-ocr page 1-
-ocr page 2-
-ocr page 3-
A TEXT-BOOK
OF
#9830; #9632; raquo;
OPERATIVE VETERINARY SURGERY
-ocr page 4-
BIBLIOTHEEK UNIVERSITEIT UTRECHT
2912 630 1
-ocr page 5-
o^
A TEXTBOOK
OK
OPERATIVE
YETERmARY SURGERY
BY
GEORGE FLEMING, G.B., LL.D., F.R.C.V.S.
Laie Principal Veterinary Stm/eon to the Army
AUTHOR OF 'ANIMAL PLAGUES,' 'PRACTICAL HORSE-SHOEING,' ' COKTAGIOÜS DISEASES
OF ANIMALS,' ' TEXT-BOOK OF VETERINARY OBSTETRICS,' ' TUBERCULOSIS FROM
A SANITARY AND PATHOLOGICAL POINT OF VIEW,' ' HUMAN AND ANIMAL
VARIOLA,' 'PROPAGATION OF TUBERCULOSIS,' ETC.
VOLUME II
WITH NUMEROUS ILLUSTRATIONS
#9632; #9632; #9632;#9632;quot;#9632;#9632; : #9632;#9632;\:
'V.
LONDON BAILLIÈRE, TINDALL AND COX
8, HENRIETTA STREET, COVENT GARDEN NEW YORK: WILLIAM R. JENKINS
[All rights reserved] I902
-ocr page 6-
-ocr page 7-
PERFACE TO VOLUME II.
The present work was left unfinished at the death of the author, the late Dr. Fleming, who, however, had prepared nearly all the manuscript with the exception of the last chapter or so. In deference to the wish of Dr. Fleming's widow and his publishers, Messrs. Baillière, Tindall and Cox, I undertook to attend to the completion of the work as being in a sense complimentary to that of my late father, and I am responsible for the authorship of the last few pages.
Dr. Fleming's Manual has long held a high position in the not too abundant literature of veterinary science, and it is a matter of regret that he was not spared to put the final touches to the present Text-Book. Those who wish to have details of Dr. Fleming's most industrious life will find them in the Veterinary Journal of 1901.
W. Owen Williams.
The 'Sy.w Veteuinaky College,
EDINTiUHGII,
February, 1902.
I
-ocr page 8-
-ocr page 9-
CONTENTS,
PART I.
CHAPTER I. MANNER OF SEOtTBIXG ANIMALS FOR OPERATION.
General Observations
PAGES
9, 10
Section I.—Manner of securing the Horse :
(a) Standing, (6) Recumbent, (c) Latericumbent, (lt;l) Dursicum-
bent
Section II.—Manner of seccrinlaquo; the Ox for Operation : (a) Standing, (6) Recumbent
Section III.—Mannek of securing the Sheep and Goat for Operation ...
Section IV.—Manner of securing the Pig for Operation-
11—56
56—62
62, 63 63
Section V.—Mannek of securing the Dog and Cat fob Opera-
tion
64
CHAPTER II.
THE EMPLOYMENT OF ANAESTHETICS.
General AnaesthesiaLocal Anesthesia ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;... 65—70
CHAPTER III.
ELEMENTARY OPERATIVE VETERINARY SURGERY.
Section I.—Incisionsnbsp; nbsp; nbsp; nbsp; nbsp; nbsp;..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;... 71—85
Section II—Dissections
Section III.—Punctubks
Section IV.—Prevention and Arrest of H.emorrhage
Section V.—Closure of Wounds
Section VI.—Bandaging and Dressing of Wounds ...
85
86
-92
.. 93-
-112
.. 112-
-125
... 126-
-148
-ocr page 10-
CONTENTS
PART II.
Section
I.
Seotios
II.
Section
III.
Section
IV.
Section
V.
Section
VI.
Section
VII.
Section
VIII.
Seotiov
IX.
Section
X.
Section
XI.
Section
XII.
Section
XIII.
Section
XIV.
Section
XV.
CHAPTEK I. GENERAL OPERATIONS.
PACKS
-Dislocations ANU Fkactures ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;149—175
-Removal oe Tumoursnbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;175—184
—Cauterizationnbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;184—193
-Electro-Puncture or O-alvano-Punctukknbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;193
-Setonsnbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;193—200
-Injections ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;200—204
—Inoculation...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;204. 205
-Operations on Bloodvessels ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;20C—217
-Operations on Musclesnbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;217—228
-Operations on FASoi.t: and Periosteumnbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp;228—230
-Operations on Tendons and Ligamentsnbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;231—241
-Operations on Nervesnbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;241—245
-Amputations...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;246—256
—Extraction ot' Foreign Bodies erom Wounds...nbsp; nbsp; nbsp;257—260
-Trepanation, or Trephining ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;260—256
PAßT III.
SPECIAL OPEEATIONS ON OEGANS AND THEIE APPENDAGES.
OPERATIONS ON THE DIGESTIVEnbsp; APPARATUS AXDnbsp; THE ABDOMEN.
Chapter I. : Operations in the Mouthnbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;267—280
Operations on the Teethnbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;280—296
Operations on the Tonguenbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;296—300
Operations on the Palatenbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;300—302
Operations on the Salivary Glandsnbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;302—311
Operations in the Pharynx ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 311, 312
Operations on the (Ejophagus ....nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;312—328
Chapter II.—Operations on the Stomachnbsp; and Intestines ...nbsp; nbsp; nbsp;329—361
Chapter HI.—Operations on the Abdominal Wallnbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;361—392
Laparotomy, etc. ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;363—367
Operations for Hernia ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;367—392
-ocr page 11-
CONTENTS
OPERATIONS ON THE RESPIRATORY APPARATUS AND THE THORACIC CAVITY.
PA(iKS
Chapter I.: Operations on the Aik-Passages ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;..nbsp; nbsp; nbsp; 393—399
Operations in the Nasal Chambers and Maxillarynbsp; nbsp;and
Frontal Sinuses ... ... ... .nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 399, 400
Operations on the Guttural Pouches ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;101—410
OPERATIONS UPON THE LARYNX AND TRACHEA. Chapter I.—The Larynx ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ... 411—427
Chapter II.—The Trachea ...
Chapter III.—Operations on the Thorax
OPERATIONS ON THE URINARY APPARATUS
Surgical Anatomy ...
Chapter I.—Operations in or on the Bladder Cysto-Paracentesis Lithotomy and Lithotrity Calculi in Bovines Calculi in Canines Tumours
Prolapse and Inversion of the Bladder Vaginal Cystocele Amputation of the Bladder
Chapter II.—Operations on the Urethra Calculi ...
Chapter III.—Operations on the Penis Amputation of the Penis ... Phimosis Paraphimosis
427—437 437—442
443-
-450
450-
-474
454
456
470
470
470
471
471
473,
474
475-
-477
475
477-
-484
477
482
483
OPERATIONS ON THE GENERATIVEnbsp; APPARATUS.
Operations on the Female Generative Organsnbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 485—49C
Chapter I.—Operations on the Ovaries ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 497—51(i
Ovariotomy—Oöphorectomy ; Ovariotomy in thenbsp; Mare—Char-
lier's Method, Colin's Method ; Ovariotomy in thenbsp; Cow;
Laparo-ovariotomy—Mare, Cow ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 497—512
Ovariotomy in the Sow ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 512—514
Ovariotomy in the Bitch ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;514
Ovariotomy in Fowls ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 515, 516
Chapter II.—Operations on the Uterus and Vaginanbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 517—530
Tumours in the Uterus ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;518
Inversion, Eversion, or Prolapse of the Uterusnbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;519
Torsion of the Uterus ... ... ,.,nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;,.,nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;519
-ocr page 12-
CONTENTS
Chapter II. (conliimed):
Laceration and Rupture of the Uterus Hy sterotomy—Metrotomy
Amputation by Inelastic Ligature
Amputation by Elastic Ligature ...
Amputation by Multiple Ligature
Amputation by Clamp ...
Amputation by Esmarch's Method Laparo-Hysterotomy
Laparo-Hysterorraphy or Ventrifixation of the Uterus Tumours and Cysts hi the Vagina ... Prolapse or Inversion of the Vagina Wounds and Rupture of the Vagina
Vaginal Fistula
Recto-Vaginal Fistula ...
Rupture of the Perinseum Occlusion of the Vagina ... Clitoridectomy Chapteb III.—Operations on the Mamm/e Extirpation of the Mammae Injuries to the Teats Stenosis of the Milk-Duct ... Amputation of the Teat Chapter IV.—Operations on the Male Generative Organs Operations on the Prostate Operations on the Scrotum Hydrocele
Varicooele—Sarcocele Emasculation, or Castration
pm:t.s 519 520 521 521 522 522 522 522 525 525 526 528 529 529 529 529 530
530—536 582 534 535 536
537—620 544 545 546 547
548—620
OFEEATIONS ON THE EYE AND ITS APPENDAGES.
Chapter I.—Introductory ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;621
Chapter II.—Operations on the Ocular Globe ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;625
Accidents and Injuries ... ... ... ... ••#9632;nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;625
Operations for Diseased Conditions of the Eye—Paracentesis of
the Cornea ; Iridectomy ; Sclerotomy ... ... ...nbsp; nbsp; 629—633
Operation for Cataract—(1) Discission ; (2) Depression and Re-
clination; (3) Extraction ... ... ... ...nbsp; nbsp; 633—638
Tumours and Growths on or in the Eye ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;638
Extirpation of the Eye ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;639
Artificial Eyes ... ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;641
Chapter III.—Operations on the Appendages op the Eye ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;643
The Eyelids ... ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;643
Congenital or Acquired Deformities of the Eyelids—Colomba ; Ankyloblepharon ; Symblepharon ; Trichiasis ; Entropium ;
Ectropium ... ... ... ... ... ...nbsp; nbsp; 644—651
Chapter IV.—Operations on the Lachrymal Apparatus ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;651
Strabismus .., ... .., ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;654
-ocr page 13-
CONTEXTS
OPERATIONS ON THE AUDITORY APPARATUS.
PACE.S
Wounds and Contusions of the External Ear ; Hiematumata :
Abscess and Fistula : Tumours : Foreign Bodies in the Ear 656—661
OPERATIONS ON THE FOOT.
Anatomy
Influence of the Hoof in Injuries and Diseases of the Foot
Examination of the Foot ...
Instruments for Operations on the Hoof
Operations on the Hoof
Fissure of the Hoof—Sand-crack ; Quarter-crack
Horn Tumour, Keratophyllocele, Keratocele
673-678. 679-
663 666 667 668 670
-678 679
683
Wounds—Pricks and Drawn Nails Quittor ... Seedy-toe Canker ...
Frost-bit^
Gathered Nail; Drawn Nail
683 685 686 687
..
-ocr page 14-
-ocr page 15-
LIST OF ILLUSTRATIONS.
FIG. 1.
2. 3.
4. 5.
6.
7.
Polish Gag
Short Twitch ...
Iron Hinged Twitch
Twitch
Iron Hinged Twitch
Wood Hinged Twitch ...
The Mask
The Cradle, or Necklet: a, Mask ; 6, Beads
Side-Rod
Fore-Leg secured
Tail-Hobble. Mode of attaching the Hind-Leg to the Tail
Second Mode of securing the Hind-Leg by Side-Line
Third Mode of securing the Hind-Limb by Side-Line
Fourth Mode of securing the Hind-Limb by Side-Line
Fifth Mode of securing the Hind-Limb by Side-Line
Method of securing both Hind-Legs
Method of securing Fore and Hind Limbs in the Standing Position
Raabe and Lunel's Hippo-Lasso ...
Post Travis
Casting-Rope applied ...
Rohard's Method of throwing down a Horse
Rohard's Method of securing the Horse when thrown down
Rarey's Method of throwing down a Horse
Russian Method of throwing down a Horse
Improvised Hobble
Ordinary Hobbles, with Spring Hook for Chain
Improved Hobble: a, h, the Two Portions of a Detached or Free
Hobble; c, the Principal Portion of the Chief Hobble; d, the
Terminal Link of the Chain ; e. Spring Hook Modified Spring Hook ... Simple Retention Hook
Stuttgart Method of throwing down a Horse Horse secured by the Stuttgart Method ... Danish Method of casting a Horse Berlin Method of throwing a Horse down... Miles's Method of casting a Horse
I'AOE 12
12 12 12 13 13 14 14 18 16 17 17 18 19 19 20 20 21 23 25 26 26 27 28 30 31
10. 11.
12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27.
28. 29. 30. 31. 32. 33. 34.
31 32 32 32 33 33 34 36
-ocr page 16-
LIST OF ILLUSTRATIONS.
K1G.
35.nbsp; Miles's Method of casting a Horse
36.nbsp; nbsp;Miles's Method of casting a Horse
37.nbsp; Miles's Method of easting a Colt...
38.nbsp; Improved English Hobbles
39.nbsp; nbsp;English Method of throwing down a Horse with Hobbles ...
40.nbsp; nbsp;Horse being thrown down
41.nbsp; nbsp;Cross Hobbles
i2. Flexion of the Hind-Leg in the Latericvunbent Position
43.nbsp; nbsp;Attaching the Fore to the Hind Leg in the Latericumbent Position ...
44.nbsp; nbsp;The Fore attached to the Hind Leg in the Latericumbent Position ...
45.nbsp; nbsp;Head and Crupper Apparatus to prevent Broken Back
46.nbsp; nbsp;Operating Table : Vertical Position
47.nbsp; nbsp;Operating Table : Horizontal Position
48.nbsp; nbsp;Simple Nose-Clamp
49.nbsp; nbsp;Screw Nose-Clamp
50.nbsp; Nose-Clamp, with Keeper
51.nbsp; nbsp;Nose-Clamp, with Spring and Keeper
52.nbsp; Nose-Bing
53.nbsp; Nose-Punch ...
54.nbsp; nbsp;Alsace Nose-ßing and Head-Stall
55.nbsp; nbsp;Alsace Nose-King, Applied
56.nbsp; nbsp;Vigan's Controlling Apparatus f or Oxen ...
57.nbsp; nbsp;Securing Hing-Leg by Means of the Tail ...
58.nbsp; nbsp;Ox Travis
59.nbsp; nbsp;Throwing down an Ox by Means of a Kope
60.nbsp; Rueff's Method of throwing down the Ox ..,
61.nbsp; nbsp;Gag-Speculum for the Pig
62.nbsp; Tape Muzzle for the Dog
63.nbsp; nbsp;Cox's Chloroform-Bag applied ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;••nbsp; nbsp; nbsp; nbsp; . •••
64.nbsp; Gressraquo;ell's Chloroform Nose-cap
65.nbsp; nbsp;Anaesthetic Spray Apparatus
66.nbsp; nbsp;Ordinary Scalpel
67.nbsp; nbsp;Pocket Scalpel with Spring-Back
68.nbsp; nbsp;Double Spring-Back Bistoury, with Sharp and Probe pointed Blades ...
69.nbsp; nbsp;Operating Knife with Spring-Back
70.nbsp; nbsp;Bistoury Cache, with Kegulating Screw, to cut to any Required Depth
71.nbsp; nbsp;Probe-puinted Bistouries
72.nbsp; nbsp;Dra wing-Knife, or Searcher
73.nbsp; nbsp;Dressing Scissors, Open Shanks ...
74.nbsp; nbsp;Dressing Scissors, Close Shanks, Probe-pointed
75.nbsp; nbsp;Dressing Scissors, Curved
76.nbsp; nbsp;Rowelling Bistoury
77.nbsp; nbsp;Ordinary Dissecting Forceps
78.nbsp; nbsp;Fine Curved Forceps ...
79.nbsp; nbsp;Holding Scalpel: First Position...
80.nbsp; nbsp;Holding Scalpel: Second Position
81.nbsp; Holding Scalpel: Second Position
82.nbsp; nbsp;Holding Scalpel: Third Position
PA(;E 38 39 40 41 41 42 43 44 45 45 54 55 55 57 57 57 57 58 58 59 59 59 60 60 61 62 63 64 67 69 70 71 71 72 72 72 72 73 73 73 73 74 74 74 74 75 75 75
-ocr page 17-
LIST OF ILLUSTRATIONS.
KIO.
83.nbsp; nbsp; Holding Scalpel : Fourth Position
84.nbsp; nbsp; nbsp;Holding Scalpel : Fifth Position
85.nbsp; nbsp; nbsp;Holding Scalpel: Sixth Position
86.nbsp; nbsp; Holding Scalpel: Seventh Position
87.nbsp; nbsp; nbsp;Holding Scalpel: Eighth Position
88.nbsp; nbsp; nbsp;Holding the Drawing-Knife : First Position
89.nbsp; nbsp; nbsp;Holding the Drawing-Knife : Second Position
90.nbsp; nbsp; nbsp;An Incision Director ...
91.nbsp; nbsp; nbsp;Manner of directing the Bistoury, or Scalpel, by the Finger
92.nbsp; nbsp; Form of Incisions
93.nbsp; nbsp; Lancet with Regulating Slide ...
94.nbsp; nbsp; nbsp;Abscess Knife
95.nbsp; nbsp; nbsp;Manner of holding the Lancet ...
96.nbsp; nbsp; nbsp;Another Manner of holding the Lancet ...
97.nbsp; nbsp; nbsp;The Fleam ...
98.nbsp; nbsp; Manner of holding the Fleam ...
99.nbsp; nbsp; Trocar for puncturing the Rumen
100.nbsp; nbsp;Trocar for puncturing the Chest
101.nbsp; nbsp;Trocar for puncturing the Intestine
102.nbsp; nbsp;Manner of holding the Trocar ...
103.nbsp; nbsp;Exploring Needle and Abscess Knife
104.nbsp; nbsp;Fine Exploring Needle
105.nbsp; nbsp;Improved Exploring Needle
106.nbsp; nbsp;Exploring Needle and Trocar ...
107.nbsp; nbsp;Subcutaneous Injecting Syringe and Needles
108.nbsp; nbsp;Modified Aspirator
109.nbsp; nbsp;Improved Aspirator ...
110.nbsp; nbsp;Puncture Cautery
111.nbsp; Field's Tourniquet
112.nbsp; nbsp;Artery Forceps
113.nbsp; nbsp;Improved Artery Forceps
114.nbsp; nbsp;Dieffenbach's Artery Forceps, or Clamp , .
115.nbsp; nbsp;Improved Artery Forceps, or Clamp
116.nbsp; nbsp;Tenaculum ...
117.nbsp; nbsp;Aneurism Needle
118.nbsp; nbsp;Ligating an Artery : Simple Knot
119.nbsp; nbsp;Applying a Ligature to an Artery
120.nbsp; Ligature properly tied
121.nbsp; nbsp;Ligature improperly tied
122.nbsp; nbsp;Method of making an Incision over an Artery
123.nbsp; nbsp;Exposing an Artery ...
124.nbsp; nbsp;Passing the Ligature under an Artery ...
125.nbsp; nbsp;Ligating an Artery in its Continuity
126.nbsp; Torsion of an Artery ...
127.nbsp; nbsp;Torsion Forceps
128.nbsp; nbsp;Transfusing Apparatus : a, Le Page's ; h, Aveling
129.nbsp; nbsp;Suture Instrument
130.nbsp;Suture Needles : Small, for Thread
I'AOE
75 76 76 76
77 77 77 81 82 84
87 87 87
89
90
90
90
90
91
91
92
94
100
100
100
100
100
101
102
102
102
102
104
104
106
106
108
108
111
116
117
Ö—2
-ocr page 18-
LIST OF ILLUSTRATIONS.
FIG.
131.nbsp; nbsp;Suture Needles: Large, for Wire
132.nbsp; nbsp;Suture Forceps
133.nbsp; nbsp;Improved Suture Needle with Handle ...
134.nbsp; Folding Tubular Suture Needle
135.nbsp; nbsp;Pin Forceps, or Director
136.nbsp; nbsp;Interrupted Sutures : Tying
137.nbsp; nbsp;Interrupted Sutures : Tied
138.nbsp; Looped Suture
139.nbsp; nbsp;Uninterrupted Suture...
140.nbsp; nbsp;Twisted Suture : Figure-of-Eight Twist...
141.nbsp; nbsp;Twisted Suture : Circular Twist
142.nbsp; nbsp;Single Pin Suture
143.nbsp; nbsp;Quilled Suture
144.nbsp; nbsp;Dossiled Suture
145.nbsp; Zigzag Suture
146.nbsp; nbsp;X Suture ...
147.nbsp; T Suture
148.nbsp; nbsp;Dressing Forceps
149.nbsp; nbsp;Syringe for washing out Wounds
150.nbsp; nbsp;Syringe for injecting Fluid into Wounds and Fistulse
151.nbsp; nbsp;Caustic Holder
152.nbsp; nbsp;Flexible Spray Producer
153.nbsp; nbsp;Square Compress
154.nbsp; nbsp;Long Compress
155.nbsp; nbsp;Triangular Compress ...
156.nbsp; nbsp;Ci'avat Compress
157.nbsp; Maltese Cross Compress
158.nbsp; nbsp;Half Maltese Cross Compress ...
159.nbsp; nbsp;Double-Tailed Compress
160.nbsp; nbsp;Treble-Tailed Compress
161.nbsp; nbsp;Graduated Compress (a, 6)
162.nbsp; nbsp;Perforated Compress ...
163.nbsp; nbsp;Bandage in Single Holl
164.nbsp; nbsp;Bandage in Double Roll
165.nbsp; nbsp;Manner of rolling Bandage
166.nbsp; nbsp;Manner of applying a Spiral Bandage in Half-Twists
167.nbsp; nbsp;Simple Forehead Bandage : Front View...
168.nbsp; nbsp;Simple Forehead Bandage : Side View ...
169.nbsp; nbsp;Compound Forehead Bandage : Front View
170.nbsp; nbsp;Compound Forehead Bandage : Side View
171.nbsp; nbsp;Monocular Bandage : Front View
172.nbsp; nbsp;Monocular Bandage : Side View
173.nbsp; nbsp;Binocular Bandage : Front View
174.nbsp; Binocular Bandage : Side View
175.nbsp; Ear Bandage : Front View ...
176.nbsp; nbsp;Ear Bandage : Side View
177.nbsp; Throat Bandage
178.nbsp;Top of Neck Bandage...
117
117
117
118
118
119
119
120
120
121
121
122
122
123
123
124
124
126
127
127
127
128
129
129
129
129
130
130
130
130
130
130
131
131
131
132
133
133
134
134
134
134
135
135
135
135
135
136
-ocr page 19-
LIST OF ILLUSTRATIONS.
F1C.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;l-AGE
179.nbsp; nbsp;Bandage for Sides and Front of Neck .. ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 136
180.nbsp; nbsp;Bandage for Withers ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 137
181.nbsp; nbsp;Bandage f or Back .. ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;137
182.nbsp; nbsp;Bandage for Croup ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 138
183.nbsp; nbsp;Bandage for Hip ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 138
184.nbsp; nbsp;Bandage for Testicles... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 139
185.nbsp; nbsp;Bandage for Testicles, applied ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 139
186.nbsp; nbsp;Bandage for Perinaeum ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 139
187.nbsp; nbsp;Bandage for Abdomen .. ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 140
188.nbsp; nbsp;Bandage for Chest .. ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 140
189.nbsp; nbsp;Bandage for Breast ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 141
190.nbsp; nbsp;Bandage for Shoulder... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 141
191.nbsp; nbsp;Bandage for Point of Shoulder, applied ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;141
192.nbsp; nbsp;Bandage for Shoulder, applied ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 142
193.nbsp; nbsp;Bandage for Fractured Scapula... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ..nbsp; nbsp; nbsp; 142
194.nbsp; nbsp;Bandage for Elbow ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 143
195.nbsp; nbsp;Bandage for Elbow, applied ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 143
196.nbsp; nbsp;Bandage for Forearm ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 143
197.nbsp; nbsp;Bandage for Knee ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 143
198.nbsp; nbsp;Bandage for Stifle, applied ... .. ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 144
199.nbsp; nbsp;Bandage for Thigh ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 144
200.nbsp; nbsp;Bandage for Thigh, applied ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 144
201.nbsp; nbsp;Bandage for Hock and Shank ... ... ..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 145
202.nbsp; nbsp;Bandage for Hock and Shank, applied ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 145
203.nbsp; nbsp;Bandages f or Dog : a. Ears ; ^, Mammse ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 146
204.nbsp; nbsp;Horse in Slings ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; . .nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;..nbsp; nbsp; nbsp;152
205.nbsp; nbsp;Apparatus for Fracture of the Nasal Bones ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 164
206.nbsp; Apparatus for Fracture of the Nasal Bones, appliednbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 164
207.nbsp; nbsp;Apparatus for Fracture of the Lower Jaw ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 167
208.nbsp; Apparatus for Fracture of the Lower Jaw, appliednbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 167
209.nbsp; nbsp;Apparatus for Fracture of the Lower Jaw, appliednbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 168
210.nbsp; nbsp;Splint for Fractured Horns ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 169
211.nbsp; nbsp;Splint for Fractured Horns, applied ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 169
212.nbsp; nbsp;Apparatus for Fractured Scapula ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 170
213.nbsp; nbsp;Apparatus for Fractured Scapula, applied ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; 170
214.nbsp; nbsp;Iron Splint for Fracture of Bones of the Fore-Limbnbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 170
215.nbsp; nbsp;Iron Splint for Fracture of Bones of the Fore-Limb, appliednbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 170
216.nbsp; nbsp;Iron Splint for Fracture of the Lower Bones of the Limb ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 171
217.nbsp; nbsp;Iron Splint for Fracture of the Lower Bones of the Limb, applied ...nbsp; nbsp; 171
218.nbsp; nbsp;Adjusting Splint for Luxations and Fractures of the Limb...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 172
219.nbsp; nbsp;Apparatus for Luxated or Deformed Fetlock ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 173
220.nbsp; nbsp;Movable Iron Splint ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 173
221.nbsp; nbsp;Iron Splint bandaged on the Limb ... ... ..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 174
222.nbsp; nbsp;Iron Splint for the Hind-Limb.,. ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 174
223.nbsp; Chain Écraseur ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 176
224.nbsp; Wire Ecraseur ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;..nbsp; nbsp; nbsp;177
225.nbsp; Ecraseur for Chain and Wire ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; 177
226.nbsp; nbsp;Manner of performing Quadrisectional Ligation ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 179
-ocr page 20-
LIST OF ILLUSTRATIONS.
FIG.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;1'AGE
227.nbsp; nbsp;Ligatures separated in Quadrisectional Ligation ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 180
228.nbsp; nbsp;Ligatures tied in Quadriseotional Ligation ..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 180
229.nbsp; nbsp;Ligating Male and Female Needles for Quadriseotional Ligation ...nbsp; nbsp; 180
230.nbsp; nbsp;Manner of passing the Needles... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 180
231.nbsp; nbsp;Manner of withdrawing the Male Needle ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 180
232.nbsp; nbsp;Manner of forming the Double Loop ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 180
233.nbsp; nbsp;Manner of withdrawing the Female Needlenbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ..nbsp; nbsp; nbsp;181
234.nbsp; nbsp;Needles for Multiple Subcutaneous Ligation ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 181
235.nbsp; nbsp;Manner of passing the Subcutaneous Multiple Ligationnbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 182
236.nbsp; nbsp;Manner of passing the Subcutaneous Multiple Ligationnbsp; nbsp; nbsp; nbsp;..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 182
237.nbsp; nbsp;Manner of passing the Subcutaneous Multiple Ligationnbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 182
238.nbsp; nbsp;Manner of passing the Subcutaneous Multiple Ligationnbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 182
239.nbsp; nbsp;Manner of passing the Subcutaneous Multiple Ligationnbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 182
240.nbsp; nbsp;Manner of passing the Subcutaneous Multiple Ligationnbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 182
241.nbsp; nbsp;Manner of passing the Subcutaneous Multiple Ligationnbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 182
242.nbsp; nbsp;Cautery ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 185
243.nbsp; nbsp;Cautery ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 185
244.nbsp; nbsp;Cautery ... ... ... ... ..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 185
245.nbsp; nbsp;Cautery ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 185
246.nbsp; nbsp;Cautery ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 185
247.nbsp; nbsp;Cauterisation Designs.. ... ... ..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 186
248.nbsp; nbsp;Cauterisation Designs... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 186
249.nbsp; nbsp;Lines in a Circle ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ..nbsp; nbsp; nbsp;186
250.nbsp; nbsp;Lines in Two Directions ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;..nbsp; nbsp; 186
251.nbsp; nbsp;Radiating Lines ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 186
252.nbsp; nbsp;Lyre-shaped Design ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 186
253.nbsp; nbsp;The Various Arrangements of Cautery Lines ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 187
254.nbsp; nbsp;Manner of tracing the (Cauterisation) Lines within Circles...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 188
255.nbsp; nbsp;Manner of tracing the (Cauterisation) Lines within Circles...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 188
256.nbsp; nbsp;Manner of tracing the (Cauterisation) Lines within Circles...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 188
257.nbsp; nbsp;Manner of tracing the (Cauterisation) Lines within Circles...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 188
258.nbsp; nbsp;Cauterisation in Points ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 189
259.nbsp; Seton Needle in Handle ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 194
260.nbsp; nbsp;Seton Needle curved laterally ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 194
261.nbsp; nbsp;Manner of tying the End of a Seton ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 195
262.nbsp; nbsp;Trocar for Intra-venous Injection ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 201
263.nbsp; nbsp;Nasal Irrigator ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 203
264.nbsp; nbsp;Anatomy of the Coccygeal Region ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;218
265.nbsp; nbsp;Tail Incisions ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 220
266.nbsp; nbsp;Tail Incisions ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 220
267.nbsp; nbsp;Tail Incisions ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 220
268.nbsp; nbsp;Tail Incisions ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 220
269.nbsp; nbsp;Tail Incisions ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 220
270.nbsp; nbsp;Bartlet's Tail Apparatus ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 223
271.nbsp; nbsp;Bartlet's Tail Apparatus, applied ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;224
272.nbsp; nbsp;Tail Support applied ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 225
273.nbsp; Tail Support... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 225
274.nbsp; nbsp;Anatomy of the Long Vastus and Fascia Lata ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ..nbsp; nbsp; nbsp;227
-ocr page 21-
LIST OF ILLUSTRATIONS.
