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competent inspection of all animals killed in them, would deprive the local butchers of the profit which they at present reap at the expense of the farmer in cases such as those which our correspondent cites, but the information which he gives is interesting mainly for the side­light which it throws on the utterly inadequate means at present taken in Aberdeenshire to prevent diseased carcases from passing into the market. The facts disclosed conclusively prove that if there is any necessity for inspection of meat at all, such inspection must be com­pulsory and general. The mere erection of public slaughter-houses in large cities will not protect the inhabitants from the risk of con­suming unwholesome meat, as long as dressed carcases without the viscera may be sent in from districts in which no inspection is prac­tised.

eLI N I CAL ART I C L E S. --0--

LAPARO-COLOTOMY IN THE HORSE. (Mr Rickards' Case.)

By Messrs J. E. RICKARDS, H. G. ROGERS, W. W. DOLLAR, and J. A. W. DOLLAR, London, collaborating.

(Mr Rickards' Report.)

THE subject of this case was a roan mare about eleven years old that had been under my observation in a job-master's stud for six years since she was bought. She was in capital hard-working condition, and had never had any serious illness or even an attack of colic until 6th June, although she had passed several small calculi about two years before. On the date mentioned she had a slight colicky attack, and received 1 oz. of chlorodyne, together with half a pint of oleum lini.

JthJune.-The mare continued dull and did not feed. No action of the bowels. Evening temperature rose to 102'8°, but she had no violent pain.

8th June.-Morning. Much about the same. Temperature, 101'4°. At 5 P.M. her temperature rose to 103°, pulse 60, repirations increased. Still she had no pain, but early in the day she passed a small mass of f;eces thickly coated with mucus.

9tll June.-Morning. Very dull, not feeding at all. Temperature 100'4°. Quiet, and free from marked pain. About 5.30 P.M. she became very uneasy and had considerable pain. Her temperature rose to 103'4°. Pulse 60, but the pain was relieved towards 2 A.M., after she had had 6 drachms of Indian hemp.

IOtil June.-Io A.M. Pain returned, temperature 102'6°. Pulse 60, good volume. Respirations rapid. By 12 o'clock she was again much relieved, but on exploration per rectum I detected a hard mass in the flank which I recognised as a calculus. I consulted my friend

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Mr Rogers, and we then went on to Mr J. A. \V. Dollar and arranged to operate on her as soon as possible. At 5.30 P.M. pulse was So, temperature 101·S0, respirations frequent, membranes deep maroon-red. Quiet since midday. Messrs Rogers and Dollar both detected the calculus on exploration, but said it had shifted slightly towards the right and downwards, so that it then lay nearly in the middle line.

(ll!r J. W. Dollar's Report.) Before proceeding to a description of the actual procedure adopted,

it may be advisable to shortly point out the anatomical relations of the seat of operation and of the structures involved.

The incision took an oblique course parallel with the obliquus abdominis internus muscle, from a point about an inch below and in front of the external angle of the ilium to another point in front of the costal cartilages of the false ribs some 7 inches distant. The skin in this region is very thick and lies immediately over a considerable sheet of fat, being only separated from it by the fascia of the panni­culus carnosus. Between the two there pass down small nervous branches derived from the second and third lumbar nerves which supply the skin on the front of the thigh. The fat being cut through, the external oblique muscle comes in sight, though only in the lower portion of the wound. Below this, one arrives at the internal oblique muscle, which in its turn covers the transversus abdominis. If made as above described the incision in the male is well in front of, and above, the inguinal canal and its contained vessels and other structures. At this point some care is required, as the line of incision through the internal oblique is crossed by branches of the circumflex iliac artery (a branch of the external iliac), which lie on the deep face of this muscle. The transversus abdominis now appears in the lower end of the wound, and having been cut through reveals a layer of exceedingly soft and diffluent fat which covers the parietal peritoneum.

It is unnecessary to enter deeply into the relations of the various sections of the bowel, and indeed such a task would prove very diffi­cult on account of their large variations in position, but the following points may be of some slight assistance. The small intestine is of a less calibre than the other bowels, has a smooth and regular contour, and is usually lodged in the left flank, i.e., just below the point of our incision. The c;:ecum is a large roughly pyramidal shaped gut. It generally lies with its base in the right sub-lumbar region and its point or blind end in the epigastrium, so that the blind end is usually the first portion of intestine which appears on making an incision into the abdomen if one commences at the ensiform cartilage and follows the linea alba. The large colon commences at the crook of the c;:ecum, that is in the right sub-lumbar region, and extends downwards and forwards towards a point above the sternum. It then passes down­wards and to the left, making its suprasternal curvature, and runs back along the abdominal wall of the left side. Being once more reflected it returns as far as the diaphragm immediately above the second portion, where it makes its last curve and passes back on the right side of the abdomen above the first part. It may be known by its four muscular bands. The floating colon, which succeeds it, is lodged in the left flank, and is mixed with the convolutions of the small intestine. It has only two muscular bands, is puckered, and

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terminates in the rectum. For the purposes of this operation it need only be remembered that the blood supply of the floating or single colon is from the anterior and posterior mesenteric arteries, and that these vessels descend to the gut enveloped in the folds of mesentery. They then pass along its attached aspect giving off branches freely which run transversely to the long diameter.

