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A MANUAL OF OPERATIVE VETERINARY SURGERY BY Ae LEU RAR Dy NEI Neve Dean and Professor of Anatomy, Surgery, Sanitary Medicine and Jurisprudence in the New York American Veterinary College; Officier du Mérite Agricole de France; Member of the Société Centrale de Medécine Vétérinaire ( Paris) ; Honorary Fellow of the Royal College of Veterinary Surgeons (London) ; Corresponding Member of the Academy of Medécine of Brux- elles; Honorary Member of ‘the Société Vétérinaire a’ Alsace- Lorraine, etc. Author of ‘‘Vade Mecum of Equine Anatomy,’ ‘‘How to Tell the Age of Domestic Animats,” ‘‘Animal Castration,” ‘‘Lameness of Horses,’ Translator of ‘‘Bouley on Hydrophobia,” of ** Zundel on Diseases of the Foot’’; Editor of the ‘‘Ameri- can Veterinary Review,’ etc., etc. WITH NEARLY 600 ILLUSTRATIONS New York WILLIAM R. JENKINS VETERINARY PUBLISHER AND BOOKSELLER 851-853 SixrH AVENUE 1906 LIBRARY of CONGRESS One Copy Received JUL 24 1906 Qoryiignt entry Copyright, 1891, 1906 by A. Liautard, M.D., V.M. All Rights Reserved PRINTED BY THE PRESS OF WILLIAM R. JENKINS NEW.YORK DR. A. CHAUVEAU, f _ Member of the Institute (Paris), General Inspector of the Veterinary Schools e ae vance), Professor to the Museum of Natural Hisy Bao) 7 i. “As a humble token of the high appreciation of his scientific labors _ hep i ae in behalf of Veterinary and Comparative Medicine, this work is, with - | 5 _ Kind permission, dedicated by : Me : ee | | | | ‘THE AUTHOR. a a ~- A Ba eee ee itech ah PREFACE. If an apology should be deemed necessary for any apparent tardiness in the execution of the special undertaking of which the present work is the result, it will not be very far to seek, but may be readily found by a reference to the various and unceasing vocations in which the author of the Manuva or OPERATIVE VETERINARY SurGERY is habitually engaged. The labor of its preparation has, in fact, been alternated and shared with that of other literary engagements of an imperative and unremittent char- acter, and the onerous and exhaustive duties pertaining to his collegiate functions, to say nothing of the demands of an extensive practice. Engaged for years in the work of teaching this special department of veterinary medicine, and having abundant opportunities, which have not been neglected, of realizing the difficulties which the student who earnestly strives to perfect himself in his calling is obliged to encounter, I formed the determination long since to do what lay in me to facilitate his acquisi- tion of knowledge; and it was then that I projected the present volume, and began the accumulation of material by the compilation of data and arrangement of memoranda, with the recorded notes of my own experi- ence, the fruit of a long and extended practice before referred to; and of course a careful study of the various authorities who have illustrated and organized our copious veterinary literature. Moreover, haste in the pub- lication, and a thorough digestion of the subject and the systematic order- ing of material, could not be very easily combined, and a little delay in the issue will prove no detriment to the value of the book. With his own kind permission, the work is dedicated to Professor A. Chauveau, General Inspector of the Veterinary Schools of France, as a token of my high appreciation of his services as a scientist, and in recog- nition of his standing among the lights of our profession; and especially of my estimation of his excellent book on anatomy, in which he so ably lays the foundation of the knowledge which constitutes the indispensable condition of all success in surgical practice. V1 PREFACE. _I have been liberal with European authors, not only in freely cred- iting them with their discoveries and theories, and in many cases quoting literally their opinions and arguments, but especially so in adopting their illustrations and enriching the work with the artistic representations orig- inating in their’s—an emphatic manifestation of my high estimate of their value and the skill of their execution. And it is thus that the names and accomplishments of Rigot, Bouley, Gourdon, Peuch, Toussaint, Cadiot and Zundel, of France; of Brogniez and Degives, of Belgium; of Hert- wig, Hering, Moller and Hoffman, of Germany; of Lanzillotti-Buonsanti, of Italy; and of Williams and Fleming, of England, will become famil- iarly known to our readers. But while I have in great part been guided in my work by the char- acter of that of our predecessors, I have not restricted myself to the lines observed by them, or exclusively respected the authority or prece- dents of European surgeons, but have sought to do justice to the progress of American veterinarians by honoring the contributions they have made to our surgical knowledge; and it is due to accident alone, and to no in- vidious design, if any omission or oversight has been committed, by which any to whom credit should be awarded have failed to receive it. The chapters of the Manuva which treat respectively upon ‘‘ Frac- tures’? and upon ‘‘ Operations on the Foot” are reprinted from my own previous writings. Thus, in the first instance, the remarks upon frac- tures, with the kind permission of the Hon. Jeremiah M. Rusk, Secretary of the Department of Agriculture, are extracted from an article published in ‘‘ The Special Report on Diseases of the Horse;” and in the second in- stance, touching the subject of operations on the foot, I have not hesitatea to utilize my own translation of Zundel, produced as long ago as the year 1881. In both cases improvement has been made upon the previous treat- ment of these topics by the addition of numerous illustrative plates which accompany the text. In the chapter upon operations on the genito-urinary apparatus the reader is referred to my special work on the subject of ‘‘ Castration,” which is not included in the present volume. In completing the task undertaken in the preparation of the Manvat, however perfect or imperfect may be the manner of its execution, while I have been influenced by a desire to effect something for the benefit of all classes of practitioners, including those of recent graduation, my ob- ject above all has been to facilitate the labors of the young student while industriously and anxiously toiling for the knowledge which is to qualify PREFACE. Vil him for a successful career in a useful and honorable profession; and if I shall have succeeded in this object, and the success shall be certified by the verdict yet to be pronounced, I shall feel fully satisfied and more than ever encouraged to persevere in my efforts to elevate the standard of vet- erinary science in America. No toil has been spared, no effort relaxed, in the prosecution of the design and desire to compel the approval of the judicious, and even to escape the strictures of the critical, and I have not failed to seek for aid and counsel from competent coadjutors. The entire text has undergone revision, with a view to the improvement of its idiomatic structure, by my esteemed friend, H. D. Holt, M.D., of Jersey City, N. J., to whom I am also indebted for the favor of supervising the proof and overlooking the © issue and arrangement of the various chapters; and my publisher has exercised a true liberality in providing an external garment and garni- ture for the contents of the book, in all respects correspondent with their value and interest. To that gentleman, therefore, are due my warmest acknowledgments for whatever of internal and external attractiveness may characterize the MANUAL OF OPERATIVE VETERINARY SURGERY, and they are cordially and freely tendered. I have now only to express the hope that this contribution to the cause of veterinary progress may be as kindly received and favorably judged by my colleagues as it is honestly designed to effect its object by me, and that any shortcomings in the execution of the work may be len- iently regarded. And so it goes into the hands of the public, to share the fate of all human ventures, for better or for worse, as its fate may be. THE AUTHOR. CONTENTS. PAGE. PMT EODUOTIONS osnc'6 oiss 4 occ le Tae wale Serie iarieistetereitarsiete See pactain ak CHAPTER I. VANS MOREY ES TEPAIN Dosis aps teioraisiersiers . 0. .0:.52 2). ¢ axter eee 503 o im Larve, Fruminants.0 t.-6<3 2s sic-stog mbes ee nace= 503 ae OTHE MUMUIALSG eats eo AG « Maou an Babe ola 504 oc at the Subcutaneous Abdominal ............... 504 $8 ompiinll Animals. cia. crc eraraic eacyereie ys eiietale eee aa 505 Accidents Following Phlebotomy.........................- 506 X1V CONTENTS. OPERATIONS ON THE CIROULATORY SysTEM.—Continued. PAGE. SAPLOTLOLOTIY So Fe cielo alidlei st pei aoe eters Ne SARIS aero ie rahe ae vee LE 514 Arteriotomy at the Transversal of the Face................. 514 sd fS-E- SIP OStETION AUTICUIAT AS “eracie cetera eer stcioe 515 6 ac MS Median: Caudal 22's! s Petes acca ape vase neces 516 Capillary Bleeding Sox. eae ek ste ee Un AR ene ee 517 Bleediny atthe Palates Toc e essence 2 scien ere srorbieps ne s.cle'e\e eel aL 67" Cox's Ghloroform: Bags tne hica bee) oss ole osteo oe eee 71 68 Gresswell’s Chloroform Bag.............. ns.s be vee OS 72 69 Carlisle’s ef Miahialen ee oa. eas a oad cane eee eee 72 me t Simple Speculam/Orisi. 1. 65 iets piienieines\s > sale oeicbe os ee eee 82 72 \Broguies Speculum Origen cee ck sieves 6 )- e210 eine sisisceiele ee eee 82 73 Green’s sf SeaifalNaveiadaleteos Sihetsrs aie le\s wie acl Colceid le toe chest eaenamea 83 74 Grange’s SOE CMI B ain oon Cn ENC MEO MREEEETARSIA Doc cc.on noc 83 4D) (Reynal’s\ Moth (Remector ys cies pate se nleys da sie viele le: se ne Oe 34 83 $0 93 94 95 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 TABLE OF ILLUSTRATIONS xk PAGE OSG) SPST. cca ein ries p's alarm ns alee PR Ur array 84 TONS He CULMS seys .reteras ae cro eyerscas oust atayeiete ete rate stated tase «reel cise ae eee Pare te Faerie 102 Resi .fe Ola otitis aye tots mrcse sets nyc oretcce te dae eeeer cists MENS eee aye 102 DSOMAED WONMPLESS: atccafsuei itnls nin ase > ceclensee nile ercaste esther s = dettemeters choke 103 Nome NC OMMpLESS ese ace sverci eve seveiersl ay evs sie celeio be eke ate Gt opetctenctapelerc seeleoe heen yan 108 rian gular OMpresssans vache eae aCe ee eee eee 103 Neck=iirey Compress. \a:7s statakeerlcts eu tetova we eeatelen emetet ate cle re et ietoe 103 Maltese-CrossCompress\. seers = ae na ctiae ese ee ae ee 103 Malt Mal fese-Cross:Compress, 4, 35 520-7 $i5:c:2 5 12 Saiandatoee scone 103 WD GmOleHOOnNpPTeSs! ssc) sevioyet sts as deyetapelc aways eine ees ave eRe aI 103 AED LEC OMIPT ESS. hoi chevaiasecaterasry eater a weclaissobe eistouenctalntore oie ae Oa ae 103 Graduateds Compress... soa sceptics os esos es pee 104 Perforated Comprossis<) vac ak eae ate te ele as nek ee ee 104 PE lahessOMe SOS). pecs telson tra a oceect cee add shen dhe SE Raa 104 Berns] Moistened Pads iiss. 5. sa ssa)aerneel sia is ones ale ome ore 106 sunple Krontal Bandage (full view). 2.2... 0 cece sees ees canes 107 ee % hae ealsinbot< bandapeton Transversal: W OUNG. << ca.,.1,eeie 2 ealsicieaiae > sede eee eos 145 179 iy S “lrongitudinal Wrounmdsy': <,< .a-csctersecicie sa eve cteeeiee 146 180) Warious Sukured: Needles. | oo. <<< cn siamo aloceveiee thace tem Crieiae me eae 149 131 GroovedNeediles for Metallic'Suturess.. +. 4402 ee ees calcio 150 BS ee OPO LUT ASH INGEUULE I a cs ates bin.cavare & avceusia ei ai ticke Direkt nerecatetar uO vn Ce Toe 150 Mi EMERGING UN CCUG oso. 5 c/s: esata ic« cas = ais sv stave ete vate Ml acne Mn a etelee es 150 BSA IMP SONS NCCUIG Ss ae acecinin cl nisieadl tale Scie «erent elses eames aaah suai as 150 uso) vecdie Holder: of Mathie. 024 53 setae cea can dete dae to nnenone 151 See SUES SUORCOOS cores s,ate/cotc Stuer cfonepsye Miskele hate otherhelatned beer omen 151 A Site ECOG) OFTEN FOIGOR>: 2/570. . scaSepee Aa spree a eee eee ter 151 ea eiilpleor Imiberrupped SuvUre. ..enemee cet meneienn sees ea ae 152 Bis aM TOO PIE (OUI GMUEC har a2,0,s ae isco ays) 6 nie Sena tetas etiam elie OER eae 152 Oe CLOVER SiS MGUEE ./.,<'s,2, a cacle «sel ee eee. Toe eek cree PE EES 153 EEO OSSUCH PTLD ULC 5 5c asc nie ea ae ME REPAIY Stee oh PGR a ree etnG Gee 153 ere UO SUILPITG) a: 5: «5's saa averae cy Ceemere RT at SIS VAS nay te Been ae A 153 9s; SuLuTeswitheAdhesive, ban dagenmemurna sce icisis ceil semen neuer 153 Le See LOM PIM UUM. <<. <<, laser ee mete oe aie alere eats Sele AU OO Oe 154 aac wasted Sutures... o/s ete eee tee cece eee e nee e cece eens 155 LIC fae 1 1 a POMPE DA Tn OR EMA a Cie Ca eV Ay 155 HOS y Suture of Che: Warrier a. trl sneeioees ais waiten any Saatene See nee 155 BRO EE SSM TUG cs 25's jn inc cae ee EOP eats he aie, Seta aiehe ot eens Marae ee me hs 156 200) XM SULIT... cs cece Uisrepenacsrabens ore ot acevshe ied Ov etaredsiche) tees Pe ER Te 156 Sal WarLOUs’ CAULOLIES ci cysc hte tet utero dial alo ra cate Be hore aye a 161 yor Old-fashioned Draywianesse ter ase sis ot aiclne sas dae eeeie ee eee 162 US MEIN fh le) TAN gear pated ears os Ak ave onteeiac chee Cao aE Ee 163 20f | Various Hormnsiot Drawang inl Birino, oc. isiylasitecs iden ae ee 163 20d shinies 1m Dots andak ommtsee ys ae keen iets ete vis ocpater eree 173 UGE eAIS | CAULCLY, a cle Mreane alia dle tel arvana bieteue acster Sere 175 ie ceo lame lt Camber yer. ace opiates tose eh ns aac) sce ae ies aig saver ey etc ha ah aot 76 SS vnoursher: Caubernye weecserte ae mete aie 04 a oceuartvathentrerae ait ia ave wet ae 177 cod Cantery with ChaugingrPoimts.* |. sijic 3 Nes ac Sainte easel eccaeene 178 mu) s pourenetsCamtenye a tinietc aie Alslalvs Sok je aca nwrcidee se tends & Bier satiate 179 ily Aut ouhenmic, Guibetye sa. oct ak Veet Sakae abner aici pee speeneie il a ae Rberies! Of PM ANCION + cic lascia’sinoe tion nists Sec cin le Owain eo 181 SUS MMEUnnIoT a Lav NAmeLn wun. SMM s Sata ee we awe lace. Kae 181 214 Paquelin (GENT yA eee era ote Ps pan rad Me A OT RR RR 182 xxii TABLE OF ILLUSTRATIONS FIG. PAGE Bip Paquelinwand de: Place, Cautery acces ti, s0\cievh bots teotertetctels 183 DUG e Seto Enh xi s.h dickens as Ue EAE Rew oe cake MSE. 189 217) 218 | PAGE SOOM NEOULOS sn. stsrcin aie sateuellelomielaniaferstetstein eis te sears cioie cclalus sie eats 189 220 221 | 228i roe Seton Need lew 25h. i) ssi Pretec ctapere ete werne ciate espe mete NA Pe re 190 225. ‘QuillSuture’ Needles 2. 40/0 So.sjsencs cals cere ay ae a's erredoteye aie erence 180 224 Rowell Seton owes tel a Rea s Seta ae ras oho er 197 22) Heraseuriok Chassalenacy.. os or v's Ate anoaletrae Cael oa os ae aes 277 BS DEOL CAG LAD Ve fcta at eile fis ea ieech Dar Meta e oie oo eA hog ie ea 278 Bourgelat’s Iron Splint for Fractured Tibia.................... 279 Splint and Dressing for Fractured Cannon Bone................ 280 oe sf 23 on Lower Partiol Worelem (9. )i)/s.0.6 i220 eas 281 Bourgelat’s Splint for Fracture of the Cannon and Phalanges.... 282 Longitudinal Fractures of the Os Suffraginis................... 283 Comminuted Fracture of the Os Suffraginis..................... 284 Animal with Fracture Below the Knee with Splints and Support, Resting in Simpseeewen.. . 25.26% .604 were gee Meer eae Fracture of Os Sesamoids..........0..0... rite ahead a-eiw ad abd a tite iaiet WW 0 DH ® or t Amputating KniveSteepiie. ss 62/6 o5« - Siojetoi ora sheila aia, <\ oie ay ater eda @D wo Amputating’ Saw eecweas ise e 309 saeas sakes aera nes Wooden Lee-attercAinputationac.... cee eee ee ene Cnarlier’s Meee OF ee of Horns in a Calf, 1st Step.. se sé “ee ee ee od ee Marl Cutters caresses oe ol cnte ee eee ee Gu eee daar e ee WwW Ww WW Ww Oood wo Oo oO wore 6é ee © 09 Co H= CD 6) a) 8) ¢ saa aime! oo wheyme) a) Om vie, ef =\6 jos si v6) oF ep a 0mm 0101610 @.— Nine of es s ) £§ 25) prin s Tail Cmtiename nse «joist morsels wrdldescls oriole hae 295 296 enemas CATH ONY.. eee terame s viele eocoreme, oop chtrre Ma ee soe eee SO RTI 2S) Old-fashioned, Prepbume: eyo 2. lis ise toes elles uate Bon Micnaiza re phinedrs ues, sw 1s Gu eaatcseerse aioe cea lee B00) (Sincle-Handed uirepiines wis. 27 acta. cis wacctoeieee es Ad oaece Meee ree 301 Operation of Trephining. Modus Operandi.......... ......... 236 236 237 249 250 251 251 254 254 255 256 256 257 257 280 281 xxiv TABLE OF ILLUSTRATIONS FIG. PAGE 302 Bone Scrapers and Hlevators............0cseeeeeeeees si Share SPOS 287 on t Parts of the Head where Trephining is Performed............... 288 305 Common Points of Selection for Trephining.................0.- 289 BAD ORCISSONS aye lcsc cia lars mis chao okoie alePatounlos uapoPain Al aleee oacperlausysieeaie ie! Mistelasiets = 292 BON SMSUOULY,..is ohic-sicia oiciee ie biem mis pila ek menace meter tae Cae wages afore 292 SS! 5 FROYTOSUQMMBL. 52s ioioie vc cieis eve ieie'as SonD/aEs cel w/aiats eh olh a eles niel eye eteteferar eve alclnrenet 292 309 Seton Needlese ig.ca! < ly seliis clsiemverees SOS DUR bom Bae orarkc oe ol oie 292 SO MViaTious, HOLMS! OL) SAWS) vetelscrtare cicteysictletatel-lecislstete toe ete araarel= 293 Sel, HAIN SAW << since, ojeuaie crs) © s.a.cvetornia arateielsiete sie eee te eee oe EET 294 BlZs Bone: MOorceps..... sieictatsioie ciateteseeselenekevene cl verti esefeheterel she ehemseeasierreret re 294 Bilis ROUSE! vicreeis ele eieteleierete alc: cigs a ale atelSteleahoie = Ye mtateianeutetetcasaveiete Cmonertevs = 294 BLOM CHISE) s. 50 eia'e shinies = crate eSie Mstoeiars starch tales he REIS ttl te eee eee 294 SUSE Mallet caso alarotecciacsateles tue sietaistorels elem platalniqpstan! atl yelsoietes ate alert temne 294 314 Anatomy of the Perineal, Anal and Caudal Regions............. 298 31d . Bistoury for Caudal iM yotomiy si... cic scene etic tore reel 299 3154 How to Hold the Bistoury and Make the Incision............... 299 316 Transversal Incisions in Caudal Myotomy.... ................ 300 3164 Caudal Myotomy by Longitudinal Incisions.................... 300 317 Operation by Mixed Incisions (Vatel’s Method)................. 301 Sis: Caudal Dermatome \...,staeaeeetea es! nots ea ee ee 536 fate Artery Horceps for Torsion... 5:6 semeieeet! a ooo) ote eet eee Ac? web lantar Nerves Digital Recioneesapepee sees ae sae. fe eee 548 463 Plantar Nerve on the Posterior Face of the Phalanges........... 549 AG4 Blunt Tenaculum, with Hlastie Band \22e.-:.-.2 2575252922282 2 pl 465 i ERE AD SAA ees c ryt ROO Sey ack ee Norte eam et STC E 266. hightiand lett Neurotomes.jsegmactocs. ses ss ase eo eee. 551 iret UAL CECI sca c or 5 \-) «co's + so 2 cetera cree ellen) et) ay eee ae TE abon Hewale Catheter. 1 .\.) -/ teeter ee eae Dee Roe eet one a DON 469 Anatomy of the Perineal, Anal and Caudal Regions.......... .. 559 AVON wsecuretor ischial Urethrotomyameres cents asec eee ae eee 563 es t Forceps to Remove Foreign Bodies from the Bladder............ 564 Ai Sethe OL LTOCDEL . 5. ‘eRe eRe ee Tae ele ee ee os 465 AGA, Lithotrivor of Guillonsceaseese ew. oe Skiee) aod oe ern ele ... 466 ory crushing Horceps of Bomleyeuers 14220 santo =| ES = =2 = S\N : , y yy 5 7 - SS Fig. 22.—Horse about to be Cast. SECURING SOLIPEDS. 35 instinctively abandons the effort to keep his feet, and assumes the recumbent posture in order to avoid the shock of a heavy fall. H. Bouley recommends that the first movement in this final step should be an attempt to back the horse, in order to move the fore legs first, and then to bring the hind legs forward, if the base of support is still too broad. The twitch should now be removed ; in fact, the most prudent plan would be to remove it the moment the hobbles are in place The final step of the act of literal throwing or casting beng accomplished, the last indication remaining to be fulfilled is to secure the patient in the most favorable position for the surgeon to perform the important work of which all that has been under- taken has been but preliminary. It is properly the permanent (for the time being) adjustment of the body in such a manner as to allow the surgeon the best possible access for all his manipula- tions to the region which is to be the seat of his dissections and other operative movements, without any unsteadiness or opposition. Bouley’s directions for this purpose are that the operator, watching for the right moment, as the horse begins to totter, gives orders to the assistants having charge of the ropes acting on the body, the tail and the head, by a prompt and simultaneous action, to pull in the direction of the side on which the animal is to lie, and to those at the casting rope’to pull firmly but not harshly in the opposite direction, while he himself pushes the body of the animal towards the bed. By this arrangement of opposing tractions the casting is easily effected; but unless the assistants act in perfect concert, and especially if the casting rope be drawn too rapidly and suddenly, the animal will be raised from the ground with a sudden lift, to fall so heavily on the bed as to possibly subject him to the risk of sustaining severe injuries. Bouley remarks on this point: “An animal is properly cast only when, bending his knees, he lies down softly and easily on his side, bringing to the ground successively the shoulder, the ribs and the hind quarters; or again when, the fall beginning from behind, the order is exactly reversed.” Once down, the forcible traction upon the chain brings the four legs in close proximity, the spring hooks or padlock passing through the link nearest to the ring of the hobble through which the chain passes, coming out last. To provide against the possi- C5 Mt ven eo a fey dee 3 oie 36 MEANS OF RESTRAINT. ble breaking of that portion of the chain which embraces the four hobbles, Peuch & Toussaint advise the passing of the casting rope and chain a second time through the rings of every hobble before it is secured with the spring hooks. The animal being down, the | straps of the Bernardot & Buttel apparatus are buckled, and the head well extended on the neck. The use of this apparatus con- siderably diminishes the difficulties involved in the contention of the head. Before its introduction, two assistants were required to keep it in extension and comparatively motionless; and even then the results were not always easily reached nor accidents avoided, whereas, with this halter and surcingle arrangement a single strong assistant is sufficient to secure control of the head; “ = Pr pt (i Fig. 23.—Horse Thrown and Secured by Bernardot & Buttel Apparatus, SECURING SOLIPEDS. 37 and it has the advantage, besides, of “ preventing fractures of the vertebral column, rupture of the diaphragm, and rupture of in- ternal viscera.” In some exceptional cases the surgeon will be obliged to im- provise his hobbles. This may be done by fastening four ropes of suitable length around the coronets, allowing sufficient room - for the passage of the casting rope between the hobbles and the skin, or again placing an iron ring through these loops of rope, which are secured by a knot on the outside of the leg, as suggest- ed by Mr. Dneubourg. The removal of the hobbles and of the other apparatus em- ployed in casting the animal, demands similar care and attention to that which was required to put them on. While the Bernardot & Buttel surcingle is unbuckled, the assistant loosening the Fig. 24.—Improved Hobbles of Dneubourg. straps of the cap, and ready to remove it at a moment’s notice, the operator placing himself facing the soles of the feet, in order to be out of danger, cautiously unscrews the screw-pin which fastens the chain to the principal hobble, and removes it, when all the hobbles becoming loose, are removed, and the animal being freed from all restraint, is allowed to rise. While the animal is rising it will be but prudent in the by- standers to allow him all the scope he may choose. The action is sudden and somewhat violent, and he may move his hind legs 38 MEANS OF RESTRAINT. with a sudden jerk which may throw the hobbles off with force suf- ficient to severely hurt some unguarded spectator upon whose per- son they might infringe. We have been witness to such an oc- currence, when they were thrown a distance of twenty feet, with violence sufficient to inflict, possibly, dangerous injuries. An animal thrown and secured as has been described is in a suitable position for the majority of operations, such as those about the head and neck, of the body, or of the upper part of the legs. Butin many cases, it is necessary to fix a leg in a peculiar position either to expose a given region of the body, or when the limb itself becomes the seat of operation. The action of se- curing the animal in the recumbent position is one of great im-_ portance, and none of its details ought to be overlooked. And there are several points to which we have already referred in our introduction, which may be again noticed with advantage. Bear- ing in mind the accidents which may result from keeping the horse in a state of painful passivity, and his instinctive struggles to free himself, not to mention the painfulness of the constrained posture itself, the inference is palpable that it is incumbent on the surgeon to release the suffering patient from his trying constraint at the earliest moment consistent with the proper completion of the operation. Again, in securing the legs, care must also be taken that, although a given position of a leg may facilitate the movements of the operator, it is not justifiable if there is another mode of securing the same object by means more comfortable and less dangerous to the patient, as well as easier for the surgeon. An experience of many years has taught us that six principal modes of fixing an animal’s leg, fulfil all necessary requirements, and that the special purposes and effects of these are such as to forbid their modification. In considering these six specific modes, it will promote facility of description if the reader will follow our references to the dif- ferent legs on a sort of mental diagram which by a mode of ab- breviation by initials will designate—supposing the animal to be thrown on the near side—the near anterior as N.A.; the off anterior as O.A.; the near hind as N.H.; and the off hind as O.H. First position—Exposing the inside of the N.A. leg.—A loop of the plate-longe is secured on one of the fore legs, above the knee, say the off leg, carried in front of the near leg, under it, back and between the fore legs, always above the knee, to return i Te S 2, SECURING SOLIPEDS. 39 Fic. 25.—1st Position. Neurotomy. to the starting point, around the off leg again, back to and be- tween the legs, thus forming a complete figure 8. This is re- peated twice or three times, when a turn around all the crossings of the rope between the legs ties up all the twists of the rope and a double slip-knot is made on the forearm of the off fore leg. Both legs thus secured, the near leg is released from the hobble, and carried forward by an assistant pulling on it with a rope tied around the foot. For reasons already stated, we consider this position as the only one justifiable for neurotomy on the inside of the off leg, or for tenotomy. Firing on the inside of the coronet for ringbone, or along the tendons, might also be performed in this position. Second position—Securing the off fore on the off hind leg.—The loop of the plate-longe is placed on the O.A. leg about the middle i) mth y NTHEAHCHHLAAN Yiyveree ' FIG. 26.—2d Position. 1st Step. 40 MEANS OF RESTRAINT. of the cannon region, from there carried backwards over the O.H. leg, above the hock, between both hind legs, and forward, be- tween the fore legs and reflected back over the forearm, about its middle, when it is given to an assistant stationed at the back of the animal. An assistant is placed in front of the animal, kneeling on the bed, and prevents the rope which passes in front and over the forearm from slipping down too rapidly. The leg being released from the hobble, the operator holding it carries it backward, while the assistant at the back pulls slowly but steadily on the rope, the action of this lever of the first kind, with its fulcrum on the O.H. leg, the resisting power at the foot of the animal and the moving power at the forearm of the off, moves and draws the leg backward until it reaches the cannon bone of the hind leg. At that moment, steadily holding every- thing in place, the rope that is passing above the hock on the near hind leg is allowed, cautiously, to slip below the hock, and the near fore leg is then brought to the middle of the near hind cannon bone, where it is secured with a double figure 8. Other sur- geons secure the fore leg above the hock as in the plate we borrow from Peuch and Toussaint (Fig. 27). The danger of injury to the tendo-Achilles has caused us to change that position to the one ey (| SSS = Ss : = ——— ——— SSS 2 = —S== SSS === ——— — S —— De: Fig. 27.2d Position. 2d Step. SECURING SOLIPEDS. 41 above described. In this position the inside of the N.A. leg is ex- posed, and it can be fired, either for disease of the knee or of the tendons and burs. All operations upon the foot of the O.A. can be performed except those required on the inside of that foot, such as those for inside quarter-crack, complicated suppurating corn or inside cartilaginous quittor. Fig. 28.—3d Position. Securing Upper Hind to Upper Fore Leg. , Third position.—Securing the off hind upon the corresponding fore leg.—In this the rope is first secured in the middle of the off hind cannon region, carried forward and over the forearm, above the knee, in front of the forearm, back between the fore legs, between the hind legs and over the near hind leg, above the hock, to the assistant stationed at the back of the animal. Re- moving the leg from the hobble, and pulling on the rope the near hind leg is brought, by the same method, to the middle of the off fore cannon, where it is secured witha figure eight twist of the rope. In this operation the inside of the near hind leg is ex- posed from the hock down, and in that position, operations on the inside of the hock can be performed, such as firing for spavin, thorough-pins, curbs, and cunean tenotomy, as well as firmg on the inside of the tendons, or even tenotomy. As far as the off hind leg is concerned, only operations on the foot are justified, with the exception of those on the inside of that part of the leg. Fourth position—Securing the near fore on the off hind leg.— The rope is secured by a loop on the middle of the cannon of the near fore leg, which rests directly on the bed, carried backward over the off hind leg above the hock, back between the hind legs, 42 MEANS OF RESTRAINT. Fic. 29.—4th Position. Securing Under Fore on Upper Hind Leg. forward wnder the forearm of the near fore leg, between the fore legs and back to the assistant at the back of the animal. In this action it again becomes a lever of the first kind, with the fulerums above the hock, the resistance at the lower part of the near fore leg and the moving power at the forearm. The leg is drawn from its deep position to a superficial one, and secured with a figure eight on the middle of the near hind cannon, and not above the hock, for reasons already considered. This posi- tion is only justifiable for operations on the inside of the near fore foot, such as complicated quarter-crack, complicated suppu- rative corns, inside cartilaginous quittor, and the like. The pe- culiar awkwardness of this position, in which the leg is carried in excessive adduction subjects the animal to the danger of severe SECURING SOLIPEDS. 43 lesions in the axillary region, and it is justifiable only in the cases specified. Fifth position—Securing the near hind on the cannon of the off fore leg.—The rope is first tied up by a loop on the middle of the near hind cannon bone, forward over the forearm of the off fore leg, between the fore legs, and back to under the near hind leg, between the hind legs and to the back of the animal, where it is held by an assistant. The legis again drawn from under hin, is steadily brought to below the knee of the off forearm and secured as in the other positions. In this position the only operations to be performed are those on the inside of the digital region, or rather of the foot of that leg. FIG. 31.—6th Position. Sixth position—Securing the off hind leg near the neck or shoulder of that side of the body.—The rope is tied up by a loop around the coronet of the off hind leg, that is below the fetlock, carried forward toward the superior border of the neck, under the neck and then toward the inferior border of that region, back over the whole length of the animal to the front of the hind legs, between these and over the tibial region of the off hind leg, where an assistant holds it to the back. Other assistants, pulling on the rope, and making it slide as it passes on the borders of the neck, 44 MEANS OF RESTRAINT. the operator carries the leg forward until it reaches the outside sur- face of the shoulder, or the lateral parts of the neck, where the rope is secured by a double twist and knot around the coronet of the near hind leg displaced. This awkward and painful position is for operations in the inguinal region, including castration, in- guinal hernia, removal of champignon, amputation of the penis, or remoyal of tumors. When the operations which have necessitated these various positions have been completed, the leg which has been restrained should be returned into its proper hobble, and this should be done slowly and carefully, avoiding any unnecessary motions or noises, and the animal relieved of his means of restraint as in all other operations. Fic. 32.—Side Bar Hobbles, In a few instances, however, aside from these various modes of securing individuals, the surgeon has recourse to the side bar hobbles, which carries a hobble of its own at each end, one hobble being fixed on a fore, the other on a hind leg. Some of the English veterinarians are using the cross hobbles, Fic. 33.—Cross Hobbles. which has the advantage of being adapted for use upon legs diametrically opposite, such as the near fore and the off hind legs, and vice versa. B.— Casting with ropes. The hobbles are not the only kind of apparatus devised for throwing horses, nor are they all made according to the English pattern, although the same general principles pre- vail in all. Ropes in the form of side lines, either single or SECURING SOLIPEDS. 45 double, are often substituted for hobbles, and for many varieties of these special claims are made by their inventors, or by those who give them their preference, and use them in their practice. Without entering into the consideration of the comparative merits of these various methods, which vary, not only in nearly every country of the world, but even in different sections of the same country, there is a mode of their application, upon which we have a word of comment to offer. This is the mode with a single, and that with a double rope. (Ist.) With a single rope.—This is the simpiest mode of casting, but it is also the least safe. It is the oldest of the methods in use, but has in our days been more or less modified and improved. The method of Rohard seems to be as perfect as any of them. In this, a rope from twenty to twenty-five feet in length is necessary. The horse being placed near the bed where he is to be thrown, is held in the ordinary manner. [If he is tolie on the near side, the operator is placed on the right, near the shoulder with the rope, in which is a knot about six feet from its end, which Rohard calls the ring knot (a), and immediately below it is another, called the stopping knot (b), through which the rope will run. “In this way,” says Rohard, “there is a large loop i; "WY ), Vi. ° 1 SS a= : a / = Ss SS SS eas = ae Fle. 34.—Application of the Rohard Method. 46 MEANS OF RESTRAINT. formed, which is thrown over the neck, while both knots made lie a litile below the point of the shoulder.” Taking with the free portion of the rope, a twist round both forearms, passing behind them first, then forward across the near fore leg, in front of both fore legs, and backward across the off fore leg, over the rope, it is carried across the abdomen, to the near hind coronet, which it surrounds from without inwards, to be brought back to the posterior part of the withers on the near side, where the operator takes hold of it. Then by degrees slowly pulling on the rope, 4 and making the animal raise his near hind leg by quietly urging 4 him, this leg is carried forward, with a uniform movement, until at one moment, the animal attempting to resist or struggle, — the assistant at the head carries it toward the bed, the operator pressing with his body against that of the animal, until he slowly settles down without injury on his side. To fix the leg definitely, NG Ce on \ ant “i ee \ y , Z = ee Bas EG — fe SS aS EP \ of eer Frag. 35.—Animal Secured by the Rohard Method. one begins by the near hind leg. Making a double twist of the rope around the coronet of that leg, this is carried towards the loop which passes around the neck, and is there secured by a double knot (a), and carried back to the off hind leg, which is then carried far forward and secured to the same collar loop, with a single knot (2). To release the animal, it is merely necessary to untie the stopping knot, when the rope becomes loosened from the legs. SECURING SOLIPEDS. 47 (2d.) With double side lines, or two ropes.—Thisis dene by means of a long rope, doubled in its middle, and having a knot made in such away as to form a loop large enough to be drawn over the head and neck of the animal; the two ends below the knot are then passed in front of the chest and between the fore legs, carried, one to each hind leg, around the coronet, turning it once around the main rope, and passed on the collar loop from within outwards, to strong assistants standing on each side of the animal. By steady pulling both hind legs are carried forward, until the animal loses his balance and settles on his haunches, when a strong effort of the assistant at the head brings him down on the bed. The hind legs are secured to the collar loop with the ends of the rope, and the fore to the hind legs in the same manner. The various methods of casting which we have been consider- ing, with hobbles and with ropes are, as we have before said, not the only plans recommended. Almost every country «f Europe, while also using the hobbles, has a fashion of its own in which the ropes are utilized, and as to the fact of their widespread, if not universal use, it would seem that not a few veterinarians of exten- sive practice have originated and employed special methods of their own devising, for which they claim more or less superiority. Among those recommended in this country, we may mention the apparatus of Mr. Miles, which he has used for years in his exten- sive practice as castrator. Dr. Wm. Dougherty, of Baltimore, has sent us a set of rope-hobbles and side-line, which upon personally testing we are able to recommend as possessing important points of excellence, especially in casting young colts for castration. For further ight and broader information on this subject we must refer our readers to the standard authors by whom it has been discussed in the French, German, Danish and Russian tongues, feeling at the same time quite confident that the general rules which we have suggested and illustrated for the performance of the operation of casting are sufficient to guide any intelligent operator through all the steps of the proceedings. C.—Casting on the Operating Table. The necessity of employing such a number of assistants in throwing a horse, with the difficulties often encountered in con- ducting all the steps of the operation, and the accidents which 48 MEANS OF RESTRAINT. too often accompany its execution, have led to the invention of other means of accomplishing the object in which the objections to the old method are sought to be obviated. It was with this view that the operating-beds of Lafosse in France and Hart in Wurtem- i i uN | | : a 558 SS SSS tj § Z ZZ WN} ‘i LSA ICMAT | TRACT nul Fic. 36.—Wall-bed of Fromage de Feugré burg were contrived. The wall-bed of Fromage de Feugré pos- sessed many advantages, but was abandoned on account of its complicated structure. Of late years, however, several other forms of operating tables have been devised, of which one espe- cially is highly commended by European authors. It is that of Mr. J. Daviau which consists of a broad and heavy table, furnished with pads, surcingles, hobbles, ropes and other necessary appurten- ances for securing the animal, and which is moved by a peculiar crank arrangement which permits its adjustment in any required position, from the horizontal to the vertical, and by which it may be turned down flat upon an iron frame. The apparatus is placed solidly on the ground, or can be made movable by a set of low wheels attached to the heayy wooden frame upon which the table and the crank are supported. Mr. Daviau claims for his invention: 1st. That it obviates “all the complications” accompanying the ordinary system of throw- ing. 2d. It allows “the easy and comfortable rising of the horse” after the operation, without danger. 3d. It gives entire security to the operator, who can perform his task alone and without the Fee, Be vf LAC ONSESSSS ~ w, a F i si dy : “y ~ I [GERSTNER ws es ay Maes, SS SECURING SOLIPEDS. iJ} 4) 49 Full Back View. Fia. 37.—Daviau’s Table. iS & < [em a mM a a Fe S A th ites ) ire ( if —ae y/ 4 \ y) m= i ~ WT / s 5 eI — . ~ 7m hb svi — \ x ~" J —. = By, te ‘MO}}B10dO SUIOFZ1OpuyQ puv ‘UOIsOg UL [RUIUYy OUT, “OldBy §NBjAvd—'6s "HLT v7] eee v es it ‘UOT}ISOd [V}UOZIIOY B UL TVR —"QOPr “DIT Ry ; Back View; showing the working of pulley to draw the table down. MEANS OF RESTRAINT. Fie. 40.—Hodgson & Magee’s Table. 52 SECURING SOLIPEDS. 53 need of assistant. 4th. No assistants are needed to be exposed to danger, and the responsibility of the operator is diminished. 5th. Economy of time. 6th. Economy of material and space for the performance of the ordinary operation of casting. In this country several forms of tables are in use. Those of Dr. Tiffany, Price and others, all of which are constructed somewhat upon the same principles with respect to the action of an iron crank to control the position of the table. Doctors Hodgson & Magee, both veterinarians of New York, have invented a table which for simplicity seems to surpass any one we have yet seen (Fig. 40). Like the others, it has slings, ropes, hobbles, pads, etc., but dif- fers from them in two important particulars. The first is the manner in which the table is lowered and raised ; the second, the manner in which the hobbles are secured and made immovable. In the middle of the superior border of the table, and directly below it on the posterior face, are two solid iron rings. In the ceiling of the operating room, or on the cross-piece of the frame in which it is enclosed, and directly opposite that in the border of the table there is another. Another is fixed in the floor some dis- tance back of the frame upon which the table rests when in a horizontal position. To these rings two systems of pulleys are attached, one connecting that in the ceiling with that in the bor- der of the table ; the other connecting the ring on the posterior face of the table with that in the floor. Besides this, under the table are two strong iron eyelets through which chains are passed, which at one end are secured to the hobbles by openings through the table, and at the other are secured from slipping through the ring by a wide T arrangement, secured on the last link. These chains measure the distance which exists between the rings on the floor and the table when in a horizontal position. When the horse is brought alongside the table and tied up with the slings, the halters and head-straps securing him, and the hobbles being in place, the rope of the upper pulley is pulled by an assistant, and the table moved slowly into the proper position. The rope being then fastened to the ring in the floor, the table is immovable. Upon the completion of the operation the rope is gradually slackened, while an assistant pulls on the rope of the base of the table which is thus restored to the vertical position. 54 MEANS OF RESTRAINT. MEANS OF SECURING OTHER DOMESTIC ANIMALS. (a) Bovines.—With these animals benignant measures are of little avail. Kindness may in some possible cases—but they will be rarely met with—succeed to a limited extent, but to trust to the influence of the treatment so often effective with an intelligent and docile equine, such as the petting caress, the soothing tone of voice, or the kindly glance of a human eye, with even the placid and mild-eyed milch kine, will be only an act of misplaced con- fidence. To blind them, to induce dizziness by turning them rapidly in a small circle, may at times produce good results, but even then these measures will be more reliable if combined with more palpable agents of restraint. Cattle may be kept quiet in the standing position by raising their heads, by passing the index finger and thumb of one hand into the nostrils, with the arm over the face, and raising the tip of the head upward, while the other hand, grasping one of the horns, moyes the top of the head downward, the resistance of the animal being overcome by pinching the nose with the hand which grasps it with more or less force. By this means the head of the animal is fixed, and the operator guarded against injury from the horns, and the movements more or less limited. While maintain- ing this position, the cavity of the mouth can be examined and even short and simple operations rapidly performed. Another device for preventing the animal from using his horns as a means ri Waim L2Ay Wy > 1S 1S oN . ~ » ) R S x y ~' ~ x ~' ~ a ~, \ = S 1 8 La COEF Gb, N OTTIROZE ae. 2, LLLAD TP , ey ea Boe Ypjosb ING y INS A RS , FIG, 41. Securing Cattle, a (\ pouring we \"g I 2EL2 LLL, aaa Sa ie \ S$: i Wess j N 3 = ZT - i) ‘ a} Oy SECURING OTHER DOMESTIC ANIMALS. 55 of contention is to tie along rope around their base, passing it along the neck and the back with one loop around the ribs and another further back around the flanks, and when reaching the tail securing it there by a knot at the base of that member. The head is thus kept elevated, and he is restrained from motion by the pain experienced by the tail when the rope is tightened by his attempt to flex it. This assures his passiveness (Fig. 42). The practice of shielding the sharp points of the horns with smooth, metallic balls is one which tends largely to diminish the power of the animal for doing harm, by obviating to a great ex- tent the danger from punctured wounds to which those who han- dle them are exposed. The best mode, however, of securing cat- tle while standing, is by tying the head up to a post or a tree, or again by yoking an individual with his mate or another animal of the same species. Kicks must also be guarded against. Those by the fore legs are avoided by raising one foot and tying it on the forearm, thus compelling the animal to stand on three legs. But the hind legs of cattle are the most dangerous from their ability to kick in so many directions, whether backward, forward or outward. Several methods are recommended by which to guard against this form of danger. Among these may be mentioned the passing of the tail forward between the hind legs and then outward, car- rying it towards the stifle of the leg from which the kick may pro- ceed, and holding it firmly with a backward pull; thus surround- “ty * rT! { eae aT RIDAN: Ht i) if V A sift \ ij , Rs 56 MEANS OF RESTRAINT. ing or tying the leg with the tail. Again, to pass a twitch round the leg above the hock, and to turn it until the tendo-Achilles pressed upon, is brought in contact with the posterior face of theleg. A loop of rope twisted upon a stick will answer the same purpose. The use of hobbles, single or double, or of the side lines to secure the hind legs, has also been recommended, as with solipeds, with the difference that the horns furnish a strong means of support, which is entirely lacking in the soliped. A method approved by some of controlling the motion of the animal is to pass a rope on one hind leg above the fetlock, and to carry this leg well forward, or even to raise it from the ground and to tie it by the rope to the forearm of the same side above the knee or around the horns. The use of a long bar of wood held under the abdomen by two assist- ants in front of the stifles ; keeping the animal pressed against a wall by means of a wooden bar, with which an assistant pushes firmly against the stifle of the side opposite to that upon which the operator stands ; binding the animal against a wall with a rope fixed to a ring in front of the chest and one behind the hind quar- ters—all these are simple means employed to keep cattle quiet in the standing position. Some individuals, however, and especially bulls, are altogether intractable, and require more severe and effectual modes of pun- ishment. These are applied upon the muzzle of the animal in his nasal septum by nippers or clamps, or with rings. Nippers are of divers forms. One true, single clamp is commonly used in Italy, and has been modified in England; another is in use in Hol- Fic. 43.—Italian Fic. 44.—Modified Figs. 45 A and B.—Modified English Nose Clamp, English Nose Clamp « Nose Clamps. SECURING OTHER DOMESTIC ANIMALS. ow land, which is a true screw-clamp ; another, which is preferred in France—are a few among the varieties of this single instrument for the application of pressure upon the septum nasi. They are generally secured on the front of the face by ropes or straps. They are effectual appliances, and by their aid the head can be kept up and the animal controlled without difficulty. Among the rings the simplest are most commonly in use. They are made in two parts, articulated at one extremity, and united at the other when in place by a rivet or screw. They vary much both in form and size. Some (though still known as rings) are square; others Fic. 46.—Square (?) Rings for Cattle, are round and elliptical. The ring of Rolland, the Alsace ring, and some of simpler construction carry an auxiliary ring at some part of their circumference with which to secure them on the-face of the animal by means of ropes or straps. These rings are applied after the perforation of the nasal septum with a trocar or a punch-nip- pers, making an opening of a size corresponding to that of the ring. Sometimes the perforation is made with a hot iron, the Fig. 47.—Ring of Rolland. animal being properly secured and tied to a tree, or placed in a yoke with the head elevated, the operator making a quick punc- ture through the cartilage, and introducing the ring and riveting it. The hemorrhage soon ceases spontaneously. In order to dispense with the punch, trocar, and the puncture with the hot iron, rings of a special construction have been in- vented. These also consist of two parts, and are also articulated, 58 MEANS OF RESTRAINT. \ Dy j),) | y Wil C19) Fic. 51.—Rings with Points. (aX SECURING OTHER DOMESTIC ANIMALS. 59 one of the joints haying a sharp point with which the ring is pushed through the cartilage. A simple form represented in Figure 51 shows the point passing through an eye at the other extremity of the ring to be bent over it in order to close the in- strument. The ring used in some parts of France is contrived Fie. 52.—French Rings, somewhat on the same plan, but is more complicated. That of Rueff is a kind of broken circle, which, when closed, forms a per- fect ring in which the branches are kept together by a small screw. Fic. 53.—Ring of Rueff. The rope which is attached to the nasal ring is not always suffi- cient to drive or control bulls, and conductor sticks armed at the end with iron hooks of various shapes are recommended, The apparatus of Vigan is a very simple one, but it fulfils all require- ments and suffices for the restraint of the most vicious animals. It consists of a wooden pole with an iron prolongation haying a wide ring by which to hold it, and at a short distance from this a hook to be inserted into the nose ring. Back of this is a strap to secure around the horns the bar over the top of the head as it passes between the horns. At the other extremity is an iron stifle through which a surcingle is passed to be tied around the body of the animal. Painful, and still easy to apply, this apparatus is not only a powerful means of restraint, but is sufficient to prevent any motion of the head. 60 MEANS OF RESTRAINT. SECURING OTHER DOMESTIC ANIMALS, 61 Fic. 56.—Steer Placed in Stock. The use of stocks for the control of bovines is often also re- quired. These are used principally in shoeing oxen, but are available for some operations which require greater passiveness than can be obtained by the applications of the simpler means above described. It is only in exceptional cases, and when an operation is likely to be unusually painful and prolonged, that the recumbent position is required with bovines. The casting of cattle may be effected with or without hobbles, but in either case special care is necessary to provide asufficiently thick bed to protect the head, and guard against the possible danger of fracturing the horns. A long board placed transversely across the neck, with an assistant. seated on each end, affords an excellent means of controlling his efforts and struggles. When hobbles are used, they must be of smaller size than those used for horses, and should be placed above the fetlocks. To cast bovines without hobbies, either of two methods, one invented by Rueff of Germany, and another described by Gwell and Hertwig, will answer the purpose. In the first, the Rueff method, a rope some thirty-six feet long isrequired, in the middle of which a loop is made and fixed round the base of the horns. The two free ends are then passed between the fore and the hind legs, each being twisted from within outwards, around one of the coronets, and brought back to the loop at the base of the horns, through which they are passed to assistants, one on each side, with directions to pull backwards. The feet are thus brought close together, and the animal seats himself on his hind quarters, 62 MEANS OF RESTRAINT. and finally stretches himself on the bed. If he struggles, the traction on the ropes only expedites the fall. If he pushes for- ward, or attempts to kick or even only moves his feet, the running of the rope is so much more facilitated. In the other mode, a rope about the same length and carrying in one extremity a loop which is thrown over the horns, is passed backwards along the superior border of the neck, as far as about its middle, where a loose loop is made; then carried backwards at the side of the vertebral column, where another loop is made, be- hind the shoulders, and a third one around the abdomen, on a level with the flank, where an assistant holds it backwards by the side of the sacrum. If the animal is to bethrown on the left side, the rope must pass on the right of the base of the tail, and vice versa. Two assistants pull on the rope, while another holds the headand tries to bring the animal down. The traction on the ropes tight- ens the three loops, and under the effect of this force the animal is made to lie down quietly. It facilitates the operation to lubri- cate the rope with a litile grease or soap. In order to avoid complications from lacing the ropes too tightly about the body, itis always indicated to subject the pa- tient to a moderate fast previous to casting by this mode. (6) Ovines anp Caprines.—Although these animals are timid and comparatively lacking in strength, they are at times capable of struggling violently and becoming dangerous, and they can- not be subjected to surgical treatment without being cast. Thisis done by grasping both legs of one lateral biped, the right fore and hind legs, for instance, and laying him over on the opposite side, the left, and vice versa. If all the legs are to be secured, those of each lateral biped are first tied, and with the two cords a straight knot is made, binding all together. - If the seat of operation is the head, the animal is held by an assistant, who sits with the body of the animal between his legs, with its back close to his own body, holding the fore legs with his hands, and controlling the hind quarters between his legs. In some cases when the operation is light, the operator holds the an- imal himself without help. (c) Swrne.—Securing a good hold of this animal is not always an easy task, and it sometimes requires not a little skill and cun- ning to do so. When seized, two assistants are necessary to cast him, especially if he is of large size, and when down, either a muz- SECURING OTHER DOMESTIC ANIMALS. 63 Fig. 57.—Twitch for Swine. zle must be put on his snout to prevent his biting, or a peculiar twitch placed between his jaws and twisted over the upper one. If an examination or operation is to be made about the mouth, a wooden gag placed between the jaws and held with cords, will be found of great utility. Thevarious operations performed upon TO) Fig. 58.—Gag for Swine. the noses of swine, to prevent themfrom digging the ground, may be considered to some extent as means of restraint. The incision of the snout, which consists in making several transverse cuts through it; the nasal tenotomy, though not so successful; the application of rings through the nose, by the same methods as Fic. 59.—To Prevent Swine from Digging. « 64 MEANS OF RESTRAINT. Fic. 59a.—Another Mode. those used in cattle, are simple means which only need mention, be- ing more frequently performed in fact by raisers and breeders of swine, and indeed rather belonging to their special domain than to that of the professional veterinarian. Fia. 60.—To Prevent Dogs from Biting. (7) Does anp Cars.—Dogs can be prevented from biting by muzzling them, or with a eord or band wrapped first around the lower jaw, and then around both, and secured over the neck behind the ears. To examine the mouth in the absence of a speculum, as the one represented in Figure 61, the mouth may be held open by cords passed around each jaw behind their tusks, and pulling them apart. If the animal is dangerous or ugly, the collar nippers SECURING OTHER DOMESTIC ANIMALS, — 65 7 = aa Till tsar” Fig. 62.—Keeping the Mouth of a Dog Open. Fic. 63.—Collar Nippers for Dogs. become very handy, in order to hold them by the neck and keep them under control, whether for operation or for administration of medicines. Cats are most difficult to handle. They bite and they scratch, and they are often unconquerable until they are fully subjected to general anesthesia. In many instances, the co-operation of a good assistant, accustomed to handling them, may be found necessary. They may sometimes be madeamenable to treatment by grasping them by the neck behind the ears, and close to the head with one hand, and securing the fore paws with the other, while a second assistant holds the hind legs, or it may become necessary to have the four paws tied tightly together, and only the head held by the assistant. We have heard of the utilization of a man’s boot as a means of feline restraint, particularly in the castration of the male, or “Tom,” the head and body of the animal being thrust into the leg 66 MEANS OF RESTRAINT. of the garment, leaving only the posterior portions exposed and accessible to the operator. This may not be a scientific device, but its effectiveness can hardly be doubted. SURGICAL ANESTHESIA. A resort to the various means of restraint, which we have been considering, is sufficient in a majority of cases to bring under perfect control such animals as require to be subjected to surgi- cal treatment. But there is a class of cases in which they become inadequate to meet the great requirements of inducing in the pa- tient a condition in which a great diminution, or the entire suspension, of sensibility and consciousness, with all power of muscular reaction, is established throughout the organism. This result is obtained through the characteristic action of the special therapeutical compounds, known as anesthesia. It is not merely as a more effectual means of securing control over refractory patients that their administration is justified. Itis also prompted by a proper humanitarian feeling in cases in which severe and prolonged suffering accompany the operation. In veterinary surgery, the indication for anesthesia, has not, to the same extent as in human, the avoidance of pain in the patient for its object, and though the duties of the veterinarian include that of avoiding the infliction of wnnecessary pain as much as possible, the administration of anesthetic compounds aims prin- cipally to facilitate the performance of the operation for its own sake, by depriving the patient of the power of obstructing, and perhaps even frustrating its execution, to his own detriment, by the violence of his struggles, and the persistency of his resist- ance. ‘To prevent these, with their disastrous consequences, is the prime motive in the induction of the anesthetic state. That it per- fectly succeeds in fixing the patient in the attitude most favor- able for the surgeon in the execution of the various parts of his task, needs no affirmation, nor need we attempt to measure the value of the discovery, which has proved itself to be such a price- less benefaction to the world. There are special cases where anesthesia is more particularly necessary than in others, and where absolute immobility of the patient is essential, and entire muscular relaxation indispensable. Thus it is indicated in the reduction of fractures or dislocations in SURGICAL ANESTHESIA. 67 the large domestic animals; in cases of delicate manipulation and dissection with sharp instruments, as in the operation for strangulated inguinal hernia; in the reduction of other hernial tumors, in the performance of neurotomy; in operations upon the eye, and in the removal of tumors of certain kinds. Itis also indicated in certain operations upon the foot, which are always accompanied with great pain, such as that for the extirpation of a portion of the quarter of the foot, in the removal of the cartilage affected with necrosis (quittor); or again, in deep punctured wounds of the sole, where the resection of the plantar aponcurosis becomes necessary, or the bones are scraped with the knife. The anesthetic condition is also very favorable for the reduc- tion of displaced organs, as of a prolapsed rectum, or uterus, or bladder. In operations upon the teeth, in some cases of parturition, in castration, in firing, or even in the application of hobbles, the induction of the anesthetic state has often been of great benefit in quieting nervous animals, and subduing them to a condition of passiveness, which relieved the movements of the surgeon from all embarrassment and uncertainty. As with human patients, anesthetics are contra-indicated in animals subject to diseases of the heart or of the lungs. A full stomach is also always a contra-indication of their administration, especially in solipeds, which are lacking in the ability to relieve it of its contents by vomiting. Anesthesia may be either local or general, according to the area of its effects. Local, when applied to the skin over a limited surface, to which its effects are confined ; and general, when ad- ministered by inhalation, and through the respiratory organs in- fluencing the entire economy. In local anesthesia the effects are obtained either by the pulveri- zation of the proper substance upon the region where it is required to take effect, or by the subcutaneous injection of special agents. General anesthesia is usually produced by the inhalation of the vapors of ether or of chloroform. LOCAL ANESTHESIA. The special indications for this are so numerous that they may almost be considered as general, if not universal, and its applica- tion is so simple and easy a process, and its effects usually so cer- 68 MEANS OF RESTRAINT. tain, that it would become the practitioners of our day to utilize it more frequently and extensively than they do. It is available as well as useful in the simplest operations, and may be employed in the opening of abscesses and cysts; in the puncture of cold abscesses with the hot irons; in the puncture of the cornea; in neu- rotomy ; in simple incisions of the skin; in the removal of small tumors, etc., etc. We have used it with the best results in ureth- rotomy, in caudal myotomy, in amputation of the tail, and the removal of mammary tumors in dogs, ete. Bouley long ago rec- ommended its application to surgical diagnosis, in cases of doubt- ful lameness, an expedient which has recently been introduced into this country by several veterinarians, for the differential diagnosis of shoulder and foot lameness. We have remarked that the anesthesia can be produced in several ways, though two are principally in use. Among these properly termed minor and secondary expedients, are the applica- tion of cold water or ice, and cooling or freezing mixtures, and pressure upon the blood-vessels and nerves, which have for years been among the adjunct and agencies of surgical practice, but have given place in recent times to methods more potent and more certain in their effects. Notwithstanding this, however, some mention of their nature and qualities, and the methods of utilizing them will not be out of place, if only as a matter of gen- eral reference, and a case might arise in practice when the infor- mation might become practically valuable. Ist. Pulverization of an Anesthetic Liquid.—The apparatus employed for this process is the invention of Dr. Richardson, and though the spraying tube has been from time to time more or XQ Fia. 64.—Richardson Atomizer. LOCAL ANESTHESIA. 69 less modified, the mode of its employment continues unchanged ; though any substance susceptible of easy pulverization may be employed. Ether is the agent most frequently chosen. Rigolene has given us great satisfaction in our own practice. In impinging upon the skin ina state of excessive division, the rapid evaporation of the liquid lowers the temperature of the surface with which it comes in contact, and it is this process of refrigeration which diminishes the local sensibility, and, as the effect increases, overcomes it entirely for the time being, or so long as the spray continues to be thrown upon the part. Some slight objections, however, may be alleged against this © mode of producing insensibility, arising from the special proper- ties of the fluid employed, and for this reason the mode by sub- cutaneous injection is somewhat to be preferred. 2d. Subcutaneous Injections.—Both ether and chloroform have been recommended, and extensively used, in this manner, but without doubt the salts or compounds of cocaine possess ad- Fic. 65.—Syringe of Prayvaz. vantages over either of them. An epidermic syringe, or that of Pravaz, is generally used for the purpose, with a solution of from four to twenty per cent. strength, according to circumstances. If used on a tumor a certain quantity of the solution, perhaps twenty drops, is injected under the skin at two or three points around its circumference, the desired effect following, and the parts being ready for the operation within from eight to ten minutes, more or less, according to the strength of the dose administered. Hither of these modes of local anesthesia is harm- less, and may be employed without risk or fear of complications. 70 MEANS OF RESTRAINT. GENERAL ANESTHESIA. The three principal agents which recommend themselves by the efficiency and certainty of their action in producing general anesthesia, are ether, chloroform and chloral hydrate. Their adaptation varies, however, with the animals subjected to their administration, Chloroform and chloral are chiefly used for the larger animals, principally horses, while chloral and ether are re- served for the smaller kinds, with which chloroform is so generally dangerous, and even so often fatal, that its use with them is almost entirely discarded. Insensibility by Anesthetic Vapors.—The modes adopted for the inhalation of the vapors of chloroform are numerous, but among them all the merit of simplicity should probably be award- ed to that which is recommended by Bouley. This consists in the introduction into each nostril of a small sponge, or a ball of oakum, saturated with the ether or chloroform, and held in place by the hands of assistants. The inhalation of the vapors, which are thus mixed with air, proceeds rapidly, the sponges being recharged as soon as they become exhausted, and returned to the nostril, until the object in view is accomplished. But while this mode is a very convenient one, we conceive it to be liable to certain objections. First, unless the pouring of the liquid is very carefully per- formed and in such quantity that the sponge is not over-saturated, there is danger that a large portion of it may be wasted, by run- ning off, either on the bed, or possibly, into the nostrils, causing, in the latter case, great irritation of the mucous membrane. And if the anesthesia is to be continued for a considerable length of time, the effect produced upon the delicate membrane of the nose may be sufficiently serious to end in the sloughing of the parts. It must certainly have been with the view of avoiding this complication that Defays invented the inhaler shown in figure 66 with its wide range of application, from the dog to the horse. Many veterinarians have adopted an arrangement consisting of a strong leather muzzle with large openings at its bottom and sides for the free admission of the atmospheric air, the sponge or oakum charged with the chloroform or ether being placed in the bottom of the muzzle, which is fixed upon the animal’s head in the GENERAL ANESTHESIA. (il Fig. 66.—Apparatus of Defays. ordinary way. This is a very convenient, though quite a simple contrivance, but English veterinarians, and among them Mr. R. Cox, recommend in preference a chloroform-bag, in the form of an ordinary bag, made of strong canvas, both ends of which can be closed by a running string, one being tied around the nose 7 Yi Y fp, Wiffft FIG. 67.—Cox’s Chloroform Bag in Position. while the bag is secured by cords to the halter or to the straps of the cap. The chloroform is introduced into the bag by means of a thin piece of cloth saturated with the liquid. The chloroform nose-cap recommended by Mr. Gresswell also answers a very good purpose, and in fact, possesses advantages which render it superior to the apparatus of Mr. Cox. It is not so portable in its form, but is more durable in its construction. In fact, it produces the features of the ordinary stable muzzle which we have already mentioned. The apparatus of Carlisle is also one of English invention, for which great merit is claimed. We have used it, and the trial has shown it to possess many features of marked superiority over the others. The quantity of liquid required to bring a large animal under complete general anesthesia cannot be positively ascertained. 72 MEANS OF RESTRAINT. n i) hy : : sa Fic. 68.—Gresswell’s Chloro- Fic. 69.—Carlisle’s Chloroform Inhaler. form Nose-Bag. While it has often been induced by the inhalation of a single ounce, there are cases in which two, three, or even more have been necessary. An essential point to consider is that the chloroform should be absolutely pure. Mixtures of two or more drugs have also been employed, usually ether and chloroform, with or without the addition of alcohol, but the result of all ex- perimental tests has been, with us, to establish the conviction, that as yet, chloroform used singly has proved itself to be the most effective and the safest of all. The administration of chloroform of course pre-supposes, besides all the other conditions and preliminaries of an operation, such as previous fasting, the preparation of the bed, and other incidental steps, the act of throwing the patient. ; When the effects of the inhalations begin to become manifest, the first physiological change noticed is an extreme agitation, accompanied with coughing. The animal struggles more or less violently, the irritation and tickling of the throat produced by the vapors upon the laryngeal mucous membrane, giving rise to a spasmodic motion of the glottis, and whether the patient be a oe 4 GENERAL ANESTHESIA. fo large or a small animal, he exerts his strength to rid himself of the apparatus and regain his freedom of motion. These manifestations are, however, but of short duration, and are soon followed by a state of passiveness, the respiration be- coming easier, the cough disappearing and his energy subsiding ; and in short, he is subdued. The eye then assumes its character- istic expression, its brilliancy is lost, it is wide open, the pupils slowly dilate, the gaze becomes fixed, the sensibility of the cornea is lost, and the light ceases to effect it. The mouth becomes more or less loaded with saliva; the pulse, which must be carefully noted by an assistant, becomes slow and weak, the respiration returns to its normal condition; the state of complete anesthesia has been reached, and the patient, in happy unconsciousness, is ready for the surgeon. The time required to reach this condition varies with the sub- ject, and especially with the quality of the drug administered. The average period is from one to five minutes in small animals, and from ten to fifteen in the large. In some few cases, however, half an hour may elapse before complete insensibility is produced, and again animals are encountered with peculiar idiosyncrasies, which remain entirely refractory, and successfully resist every attempt to reduce them to insensibility; a statement equally true when applied to human patients. The duration of the Anesthesia.—Some animals remaining under the influence only for a few minutes, sometimes from fifteen to thirty or forty, it becomes necessary to prolong the insensibil- ity by renewing the inhalation, and they must, therefore, be con- tinued until the completion of the operation. Recovery from the anesthetic state does not always take place immediately and per- fectly. As the effect begins to subside, the animal, having parti- ally regained his senses, begins to move his eyes, raises his head, perhaps allows it to fall back slowly on the bed, lying flat on his broadside ; then his legs begin to move, and presently he attempts to spring suddenly to his feet. He may succeed in doing so, but again, his muscles may not have yet recuperated their power of full action, and there may be danger of his experiencing a heavy fall on the bed. His condition is one of drunkenness, and he re- quires to be watched, and, if necessary, aided, in order to prevent him from injuring himself by efforts beyond his strength while in a state of weakness of which he is unaware. 74 MEANS OF RESTRAINT. The symptoms of general anesthesia by chloroform, which we have detailed, are those of ordinary cases. There are, however, other symptoms which the vigilant operator will not fail to look for, which are of great importance as indicative of the dangers, and premonitory of some of the casualties incident to the situ- ation. These we reserve for subsequent consideration. Anesthesia by the Administration of Chloral.— While this drug and its compounds, as sometimes used, produces in some cases a condition of insensibility quite as complete as that ob- tained by chloroform or ether, yet there are cases in which only a less complete degree of success can be secured, though still suffi- cient to be of great assistance to the surgeon as well as of relief to the patient. That the intra-venous injection of chloral has been shown to be the best of all modes of obtaining anesthesia, is an admitted truth, but unfortunately it is a method of introducing it into the system which will scarcely ever become sufficiently prac- ticable to be available outside of the laboratory. Efforts to over- come the difficulty referred to have not been wanting, however, and Messrs. Cadeac and Mallet have experimented with chloral by combining its action with that of muriate of morphine. By first injecting subcutaneously a certain quantity of a solution of mor- phine, and following it after a few minutes by a rectal injection of a solution of chloral, they have obtained complete anesthesia in a very short time. Fora horse they have used eighty centi- grammes to one gramme of the morphine, and from eighty to one hundred grammes of chloral; and, for a dog, ten centigrammes of morphine and twenty grammes of chloral. The administration of chloral in the form of balls, as commonly practised by many veterinarians, in doses varying from one to one and a half ounces, given on an empty stomach, and from one to two hours before the operation, is undoubtedly good practice. We have not personally had the opportunity of testing it m cases of long and tedious dissections, but the benefit we have often de- rived from it in short, though painful operations, justifies us in recommending it, not only for this very object, but in any case, where, from any possible cause, an animal is likely to receive severe injuries during his struggles to liberate himself. dle dnd 4 Pa ¥ ACCIDENTS OF GENERAL ANESTHESIA. 75 ACCIDENTS OF GENERAL ANESTHESIA. Notwithstanding the caution observed in the use of ether or chloroform, and however pure these articles may be, accidents must be expected during their administration. They are not always of a serious nature, but they may at times have fatal results. Among those of minor importance is the cough which becomes at times quite troublesome, but may be readily subdued by a tem- porary arrest of the inhalation ; vomiting, which often occurs in small animals, but which can be guarded against by causing the patient to fast long enough to insure an empty stomach before being etherized, and spasmodic contractions, of which the exis- tence, when undoubtedly present, is often overlooked. Among those of more serious nature are syncope, either cardiac or res- piratory. Cardiac syncope is a very serious accident, and in a majority of cases proves fatal, especially in large animals. It is sudden in its manifestation, and often unobserved until at too late a period of the operation. Itis due to a gradual diminution, followed by an arrest of the muscular contractions of the heart, and as far as our observation extends is always associated with pre-existing heart disease. The application of cold douches, of heart stimu- lants, ammonia given by inhalation or internally, are the first in- dications in these cases. Respiratory syncope, which is far less dangerous, arises from the influence of the laryngeal nerves upon the activity of the res- piratory centers. Its access is sudden, being caused by the arrest of the respiration. There is no convulsion, though the intoxica- tion produced by the anesthetic vapors is sudden in its gs and is generally detected only by careful watching. The application of electricity, that of the electro-puncture, and especially persevering efforts to effect artificial respiration, may sometimes saye the animal, provided the trouble is not connected with the complete arrest of the contractions of the heart. In view of these possible incidental conditions, some general rules suggest themselves tending to their avoidance. Great care and exactness in gauging the doses of the anesthesia, with such caution in their administration as to produce a slow and gradu- ated effect, is one point. Free allowance for the introduction of air with the vapors inhaled; close attention to the state of the 76 MEANS OF RESTRAINT. circulatory and respiratory apparatuses, and the manner in which their functions are executed, by ncticing the heart-beat and watch- ing the pulse and the movements of respiration at the flanks, are other points of importance. Another point is the need of bearing in mind that an animal submitted several days in succession to general anesthesia be- comes more and more susceptible to its effects, and therefore more exposed to the dangers they imply. ACCIDENTS INCIDENTAL TO THE USE OF MEANS OF RESTRAINT. We have already considered some of the accidents which are likely to interfere with the successful application of the means of restraint, and especially with reference to the final act of the pre- liminary series which occur at the moment of throwing the animal and depositing him on his bed, particularly such as may follow the neglect of properly protecting the head with the cap or blinkers, or by an unnecessarily prolonged use of the twitch, or from the sudden and violent movements of the animal himself. These can usually be obviated by proper forethought and watch- fulness. But the most careful attention cannot always assure immunity from miscarriage and casualties. Thus, a common mis- hap, and one which cannot be anticipated nor prevented, is the sudden and heavy fall of the animal just as his equilibrium is lost. The lesions which may follow this casualty may have their seat either in the hard or soft structures, and are of the most serious character, not only including, at times, fractures and dislocations, and lacerations of the soft tissues, including the muscles, but may affect the viscera, and even the blood vessels and the nerves—in this last case involving the parts in all the evils of local paralysis and its disabilities. (a) Fractures. This form of injury may have its seat in the vertebral column, the ribs, and the bones of the extremities. Ist. Mractures of the Vertebral Column.—In the list of frac- tures, those of this region of the body are the most frequent. The numerous reports of cases which are made public by veterin- ary writers furnish sufficient evidence of the facility and frequency of their occurrence, even when the most careful attention has been ACCIDENTS DUE TO RESTRAINT. citi bestowed on all the details of the work of casting. The very peculiar circumstances under which these spinal fractures some- times take place, baffling calculation, and occurring when least expected or prepared for, illustrate the responsibility which the veterinarian assumes, and the culpability with which he would become chargeable by undertaking the work without due caution and preparation, or without notifying the owner of the animal of all the hazards and difficulties attending the case in all its steps and stages. As will be seen when we come to the consideration of this special lesion in the chapter on fractures, the symptoms which accompany this accident are distinguished, as to one feat- ure, by the suddenness of their appearance, which takes place at the moment of the infliction of the injury or immediately after. But the most important of the characteristics of the case is the grave fact that the fracture is almost always of the comminuted kind. This is held to be due to the excessively powerful mus- cular contraction, resulting in the over-arching of the vertebral column simultaneously with pressure from the abdominal organs, caused by the sudden extension of the anterior and posterior bipeds, bound together with hobbles, the violence of the siruggle so powerfully pressing the vertebree together as to result in the yielding of their spongy structure; and the crushing or grinding of the bone is the consequence. This theory of the production of fractures of this character has been adopted by the majority of European veterinarians, es- pecially by those of France, where it is understood as ‘“Bouley’s Classical Theory.” In 1889, however, another theory was pro- pounded and defended by Mr. Moussel, of Alfort, differing en- tirely from that of Bouley, in which he claims that the kind of fracture in question is not caused by an over flexion of the spine, but, on the contrary, is the effect of an excessive extension / result- ing from greater contraction of the ilio-spinalis muscle. According to Dickerhoft, “three factors are active in the cau- sation of these fractures. In the first place, the animal must have some object as a point @ appui for one hind leg; that point must be connected with either one of the other extremities or directly with the trunk. * * * Secondly, the horse must make his vertebral column tense by the contraction of the spinal extensor muscles. * * * Thirdly, the horse must, simultaneously with the extension of the hind leg and that of the vertebral column, draw its pelvis 78 MEANS OF RESTRAINT. to one side. * * * But no one of these three elements, in itself, will produce a fracture; they must all concur.” Whatever may be the value of these theories, the fact that at post-mortem examinations fractures have been discovered, in some cases in the annular portion, and in others in the body, seems to prove that any one of them is equally applicable with another. To prevent these fractures, therefore, becomes the principal object of the surgeon at the critical moment when the animal is thrown. This involves a strict attention to the rules which we have laid down for his guidance in the various steps of the act of casting ; and, moreover, to have recourse, as often as possible and as the indications suggest, to the aid of anesthetic agencies, and by no means to ignore the value or neglect the use of the appa- ratus of Bernardot & Buttel. 2d. Hractures of the Ribs.—These fractures are undoubtedly frequent, as the result of heavy falls upon a badly-made bed—too hard or too thin, or perhaps concealing hard substances, as stones or the like. 3d. Fractures of the Pelvic Bones.—There are but few cases on record of this kind of injury, but they are possible, as the re- sult of carelessness in the preparation of the bed or improper casting, or powerful muscular contraction. 4th. Fractures of the Bones of the Hxtremities.—Though prob- ably less common than those last referred to, these lesions are not unknown in veterinary practice. They occur principally in the diaphyses of bones, or near to, or at the epiphysis, and are often in- complete in their nature. Delafond describes a case of fracture of the femur taking place during the application of the clamps while undergoing the operation of castration ; and another case is recorded of which the trochanter of the femur was the seat. Rey has reported a case of fracture of the cubitus taking place as the animal, when freed from the hobbles, made a violent effort to spring from the bed upon which he had been thrown to be fired for a chronic enlargement. These fractures of the extremities may be avoided by careful attention, not only at the time of throwing the patient, but in placing him in position and in properly securing him, and giving him judicious assistance in regaining his feet. 5th. Dislocations. —These accidents are of very rare occur- rence. One case, however, is recorded of a dislocation backwards of the humerus, complicated with fracture of the cubitus. INJURIES TO SOFT TISSUES. 19 (0) Insurtes to Sorr Tissvgs. Ist. Lacerations of Muscles and their Annexes.