Diseases of cattle, sheep, goats and swine

by G. Moussu; Jno. A. W. Dollar

HÆMORRHAGIC SEPTICÆMIA IN CATTLE.

In 1902 Drs. Wilson and Brimhall, of the State Board of Health of Minnesota, U.S.A., described under the title of “hæmorrhagic septicæmia of cattle” a widespread infectious disease of bovines which has the following general characteristics:—The disease is distributed the world over, but is apparently most common in low-lying regions, and most general in wet seasons. The animals attacked are of all ages. The onset of the disease is sudden, its course rapid, and its termination usually (90 to 98 per cent.) fatal. Thirty to 90 per cent. of all animals in an infected herd die. The clinical symptoms are refusal of food, cessation of rumination and lactation, initially increased temperature (107° to 109° F.: 42° to 43° C.), rapid, laboured breathing, sometimes bloody discharge from nostrils, bladder, and bowels, and non-crepitant swellings in the throat region, back of shoulders, or about the fetlocks. The most striking pathological lesions are hæmorrhages from 1 millimètre to 20 centimètres in diameter, throughout the subcutaneous, submucous, subserous and intermuscular connective tissue, infiltrating the lymphatic glands, and involving several or all of the internal organs. The spleen is neither enlarged nor darkened. The causative bacteria, which may be isolated from the larger hæmorrhagic areas, lymph glands, heart’s blood, lung, spleen, etc., have the following distinguishing characteristics:

Ovoidal bacilli, with rounded ends of 0·5 to 0·8 microns in transverse diameter, and 1·0 to 1·5 microns in length; sometimes paired and sometimes in chains of three to six individuals. The bacilli in the tissues exhibit polar staining with an unstained “belt” or “middle piece.” They are non-capsulated, non-spore-forming, non-Gramstaining, and non-motile. They grow best aërobically at 98·5° F. (37° C.), though capable of developing anaërobically and at room temperature; prefer the depths rather than the surfaces of media; grow feebly, if at all, on potato; fail to liquefy gelatine; produce acid, but no gas in glucose media, neither acid nor gas in lactose media; and develop varying amounts of indol and phenol in peptone solution. The organisms have been named Bacillus bovisepticus. The lesions of the disease are reproduced in cattle and other animals by inoculation of pure cultures of the organism.

It should be insisted upon that the identification of the disease in a locality in which it has not been previously described, or by veterinarians not having had previous experience therewith, shall take into consideration—(a) the essential clinical symptoms; (b) the pathological lesions as observed before the onset of decomposition; and (c) the morphological and biological identification of the specific bacilli.

The following is a tabulated list of the principal epidemics so studied and reported to January 1st, 1901:

Table showing the Principal Epidemics of Hæmorrhagic Septicæmia in Bovines due to Bacillus bovisepticus.
Name of observer.	Year.	Locality.	Local or reporter’s name of disease.
Bollinger	1878	Germany	Wild und Rinderseuche.
Kitt	1885	„	Rinderseuche.
Kitt	1887	„	Septikæmia hæmorrhagica.
Poels	1886	Holland	Septic pleuro-pneumonia of calves.
Oreste et Armanni	1886	Italy	Barbone.
Jensen	1889	Jutland	Rinderseuche.
Piot	1889	Egypt	Kounnaq.
Van Eecke	1890 1895	Java	Septichæmia hæmorrhagica.
Hubenet	1895	„	„ „
Galtier	1891	France, imported from Algiers	Infectious pneumo-enteritis.
Reischig	1891	Hungary	Maladie des buffles ou Angine Charbonneuse.
Bongartz	1892	Germany	Wild und Rinderseuche.
Jakobi	1892	„	Wildseuche.
Buch	1892	„	Hæmorrhagische septikæmia.
Güllebeau and Hess	1894	„	Septikæmia hæmorrhagica. Charbon Blanc.
Fischer	1894	Dutch Indies	Septichæmia hæmorrhagica.
Leclainche	1895	France	Pneumo-enteritis.
Von Ratz	1896	Hungary	Barbonekrankheit.
Sanfelice, Loi, and Malato	1897	Sardinia	„
Bosso	1898	Italy	Septicæmia hæmorrhagica.
Pease	1898	British India	Ghotwa or Ghotu.
Lignières	1898	Argentina	Pasteurellosis bovina. “Diarrhœa” and “Enteque.”
Fenimore	1898	Tennessee	Wild and cattle disease.

It may not be out of place to give at this point a short list of the principal infective diseases of definitely known ætiology, with which hæmorrhagic septicæmia in cattle has been, and may readily be, confused:

Name of disease.	Diagnostic points.
Anthrax	Altered condition of blood, enlarged spleen, presence of B. anthracis, etc.
Black-quarter	Usually localised lesion, crepitant tumour, presence of B. anthracis symptomatici.
Septicpneumo-enteritis of calves (Galtier)	Due to a spore-bearing bacillus—“Pneumobacillus septicus”—which grows rapidly on potato.
Septicæmia of calves	Due to typhoid-like bacilli.

CONCLUSIONS.

(1.) Eight outbreaks of hæmorrhagic septicæmia in cattle due to B. bovisepticus occurred in Minnesota from August to December, 1900.

(2.) So far as can be determined, the only other outbreak of this disease hitherto published as occurring in America was one near Knoxville, Tenn., in 1898. The foci of the disease have also apparently been present in Texas and the district of Colombia. No relation can be traced between the disease elsewhere and the present outbreaks, nor between any two of the present ones.

(3.) Of 160 animals in the eight herds, sixty-four showed symptoms of the disease, and all such died—a mortality of 40 per cent. of all the animals in the herds, and of 100 per cent. of those showing symptoms.

(4.) The chief symptoms were loss of appetite, fever, stiffness, swelling of the legs and throat, and a black, tarry, or bloody discharge from the bowels. Bloody urine and bloody nasal discharge were present in some cases. Death occurred usually in from six to twenty-four hours after the first appearance of symptoms.

(5.) The chief lesions discovered at autopsy were ecchymoses, and small and large hæmorrhagic areas in the subcutaneous connective tissues, muscles, lymph glands, and throughout the internal organs. The cervical lymph glands, heart muscle, and alimentary canal were most affected. The spleen was not enlarged nor darkened (except after onset of decomposition).

(6.) From the twenty-two animals on which autopsies were made the same bacillus was obtained from all the tissues examined. Where the examination was made immediately after death—nine cases—it was unmixed with any other organism.

(7.) The bacillus was identified as belonging to the hæmorrhagic septicæmia group of Hüppe, best specifically designated as B. bovisepticus; and besides causing hæmorrhagic septicæmia in cattle (synonyms—rinderseuche, buffleseuche, barbone, khounnaq, charbon blanc, ghotwa, pasteurellosis bovina, etc.), closely resembles, if, indeed, it is not identical with, the bacilli causing wildseuche, swine plague, schweineseuche, rabbit septicæmia, chicken cholera, grouse disease, duck cholera, etc. The organism was studied in direct coverglass preparations, parallel cultures in and on various media, and by inoculation of animals in which the characteristic lesions were reproduced, and from the tissues of which the inoculated bacilli were recovered in pure culture.

(8.) An attempt was made to immunise cattle by the injection of filtered, and later of the killed, cultures of the bacillus. The chief difficulties met with were in maintaining the virulence of the bacillus on artificial media, and in determining the proper dosage. The experiments were too few, and the results not sufficiently tested to warrant conclusive statements as to the protective value of the inoculations, but it would appear that a fairly high degree of immunity was produced.

(9.) The prompt removal of the dead animals and isolation of sick ones, accompanied by thorough disinfection by fire, carbolic acid, corrosive sublimate, and freshly-slaked lime, apparently served to check each outbreak within a short time after the measures were instituted.

SECTION XI.
OPERATIONS.

CHAPTER I:
CONTROL OF ANIMALS.

CONTROL OF OXEN.

The safe and efficient performance of surgical operations renders it necessary that the animal should first of all be placed under complete control. This precaution, therefore, is the first to merit attention. Animals are either secured completely or to a more or less limited extent, according to circumstances. The ox, for example, may be secured by the head, one or more limbs may be fastened, or, by being placed in a trevis, the whole of the animal may be secured.

PARTIAL CONTROL.

(1.) The simplest method of securing the ox is to grasp the nostrils or lower extremity of the septum nasi between the thumb and index finger of the right or left hand (Fig. 57).

(2.) This method may be rendered more complete by the assistant passing his arm from behind forward over the animal’s head between its horns, and then grasping the nostrils as above described, whilst one of the horns is firmly held with the other hand (Fig. 58).

(3.) A third method consists in fixing the head to a post, tree, fence, or other solid body, by passing a rope round the base of the horns and tying it to the object selected.

CONTROL OF THE LIMBS.

To prevent the animal kicking or moving about during an operation it is sometimes necessary to fix the limbs. A front leg may be lifted as for shoeing, or may be kept lifted by means of a rope passed around the fetlock, over the withers, downward between the front legs, outside the forearm, in front of the chest and inside the pastern, after which one or more turns may be made around the pastern to prevent the rope slipping.

A hind limb may be secured in a simple way by passing the end of the tail round it in front of the hock (Fig. 284); any violent and extensive movement of the limb is then necessarily painful to the animal owing to the tension of the tail.

Fig. 284.—Fixing the head and a hind limb.

Greater security, however, is given by passing a rope backward and forward around the hind legs, above the hocks, in the form of a figure of eight (Fig. 285). This does not prevent all movements of the hind limbs, but it limits them and secures both animal and operator from danger.

Fig. 285.—Fixing the hind limbs.

Should it become necessary to examine the hind foot or interdigital space, it is useful at times to pass a loop of cord round the leg in the region of the tendo-Achillis, and to twist and tighten this loop by a short, stout stick passed through it; this is the leg twitch described in Dollar’s “Operative Technique,” p. 7.

For such examinations, however, the animal is usually placed in the trevis, or is secured to the side of a long waggon (Fig. 286).