A noteworthy and significant feature in connection with cases of intestinal calculus is the sudden narrowing which occurs at the termination of the double and the commencement of the single colon. Whilst the diameter of the former in a 16-hand carriage horse may be 7 to 8 inches, that of the floating colon is not more than 3 inches. As far as I am aware, calculus formation chiefly occurs in the last portions of the double colon. The stone may continue lying there for indefinite periods. It may even cause pocketing, and thus the normal lumen of the double colon be in no way interfered with; but imme­diately a backward movement is commenced, the greatly decreased diameter of the floating colon opposes an insuperable obstacle to further progress, and determines the onset of those changes which appear to be always followed by death.

The instruments employed, viz., scalpels, Wells forceps, scissors, dissecting forceps, retractors, etc., were placed in shallow porcelain trays containing 5 per cent. carbolic solution. An ample provision of silk and hemp ligatures, tape, pin and wire sutures, needles, etc., was made in another tray containing the same disinfectant. Clean sponges for mopping out the wound were placed in a basin containing 5 per cent. carbolic solution. Four or five larlte clean cloths were also got ready for use in covering the abdomen.

Before the animal was cast the hair was removed over a space extending from the hip joint to about the posterior edge of the 8th rib, and from the spines of the vertebrce above to within 8 inches of the middle line of the abdomen below. In the centre of this space an approximately circular area was shaved, The animal was then cast, chloroform was administered (with a free supply of air), and in about ten minutes the animal had reached the third stage of ancesthesia. The seat of operation and its surroundings were then thoroughly dis­infected with 5 per cent. carbolic solution. During the administra­tion of chloroform Messrs Rickards, Rogers, V/. Dollar and myself thoroughly cleansed our hands and arms by washing, brushed out the finger nails, and freely bathed the parts with 5 per cent. carbolic solution. Mr Rickards very kindly permitted me to perform the section. The skin was incised for about 7 inches in a diagonal direc­tion from the antero-inferior spine of the ilium obliquely downwards towards the costal cartilages.

The panniculus and fat were then cut through, small bleeding vessels were picked up and twisted, one of the branches of the second lumbar nerve which crossed the wound was cut, and the external and internal oblique muscles came into view. To avoid bleeding the internal oblique muscle was torn through instead of being incised, and the layer of fat covering the peritoneum then became visible. During the division of muscles hcemorrhage was very slight. Sponges wrung out of 5 per cent. carbolic were freely used, and all blood was soaked up before opening the peritoneum.

A slight pause was made at this point to guard against over-looking

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possible bleeding. The peritoneum was then broken through with one finger, the opening enlarged until it corresponded with the wound in the internal oblique, and after a very short manipulation the calculus was discovered, and the bowel containing it drawn towards the wound. At this stage it became necessary to enlarge the incision in order to withdraw the bowel. This was done by Mr Rogers, while I still continued to grasp the bowel. The abdomen having been covered with cloths soaked in 5 per cent. carbolic, the intestine and calculus were drawn forward, a piece of broad tape passed round the whole mass of intestine (which was covered with mesentery), and as it seemed impossible to arrive directly at the bowel, an incision was made through the mesentery covering it, and on to the bowel. The stone could then be distinctly felt, and it was liberated by a free longi­tudinal cut about 5 inches in length opposite to the insertion of the mesentery, i.e., on the free margin of the intestine. The calculus was removed, the bowel emptied of its contents and cleaned as far as possible with sponges wrung out of carbolic. The edges of the wound were then inverted so as to form a kind of" butt seam," the two serous surfaces being in contact, and the parts brought together by about fifteen interrupted silk sutures placed at intervals of i of an inch, care being taken to pass the sutures through the serous and muscular coats only and not to such a depth as to penetrate the mucous coat. The calculus was irregularly triangular, flattened on both sides, and had an extreme width of 5 inches and a circumference of 15k inches. It weighed 2 Ibs. The bowel was carefully cleansed, all small pieces of blood clot, etc., being picked off and returned to the abdominal cavity.

