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VETERINARY MEDICINE SERIES

No. 1

SPRINGTIME SURGERY

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D. M: Campbell, D.V.S.

Editor, American Journal of Veterinary Medicine

THIRD EDITION

REVISED AND ENLARGED

Chicago
American Journal of Veterinary Medicine

1918

Copyright, 1913
D. M. Campbell

The Rajput Press, Chicago

PREFACE TO THIRD EDITION

Advantage has been taken of the exhaustion
of the last edition to correct afew typographical
errors and, at the suggestion of the authors, to
make slight changes in some of the articles.

The remarkable sale of this work has made
necessary the third edition, within a year from
the date of its first publication. There are many
evidences that it has proven helpful to a large
number of veterinarians and that this edition
will meet with the cordial response given its
predecessors.

THE EDITOR.

Chicago, March 1918.

Veterinary Medicine Series
No. 1

PREFACE TO SECOND EDITION

The fact that a second edition, of a veterinary
publication, should be required, within thirty
days from the time the first edition was received
from the bindery—thus establishing a new record
among veterinary publications—is proof positive
of its usefulness and its welcome. SPRINGTIME
SURGERY has had this remarkable sale. A higher
commendation is scarcely possible, a further one
unnecessary.

This work is unique, an innovation in veterinary
literature, and has appealed strongly to practis-
ing veterinarians. The thanks of the editor, and
all credit for the usefulness of SPRINGTIME SUR-
GERY, are due to the contributors who have given
of their time and talents for the enlightenment of
the Profession.

Three articles have been included in this that
are not contained in the former edition, two in
the former have been omitted from this edition. |
A number of those in the first edition have been
thoroughly revised for this one by the authors.

THE EDITOR.

Chicago, April, 1912.

SUCCESS

Pluck will win—tts average is sure,

He wins the fight who can the most endu

Who faces issues, he who never shirks,

Who waits and watches and who always w

PREFACE TO FIRST EDITION

There is an obvious advantage in having
grouped, in one small volume, really meritorious
discussions of the cases most common at any
season. The articles in this book, which are re-
printed from the American Journal of Veteri-
nary Medicine, constitute, we believe, the most
instructive yet brief description, and the most
helpful case-reports to be gleaned from the liter-
ature on the surgical and obstetric problems com-
mon during the foaling and castrating season.
The discussions of ‘Springtime Surgery,” while
in no sense exhaustive, yet constitute, for the
practising veterinarian, a valuable supplement to
the standard textbooks of veterinary surgery
and obstetrics.

The superior merit of these articles amply
justifies their reproduction in a form more per-
manent than is offered by magazine publication.
The frequent requests from subscribers for
copies of the issues of “Veterinary Medicine”
containing various of these articles convinces us, ©
that their presentation in book form will be wel-
comed by a large number of veterinarians and
that this volume will be of much usefulness in
this field.

THE EDITOR.
Chicago, March, 1912.

TABLE OF CONTENTS

Castration: of Cryptorchids \: .0i.0%..\20 oes 9
Practical Methods of Cryptorchidectomy.... 39
Cryptorchidectomy in Horses .............. 15
An Interesting Monorchid ...............- 83
A Castrator’s errors es ce a ae ee 87
Hemorrhage After Castration .............. 91
Castration of Pigs Having Scrotal Hernia... 93
Operation on a Hermaphrodite ............. 97
Spaying Heifers on Western Ranches....... 101
Oophorectomy In Cats). vic. ea ee 111
Prolapsus Uteri: Its Successful Treatment. .113
Unusual Case of Obstetrics .\...:..... 2.0 «ae 116
Proper Replacement of the Everted Uterus. .117
Pervious Uracil ee en ed ee 120
Care of Navels'in Newborn .... 2... 6.0 ae 123
Superfetation with Report of a Case......... 133
PRE TORNB TEE oo ea Gs a lal nein eh Ie oo i ee 137
Treatment of Contracted Tendons in Foals...141
Minor Means of Restraint. 2.03). 6's «cps ss co 145

The Treatment of the Injured Hand ........ 153

Castration of Cryptorchids *

By W. L. WILLIAMS, V. S., Professor of Surgery and
Obstetrics in the New York State Veterinary College,
Cornell University, Ithaca, New York, author of
“Veterinary Obstetrics,” “Surgical and
Obstetric Operations,” etc.

It is generally considered advisable to castrate
all male domestic animals which are to be regu-
larly used for work or as human food. However
true this may be of normal males, it is empha-
sized in most cases of cryptorchids or hidden
testes. | |

It is especially desirable that the cryptorchid,
or the monorchid, be castrated, in order that he
may not be used for breeding purposes, because
he may largely transmit the defect to his off-
spring. In addition to this, the abdominal testicle
usually induces a perverted sexual desire, closely
analogous to the nymphomania of the female.

*Reprinted from the Missouri Valley Veterinary Bulletin, April, 1910.

10 SPRINGTIME SURGERY

Etiology.—The causes of cryptorchidy are
various, and are not wholly understood. We
meet with three groups of causes or conditions
which are of interest:

1. Arrested development, or descent of the
organ.

2. Aberration of the development of the organ
—teratoma.

38. Pathologic conditions of the testes.

In the first case, the testicle forms normally,
and drops from its embryonic location into the
peritoneal cavity, but fails to descend into the
scrotum. It then retains its fetal character, is
small, soft, flaccid and histologically shows the
fetal spermatoblasts, but no spermatozoa. The
gland is therefore without procreative function,
but induces often a sexual mania. Its position
varies, being located at any point on a line pass-
ing from the embryonic seat, near the posterior
end of the kidney, to and into the internal in-
guinal ring.

The second class, the teratoma, comprises a
widely varying group of dermoid cysts, of al-
most any dimensions and containing epidermal

CASTRATION OF CRYPTORCHIDS 11

debris and structures, such as hair, dental tissues,
etc. They are highly interesting because they
suggest that the sexual glands are really of epi-
blastic origin, as contended by some embryolo-
gists, instead of mesoblastic, as asserted by most
authorities. |

The third group comprises extremely variable
pathologic changes, such as cystic, calcareous or
other forms of degeneration, malignant new-
growths, etc.

These three groups are known to be of very
unequal size, though definite data as to the pro-
portions of each are wanting. Ninety-one cases
have been operated upon in our clinic, of which
ninety belonged to the first group, none to the
second, and one to the third. In private practice
we have met with one additional case of patho-
logic testicle, but no teratoma.

The teratoma are considered so unusual that
they are largely recorded, and probably an ex-
aggerated idea of their prevalence is acquired.
It is highly important that these three classes be
kept in mind, since they have an essential bear-
ing upon the surgical procedure in castration.

12 SPRINGTIME SURGERY

Other less essential elements entering into the
surgical problem of cryptorchidy are whether the
testicle is abdominal or inguinal in location, and
to what species the animal belongs.

Cryptorchid castration, like many surgical pro-
cedures, was at first chiefly empiric in character,
and in fact is still largely practiced as an empiric
operation, the operation being largely taught and
learned in a manner devoid of scientific knowl-
edge. —

Preparation. The preparation of an animal
for the cryptorchid operation does not differ ma-
terially from the general rule for other abdominal
operations. We desire that the patient shall be
in prime physical condition, having had abundant
exercise or work to place him in good, vigorous
health. Before the operation, the alimentary tract
should be emptied either by restricted diet or by
hypodermic catharsis. Fullness of the alimen-
tary tract should be obviated for general surgical
reasons and for the special purpose of facilitating
the operation, by affording greater intra-abdomi-
nal room and preventing prolapse of abdominal
viscera through the wound.

CASTRATION OF CRYPTORCHIDS 13

Control. The securing of the patient, in case
of the horse, needs be either in dorsal recum-
bency, or in the lateral position, with that side
upon which the hidden testicle is located, upper-
most. There is but one essential detail in secur-
ing the horse: The thigh on the side of the hid-
den testicle must be fully abducted. This may be
effectively accomplished by many methods of cast-
ing, and may be perfectly attained upon some
types of operating table.

If the thigh is not completely abducted, the
operator may find his hand so compressed that it
is soon fatigued and disabled, and the operator
confused and lost. It is a great error to attempt
the operation except this abduction is complete
and secure. Should the apparatus slip during the
operation, and the operator’s hand become com-
pressed, it is liable to greatiy confuse even an ex-
perienced surgeon.

The question of general anesthesia is one upon
which operators may justly differ. For the be-
ginner, it is the best way. The beginner may,
under proper aseptic precautions, manipulate an
anesthetized cryptorchid for half an hour or an

| ae SPRINGTIME SURGERY

hour, without serious harm to the patient, and
without seriously transgressing the general senti-
ment of humanity for animals, which is develop-
ing so rapidly amongst our people. Anesthesia is
also highly important for the experienced opera-
tor. The inguinal region needs to be kept as
freely open and the tissues as passive as possible,
this can be attained only by general anesthesia.

When the beginner is working upon an anes-
thetized patient, he is relieved from the dis-
turbances of change in position and the shifting
in the relations of parts. The abdominal viscera
are not forcibly pushed against his hand or
through the opening. It is of great importance
also that the beginner should be relieved, through
the general anesthesia of his patient, from the
confusing and enervating mental anxiety caused
by the pain he is otherwise inflicting upon the pa-
tient, as expressed by violent struggling, sweat-
ing, groaning, etc.

Again, general anesthesia is always best, even
for the experienced operator in all cases of com-
plications, and the surgeon rarely knows that a
case is complicated until deeply in the operation,

CASTRATION OF CRYPTORCHIDS 15

where he cannot retreat or readily modify his
plans. We believe in general anesthesia in all
cases.

Diagnosis—Some advise rectal exploration
prior to securing the patient for operation. The
procedure has certain value. In those cases of
monorchidy where the scrotal testicle has been
removed (a very unfortunate and inadvisable
procedure), the operator may determine definitely
upon which side the hidden testicle is located. It
may further give him important information as
to whether the retained gland falls within our
first, second, or third class. Should it belong to
the second or third class, the examination reveals
to the operator the nature of the conditions, fore-
warns him of the obstacle to be overcome, and en-
ables him to plan his operation.

On the whole, rectal exploration prior to opera-
tion is largely impracticable. It is generally in-
convenient to make such examination until im-
mediately prior to the operation, and at that time,
it is as a rule imprudent because of the difficulty
of cleansing the hands properly after they have
been soiled by feces.

16 SPRINGTIME SURGERY

Asepsis and _ Disinfection—Another point
of very great importance is the question of dis-
infection of the operative area, and the main-
tenance of asepsis. The problem is somewhat
alike, whether the incision be made in the scro-
tal, inguinal, prepubian or flank region. In the
horse, the incision is usually made in the scrotal
or inguinal region, while in other animals it is
best made in the upper flank. While the skin of
the scrotal and inguinal regions is very thin, soft,
and usually almost hairless, it is nevertheless
thickly covered with sebum, which is very insolu-
ble and difficult to remove. Washing for a few
minutes with any ordinary antiseptic, even though
preceded by soap and warm water, is of scant,
if any value. The problem of the practical dis-
infection of this region has not been solved. The ©
profuse application of alcoholic or ethereal solu-
tions excoriate the delicate skin.

Careful investigations need be made toward
solving this problem. Possibly a good method
would be to wash the parts thoroughly, an hour
or two prior to the operation, with soap and hot
water, perhaps mixed with kerosene in emulsion,

CASTRATION OF CRYPTORCHIDS 17

or with lysol, bacterol, or carbolic acid. The
sheath being always dirty bacteriologically, the
smegma from this should be carefully cleared
away, and the sheath and prepuce anointed with
an antiseptic oil, glycerin or vaseline. The skin
having been allowed to dry completely, when the
patient is secured for the operation, the opera-
tive area may be liberally covered with tincture
of iodine, and allowed to dry before making the
incision. After the skin incision has been made,
additional security might be attained by again
applying the tincture of iodine to the margins of
the cutaneous wound.

Incision.—Some operators make their incision
through the skin and dartos in the scrotal region,
parallel to the median raphe and one to two inches
laterally therefrom. Others make their incision
directly over the external inguinal ring and in the
same direction. By the first method, the operator
inserts his hand through the wound in the skin
and dartos, divides the loose areolar connective
tissue and pushes aside the numerous vessels, in
an upward and outward direction until he reaches
the external inguinal ring immediately at that

18 SPRINGTIME SURGERY

point at which the second operator would make
his incision.

The incision over the external ring is therefore
more direct and the resulting wound less exten-
sive, in which respect it is more conservative and

preferable. The scrotal, incision has the impor-
tant advantage over the inguinal, in that the in-
evitable movements of the thigh after the opera-
tion disturb the cutaneous wound over the inguinal
ring, but do not seriously involve the scrotal
wound. We prefer the scrotal incision.

Inguinal Cryptorchidism. — Having reached
the loose areolar tissue in the external abdomi-
nal ring, whether indirectly through a scrotal in-
cision or directly through an inguinal wound, the
operator, with his fingers in the form of a cone,
and by means of a rotary motion, pushes the
areolar tissues aside and cautiously advances his
hand upwards, outwards and slightly forwards
toward the internal inguinal ring, or the position
which it should occupy. Care should be taken to
note here the presence or absence of a dis-
tinguishable gubernaculum testis, of the epididy-
mis or of the testicle itself.

CASTRATION OF CRYPTORCHIDS 19

If a recognizable gubernaculum is present, it
may be an important guide to the internal ring,
and hence an aid of value to the operator, especi-
ally to the beginner; or the operator, by grasping
this and drawing upon it, may bring the testicle
out through the ring and grasp it. Usually the
presence or absence of this structure in a recog-
nizable form may be suspected by the presence
or absence of a distinct dimple or depression at
the fundus of the scrotum.

When the epididymis has descended into the
scrotum, it is recognized as a somewhat firm cord
about the size of a man’s finger, and is well nigh
indistinguishable from the stump of the sper-
matic cord following castration. It is more free
from adhesions to surrounding tissues, and its
obtuse extremity is connected with the skin and
dartos only by the indistinct gubernaculum. Cut-
ting through the peritoneal sheath of the cord,
the operator exposes the vas deferens and tail of
the epididymis firmly attached, naturally, not by
adhesions, at the distal end of the tubular cord.
By exerting traction upon the tail of the epididy-
mis, the head of that organ may be brought into

20 SPRINGTIME SURGERY

view, the entire epididymis being abnormally
elongated and attenuated. The testicle itself re-
mains firmly lodged above the internal ring, or
incarcerated in it, and, however much traction
may be exerted on the epididymis, the gland
usually remains immovably fixed.

The first case of this kind with which we met
led us into error, and we removed the epididymis
and a portion of the vas deferens, while we left
the testicle in the abdomen. Later in our clinic
we operated upon a case, the history of which
could not be traced, but which had evidently been
operated upon by some one who had fallen into
the same error, removing the epididymis and
leaving the testicle. The condition offers some
difficulty to overcome. The most direct method is
to freely incise the peritoneal sheath down to the
internal ring and either dilate this by forcing the
finger through the ring along side of the vas de-
ferens and epididymis, or by cautiously incising
the ring with a scalpel or bistoury. The testicle
may then be withdrawn and removed.

If the testicle itself is encountered in this re-
gion (inguinal cryptorchidism) the gland is to be

CASTRATION OF CRYPTORCHIDS 21

seized and forcibly brought out through the
wound. Having passed through the internal ring,
the gland is covered by the cremasteric fascia or
tendon and by the parietal peritoneum, which are
to be incised as soon as brought to view, and the
testicle laid bare. It is to be noted that in all
eases of abdominal eryptorchidism, including
those we have mentioned where the epididymis
has descended into the scrotum, the testicle, when
brought out, is naked; while in inguinal cryptor-
chidism, the testicle is inevitably brought out
covered by the cremasteric structures and the
parietal peritoneum.

Locating the Internal Inguinal Ring.—
Encountering neither gubernaculum, epididymis

or testicle in the inguinal region, the operator
should search for and locatethe internal abdom-
inal ring, whether he designs to penetrate it or
not, as it constitutes the immediate, logical guide
to the location of the testicle.

This ring may usually be recognized in the
eryptorchid horse, as an elliptical slit, appearing
to the touch as about three-fourths to one and
one-fourth inches long by one-half inch wide,

22 SPRINGTIME SURGERY

directed obliquely forward and outward in its
greater diameter. It is covered by a thin layer

of peritoneum, while its margins, the borders of

the great and small oblique muscles, are distin-
guished by their greater thickness and firmness.
This ring is located two to four inches upward,
outward and slightly forward from the external
abdominal ring. It is just opposite and very near
to the crural ring, and, by palpating outward
against the thigh, the operator easily recognizes
the pulsating femoral artery as it emerges from
the crural ring.

In some cases the internal ring is unrecog-
nizable by palpation, but the determination of its
approximate location is nevertheless essential to
scientific cryptorchid castration. The recog-
nition of the ring is especially difficult in animals
previously operated upon unsuccessfully, and fol-
lowed by the formation of a large amount of
dense, cicatricial tissue. When the ring has been
recognized, if the operator will approximate his
thumb, index, and second fingers to constitute an
incomplete circle of one to two inches in diameter

and press the ends of the digits against the abdom-

CASTRATION OF CRYPTORCHIDS 23

inal muscles about the margins of the ring, the
peritoneal curtain closing the ring, the processus
vaginalis, tends to push outward in the form of
an obtuse cone, while enclosed within it are the
gubernaculum and usually the tail of the epididy-
mis and the base of the vas deferens. The guber-
naculum, in its intra-abdominal position, is recog-
nized, as a somewhat distinct, firm, straight cord,
about one-eighth of an inch in diameter, some-
what movable within the peritoneum. The two
latter are recognizable as hard dense, coiled cords
or filaments, which are readily grasped beween
the thumb and fingers, and clearly recognized by
palpation.