FIG.
275.nbsp; Periosteotomy Knife ...
276.nbsp; nbsp;Sharp-pointed Tenotom
277.nbsp; nbsp;Blunt-pointed Tenotom
278.nbsp; nbsp;Inside of the Hock, with Cunean Tendon exposed
279.nbsp; The Cunean Tendon raised for Division ...
280.nbsp; nbsp;Vessels and Nerves of the Horse's Fore-Limb : External Aspect
281.nbsp; Vessels and Nerves of the Horse's Fore-Limb : Internal Aspect
282.nbsp; nbsp;Ordinary Amputating Saw
283.nbsp; nbsp;Improved Amputating Saw
284.nbsp; nbsp;Circular Amputation ..
285.nbsp; nbsp;Flap Amputation
286.nbsp; nbsp;Oval or Oblique Amputation
287.nbsp; nbsp;Ordinary Docking Machine
288.nbsp; nbsp;Improved Docking Machine
289.nbsp; nbsp;Removing the Horns of the Calf ; First Stage
290.nbsp; nbsp;Removing the Horns of the Calf : Second Stage
291.nbsp; nbsp;Bullet Forceps, with Shifting Blades
292.nbsp; nbsp;Curette Bullet Extractor
293.nbsp; nbsp;Ordinary Trephine
294.nbsp; nbsp;Brace and Bit Trephine, or Trepan
295.nbsp; nbsp;Points for opening the Sinuses in the Horse's Face
296.nbsp; nbsp;Ordinary Unilateral Mouth Speculum or Gag
297.nbsp; nbsp;Ordinary Circular Mouth Speculum or Gag
298.nbsp; nbsp;Varnell's Unilateral Mouth Speculum
299.nbsp; nbsp;Fearnley's Bilateral Mouth Speculum 800.nbsp; Rigot's Bilateral Mouth Speculum
301.nbsp; nbsp;Dominick's Mouth Speculum
302.nbsp; nbsp;Bayer's Wedge Mouth Speculum
303.nbsp; nbsp;Leoellier's Mouth Speculum
304.nbsp; nbsp;Brogniez's Self-retaining Mouth Speculum
305.nbsp; nbsp;Maokel's Self-retaining Mouth Speculum
306.nbsp; nbsp;Rogers' Self-retaining Mouth Gag
307.nbsp; nbsp;Boswell's Self-retaining Ratchet Mouth Gag
308.nbsp; nbsp;Haussmann's Self-retaining Mouth Gag ...
309.nbsp; nbsp;Wolf's Mouth Dilator for Dogs...
310.nbsp; nbsp;Wolf's Mouth Dilator, Improved
311.nbsp; nbsp;Reynal's Tongue Depressor and Oral Illuminator
312.nbsp; nbsp;Bayer's Electric Lamp for the Illumination of the Mouth and Nasal
Cavities (full size) ...
313.nbsp; nbsp;Raymond's Electric Illuminator
314.nbsp; nbsp;Small Electric Lamp for Illuminating Purposes
315.nbsp; nbsp;Tooth Chisel...
316.nbsp; nbsp;Incisor-Tooth Forceps...
317.nbsp; nbsp;Incisor-Tooth Forceps...
318.nbsp; nbsp;Forceps for Splintered or Broken Teeth ...
319.nbsp; nbsp;Tooth Rasp ...
320.nbsp; nbsp;Chisel for the Molar Teeth
321.nbsp; nbsp;The Odontritor of Brogniez
PAGE
230 231 231 238 238 242 242 245 245 247 247 248 253 253 256 256 259 259 261 262 263 268 268 269 269 269 269 270 271 271 272 273 274 274 276 276 277
278 279 280 281 281 281 281 284 284 284
-ocr page 22-
LIST OF ILLUSTRATIONS.
PIG.
322. 323. 324. 325. 326. 327. 328. 329. 330. 331. 332. 333. 334. 335. 336. 337. 338. 339. 340. 341. 342.
343. 344. 345. 346. 347. 348. 349. 350. 351. 352.
353. 354.
PAGE
Gowing'a Guarded Tooth Chise ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 284
Screw Tooth Chisel ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 285
Tooth Saw ... ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 285
Arnold's Tooth Shears ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 285
Kobertson's Tooth Shears ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 286
Thompson's Tooth Shears ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 286
Edgar's Tooth Excisor ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 286
Crawford's Tooth Shears ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 287
Tooth Eorceps for removing Deciduous Molars or Old Stumpsnbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 288
Lecellier's Forceps for removing Temporary Molars ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 288
Position of the Molar Teeth in the Jaws... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 289
Trephining the Sinuses ... ... ... ..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 290
Molar Tooth Key ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 292
Bouley's Molar Forceps ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 292
Frick and Hauptner's Molar Forceps ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 293
Gowing's Molar Forceps, with Screw Lever Handle ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 293
Robertson's Molar Forceps ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 294
Santy's Molar Forceps, with Fulcrum ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 294
Forceps for extracting Dog's Teeth ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 296
Tongue Suspender ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 298
Situation and Relations of the Parotid Duct on the Cheek and behind
the Lower Jaw ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; .nbsp; nbsp; 306
Anatomy of the Parotideal Region ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 309
Horse Probang ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 315
Mouth Gag for Ox (Ordinary Pattern) ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 317
Mouth Gag for Ox (Armatage's Pattern) ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 317
Monro's Cattle Probang ... ... ... .,nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ..nbsp; nbsp; 317
Cattle Probang fitted with Corkscrew ... .. ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 317
Baujin's Cattle Probang ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;..nbsp; nbsp; nbsp; 318
English Oisophageal Forceps ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 319
Calf Probang ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 320
The Cervical Portion of the CEsophagus, and some of its Relations in
the Neck ... ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 322
The Usual Situation for (Esophagotomy ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 323
Trocar and Cannula for Tympanites in Cattle ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 330
Transverse Section of Ox's Body between the Last Rib and Anterior
Spinous Process of the Ilium ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 331
Trocar and Cannula for Rumenotomy in Sheep ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 332
Bräuer's Gastrotome ... .. ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ..333
Straight Trocar and Cannula for Puncture of the Intestine...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 339
Curved Trocar and Cannula for Puncture of the Intestine ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 339
Improved Trocar and Cannula for Enterocentesis ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 339
Transverse Section of Horse between the Last Rib and Anterior
Spinous Process of Ilium ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 341
Lembert's Suture ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 345
Apposition of Peritoneal Surfaces of Margin of Wound by Lembert's
Suture ... ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;346
Joubert's Suture ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 347
356. 357. 358. 359. 360. 361.
362.
364.
-ocr page 23-
LIST OF ILLUSTRATIONS.
FIG.
365.nbsp; nbsp;Commencement of Gely's Suture
366.nbsp; nbsp;Gely's Suture completed
367.nbsp; nbsp;Wölfler's Suture
368.nbsp; nbsp;Czerny's Suture
369.nbsp; nbsp;Mode of making an Intestinal Graft
370.nbsp; nbsp;Chaput's Intestinal Sutures
371.nbsp; nbsp;Rogers'Suture
372.nbsp; nbsp;Rogers' Suture
373.nbsp; nbsp;Murphy's Enterotomy Button ...
374.nbsp; nbsp;Double Ligation of Prolapsed Invaginated Rectum
375.nbsp; nbsp;Straight Bistoury Cache
376.nbsp; nbsp;Curved Bistoury Cache
377.nbsp; nbsp;Rectal or Vaginal Dilatornbsp; nbsp; nbsp; nbsp; nbsp; ..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...
378.nbsp; Simple Aspirator
379.nbsp; nbsp;Aspirator with Escape-tube in Receiver ...
380.nbsp; nbsp;Situation and Direction of Flank Incision in Laparotomy in the Horse
381.nbsp; nbsp;Flank Wound in Laparotomy ...
382.nbsp; nbsp;Combe's Perforated Clamp for Umbilical Hernia ...
383.nbsp; nbsp;Bordonnat's Dentated Clamp ...
384.nbsp; Pritchard's Steel Clamp for Umbilical Hernia
385.nbsp; nbsp;Metherell's Steel Clamp for Umbilical Hernia
386.nbsp; nbsp;Inguinal Hernia
387.nbsp; nbsp;Strangulated Inguinal Hernia : Horse ...
388.nbsp; nbsp;Interstitial Inguinal Hernia on the Right Side
389.nbsp; nbsp;Anatomy of the Inguinal Ring and Tunica Vaginalis of the Horse ...
390.nbsp; nbsp;Russell's Inguinal Hernia Clamp
391.nbsp; nbsp;Operator's Protective Mask for Nasal Inspection of the Horse
392.nbsp; nbsp;Nasal Dilator
393.nbsp; nbsp;Nasal Dilator, applied...
394.nbsp; nbsp;Nasal Reflector
395.nbsp; nbsp;Nasal Reflector with a Rivet Hole at the Periphery for the Protective
Disc
396.nbsp; nbsp;Nasal Reflector with its Protective Disc
397.nbsp; nbsp;General View of the Panelectric Rhinoscope and Laryngoscope
398.nbsp; nbsp;Polansky and Schindelka's Rhinoscope
399.nbsp; nbsp;Panelectroscope
400.nbsp; nbsp;Trephining the Nasal Bone
401.nbsp; nbsp;Surgical Anatomy of the Guttural Sac
402.nbsp; nbsp;Surgical Anatomy of the Guttural Sac
403.nbsp; nbsp;Surgical Anatomy of the Guttural Sac
404.nbsp; nbsp;Gunther's Guttural Pouch Catheter
PAGE
347 347 348 348 348 351 352 352 353 358 359 359 360 362 362 365 366 370 371 371 371 377 378 379 381 382 393 394 394 395
395 395 396
397 398 400 401 402 403 404
405 407 409 412 413 413
405.nbsp; nbsp;Longitudinal and Vertical Section of a
Horse's Head, showing the
Manner in which Gunther's Catheter is passed ...
406.nbsp; nbsp;Hyovertebrotome
407.nbsp; nbsp;Operation of Hyovertebrotomy ..
408.nbsp; nbsp;Tampon Cannula
409.nbsp; nbsp;Laryngeal Electric Lamp
410.nbsp; nbsp;Farabceuf's Broad Retractor
-ocr page 24-
LIST OF ILLUSTRATIONS.
KIG.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; PACE
411.nbsp; nbsp;Long Laryngeal Scissors ... ... ... ... ...nbsp; nbsp; 416
412.nbsp; nbsp;Vachetta's Spring Dilator ... ... ... ... ...nbsp; nbsp; 416
413.nbsp; nbsp;Long Laryngeal Knife ... ... ... ... ...nbsp; nbsp; 416
414.nbsp; nbsp;Curved Laryngeal Knife ... ... ... ... ...nbsp; nbsp; 416
415.nbsp; nbsp;Vulsellum Forceps ... ... ... ... ... ...nbsp; nbsp; 417
416.nbsp; nbsp;Laryngeal Suture Needle ... ... ... ..nbsp; nbsp; nbsp;417
417.nbsp; nbsp;Laryngeal Hook ... ... ... ... ... ...nbsp; nbsp; 417
418.nbsp; nbsp;The Larynx and Trachea opened for the Operation of Arytaenoidectomynbsp; nbsp; 418
419.nbsp; nbsp;Incision through the Mucous Membrane of the Immovable Arytaenoid
Cartilage... ... ... ... ... ... ...nbsp; nbsp; 419
420.nbsp; nbsp;Separating the Vocal Cord from the Arytienoid Cartilage ... ...nbsp; nbsp; 420
421.nbsp; nbsp;Dissection of the Arytasnoid Cartilage at its Lower Border and
Posterior Surface ... ... ... ... ... ...nbsp; nbsp; 420
422.nbsp; nbsp;Division of the Arytaenoid Cartilage at its Articular Angle... ...nbsp; nbsp; 421
423.nbsp; nbsp;Excision of the Arytaenoid Cartilage by means of the Curved Scissorsnbsp; nbsp; nbsp; 422
424.nbsp; nbsp;Manner of suturing the Laryngeal Mucous Membrane ... ...nbsp; nbsp; 423
425.nbsp; nbsp;The Mucous Membrane sutured over Wound ... ... ...nbsp; nbsp; 424
426.nbsp; nbsp;Bayer's Laryngeal Irrigator ... ... ... ... ...nbsp; nbsp; 426
427.nbsp; nbsp;Anatomy of the Tracheal Kegion ... ... ... ...nbsp; nbsp; 428
428.nbsp; nbsp;Spooner's Tracheotome ... ... ... ... ...nbsp; nbsp; 429
429.nbsp; nbsp;Simple Provisional Tracheotomy-Tube ... ... ... ...nbsp; nbsp; 430
430.nbsp; nbsp;Renault's Tracheotomy-Tube ... ... ... ... ...nbsp; nbsp; 430
431.nbsp; nbsp;Field's self-retaining Tracheotomy-Tube .., ... ... ...nbsp; nbsp; 430
432.nbsp; nbsp;Arnold's self-retaining Tracheotomy-Tube, with Gauze CaiJ ...nbsp; nbsp; 430
433.nbsp; nbsp;Arnold's 'Reliance' Tracheotomy-Tube disjoined ... ...nbsp; nbsp; 431
434.nbsp; nbsp;Arnold's 'Reliance ' Tracheotomy-Tube put together and secured ...nbsp; nbsp; 431
435.nbsp; nbsp;Arnold's Improved Nelson's Tracheotomy-Tube, Front View ...nbsp; nbsp; 431
436.nbsp; nbsp;Arnold's Improved Nelson's Tracheotomy-Tube, Back View ...nbsp; nbsp; 431
437.nbsp; nbsp;Arnold's Improved Nelson's Tracheotomy-Tube—Pieces separated for
cleaning ... ... ... ... ... ... ...nbsp; nbsp; 432
438.nbsp; nbsp;Operation of Tracheotomy ... ... ... ... ...nbsp; nbsp; 433
439.nbsp; nbsp;Gowing's Inter-Annular Tracheotomy Trocar and Cannula... ...nbsp; nbsp; 435
440.nbsp; nbsp;Poulton's Intra-tracheal Syringe, with its Trocar and Cannula ...nbsp; nbsp; 436
441.nbsp; nbsp;Trocar and Cannula for the Operation of Thoracocentesis ... ...nbsp; nbsp; 438
442.nbsp; nbsp;Billrotb's Paracentesis Trocar and Cannula .. ... ...nbsp; nbsp; 440
443.nbsp; nbsp;Reul's Trocar and Cannula for Thoracocentesis and Thoracic Medi-
cation ... .. ... ... ... ... ...nbsp; nbsp; 441
444.nbsp; nbsp;Semi-Diagrammatic General View of the Genito-TJrinary Organs of
the Horse: Male ... ... ... ... ... ...nbsp; nbsp; 444
445.nbsp; nbsp;Free Portion of the Horse's Penis ... ... ... ...nbsp; nbsp; 446
446.nbsp; nbsp;Section of Free Portion of Horse's Penis... ... ... ...nbsp; nbsp; 446
447.nbsp; nbsp;Genito-Urinary Organs of the Bull: Semi-Diagrammatic ... ...nbsp; nbsp; 448
448.nbsp; nbsp;Section of the Vulva, Vagina, and Bladder and Urethra of the Cownbsp; nbsp; 449
449.nbsp; nbsp;Penis of the Dog, seen from the Right Side and Below ... ...nbsp; nbsp; 450
450.nbsp; nbsp;Vesical Catheter : Horse ... ... ... ... ...nbsp; nbsp; 452
451.nbsp; nbsp;Vesical Catheter: Horse. Double Channel for washing out the
Bladder ... ... ... ... ... ... ...nbsp; nbsp; 452
452.nbsp; nbsp;Spiral Gum-Elastic Vesical Catheter: Mare ... ... ...nbsp; nbsp; 452
-ocr page 25-
LIST OF ILLUSTRATIONS.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;xxiü
t'Ki-nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; PAUS
453.nbsp; nbsp;Metallic Vesical Catheter : Mare ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 452
454.nbsp; Vesical Catheter : Mare. Double Channel ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 452
455.nbsp; nbsp;Vesical Catheter: Dog. Elastic Gum Web ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 452
456.nbsp; Lithotomy Knife : Sharp Point ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 461
457.nbsp; nbsp;Lithotomy Knife : Blunt Point... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 461
458.nbsp; nbsp;Lithotomy StafiE: Grooved ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 461
459.nbsp; nbsp;Screw Three-bladed Dilator ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 461
460.nbsp; nbsp;Lithotomy Probing Sound ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 461
461.nbsp; nbsp;Lithotomy Scoop ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 461
462.nbsp; nbsp;Lithotomy Forceps for Hard Calculi ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 461
463.nbsp; nbsp;Lithotomy Forceps for Soft Calculi ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 462
464.nbsp; nbsp;Perinaeal Suture Needle ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 462
465.nbsp; nbsp;Lithotomy Drainage-Tube ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 462
466.nbsp; nbsp;Lithotrite: Screw Action ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ..nbsp; nbsp; nbsp;462
467.nbsp; nbsp;Arnold's Lithotrite ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 462
468.nbsp; nbsp;Guillen's Lithotrite .. ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 464
469.nbsp; nbsp;Bouley's Lithotrite ... .. ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 464
470.nbsp; nbsp;Lithotrity : Manipulating the Calculus into the Jaws of the Lithotritenbsp; nbsp; 468
471.nbsp; nbsp;Remains of Horse's Penis after Amputation ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 479
472.nbsp; nbsp;Amputation of the Horse's Penis by Elastic Ligature ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 481
473.nbsp; nbsp;Generative Organs of the Mare, ilaquo; site ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 486
474.nbsp; nbsp;Arrangement of Arteries on the Anterior Portion of the Vagina,nbsp; etc.nbsp; nbsp; nbsp; 487
475.nbsp; nbsp;Transverse Section of the Body of the Mare in Front of thenbsp; First
Lumbar Vertebra ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 488
476.nbsp; Transverse Section of the Cow immediately in Front of thenbsp; Last
Lumbar Vertebra... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 489
477.nbsp; nbsp;Antero-Posterior Section of the Body of a very Young Sownbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 490
478.nbsp; nbsp;Generative Organs of the Bitch ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 490
479.nbsp; nbsp;Attachment of the Ovary to the Broad Ligament in the Marenbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 491
480.nbsp; nbsp;Ovary of the Cow ... ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 492
481.nbsp; Attachment of the Ovary to the Broad Ligament in the Cownbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; 493
482.nbsp; nbsp;Lateral View of the Abdominal Viscera of a Fowl Three and a Half
Months old ... ... ... ... ..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 494
483.nbsp; nbsp;Section of Cow's Udder ., ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 495
484.nbsp; nbsp;Charlier's Vaginal Dilator employed in.Ovariotomy : closednbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 499
485.nbsp; nbsp;Charlier's Vaginal Dilator employed in Ovariotomy : open...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 499
486.nbsp; nbsp;Charlier's Modified Vaginal Dilator and Hand-Rest ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 499
487.nbsp; nbsp;Charlier's Ovariotomy Knife, with the Blade projecting ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 500
488.nbsp; nbsp;Charlier's Ovariotomy Knife, with One Side of the Handle moved offnbsp; nbsp; nbsp;500
489.nbsp; nbsp;Ovariotomy Knife, with sliding Blade ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 500
490.nbsp; nbsp;Ovariotomy Knife, with sliding Guard ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 500
491.nbsp; nbsp;Ovariotomy Knife, with sliding Guard ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 500
492.nbsp; nbsp;Jaws of Charlier's Ovariotomy Forceps ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; 500
493.nbsp; nbsp;Charlier's Thimble for Ovariotomy ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 500
494.nbsp; nbsp;Incision of the Upper Wall of the Vagina, showing the Position of the
Right Hand on Charlier's Dilator ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; 502
495.nbsp; nbsp;Incision of the Upper Wall of the Vagina, the Right Hand resting on
Charlier's Modified Dilator... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; ,r)03
-ocr page 26-
LIST OF ILLUSTRATIONS.
FIG.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; PAGE
496.nbsp; nbsp;Torsion of the Ovariau Ligament and Bloodvesselsnbsp; nbsp;in Charlier's
Method of performing Ovariotomy ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;503
497.nbsp; nbsp;Colin's Torsion Forceps ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;504
498.nbsp; nbsp;Colin's Limiting Forceps ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;504
499.nbsp; nbsp;Vertical Antero-Posterior Section of the Abdominal and Pelvic Cavities
slightly to the Right of the Middle Line, showing the Internal
Generative Organs of the Mare and Removal of the Left Ovary ...nbsp; nbsp; nbsp;50(5
500.nbsp; nbsp;Viborg's Knife for Ovariotomy in the Sow ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;512
501.nbsp; nbsp;Helper's Ovariotomy Knife ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;512
502.nbsp; nbsp;Instruments for castrating Poultry ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;515
503.nbsp; nbsp;Reflecting Vaginal Speculum ... .. ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;517
504.nbsp; nbsp;Polansky's Vaginal Speculum and Dilator ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp;518
505.nbsp; nbsp;Suspensory Apparatus for the Cow's Udder ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;531
506.nbsp; nbsp;Milking Catheter or Tube, with Rings, etc. ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;531
507.nbsp; nbsp;Milking-Tube, with a Shield ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp;531
508.nbsp; nbsp;Milking-Syphon ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;531
509.nbsp; nbsp;Morier's Teat Perforator ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;535
510.nbsp; nbsp;Kühn's Teat Forceps ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;..nbsp; nbsp; nbsp;536
511.nbsp; nbsp;The Testes and Spermatic Cords ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;538
512.nbsp; nbsp;Veitico-Trausverse Section of the Generative Organs ofnbsp;a Horse ...nbsp; nbsp; nbsp;539
513.nbsp; nbsp;Right Testis exposed by cutting through the Scrotum, etc.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp;540
514.nbsp; nbsp;Left Testis enclosed in the Tunica Vaginalis Communisnbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;541
515.nbsp; nbsp;Right Testis of the Horse ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;..nbsp; nbsp; nbsp; 542
516.nbsp; nbsp;Genital Organs of a Male Fowl... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;544
517.nbsp; nbsp;India-rubber Testicle-Suspender for the Horse ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;546
518.nbsp; nbsp;Castrating Knife ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;553
519.nbsp; nbsp;Ordinary Clamp ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp;553
520.nbsp; nbsp;Clamp with India-rubber Rings ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;553
521.nbsp; nbsp;Clamp with Accessory Screw Clamp to close it ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;554
£22. Wilkinson's Castration Clamp ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;.nbsp; nbsp; nbsp; nbsp;554
523.nbsp; nbsp;Ecraseur (Miles'Pattern) ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;554
524.nbsp; nbsp;Ecraseur (Robertson's Pattern)... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;555
525.nbsp; nbsp;Ecraseur (Dewar's Pattern) ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;555
526.nbsp; nbsp;Reliance Castrator ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp;555
527.nbsp; nbsp;Eeliance Castrator ... . . ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;556
528.nbsp; nbsp;The Huish-Blake Castrator ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ..nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;..nbsp; nbsp; nbsp;556
529.nbsp; nbsp;First Position of Operator in the Standing Operationnbsp; nbsp; nbsp; nbsp; nbsp; nbsp; .nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;557
530.nbsp; nbsp;Second Position of Operator ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;558
531.nbsp; nbsp;Spreader ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp;559
532.nbsp; nbsp;Manner of seizing the Testicles previous to opening the Scrotum ...nbsp; nbsp; nbsp;561
533.nbsp; nbsp;Left Hand grasping the Testes and making the Scrotum on their
Surface Tense before incising it ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;562
534.nbsp; nbsp;Castration by the Covered and Uncovered Operationsnbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ...nbsp; nbsp; nbsp;565
535.nbsp; nbsp;Curved Clamp ... ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;566
536.nbsp; nbsp;Clamp Forceps ... ... .. ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;566
537.nbsp; nbsp;Robertson's Torsion Forceps ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;568
538.nbsp; nbsp;Williams's Torsion Forceps ... .... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;568
539.nbsp; nbsp;Bayer's Torsion Forceps ... ... ...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;...nbsp; nbsp; nbsp;568
-ocr page 27-
LIST OF ILLUSTRATIONS.
FIG.
540. 541. 542. 543.
544. 545. 546. 547. 548. 549. 550. 551. 552. 553.
Torsion by Eenault and Delafond's Forceps
Tögl's Fixed Torsion Forceps ...
Tögl's Movable Torsion Forceps
Grasping the Testis preparatory to applying the Torsion Forceps on
the Spermatic Cord The Torsion Forceps applied to the Spermatic Bloodvessels Clamp for Castration by the Actual Cautery Double Clamp for Castration by the Actual Cautery The Ordinary Castration Clamp The Ordinary Clamp in the Covered Operation Applying the Clamp in the Uncovered Operation ... The Clamp applied in the Uncovered Operation ... Ligature-carrier
Testis of a Cryptorchid Horse with a Serous Cyst attached to it Semi-diagrammatic Figure of the Upper Surface of the Prepubic
Kegion, showing the Position of the Testes in Abdominal
Cryptorchidism Unilateral Abdominal Cryptorchidism Incomplete Abdominal Cryptorchidism ... Vertical and Transverse Section of the Posterior Abdominal Region,
showing a Portion of the Sublumbar, Iliac, and Prepubic Regions
of a Horse, with the Testes in the Scrotum Inguinal Canal seen from the Flank, the Ring being divided Prepubic and Inguinal Regions seen from Below, and showing on
each Side of the Middle Line the Inguinal Ring and Entrance to
the Inguinal Interspaces or Canals Ligature Needle for closing Wound in Inguinal Ring Position of Horse in Operation for Cryptorchidism, showing Situation
of Incision in the Skin over the Inguinal Ring Cryptorchid Castration Transverse Vertical Section of the Internal Posterior Abdominal
Region, showing the Origin and Arrangement of the Internal
Oblique and Cremaster Muscles First Stage in Bistournage of the Bull: Drawing down the Testes ... Second Stage : Displacement of the Testes Second Stage : Position of Left Hand Second Stage : Position of Both Hands ... Second Stage : Displacing the Testis Second Stage : the Testis being turned upside down Second Stage completed : Position of the Hands and Testis Third Stage—Torsion of the Spermatic Cord : Position of the Hands Termination of the Operation : the Scrotum ligated, and the Testes
pushed up towards the Inguinal Rings Form of Ligature for the Castration of Lambs Torsion Forceps for the Castration of Lambs Torsion Forceps for Lambs (Australian Pattern) ... Castrating Scissors for Lambs ... Cocaine Bottle and Drop Implement with India-rubber Cap
FACE
569 569 569
570 571 572 572 573 574 574 575 581 584
554. 555. 556.
585 586 586
557. 658.
587 592
559. 560.
561.
562.
593 595
597
563. 564. 565. 566. 567. 568. 569. 570. 571.
572. 573. 574. 575. 576.
609 609 610 610 611 611 611 611
612 613 613 614 614 621
-ocr page 28-
LIST OF ILLUSTRATIONS.
FIG.
577.nbsp; nbsp;Cocaine Sprayer
578.nbsp; Brogniez's Eye-Protector for the Horse
579.nbsp; Eye-Protector
580.nbsp; nbsp;Brusasco's Eye-Protector for the Dog
581.nbsp; Brusasco's Eye-Protector applied
582.nbsp; nbsp;Ophthalmoscope with Lenses ...
