The closed fist may now be planted in the rounded end of the largest horn and pushed on so as to turn it back within itself and carry it on through the vagina, the other hand being used meanwhile to assist in the inversion and in pushing the different masses in succession within the lips of the vulva. In case of failure, resort should be had at once to a plan which I have successfully followed for many years. Take a long linen or cotton bandage, 5 or 6 inches wide, and wind it around the protruding womb as tightly as it can be drawn, beginning at the free end and gradually covering the entire mass up to the vulva. By this means the greater part of the blood will be forced out of the organ and its bulk greatly reduced, so that its reduction is much facilitated. An additional advantage is found in the protection given to the womb by its investing bandage while it is being pushed forward into the vagina and abdomen. In manipulating the exposed womb there is always danger of laceration, but when the organ is covered with a sheet it is next to impossible to tear it. The subsequent manipulation is as in the other case, by pushing the blind end forward within itself with the closed fist and carrying this on through the vagina into the abdomen with the constant assistance of the other hand. Often it will be found convenient to use the edge of the left hand to push the outer part of the protruding mass inside the lips of the vulva, while the right hand and arm are carrying the central portions forward through the vagina. An intelligent assistant, pushing with the palms of both hands on the outer portion of the mass, will also afford material assistance. As the womb is turned within itself the wrapping bandage will gradually loosen, but once the great mass has entered the passages it is easy to compel the rest to follow, and the compression by the bandage is no longer so important. When the womb is fully replaced the bandage is left in its interior in a series of loose folds, and can be easily withdrawn. It is well to move the hand from side to side to insure that the two horns of the womb are fully extended and on about the same level before withdrawing the arm and applying a truss.
When the womb has been long everted and is gorged with blood, inflamed, and friable there is often the additional disadvantage that the animal is unable or unwilling to rise. When lying down the straining can not be controlled so effectually, and, even in the absence of straining, the compression of the belly is so great as to prove a serious obstacle to reduction. The straining may be checked by 2 or 3 ounces of laudanum or 2 ounces of chloral hydrate, or by inhalation of chloroform to insensibility, and then by raising the hind parts on straw bundles the gravitation of the abdominal organs forward may be made to lessen the resistance. If not successful in this way, the cow may be further turned on her back, and if return is still impossible, the hind limbs may be tied together and drawn up to a beam overhead by the aid of a pulley. In this position, in place of the pressure backward of the bowels proving a hindrance, their gravitation forward proves a most material help to reduction. In seeking to return the womb the sponging with ice-cold water, raising on a sheet, and wrapping in a tight bandage should be resorted to. Another method which is especially commendable in these inflamed conditions of the womb is to bring a piece of linen sheet, 30 by 36 inches, under the womb, with its anterior border close up to the vulva, then turn the posterior border upward and forward over the organ, and cross the two ends over this and over each other above. The ends of the sheet are steadily drawn, so as to tighten its hold on the womb, which is thus held on the level of the vulva or above, and cold water is constantly poured upon the mass. The reduction is further sought by compression of the mass with the palms applied outside the sheet. Fifteen or twenty minutes are usually sufficient to cause the return of the womb, provided straining is prevented by pinching the back, or otherwise.
In old and aggravated cases, with the womb torn, bruised, or even gangrenous, the only resort is to amputate the entire mass. This is done by tying a strong, waxed cord around the protruding mass close to the vulva, winding the cord around pieces of wood, so as to draw it as tightly as possible, cutting off the organ below this ligature, tying a thread on any artery that may still bleed, and returning the stump well into the vagina.
Retention of the returned womb is the next point, and is most easily accomplished by a rope truss. Take two ropes, each about 18 feet long and an inch in thickness. Double each rope at its middle, and lay the one above the other at the bend, so as to form an ovoid of about 8 inches in its long diameter. Twist each end of the one rope twice around the other, so that this ovoid will remain when they are drawn tight. ([Pls. XXII], [XXIII].) Tie a strap or rope around the back part of the neck and a surcingle around the body. Place the rope truss on the animal so that the ovoid ring will surround the vulva, the two ascending ropes on the right and left of the tail and the two descending ones down inside the thighs on the right and left of the udder. These descending ropes are carried forward on the sides of the body and tied to the surcingle and to the neck collar. The ascending ropes proceed forward on the middle of the back, twisting over each other, and are tied to the surcingle and collar. The upper and lower ropes are drawn so tightly that the rope ring is made to press firmly all around the vulva without risk of displacement. This should be worn for several days, until the womb shall have closed and all risk of further eversion is at an end. Variations of this device are found in the use of a narrow triangle of iron applied around the vulva and fixed by a similar arrangement of ropes, surcingle, and collar ([Pl. XXIII], fig. 3), a common crupper similarly held around the vulva ([Pl. XXII], fig. 1), stitches through the vulva, and wire inserted through the skin on the two hips ([Pl. XXIII], fig. 2), so that they will cross behind the vulva; also pessaries of various kinds should be inserted into the vagina. None of these devices, however, present any advantage over the simple and comparatively painless rope truss described above. Such additional precautions as keeping the cow in a stall higher behind than in front, and seeing that the diet is slightly laxative and nonstimulating may be named. If straining is persistent, ounce doses of laudanum may be used twice a day, and the same may be injected into the vagina.
If the womb has been cut off, injections of a solution of a teaspoonful of carbolic acid in a quart of water should be used daily, or more frequently, until the discharge ceases.
EVERSION OF THE BLADDER.
A genuine eversion of the bladder is almost unknown in the cow, owing to the extreme narrowness of its mouth. The protrusion of the bladder, however, through a laceration sustained in calving, in the floor of the vagina and its subsequent protrusion through the vulva, is sometimes met with. In this case the protruding bladder contains urine; this can never be the case in a real eversion, in which the inner surface of the bladder and the openings of the ureters are both exposed outside the vulva. The presence of a bag containing water, which is connected with the floor of the vagina, will serve to identify this condition. If the position of the bladder in the vulva renders it impracticable to pass a catheter to draw off the urine, pierce the organ with the nozzle of a hypodermic syringe, or even a very small trocar and cannula, and draw off the water, when it will be found an easy matter to return the bladder to its place. The rent in the vagina can be stitched up, but as there would be risk in any subsequent calving it is best to prepare the cow for the butcher.
RUPTURE OF THE BLADDER.
This has been known to occur in protracted parturition when the fetus finally passed while the bladder was full. The symptoms are those of complete suppression of urine and tenderness of the abdomen, with a steady accumulation of liquid, and fluctuation on handling its lower part. If the hand is introduced into the vagina it is felt to be hot and tender, and perhaps slightly swollen along its floor. As a final test, if the lower, fluctuating part of the abdomen is punctured with a hypodermic needle, a straw-colored liquid of a urinous odor flows out. The condition has been considered as past hope. The only chance for recovery would be in opening the abdomen, evacuating the liquid, and stitching up the rent in the bladder, but at such a season, and with inflammation already started, there would be little to hope for.