Securing the Testicle— These facts we have
found of the greatest importance in the clinical
teaching of the operation. It is the keynote in
our method of instruction. We advance the
operation to this point, seize the processus vagin-
alis enclosing the gubernaculum, the vas deferens
or the tail of the epididymis between the thumb
and fingers, introduce a long pair of forceps, and
seize the gubernaculum, epididymis or vas defer-
ens, still covered by the peritoneum. We then

24 SPRINGTIME SURGERY

secure the forceps in this position, with the de-
sired structure firmly caught, and the beginner
introduces his hand, palpates all the parts, rup-
tures the peritoneum, grasps the gubernaculum
and then the vas deferens, followed by the epi-
didymis, and completes the operation.

Reaching and recognizing the internal ring,
operators divide themselves into two or more
groups in their further procedure.

We recommend, in those cases we have just
mentioned, in which the operator can grasp the
vas deferens or epididymis outside the ring in the
processus vaginalis, still covered by the perito-
neum, that the peritoneal covering be ruptured
by dragging upon it, the tail of the epididymis
grasped and drawn out and the testicle itself
brought out by traction upon the epididymis, thus
completing the operation without the insertion of
the hand or even of a finger into the abdominal
cavity. In some cases, the testicle may not be
drawn through the narrow ring by traction alone,
in which instances we insert an index finger,

dilate the ring, and, exerting traction on the epi-

| aes
a ee

CASTRATION OF CRYPTORCHIDS 25

didymis with the other hand, guide the gland
through the ring with the introduced finger.

Should we be unable to grasp the epididymis
outside the ring, we penetrate the ring with an
index finger, and, directing it backward, hook the
index finger over the gubernaculum as it leaves
the posterior margin of the ring, to immediately
lose itself in the tail of the epididymis. This is
grasped, drawn through the ring, and the opera-
tion then proceeds as before.

Should the operator fail to locate the ring, he
needs at least to determine its approximate loca-
tion, penetrate the muscular wall as near to the
normal position of the ring as he can determine
with his index finger, and, palpating the surface
of the peritoneum, locate and grasp the guberna-
culum, and eventually the vas deferens.

Theoretically, should the operator fail to locate
the testicle by this plan, he should next introduce
the entire hand into the peritoneal cavity, again
search for the gubernaculum, the epididymis, and
especially for the gland itself, and as a final re-
sort search for the vas deferens about the urethra
and trace it back to the gland.

26 SPRINGTIME SURGERY

Practically, when an operator must insert his
entire hand into the abdominal cavity in his search
for the testicle, it is the operator, and not the tes-
ticle, which is lost, with often a far too poor pros-
pect of finding himself and recognizing the defi-
nitely located and attached organ.

Too many operators, and especially beginners,
search for, and attempt to identify the testicle,
without considering the relations to the gland of
the gubernaculum and vas deferens. Searching
independently of these for the gland is like a
shore fisherman on a dark night, who has securely
hooked and landed a fish in the darkness, and
starts groping about to find it, instead of follow-
ing his pole to the line, and thence along the line
to the hook, where the fish is definitely fixed and
located. So, in castrating a cryptorchid, the tes-
ticle need not be “found” in the common mean-
ing of the word, because it is not “lost,” for the
epididymis and vas deferens are definitely and
closely moored at the posterior commissure of the
internal ring by the gubernaculum and at the
proximal end of the epididymis, securely fixed, is
the gland itself.

CASTRATION OF CRYPTORCHIDS 27

Going back to the course of the operation, when
the operator has reached the internal ring or its
immediate vicinity, many operators diverge from
the technic we have recommended.

Instead of penetrating the ring, they push
somewhat upward and forward and penetrate the
fascia of the small oblique muscle. By this plan,
the insertion of at least one finger in the abdom-
inal cavity is necessitated, which, by the direct
method we have suggested, may be obviated. Be-
yond this, the operation is identical.

It is, we believe, erroneously contended by the
advocates of this plan that prolapse of the abdom-
inal viscera is thereby obviated. The only cases
of visceral prolapse from cryptorchid castration
observed in our clinic have been patients operated
upon by experienced castrators who were uncom-
promising devotees to this plan, and applied the
technic in their operations.

In the ordinary cryptorchid castration, where
the testicle is small and flaccid, and where it is
drawn through the ring by traction on the vas
deferens and epididymis or the withdrawal is sup-
plemented by the very slight dilation of the ring

28 SPRINGTIME SURGERY

by the insertion of one finger, the danger from
visceral prolapse is very remote. We have not
observed the accident under these conditions.

If the entire hand is forced through the ring,
admittedly there is danger of prolapse. If the
entire hand is forced through the fascia of the
small oblique above and anterior to the internal
ring or elsewhere in the vicinity, the inevitable
rent will pass down, and involve, or pass along-
side the ring and produce a tear essentially iden-
tical with that caused by forcing the hand directly
through the ring.

Pathologic Testicles—— Should the testicle fall
within the second or third class we have men-
tioned, and be greatly enlarged, so that it must
be removed entire, it matters little whether the
internal ring is enlarged to permit its escape or
the same sized opening is made in close prox-
imity to the ring. There results a great rent
through which visceral prolapse is highly proba-
ble. Should the operator know in advance that
he has a testicle of extraordinary size to deal
with, he should abandon the inguinal route and
choose the upper flank as the safer and better.

CASTRATION OF CRYPTORCHIDS 29

Indeed, under modern surgical technic, the
flank operation is in any case quite as safe as
the inguinal, whenever the operator inserts his
hand into the peritoneal cavity.

Should the testicle be in a pathologic state, and
adherent to the intestines or other viscera, the
flank operation is advisable or even necessary.
In the one pathologic testicle removed in our
clinics, the patient being a pig, the testicle was
firmly adherent to two loops of small intestine.
It was necessary to draw these out with the
gland and dissect them away.

In other animals than the horse, we con-
stantly prefer the flank operation, except we can
recognize the epididymis in the inguinal region,
and draw the gland out by traction.

Laparotomy.—For the flank operation, the
patient is secured in lateral recumbency with
the head end inclined, the flank shaved and dis-
infected, and an incision is made as for flank
spaying, of a size to admit one finger or the en-
tire hand, according to the conditions.

In small pigs and dogs and cats we have found
the small wound sufficient. In large boars we

30 SPRINGTIME SURGERY

have been forced to make the opening large
enough to admit the hand.

Inserting the index finger, or the entire hand,
the operator frequently recognizes the gland at
once, lying just by the incision. Otherwise he
reaches the inguinal ring, grasps the guberna-
culum, glides along it to the epididymis, and
thence to the testicle.

Double Cryptorchids—In double cryptor-
chidism in small animals, both testes may be re-
moved through one incision, or, having opened
the wrong flank when but one gland is retained,
he may still complete his operation through the
erroneous incision. He merely needs pass his in-
dex finger, or his hand, along the floor of the
abdomen, across to the opposite inguinal ring,
grasp the gland, draw it across to the other side
and out through the incision.

So, in the cryptorchid horse, if he is a double
cryptorchid and the operator has inserted his en-
tire hand in order to secure the first testicle, he
should not make a second wound, but reach
across beween the viscera and abdominal floor,
‘seize the second testicle and remove it through

CASTRATION OF CRYPTORCHIDS 31

the first wound. Likewise, in operating upon a
horse with one abdominal testicle, where the
scrotal testicle has been removed, and the opera-
tor errs by cutting in upon the wrong side and
has inserted his hand into the peritoneal cavity,
he should not make a second wound, but remove
the testicle through the wound already made.

After Treatment.—After a cryptorchid tes-
ticle has been withdrawn from the abdomen, the
method of severing the cord is usually a minor
matter. In our first class, which includes proba-
bly ninety-nine per cent of the cases, and in
which the gland has been arrested in its develop-
ment, it is comparatively non-vascular and does
not bleed. |

The completion of the operation may vary. In
the flank operation, the abdominal wound is
naturally sutured. If the inguinal operation has
been cleanly accomplished with unimportant lac-
eration of tissues and without danger of visceral
prolapse, it may well be sutured. If there is
danger of visceral prolapse or of serious infec-
tion, antiseptic tampons should be inserted up to
the internal ring, and held in position by sutures.

32 SPRINGTIME SURGERY

By means of large tampons, an enormous rent
in the abdominal floor may be successfully closed,
and prolapse obviated. In large rents, the safest
way to tamponade is to take a broad and ample
piece of cheesecloth, and spread it with its center
over the wound. Then take masses of convenient

size of gauze, cheesecloth or cotton, boiled, im-—

mersed in a disinfectant and pressed dry, and
push them in to the internal ring, inside the sheet
of cheesecloth. No matter should it extend a few
inches into the abdomen, it cannot escape. When
the wound is well filled, the tampon is secured in
place by scrotal sutures.

After twenty-four to forty-eight hours, the
sutures are to be removed, the packing inside the
sheet of cheesecloth cautiously withdrawn, fol-
lowed by the sheet of cheesecloth itself. Blood
clots are then to be mopped out with antiseptic
gauze, and, if deemed advisable, a new smaller
tampon inserted for another day.

According to the degree of infection, the wound
may be let alone or mopped out daily with swabs
of antiseptic gauze, preferably saturated with
tincture of iodine. The inguinal wound should

|
|

CASTRATION OF CRYPTORCHIDS 33

not be irrigated, lest the antiseptic be forced into
the peritoneal cavity.

Should fever arise, and not be promptly re-
lieved by local handling of the wound, we recom-
mend large doses of quinine or potassium iodide,
usually preferring the former. To a medium
sized horse we give one to three ounces of quinine
daily until the fever yields or toxic effects, such
as trembling or diarrhea appear, when we change
to potassium iodide.

Mortality. — This is not well known in crypt-
orchid castration. In the ninety-one cases in
our clinic there were included twenty-eight pigs,
one dog and one cat, among which there were no
losses. |

Of the sixty-one horses, fifty-six or ninety-two
per cent recovered, and five animals or eight per
cent died. These losses are abnormally high.
Four of the five cases succumbed to infection.

In the earlier years of our clinic, the opera-
tions were essentially all by students. In many
cases, six to ten different students each inserted
his hand into the inguinal wound and palpated
the parts. Three of the fatal infections resulted

34 SPRINGTIME SURGERY

from this practice. This plan was then aban-
doned, since which but one fatality has occurred
from infection, following the operation by a mem-
ber of the staff. |

Hospital Infection—In our clinic we have
had another obstacle to meet. The late Professor
Williams of Edinburg wrote more than a quarter
of a century ago advising against the castration
of horses when the wind was from the east, and
to avoid operating in any kind of weather in the
neighborhood of a veterinary college.

Whatever may be effect of an east wind in
England, the dangers of operating in a veteri-
nary college are not to be ignored. Prior to the
days of antiseptic and aseptic surgery, surgical
operations on man in hospitals were followed by
an appalling mortality, but the mortality from
wound infections in hospitals for man have been
very largely overcome.

Veterinary surgery offers a different problem,
especially in the horse, and the details of efficient
asepsis and antisepsis in veterinary hospitals is
not yet satisfactory. A prime difficulty in our
work is cheapness in the construction and equip-

—

CASTRATION OF CRYPTORCHIDS 35

ment of our veterinary hospitals, with limited
opportunity for efficient disinfection.

From the beginning of our clinic in 1896 up to
a recent date, we have noted an increased ten-
dency toward serious infections, from the open-
ing of the clinic-in the autumn to its close in June.
The hospital and operating room were then va-
cant and open for the summer months. In other
words, the presence in the hospital’ and in the
operating room of cases of fistulous withers, poll-
evil and other chronic, profusely suppurating
maladies so befouled the establishment that viru-
lent infection abounded. Our cryptorchid cas-
trations came almost wholly toward the close of
our school year, when infection of our hospital
had apparently reached its highest virulence.
This we have fought so energetically that we now
believe we can perform most operations in our
hospital with greater safety than outside, and be-
lieve we can castrate as safely as anywhere.
Neither do we observe increased infection as the
year advances. In fact, we last year extended our
clinic to cover the entire year, and are still able
to keep wound infection under satsifactory control.

36 SPRINGTIME SURGERY

Sources of Infection Aside from the disin-
fection of the instrument and of the hands, arms
and clothing of the operator, there are other neg-
lected sources of infection which the veterina-
rian should recognize.

Our casting apparatus constitutes a highly
dangerous bearer of virulent infections, and the
body surface of the animal, with its massive coat
of hair, which it is perhaps shedding, affords
ample opportunity for the entrance of infection
into the wounds. We should devise better means
for obviating these.

Aside from infection, the mortality from crypt-
orchid castration is well nigh negligible. Of
course, casting accidents may occur, and some
losses have taken place from intestinal prolapse.
The latter, can and should, always be obviated.

Complications— Among our five deaths, one
was due to an accident based upon an error. We
opened the patient on the wrong side, recognized
the vas deferens of the testicle which had been
removed, but, before we were aware, had made a
rent in its peritoneal fold. We reached across
to the opposite side, grasped the testicle and re-

CASTRATION OF CRYPTORCHIDS 37

moved it through the wound. A loop of the small
intestine dropped through the peritoneal rent be-
hind the vas deferens of the testicle which had
been removed at a prior date, the intestine be-
came strangulated and the patient succumbed.
Had such a result been anticipated or thought of
as a possibility all danger could have been obvi-
ated, after the rent had been made, by rupturing
the vas deferens, thus leaving no place for the
incarceration of the viscera.

So with other complications which may arise.
The operator should preserve his equanimity,
and, in cases of error or unexpected complica-
tions, promptly and coolly meet the conditions.
To this end, the operator needs be fully prepared
for emergencies, have the surroundings in all es-
sentials suitable, have abundant help at hand,
and, beyond all else, needs be in good physical
condition, free from fatigue of body or mind.

In the one fatal error we have recorded, the
difficulty was largely referable to the fact that
the writer was ill, and should, by all rules of pro-
fessional action, have been in bed instead of at
the operating table. Good surgical work requires

we are unfit, and then meet with complicati or

Practical Methods of
Cryptorchidectomy’

By Charles Frazier, B. Sc., M. D. V., Professor of
Pathology and Bacteriology and Dean of the
McKillip Veterinary College, Chicago

It is my purpose in this article to outline a
technic which has given uniform success in my
hands, one that is based on a thorough study of
the anatomical and surgical conditions met, and
one which I am sure any one can follow who has
any skill whatsoever. I want at this point to em-
phasize the fact that the operation, as practically
carried out, is a simple one.

Preparation of the Patient— This can be
summarized in one statement. Have the patient’s
bowels moderately full of ingesta and absolutely
free from the irritability produced by cathartics,
change of food and emptiness. Do not give

*Reprinted from the American Journal of Veterinary Medicine,
May, 1911.

40 SPRINGTIME SURGERY

cathartics of any kind; do not starve the patient
and do not upset the intestinal canal by a radical
change of food.

A bowel that is moderately distended with in-
gesta, free from all forms of irritation, in nor-
mal and perfect physical and physiological con-
dition, is the one that is not going to be upset by
any amount of clean manipulation in the abdo-
men and surely is not the one to prolapse most
frequently. Peritoneal irritability explains in a
large degree prolapses of the omentum. The
omentum has been aptly called the “policeman of
the belly,” searching out, as it does, localized
peritoneal disturbances, and through some power
of its own going to such areas and attempting to
cover them over by adhesions, where there is in-
jury to or loss of the peritoneal tissue. Thus it is
apt to wander down the inguinal canal at inop-
portune times.

Rectal Examination Prior to the operation
this is not to be thought of as a routine practice.
In animals that have had one testicle removed and
a diagnosis as to the side is wanted, there is a
better way of proceeding than by rectal examina-

——_— sa” = —— |

—
ee

PRACTICAL CRYPTORCHID CASTRATION 41

tion, and further, in such cases, a rectal exami-
nation by the best operators gives no positive re-
sults and frequently leads to harmful procedures.
The question of the side upon which to operate is
not, except very rarely, a difficult one to decide.
The answer is obvious if the animal has never
been operated upon or if one testicle has been
removed and there is but one scar and that
clearly upon one side of the scrotum. A diagno-
sis is to be made, not at all upon the history the
owner gives, but upon one’s own findings. This
examination is to be made after the animal is
cast, and consequently will be considered later.

Disinfection Antiseptic applications to the
scrotum, prepuce and thighs, some hours preced-
ing the operation, have no place in the technic.
Theoretically they may be defended, but practi-
cally they cannot.

The total pre-operative treatment therefore
consists of placing the patient upon a moderate
diet for twenty-four to forty-eight hours preced-
ing the operation. Nothing else is necessary, and
other processes are not only superfluous but in-
convenient to the general practitioner.

42 SPRINGTIME SURGERY

The operation is carried out in as simple a rou-
tine method as possible, keeping in mind at all
times these three dangers, viz., casting accidents,
prolapse of the bowels and infection.

Equipment.— The necessary equipment for the
operation consists of the following: A casting
outfit, scalpel, emasculator and ecraseur, operat-
ing sheets, green soap, tablets of bichloride of
mercury, finger-nail brush, sterile, dry gauze
packs in a sterile container, a trocar, a one-quart
bottle, and a large needle and suturing material,
preferably linen tape one-fourth inch broad.

Casting — For the sake of uniformity of
method all patients should be operated upon in
the casting harness. The operating table offers
no advantages and is not always at hand. The
casting harness to use is the one that you are fa-
miliar with, providing you are skilled in its use
and can adapt it to the operation. Properly con-
fining the animal is a larger question than the
actual operation, since upon it depends, not only
one’s success in satisfactorily performing the
operation, but also the danger of casting acci-
dents, and to a degree the dangers of prolapse of

PRACTICAL CRYPTORCHID CASTRATION 43

the bowels and of peritoneal infection. The re-
quirements of such a harness are:

1. It must hold the animal firmly so that no
change of position is possible.

2. All four legs and especially the hind legs
must be fully flexed upon themselves and held so
firmly that change of position is impossible.

8. The hind legs must be held by the harness
in a widely abducted position with the legs so
flexed that the hoof is just slightly in advance of
the stifle.

I cannot emphasize too strongly the impor-
tance of this latter requirement. One should
study and practice the art of casting until he is
perfect in it; too many failures in surgical opera-
tions are the direct result of bunglesome and im-
perfect tying.