583.nbsp; nbsp;Liebrich's Ophthalmoscope
584.nbsp; Manner of using the Ophthalmoscope
585.nbsp; nbsp;Desmarre's Eyelid Retractor
586.nbsp; nbsp;Spring Retractors for Large Animals
587.nbsp; Spring Retractor for the Dog ...
588.nbsp; nbsp;Cataract Needle
589.nbsp; nbsp;Graefe's Cataract Knife
590.nbsp; Iris Forceps ...
591.nbsp; Waldon's Fixation Forceps
592.nbsp; Iridectomy in the Horse
593.nbsp; nbsp;Operation of Discission for Cataract
594.nbsp; nbsp;Operation for Cataract by Depression and Reclination in the
595.nbsp; nbsp;Cystotome
596.nbsp; nbsp;Curette
597.nbsp; Beer's Cataract Knife...
598.nbsp; nbsp;Extraction of Hard Cataract by Flap Operation in the Dog
599.nbsp; nbsp;Artificial Eye for Horses. Full Size ; Front View
600.nbsp; nbsp;Artificial Eye for Horses. Lateral View, to show Convexity
601.nbsp; Director
602.nbsp; nbsp;Entropium Forceps
603.nbsp; nbsp;Berlin's Entropium Operation ...
604.nbsp; nbsp;Schleich's Operation for Entropium
605.nbsp; nbsp;Frühner's Operation for Entropium
606.nbsp; Ectropium of the Lower Eyelid of a Horse, due to Tumour of the
Conjunctiva
607.nbsp; nbsp;Dieffenbach's Operation for Ectropium
608.nbsp; Wharton Jones's Operation for Ectropium : Incisions around Cicatrix
609.nbsp; The same Operation : the Incisions sutured
610.nbsp; Manner of passing the Sound into the Lachrymal Sac and Duct
611.nbsp; nbsp;The Lachrymal Canal, showing its Course from the Eye to its Inferior
Opening in the Nostril
612.nbsp; nbsp;Strabismus Scissors
613.nbsp; Otoscopes in Three Sizes
614.nbsp; nbsp;Stewart's Bivalve Otoscope
615.nbsp; nbsp;Kramer's Bivalve Otoscope
616.nbsp; nbsp;Angular Toothed Forceps for Dog's Ear
617.nbsp; Angular Blunt Forceps for Dog's Ear
618.nbsp; nbsp;Aural Scoop ...
619.nbsp; Aural and Nasal Snare (Blake's Model)
620.nbsp; nbsp;Aural Insufflator
621.nbsp; nbsp;Aural Insufflator with India-rubber Tubing and Ball
622.nbsp; Aural Syringe
PAGE 621
622 622 623 623 623 624 624 627 627 628 628 629 629 631 632 634 635 636 636 637 637 642 642 644 645 647 648 649
649 650 650 650 652
653 655 656 656 657 657 657 658 658 658 658 659
-ocr page 29-
LIST OF ILLUSTRATIONS.
K1Ü.
623.nbsp; Median Antero-posterior Section of the Horse's Foot
Ö24.nbsp; Compression Forceps, for ascertaining the Seat of Pain in the Horse's
Foot
Ö25.nbsp; Another Pattern of the Same ...
626.nbsp; nbsp;Hoof-cutter ...
627.nbsp; nbsp;Straight-handled Drawing Knife
628.nbsp; nbsp;Hoof Searcher
629.nbsp; nbsp;Different Kinds of Hoof Knives
630.nbsp; nbsp;Hoof Saw, Straight Border
631.nbsp; nbsp;Hoof Saw, Convex Border
632.nbsp; nbsp;Drill-stock, with Archimedian Action, and fitted with different sized
Drills to Bore Holes in the Hoof-Wall
633.nbsp; nbsp;Iron for Burning Indentations in Hoof-Wall for Insertion of Clamp
634.nbsp; nbsp;Sand-crack Forceps and Clamp
635.nbsp; nbsp;Screw Clamp for Sand-crack
636.nbsp; nbsp;Spanner for screwing up Screw Clamp
637.nbsp; nbsp;Horse's Foot dressed and enveloped in Calico or Canvas supported
by Plaited Straw Bands
638.nbsp; nbsp;Foot with Splints inside of Shoe
639.nbsp; nbsp;Seat of Operation for Quittor ...
640.nbsp; Pointed Iron for Quittor
PAGE
663
667 667 668 668 669 669 670 670
674 674 675 675 675
677 682 684
684
-ocr page 30-
-ocr page 31-
PART IL
SPECIAL OPEEATIONS ON OEGANS AND THEIR APPENDAGES.
OPEEATIONS ON THE DIGESTIVE APPAEATUS AND THE ABDOMEN.
The operations required to be performed on what may be termed the ' digestive apparatus,' and on the abdomen, are somewhat numerous, while several of them are of great importance, and demand much skill and manipulative dexterity for their accom­plishment.
They comprise operations in the mouth and its immediate vicinity (on the teeth, tongue, salivary glands, etc.), as well as on the oesophagus, stomach, intestines, and, in connection with these, the abdominal wall. These operations will be described in the following chapters.
CHAPTEE I. OPERATIONS IN THE MOUTH.
Instruments.
SpeculaGags.—In performing operations in the cavity of the mouth, as well as in the pharynx generally, it is nearly always essential for the convenience, and even safety, of the operator that the jaws of the animal to be operated upon should be main­tained firmly and securely apart by mechanical means.
For the Horse these means are various, and are in the form of instruments or apparatus to which particular names have been given, such as ' balling-irons,' ' gags,' ' specula,' etc. However
18
-ocr page 32-
268
OPERATIONS ON THE DIGESTIVE APPARATUS.
much these may differ in form and structure, in principle they are identical, and are devised to keep the mouth open to the necessary extent, so as to allow the operator ample space for his manipulations, and also protect his hands against injury from closure or lateral movement of the animal's jaws.
The commonest and simplest form of instrument is that known as the ' balling-iron,' of which there are several patterns. The most objectionable pattern is that which has fixed branches, and therefore does not allow of adjustment to different-sized mouths (Figs. 296, 297); those which permit this adjustment are always to be preferred, and of these there are a number of good models.
Fig. 290.—Ordinary Unilateral Mouth-Speculum or Gag.
Fig. 207.—Ordinary Circular Mouth-Speculum or Gag.
That of Varnell (Fig. 298) is simple and useful, the branches— which are open at one side—being covered with indiarubber to guard the gums and dental interspaces from abrasion, while the upper branch is moved through the handle to which the lower one is fixed, the distance between the two branches being graduated by means of a screw at the end of the handle.
Fearnley's ' mouth-dilator' (Fig. 299) is somewhat different in shape, the handle being in the middle of two vertical side-bars, which have a fixed transverse bar near the bottom, and a movable one (A) that can be fixed at each side by a screw (A) in the upright branches.
A similar but simpler speculum is in use in France and Ger­many (Fig. 300); in this the degree of separation between the
-ocr page 33-
OPERATIONS IN THE MOUTH.
269
fixed and movable sliding bars is regulated by the screw handle. A very simple form of speculum, also employed in Germany, has been devised by Dominick. It is merely a half-round piece of
1
Fig. i98.—Varnell's Uxilatkral Mouth-Speculum.
Fig. 299.—Fearnley's Bilateral Mouth-Speculum.
iron bent to form rather more than three-fourths of a circle, or, rather, oval ring, the convex side of the iron being inwards; this has two straps attached to the upper branch, which is somewhat
ïii'
m
Fig. 300.—Rigot's Bilateral Mouth-Speculum.
Fic. 301.—Dominick's Moutii-Speculum. (Improved by Pflug.)
straighter than the other. The upper branch is applied to the roof of the mouth, behind the canine teeth, and the straps are buckled across the nose in order to retain the instrument in the mouth.
-ocr page 34-
270
OPERATIONS ON THE DIGESTIVE APPARATUS.
the more convex branch being lodged behind the inferior canine teeth. This has been improved by Pflug, as seen in Fig. 301, the strap being passed through a pad of india-rubber, which is applied to the roof of the mouth, and the iron itself is also covered with the same material.
Another speculum in use in Germany is that introduced by Bayer (Fig. 302), and is said to be very simple and effective. It is on the wedge principle, and is similar in shape to the speculum ons employed in human surgery. It consists of a body (a), a roughened tooth-plate {b), and a handle {d). It will be under­stood that it operates as a wedge between the upper and lower molar teeth of one side, which act as a fulcrum for it. To use this instrument, the operator grasps with his left hand the handle {d) by the ring (e), so that the thumb passes through it from within outwards, the other fingers passing round the handle at c. By the right hand the tongue is drawn from the mouth, and the wedge is then pushed between the molars, in which position it can be maintained by the thumb alone, supported by the head-collar strap, so that the tongue may be passed to the fingers of
Fig. 302.—Bayer's Weikje Moi'th-Speculum.
the left hand, leaving the right one free. The advantages claimed for this instrument are: (1) It opens the mouth to the fullest extent without injuring it; (2) it does not damage the mucous membrane; (3) the hand of the operator is quite safe. The chip­ping of salient portions of teeth that may occur from pressure is of no importance.
In France, Eigot's and Lecellier's specula are chiefly in use. The latter (Fig. 303) differs from the other models in having the two transverse bars concave on their inner aspect, which renders them better adapted for the passage of the operator's hand into the Horse's mouth, while they fit the jaws more closely.
quot;With the view of dispensing with the services of the assistant who holds the speculum in the Horse's mouth while the operator is manipulating, various specula have been produced which are retained by leather straps on the head. Of these, five only need be alluded to—those of Brogniez, Mackel, Eogers, Boswell, and Haussmann—though Dominick's also belongs to this category.
Brogniez's speculum (Fig. 304) consists of an iron curved handle-piece with a screw at each end, to each of which is
-ocr page 35-
OPERATIONS IN THE MOUTH.
271
attached a leather strap. One of these straps passes over the upper, the other over the lower, jaw, and the whole apparatus is fastened on the head by means of three straps that join a single
Fig. 303.—Lecelliek's Mouth-Speoulum.
strap that passes behind the ears. The mouth can be widened to the necessary extent by means of the screws, and the speculum can be held or moved by passing the fingers through an opening
Fig. 304.—Brogxiez's Self-retaining Mouth-Speculum.
in its middle. A cord fastened to the upper part and passed over a beam above will suffice to raise the Horse's head to a convenient height.
,
-ocr page 36-
272
OPERATIONS ON THE DIGESTIVE APPARATUS.
Mackel's speculum (Fig. 305) is recommended because of its simplicity, lightness, and general handiness. Like the last, it can be fixed in the manner of a bridle, and the mouth may be dilated to a considerable extent, while both hands of the operator are left free, no assistant being required. It is formed by two vertical and two transverse bars, the former having a screw-thread (a a) along nearly their whole length, while a screw nut (amp;) on each side of them raises or lowers the upper transverse bar. The arrangement is attached to a kind of headstall. In using it, the lips are liable to be pinched by the screw nuts unless care is taken; the upper transverse bar must also be kept parallel with the lower one, and the headstall be properly fitted to the Horse's head, so that the apparatus may stand square in the mouth.
Eogers' speculum (Fig. 306) is perhaps more advantageous than the other two self-retaining instruments. It is composed of two
Fio. 305.—Mackel's Self-rktaixinc Moi/TH-Si'eguluji.
vertical metal side-frames, connected by three transverse india-rubbercovered bars; two of the latter rest upon the lower jaw, and as they are some inches apart, they form a firm base for the instrument when it is in the mouth. The third bar, which is applied to the upper jaw, can be raised or lowered and kept at any distance from the lower bars, according to the requirements of the operator, by a rack-and-pinion motion, the handle for which is placed conveniently, so that the space between the upper and lower bars can be almost instantly increased or diminished. One of the side-branches has a handle, by means of which the Horse's head can be steadied, and a strap over the head holds the instru­ment firmly in the mouth. The ironwork is nickel-plated to prevent oxidation. The reputed advantages of this speculum are: (1) When properly fixed in position, it is rigid on its base ; (2) it permits any part of the mouth to be fully explored or operated
-ocr page 37-
OPERATIONS IN THE MOUTH.
273
upon; (3) it is perfectly safe in use, and can be applied to] any sized mouth.
A ratchet gag, Boswell's, similar in construction, but possessing perhaps greater advantages (Fig. 307), has also been made in England. These ratchet gags are very convenient, as they allow the mouth to be widened to a greater or lesser degree with ease and rapidity, and permit the muscles of the jaws to be relieved
Fio. 300.—Eooehs' Selk-eetainixg Mouth-Gag.
without removing the instrument from the mouth, while they remain on the head by means of straps.
Haussmann's mouth-speculum is stated to be the most perfect ever produced (Fig. 308). It consists of four curved side-bars, two on each side, hinged at the rear ends; to the opposite ends are attached two cupped plates, or two cross-bars, as preferred. The speculum is introduced into the mouth in the same manner as a bit, and, when spread, is kept open by means of two ratchet
-ocr page 38-
274
OPERATIONS ON THE DIGESTIVE APPARATUS.
bars (capable of sustaining immense pressure), connected with and at right angles to the curved side-bars, as shown in Fig. 308. Thus held open, there is no possibility of the instrument closing, and operations on, and examinations of, the teeth can be made with the greatest facility.
Fig. 307.—Boswell's Self-retaining Ratchet Mouth-Gag.
A special feature of advantage which can be found in no other speculum is the curved side-bars, which expose the front molar teeth, and afford an unobstructed view of the mouth from either side, with the greatest possible space to operate in.
Fig. 308.—Haussmann's Self-retainino Mouth-Gag.
For making examinations and operating upon the molar teeth, the semilunar cupped plates (a a), which are so made that they will fit any mouth, should be used, so that the pressure of the jaivs will be brought upon the front-teeth instead of the soft tissues of the gums, thereby causing no laceration or pain. The animal.
-ocr page 39-
OPERATIONS IN THE MOUTH.
275
receiving no injury from the instrument, will not fight it or make any resistance whatever.
For operating upon the incisor teeth, the cup-plates should be removed and the cross-bars substituted. These cross-bars adapt themselves to the contour of the upper and lower jaw, and, being so shaped, receive the pressure uniformly, thus preventing bruising or hurting the gums.
To explore or operate in a Horse's mouth with the ordinary specula, such as have just been described, if the Horse is in the standing position, the operator places himself in front of the animal, holding the speculum in the right hand. He then passes the left hand into the space between the incisor and molar teeth on the right side of the mouth, seizes the tongue and gently with­draws it, pressing it at the same time against the angle of the mouth to be out of the way, but to prevent injury to the organ through the Horse's struggles or tossing of the head, the fourth and fifth fingers should have a hold on the jaw at the lower dental interspace. The right hand now places the superior transverse bar in the mouth, behind the upper incisors, and pushing it upwards so as to cause the mouth to be opened, the lower trans­verse bar is carried beyond the inferior incisors and the speculum raised across the mouth. If one of the transverse bars is movable, the mouth can be opened to the required extent; but great care is necessary in all cases and with all specula, in order to avoid separating the jaws too much, as this causes the animal pain, injures the muscles of the jaws, or may even produce dislocation or fracture of the lower jaw. The speculum is then given to the assistant to hold (if it be not self-retaining), so as to leave the right hand free; but if the operator requires both hands, then the assistant must hold both speculum and tongue, while another assistant should steady the Horse's head. It ought to be remembered, when employing all mouth-specula, that the instru­ment should be removed at intervals—all the briefer the more widely the mouth is opened—so as to relieve the tension on the jaws; and special regard should be had to handling the tongue gently, so as not to pull it excessively or otherwise damage it.
For the Ox, a speculum similar to one of those in use for the horse may be employed.
For the Dog, a speculum like Bayer's (Fig. 302), but of course proportionately smaller, is very useful when employed in the same manner. The mouth of the Dog can be opened and main­tained wide, however, by passing a piece of strong tape behind the fangs of each jaw and pulling them apart; or by the use of a gag, consisting of a round piece of wood with a cord or strap at each end to fasten behind the head after the wood has been placed across the mouth. With quiet animals, and if little pain is to be inflicted, the jaws may be held apart by the hands. For powerful or savage Dogs, however, it is advisable to have a
-ocr page 40-
276
OPERATIONS ON THE DIGESTIVE APPARATUS.
speculum or gag that will keep the mouth open without danger to the operator, and for this purpose Wolf's mouth-dilator (Fig. 309) is most convenient, as the jaws can be separated to any extent, while the instrument is securely attached to the head. Recently it has been much improved (Fig. 310).
Fig. 309.—WoLf'd Mouth-üilatok fok Doglaquo;.
With the Cat, pieces of tape to pull the jaws apart, or a wooden gag as for the Dog, will suffice to keep the mouth open; but this animal should be securely wrapped in a strong cloth or enclosed in a bag, the head only projecting, before attempts are made to interfere with its mouth.
Fig. 310.—Wolf's JIouth-Dilator. (Improved.)
The mouth of the Pig may be examined or operated in by using a small speculum of Bayer's pattern, or a wooden gag similar to that for the Dog. A walking-stick may even be em­ployed by introducing it across the mouth and pressing the lower jaw downwards.
-ocr page 41-
OPERATIONS IN THE MOUTH.
277
1
Tongue-Dbpeessoes.—In order to obtain as much space as possible in the oral cavity, either for inspection or operation, and also to prevent injury to the tongue, it is frequently necessary to depress that organ in the floor of the mouth. This can be done by using a strong wooden or metal spatula, or, better still, by the depressor introduced by Eeynal (Fig. 311). This is a trowel-like instrument, the blade of which for the Horse may be from eight to ten inches in length, and two to two and a half inches broad at its widest part, which is the middle of the blade. The blade is concave superiorly, and convex inferiorly, for contact with the tongue. To assist in illuminating the cavity, this blade may be nickel- or electro-plated. The neck of the instrument is long, and forms two bends before terminating in the handle, so as to admit of its use without interfering with the manipulations in the mouth. This tongue-depressor may also be utilized in pulling or pressing the cheek outwards, and serves to illuminate the posterior teeth, the inner surface of the cheeks, and the roof of the mouth.
An ordinary metal spoon will suffice to depress the tongue of the Dog, Cat, and other small animals.
FlO. 311.—REVNAL's TONOITE-PSPRESSOB AND OitAL ILLL'MIS'ATOR.
Illuminating Appaeatus.—In exploring and operating in such cavities as the mouth, nasal cavities, larynx, trachea, vagina, etc., it is frequently found that ordinary daylight, or even sunlight, does not illuminate them sufficiently, and then—and also always at night—it is necessary to have recourse to artificial illumination. An ordinary unprotected light may suffice in some circumstances, but when employed in the region of the nostrils it is usually quickly extinguished; consequently, reflected light has to be made available, unless a special apparatus be brought into use. If a candle or lamp be employed, it is held at a distance from the nose, and the light from it is reflected into the cavity by a mirror. Any kind of mirror may be employed for this purpose, but perhaps the best is a medium-sized concave one. Such a mirror is often resorted to when sunlight is available; but a candle, paraffin-lamp, or gaslight will answer when this cannot be had.
Mention has been made of Eeynal's tongue-depressor, when nickel- or electro-plated, serving as an oral illuminator. But for the mouth and other cavities, various kinds of illuminating apparatus have been introduced at different times. Brogniez's
.
-ocr page 42-
278
OPERATIONS ON THE DIGESTIVE APPARATUS.
stomatoscope consists of a concave mirror attached to an oil of turpentine lamp, the flame of which is easily extinguished. But a mirror constructed like that of an ophthalmoscope, though with a larger area, is easier to use, and may be employed both as a stomatoscope and a rhinoscope, but a strong and steady light is required. A simple and easily-improvised reflector may be made by tying a silver or plated spoon to a candle, or the reflector of a carriage-lamp may be employed as a mirror in cases of emer­gency.
Fig. 312.—Bayer's Electric Lamp for the Illumination of the Mouth and Nasal Cavities. {Fxdl Size.)
It having been found that an uncovered light dazzles the eyes during the examination of cavities, and therefore renders the view uncertain, platinum glow-lamps in connection with an electric battery have been tried, the radiation of heat from them being checked by surrounding the connecting wire with water or other non-conducting substances. Subsequently charcoal points were adopted, and these gave a very intense, steady, and pure light; then reflectors and lenses were fitted to the lamps. Bayer,
-ocr page 43-
OPERATIONS IN THE MOUTH.
279
of the Vienna Veterinary School, invented an electric lamp which has heen most successfully employed in veterinary surgery to illuminate such cavities as the mouth and nostrils (Fig. 312). In the centre of a parabolic silver-plated reflector (E) are two platinum wires (P), which are fixed by means of two slides (Sch) into slits in two metal rods (St). One of these rods penetrates the handle (H), and is connected with the wire (K) by pressing the spring (D). Both wires are in connection with an accumu­lator, which can be worn around the neck of the operator or carried in his pocket. This accumulator can be charged any­where from an electric battery. On pressing the spring (D) the poles are connected, light is at once emitted, and continues as long as the circuit is maintained. The intensity of the light can be considerably increased by the addition of a lens (L). By means of this little instrument the oral and nasal or any other open cavities can be better and more conveniently illuminated than by sunlight, while the tint of the surfaces is unaltered and
Fig. 313.—Eaymond's Electkic Illuminator.
the eyes of the operator are not dazzled or fatigued. The light, however, can only be depended upon to last for an hour at the utmost, and it is therefore advisable, if required for a longer period, to have another accumulator ready. It has been found that the accumulator is very sensitive, so that the battery must be regularly supplied with acid before it is used.
The chief drawback to the general employment of this most useful illumination apparatus has been its expense, and it has also been found that it is capable of improvement.
Eaymond's electric lamp (Fig. 313) is most useful and effective. It is bent at an angle within about two inches of the handle, though for most purposes it might be straight, and at the end, on one side of the globe containing the platinum wire, is a shield to protect the tissues from heat; the posterior surface of the shield, which is of metal, may be covered with india-rubber, vulcanite, ivory, or bone, and the front (facing the lamp) is plated, and so constitutes a mirror.
-ocr page 44-
280
OPERATIONS ON THE DIGESTIVE APPARATUS.
In 1893, a small and cheap electric lamp for veterinary pur­poses was exhibited at a meeting of the Central Veterinary Society. This consisted of a combination of two tubes provided
Fig. 3U.—Small Eleoteic La.mp tor Veterinary Purposes.
a, Tube containing lamp; 6, tube to introduce into mouth or other cavity, with eyepiece at
c ; d, box containing three dry cells in cement.
with the electric light, with a glass protector for the eye of the observer, who was further guarded from danger by a leather shield. The light was furnished by three dry cells cemented in a box (Fig. 314).
OPERATIONS ON THE TEETH.
Operations are usually performed on the incisor and molar teeth of the Horse—most frequently the molars—and are chiefly levelling, resection, and avulsion or extraction.
Horse.
Incisors.
The incisors of the Horse can be easily examined by the eye and hand, and irregularities in shape or wear are remedied by suitable instruments, as the rasp, file, or chisel; while extraction can be generally effected by strong forceps. The rasp may be an ordinary horse-shoeing one, or the usual tooth-rasp for the molar teeth, and a file may be employed to smooth the edges of the teeth; the chisel need not be large (Fig. 315); but the forceps must be strong and easily manipulated (Figs. 316, 317). For broken or splintered teeth, a convenient form of forceps has a spring between the handles, and the jaws are better adapted for securing a firm hold (Fig. 318).
(1) Levelling the Incisor Teeth. This is effected by the rasp, which should be frequently dipped in a bucket of water during the operation, in order to get rid of the teeth detritus.
-ocr page 45-
OPERA TlOyS ON THE TEETH.
281
(2) Resection of the Incisor Teeth.
This is necessary when one or more of the teeth become over­grown and injure the lips or hinder prehension of food. If it would require too much time to remove the projection by means of the rasp, then recourse must be had to the chisel. In using this instrument, care must be taken not to break off too much of the tooth or to loosen it. The head must be well steadied, a gag having been placed in the mouth, and the chisel, held firmly against the portion of tooth to be removed, is to be struck a short sharp
ARNOLD 5S0NS LONDONnbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;_______ ^^BBl
----------------nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ------=—nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; ==—^3
Fio. aiö.—Tooth Chisel.
Fig. ;:17.—Incisor-Tooth Forceps.
Fig. 31S.—Forceps for Splintered or Broken Teeth.
blow with a hammer. When possible, the chisel should be placed at the side of the tooth, not the front, as then there is less risk of loosening it. The screw chisel, to be described immediately, may be used with advantage, as it is less likely to splinter or loosen the tooth. After resection, the part should be rendered smooth by the file.
Extraction.—Extraction of the incisors is often rendered neces­sary when the adult teeth are split or broken, when there are supplementary teeth, or when the temporary teeth are not shed in due course, but are retained against the permanent teeth. No special directions are required for extraction. The Horse has to
i
-ocr page 46-
282nbsp; nbsp; nbsp; nbsp; OPERATIONS ON THE DIGESTIVE APPARATUS.
be secured firmly, a gag applied, and the tooth or its fragments removed with a firm, steady, and slightly rotatory pull. The wound is to be dressed with water and kept clean.
Molaes.
The molar teeth most frequently demand surgical interference, from their being more exposed to accidents, disease, and irregu­larity of growth, while the essential part they assume in mastica­tion renders defects in them of more or less serious importance to the animal. The chief symptom that indicates these teeth being amiss is imperfect and slow mastication, the movements of the lower jaw being less free, and in some cases more to one side than usual. When mastication is much interfered with, there is generally abundant salivation, the saliva flowing copiously; but the hay, being insufficiently crushed, can only be swallowed in small quantities or not at all, so that the bolus drops from the mouth or is retained in that cavity until several are accumulated and form a large mass; it is the same with the oats which the animal attempts to crush, but which, profusely insalivated, are partly swallowed more or less whole and partly fall from the mouth. With rapidity, varying according to the nature and extent of the defect, the animal loses condition and vigour, and there may also be signs of indigestion, which may be misleading unless the state of the mouth is ascertained. An inspection of this cavity, made by means of the gag or speculum, the tongue being slightly and carefully withdrawn, and illuminated, if pos­sible, by natural or artificial light, will reveal excoriations or wounds of the cheeks or tongue, according as the upper or lower molars are involved on one or both sides, due to irregularity in the wear or growth of the teeth, or other condition visible to the eye. Manual examination of the teeth will also furnish more important information in the majority of eases than the eye, as the hand can be introduced as far as the last molar, and irregular growth or wear, fracture or caries, etc., can be more certainly detected in this way. It is to be remembered that the tables of the upper molars are directed obliquely inwards, therefore their outer margin is most frequently irregular; while the tables of the lower molars slope outwards, so that their inner border is generally at fault.
In addition to the profuse salivation, as has been stated, masses of semi-masticated food may be found lodged between the teeth and the cheeks, while the mucous membrane is hot and injected. When caries of the teeth is present, there is the peculiar fetid odour attending that condition; and if the animal is suffering pain, it gives evidence of this by its expression and the manner in which the head is carried to one side—that on which the diseased tooth is situated. Irregularity in wear of the upper molars, as well as anomaly in their direction, can often be detected externally in the region of the cheek by the hand, rubbing or pressure causing the
-ocr page 47-
OPERATIONS ON THE TEETH.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;283
animal pain; or even by the eye when the direction of the tooth or teeth is very abnormal, or abscess or fistula is present. Sur­gical intervention, then, is required when the molar teeth are irregular on their borders or tables, when they are anomalous in their direction, position, or number, or when there is disease or fracture. This intervention takes the form of (1) levelling, (2) excision, or (3) extraction.
1. Levelling the Molar Teeth.
The gag is generally required, the animal being in the standing position, the hind-quarters placed in a corner, and one or two assistants holding the gag and the tongue, and observing the pre­cautions aheady insisted upon with regard to these. It should be here remarked, with regard to the position of the animal when operating upon the teeth, that the standing attitude is the best when it can be adopted, both for the convenience of the operator and the safety of the patient; and even the mouth-gag should not be employed when it can be dispensed with, as it fatigues the muscles of the jaws, and more or less injures the mouth. The following directions are observed by those who dispense with the gag : The mouth should be kept open and instruments manipulated by the hand and arm ; if operating on the lower molars, pass three fingers alongside the tongue, and press it over between the molars of the opposite side, the other finger and thumb being employed to make pressure on the rasp or in guiding the shears or forceps: the arm at the same time is in the interdental space. When •operating on the upper molars, press the thumb against the first molar, the fingers passing up along the inside of the cheek, allow­ing the rasp to run between thumb and fingers, with the arm in the interdental space. In operating on the upper or lower in­cisors, the arm is also placed in the interdental space, and the thumb and first finger are passed round the incisor teeth to raise the upper lip or hold away the lower one. If the animal is very unsteady, a twitch on the nose will be necessary; but it is seldom that further restraint is required.
Instruments.—These are a tooth rasp or tooth chisel, or both ; a bucket of water to dip the rasp in, in order to free it from tooth raspings; a hard brush dipped in the water may be also usefully #9632;employed in their removal.