An attempt was made to suture the parietal peritoneum, b.ut owing to its being so friable only three or four silk sutures could be inserted. The muscles were also sutured in their order, silk being used. After cleansing the internal oblique muscle the wound was freely dusted with iodoform, and afterwards with boric acid, plenty being left inside. Lastly the skin was brought together with hemp, dusted with iodoform, and a large pad of wood wool was placed over the entire wound surface. The operation was complete at 7.15 and the mare left to recover from the effects of chloroform.

( lib Rickards' Report.)

7.30 p.M-Pulse 74, respirations 42, temperature 101'4°. 9 P.~I.-Pulse 90, small and soft, respirations 60, temperature 103'8°.

The animal had not risen, and therefore received four drachms of ether hypodermically, after which she rose with a little assistance and walked to a loose-box a few yards away, when a fresh pad of wood wool and a broad bandage were used as dressing. The mare was placed in slings, not because she was unable to walk about, but to keep the parts operated on as much at rest as possible.

9-45 P.M.-5 grains of morphia were given hypodermically and at 10.30 P.M. 2 drachms of opium in bolus. The mare drank 2 quarts of milk by 12 o'clock midnight.

12.15 A.M.-Pulse 86 (?), temperature 105'4°, respirations frequent. Animal very restless. Keeps on moving backwards and forwards in slings. At 12.30 A.M. gave 6 drachms of Indian hemp. Restlessness continued until 2-40 A.M. when 1 drachm of opium in bolus was given.

N

17 2 CLINICAL ARTICLES.

At 4 A.M. she became quiet, at 6 A.M. another drachm of opium was given. The mare continued comfortable until 10 A.M. when she was again in a good deal of pain. Temperature 104"7°, pulse 70, respirations 24. The pain increased up till 12 midday, when she received 4 drachms each of Indian hemp and chloral hydrate.

3 P.M. Drowsy. Pulse very frequent and small. 445 P.M. Temperature 105°, pulse 116. I drachm of opium given. 8. 15 P.M. I drachm of opium. Pain continued to increase until

10.30 P.M., when she died.

(Mr Dollar's Report). The autopsy was made at 11.30 A.M., Tuesday, 12th June, when rigor

mortis was well marked. Messrs Rickards, Rogers and myself were all present and assisted.

The external wound was dry, though there was a little weeping from the lower extremity. Animal in good condition, thick layer of abdominal fat, muscles rather friable. On opening the peritoneal cavity about 6 ozs. of an opaque blood-stained fluid containing a few very small shreds of blood-stained lymph were found iu the abdomen. Small shreds of lymph were also adherent to the parietal peritoneum in the neighbourhood of the wound. The seat of operation in the abdominal walls shows the following appearances. External (hemp) sutures holding well. No trace of inflammation or suppuration. The wound in the external oblique had only been partially sutured, but the sutures were still holding and the edges of the muscle in apposition between them. The internal oblique was perfectly in contact through­out. There was no trace of suppuration or inflammation, and on dividing the sutures the edges of the muscle were found to be commencing to adhere by the exudation of coagulable lymph. An astonishing degree of union had occurred here. The deeper layers of the muscle were slightly infiltrated with fluid from the peritoneal cavity and the exposed portions somewhat stained. This was, however, only on the surface, and seemed entirely due to post-lIlortem change, as the animal had been dead for thirteen hours. The peritoneum presented a lacerated wound about 6 inches in length extending in the direction of the obliquus abdominis internus muscle. Owing to the great depth of the external wound only the upper part of the peritoneal incision had been brought together. Around the wound for a distance of about an inch, and more marked at certain points than at others, a zone of sub-peritoneal tissue was infiltrated and blood stained. This staining rapidly shaded off into the surrounding healthy tissue, so that at a distance of 3 inches the peritoneum appeared perfectly healthy. The sub-peritoneal fat was exposed, and a portion about the size of a hen's egg protruded through the wound into the abdominal cavity. The surface of the parietal peritoneum as a whole was smooth and glistening, and no change could be detected on it at any point, nor were any lymph shreds adherent to it as far as could be seen, though the peritoneum covering the intestines showed a few very small shreds in one or two spots. The colour of the sub-peritoneal infiltratiop varied from a brick­red to a deep purple gray. The muscular tissue throughout seemed infiltrated and friable. The bowel wound was situated about 2 feet 6 inches from the commencement of the floating colon. It consisted of an incision about 6 inches in length and was closed by fifteen

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sutures. The three sutures nearest the colon end showed slight signs of cutting out. There were diffuse inflamed patches, varying in size from that of a sixpenny-piece to that of a five-shilling-piece, over a length of about 2 feet of the bowel. Slight deposits of lymph could be noted over these points.

