calhises 191 pelvic walls and the vagina, which may interfere with fer- tility — not so frequently with fertilization as with parturi- tion. These should always be observed carefully and pre- cautions taken against impending difficulty. If the tumors are irremovable, the animal should not be bred; if she is pregnant, artificial abortion may be performed, in the early stages, or, if the fetus is of value, pregnancy may be per- mitted to continue to full term and the young removed by hysterotomy. A commoner interference with reproduction consists of calluses resulting from fractures or other injuries to the bony girdle of the pelvis. Pelvic fractures with large cal- luses are especially common in nymphomaniac cows, and sometimes unfit them for breeding. Even if the nympho- mania can be overcome, where such injuries are encoun- tered during examination, the veterinarian should judge carefully of their importance and act accordingly. If they are of such a character as to prevent parturition, the ani- mal should not be treated for the disease of the genital or- gans, but be sent to slaughter. Exceptions might be made in highly valuable cows, which, if the nymphomania or other disease is curable, might be bred and delivered at full term by hysterotomy. Chapter VI SYSTEMIC DISEASES AND DERANGEMENTS INTERFERING WITH REPRODUCTION Reproduction is the culminating function of animal life. The fundamental demand of the individual is the mainte- nance of life, and it is only when this has been reasonably assured that any additional power may be directed to the reproduction of the species. During the most active stages of growth, most animals do not breed. When old age comes, and the maintenance of nutrition is difficult, reproduction becomes uncertain or ceases. Throughout adult life, any element which interferes seriously with nutrition promptly imperils reproduction. During the course of acute infectious diseases, with rare exceptions, male animals do not elaborate spermatozoa and females do not ovulate. At the same time, sexual desire ceases. In the pregnant female such diseases imperil the life of the fetus. So it is frequently said of cows that foot- and-mouth disease, pleuro-pneumonia, and similar fevers tend to cause abortion. This does not imply that the in- fectious fever directly causes the abortion, but rather that the infection present within the pregnant uterus, capable under favorable conditions of causing the death and expul- sion of the fetus, is rendered virulent by the general de- pression of the system due to infectious fever. Such chronic, debilitating affections as the bone diseases — osteoporosis, rickets, spavin, ringbone, and others — commonly lead to sterility through their devigorating influence. A. Overwork Animals subjected to severe work are strongly inclined to be sterile for the time. In stallions which are being trained for the turf, there is usually temporary sterility, without any evidence of disease or degeneration of the glands. The resources of the animal are wholly consumed in the physical work which is demanded, and there remains no reserve force' to provide reproductive energy during this period. Starvatio7i 193 B. Starvation Starvation exerts an influence parallel to that of acute disease. In the young animal the development of the sex functions is advanced or delayed according to the state of nutrition. In highly fed, vigorous heifer calves, ovulation and estrum may occur at six months, or even earlier. In countries where cattle are reared in a semi-wild state, con- stantly running at large where herbage is scanty, they rarely ovulate until nearly two years old, so that, although the bulls run in the herd, the heifers do not conceive until well grown. The nutritive supply beyond the necessities of the individual do not suffice for reproduction. In cattle more highly domesticated, if they are underfed or otherwise badly handled, ovulation or estrum frequently fails. I have observed two-year-old heifers, badly kept, though not ex- tremely poor, which failed to come in estrum because of poverty, but bred promptly when the food supply was in- creased. Semi-wild cattle generally conceive in early sum- mer, at the time when grazing is at its best and the animal has recovered its vigor after the privations of winter. The same rule applies to cattle stabled in winter and grazed during the summer. Animals which do not come in estrum in the stable or, doing so, do not conceive, frequently breed when increased vigor has been gained after grazing on good pasture. A high state of nutrition does not necessarily accompany an abundance of food. Any food may be so damaged that its nutritive value may be lowered or destroyed, or, con- taminated by various bacteria or fungi, it may become toxic. Mere quantity of food, and even of technical nutritive ele- ments in the food, does not mean good nutrition, I observed a stable of cows and heifers which were getting an abun- dance of hay and grain of excellent quality, but all were un- thrifty and emaciated. The non-pregnant animals did not come in estrum. One cow could scarcely get up when down. They were in charge of a lazy attendant, who gave them plenty of food with fair regularity, but did not keep them 13 194 Diseases of the Genital Orgatis clean. So far as I could learn, the foundation for the de- bility was his failure to carry a reasonable supply of water a few paces. A change of caretakers promptly relieved the condition, and within a month cows began to show estrum and conceived promptly. C. Obesity Abundant food and a high state of nutrition must not be confused with obesity. Obesity is not vigor, but may be the reverse. Vigor and an abundance of fat may coexist and are not incompatible. While obesity may sometimes cause sterility, it is far more frequently true that sterility causes obesity. That is, if a cow or heifer is sterile, she does no work, has abundant food, and is perhaps closely confined in the stanchion. No special functional activities are present, such as the secretion of butter fat or other product, which would consume the extra nutrient materials taken in the food. Consequently the animal takes on an abnormal quan- tity of fat. In many cases the obesity of sterility apparently has a more interesting significance than the mere conversion of redundant nutritive material into fat. This is preeminently notable in cattle. The sterile heifer or cow frequently has irregular, lumpy deposits of fat, especially great, irregular lumps about the external iliac and ischiatic tuberosities. The hair becomes rough and lustreless. The form of the body becomes coarse and uncouth. If the genital organs are examined, no great departure from the normal is found. Perhaps the ovaries are rather small and the genital system is wanting in tone. The animal may be dull and estrum ca- pricious. The cause appears to be a disturbance of endocrine secre- tions, probably a faulty secretion of the ovaries themselves, which so modifies the nutritive system as a whole that fat deposits are made in a manner quite in conflict with the gen- eral physiologic laws of nutrition. Physiologic heifers or cows may carry quite as much fat as the obese, sterile ani- mal, but it is more evenly distributed, the coat retains its Obesity 1 95 lustre, the animal is bright and alert, and is fertile. I think that obesity as a cause of sterility in cattle has been over- emphasized, though I admit the importance of controlling it by properly adjusted rations, combined with exercise. A distinction needs to be made between obesity and over- feeding. While obesity is sometimes due to overfeeding, especially when combined with idleness, overfeeding may cause a serious impediment to sex functions without pro- ducing marked obesity. I have seen bulls which were fed an excessively large amount of very poor, hard, woody hay. The manager, wishing to prevent them from getting over- fat, was feeding coarse hay in the dairy. After the cows had picked out the best portions, the refuse, consisting of weeds and very coarse stems of hay, was fed to the bulls, with a view to affording an abundant bulk of food having a very low nutritive value. The abdomen of each bull, though they were in moderate flesh, became excessively large. Some individuals lost almost completely their sexual desire. While ruminants are adapted to using large vol- umes of dry fodder, the hygienic maximum is readily ex- ceeded, especially in herd bulls closely confined. Even when such overfeeding with a poor quality of fod- der does not seriously depress the sexual functions, it not infrequently interferes with the physical ability to copulate. The immense weight of the load in the rumen, with its pres- sure against the diaphragm and lungs, renders the bull slow, awkward, and short of breath. I have seen such bulls fail utterly to copulate. The great intra-abdominal weight and tension made mounting very difficult, and the enormous belly served to prevent coitus, since the pressure of the tense abdomen upon the rump of the cow forced the abdominal viscera against the diaphragm so that the bull was quickly out of breath and exhausted. A breeding male should be fed like any other animal which one desires to keep in vigorous condition. The bulk of the food and the amount of nutriment contained should be ad- justed to the needs of the individual, having due respect for size, age, and the exercise or work provided. 196 Diseases of the Genital Organs The direct influence of certain foods upon fertility has frequently been asserted but is difficult to trace. It is a favorite habit of the breeder and dairyman, when his herd shows a low rate of reproduction, to attribute it directly to food — ensilage, alfalfa, clover, cottonseed meal, and well- nigh every food. Indirectly, foods modify reproduction greatly because the general vigor depends more upon the quantity and quality of food than upon any other one ele- ment. D. Idleness and Overfeeding Impotence of the male is sometimes expressed chiefly by an absence of sexual desire in the presence of females prop- erly in estrum, without any visible changes of the reproduc- tive organs. Sometimes he may pay attention to the female, with more or less complete erection of the penis, then desist in his attentions, and turn away. When the next female is presented, he may show normal sexual vigor. In some cases, there is said to be an individual psychic in- fluence which prevents the male from copulating with a cer- tain female. This is alleged to be especially true of individ- ual stallions, to which certain mares seem to be repulsive, so that they refuse to copulate with them. The presence of young at the side of the dam is sometimes alleged to repress the sexual appetite of the male. This is usually seen, however, only in those males depressed in their vitality. It is almost, if not always, erroneous to attribute absence of sexual de- sire to the caprice or idiosyncracies of the male, by which a female of a certain type or color becomes repulsive to him and fails to arouse his sexual appetite; the real cause lies in bad management or in disease. The tendency to loss of vigor on this account is usually not noticeable in the young, but, as soon as the animal has become mature and grown quite fat, the disposition becomes marked. This form of impotence is seen almost exclusively in those animals which are closely confined, highly fed, and not properly exercised. It is commonest in draft stallions, but is observed in bulls, especially of the beef breeds, and in male breeding animals of all species. It tends to disappear Idleness and Overfeeding 197 promptly upon a correction of the method of keeping, pro- viding that it be applied sufficiently early. The difficulty should be prevented by not forcing the young male designed for breeding purposes too rapidly in his development. He should be allowed only a moderate diet, with plenty of exercise and freedom, or be given actual work. Upon the appearance of these defects in the mature ani- mal, much can be done, if handled opportunely, by restrict- ing the diet and causing an abundance of exercise. A healthy young draft stallion belonging to one of my clients refused almost wholly to serve mares. He was being highly fed and was getting a very limited amount of exercise, at a slow walk. Being appealed to for advice, I reduced his food ration one-half and prescribed eight miles exercise daily, at a brisk walk. Within a few days, his sexual de- sire had fully returned. He finished his season's work in good form, and was effective as a sire. The same general principles apply to other breeding males. In countries where cattle are habitually worked, the bulls are kept in breeding condition by moderate draft service. It would be well to imitate this plan in America, where bulls and stal- lions are not habitually used for work, but could readily render valuable service while being greatly benefited by the vigorous exercise secured. Under general conditions, it is perhaps the best possible and most economic manner by which sufficient exercise for these animals can be as- sured. Incidentally, it should be noted that such exercise or work tends very strongly to prevent that viciousness in bulls and stallions which renders them dangerous to their keepers. Zschokke emphasizes the value of the proper selection of food for the purpose of arousing sexual desire, and insists especially that the hay should be aromatic, as should also the oats. Not only should they be well cured and sweet- smelling, but he believes that the admixture of certain stimulants, such as calamus, pepper, powdered mustard, and even powdered cantharides, are advantageous. He 1^8 Diseases of the Genital Organs recommends that these remedies be fed with cut hay and that they be allowed for two or three days in succession and then omitted for the same length of time, when they may be given again. I doubt very greatly the value of aphrodisi- acs, or sexual stimulants, in breeding animals. Sexual in- stinct is normal and so universal in animals of breeding age and in proper health that I fail to see the value of ex- citing sexual desire artificially. If sexual instinct is ab- sent, it is because of some disease of, or depression in the general vigor of the animal, which can not readily be re- moved by aphrodisiacs. It has not been shown that the arousal of sexual appetite by means of these drugs insures or even favors fertility. A constant and wide distinction must be drawn between copulation and fecundation. The fundamental function of the male is the elaboration of virile spermatozoa, or male cells, and of the female to produce healthy ova. Copulation serves merely to transfer these fecunding cells from the testes of the male to the vagina of the female. Copulation is in vain without vigorous sper- matozoa and healthy ova, and no data exist to show or sug- gest that any drug may directly cause or favor their devel- opment. Certainly it must be admitted that tonics, alteratives, or other drugs capable of influencing favorably the restoration of a diseased animal to a state of health must also improve its reproductive powers, by restoring the equilibrium of the body and enabling it to perform better all its normal func- tions, among which is reproduction . The highest state of the general vigor of the body is, consequently, the most favorable condition for the production of virile spermatozoa and ova, which constitute the first essential in fertility . Sometimes there is an apparent absence of sexual desire in young males when first brought in contact with estrual females for purposes of coitus. If such animals are turned loose with the females, the difficulty is generally overcome very promptly. The preparation of breeding animals for the show is al- ways dangerous for their sexual vitality. In order to get Idleness and Overfeeding 199 them in high condition, they are frequently closely confined and fed in such a manner as to produce the greatest amount of fat, in the hope that they may make a better showing and more certainly win a prize. It is an unfortunate fact that many of the most richly bred animals, designed for breeding purposes, which capture the most coveted prizes at the livestock fairs, have their breeding powers either tempo- rarily or permanently destroyed in the process of feeding them for the show. There is no effective method for over- coming this except by the exercise of greater intelligence on the part of the owners of show animals, which may be furthered by judges in livestock exhibitions paying less at- tention to the amount of fat and more to the form and gen- eral vigor of the animal, in the allotment of premiums. In order to show breeding animals with safety, it is absolutely essential that abundant exercise should accompany the pre- paring process, if the sexual vigor of the animal is to be safely preserved. The result is not the same with all individuals. There are some which can withstand almost unlimited abuse in this direction and continue to breed regularly, while others are very susceptible and soon become temporarily or per- manently sterile. Once this sterility is established, the only thing that can be done is to correct errors in care by moder- ating the diet and enforcing vigorous exercise, which will sometimes, though not always, restore the sexual powers. In a general way, the food of a breeding male needs to be rich in protein, as compared with the amount of hydro- carbons and carbohydrates. The commonest foods, when well grown and cured, are the best for the breeding animal, such as bright, aromatic hay and clean, well developed oats, along with grass, to which may be added, in the winter, roots and tubers. Rarely, if ever, is it necessary or even advisable or permissible to add to the food any sexual stimu- lant like pepper or mustard. It should be observed that interferences with reproduc- tion by confinement, overwork, overfeeding, starvation, and other imprudent details of handling exert their pernicious 200 Diseases of the Genital Organs influence through two separate channels. In the first place, overwork or starvation, by lowering nutrition of mature genital cells, directly inhibits reproduction. The functions of the sex glands are such that neither the physical over- exertion of the animal nor starvation can extend its influ- ence beyond the duration of the abuse. The function re- turns with restoration of bodily vigor. The indirect effects of these errors are far more serious and enduring. In all animals the genital organs commonly contain bacteria which, so long as the animal is healthy, may insidiously multiply at a rate barely to maintain their status. When for any reason the vigor of the animal is lowered, the genital tract participates in the depression and bacteria multiply and rapidly increase in virulence. Soon permanent injury of essential structures may occur, and reproduction becomes difficult or impossible. At one time there was much said about "fatty degeneration" of the genital organs as a bar to reproduction in fat animals. I know of no adequate ground for such an assertion. In most animals the genital organs are among the last to act as de- positories for fat. A notable exception is the bitch, in which the uterine ligaments are loaded with fat, but these are not essential and the fundamental organs are not visibly involved. As knowledge of the diseases of the genital organs ad- vances, the belief in the direct influence of food, work, and housing recedes, but their indirect influence, through the general lowering of vigor and a correlatively increased viru- lence of bacteria present, comes into greater prominence. The proper nutrition, housing, and physical exercise of breeding animals is one of the great fundamentals in the problem of reproduction, because the vigor which these in- duce constitutes an invaluable armor against the extension of infection. E. Excessive Sexual Use The number of copulations which a male animal can effec- tively perform is an important question for the breeder. It Excessive Sexual Use 201 probably varies greatly with different individuals. Natu- rally, the power of a male does not depend so much upon the number of females with which he is expected to copu- late as upon the number of copulations essential to produce fertilization. It has been determined by careful investiga- tion that, when the number of copulations during a given day is increased, the abundance of spermatozoa in the semen rapidly decreases and, if this service is pushed too far, the spermatozoa fail almost entirely, causing an interruption of the fertility of the animal. Much will depend upon the age and vigor of the male animal. Zschokke states that 80 to 100 cows may be bred to a single bull when the animal is kept confined and his service somewhat regulated by the breeder but, if allowed to con- sort with the cows at pasture, not more than 50 should be allowed. In the western range country of America, the al- lotment is very much smaller and it is considered safer that there be one bull to each 20 or 25 cows. This is necessitated largely by the fact that, during the principal breeding sea- son, the bulls have not yet fully recovered their vigor from the long and trying winter with scant food supply. Zschokke further holds that the bull should not be allowed to serve more than three cows in any one day and that, under such conditions, there should be one or two days per week of complete rest. Many horse-breeders apply a similar standard in the use of stallions. The total number of females, however, may be greatly increased if the service is distributed throughout the year. Noted stallions, it is claimed, have served suc- cessfully, and without apparent injury, two or three hun- dred mares during the year, but in such cases the service was evenly distributed over the entire period. Zschokke draws attention to the erroneous belief that a long abstinence from coition serves to store up a large amount of semen, which will answer for a series of copula- tions. There is no reservoir for such purpose, and all sper- matozoa which may be formed and not used in copulation soon disintegrate and are expelled or absorbed. Excessive sexual use is largely a comparative term, in- 203 Diseases of the Genital Organs dicative of a relative over-use under existing environment. There is no question but that a breeding male may be readily over-used and that such is a frequent occurrence, but more commonly the use is relatively excessive because of bad man- agement, where proper handling of the male would enable him to make the number of services demanded, safely and efficiently. My belief is that most males are called upon to copulate too frequently. The most hygienic rule for reproduction in the higher mammals is monogamy, and any departure from that ideal is necessarily at some peril. Since great sires which have cost heavily are expected to repay their owner by begetting a large number of highly valuable young, poly- gamy is crowded to its limit, and beyond. There are two fundamental facts bearing upon sex hygiene which every breeder should know and heed. Most breeding animals of both sexes carry important infections in their genital tracts, and coitus stimulates and heightens genital infections. The number of copulations which a bull or stallion may safely perform depends first upon the degree of infection or dis- ease in his genital organs, and, second, upon his general health and vigor. While many accounts are published of the great numbers of copulations made by various bulls or stallions, or the large number of progeny to their credit, they constitute an infinitesimal proportion of the total. Clinically we observe bull after bull breaking down genitally under what would appear to be very moderate use. Ad- mittedly the infection was probably there already but the repeated copulations served to vitalize it and establish seri- ous disease, precisely as coitus intensifies syphilis and gonor- rhea. Moderate work of the male during the breeding sea- son is not injurious, but favorable. It is a constant observa- tion that a male breeding animal which is regularly exer- cised or moderately worked is capable of rendering a greater number of effective services than one which is closely con- fined. Some writers condemn such foods as oil cake and malted Otianism, or Masiiirbat707i 203 grain for the male and prefer the various grains, especially oats, barley, peas and beans in moderate quantity. To these should be added hay and grass in sufficient amount. Roots, tubers, meal and molasses are not considered essential as a part of the food supply for breeding males, but may, by aid- ing in the maintenance of a good state of digestion, con- tribute to the general vigor. The feeding of salt has long been regarded as important for maintaining fertility, and some have superstitiously ac- corded it a prominent place, but it can not act directly and serves merely to favor fertility indirectly by aiding diges- tion and assimilation. Apparently some believe that a male breeding animal re- quires a different kind of food from the female. Funda- mentally that is absurd, but when a bull is kept absolutely confined and is wholly idle physically, he requires less food per unit of body weight than a cow which is yielding a lib- eral quantity of milk and probably gets some exercise daily in the open field or paddock. The feeding needs to be ad- justed the same as it would be between a cow which is milk- ing heavily and another which is dry. F. Onanism, or Masturbation Masturbation, as a cause of sterility, is mentioned chiefly in the stallion and the bull. It is said to be very common in improperly kept stallions. Spinola (Handbuch der spec. Pathol. 1858, II Bd.) records this vice in the bull. In the stallion there is an erection, the penis is moved up and down, imitating coitus, and finally ejaculation occurs. In the bull, the ejaculation is induced by an erection and the alternate protrusion and withdrawal of the penis. This is generally seen in idle males which are closely confined, over-fed, and sparingly used for breeding, and in racing stallions when sexual debility is brought about by hard work. It is undetermined whether the vice causes the im- potence or the sexual weakness induces the masturbation. Correction may be brought about by such feeding, exer- cise and other care as will maintain the general vigor of the 204 Diseases of the Genital Organs animal. Moderate work or exercise and judicious feeding, or, in animals which can not be worked or artificially exer- cised, the allowance of freedom in a commodious paddock — still better, in a properly enclosed pasture — ^tends largely to prevent or cure the vice. Once the habit has become fixed, it should be prevented by a shield so arranged as to cause pain whenever the penis is protruded. It is a vice of idle- ness and debility, and any and all remedies must fail in their aim until the return to normal vigor is attained. Chapter VII COITAL INJURIES In the wild state, severe and fatal battles between rival males are not infrequent and the same prevails to some de- gree among domesticated animals, although, as a general rule, if several males are kept together they lose much of their combativeness. I have seen an instance of a fatal fray between two rams which had been regularly kept to- gether. When a strange male wanders into a herd or group of fe- males with which a male is regularly consorting, there is at once a determined fight between the two, which ends only with one or the other becoming vanquished. In these bat- tles, injuries of the most diverse character occur, according to species and chance. The only method of prevention is the proper confinement of male animals. In most countries there are laws against the running at large of male animals but these are not enforced against carnivora. This excep- tion should be overcome by the confinement of all females. There is further danger to the male, especially horses and cattle, of injuries in attempting to escape from or break into enclosures in order to reach females. The appearance of a female in estrum near the enclosure of a male causes him to make violent attempts to escape from his confinement and reach the female. Consequently it is important that en- closures intended for the confinement of male breeding ani- mals should be especially secure and, as far as possible, all elements avoided in their construction which would endan- ger the animal in an effort to escape. In the preparations for copulation there is little danger except in case of horses. Breeding customs and conven- ience bring into the procedure a period of "trying" or "teas- ing" of the mare by the stallion, to determine the existence of estrum and bring about the desired degree of sexual ex- citement before permitting an attempt at copulation. In this act there are numerous dangers, especially to the stal- lion. 2o6 Diseases of the Genital Organs It is desirable, if not frequently essential to safety, that special conveniences for restraint be provided for this pur- pose. They should consist ordinarily of a strong, solid wall about three feet high and ten to twelve feet long, with a rather broad and rounded top. The chief object of the struc- ture is the avoidance of kick wounds which may be inflicted upon the stallion by the mare. To this end it should be merely of sufficient height to guard against such an acci- dent and sufficiently resistant that the mare can not kick through it. A single pole to separate the stallion and the mare is insecure and hazardous, as either may kick through beneath it and injure the other. It is highly essential that the top of the structure be rounded, smooth, and free from projections. Either the mare or stallion may get beyond the control of the groom and kick or leap upon the structure. The wall should be low enough that either animal, getting upon it by rearing or kicking, may readily free itself without injury. I once at- tended a stallion, which, having passed beyond the control of the groom, reared to mount the mare and became im- paled upon a projecting post at one end of the structure, causing a serious hernia and almost eventration. Posts should not extend above the top of the structure or, doing so, should continue so high as to make injury in this manner impossible. A. Kicks and Fractures When this preparatory period has been passed and copula- tion has been decided upon, there arise fresh dangers to the stallion from kicks by the mare while approaching her or in the act of mounting. Two methods of avoiding accidents at this point are used — without and with hobbles. In the first method, when both stallion and mare are well broken and controllable and competent grooms have each well in hand, the stallion should be caused to approach the mare's head, and then allowed to mount from the side instead of from the rear. If both are kept well in hand, any attempt to kick on the part of the mare should be at once counter- Kicks and Fractii res 207 acted by vigorously drawing her head toward the stallion, thus turning her heels from him. When coition has been completed and the stallion is dismounting, the same rule should constantly be applied and the mare at once caused to face the stallion in order to avoid kicks. Owners of valuable stallions generally prefer to obtain yet greater security by the application of hobbles. Two forms are used, of which there are numerous varieties. By one plan, a hobble is buckled about each hind pastern and to each hobble is attached a rope of sufficient length, the two free ends of which are carried forward between the fore- legs and securely tied to a strong collar or carried upward on either side of the neck and tied on the top sufficiently tightly to prevent the mare from kicking backward any ap- preciable distance. By the second plan, the hobbles are at- tached to the hocks instead of the pasterns. In this case, each hobble is branched ; one portion of each is attached above and the other below the hock of each hind leg, and by ropes or straps fixed forward the same as in the first. The latter plan possesses some points of superiority : the mare is not so liable to injure herself by becoming entangled in the ropes, and the stallion is probably also exposed to less dan- ger of getting his foot caught in the securing apparatus. Whatever the form of breeding hobbles or other confining apparatus, they should be secure and strong. Nothing can well be more dangerous for the breeding stallion than weak hobbles which lead to a false feeling of security and throw the otherwise careful groom off his guard. I was called to attend a valuable stallion suffering from a compound tibial fracture, the result of a kick during attempted copulation. Because the mare was not properly in estrum, or for other reason, she was unexpectedly ill-natured. When the stal- lion was attempting to mount she commenced to kick, the old hobbles, in which the owner of the stallion had trusted, gave way, and the fatal accident at once followed. The breeder should never trust partly to hobbles and partly to the gentleness of the mare or good luck. If hobbles are to be trusted at all, the breeder should know that they are so 2o8 Diseases of the Genital Organs strong that no mare can break them, always allowing a safe margin of strength beyond that considered essential, and that the fastenings are secure in every detail, making slip- ping or accidental detachment impossible. If accidents are to be avoided, it is highly important that the mare is properly in estrum and that she is not frightened or angered. Gentleness and patience in the handling of both stallion and mare and postponing copulation until the proper moment are always essential elements of safety in breeding. Some breeders place a twitch upon the mare's nose until the stallion has safely mounted her. Much of the danger arises through the lack of ability upon the part of the groom to diagnose estrum. Some grooms think when a mare crowds against the teasing-pole and urinates, she is in estrum, when as a matter of fact she is angry. A groom should learn that a mare, not in estrum at all, when confined to be teased by a stallion and unable to get away, will crowd to- ward him, squat, and expel small quantities of urine simply as an expression of anger (a gelding, when tightly confined, occasionally gives vent to his anger by a characteristic neigh and the expulsion of urine in small quantities). If opportunity offers, such a mare will kick viciously. Some stallions are so poorly broken that they rush at a mare vio- lently and, if opportunity is given her, she will kick from fright in self-defense. The proper knowledge on the part of the groom, enabling him to diagnose estrum, and the proper control of the stallion, are prime essentials to safety. In breeding mares to jacks, it is customary to place the mare in a pit where she is closely confined and rests upon a plane a foot or more lower than that upon which the jack stands. This not only gives an advantage to the compara- tively small male by affording him an elevation, but also secures him against kicks from the mare, a highly essential precaution because, since the mare ordinarily resents copula- tion with the ass, the act is largely in the nature of rape. Disparity in size is a common cause of fractures in cattle of both sexes. When a young bull attempts to copulate with a large cow, he is liable, at the moment of the sudden copu- Kicks and Fractures 209 latory thrust, to lift his feet entirely from the ground, so that they glide forward, he falls backward, and may break his spine in either dorsal, lumbar, or sacral region. In one case brought to my attention, a similar accident occurred to a cow which, being in heat, mounted one of her mates, slipped, fell, and fractured her spine so that she had to be destroyed. The danger of falling when the ground is slip- pery or copulation is undertaken upon a concrete or other smooth floor, is to be obviated by the removal of the causes. In females mated with too large a male, fractures of the spine, pelvis, and limbs occur. The danger is greatly ag- gravated by slippery or uneven ground or by other unfavor- able surroundings. Injuries to the female because of the great weight of the male are not rare though far less com- mon than one would be inclined to expect when the disparity in size is considered. It is not rare to see females served by males two, three, or more times as heavy, and yet escape in- jury. In the smaller species, as the pig and dog, the female can quite readily drop to the ground under excessive weight and escape injury, but in the cow and mare there is danger of serious injury when the weight of the male becomes too great. Fractures from this source are most common in cattle and generally the result of a fall at the moment the bull makes the violent copulatory thrust. Some breeders overcome this danger by using a breeding rack or cage, as described above, so that the heifer can not be forced for- ward and down. Each side of the rack presents a shelf upon which the fore feet of the bull rest, preventing his en- tire weight from falling upon the heifer. Sometimes an awkward helper holds the head of the cow to one side and, when she moves forward, draws firmly on the halter, bend- ing her head sharply to one side and causing her to fall. Either she should be left free or any restraint should be ex- erted by two men, one on either side, thus pushing directly backward. Nymphomaniac cows suffer frequently from pel- vic fractures, which will be discussed under Cystic Degen- eration of the Ovaries. In one instance a heifer of about five months and weighing about 400 pounds was served by 14 2IO Diseases of the Genital Organs a bull weighing 2000 pounds and suffered a fracture of the pelvis. The injury was not sufficiently serious to prevent her giving birth in due time to a calf. In another instance, a sucking filly was mounted by a large stallion which had accidentally broken into a field with her, causing dislocation of the sacro-iliac articulation on one side and fracture of the iliac shaft on the other, rendering her useless for labor. She was bred at two years, and destroyed at three years, because of irremediable dystocia. It is desirable that young females which come in estrum very early in life should be securely segregated from mature males, not alone because of the undesirability of very early breeding, but in order to avoid serious injuries from dis- parity in size. It is also essential to remember that a male breeding animal regularly confined, in case of accidental escape, will attempt rape upon the most immature young, as in the foregoing case, with serious or fatal results. The violent copulatory thrust of the bull occasionally causes a fracture of the base of the tail or the caudal end of the sacrum. I have observed it most frequently in Jerseys, perhaps because the sacrum is relatively smaller and less resistant than in other breeds. It seems to occur at the mo- ment of the copulatory thrust. So far as known, it is not subject to remedy. The result is usually caudal paralysis, with a lateral curvature of the tail and caudal end of the sacrum, disfiguring the cow and destroying the protective value of the tail against flies, without otherwise injuring the animal. B. False Copulation False copulation, or entrance of the penis into the anus instead of the vulva, is possible in most domestic animals. Harms records it as occurring in the mare, cow and sow. I have observed it only in the mare and, in all, four times, though I have known of numerous other instances. It is by no means rare and is highly dangerous. Its causes are va- rious, but it is probably due largely to resistance on the part of the female. Sometimes a female is thought to be in es- False Copulatio7i 211 trum when she is not. Perhaps she has been in estrum an hour or two before and the owner or person in charge be- lieves it best to use forcible restraint in order that copula- tion may occur. Some, erroneously believing that, when estrum fails to appear at the expected date, it may be brought about by rape, proceed to force coitus. Coition is safe only when estrum is present in the proper degree. The mare has ample power to close the vulva against the ready entrance of the penis, thus causing it to glide upward and forward against and into the anus, which opening may be more readily forced. The accident is also invited in aged cows or mares with pendulous abdomen in which the tension upon the rectum draws the anus and superior commissure of the vulva down- ward and forward, thereby causing the vulvar opening to approach the horizontal instead of the perpendicular. The penis then tends to glide forward and slightly upward over the oblique vulvar opening, to strike against the inferior surface of the tail and become deflected into the anus. It may be purely accidental. Harms thinks it may result from smallness of the female. All cases I have observed have been in mares of medium or large size. The extent of the injury varies. Apparently, the acci- dent may cause little or no injury in some cases, though, of those which are brought to the attention of the veterinarian, a large proportion are fatal. The extent of the lesions will vary according to the size of the penis, the violence of the copulatory act, and the quantity and character of the feces in the posterior portion of the rectum. Should the rectum be quite empty or filled only with pultaceous feces, as in a cow, or in a mare on green food, the penis may force its way along in the bowel unless it is caught in the folds. If the rectum is impacted with dry feces, as is usually the case in the mare, the penis is deflected and tends to pass through the rectal walls. The rupture may occur either into the peritoneal cavity or into the periproctal connective tissue. In the former case, in the mare, the opening is so great that feces drop at once into the peritoneal cavity and cause pro- 212 Diseases of the Genital Organs found irritation. No sooner has the stallion dismounted than the mare trembles, looks anxiously at her sides, may pass some feces and blood, moves uneasily, and may lie down, but does not roll violently. The pulse is rapid and weak, the breathing is shallow and quickened, the abdomen is held rigid, and the patient looks tympanitic. The symp- toms resemble in many particulars those of rupture of the stomach. The diagnosis is readily made by manual explora- tion per rectum, since the hand passes easily out through the rupture into the peritoneal cavity. In one of my cases of rupture into the peritoneal cavity, the mare lived some eight hours ; in another, less than four hours. Not all cases lead to rupture into the peritoneal cavity. In one instance under my observation, in an old brood mare, no history of injury was obtainable, and apparently the rup- ture had not occurred during the several years of ownership by her last proprietor. She died under symptoms of colic. Autopsy revealed a large intra-pelvic sac, opening into the rectum, which had been habitually filled with feces but, be- coming over-distended, had obstructed the bowel and caused a rupture of the sac into the peritoneal cavity. It was al- most certainly the result of an old penial wound. In another case I recognized the accident at the time of its occurrence. Blood and feces were voided, and the perineal region was swollen. Manual exploration revealed a large rent through the rectal walls into the periproctal connective tissue, six to eight inches from the anus. The resulting sac contained about two liters of feces impacted into the readily distensible wound. The feces occupying the sac and those from the rectum immediately anterior to the rupture were carefully removed by the hand, and the sac was cautiously flushed out with an antiseptic solution. This method of handling, repeated twice daily, along with restricted, laxa- tive diet and complete rest, brought about a prompt recov- ery with little sacculation. According to Harms, false copulation in the sow is usu- ally followed by no more serious consequences than a swollen anus, accompanied by a bloody discharge. False Copulation 213 In the mare the accident is preventable by ordinary pre- cautions on the part of the stallion groom. Service should not be attempted in case of a mare not certainly in proper estrum. It is the duty of the groom to see that the penis of the stallion is properly entering the vulva of the mare. If the mare is kicking or otherwise violently resisting the stal- lion, he should be promptly withdrawn, since copulation un- der such circumstances is unwarrantedly dangerous for both animals. Such violent resistance of the mare is some- times cited by the groom as an excuse for his failure to know that the penis of the stallion was being properly en- tered in the vulva, but it is not valid. The mare or cow with retracted anus should be placed with her hind feet on a lower level than her anterior members, leaving the ground upon which the male is to stand at a higher level and thus bringing the vulvar opening more nearly perpendicular. In the cow and sow, the accident is not usually preventable. The prognosis of penial injuries to the rectum must be based largely upon their position and extent. When the lacerations perforate the peritoneum, allowing feces to es- cape into the peritoneal cavity, the injury is essentially fatal : veterinarians have not yet succeeded in successfully handling such lesions. When the rupture of the rectal wall occurs behind the peritoneum or, occurring more anteriorly, does not perforate it, the prognosis is good, if timely surgi- cal aid is given, though, after a long time, serious or fatal results may follow the impaction of feces in the sac formed in the pelvic connective tissue. The pressure of the feces es- caping from the rectum tends constantly to push the loose connective tissue aside and, eventually, to form a large sac, which is constantly filled with fecal masses. The handling in such cases consists of gently removing the feces from the sacculated wound cavity in the pelvic con- nective tissue and cautiously flushing it out at least twice daily with a mild antiseptic solution. At the same time, the rectum should be manually emptied as far as the attendant can reach and the feces thus prevented from dropping into the sac. The patient should be kept at rest on a very scant, 214 Diseases of the Genital Organs laxative diet during the treatment, until the rupture is quite healed, as it is highly important to guard against ex- tensive sacculation in the part, which can be done only by avoiding the accumulation of feces in it. In some instances, the injuries to the rectum from the en- trance into it of the penis are comparatively trivial — merely wounds of the mucosa and part of the muscular walls, with the passage of bloody feces, some swelling about the anus, and other slight symptoms of injury, which readily pass away under repeated antiseptic enemata. From a forensic standpoint, the owner of the stallion is probably always responsible, since the accident is preventa- ble with proper care upon the part of the groom. Such were the findings in the only case which I have seen tested in the courts. C. Laceration and Rupture of the Vagina The vagina, especially of the mare, is not infrequently lacerated or ruptured by the penis of the male. The size of the penis of the stallion does not bear a constant ratio to that of the body, but is comparatively excessive in coarsely bred animals with long legs and large heads. Such stallions, copulating with small mares, constantly tend to produce vaginal injuries. Sometimes it is merely a slight laceration in the mucous membrane, which may cause limited hemor- rhage and some straining ; sometimes the lacerations in the mucous and muscular walls are extensive and induce marked symptoms of wound infection in the vagina, with tumefac- tion, discharge and straining; sometimes the vaginal walls are completely ruptured, with great danger of fatal perito- nitis. In one instance I investigated, a series of injuries was caused by a recently introduced stallion, which had been put to service among comparatively small mares. Almost every mare served by him exhibited signs of vaginal injury: some were severely lacerated ; in one there was a fatal rupture. The horse was found to be an overgrown, coarse, leggy grade draft stallion about eighteen hands high, with an enormous Laceration and Rupture of the Vagina 215 penis which would have been dangerous with heavy draft mares, while in his neighborhood most animals were of small roadster or common stock. When such injuries occur, there is observed an abnormal amount of straining immediately after copulation, with, per- haps, some discharge of blood from the vulva. Later, swell- ing of the vulva and a muco-purulent discharge may occur. If the wound penetrates the peritoneal cavity, septic peri- tonitis is highly probable, with early collapse and death. Injuries to the mare from this cause should be obviated by means of a roll or padded surcingle encircling the body of the stallion and passing just in front of the sheath in a manner to prevent the penis from entering the vagina to its full length, the pad or roll being adjusted in size according to the case. The diameter of the roll should always be ample, since little fear need be entertained that preventing the en- trance of the entire length of the penis will unfavorably af- fect the results of copulation, as general observations show to the contrary. In constructing this roll or pad, an ordi- nary surcingle may be used and a tube made of sheeting or other sufficiently strong material, open at each end, which is slipped over the surcingle. Padding of cotton, oakum, or other material is then to be inserted into the tubular cover- ing until it is tightly filled so that it presents a diameter of 4 to 8 inches in that part of the surcingle to come in contact with the abdominal floor, after which the open ends of the tube are to be secured to the surcingle and closed by tying. When the stallion is ready for service, the surcingle is passed around his body just in front of the opening of the sheath, and secured by buckling. In copulation, only that portion of the penis projecting beyond the roll can enter the vagina. Non-fatal laceration of the vagina should be handled along general antiseptic lines. The practitioner should re- member that this organ reacts strongly to irritants and that thorough disinfection should be brought about largely by mechanical flushing rather than by heroic attempts to de- stroy the micro-organisms in position. , Coital injuries to the vaginae of cows have not come un- 2i6 Diseases of the Genital Organs der ray observation. I am of the opinion that they are very rare. The vagina of the cow is very long and elastic. Dur- ing estrum it is highly lubricated with an abundant, thin mucus, rendering it virtually impossible for the penis of the bull to become caught in the lateral walls. If the heifer or cow were not in estrum and the vagina were dry, the case would be quite different. I have seen a number of cows which could not copulate without great peril because of severe vaginal stricture. Per- haps that is the explanation of the cited instances of vagi- nal injury by the penis. Lacerations of the vagina by the penis are also liable to occur in other domestic animals, though less probable than in the miare. Their symptoms, prognosis, and treatment are essentially the same. D. Rupture of the Uterus by the Penis of the Bull Duranton(0 states that in one instance the penis of the bull passed through the cervical canal and ruptured one of the uterine cornua. This is highly improbable, if not abso- lutely impossible. It is almost certain that the real culprit was a man, who had either committed sadism or had at- tempted to "open the womb". Veterinarians should be always on their guard in accept- ing accounts of injuries to the vagina or uterus of the cow by the penis of the bull. Many owners and caretakers have an abiding faith in the efficacy of "opening the womb" just before coitus, as a remedy for sterility, and not infrequently are not publicly proud of their faith. As a consequence, the operation is often kept secret, especially if the layman has become frightened because hemorrhage has followed his efforts. Later, if disaster follows, the true history is not given the veterinarian. Often a workman will under- take such an operation without the knowledge of the owner, and, suspecting he has injured the animal, quite naturally keeps his bungling work a secret, so that the bull is blamed with having caused the lesions. ^Journal de Lyon, 1888, Alleged Rupture of the Urinary Bladder by the Penis 217 In examining a sterile heifer, I encountered a chronic, indurated, cervical abscess, which is shown in Fig. 39. The origin appeared perfectly clear to me. Upon inquiry, it was at once admitted that a man had attempted to "open" her to cure the sterility. Repeatedly I have observed in- juries to cervix and uterus by veterinarians. E. Alleged Rupture of the Urinary Bladder BY THE Penis Uebele, cited by Harms, reports that a heifer died from rupture of the urinary bladder a few days after coitus. Any veterinarian who has passed a catheter through the urethra of a cow should appreciate the difficulty of the pas- sage of the penis of the bull through that narrow canal, ob- structed at the beginning by the valve-like cul-de-sac. An ignorant meddler, mistaking the urethra for the cervical canal, might cause such injury. The veterinarian should take every possible precaution against being deceived, whenever the lesions appear so removed from the ordinary. Under certain abnormal anatomic conditions, the urethra might well suffer severe lesions during attempted coitus, especially when the lower portion of the hymen persists. The hymeneal remnant slopes somewhat upward and back- ward, forming a sort of pouch in the floor of the vulva, with the urethra at its bottom. The membrane, catching the penis, may deflect it downward into the urethra, and either the penis or the urethra and bladder, or all, may suf- fer injury. But that is aside from the point. The healthy normal genital tract of the heifer or cow is not readily damaged by the penis of the bull during coitus. When such post-coital injuries are recognized, the diagnosis as to cause should be very guarded. Under certain conditions, a false diagnosis might well lead to litigation, especially when a bull belonging to one man breaks into an enclosure where cows belonging to another are kept. In all such injuries the veterinarian should not fail to give consideration to two other possibilities, each of which is more probable than penial injury — sadism (which see) and 2i8 Diseases of the Getiital Organs meddling by incompetent persons in an effort to "open the womb". In the mare, this accident would seem more possible be- cause of the very wide, valveless meatus, through which several fingers may be passed, but the penis of the stallion is large and the glans very broad. Elsewhere I have de- scribed a filly with a persistent, though perforate hymen, which deflected the penis of the stallion downward and ap- parently caused a wide dilation of the urethra but no harm to the bladder. F. Vaginal Hemorrhage Following Coitus Hemorrhage following coitus is not rare. It often follows copulation of a virgin female, owing to slight lacerations of remnants of the hymen. In cattle, when the granular venereal disease is very severe, hemorrhage in both sexes often follows coitus. This will be discussed in a succeed- ing chapter. If stricture of the vagina is present, coitus is always liable to cause hemorrhage. Often lacerations of the vagina during coitus, already cited, cause more or less hem- orrhage. Tumors of the genitalia which are lacerated by coitus may bleed quite profusely. G. Urethral Hemorrhage in Stallions Hemorrhage from the urethra following coitus was ob- served by me in a valuable racing stallion. The patient, a famous imported thoroughbred in fine physical condition, had been a successful sire. He was very vigorous in copu- lating. Without warning, he suddenly began to bleed pro- fusely from the urethra after each coitus. The act of copu- lation appeared normal, and was completed promptly and naturally. A moment after dismounting, before the penis had retracted, there was a sudden gush of bright red blood, estimated at about one pint, after each copulation. The source of the hemorrhage could not be determined, though it probably emanated from the pelvic urethra, vesi- culae seminales, prostate, or Cowper's glands. Its cause was Contusions of the Neck and Withers front Bites 219 not learned. He was withdrawn from the stud, kept sexu- ally quiet, exercised freely, and fed lightly. Later he was returned to the stud. He had been kept in sight of the mare while the breeding hobbles were being applied, during which time he became highly excited. This was changed so that the mare was properly shackled before he was brought into her presence. He was then allowed to copulate promptly, before excessive erection could occur. The difficulty ceased. H. Contusions of the Neck and Withers from Bites In the mare, injuries to the neck and withers are liable to occur from bites by the stallion during coitus. This is proba- bly most common among heavy draft stallions, some of which are very rough and cause more or less serious lacerations or contusions, at times leading to fistulous withers. There seems to be no means for breaking the stallion of the vice. The only effective method of control is the application of a muzzle prior to coition. I. Penial Injuries Injuries to the penis of the male just before, during, or after copulation are by no means rare. The penis of the stallion is most liable to injury from kicks by the mare just as he mounts or dismounts. The prevention of such injuries has been discussed above. Such contusions of the penis dur- ing its great vascularity in the breeding season are very difficult to handle. The stallion needs to be kept quiet and free from sexual excitement. The penis should be retained at rest within the sheath, by means of a suspensorium, and the resulting local inflammation ameliorated by the applica- ton of cooling astringents such as lead acetate, hamamelis, tannin, belladonna, etc., combined if necessary with anti- septics. Generally the patient may have quiet walking ex- ercise, a restricted laxative diet, saline laxatives, or in case of serious disturbance, prompt cathartics of the hypodermic alkaloidal group (eserin, arecolin, etc.). 