Chapter VI: Genito-Urinary Organs (1)

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when operation on the urethra, or even on the extremity of the penis, becomes necessary the organ must first of all be withdrawn.

The manipulation is as follows:—

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

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

URETHROTOMY IN THE OX.

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

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

ISCHIAL URETHROTOMY.

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

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

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

The urethra can be incised by one of three methods.

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

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

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

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

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

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

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

SCROTAL URETHROTOMY.

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

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

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

One of two conditions may exist.

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

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

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

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

With ordinary antiseptic precautions little danger is to be feared.

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

PASSAGE OF THE CATHETER AND URETHROTOMY IN THE RAM.

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

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

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

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

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

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

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

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

PASSAGE OF THE CATHETER IN THE COW.

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

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

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

CASTRATION.

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

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

CASTRATION OF THE BULL AND RAM.

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

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

BISTOURNAGE.

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

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

=Manual Technique.= The operation comprises four stages:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

MARTELAGE.

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

The practice is very ancient.

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

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

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

CASTRATION BY CLAMS.

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

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

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

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

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

CASTRATION BY TORSION.

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

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

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

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

CASTRATION WITH THE ACTUAL CAUTERY.

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

CASTRATION BY THE ELASTIC LIGATURE.

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

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

CASTRATION OF THE RAM.

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

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

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

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

CASTRATION OF BOARS AND YOUNG PIGS.

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

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

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

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

CASTRATION OF CRYPTORCHIDS.

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

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

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

To avoid subsequent complications antiseptic precautions should be taken.

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

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

FEMALE GENITAL ORGANS.

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

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

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

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

CASTRATION OF THE COW.

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

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

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

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

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

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

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

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

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

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

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

The operation comprises three stages:

=First stage.= Puncture of the vagina.

=Second stage.= Finding and securing the ovaries.

=Third stage.= Ablation.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CASTRATION OF THE SOW.

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

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

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

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

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

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

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

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

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

The operation comprises four stages:

=First stage.= Incision of the skin and subjacent muscles.

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

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

=Fourth stage.= Suture of the wound.

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

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

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

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

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

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

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

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

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

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

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

SUTURE OF THE VULVA

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

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

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

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

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

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

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

TRUSSES.

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

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

SECTION OF THE SPHINCTER OF THE TEAT.

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

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

DILATATION OF THE ORIFICE OF THE TEAT.

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

ABLATION OF THE MAMMÆ.

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

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

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

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

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

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

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

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

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

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

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

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

=First stage.= Elliptical incision, including the teat.

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

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

=Fourth stage.= Suture and drainage.

INDEX.

A.

PAGE

Abdominal cavity, diseases of, 478

Ablation of the mammæ, 771

Abomasal indigestion, 182

Abomasum, 114
„ hernia of the, 493
„ obstruction of the, 194
„ strongylosis of, in the ox, 268

Abortion, epizootic, in cows, 553

Acariasis, non-psoroptic forms of, 645

Accessory glands of the genital apparatus, 597

Accidental phlebitis, 396

Acid theory in diseases of bones, 3

Acids, caustic, poisoning by, 217

Acne in the sheep, 606

Acorns, poisoning by, 228

Acquired herniæ, 489

Actinomycosis, 672

Actual cautery, castration with the, 758

Acute cystitis, 511
„ deep-seated glossitis, 131
„ eczema, 599
„ enteritis, 203
„ gastric indigestion in swine, 185
„ gastritis, 188
„ inflammation of the gastric compartments, 186
„ laryngitis, 333
„ mammitis, 573
„ metritis, 550
„ nephritis, 528
„ parotiditis, 134
„ peritonitis, 478
„ pleurisy, 361
„ tuberculosis, 704
„ vaginitis, 544

