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The treatment of torsion of the gravid uterus in cows
ABSTRACTS AND REPORTS.
owner delivering the necessary internal organs at latest three days after the animal's death for the purpose of bacteriological examination. Only twenty· four demands for compensation were made. Careful bacteriological exammation of the organs forwarded, comprising microscopical examination, inoculation of mice and pigeons, and cultivation on artificial media, showed, however, that in twenty-three of the cases death had not resulted from inoculation. In the twenty-fourth case no satisfactory distinction between swine erysipelas and mouse septic~mia bacilli could be made on account of the advanced state of decomposition of the organs sent. As the animal from which these organs had been obtained had died at least four days previously this demand was also dismissed. (Beisswanger, Berliner Thieriir::tl. Wocltenscllrift, No. 33, lIth August 19 0 4, p. 5 6 5.)
THE TREATMENT OF TORSION OF THE GRAVID UTERUS IN COWS. IN the Berliner Archi,l 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 al1lmal 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. . Haase divides his cases into three groups according to the method of tre:ttment employed. The first comprises cases where delivery was effected without rolling or hobbling the animal, which was either standing or lying down. The second, cases in which delivery was only possible after rolling, and The third, two cases which Haase himself did not treat but only examined. In describing the degree of torsion he 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 fcetus, 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. Case No. I.-Primipara. A three-year-old Simmenthaler cow had shown pains for some hours without labour being completed. On manual examination moderately tense folds running towards the right could be felt on the upper wall of the dilated cervix uteri, so that it was necessary to bend the arm at the wrist and avoid the folds in order to pass the hand into the uterus. The calf still lay in the unbroken membranes, with the head and fore limbs directly behind the obstruction. There was therefore moderate torsion between one
ABSTRACTS AND REPORTS.
quarter and one third of a revolution, towards the right. Haase broke the membranes, and, after allowing a portion of the fluid to escape, secured the fore-limbs and head with straps, and by careful traction delivered the calf alive. Slight bleeding from the vagina followed. On the lower wall of the uterus, at the point where it becomes continuous with the cervix, was a rupture nearly as large as a cheese plate, implicating, however, only the mucous membrane. This was due to the lower wall having been pressed against the anterior edge of the os pubis. Lysol injections were made daily, and the wound healed in about a fortnight. The cow and calf remained healthy. Case 2 was that of a black and white Holland cow, which had travelled a considerable distance by rail and had afterwards been forwarded by cattle van. It had shown labour pains without, however, the calf appearing. On turning the animal round slight crepitation could be heard. The right hip seemed lower than the left, giving the pelvis an oblique appearance. Fracture of the pelvis was suspected without its exact position being diagnosed. Semicomplete torsion of the uterus was revealed on careful examination. No attempt was made to roll the cow because of the severe injury already existing. By cautious traction on the hind limbs the calf was delivered but proved to be dead. Moderate bleeding from the vagina followed. The animal died two days later. Post-mortem examination provt;!d it to have suffered from luxation of the left sacro-iliac joint, the two surfaces being separable, a fact which explained the crepitation and oblique position of the pelvis during life. The upper wall of the uterus also showed a torn wound about 8 inches long communicating with the peritoneal cavity. The peritoneal cavity itself contained blood-stained fluid and a large blood clot. The animal had died from septic::emic peritonitis. Haase considers that both the luxation of the sacro-iliac joint and torsion of the uterus were probably caused by a single violent shock, such as a sudden fall or severe concussion produced in shunting the cattle truck. Case 3 was that of a young Simmenthaler cow with slight torsion towards the left, which Haase estimated at one quarter to one third. By cautious traction on the fore-limbs the young animal was safely delivered. Cow and calf remained healthy. Case 4 was that of a primipara of Simmenthaler breed which showed onequarter to one-third torsion towards the right. By slow cautious traction on the hind limbs the calf was brought into the maternal passages, but complete delivery necessitated the use of considerable force. The calf was dead. It weighed nearly 120 lbs., and was therefore rather above normal size. The mother escaped rupture but showed severe inflammation of the vagina and cervix, which subsided in about fourteen days, after frequent irrigation with I per cent. lysol solution. As shown by the above cases, Haase was partially successful in delivering animals suffering from torsion of the uterus without casting them, particularly in Cases I and 3. He had greater difficulty, however, in effecting delivery where rolling proved necessary in order to reduce torsion. Being uncertain as to the direction in which to roll, he in some cases tried first one and then the other. Only after considerable experience did he discover the correct direction. Case 5. An adult cow of Simmenthaler breed and in very good condition had shown labour pains for ten to twelve hours without delivery being effected. Semi-complete or complete torsion of the uterus was diagnosed. The cervix was firmly constricted. The spiral folds were extremely tense, so that manual examination was only possible by the exertion of considerable strength, and by strongly flexing the wrist the fore feet and head of the calf could be felt. The owner having been informed of the gravity of the case, the animal was hobbled and rolled on a smooth horizontal floor thickly covered with
ABSTRACTS AND REPORTS.