—These are the result of the distorted positions into which the extremities are forced while undergoing operations. They may be discovered immediately, or may be developed a few days after the operation. Inflammation of the olecranean and pectoral muscles, of those of the croup, and of the anterior part of the shoulder have been re- ported. Bouley has seen a rupture of the aponeurosis of the great and of the small oblique muscle of the abdomen, and one rupture of the flexor metatarsi. A case of laceration of the diaphragm is recorded by Bouley, Jr. In one of our own patients, laceration of the olecranean muscles was followed by such severe complications, that it became necessary to destroy the patient. 2d. Ruptures of the Viscera.—These are of rare occurrence, being generally prevented by the precaution of refraining from. throwing the animal, until assured of an empty digestive canal by previous fasting. Accidents, however, have been witnessed by Gohier, who has noticed their occurrence upon the rectum near the anus. This horse had drunk freely of water before being east. Bouley, Jr., has seen a case of rupture of the diaphragm. Rey has known one of the heart, Schaak one of laceration of the humeral artery, and eyen the giving way of the vena cava, in a case of anervous animal upon which means of restraint were being applied to dress a small wound. The patient suddenly fell, and, struggling violently, died ; and at the post-mortem the abdomen was found full of blood, and the vein torn back of the kidneys. 3d. Injuries to Nerves.—These are accompanied with loss of power, usually temporary, but sometimes permanent. The posi- tion in which it is sometimes necessary to fix an animal, as in the diagonal, is that in which they are most likely to occur. The symptoms of paralysis which are then manifested, betray them- selves when the animal has just risen from the bed, when, upon being called upon to move, the leg is discovered to be unable to carry its weight, flexing upon its various bony levers, and render- ing locomotion impossible. Sometimes these symptoms are of but short continuance, and disappear under the influence of strong stimulating frictions. The leg was, according to the popular phrase, “asleep,” because of a temporary arrest and sluggishness of the circulation. But in other cases, the condition is brought 80 MEANS OF RESTRAINT. on by a true lesion of the nerves, the brachial, the lumbar plexus, or some of their branches having undergone some traumatic hurt which may prove more or less refractory to treatment. 4th. Asphyxia.—According to Peuch and Toussaint, this ac- cident may result from the ignorance of assistants, who, in con- trolling the animal and keeping him down on the bed, have com- pressed the nostrils too tightly ; or again it may be caused by the excessive pressure of the throat straps of the halter, or of the rope which encircles the neck when a horse is placed in position for castration. To explain the causes of this accident should be, with an intelligent operator, sufficiently to hint the means of prevent- ing its occurrence. Conclusions.—A review of the matters we have been considering in this chapter may not be out of place, nor unprofitable, even at the risk of being, perhaps, a little repetitious. In view of the oc- currence of these accidents, and appreciating the responsibility assumed by the surgeon when about performing an operation upon a more or less valuable animal, he cannot but be conscious of the obligations which impose themselves upon him to take every precaution to avoid them. He should therefore guard against their eventual contingency, by closely inquiring concerning the condition of his patient, and by satisfying himself that every part of the apparatus of restraint is in good order; should avoid rough treatment and employ anesthesia when possible, and never put an animal in a constrained position for treatment when an operation can be otherwise performed more advantageously and easily and comfortably to his patient, and he should never allow him to re- main in his restrained and compulsory recumbent position longer than is strictly necessary. And above all, he should never under- take an operation without having fully acquainted the owner of the animal of the possibility of accidents. The fact of thus ex- plaining matters to an owner, and of obtaining his intelligent con- sent does not, of course, relieve the surgeon of his responsibility, but rather, on the contrary, confirms and increases it by thus add- ing a new, though an implied pledge to his employer to devote his most conscientious endeayors and exercise his best skill in the matter, in token of his appreciation of the confidence placed in his skill and faithfulness. da -. «“ oS ae CHAPTER IZ. SURGICAL) DIAGNOSIS. The first query to be settled in examining a diseased animal is whether the ailment with which he is attacked is merely a case of disordered function, requiring only the administration of the proper drugs to restore the usual order of things, or a case de- manding the operative skill and expert ministrations of the sur- geon, with bistoury and cautery and suture. The decision of this query involves a thorough knowledge of anatomy, and is compara- tively more difficult, as well as more important, than the mere medical diagnosis of diseases pertaining to internal pathology. Errors in surgical diagnosis are always both more dangerous and more important than those of a mere medical character, inasmuch as they are likely to be more readily exposed, and to involve a greater amount of responsibility on the part of the surgeon. To insure the certainty of his diagnosis, the surgeon must call into exercise all his resources of knowledge and experience, and employ all his faculties of observation and discrimination, with such instrumental aid as may serve to facilitate and confirm his conclusion, as to the nature of the cases before him. He must especially employ all his organs of sense in the investigation. A single sense is sometimes sufficient to diagnosticate the character of some special lesions, but more commonly each sense is an auxiliary of the others, and all are complementary to each. In fact, the surgeon is not justified in reaching a conclusion as to the detection of an affection, which is discovered by the sight, or touch, or smell, or hearing, alone, but to escape the possibility of error, he is bound to confirm his discovery by the corroboration of another, or what is still better, of all the others, if possible. In these cases, as in others, the eye is the most valuable and comprehensible of the organs. Ist. Sight.—Visible changes of contour, or color, or other deviations from the usual appearance of tissues, or of regions, are of course first made known through the sight of the eye. De- formities, unless of very minute dimensions, with abnormal 82 SURGICAL DIAGNOSIS. growths, prominent swellings and changes of direction in the bony levers, belong to the same category, and if these are not suf- ficiently distinct or conspicuous, and seem likely to escape the visual observation of the surgeon, a careful measurement may de- cide the point. The eye must also discern the changes occurring in the various visible membranes, as for example, the heightened redness of a congested membrane, and the paleness of an anemic subject. Again, if there is abnormal motion in a part, as in fractures and dislocations, it is to the eye that the disclosure is first made. This application and study of the use of his eye will be very serviceable to the surgeon in the examination of the external sur- face of the body, but when examinations within the organism, or within its cavity, become necessary, however strong a light he may have at his disposal, he will be compelled to have recourse for assistance to the speculum, to hold the parts open. There are many forms of this instrument. The speculum oris, for the mouth, has very numerous shapes, some of them very simple, as in Figures 70 and 71, and some com- a ee CAUDAL MYOTOMY. 305 FIG. 323.—Elevating the Tail with Pulleys. also has the advantage of equalizing the strain on the hair. In respect to the amount of weight to be employed in this process, much caution must be exercised in order to avoid excess. An error here might cause the loosening and loss of the hair, with the troublesome consequences of greatly interfering with the final result at the cost also of much suffering to the horse. The cord should run freely through the pulley and be of sufficient strength to allow the animal to lie down if disposed to do so. It will be a prudent precaution to accustom the animal to the use of the pul- leys by placing them on him for a few hours daily for a short pe- riod in anticipation of the operation. It will be necessary—as we before remarked—for the horse, after that, to remain in the pul- leys not less than two, and possibly three or four weeks, although after a short time he may be relieved for the purpose of taking proper exercise. The Bartlet’s apparatus recommended by G. Fieming may also give very good results (Fig. 324). Caudal myotomy is an operation, which, though simple in it- self, may be followed by numerous and, at times, severe compli- cations. Out of one hundred and forty-one animals operated upon by Hering, four died from either gangrene, severe petechial fever or suppurative infection. Among the most common acci- dents met with are the following : aad rs wey Ler eae ie 306 OPERATIONS ON MUSCLES AND THEIR ANNEXES. Fic, 824.—Bartlet’s Apparatus, Separate and in Position. Ist. Hemorrhage, which is not generally serious, taking place mostly ‘when the tail is loosened and allowed to hang down, and. ceasing as soon as itis again placed in an elevated position. It is but seldom that it becomes necessary to interfere for the pur- pose of arresting it, which is easily effected by the ordinary means, as pressure or the application of hemostatics. 2d. Gangrene is one of the most dangerous sequele of the operation, whether resulting from excessive traction on the tail by the heavy weights, a dressing too tightly applied, or excessive inflammation, or, according to Hering, to the completed section of all the arteries supplying the tail. When becoming gangren- ous, the wounds assume a brown or blackish appearance, the sup- puration becomes sanious, with a repulsive, swt generis odor, the tail is swollen and flabby, and the oedema surrounding is cold and puffy. The gangrenous process generally begins toward the end of the tail and progresses rapidly, endangering in time the life of the patient. It is often only by the most energetic measures that it can be controlled, such as the free use of antiseptics, scarifica- tion, cauterization, or even amputation. 3d. Wounds of the Vertebrve and of their Ligaments.—These injuries, not so serious in their character, are usually produced by the contact of the knife during the operation, causing a scraping of the bone and wounding of the periosteum or the ligaments which unite the vertebre. Another injury is a re- sulting necrosis caused by the formation of a fistula, from which a thin sanious pus is discharged, and which forms a wound which refuses to cicatrize. Though Zundel affirms that this complica- tion is most common after the subcutaneous operation, long experience with this process fails to justify our agreement with ' CAUDAL MYOTOMY. 307 this assertion. When disease of the bones exists, the indication is to promote the exfoliation of the necrosed parts by free open- ings, antiseptic dressings, and, if necessary, caustic injections. Anchylosis of the vertebree is a common sequel of this complica- tion. 4th. Adbscesses.—These suppurative collections are not uncom- mon, especially in animals having peculiar idiosyncrasies, as in cases of strangles. They may extend to the root of the tail, around the anus, or any part of the hind legs even to the rectal region. They require treatment similar to that of all analgous gatherings. 5th. Anal Fistule.—This accident occurs when the first in- cision is made so near to the anus that it enables the pus, when it forms, to filtrate between the skin and the rectum into the pel- vic cavity, and is a condition which can be relieved only by giving free exit to the collected suppuration. 6th. Zetanus.— This termination can, in many instances, be avoided by antiseptic measures during and after the operation. Tth. The introduction of air into the veins is also mentioned by Loiset and Brogniez, but in our opinion there is no more reason to expect its occurrence in this than in any other operation. 8th. Hxaggerated Elevation of the Tail._—This is one of the most common of all the sequele met with. In this case the tail, instead of being carried horizontally and hanging gracefully, is, on the contrary, either elevated vertically, or even laid back on the croup. This is not precisely due to improper manipulations during the operation, but is rather the result of the application of too heavy a weight and an excessive amount of traction while the animal is in pulleys. The most effectual way of avoiding this un- pleasant incident is to watch closely the progress of the cicatri- zation by taking the patient out for exercise and watching the manner in which he carries his tail, and then increasing or di- minishing the weight on the pulley, and shortening or lengthen- ing the period of its use. Operation for Abnormal Deviation of the Tail—This is in- dicated where there is a lateral curvature of the tail, and the animal carries it sidewise, whether it be a congenital habit or oceurs as one of the complications of pricking; and also when he carries it in an excessively elevated position. In these cases myotomy is performed, according to the requirements, either on 308 OPERATIONS ON MUSCLES AND THEIR ANNEXES. the lateral caudal muscle on the side to which the tail is carried, or upon one or both of the superior sacro-caudal muscles, the elevators of the tail. Asa rule, one incision only is necessary, and it must be done subcutaneously, and in the subsequent treat- ment, instead cf placing the animal in pulleys, the tail must be tied up to the surcingle on the side opposite to that of the opera- tion; or it may be allowed to hang down free. An experience on our part of many years, has rendered us skeptical as to the success of lateral caudal myotomy, a careful dissection of the tails of animals affected with this deformity having proved the existence of an abnormality in the formation and development of the caudal vertebrze which has been either the cause or effect of the trouble. Operations performed upon animals of this class have not been usually followed by a satisfactory result. CRURAL MYOTASE—CRURBAL MYOTOMY. This affection is peculiar to bovines, and is a species of dis- location, or displacement of the long vastus muscle—the external ischio-tibial. It is a lesion which forms a very serious impediment to the act of locomotion, by its disabling effect upon the movements of the hind leg. The nature of crural myotase will be understood by those who are familiar with the anatomy of the region in cattle. With them, the biceps femoris covers, in its normal position, the whole of the coxo-femoral joint, in such a manner that its anterior border (a 6), Fig. 325, is situated in front of the jomt. This border, from the articulation to its lower end, forms a kind of tendon, (ce) closely connected with the aponeurosis of the fascia lata, (f) whose divided layers surround the muscle, adhering intimately to its two faces, the deep and the superficial. Passing over the trochanter of the femur, with the assistance of a large mucous bursa, the biceps is quite thin, and is kept in position by an aponeurosis (c) which partially covers the gluteus externus, and is united to the fascia lata. When this aponeurosis is lacerated at a point on a level with the hip joint, while the leg is carried backward, in excessive ex- tension, it is possible that the trochanter, thus carried forward, may become engaged in the laceration, the biceps itself being hooked, as it were, behind the trochanter, and prevented from re- CRURAL MYOTOMY. 309 FG. 325.—The Biceps Femoris in Cattle. Fia@. 326.—The same over the Normal Position. Trochanter. turning in its normal direction. This accident has been noticed and mentioned in the remotest ages. It may result from both predisposing and occasional causes. Among the former may be reckoned the conformation of the animal, as when, for example, the croup is short, flat and narrow, the hip joint not prominent, and the trochanter high. Among the predisposing causes may also be included that of leanness, as when the animal is thin and in poor condition, and the cellular tissue deficient. The combina- tion of these causes renders it easy for the muscle to slip over the trochanter, now relatively prominent, and it is thus that the dis- location occurs. Occasional causes also call for mention. These include all mischances likely to bring about the excessive extension of the leg, such as falls, missteps, slipping, jumping, kicking, blows, etce., any of which may thus affect the limb and produce the lesion under consideration. And withal, it may take place without any visible, direct and efficient agency beyond the circumstance of the excessively lean condition of the animal, and even if the difficulty is remedied, and the displacement is reduced, while the same state of things continues, there is a constant liability to a return of the difficulty. 310 OPERATIONS ON MUSCLES AND THEIR ANNEXES. The symptoms characteristic of this lesion are readily identi- fied. Principally, there is great difficulty in flexing the hip joint. The diseased leg is dragged on the ground,‘carried outward and backward and the animal resting it on the ground by the point of the hoof only. It very much resembles the position of a limb of a horse suffering with a dislocated patella. The anterior border of the muscle, hooked by the trochanter, forms a longitudinal projection, resembling a stretched cord, which becomes more and more marked when examined nearer the coxo-femoral joint. It can be made more prominent by raising the opposite leg, when it will be found extending obliquely downward from the joint to the patella. As the trochanter is no longer covered by the muscle, this bony eminence becomes directly subcutaneous, and may be readily recognized, holding posteriorly the displaced muscle, which forms a kind of tumor behind it. These symptoms, being rarely associated with inflammatory phenomena, are not always easy to detect. There are cases where the lameness, and the carrying of the leg outward and backward, are the only apparent symptoms. The lameness, however, is. characteristic, and may be temporary or intermittent, being more severe when the animal is traveling up-hill than when descending, but remaining the same on both soft or hard ground; and it sometimes happens that while the animal is in the act of descend- ing, the muscle will suddenly return to its place with a clapping sound, and the lameness subside, though only to return again as soon as the slightest effort is required of the animal, and bis hind leg is again carried backward more forcibly than usual. This peculiar intermittent character is sometimes the cause of an error of diagnosis which confounds this affection with the dislocation of the patella, but the exploration of the stifle will always serve to establish the differential diagnosis. This accident is more or less serious in its consequences, and is particularly detrimental to the usefulness of working animals. It may sometimes, however, subside spontaneously or by simple rest, and especially if the condition of the animal is improved by good feeding with fat-producing fodder. Sometimes the displace- ment is complicated by a laceration of the mucous bursa with the formation of a hygroma of warm, painful, edematous swellings, indicating the rupture of the aponeurosis or the inflammation of the cellular tissue. “Se CRURAL MYOTOMY. 311 Generally the dislocation is unilateral, butin other cases it may occur in both legs. This last condition is always of a serious nature, and seldom responsive to treatment. The displacement of the biceps femoris seldom recovers naturally, although where in- complete and intermittent, it may be benefitted by long rest, or when, as we have before remarked, it is due to the excessive lean- ness of the patient, in which case a liberal fattening diet will prove the best remedy, by removing the cause of its appearance. Local, external topical treatment by blisters, plasters, setons, etc., are of no avail. The section of the muscle or the operation of crural myotomy, is the indication. The modus operandi is not uniform, although the final object is the same in all. Our opinion in respect to the best way of operating is in favor of that by the subcutaneous section. Thisis performed below the trochanter, and yet as near to it as possible, where the excessive tension of the hooked muscle can readily be felt. This consists simply in making a small incision through the skin, by which to introduce a blunt bistoury, which is inserted under the muscle, with a director or a finger for a guide, and whenat a proper depth turned to bring the sharp edge towards the aponeurosis, and cutting it from within outward, carefully avoiding the section of the skin. Fic. 327.—Gouze’s Bistoury. The bistoury invented by N. Gouze answers the purpose very well. There is no after-treatment required beyond the ordinary care re- quired for all wounds. Simple as the operation of crural myotomy is, some complica- tions may accompany it. Hemorrhage is notuncommon, usually subsiding without inter- ference, but sometimes requiring the application of hemostatics. Inter-Muscular A bscesses.— Diffused Suppuration.—These are the result of improper manipulations during the operation, such as lacerations of the cellular tissue by introducing the fingers too frequently into the wound, or dividing the muscle in several places. Gangrene.—Though but rarely met with, this should be re- membered among the possible contingencies. It may occur as the 312 OPERATIONS ON MUSCLES AND THEIR ANNEXES. result of the presence of clots of blood or other mortified tissues in the wound, and is indicated by the bad appearance of the parts, the peculiar cedematous swelling, first warm and painful, but sub- sequently becoming cool and painless. This condition requires prompt and efficient treatment, both external and internal. In Solipeds.—We once had occasion to resort to crural myotomy for the relief of a case of pseudo-dislocation of the patella of several months’ standing. The division was made towards the lower por- tion of the muscle, and was followed by satisfactory results, though not immediately. OPERATIONS UPON FIBROUS TISSUES. TENOTOMY. In the terminology of surgery, tenotomy means the section of tendons—an operation which contemplates the correction of de- formities, from whatever cause they may proceed; the relief of pressure upon exostoses, and the prevention of the complete execu- tion of a normal function, as that of flying in birds. Our atten- tion will, accordingly, be directed to the study of the five varieties of plantar, carpal, antibrachial and tarsal tenotomy, with that of the wings of birds. Pruantar TENOToMY. This operation is the proper remedy for the deformity known as knuckling, or the malposition which arises from the exaggerated flexion of the fetlock joint, and consists in the subcutaneous section of the tendons of the flexor of the phalanges. In this affection of knuckling, which is mostly peculiar to solipeds, there is lameness more or less marked, with a hard and painful enlargement of the tendons, and a consequent interference with the act of locomotion, caused by an incomplete flexion of the articulations. The fetlock is carried forward, and contact with the ground is effected with the toe alone. Instances of spontaneous cure or abatement are exceedingly rare. On the contrary, it has a tendency to aggravation, the swell- ing increasing, and the deformity becoming by degrees more and more developed, until at length the anterior face of the wall of the foot rests on the ground, and the case assumes all the well estab- OPERATIONS UPON FIBROUS TISSUES. oily lished characters of a recognized club-foot. Ina majority of cases the disease is localized in the tendon of the deep flexor of the phalanges, but it often extends to the superficial tendon as well, or may involve the tarsal or carpal band, or the suspensory ligament. This deformity of knuckling may exist in three different degrees: either the cannon bone and the phalanges meet in an almost ver- tical line, as in the case of the animal straight or upright on his pasterns, which is the first degree; or the bones meet to form an angle opening backward, the phalanges being somewhat oblique in that direction, instead of forward, asin the normal state, and the animal still resting on the entire plantar surface of the foot, which is the second degree; while in the third degree these conditions are still more exaggerated, the animal traveling altogether on his toeand exhibiting a case of the perfect talipes. This last conformation, which exists principally in the hind legs, is specially due to the retraction of the deep flexor, while in the other degrees it is the superficial flexor which is diseased. Lesion of the suspensory ligament may coexist in either case. The condition of the tendons, from which this deformity arises, is not the only question to take into consideration when the pro- priety of the operation is to be determined. The causes which have produced it must not be overlooked. For example, while in the hind legs the accident has usually a traumatic cause, such as a sprain, violent over-exertion, lacerations, or contusion of tendons; when the fore legs are affected it is most commonly as the accom- paniment of some lesion in other parts of the leg, as of the foot or the digital region proper, such as bad feet, navicular disease, contraction of the heels, corns, quarter and toe-cracks, quittors, deep punctured wounds, and very commonly ringbones, gr other exostoses. Taking all these various causes into consideration, with their specific natures, and the extent of the lesions which accompany them, we are justified in believing with Gourdon, that plantar tenotomy is indicated with fair chance of success, when the knuck- ling results from traumatism, and the perforans tendon is alone diseased; and even when both tendons are affected, good results are still not improbable; but that it is contra-indicated whenever complications exist which are likely to prevent the leg from re- turning to its natural position, as when the disease is of long standing; when there are alterations of the articular surfaces; 314 OPERATIONS ON MUSCLES AND THEIR ANNEXES. anchylosis of the fetlock; exostoses; adhesions between the ten- dons and the bones; large engorgements of the tendinous struc- ture; or chronic dilatation of the synovial bursz surrounding the region of the fetlock. Remediable cases would seem, from this, to constitute rather a small minority of the whole number. The fibrous tissues acted upon in plantar tenotomy, are the tendons of the flexors of the phalanges, in that part of their length which is situated back of the cannon bone, between the carpal or tarsal sheath and the fetlock. The superficial tendon reaching the fetlock forms a ring through which the deep flexor passes, a cir- cumstance from which has been devised the manner of perforatus and perforans, by which they are known. Fic. 328.—Median section at the infe- rior row of the carpus—of the metacar- pus and suspensory ligament. 1. Os magnum. 2. Posterior common ligament of the carpus. . Band to the perfcrans. . Suspensory ligament. . Its superficial layer. . The deep. . Principal metacarpal bone. ao oo Ff oO ~ The superficial tendon is covered by the fibrous expansion of the two carpal and metacarpo-phalangeal sheaths in the fore, and by the tarsal and metatarso-phalangealin the hind leg. The deep flexor toward the middle of the cannon receives a strong, fibrous band coming from the posterior ligament of the carpus or tarsus. Below and between the two’small metacarpal or metatarsal bones is the suspensory ligament, a strong band, thin superiorly at its origin, and bifid inferiorly. Between the suspensory ligament and the cannon bone, there is an interosseous vein and the two inter- osseous arteries; on the side of the tendons, the internal and ex- ternal collateral veins, with, in the fore leg, the principal artery « OPERATIONS UPON FIBROUS TISSUES. 315 collateral of the cannon, and the internal plantar nerve as its satellite on the inside, and the external plantar nerve on the out- side of the leg; while on the posterior leg the principal artery of the cannon, which is the collateral metatarsal, is situated on the outside of the bone, and comes in relation with the tendons only in the lower part of the metatarsus. In the anterior legs, the carpal bursa, lined with its synovial sac, extends downward on the flexor tendons as far as below the superior third of the metacarpal region ; the synovial vaginal sac of the sesamoid sheath runs upward along the tendons, as far as the lower extremities of the small metacarpal bones. It is at about the center of the middle third of the cannon that the operation can be performed without fear of injuring either of these synovial SACS. In the hind legs the tarsal sheath extends as far as the upper part of the middle third of the metatarsal region, and the sesamoid sac being the same as in the anterior leg, a little larger space is left for the operation. Modus Operandi.—To perform plantar tenotomy, the animal must be thrown. Some practitioners operate with the horse on his feet, but this position is dangerous, although by the use of cocaine, much of the risk attending it may be obviated. The animal is thrown on either side, according to the leg upon which the operation is to be performed. If on the fore leg, it must be on the side of the leg to be operated on in order to expose the inside of the limb; if on the hind leg, the animal should be thrown in such a manner as to make the leg upon which the operation is to take place the upper one. The arrangement, according to Gourdon, makes the operation feasible both on the inside of the fore, and the outside of the hind leg. Several modes of proceeding have been practiced. The old method is by alarge lateral incision, in which the tendon is ex- posed, divided either with a bistoury, or by being raised from the wound and then divided. But this style of procedure necessitates the formation of large wounds, and is liable to severe and trouble- some complications, which the modern or subcutaneous method obviates. In performing the subcutaneous division, two instruments are necessary. These are the straight and curved tenotomes. The blade of the former is narrow, straight, thin and pointed; that of 316 Fie. 330.—Curved Tenotomy Knife. the latter narrow, curved and blunt, and sharp on its concave edge. The animal being prepared, a puncture of the skin is made over the tendinous region (carefully avoiding the synovial sacs, as men- tioned above), by introducing the straight tenotome perpendicu- larly between the tendons, until the point of the instrument is felt on the opposite side of the leg. A slight sawing motion of the instrument then cuts through the connective tissue which unites them, and permits the introduction of the curved tenotome into the tract made by the straight instrument, and the latter is slowly withdrawn. At this point the leg is carried into excessive exten- sion by the assistants, by means of ropes secured respectively, one about the knee, and one about the foot, and pulling that of the knee backward and that of the foot forward. The fetlock being thus stretched to its utmost, the operator, with the edge of the curved tenotome turned toward the deep flexor, makes a slight sawing motion with the instrument, and cuts through the fibrous structure from behind and forward, a peculiar crackling sound in- dicating when the sectionis accomplished. The retracted extrem- ities of the tendons can now be felt with a wide interval between them, and the straightening, more or less, of the fetlock gives fur- ther proof that the operation is completed. This is the method in simple tenotomy. Some operators have suggested the introduction of the instrument between the sus- pensory ligaments and the perforans in preference to the mode we have described, in which case the section of the tendon must be made from before backward. It is, however, a complicated pro- cess, and one which is not without danger of injuring tissues which ought to be left intact. The mode of operating known as the Bernard method is based on this principle. The double tenotomy, though considered at first as a severe OPERATIONS UPON FIBROUS TISSUES. 317 operation, does not involve as many objections as at first thought, but, on the contrary, has often been followed by very satisfactory results. It is, therefore, a justifiable operation when the defor- mity of the fetlock is quite extensive. In fact, it is unavoidable when both tendons are united, or when the deviation in the di- rection of the bony levers is caused equally by the common con- traction of both. In performing this double tenotomy, the divis- ion of the deep flexor being made by the manipulations already described, the curved tenotome being still retained in the wound between the tendons, the operator simply reverses its position in order to bring the cutting edge in contact with the superficial tendon, and completes the operation precisely as already described. In this division of the tendon great caution must be observed, in order to avoid making a complete transverse section of the skin. Double tenotomy is also performed in some cases by introducing the tenotome between the suspensory ligament and the tendons, and dividing them by a section made at once through both from before backward. In some peculiar cases, besides the division of the two tendons, that of the suspensory ligament has also been included, sometimes in connection with the tenotomy, and sometimes independently. In this case, the place selected differs from that which is indicated for the simple or double operation. It is, indeed, toward the lower extremity near the bifurcation, and toward the lower third of the cannon, where it is more readily reached. The straight tenotome is first introduced, flatwise on either the internal or external face of the leg, between the ligament and the deep flexor of the pha- langes, carefully avoiding the blood vessels and nerves, and the curved instrument is inserted with its cutting edge toward the ligament, the section being made by cutting from behind forward. The instrument must not be introduced between the bone and the ligament, nor must the section be made from before back- ward ; such a course not only endangering the nerves and blood vessels, but also involving the risk of breaking the blade of the tenotome at the bottom of the wound. Whatever mode may have been followed, and however many tendons may have been divided, or whatever force may have been applied to the rope by the assistants who made the traction, it is an exceedingly rare result to obtain a perfect straightening of the leg, most especially when the disease has been of long continu- 318 OPERATIONS ON MUSCLES AND THEIR ANNEXES. ance, and chronic adhesions may exist. A short walking exercise following the operation may facilitate the straightening of the leg, and in any event can have no injurious effect. But even with this, it is sometimes several days before any well-marked improvement can be discerned. There are cases, indeed, when ten or fifteen days may pass without noticeable change, but if it fails to appear after such a lapse of time, the case may be considered hopeless. There are practitioners, however, among whom are Didot, Delward and Hering, who object to this exercise, and hold that the natural and spontaneous straightening of the fetlock can be greatly assisted by proper shoeing, as, for exam- Fie. 332.—Mov- ple, by wearing a shoe with a *”° To-Go". Fic, 331.—Shoe with Pro- long toe, such as are used in cases of club- longed Toe, for Club-Foot. foot, or again, by having peculiar movable toe-corks by which the effect of the bearmg of the shoe is in- creased. The ordinary long-toed shoe represented in Fig. 333 is often worn with advantage. Fig. 333.—Long-Toe Shoe. Complete rest after the operation will benefit the patient in the most essential manner by diminishing the causes of pain and favor- ing the cicatrization, and possibly preventing an exaggerated ex- tension at the fetlock. Itis only after from twenty to twenty-five days that moderate exercise may be allowed, and not less than six OPERATIONS UPON FIBROUS TISSUES. 319 weeks should elapse before the ordinary labor of the patient can be resumed. The resulting wound needs no special dressing, and by being thoroughly sterilized by antiseptic manipulations, the parts will heal without trouble. The suggestions of poultices, fomentations, counter irritation, blisters and firing of old-time surgery must be strictly ignored. If, however, all the measures recommended for the straighten- ing of the leg should fail, and, on the contrary, a tendency to an Fie. 334. Fia. 335. FIGS. 334, 335, 336.—Various Apparatus Recommended after Tenotomy. excessive extension of the fetlock should be manifested, the appli- cation of some of the various kinds of apparatus designed for the correction of these defects may be experimentally tried, with a 320 OPERATIONS ON MUSCLES AND THEIR ANNEXES. possibility of good results. According to their peculiar working arrangements, slowly increased extension might be maintained, or the leg might be steadily retained in a given position, or with the power of regu- lated motion, the result being an important and permanent improvement in the value and comfort of the animal. The accidents, which may be apprehend- ed in connection with plantar tenotomy are hemorrhage and wounds of nerves, or of the skin, or of the synovial sacs ; an exag- geration of the extension, and a return of the original deformity. To these Peuch and Toussaint add gangrene. (a) Hemorrhage, both arterial or vein- oa ous. But this may be avoided by careful attention to the rules laid down for the operation, and if it should occur, hemostatis by pressure must be resorted to, and the band- age can be safely removed, or at least the pressure diminished, in from twelve to twenty-four hours. (6) Wounds of Nerves.—These cannot very well be avoided, and while they are manifested by severe struggles of the animal at the moment of their occurrence, they involve no danger other than those pertaining to similar injuries in other regions, viz.: the temporary suspension of the sensorial functions. (c) Wounds of the Skin.—These are among the comparatively severe complications, and when they occur, they destroy all the advantages which properly accompany the operation as a subcu- taneous process. They are likely to complicate the operation with fungoid growths upon the stumps of the tendons, abundant sup- puration, ugly cicatrices, etc., and should therefore be specially guarded against. (d@) Wounds of the Tendinous Burse.—These may be attrib- uted to an improper selection of the place where the puncture should be made, and may be recognized by the flow of synovial fluid from the wound. Suppurative synovitis may then complicate the case with fatal effect. The treatment they require is that directed for open synovial tumors. Local applications, rest, pres- sure, counter irritation, blisters and firing are the indications. . =~ OPERATIONS UPON FIBROUS TISSUES. oe (e) Hxaggeration of the Extension.—This may take place when artificial means to produce sudden extension are too power- ful, or when the violent efforts of the animal have caused a ten- dency in the parts to give way suddenly. The apparatus before referred to must be here brought into requisition. (f) Return of the Original Deformity.—This results from the retraction of the new tissue formed between the stumps of the divided tendon. It occurs as a consequence of returning the animal to his work at too early a date, and when the newly formed tissue has not yet become sufficiently matured and solidified to sustain the strain to which it had been subjected. Rest, cold water bathing in a running stream, vesicating applications and firing have been recommended as remedies, and even a second section of the tendon may be suggested, though with but a doubt- ful prospect of good results. CarpaL TENOTOMY. This defines the section of the tendons of the external and oblique flexor muscles of the metacarpus. They are inserted on the trapezium bone of the carpus, and their retraction occasions the deformity known as sprung knees, a condition brought on by excessive and exhaustive labor, though there is a class of pa- tients in which the lesion may be ascribed to a congenital taint, and it is principally for the benefit of this class of patients that the operation is indicated and usually performed. It is principally favored and utilized in Germany, where it was originated by Dieterichs, though afterwards adopted and practiced by Prud- homme, Lafosse, Miguel, Brogniez, Hering, Gourdon and others. The operation can be performed on either tendon singly, or on both ; but according to Hering, the division of the external mus- cle is generally sufficient. The anatomy of the region should be described before passing to a detail of the steps by which the section of the tendon is ef- fected. The external flexor is situated on the posterior external part of the forearm, and terminates by the branches, one of which, the funicular, is anterior, and passing in the groove of the external face of the trapezium, becomes attached to the hand of the exter- nal rudimentary metacarpal bone; while the other posterior, wide and short, goes to the supero and posterior circumference of the same bone, in connection with the middle flexor, to which it is oan OPERATIONS ON MUSCLES AND THEIR ANNEXES. united. The section must be made above the bifurcation of the tendon, to avoid the artery which passes under it, though it is quite deeply situated, and besides, there is no danger of injuring the synovial sac of the carpal arch. The oblique flexor is situated back and inside of this, and hasits tendon single, terminated on the trapezium, with the posterior tendon of the external flexor. The section must be made before the union of the two tendons, in order to avoid injury to the carpal arch. The animal is thrown, and the knee extended with two ropes, one above and one below the knee, and drawn in opposite direc- tions. The same instruments are used for carpal as for plantar tenotomy. The incision of the skin is made about two inches above the knee with the straight tenotome, immediately in front of the tendon, which is easily felt under the skin, and is raised with the fingers ; the curved tenotome is inserted between the skin and the tendon, from before backward, and the section made as in the plantar operation. Gourdon suggests the introduction of the knives under the tendon instead of between that and the skin. By this mode the division is made from within outward, while in the other way it is made from without inward. The external flexor being thus divided, the section of the middle flexor is made a little below; the puncture of the straight tenotome is made between the two tendons, and the curved tenotome inserted as before, between the skin and the tendon from before backward, or preferably, from without inward, and when its blunt end is felt on the posterior border of the muscle, the section is made from without inward, with the usual motion of the knife. Only a simple dressing is required, but the animal must be kept at rest for at least.a month. The modus operandi to which we give the preference over that which we have just narrated, and which we have described in our work on lameness, is very simple. The animal being thrown, on the side opposite to that of the operation, and the knee extended as usual, the operator, who is in front of the knee, feels for the space between the two muscles, where they are about to unite, and this being found, a straight tenotome is introduced through the skin from before backward, about two inches above the super- ior border of the trapezium, and under the thickness of the middle flexor, and when the point of the instrument is felt on the OPERATIONS UPON FIBROUS TISSUES. 323 other border of the muscle, in front, the curved tenotome is in- serted and the straight one withdrawn, and the tendon divided from within outward; the straight tenotome is then re-introduced through the same opening, between the muscles, and carried from behind forward on the posterior border of the external flexor, under its thickness, until the point of the instrument is felt on the anterior border, when the curved tenotome is again re-insert- ed, and the division of the tendons performed as before. The wound of this operation is simple, heals readily, and is liable to no complications or accidents. Of course the operator must ex- ercise due caution, when dividing the tendons from within out- ward, to avoid making a complete section through the skin. Anti-Bracut1aAL TENoToMY. This operation has been recommended for the relief respec- tively of sprung knees and knuckled fetlocks, but by reason of the numerous and almost constant failures by which it was character- ized, has been discredited, and banished from the domain of our surgery. It consisted in the section of the tendinous band which from the lower extremity of the coraco-radialis extends downward to mingle with the fibres of the anti-brachial aponeurosis, in pass- ing a little below and in front Of the elbow joint. Brogniez, who recommended the operation, performed it by making a longitudinal incision of the skin over the course of the tendon, which is readily felt under the skin, and passing the point of a convex bistoury over the aponeurosis and the band, dividing it from without inward. ° TarsaL TENOTOMIES. Two modes of operation are practised upon some of the tendons surrounding the hock joints, one upon the cunean branch of the flexor metatarsi muscle, the other upon the tendons of the lateral extensor of the phalanges. They are known distinctively as the cunean and the peroneo-phalangeal tenotomy. (a.) Cunean Tenotomy.—The flexor metatarsi, one of the muscles of the anterior tibial region, is composed of two por- tions, one muscular, the other tendinous. The tendinous portion is situated between the muscular portion and the anterior extensor of the phalanges, and is attached above to the inferior extremity of the femur, between the external condyle and the external 324 OPERATIONS ON MUSCLES AND THEIR ANNEXES. border of the trochlea of that bone, and passes in the groove situated between the anterior and external tuberosity of the superior extremity of the tibia, downward to the hock, where it rests on the anterior face of that joint and is attached by two branches, one to the cuboid, on the outside of the hock, the other to the superior extremity of the principal metatarsal bone. The muscular portion, which rests on the external face of the tibia, from the upper part of which it takes its origin, terminates in- feriorly by a tendon which passes through a ring of the tendinous portion, and becomes more superficial, and then divides into two | branches, a large one, which goes to the superior part of the principal metatarsal bone, in uniting with that of the tendinous portion, and another, smaller, which bends inward, to terminate at the small cuneiform bone. This branch is chosen as the seat of operation. i The operation recommended by Abildgaard and Viborg, was indicated by Hertwig, and at a later period performed by Lafosse, Hering, Mantel, Grad, Bugniet and Dieckerhoff. It is very com- monly performed on this continent, and, like many other operations at the time of their first introduction, has been both used and probably abused to such an ex- tent that it has not yet received the credit to which it is fairly entitled. It is indicated for the relief of the pres- sure which this branch makes upon the distended periosteum of the enlarged tar- sal exostoses known as spavins, and when lesion in the hock, it will prove essen- tially beneficial. But if, with the new erowth of bony deposits, the joint itself Fig. 397.—Cunean Branch of the should be involved, and some of the ar- oxo: Seas ticular diseases should be present, the result, so far as the removal of pain and lameness is concerned, is not always certain. Although more or less satisfactory at times, in many instances it entirely fails. The difficulty of positively diagnosing the condition of the articular surfaces justifies the surgeon in operating, when the tense condition of the tendon, its pressure upon the exostosis, and the irritation of the synovial sac the exostosis is, strictly speaking, the only . OPERATIONS UPON FIBROUS TISSUES. 825 which aids its movements, which it produces, point with certainty to the cause of the lameness. The instruments necessary are scissors, a straight and a con- vex bistoury, a dissecting forceps, a curved director, and perhaps a curved tenotomy knife. The animal is cast on the side of the leg to be operated upon, the upper leg carried forward and secured on the upper forearm, and the hair clipped over the tract of the tendon, which can be readily identified by an oblique groove generally found running on the upper portion of the bony enlargement. An incision about two and a half inches long is made with the convex bis- toury, either parallel to the tendon, or slightly oblique, and right FIG. 338.—Tarsal Tenotomy. Cunean Fig. 339.—Tarsal Tenotomy. The Tendon Exposed. Tendon Raised. across its direction. This incision is generally accompanied by a somewhat troublesome capillary hemorrhage, which ought to be controlled before proceeding further. The tendon may then be felt through its bursa, which is raised with the dissecting forceps and opened, when the tendon is readily exposed. The curved director is then inserted under the tendon, which is easily raised from its tract, and by guiding the tenotome along its groove the section is made by a single stroke. Some practitioners complete the operation by amputating a portion of the tendon. This is unnecessary, and complicates the operation by subjecting the parts to the necessity of a repairing 326 OPERATIONS ON MUSCLES AND THEIR ANNEXES. process, which is not needed for the result of the operation, and exposes the animal to a complication of inflammation of the synovial bursze which ought to be avoided. To obviate these dangers, Dieckerhoff is of the opinion that the division of the bursa is all that is required, and states that he has often secured good results, from that alone, without the section of the tendon. Besides this mode of operating, which may be called the open incision, there is another procedure by subcutaneous division, which is also recommended by some, but the difficulty of discover- ing the tendon in its bony groove, and in reaching it properly, and the possible complication of subsequent inflammation of the bursee, will probably secure the preference for the method by open incis- ion. The operation is completed by closing the wound with a stitch of suture, and protecting it with antiseptic dressings. The results of the operation are sometimes immediate. though in some cases not apparent for a few days, but if after the lapse of two or three weeks the lameness has not either disappeared or greatly abated, it may be safely concluded that it is attributable to some cause other than the pressure of the tendon. (6.) Peroneo-Phalangeal Tenotomy.—Though the true pathology of the peculiar affection of the hock joint known as springhalt, and the cause that excites the spasmodic action characterizing it, are far from being satisfactorily known, it has been observed that in animals thus affected the tendons of the ex- tensors of the foot in front of the hock have a tense or rigid character, which renders them unusually prominent; and it is this symptom which suggested to Brocar, a Belgian veterinarian, the division of the tendon of the lateral extensor of the phalanges, or peroneo-phalangeal muscle, as a means of cure. Brocar, Brogniez, and Delwart performed it, and have recorded their success in numerous cases. The lateral extensor of the phalanges terminates inferiorly by a round tendon, which passes into the groove situated on the out- side of the lower extremity of the tibia, in a sheath formed at the expense of the superficial external ligament of the tibio-tarsal joint. In this sheath it bends forward and downward to join the tendon of the anterior extensor toward the middle of the metatar- sus, which it crosses downward, forward and inward. The operation is of the simplest nature, and may be performed with great facility. The animal being cast, and the section com- OPERATIONS UPON FIBROUS TISSUES. a ya pleted through a small incision made over the tendon, a little be- low the hock, and near its junction with the principal extensor, about one inch of the tendon is removed. Sometimes the action of springhalt ceases at once, when the animal is allowed to rise to his feet. Other cases require a few days for the completion of the cure. The simple operation has proved satisfactory in our hands in two cases. TrnotTomy IN Brrps. The operation is performed in this instance with the object of preventing the animals from flying, and consists in the section of the tendons of the extensor muscles of the carpus and phalanges. The bird is held by an assistant, with its wing extended, and a few feathers are pulled out from each side of the carpal joint, as well as in front of the radius, to expose the skin, through which the extensor tendons, two in number, are readily seen. A small incision being made through the skin, the tendon is raised with forceps, and a portion of it amputated, the operation being re- peated on the other side of the wing upon the extensor tendons of the digits, between the radius and the cubitus. The treatment is applied to both wings; it is without hemorrhage, and the wounds heal in two or three days. CHAPTER VIII. OPERATIONS ON THE DIGESTIVE APE ARATUS, ON THE TEETH. The office fulfilled by the dental system in the preliminary preparation of the ingesta, and the first step im the process of di- gestion, is necessarily one of the utmost importance. Of course, therefore, any diseased conditions which may interfere with its efficient action, especially with the herbivorous animals, become matters of deep interest to the veterinary practitioner. All facts and circumstances concur to establish and substantiate the claims of that branch of veterinary science which refers to the care of the teeth as a very important specialty, and we shall, there- fore, so estimate and so elucidate the subject of veterinary dentis- try, so successfully studied and so largely developed in recent years by American veterinarians. The diseases of the teeth to which our domestic animals are subject may be due to various pathological conditions. The den- tal arches formed by their arrangement in the jaw may be the seat of congenital deformity; the teeth may possess abnormal qualities in respect to their number, their shape and their direc- tion; or, again, in the condition of their grinding surfaces, and there may also be special diseases of the siesta ss ee substances of the tooth itself.* The abnormality which exists in relation to the number of the teeth is of not uncommon occurrence in horses, in which animal we * sometimes discover the presence of supplementary molars, resulting either from the persistence of a temporary tooth which has failed to be shed at the proper time, or may be due to an excess of de- velopment in the evolution of a dental follicle, as we may observe in the formation of the wolf tooth. In relation to the shape of the dental arches, there are cases * We take pleasure in recommending, in connection with this subject, the excellent little work on Horses’ Teeth, written by Mr. William H. Clarke. OPERATIONS ON THE TEETH. 329 where, instead of presenting the regular and correct natural lines, the upper and lower molar arches so far disagree as to render their perfect coaptation impossible, and render the execution of their function to a great extent impracticable. The direction or implantation of the teeth is, at times, so far irregular and abnor- mal as to change the frictional surfaces in such a manner as to remove the wear and abrasion from the crown to the surface of the organ. In relation to the disposition of their rubbing sur- faces, it is well known that on account of the difference existing in the consistency and power of resistance, two of their elements, the enamel and the dentine, their frictional surfaces become rough, irregular and sharp; and, as they sometimes assume excessive dimensions, they may give rise to serious phenomena, especially when they have their seat in a part of the dental arch where no resistance can be offered to their development, as when the cor- responding tooth of the opposite jaws becomes diseased or absent. The special diseases of the elementary constituents of the teeth exist in the depth of their substance, and consist in caries or ul- ceration of the tooth, the affection involving the dental pulp itself, with other diseases pertaining to the alveolo-dental membrane, all of them being accompanied by a series of well understood symp- toms, severely distinctive in their character, and which in the ma- jority of cases call for the assistance of the veterinary dentist in order to relieve the suffering animal from the distress in which his human master knows but too well how to sympathize. The symptoms pertaining to the various conditions above al- luded to may be either common, or general, or special. Among the general symptoms, the first to be observed is a change in the style of performing the function of mastication, proportional to the sensitiveness occasioned by the dental lesion. Thus it is ob- served that although the animal seizes his food with the same avidity as if his teeth were in good order, the motion of his jaws, the chewing of the food, are slowly and carefully performed, the lateral movements of the lower jaw occurring in a hesitating man- ner, and often made on one side of the mouth only. In eating hay, the mouthful of the food is never triturated as it ought to be, and before the process of mastication is completed the animal drops it out of its mouth in the shape of a flattened bolus, satu- rated with saliva, to seize it again and make a new attempt at mastication, perhaps twisting his jaw in different directions in his 330 OPERATIONS ON THE DIGESTIVE APPARATUS. endeayor to accomplish the act without pain. The attempt seems, however, to be vain; again the mouth is opened and the same flattened bolus is dropped in the manger, and this continues until the poor animal, suffering and hungry, is seen standing before a rack full of hay for which he both longs and fears to touch. The suffering horse will sometimes swallow his oats imperfectly mas- ticated, but the partial chewing is performed slowly and with dif- ficulty, his manner indicating the pain it costs him; dipping his nose in the manger, chewing on the grain for along time, and impregnating it with saliva before he swallows it. Soft food, bran and mashes, cooked roots, scalded grains, and the like, are the only aliments that can, without difficulty with this imperfect de- gree of mastication, enter into the pharynx. Animals suffering with diseases of the dental apparatus are often affected with colics. At first they may be slight and inter- mittent, but they soon become more severe and more frequent. They may last for several days, and may be marked by the pecu- liarity that during their continuance defecation may still continue, though irregular as to time, and the movements scanty in amount, the feces besides being in small and adherent lumps, and more or less coated. In other cases they are soft, and the animal has a tendency to be washy, and more or less to scour, but in either case the droppings are more or less loaded with unmasticated food. All these symptoms are manifestations resulting from an imperfect digestion. It is easy to understand that if this condition continues for any length of time the entire economy will suffer from it. The animal looses flesh; his coat becomes dull, dry and staring; his force and ardor diminish; he sweats easily, and all his other func- tions exhibit evidences of the weak condition of an organism de- prived of the nutrition and strength which follow the ingestion of food thoroughly masticated and well digested. Having recognized these symptoms, which, if not seen by the surgeon, should be brought to his attention through the history of the patient; when intelligently stated, the diagnosis may be considered established. But it becomes positive only after an examination of the mouth, by which the special symptoms per- taining to each alteration are elicited. The inspection of the mouth, which may be kept open by the use of the various speculums, or by merely pulling the tongue ee! Shis OPERATIONS ON THE TEETH. 331 sidewise out of the way, will, in a great majority of cases, easily lead to the detection of the cause which interferes with masti- cation. First of all, when the mouth is opened, a peculiar symptom will be observed, consisting in a change in the salivary secretion. This will be increased more or less, and as the saliva will escape freely, a peculiar acid odor will be noticed proceeding from it, and on looking for the cause of this trouble, if it be one or other of the irregularities already mentioned, such as the projection of one of the teeth, the vicious inclination of their crowns, the sharp edges, etc., critical inspection will soon reveal them. The teeth will be found to be soiled with greenish food-detritus on the side where the difficulty exists, and on that same side the animal will be found to have stored the surplus food which he has accumu- lated between his teeth and the cheek. If, however, in consequence of being situated so far back in the mouth that the eye fails to detect the condition of the part, he can complete his examination with his hands. With due prac- tice in this mode of investigation, one may become sufficiently expert in the manipulation of the mouth to dispense entirely with the aid of the speculum; though of course there will be cases when in order to establish a thorough diagnosis of the exact and positive condition of the part, this instrument cannot be dispensed with. There are also conditions where the examination cannot be carried out in the standing position, even with the assistance of means of restraint, and the animal must be thrown down, and even, says Bouley, “ placed under the effects of ether. In this condi- tion, the jaws are readily kept open and immobile, the tongue is free from contraction, and the hands and fingers can be carried over the entire length of the dental arches without the slighest danger to the operator.” Manual exploration removes all doubt about the diagnosis, since the surgeon may, by skillfully practicing the taxis, recognize all the irregularities present, whether the vicious direction of the dental surfaces, the uneven wearing of the teeth, the cavities which may exist in their thickness, or the condition of their im- plantation with that of the alveolar cavity, ete. When the mucous membrane has been excoriated by the sharp projections of the teeth, when the gums are highly inflamed, and the jawbones have been bruised, and are necrosed and suppurating ; don OPERATIONS ON THE DIGESTIVE APPARATUS. when the saliva which flows from the mouth is abundant, gluey and foetid in odor; when the mouth is hot, the mucous membrane injected, and in the regions where this diffused inflammation has started, lesions are apparent corresponding to the cause that pro- duced them, such as deep cuts on the internal face of the cheeks, which have been torn by the asperities of the teeth; when there is swelling and redness of the gum at the point where itis inflamed ; when there is enlargement of the bone, with a grayish hue at the point where it is exposed and in process of sloughing; or again if these fistulas penetrating the spongy tissues of the maxillary bone —all this becomes evident under the careful and accurate manip- ulation of the instructed fingers. Besides the exhibition of the general symptoms belonging to all discases of the dental apparatus, caries of these organs is characterized by some special characters belonging to them ex- clusively. Principal among these is the peculiar foetor of the in- terior of the mouth and of the saliva flowing from it, which is sui generis. There is also the escape from the mouth of this saliva in excessive quantity and inlong, slobbering masses. Then there is the existence on one of the faces of the carious tooth, and principally on the crown, of a blackish spot, or of a hole, or of a large excavation, penetrating the substance of the tooth at a vary- ing depth, according to the extent of the disease and the duration of its existence—the violent pain experienced by the animal when the percussion is applied on the tooth, or its cavity explored with the instrument—the swollen condition of the gum surrounding the diseased tooth; its red color; its want of adherence in some places, and the hemorrhage with the oozing of pus when pressure is ap- plied directly over those same places; the soiled appearance of the dental surfaces on the side of the diseased tooth, caused by particles of food remaining adherent to their anfractuosities, and filling up the cavity of the carious tooth, or forcing themselves between the tooth and the gum, and spreading, diffusing the most repulsive odor—these all belong to a carious condition of one or more of the teeth. But if in addition to this the caries is of long standing, and has advanced towards the root of the tooth, the or- dinary complications pertaining to its development in the maxil- lary bone at the alveola take place, and that point becomes the seat of an inflammatory swelling, manifested externally by a pain- ful enlargement, hot and cedematous, which gradually increases, OPERATIONS ON THE TEETH. 333 though at a given time it may remain stationary, hard and resist- ing. Again, as the progress of the disease continues, the hyper- trophied dental root, by its continued pressure outward, may destroy the external surface of the bone, and form a communica- tion between the bottom of the diseased alveola and the external plate of the maxillary. In these cases pus, saliva and putrefied food collect or filtrate into the subcutaneous cellular tissue, and an abscess is formed which soon ulcerates and empties itself on the surface of the cheek. Once open, this abscess has no tendency to heal, but, on the contrary, maintains its fistulous form, and dis- charges through its opening a mixture of pus, saliva and food, having the very repulsive and characteristic odor already men- tioned. Exploration of this fistula with the probe will give different results according as the fistulous tract is straight or irregular. In the first instance, the probe will penetrate directly into the mouth, opening on one of the faces of the diseased tooth, or even passing into the center of its carious crown; while in the other case it is arrested by the spongy substance of the ulcerated max- illary; or it may strike against the root of the diseased molar. At this point, changes will have taken place in the mouth, upon the surface of the teeth, on the side of the jaw where the disease exists. These changes vary, and consist either in a great obliquity of the tables of the teeth, the crowns or rubbing sur- faces being beveled in very oblique and opposite directions, or in the well marked elevation or projection of the molars correspond- ing to the diseased grinders, in the healthy jaw; a projection which is in proportion to the diminished size of the opposite carious tooth which stands much lower. The first condition is observed when the pain caused by the caries has entirely prevent- ed mastication on the diseased side, and the second, when, not- withstanding the caries, the performance of mastication has still continued. The condition then presented by the carious tooth may also vary. In some cases it may still be complete in its alveolar con- nection, though otherwise partly destroyed, and yet firmly ad- herent by its root. In others it may be broken, entirely or in fragments, merely parts of the outer surface being present; while again, some broken fragments, more or less detached, may remain in the alveolar cavities. Caries of the first and second superior molars may become 334 OPERATIONS ON THE DIGESTIVE APPARATUS. complicated with lesions of the nasal cavities, when the ulcerating process has been followed by a perforation between one or other of these cavities and the mouth. This lesion is accompanied by a discharge taking place on the side of the nose corresponding to that of the diseased tooth. This discharge is of a muco-purulent character, and mixed with saliva and food, which gives it the usual fcetid odor as well’as a peculiar green appearance. It is very different from that belonging to glanders, and is too charac- teristic to justify by its presence an error in diagnosis in that direction. If, however, the same complications take place in the molars, whose roots rest on the sinuses of the head, the symp- toms which are manifested are often so nearly similar in aspect to those of chronic glanders, that the commission of an error should not be considered wholly inexcusable. Careful examina- tion will readily bring out the differential diagnosis between the two diseases, though so different in their ensemble. When the caries of one of these last molars exists to such an extent as to transform the mucous membrane of the sinuses into a sup- purative surface, and to cause the development of granulations upon its surface; or to allow the collection of pus in the cavity of the sinuses, a discharge becomes established through the nostril of the side of the diseased tooth and affected sinus. This dis- charge is white, grumous, very abundant, and keeps increasing, and has also anextremely foetid odor, identical with that of dental caries. The lymphatic glands of the maxillary space then become swollen, hard, though painless, and loose under the fingers. The plates of the zygomatic, of the superior maxillary and of the nasal become swollen, and give a dull sound on percussion. Sometimes their surfaces are so thinned out that it flexes under the pressure of the fingers, and they are then surrounded by an cedematous infiltration of subcutaneous cellular tissue. The long and minute consideration which we have thus given to the diseases of the dental apparatus has been principally devoted to the molar teeth of herbivorous animals, although many of the conditions observed in the grinders may also be found belonging to the incisors. Indeed, incisor arches may also offer abnormali- ties in the number of teeth, in their position, and in the direction or the length of these organs, and they may also become the seat of accidental lesions, such as fractures, luxations, or the too OPERATIONS ON THE TEETH. 335 rapid wearing of various parts of their surfaces, though it seldom reaches the point of caries. The different indications which the majority of these patho- logical conditions may impose resemble so nearly those required under similar circumstances for the grinders, that it becomes un- necessary to appropriate a special chapter to their discussion, and we therefore proceed to the consideration of the general opera- tions performed upon the teeth, according to the indications . which may be from time to time presented. OPERATIVE DenvTaL SurGERY. Two principal indications present themselves under this head- ing. First, the leveling of the frictional dental surfaces, for the removal of any existing asperities or sharp projections, in order to establish a perfect coaptation, as well as the free movement necessary for the execution of their function of attrition. Second, the extraction of the teeth which have undergone such important alterations in their structure, that their conservation becomes in- compatible with the regular execution of mastication, or because of the serious complications they may involve. Leveling of the Dental Arches.—The original mode of operat- ing to level the molar teeth consisted in making the animal chew on the blacksmith’s rasp. It is a simple process, easy to perform, without danger to the animal, and so well answering the purpose that even to-day the process is still in extensive use. But this modus operandi is not without its inconveniences, among other objectionable points, requiring to be repeated for several days until perhaps the teeth have become smooth by rubbing against the rough surface of the rasp—a result not always as satisfactory as it might be. More appropriate instruments have therefore been invented, though, in point of fact, none of them are other than more or less modified rasps or files, as they are truly called. Their number and variety are to-day very great, and their quali- ties vary very much, according to the taste, the ideas, and often the dexterity of those who use them. Samples of these files are represented in Fig. 340, and according to their general construc- tion may be classified as rough and fine rasps, flat and angular, guarded, double and single on one or other of their edges. Some are simple, and formed of a single piece, while others are jointed and compound, and may be screwed or unscrewed with facility 336 OPERATIONS ON THE DIGESTIVE APPARATUS. FIG. 340.—Samples of Tooth Rasps. for use and transportation; some have the rasp fixed to a solid handle, and again, the handle in others is moveable, and may be changed as indications may present themselves. Their number in this country is about incomputable, and while many which we find registered in the patent office are of real value, many others have no reason for being beyond their maker’s whim. As we have said, the advantages which any of them may possess depend more on special conditions than on the result to be obtained, in the removal of the small, sharp edges of the external surface of the tooth, or its lateral faces, resulting from an excessive develop- ment in the enamel. Whatever may be the file which the veterinary dentist may see fit to use, the manipulations required in its handling will be in all cases the same. In referring to this, the first question which ; offers is, whether the use of the speculum is necessary to enable ‘the surgeon to file a horse’s teeth? There is no doubt that in )mnany instances it will be difficult, and even perhaps impossible, | to compel the patient to keep his mouth sufficiently open to per- ; mit the use of the rasp with the necessary delicacy and freedom, or prevent him from constantly biting it, or keeping his jaws closed during the operation. In every instance, the play of the instru- ment will be sure to be interfered with by the excited patient. We believe that American practitioners were the first to dis- pense with the speculum in these cases; and that to Mr. House, a celebrated veterinary dentist, who died not many years ago, is due, in fact, the paternity of this specialty in veterinary surgery. Whether the mouth of the animal is held open with a specu- OPERATIONS ON THE TEETH. 337 lum, and the tongue drawn out and held on one side by an assist- ant, or whether the operator himself controls the tongue with one hand while working the instrument with the other, the manipula- tions must be the same, viz.: the passage to and fro of the file over the surfaces requiring to be corrected, wherever they are rough and sharp; filing them just as the smith files the iron he is shap- ing as he holds it in the vise. We believe, however, that the rasping out ought to be done slowly, softly and without giving the animal any cause for fright or excitement. The method sometimes practiced of using the rasp with a succession of rapid movements over the dental arches is certainly dangerous and liable to be ac- companied with accident to the patient. An irritable, struggling animal, by violent movements of the head, or in his attempts to chew on the rasp, may easily receive injuries from the rough con- tact of the instrument with the delicate structures of the mouth. After such a passage of the rasp a number of times over the teeth, the hand introduced in the mouth will at once detect the effect upon the patient. Although the use of the speculum may be advantageous in many instances, there is certainly a risk attending its use, in the possibility of bruises and lacerations which may occur at the bars when the animal, annoyed by its application, chews upon it in his endeavors to close his mouth. The work of ji/ing when the teeth are sharp is of common in- dication, and finds its direct application under the special condi- tion that the edges or asperities which are treated should not be too large or too prominent. If this should be the case, and the inefficiency of the file or rasp, however, become evident in the trial, other means remain for accomplishing the desired purpose. Such a contingency was not lost sight of in former years, and chisels and gouges were then employed to reduce the excessively devel- oped projections of enamel. With these instruments the patient was either thrown or treat- ed on his feet, his mouth being opened with a speculum, with his tongue drawn out and held on one side. The chisel was then laid against the dental projection, and an assistant striking it with a hammer, the excess of tooth was knocked off. Bouley considered this mode of operation dangerous. “The chisel might, under the impulse received by the hammer, slide in the mouth and severely injure the tongue, the cheeks, and the soft or the hard palate; or 338 OPERATIONS ON THE DIGESTIVE APPARATUS. in animals advanced in age, the tooth might be fractured or dis- located; or again, the operator himself might be injured by the instrument, when, suddenly displaced by a movement of the ani- mal, the assistant knocks against it.” It was to remedy this objection that Brogniez invented his odontritor (Fig. 341), an instrument which carries on one end a blade sharpened on both edges, and on the other is hollowed out, in order to allow the play of a rod through one-half of the length of the instrument. This rod is provided with a transversal handle, which also acts as a hammer, by which the blow is carried against the sharp edges of the tooth. When the odontritor is used, it is not necessary to use a spec- ulum to open the mouth, the holding of the tongue out of the mouth being sufficient. The operator, holding the instrument with the left hand, places the anterior sharp edge against the pro- jecting portion of the tooth, and holding the rod by the handle full in his right hand, moves it to and fro, striking at the proper points as he moves it. This operation is repeated on both jaws until all the sharper edges of the teeth have been cut off, and is completed by passing the rasp over the dental plates, as is done when the teeth are not too sharp. Several modifications have been made in the conformation of the odontritor, but that of Prangé is probably the best (Fig. 342) It consists in having three blades, which may be changed at will and which vary in the form and disposition of their cutting edges. This instrument is considered superior to that of Brogniez, and is thought to work to better advantage when the elevation of the tooth is well marked. The odontritor answers perfectly for leveling the molars when the projections are not excessively developed, or do not offer too ereat resistance to the action of the blade. But when an entire tooth projects above the general level, the odontritor ceases to be of any advantage, and it becomes necessary to perform the resec- tion of the tooth, consisting in the removal of all that portion of it which rises above the level of the general dental surface. To Brogniez is due again the first instrument invented for the performance of this operation in the chisel odontritor (Fig. 343). This is composed of two rods, one of them having at one end, like the ordinary odontritor, a frame of sufficient dimensions to allow the entire molar to pass through it, and on the anterior border of 339 OPERATIONS ON THE TEETH. eR AAU e} Fig, 341.—Brogniez’s Odontritor. Fig. 342.—Prangé’s Odontritor. OPERATIONS ON THE DIGESTIVE APPARATUS. | this frame a solid’ blade with a sharp con- cave edge turned backward. The other extremity of this rod carries a transverse prolongation, which serves to change the position of the blade when necessary, and which has on its shorter portion a hole through which the other rod is allowed to slide. This second rod has on one end a sharp blade which slides into suitable grooves made in the frame of the first, and is curved forward on its front edge. On the other extremity it carries a metal- lic mass which is used as a hammer. In using this instrument, the tooth being enclosed in the frame between the two blades, the movable rod, with its sharp edge, is pushed against the blade of the frame, and a strong blow of the hammer || cuts off the tooth smoothly and evenly. The chisel invented by Gowing (Fig. 344), works somewhat on the same princi- ple as that of Brogniez. Resection of the teeth has also been per- | formed with the instruments used for the same operation on bones. Saws of various | form and design are also recommended, | the chain saw, which we have often used, being one of these. But there are serious fs ee objections to this latter instrument, among : which is its liability to become heated while in use, when it becomes unable to “bite” upon the hard i| |i) dental substance, and may, moreover, break or slide. ai | The only method of overcoming these ai objections, which, in fact, may occur in using any kind of saw, is by hold- ing a wet sponge against the tooth to: which the instrument is applied—a precaution which is not always of easy adoption, and which can scarcely be 4 effected without more or less danger hs) of wounding the hand which holds Fig. 343.—Brogniez’s Tooth Chisel. NAMEN a OPERATIONS ON THE TEETH. 341 Fia. 345. TT TU SAAS SS House’s Molar Cutter. Liautard’s Cutter. Scheffler’s Extractor and Molar Cutter. 342 OPERATIONS ON THE DIGESTIVE APPARATUS. Fic. 345a.—Hamlin’s Molar Cutter. the sponge. But when none of these modes of operation can be readily applied, the use of the tooth-chisel becomes the order. Its application is simple, and with a well-made instrument in the hands of an expert operator, quick and strong, the resection can be readily performed. The array of tooth-chisels or resectors is beyond compute in variety and number, and especially in this country where the in- stinct of mechanical invention is so universal, and the specialty of ‘veterinary dentistry is so extensively practiced, and many different kinds can be inspected among the samples of workmanship which decorate the show-cases of our instrument makers. Among the principal forms, we may, however, mention those which recall the names of Lafosse, Moller, Scheffers, Gowing in Europe, and of Clarke, House, Liautard and Hamlin in this country (Figs. 345, 3452). Some of these instruments have their jaws closed, others have them open. Some work by a peculiar thread-screw arrange- ment, others by the manual power of the operators; and again, the blades of some are straight and others curved, and still others are sharp like a concave saw. In their application they all work upon about the same principle, and are used in the same man- ner. The mouth being opened, the tooth is seized between the jaws of the forceps, and by the pressure of the screw with which some of them are armed, or by the unaided strength of the operator, the tooth is squeezed and cut off with a sudden snap, followed by the dropping out of the mouth of the amputated portion. As a rule, the surface left on the tooth shows but a sli¢ht roughness, which can be smoothed off with the rasp. OPERATIONS ON THE TEETH. 343 Extraction oF TEErTu. The extraction or removal of teeth is indicated for the reduc- tion of any excess in their number, which may interfere with mas- tication ; or when these organs are abnormal in form or direction, and obstruct the growth or usurp the place of a permanent tooth ; or when they are diseased with caries, or affected with any of the pathological conditions which we have before considered ; or when they become the cause of a dental fistula. To extract the incisors of any of our domestic animals, the molars of dogs, or the caduc molars of large herbivorous animals, some of the various forms of tooth forceps that are used in human Fig. 346.—Samples of Tooth Forceps. dentistry or the different shapes of the key of Garangeot or special larger forceps, such as that of Lecellier (Fig. 348) or the enlarged Garangeot’s key, as modified by Delamarre (Fig. 349), will be necessary. The modus operandi is generally simple; the tooth, still firmly attached to its alveola, or perhaps loose and more or 344 OPERATIONS ON THE DIGESTIVE APPARATUS. Fic. 347.—Garangeot’s Keys. less pushed out of its place by a succeeding growth, is seized be- tween the jaws of the forceps, or of the Garangeot’s keys, and is easily wrenched from its position by a strong pull or with a slight twisting motion sufficient to lacerate its last adhesions. The extraction of the permanent molars of a horse is a diffi- cult and, under some circumstances, a serious operation. Their mode of implantation and insertion in the alveolar cavities; the great length of their roots as compared to the small dimensions of their free portion; the narrow connections which exist be- tween them, and withal, the solidity of the dental arch—all these conditions are sufficient to explain the serious character of the prognosis of this operation, and the difficulties which are often encountered when the organ to be removed is the molar tooth of a horse. These difficulties, however, vary considerably under pe- culiar conditions, such, according to Peuch & Toussaint, as “the age of the subject, the position of the tooth on one or the other jaw, and the degree of alteration of the tooth to extract.” For example, the operation is more difficult in young animals than in adult, or older subjects, the latter requiring less effort, the root of the tooth being shorter and the adhesion to the alveola less solid. The upper are less firmly attached than the lower OPERATIONS ON THE TEETH. 345 Hp i SSS SSS ss] == ——— SSS SE ——* es: Fiad. 348.—Lecellier’s Tooth Forceps Fia. 349.