perforated drainage tube to the end of the vagina, and connecting it
with a syringe, or, better, with a small cistern hung from the wall,
which allows the required pressure to be obtained.
When there are deep and severe wounds, the parts should be washed out
once or twice daily and the vagina should be packed with surgical wool
and iodoform gauze. The septic liquids are absorbed by the dressing,
which acts continuously. This dressing is renewed until recovery takes
place.
CONTAGIOUS VAGINITIS.
During the past few years certain observers have described a disease
which has been termed “contagious vaginitis,” in consequence of the
facility with which it is transmitted.
This vaginitis may be transmitted by copulation, the bulls then serving
as propagators of the disease. The bulls themselves are usually affected
with balanitis.
The causative agent of the disease is unknown.
This contagious vaginitis is characterised by all the symptoms of acute
vaginitis, and it is only from the fact of its appearing in all the
animals served by one bull that its contagious character is established.
A short time after service the vulva appears swollen and extremely
sensitive; at the same time general disturbance appears, viz.,
diminution of appetite and of milk secretion, slackening of rumination,
etc.
Vaginal exploration, which is somewhat difficult, reveals a
papulovesicular eruption, accompanied by a muco-purulent discharge.
This vaginitis is easy to diagnose. It may disappear spontaneously, and
the treatment differs in no respect from that of ordinary acute
vaginitis.
CROUPAL VAGINITIS.
Croupal vaginitis is a form of acute vaginitis, from which it is
distinguished by the formation of false membranes resembling those of
diphtheria over the whole of the vaginal mucous membrane.
It was described by Baumeister. Moussu has only seen one case, and that
at a period which rendered recovery out of the question.
=Symptoms.= The external symptoms are those of acute vaginitis, with
greyish, fœtid, purulent or sanguinolent discharge. On examination, the
mucous membrane is found to be covered with yellowish, greyish false
membranes, and with vegetations of a greyish, dirty, verrucous
appearance. The entire extent of the vaginal mucous membrane may be
attacked, together with the neck of the uterus. In Moussu’s case the
uterus itself was entirely invaded.
These false membranes and vegetations are very adherent, and bleed
freely at the slightest touch. They are apt to extend by degrees.
The cause of this infection has not yet been determined. It appears to
obtain access to the parts during parturition, and develops insidiously
for a week or two, when widespread lesions have already formed.
=The diagnosis= is extremely easy.
=The prognosis= is grave, for the lesions have a tendency to extend
towards neighbouring organs. Moreover, the general health is severely
affected; there is rapid wasting, loss of appetite, and continued fever
and death occurs from exhaustion, intoxication, and possibly infection.
=Treatment.= The treatment suggested for the ordinary acute forms
appears to be useless in this condition. The new membranes show too many
folds, depressions, and accidental culs-de-sac for simple injections to
have any real effect. Better results might be expected from packing with
antiseptic gauze or from the use of antiseptic ointments applied after
washing out the cavity with permanganate of potash solution or hydroxyl.
Curettage, followed by the use of gauze dressings, might also be tried;
considerable difficulty must necessarily be anticipated in operating in
a cavity which has become inextensible and partly filled with
vegetations and false membranes.
CHRONIC VAGINITIS.
Chronic vaginitis usually represents the last stage of some form of
acute vaginitis, though it occasionally develops in a slow and
progressive fashion as a primary condition in consequence of some
deep-seated genital lesion. There is usually a constant discharge of
irritant material.
The symptoms are not very striking, and are purely local.
Externally all that can be detected is a continuous or, much more
frequently, an intermittent muco-purulent discharge from the vulva,
which occurs only on urination, defæcation, coughing, etc.
Locally, examination with a speculum discloses the fact that the mucous
membrane is of a greyish colour, thickened, less yielding than usual,
and in places sclerosed. The entire thickness of the mucous membrane is
affected, as also at times the muscular tissue, chronic irritation
having caused sclerosis.
The =diagnosis= is very simple, and the =prognosis= of no particular
gravity, because the animals can always be fattened. The condition is
only grave as regards animals intended for breeding.
=Treatment= is often very successful, but, as in all chronic diseases,
it extends over a considerable time. Practically it is not often
attempted. It does not differ greatly from that of ordinary acute
vaginitis, but the best results seem to follow the use of astringents.
METRITIS.
Infectious or traumatic diseases of the uterus are of the greatest
importance in bovine pathology, both on account of their frequency and
gravity. They comprise septic metritis, acute metritis, and chronic
metritis.
SEPTIC METRITIS.
Septic metritis is also termed “metro-peritonitis” and “parturient
septicæmia.” It may be compared with puerperal fever in woman.
These terms are sufficiently explicit to indicate that if at first the
metritis is typical it frequently becomes complicated with peritonitis,
and too often also with true septicæmia.
=Causation.= The disease only appears after parturition or abortion, and
during the few days immediately succeeding delivery. Parturition may
occur spontaneously in a perfectly regular and easy manner, and
nevertheless be followed by fatal metritis as a consequence of
infection. Usually the labour has been difficult, and the after-birth,
or portions of the fœtal membranes, have been retained. Septic metritis
then develops in consequence of their putrefaction.
Infection with microorganisms is therefore the essential cause, and the
only one of importance. None of the conditions formerly invoked can do
more than favour or check the course of this infection.
Moreover, the subsequent complications are entirely due to the special
character of the infective agent.
These infective agents may be of various descriptions. They have been
the subject of numerous investigations, on account of the gravity of
puerperal fever in woman. Pasteur, Colin, Chauveau and Doléris were the
first to take up this question. In veterinary medicine several inquiries
have been instituted, but a great deal remains to be done. The most
frequent agents are varieties of streptococci, of the colon bacillus,
and of putrefactive bacteria.
Septic metritis may occasionally be purely accidental and only affect
one animal, but infection of stables by a primary case is an obvious
cause of propagation. Moussu has seen six animals successively die of
septic metritis in one year, and in a stable which had not been
disinfected after each death.
=Symptoms.= The first symptoms occur between the first and fourth days
after parturition, when the uterine mucous membrane is still tender,
discharging and bleeding, and the lochial discharge is abundant. The
disease rarely appears after the first week. The earliest symptoms are
dulness, depression, loss of appetite, and general weakness. The animals
appear exhausted, the secretion of milk is diminished or altogether
suspended, and all the chief functions of the body are interfered with.
The temperature varies in a peculiar and significant way. In some forms,
due to infection with streptococci or to mixed infection, it rises to
104° or 105° Fahr.; in others it remains stationary or falls below
normal. It might be thought that in these latter cases, which are
usually due to infection with the colon bacillus, the general condition
was not grave. This, however, would be a very serious error, for in such
cases death follows as rapidly as in the others.
The patients, or some of them at least, have slight colic and peritonism
when the infection extends to the peritoneal pockets at the entrance to
the pelvis. At a later stage they appear prostrate, remain lying, and
seem to be suffering from paralysis of the hind quarters.
None of these general symptoms are in themselves significant, and to
appreciate them at their true value the local signs must be taken into
account.
The external genital organs are moderately swollen, the vagina is
infiltrated and sensitive, and is soiled by exudate of varied character.
The neck of the uterus is sometimes prematurely contracted after the
first or second day, constituting a troublesome complication both in
examining the parts and in treatment. When, however, it is dilated and
the hand can be passed, it is found that the uterus itself is not
contracted or is only half-contracted, and that it is filled with a
reddish-grey liquid of putrid appearance, sometimes without smell, at
others fœtid or even putrid.
The uterine mucous membrane is infiltrated, thickened, and extremely
fragile, partially destroyed, and breaks at the slightest touch. The
cotyledons may become loosened by necrosis, and accumulate in the
depression formed by the gravid horn of the uterus; otherwise they may
be detached without difficulty.
When the neck of the uterus is prematurely contracted direct exploration
gives no result, but rectal examination reveals a much enlarged uterus,
filled with liquid or distended with putrid gas.
If, however, the after-birth has not come away, fragments of fœtal
membranes may be removed from the deeper portions of the uterus or the
surface of the cotyledons.
Death is inevitable unless treatment is early initiated. The animals
succumb to infection produced by germs entering the vascular apparatus.
When the infection extends by contiguity of tissue to the peritoneal
cavity the immediate causes of death are infection and intoxication. In
cases where the infection remains localised within the uterus the animal
is poisoned by the absorption of toxins through the uterine mucous
membrane.
The condition may prove fatal in from four to six days in the cow, but
in a shorter period in the goat, ewe, and bitch.
=Lesions.= The uterus is excessively fragile, and can be torn at will.
The mucous membrane in which the microorganisms more particularly
develop appears necrosed in places. Large areas are sloughing or
ulcerated.
The vessels are thrombosed, and extensive portions of the organ may be
affected by true capillary phlebitis.
The lymphatics are dilated and distended with pus in animals which have
resisted for some days.
If there is peritonitis, the entire floor of the abdominal cavity is
affected, and sometimes the peritonitis is generalised.
The lesions in the other tissues and viscera are similar to those found
in septicæmia and in general intoxication, such as injection of the
capillary system, and interstitial extravasations of blood in the
pleura, pericardium and other tissues.
=Diagnosis.= The diagnosis of septic metritis is not very difficult,
though something more is required than simple observation of external
signs. From the clinical standpoint it is of no great importance to
distinguish between the various forms or to determine the responsibility
of microorganisms for the infection. In every case the practitioner must
utilise all the means at his disposal.
=Prognosis.= The prognosis is extremely grave, and death almost
invariably occurs when treatment is not early undertaken.
=Treatment.= Treatment should be prompt and energetic. Infection of the
genital organs being the cause of the symptoms, it is against this that
remedies should be directed. The parts should first be thoroughly washed
out with boiled water at the body temperature. A stiff drainage tube
about 6 feet in length is passed to the base of the uterus and connected
at its free end with a reservoir of liquid, which can be raised so as to
obtain sufficient pressure. During this operation the animals should be
placed with the front limbs higher than the hind.
When the liquid injected returns perfectly clear, antiseptics may be
employed. Strong solutions containing mercury, carbolic acid, lysol or
creolin should be avoided, partly because of their toxic action, but
principally because they cause irritation and violent expulsive efforts.
A 25 per cent. hydroxyl solution gives surprisingly good results. A 1 in
2,000 iodine solution (iodine 15 grains, potassium iodide 1 drachm, warm
water 4 pints) is also of very great service.
As the first irrigations are difficult to carry out thoroughly, it is
often advisable to cleanse the parts directly by means of a large
disinfected sponge, which should be passed over the whole surface of the
mucous membrane and into the depressions of the uterus, thus directly
removing septic liquids. Thereafter irrigation will be easier and more
efficacious.
This method, however, of cleansing the parts is dangerous for the
operator unless he takes the antiseptic precautions necessary in every
case of delivery.
When the neck of the uterus is prematurely contracted, the difficulties
become much greater, and are sometimes insurmountable on account of the
impossibility of dilating it. It then becomes necessary to use metallic
canulæ or uterine sounds made of aluminium in order to pass through the
neck of the uterus. Liquids can be evacuated by compressing the uterus
through the wall of the rectum, but the method is very troublesome.
This local treatment should be practised twice a day at least until all
danger is over, and may be completed by the administration of diffusible
stimulants, such as alcohol in doses of 6 to 10 ounces, acetate of
ammonia in doses of 2 drachms, wine, coffee, and diuretic decoctions.
These may be given with food or drink to whatever amount is considered
necessary if the animals still retain their appetite. The food should be
light and easily digested.
From 8 to 12 pints of physiological salt solution may be injected
intravenously every day, the temperature at which this fluid is injected
being varied according to the degree of fever. (Physiological salt
solution consists of chloride of sodium 9 parts, sterilised water 1,000
parts.)
=Prophylaxis.= Should a case of septic metritis occur in a byre
containing other cows about to calve the building should be disinfected.
ACUTE METRITIS.
The term “acute metritis” is used to indicate a variety of inflammation
of the uterus of a sufficiently grave character, which, however, does
not prove fatal in twenty-four or forty-eight hours.