Opeeation.—This is simple. If the outer border of the upper, or inner margin of the lower, molars is sharp and only slightly irregular, then the rasp carefully passed along it with firm pres­sure will soon make it even and smooth. The rasp should be so managed that in its backward and forward movements it will not injure the cheeks, gums, or tongue. The shape of a well-made rasp tends to prevent accidents (Fig. 319), and especially if its borders are guarded by india-rubber or other soft material. When the asperities are larger, and would require more time and labour .to remove them, recourse may be had to the tooth chisel, of which
19
.
-ocr page 48-
284
OPERATIONS ON THE DIGESTIVE APPARATUS.
there are various forms. The simplest is a long steel chisel, with a sharp serrated end to prevent it slipping off the tooth (Fig. 320). This has to be held firmly against the part to be removed, while the opposite end is struck a somewhat light sharp tap by a hammer
sect;8
2 o X
3 |i
o 5
2 tyr
£ a
.2 o
3
1
C
or mallet. But it is evident that the use of such an instrument must be attended with risk of damage, either splitting or loosen­ing of the teeth or injury to the soft parts, and to avoid this a guarded chisel is generally employed, the guard fitting over the tooth to be operated on, and the chisel, working through the
-ocr page 49-
OPEHATIONS OX THE TEETH.
285
handle into this, is pushed smartly against the projection. The earliest of these contrivances is that of Brogniez (Pig. 321); but jn this country Gowing's—similar in principle (Fig. 322)—is generally employed. On account of the steadiness with which it can be used, and generally its greater efficiency, a screw is pre­ferred to a striking chisel (Fig. 323). No particular directions are required for the performance of this operation. It is advisable to use the rasp after the irregularities have been removed, in order to level and smooth the part. If more than one tooth is to be operated upon, the anterior should be done first, and so on to the most posterior.
320.—Arnold's ToOTB Shkars.
2. Excision of the Molar Teeth.
When the irregularities or projections are so large that none of the instruments mentioned are suitable, then recourse must be had to their excision. To accomplish this, if the molar is easilv accessible, a tooth saw (Fig. 324) will sometimes suffice; but the operator must be cautious in using it. Shears are generally pre­ferred, and of these there are many patterns; but the general principle upon which they are constructed is the same, the blades being acted upon by a powerful screw (Figs. 325, 326, 327). Un­less great care is observed, however, there is danger of cutting the
,
-ocr page 50-
286
OPERATIONS ON THE DIGESTIVE APPARATUS.
cheeks or gums, especially if operating upon tha posterior molars. This is obviated if a modified tooth chisel be used, moved by a screw against a sharp edge in the guard (Fig. 328). As sometimes the entire body of a tooth projects above its fellows, and has to be excised to their level, it is evident that these instruments must be very strong and rigid, and of sufficient dimensions to embrace the largest of the upper molars.
Another form of this shears, acted upon by two handles instead of a screw handle (Fig. 329), is most useful, in that there is no
Fu;. 326.—ROBEBTSOK'S Tooth Shears.
Flo. ;i27.—Thojipson's Tooth Shears.
MLP a^ONSLOMDOPi 1^1^
Fic. Ö2S. —Edoar's Tooht Excisor.
tendency to fracturing the jaw or loosening the fang of the tooth, because of the equal pressure brought to bear on the posterior as well as the anterior part of the crown in the act of cutting it. There is no suffering inflicted on the animal, and no after-treat­ment is required, because it is usually a clean level cut.
Opeeation.^—This does not require much description, whether saw or shears be used. The former can only be safely or con­veniently employed on the anterior molars, and shears, from their rapidity of action, are preferable in the great majority of cases.
-ocr page 51-
OPERATIONS ON THE TEETH.
287
Position—When only one or two of the front-molars are to be opSÄpoÄ HorL will stand ; but if ^^ZSS -to be excised, or if the animal is restless, then it is generally IdvtbleTo place it in the latericumbent posit^ body in order to prevent fragments of tooth falling mto the larynx The animal should lie so that the molars to be operated on will be on the upper side, and the head may be raised to a convenient height by a sack filled with hay placed beneath it COTECHquot;c.-Insertya mouth-gag with sufficient space toalbw the shears to be easily manipulated in the mouth—a dilatame gag is bes ; an assistant partially withdraws the tongue from the mouth and away from the molars to be cut; the cutting parts of The shears are placed on the portion of tooth tobe removed and the handle of the screw is smartly turned by the ^J0^*** assistant, another holding the instrument; after a sufficient number of turns the piece of tooth comes away with a ^dang sound the piece is to be removed from the mouth before the tongue is
Crawkord's Tooth Shear.--.
released When more teeth are to be levelled it is well to remove the gaa after each tooth is operated on, in order to rest ^muscles of quot;the jaws and the tongue. The operation may be
^iSÄä^Se has to be done, if the operation bas been carefully performed, beyond washing out the mouth with water, which may be slightly acidulated.
3. Extraction of the Molar Teeth. Extraction of the molar teeth is indicated when mastication is interfered with, because of their being supernumerary (usually from retention of the deciduous teeth), or when they are frac­tured carious, or involved in alveolar periostitis with its conse­quences Th^ removal of deciduous teeth is comparatively easy 2nd can be effected by a conical-pointed gouge, which is inserted between it and the table of the permanent tooth on which it rests the mouth being kept open by a gag; or long-handled forceps
-ocr page 52-
288
OPERATIONS ON THE DIGESTIVE APPARATUS.
(Fig. 330), or Lecellier's forceps (Fig. 331) may be employed. This removal should not be attempted until the crown of the permanent tooth projects some distance from the alveolus, and the animal is really inconvenienced in eating. Then the point of the chisel can be inserted between the two teeth, and the tem­porary one prised off.
Removal of the permanent molar teeth is generally a difficult operation, and one requiring the employment of great mechanical force, owing to the manner in which they are implanted in their
330.—Tooth Forceps for re.movixo Deciduous Molars or Old Stoiiraquo;*
alveoli, the considerable length of their fangs, and the comparatively small size of the crowns—upon which the extraction instruments can only act—as well as the closeness with which these teeth are in contact.
But the difficulties to be encountered vary with circumstances. In young animals the molar teeth are much more firmly and deeply implanted in the alveoli than in old ones; and they are less firmly fixed in the upper than in the lower jaw, owing to the presence of the maxillary sinuses. It is generally easier to operate on the anterior than the posterior teeth, as they are more
Fig. 331.—Lelellier's Forceps for removixo Temporary JIolars.
accessible to instruments; whereas, because of the length of the Horse's jaws, the more posterior the teeth are, the difficulty is increased, until the removal of the last molars in either jaw becomes an almost impossible task, not only because of their situation, but also from the shape of the crown, which protrudes less than in the others. The condition of the teeth and the alveoli has also a considerable influence in this respect. Teeth affected with caries or periostitis are usually less firm than those in health, and espscially if suppuration has taken place; then
-ocr page 53-
OPERATIONS ON THE TEETH.
289
sometimes a small degree of force will remove them, particularly if caries has proceeded so far as to permit them to be extracted in longitudinal fragments. But when the crown has been more or less destroyed by caries, and the fang is at the same time affected with exostosis, then indeed extraction becomes a very serious matter for the operator, as not only is it most difficult to seize the tooth, let alone remove it, but the adjoining teeth, although healthy, are looser than usual, and are therefore more easily dis­placed or broken during the efforts made to carry out the opera­tion. In some rare cases, from defective composition of the teeth or other cause, they are so much worn and so loosely implanted in the jaws that they may be extracted by the fingers.1
The removal of the molars may be effected in two ways : (1) By opening the maxillary sinuses and driving the tooth from its alveolus by means of a punch applied to its root through this opening; (2) by pulling the tooth, in seizing its crown by a suit-
Filt;;. 332.—Position of thk Molae Teeth in the Jaw.s.
able instrument introduced into the mouth, and extracting it from the jaw.
Whichever method is resorted to, the inclination and position of the roots of the teeth must be remembered, in order that pres­sure or traction may be made in the proper direction and on the right tooth, the three anterior or premolar fangs (above and below) being inclined somewhat forward, and the three posterior directed slightly backwards (Fig. 332). The molars at each end of the row (above and below) have three roots, but the intermediate ones in the upper jaw have four, while in the lower jaw they have only two.
Opebation—1. Method by Eeteopulsion.—This is perhaps the oldest method for the removal of molar teeth, and is some-
1 A case of this kind I observed in a middle-aged artillery Horse at the Woolwich Infirmary stables some years ago, in which all the molar teeth were so loose that some of them were removed by the fingers.
-ocr page 54-
290
OPERATIONS ON THE DIGESTIVE APPARATUS.
times the only one that can be adopted for the most posterior molars, or in cases in which any of the teeth cannot be seized by instruments, or when suitable instruments are not at hand; and although a more formidable and tedious operation than extraction, yet, in addition to its other advantages, it allows the sinuses to be cleansed and dressed, when these are diseased, before or after the teeth are removed.
Instruments.—Scalpel and forceps; trephine; bone forceps ; round, slightly-tapering punch, the end of which is flat and about an inch in diameter ; sponges, water, and a large syringe.
Position.—Latericumbent, on the side opposite to that of the tooth to be removed.
Technic.—The Horse is completely ansesthetised, and the situation of the fang of the tooth to be removed accurately
Fin. 333.—TREPHixixci THE SnrusES. (After Cadiot.)
B, Ä, Opening into the infel'ior maxillary sinus; e, cï, c, line of incision for a large opening into the maxillary sinuses ; a, h, line of incision for retropulsion of the first molars.
determined upon. If it is an upper molar, make a large V-shaped or crucial incision through the skin over the maxillary sinus at a point corresponding to the fang of the tooth, care being taken not to injure the labial or nasal muscles; dissect back the flaps of skin ; scrape the exposed bone to a sufficient extent; with the trephine make two openings through the external table of the bone, parallel to the row of teeth, and a third opening above and between these ; with the bone forceps remove the intervening piece of bone, which leaves a triangular space (Fig. 333). If there is any pus or foreign matter in the cavity, clear it out, and the fang of the tooth being ascertained, the end of the punch is placed on it, the mouth-gag is applied, and the operator's hand holds the crown of the tooth while an assistant strikes the punch smart measured blows, the effects of which are noted by the hand in the mouth, and the force
-ocr page 55-
OPERATIONS ON THE TEETH.
291
of the blows regulated accordingly, the punch being held in the direction of the tooth. Sometimes the tooth is easily displaced ; in other cases it requires repeated and strong blows to drive it out, and it may break into two or more pieces.
The technic is the same in removing the lower molars, though, as there are no sinuses, the alveolus of the tooth to be removed must be opened directly by the trephine. If the last molars are to be operated upon, it is necessary, after incising and dissecting back the skin, to cut through the masseter muscle before applying the trephine. When the third or fourth tooth is to be removed, great care must be taken not to injure the parotid duct or the glosso-facial artery and vein; and to avoid damaging the important nerves which pass through it, the trephine must be applied above the maxillo-dental canal. As the lower jaw is easily fractured, the blows on the punch should be lighter than those required for the upper molars.
Aptee-Teeatment.—If the sinuses are healthy, then they only need washing out, and the divided skin over the opening brought together by suture ; if they are diseased, then at least a portion of the trephined space should be left open for the injection of detergent or other necessary medicaments. If the face-wound is a long time in closing, and the animal must be worked before this has taken place, a plaster may be fixed over it, or a leather plate be attached to the cheek of the bridle, so as to cover the opening while the Horse is out of doors. The cavity left by the removal of the tooth gradually disappears, though never completely, by the oblique direction the adjacent teeth assume in converging towards each other. Sometimes a fistula will remain for some time, and this can be treated according to surgical principles.
2. Method by Exteaction.—This is preferable to the last method in all cases in which it is applicable, as there is not so much damage done to the hard and soft tissues surrounding the tooth to be removed; though it is not without its disadvantages, as it sometimes happens that the appropriate instruments are not at hand, and the last molars are generally extremely difficult to deal with by this method.
Instruments.—Many and varied in shape and complexity are the instruments which have been devised for the extraction of the Horse's molar teeth, whether these were to be removed by luxation or by direct avulsion. A long blunt gouge was at one time em­ployed to loosen and detach the tooth when it was not very firmly implanted; then this was replaced by a long iron lever, about twenty inches in length, bifurcated at one end, the bifurcations being bevelled to a thin edge on their inner border. In using this instrument, the tooth was fixed between the prongs by striking it at the opposite extremity with a hammer; then the incisors being made to act as a fulcrum, the tooth was raised out of its socket; if unsuccessful at the first attempt, the operation was continued by repeated blows until the tooth was completely loosened. This instrument could only be employed on the first
#9632;
-ocr page 56-
292
OPERATIONS ON THE DIGESTIVE APPARATUS.
molar, or on those projecting above or laterally beyond their fellows, and even then it often failed.
A lever of the second kind was for some time employed, this being merely a greatly enlarged human tooth-key (Fig. 334), by which the tooth was loosened and torn out of the alveolus by a powerful wrench or twist. But this instrument was difficult to manipulate, and often failed to effect extraction, while it exposed
n
k
r
u
Fie:. 0^4.—Molak Tooth Kky.
the jaw to fracture, and the tooth was liable to fall into the pharynx and be swallowed.
A great number of powerful forceps of various patterns have been introduced, certain advantages being claimed for each; some are simple, and others very complicated, and probably every operator has his own particular instrument among them, which he prefers because of its efficiency. It is one or other of these that is now
Fie. 335.—BofLEY's MOLAR FORCEPS.
generally employed when the crown of the tooth can be effectively seized, though it may be necessary to have more than one kind of forceps to suit different mouths or teeth ; indeed, some authori­ties, as the Günthers of Hanover, have devised a particular forceps for each tooth. But as a rule this is unnecessary, and the majority of practitioners limit themselves to one or two. It would, therefore, serve no very useful purpose to describe all the
-ocr page 57-
OPERA TIONS ON THE TEETH.
293
forceps which have been from time to time introduced, so that only a small number will be noticed.
In France, one of the best keys or forceps employed is that of Bouley (Pig. 335), which is very powerful; as the operator, after placing the jaws on the tooth and screwing them tight on it by means of the screw, can wrench the organ laterally by actin^ on the transverse lever with his hands.
In Germany, the most recent introduction is the forceps of Fnck and Hauptner (Fig. 336), in which the tooth is also grasped
FmcK and Haüptnee's Molak Pokoeps.
hrmly through the medium of a screw, and which can be em­ployed as a lever of the first or second class. The jaws are clumsy, however, and there may be difficulty in getting them well on some teeth, especially the last upper molars.
Gowing's forceps (Fig. 337) have long been popular in England; they resemble Bouley's—in fact, the latter is only a modification of Gowing's, which is used in the same way. Eobertson's forceps (Fig. 338) have also been found very serviceable, the fulcrum being screwed on the instrument near the joint, and the grasp of
Molar Forceps, with Screw Lever Handle.
the tooth, as well as the lever needed to start it from its cavity is secured by a long screwed handle.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;'
But perhaps the simplest and most efficient of the British models is that of Santy (Fig. 339), which has been largely used in this country. This affords an excellent grip of the tooth, a quot;rip which is secured by a sliding bar on the handles, while the neces­sary leverage is ensured by the insertion of a fulcrum beneath the joint of the instrument, and which rests on the tooth in front,
without injuring it
The fulcrum should be a long iron rod, bent
-ocr page 58-
•294nbsp; nbsp; nbsp; nbsp; OPERATIONS ON THE DIGESTIVE APPARATUS.
at a slight angle at each end; to these ends a small block of hard wood is attached, one thicker than the other; these act as fulcra, according to requirement. The longest molars have been extracted by these forceps, and even the fifth and sixth, without breakinraquo; a fang.
In addition to forceps, a dilatable speculum, water, and sponges, with fine tow and a htemostatic agent, are needed for the opera­tion.
Fir.. 338.—RoiiEinsox'.s Molak Forceps.
Position.—Sometimes molar teeth are extracted while the animal is standing, but usually it is placed latericumbent on the opposite side to that on which the tooth is, and if the operation is likely to be tedious or very painful, an anaesthetic ought to be administered.
Technic.-—1. A gag in the mouth maintains the jaws a con­venient distance apart; this is held by an assistant, who also
Fir.. 888.—Santt's MoLAii Forceps, with Fulcrum.
holds the tongue to one side, with all due precautions if the animal is not insensible. 2. An examination is made to ascertain exactly the position and condition of the tooth which is to be extracted, and to remove any semi-masticated food that mio-ht interfere with its seizure by the forceps. 3. Should the tooth be so overgrown that the forceps cannot be properly placed, then it may be shortened by means of the shears; or if an intervening tooth present a similar obstacle to the placing of the forceps, it
-ocr page 59-
OPERATIONS ON THE TEETH.
295
must be cut by that instrument. 4. The forceps is placed with certainty on the tooth, the cheek being pushed aside with a smooth rod; if there is any difficulty in getting a good firm hold of the tooth because of its misdirection outwardly, it may be useful to remove or reduce the width of the gag and move the lower jaw to one side in order to allow more room. If possible, the hand should guide the forceps on to the tooth. 5. The operator gives the forceps a slight lateral or rotatory movement to loosen the tooth, though care must be taken not to break it or the jaw ; then the fulcrum is placed under the forceps, resting on the table of the tooth immediately in front of the one in the forceps, which is now raised out of the socket by forcibly pressing the handles steadily downwards in the direction of the long axis of the tooth; when the latter is partially extracted, a sucking sound is heard, produced by the air passing into the socket; the forceps is then made to take a deeper hold, or a thicker fulcrum is put under it, and, inclining the pressure somewhat towards the inner side, the tooth is completely removed from the alveolus and the mouth.
If more than one tooth is to be extracted, it is generally advis­able to remove the most posterior first if this be convenient. If upper and lower teeth must be removed, the lower should be the first.
Aftee-Teeatment.—As a rule, little treatment is necessary after the operation beyond removing the blood from the mouth and plugging up the cavity with tow saturated in dilute iron per-chloride (1 to 2) if there is much haemorrhage, or in an antiseptic solution if this is slight. Should there be dental fistula, this will require special treatment. The cavity should be replugged every third or fourth day with tow and diluted iron perchloride (1 to 4) if necessary. The diet should be soft nutritious food until all pain has disappeared and hard food can be masticated. If the cavity is in the upper jaw, and there is a probability of food finding its way into the sinus, then it may be necessary to fill the alveolus with guttapercha pressed into it while soft (from being steeped in warm water); this plug will be retained for a considerable time if two copper wires be passed through it before it is inserted, which are to be secured around the tooth at each side of the alveolus.
It will be necessary from time to time to examine the mouth and regulate the length of the tooth opposite, as this will become prominent and interfere with mastication, as well as damage the jaw it comes in contact with; the other teeth may also become irregular or displaced, and need rectification.
Ox.
The teeth of the Ox rarely require attention, and then it is usually extraction in consequence of disease either of the teeth themselves or, as is most frequently the case, of the bones in which they are implanted. As their removal is easily accom-
-ocr page 60-
29(5nbsp; nbsp; nbsp; nbsp; nbsp;OPERATIONS ON THE DIGESTIVE APPARATUS.
plished in the standing posture, no special directions are deemed necessary.
Dog.
The operations on the teeth of the Dog are limited to blunting the points of the incisors and canines by means of cutting forceps or a file, to prevent the animal inflicting wounds; extraction when the teeth are loose or diseased; and scaling or cleaning them when they are crusted with tartar.
Blukting.—No detailed description is needed for this operation. The animal is conveniently placed, held by one or two assistants, a mouth-gag applied, and the teeth mentioned resected by bone forceps and smoothed by means of a file, or blunted by filing only. The file should not be very rough, and the head must be held steadily by the assistant.
Exteaction.—This is effected by means of strong dissecting forceps if the teeth are very loose, or by forceps of a smaller size than Fig. 317 if they are firm in the jaw (Fig. 340). quot;When this is the case, it may be advisable—and, indeed, it should be the rule—to place the Dog under the influence of an anaesthetic. If many teeth have to be removed, it is often the safest procedure to extract only one, two, or three at a time, lest haemorrhage be too
FlO, 340.—FORCKE'S FOR EXTRACTING DOfl's TEETH,
copious. No particular after-treatment is necessary beyond clean­liness and giving the animal soft food.
Scaling.—quot;When tartar has accumulated around the teeth, this is removed by scraping. This can be done by means of a small short-bladed knife, or by the special instruments used in human dentistry for this purpose. The mouth-gag is usually necessary, and care should be taken not to injure the gums or loosen the teeth. These should be afterwards brushed with dilute hydro­chloric acid.
OPERATIONS ON THE TONGUE.
Operations on the tongue of the domestic animals are much less frequent than in mankind, and consist chiefly in (1) scarifying the organ, in order to reduce tumefaction due to inflammation or other morbid conditions; (2) in removing foreign bodies; (3) in repairing wounds so frequently occurring from various causes; (é) in amputation when the organ is seriously injured or diseased; and (5) in operations on the fraenum.
The symptoms of these conditions are usually very marked; they may be protrusion of the tongue from the mouth, haemor­rhage, salivation, difficulty in mastication and deglutition, mani-
-ocr page 61-
OPERATIONS ON THE TONGUE.
297
festations of pain, etc. An inspection of the oral cavity, which these symptoms lead to, reveals the nature of the affection, and affords an indication of the kind of operation necessary.
1. SCAEIFICATIOK.
Owing to the rigidity and thickness of the lingual mucous membrane, when inflammation from any cause is severe the resulting tumefaction is likely to run on rapidly to gangrene, unless relief is afforded by scarification. The length and depth of the incisions will, of course, depend upon the extent of the swelling; but as a rule they should be made longitudinally, nearly or quite the whole length of this, and their depth must be in proportion to the tumefaction; though they ought never to be so deep as to incur the risk of wounding the lingual artery.
Aftee-Teeatment.—This will depend upon the cause of the swelling; but usually all that is necessary is to bathe the tongue with some weak antiseptic (as solution of boracic acid) or astringent (as solution of alum or tannic acid) fluid.
2. Eemoving Foeeigk Bodies.
Foreign bodies often become fixed in or about the tongue, and when these are small or thin it is frequently difficult to detect them, especially if they are towards the root or sides of the organ, notwithstanding close examination. The chief symptoms are impeded mastication and trouble in swallowing, salivation, the mouth maintained more or less open, and perhaps protrusion of the tongue, which may be discoloured, swollen, and hot.
The mode of removal of these bodies, when detected, will depend on their character and the manner in which they are fixed in or on the tongue. A mouth-gag may be required, but it is rarely necessary to lay the animal down; forceps or the hand will remove sharp bodies which have penetrated the organ, and it has been remarked that these are generally inclined obliquely from behind to before, so that in extracting them the tongue should be pulled well forward and the penetrating body pushed or pulled backwards and upwards.
3. Opeeations fok Wounds.
Wounds of the Horse's tongue are of frequent occurrence ; they are usually transverse and generally lacerated, varying consider­ably in extent, from a small incision or tear to almost complete detachment of a portion of the organ ; not infrequently a part is entirely separated, and the resulting wound must then be treated on general principles, cleanliness and soft food being the chief points requiring attention.
In order to suture wounds of the tongue, the Horse may be cast, but unless very intractable, or the injury is severe and not easily accessible, this operation may be performed in the standing position. In any case a mouth-gag is necessary. If large bloodvessels are
-ocr page 62-
293
OPERATIONS ON THE DIGESTIVE APPARATUS.
divided, they must be secured and tied. The wound is to be well cleansed, and the cut surfaces brought into apposition by interrupted suture. The suture material may be of soft lead, wire or strong silk, and the sutures placed close together and deep, so as to ensure a firm and durable hold if the wound is extensive. The object being to obtain union by the first intention, if the semi-detached portion has sufficient vitality, the tongue must be kept as im­movable as possible until this has taken place. This immobility may be achieved to a considerable degree in closing the mouth by means of a muzzle, or by placing the tongue as far as the frsenum in a fine net or muslin suspensory bag (Fig. 341), which is kept on the organ by a tape at each side, that can be tied to the head-collar. The muzzle may be used as an adjunct to this suspensory apparatus.
Should a point of suture give way, it may be replaced by a fresh one if considered necessary.
When union has taken place, the sutures are to be removed.
Fl(i. 341.—TON'GUK.SUSPKNDER.
but until then the suspensory bag should be taken off at least once a day and washed in boric solution. The mouth is to be washed out two or three times daily, and the diet must be fluid or pultaceous food ; all hard, dry food must be withheld until the wound is healed
4. Amputation op the Tongue.
Glossotomy is resorted to when disease has invaded the an­terior portion of the tongue; when it is paralysed or prolapsed from accident, disease, or habit; or when it has been so injured that repair is not possible. This operation can be practised more advantageously on the Horse and Dog than on the Ox, which, owing to its tongue being largely prehensile in function, cannot seize its food so well after losing a considerable portion of it. A Horse may lose about four inches without suffering marked inconvenience, but more than this delays mastication and hinders drinking. Dogs are particularly inconvenienced in lapping fluids
-ocr page 63-
OPERATIONS ON THE TONGUE.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; 299
when the tongue is shortened. Horses have been able to eat when the organ has only extended to the fraenum.
Operation.—In some cases the tongue is so deeply incised accidentally, that removal of the partially-detached portion is a very simple matter, and may be effected with scissors, the animal being in the standing position and the mouth kept open by a gag. The haemorrhage is usually trifling if the part removed be near the point of the tongue, and soon ceases; but if considerable and persistent, it may yield to a hasmostatic agent, such as iron per-chloride, and keeping the mouth closed for some time. When a larger portion has to be amputated, then the animal may be handled while standing or latericumbent, and the organ operated upon in either of three ways : 1. It may be tightly encircled by an elastic ligature close above the portion it is desired to remove, the ligature to be left on, and, if necessary, made tighter, until separation has taken place. But this is a slow and most painful process, and not to be recommended. 2. The tongue is seized by the hand, held fixed by broad-mouthed forceps, or by a stout piece of silk or twine passed through it, and amputated at the part designed by a scalpel or bistoury. The artery may be secured by ligature, or the haemorrhage suppressed by the actual cautery, though this is not to be recommended, as, unless applied with great care and for the briefest time possible, and frequently until bleeding is stopped, it is likely to scorch the mouth. 3. Amputation by means of the chain ecraseur, which is preferable to the other two methods, as it is more rapid, and there is less risk of haemorrhage; the chain is placed around the tongue immediately beyond the part to be taken away, and the handle of the instrument turned slowly and steadily. A muzzle should be worn for a short time after the operation.
After-Teeatment.—The mouth may be washed out with an astringent or antiseptic solution, and the wound kept clean. The diet should consist of soft mashes and gruel for the Horse and Ox, of broths and soups for the Dog, until the wound has healed.
5. Operations on the Fr^num of the Tongue.
Tongue-tie.—This congenital defect is occasionally witnessed in young animals, and may prove detrimental to their sucking, drinking, or eating. The tongue is attached too forward in the floor of the mouth by the fraenum being either too short or too near the point. This can be remedied by the simple operation of cutting through the fraenum to a sufficient depth by sharp-pointed scissors. No subsequent treatment is necessary beyond keeping the wound clean.
Eanula.—Sometimes a non-inflammatory soft tumour, whitish in colour, and from the size of a hazel-nut to that of a fowl's egg, becomes developed on the fraenum, and is probably due to closure of a mucous duct, as it contains a thick yellow fluid. It inter­feres with eating and drinking when large, and has to be removed.
20
-ocr page 64-
300nbsp; nbsp; nbsp; nbsp; nbsp;OPERATIONS ON THE DIGESTIVE APPARATUS.
This is permanently effected by incising it, and extirpating the sac-wall by means of scalpel or sharp-pointed scissors and forceps. Soft food and cleanliness are all that is necessary until the wound is healed.
OPERATIONS ON THE PALATE.
The operations on the palate are very few, and are limited to abstracting blood from it, repairing wounds, and, it may be, remedying the congenital defect known as ' cleft palate.'
Abstracting Blood feom the Palate.
This operation is seldom resorted to nowadays, though at one time it was very fashionable for the relief or cure of the somewhat hypothetical disorder known as ' lampas.' But in certain morbid conditions, blood might be withdrawn from this region with advantage by puncturing the submucous venous network.
A mouth-gag is applied, and the animal's head raised to a hori­zontal position. The operator holds the tongue in the left hand against the right interdental space, and with the right hand armed with a lancet or bistoury, point directed upwards and edge for­wards, a deep puncture is made in the middle line at the fifth or sixth palatine furrow, the cut being extended to about one-third of an inch by bringing the point of the instrument slightly down­wards to that extent. If the operation has been properly per­formed, the haemorrhage in nearly all cases ceases spontaneously in due course ; but exceptionally it continues too long, and then it can be suppressed by placing a pledget of tow saturated with iron perchloride, or a short piece of wood wrapped in a piece of cotton, across the wound, fastening it firmly there by a wide piece of tape brought across the palate, and tied in front of the face and to the head-collar.
