Observations on equine surgical practice

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GENERAL ARTICLES.

OBSERVATIONS ON

EQUINE SURGICAL PRACTICE.

By JAMES MACQUE;EN, F.R.C.V.S., Royal Veterinary College, London. THE preliminary diagnosis of surgical cases, apart from some lamenesses, is not specially difficult so long as the one thing needful is to give the case a name. But with most serious ailments it is necessary, or, at least, desirable, if only for the purpose of inteIligent treatment, to ascertain as far as possible the nature and extent of mischief and the condition of the structures involved. Without this information, treatment, although eventually successful, sometimes surprisingly successful, is too often speculative and unsatisfactory, and not infrequently the owner of the horse is fully justified in grumbling at the protracted recovery. In forming a diagnosis, the history of the case. when reliable, the signs furnished by the patient, the situation of the injury or disease, the character of the swelling, wound, or discharge, the temperature and pulse, and the degree of immobility and pain are all more or less helpful. When careful exercise of the natural senses fails to obtain sufficient information for the purpose, resort may be had to instrumental aids, of which the most serviceable amongst many are the exploring needle, a fine trocar and canula, and various probes and sounds. In some cases a positive diagnosis cannot be made, even with the assistance of an operation. Exploratory incision, so promising, does not always yield the result required, and in certain regions it should only be practised after due consideration. Laparotomy conducted with a definite object in view can be performed successfully, but in obscure abdominal affections groping about the horse's bowels for some defect, which can only be remedied outside the abdomen or in the post-1Jlortem room, is still a dangerous operation. Experience of abdominal cases has convinced me that while the large colon, c;:ecum, and floating colon may be handled, even roughly, without very great risk, the small intestine will not withstand more than the gentlest manipulation. Septic peritonitis, which is responsible for most of the fatalities following interference with the bowels of the horse, may arise not only from infection conveyed from without but also from infection inside the bowel, brought about by bruising of the mucous membrane. Diagnosis based on a prominent symptom may be weIl founded or it may be decidedly insecure. Before giving a definite opinion it is well to look beyond the most attractive symptom; and merely to suggest caution in diagnosis I venture to submit a rough summary of variable cases sometimes encountered in practice : Swelling of the lips arises from systemic as well as local causes, from purpura, strangles, and glanders, bites, stings, and other injuries, drugs, facial paralysis, and from the head being carried abnormally low, as in some cases of injury or disease of the cervical region. The depression above or behind the chin may be filled up in consequence of periostitis, tumour formation, or fracture of the lower jaw, or of bruising by the curb chain. The mouth may be offensive from the existence of diseased teeth, enlarged inter-molar spaces, foreign body

GENERAL ARTICLES.

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embedded in the cheek, palate, or tongue, ruptured frcenum, lacerated tongue, necrosis of the inferior maxilla at the bar, or from disea»e beyond the cavity of the mouth. Pendulous or protruding tongue may be due to paralysis, severe laceration, tumour at the root, hypertrophy, or to habit or vice. Quidding of food may be symptomatic of most of the conditions jllS~ mentioned, though it is more often connected with carious and irregular molar teeth, sore throat, and wound of the soft palate. Quidding may exist for a day or two, and then disappear without treatment, and even before the cause has been discovered. Symptoms of choking may occur without obstruction, may recur after removal of a foreign body, or immediately after a probang has been passed into the stomach and before food or water has bee n given. Nasal discharge, with or without offensive smell, may proceed from simple catarrh, laryngitis, lung d is ease, pharyngeal abscess, empyema of the g uttural pouch, chronic rhinitis, necrosis of the maxillary or turbinal bones, cariolls molar fan g, alveolar fistula, tumour or pus in a facial sinus, glanders, strangles, and, in foals, from cleft palate. Nasal roaring may be caused by swellin g at the nostril, dilator paralysis, atheroma, polypus or other tumour, glanders, and some other diseases of the Schneiderian membran e, deviation of the septum, inward bulgin g o f the external nasal wall, and by fracture with displacement. A small discharging wound of the cheek may be the outlet of a sinus, or a buccal, dental, or salivary fistula ; and a similar wound in front of or below the ear may be a isnus in connectio n with a necrosed bone, an unhealed fracture, or a dentigerous cyst, or it may be a fistula of the joint of the jaw. Tears overflow the eyelid in consequence of excessive secretion, defective excretion, foreign body, conjunctivitis, obstruction of the nasal duct or puncta. cedema of the conjunctiva (ophthalmia, purpura, influ enza), tumour of the orbit, disease of the m em brana nictitans, and entropium, which occurs occasionally in horses. A swelling at the poll may be a mere synovial distension requiring no active treatm ent, a simple superficial abscess, or a serious bruise complicated by necrosis of ligament and bone. Inability to raise the head, with more or less lateral bending of the neck , may he due to rheumatism, muscular or ligamentous strain, partial luxation, fracture, or tuberculosis of the cervical vertebrce. A small wound with cedematous swelling over the breast is generally connected with disease of the sternum, but it may be traceable to the spine, shoulder-blade, or a rib. A circumscribed swelling with sinus over the chest wall may be superfici a l and trivial, or it may arise from unhealed costal or chondral fracture, and perforation of the pleura may be imminent. An abdominal swelling may be an abscess with protruding bowel, a h ernia of no urgency, or a tumour masked by ced ema. Staling into the sheath may be congenital, or it may result from operation on the penis, tumour, paralysis, or from chronic cystitis with urinary incontinence. Blood in the urine may come from any part of the urinary tract. Symptoms of colic and irritation of the bowels may be caused by abscess in the wall of the rectum , recto-vaginal, or horseshoe fistul a. Paralysis of the tail, with fcecal retention, may result from sacra l or coccygeal fracture, nervous lesion without fracture, or ruptured rectum, and it may be associated with locomotor weakness, urinary overflow, and cystitis. Q