=Causation.= In domestic animals acute metritis develops exclusively
after difficult parturition and as a consequence of the tearing of
tissues or accidental post-partum infection.
At one time it was the rule to recognise a traumatic form consequent on
wounds by embryotomy hooks, crutches, cords, etc., etc. There is no
reason for maintaining this distinction, because the essential condition
for the development of metritis is the infection of the injuries.
Acute metritis follows non-delivery, incomplete delivery, or accidental
infection.
=Symptoms.= The external signs are very few, and must be carefully
studied, in order that wrong conclusions may be avoided.
Certain of these external signs suggest general disturbance such as one
finds in all acute visceral inflammations, viz., loss of appetite,
progressive wasting, irregular slight fever, diminution or cessation of
the secretion of milk, dulness, etc.
The others are purely local. The discharge from the vagina is mucoid,
muco-purulent, sanguinolent or fœtid, according to circumstances. It is
small in quantity, and occurs only when the animal lies down or makes
expulsive efforts. Examination with the speculum reveals the existence
of slight secondary vaginitis and more intense inflammation of the neck
of the uterus, which remains half open. Rectal examination shows that
the uterus is abnormally large and more difficult than usual to
displace. If acute metritis has existed for some weeks, the uterus is
painful to the touch, and sometimes fixed in position in consequence of
the development of parametritis and of slight pelvi-peritonitis, the
occurrence of which is always indicated by temporary tympanites.
Cases of acute metritis may recover spontaneously, but they rarely do
so. The condition usually tends to become chronic or to be complicated
with peri-uterine diseases which may prove fatal.
=Diagnosis.= The diagnosis can be established without difficulty by
rectal examination and direct examination with a speculum.
=Prognosis.= The prognosis is grave, because the patients are
temporarily or permanently incapable of becoming pregnant, and because
acute metritis may be complicated with pelvi-peritonitis, phlebitis of
the intra-pelvic veins, etc.
=Treatment.= The uterus, and particularly the uterine mucous membrane,
being affected, all our efforts should be concentrated on that organ. A
careful study of the lesions shows that the glandular follicles are
infected, and with them the entire thickness of the mucous membrane. The
object to be attained, therefore, is the perfect disinfection of this
tissue. The parts should repeatedly be washed out with warm water at
blood-heat, followed by antiseptic injections containing 4 drachms of
chloral per pint; a 1 in 2,000 iodine solution or 20 per cent. to 25 per
cent. hydroxyl solution, etc. Despite such injections, the inflammation
disappears slowly and with difficulty, and when the neck is sufficiently
open it might perhaps be possible, as in human medicine, slightly to
curette the mucous membrane of the uterus and plug the cavity with
iodoform gauze.
Where, however, the neck of the uterus is so far contracted as no longer
to admit a sound or canula for irrigation, the difficulties are very
great. Nothing effectual can be done until the neck of the uterus is
dilated, an exceedingly troublesome operation.
In the forms termed “post-partum traumatic metritis” antiseptic
injections must not be made with any considerable pressure, because of
the danger of rupture; plugging the cavity with antiseptic gauze is
preferable.
CHRONIC METRITIS.
Chronic metritis is often the termination of acute metritis, though
inflammation of the uterine mucous membrane may assume the chronic form
from the first. All post-partum infections with pathogenic microbes may
give rise to chronic metritis, as may the various forms of cystitis,
vaginitis, rupture of the vulva, etc. Tuberculosis also leads to chronic
metritis, which is easily diagnosed by a simple bacteriogical
examination of the discharge.
=Symptoms.= Chronic metritis is accompanied by bad general health and
persistent local disturbance. The animals show a permanent muco-purulent
discharge varying in amount, or simply an intermittent discharge, which
is then more abundant and only lasts some hours or some days, but
reappears after irregular intervals. On examination the neck of the
uterus is found to be half open, slightly hypertrophied, sometimes
sensitive, and covered with vegetations.
Examination through the rectum may show the organ to be considerably
hypertrophied, sensitive, and comparatively immobile. Cases are
numerous, however, in which the examination reveals nothing very
striking.
In other cases, vaginal examination by means of the speculum reveals
nothing, except that the neck of the uterus is completely closed, and
yet on rectal examination the uterus is found to be of large size,
tense, uniformly fluctuating, and in exactly the position to be expected
were the animal pregnant. This clinical form was formerly termed
“hydrometritis,” but it would be better named “pyo-metritis,” inasmuch
as it depends on chronic metritis. The neck of the uterus remains
contracted, and the morbid products accumulate in the body and uterine
horns, which are gradually dilated. Then suddenly the uterus is seized
with reflex contractions overcoming the resistance of the neck and
expelling the contents in one jet. The discharge may continue for some
days, after which the neck again closes and the disease enters on a new
phase.
=Lesions.= The lesions affect the mucous membrane, more particularly the
glandular tissue and the interstitial tissue. From the anatomical and
pathological point of view different forms are recognised, some with
glandular and mucous atrophy, others with marked hypertrophy, the mucous
membrane being covered in some cases with vegetations and fungus-like
growths.
=Diagnosis.= From a clinical standpoint, it is only necessary to
distinguish the ordinary forms from tuberculous metritis, which latter
is of no clinical importance on account of the impossibility of
treatment.
=Prognosis.= The prognosis is grave, as in all chronic diseases.
Furthermore the animals are, for the time being, sterile and difficult
to fatten.
=Treatment.= One of the fundamental conditions of treatment is to attack
the disease locally, and it is necessary, therefore, that the uterine
neck should be dilated.
If the neck of the uterus is pervious, the parts must be washed out
daily with antiseptic solutions, after having lightly curetted the
mucous membrane with a blunt curette. Boiled water is first used, and is
followed by solutions of chloral, iodine, hydroxyl, or permanganate of
potash.
When the neck of the uterus is contracted, it must first of all be
dilated. In practice such treatment is sometimes considered too costly,
so that the animals are slaughtered or recovery is left to chance.
Moussu has seen several animals suffering from metritis, and even from
salpingitis, recover spontaneously after six to eight months at grass.
EPIZOOTIC ABORTION IN COWS.
This disease, which was carefully investigated, first by Professor
Nocard of Alfort, and afterwards by Professor Bang of Copenhagen, may be
regarded as a specific uterine catarrh, determined by a definite species
of bacterium.
It often affects large numbers of animals in one district or on one
farm, and causes very serious loss. It is conveyed from cow to cow
either by the bull or by litter or utensils used in the byre which have
been soiled by the uterine discharges of an infected cow. As in many
other infectious disorders, one attack of the disease seems to confer a
certain immunity, and although some cows become sterile after an attack
and others continue to abort, a certain proportion after aborting two or
three times acquire relative immunity, so that they conceive and carry
their calves the full time. This is probably why epizootic abortion
usually ceases after some years in herds which are kept isolated and do
not receive fresh recruits.
The microbe of epizootic abortion is a very small bacterium which stains
well with Löffler’s methylene blue. When massed together these bacteria
resemble cocci, but isolated specimens are seen to be true bacteria
containing one, two, or occasionally three roundish, elongated
deeply-stained granules. They do not stain with Gram, and are
non-motile.
These bacteria exhibit remarkable vitality. Bang relates cases which
seem to prove that they may exist within the uterus for at least
fourteen months, and in the uterine exudate outside the body for at
least seven months, even at comparatively low temperatures.
On _post-mortem examination_ one finds between the mucous membrane of
the uterus and the fœtal envelopes an abundant odourless exudate,
dirty-yellow in colour, somewhat thin, pultaceous, slimy, or lumpy in
character. Under the chorion is found a thin, clear, gelatinous
substance contained within the fine connective tissue lying between the
chorion and allantois. The umbilical cord is often œdematous. All these
exudates contain the specific minute bacterium.
The above exudate forms the peculiar dirty, reddish yellow, slimy,
flocculent, pus-like _odourless_ fluid which escapes from the vagina
during or immediately after the act of abortion.
The results of infection of the uterus with Bang’s bacterium may be
delayed for a considerable time. In two cases where he injected pure
cultures into the vaginæ of pregnant cows no apparent local results had
been produced at the end of thirty-three and thirty-five days
respectively when the cows were slaughtered; but in the case of two
other pregnant cows, inoculated three months after conception, signs of
abortion became apparent, and one cow in fact aborted in about ten
weeks; post-mortem examination revealed the characteristic local
changes, and microscopical and cultural preparations clearly established
the presence of the specific organism.
Although the sexual organs form the usual channel of infection, it seems
possible that the organism may in some cases enter the body through the
respiratory or digestive tract.
=The treatment= in this condition is chiefly of a prophylactic
character. Bulls which have served cows belonging to herds known to be
infected should not be allowed to cover healthy cows. They should
undergo careful local disinfection, and for a time be withdrawn from the
stud.
Cows which show signs of impending abortion should at once be removed to
a separate shed. The fœtus and its envelopes should be buried or burnt,
and the person who attends the diseased cow should be prohibited from
entering the common cow-shed.
Where space does not admit of this the affected cows should be removed
as far as possible from those still healthy and placed in a separate
row. When they abort the after-birth should be removed by hand, and the
uterus daily washed out with some non-irritant but effectual
disinfectant. Even after apparent recovery a period of probation should
elapse before the cow is again put to the bull.
The genital organs and vaginæ of the still healthy animals may also be
irrigated with a disinfectant solution, in order, if possible, to ward
off infection. For disinfecting the channels and floor of the stable
quick-lime will be found clean, non-odorous, cheap and effective.
In dealing with this disease one must always bear in mind the great
vitality of the bacterium, the relatively long time it may persist
either in the animal’s body or in the infected sheds, and the
considerable period which may elapse before its effects become evident.
The same or a similar organism seems capable of producing abortion in
sheep and mares.
SALPINGITIS SALPINGO-OVARITIS.
This section will be brief, because the condition is very far from
having been thoroughly elucidated. Moussu himself has only studied a
single case of simple suppurative salpingo-ovaritis.
Salpingitis and salpingo-ovaritis, _i.e._, inflammation of the Fallopian
tubes and of the ovaries, can only develop as a consequence of ascending
infection, as a complication of acute or chronic metritis, by
auto-infection during the course of tuberculosis, or as an accident
during what is known as tubal gestation.
Tuberculous salpingitis is frequent, and exists in a very large majority
of cases of genital tuberculosis. Accidental salpingitis as a
consequence of tubal gestation is extremely rare, and is usually
overlooked or mistaken for some other condition.
From the clinical standpoint, therefore, we recognise two varieties of
salpingitis—the one suppurative, the other tuberculous.
=Symptoms.= The external symptoms are similar to those of metritis,
because salpingitis develops as a complication of metritis after
parturition, abortion, or retention of the after-birth. The only
external symptom is a discharge of varying quantity from the vulva. This
may be intermittent or permanent, and it is accompanied by frequent
expulsive efforts in no respect characteristic.
The nature of the lesions is ascertained by rectal examination, and as
lesions of the uterus, of the Fallopian tube, and sometimes of the ovary
often co-exist, the examination must be carried out methodically and
gently in order to distinguish between the parts touched. The normal
relationships may be modified by uterine lesions, inflammatory
adhesions, local peritonitis, etc.
=Diagnosis.= The diagnosis requires care.
=Prognosis.= The prognosis is grave. The lesions are too deep-seated to
be directly attacked, and, moreover, salpingitis may terminate in
pyo-salpynx, _i.e._, in encysted abscess of the Fallopian tube.
=Treatment.= The treatment is similar to that of metritis. The natural
opening of the Fallopian tube into the uterus allows pus and morbid
products to escape, and when the metritis disappears the salpingitis may
diminish and recovery may take place.
Treatment therefore is quite indirect, for in veterinary surgery it is
useless to attempt to repeat on large domestic animals the brilliant
operations of human surgery. The relations between uterine diseases and
those of the Fallopian tubes are so close that this method of treatment
gives excellent results. Moussu has seen a case of chronic metritis
complicated with salpingitis recover after simple uterine treatment.