Opeeation foe Injuries.
The palate is not infrequently injured accidentally, and the operative procedure to be adopted must depend upon the nature of the lesions. Haemorrhage, if not arterial, may be checked by the application of a haemostatic agent or pressure in the manner just indicated. Covering the dorsum of the tongue thickly with flour, and fastening the jaws together for six to eight hours, has been recommended.
When arterial bleeding is due to opening of the palatine artery, that vessel must be ligatured. In order to accomplish this, the Horse should be cast, the mouth maintained open by a gag, and the vessel exposed and tied.
Opeeation foe Cleft Palate (Staphyloeaphy).
This abnormal condition has been observed in the Equine, Bovine, and Canine species; but the eases recorded are few in number, and operation does not appear to have been attempted, in
-ocr page 65-
OPERATIONS ON THE PALATE.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; 301
consequence of the difficulty in reaching the soft palate, due to the length of the jaws. But before condemning an animal to be destroyed because of this congenital defect, especially if it be of sufficient value to warrant the experiment, an attempt might be made to remedy it by pursuing the course adopted for cleft palate in mankind.
Instruments.—A long curved needle set in a handle, with an eye close to the point, armed with a waxed thread of ordinary suture-silk; a long pair of forceps to seize the thread; long hooked forceps to catch the soft palate; a long narrow-bladed knife to pare the margins of the cleft; small and large scissors ; sponges and water.
Position.—The animal should be placed on its side and anaBsthetised; then the neck should be raised on a stuffed sack and the head turned upwards, the mouth towards the light as much as possible; the jaws are kept wide apart by the gag—a unilateral one is most convenient. The tongue is withdrawn from the mouth and held steadily by an assistant, who, with one on the other side, maintains the head in position. If there is any apprehension of much hemorrhage and the blood finding its way into the trachea, a tampon cannula may be inserted into the trachea.
Technic.—1. The edges of the cleft are slightly pared to make them raw, the cleft portion being made tense at the bottom by the hooked forceps ; the knife is entered close to the forceps, with its back towards the tongue, and carried upwards to the apex of the cleft, and repeating the procedure on the opposite side, a continuous strip of tissue may in this way be removed. 2. The margins are brought together by passing the point of the curved needle with the waxed thread from below upwards, about a quarter of an inch from the edge of the fissure; the thread is caught by the flat forceps close to the eye of the needle, and drawn as a double thread out of the mouth, with the single ends also hanging out; the needle is then withdrawn, leaving the double thread through that edge of the cleft. A similar double thread is passed from below upwards through the other margin, at the same distance from the cut surface, and exactly opposite the first thread. There is now a double thread through each side of the fissure. The left hand loop is passed through the right one, and on pulling the ends of the right thread the left is drawn through the rigbt side. By holding one end and pulling on the left loop, the thread becomes single, and the ends may remain hanging out, one at each side of the mouth, ready, when the other stitches are passed, to be drawn tight and made fast. As many more threads as may be necessary are introduced in a similar manner along the margins, and then each is tied securely, first with a slip-knot, and then with a double reef-knot, to keep the edges in apposition. The threads must not be drawn very tight, as the circulation in the edge of the cleft might be interfered with when the inevitable swelling occurs. If the cleft extends into the hard palate, the
-ocr page 66-
302nbsp; nbsp; nbsp; nbsp; nbsp;OPERATIONS ON THE DIGESTIVE APPARATUS.
mucous and periosteal tissues have to be separated down to the bone close to the alveolar ridge on each side, so as to allow these tissues to be drawn to the median line by suture. Care must be taken not to wound the artery in making these incisions.
In operating on mankind, it is sometimes required to divide the levator palati and the palato-glossus or palato-pharyngeus when these muscles exercise any action on the soft palate during the operation.1
The mouth is to be kept as free from blood as possible.
Aftek-Teeatment.—The jaws should be held together by a muzzle-strap, and the diet must be altogether fluid and very nutritious, so that a smaller quantity will suffice for several days until union between the edges of the cleft has taken place. It is advisable to have the head tied up to the wall, so as to limit movement. At the end of four to six days the stitches may be removed; but to do this the animal must be again laid down, with the head in the same position, though an anaesthetic may not be necessary.
OPERATIONS ON THE SALIVARY GLANDS.
The operations performed on the salivary glands are few in number and seldom required. They are generally related to the ducts of the parotid and submaxillary glands, though disease of the glands themselves may necessitate operative procedure upon them. Operation is demanded in the case of (1) salivary calculi, (2) salivary fistula, (3) glandular abscess, (4) glandular tumours.
1. Salivaey Calculi.
Salivary calculi or concretions are formed most frequently in the duct of the parotid gland (Stenon's duct) and in that of the submaxillary gland (Wharton's duct). In Stenon's duct the calculi are generally observed in Horses and Cattle, in which there may be one, two, or more in one canal; but there is usually-only one, which may acquire the dimensions of a small apple, and weigh as much as twelve or thirteen ounces. When they attain a certain size they can be seen on the cheek; they feel as a hard and somewhat elongated movable tumour situated on the course of the duct, near its opening into the mouth, though in some cases they may be lower down, and as far back as the posterior border of the inferior maxilla. The duct itself is distended behind the calculus, the distension being all the greater if this entirely occludes the canal, and the parotid gland itself may be tumefied. The concretions—for they are nearly always due to the entrance of a foreign body into the duct from the mouth, lime-salts being gradually deposited around it—are generally limited to one side.
Opebation.—When the concretions are small and high up in the cheek, manipulation may successfully push them onwards and
1 Gant, 'Science and Practice of Surgery.'
-ocr page 67-
OPERATIONS ON THE SALIVARY GLANDS.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;303
into the mouth. With this object, the Horse is placed lateri-cumbent, the head and neck raised on a stuffed sack, and the mouth well opened by a gag. The operator makes steady pres­sure upwards on the calculus, so as to force it into the mouth of the duct, where he can seize it with the other hand. If he cannot remove it, a slight enlargement of the mouth of the duct inside the cheek may be made by a sharp- or probe-pointed curved bistoury. quot;When the calculus is large, however, the duct must be opened in order to extract it. The animal should be well fed for a day or two previous to the operation, and a good feed given immediately before it.
Position.—The operation can usually be accomplished while the animal is standing, though, if it be a Horse, a twitch on the nose will be necessary.
Instruments, Apparatus, etc.—Scalpel and forceps, suture-needle and waxed silk thread, collodion, shreds of lint, sponge, and anti­septic solution.
Technic.—1. Remove as much of the hair as possible from the skin on and around the tumour, and have the surface sponged with the antiseptic solution. 2. A transverse or longitudinal incision— the former to be preferred, if convenient—is made through the skin and subjacent tissues down to the concretion, and of sufficient extent to allow of this being removed. 3. Eemoval being effected, the wound is carefully and at once closed by the interrupted or Lembert's suture ; over the wound is painted a layer of collodion, on which are laid in various directions the small shreds of lint and more layers of collodion. The jaws are kept together by a close-fitting muzzle or mouth-strap.
If the concretion has been of such great size as to convert the portion of duct in which it had formed into a capacious cyst, the external pressure of the suture and dressing, as well as the process of cicatrization, may reduce this somewhat. But if the canal in the upper part of the duct is obliterated, then it is evident that another procedure must be adopted; this will be described imme­diately, when treating of making an artificial duct.
Afteb-Tbeatment.—The diet should consist only of thin gruel of flour or oatmeal, first given twelve hours after the operation, and then sucked through between the closed jaws; though water may be allowed to be taken in the same way soon after the operation. The animal should be kept tied up for four or five days, and in six days the muzzle may be removed and hard food allowed. If no saliva escapes from the wound, it may be inferred that it is closed; but there need be no hurry to remove the collodion and the stitches. It is a favourable indication of cure if, before these are removed, the posterior part of the duct is not unduly distended, or has nearly regained its normal size.
Calculi in Wharton's duct are usually removed by manipulation with forceps, and do not require a cutting operation.
-ocr page 68-
304nbsp; nbsp; nbsp; nbsp; nbsp;OPERATIONS OK THE DIGESTIVE APPARATUS.
2. Salivaey Fistula.
(a) Fistula of the Parotid Duct.
Salivary fistulas may occur in connection with the glands, but then they generally heal readily, as in the parotid gland, where they either disappear spontaneously or are cured by simple treat­ment, such as a blister applied to the surface, and the animal fed sparingly on soft food. They are more serious when situated in the gland duct, and by far the most frequent situation is the parotid duct of the Horse, where they are generally due to an accidental injury. The saliva escapes abundantly when the animal is eating, and particularly if the food be dry; and though this loss does not appear to affect the Horse's health to any marked degree, yet the discharge is unsightly and disagreeable, and leads to blemish of the part over which the saliva flows. The usual seat of fistula of the parotid duct is on the cheek at the margin of the masse ter muscle, and towards the inferior border of the lower jaw.
When recent, and especially if the duct is not completely divided, the injury can be remedied by closing the wound in the skin by suture, and following the treatment laid down for healing the incision made for the extraction of salivary calculi. When the wound is contused, or of such a character that the ordinary con­tinuous or interrupted suture cannot be employed, the twisted suture around pins inserted at intervals on each side of the injury may effect the closure of the wound; or the drawing or purse-string suture—made by passing a stout silk thread in a curved needle out and in around the opening, and pulling and tying the ends, so as to bring the edges close to the centre—may be more suitable. The actual cautery or caustics should not be employed to close the wound, as they generally aggravate the case and render it more refractory to subsequent treatment. If the upper portion of the duct is patent and the saliva can enter it, then the suture, collodion or styptic-colloid and shreds of lint laid on thickly and widely, muzzling, and keeping the animal on nutrient gruel for some days, will effect a cure.
When the upper part of the duct is occluded through inflam­matory processes, however, and cannot be opened to allow the saliva to pass into it, then one of four courses can be adopted: (1) Making an artificial canal or opening from the wound into the mouth; (2) ligation of the parotid duct below the wound ; (3) dividing the duct transversely ; (4) destroying the function of the gland.
(1) Making an Artificial Duct.
The Horse must be prepared by good feeding, as he will have to undergo semi-starvation for some days after the fistula has been operated upon.
Opebation.—This is in two parts, the first being the formation of the artificial passage, and the second closing the external wound.
-ocr page 69-
OPERATIONS ON THE SALIVARY GLANDS.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;305
Instruments.—Scalpel and forceps; a long narrow seton-needle or sharp-pointed probe, with an eyehole at the point; a long, thick silk thread, doubled or trebled to form a seton, or a long piece of soft lead wire slightly thinner than a goose-quill.
Position.—The Horse may be operated upon in the standing position, with a twitch on the nose ; or it may be laid latericum-bent, the fistula side being uppermost.
Technic.—1. The seton-needle or probe is passed from the wound upwards, between the skin and facial panniculus, as nearly alongside the occluded portion of the duct as possible, care being taken not to injure the vessels that run in the same direction. When it has reached the point at which the duct opens into the mouth, it must be moved a little laterally, so as to leave room for the passage of the seton or wire, then pushed through into the mouth and withdrawn. 2. The needle or probe, armed with the silk thread or lead wire (though the latter may be passed alone), is pushed up the space thus made, and the point carried into the opening in the mouth, so that the hand, introduced into that cavity through the mouth-gag, can seize the end of the seton or wire and bring it down to the lips, where it can be fastened to a flat button, and then pulled up to the mouth-wound inside the cheek ; the other (external) end, the needle or probe having been withdrawn from it, is cut off close to the fistula and secured in a similar manner.
The Horse may be worked and fed as usual if required, but it will be better to keep him quiet for two or three weeks until the seton or wire shall have formed a semi-indurated passage. Then the operation must be completed by withdrawal of the seton or wire, removal of any indurated non-vascular tissue or cyst-wall from the fistulous wound, and closure of this in the manner already described, followed by the treatment also indicated for open parotid duct.1
(2) Ligation of the Parotid Duct.
When the above treatment is unsuccessful or inapplicable, then recourse may be had to ligation of the parotid duct either on the cheek or behind the lower jaw, according to circumstances.
Operation.—This is simple, but it requires an accurate know­ledge of the anatomy of the region and the course of the duct behind the jaw and over the cheek (see Fig. 342).
Position.—Latericumbent, on the side opposite to that to be operated on ; head raised and extended, and head-collar removed.
Instruments.—Scalpel and forceps; curved blunt needle in handle, with an eye at the point armed with a waxed silk thread.
1 I believe I was the first to perform this operation for the cure of fistulous parotid duct in the Horse so long ago as 1857 ; the ease was completely successful (see the Veterinarian, vol. xxx., p. 388). I was not then aware that a similar operation for this condition had been performed by Hübner on a Cow in 1834. Since the report of my operation was published, it was successfully performed in 1860 by Lafosse, in 1861-62 by Prambolini, in 1861 by Mottet, in 1880 by Morot, in 1882 by Labat, and in 1885 by Nocard.
m\
-ocr page 70-
306
OPERATIONS ON THE DIGESTIVE APPARATUS
Technic(a) Cheek Operation.— Carefully make a straight vertical incision through the skin about one to two inches from the border of the inferior maxilla and slightly behind the glosso-facial artery; cut through the thin layer of panniculus and the connective tissue and expose the duct, which appears as a narrow, white, flat cord. Pass the needle under it, avoiding the vein, seize one end of the ligature, withdraw the needle which carries the other end, and tie sufficiently firm to cause gradual oblitera­tion of the vessel.
(b) Jem Operation.—At the antero-inferior part of the parotid gland, about an inch behind the ascending portion of the lower
Fk;. 342.—Situation and Relations of the Parotid Duct on the Cheek and uehind the Lower Jaw. (After Cadiot.)
A, Tendon of the sterno-maxillaris muscle ; B, parotid gland ; C, post-maxillary portioTl uf duct; D, cheek portion of duct; E, facial vein ; F, facial artery.
jaw and above the tendon of the sterno-maxillaris muscle, make an incision slightly oblique downwards and forwards, and about one and a half inch long, through the skin and panniculus ; carefully dissect through the connective tissue in which the duct is enveloped, expose that vessel, and tie it in the same manner as on the cheek.
Aftee-Teeatment.—No food should be allowed for one or two days except thin gruel, which should be sucked into the mouth, the jaws being held together by the muzzle. Soft food must be given for some time. The parotid gland becomes tumefied soon after the operation, but this subsides gradually, and atrophy commences.
B
-ocr page 71-
OPERATIONS ON THE SALIVARY GLANDS.
307
(3) Division of the Duct.
Transverse division of the parotid duct below the fistula has been recommended and practised, the inflammation supervening on the incision leading to closure of its canal and ultimate atrophy of the gland. But this operation has no advantage over ligation of the duct, which is certainly to be preferred, as it entails less risk and is more certain of achieving the desired object. The operation is the same except that, instead of passing a ligature round the vessel, this is simply cut through.
(4) Destroying the Function of the Gland.
So unsuccessful was the treatment adopted for the cure of fistula of the parotid duct, that for a very long time, in the great majority of cases, suppressing the function of the gland was con­sidered the most advisable course in order to get rid of the annoying escape of saliva. But it is to be hoped that this step is seldom taken now, as the skilled operator can generally effect a cure of salivary fistula without destroying a gland so important to mastication and digestion. But cases may, nevertheless, be met with in which its function must be abolished. This is attained by injecting into the duct, by means of a syringe, any irritant prepara­tion that will destroy its power of secretion without setting up severe inflammation. Of the many which have been so employed, the following have been successful: Tincture of iodine 30 parts, potassium iodide 1 part, water, 69 parts; tincture of iodine and water, equal quantities; a 30 per cent, dilution of alcohol in water ; a 20 per cent, solution of lactic acid. The injection may be made into the duct at the fistula, or at either of the points indicated as those suitable for its ligation, and it may be repeated as often as is desirable, though one or two injections are generally effective.
{h) Fishda of the Whartonian Duct.
Fistula of the duct of the submaxillary gland is of rare occur­rence, but instances are on record, and they have proved so intractable to surgical treatment that extirpation has been neces­sitated. This is a comparatively simple operation when the operator is sufficiently acquainted with the situation and relation of the gland. This is an elongated, flat, narrow body, lying to the inside of the parotid gland at the side of the larynx, slightly curved upwards and forwards, and extending from the wing of the atlas to the commencement of the intermaxillary space.
Opebation.—No preparation of the animal is necessary beyond that required previous to casting.
Instruments.—Only a scalpel and forceps are necessary, with water and sponge, and a suture needle and thread.
-Posjitcw.—Latericumbent, head and neck slightly raised.
Technic.—The head-collar being removed, an incision about three inches long is made through the skin and panniculus, along the inferior border of the gland, in the direction of the glosso-
-ocr page 72-
308
OPERATIONS ON THE DIGESTIVE APPARATUS.
facial vein. Cutting through the connective tissue, the gland is exposed; this is isolated by the fingers tearing it away from its surrounding connective tissue, and lifted outwards, when the fingers of the other hand free it at each end, which is cut through, and the organ removed. The wound may be closed by suture.
Aftek-Teeatment.—Little is necessary beyond keeping the wound clean and allowing soft food for a few days.
3. Abscess of the Salivaey Glands.
Inflammation of the parotid and other salivary glands, leading to abscess formation, is not infrequent, though the parotid is most liable from several causes, some of which are specific. This sup-purative inflammation is witnessed in Horses more particularly; occasionally it is so acute, and the tumefaction is so great in the parotideal region, as to endanger life. The swelling is generally confined to the parotid gland, and the presence of pus may be detected, when it reaches near the surface, by palpation. Then it is advisable to evacuate it by incision, especially if the respira­tion is seriously interfered with, when it may also be necessary to resort to tracheotomy.
Operation.—This must be performed while the animal is standing, and a twitch on the nose may be necessary.
Instruments.—A bistoury, lancet, or scalpel; sponge and tepid water.
Technic.—The skin over the swelling being washed with an antiseptic fluid, a vertical incision from one to two inches in length is made through it at the most prominent part, and the subcutaneous fascia divided with great care, so as not to wound any bloodvessels. The fore-finger is now introduced into the opening, and perforates the gland tissue in order to reach the pus cavity, the other hand assisting by pressing the swelling upwards. The pus usually escapes in a strong jet, owing to the tension, and the operator should stand to one side to escape this. The cavity-should be emptied as completely as possible by syringing tepid water into it, and afterwards a solution of Condy's fluid, carbolic acid, or corrosive sublimate. Or an attempt may be made to remove the pus by aspiration, a small incision being made through the skin, and the needle of the aspirator carefully introduced into the pus cavity.
The same procedure is required when suppuration occurs in the lymphatic glands beneath the parotid.
Afteb-Treatment.—Cleanliness and fomentations with warm water, or poultices, expedite the subsidence of the swelling; the wound is to be syringed out occasionally with tepid water, and injected with a weak antiseptic.
4. Tumours of the Salivary Glands.
Tumours are most frequently met with in the salivary glands of the Horse and Ox, and they are often of new formation ; in the
-ocr page 73-
OPERATIONS ON THE SALIVARY GLANDS.
309
former animal they are usually melano-sarcomatous, and in the latter actinomycotic. They cannot be mistaken for inflammatory tumefaction, because of the absence of abnormal heat and pain, their slow growth, and their outline. When they cause so much inconvenience as to render valuable animals useless or threaten ex'stence, then it may be desirable to attempt their removal by operation. If the tumour is small and has not invaded surround­ing tissues, it may be removed without much trouble; but when extensive and its margins are undefined, its eradication demands
Fig,
343.—Anatomy of the Parotideai, Beoiok. The Skin, Pakotido-aurictlaris Milscle, and Parotid Gland have been removed.
Upper part of parotid gland ; D, digastricus muscle; Sit, stylo-hyoid muscle ; S?iif stylo-maxillaris muscle ; T, thyroid body ; H, posterior border of the hyoid cornu ; 1, eommoii carotid artery; 2, external carotid artery; S, transverse artery of the face ; 4, maxillo-muscular artery ; 5, posterior auricular artery ; 6, thyro-laryngeal artery ; 7, jugular vein ; S, glosso-faciaivein ; 0, transverse vein of the face ; 10, maxillo-muacular vein ; 11, anterior auricular vein; 12, posterior auricular vein ; 13, facial nerve ; 14, anterior auricular nerve.
a more serious operation—possibly excision of the entire gland. The measure is not without risk, and demands considerable operative skill; but it has been repeatedly performed with suc­cessful results. We will deal with total removal of the parotid gland, which has also been effected when that organ was affected with gangrenous sloughing and fistula.
Operation.—A knowledge of the complex anatomy of the paro­tideai region is, of course, essential, as well as manipulative skill.
Instruments and Appliances.—Curved and straight bistouries ; scalpel and dissecting forceps; blunt flat hooks ; scissors; suture-
-ocr page 74-
310
OPERATIONS ON THE DIGESTIVE APPARATUS.
needles and strong silk thread, well waxed ; small round wooden pins ; torsion and bull-dog forceps ; fine antiseptic tow or lint.
Position.—Latericumbent, on the side opposite to the diseased gland. An anaesthetic should be administered, and the head-collar removed after the head has been somewhat elevated by a stuffed sack placed beneath it, which should also make the gland more prominent.
Technic.—According to Degive, the skin over the gland is cleansed and dressed with an antiseptic solution. 1. An incision is made through the skin in the direction of the middle of the gland and the parotido-auricularis muscle, extending from the base of the ear to beneath the glosso-facial vein, the muscle remaining attached to the skin ; the dissection should extend beyond the extremities and sides of the gland. 2. The gland must now be separated as completely as possible, though there are some points where great care must be taken in doing this, as at the base of the ear and at the masseter, where there are blood­vessels and the subzygomatic nerves; but to avoid injury to these a few of the lobules may be left, as they are soon destroyed by subsequent inflammation. In order also to escape damaging the numerous important vessels and nerves in this region, as much of the dissection as possible should be made with the fingers or blunt instruments, such as a director, probe, or the points of closed dressing forceps or blunt-pointed scissors. The posterior auricular vein must be ligatured and divided at an early period in this dissection, and its satellite nerve isolated ; then the anterior border of the gland is dissected from above to below, and to separate this from the subzygomatic vessels and nerves, the superficial connective tissue is divided with the bistoury or scalpel, the separation being completed by the director. In the same way the jugular vein is isolated throughout from the gland; and this being accomplished, the latter is cut into two parts in the middle, one above, the other below, the jugular canal. The dissection of these two portions is completed by cutting through the tissue still attaching them internally and at their posterior border. The inferior portion is detached from above to below, but the superior half is removed from below upwards, avoiding (1) the four branches of the carotid—external carotid, temporal and internal maxillary, and posterior auricular; (2) the two nerves, superficial temporal and facial, with its three divisions; (3) the guttural pouch contiguous to the upper end of the gland.
The small vessels which may be divided during the dissection are ligatured or twisted, according to their size ; and by frequent sponging during the operation, or applying pads of fine tow or lint to bleeding surfaces, the haemorrhage that might embarrass the operator is checked.
The wound is dressed with an antiseptic solution and powdered with boric acid or iodoform, then filled with fine tow or lint, and the margins brought together by temporary or quilled suture.
-ocr page 75-
OPERATIONS IN THE PHARYNX.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; 311
Apteb-Teeatment.—In one to two days after the operation the dressings will probably require renewal, when the sutures may be relaxed or removed and the former dressing repeated; though, if the wound appears to be healthy, the lint or tow need not be applied, dry dressing being carried out by the use of boric powder or iodoform, or a mixture of both. If, however, there is much discharge, this may be absorbed by keeping pledgets of carbolised tow or lint in the wound, the lower end of which must be left open; a drainage-tube may be advantageously employed if the discharge is very profuse. As it becomes dimin­ished and the wound drier, the lint may be discontinued and the surface dusted with a mixture of iodoform and powdered starch (1 to 2). This will form a crust that should be allowed to remain until the wound is healed, which, under favourable circumstances, may be in about a month.
The diet for the first week or two should be soft and require little mastication.
OPERATIONS IN THE PHARYNX.
Operations in the pharynx are usually necessitated by the presence of foreign substances, abscess, or tumours in that cavity. The foreign bodies are most frequently noted in the pharynx of Dogs and Cats, and generally find their way into that cavity with the food; in Cattle they are not uncommon, and may be pieces of unmasticated food, as well as various objects of a non-assimilable kind ; while in Horses they are rare, and may be masses of solid food or other matters which cannot be passed into the oesophagus.
Abscesses may form in any part of the pharyngeal cavity, but they are usually most serious when located at the back of that space, constituting what is known as post-pharyngeal abscess. Collections of pus also form in the guttural pouches, and when they are large they unite and project as one mass into the pharynx, interfering with deglutition, and possibly respiration.
The tumours may be benignant or malignant; they are usually located towards or upon the posterior wall of the pharynx.
The diagnosis will rest upon the history of the case presented : the gradual or sudden development of symptoms, the character of these, and the evidence furnished by a manual examination and possible ocular inspection. The symptoms will depend upon the situation, nature, and volume of the body, and are related to mastication, deglutition (or suspension of that act), and respira­tion.
Opbeation.—This will depend upon the evidence afforded by an examination of the pharynx. Masses of food or foreign bodies may be removed directly by hand or with the aid of instruments, the mouth being maintained open by the double-sided or unilateral gag in the larger animals, the operation being carried out in the standing or recumbent position, according to circumstances.
Abscesses in the pharynx may be opened in the usual way
#9632;
-ocr page 76-
312nbsp; nbsp; nbsp; nbsp; OPERATIONS ON THE DIGESTIVE APPARATUS.
when accessible, and if their spontaneous evacuation cannot be waited for. This may be effected in the standing position or latericumbent, the mouth being kept open with the gag, and the incision made with the bistoury cachée, or a long straight-pointed bistoury, the whole of the blade of which is wrapped in tow except about half an inch of the end.
Post-pharyngeal abscess, due to an accumulation of pus in the guttural pouches, may be evacuated by an external operation to be hereafter described when dealing with operations on the respiratory apparatus, or through the mouth.
The Horse is secured, the mouth-gag applied, and the operator having satisfied himself that the swelling is due to pus, the point of the bistoury is pushed into its centre, in the middle line of the posterior wall of the pharynx, so as to avoid the carotid arteries on each side. Little has to be done after the pus escapes, and the wound soon heals.
In cases of tumours in the pharynx, the operative treatment must depend upon their nature, form, and seat. In the larger animals, and especially the Horse, their removal is difficult because of the length of the mouth. If pre-epiglottidean and having a narrow pedicle, their excision is less embarrassing than when they are lateral or post-pharyngeal and grow from a wide base. In these animals operation must generally be considered serious because of these circumstances. The position should be latericumbent, and anaesthesia greatly facilitates the procedure. The head and neck are suitably raised, and the hand introduced into the pharyngeal cavity, where the tumour may be seized by the fingers and possibly torn or twisted off, or surrounded by the chain or wire of the ecraseur, or incised by a bistoury cachet or obstetrist's finger-ring knife. Should there be danger of suffo­cation during the operation, which is more especially to be appre­hended when the tumour is post-pharyngeal, tracheotomy ought to be previously practised.
In some cases of post-pharyngeal tumour, when it is inferior, it may be removed by the ecraseur through the larynx, the interior of which may be reached through an opening in the crico-thyroid ligament, or, better still, by incising two or more of the upper rings of the trachea, respiration having been ensured by the in­sertion of a tampon-cannula in that tube, as in the operation of arytenoidectomy (which see).
The subsequent treatment must depend upon the extent and seat of the operation, and the diet ought to be soft or fluid food until the soreness has disappeared and swallowing is easy.
OPERATIONS ON THE (ESOPHAGUS.
Operations on the oesophagus are much more frequently re­quired, especially with Cattle and Horses, than those in the pharynx, owing to the narrowness and great length of this tube and its special function. The fact that a large portion of the tube
-ocr page 77-
OPERATIONS ON THE (ESOPHAGUS.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp;313
is inaccessible externally, from its lodgment in the thorax, also militates against operative procedure in that region, though in the cervical region it is easily reached.
Operations are necessitated when (1) food or foreign bodies have become impacted in it, (2) in cesophagotomy, (3) for fistula, (4) for constriction or stenosis, (5) for sacculation, (6) for rupture, (7) for disease, (8) in catheterism.
1. Operation for Impactment.
Impactment may occur at any part of the oesophagus, but it generally takes place at its upper part near the pharynx, before its entrance into the thorax, and at or near the diaphragm. The obstruction or impaction may be due to food, or to foreign bodies of different kinds, -which, from their roughness, hardness, angu­larity, or sharpness, become very firmly lodged, and wound the walls of the tube, while they necessitate more varied and careful procedure for their removal. This is the case most frequently in the Cow.