220 Diseases of the Genital Organs Lesser injuries to the penis of the stallion are caused by the tail hairs of the mare, pushed into the vagina by the glans, which, being drawn tightly across the penis, cut the organ. This is to be prevented by the stallion groom, who should draw the tail of the mare aside at the commencement of the copulatory act ; apply a bandage about the base of the tail extending low enough to secure any hairs that might be caught by the glans penis ; or braid the hairs of the tail upon its dorsal surface. The danger of injury to the penis of the bull is increased when a large male attempts to copulate with a small heifer, with a very narrow vulva and perhaps important remnants of the hymen. The presence of severe granular venereal disease lessens the caliber of the vulva and the roughness caused by the nodules increases materially the resistance to the entrance and the two combined, with the pain caused by the forcible contact, render injury more probable. Some- times the penis of the bull withstands violence surprisingly well. I examined a neuter, or freemartin, with severe lacer- ations of the vulva and periproctal tissues. The owner re- lated that, as the "heifer" would not come in estrum, he de- cided to stimulate its appearance by causing the animal to be raped by the bull. (The practice of raping females which fail to come in estrum is not rare amongst a careless, ignor- ant class of breeders.) The penis of the bull had caused serious injury to the neuter, compelling prompt slaughter. The penis of the bull escaped known injury. Coital injuries to the penis and prepuce of the bull are probably more common and vital than those occurring to the genital canal of the cow. Exposure to minor injuries is constant. In cattle the universal presence of the granu- lar venereal disease causes a constant genital catarrh, which, escaping at the inferor vulvar commissure, befouls the vul- var tuft of hairs. The muco-pus forms hard, dry crusts upon the tuft. The sticky muco-pus also catches up and in- corporates in the crusts various foreign bodies. The en- crusted vulvar tuft is liable to become caught and forced Penial Injuries 221 into the vulva alongside the penis, abrading it and threaten- ing to transfer to the abraded parts any infection included within its mass. The injury can and should be prevented by keeping the vulvar tuft clean by washing. In abattoir bulls, the penis is often found eroded, owing to the withdrawal into the prepuce of loose, dirty hairs from the preputial tuft^ but I have not observed this in breeding bulls. Some breeders attempt to prevent the pulling of hairs into the prepuce by clipping away the preputial tuft. This invites another, and equally important danger from the multiple minute abrasions of the prepuce and glans from the short hair stubs. "Broken penis" in the bull is often reported. It is be- lieved that the penis becomes caught against the side of the vulva or elsewhere and the animal at the moment of making the violent copulatory thrust, doubles the organ sharply upon itself, "breaking" it or otherwise causing serious in- jury. Sudden and violent bending of the erected penis causes such injuries to its tissues that the "broken" organ remains curved or bent at an angle. That portion beyond the point of injury does not become erected. Thus the ani- mal is rendered useless as a breeder or the injury causes severe balanitis or inflammation of the prepuce, leading to adhesions so that the organ can not be protruded. Clini- cally I have observed the injury following, and apparently due to coitus by a large bull with a heifer. In one instance, the breeder believed the penis of the bull had been injured in casting him by the compression method, in which the noose about the flank crosses the penis just in front of the scrotum. I have cast bulls so frequently by this method, without observing injury, that I could not accept his con- clusions regarding the cause without important reserva- tions. The injury is liable to pass unnoted for several days, until the bull is brought out for breeding and is found to be incapable of copulating, or capable only with diflficulty. A narrow vulva, sometimes accentuated by great swelling of the vulvar mucosa because of severe granular venereal dis- 222 Diseases of the Genital Organs ease, important hymeneal remnants, vaginal stricture, or other obstacles to the passage of the penis into the vagina, tends constantly to cause the penis to be violently bent, most readily at the base of the glans, where the encircling pre- puce is attached. At the same moment the prepuce is per- haps overstretched. Both penis and prepuce become inflamed, swollen, and sensitive. Protrusion of the penis becomes very difficult or impossible. Frequently the pain is too great to permit copu- lation. The swelling and the pain about the base of the glans are very marked. The prognosis is good. The bull usually recovers anato- mically and functionally. Exceptions may occur, owing to chronic irregular induration of the corpus cavernosum, which causes the penis to become bent in such a manner that copulation becomes difficult or impossible. Such in- juries to the penis are preventable where the causes are recognizable in advance. Once they have occurred,- the handling consists fundamentally of sexual rest and anti- sepsis. The sexual rest should be as complete as practicable without unnecessarily curtailing physical exercise. On no account should attempts at copulation be permitted until re- covery appears to be complete. Since in the bull the pre- puce is nearly always involved, it should be kept clean. In addition, warm douches exert a favorable action upon the inflamed penis. The douche should consist of warm physi- ologic salt solution or a very weak, warm, antiseptic liquid, as a 0.25 per cent. Lugol's solution. The salt solution douche may be repeated twice daily, or as frequently as may be de- sired in an individual case. The Lugol's solution can not as a rule be applied more than once, or at most twice daily, without causing irritation. If the parts are very irritable, iodoform suspended in oil may be used instead of the douches. The best instrument for applying the douche is the soft rubber catheter seven feet in length, designed specially for this purpose. Or one may substitute for this the rubber RnpUire of the Prepuce 223 horse catheter, the length of which is to be supplemented by splicing with two or three feet of ordinary tubing, attached to a hospital irrigator. The catheter should be cautiously pushed through the sheath into the prepuce, the irrigator elevated one to two feet above the bull's back, the sheath opening compressed about the catheter with the hand, and the douching fluid caused to flow into the sheath and pre- puce until they are fully distended, when it should be al- lowed to escape, and the process repeated as often as con- sidered expedient. J. Rupture of the Prepuce Rupture of the prepuce sometimes occurs, as shown in Fig. 60, presumably due to the violence of the copulatory thrust, associated with a narrow vulva, hymeneal stricture, or possibly other unfavorable anatomical condition. How common it may be, I am unable to state. My one example. Fig. 61, is from the abattoir, and hence without clinical his- tory. Clinically, rupture of the prepuce is subject to defi- nite diagnosis only by the forcible protrusion of the penis, as already described. It may be suspected by a history of marked hemorrhage following the coitus during which the lesion has occurred. A slight rupture may perhaps recover without impair- ment of breeding efficiency, but severe or extensive rupture probably closes the breeding career of the animal, because the ruptured parts may, in healing, become adherent to the surrounding framework of the sheath, incarcerating the glans penis and causing permanent and irremediable phi- mosis. The prevention of such injuries is more important and practicable than their handling. They are most liable to occur in confined males which are suddenly brought in con- tact with females, not always in a proper state for coition. The female may be nervous or timid at the approach of a strange male or, still worse, estrum may not have reached its fullness or may have begun to decline so that she will not 224 Diseases of the Gejiital Organs stand well, and owing to her resistance the accident may occur. Slippery or uneven ground may also render the act insecure and lead to injuries to the penis. Prevention should be based chiefly upon the avoidance of these and other dangers. With cattle especially, it is im- portant that the female be properly in estrum, and that the Fig. 6i — Rupture of Prepuce. Bull. C, Glans ; F, fornix ; RR^ rupture of the prepuce near its juncture with the sheath. ground or floor of the enclosure in which copulation is to occur be reasonably even. Zschokke commends (Der Un- fruchtbarkeit des Rindes, page 66) service stocks consist- ing of five posts upon which are fixed two beams which meet in front to constitute an acute triangle, open at the base, into which the cow is led and from which she can not readily escape or make any extensive movements. In the handling of such injuries to the penis, little can be done beyond the allaying of infection by means of antisep- tic douches and the avoidance of sexual excitement, com- Stra ng u la ted Hern ia 225 bined with such local and general treatment as would tend to control inflammation. In the dog, in which, during copulation, the prominent glans penis becomes tightly fixed in the vulva of the bitch, the male may dismount and turn in the opposite direction, thus bending the penis abruptly. If disturbed by other dogs or in any other manner, violent dragging upon the penis follows, which leads to injuries of a more or less seri- ous character, chiefly to swelling and inflammation of the parts, occasionally followed by paraphimosis. These in- juries are not usually observed under proper breeding ar- rangements, but are generally seen where bitches are per- mitted to run loose and a large number of dogs congregate, with the resultant fighting. The handling of such injuries to dogs consists of essen- tially the same methods as in the bull, chiefly disinfection. If paraphim.osis results, it should be overcome. A local an- aesthetic, with perhaps some adrenalin, may be applied to the swollen glans penis, after which, with the aid of digital compression or by means of an elastic bandage, the size of the congested organ may be so reduced that it can be pressed back into the prepuce. If not, the margin of the prepuce is to be enlarged by incision sufficiently to permit the penis to return. K. Strangulated Hernia Copulation is one of the commonest causes of strangu- lated inguinal hernia in the stallion, and occasionally in other male animals. When the stallion mounts the mare, the inguinal region is subjected to increased pressure from the weight of the abdominal viscera. The position of the abdomen is changed from horizontal, or a declination down- ward and forward from the inguinal ring towards the dia- phragm, to almost the perpendicular, with the entire weight of the abdominal viscera pressing downwards upon the pel- vic inlet and inguinal opening. The pressure is further augmented by the abdomen of the stallion becoming forcibly 15 226 Diseases of the Genital Organs compressed against the buttocks of the mare, as well as by the vigorous contraction of the abdominal muscles during the act, all of which combine to increase the intra-abdominal pressure and tend to force a small section of intestine through the inguinal ring, where it quickly becomes strangu- lated unless it promptly returns to its proper position when the stallion dismounts. In such case, soon after dismounting, in fifteen to thirty minutes, or even earlier, the stallion exhibits symptoms of colic, kicks at his belly, looks at his flank, breathes rapidly, sweats profusely and rolls violently. The agony is excru- ciating and constant, increasing in intensity, the sweat be- coming more profuse until, after ten to twelve hours in very acute and unrelieved cases, the violence abates, the body surface, bedewed with sweat, becomes cold, and the pulse rapid and weak or imperceptible, indicating gangrene of the incarcerated bowel, to be soon followed by death. If the inguinal region is carefully examined, a tense fluc- tuating swelling may be recognized, but in many cases the incarcerated intestinal loop is so small that its presence can be determined only by very careful palpation. Examina- tion per rectum usually gives more definite results : the in- carcerated intestine can be felt and grasped, making the diagnosis definite and final. The handling needs to be prompt, and usually radical, if the life of the patient is to be saved, although spontaneous recovery occurs in some cases. If the agony of the patient does not prohibit the attempt, the operator may insert his hand per rectum, grasp the incarcerated intestine, and, drag- ging gently and cautiously upon it, attempt its replacement. At times this succeeds. Should this fail, the animal is to be cast in dorsal recum- bency, with the hind legs sharply abducted, and the inguinal region freely opened. He should at once be placed under complete anaesthesia. The dragging on the incarcerated bowel per rectum may now be repeated, accompanied by digital manipulation or compression externally with the other hand or by an assistant. Strangulated Hernia 227 Failing in these efforts, herniotomy should be performed with the least possible delay. After thorough disinfection of the region, proper sterilization of hands and instruments, and covering the adjacent parts, including the hind feet and legs, with aseptic or antiseptic towels or napkins, the scro- tum is to be freely and cautiously incised down to the in- carcerated intestine, after which the carefully disinfected and moistened index finger is to be passed up along the an- terior side of the herniated bowel to the point of incarcera- tion, in the internal ring. Using the finger as a guide, a herniotome, probe-pointed bistoury, scalpel, or such other instrument as the exigencies of the situation demand, is in- troduced through the ring at its antero-external angle and the tissues are sufficiently divided, forward and outward, to permit the incarcerated intestine to return. Sterile or anti- septic gauze is then introduced into the wound and packed closely against the internal ring in a manner to avoid all danger of a recurrence of the hernia, and the scrotal wound is closed by sutures. The tampon may be omitted and deep sutures taken in the internal ring, closing it against future hernia. Twenty-four to forty-eight hours later the antiseptic gauze may be removed, and the wound disinfected, closed, and thereafter left undisturbed or handled according to in- dications. If the strangulation of the intestine has already led to the necrosis of the incarcerated loop, resection of the intestine should be promptly performed. When herniotomy is performed, if there is doubt concerning the viability of the incarcerated loop, after the inguinal ring has been freely dilated, additional intestine may be drawn out and the parts carefully examined. The intestine should be kept moist with physiologic salt solution. The operation of resection, be- longing to surgery, need not be described here. The prog- nosis in herniotomy is good in properly selected cases. Chapter VIII PARTURIENT INJURIES A. Lacerations of the Perineum Lacerations of the perineum occur in two distinct ways, and almost exclusively in mares. The more important type of laceration of the perineum is due to one of the extremi- ties of the fetus, generally a foot, becoming misdirected during parturition, being forced up through the roof of the vagina and floor of the rectum, and protruding from the anus. The violent expulsive efforts of the mother drive the fetus along and tear asunder the entire partition between the rectum and the anus above and the vagina and vulva below, converting the two posterior openings into a common cloaca. The accident and its handling have been fully de- scribed in the companion volume. Veterinary Obstetrics. It is referred to here because, as a general rule, if not prop- erly handled, it closes the breeding life of the animal. The unhealed tear permits feces to drop into the vagina, keep- ing up a constant irritation and fecal infection. It also renders copulation virtually impossible. If the cervix and uterus are healthy, artificial insemination may succeed, and if pregnancy ensues the injury will offer no impediment to parturition. The second type of laceration of the perineum may occur in any animal, though most frequently in the mare. In this type of laceration, the injury is due to overstretching of the vulva by the volume of the fetus. In almost all cases the in- jury occurs at the superior commissure of the vulva and ex- tends obliquely upward to the right or to the left outside the anal sphincter. Such lacerations are of importance princi- pally because they permit the superior commissure of the vulva to drop forward, rendering the vulvar opening hori- zontal and interfering with copulation. Still more impor- tant, they destroy the physiologic function of the vulva as a sphincter and as a barrier to infection, so that the vagina Recto- Vaginal Fishila 229 tends to become more intensely infected than usual, and this infection may extend through the cervical canal into the uterine cavity and beyond. Consequently it is of importance that such lacerations be repaired as promptly as possible. Owing to the constant tension of the muscles and fascia extending from the vulva to the ischial tuberosity, the margin of the sacro-sciatic liga- ment, and the sacrum, it is difficult to retain the parts in apposition while healing. Therefore it may be advisable to isolate largely, upon one or both sides, the anus and vulva from the adjacent structures by making two approximately parallel incisions from above to below on either side of the anus and vulva, extending through the skin and subcuta- neous tissues, so that outward tension upon these can no longer exist. After the injury has been repaired, the in- cision will heal and the function of the parts be restored. B. Recto- Vaginal Fistula Recto-vaginal fistula, like the first type of ruptured peri- neum, belongs virtually exclusively to the mare. Its origin is the same. An extremity of the fetus, almost always a hoof, pushes up through the roof of the vagina and rectal floor into the rectum. The position of the deviated member then becomes corrected, and birth is completed without the tissues posterior to the puncture becoming divided. As a rule, the erroneous position of the foot is probably corrected by an attendant who, realizing the peril, quickly pushes the foot from the anus and rectum back down into the vagina. The opening persists. The result is analogous to the com- plete rupture of the perineum. Feces drop through the fis- tula and cause fecal infection. The prognosis and handling are the same as for complete rupture of the perineum. C. Lacerations of the Cervix Lacerations of the cervix have been generally ignored. Not alone have the parturient lacerations of the organ been 230 Diseases of the Genital Organs disregarded, but there has been a very general disregard for surgical invasion of the cervix in a manner equivalent to laceration. There has come down to the present day a legend of frequent stricture and induration of the cervix, of a character to prevent parturition, which may be relieved by a free and careless dilation of the canal by incision. Ow- ing to a gross and common misconception with reference to the non-dilation of the bovine cervix at the time of parturi- tion, it is quite habitual to dilate a perfectly normal cervix by cutting, when, as a matter of fact, the whole fault lies in a paretic uterus. The cervix has no inherent power to di- late, but is dilated passively by the contraction of the uter- ine walls upon the fetus and its fluids. Adhesions, or in- durated thickenings, in the cervix occur with such frequency as to constitute a basis for the fiction of the frequency of induration. Practitioners should be on the alert and re- member the three salient facts — that the cervix of the cow is physiologically very rigid, that its non-dilation at time of parturition is almost always due to atony of the uterus from intra-uterine infection, and that the part played by the cer- vix is essentially passive. If this is fully understood, dila- tion of the cervix by incision will not be rashly applied. In whatever manner the laceration or division of the cer- vical wall occurs, the fissure heals neither perfectly nor readily and the vaginal opening of the cervical canal gapes. Naturally infection of the cervix follows and a pernicious interference with fertility results. Lacerations of the cervix should be repaired as promptly and accurately as possible. If recognized at first, they should be carefully sutured with slow-dissolving catgut un- der the best available asepsis. When a persistent fissure in- terferes with fertility, the vaginal end of the cervix had best be amputated as far forward as the fissure extends. The technic of trachelectomy is described later under "Cervici- tis". Chapter IX SODOMY AND SADISM Injuries to the Genital and Neighboring Organs of Animals by Sexually Psychopathic Men It is of fundamental importance that veterinarians shall have in mind the extremely variable injuries which may be caused to animals by sexual perverts. Failure to diagnose these injuries has been the common lot of veterinary prac- titioners. The errors in the diagnosis of such injuries mis- lead the public, tend to cause a repetition of the acts upon other animals, and result in extensive losses to owners, be- cause under the shadow of error the culprit is not detected, nor is any intelligent effort made at detection. Finally, the error is deeply humiliating to the erring veterinarian. Veterinary literature is very poor in this field. The prin- cipal contributors to our knowledge have been Guillebeau\ Cadiot-, and Eggimann\ The following includes the more important portions of the contribution of Guillebeau. The injuries may be placed under two headings — sodomy and sadism. Sodomy, or carnal intercourse between man and the lower animals, while highly repulsive to moral stand- ards and in sharp conflict with statutory laws, is generally of but scant interest to veterinarians, as Guillebeau points out, because no physical injury follows in the large domestic animals and the specific venereal infections of man are not transmissible to animals. Guillebeau relates that in a remote suburb several neigh- bors, upon separate mornings, each found a dead hen which had been left apparently well the evening before. The fourth hen was presented for autopsy. ^ Ueber Verletzungen der Haustiere durch sexuell psycopathic Menschen. Von Alfred Guillebeau in Bern. Schweizer Archiv. fiir Tierheilkunde. XLI Band, 1899, page i. ^ Cadiot, P. J. Bulletin d. 1. Soc. Centr. de Med. V^t. vol. 50, page 257. ' Eggiman, F., Schweizer Archiv. f. Tierheilkunde. Band 35 (1893) page 103. 232 Diseases of the Geiiital Organs The well-filled crop and well-developed ^%% in the oviduct indicated sudden death. The liver presented several lacera- tions covered with blood, and on its caudal side between the intestinal loops an extensive hematom. The connective tis- sue of the groin was infiltrated. The egg tube contained a hard-shelled ^%'g. The cloaca was gaping and dilated to 21/2 cm., much larger than normal. Four days later another dead hen was brought for autopsy by another neighbor. The cadaver presented the same lesions, with the addition that the left tibia was broken and, yet more important, two mammalian spermatoza were found in the cloaca. The liver rupture was apparently due to the violent holding of the hen to prevent her escape. Later, in another locality, an owner lost a number of hens, one at a time, at intervals of one to a few days, and finally a sick bird was brought Guille- beau for observation. Eight days later it was necessary to kill her. The autopsy revealed bloody serum and fibrin clots in the body cavity, the liver greatly enlarged and con- taining large cavities filled with blood serum, the intestines adherent. Apparently the wounds were essentially like the foregoing, but not so severe as to cause immediate death. The incentives to such an offense lie in a great sexual craving with a low moral sense, while in other respects the person may be normal or even bright. The subject is without material veterinary interest be- yond diagnosis, and through this means to enable the owner to secure police protection. Sadism, or that type of sexual perversion which leads per- sons to mutilate the genital and neighboring organs, is of far more frequent interest to veterinarians and, owing to the endless variety of mutilations, offers extraordinary diffi- culties in diagnosis. Many of the mutilations prove fatal, and the pervert is so persistent in the perpetration of the offense that delay in diagnosis may cause great economic loss, as well as serious embarrassment to the veterinarian. Errors in diagnosis have certainly injected into our litera- ture some very mysterious and illogical accounts of coital injuries. Quite naturally a sex pervert is equally or more liable to commit the offense upon an animal in estrum, at Sodoniy and Sadism 233 which time also the female copulates if opportunity is of- fered. The coincidence of physiologic copulation with a male of the same species and sadism by a psychopathic man may, and undoubtedly does, lead veterinarians to attribute to coitus injuries which are highly improbable or impossible from that act. In one instance cited by Guillebeau, recorded by Eggi- mann, five cows and two heifers in one establishment were mutilated in the vagina and rectum, and four of them died. Two aborted putrid fetuses. The seven animals had re- ceived a total of over thirty punctured wounds, one animal alone having fifteen punctures. The wounds were of various depths, about the diameter of a goose quill, and surrounded by necrotic tissue. The wounds penetrated the peritoneal cavity, the uterus, the rectum, and the pelvic connective tis- sues and mutilated the urethra, bladder, and the urethral valve. Extensive and fatal hemorrhages ensued, as well as metritis, vaginitis, peritonitis, etc. The culprit was not dis- covered and no legal action taken. Guillebeau records that in 1896, in Obersteg near Bern, in an isolated establishment far back in the mountains, ten cattle and ten goats were injured, mostly fatally. The depre- dations began in January, when the father of the culprit lost two cows, two goats, and later two cattle. In March two cattle and six goats were mutilated, in April three cattle and two goats, and in May one heifer. In June two cattle belonging to neighbors were injured. The monetary loss was $720, one-half of which fell upon the father of the of- fender. The last animal of the group was destroyed ten days after mutilation and an autopsy made. The vagina contained a large volume of red, stinking exudate. Fistulae extended from the vagina forward. Two of these were ten cm. long. One was fifty-five cm. long, involving wounds of the liver, spleen, diaphragm, and lung, and reaching the region of the eighth rib, or about the middle of the chest. The frightful injuries revealed by the autopsy made it clear that the culprit had accomplished his designs with a 234 Diseases of the Genital Organs stick. The extraordinary resemblance between these in- juries and those recorded above in Langnau was apparent. The symptoms, in the cases not immediately fatal, con- sisted of straining, bloody discharge from the vagina, swell- ing of the vulva, and general weakness. Six months later the investigation was taken up by Professor E. Hess and the culprit detected. He was a large, nineteen-year-old man, bent somewhat forward, with a handsome face, downy beard, and dangling arms. He had suffered from inflamma- tion of the brain at four years. His cranium was small, and he was regarded as idiotic. In school he could not learn and when grown was incapable of work except as an assistant in caring for cattle. Taken into custody, he con- fessed his guilt several times and later withdrew his con- fession. He went about his misdeeds so craftily that he had never been caught. The Cases in Wolfikon, Schwartzenbach, and Rickenbach. In March, 1894, in a stable containing fifteen cattle, eight — all in one row of stanchions — became ill. Amongst them were three calves, one only a few days old. There was a bloody vaginal discharge, depression, and peritonitis. Some showed crepitant swelling of the loins and croup. Within a week four animals had died and four had been killed. All were buried with their hides on. Fifteen hun- dred kilos of hay was burned for fear of bad contamination. The guilty caretaker and his clothes were carefully disin- fected. The cattle which had escaped mutilation were dis- infected and removed to other quarters. In two weeks, two of the remaining seven animals became affected, one of which died and the other was slaughtered. The remaining five head were slaughtered in order to escape, partially, the impending loss. After about two months, the tenant pur- chased two cows, but in a short time he buried one and re- turned the other to 'the seller. The same caretaker of the cattle was still in charge. He purchased goats, which re- mained well. It was soon hoped that the ban which had hung over the place had disappeared. The tenant bought Sodomy and Sadistn 235 three goats, which promptly died under the same conditions as the cattle. He became discouraged, sold his hay to be fed to horses only, and sold his farm. The servant found employment with another party in Schwartzenbach. Here, as in the preceding place, a heifer, a goat, four oxen, and a cow soon became ill. Three oxen were buried. The flesh of the other cattle was used for food. The investigator was struck with the similarity of the mu- tilations of the sexual organs with those observed in Wolf- ikon. A Capuchin Tnonk, evidently a good judge of men, when consulted, advised the discharge of the servant. The losses became noised about the neighborhood and were at- tributed to the young man who had cared for the cattle. On November 12, 1895, he obtained a new position in Ricken- bach, not far away from his previous place. Fourteen days later, a cow cared for by this man sickened like the preceding and had to be destroyed. Autopsy revealed a finger-sized fistulous wound in the rectum, two blood-covered lacerations in the vagina, and hemorrhage into the peritoneal cavity. On the next day a cow died suddenly from symptoms of vaginal and rectal hemorrhage. A third animal had to be destroyed on November 29. In the vagina only one perfor- ating wound was found, but in the rectum thirty-five, six of which were perforating. A fourth animal injured would probably recover. The servant was discharged and a few days later arrested. At first he denied his guilt, but later confessed that he had caused the injuries by forcing a stick into the rectum and vagina and pushing it back and forth until the animal bled. The culprit was twenty-four years old and a capable worker in stable and field. He was good- natured but represented as wanting in judgment. In Wolf- ikon, the scene of his first crimes, he was three years in one position, but apparently he had come to sexual maturity very late and part of the period of service preceded this. His teacher, the local pastor, and the alienist who observed him after arrest regarded him as of very low intelligence. The size of the cranium was below normal. In the hearing. 236 Diseases of the Genital Organs the young man showed some of the talents of a trader. He had at his command about 5000 francs and criticized the reckoning of damages. In recent years, while feeding, milk- ing, and grooming the cows, he had had frequent erections, fits of excitement, and delusions. At first he merely forced his hand into the posterior body openings of his charges ; later he used a stick, always, according to his statement, under the pressure of a dark, powerful, inner craving at times when he also suffered from sleeplessness, sweating, dysuria, and erections. He seemed conscious of the wrong, but powerless to resist his cravings. He was adjudged ir- responsible, but made to pay as far as possible for the losses caused. This simpleton had led the veterinary diagnosti- cians a merry chase. According to the official report of the first cases in Wolfikon, the animals had died of an undeter- mined epizootic, probably anthrax. The second outbreak, in Schwartzenbach, was diagnosed as "intestinal diph- theria", especially a localization of malignant, catarrhal fever of rectum and vagina. In both places elaborate pre- cautions against the spread of the malady were taken by thorough disinfection. Second Outhi^eak in Rickenbach In the same stable in Rickenbach, in which in November, 1895, the acts described above were committed, an ox had to be destroyed in April, 1897, because of rectal hemorrhage. The illness lasted four days. After twelve hours there were symptoms of colpitis. After four days there escaped from the rectum four liters of blood. The animal was weak. Peritonitis was apparent. Autopsy revealed bloody infiltra- tion of the pelvic organs, kidneys, and adrenals. The veteri- narian found numerous injuries in the rectal mucosa, five of which were penetrant. The culprit was an eighteen-year- old caretaker of the animal. Apparently he was not as stupid as his renowned predecessor, but, according to his story, the master had related the misdeeds of the other, and seeing in the stable day after day the short stick previously Sodomy and Sadism 237 used, finally awakened in him a desire for the same experi- ence. The Occurrence in Le Menil-aux-Cerfs When the trauma is induced by less violent means than those already described, the difficulties of diagnosis increase. In a stable of about ten cows, there occurred, within three weeks after a change in caretakers, vaginitis in all the ani- mals. Ten new cows added later soon developed the vagini- tis. The heifers, when they reached sexual maturity, also suffered. With the advent of estrum the vaginitis became worse, and at the same time the disease increased in in- tensity in the cows near the one in estrum, even though cas- trated. The symptoms began with swelling of the perineum, then a discharge of clear, tough mucus, which later became thick and purulent. Once colic followed estrum for several days. The general health, nutrition, and lactation suffered little. Pregnant animals generally did not abort. The local handling had little effect : some cows conceived again ; sev- eral remained sterile and had to be discarded. The owner was compelled to sell the sterile animals for less than the cost of new ones. He was tormented with the fear that they had been inoculated with syphilis. Investigations were finally made by Schwartz of Bern. Four cows were visibly diseased ; all showed colpitis, and two of them severe annular vaginal stricture. Five other cattle offered nothing re- markable. The cows had been bred to two public bulls which had also been used for numerous other cows. Neither the cows nor the bulls suffered from any visible genital dis- ease. The conclusion was finally reached that the injuries were due to rough handling by some evil-disposed person but it appeared very difficult to so much as suspect the cul- prit. Several weeks had elapsed when by accident it was discovered that the caretaker of the cows was the culprit. Aside from this the man was a model : he was a quiet, punc- tual, thorough worker, and, until the accidental revelation, beyond suspicion. The identification of the culprit revealed 238 Diseases of the Genital Orgayis also his method. It consisted of pushing a fork handle into the vagina and rapidly turning it in a wide circle. This special form of sadism served to explain the strictures of the vaginae. No punishment of the offender was under- taken, because it was feared it would lead to endless trouble, and the model servant was permitted to go his way unmo- lested. I have found no account of this type of injuries in this country. They probably occur and escape diagnosis. In connection with public institutions for mental defectives we have many valuable dairy herds in which the cattle are largely placed in charge of "trusties". Since such mental defectives might resort to such practices, veterinarians hav- ing charge of such herds would do well to keep this possi- bility in mind and not be led too far afield in diagnosis. PART II TUMORS OF THE GENITAL ORGANS The fundamental nature of tumors is essentially undeter- mined. Clinically, many of the benign tumors of animals bear strong evidences of transmissibility. They appear un- expectedly in a stable or herd, or in a group of animals within a herd, and involve simultaneously a large percentage of the group. At present the general concensus of scientific opinion appears to be that malign tumors are due to infec- tion. Certain new-growths formerly regarded as true tu- mors, like actinomycosis and botryomycosis, are now defi- nitely classed as infections. In the dog, there occurs a clearly defined venereal tumor definitely ascribed to infec- tion, which is included among venereal infections instead of among tumors. Chapter X A. MALIGNANT TUMORS 1. Malignant Tumors of the Male Genitalia Herbivora, and especially ruminants, are apparently highly resistant to malignant neoplasms. This may be ap- parent only because most domestic ruminants are slaugh- tered early in life for food. More than fifty per cent, of all dairy calves born are slaughtered for veal. More than ninety per cent, of male cattle of beef breeds are castrated and are slaughtered at three to four years of age. The aver- age age of dairy cows is below six years, though occasionally they live to fifteen, eighteen or more. Malignant neoplasms affect chiefly adult or old animals. Naturally it follows that they would be rare in species where the technically normal duration of life is greatly abbreviated by artificial means. Malignant neoplasms in domestic animals are most fre- quent in dogs and horses, both of which are largely kept 2^o Diseases of the Genital Organs until old age. In the dog, the animal which suffers most frequently from malignant tumors, the normal span of life is but ten to twelve years, the briefest among domestic ani- mals. Malignant new-growths may invade any portion of the genital system, of either sex and in all species, and may vary greatly in histologic type. Malignant tumors of the genital organs of bulls (as well as of rams and he-goats) are exceedingly rare. I have not observed a well defined clinical case and have no clearly identified specimen in my collection. Possibly I am in error. Young bulls very frequently have angry-looking, highly vascular tumors on the glans penis which, examined histo- logically, are found to be epithelial. They are commonly described as carcinomata, but histologists are not wholly agreed upon this point. So far as I have observed clinically, they are usually not malign, however suggestive their ap- pearance may be. When carefully excised, they show little tendency to recur ; when neglected, they cause no daughter tumors in the peri-penial lymph glands. The diagnosis and handling of malign tumors of the geni- tal organs of bulls (and of rams and he-goats) must be based upon general principles. When involving the glans penis in a valuable bull, liberal amputation may be applied, which, if timely, may eliminate the tumor and preserve the procreative powers of the animal. The amputation should be made under the technic described later for the amputation of the penis of the stallion. At one time I doubted the ability of a bull to copulate readily after the amputation of the glans penis. I attended one famous sire which had suffered from a tumor on the glans. Sections of the tumor had been examined by a pathologist and pronounced carcinomatous. The glans had been amputated. The stump refused to heal, and was in- tensely inflamed and angry. After long and patient hand- ling, the stump healed and the bull returned successfully to breeding. Maligna7it Tumors 241 When amputating the penis of a bull (or ram or boar) it must be recalled that these animals are always affected with the granular venereal disease, which retards healing and aggravates the wound. Prior to amputation it is therefore advisable to disinfect the glans, prepuce, and sheath by- douching the parts daily for five to eight days with a 0.25 to 0.5 per cent. Lugol's solution, or other safe antiseptic. After the penis has been amputated, it is desirable to con- tinue the douching until the healing is complete. The bull should be kept apart from cows in estrum, and otherwise handled in a manner to obviate sexual excitement, because erection inevitably aggravates any penial disease. It is bad policy generally to cause the bull to become sexu- ally excited in order to have him protrude the penis for visual examination in case of disease. It is better, and far more satisfactory from every standpoint, to cast the bull and expose the penis by eliminating the S-curve, as de- scribed in Chapter II. If the ordinary douching of the sheath and prepuce fails to hold in check the infection and inflammation in the stump, the animal should be cast, the penial stump exposed, and the inflamed) areas pencilled over with silver nitrate or dressed with a strong solution of the same. It should be remembered that the conditions are inimical to prompt healing and that it is far better to hasten the healing pro- cess to the maximum by giving concentrated attention at the beginning, thus obviating the necessity for prolonged handling which will in the end greatly exceed the total care required if minute details are faithfully followed at first. Hendryckx^ states that in the course of malignant disease of the testicle the organ may undergo necrosis and open upon the exterior of the scrotum and the new-growth as- sume the clinical characters of external cancer. When malignant neoplasm of the testicle is diagnosed or seriously feared, the gland should promptly be removed. A 1 Bayer and Frohner. Handbucb der tierarztliche Chirurgie und Geburts- hilfe, Vol. Ill, Part 2, Page 439, 1899. 16 242 Diseases of the Genital Organs positive diagnosis of malignancy, with all the risks of ex- tension and of daughter tumors, should not be awaited. Any chronic tumefaction of the testicle sufficient to arouse fear of malignancy should be treated decisively and promptly as malignant. In any case, the function of the testicle is almost certainly destroyed and the ablation of the hopelessly diseased gland is the prudent course to pursue. The removal of one testicle neither destroys nor curtails the reproductive power of the animal. The removal of a testicle which is presumably affected with a malignant new-growth should preferably be effected by the covered operation. The skin and dartos are freely incised down to the cremaster muscle or its fascia. The cremaster, its fascia, and the peritoneal layer of the scro- tum are kept intact and a separation made between the cre- master and dartos up to the external inguinal ring. The spermatic cord, covered by the cremaster muscle and the scrotal peritoneum, is then securely ligated at a point as high as is convenient or required. It is best to arm a heavy needle with a strong thread and pass it through the cremaster muscle, scrotal peritoneum, and spermatic cord. The needle is removed and the ligature tied about the spermatic cord and cremaster very tightly, in order to make inevitable the immediate necrosis of all included tissues. The included mass is then excised on the distal side of the ligature at a distance sufficient to guard securely against its slipping, generally about one inch. The cavity in the scrotum should then be tamponned with antiseptic gauze and the cutaneous wound closed by sutures. The gauze should be allowed to protrude at the lowest part of the wound, in order to permit drainage. Malignant tumors of other portions of the genital tract of the bull are not as amenable to handling as are those of the glans penis and the testicle. They need to be handled according to general principles. Malignant tumors of the genital organs of horses are not at all rare. According to my observation, they are com- Malignant Tumors 243 moner in geldings than in stallions. This relates especially to the penis. Clinically, also, I have seen more malignant neoplasms in the stumps of the spermatic cords of geldings than in the testicles of stallions. It is possible that the es- sentially dormant genitalia of emasculated animals are more vulnerable to malignant new-growths. The testicle and epididymis of the stallion is only very rarely the seat of malignant tumors. In one stallion I diag- nosed clinically malignant disease of the testicle, but had no opportunity to verify my diagnosis by direct examina- tion of the gland. In the college collection there are no specimens of malignant disease of the testicles of the horse. When cryptorchidy occurs in man, it commonly raises the question of malignant disease of the testicle. Although cryptorchidy is very common in horses, the condition is rarely, if ever, attributable to malignant disease. The clini- cal diagnosis of malignant disease of the testicles is to be made upon the same general basis as the diagnosis of malig- nant tumors of other organs. When malignant disease of the testicle in the horse is se- riously feared, the gland should be promptly removed for the sam.e reasons and in the same manner as already de- scribed for the bull. Malignant disease of the testicles and epididymis in other domestic animals is rarely reported. Clinically I removed successfully a cryptorchid, cancerous testicle from a pig. It was adherent over its entire surface to the adjacent in- testines and mesentery, so that it had to be dissected away carefully. Malignant disease of the penis, sheath, and prepuce in the stallion is generally supposed to be common. At least, writers upon veterinary surgery, as CadiotS Bayer and Frohner-, and others, would lead the reader to believe so. I have not observed a case in either penis, prepuce, or sheath in a stallion, and my collection contains no specimen. 1 Traite de Therap. Chir. d. Animaux Doiuestiques, 1898, p. 674. 2 Handbuch d. Tier. Chir. u. Geburtsh., 1899, vol. iii, Tart II, p. 345. 244 Diseases of the Genital Organs On the other hand, the occurrence in geldings has been rela- tively common. This may be apparent only. Since in America essentially all colts not desired for breeding pur- poses are castrated, the ratio of stallions to geldings is less than five per cent. Consequently one would logically expect to see at least twenty to twenty-five malignant new-growths in geldings to one in stallions. The malignant tumors of these parts may be sarcomatous but are most frequently carcinomatous. Their character is generally diagnosable by clinical examination. Usually there is abundant necro- sis of the diseased parts and rapid growth and in all re- spects they show typical malignancy. As in malignant dis- ease generally, there is rarely any early trace of cancer cachexy. The general health of the animal remains as a rule unimpaired for several months, unless the disease in- terferes with some vital function either by mechanical im- pediment or by invading a vital organ (liver, lungs). Ma- lignant disease of the penis, sheath, and prepuce ordinarily proves fatal indirectly, through daughter tumors in a vital organ. Thus, in one case in my clinic, carcinoma of the sheath caused death through the breaking down of a daugh- ter tumor in the lungs. The clinician should not err in diagnosing benign tumors of the penis as malign. The ordinary benign epithelioma of the equine penis is highly vascular and undergoes pres- sure and attrition necrosis. The necrotic tissues and the sebum produce much highly fetid pus containing tissue de- bris, and often blood. That should not be accepted as evi- dence of malignancy. The necrosis of malignant neoplasms is fundamental and inherent, and not attributable to pres- sure or attrition. When essential, the diagnosis may be safeguarded by the removal of a portion of the tissue for pathologic study. The veterinarian should also be on the alert in diagnosis not to mistake bursattee of the penis and prepuce for ma- lignant neoplasms. The necrosis of bursattee is funda- mental, like cancer, but its other characters serve to differ- I Amputation of the Penis 245 entiate it. This will be discussed while dealing with the in- fections of the genitalia of horses. The handling of malignant disease of prepuce, sheath, and penis of the breeding stallion calls for prompt and skillful measures. The early ablation of the neoplasm is the only course known which offers hope . Even then the hope is based upon the complete extirpation of the growth, in such a manner as not to interfere with the power to copu- late. When involving the sheath only, complete removal may be possible, but there is danger of such deformation of the parts as will cause faulty direction of the erected penis. If the prepuce is involved, a greater danger faces the surgeon because adhesions between the direct and re- curved portions may bar the protrusion of the penis. When the penis itself is involved, the amputation of a part or all of the glans does not disable the animal, but if the amputation needs to be on the proximal side of the pre- putial ring, the breeding capacity of the animal is probably ruined. I find no conclusive data on this point, but it has been proven clinically that the glans can be amputated with- out serious interference. In the present state of our knowl- edge, when the malignant growth has extended beyond the glans into the penial body, no hope should be given of re- storing the breeding powers. In a gelding I have seen the cancerous growth involving the entire penis from the glans to the attachments of the crura to the ischial tuberosities. 2. Amputation of the Penis Almost, if not all cases of malignant tumors of the glans penis should be handled by the amputation of a portion or all of the glans. The amputation should be carried out by the following technic, which affords ample security against urethral stricture and provides a tapering stump which can most readily enter the vulva in copulation. The amputation of the penis of the stallion affords a technic equally applica- ble to that of other species. 