To secure the limbs beneath the abdomen a strip of webbing or a rope is fastened round the pastern, passed between the fore limbs, then in front of the shoulder of the opposite side, over the withers and beneath the elbow of the same side, being secured with a slip-knot.

For castration in the standing position a hind and a fore limb may be fastened together, as shown in Fig. 287.

In examining the sole of the hind claws, the animal’s head may be secured to a tree, and the hind limb lifted by a strip of webbing or rope fixed to the body of a waggon (Fig. 288).

GENERAL CONTROL.

General control in the standing position can only be made really effective by using the trevis, in which both the head and the fore and hind limbs are secured.

Fig. 286.—Fixing a front limb. Examining a hind foot.

Fig. 287.—Fixing two limbs of one side for the operation of bistournage.

The practitioner, however, is often content with much less perfect methods, using either the so-called “bulldogs” or the nose ring, which may usually be so manipulated as to control all but the most dangerous animals. The nose ring is seldom employed except for bulls, which are usually ringed at an early age; the “bulldogs” can be employed and removed at will.

In inserting a nose ring the head is securely fixed, the centre line of the muzzle is grasped with the left hand, and the septum nasi is pierced with a straight bistoury, the cutting edge being turned in a backward direction; the aperture being thus prepared, the ring is introduced and fixed. Some operators prefer to use a trocar, slightly exceeding in diameter the ring to be worn; in that case the manual technique is the same. The puncture is made, the trocar alone is withdrawn, and the canula remains in situ; one extremity of the ring is then inserted into the canula, and both are drawn through the septum together. There is no difficulty in thus inserting the ring, though puncture with the trocar is perhaps rather less convenient than with the bistoury.

Fig. 288.—Fixing an ox for the examination of a hind limb.

Relative control without casting may also be effected by attaching the end of the tail to the base of the horns or the head to the cannon bone of a front or hind limb. These methods, however, are of little value except to prevent animals at grass from escaping entirely during operation.

CONTROL BY CASTING.

Oxen should always be cast on a thick straw bed to avoid fracturing the horns.

The simplest method consists in using hobbles and ropes, as for the horse.

Fig. 289.—A, “bulldogs” operated by a screw; B, “bulldogs” with a sliding ring.

Another, though less practical, method consists in using two long ropes, each fixed to the base of the horns and passed first between the front, then the hind limbs, round the hind pasterns from within outwards and then brought forward (Fig. 292). When the ropes are drawn tight by assistants standing in front of the animal, the latter usually falls on its hocks and rolls over to the right or left, according to the direction given to it.

A third method is particularly useful in young or feeble animals. It consists in fixing around the horns a rope about eight to ten yards in length, the free end of which is carried along the upper margin of the neck and back. A loop is formed embracing the base of the neck, a second behind the shoulders in the region occupied by the girth, and a third around the flanks (Fig. 293). By pulling in a backward direction the rope is drawn tight, and the animal first backs and afterwards falls on its hocks, subsiding either to the right or left, as in the case previously mentioned.

Fig. 290.—Nose ring open for insertion.

Fig. 291.—Nose ring closed.

In using either of these two methods it is very important, as soon as the animal falls, to secure the limbs in a certain way, according to the nature of the operation to be performed. This can be effected with hobbles and ropes passed round the hocks, above the knee, etc.

CONTROL OF SHEEP AND GOATS.

The above animals may be secured, whilst standing, by grasping the head and neck or, when cast by crossing the front and hind limbs in the form of an X and tying a soft rope or piece of webbing round the crossing of the limbs.

Fig. 292.

Fig. 293.

CONTROL OF PIGS.

No difficulty is usually experienced in controlling young pigs, either when standing or cast, only one or two assistants being required, but aged animals are more difficult and more dangerous to deal with, and by their tusks sometimes inflict severe wounds.

In the standing position they can be partially fixed by passing a running loop behind the canine teeth of the upper jaw, but should the examination to be carried out prove to be of a difficult character it is best to cast the animal.

A strong assistant grasps one of the hind limbs by means of a running loop, fixed, for example, above the right hock. He rapidly slides his left knee towards the front of the left side of the chest, passes his left hand over the withers, and by the combined use of his knees and arms throws the animal on its left side, controlling as far as possible the struggles of the right front and hind limbs, which he grasps with his hands.

The animal is then further secured by rapidly passing a thin rope in figures of eight around the front and hind limbs. If necessary all four legs may be brought together and fastened by a rope passed round the region of the pastern; a muzzle can afterwards be applied to prevent biting.

ANÆSTHESIA.

Oxen rarely receive general anæsthetics, though in certain obstetrical cases they may be necessary. Ether and chloroform are given by inhalation, and chloral of 10 to 20 per cent. strength by intravenous injection. In utilising the latter method the injection should be made slowly, the pulse and heart being closely scanned to prevent cardiac syncope. The dose of chloroform varies with the size of the animal, 2 ounces often sufficing for a full-grown ox. The same methods may be used for sheep, goats, and pigs, the doses being suitably altered. (For fuller particulars see Dollar’s “Operative Technique,” pp. 44 to 70.)

Most frequently, however, the surgeon contents himself with producing local anæsthesia by the injection of a 4 to 10 per cent. solution of cocaine.

CHAPTER II.
CIRCULATORY APPARATUS.

BLEEDING.

Bovine animals are usually bled from the superficial jugular, or the mammary vein.

Bleeding from the Jugular.—The animal having been suitably fixed, the jugular is raised by means of a cord drawn tightly round the base of the neck, and the vessel is opened with a fleam about the middle of the neck.

The skin of the ox being thick, a long-bladed instrument is necessary. When the bleeding ceases, the cord is removed: some practitioners take no precautions as regards the wound; it is better to insert a pin suture.

Bleeding from the jugular may also be performed with the trocar, particularly in animals with fine, thin skin.

Bleeding from the Mammary Vein.—The mammary vein may be opened with the fleam, the straight bistoury, or the lancet. The head is firmly fixed and the hind limbs controlled by a rope passed in a figure of eight above the hocks.

In bleeding on the left the operator places himself at an angle to the animal’s side, opposite the hypochondriac region, with his back towards the animal’s head, and holds the fleam in his right hand. To operate on the right-hand side the fleam is held in the left hand.

This method of bleeding always causes thrombus formation, on account of the low position of the opening in the vein. The animal’s bed should be kept very clean, in order to prevent any local infection which might cause hæmorrhagic or suppurative phlebitis. The lancet or bistoury can only be used in animals with very fine skin.

In bovine animals small quantities of blood are sometimes taken from the facial vein or the veins of the ear or tail.

BLEEDING IN SHEEP.

On account of the quantity of fatty tissue and wool covering the jugular furrow in the sheep, bleeding is scarcely practicable at that point. The operation is usually performed on the angular vein of the eye, the external saphenous vein, or the subcutaneous vein of the forearm.

In operating on the facial vein the animal’s head is firmly held, the operator compresses with the fingers of his left hand the facial vein at the point where it passes into the maxillary fissure, and with a lancet opens the angular vein of the eye or one of the other branches of origin which project prominently beneath the skin. Bleeding ceases as soon as the pressure is relaxed.

In the case of the external saphenous vein, the vein is raised by compressing the middle region of the limb and the vessel is opened with a lancet, a little above and towards the outside of the hock.

Fig. 294.—Angular vein of the eye and facial vein.

The subcutaneous vein of the forearm can be raised by compressing the fore limb below the elbow. The vein is visible throughout the length of the inner surface of the radius, and can easily be opened with a lancet.

It is also possible to withdraw small quantities of blood by opening the marginal veins of the ear.

BLEEDING IN THE PIG.

Breeders sometimes bleed by slitting one of the animal’s ears or cutting the tail. It is preferable to bleed with a lancet from the marginal veins of the ear, the external saphenous vein a little above the hock, or the subcutaneous vein of the forearm.

SETONS, ROWELS, PLUGS, OR ISSUES.

Although the application of setons is still practised in horses, that of “issues” has largely been given up in bovine animals, although some practitioners still regard issues as of considerable value and as producing effects similar to, or better than, those of sinapisms.

They are usually inserted in the region of the dewlap; the materials employed comprise black and white hellebore, veratrine and stems of clematis.

Two methods are practised.

In the first, a transverse fold is raised in the skin of the dewlap, which is divided with a stroke of the bistoury, leaving a little aperture in the skin. By introducing the rounded ends of a pair of curved scissors the subcutaneous connective tissue is broken down, leaving a little space beneath the skin, into which the plug is introduced. Swelling takes places very rapidly—in twenty-four to forty-eight hours it is very considerable—and if the substance employed is violent in its action, like hellebore, it must be withdrawn, as otherwise considerable sloughing takes place. To facilitate this object a thread or piece of string is usually attached to the plug before it is inserted.

In the second method, the irritant material is attached to, or smeared on, a strip of broad linen tape which is passed in precisely the same manner as in the horse (see Dollar’s “Operative Technique,” pp. 107–111).

CHAPTER III.
APPARATUS OF LOCOMOTION.

Fig. 295.—Dressing for claw after operation.

The customary operations on the apparatus of locomotion are almost entirely confined to the feet. They consist in operations for sand crack, picked-up nail, stabs by nails and bruising of the sole, elsewhere mentioned. As they call for no special precautions they need not be further mentioned here.

SURGICAL DRESSING FOR A CLAW.

The surgical dressing necessitated by the operation for sand crack, picked-up nail, or injury to the heels is often very difficult to fix in the ox, and necessitates a support round the pastern. It can, however, be secured in the following way:

The seat of operation is covered with small antiseptic pads, which are also applied round the pastern and in the interdigital space. A bandage is then passed twice round the pastern and over the posterior two-thirds of the claw, as in fixing the dressing used after removal of the lateral cartilage in the horse. The bandage is then passed repeatedly round the pastern in an upward direction and tied above the interdigital space.