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GENERAL ARTICLES.

Prognosis, or the faculty of predicting what will happen in disease, Owners of horses are usually very is closely allied to diagnosis. anxious to know not only what is amiss, but also when the animal will be fit to resume work. Where knowledge is defective the answer should be guarded; and in most doubtful cases it is advisable to bear in mind the difference in metallic value of speech and silence. A little anatomy is a dangerous tHing, and unless the probable physiological and pathological changes of the case can be realised by promptly recalling the anatomical features of the damaged region, only a provisional prognosis should be given. To confess ignorance of what may happen in disease requires a fair amount of force of character. Experience gives confidence; and the tactful practitioner overcomes the immediate difficulty of the situation by pleading time. The preparation of the horse prior to severe operation is a wise precaution, though it should be stated that accidents to surgical patients, prepared or not, are extremely rare. Some animals, before operation, require rest and making up, but commonly the preparation indicated consists in reducing condition by a restricted diet, salines, and a dose of purgative medicine. Horses in hard condition, recently in training or just removed from stud service, should always be prepared by a relaxing diet. Constipation or overloaded bowels should be avoided when the operation includes casting and amesthesia. Injury to the spine, fracture, muscular rupture or strain, with its sequel atrophy, and other accidents equally inconvenient to the operator, are less likely to happen after careful preparation of the subject. Operation wounds heal more rapidly in horses of moderate condition than in horses which are very fat. Preparation prior to simple standing operations may be considered superfluous, though sometimes the effects of the operation or after treatment are sufficiently disquieting to suggest the regret that the horse was not carefully prepared. In urgent cases, where the delay would expose the patient to increased risk, preparation is contra-indicated. To illustrate one aspect of the disadvantage of proceeding to operate without due preparation of the subject, the following instance is given :-An aged stallion, reported savage and intractable, was brought to the College for castration. He was immediately put down and secured for operation. One testicle was in the scrotum, the other was concealed. Having searched the inguinal canal with a negative result, chloroform was administered and the hand passed into the abdomen, where a fully developed testicle was found; but owing to the state of the bowels, which were filled to repletion, the testicle could not be moved in any direction. To increasE', if possible, the space for manipulation, the position of the horse was altered from time to time, yet the testicle could not be brought into the canal, even with the assistance of a hand in the rectum. Failing to move the testicle, the hand was withdrawn from the abdomen and the scrotal wound sutured. The other testicle was removed in the usual way. Two months afterwards, as arranged with the owner, the horse was returned for further operation. He was carefully prepared for ten days, then cast and chloroformed, and without special difficulty the testicle, still in the abdomen, was brought into the canal and excised. This horse, like many more of similar temper, made an excellent recovery.

