Chapter 13

BLEEDING; TORSION; CASTRATION, PARTURITION; AND SOME DISEASES CONNECTED WITH THE ORGANS OF GENERATION.

BLEEDING.

This operation is exceedingly useful in many accidents and diseases. It is, in fact, as in the horse, the sheet-anchor of the practitioner in the majority of cases of an inflammatory character. There is some difference, however, in the instrument to be used. The lancet is the preferable instrument in the performance of this operation. The fleam should be banished from among the instruments of the veterinary surgeon.

A ligature being passed round the lower part of the neck, and the head being held up a little on one side, the vein will protrude on either side of the windpipe. It will usually be advisable to cut away a little of the hair over the spot designed to be punctured. When a sufficient quantity of blood is abstracted, it will generally be necessary, and especially if the dog is large, to pass a pin through both edges of the orifice, and secure it with a little tow.

When no lancet is at hand, the inside of the flap of the ear may be punctured with a pen-knife, the course of a vein being selected for this purpose. In somewhat desperate cases a small portion of the tail may be amputated.

The 'superficial brachial vein', the 'cephalic' vein of the human subject, and the 'plat' vein of the farrier, may be resorted to in all lamenesses of the fore limb, and especially in all shoulder-wrenches, strains of the loins, and of the thigh and the leg, and muscular and ligamentous extensions of any part of the hind limbs; the 'vena saphena major', and the 'anterior tibial' vein may be punctured in such cases.

The quantity of blood to be abstracted must be regulated according to the size and strength of the dog and the degree of inflammation.

One or two ounces may be sufficient for a very small dog, and seven or eight for a large one.

TORSION

To M. Amusat, of Paris, we are indebted for the introduction of the artery-forceps for the arresting of hemorrhage. I shall do but justice to him by describing his mode of proceeding. He seizes the divided vessel with a pair of torsion-forceps in such a manner as to hold and close the mouth of the vessel in its teeth. The slide of the forceps then shuts its blade, and the artery is held fast. The artery is then drawn from out of the tissues surrounding it, to the extent of a few lines, and freed, with another forceps, from its cellular envelope, so as to lay bare its external coat. The index and thumb of the left hand are then applied above the forceps, in order to press back the blood in the vessel. He then begins to twist the artery. One of the methods consists in continuing the torsion until the part held in the forceps is detached. When, however, the operator does not intend to produce that effect, he ceases, after from four to six revolutions of the vessel on its axis for the small arteries, and from eight to twelve for the large ones. The hemorrhage instantly stops. The vessel which had been drawn out is then replaced, as the surrounding parts give support to the knot which has been formed at its extremities. The knot becomes further concealed by the retraction of the artery, and this retraction will be proportionate to the shortening which takes place by the effect of the twisting, so that it will be scarcely visible on the surface of the stump. It is of the utmost importance to seize the artery perfectly, and to make the stated number of twists, as otherwise the security against the danger of consecutive hemorrhage will not be perfect.

Mr. W. B. Costello, of London, was present when the operation was performed at Paris. He brought back a full account of it as performed there, and availed himself of an early opportunity of putting it to the test before some of our metropolitan surgeons. A dog was placed on the table, the forceps were applied, and the operation perfectly succeeded.

A few days afterwards a pointer bitch was brought to my infirmary, with a large scirrhous tumour near the anterior teat on the left side. It had been gradually increasing during the last five months. It was becoming more irregular in its form, and on one of its tuberculous prominences was a reddish spot, soft and somewhat tender, indicating that the process of suppuration was about to commence.

I had often, or almost uniformly, experienced the power of iodine in dispersing glandular enlargements in the neck of the dog, and also those indurated tumours of various kinds which form about the joints of some domesticated animals, particularly of cattle; but frequent disappointment had convinced me that it was, if not inert, yet very uncertain in its effect in causing absorption of tumours about the mammæ of the bitch. Having also been taught that the ultimate success of the excision of these enlargements depended on their removal before suppuration had taken place, and the neighbouring parts had been inoculated by the virus which so plentifully flowed from the ulcer, I determined on an immediate operation; and, as the tumour was large, and she was in high condition, I thought it a good case for 'the first trial of torsion'. She was well physicked, and on the third day was produced before my class and properly secured. I had not provided myself with the 'torsion forceps', but relied on the hold I should have on the vessel by means of a pair of common artery forceps; and the effect of imperfect instruments beautifully established the power of torsion in arresting hemorrhage.