—Garangeot’s Ke for Molar. fied by Delamarre. molars, the presence of the cavities of the sinuses, and the diminished thickness of the walls of their alveola rendering their 346 OPERATIONS ON THE DIGESTIVE APPARATUS. insertion and implantation less tenacious than in the lower. The extraction of the front is less difficult than that of the posterior molars. “aie ae as when the teeth are partly destroyed by ; caries, a single effort will be suffi- cient to extract them; but in other cases, as when the seeds is dis- eased, and the roots adhere more intimately to the alveola, the extrac- tion becomes very difficult. And again, if the tooth having a hyper- trophied root, resists the action of the instruments through the op- position of those immediately sur- rounding it, which, though healthy, are less firmly fixed in their alveola, which are mechanically dilated by the outward pressure made upon the plates of the maxillary bone, is easy to loosen and dislocate them; and this is a circumstance’ which must not be overlooked during the manipulation required for the ex- traction, in order to avoid serious disturbances of the dental appa- ratus. Tn the extraction of a molar, the patient must be thrown, and the head well elevated, the mouth being kept well open by means of a per- fectly safe speculum, such as that of Lecellier (Fig. 350), but we think it rather clumsy to handle. Bouley recommends the etherization of the patient. The mouth is to be thor- oughly cleansed. There are circum- stances, however, in which the op- eration of casting is unnecessary, and, in fact, our own personal ex- perience has raised doubts in our mind as to the necessity at any \) N N nN N 1 N N N Fic. 350.—Speculum of Lecellier. OPERATIONS ON FIG. 351.—Plasse Molar Extractor (full view). THE TEETH. 347 FIG. 352.—The same (side view). 348 OPERATIONS ON THE DIGESTIVE APPARATUS. time of exposing the animal to the possible accidents which may attend this mode of restraint. We hold strongly to the expedi- ency of performing the operation in the standing position. There will necessarily be cases in which to attempt to remove a tooth with the animal standing would be simple folly and time lost, but with many operators in this country, we have in several instances succeeded in extracting a condemned molar without any other means of restraint than a twitch on the patient’s lower lip or on his ear. The removal of molars is effected in two ways—by pul- ling, or by repulsion or gouging out. The method by extraction or evulsion, is preferable whenever it is practicable, having the advantage of causing less injury to the surrounding structures, and is objectionable, principally for the posterior teeth, which always oppose great difficulties to the operation. The oldest instrument used in this operation is the enlarged key of Garangeot, as modified by Delamarre. Its appli- cation has always seemed to us difficult, if not dangerous, and we think that it involves more or less risk of fracture of the plates of the maxillary bone, on which account we prefer the large tooth forceps, which may be found under many forms and designs, The forceps of Plasse (Fig. 351), of Wendenburg (Fig. 353), of Pill- wax (Fig. 354), of Gowing (Fig. 355), of the same inventor, as modified by Bouley (Fig. 356), those of Gunther (Fig. 358), the key-forceps of Bouley (Fig. 357), those of House, of Walters, and many others will furnish the operator a large collection from which to select. Many of these instruments are very complicated (as that of Scheffer); some are clumsy and difficult to handle; have levers, like those of Wendenburg and Pillwax; many work by merely grasping the tooth and holding it by a peculiar arrangement of spring, or of thread-screw, and thus to the end of the chapter. We have for many years given the preference to the simple forceps of Gowing, leaving off the little rod which is connected with the cross-piece which carries the thread, and which is to be screwed on the handles of the instrument to hold them firmly to- gether. What we think most essential in the instrument is that its arms should be firm and so solid as not to bend or yield when the screw is applied on them, and that the jaws of the forceps should not be too narrow nor too curved, and above all, that the instrument should not be made unnecessarily heavy, a fault which we have too often observed in some of the continental patterns. OPERATIONS ON THE TEETH. 349 FIG 353.—Wendenburg Fic. 354.—Pillwax’s FIG. 355.—Gowing’s Forceps. Forceps. Forceps. Besides the forceps which we have named there are many others, but whatever may be their plan or shape, the manner of using them includes nearly the same manipulations for all. These, in their various steps, are done about as follows: the animal be- ing properly secured, with his mouth open, and his tongue drawn 350 OPERATIONS ON THR DIGESTIVE APPARATUS. FIG. 356.—Gowing’s Forceps, Modified by Bouley. out on one side, an assistant inserts the forceps into the mouth, adjusting it to the tooth to be extracted, and notifies the op- erator of the moment when he can close the jaws of the instru- ment together, which is done in various ways according to the kind of instrument in use. When the tooth is properly seized and firmly held by the forceps, the operator, using all his force, carefully and slowly oscillates the instrument from left to right, and from right to left, in order to produce the gradual dislocation of the organ, and when it is loosened from its attachments it is drawn vertically out of its cavity by a final movement of evulsion. There are instruments possessing a lever attachment close to the OPERATIONS ON THE TEETH. 351 Soe > SS LOD Y \ Ny \ V \ 4 4 Fig. 357.—Bouley’s Tooth Keys. jaws by which the extraction of the tooth is considerably facilitat- ed. If the animal has not been put under general anesthesia the dislocation of the tooth is very painful, and often accompanied by ANA mE 352 OPERATIONS ON THE DIGESTIVE APPARATUS. Fia. 358.—Gunther’s Forceps. violent struggles, at the critical moment; and if the tooth is not very strongly held by the forceps, it is possible that it may slip out of the jaws of the instrument and drop into the mouth. To avoid the possibility of its passing into the pharynx, we think it would be but a prudential measure to have an assistant keep his hand in the animal’s mouth ready to secure the tooth, if necessary, before it passes beyond the soft palate. OPERATIONS ON THE TEETH. 353 The second mode of extracting molars, or that by repulsion or gouging, is the only one possible under all the circumstances, when the prehension of a carious or diseased tooth cannot be effected by the instrument used in the first method, as, for in- stance, in cases of disease of the posterior molars when the carious tooth is so far diseased or destroyed that not enough of its sub- stance remains above the root to be reached by the forceps; or again, when the exostosis of the root has reached such dimensions that it will not allow its exit from the alveolar cavity, whatsoever efforts may be made to overcome its resistance. This operation was first recommended by H. d’Arboval, and although it has been condemmed by some practitioners, is certainly indicated for all operations upon the molars. All the superior molars, together with the three anterior inferiors, are readily reached by their roots, in trephining the external plate of the bones in which they are implanted. The posterior inferiors are the only ones that present any serious objections, and the trouble is truly a tangible one, being nothing less than the necessity of passing through the entire thickness of the masseter muscle. The tooth demanding removal being surely identified, and the impossibility of removing it by the mouth well established, the animal is thrown on the side opposite to that which is occupied by the diseased organ, and placed under complete anesthesia. The location of the alveolar walls, upon which the operation is to be made in order to reach the root of the tooth, must be first well determined. If it is one of the last three upper molars, it will corres- pond to the sinuses. But the operator must not allow himself to be deceived by the presence of a fistulous opening, which, by ap- pearing on the surface of the skin to indicate the point of attack, may in fact mislead him by conducting him to a point consider- ably remote from the diseased tooth. A positive and satisfactory diagnosis being settled, and the hair being clipped, a large V or cross-shaped incision is made over the spot selected for the tre- phine, and carefully avoiding the infliction of any injury to the muscles of the region, the sinuses are opened by removing two or three circular portions, at a tangent to each other, to effect the removal of a fair-sized piece of the bone. The edges or prolonga- tions which remain are levelled off with the bone forceps, which is certainly preferable to any other means; or if the opening made in the bone is too small, it can also be enlarged by using the same 354 OPERATIONS ON THE DIGESTIVE APPARATUS. bone forceps, by nipping off fragments from the edges and making entrance into the sinuses of the proper dimensions. The wound and the sinuses are then thoroughly cleaned out, and the blood and the pultaceous purulent collection found in their bottom thoroughly removed. This exposes the root of the tooth, in the form of a hard, dry, greyish mass, analagous to a piece of necrosed bone. The operator, then holding the blunt gouge, or repoussoir in his left hand, applies it through the sinuses against the middle of the dental root, and with a strong mallet held in his right, strikes upon it with firm and steady blows. The mouth of the animal being held open by the speculum, an assistant with his hand upon the crown of the tooth studies the effect of each blow, and notes as it yieldsto the percussion, and moves and loosens until it becomes detached, and falls, liberated into his hand, secured by his continuous grasp from any possible danger of being swal- lowed. Asarule the tooth is pushed out of its cavity by the first blows, either entire or in as many portions as it may have been divided into by the carious process. But at times it becomes necessary to repeat the percussion and to use considerable force to compel it to leave the jaw. The modus operandi is about the same for any of the molars, though for the lower teeth greater force in the blows of the mal- let is generally required, in consequence of the greater thickness of the walls of the alveolar cavities in the lower maxillary bone. If it is one of the posterior lower molars which is the subject of the operation, the masseter muscle must be cut through, but the general manipulations are otherwise the same, care being required, however, to avoid injury to the glosso-facial artery, or the duct of Steno. Though apparently a severe operation, this is not a dangerous one, the wounds which it involves healing rapidly, and the great advantages which are realized by it, among which may be included the cleansing of the sinuses, and the removal of their suppurative collection, which could not be otherwise secured, amply compen- sating for the severity of the process. After the operation the wound is, of course, to be thoroughly cleansed, fragments of bone to be remoyed, and acidulated gargles used to wash the mouth and the cavity of the alveola of its blood. The cicatrization of the external wound generally gives no trouble to the surgeon, and requires no particular methods be- OPERATIONS ON THE TEETH. 355 yond those of ordinary cleanliness and proper attention to the granulating process. It is the cicatrization of the internal wound which requires attention, and in some cases a great deal of it. This isin order to guard against the collecting and the packing of the food in the cavity of the alveola, and thus interfering with its closing up by proper granulations. The diet of animals thus operated on must, of course, consist almost entirely of liquid food, as mashes of bran or of oatmeal; hay teas, flour water, milk, etc., or of cooked roots, scalded grains and the like. According to some authors, fibrinous food is dangerous only during the early days immediately following the operation, but our experience has taught us that neither solid nor semi-solid food is to be allowed to an animal which has lost a molar tooth, for a period of from three to’ four weeks, and during that time the alveolar cavity ought to be thoroughly cleansed out after every meal, until all possibility of danger has subsided. The vacuum left in the dental arch after the removal of a tooth is never entirely filled up, but it gradually diminishes, in conse- quence of the oblique direction which the teeth in front and behind are disposed to assume, and which, though it brings them closer to each other, never brings them into actual contact. It may hap- pen that by reason of this vacant space the tooth on the opposite side of the jaw may acquire a tendency to grow to excess, and from want of wear, ultimately project above the level of the other teeth. In reference to this it will be but prudent to watch the condition of that particular tooth, and to be prepared to reduce it to its proper level, if that should become necessary. In reference to accidents that may occur during operations upon the teeth, we have already mentioned the possibility of deg- lutition of the tooth as it is drawn from its socket. In some cases reported by Renault and Bouley fatal results have followed, caused by violent colics thus induced. Strong cathartics have been rec- ommended in these cases for the removal of the foreign body, but the precaution which we have already mentioned will effectually prevent the possibility of this accident. Bruises and excoriations of the bars, with the speculum, and hemorrhage, are accidents which also sometimes accompany these operations of extraction. The first is not usually a matter of any importance, unless necro- sis of the jaw should follow; and as for the hemorrhage, unless it results from direct injury to the palatine artery, it is easily con- 356 OPERATIONS ON THE DIGESTIVE APPARATUS. trolled by pressure and packing with oakum or compressed sponges. Fractures of the alveola, or of the lower maxillary bone, are of a more serious character than any of the preceding injuries, the last, mentioned in a case recorded by Koerter, having necessitated the destruction of the animal. Firnine TEeeru. This operation has not, we believe, as yet entered into the general practice of veterinary surgery, and, with the exception of a few veterinarians on this continent who have attempted it, we think that in the presence of the many difficulties which exist in realiz- ing a perfect result, similar to those obtained with the thorough work of human dentistry, it will be some time before this branch of veterinary dentistry can be practiced with any great prospect of good and permanent results. Our experience in filing the teeth of our domestic animals is very limited, and on that account we will refrain from saying more about it, referrmg our readers to the work of Dr. Hinebauch on “Veterinary Dental Surgery,” where the subject is treated rather extensively. CantnE DENTISTRY. Operations on the teeth of the dog are sometimes indicated under some peculiar and abnormal conditions, such as irregu- larity in number or in direction, or in cases of traumatism, such as fractures or dislocations. Their extraction is performed with tooth forceps, as we have already had occasion to remark. Their resection has been recommended by a French veterinarian, Mr. Bourrel, as.a means of preventing rabid inoculation (Fig. 359). The operation is a very simple one, and consists in smoothing over the sharp points of the teeth with a file, though sometimes sharp nippers are used in preference. But an operation which is of daily necessity is that of clean- ing the teeth by removal of the accumulation of cement or tartar, which gathers on the external surface of the tooth, at its insertion in the alveolar cavity, where it forms a thick crust, of greenish gray color, composed of microscopic fungi. In neglected cases, the gums become irritated and ulcerated, and the tooth, partially denuded of its gum, exposes not only its free portion, but por- tions of the root also, sometimes even becoming loose and drop- ping out of the jaw. There is in these cases a free and abundant OPERATIONS ON THE TEETH. 357 \\\ iar FIG. 359.—Bourrel’s Mode of Filing Dog’s Teeth. flow of saliva, of a characteristic and putrid smell; mastication becomes impossible, and the animal becomes a regular martyr to the lack of attention of his dental apparatus. The formation of these concretions can be prevented in animals in the same way and with the same care that is exercised in respect to the human when teeth-washing, brushing, etc., with some of the properly com- pounded tooth powders, will remove a slight coat of the offensive deposit, but if the accumulation is quite large, it must be scraped off with proper instruments (Fig. 360), carefully avoiding, if prac- ticable, any injury to the gums, or the loosening of the teeth. a Fic. 360.—Tooth Scrapers. 358 OPERATIONS ON THE DIGESTIVE APPARATUS. If several teeth are loose, and their loss is threatened, the bet- ter course in regard to their extraction will be to remove them singly, and not all at the same time, lest a serious hemorrhage might supervene, which might eyen endanger the animal's life. OPERATIONS ON THE TONGUE. The pathological lesions to which this member of the digestive apparatus is subject, and which may require surgical interference, are principally wounds and tumors, the former demanding either sutures or amputations of the organ, partial or complete. The latter, however, present a greater variety of indications, according to the nature of the neoplasm with which the organ may be af- fected. Wounds of the tongue are quite frequent, but the most common are probably those of the lacerated kind, though again, they may be theresult of contusion, incision, or may even be caused by burns. Produced generally by self-inflicted bites, caused by falling, or during epileptic seizures, they are usually made by the incisors. A badly made bit, or a halter or rope tightly binding the mouth and pressing down the tongue, may also produce a bruise, or even a complete laceration of the organ. They are also not uncom- monly seen as the result of bites inflicted by one animal upon an- other, placed in an adjoining stall, when the separation between them has been insufficient. In these cases, not only a portion of ~ the tongue, but often also the freenum may be more or less lacer- ated—a condition which may also take place when the tongue has been pulled out by an assistant, a groom or other person, and the horse rebelling, pulls back violently and suddenly. Against such opposite forces the soft structure of the frenum readily gives away. The burnt wound, or scalding of the tongue, may arise from the administration of a drench not sufficiently cooled, or of too irritating a nature. The common way of steaming horses with bran heated with boiling water, is also an occasional cause. Injuries such as these are generally easily detected, present- ing, as they do, a series of symptoms which may properly be called general. Difficulty in eating, and a more or less abun- dant flow of stringy saliva, which also may be mixed with blood, is apt to be. among the signs. In relation to the special char- acters, noticeably, there may be in one case a protrusion of the OPERATIONS ON THE TONGUE. 359 tongue out of the mouth, with perhaps a drawing of the organ to one side, or it may be pressed between the incisors and hanging more or less outside of the buccal cavity. In opening this cavity, the tongue may then be seen to be lacerated at its free portion, the laceration being transversal or longitudinal, complete or incomplete, and varying in dimensions, from a small portion of the organ nipped from the main body, to nearly the entire portion in front of the frenum. If the anterior portion is missing, the freenum may be seen in its normal condition, or again may be exten- sively torn, in which case the tongue is commonly hanging out of the mouth. If the laceration is complete, the part in front of the cut may have dropped outside and fallen into the bedding of the animal, or of the one next to him, both stalls being more or less spattered with blood from the hemorrhage which has accom- panied the injury. In cases of burns, the tongue presents all the symptoms of glossitis, it is swollen, its epithelium readily peels off, the saliva- tion is abundant, and the mouth heated and sore. Considered from one point of view, the prognosis of lacerated wounds of the tongue is not serious, there being but few forms of that injury which are not more or less amenable to treatment. The nature of the prognosis varies, of course, with the extent of the wound, the depth of the tissue which it involves, and the amount of substance already lost or requiring remoyal. A complete section is always a serious matter, especially in herbivorous animals, by which the tongue is so largely employed, and so ef- ficient, as an instrument for the prehension of food, as well as for aiding in its mastication, by keeping it in contact with the grind- ers during the process of chewing. In carnivorous animals, as in dogs, we have seen the complete sloughing of the free portion attended with such difficulty in eat- ing, that the destruction of the patient became necessary in order to avert his death by starvation. In almost all conditions of laceration of the free portion of the tongue, there is an indication of an attempt to effect the union of the divided parts, and our experience has led us to the conclusion that no one is justified in refusing to treat a wound of the tongue or abandoning such a case without at least an effort to save it, even, as in some cases, where the divided parts are held together by the smallest portion of substance. 360 OPERATIONS ON THE DIGESTIVE APPARATUS. SUTURE. It is only by suture that the attempt can be successfully made. Peuch, Toussaint and Zundel advise the throwing of the horse, but we prefer the standing position for the operation. The instruments necessary are strong needles for metallic sutures, and soft, pliable lead wire. We prefer this kind of suture as being less liable to cut through the muscular structure of the organ and haying less tendency to give way. Having carefully washed the surfaces of the lingual wound, we apply an interrupted suture, varying the number of stitches, according to the extent of the laceration, and prefer the interrupted to the continued suture for the reason that if one stitch fails to hold, it can be easily re- placed by another. The important point is to secure a thorough hold for each stitch, or in other words, to involve a good portion of the tongue in the stitch on each edge of the wound. Wounds of the freenum need no special treatment, but there is an indication which by its application greatly facilitates, though indirectly, the cicatrizing process of q sll, i all the two parts. It consists in placing All! iil | YA the tongue in a muslin suspensory, ct ‘5 Nil | [i ORR el having the shape of the free portion SOCONE Az of the tongue, and sewed together ARN eer on a part of their circumference, leay- ing an opening for the organ to enter. This suspensory is kept in place by two strings attached to the halter on each side of the cheeks. The use of this easily made appliance has given us great satisfaction, not only in keeping the tongue in the mouth, but also in limiting the movements of the organ, and preventing the giving way of stitches. The suspensory is to be taken off two or three times a day, and washed, or changed for another, but must be kept in place as long as this condition of the patient requires it. The mouth is to be kept clean by antiseptic astrin- gents and cooling gargles, by means of a syringe or an irrigator. The use of peroxide of hydrogen has given us excellent results in these cases. Nocard recommends the application of a muzzle upon the patient’s nose, to prevent the prehension of fibrous food, keeping the mouth closed, and restricting the movements of OPERATIONS ON THE TONGUE. 361 the jaws. During the treatment the animal is to be fed with liquid or semi-liquid food, as mashes and gruels of all kinds, with teas, milk, etc. It is only when the stitches are all united that the animal can be brought by degrees to its ordinary diet. After several days the sutures can be removed. AMPUTATION, OR GLossoToMy. When the sutures have failed, or when the peduncle which holds the divided portions of the tongue together is too small to permit the processes of circulation and nutrition to go on, the in- dications are to amputate the part of the tongue below it. This is done with the scissors; the hemorrhage that may follow is sel- dom serious, and soon ceases spontaneously, or yields to the use of hemostatics. Sometimes, instead of direct amputation, or in order to avoid the hemorrhage, the removal of the divided portion is effected with an elastic ligature—a mode of treatment also com- monly used for the removal of lingual tumors. The ecraseur has also been recommended, on account of the absence of hemorrhage attending its use. The animal whose tongue has been amputated eats slowly and with difficulty. His prehension of liquids is also necessarily interfered with. It requires time and practice for him to acquire facility in performing the old functions with curtailed means. ADENOTOMY. This operation consists in the dissection and removal of such of the glands as are accessible and amenable to that method of treatment, including the lymphatic and salivary, and is described as parotidian or maxillary, as one gland or the other becomes the subject of operation. The extirpation of these organs is indica- ted by pathological changes occurring in their structure, as in cases of chronic infiltration following. a suppurative process, as seen in the lymphatic glands of the inter-maxillary space after strangles, and again when they become the seat of scirrous de- generation, or of melanotic deposits, or in cases of salivary fistula complicated with loss of substance of the excretory ducts. Parotidian adenotomy is a very delicate operation, and has, therefore, been but seldom attempted. To Leblanc, in 1822, is due the record of its first performance, and of the advantages attending it. A reference to Figures 396 and 397, which show 362 OPERATIONS ON THE DIGESTIVE APPARATUS. both the superficial and the deep anatomical structures of that region, will at once suggest the difficulties to be encountered in the numerous and important blood vessels, which must be either avoided or ligatured, and the important nerves which must be saved According to Brogniez, the operation is fully justified by its results, and possesses an undeniable claim to admission into the domain of authorized veterinary surgery. After Leblanc, it was performed by Brogniez, Vanhaelst, Delwart, Barlow and Per- civall. ; The Zraité de Chirurgie Vétérinaire furnishes the following description of the manual execution of parotid adenotomy: “ The animal, being well prepared, is thrown, with the parotid region of the side on which he lies resting on a small bundle of straw, in order to render the gland, which is to be operated upon, more prominent, and the hair being clipped, a long incision is made in the direction of the organ, viz., from the anterior part of the base of the ear down to below the glosso-facial branch of the jugular vein. This first incision, it may be remarked, must be’*made more to the anterior border of the gland, which is strongly adherent to the maxillary bone, as well as to the blood vessels and nerves passing that point, and, if necessary, a second incision can be made be- hind the first and perpendicular to its lower extremity. The skin being dissected from the whole extent of the gland, the beginning of the separation of the organ is made near the facial nerve, from thence gradually working downward. The lower extremity of the gland is isolated, and after it the posterior border, to terminate by the superior extremity, which surrounds the concha—in other words, without reference to the muscular layer that covers it, or to some little glandular masses which are isolated from the prin- cipal mass, nor even to its central portion situated under the fa- cial branch of the jugular vein; the gland being thus separated is removed in its whole circumference. After ligating the blood vessels which may have been opened, the wound is dressed and closed with quill sutures. Suppuration is soon established, the eranulations rapidly develop themselves, and the cicatrization is soon accomplished.” The most serious complication usually met with is the section of the facial and sub-zygomatic nerves, which is followed by par- alysis of the face and lips on that side. Director Degives divides the operation into three steps. Zhe first includes the tneision OPERATIONS ON THE TONGUE. 363 and dissection of the skin. The incision is made lengthwise, from the base of the ear down to the middle of the external face of the gland, that is, as far as below the glosso-facial vein, and involving the skin and the parotido-auricularis muscle, the dissection of the skin being made a little beyond the borders and extremities of the skin. The dissection of the gland forms the second step, and must be as complete as possible. There are some parts where the gland is difficult to isolate, especially at the base of the ear, at its masseterine adhesions near the sub-zygomatic blood vessels and nerves, but at these points some little glandular granulations may be left. In this dissection the use of the fingers or of the dull end of the handle of a dissecting scalpel is recommended in order to avoid the blood vessels and nerves which are so intimately connected with the organ. Beginning with the ligation and section of the posterior auric- ular vein, the anterior border of the gland is isolated from above downward, carefully avoiding the sub-zygomatie blood vessels and nerves, after which the jugular vein is isolated in the whole extent of its parotid course, and the gland divided into two por- tions, one above, the other below the vein. The dissection of the upper portion is made from below upward, avoiding first, four ar- terial divisions, including the external carotid, the temporal trunk, the internal maxillary, and the posterior auricular; second, the superficial temporal and the facial nerves; and third, the guttural pouch, which is intimately adherent to the internal face of the gland above. The smaller arterial branches that are divided are ligated or twisted. The lower portion is then carefully dissected from above downward. The dressing of the wound, which is the third step, is performed according to the process of Brogniez. Maxinttary ADENOTOMY. We find but a single description of this operation, which is by Director Degives in his Manwel de Medécine Opératoire Vétéri- naire. Recommending it only as the last treatment in the re- fractory fistula of Warthon’s duct, he first divides the skin and the cutaneous muscle against the inferior border of the gland, parallel to the glosso-facial vein, and makes an incision about four inches long, which brings him to the loose and abundant cellular tissue which surrounds the gland. The dissection is made with 364 OPERATIONS ON THE DIGESTIVE APPARATUS. the fingers by tearing the connective tissue in the middle part of the gland; when taking hold of it at that place it can be care- fully pulled out, the division of the cellular tissue which holds it being easily detached with the fingers or a blunt instrument. The position of the wound is such that no special dressing is indicated, suppuration having a free exit. OPERATIONS ON THE. GSOPHAGUS. The surgical affections which require interference with the cesophagus and adjacent regions are classified as follows: Bruises, wounds, lacerations, ruptures, tumors, jabot, obstruction by for- eign bodies or alimentary masses, and strictures. The various operations of direct application which are indicated in connection with these casualties are: Catheterism of the cesophagus, the taxis, the crushing of the foreign bodies, and cesophagotomy. This classification, arranged by Peuch and Toussaint, meets with our acceptance, including the operations enumerated, and in our con- sideration of the subject we shall, for the present, refer our readers for descriptions of the various forms of disease to the standard authorities upon veterinary medicine, especially includ- ing in the list the excellent work of Professor Williams. Before entering upon a description of these operations, a re- view of the surgical anatomy of that organ will be in place. The cesophagus is a long musculo-mucous canal, which at the third step of deglutition carries the food, both liquid and solid, from the pharynx to the stomach. Stretched between these two or- gans, it successively occupies the neck down its inferior region, the entire length of the thorax, and a small portion of the abdomen. At its origin (Fig. 362), situated on the median line, it communi- cates with the pharynx by an opening above the glottis; from thence it runs obliquely downward, from before backward, be- hind the trachea, until about the middle of the neck, where it begins to deviate to the left, resting from thence on that side of the trachea. In this situation it enters the thorax, to resume its former position on the trachea; passes above its bifurcation and the base of the heart, running through the layers of the posterior mediastinum, which covers it, reaches the right pillar of the dia- phragm, and passes through it, and entering the abdomen, has its termination on the left side of the small curvature of the stomach. OPERATIONS ON THE CSOPHAGUS. 365 Fic. 862.—Anatomy of the @sophagus and Jugular Vein of the Horse. J J, jugular vein; C, carotid artery; O H, sub-scapulo hyoideus muscle; D, esophagus; §, sterno- maxillaris muscle; M, mastoido-humeralis muscle. The relations of the esophagus must then be considered accord- ing to its divisions of the cervical, thoracic and abdominal portion. At its point of origin, at the pharynx, it is situated between the larynx and the guttural pouches. In the upper half of the neck it is in relation, in front, with the trachea; behind, with the long muscle of the neck; and on the side with the car tid and its satellite nerves. Below this point, and as it deviates to the left, it is related to the left side of the trachea, upon which it rests, and on its outside, with the scalenus muscle, the carotid artery and the jugular vein. In a very few instances, instead of passing to the left of the trachea, it deviates to the right, but otherwise holds the same relations as when inits normal position. At its entrance into the thorax, the cesophagus, still on the side of the trachea, corresponds outwardly with the inferior cervical ganglion and its branches, and to the vertebral, superior cervical and dorsal arteries 366 OPERATIONS ON THE DIGESTIVE APPARATUS. and veins, which cross its course and further back, returning be- tween the trachea and the longus colli, it passes over the left bron- chia and to the right of the thoracie aorta. Beyond this, placed between the folds of the posterior mediastinum, it is received into the groove of the internal face of the lungs, with the cesoph- ageal arteries and nerves. Passing through the opening of the right pillar of the diaphragm, we find it in its abdominal portion related on the right to a notch of the superior border of the liver, and ending at the cardiac. The structure of the cesophagus is formed of two coats; one of external and muscular, the other of internal and mucous membrane. The external is composed of muscular fibers, spiral, red and longitudinal, striated in its anterior three quarters, and white in the posterior quarter. Anteriorly, the crico-pharyngeus furnishes it with a sort of circu- lar necktie. Towards its posterior portion, the muscular coat is much thicker than in the other parts, and as it passes through the pillars of the diaphragm, it is more or less pressed upon. These three points must be remembered, inasmuch as they serve to ex- plain the resistance which is encountered by instruments, such as the catheter, or the probang, when introduced into its cavity. The internal coat or mucous membrane is whitish, with longi- tudinal folds, which are so developed at the cardia that they may resist the passage of the probang into the stomach. CEHsoPpHAGEAL CATHETERISM is an opération consisting in the introduction of a special instru- ment, solid or hollow, but always flexible, into the cavity of the cesophagus, either to remove bodies that obstruct it, or to aid the exit of gases which have accumulated in the stomach. It is therefore indicated in three principal conditions, viz. : first, tympanitis im ruminants; second, in cases of wsophageal dilatation, or jabot ; and third, to dislodge foreign bodies arrested in its canal. In cases of tympanitis, it is of advantage if the trouble is not too far developed, and danger of suffocation not too imminent. In cases of wsophageal jabot, due to a more or less extensive dilatation of the organ, in consequence of the lodgment and packing of food, it is in many instances of but very little benefit. When foreign bodies are lodged in the cesophagus, an accident to which horses are liable, and which is very common in cattle a OPERATIONS ON THE SOPHAGUS. 367 and in dog's, it is often of great advantage. The operation would naturally depend very largely for its success upon the size of the foreign body, which of course is a variable circumstance, and also on the condition of its external sur- face, whether rough or smooth, or having projecting points; depend- ing much likewise on the situation in the length of the canal, and whether it has become engaged in the cervical or the thoracic portion of the passage. Probangs for the throat and a = speculum for the mouth are instru- = ments necessary for this operation. = : Sule There are various forms of pro- = bangs, the designs of different in- ventors. The first, which, accord- ing to Brogniez, was invented by Monro of Edinburgh, has been more or less perfected. The pro- bang of Baujin (Figure 363) is re- yersible, and may be so adjusted as to either push down or extract the offending substance from its place of lodgment. The instru- ment in ordinary use is designed essentially to push the obstruction through the passage. It is found in all our surgical instrument ma- = MI [3 PING ¥ { Helnall i ek eS Out in im I 0) L\ es (J EVIE, I, ralian Kk a res | \ 7 Y qr} fi ' vl \\ ah it yh OW \\ H a at ull a: Ay a FIG. 363.—Baujin’s Probang. kers’ shops, and is made of whalebone or of rubber, separable in two parts, connected by a screw. One end (Fig. 364) has a bulb- ous enlargement, the other a blunt mass or head, made concave Fic. 364.—Ordinary Whalebone Probang. 368 OPERATIONS ON THE DIGESTIVE APPARATUS. on its free end, the better to act without slipping against the ob- ject with which it is to come in contact. The probang of the stomach pump forms an excellent instrument for that purpose. Dr. Peabody has constructed a simple implement of strong, thick wire, twisted together and forming a rod of sufficient length, protected by a tube of India rubber, and having one end formed into a ring or loop, to serve as a handle, while at the other ex- tremity a sponge of suitable size is secured and formed into a bulb resembling that of the ordinary probang. Degives recom- mends for use in cases of emergency an extemporized instrument, formed of a whip handle or a branch of a tree, of sufficient length, of the size of the little finger, with a bulb composed of a ball of oakum covered with cloth. This bulb is attached to the end with strong twine, of which a free end is left of equal length with the instrument, in order to draw out the broken fragments in case of fracture of the probang. Whatever form of probang may be used, it is always neces- sary to associate with it a speculum to keep the mouth sufficiently open and immobile. Those which are recommended and em- FIG. 365.—Brogniez’s Gag. ployed in the exploration of the mouth are available for this pur- pose. Butas these are not always obtainable, some ingenious and simple apparatus can be made at a moment’s notice like that illus- trated in Figure 365, which, or something equivalent, ought to be within the scope of the inventive and constructive capacity of any well equipped surgeon. OPERATIONS ON THE (ESOPHAGUS. 369 In ruminants the operation is performed in the standing posi- tion, with the head extended and elevated on the neck. In soli- peds it cannot be performed except while the animal is down, and when the head can be placed in the proper position of extension to allow the instrument to pass beyond the elbow formed by the pharynx and the esophagus. The animal being in position, and the speculum adjusted, an assistant draws the tongue out of the mouth, and the operator, placed in front of his patient, passes the probang through the opening of the speculum, and rapidly pushes it into the mouth, resting it upon the hard palate, in order to pre- vent its being displaced laterally by the motion of the tongue. At the bottom of the mouth the probang meets with some little re- sistance at the soft-palate, but the instrument soon reaches the fauces, in the pharynx, and penetrates the cesophagus. At this moment possibly some resistance may be encountered, owing to the contraction of the crico-pharyngeus muscle, but once engaged in the cesophagus the instrument readily passes the proper dis- tance downwards, according to the requirements of the case. If the object in view is to relieve tympanitis, and a true catheter, tube, or stomach pump or hollow probang has been used, the gases will find a means of exit as soon as the instrument has penetrated the stomach. If the catheterism has been performed for the displacement of foreign bodies, the resistance they offer to the pressure of the probang must be overcome by a steady, and, at times, quite a powerful pressure of the instrument, caution being always neces- sary to avoid causing laceration of the wall of the passage. When the obstruction is even but slightly loosened, its complete dis- lodgment often follows from the mere unassisted contraction of the cesophageal muscles. Caution and gentleness must not be overlooked even in the mere withdrawal of the probang. It should be practiced as a maxim, indeed, that whatever instrument may be, for any purpose, made use of, not alonein the propulsion of the intruding body in these cases, the operator must never re- mit his caution and gentleness, nor lose sight of the fact of the natural liability to accident always accompanying surgical in- terference with the organs and tissues having their place in the interior regions of the animal organism, and not cognizable by the eye. Serious accidents have been recorded as resulting from a lack of care and attention in the manner of withdrawing the in- 370 OPERATIONS ON THE DIGESTIVE APPARATUS. strument. Lacerations of the esophageal walls, rupture of blood vessels, perforation of the trachea, abscesses of the mediastines, pleurisy and pericarditis belong to the list of recorded casualties in this connection. To facilitate the working of the probang, in these cases, certain practitioners have recommended the adminis- tration of oil or mucilaginous drenches. Tue Taxis. The cesophageal catheterism which we have just considered is principally applicable to cases where the obstruction is in the thoracic portion of the passage. When it is in the cervical por- tion, instead of propulsion or intrapulsion, it is by extrapulsion, or by the course of the natural passages that the foreign body is to be removed. In this case the taxis is made to take the place of the ordinary artificial appliances, and the hands become the in- struments with which the surgeon seeks, by making forcible and methodical pressure, to move the impacted object back into the mouth. In 1820, Delafoy recommended a process which is to-day ad- mitted to be one of the best modes of relieving cattle when suf- fering with this difficulty, and many other methods have since then been devised, but most of them are merely modified plans of Delafoy’s method. We shall consider them as briefly as possible. In order to raise the ¢mpact (as we shall for convenience call it) back into the pharynx, Delafoy has the animal thrown, on the right side, and administers a glass of sweet olive oil, and while an assistant steadies the cesophagus, applies with his fingers upon the impact, a retrograde motion which carries it upward, back and to the pharynx. When it reaches that cavity, the head is raised, the jaws are opened with a speculum, and the operator, passing his hand through that instrument into the back of the mouth, seizes the impact and brings it away. Lindenberg keeps the patient on his feet instead of casting him, but otherwise ob- serves the same modus operandi. Denenbourg operates with his patient in a standing position. While an assistant holds the head, well extended, and elevated on the neck, he places himself on the right side of the animal, and with the fingers pressing be- low the impact (like Delafoy), displaces it and gives it the as- cending motion which transfers it to the pharynx, and keeps it there by pressing hard below it. Then putting an assistant in his OPERATIONS ON THE CSOPHAGUS. . ai place he proceeds like the others to remove the impact with the hand passed through the speculum. Schaack operates also in the standing position, the hind legs being hobbled above the hocks, the head is kept, as much as pos- sible, in a horizontal position, and a speculum placed in the mouth. The operator takes his place on the left side, in front of the shoulder, the right hand on one side of the neck, the left on the other. Ifthe impact is rather low down, or near the chest, the extremities of the fingers are brought together and employed to push it upward, with careful manipulations. If it is situated higher up, near the cesophagus where it is less surrounded by muscles, the pressure is made with the fingers closed. In either case, however, when it has reached the throat, Schaack holds it there, while an assistant with his hand boldly introduced into the mouth, seizes it and draws it out of the pharynx. According to Peuch and Toussaint, Mr. G. Tisserand, in cases of jabot, operates as follows: Making a point of support on the neck with the right hand, with the left he violently shakes the part where the projection of the jabot is most prominent, and then applies alternate movements, up and down, with a lateral shaking of the enlargement until the patient voluntarily lowers his head, and as he snuffles throws out through the nostrils and the mouth, abundant mucosities, mixed with alimentary detritus. If the first manipulations fail, Tisserand advises the occasional ad- ministration of mucilaginous decoctions, or oil, or even plain water. The method of Martin is one whichis also held in high esteem, and at the hazard of needless repetition and unnecessary minutize we give it in detail. Instead of extending the head, which has a tendency to stretch the cesophagus and diminish its diameter, he keeps the head of the patient low down, at about a foot from the ground, and placing himself on the left side of the neck, he passes his right arm over the neck, in such a manner that envelop- ing the neck between both arms, his hands can join on the lower border of the neck, and both thumbs pressed in the jugular grooves, one on the right, the other on the left. It is by succes- sive pressures from behind forward, that he succeeds in pushing the impact in the pharynx. Then comes a peculiar step of the operation: As by its presence the soft palate closes somewhat the posterior opening of the mouth, the impact cannot re-enter this cavity, and thus, while the mass is in the pharynx and resting on Vey Re Wi FAG a Me i Nee.) 372 OPERATIONS ON THE DIGESTIVE APPARATUS. the posterior face of the velum palati, with both thumbs he pushes it from above downward and from behind forward; the effect of this is to depress the base of the tongue, and to enlarge the isthmus of the throat sufficiently for the impact to pass through it, back in the mouth, and drop it tothe ground. If, however, the pressure required in this step of the operation could not, for one reason or another, such as excessive thickness of the lower border of the neck, for instance, be maintained, then the impact is ex- tracted with the hand. Courioux has advised the application of a cord around the neck, below the impact to be moved upwards with it, as the dis- placement is accomplished. The object of this is to retain what- ever progress may be gained by preventing the mass from re- ceding again. It forms a substitute for the fingers in holding it in position. The extraction by the mouth of many substances arrested in the csophagus has also been effected with instruments. Forceps long and curved, hooks and hollow sounds, having metal- lic nippers or jaws, like that of Baujin, have been recommended. That of Wegerer is probably entitled to the highest commenda- tion of all. But with all their ingenuity and perfection their use is not without danger of causing lacerations of the cesophageal walls, and they are constantly liable to get out of order. CRUSHING THE F'orEIGN Bopy. At times the obstruction takes place in the cervical portion of the cesophagus, and attempts to displace it, either toward the mouth or the stomach, have failed. To meet this emergency various means have been sought for, either to crush the impact, or cut it in small pieces. One suggestion for the first object is to break it with blows of a mallet, a piece of wood, or other object held by an assistant, furnishing the point of resistance. But this is obviously a dangerous process, nearly certain to produce bruises and lacerations of the soft structures, with probably sub- sequent gangrene. At best it can be available only when the im- pact is in the form of a comparatively soft mass, such as ripe fruit or the like. Professor Lafosse had in 1846 suggested subcutaneous incis- ion, and this was put in practice in 1855 by Chapard for the relief of a cow choked by a piece of a beet. A simple puncture of the OPERATIONS ON THE C&SOPHAGUS. 373 cesophagus was first made, with a straight tenotome, below the obstruction, then a curved tenotome was introduced through the wound, and by careful movements in the mass of impact, it was sufficiently divided to enable it to resume its usual course down- ward into the rumen. Though this mode of operation has not - become established in general practice, the application of its prin- ciple has not been overlooked, and has not been without its influ- ence in simplifying the performance of the operation of cesopha- gotomy. CHSoPHAGOTOMY. When the obstruction is in the cervical portion of the cesopha- gus, and, either because of its nature or of its form, cannot be displaced by any of the means we have discussed, the division of the organ itself furnishes the only escape from the consequences of the difficulty. The operation of cesophagotomy consists in the exposure of the cesophagus and the incision of its walls. While it is usually performed for the removal of obstructing bodies, it is also indicated in some cases as a mode of facilitating the adminis- tration of drugs, or, under special circumstances, of food and drinks. It is of French origin, and its adoption in veterinary surgery seems to have occurred in 1782, when it was performed by Lom- pagieu Lapole to remove an orange, arrested in the inferior region of the neck. Since that epoch it has been performed on horses, cattle, dogs, and even on swine. Damoiseau, Felix, Michel and others have performed it on cattle; Thissine, H. Bouley, Reynal, Rey, Marrel, Mauri on the horse; Peuch, Macgillivray, Williams, on dogs, and Lagrange on pigs. H. Bouley performed it to re- move a piece of corncob and a large molar tooth which, after ex- traction, had slipped into the cesophagus; Baldwin extracted a large piece of a root; Rey removed a cork; Peuch took away pieces of bone from a dog. In fact, the operation has generally, if not exclusively, as is but natural, been appropriated to the relief of patients laboring under the difficulty we have been discussing. A claim has been made in its behalf as a means of relief in lock- jaw, by facilitating the artificial feeding of the sufferer. But such a claim, as to any practical value which may be supposed to attach to it, cannot in anywise possess any validity, nor be to any extent sustained when we take into consideration the history and the 4 x 374 OPERATIONS ON THE DIGESTIVE APPARATUS. nature of tetanus and its origin, with the complications and con- sequences likely to accompany and to follow it. Marrel has rec- ommended it in cases of fractures of the jaws; but such practice would truly furnish an example of the proverbial case in which the remedy is worse than the disease. It has also been recom- mended for the relief of jabot, and has been, in some cases, fol- lowed by favorable results. — The instruments necessary for this operation are a convex and a straight bistoury, a pair of dissecting forceps, a director, a needle and strong thread; to these may be added a pair of scissors and two blunt tenaculums, with also large forceps to grasp the impact and extract it, close at hand. The animal must be kept in the standing position, and held under thorough control by an assist- ant, with a twitch on the lower lip or on the ear, and either fore foot raised or both fore legs hobbled. It must be taken into consideration that the cervical portion of the cesophagus is situated immediately behind the trachea, con- tinuing thence as far as the middle of the neck, when it deviates to the left, where it occupies the lower third of the neck; and again, that this cervical region is surrounded by an abundance of loose connective tissue, having on each side the carotid and its nerves. It will also be observed that the lower third of the neck forms a triangular space, with above it the inferior border of the sub-scapulo-hyoideus muscle, and on the sides the sterno-maxil- laris, levator-humeri and scalenus. In this space it is in connec- tion on the inside with the trachea, upon which it rests; and on the outside with the scalenus, the carotid, the jugular and the nerves of that region—organs which are all covered by the cuta- neous colli and the skin. The point of separation of the middle and lower third of the neck, in the left jugular groove, is the place of election or of ne- cessity for the operation, or where the incision of the skin must begin, a little above and behind the jugular. If the obstruction is considerably prominent, this incision must be made directly over it. Peuch and Toussaint, in their excellent work, divide the oper- ation into three steps, which they thus describe :— 1st. Step. Incision of the skin and dissection of the subja- cent tisswes.—Standing on the left side, the operator first deter- mining the situation of the jugular vein, clips the hair from over OPERATIONS ON THE GSOPHAGUS. 375 the tumor, stretches the skin with the left thumb and index finger, and with the convex bistoury, extends the incision from the initial point, about four fingers’ breadth down, parallel with the blood vessels. The incision divides the skin, and the cuta- neous muscle, and exposes the jugular and carotid and their nerves. - The thumb of the left hand is then introduced into the incision and depresses forward the blood vessels and nerves, while the other fingers of the same hand are embracing the tracheal border of the neck. The csophagus is thus exposed on thé lateral border of the trachea, and the cellular tissue which covers the organ is then divided. By raising the upper lip of the incision with a blunt tenaculum the cesophagus may be still more exposed. 2d Step. Loosening or isolation of the cesophagus—Cutting away part of the cellular tissue, the cesophagus is seized with the thumb and index of the right hand and drawn outward. The vasculo-nervous fasciculus are then let loose, the cesophagus is Fic. 366.—The sophagus Drawn Outward and Raised with the Scissors. 376 OPERATIONS ON THE DIGESTIVE APPARATUS. drawn out with the left hand, the right holding the curved scis- sors, which being passed from above downward, and separating the remaining portion of cellular tissue, holds the organ resting upon its blades, in readiness for the third step (Fig. 366). 3d Step, or Incision of the wsophagus.—The operator then, supporting the scissors with the esophagus resting upon them, in the left hand, with a straight bistoury with the edge turned upward, in the right, makes a large puncture in the cesophageal walls, passing through their entire thickness, and afterwards en- larging it with the aid of a director. At this point of the operation, and at each deglutition, there is usually an escape of mucosities mingled with food. When the impact forms a decided projection, the incision should be made directly over the prominence. Professor Nocard has modified the operation in cases where the obstruction can be divided in small pieces, by making only a correspondingly small incision. He uses both a straight and a curved tenotome, and performs the first and second steps as in the preceding methods, the third one being made as follows: “The cesophagus being exposed, isolated and placed over the scissors, the operator introduces the straight tenotome through the cesophageal membranes, the blade running parallel with the muscular fibers, into the thickness of the impact (apple, potatoe, pieces of beet, etc.,) avoiding injury to the opposite surface of the canal; then sliding the curved tenotome against the straight one, and pushing it through the entire mass until it touches the op- posite wall of the cesophagus, he withdraws the straight instru- ment, and divides the impact by movements of the curved instru- ment, analogous to those made in the division of the tendons in the operation of plantar tenotomy. The blunt end of the curved tenotome protects the cesophagus from any enlargement of the original wound.” Cagny, after exposing the cesophagus, as already described, crushes the obstruction by repeated gentle blows of a small mallet, as before described. He prefers this mode to that of in- cision if the impact, though hard and flat, possesses but little force of adhesion. When the objects of the esophagotomy have been realized, there is no necessity for further interference, the appli- cation of sutures being generally considered rather injurious than otherwise, and though the resulting wound is of a somewhat com- plicated nature, its perfect cicatrization in a comparatively short GASTROTOMY. at: time is the general rule. The principal indication is cleanliness in the removal of the discharges, and of any mucosities or food that may escape over its surfaces. H. Bouley has experimentally proved that to obtain the cicatrization of cesophageal wounds it is essential “to feed the animals with food of fibrous texture, and nothing but pure water to drink.” By respecting this indication all danger of complications is avoided. The possible accidents and complications are: wounds of the blood vessels during the first steps of the operation, but the hemorrhage that follows may be stopped by pressure or ligature; edematous swelling of the wound, suggesting the infiltration of food or pus in the surrounding cellular tissue. Itmay terminatein a. simple abscess, or it may be the precursor of a fatal gangrenous complication: purulent infection, septicemia, tetanus, are also possible sequele of cesophagotomy, but a faithful and judicious application of antiseptic means in dressing and nursing the patients will usually baffle the possible evil. GASTROTOMY—RUMENOTOMY. This title, in our opinion, ought to include the puncture or in- cision of the rumen, when designed to liberate confined gases or to remove the solid contents which may have accumulated in that viscere. In the first case it is indicated when the tympanitic condition of the first compartment of the stomach exhibits alarming symptoms and resists all ordinary remedial indications ; and in the second, when the gases of the rumen are mixed with the alimentary mass contained in that organ and a larger opening than that made by the trocar becomes necessary, for their re- moval. In either case the left flank must be the seat of election for the operation, the rumen occupying that side of the abdomen, and situated at a point equally distant from the last rib, the angle of the ilium and the transverse process of the lumbar vertebre. Tabourin suggests the last intercostal space as the proper place for the operation. The instruments necessary are a large trocar (Fig. 367) with a straight and a curved bistoury. The gastrotomes invented by Brogniez (Fig. 368) and Sajoux are too complicated. The animal must be in the standing position. Puncture of the rumen.—The operator, facing the left flank, makes an incision through the skin, about an inch and a half long, 378 OPERATIONS ON THE DIGESTIVE APPARATUS. Fic. 367.—Large Trocars, with the bistoury, or with the blade of a lancet. Then placing the trocar perpendicularly upon the flank and into the cutaneous incision, presses it against the muscles, and with his right hand strikes a heavy blow on the handle of the instrument and forces it into the cavity of the rumen, provided the blow has been suffi- ciently heavy. The blade of the trocar is then withdrawn, the canula being left in place, and the gases allowed to escape, as in the operation of enterotomy. Incision of the rwmen.—The operator, using a convex bistoury, makes an incision in the middle of the left flank, beginning a little below the point selected for the puncture of the rumen, and measuring a length of from three to four inches, cuts through and divides the entire thickness of the skin, and the walls of the rumen. The hand is then introduced and employed for the re- moval of the food contained in the cavity. The further cleaning out of the rumen may be done with a large spoon. Schaack recommends the removal of only a limited portion of the ferment- ing mass, and that the walls of the organ should not be scraped. While the puncture of the rumen does not require to be fol- lowed by any special subsequent treatment, the wound of the in- cision needs to be closed immediately after the removal of the contents of the organ. This must be attended with every anti- septic precaution, and the closing be done by means of the inter- rupted suture. The parts should be thoroughly cleansed. Adhe- sion may be promoted by the application of a wide band of ad- hesive plaster placed all round the animal, as recommended by Professor Brush of the American Veterinary College. The wound . of the puncture heals rapidly, while that of the incision requires from a week to ten days, and if properly treated, unites by the first intention, without suppuration. The accidents which are : } q | | ’ — GASTROTOMY. 379 Fic. 368.—Brogniez’s Gastrotome,. likely to follow these operations are subcutaneous emphysema, abscess, or peritonitis. The first of these is not uncommon, or dangerous; the abscesses are comparatively rarer; the peritonitis generally proves fatal. 380 OPERATIONS ON THE DIGESTIVE APPARATUS. ENTEROTOMY. The division or puncture of the intestines, or enterotomy, is an operation the object of which is to facilitate the exit of gases contained in these organs, to prevent their excessive dilatation, and to obviate certain too commonly fatal complications. It was mentioned at an early day by Vegetius, especially in connection with the treatment of wind colics, but not again spoken of until 1776, when Roem, Bomyinghausen, and at a later date, Barrier and Herouard obtained good results from it. Bourgelat and Chabert recommended it in the early stages of the disease, but, notwithstanding the favorable dicta of all these authorities, the operation was not fully admitted to a place in the domain of veterinary surgery until Bernard, Dieterichs, Falke, Rey, Schaack, Hayne, Eckel, Blendeiss, Charlier and others, had proved by nu- merous facts that when performed under favorable circumstances it is not only harmless, but is capable of insuring results of the most beneficial character. Intestinal puncture is indicated in cases of tympanitis or flat- ulent colic, due to indigestion, or to an intestinal obstruction, and must be performed whenever the accumulation of gases has resisted ordinary forms of treatment. The indication, in our opin- ion, is to operate early in the disease, as an almost positive means of avoiding the complications, or rupture of the stomach or lacera- tion of the intestines, which, if unchecked, may accompany the flatu- lent accumulation. Enterotomy is also recommended in cases of strangulated hernia, when the gases which are imprisoned in the hernial intestines prevent its reduction. Imbert used it with ad- vantage in reducing a strangulated ventral hernia. In former days Chabert performed the operation through the rectum, and Abadie, in 1875, reported a case in which he reached the intes- tines through the vagina. But while it may be possible to ob- tain access to the dilated intestines through these channels, it is evident that it is a method which must oppose more difficul- ties and involve more complications than the puncture through the flank. The point of selection for the operation is about the center of the space formed forward by the border of the last rib, behind by the external angle of the ilium, and above by the extremity of the ENTEROTOMY. 3881 Reb Fic, 369.—Trocars for the Ccoecum. FIG. 370.—Brogniez’s Enterotome. transverse processes of the lumbar vertebre, on the right flank— since it is there that the dilatation of the intestines is most prom- inent. The puncture, if made at this stated point, penetrates the second portion of the large colon; if it is made nearer the lumbar vertebree, it enters the arch of the ccecum. The only instrument necessary to perform enterotomy is a trocar. The instrument used in cattle for puncture of the rumen 382 OPERATIONS ON THE DIGESTIVE APPARATUS. was formerly employed, but it is quite unnecessary and of no ad- vantage to use a canula of such dimensions merely to allow the © escape of the gases. A small, round trocar is now in general use, and is in our estimation to be preferred to the ordinary flattened form of instrument (Fig. 369). The enterotome of Brogniez (Fig. 370) is too large an instrument, and its use endangers the walls of the intestines and the surrounding blood vessels. Brogniez reports a case of injury to one of the ccecal arteries by the point of this instrument. We have frequently had re- course to the trocar of the epidermic syringe used for horses, when no other instrument was conveniently at hand. The animal suffering with flatulent colics is treated while on its feet, and the pain it endures is usually of so intense a kind that no means of restraint are necessary, and it remains per- fectly indifferent to the insignificant and minor pang of the oper- ation. The principal caution to be observed, is to be on guard against the patient’s suddenly falling, but if this should occur it need not interrupt the operation, which may be continued with- out forcing it to rise. The modus operandi is very simple. The spot being acurately determined, the point of the instrument is pressed perpendicu- larly upon the skin with one hand, and driven by a strong, quick blow with the other upon the handle, through the skin and the in- testinal coats into the visceral cavity. The withdrawal of the rod, leaving the canula in place, completes the process, by giving vent to the gases. These escape with more or less force, as announced by a whistling sound as they pass out of the tube. The intestines must then be entered from above downward, and not as recom- mended by Hertwig, who punctures the most dependent part of the abdomen, and thus exposes his patient to serious subcutaneous infiltrations. Peuch and Toussaint suggest the propriety of making a small preparatory incision through the skin with a bistoury, pre- vious to the main puncture with the trocar. The escape of the gases continues for a varying time, according to the amount of the accumulation. The instrument should continue in the wound while the escape continues, and until the tympanitic con- dition of the intestines disappears. If the escape of gas should suddenly cease, it will be because the canula is filled with focal or other matters, and the trocar must be re-inserted into its * ———— a lt a ee PARACENTESIS. 383 canula until the renewed escape of the gas proves that the ob- struction has been removed. If, however, they still fail to find an exit through the canula, a second puncture must be made at a short distance from the first. The wound of the puncture re- quires no treatment. According to Zundel, enterotomy is comparatively—in ordin- ary cases—harmless; still, however, complications more or less severe are possible, and have been observed. Hemorrhages, though of no alarming nature, have been noticed, and several cases of abscess have been recorded, either at the seat of the operation, or at the wound of the flank, and even in the groim. Peritonitis has also been encountered. Subcutaneous emphysema has been mentioned by Bouley; but in an experience of many years, we have never seenit. Laceration of the floating colon has been reported by Schaack. As a means of prevention against these accidents we would recommend great care in the introduc- tion of the trocar through the abdominal walls, and especially a condition of thorough cleanliness, with a careful disinfection, of the instrument. PARACENTESIS. This term, with its synonyms of puncture and tapping, 1s at the present time applied exclusively to the operation performed upon the abdominal walls for the purpose of evacuating the seros- ity collected in the peritoneal cavity, as the result of dropsical ef- fusion. It consistsin puncturing the abdominal walls in the man- ner practiced in enterotomy and gastrotomy. The operations are similar, while the purpose varies materially in the several cases. This operation had already been recommended by Vegetius— afterward employed by Vitet, as a last resort in ascitis. Lafosse, Jr., also speaks of it, and in more modern times we find it advo- cated by St. Cyr, Lafosse, Forster and others. Though in the majority of cases forming only a palliative treatment, it is never- theless indicated in chronic dropsy of the abdomen, when all other forms of treatment have failed to produce the resorption of the fluid, especially when its accumulation interferes with the ab- dominal and thoracic functions. In these cases of ascites it has been performed upon horses, cattle and dogs. The injection of tincture of iodine into the peritoneal cavity, after the removal of ee 384 OPERATIONS ON THE DIGESTIVE APPARATUS. the effusion, has been successfully added as a means of preventing the return of the fluid. In selecting the place where the operation is to be performed, Brogniez, Degives, Peuch and Toussaint advised the middle of the linea alba, at an equal distance from the xiphoid cartilage of the sternum and the anterior border of the pubis; Zundel, on the contrary, recommends “a puncture on the right side in ruminants, on the left in horses, on a point at an equal distance between the umbilicus and the external angle of the ilium, about on a line run- ning from the stifle towards the cartilage of the last rib.” He adds, however, “to select the point where the liquid is most de- tectable and fluctuation better felt.” A trocar of the size of a quill for large animals, and an aspirator for the small, are the only instruments required. In operating on large animals, they are kept standing, while small animals are laid upon a table and placed slightly on their backs. Placing himself on the left side of the animal, after having selected the place where the puncture is to be made, the operator, holding the trocar Fia. 371.—Holding the Trocar in Paracenthesis. full in his hand and limiting its action by keeping his fingers a short distance from the point of the instrument, pushes it by a rapid and firm pressure through the thickness of the abdominal walls, until he feels that he has overcome their resistance, and that the instrument has passed into the cavity. The trocar is then withdrawn from its canula and the fluid escapes through the tube. Director Degives describes another modus operandi, which he calls subcutaneous, in which the opening of the skin does not cor- respond with the division of the deeper muscular layers, and by which the opening becomes covered by the skin. To effect this the skin is drawn a little aside, then punctured, or a large fold of the tegument is taken hold of, and the puncture made at its base. In either case, when the skin is loosened, its retraction completely closes the abdominal opening. HERNIA. 885 If the escape of the fluid should stop or diminish, a blunt stylet can be introduced into the canula to clean it of any albu- minous or epiploic mass which may obstruct it. The operation in small animals is performed in the same manner. As the removal of the entire accumulation of the fluid is dan- gerous, though less so than in thoracentesis, it is better to permit a portion of it toremain. The quantity is sometimes enormous, ranging between thirty-five and ninety-six quarts. After the quantity desired has been obtained, the canula of the trocar is carefully withdrawn, and a bandage or roller of adhesive plaster placed around the body of the animal. Among accidents possible in this operation, wounds of blood- vessels or of the intestines, and fatal peritonitis may be men- tioned. HERNIA. GENERAL VIEW. In a general sense, any tumor formed by the entire or partial escape and protrusion of an organ, either wholly or in part, from the restraining tension of the integuments, or from the cavity which forms its normal location, is a hernia, or in popular phrase, arupture. The more special application of the term is to the dis- placement of the abdominal viscera, but it is also employed to describe the encephalocele, or protrusion of the brain through the cranium; the projection of the iris and the jadot, or protrusion of the cesophagal mucous membrane, throughits muscular coverings. And again the prominence of a synovial membrane beyond its ordinary bounderies: that of a muscle through its aponeurotic envelope; the prolapsus of the rectum; of the vagina; of the uterus, etc., etc.,—these also receive the same designation and are recognized members of the hernia family. We shall, in the pres- ent chapter, mainly limit our consideration to the displacements of the abdominal digestive organs. The rationale of the formation of a hernia becomes a matter of easy comprehension, when we take into consideration the gen- eral anatomy of the abdomen, and especially the structure of its inferior wall. The muscular layers which form the exterior wall of this large splanchnic cavity are not of equal density through their whole extent, and consequently do not offer in every part an equal amount of resistance to the outward pressure of the interior 386 OPERATIONS ON TI) DIGESTIVE APPARATUS. contents. In one place musculo-cartilaginous, or bony, it is in another, musculo-aponeurotic. In some parts protected by only a single layer of muscle, as in its anterior wall; in others the layers of muscular aponeurotic structure, or of fibrous bandages, are re- inforced by a powerful elastic band, as in the inferior portion, by the tunica abdominalis. But besides this variety in the elements 2 FG. 372.—Muscles of the Inferior Abdominal Region. 1, aponeurosis of the great oblique; 2, fleshy portion ol the smali oblique; 3, straight of the abdomen; 3’, transverse of the abdomen; 4, pre-pubic tendon; 5, inguinal ring; 6, its anterior border; 7, the posterior; 8, external commissure; 9, internal commissure; 10, posterior border of the aponeurosis of the great oblique; 11, internal crural aponeu- rosis; 12, flap of the aponeurosis of the great oblique, drawn downward to show the origin of the reflex portion which forms the crural arch; 14, remains of the umbilicus, forming the walls of the cavity, there is also to be taken into con- sideration the fact that, at certain points in the walls, natural openings exist, and that the abdominal cavity is therefore not strictly a close cavity. These passages consist of the inguino-cru- ral openings, the umbilicus and those found in the diaphragm for HERNIA. 387 the egress of certain organs out of the abdomen, either during foetal life or after birth. The hernia, when not arising from a traumatic cause, is the result of some violent muscular effort on the part of the animal, in the course of which the viscera are made to exert a violent out- ward pressure upon the walls of the abdomen. If the pressure bears against any of the more solid portions of the wall, there will be no yielding, and the parts will remain uninjured and intact. But if the pressure becomes unduly violent, and the attack is di- rected against some one of the weaker supports, there must be a yielding, and the intestine or omentum, as the case may be, will be forced through the opening which falls most nearly in line with the direction of the violence. The resistance fails, the viscera passes through the aperture, and there is a protrusion, a rup- ture, a hernia. Two elements must enter into the composition of all hernias, with the exception of eventrations. They are the sac, and the displaced organs which form its contents, and the mode of its formation may be readily comprehended by a consideration of the figures 373, 374, 375, which show the progressive displacement of the peritoneum, as it is pushed through the opening of the ab- dominal walls, by pressure of the intestines, which are also gradu- ally passing through the same opening. The figures show in what manner the hernial or peritoneal sac is formed. The sac is thus shown to be the prolongation of the perito- neum, which is displaced, moved and distended, or may have sus- tained partial laceration of its fibres. It may even happen that the rupture of that serous membrane is complete, and that it has become lodged in the cellular tissue. In such a case the lacerated peritoneum soon throws out a provisional reparatory sheath, which becomes continuous with the natural serous membrane. Whether formed by the peritoneum itself, or by a membrane of secondary formation, the sac is always composed of a middle por- tion, or body, and an opening, or ring, which constitutes a means of communication with the abdominal cavity, with a neck or canal, a narrowed portion, uniting together the body and the opening of the tumor. But little uniformity exists in the formation of the ring or opening of a hernia. In some instances it is round or oblong, in others it is a narrow slit, and again it exhibits a triangular outline. 388 OPERATIONS ON THE DIGESTIVE APPARATUS. FIG. 373. EXPLANATION.—In these three figures an idea of the mode of formation of hernias is given: ad aa ad, represent a section of the abdominal wall; o o o, the aponeurotic opening through which the peritoneum, pp pp pp, is engaged to form the hernial sac, s; the intestine, 7 i 7, is shown entering the hernial sac gradually. FIG. 374. FIG. 375. In the ventral kind the aperture is wide and of varying dimen- sions, and it may, moreover, be quite wanting, or again, it may be long and cylindrical, as in inguinal rupture; while in the um. bilical variety it is very short, and represented merely by the thickness of the edges of the hernial ring. The dody or middle portion of the intestines, or that which becomes lodged in the cavity of the sac, also varies in size, direction and form, and may be considered under the four principal heads of the cylindrical, HERNIA. 389 Fig. 376,—Cylindrical Hernial Sac. Fig. 377.—Spheroidal Hernial Sac. FIG. 378.—Conical Fig. 379.—Pyriform Fic. 880.—Hernial Sac Hernial Sac. Hernial Sac. _ in Clusters, or having three contractions— SJ, a, b. ‘y 7 FIGs. 381, 382.—Multilobular Hernial Sacs. 390 OPERATIONS ON THE DIGESTIVE APPARATUS. the spheroidal, the convex, the pyriform, to which Zundel adds the clustered and the multilobular. The relation as to dimensions between the body of the hernia and the measurement of the ring is a point of importance in re- lation to estimating the more or less serious nature of a case. It will readily be inferred that with a narrow and contracted open- ing, an obstruction may easily take place, and at an early date, and that in due time the result will be manifested in the legitimate form of a strangulation, an accident which will be accompanied with various phenomena, according to the degree of pressure and the duration of the period of formation, and all of them attended with trouble and danger. At first, as the capillary circulation becomes retarded and diffi- cult, the intestines assume a red color, which passes successively through many shades, from deep red to brown or a blue-black, indicating the arrest of the blood, of which the dreaded sequel may be looked for in the appearance, a little later, of signs of mor- tification of the parts involved. The blood then transudes through the walls of its vessels, and filtrates into the sub-serous and sub-mucous cellular tissue, thus increasing the bulk of the contents of the sac. At the same time the external surface of the protruding intestines becomes the seat of what is at first a yellowish exudation, but which becomes a bloody deposit, ready for organization if the patient lives long enough to survive the pains of the strangulation. By the eight- eenth or towards the twenty-fourth hour, however, signs of total gangrene make their appearance and the hernial portion becomes flabby, cool, and insensible; the odor becomes very offensive, and the tissues easily lacerated or torn. The fatal end is then near, being rarely deferred beyond the twenty-fourth hour, unless im- mediate relief has been interposed. But, of course, every case does not observe this regular succes- sion of symptoms, nor reach the same final termination, and in the instances in which the interference with the circulation is less pronounced and the degree of pressure upon the protruding organ is lighter, probably not more than sufficient to interfere moderately with the movement of the intestinal contents, we have a modified evil to contend with in the obstruction or engorgement of the hernia, with consequences in view less discouraging to con_ template The exudation upon the surface of the contents of the Fig. 383.—Strangulated Inguinal Hernia. A, intestinal circumvolution. B, herniated portion of the intestine. DD, neck of the vaginal sac compressing the intestines. E, internal wall of the vaginal sac. T, tes- ticle in the fundus of the vaginal sac. sac has resulted in an adhesion with the internal surface, and the hernia has taken its place in the class of the irreducible. Hernias of long standing, which have, at intervals, shown indications of obstructions, are, in the greater number of instances, in fact, ir- reducible. There are still, however, cases of simpler condition in which the viscera continue to be movable in the sac, in which fact they are due to the lubricating effect of a free serous exudation. 392 OPERATIONS ON THE DIGESTIVE APPARATUS. Aside from other distinguishing characteristics, all hernias are divisible into two classes—internal and external. Of the latter, some, as the eventration, have no containing sac, while the others, which have a serous covering, are in reality alone entitled to be considered as the true hernias. These, usually occurring through one of the natural openings, are called natural, in opposition to the accidental, which, like the ventral hernias and the eyentration, occur through accidental and artificial openings. Any of the ab- dominal viscera, with the exception of the pancreas and the Iid- neys, may enter into the formation ofa hernia, and as each is known by the name of the displaced organ, we are given the designations of enterocele for a hernia of the small intestines ; epi- plocele, for that of the omentum, and entero-epiplocele of both the intestines and omentum. The name of gastro-ventral 1s given to the ventral hernia which involves with it the stomach; cystocele, when it is the bladder which is affected, and hysterocele when the uterus is concerned. Hernias can be, moreover, congenital or oc- casional—that is, they may exist at birth or previous to it, and also when making their appearance under special causes after birth. They may be also considered as acute when recent, or chronic, when of long standing. Their originating causes are numerous, and may be said to comprehend any which may predispose an animal to such a lesion by contributing to an increase of the pressure which the organs contained in the abdominal cavity bring to bear upon its walls, or any weakness in the walls, which may diminish their power of re- sistance to the pressure, as, for example, a condition of leanness arising from a sudden or recent change from a state of obesity; blows upon the abdomen; wounds and cicatrices of the abdomi- nal walls; violent, jerking efforts, such as those required in com- pulsory jumping or hauling, or in any other of the struggles to which they are too often forced, and even when under the sur- geon’s hands, when, as a patient, the animal is cast and secured for an operation; the rapid relaxation after contraction of the natural openings, repeated pressure, or excessive dilatation, as with stallions used for covering mares, may be placed among the predisposing causes. They have also been observed in mares, after violent efforts during parturition; also during colics and other tympanitis. To recapitulate and partly to repeat The general symptoms characteristic of hernias, are compar- a ae eee eee ‘4 =~ HERNIA. 393 atively easy to recognize, and can be reduced to two principal points, to wit—the discovery of a tumor, and appearance of an opening coexisting in the abdominal walls. These tumors and openings offer many varieties of form and character. The tumor located opposite to a natural opening, or under a breach or sepa- ration in the structure of the abdominal walls, or under a cicatrix, forms a mass, indolent, elastic, remittent, of varying size, but di- minishing or increasing under peculiar conditions, such as rest or pressure, and the standing, or the lateral or recumbent position, etc., and having different forms, being located in various places. It has also, in many instances, the quality of being reducible, that is, it may be made to disappear by means of certain manipu- lations and appropriate treatment, and arrangements of position, to return to their previous status when these agencies are sus- pended; or again, they will become permanently irreducible under special pathological changes already alluded to. The presence of borborygmus is also an important item among the means of form- ing a physical diagnosis of these tumors. This is detected more or less readily when the displaced organ is a portion of the in- testines. They are, however, missing when the hernia is formed by other organs, as, for instance, in case of epiplocele. Other points connected with this subject remain to be mentioned. Among these are the final symptoms, and more or less remote re- sults, which may follow the presence and working of the lesion upon the general economy and the physiological functions at large, when the acute action has passed away. The constitutional symptoms, or what may be so denominated, will vary, in their nature and their intensity, correspondingly with the condition of the hernia and the complications which may ac- company each case. Among these complications, four principal ones may be mentioned as taking precedence: Ist. Zrreducibility.