255
straw. During a period of one and a half hours about twenty turns in either direction were given. The torsion was not reduced in the slightest degree. As the owner strongly opposed slaughter and, against Haase's advice, demanded that attempts at delivery should be made despite the torsion, Haase placed cords on the front legs. He was unable to pass a cord round the neck, but inserted a hook into the orbit. By employing considerable force whilst the cow was standing the calf was extracted but proved to be dead. The mother appeared to have survived the operation well, but three or four minutes later shuddered severely, lay down, and died. Death had resulted from bleeding into the abdominal cavity. Case 6. Primipara with half to three-quarter torsion of the uterus. The animal was turned about fifteen times in either direction, but, no diminution occurring in the torsion, it was slaughtered. Case 7 was that of a cow which had borne several calves. Having shown labour pains for two days, the animal was examined and found to be suffering from half to three-quarter torsion of the uterus, towards the left. After casting it was rolled about twenty times in either direction, but without the torsion being reduced. Before slaughtering, Haase determined to try a new method. The animal was lying on its left side and was rolled down-hill on to its right side. The torsion seemed at once to have been reduced, and the calf was born alive, though it died about ten minutes later. The uterus showed an incomplete rupture as large as a cheese plate in the region of the anterior margin of the os pubis. The rupture did not communicate with the peritoneal cavity, but three days later the cow died of puerperal septic::emia. From the results of this case Haase concluded that the rolling should be performed on a sloping bed and in the direction of torsion. Case 8 showed semi-complete torsion towards the left. The animal was hobbled and placed on its left side. A sloping bed of straw was made, extending backwards from the level of the crib to the stable drain. On this the animal was laid on its left side and rolled over once down-hill, so that it came to rest on its right side. The torsion was immediately reduced and delivery effected. A penetrating rupture of the upper wall of the uterus, however, was detected, and the animal was slaughtered. Case 9 was that of a cow with semi-complete torsion towards the right. A bed was prepared as above described, the animal laid on its right side, and rolled down hill on to its left side_ The torsion in this case was also reduced; the calf was delivered but only lived fifteen minutes. The cow suffered no injury and remained healthy. Case 10 was that of a Simmenthaler cow in good condition. She had previously borne several calves and had no difficulty in delivery. As labour pains were not followed hy the appearance of the calf, the neck of the uterus was examined and found to be thickened. No constriction could be detected, nor were spiral folds present. As this condition persisted for several days, and the animal began to show fever, loss of appetite, and tympanites, the case was regarded as torsion of the uterus and the animal was slaughtered. Post-JJlortem examination showed torsion of the anterior portion of the gravid cornu of the uterus. Examination per rectum might possibly have enabled this condition to be detected during life. Case I I was that of a well nourished Simmenthaler cow which showed labour pains without delivery following. Semi-complete torsion of the uterus towards the right was diagnosed. Haase recommended attempting reduction, but the owner opposed this and called in another veterinary surgeon. The calf was delivered dead and the cow was at once slaughtered. Considering in detail the circumstances attending this disease in cows, the
ABSTRACTS AND REPORTS.
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 o(the two ligaments in the neighbourhood of the two external angles of the ilium. The uterus, however, is also steadied in position by the vagina and by the cellular tissue surrounding it; in fact, in non-pre.e-nant 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 fcetus, however, the conditions become changed. In consequence of the increased weight of its contents the uterus exerts tension 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 fretus 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. (Haase, Berliner Tierdrzfl. TVochenschr., No. IS, 7th April 1904, p. 277·)
AN OUTBREAK OF SARCOPTIC MANGE IN PIGS. SARCOPTIC mange in pigs has not often been described, so that the following details of an outbreak implicating a large number of animals in one place may prove interesting. During 1901 M. Scholl saw the pigs in question, and noted incidentally that a large number of them showed considerable irritation and were rubbing themselves on surrounding objects. At that time he attached little importance to the fact, but on subsequent visits his attention was more closely called to the matter, and he finally con· cluded that almost all the pigs on this particular farm, including many sucking pigs, were suffering from a pruriginous disease of the skin of a more or less advanced character. In the meantime many of the animals had seriously suffered in condition. The sucking pigs, though born healthy, fell away greatly in two or three weeks. In a month to six weeks many showed extreme wasting and others died. At this time M. Scholl was asked to undertake treatment.