Æsculaceæ, 246

Agalaxia, 587

Agaricaceæ, 225

Alkalies, caustic, poisoning by, 217

Aloes, poisoning by, 221

Alsinaceæ, 229

Ambrosiaceæ, 256

Amputation of the claw, 730

Anæmia in cattle, 268
„ lambs, 268
„ sheep, 268

Anæsthesia, 726

Annual mercury, poisoning by, 256

Anomalies, physiological, 567

Anus, 116
„ imperforate, 742

Apiaceæ, 247

Apocynaceæ, 251

Apparatus of locomotion, 730

_Aragallus spicatus_, poisoning by, 237

Arsenic, poisoning by, 218

Arsenical dips, 632

Arteries, examination of, 371

“Arthritis of milch cows”, 99

Articular rheumatism, 89
„ causes, 89
„ complications, 91

Articulations, diseases of, 45

Ascites, 483

Asclepiadaceæ, 252

Aspergilli, pneumo-mycosis due to, 350

B.

Barberry family, 235

Beech family, 228

Beef measles, 79
„ cause, 79
„ symptoms, 81
„ where prevalent, 79

Bell-flower family, 255

Berberidaceæ, 235

Biceps femoris, 70

Bile ducts, cancer of, 282

Bilharziosis in cattle and sheep, 439

Bistournage, 751

Bitter milk, 591

Bladder, diseases of the, 511
„ eversion of the, 519
„ paralysis of the, 519

Bleeding, 727
„ in the pig, 728
„ in sheep, 727

Blood, diseases of the, 406
„ examination of, 372
„ poisoning in sheep and lambs in New Zealand, 415
„ -vessels, diseases of, 396

Blood-wort family, 228

Bloody flux in calves and lambs, 271

Blue milk, 590

Boars, castration of, 759

Bog spavin in the ox, 46

Bone, actinomycosis of, 681
„ tumours, 30

Bones and articulations, tuberculosis of the, 701

Bones, diseases of, 3
„ „ acid theory, 3
„ „ inflammation theory, 4
„ „ theory of insufficiency, 3

Bovine animals, calculi in, 515
„ piroplasmosis, 416

Box family, 246

Brain, tuberculosis of the, 702

Braxy, 435

Bronchi, 333

Bronchitis, 336
„ chronic, 337
„ pseudo-membranous, 339
„ simple acute, 337
„ verminous, in sheep and cattle, 340

Broncho-pneumonia, gangrenous, due to foreign bodies, 351
„ infectious, 354
„ of sucking calves, 356
„ sclero-caseous, of sheep, 358

Bryony, poisoning by, 256

Buckwheat poisoning, 606

Bull, castration of the, 751

Bunch-flower family, 227

Bursal sheath of the flexor tendons, distension of, 49

Butneriaceæ, 235

Butter, milk without, 589

Buxaceæ, 246

C.

Calculi in bovine animals, 515
„ urinary, in sheep, 518

Calculus formation, 514

Calves, depraved appetite in, 160
„ diarrhœic enteritis in, 212
„ dysentery in, 210
„ goitre in, 453
„ intestinal coccidiosis of, 271
„ lumbricosis of, 267
„ mycotic stomatitis in, 124
„ necrosing stomatitis in, 123

Calving, dropping after, 461

Campanulaceæ, 255

Cancer of the bile ducts, 282
„ liver, 282

Cancerous pericarditis, 375

Canker, 40
„ treatment, 41

Capillary system, examination of, 372

Carbolic acid poisoning, 221
„ dips, 633

Cardiac anomalies, 374

Carduaceæ, 256

Carrot family, 247

Caseous lymphadenitis of the sheep, 453

Casting, control of oxen by, 723

Castor oil cake, poisoning by, 257

Castration, 751
„ complications after, 760
„ by clams, 756
„ the covered method, 757
„ „ elastic ligature, 758
„ „ exposed method, 757
„ torsion, 757
„ of boars and young pigs, 759
„ „ the bull and ram, 751
„ „ „ cow, 761
„ „ cryptorchids, 760
„ „ the ram, 759
„ „ „ „ by bistournage, 759
„ „ „ „ „ ligature, 759
„ „ „ „ „ tearing, 759
„ „ „ sow, 765
with the actual cautery, 758