The operating sheets mentioned in the list of
articles needed for the operation have served me
very valuable purposes and saved me much time
and annoyance during operation. They are
merely muslin sheets one and one-half yards
Square, some of which have central oval openings
seven inches long by one inch wide.

44 SPRINGTIME SURGERY

Plan of Procedure.—The details of conduct-
ing an operation in the country are about as fol-
lows: Upon arriving at the place of operation a
spot for casting is selected. There are no par-
ticular specifications regarding a casting site ex-
cept that it be level and of sufficient size. A grass
plot is best, although not indispensable. A clean
operation can be done anywhere, but more care
is required in dirty, dusty surroundings. When
the casting site is selected, the owner is directed
to procure a pail of warm water and a basin and
to have the patient brought out. While this is be-
ing done the operator prepares his equipment for
the operation. The scalpel, emasculator, ecras-
eur and needle, threaded with a piece of tape fif-
teen inches long, all previously sterilized by boil-
ing, are laid out on a clean (if not sterile) towel
on some improvised table, as a board, box or
medicine case. The quart bottle is filled with
water and to it is added enough mercuric chloride
tablets to make a solution of 1-1,000 or even
1-500. The can of sterile gauze, the nail brush,
soap and operating sheets are placed conveniently
near. The horse is then cast and tied, the opera-

PRACTICAL CRYPTORCHID CASTRATION 45

tor (who, in country practice, must do the tying
as a rule), wearing gloves to protect his hands to
a certain degree from contamination. Chloro-
form is not used.

After the animal has been cast and properly
tied for the operation, is the time to make the
examination if a diagnosis of side is necessary.
Of course, this is a question that needs attention
only when one testicle has been removed and
there is a scar on both sides of the scrotum. The
side from which the testicle has been removed
can be told in all cases by the presence of the
stump of the cord or the spermatic fascia in the
scrotum or inguinal canal of that side except in
cases where the testicle removed was an abdom-
inal testicle, when there will be no stump pres-
ent. These cases are rarely met with, and a posi-
tive diagnosis of the side can be made only by
abdominal exploration during the operation.
Ordinarily when one testicle is removed it is a
descended testicle and its removal leaves a stump
in the scrotum and inguinal canal that can be
easily determined by careful examination. ‘The
history by the owner is usually of no value and

46 SPRINGTIME SURGERY

the character of the scrotal scar means nothing.
As the operation proceeds the operator further
satisfies himself as to his diagnosis as will be
mentioned hereafter.

A determination of the side having been made,
the patient is placed in a position half way hbe-
tween a lateral and dorsal decubitus, with the
operative field uppermost. This is usually best
accomplished by placing the horse in a lateral po-
sition and then by means of a rope noose on the
upper hock have an assistant apply a little trac-
tion as if to roll the patient over on its back.
This not only places the patient in a good position
but abducts the upper limb and improves the con-
dition of the operative field and thus facilitates
the operation.

Cleansing the Field of Operation— The next ©

question for the operator to concern himself with
is that of the aseptic preparation of the opera-
tive field. An appreciative mind will understand
that all the dangers of this, as well as any other
surgical operation, are increased by prolonging
the period of the operation. Consequently the
period from the time the casting harness is put

PRACTICAL CRYPTORCHID CASTRATION 47

on the patient until the animal is again up and
in its stall should be as short as is consistent with
good surgical principles. The process of asepti-
cizing the operative field is one in which much
time can be saved by a study of the conditions.
Excessive scrubbing and cleansing is not only
without results of value but often productive of
conditions exactly opposite to those at the pro-
duction of which the process is aimed. Absolute
asepsis can not be obtained in veterinary practice
except at a great outlay of expense and trouble
that is not justifiable. In cryptorchid operations
relative asepsis is all that is needed for success-
ful work. Peritoneal infection and scrotal infec-
tion are the least of my fears when operating. A
good rule is to be as aseptic as the conditions
will allow without endangering your patient by a
prolonged, bunglesome technic (and without los-
ing money on the operation).

The method that I follow in country work in
preparing the operative field requires from two to
five minutes, the length of time consumed depend-
ing on whether it is done by myself or by an as-
sistant while I am scrubbing my hands. The

48 SPRINGTIME SURGERY

process consists of scrubbing the scrotal area
only, with green soap and water until it is free
from visible dirt. The upper foot, leg and thigh
are then encased in an operating sheet which is
clean (not sterile) and which is applied in a few
seconds of time, being made so as to fit the parts
and supplied with proper means of attachments.
This protects the field against serious contamina-
tion from that source. The lower leg may be
covered in a like manner, but this is rarely neces-
sary. The soap and water scrubbing is confined
to a small area of the scrotum at the point where
the incision is to be made. This is important.
Uncleaned areas near the field of operation are
covered by a sheet and are just as removed from
the operation as if they were on another animal.
The soap and water scrubbing over, and the
two hind legs encased in protective sheets, the
operator proceeds to scrub his hands and arms,
paying particular attention to the hand that is to
be inserted into the belly wall. Relative asepsis
only is aimed at by a one- to three-minute scrub-
bing of the hands with the brush and green soap,
followed by a short scrub in the bichloride solu-

PRACTICAL CRYPTORCHID CASTRATION 49

tion. This being done, the operator with clean
hands gives a short final scrub to the operative
field which is then subjected to an application of
the bichloride solution and an operative sheet
spread over the belly and scrotal region so that
the opening comes over the line where the in-
cision is to be made. The area of the incision is
then painted with tincture of iodine, a quick,
practical and efficient means of producing sur-
face asepsis.

The Incision— The routes by which the ab-
dominal cavity is entered by cryptorchid cas-
trators may be clased into three general groups,
Wiz. :

1. Through the inguinal canal.

2. Directly through the belly wall in the neigh-
borhood of the internal ring.

3. Directly through the belly wall in the upper
flank region.

There are a number of varieties of each group,
each of the numerous operators varying the
process to suit his individual taste.

The method that I prefer is the inguinal canal
route. The technic of entering the abdominal

50 SPRINGTIME SURGERY

cavity by this route is as follows: An incision,
five or six inches long, is made through the
scrotum parallel with and one or two inches
from the median raphe. This incision is carried
through the skin and dartos into the scrotal sac.
When this is done the scalpel is laid aside and the
remainder of the process is carried out entirely
by blunt dissection with the fingers. The scro-
tum is found to contain considerable areolar
fascia and a mass of blood and lymph vessels.
No attention is paid to these; they are pulled this
way or that, until an opening is made through
them down to the external ring of the inguinal
canal, which is but an oval slit through the apo-
neurosis of the external oblique muscle, large
enough to freely to admit the operator’s hand.
This muscle is located just in front of the pubis
and at the side of the prepubian tendon, land-
marks that are easily determined. The exposure
of this ring and the introduction of the hand into
it is a matter of no difficulty. The fingers of
both hands are used in the dissection up to this
point. Now but one hand is required to finish
the opening. :

PRACTICAL CRYPTORCHID CASTRATION 51

Traversing the Inguinal Canal.— The oper-
ator places himself so that he is facing the field
of operation and uses the right hand if it is the
left testicle that is retained and vice versa. The
hand used is inserted through the scrotal incision
and through the external inguinal ring into the
inguinal canal. The fingers of the hand should
be bunched and directed toward the internal in-
guinal ring, to which they are gradually forced,
separating the muscular belly of the internal ob-
lique muscle, which lies on the palm or side of
the hand, from the aponeurosis of the external
oblique muscle and Poupart’s ligament which lies
on the back of the hand. While the introduc-
tion of the hand through the external ring and
into the canal is always an easy matter, the pass-
ing of the hand up the canal in the proper direc-
tion and the locating of the internal ring is, to the
uninitiated, usually attended with more or less
difficulty. The direction to go is deep into the
fold of the groin, keeping back against Poupart’s
ligament and the thigh muscles.

Most beginners, I have found, have trouble in
locating the internal ring because of two chief

52 SPRINGTIME SURGERY

mistakes. One is in keeping too far forward and
the other is in being afraid to insert the hand far
enough up the canal. I therefore try to empha-
size the importance of going high up into the
groin and keeping back against the thigh when -
forcing the hand up the canal.

Locating the Internal Inguinal Ring.—
After the canal has been traversed by the hand
the selection of a spot for the opening into the
belly is the next thing of importance. There are
four places that may be used and are used by
various operators.

1. Through the internal ring.

2. Below the internal ring.

8. In front of the internal ring.

4. Above the internal ring.

No matter what position is selected for the
opening, the wise operator will first locate the in-
ternal inguinal ring as a starting point. This
ring represents the upper end of the inguinal
eanal. After the hand has been forced up the
canal to a point beyond the upper border of the
internal oblique muscle the operator finds that
only a relatively thin structure separates his

PRACTICAL CRYPTORCHID CASTRATION 53

fingers from the abdominal viscera, which can be
felt more or less clearly. This thin membrane
consists of two chief parts or layers. These are,
first, the general fascial lining of the abdomen,
which is often designated as the transversalis
fascia and is spread out as a lining of the entire
abdomen and pelvis, and, second, the peritoneum.

In the animal with the testicle undescended the
internal ring is not an opening or a slit as it is
sometimes said to be but it is merely a thinned-
out area of the above mentioned _transver-
salis fascia, this area being bordered and limited
in front and below by an arched band of con-
nective tissue which, after the descent of the
testicle through the fascia at this point, forms
the true ring. The upper and posterior borders
of the thinned-out area of the fascia have no
limiting band of fibers and, as a matter of fact,
in the ridgling the area is not defined at all in
these two directions. (The anatomical facts may
be beautifully demonstrated by a dissection of a
seven or eight-months’ fetus.) Consequently, the
operator, in searching for the internal ring, does
not feel for a slit-like opening, but searches for a

54 SPRINGTIME SURGERY

thin portion of the membrane which presents an
arched, limiting band of fibers in front and below.
This band may often be demonstrated externally
by deep palpation in the middle of the fold of the
groin. Its determination with the hand in the
canal is a matter of little difficulty.

In a great many cryptorchids the testicle or
epididymis has partially descended through this
area and one may find a condition of affairs vary-
ing from a mere looseness of the fascia in the
area to a finger-like projection of it containing
the tail or more of the epididymis. Ofttimes the
tail of the epididymis has descended through this
area and the band of fibers, which normally con-
tracts after natural descent of the testicle, has
contracted down, constricting the testicular struc-
tures so that the globus minor of the testicle is
below the band and the globus major and the
body of the testicle is above and within the ab-
dominal cavity and unable to descend further.

The internal ring, or better, this area in the
transversalis fascia, lies just anterior to the shaft
of the ilium at about its middle and the fascia just
behind the ring is reflected backward into the

-

PRACTICAL CRYPTORCHID CASTRATION 55

pelvis where it becomes the pelvic fascia and
where it is more or less firmly anchored. I, there-
fore, often consider the internal ring in the ridg-
ling as being a thin area in the transversalis
fascia bordered anteriorly and inferiorly by this
arched band of fibers and posteriorly and supe-
riorly by the shaftof the ilium, around which the
fascia is reflected into the pelvis and to which it is
more or less intimately attached. This area as de-
fined is just about large enough to admit a hand
with ease. The recognition and protection of the
integrity of the borders of this internal ring is a
matter of much importance in the operation.

In the process of passing the hand up the canal
and in locating the internal ring, the operator
may inform himself concerning a number of
things. If it is a second operation he may ob-
serve by the scar tissue how far up the inguinal
canal the previous operator went and where and
whether or not he entered the abdominal cavity.
If a diagnosis of side has been made, the operator
while in the canal confirms it by the absence of
the cord stump in the canal. One, of course, ob-
serves whether or not the testicle or any part of

56 SPRINGTIME SURGERY

it has descended into the canal, producing a com-
plete or partial flanker. If it is a complete
flanker, all of the testicle having passed through
the inner ring, the case is handled as a plain colt.
If only a part of the testicle is descended, ignore
the condition and operate as a ridgling, making
the opening at the usual point. In the partially
descended testicle it is almost always the tail of
the epididymis that has descended and the ring
has contracted down around it so that the testicle
cannot pass through and usually cannot be pulled
through with safety to the ring. I have found
that these are best handled by passing up along
the side of the descended tail and, making the
opening at the usual place, pulling the descended
portion back into the belly and out the opening.

Opening the Peritoneal Cavity— I have
satisfied myself that the best place to open into
the peritoneal cavity from the upper end of the
canal is at a point just in front of the shaft of
the ilium, at the upper part of the internal in-
guinal ring. In operating, I locate the internal
ring and then proceed upward and somewhat
backward until I come to the point where the

PRACTICAL CRYPTORCHID CASTRATION 57

fascia passes back into the pelvis and here I
thrust two fingers through into the belly cavity.
In making the opening one must remember that
there are two layers to go through, the fascia and
the peritoneum. Sometimes the peritoneum
pushes ahead of the fingers and strips off of the
wall and requires a special effort to puncture.
This is particularly true in older horses and in
second operations where age and inflammation
have thickened and toughened the peritoneum.
It is also more apt to occur in the horses with
empty intestinal tracts.

Before leaving the subject of the opening into
the belly I wish to emphasize one thing. Preserve
the integrity of the band of fibers that bounds
the internal ring anteriorly and inferiorly. This
band is not easily torn, but in the use of force in
extracting the testicle or in other manipulations,
see to it that no great tension is thrown upon it.
So long as this band is intact the rent in the fascia
is limited by it. If it is torn across, any increase
in the intra-abdominal pressure may cause it to
tear farther down and the protection against pro-
lapse of the bowel is lost. In all cases where an

58 SPRINGTIME SURGERY

enlargement of the opening is necessary make it
upward and backward; never by use of the knife
or other means enlarge the opening in the other
directions. If one finds a testicle so large that
it cannot be forced out through this area with-
out endangering this band of fibers, then it is too
large a testicle to be removed through the in-
guinal region. This is too dependent a portion of
the belly wall for large openings, at any point.
My method of handling such cases, which fortu-
nately are very rare, is, if the testicle cannot be
forced through the opening after all means of
reducing its size (tapping of cysts, etc.) have
failed, to discontinue the operation at this point,
allow the inguinal wound to heal, and after three
or four weeks remove the testicle through a lapa-
rotomy in the upper flank region.

Locating the Testicle— We will presume
that the operator has traversed the inguinal canal,
located the internal ring area, and advanced be-
yond this area in a direction upward and backward
until he finds his fingers against the pelvic inlet
at the middle of the shaft of the ilium, and at this
point has thrust two fingers through the medium

PRACTICAL CRYPTORCHID CASTRATION 59

separating his hand from the peritoneal cavity.
With the same movement by which the opening is
made, it should be enlarged to a size sufficient to
admit three fingers, by the spreading of the two
fingers that have been used. If this is carried
out quickly and if the rent made is held open by
the two fingers and at the same time the hand is
retracted somewhat so as to make an empty space
in the upper end of the canal, the testicle or some
part of its cord will be forced out into the palm
of the hand. This will occur in a very large per-
centage of the cases, in all that are not compli-
cated by adhesions or grossly pathological testicles.

This little process of “coaxing” the testicle out
is possible only when the animal is properly tied,
when the opening is properly located, when the
abdomen is not too empty, and there is an intra-
abdominal pressure, and when the animal is not
anesthetized. To the beginner, with some doubt
as to his ability, there is no more pleasant sensa-
tion than that produced by the testicle forcing
itself upon him and down the canal.

If the “coaxing” process fails in its purpose
after a few seconds’ trial, then the fingers explore

60 SPRINGTIME SURGERY

the region inside the opening. The cord struc-
tures pass from above downward in close juxta-
position to the opening. They are attached to the
belly wall near the opening and consequently can-
not get far away. More often they are right be-
neath the finger tips, very often they are in front
of the opening and less frequently they are be-
hind the opening. In the past six years with a
large series of cases it has not been necessary for
me to introduce the entire hand into the abdomen
to locate the testicular structures. I have, in
several cases, introduced the hand into the abdo-
men for the purpose of examining pathological
and enlarged testicles, and for overcoming cer-
tain conditions in the removal of testicles.

No Search Necessary.— With due attention to
the entrance into the abdomen, search for the tes-
ticle is eliminated. It is right at the finger tips
when they are introduced. The only thing that
is necessary is to be able to recognize the differ-
ence, by sense of touch, between the testicular
structures and loops of bowel. This should not be
difficult, but I notice that some are unable to do
it with certainty. Examination of the structures

ia

PRACTICAL CRYPTORCHID CASTRATION 61

that present themselves to the fingers will soon
reward the operator by a discovery of the cord or
testicular parts. If in doubt, bring the structure
down the canal and examine it by the sense of
sight. Remember that some of the structures
wanted are just inside the opening and that a
little patience will reveal them.

The time-worn quack story about going up to
the diaphragm and the spine to find the testicle
is to be forgotten. It is for the edification of the
laity only. I have never found it of value to use
the gubernaculum as a guide in finding the testi-
cle. Some parts of the epididymis, cord or testicle
presents itself invariably upon entering the peri-
toneal cavity, and rarely indeed is the slightest
search required.

Removal of the Testicle—The testicular
structures having been located and recognized,
they are brought down the canal and removed.
This is usually an easy matter. The testicle and
epididymis are drawn down by the fingers until
an emasculator can be applied. It is well to have
at hand an ecraseur to use in case the cord struc-
tures are so short that the testicle cannot be

62 SPRINGTIME SURGERY

drawn far enough down to use the emasculator.
One can use an ecraseur in all cases and dispense
with the emasculator altogether, but I have found
that an emasculator can be used in about ninety
per cent of the cases and, being a much quicker
and easier method than the other, one is justified
in carrying both instruments in his equipment. In
cutting off the testicle see that the three parts are
removed, viz., body of the testicle, head of the
epididymis and tail of the epididymis. These
three parts are often far separated in a retained
testicle and it is well to see that they are all in-
cluded in the parts removed.

