Читать книгу Special Report on Diseases of Cattle - Lowe - Страница 45

First prepare a bandage (must be of strong material), about 10 yards long and between 3 and 4 inches broad, and a flexible and solid piece of pasteboard adapted in size to the surface of the hernia. The protruding organ must then be replaced in the abdomen and maintained in that position during the application of the bandage. This being done, a layer of melted pitch and turpentine is quickly spread on the skin covering the seat of the hernia, so as to extend somewhat beyond that space. This adhesive layer is then covered with a layer of fine tow, then a new layer of pitch and turpentine is spread on the tow, and the piece of pasteboard is applied on the layer of pitch, its outer surface being covered with the same preparation. Lastly, the bandage, adhering to the piece of pasteboard, to the skin, and to the different turns which it makes around the body, is carefully applied so as to form an immovable, rigid, and solid bandage, which will retain the hernia long enough for the wound in the abdominal walls to heal permanently.

If the hernia is old and small it may be treated by injecting a strong solution of common salt about the edges of the tear. This causes swelling and inflammation, which, respectively, forces the protruded organ back and closes the opening. There is some risk attached to this method of treatment.

In small, old, ventral hernias the method of compressing and sloughing off the skin has been used successfully. If the hernia is large a radical operation will be necessary, and this is also true when the symptoms indicate that a hernia is strangulated. This operation is performed by cutting down on the hernia, restoring the organ to the abdominal cavity, and then closing the wound with two sets of stitches; the inner stitches, in the muscular wall, should be made with catgut and the outer stitches, in the skin, may be made with silk or silver wire. The strictest surgical cleanliness must be observed. Bleeding vessels should be tied. Then a compress composed of ten or twelve folds of cloth must be placed smoothly over the seat of injury and a bandage applied around the body, the two ends being fastened at the back. In the smaller kinds of hernia, nitric acid may sometimes be applied with success. This treatment should not be applied until the swelling and inflammation attending the appearance of the hernia have subsided; then, the contents of the hernia having been returned, the surface of skin corresponding to it is sponged over with a solution composed of 1 part of nitric acid to 2 of water. This treatment acts by exciting considerable inflammation, which has the effect of causing swelling, and thus frequently closing the hernial opening and preventing the contents of the sac from returning. A second application should not be made until the inflammation excited by the first has subsided. In what is termed spontaneous hernia it is useless to apply any kind of treatment.

Umbilical hernia.—The umbilicus, or navel, is the aperture through which the blood vessels pass from the mother to the fetus, and naturally the sides of this aperture ought to adhere or unite after birth. In very young animals, and sometimes in newborn calves, this aperture in the abdominal muscles remains open and a part of the bowel or a portion of the mesentery may slip through the opening, constituting what is called umbilical hernia. The wall of the sac is formed by the skin, which is covered on the inner surface by a layer of cellular tissue, and within this there is sometimes, but not always, a layer of peritoneum. The contents of the hernia may be formed by a part of the bowel, by a portion of the peritoneum, or may contain portions of both peritoneum and bowel. When the sac contains only the peritoneum it has a doughy feel, but when it is formed by a portion of the bowel it is more elastic on pressure.

Causes.—In the new-born animal the opening of the navel is generally large, and may sometimes give way to the pressure of the bowel on account of the weak and relaxed condition of the abdominal muscles. This defective and abnormal condition of the umbilicus is frequently hereditary. It may be occasioned by roughly pulling away the umbilical cord; through kicks or blows on the belly; through any severe straining by which the sides of the navel are stretched apart. We may mention in this connection that it is best in new-born calves to tie the umbilical cord tightly about 2 inches from the navel, and then to leave it alone, when in most cases it will drop off in a few days, leaving the navel closed.

Treatment.—It is well to bear in mind that many, and especially the smaller, umbilical hernias heal spontaneously; that is, nature effects a cure. As the animal gets older the abdominal muscles get stronger and possess more power of resistance to pressure, the bowels become larger and do not pass so readily through a small opening, so that from a combination of causes there is a gradual growing together or adhesion of the sides of the navel. In cases of umbilical hernia in which there are no indications that a spontaneous cure will take place, the calf should be laid on its back; immediately on this being done the hernia will often disappear into the abdomen. If it does not, its reduction may be brought about by gentle handling, endeavoring, if need be, to empty the organs forming the hernia before returning them into the abdomen. After the hernia has been returned, the hair should be clipped from the skin covering it and a compress composed of 10 or 12 folds of linen or cotton should be applied, first smearing the skin with pitch and then a bandage about 3 inches wide should be passed round the body so as to retain the compress in position. The lower part of the compress should be smeared with pitch, and also those portions of the bandage which pass over it, so as to keep it solid and prevent it from shifting. In some cases it will be found that the contents of the sac can not be returned into the abdomen, and this generally arises from the fact that some part of the contents of the sac has grown to or become adherent to the edges of the umbilical opening. In such a case the skin must be carefully laid open in the long direction, the adhesions of the protruding organs carefully separated from the umbilicus, and after the protruding parts have been returned into the abdomen, the sides of the umbilicus must be freshened if necessary by paring, and then the edges of the opening brought together by catgut stitches; the wound in the skin must then also be brought together by stitches. The wound must be carefully dressed every day and a bandage passed round the body so as to cover and protect the part operated on.