AMPUTATION OF THE CLAW OR OF THE TWO LAST PHALANGES.

It sometimes happens that certain grave diseases in the foot or pastern (stabs or picked-up nails, panaritium of the interdigital space, necrosis of the ends of the flexor tendons, etc.) are accompanied by necrosis of the bones, suppurative synovitis, and even suppurative arthritis of the second and first inter-phalangeal joints.

If carefully treated these forms of arthritis may disappear, leaving the joints anchylosed, but unfortunately the application of the necessary antiseptic injections (free injection with warm boiled water, injection of 10 per cent. iodised glycerine, 3 per cent. carbolic glycerine or ·1 per cent. sublimate) is difficult and costly.

Fig. 296.—Anatomical relations of the inter-phalangeal joints.

Fig. 297.—Disarticulation of the claw and third phalanx.

It is better, in such cases, to remove the claw or the two last phalanges. With antiseptic precautions the stump heals, and recovery takes place without the interminable suppuration and pain which otherwise cause such grave loss of condition.

(1.) Disarticulation of the Claw and Third Phalanx.—The patient is cast and suitably fixed. The horn-secreting coronary band of the claw must be preserved.

First stage. The horny wall immediately beneath the coronary band is thoroughly thinned and the tissues are divided as far as the bone.

Second stage. Disarticulation: The tendon of the extensor pedis is divided and the joint opened. The claw is pressed backwards, and first the external and internal ligaments, then the flexor tendons of the phalanges, are divided.

Fig. 298.—Amputation of the two last phalanges. First and second phases.

Fig. 299.—Amputation of the two last phalanges. Third phase.

This operation is of no great use, because, on account of the position of the joint and the arrangement of the articular surfaces, the end of the second phalanx extends beyond the line of section. To avoid complications, therefore, it is better to remove the lower extremity of the second phalanx, which, moreover, is always injured to a greater or less extent in cases of pedal arthritis. To effect this it is only necessary to draw back the flap of skin a little and rapidly divide the second phalange at its upper third with a fine saw. The points of section of the tendons and ligaments must be carefully examined, and if they exhibit necrosis should be further shortened.

The stump is enveloped in a surgical dressing fixed to the pastern.

Amputation of the two First Phalanges.—When necrosis is very serious and has extended a long way upwards, it is often better immediately to resort to amputation of the two last phalanges.

The region is first shaved and thoroughly cleansed. The coronary band of the claw is also preserved in this case.

First stage. The horn below the coronary band is thoroughly thinned and the tissues are divided as far as the bone.

Second stage. The skin covering the front of the limb is vertically incised from the lower third of the first phalanx (Fig. 298) to the coronary band; the skin is separated and external and internal flaps are formed.

Third stage. The extensor pedis tendon is divided, the first inter-phalangeal joint opened, the internal and external lateral ligaments are divided, the claw is pressed backwards, and the flexor tendons are also divided.

To facilitate disarticulation, and particularly to facilitate section of the lateral ligaments, the claw is rotated successively outwards and inwards.

According to circumstances, the lower extremity of the first phalange is either scraped or divided and the stumps of the tendons are carefully trimmed to a regular shape.

A surgical antiseptic dressing is applied over the whole of the seat of operation.

Several other methods of performing this operation will be found in Möller and Dollar’s “Regional Surgery,” pp. 831–835.

CHAPTER IV.
DIGESTIVE APPARATUS.

RINGING PIGS.

Fig. 300.—“Ringing” the pig.

This operation is customary in countries where pigs are allowed to roam more or less at liberty, and it is necessary to adopt some precaution to prevent them from uprooting the soil and thus causing damage, but the practice tends nowadays to disappear. It simply consists in passing through the nose some object which on being rubbed against anything causes pain and thus checks the animal’s natural proclivity.

Numerous methods have been suggested. One of the simplest is as follows: The animal having been cast, suitably secured and muzzled, two thick iron wires sharpened at the ends are passed through the snout, and the two ends are then twisted together in the form of two rings. These can, if necessary, be united.

Another method, perhaps even more efficacious, consists in bending a thick wire into the shape of the letter U, and preparing a small metal plate with two holes corresponding in position to the distance between the two nostrils. The ends of the wire, being sharpened, are passed through the nostrils and securely united to the metal plate by being bent into a spiral or simply at right angles.

ŒSOPHAGUS.

The operations practised on the œsophagus comprise passage of the œsophageal sound or probang, taxis, crushing of foreign bodies within the œsophagus, and œsophagotomy.

PASSING THE PROBANG.

Passage of the probang is called for in cases of marked tympanites, suspected dilatation or contraction of the œsophagus, and accidental obstruction. Special or improvised instruments may be used, according to circumstances.

The animal is secured in a standing position with the head extended on the neck and in a straight line with the body. A gag is placed in the mouth and the tongue is grasped and withdrawn by an assistant, whilst the operator, having carefully oiled the probang, passes it through the gag towards the back of the pharynx. Violence should be avoided, the probang being gently slid along the centre of the vault of the palate. When the animal makes swallowing movements, the apparatus is slowly pushed onwards.

This manipulation, though simple, requires some dexterity, because at the moment when the instrument enters the pharynx the animal often thrusts it to one side or the other with the base of its tongue, bringing it between the molar teeth, and so crushing, or at least injuring it.

The passage of hollow probangs gives comparatively little relief in cases of tympanites, because the probang is almost always obstructed by semi-digested material from the rumen, or plunges into the semi-solid masses of food contained therein.

When the œsophagus is dilated at a point within the thorax, the progress of the probang is checked by the accumulated food material, and it becomes possible to determine approximately the place where the dilatation occurs. In the same way, should a slender probang be arrested at a given point in the œsophagus, this indicates that there is contraction of the tube at that point.

In cases of obstruction the cupped probang is always arrested by the foreign body. Efforts to thrust the latter onwards should always be made with great caution, otherwise the œsophagus may be greatly distended or its walls even ruptured.

CRUSHING THE FOREIGN BODY.

No attempt should be made to crush a foreign body within the cervical portion of the œsophagus unless it is quite certain that that body is of comparatively soft character. Crushing may be performed by lateral pressure with the fingers within the region between the two jugular furrows, or mechanical means may be adopted.

In the latter case a small piece of board is applied to one side of the neck behind the foreign body, whilst gentle blows are given from the opposite side with a little wooden mallet. Whatever precautions may be taken, however, this method cannot be recommended.

The same remark applies to the use of forceps, the jaws of which are so fashioned as to escape pressing on the trachea whilst they grasp directly the foreign body through the walls of the œsophagus.

ŒSOPHAGOTOMY.

Œsophagotomy, or incision of the œsophagus, is an operation which, though sometimes necessary, should only be regarded as a last resort after all other methods have failed. Unfortunately it can be performed only in the region of the neck, and even then the most favourable point (viz., the lower third of the jugular furrow) cannot always be selected, the operation having to be performed directly over the foreign body.

The animal may be either standing or lying down. The seat of operation should be thoroughly cleansed and disinfected.

First stage. Incision through the skin and subcutaneous connective tissue above the level of the jugular vein and opposite the foreign body.

Second stage. Isolation of the œsophagus by dissection and tearing through of the connective and fibro-aponeurotic tissue at the base of the jugular furrow.

Third stage. Incision through the œsophagus for a distance just sufficient to enable the foreign body to be extracted.

Fourth stage. Suturing of the mucous membrane, suturing of the muscular walls of the œsophagus, suturing of the skin, precautions being taken to allow of drainage at the lower part of the operative wound.

SUB-MUCOUS DISSECTION OF THE FOREIGN BODY.

As œsophagotomy, despite every precaution, often leads to fistula formation, Nocard has recommended submucous dissection of the obstructive body, such body being usually semi-solid. This method has considerable advantages.

The first and second stages of the operation are exactly the same as those above mentioned.

The third stage consists in puncturing the walls of the œsophagus with a straight tenotome immediately behind the foreign body, as in tenotomy. A curved, button-pointed tenotome having next been introduced and passed with the blade flat between the foreign body and the mucous membrane of the œsophagus, it is turned on its axis, and attempts are made to divide the obstruction. A few moments are often sufficient to effect this, after which the substance may be further broken up by the fingers.

These various methods may lead to delayed complications, such as dilatation or contraction of the mucous membrane of the œsophagus, muscular atrophy of the œsophageal walls, œsophageal fistula, and, sometimes, abscess formation.

RUMEN.

Two operations are currently performed on the rumen, puncture and gastrotomy.

Fig. 301.—Trocar for puncture of the rumen.

PUNCTURE OF THE RUMEN.

Puncture of the rumen is essentially an urgent operation for the relief of acute and rapidly progressive tympanites. It is performed in the left flank, at an equal distance between the last rib and the angle of the haunch, and an inch or two beyond the transverse processes of the lumbar region.

First stage. Incision of the skin to the extent of about one inch (not absolutely necessary).

Second stage. Puncture with a sharp trocar directed forwards, downwards, and inwards. In making this puncture the point of the trocar is passed through the incision, and a sharp push is given. The sensation of resistance overcome indicates that the trocar has penetrated the cavity of the rumen. Gas then escapes. When the operation is completed, and the canula is being withdrawn, care should be taken to press down the skin on either side with the fingers of the left hand, to prevent accidental lifting and laceration of the connective tissue. Even so slight an accident as this might cause serious complications at a later stage.

In the absence of a trocar, and in cases of extreme urgency, the rumen may be directly punctured with a straight bistoury, and after the punctured wound is slightly enlarged, but before the blade of the bistoury is withdrawn, an improvised canula, consisting of a hollow elder twig, may be introduced. Were the blade of the bistoury withdrawn before the introduction of the canula, the rumen would be displaced, and the points punctured would no longer correspond.

Complications, such as respiratory or circulatory syncope, attacks of vertigo, etc., have been noted, but these in reality are very rare.