‘‘Cutting "Em Proud’’ a Fake. I might say
in this connection, that the old idea that leaving
on the stump of the cord, a part of the epididymis
would influence the nervous and physical develop-
ment of the animal and give to it the characteris-
tics of a stallion cannot be substantiated. The
influence that the testicles have upon the physi-
cal and temperamental development of the ani-
mal depends upon an internal secretion elabo-
rated by these organs, absorbed into the blood
and lymph channels and exerting its influence, in

PRACTICAL CRYPTORCHID CASTRATION ~ 68

harmonious relation to other internal secretions,
upon the activity and metabolism of the various
systems of organs. This internal secretion is
elaborated largely if not entirely by groups of
epithelial cells embedded in the stroma of the
body of the testicle and not found in any part of
the epididymis. I have satisfied myself on the
proposition by leaving the epididymis in a few
castrated animals with negative effect.
Complications That May Exist. — Occasion-
ally more or less difficulty is met with in bringing
the testicle through the opening and down the
canal. When one has located the cord and moder-
ate traction on it fails to bring the testicle into
the canal it is due to one of the following causes:

1. An enlarged testicle, which hangs heavily
over the border of the ring.

2. A partially descended testicle, the tail of
which is gripped by the contracted ring (this, of
course, should have been recognized previously).

3. Adhesions of the testicle to the abdominal
wall at some point. |

In the presence of any of these complications
the first thing to do is to examine and diagnose

64 SPRINGTIME SURGERY

the complicating conditions. The cord which has
been grasped and pulled down into the canal is
held by the fingers of the free hand or by a pair
of heavy forceps. The hand in the canal is then
passed up along the cord and with the fingers, or
if need be the entire hand, in the peritoneal cavity
the structures are examined, remembering that
the testicle is attached to the lower end of the
doubled cord in the inguinal canal and that by fol-
lowing this out the testicle will be reached. Oc-
casionally it may be best to turn the cord loose,
especially if the entire hand is inserted into the
abdomen. Cases of these kinds are fortunately
rare and when one is met a little patience on the
part of the operator will allow him to make a
positive diagnosis of the complicating condition.
The treatment of adherent testicles is obvious.
The adhesions are broken up and the testicle
brought down. In the cases in which the tail of
the epididymis has descended through the internal
ring and is in the grasp of the ring the treatment
consists in pulling it back into the belly and out
through the opening and down the canal. The
handling of enlarged testicles is a subject of more

PRACTICAL CRYPTORCHID CASTRATION 65

importance. From a practical standpoint the en-
larged testicles may be divided into two classes,
viz., cystic and solid, the former admitting of a
reduction in size by tapping. Upon the discovery
of an enlarged testicle during the progress of the
operation the operator settles two questions in his
mind. First, is the testicle small enough to pass
out through the ring safely? This, however,
varies greatly in different cases and the operator
is the judge of the possibilities in a given case.
Second, is the testicle cystic? If so, it is tapped
through the inguinal canal with a long trocar.

The technic is as follows: An assistant, not
necessarily but best a skilled assistant, empties
the rectum of the patient and inserts the hand into
the same as far forward as possible. By the direc-
tions and assistance of the operator, the assistant,
by rectal manipulation, pushes the testicle up
against the internal ring and holds it there firmly
by pressure from behind. The operator then in-
serts a trocar up the canal, and it is usually an
easy matter to draw off the cystic fluid. The
rectal manipulation of an assistant is of great
value also in the withdrawal of a large testicle

66 SPRINGTIME SURGERY

through the internal ring. Where the mass is so
large that there is difficulty and danger in pulling
it through the ring by traction on the cord alone,
then an assistant working through the rectum can
be of great assistance. He can force the testicle
through the ring in a manner that is much safer
than that of pulling it through and much larger
testicles can be removed safely by such means
than can be removed by pulling alone.

Laparotomy May Be Necessary.—If the ex-
amination or repeated trials demonstrates the

fact that the testicle is too large to be safely re-
moved through the inguinal canal and its size can-
not be reduced by tapping or other means, then
there is but one thing to do. Discontinue the at-
tempts at removal, dress the wound, allow the
patient to rise, and wait a couple of weeks until
the inguinal wound is healed and then take the
testicle out through a laparotomy opening in the
upper flank. One might argue at this point that
a rectal exploration preceding the attempted oper-
ation would have made unnecessary the exposure
of the patient to the dangers attending the"abdom-
inal exploration, but this is not true. I have yet

PRACTICAL CRYPTORCHID CASTRATION 67

to see the man who is positive enough in his find-
ings by rectal examination to gamble on his diag-
nosis. Abdominal exploration is certain in its re-
sults and the dangers are practically nil when one
practices good technic.

The tapping of cystic testicles is not attended
by any danger. The contents of these cysts is
sterile and leakage into the peritoneal cavity is of
no consequence. I remember of but one report in
the literature of an infected testicular cyst. They
are so rare as to be of negligible import.

Wound Treatment—After the testicle has been
disposed of. The dressing of the wound is to be
undertaken. This is simple. It is best explained
by emphasizing a few things that it is important
not to do.

Do not, at any time, introduce any kind of anti-
septic or aseptic fluids into the inguinal cauaal.
From the time the operator takes his scalpel to
make the scrotal incision until the operation is
completed, clean methods are important, but anti-
septic solutions within the abdomen are tabooed.

Do not at the end of the operation remove the
blood from the wound. There is no hemorrhage

68 SPRINGTIME SURGERY

of any consequence and it is seldom that one needs
to ligate a bleeding point. The only hemorrhage
that one can have is from the vessels of the dartos
and they are small. Hemorrhages from the stump
of the cord is practically unimportant except oc-
casionally in pathological testes, in which case one
can ligate before cutting off with the crushing in-
struments.

Do not introduce a pack of any size into the
inguinal canal. I believe that any operation that
requires the canal to be packed is, generally speak-
ing, a failure. Operating by the foregoing
method, heeding the warnings that have been
given, one will never have need for the pack.

The opening into the belly that is described in
the foregoing is a self-protecting one against es-
cape of the viscera. Of course, it is possible for
a loop of bowel to come down, but I have never
had such to occur. A dressing of the wound
that is to be recommended is as follows:

As soon as the testicle is disposed of a small
pack of dry sterile gauze is placed in the scrotum
and the scrotal wound is sutured by a continuous
suture of the linen tape. Its chief purpose is to

PRACTICAL CRYPTORCHID CASTRATION 69

absorb by capillarity, the juices collecting in the
wound and when removed, twenty-four hours
later, to leave an open, well-drained wound. In
suturing the wound it is well to leave the ends of
the sutures long so that they hang down a dis-
tance of four or five inches. This facilitates their
removal. The owner or caretaker of the patient,
if in country work, is shown how the stitches are
put in and how and when to remove them.

Accidents Subsequent to Operation. The
release of the patient from the casting harness

should be conducted with care. The period of re-
lease and until patient gains his feet, if attended
by struggling, is a time when intestines may be
forced down into the canal. Consequently this
is to be considered one of the danger periods. The
ropes must be removed with dispatch and removed
quietly so as not to excite the patient. When un-
tied the patient is given assistance in arising so
that awkward movements, as wide abduction of
the hind limbs, will not occur to open up the canal
and tempt intestinal protrusion. I believe that
the only danger of intestinal prolapse with the
above operation is when the animal, carelessly

70 SPRINGTIME SURGERY

forced to arise by the operator, awkwardly stag-
gers about with the hind limbs widely apart and
the belly muscles tensely contracted in its attempt
to gain a balance. Therefore, care at this time is
important.

If the intestines should prolapse at this time (a
thing which I have not seen with this operation,
but have experienced in using other methods),
the scrotal pack and sutures will protect against
all dangerous conditions until they can be re-
turned. With the internal ring intact, as soon as
the animal is squarely on its feet there will be a
tendency for the intestines to return to the belly.
This may be assisted if necessary in two ways.
One can use a little pressure upward on the in-
guinal region or he can insert the hand into the
rectum and by sweeping it across the region of the
internal ring, pull the intestines back into the
belly.

After-Care— The after treatment of the pa-
tient is simple. As soon as he is released he is
given a little water and is tied in a comfortable
place and in such a manner that he cannot lie
down. He is allowed a moderate ration of food

PRACTICAL CRYPTORCHID CASTRATION 71

and is kept quiet for twenty-four hours. At the
end of this time, in the uncomplicated cases, the
earetaker removes the sutures and pack after
which the patient is treated as he would be had
he been a straight colt. He is allowed to run at
large or is given plenty of exercise and a full
diet. JI have never found irrigation or other
treatment of the wound necessary. He is kept
standing only twenty-four hours.

In Conclusion— We may say the uncompli-
cated case requires but a short time for castra-
tion and is but little affected by it. These cases
will feed immediately upon being tied in their
stalls and there are no post-operative complica-
tions of any sort to deal with. Swellings of the
scrotum and prepuce is usually less in evidence
than in straight colts as the pack produces a bet-
ter draining wound. Peritonitis is an evidence of
inexcusable errors and carelessness in operating.

Double cryptorchids are quite frequently met
with. They are handled as the single ones. Re-
moval of the two testicles through a single open-
ing is rarely advisable. Remembering that prac-
tically all cryptorchid testicles may be removed

72 SPRINGTIME SURGERY

with but one or two fingers inserted into the peri-
toneal cavity, one can see that the opening up of
the second inguinal canal would be far less in-
jurious than inserting the whole hand through
the belly wall in the attempt to bring across the
second testicle. It is best to make a double opera-
tion, but remove both testicles at one casting.

The operation where entrance to the perituneal
cavity is made by an incision directly through the
belly wall in the neighborhood of the internal ring
is used by several operators and with success. I
have not found it as satisfactory, from a number
of standpoints, as the inguinal-canal route.

An operation that one will very infrequently
have occasion to use is that in which the peri-
toneal cavity is reached through its triangle of
the upper flank. This operation is the one of
election when a large testicle is to be removed.
The opening is made at a point where it can be
completely controlled from a surgical standpoint,
it can be closed and protected and it is where
danger of intestinal prclapse is absent. Opening
the belly cavity in this region is a safe procedure
under even moderate aseptic conditions. I have

PRACTICAL CRYPTORCHID CASTRATION’ 73

had occasion to use it in cryptorchids and have
repeatedly used it in spaying mares. The time-
honored pronunciamento, that it is fatal to
open the abdominal cavity of the horse, belongs
to the pre-Listerian era and has little bearing
on modern aseptic surgery. Successful lapa-
rotomy in the equine depends merely upon con-
trolling the concomitant infection of the peri-
toneum, aside from which, it presents no serious
difficulty.

Young patients are much more satisfactory to
operate upon than older ones. One should, in
studying the operation, select untouched year-
lings or two-year-olds for his first patients, the
yearlings being preferable to the two-year-olds.

Complicating conditions in young patients are
exceedingly rare; in older ones they are much
more common. Adhesions, hyperplastic and
cystic testicles and the partially descended and
strangulated testicles are all results of age. Older .
animals are more difficult to confine properly and
being more liable to present complicating con-
ditions are more apt to suffer from the accidents
of the operation.

74 SPRINGTIME SURGERY

To the beginner I would recommend that he
select a young patient, and before operating care-
fully map out his plan of procedure. Nothing
counts like system and nothing succeeds like the
uniformly systematic man.

Cryptorchidectomy in Horses”

By C. E. Steel, D. V. S., Oklahoma City, Oklahoma

Comparatively few of us have the opportunity
to castrate cryptorchids often enough to become
really proficient in this operation and yet it is one
that, with a knowledge of the anatomy of the
part concerned in the operation and with modern
surgical antiseptic and aseptic measures at our
command, the average practitioner should not
“side-step” in favor of the so-called specialist,
who often is anything but clean and scientific
in such work.

As Dr. L. A. Merillat has said: ‘It is indeed
remarkable how one can mutilate a ridgling with
impunity in the frantic search for a well hidden
testicle, if the parts are not infected in the effort.”
Most of us know of one or more empirics who
are successful ridgling operators in spite of their
uncleanly methods and utter ignorance of asepsis

*Reprinted from Missouri Valley Veterinary Bulletin, January, 1910.

76 SPRINGTIME SURGERY

and antisepsis. When we compare our own
efforts with such men, we are somewhat inclined
to lose faith in the value of antiseptic precau-
tions and to lose confidence in ourselves.

From long practice, professional ridgling cas-
trators become expert and the’ time required to
perform the operation with them, usually amounts
to but a few seconds or minutes after the animal
is secured. With the hands of the skillful
though unscientific operator ordinarily clean,
the peritoneum is far less likely to become con-
taminated than with the inexperienced operator,
who usually employs some half-way measures
toward securing asepsis and frequently hunts for
the testicle for dn hour, or more, and sometimes
even then fails to find it, much to his own em-
barrassment and humiliation. The obvious de-
duction is supplant lack of experience by the
strictest precautionary measures at our hands.
In fact, however skilled one becomes he should
most religiously follow the technic of preparing
the operative field, instruments and hands, as
though he expected to search indefinitely for the
hidden testicle.

CRYPTORCHIDECTOMY IN HORSES 717

The following is about the routine which I
have employed and, I may say considering the
number it has been my lot to operate upon dur-
ing the past few years, and the results attained,
it seems to be a practical method.

I first apply a twitch to the nose, lightly, and
make an inguinal examination with the animal
in the standing position. In some horses in good
condition, particularly those over two years old,
the superficial inguinal lymphatic glands may
deceive one, especially in nervous or ticklish ani-
mals, in which squeezing these glands may cause
them to flinch, much as would pressure upon the
testicle itself. The importance of this prelimi-
nary step is considerable in some cases, aS many
owners of ridglings are not willing to assume the
risk incidental to the operation, and the veteri-
narian’s sense of touch is called upon to decide
whether the horse is an abdominal ridgling or
merely a “high flanker.’ In exceptional cases it
may be necessary to caste the animal to make a
correct diagnosis, but in horses thin in flesh it is
an easy matter to determine whether they are
ridglings.

78 SPRINGTIME SURGERY

The animal is prepared for the operation by
withholding feed and perhaps water for a period
of twenty-four hours, depending somewhat on
his condition; this is not always advisable, as cir-
cumstances may make it inconvenient or im-
possible. For casting select a grassy spot away
from manure heaps and other insanitary con-
ditions usually met with around stables, and tie
up the tail securely. With a modified Conkey
throwing harness and a hood to protect the eyes
of the patient cast and tie him. I do this myself
with the aid of one man at the head and another
with one of the side-ropes. But it is preferable
to have an experienced assistant to do the hand-
ling of harness and ropes, and tie up feet with
damp cloths. Having previously scrubbed my
hands with a brush and thoroughly cleansed
nails with water and soap and rinsed well in a
1-3,000 bichloride solution, have an emasculator,
ecraseur, curved needles, sterilized silk, artery-
forceps, and convex bistoury, or regulation cas-
tration knife at hand in one per cent chinosol
solution in a clean pan. I have also a kettle of
boiled water, cooled to luke-warm temperature, a

CRYPTORCHIDECTOMY IN HORSES 79

clean pan, a cake of soap and clean towels ready
for use and after having an assistant wet down
the entire abdomen to allay flying hairs and dust,
1 have the scrotum and inguinal region scrubbed
well with soap and water, containing any relia-
ble antiseptic, then thoroughly rinsed with bichlo-
ride solution, 1-3,000 strength. If I have had to
assist in the castrating (with gloved hands, of
course) I proceed to wash my hands and wrists
in same strength solution, and with twitch ap-
plied to the patient’s nose, make a four or five-
inch incision about one inch from the median
line. I prefer the side on which I am operating,
uppermost. In making the incision I try not to
go deeply, and thus avoid wounding the large
scrotal veins that may lie in such a tortuous net-
work that it is hard to keep from cutting them
if the knife goes deep. If, however, any of the
larger blood vessels are severed, it is not a diffi-
cult matter to take up with artery-forceps and
ligate, a thing it is advisable to do at once.

If the animal has not been operated upon
before, it is an easy matter to break or tear down
the fascia in an outward and forward direction

80 SPRINGTIME SURGERY

for a distance of from six to ten inches, depend-
ing upon size and condition of animal. If, how-
ever, he has been tampered with, the cicatrical
tissue may offer considerable resistance. One
should use judgment though, and be sure to
break down sufficient tissue to insure plenty of
working room for the hand, so as not to tire it in
succeeding steps of the operation.

Having penetrated to the above-named dis-
tance, one should be in the neighborhood of the
internal inguinal ring, which is recognized by a
much thinner feeling than the surrounding parts.
A rotary motion of the hand will aid in reaching
_ the part, and some operators employ sterilized or
antiseptized oil to facilitate the process. I have
never used oil. When my fingers have reached
the peritoneum covering the internal inguinal
ring I instruct the man at the head to tighten
the twitch, and at the instant of full inspiration I
perforate it with either index or second finger
or both, and usually contact the testicle immedi-
ately. In many cases, however, I have had to
search or finger for the organ or the vas deferens
for varying lengths of time, but in no case have

Bil

CRYPTORCHIDECTOMY IN HORSES 81

I found -it necessary to insert more than two
fingers into the abdominal cavity excepting where
a cystic formation or other abnormality was
present. )

The fecal matter in the floating colon is not
to be mistaken for the testicle, being easily dis-
tinguished by its softer consistency. Mesenteric
arteries should be easily recognized by their dis-
tinct pulsations and not mistaken for the vas
deferens. A flabby, undeveloped testicle and epi-
didymis, however, closely resemble in touch the
small intestine. In a number of cases I have
withdrawn the small bowel to the outside suffi-
ciently to recognize it, without bad after-effects.
An assistant with the ability to recognize a tes-
ticle through the rectal wall, can sometimes
render valuable aid in locating the missing organ
and the operator should resort to it himself with
his disengaged hand and arm, rather than keep
the animal down unnecessarily long; prompt and
careful cleansing of the hand and arm by an as-
sistant before the instrument or the operating

field is touched during the remainder of the

82 SPRINGTIME SURGERY

operation will usually avoid infection from the
procedure.

