DISEASES 01 THE LIVER. 241 



DISEASES OF THE LIVER. 



A veterinary practice has improved, much light has been thrown on the diseases 

 af the liver not perhaps on the more advanced and fatal stages ; out giving us the 

 promise that, in process of time, they may be detected at an earlier period, and in a 

 more manageable state. 



a surgical operation ; and Mr. Spooner kindly offered to be present, and to give me his valu- 

 able assistance. 



' On the 24th, our patient was considered to have had sufficient preparatory treatment, and 

 she was operated upon. We availed ourselves of the opportunity ot putting to the test that 

 which some among us had doubted, and others had positively denied, but which had always 

 bepn maintained by our talented chemical lecturer the power of opium to lull the sensation 

 of pain in the horse. We therefore gave her two ounces and a half of the tincture of opium, 

 shortly before she was led from the box to the operating house, and the power of the drug was 

 evident through the whole of the operation. 



" After a careful examination, externally, as well as per rectum, in order to ascertain the 

 situation and probable size of the laceration of the muscles, an incision was carefully made 

 through the integument into the sac, in a line with the inferior border of the cartilage of the 

 false ribs, which incision was about seven inches in length. This, as we had hoped, proved 

 to be directly upon the aperture in the muscular parietes of the abdomen. The intestine? 

 were exposed ; and, after having sufficiently dilated the opening to permit the introduction of 

 the hand, they were quickly returned, portion after portion, into their proper cavity, together 

 with a part of the omentum, which we found somewhat annoying, it being frequently forcer 

 back again through the laceration. 



"At times, it required the exertion of our united strength to prevent the escape of thu 

 intestines, and which was only effected by placing our hands side by side, covering and 

 pressing upon the opening. By these means we succeeded in keeping in the viscera, until 

 we were satisfied that we had placed them all within their proper cavity. At about the cen- 

 tral part of the aperture, we decidedly found the greatest pressure of the intestines to effec! 

 an escape. 



' ' A strong metallic suture of flexible wire was then passed through the edges of the lacera- 

 tion, taking m the peritoneum and portions of the transversalis, rectus, and internal abdomi- 

 nal muscles ; and other sutures, embracing the same parts, were placed at convenient dis- 

 tances, so as nearly to close the aperture. Two sutures of smaller metallic wire, and three 

 of stout silk cord, were then passed through the external abdominal muscles, and their apo- 

 neuroses, which effectually shut up the opening into the abdomen. The integument was 

 then brought together by the interrupted suture, taking care to bring out the ends of the 

 other sutures, and which had been purposely left long, so that in case of supervening inflam- 

 mation, or swelling, they might be readily examined. The whole operation occupied rather 

 'ess than an hour, our poor patient being occasionally refreshed with some warm gruel. 



" The hobbles were now quietly removed, and, after lying a few minutes, she got up, and 

 was placed in a large loose box. A compress and a suspensory bandage, that could be tight- 

 ened at pleasure, were applied to the wound. The pulse was now 84. She was ordered to 

 be watched, and to have some tepid water placed within her reach, but on no account to be 

 disturbed. 



" At 10, P. M., the pulse had sunk to 66. The respiration, which had been much accele- 

 rated, was quieter. She was resting the leg on the side operated upon, but did not appear to 

 be suffering any great pain. Some faeces had passed, and she had taken a small quantity oi 

 bran mash. The parts were well fomented with tepid water, an oleaginous draught was 

 administered, and likewise an enema. 



"25th. The pulse is a little quickened ; the sac which had contained the protruded intes- 

 tine was filled with a serous effusion. I made a dependent orifice in it, ana from three to 

 four pints of fluid er-caped. This much relieved her, and she continued to go on favourably 

 throughout the day. 



"26th. Suppuration now began to be established, and the parts were dressed with the 

 compound tincture of myrrh. 



" 30th. She was enabled to take a little walking exercise ; and on this day some of the 

 integumental sutures came away. 



" Nov. 4th. The sloughing process being now set up, three of the smaller metallic sutures, 

 that had been used to bring the edges of the laceretion together in the external abdominal mus- 

 cles, came away. The parts were minutely examined, and we detected a sinus running 

 towards the mammae, and filled with pus. With some little difficulty it was opened, and a 

 tape passed through it, so as to allow the pus to escape as quickly as it was formed. The 

 appetite was tolerably good, and the pulse ranged from 52 to 56. 



" 6th. The patient was so far recovered that I ventured to turn her into one of the pad- 

 docks for a few hours' exercise, taking care to avoid any exposure to cold, if the weather wa 

 ntorn?y. 



" 1 Ith. An incident occurred which nearly brought our hitherto successful case to a frtal 

 termination. 1 saw her safe about 1, P. M. ; but at two o'clock a messenger came in hvrte 

 lo apprise me lhat she was in a pond at the bottom oi' the oaddock, and fixed in the m ;d 

 21 2F 