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The restraint of horses for operation is a long and complicated subject which cannot be explained satisfactorily on paper. Nor can it be learned by precept; and I doubt if even example can influence the manipulatory methods of the few who approach the horse as they would a ruffian, who use instruments as they would a dagger or a bowieknife, and who persistently prod wounds as others mix a mash. Such surgeons will never operate decently on the standing horse. For them horses should be put down, securely fixed, and deeply chloroformed. But some surgeons are agile, resourceful, and dexterous -using" the gentle hand." For them the restraint required is of the simplest kind, while others, more ceremonious, insist upon elaborate security at every operation-from disentangling the eyelashes of a pet dog to the radical cure of equine inguinal hernia. The remark is often heard that there are many veterinary surgeons, but very few operators. vVhat can be the reason? Is it because general practice, by its tacit defiance of Solomon's teaching" that the race is not to the swift, nor the battle to the strong," unfits the veterinary surgeon for neat and exact operations; or is it because the precious groundwork of anatomy, seldom thoroughly scanned, yet so essential to the surgeon, has been forgotten, and nO\vonly irritates by the importunity of its loss? Doubtless there are other reasons of which something might be said, but this is not the place for professional introspection. The various means of restraint employed in operations on the horse in the standing position comprise blinds, twitches, Polish and other gags, Rarey strap, side-lines and covering hobbles, electric bit, hippolasso, holding up a foot, placing the horse in a travis or stocks, in slings or other suspending apparatus. \Vithout these aids horses may be rendered manageable by partial amesthesia, by subcutaneous injection of morphia, by chloral, Indian hemp, or opium given in bolus or electuary, or by free application of cocaine to the seat of operation. Blindfolding, which prevents the patient seeing the operator, probably exerts a quieting influence, though many horses will not tolerate blinds and operation of any sort at the same time. Blindfolding with or without the twitch, may succeed or fail. There is no rule-trial is the only guide. The ordinary twitch on lip or ear distracts the horse's attention from the operation, which may be less painful than the action of the twitch. Occasionally two twitches are better than one, but the restraining power of the twitch does not depend on the num ber of loops. The degree of compression produced by the twitch may not be measureable, but it is worth attention. Horses that appear nauseated, or threaten to go down under an over-twisted twitch, may stand quietly enough for firing with no other restraint than that furnished by the bridlt: and a whispering groom. The twitch is abused in two ways: by anti-cruelty humbugs and the like, whose words, uttered at a distance, all end in I or Ie, and by stablemen who twist it up in the belief that" the more it 'urts the better it haets." Both need instruction, the one muscular, the other mental. The humane twitch, perhaps so-called, because it seems to sicken the horse, is a cord about 3 yards long, with a running noose at one end. The noose is placed on the lower jaw, behind the incisors, and the shank is carried backwards over the neck, then forwards and through the noose at the jaw, where it is secured by a slipknot-after

GENERAL ARTICLES.

forcing the horse's chin towdrds his breast. It is a severe twitch, and its action endangers the horse's neck. The Polish gag is a loop of rope or raw hide passed through the mouth and over the poll. When tightened up it forces the cheeks between the molar teeth and holds the mouth open. Its use causes much discomfort, and is only resorted to when other means fail. The advantage of having a foot held up by hand or by the Rarey strap is well known. But many horses while being fired prefer to have all four feet on the ground. This I have frequently proved. The operation, commenced with twitch, blinds. and a foot held up, has been continued to the end after dropping the raised foot. For tiring a young horse that refuses to submit quietly to a simple operation the Rarey strap is very effective; but its use requires ample space (where the ground is not too hard) and knee-caps, which are sometimes forgotten. Lunging sometimes serves equally well and with less risk of accident. The travis and slings are specially valuable in operating on horses, sometimes called" dancers," which cannot be made to stand quietly in one place, and which for some reason must not be put down. Operations on the head, neck, back, and tail, some operations on the legs) and most operations on the feet, can be very conveniently carried out on the horse properly secured in a travis. Controlling horses for operation in the standing position by means of drugs is convenient, very safe, and, bearing in mind the assistance required in throwing horses, decidedly economical. Where ordinary measures are impracticable, and casting is prohibited, drugs should be tried. Half-an-hour before the time fixed for operation, the horse, according to size, breed, and temperament, may be given in bolus or electuary, t a drachm to 2 drachms or more of powdered opium, or a sufficient dose of Indian hemp, or chloral hydrate. To prevent accident from stumbling or falling while under the influence of the drug, the horse should wear knee-caps. By this method very restive horses will submit quietly to severe operations performed expeditiously. (To-be Continued.)

SOME DIFFICULTIES ASSOCIATED WITH THE ERADICATION OF SWINE FEVER.

By E. PEACEY, M.R.C.V.S., Wakefield. THE present condition of swine fever is one that is frequently the subject of general criticism offered voluntarily both by the profession generally and the laity, and not without assuming in the majority of instances a pessimistic view as to its final extinction and eradication. My object is to mention a few of the everyday factors seldom considered but by no means of the least importance. Diagnosis.- The disease was for a long time imperfectly understood, and although mentioned and described as far back as forty years ago, even then and until quite recently it was mixed up with other diseased conditions common to swine, such as necrotic contagious pneumonia and swine erysipelas. At the present day swine erysipelas is frequently met with, and is differentiated as a distinct