When the testicle has been located and brought
into view it is removed either with an emascu-
lator or an ecraseur and the opening into the abdom-
inal cavity carefully examined to determine the
size of the peritoneal opening and make abso-
lutely sure that no bowel protrudes. If, by any
mischance, a larger opening has been made than
one feels safe in leaving, even when no intestines
have escaped, I prefer to pack carefully the en-
tire wound and stitch the packing in with a con-
tinuous suture. In ordinary cases, such packing
is not necessary.

In releasing the animal, I prefer to have him
stand quietly for from six to twelve hours. If
he has been packed, instruct the owner how to
remove the gauze, and have him turned to grass,
or exercised sufficiently to overcome soreness.
Should swelling occur around the scrotal wound,
insist strenuously on exercise, first, last and
every time. If peritonitis develops after such an
operation as described, the animal is doomed to

die, in nearly all cases, in spite of treatment.

An Interesting Monorchid’
By Frederick Hobday, F. R. C. V. S., London, England

This, a two-year old chestnut cart-horse, be-
longing for Mr. T. Stainton, M.R.C.V.S., was of es-
pecial interest as it proved to be a true mon-
orchid. There was no evidence or history of any
prior attempt at castration; in fact, it was known
with certainty that no testicle had ever been re-
moved. The left one was present in the scrotum
and was removed without any trouble. On the
right side the abdomen was penetrated in the
usual situation, close to the inguinal ring, and a
careful search revealed not only the absence of
testicle, but a gradual merging of the end of a
rudimentary cord into the lining of the perito-
neum of the pelvis. After making sure of this
by tracing it repeatedly, the hand was withdrawn
and the inguinal canal carefully closed by sutures.

*Reprinted from the American Journal of Veterinary Medicine,
October, 1910.

84 SPRINGTIME SURGERY

The colt was allowed to come out of his anesthe-
sia and he got up apparently none the worse for
his experience. This was about 5 o’clock. At
10:15 p. m. the animal was heard to be making a
noise in the box as if in violent pain, and upon
examination the bowels were found to have de-
scended. The weight had ruptured one of the
sutures and a loop of bowel had come down nearly
as far as the hocks. 3

Assistance was summoned, and after consider-
able difficulty the colt was cast and the bowel re-
turned. As much washing and disinfecting was
done as was possible under the circumstances, and
a plug of cotton wool was inserted. This was in-
serted underneath a row of sutures, and then fol-
lowed by a second row of sutures, in such a way
that the pad could be changed without danger of
allowing the bowel to escape, the first layer of
sutures not being touched or interfered with in
any way.

On the following morning the colt’s tempera-
ture was 103° F., and during the subsequent days
it varied between 102° and 103° F. The pad of
cotton wool was changed on numerous occasions,

AN INTERESTING MONORCHID 85

and febrifuges, tonics, or stimulants were admin-
istered internally at discretion. Anti-strepto-
coccic serum was also given.

Peritonitis was evidently present, and in spite
of all efforts death eventually took place a month
after the operation.

An autopsy at which Dr. Kendall, D. V. S.,
M. R. C. V. S., and Mr. Benson, M. R. C. V. S., in
addition to Mr. Stainton and myself were also
present, confirmed the absence of any testicle on.
the right side, nor was there any evidence of such
an organ ever having existed, the spermatic cord
being clearly traceable and merging impercepti-
bly into the peritoneum of the pelvis. Such cases
are rare, and are worth recording. I have already
reported a similar case in my little brochure upon
“Cryptorchid Castration,” and a further still more
curious point in which both testicles were absent.

The remainder of the autopsy was of interest
only in connection with the peritonitis. The loop
of bowel which had descended was matted to-
gether, and there was a long abscess between the
two portions of the loop. This contained a piece
of dirty straw which must have been overlooked,

86 SPRINGTIME SURGERY

as it quite readily might have been, when the
bowels were washed and returned. :

On the left side the end of the cord from which
the testicle had been removed could be found
quite easily, and had nothing about it upon which
to make any comment.

A Castrator’s Error’
J. L. Perry, M. R. C. V. S., Cardiff, Wales

I received a letter asking me to attend a cart
horse, aged three, upon which an attempt at cas-
tration had been made by an unqualified man
three days previously.

The owner said in his letter: “The castrator,
a man who does all that kind of work about here
and has hitherto been most successful, ‘bunched’
up something in the clam. I saw at once it was
not a testicle, and told him so. He insisted that
the colt was malformed and that it was the other
testicle all right. I, however, left in disgust, and
learned afterwards that he had at once proceeded
to sear through this ‘something’ with the hot iron,
immediately this was completed about twelve
inches of penis fell from the horse’s sheath to the
ground.” So he had amputated the penis in mis-
take for a testicle! He then found and removed

*Reprinted from American Journal of Veterinary Medicine, May, 1911.

88 SPRINGTIME SURGERY

the other testicle. The horse was now very weak
and ate but little, his sheath was a tremendous
size, like a sack of potatoes. .

Mr. C. E. Smith, M. R. C. V. S., saw the horse
in my stead. He found the sheath almost justi-
fied the description given it by the owner of the
horse. It was engorged and pointing in places
with infiltrated urine. After casting the animal
and well lubricating the inside of the sheath with
vaseline, he discovered, after a lot of tedious manip-
ulation, the mutilated end of the penis about a
foot away from the natural opening of the sheath.
The swelling being so severe, the urine could only
come away in a small dribble, so he decided to
make an opening for the penis stump to come
through the sheath in a position close to the
proper castration wounds. The urethra pro-
truded about one-eighth inch, but it was impossi-
ble to get a skin attachment for it; so it was left
as it was with the intention of completing this
part of the operation later on when the swelling
had subsided. Punctures were made in various
parts of the sheath to allow the urine which had
infiltrated into the surrounding tissues to drain

A CASTRATOR’S ERROR 89

away. All the parts were thoroughly cleansed
with warm antiseptics and dressed with carbo-
lized vaseline.

I saw the case myself ten days afterwards.
The sheath was slightly swollen; horse eating
and improving in condition. Standing behind
him and pulling the tail aside I could see about
four inches of penis hanging through a wound
in the sheath, and in position just where a mare’s
teats would be. The penis pointed downwards
and backwards, and when urination took place
there was a stream about the calibre of a clinical
thermometer case directed upon the points of the
hocks. The urethral opening was clearly dimin-
ished in lumen, and I told the owner that the
horse should be cast again, and a further small
portion of the penis removed so that the urethra
could be properly everted and stitched back to
avoid further stricture. This he would not con-
sent to, preferring to “‘wait and see” how the
horse went on.

I was not asked to attend the horse again, but
being in the locality a month or two afterwards
saw him at grass. Both hocks were then in a

90 SPRINGTIME SURGERY

terrible mess, due to the constant dribbling of
urine upon them. The urethral opening was evi-
dently very small, as one could see the urine com-
ing away from the penis in a very fine spray.
Owner still refused surgical interference. I
wrote him about twelve months ago on another
matter, and asked him how “Farmer” was going
on, expecting to hear he had been sent to the
kennels. His reply was, “The horse is working
on the farm regularly, and except for requiring
an occasional drench does all right.”

I might add that I tried at the time to per-
suade the owner to institute proceedings against
the castrator, either for cruelty or in a civil court,
but this he would not do, the reason being, as I
learned afterwards, that he had arranged terms
for the castrator to pay him the sum of $125 in
instalments, as damages. This would, of course,
account for his desire to avoid further expense
or publicity. He wanted the matter kept quiet
till the money was paid; hence aiso his employ-
ing me in lieu of other veterinarians nearer his

home.

Hemorrhage After

Castration’*
By Wirt R. Barnard, D. V. S., Belleville, Kansas —

I was called to see a two-year-old colt castrated
nine hours previously by a non-graduate prac-
titioner. The owner had stopped the hemorrhage,
but I found the colt very weak and staggering,
pulse imperceptible, respiration abdominal and
hurried. I administered one dram of nux vomica
and in thirty minutes noticed great improvement.

The next morning, the owner telephoned the
colt was down, unable to rise, and acting crazy.
I made the call and gave nine pints of normal
saline solution intraperitoneally. The colt ate
and drank well, but after attempting to rise
Showed cerebral disturbance. I left a mixture of
nux vomica, belladonna, digitalin and ferric
chloride to be given in full doses every two hours.

*Reprinted from the Missouri Valley Veterinary Bulletin, May, 1908

92 SPRINGTIME SURGERY

In. addition to this the colt was fed one-half
gallon of fresh milk, one-half dozen eggs and one-
fourth pound of sugar, well-mixed, twice daily,
and all the hay and grain he wanted. After three
and one-half days he got up on his own accord
and has been doing well ever since. I noticed
a decided change for the better after giving the
saline injection and had not the distance from
my office been so great I would have given a
second injection.

At another time I was called to see a two-year-
old mule that was bleeding badly, a result of
castration by an empiric. I checked the hemor-
rhage externally, but the colt died twelve hours
later from internal hemorrhage. I was called to
this case in the night and the weather was so dis-
agreeable and the lack of conveniences such, that
I did not throw this colt and secure and ligate the
artery—the only proper procedure. The animal
died in spite of all medication though I now be-
lieve that full physiological doses of atropine hy-
podermically would have checked this as it will
most other internal hemorrhage.

Castration of Pigs Having
Scrotal Hernia

By D. M. Campbell, D. V. S., Chicago

Cases of scrotal hernia in pigs or a rupture
as the farmer calls it is a markedly hereditary
condition. On some farms from year to year
there are numerous cases of this kind among the
pigs; on other farms this condition is scarcely
known, its presence or absence depending, as may
easily be demonstrated, upon heredity.

Some farmers castrate these pigs as readily as
they castrate their ordinary boar pigs, but a great
many others find the operation difficult or are en-
tirely unable to perform it and with them such
pigs are usually destroyed as soon as the hernia
is noted or the condition is allowed to grow worse
until death results from strangulation of the in-
testine or from a traumatism to the scrotum.

94 SPRINGTIME SURGERY

The value of the animal is so slight that
unless there is a considerable number of these
“ruptured” pigs in the same brood or there be a
very large number of hogs raised upon the place,
this work can never amount to much from the
veterinarian’s point of view, but frequently when
he is called to a farm for other work he is asked
to castrate one or two or three of these pigs.

There is scarcely an operation that is more
simple than this one and yet it is one with which
some veterinarians have experienced a great
deal of difficulty, because of faulty technic. To
throw the animal, hold him on his side and at-
tempt to castrate him, as is done in ordinary cas-
tration is to bring on such forcible extrusion of
the intestines that no operator can successfully
accomplish the castration, but if the pig be held
up by his hind legs with his back to the holder
and with his forefeet j ust touching the ground
and possibly his neck between the ankles of the
man holding him the intestines will of their own
accord, or can readily be made to, return to the
abdominal cavity and while held in this position

castration is an exceedingly simple operation.

SCROTAL HERNIA 95

Observe the usual aseptic precautions advisable in
all minor surgery. If the inguinal aperture in
the abdominal wall is very large it may be neces-
sary to hold the testicle through the scrotum while ©
the intestines are manipulated to prevent its re-
turn into the abdominal cavity along with the
intestines, in which case the animal would have to
be lowered before the testicle would again return
to the scrotum, thus causing annoyance and repe-
tition of the manipulation of the intestines.

Holding the testicle between the thumb and
fingers as for ordinary castration cut through the
skin and dartos as for the covered operation.

Strip the cellular tissue from the tunica vaginalis
as close up to the internal inguinal ring as it is
possible to get. Then place a ligature very tightly
around the tunica vaginalis or sac including the
cord, vas deferens, the arteries, veins and nerves,
first making certain no portion of the intestine is
included in the ligature and that it is close enough
to the internal inguinal ring to prevent subse-
quent saculation and a further escape of the in-
testine from the abdominal cavity. The ligation
may be made with any stout cord, that has been

96 SPRINGTIME SURGERY

rendered aseptic and the ends of it should be left
long enough to hang slightly out of the scrotal
wound. | Cut off the cord with its covering mem-
brane just back of the ligation. It is a serious
mistake to incise the tunica vaginalis before the
cord is ligated. Remove the other testicle and
the operation is complete.

The peritoneal surfaces of the tunica vagi-
nalis will adhere in afew hours and in two or
three days the portion of the tunic below the
ligation will slough off and come away together
with the string with which it is tied. It is neces-
sary to make the wound rather low so that drain-
age may be free. The entire operation requires
less than one-half the time it takes to describe it
and the mortality is practically nil.

It may be beneath the dignity of some veteri-
narians to charge a fee for this operation but the
operation is not too insignificant to be appre-
ciated by the owner and it is well worth while
viewed from any angle. If undertaken at all
of course it should be well done.

Operation on

a Hermaphrodite’
By O. D. Chedester, D. V. S., Cordell, Oklahoma

Hermaphrodism is a condition in which there
is a combination in a single individual of both
male and female generative organs. In some
cases, the individual possesses only one set of in-
ternal genitals, but both male and female exter-
nal genitals. In others the internal genitals of
both sexes are present. The former class is the
more common and to it the case described below
probably belonged. Hermaphrodites which simu-
late the male more nearly than the female are of
much more frequent occurrence than are those
which most nearly resemble the female.

A client of mine possessed a small, four-year-
old, bay, hermaphrodite horse, weighing less than
900 pounds. The head, neck and shoulders of

*Reprinted from the American Journal of Veterinary Medicine,
March, 1912.

98 SPRINGTIME SURGERY

this animal resembled a stallion. The posterior
half of the body with its perfect udder, resembled
a mare. Its disposition was that of a stallion.
The short penis, about three inches long, in an
almost continuous state of erection, extended
through a small opening six inches below the
anus. Through this penis the urine was passed,
usually dropping on the tail, legs and, buggy
wheels though it sometimes reached the dash-
board, making it disgusting as well as embarrass-
ing to drive the animal.

The faults of this critter were many. It could
not be safely turned out with other horses or
even into a pasture adjoining one in which other
horses were kept. It could not be worked with
other horses with any satisfaction. Every equine
looked to it like a mare in estrum. With half an
opportunity it would mount as for copulation
and with the aid of its tail pressed against the
erected penis would discharge the semen in its
own tail. This young animal, though quite a
curiosity, was worthless for practical purposes.
The case, however, offered a fine opportunity for

A HERMAPHRODITE OPERATION 99

some experimental operating on my part, and as
the owner agreed to it, the experiment was made.

This animal was cast and chloroformed; the
tail bandaged and the operative field cleansed.
A sterile soft catheter was introduced and the
bladder and the urethra irrigated with an anti-
septic solution. The penis was dissected one
and one-half inches inward and upward and ampu-
tated, leaving the urethra protruding one-fourth
of aninch. The catheter was left in situ and the
bladder and urethra irrigated daily with a five
per cent potassium permanganate solution for one
week. The wound was given a daily dry dressing.

Owing to the position and irregular size of the
urethra the amputation was much more difficult
than this operation is ordinarily. Two weeks
later a second operation was performed by lay-
ing open the urethra for a distance of three
inches, thus for urinary purposes replacing a
vulva. The wound was packed and the edges al-
lowed to heal without uniting. From this open-
ing the urine is now expelled as expeditiously

as it is from the urethra of a mare.

100 SPRINGTIME SURGERY

The patientgvas given the following treatment:

Nucleinic acid (yeast) grs. Xi
Sodium chloride grs. vi
Sodium bicarbonate grs. V
Phenol m. li
Aqua destillata 0Z. 1

Mix, filter and give hypodermically one dram
twice daily in an equal quantity of normal saline
solution. In one week the animal was well and
ready for work and medication was discontinued.

As the testicles, if developed, were in the ab-
dominal cavity, their removal was planned for a
third operation, but never attempted because not
necessitated by the changed disposition of the ani-
mal which strangely enough from the first opera-
tion became docile and began to grow and fatten
until now it weighs more than 1,300 pounds. It
can be turned loose or worked with other horses
with satisfaction, and is a beast of burden equal
to a mule. How are we to explain the loss of
sexual desire without the removal of either testi-
cles or ovaries?

on i_,_

Spaying Heifers on Western
Ranches’

By A. W. Whitehouse, D. V. S., Boulder, Colorado

Calls for this work on the part of the cow-
men are not at all regular, and depend on three
factors: the demand for breeding she-stock, the
price at market points on fat open-cows and
heifers, and the amount of available grazing.
Perhaps the most important of these is the price
of fat open-cows. When, as at present, these sell
within a dollar or a dollar and a quarter of steers
of similar breeding, very little spaying will be
done. There is now no discrimination at mar-
ket points against spayed heifers as such, and
they sell on their merits at a price fully equal to
steers in similar condition. This is as it should
be, for they certainly dress out as well as steers,
and sometimes better.

*Reprinted from the American Journal of Veterinary Medicine,
April, 1911.

102 SPRINGTIME SURGERY

One big outfit for which I have worked, from

an annual brand of about 2,000 calves of both
sexes, “cuts” the poorer half of the heifers for
spaying each year, and this bunch, though it con-
tains all the odd colors and ill-shapen calves, is
said to make them more money than the open
heifers or the steers. Spayed heifers are quieter
than steers, and though they will not quite come
to the same weight, they will ripen more quickly,
and on very much less feed.

In discussing spaying with an owner who is
contemplating it for the first time, it is well to
advise him to be prepared to carry the heifers
over at least two seasons, as it requires that
length of time for the complete unsexing of the
carcass and to derive the full benefit of the
operation.

While the median-line operation is easier and
quicker, and the immediate loss, providing the
stitching is quite perfect, should be no greater,
yet there are good reasons for preferring the
flank operation. One of my clients has had a
good opportunity to compare their merits, and I

SPAYING HEIFERS 103

have been able to confirm his observations. Hav-
ing 400 flank-spayed yearlings of his own breed-
ing, he purchased 800 median-line spayed year-
lings from a neighbor,the operations having been
performed within six weeks of each other.
Among the fiank spayed yearlings were a very
few rather persistent stitch abscesses (in a
harmless place) which eventually disappeared.
Among those operated upon through the median
line there were a number of hernial sacs, and
more having a (supposedly peritoneal) fistula
which discharged a fluid usually clear. These
did not fatten, and some few died, a year to
eighteen months later.