The symptoms of impaction, or ' choking' as it is popularly termed, are usually well marked. Mastication ceases, and the animal makes gulping or choking movements with the head and neck, which are extended, while there is frequently an urgent cough, and the countenance betrays anxiety and distress. There may also be repeated attempts at vomition, and if the obstacle is large in volume respiration is seriously interfered with. Salivation may be profuse, and as it is usually impossible to swallow, any fluid taken by the mouth is either ejected again or returned by the nose along with saliva and mucus. The symptoms are most urgent when the obstruction is near the larynx, and when in the cervical portion of the tube the obstruction can usually be seen ; when the thoracic section is blocked, diagnosis is not so easy; but when fluids are swallowed, they accumulate in the tube until it is distended for some distance up the neck, and this leads to a suspicion of occlusion. There may be abdominal tympanites in the Horse, but this is the rule in the Bovine species, in which the rumen soon becomes greatly inflated with gas, while there is champing of the jaws, violent cough, and salivation. Tympanites in the Ox, if not soon relieved, quickly leads to grave conse­quences by interfering with respiration ; though death by suffoca­tion, through pressure on the trachea, is usually the termination of choking when relief is not obtained.
Of course, operation will not be undertaken until ample time has been allowed for the obstacle to be overcome by natural effort, by external manipulation on each side of the oesophagus after administering water, oil, or mucilaginous fluids, pressing the substance gently upwards or downwards, or kneading it if it can be softened. It must be remembered that, if successful in raising the obstacle into the pharynx, especially in the Horse, the soft palate prevents its passage to the mouth, so that the hand must
-ocr page 78-
314nbsp; nbsp; nbsp; nbsp; nbsp;OPERATIONS ON THE DIGESTIVE APPARATUS.
be introduced into that cavity to remove it. When a sufiBcient time has elapsed and these measures fail, a dose of pilocarpine may assist in effecting removal; but if there is danger, as is more especially the case when the substance is lodged in the thoracic section of the tube, then it may be necessary to attempt me­chanical removal by means of the cesophageal catheter, sound, probang, or forceps. Indeed, if the symptoms are urgent, it may be necessary to have recourse to these at once, and especially if the obstructing substances are hard, of large volume, and cannot be promptly removed otherwise.
In operating on the oesophagus, it is necessary to remember that it is longer and narrower in the Horse, comparatively, than in any other of the domesticated animals, being from fifty to sixty inches in length, according to the size of the creature; its walls are also thicker, and near the stomach become very strong. In its course down the neck, about the middle, it deviates to the left side, but regains the middle of the trachea after it enters the chest; in very rare instances this deviation is to the right side. The foramen in the diaphragm through which it passes to the stomach, and the great thickness of its walls at this part, offer the strongest resistance to the passage of hard bodies of any unusual size ; in addition, it would seem that the muscular coat not only at this point, but throughout its whole length in the Horse, be­comes spasmodically contracted behind the obstructing substance. Besides all this, the mucous membrane at the junction of the oesophagus with the stomach is thrown into a number of large longitudinal folds, which increase the resistance to the entrance of any body unusually large.1
In Bovines the oesophagus is slightly constricted a little above its middle, and below this it becomes wider and thinner; in Ovines there is no constriction in the middle, the walls are comparatively thin, and gradually become more so as the tube descends; in the Caprine species there is a constriction in the middle of its length; in Swine there is also a constriction in the same part; in Dogs there are three constrictions; in Cats two, top and bottom.
1 Nevertheless it is sometimes astonishing to find Horses swallowing compara­tively large objects without sustaining any apparent damage at the time. A memorable instance of this occurred in my own experience, while serving with the 2nd Life Guards. When being groomed, a troop Horse swallowed the cast-iron weight (log) that is fastened to the end of the head-collar chain to keep it down, and which happened to be lying in the manger, detached from the chain. This article is circular in outline, flattened on both faces, and round at the circumference ; it weighs 1J lb., measures 24 inches in diameter and If inch in thickness, and has a perforation in the middle for the T of tl'6 chain to pass through. The first indications the animal gave that it had ingested this large and heavy object were the extraordinary movements of its head and neck, which were described to me as ' serpentine,' and the frightened look. The trooper ran for the Farrier-Major, and when the latter arrived the Horse did not seem amiss, but there was a quantity of saliva in the manger. It was when about to secure the Horse by his head-collar that the log was missed, and of course it could not be found. The animal remained in good health while I was in the regiment, and though laxa­tive medicine and food were given for some days after the accident, the log was retained.
-ocr page 79-
OPERATIONS ON THE (ESOPHAGUS.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; 315
Horse.
Instruments mul Appliances.—One or all of the instruments above-named, as well as a wire snare, mouth-gag, one or two twitches, some oil or grease to lubricate the instruments, and thin gruel to administer before or during the operation.
The ordinary Horse probang (Fig. 34:4) is about six feet in length, with a handle at one end and a conical concave expansion at the other, the stalk being of cane or whalebone for flexibiUty; but in cases of emergency a useful probang may be extemporised by employing a piece of stout rope six or seven feet long, or a whip-handle. Other forms of probangs are in use, and will be referred to when treating of impaction in Bovines.
When the obstruction is at the upper end of the oesophagus, and cannot be reached by the hand or pushed upwards by ex­ternal taxis, a snare or loop of one-eighth inch wire, fastened to the end of a cane or probang, may be passed over it, so as to pull it forwards into the mouth.
Position.—The probang can sometimes be passed into the oesophagus of the Horse in the standing position, with a twitch applied to the nose or ear and a gag in the mouth; but it is generally necessary to place the animal latericumbent.
^
6 FEET
Fiii. ^44.—Hor.sk Probang.
Technic.—Whether the animal is standing or lying, the head and neck must be extended as much as possible, so as to bring them into a straight line. The mouth-gag is applied, and the probang, well oiled, is carried back in the mouth, guided carefully over the epiglottis and into the oesophagus, down which it is steadily but gently pushed until it reaches the obstacle; upon this moderate and intermittent pressure downwards is to be made. If the obstruction is in the cervical portion of the tube, an assistant may usefully aid the probang by employing taxis with both hands on the substance at each side of the neck. Should the body remain immovable, the probang may be removed, a small quantity of oil or gruel administered, and the attempt to push it downwards again resumed.
It has been recommended to employ the probang fitted with spring forceps (Figs. 349, 350) or with the corkscrew (Fig. 348) when the substance cannot be displaced by the ordinary probang, and is hard or sufficiently dense to be penetrated and held by the screw; and in certain cases this recommendation may be accepted, as the assistant can render much service in enabling these instru­ments to seize the substance by holding and steadying it until they get hold of it; if they cannot withdraw it, they may serve the very important purpose of crushing or breaking it, and so allowing
21
#9632;
-ocr page 80-
316nbsp; nbsp; nbsp; nbsp; nbsp;OPERATIONS ON THE DIGESTIVE APPARATUS.
the fragments to be passed either up or down. quot;When the obstacle is in the thoracic section of the oesophagus, it is obvious that the operator must be at a great disadvantage, and such cases are very serious if the obstacle cannot be easily moved through the diaphragmatic foramen into the stomach.
Ox.
In this animal choking is of comparatively frequent occurrence, not only from the fact that the cesophageal canal gradually becomes smaller from its commencement to the bottom part of the neck, but also from the kind of food given, more especially roots, such as turnips. The symptoms presented are similar to those shown by the Horse, with the addition of abdominal tym­panites, which is rapidly developed, and is due to retention of the gases normally generated in large amount in the rumen, and which always escape through the oesophagus, but now distend the viscus and the intestines to such a degree as to produce suffo­cation if not liberated. This is achieved by the operation of rumenotomy (which see).
Operation.-—If the foreign body is fixed towards the entrance to the oesophagus, it may be pushed into the pharynx by external taxis on each side of the neck, immediately behind the substance, the operator standing on the left side of the animal with his right arm over the neck, the head being left free. In this way the obstruction may be loosened and pressed forward. Or the mouth-gag is applied, and the hand, introduced into the mouth and pharynx, may seize the object and remove it, care being taken not to obstruct the larynx for more than a few seconds.
When the substance is lower down the neck, taxis should still be attempted, with the view of pressing it up into the pharynx, and making the animal swallow a small quantity of oil or other lubricant may assist in effecting this manoeuvre. But it must be remarked that in practising taxis at any part of the cervical portion of the oesophagus, the greatest circumspection must be observed if the object to be removed is angular or sharp, other­wise serious injury may be inflicted. It should also be remarked that certain substances can be kneaded externally, and so worked with oil or gruel into a soft or yielding mass that it can be moved upwards. When the object is hard and in the upper part of the oesophagus, the wire snare already described may be tried.
If these measures fail, owing to the obstruction being too low down the tube or too firmly fixed, then the oesophageal sound or probang must be used if the substance is not likely to lacerate the walls when pushed downwards.
As with the Horse so with the Ox, an oiled whip-handle or a piece of rather stiff rope well greased, and passed through the mouth into the oesophagus, may be employed in cases of emer­gency when no better appliances are at hand. The tongue should be wrapped in a cloth and held to one side by an assistant, who
-ocr page 81-
OPERATIONS ON THE (ESOPHAGUS.
317
also keeps the mouth open while the rope or whip-handle is introduced.
But the usual appliances are a mouth-gag and probang, and, if need be, the oesophageal forceps.
The mouth-gag used for the Horse may be employed, but that for the Ox is usually a piece of wood with a hole in the centre
Fie:. 345.—Mouth-Gao for Ox. Pattern.)
(Ordinary
Fin. 348.—Mouth-Gao for Ox. (Annatage's Pattern.)
and a handle at each side, to which a cord or strap is attached, and which is passed over the head (Figs. 345, 346).
The ordinary probang is larger than that used for the Horse, and is similar in construction, being formed of spiral wire (Monro's pattern) covered with leather, and furnished with a cane Stilette (Fig. 347). This probang may be fitted with a portable screw, or a special probang with that instrument fixed in it is used for
SFEET LONG.
Fio. 347 —Monro's Cattle Probaso.
6 FEET
Flo. 348.—Cattlf, Phobano fitted with Corkscrew.
screwing into the obstruction (Fig. 348), and withdrawing it in the same way as a cork is extracted from a bottle. The forceps probang is safer and more useful, the forceps being concealed in the expansion at the end; when the obstruction is reached, the forceps is pushed out by the handle, and the jaws spring open around it; these being toothed or hooked, take a firm hold, which can be increased by slightly drawing back the handle.
.
-ocr page 82-
f^
318
OPERATIONS ON THE DIGESTIVE APPARATUS.
A French model, Baujin's (Fig. 349), serves the double purpose of the ordinary probang and forceps probang by merely reversing the ends. This, like the preceding instrument, is a long tube formed by spiral iron or steel wire to constitute a flexible rod, which is covered with leather, having at one extremity the pro-
Fio. 8-19.—Banjin's Cattle Pbobanc.
A, Exterior of tho instrument, with the end, 6, unscrewed. B, Interior, showinpt a running ring which closes or relaxes the spring hooks around it. p, inside of which is the part for the sound, b, to be screwed on c'; m, the part into which the spring hooks are implanted ; g, ff, a flexible rod, one end of which screws on c', the other having a ball, and which serves as a Stilette lodged in the tube ; I, a funnel-shaped expansion for pushing obstructing bodies onward ; (, the spiral wire.
peiling end (an expanded hollow piece of metal), and at the other a metal screw fixed on the leather, on which may be screwed either a sound or a piece consisting of six hooks, which can be brought close together or widely separated by means of a ring that is acted upon by a long stilette screwed into this apparatus and moving freely inside the tube.
-ocr page 83-
OPERATIONS ON THE (ESOPHAGUS.
319
An English forceps probang (Fig. 350) is similar in principle, though only one end is utilised; instead of having six spring hooks, however, it has two serrated or toothed blades, that are acted upon by a rod moved inside the probang by a handle at the opposite end.
In Germany there is a forceps probang in use not unlike this— the model of Delves and Hertwig.
Position.—Standing, with the head extended in a line with the neck by two assistants, or, better, the head elevated to a con­venient height by a rope round the horns and passed over a beam above the animal, the nose being extended.
Technic.—The mouth-gag is placed between the jaws and fastened behind the horns, the probang, well oiled, is passed through it over the tongue and carefully into the pharynx and oesophagus, avoiding the laryngeal opening immediately beneath that of the oesophagus, and entrance into which will immediately induce violent coughing and efforts to breathe. Entering the oesophageal canal, the instrument is pushed steadily on until it comes in contact with the obstruction, when it should be more firmly, but intermittingly, pressed or tapped onwards ; great force must not be employed. In the cervical region the hands of an
4
u
IRHOLD JLSONS
Fio. 35C.—English Oesophageal Forceps.
assistant manipulating externally may assist in displacing the body; or the probang may be withdrawn after a brief attempt, the animal allowed to rest a few minutes, then some oil or gruel administered, and another trial made if there is any expectation of success. The movement of the obstruction is made evident by the progress the probang makes, owing to the diminution of resistance, and the final cessation of this when the end of the instrument enters the stomach. If there are indications, how­ever, that the substance cannot be pushed onwards, or that it is dangerous to attempt this, then the corkscrew or the forceps probang must be tried.
The first is passed down to the obstruction like the ordinary probang, and when it is firmly placed against it, the handle is turned in the direction to project the screw into the substance, so as to obtain a good hold of it; the instrument is then steadily withdrawn, the hands of an assistant placed on each side of the oesophageal furrow aiding in carrying the mass up the neck.
The forceps probang is more likely to be effective in the removal of bodies, whether sharp or angular, solid or semi-solid, than the corkscrew, and, indeed, should be the first tried. It is passed down the oesophagus until the wide end touches the obstacle, the
-ocr page 84-
320
OPERATIONS ON THE DIGESTIVE APPARATUS.
handle being drawn back; on contact with the substance to be removed, the handle is pushed down by one hand, the other holding the probang, and attempts are then made to make the jaws now extended obtain a good hold; when this is effected, the hold may be tightened by pulling the handle out to a certain extent, and then the instrument can be withdrawn in the manner suggested when using the corkscrew probang.
It is taken for granted that there is time for these attempts to be made, and that the tympanites, which always begins early, has either not proceeded to a dangerous stage or has been relieved. If there is great inflation of the stomach and intestines, so that respiration is impeded, then rumenotomy should be performed before any attempt at catheterism is made. And even in cases in which abdominal distension is not serious when these attempts begin, and the obstruction cannot be readily removed, it is neces­sary to allow the gases in the rumen to escape by puncture of that viscus; then administer a quantity of gruel or oil, and wait for some time, as it has frequently happened that the obstructing substance has passed spontaneously into the rumen after a variable period.
If all these measures fail, and the obstacle is fixed in the cervical portion of the oesophagus, then recourse must be had to cesopha-
-laquo;-vr.^a^lKS^^^^KS
ARNOLD a SaNSLONDOt:
Flo. 351.—Calf PROBAXf:,
gotomy, an operation which will be described presently. But if the obstruction is in the thoracic portion, this operation cannot be resorted to, and little can be done except carefully administer­ing oil or thick linseed gruel in small quantities at a time, and waiting for these to soften and disintegrate the substance, keeping the wound in the rumen open to allow the gases to escape as they are generated. A solution of veratrine subcutaneously administered might be tried, as it acts upon the muscular coat of the oesophagus, inducing spasms of its fibres.
Impaction of the oesophagus sometimes occurs in Calves, and must be treated in a similar manner; but the probang used is, of course, much smaller and shorter (Fig. 351), and the handling must needs be gentler.
Carnivora.
Foreign substances are more frequently lodged in the pharynx than the oesophagus of these animals, and the symptoms are usually well marked. Before operative procedure is adopted, if the obstruction cannot be removed through the mouth by means of forceps, a solution of apomorphine subcutaneously adminis­tered may lead to its dislodgment. If the substance can be felt in the neck, and it be not sharp or angular, taxis may move it upwards, or a wire snare may be passed down the oesophagus
-ocr page 85-
OPERATIONS ON THE (ESOPHAGUS.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; 321
from the mouth ; but a long probe or small catheter should not be employed to push the obstacle downwards unless it is smooth on the surface. As a last recourse oesophagotomy should be performed.
Pigs.
Pigs rarely suffer from choking where they are carefully fed; but according to Möller, who quotes from Lothes, when they are roaming in great droves, and are fed on potatoes and roots, pieces of these frequently lodge in the pharynx or oesophagus. When fixed in the pharynx, they produce the usual symptoms, a very marked one being a screaming or shrieking noise instead of the natural grunt; when in the oesophagus, vomiting is induced, and the offending substance may be dislodged during this act, but if retained tympanites ensues, which may lead to asphyxia. If the animals are lean, the substance may be felt in the region of the pharynx or neck, and assistance must be afforded timeously, though little can be done if the animal is fat. External taxis may move it into the mouth, or if in the pharynx or slightly below it, the wire snare or a blunt hook may succeed in drawing it forward; if lower down, a small probang or flexible rod may push it into the stomach, mucilaginous fluids being given in small quantity at the same time. Under certain conditions, oesopha­gotomy can be successfully performed on the Pig.
Fowls,
Sometimes the crop of fowls, from various causes, becomes impacted with food, or with feathers or other foreign substances that remain there, and produce serious symptoms which may terminate in death, if this diverticulum of the oesophagus is not emptied. The crop is greatly distended, and may feel hard and nodulated. Pressing it gently and kneading its contents with the fingers, at the same time giving small doses of hydrochloric acid, as suggested by Zürn, may succeed in getting rid of some substances, but will be of no avail with others.
I have on several occasions successfully opened the sack by means of a sharp knife, and removed the contents (usually feathers) with forceps. The incision need not be large, and can be closed by several fine sutures.
2. (ESOPHAGOTOMY.
This operation is resorted to when foreign bodies are so firmly fixed in the cervical portion of the oesophagus that they cannot be otherwise removed, or when, from their form, it would be dan­gerous to push them upwards or downwards, because of their lacerating the walls of the tube; it is also performed on other occasions. Incision of the oesophagus has been successfully and repeatedly practised on the Horse, Ox, Dog, and Pig; and the operation itself is not at all difficult, especially if the impacted body forms a prominence on the side of the neck. Otherwise, it
-ocr page 86-
322
OPERATIONS ON THE DIGESTIVE APPARATUS.
is well to remember the anatomy and relations of the cervical portion of the tube, which, for convenience of description, is divided into three sections—upper, middle, and lower.
It has already been stated that in the Horse, at its commence­ment, the oesophagus is immediately above or behind the trachea, where it is comprised between the guttural pouches and the posterior crico-arytenoid muscles; in the cervical region (Fig. 352) it is enveloped in an abundance of loose connective tissue, which lightly attaches it to adjacent organs, its relations to which vary
Fig. 852.—The Ckrvicai, Portion of the (Esopiiaous, and SOME ok it.s Relations in the Neck. (After Peuch and Toussaint.)
A, A, Jugular vein ; B, sterno-maxillaris muscle ; C, Carotid artery ; D, oesophagus; E, trachea ; F, F, subscapulo-hyoideus muscle ; G, mastoido-humeralis muscle ; H, parotid gland.
on its course. Superiorly, to about the middle of the neck, it lies on the trachea, with the longus colli muscle above it, and on each side the common carotid artery and satellite nerves (pneumo-gastric, inferior laryngeal, and sympathetic), also the jugular vein ; at the middle third it begins to deviate to the left, and this deviation becomes most marked in the inferior third, continuing in this position after its entrance into the thorax ; at its lower third it has the trachea on its right or inner side, and occupies a sort of triangular space (apex forwards), formed above by the lower border of the subscapulo-hyoideus and laterally by the
-ocr page 87-
OPERATIONS ON THE (ESOPHAGUS.
323
sterno-maxillaris and inferior scalenus muscles, with the above-mentioned vessels and nerves, all of which are covered by the cervical panniculus muscle and skin.
In operating for impaetion, the place selected must depend upon the seat of obstruction, and when this forms a prominence the incision may conveniently be made over it. Otherwise, if
Fig. 353.—The Usual Situation for (Esophaootomv. (After Cadiot.) a, Trachea ; b, carotid artery; c, oesophagus.
there is any choice of situation, the incision is made on the left side, in the jugular furrow, about the junction of the middle and lower third of the tube, and slightly above and behind the jugular vein.
Instruments and Appliances.—A straight and a curved bistoury, grooved director, dissecting and longer forceps, handled tenaculum or aneurism-needle, suture-needle, and fine carbolised catgut.
-ocr page 88-
324
OPERATIONS ON THE DIGESTIVE APPARATUS.
Position.—The larger animal, can be operated on in the standing position ; the Horse, if necessary, with a twitch on the nose, and the opposite fore-foot may be held up, or one or both fore-feet can be secured by a line or hobbles, if the animal is inclined to be troublesome. The Ox can be secured by holding the head firmly and applying the ' bull-holder' to its nose; and the smaller animals may be placed latericumbent, and raised on a bench or table.
Technic.—The Horse will be the animal more particularly referred to, though a similar procedure will be suitable for the Ox.
There are two procedures, one of which aims at making a small incision directly through the wall of the oesophagus, dividing the obstructing body if it can be cut, and pushing the pieces up or down the tube; in the other, the tube is also incised, the wound being sufficiently large to allow the obstructing sub­stance to be withdrawn through it. In both the first stage of the operation is the same.
First Procedure.—-An incision is made through the skin—which may have had the hair removed from it for some distance pre­viously—on the left side of the neck, near the border of the mastoido-humeralis muscle if possible, and immediately in front of or below and parallel to the jugular vein, the situation of which can readily be ascertained by causing the blood in it to fiow up and down by pressure of the fingers. It is generally recommended that the incision be made above or behind the jugular vein, but below it is preferable. The incision may be from three to five inches in length, according to circumstances, and is most safely and promptly made by raising a transverse fold of skin of the requisite depth and snipping it across with scissors, or passing the curved bistoury through its base and cutting outwards. The panniculus is divided in the direction of its fibres, and the subscapulo-hyoideus muscle also must be cut through if it crosses the part. The wound is kept open by the fingers of the left hand, which also keep away the jugular vein while the connective tissue is cut through and that which surrounds the oesophagus is incised; there should be no tearing of this tissue by the fingers, as is generally recommended. The position of the carotid artery is ascertained by its pulsations, and the oesophagus can scarcely be mistaken, even when it is only slightly dilated by the obstruction, though it has not the same appearance in the dead animal that it has in the living one, in which it is flaccid, soft, and readily movable, though always pale. Being exposed either behind or at the side of the trachea, the fore-finger is passed round it and detaches it from that tube for a little distance, but no more than is absolutely necessary, and it is drawn outwards. Curved scissors may now be passed below it to keep it out, and a straight scalpel or tenotomy knife is passed into it lengthways, and into the obstructing substance—if this be potato, apple, turnip, or other similar body—nearly to the opposite side, though care must be
-ocr page 89-
OPERATIONS ON THE (ESOPHAGUS.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; 325
taken not to wound this. A curved or probe-pointed bistoury is introduced alongside the tenotome, which now serves as a director, until it reaches the opposite wall, when the tenotome is with­drawn, and the substance is divided by moving the edge of the bistoury against it in the easiest and most convenient manner.
The fragments of the substance can then be passed downwards by the hand or probang, or they may glide down spontaneously. The incision in the cesophagus is scarcely longer than the breadth of the knife, and it often heals rapidly.
Second Procedure.—This is carried out in the same manner, so far as the exposure of the cesophagus and its incision are concerned. The tube has in some cases to be carefully opened if the incision is not made immediately over the foreign body, or the shape of this is not favourable for a direct single cut through its wall. The curved scissors being placed behind and across the portion of cesophagus to be opened, this is held firmly against them by the thumb and first finger of the left hand while the knife in the right carefully makes a small longitudinal incision through the muscular and mucous coats; into this a grooved director is passed, the groove outwards, and along it the bistoury is run so as to enlarge the incision in the same direction to the necessary length. The foreign body is now removed and the wound sutured, the material being fine catgut. Some authorities are of opinion that the wound in the mucous membrane should alone be closed by suture; others advise that, after this is done, the mus­cular coat should also be dealt with in the same way; while others recommend that the skin wound also should be closed by strong silk or wire sutures. Much will depend upon circum­stances, but it will generally be found that closure of the opening in the mucous membrane to prevent leakage is sufficient, as the wound in the muscular coat has a tendency to close spontaneously and at once. Suturing the skin is not very advantageous, as primary union of it is scarcely possible.
The operation should be performed as quickly, and with as little laceration and bruising as possible. Should there be a pouch at the bottom of the skin wound likely to lodge discharge, the wound must be enlarged downwards, so as to efface it. A bandage may be placed round the neck to keep the wound clean.
After-TeeATMENT.—No food or water should be allowed for twenty-four hours after the operation, after which water and damp chopped hay may be given for some days; and if the wound is healing favourably, and there is no leakage of water or saliva between the sutures—which need not be removed—then pul-taceous food in small quantities at a time can be ingested until recovery is complete, so far as the oesophagus is concerned.
The wound is to be treated antiseptically as far as possible, and should pus form, this must be got rid of by a counter-opening.
#9632;
-ocr page 90-
326
OPERATIONS ON THE DIGESTIVE APPARATUS.
3. Opebation foe Fistula of the (Esophagus.
In consequence of foreign bodies in the oesophagus causing injury to its walls, as a result of disease or injury, or of the above-described operation, one or more fistulous openings may appear at any point of its cervical portion, and not infrequently after the formation of an abscess. The existence of oesophageal fistula is rendered evident by the escape of saliva, mucus, water, and sometimes fine particles of food mixed with these.
Operation.—CEsophageal fistula is often very difficult to cure, the difficulty being increased by its situation, as when in con­nection with the pharynx.
The animal should be well fed for some days, to enable it to dispense with food during a certain period after operation; the fistula should then be opened out by the knife, its track scarified, and, if necessary, the wound closed by catgut suture. If the situation renders the use of the knife hazardous, the fistulous track may be cauterised or treated with a strong solution of cor­rosive sublimate. A large layer of collodion should also be painted over the opening afterwards.
After-Teeatment.—The animal must be compelled to fast for two or three days, its jaws being kept together by the strap muzzle, so as to check the secretion of saliva and hinder de­glutition.
4. Operation foe Constriction (Stenosis) of the (Esophagus.
Cases of constriction of the oesophagus in Horses are on record ; it may be due to several causes, and it gives rise to difficulty in swallowing, impaction of the tube with food, and usually results in emaciation, debility, and death.
Operative treatment must largely depend upon the cause of the stenosis and its seat, and also whether it is due to internal con­traction or external pressure. Passing the sound will fix its location with tolerable certainty; and if this is in the cervical portion, manipulation will ascertain whether an external cause, such as a tumour, enlarged gland, etc., is producing the stoppage in the tube. It may be possible to dilate the oesophagus at the narrow portion, if the constriction is owing to contraction of the tube itself, by passing a sound sufficiently small through it fre­quently and carefully, gradually enlarging the instrument as the lumen widens. An accessible tumour may be removed, and it may even be advisable to perform oesophagotomy if there is reason to believe that a growth, parasites, or any other cause, is fixed in the interior.
5. Operation foe Sacculated (Esophagus.
The oesophagus sometimes becomes pouched or sacculated (ectasia) when the muscular coat has been ruptured, the lining membrane passing through the rupture and constituting an oesophagocele, into which fluids and solid food may pass. It
-ocr page 91-
OPERATIONS ON THE (ESOPHAGUS.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; 327
maybe the result of stricture, of impaction, of laceration by the probang, or of external injury ; it may also be very extensive, so as to form a large diverticulum that will contain some pints of fluid, and in other cases it is small and well defined, though it has always a tendency to enlarge. It occurs most frequently in the thoracic portion of the tube, and when it is observed in the cervical part it is usually towards the lower end of the neck. It is only in the region of the neck that it can be made amenable to surgical treatment, and here its presence is manifest, so that there need be no difficulty with regard to diagnosis; as after feeding it increases much in size, and gradually diminishes after­wards.
The animal usually feeds slowly, as deglutition is retarded, and there may be symptoms of choking from pressure on the trachea, while attempts at vomiting are sometimes witnessed, especially if the sac be manipulated when full; this may also evoke symptoms of dyspnoea.
Opeeation.—-As mentioned, it is only when the oesophagocele is situated in the neck that operation can be attempted.
Posiitora.—Standing or latericumbent, the latter being prefer­able, as the operation may be troublesome and occupy some time.
Instruments.—The same as for cesophagotomy.
Technic.—-The procedure is the same as for oesophagotomy, so far as exposure of the sac is concerned. If the diverticulum is small comparatively, then the extruded mucous membrane should be carefully passed intact through the muscular rupture into the oesophageal canal. The edges of the muscle-wound are then to be brought together either by continuous fine catgut suture, or by a number of points of suture placed near each other. If the oesophagocele has been in existence for some time, it will be necessary to make the edges of the wound a little raw before applying the suture.