246 Diseases of the Genital Organs Instruments. Scalpel, elastic ligature, strong silk suture, strong piece of tape 1 m. long, artery and compression for- ceps. Technic. The operation is carried out on the recumbent Fig. 62 — Amputation of Penis. First stage of operation. T, Elastic ligature used as tourniquet ; CS", cor- pus spongiosum of urethra ; 5", skin ; CC, corpus cavernosum ; U, urethra ; L, ligature ; C, catheter. animal, under local or general anaesthesia. The upper hind foot is drawn backward or upward or otherwise so fixed as not to obstruct the field of operation. The point of opera- tion is determined by the character of the disease and the Amputation of the Penis 247 object to be attained. It may be made at any point from the glans penis to the attachment of the corpus cavernosum to the ischium, but if possible in front of the preputial ring. After the penis has been drawn out, and the preputial re- gion carefully cleansed and disinfected, an assistant grasps the organ just behind the preputial ring and holds it firmly. A catheter is then introduced into the urethra and pushed upward beyond the point where it is designed to amputate FIG. 63 — Amputation of the penis showing needle inserted for a suture. V, Dorsal vessels of penis ; A, fibrous tunic of the corpus cavernosum ; .S", skin ; CC, corpus cavernosum ; CS, corpus spongiosum of urethra ; U, urethra. the organ. A temporary elastic ligature, T, is then applied above the assistant's hand around the penis, or a piece of tape is looped around it above the hand and is made to serve both as a tourniquet and as a means for holding the penis, or the penis may be grasped in front of the ligature with double tenaculum forceps and held. 248 Diseases of the Genital Organs A small cord is applied just behind the glans penis, L, Fig. 62, and a triangular incision is made on the ventral surface of the organ about 4 cm. long by 3 cm. wide, the base of the triangle being forward as shown in the figure ; this incision is carried through the skin, S, the corpus spongiosum, CS, and along the corpus cavernosum, CC, down to the urethra, Fig. 64 — Amputation of the Penis. Completed operation showing sutures. U, Urethra. T, Elastic Ligature. U. In the triangular area the tissues are dissected away without opening or wounding the urethra and then a longi- tudinal incision is made from near the apex of the triangle to its base through the urethral walls to the catheter. Be- ginning at the apex of the triangular wound, a series of in- terrupted sutures is inserted, as shown in Fig. 64, in such a manner that they pass through the urethral wall and the skin, so that when tied the wounded surfaces are completely Amputation of the Pe?iis 249 hidden and the urethral mucous membrane is brought into apposition with the integument. These sutures are contin- ued down to the base of the triangle, the catheter is removed and the organ is excised by a cut extending in a slightly oblique direction from below upward and forward. A straight needle armed with a silk suture is passed through the margin of the urethral wound, the adjacent fibrous cap- sule of the corpus cavernosum, and across but not through the erectile tissue, inserted again into the superior portion of the fibrous capsule and carried out through the adjacent dorsal vessels and the skin, as shown in Fig. 63, and, bring- ing the ends of the sutures together, tied in such a way that the urethral mucous membrane and the margin of the skin are brought into immediate contact and the blood vessels se- curely closed in such a manner as to guard against hemor- rhage. By this plan when the sutures are tied, the cut bor- ders of the fibrous envelope are brought together over the erectile tissue, thus preventing hemorrhage from that tissue also. As many sutures are inserted as may be required to close the wound securely and finally leave every part wholly covered with epithelium. By this plan stricture of the ure- thra in the process of healing is avoided. The tourniquet is removed and the patient released. The principles here laid down are applicable and advisa- ble in the amputation of the penis in all domestic animals. In the dog, the point of amputation should be above the penial bone. Once the amputation has been successfully completed, the healing of the stump should be favored by keeping the parts scrupulously clean with frequent douchings. The patient is much better if given abundant exercise, avoiding con- stantly, as far as may be practicable, any sexual excitation because erection strains the sutures, engorges the wound area, arid seriously impedes the healing process. The diet should be scant and laxative. 250 Diseases of the Genital Organs 3. Malignant New-Growths of the Female Genitalia Malignant tumors of the female genital organs, generally- very rare, are most often seen in the vulva and ovary. I have observed but one case of malignant tumor of the uterus — that one case in the bitch (see Fig. 65). The malignant growth involved the entire genital tube, but was apparently most advanced in the uterus. The symp- toms consisted of a profuse, fetid, purulent discharge from the vulva, with swelling and obstruction of the lumen of the genital passage. When discovered, it was inoperable. Fig. 65 — Sarcoma of Genital Tract. Bitch. /, Rectum ; 2, left oviduct ; j, ovary ; 7, uterus ; 5, vagina ; 6, urinary bladder. I have seen two clinical cases of ovarian carcinoma of the cow. The first (see Fig. 67) was in a pedigreed Holstein heifer which had proven sterile. Upon rectal pal- pation the right ovary was found to be enormously enlarged. Malignant New- Groxvths or the Female Geytitalia 25 1 Fig. 67— Angio-Sarcom of Ovary, Heifer. /, Left cornu ; 2, enlarged right ovarian arter_v ; j, lumor. Eelow, section of tumor. 2S2 Diseases of the Genital Organs about four inches in diameter. The right uterine artery, enlarged to many times its size, as indicated in Fig. 67, pulsated with great force. The left ovary was minute and non-functional. Slaughter was advised, since the examina- tion indicated clearly that surgical interference would be highly perilous because of the enormously enlarged ovarian artery. The removal of the ovary, also, would leave the left gland, which would probably not function. The clinical diagnosis was angioma. Upon slaughter it was found that the ovary had ruptured at one point, causing profuse hemor- FiG. 69 — Cyst- Adenoma of Ovary. Sow. Weight of tumor 38 lbs. /, Necrotic area ; 2, 2, cystic areas. rhage. The entire peritoneal surface was thickly studded over with tufts of yellowish new-growth. Histologically, the tumor proved to be a carcinoma, or rather angiocar- cinoma. Benigyi Tumors of the Genital Org a^is 253 My second clinical case was in an aged Guernsey cow. The ovary was about five or six inches in diameter, spheri- cal, tense, and smooth. It was diagnosed as a thick-walled cyst of the non-nymphomaniac type. It was considered both impossible and imprudent to rupture the cyst. Ovariotomy was performed through a flank incision. Histologic exami- nation showed the tumor to be a carcinoma. I have not observed clinically in other animals than the cow an instance of malignant disease in the ovaries, and have but one specimen of malign tumor of the ovary other than those mentioned above. This is a multilocular ovarian tumor from a sow, shown in Fig. 69. The sow weighed about three hundred pounds, and the ovary thirty-eight. Clinically it would have been difficult or impossible to diag- nose. Inevitably the abdomen of the sow was greatly en- larged, but that might have been from hydronephrosis or many other conditions. In this fat sow, the discovery was made after slaughter. Carcinoma of the vulva is not at all rare in the cow. It presents highly distinctive clinical characters which render a reliable diagnosis comparatively easy. When reported to the veterinarian, it is not ordinarily subject to surgical in- terference. As a rule, when the genital organs of a meat animal are invaded by malignant new-growths, if they are still local- ized, the general condition good, and the subject not of great breeding value, the animal should be sent to slaughter. B. Benign Tumors of the Genital Organs 1. Benign Tumors of the Male Genitalia Benign tumors are very common upon the penis, sheath, and prepuce of horses and cattle. These two species are very prone to growths of benign epithelial tumors, or **warts", about the face and lips and upon the external geni- tal organs. They are observed almost entirely in young animals. Generally they are papillomatous in type and tend to become polypoid or pedunculated. This is especially true 254 Diseases of the Genital Organs when they are located upon the glans penis or within the sheath, where constant compression acts to modify their form. The attrition caused by protruding and retracting the penis tends to abrade the epithelium covering the tumor. The mucus, sebum, and sometimes urine, tend to macerate and irritate the new-growth. As a consequence of these conditions, ulceration, superficial necrosis, and suppuration, with highly repulsive odor, are frequent and not rarely lead to error in diagnosis. It is only rarely that this type of tumor attains such size as to cause phimosis or paraphimosis. Possibly one reason for this is that, with the small peduncle, when the tumor be- comes sufficiently large to retard the movements of the penis, the stalk divides and the tumor drops away. I have had them drop off in my hand when attempting to make a physical examination. They are readily observed during copulation. The copulatory attrition and great vascularity of erection commonly cause hemorrhage. Such tumors call for early excision. Benign penial tumors, if not promptly removed, may extend and eventually call for amputation of the penis, though, had opportune attention been given, mere excision of the tumor would have sufficed. The animal should be cast for the operation, with all four limbs extended, or may be secured upon the operating table. The penis, whether of stallion, bull, or other male, should be exposed and secured as advised in Chapter II, and either general or local anaesthesia applied, as conditions may dic- tate. When the peduncle is small and superficially attached, it should be excised, removing a liberal amount of normal tissue with it in order to have assurance that all the neo- plasm is included. Care should be taken not to remove an unnecessarily large amount of tissue, because the contrac- tion of the cicatrix is liable to bend the penis at an angle and make copulation difficult or impossible. The invasion of the penial tissue had best not be circular nor transverse, but preferably the base of the peduncle should be removed by making two incisions beginning above or on the proximal Betiign Ttimors of the Getiital Orgayis 255 side of the base of the peduncle, diverging sufficiently to pass on either side of it, and then converging to meet at an equal distance on the distal side of the base, making a wedge-shaped incision extending into the penial tissues, so that the wound may be closed with chromatized catgut. In this manner deformation of the penis will be avoided as far as practicable. A careless transverse incision is more liable to invade an important nerve or arterial trunk and inter- "^ Fig. 70 — Dermoid Cyst. Cryptorchid Stallion. /, Glandular tissue ; 2, osseous tissue ; ?, cavity in the bony structure ; 4, epi(lid3-niis ; 5, spermatic cord. fere with the erection of the tissues supplied by the vessel. If, in spite of such precautions, deformation occurs which prevents copulation, or if the base of the tumor is too ex- tensive to permit excision without serious deformation, re- course must be had to amputation, as already described. Many other types of benign tumors involve the male geni- tal organs, but they occur very rarely and offer nothing of special importance in handling with reference to breeding. 256 Diseases oj the Genital Organs Fig. 70a — Dermoid Cyst of Ovary. Mare. /, Cystit ovary, the cyst being filled with loug. matted hairs C, cartilage ; 2, normal ovary from same animal. Fig. yob — Cystic Ovary of Mare. Divided. The cyst was about 8 inches in diameter with very thick, resistant walls. /, Exterior of cyst, showing at P, the pavilion of the oviduct flattened against the cyst ; 2, the interior of the cyst, showing the thick walls. Benign Tumors of the Female Genitalia 257 Dermoid cysts of the testicle occur now and then, contain- ing bones, teeth, hair, or all three (see Fig. 70). Such tes- ticles occur almost wholly in the horse, are generally crypt- orchid, and are beyond remedy as to breeding, but should be removed in order to eliminate the sex desire, frequently perverted, which they cause. If the other testicle is sound, the animal is fertile. I^o data exist to indicate that such an aberration in developmeht does or does not tend to recur in the progeny of such a male, but, since arrests in develop- ment generally tend to be transmitted to the offspring, it is well to be on guard and view with distrust the use, as a sire, of an animal so affected. Cysts of the testicle, epididymis, and spermatic cord are recorded. 2. Benign Tumors of the Female Genitalia Benign tumors of the ovaries proper are exceedingly rare. I have no well-marked example in my collection, al- though they are recorded in great variety. Since, when they involve one ovary only, fertility is unimpaired, they are not sought in connection with sterility. They are but rarely of such volume as to change the appearance of the animal. Most frequently they attract clinical attention by causing incarceration colic, the tumor having fallen over an intestine so that its long peduncle becomes wrapped about it in a manner to prevent the free passage of feces along the canal. Generally the bodies leading to such incarceration colic are not true tumors. Most frequently they are ovarian (Fig 71) or par-ovarian (Figs. 72-74) cysts of large size. There are at least four distinct types of ovarian cysts in cows, and probably an equal number in other species : 1. There are generally present a large number of small cysts, from 1/20 to 1/10 of an inch, apparently atretic folli- cles. They have no known relation to breeding efficiency or to the general well-being of the animal. 2. The moderate-sized cysts of nymphomania, apparently resulting from the death of the jovum, as a result of ovarian infection associated with an increased volume of follicular fluid. 17 Diseases of the Genital Organs Pjg 71— Large ovarian cyst of pregnant cow (above) with pair of normal ovaries (below), showing corpus luteum of pregnancy. Benigfi Ttimors of the Female Genitalia 259 3. Cystic degeneration of the corpus luteum. 4. Large, single, thick-walled cysts which may reach an indefinite volume and are of unknown origin. The fourth type described commonly bars functional ac- tivity in the involved organ, but does not interfere with the reproductive powers of the other gland. The chief interest in such cysts is their volume and their power, in common with par-ovarian cysts, to cause incarceration of the intes- FiG. 72— Parovarian Tumor of Mare, Incarcerating Rectum. View from right side with the tumor, T, almost hidden by the constriction caused by the pedicle. Lettering same as Fig. 74 tines. The diagnosis of large ovarian or par-ovarian cysts must, as a rule, be tentative only. One large and somewhat cystic, malignant, ovarian neoplasm in a cow was diagnosed by a colleague as an "abscess in the uterine ligament". I diagnosed it as a large ovarian cyst. This also was erro- neous. It was indeed somewhat cystic, but the error would have been very important had an attempt been made to rup- ture or puncture the malignant growth within the peritoneal 2 6o Diseases of the Genital Organs cavity. Therefore it is best to use caution in diagnosis, when the ovary is extremely large. However confident one may feel that he is dealing with a benign cyst, he should re- member that it may be malignant and in operating proceed upon a safe course by performing laparotomy and, if pos- sible, removing the gland intact. Fig 73 — View of Fig. 72 from left side, the tumor exposed by cutting away part of mesentery. Lettering same as Fig. 74 In mares and cows the diagnosis of uncomplicated cases is to be made by rectal palpation, with the uterus and ova- ries drawn back as far as prudent by fixing uterine forceps upon the cervix and exerting traction. If the cyst is very large, the ovarian ligament and the oviduct may be much elongated, so that the ovary may lie far ahead of its normal Benign Tumors of the Female Genitalia 261 location, anterior to the apex of the uterine cornu When large ovarian tumors cause incarceration colic, the diagno- sis is not always easy. If the incarceration involves the pel- vic portion of the rectum, the veterinarian faces a rather delicate problem in diagnosis. He can not palpate the uterus and ovaries per vaginam, and he may find palpation per rectum barred by incarceration. The principal question lies between a stricture of the rectum and a mechanical con- striction investing the gut from within the pelvic cavity. The investment of the rectum by means of the peduncle of Fig. 74— Schematic illustration of method of incarceration. /, Intestine ; 31, mesentery ; O, ovary ; T, parovarian tumor or cyst ; P, pedicle of tumor ; R, rectum ; R\ rectum posterior to point of strangulation. an ovarian or other tumor produces no changes in the walls of the rectum such as those encountered in actual stricture. There is no inflammation, no sclerosis, and no edema of the rectal walls, if they have not been neglected nor tampered with. The hand may pass freely along the rectum until it comes suddenly upon the constricted portion, when further progress is more or less completely barred. In the incarcera- tion colic caused by the parovarian cyst illustrated in Figs. 72, 73 and 74, the clinical features were identical with those due to ovarian incarceration of the intestine. I found that anteriorly a finger could be passed through the constriction into the free portion. The constriction was necessarily lim- ited in area to the diameter of the peduncle of the cyst. The 262 Diseases of the Genital Orgaiis distinguishing element in the case should have been (my colleagues and I each failed in diagnosis) that the constric- tion was not in the rectal wall but was due to an investing cord outside the intestine. The history aids in diagnosis. True stricture usually develops gradually, and commonly has a history of prior injury. Perirectal abscesses or tu- mors develop slowly, and the symptoms of colic come on gradually. Ovarian and parovarian pedunculated tumors cause no clinical manifestations until some accidental dis- placement of the tumor causes a sudden incarceration of the intestine by the tumor peduncle and violent colic quickly ensues. In the diagnosis of this type of intestinal incarceration, it is not essential that the histologic character be deter- mined. It is of little surgical consequence, for the moment, whether the tumor be ovarian or par-ovarian, cystic or solid. It calls for prompt relief by surgical means. These tumors attain a diameter of four to twelve or more inches. Owing to their weight they drop forward and downward in the abdomen and their attachments become greatly elongated. They consist of a single cyst, generally showing traces of ovarian tissue, flattened out on one side of the spherical cyst. I have seen one in a mare presented in my clinic because of recurrent severe colics. Rectal ex- amination revealed an ovarian tumor, regular in outline, about ten inches in diameter. Its cystic character was as- sumed, but could not be definitely ascertained. The ovary (left) was successfully removed through an incision in the left flank by my colleague. Frost, and myself. The cyst was punctured with a trocar after it had been brought into the laparotomy wound. This permitted it to be removed through a moderate-sized opening. Similar ovarian cysts occur in the cow, but so far as known do not so frequently incarcerate the intestines. They have the general clinical importance of benign ovarian tumors and demand surgical removal merely because of their physical menace to the health and life of the patient. Since they tend to cause in- creased size of the ovarian artery care is necessary in their Vaginal Ovariotomy in the Mare 263 removal to avoid danger from hemorrhage. The arteries had best be ligated with chromatized catgut. Sometimes vaginal ovariotomy is practicable. Usually it is best to re- sort to laparotomy in the upper or middle flank region. When considered prudent to operate through the vagina, the technic should be essentially that for ordinary ovario- tomy. Vaginal Ovariotomy in the Mare Instruments. Colin's scalpel, ratchet ecraseur 55 cm. long, vaginal tensor. Preparation of patient. It is best to keep the animal on a scant laxative diet for at least 24 hours, and preferably longer, prior to the operation, so that the alimentary canal shall be somewhat empty, thus decreasing the intra-ab- dominal tension and relieving the operator from much an- noyance due to the pressure of the viscera. When incar- ceration colic is present, there is of course no opportunity to await the general preparation of the patient. Before commencing the operation, it is best to have an assistant empty the rectum manually. Enemas should not be em- ployed, because there is danger from the expulsion of liquid feces during the operation. It is best, also, to empty the bladder before operating; otherwise the animal is quite sure to urinate during the operation. Technic. The introduction of the hand into the vagina of the non-anaesthetized mare causes the admission of air along the hand and arm. The vulvar lips fail to envelop the hand and arm closely and the irritation or shock causes the animal to draw air alongside the arm into the vagina, fully ballooning it. The movements of the diaphragm and chest walls tend to cause a vacuum of both chest and ab- domen during inspiration, and, if the vulva is partly propped open and the abdominal walls are fixed, air rushes in. The vagina may also be distended by filling it with warm water. Under these conditions the vaginal walls become hard, and stand apart from each other, closely applied against the pelvic walls at every part except at the points where the 264 Diseases of the Genital Organs bladder and rectum intervene. These organs, pressed out flat, occupy a minimum amount of space. In the quiescent state the vaginal walls are in contact. From the perineum forward to within about 10 cm. of the uterine os, the. vulva and vagina are connected above with the rectum by the pel- vic connective tissue. Anterior to this point, the vagina is covered by peritoneum. It is in this area that the incision needs to be made in the operation. The ballooning of the vagina profoundly alters the relation of this operative area, changing it from the horizontal in the quiescent organ to the perpendicular in the ballooned condition. These varia- tions permit of two methods of operating: (1) On the bal- looned organ without anaesthesia and with animal confined Fig. 75 — Special spaying ecraseur, 55 cm. long. in the standing position. (2) On the quiescent organ in the recumbent position under anaesthesia : 1. Without anaesthesia. Secure in the stocks with the head elevated, a rope over the back to prevent rearing, straps beneath the body to prevent lying down, straps or ropes before and behind the animal to prevent backward and forward movements, all four feet pinioned to the floor, and the tail firmly secured and stretched to a beam above. Apply a bandage to the tail extending 12 to 15 inches from its base, in order to secure the tail hairs out of the way of the operator. With soap, water, and brush cleanse the tail, perineum and vulva thoroughly, being especially careful to remove all detachable masses of sebum ; 50 per cent, alcohol or gaso- line may be used sparingly to aid in removing this. Too free a use of alcohol excoriates the delicate skin. Cleanse the clitoris carefully. Follow the washing with a free sp- Vaginal Ovariotomy in the Marc 265 plication of 1:1000 aqueous sublimate solution to the exter- nal parts and for a short distance inside the vulvar lips and to the clitoris. Do not introduce irritant disinfectants into the healthy vagina nor deeply into the vulva, as they may cause severe straining during and subsequent to the opera- tion and, by injuring the vulvo-vaginal mucosa, favor subse- quent infection of the vaginal v^ound. The vagina may with benefit be flushed out mechanically with 0.6 per cent, salt or soda solution. Wash away the sublimate solution with a tepid 0.6 per cent, soda bicarbonate solution, and fill the vulvo-vaginal canal with the same. After thorough disinfection of the hands and arms, remove the disinfectants by washing in sterile soda solution, which at the same time renders the Fig. 76 — Colin's scalpel. hand unctuous and readily introduced through the vulva. Armed with the guarded sterilized scalpel. Fig. 76, intro- duce the hand into the vagina promptly and when the organ is well "ballooned," unsheath the knife. Place it just above the OS uteri, parallel to the long axis of the uterus, a few mm. to the right or left of the median line in order to avoid a loose fold of mucous membrane generally existing there. Hold the blade vertical — that is, with the cutting surface parallel to the longitudinal muscular fibers of the vagina — and, guarding the possible extent of its introduction with the thumb and fingers, push it directly forward with a quick thrust through the vaginal mucosa, the muscular walls, and the peritoneum, until the disappearance of resistance indicates that the latter has been penetrated. This is the most critical step in the operation. If the hand is introduced into the vagina immediately after the injection of the sterile saline solution, the vagina 266 Diseases of the Genital Organs will generally be found "ballooned" or will quickly become inflated under manual movements. If the solution is thrown out, the vagina may collapse and closely invest the hand. In this case more of the liquid should be injected, and it will again dilate. If the hand is introduced without the knife, withdrawn, and then introduced with it, it will frequently be found that the vagina has collapsed and needs a second filling with the fluid. Patience until dilation is accomplished and promptness to act when it is attained are prime requi- sites to success. The knife should be pushed through the vagina quickly, making a clean wound the width of the blade, and the latter withdrawn and laid aside. It should be remembered that in this ''ballooned" state, the anterior wall of the vagina is but 2 or 3 mm. thick and easily penetrated. Introduce the hand again, push one finger into the incision, then a second and third, and eventually, holding all the fingers in the form of a cone, push the entire hand into the peritoneal cavity. Im- mediately below the incision and continuous with the tissues involved in the wound, lies the uterus, with a transverse di- ameter of 4 to 6 cm. With the palm of the hand downward, trace the uterus forward 15 to 18 cm., where it ends abruptly in two cornua of about the same size as the body, which are given off horizontally at almost right angles. Trace these to the right and left for 14 or 15 cm., where they end obtusely, and 3 or 4 cm. beyond this in a direct line, resting upon the anterior border of the broad ligament is the ovary, varying in size according to the degree of disease. Prepare the ecraseur for use by withdrawing the chain until the loop is barely of sufficient size to admit of its being readily slipped over the ovary (or par-ovarian cyst as de- scribed below) . Grasp this loop and the end of the ecraseur tube in the hand, carry the instrument to the ovary or tu- mor, and drop the loop over it from above. Pass some of the fingers beneath the ovary or tumor, push it up through the chain loop, and grasp it there with the thumb and index finger. Holding the ovary with one hand, tighten the chain quickly with the other, examine to make sure that a loop of intestine is not caught, draw the ovary well through the Vaginal Ovariotomy in the Mare 267 loop, include a large portion of the oviduct, and crush off promptly, holding to the gland until carried out through the vulva. If the tumor or cyst is very large it may not be practicable to remove it through the vaginal incision. The incision may be enlarged six to ten inches, but after such enlargement suturing is necessary in order to avoid pro- lapse of the intestines. The suturing of the vaginal in- cision is not, however, a serious task. The lips of the wound may be grasped by means of long dressing forceps and held firmly while the operator with a short, curved needle closes the incision by means of a continuous suture beginning at the anterior end. When the ovary is cystic or the surgeon is dealing with a large parovarian cyst, the cyst may be grasped by its peduncle and engaged in the vaginal in- cision. The cyst may then be punctured with a trocar or scalpel and the liquid contents permitted to escape into the vagina or through the canula of the trocar, beyond the vulva. Wash away any blood from the external parts. Apply sublimate solution freely to the vulva, perineum and tail. Keep the patient quiet for five or six days, and feed lightly on a laxative diet. 2. In operating under anaesthesia, the animal should be cast or confined upon the operating table in lateral recum- bency, preferably with the posterior part of the body some- what higher than the anterior in order to avoid visceral pressure in the pelvic cavity. Place the animal under com- plete anaesthesia. Prepare the parts as already described. Carry the knife into the vagina as directed previously and render the roof of that organ tense by pushing the os uteri downward and forward with the hand or by means of the vaginal tensor or speculum. It is important that the vagina be held well down toward the floor of the pelvis, so as to carry it away from the rectum, posterior aorta, and iliac arteries while the incision is being made. The incision is now to be made just above and behind and a trifle to one side of the OS uteri, in essentially the same manner as under 1, except that when the vaginal tensor is used, the cut is made upward and backward instead of directly forward. The 268 Diseases of the Genital Organs remainder of the operation is identical with what we have described under 1. Under anaesthesia the vagina is flaccid and cannot be made to "balloon" but may be distended with sterile soda or salt solution. Dangers. Wounding of the rectum is scarcely possible un- der the first method, if it has been emptied as advised above, if care is taken not to attempt the incision until the vagina is well "ballooned," and the stab wound is made directly forward. If made upward when the organ is so tensed, the accident is highly probable, and with the undilated vagina, where it is necessary to cut upward, the danger is ever present. In order to avoid this danger, when operating by the first method, the operator should await the complete '"ballooning" and then make his incision as directed. In the second method, the accident is to be prevented by being care- ful to push the vagina down away from the rectum and hold it away while the incision is being made. If the wound in the rectum passes through the pelvic connective tissue be- hind the peritoneum, it is of little consequence, but the oper- ation should be abandoned; if the bowel is opened into the peritoneal cavity, the accident is generally, though not al- ways fatal. The vaginal incision may be enlarged and the wounded portion of the rectum drawn out through the vulva. The wound may then be closed by sutures. Wounding of the iliac arteries, which generally produces prompt death from hemorrhage, results from the incision being made upward instead of forward when the vagina is "ballooned" or from a failure to hold the roof of the vagina down and away from the part while making the incision in the flaccid organ, as is the case with the recumbent animal under anaesthesia. It is most likely to occur with timid operators who become nervous, especially when the vagina does not "balloon" promptly or the mare is not well se- cured. The accident is wholly unnecessary if the operator will await the "ballooning" in the first operation, while by the second method it is prevented by proper care in holding the vagina downward and forward during the incision. When it has occurred, it is generally beyond remedy, though Vaginal Ovariotomy 171 the Mare 269 in some cases the prompt intravenous injection of adrenalin chloride may stay the hemorrhage and save the life of the patient. Woundifig of the uterus may occur when the incision is directed downward and may greatly embarrass the operator and confuse him because his fingers or hand may pass through the incision into the uterine cavity. It is to be avoided in the first operation (without anaesthesia) by care- fully directing the incision straight forward. When the accident occurs, it is of little consequence beyond the em- barrassment and may be overcome by again dilating the vagina with fresh injections of the soda solution and mak- ing a new incision. If preferred, the first cut may be cor- rected by placing an index finger against the peritoneum at the upper part of the wound, and, with a sudden and vigor- ous thrust, breaking through into the peritoneal cavity, or by again using the scalpel and directing the incision prop- erly. If it is attempted to rupture the peritoneum with the finger, this must be done by a sharp thrust, since otherwise a large section of the membrane will be pushed away from the subjacent tissues. Incomplete pe7ietration of the vaginal wall is liable to oc- cur if the scalpel is dull, if the vagina is imperfectly "bal- looned" and flaccid, or if the operator is unduly timid. It is best prevented by avoiding the causes mentioned. Once it has occurred, it is generally best, in the operation without anaesthesia, to again "balloon" the organ and make a new incision either to the right or left of the first. It may be overcome also by thrusting the index finger through the peritoneum as described in the preceding paragraph or by completing the cut with the scalpel. The mistaking of a ball of feces for the ovary or tumor has occurred to inexperienced operators and the fatal error of removing the portion of the rectum surrounding the fecal pellet committed. The blunder is uncalled for : the fecal ball is movable in the bowel, the intestine is far more mas- sive than the broad ligament, and the ovary is to be definitely identified by its being lodged in the broad ligament just be- 270 Diseases of the Genital Organs yond the end of the cornua, which is continuous with the uterus. If, therefore, one traces the uterus forward to the cornua, and thence along each of these to their extremities and along the borders of the broad ligament to the ovary, as above directed, the error will not occur. The vaginal incision may be made too low and pass be- neath the broad ligament. This is to be avoided by being careful to keep close to the median line and above the os uteri. If it occurs, the operation may be completed from be- neath without very great difficulty, only that the ovary now lies above the hand and must be drawn down from above the broad ligament in order to fix the ecraseur upon it. Infection, which always constitutes the most serious dan- ger, is to be avoided by properly securing the animal, by the avoidance of irritant antiseptics in the vagina, by rigid asepsis at every stage, and by carrying out the mechanical parts of the operation deliberately, vigorously, and neatly. If infection should occur, it will generally take the form of pelvic cellulitis with abscesses and rectal stricture. Enemas of normal salt or soda solution afford the surest relief of the stricture and impaction in front of it. The abscesses must be watched and opened early into the vagina or rectum, and the case treated internally and locally according to general surgical principles. Vaginal Ovariotomy in the Cow While vaginal ovariotomy is the common method used in the cow and mare for the simple purpose of removing healthy ovaries in castration, or of ovaries aberrant in function as in nymphomania, it is not of great value in the removal of ovarian tumors, since as a rule they are too large for removal by this route. Neither does the vaginal opera- tion afford satisfactory opportunity for controlling hemor- rhage if increased vascularity exists. Instruments. Colin's scalpel, vaginal dilator, spaying ecraseur, or emasculator. Technic. Confine the cow in the standing position in the stocks, secure the head firmly, and pass two boards beneath Vagiyial Ovariotomy iji the Cow 271 the abdomen and sternum to prevent lying down, and a rope over the middle of the back to prevent arching of the spinal column and straining. Wash and disinfect the tail and the perineum and flush out the vagina with a 0.5 per cent, solution of carbolic acid or lysol at a temperature of about 100° F. Insert the vagi- nal dilator with one hand and push the prolongation at the anterior end into the os uteri. With the other hand, elevate the handle of the dilator, and depress and push forward the uterus, thus rendering the roof of the vagina tense and push- ing it downward away from the rectum. Carry the scalpel into the vagina with the right hand and, resting it in the oval of the dilator, make an incision through the roof of the vagina, beginning at a point 8 to 10 cm. posterior to the os uteri and extending backward on the median line for a dis- tance of 2 or 3 cm. Be careful to make the incision entirely through the mucosa, muscle and peritoneum at the first cut, since any failure to complete it tends to cause the perito- neum to separate from the muscular coat and form a pocket between them, while the serous membrane, being very elas- tic, renders it difficult to complete the incision. Introduce two fingers through the incision, if the ovary is not greatly enlarged, and, reaching over the side of the vagina to the right or the left, the right or left ovary respectively is recog- nized, when normal in volume, lying immediately against the lower part of the base of the uterine horn, just at the anterior border of the pubis, in a mass consisting of the cord-like Fallopian tube and the fimbriae of its pavilion. When the seat of an extensive tumor or cyst, it shifts its lo- cation downward and forward a variable distance according to its weight. The normal ovary may be distinguished as a firm oval mass 2 to 4 cm. in length and 1 to 2 cm. in its lesser diameter attached to the broad ligament. If not promptly recognized by the sense of touch, trace the vagina and uterus forward with the fingers from the vaginal incision to the cornua and follow them as they bend forward and down- ward, and then backward and upward to the oviducts, until the ovary is reached where it is attached to the broad liga- ment, just beyond the fimbriated end. 272 Diseases of the Genital Organs Grasp the ovary between the fingers and, if not too large, draw it through the incision into the vagina. Introduce the emasculator with the other hand, and, when the ovary is reached, open the instrument far enough to admit the ova- rian attachments between the jaws, push the ligament be- tween the jaws, close the forceps and sever the ovary. Or introduce the ecraseur, draw the ovary through the loop of the chain and, holding it securely until the instrument is tightened, crush it off. If the ovary is the seat of an exten- sive tumor, the hemostatic power of the ecraseur or emascu- lator must not be relied upon. The same is true in a lesser degree of nymphomaniac ovaries. In such cases it is far more prudent to ligate the artery with large chromatized catgut, passed through the ovarian ligament by means of a needle. For this purpose the ovary is drawn into the vagina and its ligament engaged securely in a long pair of forceps. The ligature is passed through the pedicle of the tumor and tied tightly outside the forceps. The attachments are then divided between the ovary and the ligature, care being taken to leave a sufficiently long stump to give ample safety against slipping. It is essential that plenty of the broad ligament and ovi- duct be excised with the ovary to insure the entire removal of the gland, because the accidental leaving of the smallest particle of ovarian tissue may cause a development of this into abnormally large cystic ovisacs, tending to increase in- stead of decrease nymphomania. Generally no after care is necessary. The dangers are similar to those in the mare. The iliac arteries may be wounded in the same manner. The accident is preventable by being careful to push the vaginal roof well downward away from the rectum and sacrum. Another danger appears in the presence of the rumen, the supero-posterior portion of which, when filled with food, projects into the pelvic cavity so that, if the cut is directed forward, a stab wound readily penetrates its walls with fatal results. Make the cut upward and backward. Ovariotomy in the Cozv and Mare by the Flafik 273 Ovariotomy in the Cow and Mare by the Flank Instruments. Clipping shears, convex scalpel, spraying emasculator or ecraseur, heavy needle and thread. The animal may be secured as in the preceding or con- fined in lateral recumbency with the hind legs extended backward and the anterior limbs forward. To accomplish this, loop a rope about the two fore feet, another about the two hind feet, and, drawing upon these, cast the animal and secure it in recumbency with the legs extended and body stretched by fastening the ropes to two strong posts about 8 to 10 m. apart. The operation may be performed in either flank. The recumbent animal should lie with the diseased ovary uppermost. Clip the hair from the upper part of the flank and shave the operative area, disinfect an area 15 to 25 cm. square, make an incision about 12 cm. long be- ginning at a point equidistant from the anterior tu- berosity of the ilium, the ends of the transverse processes of the lumbar vertebrae and the last rib, and extend it downward perpendicularly, severing the skin and subcu- taneous muscle. If the attachments of the tumor are short, it may be impossible to bring it out through an incision in the upper flank. In such cases the laparotomy should be performed in the middle or lower flank region. Divide the external oblique muscle in the direction of its fibres by means of the scalpel handle or the fingers, and repeat the process upon the internal oblique, after which puncture the peritoneum with the scalpel. By thus dividing the external and internal oblique muscles, an X-shaped opening through the abdominal walls results, which closes automatically and obviates the need for peritoneal and muscular sutures. It also conserves in the highest measure the integrity of the muscular walls. Force one hand through the opening into the peritoneal cavity and search for the ovary or tumor at the same point and by the same method as in the preceding operation : that is, locate the uterus within the pelvic cavity, between the rectum and bladder, and trace it, the cornu, and broad liga- 18 274 Diseases of the Geyiital Organs ment to the ovary. Then draw out the diseased ovary through the abdominal incision and remove it under ample safeguards against hemorrhage. Cleanse the wound and close the skin incision with continuous sutures. Benign Tumors of Oviducts, Uterus and Cervix Benign tumors of the oviducts, uterus, and cervix are ex- tremely rare. I have in my collection no tumors of oviduct or cervix and but two of the uterus — one a fibroid from a cow, the other a myom from a mare. The tumor from the cow (Fig. 77) is from the abattoir, and hence without his- tory. It is oblong, of even contour, measures 4x7 inches, and is located near the apex of the cornu. The uterine walls show no changes from its presence. The myom from the mare (Fig. 78) was unobserved until, while at work, the tumor, which weighed eleven pounds, became dislocated, and caused pain with expulsive efforts of such violence that the tumor was forced out through the vulva and could not be returned. The dragging upon the uterus and its ligaments caused great suffering. The case was entered in the clinic of my colleague, Frost. The tumor was removed, the uterine wound sutured, and the uterus returned to its position. The mare died a few hours later of hemorrhage from the uterine artery, which was ruptured by the violent dragging of the expelled tumor. The tumor measures 5 x 11 inches. In one case of tumor of the uterus, diagnosed clinically as a fibroid, the cow bred several times in the opposite horn, but after the tumor had reached a diameter of 10 to 12 inches, she became sterile, probably owing to the presence of the neoplasm. Benign uterine tumors may generally be diagnosed clini- cally with reasonable assurance. Ordinarily the tumor grows slowly, causes no discharge or irritation, is not pain- ful upon manipulation, is usually very firm, and presents an even contour. The malign tumor would generally give evi- dence of its presence by the discharge of pus and necrotic debris. The macerating fetus gives an irregular swelling. Benign rumors of Ovidnds, Uterus and Cervix 275 pjG. 77 — Uterine Fibroid. Cow. C Cervix ; T, Tiiinor. Pig. 78— Uterine Fibroid. Mare. The dark periphery is due to profuse hemorrhage, apparently the result of contusions and the incarceration of arteries during prolapse of the tumor and uterus through vulva. 276 Diseases of the Genital Organs the fetal bones are commonly palpable, and there is a very fetid discharge. The desiccating uterine hematoma and the desiccating fetus in its early stages are less firm than the fibroid and fill one horn and uterine body from the cervix to the ovarian end of the cornu. The tumor, on the other hand, occupies but a part of the total length of the uterus. When clinically recognized in valuable breeding animals, uterine tumors should be removed after performing laparo- tomy, as indicated for spaying through the flank. If the tumor can be removed without destroying completely a transverse section of one cornu, the cornu and ovary should be preserved, but if the removal of the base of the tumor will lead to the occlusion of the lumen of the horn, the en- tire cornu on the ovarian side of the tumor, with the ovi- duct and ovary, should be removed. The hysterotomy in- cision should be closed by intestinal sutures. Tumors, usually fibroids, occur not rarely at the hymeneal ring, emanating apparently from the vestiges of the hymen. They are largely pedunculated. They have already been referred to incidentally while considering vaginal hernia. When recognized, they should be removed by incarcerating the pedicle in a suture or ligature. It is best to arm a needle with a strong suture and, exerting moderate traction upon the tumor, pass the needle deeply through the vulvo-vaginal wall in a manner to include the entire base of the new- growth. Tie the suture very firmly, incarcerating the en- tire base of the pedicle and causing prompt necrosis of the tumor. The body of the tumor may then be excised, leaving enough of the pedicle to insure the safety of the ligature. Do not attempt ecrasement or plain incision because of the great danger of vaginal hernia. I have observed two instances of apparently infectious vulvar benign epithelioma, both in heifers. In one instance, two heifers in contiguous stanchions developed epithelial tumors, or "warts," in the vulva. The tumors were uneven and highly vascular. They were three inches or more in diameter. In the other instance, in a group of 26 heifers in one lot, none of which had copulated, 15 developed vulvar Be7iign Tutnors of Oviducts, Uterus and Cervix 277 tumors. The tumors were confined, so far as could be de- termined, to the interior of the vulva, largely at the superior commissure and about the meatus urinarius. The tumors were of every size up to four inches in diameter. In two or three of the heifers where the tumors were very large, the growths protruded from the vulva, especially when the ani- mal was recumbent. The tumors caused no visible distress or injury to the animals. Some of the larger tumors were removed after transfixing and ligating their bases with strong sutures. Much care was necessary in one or two cases to avoid invading the meatus urinarius. The tumors had developed during the winter months while the heifers had been confined largely to the stable. With the advent of spring, with grazing, the new-growths disappeared spon- taneously. They behaved clinically much like the comm.on "warts" and the ringworm of the head and face of young cattle. PART III INFECTIONS OF THE GENITAL ORGANS SECTION I. THE GENITAL INFECTIONS OF CATTLE CHAPTER XII THE SPECIFIC VENEREAL DISEASES 1. The Vesicular Venereal Disease of Cattle. Vesi- cular ExANTHEM. Aphthous Venereal Disease. Blaschenausschlag The vesicular venereal disease of cattle is widespread in continental Europe, and occurs somewhat rarely in the United States. It is highly contagious. Ordinarily it is transmitted by copulation. After handling diseased ani- mals, it is readily transmitted by careless manipulations of the genitalia of healthy animals, and by grooming apparatus, such as brushes, currycombs, and sponges. It is yet more certainly carried by means of douching apparatus or other instruments used in handling the diseased animal and thence brought into contact with the sound genital mucosa of an- other. It is one of the most intensely contagious diseases known to veterinarians. Whenever genital contact occurs, whether directly through coitus, or indirectly by such means as suggested above, infection is practically certain. A dis- eased cow may transmit the infection to her neighbor by switching her tail. The vesicular venereal disease is analogous to the genital horse pox, or vesicular exanthem of horses, though they are not known to be related. It bears some resemblance to the chancroid of man. The symptoms are very acute and marked. In the fe- male the disease appears suddenly as an intense vulvo- vaginitis. The vulvo-vaginal mucosa becomes greatly in- jected and swollen. It soon shows numerous dark red pe- techiae, which quickly develop vesicles. The vesicles, which The Vesicular Venereal Disease 279 are of short duration, either rupture as vesicles or become pustular and rupture, in each case leaving an ulcer. The ulcers, which are one-eighth to three-sixteenths of an inch or more in diameter, very shallow, and exceedingly angry in appearance, give rise to an abundant muco-purulent dis- charge which, issuing from the vulva, soils the vulvar labiae, the tail, and the adjoining parts. The vesicles and ulcers continue to develop in successive crops for a number of days. The ulcers heal with only a very slight, temporary scar. Much pain is present. The ulcerating mucosa is intensely sensitive. Any attempt at manipulation causes very great resistance. The ulcers bleed freely upon touch. When un- disturbed, the cow is uneasy, as shown chiefly by frequent switching of the tail and more or less stamping of the hind feet. When urination occurs, the urine, coming into con- tact with the highly inflamed ulcers, causes very marked and intense pain. The animal switches her tail violently and stamps the hind feet in rapid succession. Whenever the animal defecates, the mechanical pressure unavoidably causes pain, because of the extreme tenderness of the vulva and vagina. The pain is not as acute as that observed in urination. Whenever the animal moves, the muscles of the limbs which come in close contact with the vulva naturally drag upon the inflamed organ, causing pain, which is re- vealed by a stiffness of gait. The infection does not necessarily prevent impregnation. If the cow becomes pregnant, there seems to be no unfavor- able influence upon the life of the embryo. It is stated that in some cases the disease results in chronic catarrh of the vagina. A commoner, and apparently more threatening termination is adhesions between the walls of the vagina, which may cause more or less constriction of that canal. In the bull the symptoms of the disease are analogous to those observed in the cow. The mucous membrane of the penis, prepuce and sheath becomes inflamed, swollen and tender. The eruptions in the mucosa of the genital organs are identical with those observed in the cow. The urethra may also become involved, giving rise to a muco-purulent 28o Diseases of the Genital Organs discharge therefrom. Urination causes pain of the same general character as that observed in the cow. The swelHng of the penis and the sheath may be so great as to cause phi- mosis. Erection of the penis causes bleeding. This is fur- ther emphasized by copulation. Kampmann records a case of extensive necrosis, with permanent deformity of the penis, due to this disease. So far as known, the disease does not affect other species of animals. The period of incubation is brief. The course of the disease is brief and stormy. Spontaneous recovery generally occurs in from ten to thirty days. It is said that no enduring or valuable immunity is acquired, and that an animal may readily become re-infected by copulation. The pathogenic organism which causes the disease, as is common in diseases associated with vesicles, is unknown. Ordinarily an outbreak of the disease appears suddenly and can not be traced to other herds. Like genital horse pox, it appears to develop spontaneously. No suggestion of any exposure from strange cattle exists. Suddenly the out- break is present in the stable in its most acute and highly contagious form. Several or many animals are already infected. Once established, the infection is readily traced from animal to animal. It may then spread to a few neigh- boring herds through the agency of the bull, but it is so evi- dent that it is quickly observed by the layman, who natu- rally takes measures to control it. The disease then dis- appears, until suddenly it reappears in some other area without any connection whatever being traceable between one outbreak and another. Ordinarily the differential diagnosis of the vesicular ve- nereal disease is easy. At times there has been confusion with the nodular venereal disease, but this is unnecessary. The former is characterized by vesicles and ulcers ; the lat- ter by nodules or granules, which may be translucent, but are hard and solid throughout. The nodular venereal dis- ease is chronic. While there may be a copious muco-puru- lent discharge and the affected parts may be sensitive, the tenderness is not as marked as in the vesicular venereal The Vesicular l^enereal Disease 281 disease. The very rapid spread of the vesicular disease serves also to distinguish it from the virtually omnipresent nodular venereal disease. The progfwsis is highly favorable. Recovery from the disease is prompt, and almost always complete. It causes small loss to the dairyman. The cow retains her appetite, she does not lose perceptibly in flesh, and the milk supply is not seriously disturbed. Rarely, especially following the use of strong antiseptics, constriction or atresia of the va- gina may follow, which may interfere later with copulation or parturition. The control of the disease must rest fundamentally upon isolation, especially sexual isolation. Since the disease is preeminently venereal in character, breeding should be completely suspended until all signs of the disease in the herd have disappeared. Even steers or oxen should not be permitted to run in pasture or in paddocks with cows, be- cause in attempts at copulation they might transmit the disease. It is not necessary to separate the diseased from the healthy by any great distance. Close proximity should of course be avoided, because the disease might be trans- mitted from animal to animal through the medium of the tail or soiled bedding. Diseased animals should on no ac- count be bred until they have thoroughly recovered, and even then it is v/ell to use antiseptic precautions just before and after breeding. For this purpose, both the vagina of the cow and the sheath of the bull should be thoroughly disinfected prior to permitting copulation. The disinfection of the sheath of the bull should be repeated immediately after copulation, and the douching of the vagina of the cow may be carried out within five or six hours after copulation and repeated occasionally until the attending veterinarian believes than any possible danger has been eliminated. The thorough disinfection of the stalls and of the soiled parts of the animals contributes materially to the control of an outbreak. The treatment of the disease consists of the disinfection of the copulative organs and of those parts of the animal 282 Diseases of the Geyiital Organs which have become soiled from the venereal discharges. Disinfection is a difficult problem and must be conducted with caution. The genital mucosa is in such a highly irri- table state that one can not with success employ any strong disinfectant. It must constantly be borne in mind that a mucous membrane can not be definitely disinfected and that any radical effort to disinfect will serve only to irritate and destroy the genital epithelium and intensify the disease. Something must be used which is non-irritant. It will be found that a mechanical cleansing of the parts with a physi- ologic salt solution will best answer the purpose. In this way the tissue debris and pus may be washed away and the highly sensitive ulcers cleansed without inducing any ma- terial pain. On the other hand, the douching actually tends to soothe. If the animal will bear it without pain, very mild antiseptic solutions may be used as a douche, such as 4 per cent, boric acid. Whatever antiseptic is selected, its action should be carefully noted, and whenever it causes straining its use should at once be discontinued. If the cow is not in milk or if the milk is not to be used for human consumption, one may use a dressing of 10 per cent, iodoform in oil in- troduced through a catheter or tube. If the cow is being milked, the use of iodoform inevitably taints the milk in such a manner as to render it obnoxious. In some continental European states, the disease is re- portable as a dangerous contagion, subject to legal regula- tions. I have observed several outbreaks, all handled by voluntary personal quarantine. The symptoms are so strik- ing that any intelligent breeder should realize that his in- terests dictate adequate control measures. Under the spe- cific laws for the control of contagious diseases in most states, it may very properly be reported, and should be, if the attitude of the custodian threatens the extension of the disease. I have not known of an outbreak reported to the sanitary authorities in America. The Nodiclar Venereal Disease 283 2. The Nodular Venereal Disease. Infectious Vagi- nitis. Vaginitis Verrucosa, Metritis et Vaginitis Infectiosus. Ansteckende Scheidenkatarrh, Etc. The classification of the nodular venereal disease as a specific infectious malady is not free from objection. Isep- poni of Chur (Switzerland) was the first writer to bring the disease (or the lesions) notably before the veterinary profession as a distinct, specific malady. He was promptly followed by numerous veterinarians. His views were en- dorsed first by his Swiss colleagues, and later by Austrian, German, French and other Continental European veterina- rians. Leading European authors — Friedberger and Froh- ner, Hutyra and Marek, and others — assigned it a definite place amongst infectious diseases of cattle. The lesions characterizing the condition are so nearly universal that, soon after the publication of Isepponi's observations, a few veterinarians, instead of considering it specific, held that it is in fact a physiologic condition and that the absence of the granules or nodules indicates disease. The dissenters were not men of authority or prominence in the profession. The vast majority of veterinarians in the front rank ac- cepted and supported the teachings of Isepponi. The prominence of the nodular venereal disease was based chiefly upon the belief of Isepponi and his followers that it was responsible for most, or much, of the sterility and abortion of cattle. Although sterility and abortion have been recognized throughout history as a cause of serious losses among animals, the interferences with reproduction had reached a phase in the time of Isepponi where they were causing greatly increased concern to individuals and to the state. The views regarding the causes of abortion were chaotic and the people were so anxious to find some rallying point that they eagerly grasped the first plausible explanation, hoping that behind the recognition of the cause lay a remedy. For about ten years the belief in the importance of the nodular venereal disease spread. This belief rested upon clinical observations. It was held, by those who studied the problem, that the amount of sterility 284 Diseases of the Genital Organs and abortion in a herd was parallel to the virulence of the nodular venereal disease. All deductions were based upon the presence or absence of given lesions. Bacteriology was making enormous strides. Wherever a distinct lesion was recognized, search was made for a bacterial invader as a cause and efforts were directed to- ward the experimental transmission of the disease. Oster- tag, after a brief bacterial study of the disease, reached the conclusion that it was due to a streptococcus. No one seri- ously attempted to cause sterility or abortion experimentally by the artificial transmission of the disease. Wider ob- servation showed the lesions to be essentially omnipresent. Many began to doubt that these lesions could be the cause of sterility and abortion, since in that case the bovine species would be wiped out. Many were not ready to believe (though abundant examples exist) that an infection can ex- ist generally and only now and then prove serious. Ten years after the interesting observations of Isepponi, Bang made his famous discovery of the B. abortus and sur- passed in the plausibility of his teachings by experimentally inoculating pregnant animals which were assumed to be free from the B. abortus infection. Some of the experiment animals aborted and from the uterus of the cow or the stomach of the abort Bang recovered a bacterium which, it was assumed, was the lineal descendant of the bacteria in- troduced. The teachings of Bang quickly gained a promi- nent place. In the enthusiasm which grew up, sterility was essentially forgotten or assigned a secondary place. The nodular venereal disease was promptly overshadowed as an important genital infection. The B. abortus occupied the field of thought in connection with genital diseases, and all else was consigned to oblivion. During the two past decades little has appeared in veteri- nary literature concerning the nodular venereal disease, and that little has been generally ignored or roundly con- demned. The disease is still described in recurring edi- tions of the foremost treatises upon veterinary medicine, rather as a matter of habit than because of any living in- The Nodular Venereal Disease 285 terest in the subject. It has never received, and is not re- ceiving serious study at the hands of pathologists and bac- teriologists. The disease is accordingly a difficult subject with which to deal. It may be said to be a lesion without a known cause and regarding the effect of which there is very scant knowledge. I feel that the disease should be recog- nized as holding a definite place amongst the genital infec- tions, but do not believe that at present it should have as- cribed to it that importance with which Isepponi and his followers clothed it nor that it should be so utterly ignored as it has been recently. The nodular venereal disease may be described as a vir- tually universal, chronic infection aff'ecting the mucosa of the copulatory area of the genitalia. It involves both sexes and all ages of ruminants and swine. It expresses itself clinically in the form of granular or nodular elevations in the mucosa of those parts participating in coitus (vulva, vagina, sheath, prepuce, and glans penis). The essential clinical symptom is the appearance in the genital mucosa, protruding above the surface, of nodular, conical, or spheroidal elevations, usually 1 to 2 mm. in di- ameter. (See Figs. 79, 80.) In the female they are best observed clinically by holding the vulvar lips apart and causing a strong light to enter obliquely. The examina- tion may be conducted advantageously in a well-lighted stable, by having the animal placed with her posterior parts presenting toward a window somewhat above the level of her back. The examiner grasps each vulvar lip between the thumb and fingers and, drawing the lips backward and outward, exposes the interior of the vulva to vision. The light, falling obliquely into the vulvar cavity, by refraction brings the nodules clearly into view. In order to examine every part, the examiner should shift his position again and again, that he may view each area at the proper angle. In order to examine satisfactorily the roof of the vulva, the eye of the examiner should be on an approximately hori- zontal line with the mucosa. Highly satisfactory examina- tions may be made in dark stables or at night with the aid of a good reflecting lamp or an electric flash light. 