TORSION OF THE UTERUS.
Although torsion of the uterus is a condition more particularly
pertaining to the domain of obstetrics, a few remarks on the subject may
not be altogether out of place at this point.
The accident is commonest in the cow, but it has also been described in
the mare, ewe, bitch and cat, and it probably occurs, though less
frequently, in the other domestic animals. In the cow it is commonest
during the last month of pregnancy.
Very little is known as to its cause, though the consensus of opinion—if
any consensus can be said to exist in face of the existing divergent
views—appears rather to indicate that it follows falls in awkward
positions, sudden efforts, severe prolonged exertion, or tympanites.
In pregnant cows the uterus assumes the appearance of a pendulous organ
the body and horns of which constitute the bob of the pendulum, whilst
the ligaments represent the cords by which it is suspended. The fixed
points are formed by the insertions of the two ligaments in the
neighbourhood of the two external iliac angles.
The uterus, however, is also steadied in position by the vagina and by
the cellular tissue surrounding it; in fact, in non-pregnant animals it
can scarcely be regarded as pendulous, but rather as freely floating and
readily yielding to the movements of the surrounding organs.
As soon as the uterus is occupied by a fœtus, however, the conditions
become changed. In consequence of the increased weight of its contents
the uterus exerts a pull on the broad ligaments and sinks lower in the
abdominal cavity. The vagina and the surrounding connective tissue are
rendered tense to a degree depending on the increasing weight of the
calf. The uterus then more closely resembles a pendulum, the bob being
represented by the fœtus and its envelopes. The suspensory apparatus can
be divided into three parts, viz., the two broad ligaments and the
tissue connecting the uterus to the vagina.
The pull on the vagina increases greatly as soon as the gravid uterus is
twisted either to the right or left, for, torsion being attended with
more or less extensive displacement towards the lower abdominal wall,
the tension on the vagina must become more marked.
Considering now how the spiral folds and the constrictions which are of
such importance in diagnosis are formed, we find that both structures,
viz., the wall of the uterus and the ligaments, are implicated, though
to different degrees. Whilst the spiral folds are more particularly
formed by the wall of the uterus, the broad ligaments are chiefly
responsible for the constrictions, though to some extent the spiral
folds also contribute to their production. The spiral folds of the body
of the uterus are formed solely by twisting of its own walls. This can
easily be shown by taking any tubular organ whose walls are not too
rigid, and twisting it round its horizontal axis.
The broad ligaments contribute less to the formation of the spiral
folds, though they play a more important part in producing constrictions
and thus in compressing the wall of the uterus.
=The symptoms= are ill-defined. Sometimes there is difficulty in
micturition, but as a rule little evidence exists of any abnormal
condition until the advent of labour pains. The first pains, which are
usually feeble and separated by rather long intervals, are succeeded by
colic. The succeeding efforts steadily become more violent and frequent,
but the “water-bag” fails to appear, and in a period varying between
twelve and forty-eight hours the pains subside. Rumination is at first
suspended, the pulse and respiration are accelerated, and the surface
temperature is irregular.
If treatment is not undertaken similar symptoms, but of exaggerated
intensity, may again appear in from one to six days. Failing relief
death always follows after a varying interval.
=The diagnosis= is not difficult, provided the maternal passages be
examined. On passing a carefully lubricated hand into the vagina the
operator discovers, at a varying distance from the os uteri, signs of
collapse and twisting of the canal. In cases of quarter twist it is
often possible, by rotating the hand so as to follow the spiral folding
of the vagina, to introduce the fingers as far as the os uteri; but in
half or complete rotation only one or two fingers can be passed so far,
or it may be altogether impossible to reach the os.
In the _Berliner Archiv_ for 1902 Lempen gave a summary of the extensive
literature dealing with this disease and of the varying views held
regarding its origin and treatment, particularly as to the direction in
which the animal should be rolled in order to reduce the torsion.
In common with the majority of authors, Lempen rightly concluded that
the rolling should be in the same direction as the torsion. He also
proposed to describe the torsion as being to right or left, according to
the direction of the spiral folds to be found on the upper wall of the
dilated cervix uteri when the examiner stands behind the animal. This
mode of describing the changes seems least likely to cause
misunderstanding.
In describing the degree of torsion Haase takes as his index the upper
wall of the uterus. Where this has moved through an angle of 90 degrees
he speaks of quarter torsion; when through an angle of 180 degrees (in
which case the upper wall will have become the lower) of half or
semi-complete torsion; when through an angle of 270 degrees as
three-quarter, and when through 360 degrees (the upper wall having then
described an entire circle and returned to its former position) as
complete torsion.
In forming a diagnosis, the extent to which the maternal passages seem
fixed in position, the amount of resistance they offer to the hand, and
the degree of tension in the spiral folds to some extent indicate how
far torsion has proceeded. Where the spiral folds are very tense and the
passages completely immovable, so that the operator cannot reach the
fœtus, torsion is usually complete; in cases of less complete torsion
(one-quarter to three-quarters) the cervix uteri is closed and displaced
to a proportionate extent, and the resistance to the passage of the hand
is in keeping.
=The prognosis= is very grave.
=Treatment= is difficult, and of the numerous methods suggested
(laparotomy and direct abdominal taxis, vaginal hysterotomy followed by
abdominal taxis, vaginal taxis, etc.) most have fallen into desuetude or
are looked on as of so desperate a character as only to be justified in
extreme cases. That which most merits attention and has been attended by
most uniformly favourable results consists in the rotation of the
animal’s whole body. The best results are said to be obtained by casting
the animal, or causing it to lie down, on a sloping surface with the
hind quarters higher than the fore and then to roll it down hill, in the
same direction as the spiral twists discovered in the vagina. It is
possible to follow the course of the manipulation by retaining the hand
in the vagina, but failing this the vagina should be examined after each
attempt. Even, though the first attempts fail hope should not be
abandoned, for Haase has succeeded in effecting delivery after rolling
the animal _twenty_ times. The operation should be performed smartly and
the animal’s body be rolled as a whole, the fore limbs turning along
with the hind.
TUMOURS OF THE UTERUS.
The study of tumours of the uterus is still so incomplete that it would
be impossible to give a precise description of them. This is to a great
extent due to the fact that as treatment is difficult the animals are
usually slaughtered as soon as an assured diagnosis can be given.
The general =symptoms= of tumours of the neck, body, or horns of the
uterus resemble those of chronic metritis, viz., permanent or
intermittent discharge from the vulva, wasting, expulsive efforts,
dysuria and sterility. The position of the tumour, its form, point of
insertion, size, consistency, mode of attachment, etc., can be detected
by vaginal or rectal examination.
The diagnosis having been made, the only question is as to =treatment=.
Should the tumour prove mobile, clearly delimited, and with a
well-marked pedicle, it can be removed either by tearing away or by
breaking into fragments, or again simply by dividing the pedicle and
applying antiseptic pads to check bleeding. But if the tumour proves
largely sessile and ill-defined and it extends into neighbouring tissues
the animal should be slaughtered, as such patients can neither be
fattened nor used for reproductive purposes.
TUMOURS OF THE OVARY.
We might repeat in regard to tumours of the ovary what has just been
said as regards those of the uterus, though the former are much commoner
than the latter.
Clinically, ovarian tumours may be grouped under two heads, solid
tumours and cystic tumours—the first represented by the fibromata,
fibro-sarcomata and epitheliomata, the second by uni- or multi-locular
cysts.
All these tumours are dangerous; they may develop rapidly, and they
rarely fail to produce disturbance, the animals presenting various
genital troubles, among which may be mentioned sterility and
nympho-mania.
The cystic tumours, which develop at the expense of epithelial
invaginations of the peritoneal covering or at the expense of Pflüger’s
tubes, and not, as was formerly believed, by the morbid development of
the Graafian vesicles, constitute dangerous growths, true
cysto-epitheliomata or cystic epitheliomata, capable of producing fatal
complications (vascular disturbance, local or general peritonitis,
compression of the ureters, etc.).
=The diagnosis= must be arrived at by vaginal and rectal examination. It
is usually possible to distinguish the condition from disease of the
kidney, bladder, or pelvic lymphatic glands.
=Treatment.= The only possible treatment is removal of the diseased
ovary and of the ovarian tumour, but much depends on circumstances. If a
large tumour has formed extensive adhesions, ablation may be
impracticable or so dangerous that under the circumstances in which
veterinary practitioners are forced to operate it cannot be undertaken.
If, on the contrary, the ovarian growth is free and pedunculated, even
though of large size, extirpation is possible.
The method is exactly similar to that of castration of the cow, and
follows the same rules, but the vaginal incision has to be much longer,
so as to allow the entire hand to be passed as far as the tumour. The
pedicle is divided by means of the _écraseur_, which should be worked
very slowly. In removing very large tumours, however, it is possible to
operate from the flank.
GENITAL MALFORMATIONS.
IMPERFORATE VAGINA.
Many forms of genital malformation occur, but only those which produce
sterility are pathologically important.
One alone causes very marked disturbance, viz., imperforate vagina. This
condition may be accidental or acquired, and may follow either difficult
parturition, with circular lesions of the vagina, or burns or
cauterisation of the vagina, followed by adhesion of its walls.
It is generally of congenital origin, and the obstruction as a rule is
in the region of the hymen, as a consequence of some anomaly in
development, and not of abnormal development of the hymen itself.
This imperforate condition of the vagina is not attended by grave
consequences during early life; but later, when the generative functions
become active, all the products of secretion of the uterine and vaginal
mucous membranes accumulate in the closed cavity, giving rise first to
muco-metritis, then to muco-kolpitis, similar in its development to the
hæmato-kolpitis of young girls. The uterus gradually becomes distended
with liquid, the neck is dilated, and a portion of the vagina may attain
enormous dimensions, so much so as to suggest pregnancy.
=Symptoms.= The symptoms become appreciable only after a time—about one
year or fifteen months in heifers—and they seem to be associated with
the appearance of œstrum. The animals make continued expulsive efforts,
which when the genital canal is much distended may become extremely
violent. There is also dysuria as a consequence of compression, together
with uterine and vesical colic, loss of appetite and wasting.
=Diagnosis.= The diagnosis requires care, and can only be arrived at
after examination of the vagina and examination per rectum. In young
females this examination is extremely difficult, because of the
narrowness of the genital tract and of the rectum. For vaginal
examination we prefer to use a small speculum, which exposes the depths
of the vagina or the transverse septum without necessitating other
manipulation. On rectal examination the uterus and vagina are sometimes
found to be enormously enlarged, and to contain a quantity of fluid, but
no fœtus.
[Illustration: $1]
=Prognosis.= The prognosis is grave. Unless treatment is undertaken the
animals die in consequence of exhaustion or secondary peritonitis.
=The treatment= is simple, and consists in aseptic puncture of the
septum and evacuation of the contents. The operation is carried out with
a long, large-sized trocar, which is passed through the centre of the
most prominent portion of the transverse septum where it projects
towards the vulva. Five, ten, or fifteen quarts of mucous fluid escape,
and the constitutional disturbance disappears almost instantly.
Antiseptic precautions are necessary in order to avoid the development
of secondary pyo-metritis. The artificial orifice can afterwards be
gradually dilated to allow free exit to the discharges, but in practice,
as the animals cannot be used for breeding purposes, they are usually
fattened for slaughter.
NYMPHO-MANIA.
The term “nympho-mania” is employed to describe a special condition in
female animals which is manifested by continual sexual excitement. The
animals are almost always sterile. The disease is most frequent in cows.
=Causation.= This general condition may depend on one of many causes,
but is rarely due to a true neurosis, as was once believed. Some morbid
influence of genital origin is always responsible for the appearance of
the symptoms.
Nympho-mania, therefore, often co-exists with lesions of the ovaries
(simple ovaritis, cystic ovaritis, tumours of the ovary), with lesions
of the Fallopian tubes and of the uterus (salpingitis, chronic metritis
and tumours of the uterus), with chronic vaginitis and lesions of the
clitoris (hypertrophy and tumour formation), and even with peri-vaginal
or peri-uterine lesions (cysts or tumours).
