LIGATION. 605 



exists, the greater the difficulty and the less the chance of success, 

 though even in these cases cure is occasionally effected. Larsen 

 immediately reduced a prolapse, about 32 inches in length, which 

 occurred during the castration of a horse, caused an assistant to 

 keep the anus closed, and completed the interrupted operation. 

 When the animal rose, the prolapse had disappeared and did not recur. 

 In reposition care must be taken simultaneously to reduce the 

 invagination. For this purpose it is not sufficient to thrust the 

 protruded bowel through the anus, but the extreme end must be 

 carried forward at least twice the length of the prolapsed part. In 

 large animals this is best effected with the arm, in the smaller (dogs) 

 by means of a tallow candle. Stockfleth used a stick ; the end 

 covered with tow and rubbed with fat. Infusions of warm water 

 injected whilst the hind-quarters are raised may also assist reduction. 

 Horses should be cast and anaesthetised, and after reduction has been 

 effected, they should be kept down for 5 or 6 hours and, if necessary, 

 given a narcotic. When the animals strain violently, narcosis must 

 be resorted to, for which purpose chloral or morphine is very useful. 

 The greatest obstacle to reposition and permanent cure lies in severe 

 straining. Large animals should, therefore, be watched for some 

 hours, and if it sets in, pressure should be exerted over the loins. 

 Mild clysters and the application of cold combat inflammatory 

 symptoms about the anus and rectum. 



To ensure retention, the anus may be sutured. Strebel inserts 

 two strips of leather in the neighbourhood of the ischial protuberances, 

 and crosses them over the anus ; by applying tow or sponges below 

 these the intestine is held back ; in horses, the tail has been fastened 

 so far forward with straps as to exercise pressure on the anus. Andre's 

 " tobacco-pouch " suture has been strongly recommended. This 

 is a continuous suture, made by passing a narrow tape in and out 

 under the skin, and working in a circle ; it should be left in position 

 for twenty-four to thirty-six hours. To allow of defsecation the 

 tape is, when necessary, loosened, and afterwards again drawn tight 

 and knotted. It is clearly not to be employed in cases of invagination 

 where its use would be irrational. Cocaine suppositories may be 

 tried in severe straining. 



When prolapse with invagination has already existed for several 

 days, reposition becomes impossible, nor should it be attempted 

 if structural change has occurred. Nothing, then, remains but to 

 remove the protruded portion, for which purpose one of the following 

 methods may be employed, viz. : — 



(1.) The use of irritants. Jessen powders the protruded parts 