286 Diseases of the Genital Organs Fig. 79 — The Nodular Venereal Disease. Vulva and Vulvar E;ud of Vagina. Cow. (Hutyra and Marek] The Nodular Venereal Disease 287 The nodules are also recognizable upon digital palpation, since the elevations are very evident to the sense of touch. At times digital palpation may have an advantage over vision, because the mucosa may be edematous to such a de- gree that, even when the nodules are abundant, they are rendered invisible. Fig. So — Mild Nodular Venereal Disease. Heifer. /, Vulva ; 2, clitoris surrounded by iiodules ; j, hymeneal scar ; 7, vagina. Under the prevailing conditions in American dairy herds, and presumably in the dairy herds of the world, calves usu- ally develop clinical signs of the disease at from four to twelve weeks of age, and from that time through adult life to old age present a series of interesting vacillations of in- tensity, so great that various writers have designated the disease as acute, subacute, chronic, cured, sound, etc. In the newborn heifer calf, the vulvar mucosa is usually 288 Diseases of the Genital Organs smooth, moist, and pale rose-colored for a period varying from four to twelve weeks, or even longer. Finally, visual inspection reveals the presence of several or many spheroido- conical nodules in the vulvar mucosa, 1 to 2 mm, in diameter. Usually they are colorless or faintly yellowish in the center and present the appearance of small, tense vesicles, but close examination reveals the fact that they are hard to the touch and contain no fluid. Encircling the base of each nodule, there is usually a pale or bright red area due to in- creased vascularity, giving the lesion the appearance of a minute vesicle, with a vascular girdle. The nodules are scattered here and there, frequently along the floor of the vulva in the clitorial region, but quite as often on the sides or roof of the vulva. Except for the nodules and the vascu- lar girdle about the base of each, the surface of the mucosa in the early stage is smooth, pale rose-colored, and normal. There is no swelling, no inflammation, no discoloration of the vulvar mucosa not occupied by the nodules, and no marked mucous or muco-purulent discharge. Slowly and insidiously the disease appears in calves which have hitherto seemed free, so that, the older the heifers, the larger the percentage showing evidences of the infection. The rapidity and uniformity of the development of the malady depend largely upon environment. Usually, in the closely housed heifer calves in large dairies, fed carelessly upon raw, mixed milk, more than 90 per cent, show the disease at four months, and before they are one year old the visible infection reaches 100 per cent. If by any chance an individual escapes infection until breeding age, the first copulation conveys the disease. In heifer calves of the beef breeds, which nurse their dams, the in- fection develops much more slowly. In experimental heifer calves, I have kept individuals up to six months, and even to one year old, without any visible trace of infection. The influence of environment upon the spread of the in- fection in heifer calves is further shown in Table I, wherein the 122 veal heifers observed showed an average infection of 61 per cent. The percentage of infection among these The Nodular Venereal Disease 289 Nodules or Granules NOT Present i "^ 1 ^ 1 Nodules or Granules Present Percent 92 70 30 .... 1 0^ =« rf i5 W t3 W a !5 « & *. ■-• r1 " H 1-. rj a nJ X P w J a « P VO ONOO CT^ U-. CO t^ t^CO CO CO is ES OR ULES ENT Per NODUL Gran Pres )^ 00 CO ^ '^ IH t^ 5* r^ On IN P) tN M H- (N r^ ^ w w i4 cc P W ^ o 10 M o « i4 W P 00 t^ rO C t^ t^ 0^ N 1-1 •* tj ja ri rt (u o 19 290 Diseases of the Genital Organs calves is markedly below the average among heifer calves of corresponding ages in eastern dairy herds. Western veal calves largely run at liberty in the open, exposed only to the infection from their dams. When the nodules are quite numerous, they tend to be- come arranged in longitudinal, parallel rows corresponding Fig. 81 — Vulva of Heifer Grown Experimentally upon Boiled Milk. The vulvar tuft of hairs is unstained and free from niuco pus. to the longitudinal folds of the vulvar mucosa, as shown in Fig. 79. The nodules are located upon the summits of the rugae, emphasized and rendered more distinct by the in- flammation of the mucosa, which causes it to swell, harden and thicken, and forces it into marked folds. The individual nodules change in appearance. They increase little in size and projection. The vascular areas about their bases be- come more deeply injected and the vascularity may extend The Nodular Venereal Disease 291 more or less completely over the surface of the nodules, so that some of them appear as bright red elevations or as petechiae on the vulvar mucosa. The mucosa itself, between the nodules, becomes involved and is injected, red, and swollen. With the advent of defi- nite irritation of the vulvar mucosa, a slight muco-purulent. ^Si^T^ ■ ■ ■ ^B ^" 1 4 "t ^^^^KF ^Hl ^|i(f_^ f^^!^ j^i^^H ^^^Bt E'^ 1 '•.* 1^1 ^^K^ ^fe ■t/ J \ ^H ^■h 1 ^4 ^IH^^I ^H J 1 E^f >5t 1 ^H ^^ffff< *m w 1 ^^■s ' ''^^'' tH 1 ^^^^^^^^^hCu£l^_. i/ •hH 1 ^?Riv™ B HH^^^H^B^mBFiT .' 1 HI i^lu Fig. 82 — Vulva of Heifer fed in ordinary manner as a Calf, Showing Matting and Staining of Vulvar Tuft. vulvar discharge ensues. It is not at first marked. Many say it is not present, or rather that the discharge noted is normal. There is, however, a visible discharge which so mats together the vulvar tuft and surrounding hairs in the heifer calf that, in opening the vulva for inspection, the ex- aminer must frequently break down the adhesions between the surrounding hairs before the vulvar lips may be parted. Some contend that this is normal, but in experiment heifer 292 Diseases of the Ge?iital Organs calves such vulvar discharge has not appeared until after visible infection. Up to the date of puberty, or estrum, the nodular venereal disease of heifer calves generally behaves essentially as a dormant malady, without material significance for the im- mediate welfare of the animal (See Fig. 80). Various ob- servers may and do hold divergent views. Numerous cases are viewed by veterinarians as sound because of the mild- ness of the symptoms, but the nodules are there, and, so long as they are admitted as the deciding lesion of the malady, the heifer must be regarded as infected. Copulation is the signal for the awakening of the dormant infection, which then behaves like venereal disorders in ani- mals and in man under the stimulus of sexual contact. Within twenty-four hours after copulation, the evidences of sexual irritation are marked. The mucosa becomes scar- let, swollen and tender, and in a large proportion of cases there is a very notable muco-purulent discharge, which ad- heres to the vulvar tuft and soils the under surface of the tail, the skin of the buttocks, and the perineum. Fre- quently the vulvar lips become markedly swollen and edema- tous. If the vulvar lips are parted, the mucosa is seen to be covered with masses of stringy, semi-opaque mucus, or small flakes of muco-pus may be seen resting upon the mucosa. After copulation the nodules multiply with astonishing rapidity. Their arrangement in parallel longitudinal rows becomes well marked. They are crowded into close contact with each other upon the summits of the swollen, hypertro- phied, mucous rugae. Frequently they lose their trans- parency and assume a deep red color. In every way the malady assumes a more decisive clinical aspect of important disease. Still, the general health of the heifer is not low- ered. The intensity of the symptoms increases for a few days, remains static for a time, and may then recede slightly, but the improvement does not approach the status main- tained prior to copulation. The Nodular Venereal Disease 293 Should the heifer become pregnant at the first service, the irritation may for a time abate slightly and slowly, but the nodules remain prominent and approximately as numer- ous as ever, and the clinical evidences of disease remain essentially static, at one period apparently improved, at an- other worse, until near the time for parturition, when the vulvar mucosa becomes more reddened. A marked edema (parturient edema) then appears: the nodules are covered over and are no longer visible. Usually they may still be felt upon careful palpation. In many cases of abortion the edema of the vulvar mucosa is essentially the same as if parturition had occurred. If parturition or abortion is fol- lowed by retained placenta and chronic metritis or pyome- tra, the nodules continue masked by the persisting edema so long as serious uterine or vaginal disease continues. Otherwise, with the gradual disappearance of the edema of the mucosa, the nodules slowly come again into view. If the heifer fails to conceive at the first copulation, when the next estrual period arrives and copulation occurs, should the sterility be refractory, the symptoms tend to increase, so that sterile heifers are quite generally among the worst clinical cases in a herd. During the second and third pregnancies the symptoms of the disease retain ap- proximately the average intensity acquired during the first pregnancy. Then the severity of the malady generally abates. When the cow reaches eight to nine years of age and her sixth or seventh pregnancy, the decrease in the intensity of the disease generally becomes quite marked : the nod- ules are fewer, less prominent, and more transparent; the irritation and injection of the vaginal mucosa are definitely decreased ; and the muco-purulent discharge has largely abated. With advancing age, the vulvar mucosa becomes pale yellowish or bluish-yellow, the nodules disappear, and the clinical evidences of the disease commonly vanish from the vulva when the cow is twelve to fifteen years old. Such is a brief outline of the course of the malady as ob- served in a majority of cases, but the course is vascillating 294 Diseases of the Genital Organs and erratic in individuals and in herds. Copulation always intensifies the symptoms, especially in heifers, and one can generally distinguish by the clinical examination of the vulva practically every heifer which has copulated from those which have not. In some heifers, after repeated copu- lations, the granules become so numerous and highly in- flamed that coitus causes pain and hemorrhage, followed by abundant vaginal discharge for several days. The use of antiseptics in the vulvo-vaginal tract alters the clinical appearance profoundly. Daily washing of the va- gina with non-irritant, warm, antiseptic solutions causes the symptoms of the malady to decrease rapidly in intensity, and in a few weeks the nodules may largely disappear, the mucosa become smoother and softer, and the color change to a pale rose-red. It looks as if the continuance of the handling would soon eliminate the disease, but in the end some nodules remain, and, with a cessation of handling un- accompanied by copulation, the symptoms remain static. On the other hand, when powerful antiseptics are intro- duced into the vagina, the mucosa becomes irritated, swollen, and edematous, and the nodules thereby become veiled. Thus the clinical signs of the malady appear insidiously, usually when the heifer is but a few weeks old. The disease pursues a comparatively uneventful course up to breeding age, then becomes suddenly intensified after coitus, and quickly reaches its zenith, where it maintains, with certain vacillations, an approximately horizontal course for three or four years, when it begins to abate slowly in intensity and with the advent of old age more or less completely disap- pears clinically. It will be seen by a study of the preceding table that spayed range heifers of the beef breeds show the disease in a lower ratio than other animals, but the ratio does not give a clear view of the facts. The intensity of the disease de- pends very largely upon the frequency of copulation. The spaying of range heifers was generally done very carelessly and hastily. The operator thrust his hand through the wound, grasping the ovaries and stripping them from the I The Nodular Venereal Disease 295 broad ligament between the thumb and fingers. The re- sult was that in 50 to 60 per cent, of the animals some ovarian tissues were left, which developed ovisacs and cysts. The heifers came in estrum or were nymphomaniac and copulated freely with range bulls. In such imperfectly spayed animals the lesions, which were always seen, showed considerable intensity. In the perfectly spayed heifers the vulvar mucosa was generally normal, smooth, and pale rose-red, with but few if any visible nodules. Another striking illustration of the influence of coitus upon the intensity of the disease was observed in a lot of 270 two-year-old range Hereford heifers which had evi- dently been kept away from the bull, except in the case of one individual which had copulated and become pregnant. In the 269 non-pregnant animals, the disease was quite uni- formly present, but only a few nodules were seen in each individual. Careful inspection was required lest they be passed over. The vulvar mucosa of the one pregnant heifer, however, bore more of the nodules than the other 269 to- gether. In this one heifer the entire mucosa was swollen and red, and dense masses of nodules crowded thickly upon each other. Throughout its long course, the intensity of the infection rises and falls, sometimes in obedience to known causes, as copulation, sometimes for reasons not yet understood. Dur- ing the period at which the disease is at its zenith, few ani- mals fail to show the clinical evidences of its presence, as shown by Table I, according to which the evidences of the disease were apparent in 95 per cent. This is no higher than regularly observed in dairy herds. The Nodular Venereal Disease in Bulls. Balanitis. Balano-Posthitis The nodular venereal disease is the basic cause of balani- tis, balano-posthitis, or akrobustitis, in the bull. There can be no distinction of value between infections of the sheath, the prepuce, and the mucosa of the glans. The continuity and contiguity of the three areas render inevitable the extension 296 Diseases of the Genital Organs 9* u S3 (1) ■— ( O A m a o u O The Nodular Venereal Disease 297 of any ordinary infection from one to the other. Various mechanical injuries may occur, and an indefinite variety of infections may invade the area, but the nodules, v^hich are already present, either complicate or are complicated by them. Consequently it appears desirable to deal with bal- anitis as being ordinarily identical with the nodular vene- FiG. 84 — Bull Calf of same age as Fig. 83. Grown in ordinary manner on Raw Milk, showing Matted and Stained Pre- putial Tuft. The body hair is also shown to be harsh and rough. real disease. This does not prevent or complicate separate consideration of rupture of the prepuce or other mechanical injuries, or of such localized specific infections as actinomy- cosis or tuberculosis, which have already been discussed. The inflam_mation of the sheath, prepuce and mucosa of the glans, due to the nodular venereal disease, is practically universal in bulls, but the degree of inflammation varies widely. The ordinary degree plays no visible part in the Diseases of the Genital Organs !^ o A Tlie Nodtdar I'enereal Disease 299 Fig. 86— Penis of Bull showing the Nodular Venereal Disease. (From same bull as Figs. 126, 127.) /, Glaus showing confluent nodules 2, fornix ; 3, the prepuce reflected, showing solitary nodules ; 4, the sheath reflected. 300 Diseases of the Genital Organs problem of reproduction. It existence is evidenced by a discharge of muco-pus, which flows from the sheath open- ing and mats together the preputial tuft of hairs, at the same time staining them a dark, dirty, brownish-black. (See Figs. 83, 84.) This occurs early in the life of the ani- mal, but the time of its advent varies largely according to the environment and health of the calf. In large dairy herds, where sterility, abortion, calf scours, and pneumonia are severe, the evidences of balanitis occur with great uni- formity when the bull calf is twenty to sixty days old, but Fig. 87— Glans of Bull Showing Severe (confluent) Nodular Venereal Diseases. in the calves of grade beef cows, which nurse their young and live in the open, the evidences of genital catarrh appear tardily and the bull calf may reach four to ten months of age without showing very marked evidences of matting and discoloration. Between these extremes, every possible grad- ation occurs, and wide variations are observed in individu- als confined in the same stable. Once the matting and staining have developed, they remain permanent throughout the life of the bull. The staining of the hairs is "fast" and can not be washed out by any ordinary means. The Nodular Venereal Disease 301 Inspection of the mucosa of the glans, prepuce and sheath reveals the presence of a few or many small nodules, as in- dicated in Figs. 85, 86, 87. The number and appearance re- main static in the calf up to breeding age. Coitus greatly increases the number of granules, which tend to become confluent, causing an enormously thickened, roughened con- dition of the mucosa of the parts. Even with this increase Fig. 88— Section of a Single Nodule from the Vestibule of the Vagina. Showiug an Elevation in the Mucosa. (Thorns). of the infection, there is ordinarily no notable interference with coitus or fertility. Now and then, however, the parts become so intensely inflamed that the bull hesitates to copu- late. The attrition of coitus removes the epithelium from the summits of some of the nodules, creating minute abra- sions and inducing hemorrhage. In still more severe cases, the involved mucosa becomes so swollen that the penis can no longer be protruded, and phimosis becomes established. 302 Diseases of the Genital Organs The history of the nodules has been studied chiefly by Thorns. He found them to consist of clumps of cells encap- suled within the mucous membrane. The cells, which are mononuclear, can not be differentiated microscopically from ordinary lymphocytes. The capsule surrounding the cell mass is not dense, but is well defined and furnishes no stroma. So far as observed, no capillaries enter the cellular Fia. 89 — Section through four contiguous nodules which cause a single, rather flat elevation of the surface. (Thoiiis. ) mass, but are confined to the peripheral zone, where they are large and prominent. (See Figs. 88, 89, 90, 91.) When the nodules are very numerous and the mucous membrane is thrown into folds, the nodules projecting above the surface of one fold may come into contact with those from the contiguous ridge, and, by attrition, the superficial layer of epithelium may be worn away. It is very largely due to this secondary lesion that a considerable amount of The Nodular Venereal Disease 303 muco-pus is formed in many severe cases. These attrition lesions are also responsible for frequent hemorrhages. The biology of the nodular venereal disease has not been satisfactorily determined. Ostertag discovered, in the muco-pus of the vulvae of cows, a streptococcus which he believed to be the essential cause of the disease. He intro- duced the organism, which he had grown experimentally. Fic. 90 — A knob-like elevation of the mucosa due to several contiguous nodules. ( Thorns. ) into the vulvae of supposedly sound heifers, and believed that he produced the disease. It is a notable fact that in Ostertag's experiments, while he believed he had trans- mitted the disease to cows and heifers by means of pure cultures, he failed to transmit it to sheep, goats, and swine, although they regularly suffer from it. It is not clear, however, just what he accomplished. Doubt is thrown upon 304 Diseases of the Genital Organs his findings by the symptoms and course of the experi- mental disease which he records, since they are not the symptoms seen in the first stages of the disease as I have seen it in hundreds of heifer calves from two to six months old, as well as in a number of experimental calves. Oster- tag says : "The first symptoms of infectious vaginal ca- tarrh are swelling of the vulva, redness, swelling and sensi- FiG. 91 — A section from roof of the Vagina showing marked nodule- formation without macroscopically visible elevation of the mucosa. (Thorns.) tiveness of the vaginal mucosa with a muco-purulent de- posit." In the earlier stages of the malady, as I have ob- served it, there are present none of the symptoms empha- sized by Ostertag. On the contrary, the disease comes on insidiously. The first sign is the appearance of a few nod- ules in the vulvar mucosa, sharply defined above the sur- rouding epithelium, as pale yellow or colorless transparent elevations having a vascular girdle about their bases. Some The Nodular Venereal Disease 305 would call such heifer calves sound, but, if two or three typical nodules do not indicate the nodular venereal dis- ease, it would be difficult to understand how two hundred or three hundred nodules can assure us of the existence of the malady. In other words, Ostertag describes, not the be- ginning of the disease, but an "explosion" of the existing malady under profound irritation. It is not strange that virulent streptococci induced the symptoms he describes, nor that he was able to recover from his experimental animals pure cultures of the microorganism. The disease is so universal that an investigator is not warranted in assuming that a given heifer or heifer calf is not affected. Calves born during severe outbreaks are fre- quently so badly diseased that they die. Therefore, it is not unreasonable to assume that in some cases at least calves are born with the nodular venereal disease. Extended ob- servations upon the genital organs of veal calves upon the killing floors of abattoirs show that almost all of them de- velop clearly and positively the symptoms of the disease at a very early age, usually within sixty days after birth. It is not known, however, when the infection really became established, but only when the clinical evidences became visible to the naked eye. Recent investigations indicate that, assuming that the calf is sound when born, which is not the general rule, it remains free from the nodular ve- nereal disease if fed upon boiled milk. Such being the case, it would appear that the infection may enter the or- gans of new-born calves vdth the first milk consumed, and that the appearance of visible lesions in the genital tract merely marks the duration of time between the ingestion of the infection and the establishment of the clinical evidences of its presence. Accordingly, any calf which may be se- lected for experimental purposes, with a view to determin- ing the transmissibility of the nodular venereal disease or the power of any known organism to cause it, can scarcely be accepted as sound, because it is not known how thor- oughly the calf is already infected and upon what day the evidence of such infection would ordinarily appear in the 20 3o6 Diseases of the Genital Organs genital tract. It is not known that these lesions in the geni- tal tract are the sole or primary lesions of the disease. Va- rious writers have asserted that these lesions have been dis- covered in the uterine mucosa, and that the streptococci have even been found in the ovaries. Streptococci are common in the genital tracts of animals. The streptococcus which Os- tertag has described does not differ materially, so far as may be learned from his description, either in staining or in cultural behavior, from other streptococci. On the whole, therefore, the evidence relating to the biology wants some of the essentials for arriving at a safe conclusion. When the nodules increase they do so numerically, and when first observed are of full size. When they disappear, they van- ish numerically, but those which remain are essentially as large as ever. The Relationship of the Nodular Venereal Disease to Sterility and Aboj^tion. Isepponi, Zschokke, Hess, and many others were thoroughly convinced that this infection was the cause of abortion, sterility, and other diseases of the genital organs of cows. The evidence which they submit is clinical, and in large measure circumstantial. When abor- tion breaks out in a serious form, veterinarians, seeking for an explanation, tend always to search for any evidence which may offer an acceptable hypothesis for the occurrence of the disaster. If the nodular venereal disease has been accepted at a given time or in a given country as the re- sponsible cause of abortion and allied disasters, the exam- iner is very liable to look closely for these lesions, and when- ever he does so he is certain to find them. He then as- sumes that the cause of the disaster is revealed, and does not investigate carefully the character of his evidence. In fact, the definition of nodular venereal disease, as given by various observers, differs widely. As a general rule the diagnosis is not based upon the appearance of nodules in the vulvar mucosa, but rather upon the number of nodules and their clinical appearance. Hess, for example, says that an animal has the nodular venereal disease when there is a large number of the nodules present in the vulvar mucosa The Nodular Ve?tereal Disease 307 and muco-pus upon the inflamed mucosa. The number of nodules necessary to warrant the term "numerous," the amount of inflammation necessary to warrant the diagno- sis of inflammation, or the amount of muco-pus necessary for recognition as such, varies with each observer. In Bulletin 106 of the United States Department of Agricul- ture, I took as my basis for diagnosis the visible existence of nodules in the vulvar mucosa. If nodules were present, were they two or three or even only one, if they were typi- cal, I classed the individual as infected ; if I failed to recog- nize any of the lesions, I classed it negative. Whenever sterility and abortion are highly virulent in a herd, the nodular venereal disease is intense ; whenever the rate of abortion is very low, there is a correspondingly low intensity of the nodular venereal disease. This parallelism is very striking and suggestive. It constitutes evidence of a possible relationship between this infection and the breed- ing disasters, which should not be ignored. However, it is merely a bit of interesting evidence — not proof . It has been stated by some observers that, with the ad- vent of the disease in a herd of cows, abortion broke loose as a storm. The truth of the matter is that the infection was discovered after the outbreak of the abortion. There is no good reason to assume that it had not existed in the herd from the very beginning. No search was made for it until the abortion storm broke ; then observation revealed its presence, and the disease was attributed to it. Some observers have recorded that in outbreaks of abor- tion in sows a clinical examination revealed the presence of the nodular venereal disease. Hence it was said that the disease had been transmitted from cows to sows and that thereupon "contagious abortion" broke out. Thus it has been claimed that, wherever the nodular venereal disease appears, extensive losses from abortion must follow. Had the observers taken the precaution to examine the genital organs of supposedly healthy sows in herds where abortion did not prevail, there also the disease would have been found. 3o8 Diseases of the Genital Oigans Under the circumstances, it seems perfectly clear that the nodular venereal disease has not been proven to be the direct cause of sterility or abortion in cattle or in other do- mestic animals. Whether it does or does not directly cause sterility or abortion, clinical evidence indicates clearly that it is a disease which merits the respectful attention of in- vestigator, practitioner, and breeder. The avenue and date of infection are not clear. In large dairies, rich in genital infections, the evidences of the pres- ence of the nodular venereal disease are well established at thirty to sixty days after birth. This shows clearly that the primary infection is not due to coitus. Careful observa- tion also indicates that the infection is not generally refer- able to intermediary bearers such as attendants or stable equipment. Neither can it be ascribed to ordinary cohabi- tation with other calves or cattle, since calves confined in isolated stalls suffer the same as other animals. Experi- mentally I have kept calves in close proximity to diseased cattle, all cared for by the same attendant, with no special precautions, without any evidence of transmission. My experiments indicate with great emphasis that the infec- tion which appears so uniformly in the young calf is blood- borne from the alimentary or pulmonary tract, and its de- velopment may be accelerated, controlled, or prevented at will by the method of feeding. When the grade beef cow nurses her calf in the open field, it does not so promptly nor so markedly develop evidences of infection. The higher the intensity of calf scours and pneumonia in a stable, the more prompt and intense are the evidences of the nodular venereal disease. When the health of the calf is better, but there are adhesive feces, a rough lustreless coat, pot-belly, and a hacking cough, the advent of the genital catarrh is later and less marked. If the calf is born in good health, and diarrhea, indigestion, hacking cough and general un- thrift are avoided, the evidences of the disease do not ap- pear for several months. While it has not been proven that the nodular venereal disease is the cause, or an important cause, of sterility or The Nodular Venereal Disease 309 abortion, it is still true that sterility, abortion and calf dys- entery run parallel with the nodular venereal disease. Calves thirty to sixty days old do not suffer from dysentery or pneumonia if they are free from the clinical evidences of the nodular venereal disease. New-born calves break down with dysentery before the signs of the nodular venereal dis- ease are established. If the evidences of the disease are present, the calf exhibits one or several of the following symptoms : dysentery, torpidity of the bowels alternating with diarrhea, sticky feces adhering to the hairs of the tail and buttocks, pneumonia, a hacking cough, lustreless coat, and pot-belly. When such a calf reaches breeding age, its fertility is uncertain. It is highly interesting to observe that, in applying the agglutination test for B. abortus to the blood of calves, the reactions are parallel to the manifestations of the nodular venereal disease : the blood of calves severely infected re- acts highly to the B. abo)'tus test, and vice versa. The sig- nificance of this parallelism is undetermined. By no means does it show that the B. abortus is or is not the cause of these lesions. It is not known to M^hat degree blood samples from the same animals may react to the agglutination test for the streptococci, colon-like bacilli, micrococci, and other bacte- ria commonly recognized in the genitalia of cattle. The most important consideration regarding the nodular venereal disease, pending scientific study of the problem, is that it causes important disease of the copulatory mucosa (balanitis, posthitis, colpitis, vaginitis) which produces def- inite injury. Frequently the disease is so severe that it causes recognizable pain in coitus, followed by hemorrhage owing to the summits of the nodules becoming removed by attrition. Each of the multiple small abrasions constitutes an open and inviting avenue for infection by any agent pres- ent. In the bull the mucosa may be so severely swollen that phimosis is established and coitus is barred. The vulva of the heifer is frequently so inflamed that it bleeds under gentle digital palpation, and the vulvo-vaginal mucosa is covered over with much stringy, tough muco-pus. What- 3IO Diseases of the Genital Organs ever may be the final decision as to the significance of the nodular venereal disease, these definite injuries should be recognized and preventive or ameliorative measures applied. The prognosis of the nodular venereal disease is good. It can not be definitely cured by any known means, but it may be controlled and its power for harm mitigated. It is im- practicable at present to prevent it wholly, but the proper handling of new-born calves does, for all practical purposes, render it harmless so far as now known. The handling of the nodular venereal disease is based upon application of adequate measures for the healthy rearing of calves and for sex hygiene in adults. Considering the nodular venereal disease as one which at- tacks the new-born calf and continues throughout the ani- mal's life, the most fundamental necessity is to grow the calf so that the infection will not develop in a serious form. This can be done only by strict attention to the feeding and other hygienic questions, which will be more thoroughly discussed in Section 3 of Part III, under "Congenital In- fections of Calves." Here the invasion may be controlled in such a manner that it tends to protect the animal against the more severe type of the disease during its adult life. The disease is so highly infectious, however, that the ul- timate control must include proper sex hygiene in the adult of each sex. In the bull the handling of the nodular vene- real disease resolves itself into the control of balanitis, or balano-posthitis. Here handling should be preventive or controlling rather than curative. It is just as necessary to control the disease from the standpoint of secondary as from that of the primary disease itself. If the disease is per- mitted to acquire great intensity, so that the summits of the nodules become denuded of their epithelium, a gateway for various infections is opened, imperiling the sex health of the animal. The breeding bull should always be viewed from the standpoint of a male which is expected to copulate with an indefinite number of females, each of which, since she may bear infections within her genital tract, is a poten- tial danger for the male. He in turn, after such exposure, carries an equal peril for the female. The Nodular Venereal Disease 3 1 1 The handling of balanitis consists essentially of cleanli- ness. It has been stated that genital catarrh is essentially universal in bulls. While its presence has been ignored generally, there should be no doubt regarding its importance in i-elation to the reproductive functions. Whenever the ca- tarrh becomes at all advanced, the epithelium upon the sum- mits of the granules or nodules becomes damaged and af- fords an avenue for the entrance of other infections. It is probably largely through these lesions that primary genital tuberculosis is established, as has already been stated in Chapter XIII. Consequently it is important, for the sexual health of both the bull and the cows with which he copu- lates, that the genital catarrh shall be held in abeyance at all times and not permitted to become so exaggerated as to interfere with coitus. According to present knowledge, it seems highly probable that, when the genital catarrh of the bull becomes severe, its existence must be inimical to the welfare of the female with which he copulates. The infec- tion, introduced deeply into the vagina, necessarily remains behind, adding to the infection already present. While we do not know the exact significance of the infection, it is im- possible to conclude otherwise than that it is detrimental. The best method at present available for maintaining the health of the prepuce, sheath and glans is by douching the parts at frequent intervals, say two or three times a week, when the bull is at rest, and thoroughly douching the parts just prior to and immediately following each service. The best apparatus for carrying out the douching plan is an or- dinary agate hospital irrigator of one gallon capacity, to which a pure gum douching catheter is attached. This in- strument, the diameter of the ordinary horse catheter and seven feet long, has the end rounded so that it may be intro- duced freely and safely into the sheath and prepuce. It is made of pure soft rubber, which is smooth, pliable, and re- sistant to hot water, so that it may be repeatedly boiled for purposes of sterilization^ ' Upon my request, the firm of Sharp & Smith, Chicago, have placed in stock a catheter of the dimensions stated. It is of sufficient length that, when the irrigator is suspended above the bull, it is abundantl}- long for in- sertion into the sheath. 312 Diseases of the Genital Organs The technic of douching is very simple. The irrigator is filled with a warm physiological salt solution (1 oz. common salt to 1 gal. water) to which may be added with benefit 14 of 1 per cent, of Lugol's solution. The irrigator is then sus- pended two or three feet above the back of the bull and the catheter gently inserted through the sheath into the prepuce. The insertion is facilitated by the application of a small amount of lard or oil. The douching fluid should be allowed to flow slowly from the catheter before it is inserted into the sheath, in order that all air bubbles shall be forced out. Once introduced, the fluid is permitted to flow freely into the sheath and prepuce. At the same time, the operator should grasp the opening of the sheath and compress it so that the fluid may not escape. This causes the sheath and prepuce to become thoroughly distended, the many complex longitudinal folds of the mucous membrane to become ob- literated, and the fluid to come in contact with every part. When the sheath has become thoroughly distended, the operator should suddenly release the compression on the sheath opening and permit the fluid to escape. As soon as it has all escaped, he should again compress the mouth of the sheath and repeat the operation several times, in order to insure thorough mechanical washing. In numerous publications from apparently authentic sources, directions are given for douching the sheath and prepuce of bulls, of which it is impossible for me to approve. Writers frequently state that the douching can be carried out successfully by using a piece of ordinary rubber tubing. In my judgment this is not true. The ordinary rubber tub- ing is mixed with lead and other diluents which render it very rigid and harsh. Since the end is cut squarely, and frequently roughly, any attempt to push the tubing into the upper part of the sheath and into the prepuce inevitably abrades the mucosa. I think the use of a piece of ordinary rubber tubing can not be too strongly condemned. If the work is worth doing at all, it should be done in a surgical manner with an appliance suitable for the task. Another very common error, according to my view, is the The Nodular Venereal Disease 313 advice of some writers that a force pump should be used for douching. A pump is exceedingly difficult to keep clean. It almost inevitably becomes dirty. Most pumps are not subject to disinfection or to sterilization by boiling. With a pump there is always danger of including in the douching fluid air bubbles, which may flow into the sheath and pre- puce under great force, giving the animal a shock which causes him to move suddenly with danger of injuring both himself and the operator. The pump is also an extravagant appliance. With the irrigator, the douhcing can be carried out readily by one man, whereas with the force pump two men are necessary. Ordinarily a bull is well accustomed to one man, and that one can manage him better alone than in the presence of others. It is frequently asserted that certain bulls will not permit the douching without violent and stubborn resistance. I have not found this to be true. Repeatedly, caretakers have been exceedingly dubious about their ability to douche the bull, but with such an apparatus as I have described, and with ordinary prudence in handling the animal, I have found that the douching can be carried out without violence on the part of the animal. He will stand for the douching as well as for grooming. The success of the douching de- pends upon gentleness and tact on the part of the operator and his having at hand suitable equipment for the work. Failures in douching, so far as I have known, have always been due to lack of proper apparatus or to faulty method, or in some cases to faulty solutions used. The douching fluid should always be warm — not hot — and should be wholly free from irritation. Some writers advise a strong disinfectant. These always prove highly irritant and serve to infect instead of disinfect. That is, an irritant disinfect- ant introduced into the sheath and prepuce destroys the protective epithelium of the part, and the dead cells re- maining supply a new and fertile field for the multiplication of bacteria. It is impossible to disinfect wholly the genital mucosa, and no such vain attempt should be made. Instead, a high degree of mechanical disinfection should be obtained by using a neutral or slightly bactericidal douche. 314 Diseases of the Genital Organs When the balanitis becomes severe and coitus becomes difficult or impossible, the douching should be carried out diligently, once or twice a day, according to conditions. Great care should be taken not to use an irritant douche. There is a great tendency among some veterinary practi- tioners, when the infection of the sheath and prepuce be- comes marked, to attempt to disinfect with some very pow- erful solution. These only intensify the disease present. In one case where I was consulted, the attending veterinarian had used 10 per cent, silver nitrate, 5 per cent, compound cresol, a strong solution of lysol, and other disinfectants. Each change was for the worse and the highly valuable bull had been pronounced incurable and slaughter advised. A mild douche, such as advised above, ameliorated the symp- toms very promptly. Within fifteen days the bull was back at work in prime condition, and remained competent and fertile. Whenever balanitis is severe, a bull should be taken out of service and kept as free from sexual excitement as possible until the severe symptoms have abated. The general principles in controlling the disease in the female are essentially the same as in the male. In breeding heifers for the first time, it is important and prudent to ex- amine the vulva and vagina carefully, in order to determine the intensity of the disease. Frequently it is found to be so intense that there is considerable muco-pus present before coitus has occurred. If such be the case, it is important that the intensity should be ameliorated by flushing the vagina three or four times a week with a warm, physiologic salt solution, to which has been added 14 to y± per cent, of Lu- gol's solution or of chlorazene. After coitus has occurred and time has been given for the spermatozoa to pass out of the vagina and through the cer- vical canal on their way to the oviducts, the vagina should be douched in order to overcome the irritation of coitus. It has already been stated that this irritation is very profound and causes a tremendous increase in the number of nodules, in the inflammation of the mucosa, and in the amount of The Nodular Venereal Disease 315 muco-pus present, so that the vulva of the heifer presents an appearance which shows very definitely the fact that she has copulated. By timely douching, this irritation and ex- plosion of the infection may be obviated. Itf is quite safe to douche within four or five hours after coitus. The evil ef- fects of coitus may be controlled by douching at any time after the period named up to about twenty-four hours. The control may be rendered more complete by repeating the douche at intervals of twenty-four hours for three or four times. It may then be omitted. The control of the disease at any period in the sexual life of the animal may be brought about in a similar manner. Whenever the irritation is marked, the vagina may be douched with a very mild anti- septic two or three times a week, and such douching may be continued indefinitely. There is an old prejudice, sometimes still revived, against douching the vagina for fear of causing abortion. No reason exists, so far as I know, why such re- sult should follow a vaginal douche. Clinically I have seen no tendency whatever for the douching to produce any ill effects. It is a valuable hygienic and economic measure, when properlly carried out, especially upon cows which are constantly confined in the stable. While douching the va- gina, the operator also washes the exterior of the vulva and keeps the parts clean. In douching the vaginae of cows, one must take care not to transmit from one to another some important form of in- fection. Under proper precautions as to cleanliness, no such danger ordinarily exists. Since the infections in a given herd are fairly uniform, there is very little danger that one female has a more serious genital infection than her neigh- bor. There are, however, important exceptions. In a herd where tuberculosis exists and an animal chances to have genital tuberculosis, douching her vagina and then the va- ginae of other females without thoroughly disinfecting would be highly perilous. However, as, under proper veteri- nary supervision, no cow with genital tuberculosis should exist in the herd, such an exposure is unjustifiable. The same conditions apply to the vesicular venereal disease, 3i6 Diseases of the Genital Organs which has been described previously. Careless douching would spread this infection rapidly throughout the entire herd. As with tuberculosis, this is wholly unjustified, be- cause the animal with vesicular venereal disease should be in strict quarantine. Perhaps the greatest danger involved in the general douching of a herd is from those animals which may have a very virulent infection of the genital organs, as retained afterbirth or pyometra. Here again the prudent veteri- narian places the seriously infected animal under efficient quarantine and before an apparatus is used for douching virtually sound animals, except for moderate nodular vene- real disease, it is to be thoroughly disinfected by boiling. The best method for douching the vagina and washing the exterior of the vulva is by means of a gravity apparatus suspended from an elevated track behind the row of cows. Depending upon the size of the herd and the surroundings, one may use a five-gallon pail with a faucet or a barrel of the most convenient size, attaching to it a soft rubber horse stomach tube. The vessel is filled with the desired solution and elevated upon the track approximately two or three feet above the backs of the cows, the tube is inserted into the vagina for a sufficient distance, and the fluid is per- mitted to flow in rapidly until the vagina fills and the wall contracts and expels the fluid. Before inserting the tube into the vagina, the exterior of the vulva should be washed with sufficient care to avoid dragging any large particles of dirt into the vagina. By such a plan, the breeder or dairy- man has it in his power to mitigate and control the severity of the nodular venereal disease. With proper equipment, the application of these hygienic measures is neither diffi- cult nor expensive. One man can readily douche the vagi- nae of forty to sixty cows an hour, and do it reasonably well. CHAPTER XIII NON-VENEREAL INFECTIONS WHICH INVADE THE GENITALIA 1. Genital Actinomycosis Although actinomycosis may invade any organ in the body, it rarely involves the genital system. Apparently this is not due to any notable resistance of the genital or- gans against this infection, but rather to the comparative infrequency of exposure. Actinomycosis of the genital or- gans of cattle does occur, possibly with greater frequency than recorded diagnoses would indicate. Clinically, I have observed actinomycosis of the prepuce, sheath, and inguinal lymphatics in a bull. There was present in the prepuce an actinomycotic mass five or six inches in diameter and in the peripenial and inguinal lymph glands several actinomycotic masses. One instance of penial actinomycosis in the bull has been brought to my attention, in which there was upon the glans an actinomycotic tumor about one inch in diame- ter. The veterinarian under whose observation the case oc- curred very naturally diagnosed penial tuberculosis. I have seen two clinical cases of genital actinomycosis in cows. In my first case there was merely the history of ster- ility in a highly valued pedigreed cow regarding which a colleague called me in consultation. There were extensive pelvic adhesions, with indistinct outlines of the genitalia and large, indurated abscesses in the mesometrium. Since the animal was evidently incurable, she was slaughtered. Autopsy revealed several sclerotic abscesses, three to four inches in diameter, located in the mesometrium, with other abscesses in the liver. Histologic search showed that the abscesses were actinomycotic in origin. No definite avenue of invasion was determined. My second case of genital actinomycosis was in a cow that had calved and had suffered from retained placenta. I at- tended her and removed the placenta manually. Apparently she did well for a time but after a few months, as she failed to breed or to show estrum, she was again examined. I 3i8 Diseases of the Genital Organs -■ ^'-Jfi g m' Fig. 92— Genital Actinomycosis. Cow. Above, dorsal view of genito-urinary tract showing irregular enlarge- ment and extensive pelvic adhesions; below, median longitudinal section through genito-urinary tract. /, Vagina ; ^, os uteri externum ; j, base of left uterine horn ; 4, apex do ; 5, actinomycotic uterine body ; 6, actino- mycotic abscesses in uterine horns ; 7, S, cross sections of actinomycotic oviducts ; 9, actinomycotic abscess in ovary ; 10, corpus luteum (var. nigrum ) ; //, //, actinomycotic invasion of urinary bladder. Non- Venereal Infectio7is zvhich hivade the Genitalia 319 found complete pelvic adhesions and a greatly enlarged sclerotic, and irregular uterus. I diagnosed tuberculosis and advised immediate slaughter. Inspection revealed that the disease M^as confined wholly to the genito-urinary organs and that the lesions were actinomycotic. The general ap- pearances are illustrated in Fig. 92. Accurate clinical diagnosis of genital actinomycosis is dif- ficult. Sometimes it closely simulates tuberculosis. Here the tuberculin test may greatly aid, but tuberculosis may exist in other organs and cause a reaction although the genital disease is actinomycotic. In some advanced cases of tuber- culosis with involvement of the genitalia, tuberculin causes no reaction. There occur also in sclerotic metritis due to common pyogenic invasions pelvic adhesions with abscesses closely resembling genital actinomycosis. Ordinarily an accurate clinical diagnosis as to species of infection is not demanded. The lesions render the case hopeless and dic- tate slaughter. Then should follow accurate post-mortem diagnosis, in the interest of contact animals. Rarely the disease may be amenable to treatment, but for this purpose needs to be diagnosed early and surgical and medicinal interference promptly put into effect according to the general plan for handling actinomycosis of other or- gans : the seriously diseased tissues should be surgically re- moved and potassium iodide administered internally. When the disease involves the glans penis of the bull, the affected part may be successfully amputated, as described for ma- lignant neoplasms of the penis. 