Subcutaneous Emphysema.—When the canula is carelessly removed, and the subcutaneous connective tissue is torn, local emphysema may occur if the pressure of gas in the rumen is very great. This gas enters the puncture, proceeds along the connective tissue, particularly the subcutaneous connective tissue, and causes crepitant subcutaneous emphysema, very easy to recognise. This emphysema may remain localised in the neighbourhood of the puncture and gradually become absorbed. It may, however, extend to the whole of the flank or even beyond, and in exceptional cases bring about generalised subcutaneous emphysema. Such very extensive emphysema as this rarely becomes reabsorbed without complications.

The suppuration which follows puncture of the rumen may assume one of two forms:—

(a) That of a little local abscess at the point of puncture, when foreign matter or the microbes of suppuration have been left in the path made by the withdrawal of the canula. Such abscesses are of little importance. They rapidly heal if opened and treated with antiseptic injections.

(b) That of diffuse subcutaneous or interstitial suppuration following accidental emphysema.

The pressure of gas forces fragments of food material between the layers of tissue, and suppuration is set up, the pus escaping by a fistula at the point of puncture. Such suppuration is decidedly dangerous, because it may result in necrosis of the aponeurotic layers of the small oblique muscle, in which case recovery is tedious and uncertain.

Treatment consists in laying open the orifice and fistula, and making a counter-opening at the lowest point of the swelling. Free drainage and abundant irrigation with boiled water at the body temperature, followed by antiseptic injections, complete the treatment.

Peritonitis is not altogether exceptional as a sequel to puncture of the rumen, if ordinary precautions are neglected or if infective material or fragments of food pass into the peritoneal cavity.

At first the condition is usually local, but it may extend and assume the form of general peritonitis two or three weeks later. The symptoms are those of acute peritonitis.

Speaking generally, however, puncture of the rumen in cattle and sheep is seldom followed by any complication.

GASTROTOMY.

Gastrotomy is performed for the relief of impaction of the rumen and to remove foreign bodies, such as linen, nails, bits of leather, etc., which have been swallowed.

Fig. 302.—Gastrotomy. Pa, Skin; 1m, 2m, muscular layers; Pe, peritoneum; R, rumen, showing line of incision.

A vertical or slightly oblique incision is made in the left flank, extending from the fourth transverse process of the lumbar vertebræ towards the last rib. The operation comprises the following stages:—

Fig. 303.

First stage. Incision through the skin for a distance of from 6 to 10 inches, according to the size of the animal.

Second stage. Incision through the muscles and peritoneum and torsion of any small muscular arterioles, which may be divided.

Third stage. Fixation and immobilisation of the rumen with from four to six sutures (Fig. 303).

Fourth stage. Vertical incision into the rumen; manual examination of the cavity and its contents.

Formerly the operation was confined to these stages. In such cases localised adhesive peritonitis follows, causing the rumen to adhere to the internal surface of the abdominal wall, and the fistula continues in existence for months before complete cicatrisation. It is better, therefore, to insert sutures in the rumen, in order to secure more rapid and complete closure.

Fifth stage. Suture of the rumen with carbolised silk. The lips of the wound should be brought together face to face, or they can be slightly inverted, but the sutures should only pass through the peritoneum and muscular coats, avoiding the mucous coat. If the silk threads pass through the mucous membrane and come in contact with the gas in the upper zone of the rumen they are rapidly macerated, and the sutures tear out before the wounds can heal. The rumen should always be kept fixed to the abdominal wall towards the upper and lower extremities of the operative wound, in order to avoid displacement and occurrence of peritonitis. For a similar reason the passing of the silk sutures should be preceded by careful disinfection of the operative wound, and free washing of the parts with boiled water.

Fig. 304.

The operation is concluded by bringing the skin together with a few silk sutures and inserting a strip of iodoform gauze into the lower portion of the wound, to serve as a drain.

LAPAROTOMY.

Laparotomy is comparatively seldom performed on animals of the bovine species, though it may become necessary in dealing with cases of hernia, uterine torsion (where direct taxis is called for), Cæsarean section, invagination or strangulation of the intestine, and under a few other exceptional circumstances.

If simple exploration is aimed at, the operation is most conveniently performed from the right flank with the animal in a standing position, but should a prolonged operation be contemplated the animal should be cast. The incision varies in length, according to circumstances, from 8 to 16 inches, and, like that in gastrotomy, should correspond in direction with the fibres of the small oblique abdominal muscle; the seat of operation should previously be washed, shaved, and disinfected.

The operation comprises the following stages:—

First stage. Incision of the skin.

Second stage. Incision through the muscles and peritoneum.

Third stage. Exploration, inspection, palpation, extraction or ablation, etc.

Fourth stage. Suture of the peritoneal opening, the lips being brought together face to face.

Fifth stage. Suture of the muscles and the skin. It is sometimes advisable to insert a drain of iodoform gauze under the skin.

In small animals, such as the sheep, goat, and pig, laparotomy is more easily practicable, and can be performed either in the right flank or towards the white line. The stages of operation are exactly the same, but after operating near the white line it is extremely important to use numerous and strong sutures, and afterwards to apply a suspensory bandage around the abdomen, securing it above the loins.

HERNIÆ.

The situation and nature of the hernia determine whether or not a radical cure should be attempted.

Fig. 305.—Inguinal hernia in a young pig.

When a decision has been arrived at the seat of operation must first of all be thoroughly cleansed and disinfected. The animal is cast in a convenient position, and a general anæsthetic is given or a subcutaneous injection of 1 per cent. cocaine solution administered.

The operation comprises:—

First stage. Incision through the skin covering the hernial sac, opposite the orifice of the hernia.

Second stage. Isolation of the hernial sac.

Third stage. Reduction of the hernia and breaking down of any adhesions that may exist.

Fourth stage. Resection of the sac and obliteration of the peritoneal orifice by suture and ligature.

Fifth stage. Suturing of the muscles and skin, and application of a surgical dressing.

In practice, the deep sutures should be of bichromatised catgut or silk, and the skin sutures of catgut ligature or aseptic silk.

INGUINAL HERNIA IN YOUNG PIGS.

One of the most frequent forms of hernia which the practitioner is called on to treat is inguinal hernia in young pigs. Although this allows little tendency towards strangulation it is always desirable to operate, as otherwise the patients develop badly. There is no difficulty in this, though the animals must be cast and placed on their backs, the hind quarters being raised (Fig. 305).

First stage. A longer or shorter cutaneous incision over the neck of the hernia and along its greater curvature.

Second stage. Isolation of the hernial sac, consisting of the dilated internal sheath.

Third stage. Direct reduction of the hernia without opening the sac, provided no adhesions occur, or, in the event of adhesions, after incision of the sac.

Fourth stage. Torsion of the hernial sac and of the testicular cord up to the inguinal ring. Application of a catgut or silk ligature around the sac and cord at the level of the inguinal ring.

Fifth stage. Fixation of the ligature to the lips of the ring. Suture of the skin wound, and drainage of the wound with a strip of iodoform gauze.

IMPERFORATE ANUS.

This anomaly of development, which is not uncommon, presents two different degrees of development.

In the first degree the rectum is well formed, and extends as far as the skin below the base of the tail.

In the second the rectum is incomplete or non-existent, the floating colon terminating in a blind end at the entrance to the pelvis.

In calves, lambs, and young pigs very often imperforate anus is not diagnosed until the second or third day after birth. Defæcation cannot occur, and death is inevitable unless an artificial anus be established.

First Degree.—The patient loses appetite, the abdomen remains distended, and on examination of the anal region a doughy swelling is felt, which projects backwards when the animal strains. The operation is quite elementary, and always proves successful.

First stage. The skin beneath the tail is incised vertically; the rectal cul-de-sac projects towards the incision.

Second stage. The rectal cul-de-sac is punctured, the contents are removed, and the rectum and skin united by a few sutures. An anus is thus established, though there is no sphincter.

Second Degree.—The general symptoms are similar, though very often the little patient shows symptoms of atrophy or arrest in development. The operation is somewhat complicated.

First stage. Vertical incision through the skin at the base of the tail.

Fig. 306.—1. Prolapse of the rectum and vagina; 2, schema showing the relations of the layers of the rectum in prolapse; 3, first phase, showing manner of fixing the superposed layers of tissue by inserting four sutures—the left index finger is inserted into the rectum in order to manipulate the parts; 4, interrupted sutures inserted around the bowel after amputation.

Second stage. Digital exploration of the cavity of the pelvis after breaking down of the layers of connective tissue, and search for the blind end of the floating colon. When discovered, the colon is grasped between the jaws of a clamp or large forceps with smooth jaws, and gently drawn towards the opening.

Third stage. Puncture of the blind end of the colon, and suture of the latter to the cutaneous wound, as in the former case.

A third condition may exist, where the extremity of the colon remains within the abdomen. Operation by way of the pelvis then proves unsuccessful. If considered advisable, an opening may be made through the right flank, so that the floating colon may be brought to the surface and an artificial anus produced in this region.

An incision 1 or 2 inches in length is made below the haunch, to allow of the introduction of the index finger, with which the loop is sought. The colon is withdrawn, and the operation thenceforth is as above described.

PROLAPSUS AND INVERSION OF THE RECTUM.

This condition occurs in young pigs in various degrees. The necessity for reduction depends on the extent to which tearing or gangrene of the mucous membrane has progressed. The inverted portion is carefully washed, freely dressed with some non-irritant fatty substance such as vaseline, and progressively pushed back with the thumbs and index fingers of both hands applied flat on either side of the anus. To facilitate reduction it is best to check the animal’s expulsive efforts by placing a gag in the mouth.

In more aggravated cases, when prolapsus of the rectum has returned several times and the mucous membrane is gangrenous in places so that such a complication as peritonitis of the pelvic cavity is to be feared, it is better to amputate the prolapsed portion.

The animal is secured either standing or lying down, and a large enema is administered to remove the contents of the rectum. The herniated portion of bowel is carefully examined, for it sometimes happens that loops of intestine have become lodged in the dilated peritoneal sac, produced by displacement of the rectum. In such cases reduction should be effected before anything more is done, and for this purpose the patient’s hind quarters should be lifted or even suspended.

