Читать книгу Special Report on Diseases of the Horse - Charles B. Michener - Страница 58

There are several kinds or hernias that require notice, not all of which, however, produce serious symptoms or results. Abdominal hernias, or ruptures, are divided into reducible, irreducible, and strangulated, according to condition; and into inguinal, scrotal, ventral, umbilical, and diaphragmatic, according to their situation. A hernia is reducible when the displaced organ can be returned to its natural location. It consists of a soft swelling, without heat, pain, or any uneasiness, generally larger on full feed, and decreases in size as the bowels become empty. An irreducible hernia is one that can not be returned into the abdomen, and yet does not cause any pain or uneasiness. Strangulated hernia is one in which the contents of the sac are greatly distended, or when from pressure upon the blood vessels of the imprisoned portion the venous circulation is checked or stopped, thereby causing congestion, swelling, inflammation, and, if not relieved, gangrene of the part and death of the animal. According to the time or mode of origin, hernias may be congenital or acquired.

Congenital scrotal hernia.—Not a few foals are noticed from birth to have an enlarged scrotum, which gradually increases in size until about the sixth month, sometimes longer. Sometimes the scrotum of a six-months-old colt is as large as that of an adult stallion, and operative treatment is considered. This is unnecessary in the great majority of cases, as the enlargement often disappears by the time the colt has reached his second year. Any interference, medicinal or surgical, is worse than useless. If the intestine contained within the scrotum should at any time become strangulated, it must then be treated the same as in an adult horse.

Scrotal hernia is caused by dilatation of the sheath of the testicle, combined with relaxation of the fibrous tissues surrounding the inguinal ring, thus allowing the intestine to descend to the scrotum. At first this is intermittent, appearing during work and returning when the horse is at rest. For a long time this form of hernia may not cause the least uneasiness or distress. In course of time, however, the imprisoned gut becomes filled with feces, its return into the abdominal cavity is prevented, and it becomes strangulated. While the gut is thus filling the horse often appears dull, is disinclined to move, appetite is impaired, and there is rumbling and obstruction of the bowels. Colicky symptoms now supervene. Strangulation and its consequent train of symptoms do not always follow in scrotal hernia, for often horses have this condition for years without suffering inconvenience.

Inguinal hernia is but an incomplete scrotal hernia, and, like the latter, may exist and cause no signs of distress, or, again, it may become strangulated and cause death. Inguinal hernia is seen mostly in stallions, next in geldings, and very rarely in the mare. Bearing in mind that scrotal hernia is seen only in entire horses, we may proceed to detail the symptoms of strangulated, inguinal, and scrotal hernia at the same time. When, during the existence of colicky symptoms, we find a horse kicking with his hind feet while standing or lying upon his back, we should look to the inguinal region and scrotum. If scrotal hernia exists, the scrotum will be enlarged and lobulated; by pressure we may force a portion of the contents of the gut back into the abdomen, eliciting a gurgling sound. If we take a gentle but firm hold upon the enlarged scrotum and then have an assistant cause the horse to cough, the swelling will be felt to expand and as quickly contract again.

The history of these cases will materially aid us, as the owner can often assure us of preceding attacks of "colic," more or less severe, that have been instantaneously relieved in some (to him) unaccountable manner. The colicky symptoms of these hernias are not diagnostic, but, probably, more closely resemble those of enteritis than any other bowel diseases. In many cases the diagnosis can be made only by a veterinarian, when he has recourse to a rectal examination; the bowels can here be felt entering the internal abdominal ring.

Treatment of inguinal hernia.—If the reader is sure of the existence of hernia, he should secure the horse upon its back, and, with a hand in the rectum, endeavor to catch hold of the wandering bowel and pull it gently back into the cavity of the abdomen. Pressure should be made upon the scrotum during this time. If this fails, a veterinarian must be called to reduce the hernia by means of incising the inguinal ring, replacing the intestines, and to castrate, using clamps and performing the "covered operation."

