RUMENOTOMY. 585 



The hair over the left flank is now clipped, the skin cleansed, 

 and a strong knife, with its back towards the spine, introduced at 

 the point where the rumen is usually punctured (Hertwig's method). 

 With a drawing movement, the wound is now extended downwards, 

 in oxen for a distance of 4 to 6 inches, in sheep 1| to 4 inches. To 

 prevent food entering the peritoneal sac, it is necessary to avoid 

 making the skin wound smaller than that in the wall of the 

 rumen. 



The operation may also be carried out by first cutting through 

 the skin at the point indicated, dividing the abdominal muscles, 

 and finally incising the peritoneum and wall of the rumen. 



Immediately the rumen is opened gas and fermenting food often 

 rush out with considerable force. To maintain the opening in the 

 rumen in contact with that in the abdominal wall and to prevent 

 food entering the peritoneal cavity, tape sutures are inserted through 

 both rumen and abdominal wall — one on each side and one in the 

 lower angle of the wound ; and as a further precaution against soiling 

 the peritoneum a piece of mackintosh cloth may be placed over 

 the edges at the lower angle of the incision. The tapes are 

 introduced from within outwards, and each carries at its end a 

 tuft of tow, which acts like a knot ; the free ends being drawn, 

 open the wound and hold the rumen in position. Employing the 

 hand or a scoop, two-thirds of the contents of the paunch should 

 be removed. 



The rumen having been partially emptied, stimulants or antiseptics 

 may be poured into the stomach ; then the wound of the rumen 

 is carefully cleansed and closed with silk or catgut, Lembert's sutures 

 being used. These are so placed that no food material can pass 

 between them, and it is very important that the edges of the wound 

 be inverted with the peritoneal surfaces in close apposition. The 

 opening in the abdominal muscles is closed with a continuous suture 

 of strong silk, and that in the skin may be left patent without serious 

 disadvantage. If, however, healing by first intention is desired, the 

 cutaneous wound should also be closed, preferably with quilled- 

 sutures, and afterwards protected with a pitch plaster. Sometimes 

 the wound heals in a few days, but may take weeks and even 

 months, or leave behind a fistula of the rumen. 



Obich recommends suturing the wall of the rumen to that of the 

 abdomen, and leaving the stitches in for seven or eight days. Meyer 

 is opposed to this, and states that it causes tearing. Extensive 

 adhesion of the rumen to the wall of the abdomen certainly interferes 

 with digestion. 