In exceptional cases it may be found occurring as a simple nervous
disturbance without genital lesion, and it would then appear to be due
to some temporary genital affection having produced nervous irritation.
In short, nympho-mania may be considered as almost invariably the result
of a genital lesion.
=Symptoms.= The symptoms are very clearly marked. They consist in
persistence of the sexual appetite, which is quite abnormal in female
domestic animals. The patients lose flesh, feed badly and irregularly,
annoy their fellows, cause accidents, and sometimes become dangerous.
=Diagnosis.= The diagnosis of nympho-mania is so simple that the
condition is generally recognised by the owners or cow-herds. The only
difficult point lies in discovering the exact cause. Complete
examination of the genital organs per rectum and per vaginam is
absolutely necessary to settle this question.
=Prognosis.= From an economic standpoint the prognosis is generally
grave.
=Treatment.= The treatment varies considerably, according to the nature
of the lesion.
In mild cases where nympho-mania is due to some lesion of the clitoris
(balanitis, hypertrophy, or tumour formation), the radical treatment
consists in clitoridectomy. The operation is comparatively slight, the
organ being removed with forceps and scissors, or with a bistoury after
the animal has been hobbled or placed in a trevis. The hæmorrhage which
follows removal of the clitoris is of little importance, and
after-treatment simply consists in keeping the parts clean.
Animals so treated can sometimes be preserved for breeding.
[Illustration: $1]
When nympho-mania co-exists with, and is a delayed consequence of,
either chronic vaginitis or metritis localised in the neck of the
uterus, or, again, chronic metritis of the cavity of the uterus, etc.,
the treatment must be directed against these diseases, and the nervous
condition may be sufficiently modified to render the animals useful for
breeding, or at least for slaughter, while fattening is easy.
Similarly, when the nervous condition results from a lesion of the
ovary, improvement will only follow removal of the diseased part. The
operation is similar to that of castration of the female. It presents,
however, certain added difficulties, in consequence of the size of the
organs and of the abnormal adhesions which often occur. Nevertheless,
these difficulties are seldom insurmountable.
In the case of peri-uterine disease operation is difficult, and it is
better to slaughter the animal.
Finally, as may occasionally happen, should there be no congenital
lesion capable of explaining the appearance of nympho-mania, the disease
may be regarded as a neurosis, and may then be treated by such sedatives
as the bromides of potassium, sodium and strontium, in doses of 2 to 3
drachms per day, divided into two or three portions. Bromide of camphor
also gives excellent results by acting simultaneously on the nervous
system and calming excessive genital irritation.
The above method of treatment is much preferable to performing
clitoridectomy, or ovariotomy as a kind of panacea, although certain
writers have suggested these operations without taking into account the
special local conditions.
CHAPTER V.
DISEASES OF THE MAMMARY GLANDS.
In animals used for the purpose of providing milk, viz., cows, goats,
and milch ewes, diseases of the mammary glands are of daily occurrence,
but are rare in those in which the mammary function is limited to the
nourishment of the young, such as the mare, female ass, sow, etc.
In order clearly to understand the development of these diseases, it is
necessary to bear in mind the anatomical construction of the organs, for
which purpose we may take as a type the mammary gland of the cow, which
is the most complicated.
The udder of the cow is of hemispherical shape. It is situated in the
inguinal region, and is composed of two parts, the right and left, which
are absolutely independent and can easily be isolated from each other
along the median plane throughout their extent. The mass of parenchyma
is enveloped in a fibrous envelope, which is covered with a very loose
layer of subcutaneous connective tissue. Each half is subdivided into
two quarters, an anterior and a posterior quarter. Each quarter again
represents a distinct gland, although anatomical separation between the
anterior and the corresponding posterior quarter would be almost
impossible, the separating fibro-connective partition being common to
both glands.
In very good milkers it sometimes happens that two small supplementary
glands may be found behind the posterior quarters, bringing up the total
number to six.
=Parenchyma.=—Each of these glands is provided with a teat containing a
large sinus. Anatomically the mamma consists of glandular tissue
arranged like a bunch of grapes, in which the active tissues of the
acini deliver their secretion into little excretory canals, which unite,
forming a large collecting plexus. The collecting canals, or
galactophorous canals, open into the galactophorous sinus, which
occupies the entire depth of the teat and communicates with the exterior
by a small pore provided with a sphincter. The interacinous connective
tissue of the udder and the subcutaneous tissue of the teat, which
envelops the galactophorous sinus, is extremely rich in elastic fibres,
enabling the organ to undergo great changes in volume without injury.
=Vessels.=—The mammæ are supplied by two great arteries, the mammary
arteries, which are given off from the prepubic arteries, pass into the
inguinal canal, and penetrate the gland by its upper, deep face. Each
principal lateral artery divides into two trunks, one for the anterior,
the other for the posterior quarter.
[Illustration: $1]
The veins which collect the blood from the mammæ form two systems, the
first accompanying the mammary arteries, the second, more superficial,
giving rise to the anterior subabdominal mammary veins. The
arterio-venous plexus of the udder, which represents the vascular
pedicle of the organ, penetrates the gland, near a line dividing the
posterior and middle thirds of the upper surface, an inch or so in front
of the mammary lymphatic gland.
=Lymphatics.=—On either side of the middle line lies an extremely rich
lymphatic plexus, the origin of which is to be found near the ends of
the teats and in the peri-acinous spaces.
The superficial collecting vessels are dispersed under the skin,
perforate the fibrous sheath towards the base of the teat, and
anastomose with one another on the surface of the gland, the anastomosis
being most intimate between those of the same quarter, finally emptying
separately by two large trunks into the retro-mammary lymphatic gland of
the same side.
The vessels of the anterior quarter enter the lymphatic gland at its
most anterior point; those of the posterior quarter join it a little
below.
The retro-mammary lymphatic glands are two in number, and are situated
very high and towards the back, above the posterior quarters and close
to the perineum, outside the fibrous envelope of the gland. They are
sheltered in a recess excavated within the depths of the gland itself.
The main collecting lymphatics from the anterior and posterior quarters
enter it separately.
The lateral efferent vessels are divided into two groups, one of which
ascends vertically in the perineal region, towards the lymphatic glands
round the anus; the other passes through the inguinal canal towards the
sublumbar region, together with the blood-vessels.
The mammary nerves are two in number. The anterior has a downward course
outside the fibrous envelope and supplies the teat; the posterior nerve
is similarly distributed. In other domestic female animals which have
only two mammæ the general arrangement is precisely the same.
PHYSIOLOGICAL ANOMALIES.
=Imperforate condition of the Teat.=—It sometimes happens that although
the udder is otherwise well formed, the teats, or more frequently a
single teat, proves to be imperforate. Between the galactophorous sinus
and the exterior, opposite the sphincter, a little membrane may be found
which closes the teat and entirely prevents the contents of the udder
from escaping. Its existence is only discovered when the animal first
calves and lactation commences. Not a drop of milk can be withdrawn,
although the udder is swollen. Local examination readily reveals the
defect.
=Treatment= is very simple and effective, the membrane being perforated
with the end of a milk catheter.
=Contraction of the Sphincter= (_Atresia of the Extremity of the
Teat_).—Under other circumstances the teat may present a distinct
perforation, and yet milking may be impossible, or at all events may be
extremely difficult. This is sometimes due to contraction of the
sphincter, or possibly to atresia of the orifice.
=The diagnosis= of this condition is easy, but the outlook is not
promising.
=Treatment= is rather difficult. Some operators recommend dividing the
terminal sphincter with a small, specially formed bistouri caché,
provided with two cutting points. The operation has very satisfactory
immediate results, but after the little wounds so produced have healed,
cicatricial contraction takes place around the orifice.
Forcible dilatation is far preferable. It is carried out in the same way
as in human medicine, where the sphincter ani or the orifice of the
uterus has to be dilated. No superficial lesion and no incision is
produced; the result is therefore more permanent (see “Operative
Technique”).
WOUNDS OR TRAUMATIC LESIONS.
CHAPS AND CRACKS.
These injuries consist in little transverse or oblique wounds of the
teat.
=Causation.= In free milkers the udder appears completely relaxed after
milking. In the intervals between the different milkings, however, the
quarters become swollen, and are sometimes so distended as to overcome
the resistance of the sphincter at the base of the teat. The teats are
then greatly elongated, and, despite the richness of the tissues in
elastic fibres, this distension leads to little superficial epidermic
fissures.
These small lesions are unimportant, but if they become infected by
contact with the litter they granulate and suppurate, so that grave
complications may eventually follow.
The wounds caused by the calves’ teeth when sucking, or simply by the
rough way in which the little animal seizes the teat, may produce
similar accidents.
=Symptoms.= The teat shows one or more little transverse fissures, a few
millimètres to a centimètre or more in length. The base of the fissure
appears of a reddish or brownish-red colour, and has thickened,
indurated, painful, discharging or suppurating margins. Local
sensitiveness may be either slight or very pronounced. In the latter
case, the patients resist being milked, and even refuse to let the calf
suck.
=Diagnosis.= The diagnosis is extremely simple.
In a general sense the =prognosis= is favourable, but nevertheless the
local infection may extend and become generalised, thus giving rise to
interstitial mammitis, sometimes of a very grave character. On the other
hand, the sensitiveness may of itself render milking difficult or
impossible, and thus cause serious distension of the gland with milk.
=Treatment.= As both sucking and milking aggravate the lesions, they
should be prevented by the insertion of a milk catheter.
The surface of the udder and the wounds should be cleansed with an
antiseptic solution and be dressed with a 20 per cent. camphorated
vaseline or with carbolic or iodoform ointment, to favour healing. If
the cracks produce excessive sensitiveness a small quantity of orthoform
may be added to the camphor ointment. Before the milk catheter is
inserted, the teat should be very carefully cleansed with boiled water
and the catheter sterilised by boiling. Neglect of these precautions may
result in infection of the galactophorous sinus and mammitis.
MILK FISTULÆ.
=Causation.= Any accidental injury to the udder which establishes
connection between the galactophorous canals or the galactophorous sinus
and the exterior may give rise to milk fistulæ, if the injury occur
during lactation.
Apart from lactation these wounds may be grave, though if carefully
treated they heal without complication. During lactation, on the
contrary, the milk escapes permanently from the injured spot,
cicatrisation cannot occur, and a fistula forms.
[Illustration: $1]
=Symptoms.= The principal symptom is the permanent discharge of milk.
The fistula may be large or small, according to circumstances. In rare
instances it is situated on the udder itself, but it is commonest on the
teat. Milk may escape in mere drops or, on the other hand, in
considerable quantities.
=Diagnosis.= The diagnosis presents no difficulty.
=Prognosis.= The prognosis is grave so far as the loss of milk is
concerned, although the lesion has no effect on the general health. It
is particularly serious, however, because it may cause the interior to
become infected, and an acute parenchymatous mammitis may thus be set
up. It must also be borne in mind that old fistulæ are much more
difficult to obliterate than recent ones.
=Treatment= is much more troublesome than might at first be thought, the
great obstacle to repair being the continual secretion and discharge of
milk.
At first, attempts should be made to re-establish and render permanent
the natural method of discharge. This can be effected by inserting an
aseptic milk catheter and fixing it in position with a little pitch
bandage.
The course of the fistula is then cleansed, curetted, and rendered
aseptic in some way, as for example by washing with boiled salt solution
and dilute hydroxyl.
As there is little hope of obliterating the fistula by merely suturing
the skin, its course should first be closed by passing one or two deep
sutures without touching the external orifice and without passing over
it (Fig. 238). The discharge of fluid being then entirely stopped, the
external portion of the fistula is thoroughly cleansed, powdered with
iodoform, and finally closed with external, closely-applied sutures.
These sutures are protected with a little cotton wool or collodion
dressing, and healing then almost invariably occurs.
The animal should be given a very clean bed, and closely watched to
prevent it tearing out the milk catheter. On the fourth or fifth day the
catheter is removed, and is afterwards only used at intervals.