This is my technic for the flank operation:

Preparation — Just preceding the spaying,
thirty-six hours of starvation is desirable but not
often obtainable on the range from lack of suit-
able corrals. The animals should be watered the
night before the operation or they get too
“‘proddy.”’

Restraint.— I have never tried the chute and
should suppose it slow. It is desirable to jam a
lot of them in a small corral for roping and

104 SPRINGTIME SURGERY

“snake” them out into a big corral of at least
an acre for the operation. If the operating
corral is small the spayed heifers are always
charging the operator. We usually rope them
by the head and the hind feet and stretch them.
The upper or left-forefoot goes into the neck
noose and a figure of eight is put on just above
the hind fetlocks. The adjustment of this re-
quires a good man on the tail. It is best to
have a man sit on the head with the forefoot
pulled over with a handle noose. It is hard,
however, to get the boys to do this as they
prefer to stretch them between two horses. This
brings the abdomen too tight, and after breaking
through it is often necessary to ask the man on
the hind rope to slacken, so that occasionally the
heifers kick loose from the figure eight knot.

Field of Operation— Have the left side
uppermost in the recumbent position; stand at
the loin and rump and not at the abdomen. Grasp
all of the flank you can get into the left hand and
tense the skin. About two inches from the heel
of the hand begin the incision and cut straight
towards you—make it plenty long enough for
easy work.

SPAYING HEIFERS 105

I never clip or shave the hair from the field of
operation, considering that there isn’t time to do
a good job and I am more likely to introduce
clipped hair than loose hair, though I often find a
little of the latter in my hand. I swab the field
very freely with a two per cent solution of zeno-
leum or some of the coal-tar disinfectants.

The incision will be very little if any forward
of the point of the ilium and will be surprisingly
low down when they get up. Here the external
oblique muscle is aponeurotic. I make an in-
cision parallel with the fibres about one inch long
and enlarge with the index finger of each hand.
I then force my right hand cone-shaped into the
incision and as soon as I feel the peritoneum,
jerk in my hand so as not to separate it from
the wall.

Equipment.— I wear blue overalls and a
jumper, a clean suit each morning; have my shirt
sleeves rolled up but the jumper sleeves hanging
loose for a protection from the sun.

For the skin and aponeurotic incision I buy
old razors and carry four with me. The blade is
ground away so that there is only about one inch

106 SPRINGTIME SURGERY

of it left at the end and a cutting edge put on the
heel. I have a scalpel in my pocket but seldom
use it. The other instrument is a pair of curved
serrated shears six and one-fourth inches long
such as some use for spaying bitches. I havea
pair of long spaying shears (serrated) and a
spaying emasculator but never use them.

At the fence I have several pans, etc., and the
instruments go into a five-percent carbolic acid
solution when not in use. One pocket of my jump-
ers I keep soaked in five percent carbolic acid and
carry the instruments in it. I wash as often as
possible in surgeon’s boric-acid soap and water,
but I cannot stand antiseptics in it for more than
half a day’s work.

Removal of Ovaries——After breaking in, as
described, I turn the fingers toward the pelvis
keeping the peritoneal wall in touch and with the
back of the hand push back a fold of intentine.
The left ovary should lie close at hand. I grasp it
and bring it to the surface and with an instru-
ment, razor, scalpel, or scissors shred the broad
ligament till the ovary lies passive, but attached,
in the left hand. Possibly dipping the right arm

SPAYING HEIFERS 107

in the swab bucket I reintroduce it and follow the
broad ligament to get the right ovary. Sometimes
the tension has brought this within two inches of
the surface and sometimes it is very hard to find
(the weak point of the recumbent operation). I
break down the broad ligament by passing the
fingers through it and gradually bring it to the
surface. This breaking through the broad liga-
ment is very wearing on the skin of the fingers,
soaked as it is, and the ligament cuts nearly to the
bone on the first and fourth fingers near the distal
joint. If the ligament is tough it needs shredding
with the scalpel held in the left hand; it is rather
risky to transfer the ovary to the left as it snaps
back if the heifer struggles. Most of them, how-
ever, come out on a shred. I never introduce an
instrument into the cavity, feeling that in rough,
hasty, routine work there is danger in so doing.
Finally I shred the ovaries off, using an instru-
ment if necessary.

Sutures——One in the aponeurosis of the ex-
ternal oblique and two in the skin—all three in-
terrupted. I use common string cut in suitable
lengths, soaking it all day in a strong coal tar

108 : SPRINGTIME SURGERY

dip, ten percent solution.. An assistant does this
work. He dips his hands frequently in an anti-
septic solution. Most of the heifers go to market,
but one of my clients has butchered a few and he
tells me that there is an adhesion of skin and
deeper structures at the operative wound, but
that the string has disappeared. When every-
thing is going smoothly the operator works a
little faster than the stitcher.

Steel sacking needles, five inches long are best
but the six-inch needle will do. Have a mechanic
take the temper out, and give them a slight curve
in the pointed one-third, with the curved part
flattened and a cutting edge on each side and then
re-tempered. Good steel needles are hard to get,
the common ones will not do. The edge should be
kept sharp enough to cut the suture string when
the stitches are complete. This is the only good
design for a needle. Such a one will go through
the gastrocnemius tendon or plantar cushion with-
out hard pressure and without a jerk.

After Treatment.— I dress liberally with pine
tar thickened with flour according to the weather
and let them drift on to good pasture direct from

SPAYING HEIFERS 109

the corral; if they have to be moved it must be
by good cowmen and very carefully. Confinement
in a lot, or corral, I have never tried and should
not care to. |

Failures.— In about one percent I fail to get
the deep ovary in a reasonable time and let
them up.

I never spay pregnant heifers, stopping at
once even if I have removed the left ovary before
being aware of the condition.

Mortality— When the last bunch I spayed
was nearly finished the boys broke the leg of one
in throwing her, but I think they were getting
tired of bacon. In each of two lots that I spayed,
one heifer was found dead about six weeks later,
tion. This has been the total loss among up-
wards of 1100 heifers spayed during 1910 and
1911. I am not a quick operator, about 125
heifers a day being my limit, and the antiseptics,
peritoneal fluid and sun are very hard on my skin.
If my results have been good I attribute it to two
things: first, reasonable cleanliness, and second,
never using an instrument except on structures in
plain view.

110 SPRINGTIME SURGERY

Prospective. —Spaying heifers is becoming more
and more popular on the ranges as the price of
good beef increases over that of poorer grades.
And resident veterinarians are doing a larger and
larger percentage of this work which was for-
merly done almost exclusively by itinerant “special-
ists.” No veterinarian locating in this region

can afford to neglect spaying.

Oophorectomy in Cats’

By G. E. Corwin, Jr., D. V. S., Canaan, Conn.

In performing feline oophorectomy and to in-
sure a successful termination, the operation
should differ materially from that usually per-
formed upon bitches.

If the median-line operation is followed with
cats, they will invariably remove, or at least dis-
turb, the stitches and always give more or less
trouble if not actually bringing on a fatal termi-
nation by this means. Upon cats the following
technic for the operation will give best results:

Place the animal upon a slanted table, sus-
pended by the hind legs and with the head low-
ered. Shave and disinfect the skin for the flank
operation, either side, and when properly pre-
pared anesthetize with ether.

In making the incision, first make it through
the skin only, at a point anterior or posterior to

*Reprinted from the American Journal of Veterinary Medicine,
December, 1911.

112 SPRINGTIME SURGERY

the incision to be made in the muscle and perito-
neum, then draw the skin incision to the point to
be incised in the muscle.

Pick up, with the sterile, little finger, the fallo-
pian tubes, which can readily be located without
the use of the probe.

Draw the ovaries into the incision and remove.
Return the tubes. Suture the muscles and peri-
toneum with the same interrupted, sterilized,
catgut sutures, (two probably being enough)
wipe dry with sterile absorbent cotton, and allow
the skin incision to return to its proper position,
which will cause the incision in the muscle to be
entirely covered.

Do not put any suture in the skin incision, and
the cat will do no other harm to it than licking.
If sutures are used in the skin the cat will try to
and usually does remove them. This is the pri-
mary cause of the median-line incision being so
troublesome.

Do not use any carbolic preparation for disin-
fecting instruments to be used on a cat, nor use
any such preparation for disinfecting the skin of
these animals. I prefer chinosol.

Prolapsus Uteri: Its Successful
_ Treatment’

By A. J. Treman, D. V. M., Lake City, Ia.

On the morning of May 17, 1909, the phone
wakened me uncomfortably early. Answering it,
I learned that a farmer eight miles away wanted
me to come, in a hurry, to his place. His answers
to a few questions revealed that he had a mare
with an eversion of the uterus. I directed him to
get a large dishpan, fill it with clean hot water
and place the everted mass into it and keep pour-
ing hot water over it continually until I arrived.

When I arrived, I found a fine large five-year-
old,mare, with a complete eversion of the uterus
and vagina. The pulse was weak and rapid, res-
pirations hurried and distressed, the animal
suffering considerable pain and quite weak; how-
ever the owner had carefully followed my instruc-
tions, and all hemorrhage was stopped, there was

*Reprinted from American Journal Veterinary Medicine, Dec., 1911.

114 SPRINGTIME SURGERY

only moderate swelling of the mass, all the parts
were reasonably clean and pliable and ready to
be replaced. I immediately administered hypo-
dermic stimulants and a small dose of aromatic
spirits of ammonia, then proceeded to put myself
in readiness to replace the organ. By the time
this was done, I found that the patient was show-
ing some effect from the stimulant.

With some difficulty we succeeded in getting the
animal upon her feet, after which it was com-
paratively easy to replace the organ. With the
return of the uterus, I inserted my hand and arm,
as the Dutchman said, ‘‘Yust so far as I had any,”
and did what I could to restore all the parts to
their natural position, meanwhile resisting the
animal’s straining. While my hand was still in
the uterus, I had an assistant pump in a pail full
of clean, hot, weak, disinfectant solution, this dis-
tended the uterus and horns to such an extent
that I was able to restore all the parts to their
normal position before the animal strained
enough to throw out any of the solution. Then
I siphoned off the liquid, injected more and si-

phoned it off, and kept on repeating this until

PROLAPSUS UTERI 115

the liquid was returned clean and there was a
contraction of the uterus to such an extent that
on withdrawing the hand I was able to siphon off
practically all of the liquid. After this there was
very little straining, and though I placed a truss
in position it was not really necessary.

For several hours we had to be very faithful
with our stimulants, and left generous doses of
quinine, iron and strychnine to be given. On the
second and third days following, we thoroughly
flushed the uterus. This animal made a com-
plete and uneventful recovery. I have had other
cases that seemed hopeless make a nice recovery
under this plan of treatment, two points of which
I wish to emphasize.

First. Endeavoring to get the owner to thor-
oughly irrigate the prolapsed mass until I get to it.

Second. Filling the returned uterus with a hot,
weak, disinfectant soluticn, to help in restoring
all parts to their normal positions, and the re-
peated injections and siphoning of the solution
until there is a strong contraction of the organ.
This I find valuable in all cases where flushing is
necessary.

Unusual Case of Obstetrics’

By Dr. H. Jensen, Kansas City, Missouri

A gentleman called at my office stating that
one of his valuable brood mares was having labor
pains though she was not due to foal for a couple
of months. A few doses of viburnum was pre-
scribed and I heard nothing more about the
matter.

About two months later I was called to his
place and informed that in the forenoon this
mare had given birth to a dead colt but kept on
straining. On examination I found lodged in the
os a scapula, and in the uterus I found the com-
plete skeleton of another foal. All the soft struc-
tures were gone, the bones all disarticulated but
no decomposition. The uterus had contracted
considerably by this time, and a number of bones
were firmly imbedded in the folds of the uterus,
the womb was flushed a few times with antisep-
tic astringents and recovery of the mare followed.

*Reprinted from the Missouri Valley Veterinary Bulletin, August, 1909.

Proper Replacement of
the Everted Uterus’

By Sam Meader, D. V. S., Goff, Kansas

Eversion of the uterus is a very common occur-
rence in cows. Presumably the reason for the
greater frequence of this condition in cows than
in other animals is on account of the closer union
in this animal between the placenta and the uterus.
The peculiar arrangement in the cow by which
the fetal coverings are in effect buttoned over the
maternal cotyledons renders the separation of the
afterbirth difficult and often attended by eversion
of the uterus.

It is not the cleansing and replacing of the
everted uterus, difficult though the operations are,
that give the veterinarian the most trouble. It is
keeping the uterus in place during the subsequent
twelve to seventy-two hours that taxes his pa-

*Reprinted from the Missouri Valley Veterinary Bulletin, August,
1909.

118 SPRINGTIME SURGERY

tience, ability and ingenuity. Anodynes, sutur-
ing the vulva, the use of pessaries, surcingles, ele-
vating the rear of the cow, all have their incon-
veniences and drawbacks and at times all fail.

We know in human kind what discomfort and
pain and even alarming constitutional symptoms
may result from even a comparatively slight dis-
placement of the uterus. Having this in mind, it
occurred to me that possibly the straining and
consequent eversion of the uterus in the cow may
be due to the traction upon and resulting dis-
placement of the uterus by a too closely adherent
placenta. And that the straining following the
replacement of the organ was due to a failure on
the part of the operator to get it into the normal
position.

I have recently been trying the long-continued
effect of gravity on the uterus filled with water
and in the limited number of cases in which I had
the opportunity to try it I have been pleased with
the results. The following case wili illustrate:

A cow that had everted her uterus after giving
birth to a living calf. I found the animal in an
old peach orchard that was grown up with under-

EVERTED UTERUS: REPLACEMENT 119

brush. She had been walking about considerably
and the uterus was very much lacerated, swollen
and bleeding and thoroughly covered with feces
and other dirt. It was a case where the indica-
tions were for continued straining. I cleaned up
this uterus carefully in a warm three percent
Creolin solution and with considerable difficulty
replaced it after standing the cow in the stall with
her hind feet about a foot higher than the front
ones. She at once began to strain violently. With
my arm inserted and with the aid of an assistant
I commenced running in a weak solution of
potassium permanganate and continued this for
two hours, when her straining had nearly ceased.
I instructed the owner to continue the irrigation
for two hours longer. No other treatment was
given. The following evening and the next morn-
ing the owner reported the cow doing fine. She
did not strain any more and a week later she had
fully recovered, all discharges having stopped.

Pervious Urachus
By C. L. Wilhite, D. V. S., Manilla, Ia.

During the latter part of the period of ges-
tation the urine passes from the fetus through a
canal or tube into the allantoid cavity (a space
between the outer and inner folds of the placenta,
the chorion and amnion, and lined with the mid-
dle fold of the allantois). This canal is called the
urachus. When parturition begins this urine con-
tained in the allantoid cavity is a part of the fluid
that passes when the placental envelopes break.

Some authorities claim that pervious urachus
is caused by a stricture of the urethra, but I have
found such to be the cause in only a few of many
cases that I have met. I believe it is caused by
some freak of nature or a disease which prevents
closure of the urachus at the bladder at birth or
soon afterwards.

*Reprinted from the American Journal of Veterinary Medicine,
December, 1911.

PERVIOUS URACHUS 121

In cases of pervious or persistent urachus the
urine passes from the umbilicus in a stream or by
drops during the act of urination and in occa-
sional cases drips continuously. The hair around
the umbilicus is generally wet. As the affliction
gets older there is a catarrhal discharge and later
pus. Occasionally, perhaps often, there is an in-
fection present which if unmolested, works up
the umbilical vein to the portal vein, then quickly
to the liver, next the joints swell and the battle
for life is on.

In 1907 I treated nine cases of pervious
urachus which later developed septic arthritis.
I used ligatures, cautery, injections, and, as the
disease developed, several pounds of echinacea
and other drugs too numerous to mention. Eight
died of the nine and one lived but remained an
unthrifty dwarf. I had about the same success,
or rather failure, with my cases in 1908 and 1909.

In the spring of 1910 a veterinarian recom-
mended pure oil of turpentine to me as a cure
for sweeney and gave me a bottle to try. After
seeing the swelling it caused I decided to try it
on a case of pervious urachus to close the opening.

122 SPRINGTIME SURGERY

I did so, and the leaking stopped in a few hours.
Since then I have been using it continuously and
have had only a few fatalities.

The treatment is as follows: Cast the patient
without ropes so it may be let up quickly when
through. Clip the hair around the umbilicus and
wash with soap and water. Rub dry with a clean
cloth. Cleanse the urachus with peroxide in a
syringe with a long, small nozzle clear into the
bladder. Wash the foam out with pure water.
Get a few drops of pure oil of turpentine in the
syringe, insert nozzle into the urachus to within
an inch and a half of the bladder, as near as can
be guessed. Inject turpentine slowly drawing the
Syringe out at the same time then let the patient
up quickly. Inform the owner that the patient will
do some scratching for a while, and that if the
navel is leaking in three or four days the treat-
ment will have to be repeated. Generally one
treatment will suffice. Occasionally it takes two
or three.

Females are more easily cured than males. If
all the urine passes from the urachus there is a
stricture of the urethra and it should be cathe-
terized if possible.

Care of Navels in Newborn’

By W. L. Williams, V. S., author of “Veterinary Obstetrics,”’
“Surgical and Obstetric Operations,” etc., Professor of
Surgery in the New York State Veterinary College,

Cornell University, Ithaca, New York

The care of the navel of the new-born domes-
tic animal has been the subject of much differ-
ence of opinion amongst veterinarians and lay-
men and has been greatly influenced by compari-
son with the theories and practices of human
obstetrics.

