To turn the uterus inside out is not an event of common occurrence in the mare. In the cow it is not only more frequently observed but it is likewise less serious in its consequences, though it is in no case free from danger to the life of the animal.

Causes

Old mares which have been long at the stud are more liable to this outward displacement of the uterus than are young ones, and the prospects of successful treatment are more favourable in the former than in the latter. The exciting cause of inversion of the uterus is excessive straining, commenced during parturition and continued after the birth of the foetus, or the extrusion of the organ may follow immediately after delivery.

Symptoms

After a period of violent straining, of shorter or longer duration, a fleshy-looking mass is observed to project from the vulva, and quickly to enlarge and extend downwards for a greater or less distance, depending upon the degree of displacement. Should the entire uterus be inverted it may reach as low as the hocks. If in this condition it is allowed to hang down, the colour of the exposed membrane changes from red to purple, and may deepen to blackish red. At the same time the organ swells and the mucous membrane becomes soft and easily torn, while at the same time a bloody-looking fluid oozes from the surface. Although at first the mare displays no evidence of severe suffering, active disease in the uterus quickly appears and leads to a fatal issue, unless relief can be afforded. At this time the mare evinces pain by looking towards the flanks, pawing, and general restlessness, in which she may lie down and rise again from time to time. Should help not be at hand the face becomes pinched and anxious, cold patchy sweats appear on the body, the muscles quiver, the legs and ears are cold, the pulse quickens almost beyond numeration, the body temperature is heightened to 105° to 107° and collapse soon puts an end to the case.

Inversion of the Uterus.

Fig. 237. - Inversion of the Uterus.

Treatment

Inversion of the uterus needs prompt professional attendance, but in saying this it is not to be understood that there is nothing for lay hands to do. On the contrary, the owner or attendants may render most valuable services pending the arrival of the expert. In this connection it is necessary they should know that so long as the uterus is allowed to hang down so long is the circulation in it being obstructed and inflammation consequently excited. The blood entering it is in a large measure prevented from leaving it, owing to its depending condition. As it accumulates, the organ swells, increases in weight, and assumes a black colour, besides which it becomes soft and foul, at best rendering its return difficult, if not impossible. Until, therefore, the veterinary surgeon arrives some attempt should be made to guard against these objectionable and dangerous conditions.

With this object an old, though clean blanket, should be procured, and being folded once and soaked in a warm solution of carbolic acid, should then be passed under the womb and raised by a couple of men standing one on each side behind the mare, until the displaced organ is brought into a straight line with the vaginal opening. By this means the weight is removed from the part by which it hangs, and the circulation is restored and facilitated. The effect of cold and exposure, which tends to cause congestion, may be guarded against by covering it over with a flannel wrung out in warm carbolized water. Failing to procure professional assistance an attempt should be made to return it. Before commencing to do so the hands of the operator should be thoroughly cleansed and dressed with carbolized oil, and should any dirt have become attached to the extruded organ it must be carefully removed by washing with warm carbolized water. The organ should also receive a dressing of carbolized oil over its entire surface. When the uterus has become much swollen and congested it will be necessary to effect a reduction in its size before it can be returned. To do this the surface of the mucous membrane will require to be scarified, i.e. be pricked here and there at numerous points with the point of a clean lancet or knife and then fomented with warm carbolized water.

In commencing to put it back, that part of the organ nearest to the vaginal opening should first be pushed inward, and the part next succeeding should follow until a considerable portion has been replaced. Then, while it is still supported in position, the doubled fist should be placed against the extreme end of the extruded part, and by careful, gentle, and continued pressure the whole returned to its place. In order to obtain all the available ,room possible for this purpose the rectum should be emptied of faeces before return is attempted.

On completion of the operation the mare will be benefited by a full dose of tincture of opium to check straining, after which she may be placed in a stall with the hind-legs underpacked with litter so as to elevate the hind parts, and a truss should be adjusted to the vaginal outlet in such a way as to prevent the escape of the viscus again.