Rumination - 6

HORSE SENSE”: A PATH FINDER FOR A PROFESSIONAL*

*AN EXPERIENCE WITH A PACHYDERM*
Horse-sense, a robust and plain thinking resulting in fruitful action in the face of adversaries to achieve the purpose, is perhaps a special endowment of human brain. A professional should rise up to an occasion against odds by stretching his imagination, judicious application of wisdom and common- sense. A cool head and warm feet are the essential pre requisites. A wise person will learn from other’s experience, but becomes wiser from his own:
Nostalgia and nostalgic memories either of happy note or otherwise prepares the mind to face any challenge of current concern.
Horse-sense should fill the memory, rule the heart and guide the feet. Nostalgia is a mine of information, a paradise of glory and a river of pleasure. To be wise apply it, to be safe believe it and to be successful practise it. As a veterinarian with five decades of experience, I had faced many a situations of horse sense and wish to share with you all one such incident.

I was called to examine and treat a temple male baby elephant a few years ago , as it was reported to be sick since 3 weeks. The anamnestic data at the time of physical examination revealed that he had not passed faeces and also anorectic since 3 days.

A thorough physical and clinical examination of the case was made, and I decided to administer liquid paraffin orally. But the animal was not inclined to drink the liquid paraffin when offered. The animal, however, evinced interest in drinking water. Unfortunately the mahout was reluctant and non-cooperative in providing drinking water to the elephant for some personal reasons. It immediately struck to my mind, that water was deliberately withheld by mahout and hence I kept the mahout out of the sight of the animal with the help of temple authorities. Then I asked to bring two identical metal pots, one with full of water and another with liquid paraffin.


I requested the mahout’s wife to order the elephant to drink. I knew very well that the elephant would obey her orders since she was assisting her husband daily in the management of the elephant. I asked her to keep the water pot a few yards away from the elephant but with in its sight and then to order to drink the water. When the water pot was sighted the animal made all efforts to drink the water. Since its hind limbs were tied to the temple pillar it could not succeed in its attempt. After a few attempts, the water pot was kept within the reach of the animal and was suddenly withdrawn when the animal attempted to reach it. By this act its eager to drink the water got heightened, but not allowed to drink. This set in a bad temper in the pachyderm.
Taking advantage of this psychic crave, I asked the mahout’s wife to keep the other identical pot with liquid paraffin within the reach of the elephant. When she obeyed my instruction with all its eagerness; the elephant drank off the liquid paraffin fully in one attempt. However, moments later realizing that he had been tricked he trampled the pot out of the shape.
When he settled down, water was provided ad libitum to drink. The animal quenched its thirst. He passed faeces a few hours later. He was coaxed to eat sugarcane, banana fruits, and coconut kernels with jaggery. This helped me in proceeding further with my treatment.


Prevalence of horse sense on the part of a professional, in winning over the confidence of the Pachyderm, I, opine is a pathfinder for further professional assistance.

Rumination - 5

UREA POISONING

In 1959, during the month of December, by 8.00 p.m., I was returning to my residence on my bicycle after dinner at a hotel. From a distance I noticed a Fiat car in front of my residence. Before, I got down from my bicycle; I noticed some busy activities in the front portion of the building from where the veterinary dispensary was functioning. I heard a loud conversation of night duty attendant with somebody. Before, I alighted from my bicycle, the driver of the stationed car shouted “Doctor has come”. A well dressed young man and my attendant dashed towards me from the dispensary building.

“Doctor, very urgent. Some of our best cows died all of a sudden this evening. I have come with my car. Please come to my village and save my other ailing animals” the young man pleaded plaintively.

I just turned around and glanced at my attendant who had served in that station for 40 years (including his “boy service”).

“Sir, everything ready. This gentleman is the son of a prominent, big landowner of this taluk who is also a regular client to our dispensary. His village is 20 miles away from here. Please change your dress. We can go and return by night itself” appealed the elderly attendant.

With a reluctant smile, I moved into the residential portion of the building. Though I wanted to help the worried client, my physical tiredness due to the day long strenuous work in that taluk headquarters dispensary, made me think twice before accepting the urgent call to an interior village that too in that cold weather.