As all the sutures can be of aseptic catgut or silk, there is no
necessity to trouble about their removal. The dressing can be left until
it falls away of itself.
INFLAMMATORY DISEASES.
CONGESTION OF THE UDDER.
Congestion—_i.e._, distension of the vascular plexus as a consequence of
momentary stasis, vaso-motor disturbance, or paralysis of the little
vessels in the udder—can only be regarded as pathological in cases when
it precedes mammitis or when it results from prolonged neglect to milk
the animal, external irritation, etc. It was studied long ago by H.
d’Arboval, Gellé, Delafond, Trasbot, Lucet, etc.
It also occurs, but in a form which might almost be termed
physiological, after the first parturition in the large milch breeds,
where the rush of blood which precedes secretion is very great.
=Symptoms.= The udder is swollen, tense, doughy, shining, and œdematous,
not very painful on pressure, but sufficiently so to interfere with
movement. The general condition is little altered, but the temperature
of the udder is abnormally high.
Manipulation reveals the existence of more or less œdema, the parts
preserving the imprint of the finger. Sometimes this œdema extends along
the abdominal wall in front of the udder. The milk may be grumous or
even sanguinolent. The congestive state continues for some days, eight
to ten at the most, and may gradually disappear by resolution. Not
infrequently it terminates in acute mammitis after forty-eight hours.
=Lesions.= In simple mammary congestion the lesions are confined to
excessive dilatation of the peri-acinous capillary vessels, and
extravasation into the connective tissue. On section the tissue has a
dark-red appearance.
=Diagnosis.= The diagnosis is simple.
=Prognosis.= The prognosis is less alarming than might at first sight be
supposed.
=The treatment= consists simply in hygienic precautions, frequent
milking, emollient, sedative applications to the udder, and frequent
washing. As far as possible the use of milk catheters should be avoided.
Boric vaseline and belladonna ointment may be recommended. In very
serious cases blood can be withdrawn from the jugular. This is better
than bleeding from the mammary vein, which always entails the risk of
thrombus formation.
MAMMITIS.
Under the heading “mammitis” are included different forms of
inflammation of the mammary tissue, whether such inflammation attack the
parenchyma of the gland or the interstitial tissue. Generally the whole
gland is invaded at the end of a few days, whatever the point of origin,
and the inflammation is therefore of a mixed character.
Mammitis has been recognised from very early times. In his researches on
“contagious mammitis” Nocard in 1884 showed that infection was the
principal factor in its evolution.
Numerous classifications, based on the causes or on the pathological
anatomy of the condition, have been suggested; but most appear too
rigid, and therefore, without discussing them, we confine ourselves to
giving the following _résumé_:—
Rainard (1845) │Lacteal engorgement.
„ │Cellulitis of the udder.
„ │Mammitis │Acute.
„ │ „ │Chronic.
Lafosse (1856) │Mammitis │Acute.
Trasbot (1883) │ │
„ │ „ │Chronic.
Saint Cyr (1874) │Mammitis │Catarrhal.
Violet (1888) │ │
„ │ „ │Phlegmonous or interstitial.
„ │ „ │Parenchymatous.
│Primary mammitis │ │
Lucet (1891) │ (properly │Acute │Galactogenous.
│ so-called) │ │
„ │ „ │ „ │Lymphogenous.
„ │ „ │Chronic │Galactogenous.
„ │ „ │ „ │Lymphogenous.
„ │Symptomatic │Acute │Hæmatogenous.
│ mammitis │ │
„ │ „ │ „ │Lymphogenous.
„ │ „ │Chronic │Hæmatogenous.
„ │ „ │ „ │Lymphogenous.
All these classifications are justified by the guiding ideas of the
writers, yet, as in every case of attempted systematisation, they have
the disadvantage of not being in entire agreement with clinical
experience.
For instance, the differences between catarrhal and parenchymatous forms
of mammitis are only of degree, and it is difficult, therefore, to see
why they should be divided into two distinct varieties. The difference
is in regard to the prognosis.
Similarly in practice it is difficult and sometimes impossible to
distinguish between an interstitial and a parenchymatous mammitis,
because all the tissues of the gland may be involved at a given moment.
The only factor which allows of differentiation is the discovery of the
point from which infection took place. Finally, it is sometimes so
difficult to distinguish between galactogenous and lymphogenous mammitis
that the attempt has had to be abandoned. In gangrenous mammitis of
milch ewes, for example, the infective organism is found not only in the
sinus and the galactophorous canals, but also in the serosity of the
interstitial tissue and of the perimammary œdema.
Without doubt the causative agent of mammitis may enter the gland by
three principal channels—the galactophorous sinus, the lymphatic plexus
(after some injury), and the blood circulation. But from the clinical
standpoint it is not at all necessary to identify all the causes in
order to establish the classification.
The symptoms allow of a division only into acute and chronic mammitis.
Careful examination of the general condition of the patients will
afterwards allow cases of primary mammitis to be distinguished from
secondary or symptomatic mammitis such as occurs in tuberculosis.
Finally, consideration of the conditions under which a particular case
of mammitis has appeared, and study of the symptoms in detail
(peculiarities of the milk, local temperature, hardness of the tissues,
œdematous infiltration, etc.) will in most cases indicate whether the
mammitis be parenchymatous or interstitial.
This system really differs little from that adopted by Lucet in his work
on Mammitis.
The classification adopted in the following pages is as follows:—
Mammitis│Acute │Primary │Parenchymatous or galactogenous.
„ │ „ │ „ │Interstitial or lymphogenous.
„ │ „ │Secondary or │Hæmatogenous.
│ │ symptomatic. │
„ │ „ │ „ │Galactogenous.
„ │Chronic│Primary │Simple.
„ │ „ │ „ │Parenchymatous.
„ │ „ │ „ │Interstitial.
„ │ „ │Secondary │Parenchymatous.
„ │ „ │ „ │Interstitial.
We shall leave on one side everything concerning secondary symptomatic
mammitis, the study of which merges into that of the general diseases
from which it arises.
ACUTE MAMMITIS.
=Causation.= The general cause of acute mammitis, like that of chronic
mammitis, is infection by pathogenic organisms, whether such organisms
enter by the usual natural path, viz., the galactophorous sinus and
excretory apparatus, by the lymphatic path, owing to some accidental
injury, or, again, by the blood circulation.
Infection of the lymphatics undoubtedly plays a part in superficial and
interstitial inflammations, and it is proved that certain microorganisms
may pass into the milk, as it has been proved that they pass through the
kidney.
But if infection is the determining cause, certain secondary favouring
influences must not be overlooked.
Thus lactation is an almost indispensable condition. It is true that
some cases of mammary inflammation apart from lactation have been
described, but they have been the result of violence, accidental or
mechanical.
Accumulation of milk in the udder (overstocking) has unquestionably a
certain influence in the large milk-yielding animals, not because it
directly produces inflammation, but because milk then escapes
spontaneously; and as the udder cannot be entirely evacuated without
external assistance, the entrance is kept permanently open for the
passage of germs, which are freely transferred to the teat from the
litter and surrounding objects.
Cold, or rather chills, also act in a complex manner, particularly by
disturbing vaso-motor control. Different forms of mechanical violence,
such as blows, crushing strains, wounds, etc., may immediately and
directly set up local or general inflammation.
Bacteriological investigation has proved that numerous and varied
microorganisms can be found in the milk or interstitial exudates in
cases of mammitis, but only a few special forms have been proved to be
specific: streptococcus of contagious mammitis of milch cows, and
micrococcus of contagious gangrenous mammitis of ewes (Nocard).
=Pathology.= The pathogenic results produced by infective organisms
depend on their number and power of reproduction, and on the activity of
their life products.
The most immediate and regular result of acute mammary infection is
coagulation of the milk within the udder by decomposition of the
lactose, and the formation of lactic or even of butyric acid. The acini
and excretory canals are dilated by coagula, and can no longer expel
their products of secretion, so that the colonies of microorganisms
develop there in full security. The active epithelial cells undergo
granular degeneration and disappear, whilst the walls of the glands
become infiltrated and large numbers of leucocytes are poured forth
around the glandular culs-de-sac.
The tissues being thus affected, the virulent organisms penetrate from
the acini into the interstitial tissue, and from this time onwards the
lesions become mixed.
Inversely, should infection originate in the lymphatic spaces, a time
arrives when the organisms make their way from the interstitial tissue
into the acini, with a similar result in the end.
The development of the lesions may be arrested or may pass on to
suppuration, or even gangrene, of the parenchymatous lobules. Cases
happen in which infection is so rapid and severe that the successive
stages cannot even be identified, and gangrene appears without any
preliminary stages at all. Luckily the commonest forms are less serious.
=Symptoms.= Acute mammitis is characterised by its sudden appearance,
more or less acute general symptoms (dulness, fever, and loss of
appetite), and variable local symptoms. When the practitioner is able to
follow the development of the disease throughout, he may sometimes
distinguish well-marked signs, which permit the two clinical varieties
to be distinguished.
A. =Interstitial Mammitis.=—This form, which might perhaps also be
termed peri-mammitis when it primarily affects the subcutaneous
lymphatic spaces, has also received the names of phlegmonous and
lymphogenous mammitis.
It is characterised by alarming general symptoms, and particularly by a
rise in temperature of 2°, 4°, or even 5° Fahr., with all its
consequences, such as loss of appetite, stoppage of rumination,
acceleration of breathing and circulation, slight tympanites,
constipation, and by the thrusting of the hind limb on the affected side
away from the centre line. The animals groan when forced to move.
These symptoms sometimes precede by a considerable interval the
appearance of the local changes, which consist in painful swelling of
one or two quarters, rarely of more.
The perimammary subcutaneous tissue is infiltrated, œdematous, painful
on palpation and preserves the imprint of the finger. The teat is tense,
swollen, very tender, and of reddish colour. In the grave forms the
swelling extends forwards under the abdomen in the direction of the
umbilicus, and backwards towards the perineum. The local temperature is
abnormally high, the secretion of milk in the diseased gland is modified
or checked, and sometimes this phenomenon extends by reflex action to
the neighbouring quarters, although the latter may not themselves be
affected. The inflammation rarely extends from one quarter to another,
because the lymphatic plexuses do not anastomose (Fig. 237).
The animals lose appetite and fall away rapidly.
Resolution may occur after from five to eight days. By degrees all the
symptoms then become less marked. The appetite returns, pain diminishes,
the fever drops, and the lesions gradually disappear, but the yield of
milk rarely regains its former amount.
Suppuration may occur; sometimes a superficial subcutaneous abscess
forms, more rarely, a deep-seated, interstitial abscess, originating in
the connective tissue or lymphatic spaces. With a superficial abscess,
the local symptoms again revive to a slight extent; these are present in
a more marked degree where the abscess is deep-seated. An extremely
sensitive œdematous swelling forms, the skin covering which is at some
point of a deep-red tint, whilst fluctuation gradually appears.
In cases of deep-seated abscess formation the general condition becomes
alarming; the affected quarter is tense throughout, hard and very
sensitive.
Deep-seated suppuration is difficult to detect, and exploratory
punctures with a fine needle may be necessary before the diagnosis can
be made.
Local or diffuse gangrene forms a rare complication. It is due to the
vessels of one or several glandular lobules becoming obliterated or
thrombosed.
Such a termination is indicated by extreme aggravation of the general
symptoms, feebleness of the heart and great weakness of the patients,
who fall into a condition of coma. Locally the udder remains œdematous,
the skin becomes of a blackish-violet colour, whilst the local
temperature falls and the animals die from exhaustion and intoxication.
=Parenchymatous Mammitis.=—Parenchymatous mammitis when mild is also
termed catarrhal mammitis. It is in reality true primary mammitis;
interstitial being primarily and practically perimammary lymphangitis.
In this case infection occurs through the teat, and may be localised in
the sinus or excretory apparatus, giving rise to galactophoritis, but it
usually extends to the acini. Inflammation of the mammary tissue is
therefore direct and primary. It rapidly extends, however, through the
glandular wall into the interstitial tissue, thus setting up (from the
anatomo-pathological standpoint) a mixed mammitis. Clinical distinction
between this form and interstitial mammitis is at first easy.