—This is more frequent in old cases than in new, and is probably due to the increase in size of the dis- placed organ to the degeneration of the tissues, or to old adhe- sions between the organ and its covering, the sac. These cases, which may be considered rather permanent than merely chronic, maintain their status, either completely or partially, unchanged. Yet they cannot, naturally or rationally, be held to be compatible with a sound constitution or unimpaired stamina in the animals so conditioned, and their liability to contract indispositions easily 394 OPERATIONS ON THE DIGESTIVE APPARATUS. has frequently been remarked. Difficulty in the performance of movements requiring effort has also been noticed, with conse- quenily a liability to suffer traumatic injuries from external vio- lence. To this must be added a fagility in contracting: 2d. Inflammation.— Generally this occurs as the result of external injuries, but it may also occur without any apparent cause. Its seat is the sac or its contents, and it affects the serous structures alone, or assumes a phlegmonous aspect. The infiam- mation of the serous tissue is often overlooked, while that of the phlegmonous cannot pass unobserved. It may sometimes assume a very serious character, and become even more dangerous than the true strangulation. 3d. Obstructions or engorgements, common in intestinal her- nias, are due to the accumulation of alimentary or stercoraceous masses in the displaced intestines, or to gases which interfere with the reduction of the hernia. This is often complicated with strangulation, but is not in itself of a very dangerous nature. 4th. Strangulation.—This condition has been already consid- ered. It is the result of excessive pressure upon the blood vessels of the displaced organ, and while under its three periods or degrees of congestion, inflammation, and gangrene, has usually a fatal termination. The general treatment of hernia has the two objects in view of the destruction or obliteration of the sac, and the reduction or closing of the ring. If the first is not always easy to accomplish the reduction of the diameter of the ring often is so. Hach form of hernia demands some special directions for the realization of these two objects, and these will each receive its own share of attention as they may in turn come under our notice in further treating the various forms of hernia. InaurnaL Hernia. Inguinal hernia results from the passage or presence of a portion of the intestines, or of the omentum, or of both together, in the testicular or vaginal cavity whose opening of communica- tion with the peritoneum or inguinal ring continues in its normal condition, having never closed. A brief survey of the general anatomy of the region involved will be a necessary preliminary to our discussion of the subject, which is one of interest and im- portance. ee bi HERNIA. 395 L D E Fic. 384.—Anatomical Disposition of the Inferior Inguinal Ring and Testicular Sac. EXPLANATION OF Fic. 384.—A C, testicular sac, in which are shown—Ist, the neck situated above the letter A, and concealed in the inguinal canal; 2d, a middle portion extending from A to B; 3d, a fundus, B C, where the testicle is. DD, division of the scrotal artery. IF G, inferior inguinal ring, whoso internal commissure is rounded and formed of white fibres crossing each other and attached to the prepubic tendon. H H, fleshy portion, from the small oblique, and forming the antcrior and internal lip of the inguinal ring. K K, postero internal edgo of the inguinal ring, formed princi- pally by an aponeurotic portion of the great oblique. L, scrotal artery. M, veins of the scrotum and of the penis. N, part of the penis thrown backward. 000, tunica abdominalis. P, muscles of the flat of the thigh, short adductor of the thigh. The inguinal canal is an infundibuliform cavity, flattened from one side to the other. It is situated in the groin, and 396 OPERATIONS ON THE DIGESTITE APPARATUS. through it pass the testicular cord and the testicular blood ves- sels, in the male, and the blood vessels of the mamme in the female, as they emerge from the abdominal cavity. Situated on one side of the prepubic region, it observes an oblique direction, downward, backward, and from without inward, being formed posteriorly by the crural arch, and anteriorly by the fleshy portion of the small oblique muscle of the abdomen. Inferiorly it has an opening called the inferior inguinal ring, which is made through the aponeurosis of the great oblique, oval in shape, and possessing two lips, edges or pillars, united together by two commissures. The lips, divided into anterior and posterior, are formed by the fibres of the aponeurosis of the great oblique muscle of the abdomen, and a few of the muscular fibres of the small oblique, reinforced by some bands of the tunica abdominalis. The commissures, divided into external and internal, result from the union of the extremities of the two pillars. The superior opening of the inguinal canal is known also as the peritoneal or superior inguinal ring, and is situated in front of and directly opposite the crural ring. It represents a single slit, subject to dilatation, placed also between the crural arch and the small oblique of the abdomen, and allowing on its inner border the pas- sage of the anterior pudic or posterior abdominal artery, it sur- rounds the neck, and forms the entrance of the vaginal sheath. It is open in horses, and often in bovines also, and it allows a direct communication between the cavity of the vaginal sac and that of the peritoneum—undoubtedly a predisposing condition to hernias, not to be overlooked. The testicular sac offers to our attention, from the point of view from which we now consider it, an entrance, or true infundibulum, overlapping the internal opening of the inguinal ring or canal; a neck situated just below that ring, a continuation of the infundibulum or entrance, and which at a short distance from its origin offers a well marked contraction in its diameter—this being the point where strangulation takes place—a middle part, containing the spermatic cord; and a bottom, or true cul-de-sac, where the testicles and the epididymis are lodged. ke The special signification of the terms which have been else- where and already employed to designate and classify the varie- ties of form and manifestation characterizing different varieties of hernia are of interest, and should not be lost sight of. They are HERNIA. 397 divided principally into recent or acute, and old or chronic, and we find them considered as enterocele, epiplocele, and entero- epiplocele, according to their contents. The name of vaginal hernia has been used to denote a case in which the intestine is directly engaged in the inguinal canal; and hernia of the ring, or hernia in the canal, describes that in which the viscera have en- tered but a short distance into the sheath. Bubonocele signifies that the intestine has entered but a very slight distance into the inguinal sheath, in opposition to the oscheocele or scrotal hernia, when. the intestine falls quite down into the sac, and with the testicles themselves, occupies the bottom of the scrotum. Inguinal hernias are generally accidental, but, as some authors hold, are also sometimes congenital, having been found existing . at birth; and in many instances they become permanent, the in- testines occupying the vaginal sac without change, as a fixity. Then, again, they may be intermittent, disappearing more or less completely, under peculiar conditions, only to reappear under the stress of new influential causes. Of course the classification of re- ducible and irreducible, always holds. The classification of the hernia of castration, which takes place during or after that opera- tion, is considered by some to be properly one of the forms of eventration. A consideration of the anatomical disposition of the vaginal canal, and especially of its upper ring, which presents an opening communicating with the peritoneal cavity, will explain the reason why inguinal hernias of the horse are more common in the stallion than in the gelding. It is rare in’ bovines, but Lafosse has seen it in sheep and in rams and although the anatomical disposition of the canal in the dog render its occurrence difficult, Wolstein has observed it in that animal. Cases are rare in females, but Girard, Jr., has seen it in mares, Rychner in cows, and Hering, Hertwig and Goubaux in bitches. Recent Incurnat, Hernta. When the hernia appears suddenly, in a subject not predis- posed to it, the first symptoms are those of abdominal pain, ap- pearing suddenly and without warning, and quite inconsistent with the general perfect health of the animal. These symptoms are at first vague in their significance, and definable merely as ex- hibitions of simple pain in the abdomen. 398 OPERATIONS ON THE DIGESTIVE APPARATUS. If in the stable, the animal becomes restless, paws with his fore feet, gazes earnestly toward his flanks, and flexes his legs, as if to lie down, and perhaps accomplishes that movement, but only to resume the standing position. The skin is moist, the per- spiration appearing on the face, around the ears, behind the shoulders and in the groins. If he is in harness, his action is changed, he shortens his steps, stops pulling, wants to stand still, and becomes covered with abundant perspiration running over him and dripping from his belly. These first symptoms excite suspicion as to the real cause of the trouble, but they soon assume a character which changes the suspicion into certainty. They rap- idly assume greater severity, increasing in the ratio of the suffer- ings of the animal, which then has no more rest or intermission, and gives evidence of the most intense abdominal pain. He paws and stamps upon the floor more and more violently, sometimes kicking his abdomen; gazes anxiously toward his flanks; lies carefully down and rolls to and fro on his. back, sometimes keeping the dorsal position for a few moments, as if he could only thus find relief; then suddenly rises to his feet and repeats the movements, which give evidence of the torture he suffers, but more forcibly and rapidly than before. The expression of his face soon becomes characteristic. The lips are contracted, the nostrils are retracted and dilated, and the widely opened eyes ap- pear unnaturally large and prominent, rendering their agonized expression more and more striking. The respiration becomes ac- celerated and the pulse more rapid; the perspiration streams more copiously from his body and the poor animal groans under the weight of his trouble. After a lapse of some hours, the time arrives for the occurrence of strangulation, which may be pronounced the crisis or fatal event of inguinal hernia. It is characterized by a peculiar mo- tion of the head, which is thrown up and down repeatedly (and which the French have designated by the word “encensé.”) This motion, which is sometimes habitual with horses while in harness, has a peculiar meaning when it becomes the expression of the colic of hernia. It is then performed slowly, the head being ele- vated gradually and extended upon the neck, to be suddenly dropped again as if from weakness, to be again raised and dropped during the few and brief intervals of remission of the pains, while the animal possesses the ability to keep on his feet. HERNIA. 399 In fact, when the hernia is completed, the colics are so violent that the animal no longer lies down, but literally throws himself with violence upon the ground, having become forgetful of the natural instinct of conservation, and now rendered indifferent to all other pain by the overpowering force of the hernial torture. With his body covered with bruises, and bleeding from numerous superfi- cial wounds, he now becomes a pitiable object. There are animals of particularly sensitive temperament which will even, like those in a rabid furor, bite themselves on their flanks and forearms in their delirious desperation. During these excessive sufferings there seem to be just two positions in which the animal can experience a comparative de- gree of comfort. They are, lying on his back, or maintaining the dog-sitting posture, on his haunches. But these movements of reprieve are of but short duration, and the pains may continue to be manifested without cessation, by tumultuous, violent, unequal struggles, which may continue twelve or fifteen hours, or even more. At last, toward from the fifteenth to the twentieth hour, all the signs of pain subside, and a great calm succeeds to the previous violent agitation. This, however, is far from bemg a good sign, or an indication of the termination of the disease. It is, on the contrary, a sure token that a fatal termination is close at hand, and if the patient has ceased to suffer, it is because the anesthesia of death has fallen upon the organ in which his pains originated. The parts which were so recently altogether too much alive, have died. Gangrene has attacked the imprisoned intestine, and with its appearance, loss of feeling has also come—and death —for death is the loss of feeling. The animal is now in a con- dition of extreme prostration. The temperature is diminished; the perspiration is cold, the pulse is imperceptible, his face is without expression, the poor brute can scarcely maintain a stand- ing posture or move his legs when urged to, stir, and when the last remnant of his strength is exhausted, after a few hours, he drops upon the earth and dies without a struggle. Death rarely delays beyond twenty-four hours following the strangulation. This is the extreme limit, and in the greatest number of cases it takes place within a shorter period. These manifestations (the description of which we borrow from H. Bouley), constitute the series of general symptoms of hernia, but, at the same time, they do not belong exclusively to that kind 400 OPERATIONS ON THE DIGESTIVE APPARATUS. of injury. They are those of any violent abdominal pain spring- ing from any cause, and may be met with in invaginations, volvulus, intestinal obstruction, etc. But ifnot possessing any positive and intrinsic significance in themselves, they assume great value in the diagnosis, when added to the series of local, or pathognomic symp- toms which have their origin and limit in the inguinal region. Two methods are available for the location of the seat of the lesion, one being the external exploration of the inguino- scrotal parts, the other consisting in the internal rectal examin- ation of the pubic region. In a horse, and especially a stallion, suffering from colics, the indication to a general and immediate examination of the inguinal region, for abnormal appearances, is always present, and it will not be safe to be too easily satisfied with visual examination exclusively, to become certain that no part of the intestines is engaged in the vaginal sac. The eye may be deceived; it is the touch alone which will prevent all possibility of error. The sensation imparted to the touch at the beginning of a recent inguinal hernia is that of a thickened testi- cular cord which has lost its usual suppleness, and whose con- stituents can no longer be determined under the pressure of the fingers. Thus thickened, the cord gives asensation of resistency, increasing as the exploration is carried further up in the groin, while toward the bottom of the sac, the scrotal mass feels fuller than usual, the testicle becoming less movable, giving the sensa- tion of aslightly puffy tumor. After several hours duration of the disease, the characters become better marked, in consequence of the increase in the size of the intestine, and the amount of exu- dation, and there is also a formation of gases above the neck of the sac, which also contributes to its increase in size. The hernial tumor has thus. become changed from its original appearance, by its enlarged size, and is easily detected by the great general tension caused by the presence of the accumulating gases; the cord is found to be tumefied in its whole length, while its renitentcy increases as it extends upward into the canal. Direct pressure with the fingers upon the tumor does not seem to cause great pain, probably because this local sensation is dulled by the extension of the excessive pains which radiate from the hernia throughout the entire abdominal system. The external characters of the inguinal tumor become more noticeable when both sides of the testicular regions are compared, the difference between the HERNIA. 401 healthy and the diseased regions being then easily ascertained. Continued spasmodic movements of the healthy testicles have been observed. In the rectal examination of the horse, the hand may be easily carried beyond the anterior border of the pubis, and the condition of the superior opening of the inguinal canal, and the state of the organs engaged in it thus ascertained. In the normal condition, the anterior pillar of the superior opening of the canal is easy of identification. It is in front and on each side of the pubic region, and by reason of the extensi- bility of its muscular structure, requires no greater force for its separation from the posterior pillar than the introduction of two fingers into the ring. When the intestine is in the vaginal canal, after having passed through the superior opening, it can be felt with the hand through the walis of the rectum, its situation being generally on the inner side; and being thus recognized, it can be raised, pulled upon, and sometimes even extracted from the open- ing through which it had passed. But to be able to judge accu- rately the nature of the object which has been felt, requires in the surgeon an amount of experience in the taxis not always pos- sessed, while its absence may at times betray the explorer into serious error. Moreover, the sensations transmitted through the rectum cannot in every case be truly interpreted, and it sometimes becomes necessary to combine the two modes of examination em- ployed simultaneously—the rectal investigation and the external, manual, testicular exploration. Thus, when with one hand in the rectum, pressing on the in- ternal ring, and the other pushed well into the depths of the in- guinal region, both are brought in contact, and it is discovered by the actual touch that the inguinal canal is clear, the hypothesis of strangulated hernia is at once negatived. On the other hand, if there is hernia, and the imprisoned intes- tine is encountered, the fingers of the two hands cannot possibly come in contact, and the next question will be one of indication, if not of prognosis. As a rule, the prognosis of recent inguinal hernia is always seri- ous. If developed without organic predisposition it is necessarily a serious lesion by reason of its tendency to spontaneous strangu- lation, which when unrelieved means death by torture, unless the fatal event should be humanely anticipated and prevented by the 402 OPERATIONS ON THE DIGESTIVE APPARATUS. fiat of a compassionate master. But a fatal prognosis need not be unnecessarily volunteered. Timely and vigorous measures, es- pecially emphasizing the “timely,” may still prevent the strangu- lation and defer the sentence of mortality, and the sooner, there- fore, the means of relief are applied, the more certain will be their effect. Every minute’s delay increases the force of the disease and lessens the chances of success. It is rarely the case that the lapse of fifteen hours leaves any room for confidence, though it is not yet time to abandon hope. Within that period there are many chances for saying the patient, but after the earlier periods of the attack a single hour’s neglect may be fatal—that hour may prove to be the turning-point of the conflict. The treatment of recent inguinal hernia assumes two forms, consisting of the tas, and the operation of herniotomy, or the en- largement of the neck of the vaginal sheath with a cutting instru- ment. The first mode is indicated at once, or as soon as the her- nia is recognized. The reduction must be accomplished in the shortest time possible, the danger of strangulation becoming more imminent and threatening with the lapse of every moment. The taxis may give immediate relief, and may be materially assisted by douches of cold water. In this case the taxis consists in the manipulation of the part with the hands, by pressure and otherwise, for the purpose of re- placing the protruding intestine in its proper cavity; technically, the reduction of the hernia. This manipulation is applied either by simple pressure over the external surface of the diseased part, or, if practicable and necessary, by supplementing it with a proper traction applied upon the intestine from within through the rectal walls. This manipulation may be applied by two processes, first the subcutaneous, medial or indirect; and second, the direct taxis. Ist. The Indirect Taxis.—In the first or indirect method, the animal is placed in a standing position, with the hind legs secured. Then the hand and arm of the operator, well oiled, are introduced . into the rectum, using the right, if he is to operate on the left side, and vice versa. When in the rectal cavity, the hand is carried to the anterior border of the pubis, while with the other, passed in front of the patella, pressure is applied upon the scrotal sac, and the intestine pushed toward the superior opening. The hand in the rectum then grasps the loops of the hernia, through the rectal walls, and at the same time pulls them upward. Through these HERNIA. 403 manipulations the surgeon may succeed in removing the difficulty, if by that time the testicular sheath continues to be free from con- gestion. But if this already exists, and the colics are increasing in severity, the taxis in the standing position becomes impossible and it will be necessary to throw the animal. This done, he must be placed in the dorsal position, with his hind legs kept apart and his haunches raised as much as possible by bunches of straw. In this position, the operator must proceed to practice what must be described as an exceedingly delicate massage or taxis upon the scrotal sac, both hands being used, in such a manner as to crowd or press the intestinal mass toward the superior opening of the canal. The design of this is to stimulate the circulation through the capillaries, and also to free the cavity of the intestine from the semi-fluid and gaseous contents which may be present, by this means diminishing its volume and facilitating its reduction. That this must be done with the utmost caution and patience, needs hardly to be urged. And it should be persevered in for at least a period of thirty seconds before advancing to the other step, which consists in gradually pushing the intestine toward the opening. If the protruding loop is not too long, and the massage has succeeded in its design, and the bulk of the tumor has been sufficiently diminished, and, above all, if the hernia has had but a short existence, it may be within the probabilities that this external taxis alone will be sufficient to reduce it. But such a result cannot be counted on with any degree of certainty, and it is then the simple dictate of wisdom to make assurance sure, if possible, by having recourse to double taxis, and attacking the danger at both its internal and external accessible points. For a single operator to undertake the performance of both branches of this compound manipulation can hardly be advised. Few men possess the necessary powers of endurance, and an acci- dent might easily compromise the very life of both surgeon and patient. At the least, it involves quite an unnecessary amount of effort and fatigue. All the reasons are in favor of a division of the work, by which a competent assistant will be put in charge of the rectal taxis portion of the labor, while the practitioner in chief will direct and execute all the other steps of the treatment. The successful result of the operation will be known at once by the diminution of the tumor, the disappearance of its puffy and tense condition, by the sudden sensation of yielding, felt by 404 OPERATIONS ON THE DIGESTIVE APPARATUS. the hand working in the rectum, and also by the facility with which the fingers of that hand can be introduced into the now liberated superior ring. Anesthetics have been recommended as powerful adjuncts in the application of the taxis, in this class of cases. Bouley recommended their use, and Baggt, a Russian veterinarian, agrees with Bouley, in advising their administration. His pro- ceeding is thus described: The rectum being emptied, a solution of two to four grammes of chloral and sixty or seventy centi- grammes of acetate of morphia are thrown into it, while at the same time compresses of chloroform are laid on the diseased side of the inguinal region. In the course of ten minutes there is such a relaxation of all the tissues that the reduction by rectal taxis is quite easy. The spermatic cords are then surrounded by rolls of bandages moderately tight, in order to prevent the return of the hernia. These bandages are left on for eight or ten hours. The danger of strangulation upon the testicular cords is an im- portant objection to the adoption of this process. Severe appli- cations of douches of cold water applied for one or two hours previous to the taxis have been successfully employed by Steff and Lacassin. A process known as that of Patey, from its discoverer, con- sists in the injection of oil of belladonna into the hernial sac, the action of the oil, it is claimed, producing the dilation of the pseudo-sphincter, which prevents the reduction. It causes a cer- tain flaccidity of the parts, renders the taxis much easier, and con. siderably facilitates the reduction. 2d. The Direct Taxis.—This procedure is of too dangerous a character to maintain a place in the domain of veterinary surgery, except under very exceptional conditions. It consists in apply- ing the manipulations of the taxis directly upon the intestine, previously exposed by the dissection of the testicular envelopes. These manipulations, which are dangerous when the intestine is distended by gases or fluids, may, however, be rendered easier by relieving the intestinal loop, through the use of a fine needle- trocar or aspirator, of the cause of its abnormal dilatation. The method of Renault, mentioned by Zundel, is also a form of direct taxis which, though it may be employed in cattle, involves a subsequent fatal peritonitis in the horse. The operation con- sists in the opening of the flank and the performance of the re- HERNIA. 405 duction by direct traction with the hand thus introduced into the abdomen. The operation of herniotomy is that which consists in the section of the neck of the vaginal cavity. Itis the proper opera- tion for strangulated hernia. Bouley has said: ‘‘This operation is not, as one may be inclined to think, a last resource, which is not to be used except after the taxis, under its various forms, has been applied and failed. Far from it. We believe, on the con- trary, that in the horse, the taxis is a means of treatment which is truly indicated only in the first five or six hours of the descent of the intestine; that even, in this first period of time, one must not use it too much nor too long, from fear of the complications which might arise through the rectal manipulations, and that after this limit of a few hours has elapsed, it is better to have re- course immediately to the operation, without trusting to vain hopes from the use of the taxis.” The operation is comparative- ly a simple one, the dangers which were formerly apprehended haying been greatly reduced by a better knowledge of the seat of the strangulation, and of the parts to be divided, and the ratio of mortality is now so small—forty-two recoveries out of fifty-two operations—that hesitation is no longer justifiable. The instruments required for this operation are straight and curved bistouries, scissors, an ordinary director, a herniotome (Figs. 384a, 385), or blunt, straight bistoury, and a pair of curved clamps with strong cords to secure their branches. The hernio- tome is a bistoury-caché, which, however, since the use of general anesthesia, has been replaced by the blunt, straight bistoury, en- ables the operator to divide the neck of the vaginal sheath in the right place with more certainty than heretofore, and to regulate more accurately the dimensions necessary to relieve the strangu- lation. The director which is best adapted for use in herniotomy is one which has a flat, lanceolated, grooved surface at one end, and which, while it guides the blade of the bistoury, contributes likewise to the protection of the intestine against the possibility of injury by the sharp edges of the bistoury. The patient to be operated on is laid upon a soft bed, anes- thised as completely as possible, and placed upon his back. The hind leg corresponding to the side where the hernia is located is freed from the hobble, secured with a rope, and carried outward in abduction, with the rope made fast to a fixed point near by— 406 Fig. 384a. Herniotome. OPERATIONS ON THE DIGESTIVE APPARATUS. as a ring in the wall, a post, a tree, or other immovable object. If the opera- tion is to be performed at night, which is too often necessarily the case, the presence of additional assistants will probably be required, in order to insure an abundant amount and proper man. agement of light, which is indispensable | in so delicate a dissection. In operating, the surgeon kneels be- hind the patient and with a curved bis- toury begins by making a long incision upon the tumor, parallel with the long axis of the testicle. This incision is similar to that which is made in castration with covered testi- cles, and must involve only the scrotum, the dartos, and the first layers of the lamellated cellular tissue which unite this last to the tunica erythroidea. The remaining portion of this lamelle is then carefully incised, until the fibrous coat is exposed, and the tumor is entirely enuclea- ted from its envelope of cellular tissue. This done, the fibres of the tunica erythroidea are scraped apart with the point of the straight bistoury, until the vaginal sac has been open- ed, which the operator dis- covers by the appearance of a stream of liquid pass- ing through. The canula- ted director is then intro- Wee duced into the opening and Herniotomes of Colin. HERNIA. 407 guides the bistoury, with which the hernial sac is now freely opened, in front and behind. This free cutting allows the escape of all the serous or sero-sanguineous fluid contained in the sac, varying in quantity according to the duration of the hernia. The contents of the hernial sac are now exposed. They consist of the testicle, pushed outward, against the commissure of the ring; the loop of the intestine, placed on the inner side of the spermatic cord, rarely extending as far down as the testicle, but _ usually reaching to the level of epididymis, and again, not un- commonly remaining in the condition of a bubonoale. But what- ever may be the dimensions of the protruding loop, the intestine is always easily recognized by the roundness of its form, the smooth- ness of its surface and its color, which may range from various shades of red to bluish black. Itis also recognized by the changes which have taken place in its consistency, resulting from the bloody and serous infiltration which has taken place inits structure. The intestine should now be carefully wiped off with a soft, fine sponge, . or washed with lukewarm water, in order to free it from any de- posits or adhesions of serous or bloody matter that may be present. The opening of the hernial sac should be immediately followed by the exploration of the neck with the index finger, with a view to the determination of the exact point where the strangulation exists, and to judge of its degree of tightness. This will not be found upon the superior opening of the inguinal canal, as thought by Girard, D’Arboval, Hertwig, Hering, Lafosse, Rey, Verrier and others, but should be looked for two or three centimetres below that opening, as demonstrated by Bouley; that is, where the neck of the vaginal sac is situated. This point made out, if the hernia is very recent, and the intestine has not yet become the seat of thick- ening, a few tactical manipulations can be applied, the internal face of the vaginal sac having first been lubricated with sweet oil, or some mucilaginous substance, or even oil of belladonna; and even cool irrigation has been of service. In the performance of this taxis the first step is committed to the assistant, who stretches both borders of the sheath in order to separate them in the form of a funnel, the testicle being drawn outward, in order to stretch the cord also. The operator then applies both hands upon the loop of the intestine, and with moderate and gradual pressure endeavors to push it through the neck of the vaginal sac. Rectal taxis applied at the same moment may also be of great assistance. But these 408 OPERATIONS ON THE DIGESTIVE APPARATUS. efforts must not be persevered in too long. If not successful al- most immediately, it is better to have recourse at once to the in- cision of the neck of the sac than to expose the intestine to the subsequent effect of pressures or tractions of which the termina- tion may be a fatal gangrene. The following steps are recom- mended by Bouley in making this incision. Says this author: “One assistant takes hold, with both hands, of the edges of the incision made through the vaginal sac, stretching them into a funnel shape; another draws the testicle outward and backward, to stretch the cord. Then the operator having explored with his finger the con- dition of the neck, introduces the blunt bistoury or the herniotome (Fig. 386) as far as the neck of the sac, taking for his guide the index finger of his right hand (Fig. 388), introduced into the neck or canulated director, and holding the instrument in such a manner that its back rests against the pulp of the fin- ger which supports it, and its sharp edge turned outward, corresponds to the stiffened band of the neck, to- wards the internal face of the thigh. This band will thus become stretched over the knife in such a manner that it divides itself upon the sharp edge of the instrument, with the aid per- haps of the slightest pressure made by the finger which supports it. The important point is to make a very lim- ited incision, dividing only the thick- ness of the vaginal sac and its fibrous covering, and avoiding the wounding of the cremaster, that being one of the conditions of the closing of the sheath. The division once made, the degree of dilatation of the neck is readily made out, and if the finger can be easily in- troduced into it, the reduction of the hernia becomes then an easy task. The modus operandi by the use of the herniotome differs but little from the preceding. When this instrument Fig. 386.—Narrow blunt Bistoury used as Herniotome. Fig. 387.—The bistoury sliding flatwise on the Grooved Directory. HERNIA. 409 Fig. 388.—Holding the Bistoury upon the Grooved Director. is to be used, a careful measurement of the amount of opening to be allowed to the blade must first be made. Then, guided by the side of the index finger, and with its blade turned outward, the instrument is introduced into the sac. When it has reached the proper point where the division is to be made, the blade is brought out by pressing upon the peculiarly-contrived handle of the instru- ment, and the division of the band of the neck is completed. After the division at the point of strangulation, the taxis is to be used, both externally and by the rectum, carefully taking into consideration the condition of the intestines in the application of the various manipulations required. Upon reduction of the hernia, obliteration of the sac is secured by the application of a clamp, curved or straight, upon its parietal layers, embracing between them the spermatic cord. In short, the final steps of the operation will be precisely those by which the operation of castration with covered testicles is completed. This methed of closing the vaginal sac is the best, the simplest and the most certain in its results. Itis true that the objection that it implies castration is a weighty one, but the mutilation which it involves is a condition of radical recovery which cannot be obtained by any other means. The attempts which are made to save the testicles, which are justifiable only in the case of very valuable animals used for breeding purposes, are nearly always followed by fatal results. Among these may be mentioned the process by which, in- stead of leaving the testicle to drop under the effect of the pressure of the clamp, it is left inclosed in the vaginal sac, whose divided edges are brought together by sutures. Schmidt has attempted to push it back into the abdomen; but such methods have been followed by fatal peritonitis. Bouley has 410 OPERATIONS ON THE DIGESTIVE APPARATUS. also advised a subcutaneous herniotomy, which was put into prac- tice afterwards by Siegen & Verrier, in which the careful puncture of the sac was made at the origin, or, preferably, at the flabelli- form insertion of the cremaster. After enlarging the opening, the index finger is introduced into the neck, carrying with it the blunt bistoury with which the structure is divided, and the reduction is completed by the taxis, the wound being closed by several points of suture. The use of antiseptics in our day obviates a large portion of the danger arising from the complications which may follow these modes of operation. The operation for strangulated hernia in the gelding does not differ much from that indicated for stallions, except in the man- ner of closing the wounds, the clamp, in this class of patients, being applied upon the hernial sac, involving the skin, as is done in some cases of treatment for umbilical hernia. The treatment of the patient subsequently to the operation is generally a simple matter, the violent colics, with other manifesta- tions of the hernia, having suddenly subsided, and the patient being comparatively free from pain. He will probably give evi- dence of some slight abdominal uneasiness, which will probably be due to the pressure of the clamp upon the testicular cord, but this will not be of long duration, probably requiring no other at- tention than a moderate walking exercise. The animal is then turned loose in a box stall and placed upon a diet suited to his case, and watched for future developments. The wound requires no special attention but cleanliness, and towards the fifth or sixth day, when the suppuration is estab- lished, the clamp can be removed. It is about this time that complications may be looked for. A fatal peritonitis, for example, may appear between the fifth and tenth day, when everything has seemed to be progressing fayor- ably, and bid defiance to treatment, especially if the intestines were already in a gangrenous condition when the reduction was made. After ten days there need be no more fear of complica- tions, so far as the hernia is concerned, but it is not yet too late for those of castration, which may still occur. The duration of convalescence will average from twenty to twenty-five days, after which the animal can resume his work. A return of the hernia, recidive, is a rare and almost impossible event when the reduction has been completed by castration. HERNIA. 411 During the operation certain accidents may occur, including eventration, an extra vaginal hernia and injuries to the intestines. At the present time, eventrations are rare, by reason of the fact that the division of the superior ring itself is no longer per- formed. Yet they may occur through an accidental slip of the knife, or a tearing of the walls of the vaginal sheath during ma- nipulation for the reduction, and the accident is usually a fatal one. Of extra vaginal hernia, Bouley says: ‘‘ While making the in- cision of the neck, sometimes the cremaster muscle is divided in the direction of its length; an accident possible, especially when one uses the concealed herniotome, and when too much freedom is allowed to its blade. It is then possible that the intestines may become engaged through this incision, and appear outside of the vaginal sac, above the inguinal ring. If at this moment, by mis- applied taxis, the intestines should fail to re-enter the cavity of the sac, eventration may take place. But if, on the contrary, the intestine is first carefully returned into the vaginal cavity, and then into the peritoneum, the edges of the peritoneal opening of the canal being intact, the intestines will then be prevented from making another exit.” Wounds of the intestines may take place either through a misdirection of the bistoury during the struggles of the animal, or possibly from the nails of the operator or his assistants, and the fact of their possibility suggests a sufficient hint touching the obvious means of obviating their occurrence. The gravity of these injuries will be measured by their extent. Oxp InevrnaL Hernia. Old, or chronic inguinal hernias, are those of which the charac- teristic condition is that owing to the state of dilatation of the vag- inal sheath, the intestine contained in it is enabled, without jeop- ardy to the life of the patient, to continue its function in the same manner as if it had remained in the open cavity of the abdomen. The vaginal sac has in this case become a kind of large diverticu- lum of such dimensions as to allow, without interference, the work and motion of the intestinal tract, lodged within it, to go on in a natural way. These hernias are divided into continued, or perma- nent and intermittent—a division elsewhere alluded to—but they may also be distinguished as simple and complicated. 412 OPERATIONS ON THE DIGESTIVE APPARATUS. Among the varieties belonging to the latter category may be named: the laceration of the superior opening of the testicular sheath; the collection of serosity in the sac (hydrocele); the sar- comatous transformation of the testicle where the hernia exists (sarcocele); the adhesion of the intestines to the walls of the sac (irreducible hernia); with obstruction and strangulation. Although their causes belong to the list which we have already considered, there is still a sort of latent difference observable in the effects to which they severally give rise, as evidenced by the slowness and tardiness of their maturity. They often appear, also, as a sort of relapse or reactionary sequele (recidive of the French) of acute hernia improperly reduced, or as a consequence of the ab- normally dilated condition of the upper ring, while this constitutes a predisposing cause. But this same condition of dilatation may be congenital, and in animals with a predisposing conformation chronic hernia of the intermittent kind is of easy occurrence. Whatever may be their mode of formation, however, they are gen- erally of long standing, and readily diagnosticated by their positive and familiar characters. Chronic hernias are generally of larger dimensions than the acute, and when exclusively vaginal, filling the cavity of the scro- tum and forming a true oscheocele. If the laceration of the supe- rior opening of the canal has allowed the formation of a sac and of an adjunct tumor, in front and outside of the cord, the hernial tu- mor will then consist of two lobes, the smaller situated in the depth of the groin, under the ventral walls, and the larger occupying the scrotal sac. These hernial tumors are usually formed by the small intestines and the floating colon, in exceptional cases, by the pelvic curva- ture of the colon as well. They vary also in volume as well as in consistency, from an obyious cause; enlarging after meals, to con- tract again when the abdomen is empty; and again, giving various impressions under the hand, according as their contents are gas- eous, liquid or solid. In the first condition, when the intestines are empty and the animal is at rest, the tumor is soft, supple, elas- tic and more or less reducible, but when the animal is in action it increases in bulk, and becomes more tense and elastic, and less easy of reduction. There is therefore a condition of intermittency in their character, which is due to the peculiar conditions in which the animal may be placed. The form of these tumors corresponds HERNIA. 413 to that of the testicular sac in which they are contained, the in- guinal oscheocele being pyriform, with its contracted portion resting in the groin. Vermicular movements of the intestines and borborygmus are symptoms easily detected in large hernias. The tumor of a chronic hernia is painless, or nearly so. Rectal examination furnishes evident indications of the possibility, and of the presence of the hernia by the degree of the dilatation of the ring and the size of the organ engaged init. In such a case, the dila- tation may be so great, even notwithstanding the presence of the intestines, that the hands, placed respectively, one in the rectum and the other in the inguinal region, can be brought in such near proximity as to touch each other. All these symptoms, taken to- gether, or even isolated, are sufficiently characteristic to establish a positive diagnosis of simple chronic hernia, The serous exudation which necessarily exists in chronic hernia, may, when it is excessive, render the nature of a hernial tumor more obscure, and give it the appearance of a case of true hydrocele, the serous sac in these cases being so full as to render it impossible to discover, either by sight or feeling, the presence of the intestines contained in it, even the elastic resistance of its walls being undetectable. But here a rectal exploration will help to solve the question; and, again, by placing the animal in the dorsal position, the gravitation of the liquid into the abdomen will readily reveal the truth by leaving the intestine alone in the sac. Great caution is necessary in these doubtful cases, in which a misdirected stroke of the bistoury, thoughtlessly or accidently made, might prove certainly fatal, by incising the intestinal knuckle, which it really is, instead of simply opening the mere serous sac which it was supposed to be. The formation of a sarcocele may also render the diagnosis difficult. In these cases the testicle, considerably tumefied, rough on its surface, and hard and painful, is felt at the bottom of the sac, and thus conceals the character of the hernia. Still, with sarcocele hernia coexistent, the scrotal tumor acquires an appearance and proportions differ- ent from those of its uncomplicated state. In this last case, the testicle constitutes the principal mass, and the elongated cord, stretched by the weight of the organ, can be easily traced with the fingers quite up into the groin. If, on the contrary, both hernia 414 OPERATIONS ON THE DIGESTIVE APPARATUS. and sarcocele are present, the testicle is bosselated and hyper- trophied, and the cord which supports it is surrounded by the protruding intestines, which form on the outside an elongated mass, of a consistency either puffy or perfectly elastic, according to the period of digestion. Intelligent rectal exploration will always reveal the presence of the intestine through the ring. When chronic inguinal hernia becomes complicated with acute inflammation of the displaced organ, the scrotal tumor becomes warm, painful, evenly tense and remittent, and assumes nearly all the characters of a phlegmonous tumor, that a strong tempta- tion is offered to open it with the bistoury. But, if this is con- templated, it should be preceded by a rectal examination, carefully made, as the only means of avoiding a possible error of diagnosis whose consequences would be fatal. If the inflammation con- tinues to be localized, the intestine contracts adhesions with the walls of the sac, and the hernia becomes irreducible; but if, on the contrary, the phenomena of inflammation extend to the peri- toneum, an acute peritonitis is established, and the patient suc- cumbs in a few days. The obstruction or engorgement, which is a possible complica- tion of chronic inguinal hernias, consists in the distension of the intestinal loop by the lodgment of alimentary masses of varying bulk which accumulate, and for the time being, occlude the intes- tinal tract. This complication may be recognized by the in- creased volume of the tumor, its greater weight, and the sensa- tion of a softish and puffy mass contained in it. Itis often, how- ever, but a temporary trouble, the colics which attend it yielding easily to appropriate treatment, and the removal of feces from the rectum by back-raking being often sufficient in itself to afford relief. But in exeeptional cases, treatment fails; the obstruction becomes persistent; the feeces accumulate in the protruding in- testines; the tumor is increased in bulk, and at length a period arrives when such a disproportion between the volume of the dis- tended intestine and the capacity of the opening through which it has passed is established, that all the conditions necessary for strangulation are fulfilled. This soon takes place and becomes evident by the exhibition of symptoms akin to those pertaining to its analogue of the recent or acute variety. There is, how- ever, a difference between the two forms in respect to the impor- tant matter of their comparative amenability to treatment, inas- HERNIA. 415 much as while strangulation in the acute cases is only relieved with great difficulty, without resorting to the operation of herni- otomy, it is not uncommon in those of a chronic character, also strangulated, to succeed by a careful exercise of the taxis, in dis- placing the alimentary mass which causes the obstruction, and thus forms one of the contributing conditions of the strangula- tion. It is only in case of failure in this endeavor that herniot- omy becomes admissible. A chronic inguinal hernia is always a serious ailment, though not necessarily incompatible with the life and health, and even partial usefulness of the horse. It must, however, constitute a blemish which cannot fail largely to depreciate his commercial value, since it must always be liable to interfere with the efficient performance of his accustomed labor, besides keeping him in a state of greater or less exposure to complications and tendencies which are a constant source and menace of danger to the valetu- dinarian animal. Operations for the relief of hernia are always attended with a certain gravity, even when they are of the simplest character of which they are capable, and if complications exist the danger must necessarily be intensified and aggravated, even to the ex- tent of jeopardizing the life of the patient. In the excellent work of Peuch & Toussaint, speaking of the applications of treat- ment, they remark: “In animals less than fifteen months of age suffering with hernia, the expectant method is the proper indica- tion, since the lesion may disappear as the animal gets older and develops. Inguinal hernias of small size must be left alone, not interfering, while in that condition, with the work of the animal. The operation in chronic inguinal hernias, complicated with lacer- ation of the superior opening of the inguinal canal, and conse- quently with ventral hernia, is contra-indicated by the imminent danger of the occurrence of eventration during the operation, or when the clamp is removed. When, however, the hernial tumor has assumed such enormous dimensions, that, like the udder of a cow, it hangs down to the hocks, there is no more contra-indica- tion, the animal being then useless - and yet some slight chances of success still remain. Hernias complicated with hydrocele, sar- cocele or obstruction, are cases calling for operation, and when the point of strangulation has been reached, the indication of immediate and urgent interference is imperative.” 416 OPERATIONS ON THE DIGESTIVE APPARATUS. To this we may add, with Bouley, that the operation is also indicated when the hernia is exclusively vaginal and of sufficient proportion to interfere with the locomotion of the patient. It is also indicated as a means of preventing its further development. The operation for chronic inguinal hernia identifies itself with that of castration with the use of the clamp, and by the process known as covered testicles, as it is by this alone that the accom- plishment of the ultimate purpose in the reduction of the hernia and release of the strangulation can be obtained. The instru- ments required are those needed in castration. The clamp, how- ever, requires to be of increased length and dimensions, and Fig. 389.—Straight and Curved Clamp. curved, in order to adapt itself to the parts. A broad cloth, such as a bed sheet, may prove useful to receive and protect the intes- tines in case they should protrude too extensively. The animal is placed in the decubital position on his back, with the leg of the affected side maintained in abduction. Anes- thetics are generally used, especially when there are fears of com- plications, while, in fact, they ought never to be omitted. The operator then, with the convex bistoury, makes carefully, on the inferior border of the hernial sac, an antero-posterior incision, parallel to the median raphe of the scrotal region, cutting through the skin, the dartos and the first layer of the cellular tissue under- neath. He then with his hands tears the adhesions which exist between the dartos and the tunica erythroidea, in order to enucle- ate the hernial tumor in its entirety. This step is easily effected when the cellular tissue, which covers the fibrous coat, is not in- durated, but if that should be the case when adhesions exist, the s HERNIA. 417 dissection should be carefully made with the knife until the ad- hesions are completely divided and the fibrous coat fully exposed. The reduction must then be attempted without opening the sac, and in the absence of any adhesions this is effected without diffi- culty, the inguinal opening being so large that, through the force of mere gravitation, the dorsal position in which the animal is placed is often sufficient in itself to cause the return of the intes- tines into the abdominal cavity, even the testicle and the hernial sac often following it in its inward movement. If the reduction does not take place in this manner, or in con- sequence of the position of the animal, the taxis, both scrotal and rectal, is then indicated to be performed in the same manner as for acute hernia. Difficulties in effecting this reduction may arise from three causes—either, first, the bulk of the mass repre- sented by the protruding intestines; or second, its obstruction ; or third, the adhesions which it may have contracted with the walls of the sac or with the spermatic cord. To obyiate the first difficulty, while the manipulations of the taxis, scrotal and rectal are simultaneously continued, it will be well to relieve the position of the animal, and instead of keep- ing him lying absolutely on his back, to allow him to turn slightly, and to rest on the side opposite the hernia. In this way the mass will not be so heavy to manipulate, and will be in a better position to follow the dependent direction in which it must be pushed by the scrotal taxis, while at the same time, by ~ the rectal manipulation, it can be more easily unfolded and drawn from the cavity in which it wasimprisoned. But if, notwithstand- ing all these precautions, this difficulty in the reduction cannot be overcome, the indication of opening the sac still remains. The incision of the sac is performed as in cases of recent hernia, the bed-sheet already mentioned being held in readiness to receive the intestinal mass as it will be exposed. Then the animal being completely under the influence of ether, and in the dorsal position, an assistant grasps the edges of the sac and stretches them apart, funnel-wise, using both hands alternately, gradually pushes the intestines towards the hernial opening, an assistant at the same time slowly unfolding the mass and permit--» ting it to slide into the abdominal cavity. Rectal taxis may largely assist in this step of the operation. If the reduction is rendered impossible by the interposition of 418 OPERATIONS ON THE DIGESTIVE APPARATUS, obstructions, the first indication will be to evacuate the intestines by a methodical pressure which will displace the alimentary mass and return it toward the abdomen. The puncture made with the aspirator has proved very beneficial in these complications. The adhesions require the most careful dissection, especially when they are short, and when both the visceral and parietal layers of peritoneum are closely united. The separation must be done by a succession of short, limited incisions, at the expense of the thickness of the parietal layer. When strangulation of chronic hernia occurs, it is due not to want of room at the hernial ring, but to the enlarged bulk of the protruding organ, which constitutes the obstruction. Conse- quently the indication for herniotomy is not present. On the contrary, as serious eventration is always to be feared, the only indication is the removal of the obstruction as already indicated. When the reduction has been completed, the occlusion of the vaginal sac is to be obtained by the application of the clamp, applied as high up as possible, as in cases of strangulated acute hernia. ‘ In cases of inguinal, complicated with ventral hernia, attempts at reduction may be made by placing a long clamp over the coy- erings of the latter, involving with them the hernial sac and its cutaneous envelope, as practiced in some cases of the umbilical form. We need but briefly to refer to certain different modes of treat- ment of the various forms of hernia by the use of bandages, rec- ommended by Petard, Grau, Klinger and Marlot, together with the application of sutures upon the edges of the inguinal canal, patronized by Hertwig and Dieterichs, to say that none of these, any more than some others, borrowed from human surgery, can give more satisfactory results, or be employed with greater safety, and effect a radical cure better than the use of the clamp and the castration by the process of the covered testicle. InaurinaL Hernia IN GELDINGS. Although inguinal hernia in the gelding is certainly less com- mon than in the stallion, it is not, therefore, of impossible occur- rence. But from the fact of its rare appearance it is far more likely to be overlooked, and therefore neglected, with similar fatal HERNIA. 419 results to those in the stallion, when it reaches the stage of strangulation. From the fact that, as the result of castration, the superior opening of the testicular sheath is more or less closed, it becomes a matter of rational inference, that hernia in a gelding is not of posterior occurrence to castration, but that its existence is due to a congenital disposition, and that by the operation of gelding they have been reduced to their smallest proportions, in relation to the dimensions of the intra-vaginal sac, to the dimensions, in fact, of a bubonocele, which continues unobserved in consequence of the smallness of its size, and the depth of its location. These hernias are detected outwardly by a physical symptom, to wit, the existence in the inguinal region, on either side of the penis, and above the cicatrix of castration, of a tumor about the size of an egg, soft, depressible, altogether painless, sometimes elastic and at times puffy. It varies much in size, diminishing with rest and quiet, and increasing with effort and active move- ment. It may, in fact, under the first condition, entirely disap- pear, to return as soon as the animal is put to work. In a word, it has the true character of being intermittent. Aside from these symptoms, rectal exploration furnishes positive data of its exist- ence, by the abnormal dilatation of the ring, easily detected, and by the pressure of the intestines lodged in it. This hernia is also susceptible of strangulation, and is then ac- companied by violent abdominal pains, which must not be ignored as to their possible diagnosis and significance. The indication for careful examination in that direction must, indeed, never be overlooked in cases of violent colics in geldings. If these colics are due to strangulated hernias, the presence of a round, tense, resistant and painful tumor will be detected in either of the in- guinal regions, and, according to Bouley, more commonly on the left than on the right side. The strangulation in this class of hernia is generally irreducible, and becomes rapidly fatal; if not relieved immediately, it is not relieved at all. The first indication of treatment is the reduction of the hernia by simple, external taxis, or by combining with it the rectal taxis. The reduction will be followed by the disappearance of all the symptoms, and the animal will be apparently well, until a second attack takes place. After the reduction, steps must be taken to prevent its return, by an operation similar to one of those used in 420 OPERATIONS ON THE DIGESTIVE APPARATUS. umbilical hernia, to obtain the reduction and retention of the in- testine, by the application of a proper clamp upon the sac coy- ered by the scrotal skin. The treatment of the gelding for strangulated hernia does not differ from that of the stallion. Ordinarily, the taxis is sufficient to reduce such complicated hernia, but in case of failure in obtain- ing rapid success one must be careful not to carry on the manipu- lations so long as to encounter the risk of lacerating or tearing the tissues. The wiser and safer plan will then be to have recourse to the operation of herniotomy, an operation which should be performed with the greatest care in separating and dividing the existing cicatricial adhesions of castration. The clamp is after- wards placed upon the hernial sac, with its cutaneous covering, requiring a longer time to slough, and constituting a means of retention most favorable to the success of the operation. CruraL Hernia, or merocele, is that form of rupture in which the abdominal organs make their escape through the crural ring. It is a rare affection among our domestic animals, but has been seen by La- fosse,.Jr., in the horse, by Girard, Jr., in the dog, by Dandrieu in cows, and by Hertwig in horses, donkeys and dogs. It is said to be more frequent in males than females. It results from violent muscular efforts, and especially from the slipping apart of the legs when already separated or straddling in abduction. It is char- acterized by a somewhat well defined tumor, of moderate size, situated behind the inguinal ring, towards the middle of the flat part of the thigh. When the rupture is recent, the animal is some- what stiff in his gait, especially on the affected side, and carries his leg in abduction. There isalsoa degree oflameness. Accord- ing to Hertwig, the tumor is easily reduced, and not very painful. In a few cases it may be complicated with strangulation. The organs which have been found in the sac have been portions of the small intestines ; the omentum, as reported by Hertwig, and the bladder, in one cow, according to Dandrieu. The prognosis in cases which receive early attention, is not serious. The treatment consists in reducing the rupture, and afterwards closing the passage through which it occurred. ‘This is effected by making an incision through the skin over the tumor, and closing HERNIA. 421 the ring with a few stitches upon Poupart’s ligament and the small adductor of theleg. A good blister rubbed over the enlargement completes the treatment. According to Zundel, three weeks of subsequent rest are required to assure recovery. PerineAL HERNIA. Thisis a very rare lesion and, as Zundel describes it, is the pas- sage of the peritoneum and viscera through the vasculo-aponeur- otic floor of the bottom of the pelvis. Itis, however, reported to be common in dogs, in which animal it is situated between the ischium, the sacrum, the anus and the urethra, and is often mistaken for an abscess. It is more frequently formed by the bladder than by the intestines. Pancreatic Hernia. This hernia was first observed by Prinz, and afterwards noticed by Husson, Roell, and others. It is caused by the strangulation of the jejunum and the anterior part of the ileum through the hiatus of Winslow, the orifice above the right angle of the pan- creas, and of the vena cava, in front of the right kidney. It is accompanied by symptoms of intestinal congestion, and cannot be reached by any form of treatment, if indeed it can be accurately diagnosed during life. Petvic, ok IntErNaL Hernia oF OXEN. This form of hernia is principally described by Zundel, from whom we extract’the following: “It is the strangulation of a loop of intestines, which has pushed through the ruptured peritoneum, from before backward, between the testicular cord and the lateral wall of the pelvis, the rupture of the peritoneum having resolved during some of the manipulations of castration from excessive stretching of the cord, as in the operation by tearing. It is, there- fore, exclusively a lesion of the ox, and cannot affect the bull. It is quite common in Germany, and has been met with in England, Mecklenburg and Alsace. It was first described by Oesterten, in 1811, followed by Anker in 1824, and later by Zundel, Ostertag and Tues. It is comparatively often seen, and in many cases over- looked. The first intimation of the presence of the disease appears in the onset of symptoms of a violent attack of colic. The animal becomes anxious and restless, lies down hastily and rises again 422 OPERATIONS ON THE DIGESTIVE APPARATUS. suddenly; turns about, moyes to and fro, lashes with his tail, and, in a word, betrays all the usual signs of intense suffering, and it becomes difficult, if not dangerous, to approach him in order to make a proper examination. The temperature of the body is ele- vated, there is some perspiration, the nose is hot, though still moist; both respiration and circulation are accelerated. The ani- mal refuses food or drink, rumination is suspended, and though defecation has not ceased, the feces are hard, blackish and coated. In from six to twelve hours, this state of febrile excitement subsides, and the animal becomes dull and quiet, gazing towards its flanks, the ears dropping, the hind leg corresponding to the side of the hernia is extended backward, and at the same time the lumbar region is relaxed downward. If the animal is lying down he may remain quiet for a while, with his hind leg still extended, but will presently spring to his feet with his back arched as before, at the lumbar region, but which drops again and straightens im- mediately. When he walks it is with a stiff action, principally towards the diseased side; the extremities are cool, the pulse is small and insensible, respiration is accelerated ; constipation at length becomes complete with mucous and bloody passages, per- haps accompanied with flatulence, but micturition is still easy. Two or three days later there are other changes. The period of calm terminates, and is succeeded by a season of alternating agitation and repose—action and reaction of the fluctuating in- flammatory process. The animal now and then utters grunts of pain, his pulse be- comes smaller, and is at length imperceptible, and all the un- favorable manifestations are exaggerated. Hither gangrene has supervened, or, as some would judge, enteritis, and all the symp- toms point towards the more fatal termination, It is only by rectal examination that the diagnosis can be posi- tively established, and when this has been carefully and success- fully made, he will have discovered what may be thus described : a puffy mass, indefinite as to size, situated usually nearer the sacrum than the pubis, onthe side of which, generally the right, a portion of the intestines has slipped under the testicular cord— this being the definition of a crural hernia. It may bea simple protrusion of the intestine, and again, this maybe twisted around the spermatic cord, a condition particularly likely to terminate in strangulation. HERNIA, 423 This lesion may continue as long as nine days, four to five being the average duration, and it may terminate by spontaneous reduction, but the trustful surgeon who too confidently and too often expects to find that Nature has dispensed with his aid in this kindly way, is doomed to encounter many disappointments. Or it may end in gangrene or enteritis. The fact that the disease, if not interfered with, may terminate fatally in so brief a period as five days, of course renders the prognosis quite a serious one, unless the nature of the ailment has had an early identification and measures have been taken to avert the danger. The gravity of the prospect is, of course, in- creased when the complication with strangulation or enteritis, as before mentioned, enters into the case. The treatment, as in other cases, consists in the reduction of the hernia. With a small proportion of patients this may be effected by the simple act of causing the animal to walk down a steep declivity—a sort of spontaneous, or semi-spontaneous cure, from which, although founded on anatomical principles, too much must not be confidently expected. We copy from Zundel his de- scription of other and more scientific methods: (a) Reduction by Simple Taxis.—The animal is placed on an inclined plane, with his hind-quarters raised, and an assistant on one side of him ready, at a given moment, to press on the loins. The operator, with his hand in the rectum, searches for the in- testinal loop, and when he has found it, holding it in the bottom of his hand, he feels for the opening under the spermatic cord, which he dilates with his fingers, and now, while the assistant presses hard on the loins, as just mentioned, the intestine may be readily felt moving downward and forward under the cord, to resume its normal position. Although simple, and, in the ma- jority of cases, successful, this mode has the defect of leaving the animal exposed to a return of the hernia. (6) Reduction by Laceration of the Cord through the Rectum. —This method is recommended by Metzger, Hisele, Schenck, Gierer and Ostertag. It consists in tearing away the adhesions formed by the stump of the cord after castration, and loosening it from the inguinal ring. It is, however, difficult to do, and not without danger. The hand being introduced into the rectum, and the opening found, the fingers are closed in the form of a wedge, and with a slight movement of rotation pushed through 424 OPERATIONS ON THE DIGESTIVE APPARATUS. the opening, and the cord thus separated from its adhesions. After a while, the pressure, which was quite firm at first, dimin- ishes, and the intestine gradually returns to its position. This mode is slow in its steps, but it is successful in its results, even in cases of obstruction and of strangulation. When it fails, it is because of the strength of the adhesions between the cord and the abdominal walls, or the inguinal canal. (ec) Division of the Stricture through the Rectum.—To per- form this operation, invented by Schmidt, a trocar about sixty- five centimeters (some thirty-five inches) long is necessary. This trocar has its point attached with a screw, in order to permit its removal and the substitution of a blunt bistoury. With the left hand in the rectum, a fold of that intestine is secured a little be- hind the point of stricture, and the trocar pushed through it. The stylet of the instrument being then withdrawn, leaving the canula in place, the point of the trocar for the bistoury is then inserted, while the hand, still in the rectum, leaves the rectal fold loose, feels for the spermatic cord, raises it and guides the bis- toury against it, which with comparative ease completes the di- vision of the stricture. (d) Division of the Stricture after Incision of the Flank.— Through an incision made in the middle of the right flank, the hand is introduced and grasps the spermatic cord, which is then divided with a bistoury caché, or, which is better, with the inside edge of a hook kept sharp, similar to the hook used in some cases Fig. 390.—Sharp Hook for the Section of the Testicular Cord. of distokia. The hernia being reduced, and the wound in the flank brought together with sutures, a circular bandage is applied around the abdomen. With the reduction of the hernia, what- ever may have been the means of accomplishing it, the symptoms subside, and the treatment is completed by the administration of laxatives or sedatives, rectal injections, etc., as the indications may require. = HERNIA. 425 UmepinicaL Hernia. Umbilical hernia is the protrusion through the non-obliter- ated umbilical ring of either the omentum or the small intestine, or both. Itis also known as an exomphalus or omphalocele. It receives the name of enteromphalus or epiplomphalus when formed by the displacement of the intestines, or that of the omentum separately, and when both of those organs are implicated it be- comes an entero-epiplomphalus. Umbilical hernia is quite com- mon in horses and dogs, not less so in bovines, and has been no- ticed in swine and sheep. It is most common in young animals, especially soon after birth, is at times congenital, and may be long continued, even to adult age, or for eight, ten or twelve years. Umbilical hernias are either congenital or accidental. The former are formed during fcetal life and continue at birth, al- though, according to some authors, they are, strictly, not so much congenital as accidental, and are, in fact, the result of the pulling and stretching of the umbilical cord during the act of de- livery. However this may be, they do usually, in fact, make their appearance during the second and third months following birth, when through the persistency of the opening, and the imperfec- tion of the umbilical cicatrix, the intestines are enabled to pro- trude through the ring, and subsequently to prevent its closing by their presence. But again, while the cicatrix is weak, the ac- tive exercise and forcible movements of the young animal while at play may cause the rupture; and still, again, the protrusion may be caused by intestinal derangements. Indeed, all traumatic causes, such as contusions, blows, and any violent efforts taking place during the period of consolidation of the closing cicatricial tissue, may become an originating cause of this lesion. Animals of low and lymphatic constitution are much predisposed to this trouble, especially such as feeble colts, born of mares badly cared for and insufficiently fed during gestation. Heredity fills a large place among the predisposing causes in low-conditioned mares with féeble organizations, and suffering with similar trouble when young, dams of this class naturally bringing forth foals of defective stam- ina, lable to perpetuate the same constitutional tendencies. The symptoms of umbilical hernia are generally exclusively local. It is characterized by a semi-globular or pyriform tumor situated on the median line of the abdomen at the umbilical ring, 426 OPERATIONS ON THE DIGESTIVE APPARATUS. and varying in dimensions from the size of a hen’s egg to that of a child’s head—dimensions which may vary according to the con- dition of vacuity or fullness of the intestine; the position of the animal, whether standing or lying, or according to the length of time it may have existed. The consistency of the tumor is very variable. It may be soft, easily depressed by the finger ; elastic, when distended with gases; or soft and puffy when containing alimentary matter—these changes being accounted for by the na- ture of the organ. An enteromphalus will give the sensation of an elastic mass, while the epiplomphalus will form a puffy swell- ing. This species of hernia is almost always painless, and exhib- its as one of its peculiar and constant symptoms the character of being reducible. In the generality of cases, it can be made to disappear temporarily by the taxis and by forcing the protruding portion back into the abdomen, but only to reappear at once as soon as the pressure is withdrawn, especially if the animal is on his feet. On being thus reduced, the opening of the ring can readily be detected, and the fingers may be freely introduced through its diameter and its form and dimensions ascertained, shewing it to be sometimes elliptic, sometimes circular, and some- times irregular, the originating cause of the hernia itself deter- mining the difference. Besides these more common symptoms of umbilical hernia, there are others which can be detected by more careful examina- tion. For instance, on applying the hand over the tumor, the ver- micular motions of the intestines may be recognized, and by feel- ing in the hernial sac, the presence of feecal masses may be discov- ered; and it may be possible by auscultation even to detect the presence of borborygmus through the displaced intestines, and even to observe its true nature, by reason of the transparency of the sac and its envelopes. These are the most ordinary symp- toms of an exomphalus, although it is subject to complications, and the symptomology will vary accordingly. There are cases, but they are rare, in which the hernia be- comes irreducible. The most serious of these are such as are found to have become so in consequence of the formation of ad- hesions between the protruding organ and the hernial sac—a very infrequent occurrence. The most common cause will be the pres- ence of undigested masses of food accumulated in the intestines, such as hard balls of feeces or sand. 42 J = HERNIA. 427 Inflammation of umbilical hernia may follow blows or bruises, though such a result from these accidents is not a common one, and its occurrence will naturally be accompanied with changes in the appearance of the tumor, such as the usual phenomena attending inflammatory action, as increase of temperature, ten- derness or pain, cedema, etc., which may even at times so com- bine their effects as to render the hernia irreducible. Engorge- ments and strangulations, however, are very rare complications of this form of hernia, a fact easily understood when it is con- sidered that the neck of the hernial sac is formed by the umbilical ring itself. An exomphalus is usually an affection of little gravity, and often disappears spontaneously, or if it persists after the period of weaning, is easily radically cured when the animal grows and develops. Yet even if undisturbed and unchanged, they persist in remaining, their existence is not incompatible with perfect health and full ability to labor, however they may reduce the com- mercial value of the animal. They are less injurious to young animals than to adults, and less dangerous when small than when assuming large dimensions. When simple, they are easily amen- able to treatment, but if complicated they become dangerous, es- pecially so when the capacity of the ring is so disproportioned to the dimensions of the protruding intestines that strangulation be- comes an accident of easy occurrence. Reducible hernia is at- tended with but little hazard, while the danger arising from the possible formation of adhesions in cases which have passed into the irreducible class becomes a matter of very serious import. If it is an admitted fact that animals suffering with umbilical hernia do often recover spontaneously, the recovery being a normal incident of the natural development of the animal, due to changes of position in the abdominal contents, not to specify other effi- cient causes ; then the question of immediate or early interfer- ence undoubtedly receives and justifies a negative answer. Our own testimony is that we know of cases where patient waiting, even for a period of twelve months, has been rewarded by the ' radical disappearance of the hernia. But the objections to such long waiting are of a tangible and serious nature, and surgical interference becomes imperative and indispensable. The persons are few who are able or willing to nurse an idle horse for a year for the sake of saving him from the pain of an operation. 428 OPERATIONS ON THE DIGESTIVE APPARATUS. The object of all treatment is, of course, the reduction and re- tention of the hernia, but the means of doing so are various. They are mainly included under four heads. The first method is by bandages ; the second, by external or topical applications ; the third, by surgical operations for the constriction of the tumor; and the fourth, such special treatment as may be required to meet complications. 1st. Bandages.—The bandage of retention is essentially a belt buckled around the body, by which a pad is kept over the open- ing of the umbilicus to prevent the escape of the abdominal con- tents, and temporarily perform their office in the subcutaneous hernial sac. It is designed to aid in the mechanical closing of the umbilical opening until that takes place by the process of physio- logical change in the sac and its borders. The forms of bandage in use are many and various, among which Peuch and Toussaint name four principal kinds. A most import- ant requisite in all of them is that while they possess the solidity and fixity necessary to retain the reduced hernia in place, they shall cause the minimum amount of discomfort to the patient. The bandage of Marlot, according to Zundel, is the one which best fulfills the three conditions of solidity, fixity and elasticity. It consists of a kind of padded saddle, with straps at its four corners, buckling on two belts, the anterior or pectoral, which sur- rounds the chest like a girth, and the posterior or ventral, which presses the retaining pad against the umbilicy. This pad isa wide hair cushion of a moderate thickness, kept in place and pre- vented from slipping back by a longitudinal girth connecting the pectoral and the ventral belts. The bandage of Massicra is much recommended in Italy. This also is a small saddle with two wide girths passing under the thorax, and pressing against the sternum and the epigastric re- gion, with a steel band corresponding at its posterior extremity with the umbilical ring, forming a plate padded with a hair cushion. The apparatus of Strauss, used in Germany, is made somewhat on the same principle, but is reinforced by a kind of breeches which prevents it from slipping backward. The length of time necessary for a patient to wear a bandage will vary with the dimensions of the hernia—from one to three months, according to Lafosse, being required to obtain a radical eure. Marlot claims that an average of thirty-two days is all that HERNIA. 429 isnecessary. The bandages must be applied only after the perfect reduction of the hernia, and the most accurate adaptation of the pad to the umbilical opening. These appliances are of difficult adjustment and are unavoidably uncomfortable to the animal from their liability to chafe and excoriate the skin. They, therefore, constitute a mode of treatment which must necessarily be attended with uncertainty, and, therefore, as justifying only a careful and modified recommendation. Still, it has inthe hands of many prac- titioners given very satisfactory results. 2d. Local Applications.—The treatment by irritating local med- ication aims to produce in the tissues surrounding the hernial sac an inflammation which will end in a serous infiltration which will crowd away the protruding organ, prevent its return into the open- ing, and subsequently facilitate the obliteration of both the-sac and the ring. This result is obtained by the use of certain chem- ical agents, which applied on the hernial tumor tend to produce various degrees of inflammation, from simple rubefaction to com- plete escharification of tissues. In former times sulphuric acid was recommended, and as late as 1833, Hertwig employed it in appli- cations made during two or three days. Blisters and their con- geners have had their day. Astringents have also been recom- mended, as also caustics, principally in the form of ointments, as that of chromate of potash, in the proportion of one part in eight, as recommended by Foelen—these also have had their advocates. But of all these, nitric acid, applied externally, is the one which has proved most satisfactory and least dangerous. The treatment consists in applying acid upon the tumor of the exomphalus, in sufficient quantity to produce an escharotic effect, and afterwards promote the sloughing of the cutaneous sac. The mode is thus described: After positive diagnosis of the nature and character of the tumor, the animal being kept in the standing posture, the hairs cut short, the acid is applied over the entire sur- face of the sac, by rubbing it in with a brush, or a small ball of oakum secured at the end of a stick, and dipped into the acid— which should register 34° to 36° Baume—first passing it circularly over the base of the examphalus to define the place where its action is required, and then including the entire surface. A sufficient quantity of the caustic must be applied, and with enough energy to produce the disorganization of the skin in its entire thickness, and positively produce its mortification. Experience has proved 430 OPERATIONS ON THE DIGESTIVE APPARATUS. that the deeper the action of the caustic, the more successful the operation is likely to be. It is said that nearly one ounce of the acid is required for a tumor as large as a man’s fist, and that the friction should be continued from three to five minutes. The duration of the friction and the quantity of the acid to be used must, however, be guaged by the dimensions of the tumor, and also with careful consideration of the thickness of the skin. Dayot, to whom is due the positive and practical introduction of this mode of treatment, proposes to apply the acid in instalments, and recom- mends that the application be repeated once or twice an hour, according to the thickness of the skin, until the desired effect is assured. The result of our own experience is a conviction that as a rule only a single application is necessary. Nitric cauterization produces a yellow eschar, which ordinarily remains for a long time, soft, supple, and unctuous to the touch, but the epidermis of which is easily lacerated. In some cases the formation of the eschar is followed by a large swelling of the cauterized parts and the sur- rounding tissues. Sometimes it makes its appearance immediately following the operation, but more commonly it appears at a later period, gradually increasing during the first hours following the cautery, although again, in other cases, this swelling is altogether absent. The cedema is the direct effect of the action of the caustic upon the subcutaneous cellular tissue, which becomes infiltrated ; and in this condition applies a uniform pressure in all directions upon the peritoneal hernial sac, crowding back into the abdominal cavity the displaced intestines and preventing their return by the kind of retentive bandage which is formed by the engorgement which takes place around the sac. In the days following, after reaching the maximum develop- ment, the cedema gradually diminishes by resorption, becoming at the same time somewhat harder, the portions of cauterized skin which is in its center meanwhile gradually drying, and becoming transformed into a dry, hard plate. In place of the hernia there now remains a fibrous mass of new formation, which gradually diminishes and is soon more or less resorbed. In the meantime, while these phenomena are taking place, the process of the separation of the eschar has begun and progressed, and on the eighth day, on the boundary between the dead and the living structures, a fissure shows itself, and minute granulations appear. The separation goes on slowly, from the eae HERNIA. 