Catarrhal gastritis in swine, 190
„ stomatitis in sheep, 122
„ „ general, in swine, 126

Catheter, passage of the, in the cow, 750
„ „ „ „ ram, 749

Cattle, anæmia in, 268
„ bilharziosis in, 439
„ diarrhœa in, 268
„ hæmorrhagic septicæmia in, 716
„ parasitic gastro-enteritis in, 268
„ pseudo-membranous pharyngitis in, 141
„ verminous bronchitis in, 340

Caustic acids, poisoning by, 217
„ alkalies, poisoning by, 216

Cerebral congestion, 456
„ tumours, 459

Changes in the milk, 587

Chaps, 568

Chemical dyspepsia, 195

Chenopodiaceæ, 229

Chorioptic mange, 636, 640, 642

Chronic bronchitis, 337
„ cystitis, 513
„ diarrhœa, 207
„ eczema, 600
„ enteritis, 207
„ gastritis, 194
„ glossitis, 132
„ indigestion, 194
„ mammitis, 581
„ metritis, 552
„ nephritis, 530
„ parotiditis, 136
„ pericarditis, 389
„ peritonitis, 481
„ pleurisy, 362
„ simple synovitis, forms of, 45
„ tympanites, 194
„ vaginitis, 546

Circulation, organs of the, 370

Circulatory apparatus, 727

Clams, castration by, 756

Claw and third phalanx, disarticulation of the, 731
„ amputation of the, 730
„ surgical dressing for a, 730

Claws, congestion of the, 31

Clément’s bath, 623

Clotted milk, 589

Cœnurosis, 467

Colchicum poisoning, 256

Cold water, colic due to ingestion of, 162

Colic, 116
„ as a result of strangulation, 167

Colic due to invagination, 163
„ in the ox, 162

Common salt, poisoning by, 217

Complications after castration, 760

Condylomata, 38

Congenital herniæ, 487

Congestion, pulmonary, 343
„ of the claws, 31
„ „ kidneys, 527
„ „ liver, 280
„ „ udder, 570

Congestive colic, 162

Conjunctivitis, 662

Contagious disease (takosis) of goats, 412
„ mammitis in milch cows, 580
„ vaginitis, 545

“Contagious foot disease”, 41

Contraction of the sphincter, 567

Control of pigs, 725
„ sheep and goats, 725
„ oxen, 720
„ „ by casting, 723
„ general, of oxen, 722

Contusions of the sole, 31

Convallariaceæ, 228

Copper poisoning, 221

Coryza, gangrenous, 320
„ simple, 319

Cotton cake, poisoning by, 257

Covered method, castration by the, 757

Cow, castration of the, 761
„ „ „ complications in, 764
„ passage of the catheter in the, 750

Cows, epizootic abortion in, 553

Cowper’s glands, 597

Cow-pox, 665
„ and human variola, 669

Cracks, 568

Creolin bath, 324

Croupal vaginitis, 545

Crowfoot family, 230

Crushing a foreign body in the œsophagus, 735

Cryptorchids, castration of, 760

Cysticerci, infection with, 73

Cysticercosis, 290
„ peritoneal, 485

Cysticercus disease of the pig, 73

Cystic parasites of animals, table of, 73

Cystitis, acute, 511
„ chronic, 513

Cysts of the udder, 585

D.