Two elliptical incisions were made on the face of the tumour, and prolonged anteriorly and posteriorly about an inch from it. The portion of integument that could be spared was thus enclosed, while the opposed edges of the wound could be neatly and effectually brought together after the operation. The dissection of the integument from the remaining part of the face of the tumour was somewhat slow and difficult, for it was in a manner identified with the hardened mass beneath; but the operation soon proceeded more quickly, and we very soon had the scirrhus exposed, and adhering to the thorax by its base. About two ounces of venous blood had now been lost.

I was convinced that I should find the principal artery, by which the excrescence was fed, at its anterior extremity, and not far from the spot where the suppuration seemed to be preparing: therefore, beginning posteriorly, I very rapidly cut through the cellular texture, elevating the tumour and turning it back, until I arrived at the inner and anterior point, and there was the only source of supply; the artery was plainly to be seen. In order to give the experiment a fair chance, I would not enclose it in the forceps, but I cut through it. A jet of blood spirted out. I then seized the vessel as quickly as I could, and began to turn the forceps, but before I could effect more than a turn and a half I lost my hold on the artery. I was vexed, and paused, waiting for the renewed gush of blood that I might seize the vessel again; but to my surprise not a drop more blood came from the arterial trunk. That turn and a half, considerable pressure having been used, had completely arrested the hemorrhage. I can safely say that not more than four drachms of arterial blood were lost.

The wound was sponged clean: there remained only a very slight oozing from two or three points; the flaps were brought together, secured by the ordinary sutures, and the proper bandages applied. The weight of the tumour was twenty-two ounces; there was no after-bleeding, no unpleasant occurrences; but the wound, which had been nearly six inches in length, was closed in little more than three weeks.

He will essentially promote the cause of science, and the cause of humanity, who will avail himself of the opportunity which country practice affords of putting the effect of torsion to the test: and few things will be more gratifying than the consciousness of rescuing our patients from the unnecessary infliction of torture.

In docking, it will be found perfectly practicable: our patients will escape much torture, and tetanus will often be avoided. The principal danger from castration has arisen from the severity with which the iron has been employed. The colt, the sheep, and the dog will be fair subjects for experiment. The cautery, as it regards the first, and the brutal violence too frequently resorted to in operating upon the others, have destroyed thousands of animals.

CASTRATION.

This operation is performed on a great portion of our domestic animals. It renders them more docile, and gives them a disposition to fatten. It is followed by fewest serious accidents when it is performed on young animals. The autumn or spring should, if possible, be chosen for the operation, for the temperature of the atmosphere is then generally uniform and moderate. It should be previously ascertained that the animal is in perfect health; and he should be prepared by a mash diet and bleeding, if he is in a plethoric state, or possessed of considerable determination. If it is a young animal that is to be operated upon, an incision may be made into the scrotum, the testicle may be protruded, and the cord cut without much precaution, for the blood will soon be stayed; but for older animals it will be advisable to use a ligature, applied moderately tightly round the spermatic cord a little more than an inch beyond its insertion into the testicle; the scalpel is then used, and a separation effected between the ligature and the testis. The vas derens needs not to be included; a great deal of pain will then be spared to the animal.

The ordinary consequences of castration are pain, inflammation, engorgement, and suppuration. The pain and suppuration are inevitable, but generally yield to emollient applications. The engorgement is often considerable at first, but soon subsides, and the suppuration usually abates in the course of a few days. It has been said that the castrated dog is more attached and faithful to his master than he who has not been deprived of his genital powers: this, however, is to be much doubted. He has, generally speaking, lost a considerable portion of his courage, his energy, and his strength. He is apt to become idle, and is disposed to accumulate fat more rapidly. His power of scent is also very considerably diminished and he is less qualified for the sports of the field. Of this there can be no doubt. It has been said that he is more submissive: I very much doubt the accuracy of that opinion. He may not be so savage as in his perfect state; he may not be so eager in his feeding; but there is not the devotion to his master, and the quickness of comprehension which belongs to the perfect dog.