The operation for removal comprises two stages:

(1.) Fixation of the two layers of bowel by the passage of either two or four sutures about ½ an inch behind the anus.

(2.) Circular amputation of the sutured tissues; insertion of interrupted silk sutures through the lips of the wound; reduction. The patient is restricted to milk diet for a week. Laxative gruels, etc., may then be given.

The complication to be feared is peritonitis of the pelvic cavity owing to the sutures tearing out and allowing infective material to pass from the bowel into the cavity.

Slight cases of prolapsus might possibly be treated by the injection in lines of melted paraffin wax beneath the mucous membrane of the last part of the bowel. The injection is made by means of a large syringe provided with a long needle, the needle being gradually withdrawn as the melted wax is expressed. Four “pillars” of wax are usually injected at equidistant points. As they solidify they support the bowel and prevent the recurrence of the prolapse. The operation, however, is delicate, and scarcely to be recommended in pigs. Moreover, in man, in whom it has chiefly been practised, the deferred results have not always proved satisfactory.

CHAPTER V.
RESPIRATORY APPARATUS.

TREPHINING THE FACIAL SINUSES.

This operation is necessary when pus, tumours, or parasites exist within the sinuses, and in some cases where tumours form within the nasal cavities, etc.

TREPHINING THE HORN CORE.

This cavity is opened in front, at the base of the horn, about ¾ of an inch above the keratogenous band.

FRONTAL SINUS.

The frontal sinus may be trephined at one of two points, that is, either towards its highest or lowest extremity.

In the former case the point selected is in the direction of the axis of the horn core, about ¾ of an inch nearer the middle line than the base of the horn itself.

The animal should be cast.

First stage. A V-shaped incision ¾ of an inch long on each side is made through the skin and subjacent tissues, exposing the bone.

Second stage. The skin and periosteum are dissected away and reflected upwards.

Third stage. Trepanation.

The lower portion of the cavity is trephined within the angle formed by a transverse line uniting the upper margin of the orbits and the inner margin of the super-orbital foramen.

The stages are precisely the same as those above described.

MAXILLARY SINUS.

In adult animals the maxillary sinus is opened immediately above the maxillary tuberosity. In the young the point selected is ¾ of an inch higher.

TRACHEOTOMY.

In bovine animals tracheotomy is only performed in urgent cases, in order to ward off asphyxia or to facilitate some other operation on the upper air passages. It is performed exactly as in the horse, the animal either standing or lying down. In the former case, the animal may be placed in the trevis, but two strong assistants holding the animal’s head and nose by means of “bulldogs” are often sufficient.

To prevent the animal from striking out with the front legs, a rope is passed above and around the knees in the form of the figure 8; the animal is backed into a corner, and operation is then quite safe.

Large animals must be cast or placed in the trevis.

The seat of operation should be washed, shaved, and disinfected.

The operation may be divided into four stages.

First stage. Vertical median incision about 2 inches long through the skin at the height of the upper third of the trachea.

Second stage. Separation with a blunt director of the muscles covering the trachea. Incision through the pretracheal connective tissue.

Third stage. Circular or elliptical opening through the trachea of a size corresponding to that of the tracheotomy tube.

Fourth stage. Insertion of the tracheotomy tube.

CHAPTER VI.
GENITO-URINARY ORGANS.

In the domestic ruminants the penis exhibits a peculiar S-shaped curve, situated in the subpubic region (Fig. 226), so that when operation on the urethra, or even on the extremity of the penis, becomes necessary the organ must first of all be withdrawn.

The manipulation is as follows:—

The animal having been fixed by the head and front legs in a standing position, and if possible thrust against a wall, the operator stands on its left side. With his right hand he seizes the penis and the skin immediately in front of the scrotum and pushes them forward in the direction of the opening of the sheath.

The extremity is nipped between the first fingers of the left hand, and to prevent the glans slipping or escaping when the right hand is removed (for the purpose of taking a fresh hold of the body of the penis further back) the operator may reverse the free extremity of the penis so that it forms a loop, and thus secure a firmer hold. With the right hand the skin is thrust backward, a new portion of the sheath fixed, and the organ again pushed forward. In this way the penis is gradually extended. When the animal is cast, this manipulation is much easier.

URETHROTOMY IN THE OX.

Urethrotomy consists in incising the urethra, usually for the purpose of extracting a foreign body or calculus which impedes micturition. In the ox, calculi may become fixed either in the intra-pelvic portion of the urethra, though this is very rare; in the ischial curvature, or more commonly at some point in the S-shaped curve of the penis; or sometimes even within the sheath itself.

Urethrotomy is performed in the ischial or scrotal region, according to the point where the obstruction exists.

ISCHIAL URETHROTOMY.

Urethrotomy is performed in the ischial region either to displace or indirectly to abstract a foreign body fixed in the membranous portion of the urethra, or directly to remove one from the spongy portion opposite the ischial curve.

Calculi fixed in the intra-pelvic region are detected by rectal exploration.

The exact position of the foreign body is determined by inspection and palpation, whilst distension of the urethra by urine may be noted even before more striking symptoms appear.

The urethra can be incised by one of three methods.

The animal should be secured, if possible, in the standing position.

The first method, which dates back to very early times, consists in puncturing the urethra at one stroke with the fleam or lancet, and opening it more freely, after introducing a grooved director. This method is very useful where rupture of the bladder is imminent.

The extraction of a calculus fixed in the ischial region, or the manipulation of an obstruction at any other point, can afterwards be undertaken.

Second method. A second method consists in incising the subcutaneous tissues, layer by layer, until the urethra is reached at the ischial arch.

The operation is terminated by puncturing the urethra and enlarging the incision in an upward direction after passing a grooved director. This method minimises hæmorrhage and urinary infiltration. By previously injecting cocaine, the operation may be made practically painless.

Third method. Puncture of the urethra by a single stroke with a straight bistoury at the ischial arch.

The opening is enlarged in an upward direction with the same instrument.

SCROTAL URETHROTOMY.

Scrotal urethrotomy is necessary when the calculus is situated in one of the S-shaped curves of the penis or nearer the glans.

The operation is facilitated by casting the animal and withdrawing the penis from the sheath, but as there is considerable danger of rupturing the bladder when casting an animal with marked distension of that organ, the more serious operation should be preceded by puncturing the urethra with a fleam at the ischial arch.

By repeated moderate traction on the extremity of the glans, the S-shaped curve can be obliterated and the anterior portion of the penis withdrawn beyond the sheath.

One of two conditions may exist.

First case. Where the calculus is in the anterior, extra-prepubic portion, it is removed through an incision made directly over it. After extraction and disinfection, one or two sutures are inserted.

Second case. Should the calculus be situated in that portion of the penis which remains within the sheath after the fullest withdrawal of the organ, it is necessary to proceed as follows:—

(1.) The skin covering the sheath, the subcutaneous tissue, and the mucous membrane are first incised for a length of from 1¼ to 1¾ inches.

(2.) The penis is drawn through this opening; an incision is made directly over the calculus, dividing the fibrous layer, erectile tissue and mucous membrane of the urethra; the parts are disinfected and the wounds closed with sutures.

With ordinary antiseptic precautions little danger is to be feared.

Even should infiltration of urine occur, the operator need not be unduly anxious, for, provided the parts are punctured or scarified early, recovery usually follows.

PASSAGE OF THE CATHETER AND URETHROTOMY IN THE RAM.

Obstruction of the urethra in rams is more commonly caused by deposits of gravel than by single large calculi. It is generally found in highly-fed animals, in which gravel accumulates and becomes massed together at some point in the canal, often near the free extremity, where it forms a plug, causing complete retention of urine. In other cases this retention is due to a mass of sediment formed by vesical mucus and fine gravel which collects about the neck of the bladder.

Three operations have been advised for the removal of this condition:—

(1.) Section of the Appendix of the Penis.—When the disease is just appearing the sedimentary material may be collected at the anterior extremity of the penis behind the appendix. The shepherds in such cases remove the extremity of the penis. The resistance disappears, the plug formed of gravel yields to the pressure of urine, and micturition occurs as usual. Excision of the appendix, however, incapacitates the ram for service.

(2.) Passage of the Catheter.—Passage of the catheter has been recommended for the removal of deposits of gravel in the urethra, but it seems a very questionable method.

Should it be determined on, the animal must be placed on its back. The penis is then withdrawn and the double S-shaped curve is obliterated. An incision is made over the canal behind the appendix and a soft gutta-percha sound is passed. The sabulous accumulation is thus dispersed.

(3.) Urethrotomy.—Scrotal urethrotomy may be performed as in the ox.

Fig. 307.—Passing the catheter in the cow.

Ischial urethrotomy is impracticable in very fat animals, but when the obstruction is about the neck of the bladder, and the animal’s condition admits of it, this operation may be performed.

The patient is fixed on its back, and a metallic or gutta-percha sound is passed into the urethra. The tissues are incised layer by layer in the direction of the sound. Once the urethra has been opened the soft magma may be washed out of the bladder by a free injection of boiled water or similar aseptic liquid.

Fig. 308.—Catheter for cows.

PASSAGE OF THE CATHETER IN THE COW.

It sometimes becomes necessary to examine the bladder of the cow.

There is an obstacle, however, to the introduction of the sound into the urethral canal. The meatus urinarius is covered by a little valve which springs from the lower wall and forms behind the real opening of the urethra a cul-de-sac, into which the point of the catheter is apt to pass. The instrument usually employed is of gutta-percha, glass, or, better still, of metal, as more easily sterilised (Fig. 308). It is held like a pen, and is directed along the floor of the vagina as far as the opening of the meatus, being guided by the index finger of the left hand, which has previously been introduced. The point being very slightly depressed, it enters the cul-de-sac. It is then only necessary to reverse the movement, that is to say, raise the point, whilst gently pressing forward; a slight resistance is felt and the sound enters the bladder. If necessary the little valve may be held down by gently pressing on it with the point of the left index finger.