In general we accept as a truism in practice
that a given course of action is alike applicable
in all mammalia and hence that the correct
method of dealing with the navel of a child will
apply to all mammals. There are however some
very important differences among mammals which
serve to test the applicability in practice of this

*Reprinted from the American Journal of Veterinary Medicine,
April, 1911.

124 SPRINGTIME SURGERY |

generally accepted theory. The navel cord of the
foal and the calf are much more ample compara-
tively than that of the child or of the young of car-
nivora. The environment in which young are
born differs widely, and the care bestowed upon
the navel cord by the mother also varies greatly.
The attitude of the young animal further changes
conditions materially.

In herbivora the navel cord is normally rup-
tured by linear tension. It generally parts at a
particularly frail point near the umbilicus. The
cord being tensely stretched at the moment of
parting, the umbilic arteries are much elongated
and when they finally break, the proximate ends
recoil, retracting into the abdominal cavity, draw-
ing with them in an inverted state the surround-
ing loose perivascular tissue. The ruptured
arterial stump is thus promptly withdrawn from
the exterior where it might become infected, and
the inverted, adherent connective tissue at once
aids the contracting arterial stump in controlling
the hemorrhage. The umbilic vein, or veins, col-
lapse. The stump of the urachus retracts within
the abdominal cavity between the two arterial

CARE OF NAVELS IN NEWBORN 125

stumps. Thus the vessels are promptly out of
harm’s way. The mother next gives the navel im-
portant attention by licking. This act is gener-
ally supposed to be purely cleansing but it is very
much more. When intact, the naval cord is
largely made up of the gelatinous, semi-fluid
Whartonian gelatin which if left in the cord
affords an excellent breeding ground for patho-
genic microorganisms. This fluid, under normal
conditions, slowly oozes from the stump of the
cord and the latter finally desiccates, but the
mother greatly hastens this process by a kind of
tongue-massage. The fluid is forcibly pressed out
during the licking process. This is especially em-
phasized in the cow with her rough, prehensile
tongue, with which she exerts much force. In
harmony with this, calves suffer far less from
navel infection than do foals, whose navels get
less tongue massage from the mother. In fact
naval infection in calves is seen mostly in those
early removed from their dams and this natural
care of the navel by the mother prevented.
Ligation Harmful. — Many veterinarians and
most veterinary obstetricians advise or practise

126 SPRINGTIME SURGERY

the ligation of the navel cord of the new-born.
They do not generally state their reasons there-
for. It was advised by Nocard for the preven-
tion of “white scours” in calves, though just why
it should prevent this dreaded disease is not clear.
It certainly can not prevent the entrance of in-
fection through the navel. We may limit infec-
_ tion to some extent by a ligature around a living
tissue, as when we ligate a hernial sac, but even
there our power is vague. In that case however
we apply the ligature to living, active tissues,
cutting off nutrition on one side of the ligature
and leaving it comparatively undisturbed on the
other side, where a protective wall against any
threatening infection is quickly established. In
the navel cord it is quite otherwise. The interrup-
tion of the placental circulation and establish-
ment of the pulmonary functions renders the um-
bilic stump a dead mass of tissue. The arterial
stumps and the urachus have retracted and are
no longer in the cord, while the vein or veins have
wholly ceased to function and are dead. The re-
maining umbilic tissues, the amniotic sheath of
the cord, the areolar tissue and Wharton’s jelly

CARE OF NAVELS IN NEWBORN 127

included within it are dead and all that now re-
mains of the navel stump must ooze away, desic-
cate or decay. It must be clear to anyone that a
ligature applied around a columnar mass of dead
tissues can not prevent the invasion of bacteria
on either side of the ligature; it can not hold
either the distal or proximal tissue against bac-
terial invasion.

Fortunately for the calf the navel cord usually
ruptures before the birth act has been completed
and the arterial and urachal stumps have re-
tracted within the abdomen out of reach of the
meddler. In the foal the navel cord is longer and
a ligature may be applied before it is ruptured
and the arteries and urachus become incarcerated
and their infection rendered probable.

The most serious objection to ligation lies in
the fact that the ligature imprisons within the
amniotic sheath all of Wharton’s jelly and all blood
which may ooze from the withdrawn arterial
stumps if they have retracted. If the arteries
have not retracted and are caught in the ligature
a large blood clot is imprisoned just above the
ligature; any urine oozing from the retracted

128 SPRINGTIME SURGERY

urachus is also imprisoned, and any blood re
maining in the umbilic vein or veins is likewise
retained. This retention of liquids within the
dead tissues serves to invite infection and is in
direct conflict with surgical principles, one of the
most fundamental rules of which is the ample pro-
vision of freedrainagefor all inactive useless fluids.
Sources of Infection—The ligation of the
navels of new born domestic animals is rarely
carried out under aseptic or antiseptic precau-
tions of even a crude character; usually the
hands of the ligator, and the ligature are bear-
ers of infection. After meeting this danger the
foal or calf spends much of its time with the navel
stump in contact with dung or other filth. When
standing the moist navel stump is a favorite feed-
ing place for flies, bearing various infections.
But it is held, the human obstetrician ligates
the navel stump and why should not we also?
The cases are not parallel. The human obstetri-
cian ligates the cord under careful antisepsis,
after expressing the jelly of Wharton and other
fluids, then applies antiseptic or aseptic dress-
ings to the wound which is retained in place by a

CARE OF NAVELS IN NEWBORN 129

clean bandage and the infant is kept ip a dorsal
recumbency with no opportunity for fecal, urinal
or other soiling of the dead stump.

_ Navel Hemorrhage Not Serious.— If the liga-
tion of the navel cannot prevent infection there
would seem to be but two other reasons for the
procedure, hemostasis and fashion. In an exten-
sive obstetric practice extending over thirty-two
years the writer has not observed fatal or impor-
tant naval hemorrhage and has learned of but
one case from his fellow veterinarians. That one
case was in a foal, belonging to a veterinarian
who ligated the cord. Apparently he had excised
the cord too long, the excised arterial stumps re-
tracted up through the ligature and failed to
close as the ruptured end would have done, the
escaping blood accumulated above the ligature,
distending the amniotic sheath of the cord, pushed
it off and permitted the fatal hemorrhage.

Fatal umbilic hemorrhage rarely, if ever, fol-
lows the normal division of the umbilic cord by
linear tension (herbivora) or by gnawing (carnivy-
ora). Ligation is wholly superfluous from a
hemostatic standpoint and if accompanied by ex-

130 SPRINGTIME SURGERY

cision of the cord adds greatly to the danger from
hemorrhage because an excised artery bleeds
more freely than an artery severed by any other
method. Clinically an artery is generally not
held by a ligature about the cord, especially if the
cord is divided reasonably short. As that is the
case in most navel ligations the control of the
hemorrhage is due, not to the ligation but to auto-
hemostasis, in the ordinary course of the normal
physiologic powers of the umbilic arteries.

If we examine the question clinically we find
that the above conclusions are borne out by every-
day experience.

Prevention of Infection— Foal after foal
perishes from navel infection and a far larger
percentage of foals succumb with, than without,
ligation. On the other hand, navel infection is
uniformly prevented by open antiseptic, desiccant
handling of the navel. If the normally ruptured
navel, or the navel artificially divided in a man-
ner simulating the natural method (linear ten-
sion, scraping, ecrasement) under antiseptic pre-
cautions—the jelly of Wharton pressed out and
a desiccant antiseptic applied navel infection is

CARE OF NAVELS IN NEWBORN 131

promptly and effectively barred. If the freshly
ruptured navel, from which the Wharton’s jelly
and other fluids have been expressed, is immersed
in a 1-1000 corrosive sublimate solution for fifteen
to twenty minutes it will have become well dis-
infected. This may be conveniently accomplished
by filling a cup with a solution and pressing it
against the abdominal floor around the navel,
thus immersing the navel stump within the solu-
tion. After this thorough disinfection, desicca-
tion of the stump may be hastened and the sealing
of the wound against infection insured by dust-
ing the stump over with a powder consisting of
equal parts of gum camphor, alum and starch,
finely powdered. This may be repeated every
thirty minutes until the desiccation is complete
and a hard, dry antiseptic scab is the sole rem-
nant of the umbilic stump; the wound is sealed
and infection is excluded.

If sure that the navel is reasonably clean, the im-
mersion of the stump in the corrosive sublimate
solution may be safely omitted and the desiccating
antiseptic powder at once applied. Or after the
cord has been ruptured and the fluids expressed

132 SPRINGTIME SURGERY

from the stump it may be efficiently disinfected
and desiccated by the application of tincture of
iodine, but this needs be done with great care,
lest the skin about the navel be blistered. Iodine
is not wholly safe in the hands of the layman, and
it is the layman who must usually care for the
navel of the new-born under directions from the
veterinarian. |

While we frequently see glowing accounts of
how navel infection in new-born animals has been
cured by this or that veterinarian by bacterins or
other very remarkable remedies, the conservative
veterinarian would as yet prefer secure prophy-
laxis to glorious, sensational cures. He may not
get as much money out of it, but he will gain
much in satisfaction and in professional standing.

Superfetation With Report
of a Case

By R. F. Bourne, B. Sc., D. V. S., Professor of Physiology,
Kansas City Veterinary College

By the term superfetation is meant conception
in an animal already pregnant before the termi-
nation of the primary period of gestation. This
term should not be confused with superfecunda-
tion—the fertilization of two or more ova of the
same ovulation by separate copulative acts.

Opportunity for erroneous conclusions in cases
of this character is so great that some authori-
ties have doubted the possibility of its occur-
rence; but there are recorded, several indisputa-
ble cases of superfetation and doubtless some who
read this may recall occurrences in their own ex-

perience. However, these instances seem to be

*Reprinted from the Missouri Valley Veterinary Bulletin, July, 1909.

134 SPRINGTIME SURGERY

exceedingly rare; far rarer than cases where
double conception has resulted from connection
with two different males at intervals separated
only by a few hours. Fleming records cases
where women have borne twins, one white and
one mulatto, from copulation with a white man
following that with a negro or vice versa, and
similar cases where a horse and a mule colt were
delivered at one birth when service with a horse
and a jack was had on the same day. These are
cases of superfecundation.

The more remarkable instances are those in
which conception has occurred from two copula-
tive acts, weeks or months apart (superfetation),
and where each fetus is carried for the full period
of gestation. One of these cases occurred in New
York in 1876. A five-year-old mare bore a fully-
developed, well-formed dead colt on February
twenty and on the second of April another sound,
healthy fully-developed live colt. Other cases in
which two fetuses in different stages of develop-
ment have been delivered at one birth are more
frequent. The following case of this kind re-
cently came under my observation.

SUPERFETATION 135

I was called by a farmer who reported that
he had a mare which had foaled and which was
not behaving properly. Upon my arrival about
nine p. m., I found a black, twelve-year-old mare
exhibiting symptoms of mild colic and treated
her accordingly. Vaginal exploration revealed
conditions normally present after parturition.
The owner then related the following history:
The mare had been purchased by him five months
before, and was said to be in foal from a horse
or jack, she having been bred to both. She had
been served first by the jack, and in order to in-
sure conception was returned, some three weeks
later, to the town where the jack was kept. In
the meantime, however, the jack had been re-
moved and the owner allowed the mare to be
served by a percheron stallion. So far as the
present owner knows no subsequent service was
had and the opportunities for it seem very re-
mote, judging from the conditions under which
most farm mares are kept.

A few hours prior to my call the mare gave
uneventful birth to two colts, one an immature
mule and shortly after a well-formed full-term

136 SPRINGTIME SURGERY

horse colt. Both were dead. The mule’s body
was not yet completely covered with hair and its
size was not more than one-third that of the
full-term foal.

The only explanation I can offer as to the im-
mature state of this foal was that it had been
carried dead for some months and had resisted
decomposition and mummification until normal
conditions had delivered it along with the horse
colt. The carrying of a dead fetus for this
length of time is not rare and unless service was
had with a jack at a later period than that with
the stallion, we must accept some such explana-
tion. Parturition occurred about two weeks be-
fore the normal period of gestation, for the
horse colt, had expired.

x

Atresia Ani"

By A. T. Kinsley, M. Sc., D. V. S., Pathologist, Kansas City
Veterinary College, Author of “Veterinary Pathology” etc.

During the embryonic stage of intrauterine
life the specialized tissues and organs are formed.
The fetal period is the time during which the
structures formed in the embryonic stage grow
and develop. At birth the young of a given
species are of a definite shape, contour and type;
the form or type which is most common is ac-
cepted as normal; and deviations from the nor-
mal are designated malformations, anomalies or
developmental errors. Many new strains and
breeds of live stock have been the result of de-
velopmental errors becoming a fixed peculiarity.
Thus the polled cattle, the Boston bull-dog, the
Mexican (hairless) dog, and the five-toed chicken
had their origin.

A variety of malformations are of course
seen at the season when veterinarians are called

*Reprinted from the Missouri Valley Veterinary Bulletin, June, 1908.

138 SPRINGTIME SURGERY

to attend cases of parturition. Obstetrical cases
in addition to the general practice entails the ex-
penditure of considerable energy and the prac-
titioner may not be as careful and observing in
some cases as he should be.

Atresia ani is a malformation that is not rare
and is frequently not observed by the attending
obstetrician. This malformation is the result of
imperfect union of tissues. During the earlier
stages of development, i. e., the embryonic period,
the digestive tract from the pharynx to the rec-
tum inclusive is formed from the entodermal
tube. The anus is formed in the fetal stage by
invagination of the skin surface, the anus and
rectum are at this stage separated by a thin
membrane. Normally the rectal and anal walls
fuse, the separating membrane is absorbed and
thus there is produced a continuous canal.

Failure of the anal invagination, failure of
fusion of the anal and rectal walls, or failure of
solution of the separating membrane would re-
sult in an imperforation and there would be no
outlet for the escape of the contents of the diges-
tive tube.

Mf

ATRESIA ANI 139

The communication between the bladder and
intestine may persist thus allowing the fecal mat-
ter to discharge into the bladder. A communica-
tion may also occur between the intestine and
urethra or the intestine and vagina.

The young of any domestic animal could not
survive long without evacuation of the contents
of the digestive tube. Atresia ani occurs most
frequently in pigs and calves, though colts and
other animals are not exempt. This. malforma-
tion is usually easily relieved by an operation the
nature of which depends upon the specific con-
dition existing. If there has been failure of ab-
sorption of the separating membrane it may be
ruptured by the use of a blunt instrument no
further treatment being necessary. In those
cases resulting from the failure of fusion of the
rectal and anal walls, the intervening tissue
should be very carefully dissected and the walls
of the rectum and anus approximated and
sutured. When there has been a failure of cuta-
neous invagination a crucial incision should be
made through the skin and the intervening tissues
bluntly dissected to the lumen of the rectum, then

140 SPRINGTIME SURGERY

the mucous membrane of the rectum should be
pulled outward, sutured to the skin or margins of
the opening made by the dissection so that the
mucous membrane and skin are continuous and
form a lining for the artificial opening.

If there is a communication between the intes-
tine and the bladder urethra, or vagina it should
be closed by a plastic operation and the external
opening made as indicated above.

—

BE ts

Treatment of Contracted
Tendons in Foals

By James Smellie, M. D. C., Eureka, Illinois

The title of this paper should really be “Treat-
ment of Contracted Tendons and Ligaments in
Young Colts,” because in the majority of cases
the ligaments are just as much at fault as are the
tendons. The contraction of one or both of these
structures is a condition that the country prac-
titioner meets very often, and in most cases, it is
quite serious.

Every year we see a number of colts born with
such marked contraction of the flexor tendons and
posterior ligaments of the forelegs that the ani-
mal knuckles over on the fetlock joint, and is un-
able to extend the phalanges. The condition, if
allowed to continue very long, causes an undue

*Reprinted from the Missouri Valley Veterinary Bulletin, Feb., 1910.

142 SPRING-TIME SURGERY

extension of the extensor pedis tendon, and also
of the anterior part of the capsular ligament.
This, combined with the bruising of the skin, from
contact with the ground sets up a thickening over
the joint that is apt to remain.

In some colts the flexure is at the carpus. In
such cases the metacarpal muscles and check liga-
ments are most affected; in some cases delivery
is effected with the front legs flexed. I have seen
a few cases of this condition in the hind legs, with
the contractions at the fetlock and the flexor ten-
dons most affected.

Etiology.— This malformation is caused, I be-
lieve, by the limbs becoming flexed in utero and
for some inexplicable reason, remaining that way
too long. It may possibly be hereditary in some
cases, when one or both parents have upright
shoulders and short straight pasterns. I know
of a mare of such conformation that has had two
colts in succession, sired by the same horse, that
knuckled completely over on one front fetlock,
and could touch the ground with only the toe of
the other leg. Her colts were sound when sired
by another horse.

CONTRACTED TENDONS IN FOALS 143

Treatment.— Only in those cases where the
colt was lively and energetic have I ever been
successful in my treatment of them. When the
animal is young the ligaments and tendons will
stretch a long way if the limbs can be brought
into position so the animal can use them.

In the hind leg, it is comparatively easy, pro-
vided the flexors are not too short. I make a bar
shoe exactly the size of the foot with a projection
coming straight forward about three inches, then
turning it up to form a brace to which the limb is
strapped. The fetlock joint forms an admirable
fulcrum for the brace, and every time the ani-
mal stands up it stretches the tendon, which soon
allows the foot to assume its natural position. If
there is too much contraction section of the per-
forans has to be performed.

In the front leg, treatment is more difficult, be-
cause all joints flex in one direction. I make a
bar shoe exactly the size of the foot with a forked
projection in front extending from two to four
inches. If the joint is weak and inclined to break
over outward, it may be necessary to weld on a
spur on the outside of the shoe. It is necessary

144 SPRINGTIME SURGERY

to raise the points of those projections and give
the foot a rolling motion backwards. The feet
are very soft for a few days, but generally about
the third or fourth day, the hoof is hard enough
to hold the nails. ,

In a few cases where the joints were weak, I
have had to put on a plaster cast for a few days
to stiffen the joints enough so the animal could
get in the habit of using its feet.