=The symptoms= usually occur in the following order:—Swelling of the
affected quarter or quarters; appreciable increase in size and
sensitiveness; the presence at first of curdled milk in the
galactophorous sinus, then of clots mixed with slightly red tinged
serosity; complete cessation of the yield of milk, and suppuration in
the secreting portions of the gland.
The general symptoms appear only after the objective signs, and vary
greatly in intensity, according to the case. As in the interstitial
form, there may be marked fever, loss of appetite, cessation of
rumination, groaning, and difficulty in walking.
In some grave forms, where development is peracute, infection spreads
rapidly from the glandular to the interstitial tissue, and subcutaneous,
subabdominal, or perineal interstitial œdema occurs secondarily.
The udder is turgid, tense, shining, and of reddish-violet colour in
places, as if a deep-seated abscess were developing.
Pressure on the galactophorous sinus causes the flow of reddish-grey
milk, sometimes fœtid or of gangrenous odour. The animals seem
exhausted, show signs of profound intoxication, are unable to rise, and
appear paralysed.
But besides these grave forms are others, in which the patients seem
scarcely to suffer: appetite is preserved and all the vital functions
are in full activity. Only the local signs are of importance.
This variability in the clinical symptoms of acute forms of mammitis is
entirely due to differences in the pathogenic infecting organisms.
Parenchymatous mammitis may end in resolution in three to four days,
with progressive but slow return to the physiological condition. This
termination is announced by the gradual disappearance of all the
symptoms and the return of milk secretion. It is, however, quite
exceptional for the former condition to be fully restored, and in many
cases the affected quarter must be regarded as lost from the
physiological standpoint.
It gradually becomes hardened, sclerotic and atrophied.
Suppuration is very common. It attacks the galactophorous sinus, the
excretory canals, and even the acini. If obstructions occur in the
course of the collecting vessels, or if evacuation is not artificially
stimulated by milking, the pus collects in the depths of the gland, and
enormous diffuse abscesses may form at the expense of the mammary
tissue.
Circumscribed or diffuse gangrene, as a primary condition, is rarer.
Infective organisms rapidly invade even the depths of the gland, the
interstitial and subcutaneous tissue, and thrombosis due to infection or
intoxication occurs, followed by gangrene. Death results from infection
or intoxication.
Complications such as necrosis of the abdominal tunic, of the fibrous
tissue enveloping the mamma, and of the muscular layers on the inner
surface of the thighs, may occur in the suppurative forms.
=Diagnosis.= The diagnosis of acute mammitis is easy, and the
interstitial forms (mammary lymphangitis) can be distinguished from the
parenchymatous forms very early in the attack.
Careful examination suffices to differentiate between this condition and
mammary congestion or primary chronic mammitis. The examination,
however, must be much more thorough and searching when a specific
disease (such as tuberculous mammitis) is in question.
=Prognosis.= The prognosis of acute mammitis is always grave, whatever
form the disease may assume, for, if the animal’s life is not invariably
endangered, its economic value is always affected. Moreover, should
superficial or deep-seated abscesses form, prolonged suppuration may
follow, resulting in loss of condition and enormous depreciation.
=Lesions.= The lesions of interstitial mammitis are similar to those of
ordinary lymphangitis, the condition originating near the teat and
gradually extending to the layers of connective tissue between the
acini, mammæ, etc.
In the parenchymatous form the inflammation may remain partial, and be
localised in particular tracts of glandular tissue. The secreting
epithelium, when infected, exhibits cloudy swelling, becomes loosened,
and disappears; the margin of the gland and the interstitial divisions
become infiltrated with enormous numbers of white blood corpuscles, and
are the seat of suppurative processes which end in the production of
small acinous abscesses. By the union of neighbouring abscesses large
branching collections of pus are produced, and lead to partial or total
destruction of tracts of the parenchyma, of the connective tissue
divisions, vessels and aponeuroses.
The abscess tends to break through the skin, which becomes inflamed and
ulcerated, or, when the microorganisms are of slight virulence, the
tissues may react, so that the abscess becomes surrounded with a thick
indurated wall, and finally encysted.
=Treatment.= Very numerous methods of treatment have been proposed, an
admission which, in itself, suggests that no perfect one has been
discovered. No infallible system, in fact, exists of arresting the
disease and restoring the parts to their normal condition.
From a prophylactic standpoint, mammitis can be avoided by placing the
animals under proper hygienic conditions, paying special attention to
cleanliness, avoiding overstocking, and treating excoriations or
injuries to the teat or udder as soon as they appear.
Once acute mammitis has developed, general and local treatment must both
be attempted.
The older practitioners were in the habit of bleeding from the mammary
or jugular vein. Since their time, however, objections have been made to
bleeding because acute mammitis has been proved to be of an infectious
character, and, therefore, it is undesirable to lower the patients’
resisting power.
This reasoning, however, appears to be erroneous. Little by little the
advantages of bleeding, both in intoxications and infections, have been
recognised, and one thing at least is beyond dispute, namely, its action
on fever. Undoubtedly, it must not be resorted to without judgment, nor
should it be freely employed in debilitated animals; but in
well-nourished patients its effect on fever and on the accompanying
respiratory and circulatory disturbance is immediate.
We, therefore, recommend moderate bleeding from the jugular.
Bleeding from the mammary vein entails too great a risk of infection to
be commendable.
Purgatives and diuretics diminish or prevent accidents such as
intoxication and the complications resulting from temporary suspension
of the digestive function.
Local treatment is more or less efficacious in mammary infection. To
relieve pain and check infection it should be of an emollient and
antiseptic character. Ointments containing 10 per cent. of carbolic
acid, boric acid or iodine, or 12½ per cent. of camphor, opium or
belladonna, are of real service during the first stages, particularly of
mammary lymphangitis and interstitial mammitis.
Repeated applications of 10 per cent. carbolic glycerine have similar
advantages.
In the less acute forms originating in the parenchymatous tissue, mild
ointments of plumbic iodide, Goulard’s extract, or mercury may also be
used if precautions are taken to prevent the animals from licking, and
so poisoning themselves.
When the tendency to suppuration is marked, vesicants hasten the
development of the abscess and facilitate puncture. The most commonly
used are the 33 per cent. tartar emetic ointment or the 10 per cent.
biniodide of mercury ointment.
If, on the other hand, the mammitis is of the interstitial type, with
severe subcutaneous œdema, extending over the belly and towards the
perineum, good results often follow deep firing in points over the
swollen region. The points should be widely spaced, venous branches
being avoided. In this way numerous ducts are formed by which the toxic
and septic liquid which causes the œdema is enabled to escape.
This method of treatment can be supplemented by the simultaneous use of
antiseptic ointments.
Finally, in mammitis of the parenchymatous type, where there is no
marked tendency to invade the interstitial tissue, the most important
point is to wash out the interior of the gland, and even the acini as
far as possible, with antiseptic fluids. Practically this is difficult
to effect, because such irrigation must be performed aseptically, and
cannot properly be left to the cowmen.
In current practice, therefore, one often has to be content with
stripping the udder every hour. Milk clots which accumulate in the
sinuses and galactophorous canals are broken down by soft pressure, and
withdrawn with more or less difficulty. By repeated milking they are
prevented from accumulating in the galactophorous sinus and canals, a
very important point. Neglect of this precaution enables the colonies of
microorganisms to develop uninterruptedly in the culs-de-sac, whereupon
the coagula formed of casein obstruct the excretory channels and
complications develop despite all external treatment.
By repeated friction of the udder as in milking the advantages that
would be produced by washing out the gland from the direction of the
acini are secured, and thus the ascending infection is checked.
The diseased udder must always be emptied before making antiseptic
injections, which would otherwise be useless.
Should the practitioner decide to face the practical difficulties of
injections, he must take care that his instruments are aseptic; that the
solutions employed are always at or about bodily temperature; that these
solutions are incapable of irritating even tissues so tender as the
epithelium of the acini or of the galactophorous canals; and, finally,
that the drugs employed will not coagulate the milk within the gland.
Bearing in mind these points, the practitioner will do well to restrict
himself to the use either of boiled water, physiological salt solution
(·9 per cent.); alkaline 3 per cent. solution of borate of soda; or ·05
per cent. of fluoride of sodium. Every precaution having been taken,
from 12 to 20 ounces of liquid can be injected into each quarter,
according to its size. The solutions should be made to penetrate as far
as possible into all portions of the gland by gently manipulating the
parts, and should again be withdrawn in about a quarter of an hour.
It must always be remembered that failure to observe the above
precautions may make matters worse instead of better, and therefore that
intra-mammary injections can only be of value when carried out by a
skilled person.
In otherwise hopeless cases there remains as a last resort total or
partial ablation of the mamma. This operation is advisable in cases of
diffuse gangrene, or of intense massive suppuration, where there is
imminent danger of death from infection.
Directions for its performance will be found in Möller and Dollar’s
“Regional Surgery” (uniform with the present volume), p. 454.
CONTAGIOUS MAMMITIS IN MILCH COWS.
Although its cause was unknown before the investigations of Nocard and
Mollereau in 1884, this disease is of very common occurrence in England,
in large dairies in the environs of Paris, and is also seen, though more
rarely, in Normandy, in Brie and the Soissonnais, causing serious losses
on account of its transmissibility.
It had been described in Germany by Gerlach as early as 1854, and Kitt
in 1885 recognised it as common, and proposed for it the title of
“contagious catarrhal agalaxia.” It also occurs in Denmark, Italy, and
England.
Contagious streptococcic mammitis of cows always assumes a chronic form,
during the course of which indurated centres appear, varying in size
between that of a hazel-nut and a walnut.
=Causation.= The cause is always to be found in contagion, the disease
being due to a streptococcus, which has been carefully studied by
Nocard. Its transmission from a diseased to a healthy udder is explained
by the fact that the milkers are careless as to cleanliness, and thus
directly convey the germs to healthy teats and facilitate infection.
=Symptoms.= As in chronic mammitis, general symptoms are not well
marked, though some cases are ushered in with cough, slight nasal
discharge, and offensive diarrhœa. The first appreciable indication is a
change in the milk, which diminishes in quantity, and, although normal
to all appearance, coagulates rapidly if left undisturbed. Infection has
already taken place, although nothing can be detected on examining the
udder.
Next appears a nodule of hardened tissue above the teat. This nodule is
of rounded or ovoid shape, ill-defined towards its periphery, and it
becomes progressively enlarged without any sign of acute inflammation.
The milk becomes watery and of a bluish colour. Microscopical
examination reveals numerous streptococci. The hardening process
proceeds slowly. At the end of several months the sclerosis may only
have extended to one-third of the height of the infected quarter. With
the appearance of these lesions the character of the milk again changes.
It becomes yellowish in colour and fœtid, and contains a fibrous
reticulum, whilst its reaction is distinctly acid. The lesions, which at
first had been confined to one quarter, successively extend to the
others unless precautions are taken.
=Lesions.= The lesions consist in mammary sclerosis, with nodules which
progressively increase in size. This sclerosis originates in the
galactophorous canals, and extends first to the periphery, then to the
interstitial connective tissue; the latter undergoes hyperplasia and
confines within its tracts the true glandular elements, destroying their
secretory power. Locally, catarrhal mammitis exists.
The lesions can easily be recognised on microscopic examination, and,
when the section is suitably stained, numerous streptococci can be
detected in the acini, which are blocked with proliferating epithelial
cells. These lesions are due to the invasion of colonies of
microorganisms, which spread from below upwards.
The streptococcus causing this mammitis colours readily with thionin and
methylene blue. It can be cultivated in liquid and solid media
containing sugar or glycerine, but growth is impeded by the presence of
peptone or common salt. Under ordinary circumstances the culture dies
after some weeks, but if the acidity of the medium is neutralised by the
addition of powdered carbonate of lime, it preserves its vitality for
six or eight months. The culture when injected into the udder of a
healthy cow or she-goat reproduces the disease. The microorganism is not
pathogenic for any of the smaller animals used for purposes of
experiment.