The removal of the ovaries, or spaying of the female, used to be often practised, and packs of spayed bitches were, and still are, occasionally kept. In performing this operation, an opening is made into the flank on one side, and the finger introduced--one of the ovaries is laid hold of and drawn a little out of the belly; a ligature is then applied round it, just above the bifurcation of the womb, and it is cut through, the end of the ligature being left hanging out of the wound. The other ovary is then felt for and drawn out, and excised and secured by a ligature. The wound is then sewed up, and a bandage is placed over the incision. Some farriers do not apply any ligature, but simply sew up the wound, and in the majority of cases the edges adhere, and no harm comes of the operation, except that the general character of the animal is essentially changed. She accumulates a vast quantity of fat, becomes listless and idle, and is almost invariably short-lived.

The female dog, therefore, should always be allowed to breed. Breeding is a necessary process; and the female prevented from it is sure to be affected with disease sooner or later; enormous collections and indurations will form, that will inevitably terminate in scirrhus or ulceration.

A troublesome process often occurs when the female is not permitted to have young ones; namely, the accumulation of milk in the teats, especially if at any previous time, however distant, she may have had puppies once. The foundation is laid for many unpleasant and unmanageable complaints. If she is suffered to bring up one litter after another, she will have better health than those that are debarred from intercourse with the male.

The temporary union which takes placed between the male and female at the period at which they are brought together is a very singular one. The corpora cavernosa of the male and the clitoris of the female being suddenly distended with blood, it is impossible to withdraw either of them until the turgescence of the parts has entirely ceased.

PARTURITION

The pupping usually takes place from the sixty-second to the sixty-fourth day; and the process having commenced, from a quarter to three quarters of an hour generally takes place between the production of each puppy.

Great numbers of bitches are lost every year in the act of parturition: there seems to be a propensity in the females to associate with dogs larger than themselves, and they pay for it with their lives. The most neglected circumstance during the period of pregnancy is the little exercise which the mother is permitted to take, while, in point of fact, nothing tends more to safe and easy parturition than her being permitted or compelled to take a fair quantity of exercise.

When the time of parturition has arrived, and there is evident difficulty in producing the foetus, recourse should be had to the ergot of rye, which should be given every hour or half hour, according to circumstances. If after a certain time some, although little, progress has been made, the ergot must be continued in smaller doses, or perhaps suspended for a while; but, if all progress is evidently suspended, recourse must be had to the hook or the forceps. By gentle but continued manipulation much may be done, especially when the muzzle of the puppy can be brought into the passage. As little force as possible must be used, and especially the foetus little broken. Many a valuable animal is destroyed by the undue application of force.

If the animal seems to be losing strength, a small quantity of laudanum and ether may be administered.

"The patience of bitches in labour is extreme," says Mr. Blaine; "and their distress, if not removed, is most striking and affecting. Their look is at such time particularly expressive and apparently imploring."

When the pupping is protracted, and the young ones are evidently dead, the mother may be saved, if none of the puppies have been broken. In process of time the different puppies may, one after another, be extracted; but when violence has been used at the commencement, or almost at any part of the process, death will assuredly follow.

'June' 15, 1832.--A spaniel bitch was brought to my infirmary to-day, who has been in great and constant pain since yesterday, making repeated but fruitless efforts to expel her puppies. She is in a very plethoric habit of body; her bowels are much confined, and she exhibits some general symptoms of febrile derangement, arising, doubtless, from her protracted labour. This is her first litter. Upon examination, no young could be distinctly felt.

Place her in a warm bath, and give her a dose of castor oil, morning and evening.