owner delivering the necessary internal organs at latest three days after the animal's death for the purpose of bacteriological examination. Only twenty· four demands for compensation were made. Careful bacteriological exammation of the organs forwarded, comprising microscopical examination, inoculation of mice and pigeons, and cultivation on artificial media, showed, however, that in twenty-three of the cases death had not resulted from inoculation. In the twenty-fourth case no satisfactory distinction between swine erysipelas and mouse septic~mia bacilli could be made on account of the advanced state of decomposition of the organs sent. As the animal from which these organs had been obtained had died at least four days previously this demand was also dismissed. (Beisswanger, Berliner Thieriir::tl. Wocltenscllrift, No. 33, lIth August 19 0 4, p. 5 6 5.)
THE TREATMENT OF TORSION OF THE GRAVID UTERUS IN COWS. IN the Berliner Archi,l 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 al1lmal 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. . Haase divides his cases into three groups according to the method of tre:ttment employed. The first comprises cases where delivery was effected without rolling or hobbling the animal, which was either standing or lying down. The second, cases in which delivery was only possible after rolling, and The third, two cases which Haase himself did not treat but only examined. In describing the degree of torsion he 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 fcetus, 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. Case No. I.-Primipara. A three-year-old Simmenthaler cow had shown pains for some hours without labour being completed. On manual examination moderately tense folds running towards the right could be felt on the upper wall of the dilated cervix uteri, so that it was necessary to bend the arm at the wrist and avoid the folds in order to pass the hand into the uterus. The calf still lay in the unbroken membranes, with the head and fore limbs directly behind the obstruction. There was therefore moderate torsion between one
ABSTRACTS AND REPORTS.
quarter and one third of a revolution, towards the right. Haase broke the membranes, and, after allowing a portion of the fluid to escape, secured the fore-limbs and head with straps, and by careful traction delivered the calf alive. Slight bleeding from the vagina followed. On the lower wall of the uterus, at the point where it becomes continuous with the cervix, was a rupture nearly as large as a cheese plate, implicating, however, only the mucous membrane. This was due to the lower wall having been pressed against the anterior edge of the os pubis. Lysol injections were made daily, and the wound healed in about a fortnight. The cow and calf remained healthy. Case 2 was that of a black and white Holland cow, which had travelled a considerable distance by rail and had afterwards been forwarded by cattle van. It had shown labour pains without, however, the calf appearing. On turning the animal round slight crepitation could be heard. The right hip seemed lower than the left, giving the pelvis an oblique appearance. Fracture of the pelvis was suspected without its exact position being diagnosed. Semicomplete torsion of the uterus was revealed on careful examination. No attempt was made to roll the cow because of the severe injury already existing. By cautious traction on the hind limbs the calf was delivered but proved to be dead. Moderate bleeding from the vagina followed. The animal died two days later. Post-mortem examination provt;!d it to have suffered from luxation of the left sacro-iliac joint, the two surfaces being separable, a fact which explained the crepitation and oblique position of the pelvis during life. The upper wall of the uterus also showed a torn wound about 8 inches long communicating with the peritoneal cavity. The peritoneal cavity itself contained blood-stained fluid and a large blood clot. The animal had died from septic::emic peritonitis. Haase considers that both the luxation of the sacro-iliac joint and torsion of the uterus were probably caused by a single violent shock, such as a sudden fall or severe concussion produced in shunting the cattle truck. Case 3 was that of a young Simmenthaler cow with slight torsion towards the left, which Haase estimated at one quarter to one third. By cautious traction on the fore-limbs the young animal was safely delivered. Cow and calf remained healthy. Case 4 was that of a primipara of Simmenthaler breed which showed onequarter to one-third torsion towards the right. By slow cautious traction on the hind limbs the calf was brought into the maternal passages, but complete delivery necessitated the use of considerable force. The calf was dead. It weighed nearly 120 lbs., and was therefore rather above normal size. The mother escaped rupture but showed severe inflammation of the vagina and cervix, which subsided in about fourteen days, after frequent irrigation with I per cent. lysol solution. As shown by the above cases, Haase was partially successful in delivering animals suffering from torsion of the uterus without casting them, particularly in Cases I and 3. He had greater difficulty, however, in effecting delivery where rolling proved necessary in order to reduce torsion. Being uncertain as to the direction in which to roll, he in some cases tried first one and then the other. Only after considerable experience did he discover the correct direction. Case 5. An adult cow of Simmenthaler breed and in very good condition had shown labour pains for ten to twelve hours without delivery being effected. Semi-complete or complete torsion of the uterus was diagnosed. The cervix was firmly constricted. The spiral folds were extremely tense, so that manual examination was only possible by the exertion of considerable strength, and by strongly flexing the wrist the fore feet and head of the calf could be felt. The owner having been informed of the gravity of the case, the animal was hobbled and rolled on a smooth horizontal floor thickly covered with
ABSTRACTS AND REPORTS.