If the sac is very large and the loose mucous membrane difficult to return into the tube, or, when returned, if it is likely to hinder the passage of food, then the superfluous portion of the membrane should be excised and sutured with the fine catgut, and the open­ing in the muscular coat also closed by suture.
After-Treatment.—This will be the same as for oesopha­gotomy. Food must be withheld for two days and only water allowed, the strap muzzle being worn. A bandage should be applied to the wound in the shape of a glue or pitch plaster to support the sutures during swallowing; a thick layer of collodion will answer the same purpose, but whether this or the plaster be employed, it should afford support on both sides of the oesophagus at this point.
6. Operation for Euptuee of the (Esophagus.
Complete rupture of the oesophagus may occur as the result of accident or disease, and can only be dealt with if it is in the cervical portion. Food and water become extravasated sub-
I #9632;
-ocr page 92-
328
OPERATIONS ON THE DIGESTIVE APPARATUS.
cutaneously, and may give rise to extensive inflammation, sup­puration, and gangrene.
Opekation.—This is similar to cesophagotomy, the procedure being modified according to circumstances—i.e., whether the acci­dent was due to an internal or external cause, the character of the wound, etc. After cleansing the wound—incising the skin if it is not an open wound—and getting rid of all foreign matters, the lesion is to be treated on the lines just indicated, and the after-treatment is to be the same.
I
7. Operation foe Disease of the CEsophagus.
Disease of the cesophagus is rare in animals. Parasites some­times locate themselves in its walls and give rise to tumours, which may impede swallowing; polypi, papillomata, melanotic, and other growths may arise from the surface of the mucous membrane, and extremely rarely the tube may be invaded by carcinoma. No rule can be laid down for surgical treatment in these cases, as so much must depend upon circumstances. Should it be necessary to open the oesophagus, this can be done according to the directions already given, and the same indications for after-treatment will hold good.
8. CESOPHAGEAL CatHETEEISM.
This term is here applied more particularly to the introduction of a tube through the mouth and oesophagus to the stomach, to permit the escape of gases which have accumulated there, or for the passage of food, medicine, or other fluids. The Bovine species most frequently requires oesophageal catheterism.
Opeeation.—This is almost identical with that resorted to in cases of oesophageal impaction, in which a probang is passed into that tube; and the position, instruments, and appliances are the same, the probang being hollow and suitable for the species of animal.
Technic.—The head is raised and extended in the manner already described, and firmly held; the mouth-gag is inserted, and the operator stands before the animal with the sound—pre­viously well oiled—in both hands ; the tongue is partially with­drawn from the mouth by an assistant, and the sound is then passed into that cavity, carried up against its roof, and pressed through the pharynx into the oesophagus, down which it is made to glide steadily until it reaches the stomach. In Horses, and particularly if they are old, there is some resistance at the last portion of the tube, and this must be overcome without too much force. quot;When the gastric cavity is penetrated, which is known by the cessation of resistance and the length of sound introduced, the stilette is withdrawn from the latter, and the gases escape. But the sound is often blocked by food carried into it by the gases, and the stilette must be passed through it whenever this occurs; even this, however, is not always sufficient, and then it is neces­sary to practise rumenotomy.
-ocr page 93-
OPERATIONS OxV THE STOMACH AND INTESTINES. 329
CHAPTER II.
OPERATIONS ON THE STOMACH AND INTESTINES.
Opeeations on the abdominal viscera are comparatively few in animals, when compared with the large number practised on man­kind. There are several reasons for this. Disease of the viscera, especially that of a malignant nature, is much less frequent in them; the after-treatment of some operations, even if these are undertaken, cannot be satisfactory, because of the difficulty, if not impossibility, of carrying out aseptic or antiseptic measures so thoroughly as in human surgery; position cannot be fixed or controlled as in man, with whom the dorsal attitude is so valuable after abdominal operations, whereas the dorsicumbent position in all the domestic animals, though most desirable because of the great bulk and weight of the viscera in the Horse and Ox . especially, is most unnatural, and cannot be maintained without violent struggles and straining efforts, for more than a few minutes; animal life is not so valuable as human life, and the expense of operations and their subsequent treatment only too frequently militates against their adoption; while a perfect, or even a useful, cure cannot always be guaranteed, and without this operations are not usually sanctioned. Human life is too sacred to be sacrificed, and suffering is not allowed to continue, if by operation the one may be preserved or the other alleviated, even if the patient remain crippled or useless to himself and the community for the re­mainder of his days; while many appliances, conveniences, and means for restoring him to usefulness or an endurable existence are at the disposal of the surgeon, but are not available for the veterinary surgeon.
Notwithstanding all these disadvantages, operations on the abdominal organs of animals are more frequently attempted now, and often with more successful results, than was the case a few years ago, and especially since the introduction of asepticism; for many veterinary surgeons have adopted this system, so far as it can be employed in their practice, and with great advantage ; as it has enabled them to undertake operations which they pre­viously would not have ventured upon—at least, with any hope of success; while it has given them confidence, which may lead them to attempt others that will rescue animals from suffering and inefficiency, or even death.
Lapaeo-Eumenotomy.
This operation is performed on Euminant animals, chiefly the Ox tribe, for impaction of the rumen with food, or its dangerous distention with the gases given off by fermentation while its function is partially or wholly in abeyance, and these gases cannot escape by the ordinary channel, the oesophagus.
IB
-ocr page 94-
330
OPERATIONS ON THE DIGESTIVE APPARATUS.
Gastrotomy might be the term employed to designate the operation; but the above is perhaps preferable, as only one division or compartment of the viscus is most seriously involved, the rumen. In the Ox tribe this is an immense receptacle, occupying nearly three-fourths of the abdominal cavity, and situated chiefly on the left side, where, when it is distended, it forms externally a great prominence between the angle of the haunch and the last rib, where it may be punctured or incised.
quot;When the disengagement of gases is rapid, the symptoms are quickly developed. They are: uneasiness, breathing and pulse quickened, the superficial veins become enlarged, there is great abdominal distention of a tympanitic character at the upper part of the left side, though as it becomes more acute it extends to the right side. The breathing is quicker, shallower, and dyspncea is more and more marked as inflation progresses, until the animal falls and dies of suffocation, if not relieved. Death often occurs in a very brief space.
The condition may be treated at the very commencement with internal remedies, or by oesophageal catheterism; but in acute cases these are not often successful, and as time is of great importance, it is generally advisable to resort at once to (1) punc­ture, or (2) incision of the rumen.
Fio. 354.—Trocar and Cannui.a for Tympanites in Cattle.
i
When the presence of injurious foreign bodies is suspected in the rumen, that viscus may be incised, and search made for them in its cavity, and even into the second compartment of the stomach.
Opeeation—1. Puncture.—The operation is very simple, and can be readily performed.
Instruments.—A large trocar and cannula (Fig. 354), or even a pocket-knife in an emergency.
Position.—Standing. The animal, if restless, may be held (right side) against the wall by an assistant, and, if likely to kick, the tail should be passed round the left leg and held firmly; the nose-clamp can also be applied.
Technic.—If there is time, the hair may be removed from the seat of operation, and the skin cleansed. The part for puncture may be anywhere between the angle of the ilium or haunch and the last rib, a few inches from the transverse processes of the tumbar vertebrae, on the left side. The operator stands facing that side, and either makes an incision through the skin at the part indicated—which is preferable, because of the thickness of the skin—or drives the trocar and cannula, previously oiled or wetted, directly through the skin into the rumen with a slight rotary twist; a smart blow on the handle with the open hand
-ocr page 95-
OPERATIONS ON THE STOMACH AND INTESTINES. 331
may be necessary to effect penetration. The instrument should be passed to a considerable depth—as far as the shield if need be -—and the trocar withdrawn, when the gas will escape with force, though the cannula may be frequently blocked by food passing
Fig. 355.—Transverse Section op Ox's Body between the Last Bib and Anterior SriNous Process of the Ilium. (After EUenberger and Baum.)
A, Left side; B, right side; C, dorsal region; D, ventral region, a, Rumen ; b, colon ; c, small intestüie; d, gland; e, pancreas; ƒ, psoas magnus muscle; g, abdominal muscles.
into it; this must be pushed back by the trocar, a long probe, or piece of stick.
The cannula remains in the rumen until the gas has escaped and the animal is relieved. Some cannuliB have a hole in each side of the shield, in which a tape is tied; the two tapes are
22
-ocr page 96-
332
OPERATIONS ON THE DIGESTIVE APPARATUS.
fastened round the body, and in this way the tube can be re­tained in the cavity for a long time; as the tapes become tense or unduly relaxed, however, according as the rumen becomes flaccid or the cannula becomes choked from particles of food, some practitioners pass a tape through the skin and over the shield at each side in the manner of a loop, which effectually retains the instrument in the wound.
Medicaments may be passed through the cannula into the rumen to fulfil certain indications—for example, when fluid, food, and gas are ejected through it like soap-bubbles, this condition can be largely remedied by pouring a quantity of ether into the instrument, so as to reach the cavity.
Sometimes subcutaneous emphysema is a sequel when the trocar has been introduced without first incising the skin; but this usually disappears in a few days. Abscess and peritonitis have also been reported as sequelae; but these must be exceed­ingly rare, and due to some mismanagement.
When the only instrument to hand is a knife, this is held like a dagger, the back towards the vertebrae, and a stab made through the skin directly into the rumen. The wound should be suf­ficiently large to admit two fingers, which keep the lips apart.
Fig. 366.—Teocak and Oakitola fob Rumenotomy in Sheep.
and so permit the gas to escape; but it will be evident that this procedure is not so safe as that with the trocar and cannula.
The operation is performed in a similar manner in the Sheep and Goat, the trocar and cannula being much smaller (Fig. 356). The wool or hair must be cUpped off the part where the puncture is to be made.
Afteb-Teeatment. — No after-treatment is required, as the wound soon heals when the cannula is removed. The wound may be dressed with an antiseptic, however, and especially if flies are about.
2. Incision.—When the distention of the rumen is due to a large quantity of fermenting food, and the cannula does not afford sufficient relief, then the organ should be incised to a sufficient extent to allow of much of the food being removed through the wound by means of the hand or duck-billed forceps.
Instruments and Appliances.—Bistoury or scalpel; suture needles and strong silk thread; duck-billed forceps or Bräuer's trocar and cannula, or both ; a towel or piece of waterproof material; large suture or small seton needle, and tape.
Various trocars or gastrotomes have been devised to facilitate the removal of the food from the rumen, such as those of Brogniez, Sajoux, and Bräuer; but only the latter appears to have been much employed, because it is the simplest and easiest
#9632; #9632;
-ocr page 97-
OPERATIONS ON THE STOMACH AND INTESTINES. 333
managed (Fig. 357). It is a magnified trocar and cannula, the latter being so large that the food can be removed through it by means of duck-billed forceps; the cannula is made of thin gat vanised iron, though it might be of steel, is oval in shape, being nearly five inches long, and about two inches wide at the top, and a little smaller at the bottom; while the stilette (similar in form) and its handle are of wood, the point being formed by two sharp steel blades fixed on it. If this trocar is not used, then it is well to have a towel, a large syringe, and water and sponges.
Position.—The animal is secured in the same position as for puncture of the rumen.
lt;H^
Fro. 357.—Bräuer's Gasteotome. a, Its trocar and cannula; b, sheath or collnrlaquo;
Technic,—If possible, the hair should be removed and the skin cleansed at the part to be incised, which is about the same place as, or a trifle higher than, that recommended for puncture of the rumen. The incision is to be made in the same way, with the back of the bistoury towards the spine, the knife being thrust deeply through the skin and muscles into the rumen, and drawn down­wards so as to make a convenient-sized wound—say four to eight inches long—according to the size of the operator's hand, taking care to have the skin and muscle incision as long as, or even a little longer than, that in the rumen. When the operator is not very expert, or when the case is not very urgent, the skin may be first
22—2
-ocr page 98-
334nbsp; nbsp; nbsp; nbsp; nbsp;OPERATIONS ON THE DIGESTIVE APPABATUS.
incised, then the muscles and peritoneum, and finally the rumen, #9632;which then presses up through the opening and can be most readily penetrated. Gas and particles of food are usually forcibly ejected for a brief period, and as the former is inflammable, it is advisable not to have a light in too close proximity.
Before commencing to remove the ingesta, it is well to take precautions against portions of it escaping into the peritoneal cavity. One way to avert this troublesome accident is to pass a towel, or, better, a piece of thin waterproof material, partly into the rumen at the lower part of the wound, the other portion being left hanging out; another is to pass a narrow tape, by means of a large suture needle, through the skin, muscles, and rumen, so as to bring them close together at the lower part of the incision; and another is to pass a piece of tape in the same manner through each side of the opening, as this not only keeps the rumen close to the overlying tissues when the tapes are tied, but the ends of these serve to pull the sides apart, so that there is more room for the hand.
The hand now removes the food carefully and leisurely, as some authorities have stated that if the rumen is emptied too quickly there is danger of the animal collapsing. It is not necessary to empty it completely, for if about two-thirds of the contents are taken away the case generally does well, and the operator and patient are spared further fatigue.
When sufficient food has been taken out, if the patient requires it, a stimulant or any other medicine can be introduced into the rumen through the wound, and it is often good practice to pass in a quantity of salt and water—two or three gallons—which arrests further fermentation, and acts as a laxative and tonic.
When Bräuer's gastrotome is employed, the skin incisiqn is made about five inches long, and in the manner and direction just described, and the instrument forcibly driven into the rumen by a hammer or mallet, the long axis being of course vertical. Then the stilette or trocar is withdrawn, and the food lifted out with duck-billed forceps. It will be perceived that, in using this cannula, there is no danger of foreign matters entering the peri­toneal cavity.
The rumen having been emptied to the necessary extent, the wound, after being cleaned, is then to be dealt with when the temporary sutures have been taken away.
In cases in which foreign bodies are suspected to be giving rise to mischief in and from the rumen, the procedure is the same in opening it. Then the hand and arm are passed downwards and forwards into its cavity, and search made there, and also in the reticulum, which is situated towards the right side. When the body or bodies have been found and removed, or if the search has been fruitless, the after-procedure is the same. The wound in the rumen itself is to be closed by interrupted suture of fine catgut or silk thread, the sides of the wound to be turned inwards, so that the peritoneal surfaces may be in apposition;
-ocr page 99-
#9632;
OPERATIONS ON THE STOMACH AND INTESTINES. 335
this ensures prompt adhesion between them. Then the muscles may be sutured in the usual manner, and the wound in the skin left open, or muscles and skin may be brought together by strong waxed thread. It is sometimes advisable to apply a glue or Burgundy pitch plaster over all, to expedite healing and keep away flies.
Aftbb-Tbeatment.—Beyond care in feeding, little, if anything, requires to be done to the animal after the operation.
Sheep.
In Sheep a similar procedure has to be adopted, the wool being clipped off the part of the skin which is to be incised, and the in­cision made in the same place and direction as in the Ox; but the wound, of course, must not be so large, as it is better to dis­pense with passing the hand into the rumen, and to employ, in­stead, long duck-billed forceps or tongs, if the food is sufficiently solid to be lifted out by them, or a small ladle, or even a long-handled spoon bent at an angle near the wide end, the concavity of this being upwards, if the contents of the rumen are pul-taceous.
Lapaeo-Gastrotomy.
Allusion will be made hereafter to operations on the abdominal wall; at present we will deal with those on the stomach and intestines, through the parietes of that cavity.
Hitherto operations on the stomach, with the exception of those on the first compartment of that organ in ruminants, and which have just been described, have generally been performed on small animals. The reticulum of the Ox has been explored by the hand being passed downwards and forwards to the right side of the rumen, after incision of the flank on the right side as for rumenotomy. Gastrotomy, however, has seldom, if ever, been practised on the larger domestic animals, and has only been most successful in the Dog, having been resorted to for the extraction of foreign bodies from the stomach.
Instruments and Appliances.—Those required for laparotomy, to be presently described, are sufficient. Appliances for carrying out antiseptic precautions as thoroughly as possible.
Position.—Latericumbent or dorsicumbent, according to the situation of the laparotomy—flank or lower aspect of abdomen. The latter is usually preferred.
Operation.—The animal is completely narcotised, and the abdominal cavity is opened after the skin has been shaved and cleansed. One or more fingers are to be introduced through the wound; in the larger animals the entire hand must be passed into the cavity. The stomach is sought for and carefully brought up to the wound, where it can be operated upon; but every endeavour must be made to prevent any of its contents passing into the peritoneal cavity. This is best effected by bringing the part which is to be incised outside the abdominal wall; to pre-
#9632;
-ocr page 100-
336
OPERATIONS ON THE DIGESTIVE APPARATUS.
vent the bowels following, they should be held back by sponge or cloth damp with antiseptic mixture, as carbolic acid, 1 to 100. After removal of the foreign body, the wound in the stomach should be closed by continuous or other of the sutures to be immediately described, the viscus washed with antiseptic solution —as boracic lotion—and returned to the abdominal cavity, and the external wound sutured as in laparotomy. Over and around this external wound boracic acid powder or iodoform should be sprinkled, a single or double layer of cyanide gauze applied, a pad of lint, absorbent wool, or fine tow being laid upon this, and a wide bandage placed over the whole and rather firmly secured around the body. If it is considered necessary to establish drainage, this should be effected by cyanide gauze tampon, in preference to an india-rubber or glass tube.
Aftee-Teeatment.—No solid or fluid should be allowed to reach the stomach for some time, but a very small quantity of milk or beef-tea, to which a little brandy may be added, may be placed in the mouth by means of a sponge slightly saturated with it, reliance being placed upon sustenance administered per rectum by enema. After four or five days, small quantities of easily-digested fluid or semi-solid food may be given by the mouth, and a frequent but very limited allowance of tepid water to drink. If the animal be a Dog, it is advisable to have it muzzled immediately after the operation is completed, to prevent its tearing off the bandage and disturbing the wound. The muzzle should be worn until the wound is healed. The wound itself, if it has been properly sutured and dressed, need not be disturbed for two or three days, when it may be again treated antiseptically and the bandage reapplied; it should be kept as dry as possible.
Gasteostomy.
This operation, which consists in attaching the stomach to the abdominal wall—the parietal peritoneum only by preference— with the view of making a more or less permanent opening into the organ, so that nourishment may be passed into its cavity when food cannot reach it through the oesophagus, has not yet, so far as I am aware, been resorted to for this purpose in animals ; it has, however, been practised on them with experimental objects, and it might happen that it would be necessary to perform it in order to preserve life. It will therefore be briefly described in outline, the principles being applicable in the case of large as well as small animals.
Instruments.—The same as for abdominal section.
Position.—This will be latericumbent or dorsicumbent, the former if laparotomy is to be practised at the flank, and the latter if on the lower part of the abdomen.
Opeeation.—The skin and abdominal muscles are incised to the extent of two to four inches, according to the size of the animal, all possible antiseptic precautions having been adopted.
-ocr page 101-
OPERATIONS ON THE STOMACH AND INTESTINES. 337
The parietal peritoneum is cut through to a slightly less extent, and the stomach is sought for by one or more fingers ; when found,' it is -wholly or partially drawn out and held by an assistant, while the operator attaches it to the peritoneum, all round the opening in that membrane, by means of sutures. These may be Halsted's sutures, each of which is in the form of a blanket stitch, passing in a radial direction through the peritoneum, then through a quarter to half an inch of the stomach wall, and back again through stomach and peritoneum ; it is then tied and the ends cut short. Each stitch is placed from half an inch to an inch apart, the number required depending upon the size of the organ or the opening in the peritoneum. A guiding suture may be placed in the middle of the exposed portion of the stomach, and the skin wound may be lessened by one or two sutures. The organ is then put back into the abdomen without straining the sutures, the wound being packed with antiseptic gauze. The stomach retracts considerably, dragging with it the peritoneum; in three or four days, however, when the gauze is removed, it is readily accessible, and an opening is made into it at the part indicated by the guiding suture, by means of a scalpel or tenotomy knife, the opening being made the required width with the assistance of a director. The width will, of course, depend upon circumstances, but it need not be large if only a catheter is to be fixed in it for the passage of fluid food or medicaments. The catheter is securely fixed in the stomach by tying it to the guiding suture.
Attaching the stomach to the parietal peritoneum only is prefer­able to suturing it through the entire thickness of the abdominal wall, as it forms a firmer adhesion, returns to its normal position, dragging with it a funnel-shaped portion of parietal peritoneum, which has a great tendency to contract, and so prevent the escape of stomach contents ; the stitches also, not passing through the skin and muscles, are not liable to become septic, and may there­fore be left in permanently, to serve as a support to the adhesions between the stomach and peritoneum. Deferring incising the stomach for three or four days after suturing it to the peritoneum also obviates risks of wound infection.1
If a catheter is not inserted in the stomach, the fluids that escape, gastric or other, will tend to irritate the wound and cause trouble. This may be considerably, if not entirely, obviated by adopting a plan which has been successfully carried out in cases of gastrostomy in the human subject,2 in which the opening was seldom larger than a sixpenny piece. A circular disc of sheet india-rubber, the thickness of a shilling, and nearly twice the diameter of the orifice to be closed, has a strong silk thread passed through it by a needle a little to one side of the centre, and back again a short distance from the first puncture, so that the two ends are parallel, these being six inches long. The disc is rolled up, held lengthways in a fine pair of dressing forceps, and introduced into the interior of the stomach, where, being
1 British Medical Journal, Oetobor 24, 1896.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; - Hid., June 6, 1896.
-ocr page 102-
338nbsp; nbsp; nbsp; nbsp; nbsp;OPERATIONS ON THE DIGESTIVE APPARATUS.
released (the ends of the thread are held outside), it assumes its original shape. By drawing the strings the disc is lifted up against the mucous membrane, and prevents anything passing through ; it can be so kept by tying the threads across a roll of lint, or piece of wooden pencil, or a goose-quill placed over the external orifice, with sufficient firmness to keep the roll close on the skin. When fluids are to be introduced into the stomach, the threads are untied and held, the roll removed, and the disc pressed back into the stomach by means of a probe or director. . Should it be desired to close the wound after gastrostomy, a similar procedure will suffice, the plate being allowed to remain without disturbance. It would be advisable, however, to have this made of some substance, as gelatine, which would in time dissolve in the stomach. There might be several threads or plated wires passing loopways through the disc, and this being placed and drawn up in the stomach in the manner just described, the margins of the fistula could be made raw by paring them, which will necessitate pulling out the organ to some extent; on this being put back, with a handled curved needle each wire is threaded separately, and carried through the coats of the stomach and abdominal wall from within outwards close to the edge of the opening. In this way one row of sutures passes through one side of the opening, and the other row through the other side, so that the edges can be brought together and the sutures tied externally. In this way the opening is completely closed by what is practi­cally a button suture, the button being in the stomach. When sufficient time has elapsed the suture can be cut and withdrawn whole, the plate being dissolved, or, if insoluble, got rid of by vomition or through the intestinal canal.1
Bntebocentbsis.
The simplest operation on the intestines is that of puncturing them through the abdominal wall for relief in cases of tympanites in. Solipeds, though it is attended with more risk of accident, and even of danger, than puncture of the rumen in the Ox. The risk is also greater if the intestine be punctured through the rectum, as is sometimes done, or even through the vagina. In cases of strangulated intestinal hernia, inguinal or ventral, when gases have formed in the strangulated portion to such a degree as to prevent reduction, puncture is resorted to for their escape. But the operation is most frequently practised in cases of intestinal inflation due to indigestion or obstruction, the portion of intestine punctured being either the caecum or colon, and the seat of puncture is generally the right flank, though the left may also be selected under certain circumstances. As mentioned, the dis­tended viscus may also be pierced through the rectum or vagina, but there are serious drawbacks to the selection of these situa­tions. We will therefore chiefly treat of the operation as performed from the external surface of the abdomen.
1 British Medical Journal, July 4, 1896.
#9632;
-ocr page 103-
OPERATIONS ON THE STOMACH AND INTESTINES. 339
The operation is only resorted to in urgent oases, when the distention of the large intestines is so great as to lead to impend­ing suffocation, by pressure on the diaphragm and fixation of the asternal ribs, marked by] hurried, shallow respiration, distress, and unsteady gait; the abdomen is greatly distended, particularly in the region of the flanks, and the animal rarely lies down because of the difficulty in breathing, though the restlessness may be as extraordinary as in spasmodic colic. To prevent a fatal termination, evacuation of the gas must be early and quickly effected, and as remedies are slow in removing what may be the cause of fermentation, this measure relieves the urgent symptoms, and permits of time for medicines to operate.
IWate
Fig. 358.—Straight Trocar and Caknula for Puncture of thf. Intestine.
Fig. 359.—Curved Trocar and Cannula for Puncture of the Intestine.
ARNOLD,', 30NSiOMDOtr-
m
Fig. 360.—Improved Trocar and Cannula for Enterocentesis.
Instruments and Appliances.—As the operation has usually to be hurriedly performed, without the opportunity for making special preparations, the instruments are limited nearly always to a trocar and cannula, and perhaps a bistoury in addition. But, if possible, scissors or a razor, a disinfecting sponge, a little ether or alcohol, iodoform, and collodion or pitch plaster, should be available, as well as soap and water. A twitch may be required.
With regard to the trocar and cannula, these should be com­bined in an instrument measuring, excluding the handle, about six or eight to ten inches in length, and about one-third of an inch in diameter if round; some operators prefer it a little flattened in shape, and instead of being straight (Fig. 358), others like it slightly curved (Fig. 359). An improved instrument (Fig. 360)
-ocr page 104-
340nbsp; nbsp; nbsp; nbsp; nbsp;OPERATIONS ON THE DIGESTIVE APPARATUS.
has the point of the trocar spear-pointed, so that the perforation in the intestine is only a fine slit, much smaller, and likely to heal more rapidly, than that made with the ordinary trocar. It is also longer than the ordinary trocars, so as to ensure its passing for some distance into the howel. The cannula has likewise a very fine bore, sufficient to allow the escape of gas, but less liable to become choked than a larger bore would be. The instrument has a cap or cover to protect the point from injury when not in use.
The instrument should be kept scrupulously clean, in order to avoid unfavourable sequeke, and to ensure this it should be boiled for a few minutes before being used, when it may be made warm; after, use it ought to be again cleansed, and washed in carbolic or boracic solution.
Position.—The standing position is the most convenient for the operator, and is that which the animal usually maintains ; but the operation can be readily performed in the recumbent position, and sometimes with better success.
Operation.—The right side is, for anatomical reasons, pre­ferred for puncture, as the caecum and higher flexure of the large colon are in that situation, and to these the gas ascends; whereas on the left side the low-lying flexure of the colon is likely to contain more fseculent matter. The operation has been performed in various places in the region of the flank when gas does not escape after one puncture, and generally with impunity, owing to the extremely distended condition of the large intestines ; but the normal situation of these viscera indicates where enterocentesis is most likely to be successful (Fig. 361). High up on the right flank the distention is generally most marked, and tympanitic resonance loudest on percussion; where this is greatest should be the seat of puncture. As a rule, the instrument is inserted at a point on the right side, between the external angle of the ilium, the transverse processes of the lumbar vertebrae, and the middle of the last rib. This will ensure the entrance of the trocar into the arch of the caecum or, if lower, the colon; the former being situated above the latter, and the viscus whose evacuation gives the best results. If the left side is selected, the puncture should be made much lower—almost in front of the stifle, in fact. It may be necessary to apply a twitch to the nose to steady the animal, and it may also be advisable to have the fore-foot on the same side held up, to prevent injury to the operator.
If there is time and opportunity, the skin at the seat of opera­tion should be prepared by clipping or shaving off the hair, wash­ing well with soap and water, and rubbing with ether, then with carbolic solution.
Technic.—It is advisable to make a small opening through the skin by means of the bistoury or rowelling scissors, as this facilitates the passage of the trocar. This incision may be made immediately over the part to be punctured, or the skin may be drawn to one side of it and the incision practised, so that the abdominal wound will be covered by intact skin when the cannula is withdrawn.
I #9632;
-ocr page 105-
OPERATIONS ON THE STOMACH AND INTESTINES. 341
The trocar is inserted into the incision and held perpendicu­larly in the left hand; with the palm of the right hand a smart
Fig. 361.-
-Transverse Section of Horse between the Last Rib and Anterior Spinous Process of Ilium. (After Ellenberger and Baum.)