'June' 16.--The bitch appears in the same state as yesterday, except that the medicine has operated freely upon the bowels, and the febrile symptoms have somewhat decreased. Her strainings are as frequent and distressing as ever. Take two scruples of the ergot of rye, and divide into six doses, of which let one be given every half hour.

In about ten minutes after the exhibition of the last dose of this medicine, she brought forth, with great difficulty, one dead puppy, upon taking which away from her, she became so uneasy that I was induced to return it to her. In about a quarter of an hour after this I paid her another visit: the puppy could not now be found; but a suspicious appearance in the mother's eye betrayed at once that she had devoured it. I immediately administered an emetic; and in a very short time the whole foetus was returned in five distinct parts, viz., the four quarters and the head. After this, the bitch began to amend very fast; she produced no other puppy; and as her supply of milk was small, she was soon convalescent.

Twelve months afterwards she was again taken in labour, about eleven o'clock in the morning, and after very great difficulty, one puppy was produced. After this the bitch appeared in great pain, but did not succeed in expelling another foetus, in consequence of which I was sent for about three o'clock, P.M. I found her very uneasy breathing laboriously; the mouth hot, and the bowels costive; but I could not discover any trace of another foetus. She was put into a warm bath, and a dose of opening medicine was administered.

About five o'clock she got rid of one dead and two living puppies.

'2d'. She is still very ill; she evinces great pain when pressed upon the abdomen; and it is manifest that she has another foetus within her. I ordered a dose of the ergot, and in about twenty minutes a large puppy was produced, nearly dying. She survived with due care.

I cannot refrain from inserting the following case at considerable length.

'Sept.' 4, 1820.--A very diminutive terrier, weighing not 5 lbs. was sent to my hospital in order to lie in. She was already restless and panting. About eight o'clock at night the labour pains commenced; but until eleven scarcely any progress was made. The 'os uteri' would not admit my finger, although I frequently attempted it.

At half-past eleven, the membranes began to protrude; at one the head had descended into the pelvis and the puppy was dead. In a previous labour she had been unable to produce her young, although the ergot of rye had been freely used. I was obliged to use considerable force, and she fought terribly with me throughout the whole process. At half-past one, and after applying considerable force, I brought away a large foetus, compared with her own size. On passing my finger as high as possible, I felt another foetus living, but the night passed and the whole of the following day, and she ate and drank, and did not appear to be much injured.

Several times in the day I gave her some strong soup and the ergot. Some slight pains now returned, and by pressing on the belly the nose of the foetus was brought to the superior edge of the pelvis. The pains again ceased, the pudenda began to swell from frequent examination, the bitch began to stagger, and made frequent attempts to void her urine, with extreme difficulty in accomplishing it. I now resorted to the crotchet; and after many unsuccessful attempts, in which the superior part of the vagina must have been considerably bruised, I fixed it sufficiently firmly to draw the head into the cavity of the pelvis. Here for a while the shoulder resisted every attempt which I could make without the danger of detruncating the foetus. At length by working at the side of the head until my nails were soft and my fingers sore, I extracted one fore leg. The other was soon brought down; another large puppy was produced, but destroyed by the means necessary for its production. This was the fruit of two hours' hard work.

She was completely exhausted, and scarcely able to stand. When placed on the ground she staggered and fell at almost every step. Her efforts to void her urine were frequent and ineffectual.

At four o'clock I again examined her; the external pudenda were sore and swelled, and beginning to assume a black hue. It was with considerable difficulty that I could introduce my finger. A third foetus irregularly presented was detected. I could just feel one of the hind legs. No time was to be lost. I introduced a small pair of forceps by the side of my finger, and succeeded in laying hold of the leg without much difficulty, and, with two or three weak efforts from the mother,--I could scarcely call them pains,--I brought the leg down until it was in the cavity of the pelvis. I solicited it forward with my finger, and, by forcibly pressing back the 'labia pudendi', I could just grasp it with the finger and thumb of the right hand. Holding it there, I introduced the finger of the right hand, and continued to get down the other leg, and then found little difficulty until the head was brought to the superior edge of the pelvis. After a long interval, and with considerable force, this was brought into the pelvis, and another puppy extracted. This fully occupied two hours.