2. Genital Tuberculosis Tuberculosis of the genitalia of cattle has generally been considered as rare and of scant scientific and economic im- portance. William Williams' states, "If the cow be in calf, abortion is apt to occur ; if not pregnant, the condition called nymphomania is frequently present." Law- states, "The generative organs also occasionally suffer (from tu- ' Principles and Practice of Veterinary Medicine, 1875, p. 347. ^ Vet. Med., Vol. IV, 1902, pp. 44S, 449. 320 Diseases of the Genital Organs berculosis), in which case an early and rather persistent symptom is sterility, with a too frequent, or it may be per- sistent desire for the bull (nymphomania). * * * in cases of uterine tuberculosis, the nymphomania may be supplemented by a purulent discharge. * * * Genital tuberculosis in the bull is associated with nodular swelling of the testicle, epididymis, or cord, hydrocele, and excep- tionally tubercle on the penis or in the prostatic sac." Friedberger und Frohner^ state that genital tuberculosis occurs rarely in both sexes and may invade any portion of the genital system. Hutyra und Marek- mention the occur- rence of tuberculous epididymitis and orchitis, sometimes accompanied by tuberculous abscessation of the testis, with a consequent fistula. They consider penial tuberculosis as extremely rare, and claim that when it occurs the glans penis becomes studded over with tubercles. Quoting Hess, they regard uterine and tubal tuberculosis as rare and as causing sterility and nymphomania. Vulvo-vaginal tuber- culosis is mentioned as a rare possibility. Hoare- describes genital tuberculosis very briefly, without according it an important place. He admits the possibility of transmission by copulation. He mentions a single case of primary penial tuberculosis. Most veterinary literature concerning genital tuberculo- sis is in sharp contrast with my personal observations. The difference in view is possibly due to a variation in the di- rection of study. Veterinarians rarely look for genital tu- berculosis, since ordinarily it does not affect the general well-being of the patient. Clinically, it is only when one concentrates his observations upon the diseases of the geni- tal organs in connection with sterility that he recognizes genital tuberculosis and realizes its importance. The geni- talia are not inspected frequently in the abattoir. They are not used as human food. When they are tuberculous, the lesions possess little or no importance in relation to the * Speciellen Pathologic und Therapie. ^ Spezielle Pathologic und Therapie der Haustiere. 3 System of Veterinary Medicine. No7i-Ve7iereal Infections ichich Invade the Genitalia 321 value of other tissues for food. Hence, much genital tuber- culosis may pass unnoted. The genital mucosa offers a highly vulnerable field for tuberculous invasion, but genital exposure to tuberculosis is rare as compared with exposure through contaminated food. That is, when open pulmonary tuberculosis exists, the patient is constantly contaminating mangers, food, and water by means of her sputum, so that companions are ex- posed daily and hourly. When genital tuberculosis exists, the exposure may be identical, because of the genital dis- charges contaminating food and water, but the special ve- nereal exposure occurs only during the very brief period of copulation, I have not observed tuberculous orchitis or epididymitis. There is no example of either in my pathologic collection of genitalia, and no specimen in the collection of any depart- ment of the college. The scattered records in veterinary literature of tuberculous orchitis and epididymitis do not serve as a very accurate basis for outlining the clinical symptoms. In a general way, it is stated that the epididymis and testes show painless enlargement and hardening. The demarcation between the epididymis and the testis gradu- ally becomes clouded, and finally is lost. Apparently the epididymis usually becomes involved first, and the disease extends thence to the gland. The tuberculous process is said to be located usually in the parenchyma, having its basis in the mucosa of the epididymis and testis. In this manner the disease may be well advanced before peripheral inflammation or tuberculous extension involves the peri- toneal coverings, to cause adhesions and hydrocele. Rarely, abscessation is said to ensue, resulting in a fistula. The clinical diagnosis of tuberculous epididymitis and orchitis is difficult. Painless tumefaction of the testis is not characteristic of tuberculosis, but may ensue from various pyogenic infections. Peritoneal adhesions, hydrocele, and abscessation are quite as probable, if not more so, from other infections than from tuberculosis. Next to the excision of the testis and its examination, tuberculin offers the best 322 Diseases of the Genital Organs means for diagnosis. As is well known, tuberculin has its limitations, and may fail. If the patient responds to tuber- culin, the evidence of tuberculous epididymitis or orchitis is not complete. There may be tuberculous lesions in other organs, causing the response to tuberculin, while the lesions in the epididymis and testis may be non-tuberculous. When but one testicle is involved, its removal and histo-biologic ex- amination offers by far the most reliable means for diag- nosis. If the disease has existed for some time, the re- moval of the testis is in no case an economic waste, because as a general rule chronic epididymitis or orchitis signifies permanent loss of function of the involved gland. Its re- moval is the best curative measure and the greatest avail- able protection for the other testicle and for the breeding life of the bull. The path of tuberculous invasion of the epididymis and testis has not been clearly learned. The infection is not primary. It does not seem to be secondary to penial infec- tion. While I have observed several cases of primary penial tuberculosis, I have not noted subsequent tuberculous epidi- dymitis or orchitis. It appears highly improbable that the tubercle bacilli would traverse the long urethra and vas deferens and reach the epididymis without leaving behind evidences of its passage in the form of penial or urethral tuberculosis. When the infection is wholly within the tu- bules of the epidymis or testis, as appears usually to be the case, the invasion is apparently not direct from the perito- neum. When the scrotal peritoneum is first involved, it would appear probable that the invasion occurred from the peritoneal cavity through the open inguinal ring. Appar- ently most instances of tuberculous epididymitis and or- chitis are referable to hematogenic sources and constitute a part of generalized tuberculosis. The prognosis for the involved gland is hopeless. If only one gland is involved, it may be successfully removed, leav- ing the bull perfectly fertile. The difficulty is that, since the tuberculous epididymitis or orchitis is usually a second- ary rather than a primary lesion, the basic lesion remains Non- Vc7iereal Infections ichich Invade the Gejiitalia 323 and probably unfits the bull for breeding except when mated with infected cows held under the Bang plan. Even in such cases, it needs to be determined that the vas deferens, vesi- culae seminales, prostate gland, and penis are free, or the bull becomes a serious menace even to tuberculous cows, be- cause when such parts are involved tubercle bacilli may be Fig. 93 — Tuberculosis of Sheath and Prepuce of Bull. S, Sheath ; U, urethra ; G, glans ; F, fornix ; CC, corpus cavernosum, /, /, fissure extending into tubercular mass. ejaculated with the semen from the sound testicle, inducing primary genital (venereal) tuberculosis in the cow, which may promptly bring her breeding life to a close. Tuberculosis of the vas deferens, seminal vesicle, and prostate is possible, but apparently too rare to be of great 324 Diseases of the Genital Organs economic importance. Tuberculosis of the vesiculae semi- nales or prostate would tend to interfere with urination and copulation (ejaculation). The diagnosis of tuberculosis of these parts would be based necessarily upon rectal palpation. Penial Tuberculosis. Penial tuberculosis is comparatively common in the bull. The corpus cavernosum, urethra, and urethral mucosa are not involved as frequently as the sub- mucosa of the glans, prepuce and sheath, and the adjacent penial lymphatics. Tuberculosis invades any organ far more readily when the protective epithelium is wounded. The anatomy of the copulatory apparatus of the bull and the mechanism of copu- lation render epithelial injuries more probable elsewhere than in the mucosa of the glans penis itself. The penis of the bull (and of ruminants generally) is very firm. The transverse diameter and the rigidity of the penis are but slightly modified by erection. The protrusion of the penis during copulation is brought about almost wholly by the elimination of the sigmoid flexure (See Fig. 99), the ac- complishment of which requires the relaxation of the re- tractor penis muscle. When at rest, the penis lies within the prepuce, above the sheath. As a rule, no distinction is drawn between the mucosa of the sheath and that of the prepuce, although they have a wholly different embryologic history. The sheath exists as a distinct structure at the time of birth ; the prepuce does not. In the new-born rumi- nant and porcine male, the sheath constitutes a compara- tively short infundibulum, terminating at the bottom in the meatus urinarius (Fig. 8, page 14, and Fig. 9, page 15). No part of the glans penis is exposed. At the time of birth, the two layers of mucosa, one of which is later to form the mucosa of the glans penis and the other the mucous mem- brane of the prepuce, are firmly adherent to each other. Later, when sexual maturity approaches, the tissue between the two layers of mucous membrane, which serves to bind them together, slowly gives way, and the preputial sac finally becomes established. In the abattoir, one may ob- serve in veal calves every gradation of the development of No7i- Venereal Infections zvhich Invade the Genitalia 325 the prepuce. The gradations may be seen also in castrated males (Fig. 9a, page 16). The preputial sac may be totally absent, or there may be any degree of development, accord- ing to the stage of sexual development at the time of castra- tion. The anatomy and the mode of protruding the penis during coitus have been described on page 14. The coital Fig. 94 — Rupture of Prepuce From Coital Violence. CC, Corpus cavernosutn : F, fornix ; P, prepuce ; G, glans ; U, urethra ; R, coital rupture. At the right end of the rupture the ruptured border of the prepuce is folded upon itself. thrust of the bull is vigorous, or sometimes so violent that the prepuce is torn or ruptured, as shown in Figs. 61 and 94. The abraded or ruptured portion is withdrawn at once, with the retraction of the penis, and any infection which has en- tered the wound is carried along. - - ■ 'i r A G •'■; ~ -I r^ ^s ■\ ^\r^ "^Tb CC P u Fig. 95 — Tuberculosis of Glans and Prepuce. G, Glans ; P, prepuce ; F, fornix ; U, urethra ; CC, corpus cavernosuni ; Tb, tubercle in tip of glans ; A, tuber- cular abscess in prepuce. 326 Diseases of the Genital Organs The superficial genital mucosa of the bull, as well as that of the ram and the boar, is further exposed to abrasions and consequent infection by the presence of the granules or nodules of the granular venereal disease — a chronic infec- tion which is essentially universal. The granules or nodules frequently become inflamed, especially from excessive coitus, the epithelium at the summits of the granules becomes abraded, and hemorrhage ensues. It is not rare to see the granular venereal disease so severe that the parts bleed after each coitus, if the bull will copulate. Sometimes the pain is so great that he refuses to copulate; sometimes the swelling of the sheath is so great that the penis can not be protruded — ^the bull has phimosis. Therefore, in addition to the very delicate epithelium of the genital mucosa, the prepuce itself may be ruptured, or a multitude of minute abrasions may occur at the summits of the granules regularly present. These abrasions offer special facility for invasion by pathogenic bacteria. If the cow is afflicted with tuberculous genital catarrh, any abra- sions existing upon the penis, prepuce, or sheath of the bull, or occurring at the time of copulation, invite tuberculous infection. The entire group of such tuberculous infections may be classed as primary venereal or coital tuberculosis. Primary tuberculosis of the copulatory organs of the bull may involve any tissue or part contributing to the copula- tory apparatus. The principal types I have observed are: (1) Tuberculosis of the glans penis, (2) Sheath tuberculosis, (3) Preputial tuberculosis, (4) Tuberculosis of the penial lymph glands. (1) Tuberculosis of the glans penis is not very rare. I have observed two cases clinically, and others in the abat- toir. One clinical case was in a large Holstein herd bull. For some months, he had been unable to copulate with small or medium-sized cows, but could do so successfully with large cows with commodious vulvae. Attempts at copula- tion were generally followed by a limited amount of hemor- rhage. The glans penis was enlarged, especially at its apex. Non- Venereal Infections which Invade the Genitalia ^ 327 03 (fl O y . H >> 3"^ 1^ t/) --. 0.2 .^ a ^ Oh "^ bo "^ H ^ o tn r^ en •H tn a; .- o O tn tn cs .2 a! 30 .^ o ^% tn -d in ^' a s^ ^f biO =« fl en .r-. tn .3 tn OJ A '73 3 I (j3 328 Diseases .of the Genital Organs The surface was dark-colored, congested, somewhat eroded, and suppurating slightly. Inability to copulate was appar- ently referable to the combination of four factors — ^the en- largement of the glans ; the roughening of its surface, due chiefly to the destruction of the epithelium, thus hindering the introduction of the glans into the vulva ; the pain ; and the flaccidity of the diseased area. The penis was protruded readily. When the bull was confined upon the operating table, the penis could be pushed out of the sheath and pre- puce by forcibly effacing the sigmoid flexure. When thus forced out and securely grasped so that the part could be closely inspected, it was seen that the apex of the glans for a distance of about 3 inches was much inflamed and en- larged, and bled readily upon touch. The diseased tip was dark livid, the epithelium largely destroyed, and the surface contaminated by purulent exudate. The appearances were strongly suggestive of tuberculosis. The diseased tip of the glans was amputated. The histologic appearances were those of tuberculous lesions, and stained smears showed tubercle bacilli. The operative wound progressed very fav- orably for a time, and the bull was promptly discharged from the clinic, apparently on the safe road to recovery. The patient belonged to a breeder devoid of serious regard for the control of tuberculosis. It was understood that the disease was rampant in his herd and that he was more con- cerned about concealment than about control. I was unable to follow the case. Apparently the patient, valued at about ten thousand dollars, had contracted the infection by copu- lating with a cow having genital tuberculosis. After becom- ing infected, he was evidently a very serious menace to any healthy cow with which he might copulate. The venereal peril was limited chiefly by the fact already related, that he could not copulate with most cows and heifers, but only with those having commodious vulvae. The attitude of the owner prevented any investigation of the herd in an eff'ort to learn whether any harm had come to cows from copulation with this animal. So far as I have observed, he was one of the most dangerous bulls I have seen with genital tuberculosis, Non- Venereal Infections "which Invade the Genitalia 329 because in most cases copulation is promptly and absolutely excluded and venereal transmission thereby avoided. A very interesting abattoir specimen is illustrated in Fig. 61, in which there has been a rupture of the prepuce and also tubercular infection at the tip of the glans penis. The rupture of the prepuce probably furnished the avenue for the tuberculous invasion. Tuberculosis of the submucosa of the glans is illustrated in Fig. 96. This specimen shows numerous tubercles in the submucosa. They were not recognizable clinically. The disease was brought to a crisis by the larger tuberculous abscesses in the prepuce and about the base of the glans, which rendered protrusion of the penis impossible. (2) Tuberculosis of the peyiial sheath is presumably rare. In my collection I have but one well defined specimen. It was obtained from the abattoir and is without clinical his- tory. Fig. 93 indicates that penial incarceration occurred early, rendering the animal impotent and causing him to be sent to the shambles. Clinically, the condition could not well have been differentiated, upon ordinary examination, from other infections of the sheath wall, especiallj" actino- mycosis. Amongst chronic infections, however, tuberculo- sis is by far the m.ost probable, and a provisional diagnosis of tuberculosis should be made. The tuberculin test may serve as an aid, but is subject to severe limitations. If it is reasonably certain that the bull was tubercle-free prior to the development of the lesion, the test possesses great value. Exploratory incision through the external skin, and the re- moval of material for bacterial and inoculation studies, is of great diagnostic value. So long as the bull can protrude the penis and copulate, he constitutes a serious menace. Since the infection is pri- mary, and the fundamental lesion in the mucosa is natu- rally open, any tuberculous excretions occur within the sheath. The glans penis inevitably becomes contaminated, but not necessarily infected. In copulation, however, the surface contamination is carried into the vulva and vagina of the female. In protruding the penis, as will be under- 330 Diseases of the Genital Organs stood by studying Figures 10, page 17, and 11, page 18, until the swelling becomes too great for copulation to occur, the sheath mucosa is reflected, and when the penis is fully protruded the tuberculous membrane itself, constituting the covering of the penial base, enters the vulva of the cow dur- ing coitus. Fig. 97 — Tuberculosis of the Glans and Prepuce. /*, Prepuce ; F, fornix ; Tl\ tubercular masses. Accordingly it is essential that great care be exercised in •making a diagnosis when inflammatory conditions of the sheath exist, and that every available means be taken to eliminate the question of tuberculous infection. However, one must not carelessly incise the sheath deeply, for diag- nostic or other reasons, lest the resultant cicatrix incarcer- ate the penis. If tuberculosis is diagnosed, the bull should be excluded from service, even to reacting cows, and promptly sent to slaughter. (3) Py^eputial tuberculosis is apparently less common Non- Venereal Infections ivhich Invade the Genitalia 331 than tuberculosis of the glans or of the sheath. The prepu- tial membrane, which is far more delicate than that of the sheath, is exposed during copulation to special injury at the base of the glans. At this point the epithelium of the glans becomes reflected, to constitute the lining epithelium of the preputial sac. At the moment of the copulatory thrust, the parietal, or outer preputial membrane is sud- denly and violently reversed, to constitute the covering of the penis from the base of the glans backwards for a dis- tance approximately equal to the length of the glans itself. Further back, the sheath mucous membrane succeeds the prepuce as the mucous covering of the protruded penial body. The prepuce and the sheath mucosa become completely reversed. That end of the sheath mucosa which, while the penis was at rest, was situated most anteriorly now be- comes most posterior. The mucosa of the sheath and of the prepuce become reversed in relation to each other. When the penis is at rest, the prepuce is behind the sheath, but when the penis is protruded the prepuce is in front of the reversed sheath mucosa. Accordingly the prepuce, at the point of its attachment to the base of the glans, is one of the most vulnerable areas at which tuberculosis and other infections may effect an entrance. When infection occurs, it usually leaves scant trace in the epithelium of the glans, but involves chiefly the lymph glands of the submucosa. As soon as infection occurs and inflammation is estab- lished, the loose areolar tissue between the prepuce and the external dartoid sheath becomes involved, adhesions occur, and the penis is incarcerated. By studying Figures 8-11, pp. 14-18, it will be seen that as soon as such inflammatory adhesions become established copulation is at an end, be- cause the preputial wall can not become reflected upon the body of the penis. The adhesion of the outer with the inner layer at the base of the glans serves to hold the penis firmly in its retracted position. Clinically, the lesion is probably not usually observed un- til well established. That is, the infection probably goes unobserved even though several copulations are made dur- 332 Diseases of the Genital Organs Non- Venereal Infections which Invade the Genitalia 333 ing the few succeeding days. When the lesion has reached a certain development, a given copulation, especially with a heifer, irritating the lesion severely, sets aflame the estab- lished infection. Then the lesion is observed, and is natu- rally attributed to mechanical injury referable to the last copulation, though this is only partly true. Then swelling in the preputial region becomes evident, incarceration of the penis follows quickly, and copulation can no longer occur. The diagnosis is fundamentally dependent upon symp- toms essentially identical with those seen in sheath tubercu- losis, except that the lesion is located further backward, just anterior to the scrotum. It can not be differentiated from other infections by an ordinary physical examination. Before a technical diagnosis can be made, it is essential to include the tuberculin test and bacterial search. In a breed- ing sense, the lesion is not subject to cure. (4) Tuberculosis of the penial lymph glands is by far the most commonly observed type of genital tuberculosis in bulls. Apparently entering through a lesion, either recog- nizable or unrecognizable, of the glans, sheath, or prepuce, it may involve the lymph glands at any point from the mar- gin of the sheath, along the prepuce, and up to and above the sigmoid flexure. Clinically, in opening the small peri- penial abscesses, I find that they contain thick pus, and that the abscess walls are dark, angry red, without calcification. The lymph glands lie chiefly along the sides of the penis. When involving the small glands outside the mucous mem- branes of the sheath and prepuce, the inflammatory adhe- sions soon prevent the reflection of these membranes upon the exterior of the penis, make its protrusion impossible, and exclude copulation. Swellings in the region, usually well defined and painless, are evident. Abscessation gradu- ally develops, but the abscesses are small and their walls sclerotic, non-fluctuant, and without a tendency to "point" or break. The lesions are well illustrated in Figures 96, 97, 98 and 99. Sometimes the sigmoid lymph glands are involved, while those of the sheath and prepuce are slightly or not at all 334 Diseases of the Genital Organs affected. In such cases, as shown in Figures 98 and 99, the chief clinical phenomenon is inability to protrude the penis and copulate. The inflamed glands induce adhesions which inhibit the elimination of the sigmoid flexure. Palpation of the region readily enables the veterinarian to detect the enlarged glands. The enlargement of the lymph glands of the sheath, pre- puce, or sigmoid flexure constitutes strong evidence of pri- mary venereal tuberculosis. Other infections may induce similar adenitis, but commonly the veterinarian is justified in provisionally diagnosing such lesions as tuberculosis. He may, should circumstances demand, search for bacterial or other evidence. On the whole, any chronic adenitis of these glands ruins the breeding value of the bull and dictates slaughter. A positive diagnosis is highly important, even when made post mortem. If it is tuberculosis^ — and that is the rule — there must be highly dangerous cows in the herd, the genitalia of which should be subjected to very rigid search for tuberculosis. While a bull may become infected in copulating with a cow when the exterior of the vulva is contaminated with tubercle-bearing fecal excreta, this is improbable. The assumption should generally be that the infection has arisen from copulating with a female having tuberculous genital catarrh. Such an offender should be detected and eliminated. She is almost always incurably sterile. She constitutes a great peril to any breeding sire, and is one of the worst "spreaders" of tuberculous infection. Tuberculosis of the Female Genitalia Every part of the genital organs of the cow is subject to invasion. My collection contains examples of ovarian, tubal, uterine, cervical, and vaginal tuberculosis, and I have ob- served clinically vulvar tuberculosis. (1) Ovarian tubeixulosis is very rare, but is far more common than orchitic tuberculosis. The ovary is more ex- posed to the infection than the testicle, especially in the presence of extensive peritoneal lesions. I have obtained but two good examples. One of these. Fig. 100, is highly Tiiberailosis of the Female Genitalia 335 interesting, because casual examination suggests that the avenue of invasion of the ovary was through the physiologic lesion, the crater of a ruptured ovisac. The dense invest- ing tunic of both the testis and the ovary appears to offer a highly effective barrier against tuberculous invasion, with the important difference that in the ovary there occur in- tervals (ovulation) when the tunic is ruptured and its con- tinuity temporarily in abeyance. Viewed in this light, more V 3 Tb V CI Fig. loo— Tuberculosis of Ovary and Oviduct. /, Section through oviduct ; 2, oviduct thrown into coils by elongation ; J, ovary showing a corpus luteum, CI, and a tubercular mass, To, in crater of a ruptured ovisac. ovarian than orchitic tuberculosis might be expected. Ap- parently this is true. Nevertheless, the ovary is highly re- sistant to the infection, as compared with other portions of the female genitalia. Frequently the uterus and oviducts are highly tuberculous, while the ovary remains normal. In the second example of ovarian tuberculosis in my collection, shown in Fig. 101, the ovaries and oviducts have largely undergone tuberculous necrosis. Generally, when the ovi- ducts are involved, the pavilion is adherent to the ovary, and the peritoneal side of the pavilion is studded over with 336 Diseases of the Genital Organs / fe' ^' 3 a •iH o CO 0\J ir 1) c« ca ^ o >^ P OJ (B ^ N Pi " •? H o to ri ■^ I I ° o kT O fa Tuberculosis of the Female Genitalia 337 tubercles, as shown in Figures 102, 103, 105 and 106, but the adherent, encapsulated gland resists invasion. Ovarian tuberculosis can not, in my experience, be directly and positively diagnosed clinically. Clinical diagnosis is not highly important, since ovarian invasion rarely, if ever, oc- curs without tubal and uterine tuberculosis, each of which is open to reasonably safe clinical diagnosis. So far as I am aware, ovarian tuberculosis induces no clinical symp- toms. There is a definite impression given in veterinary literature that ovarian tuberculosis sometimes causes ster- ility, but there is no evidence submitted. So far as I have seen, it is the coexisting or preexisting tubal and uter- ine tuberculosis which causes the sterility. Statements oc- cur also (Huytra and Marek, Law) that genital tuberculo- sis, either through the invasion of the ovaries or otherwise, induces nymphomania. No evidence is submitted upon the point. The power of tuberculosis of any portion of the genital tract to cause nymphomania is probably pure legend. A careful study of nymphomania shows it to be due to a definite type of cystic degeneration of the ovary, wholly de- void of any trace of relation to tuberculosis. Genital tuber- culosis and the nymphomaniacal type of ovarian cyst m^y coexist, but that is not evidence of either identity or rela- tionship. (2) Tubal tuherculosis is, next to uterine tuberculosis, the commonest type observed in the genitalia of cattle. In many specimens, the appearances suggest that the infection has invaded the oviducts centrifugally from the peritoneal cavity through the pavilion. In other instances of even severe uterine tuberculosis, the oviducts are free. Tuber- culous oviducts are usually recognizable by rectal palpation. They become enlarged and very hard. Generally they are adherent and studded over with large tubercles. The tuber- culous tubes vary in transverse diameter up to 0.5 inches or over. When much enlarged, they become elongated and thrown into folds lying in front of and lateral to the ovary, as shown in Figures 103-106 inclusive. The disease may be 338 Diseases of the Genital Organs Tuberculosis of the Female Genitalia 339 confused with ordinary pyosalpinx or hydrosalpinx. In ordinary pyosalpinx, there are two types. In the first and commonest, there is not much pus and the oviducts are not greatly enlarged, but are very firm and of even contour; in the second, the pus is voluminous and the oviduct walls at- tenuated, giving a soft fluctuating tube, with thin, atonic Fig. 103 — Tuberculosis of Ovary and Oviduct.. The Oviducts are very Nodular and Enlarged, the Ovary Adherent in the Pavilion and Broad Ligament. Ov, Oviduct lying lateral to the ovary ; O, ovary ; UC^ uterine cornu. lymph, firm and fluctuant. Tuberculous salpingitis is, in my experience, always nodular, the tubes very hard, ad- herent, and quite large. walls. In hydrosalpinx, the oviduct is distended with Tuberculosis of the oviduct is almost, if not always bi- 34P Diseases of the Genital. Organ? -c V Fig. T04 — Dorsal Surface of Tuberculous Oviducts, Uterus, and Vag-ina, Showing extensive Pelvic Adhesions and Adhesions of Ovaries in Pavilion of Oviduct and Broad Ligament. O, Ovary ; UC, uteriue cornu ; Ov, oviduct extending laterally to the ovary ; U, uterus ; V, vagina. Tuberculosis of the Female Genitalia 341 lateral, rendering the animal incurably sterile as well as a peril in a breeding or milking herd. The pus from tuber- culous pyosalpinx escapes through the uterus and cervix to the vagina, to constitute a very serious menace to the bull. (3) Uterine tuberculosis is the commonest and most dan- gerous type of genital tuberculosis. It is supremely dan- gerous to the bull when copulating with the affected animal. The discharges resulting from the tuberculous uterine ca- tarrh soil the vulva, tail, thighs, and ultimately the udder, and contaminate the milk. Thus the milk becomes intensely dangerous for calves, for other animals, and for man. In its peril to animal and human health, uterine tuberculosis vies with tuberculosis of any other organ. Uterine tuber- culosis is quite variable, showing three somewhat separable types: (a) Peritoneal uterine tuberculosis with extensive pelvic adhesions, as shown in Figures 104, 105, 106. (b) Tuberculosis of the glandular structure of the uterine mucosa, as shown in Figures 105, 106, 107, 108, 109. (c) Tuberculosis of the epithelial layer of the mucous membrane, as shown in Fig. 110. No clear line of demarcation can be drawn between the three types, but in most cases one of the three groups of lesions predominates. In uterine tuberculosis there is generally a persistent, ob- stinate uterine catarrh. In some cases the catarrhal dis- charge is inconspicuous. Douching the uterus may reveal very little pus. In some cases of tuberculous uterine ca- tarrh, uterine douches affect the catarrh favorably for a time, but permanent relief I have not observed. Where there have been apparently favorable results from douch- ing, misleading the practitioner as to the nature of the malady, limited observation indicates that copulation sets the infection aflame. In such cases as illustrated by Fig- ures 108 and 109, the catarrh is profuse, but not generally fetid. Like tuberculosis of the oviducts, uterine tuberculo- sis is usually, if not always, symmetrical, or bicornual. Generally the uterus contracts extensive pelvic adhesions. 342 Diseases of the Genital Orga7is P'lG. 105. Horizontal section through dorsal surface of uterus, cornua, ovaries, and oviducts of Fig. 104. V, Vagina ; Tb, tubercular nodules in right vaginal walls (below) ; C cervical wall ; CC, cervical canal ; U, uterus; Tb, tuber- cles in cornua (above) ; O, O, ovaries ; CL, corpus luteum in right ovary ; Ov, tubercular oviduct greatly enlarged and elongated, pushed laterally far beyond the ovary ; UC, uterine cornu. Tuberculosis of the Female Genitalia 343 In many cases the peritoneum is so involved that ovaries, oviducts, uterus, and broad ligaments constitute a complex adherent mass, as in Figures 104 and 106, where it is diffi- cult, though generally possible, to identify the various parts by rectal palpation. Pelvic adhesions due to genital tuber- culosis resemble those caused by other infections. The ad- hesions due to tuberculosis are often accompanied by palpa- ble tubercles. Their recognition aids materially in diagno- sis. Non-tuberculous pelvic adhesions are frequently ac- companied by sclerotic abscesses of an ovary, oviduct, uter- ine horn, or the three areas combined. In my collection, no abscesses exist in any case of tubo-uterine tuberculosis, not even abscesses of the lymph glands in the broad ligaments of the uterus. Tuberculous pyosalpinx and pyometra, with necrosis of the uterine mucosa, as indicated in Figures 96 and 97, is common enough. There is one important differ- ence in the clinical history of tuberculous and non-tubercu- lous pelvic adhesions. The non-tuberculous adhesions are commonly preceded by acute metritis, largely with placen- titis and retained fetal membranes ; tuberculous pelvic ad- hesions ordinarily arise independently of acute metritis. The cow from which Figures 104 and 105 were taken was entered in our clinic for sterility. There was slight uterine catarrh (tuberculosis of the uterine mucosa) which abated under antiseptic douches. The ovaries, oviducts, and uterus were normal by rectal palpation. She appeared so well that she was mated with a valuable herd sire. Soon afterward, she broke down, and upon re-examination genital tubercu- losis was evident. When destroyed, extensive generalized tuberculosis was revealed. She entered our clinic without a history, but upon the assumption of freedom from tubercu- losis, and no careful search was made in that direction. Ap- parently the disease was forced to its crisis by copulation, the patient gave way to the infection, and a diagnosis of genital tuberculosis became practicable. Fortunately the sire escaped, largely perhaps because the cow was douched just prior to copulation. The case illustrates vividly the in- sidious and subtle manner in which genital tuberculosis in 344 Diseases of the Getiital Organs the cow may develop, and how the veterinarian needs to be on his guard. In some cases the tuberculous uterus remains to the end free from adhesions, as in Figures 107, 108 and 109. In my collection some of the uteri in which the mucosa is most extensively involved and which have undergone the maxi- mum increase in size have suffered least from pelvic adhe- FiG. io6 — Tubercular Genital Tract from a Non-Reacting' Cow iii Advanced Tuberculosis. ' A section has been removed from the dorsal surface exposing the interior of uterine body and horns. /.Cervix; i>, cornua of uterus showing tuber- cular masses ; j, j, j, j, sections through the oviducts ; 4, 4, ovaries. The left ovary (above) was buried beneath the adjacent cornu, 2, so it has beep excised and carried out where it conies into view. Tuberculosis of the Female Genitalia 345 OJ '-' 346 Diseases of the Gefiital Organs sions. Is this because in such cases as Figures 107 and 109 the infection of the uterine cavity has been primary (vene- real) and in those cases with extensive adhesions, as in Figures 104 and 106, the infection has invaded the tract by continuity from the general peritoneum? The freedom of the oviducts in Figure 107 appears to emphasize this sug- gestion. Fig. io8 — Uterine Tuberculosis Involving chiefly the Uterine Glands, the peritoneum being free. Longitudinal Section of Fig. 107. CC, Cervical canal ; /, pus in cavity of cornu ; 2, pus in apex of cornu. When the uterus is enlarged, sclerotic and comparatively free from adhesions, the tuberculous character is difficult of clinical recognition. One may meet with similar sclero- tic hypertrophy in actinomycosis (primary genital) and in chronic purulent sclerotic metritis with destruction of the Tuheradosis of the Female Genitalia 347 iG. lOQ -Advanced Tubo-Uterine Tuberculosis, with Necrosis of Mucosa and Pyometra. Ov Oviduct, greatly enlarged and consisting of a mass of tubercles ; ' C, cervical canal. 348 Diseases of the Genital Organs uterine mucosa. In such cases, however, the outlook for the breeding life of the patient is hopeless and an accurate clini- cal diagnosis is not imperative. In some cases of uterine tuberculosis, the masses of tubercles are so voluminous that they throw the uterine walls into great transverse folds which may be palpated per rectum. When such folds are present, they have a distinct diagnostic value. Usually in chronic abscessation of the uterus due to ordinary pyogenic bacteria or to actinomycosis, while the uterus is enlarged and hard, it is very irregular in outline. At one point there may be little or no enlargement. In actinomycosis and in pyogenic abscessation of the genitalia, some one part usually contains a great abscess or abscesses quite overshadowing other lesions, but in tuberculosis there is a strong tendency to symmetrical enlargement. The two horns are approxi- mately alike in volume, form, and consistence. This is im- portant to remember in making a diagnosis. In one cow of great breeding value, a reactor to tuberculin, which had not calved for two years and had long suffered from an abun- dant, fetid, highly repulsive genital discharge, I found one uterine horn much enlarged, three to four inches in its transverse diameter, very hard, and irregular in contour. The other horn was approximately normal. The findings by palpation, in conjunction with her reaction to tuberculin^ led me to Mia^nose- uterine tuberculosis. The autopsy re- vealed, instead, a macerating fetus, the bones of which caused the irregular bulging of the cornu. Had I recog- nized the fact that in uterine tuberculosis the enlargement of the horns is usually symmetrical and that the pus from the tuberculous uterus is not usually fetid, the error would probably have been avoided. In those cases of uterine tu- berculosis where only the superficial mucous layer is in- volved, as in Fig. 110, the diagnosis by ordinary clinical ex- amination fails. The ovaries, oviducts, and uterus are nor^ mal to palpation, the uterine catarrh is scant, and no out- standing clinical evidences of genital tuberculosis are present. The outstanding elements in the differentiation of ut6ro- Tiiberadosis of the Female Genitalia 349 tubal tuberculosis are the pelvic adhesions, the tubercles in the genital peritoneum, the symmetrical enlargement of the uterus, and the obstinate uterine catarrh. No one of these Fig. I io— Miliary Tuberculosis of the Superficial Uterine Mucosa of a Virgin Heifer. F, Vagina ; C cervix ; UC, uterine cornn ; Ov, oviduct. The uterine horns are laid open to show the numerous small tubercles upon the mucous surface symptoms, alone, is sufficient for a positive diagnosis. If the patient reacts to tuberculin, the probability of genital tuberculosis is increased. No data are at hand regarding bacterial search of the genital discharges. Such search 350 Diseases of the Genital Organs would probably aid materially in diagnosis. A negative tuberculin test is not conclusive evidence that genital tuber- culosis is not present. The very valuable herd bull, from v^hich Figure 96 was made, quite certainly contracted the infection from a cow which had successfully passed several tuberculin tests, in spite of severe generalized, utero-tubal tuberculosis, and marked uterine catarrh. While in many cases, such as delineated in Figure 104, quite an accurate physical diagnosis of genital tuberculosis may be made, not all cases may be detected. The important point is that utero-tubal tuberculosis may almost always be tentatively diagnosed by rectal palpation and the veterinarian and owner placed on guard. So long as the symptoms named are present, the tentative diagnosis of utero-tubal tubercu- losis is not only justified, but obligatory, from the sanitary standpoint. When uterine catarrh is present, copulation is contra-indicated by every consideration of hygiene. Fer- tilization can not occur; coitus aggravates the catarrh and imperils the bull. The retention in a dairy of a cow with obstinate uterine catarrh is unjustified by every considera- tion of health and decency. The afflicted animal is unfit to associate with others in such a manner that their food may become contaminated with the genital discharges. A tentative diagnosis of utero-tubal tuberculosis works no serious injury. If the cow recovers, as a rule the recovery automatically corrects the diagnosis ; if she fails to recover, she is worthless for breeding or dairying, and fit only for slaughter, whether the infection be tuberculous or not. (4) Tuberculosis of the cervix is presumably rare. I have but one specimen (Figures 111 and 112) derived from the abattoir, and hence without a clinical history. In this case, the uterus and oviducts are also involved. The illus- trations suggest the probable clinical features. The greatly swollen, hard, smooth lips of the cervix could not well be missed by an expert examining the genitalia clinically. While uterine catarrh was evidently present in this animal, it presumably had nothing to do with the cervical lesion. The lesion was apparently closed and caused no discharge. Tuberculosis of the Female Genitalia 351 The surgeon, meeting with such condition, would logically incise the tumor, revealing the nature of the lesion. I have repeatedly opened cysts in these parts. In so doing, I al- ways draw the cervix back into the vulva before operating, so that the field is freely open to view and the contents which may be released are readily seen. If purulent, they at once raise the question of tuberculosis, which, once raised, Fig. Ill — Tuberculosis of the Vaginal Portion of the Cervix 7, Greatly enlarged tubercular lip of os uteri externum ; 2, a second, lesser tubercular tumefaction of lip ; j, mucous folds of the first annular cervical fold. Between it and / is the os uteri externiun. should not be dismissed until the diagnosis has been made perfectly clear. On no account should a cow be permitted to copulate when a cervical lesion exists, unless it is clearly shown to be non-tuberculous. Even harmless-appearing cysts should not be passed over carelessly. Like vulvar cysts, discussed below, they may be tuberculous. The cervi- 35^' Diseases of the Genital Orgayis V cal lesion, when open, is evidently extremely dangerous. These cysts, usually found laterally from the os uteri ex- ternum, presumably consist of retention cysts in the ducts of Gartner (See page 39). (5) Vaginal tuberculosis is apparently very rare. Fig- ure 105 illustrates the only specimen in my collection. It was not recognized clinically, although I examined the pa- tient several times. However, I did not search for vaginal tuberculosis. Possibly it was of recent origin. It is important for the veterinarian, in dealing instru- mentally with diseases of the genitalia, to bear in mind that he may, by the careless use of the uterine forceps, implant the infection in the cervix, or in the vagina at its point of continuity with the cervix. He may re-infect these parts, through instrumental lesion, with the discharges from the patient's uterus. If careless in his methods, he may carry the infection from a tuberculous cow to a healthy one. Un- der reasonable precautions, the danger is quite negligible. Figure 105 shows the tuberculous lesions within the vaginal wall, closed. If open, the lesion would have the same danger as an open lesion of the cervix. (6) Vulvar tuberculosis has occurred twice in my prac- tice, each time readily diagnosed, though in one case the nature of the lesion was at first misleading. In this case, at the first examination, a cyst one inch in diameter, located apparently in Bartholin's gland (See page 44), was incised, and a small amount of sero-purulent content escaped. Prior to my next examination, the patient had reacted to the tu- berculin test. When I examined her, the lesion presented the typical characters of a tuberculous ulcer. My second case was more readily diagnosed. The vulvar lip, which was swollen and sclerotic, presented an old fistulous open- ing, from which small volumes of thick pus could be pressed out. Centripetally, a tuberculous gland, two to three inches in diameter, lay alongside the vagina. In addition, both supramammary glands were greatly enlarged, and at each internal inguinal ring glands three inches in diameter were palpable. Autopsy showed extensive generalized tubercu- losis. Tiiberadosis of the Female Genitalia 353 Vulvar tuberculosis is evidently a very dangerous type for the bull. In my second case, the cow had been bred only a few days before my examination to the herd bull, valued at more than ten thousand dollars. Fortunately he escaped infection. Tb Fig. 112 — Sagittal Section, of Fig. iir. Os^ Os uteri externum ; C, cervical canal ; Tb tubercles in lip of os uteri : A, A, tubercular abscesses. The importance of genital tuberculosis in cattle calls for much greater interest upon the part of the veterinarian. In dairies and pedigreed breeding herds, tubercular uterine catarrh is one of the most dangerous and repulsive types of tuberculosis. The search is generally limited to the tuber- culin test, which too often fails to detect the disease. The cow whose uterus is shown in Fig. 94 belonged in a small, 23 354 Diseases of the Genital Organs high-class Guernsey herd which had been tested semi-annu- ally for several years. This cow passed each test satisfac- torily. Each test revealed reactors, which upon slaughter showed recent lesions only. It was evident that lurking somewhere in the herd was a non-reacting spreader of a dangerous type. In making a survey of the genital organs of the herd, with reference to breeding, I designated this animal as the non-reacting spreader. When diseases of the genitalia occur, closing the breeding career of an animal, a definite diagnosis is of great im- portance. If tuberculosis is the probable or possible cause of sterility, but can not be clearly diagnosed clinically, slaughter without accurate post-mortem diagnosis is wholly unjustifiable. If a cow is sterile because of genital tuber- culosis, she has almost certainly seriously endangered the bull and other cattle. If a bull becomes disabled for coitus because of genital tuberculosis, it is not enough to send him to the shambles because he can no longer be used for breed- ing. Somewhere there is almost certainly a cow with geni- tal tuberculosis which transmitted the infection to him dur- ing coitus. She is liable to transmit the infection to another bull and is highly dangerous to other cows. The diagnosis of tuberculosis in the bull is therefore highly necessary for the control of the disease in contact animals. For this pur- pose post-mortem is as valuable as clinical diagnosis. The control of these dangers evidently depends chiefly upon the more general and accurate diagnosis of genital le- sions in both sexes and the more general adoption of efficient sex hygiene in breeding cattle. The lesions are to be de- tected through two chief agencies — dairy inspection and in- spection of the genitalia in connection with sterility. At present, dairy inspection fails utterly in most cases in rela- tion to genital disorders. Repeatedly I find, in regularly in- spected herds, and even in certified dairies, cows with quarts or gallons of fetid pus in the uterine cavity, large volumes of which are pressed out from time to time while the cows are lying down. Advancement in this field is one of the most urgently needed reforms in dairy inspection. Tuberculosis of the Female Genitalia 355 The greatest weapon for the control of the danger Hes in the more general inspection of the genitalia of cattle, as a safeguard against sterility and abortion. It is becoming more and more apparent that a careful physical examina- tion of the genitalia of cows, prior to breeding, is a wise precaution of distinct scientific and economic importance, and that the breeder should take far greater care in the sex hygiene of the bull. If penial injuries and infections are to be averted, having first ascertained that the genital organs of the cow are healthy, the external genitalia of both cow and bull should be carefully washed before permitting copu- lation. It is highly important, in the prevention of penial lesions, which may serve as infection avenues, that the crusts of pus in the vulvar tuft of hairs of the cow be re- moved by washing. Otherwise, these crusts of pus may be caught and forced into the vulvar opening, to abrade the penial mucosa. After copulation, the penis, prepuce, and sheath of the bull should again be carefully and efficiently douched. These precautions go hand in hand with those designed to control sterility and abortion. CHAPTER XIV THE GENERAL INFECTIONS OF THE GENITAL ORGANS OF CATTLE The mammalian genital tract opens freely upon the ex- terior, rendering it possible for any infection upon the ad- jacent body surface, capable of growing within the genital tract, to invade it, either actively or passively through the agency of a bearer (copulatory organs of the opposite sex during coitus, surgical instruments, hands of operator). Vastly more important, as far as at present known, is the transmission of important infections from the alimentary and pulmonary tracts, through the blood stream, to the geni- tal tract. Thence the infection is carried, in the female, back to the alimentary tract of the fetus. That is, as will be more fully discussed when considering fetal infections, if there is infection in the uterus of the pregnant female (which is the rule) it tends to penetrate the thin chorion and amnion and to be swallowed promptly by the fetus, along with the amniotic fluid. If the fetus has sufficient vigor, the bacteria are harmlessly included as a component part of the meconium, to be expelled soon after birth ; if dis- ease of the fetus occurs before birth, and the gastro-intes- tinal epithelium is destroyed or devitalized, infection ensues. The bacteria may then enter the blood stream, to be lodged later in the articulations (arthritis) but, since they were originally derived from the genital tract of the mother, tend logically to return to the genitalia. If the infections within the uterus of the pregnant cow commonly invade the ali- mentary tract of the fetus, it follows that subsequent to birth the same infections may be expelled from the diseased uterus, contaminate the milk, be swallowed by the calf, and cause disease having the same peril for it as if the infection had been swallowed prior to birth. Each year adds to the number of known species of micro- organisms capable of invading the genital tract of cattle and of other domestic animals and, according to the best The General hifecHons of the Genital Organs of Cattle 357 available evidence, capable of attaining such intensity as to interfere seriously with the reproductive functions. They may reside indefinitely in the genital tract without causing disaster but ready at any time, taking advantage of an in- jury to, or loss of vigor in, the area occupied, to cause seri- ous harm. Their method of injury, however, is less definite in character for each recognizable organism than the patho- logic processes described in the preceding sections. The vesicular venereal disease stands out definitely, by its symp- toms and clinical history of transmission, as a specific con- tagion. The nodular venereal disease offers a distinct and characteristic lesion, although its cause it not definitely de- termined and its importance is largely a matter of opinion. Actinomycosis and tuberculosis are fully recognized as spe- cific diseases causing genital injuries identical with well recognized lesions in other organs, each of which is due to a recognized species of organism. In the following section there will be discussed, as general infections, an extensive group of lesions due to, or believed to be due to, infection which far surpasses, in its peril to the reproductive organs, the four preceding diseases. Each may severally or jointly produce a variety of lesions, but no one lesion can with confidence be attributed clinically to any one organism. Several or many different bacteria or other organisms may cause ovaritis, salpingitis, metritis, or cervi- citis, and these lesions may prevent, interrupt, or imperil reproduction. Moreover, it is difficult or impossible to dif- ferentiate clinically between them. If salpingitis is present and diagnosable, it may be due to a streptococcus, a bacillus, or a micrococcus, or to a combination of the three, but the exact status can be determined only by a bacterial study of the diseased tube after its removal from the abdominal cav- ity. They will be discussed, therefore, as a group having a common tendency to cause an extensive list of pathologic changes with serious injury to the reproductive functions. The lesions produced by the infection — not the identity of the infecting agent — will constitute the basis for classifica- tion. 358 Diseases of the GeJiital Orga^is I. THE GENERAL INFECTIONS OF THE GENITAL ORGANS OF BULLS The diseases of the genital organs of bulls, as a factor in the problem of reproduction, have received scant attention from veterinarians. A belief had grown up and held the undivided attention of veterinarian, dairyman, and breeder, that the great and only important menace to reproduction in cattle was a specific infectious disease of the pregnant female, designated "contagious abortion." During the past few years that belief has been undergoing disintegration, until very few veterinarians now cling unreservedly to the tradition. There has been much unintelligent controversy over the part played by the bull in genital diseases of cattle, because consideration has been largely restricted to the question of the part played by the bull in transmitting to cows the bacillus discovered by Professor Bang, which was regarded as the specific cause of the abortions occurring in cattle. The attitude assumed was that the only infection of interest which, attacking the genital organs of a bull, might possess danger for a cow with which he might copulate was the B. abortus. If, therefore, a bull was not ejaculating with his semen the B. abortus, he was assumed to be virtually be- yond criticism from the standpoint of infection. The study of the semen of bulls and the bacteriology of the genital or- gans and of the semen, except for a few searches made for the B. abortus, have been of no consequence. Little or noth- ing was known of the diseases of the testicles, unless they became enormously enlarged or underwent abscessation. The subsidiary structures — the epididymis, vas deferens, vesiculae seminales, prostate and Cowper's glands — were ig- nored. These facts show the strangling grip so long held by "contagious abortion" upon the study of the infections of the genital organs. The time has arrived for a frank recognition by breeder and veterinarian that the bull is one-half the breeding herd, that the other half is valuless unless he is genitally sound, and that, speaking in percentages, he is probably as great an offender as the cow. In other words, probably as large a The Geyieral hifections of the Genital Organs of Cattle 359 proportion of bulls as of cows go to slaughter on account of sterility or low fertility. A general outline for the clinical examination of the geni- tal organs and the semen of bulls has been given in Chapter 11. It remains to describe more fully the examination of the semen in the course of genital diseases and to point out as far as possible the relation of changes in the semen, and especially in the spermatozoa, to clinical manifestations of genital disease. ^The technique which I have pursued in collecting and examining semen from bulls is as follows : The bull's sheath is first douched with 1/2 Per cent. Lugol's solution or 14 per cent, chlorazene. The cow's buttocks are thoroughly cleansed with a disinfectant and washed with a 1/2 per cent, chlorazene solution, and the vaginal mucus is removed manually. If a bacteriological examination of the semen is desired, the vagina should be thoroughly cleansed with a douche of I/2 per cent, chlorazene, which must be com- pletely removed several minutes before copulation. As only a slight trace of chlorine or other disinfectant will cause im- mobility of the sperm cell, it is desirable that cleansing of the parts for studying the motility of the spermatozoa be done with sterile v^ater or a normal saline solution. In either case, all possible vaginal mucus should be removed, just prior to service, with the well disinfected hand which has been washed with sterile water. The method is not en- tirely satisfactory from the bacteriological standpoint. Two sources of bacterial contamination must be considered : first, extraneous, and second, the vaginal flora. Contamina- tion from the first source may be largely prevented by care- fully cleansing the parts immediately prior to inserting the hand for the sample, but, owing to the almost constant fecal contamination of the vulva and the adjacent parts, it is well- nigh impossible wholly to prevent contamination during 1 The results of clinical examinations of bulls, with directions for the ex- amination of semen and spermatozoa from diseased or suspected bulls, are by W. W. Williams ; the micro-photographs of the preparations are by Professor B. F. Kingsbury. 