When the carpus is affected, tenotomy of the
metacarpi medius and the perforans tendons has
to be performed.

Minor Means of Restraint
By D. M. Campbell, D. V. S., Chicago

The veterinarian and particularly the young
veterinarian who can control his patient with the
least expenditure of time and energy on his own
part as well as with the greatest measure of
safety to himself and to the animal is in a fair
way not only to do better surgery because of
this perfect control but to win favor with his
clients and a reputation for “‘horse sense” which
is so necessary to one who would be considered
by stockmen a master in his profession.

On the other hand the inability to cast, throw
or tie an animal as well as the owner himself can,
is one of the greatest handicaps a veterinarian
can have, not only because of the actual incon-
venience to which he is subjected but also be-
cause of the lessened respect—the almost con-
tempt the owner will have for a veterinarian on
this account alone. A veterinarian’s clients ex-

146 SPRINGTIME SURGERY

pect him to know more about their animals than
they themselves do and regard with suspicion the
knowledge of a veterinarian who knows less
than they about controlling animals.

An ever-present example of the above may be
seen in the regard most horsemen have for the
incompetent veterinary dentist who, though he
knows very little about a horse’s teeth and their
abnormalities, from long practice is able to handle
the horse while dressing the teeth in a very skill-
ful manner, and to float the teeth quickly, without
the use of a speculum and with almost no resist-
ance from the patient. Contrast the effect of
such ‘‘smooth work” with the bunglesome method
of some competent though unpracticed veter-
inarian who has done little of this work and
whose final results when the work is completed
are infinitely better than the other, and one may
see at once how much horsemen appreciate
“horse sense’”’—“handiness.”

Nothing else is quite equal to ingenuity and
of course common sense in handling animals.
To some extent every case presents its own prob-
lem; but a few suggestions that are capable of

MINOR MEANS OF RESTRAINT 147

modification to apply to a large variety of cir-
cumstances may be useful, particularly to the
recent graduate in veterinary medicine whose
boyhood and early manhood was not spent on a
farm or among animals.

To Handle the Hind Feet of an Unbroken
Horse*.—Take a piece of five-eighths inch rope
with a noose at one end that will not slip and
large enough to go around the neck near the
shoulder, then put a half-hitch around the body,
just back of where the backband of a harness
comes, then take on back through a strap buckled
firmly around the root of the tail. To this fix a
ring or a knot and connect a small block-and-
tackle with it and to a hobble on the foot to be
raised. A ten-year-old boy can do the rest.

To Pass the Knisely Stomach Tube*—-Draw
very tightly around the nose a common harne
strap, this is placed just high enough so as not
to interfere with the animal’s breathing. Then
lubricate the tube and pass it in through the in-
terdental space and down the esophagus as usual.

*By H. B. Treman, D. V. M., Rockwell City, Iowa; reprinted from
the Missouri Valley Veterinary Bulletin, July, 1909.

148 SPRINGTIME SURGERY

The anima] breathes much easier than it does
when a mouth speculum is used and consequertly
does not resist the operation so strenuously. Be-
sides, the little strap is far more convenient to
carry than a heavy speculum. I also think that
the tube is less liable to enter the trachea when
so used than it is with the mouth held open.

Restraint for Cattle—I have been surprised
to find some veterinarians unfamiliar with the al-
most universal means or method for throwing a
cow, and many others that though familar with
this means of throwing the animal have thought
that after the animal is thrown it needs further
tying to hold it down for various operations.
This is not the case. Two ropes, one with which
to tie the animal by the head and another single
rope twenty-five feet long are sufficient for one
man to throw and hold the largest bull for an
operation for actinomycosis or for putting a ring
in his nose or for almost any other operation
except upon the feet and legs.

To cast and control cattle where one has not
the assistance of trained cow men and cow horses

or ponies, select a piece of sloping ground, the

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MINOR MEANS OF RESTRAINT 149

steeper the slope the better within reasonable
limits. Tie the animal by the horns or with a
halter at the ground to a strong stake or post,
then loop one end of a strong rope around the ani-
mal’s neck near the shoulder. Tie the loop so
that it will not slip. Take a “half hitch” or loop
behind the shoulder and another just in front of
the anterior angle of the ilium and the udder or
scrotum. The first of these “half hitches” is not
essential but the second is very necessary. Then
get the animal to stand back from the post to
which it is tied as far as possible and pull steadily
and strongly upon the rope, determining the side
upon which you want the animal to lie by pulling

at a slight angle.

If in falling the animal should slacken the rope
by which it is tied at the head it must be allowed
to rise and the throwing repeated and kept up
until the animal falls with the head rope taut.
With a very little experience the operator will be
able to accomplish this quickly, usually at the first
throw, and in no case requiring more than two
attempts.

150 SPRINGTIME SURGERY

After the animal falls keep the rope tight and
it will very soon cease to attempt to rise. Then
have an assistant take the rope and pull strongly
upon it almost at a right-angle to the long axis of
the animal’s body, standing just a little bit back
of where a right angle line would run. Allow
the legs to remain free and the animal to use
them as much as it likes. In this way the strug-
gling will do no harm and even cows heavy with
calf may be operated upon for lump jaw or other
ailments without the slightest danger of produc-
ing an abortion or otherwise injuring them.

With the animal in this condition an operation
upon the fore feet or fore legs offers little diffi-
culty. Simply flex the legs strongly and tie them
there. The hind feet offer a little more difficulty,
particularly if it is desirable to keep an animal
in an advanced stage of pregnancy from injur-
ing itself through struggling, but the ingenious
veterinarian will have little difficulty.

To Control Cattle in a Standing Position. *
—For castrating old bulls, or for giving them

*Reprinted from the American Journal of Veterinary Medicine, July,
1911.

MINOR MEANS OF RESTRAINT 151

tuberculin injections, when they evince a desire
to kick and for many other operations not upon
the head, cattle may be restrained without going
to the trouble to cast them, by the following very
simple expedient:

Have the animal securely tied by the head and
take two strong poles—fence rails serve admira-
bly, and cross them beneath the animal. Two
assistants should then lift upon the rails, so that
the animal rests, just in front of the udder or
scrotum, a part of the weight upon the rails
crossed saw-buck fashion with the long ends up.

To Break a Horse From Pulling Back.—
One may often curry much favor with his clients
by showing them how to break a horse from pull-
ing back upon the halter. This is a very simple
matter and one with which every veterinarian
should be familiar.

Take any strong rope but preferably a new
three-eighth-inch hard twisted one such as is used
for lariats and make a small, non-slipping loop
in one end. Place the rope about the horse’s body
ant posterior to the fore legs, run the free end
of the rope through this loop, take it between the

152 SPRINGTIME SURGERY

forelegs and forward through the ring in the
head stall of the halter. Tie to the manger or a
post or anything solid, just short enough so that
when the animal backs as far as this rope will
let him he will still lack about a foot of taking
up the slack in the halter rope and then leave
him to his own salvation, or if he should refuse
to pull, after a reasonable time, induce him to do
so by “‘shooing” him or slapping him over the
head with a sack or something of that kind. It
is best, however, to let him get caught at his old
trick of his own initiation. The tightening of the
rope about the chest will frighten the animal very
much and he will at once spring forward and will
not repeat the process until he forgets about it.
Three or four experiences of this kind are usually
sufficient to break the habit in the worst puller.

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The Treatment of the
Injured Hand *

How to Cleanse it and How to Examine it

By Ralph St. J. Perry, M. D., Santa Fe, Isle of Pines, Cuba

[EpITor’s NoTE.—Minor injuries to the hands that are infected dur-
ing their work and become serious are of such common occurrence
among veterinarians that no apology is required for presenting this
excellent article, a chapter from Dr. Perry’s book on “The Injured
Hand,’”’ here even though it deals with no phase of veterinary surgery.
The principles here given apply alike to minor surgery of both man and
animals. Dr. L. A. Merillat, the most widely read surgeon among
veterinarians has pronounced this article the best “surgery” that has
ever appeared in a veterinary publication.]

Probably every accidental wound is an infected
wound. Out of several hundred of such injuries
only two were found to be noninfected when sub-
jected to bacteriologic tests. The infection usually
is coincident with the injury, and it is doubtful
whether any method of wound cleansing has yet
been devised which will surely and immediately
eliminate this primary infection.

*Reprinted from the American Journal of Veterinary Medicine, No-
vember, 1910.

154 | SPRINGTIME SURGERY

The rapidity with which infection can spread
from one portion of a wound to another, or from
an infected wound to adjacent healthy tissues, is
startling. Schimmelbusch inoculated the tip of a
mouse’s tail with anthrax germs and ten minutes
later cut off the tail at its root; the mouse died of
anthrax. Reichel maintains that one minute after
inoculation the most thorough antiseptic treat-
ment is powerless to prevent infection. What,
then, can be expected where an injury is rarely
seen by the surgeon until fifteen minutes after its
infliction, while oftener it is thirty minutes or an
hour?

Observation and experiment have proved that
powerful antiseptics devitalize the tissues and do
more harm than good. This is particularly true
of carbolic acid, cresylic acid and corrosive sub-
limate. These are cited because they are the ones
most commonly used by the profession and laity,
and the most dangerous. If it be true that these
antiseptics cannot prevent or counteract infec-
tion and that they by their destructive action upon
the tissues really tend to create a field for the de-
velopment of germs, why use them at all? The

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TREATMENT OF INJURED HAND 155

question is a proper one, and my answer is, Don‘t!

Don’t use carbolic-acid.

Don’t use cresylic acid!

Don’t use corrosive sublimate!

But if not these, what would you use? It is
desirable to use an antiseptic which will prevent
further infection and the further development of
infecting germs already in the wound. We want
a protective and preventive which is not caustic
or irritating, something that will cleanse without
doing injury and which will guard against the
assaults of extraneous germs.

Surgical Cleansing of the Injured Hand.—
The vast majority of injured hands are those of
mechanics and laboring men and come to the sur-
geon smeared with machine grease, paint, varnish,
mud, mortar, sawdust, flour, tobacco quids, cob-
webs, and many other substances which are a part
of honest labor or which have been applied to the
wound in well-meant but misguided efforts to stop
bleeding or ease pain. To remove these substances
I use three applications:

Warm saline solution,

Gasolin, plain and iodized,

Warm solution of mercuric cyanide.

156 SPRINGTIME SURGERY

The saline solution (a teaspoonful of clean table
salt to each pint of boiled water) is familiar to all
and needs no special mention. It is used to re-
move the grosser portions of the dirt—the term
“dirt” being here employed as applying to all mat-
ter out of place. 7

Use Gasolin to Remove Oil and Grease.—
In cases where the injured parts are soiled with
machine grease, paint, oil, varnish and similar
substances not removable by water, resort is had
to ordinary commercial gasolin. The use of gaso-
lin for this purpose, while not general, is not a
novelty. I have so utilized it for more than
twenty-five years; others have used it, and it is
now quite generally used by surgeons who have
much factory, machine-shop or railroad surgery.
While acting as a solvent for fats, oils, gums, wax
and resins, it is, to a certain extent, antiseptic, be-
sides causing no pain; hence it makes an excel-
lent detergent when the parts are besmeared with
such substances.

The addition of resublimed iodine to the gasolin
(one dram to the pint) increases its antiseptic
powers without affecting its detergency. Iodized

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TREATMENT OF INJURED HAND 157

gasolin should be freshly prepared, in small
quantities, at the time of use.

To use the gasolin, pour it directly upon the
wound from a small-mouth bottle, letting it
wash all over portions of the injury; also make
a mop of absorbent cotton or gauze, saturate with
the gasolin and gently rub over the parts until
cleansed. If the dirt be unusually tenacious, a
soft tooth-brush may be used. The body-heat
causes the gasolin to evaporate from the surface,
leaving the parts clean and dry.

Gasolin is almost as efficient as hydrogen per-
oxide in breaking up adherent clots, and is not
painful.

By way of caution: The surgeon must remem-
ber that gasolin vapor is highly inflammable, even
explosive; also, that if it gets into the eye, ear or
closed cavities it may cause pain, just as do ether,
chloroform and other quickly volatilizing liquids.
Benzin may be substituted in an emergency.

Mercuric Cyanide Solution. — The mercuric-
cyanide solution has been a favorite cleansing so-
lution with me for many years. Since I first called
attention to its use in antiseptic surgery (in 1898)

158 _ SPRINGTIME SURGERY

its use has become quite general because of the
following advantages:

Mercuric cyanide is freely soluble in hot or cold
water, and in alcohol; it does not stain the finger-
nails or give rise to eczema or other inflamma-
tions of the skin; it does not coagulate albumen
in blood, mucus, purulent or other discharges or
excretions; it is not precipitated or decomposed
by soap; it does not corrode steel, nickel or silver;
it can be used in any kind of a vessel—enameled,
porcelain, tin, papier-maché or wooden; it is in-
expensive.

Some of my critics, especially the laboratory
bacteriologists, have maintained that mercuric
cyanide is not an antiseptic, that it will not in-
hibit germ growth; but to these I say that I have
used it for now more than ten years, and the re-
sults have been more satisfactory than I obtained
from other antiseptics. The practical experience
of many other surgeons corroborates my own.

Other critics say it is too dangerous an anti-
septic for general use, that its lethal effects are
too sudden should one of the laity accidentally
swallow some of it. But these should remember

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TREATMENT OF INJURED HAND 159

that this agent is for the use of surgeons and not
of the laity, that the latter have no business with
it, and that in the hands of a competent surgeon
it is as safe as an amputating knife or other in-
strument.

In cleansing the parts around a wound it is
sometimes desirable to use soap, and I have

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found “‘mechanics’ soap,” a coconut-oil soap plus
fine sand, or rather stone, as good as any of the
higher-priced antiseptic soaps. If desirable, an
antiseptic solution may be used as a rinsing appli-
cation after the soap.

Hydrogen peroxide I do not often use in pri-
mary cleansings, since little difficulty has ever
been experienced by using the methods just de-
scribed. Before attempting to cleanse a wound
always apply a tourniquet to prevent further
bleeding. .

Examination of Injuries.—Having cleansed
the wound of all extraneous matters, the surgeon
should see to it that his own hands are again ren-
dered surgically clean, after which he may pro-
ceed to examine into the nature and extent of the

injuries.

160 SPRINGTIME SURGERY

In making such examination, use the fingers
rather than instruments, as much as possible, but
gently, very gently, depending upon the tactile
sense to determine what conditions exist, using
the eyes, ears and nose as aids to the sense of
touch.

The tactus eruditus, the educated sense of touch,
is nowhere of greater importance than in surgi-
cal practice. While manual dexterity is advan-
tageous in the technic and mechanical work of the
profession, the great importance of a correct
diagnosis speaks for the value of the educated
touch. This tactus eruditus can be rapidly and
readily acquired in the everyday experiences if the
student or practitioner will only make the effort
to determine size, shape, surface qualities and
other physical attributes by the touch, thus learn-
ing to identify objects by their ‘‘feel.”’

Care in Handling.—Simple superficial wounds
will require very little handling; incisions, punc-
tures and lacerations due to known causes call
for nothing more than a careful inspection. Where
the presence of a splinter of wood, metal or glass
is suspected, a very gentle digital examination

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TREATMENT OF INJURED HAND 161

will discover the foreign body more readily than
a rough examination or probing with a metallic
probe.

In searching for deeply imbedded foreign
bodies, use the probe as little as possible. If the
body be a bullet, needle or other metailic substance,
use the x-ray. The indiscriminate use of the
probe in bullet wounds, fractures, necroses, sin-
uses, etc., cannot be too strongly condemned.
Modern methods are so much more superior, defi-
nite and less dangerous that the probe has been
to a large extent rendered obsolete and should
only be resorted to when other methods are not
at command.

The tactile sense should easily detect fractures
and dislocations if the parts be not swollen too
much, and in open wounds of joints should be able
to determine the condition of the cartilage sur-
faces. Should it be necessary to use instruments
in examining a wound, they should be sterilized.

The Sense of Smell.—The sense of smell is
of much assistance in determining the condition
of wounds, as all emit characteristic odors of
fresh blood, “healthy” pus, tissue necrosis, etc.,

162 SPRINGTIME SURGERY

according to their age, stage of healing, infections
and dressings.-

The odors given forth by wounds may be more
or less modified by those natural to the body, due
to the perspiration and other cutaneous secre-
tions. In ordinary persons this odor is sulphur-
ous, especially so in red-haired and freckled indi-
viduals; brunettes possess a prussic-acid and
blondes a feeble musk odor; fat persons have a
more pronounced odor than lean ones, the former
frequently having an oily odor due to excessive
fatty acids in the sebaceous secretions. Race, sex,
age, personal cleanliness and complicating skin
diseases also influence the odors of wounds.

Various foods and some medicines taken inter-
nally impart odors to the skin secretions which
may modify the normal wound odors, and local
applications to the seat of injury may be expected
to do so.

A recent undressed wound presents the odor of
fresh blood, which, if there be union by first in-
tention, gives way to that of the dressings ap-
plied. A wound bathed in pus from healthy gran-
ulations gives a characteristic odor which is not

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TREATMENT OF INJURED HAND 168

offensive; if, however, there be necrosis, decom-
position of the discharges or maceration of callo-
sities or scabs, there is a very pronounced and dis-
agreeable odor of putrefaction. I have noticed in
wounds in syphilitics a characteristic odor, also in
those made by ice-cutting tools, and in human
bites. Wounds infected with glanders or diph-
theria present the peculiar odors of those diseases.
All these things the experienced surgeon bears in
mind.

Macroscopic inspection of wounds will reveal
much concerning their extent and condition, but
the eye must be supported by the touch, as there
are many things in 2n injury which the eye cannot
detect and many appearances which are highly de-
ceptive. ; In cases where there is doubt as to the
nature of infection resort is had to bacteriologie
culture and miscroscopic examinations.

A most important adjunct to the ocular exami-
nation of injuries is the x-ray apparatus whereby
fractures, dislocations, bone inflammations and
necrosis can be definitely determined and metallic
bodies located.

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