My diplomatic attendant who followed me wheedled. “Sir, his father is a very decent, educated man who owns more than 300 animals. He is a strong supporter of our dispensary. We must go immediately and attend the ailing animals”.

Though physically tired mentally decided to attend the case since no other veterinarian was available anywhere in that taluk at that time. I changed my dress and proceeded immediately to that village with the young gentleman.

During our car journey, I enquired the young man. “Do you know anything about the illness of the animals”.

“Yes Sir. My father is in the habit of listening to the farmers’ programmes of All India Radio daily evening. Today, AIR broadcast a talk on the benefits of feeding urea to cattle. It was time to feed concentrates to all the animals in our farm. After hearing that talk, he mixed a handful of urea which was stored in our godown for agricultural purpose in the feed trough of every animal. Within half an hour 3 high yielding Sindhi cross-bred cows which were fed at first, fell down with colicky pain one by one and died. Immediately all the feed troughs were removed to prevent the animals from consuming the urea-mixed concentrates. However, a few animals were restless with salivation. Immediately I rushed to you sir, for your help”.

After hearing the brief history of the case, I was worrying about the approach of treating such poisonous cases. During that time, the words of “Rumen Medicine” and “Urea Toxicity” were unheard of by the veterinarians in this country. So, I decided to treat the ailing animals, as per the general principles to be followed to treat the poisoning cases.

At 9.00 p.m., we reached the village. The owner was surrounded by his workers with an expression of utter sorrow and disappointment at the entrance of the cattle shed. He was visibly upset and could not talk to me freely. “This is my fate. Even though my old servant resisted to feed urea, I, myself mixed urea in feed troughs of all the animals, with a pride that I am the first farmer in this district to adopt all the newer scientific developments in the field of animal husbandry practice. Unfortunately, my best cows died before I could do even first aid. I have arranged to drench white of egg stirred in milk to all the ailing animals as first aid. Please save the other animals” he implored.

I examined all the eleven ailing animals. Except Cal. BoroGluconas injection, no other drug was available in my armamentarium at that time. All the ailing animals were given 150 – 200 ml of calciumborogluconas by i/v. In those days, glucose injection was available only as 20 ml ampules even for medical practitioners. That too was not available then in that village. So, I collected tender coconut water from tender coconuts which were available in plenty in that farm. I injected 450 ml by i/v to every animal. To neutralize the alkali I administered lime juice extracted from 50 lime fruits to each ailing animal orally. Then I returned to headquarters by 4.00 a.m. and prescribed 4 tablets of “Strinacin”(combination of Streptomycin with Sulpha) for oral administration to each animal. The owner purchased the tablets in medical shop at taluk headquarters and administered in the morning. When I visited the farm in the evening all the animals had recovered.

I advised the owner, not to adopt any newer techniques/findings/ suggestions, either by reading journals or by hearing radio news, with over enthusiasm, better to contact his veterinarian and discuss with him in detail all the pros and cons of newer suggestions and then adopt the newer technology, if found suited to him. I also pointed out him that the administration of white of egg the urea poisoning would only aggravate the condition. It is quite risky to use urea as feed. If anybody wants to use it, he / she must have good understanding of its utilization and limitations. If not, the feeding of urea will lead to heavy loss to farmers due to the toxicity.

Rumination - 4

“Bony Theory and Flesh of Practice”


Recently, sensational news was published in the news papers about a sanitary worker of a hospital in the state of Madhya Pradesh. The sanitary worker removed a tumour successfully from the neck of a child before the surgeon entered the theatre. Though it is considered as an improper as well as a criminal act, we have to appreciate his surgical skill which he had inculcated during his service by assisting many surgeons in the theatre.

I too had such an experience during my early days of service. Within 4 months of service in a rural minor veterinary dispensary, I was transferred to a taluk headquarters dispensary during the 3rd week of December, 1959. The dispensary was located in a rented building with facility for residential quarters to veterinary asst.sugeon. In the midnight of the second day of my joining duty, the night duty attendant woke me up and informed that a farmer had come in a taxi from a village 10 miles away to pick me up to his village to attend his animal suffering from dystokia. But, I was hesitant to move out during that winter night since I had a fear that I could not return to my morning duty (6 am) in time after attending the dystokia. However, the farmer besought me to help him by attending his animal which was struggling to deliver the foetus since that evening. My attendant also persuaded me to help the farmer. Then, my attendant and myself proceeded to that village with necessary kit gathered by my senior and experienced attendant.
During my 10 miles journey in the taxi in that cold night I was recollecting from my memory the “Bovine dystokia” taught to me in the college. There was no separate Dept. of O&G during my college days. The theory of Obstetrics was taught by surgery teachers along with surgery. We did not have an opportunity to handle “Bovine dystokia” due to want of such cases in the cattle ward of the college hospital. Though I had theoretical knowledge I had no practical training to handle bovine dystokia in field conditions. Furthur, it was my first dystokia case in my professional career. So, I was in jittery mood and also I was mentally preparing me to face the situation.