360 Diseases of the Genital Orgayis coitus. The danger of contamination of the semen from the vaginal flora, although undoubtedly lessened by the above method, can not be said to be nullified. Some other technique may lessen the contamination from each source. Recently I have used a common sputum cup for the with- drawal of samples from the vagina. This method has con- siderable advantage in the prevention of contamination. An examination of the vaginal mucus taken prior to service may serve as a check on the vaginal flora. With careful disinfection, it seems that many samples may be taken free from fecal flora, as only a few give a growth of the colon group. If the sample is to undergo a bacteriological ex- amination, it should be placed in a sterile vial, cooled im- mediately, and cultured at the earliest possible date. Semen for clinical and histological examination must be placed in a warm vial, kept at a temperature ranging from 100° to 104° F., and examined under the microscope within thirty to forty-five minutes after sampling. First, the physical characters of the semen are noted, in- cluding the quantity, color, consistency, and coagulability. A drop of semen is then placed on a warm microscope slide and covered with a thin cover glass. Under a low-power lens, the relative abundance of the spermatozoa is noted. The semen is then placed under an oil immersion lens in order that the degree of motility and the percentage of cells which are motile may be observed. When possible, the length of time which the motility continues should be re- corded. I have observed motility as much as four hours after taking a sample, and it is probable that, in a specimen kept under proper conditions, the motility outside of the female genital tract continues even longer. Much of the cellular morphology can be determined by examining the fresh specimen under the oil immersion lens, and the rela- tionship between the non-motility and the morphological imperfection can be established. For the determination of the finer morphological details, a stained preparation is best. The film should be made from a strictly fresh sample of semen, fixed with heat, and The General hifedions of the GenHal Organs of Cattle 361 the mucus removed by placing it in a 0.5 per cent, chlora- zene solution for eight to ten minutes. The slide is then washed with clear water, to remove all traces of chlorine, and stained with carbol-fuchsin with heat for one to two minutes. The carbol-fuchsin is washed off with water. The film is stained for eight minutes with alkaline methy- lene blue. Then the methylene blue is washed off and the film is dried with filter paper. The head of the healthy cell should be brought out in clear detail. The neck granule, the cell membrane, and the nuclear membrane should stain very dark. The nucleus should stain slightly darker than the cytoplasm. If the counterstaining with methylene blue is continued only about five seconds, the nucleus remains bright red and the cytoplasm stains light blue, but the nu- clear membrane is left indistinct. The nucleus itself retains an alcoholic eosin stain better than carbol-fuchsin, but after the use of eosin it is difficult to counterstain so as to bring out the details. Recently, I have used acid stain consisting of alcohol two parts, carbol-fuchsin two parts and eosin one part. Staining is carried on one and one-half minutes, and the cells then counterstained with a fifty per cent. Loeffler's methylene blue for three to five seconds. By this method, an exceptionally clear detail is obtained. Various stains may be used, but eosin and carbol-fuchsin as acid stains and Loeffler's methylene blue as a basic stain have been found more satisfactory because their stability makes them better for field use than many of the aniline stains. Considerable experience is required for proficiency in the proper prepa- ration and interpretation of stained specimens. For fecundation it is necessary that a healthy sperm cell unite with the ovum. Ostensibly the spermatozoon, as is the case with other cells of the body, may undergo certain destructive or degenerative changes affecting its physiologi- cal function. This may occur during the process of sperma- togenesis, in which case the immature cells are eliminated, or degenerative changes may take place after the cells have reached maturity and while they lie in the seminiferous tu- bules or epididymis. If the sperm cell be arrested in de- 362 Diseases of the Genital Orgayis velopment, defective or weakened, either it loses its ability to unite with the egg, or, if union takes place, the fertilized ovum undergoes an early death or develops a constitution- ally weak embryo. Thus Adami and Nicholas state : "What is true regarding infectious diseases must to some extent hold also regarding chronic intoxications of various orders. The results of constitutional disease in either parent may be the following, according, on the one hand, to the ex- tent of the influence of the disease, or intoxication, upon the germ plasm of that parent, and on the other, to the ac- tivity or potency of the germinal matter contributed by the other parent : 1. Sterility. The germ cells being so profoundly modi- fied that either (a) they are destroyed, (b) their develop- ment is arrested, or, (c) being developed (ova or sperma- tozoa) , are imperfect and incapable of fusing with the germ cells of the other parent. 2. Imperfect development of offspring, (a) Of such ex- tent as to lead to intra-uterine death and abortion; (b) of less extent, a viable individual being produced presenting either — (1) Gross anatomical defects. (2) No gross anatomical defects, but lowered vitality, presenting itself either in the form of weakened powers of resistance against disease in general, or ( ?) proneness to develop the same disease as the parent." The spermatozoa which I have studied are frequently characterized by definite morphological changes in the cells. In order to understand fully these changes, it is essential that the normal spermatozoon shall be known and the eye trained to differentiate between the normal and the ab- normal. The cell is divided into four main parts — head, neck, body and tail. The head, oval in contour, is encompassed by a thin line, the cell membrane, which takes an acid stain more deeply than other portions. The head is divided into two portions — the cytoplasmic and nuclear elements — by a semi-ellipti- The General Infections of the Getiital Organs of Cattle 363 cal line, the nuclear membrane. The nucleus, of full oval contour except at its base, occupies normally a little more than one-third of the basal area of the head. Its sides con- form to the general contour of the cell membrane. The chromasomic material does not occur in this cell as definite granules, but is disseminated throughout the nucleus. The nuclear element in a healthy cell takes a basic stain, and when stained with methylene blue appears very slightly granular and darker than the cytoplasmic portion. The cytoplasmic portion of the head, anteriorly and later- ally, corresponds in contour with the general oval outline of the cell membrane. Caudally, it lies against the nucleus, whose convex face is directed into the base of the cytoplasm, forming a shallow cup or fovea in the latter. The cytoplasm of the head takes carbol-fuchsin very faintly, which, when counterstained with methylene blue, is entirely replaced by the latter. The neck parts in the bovine spermatozoon are very small and not defined except under a very high magnification. In the human spermatozoon two neck granules are described. In spermatogenesis they arise from a single granule, which in the last stages of development divides. One granule passes to the caudal end of the neck and remains there in close relation to the connecting piece or body ; the other granule passes to the anterior end to become fused with the base of the head. If such separation of the neck granules occurs in the bovine spermatozoon, it is not brought out by my present method of staining. The neck granule appears as a single bar, fused to the base of the head. Apparently there is a slight concavity at the base, into which the neck is inserted, obscuring most of it from view. The granule, fused into this concavity, appears therefore to be located within the nuclear material; this is undoubtedly never the case. Aside from this granule, the neck remains unstained under the methods which I have employed. By the embryologist it is held that, when fecundation takes place, the sperm head enters the cell membrane of the ovum. The sperm then loses its tail, which separates be- 364 Diseases of the Genital Organs tween the neck and connecting piece. It appears then that the head, which has up to now faced the center of the cell, becomes reversed and faces the cell wall. From the neck granules, which migrate toward the center of the cell, are formed the centrasomes, or polar bodies, which play such an important part in the mitotic process. It is quite clear that an arrest in the development of the centrosmic precursor may be a potent cause of sterility. Judging from some stained preparations on hand, it appears quite certain that this arrest in development occurs to a greater or less degree. The hody, cylindrical in form, about one and one-third times the length of the head, takes readily either acid or basic stain, and reveals in the properly stained preparation a spiral filament encircling its entire length. The body is succeeded by the tail, of slightly smaller diameter and about four times as long. The tail, tapering posteriorly, ends as a very fine filament. As the body and tail function only in a locomotive capacity, I shall not deal further with them, but shall study the pathologic changes in the heads of various samples of spermatozoa, and the accompanying gross anato- mical and functional changes in the genital apparatus of the bull. Bull U, Figs. 113, 114. Eleven years old. For three years was used as sire in a herd of about one hundred mature fe- males. Served sixty-three cows, with two hundred and fifty-one copulations, seventy-five (29.8 per cent.) of which resulted in conception. In 1916, ten cows were served, of which twenty per cent, failed to conceive and twenty-five per cent, of those conceiving aborted. In 1917, thirty-six cows were bred, of which 11.1 per cent, failed to conceive and 21.95 per cent, of those conceiving aborted. In 1918, forty cows were bred, of which 35.6 per cent, failed to con- ceive and 27 per cent, of those conceiving aborted. In 1919, thirty-eight cows were bred, of which 79 per cent, failed to conceive and 40 per cent, of those conceiving aborted. After about three or four months in the herd, the bull's fertility became lessened. Since May 1, 1919, he has been 1 he General Infections of the Genital Organs of Cattle 365 used frequently, with no conceptions. The sudden sterility of about 75 per cent, of the herd had been thought to be due wholly to the condition of the cows. A large proportion of the cows (36.5 per cent, of those served) showed macro- scopic pathologic changes, especially cervicitis, but only in a few cases of sufficient severity to account for sterility on such a large scale. Fig. 113 — Spermatozoa from Bull No. 4. Number comparatively low. Cells nou-motile when ejaculated. Many Tailless Spermatozoa. On Dec. 5, physical examination revealed a severe balano- posthitis and testicles slightly atrophied, with slightly di- minished tone. Coitus was normal. About 7 mils, of semen were obtained, which was very viscid, of a light straw color, and more translucent than normal. The spermatozoa were non-motile. About fifty per cent, of the normal number were present. In fresh specimens, many spermatozoa lay upon their sides, giving the appear- ance of extremely narrow heads. In stained preparations 366 Diseases of the Genital Orgayis many detached tails were present. The head stained as a homogeneous mass instead of showing its component parts as in the healthy cell. In this specimen of spermatozoa there appeared to be a total absence of the nuclear mem- brane, and in many cells the upper granules were missing. There was an almost total disintegration or arrest in devel- opment of the integral cellular elements — the nucleus and Fig. 114 — Spermatozoa obtained from Bull No. 4. Taken 25 days after those shown in Fig. 113, during which period the bull had complete sexual rest. Spermatozoa were still non-motile, but showed better staining qualities. neck granule. On Dec. 5th, 1919, this bull was ordered withdrawn from service. On Dec. 30th, after twenty-five days of complete sexual rest, another sample (Fig. 114) was obtained, which showed a remarkable improvement in the staining qualities. The cell was not normal, though the head stained much bet- ter. The connecting piece appeared enlarged and was con- torted by the presence of a much enlarged spiral filament. The General Infections of the Genital Organs of Cattle 367 Ordinarily the filament is so small that special staining is required to show it. The nuclear portions of the heads were uniformly undersized. It was ordered that this bull should have complete sexual rest until further study should deter- mine a more normal condition of the semen and sperma- tozoa. Jan. 29, 1920. Motility still absent and fewer spermato- FiG. 115 — Spermatozoa from Bull No. 5. Spermatozoa motile, but heads abnormally narrow and nuclei very small. zoa. About fifty per cent, of the spermatozoa were tailless. Many of the heads had a very narrow tapering basal por- tion, running to a point at its juncture with the neck. The nuclear portion was generally differentiated, but not as dis- tinct as normal. The neck granules were very small and generally imperceptible. Mar. 6, 1920. Physical examination revealed no changes. Twenty mils, of semen were obtained, containing considera- ble vaginal mucus. The semen was very viscid, and at first 368 Diseases of the Genital Organs slightly turbid. Firm coagulum formed within thirty min- utes. The sperm cells were decreased in numbers and non- motile. There was a slight microcephalia and many loos- ened heads throughout the sample. April 5, 1920. Physical examination revealed no new macroscopic changes. About twenty mils, of turbid, semi- translucent semen were obtained, containing considerable r 1 ? .^ . J' Vf Fig. 1 1 6— Spermatozoa from Bull No. 7. Many with small heads and atrophic nucleus. epithelial debris. A firm coagulum appeared almost imme- diately after obtained, leaving the main part of the mucus colorless and translucent. Sperm cells, entirely non-motile, were present in numbers not to exceed twenty-five to fifty per cent, of normal. Fifty per cent, of the spermatozoa were without tails. Almost all were microcephalic, espe- cially those which were tailless. In these there was a very marked diminution in size and uniform tapering of the basal portion of the head. In most heads the nuclear por- The General Infections of the Genital Organs of Cattle 369 tion was clearly defined. The neck granule was either ab- sent or very small and stained faintly. Bull 5, Fig. 115. Eighteen months old. Served twelve cows, with but one conception. The seminal vesicles ap- peared slightly arrested in development and the left gland was inflamed. Four to seven mils, of seminal fluid were ob- tained, containing motile atypical spermatozoa. The head Fni. 117. Spermatozoa from Bull No. 8. Cells show degeneration, as indicated by want of definition of the nucleus. Some cells are abnormally large. was narrower than normal and the nucleus constricted, causing a marked decrease, not only in the breadth, but in the total volume of the cell. The component parts were clear in detail, but arrested in development. Streptococcus viri- dans and staphylococcus albus and aureus appeared in cul- ture from this sample. Bull 1. Imported. About five years old. Served seven heifers, one or two of them twice, with no conceptions. All seven conceived from first service by another bull. 24 370 Diseases of the Genital Orgayis Examination revealed granular balanitis. On the left side there was orchitis, epididymitis, and spermatocystitis. Both vesicles were enlarged. So far I have been unable to get a sample of semen from this bull. More recently fluid of lymph-like consistency has been palpated in the left seminal vesicle. (See Figs. 86, 126, 127.) Bull 7 , Fig. 116. Out of a total of sixty-three cows served in the past three years, there have been forty (66 per cent.) conceptions, nine (22.5 per cent.) of which have resulted in abortion. This bull is not the chief sire of the herd. Al- most all repetitions of service in the herd are with cows on which this bull has been used. Only two abortions have oc- curred amongst cows bred to other bulls. Cows bred to other bulls have almost invariably conceived at first service, but repetitions are frequent with Bull 7. The vitality of his progeny is generally below normal. Physical examination showed all genital parts apparently normal. Coitus was normal. Ten mils, of macroscopically normal semen were obtained. Smears showed cocci which failed to grow in cultures. There were also present large Gram positive rods. Paracolon bacilli were obtained on culture. Motility of spermatozoa normal. The heads were slightly smaller than normal, with a very evident arrest in development, affecting principally the nucleus and causing many of them to appear pear-shaped. Bull 8, Fig. 117. Two-year-old. Since first used, June 15, 1919, has shown poor fertility. Has served twenty-seven cows, with thirty-six copulations. ThiS' -resulted in six (23.2 per cent, of cows bred, 16.7 per cent, of copulations) conceptions, none of which has terminated. Physical ex- amination revealed a slight granular balanitis and small vesiculae seminalesy- which were apparently slightly ar- rested in development. Three to five mils, (which is less than normal yield) of normal-appearing semen were ob- tained on two occasions. Degeneration of the cell was in- dicated by a lack of definition between the cytoplasmic and nuclear elements. In some cells, the nuclear membrane presented a concavity instead of the normal convexity pro- The General Infectio7is of the Genital Organs of Cattle 2>7i jecting into the cytoplasmic portion. Many of the cells ap- peared about normal. Some of the cells were too large ; they might be termed megalocephalic. Bull 9, Fig. 118. Seven-year-old. Has served twenty- seven cows — twenty-nine recorded copulations with eight (29.6' per cent.) conceptions resulting. Physical examina- tion revealed bilateral seminal vesiculitis. Ten to twelve mils, of semen of normal appearance were obtained. It con- tained numerous short-chained streptococci on smear. The spermatozoa, all parts of which showed in clear detail, were apparently normal. Fig. ii8 — Spermatozoa from Bull No. 9. Cells apparently normal, but semen contained short streptococci. Bull 10. Three-year-old. Has been in present herd two and one-half years. Total number of cows served, fifty, with ninety-one copulations resulting in thirty-four concep- tions in twenty-nine cows (two conceptions each in five cows) , of which six aborted. Since October 22, 1919, there have been eleven copulations with eight cows, and no concep- 372 Diseases of the Genital Organs tions. Twenty-one of the cows (42 per cent.) served did not conceive. Examination of cows revealed little cause for sterility. Examination of bull revealed presence of seminal vesiculitis on left side. Organs and erection normal but, owing to the custom of placing cows for service with their hind parts raised, half an hour to an hour was often re- quired to serve a cow, leading to an increased strain on the genital apparatus, which may have been a potent factor in Fig. 119. — Spermatozoa from Bull No. 11. Cell heads stained poorly, because the nuclear membrane was imperfect. the production of the spermato-cystitis and decreased fer- tility. Owing to unfavorable conditions for coitus, I was unable to get a sample of semen. Bull 11, Fig. 119. Four-year-old. Has served sixty -two cows, with a total of one hundred and seven copulations, resulting in twenty-nine conceptions and eleven (37.9 per cent.) abortions. From the first his fertility has been low. Twenty-eight cows served by this bull (45.1 per cent.) sub- sequently conceived from service by another bull. The General Infections of the Gemtal Organs of Cattle 373 Examination revealed bilateral spermatocystitis, with other portions of the genital apparatus normal. Organs excellent but copulation interfered with by considerable pain on erection, evidently due to the sensitiveness of the seminal vesicles. About ten mils, of apparently normal semen were obtained, containing sperm cells of low motility. Firm coagulum appeared within a few minutes. The head parts did not stain well. The nucleus stained poorly. The nuclear membrane was not well defined. The inefficiency of Bull 11 was so marked, especially in contrast to other sires used in the herd, that his slaughter was found advisable. Laboratory examination of the or- gans, including testicles, epididymes and seminal vesicles, revealed no macroscopical lesions. Cultures and smears from these organs were negative. The sterility appeared entirely referable to the changes occurring in the germinal cells. The infection in the female was probably not specific, but merely the result of lowered resistance or a predisposi- tion on the part of the embryo to those organisms of low vitality which ordinarily inhabit the female genital tract. Sterility of the bull may be directly due to conditions af- fecting his general health, but is more frequently referable to demonstrable pathologic conditions occurring either in the germinal cells or in the glandular structures of the geni- tal system. These changes may or may not be accompanied by recognizable infection. The diversity of the bacteriologi- cal findings of the genital glands and of the semen do not clearly indicate the presence of a specific type of infection. A streptococcus of the viridans type is most frequently found. In the female genital organs of one herd which has been subjected to numerous bacteriological studies, appar- ently this organism predominates. In this herd the ovi- ducts are most seriously involved. This usually follows cervicitis which yields to treatment, while the tubal disease defies all efforts at control. The bull is apparently an im- portant, if not the chief factor in bringing about these con- ditions. It is common to find morphological changes in the sperma- ^.*rN \,„v- 274 '"•'^-' J "'''''Mhe(^6is'of''the Genital Orgaiis tozoa. These occur mainly as abnormal development or ar- rest in development. Quite frequently I have seen extremely large spermatozoan heads (megalocephalia) which so far as determined are otherwise normal. Abnormally small heads appear with much greater frequency.^ - Morphological altera- tion in any considerable proportion of the spermatozoa defi- nitely decreases the .procreative capacity of the bull. The germinal cell may also be of low vitality without showing morphological deviations. It is a well demonstrated fact that the vitality of some bulls is so lowered that a healthy vigorous calf is rarely produced. The cause for this may be an inherent weakness, the devitalizing effect of a general constitutional disturbance, or a local inflammation of the germinal epithelium. My studies of numerous herd sires bring out many in- teresting problems. Since it has become my regular prac- tice to examine the semen of bulls in herds where there is a high rate of abortion, I have been interested to find that the spermatozoa almost always show marked pathologic changes. I have not as yet been able to correlate such changes with any specific infection. From results thus far obtained, it appears unsafe to conclude that abortions oc- curring in a herd are due to a specific disease of the female, chiefly or alone, if the sire is not first subjected to a thor- ough examination. Although it has been impossible to work out all data on bulls examined up to the present time, the results so far in- dicate : (1) that sterility of varying degrees in bulls is very com- mon, '(2) that such sterility is associated commonly either with an arrest in the development of the sperm cell or with dis- integration after reaching maturity, (3) that, as the sterility is accompanied, in a large pro'- portion of the cases so far studied, by spermato-cystitis, with no atrophic orchitis, it appears that the destruction or devitalization of the spermatozoa is due to the toxic sub- stances derived from bacterial infection. Degen era five Orch itis of Calves 375 (4) that such infection is present, not only in the semi- nal vesicles, but also in the seminiferous tubules and epidi- dymes, (5) that the determination of the motility of spermato- zoa does not constitute a reliable standard for the measure- ment of their vitality and powers of fecundation, (6) that some outbreaks at least of the so-called contag- ious abortion are entirely referable to a lessened vitality of the spermatozoa. A. Orchitis 1. Degenerative Orchitis of Calves. Destruction of Spermatogenetic Epithelium in Calves. Arrest IN Development of Scrotal Testes. Desquamative Orchitis There occur not infrequently cases of absolute sterility in young bulls, which reveals itself immediately when the ani- mal is put into service. The general condition of the bull may be beyond criticism. He is distinctly masculine in his head, neck, and voice and shows normal sexual desire. He copulates comparatively promptly but, observed closely, is seen to ejaculate slowly and in a manner to raise doubt. After copulation, little or no semen can be recovered from the vagina. Microscopic search shows the total absence of spermatozoa. Clinical examination of the testicles shows them to be small and flaccid. The two glands are symmetrical and one- fourth to three-fourths the normal volume. Histologically, the epithelium of the tubuli seminiferi has disintegrated and the tubuli contain detritis. Spermatozoa are absent. Ordinarily there remains but a single epithelial layer on the basement membrane of the tubule. A few im- perfect spermatozoa or spermatoids may be present in the cellular debris in the lumen of the tubules. The tubules of the epididymis participate in the epithelial destruction. The degenerative changes are evidently of bacterial ori- gin, but the form of bacteria has not been studied. The de- structive changes appear to be quite analogous to those oc- curring in the oviducts, in which streptococci of the veri- 2^6 Diseases of the Genital Organs dans type predominate. The B. abortus of Bang is not known to participate in the destruction. The clinical diagnosis appears to be simple and clear, but the subject deserves further study. When discussing "Ar- rests in Development of Scrotal Testes," I have referred to Fig. 121 — Degenerative, or Desquamative Orchitis in Young- Bull. ^, Normal testis of bull ; B, degenerative testis of sterile bull ; /, testis; 2, head of epididymis ; j, body of epididymis ; 7, globus minor. the clinical characters here described. The glands have much the consistency of cryptorchid testicles, in which the arrest in development is assumed to be purely embryologic, unassociated with infection. Possibly such arrests occur in scrotal testes without infection, but this is improbable. Degenerative Orchitis of Calves 377 Cryptorchid testicles based upon embryologic arrest are al- most invariably much smaller in volume than in the condi- tion under discussion. It appears highly probable that in all, or virtually all scrotal testicles of the type described the changes are referable to bacterial invasion. The period of invasion appears to be that of the nursery. At least the era of invasion precedes puberty, so that from the first copula- FiG. 122— Degenerative (Atrophic) Orchitis in Young- Bull. /, Normal testis ; 2, atrophic degenerate testes ; j, body of atrophic gland ; 4, head and, j, tail of epididymis ; (5, scrotal peritoneum turned back, showing adhesions to testicular peritoneum. tion the animal is absolutely unfertile. The invasion may be intra-uterine, but this appears doubtful. The bacterial invasion of living bovine fetuses is commonly restricted, so far as determined, to the alimentary tract. Perhaps it v^ould be more accurate to term the presence of bacteria in the fetal alimentary canal as bacterial "inclusion" rather than "invasion." That is, the bacteria from the utero- chorionic cavity of the cow invade the amniotic fluid by 378 Diseases of the Genital Organs penetrating the chorion and are then swallowed by the em- bryo in the constant physiologic process by which the fetus swallows its amniotic fluid. When the ingested amniotic fluid is absorbed, the contained bacteria, with cellular de- bris, remains as a filtrate to constitute the meconium. Nor- mally the bacteria, once imprisoned in the meconium, re- main so permanently and are expelled as a component part of it by the new-bor^n -calf . Aborts, which commonly suf- fer from dysentery prior to their death and expulsion, are subject to general bacterial invasion. The heart blood of the fetus may contain the same bacteria as the utero-chori- onic space of the mother. This also appears to be true at times of prematurely born calves or of very sick calves born at the completion of the normal duration of pregnancy, but these ordinarily succumb to disease (calf sepsis, calf scours, calf pneumonia) . The infection probably occurs most fre- quently soon after birth, while the digestive or respiratory epithelium is damaged or destroyed as a result of dysentery or pneumonia, or in the presence of a lesser degree of diges- tive or pulmonary disturbance. The condition presents an interesting problem in the ethics of the sale of pedigreed bull calves for breeding pur- poses. I have not known a breeder to recognize the defect prior to sale and believe that he would not ordinarily see it until his attention is attracted to the condition by the ster- ility. The sale of such animals is, therefore, usually honor- able. When the bull fails to breed and the disease is recog- nized, the breeder is usually equally honorable in making prompt retribution. In one instance, however, where a young bull was sold at a very high, perhaps exorbitant price, the seller refused to make restitution. The case was brought into court. There was no written warranty, but the statutes of the state where the sale was made hold that the purpose for which an article is sold carries with it an implied warranty of fitness for the use for which the article is purchased. The contention of the defendant was that the shipment of the bull from the Atlantic to the Pacific Coast in a common box-car had caused a degeneration of the tes- .Orchitis in Adiilt Bulls . 379 tides as a result of the vibration of the car. He supported the plea by the evidence of numerous veterinarians with such success as to cause a mis-trial of the case. The condition, once established, is evidently beyond rem- edy. If my view of its origin is correct, it can generally, if not always, be prevented by the proper handling of young calves. 2. Orchitis in Adult Bulls I have not observed, and have not found described in adult bulls a degenerative orchitis with desquamation of the spermatogenetic epithelium with flaccidity of the testicle, as described above in bull calves. This is probably, if not certainly, due to the absence of careful study. It would be difficult to assume that bacteria causing the destruction of the spermatogenetic cells in calves may not also invade and cause similar injury to the adult testicles. There would be differences, however, in the results from the invasions at two separate epochs. Doubtless there is a difference of re- sistance. The essentials are that there shall be a type of organism which may invade the tubuli seminiferi and cause a slow disintegration of their lining cells without arousing the classic signs of inflammation, "heat, pain, redness and swelling," and impotent to cause abscessation or total ne- crosis. Clinical data are at hand which warrant the tentative conclusion that such degenerative or desquamative orchitis exists frequently and is serious. Some bulls demonstrate moderate fertility at the commencement of their breeding career, but show upon close study a slowly advancing, in- sidious sterility. At first the difficulty is ascribed to the cows. The bull appears well, has normal sexual desire, and copulates eagerly. In large herds where several sires are kept, a comparative study of his breeding shows him to be less fertile than other bulls under analogous conditions. Further study reveals the fact that his pregnancies are less secure, so that, while the general rate of observed expulsion of fetal cadavers is, for example, 10 per cent., his rate is 20 380 Diseases of the Genital Organs or 25 per cent. In many cases the fertility appears inter- mittent. For a brief period all copulations fail; then follows a period of fair fertility. If the semen is examined, inter- esting changes are found in the spermatozoa. In this inadequately studied field, the best that can at present be done is to study the spermatozoa, their degree of Fig. 123 — Purulent Periorchitis (Empyema of Scrotum) with Necrosis and Atrophy of Testes. /, Vestige of testis sectioned, showing ou the right remnant of paren- chyma ; 2, epididj'inis ; j, vas deferens ; 4, scrotal wall turned back. On the right of the right-hand figure the broad white streak between 2 and 4 is a deep incision made to keep specimen open. the sperm heads. If spermatozoa are abundant but all dead, the tubuli seminiferi must be comparatively sounds and death has occurred somewhere in the excretory appara- motility, the frequency of the separation of heads and bodies, and the staining characteristics, size, and form of tus. If the spermatozoa are scant and marked disintegra- tion has occurred, it would appear that the damage may Orchitis in Adult Bulls 381 O tn ca o • s a « ?! .. - tn pq UJ X ™ o g Si « «§«^ 2 "^ '-5 *S to ." t* (U I'S ^-^ ° ~a •5 s' 382 Diseases of the Genital Orgajis have taken place within the tubuli seminiferi. If no sper- matozoa are present in the semen, it follows that the excre- tory ducts are blocked or that the spermatogenetic epithe- lial cells are destroyed. So far as known, the blocking of the excretory ducts, as in cases of epididymitis or epididy- mal abscess, is recognizable upon physical examination. Severe orchitis, not common in bulls, ordinarily termi- nates in abscessation. Very rarely it appears as an en- zootic. Wallraff (Repertorium der Tierheilkunde, 1846, p. 219) records an outbreak of purulent orchitis in horses, cattle and goats. The disease had existed in his locality, in Freu- denstadt for a number of years. At least it was known in 1832, fourteen years prior to the date of his contribution. For a year prior to his report, the disease had been very common and caused a very considerable loss among breed- ing bulls. It involved animals of all ages, attacking many calves when only 10 to 20 days old. The disease began with light fever and loss of appetite. The animals stamped their hind feet as if afflicted with colic. Presently the testicles became more or less swollen, the scrotum red, hot, and painful upon manipulation. This condition continued from three to five days. Then, upon one or both sides of the scro- tum, a small opening appeared, from which at first a stink- ing discharge, mixed with blood, escaped. After one or two days this discharge was superseded by ordinary pus. This continued for five to fourteen days, until the testicle was wholly destroyed. Wallraff uniformly observed the swell- ing and suppuration in the left testicle first. As a general rule, after one testicle was destroyed, the other also under- went destruction later, though in some cases one of the tes- ticles escaped. The disease had little danger for the life of the animal. After the destruction of the testicle, the animal recovered without any very great enlargement of the scrotum. In one case, when the abscess in the testicle ruptured, the bull almost bled to death. Wallraff failed to recognize the cause. For a time he thought it was hereditary, and con- Orchitis in Adult Bulls 383 tinued to believe that it might be so. However, he found that sound males introduced from other sections, where the disease was unknown, contracted the malady, and conse- quently felt that there must be a local infection of some kind. While there seemed to be no great danger to the life of the patient, there was very serious loss in condition and also, in all or nearly all the cases, the breeding life of the animal was brought to a close. Consequently, as a rule, when the disease was observed early, the animal was sent to the butcher as the most economic course. Once the disease was established, castration apparently proved the most direct method of handling. There is no very clear line of demarcation clinically be- tween orchitis and epididymitis. The symptoms are funda- mentally alike. The tumefaction of one structure quickly encroaches upon the other and the two organs blend. Com- monly also the disease processes in orchitis and epididymitis blend, so that one is rarely present without the other. Orchitis ordinarily reveals itself by a more or less pro- nounced swelling of the testicle. As a general rule, the dis- ease is unilateral in the bull, there being no commonly known acute systemic infection which tends to involve simultane- ously both the glands, as observed in the infectious cellulitis of horses. When orchitis, due to infection, causes definite changes in the gland itself, they usually occur very promptly, with much swelling and pain. As a rule, there is loss of ap- petite with elevation of temperature. The very firm envel- ope or tunic of the testicle renders any inflammation of the gland excessively painful. At the same time it prevents prompt relief by free swelling and tends to cause destruction of the tissues as a consequence of blood stasis from com- pression. A common result of orchitis in the bull is the formation of an abscess in which the entire gland, along with the epididymis, undergoes necrosis and purulent destruction. In the one instance of abscessation of the testicle of the bull in the college collection, the abscess has attained a diameter 384 Diseases of the Genital Orgajis of about ten inches. The capsule of the abscess, shown in Fig, 124, consists chiefly of the cremaster muscle and its fascia. The testicle and epididymis have almost completely disappeared, though faint traces of the necrotic gland are found embedded within the pus. A few bands of connective tissue pass across the abscess cavity from wall to wall. The biology of orchitis in bulls has not been determined. Erhardt (Schweizer Archiv. fiir Tierheilkunde, Vol. 38, p. 79) records a case of orchitis in a bull due to the vesicular venereal disease of cattle. Other writers also attribute cases of purulent orchitis in the bull to the granular venereal dis- ease, but this view is difficult of verification because the biology of the malady is unknown. So far as known, the B. abortus of Bang plays little or no part in the causation of orchitis. Necessarily the prognosis of orchitis is highly unfavora- ble. As a general rule, when the infection is so severe as to cause definite clinical symptoms, the organ does not re- cover its physiologic function. The danger to the life of the animal is not great. The treatment of orchitis has not been definitely formu- lated. Theoretically there might be some justification in local applications intended to lessen the inflammation, such as ice-packs or the application of cold water, along with support by means of a suspensorium. Practically I have not known this plan to accomplish any good and I doubt very greatly its efficiency. If, however, one has reason to believe that the orchitis is due to traumatism, the local treatment should be applied and should promise well. I am not certain how frequently traumatic orchitis occurs in do- mestic animals. Many writers give it a prominent place, though upon what ground is not perfectly clear. Gmelin (Handbuch der Tierarztlichen Chir. u. Geburtshilfe, Bayer und Frohner, p. 432) states that the commonest cause of orchitis is traumatism, but I have not seen this in any do- mestic animal save in one case of gunshot wound. As a general rule, as stated above, the functional life of the gland is at an end. Whenever this may be assumed, the Degenerative Epididymitis of Calves 385 most direct and radical method of handling is castration. When only one gland is involved, its removal does not inter- fere with the animal's fertility and affords the best and promptest remedy that we possess. In castrating such an animal it is to be remembered that the gland is generally adherent to the parietal peritoneum of the scrotum and, thl-ough it, to the cremaster and its fascia. Therefore it is more convenient, as well as less dangerous, to castrate by the covered operation. In this operation the skin and dartos are freely incised at the lowest part of the scrotum and a separation made with the handle of the scalpel, or with the fingers, between the dartos and the cremasteric fascia up to the inguinal canal. A ligature is then applied to the spermatic cord covered by the cremaster muscle, and the testicle, with its coverings, cut away an inch or two beyond the point of ligation. The ligature should preferably be of heavy chromatized catgut with a durability of about twenty days. B. Epididymitis 1. Degenerative Epididymitis of Calves. Arrest in Development In the preceding article upon degenerative orchitis in calves, it has been mentioned that, when that disease occurs, the epididymis ordinarily participates in the pathologic changes. From what I have been able to observe, the epi- didymitis is probably the more important and primary lesion. There are no outstanding clinical symptoms beyond those already described under orchitis. So far as has been ob- served, the calf as a nursling presents no symptoms which attract any attention. This may be due to the fact that, since the testicles of calves are not observed, changes which are perfectly visible may occur without being noted. When the calf comes to breeding age, he is found to be sterile and when examined critically, as already stated under orchitis, the testicles, with the epididymes, are found to be small and 25 386 Diseases of the Genital Organs soft. So far as known, the disease is always bilateral and apparently dates back to infection during the nursing pe- riod, as described under orchitis. The condition, which is beyond remedy, can be prevented only by the protection of the young calf against the inroads of infection. This will be more fully discussed under the infections of new-born calves. 2. Chronic Indurated Epididymal Abscesses of Calves I have observed one instance, in a young bull of poten- tially great value, a long-standing, indurated abscess in the globus minor of each epididymis. The bull, well developed in all respects, was very vigorous and copulated freely, but was absolutely sterile from the beginning. Physical exam- ination revealed a hard enlargement, one inch or more in diameter, in the globus minor of each testicle. Tuberculosis of the epididymis was suspected, but he failed to react to the tuberculin test. One of the glands was then removed for examination. The epididymis was found to contain a small abscess with indurated walls, which had something of the appearance of a tubercular abscess but was without calcification, and no tubercle bacilli could be found. Later the bull was slaughtered and the other testicle was found to be essentially identical. The diagnosis of chronic indurated abscess of the epidid- ymis is comparatively simple. So far as we know, the ab- scess is most liable to occur in the globus minor, which in the bull projects beyond the lower end of the testicles on its posterior surface, where it is very readily palpated. If any doubt arises on the part of an inexperienced examiner, the comparison of the diseased epididymis with that of a healthy animal at once reveals the great departure from physiologic condition. Both the enlargement and the hardness are well marked and not readily mistaken for anything else. Should the abscesses occur at other points in the epididymis, they are quickly recognized by the same general symptoms. The head of the epididymis is readily palpated except for the covering of the cremaster, as shown in Fig. 2 on page 5. Chronic Indurated Epididynial Abscesses of Calves 387 The body of the epididymis is not so easily palpated, as in- dicated in Figures 3 and 4 on pages 7 and 8. If there is any material enlargement, however, it should be detected with- out great difficulty. When the gland has revolved outward, as shown in the right testicle of Fig. 4, it is brought more readily into view and can be more definitely palpated. Fig. 125 — Chronic Abscessation of Epididymis in Young- Bull. A, Normal testicle from sound bull ; /?. diseased testicle. /, Testicle ; 2, body of epididymis ; j, tail of epididymis greatly enlarged in diseased gland ; j', section through epididymis, showing pus in the epididynial tubes ; ./, portion of scrotal wall thrown back showing adhesive bands. The condition described above appears to be closely re- lated to the degenerative epididymitis already spoken of. It appears quite evident that the abscessation occurred during the nursery period, so that it was well established before the bull had reached breeding age. Schroeder' records an in- stance of abscessation of the epididymis in which the B. ^ Some Facts about Abortion Disease, Jour, of Ag. Research, Vol 9, 19 17, P- 15- 388 Diseases of the Genital Organs abortus was recognized. He does not state, however, that no other organisms were present. He reaches the conclu- sion that the B. abortus was the cause of the abscess. This is not very clear. It has not been definitely shown that the B. abortus of Bang is pyogenic when injected into the tis- sues. We do know, however, that it is associated with sup- puration in the uterine cavity. Whatever may be the biology of the disease, the prognosis is hopeless. Fig. J26 — Orchitis and Epididymitis. Bull. A, Left testis ; B, normal left testis for comparison ; C, Right testis. /, Globus major of epididymis, greatly enlarged and adherent to testis ; J, 4, tail of epididymis ; 5, 6, 7, normal globus major, body and globus minor of epididymis respectively; S, inflamed globus major; 9, parietal scrotal peritoneum adherent to testicle, incised and turned back. 3. Epididymitis of Adult Bulls Epididymitis develops occasionally in adult bulls which have a history of normal fertility over a somewhat ex- Spermato- Cystitis 389 tended period. Then without cause there develops, gener- ally very gradually, an increasing degree of infertility. An increasingly large percentage of the cows which he serves fail to conceive. The bull may be apparently vigorous, both physically and sexually, or there may be hesitancy or diffi- culty in coitus. It is not known, however, that the epidid- ymitis causes this hesitancy or difficulty, which may be due, so far as is now known, to other lesions existing at the same time. If the semen of such a bull is examined, the sperma- tozoa are found largely or wholly dead. Upon physical ex- amination, one or both epididymes are found to be swollen and tender. As in the indurated abscess of the epididymis in the young animal, so in the adult bull, the inflammation is largely concentrated in the globus minor. The swelling is hard and painful to the touch. The cause of such epidid- ymitis is unknown, beyond the fact that it is evidently due to infection. No studies have been made regarding the character of the infection. It probably differs greatly in different individuals. It is not generally pyogenic, so far as yet determined. So far as known, there is no hope for recovery and noth- ing to advise in the way of treatment. It is barely possible that in some cases one might achieve results by the removal of the diseased gland. However, there is the constant dan- ger that the other gland is similarly, although not palpably infected, in which case the removal of one gland would be of no avail. In other cases I have found clinically that the seminal vesicle was at the same time similarly inflamed, so that no good could be expected from removing the diseased epididymis and testicle while the diseased seminal vesicle was allowed to remain. The only hope, therefore, in remov- ing the one gland is that the opposite gland is sound and that there is no disease of the seminal vesicle or other glands about the pelvic urethra. C- Infections of the Glands of the Pelvic Urethra 1. Spermato-Cystitis. Semino-Vesiculitis Semino-vesiculitis, or inflammation of the seminal vesi- cles, has attracted scant attention in bulls or other breeding 390 Diseases of the Genital Organs males. It is therefore impossible at present to make a re- liable estimate of the frequency of its occurrence. Enough study has been given the subject recently to show that semino-cystitis is neither rare nor unimportant in breeding bulls. Fig. 127 — Purulent Spermato-Vesiculitis. Bull. ( From same animal as Figs. 126 and 86). On the left is included a normal pelvic urethra, urinary bladder, and seminal bladder for comparison. /, /, Greatly enlarged vesiculae seniinales ; 2, 2, enlarged terminal portions of vasa deferentia ; 7, urinary bladder ; 7, pelvic urethra covered by Wilson's muscle and prostate gland ; 5, body of prostate. The symptoms have not yet been clearly defined. In the cases observed clinically, there was hesitancy in the ejacu- lation of semen, and a markedly deficient volume of the seminal fluid. Taking into account the present belief in the function of the seminal vesicles, the symptoms thus far Spermato- Cystitis 391 observed appear logical and inevitable. In ruminants, swine and solipeds, the seminal vesicles are the outstanding subsidiary sex glands connected with the pelvic urethra, and are believed to supply the chief volume of the semen, serving as a diluent in which the spermatozoa, arriving from the testicles, may swim. This facilitates the ejacula- tion of the highly concentrated mass of spermatozoa. At the same time it is believed that the physiologic secretion from the vesicles stimulates and energizes the spermatozoa, rendering them more active. In harmony with this view, present studies show that when the vesicles are inflamed, not only is the ejaculation tardy and the volume of semen scant, but the spermatozoa are non-motile or feeble. Spermatozoa taken from the epi- didymis in a healthy animal are vigorous. Hence it would appear that in semino-vesiculitis the vesicular fluid from the diseased organ devitalizes the spermatozoa. The clinical examination of the bull reveals, upon rectal palpation, enlargement and irregular, nodular swelling, with extreme sensitiveness. The physiologic gland, as shown in Figs. 5-7, page 11, may be freely manipulated without causing any evidence of pain but, once it is in- flamed, the bull immediately winces upon the most moderate pressure. There are few glands or organs in the body which show such marked sensitiveness when inflamed as do the vesiculae seminales. The clinical history of semino-cystitis is a progressive, or probably sometimes sudden, sterility. Cows fail to conceive uniformly, or there is total sterility. Naturally the cows and heifers are examined, and no explanation for sterility is discovered. Therefore, attention is turned to the bull. In one bull, the vesiculitis was associated with epididymitis, presumably due to a common cause. There appeared to be also some inflammation of the vas deferens. The bull had been imported from England at high cost for breeding some very valuable heifers. Seven were bred without a concep- tion. It is not improbable that epididymitis and semino-cystitis 392 Diseases of the Genital Organs are commonly associated, but whether the epididymitis is the progenitor of the cystitis, or vice versa, there is no evi- dence to show. Thus far the affection has been chiefly ob- served in young bulls, but most bulls are young. There seems quite a probability, however, that the infection, like epididymitis, is largely an invasion during the nursery pe- riod, and that it lies somewhat dormant until unfavorable hygienic conditions, close confinement, overfeeding, or ex- cessive coitus arouse the infection to destructive virulence. On the other hand, the possibility, if not probability, of ac- quiring the infection through repeated coitus with highly infected cows, must be frankly acknowledged and the proper hygienic handling of bulls maintained in order to anticipate such disease. Neglect of the study of the genital infections of bulls ren- ders it impossible to speak with any assurance regarding the bacteriology of semino-vesiculitis. Buck and others, searching the vesiculae seminales, vasa deferentia, epididy- mes and testes of 37 out of a group of 235 bulls, for the B. abortus, recognized that organism in the vesiculae seminales of 4. There appears nothing in their communication to in- dicate that they were interested in the bacteriology of the organ. Evidently they searched merely for the one organ- ism, ignoring all others. While they recognized the B. abor- tus in bulls, they have not stated that the cystitis was due to that bacterium. The B. abortus probably plays a negligible part in the causation. Vesicles from bulls, slaughtered be- cause of sterility but not showing evident enlargement, sub- mitted to Carpenter, revealed a streptococcus. It would normally be suspected that the infections of the vesiculae seminales and epididymes would be analogous to those of the oviducts, in which streptococci appear to be the commonest offenders. The prognosis, from the standpoint of reproduction, is highly unfavorable. It seems improbable at present that, once well established, semino-cystitis can recover, although further observation may modify such a view. There is no effective method known for handling the dis- Balanitis. Balano- Posthitis 393 ease. It is beyond the reach of the surgeon. It is not known that any internal disinfectant can efficiently reach the or- gan. With the bacteriology virtually undetermined, vac- cines, bacterins, and other biologic products can not be ad- vocated. The most that can be suggested thus far is sexual rest and good general hygiene with, as a rule, eventual slaughter. 