431 circumference to the center, leaving, when complete, a rose surface, granulating evenly, small fibrous formations sometimes appearing in its center. This wound heals rapidly, leaving a contracted cicatrix, which assists in keeping the hernia in its place, while the indurated skin, which for some time remains adherent to the still fibrous, abdominal, subcutaneous tissue, contributes to the com- plete obliteration of the ring. After a month the cure is radical, and in place of the hernia, there remains only a hairless cicatrix, often without pigment. Though this treatment is simple, and has, by the results it has shown, justified the credit it enjoys among those who have had experience and knowledge of its working, it must not be at once accepted as infallible, or unattended with danger. Cases are on record which negative such a claim. For instance, too severe a cauterization may be followed by the entire sloughing of some portion of the abdominal walls, followed by a large eventration ; and peritonitis, tetanus and intestinal fistulz are complications which have sometimes disappointed hopes which seemed to be well founded. Animals to which this treatment has been applied must be carefully watched for some time during the period following the cauterization. They must be especially prevented from indulging the tendency they often betray—to bite, or scratch with their feet or legs, the irritated, cauterized surface. A cradle or aprons hanging in front of their hind legs, or even bandages may prove effectual to prevent this suicidal habit. The topical remedies we have mentioned before, might in strictness be considered as coming under the head of external treatment, since they have all been applied to the surface of the skin. There is, howevor another mode of application which is subcutaneous, and which is represented by the method of Dr. Luton, and employed in the treatment of the same ailment in children. It consists in injecting subcutaneously, at each cardinal points of the hernial sac, a few drops of a saturated solution of chlorides of sodium (kitchen salt). We have had but one oppor- tunity to try the value of this treatment, which we improved by injecting ten drops of this solution at each point of a hernial tumor. We produced an enormous swelling, followed after several weeks by resorption and complete disappearance of the hernia. According to Peuch and Toussaint, our friend M. Cagny has 432 OPERATIONS ON THE DIGESTIVE APPARATUS. made the same experiment, but failed to obtain a successful result. 3d. Surgical Operations for the Constriction of the Tumor.— Modes of surgical treatment are numerous, usually haying in view the destruction of the hernial sac, by the process of mortification, so controlled and directed as to bring about the necessary work of adhesion between the walls of the sac, above the line where the mortification begins, with the formation of a secondary cicatriza- tion between the edges of the skin, where the mortified sac has dropped off. Before casting the animal, without which the operation cannot be performed, the surgeon must satisfy himself that the hernia is reducible, and that there is no adhesion, and should carefully measure the dimensions of the sac in order to know accurately where the constriction must be applied. The animal must be placed well on his back, with his hind quarters elevated—a posi- tion which is sometimes sufficient alone to enable the hernia to reduce itself. If that fails to occur, the sac can be evacuated by the taxis. Itis then to be well stretched, and the application of the means of constriction proceeded with. These means are many, but may be considered under the three heads of the ligature, the clamp and the sutwre—all of which are occasionally combined in use, as the ligature with the suture, or the suture with the clamp. (a) The Ligature.—This old mode of operation consists in the application—the hernia having been reduced—of a strong cord, firmly tied at the base of the hernial pouch. The modus operandi is very simple. The hernia being already reduced, either by the taxis or by the power of gravitation, as before mentioned, and the horse in the right position, on his back, the sac is raised from the abdomen, and a strong ligature, firmly tightened, is applied at its base, a strong fishing line forming the best of ligature for this purpose. The degree of tightness of the ligature must be such that the mortification of the sac will be a gradual process, and that it does not slip from the walls of the sac, on account of the progress of the inflammatory swelling. Still this constriction must not be permitted to become so ex- treme as to produce too rapid a sloughing of the skin, with the possible result of a calamitous eventration. In order to prevent the displacement of the ligature, some HERNIA. 433 practitioners recommend the introduction of two small wooden pins just under it, either parallel or crossing each other, through the base of the sac. If the hernia is very large, instead of employing this mode of simple ligature, en masse, the operator may use two ligatures. By pushing through the middle of the sac, close to the abdomen, a dog seton-needle, carrying a doubled cord, and converting it into two parts in cutting it from the needle, each length will serve to embrace half of the tumor, in the manner practiced in the pro- cess of removing large, hard tumors by ligature. Legoff has rec- ommended the use of several ligatures dipped into ammonia, placed one above the other upon the whole length of the sac, from its bottom to its base, tightening them more and more as they ap- proach the abdomen. By this process he combined constriction with cauterization. This mode of treating umbilical hernia is a simple and easy one, but yet it is not very frequently practiced. The uncertainty of its results, the possibility of the sloughing of the skin at too early a period, with the danger of eventration, as well as that of injuring the intestines with the wooden pins or the needle, have all combined to impair its credit and discourage its use among care- ful operators. (6) Clamp.—In this process, which dispenses with the caustic, after the reduction of the hernia, the skin is stretched and pressed between the branches of a wooden clamp or of a specially adapted forceps. The clamp is a simple implement, and may be made with a curve, in which case its convexity is made to adapt itself to that of the abdomen. When applied, it is pressed close to the abdom- inal walls, and its branches brought together with nippers adhoc, and secured with a strong cord, as in the process of castration. The clamp is left on from nine to fifteen days. In many cases, the displacement of the instrument is prevented by using the wooden or metallic pins passed through the skin below it, the ends of the latter being bent over to keep them in place. This operation possesses some great advantages, but offers also some special dangers, among which is the instinctive tendency of the patient to get rid of the irritating appliance by tearing it off. Another objection to the clamp is found in the danger of caus- ing troublesome excoriations of the sheath by the friction which it necessarily occasions. Benkert and Brogniez have advocated 434 OPERATIONS ON THE DIGESTIVE APPARATUS. the use of metallic clamps, but an important objection is found in their weight. Borhauer had the branches of the wooden clamp perforated in several places for the introduction of the pins which held it in place. Bordonnat has invented a special form of me- tallic clamp or rather forceps, with sharp points on the inner bor- der of one of its branches about one-half or three-quarters of an inch apart, and in the other a corresponding number of holes into which the points are designed to fit when the instrument is closed. Each branch has a prolongation at each end, which on one carries a vertical projection cut with a screw-thread, while in the other there are holes corresponding with the projections, and there are nuts to fit the screws. When the instrument is applied, and the projections passed through the holes, the nuts not only hold it in place, but are adapted to fix the pressure at any desired point, or change it at pleasure. The umbilical forceps of Marlot is made of two small wooden plates, slightly curved lengthwise, and brought together by means of gooves in their dove-tailed extremi- ties, through which screws are fastened. This instrument, like the metallic clamps, is objectionable principally on account of its weight, and is generally less practical than the ordinary clamp. (ce) Sutures.—These are of various kinds, all agreeing, how- ever, that the stitches upon which they rely shall be so close and tight that the circulation will be so effectually cut off in every part of the hernial sac that mortification cannot fail to follow. The Quilled Suture.—This consists in placing the sac between two small rods of hard wood or metal, and tying them before and behind with strong cord twisted and rolled around their extremi- ties, and also by passing here and there in their length sutures of double the strength of those which are applied in cases of ordi- nary quilled suture. Acting somewhat by pressure, this mode much resembles the treatment by the clamp, but is little used at present, notwithstanding some small advantages which it may be thought to possess. HERNIA. 435 Twisted Sutures.—This consists in applying upon the hernial sac several stitches of strong cord in order to keep the reduced hernia in statw quo. It is sometimes used in dogs, but is uncer- tain and dangerous. Suture of Delavigne.—This is another dangerous mode of operation, no longer in practice because of the hazard of injury to the intestines. It consists in applying a strong double suture at the base of the sac in the following manner: With a small needle, like that used by harness makers in sewing leather, a thread is passed through and through on both sides of the flat, cutaneous surface from right to left, or vice versa, then carried back the re- verse way at a small distance from the first puncture, and the sutures firmly tied. This is repeated until the entire sac is in- cluded and the sutures have gone beyond the umbilicus. From fifteen to twenty days are said to be sufficient to effect a radical cure. Method of Mangot.—To make a closing suture on the hernial sac, without danger to the intestine, Mangot has recommended the use of a perforated plate of lead, by which to aid in the reten- tion of the intestines in place and accurately define the line upon which the sutures are to be applied. The plate is made to cor- respond in dimensions with the opening of the umbilical ring, but somewhat longer and wider. Besides the longitudinal slit in its center, it also has an eye at each corner for the attachment of strings to secure it in place by tying them over the back. The hernia being reduced, and the plate put in place by pushing the skin of the sac through its longitudinal opening, the operator ap- plies a continued suture over and on the outside of the plate to keep it in position, with the flap of sewed skin hanging below it, the entire apparatus being securely attached to the abdominal walls by two pins running through the sac at the extremities of the suture. During the first days there is much inflammation. About the third or fifth day the pins are removed and the skin below the su- ture excised, leaving the plate to be retained only by the strings which pass over the back. These are sufficient, however, to keep it in place, and its removal will not be necessary until inflamma- tion is well established all around them. A simple dressing, held in place by a bandage, will help the cicatrization, which is said to take place in from seven to eight days. 436 OPERATIONS ON THE DIGESTIVE APPARATUS. Method of Hannon.—The modus operandi here indicated does not vary from that of Mangot, except in being modified by the use of the quilled su- ture, as before described, instead of employing the transversal pins of Man- got. Method of Mignon.—This is a com- plex mode, consisting of a combination of the ligature, the clamp and the suture. Like Mangot, he passes the skin through aplate of lead, attaches perforated clamps on the protruding sac below it, and pass- es the stitches or sutures through the perforations in the clamps. Method of Benard.—This is strictly speaking, the application of the crossed suture, a stitch exactly resembling that of harness and shoemakers in their re- spective trades. In making it, a peculiar forceps is used, which is applied like a clamp, and serves not only to keep the sac closed and secured, but also to pre- vent the return of the intestines into its cavity, and to assist in guiding the two needles with which the suture is made. Its branches are at one end articulated together, and also at the other in order to fit into handles. Itis twenty-two cen- timeters in length, without including the handles; two centimeters in height, and one and a half in thickness. The branch- es are brought together tightly by a spe- cial screw arrangement near the handles, and each has a number of holes, placed recularly, one centimeter apart, and uni- ted by a groove. Two strong straight needles and strong waxed thread are re- quired. In operating, the hernia being first reduced, the skin is well stretched Fic. 392.—Nippers of Benard. eA HERNIA. 437 between the branches of the forceps, then these are tightened by the screw management of the handles, and next the instrument is committed to the care of an assistant. The crossed suture is then made by the simultaneous passage of the needles through the holes in the branches of the instrument. The directions to insert the needles simultaneously must not be overlooked. If disregarded, the penalty liable to follow will be the tearing of the waxed thread with the points of the instrument, and also a tang- ling of the thread. This method gives a stronger ligature than Mangot’s, but it lacks the support furnished by the metallic plate. Method of Mariot.—The methods of Benard and Mangot are here combined. A peculiar thin forceps is used having dotted grooves on its outer surface to indicate where the stitches are to Fic. 393.—Plate and Nippers of Marlow. be placed. When the suture is finished and the forceps removed a plate of zinc like that of Mangot is applied, as a means of reten- tion, the zine plate being thought to be an improvement upon that of lead, on account of its adapting itself better to the parts. Method of Chedhomme.—The animal in this method is kept on his feet, properly secured, and a plate of lead applied, as in the process of Mangot. The hernial sac, folded in two on its longitu- dinal axis is then passed through the opening of the plate, the operator making the least possible traction until the remaining por- tion of the umbilical cord, which is still quite large, is firmly held between the thumb and the index finger of the right hand. Then a stronger traction is made upon the sac, at the same time moving it in various directions, while with the left hand the plate is strongly pressed towards the abdominal walls. Then with the intestines entirely replaced, the operator grasps the sac with the 438 OPERATIONS ON THE DIGESTIVE APPARATUS. left hand, and with the right, introduces a strong needle which is pushed through and through at each extremity of the sac, and an elastic ligature passed three or four times around its base. Towards the tenth day the slough is completed, and only a small wound remains, which cicatrizes rapidly. Direct Suture of the umbilical ring.—Director Degive recom- mends for the treatment of umbilical hernia in young dogs, the direct interrupted sutures of the ring, the number of stitches varying with its dimensions. After bringing the threads together the wound is left open until they have safely eliminated themselves. We have employed this mode of operation for many years in the hospital of the American Veterinary College, using antiseptic pre- cautions, and with the best results. Making a longitudinal line on the median line of the sac, and having carefully pushed back the intestines, the edges of the ring are sewed together with two or three stitches of cat gut ligature. The parts were then thor- oughly washed with a solution of bichloride of mercury, and the edges of the skin brought together with silk sutures and a com- pressing bandage applied for the protection of the wound from the patient's own teeth. Complete cicatrization follows in a few days. Whatever may be the original mode of treatment the secondary effects are about the same in each case. They consist of irritation of the parts, more or less marked, and betrayed by the patients by varying degrees of restlessness, and possibly, in some cases, by abdominal pain or colics. After a few hours the swelling of the part begins. A diffused cedema takes place above the point of compression, and the hernial sac is slightly swollen and warm and becomes covered with little phlyctenoids, indicating a commencing necrosis. Perhaps a litile fever is manifested and there is great thirst. By the third day the swelling is quite large, and in males it may involve the sheath. The sac then becomes cooler, the fever subsides, the appetite re- turns, and the animal which has instinctively kept his feet, rests himself by lying down. On the fourth or fifth day the skin of the sac is insensible, cold and flabby, and the sloughing process between the living and the dead skin has begun. Little by little this pro- cess becomes more active, and the separation becomes more and more marked, the secretion around its opening a purulent character, and from the sixth to the tenth day the complete sloughing will have taken place. The wound that remains is now granulating. "ee ~ a iw, HERNIA. 439 Its length exceeds its width, and it is somewhat depressed in its center It progresses rapidly towards cicatrization, only a small scar remaining, and this is readily concealed by the growth of the surrounding hair. (d) Operation in Cases of Complications.—If the hernia is irreducible and there is strangulation, the enlargement of the ring must be carefully made with a curved, blunt bistoury, having a short, guarded sharp edge. When the reduction is prevented by adhesions, the operation necessary for their division will demand the exercise of the utmost skill and caution to avoid injury of the peritoneum, and there should especially be no neglect or parsi- mony in respect to the employment of antiseptic precautions. In fact, it would in many instances be wiser to leave the animal to the resources of nature than to undertake an operation of so much delicacy and importance, and which involves so many serious con- sequences, without amply providing every resource of skill and knowledge, and anticipating every contingency of accident or dan- ger. In some cases, when the strangulation has been due to the formation of gases in the protruding intestine, we have used the aspirator for their removal, and then have met with no difficulty in reducing them by the taxis. This is a means, however, which is also recommended in the treatment of strangulated inguinal hernia, and is discussed in the chapter appropriated to operations in that region. DIAPHRAGMATIC HERNIA. A diaphragmatic hernia, or diaphragmatocele, istormed by the displacement of one of the abdominal organs, and its intrusion into the pleural cavities, through a laceration of the diaphragm. It is necessarily an accidental opening, through which sucha dis- placement takes place. One case is on record, and only one, where the hernia passed through a normal opening, viz., the ceso- phageal. The causes which give rise to ruptures of this kind may be classified under three heads: first, external violence; second, pow- erful contraction of the expiratory muscles while making a violent effort; and third, the exertion of force and pressure upon the dia- phragm by the organs, situated on its posterior face. (a) External Violence.—Yoremost in this category are blows or contusions on the posterior costal region, such as may be made 440 OPERATIONS ON THE DIGESTIVE APPARATUS. by the shafts of vehicles with either the blunt or broken ends. The laceration of the diaphragm may occur either with or without involving the fracture of the ribs. Several cases of this kind have been seen and recorded by Professor Barrier. (0) The Powerful Contractions of the Expiratory Muscles during Violent Muscular Eifforts——It may result from the vio- lent and concentrated action of the abdominal muscles, compress- ing powerfully the intestinal mass, and crowding it against the diaphragm, until it destroys its continuity at one or more points, sufficiently to admit of the passage of the abdominal organ into the thoracic cavity. Durand has seen it in a six-months-old colt; Didry and Fabey have reported cases where the hernia took place during violent efforts in hauling a load, and Franconi met with a case of a similar character to the one referred to in which the rup- ture opened into the cesophagus. Schild has seen it associated with the efforts of parturition. (ec) Violent Action and Pressure upon the Diaphragm by the Organs Situated on its Posterior Face.—The obliquity, forward and downward, of the inferior plane of the abdomen, is shared forward upon the posterior face of the diaphragm by the organs related to it, as the liver, the stomach and the anterior curvatures of the large colon. These are bulky organs, and their united weight being very considerable, the pressure it exerts upon the diaphragm, under any extra impulse would tend directly and nat- urally to the disruption of the weaker muscular fibres of the midriff, and these yielding, the hernia would immediately become developed, and thus we have the generation of this kind of hernia. A sudden fall might easily bring this to pass, in a second or two of time. Bouley has recorded a case in which this accident oc- cured in an animal cast for a surgical operation. Pilton has seen it take place in an animal falling down while butting against a slope of ground. Diaphragmatic hernias, like others, are either acute or chronic ; or conyertibly, recent and free, or of old standing, with adhesions. The distinctions of hepatocele, splenocele, stomachocele and entero- cele are of but little importance, none of these differences being discoverable in the living animal. The symptoms of acute hernia of the diaphragm differ, accord- ing to the extent of the laceration of the muscle, and the size of the displaced abdominal mass. There are cases in which the in- HERNIA. 441 jury is of so aggravated a character from the first, that a fatal result immediately follows the formation of the hernia, the only characteristic symptoms present being those of rapid asphyxia. In other cases, though death must inevitably follow, the life of the animal may be prolonged for several hours, or even several days. And again, there are recent hernias which have been formed under such conditions that they are still compatible with the sur- vival of the animal. These assume the chronic character, and not infrequently escape discovery. The horse affected with diaphragmatic hernia becomes dull, anxious and uneasy, avoiding his manger and avoiding his food. He paws in the stall, giving evidence of suffering from abdominal pains, but which betray no peculiar characteristics, and possess no special or positive significance. Very often colics precede the hernia, and its formation complicating the case, the colics be- come more violent. During these colics the animal hesitatingly and carefully lies down, rolls much, and assumes various attitudes of no special significance, though the dog-sitting posture is some- times held to be characteristic. During these colics, which are more persistent than those due to intestinal indigestion, the pulse remain strong and quite regular, and respiration is not only ac- celerated, but difficult—the physiognomy is anxious, with an ex- pression of apprehended suffocation, the nostrils are tetanically dilated, inspiratory movements are performed with effort, and expiration is of twice or three times its normal frequency. The coexistence of this condition of the respiration-with the colics is a sign of great importance as an element of the diagnosis. At times auscultation furnishes valuable data. Borborygmus may be detected in the thorax, where the respiratory murmur ought to be heard, and dullness on percussion takes the place of the nor- ‘mal resonance, where the respiratory murmur has disappeared. Bouley, though he recommends this means of diagnosticating, considers it to be applicable only for hernias of large size, in which, according to Lafosse, an increase in the size of the thorax, a well marked projection of the cartilaginous circle of the ribs, and to- gether with these, areduction in the size of the abdomen would be noticed. When the hernia is small, the respiratory function is unaltered. Acute diaphragmatic hernias, not necessarily of fatal tendency, are more difficult to detect. Probably from their rareness they 442 OPERATIONS ON THE DIGESTIVE APPARATUS. often escape discovery, notwithstanding a somewhat positive exhi- bition of abdominal and thoracic symptoms. And if this is so with the acute form, it must necessarily more frequently occur with chronic cases, which not only do not jeopardise life, but even fail to interfere with the usefulness of the animal. The horse thus affected not only has the double expiration of his emphysematous lungs, but he continues to be subject to intermittent colics, and especially if the hernia is formed by the intestines, and they con- tinue to suffer from occasional obstructions. To this complication of occasional actual obstruction must be added a perpetual liability to become strangulated, with a certainty of speedy death following that accident. The lesions found at the post-mortem examinations of ani- mals which have died with this description of hernia varies. The accidental diaphragmatic openings may exist in different parts of the central aponeurotic portion or in the peripherical muscular zone, and may assume various forms, being at one time round, at another eliptic or triangular, or indefinite and irregular, at times very narrow, at others so extensive that the abdominal and thoracic cayities are no longer distinct. Between these two extremes there are many degrees and ample scope for the formation of chronic hernias of a non-malignant character. When the hernia is recent and has existed before death, the borders of the laceration whether muscular or aponeurotic, are irregular, thready, infiltrated and bloody, with small blackish clots adhering to the extremities of the red muscular fibres. But when the rupture is of post-mortem formation, resulting from excessive meteorism, there is no trace of capillary hemorrhage upon the lacerated edges of the aperture. With a chronic hernia these edges have various aspects; at times thin, at others in thick cords; now torn in scallops, and again with a regular edge, they are always smooth, hard, of fibrous consistency, and even presenting a cartilaginous aspect. There is never any formation of a special serous sac for these hernias, even for those which take place through the normal openings. The organs most commonly met in these diaphragmatoceles are the omentum, the small intestines, the anterior curvature of the large colon, and more rarely, the spleen and the stomach. If not con- gested by pressure in passing through the opening, they continue to perform their functions. In these injuries the prognosis can never be confidently favor- a + ee (Vind ie HERNIA. 443 able. It is always serious. Some Ixll immediately, while with others there may be a respite of several hours or days, and with those which are chronic, there may be no apparent impairment of life or health. But whatever may be the character or the aspect of a given case, and however the prognosis may vary, it must never be forgotten that diaphragmatic hernia has this invariable character, thatits effect is always to interfere with the respiration ; that the horse is at the best permanently affected with heaves, is unable to perform any active or laborious service where strong lungs are needed, and is always more or less liable to engorgement and strangulation. Diaphragmatic hernias are incurable, their sit- uation, in the deepest interior of the anatomy, rendering it impos- sible to apply any means of direct therapeutic treatment. They cannot be reduced, and even if that were practicable, they could not be secured and retained in situ. Attempts have been recom- mended by Bouley to reduce them by making an incision through the flank and replacing the protruding organ in its proper posi- tion by the taxis with the hand in the abdominal cavity. Whether in our days of perfect antiseptics such an operation could be suc- cessfully performed on the horse is a question not yet solved. The experiment might be attempted with better chances of success in cattle. In any case the operation will be justifiable only as a last resource, and when the life of the suffering animal is abso- lutely in jeopardy, in fact, as a final alternative, a dernier resort. VENTRAL HERNIA. This term includes all hernial tumors produced by the pro- trusion of one or several of the abdominal organs through an ac- cidental opening in the muscular and fibrous walls of the abdomen, under the skin, which remains intact. The opening through which this kind of rupture takes place is always accidental, unlike those which pass through the natural channels, as the umbilical or in- guinal, but still, in common with them, has a peritoneal lining. Ventral hernias are of quite common occurrence, principally however, in large animals, while in small quadrupeds they occur less frequently, and they may take place in any part of the abdo- men. They are known by distinctive names, corresponding with those of the protruding organ, as gastrocele, hepatocele, enterocele and epiploocele, ete. They usually originate as direct causes in blows or contusion 444 OPERATIONS ON THE DIGESTIVE APPARATUS. Fic. 394.—Ventral Hernia. upon the abdominal walls, made by blunt bodies, which, lacking force to pierce through the elastic skin, are yet sufficient to lace- rate the interior abdominal walls. An example of this occurs in a thrust from the shaft of a vehicle, or its broken end, in case of a fall, or of kicks or horning among cattle in the field. In colts they are more commonly found in the lower wall of the abdomen, the animal frequently inflicting them upon itself by attempting too high a jump over a picket fence, and failing to clear it properly. Serres says that in cattle they may follow a severe distension of the abdomen under the influence of tympanitis, abdominal dropsy, or gestation. The character of a case of ventral hernia will vary in respect to its being acute and recent, or chronic and old. Indeed, the lapse of but a few hours will materially change its character from one to the other. If seen immediately after the infliction of the a HERNIA. 445 injury, it is in the form of a round, soft, elastic tumor, well- defined in its outlines, and easily reducible. But if not examined until after a season of delay, the definite configuration disappears, and it is changed into an inflammatory swelling, edematous, warm and painful to pressure—in fact having the aspect of a warm ab- ‘scess. In the recent cases, the edges of the torn abdominal walls may be identified through the thickness of the skin, but the sur- geon will vainly try to make out this condition if the inflamma- tory process following the lesion has become established, and the serosity and the blood have become sufficiently infiltrated into the cellular tissue to make the change described. After a few days, if the hernia is not situated too low in the abdomen, the swelling moves downward toward a more dependent spot, and gradually abating disappears in about two weeks. Upon reaching this point, the hernial tumor is once more recognized, constituting, as it does, the exclusive manifestation of the displacement of the in- testinal mass, and its presence outside of its natural cavity. It is recognized by its changing conditions—elastic when the intestine isempty; soft and puffy during digestion ; by its state of tension, increasing with effort, and by being painless, depressible and re- ducible. When reduced, the edges of the opening are easily made out, but it isnot uncommonly found, upon the subsidence of the inflammatory process, that, during the continuance of that state, adhesions of the protruding organ with the walls of the sac have formed, and the hernia has become irreducible. In their dimensions, ventral hernias vary considerably. They may measure from the size of a large nut to that of a man’s head, or even exceed that. Zundel reports a case where the rumen had penetrated into the sac, which hung almost to the ground, and had produced a dis- placement of the mamme, crowding them in a mass toward the right side of the abdomen. Although the diagnosis of ventral hernia is not difficult, it is still not impossible to mistake a recent case for certain other affec- tions of the abdominal walls, such as tumors of bacterian anthrax, or those of a bloody nature, or with phlegmonous or cedematous growths. The reducibility and elasticity of the tumor, the bor- borygmus, and the presence of the opening through the abdomi- nal walls, are intelligible signs by which to recognize the ventral hernia. Aspiration of the tumor may sometimes be performed, and rectal examination will also be of great assistance provided 446 OPERATIONS ON THE DIGESTIVE APPARATUS. the injury is not beyond the reach of exploration with the hand. Certain complications are not uncommon in ventral hernia. Besides irreducibility already mentioned, excessive inflammation has sometimes been followed by traumatic peritonitis. Lacera- tions of the displaced organs have proved fatal. Internal hemor- rhages, fistulas and consecutive eventration have also been record- ed. Strangulation is not unknown, though it is comparatively rare. But with all these possibilities, it is not a rare circumstance to meet with animals affected with ventral hernia, even of large di- mensions, which have reached a good age with all the appearance of perfect health. From data like these upon which to found a judgment, it ought not to be difficult to deduce a prognosis which should never be far wrong. But, although compatible with the life, health and utilization of the animal, such a lesion must neces- sarily detract more or less from its commercial value. Under any circumstances, it is a blemish. The least dangerous of this class of ruptures are those which are situated on an elevated point of the abdomen. Recent and uncomplicated, they are amenable to treatment more or less, according to their extent; if old or chronic, the chances of success are reduced ; if strangulated, they are generally fatal. Usually, a ventral hernia, to be curable, must be treated when it is recent, and before sufficient time has elapsed for the intestines to become, as it were, accommodated to their new position, and especially before the cicatrization of the borders of the lacerated openings has taken place. Recent and free from complications, all that is required is their reduction and retention in their proper place. When reduced, whether by rectal taxis or by external pres- sure, the parts are covered with a mixture of pitch and Venice turpentine melted together, upon which is spread oakum cut in small, short threads, which is to be covered with a second appli- cation of the pitch, after which a sheet of pasteboard, itself also impregnated with the pitch mixture, is placed over the opening. The whole is then covered and held in place by a broad bandage carefully rolled around the abdomen. Leather is sometimes used in lieu of the pasteboard. This bandage, when applied upon male bovines, requires to be carefully adapted in order to avoid any possible interference with the penis, and its freedom of motion in the act of micturition. The complications of swelling or bloody tale —s oe HERNIA. 447 extravasations must not prevent the immediate application of the bandage. In eases of chronic hernia, compression is no longer sufficient. Jannet recommends the use of clamps as in umbilical hernia, and reports having relieved a case where the tumor was as large as a child’s head. Leblanc advises the quilled suture, and Schwane- feld cured by this mode a hernia twice as large as the head of a man. Hertwig speaks favorably of the application of Delavigne’s method in exomphalus. Going, Lafosse and Hertwig have ob- tained success with nitric acid injections, and Krantz and Schutt with blisters. Peyon, Dandrieu, Terrien and Obich have had good results with the direct suture of the ventral walls in bovines, and even solipeds. Bouley objects to the suture of the edges of the opening, and also to injections into the evacuated sac of irri- tating substances, to excite inflammation and produce the adhe- sion of its walls. We have ourselves experimented several times with the subcutaneous injections, but every attempt has resulted in failure. According to Peuch & Toussaint, if old ventral her- nias are to be treated, the best plan is to have recourse to bandag- ing, as employed in the treatment of exomphalus. EVENTRATIONS. An eventration may be defined as a compound hernia, and it constitutes an accident of the first degree of severity, consisting in the formation of a hernia, of indefinite dimensions, taking place through an opening involving the entire thickness of the abdomi- nal walls, the skin included, in such a manner that some portion of the abdominal viscera, but most commonly the intestines or the omentum, become directly exposed. Ordinarily they are due to some traumatic lesion, such asa thrust from or a fall upon a sharp body, or they may be produced by stab wounds, or punctures with a fork or a knife; or again, by kicks inflicted by other animals, or horn-blows, when cattle are crowded into too contracted a space and struggle for more room, or quarrel when herded in pastures. And they quite commonly end the career of the wretched victims of barbarity which are compelled to assist in the bloody and cruel sport of the Spanish bull fight. They are also observed at times following severe surgical manipulations, as in castration, during the operation for strangulated inguinal hernia, after the efforts of 448 OPERATIONS ON THE DIGESTIVE APPARATUS. distokia. They may also form one of the complications of some of the forms of the treatment of umbilical hernia. In the smaller animals, such as dogs, they may be produced by a severe bite by a larger animal. The pathognomonic symptom of an eventration may be con- sidered the protrusion of a portion of the abdominal contents through its lacerated walls. If the opening through which this takes place is small, the viscera will appear as asmall round tumor, which presently becomes transformed into a large mass of intes- tinal circumvolution, which itself varies in dimensions, according to the extent of the laceration. As the exposed intestines begin to protrude, they for a period retain their physiological appear- ance and normal color, but they undergo rapid changes, becoming progressively darker, blueish and then black, and grow cool to the touch. The viscera as they protrude from the abdomen may be quite intact, but they often are injured, bruised or torn, the con- ditions varying according to the peculiar circumstances attending the accident. And not only is this so, but the sequel of the case must be especially considered, since an eventration which possibly might be susceptible of cure, if carefully tended from the first, may become so aggravated and exaggerated as to preclude all possibility of remedy, as when the wounded creature, frantic with pain, from colics and otherwise, in rearing and struggling, forces his entrails more and more out of their place, and tears and tram- ples them upon the earth until they become a mere mass of crushed and bruised viscera, ground into the earth. And yet, colics are not always present in eventrations, even in horses whose irritable temper, combined with the condition of the injured parts, would naturally tend to render their occurrence quite inevitable. The prognosis of their injuries varies according to the species of the animal, and also under the special condition and circum- stances of each case, as judged by itself. In horses, it is, in the majority of cases, a fatal accident. The sensitiveness of the animal to impressions upon the nerves, and the delicate susceptibility of the peritoneum account for this. In ruminants they are less serious, and certainly still less so in carnivorous animals, where sometimes the whole intestinal mass may be seen hanging through the laceration, and with extensive co-existing inflammation, with- out the occurrence of a fatal termination. Swine are also very sensitive to this kind of injury, though the EVENTRATIONS. 449 prognosis may vary with them, according to the condition of the lesion, being more or less favorable according as the bulk of the protruding viscera is less or greater. The chances of recovery will also vary in the ratio of the degree of the exposure of the vis- ceral organs to the atmospheric air, or to the severity of any traumatic accidents they may have encountered. The indications of treatment suggested in these cases is obvious. The first is always, when practicable, reduction. To return the intestine to the situation designed by nature for its occupancy is the first step to take. Ifit has not been seriously wounded, and is in a state of cleanliness, and has escaped contact with the earth and other soils and stains, simple washing may be attended to at once. But if, on the contrary, it is bruised, soiled and inflamed, it must be carefully cleansed with warm water, before being re- turned to its position. This reduction must be carefully per- formed by the taxis, and if the opening of the abdomen is too small to allow this to be accomplished with facility, it will be good prac- tice to enlarge the opening with the knife, rather than to hazard the too free manipulation of the tender parts which will form the dangerous alternative which may become the exciting causes of consecutive inflammatory, and perhaps gangrenous sequele. If instead of the intestines the eventration allows the exit of the omentum, this also must be cleaned and washed, if necessary, and returned, though in some instances it may be torn or cut off after ligating its large blood vessels, or better yet, ligating the whole mass with animal ligature. The second step of the operation con- sists in applying means of restraint to retain the returned organ and prevent a second exit. The quilled suture is at this jnncture the means which always first suggests itself to the surgeon’s mind, The clamps have their advocates, but Zundel prefers the metallic interrupted sutures. The entire application is to be supported, reenforced and protected by a wide bandage, similar to some of those recommended in umbilical hernia. LAPAROTOMY. This operation, which consists in the opening of the abdominal cavity through the loins or flanks, is one which, considering the general indication for which it is performed in human surgery, has found but little application and occupies but a small place in 450 OPERATIONS ON THE DIGESTIVE APPARATUS. veterinary practice. According to Director Degives, who furnishes the only description of the operation to which we have been able to obtain access, the indication for laparotomy occurs in cases of intestinal invagination, internal hernia and intestinal strangulation and for the removal of foreign bodies from the abdominal cavity or the intestinal tract. Once a celebrated surgeon of New York had decided to prac- tice it upon one of his valuable dogs, which was suffering with impaction caused by the lodgement of a mass of hair in the intes- tines, which we fortunately succeeded in softening and removing by internal treatment. The indications for the operation are im- perative as soon as a fatal result becomes imminent and certain. The instruments necessary are a convex bistoury and suture needles. Dr. Degives briefly describes the operation as follows: “ Posi- tion and Restraint of the animal standing up, or in stocks, or resting against a wall or its equivalent. If the animal is restless let him be thrown down on the side opposite to that of the opera- tion, which is divided into three steps. First Step, opening of the jflank.—The abdominal opening must be in the upper part of the flank, upon a line between the hip and the last rib. This opening may be made in two ways: Ist, or Simple Method.—It consists in making an incision through the various anatomical layers, in the same direction, in order to form a simple vertical wound, large enough to admit the hand. The parts having been shaved, the division of the skin, the abdominal muscles and the peritoneum is made successively with the convex bistoury. The incision of the deep layers alone pre- sents any difficulty, and this requires some attention, the hemor- rhage being sometimes troublesome; but when the peritoneum is exposed, the incision is increased, from without inward, with either a blunt bistoury or the straight bistoury controlled by a grooved director, an assistant protecting the intestines from the contact of the instrument. 2d, or New Method, by. Complex Incision.—In this each mus- cle is divided in the direction of its own proper fibres. Thus, the first is a transverse, cutaneous incision; second, three muscu- lar divisions, running in directions more or less opposed to each other; the first, obliquely downward and backward; the second. obliquely forward and downward, and the third transversal and parallel to that of the skin. These incisions are very easily made, LAPAROTOMY. 451 little more being necessary than a simple laceration of the intesti- nal tissue with the fingers—there is little or no hemorrhage. The opening thus made admits the hand into the abdomen, and when it is removed the fibres of each muscle having a tendency to come together spontaneously, the opening is more or less effectually closed. Second step.—This varies, to correspond with the object of the operation; Ist, whether the extraction of a foreign body in the abdomen or intestines, or 2d, the reduction of an invagination or of an internal hernia (diaphragmatic, mesentoric, epiploic, or pan- creatic), and, 3d, the displacement or removal of a tumor involving the intestines. In the reduction of an internal hernia, it may be necessary either to pull or to push upon the displaced organ. In some cases the hernial ring must be enlarged, and if that cannot be done with the fingers, the bistoury must be used. The reduction of an intes- tinal invagination is obtained by the combined action of a slight traction on the invaginated part and a steady external pressure upon the enlargement formed by it in the portion of the intestines in which it is enfolded. When the swelling of the organs or the presence of abnormal adhesions prevent the reduction, the traction must be increased and in opposite directions—the invaginated por- tion in one, the enfolded portion in the opposite. Tf a stone, a calculus, or any foreign body is to be extracted, the intestine is to be incised at some distance from the insertion of the mesentery, on its lateral face, between the two curvatures. On the removal of the body the intestinal suture is to be applied. Third step, Closing the Parietal Wound.—When the complex incision has been made, a strong cutaneous suture is all that is re- quired. When the division has been a simple one, the edges of the muscular wound are brought together by ordinary interrupted sutures, and the skin is afterward sewed up. The drainage at the lower part of the wound is always advantageous.” As enteritis and peritonitis are common sequele of this opera- tion much care and watchfulness devolve on the surgeon in direct- ing the regimen and nursing of the patient in order to prevent the possibility of their access from becoming a certainty. CHAPTER IX. OPERATIONS: “ON. THE] RESPIRATORY APPARATUS, ON THE GUTTURAL POUCHES—HYOVERTEBROTOMY. This term fails to meet the approval of Zundel, who has pro- posed that of Hyospondylotomy as a substitute, in order the better to indicate the puncture of the sac of the guttural pouches which it signifies. The former name, however, has been generally ac- cepted, and while its etymology would point to the operation by which the puncture referred to is made between the hyoid bone and the atlas, it is still used to mean generally, the puncture of the pouches, at whatever point it may be made. These guttural pouches, which exist exclusively in the solipeds, and are two in number, are situated between the cranium, the pharynx and the atlas, resting upon each other on the median line, each one, by an expansion of the mucous membrane of the Eustachian tubes, forming a sac and filling the triangular space situated posterior to the pharynx and extending to the larynx. The mucous membrane which forms them is easily stretched, and the. cavity may thus become greatly distended by the accumulation of pus, and when this is the case, the pouch extends below the larynx and the lower extremity of that organ. Thus situated in the parotid region, these two sacs sustain important relations to other points, varying according to the position, whether of extension or flexion, of the head upon the neck, and are covered by seven separate tissues, as represented in their order from without inward, by 1st, the skin; 2d, a layer of subcutaneous connective tissue, more or less abundant; 3d, a thin expansion of cutaneous muscle with the parotido-auricularis muscle; 4th, the parotid gland, whose internal face is moulded upon the muscles and blood vessels un- derneath; 5th, the following muscles in the order as named from above downward, viz., the small oblique of the head—the stylo- hyoideus, which fills the space left between the anterior border of HYOVERTEBROTOMY: 453 Fig. 395.—Antero-Posterior Section of the Head, showing the Mouth, Fances, and Nasal Cavities. 1, genio-glossus muscle; 2, genio-hyoideus muscle; 3, the velum palati; 4, pharyn- geal cavity; 5, esophagus; 6, guttural pouches; 7, pharyngeal opening of the Eustach- ian tube; 8, laryngeal cavity; 9, lateral ventricle of the iarynx; 10, trachea; 11, ethmoi- dal turbinated; 12, maxillary turbinated; 13, ethmoidal volutes; 14, cerebral compart- ment of the cranian cavity; 15, cerebellar compartment of the same; 16, falx cerebri; 17, tentorium cerebelli; 18, superior lip; 19, inferior lip. the styloid process of the occipital bone and the superior border of the long branch of the hyoid, through which the puncture is made in order to enter the guttural pouches, and back of this the stylo-hyoideus and the superior border of the digastricus ; then, 6th, on the deepest layer, the guttural pouches are found supe- riorly, resting intimately on the internal face of the stylo-hyoideus muscle, inferiorly closely cemented with the posterior face of the pharynx and posteriorly with the superior extremity of the long muscle of the neck; and 7th, the numerous and important blood vessels and nerves belonging to the parotid region. 454 OPERATIONS ON THE RESPIRATORY APPARATUS, AK \\ \\ \“i—°“"[ \\\ RN Hh a Ui Fia. 397.—Parotid Region—Superficial Layer. PP, parotid gland; Mpa, parotido-auricular muscle; 3, transveral artery of the face; 4, maxillo-muscular vein; 7, jugular vein; 8, glosso-facial vein; 9, transversal vein of the face; 10, maxillo-muscular vein; 12, posterior auricular vein; 13, facial nerve; 15, auricular branch of the 2d cervical pair. The arteries are the three divisions of the primitive carotid ; Ist, the occipital, which, by its mastoid branch, runs over the ex- ternal surface of the styloid process of the occipital bone ; 2d, the internal carotid, which runs upward through the thickness of the fold of the mucous membrane which forms the guttural sacs; 3d, the external carotid, with its parotid branches, the maxillo-mus- cular, the posterior auricular, the superficial temporal trunk and the internsi maxillary The veins, which are numerous, empty HYOVERTEBROTOMY. 455 nny \ A KK li Ait! Fie. 397.—Parotid Region—Middle Layer. P, parotid gland; D, digastricus muscle; Sh, occipito, or stylo-hyoideus, muscle; Sm, sterno-maxillaris muscle; P, thyroid gland; H, posterior border of the great branch of the hyoid bone; 1, primitive carotid artery; 2, external carotid artery; 8, transversal artery of the face; 4, maxillo-muscular artery; 5, posterior auricular artery; 6, thyro-laryngeal artery; 7, jugular vein; 8, glosso-facial vein; 9, transversal vein of the face; 10, maxillo-muscular vein; 11, anterior auricular vein; 12, posterior auricular vein; 13, facial nerves; 14, anterior auricular nerve. into the jugular or its different branches. The principal nerves of the parotid region are the facial, the pneumogastric, the spinal, the superior cervical ganglion of the sympathetic, the great hypo- glossus and the glosso-pharyngeal. These nerves, with the exception of the facial, are situated on the external face of the pouches below the long branch of the hyoid bone and the stylo-hyoideus. 456 OPERATIONS ON THE RESPIRATORY APPARATUS. This rapid summary of the anatomy of the parotid region will sufficiently indicate the dangers which the surgeon is likely to encounter at successive steps of the operation, and especially if he duly considers the location of the occipito-hyoideus, which must be reached before the puncture can be made, and again, the pecu- liar course followed by the posterior auricular artery as it emerges from the parotid to reach its destination. Hyovertebrotomy is indicated in all cases of repletion of the suttural pouches resulting from a purulent collection and main- — tained by a process of chronic inflammation. It is principally when horses have become liable to be attacked with strangles that these purulent collections are formed. They are marked by an increase of size in the pouches, gradually augmenting with the continued formation of the pus, and interfering more and more with deglutition and respiration, sometimes assuming such pro- portions as even to threaten suffocation. Attacks of pharyngitis or laryngitis, or catarrh of the anterior chambers of the respira- tory apparatus and nasal cavities, or sinuses, are at times noticed in connection with this affection. To revert to the anatomical arrangement of the parts: The guttural pouches, opening into the cavity of the pharynx by a narrow slit, are situated on the lateral surface, and thus allow any collection of pus they may contain to flow without interruption into the pharynx,and hence into the other nasal cavities. We have here an explanation of the fact that a discharge from the nose in any one of a variety of affections, such as suppuration of the guttural pouches, pharyngitis, laryngitis, catarrh, and also the dis- charge of elanders, may all possess different characteristics, and each exhibit a different aspect, and therefore demand a different diagnosis and require different treatment. The discharge from the guttur al pouches is whitish, glairy, more or less mixed with mucosities, inodorous, non-adhesive to the wing of the nose, and intermittent, being marked during mastication or deglutition, and especially while swallowing liquids—in all form- ing an assemblage of characteristics which should be sufficient to distinguish the affection from all others. There is, besides this, a negative point, in the absence of chancres, which with the distinct nature and peculiarity of the discharge, and the characters so typical of the maxillary lymphatic glands in that disease, will largely aid in determining the difference between the two affections. HYOVERTEBROTOMY. © 457 In respect to glanders, moreover, the bad odor, the thick, gru- mous nasal discharge, and the soreness and dullness on percussion of certain parts of the face, will in many cases serve to identify and distinguish a pathological condition of the sinuses very dif- ferent from that of the disease we are considering. Gohier and Vatel also refer to guttural tympanitis, or dilatation of the pouches by air, as a feature of their disordered condition. The amount of pus collected in the pouches varies in different cases to such an extent that from only a trifling degree of dilatation it may be suf- ficiently extensive to produce a sensible projection of the sac below the parotid. This dilation furnishes a guide for the determination of the proper point at which to make the puncture, whether in the upper, in the middle, or in the lower part of the pouches. The upper operation is hyovertebrotomy proper. Besides these three modes of operation, Gunther has proposed a fourth method which consists in penetrating the pouches through the nasal cavities. Upper operation—Hyovertebrotomy proper.—As described by Chabert and Fromage de Feugré, this is one of the finest and most delicate operations of veterinary surgery. Extremely so when per- formed on horses whose pouches are healthy and normal in size, it loses a great deal of its apparent difficulty when these are full of pus with prominent and well developed walls. The nerves and blood vessels which surround them are then easily pushed aside from their position, and the lobules of the parotid are more or less separated. The instruments required for this operation are: a pair of scissors, a convex and a straight bistoury, a dissecting forceps, am Fic. 398.—Curvyed Trocar, or Hyovertebrotome. S probe, or preferably, the curved trocar, the hyovertebrotome (Fig. 398), and a piece of tape. Artery forceps and ligatures ought to be always within reach. | Bouley, Zundel and others recommend that the animal should be kept in the standing position with simply a twitch on the lip, 458 OPERATIONS ON THE RESPIRATORY APPARATUS. but our experience has taught us that the recumbent position is the safest, especially if there are plenty of assistants at hand, with instructions to keep the head of the animal steady, and in a mode- rate state of extension on the neck. The operation is divided into three steps; 1st, Zhe incision of the skin and dissection of the parotid ; 2d, The puncture of the pouch through the occipito-hyoideus muscle; and 3d, The estab- lishment of the counter-opening. Before considering these three steps, it will be well to answer sundry important questions put by Lecoq in the first good de- scription of the operation, made in 1841. Where shall the puncture be made ? The anatomical disposition, which we have already examined, suggests as an answer to this query, that the occzpito-hyoideus muscle is the proper place for the puncture. Its inner side is lined with the mucous membrane of the pouches, and as has al- ready been remarked, when this is distended by fluid and becomes tense and resisting, it is in a much better condition for the pass- age of the knife through its thickness than when flabby and soft, and therefore movable and shifting, as if endeavoring to evade the knife. At any other point the pouches are so surrounded by im- portant blood vessels and nerves that the operation is precluded by the danger which would be incurred by attempting it. Where must the first incision be made to reach the occipito- hyoideus muscle ? It would be easy to reach the muscle by a division of the paro- tid gland, but this would involve the formation of a fistula, and a wound difficult to heal, to avoid which the gland must be raised out of the way. This should be done by raising the posterior bor- der, where it is loose and free from blood vessels or nerves of importance, in preference to doing so by disturbing the anterior border or superior extremity, where the posterior auricular artery, the facial nerve and the sub-zygomatic artery are situated. The superior extremity of the incision must begin near the inferior border of the tendon common to the splenius and small com- plexus muscles, a little in front of the transverse border of the atlas, and extend downward for a space of two or three inches. Upon what point of the muscle must the puncture be made? The answer to this is—upon the central portion of the muscle. The introduction of the bistoury into the superior part of the * ; eg ag - HYOVERTEBROTOMY. 459 muscle will involve possible danger to the posterior auricular ar- tery, and the risk of the division of the facial nerve. In what direction must the sharp edge of the bistoury be turned ? . The reply to this is the point of minimwm danger from irregu- lar motions of the instrument, caused by the struggling of the patient; and this result is most likely to be accomplished by carry- ing the bistoury towards the tuberosity of the hyoid bone, and consequently in the direction of the patient’s nose. With the instrument turned towards the ear, there would be possible dan- ger of dividing the posterior auricular artery, the facial nerve or, perhaps, the internal carotid. In carrying it toward the atlas, the internal carotid, and the nerves surrounding it, would be the endangered parts, if any. If directed downward, toward the larynx, a division of the great hy- poglossus, and possibly of the external carotid, might be possible. What must be the direction of the instrument? If the bistoury is pushed through the occipito-hyoideus muscle, and in a direction perpendicular to it, there will be great danger, at a certain depth, of reaching and penetrating through the in- ternal carotid artery; but if an oblique direction be given to the instrument, not only is this danger avoided, but no accident be- yond some slight muscular injury, of no importance, need be ap- prehended. Where is the counter-opening to be made? The right place will be the most dependent part of the pouches, and the instrument used must be either the S probe or the trocar, as will be hereafter described. These preliminary points being understood, we shall the more intelligently follow the description of the three steps of the opera- tion, which we now proceed to give. 1st. The Incision of the Skin and Dissection of the Posterior Border of the Parotid.—This incision is made a little in front of the transverse process of the atlas. It includes the skin and some subcutaneous aponeurotic fibres, and extends to the posterior bor- der of the parotid, which is at this point exposed. With the straight bistoury and dissecting forceps, the parotid border is dissected, and under it the aponeurosis of the levator-humeri is divided. The finger is then pushed between the aponeurosis and the small oblique muscle of the head, in order to reach the occipito- 460 OPERATIONS ON THE RESPIRATORY APPARATUS. hyoideus, which is readily identified by feeling for the styloid pro- cess of the occipital bone and the superior border of the long branch of the hyoid. Some little hemorrhage and some strug- gling of the patient may follow this incision, caused by the divis- ion of the auricular vein and nerve, but the consequences will not be serious. 2d. Puncture of the Pouch through the Muscle.—The central point of the muscle being identified, the operator, with a straight bistoury held in the manner of a writing-pen, introduces it under the parotid, obliquely, from above downward, and from behind forward, and thus divides the muscle through and through, and penetrates the pouch. If the puncture proves to be sufficiently large, the index finger is introduced into the opening for explora- tion, and, if necessary, for its further dilatation. If the collection of pus is not very abundant, and the mucous membrane lining the sac not greatly distended, it will be important to have a very sharp-pointed instrument, which will make its work of incision sure, instead of merely pushing the membrane away from the internal face of the muscle—an accident which might lead to serious results. But again, when the collection is abundant and the pouches much distended, the use of the bistoury may prove unnecessary, the puncture being then readily made by pushing the index finger through both the muscle and the mucous membrane of the pouch. 3d. Making a Counter-Opening.—The S probe, or curved tro- car (Fig. 398), is introduced through the opening made, and is pushed down to the bottom of the pouch, where the mucous mem- brane is easily torn; it is then carefully directed toward a point a little below the glosso-facial branch of the jugular, back of the thick border of the maxillary bone, and pushing against it with sufficient force, the instrument forms a prominent point under the skin. If the S probe is used, an incision is made with the bistoury through the skin, and the instrument is exposed. If the curved trocar, it is by a strong pushing movement passed through the skin and brought outside. Whatever instrument may be used, a piece of tape or kind of seton is introduced from the lower through the upper opening, and the continued escape of pus thus facilitated and ensured, The extremities of this piece of tape are secured together by tying them with the knot used with the or- dinary seton. cy tlic mile iia HYOVERTEBROTOMY. 461 The attention required by the patients after the operation 1s of the simplest kind, consisting in keeping the wounded surface thoroughly clean and keeping up the flow of the pus. This will at first make its escape through the upper opening, but will soon find its way through the lower one, and so long as it is discharg- ing the opening must not be allowed to close, nor must the seton be moved. Puncture in the Middle and the Lower Regions of the Parotid.—-These modes of operation are so nearly identical that, with H. Bouley, we think they may with propriety be jointly con- sidered. In these cases but little attention to the anatomy of the part is required. The growth of the purulent collection distends the pouches, displaces the blood vessels and nerves, separates them more or less from the parotid, and becomes more superficial, and, in fact, may ulcerate through the skin and empty itself spontane- ously. But this process is a very slow, tedious and painful one, and subjects the patient to such a degree of suffering, that it be- comes a duty imperative to interpose the resources of surgery for its relief. The puncture in this case should be made as early as possible, and at the fluctuating point, as with an ordinary abscess. It is made with the bistoury, or, what would be better, with the olivary actual cautery, by which the prevention of hemorrhage will be as- sured. The opening thus made and cauterized, will, moreover, have less tendency to close too rapidly, besides which the modify- ing effects of the cauterization will have a highly advantageous in- fluence upon the healing process. The opening of the pouch at its lower extremity has been recommended when the purulent collection is small, or when con- eretions of inspissated pus are supposed to exist in the cavities. It is done by first dissecting the wide and thin lower portion of the parotido-auricularis, then of the base of the parotid, under which the distended pouch is seen and punctured. We remember a case where the collection in both cavities was such that we had no difficulty in opening them on each side of the neck, about on a level with the thyroid glands, the lower operation with emphasis ! Puncture Through the Eustachian Tubes.—Gunther has in- vented a tube, rounded at one extremity, a sort of hollow bougie, 462 OPERATIONS ON THE RESPIRATORY APPARATUS. which he introduces into the guttural pouches by passing it — through the nasal cavities and the Eustachian tubes. Although in performing this operation the animal is thrown down, it is very difficult to accomplish, and requires to be preceded by the operation. of tracheotomy. It also requires to be repeated several times, by reason of the liability of the collection to return. The mode of operation is a matter of no importance, since the solutions of continuity resulting from it seldom assumes a form more serious than that of an ordinary simple wound, and requir- ing no special directions as to treatment. Even ordinary de- tergent washes are scarcely necessary. LARYNGOTOMY—ARYTENECTOMY. | x The history of surgical interference at the larynx, to relieve the \ / peculiar difficulty of respiration known as roaring, depending | | upon paralysis of the laryngeal muscles, dates as far back as 1845, / when Professor Gunther, of Hanover, attempted, in succession, the — resection of the vocal cords, the removal of the vocal cord of the paralyzed side of the larynx, the partial excision of the arytenoid cartilage, the entire extirpation of that cartilage, the removal of the vocal cord and of the corresponding laryngeal ventricule, and finally the fixation of the arytenoid, by an anchylosis at its artic- ulation with the thyroid cartilage. The results obtained by Gun- ther were more or less successful. These experiments were repeated by Gerlach, H. Bouley, Stockfelth and Bassi, but subsequently repudiated and ignored. But in later years Professor Moller, of Berlin, and George Flem- ing, of London, have turned their attention to the subject, with the suggestion of various new modes of operating, which have yielded results more or less encouraging. The matter has been followed up by other veterinarians in various parts of the world, and re- cently especially by Professor Cadiot, and the successes which have been recorded, though not always perfect, seem to justify the prosecution of further inquiries and new trials for the relief of a disease which has thus far baffled the skill of veterinarians, and consigned many a valuable animal to the hands of the knacker. The operation of Professor Moller, also recommended by Pro- fessor Cadiot, as at present practiced, is the excision of the para- lyzed cartilage. That of George Fleming is the removal of the LARYNGOTOMY—ARYTENECTOMY. 463 cartilage and the vocal cord. / We shall describe the Fleming and ~ Gadiot modes as we find them recorded in their own works. “Roaring in Horses,” by the former, and “The Surgical Treat- ment of Chronic Roaring,” by the latter. L “ The Fleming Method.—The special instruments necessary a small ordinary forceps; scalpels; bull-dog forceps; tracheal Fia. 399 —Tracheal Tampon Canula. tampon; a canula, formed of along tracheotomy tube, with an india rubber bag surrounding its middle. This bag is inflated by means of an india-rubber air-pump, after the insertion of the tube into the trachea, and is useful in preventing the flow of blood into the bronchii during the horse’s getting up after the operation, and for half an hour subsequently. Other instruments required are a razor-shaped knife, with which to excise the cartilage; a bent knife with which to remove the muscles from the outside of the arytenoid cartilage; a hook to seize and raise the lower end of Fic. 402.—Hook to Secure the Cartilage. 464 OPERATIONS ON THE RESPIRATORY APPARATUS. Fic. 406.—Electric Lamp. the cartilage; a special forceps with toothed ends, to seize the body of the cartilage ; curved scissors to cut through the mucous membrane; two retractors to keep the trachea opened during the operation ; and an electric lamp to illuminate the interior of the larynx. Fleming describes the operation as follows: “The horse should be well fed for a day or two preceding the operation, but have little or no food or drink for some hours before its actual performance. In the case of thoroughbred horses, a dose of four ounces of tincture of opium in a pint of water, half an hour be- fore operating, is advisable. The hair must be removed closely from around the upper part of the trachea and larynx, before the ' LARYNGOTOMY—ARYTENECTOMY. 465 animal is cast, and he is thrown in the usual manner, on a good bed of straw or moss or litter. The chloroform bag is put on, and when the required state of narcosis is induced, the animal is placed on his back, and maintained there by sacks filled with straw, placed close under each side of the body. The neck and head are ex tended in a line with the body, the head placed on the vertex and kept steady by an assistant. The operator places himself in a kneeling position, on the off, or right side of the body, if right handed, beside the neck, with his back to the shoulder and face toward the head.” The operation is divided into three stages: First Stage.—“ With a scalpel, an incision of from four to six inches in length is made through the skin, the middle line of the larynx and trachea, opposite the posterior border of the lower jaw, extending from the body of the thyroid cartilage to the second or third tracheal ring. This exposes the subscapulo-hyoid, sterno- hyoid and sterno-thyroid muscles, which are incised to the same extent, and as close as possible to their line of junction (raphe) in the middle, the section being then carried through to the larynx and trachea. There is a variable amount of hemorrhage now to contend with, which, if only oozing, may be checked by sponging it dry until the blood has ceased to flow; and if it comes from twigs of arteries or veins, they may be seized, and twisted, or ligated.” Second Stage.—* The middle crico-thyroid ligament, cricoid car- tilage, and one, two or three tracheal rings are cut through, in a straight line, exposing the interior of the larynx and trachea. If blood vessels are cut, they should be taken up. A retractor is applied to the sides, and these being pulled gently apart by an assistant, there is ample space in which to manipulate. The con- vex lower border of the arytenoid on each side can now be seen, and if the respiration is deep, that which is next the operator (the right), will be observed to move actively from the side toward the middle ; while if the roaring is due to paralysis of the left dilator muscle, there is no movement in the opposite cartilage. When the breathing is very tranquil, which is often the case, the right carti- lage moves almost imperceptibly, and it becomes necessary to as- certain whether the left one is really immovable. This can be done by passing the finger, or a long probe, up toward the epi- glottis, when the act of swallowing will be excited, during which 466 OPERATIONS ON THE RESPIRATORY APPARATUS. the right arytenoid cartilage is energetically jerked into the mid- dle of the cavity; but the left one is either motionless or only feebly stirs, depending upon the degree of the wasting of the con- strictor muscles on that side. “Tf any blood lodges in the trachea, it can be removed by large or small (handled) sponges, which may be passed to the operator by an assistant who receives and washes them. As the horse is now breathing through the wound, the chloroform bag may be removed. “Tt is always advisable to examine the interior of the larynx carefully, in order to ascertain its exact condition, as there may be something more in the case than an immovable cartilage. For this purpose the electric lamp is invaluable. Bs if : ye > a0 y \ iil ss at pret Ms SJ" Fre. 407.—Left Side Section of Larynx, showing the Parts excised in the Operation for Roaring. “The left arytenoid cartilage may be excised by commencing at the lower convex border, or at the upper part, where it meets the right cartilage (Fig. 407). If the latter method is selected, then a cut with a razor-shaped knife is made through the mucous LARYNGOTOMY—ARYTENECTOMY. 467 membrane, into the arytenoid ligament and arytenoid muscle, as close to the margin of the cartilage as possible, beginning between the cartilage of Santorini, downward and then upward and the vocal process at the insertion of the vocal cord (Fig. 407). The hook is inserted in the vocal process, which is raised, and the vocal cord is separated from the cartilage by the scissors; then the muscles on the outside of the cartilage are cut with the bent knife, or, what is better, pushed from its surface as close as possi- , ble. The hook is removed, and the body of the cartilage seized ) with the rachet forceps. The mucous membrane connecting the cartilage with the vocal pouch is divided, with the curved scissors, cutting as close to the cartilage as possible, to save the membrane. “The arytenoid cartilage is now free, except at its articula- tion with the cricoid, and it may either be disarticulated or cut through with the scalpel at this point, care being taken to leave no loose portionsor shreds. The cartilage being now only retained by the soft parts at the upper portion (or base of the arytenoid cartilage), these are cut through, close to it, with the scissors, when it is altogether detached. ‘Care must be taken to avoid wounding the other cartilages, or the pharyngeal mucous membrane, and to spare that membrane in proximity to the arytenoid cartilage as much as possible, remov- ing only that which covers its surface and the cartilage of Santorini. “The vocal cord is now removed close to its attachment to the thyroid cartilage, in front and at its fixed border (Fig. 407). This can be done with the scissors, a finger being passed to the bottom of the ventricle to facilitate the excision; or the cord may be drawn from the side by inserting a hook in it, to allow plenty of room for the scissors. “Tf the hemorrhage is troublesome, which it seldom is, the blood can be mopped out of the trachea with the sponges. It cannot pass down that tube, owing to the position of the neck. If necessary, the electric lamp may be employed to ascertain how the operation has been performed, or even during it performance ; but after a little experience this is unnecessary.” Third Stage.—‘*The trachea being completely freed from blood, and the tampon canula introduced, the bag being inflated after it has been properly placed into the trachea by means of the air-pump, the canula is secured in position by a tape around the 468 OPERATIONS ON THE RESPIRATORY APPARATUS. neck. Itis only required for about half an hour, until the hemor- rhage has ceased, as it will prevent the entrance of blood into the lungs while the horse is getting up, and for a short time after- ward respiration being carried on through the tube. It ought not to be left any longer, being liable to injure the interior of the trachea. The blood being again removed from the larynx, one or two syringe-fulls of the common salt or borax solution are inject- ed into it and the pharynx. This washes out these cavities and the sinuses of the head, a necessary precaution, as putrefying blood in them sometimes gives rise to troublesome consequences. Swallowing should be induced by touching the epiglottis, and then the horse may be turned on his side, the lower margin of the wound being depressed, to allow the remaining blood and water to flow out. This completes the operation. “The horse is nosy allowed to recover from the chloroform; and when ready he may be assisted to get upon his feet, care being taken that the canula is not displaced while doing so. The wound is kept open with the finger for a short time, to allow any remaining blood to escape, and itis afterward cleansed away from around the wound, the face and nostrils sponged to refresh the patient, and if the weather is cold, the body clothed and the legs bandaged.” Method of Cadiot.—The special instruments required are a Fia. 409.—Curved Scissors. Fia. 410.—Spring Tenaculum, or Dilator. blunt bistoury, curved scissors, whose blades are nearly perpen- dicular to the branches, a spring tenaculum, a hooked or long bull-dog forceps, a canula tampon, like that used by Fleming, a LARYNGOTOMY—ARYTENECTOMY. 469. Fig. 411.—Hooked Forceps. peculiar curved needle, shown in Figure 418, straight, long and ordinary curved scissors, bistouries, dissecting forceps, artery nip- pers, loose and fixed sponges, thread, cotton, pheniated or iodo- formed gauze, and antiseptic solutions. The preparation of the animal is similar to that in Fleming’s method. First Stage.—Incision of the Skin and Muscles covering thé Larynx.—The incision must be made on the median line, and ex- tend from the body of the thyroid to the second or third tracheal ring. This is done with the convex bistoury, first dividing the skin in its whole length, when the edges separating show the raphe of the sterno-hyoid and omoplat-hyoideus muscles. The muscular layer can then be divided exactly upon the median line. The division of the prelaryngeal connective tissue closes the first stage. The hemorrhage is always light and easily controlled. Second Stage.—Incision of the Larnyx and of the First Two Rings of the Trachea, Introduction and Fixation of the Can- ula.—The incision may be made by a single stroke of the knife, dividing the crico-thyroid, and with it, successively, the cricoid and the crico-tracheal ligaments, and the first rings of the trachea. But by this mode of operation, the vocal cords may be injured, and to avoid this, the bistoury held perfectly vertical, with the edge turned backward, is inserted through the crico-thy- roid ligament, immediately in front of the cricoid cartilage, and this is divided with the crico-tracheal ligament, as well as the first ring of the trachea. The edges of the laryngo-tracheal incision are then opened with the spreaders, or the spring tenaculum, and the division of the thyro-cricoid ligament is completed, from be- hind forward, and from within outward. As by the act of inspi- ration the vocal cords move more or less outward, this movement should be carefully watched while making the incision of the crico-thyroid membranes to save them from injury. The canula- tampon is then introduced, and when in place, is moderately in- flated by an assistant, the operator measuring the degree of dila- 470 OPERATIONS ON THE RESPIRATORY APPARATUS. tation with his fingers in the superior part of the trachea. When it is sufficiently expanded, a ligature is applied upon the India rubber tube, and this is cut off. Though the tampon 1s inflated, hie "Wns f if % 2: ji feria} Fig. 412.—Arytenectomy. The second step is over. The crico-thyroid ligament, cri- coid cartilage, crico-tracheal ligament and the two first tracheal rings are divided. The canula and the tenaculum are in place—c ce, Cricoid Cartilage. 1, First Ring of the Trachea. ; the canula has a tendency to slip in the larynx, and for the pre- vention of this accident should be secured by bands or strings tied backward over the neck. _ Third Stage.— Ablation of the Arytenoid Cartilage. —The ablation of the cartilage is effected by several steps: (a) Incision of the Mucous Membrane along the Superior and Posterior Borders of the Cartilage.—With a blunt bistoury and a slight pressure, an incision is made in the mucous mem- brane along the side of the superior and posterior borders of the TARYNGOTOMY—ARYTENECTOMY. 471 arytenoid (see Fig. 413), the instrument being then carried into the larynx on the median line, from before backward to the ceri- coid, and thence from within outward and from below upward, as far as the insertion of the vocal cord. To save the mucous mem- Fia. 413.—3d Step. a, Incision of the Mucous Membrane along the Superior and Pos- terior Borders of the Arytenoid. brane, the incision may be made at some distance from the bor- ders of the cartilage, but the division of the membrane must be complete. (6) Section of the Vocal Cord; Dissection of the Cartilage on its Inferior and Anterior Borders and External Face.—With long, sharp, straight scissors, the vocal cord is excised at its in- sertion upon the arytenoid (see Fig. 414). The cartilage is then, by small nips of the scissors, made from behind forward, dis- sected in dividing the mucous membrane along its inferior bor- der, and the muscular fibres of the crico-arytenoid and thyro-ary- tenoid, inserted on its external face (Fig. 415); the mucous mem- brane, which covers the anterior border, being divided from above 472 OPERATIONS ON THE RESPIRATORY APPARATUS. Fig. 414.—3d Step. 0b, Section of the Vocal Cord. downward with the scissors. To facilitate this part of the oper- ation, the cartilage must be firmly held with either the hooked or the bull-dog forceps, and carried toward the median line, when the inferior border and the external face are dissected, and drawn backward and upward when the dissection goes on, on the ante- rior border. The only important or particular caution needed here, is to hold the point of the scissors always in contact with the cartilage, to keep close to it, to save the mucous membrane, and to avoid the laryngeal ventricle as well as the tissues loosened from the external face of the cartilage. Toward the end of this third step, when the cartilage is separated from the fibres of the thyro-arytenoid muscle, a hemorrhage takes place from the divid- ed laryngeal branch of the thyroid artery (Fig. 416). This must be controlled by torsion or artery nippers. (c) Section of the Cartilage near its Articulation with the LARYNGOTOMY—ARYTENECTOMY. 473 is it il : i a, \ Fic. 415.—3d Step. b, Dissection of the Arytenoid at its Inferior Border and its External Face. Cricoid.—Raised and immobilized with a strong forceps, or the hook forceps, held with the left hand, the arytenoid is separated from without inward near its postero-superior angle, the articu- lar, with the blunt bistoury. Held ina vertical direction, or some- what obliquely downward and forward, the bistoury is moved to- ward the external part of the arytenoid, immediately in front of the cricoid, and the section is made by a limited and careful saw- ing motion. When the arytenoid is partially ossified, which is a condition encountered in nearly one half of the patients, some force may be used. A feeling of cessation of resistance, and an increased mobility of the cartilage, indicates the completion of the section. (d) Dissection of the Cartilage by its Superior Face (Fig. 417). —This is done with the curved scissors. The cartilage being well AT4 OPERATIONS ON THE RESPIRATORY APPARATUS. Fie. 416.