It is sometimes an advantage to expose the seat of operation. In such cases the lips of the vulva and the walls of the vagina may be separated by retractors or by the use of a speculum.

CASTRATION.

Castration is performed for the purpose of removing the reproductive power, either by obliterating the testicle or ovary or by suppressing their functions.

In ruminants, the testicles are elongated and placed in a vertical position, the upper portion of the scrotum presenting a constriction and the whole scrotal mass resembling in shape a cone with its base downwards.

CASTRATION OF THE BULL AND RAM.

These two animals, when destined for slaughter, are usually castrated either at birth or at latest two or three months afterwards. In Normandy, in Franche-Comté, and in England breeders castrate young bulls by torsion of the cord.

Two incisions about 1¼ to 1¾ inches in length are made on the lower extremity of the scrotum. The testicles are enucleated and the testicular cords seized with two pressure clamps, with which torsion is effected. In the South of France, in Auvergne, and in the Limousin, bulls intended for working are not castrated until after the lapse of some months, on account of the influence which the testicles have on the development of the bones and muscles. Such animals are only operated on at the age of from six months to a year, and as a rule the method employed is that of bistournage.

BISTOURNAGE.

This method of castration has been practised from time immemorial. It consists essentially of torsion of the testicular cord, and aims at obliterating the vessels which it contains, and thus bringing about atrophy of the organs served by them.

The Bull.—The animal is operated on in the standing position. The head is fixed to a post or ring somewhat high up, in order to check movement of the hind legs. The hind legs are also partially secured by means of ropes or two pieces of webbing passed in a running noose about the hocks and fixed above the knee. No preliminary disinfection is practised, because no wound is made.

Fig. 309.—Bistournage. First phase. Manipulating the scrotum.

Manual Technique. The operation comprises four stages:

Fig. 310.—Bistournage. First phase. Thrusting the testicles upwards; manipulating the scrotum.

First stage. The operator, standing behind the animal’s hocks, grasps the testicular cords with the hands, immediately above the testicles, and by exercising strong pressure, thrusts the latter to the extreme base of the scrotum. The movement is next reversed; seizing the base of the scrotum with the right hand, he draws it smartly downwards, whilst he places the left hand above the right, and thrusts the testicles towards the abdomen. If the testicles do not rise sufficiently high, the right hand is slipped between these and the left hand, and the testicles are thus thrust upwards towards the lower inguinal rings, slightly dilating the latter.

After this manipulation has been repeated two or three times, the scrotum, etc., become more pliable and the testicles more easily displaced. The second stage of the operation is thus facilitated.

Second stage. The second stage of operation may be effected by one of two methods.

Fig. 311.—Bistournage. Second phase.

Old method: The oldest method consists in allowing one of the testicles to rise towards the inguinal ring and to turn the other in a vertical plane. If, for instance, it is desired to turn the right testicle, the cord is grasped between the thumb and index finger of the left hand (Fig. 311), the lower part of the scrotum is seized with the right hand, and the object then is to slide the point of the testicle along the dorsal surface of the fingers (Fig. 311). Simultaneously the operator presses on the base of the testicle with the thumb of the left hand, thus causing a rotary movement in a vertical plane; the tail of the epididymis becomes uppermost. A certain empty space separates the testicle from the base of the scrotum.

Third stage. Torsion of the cord. The testicle having been rotated, the cord must be twisted so that the vessels may be obliterated. The left hand continues grasping the cord, which is then brought in front of the testicle, whilst with the right hand the testicle is pushed backwards and is made to describe a semi-circle. The cord was previously on the left side; it is now on the right, and simultaneously the testicle passes from right to left.

Fig. 312.—Bistournage. Third phase.

In completing the turn the hands must not be changed, and, above all, must not let go their hold; and the cord is pushed forwards and towards the right with the right hand, whilst the testicle is pushed backwards and to the left with the left hand. The cord and the testicle resume their original position; one complete turn has been effected. These manipulations are repeated several times, and the cord soon assumes the appearance of a large, hard, tense string. To ensure obliteration seven or eight turns should be made in the case of the bull and four or five in that of the ram.

Torsion of the right testicle being complete, the gland is thrust towards the upper part of the scrotum and the left testicle is submitted to the same manipulation, the position of the hands, however, being reversed.

Fourth stage. Fixation of the testicles in the inguinal region. Both testicles having been thrust upwards as far as possible into the inguinal region, the scrotum is ligatured below them. Tape or thick cord should be used, to guard against gangrene of the lower portions of the scrotum. A considerable œdematous swelling soon occurs, and when at the end of twenty-four or forty-eight hours infiltration is well developed, the ligature should be removed.

Dubourdieu has described a different method, in which the testicle is rotated in a horizontal plane. The position of the hands is then different. The left testicle, for instance, being at the base of the scrotum, the cord is grasped with the right hand opposite the base of the testicle, and the tail of the epididymis and the testicle are held with the whole hand whilst being rotated. If care is taken to fix the cord with the right hand, rotation is more rapid and easier than in the preceding method.

Fig. 313.—Bistournage. Second phase. Dubourdieu’s method.

Fig. 314.—Bistournage. Second phase. Dubourdieu’s method.

Difficulties in Operation.—Bistournage is highly commended in France on account of its avoiding all the complications resulting from sanguinary operations. Nevertheless it presents great difficulties, particularly in bulls of from two to three years of age, in which the testicles are hard to manipulate on account of their size, the thickness of the connective tissue, and sometimes because of abnormal adhesions. In such cases the preliminary manipulation alone sometimes extends over half an hour.

Bistournage is of doubtful efficacy when the testicles are small and round, because after the ligature has been applied the testicular cord tends to untwist, and the shape of the testicles readily lends itself to such movements. If untwisting occurs, the operation fails.

Consequences of the Operation.—The operation is often followed by more or less violent attacks of colic; the animal may suffer for five or six hours, after which it recovers.

If torsion has been clumsily performed, or if the ligature becomes displaced, the testicle may descend and the cords untwist; the latter then appear to have lost the firm, tense consistence which they presented after operation. To prevent slipping of the ligature and untwisting of the cord, Guittard suggests the use of an iron needle, with which the scrotum is pierced through the median line, just beneath the testicles when at their highest position; above this is placed the ligature, which then cannot possibly slip.

The Basque operators, in order to avoid untwisting, exercise vigorous traction from above downwards after rotating the testicle. In this way ruptures occur which diminish the elasticity of the cord and the epididymis, and tend to check the untwisting of the former.

When the operation has succeeded the testicles gradually atrophy. They do not disappear completely, and may sometimes be found several years later of the size of a hazel-nut or a chestnut and of fibrous consistence. It need scarcely be said that in the event of bistournage failing, cutting operations can always be resorted to.

MARTELAGE.

The process of martelage consists in mutilating with a mallet the testicular cord whilst still covered by all its envelopes. This mutilation injures the walls of the arteries, causing the formation of a clot, which cuts off the supply of blood to the testicle and causes the gland to atrophy.

The practice is very ancient.

The animal is fixed by the horns as if for bistournage, and the limbs are secured by two strips of webbing or two ropes, as in the former case, though some practitioners neglect the latter precaution.

Two cylindrical rods the size of broomsticks and a wooden mallet or farrier’s hammer are the instruments employed.

The method, however, is barbarous, cruel, and of doubtful value. It would never be countenanced in England.

CASTRATION BY CLAMS.

Castration of bulls by means of clams has been practised in many different forms.

Fig. 315.—Crushing the testicular cord. (This method is to be strongly condemned.)

Castration by the Exposed Method.—The operation is the same as in the horse, the scrotum being incised on either side, and the dartos, connective tissue, tunica vaginalis scroti, and tunica vaginalis testis being divided. Short clams are applied to the cord, and the lumen of the arteries is completely obliterated in five to six days, when the clams can be removed.

Instead of an incision being made for the removal of each testicle, the scrotum and dartos may be divided in the middle line, after which incisions may be made to the right and left respectively, exposing the fibrous tissue and enabling the testicles to be enucleated. A clam may then be applied to each cord, or the two cords may be included in one pair of clams.

This method has the advantage of inflicting less injury on the scrotum, a point which is of some importance in animals destined for slaughter.

Castration by the Covered Method.—This operation is identical with the preceding, except that the incision of the scrotum does not involve the cremaster and fibrous tunic, or the tunica vaginalis scroti.

CASTRATION BY TORSION.

The cord may be twisted throughout its entire length or torsion may be limited to a part of the cord, hence the two methods hereafter described.

(a) Limited Torsion.—The testicles are exposed as in castration by the open method. The cord is then drawn forward and fixed by means of forceps applied just outside the scrotum; ¾ to 1 inch below this point the torsion forceps are applied. The cord is slowly twisted, and usually ruptures about the centre of the fragment included between the two pairs of forceps.

Fig. 316.—Castrating the ram by ligature. (This method is to be strongly condemned.)

(b) Direct or Unlimited Torsion.—First stage. The testicle is exposed, as in castration by the covered method.

Second stage. The cord and vaginal tunic are twisted by grasping the testicle, which is protected with a piece of clean linen.

CASTRATION WITH THE ACTUAL CAUTERY.

The testicles are exposed, the cords are seized with clams and divided separately or together with a sharp-bladed cautery at a white heat. The eschar so produced is sufficiently dense to obliterate the vessels.

CASTRATION BY THE ELASTIC LIGATURE.

This method has been largely employed during the last ten or fifteen years. It consists in applying to the upper part of the scrotum several turns of a tensely stretched round or square rubber thread. The two ends of the rubber thread are crossed and tied with string. About the seventh or eighth day the testicles may be removed with a knife close to the ligature, provided the process of delimitation is well advanced.

The chief objection to this method lies in the fact that the scrotum is destroyed, which lowers the value of the animal from a commercial point of view.