The bitch now appeared almost lifeless. As she was unable to stand, and seemed unconscious of every thing around her, I concluded that she was lost: I gave her one or two drops of warm brandy and water, covered her up closely, and put her to bed.

To my surprise, on the following morning, she was curled round in her basket; she licked my hands, and ate a bit of bread and butter; but when put on her legs staggered and fell. The pudendum was dreadfully swollen, and literally black. In the afternoon she again took a little food: she came voluntarily from her basket, wagged her tail when spoken to, and on the following day she was taken in her basket a journey of 70 miles, and afterwards did well; no one could be more rejoiced than was her master, who was present at, and superintended the greater part of the proceedings.

'The beneficial effect of Ergot of Rye in difficult Parturition'.--The following case is from the pen of Professor Dick:

On the 10th instant, a pointer bitch produced two puppies; and it was thought by the person having her in charge that she had no more. She was put into a comfortable box, and with a little care was expected to do well. On the next morning, however, she was sick and breathed heavily, and continued rather uneasy all the day.

On the forenoon of the following day I was requested to see her. I found her with her nose dry, breath hot, respiration frequent, mouth hot and parched, coat staring, back roached, pulse 120, and a black fetid discharge from the vagina. Pressure on the abdomen gave pain. A pup could be obscurely felt; the secretion of milk was suppressed, and the skin had lost its natural elasticity.

Tepid water with a little soap dissolved in it was immediately injected into the uterus, which in a considerable degree excited its action; and this injection was repeated two or three times with the same effect.

After waiting for half an hour, the foetus was not discharged nor brought forward; therefore a scruple of the ergot of rye was then made into an infusion with two ounces of water, and one-third of it given as a dose; in half an hour, another one-third of it; the injections of warm water and soap being also continued. Soon after the second dose of the infusion, a dead puppy was expelled; the bitch rapidly recovered, and, with the exception of deficiency of milk, is now quite well.

This case would seem to prove the great power of the ergot of rye over the uterus; but, until more experiments are made, it is necessary to be cautious in ascribing powers to medicines which have not been much tried in our practice. It is not improbable that the warm water and soap might have roused the uterus into action without the aid of the ergot; and it is therefore necessary that those who repeat this experiment should try the effects of the medicine unaided by the auxiliary.

The Professor adds, that the great power which this drug is said to have on the human being, and the apparent effect in the case just given, suggest the propriety of instituting a further trial of it, and of our extending our observations to cattle, amongst which difficult cases of calving so frequently occur.

Mr. Simpson thus concludes some remarks on ergot in difficult parturition. This medicine possesses a very great power over the uterus, rousing its dormant or debilitated contractility, and stimulating it to an extra performance of this necessary function after its natural energy has been in some measure destroyed by forcible but useless action. The direct utility of the ergot was manifested in cases where the uterus appeared quite exhausted by its repeated efforts; and certainly it is but fair to ascribe the decidedly augmented power of the organ to the stimulus of the ergot, for no other means were resorted to in order to procure the desired effect. Its action, too, is prompt. Within ten minutes of the administration of a second or third dose, when nature has been nearly exhausted, the parturition has been safely effected.

'Puerperal Fits'. Nature, proportions the power and resources of the mother to the wants of her offspring. In her wild undomesticated state she is able to suckle her progeny to the full time; but, in the artificial state in which we have placed her, we shorten the interval between each period of parturition, we increase the number of her young ones at each birth, we diminish her natural powers of affording them nutriment, and we give her a degree of irritability which renders her whole system liable to be excited and deranged by causes that would otherwise be harmless: therefore it happens that, when the petted bitch is permitted to suckle the whole of her litter, her supply of nutriment soon becomes exhausted, and the continued drain upon her produces a great degree of irritability. She gets rapidly thin; she staggers, is half unconscious, neglects her puppies, and suddenly falls into a fit of a very peculiar character. It begins with, and is sometimes confined to, the respiratory apparatus: she lies on her side and pants violently, and the sound of her laboured breathing may be heard at the distance of twenty yards. Sometimes spasms steal over her limbs; at other times the diaphragm and respiratory muscles alone are convulsed. In a few hours she is certainly lost; or, if there are moments of remission, they are speedily succeeded by increased heavings.