255
straw. During a period of one and a half hours about twenty turns in either direction were given. The torsion was not reduced in the slightest degree. As the owner strongly opposed slaughter and, against Haase's advice, demanded that attempts at delivery should be made despite the torsion, Haase placed cords on the front legs. He was unable to pass a cord round the neck, but inserted a hook into the orbit. By employing considerable force whilst the cow was standing the calf was extracted but proved to be dead. The mother appeared to have survived the operation well, but three or four minutes later shuddered severely, lay down, and died. Death had resulted from bleeding into the abdominal cavity. Case 6. Primipara with half to three-quarter torsion of the uterus. The animal was turned about fifteen times in either direction, but, no diminution occurring in the torsion, it was slaughtered. Case 7 was that of a cow which had borne several calves. Having shown labour pains for two days, the animal was examined and found to be suffering from half to three-quarter torsion of the uterus, towards the left. After casting it was rolled about twenty times in either direction, but without the torsion being reduced. Before slaughtering, Haase determined to try a new method. The animal was lying on its left side and was rolled down-hill on to its right side. The torsion seemed at once to have been reduced, and the calf was born alive, though it died about ten minutes later. The uterus showed an incomplete rupture as large as a cheese plate in the region of the anterior margin of the os pubis. The rupture did not communicate with the peritoneal cavity, but three days later the cow died of puerperal septic::emia. From the results of this case Haase concluded that the rolling should be performed on a sloping bed and in the direction of torsion. Case 8 showed semi-complete torsion towards the left. The animal was hobbled and placed on its left side. A sloping bed of straw was made, extending backwards from the level of the crib to the stable drain. On this the animal was laid on its left side and rolled over once down-hill, so that it came to rest on its right side. The torsion was immediately reduced and delivery effected. A penetrating rupture of the upper wall of the uterus, however, was detected, and the animal was slaughtered. Case 9 was that of a cow with semi-complete torsion towards the right. A bed was prepared as above described, the animal laid on its right side, and rolled down hill on to its left side_ The torsion in this case was also reduced; the calf was delivered but only lived fifteen minutes. The cow suffered no injury and remained healthy. Case 10 was that of a Simmenthaler cow in good condition. She had previously borne several calves and had no difficulty in delivery. As labour pains were not followed hy the appearance of the calf, the neck of the uterus was examined and found to be thickened. No constriction could be detected, nor were spiral folds present. As this condition persisted for several days, and the animal began to show fever, loss of appetite, and tympanites, the case was regarded as torsion of the uterus and the animal was slaughtered. Post-JJlortem examination showed torsion of the anterior portion of the gravid cornu of the uterus. Examination per rectum might possibly have enabled this condition to be detected during life. Case I I was that of a well nourished Simmenthaler cow which showed labour pains without delivery following. Semi-complete torsion of the uterus towards the right was diagnosed. Haase recommended attempting reduction, but the owner opposed this and called in another veterinary surgeon. The calf was delivered dead and the cow was at once slaughtered. Considering in detail the circumstances attending this disease in cows, the
ABSTRACTS AND REPORTS.
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 o(the two ligaments in the neighbourhood of the two external angles of the ilium. The uterus, however, is also steadied in position by the vagina and by the cellular tissue surrounding it; in fact, in non-pre.e-nant 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 fcetus, however, the conditions become changed. In consequence of the increased weight of its contents the uterus exerts tension 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 fretus 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. (Haase, Berliner Tierdrzfl. TVochenschr., No. IS, 7th April 1904, p. 277·)
AN OUTBREAK OF SARCOPTIC MANGE IN PIGS. SARCOPTIC mange in pigs has not often been described, so that the following details of an outbreak implicating a large number of animals in one place may prove interesting. During 1901 M. Scholl saw the pigs in question, and noted incidentally that a large number of them showed considerable irritation and were rubbing themselves on surrounding objects. At that time he attached little importance to the fact, but on subsequent visits his attention was more closely called to the matter, and he finally con· cluded that almost all the pigs on this particular farm, including many sucking pigs, were suffering from a pruriginous disease of the skin of a more or less advanced character. In the meantime many of the animals had seriously suffered in condition. The sucking pigs, though born healthy, fell away greatly in two or three weeks. In a month to six weeks many showed extreme wasting and others died. At this time M. Scholl was asked to undertake treatment.