—3d Step. c, Section of the Arytenoid near its Articular Angle. A, Laryngeal Branch of the Thyro-Laryngeal Artery. raised with the forceps, the scissors are introduced under its poste- rior portion, with the branches held almost vertically, and close to the cartilage, from behind forward, and the fibres of the arytenoid muscle are nipped off. With careful attention, the perfect dissec- tion of the entire cartilage, including its beak, may be effected. During this part of the operation, blood and pharyngeal mucosi- ties may interfere with the manipulations, and must be removed with pieces of soft cloth, wadding or sponges. When these various manipulations have been well executed as described, the surface left by the loss of substance presents a neat and smooth appearance, not only on its borders, but over its en- tire extent. Professor Cadiot, in this step of the operation, omits the excision of the vocal cord, which he considers unnecessary. Fourth Stage. Sutwre.—The borders of the wound are brought LARYNGOTOMY—ARYTENECTOMY. 475 Fic. 417.—3d Step. d, Excision of the Cartilage with the Curved Scissors. together with two or three interrupted catgut sutures, made with a special needle (Fig. 418). Three of these are generally re- quired (Fig. 419). After cleansing the larynx of the blood, it is dressed with wad- ding or iodoformed gauze. The edges of the external wound are brought together by two interrupted sutures, one upon the mus- cular coat, the other on the skin, the latter being so placed as to prevent the displacement of the canula. The care of the wound, aside from the matters of cleanliness and the application of antiseptic measures, varies according to the two modes of operation. But they agree in advising the: early removal of the canula at a period not later than the day following that of the operation. Careful diet is indicated, but Fleming advises strict fasting from both food and water for two or three days, while Cadiot per- mits the animal to have his ordinary diet without interruption. 476 OPERATIONS ON THE RESPIRATORY APPARATUS. Fia. 418.—4th Stevo. How to Apply the Sutures. There is no serious febrile reaction, and after three or four weeks the cicatrization is complete. ' The result of the operation cannot be fully ascertained until about three months after the operation, when the animal can be tested. The application of the sutures constitutes an improvement, we believe, on Fleming’s operations for assisting the cicatrization of the laryngeal wound, which, however, can be more easily watched if the external sutures recommended by Cadiot are dispensed with. | Excessive granulations, when detected, must be cauterized with chloride of zinc or nitrate of silver. Among the accidents and complications that may follow ary- tenectomy, and which are mentioned by Fleming and Cadiot, are wounds of the mucous membrane and of the arytenoid left in the larynx, incomplete deglution of the dressing, pneumonia from TRACHEOTOMY. ATT SS SS Fia. 419.—The Sutures are in Place; three are necessary. foreign bodies, excessive granulations of the cicatrix, pyemia, tetanus, besides those which result from the division of the carti- laginous structure, such as deformity of the tracheal rings, and the contraction of the tracheal diameter. TRACHEOTOMY. This term represents an operation consisting in making a methodic opening of varying dimensions, in the cervical position of the trachea, in order to provide a free channel for the atmos- pheric air into therespiratory tract. Its ultimate object is either the removal of foreign bodies, or of the abnormal growth from the larynx, or to facilitate the passage of the air necessary to respira- tion. Its subjects are principally the large domestic animals, more especially the horse, and it has also been employed with advantage on ruminants, and often successfully on dogs. 278 OPERATIONS ON THE RESPIRATORY APPARATUS. The importance of the operation, with its utility, is readily demonstrated by studying the effect of its performance, and esti- mating the relief which immediately follows, in some special cases of ailment or accidents, complicated with the danger of immi- nently impending suffocation. It is performed in the middle of the inferior border of the neck, in that portion where the trachea. F1G. 520.—Tracheal Region. 7, Trachea; A A, Sterno-Hyoideus and Thyroideus Mus- cles; S H, Sub-Scapulo-Hyoideus; S M, Sterno-Maxillaris; J, Jugular Vein. being most subcutaneous, can be readily felt, in the lozenge formed by the diverging branches of the sterno-maxillary muscles below, and the two converging sub-scapulo-hyoideus above. The trachea is here merely covered by the subcutaneous band of the sterno-hyciaeus and sterno-thyroideus, and the whole is wrapped TRACHEOTOMY. 479 by the thin expansion of the cutaneous colli. In this middle third of the neck, the cartilaginous rings of the trachea, with the liga- ments between which unite them, are readily identified. The indications of tracheotomy, which are quite numerous, are enumerated by Zundel, under five principal heads: 1st, when an obstacle exists which interferes with the free access of air to the lung, as in case of contraction or obstruction of any portion of the air passages, including all the diseases of the upper part of the respiratory tract, and acting directly, such as acute laryngitis, cedema of the glottis, and polypi or paralysis of the larynx; or to- gether with those which act indirectly, as strangles, purulent col- lections in the guttural pouches, anasarca and purpura hemorrha- gica; 2d, when foreign bodies have become lodged in the fauces or the larynx, in order to facilitate their extraction, either directly, by means of special forceps, or indirectly, by pushing them back into the mouth to enable the surgeon to grasp them with his hand ; 3d, to remove tumors, polypi, cysts or cancerous growths ; 4th, in cases of fractures of the bones of the face, of the cartilages of the larynx, or of the trachea; and 5th, again, when the trachea has become the seat of any specific lesions, such as tracheocele; caries of the tracheal cartilages, or of deformities, such as may result from frac- tures, ossifications and contractions. The operation is, however, contra-indicated when the cause or object which impedes respiration occupies a point so low in the passage as to be beyond reach by the tracheotomy tube ; or when the difficulty in breathing and the danger of suffocation are due to a diseased condition, either of the lungs or of the heart. The instruments required for the operation are: a pair of curved scissors, a convex and a pointed bistoury, a sharp-pointed tenaculum, a bull-dog forceps, two blunt tenaculums and a trach eotomy tube. Some special instruments for the division and am- putation of the trachea have been invented, but the tracheotomes, as they are called, do not generally serve as good a purpose as the ordinary instruments already named. Tracheotomy tubes are of various forms and devices. Some are of very simple construction, and others are more or less com- plicated. The ordinary tube consists of a bent and curved can- ula, made of various diameters, more or less cylindrical, and secured on a square plate, nearly flat, or with a curve in order to adapt it to the convexity of the neck, and with an eyelet or 480 OPERATIONS ON THE RESPIRATORY APPARATUS. Fig. 421.—Ordinary Tracheotomy Tube, front and back view. slit at each corner, for the attachment of bands or straps. These tubes are generally made of silver or nickel-plated metal, though gutta percha is the material sometimes used, its lack of solidity, however, rendering the instruments composed of it uncertain and dangerous. Besides this ordinary tube, there is a long catalogue of others, among which we have those invented by Dieterichs, Gowing, Spooner, Vachette, Pradat, Brogniez, Leblanc, Renault, Peuch, Inlin, Trasbot, and these do not exhaust the list. But among all this host of instruments of this class there is probably none which fulfils its purpose better than that of Director Degives, somewhat modified by Professor Peuch (Fig. 430), which, by its simplicity, and especially from the fact of its being a self-holder, has proved itself to be the most convenient of all for general prac- tice. When once inserted and adjusted, this tube may be left in place without danger of removal or dropping of itself, while the or- dinary tube, which requires to be secured by strings tied over the neck, can never be as safe as the self-retaining instruments, which hold themselves. , There are two methods of performing the operation, one of which may be called the classical, and the other the immediate method. In the former, two adjoining tracheal rings are divided, and re- moved, in part or totally ; in the latter, a longitudinal incision is made through the rings without loss of substance (Fig. 433). In TRACHEOTOMY. 481 FIG, 422.—Tube of Dieterichs; Fig. 423.—Gowing’s Tracheotomy Tube. posterior view. FIG. 424.—Spooner’s Tracheotomy Tube. either case the animal is, if possible, kept on his feet, with the head elevated by a twitch applied on the lower lip. It may sometimes be necessary to place him in stocks; to hobble his fore legs, or perhaps only to raise one of the fore feet. In some instances the patient is unable to stand, and, in fact, is already down when the surgeon is called, and this is probably one of the only conditions when the longitudinal incision is fully justified. Classical Method.—This includes three steps, the object of 482 OPERATIONS ON THE RESPIRATORY APPARATUS. Fia. 426.—Tube of Pradat. Fig. 427.—Tube of Brogniez. the first being the the exposure of the trachea; of the second, to open it by removing a circular portion of the organ; and the third by the introduction of the tube into the aperture prepared for it. A tee See as \ +>, -4 TRACHEOTOMY. 483 Fig. 430.—Tube of Peuch. The operator stands facing the animal, slightly on the right. Grasping the trachea (the hair having been closely clipped), he fixes and stretches the skin with the left thumb and fore finger, at about the middle of the tracheal region, and incises it with a sin- gle stroke of the convex bistoury, cutting through the skin and the cutaneous muscle. The incision is about three inches in length, and exposes the sterno-hyoideus and thyroideus muscles. These must be carefully isolated from the face of the trachea by 484 OPERATIONS ON THE RESPIRATORY APPARATUS. TRACHEOTOMY. 485 the dissection of the cellular tissue which confines them, and drawn apart by means of two blunt tenaculums, leaving a gaping wound through which to reach the trachea, which is thus exposed, and in readiness for the second step of the process. Second Step.—In the second step portions of the two cartilages which have been selected, are held by the pointed tenaculum, passed through the connecting ligament, are excised, and a circular open- ing established by the removal of a semilunar segment from each ring. It is necessary at this point to be certain that the isolated valve is securely held, to guard against the force of suction, by which it may be liable to be drawn into the trachea as the new breathing place is suddenly opened. Third Step.—This consists in the insertion of the tube into the aperture prepared for it, and is the simplest and easiest part of the procedure. The only difficulty likely to occur is from the neglect or error of the operator in measuring the dimensions of the opening, and securing a perfect coaptation between that and the tube. If the opening proves to be too narrow, it must, of course, be enlarged, with the caution before mentioned against losing any detached portions by the suction of the trachea. The bull-dog forceps is of value here. If the tube is of the self-hold- ing kind, its introduction completes the operation ; but if the or- dinary tube before described is used, the tyimg over the neck of the tapes attached to the flat plate becomes the final manipulation. If no tube is at hand, the wound must be held apart with tapes applied upon its edges, and tied over the neck. Immediate Operation by Longitudinal Incision.—This is done with the sharp straight bistoury, passing it at once through all the tissues, penetrating the trachea between two cartilages, and making a vertical incision of two or three rings. This mode, as we have said, is principally justifiable in case of emergency when suffocation is imminent, and no time can be lost in proeur- ing the instruments necessary for the classical operation. There is still another mode of operating, credited to Kris- haber, which, from the location where it is performed, is better known as sub-cricoidean tracheotomy, and which consists in mak- ing the opening through the crico-tracheal ligament, which unites the cricoid cartilage to the first tracheal ring. It includes three steps, comprising the incision of the skin and dissection of the underlying muscles, the incision of the ligament, and the inser 486 OPERATIONS ON THE RESPIRATORY APPARATUS. tion of the tube. This mode of operating is simple and of easy performance, especially in the absence of any swelling of the re- gion. It prevents perichondritis, and is not followed by changes in the diameter of the trachea. It has, besides, the advantage of allowing the tube to be, to a great extent, concealed, and thus removes one of the principal objections urged against the operation in cases of chronic roaring, for which it might well be recommended. The subsequent measures vary somewhat, depending upon whether the operation has been performed as only a temporary expedient, or as a permanent means of relief for the difficulty in breathing. In the first case, it is not necessary to remove the tube before the acute symptoms, which have required its intro- duction, have subsided, which is a condition which generally does. not continue more than two or three days. If, however, during that time the canula of the tube should become closed by the dis- charge or other pathological secretions, it must be removed, cleansed and replaced, to be left until its use becomes unneces- sary, which will be readily discovered by the restored regularity of the respiration when the tube is removed or its canula becomes occluded. If the tube is to be worn permanently, careful attention should be paid to its proper fit and adjustment, and its daily removal and thorough cleansing should never be overlooked. It should be ascertained that the instrument fits properly, being held with sufficient firmness in the opening, and making a safe and moder- ate pressure on the soft tissues around. When the instrument has been worn for a (variable) time, the opening of the trachea has a tendency to contract, and becomes smaller by reason of the development of the granulation of the edges of the wound. In this case it may become necessary to enlarge the opening, by the excision of the granulations, sufficiently to allow of the ready re- introduction of the tube. When it becomes desirable to close the wound, the removal of the tube, and the application of an ordi- nary dressing, protecting it only by a pad of antiseptic oakum, kept in place by a few turns of bandage around the neck, is all that is necessary. Usually, after two or three weeks the cicatrix is complete. The operation of tracheotomy may be accompanied or followed by various accidents : ee] TRACHEOTOMY. 487 Hemorrhage is rare, the small amount of bleeding which occurs proceeding from the division of some of the arterioles, branches of the carotid, passing between the cartilages over the surface of the inter-cartilaginous ligament. It ceases spontane- ously, and never requires any special attention. : Emphysema of the neck may take place when the cellular tis- sueis very loose and the edges of the skin overlap the tracheal in- cision. It generally subsides without interference, or by moder- ate, regulated pressure. Tracheocele.—Renault so denominates certain growths which appear on the tracheal mucous membrane, as the result of the ir- ritation produced by the friction of the branches of the tube which come in contact with it. He claims to have noticed their appear- ance six weeks after the removal of the instrument. The nature of the tumor varies much. They may be purulent, but they are more commonly fibrous and of slow growth; and may sometimes take the character of ossification of the cartilages. If these ob- structions appear above the seat of the operation, the trouble is easily remedied by the reintroduction of the tube, but if, how- ever, they are found below that point, it is a more serious com- plication, since it requires a second operation at a point below that of the first. The obstruction of the trachea by plastic exudation above and below the seat of the operation, or its contraction, caused by the overlapping of the divided ends of the rings which may have been incised, may also be met with, and can only, as in the former case, be overcome by a second operation. We personally remember a case in which the formation of a post-tracheal abscess, which had produced extensive contraction in the calibre of the trachea, proved fatal through the impossibility of the introduction of a tube after a second operation. The patient had been treated sey- eral weeks previously for an attack of strangles, which had re- quired an operation, and some six weeks after his recovery was brought back suffering with a severe attack of roaring. As he entered our hospital he fell to the ground, and the second opera- tion was rapidly performed by a longitudinal incision, but the tubes we had at hand were all too large, and in a few moments the animal died. At the post-mortem a large abscess was found behind the trachea, just opposite the seat of the first operation, and the pus in collecting had so compressed and deformed the 488 OPERATIONS ON THE RESPIRATORY APPARATUS. trachea that the index finger could scarcely be inserted into the passage. THORACENTESIS. The usual intention of this operation is the removal from the thoracic cavity of suppurative matter (empyema) or blood or se- rous fluid, by puncturing the walls of the chest. It is indicated in hydrothorax and in some traumatisms of the chest, and when- ever there is a large collection of bloody or other fluid in the thorax; in all cases, in fact, where the ordinary forms of treatment have failed to relieve the patient thus affected. Although extensively performed in human surgery, where the advantages and facilities of operating are so many and so manifest, it has naturally proved less beneficial to veterinary patients. And still, though probably in the majority of the cases in which it has been employed the relief which has followed it has been of only a temporary charac- ter, and served only to prolong briefly the life of the animal sub- jected to it, some few cases are on record in which it has given very excellent results. The researches of St. Cyr have, moreover, demonstrated that the operation is perfectly harmless, contrary to the opinion formerly held, and that a large proportion of its fail- ures to effect recovery are due to the fact that its application had been too long postponed to justify a reasonable expectation of success ; when, in fact, it had been deferred until the accumula- tion of fluid had already become too abundant, and the pleural membranes had already assumed the condition of a tendency to pyogeny. On this point, Peuch and Toussaint remark that if the punc- ture is made when only the lower third of the cavity is full, and if after the evacuation of the liquid a diluted solution of tincture of iodine is injected into the pleural sac, as is done in human surgery, perhaps more satisfactory results might be realized. Our own view, however, is that the disposition of the pleura and of the cavities, which they form, would scarcely justify the in- jection. ; The instruments required are a straight or convex bistoury, and a small trocar, straight or slightly curved. Reul has invented a paracento-injector trocar (Fig. 434), which is used for both the puncture and the subsequent injection of the medical compounds. The use of the aspirator (Dieulafoy) is also recommended. THORACENTESIS. 489 Ey According to St. Cyr, the proper place for the puncture is between the seventh and eighth sternal ribs, a little above the spur vein, this point permitting the removal of a larger quantity of fluid than any other, with the advantage also of offering a wider | space between the ribs, and a dimin- fic ished thickness in the muscular sub- ; stance. Unless there are special rea- sons to the contrary, the puncture is made on the right side; if operating on the left is indicated, care must be taken to avoid injuring the heart. For this reason the puncture is made between the eighth and ninth ribs, with the point of the in- strument turned backward. The puncture is made with the patient on his feet, and he rarely needs any apparatus of restraint, though it will always be judicious to apply a twitch on his lip. St. Cyr describes the operation as follows: “The operator makes an incision with the bistoury, about one inch long, near the anterior border of the eighth rib or of the ninth, if he is on the left side, dividing the skin and superficial muscular layers until he reaches the internal intercostal muscle, which he leaves intact. In piercing the cavity, he holds the trocar with the right hand, guarding against its entering the chest too deeply by keep- ing his fingers sufficiently near the point to gauge and control its depth through the remaining undivided muscle. What remains then is to withdraw the rod from the trocar, and keep the latter in place while the fluid escapes. Any albumino-fibroid clots, which may enter the canula and obstruct the flow of the liquid, may be dislodged by introducing a blunt stylet into the tube. When the canula is withdrawn after the escape of a sufficient amount of fluid, the wound is closed with a single pin suture. The trocar of Mr. Reul is inserted (Figure 434) in the usual manner, with the nut E closed, and after removing the desired Fig. 434.—Trocar paracento-injecteur de Reul. 490 OPERATIONS ON THE RESPIRATORY APPARATUS. quantity of fluid, the nut F is closed and E is opened. In the funnel D, the diluted tincture of iodine is poured and carried into the chest as slowly as the operator thinks proper, where it mixes with the remaining portion of the fluid. When the injection re- turns in the instrument to a level with the little piece of glass C, the nut Eis closed, and the instrument removed, thus guarding entirely against the introduction of air into the chest. In respect to the quantity of fluid that can be safely removed at once, there are varying opinions. Some practitioners hold that the cavity ought to be entirely emptied, or, at least, so far as the location of the puncture allows, while others favor the method of discharging the contents by installments. According to St. Cyr, who has experimented very extensively in this matter, the removal of a small quantity is followed by a negative result, the fluid forming again in a very short time; while, on the other hand, if the entire accumulation is taken away at one time, amounting, perhaps, to forty or fifty quarts, it must be at the hazard of encountering, as supervening disorders, syncope, rupture of the pulmonary vesicles, congestions, or splenic or hep- atic hemorrhages, with an ultimate fatal termination. The question thus remains unsolved, and if recoveries have been recorded by Lafosse, Jr., Strauss, Massot, Bar and others, failures have followed the operation in the hands of Gohier, Pilger, Bassi, Dieterichs, Prudhomme, St. Cyr, ete. Pellé and Sewell have obtained recoveries when removing all the fluid at once. Our own experience has been negative in the cases in which we have observed both conditions—that of partial, and, as well, that of the entire removal of the fluid. Supplementing the operation with medicinal injections of some sort has been recommended. Hertwig has used astringent solutions ; Leblanc, Bouley and Prudhomme have favored the use of tincture of iodine, and the following prescriptions, used in human surgery, are recommended by Peuch and Toussaint : Weak Solution—B—Tinct. of iodine, 10 parts; iodide of potass., 1 part; distilled water, 100 parts. This is first used, but, if it fails, the following is injected : Strong Solution—&—Tinct. of iodine, 30 parts; iodide of potass., 4 parts; distilled water, 100 parts. The general treatment recommended for those forms of dis- eases in which these liquid accumulations originate, must be per- oe THORACENTESIS. 491 severed in after the thoracentesis, including the counter-irrita- tions, diuretics, tonics, stimulants, alteratives, ete. The operation is performed on the dog also in the same man- ner as on the horse, but either with smaller trocars, or, what is better, with some one of the aspirators recently invented. With this animal the results are more satisfactory on account of the simplicity and unilateral development of the pleuritic effusion. CHAPTER X. OPERATIONS ON THE CIRCULATORY SYSTEM | BLEEDING—VENESECTION. The term bleeding, or venesection, signifies the opening of certain veins for the escape of a portion of the blood, for a ther- apeutical, or experimental purpose. If it is designed to reduce the volume of the circulation, it is known as general, and is per- formed upon some one of the larger blood vessels; if practiced to remove blood only from a given region, it becomes Jocal, and in that case the smaller vessels are divided. A better division is that which is based on the nature of the vessel which is opened, and thus it is phlebotomy, if a vein is opened; arteriotomy, if an artery; and capillary, or arterio-phlebotomy, when the opera- tion is practiced upon the capillary system. There has been much discussion upon the question of the utility of blood-letting, and strong advocates and earnest oppo- nents, who have argued its benefits and denied its usefulness, and, in fact, ascribed evil results to its practice, whether the depletion affects the general circulation or a limited region. But upon this we shall not enter. Those who maintain its practice consider it to be indicated when it is desirable to reduce the activity of the circulation, or, on the contrary, to stimulate it in parts where, from different causes, it has been temporarily suspended, and to stimulate absorption, or to relieve the organism of foreign ele- ments. It is, however, contra-indicated in all eruptive fevers, in anzemic patients, and in those suffering with typhoid diseases. The old fashion of “ taking blood” as a prophylactic measure, or at a certain season of the year, is simply the result of an ignor- ant delusion. The quantity of blood that can be removed must vary, of course, with the size, the nature and the condition of the animal. PHLEBOTOMY. 493 Gourdon recommends the following scale as representing the aver- age bleeding, proper, for the animals named : The horse, between 4 and 5 pounds; large ruminants, 5 to 6 pounds; pig, 1 to 14 pounds; sheep, 6 to 9 ounces; dog, 3 to 6 ounces. PHLEBOTOMY. Phlebotomy, or the opening of veins, is the mode universally adopted for general bleeding, and is generally performed upon superficial veins. The instruments necessary are fleams, lancets, scissors, bleed- ing-sticks, pins, pin-holders, graduated jars or vases, and a piece of silk, and, for small animals, bandages. The fleam, made in various forms, resembles a small lancet, and is secured on a steel support received into a metallic, horn or gutta-percha handle. Ordinarily, two or three lancets of different Fig. 485.—Ordinary Fleam, with three blades. sizes have one common handle, upon which they are so mounted as to be used singly with facility. Some of them, of German make, or of English invention, or of a Belgian pattern, act with a spring, like the phlebotome of Brogniez. The bleeding-stick is simply a stick of hard and heavy wood, a foot or more in length, with which to drive the fleam into the vein. 494 OPERATIONS ON THE CIRCULATORY SYSTEM. Fia. 437. FIa. 436. FIGs. 486, 487, 438.—German and English Spring Fleams. Fic. 440,—Bleeding Stick. PHLEBOTOMY. 495 The graduated vase is to receive the blood, and at the same time measure its flow. In ordinary practice a pail is substituted. The pins must be long and strong. The pin-holder is used to assist in the introduction of the pin when the suture is made and the bleeding terminated. Sponges and cold water should be accessible. Mopus OPpERANDI. Position of the Animal.—The standing position is the one generally preserved. The animal is held well in hand by an as- sistant, and if he appears to be excited and unwilling to stand quietly, and soothing treatment has no effect, a twitch is placed f on his nose, or a cap on his head. The operation consists of three steps: 1st. Preparation of the Blood Vessel: This consists in applying sufficient pres- sure upon it to temporarily interrupt the circulation and cause it to become \ yy times with a ligature, when the loca- \R tion of the vessel permits it. In some / | Vy) blooded and thin-skinned animals, a oe \Yy little brisk exercise is sufficient to stim- BASIN << \\ hi. ; y ulate the circulation and render the A: \ \\\ S NX s 5 C \ WN veins prominent. \\ \ . 2d. Opening of the Vessel.—This is done with the fleam, the lancet or the bistoury. The fleam is more com- UD, monly used for large animals. Held as j in figure 441, it is brought opposite the dh vessel, parallel to its course, and per- fectly perpendicular to it, and at such a distance from the skin as to approx- imate very nearly, but without forming an actual contact with it. When in this position the fleam is made to pen- etrate the vessel by a smart blow with el ae ee the bleeding-stick on the back of the Menin: blade; some practitioners, instead of = 496 OPERATIONS ON THE CIRCULATORY SYSTEM. striking with the stick, apply the blow with their hands, but with cattle, the stick is indispensable. The moment the blow has been applied properly, the stream of blood escapes freely; when the blow has been too light, and the skin only divided, with but a scanty or no escape of the blood, it is called a white bleed- ing ; and slabbery when the opening is not large enough for the escape of a full stream, or when the openings of the vein and of the skin are not in apposition, which will be the case if the fleam, instead of being held perfectly perpendicular to the skin, has been held obliquely. The opening of the blood vessel with the spring fleam is performed in the same manner, except that the lancet receives its impulse from the spring instead of the stick. The puncture with the lancet or bistoury should be made with a single stroke of the instrument. In large and superficial veins, the spring lancet is as easily and safely managed as the fleam. 3d. Closing the Blood Vessels and Stopping the Flow.— When a sufficient quantity of blood has been drawn, and the pres- sure upon the vein, which has been continued during the flow, is gradually relaxed, the stream ceases, more or less completely. To terminate it entirely, a simple stitch of pin suture is applied. It is to be preferred to all other means, such as pressure, bandaging or adhesive plasters. The suture is made by grasping the two edges of the skin with the thumb and index finger of one hand, and slightly raising them, then transfixing them with a long pin through their middle, with either the hand or the pin-holder, in- cluding a fair amount of skin, and completing it by a special knot, made with silk or a loop of the long hair of the mane or tail of the animal. In applying this suture, the skin must not be pulled away from the body too far, nor the knot tied excessively ; tight. To keep the wound clean and prevent Fig. 442.—Suture after the animal from rubbing off the dressings is all ana ae that is necessary, for a few hours, after the operation. The wound heals by first intention, and the suture and the pin can be safely removed after twenty-four hours. PHLEBOTOMY IN SOLIPEDS.. Four of the principal superficial veins are selected for this operation in solipeds; the jugular, the cephalic, the subcutaneous thoracic and the internal saphena. PHLEBOTOMY. 497 PHLEBOTOMY AT THE JUGULAR. This vein is usually selected on account of its size, its situation, and the facility with which it can be opened, and the wound of the skin closed. It is, however, contra-indicated when the vessel is in any degree diseased, or when the animal is sufferimg with itching skin diseases. Formed by the superficial temporal trunk and the internal maxillary vein, the jugular descends through the parotid gland to- ward its inferior extremity, receiving several collateral veins, and reaches the groove of the lower part of the neck, which from its presence is called the jugular groove, until it reaches the lower extremity of the neck, when it enters the chest. In its course in the groove it accompanies more or less closely the carotid artery; a Fia. 443.—Anatomy of the Jugular Vein and (@sophagus in the Horse. JJ, jugular vein; C, carotid artery; O H, omo-hyoideus muscle; D, cesophagus; 8, sterno-maxillaris muscle; M, mastoido-humeralis muscle. 498 OPERATIONS ON THE CIRCULATORY SYSTEM. but in the middle third of its length becomes separated from it by the fiat ribbon-like structure of the sub-scapulo or omo-hyoideus, whose fibres pass obliquely between the two blood vessels, from below upward. It is, therefore, in the middle third of the neck that the bleeding at the jugular must be made, in order to avoid wounding the carotid artery. Besides the general rules already stated, this special bleeding requires peculiar measures. (a) Position of the Animal.He must be kept well in hand, with the head somewhat elevated, and must be prevented from seeing the various movements of the operator, by covering his head with the cap or mask, or by having the eye, on the side of the operator, covered with the hand of an assistant. (6) The fleam is generally employed, the size of the blade vary- ing according to the thickness of the skin and the condition of the blood vessels. The left jugular is generally selected, unless contra- indicated for some special reasons. (c) Preparation of the Vein.—The application of artificial pressure for the dilatation of the vein is not only unnecessary in solipeds, but has in some cases proved dangerous. In this step of the operation the hand is to be preferred as safer and more reli- able than any ligature or bandage can possibly be. The compression is made with the fingers of the hand which holds the fleam, applying it in the jugular groove, below the point where the incision is to be made. The projection of the vein may be made more distinct by moistening the hair over the spot to be punctured, with a wet sponge. The improper habit to which some practitioners are addicted, of doing this with their saliva, by spitting upon the neck is to be severely condemned. If the bleed- ing takes place on the left side, the pressure must be made with the left hand, the operator turning his back toward the hind parts of the animal. [If it takes place on the right side, the pressure is made with the fingers of the right hand. (d) Opening of the Vein.—Placed as we have described, at the side of the neck of the patient, his back turned toward his hind parts, and pressing with the fingers of his left hand which holds the fleam, as before stated, the operator grasps the bleeding- stick, and striking upon the fleam, opens the vein, and the blood escapes in a good, full stream. Maintaining the pressure on the vein throughout the flowing of the blood, he lays aside the stick PHLEBOTOMY. 499 and the fleam, and attends to the flow of the blood into the grad- uated jar, or the pail provided to receive it. (e) Keeping the Stream.—As we have said, the pressure upon the blood vessel must be sustained from the beginning to the end of the operation. Relieving it but for a moment is an error, likely to be followed by the introduction of air through the wound into the vein. Not only must it be kept up continuously, but it must be steady. The habit which largely prevails of moving the fingers or the vase up and down along the vein while the pressure is applied, and with the idea of stimulating the flow of the blood, is most dangerous. If the blood does not escape freely, though the operation has been properly performed, an increased circulation may be stimulated by making the animal move his jaws, or shak- ing the bit in his mouth, or placing the bleeding-stick or a finger of the assistant, into the mouth over the bars, and quietly moving them. (7) When the bleeding is to be stopped, the operator applies one of his fingers over the wound of the skin and gradually re- moves the pressure made below it. When this has been done, he proceeds to the application of the suture, always introducing the pin with the head turned upward, irrespective of the side on which the operation has been performed. (g) Subsequent Care.—This is the same as in other cases, but we may add that an animal that has been bled at the jugular is unfit to work for three days, in order to give time for the wound to heal completely. PHLEBOTOMY AT THE CEPHALIC VEIN. The cephalic is one of the terminal branches of the median subcutaneous vein, and runs upward and forward to pass toward the lower extremity of the coraco-radialis, where it crosses the tendinous band which this muscle sends to the anterior extensor of the metacarpus, running in the space which separates the sterno- humeralis muscle from the levator-humeri, and emptying into the jugular, a little in front of the confluent of those two veins. In this course, the most accessible portion is that which rests on the inferior extremity of the levator-humeri. The fibrous band of the coraco-radialis is the guide indicating its position, viz., a little in- side the forearm, on a level with the anterior and oblique fold which separates the arm from the forearm. 500 OPERATIONS ON THE CIRCULATORY SYSTEM. nh i oe aes. = i <7 me 2 = : ~ = = ——a FEET F, rs ete a ne oe: Sete Fia. 444.—Anatomy of the Cephalic Vein. ™, Median subcutaneous vein; 6, basilic vein; c, cephalic vein; d, inferior extremity of the coraco-radialis; t, aponeurotic band extending from the coraco-radialis to the anterior extensor of the metacarpus; 8, ster- no-humeralis; h, mastoido-humeralis; a, space between these two muscles; 7, humeral vein. On account of the presence of the other terminal branches of the main vein, from which the cephalic rises, viz., the’ basilic, pres- sure upon the cephalic does not allow of its dilatation. To obtain this, the animal must be exercised for some time, and when brought to stand still, to raise the opposite leg, or to carry the leg to be bled forward. As the vein is easily displaced from its position, it is hardly PHLEBOTOMY. » 501 safe to attempt to open it with the lancet. The fleam is always preferable. If the bleeding is from the left vein, the instrument is held with the right hand, the operator is placed against the shoulder, fleam haying its blade turned downward, the fingers resting against the chest, and with a blow of the stick the vein is opened. - This bleeding is often accompanied by the formation of a hematoma over the course of the vessel, due to the fact that very often the fleam has opened the vein through and through. This, however, is not a matter of any serious consequence. PHLEBOTOMY ON THE SuBcUTANEOUS THORACIC. This vein runs on the side of the thorax, on a level with the sterno-trochineus muscle, and is readily discovered toward the sixth or seventh rib. To render it more conspicuous, a bandage can be applied around the chest, as suggested by Chabert, or by carrying the leg of the side to be bled forward, and by rubbing hard the tract of the vein, or even by simple pressure with the fingers. The operation can be performed either by a simple puncture with a lancet, or with a fleam, held parallel with the course of the ves- sel, and between two ribs, to avoid breaking the instrument against one of the bones. The bleeding is stopped in the usual way. It is not unfrequently followed by the formation of a thrombus, which generally disappears by pressure, or astringent local appli- cations, and often by spontaneous absorption. PHLEBOTOMY AT THE INTERNAL SAPHENA. The comparatively large size of this vein, and its superficial position, both explain and justify the fact that next to the jugular, it is the one most commonly selected for the operation. For this reason phlebotomy is indicated here, when it is contra-indicated upon the vein of the neck. The saphena is formed by two branches, and in its course crosses slightly the direction of the tibia in running upward on - the surface of the tibial aponeurosis, arriving at the flat of the thigh, formed by the short adductor of the leg, and then dips in the space left between this muscle and the long adductor, where it empties into the femoral. In this course the vein is superficial, covered only by a thin skin, from which it is separated by a thin aponeurotic layer. It is at a point where the vein passes over the 502 ’ OPERATIONS ON THE CIRCULATORY SYSTEM. anterior root; 7, its posterior root; 7, femoral vein; g, deep inguinal lymphatic glands; c, short adductor of the leg; 7, long adductor of the leg; a, subcutaneous aponeurotic layer; 7, fascia lata. flat of the thigh that it must be opened. If the operation is per- formed with the fleam, the higher the better; if with the lancet, it can be done as the vein passes over the tibia, where it is more accessible. In operating, the leg opposite the one to be bled is held up and backward by a strong assistant, in the posture of the black- smith about putting on a shoe. PHLEBOTOMY. 503 If the lancet is used, the operator, placing himself on that side also, bends down, and, looking from under the abdomen of the horse, brings the instrument close to the vein, opening it by a rapid stroke, and enlarging the orifice by a slight incising motion of the instrument. If the fleam is used, the operator assumes the same position, and applies it precisely as has been described in the cases already considered. Operating on the right side he holds the fleam with the right hand and strikes with the bleeding-stick in the left, and vice versa. This position of the operator is awkward, and not without danger, exposing him to the chances of a blow with the stifle of the leg which is held by the assistant. To avoid this, Peuch and Toussaint suggest that the assistant, instead of holding the leg backward, should carry it forward, and that the operator should place himself behind the animal. It is also claimed that in that position the vein is more easily exposed. The operation is per- formed in the same way, except that the instrument is held with the right hand if one operates on the left leg, and with the left hand if the bleeding is done on the right leg. The flow of the blood in this bleeding is generally slabbery, and the introduction of the pin of the suture quite painful, and means of restraint are, therefore, often necessary before the ani- mal will submit to the application of the suture. PxuEBoTOMY ON OTHER SUPERFICIAL VEINS. Others, besides the veins which have been described, are also subject to phlebotomy, but its performance is more with some local object in view than that of a general bleeding. All are performed with the lancet, the region (Fig. 446) where they occur being at the transversal of the face,a; the angular of the eye (b); the facial or glosso-facial, d; the superficial nasal, (c); the posterior auricular (e); the deep lingual, the inferior caudal, and the median subcutaneous of the forearm. Tf required by their size and position a pinned suture is applied after the bleeding, but in several instances pressure alone is sufficient. PHLEBOTOMY IN LARGE RuMINANTS. The operation is confined to two principal veins of the large ruminants. These are the jugular and subcutaneous abdominal. 504 OPERATIONS ON THE CIRCULATORY SYSTEM. Fig. 446. PHLEBOTOMY ON THE JUGULAR. It is performed in the same manner essentially as in the soli- peds, and with the same instruments. But as cattle are less sub- missive to the preparations which precede the operation, means of restraint must be used with them, and they must be tied to a tree or a post. The jugular of cattle has thicker walls than that of solipeds, its diameter is much greater, and it is separated from the carotid in its whole length by a thicker layer of muscle. For these reasons a larger fleam becomes necessary. To dilate the vein a strong ligature is applied tightly on the neck, the pres- sure of the fingers never being sufficient to furnish the necessary force. To open the vein the blow of the stick must be heavier, and when properly given is followed, as in solipeds, by a strong stream of blood, which rapidly ceases when the ligature is loosened or removed. It is not always necessary to apply a pinned suture, but it is always safer and more prudent to do so, though the in- troduction of the pin is rendered difficult by the toughness and thickness of the skin. The value of the pin-holder is demon- strated in this case. The thrombus which so often follows this operation is not serious, and, in fact, its formation is stimulated by some practi- tioners. PHLEBOTOMY AT THE SuBcUTANEOUS ABDOMINAL. This vein is of enormous volume, extending from the udder to the xyphoid cartilage of the sternum, at the side of the abdomen, PHLEBOTOMY. 505 to terminate in the internal thoracic vein. It is, therefore, easily recognized, and particularly so in milch cows, and it is, therefore, unnecessary to use the ligature or any other means to swell its dimensions, the pressure of the fingers being more than sufficient. A fleam of medium dimension is preferable to the lancet in this case. The animal is firmly held by the head, and to prevent his kicking, is pulled forward by its tail passed between its hind legs. In opening the vein the operator places himself forward of the shoulder, his back turned toward the head of the animal, holding the fleam with the hand corresponding to the side of the animal against which he is placed. The bleeding is stopped with a pin, or, what is better, a bandage, to prevent the formation of a thrombus. : Puiepotomy oN SMALL ANIMALS. Bleeding is seldom performed on sheep. When it is indicated it is performed on the facial, the jugular, the cephalic, or the ex- ternal saphena. 'The vessel is opened with the lancet, the wool, a = Fa. 447.—Position of the Facial Vein in Sheep. if necessary, having been clipped off from the place of puncture, and the wound is closed with a pin suture. In swine two sets of veins are eligible for the operation, the posterior auricular, as it runs at the internal face of the ears, and the external saphena, where it passes along the tendo Achilles. The lancet is used upon both. The first stops bleeding without help; the second is closed with the pin suture. In dogs, the jugular is sometimes opened. This vein, from its position, requires the application of a string around the neck to swell the vessel. The puncture is made with a small fleam or a lancet, and the wound closed with a pin. The external saphena 506 OPERATIONS ON THE CIRCULATORY SYSTEM. being quite large is chosen in preference to the internal, which is very small. The place of selection is the superior part of the ven, when it nearly reaches the posterior border of theleg. A bandage is applied to stop the hemorrhage. The cephalic might be opened as ib passes toward the interior third of the humerus, the wound being closed by a stitch of twisted suture. ACCIDENTS OF BLOOD-LETTING. The operation of blood-letting may be followed by several complications, some being of little importance, while others may be sufficiently serious to compromise the life of the patient. Among them may be named: The white and the slabbery bleed- ing; wounds of surrounding non-yascular organs; the thrombus; inflammation of the vein, or phlebitis; wound of the carotid, and the introduction of air into the veins. Others, such as the lesions of nerves, syncope, etc., are seldom, if ever, encountered in yeter- inary practice. lst—WHiITE AND SLABBERY BLEEDING. It is a question whether these, properly speaking, should be classed among the true sequel of blood-letting. We already alluded to them when describing the various methods of perform- ing phlebotomy. They are often the result of the disposition of the parts, the vein being deficient in size, or more deeply situated than natural, and thus imbedded in the loose surrounding cellular tissue; or, perhaps, the cause is an unguarded movement of the animal; and it is often known to be the imperfect manipulation of the surgeon in striking the fieam too lightly, or not vertically, and so failing to bring the openings of the skin and the vein into exact coaptation. These accidents are, however, of an unimportant character, and are easily obviated by exercising more care and deliberation. 2d—Wovnpds of SurRRouNDING NoN-VASCULAR ORGANS. (a) Wounds of the Trachea.—The improper action of the surgeon is generally chargeable with this accident. He may have erred in using too large an instrument, or the error may have con- sisted in making excessive pressure when ligating the neck with the cord used to effect the distension of the jugular. It is a rare ACCIDENTS OF BLOOD-LETTING. 507 accident, but may be easily recognized by the flow of blood which escapes through the nostrils, and possibly by the changes which may affect the respiration by threatenings of strangling, suffoca- tion, etc. In this serious case the ligation of the blood vessel is the only means of stopping the hemorrhage. (0) Wounds of the Caudal Muscles.—This is comparatively a common accident with cattle, but is seldom attended with symp- toms of a serious character. The principal danger consists in the possibility of the formation of fistulous tracts, more or less re- bellious to treatment, as besides the muscles, the tendons, and even the bones may have been injured by the instrument. 3d—TxromsBvs. This is understood to be a bloody tumor, or hematoma, which is formed around the opening of the vein by the accumulation of the blood in the surrounding cellular tissue. It appears when the opening of the vein does not accurately correspond with that of the skin, or when the incision of the tegument is too small to allow a free flow of the blood through it. It often appears when the animal is allowed to rub himself after the operation, or when the opening of the vein has involved a section of one of the valves. Some veins, as the saphena, the cubital, and the subcutaneous thoracic, are more exposed to thrombus than others, even when the operation has been well performed and completed. At these veins, they are generally not serious, and are readily subdued by simple treatment, if they do not spontaneously disappear. But the thrombus, which is sometimes encountered at the jug- ular, is of a more serious character, and is not unfrequently com- plicated with phlebitis. The symptoms of this lesion are essentially local, and the symptoms and the disease are, in effect, one, consisting of a tumor of uncertain dimensions, according to the quantity of blood col- lected under the skin. In the beginning it is round, well cireum- scribed, soft, and slightly elastic to the touch, but the swelling soon becomes hard, perhaps oedematous, or somewhat diffused, when it has been caused by rubbing on the part of the animal. The simplest cases gradually disappear after two or three days. But at other times they are not so tractable, and serious trouble may ensue, the tumor becoming stationary, or perhaps increas- ing in size, and then changing its character. It becomes warm 508 OPERATIONS ON THE CIRCULATORY SYSTEM. and painful, assumes aspects of a phlegmonous nature, and per- haps becomes complicated with hemorrhages. It is not yet too late to look for resolution, but if it does not soon take place, and if the symptoms increase, and the swelling extends, the vein is changed into a hard, large cord, and a case of phlebitis is estab- lished. Absorption and resolution are now the two most favorable ter- minations of thrombus, but they are of unusual occurrence, except when the tumor is of small size, and promptly attended to. Suppuration is the more common event, and if this continues to be superficial, recovery may be looked for without obliteration of the vein. Philebitis, which commonly accompanies a deep suppurative thrombus, is always a serious termination. Abscess of the throm- bus, however, may assume various modifications, and may pass to a chronic condition, or that of induration, or one of still more serious nature, that of gangrene. When it has become developed, the animal must be immedi- ately secured to prevent him from rubbing the parts, and as early as possible the treatment should be directed to the limitation of its development and the promotion of its absorption. Local ap- plications of cold water; astringent compresses, moistened with vinegar or lead solutions; poultices of clay, of soot, or of chalk, mixed with vinegar, will very often be sufficient to control or re- move the growth. Sometimes, however, the absorption will be more effectually stimulated by frictions with cantharidis oint- ment, and in a week or ten days the thrombus will have entirely disappeared. The Girard ointment, of Venice turpentine and bichloride of mercury, is sometimes also very effective. If the tumor assumes the nature of an abcess, and this re- mains superficial, it may be opened with the bistoury, or the actual cautery, and should hemorrhages occur they must be principally controlled by pressure. 4th—PuteEBIirTIs. The first effect of the inflammation of veins is the coagulation of the blood and the formation of a clot in a given length of the vascular canal, adherent more or less to the walls of the vessel, the result being the partial or perhaps complete obliteration of the vein, and hence a certain disarrangement of the circulation, which ACCIDENTS OF BLOOD-LETTING. 509 may be supplemented by the anastomotic action of collateral ves- sels above and below the occluded portion. Or, again, the circula- tion may be entirely obstructed, and, as a consequence of the in- flammatory changes, adhesions foliow, between the clot and the venous wall, the clot being resorbed, and the obliterated vein transformed into a fibrous cord. So long as the inflammation is limited to the internal wall of the vessel, phlebitis is known as adhesive; but if it extends to the external or even to the middle structure, and becomes suppurative, itisso distinguished. Hither of these forms of the disease may be changed by a third modifica- tion to that of hemorrhagic phlebitis. These three forms or diver- sities of the disease have been established by Peuch and Tous- saint, whose views touching the treatment of the affection we also reproduce, referring our readers for the pathological history of the lesion to the various works relating to it. Ist. Adhesive Philebitis.—At the beginning of the disease, the animal must be placed under such conditions ‘as will tend most favorably to influence the process of organization between the clot and the venous walls, and to prevent the establishment of suppuration. To effect this object, the enforcement of a state of immobility in the patient is most essential. His head must be firmly secured on both sides, and his mastication made as easy as possible, by suitably regulating the consistency of his diet, in order to diminish the force of the circulation, and so far obviate the danger of the displacement of the clot and possible resulting hemorrhage. The diseased parts should be treated by local ap- plications, among which lotions of lead water, with continued cold water irrigations, will give excellent results. But ointments of any kind should be avoided, especially in warm weather, from their liability to become rancid and irritant, and to stimulate the patient to rub himself. The use of cooling applications must be perse- vered in, in preference to the frictions with vesicatories, which, especially in nervous animals with tender skin, might be liable to encourage the suppurative process. In tougher-skinned animals, and those of a lymphatic temperament, in which the inflammation has a tendency to become chronic, resolvents, blistering, liquid liniments, and alteratives are indicated, and of these, and first in order, must be named cauterization with the red iron. The conical cautery is applied on closed, fine points, and arranged quintuply, every second point being deep, while the others are 510 OPERATIONS ON THE CIRCULATORY SYSTEM. only superficial. By this peculiar mode of firing the absorption becomes greatly stimulated, and the resorption of the tumor very rapid. Cauterization, however, if beneficial in chronic, is not so in acute cases, having in the latter a tendency to be followed by sup- puration, 2d. Suppurative Phlebitis.—For this form of this serious af- fection several modes of treatment are proposed. (a) Hxpectant Treatment.—This is the plan by which the phy- sician or surgeon, administering palliatives only, trusts to the vis conservatriz for cure, watching meanwhile the development of the disease, and waiting for and expecting the guidance of nature in respect to his own interference. (6) Simple Incision.—This is the simplest of surgical inter- ferences, and means nothing more than the opening of the abscess, the enlargement of the fistulous tract, and the formation of an exit for the pus and coagulated blood which it contains. This is done with an ordinary bistoury, guided by a probe or grooved director. (ce) Injections.—The fistulous tract which exists on the phle- bitic tumor is washed with a detersive injection of solutions of tincture of iodine, or perchloride of iron; or of corrosive subli- mate, from 550 to isso. These are intended not only to remove any remaining clots softened by the suppuration, but also to stimulate the granulations and the cicatrization. (d) Enlargement of the Fistula and Introduction of a Seton. —AnS§ probe is introduced into the fistula, and when it has reached the upper part of the swelling formed by the vein, close to the obturating clot (which must not be disturbed), an incision is made over its blunt end to enable it to pass out through the skin. The fistulous tract is then enlarged with the straight bis- toury from below upward to a small extent, and between the two openings a small seton is passed by means of the probe, and se- cured in place by knotting the ends. The movement of the seton by drawing it to and fro, effects the removal of such portions of the clot as may remain in the wound. (e) Enlargement of the Intra Venous Fistula in its Whole Length.—This consists in opening the tract from its commence- ment to its superior cul de sac, as far as the adhesion between the clot and the vein extends, the incision sometimes reaching below the opening made by the fleam. Thus exposed, the tract ACCIDENTS OF BLOOD-LETTING. 511 is washed out with the tincture of iodine or perchloride of iron solution, or even destroyed with the actual cautery. The last two forms of treatment, however, are dangerous, from their liability to occasion consecutive hemorrhages. 3d Hemorrhagic Phlebitis—The most serious incident of phlebitis, proceeding, as it does, from both the adhesive and the suppurative forms, is the more or less abundant hemorrhage, which, resulting from any of the various causes which have been mentioned, may interfere with the cicatrization or obliteration of the venous wound. Three modes of treatment are practiced for their suppression. These are the twisted and the quilled suture, and the ligation of the vein. (a) The Twisted Suture.—This consists in the combination of several (two or three) long pin sutures, placed upon the wound made by the fleam, and including a larger portion of the skin at the sides than the single pin suture of an ordinary bleeding. Sometimes wooden pins are substituted for those formed of me- tallic material, and when the sutures are completed, the wound is strengthened by a coating of some strong, adhesive mixture. Some practitioners, however, prefer to this the application of a severe blistering friction, which, by the pressure of the swelling which it produces upon the internal circumjacent parts, secures practically all the effects to be obtained by a compressive bandage. (b) Quilled Sutures.—These are applied on each side of the wound, securing a good hold by placing them at some distance from the edges, and embracing tightly between them a thick por- tion of the skin. This point is important, for the reason that this portion of skin is destined to be sacrificed by being left to slough off, and this must not take place until the obliteration of the wound is entirely completed. (c) Ligature of the Vein.—The success of this operation, to be assured, requires the selection of a healthy portion of the vein on which to place the ligature, even if it become necessary to look for it among the original roots of the jugular, viz., the facial and the glosso-facial. In performing it, the animal must be secured in the recumbent position. A single incision is made through the skin, the whole extent of the obliterated vein, parallel to its axis, and the vessel exposed and separated from the surrounding tissues. The separation, which requires skillful and cautious manipulations, can be effected by means of either a director or along probe. It 512 OPERATIONS ON THE CIRCULATORY SYSTEM. will be no more than a wise precaution to apply a second ligature below the clot, to prevent the possibility of the escape of suppura- tive matter into the general circulation. The material of the ligature may be either ordinary linen cord or silk. Our own pref- erence is for sterilized catgut. The resulting wound is treated in the manner proper for all similar wounds, and in from twenty to twenty-five days complete recovery may generally be looked for. 4th. Wownd of the Carotid.—This complication of phlebotomy at the jugular is not of common occurrence, but is easily possible. It may become one of the consequences of using a fleam unneces- sarily large, and out of proportion with the dimensions of the vein and the thickness of this skin; or it may be caused by the exhibi- tion of needless violence, in striking too heavy a blow with the bleeding-stick. Nor are these the only causes to which wounds of the carotid may be referred. An abnormal anatomical disposition of the artery, either permanent or temporary, may cause it to re- ceive the wound designed for its neighbor the jugular. The symptoms pertaining to this accident are very character- istic. The color and volume of the blood, and the rapidity of the per saltum flow of the stream are sufficient evidences of the arterial and non-yenous source of the hemorrhage. Concurrently with this, a swelling takes place around the edges of the wound, increasing with greater or less rapidity, and nearly resembling the ordinary thrombus of venous extravasation, though differing from it by the rapidity of its formation. This false aneurism is now subcutaneous, and has a tendency to extend itself downward toward the lower part of the neck, and has, indeed, been found extending as far as the entrance to the chest. This accident is generally one of a serious nature, not alone in itself, but often because of the specific manipulations which it necessitates in order to overcome it. There are, however, several fatal cases on record. The indications of treatment may be either quite simple, or, at times, of serious import. If the puncture of the artery is but a small one, and the flow not abundant, one or two strong pin sutures may be sufficient to control it, especially if associated with it steady and firm pressure is established directly upon the course of the vessel, either by compressive bandages, or, what is better, with the fingers firmly pressing in the jugular groove. If, however, the wound is large, and accompanied by a ACCIDENTS OF BLOOD-LETTING. 513 correspondingly profuse hemorrhage, it becomes necessary to have recourse to the direct applications of a ligature. A description of this operation will be made the subject of our chapter on hemostasia. 5th. Introduction of Air into the Veins.—This is one of the most remarkable of the accidents attending the operation of phle- botomy. The phenomenon has been observed as early as the seven- teenth century, but it was not until 1806 that it was observed and recorded as belonging to the category of casualties connected with the familiar act of blood-letting in an animal. The first author to put the occurrence on record in this connection was Verrier, who reported a case in 1806, and he was soon followed by others with accounts of their experience with the same lesion and operation in human practice. There are two principal causes to which this accident can be attributed. One of these may be an unnecessarily large aperture in the vein, but more commonly it follows improper manipulations on the part of the surgeon, particularly the irregular pressure made upon the vein during the flow, by many practitioners, who have formed the habit of rubbing the vessel along its length, under the erroneous idea that by this movement they accelerate the bleeding. Again, and perhaps principally, the casualty may be the result of neglecting to close the wound of the skin with the finger below the point from which the current proceeds, before the pressure upon the vessel is stopped. The occurrence is made known by a peculiar gurgling sound, which is made more evident by auscultation of the heart. In the meantime, the animal is attacked by shiverings; the respiration becomes accelerated ; there is a rapid heaving of the flanks; the body becomes covered with perspiration ; the action of the heart is quickened; the countenance becomes anxious; the animal is seized with convulsions; falls down and dies, unless by the con- tinuance of the flow through the open vein the air may be carried out throngh the same channel by which it entered, or unless the quantity has been very minute. As the result of our own study, tested by many experiments, we have become strongly inclined to believe that the quantity of air necessary to produce death must be very large, more, in fact, than a careful operator would allow to enter without attempting to prevent it. The possibility of the occurrence of this accident may easily 514 OPERATIONS ON THE CIRCULATORY SYSTEM. be obviated, seeing that it merely requires careful attention to the execution of the few details which constitute the act of vene- section. But when it has taken place, the simplest and most ob- vious thing to do is, if possible, to remove the air from the vessel in which it has intruded. The means of effecting this consists in reopening the closed vein, and permitting the blood to resume its flow. The loss of three or four pounds of blood additional is usually sufficient to insure the escape of all the air. Gourdon recommends, in addition, showering with cold water, stimulating frictions, and even, if the case seems to require it, artificial respiration. ARTERIOTOMY. Bleeding from an artery is so termed to distinguish it from phlebotomy. It is not commonly used in practice, being princi- pally resorted to as a means of local depletion, and is performed only on some of the most superficial of the vessels. In fact, there are but three of these eligible by their position to the operation. These are the transveral of the face, the posterior auricular, and the middle caudal. The modus operandi differs but little from that of phlebot- omy, except that there is usually no need of the application of ar- tificial means to sweil their bulk or increase their rotundity, their position, and their distinct and characteristic pulsation, so readily detected, sufficiently revealing their location and course. In open- ing arteries the fleam is seldom used, the lancet or a pointed bis- toury being a much more eligible instrument. The incision of the vessel is made across its course instead of longitudinally, as in phlebotomy, and the flow of blood must be arrested by means of pressure with compresses or bandages. (a) Bleeding at the Transversal of the Facé.—Though the position of this artery is nearly correspondent in all animals, it is principally with solipeds that it is chosen for blood-letting. It is situated below the temporo-maxillary articulation, and crossing the direction of the fibres of the masseter muscle, where it is coy- ered only by a fine skin, it is opened at the same level with the place where phlebotomy is usually performed. Some operators prefer casting the animal, others the standing position. The appearance of the vessel is that of a small, round pulsa- ting cord, and, as before stated, it is incised, not as the veins and ARTERIOTOMY. 515 opened, but in the direction of its axis. The stream differs from that which flows from a vein, and instead of issuing with a regu- lar flow, escapes per saltwm, or by alternating leaps, synchronous with the action of the heart. It also differs from that of the veins in color, being of a lighter and brighter red. As the application of a pin suture will scarcely be sufficient to perfectly suppress the flow, pressure must be resorted to, either by direct application over the posterior border of the maxillary bone, or over the place where the artery passes, or by covering the incision with a pad of oakum, retained by means of a circular bandage passing by sev- eral turns over the upper part of the head. The animal should be tied up for several days after the penis, or until the closing of the artery is fully assured. (6) Bleeding at the Posterior Auricular.—Though the trans- versal of the face can be opened in large ruminants, as well as in horses, arteriotomy in those animals is more commonly performed upon the posterior auricular, where it is attended by all the con- . ditions of size and position required to serve the convenience of the surgeon. In cattle, upon which it has been practiced for both its general and local effects, it has been recommended in diseases of the brain, and for affections of the eyes and other parts of the head. The posterior auricular runs under the parotid gland from the base of the concha upward on its external face, near its supe- l 6 Le \ / LM Fia. 448. eae of the Posterior Auricular Artery in Cattle, 516 OPERATIONS ON THE CIRCULATORY SYSTEM. rior border, where it loses itself. It is most superficial toward the base of the cartilage as it issues from under the posterior cer- vico-auricular muscle. The operation is comparatively simple. The animal being firmly held or tied to a post or a tree, hard friction is applied to the ear to stimulate the circulation and render the artery more promi- nent. The concha is held by the left hand, with the index finger in front and the thumb behind the artery, the incision is made by piercing the vessel with the lancet held perpendicularly to the concha, the artery being cut directly across, and the incision en- larged by a downward movement of the instrument. This is fol- lowed by the appearance of a few drops of arterial blood, but which soon stops unless the flow is assisted, which is done by the operator, without releasing the ear, by striking light blows or taps with a small stick along the course of the artery between the in- cision and the animal’s head. This last step is indispensable to obtain a good, free flow, per saltwm, of course. This whipping process is continued until the stream becomes abundant, but may be suspended when it reaches that point, to be renewed again, however, if the hemorrhage diminishes. Artificial means to close the incision are not usually required, the flow generally ceasing spontaneously, but when that fails to occur a pin suture ora bandage at the base of the concha, or finally the ligation of the artery, if necessary, will effect the object. The animal must be kept confined for some time, to prevent him from rubbing the wound or shaking his head too violently. In swine, this artery is so easily reached that it is often se- lected in preference to other blood vessels which may be more or less imbedded in the fat of the animal. The knowledge of its position is very important, as it is very small and difficult to find. Running vertically between the temporo-maxillary joint, it reaches the base of the concha, and passes by the side of its convex sur- face towards its point. It must be opened at the lower third of the cartilage, where it presents its largest dimensions. The artery must be cut transversely with the lancet. The bleeding ceases spontaneously, or, if necessary, may be treated in the manner in- dicated for cattle. (Fig. 449.) (c) Bleeding at the Median Caudal.—tn cattle this artery is quite large and very superficial. It runs along the inferior face of the tail, being covered at the base of that organ by the inferior CAPILLARY BLEEDING. 517 Fig. 449.—Anatomy of the Posterior Auricular Artery in Swine. caudal muscles, then becoming superficial and readily accessible to the end of the member. In opening it, it is pierced by the lancet in the longitudinal axis of the vessel, the tail being kept elevated. Ordinarily, however, not only is the artery cut directly across, but the skin or surrounding muscular fibres are included. The incision must be made on a level with the superior third of the tail; higher up the operation may be complicated with abscess, disease of the vertebree, sloughing of the tail, ete. If it becomes necessary to stimulate the flow of blood the same “whipping” process may be employed that was recommended in bleeding from the posterior auricular. A bandage may be applied round the tail to stop the hemorrhage, though it is not commonly needed. A few practitioners prefer to operate with the fleam. CAPILLARY BLEEDING. The consideration of the operation which consists in the de- pletion of the minute extreme vessels naturally and logically fol- lows that which treats of a kindred procedure with the veins and arteries. The intention of the treatment instituted for allis the same, and their curative effects are adapted to similar ailments. These are principally local, and may be divided into two classes, to wit: those which have been in a great measure discarded from general practice, and those which still retain their place in the domain of veterinary surgery. The former includes bleeding at the palate, the coronet, and the foot, and the latter comprehends 518 OPERATIONS ON THE CIRCULATORY SYSTEM. the punctures, the scarifications, the ventouses, or cupping, and the leeching, of regular current practice. (a) Punctures ey Scarifications.—These are methods of producing small superficial wounds through the skin and the sub- cutaneous cellular tissue, to obtain the effect of a local bleeding, or the escape of any other fluid contained in the subcutaneous substance. They are indicated against local swellings and serious effusions, or cedema of the’ cellular tissue. They can be applied upon any part of the body, and though they take effect in the escape of but small quantities of fluid, their action may be stimu- lated by additional local applications, such as warm poultices, warm water fomentations, or dry, stimulating frictions. Punctures, however, are principally effective when employed to overcome cedematous swellings of the extremities, and of the genital organs, while scarifications are prescribed with better ad- vantage to obtain the resolution of cold or chronic swellings, or to control the inflammatory process in cases in which the tissues. are largely swollen and threatened with gangrene. Both the bistoury and the lancet, and, in rare instances, the fleam, are used in fulfilling these indications. In making punctures the skin and cellular tissue are pricked or pierced to the depth required, with the bistoury or lancet, by rapid thrusts distributed over the entire surface of the swelling, and when the fleam is used it is manipulated precisely as when used in bleeding, though, of course, with quick repetitions. (6) Scarifications may be defined as rather small incisions, made with a convex bistoury, with which the skin is cut from without inward, in parallel series, but which, in some instances, when an increased effect is desired, are doubled by a second series crossing the first at an angle. (c) Cupping.—This mode of obtaining capillary bleeding is very seldom employed in veterinary practice. The cups are, how- ever, indicated in subcutaneous inflammations, accompanied with swellings, and resulting from blows, contusions, kicks, and other and similar traumatic causes, and are often preferable to blisters. They are recommended in arthritis, ostitis, and even in internal phlegmasia. They render valuable aid in emptying some forms of abscesses, and are credited with the possession of power to arrest or prevent the absorption of virus introduced into wounds or deposited on their surface. CAPILLARY BLEEDING. 519 There are two modes of cupping, the dry and the scarified, or wet. The dry cup consists in the simple application of the in- strument upon the skin to produce a swelling, accompanied with more or less injection of the capillary vessels, and a local irrita- tion, which generally rapidly subsides. The operation of scarified cupping consists, first, in applying the instrument to produce the swelling, and when the tumefac- tion is sufficient following it with the scarificator. In completing the first step, which is the same as for the dry cuppings, several means are used. The skin being prepared by clipping or shaving off the hair, a small glass globe, filled with heated air, is placed over the spot selected for the operation. A small ball of wadding or oakum, either dry or moistened with an inflammable liquid, is placed in the glass and lighted, and as it begins to burn the glass is pressed upon the skin. To avoid burning the skin, pwmping, or vacuum-cups, have been devised, some of which are provided with scarificating blades. These are, however, too complicated for our general practice. When the effect of the cupping is com- pleted, the red and tumefied skin, which is exposed as the glass is removed, is scarified with instruments ad hoc, as the lancet or the bistoury, and the cup is immediately reapplied over the same spot. The blood then escapes freely from the incisions, and con- tinues to flow until the cup is filled and removed. (d) Leeches are not as frequently used in veterinary surgery as they might be with profit. They are well adapted to small animals, such as dogs, whose fine and vascular skin yields readily to their application. For applying them the skin is first smeared with a little milk, sugar, or blood, and the leech, placed in a small glass, or cup, or clean pill-box, is brought in contact with the skin by reversing the cup or box upon the chosen place. Usually it attaches itself at once, and remains until it becomes gorged with blood, when it voluntarily releases its hold. Sometimes, however, it is better to place them upon a thick compress, moistened with tepid water, and to apply this over the skin. In applying them on the leg it is a good plan to cover them with a cloth, secured with a string tied about the leg above and below, forming a sort of bag. When the animal fails to drop off, after being thoroughly gorged, a sprinkle of salt speedily causes him to release his hold. The succeeding hemorrhage will ordinarily cease after a short 520 OPERATIONS ON THE CIRCULATORY SYSTEM. time without aid, but if it is desirable to continue it, the parts may be fomented with warm water, or covered with a warm poultice. (e) Bleeding at the Palate-—Bleeding in this region of the mouth is done by a division of the capillary network which rests between the mucous membrane and the fibrous coat which lines the bones forming the palate. The bones represented by the inferior face of the palatine pro- cess of the great maxillary bone, and the posterior face of the short process of the anterior maxillary, are covered with a fibrous coat, which extends over their whole surface and the cartilage that fills up the incisive slit. On each side of the palate run the palato-labial arteries, which, forward, form an arch, and anastomose together, and give rise to a single branch, which enters the in- cisive canal formed by the internal face of the two small maxillaries. The veins, which are very numerous, form a large network which fills the space left between these two large arteries. The whole is covered by the mucous membrane, which is white, rosy, thick, adherent to the fibrous coat, and showing a number of rugee, about twenty, curved forward and diminishing posteriorly in size and prominence. Anteriorly they are Fig. 450.—Circulation very large, by reason of the presence of a ee Sa sane certain amount of cellular tissue, which di- s, grooves of thepalate; minishes by degrees, from before backward. @ Palato-labial artery. ‘The anastomosis of the arteries takes place about on a level with the third ruge of the palatine surface, and it is, therefore, posterior to this that the bleeding must be per- formed to avoid wounding the artery. The instrument requiredis the simple bistoury, or the one rep- resented in figure 451. The operator, facing the animal, and hold- ing the tongue with the left hand, draws it out of the mouth on the right side, and with the edge of the knife turned backward, makes a small incision from before backward, in the middle of the palate between the fourth and fifth rugee. There is no danger of wounding the arteries if the incision is made at the proper place and on the median line. When that is the case, the hemorrhage, continuing for a variable length of time, subsides by degrees. CAPILLARY BLEEDING. 521 Fia. 451.—Lancet to Bleed at the Palate. If, on the contrary, an artery has been divided and the flow of blood becomes sufficiently abundant and continuous to become alarming, it becomes necessary to employ hemostatic means. These may be a small sponge compressed or moistened with cold water or an astringent solution ; or, if necessary, a pad of oakum can be applied and secured with a bandage passed through the mouth and around the maxillary bone, and tied on the face. It can also be accomplished by means of a peculiar bit, represented in Fig. 452. This bit has a small board in its middle, and on each side of the bar two straps, one to act as the check-piece of a bridle, i | the other being passed over the @=— nose where they are buckled to- gether more or less tightly. The S board of the bar is padded, and jye. 459 apparatus to Apply Pressure is applied directly over the place to Stop the Bleeding at the Palate. of the incision. The pressure should be continued for several hours. This operation was first recommended in cases of stomatitis, in the peculiar form known by the unmeaning name of dampas, but is resorted to for a much better purpose in apoplectic conges- tion of the head. (f) Bleeding at the Coronet.—In the “Dictionary of Veterin- ary Medicine and Surgery,” Bouley says: “There exists on each side of the coronet, a rich superficial venous plexus resting on the cartilaginous plates of the foot, formed at this point by the union of numerous veins of the digital region. These veins are united by large communicating vessels, running on the anterior and posterior faces of the second phalanx. Nothing is easier than to open one of these vessels by plunging the point of a bistoury through the skin; the puncture being followed by an abundant flow of blood, and, if it is repeated, a large bleeding, quite as abundant as that obtained by the opening of another large vein, 522 OPERATIONS ON THE CIRCULATORY SYSTEM. can be gained. But it is not a matter of indifference whether the puncture is made in front or behind, or upon the sides of the re- gion. It must never be made on the sides, because of the danger ~ of injuring the cartilage, several cases of cartilaginous quittor having been known which were attributable to no other cause than bleeding on the side of the coronet. In front the operation is less dangerous, although a wound of the tendon of the anterior exten- sion of the phalanges is possible. It is safer to bleed on the pos- terior part of the coronet, where no danger can be looked for. This bleeding has been principally recommended as a local operation in cases of acute laminitis. (g) Bleeding on the Foot.—The toe is the part selected when bleeding is performed on the foot. It is an operation which has been known for many years, and under various forms, and with different applications has been described by Virgilius, Columelle, Absyrtus and Vegetius. It consists in the incision and removal of a portion of the sole of the foot. It is indicated in all cases where local bleeding is justified, and has, therefore, been recom- mended in all congestions and inflammations of the foot, such as bruises, burned soles and acute laminitis, though in this last case its execution is rendered difficult by the unwillingness of the ani- mal to support its weight on one leg during the operation. There are several ways of bleeding at the toe. Ist. The Chabert Method.—A special shoe must first be pre- pared; it may be simply an ordinary shoe notched on its inner border, which, without being removed, permits both the opera- tion of bleeding and the subsequent application of a dressing. In operating, the sole is pared out and a groove made between the point of the frog and the toe of the wall, with a drawing-knife, until the soft tis- sues are reached. An incision is then made with the curved bistoury at the bottom of the groove, between the wall and the inferior border of the 08 yy, 453 gnoe for pedis, and an incision made dividing all the ves- the Bleeding at the sels that come in contact with the instrument. Cy eee When the flow of blood has been sufficient, the hemorrhage is suppressed by a compressing dressing of oakum kept in place by bandages, or with plates, according to the condi- tion of the foot, and whether it had been shod with the notched shoe, or had remained entirely shoeless. SURGICAL HEMOSTASIA. ae 2d. The Valet Method.—After the preparation of the foot, as with the other method, a groove is made. It is posterior and parallel to the line which marks the separation of the wall and the sole, and the incision is made transversely, wlth a bistoury or a sage-knife. It is usually followed by a good flow of blood. An ordinary shoe is then placed on the foot, and a compressing dress- ing of oakum put on and kept in place by plates. 3d. Crepin’s Method.