Diseases of cattle, sheep, goats and swine

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

We need not go back to the methods formerly recommended. All are illusory or mischievous, such as the use of purgatives to arrest or reverse the progress of the foreign body, removal of the foreign body after opening the rumen, puncture of the pericardium, etc.

In 1878 Bastin successfully opened the pericardium and extracted the foreign body through a window produced in the thoracic wall.

This operator recommends that after drawing the left limb forward and incising the skin and muscles, the operator, with his hand bound round with a cloth, should perforate the pleura, and then having found the foreign body, proceed to extract it. By this method it seems difficult to cause perforation of the pericardium, which would certainly lead to the production of pneumo-thorax complicated with fatal septic pleurisy.

It must be borne in mind that the two pleural sacs, right and left, descend as far as the sternum (Fig. 173), and that it is not possible to touch the pericardium directly without perforating the pleura.

Moussu has drained the pericardium through the pleura in the hope of relieving the pressure on the heart and facilitating the reabsorption of the œdema, in order to permit of the subsequent slaughter of the animal, but has had unsatisfactory results. Lastly, he has practised median trepanation of the sternum in the infra-pericardiac region. Here again the operation is difficult, because of the œdematous infiltration of all the substernal region, while it is so dangerous to the patient, which must be cast and may suddenly succumb, that it is of no use in ordinary practice.

There is probably only one condition in which it would be possible to attempt intervention with a fair chance of success, that is, when there exists a fibrous connection between the pericardium, lung, and wall of the chest on the right or left side.

In such cases aspiratory puncture or incision of the pericardium in an intercostal space might prove of service, because it would not expose the animal to the danger of pneumo-thorax.

The only difficulty lies in ascertaining beyond all question the existence of such an adhesion before attempting operation, and this is really very great, even having regard to the form of the dulness and the absence of all respiratory sound in the lower third of the thoracic cavity and cardiac zone. The pulmonary lobe between the heart and chest wall may be thrust upwards and be partially adherent to the pericardium and to the parietal pleura, and at the same time it may be impossible to avoid producing operative pneumo-thorax when the cartilages are resected to admit of incising the pericardium.

The only logical method seems to be puncture of the pericardium through the xiphoid cartilage, as described below.

The topographical anatomy of the thoracic viscera shows that the point of the pericardium extends along the sternum to a point close to the lower insertion of the diaphragm, and that the pericardial sac is only separated from the xiphoid region, or rather from the region of the neck of the xiphoid appendix of the sternum, by the fatty cushion at the point of the heart.