2. Diseases of the Prostate and Cowper's Glands The pathology of the prostate glands of animals has not been studied except in the dog, where apparently the gland suffers frequently from disease. While the gland is an ex- tensive one in the bull, it is so enveloped by Wilson's muscle that it is not directly palpable. There is nothing in veteri- nary literature indicating to what, if to any appreciable ex- tent the prostate of cattle becomes diseased. In the bull Cowper's glands lie deeply buried beneath the ischio-cavernosus muscles, where they are not palpable un- less enormously enlarged. I find no record of disease in them. D. Balanitis. Balano-Posthitis In Chapter XII, under "The Nodular Venereal Disease," balanitis and balano-posthitis have been quite fully discussed as one of the practically universal results of that infection or lesion in ruminants and swine. While other infections (aside from tuberculosis and actinomycosis) may invade these parts, they offer nothing of special interest so far as is known at present. The general principles of control in- dicated for the nodular venereal disease are applicable to any infections of a general character which may be added to or associated with it. 394 Diseases of the Genital Orgajis II. GENERAL INFECTIONS OF THE GENITAL ORGANS OF HEIFERS AND COWS A. Diseases of the Ovaries. Ovaritis Simple ovaritis, or oophoritis, is not often clearly distin- guishable as a clinical entity in animals. In the preceding chapter the invasion of the ovary by such infections as ac- tinomycosis and tuberculosis has been recorded. Rarely also one encounters abscessation of the ovary. The diseases of the ovaries of cattle (and other animals) have not been scientifically studied. A few very superficial histo-biologic studies have been begun, but abandoned be- fore any material knowledge was gained or any correlation between the findings and clinical observations established. Much has been written concerning the clinical aspects of ovarian diseases. Between these two fields of study are the macroscopical findings upon post-mortem examination. The knowledge of ovarian diseases (and the diseases of other genital organs may well be included in the generalization) is consequently superficial and fragmentary. Therefore any statements, aside from the few clearly demonstrated facts which may be presented, are to be accepted with very liberal reservations and it must be confidently expected that ade- quate study will modify numerous assumptions and beliefs. In general it appears that the ovaries of cattle are fre- quently the habitat of varieties of infection of a type which may exist indefinitely in the gland without causing notable disease but which may, under certain conditions, acquire a force competent to bring about disturbances in structure and function. Bacteria (micrococci, streptococci, etc.) are found in the ovaries of heifer calves and of aged cows, with- out evidence or suggestion that the infection in the ovary of the aged cow did not acquire its ovarian habitat while the animal was yet in the nursery. Many clinical and post- mortem changes are seen in the ovaries, so associated with disturbances of ovarian function as observed clinically that certain conclusions, assumptions, or surmises are justified. Atretic Follicles 395 1. Atretic Follicles There are commonly observed in the ovaries of heifer calves, heifers, and cows numerous small cysts, varying from 1/16 to 14 inch in diameter, containing a clear liquid. They appear to be the remnants of follicles in which the primitive or permanent ova have perished and the follicular liquid has persisted, with more or less addition to its volume. I have stated that they grow as large as i/4 inch in diameter. How much larger they may grow is at present difficult to state. They may grow much larger but, should they do so, become confused with cysts of other origin and lose their identity. That is, when a larger cyst is encountered and neither clinical nor histological evidences of origin are forthcoming, accurate differentiation is impracticable. The significance of these small cysts is unknown. If they elaborate important secretions (endocrines) or in any other manner modify the sexual functions, or if they affect in any way the reproductive functions, the fact has not been demonstrated. They are quite as numerous in ovaries which function normally as in those which do not. 2. Cystic Degeneration of the Ovisacs. Nymphomania There occurs in all species of domestic animals, though preeminently in the cow, a type of cystic degeneration of the ovaries accompanied by nymphomania. So far as can be determined at present, the degeneration is one involving the unruptured ovisacs. Apparently this undergoes dis- tension, the follicular liquid becomes enormously increased, the ovum perishes, and there is little tendency for the cystic follicle to rupture and recover spontaneously. It would appear quite certain that the cystic disease is one of the ovisac itself, because, so far as I have been able to determine, there is never any lutein tissue in the cyst wall. In nearly all adult ovaries there are vestiges of cor- pora lutea, but in nymphomania they are purely vestigial and are not connected with, or visibly related to the cysts. I have not known nymphomania to develop in a pregnant animal. There are large and small cysts in the ovaries of 396 Diseases of the Genital Organs pregnant cows, but not of the nymphomaniac type. The cysts of nymphomania develop at times when physiologically the animal should ovulate. That is, she has reached breed- ing age and is not at the time pregnant. No corpora lutea are present to exclude estrum. There are no recognizable lesions in the genital tract or elsewhere which would tend to inhibit estrum, except the nymphomaniac cysts themselves. It appears justifiable, therefore, to believe that the nympho- maniac cyst is a pathologic process occurring in an ovisac which is nearing maturity. The cysts of nymphomania are exceedingly variable in size. They are rarely less than one inch, and with equal rarity exceed three inches in diameter. When larger cysts appear, like those desiribed on page 257, nymphomania is not present, and as a rule the cyst inhibits fertility upon the involved side only, while the other ovary functions and the animal breeds. When the cyst of nymphomania is present, however, fertility is in abeyance. The number of nymphomaniac cysts which may simulta- neously exist varies from one to three or four. The pres- ence of one nymphomaniac cyst does not prevent, nor tend to prevent, the formation of others. The cysts are multiple, not multilocular. That is, each cyst arises separately, so far as can now be determined, from individual ovisacs, and remains distinct throughout its existence. Hence one ovary may have two or three contiguous, nymphomaniac cysts. The cysts frequently involve both ovaries, although some- what frequently only one is affected. However, the sterility is as complete with only one ovary involved as when the dis- ease is bilateral. There is wide variation in the thickness of the cyst walls. In some cases they burst upon very slight digital pressure when being examined per rectum. As a general rule, they require moderate pressure before they are ruptured. In a majority of cases, the cyst wall is so dense that it is unsafe to rupture it by rectal pressure and it requires in some in- stances all the force the operator can command to rupture it through the vagina. In rare cases, the cysts can not be Cystic Deg€neratio7i of the Ovisacs 397 ruptured by manual pressure from the vagina and their contents can be removed only by puncture. The large nymphomaniac cysts necessarily project far be- yond the general surface of the ovary. In very rare cases, Fig. 128 — /, Nymphomaniac cysts ; i-, "cystic oviduct and corpus luteum. a. Cystic pavilion ; b, cystic oviduct ; r, cornu ; d, cystic corpus luteum with faint girdle of lutein tissue ; j, e, encapsuled corpus luteum ; /, ostium abdominale of oviduct. small nymphomaniac cysts are centrally located, giving to the ovary a somewhat spheroidal or merely plump form. The symptoms of nymphomania are usually very pro- nounced and characteristic. The cow or heifer bellows a great deal, more frequently perhaps than when in estrum. 398 Diseases of the Genital Organs There is such a distinct modification in the voice that it can scarcely be distinguished from that of a bull. The female appears to be in estrum of an exaggerated type. She will mount other cows whenever opportunity offers and, when free with other cows which are in estrum, she will ordinarily permit them to mount her. As a rule she will copulate at any time with the bull, but there are notable exceptions. Although the animal shows every evidence of an erratic estrum, in some cases she will not copulate. The manifesta- tion of the erratic sex desire is not confined to other cows or to the bull. The nymphomaniac cow may mount any animal, or for that matter man, if he is not on his guard. In some cases, cows kept in stalls with low partitions will mount the partition. After the disease has progressed for a time, usually not more than a few weeks, notable changes take place in the pelvic ligaments. The postero-superior border of the sacro- sciatic ligament, where it passes from the tuberosity of the ischium upward and forward to the sacrum, becomes re- laxed, soft and flaccid. The broad expanse of the ligament suffers similarly and sinks into the pelvis, so that the gluteal muscles drop inward toward the median line of the cavity, causing a deep excavation. The relaxation of the ligaments causes marked deformation of the pelvis : the tuberosity of the ischium becomes elevated and the tuberosity of the ilium depressed. The sacrum participates in this change of posi- tion. Its caudal end becomes greatly elevated and its lum- bar end depressed. The result is a sharp depression at the sacro-lumbar articulation, with a very marked elevation of the caudal end of the sacrum. The interosseous ligaments between the ilium and sacrum share in the relaxation, so that the sacro-ilial articulation is relaxed. This results in an uncertain, rolling or wobbling gait. If one stands near the animal when she is walking, he will now and then hear a loud grating sound caused by the slipping of the ilium upon the sacrum, which may be heard with considerable uniformity if the external tuberosities of the ilium are grasped and the rump of the cow is pushed back and forth. Cystic Degeyieration of the Ovisacs 399 .2 g a U a^ bioa cS r 1 o ja o ^ o o cfl tn o y 11 fvT U" X a •o c>^ m -^ . *. 6c ;-{ >. •~ >^ Hi s tn cfl C3 tn &C ic 1) O a ' — ' r^ c ■^ Q < JJ >. >• c en D E- o u b. fc. 2 . Q c tA; i: <*- o 1— < - 3 . z o ^ -^^ ^ ^ _o CJ w o E- K < en I. ^ 1 o z o 5s o c O u* tlX) M ec < • S -o O r" t! il u z u _o « u '-5 3 (b < =: ='' c ■^ . — ^^ CL. en z dj r( c O u J" o Infections of the Gravid Uterus 475 without notable injury to the fetus. This is analogous to the observations upon swine embryos, in which extensive necrosis commonly occurs at both ends of the embryonic sacs without invading the essential placental structures. In this manner the peril to the embryo is limited chiefly to the passage of bacteria through the necrotic area, while the placenta continues to function physiologically. Rarely, the placentitis of pregnancy is of such virulence that all cotyle- dons become necrotic simultaneously or in rapid succession. The fetus then perishes, the uterine walls are paretic, and, if the mother survives, the embryo macerates or the uterus undergoes abscessation. (e) Adventitious placental structures regularly follow the necrosis of the cotyledons, whether it occurs during or after pregnancy. Adventitious placentae are not seen in heifers, but are common in cows, where they serve as proof of the prior necrotic destruction of cotyledons. In the uterus of the pregnant heifer, placental contact is regularly limited to the distinctive cotyledonal or placental areas. With each succeeding pregnancy, there is an increased probability of necrosis of some of the cotyledons about the OS uteri internum. In the area denuded of cotyledons, ad- ventitious placental structures develop, presenting macro- scopically the appearance of the diffuse placenta of the mare. When cotyledons are destroyed, there is no visible effort at compensational hypertrophy of the remaining cotyledons, but the compensation is effected through adventitious ac- tivity of the intercotyledonal endometrium. The adventitious placental structures tend to invade the endometrium about the os uteri internum and to form over the OS a virtually continuous placental contact, constituting in effect a placental seal, separating the cervical canal from the utero-chorionic space. When parturition begins, the adventitious placental structures must give way before the cervical canal can dilate and the parturient rent occur in the chorion. The adventitious placental structures ordi- narily radiate from the os uteri internum for only four to ten inches, though occasionally they involve the entire uter- 476 Diseases of the Genital Organs ine body cavity and may extend deeply into one horn. In one abattoir cow I observed a complete adventitious (dif- fuse) placenta involving the entire endometrium. While adventitious placentae are always the consequence of coty- ledonal necrosis, extensive death of the cotyledons is not or- dinarily followed by adventitious placenta; instead, the ex- tensive disease commonly includes the endometrium and either kills the patient or renders her absolutely sterile. (f) Calcification of the placenta occurs very rarely. I have observed but one case, that being in an abattoir ani- mal. The calcification, which was very marked, involved uniformly all cotyledons. The placental stratum was pale yellow, resistant and gritty. There was no evidence that the calcification had interfered with embryonic development. The cause was not clear. It was possibly the result of inter- placental hemorrhage stopping short of placental dehiscence and embryonic death. Had parturition occurred, retained fetal membranes with necrosis of the cotyledons would probably have followed. (g) Specific placentitis, due to placental tuberculosis and actinomycosis, doubtless occurs rarely and, when pregnancy terminates, leaves behind an obstinate retention of the fetal membranes, the character of which is not clinically appar- ent. Naturally the specific disease promptly leads to in- curable sterility. 3. Infections of the Ovum, Embryo, and Fetus A. Death of the Fertilized Ovum The death of the fertilized ovum is not directly recog- nizable clinically, but its occurrence must be admitted. Ovarian infection evidently causes death of the ovum within the ovisac. When an ovum passes from the ovisac into a virulently infected oviduct, the cell is immediately placed in great peril and may perish prior to fertilization. Examina- tion of infected oviducts after slaughter of the patient shows that the highly motile spermatozoa move through the badly infected tube and reach the pavilion ready to fertilize the ovum as soon as it is discharged. Presumably this occurs Infections of the Ovnm, Embryo and Fetus 477 often, but the newly fertilized <^%^ has little, if any, more power of resistance than the spermatozoon and unfertilized ovum each possessed prior to their union. It is an indisput- able clinical fact that salpingitis generally prevents recog- nizable pregnancy. This renders it reasonably clear that the infection in the oviducts or uterus kills the spermato- zoon or ovum. The recognizable destruction of the embryo or fetus is so common that the unseen death of its earliest stages must also be frequent. Any infection capable of causing the death of an embryo or fetus must logically be more readily able to cause death of the far less resistant organism. Thus a heifer is bred possibly eight to ten or more times at regular or irregular intervals. Sometimes she may appear pregnant for one to two or more months. Finally she recognizably conceives and pregnancy contin- ues one hundred to two hundred or more days, when she is observed to expel a fetal cadaver. One death of a fertilized ^%% has been observed, while many deaths during the earlier periods have passed unseen. The deaths of the spermatozoa and of the unfertilized or fertilized ovum are far more nu- merous and cause infinitely greater economic losses than do abortions. In many valuable herds of pedigreed cattle, an average of three copulations is necessary for each recog- nizable pregnancy : there is an initial failure in 67 per cent, of attempts at reproduction. The farce of curing the disease or preventing the death of the ovum, spermatozoon, or fertilized ^^^ by measures taken after coitus, as is so common with abortion, has not become established. The avoidance of such death clearly lies in the fundamental principle that the physiologic re- production of young rests upon the sexual contact of two healthy individuals. B. Death of the Embryo with Persistence of the Embryonic Sac. Cystic Mole As soon as the embryo has formed and its sac has ac- quired recognizable dimensions, embryonic death may be clinically observed if accurate attention is given at the criti- 478 Diseases of the Genital Organs cal period. The recognition becomes largely a question of chance. Most embryonic deaths pass unseen. In such early deaths the embryonic sac is by far the greatest and most conspicuous part. Frequently the embryo dies and all traces of it disappear while its sac persists and apparently con- tinues to grow. The embryonic sac retains its usual form, but is without evident placental structure, and apparently maintains its growth and existence by absorption of liquids from the uterine cavity. One of these is illustrated in Fig. Fig. 169 — Cystic Mole. Total length 46 inches ; circumference, 7 inches. At the top of the gravid branch of the fetal sac is seen a thickened spot, apparently marking the former location, of the embryo. Compare with colored plate II. At the cervical end of the uterus, the embryonic sac is necrotic and desiccated. The necrotic tips are prominent. Sac removed 200 days after conception. 169. In this instance there remains a thickened area which faintly suggests the prior location of the embryo. The cow was examined at about sixty days after coitus and pro- nounced pregnant. The cervical canal was sealed; the uterus enlarged and distended in a manner typical of pregnancy of that duration, a typical corpus luteum of pregnancy was present, and estrum was absent. The general signs of preg- nancy failed to advance parallel to the duration of time. Later an examination disclosed the nature of the condition, and the "mole" was removed. Infections of the Ovum. Embryo and Fetus 479 The cystic mole grows slowly and soon fails to maintain the degree of distension of the uterus characteristic of the advancement of pregnancy. Finally its growth becomes halted and its size may continue static for an indefinite period unless the uterine seal is imperfect or becomes de- stroyed. Then its expulsion follows. The expelled cyst commonly shows two unequal parts representing the gravid and non-gravid horns, joined by a narrow, sometimes ne- crotic, isthmus, representing the area contiguous to the os uteri internum. Fig. 170— Desiccated Mole. Cow. The embryo had perished at probably thirty days or less ; the sac later became necrotic and desiccated. In douching the uterus it was caught in the fenestrum of the catheter. More frequently the cystic mole becomes necrotic quite early and undergoes a desiccation similar to the necrosis of the tips of the embryonic sac. The elongated sac collapses, dries and shrivels until it becomes a flattened, wrinkled, yellowish-brown cord. In such case the uterine seal is ab- sent, either having failed to form or, if formed, having been destroyed. Clinically I have seen the desiccated sac protrud- 480 Diseases of the Genital Organs ing from the cervical canal into the vagina. In douching a uterus, the dry structure is sometimes drawn into the fenes- trum of the uterine catheter, and when the instrument is withdrawn the structure is pulled out. In all cases of desiccated mole I have seen, there was present a well marked pyo-cervicitis with slight purulent endometritis. When recognized, the mole should be re- moved and the associated cervicitis and endometritis handled according to indications. It is evidently imprudent to breed such an animal until after thorough disinfection of the uterus and cervix, C. Death and Maceration of the Embryo or Fetus As a rule, when infection advances from the ovarian end of the uterus or exists in the central area and causes death of the embryo or fetus, the cadaver is not expelled because the uterine walls are rendered paretic. The same result is attained when infection, advancing from the cervical end of the uterus, proceeds so rapidly that uterine paresis is in- duced quickly. The embryo or fetus then undergoes mace- ration. If the mother survives, either the pyometra of fetal decomposition or uterine abscessation follows. (a) The pyometra of embryonic or fetal decomposition is comparatively common in cattle. It occurs at any time after pregnancy is clinically recognizable, up to the com- pletion of the ordinary duration of pregnancy. When occur- ring very early, the pyometra may be quite limited. There may be an inconspicuous purulent discharge, absence of estrum, and non-interference with general health. It is most frequently seen in heifers. In the heifer rectal pal- pation generally reveals a small uterus, distended and rounded by purulent contents. The uterus is ordinarily free from adhesions. No trace of a fetal cadaver is recog- nizable clinically. Upon post-mortem the uterus is found distended with pus and containing skeletal fragments, such as the tiny elongated ossification centers of the long bones. I have seen these less than one-half inch long. In one case the heifer had been bred about one year previously and had hifections of the Oviitn, Embryo and Fetus 481 / been supposed pregnant until near the time for parturition. The pus was thick and fetid. The pyometra had extended into the oviducts (pyosalpinx) and had irrevocably de- stroyed her breeding life. Embryonic maceration with pyometra probably causes those cases of extensive pyometra in heifers, to which allu- sion has already been made, and those in cows accompanied by such complete uterine paralysis that no genital discharge Fig. 171 — Maceration of Fetus. /, Cervical lips ; 2, greatly enlarged, sclerotic annular fold pushed across the cervical canal ; J, vagina ; ^, parietal bone of embryo ; CL, embedded corpus luteum of pyometra. The uterine walls are sclerotic. 31 is evident. In these cases, if the pyometra is due to embry- onic maceration, the embryo is so small at the inception of the pyometra that its skeletal debris is not recognizable clinically during douching. When fetal death and maceration occur later in preg- nancy, copious discharge of fetid pus commonly follows. The fetal debris is too gross and angular to be discharged with the pus. The soft tissues of the cadaver dissolve or 482 Diseases of the Genital Organs become suspended to constitute part of the pus. The bones separate at their epiphyses but fail to dissolve. I have ob- served cases where fetal death had occurred two years prior to the examination. The condition of the fetal bones ap- peared static. The bones become closely packed together in a somewhat irregular oblong mass in the base of one horn. The interstices between the bones are largely filled with thick, desiccated, intensely fetid pus. The diagnosis of this type of fetal maceration is compara- tively simple when the general outlines of the condition are known, but is often quite difficult for the beginner. There is a history of apparent pregnancy following breeding. Later the progress of pregnancy apparently halts and a highly fetid purulent genital discharge ensues. Estrum is absent. The genital discharge may be sanious, owing to pieces of the jagged fetal bones lacerating the endometrium and causing hemorrhage. Palpation of the uterus per rec- tum reveals a hard, irregular enlargement in one horn (ex- cept in maceration of bicornual twins). A careful study of the enlargement shows that the parts of the tumor move upon each other with definite crepitus. The cervical canal is generally narrow, and the cervix hard. If a catheter is introduced and the uterus douched, the pus may be largely washed out and the size of the mass rendered slightly more distinct. The bones then move more freely when palpated, rendering the diagnosis clearer. In one instance, in a tu- berculin reactor, the fetal mass was mistaken for uterine tuberculosis. Uterine tuberculosis, however, is usually sym- metrical. The actual differentiation lies in the recognition of the fetal bones. In another case the admixture of blood with the pus caused a diagnosis of uterine tumor. This error should have been avoided by more careful palpation. In the earlier stages fetal maceration and fetal desiccation may be confused. In desiccation the hematoma dims or completely hides the outlines of the fetal cadaver; in early maceration the fetal outline remains. In maceration the cervical canal is generally or always unsealed ; in desicca- tion the uterine seal is ordinarily perfect. The progress of Infections of the Ovum, Embryo and Fettis 483 desiccation is illustrated in Figs. 166-168. An old uterine hematoma of puerperal origin may also lead to confusion in diagnosis. The uterine hematoma is firm, doughy, and gen- erally regular in outline. I have met one old, greatly desic- cated, tesselated hematoma of the uterus which clinically might well have given trouble in diagnosis and might have been mistaken for the skeleton of a fetus. But the crepitus is absent. The history that the animal has or has not been bred may aid, though this is sometimes erroneous and adds to the confusion. The prognosis in advanced fetal macera- tion is virtually hopeless for the breeding life of the ani- mal. When it has continued for some months, the endome- trium is ordinarily destroyed and the suppurative process has extended into the oviducts, inducing incurable pyo- salpinx. I have not known a cow to conceive after having suffered from prolonged fetal maceration. Possibly some of them may breed. The handling of fetal maceration offers many difficulties. The cervix is usually extensively inflamed and sclerotic, and the dilation of its canal is difficult and dangerous. Forcible dilation is liable to cause serious lacerations, or the sclerotic tissues may rupture, causing an opening into the peritoneal cavity. Uterine contractions tending to expel the cadaver may be induced by dislodging the corpus luteum, but the corpus has sunken deeply into the center of the gland (the embedded corpus luteum of pyometra) and is difficult to dislodge. Sometimes the ovary is dragged far downward and forward in a manner to render it difficult to carry the ovary back over the vagina through the wall of which vig- orous compression can be exerted without danger. The corpus may be dislodged by compression per rectum, but this requires extreme care in order to avoid severe or dan- gerous rectal lesions. The corpus may always be dislodged by performing laparotomy, inserting the hand into the peri- toneal cavity, and compressing the ovary directly. But the succeeding uterine contractions will generally fail to expel the cadaver. The jagged bones become caught in the uter- ine walls, causing wounds and preventing expulsion. The 484 Diseases of the Genital Organs same difficulties face the veterinarian when he attempts to bring about the expulsion by the administration of pituitary- extract. The contractions of the uterus can be induced, but they fail to evacuate its contents, I have removed the skeletal debris by hysterotomy, but the operation was diffi- cult and the result was failure. Possibly further efforts at hysterotomy, or rather hysterectomy, may develop a practi- cal technic associated with success. From my experience I believe the more hopeful plan to be the amputation of the involved horn with its oviduct and ovary, leaving repro- duction to the other horn and ovary, which may have escaped hopeless injury. When this is undertaken, great care must be exercised to avoid the escape of any of the uterine contents into the peritoneal cavity. The abdominal incision must be made upon the involved side as far poste- rior as practicable upon the middle line of the flank. That is, the abdominal incision must be made as near to the uter- ine attachments as possible. Even then, it is difficult to lift the involved uterine horn out through the wound, and vir- tually impossible to operate within the abdomen. Attempts at handling with a view to the restoration of breeding should not be undertaken except in animals of great value. Others should be prepared for slaughter by the most economic source. Where there is old-established maceration of the fetus, the animal is frequently in good beef condition and the repulsive skeletal cadaver is so walled off that there is no logical objection to the use of the meat as human food. The uterus should be regarded as an abscess cavity. (b) Abscessation of the gravid uterus occurs when the fetus macerates and the cervical canal undergoes atresia to such a degree as to prevent the escape of pus through the genital passage. The occlusion of the cervical canal occurs by two distinct processes. (1) Abscessation of the uterus, with fetal retention, oc- curs when the fetus dies and the cervical canal becomes closed as a result of severe cervicitis. The occurrence is at first without notable clinical symptoms. The animal has Infections of the Ovum, Embryo and Fettis 485 been bred and is presumably pregnant, but the symptoms of advancing pregnancy are absent or, if the pregnancy is well advanced when the fetus dies, the symptoms are retro- grade. In one of my cases the cervical atresia was incom- plete and some portions of the fetal membranes protruded from the vulva, but the constricted cervical canal afforded insufficient exit. The cervical canal became blocked, possi- bly by a large portion of the fetal cadaver. The uterus ad- hered to, and finally opened into the rumen. Fetal debris passed into the rumen and caused several attacks of fetid diarrhea. Whole grains of corn (maize) and oats entered the uterus. The heifer suffered little in her general health, milked fairly, grew fat, and was sold for beef. In a second case, from the abattoir, the uterus adhered to the urinary bladder, as illustrated in Fig. 172. The general tendency appears to be for the uterus to adhere to, and rupture into, one of the hollow viscera. Which one, will depend some- what upon the stage of pregnancy at which maceration and abscessation occur. In early pregnancy the bladder or rec- tum forms the most probable outlet; later in pregnancy, after the fetus drops forward, the rumen is the most logical viscus into which the uterus may empty its contents. (2) Uterine torsion regularly causes occlusion of the cervical canal. Most patients die unless surgically relieved, but rarely the cow survives and the fetal cadaver macerates. In some instances there occurs a transverse rupture of the genital tube in the vagina, cervix, or uterine body, and the uterus with the fetus drops downward upon the abdominal floor. The fetus macerates but the ruptured end of the uterus is closed by the enveloping uterine ligaments like the mouth of a bag tied with twine. The uterine walls re- tain some life through one or more of the uterine vessels, the organ adheres to the abdominal floor, and finally the ab- scess points externally and the fetid fetal debris drops out. Abscessation of the gravid uterus is hopeless so far as the breeding life of the animal is concerned. The adhesions in- cident to the abscessation bring about serious nutritive dis- 486 Diseases of the Genital Organs Fig. 172— Macerating Embryo sloughing into Urinary Bladder. , Cervix ; 2, embryonic debiis with pus in body of uterus seen from above J, cornua ; 4, enibryonic debris in the urinary bladder, after sloughing through its fundus, seen from right side after sagittal section ; J, muscular walls of urinary bladder. bifedioyis of the Ovum, Embryo and Fetus 487 turbances which commonly destroy the value of the patient for other purposes. D. Emphysema of the Fetus As a rule the bacteria which infest the utero-chorionic space of the pregnant cow, and which tend to invade the fetus and destroy its life, do not form gases. Instead they most frequently cause a dry necrosis (necrosis of the tips of the embrj^onic sac) or induce maceration of the fetus. The rapid multiplication of gases within the sealed uterine cavity or the contained fetus is virtually incompatible with the life of the mother unless the cervical canal is open and establishes a free vent for the gases. Usually the crisis of uterine rupture is not reached because the patient succumbs to sepsis. Emphysema of the fetus occurs in all species of animals, usually near, or at the end of the normal duration of preg- nancy. The emphysema is apparently the result of second- ary invasion of a recent date. The life of the fetus has or- dinarily been destroyed and the uterine seal broken down by other invaders, preparing an open way for the entrance of the gas producers. When the fetus is emphysematous, the cervical canal is ordinarily open but not dilated. Some- times, as in cases of torsion of the uterus with emphysema of the fetus, the cervical canal is mechanically closed by the torsion. The mechanical injury to the cervix destroys its resistance to invasion, and emphysema results. Sometimes under these conditions the emphysema becomes so great that the fetus occupies almost the entire abdominal cavity and rupture of the uterus appears to be averted chiefly by the support afforded by the contiguous abdominal walls. The clinical symptoms of fetal emphysema are essentially those of the uterine gangrene of pregnancy already de- scribed. E. The Observed Expulsion of the Fetal Cadaver. Abortion The term "abortion" has a great variety of meanings. In veterinary medicine it ordinarily means the observed expul- sion of a fetal cadaver. If it is stated that twenty per cent. 488 Diseases of the Genital Organs of cows in a herd have aborted, it is meant that someone has observed one-fifth of the females expel fetal cadavers. Many more embryonic or fetal cadavers may have been expelled unseen, or very small embryos may have become macerated and absorbed, but these are not included. In this sense "abortion" has acquired a preeminent place in veterinary science and the phenomenon is commonly regarded as a specific disease, (a) The history of abortion is extensive. Its occurrence has been noted by biblical and other early writers and was frequently recorded in medieval times. The occurrence of abortion has generally caused greatest concern in cattle be- cause, since their milk and meat have occupied a preeminent place in the food supply of most nations, any interference with this supply imperils human life and health. Perhaps the phenomenon has occurred more frequently in cattle than in other domestic animals because the conditions favoring it have been most prominent in cattle. Abortion has been noted most in highly civilized countries with dense popula- tions where milk and its derivatives are most highly prized, and where any interruption of dairying causes a serious shortage in this highly important human food. Since, where a regular daily supply is demanded, for economic reasons no surplus cattle are kept, any serious disturbance with milk production is immediately felt. With the advancement of civilization and concentration of population, the ratio of milk- and meat-producing animals to the population becomes less and higher efficiency of each individual animal becomes essential. This increases the strain upon the animals, and the diseases interfering with reproduction become more in- tense. Accordingly abortion and other interferences with reproduction are of ever-increasing importance to the state and call for vigorous measures of control. At first abortion was frequently attributed to unfavorable weather, such as unusual dampness or dryness, to bad food, to emanations from swamps, and to accident. In early his- tory only a few diseases, such as leprosy, were attributed to contact. The belief in contact as a cause of disease ad- Infections of the Ovum, Embryo and Fetus 489 vanced rapidly during the eighteenth century. In the nine- teenth century Pasteur and others firmly established the fact that disease is chiefly due to contact and that the under- lying cause is a living microparasite passing from the dis- eased to the healthy animal as a result of direct or indirect contact. The belief in the infectiousness of abortion has experi- enced a long and eventful course of development which has not yet been completed. For a time a few abortions were ascribed to infection, but these were at first limited to those cases where ingenuity failed to ascribe any other reason. At present probably a majority of people believe that most abortions are due to infection. The observed expulsion of a fetal cadaver came to be regarded as a disease, and by many is still so designated. Those abortions believed to be due to contact accordingly became known as "contagious," "infec- tious," or "epizootic" abortion and were considered a specific malady. Many believed, and still believe, that, if a cow aborts as a result of infection, it must be due to one infecting agent and one only. Mammalian existence is divisible into two clearly defined eras — intra-uterine or ante-natal, and extra-uterine or post- natal life. In post-natal life an indefinite number of infec- tions may threaten health or life. On the other hand, it has been constructively assumed that during intra-uterine life but one bacterium or other microparasite may threaten the unborn animal. It is further assumed for all practical pur- poses that an infection invading the fetus can not cross the birth line and continue as a disease of the calf. Neither has it been commonly assumed that an infection of the pregnant female can invade the fetus within her uterus. Technically all pathologists admit that tuberculosis and syphilis may pass from mother to fetus, but this is not credited with any important bearing upon "contagious abortion." While the existence of such belief may be technically denied by the orthodox contagious-abortionists, they practically teach that "contagious abortion" is due to an infection which acts without contact. That is, if a cow aborts in the presence of 490 Diseases of the Genital Organs a healthy cow, the infection passes through the body of the healthy cow "in bond" and fatally attacks the intra-uterine young, thus passing through an intermediary organism without injury, to attack fatally a third individual. In irreconcilable conflict with such belief, the group of veterinarians to which I belong hold that the observed ex- pulsion of a fetal cadaver is a phenomenon devoid of great mystery — that fetal death is fundamentally like extra-uter- ine death and occurs in a perfectly analogous way. Not only is fetal death analogous to post-natal death, but, with a single limitation, death in the two eras is due to identical causes. The limitation — and it is a highly important one — is that many of the important infections of post-natal life are unable to attain contact with the fetus. The uterine seal serves as an effective barrier against invasion through the genital tract, and the placental filter, when healthy, is not known to permit the passage of any organism competent to cause disease. No such passage of disease-causing organism through the healthy placenta to the fetus has yet been re- corded. Even the ultra-minute disease-producers which defy the finest filter made by man, such as the virus of hog cholera, smallpox, and many others, do not destroy the life of the fetus directly, but only indirectly by destroying the life of the pregnant female. I have held that the infections causing the phenomenon of abortion are far less mysterious than generally claimed and are in all respects analogous to, and in an important degree identical with, the infections of extra-uterine life. Every part of the genital tract of both sexes and of all ages com- monly harbors bacteria of great variety. Under ordinary conditions these may not cause evident disease, but under the numerous and vital changes of function in the genital tract, they may and do acquire power to cause vital injury. The uteri of most non-pregnant and pregnant cows and heif- ers contain bacteria having pathogenic powers. The epi- didymes and vesiculae seminales of bulls often contain bac- teria which cause definite lesions in these parts. Under certain conditions such bacteria are ejaculated with the hifedions of the Ovum, Embryo a?id Fetus 491 semen during coitus. If the cows served by such a bull be- come pregnant, they largely abort. It is quite unnecessary to invoke mysterious infections to account for any and all abortions. The infections are present, abundant, and potent. (b) Abortion is ivorld-ivide and is seen in all mammalia. According to the highest authorities upon human obstet- rics, 25 per cent, of pregnant women abort. Statistically the rate of abortion is far less among domestic animals, but that may be statistically only. I have previously stated that the term abortion, as commonly used, signifies the observed expulsion of the fetal cadaver. Abortion statistics are neces- sarily based upon the observed phenomenon. Hence the more accurate the observation, the higher statistically is the rate of abortion. Such being the case, if the expulsion of the embryonic or fetal cadaver were of equal frequency in all mammalia, statistically woman would occupy first place, the dairy cow next, followed by beef cows and other domes- tic females in order of the accuracy of observation of those who are in immediate charge. Available statistics from dairy herds indicate that approximately 10 to 15 per cent, of pregnant cows and heifers are observed to abort. How many fetal cadavers are expelled unseen is pure guesswork, but, if the opportunity for observation were as good as in the human family, the probabilities are that the abortion rate in cows would statistically equal or exceed that recorded for woman. The phenomenon of abortion is probably more frequent in dairy than in beef cattle. Certainly it is more frequently seen, because the dairy cow is under very much closer ob- servation than any other domestic animal, except possibly pet cats and dogs. If the question is approached from a different angle, and the reproductive efficiency of animals studied, there is far greater accord between the various species and strains. If, for example, the reproductive efficiency of pedigreed dairy and beef cows be compared, it will be found that there is no notable difference. In many pedigreed beef herds, especially show herds, the reproductive ratio drops to 50 per cent, of 492 Diseases of the Genital Organs the ideal of one calf per cow each year. Pedigreed dairy herds ordinarily do no worse. If abortion were defined as the failur'e to produce young, there would be greater statis- tical harmony between the various species and classes of animals. I have known no herd of cattle, whether of dairy or beef breed, where abortion has not been observed. I know of no authentic record of a herd in which abortion is not seen. The frequency of abortion varies widely in different herds and at different times. Abortion is one of many phenomena d(ue to infection within the pregnant uterus. If the forma- tion of ova or spermatozoa is prevented by infection, if the genital cells are destroyed after being formed, or if the fer- tilized ovum or the minute embryo is destroyed, the disaster passes unseen and statistically becomes sterility. Abortion is, therefore, logically a phenomenon usually of the fifth to the seventh month of pregnancy, not because the intra- uterine young perishes most frequently, or even so often, at this period, but because the disaster is most frequently observed at this time. After the seventh month, the fetus may be expelled alive and the phenomenon is called prema- ture birth; a fetal cadaver may be expelled at full term and is called stillbirth; or a fatally infected calf may be born at full term and die from intra-uterine infection, but that is known as white scours or pneumonia, or otherwise. So dis- ease and death throughout the entire reproductive process is referable to a group of infections and the resulting dis- aster is differently designated according to the date and manner of its occurrence, but the final outcome is the same — non-production. Abortion is the result of two concurrent phenomena — the death of the fetus, and the existence of an endometritis of the pregnant animal of such a character as to cause the uterus to contract and evacuate its contents. In all recorded autopsies of cows which had recently aborted or were in the act of aborting at the time of slaughter, there have been recognized indisputable evidences of the presence of active infection. There has always been a definite cervical endo- Injections of the Ovum, Embryo and Fetriis 493 metritis radiating toward the ovarian end of the uterus. Pus or other pathologic exudate is constantly present in the utero-chorionic cavity or, if the fetal membranes have come away, in the uterine cavity. The exudate and, almost al- ways, the alimentary tract of the fetus contain bacteria, recognizable by cultural and staining methods. The utero- chorionic space of most apparently healthy pregnant cows and the digestive tube of most new-born, apparently healthy Fig. 173 — " The Exudate of Contagious Abortion." Cross section through the cornua of a pregnant uterus, showing exudate in utero chorionic space. /, Fetal sac in gravid horn ; 2^ fetal sac in non-gravid horn ; j, exudate in utero-chorionic cavity of gravid horn ; 7, large masses of exudate in non-gravid horn ; 5, section through cotyledon. calves contain bacteria not differing materially from those observed in abortion. In abortion, however, the bacteria are far more abundant. The variation in the abundance of bacteria is more readily studied in the abort, the fetus, and the calf. The amount of infection is very notable in the abort. The prematurely born calf usually bears in its ali- 494 Diseases of the Genital Organs Fig. 174 — Impending' Abortion, Cervicitis, and Endometritis at Cervical end, with Protrusion of Fetal Sac into the Vagina. The cervix has been laid open along its dorsal surface. /, Apparently healthy chorion protruding into vagina; 2,j, necrotic portions of prolapsed chorion ; 4, lips of cervix ; O, right ovary ; C, large cyst representing the left ovary. The left side is sterile ; the right horn pregnant about 80-90 days. (See also Colored Plates III and IV. ) Infections of the Ovum, Embryo and Fet2is 495 mentary tract very voluminous infection. When metritis exists, with or without retained afterbirth, the alimentary canal of the apparently healthy calf swarms with bacteria and the calf probably breaks down with spesis, dysentery, or pneumonia. When the cow calves vigorously and expels the membranes promptly, the infection in the alimentary tract of the fetus is scant. All clinical and bacteriological evidence indicates that the abortion is in each case referable to infection, and to infection only. In sharp conflict with all recorded evidence, the term "contagious abortion" constructively suggests a non-con- tagious abortion. The fiction of a non-contagious abortion continues to be supported by many who believe that some abortions are due to various causes other than infection. (c) Many believe in traumatic abortion but fail to ex- plain how mechanical injury can cause the death and ex- pulsion of a fetus. The bovine fetus lies upon the abdominal floor, surrounded by the abundant amniotic fluid and almost completely surrounded by the still more abundant allantoic fluid (See Colored Plate I), The head of the fetus gener- ally lies within the pelvic cavity. If in the posterior pre- sentation, the head usually lies above the sternum of the cow. When the abdominal floor is struck at a point against which some Dart of the fetus rests, it promptly floats away in its fluids. Fetal life is not dependent upon the same vital functions as extra-uterine life. Since respiration and nutrition are provided by the placentae, the sole vital func- tion of the fetus is the fetal circulation. Fatal injury to the fetus is, therefore, virtually limited to a traumatism which can directly stop the fetal heart-beat. It is not known that such injury is possible. Placental separation due to mechanical injury is unknown. I have studied carefully in the abattoir the uteri of more than two thousand pregnant cows and heifers, and have not observed an instance of any injury to uterus, fetal mem- branes, or fetus which, had the animal been permitted to live might apparently have led to abortion. I have already described inter-placental hemorrhage with fetal desiccation, 496 Diseases of the Genital Organs but evidently this is not due to mechanical injury. It does not lead to abortion, but to fetal retention. Hence it may be stated that up to the present no proven instance of me- chanical or traumatic abortion has been recorded in the cow nor in any other animal, and no logical explanation has been put forward of how mechanical injury can cause abortion, (d) Food abortion has also been asserted to occur, and every known food has been blamed. The food is alleged to be too rich or too poor in proteins or in water, or it was fed too cold or in improper volume. Much has been charged to damaged foods. Since nearly all foods are damaged some- what, bad food can be made to fit most cases of abortion. Special emphasis has been laid upon foods contaminated with fungi, such as ergot and smut, although I can find no authentic record of experimental or other evidence of the ability of any fungus to cause a healthy female to abort. McCullom, Hart, and others have experimentally shown that, by feeding cows upon a restricted kind of food (the wheat plant alone), although technically all essential food elements were given in abundance, the animals lost vigor, the calves born of these animals were weak and unthrifty, and as the experiments proceeded, abortion ensued, then conception failed, and finally the cows perished. But this is the mere decadence of vigor due to nutritive disturbance. Upon inquiry I was advised that when the experiment cows aborted they commonly had retained fetal membranes, for which up to the present there can be but one explanation — the presence in the uterus of an infection causing placentitis. The facts recorded by McCullom and Hart are of supreme and vital interest to breeders of animals. Practically the food, in a sense, caused the abortion, but the manner in which the food ration acted should be carefully considered. It seems to me evident that bacteria were present in the uteri of the experiment animals (as is commonly true) and that the devitalizing food ration given so lowered the vitality of the animals that the resident infection increased in viru- lence and caused disaster. The contention that all abortions are basically referable to infection is neither an argument Infections of the Ovtim, Embryo and Fetus 497 nor admission that the proper feeding of animals does not play a vital part in reproduction. While abortion occurs only in the presence of intra-uterine infection, infection of both uterus and fetus is common without causing, or visibly threatening to cause abortion. The bacteria commonly pres- ent in the gravid uterus and in the contained fetus cause no visible injury in many cases. If intra-uterine bacteria uni- formly prevented birth, the bovine species would soon be- come extinct. Under good hygienic conditions, if the bac- terial content of the uterus is low, a degree of resistance may be acquired sufficient to hold in leash the bacteria pres- ent. In the presence of menstrual blood or of an embryo, the virulence of the bacteria may increase and injury follow. If the resistance of the animal is lowered by faulty feeding or otherwise, infection within the utero-chorionic space be- comes more active. The amount of food may be deficient or excessive. It may be damaged by fungi. The ration may be badly balanced, or, as in the experiments of McCullom and others, though the food may contain all necessary ele- ments in the quantities technically required, may fall short in variety; then reproduction is faulty or absent. Repro- duction is dependent upon a nutritive surplus beyond other body requirements. If the nutritive supply is barely suf- ficient to maintain the general functions of the body, ova and spermatozoa are not formed. If the nutritive supply is somewhat greater, the reproductive cells form, but tend to perish later, either before or after fertilization. In this de- struction bacteria play an important part. Other factors influence reproduction. Pregnant cows or heifers moved from one establishment to another are far more liable to abort, to calve prematurely, or to suffer from metritis, probably with retained membranes, and the calf is more apt to suffer from dysentery than if the pregnant fe- males had been left at home with otherwise equally good care. The interferences with reproduction are not the re- sult of inferior care nor of exposure to a present infection, but of the lowering of their power of resistance to a present infection. Twin pregnancy is far more liable to interrup- 32 498 Diseases of the Genital Organs tion than the normal single fetus, not because bovine (or equine) twins are unnatural but because the increased drain upon the nutritive supply of the mother lowers her resistance and permits the intra-uterine infection to multi- ply disastrously. However important food and environment may be to re- production, so far as known, bacterial invasion of the utero- chorionic space of the cow is absolutely essential to abor- tion, retained afterbirth, and 99 per cent, of sterility. (e) The biology of ahortion. It is now generally con- ceded technically, though largely denied practically, that abortion may be caused by an unknown variety of bacteria. Any microorganism which may exist within the pregnant uterus, and which is capable of causing metritis and the death of the fetus, may cause abortion. Chronologically the chief infections which have been alleged to cause an im- portant amount of abortion in cows are as follows : (1) The micrococcus and short bacillus of Nocard.