by Ivor Smith
Having made the decision to operate, I returned to my surgery and collected an enormous pack of sterile instruments, metres of catgut and synthetic nylon suture material, boxes of cotton wool and sterile swabs, bottles of antibiotic, steroids and local anaesthetic, and hoped that I had not forgotten an essential item. I apprehensively removed the polystyrene boxes of Immobilon, Revivon and Narcan from the locked poison cabinet. How I wished at that moment for the anaesthetic equipment my Liverpool lecturers had used at Leahurst not so many years before. Their technique was so smooth and rehearsed: sedation of the patient, anaesthetic induction with thiopentone, tracheal intubation, administration of a halothane/oxygen mixture and controlled anaesthesia until the job was done. The thought of a student observing those operations with a syringe of Narcan in hand, awaiting the opportunity to jab it into the rear end of a lecturer, was rather comical, but this was no time for joking. I loaded everything into the back of my faithful little MG and set off.
Back at the farm, at least the ‘operating theatre’ resembled more than I had been taught to expect under field conditions by the Leahurst teaching staff. A deep layer of clean straw bedding was surrounded by straw bales. One was to be used as my operating table while the others had been arranged in tiers at varying distances, apparently to provide seating accommodation for the small crowd of observers that had arrived during my absence. Nor could I complain about a lack of light – the spotlights on all the farm vehicles were being put to good use. Richard and Judy led their mare to the centre of the operating area. It had become a little theatrical and I was aware of the hushed audience as I felt for the pulsating jugular vein in her neck. She hardly reacted as I pierced the vessel and injected the Immobilon, giving the largest dose I felt she could take in her shocked state. Just moments later she staggered and crumpled to the floor, and as she collapsed fresh blood and serum spurted from the injuries as the uppermost weight of her body put immense pressure on the wounds. I must have spent the next ten minutes and probably longer cleaning and debriding the traumatised area. Bits of metal, glass and gravel seemed to be everywhere embedded in the skin.
The repair eventually began. For the next hour I lay on the straw almost head to head with my patient, removing strips of tattered and torn muscles and dissecting back to tissues I hoped would remain viable despite the trauma of the impact. I had become oblivious to the onlookers until a hushed gasp reminded me they were still watching. I had released a large piece of bone that had been part of her sternum and was better dissected free than left to cause a problem later. I teased it out and remarked to Richard, ‘I’m sure she can manage without this bit’, and placed it on the operating table. Putting the jigsaw back together took a long time. Scores of catgut sutures later resulted in the semblance of an intact-looking brisket. To reach the lower sternal area we manoeuvered her gently on to her back and supported her with more bales. I was glad that so many strong chaps were instantly available. The operation continued into the second hour and was free of unexpected complications.
She was at last back in one piece and I was able to look down on a line of nylon skin sutures that appeared to go on forever. If it was not a work of art I thought it looked pretty good anyway. I was glad to be back on my feet, but I was much more anxious to see my patient back on hers. The decks were cleared of buckets of soiled surgical dressings, drapes, instruments and the surgical bales. The final treatments for the evening were the antibiotics, the steroids, the analgesics and anti-tetanus injections. Satisfied I could do no more I felt again for the jugular, injected the Revivon and waited. The next few minutes seemed an eternity. Then she lifted her head and slowly rose to her feet. Although looking slightly perplexed, she was soon acknowledging the presence of her owners.
I had a last look at her over the stable door before enjoying a well-deserved nightcap with Richard. He now resembled his more relaxed self and the conversation had moved on from horses to Gloucester Rugby. That particular night was a memorable one for many reasons. It was an example of what could be achieved under field conditions with the minimum of equipment and the appropriate training. It took about two months for Moffet to recover completely from the dreadful accident and I saw a great deal of her during this time. Two years later she produced a fine colt foal, Soup Dragon, who represented Britain overseas on four occasions. This was a story with a joyful ending.
Sadly, there were occasions when things did not end so well. Donkeys have been part of farming and commercial life in the Cotswolds for centuries, but in more recent times they have become increasingly popular as companion animals. Approaching maturity, the donkey stallion normally requires castration, and using Immobilon as the anaesthetic of convenience was common throughout the 1960s and ’70s. The donkey responded in a similar manner to the horse with regard to its anaesthetic effect and the immediate response to the Revivon injections was similar, initially. Sometimes, for complex biochemical reasons that I won’t try to explain here because I have never fully understood them myself, the complete anaesthetic recovery suddenly stops and the donkey returns to an unstable wobbly state. This could safely be reversed once more with further treatment with Revivon, and the owner was instructed to check frequently on the donkey in the hours following the operation.
‘Phone if you are concerned in any way’, we said.
You could bet on that call coming at midnight followed by another trip to a stable on the side of a Cotswold hill in the pouring rain. It was not always like that of course, but those are the nights that you remember.
The Smith family at Pirton Court, who are not relatives as far as I am aware, had farmed in Churchdown for several generations. They were dairy farmers in the ’70s and Howard Smith, one of the partners in the family business, was at about this time Master of the Cotswold Hunt. When I first visited the farm and met the family it was difficult to avoid Granddad Smith. He was well into his nineties and, whenever I met him on the farm, the guessing game began.