=Diagnosis= and =prognosis=. The diagnosis is easy, the presence of the
sclerotic nodules being characteristic, whilst in doubtful cases a
microscopical examination can always be made.
=The treatment= should be prophylactic and curative.
Prophylactic treatment comprises disinfection of the milkers’ hands,
which are the ordinary vehicles of contagion, and disinfection of the
cow’s udder. Diseased animals in a byre should be milked last of all,
and the milk should be destroyed.
Curative treatment is confined to local antiseptic injections. Warm
concentrated boric solution gives good results. The injections may be
repeated three or four times a day after milking, the liquid being left
for a certain time within the udder. In this way animals suffering only
from a slight attack may be cured, but when the disease is already
somewhat advanced injections lose their effect.
Injections of fluoride of sodium (·1 to ·5 per cent. strength) appear to
be much more effectual. Moussu claims to have cured by this means
several old-standing cases where all four quarters of the gland were
diseased.
These injections necessitate the same precautions as those above
indicated for securing perfect asepsis. In grave cases it is very
difficult to prevent the disease from extending in infected stables,
because the necessary precautions cannot be observed.
CHRONIC MAMMITIS.
Chronic inflammation of the udder may form a termination of ordinary
acute mammitis, or it may result from infection with organisms of a less
virulent type.
In cases of acute mammitis, where severe injury of the interstitial
tissue or mammary parenchyma has occurred, its physiological function is
partially destroyed. The circulation is disturbed, the vessels undergo
change, the layers of connective tissue are indurated and sclerotic, the
epithelial tissue is not fully restored, and chronic inflammation of the
udder persists.
Clinically, it is impossible to distinguish all the variations that may
occur, because the constituent tissues are all injured, and the disease
is of a mixed type, with very numerous variations.
=Symptoms.= When chronic mammitis follows the acute form its onset is
only indicated by gradual diminution in the signs of acute inflammation.
The appetite is regained, and all the important vital functions are
properly performed.
Nevertheless, it is possible to distinguish two different clinical
forms. In one, the secretion of milk is almost entirely suspended, the
udder becomes atrophied, shrivelled and sclerotic; the hardening
gradually continues, and the patients, being useless as milch cows, can
only be fattened for slaughter. The induration may be partial, nodular,
or diffused.
In the other form the udder is large, but the milk is replaced by a
purulent secretion which permeates the acini and galactophorous canals.
Although they eat well, the patients remain thin, and are with
difficulty fattened for slaughter.
The suppuration may be diffuse or local. In rarer cases it is localised
in the form of “cold abscess.”
=Treatment.= No treatment can perfectly restore the udder after chronic
mammitis with sclerosis and atrophy.
In the suppurating forms of chronic mammitis the morbid secretion may be
checked by internal irrigation of the udder and antiseptic injections,
but, as this treatment necessitates careful and continued attention, it
is usually out of the question.
If only one quarter is diseased the animal may be kept for milking
purposes, but where two or three quarters are attacked it should be
prepared for the butcher.
In cows suffering from chronic purulent mammitis of all four quarters,
Kroon suggests removing the teats in order to facilitate fattening. The
teats are removed with the bistouri or scissors, by which means a large
opening into the galactophorous sinus is produced, through which the
purulent secretion escapes freely and continuously; the retention of pus
and intoxication in consequence of resorption are prevented and the
animal can be fattened, which would be difficult without the operation.
GANGRENOUS MAMMITIS OF MILCH EWES.
This disease occurs in different parts of France, and has also been seen
in Germany.
=Causation.= Lafosse in 1856 attributed it to the dark and dirty
condition of the sheep-folds, a cause which certainly contributes to its
propagation, though it is not the determining cause of the disease
itself. The latter is a specific micrococcus discovered in 1875 by
Rivolta, and thoroughly studied by Nocard in 1886 and 1887.
=Symptoms.= The course of the symptoms offers a certain analogy to that
of septic engorgements and interstitial mammitis or mammary
lymphangitis. As a rule only one gland is infected, but generally
symptoms at once appear, indicating an extremely dangerous condition,
viz., peracute mammitis. The patient suddenly becomes dull and entirely
loses appetite, rumination ceases and respiration is short and jerky,
although the bodily temperature does not always rise to any marked
extent.
Local symptoms soon develop. The udder assumes a violet-red tint and
becomes the seat of an erysipelatous swelling; the local temperature
rises, but as the disease progresses it gradually falls again. Milk
secretion ceases.
All these appearances rapidly become aggravated. The patient lies down;
the œdematous swelling extends to the belly and even to the chest and
thighs; the local temperature falls, indicating the imminence of
gangrene; the teat becomes contracted, and the pulse is very frequent
and almost imperceptible. From time to time the animal grinds its teeth.
The bodily temperature next falls to 98° or even 96° Fahr. (37° or 36°
C.), and the animal shows extreme prostration. The subcutaneous swelling
extends as far as the sternum in one direction and the quarters and
perineum in the other. The udder crackles under the finger. Death occurs
without a struggle.
All these symptoms follow as a rule in barely more than twenty-four
hours. Nevertheless, in certain cases, the disease lasts for three, four
or five days. Cases of spontaneous recovery are exceptional. The
gangrenous part may become delimited and slough away, leaving an
enormous suppurating wound, which slowly cicatrises. Even though the
animals survive, they never recover condition, but remain weakly, so
that, from a monetary standpoint, death would have been preferable.
Moreover, the lambs are starved and require a foster-mother.
=Lesions.= Post-mortem examination reveals œdematous infiltration of the
udder and surrounding connective tissue, and often extensive, diffuse
gangrene. The serosity is of a reddish colour, and sections of the
diseased udder of a violet tint. The tissues of the udder and the serous
liquid contain the specific micrococcus.
It is very small, and stains readily by the Gram-Nicolle method. It
grows rapidly in liquid and solid media, liquefies gelatine, and quickly
renders neutral media alkaline.
The injection of a few drops of culture into the udder of a milch ewe
reproduces the typical disease. In any other species it is without
effect. Infection occurs through the open extremity of the teat, or the
medium of a wound, and the microorganism is so virulent that it rapidly
invades all the tissues.
=Treatment.= No antiseptic treatment appears capable of checking the
course of the disease.
Surgical treatment alone is of any value, and consists in ablation of
the udder, followed by antiseptic dressing. Only a portion of the gland
is removed: an elliptical incision is made, including the diseased teat,
the skin is then dissected free so as to form a flap; the diseased
tissue is isolated; last of all, the vessels are ligatured. The
consequences of operation are less grave than might be expected,
considering the size of the wound, which heals with fair rapidity.
Moussu has frequently practised this radical method of treatment without
losing a single case. The remaining portion of the udder becomes
hypertrophied, and is often quite capable of secreting sufficient milk
for the nourishment of one lamb.
GANGRENOUS MAMMITIS IN GOATS.
Goats suffer from a form of mammitis which presents symptoms precisely
similar as regards development and termination to that of ewes. The
disease occurs in a sporadic form in animals giving milk, whatever their
breed or the conditions under which they are kept. It has been seen at
Alfort, as well as at Lyons.
Moussu has seen it in an enzootic form in herds of milch goats near
Bizerta (Tunis), and considers that contagion results from kids sucking
healthy animals after having been suckled by diseased ones. Fifty milch
goats out of a total of three hundred were affected at the time of
Moussu’s visit, and two had already succumbed.
=The diagnosis= presents no difficulty.
=The prognosis= is very grave.
=The treatment= is precisely similar to that of gangrenous mammitis of
milch ewes, viz., ablation of the diseased udder.
Of the above-mentioned herd, twenty animals were operated on, and all
recovered without accident. Among the others treated by less radical
methods, such as scarifications, incisions, antiseptic injections, etc.,
eight died. The only justifiable treatment, therefore, is ablation.
CYSTS OF THE UDDER.
Cysts of the udder may assume one of two forms, milk or galactocelous
cysts and serous cysts; possibly the latter are only hydatid cysts.
Both varieties are of the nature of retention cysts, and result from
accidental obliteration of a milk conduit, which has been obstructed by
coagulated casein, or from atresia due to contraction of inflamed
connective tissue. The acini are isolated and become dilated, the milk
undergoes changes in composition, the secretory epithelium degenerates,
and the cyst is produced.
The serous or milk cysts may vary considerably in size, and always show
a rapid tendency to suppuration.
=The diagnosis= is based on the detection of uniform fluctuation without
excessive sensibility, and can be confirmed by an exploratory capillary
puncture.
=The prognosis= is grave, for recovery can only occur after the lining
membrane of the cyst has been destroyed.
=Treatment.= Puncture followed by irrigation is insufficient, whatever
the nature of the cyst.
Free incision, or simple puncture with a bistoury, produces suppuration
within the cystic cavity, which continues until the lining membrane is
completely destroyed; but this takes a very long time.
Removal of the entire cyst, either with the bistoury or by tearing
through the surrounding connective tissue, is the best method of
treatment. The wound thus produced heals regularly and rapidly under an
antiseptic surgical dressing.
TUMOURS OF THE UDDER.
Tumours of the udder have been little studied in the larger domestic
animals, the reason being that immediately animals cease to yield milk
they are fattened and despatched to the butcher. Clinically, therefore,
these tumours are not of great practical importance.
Without entering into general considerations of a pathological
anatomical character, by which different varieties of these tumours are
differentiated, we may say that they assume one of three different
forms. The first is sharply circumscribed, of clearly defined shape, and
easily separated from neighbouring tissues, to which it adheres but
slightly. Such tumours are benign, and have no tendency to return after
removal.
The second is ill-defined, very adherent, and appears to infiltrate the
surrounding tissue. It is malignant in character, is often impossible to
completely remove, returns after extirpation, and infects neighbouring
lymphatic glands.
Between these two varieties may be placed a third, occupying an
intermediate position as regards both its characteristics and gravity.
Practically a knowledge of the above facts is a sufficient guide in
dealing with lesions of this character.
=Canalicular Papillomata.=—There exists another variety of tumours which
is of much more frequent occurrence, and which is apt to cause mistakes.
This variety consists of inter-canalicular papillomata.
These show no sign of their existence on external examination of the
diseased udder, and can be diagnosed only by reasoning based on the
signs observed.
They are of very small size, and grow from the internal wall of the
galactophorous sinus or excretory canal. They increase in length,
finally extending for some distance along the sinus, where they remain
unrecognised until some external manifestation arouses suspicion as to
their existence.
Under the mechanical contraction due to milking they easily become
excoriated, and their existence is then suggested almost solely by the
fact that the milk is tinted with blood, for palpation of the udder very
seldom gives more than negative results.
The =diagnosis= is always doubtful. The =prognosis= is grave, because it
is impossible to remove the tumour, which is often deeply placed within
the udder. There is no curative treatment.
VERRUCOUS PAPILLOMATA OF THE UDDER.
In cows suffering from cutaneous papillomata the udder is often covered
with a varying number of little sessile warts, which are spread over a
considerable surface, are very sensitive, and bleed at the lightest
touch. Milking is thus rendered extremely painful and difficult; the
animals struggle, kick, and become dangerous.
The condition is extremely troublesome, and in spite of every precaution
the milk is always soiled.
The best method of treatment consists in removing the warts individually
with fine, sharp-bladed curved scissors.
The animals must be firmly secured, if necessary cast, and the operator
should avoid removing more of the skin covering the udder than is
absolutely necessary. The bleeding which follows is trifling, and stops
of itself. After washing the parts with an antiseptic solution, the
little wounds may be powered with a mixture in equal proportions of
tannin and boric acid.
CHAPTER VI.
DISTURBANCE IN THE MILK SECRETION AND CHANGES IN THE MILK.
Changes in the milk are so common and play so important a part in the
milk industry that it is absolutely necessary to mention the more
important, the country veterinary surgeon being frequently consulted on
this point.