CASTRATION OF THE RAM.

Most of the preceding methods may be used in castrating rams, but certain special methods are more generally employed. These we shall shortly mention.

Castration by Bistournage.—The method is exactly similar to that in the bull. The animals are placed in the position shown in the figure, except that the hind limbs are extended and held in that position by the operator’s knees or feet. The process is only applicable to animals of four or five months old.

Castration by Tearing.—This method is only practised by shepherds, and on animals a few days or at most a month old. The base of the scrotum is snipped off with scissors, the testicles are enucleated, and each in turn is seized and torn away with a sudden snatch. Even though a considerable length of cord is removed with the testicle, bad results seldom follow, provided the subject is not of greater age than that mentioned.

Fig. 317.—Castration of young pigs.

Castration by Ligature.—This method consists in passing a stout ligature in the form of a running knot over the neck of the scrotum and, by means of two short pieces of wood, drawing it tight. The method, however, is not to be recommended, as it not infrequently leads to tetanus.

CASTRATION OF BOARS AND YOUNG PIGS.

For castration boars should be cast on the left side, and three legs at least firmly secured together (Fig. 317). The best method is that of limited torsion. Care should be taken to avoid dragging the cord downwards during the operation, for the testicular artery ruptures readily, and fatal abdominal hæmorrhage may follow.

As the subjects are apt to wallow in the litter after the operation a strip of iodoform gauze should be applied and secured by one or two sutures. This is removed on the third or fourth day.

On young pigs the operation is simpler. The animal is cast on the left side and firmly held, the left hind limb being extended and the right drawn towards the right shoulder.

The testicles are grasped each in turn with the left hand, whilst with the right they are exposed by a single sweep of the bistoury. The testicles are removed by torsion with artery forceps. Many laymen simply use the hands, the cord being grasped between the left thumb and index finger, whilst torsion is effected by the right index finger thrust between the vas deferens and the body of the testicle.

CASTRATION OF CRYPTORCHIDS.

Cryptorchids are very rare amongst cattle and sheep, as the testicles enter the scrotum during intra-uterine life. The internal inguinal ring in the pig being of very small size, the condition is more common in that animal.

The same process is employed in castrating cryptorchid bulls, rams, or boars. The animal is thrown on one side and securely fixed. A vertical incision is made in the region of the flank, varying in length from 4 to 5 inches in the bull, 2 to 2½ inches in the ram, and 4 to 5 inches in the pig. The abdominal cavity is examined, the testicle found, and a ligature applied to the cord, after which the testicle is removed.

Another method consists in employing the écraseur for division of the cord.

To avoid subsequent complications antiseptic precautions should be taken.

Complications after Castration.—Whatever the method employed, swelling of a more or less abundant character always develops during the few days immediately succeeding the operation. It is, however, of little importance.

Should antiseptic precautions be neglected, suppuration, septicæmia, tetanus, and sometimes scirrhous cord may follow.

FEMALE GENITAL ORGANS.

Examination with the Speculum.—In the cow certain diseases of the vagina, bladder, neck of the uterus, and even of the uterus itself, may necessitate visual examination in addition to the manual examination commonly employed. Under such circumstances a special speculum is introduced in a closed condition, being afterwards opened and dilated to the required extent.

Before inserting the speculum, however, the genital passages should be cleaned, and the speculum itself smeared with vaseline. It penetrates readily with moderate pressure.

Heifers and similar animals require a special (small) instrument (Fig. 318).

Fig. 318.—Vaginal speculum for heifers.

In certain circumstances, moreover, it is preferable to use retractors, with which local examination is easier. These can be applied at either side of the vagina and drawn apart, thus exposing the depths of the genital tract.

CASTRATION OF THE COW.

The operation of castrating the cow is very old, and was mentioned by both Aristotle and Pliny. Many other descriptions of it have since been given. But more recently the manual technique has been considerably simplified and very fully described.

Utility.—The operation is practised for the cure of nympho-mania; also to prolong the period of milk-yielding and to facilitate fattening.

As regards nympho-mania, it is only of value where the excessive excitement is due to disease of the ovaries.

Under ordinary conditions the secretion of milk diminishes more or less, and becomes very slight after eight or nine months from calving. If, however, the cow is castrated under favourable circumstances, lactation continues for several months, sometimes for several years, beyond this period. It is said that castrated cows yield milk of a more constant composition and richer in butter fat, casein, and mineral salts than those which are not castrated, although the point cannot be said to have been fully established.

To obtain the best results the subjects should have attained their maximum yield of milk and be from five to seven years old. The best period is six weeks to two and a half months after calving. Neglect of these considerations is liable to be followed by inappreciable, doubtful, or bad results.

The influence of castration on fattening is explained by the suppression of œstrum.

Manual Technique.—An ovariotome with a hidden blade and an écraseur with an extra long stem are the only instruments required. The animals should be prepared for some days by diminishing their food supply and administering gentle laxatives.

Acute or chronic lesions of the genital tract should be held to contra-indicate operation, and it should be noted that tuberculous animals are particularly liable to awkward complications.

On the day of operation an abundant enema is given, to empty the rectum, after which the vagina is washed out freely with a lukewarm solution of some non-irritant antiseptic. The hind quarters, and particularly the neighbourhood of the anus, vulva, base of the tail, etc., should be carefully washed and disinfected with a solution of lysol, cresyl or carbolic acid.

Fig. 319.—Ovariotome.

The patients are secured in a standing position, a rope being passed in the form of the figure 8 around the hind limbs above the hocks, and the animal is then firmly thrust against a wall by several strong assistants.

The operator’s hands and instruments must be rigorously disinfected.

The operation comprises three stages:

First stage. Puncture of the vagina.

Second stage. Finding and securing the ovaries.

Third stage. Ablation.

The hand is smeared with sterilised oil, and, grasping the ovariotome, is passed into the vagina, which contracts on it and on the forearm. Within a short time, however, which may vary between two or three minutes and a quarter of an hour, the vagina becomes distended and its walls rigid, so that the operator is able to continue his manipulations more easily. This is the moment for effecting puncture, after an examination of the pelvic organs through the vaginal walls.

The blade of the ovariotome is advanced until fully exposed, and the point is brought directly above the neck of the uterus, about ¾ to 1¼ inches from it. By a sharp movement the instrument is then thrust directly forward, dividing the wall of the vagina in the median line.

The blade is next retracted into its sheath and the instrument dropped on to the floor of the vagina. The right index finger is at once passed through the orifice so made into the peritoneal cavity, in order to make certain that all the membranes have been divided. By pressing on and slightly tearing the tissues the middle finger is then introduced alongside the index. Only these two fingers should be passed into the peritoneal cavity.

In order to secure the ovaries it then suffices (Fig. 321) to thrust forward the base of the vagina, allowing the two fingers to glide over the body of the uterus and thence downward over its side to the point where the horns of the uterus originate. Here the fingers meet the ovary, which is readily recognisable on account of its size and shape (those of a walnut). The gland is nipped between the index and middle fingers, and is drawn into the vagina through the operative opening.

Fig. 320.—Castration of the cow. First phase.

In order to remove the ovary the operator seizes the écraseur with the left hand, a loop of chain about an inch long projecting, and slides the instrument along his right forearm. The arm must be retained in the vagina, the fingers grasping the ovary. The organ is slipped into the loop of the écraseur, which is then manipulated with the left hand until the pedicle is divided. To prevent hæmorrhage the screw of the écraseur should only be turned at the rate of about twice a minute. The ovary when separated is left on the floor of the vagina, the fingers being again introduced into the abdominal cavity to secure the second one. This is removed in precisely the same way.

The pedicles of the ovaries are released, and at once return to the peritoneal cavity, while the operator, in withdrawing his hand, brings with it the knife and the ovaries themselves. The lips of the operative incision come together again spontaneously as the vagina contracts.

This operation is followed by slight colic, which, however, need not cause alarm.

Fig. 321.—Castration of the cow. Second phase.

Complications: Hæmorrhage.—If the incision is unskilfully performed, it may in exceptional cases result in injury of the terminal portion of the aorta or the iliac arteries. The blood then streams past the operator’s hand, and the animal dies of internal hæmorrhage in a few minutes; nothing can be done.

If there is undue haste in manipulating the écraseur, the pedicle of the ovary is cut rather than crushed, the vessels close imperfectly, and grave hæmorrhage may occur.

In cases where hæmorrhage is slight the peritoneal clot is readily reabsorbed; but should the animal happen to be tuberculous or its vessels in any other way diseased, free hæmorrhage may occur and may eventually be followed by fatal peritonitis. Hernia of the intestine through the vagina is a rare complication nowadays, on account of the small dimensions of the perforations. In former times, when larger incisions were made, it occurred rather frequently.

Abscess Formation.—Suppuration of the wound and peritonitis or vaginitis are caused solely by the neglect of antiseptic precautions.

Pelvic peritonitis following an operation is indicated, like ordinary acute peritonitis, by loss of appetite, peritonism, colic, etc.

Even where peritonitis is avoided a local abscess often forms in the vaginal wall owing to infection of the operation wound. The symptoms are delayed for several days, sometimes for a fortnight after operation, and consist in straining efforts, moderate peritonism, diminution in appetite, etc. Vaginal or rectal examination reveals the character and extent of the disease. The abscess should be punctured through the vagina.

Finally, it may happen that castration does not prevent the recurrence of œstrum. The ovarian pedicle may have been divided too close to the glandular tissue, a fragment of which has remained adherent to the pedicle.

Certain other operative complications are also possible in dealing with cows suffering from nympho-mania which have developed cysts, tumours, or abscesses of the ovaries. It is then necessary to enlarge the incision in the vagina and take particular precautions not to rupture the cysts or abscesses in the peritoneal cavity. The operator must proceed cautiously and modify his technique according to circumstances.

CASTRATION OF THE SOW.

Castration of the sow has been practised since very ancient times. The operation is performed on animals intended for fattening, and at all ages between six weeks and maturity.