My musing was suddenly interrupted by stoppage of taxi. Within 30 minutes of travel, the taxi drew up near a vacant field where a man was standing with a hurricane light. The farmer informed that the animal was lying down nearly 2000 yards away in the open field. In that dark night we reached the site with the help of a lantern. I could see nothing outside the circle of flickering lantern which the farmer held before me. When I tried to physically examine the cow I was shocked. Both the fore limbs were protruding out of vagina and they were highly oedematous. The foetus was dead. There was no space even to introduce my little finger. When I enquired the other man guarding the animal he revealed the truth that the poor animal was suffering for the past 2 days and many quacks around the village had tried to remove the calf merely by pulling the fore limbs not knowing that will only worsen the condition. Unfortunately, even to-day most of the rural farmers approach the vets only after approaching the locally available quacks who instead of mitigate only complicate the most instances.

Recollecting my theoretical knowledge I decided to deliver the dead foetus by embryotomy (to-day’s Nomenclature: subcutaneous fetotomy). Unfortunately my experienced attendant had failed to bring the Thygesen embryotome kit due to 2 reasons.
1. Sine the farmer misinformed the real situation
2. My attendant was not familiar with Thygesen embryotome kit which was imported and supplied only a week back to that dispensary.
I was flabbergast in that situation. There was no time to return back to dispensary to bring Thygesen embryotome kit.


I bewailed to my attendant for his failure to bring the embryotome kit.
“No problem Sir, We can deliver the calf” he replied confidently.
Then he adjured the farmer to go and bring an used wooden churning staff, immediately.




I was wondering as to why he wanted a used wooden churning –staff in that juncture. However, when a used wooden churning-staff was brought, he removed the head from the handle and chiselled one end of the handle sharply like a sharpened pencil ( Fig.1). Then he requested me to make a circular incision around the hoof to separate the skin from the hoof of one protruding forelimb. When I made the incision by using embryotomy knife (Fig.2),



he pushed the tip of the sharpened end of wooden handle in 45 degree angle into the incision facing towards the uterus and then gave a blow forcefully by a wooden log on the other end. It created a skin tear up to the shoulder of the foetus. I understood the principle of his action.

Normally, when Deburin’s chisel (Fig.3) used during subcutaneous fetotomy the sharpened tip will be passed in a convenient angle above hoof and then pressed forcefully towards the uterus by holding the handle in the other end.



By this way a skin tear will be created from the hoof to the shoulder. Then by twisting the limb it will be removed from the body. Both the forelimbs also will be removed the same way to have a sufficient space to introduce the hands in to the uterus to correct the posture of the foetus and to remove it from the uterus.

By using his technique I removed both the limbs of the dead foetus. Then I easily introduced my hand into the uterus and found that the foetus was in foot nape posture ( Fig. 4)




After correction I removed the dead foetus by traction.
Since my attendant had served under many vets from the age of 7, he had learnt many practical techniques. This incident taught me a lesson that

“Mere theoretical knowledge will not be sufficient to be a successful practitioner in the field condition. Only when the bony theoretical knowledge is covered with the flesh of practical experience one can be shaped into a full-fledged successful veterinarian,”

Rumination-3

“Nature never did betray”

- wordsworth

Most of the veterinarians and few scientists are of the opinion that bacterial / viral proteins only can produce antibodies, but not plant proteins. It is not true. Few plant proteins also can produce antibodies. Ricin is one of the protein which is capable of inducing the formation of antibodies in the animal body. These antibodies allow the animals to withstand up to 800 times of normal lethal dose. Unfortunately, this information was not taught to undergraduate students on those days.

