Diseases of cattle, sheep, goats and swine

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

The cutaneous incision affords exit to large quantities of fluid, and the pectoral muscles attached to the neck of the ensiform cartilage can then be divided with the bistoury. The area of operation is thus uncovered.

Second stage. The second phase comprises incision of the tissues opposite the neck of the ensiform cartilage, about 8 inches in front of the base of the triangle and at equal distances from the points Nos. 1 and 2; incision through the skin for a distance of 8 inches, and dissection of the muscles of the ensiform region exposed at the neck of the cartilage.

By means of the index finger or the index and middle fingers of the right hand the mediastinal space is explored, and the fatty masses round the base of the heart broken through. If the pericardium is greatly distended, the point of the sac can be felt with the tip of the finger, or its position can be recognised, even from a little distance, on account of the fluid contents transmitting the impulse of the heart. The sensation conveyed to the finger is very clear.

The right index finger is then replaced by the left, and, a trocar about 10 inches long and ¼ inch in diameter being introduced along the index finger used as a director, the pericardial sac is reached. The exudative fluid transmits the impulse due to the beating of the heart, and the pulsations can be clearly distinguished when grasping the handle of the trocar.

Third stage. Digital exploration of the course of the puncture and fatty cushion at the base of the heart, with the object of discovering the position of the pericardium.

Fourth stage. Puncture with a trocar about 10 to 12 inches in length, puncture of the pericardium, irrigation and dressing.

Fig. 179.—Photograph of a patient immediately after operation. Extensive œdema of the dewlap and neck.

The trocar is inclined in a slightly oblique direction from without inwards and forwards towards the median plane, in order that the point may not deviate towards the left pleural sac; the left index finger is then withdrawn, and by a sharp thrust of the right hand the trocar is pushed forward about 1 to 1½ inches and the pericardial sac is entered.

The position of the canula should not be altered whilst liquid is escaping, for if it is thrust in too far a considerable quantity of fluid may remain in the deepest portion of the sac.