Anatomical Arrangement of the Genital Organs.—Before performing ovariotomy in the sow it is indispensable to understand the special arrangement of the genital organs. The uterine horns are very long and folded on themselves, forming convolutions which give them somewhat the appearance of small loops of intestine. Nevertheless they can readily be distinguished by the touch, for they are much smaller in size than the latter.

In young sows, two to three months old, they are of about the thickness of a small pencil. Differentiation is more difficult in sows that have borne litters, but as the ovaries alone are withdrawn, leaving the horns of the uterus uninjured, this distinction is unimportant.

The horns of the uterus are suspended in the peritoneal cavity by means of very extensive, well-developed, and very lax ligaments, and, as the horns of the uterus lie at a very acute angle one to the other, the ovaries are very close to the median line of the abdomen. The length and yielding character of the parts and the close apposition of the ovaries explain why the latter can be found and extracted through a single incision in the flank, either on the right or left side.

An ordinary convex bistoury or a special knife and two artery forceps are the instruments employed.

Manual Technique.—The animal is cast on the right or left side, preferably on the right, so that the right index finger can be employed. Full-grown sows should always be muzzled. In the case of young animals, the limbs should be grasped by assistants, the hind limbs being crossed one over the other and drawn backwards.

Antiseptic applications are highly desirable, although they are usually neglected when a layman directs the operation.

The operator places himself close to the animal’s back. The incision may be made in one of three different places.

Fig. 322.—Genital organs of the sow. 1, Ovary; 2, horn of the uterus; 3, uterus; 4, rectum; 5, vagina; 6, bladder; 7, kidney; 9, intestine.

Certain practitioners recommend a vertical incision about 2 to 2¼ inches in length, commencing at the external angle of the ilium, or ⅓ of an inch in front of it, and prolonged downwards; others make a horizontal incision parallel with the vertebral axis; and, lastly, some believe that an oblique incision following the direction of the “cord of the flank” is just as advantageous. A vertical or oblique incision is probably the best.

The operation comprises four stages:

First stage. Incision of the skin and subjacent muscles.

Second stage. Perforation of the peritoneum and discovery of the ovaries.

Third stage. Ablation of the ovaries or of the ovaries and horns of the uterus.

Fourth stage. Suture of the wound.

The tissues are divided layer by layer. The skin is formed into a longitudinal fold and divided in a vertical direction, and the subjacent muscular layers are then divided with the bistoury. The tissues are next broken through layer by layer with the index finger until the parietal peritoneum is reached. This membrane is then fissured, or at least scraped with the nail, and perforated with a sudden sharp thrust of the index finger.

Fig. 323.—Castrating knives.

This practice, however, has the disadvantage of sometimes causing the parietal peritoneum to strip away from the wall of the abdomen, which greatly increases the difficulties of operation. It is better, therefore, to grasp the peritoneum with a small pair of forceps, draw it outwards, and secure it so as to puncture it with more certainty. When experience has been acquired this precaution will be unnecessary.

The incision being made and the finger introduced into the abdomen, the operator, who kneels against the animal’s back, searches for the ovaries with his index finger. The upper ovary of the side in which the incision has been made will be found immediately in contact with the parietal peritoneum, and the operator must take care not to displace it by untimely or careless manipulation, which may thrust it away among the loops of intestine. The finger being doubled up in the form of a hook, the ovary is seized and drawn out. Sometimes it may be easier to withdraw the uterine horn, leaving the search for the ovary until a little later.

The first ovary having been discovered, its pedicle is seized between the left thumb and index finger or the jaws of pressure forceps, and then the search is continued for that of the opposite side. In young sows the horn of the uterus may be followed up from its extremity (ovarian extremity) towards its origin (bifurcation of the body of the uterus) and the search continued along the horn of the uterus of the opposite side, which is followed in the reverse direction from its base towards its extremity until the second ovary is found.

The most difficult stage is that at which the change is made from one horn to the other, for this is the moment when the contraction of the parts is most violent, the animal’s struggles most energetic and the pain most acute, so that great care must be taken not to let go the horn which has already been secured.

When the second ovary appears at the external orifice, it is secured like the preceding, and both are removed by torsion. The horns of the uterus are then freed and returned to the abdominal cavity, the wound is thoroughly disinfected and united with from one to three interrupted sutures passed through the skin. The animal is then allowed to rise. Complications are rare.

In small females the uterine horns are often removed by torsion along with the ovaries. In adults, only the ovaries are removed.

Subsequent Precautions: Operative Accidents.—The patients are kept on low diet for some days after operation. Accidental stripping away of the peritoneum at the seat of operation may sometimes result in the formation of a little abscess when the wound has been infected. This is diagnosed by direct examination or palpation. The lips of the wound are then opened in order to permit the pus to escape and avoid peritonitis. Should the horns of the uterus or the broad ligaments be roughly manipulated, they may be torn to some extent, but this rarely causes grave complications.

Bleeding from the incision in the abdominal wall is of little importance.

Hernia rarely occurs, for the opening in the peritoneum is of very small size.

In rare cases, and when care is not used, a portion of the intestine may be sutured to the margin of the wound. The intestine then becomes adherent to the abdominal wall, but grave results seldom follow.

SUTURE OF THE VULVA

In cases of recurrence after reduction of an inversion of the uterus or the vagina it may become necessary to suture the vulva in order to control the effects of straining.

Several forms of suture are employed; the best are probably those of Rainard and Strebel.

Simple Suture.—Simple suture may be formed of very flexible copper wires. Three are usually inserted, one at the base, one about the middle, and one near the upper third of the vulval opening. The ends of each suture are knotted and drawn moderately tight over the opening, then one of the ends of the highest knot is united vertically to an end of the middle knot, and the latter in its turn is similarly secured to the lowest knot.

To be reliable, sutures should embrace the entire thickness of the lips of the vulva.

Rainard’s Suture.—Rainard’s suture consists only of two oblique stitches, crossed in the form of the letter “X,” starting from the upper third of one of the lips of the vulva and terminating in the lower third of the opposite lip. The ends are tied opposite the centre of the vulval opening.

Strebel’s Suture.—Strebel’s suture consists of three stitches inserted transversely. The material employed is galvanised wire, sharpened at one end and rolled into a flat spiral at the other. Each wire, which plays the part of a needle, is inserted separately, and is afterwards twisted into a spiral by means of special forceps, the excess of length being thus taken up until the lips of the vulva are brought closely in contact.

Fig. 324.

In practice, in order to avoid the cutting and irritant effect of such sutures and to increase their efficiency, two rectangular pieces of leather are applied on either side through holes in which the actual metallic sutures are passed. West’s vulval clamp is better than sutures. It is very popular in England.

TRUSSES.

Trusses applied for the purpose of preventing prolapsus of the genital organs are now almost entirely given up, as they very imperfectly achieve their object.

Lund’s truss, shown in the illustration (Fig. 325), is perhaps the most efficient of those which survive. The essential portion of this is of metal, and is approximately of the shape of the letter “V.” The two ends may be separated and drawn together at will by means of a cord. This apparatus is held in contact with the vulva by means of strings which pass through eyes in the metallic triangle and are secured to a collar placed on the neck or to a girth secured round the chest.

Fig. 325.—Lund’s truss.

SECTION OF THE SPHINCTER OF THE TEAT.

This operation is performed to render easily pervious the ends of teats which have undergone contraction as a consequence of changes in the sphincter or from some other cause.

The animals are secured, and the teat to be operated on having been grasped between the index finger and thumb of the left hand, the point of the little cutting instrument shown in Fig. 326 is introduced into the opening of the teat, and it is then thrust in as far as the shoulder on the cutting edges.

DILATATION OF THE ORIFICE OF THE TEAT.

The results of the above operation not always proving permanent, and cicatricial contraction often following after a few weeks’ time, forced dilatation by means of the conical tubes shown (Fig. 327) has been generally substituted for it. Three instruments of varying thickness are usually sufficient. Forced dilatation may be effected at a single operation, and has not the drawback of causing cicatrices.

Fig. 326.

Fig. 327.

ABLATION OF THE MAMMÆ.

Ablation of the mammæ is rather frequently necessary, principally in cases of gangrenous mammitis, of prolonged, continuous suppuration, or of grave mammitis, where death would otherwise follow.

Provided the anatomical structure of the parts is known (Fig. 327) ablation does not present any insuperable difficulty.

In the cow, either two lateral quarters or the entire udder must be removed. The lines of incision through the skin should first of all be traced.

One half of the udder may be removed by the following method:

First stage. Elliptical incision through the skin, including the two teats of one side.

The lines of incision should extend backwards sufficiently high to enable the vessels at the base of the gland to be easily ligatured.

Second stage. Dissection and breaking down of the subcutaneous and intermammary connective tissue. The anterior mammary vein must be ligatured.

Third stage. Isolation of the mamma from the front backwards, and ligature of the vessels of supply. Extirpation.

Fourth stage. Suture and drainage of the operative wound with iodoform gauze.

Fig. 328.—Ablation of the udder in the cow. Li, Line of incision; Lp, prolongation backwards.

Fig. 329.—Ablation of the udder in the goat. Li, Line of incision; Lp, prolongation backwards.

This operation appears to cause formidable injuries, the abdominal tunic and the muscles of the flat portion of the thigh being largely exposed, but in reality the wound is less grave than might be supposed, and healing occurs in a comparatively short time, provided none of the diseased tissue is left.

The dressing is renewed at intervals of two or three days, and when cicatrisation proceeds regularly it may be omitted and replaced by antiseptic irrigation.

In the ewe and she-goat the operative technique is identical:

First stage. Elliptical incision, including the teat.

Second stage. Breaking through of the intermammary connective tissue partition and the subcutaneous tissue. Ligature of the anterior mammary vein.

Third stage. Isolation of the mamma from the front backwards. Ligature of the vessels of supply. Extirpation.

Fourth stage. Suture and drainage.