In my native (dry) district castor bean plants were grown in the boundaries of dry lands as commercial crop. There is ample chance for the grazing animals to trespass into the caster bean plant cultivated lands and consume first the castor bean leaves. But, invariably the landowners will drive them out before they consume sufficient quantity to produce toxicity. Consuming frequently small quantity of castor bean leaves during grazing the animals in my district develop antibodies and become immune to the toxicity of ricin even if they consume large quantity of castor bean leaves.

But, the animals in delta district are not exposed to this plant during their lifetime since this plant is not grown in the fields as commercial crop. The castor bean plants are grown in the delta area only in the garden more as ornamental plant. So, there is no chance for the animals grown in that area to consume the leaves of castor bean during the grazing as in dry districts. Due to this, the animals in delta districts are not immune to the toxin – Ricin. Whenever the plant is overgrown the owners cut and throw the branches of the castor bean plants from the garden in the public places. Unfortunately, the animals that are roaming in the streets will have a chance to consume sufficient quantity of castor


bean leaves to produce toxicity and death. Like that only the kid which consumed the castor bean leaves was brought to me. Due to lack of this information as veterinary student, I lost my first case in my practice.

Even today, no veterinarian in delta districts can save the poor animals which consume large quantity of these leaves since there is no antidote to ricin poison. However, they can be saved only by giving antiserum like treating tetanus cases. Unfortunately, no company in this country is manufacturing and marketing the antiserum for ricin toxicity.

If the animal was brought immediately after consuming the castor bean leaves there is a chance to save it by complete stomach wash. For that a well experienced vet and necessary instruments must be readily available at hand.

From my experience, I wish to record for the benefit of field vets and veterinary students that “A poisonous plant to grazing animals in one geographical area needs not be poisonous in other geographical area of the same district.”

”

Rumination-2

" Remember that the most beautiful things in the world are most useless"

Before discussing the reason for the death of the kid which consumed the leaves of castor bean plants the readers must know some basic information about the plant

Origin

The castor bean plant,(Ricinus communis), is a species of flowering plant. It is native to the Ethiopian region of tropical east Africa, The scientific name for the castor bean plant, Ricinus communis, has a much more logical derivation. Ricinus is the Latin word for tick and is the specific epithet for the Mediterranean sheep tick (Ixodes ricinus). Since the seeds looked like ticks, particularly large ticks engorged with blood it is named as “Ricinus”. Communis means common in Latin, and castor plants were already commonly naturalized in tropical and warm temperate regions throughout the world. Castor plants are very common along stream banks, river beds, bottom lands, and just about any hot area where the soil is well drained and with sufficient nutrients and moisture to sustain the vigorous growth. The roots, leaves, and seeds have a place in traditional folk remedies throughout the world.

Though the whole plant is poisonous the seeds or beans are extremely poisonous to people, animals and insects. When several insects feed on the plant, the plant protects itself by killing the insects by the presence of toxins. The seeds contain the highest concentration of poison. But, they are the source of numerous economically important products and the castor oil is one of earliest commercial products. Castor oil is a mixture of triglycerides, of which 75% to 90% is ricinoleic acid. Lesser amounts (1% to 4%) of linoleic, oleic, palmitic, and stearic acids are also found. The oil was used thousands of years ago in wick lamps for lighting. However, castor oil is commonly used as a laxative and for the induction of labor. The fast-drying, nonyellowing oil has been used in the manufacture of high-grade lubricants for industrial machinery and aircraft engines and in dyes, inks, paint, and varnishes. The castor cake or pulpy residue that remains after oil extraction has been used as animal feed and as fertilizer despite its unsuitability due to traces of toxins.

What is ricin?

Ricin(RYE-sin), is one of the most potent naturally occurring toxins, found in the castor beans. It is held among the top two or three deadliest poisons available in the world. It has been estimated that, gram for gram, ricin is 6,000 times more poisonous than cyanide and 12,000 times more poisonous than rattlesnake venom. If castor beans are chewed and swallowed, the released ricin can cause injury. Ricin can be made from the waste material left over (pomace ) from processing castor beans. It can be made in the form of a powder, a mist, or a pellet, or it can be dissolved in water or weak acid. Luckily ricin is immiscible with castor oil and this prevents contamination of the oil during its production. Ricin belongs to a class of proteins known as ribosomal inactivating proteins (RIPs). As their name suggests, these proteins interfere with the function of ribosomes, halt protein synthesis and thus induce cellular death. If enough cells die, lesions appear in the exposed tissues which can lead to organ failure and death of the victim.