‘How old do you think I am?’ He would ask.
‘Seventy-four?’ I offered on the first occasion, in case he was actually eighty-three. In fairness the old man did not look any older.
‘No, older than that’, was the usual reply.
‘Okay then, eighty-three?’
‘Getting nearer’, he teased.
And so the game went on until we finally reached his true age. His grandson, Mervin, shared the same family interest in horses. As an amateur jockey he had suffered severe chest injuries from a racing fall in the 1960s, but had bounced back and married Val, one of Gloucester’s prestigious Miss Gloucesters. Mervin owned a young colt that he asked me to cut, ‘cutting’ being a common usage in horse circles for castration. ‘Gelding the horse’ is the expression used in polite company. At the start of this particular operation, the lively colt was referred to by one of the farm’s labourers as one that ‘’bout time ’e ’ad is nackers off’, another frequently used expression in farming circles.
I was happy to carry out the operation no matter how it was described, and armed with the now customary polystyrene boxes of Immobilon, Revivon, Narcan and accompanied by a trusted nurse, I arrived at the farm one crisp April morning. I carried the drugs, the nurse carried the instruments and other equipment and someone else carried the essential bucket of hot water, soap and towel. Mervin led the colt out to the edge of one of the large flat fields at Pirton Court.
I ran through the emergency routine with my nurse and hoped she would not be chatting should I require her immediate attention whilst using the Immobilon. We were further assisted by one of the farmworkers, a local chap who was normally responsible for milking the cows, but, like most fellows at that time who had grown up on a farm, could competently handle most animals. He stood on one side of the colt’s head with Mervin on the other. I raised the jugular vein and inserted a large needle. Venous blood flowed from it and I attached the syringe containing the Immobilon, and injected. With that nerve-racking part over, the operation could begin, everyone
a little less tense now that the dreaded syringe and needle was safely shut away. The patient stumbled to the ground in the expected manner and over the next few minutes became increasingly relaxed as the drug took effect.
The straw bale operating table was draped, the instruments arranged neatly on it, and with the uppermost leg roped, pulled forward and restrained by our helpers, the nurse had the honour of washing, cleaning and sterilising the patient’s scrotum and surrounding area while I scrubbed up. That done to her satisfaction, she peeled a blade from its sterile packet and I clipped it into the scalpel handle. I kneeled beside the hind legs, grasped the lower testicle and incised over it. It took seconds to isolate the organ and to reveal the vascular spermatic cord. My nurse passed me the instrument that had been designed a century before: the emasculator. This particular model, made in brilliantly shiny stainless steel, was very much younger, but probably not a great deal more efficient, than the original version. It was designed to cut through and crush the spermatic cord in one operation, and to ensure this was done efficiently the tool was held in situ for a good three minutes before being removed. That’s a long time when you are holding a long, heavy instrument very still and your arms begin to complain. The cunning vet directs the jaws of the instrument to the correct anatomical position and passes the other draped end to the nurse to hold and tells her to release it when the time is up. The routine was then repeated on the uppermost testicle.
There is a right way and a wrong way of applying the instrument, and if used the wrong way round there will be problems. The business end of the emasculator that cuts and crushes does so in one direction only. Thus, if the crushing takes place below the cutting the result is a severe haemorrhage that can be difficult to control. There are two small wingnuts that are used to dismantle the metal components after use for cleaning and sterilising. To ensure that we never got it wrong, our lecturers in surgery gave us the following memorable advice: ‘Always make sure the nuts are facing the nuts.’
Having checked to ensure there was no unexpected haemorrhage, the surgical site was dusted with an antibiotic powder and the area cleaned of blood. Once the routine anti-tetanus and antibiotic injections had been given, and the restraints on the leg removed, it was time to get the patient back on his feet. I injected the appropriate volume of Revivon and waited for him to scramble to his feet, look around slightly bewildered and then begin to graze quietly. After several minutes nothing happened. There was a slight increase in his respiratory rate and once more I listened to his heart through my stethoscope. I could find no reason for the lack of response. To remove any impression that I was getting concerned I joked, ‘I think he must be too comfortable down there.’ Mervin had attached a long rope lead to his head-collar and was crouching over him. Perhaps our patient became aware of the presence of other horses neighing in nearby fields, and he decided to get up. Not slowly, but like a bat out of hell. Fortunately, Mervin was hanging on to the head-collar, which was just as well, otherwise within minutes that thoroughbred colt would have been in Gloucester. How he hung on I’ll never know – it was a brave effort and at times resembled a bucking bronco; we expected him to leap on to his back and off again, ride bareback, sidesaddle and facing backwards. The entertainment finally ended halfway through the second lap of the huge field as they decelerated to a halt. I was so relieved when it finally stopped and both my client and my patient were still in one piece. They both made a speedy recovery.
We returned to the surgery and, over a cup of strong coffee, were able to see the funny side of an event that could easily have ended in disaster. I swore to my nurse that I would never use that damned anaesthetic on a thoroughbred horse ever again. But I did. It happened not too long after the last escapade.