—The difference between this and the other processes consists in making the incision with a narrow draw- ing-knife, which provides a larger opening for the escape of the blood. A wide-webbed shoe, with a padding of oakum over the wound, suffices to control the hemorrhage. All of these methods have the same object in view, but many veterinarians prefer to make the incision a little back of the line separating the sole from the wall, and right at the toe, and they sometimes remove a small portion of the sole with the sage-knife or the bistoury. The dressing which is required in these cases must be care- fully applied, as protruding granulations may sometimes make their appearance, and interfere with the cicatrizing process. If the hemorrhage which accompanies the operation should be con- sidered insufficient, it can be stimulated by placing the animal in a foot-bath of blood-warm water. SURGICAL HEMOSTASIA. The extraneous hemorrhage, whether it be avoidable or un- avoidable, which may occur during an operation, forms one of the most embarrassing of the interferences to which the sur- geon is liable, not only from the difficulties it interposes in the way of the success of the operation, by disturbing his manipula- tions, but as well, sometimes, by the effect of the loss of blood upon the patient. It may happen, indeed, that instead of ceasing spontaneously, or yielding to the effects of the ordinary dressings, the hemorrhage becomes so obstinately persistent as in itself to constitute a serious, and, if unsubdued, a fatal accident. It be- comes necessary therefore for the operator, as one of the practical elementary incidents of his calling, to be always prepared in an emergent case to arrest the rebellious circulation by prompt and efficient measures. Hemorrhage being an essential danger in all 524 OPERATIONS ON THE CIRCULATORY SYSTEM. operations of considerable magnitude, the means of subduing it should always, especially in cases of that class, be included among the customary instruments and appliances of the working surgeon. The flow may proceed from any of the blood vessels, the arteries, however, from the nature of their functions and the force of their action, requiring more frequently and more particularly the appli- cation of precautionary and remedial measures. TEMPORARY OR PREVENTIVE HEMOSTASIA. This becomes necessary as an occasional expedient, when the presence of the blood is likely to become an obstacle to the opera- tion, and the preventive means may be applied either before or during its performance. Included under this general head is the circular compression, or ligation en masse, when the situation and the form of the region render it practicable. The effect of this being the flattening or collapse of the vessels, and the temporary closure of their calibre, one of the necessary conditions of its suc- cessful application, especially with the superficial vessels, is that they should be situated near enough to some structure sufficiently hard and solid to furnish an unyielding point appwi to the com- pressing agent. If, from the position of the artery, no such point of resistance can be made available among the surrounding parts, resistance can be established by a double pressure made in op- posite directions, in such a manner that the compressing powers can furnish mutual support, each to the other. By this plan com- pression can be effected in four different ways. Ist. By Digital Pressure—When this can be applied and proves sufficient, it is the simplest and the best mode. While it serves to obstruct the circulation, its action is limited to the ves- sel which alone needs it, andthe tissues are not contused by the pressure; it can, moreover, be suspended or renewed at will, and can be managed by an assistant who may be placed in a position in which interference with the operator can be entirely obviated, and, indeed, can sometimes be performed by the surgeon himself. It is obtained by pressing the vessel with the tips of the fingers placed either vertically upon the vessel itself, or along its course ; and only such a moderate degree of force need be employed as will prove sufficient to close the calibre of the vessel, without fatiguing the hand by unnecessary pressure. i. SURGICAL HEMOSTASIA. 525 2d. Compression with the Circular Ligature.—EHither a band- age or a circular string of sufficient strength may be employed in this method. If needed upon the leg, it should be placed upon the lower part of the limb, either dry and moderately tight, or moistened with cold water. If kept in place for a certain length of time previous to an operation, the effect will be to so reduce the force of the circulation in that part as to render the perform- ance comparatively a bloodless one. This proceeding is often associated in veterinary practice with the operation of neurotomy. In operations upon the foot, comparatively perfect hemostasia may be obtained by circumscribing the coronet with a ligature Fi4g. 454.—The Adstrictor of Brogniez. formed of a strong circular string, tightly drawn, but as a substi- tute for this, a special instrument has been invented by Brogniez, which he calls the adstrictor, which secures the same results. 3d. Compression by the Tourniquet.—The adstrictor of Brog- niez is but a peculiar form of tourniquet, which is composed of two oval cushions or pads supported by metallic plates, and se- cured on the inner face of a circular band adjustable as to its Fig. 455.—Tourniquet. length, and secured by a common buckle. This band is buckled around the leg, and the pressure is made by the pads, which are laid directly over the course of the vessel. Ath. Compression by Esmarck’s Method.—Another mode of compression, borrowed from human surgery, that of Professor Es- marck, is designed to wholly prevent the loss of blood, and enable the surgeon to perform a perfectly dry or bloodless operation. It 526 OPERATIONS ON THE CIRCULATORY SYSTEM. consists of a roller of India rubber, to be so applied around the seat of the operation as to cause the blood to recede toward the center of the body, its return being prevented by firmly placing a ligature just above the point of incision. The pressure pro- duced by this band can be regulated by means of a tourniquet, or a piece of elastic tubing, or an ordinary string that may be twisted with a stick. This mode of compression is adapted to cases of amputation of the limbs and of the tail, or the removal of tumors. PERMANENT, OR DerintrE HeEmostasia. The arrest of hemorrhage may become necessary at any step of an operation, but it is ordinarily when it has been completed that the indication must be fulfilled. It is true that in many in- stances, even after extensive lesions, the hemorrhage will cease spontaneously, but it is equally true that at other times special interference becomes a necessity. If the hemorrhage is capillary, the surgeon may safely overlook it, and leave it to subside under the influence of the retractility of the tissues; but if it is of ve- nous origin, it cannot be safely left to spontaneous action. Still, usually it is only when one of the larger veins is the seat of the bleeding that danger becomes imminent, as with those situated near the center of the circulatory system; but serious accidents are seldom to be feared. If the vein is cut across, moderate pres- sure upon the orifice will generally sure the formation of a clot which will constitute a sufficient plug, or if the vein is opened longitudinally by a lateral incision, pressure at the point of the wound, though not strong enough wholly to stop the circulation within the vessel, may still be sufficient to assure the rapid obliter- ation of the wound. But when large veins or arteries are opened, or even when the capillary hemorrhage is usually abundant, more complicated means of hemostasia must be resorted to, and not only applied carefully and securely, but also with cclerity. The means of obtaining permanent hemostasia are of two kinds—one taking effect through the physico-chemical action of special agents, the other including those which are known as surgical means proper. | P q ‘ ‘i ; ‘ q 1 ; . Se ee eee | Puystco-CuemicaL Hemosratics. Among these must be considered the refrigerants, absorbents, astringents or styptics, and potential and actual cauterization. the Fay ' ™ . SURGICAL HEMOSTASIA. 527 Ist. Refrigerants. — The agents included in this class act almost exclusively by depriving the parts upon which they are applied of their heat, and in producing a certain excitation upon the vaso-motor nerves, followed by a toxic contraction of the mus- cular fibres of the vessels, and the diminution, or sometimes the complete arrest, of the bloody flow. Their action is principally efficacious on vessels of small calibre, such as the capillaries. Cold water, snow, cracked ice, and the very volatile liquids, as ether, chloroform, and freezing mixtures, fill an important place in this category. In veterinary surgery, cold water, being the sim- plest, the most accessible and abundant, and the easiest to apply, heads the list. Itis used in the form of douches, baths, lotions and injections, or by means of compresses, pads, or cushions of oakum laid upon the seat of hemorrhage. The saline mixtures, and the snow or cracked ice, are placed in cloths, bags or blad- ders, but their action must be watched in order to obviate the possibility of congelation and mortification of the tissues, quite a possible result of excessive refrigeration. Refrigerants are generally considered as forming the least ef- fective of hemostatics, but their facility of application has brought them into common use. They are principally indicated against external capillary bleeding, or that which escapes from a small vessel, but would generally prove insufficient against a hemor- rhage from a large vessel. They may, however, prove advanta- geous against some internal hemorrhages, which, though they may be controllable by other direct means, yet can be reached by the water without difficulty or danger, and act directly or by con- tinuity in producing the necessary contraction. In this manner, injections into the nasal cavities, or the uterus, or rectum are often efficacious in arresting a hemorrhagic flow suddenly occur- ring. But in any case, refrigerants should be applied with care, and their effect watched. If they are allowed to remain too long in place, or the temperature be too low, they may induce an in- flammatory reaction and local gangrene, or produce other dan- gerous general effects upon the internal economy. On the other hand, if imperfectly applied, and without a sufficient degree of cold, their action, already weak, will become a mere useless nega- tion, if not worse. Between these two extremes there is a middle course, which the competent surgeon will be able to observe by exercising his discretion, and an appeal to his own experience. 528 OPERATIONS ON THE CIRCULATORY SYSTEM. 2d. Absorbents. —Hemostatic absorbents proper are agents which by their capillary action suck up or soak in the sanguineous element from traumatic surfaces, and haying their structure thickened and condensed by the presence of this contained liquid, coagulated in their mass, oppose thereby an invincible obstacle to the escape of the blood. Oakum, charpie, punk, spider-webs, flour, fuller’s earth, sponge, and various vegetable powders be-— long to this catalogue of medicaments. Oakum, which is the substance which meets with general favor and is most commonly _ used, is applied in the form of balls, dry, or soaked in cold water, and packed over or into the depth of a wound, and kept in place with bandages or compresses. Compressed sponge has proved, in our hands, an excellent hemostat, not only in capillary bleeding, but in that also of me- dium-sized vessels. There is, however, an objection to its use in the fact of its liability to become adherent to the tissues with which it is in contact, and the consequent danger of renewing the hemorrhage when removing it. 3d. Astringents, or Styptics.—These agents produce the co- agulation of the blood, by a chemical action, resulting from the combination of the astringent’s substance with the living tissues. Their action differs essentially from that of the refrigerants in the fact that they possess the special property of producing, by their power of fibrillar astriction, the occlusion of the vessels through the coagulation of the blood in their interior. Astringents are used in both the solid and the liquid form. Burnt alum in powder, and certain vegetable powders, belong to the first class. The solution of sulphate of iron, sulphate of copper, alum, acetate of lead, alcoholized water, solution of tannic acid, ete., are included in the second. They must be judiciously used, however, because of their liability sometimes to excite local inflammations, more or less active. The action of the liquid as- tringents is deeper, more energetic, more lasting, and more dur- able than that of the solid, and they are for that reason sometimes more reliable for the control of hemorrhages from large vessels. Their consistency renders them, of course, alone available for moistening compresses, balls, the tampon, or pads of any descrip- tion. The most powerful of this class is the perchloride of iron, which is remarkable for its power of coagulating the blood almost instantaneously. When applied with oakum upon a bleeding sur- SURGICAL HEMOSTASIA. 529 face it forms, with the blood, a blackish magma, and a resisting, strongly-adherent clot in the cavity of the vessel. 4th. Potential Caustics.—The chemical astringents have gen- erally the same mode of action. Upon being placed in contact with the tissues they enter into combination with their elements . and form a coagulum, and it is the presence of this clot which produces the hemostatic effect. They are but little used, how- ever, in veterinary practice. The nitrate of silver, some of the mineral acids, as sulphuric, nitric, or arsenious, or bichloride of mercury, are the potential caustics which are occasionally used, though it should always be with great caution, in view of the possible danger of producing an excessive effect. 5th. Actual Cauterization.—Cauterization with the hot iron is the oldest and principal hemostatic in use in the surgical treat- ment of the domestic animals, and in many instances may be made to supersede all the chemical agents we have considered, more especially in cases of capillary hemorrhage. It is applied with the iron heated to a white heat, and laid upon the bleeding sur- face, where it immediately creates a thick, impermeable eschar, adherent to the wound, and offering an insurmountable barrier to the escape of the blood. To obtain all the effect desired the wound must be thoroughly free from all extraneous substances, liquid or solid, that nothing may interfere with the rapid formation of the eschar. The blood should be well soaked out, a plug of oakum firmly pressed upon the wound, and the iron pressed perpendicularly upon the tissues; this rapidly forms the eschar. The application of the cautery must be continued for a few seconds only, on account of its lia- bility, while cooling off, to adhere to the tissues and to the eschar, with the consequent risk of reopening the wound and renewing the hemorrhage upon attempting its removal. It is better if the eschar is not sufficiently thick, after a first application, to renew it a second, or even a third time, always taking the same precau- tions, and being careful to avoid contact with sound tissues. In this operation it is essential that the temperature of the cautery should be at its maximum. Half-heated, or cooled off by the blood, not only is the application more painful, but the effects are incomplete and the hemorrhage is likely to return. If the blood escapes too freely, or coagulates too slowly, the eschar not forming, it may sometimes become necessary to carbonize the 530 OPERATIONS ON THE CIRCULATORY SYSTEM. bleeding surface by means of some combustible substance which will furnish more solid materials for the protective scar. A loop of hair, or some pulverized rosin, placed upon the wound, and burnt with the cautery, often fulfills the requirements. For hem- orrhage from parts below the surface, the edges of the wound must be separated before the cautery is introduced, to prevent its cooling before reaching the proper point of application. "When the eschar is well formed and established it should be left without interference to complete the process of sloughing. The thermo-cautery, with which the required heat can be re- tained at a uniform degree, is one of the best instruments for the application of this mode of hemostasia, there being no need of removing it until an eschar of sufficient thickness has been ob- tained. SurGcicaL Hemostatics. Among the numerous surgical means of obtaining both per- manent and definitive hemostasis, there are three which principally merit our attention: compression, ligature and torsion. (A) Compression.—We have already referred to this method while considering the subject of temporary hemostasia. There are cases in which it acts as an excellent mode of permanently controlling hemorrhage, whether proceeding from arterial, venous or capillary sources, and equally whether from a large surface or from a deep cavity, where the origin of the hemorrhage cannot be distinctly located. Still, for arterial hemorrhages it is only effica- cious for vessels of small or medium size, or when the wounds are of small dimensions. There are secondary circumstances which determine the designations of certain variations of pressure. One is the situation of the vessel, relatively to that of the bleeding orifice, when the pressure, to be effective, must therefore be direct or lateral, and with the latter, either mediate or immediate. Some- times, again, it is applied at a distance from the bleeding point, and in an indirect manner, and involves an alternative between plugging and direct compression, Tt is applied to the wound itself when the vessel has been cut directly across. It is usually effected by covering or filling the wound with a dressing of balls of oakum applied directly upon the bleeding orifice, and covering these with pads, increasing in dimensions as they become more superficial. The whole apparatus is submitted to pressure SURGICAL HEMOSTASIA. 531 by approximating the edges of the wound, as much as possible, by means of interrupted, pin, or a quill suture; or sometimes a circular bandage of dry or compressed sponge, cut into small pieces, may be used in the same manner as the oakum with ex- cellent effect, especially when the hemorrhage is abundant, or ligation become impracticable. The objection to the mode of compression, generally speaking, is its liability to become loosened in consequence of the softened and yielding condition of the surrounding tissues. Yor this rea- son the mode of applying the force directly is not often practiced, or, at least, is adopted only when the hemorrhages are small and controllable by slight pressure, or in case of the section of an in- compressible artery, like that of a bone. In order to increase the effect of direct pressure the surgeon sometimes has recourse to the joint use of some of the physico- chemical hemostatics before mentioned. (a) Immediate Lateral Compression.— This is practiced against hemorrhages due to lateral wounds of blood vessels, and is applied directly upon the opening in the vessel. The method of its application does not differ from that of direct compression, and it is liable to the same objections in its irritating effect upon the surface of the wound and consequent interference with cica- trization, and the danger of a renewal of the bleeding. More- over, if the vessel is without a solid resting-place, and there is no sufficient resisting point, hemorrhage is not arrested. But again, in a contrary condition, it may be followed by gangrene or the obliteration of the vessel, and if the wound is of such a form that this last accident cannot be avoided it is better to have immediate recourse to the ligature. It remains, then, that this mode of hem- ostasia is only advisable when the wound is small and the artery small and superficial, or in such a position that it cannot be ligated. Immediate lateral compression, however, can be made with great benefit with the finger upon the wound, pressing with the necessary force to prevent the escape of the blood, without clos- ing the calibre of the vessel. The finger is kept in position for one or two hours, with an occasional inspection to discover whether the hemorrhage has ceased, and when it is removed there remains but a simple wound, easy to dress. This mode of compression has the advantage of obviating the accidents that may occur from excessive external pressure main- 532 OPERATIONS ON THE CIRCULATORY SYSTEM. tained by ligatures and dressings, such as the division of the skin and the possibility of gangrene. The value of this measure of digital compression may be estimated by the fact of its successful application to a vessel of the dimensions of the carotid artery in a case of a wound by pricking. (6) Mediate Lateral Compression.—The compression here is applied outside of the solution of continuity, in such a manner as to leave a certain thickness of the tissues between the injured yes- sel and the compressing apparatus. It may take effect either directly upon the wound itself, or elsewhere along the course of the vessel. It can be effectively made only upon superficial ves- sels, principally arteries which, like those of the extremities, lie upon or near enough to resisting surfaces to furnish a means of support to the pressure. The manner in which temporary and permanent hemostasia can be obtained is the same, excepting that the cords, bandages and tourniquet are replaced by graded com- presses, supported by rollers or appropriate bandages, which are continued only during the existing necessity. The objection to this hemostatic method, and which it shares with all the other processes of compression, is, that when a large vessel is to be compressed, and a certain amount of force becomes necessary, Other tissues, with other vessels, veins and nerves alike, must participate in the same pressure, and, as a consequence, dis- turbances of varying degrees of severity will occur in parts situ- ated beyond the compressed surface, proportioned to the duration of their exposure to the acting cause. Hence the indication, in applying the apparatus, to begin at the peripheric portion of the region, to carry it toward the center, in passing over the wound already protected and covered by the balls, pads or compresses, which constitute the true means of compression. The principal objections to this process of hemostasia can be obyiated by leaving on the apparatus only for the minimum time necessary to obtain the cicatrization of the wound of the vessel, which will, of course, vary. according to circumstances, and will be especially influenced by the consideration whether the calibre of the vessel is to be preserved or obliterated. If the vessel be a small one, the wound of small dimensions, and the continuity of the channel is to be preserved, a few hours will be sufficient ; or, if otherwise, it is to be obliterated, one or two days will be required, or even at times one or two weeks. SURGICAL HEMOSTASIA. 533 (ce) Plugging.—This mode of compression is chosen as a per- ‘manent hemostatic to arrest hemorrhages which occur upon the surface of natural cavities, or upon wounds where the injured vessel cannot be reached. This is done with balls, or pledgets of oakum or sponge, carried with a forceps to the bottom of the cavities, or with sachets, arranged in the manner of the tampon, impregnated with an astringent solution or a cold mixture, the whole being kept in place by the dressing which closes the cavity. It is used in cases of epistaxis and hemorrhages from the uterus, or those following castration. But with all its advantages it is an uncertain mode, and opposes but a slight obstacle to the hemor- rhage ; besides which it irritates, by the pressure of the plugging material on the parts with which it is in contact, where it acts in the manner of a foreign body, which in fact it is, giving rise to some pain, and perhaps stimulating muscular contractions, and thus exciting the hemorrhage anew. However, these objections are not of sufficient weight to contra-indicate its employment as a ready and efficacious means of hemostasia, or to prevent it from being wisely appreciated and largely employed by the surgeon. (B)—Lieature.—The ligature is the typical and obvious means of hemostasia—the hemostat par excellence—perfect in its sim- plicity, though consisting simply in tying a circular thread or cord around the wounded vessel with sufficient tension to close its channel, suppress the circulation, and convert the tube into a cord. It can be applied either on the cut extremity of an artery, or upon its continuity. It is seldom applied upon veins, however, from its liability to induce phlebitis, but still, it is resorted to in wounds of large veins, or when the hemorrhage cannot be con- trolled by other means. As with compression, ligature may be immediate or mediate, and may also be divided into temporary and permanent—tem- porary, when its continuance depends upon some contingency— permanent, when it is to remain until it is eliminated by suppura- tion, or becomes organized and absorbed, as when the ligating thread is composed of some special animal fibre—which is the kind most commonly used. The instruments required for this operation are: tenaculum, aneurism needle, ligature materials, ordinary dissecting or bull- dog forceps, scalpel or bistoury, and the grooved director. 584 OPERATIONS ON THE CIRCULATORY SYSTEM, The kind of forceps used are known as artery forceps, and are of numerous varieties. Fic. 457.—Cooper Needles, or Tenaculum. The tenaculum, or aneurism needle, is a kind of blunt tenacu- lum with an eye at its end, and is used to seize or secure the vessels. The suture materials are linen thread, silk, animal ligatures, such as catgut or tendinous fibrilla, and sometimes very fine me- tallic wire. Ordinary linen thread and silk, well waxed, are most commonly used in veterinary practice. (a) Immediate Ligature.—This is the surest of hemostatic means. It is applied principally upon large arteries surrounded only by their cellular sheaths, and a difference is made in applying = A SURGICAL HEMOSTASIA. 535 it between vessels which are perfectly intact and those which haye been partially cut through or otherwise injured. The immediate ligating of an artery entirely divided includes but two steps: the prehension of the artery and the adjustment of the ligature. When drawn out of its position with the proper forceps the artery must be carefully examined for possible adhesions, and especially any nervous threads which may be attached to its sur- face—all of which must be dissected. In placing the ligature many operators carry the thread, form- ing a loop, with the forceps, and on seizing the artery and seeing that it is clear from the surrounding tissues, they slip the loop down over the instrument upon the vessel, to be tied by an assist- ant. The apparent simplicity of this movement is deceptive ; too often the loop of the ligature adheres to the wound, the ends roll over themselves and one another, the ligature cannot be properly -placed over the vessel, and the knot is tied over the forceps before the thread has reached the artery. To avoid this it is better, when the vessel has been well secured and isolated, to have the assistant apply the ligature by its middle upon the jaws of the forceps, be- hind the hand of the surgeon holding them, in order to be free in his movements. Then making first a simple knot, without twist- ing the thread, and tying it close to the forceps, he then, with the Fia. 458.—Applying the Ligature. thumbs, pushes the thread further along the artery, and ties it by pressing the thumbs together with sufficient firmness to rupture the internal membrane of the vessel. If the wound be deep, in- stead of the thumbs both indexes are used to carry the thread along the artery and tie it. The forceps is then removed and 536 OPERATIONS ON THE CIRCULATORY SYSTEM. of ip p} p ¥ Hl es J oA S77 Fa. 460.—Improperly-made Knot. a second straight knot is made (Fig. 459). The knot represented in Fig. 460 is improperly made and liable to become loosened. The extremities of the thread are left of a sufficient length to allow their being turned toward the most dependent part of the wound. If they are cut too short they are liable to become loose in the tissues, and be covered or concealed by the granulations and become the center of a suppurative gathering. Ligatures intended to remain in the tissues, must be made of animal material. The wound of an artery always involves the application of a ligature on both extremities of the course, the central and the peripheric. Where the artery cannot easily be raised or dissected from the tissues into which it is retracted, the pointed tenaculum can be used to draw it out of its position; this instrument is more suita- ble for smali than large vessels, the coat of which it is liable to tear. In the zmmediate ligating of an intact artery, and without a solution of continuity, the vessel is exposed by means of an in- cision, either parallel or sometimes oblique, and at others perpen- dicular to the artery, according to its situation and the nature of the subjacent tissues, carefully noting any projections of the bones, muscles, or tendons which can be made available as points de repere; observing, indeed, all the anatomical connections exist- ing between the different structures. When the artery has been nearly reached, in order to avoid injuring it, it should be separated by dissection with the forceps and the bistoury from the tissues covering it, or by introducing a blunt, grooved director under them, as a guide, and dividing them with the knife. The sheath of the vessel is also carefully divided and separated from the ves- sel itself, which is then carefully isolated from its vein or surround- ing adhesion, and the blunt-eyed tenaculum, or the aneurism SURGICAL HEMOSTASIA. 537 needle passed under it. Sometimes this is easily done, but in other cases the density of the connective tissue surrounding the artery is too great to allow the needle to pass readily under it, in which case the obstacle can be removed by scraping it away with the finger-nail, which will obviate the application of extra trac- tion upon the vessel. The ligature can then be adjusted around the vessel by means of the tenaculum, and the operation completed as usual. (6) Mediate Ligature.—This operation comprises including in the ligature of the vessel a certain portion of the surrounding tissue—a portion which should be as small as possible. It is done with a curved needle and a ligature of single or double waxed thread or silk. The needle is introduced into the thickness of the tissues, at a small distance from the artery, and passed around it with the ligature, which should be firmly tied in the usual way. The ligature is quite painful in consequence of the pressure it makes upon the nervous fibres which accompany the artery, and it is less safe than the immediate operation, exposing the vessel dur- ing its performance to the risk of wounds from the needle, and requiring, besides, a stronger traction upon the ligature and the knot, from the increased bulk of tissues involved; and there is, again, great uncertainty as to securing a sufficient division of the internal and middle coats of the artery. For these reasons it is less adapted to large than to small arteries. The effects produced by the application of a ligature are not wholly mechanical. It is also followed by certain peculiar changes in the condition of the vessel, and by specific inflammatory phe- nomena which result in the permanent obliteration of the tubular character of the artery. When an artery is tied with the ligature the internal and mid- dle coats of the vessel are also divided by the compressing thread, and by their retraction above and below it they form a double cone, the apices of which rest on the ligated spot, the external coat resisting and arresting the flow of the blood. A clot is then formed, and the irritation produced by the pressure of the ligature stimulating the proliferation of the cellular elements of the walls of the vessel, adhesions are soon established between them and the coagulated blood, and the termination is the solidification of the former tube. 538 OPERATIONS ON THE CIRCULATORY SYSTEM. The presence of the ligature and its effect on the surroundings of the blood vessel give rise to a process of elimination, by which, after a certain time, the ligating thread is expelled, carrying with it the vascular stump situated beyond the ligature. At the same time, and while these phenomena are taking place outwardly, the clot, adhering more and more to the vascular surfaces, soon be- comes the seat of peculiar absorbent changes, and gradually dimin- ishing in size, at length disappears. As the resorption of the clot takes place the walls of the ves- sel contract until at length the caliber of the artery becomes en- tirely obliterated, and the former tubular canal is transformed into a fibrous cord, extending from the point of the ligature to the nearest collateral vessel. This obliterating process of the arterial canal may, however, be defeated by the interference of too active an inflammation, pro- ducing the premature sloughing of the ligature, or by the exist- ence in too close proximity to the point of ligation of a collateral arterial branch. In both cases hemorrhages may follow; in the first, because the adhesion of the clot is imperfect, and in the second, because no clot has been formed. (C) Torston.—This hemostatic process has been known from an early date, but was not methodically described until about forty or fifty years ago, by Amussat, who recommended it in preference to the method of ligation. But daily experience has demonstrated its inferiority, and proved it to be a less powerful hemostatic meas- ure than that of the ligature, and, moreover, that it is only avail- able for hemorrhages occurring in small vessels. There are several ways of applying torsion. Among the principal is that recognized by Amussat. It requires four forceps, two ordinary azatomical, another whose branches are terminated by smooth cylindrical jaws, and the fourth the artery-twisting forceps. The artery is held with one of the ordinary forceps; with the other the tissues surrounding it are separated from it; then the twisting forceps grasp the artery at its extremity in place of the one first used, keeping it out of the wound, and when thus secured the instrument with the smooth transverse jaws is applied above it, close to the tissues, and firmly pressed upon the coats of the artery. In this position, the twisting forceps is given a rotary motion upon its axis, as if the vessel were to be rolled over its extremities, and is twisted upon itself by seven or eight SURGICAL HEMOSTASIA. 539 Fic. 461.—Artery Forceps for Torsion. turns. The smooth-jaw forceps is then removed, and the stump _of the artery is released and pushed into the tissues, unless the torsion has been sufficiently severe to produce the laceration and retraction of the vessel. As the result of these manipulations the two internal coats of the torn artery retract upon themselves and the external coat is elongated and rolled upon itself—all in such a manner that the clot is arrested by the retracted internal mem- 540 OPERATIONS ON THE CIRCULATORY SYSTEM. branes, as well as by the support contributed by the pseudo-plug- ging, which results from the twisting of the external coat. This process is a complicated one, but it has been modified in several ways. In one process only two ordinary artery forceps are used ; one applied at some distance from the end of the artery, transversely to its axis, and the other holding the vessel by its end in continuity to its length. Keeping the first tight on the vessel, the torsion is made by ten or twelve complete rotations of the second. Another still simpler mode consists in grasping the mouth of the bleeding vessel, and giving it a number of rotations with a strong artery forceps, the artery being thus twisted without tear- ing or entirely dividing it. Nothwithstanding all these modifica- tions, torsion is not applicable to large arteries, and cannot super- sede the ligature. It is slower in performance; it is more painful ; it requires a greater isolation of the vessel ; and the possibility of untwisting, and with it, secondary hemorrhage, is always to be feared. CHAPTER XL OPERAELONS ON THE NERVOUS SYSTEM. PLANTAR NEUROTOMY. Although the word newrotomy, when correctly defined, means, in a general sense, the dissection of nerves, it has in surgery an- other signification, and is applied indifferently to describe the di- vision, the resection or the amputation of a nerve, according to the special manipulations of a given case. In veterinary surgery, it is held to be strictly applicable to the operation which consists in the dissection and removal of a portion of a nerve, and as the present chapter proposes to treat principally of affections of the foot, it is sumply correct to employ the term plantar as a prefix to the title, as we have done. The design of the operation is the destruction of the susceptibility of the region or organ implicated in the treatment, and to subdue the pain, if not permanently, at least for a period of time sufficient to restore a working animal to his ability to labor, which, without such a relieving operation, would have been lost to usefulness and comfort. This curious and important operation has a comparatively recent history. It is of English origin, two British surgeons claiming priority in its performance. These rival contestants are Moorcroft and Sewell, who put it in practice, the former in India, and the latter in England, at about the same time. After its in- troduction, it was frequently performed by English veterinarians, among whose names occur those of Goodwyn, Coleman, Percivall, Spooner and others. Its introduction on the continent was in France, and is credi- ted to Girard, Jr., who described it in 1824, and from that date it continued to be a subject of experiment at the hands of many veterinarians. We say experiment, because it was only after a 542 OPERATIONS ON THE NERVOUS SYSTEM. long series of trials, and as the result of much discussion of its merit and value, that it secured an affirmative verdict from the magnates of veterinary practice, and became an established posi- tion in our science. Yet the objections which it encountered in Europe have not to this day been wholly eradicated, and on this side of the Atlantic there are few practitioners who still decline to give it their confidence and adopt it in their practice. The opposition which it has encountered is founded principally upon the failures, the accidents and the unfortunate sequele, which were not rarely met with during the period immediately following its original introduction. These objections we now proceed to consider. Stumbling has been mentioned as one of the first effects of the loss of the tactile function of the foot, by the destruction of its sensibility. The animal which has lost the solidity and the certainty of his gait, will only after a long time become accus- tomed to the proper use of the comparatively inert mass repre- sented by so indispensable a part of his organization as his foot, so complicated in its arrangements and adaptations, and so per- fect a portion of his anatomical structure before the extirpation of its nervous sense. And yet, while this condition of stumb- ling must be fully appreciated by those whose anatomical knowl- edge enables them to take into full and careful consideration the physiology of the part, and who have verified the objection from their own observation, there are also veterinarians of large practice and long experience who have operated in numerous. cases, even upon animals used for fast work, where the muscular. effort is of a comparatively violent character, who have met with the accident only in very rare and strictly exceptional cases. It must rationally be inferred that an unskilled operation of such a character would leave the patient in a condition of which an awk- ward and stumbling gait would be but a natural and inevitable sign. But it would also be in the course of a natural and healthy reaction for a horse to educate himself rapidly to the situation, and acquire a new certainty of movement and confidence in the use of his feet, which would soon restore him to his former abil- ity to labor. The casting off of the hoof, as a complication or termination of the operation in neurotomized horses, is one necessarily of a fatal character. This fatality has, in some instances, followed the ~ PLANTAR NEUROTOMY. 543 operation within a period of from one to two months, but on the other hand its occurrence has been deferred in other animals for years. Evidently, these varying results must be considered as the effect of different and quite disconnected causes. The truth is, indeed, that in the first instance it is due to a gangrenous dis- organization of the tissues within the foot, and in the second, in- stead of being the result of insufficient vitality, or arising from lack of nutrition of the parts, itis more probably the consequence of the unregulated force of the concussion when the foot strikes the earth—unregulated because of the loss of the discriminating instinct formerly exercised, but now lost with the missing nerve- consciousness which once controlled all the movements of the limb. Tt could scarcely happen that such a condition of things should fail, after years of continuance, to encounter some susceptible temper in which to exhibit its baleful influence. A reason which must not be overlooked in relation to the cast- ing off of the hoof is the fact that in the neurotomized animal the essential symptoms of the first development of any lesions which might give rise to it, are missing. The first of these symp- toms is the pain which is normally manifested by the lameness, and for that reason it is that the care and attention required by the foot of a neurotomized horse are at once so important and so commonly overlooked and omitted. But without ignoring the possibility of this accident, the question is presented, whether it is of such common occurrence that its frequency constitutes a cogent reason for abolishing the operation. Our answer to this, founded on the showing of the record, must be given in the negative. To quote but one among many authorities—Professor Nocard says that out of more than one thousand operations, he has never met with that accident. For ourselves, in a practice of many years, with a number of neurot- omy cases which we can count by the hundreds, we also have never encountered it. In the only case we have seen, other causes existed in the form of suppurative corns, which were overlooked, and which were, moreover, complicated with gangrene of the vel- vety and podophyllous tissues. The Softening of the Perforans Tendon and its subsequent rupture, is also a very severe sequel of neurotomy. This may take place almost immediately after the operation, or it may be postponed until after a few months, when the animal has resumed 544 OPERATIONS ON THE NERVOUS SYSTEM. his work. It has, indeed, been charged to undue haste, in com- pelling the animal to labor without allowing sufficient time for the healing process to be completed, and it is also alleged that it is a consequence of the performance of the operation on both sides of the leg at once. Itis both a possible theory and a plausible argu- ment that the failure of the tendon is the result of the shocks in- flicted upon it while ina condition of disease and unconsciousness, and this may explain the possibility of the accident without any reference to the circumstance of putting the animal to work. But this falls far short of proving that the neurotomy exercised any potent agency in bringing on the softening and rupture. And as to the effect of performing the double simultaneous operation, our opinion will be readily inferred from the fact which we here state, that out of the large number of neurotomy cases which have passed through our hands, we have seen but a single case of softening and rupture of the perforans tendon, and that was associated with a fracture at theos pedis. The horse had been operated on upon both feet, and on both sides at once, for navicular disease of old standing, and on the third day following he was found in his box standing on both fetlocks. He was destroyed and it was found that the tendons of the perforans had given away in both feet, with a fracture of the navicular bone and os pedis on one foot, and of the os pedis alone at the semi-lunar crest on the other. It is our constant habit to operate on both sides, and with this sole excep- tion, we have never met with softening of the tendons. Springhalt.—Beugnot and Renner report cases in which the performance of the operation on the hind feet was followed by the appearance of springhalt. In addition to the points we have been discussing, other alleged objections exist, which may claim superior force and value, but there are none among them of sufficient weight, in view of the many benefits realized from the operation, to justify its repu- diation and abandonment. Among these may be mentioned the theory that the foot de- prived of its sensibility by neurotomy is more exposed to the se- quele of pricks, contused wounds, corns, ete., from the cireum- stance that there is no betrayal or visible manifestation of the lameness which is usually indicative of lesions of that organ. It is further objected that in many instances the lameness shows, sooner or later, a tendency to relapse. But there is little al ae elas) ak a Je Wale tens PLANTAR NEUROTOMY. _ 545 validity in this allegation, from the known fact that in a majority of cases its early recurrence is mainly due to imperfect methods or an unskillful performance of the operation, and cannot, for that reason, be considered a proper incident of the case, but simply an accident, which may be obviated by care and precaution, and in judging the transaction, must be eliminated from the argu- ment. Probably the most important and most nearly valid objection is that the suppression of the nervous influence has more or less effect upon the nutrition of the digital region. Notwithstanding the observations of Braael, the question of the direct influence of the digital nerves upon the nutrition of that region is a pomt which has not yet been thoroughly comprehended by our physiol- ogists. For this region this objection, and the points involved in it, call for further study, and it is nearly certain that when it has received this the end will be the removal of the reproach brought against neurotomy of interfering with the vegetative life of the digital region. Having thus examined the objections which have been urged against neurotomy, a consideration of the advantages claimed for it will come next in order of mention. Leaving out of view the few failures to which the operation, in common with every human act or endeavor, whether in great matters or small, is from the constitution of things, liable, we proceed to the facts which demon- strate the usefulness and value of the treatment, with a deserip- tion of the various modes of procedure practiced by different sur- geons. The facts of the direct and successful results which be- yond question have been secured, are so numerous and so patent, and they so far counter-balance all possible accidents, that no conceivable array of abortive cases, if reported truly and with- out prejudice, can impair their force and significance. It would be impossible to reach even a proximate estimate of the value saved and the loss prevented by the restoration of unnumbered’ useless and suffering animals to comfort and usefulness. And these are what might be called the positive or direct ad- vantages of neurotomy. But besides these, there are other advan- tages in the secondary effects of the operation, of which the im- portance cannot be ignored, especially when they are commended to our attention by such authority as that of Professor Nocard, of Alfort, when he says: “In several cases I have noticed a great 546 OPERATIONS ON THE NERVOUS SYSTEM. diminution in the size of exostoses (ringbones), which we treated by neurotomy;... ” and again, “‘ Neurotomy, by removing the pain existing in the posterior parts of the foot, removes the cause for knuckling, and prevents the retraction of ‘the tendons ;” and further, “ It prevents also the serious accidents, so frequent after firing of the coronet, sloughing of the skin, cartilaginous quittor, necrosis of tendons or ligaments, opening of joints, etc., all being accidents likely to follow the severe cauterization which, to be suc- cessful, is required in the treatment of those exostoses.” Speaking of these advantages, Zundel says: ‘“‘In rare cases, besides the removal of the lameness, the recovery of the disease which gave rise to it, may also be observed. Thus, after neuro- tomy, contracted feet have, after a few months, regained their nor- mal form, and exostoses have stopped their growth and even di- minished in size.” Having thus considered this matter, both pro and con, giving on one side the objections urged against it, with the alleged facts and inferences with which its opponents seek to maintain their ar- gument, and on the other hand, shown the reasons which influence the friends of the operation in advocating and putting it in prac- tice, with their statement of its utility and the important bene- fits it is capable of conferring, we are prepared to examine into the conditions which indicate or counter-indicate this particular method of surgical interference. Bouley, speaking of its indications, said: ‘“‘When the digital region is the seat of a chronic disease, manifested by pain and continued lameness, provided the alterations of structure are not of such a nature as to interfere mechanically with the execution of the function of the region, neurotomy is indicated.” And speaking of lameness, the seat of which is not located, Messrs. Hardy and Hugues go farther, for with them “neurotomy can and ought to be performed when a lameness from an unknown cause, ‘and whose nature is not recognized, has for a period of more than three months resisted ordinary therapeutical and surgical means.” ‘ Taking these as axiomatic rules, laid down by such authorities, and substantiated by the results obtained by their observance, it becomes evident that in all cases of lameness of the nature de- scribed by these writers, or, to repeat, lameness and pain from an unknown cause, neurotomy is the indication, and if it fails to cure PLANTAR NEUROTOMY. 547 the undiscovered disease, it will, at least, relieve the lameness, if not in all, yet still in a large majority of the cases. In contraction of the heels, or in feet subject to chronic corns, as result of their conformation, and in some cases of chronic laminitis, where there is either no alteration of structure, or very little, as well as in keraphylocele, here also neurotomy is bene- ficial. But itis principally in navicular disease that its advan- tages are best illustrated. And next to these, as best adapted to prove and exemplify its benefits, must be classed ringbones and sidebones, the characteristic exostoses of the digital region. Excellent results have followed it when performed for the relief of the lameness which often supervenes upon severe injuries, or operations about the foot, such as fractures of the phalanges, crush- ing of hoof, or any of the sometimes violent acts of surgical inter- ference necessitated by the diseases of that region. The question has even been discussed of the probability of obtaining beneficial results in tetanus, following traumatic lesions of the foot ; especially in punctured wounds. A glance at the counter-indications of neurotomy will furnish a plausible explanation of the objections alleged against it in its earlier history. In the fact that the complications now recognized as thus related to it were then unknown, and consequently un- recognized, and the operation performed notwithstanding, we at once discovered a sufficient reason for the failures and bad results of the treatment, and the consequent odium into which it naturally fell. It was not yet adequately comprehended—it was misapplied—it was, perhaps, unskilfully performed—it failed. A very logical formula; but it ought not to have been denounced. Neurotomy is indicated in navicular disease, and for some in the very incipiency of the attack, all other modes of treatment being only palliative and temporary, and when it has advanced to its chronic stage an operation will be of little advantage, or wholly unsuccessful, if at this period the bone has become extensively diseased, and the tendon reduced to the condition of a mere mem- braneous pellicle. It is also contra-indicated in all forms of acute inflammation of the foot; in badly formed feet, such as the flat or pumiced of chronic laminitis ; and, again, when the lameness origi- nates in a very large exostosis or other bony disease likely to be- come a mechanical obstruction to the movements of the articula- tion, or to the play of tendons, or to produce anchylosis. To 648 OPERATIONS ON THE NERVOUS SYSTEM. resume, it may be said with Bouley, ‘one must not ask from neu- rotomy more than it can grant, by applying it to cases where the lameness must necessarily persist, even after the removal of pain in the diseased parts.” One important practical point in the performance of the opera- tion is the determination of the place where it is to be performed. A reference to the anatomical disposition of these plantar nerves will aid us here. In the forelegs both the external and inter- nal plantar nerves form branches about equal in size, running on each side of the leg, with an identical disposition. Hach of these nervous branches is situated along the tendon of the perforans F1a. 462.—Plantar Nerves in Digital Region. P, plantar nerve; A, original of the digital nerves; BBB, cartilaginous branch; CCC, cutaneous branch; D, digital artery, with the nerve back of it; E E, ramifications of the cartilaginous and cutaneous branch; FF, bulbous branches; G, Transverse branches back of the fetlock joint: V, digital vein. PLANTAR NEUROTOMY. 549 muscles, then, at a point a little above the fetlock, they ramify and divide into three branches, or digital nerves proper; one prin- cipal, posterior or continuation of the main trunk, running toward FG. 463.—Plantar Nerve on the Posterior Face of the Phalanges. P. plantar nerve; A, origin of the plantar nerve above the sesamoids; B, cartilagi- nous branch; C, cutaneous branch; D, digital artery; H, branch to the cartilaginous pbulbs—sometimes absent; I, branch of the plantar cushion; K, transversal coronary branch; M, podophyllous ramification; O, pre-plantar nerve; Q, branch to the patilobe eminence: R, arterial branches; V, vein which is sometimes found running back of the plantar nerve. the middle part of the lateral cartilage of the foot, under which it passes; a second, anterior, smaller than the posterior, which is divided toward the middle of the first phalanx, into several branches, ramifying in the tendon and other parts of the anterior region of the foot; and a third, or middle branch, which goes to the coronary band and podophyllous tissue. The consideration of the relation held by these plantar and digital branches to the blood vessels constitutes an important practical point in the opera- tion. Artery, vein and nerve descend on both sides of the fet- lock, in such a manner that the vein is situated in front, the artery 550 OPERATIONS ON THE NERVOUS SYSTEM. in the middle, and the nerve behind—the vein being on a plane somewhat more superficial than the artery, which is a little deeper. Consequently the operation may be performed at any one of four points, and on either side of the leg. These are, first, above the fetlock, on the plantar nerve proper; second, below the fetlock, on the posterior branch; third, below the fetlock, also on the anterior branch; and fourth, according to. Nocard, above the fetlock, on the anterior branch. The first or second of these locations is more often selected for the operation, and forms either the high or low process. For each of these operations there is a point of selection. In the high process this is immediately above the fetlock, where the nerve is most superficial and most easily exposed, on the outside border, and a little in front of the perforans tendon. In the low method it is below the fetlock, in the middle of that part of the coronet region where a depression is felt between the tendon and the first phalanx. The question of preference between the high and low opera- tions has been made the subject of much discussion, and it re- mains still unsolved. With many the high operation is that which yields the best results; others hold that the object especially con- templated in any given case must determine the point as the oc- casion presents itself. Itis only just to say, however, that the ma- jority of practitioners prefer the high operation ; not only because it is easier to perform, but also because it is more likely to be successful. Personally, we believe that the high operation, with some few exceptional cases, is that which will prove almost generally beneficial. The instruments necessary are, a pair of scissors, a convex bistoury or scalpel (we prefer the latter), a narrow, straight bis- toury, two dissecting forceps, a pair of blunt tenaculums, with an elastic band (Fig. 464), an aneurism tenaculum (Fig. 465), needles, thread and sponges. Those who are familiar with the operation highly commend_a new instrument, the neurotome (Fig. 466), which has been invented to take the place of the straight bistoury. Neurotomy is a simple operation, but a very painful one, and it is necessary, therefore, to have the animal well secured from the commencement of his struggles, which may endanger both himself PLANTAR NEUROTOMY. Bis Fic. 464.—Blunt Fig. 465.—Blunt Tenaculum, with Tenaculum, Elastic Band. Fia. 466.—Right and Left Neurotomes. and the surgeon and his attendants. We fully agree with the admitted rule that animals undergoing surgical operations should be thrown and properly secured. We, with other practitioners, however, have succeeded so well in obtaining complete local an- esthesia by the use of cocaine, that it has enabled us to perform the operation in the standing position. We, nevertheless, can scarcely see the necessity for general anesthesia when, as we be- lieve, the intense pain which occurs the moment of the division of the nerve can be mitigated by careful local anesthesia after the nerve is exposed, should the operator think it necessary. A careful consideration of the various methods recommended for securing an animal, when cast for operation, has induced us to adopt the following as the simplest, the safest and the easiest to apply and control: The animal is thrown upon the side of the leg which is to be operated upon, and, both legs being bound together above the knee with a few twists of a flat rope in the form of a figure 8, the leg to be treated is removed from the hobble and drawn 552 OPERATIONS ON THE NERVOUS SYSTEM. forward with a rope attached to the foot. In this manner the inside of the leg is first treated, after which the animal is turned over and the process repeated on the outside. If the operation is to be performed on both legs, the patient may be thrown on either side indifferently, and his legs secured as before described. The under leg is then first released and dealt with on the inside; then rebound to the hobble and the upper leg liberated, and the process repeated on the outside. The horse is then turned over, and the inside of the second leg operated upon is neurotomized and returned to its hobble; and finally, the upper leg, which was on the under side at the beginning, is operated on upon the outside. Our mode of operating may differ somewhat from those prac- ticed by others, but the general plan is the same. The patient, having always been prepared by local treatment of his fetlocks, which have been soaked and firmly bandaged for twenty-four hours, is cast and secured, as before stated, the hair is closely clipped with the scissors, and the parts thoroughly washed with an antiseptic solution (bichloride of mercury). Having carefully felt for the location of the nerve, which, in many cases, can be discovered by feeling the pulsations of the artery, an incision is made through the skin with, if possible, one stroke of the convex bistoury, measuring from an inch to an inch and a half in length. It is an advantage to have the incision slightly oblique to the direction of the nerve. Then, witha forceps in one hand, and the handle of a bistoury or scalpel in the other, the cellular tissue is lacerated from the edges of the incision, in order to allow the application of the two blunt rubbered tenaculums, which, when in position, hold open the wound; or sometimes threads are used instead, being passed through the edges of the wound and tied on the opposite side of the leg. If the incision has been made in the proper place, after sponging away the trifling hemorrhage which obscures the wound, the nerve may be seen at the bottom, or it may be found surrounded with more or less condensed cellular tissue, and the next move is its dissection. With a dissecting forceps in each hand, we firmly grasp the con- nective tissue with one, while with the other we tear it away immediately over the nerve, removing it by two or three small portions at a time until the nerve is exposed, lying more or less closely to the artery. Then, with a gentle two-and-fro movement, we isolate the nerve from its attachments with the cellular * q 1 Orne aa eee Oe ee PLANTAR NEUROTOMY. 553 strueture, and when it is loosened, a fact easily recognized by an apparent shrinking in its length, it is ready for the division. At times we pass under it the blunt aneurism tenaculum, carry- ing a thread with which to secure it, and when secured, passing the pointed bistoury under it, we divide it with a single upward stroke of the instrument. In other instances, instead of the ten- aculum and thread, we use the neurotome, which, having a curved, blunt end, enables us at once to isolate the nerve, and with a simple motion of the sharp edge to divide it from below upward. Upon making the section the lower end of the nerve is secured with forceps, drawn out of the wound, separated from its adhe- sions by scraping it with the bistoury, and when a portion about an inch or an inch and a half in length has been dissected, and’ the resection is completed, either with the neurotomy knife or the bistoury, the wound is to be cleansed with antiseptic washes. The edges are in a very few instances secured by a stitch of suture, but we often prefer a simple antiseptic dressing and a bandage. There is, of course, no doubt that animals will often struggle during the operation, and especially at the moment when the liga- ture is tightened upon the nerve, or when the nerve is divided, but the pain in either case is so transient that while we appreciate the value of anesthesia, we cannot recommend, in ordinary prac- tice, general etherization or chloroformization. If it is necessary to have recourse, as some do, to the tourniquet, or of any other means, to control a possible hemorrhage, a large experience in the practice of this operation has failed to show us a single case where such practice would have been of advantage. The various details of the operation are substantially the same, both for the high and the low process. It must be borne in mind, however, when operating below the fetlock, that the nerve is often concealed by a little fibrous band, which a careless operator might mistake for the nerve itself. There is probably no special attention required as supple- mental to the operation. The wound heals more or less rapidly by first or second intention, and, as a rule, after two or three weeks there are no signs of the occurrence excepting a simple linear cicatrix remaining. Of the accidents which may be en- countered during the operation, hemorrhage is the most import- ant. Generally this is referrible to an error on the part of the 554 OPERATIONS ON THE NERVOUS SYSTEM. operator in dividing the artery or the vein, and usually it is not dangerous, though it may still prove very troublesome. If the artery is divided the ligature must be applied on the truncated ends; if the vein, pressure will be sufficient. The last important point involved in a case of neurotomy is the length of time required by a neurotomized animal to recuper- ate before he can safely return to his work. It is undeniable that to a too hasty return of the patient to his accustomed labor most of the objections and alleged complications of the operation may be traced, and for this reason the answer to the question how long a rest shall follow the operation must be as long as circwm- stances will permit. Zundel, Gourdon, Fleming, and others, make a month the minimum period within which no considerable exertion should be undergone; we would sometimes be still more liberal in allotting the length of the vacation. CHAPTER XII. OPERATIONS ON THE GENITO-URINARY ge eee OS, CATHETERISM OF THE URETHRA. The object of this operation is the exploration of the interior of the bladder, and consists in the introduction of a catheter, species of canula, or through the urethral canal into that organ, for the purpose of ascertaining and removing its contents. Al- though the urethra of the male has great length, with an acute curve at the ischial arch, the operation is not a difficult one. It is described as the partial and the complete, according to the dis- tance to which the instrument is inserted into the canal, being partial when the catheter is pushed in the urethra only as far as the pelvic portion of the passage, but complete when it is carried completely into the bladder. The operation is employed in animals of both sexes, and is indicated in cases of retention of urine, due either to the pressure of calculi, or to the spasmodic contractions of the bladder, which accompany some cases of colic; or, again, when in attacks of paraplegia the animal is unable to micturate naturally. It also constitutes one of the first steps of the operation in urethrotomy, in cystotomy, and in lithotrity. We shall consider the operations separately as performed in males and in females. In Males.—The catheter used in veterinary practice for male solipeds is composed of a tube of wire, twisted in close spirals, and covered with a species of thin oil-cloth, making the outer sur- face perfectly smooth, and forming a perfect canula. It is fur- nished with a stylet made of flexible rush broom, or whalebone, which can be readily withdrawn from the cavity of the instru- ment. Metallic catheters, invented first by Brogniez, and improved on the plan of those used in human medicine, may also be ob- 556 OPERATIONS ON THE GENITO-URINARY APPARATUS. Fic. 467.—Catheter. tained, but they are not in as general use as the simpler and cheaper kind above described. India-rubber instruments, more or less pliable, constructed on the same general plan, are also made. Tn solipeds, urethral catheterism can be performed either when the animal is standing or in the recumbent position. In the first case he is kept quiet by the application of a twitch on one lip and of the hobbles on his hind legs. This done, the first step is to secure control of the penis by drawing it out of the sheath, which must first have been thoroughly cleaned and washed to remove all the sebaceous secretion which by its greasy consistency renders this step of the operation quite a difficult one, many animals resisting the attempt to accomplish this with all their force. But by obtaining and retaining a firm hold of the penis above the glans, and drawing upon it slowly, firmly and steadily, the resist- ance of the animal may be at length overcome, and the organ brought into full view. The operator then, guided by the little protrusion of the urethral canal, in the middle and a little toward the lower border of the glans, carefully introduces the instru- ment, which should be freely lubricated with oil or vaseline, pushes it slowly toward the ischial arch. When the instrument CATHETERISM OF THE URETHRA. 557 reaches the ischial space the stylet must be withdrawn in order to avoid the difficulty of bending the catheter over the curve formed at that point in the urethra. At this moment a gentle but firm and steady pressure upon the end of the instrument (easily felt at the ischial arch), made by an assistant bending it forward, will, with a little careful pushing, effect its entrance into the bladder. This will, of course, become known at once by the cessation of the resistance, and by the escape of the urine which may be con- tained in the bladder. The removal of the instrument is effected by simply drawing it carefully from the passage. Sometimes simple pressure over the ischial arch is insufficient, and the bending of the instrument into the proper direction is to be made through the rectum, and hence the indication of having that organ well emptied before proceeding to the operation. The indication of great caution in this operation is suggested by a consideration of the fact that (if the canal should chance to be of unusually narrow diameter or its walls softened by disease) there is sometimes danger of forming false passages, by punctur- ing the mucous membrane, and forcing the catheter into the erectile tissue which surrounds the urethra. This is an incident which, however, can be avoided by removing the stylet from the canula before its introduction into the urethra, the canula itself being terminated by a perforated oval bulb, perfectly smooth, and thus incapable of inflicting injury. In Catheterizing Females, a small catheter may be and is sometimes used, but as a rule, the metallic instrument is prefer- able, the conditions of the method, the shortness of the passage Fie. 468.—Female Catheter. and its comparatively large diameter, with the facility with which it can be entered; rendering the metallic on all accounts more eligible than the composition or the rubber tube. The instrument, being lubricated with oil or vaseline, the oper- ator, opening the vulva with the left hand, introduces his right, holding the instrument, into the vagina, and carries it forward to the meatus urinarius, which he can feel at about six or seven 558 OPERATIONS ON THE GENITO-URINARY APPARATUS. inches in front of the vulva. While thus holding the instrument, he feels, with the middle finger of his right hand, for the mucous valyular fold which covers the meatus, pushes the finger under it, and then, bringing the bulb end of the catheter to the opening of the urethra, inserts it into the bladder. The accidents that may arise from carelessness, or otherwise, in the catheterism of males, are not met with when treating females. URETHROTOMY. Incisions of the urethral canal are made for various purposes. The removal of foreign bodies, usually calculi; the restoration of the suspended power of micturition when is has been caused by the closure of the passage; the establishment of an artificial urethral opening ; and the penetration of the cavity of the bladder when necessary for surgical purposes—these are among the reasons for which this important canal is incised by the surgeon. It is principally performed on males, the dimensions, aside from its shortness, of the urethra in females being, as a rule, ample, and the organ sufficiently dilatable for the removal of calculi, or other objects, without involving the necessity of an operation. Among the males, the ox is the animal which most frequently re- quires it, by reason of the peculiar liability of this animal to suffer from a constitutional tendency to the formation of calculi and the fact that these accretions are often arrested in the urethra, in consequence of a peculiar double curvature, or S formation, in the penis. With horses, it is in some districts quite a common operation. In these animals, however, the calculi, though of rare formation, are larger and are more generally retained, either in the bladder or in the first portion of the urethra. In smaller animals, calculi are also quite common and troublesome, especially in dogs, on account of the presence of the bony formation in the structure of the penis. ‘ In the horse, the principal operation is performed in the peri- neal region, or the part extending on the median line from the anus to the scrotum, bounded above and on each side by the ischial tuberosities, and below by the flat of the thighs. The skin of the perineum is very fine and thin, and is hairless URETHROTOMY. 559 = . | 7. ii NBN f Ne : COG ed RR Z 4 1% \\ GZAZAZ 10 1 ~ Lf : i / UNG ZE . Fic. 469.—Anatomy of the Perineal, Anal and Caudal Regions. 11.—The skin. 2.—Portion of the aponeurotic sheath of the coccygeal muscles. 8 3.—Inferior sacro-coccygeal muscles. 4 4.—Lateral sacro-coccygeal muscles. 5 5.—Is- chio-coccygeal muscles. 6.—Suspensory ligament of the anus. 77.—Lateral caudal arteries. &.—Deep caudal vein, satellite of the median artery. 9.—Median caudal artery. 1010.—Inferior caudal nerves. 11.—Lymphatic glands. 1212.—Superficial caudal veins. 12’.—One of the superficial caudal veins. 13.—Portion of the perineal aponeurosis. 1414.—Semi-membranosus muscle. 15.—Sphincter ani. 16 16.—Ischio cavernous muscle. 1717.—Bulbo cavernous muscle. 18 18.—Suspensory ligaments of the penis. 1919.—Bulbous or internal public arteries. 20.—Incision of the urethral canal for urethrotomy. 21.—Anus. RRs, 560 OPERATIONS ON THE GENITO-URINARY APPARATUS. below the anus, but downward and on the sides, is is covered with short hair. Below the skin are found the two principal layers of aponeurotic covering, divided into the superficial and the deep. The former, of fibro-elastic texture, is the continuation of the dar- tos, and covers the perineal region, thinning down as it nears the anus, to disappear at the sphincter ani. Its most superficial fibres give attachment to a subcutaneous muscular fasiculus, which from the splineter ani runs downward to lose itself about three inches below. The latter plane, or deep aponeurosis is formed of white inextensible fibrous tissues. Intimately adherent by its external face to the superficial layer, it covers and unites with the accelerator urine, and the ischio-cavernous muscles, as well as with the suspensor and retractor ligaments of the penis. It then passes between the ischio-cavernous and the semimembranosus, to attach itself above on the ischial tuberosity and become lost downward on the thighs. Some of its fibres directly surround the fixed portion of penis, and join the aponeurosis common to all the muscles of the flat of the thigh. The suspensor and retractor of the penis form, in the upper perineal region, that is, from the anus to the ischial arch, an ex- pansion of sufficient width to form a true anatomical layer. Below this they represent bands about half an inch wide, situated on the median line, and covering the accelerator muscle. They are formed of white muscular fibres. The blood-vessels and nerves of this region, with the other parts pertaining to the anatomy of the urethra, have already been considered. The peculiarity that belongs to the penis of ruminants must not be overlooked, when the question of urethrotomy in these animals is under discussion. Their penis is very long and thin, and is surrounded in the perineal region by a complete aponeurotic sheath, and on a level with the pubis it has two curvatures, which give to the organ the form of an S. Ona level with the second curvature it gives attachment to the suspensory ligaments. The free portion of the organ is elongated, strongly filiform, and covered by a fine, rosy mucous membrane. The peculiarities possessed by the penis of the horse do not exist in cattle. The operation of urethrotomy is classified and designated with reference to the part of the urethra, which is to be divided, and this is of course determined by the location of the body to be re- moved, making the designations principally regional; and it is URETHROTOMY. 561 therefore said that the operation can be performed in three ways, though three places would be the more accurate phrase. Thus we have first, the incision at the point of the penis, or preputial urethrotomy ; second, the division in the scrotal region, or scrotal urethrotomy,; and third, the incision below the anus, or ischial urethrotomy. PreputiaL UREtTHROToMY. In horses and dogs the urethra becomes more or less con- tracted toward the full extremity of the penis, and calculi are therefore apt to become arrested in that locality ; in other cases, masses of sebaceous matter will collect in the navicular fossa. In sheep, saline concretions are found, either in the prepuce or in the urethra. All these conditions involve a contingency of surgical interference. To remove them in the horse and in dogs, a trans- verse incision is made with a bistoury over the spot where the presence of the foreign body is detected, and it is readily disposed of. If the erratic substanceis in the urethra, an incision is made through its membranes and it is removed in entirety, or sometimes after having been reduced to fragments by means of a probe or of acurator. In sheep, the simple amputation is recommended by some. The wound made in these cases heals without trouble. ScrortaL URETHROTOMY. Scrotal urethrotomy ean be performed either on the front or behind the testicles. In cattle it is ordinarily posteriorly that the calculus is lodged, more commonly in the second than in the first curvature, and lence the indication for selecting this place for the operation. Yet there are practitioners who prefer the anterior sec- tion, because the penis being more superficial at that place, there is less cellular and adipose tissue to be divided before exposing it. In either case, the animal is thrown, with the hind leg carried forward and secured as for castration. If the operation is to be performed behind the testicular mass, an incision is made on the median line, measuring about three inches in length, the cellular tissue divided with the knife or the finger and the penis drawn out through the incision. The calculus is extracted through a longitudinal incision. The canal should then be examined with a probe or bougie, to ascertain whether any more offending bodies are present, and if so, they are of course also removed. The 562 OPERATIONS ON THE GENITO-URINARY APPARATUS. wound may be either closed by sutures, or, preferably, left without interference, to obviate the possible danger of the formation of future scrotal abscesses. In the pre-scrotal operation, the hair is first clipped short, and an incision made through a transverse fold of the skin, to expose the penis. The concluding steps are the same as those in the former case. It is, however, always advisable, when the animal is secured, and before dividing the tissues, to insert the hand into the pre- puce to draw out the organ. By thus straightening it and remoy- ing the S curvature, it is possible, and sometimes occurs, that calculi are displaced and extracted without the necessity of resort- ing to the knife. The urinary fistulas which are among the sequel of scrotal urethrotomy, are of two or three weeks’ duration, seldom continu- ing longer. Care must be taken to protect the skin from the irritation produced by the dripping of the urine through the wound. Iscoian URrrTHRoTomy. This is the most common of the three operations, and is appli- cable to all males. It is performed without casting, with the animal hobbled on both hind legs and a twitch on his lip. (Fig. 470.) The decubi- tal position is seldom required. The free use of cocaine has enabled us to operate without any means of restraint, not only in horses, but in camels, which are very awkward and uneasy animals at the best, and especially when in the hands and under the knife of the surgeon. The insertion of a catheter has been recom- mended by many, to serve as a guide to the dissection of the urethra, while others prefer the artificial dilatation of the canal by the injection of water. In some cases, however, neither of these expedients is necessary. The presence of the calculus and the dilatation of the urethra above it, by the confined urine, greatly assists in the location and puncture of the canal. The incision must be made on the main line, on a level with the ischiatic arch. The structures to be divided are first, the skin, then the subcutaneous cellular tissue, the aponeurotic layers, and the accelator urine; which being completed, a straight puncture can be made in the urethra between the two suspen- sory ligaments. The incision is then extended upward or down- URETHROTOMY. 563 eS zs — z a ———— Fie. 470.—Secure for Ischial Urethrotomy. ward, as may be required, with the bistoury, guided by the grooved director, a blunt bistoury being sometimes chosen from the motive of prudence, in order to avoid possible injury to the surrounding blood vessels. In our experience we have secured very satisfactory results by adopting the method recommended by Bouley, of making one comprehensive puncture, which penetrates the canal without any preliminary dissection of the incumbent parts, especially when a catheter has been placed in the urethra for the guidance of the knife. The hemorrhage, which generally accompanies this mode of operation is of no great importance, often subsiding of itself, and seldom requiring external hemostatic applications. We believe it to be the better course, when the object in view has been realized, to leave the wound to itself, without interfering with the healing process by seeking to facilitate it by the applica- tion of sutures. It gradually granulates and closes without any special care beyond the observance of cleanliness and the neces- sary measures to prevent irritation of the skin from the contact of the urine as it “leaks” through the wound. When the urethra has been opened, in whatever region of the penis the offending foreign body may be lodged, it is readily 564 OPERATIONS ON THE GENITO-URINARY APPARATUS. Straight. Curved. Fas. 471, 472.—Forceps to remove Foreign Bodies from the Bladder. extracted with straight or curve forceps. These can also be em- ployed to secure those of comparatively small size that may be found in the bladder, and answer very well likewise for those masses of a sedimentary nature that are commonly seen in mares. There may sometime be some peculiar pathological conditions which render it necessary to prevent the closing of the wound in cases of ischial urethrotomy, and when the formation of a perma- nent artifical opening should, perhap, be attempted. The entire closing of the urethra, in its anterior portion, re- URETHROTOMY. 565 sulting from some special trauma- tism would be such a case; or again, when the formation of calculi has become an established constitutional habit, and the results of this perver- sion of the nutritive and assimilative function are always present and con- tinually renewed. In view of this unfortunate state of things, and to prevent the closing of the wound, Troeber recommends the use of a peculiar tube, which, when intro- duced into the urethra can be per- manently retained in place for an indefinite length of time (Fig. 473). We have attempted the formation of an artificial urethral opening, by ry4. 473.—Tube of Troeber, for Ischial sewing together the mucous mem- Urethrotomy in Bovines. brane of the canal and the skin, but the results of the experiment were of the most transient character. CYSTOTOMY. Improperly known also as lithotomy, is an operation which consists in the incision of the neck of the bladder to remove cal- euli of dimensions too great for removal intact through the urethra. This operation has no longer a place in our surgery, . and, in fact, there is no existing reason for its performance. Ifa calculus is of small or of medium size the neck of the bladder can always be sufficiently dilated to permit its passage, and if it should be of greater dimensions, and rendered impossible of ex- traction by its size, the operation of lithotrity is always available, and in experienced hands as nearly certain and safe as can reason- ably be expected. LITHOTRITY. This term designates the operation of crushing, or piercing, — or drilling stones in the bladder, in order to reduce them to frag- ments, preparatory to their removal by means of forceps or cur- ates, or by washing them out of the bladder with water. It mostly corresponds with, or rather, includes the lithotomy of 566 OPERATIONS ON THE GENITO-URINARY APPARATUS. Fig. 474.—Lithotritor of Guillon. human surgery. It was per- formed for the first time by H. Bouley in 1858, with the assistance of a practitioner of human surgery, Dr. Guil- lon. Horses are more specially the subjects of this opera- tion in cases when the cal- culi are too bulky and too hard to be broken and re- moved with the forceps alone. In ruminants, on the contrary, vesical calculi, though more common, and more numerous in single animals, are generally of sufficiently small size to permit the relief of the pa- tient by the simple opera- tion of urethrotomy. The instruments neces- sary for this operation are the lithotritor, or lithon- triptor, with also the crush- ing forceps. 'The lithotri- tor of Guillon (Fig. 474), or the crushing forceps of Bouley (Fig. 475), are those generally used. We are con- vinced by our experience of these instruments that the . principal, and probably the only objection that applies to them lies against their mechanical construction. We consider them to be too clumsy, too large and too heavy; objections, however, which are very easily obvi- LITHOTRITY. 567 ated by any competent instru- ment-maker. While they must necessa- i rily possess sufficient power to | crush the calculi, we fail to see \ that a proper attention to the features of symmetry, finish, and convenience of manipula- tion can involve any sacrifice of efficiency. The instrument can be made to possess ample strength, while still more easy to handle when introduced in- to the bladder through the com- paratively small opening of is- chial urethrotomy. A bivalve speculum (Fig. 476) to dilate the wound of the urethra is sometimes of great value. A large syringe, and plenty of water, or what is better, an irrigator for douches to wash out the bladder, will complete the series of neces- sary instruments. The opera- tion is performed with the ani- mal in the standing position, secured as for urethrotomy, or cast if the operator so prefer it, and placed under the influ- ence of general anesthesia. We borrow from H. Bou- Fig. 475.