A, Left side; B, right side; C, dorsal region; D, ventral region, a, crecum ; b, c, right flexures of colon; d, left flexure of colon ; e, transverse colon ; ƒ, femoral artery ; y, posterior vena cava; a, small intestine convolutions ; i, rectum; j, colic artery ; k, inferior colic artery; I, superior colic artery ; raquo;i, rectal artery; n, small mesenteric artery ; o, aorta; p, lumbar vertebra ; q, psoas magnus muscle; r, psoas parvus muscle; laquo;, glutens medius ; t, longissi-musdorsi; laquo;, transversalis abdomiuis; f,obliquu9extcrnusabdominis; w, obliquus intemns abdominis; xf panniculus camosus; y, rectus abdominis ; z, semispinalis.
blow is given on the top of the handle, so as to drive the instru­ment some inches—three to five—into the cavity of the intestine ; the trocar is then withdrawn steadily by the right hand, and the
-ocr page 106-
342
OPERATIONS ON THE DIGESTIVE APPARATUS.
gas escapes through the cannula with a hissing sound ; the tube is kept iu the viscus until the tympanites has been dispelled.
If no gas escapes at the first puncture, a second may be made a short distance lower or higher, though care must be taken not to go too near the kidney; or if the exit of gas is checked by faeces getting into the cannula before the distention is sufficiently reduced, the trocar may be pushed into the tube again, or a probe, quill, or twig inserted in order to clear it. When the gas has been evacuated, the cannula is removed slowly by a slightly rotatory movement, great care being taken that no foreign matters escape into the peritoneal cavity or into the tissues beneath the skin.
In cases of torsion of the large intestine, when tympanites may be very great, haemorrhage often takes place into the viscus, and instead of gas escaping, blood flows from the cannula. Such cases may be regarded as hopeless.
As has been remarked, enterocentesis may be performed through the wall of the rectum, but this is neither so easy nor so safe an operation as the one just described. To do it, the rectum is emptied of faeces for a considerable distance, then the oiled hand, armed with the trocar and cannula, the point of which is guarded by the fingers or by a small piece of cork, which can be readily rubbed off when required, is passed well into the rectum and clear of the pelvic cavity ; when it has reached the desired spot, the point of the instrument is uncovered, and pushed down­wards and rather outwards to the right. When it has penetrated some inches, the trocar must be withdrawn by the fingers, the cannula being still pushed downwards, so as to leave more room for the trocar to leave it. The trocar is removed from the rectum; its point still covered by the fingers, and the hand being again introduced, it holds the cannula, and moves about the distant end if needed, until a sufficiency of the gas has escaped, when the tube is taken away.
Aftek-Tebatment.—In the majority of cases no after-treat­ment is required, though to ensure a rapid recovery it may be well to dress the wound in the skin, cleansing it and powdering it with iodoform. It may be covered with a piece of adhesive plaster.
Complications do, however, occur, especially if asepsis has been neglected, or the operation has been improperly performed. The bowel has been torn; haemorrhage has resulted from the trocar wounding a bloodvessel; abscess has formed at the seat of puncture or below it; peritonitis or septicaemia has occurred; and subcutaneous emphysema has even been observed. But these are very infrequent accidents, and may be attributed chiefly to carelessness in operating, or the neglect of antiseptic pre­cautions, and must be treated, when recovery is possible, accord­ing to their indications.
I #9632;
-ocr page 107-
OPERATIONS ON THE STOMACH AND INTESTINES. 343
Entekotomy.
Incision of the intestines has been frequently practised in the Ox and Dog for the removal of obstructions, and the operation has been followed by recovery. In the Horse, however, it has been generally unsuccessful, probably because it was resorted to when too late, and perhaps also because antiseptic measures were neglected or imperfectly carried out. When performed early and under favourable circumstances, success might be anticipated in a fair proportion of cases, even in the Horse; though it offers better prospect of a favourable result in the smaller animals.
The cases that demand operative interference must depend upon circumstances which the veterinary surgeon will have to carefully consider before arriving at a decision, and in some instances this decision will have to be made without delay after a satisfactory diagnosis has been made. In the words of Mac-queen, ' Abdominal diseases amenable to surgical treatment, with few exceptions, may be diagnosed in Dogs by manipulation, in Cattle by rectal exploration or by rumenotomy, but in Horses diagnosis is extremely difficult. The size, disposition, and rela­tions of the viscera, and the common symptoms they provoke when diseased, give little hope of greater accuracy in diagnosis so long as only current methods are pursued. In the future, exploratory- incision may be reasonably expected to give some assistance. When it has been shown that the peritoneum can be opened without risk to the patient, or without adding to the gravity of the disease that may call for relief, present difficulties will diminish, and in time perhaps disappear. This view, in face of past and present practice, may be too sanguine; but with anaesthetics to suspend movement, and antiseptics to prevent contamination of surgical wounds, expectant treatment and dangerous delay may yet give place to more active measures.
' Assuming that cases of volvulus, invagination, internal hemiae, and obstruction by bands, pedunculated tumours, or by concre­tions, can be treated by surgical interference, the question arises : How may these conditions be distinguished from other abdominal affections ? At once I confess my inability to give a satisfactory answer. The history of the patient; the character of the pain, whether intense and continuous, or subacute and intermittent; distention, local or general; constipation, persistent or inter-mpted ; the action of eserine ; the posture of the patient; back­ing ; straining; the quantity of urine passed; the rejection of clysters; expulsion of flatus; and the symptoms sometimes afforded by palpation, percussion, and auscultation, merely suggest a possible cause—all are fallacious and unreliable in the diagnosis of the diseases just mentioned. If examination per rectum gives more assistance, it does not always yield satisfaction. The height of the operator and the length of his arm should be considered, as well as the state of the horse's bowels. In a healthy horse, fifteen hands high and of medium coupling, the
IB
-ocr page 108-
344nbsp; nbsp; nbsp; nbsp; nbsp;0 PER A riONS ON THE DIGESTIVE A PPA RA T US.
hand may reach the coeliac axis and the last rib. In a long-loined sixteen-hands carriage-horse, lying on his right side, I have felt without difficulty the border of the spleen, the last rib, and the left kidney ; but in the standing horse I have never reached the spleen. Experiment warrants the assertion that an imaginary vertical plane falling from the first lumbar vertebra to midway between the xiphoid and umbilicus represents the forward limit of rectal exploration. Employing the left hand for the right half and the right hand for the left half of the abdomen, all the viscera behind this boundary may be examined more or less satisfactorily in the healthy horse. In abdominal disease, especially in ob­struction, the intestines are often crowded towards the pelvis, and frequently the hand cannot pass onwards in consequence of straining and pressure from distended bowels. But when the hand has reached the flank it may, and sometimes does, discover displacements, volvulus, or invagination; recognise and remove concretions ; ascertain the condition of the contents of the colon, caecum, floating colon, and small intestine; and in hernise dis­tinguish and liberate omentum and bowel. Cases that give no sign to exploration are uncommon, and without this precious aid diagnosis, whether positive or negative, is doubtful. In this, as in other diagnostic efforts, the spirit of the practitioner dominates procedure. With faith in possibilities, rectal explora­tion may be tried again and again, and information maybe gained at every investigation.'
With accidental wounds of the intestines, there cannot be much difficulty in deciding what ought to be done in the way of operation, as this will depend to a considerable degree on the nature and extent of the lesions. The same remark applies to the extraction of foreign bodies, and to the presence of disease, displacement, etc. If an incision has to be made, this should always be, whenever possible, in the direction of the long axis of the intestine, and not transversely.
Instruments and Appliances.—Thamp;se will be the same as for laparotomy (which see), with the addition of spring and dressing forceps, straight and curved suture needles, a number of milliner's needles—straws No 5—to stitch intestine, Chinese silk twist (No. 1). For intestinal suture silk thread is to be preferred, because of its being easily rendered aseptic, and also because of its softness, flexibility, and toughness. It should be well stretched by winding it on a small ruler, boiling it in water for some minutes, stretching it again in the same manner, and then placing it in a 5 per cent, solution of carbolic acid. Black thread may be considered more advantageous than white, as it is more easily seen. All the instruments employed should likewise be rendered aseptic. These may vary, according as the animal is large or small, and special instruments will be needed for certain pur­poses, such as a small trocar and cannula to puncture the intestine.
Asceptic indications must be carefully observed throughout.
-ocr page 109-
OPERATIONS ON THE STOMACH AND INTESTINES. 345
Position.—This will depend upon the animal operated on, but it must be dorsicumbent or latericumbent. If the latter, the side to be uppermost must depend upon circumstances connected with the anatomy of the part, and the cause for operation. The abdomen is opened at the flank, or near the linea alba, and parallel to it.
Opbkation.—The animal is rendered partially or totally un­conscious ; the latter is the more desirable. The skin, after being shaved and cleansed, is incised to the necessary extent, together with the subcutaneous tissues and peritoneum. The portion of bowel to be operated upon having been exposed, is opened. The part at which the incision is made will, of course, depend upon circumstances. Macqueen, in operating upon the Horse, gives the following directions : Pass a large sponge, wrung out of a 2f per cent, warm carbolic solution, into the abdomen, and get tar­latan ready. Pass the hand into the abdomen, bring out the bowel, and hold it gently until the assistant has placed pieces of tarlatan, moistened with warm carbolic solution (2i per cent.),
Fio. 362.—Lembert's Si-tobe.
around the wound. This done, let him (the assistant) take the bowel between his fingers, applied like clamps, the hands resting, one in front, the other behind the wound. Incline the bowel towards the Horse's thigh, and slit the free border with scissors ; remove contents, and wash its mucous lining.'
The precedure may require to be varied somewhat, but the above is an outline of the course that ought to be adopted. The incision should be made in the direction of the long axis of the intestine, and its extent will depend upon the cause for it; if it be a calculus, concretion, or other foreign body, the opening should be sufficiently wide to allow it to be extracted without lacerating the borders of the wound.
When the intestinal wound is to be closed, the operator has a choice of bowel sutures, either of which he may employ as he thinks fit. We will briefly describe them, but before doing so it may be repeated that the Chinese silk twist No. 1, prepared as already described, is best adapted for closing intestinal wounds.
Lembeet's Sutuee (Fig. 362) is perhaps the one most fer-quently employed. In this the suture is passed through the
I ^H^H^^^^^^^^^^^^^^^^^^^^^—^fll
-ocr page 110-
346nbsp; nbsp; nbsp; nbsp; nbsp;OPEEATIONS ON THE DIGESTIVE APPARATUS.
serous and muscular coats, as well as the submucosa, for a reason to be given hereafter, though this tissue is not included by Lembert, Joubert, [and others; the mucosa is exempted. The needle is entered vertically about one-fourth of an inch from the margin of the wound, by gentle pressure on its blunt end with the pulp of one of the fingers, then pushed through the above-mentioned textures, carried along about an eighth of an inch beneath them, and brought out at the same distance from the wound, which it is carried across, and reinserted at an eighth of an inch from the border, carried beneath the same textures for the same distance, and made to leave at one-fourth of an inch from the wound. The thread is then cut, and the same procedure adopted for the other sutures, which should be placed one-eighth of an inch apart. When all the sutures are applied, they are tied separately, the ends being cut off near the knots. It may be observed that instead of the sutures being tied separately, the wound may be closed by one continuous suture applied in the same manner, forming what is called the ' square ' or ' quilt' stitch ; the thread, instead of being cut from the needle when it has been passed through both sides, being made to form a like stitch at a short distance, then passed
Fig. 363.—Apposition op Peeitoneal Surfaces of Margis of Wound by Lembert's Suture.
to the side from which it started, and so on until the end of the wound is reached. Or when it has been passed across twice it may be cut, and the two ends tied on the same side ; this certainly con­stitutes it a multiple suture, but then the ties are only half as numerous as in Lembert's method. In drawing the edges of the wound together, these should be inverted, so as to bring the serous membrane on each side into immediate apposition (Fig. 363), and so as to effect rapid union.
Joubert's Sutube is sometimes employed, though it is not so good as Lembert's, because it passes through the mucous mem­brane of the intestine. Yet there are occasions when it may be useful. The needle is passed obliquely through the wall of the intestine from without inwards, so that it enters about one-third of an inch from the margin of the wound, and emerges about one-eighth of an inch; it passes through the opposite side at one-eighth of an inch from the wound, and comes out on the surface a little beyond this. The sutures are placed about one-fourth of an inch apart, and successively tied, the ends being cut off close to the knots; but in drawing the borders of the wound together care must be taken, as in Lembert's suture, to invert the edges
..
-ocr page 111-
OPERATIONS ON THE STOMACH AND INTESTINES. 347
of the peritoneum, so that the two surfaces may come in contact (Fig. 364).
Gely's Sutube has its advantages in certain cases, and may even be preferred by some operators to Lembert's in all cases of wounds in the stomach, intestine, or uterus. Each end of a long thread is passed through a fine suture needle; one of these is pushed through the intestinal wall beyond one extremity of the wound, and brought out about one-fourth of an inch on the same.
Fig. 364.—Joi'bebt's Suture.
side, parallel to the wound, and about one-eighth of an inch from it. The same manceuvre is executed on the opposite side with the other needle; then the first needle is carried across the wound and passed into the hole made by the exit of the second needle, and made to come out again parallel to the wound, about one-fourth of an inch from its last entrance. This is repeated with the second needle, and so on, the intercrossing being carried out as in lacing a boot (Fig. 365), until the other end of the wound is reached, when the two threads are brought to the surface a little beyond the wound, and sufßciently tightened
FfG. 365.—OOMMENCEMENT OF Gelv'3 SUTURE.
Fio. 366.—Gely's Suture oompleted.
throughout, by means of two pairs of dissecting forceps, so as to close the opening and bring the inverted margins of the peri­toneum against each other without a wrinkle. The ends are tied securely and cut off near the knot (Fig. 366).
Wolflee's Sutuke somewhat resembles Lembert's in avoiding the mucous membrane, but it passes twice through the serous and muscular coats on each side of the wound, as shown in the annexed figure (Fig. 367).
23
-ocr page 112-
348
OPERATIONS ON THE DIGESTIVE APPARATUS.
Czeeny's Sutübe is also similar to Lembert's, the only differ­ence being a double passage through the serous and muscular tunics, as in quot;Wolfler's suture, at one point, and only through the serous membrane at another. The thread is passed through the two tunics, as in Lembert's suture, then another thread is passed through the serous membrane alone at a point one-third of an
I
Fig. 367.—WOlvler's Suture.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; Fig. 368.—Czerny's Suture.
1, Suture through the sero-muscular tunic ; 2, suture through the serous tunic only.
inch farther from the wound than the first. By this means the lips of the wound are kept in contact on the serous surface for a depth of nearly half an inch, while the sutures do not penetrate the mucous membrane (Fig. 368).
Sometimes, as a result of disease or accident, so much of the intestinal wall may be destroyed or has to be removed, that if the borders of the wound were brought together, the lumen of the tube
Fig. 369.—Mode of making an Intestinal Graft. (After Cadiot.)
would be diminished to such a serious extent as to be almost equivalent to obliteration. In such a case intestinal grafting might be attempted in animals, as it has given good results when practised in the human subject. This grafting is carried out as follows: A loop is made of this portion of the intestine, and the opening, or wounded side, is brought into contact with the oppo-
..
-ocr page 113-
If
OPERATIONS ON THE STOMACH AND INTESTINES. 349
site wall of the loop; the two portions of intestine are then attached to each other by means of Czerny's suture passed through them around the wound, as in the accompanying figure (Fig. 369).
It should be again remarked that, in bowel suturing, it is most essential that union between the divided surfaces should take place as rapidly as possible, therefore co-aptation of the serous surfaces ought to be complete; and also that infection of the wound from the intestine should be averted, by passing the sutures through the serous and muscular tunics only, avoiding perforation of the mucous membrane. In insisting upon the ob­servance of this precaution in enterorrbaphy, it must be observed that in speaking of the exclusion of the mucous membrane from the suture, and the inclusion of the serous and muscular coats, it should not be inferred that the thread is only to be passed through the latter. They will be found too fragile to withstand the strain and cutting action of the thread, and in order that the suture be effective for a certain length of time, it should include the submucosa, which has far more tenacity and resistance than these two tissues combined. Therefore the needle should pass through the serosa, musculature, and submucosa, and it is prob­ably through neglect of including the latter that cases of enter-otomy and enterectomy are not so successful as they might other­wise be, as stitches readily give way when the tough submucosa is not secured in the suture. At the same time, the stitch should not enter the lumen of the intestine, lest leakage take place. As Dr. Halsted points out,1 it is not difficult to familiarise one's self with the resistance furnished by the submucosa, and it is quite as easy to include a bit of this coat in each stitch as to suture the serosa and the muscularis alone.
The wound in the bowel having been sutured, the peritoneal cavity is to be cleansed, if it has been soiled by the contents of the intestine, blood, or extraneous matters, and the abdominal incision closed in the manner hereafter to be described.
Aptek - Teeatment.—The animal must be kept as quiet as possible for some days, and only a sufficiency of very nutritious food in the least bulky form and in a soft condition allowed, with a limited amount of tepid water to drink.
Entekectomy,
Excision of a portion of intestine has been successfully prac­tised in Cattle and Dogs for irreducible strangulation and invagi-nation of that viscus ; but it has been hitherto unsuccessful in the Horse, though there is no reason why it should not be sometimes followed by recovery in that animal, especially if the small intes­tine is operated upon, and the operation is done skilfully, suffi­ciently early, and with the usual antiseptic precautions.
1 Bulletin of the Johns Hopkins Hospital, January, 1891.
23—2
-ocr page 114-
350
OPERATIONS ON THE DIGESTIVE APPARATUS.
Instruments and Appliances.—These are the same as for laparo-enterotomy.
Position.—This may either be standing in the case of Cattle, when the animal is placed with its left side against a wall and the flank opened on the left side ; or latericumbent or dorsicumbent in the case of the Horse, Dog, or Pig, though the last-named position is usually preferred when the small intestine is to be operated upon, the abdomen being opened at or near, and parallel to, the linea alba. If the cavity is to be opened at the flank, then the position must be latericumbent, the right or left side being uppermost, as circumstances may require. This situation is to be preferred whenever possible in the larger animals, as it is the most favourable for the healing of the abdominal wound, though it may not be the most advantageous for reaching and manipu­lating some of the viscera. Opening the abdomen at its lower part, towards the linea alba, offers the greatest advantages in small animals, as it affords more room for the operator, and gives direct access to all the abdominal organs, while the healing of the wound can be better controlled than in the Horse or Ox, in which the great weight of the viscera imposes a severe strain on sutures and bandages.
If abdominal section must be performed towards the linea alba in such animals, then in closing the wound everything must be done to ensure its security by employing quilled or similar sutures, long strips of adhesive plaster, and wide body-bandages.
Opeeation.—Laparotomy is performed, and the portion of intestine to be operated upon is sought for, withdrawn from the abdominal cavity, and ligatured with tape, or clamped on healthy bowel at a short distance from the part to be resected, and on each side if possible ; if not possible, then on the side next the stomach. The bowel should be quite empty at the part that is to be cut through, to prevent contamination of the peritoneal cavity. If it be the small intestine, the mesenteric vessels will probably have to be tied with antiseptic silk thread at the part which is about to be removed. Portions of omentum which are damaged or in the way should be cut off; a ligature may be required to prevent bleeding.
Eesection is best effected by means of scissors, care being taken that when the portion is gangrenous it be removed com­pletely, so that the remaining ends are quite sound and healthy.
As much of the bowel as may be necessary having been cut out, the divided ends, cleansed with antiseptic solution, are held by one or two assistants, while the operator proceeds to apply appropriate sutures to the mesentery and the wound. With regard to the separated mesentery, Macqueen insists that no gap should be left between it and the bowel, and that it ought to be carefully folded to the right or left, and secured by fine sutures placed at the borders of the fold, or a piece of mesentery can be excised and the edges united by continuous suture.
Approximation of the divided ends of the intestine is effected
#9632; #9632;
-ocr page 115-
i'
OPERATIONS ON THE STOMACH AND INTESTINES. 351
by suture, either continued or interrupted, and Lembert's, Czemy's, or Wolfler's will be found best adapted for the purpose, though Chaput's has been highly commended in enterectomy. Whenever circumstances admit, the continuous suture is to be preferred, as it is more effectual in hindering the escape of infect­ing matters from the interior of the bowel; and if the mucous membrane is not perforated by the stitches, this danger is still further averted. The following is the procedure in applying Chaput's suture : Throughout the whole extent of each margin of the ends of the bowel, separate the muscular from the mucous coat for about one-third of an inch, then place a row of non-perforating sutures through the edge of that coat, after excision or invagination inside the intestine of the detached portion; this done, place a second row of perforating sutures in the sero-muscular coats (Fig. 370, A and B). On the posterior semi-cir­cumference of the intestine the sutures in the mucous membrane are tied inside, and on the anterior semi-circumference they are tied outside. Above the sero-muscular sutures may be placed
2
X
m
MMIiiia......!.....Uli!!1
77
Fio. 370.—Chaput's Ixtestinal Sutures. (After Cmiiot.)
A, Suture by abrasion, first procedure ; 1, mucous membrane suture ; 2, suture by abrasion. B, Second procedure : 1, mucous membrane suture by inflexion ; 2, suture by abrasion.
another row, passed through the serous membrane alone, to make the union more secure.
A simple and rapid method of performing enterectomy in the Dog has recently been published.1 The abdomen having been opened and a loop of small intestine drawn out, this was clamped in two places by means of a thin flat piece of wood pointed at one end, and having a slit in each end through which a piece of tape could be passed. The tape, knotted at one extremity, having been passed through the slit in the blunt end, the sharp end of the piece of wood was pushed through the mesentery close to the bowel, and the tape, passed over the bowel and through the other slit, was pulled sufficiently tight to compress the bowel be­tween the piece of wood and the tape to the desired degree and then fixed with a pair of artery forceps. This simple and easily improvised piece of apparatus worked very efficiently. On cutting through the bowel, its lumen was found to be full of tape-worms. After several feet of these had been removed, the operation was proceeded with. There was some difficulty in detaching the peritoneum from the upper end of the intestine, but when de-
1 Rogers, British Medical Journal, April 11, 1896.
..
-ocr page 116-
352
OPERATIONS ON THE DIGESTIVE APPARATUS.
nuded the muscular coat was easily approximated to the peri­toneal coat of the lower end by a continuous suture, which was laced up so as to bring the surfaces into intimate contact with­out being so tight as to be likely to cut through the included coats of the intestine. A second continuous suture was now em­ployed to unite the triangular gap in the mesentery, beginning at the apex. When the bowel was reached, the suture was continued around the gut to draw the piece of reflected peritoneum down over the first row of sutures, and to attach its deep fibrous surface to the serous surface of the peritoneum of the lower portion of the gut (Figs. 371, 372). This was successfully accomplished, except over a small portion, where the reflected peritoneum had
Fio. 371.—Rogerlaquo;' Suture.
A shows the peritoneal coat of the intestine turned back from one end of the section ; B, method of passing the inner suture: 1, serous coat; 2, muscular coat; 3, mucous coat.
Fig. 372.—The Same.
A, Ends of section brought in apposition on tightening the inner suture ; B, second suture shown in position, completing the junction.
curled up and could not be brought down quite so far as was desired. The clamps having been removed and the hole in the mesentery sutured, the intestine was returned, the abdominal wound sutured, and dressings strapped on it. The animal made an excellent and an uninterrupted recovery; it was sick on the day following the operation, passed a dark motion on the fourth day, and well-formed motions subsequently; on the seventh day the abdominal wound was united, when the stitches were re­moved and ordinary food allowed. On the fifteenth day the Dog was killed, when it was found that the abdominal wound was soundly healed; the great omentum was adherent to the outer side of the junction in the intestine, which was thickened at this
#9632; #9632;
-ocr page 117-
OPERATIONS ON THE STOMACH AND INTESTINES. 353
point. The gut was very firmly united, and no stitches could be seen ; a current of water flowed freely through it, and on passing the little finger into the bowel above the junction the first joint could go beyond the union, though in the normal intestine it fitted closely, showing that there was no material constriction at the seat of the resection. The advantages of this mode of operating are stated to be: (1) It can be done with the aid of the instruments in a pocket-case, ordinary round sewing needles being used (although curved intestinal needles are to be pre­ferred), and with very little assistance; (2) it can be completed in about half an hour, or only a little longer than the time re­quired with the aid of such special appliances as plates, buttons, and bobbins; (3) the junction is a double sero-fibrous one, and will combine the maximum of rapidity and firmness ; (4) the mesenteric side can be made very firm, by the apposition of the muscular coat of one end to the peritoneum of the other, and the subsequent covering up of this suture by the reflected peritoneum. This method certainly commends itself to veterinary operators, both for small and large animals.
Fir.. 373,—Murphy's Enteeotomy Button.
In order to facilitate apposition of the ends of the divided tube, bone plates and slices of turnip have been employed.
The ends of the intestine are inverted and closed ; each is then slit open at the side for about two inches from the end, and the bone plate (Senn's) or slip of turnip to which sutures have been attached, is inserted through the opening. The sutures are then passed through the wall of the intestine, and tied together to maintain the serous surfaces in apposition. A similar device in the form of a metal button has been employed for attaining the same object, and with success, in enterotomy in man (Fig. 373). This device, known as ' Murphy's button,' consists of two portions, one fitting into the other, which has a thin rim or flange to receive and hold it when it is covered by the end of the intestine. When the latter is cleared of faeces, compression clamps placed on each of the parts to be excised, and the mesen­tery ligatured, excision takes place, and a running stitch is made around the margin ; this stitch begins at the side opposite to the mesentery and runs up to it, where one return overstitch is made, named the 'puckering string,' and which, when tied round the stem of the inserted button, draws the cut end inside the clasp.
..
-ocr page 118-
354
OPPERATIONS ON THE DIGESTIVE AP AR A TUB.
\ '#9632; \'-
Particular attention has to be paid to the return overstitch at the mesentery, so that both layers of the peritoneum overlap. The other half of the button is inserted in the same way, and the two portions are then pressed together. Though employed success­fully in man, yet I am not aware that this button has proved satisfactory in the trials made with it in animals, nor, I fear, is it likely to do so, for anatomical reasons.
But these appliances are really not absolutely necessary for enterotomy in animals; indeed, it is very questionable whether they would not prove detrimental to recovery in the majority of cases, and sutures alone should be sufficient, as experience has shown. If any foreign body is employed to facilitate junction of the ends of the intestine, it should be of such a nature as to dis­solve there in the course of a few days. Probably nothing better will be found more readily than a rather broad section of unpeeled turnip, in diameter sufficient to dilate the intestine, and the centre of which has been removed, so as to leave a hole in the middle. The rind, well cleansed, together with the remaining portion of the interior, will be sufficiently resisting to support the sutures passed through it and the intestine, and at the same time will keep the ends of the gut in approximation by their serous surfaces until union has been accomplished. The turnip will gradually soften and dissolve, without causing irritation, especi­ally if it be steeped in a solution of boracic acid before being intro­duced into the lumen of the intestine. Segments of decalcified round bones might also be safely employed, as they would afford sufficient support, allow of matters passing their canal, and, being readily soluble, they will gradually disappear without unduly irritating the intestinal wound or the mucous membrane, while they could be had in various sizes. Tubes of cocoa-butter or of gelatine, and which could be made of any diameter, the thickness of their wall corresponding to their dimensions, and their ends made slightly smaller than the middle portion to facilitate intro­duction into the section of intestine, might also answer the purpose.
The intestine having been sutured and the external surface of the bowel cleansed, the wound in the abdominal wall is closed as in laparotomy.
Aftee-Treatment.—The animal must be kept quiet, and only very small quantities of nutritious soft food given at frequent intervals, after fasting for twelve hours. Should the animal suffer pain, anodynes, chiefly opium, must be administered. At the end of four or five days more food may be allowed, and after ten days the usual food in gradually increasing quantity can be safely given. The external wound requires attention, but this will be alluded to presently.
-ocr page 119-
INTUSSUSCEPTION AND STRANGULATION.nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; SSf.
OPERATION FOR INTRA-ABDOMINAL INTUSSUSCEPTION AND STRANGULATION OF THE INTESTINE.
Surgical operation for torsion and invagination of the intestine has only been successfully practised on the Ox, but it might be attempted with some prospect of success in the Horse if had recourse to before gangrene had begun to invade the imprisoned or tied-up bowel, and the animal is not too exhausted. Of course it is necessary that an accurate diagnosis of the case be made, and this is dependent upon the symptoms the animal exhibits, and also upon what may be ascertained by manual exploration per rectum. But it must be confessed that, in the Horse at least, there is very much against the success of the operation, which must be looked upon as a last resource, and a feeble one then.
Instruments and Appliances. — These are the same as for laparotomy and enterotomy.
Position.—The Ox has been operated on in the standing posi­tion, with the left side against a wall, and the hind-limbs secured by a rope, laparotomy being performed on the right side, as for rumenotomy; but with the Horse it would be necessary to place the animal on the right side, the left side being the best to reach the small intestine, which is usually involved. Or the Horse might be placed in the dorsicumbent position, if it is more likely to ensure ready access to the implicated portion of bowel.