Defæcation: examination of fæcal material, 118

Demodecic mange, 643

Depraved appetite, 158
„ „ in calves and lambs, 160
„ „ „ the ox, 158

Diaphragmatic herniæ, 496

Diarrhœa, chronic, 207
„ in cattle, 268
„ „ lambs, 268
„ „ sheep, 268

Diarrhœic enteritis in calves, 212

Digestive apparatus, 734
„ „ diseases of, 106
„ „ fistulæ of, 500
„ „ parasites of, 263
„ „ semiology of, 106

Digestive tract, tuberculosis of the, 699

Dilatation of the œsophagus, 149
„ „ orifice of the teat, 770

Disarticulation of the claw and third phalanx, 731
„ „ two first phalanges, 732

Diseases of the bladder, 511
„ „ blood, 406
„ „ kidneys, 527
„ „ liver, 279
„ „ lymphatic system, 444
„ „ mouth, 106
„ „ œsophagus, 109
„ „ pharynx, 108
„ „ salivary glands, 108
„ „ stomach, 110, 169
„ „ rumen, 110
„ „ peritoneum and abdominal cavity, 478
„ „ urinary apparatus, 502
„ produced by distillery and sugar factory pulp, 259
„ transmissible to man through the medium of milk, 593

Distillery and sugar factory pulp, diseases produced by, 259

Distomatosis, 293

Disturbance in the milk secretion, 587

Dogbane family, 251

Dropping after calving, 461

Dysentery in calves, 210
„ „ and lambs, 271

Dyspepsia, 194
„ motor, 195
„ secretory or chemical, 195

E.

Echinococcosis of the liver, 283
„ suppurative, 288

Ectopia of the heart, 374

Eczema, 599
„ acute, 599
„ chronic, 600
„ due to feeding with potato pulp, 603
„ sebaceous or seborrhœic, 601

Elastic ligature, castration by the, 758

Emphysema, pulmonary, 359
„ subcutaneous, 659

Encephalitis, 458

Endocarditis, 394

Enteritis, 203
„ acute, 203
„ chronic, 207
„ diarrhœic, in calves, 212
„ hæmorrhagic, 206

Epizootic abortion in cows, 553

Equisetaceæ, 225

Ergot family, 223

Ergot of rye, poisoning by, 223

Ergotism, 223

Ericaeæ, 249

Euphorbiaceæ, 244

Eventration, 499

Eversion of the bladder, 519

Exostoses, 27

Exposed method, castration by the, 757

External ischio-tibial muscle, rupture of the, 70

Exudative pericarditis due to foreign bodies, 376

Eyes, diseases of the, 661

F.

Facial sinuses of sheep, œstrus larvæ in the, 330
„ „ trephining the, 745

Fæcal material, examination of, 118

Fagaceæ, 228

Fagopyrism, 606

False sturdy, 330

_Fasciola hepatica_, 294

Felon, 41

Female genital organs, examination of, with the speculum, 760

Femoro-tibial articulation, luxation of the, 61
„ „ symptoms, 62
„ „ treatment, 63

Femur, luxation of, 56
„ „ „ symptoms, 57
„ „ „ treatment, 58

Fennel, poisoning by, 249

Ferments, lactic, 588

Fern family, 225

Fetlock joint, distension of the synovial capsule of the, 48
„ strain of, 54

Figwort family, 255

Fistula, parotid, 136

Fistulæ, milk, 569
„ of the digestive apparatus, 500

Flax family, 244

Flexor metatarsi, rupture of the, 72
„ tendons, distension of the bursal sheath of, 49

Food, poisoning due to, 215

Foot, diseases of the, 31
„ rot, 43
„ „ symptoms, 43
„ „ treatment, 44
„ scab, 636

Foreign bodies causing diseases of the eyes, 661
„ „ exudative pericarditis due to, 376
„ „ gangrenous broncho-pneumonia due to, 351
„ „ gastric disturbance due to, 198
„ „ migration of, from the reticulum, pneumonia due to, 348

Foreign bodies, pneumonia due to, 347

Foreign body in the œsophagus, crushing a, 735
„ „ „ „ submucous dissection of, 736

Fractures, 20

France, bovine piroplasmosis in, 424