The practitioner unaccustomed to this fearful state of excitation, and forgetful or unaware of its cause, proceeds to bleed her, and he seals her fate. Although one system is thus convulsively labouring, it is because others are suddenly and perfectly exhausted; and by abstraction of the vital current he reduces this last hold of life to the helpless condition of the rest. There is not a more common or fatal error than this.

The veterinary practitioner is unable to apply the tepid bath to his larger patients, in order to quiet the erythism of certain parts of the system, and produce an equable diffusion of nervous influence and action; and he often forgets it when he has it in his power to save the smaller ones. Let the bitch in a fit be put into a bath, temperature 96° Fahrenheit, and covered with the water, her head excepted. It will he surprising to see how soon the simple application of this equable temperament will quiet down the erythism of the excited system. In ten minutes, or a quarter of an hour, she may be taken out of the bath evidently relieved, and then, a hasty and not very accurate drying having taken place, she is wrapped in a blanket and placed in some warm situation, a good dose of physic having been previously administered. She soon breaks out in a profuse perspiration. Everything becomes gradually quiet, and she falls into a deep and long sleep, and at length awakes somewhat weak, but to a certain degree restored.

If, then, all her puppies except one or two are taken from her, and her food is, for a day or two, somewhat restricted, and after that given again of its usual quantity and kind, she will live and do well; but a bleeding at the time of her fit, or suffering all her puppies to return to her, will inevitably destroy her.

A bitch that was often brought to my house was suckling a litter of puppies. She was foolishly taken up and thrown into the Serpentine in the month of April. The suppression of milk was immediate and complete. There was also a determination to the head, and attacks resembling epilepsy. The puppies that were suffered to remain with the mother, were very soon as epileptic as she was, and were destroyed. A seton was inserted on each side of her neck. Ipecacuanha was administered; and that having sufficiently worked, a small quantity of diluted sulphuric acid was given. A fortnight afterwards she was perfectly well.

'Inversion of the Uterus in a Bull Bitch after Pupping. Extirpation and Cure.'

By M. Cross, M. V., Milan.--In July, 1829, I was desired to attend a small bull bitch six years old, and who had had puppies four times. The uterus was completely inverted, and rested all its weight on the vaginal orifice of the urethra, preventing the discharge of the urine, and thus being the cause of great pain when the animal endeavoured to void it, or the faecal matter. The uterus was become of almost a black colour, swelled, softened, and exhaling an insupportable odour. Judging from this that the preservation of the uterus was impossible, and reckoning much on the good constitution of the patient, I warned the proprietor of the danger of its reduction, even supposing that it was practicable, and proposed to him the complete extirpation of the uterus as the only means that remained of saving the bitch.

Armed with his consent, I passed a ligature round the neck of the uterus, at the bottom of the vagina, and drew it as tight as I possibly could. On the following day I again tightened the ligature, in order to complete the mortification of the part, and the separation of the womb. On the third day I extirpated the womb entirely, close to the haunch. There was very slight loss of blood, but there ran from the walls of the vagina a small quantity of ichorous fluid, with a strong fetid smell. The operation was scarcely completed ere she voided a considerable quantity of urine, and then searched about for something to eat and to drink.

The portion of the uterus that was removed weighed fourteen ounces. The mucous membrane by which it was lined was in a highly disorganized state. From time to time injections of a slight infusion of aromatic plants were introduced into the vagina, and the animal was nourished with liquid food of easy digestion.

The first day passed without the animal being in the slightest degree affected; but, on the following day, in despite of all our care, an ichorous fluid was discharged, which the dog would lick notwithstanding all our efforts to prevent it. The general health of the animal did not seem to be in the slightest degree affected.

On the fourth day after the operation, the cords that had served as a ligature fell off, and all suppuration from the part gradually ceased.

'October 20th'.--Three months have passed since the operation, and she is perfectly well.

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