Mrs Delia Beltram was a very well-known lady in the local horse world, and probably farther afield too. She had numerous horses that were kept in various parts of the county and at any time a disaster requiring veterinary attention was always on the cards, but even with Mrs Beltram’s track record it seemed extremely unlikely that a routine castration of one of them would cause any problems.
This particular young stallion was kept at stables in Sandhurst Lane on the outskirts of Gloucester and, with the boot of my car packed with the all the usual essentials, my nurse and I made our way there early one pleasant spring afternoon. It was around the time of the annual Gold Cup Meeting at Cheltenham, and as we travelled along the northern city bypass scores of race-goers were travelling in the opposite direction. I wished I could have been one of them.
We had been at the stables looking for Mrs Beltram for about twenty minutes when we started to wonder if she had forgotten the arrangement. Then she appeared around the corner of a building pushing a wheelbarrow heaped with horse manure. The next half-hour was spent searching for a suitable site to carry out the operation, borrowing bales of straw from other stable owners, finding a suitable bucket for the essential hot water, soap and towel, and a head-collar that fitted the horse to my satisfaction. Eventually, I stood next to the stallion’s head and steeled myself for administering the Immobilon injection. In my mind I knew that if ever there was going to be a jeans down day, this was going to be it.
Surprisingly, the anaesthesia and the operation went more smoothly than I had dared hope and in no time at all I was preparing to bring the stallion round and get him back on his feet. We removed every conceivable obstacle from the small paddock that I had used as the operating arena. I injected the Revivon. I had no idea about this horse’s pedigree, but I would bet his ancestors had won the Derby and the Grand National. He rose to his feet in a flash but unfortunately Mrs Beltram was no Mervin, and after two laps of the paddock he cleared the low fence, charged at the boundary hedge, jumped and cleared it with ease and disappeared up Sandhurst Lane. I had never lost a patient in this manner before. I suspected that the owner expected me to go and find him.
He had a head start but we knew in which direction he was going. My nurse dived into the car next to me and we tore off, closely followed by Mrs Beltram in her banger. Not for the first time in my professional career I felt I had recreated a scene from the Keystone Kops. We soon reached the top of the lane and the busy junction with St Oswald’s Road and its dual carriageway. There was no sign of the stallion, but fortunately there were numerous pedestrians around. Anxiously I asked one of them:
‘Have you seen a horse in the last few minutes?’ The first responder looked at us as though we were daft and replied, ‘No’. The second asked what the rider looked like and what colour the horse was. I was about to say that it was a riderless horse and the prominent colour by now would be a dark red patch somewhere in the region of the hind legs, when a third person approached.
‘Are you looking for a horse?’ the lady asked.
‘Yes!’
‘Oh, I’m so glad. I saw one a short while ago running towards the Tewkesbury road.’
There was hardly time to thank her as we sped off again. At least now we knew that our patient was probably somewhere between Gloucester and Tewkesbury, but at the rate he was travelling he could have been halfway to Worcester by now.
In the distance we could hear the sound of an emergency services’ siren. I glanced at my nurse and, half-whispering through a dry mouth, queried, ‘Do you reckon that could be anything to do with us?’ She didn’t reply but I suspected we were both envisaging a line of dented cars trying to dodge a runaway horse. A few miles down the road we neared a smallholding with stables that I knew well. Nearby were the blue flashing lights of a police car that had arrived shortly before us. I braked sharply and swerved into the yard. As I got out of the car I was greeted by a policeman, who asked, ‘Does this horse belong to you, sir?’ Perhaps he had noticed that I was still covered in congealed blood and deduced that I may in some way be related to the horse.
‘Well, he’s not exactly mine, officer’, I replied, unconvincingly.
I was praying that Mrs Beltram’s old jalopy had not broken down, as it of
ten did, and that she would soon arrive to claim her horse. I was about to explain to the officer that I had been operating on the horse when he decided to run away, when Mrs Beltram pulled into the yard and twice loudly sounded her horn. My prayers were answered and I was spared having to offer my explanation to the police. Delia, as usual, did all the talking, but did not tell him who I was. The officer eventually turned to me and commented:
‘It looks as though the horse is injured, sir, I think we should call a vet.’
I considered explaining to him that, well, actually I was a vet and I was operating on the patient when suddenly he — but it all sounded so unbelievable that it was far simpler to say, ‘Thank you, officer, I’ll take over and do all that is necessary.’ He turned off the blue flashing lights and drove off, probably wondering if he was suffering from overwork.
The next day I carried out a post-operative check on my patient, something that was not normally necessary but on this occasion, as it was about six miles from where the operation had started, I felt that there were mitigating circumstances. He showed no adverse signs following his immediate post-operative physiotherapy, but for my own wellbeing as much as his, I would not recommend it.
I am sure the reader will be glad to know that Immobillon is not commonly used today. Restraining wild animals via a dart gun is its main use. It does not take much stretch of the imagination to appreciate that there are other uses for a drug mix that can be used for other purposes. Its use as a means of quickly terminating life is an obvious one. Not surprisingly, Immobilon is at times used today for carrying out euthanasia. Once again it has to be described as something that can be used when nothing better is available.