^ In his researches Nocard recognized a short bacillus (probably paracolon or paratyphus) and a micrococcus in the utero- chorionic space of aborting cows, and in the digestive tube of the abort. He concluded that one or both organisms found were the cause of abortion in the cases investigated by him. He believed that abortion was primarily a disease of the fetus, but that the infection was derived from the uterus. He further expressed the very important view that, if the invaders failed to kill the fetus, they persisted in the individual through birth into extra-uterine life and consti- tuted the basic cause of dysentery in young calves, thus as- serting his belief in the continuity of infection between intra- and extra-uterine life. The views of Nocard were virtually discarded. Something more striking was being sought and demanded. Lehnert, in 1878, and Brauer, in 1880, believed that they had promptly and reliably induced abortion by experimental infection. In England, also, Woodhead, Aitken, McFadyean, Campbell and others as- lE. Nocard. Avortement epizootique des Vaches. Rec. de Med. Vet., Vol. Ill, p. 669. hifections of the Oviun , Embryo and Fetus 499 serted they had experimentally caused abortion. Nocard had made no such claim for his investigations. Chiefly, if not wholly upon this ground, his work was practically ig- nored. It was everywhere demanded that, ere any given in- fection might be accepted as a cause, or the cause, of abor- tion, its power to cause abortion must be clearly demon- strated experimentally. (2) The nodular venereal disease of Isepponi.^ In 1887, Isepponi, then Canton veterinarian in Chur, published the results of his clinical studies of the hitherto undescribed in- fectious vaginitis which he thought a new and rapidly spreading contagion, and which he believed to be the cause of the serious sterility and abortion in the cattle of his dis- trict. For reasons which seem to me ample, I have placed this among the specific venereal diseases in Chapter XII, where it is discussed at length. (3) The Bacterium Abortus of Bang. In 1896, Bang and Stribolt discovered in the uterus of a cow, destroyed in the act of abortion, a small Gram-negative bacterium which they succeeded in cultivating in gelatin- agar serum. The finding of the bacterium in large numbers in the utero-chorionic space and in the fetal cadaver justi- fied a suspicion that it had to do with the abortion. Bang inoculated seven cows with pure cultures of the organism. Prior to inoculating them, he did not learn whether they would or would not probably abort if left alone, and he did not know, and had no means of learning, whether they al- ready had the bacterium in their uteri. They were presum- ably taken from their normal habitat and placed under ex- perimental conditions favorable to abortion, closely guarded, so that the expulsion of a fetal cadaver would almost cer- tainly be seen. One (14 per cent.) of the seven cows aborted, which rate is no higher than would be expected without inoculation. Her uterus contained a bacterium not differentiable from the one used for inoculation. 'Beitrage z. d. Ursach. d. Unfruchtbarkeit d. Kiihe. Schw. Archiv. fiir Tierheilkunde, 1887. 500 Diseases of the Genital Organs So much emphasis has been placed upon the power of the B. abortus of Bang to cause abortion during the pregnancy existing at the time of inoculation, that a brief review of the recorded evidence is permissible. The Experimental Evidence of the Power of B. Abortus TO Cause Abortion The dictum of Bang', "Through these two experiments we have submitted the complete proof that the bacilli dis- covered by us are the cause of epizootic abortion," has exerted, and still exerts a profound influence upon the cur- rents of thought regarding abortion in animals. Two basic ideas are included in the quotation from Bang. First, abor- tion is a specific, contagious disease, like tuberculosis or smallpox, caused always by one and the same organism and by one microparasite only. Second, the bacillus described by Bang is the cause and the only cause as proven by his ex- periments. For many years the dictum of Bang was generally ac- cepted without reservation. Cattle abortion was regarded as a specific disease apart from all other diseases of cattle, and the B. abortus was considered the specific agent. It is confidently stated that Bang and Stribolt "produced abor- tion in cows with it {B. abortus)"; "The fact seems to be clearly established that the specific cause of infectious abor- tion in cattle is the organism isolated by Bang and Stribolt" ; "That the Bacillus abortus of Bang is capable of producing abortion experimentally in cattle by feeding and by intra- venous injections has been satisfactorily proven by Bang, McFadyean and Stockman, Macneal and Kerr, Good, and others" ; "Abortion disease is a specific infectious disease which is caused by a small germ known as the Bacillus abor- tus of Bang" ; ''The cause of abortion is a short, oval-shaped germ (Bact. abortus)"; "The inoculation of pregnant cattle . . . produces abortion after a variable length of time" ; i"Durch diese beiden Versuche haben wir somit den vollen Beweis dafiir gefiihrt, dass die von uns gefundenen Bacillen die Ursache des seuchenhaften Verwerfens sind." I Infections of the Ovum, Embryo and Fetus 501 s ^ s 1 tn < Q H H < I-) D Z M 00 • * § 5 -^ « § ^ •S31D £ ■ ■ : ■. ; ; ; ^ < .. •jnao aad ' . w 06 g,'5j 5. jers u data meraL pa^ioqv ~ S ■ „ ! CT.N J^ <^ ^ « ''^ ■ ^ saajpH %, ■%■■:::::: I'^-K | -= « S 5. fi g •jnaa aaj r. '.'.'.'.'.'.'.'■■■■■ '^ pa^joqv So 22. pregna) ompari cattle. Ov ■ ■ .0 « • • • ^ :;; SM.03 s, ::::•::::::.: ? n of For c la ted •}n3D J3 ' inm j; SMOO i^ • • ■ ir> ■ m Tj- JJ ,2-"T)- • e e g £ s a . 502 Diseases of the Genital Organs "A microorganism or minute germ (the abortion bacillus of Bang) is known to be the sole cause of contagious abor- tion." Such positive assertions that the specific character of cattle abortion has been absolutely proven experimentally and that the Bacterium abortus is the cause, have served to prevent a critical examination of the evidence which has been alleged to prove the specific abortifacient action of the B. abortus. Most writers upon abortion in cattle refer to the experimental production of abortion in pregnant cattle as the corner stone for the positive statements that the B. abortus is the specific agent in abortion. Little has been written concerning the actual recorded evidence. In the succeeding table the available recorded data of the experimental efforts at producing abortion with the B. abortus have been assembled, with direct and indirect con- trols. Numerous objections may be urged against their fairness. Tabulation demands brevity and inevitably leaves opportunity for misconception. (1) The seven animals consisted of: a. Two pregnant cows inoculated in vagina with pure cul- tures and killed, one nineteen days, the other twenty- nine days after inoculation. b. Two pregnant cows inoculated per vaginam with after- birth from an aborter, the one killed thirty-three, the other thirty-five days after exposure. c. Two pregnant cows, four and seven years old, a second inoculation being made thirty-nine days later, and a third dose twelve days after the second. Seventy-one days after the first inoculation, the seven-year-old cow aborted a five-months fetus. B. abortus and a micro- coccus were found in the placenta. d. A six-year-old cow was inoculated per vaginam with pure cultures. She calved eighty days later. B. abortus bacilli were found in uterine contents of the cow. (2) Out of the twenty-eight experiments recorded by McFadyean and Stockman, Experiments Nos. 7, 14, 15, 18, 22, 24 and 25 (7) were followed by abortion. In Experiment 13 the fetus underwent desiccation following death but was not expelled. Other animals were killed prior to the termination of preg- nancy, and some might have aborted had they not been killed. Lifcctions of the Oviun, Embryo and Fetus 503 (3) Thirty-nine heifers in first pregnancy were alleged to have been chased by a dog. Some months later eleven of them aborted. McFadyean testified that the abortions were not due to con- tagion. (4) These experiments were carried out under the auspices of Sir Stewart Stockman with material furnished by the Board of Agriculture and Fisheries. (5) The nine cows were all recent purchases. Five came from a herd where abortion had raged the previous year and were all pregnant when bought. Two had aborted the previous year, two were sterile or had aborted unseen, and one had calved. After inoculation all aborted. The history of the other four was unknown. Three were pregnant when purchased, the fourth was bred after buying. All nine were recent arrivals on the experimental premises, which increased the tendency to abort. (6) The heavy percentage of abortions in inoculated cows is caused by the high rate of the five cows of Moore, only one of which was known to have calved the previous year. (7) The 100 per cent, of abortions in controls is admittedly of no moment, but, since the one heifer is the only control of which I can find record, the figures are technically correct. (8) The Thurebylille herd consisted of about 130 milk cows and about 30 heifers, and the data extend from 1885 to 1896, in- clusive, or a period of twelve years. (9) The data given here are for uninoculated cows and heifers kept as controls in vaccination against abortion,* as shown in Table IV, page 353, Report Tenth International Veterinary Congress. (10) Owing to errors in diagnosis, Bland unintentionally inoculated five pregnant cows and nine pregnant heifers with living bacilli. (Herd A, two cows, four heifers; Herd M, one cow; Herd Q, one cow; Herd R, one cow; Herd B2, five heifers. Total, fourteen.) (11) The two cows which aborted following inoculation had also aborted in the pregnancy before inoculation. See also (5). (12) Bland, on page 9 of his first report in his experiments to con- trol abortion by vaccinating the non-pregnant animal, kept as "controls" 296 non-pregnant cows and heifers, thirteen of which were not known to have conceived. Bland's percentage of abortion (18.2) is based upon 296 animals, while the per- centage here given (19.1) is based upon 296 — 13, 283 animals. (13) Second report, page 15. (14) In the Bland reports the number of animals of prior year is not given and total under experiment is used, with percent- ages for prior years. 504 Diseases of the Genital Organs (15) The data cover twenty -two years, 217 cows and heifers and the 645 pregnancies recorded. (16) The data cover thirty-one months. (17) The data cover ten years and include sixty-seven cows and heifers. Bibliography I. Bang, Prof. B., Die Aetiolog-ie des seuchenhaften ("infec- tiosen") Vei-werfens, Zeitschrift f. Tiermedicin, Vol. I, p. 241. II. McFadyean and Stockman, Rep. Departmental Com. Bd. of Ag. and Fisheries, Great Britain, on Epizootic Abortion, 1909. III. Testimony of Sir John McFadyean in litigation of Chadwick vs. Gorman, Vet. Rec, March 30, 1912, p. 621. IV. Stockman, Sir Stewart, Epizootic Abortion, Rep. Tenth In- ternational Veterinary Congress, Vol. II, p. 343. V. Bland, G. R., First and Second Reports by the Agricultural Organizer of Oxford County, England, on the Epizootic Abortion Experiments carried out in 27 herds, 1911 to 1916, Oxfordshire, England. VI. Moore, V. A., and Fitch, C. P., Rep. N. Y. State Vet. Col. at Cornell University, 1912-1913, p. 89. VII. Williams, W. L., Rep. N. Y. State Vet. Col. ft Cornell Univer- sity, 1911-1912, p. 79. VIII. Williams, W. L., The Granular Venereal Disease and Abor- tion in Cattle. Bulletin of the U. S. Dept. Agr., No. 106, Sept. 12, 1914, p. 49. IX. Williams, W. L., Abortion and Sterility in Cattle. Rep. N. Y. State Vet. Col. at Cornell University, 1913-1914, p. 136. X. Williams, W. L., Abortion and Sterility in Cattle. Rep. N. Y. State Vet. Col. at Cornell University, 1911-1912, p. 85, Herd A. XI. Williams, W. L., Abortion and Sterility in Cattle. Rep. N. Y. State Vet. Col. at Cornell University, 1911-1912, p. 87, Herd B. XII. Williams, W. L., Abortion and Sterility in Cattle. Rep. N. Y. State Vet. Col. at Cornell University, 1911-1912, p. 87, Herd C. As early as 1912 (VII), I made the following statement: "It has not been clearly shown that a like number and kind of pregnant cattle would not have aborted had sterile salt solution been substituted for the Bang organism." A critical study of the tabulated data bears out this asser- tion: InfecHoiis of the Ovum, Embryo ayid Fetus 505 The 21 cows used for experimental inoculation show the largest ratio (52.4%) of observed abortion. Of the 11 aborters, however, 4 (Bland, 2; Moore, 2) are known to have aborted, and 2 (Moore) were sterile or aborted unseen the prior year. Only 1 of those aborting (Moore) is known to have calved the previous year and 1 (Bang) may have done so. Omitting the 4 known aborters and the 2 sterile cows of the previous year, there remain 15 cows which pos- sibly calved the prior year, and of these, 5 (23.8%) aborted. No controls were kept and the ratio is not sufficiently high to constitute good evidence. It is not known that each of the cows did not, when the inoculation was made, carry in the utero-chorionic cavity an infection capable of causing abor- tion. In the one Moore cow, in the group of 5, this is not merely a possibility but a definite probability, since she came from the same herd as the other 4, none of which calved the previous year. A study of the available records of experimental inocula- tion in heifers, of which it has been possible to assemble 48, shows that 10 (20. 89^ ) are recorded as having aborted. I find only one heifer recorded as having been kept directly as a control — that in my experiment (IX) — and that one aborted. A single case can not be accepted as conclusive nor as valuable evidence, but there is no other way of stat- ing the recorded fact. The question of controls has been ignored. The heifers in the Bland experiments (V) were not in- oculated to cause, but to prevent abortion. The inoculation occurred through error. The heifers were assumed to be non-pregnant at the date of inoculation, but later proved to be pregnant. These are inserted in the table under the as- sumption that the effect was the same whether the inocula- tion was made to cause or to prevent abortion. The virtual controls of Bland — (12), (13) — should be applicable, as they were definitely used as controls in efforts to prevent abortion by vaccination of non-pregnant cattle with living bacilli. 5o6 Diseases of the Genital Organs The more voluminous data regarding the frequency of observed abortions in herds show a higher rate generally than that recorded in experimental inoculations. The ex- ception is the data submitted by Bang showing but 7 per cent, in cows of the Thurebylille herd. When the data upon heifers in first pregnancy are examined, it is found that under the prevailing conditions in herds the ratio of ob- served abortions ( 52.55 ^v' ) is far in excess of the recorded abortions following experimental inoculations. When cows and heifers are taken together, the observed abortions (19'70 are but 1.08 per cent, below the ratio reported in the experimentally inoculated animals. The objection to these data may be urged that they are from "infected" or "badly infected" herds, but no data are available from non-infected herds. One often hears of non- infected herds, but any attempt to get in contact with such and secure accurate data for record leaves one with the feeling that he has been pursuing a mirage. If there are herds in which no abortions occur and in which each cow or heifer of breeding age produces a healthy calf each twelve months, the failure of those having knowledge of the facts to publish the details serves as an impassable barrier to their use. The question can be judged or decided only upon the available recorded data. The further and pertinent objection may be made that in many of the experiments the animals were destroyed prior to the termination of pregnancy and that some or many of these might have aborted had they not been killed. But it would be equally erroneous to pick out from the total those animals kept until after termination of pregnancy and ac- cept the results in this group alone. The probability of abortion decreases as the duration of pregnancy advances : the disease may be present and severe but may result in premature birth, in retained afterbirth, or in calf scours or pneumonia. On the other hand, it may be very properly maintained that the animals slaughtered prior to the termination of pregnancy were generally held beyond the alleged "period hifedions of the Ovum, Embryo and Fetus 507 of incubation" of the abortion infection and should mostly, according to the constructive standards of various experi- menters, have aborted prior to slaughter if they were to abort. Some investigators have also argued that the finding of the B. abortus in the uterine cavity of the killed animal is experimental proof that it is the cause of abortion. If that is true of the B. abortus, then it must be equally true of all the other microparasites found in the uteri of pregnant cows. It can be experimentally proven that a given organ- ism causes a coiv to abort only by those cases ivhich actually abort. It is not necessary to produce infection of the utero- chorionic space in a pregnant cow to show that the B. abortus is capable of causing such infection ; Bang proved that in the first cow in which he recognized the bacillus. If it existed and multiplied in that cow, it follows, a priori, that, implanted in another pregnant uterus of identical species and power of resistance, it would cause infection again. It has been attempted to apply to abortion the postulates of Koch who assumed as a basis for experimentally proving the specific character of a bacillus: (1) The organism needs to be obtained in pure cultures. (2) Inoculation of a sound animal with pure cultures must cause the typical symptoms and lesions observed in naturally infected ani- mals. (3) Pure cultures of the organism must be recov- ered from the tissues of the experimentally inoculated and diseased animal. Koch's postulates are inapplicable to abortion in cattle because the abortion is not the disease nor is it a lesion ; it is merely one of the possible occurrences in the course of a disease having the power to destroy the life of a fetus and to irritate the pregnant uterus in a manner to cause it to expel the fetus. While the data submitted fail to justify the dictum of Bang and others that the inocu- lation of a pregnant cow or heifer with the Bang organism will cause her to abort during the existing pregnancy and thus prove that the B. abortus is the specific cause of abor- tion in cattle, it is not proof that such inoculation is without 5o8 Diseases of the Genital Organs injurious result. Neither does it prove, nor tend to prove, that abortion is not sometimes or frequently caused by the Bang organism. I have long held that any attempt to prove experimentally that a given organism is the cause or a cause of an abortion occurring during the pregnancy in which the inoculation was made, is unwarranted and misleading. When Bang discovered the bacterium which he described, he definitely showed that it was an intra-uterine and fetal infection. No beneficent office could be ascribed to it. If capable of ex- isting in vast numbers in the one cow and fetus, it might equally well exist in equally great numbers in other uteri and fetuses of the same species and of similar constitution. There was present metritis, for which, under ordinary sur- roundings, no cause except infection is known. Bang recog- nized in the uterus an infection. If this was the only bac- terium present or recognizable (upon which point Bang is not clear) the only justifiable conclusion at which he could arrive was that the bacterium in question was the cause of the abortion. Bacterial search of the uterus of another aborting cow in which some other microorganism was found would not vitiate nor influence the conclusion reached upon the one described. Abortion is not a disease nor the symptom of any one dis- ease. So far as the fetus is concerned, abortion is death, and death is a result common to all diseases. The fact that an adult dies is not proof that it has anthrax, and the fact that a fetus dies is not proof that it was killed by B. abortus^ In so far as the pregnant female is concerned, abortion indi- cates endometritis at the cervical end of the uterus. Me- tritis exists in non-pregnant and pregnant heifers, in preg- nant cows, in cows in the puerperal stage and during the interval of rest between a period of calving and the next conception. The character of the metritis which may occur at any period in the life of the female varies infinitely and the number of bacteria capable of causing the metritis is unknown. A few instances of metritis stand apart, such as that of uterine actinomycosis and tuberculosis. They 1 Infections of the Ovum, Embryo a^id Fetus 509 are specific. But the metritis met in essentially all cases of abortion bears no mark by which it can be assigned to any one bacterium. Consequently if several bacteria are pres- ent, there is nothing in the metritis to indicate which of the invaders is responsible. Any contagion competent to injure or destroy an adult may, so far as known, equally imperil the life of an ovum, embryo, or fetus if contact occurs. The vast majority of infections do not and can not reach the intra-uterine young. The opening of the genital tract through the vulva is her- metically sealed at the cervical canal by the uterine seal. It is not known, and there is no reason to suspect, that bacteria can traverse the cervical canal and enter the utero-chorionic space of the pregnant cow while the uterine seal is intact. The mammalian placenta, so long as intact, is not known to permit the passage of any form of pathogenic organism. It has not been shown that any disease-producing organism passes during pregnancy from the blood system of the mother into the utero-chorionic space. Infection is not known to invade the uterine cavity of the pregnant female through the oviducts. There is accordingly no portal of entry into the sealed uterus of pregnancy through which bacteria have been known to enter. The orthodox con- tagious-abortionists positively assert that the B. abortus enters the uterus during pregnancy, but avoid stating by what avenue the invasion occurs. I have held that the infections which prevent or interrupt reproduction invade the uterus prior to the sealing of the cervical canal ; either the infection was present in the uterus at the time of coitus, or it was introduced during that act. The frequency of abortion in a herd usually corresponds fairly well with the intensity of infection by B. abortus. In those herds where abortion and other interferences with reproduction are common, the agglutination and comple- ment-fixation tests usually show intense infection with B. abortus. But such reactions can only show that the B. abortus is somewhere active (or has been active) and can not show that it caused a given abortion. If such tests 5IO Diseases of the Genital Organs could show that B. abortus has caused a given abortion, a typical reaction of an aborting cow to the tuberculin test would show that the abortion was due to the infection of tuberculosis. I have seen a high B. abortus agglutination reaction in a sterile heifer never known to have conceived, in which, upon autopsy, B. abortus was recovered from the udder but not from the genital tract. The sterility was ap- parently due to streptococcic salpingitis. Doubtless her blood would also have reacted strongly to the streptococcus. In the researches in my department, the blood of cows in which harmful genital infections exist reacts to several species of bacteria, such as paracolon and streptococci, but the reactions show merely the presence of such bacteria somewhere in the body, and can not show that they cause sterility or abortion. The agglutination test for the pres- ence of B. abortus is in itself fundamentally defective. I injected living B. abortus cultures in the jugular vein of a two-year-old pregnant heifer. She probably already had B. abortus in her utero-chorionic cavity. The agglutinating power of her blood was followed from 0.02 up to 0.001 and in its descent until minus at 0.02. Then she aborted and was promptly destroyed. Her blood was negative at 0.02, and her uterus was swarming with B. abortus. A vital defect of the agglutination test for the presence of B. abortus is the total absence of knowledge of the physi- ologic agglutinating power of bovine blood. Some consider an agglutination at 0.02 as proof of infection ; others place the infection-point at 0.01. As a rule the blood of new-born calves is negative at 0.1 and can be held there experimentally as long as I have cared to do so. If the calf is fed in the or- dinary manner, its blood commonly reacts positively at 0.1 or higher within thirty days. I have seen it react at 0.002 at thirteen days. The common practice of fixing upon 0.02 or 0.01 as denoting infection is absolutely arbitrary and un- supported by any recorded attempt at justification. There is no more reason for believing that agglutination at 0.02 or 0.01 denotes infection than for declaring that agglutina- tion at 0.04 or 0.1 indicates infection. Infections of the Ovum, Embryo and Fetus 511 (4) The Paratyphoid Bacillus of Moussu^ Moussu declares, apparently upon adequate grounds, that in a large section of France much abortion is due to a short bacillus of the colon group. The B. abortus is absent. (5) The Spirillum of Smith- and Others Smith, in studying a series of aborts from a large dairy herd, obtained pure cultures of B. abortus in 27 (66%) and a spirillum or vibrio in 14 (349^ ). In other aborts Smith failed to find either the B. abortus or the spirillum, but rec- ognized bacteria belonging to the colon and other groups. The lesions in the aborts did not vary with the variations of the bacteria present, but were fundamentally alike in all. (6) Miscellaneous Bacteria Isolated cases of abortion have been attributed to various bacteria other than those mentioned above. A few have been attributed to B. pyogenes. Bacterial search of the tubo-utero-cervical canal reveals a great variety of infec- tions present in non-pregnant and pregnant animals. A streptococcus of the viridans group is dominant apparently in serious tubal infections and perhaps plays an essential role in the necrosis of the apices of the embryonic sac. Probably it causes the death of many fertilized ova and of embryos. F. The Nature of Abortion The belief that abortion is generally due to a specific con- tagion of the pregnant uterus and its contents, inevitably involves the belief that the infection can not exist in the gen- ital tract prior to conception and that it must cease to exist with the termination of pregnancy. Neither can the alleged specific infection cause other results than abortion. Hence the orthodox believer in the specific character of abortion de- iProf. G. Moussu. Sur I'Avortement Epizootique. Tenth Internat. Vet. Cong., 1914. -Theobald Smith. Spirilla associated with Disease of the Fetal Membranes in Cattle. Jour. Exp. Med., Dec. 1, 1918. 512 Diseases of the Getiiial Organs nies that the infection, sometimes leading to abortion, can cause sterility, retained afterbirth, or metritis other than the specific metritis of contagious abortion, which must cease to exist at the termination of pregnancy, to be succeeded by another metritis due to other infection. So with the fetus and the calf. The fetus is invaded by "the specific infection of contagious abortion," but after the calf is born such in- fection must terminate, though the calf may promptly die from sepsis, dysentery, or pneumonia, and though bacteria which can not be differentiated from those existing in the digestive tract of the fetus are present in that of the new- born calf and apparently cause the serious or fatal disease. This group of writers use constantly the definite article "the" in connection with the alleged specific contagion, thus excluding all other infections or contagions as possible causes of abortion. That is, if the B. abo7'tus of Bang is the cause of contagious, infectious, or epizootic abortion in cattle, no other infection or contagion can act as a cause or as one cause of abortion. If the B. abortus of Bang is the cause of contagious or infectious abortion of cattle, then the statement of McFadyean and Stockman, that in one preg- nant cow which they destroyed they found uterine tubercu- losis which would soon have caused abortion without the presence of B. abortus, is erroneous. If B. abortus is the cause, B. tuberculosis can not be a cause of abortion. But that is resting the case upon what some may designate a technicality. More pertinent to the discussion is the state- ment of McFadyean and Stockman : "It is of great im- portance to note, however, that two natural outbreaks of vibrionic abortion, one in Ireland and one in Wales, were met in cows." (Abortion in Sheep, Part III, page 9.) The more recent finding by Theobald Smith, in this country, of spirilla in aborted bovine fetuses, without the B. abortus, is equally to the point. If B. abortus is the cause of contag- ious, infectious, or epizootic abortion in cattle, then either the vibrio of McFadyean and Stockman and the spirillum of Smith did not cause the abortions attributed thereto, or the abortions so caused were not "infectious," "contagious," or "epizootic." Infections of the Ovum, Etnbryo and Fetus 513 The second group, to which the writer belongs, holds that abortion is not a specific contagious or infectious disease like glanders or hog cholera, but that any infection resident in the cervical end of the uterus, or which during pregnancy invades the uterus, may, amongst other results, cause abor- tion. According to this view there are two essential factors in the causation of abortion : the infection must destroy the life of the fetus (asphyxia or inanition due to placentitis, or sepsis due to bacterial invasion of the fetus), and must arouse such an irritation of the uterus (localized metritis at the cervical end) as to cause it to contract and expel its contents. Any infection capable of bringing about these two conditions may cause abortion, be it the B. abortus, the bacillus of Nocard, the colon organism of Moussu, the vibrio of McFadyean and Stockman, or the spirillum (vibrio) of Theobald Smith. Under this conception, there is no limitation upon the number of species of microparasites which may cause abor- tion, no restrictions upon the variety of lesions and results of lesions which the infection may cause, and no obligatory period of invasion or disappearance fixed for the infection. This conception offers many analogies to wound infection. In wound infection there is an extended variety of organ- isms, each capable of producing inflammation, suppuration, ulceration, necrosis, wound fever, etc. The microorganisms are normally present upon the body surface and under or- dinary conditions cause no visible harm to the individual. When, however, the protective epithelium is destroyed by physical violence, chemical irritation, or in various ways, the bacteria upon the surface are pushed into, or otherwise enter the damaged tissues and wound infection occurs. The lesion which constitutes the avenue of infection may be visi- ble or invisible to the unaided eye. The epithelium may be destroyed or merely so damaged that it wants the power re- quired to resist the attack. A knowledge of the identity of the invading organisms is of great interest but not a vital necessity to the surgeon. The measures which will exclude streptococci will serve also 33 514 Diseases of the Genital Organs to bar staphylococci. If the wound is already infected, the surgeon uses the same means to remove or to destroy micro- cocci and bacilli. In special cases the surgeon may fear tetanus infection and take special measures against it, but that he classifies separately as a specific infectious disease. Each individual carries upon his body surface bacteria com- mon to other individuals. A moderately extensive list can be made of the most prevalent types competent to cause wound infection. In every part of the genital tract microorganisms are com- mon throughout the life of the individual. When estrum occurs, the genital mucosa is engorged and its epithelium weakened. If conception fails, menstruation follows, with denudation of the placental areas and an outflow of blood. The denuded areas furnish an avenue of invasion and the blood clots supply nutritive material for the bacteria pres- ent. Should conception occur, and the fertilized ovum de- , scend into the uterus, it encounters the microorganisms in- festing the cavity. The embryo has acquired no power to resist invasion, with the result that bacterial activity is ad- vanced. Then follows a definite metritis. As soon as the fetal organs have developed, the infection passes through the chorion and amnion into the amniotic fluid and is swal- lowed by the fetus. Accordingly the bacteriologic findings of Hagan, Carpenter, and others working in, or in collabora- tion with this department, show parallel infection in the non-gravid uterus, in the utero-chorionic cavity of the preg- nant uterus, and in the fetal alimentary tract, and later when the calf is born the same bacteria are recoverable from its stomach and intestines. There is then a continuity of infection in the mother and the intra-uterine invasion of the fetus. The results of the infection or infections upon the mother, fetus, and new-born calf will logically vary with their vol- ume and virulence. If very severe in the non-pregnant uterus, conception fails. If the infection is milder and con- ception occurs, metritis may follow and so irritate the uterus that it contracts and expels its contents. If the in- hifedions of the Ovum, Embryo and Fetus 5x5 fection has killed the fetus, and it is expelled, the result is known as abortion. If the fetus lives and is carried the full term of gestation and is then expelled, there is metritis pres- ent and perhaps retained afterbirth. The expulsion of the fetus leaves a denuded uterus. If the afterbirth is retained, it is immediately necrotic and decomposes. Then follows an aggravated metritis. It is not a new disease, but a con- tinuation of a metritis which existed during pregnancy, ac- celerated in its course by the uterine denudation of calving or abortion, aggravated by decomposing afterbirth. The infected calf when born may break down with calf scours or pneumonia. It is not usually a new disease or a new in- fection but the continuation of an infection acquired during intra-uterine life. During the course of the dysentery, the alimentary epithelium is damaged or destroyed, permitting the invasion of the body fluids by the bacteria causing the intestinal disease. If the calf suffers from pneumonia, the pulmonary epithelium is damaged or destroyed and bacterial invasion occurs. The infection had its habitat in the pregnant uterus, and thence passed to the digestive tract of the fetus. In the new-born calf apparently the infection passes through the damaged digestive or pulmonary epi- thelium, enters the body fluids, and, having an affinity for the genital tract, regains its habitat there and persists, to interfere later with first pregnancy. According to this con- ception, the infections of which abortion is one significant result constitute an endless chain. They may be intensified in the uterus of the cow just after parturition or abortion and additional infections from the exterior be added. The infection in the new-born calf may be minimized or intensi- fied by proper or improper feeding, or additional infection may be supplied to the calf by association with badly dis- eased calves or by taking milk contaminated by virulent discharges from badly diseased cows. On the other hand, the belief that abortion is a specific disease denies the endless infection-chain above described and regards sterility, retained afterbirth, calf scours, and pneumonia as associated or concurrent diseases, but recog- 5i6 Diseases of the Ge7iital Orgayis nizes no identity, continuity, or causal relationship. Each must then be handled separately as distinct maladies, in- stead of dealing with the entire list as one group, each hav- ing a continuity with the others. As in wound infection, so in the infections in which abor- tion occurs, while no limit can be placed upon the number of microparasites which may act as the causal agent, certain varieties are commonest. Thus in abortion, in one area, the B. abortus may be the predominant cause; in another, a streptococcus; and, in a third, a spirillum. In a given ani- mal or outbreak, B. abortus may be the cause, but in abor- tion generally it is merely a cause. Some believers in the specific character of abortion, when forced by recorded facts to admit that abortion may be, and is, due to various organisms, attempt to evade the difficulty by proposing the name "abortion disease" or "Bang's disease" instead of the equally misleading terms of "contagious," "infectious," or "epizootic" abortion. But that does not help matters. It is still desirable to learn how large a part of the abortions are evidently due to the B. abortus, and how much to other or- ganisms. The second conception of the nature of abortion permits the handling of the group of infections as a whole. The losses can be minimized only by breaking or weakening the endless chain of infection at its most vulnerable point, which, it is held, is at the commencement of the life of the individual. It has been advised that the genital organs of both sexes should be as clean as practicable at the time of copulation in order to favor conception. When fertilization has occurred, it is important that the uterine cavity be clean, so that metritis and infection of the fetus may be avoided. When the calf is born it should be so handled that the infec- tion it may have acquired in the uterus shall be restrained or eliminated, and that no fresh infection shall menace the calf through contaminated milk or other foods, or by inti- mate association with badly diseased calves. For example, the veterinarian handling cervicitis sees before him unmis- takable and severe inflammation due to some form or forms l7ifectio7is of the Ovtim, E^nbryo ayid Fetus 517 of infection. No matter what the identity of the infection may be, the problem which he faces is disinfection, and he elects that method which, in the present state of knowledge, promises the best results. G. Symptoms and Diagnosis The symptoms and diagnosis of abortion are essentially included in the definition given — the observed expulsion of a fetal cadaver. The symptoms are those of parturition ab- breviated. In early pregnancy there is no sinking of pelvic ligaments, no enlargement of mammae, no marked dis- charge from the vulva, no visible effort at expulsion. When abortion occurs late in pregnancy, the pelvic ligaments may sink as in parturition, the mammary gland may be en- larged and the vulva may become tumefied. But any of these phenomena may occur from other causes. After about the fifth month of pregnancy, in addition to the observation of the expulsion of the fetal cadaver, there may be retention of the fetal membranes, indicating that abortion has occurred or that abortion is then in course. Abortion may be suspected or determined with confidence upon other grounds. In the regular control of reproduc- tion in cattle, pregnancy may be reliably diagnosed at thirty to sixty days after coitus. If the diagnosis is clear and definite, as it should ordinarily be, and it is later de- termined that the pregnancy has ceased to exist and the ani- mal has not calved, it is clear she has aborted at some time between the two dates of observation. The diagnosis of pregnancy may be fairly secure upon other grounds than clinical examination. If a cow or heifer is regular in her estrual cycle, is bred, does not men- struate after coitus, and estrum fails to recur at the regular interval, it is good evidence that she is pregnant. If, after a lapse of forty to ninety or one hundred days, estrum re- curs, it is probable that an embryo has perished and has been expelled. There are numerous other conditions which may present the same history, but abortion is by far the most probable explanation. 5.1 8 Diseases of the Genital Organs H. The Date of Invasion The infection which causes abortion invades the uterus prior to the establishment of the uterine seal. The ortho- dox believers in a specific contagious abortion have stoutly contended that the infection commonly invades the uterus, fetal membranes and fetus after pregnancy has become es- tablished, the placenta has formed and the cervical canal has become hermetically sealed. As already related, they have attempted to prove, and believe they have proven their contention by experimentally causing abortion in an existing pregnancy. In the cow, as discussed in preceding pages, the experimenters have kept no checks or controls and their experimental inoculations have been followed by no higher rate of abortion than is commonly observed in uninoculated animals. They have further attempted to prove that a pregnancy already established can be inter- rupted by artificial infection of pregnant animals of other species. But, as with cows, no control animals have been kept. The rate of abortion following inoculation has not been remarkably higher than common in the species used, and there is no evidence that an equally high ratio of abor- tion would not have followed the injection of a sterile, inoc- cuous substance. It is a perfectly well known clinical fact that the various species of domestic animals commonly co- habit on farms. Horses, cattle, swine, dogs and cats are in intimate contact, but cohabitation fails utterly to cause the spread of abortion from one species to another. If abortion were spread by the means alleged by the believers in "contagious abortion" such as the eating by pregnant animals of food which has become contaminated by the dis- charges from an aborter, by the infection carried upon the boots, hands and so forth of attendants, or by the mere presence of an abortion, an abort, or the afterbirth of an abort in a stable or a field, an outbreak of abortion in one species would be the signal for many pregnant animals of whatever species to abort. The recorded evidence of the transmission of "contagious abortion" of cows to all species Infections of the Ovum, Embryo and Fetus 519 of domestic animals should, before it is accepted as proof, be supplemented by a new and extensive series of experi- ments with adequate control animals. Until this is done, the controversy over the date of invasion of the infection causing abortion can not be satisfactorily settled. I have held that there are two notable and important dates of invasion — the intra-uterine infection of the fetus and the time of coitus in adults. The latter has already been consdered earlier in this chapter (I — Infections of the Geni- tal Organs of Bulls). The first will be considered later (III — The Congenital Infections of Calves) . I. The Control of Abortion Under the views already expressed, abortion can not be directly prevented or controlled, nor is there need for such prevention or control. Being neither a disease nor a symp- tom of any one infection, it demands no separate considera- tion. It can be prevented only by the control of the infec- tions within the genitalia of both sexes. These are consid- ered elsewhere. When abortion came to be looked upon as a specific con- tagious disease, veterinarians and cattle breeders hoped for a definite remedy. Before it was believed that the cause of abortion had been determined, Brauer (1889) thought he had discovered a specific remedy in the subcutaneous injec- tion of 2 per cent, carbolic acid to pregnant cows and heifers. Highly favorable statistics were submitted by Brauer and his followers in support of the new remedy. The researches were without controls and very inaccurate. Apparently the carbolic acid was given in herds where there had recently been an "abortion storm," in which a notable decrease was to be expected, or, as occurs frequently, a few animals had aborted, all or nearly all of those which were in line to abort, and then the remedy was given. Naturally there would be no more abortions. But the career of the alleged cure was short and it was soon found that if the utero-chorionic space of a pregnant cow was highly infected and contained 520 Diseases of the Genital Organs a large volume of exudate, she would probably abort, and that carbolic acid, hypodermically or otherwise, exerted no recognizable influence. The belief of Bang and his followers that he had discov- ered the specific cause of abortion immediately aroused high hopes that a definite remedy would follow. It was believed by Bang that the discovery of the cause would be followed quickly by a cure or by some means for control. The vast majority of investigators and breeders have concentrated their efforts since 1896 upon finding a remedy for abortion, based upon B. abortus as the specific cause. There has been no more lamentable failure in the annals of veterinary medi- cine than the attempt to control abortion as a specific con- tagious disease due to the B. abortus of Bayig. The infec- tions in the genital tract of cattle have increased enormously in virulence in every country. In America numerous herds of pedigreed cattle of potentially great value do little more than maintain their numerical status. Death and disability from genital diseases of females of breeding age consume practically all heifer calves reared in the herd. The sur- plus bull calves carry into the herds where they are sold virulent infections with which they are saturated at birth. Despite this evident, pitiably disastrous failure, many in- vestigators, veterinarians and breeders are clinging tena- ciously to the belief that abortion in cattle is a specific con- tagious disease due to the B. abortus and that its control is to be brought about upon that basis and that alone. After the failure of the Brauer plan with carbolic acid. Rich of Vermont believed for a time that he had discovered an efficient systemic disinfectant in methylene blue, but the error was promptly recognized and the plan abandoned. Attempts to disinfect the contents of the pregnant uterus are contrary to all existing knowledge of its physiology and that of the embryo. Experiments show that aniline dyes, like methylene blue, do not reach the embryo, but are caught or turned back at the placenta. It is not known that any disinfectant can pass the placental filter in a manner to ex- ert practical influence. In abortion most of the infection is Infections of the Oinim, Embryo and Fetus 521 in the utero-chorionic space. Into this space it is not known that any disinfectant borne in the blood ever enters. It probably does not. Even should a disinfectant leave the blood stream and enter the utero-chorionic space, it is in- conceivable that sufficient w^ould enter to disinfect. The en- dometrium of a pregnant cow at full term represents ap- proximately fifteen square feet of mucous membrane, op- posed to which is the somewhat smaller surface of the con- tiguous chorion. Between the two there exist, in badly in- fected cows as revealed in the abattoir, from a few ounces to several quarts of "abortion exudate." It must require great confidence in the potency of disinfectants to believe that a sufficient quantity can enter the utero-chorionic cavity to disinfect it, or pass the placental filter and, after coursing through the fetus, be poured into the fetal alimentary canal and disinfect the meconium. The employment of disinfec- tants in this apparently hopeless manner has been virtually abandoned — permanently, it is to be hoped. The generally accepted theory that abortion in cattle is a specific contagious disease led many of the subscribers to that belief to hope for a specific remedy in the form of a serum, bacterin, vaccine, or other biologic substance. Nota- ble achievements in this field had been made in a number of diseases of man and animals and it was assumed that in abortion a similar victory was probable. The achievements in the biologic control of disease have been chiefly among those maladies designated as acute, in which a definite immunity follows the recovery of the pa- tient. In chronic infections little progress has been made in biologic therapy, apparently because the success of these products is dependent upon their power to produce that state known as immunity. Infectious diseases are divisible primarily into acute and chronic. In acute infectious dis- eases the infection and the patient can not long coexist. Either the infection kills the patient or there develops with- in the body of the patient substances which destroy the infection and which thereafter prevent, for a variable pe- riod, re-infection. This is known as immunity. In chronic 522 Diseases of the Genital Organs infections, such as tuberculosis and syphilis, the patient may survive indefinitely and the infection continue in viable form. The system of the patient acquires a power of re- sistance to the ravages of the infection, but not the power commonly to destroy it or to prevent reinfection. Those who regard the B. abortus as the specific cause of abortion in cattle hold confused views as to whether it is acute or chronic. Those who claim to have induced abortion experimentally, constructively hold that it is an acute in- fection. Some believe that they have induced abortion in five to ten days. At first that was the general belief. Bang in his first experiments believed he was dealing with an acute infection having a short incubation period. Experi- menters believing in the specific character of cattle abor- tion generally hold that it is an acute infection for guinea pigs: that is, if the B. abortus is injected into a pregnant guinea pig, she will abort in five to ten days. Numerous in- vestigators now hold that the B. abortus infection is virtu- ally an acute infection in the uterus and a chronic infection in the mammary glands. That is, the infection can not in- vade the uterus until pregnancy is definitely established, and can not continue in the uterus for more than a few days after the termination of pregnancy. They further hold that, after one fetal cadaver has been expelled, the uterus acquires an immunity and the B. abortus can not again readily invade it and cause a second abortion, but the mam- mary gland, once invaded, is permanently infected. Schroe- der thinks that the mammary gland is the permanent hab- itat of the B. abortus and periodically, during pregnancy, the infection may in part pass from the mammae to the uterus, cause abortion, and then promptly disappear from the uterus. It is reasonably well established that the B. abortus may be a permanent resident of the milk glands. So far as I have seen recorded, it has not been searched for elsewhere than in the genital canal and milk glands. One cow in my experimental herd, now ten years old, was inocu- lated in the jugular in her first pregnancy at about seven- teen months of age. She was probably already infected hifedions of the Ovum, Embryo a7id Fetus 523 h O < z: o h cr o £0 < r > 2: lU o or Ql dJ -J < I lU IL iu ^ I I- °^ T i2 ^ ; o o c ^ -c^rO'^'n^D'X >0(! ^ "^■^ ^4 .^ ^^I ^J V^3 ^ ^^^. ^ % ^ ^ ^1 cO cfl q