The udder acts as a natural emunctory, just like the kidney, by which
are eliminated, in consequence of special selective properties, certain
natural principles (the active principles contained in the forage and
other food, vegetable alkaloids, etc.), drugs (alcohol), and poisons
(nicotine). This physiological peculiarity explains the influence of
changes of diet on the composition of the milk in mothers and on the
condition of their offspring. In the human species it also explains
congenital alcoholism in children, and a number of diseases whose cause
was formerly unknown.
=Agalaxia.=—This term implies a temporary or definite arrest of the milk
secretion. In many instances it represents nothing more than a
disturbance in the physiological function of the gland, but in others it
forms a true diseased condition.
Thus it is beyond dispute that psychical influences may produce
disturbance in this respect. Temporary suspension in the secretion as a
consequence of removal of the offspring from its mother, especially when
the young animal has been sucking for several days or weeks, is a fact
very well known to all breeders.
Under ordinary circumstances, however, the reasons are quite different,
and when the secretion of milk is diminished or suppressed it is due to
the ingestion of plants, substances, or drugs which check the secretion
of milk. All the solanaceæ (belladonna, hyoscyamus, stramonium, woody
nightshade, etc.), certain umbelliferæ (hemlock), colchicum, etc., have
this effect.
As to agalaxia of a true pathological character, it occurs in
debilitating and grave diseases, and sometimes follows certain
contagious forms of mammitis complicated with sclerosis of the udder
(infectious agalaxia of goats).
=Diagnosis.= The diagnosis of agalaxia presents no difficulty.
=Prognosis.= The prognosis varies, according to the determining cause.
In cases of accident and in temporary agalaxia, it is sufficient to
change the food in order to restore the secretion. Cooked food and warm
drinks, with an allowance of roots such as turnips or mangolds, have
excellent results. Where restoration of the secretion is delayed the use
of what are called galactogogues has been recommended, comprising
fennel, carraway, cummin, aniseed, juniper, sulphur, etc., mixed in
equal parts and given in doses of 6 to 8 drachms per day for a cow.
They act principally through the stimulating effects of their aromatic
principles.
MICROBIC CHANGES IN MILK.
LACTIC FERMENTS.
Microbic changes in milk are much commoner than changes of a chemical
nature. Milch animals differ very markedly one from another, and,
according to circumstances, give milk of ordinary composition, milk of a
very rich character, or watery milk; but the most important changes in
composition are those due to microbic agents.
During the milking, and according to whether this is performed in a low,
dirty byre, in a clean, roomy byre, or in the open air, various numbers
of germs obtain entrance to the milking vessels, and develop there with
extraordinary rapidity. The milk may even become infected by
non-pathogenic germs while still within the udder, in the sinus and
galactophorous canals. The cleanliness of the milking vessels also has a
considerable influence on the number and variety of the microbes which
may eventually germinate in the liquid.
Among the microorganisms usually found in milk there are some, however,
which always preponderate and play the part of organised ferments, viz.,
the lactic ferments and the organisms which cause coagulation of the
casein; these may be regarded as normal constituents. The others are
more or less foreign, and may cause important changes in the milk or
cream.
The lactic ferments are numerous, comprising the lactic bacilli of
Hueppe and Grotenfeld, the micrococci of Hueppe and Marpmann, and the
bacilli and micrococci of Freudenreich. These different agents act on
the lactose of the milk, decomposing it into carbonic and lactic acids,
which coagulate the milk.
Another group of microorganisms which were well studied by Duclaux
comprises those acting on the casein, among others _Tyrothrix tenuis_,
_filiformis_, _turgidus_, _scaber_, _virgula_, etc.
These organisms secrete principles having similar effects to those of
rennet, and are capable of coagulating enormous quantities of milk.
After a certain time, they also secrete a second diastase, viz.,
casease, which acts in the ripening of cheese.
=Clotted Milk.=—This term is used in dairies to indicate milk which
coagulates in lumps immediately after being withdrawn from the udder, or
which coagulates spontaneously a few hours later.
The change may be of a chemical nature, depending on conditions of keep
or feeding. More frequently, however, it is related to a latent
non-pathogenic infection of the udder, or to immediate infection of the
milk after removal by lactic ferments contained in the milk vessels or
the atmosphere.
It is necessary, according to circumstances, either to modify the diet
or disinfect the milk vessels, and immediately pasteurise the milk.
=Milk without Butter.=—Less commonly the diseased condition is indicated
by marked diminution in the quantity of cream.
Churning only produces a poor kind of butter, particles of which do not
readily cohere. This peculiarity is due to the presence of
microorganisms, which have not yet been fully identified. It can be
prevented by disinfection of the milking vessels, as well as of the
dairy itself, and by the use of centrifugal separators.
=Putrid Milk.=—This milk is characterised by its odour. It cannot be
used for making butter. In fact, as soon as the cream separates, little
bubbles of gas form at various points and break, leaving small cavities.
These little separate cavities reunite very rapidly, and the cream
becomes reabsorbed as fast as it is formed. Afterwards oily drops formed
of butyric, capric, and caprylic acids appear in the depressions and
give the milk a repulsive odour (rancidity).
This change is seen during mammitis, but most commonly results from
uncleanliness in byres and dairies. In the latter case putrefaction
occurs about twenty-four hours after milking, and is due to the growth
in the milk of _Bacterium termo_, _lineola_, etc. These organisms are
present in the dust which falls into the milking pails in the byre; when
milk so contaminated is stored in the dairy the changes occur.
Putrid odour may also be due to the presence of ammoniacal gas in the
byre, or to special toxins liberated by microbes which have found their
way into the milk. It is most marked during the warm seasons of the
year.
The occurrence of putrid milk can be prevented by disinfecting the dairy
and the milking pails daily for a certain time.
=Mucous, viscous, or thready Milk.=—These terms are applied to a
condition which usually appears twenty-four or thirty-six hours after
the milk has been withdrawn. The milk seems thick and viscous, and can
be drawn out into threads like mucus. It sticks to neighbouring objects,
and adheres to milk vessels like molasses. It coagulates imperfectly on
standing, gives little cream, and even this cream only furnishes a
mawkish, ill-flavoured butter.
In certain parts of Switzerland the production of mucous milk is
favoured, because it is employed in making cheeses.
The change is due to the presence of various microorganisms. Those which
have been best studied are Schmidt-Mülheim’s micrococci, the
_Actinobacter polymorphus_ of Duclaux, the _Bacillus lactis pituitosi_
of Löffler, the _Bacillus lactis_ of Adametz, the _Streptococcus
hollandicus_, and, finally, three others which are much commoner,
Guillebeau’s bacillus, the _Micrococcus Freudenreichii_, and the
_Bacterium Hessii_. These microorganisms act on the lactose, decomposing
it and causing the formation of a kind of filamentous mucilage, which
can be isolated by the addition of alcohol.
The mucilaginous change in milk can be prevented by ordinary methods of
disinfection.
=Red Milk.=—Milk which becomes red some hours after withdrawal, or
within forty-eight hours after milking, should be distinguished from
milk which on withdrawal from the udder is tinted red in consequence of
hæmorrhage within the udder itself. When the milk is of a hæmorrhagic
tint the blood corpuscles are soon deposited on the bottom of the vessel
if the milk is allowed to remain undisturbed.
The tint which the milk assumes is due to the growth of chromogenic
organisms, the best known of which are as follows:—1. _B. prodigiosus_,
which produces large red patches on the surface. It grows readily on
potato and gelatine, which it liquefies. 2. The _Sarcina rosea_, which
develops first of all in the cream and afterwards invades the milk. It
grows in sterilised milk, on alkaline potato, and on gelatine. 3. The
_Bacterium lactis erythrogenes_, which liquefies gelatine and produces a
reddish coloration. Casein can be precipitated and peptonised by means
of its cultures. It develops in the milk below the cream, the serum
alone becoming red, and only when shaded from the light.
=Blue Milk.=—In this case the milk appears normal when withdrawn, but
some days afterwards shows blue patches, which gradually increase in
size, and by uniting produce a distinct blue tint at the surface.
This change is connected with the presence of the _B. cyanogenus_. The
organism grows in sterilised milk, but in this case merely produces
greyish patches, the blue tint only occurring when a certain quantity of
lactic acid is added or when the ordinary lactic ferments are present.
=Yellow Milk.=—A yellow tint occurs in ordinary milk and cream,
particularly in certain breeding districts—in Normandy, for example,
where the butter produced is greatly valued on account of this
appearance. Pathological yellow milk is the result of the growth of _B.
synxanthus Schröter_, which secretes a substance resembling rennet,
curdles the milk, and finally dissolves the clot, at the same time
producing the yellow colour.
=Bitter Milk.=—Milk which is of a normal character on being withdrawn
from the udder may acquire a bitter taste some hours later. At rest,
this milk produces a small quantity of yellowish, frothy cream. The
organisms which produce the change have been studied in Germany,
Switzerland, and Auvergne. We may mention Weizmann’s bacillus of bitter
milk, Conn’s micrococcus of bitter milk, and Duclaux’s _Tyrothrix
geniculatus_.
=Medicated Milk.=—Medicated milk may be divided into two kinds: Firstly,
medicated milk proper, which differs from normal milk inasmuch as it
contains a certain proportion of drugs, which, when swallowed by milch
cows are partly eliminated through the udder. When taken by a young
animal or child such milk has a distinct therapeutic effect, depending
on the principles employed.
It does not appear, however, that up to the present any very great
success has followed this system. It is possible to increase the
richness of the milk in phosphates, but as regards mercurial or iodine
preparations the failure has been complete.
Secondly, fermented milks, which in addition to their nutritive action
are made more digestible.
Fermented milk is easily digested, and is better borne by the weakest
stomachs.
In human practice the fermented forms of milk are two, viz., kephyr and
koumiss.
_Kephyr_ is prepared in Afghanistan and Persia from camel’s milk, but
for some years past it has been made in England with cow’s milk. A
certain quantity of cow’s milk is placed in a bottle and the ferment,
consisting of kephyr grains, is added. The lactose is converted into
carbonic acid and alcohol in consequence of the action of certain lactic
microbes.
This milk after ingestion does not require to be coagulated and then
digested before absorption, a fact which considerably diminishes peptic
digestion.
_Koumiss_ is a milk preparation resembling kephyr; it is made by the
Kirghizes with mare’s milk according to the same principles, but the
ferment employed gives more alcohol.
=Preservation of Milk.=—On account of the importance of preserving milk
for use in large towns, in hospitals, and in the army during war, the
question of its preservation has long been studied.
_Chemical Processes._—The principle of preserving milk by chemical
action consists in preventing, or at least retarding, the changes which
inevitably follow exposure to the air. For this purpose, chemical
substitutes are added which in themselves have no injurious action.
Those most commonly employed are:—
Carbonate of soda 45 grs. per quart.
Bicarbonate of soda 45 grs. „
Boric acid 15 to 30 grs. „
Salicylic acid 12 grs. „
Borax 60 grs. „
Lime 20 grs. „
The results obtained are of comparatively little value; the milk only
keeps for a few hours, or at the most for three or four days.
_Cold._—Refrigeration, which is so valuable in preserving all kinds of
animal products for long periods, has also been used for preserving
milk. Unfortunately, although cold impedes the development of bacteria,
it also has the grave inconvenience of causing the cream to separate
from the milk, and it being impossible to mix them again satisfactorily,
milk preserved in this way is more or less unfit for consumption.
_Heat._—The principle of preserving milk by heat is based on the
destruction of the microorganisms at a high temperature. In this respect
again, one meets with obstacles, for, if the heat be applied direct,
some of the principles of the milk are converted into caramel, and if
the temperature rises beyond 157° Fahr. (70° C.) the composition of the
milk is changed.
_Preservation by Oxygen._—Within the last few years the use of oxygen at
a pressure of about two atmospheres has been recommended. When the milk
is to be used it is only necessary slightly to relieve the pressure and
allow the oxygen to escape, the liquor which remains having all the
characters and qualities of fresh milk. The method appears excellent,
but is too costly for every-day use.