As with most chemicals, whether or not a person/ animal becomes ill after exposure to ricin depends on how much ricin the person was exposed to, how long the exposure lasted, what the exposure method was (inhalation, ingestion, or injection), and other factors. In general, when the dose is the same, being exposed to ricin by injection has the greatest potential for causing illness, followed by inhalation, and then ingestion.Ricin mixed with food and used as bait is highly toxic to certain pest animals, such as some rodents and insects. A dose of 0.035 milligram (approximately one millionth of an ounce) may kill a man and even small particles in open sores and in the eyes may prove fatal.

Biological warfare

Ricin was used in many attempts of assassination all over the world.

Umbrella Murder

Ricin is said to have been used in the assassination of Bulgarian exile Georgi Maskov in London in 1978. Maskov was attacked with a specially engineered weapon disguised as an umbrella, which implanted a ricin-containing pellet into his body.

For further detail please read the following links.

http://news.bbc.co.uk/1/hi/uk/2636459.stm

http://www.portfolio.mvm.ed.ac.uk/studentwebs/session2/group12/georgie.htm

During the world war II. Ricin bombs were prepared by British army. Fortunately, they were not used. There is a report that that Ricin was used Iran –Iraq war.

Unlike other plants, the castor bean plant is gifted with a special character which only saved my village goats from the jaws of death in spite of consuming the leaves of the castor bean plant, grown in our lands. I will write a pithy remark about this in my next blog.

Rumination -1

My first failure

3.8.1959 11 a.m.

“Doctor! Please do something to save this. This Saturn has devoured the castor bean leaves, which were cut and thrown out from a roadside garden. Please treat it quickly”screamed an agitated middle aged farmer who rushed into the dispensary with a kid in his hands.

But, the kid was cheerfully masticating without evincing any toxic symptoms.

“Don’t worry. I have seen many kids who lived for years after consuming the castor bean leaves from our agricultural fields. Nothing will happen to your kid. No treatment is necessary” I said.

From his facial expression, I understood that the farmer is not happy. He was repeatedly pleading for some treatment. Since I had a firm conviction that castor bean leaves are not toxic to livestock I was stubborn in my decision. The farmer left the dispensary with reluctance.

He was the first client not only to me but also to that “Minor veterinary dispensary” which was inaugurated only 2 hours back. Though that village was not provided with any other basic amenities like school, electricity, protected water supply, etc, the minor veterinary dispensary was established by Government in a small room to protect the farm animals of agriculturists, living in the tail end of Cauvery delta region of Tamil Nadu, India. Within a week of my graduation, I was appointed as Veterinary Assistant Surgeon to the newly opened dispensary. I joined in duty that day only 2 hours before without any field experience. That minor dispensary also was supplied with very few medicines as mixtures and powders by the nearby Veterinary dispensary. No equipments other than a thermometer, a syringe with few needles and a Burdizzo castrator were supplied.

In the afternoon, I was sitting alone in the dispensary. My peon, the only subordinate, went out in search of a place for our boarding and lodging in that small village. At about 4 p.m. the same farmer came back to the dispensary with his dead kid in a basket. He accused that I have not saved his kid in spite of his repeated request.

I was in a very awkward situation. As young boy, during my daily strolling around our lands where we grow commercially the castor bean plants, I have noticed the incidence of consuming the castor bean leaves by goats and their kids belonging to the villagers. These animals lived for years without showing any toxic symptoms. But, I was not able to understand why this poor animal died. When I discussed with my senior colleagues, I was not able to get any convincing reply. I learnt the reason for the death of that kid and the secret of the survival of the kids in my village who lived for years after frequently consuming the castor bean leaves only after my post graduation in “Clinical Medicine”. I will share the information with readers in my next blog..

My Views

Dear Readers

I intend to write my experience in veterinary practice as well as my views on Veterinary Educational policy in our country from my experience as Registrar and also as Vice-Chancellor of the First Veterinary University in India. Hope you will enjoy.