In small hernias nitric acid has been used successfully in the same manner as has been described in the treatment of ventral hernia. Sulphuric acid has also been used for a similar purpose, diluting it to the extent of 1 part of acid to 3 or 5 of water. In thin-skinned animals the weaker preparations ought to be preferred, and caution must be exercised in using such preparations so as not to destroy the tissues on which they are applied.

Another method of treatment is, after the contents of the sac have been returned into the abdomen, to tie a piece of strong waxed cord round the pendulous portion which formed the outer covering of the hernia. The string is apt to slacken after two or three days, when a new piece of cord should be applied above the first one. The constriction of the skin sets up inflammation, which generally extends to the umbilicus and causes the edges to adhere together, and by the time the portion of skin below the ligature has lost its vitality and dropped off, the umbilicus is closed and there is no danger of the abdominal organs protruding through it. This is what takes place when this method has a favorable result, though if the umbilicus does not become adherent and the skin sloughs, the bowels will protrude through the opening.

Gut-tie (peritoneal hernia).—In peritoneal hernia of the ox a loop or knuckle of intestine enters from the abdomen into a rent in that part of the peritoneum which is situated at the margin of the hip bone or it passes under the remains of the spermatic cord, the end of which may be grown fast to the inner inguinal ring. The onward pressure of the bowel, as well as the occasional turning of the latter round the spermatic cord, is the cause of the cord exercising considerable pressure on the bowel, which occasions irritation, obstructs the passage of excrement, and excites inflammation, which terminates in gangrene and death.

The rent in the peritoneum is situated at the upper and front part of the pelvis, nearer to the sacrum than the pubes.

Causes.—Among the causes of peritoneal hernia considerable importance is attached to a method of castration which is practiced in certain districts, viz, the tearing or rupturing of the spermatic cord by main force instead of dividing it at a proper distance above the testicle in a surgical manner. After this violent and rough method of operating, the cord retracts into the abdomen and its stump becomes adherent to some part of the peritoneum, or it may wind around the bowel and then the stump becomes adherent, so that strangulation of the bowel results. The rough dragging on the cord may also cause a tear in the peritoneum, the result of which need not be described. The severe exertion of ascending hills and mountains, drawing heavy loads, or the straining which oxen undergo while fighting each other may also give rise to peritoneal hernia.

Symptoms.—The ox suddenly becomes very restless, stamps with his feet, moves backward and forward, hurriedly lies down, rises, moves his tail uneasily, and kicks at his belly with the foot of the affected side. The pain evinced may diminish but soon returns again. In the early stage there are frequent passages of dung, but after the lapse of 18 or 24 hours this ceases, the bowel apparently being emptied to the point of strangulation, and the passages now consist only of a little mucus mixed with blood. When injections are given at this time the water passes out of the bowel without even being colored. The animal lies down on the side where the hernia exists and stretches out his hind feet in a backward direction. These two particular symptoms serve to distinguish this affection from enteritis and invagination of the bowel. As time passes the animal becomes quieter, but this cessation of pain may indicate that gangrene of the bowel has set in, and may, therefore, under certain circumstances, be considered a precursor of death. Gangrene may take place in from four to six days, when perforation of the bowel may occur and death result in a short time.

Treatment—In the first place the ox should be examined by passing the oiled hand and arm into the rectum; the hand should be passed along the margin of the pelvis, beginning at the sacrum and continuing downward toward the inguinal ring, when a soft, painful swelling will be felt, which may vary from the size of an apple to that of the two fists. This swelling will be felt to be tightly compressed by the spermatic cord. It very rarely happens that there is any similar swelling on the left side, though in such cases it is best to make a thorough examination. The bowel has sometimes been released from its position by driving the ox down a hill; by causing him to jump from a height of 2 feet to the ground; the expedient of trotting him also has been resorted to with the hope that the jolting movement might bring about a release of the bowel. If the simple expedients mentioned have been tried and failed, then the hand being passed into the rectum should be pressed gently on the swelling in an upward and forward direction, so as to endeavor to push the imprisoned portion of the bowel back into the abdomen. While this is being done the ox's hind feet should stand on higher ground than the front, so as to favor the slipping out of the bowel by its own weight, and at the same time an assistant should squeeze the animal's loins, so as to cause it to bend downward and so relax the band formed by the spermatic cord. If the imprisoned portion of gut is freed, which may be ascertained by the disappearance of the swelling, the usual sounds produced by the bowels moving in the abdomen will be heard, and in a few hours the feces and urine will be passed as usual. If the means mentioned fail to release the imprisoned portion of the gut, then an incision about 4 inches long must be made in the right flank in a downward direction, the hand introduced into the abdomen, the situation and condition of swelling exactly ascertained, and then a probe-pointed knife inserted between the imprisoned bowel and band compressing it, and turned outward against the band, the latter being then cautiously divided and the imprisoned gut allowed to escape, or, if necessary, the bowel should be drawn gently from its position into the abdomen. The wound in the flank must be brought together in the same way as in the case of the wound made in operating for impaction of the rumen.