Ventral hernia.—In this form of hernia the protrusion is through some accidental opening or rupture of the abdominal wall. It may occur at any part of the belly except at the umbilicus, and is caused by kicks, blows, hooks, severe jumping or pulling, etc. Ventral hernia is most common in pregnant mares, and is here due to the weight of the fetus or to some degenerative changes taking place in the abdominal coats. It is recognized by the appearance of a swelling, at the base of which can be felt the opening or rent in the abdominal tunics, and from the fact that the swelling containing the intestines can be made to disappear when the animal is placed in a favorable position.

Treatment of ventral hernia.—In many instances there is no occasion for treatment, and again, where the hernial sac is extensive, treatment is of no avail. If the hernia is small, a cure may be attempted by the methods to be described in treating of umbilical hernia. If one is fortunate enough to be present when the hernia occurs, and particularly if it is not too large, he may, by the proper application of a pad and broad bandage, effect a perfect cure.

Umbilical hernia is the passing of any portion of the bowel or omentum ("caul") through the navel, forming a "tumor" at this point. This is often congenital in our animals, and is due to the imperfect closure of the umbilicus and to the position of the body. Many cases of umbilical hernia, like inguinal and scrotal of the congenital kind, disappear entirely by the time the animal reaches its second or third year. Advancing age favors cure in these cases from the fact that the omentum (swinging support of the bowels) is proportionally shorter in adults than in foals, thus lifting the intestines out of the hernial sac and allowing the opening in the walls to close. Probably one of the most frequent causes of umbilical hernia in foals is the practice of keeping them too long from their dams, causing them to fret and worry, and to neigh, or cry, by the hour. The contraction of the abdominal muscles and pressure of the intestines during neighing seem to open the umbilicus and induce hernia. Accidents may cause umbilical hernia in adults in the same manner as ventral hernia is produced, though this is very rare.

Treatment of umbilical hernia.—In the treatment of umbilical hernia it should be remembered that congenital hernias are often removed with age, but probably congenital umbilical hernias less frequently than others. Among the many plans of treatment are to be mentioned the application of a pad over the tumor, the pad being held in place by a broad, tight bandage placed around the animal's body. The chief objection to this is the difficulty in keeping the pad in its place. Blisters are often applied over the swelling, and, as the skin hardens and contracts by the formation of scabs, an artificial bandage or pressure is produced that at times is successful. Another treatment that has gained considerable repute of late years consists in first clipping off the hair over the swelling. Nitric acid is then applied with a small brush, using only enough to moisten the skin. This sets up a deep-seated, adhesive inflammation, which, in very many cases, closes the opening in the navel. Still another plan is to inject a solution of common salt by means of the hypodermic syringe at three or four points about the base of the swelling. This acts in the same manner as the preceding, but may cause serious injury if the syringe or solution is not sterile.

Others, again, after keeping the animal fasting for a few hours, cast and secure it upon its back; the bowel is then carefully returned into the abdomen. The skin over the opening is pinched up and one or two skewers are run through the skin from side to side as close as possible to the umbilical opening. These skewers are kept in place by passing a cord around the skin between them and the abdomen and securely tying it. Great care must be taken not to draw these cords too tight, as this would cause a speedy slough of the skin, the intestines would extrude, and death result. If properly applied, an adhesion is established between the skin and the umbilicus, which effectually closes the orifice. Special clamps are provided for taking up the fold of the skin covering the hernial sac and holding it until the adhesion is formed.

Diaphragmatic hernia.—This consists of the passage of any of the abdominal viscera through a rent in the diaphragm (midriff) into the cavity of the thorax. It is a rather rare accident, and one often impossible to diagnose during life. Colicky symptoms, accompanied with great difficulty in breathing, and the peculiar position so often assumed (that of sitting upon the haunches), are somewhat characteristic of this trouble, though these symptoms, as we have already seen, may be present during diseases of the stomach or anterior portion of the bowels. Even could we diagnose with certainty this form of hernia, there is little or nothing that can be done. Leading the horse up a very steep gangway or causing him to rear up may possibly cause the hernial portion to return to its natural position. This is not enough, however; it must be kept there.