At the commencement of the sutures (i.e. at the point nearest the large colon) the bowel was constricted and its normal lumen of nearly 3 inches diminished to about 2 inches. In front of this" stricture" a dilation had formed, and at its most prominent point the bowel seemed as though becoming gangrenous over a circular spot about one-third of an inch in diameter. The narrowest point in the" stricture" was not more than I k inches wide. The bowel in front of this point was distended with semi-digested material. There was no mark at any point of the escape of fa:cal contents into the peritoneal cavity. On cutting through the sutures and proceeding to remove them, the amount of union which had already taken place was very remarkable. The two serous surfaces in contact were injected and of a bright red tint. Adhesion had taken place to such a degree as to require some little pressure of the handle of the scalpel to separate the parts. There was no exudation of blood or lymph between the surfaces, and the suture tracts were in no way inflamed. The deepest portions of the wound, i.e. where the cut surfaces of the muscular and mucous coats came in contact, were most firmly united. Towards the colon end, where the parts were inflamed, the union was less firm. In no case had any of the sutures penetrated the mucous coat, as I was very careful to assure myself. The wall of the bowel was not much thickened, being (even at the edge of the wound) not more than -{6 of an inch in thickness. Considerable masses of fa:ces had passed the first portion of the wound, but had failed to clear it entirely. The operation had constricted the bowel to one-half its normal diameter and prevented the passage of the large masses of hard fa:ces.

On opening the fourth portion of the large colon three other calculi of considerable size and weighing respectively 2 lbs., 2 lbs. 14 ozs., and 4lbs. 12 ozs. were discovered.

Remarks.-Summing up the entire case, it would appear that several important lessons may be deduced from it. Apart from the econo­mical value of such operations, which may be open to dispute, the instruction to be gained from them may be looked upon as consider­able. The present one shows :-

(I) That. short of entering the peritoneal cavity, incision in the region described is attended with no difficulty or serious ha:morrhage in the horse.

(2) That the operation of finding the stone and of withdrawing it is comparatively simple.

(3) That death may occur from such an operation and yet few or none of the usually described signs of peritonitis be found on post­mortem examination.

(4) That the operation of suturing the bowel without injuring the mucous coat is not so difficult as might be supposed.

(5) That union tends to occur very rapidly in the abdominal muscles and in the bowel wound. Further than this, it appears possible that the progress might have been more satisfactory had the operator

174 CLINICAL ARTICLES.

endeavoured to displace the stone in the direction of the last portion of the fixed colon, and operated on that bowel.

Three advantages would have been gained by this procedure. (I) The risk of a stricture would have been much less. (2) The point of operation would have fallen in a portion of the

bowel which was still comparatively healthy and not irritated by the previous presence in it for several days of a large calculus.

(3) It might even have been possible to explore the fourth portion of the colon and to remove the ingesta there present together with the remaining calculi. This is an important point, as it will be seen that even if the animal had lived a second fatal attack might have shortly supervened in consequence of displacement of another calculus.

CLINICAL NOTES.

By]. PENBERTHY, F.R.C.V.S., Royal Veterinary College, London.

TYMPANITES OF THE GUTTURAL POUCHES.

THE following case of this somewhat uncommon abnormality occurred in the practice of Mr R. W. Knowles, M.R.C.V.S., of Wisbeach. It is the second which has come within my experience, and the condition has not been frequently noticed in English Veterinary literature.

Early in April last Mr Knowles was called to see a foal which soon after birth was observed to have large diffuse swellings in the parotid regions. Pus in the guttural pouches was suspected, and one of these was punctured with a lancet. Instead of pus there was only an escape of air or gas. The swellings immediately disappeared from each side, and the breathing, which had been stertorous, soon became quiet. In course of half an hour the distension was great as ever. After this the swelling sometimes suddenly disappeared without interference. This went on for about six weeks, during which the general condition of the animal appeared good, though at times the milk returned through the nostrils.

On the 20th of May the foal seemed much distressed, and the guttural pouches were tapped on each side, when a considerable quantity of fcetid pus was discharged and the swelling entirely dis­appeared. In a short time, however, the distension again became established and stertor more marked. Operation was repeated again and again, and attempts made to establish an exit, but the breathing became more and more difficult and the foal was found dead of asphyxia. Unfortunately, no post-mortem examination was made, and no light can be thrown on the anatomical condition which gave rise to the abnormality. The spontaneous decline of the swelling rather indicates some uncommon condition of the mucous membrane of the Eustachian tubes, preventing the egress of air, but which was not constantly in action.

NUX VOMICA POISONING IN HORSES.

I am indebted to Mr Sherren, veterinary student, for the clinical history of the following cases, which I deem worthy of record, as