—Crushing Forceps of Bouley. ley, the father of the operation, his own description of the modus operandi: Access to the bladder having been obtained by the process already described, the essential operation is divided into three principal steps : 1st. The introduction of the lithotritor, and searching for and grasping the stone; 2d, crushing of the calculus; 3d, removal of the fragments. 568 OPERATIONS ON THE GENITO-URINARY APPARATUS. Fia. 476.—Bivalve Speculum, Ist. Introduction of the instrument for searching and grasp- ing the stone.—This step varies with the instrument, as to whether the lithotritor or the crushing forceps is used. If the first, the instrument, well greased and kept closed, is inserted through the urethral incision, with its concavity resting on the convexity of the ischial arch, and is pushed obliquely forward and downward through the pelvic portion of the urethra and the neck of the bladder. When in this cavity the branches of the instrument are opened, and by a slight and slow movement made to traverse the cystic space until it comes in contact with the calculus, which then drops into the hollow of the branch adopted by its shallow form to receive it. The jaws of the instrument are then brought to- gether and the stone firmly secured. | The same description, in every particular, applies to the ma- nipulation of the crushing forceps. In some cases, however, it is necessary to disarticulate the in- struments, and to introduce the branches separately, HE them when both have been inserted. It is important, in every case, to leave a small portion of urine in the bladder to facilitate the movement of the stone-and aid in its seizure without grasping and pinching the lining membrane of the organ. If the bladder is empty a portion of water might be injected. 2d. Crushing of the Stone. This is done by slowly approxi- mating the jaws of the instrument. It is not necessary to reduce the stone to very minute particles. It will be sufficient if their dimensions are not too great to permit their free escape through the urethral passage. In remoying the instrument after accomplishing the crushing, a great deal of the comminuted calculus is extracted between its jaws. 3d. Removal of the Fragments.—Dilating the urethral wound LITHOTRITY. 569 with the bivalve speculum, a stream of water is then thrown into the bladder, either with the syringe or the tube of the irrigator. The water ought to be tepid and antiseptic; and a hand intro- duced into the rectum and manipulating the bladder, will facili- tate the repulsion of the larger fragments, and the washing out of the smaller. The general attention required in all cases of serious operations will be necessary after the performance of lithotrity. In respect to any special dressing, they are the same as those in- dicated in simple urethrotomy. Serious, however, as this operation is, it is comparatively free from dangerous sequelee. Hemorrhages of easy control have been met, urinary abscesses, with infiltration, have occurred, serious wounds of the urethra, of the rectum and of the bladder may also happen, but they are of rare occurrence, and can be avoided by careful manipulation through all the steps of the operation. AMPUTATION OF THE PENIS. This operation is indicated in the horse when the penis becomes the seat of warty growths; of epithelial, papillomatous, or can- cerous degenerations; of fracture; of paraphymosis, or of paraly- sis. Warty growths are usually found covering more or less the free part of the penis; or its free extremity; or the glans penis; and are also sometimes met with on the inside of the sheath, their presence being accompanied with an offensive and very irritating sebaceous discharge, becoming at times so painful as to interfere with micturition. They resist the severest forms of treatment, and it is not unusual for them to develop into forms of a more alarming nature, notably those of chancroid degeneration, of which, in fact, these epithilial growths are but the seminal origin. In other cases the erectile tissue of the glans penis becomes the seat of ulceration, extending in depth, spreading in such a manner over the penis that the free portion of the organ becomes a mere mass of bleeding surface, of irregular aspect, macerating in the pus which abundantly forms, and which escapes with its peculiarity of bloody saniousity, with the most repulsive odor and irritating effect, rendering the act of micturition most painful and difficult. In many instances the animal so dreads to bring his penis out of the sheath that he urinates within the cavity formed by the folds of the skin, adding another source of irritation to that already 570 OPERATIONS ON THE GENITO-URINARY APPARATUS. existing. And if the penis is still allowed to pass out of the sheath, the micturition is made with a crooked stream, which in- stead of escaping forward is, on the contrary, discharged back- ward. In such a case no treatment will relieve the difficulty but the removal of the entire diseased structure. In fractures of the penis ; in many conditions of paraphymosis ; or in those of paralysis, the organ hangs suspended outside of the sheath, and cannot be restored to its cavity. If pushed back it soon returns to its abnormal condition, and even if retained by artificial means, will continue in place only while the means are continued to enforce it, becoming displaced again whenever the restraining agency ceases to operate. This serves to render the animal useless, in consequence of its appearance being so repul- sive as to preclude his employment in public view. Of course the only radical cure for such an ailment is the knife or its equivalent. The operation usually consists in the removal of the free por- tion of the penis, the necessity for going beyond this seldom occurring, yet in order to reach the diseased part it is sometimes necessary to divide the sheath along the median line. The general anatomy of the organ, as far as it relates to the operation, is very simple. The penis it formed by the corpus Fig. 477.—Penis in Normal Condition. cayernosum, a long, erectile structure, flattened from side to side, and grooved on its inferior border for the reception of the corpus spongiosum urethre, Terminated inferiorly by a blunt point, this corpus cavernosum dips into the erectile tissue of the urethra. After passing out of the pelvic cavity, by the ischial arch, the spongious portion of this canal, is received into the groove of the corpus cavernosum, at the anterior part, and also extends beyond it. The mucous membrane is covered externally by the tissue AMPUTATION OF THE PENIS. 2 SE which gives to this part of the urethra its name, and this erectile tissue terminates anteriorly in an enlargement, more or less developed, forming the head of the penis, or the glans penis. The urethra proper protrudes a little below the center of the head of the penis, and shows in a cavity underneath, the urethral fossa, more or less filled with a sebaceous secretion. The blood vessels which ramify in these erectile structures are the two dor- sal arteries of the penis, anterior and posterior, and the veins, which form large branches, running also upon the dorsal border of the organ. Zundel very wisely insists upon two principal conditions (to which we shall again refer) to realize in the operation, first to manage to leave a free means of exit for the urine, by cutting away less of the urethra than that of the cavernous body, and second, to avoid the hemorrhage, which is especially liable to take place in horses, on account of the abundant circulation in the erectile tissues. The animal if to be placed in the recumbent position, as in the operation for castration, that is, on the left side; or it may prove advantageous to place him on his back. Five modes of operation are described by different writers on the subject—Ist, the ligature; 2d, cauterization; 3d, excision ; 4th, by scraping; and 5th, by crushing. As an adjunct to the various instruments which these different operations may require, metallic catheters are also necessary. The Ligature.—The catheter being introduced into the urethra, beyond the point where the amputation is to be made, a strong ligature is applied at that point and tightened sufficiently, if pos- sible, to strangulate the portion of the penis which is te be removed. After from twenty-four to forty-eight hours, the external layers of the tissues will have become mortified, even to a certain depth in the penis, and a new ligature is then applied, and strongly tied like the first one. The deeper layers of the penis are also, after a day or two longer, so mortified that they continue attached to the tissues above the ligature only by a small particle, which can be divided with the knife. The catheter may then be removed or it may be allowed to remain in place a few days longer. No special subsequent treatment is required. If, after afew days, micturation seems to become difficult, the urethral opening may be enlarged by the introduction of a bougie 572 OPERATIONS ON THE GENITO-URINARY APPARATUS. or a catheter, or again enlarged by an incision with the bistoury. Instead of the ordinary string, an elastic ligature may be sub- stituted with the advantage of maintaining an uninterrupted pres- sure upon the tissues up to the moment when mortification is established in the part to be amputated. Cauterization.—No catheter is required with this plan. Two ligatures are applied, one anterior, by which the penis is kept out of its sheath, and one posterior, acting as a hemostatic, placed above the point where the division is to be made. The operator then with a flat and sharp cautery, heated to white heat, makes a complete section of the penis. But, says Zundel, “as the urethra is especially delicate and sensitive, it is better, in order to avoid its retraction, to separate it from the cavernous body about half an inch in front of the place where the section is made.” A hollow bougie of india rubber inserted into the urethra will also prevent its contraction. Professor Nocard has recommended the use of the galvano- cautery, to obtain an easier division of the tissues, a more perfect hemostatis and to shorten the duration of the operation. Excision.—After introducing a metallic catheter, a rapid sec- tion of the organ is made by a single stroke of the knife. Again, says Zundel, ‘when the urethra is reached, it must be dissected a little forward, toward the glans penis, and caused to protrude about half an inch beyond the point cauterized.” Scraping of the penis.—This method, which was put in prac- tice in 1829 by Moiroud and Delafond, consists in scraping the penis with a bistoury, in such a way that, the remaining portion of the organ forms a cone, with its apex formed by the urethra. A catheter may be introduced into the canal previous to the opera- tion and left in place for awhile; or again, it may, if thought proper, be entirely dispensed with. This mode precludes the danger of hemorrhage. Crushing.—By operating with the ecraseur, the amputation is perfected without danger of hemorrhage. The chain of the instrument is applied at the point of amputation, and by slow and gradual action, cuts through the tissues until the diseased part drops off. The danger attending this method is that the chain may break during the process, in consequence of the resistance of the cavernous tissue. This accident has certainly been encoun- tered by many practitioners, and we haye ourselves witnessed it I 4 a 4 1 q = AMPUTATION OF THE PENIS.. 573 in two instances. On one occasion it was found necessary to re- place the chain twice, and to complete the amputation with the knife. Reynal has modified the crushing operation by making the action of the ecraseur slower. He has invented a small instru- ment (ecraseur) which is left in place for two or three days, being tightened every day, or several times a day, until the mortification is complete, and the diseased penis sloughs off. In this method, a metallic catheter is placed in the urethra; in the other the catheter is not required. In reflecting upon the various modes of operation we have thus described, and noting especially the two very important, and indeed, essential requirements referred to by Zundel, in respect to the matters of micturition and hemorrhage, we are struck with the fact that in none of those methods are these obvious require- ments complied with, or if they are, it is in a manner so faintly implied, and so indefinite and unsatisfactory as to be scarcely intelligible, and certainly to leave no distinct impression on the mind, of the importance of the points referred to. In every case the danger of possible subsequent interference with micturition is threatened, whether the catheter is used during or after the operation, or even, we fear, if left inthe passage “at least two months,” as recommended by Peuch and Toussaint. We can remember cases of our own which, with even a longer retention of the catheter, were followed by failure. We have attempted the formation of an artificial urethral opening below the ischial arch, and with no better result. We are tempted to believe that the hemorrhage is less danger- ous than many think, and we believe it could be controlled by ordinary pressure, or by plugging the sheath afterward, or by still other means of hemostasia. Taking all this into consideration, we cannot but think strange of it, that the process used in human surgery, which we find merely mentioned in some European works, but which we believe has been performed by Gerlach, and which we ourselves adopted more than fifteen years ago, should be practically ignored or rejected by writers as well as practitioners. We have practiced it during the period mentioned without having encountered the slightest complication or troublesome sequel. We refer to it as the only safe, and as, therefore, the best mode 574 OPERATIONS ON THE GENITO-URINARY APPARATUS. of operation for the amputation of the penis. It differs from any that have been previously recommended, and is as follows : The animal being prepared for the operation in the ordinary way, the penis is secured with a ligature at its end and drawn out of the sheath, and another ligature tightly applied on the upper part of the organ. An incision of the skin covering the penis is made entirely around the organ and down to the cavern- ous body, with the precaution of drawing the skin slightly back- ward, so that when the amputation is completed, and the skin allowed to return to its position, it will slightly overlap the stump of the penis. We divide the cavernous body, carefully avoiding injury to the urethra, and when this organ is reached it is dissected from its groove forward into the cavernous body (Figure 477q) for a Fie. 477¢.—Amputated Penis, with the Urethra Protruding. length extending between one and one-half to two inches, when the division across the urethral canal completes the amputation. The removal of the diseased tissue being thus made, we have before us the stump of the cavernous body, almost dry, the hemorrhage being prevented by the upper ligature, which moreover, secures a good hold and good view of the mutilated organ. The urethra is then slit on its inferior border on the median raphe and both flaps turned upward and brought in contact by interrupted sutures with the skin which has been so divided as to overlap the stump (Fig. 477b). These sutures are made close to each other, of strong silk or catgut. The result is that the stump of the penis carries at its lower margin a slit of from one to one and one-half inches in length, which, after allowing for all shrinkage of cicatricial tissue, will always be sufficient to permit thorough micturition. AMPUTATION OF THE PENIS. 575 Fig. 477b,—Stump of Amputated Penis, with Stitches uniting Urethra and Skin. The sewing done and the upper ligature removed, the penis re- tracts within the sheath, and the animal is.allowed to rise. We have been performing this operation for fifteen years, and have never yet met with the slightest complication or disappoint- ment. In dogs the amputation of the penis is indicated for about the same diseased processes as in the horse. The amputation, however, does not include only the soft tissues, but alsothe bone of the penis, which is divided with nippers or a saw. The division of the cay- ernous body is done with the ligature or the ecraseur. Strictures of the urethra are of common occurrence after this operation, and can be overcome only by the repeated introduction of the catheter, or the enlargement of the urethral opening with the knife. CHAPTER XIII. OPERATIONS ON THE FOOT ANATOMY. In our domestic animals we call the foot the extremity of the leg, and even only the extremity of the digit, for, considered in a zodlogical point of view, the foot extends from the carpus or tar- sus to the last phalanx, inclusive. The foot of the horse forms an extremely important study on account of the numerous diseases to which that member is sub- ject, and also of the value of the motor powers required from the horse ; the old horsemen expressed this importance by the aphor- ism, ‘‘no foot, nohorse.” This truth finds daily its sad applications in the premature ruin of large numbers of horses rendered useless because of the defects in their feet. All the qualities of a horse are, indeed, considerably diminished and can even be entirely destroyed, by the bad conformation or accidental alterations of these essential organs. The study of the foot of the horse has been the object of many voluminous works, such as those of Gir- ard, Bouley, Bracy, Clark, Anker, Leiserng & Hartman, Lafosse, Gourdon, Reynal, Defays, and many others, to which we refer for the more complete description of the organization of the foot. The organ is composed of two orders of parts, some internal, organized and sensitive; the other external, formed of a horny, organic substance, the hoof, but entirely void of the property of vital sensitiveness. The internal parts are bones, three in number, the second and third phalanges, and the small sesamoid, which form by their reunion the articulation of the foot; special liga- ments, which maintain the connections of these bones; tendons, which fill the triple office of agents of transmission of motion, articular ligaments and organs of support of the weight of the body; a fibro-cartilaginous apparatus, superadded to the third phalanx, and which completes, so to speak, posteriorly, and increases the surface by which it rests on the hoof and transmits ANATOMY OF THE FOOT. 577 Fi4. 478..—Longitudinal Section of the Digital Region. A.—Lower part of the plantar cushion. B.—Ligamentous bands of the fibrous layers of the plantar cushion. C.—Fibrous membrane of the plantar cushion. D.—In- sertion of the plantar cushion to the inferior face of the os pedis. E.—Spongy tissue of oscoronz. F.—Articulation of first and second phalanx. H.—Perforatus tendon at- tached to the os coronz. I.—Insertion of plantar aponeurosis to the semi-lunar crest. K.—Spongy structure of os’suffraginis. L.—Section of perforatus tendon. M.—Yellow fibrous band uniting the anterior face of the perforans tendon to the posterior face of the oscorone. N.—Synovial sac of the sesamoido-pedal articular. O.—Tendinous sesa- moid sheath. P.—Synovial capsula of the articulation of the foot. T.—Perforans ten- don. Y.—Metacarpo-phalangeal joint. to the ground the pressure which it receives. These are the lat- eral cartilages and the plantar cushion ; arteries, veins, lymphatics and nerves, remarkable for their number, development and dispo- sition; and at last, a ligamentous, sub-horny membrane, or kera- Fig. 479.—Plantar Nerves in Digital Region. P.—Plantar nerve. A.—Origin of the digitalnerves. BB.—Cartilaginous branch. CC.—Cutaneous branch. D —Digitalartery. G.—Transverse branches back of the fet- lock joint. I.—Nerve of the plantar cushion. L.—Lateral band of the plantar cushion. V.—Digital vein. togenous apparatus, forming a continuation of the skin, which surrounds the parts of the foot like a stocking, and upon which the foot rests, as a shoe on the human foot. In this apparatus are found: 1st, the coronary band, which forms a rounded projection at the separation of the skin and hoof, and which serves as a matrix to the periople and the wall; at its surface are seen numer- ous villosities or papille ; 2d, the podophyllous or laminated tissue which is spread upon the anterior face of the third phalanx, and is remarkable by the sheet of parallel laminze which it presents at its surface, separated by deep furrows in which are received the analogous laminz of the internal face of the wall (Figure 481); ANATOMY OF THE FOOT. 579 NY \ 4 5 \ A RA es AAS N's Suh Fie. 480.—Arteries of the Digital Region. AAA.—Digital artery. B.—Transversal branch in front of fetlock ioint C.—Pere pendicular artery of Percival. D.—Its ascending branch. E.—The descending branch. F.—Branch to form the superficial coronary circle. G.—Posterior transverse branches. K.—Artery of the plantar cushion. P.—Circumflex artery. CC.—Ascending terminal branches of the digital artery. 3d, the velvety tissue or villous tunic which covers the plantar cushion at the interior face of the foot, and is the secreting organ of the sole and frog, its surface covered with villosities similar to those of the coronary band, and like them, of various sizes, are lodged in the porosities of the internal face of the sole and frog. The external parts of the foot are four in number: the wall, 580 OPERATIONS ON THE FOOT. Fia. 481.—Portion of the Keratogenous Apparatus. A.—The skin. BB.—Coronary band. R.—Its villosities. P.—Podophyllous tissue. Fie. 482.—Section of the Hoof. 1.—Periople. 2.—Cutigeral cavity. 3.—Keraphillous tissue. 4.—Wall. 5.—Contin- uation of the periople with the frog. 6.--The sole. 7—Union of the sole and wall. 8.—Frog stay. the sole, the frog and the periople (Fig. 482). These form, together, a horny box, the nail, or hoof, which is adapted exactly by its internal cavity to the external contour of the sub-horny membrane, contracting with-it an intimate union by a reciprocal reception, and thus completing the structure of the foot, furnish- ing to thesensitive parts an apparatus, thick, hard, resisting and at the same time elastic, which makes one with them, and protects them against violence from the substances with which the foot, from the nature of its function, must necessarily come in contact. Pee ee eee ee re ee ANATOMY OF THE FOOT. 581 The horny substance which constitutes the hoof has a fibrous aspect ; it is hollowed all over by cylindrical canals, whose superior extremities, widened into a funnel shape, cover the papille of the matrix of the hoof, either at the coronary band or velvety tissue, while the inferior open in the wall upon the plantar border, in the sole and frog, at the external or inferior face. These canals are rectilinear, except those of the frog, which are flexuous; their diameter varies from 0, 02 to 0, 2 or 04" These tubes are not only hollowed in the horny substance ; they have also proper walls, of very great thickness, formed of numerous concentrical layers, received into each other. These are lamelle of pavimentous epithelium, which constitute the horny tissue; in the walls of the horny tubes, they are grouped flatwise around their inferior canals, and stratified from within outward, so as toform successive and concentrical layers; in the intertubular horn, these lamelle are not stratified in a direction parallel to that of the tubes, but at right angles with it. Around the tubes, the lamelle have an oblique intermediate direction. A granular opaque substance fills up the space lying between the horny tubes and the papille. The hoof, which is a part of the epidermis, develops similarly, that is, by the constant formation of cells in the layer which cor- responds to the mucous malpighian body, at the expense of the plasma thrown off by the numerous blood-vessels of the keratoge- nous membrane. The velvety tissue is the starting point of the elements of the sole and frog; the perioplic band is the organ secreting the periople ; and the coronary band proper, the matrix of the wall. Upon these different parts, the epithelial cells multi- ply and flatten into lamellze, in the direction of the surface of the keratogenous membrane, as they spread from it. The wall then grows from its superior to the inferior border, and the other parts of the wall from their internal to their external face. The villosi- ties of the coronary band and of the velvety tissue are the organs around which accumulate the epithelial cells; their presence defines, consequently, the tubular structure of the horn. The lamine, in the physiological state, do not co-operate in a sensible manner with the formation of the wall; the keraphyllous laminze form themselves at the coronary band, at the origin of the podophyllous ; they descend with the wall, gliding at the surface of the layer of cells which separates them from the laminated tissue, a movement of descent which is facilitated, however, by the 582 OPERATIONS ON THE FOOT, multiplication in the same direction of the said cells. When the podophyllous tissue is inflamed, whether exposed or not, its latent activity soon manifests itself. It gives rise to a great quantity of hard horn, hollowed, as seen by Gourdon, with tubes, and oblique in a direction backward. These tubes, more irregular than those of the normal wall, are disposed in a parallel series; they are in form round, villo-papillee, which have developed on the face border of the laminz. In these cases of production of horn by the action of the podophyllous tissue alone, one never sees, between the sensitive lamine, distinctly formed horny lamin in the middle of the other cells, as it is observed in the wall proceeding from the coronary band. The horn which rises on the surface of the podophyllous, immediately after the removal of the piece of the wall, is not a permanent one; it must be replaced by the horn of the coronary band. This change is complete, microscopical examination proving that the wall which descends from the coronary band, provided with keraphyllous lamine, engages itself under the temporary wall, and slides by the action already described over the surface of the soft cells of the laminated tissue. As soon as this tissue, modified by inflammation, is covered over by the permanent wall, its papillee become atrophied, and its action returns to the limited boundaries of physiological condition.— ( Chauveau.) The foot is anorgan of support and an apparatus of elasticity; it is through it that the whole animal machine maintains its rela- tions with the ground, and that it adapts itself in its various move- ments, so to speak, to its roughness. It is this that, as a last spring, distributes and modifies the force of all the movements of the horny mass of the body, whose columns, the legs, may be considered as the resultant. Intermediate with the body and the . ground, the foot transmits all the actions of weight reaching it, and also between the body and the sensorium, toward which all sensations resulting from its contact with surrounding external substance return, the foot then becoming at the same time an organ of feeling. To adapt it to this triple formation, nature has given to it three properties, in appearance incompatible with each other, which has, however, harmonized, viz.: first, a very great external hardness, due to its horny envelope; second, a certain amount of flexibility, the combined result of the physical properties of its cortical envelope and of its mechanical disposition of its different ANATOMY OF THE FOOT. 583 parts, and thirdly, a highly developed sensibility resulting from the high organization of its tegumentary membrane.—Gouley. DISEASES AND DEFECTUOSITIES OF THE FOOT IN SOLIPEDS. Of all the domestic quadrupeds, the horse is the most exposed to diseases of the foot, which are more or less frequent in him according to the work he is subjected to, the places he lives in, and the nature of the ground upon which he travels. As rare as are those accidents in farm horses, so common are they among horses in cities, of heavy draught, and also army horses ; in all, in fact which travel continually on hard, paved and stony roads, and especially in large cities, where all those injuries can but be the result of their constant work on stone pavements, always so rough and slippery. If to these conditions are added the very numerous accidents resulting from bad shoeing, so badly carried on, one will be less surprised to see the foot becoming deformed and altered in different ways, deteriorated, and preserving with difficulty, and for a short time, its state of integrity, and becoming the seat of numerous affections. We shall distinguish the diseases proper and the vices of conformation of the foot. The former are generally sufficiently serious to merit special description. Among them some are su- perficial, as the false quarters, uncomplicated cracks, or solution of continuity, thrushes, canker; others of deeper interest, specially those of the keratogenous apparatus, such as daminitis, with its complications and sequele, keraphylocele, seedy toe, and separation of the wall, which may extend as far as entire sloughing of the hoof ; accidents then due to the suppuration accompanying several diseases of the foot. Some maladies are specially the effects of wounds, of contusions such as overreaching, quittor, bruised sole, bruised heels, corns, punctured wounds, others are results of shoeing, pricked, tight shoe, burned sole; others are deep alto- gether, such as bionions, navicular disease, and, lastly, fracture of the os pedis, or of the navicular bone. VICES OF CONFORMATION. Among the vices of conformation some are serious, as contrac- tion of the heels, flat foot, pumiced foot, club foot, crooked foot, rammy foot, and, lastly, the foot with bad horn. 584 OPERATIONS ON THE FOOT. (a) Flat foot (Germ. Platfuss)—By this is understood the foot in which the sole, instead of having the natural concavity, is, on the contrary, flat, and by its whole surface about on a level with the border of the wall and the base of the frog ; ordinarily this is accompanied with low heels, more or less contraction, and a well-marked oblique direction of the wall. Flat foot is generally observed only on front feet, and is very common in lymphatic animals or of low breed, raised in low and damp soils; it may be congenital. Large feet, badly shod or used up by very heavy work, are predisposed to it. It is claimed that the weakening of the sole by too repeated and deep paring of the sole will ultimately bring it on; it is said that abuse of poultices may produce it; it follows excess of the hollowing of the shoe by the upper surface, which, pushing the wall outward, obliges the sole to drop lower than its normal level. The horse with flat foot rests on all parts of the sole at once ; there is no elasticity of the arch of the sole, and percussions take place on it entirely. The actions of the animal are heavy, espe- cially as it is commonly seen when the feet are large. When the foot is somewhat tender, the animal lames easily, especially if the shoeing is bad, or if the animal rests on the sole or is obliged to trot on rough or stony roads, which render the percussion very painful. There arises some irritation, which keeps on increasing, and produces several accidents, such as bruised sole, corns, pumiced feet. The horse which has flat feet often has weak walls, and as the nails of the shoe become loose, this is often cast. By shoeing one may remedy this bad condition of the foot. For this, the foot must be pared flatways, the sole spared, the wall relieved only of what is broken off; the frog must be left alone, the heels also; a shoe somewhat wide in the web, protecting, therefore, the sole more than an ordinary shoe does. It will be adjusted so as to rest on the border of the wall only, and not on the sole ; still, care will be taken not to hollow it too much or to excess. Sometimes a thick shoe only is necessary, without in- creased width. Soles of gutta-percha or felt are also used, as we will see when speaking of the pumiced foot. (b) Pumiced foot (Germ. Vollfuss).—Thus is called the foot whose sole projects beyond the level of the wall, and presents a conyex surface, extending beyond the plantar border, upon which } i y d ANATOMY OF THE FOOT. 585 the horse rests. It is the exaggeration of the flat foot. In the pumiced foot the wall has a great obliquity, sometimes even assuming a nearly horizontal direction. The horse is never born with such feet ; this is amalformation, accidental, or resulting from various causes. One of the most common is lack of care of the foot, of necessary caution, for instance, in paring, or shoeing in such a way as to bring the rest of the foot on the circumference of the under part in such a way that the sole does not touch the ground, and ceases to be pressed by it. Too much concavity of the shoe may bring on this result, by resting only on a too narrow part of the inferior border of the foot ; and by opposition, not enough concavity will compress the tissues, irritate them, and produce the same alteration. Feet become pumiced by laminitis, but this is complicated with seedy toe. Never, then, is the foot pumiced in its whole extent; its deformity stops always at the limit of the inferior border of the bars ; beyond them, behind, on each side are seen the excavations of the lateral lacune of the frog, so much deeper that heels are higher. The hoof does not preserve its circular shape. It atro- phies on the side, and presents at the toe an excess of thickness in the wall; the heels assume a greater development. This deformity is very serious, and disables the horse easily; rest takes place only upon the sole and frog ; after laminitis, upon the sole and heels; it is always very painful. Work upon hard ground and pavement is next to impossible. After laminitis, one sees, during walking, that the foot rests upon the heels, and then by a motion from backward to forward. An animal with pum- iced feet has a tendency to forge and interfere; the slightest bruise of the sole gives rise to serious complications. One often observes wounds, suppurations, etc. The indications are analogous to those of the flat foot; the sole ought to be spared as well as the frog, the walls only ought to be slightly trimmed; the shoe must be made so as to carry the rest upon the border of the wall and protect the sole. When the foot is not pumiced to excess, one must use a broad web shoe, sufficiently concave to allow the sole to rest in it; but it must not be too excessive, as then the base of the rest would not be very firm. A sheet of gutta-percha, or felt, with tar and oakum, may be placed between the shoe and the foot. (ec) Club foot (Germ. Bockhuf).—This is the foot in which the 586 OPERATIONS ON THE FOOT, wall is straightened more or less perpendicularly, or even obliquely backward, so that the superior border of the wall is more forward than the inferior. The superior levers participate always in this vicious direction, which constantly brings back the rest of the foot toward the anterior part of the wall, and, according to its degree, makes the animal walk more or less on the toe, even some- time obliging him to rest on the anterior face of the hoof; the heels are raised from the ground, and the fetlock, instead of being open forward, seems to be turned backward. This deformity, which exists especially in the hind legs, is very common, and is even natural in mules, and supposes, with its presence, high heels, which throw the rest on the toe, which is always very thick. It may also exist with low heels, especially when due to overwork or other accidental cause. Horses which, like mules, are club-footed only by a peculiar condition of the parts, walk with firmness, and even pull better and work better in hilly countries. If they are unfit for the saddle, it is because their reactions are hard, and that they tire the rider. It is not so with those which are club-footed from hard work ; they continually stumble, are subject to knuck- ling, to interfering, or even to falling; and for these reasons do they always require a mode of shoeing which would give them the missing solidity, and render their walk more steady. This cir- cumstance indicates the necessity of sparing the toe, and throwing the weight back on the heels, which, however, must not be pared off too much. The best shoe for such feet must be short, thin at the heels, with a thick toe, shghtly raised upward, and prolonged beyond the level of the border of the wall; small heels to the shoe are often advantageous, as giving an opportunity for rest and relief. The shoe with truncated branches of Lafosse (slipper), which is a short shoe, not extending beyond the quarters, and leaving the heels free, is sometimes used. This shoe is very thick at the toe, and very thin at the heels. It is unnecessary to say that club foot is often cured by tenotomy, or by treatment of the tendinous retraction. (d) Crooked foot.—We «all by this name the foot whose sides are not of the same height; it may be crooked outward or inward. This deformity may result from a vice of direction of the regions above ; ordinarily, however, only from a deviation of the phalan- geal one. Sometimes it is due to bad shoeing, to bad paring of the feet; sometimes it follows unequal wearing of the foot, it being ANATOMY OF THE FOOT. 587 without shoe. Colts which have never been shod, and are walking for a long time on hard and rough ground, often present this con- _ dition. The horse with crooked feet inward, specially if the deviation is much marked at the toe, is exposed to cut himself with the internal heel of the shoe—to bruise himself ; the horse with crooked feet outward cuts himself with the inner toe. Besides these, lameness, from lacerations of articular ligaments, may often follow. This is relieved, especially in young animals, by lowering the side of the wail which is the highest, and sparing the other; the proper shoe for this condition must be thicker in the branch cor- responding to the lower side of the foot. The shoe ought to be changed quite often, in proportion to the existing difference in the height. If the foot is very crooked, it is difficult to straighten it by having a greater thickness of the shoe; it would make this too heavy. Sometimes it is better to use nails with large-sized heads on the lower side of the hoof ; and in these cases one might put on corks at the heels, external or internal, as required. (e) Rammy foot.—This is a defectuosity of the foot, always accidental, in which the surface of the wall offers more or less numerous circles, above each other and running from one quarter or heel to that of the other side. These roughnesses, arrranged in rows, rise always from the coronary band, and form as many elevations gradually descending and disappearing toward the in- ferior border of the wall. They are so much more serious that they are deep, and sometimes are accompanied with lameness, especially when in great number, close to each other, and when the foot is narrow and long. These circles are sometimes seque- lee of laminitis, and accompany seedy toe; the rings are then in the middle of the toe, which is more or less roughened, like an oyster shell, and they disappear only when the primitive alteration is removed. When they are small, not numerous, and grow down without being replaced by new ones, this favorable disposition of the wall must by stimulated by all the means which may stimulate and keep up the suppleness, by light blisters over the coronet. A light shoeing, often changed, is the best in those cases. Circles which reappear continually are due to an intimate and continued alteration, and are in company with other defectuosities, such as contraction, pumiced foot, ete. (f) Foot with bad hoof-—A hoof may be too soft or too dry. 588 OPERATIONS ON THE FOOT. When too soft, too greasy, it contains too much dampness and is lacking resistance. Horses which have this weak hoof, as said Lafosse, have the foot tender and unfit for long walks on hard and stony ground ; they are, besides, much exposed to lose their shoes, because the hoof breaks up at the nail-holes. This fault is quite common in large feet, frequently seen in Northern lymphatic ani- mals, especially in those which come from marshy districts ; if, then, those horses are submitted to stabulation, their hoof becomes dry to excess, which gives rise to narrow and contracted feet. The lower part of the foot must be pared with care, as it has but little thickness ; the application of the warm shoe while fitting must be as short as possible. An ordinary thin and light shoe must be used; the nails will be as light and thin as possible, and ham- mered in carefully. Too dry hoof is liable to break, because it has lost its physio- logical suppleness ; this brittleness is often met in animals whose feet have been much in water and afterward are placed on dry ground; it seems as if the water had dissolved the adhesion of the horny cells. The same condition follows the excessive use of poultices and also of strong grease in shape of ointments. It is wise to grease, but previously the old crust must be removed. Hoof ointments of wax, turpentine or tar are better. The foot is called dérobé (broken) when by the use of a thick nail it is more or less broken at the edges of the wall. These feet lose the shoe easily; animals then go on bare feet, and then it becomes very difficult to put other shoes on. It is necessary in these cases to punch nail holes on the shoe corresponding with parts where the hoof is sound. In paring, all the pieces of broken horn are removed, or at least as much as can safely be done. Nails are secured as high as possible; shoes must be changed as often as possible, and the hoof is to be kept supple by unctuous applica- tions. When the breaks of the horn are too large, softened gutta- percha, or a mixture of gutta-percha three parts, with one of gum ammoniac, melted together, can be used to fill the anfractuosities, all grease having been first removed by a wash with ether; the putty hardens, and the shoe can be tacked on solidly. Nails can even be punched through the gutta-percha. ANATOMY OF THE FOOT. 589 INSTRUMENTS. The surgery of the foot requires special instruments for the operations which influence action upon the hoof, as also for those which are to be performed upon the tissues of the foot proper. Besides those which are commonly required in ordinary sur- gery, such as curved scissors, probes, bistouries and forceps, others are needed of special forms and for special purposes ; among those most commonly used are the different sage knives and drawing knives. Sage knives are lanceolated blades secured to handles, and are either double or right or left. The blade, which is curved upon its long axis, may be sharp on both edges, as in the double, vl til FIa. 485. Fig. 484. Fie. 483. SAGE KNIVES. i (Fig. 483) or on only one or other edge, when it is known as a right (Fig. 484) or left (Fig. 485) sage knife, being thus adapted to use by either the right or the left hand. Drawing knives, which are made somewhat like those used by blacksmiths in the ordinary method of paring the foot, yet differ from those in being straighter in their attachment to the handle, and also on being curved on their long axis, being also sharp on both edges. The groove of the instrument is made to vary in 590 OPERATIONS ON THE FOOT. width, and thus can be used as the different steps of the operation may require (Fig. 486). Sometimes the drawing knife resembles more that of the blacksmith, as being sharp on one edge only (Fig. 487), and in this case the groove of the blade is generally much narrower than in the others. Some special operations require peculiar forms of drawing knives; for instance, those which are FIG. 487. FIGs. 486. Fig. 488. DRAWING KNIVES. made with a blade perfectly straight and narrow, very slightly sharp on the edges, but having a very narrow groove at the ex- tremity (Fig. 488). These are used principally in the scraping of diseased bone-structure, in deep punctured wounds of the foot, and in cartilaginous quittor, when small sections of cartilage are to be removed from the lateral border of the os pedis, which could not othewise be accomplished. Other instruments are also required, the description of which will be given as we refer to the different diseases where they find their applications. GENERAL OPERATIONS. Removal of the sole (Germ. Absohlen).—This is an operation by which the sole of the foot is removed by severing it from the living tissues underneath. In times gone by this operation was extensively performed, being considered indispensable as soon as the slightest lesion under the sole existed. It was alleged that ANATOMY OF THE FOOT. 591 unless this was done the suppuration would be likely to spread underneath the horn. In our days it is rarely performed, as it is considered that it presents but little advantage, so far, at least, as it involves the removal of the entire organ. Sometimes, however, portions of it have to be taken off, as in some special diseased con- dition of the foot, such as in punctured wound, pricking by the blacksmith, burnt sole, etc., the modus operandi of which will be considered when treating of these diseases. Removal of portion of the wall.—A few morbid conditions of some parts of the foot require in their treatment the removal of a portion of the wall, in order that the escape of pus, the removal of diseased tissue, or the sloughing of necrossed cartiliginous or bony structure, as in complicated cases of suppurative corns, of quarter-crack or in cartilaginous quittor. A similar operation is sometimes required in cases of toe-crack, complicated with disease of the os pedis. These will be further considered when treating of these special subjects. DReEssINes. As nearly every operation of the foot requires a mode of dress- ing peculiar to the manipulations which have been necessary, we shall, when speaking of the different diseases, where parts of the walls have been removed, include also a description of the peculiar dressing they require. There is one, however, which is thought much of in veterinary surgery, and of which we will have to say more when speaking of punctured wounds of the foot. This is the dressing with plates, which serve to retain the plantar surface, the balls and pads of oakum, which are placed to protect the wound. The application of these plates is far superior to the leather sole, because of its easy removal when the parts are being examined, and of their easy replacement; thus allowing the surgeon to change the dressing whenever he sees fit, without being obliged to remove the shoe. DISEASES. CANKER OF THE Foor. (Germ., Strahlkrebs, Hufkrebs).—Under this somewhat un- scientific,* though accepted name, is designated a peculiar disease * Crapaud of the French. 592 OPERATIONS ON THE FOOT. of the feet of solipeds, seated in the secreting tissues of the horny box, always beginning at the frog, and characterized by alteration of the horny secretion. Names of a more scientific meaning have frequently been proposed, such as gnawing ulcer (Bourgelat), schirrus or cancerous carcinoma of the frog, carcinoma of the reticular tissue of the foot (Vatel), darter of the plantar cushion, chronic podoparenchydermitis (Mercier), and epithelioma of the Jrog (Fuchs). None of these has ever been accepted, and the old hippiatric name has been retained. History.—lt is conceded that the old veterinarians were ac- quainted with canker, and Vegetius evidently speaks of it, but not until the time of Solleysel do we find a description somewhat complete of the disease and its treatment; Garsault, La Gueri- niere, Weyrother and others spoke of it, and have expressed various opinions as to its etiology, and especially as to its treat- ment. Solittle progress was discernible in the writings of Bour- gelat, Chabert, Huzard and Girard, on that very question, and so many false ideas were admitted, that Chabert in despair has called canker the opprobriwm of veterinary medicine. It is but recently that serious research as to the nature of the disease have thrown some light on the question, and estab- lished the important fact that its seat is not in the disorganized horn, but in the secreting organs, and that there is an alteration in the products of this secretion ; that it is consequently to these that remedies must be applied. We might refer to the writings of Jeannie, Crepin, Hurtrel d’Arboyal, Prevost, Mercier, Plasse, Percivall, Dietrichs, Eichbaum, Wells, H. Bouley, Reynal, Haubner, Fuchs, Rey, Megnin, etc., each of whom has furnished his contingent, while still the inti- mate nature of the disease remains but imperfectly known, and there is but little certainty either in the treatment or its results. Let us observe, however, that in our day canker has become comparatively a rare disease, especially in cities, which, doubtless, is because of the cleanliness of the streets. In the beginning of this century, canker and grease—closely related diseases—were frequent in Paris; then horses were obliged to travel through deep gutters of mud, while to-day these affections are exceptional occurrences (H. Bouley). The same thing has been observed by Percival in England. When hygienic precautions were not as well understood as they are to-day, in establishments employ- ; DISEASES. 593 ing large numbers of horses, when the stables of mail and stage coaches, and even those of military garrisons, were small, ill-venti- lated and dirty, among horses standing in filth and soiled manure, these affections were relatively common ; with hygienic improve- ments, they have almost disappeared. In the army, canker was the cause of considerable annual loss, almost as serious as those from glanders; to-day it is rare and almost unknown. Improvements in the different breeds of horses, either by bet- ter choice of reproducers, or by changes in the mode of feeding, resulting from the progress of agricultural processes, the suppres- sion of common pastures, etc., have contributed to render the disease less common. Symptoms.—lt is seldom that the symptoms of canker can be observed from the start; slow in its progress, and not surexciting the sensibility of the parts, the disease may progress without manifesting any ill effects, and consequently escape notice by the owner or groom, nothing appearing to call his attention to the affected foot. Thus, in a majority of cases canker is only dis- covered after it has been in existence for a considerable period, and when serious alterations have already taken place. It is often at the shoeing shop, when the shoes are changed, that in the laminze is observed a moisture more or less abundant, giving rise to softening and raising of the hoof. The disease sometimes attacks only one foot, often several feet at a time; at times when one foot is cured, another becomes affected, and the disease thus appears traveling alternately from one foot to another. Usually the disease begins with the inflamation of the kerato- genous membrane which covers the median lacune of the plantar cushion; the hoof covering this is softened, raised by a serous moisture, and once loose, is not renewed, the tissue producing it having lost its function of secreting the horny substance, and now secreting a serous element, which becomes the caseous matter of which we shall speak hereafter. Sometimes the disease begins by moisture in the hollow of the coronet, by a kind of grease, a disease which we shall see to be of the same nature as canker. Theis an cedematous swelling, warm, somewhat painful, of the phalangeal region, first serous, then be- coming opalescent, which seems to filtrate through the softened, but not yet raised, epidermis. This inflammation, spreading little by little toward the hoof, extends to the plantar keratogenous 594 OPERATIONS ON THE FOOT. membrane, and gives rise to an exhalation of the same nature as that of the skin which produces the separation of the hoof, and the first marks of canker. Sometimes one may observe at once, a fungoid growth of ficus, formed by an hypertrophy of the tissues underneath ; this growth is more or less moist and offensive, bleeding easily, having the aspect of cauliflowers, and protruding through a break of the softened hoof, and forming a thready detritus to be subsequently studied. Commonly, the hoof is more or less loose, and under it is a caseous matter, greasy, ordinarily of a foetid odor, easily re- moved by scraping, being non-adherent to the tissue which secretes it. Ifthe parts are well cleaned from this, the velvety tissue of the pyramidal body of the frog, appears to be covered with a smooth membrane of a slight whitish color; the external layer then appears formed by a pellucid epidermic covering, show- ing through its transparency the purplish color of the capillaries underneath. The velvety tissue is diseased, but still retains its functions, which, on the contrary, are increased but perverted, and instead of secreting a horny substance which adheres to the surface of the keratogenous membrane, produces the caseous mat- ter already referred to. The break in the hoof frequently seems small in size. Nevertheless, the alteration of the keratogenous tissues, viz: the substitution for its normal, of a pathological se- cretion, whose product is this loose caseous matter, is far ad- vanced. There is then an extensive, though a concealed separa- tion of the hoof. One then must not allow himself to be deceived into supposing it to be a limited diseased process, by the apparent external integrity of the horny box. The characteristic of canker is its tendency to spread, like can- cerous affections. Once manifested in any part of the sub-horny tissues, the special changes which characterize the disease seldom remain circumscribed; on the contrary, they generally extend from that part asa centre, throughout the whole circumference, and little by little, attack slowly but continuously the whole ex- tent of the secreting apparatus, and thus loosen the entire horny box—starting from the median lacune, or the glomes of the frog, it extends to the branches and the body of the plantar cushion ; then spreads at the side, in the lateral laminz, from there all round on the velvety tissue, then by degrees reaches the inferior ex- tremity of the podophyllous lamine and going upward, reaches Sua va DISEASES. 595 the coronary band, the last point, where, in extreme cases, the hoof preserves its adhesions with the tissues which form it. In this condition the disease process progresses more slowly than be- tween the sole and the velvety tissue, and then it seems to remain stationary; otherwise the aropping of the hoof would be possible. We have seen that often at the beginning, but especially as the disease progresses, there are growths called fici, found principally round the laminz, the frog and the sole.- These are of whitish color, opal, varying in size and in shape; they constitute an irregular mass, formed of those fici pressed together; some of these growths have a wide basis, others are somewhat peduncu- lated ; sometimes they are single, tubercular, slightly elevated ; at other times elongated bodies, true fibrous bundles. The fici are nothing more than the normal villosities of the keratogenous tissue which have become tumefied and hypertrophied, and are found principally where, in the normal state, the villosities of the velvety tissue are themselves more numerous and more developed. Where these vegetations are confluent, as upon the sharp edge of the bone, they are separated from each other by a kind of deep sinu- ous grooves, filled with the caseous matter secreted by the diseased keratogenous structure. These growths bleed easily and grow rapidly again when excised. Those most developed, and which seemed to form a homogeneous mass, constitute, however, an ageregate of smaller vegetations united in a certain part of their extent, and continued at their bases. Besides the vegetation of the living tissues, the plantar sur- face of the foot presents, in old cankers, isolated fasciculi of solid horny substance, of thready appearance, soft, analogous in their form to coarse brushes whose hairs are glued together. These isolated, still adherent, brushes are seen spreading toward the sole; they correspond with parts of the velvety tissue which have maintained their soundness in the midst of the diseased surface, and there continue to secrete healthy hoof. These horny growths are ordinarily multiple, and are of various shapes, often twisted, and give to the plantar surface a peculiar aspect, so much so, that their brushy masses sometimes retain the mud of the streets and are filled at their bases with a black and fcetid substance of an ugly appearance. When canker has arrived at a very advanced period, it is char- acterized by the deformity of the whole horny box, whose length 596 OPERATIONS ON THE FOOT. and width is considerably increased. The last of these conditions isa sure sign that the disease has spread under the wall of the quarters and of the heels, and has produced the complete separa- tion of the bars from above and below. When percussed, the hoof at the heels givesa dull sound. The excessive length is only an indirect consequence of the disease, and is due to the fact that, so as to keep the animal at work, the walls are spared as much as possible by the blacksmith, so as to avoid the contact of the protruding parts with the ground. Physiological signs are almost entirely absent in canker. It is a curious fact that the sensibility which is generally highly in- creased in all affections of the foot, even in chronic diseases, re- mains always so obscure in canker that animals may be used for a long time without lameness, though the sub-horny tissues have become quite unprotected over a large surface. Complications.—Very frequently, canker is complicated by a disease of the skin, analogous to it, known as grease ; a disease which, if not entirely of the same nature, as admitted by Plasse, Megnin, etc., is closely related to it. It is often through this that canker begins, and very often the two diseases exist together in the same animal, one sometimes following the Maasai ay as canker of one foot follows that of another. i Among the complications of canker, as generally admitted, are some injuries of the plantar cushion: inflammation and necrosis of cartileges, ligaments or tendons, and even caries of the os pedis and anchylosis, which are sometimes observed ; however, a close examination of the facts allows us to say that these accidents do not arise under the simple influence of the disease alone, but that they are due to the improper use of sharp instruments, of the actual cautery, and especially of potential caustics. As La Gueri- niere said, the deep lesions of tendons and of the os pedis, which are observed in severe cankers, have no other cause than the action of too powerful dessicatives. Duration, march, termination.—Canker is an essentially chronic disease, and may be of long continuance, even lasting for years. Still, under this heading there are. many variations, whose cause it is difficult to find. There are horses whose disorganization of the hoof is complete after two or three months. There are others where the disease remains stationary for more than a year. We have seen it remaining limited to one lacuna for months, and all eS a eT. it ail Mee lle DISEASES. 597 ‘at once assume a rapid evolution of disorganization. We have noticed this principally after the use of sharp instruments. Generally, animals affected with canker feed well, and for a long time retain a good condition ; toward the end, however, they lose flesh and exhibit symptoms of septicohemia, especially if affected with grease. We do not admit that, as advanced by some, canker can give rise to such virulent diseases as glanders and farcy. ; Diagnosis.—At the beginning, canker may be confounded with thrushes, and many veterinarians have considered this as the first stage of canker. There is, however, a great difference be- tween the two: first, as to the anatomo-pathological point of view, inasmuch as the pultaceous, foetid secretion is less abund- ant; that the loosening of the hoof is less, and that there are no fici; and again, especially in the point of view of the treatment, where single cases of cleansing, with or without dessicatives, easily control it, while canker remains rebellious to them. Prognosis.—The prognosis varies. Where the animal is young, well fed, and the disease is not too old, it is favorable. Yet it remains uncertain, as often the most benign form may last long and remain rebellious to all treatment. The severity and the extent of the internal lesions cannot be estimated by the altera- tions or deformities of the hoof, as these appearances are often deceptive. Canker, though considered incurable for a long time, is not absolutely so—far from it; with rational treatment, prop- erly carried on, it is curable in the majority of cases. There are cases, however, not very rare, where relapses and useless attempts have discouraged the owner as well as the veterinarian, and where it has been more advantageous to destroy the animal rather than to submit him to a long, tiresome, and always expensive treat- ment. Pathological Anatomy and Nature of the Disease.—It has always been considered that a morbid condition susceptible of producing disorders so severe as those produced by canker, must necessarily be a deep affection, essential and important to the organic structure, and depending on a complete transformation in its texture. And, indeed, it is the impression which predominated from the time of Solleysel down to the foundation of veterinary schools and which still exists with Girard, who considers canker as a gnawing ulcer which changes and alters the tissues it invades, 598 : OPERATIONS ON THE FOOT. and even with Vatel and Hurtrel d’Arboval, who looks upon canker as the carcinoma of the reticular structure of the foot. It is but recently that these ideas have been abandoned. Du- puy, in 1827, considered canker as a hypertrophy of the fibres of the hoof, admitting at the same time the disintegrations and softening of those same fibres occasioned by an ammoniacal sap- onization produced by an altered secretion. In 1841, Mercier expressed the opinion that canker is nothing more than a chronic inflammation of the reticular tissue of the foot, characterized by diseased secretions of this apparatus. It is now known that there is in canker no essential alterations of the sub-horny tissues; no radical change of their substance, and no deposit of heteromorphous molecules in their structure. This last mentioned fact was well observed by Robin, who in his microscopical remarks constantly observed the absence of the characterizing elements of canker. Hertwig and Haubner, who have made researches in the same direction, arrived at the same result and have noticed the absence of any cancerous cells in canker. This opinion is, however, doubted by Glisberg and Fuchs, who look upon canker as an epithelioma, though they bring no sufficient evidence to establish it. Except vegetal parasitism, of which we will speak hereafter, and which makes of canker a true dartre, an herpetic disease, as demonstrated by Megnin, there is only in canker a chronic in- flammatory condition of the sub-horny tissues which is mani- fested by a perversion in their secretion, and is complicated by a morbid hypertrophy of the villous processes by which their sur- face is normally covered. Robin has seen in the fici, papillae made thicker and more brittle by the plastic infiltration which moistens them; he has observed besides, that at the points where the secre- tion is good, it is so active, that instead of drying in sheaths, to scale off afterward in transverse pieces, as normally occurs in the frog and sole, the epithelial cells grow lengthwise, as those which form the walls of the foot. Hence these long, horned, twisted threads (epithelioma?) which are seen rising from the sole of long affected cankerous feet. It has sometimes been admitted that fici had deep roots in the tissues, and even in the plantar aponeurosis, which is an error ; injections and macerations having shown that there are no essen- tial changes in the anatomical structures of these parts, and that DISEASES. 599 what have been considered as the roots of fici were only cellular tissues, which has become indurated under chronic inflammation (Bouley). Fici are only fasciculi of villosities whose vascular net- work is no longer retained by the thick horny box which encloses them and which is infiltrated with plastic material. Bouley has already admitted that canker could not be better classified than among skin diseases, with and after dartroid affec- tions, and thus gave reason to Huzard senior; Plass also found that canker had the greatest analogy with grease, and that in it the nutrition of the horn underwent the same alteration with nu- trition of hairs in the second affection. Megnin, in 1864, observed, in operating upon fresh pieces taken from the living animal, and from one which had not received any treatment, that in canker there is constantly a cryptogam, as in favus, and that canker is a parasitic affection. Examining the caseous product of the abnormal secretion which characterizes canker, Megnin found in it a large quantity of very animated vibrios, swimming in a liquid having in suspension nu- merous epidermic cells more or less advanced in dissolution; he found besides rounded corpuscles, which he recognized as the spores of the cryptogam, and from which the vibrios escaped at the maturity of the granulations there contained. In examining the fici, he has recognized them to be an aggregate of hypertrophied villosites, at the base of which were found in the mass obtained by a slight scraping epidermic cells or parts of cells enclosed in a net-work of inter-crossed, ramified threads, appearing to rise from certain centers marked by an agglomeration of spores, forming in their whole a yellow spot. In the water of the microscopic prep- arations, one finds also several of these isolated threads, epithelial cells, globules of lymph, of blood and finally spores; very rarely vibrios ; oftener micrococci. These threads are nothing more than the parasites, the mycelium product of the vegetation of the spores ; those contained in the serosity, swell, break up, and the granulations which escape from them become for some time the vibrios, or as we prefer to call them, pseudo-vibrios ; as soon as the brownian motion, which for some time animates the eranula- tions, ceases, the cells which have proceeded from them (the micro- cooci) gather together in chains and form the characteristic threads of the mycelium. This parasite of canker has been named by Megnin the kera- 600 OPERATIONS ON THE FOOT. phyton or parasitic plant of the horn, by analogy with the tricho- phyton, the parasite of the hair. We consider this name very appropriate and prefer it to the name of odiwm batracosis, parasite of the canker, which Mr. Megnin has also proposed. Etiology.—The causes of canker are yet but little known; there is one, however, which cannot be ignored, and which, if it does not produce the disease, assists materially in its develop- ment and is indispensable to its existence. We refer to the con- dition of dampness. It is that influence of dampness which explains why the disease is so very common in the marshy lands of Poitou ; in the pastures of Holland, and in general in low grounds ; and why it is more frequent in northern than in southern coun- tries. Canker is incomparably more frequent in rainy seasons than in those where dryness predominates. We have already seen in the history of the disease that it is since the streets and the stables of administration are kept more free from dampness that canker has become less common. Sometimes the action of direct irritating causes has been admitted, and then the canker has been attributed to irritating muds and the excrementitial liquids of stables ; their contact often giving rise upon the skin, upon the glomes of the frog, to an ery- thematous inflammation, soon followed by a serous flow, which ex- tends to the sub-horny structures and gives rise to an exudation in the lamine of the frog. This cause produces the rotten frog (thrushes) but not canker. We believe that this cause has princi- pally been admitted by veterinarians who look upon thrushes as the first stages of canker, but this is not so, and for canker to develop itself under similar conditions, others are necessary, which are as yet unknown. Canker has also been attributed to narrow and contracted feet, so common in horses of meridional climates, and in which the sole is very concave, with the frog and pyramidal body shrunk in. Often in the lamine of these feet a sero-purulent moisture is dis- covered, more or less offensive, which is a rotten frog, but not canker, and but seldom followed by it. To produce canker a simple irritation of the sub-horny struct- ure is not sufficient. There must be a special cause, proper to canker, stimulating alone the characteristic changes of the cause. This cause we find in the eryptogam which characterizes canker, , propagates it, and which has no power of spontaneous existence. oe i DISEASES. 601 As with other parasitic diseases, canker is communicable by contagion ; although the examples are quite rare they cannot be doubted. MHutrel, d’Arboval, Plass, Blind and Megnin have ob- served them, and in all the cases dampness has contributed to the propogation of the cryptogam. The lymphatic constitution in an animal is eminently propi- tious to the development of canker, as it is observed to be, in fact, for all parasitic diseases. It is known by daily observation of facts that horses whose skin is thick, with the hairy system well developed, the feet flat, ‘with thick frogs, are more often affected with canker than animals of a nervous constitution. It is more particularly observed in horses with much white at their extremities, with stockings and white feet, and in those where there is a tendency to albinism. An unknown diathesis has also been considered as causing a predisposing constitutional organic condition, but this has not been justified by observation. It may happen that canker cured or dried on one foot, may attack another foot, perhaps a third, and then a fourth, to re-appear in the first; this character of the disease has often been mentioned as proof of this diathesic condi- tion ; but it may also be explained by its contagious character. The disease remains too much localized to be constitutional, as generally in diathesic diseases we have critical ernpuons upon different organs or different tissues. : Treatment.—From the preceding remarks, it is evident that in feet affected with canker, the keratogenous apparatus of the foot has undergone no essential alteration in its structure, that its thickness and density have only increased by consequence of the infiltration and organization in its net-work of the plastic products of inflammation. And, again, the secreting function of this appa- ratus, far from being arrested, is on the contrary, more active; but the products it gives instead of being concrescible, remain difflu- ent; hence the impossibility for the hoof to be restored in the regions where this alteration of secretion exists and remains. These important facts, says M. Bouley, must take the lead in the chapter of the therapeutics of canker, because they teach the practitioner that the object to effect, in the treatment of this dis- ease, is not to radically destroy the diseased tissues, as has been too often done and recommended, but to return to them their physical and physiological properties by the application on their 602 OPERATIONS ON THE FOOT. surface, of modifying agents which influence the nutritive and secreting functions of their tissues without interfering with their structure. To reach this point, the most varied pharmaceutical agents have been recommended, the most successful being those which at the same time had parasiticide properties. We, however, find it difficult to give the preference to any of them; and we have now more faith in the modus faciendi, to the skill of the operator, to the continued use of dressings properly applied, than to such or such agent; all of those which have been recommended if methodically applied, can cure canker, and it will be wise to em- ploy them alternatively ; when one fails at first it is prudent to try another; canker is a disease so often rebellious to treatment, especially when confined to the lacune of the frog, that too many remedies cannot be used. The first indication is to remove the excess of the horn of the wall, the length of which, we have said, is often very great; then prepare a convenient shoe for the dressings. This shoe nec- essarily varies, as canker is exclusively localized to the plantar surface of the foot or extends to the podophyllous laminze. Gen- erally an ordinary shoe is used, more or less covered (wide) and so hollowed as to allow the free application of plates by which the dressing is kept in place. When the condition of the disease requires the removal of large pieces of horn, a truncated slipper is used, proportioned in cutting to the extent of the parts of the wall upon which it is to be applied. There are circumstances even when shoes cannot be used, so much does the disease extend under the wall. It is then necessary to use a shoe without nails, or boots, secured to the coronet by means of straps. In all cases the rule is to take care that the dressings remain fixed in the most exact manner, and that through them a methodic, steady, but not excessive pressure is constantly applied over the diseased parts. The first step of the operation passed, the next consists in the removal with proper instruments of all the loose portions of the horn, either at the plantar surface, at the quarter, or at the heels. One must avoid, in this operation, the excision of soft parts; but the important indication is to follow the disease where- ever it exists, and to leave no part of the horn which may haye been detached by morbid exudations. Better cut the healthy structures, and have them bleed, than to neglect to completely expose a diseased part. This done, the horn is to be thinned as ‘ aa DISEASES. 603 much as possible, upon the circumference of the diseased spots, in order to give a suppleness which would ease the swelling of the uncovered parts. Upon the exposure of the disease where it exists, the fici exist- ing on the surface and edges of the velvety tissues are to be removed with the scissors or sharp sage knife; at the same time the parts of horn which may have remained are to be cut off, avoiding, however, the healthy tissue beneath, which still retains its normal character. When the canker is very extensive, so that the wall is loose on each quarter, or on all its circumference, it is of advantage to pro- ceed in the required operations at different times. This done, the shoe can be put on; after which the diseased surface and surrounding horn are to be covered with a thick layer of the medicamentous preparation. If this isin form of a paste, as is often the case, it is spread over with a spatula. If in powder, it is thrown over it carefully. If liquid, balls of oakum are soaked with it and placed on, the whole being then kept in place by pads and plates. The important point is that the dressing should be so applied as to be easily changed, that an exact, regular and sufficiently strong pressure be kept on. No better means can be used for this than the divided plates already referred to. In canker the dressing must be renewed every day, and even twice daily at the beginning of the treatment. This is an essential condition of success, whatever may be the therapeutical agent employed ; and this is not a simple difficulty in practice where the patient is not always of easy access. Moreover, this dressing is somewhat complicated, and can only be skillfully made by the vet- erinarian himself. It often occurs that upon the removal of the first dressing, (the second day) one finds the tissues already covered by a layer of hardened horn, adherent to the surfaces. One must then, with the finger, a spatula, or a dry pad of oakum, rub it off where it is found loose and movable and, if necessary, renew the application of the dressing. The same must be done at the other dressings, carefully watching if this new horn thus formed by the influence of the medication, is not separable from the parts underneath by the different morbid secretions of the disease. One must then carefully scrape off all that is not adherent, and thin the edges, and the projections of all the horn which retains its soundness ; 604 OPERATIONS ON THE FOOT. the caseous substance being also removed; the same compressive dressing to be put on again. The modification in the horny secretion, and the formation of a layer of hardened and adherent horn, are especially great in the parts where podophyllous and velvety tissues exist; but are very slow, and surrounded with difficulties in the median and lateral lacunz of the frog. After ten days of treatment, one may have brought about a normal secretion on the whole circumference of the sole, on the inferior face of the os pedis, and on the prominent parts of the pyramidal body. But in the lacunz the alteration remains isolated, and resists treatment; and it often happens that, if neglected, it may again spread and the disease reach its former extent. It is then the case, when the disease is limited to the lacunze, to add to the ingredient already in use and which is kept applied upon the restored parts, another stronger and more active agent, sometimes simply absorbent; here again it becomes diffi- cult for us to advise the practitioner, the number of recommended drugs being very large and the result depending less on their nature than in the intelligent and persisting manner with which it is applied. When caustics are used, it must be done with great care, to limit their action only to the thickness of the keratogen- ous tissue, and not to carry it to the destruction of the bone, or still worse, of the plantar aponeurosis. Let us glance at the drugs which have proved most successful in the treatment of canker: First we have the different pyrogen- ous preparations, especially wood tar, recommended by Bracy, Clark, Reynaland Bouley, and which give astonishing results. Gas tar, oil of cade, petroleum and soot have also been used, but with less advantage ; creosote and phenic acid have often shown them- selves very useful, by penetrating easier to the base of the villosities where the parasite resides and thus acting more regularly ; phenic acid proved very useful with Krause, Gerlach and Zundel. After these the best recommended preparations are the salts of iron. Hertwig seems to be well pleased with the powder of sul- phate, and Arnold recommends the pyrolignite of the same metal ; Megnin advises specially the perchloride, which, like phenic acid, is rather a powerful astringent than a true caustic. The prepar- ations of copper have also had their time, and especially the aceta- tes, such as the egyptiacum ointment (Girard, Schaack, Rainard and Rey); the baths of sulphate of copper were employed by ~ ee eee. DISEASES. 605 Verrier, Jr., of Rouen; a solution of sulphate of copper and of zine in water or vinegar were recommended by Delaval and Haub- ner; Solleysel employed the preparations of copper, but added to them arsenic andother drugs ; Eichbaum preferred the powder of chloride of lime, and Rauch ordinary lime, while Aubry employed a mixture of lime and caustic potash. Caustics were well recommended by other practitioners, but their prescriptions seem to be contrary to the rule we have laid down in the beginning. However, one must not forget that the tissues of the foot, especially when diseased, offer an extraordinary resistance to the action of caustics ; they are, so to speak, impene- trable, and the irritation they produce remains superficial, while where those tissues are healthy such agents produce a deep cau- terization. Again, this resisting force of the indurated tissues against the actions of caustics is limited, and it is possible that one, two or three applications may apparently remain inefficacious, where a fourth or a fifth will give rise to extensive cauterization. The result is explained by the repeated irritating influence of the caustic agent, which, by gradually increasing the vascularity of the parts it touches, increases also the means of their absorption and imbibition. These facts must also be present to the practitioners mind, and it is by them that he will be guided in their use, rendering them at will, simply modifying, catheretic, or deep caustics. Nitric acid was used by Percivall and Delorme, the latter con- sidering it the best means in use. Sulphuric acid has also been employed, seldom alone, but mixed with agents likely to reduce its effects and render its applications more convenient. Collignon and Renault recommend its reduction with alcohol; Mercier mixed it with four parts of oil of turpentine; Prangé with equal parts of tar, and Plass made a paste of it with burnt alum. This last remedy, very simple in its formula, was applied without any dressing ; it has proved most excellent in a great number of cases, but may give rise to too deep cauterization (Bouley, Mendel). Arsenious acid was much used by old horsemen, combined with cegyptiacum, turpentine and otheringredients. Hoffmann prefers the arsenite of soda in solution ; he sold his secret to the Austrian government for a high price. Butter of antimony was recom- mended by Huzard Sr., Prevost, and especially Huzard ; chloride of zinc was preferred at the Lyons school. The treatment of canker by actual cauterization was indicated 606 OPERATIONS ON THE FOOT. by Solleysel, but soon abandoned by him. In applying the cau- tery upon the uncovered tissues of the hoof, we encounter the chance of producing a very severe inflammation, which spreads by degrees and gives rise to extensive slough of the hoof, as a con- sequence of the serious exudation which takes place; the action of the cautery may then become either too mild or too vigorous. Still, it has been recommended by Prevost, of Geneva. Hurtrel d’Arboval, who also employed it, used it in the following manner: the parts being covered with a mixture of gunpowder and sulphur, a red-hot iron was applied to the spot, the powder burning sud- denly and the sulphur slowly. If the combustion was too slow, he increased it and kept it up by the same means. When the operation is concluded the parts are transformed into a black scar, which can be easily removed by scraping, and the application and cauterization may be repeated, and so on until it appears that a sufficient amount of heat has penetrated the tissues to destroy the material by which canker may be regenerated. The cauterization being once properly effected, then in order to sustain irritation, the foot is covered with Burgundy pitch, or resin, melted and warm, which is allowed to cool off on the foot, when a dressing of oakum and the shoe are put on. The dressing is changed as soon as suppuration shows itself and renewed with the same ingredients in the same manner until the wound becomes healthy and granu- lating. It is only for the sake of the record that we refer to the ex- clusively surgical treatment, based upon the erroneous idea that the fici of canker are abnormal products, deeply implanted in the tissues beneath, and where it was advised to look for the imagin- ary roots of these fici at their extreme limits. In this treatment, not only the diseased horn was removed, but the entire sole, the plantar cushion and often the plantar aponeurosis was excised. This practice, advised by Lafosse junior, was also recommended in the veterinary schools by Chabert in France, and Dieterichs in Germany. It prevailed for a long time, though experience showed that the wound resulting from such an operation was of very slow recovery, that the frog especially could not be regenerated, that there remained a central ulcer, and that it gave rise to such a mal- formation of the foot that the animal remained lame for a long time, sometimes for life. Notwithstanding these objections, ob- served by Jeaune, Girard and Eichbaum, this treatment is still * ee oad | , ill ne ,? 7 DISEASES. 607 followed by a few who prefer it to the simple operations of Solley- sel, which consists in the division of the loose pieces of horn and the excision of the fungoid projections. We have thus far only spoken of the local, without referring to the internal or constitutional treatment of canker, recommended by those who look upon the disease as constitutional. Without believing that it can have any real curative effect, we, however, admit its usefulness, when the disease is of old standing, and that the animal has suffered much by it. Ferruginous preparations are specially advisable, and we prefer the carbonates that are used by Delwart to the sulphates recommended by Prevost, Delaval and Hertwig, and it is well to unite them with bitters and tonic powders. Arsenious acid is prescribed internally by Delaval, Feuillette, Niederberger, Obich; and other alteratives, such as mercury, which we would not advise. Nor can we understand how any benefit is to be derived from diuretics and purgatives, and especially from the use of external emunctories, such as setons. Corns. Under this name is understood an alteration of the tissues underneath the hoof; of the heels of the horse’s foot by lesions of the living parts in the movements of expansion of the hoof; by bruises, compressions or contusions. There is then a capillary hemorrhage which extends in ecchymosis in the hoof. A corn, then, is a bruise of the living horn at the extreme end of the branches of the sole, and especially in the laminated tissue of the folds of the bars. It is a very common disease, and one to which all horses are exposed. Some have them constantly. Corns are seen mostly on the fore feet, and on the inside more commonly than on the external side. They are rare on the hind feet, because in the various gaits the weight of the body is carried more on the front legs and on the posterior part of the foot, while in the hind legs it is the front part which principally receives it. I. Divisions.—Lafosse Sr., has distinguished them into natural and accidental, while Girard considers them all as accidental. H. Bouley designates as essential those which come from other than external causes. We believe that it would be better to establish the divisions on pathological and anatomical bases, and admit a 608 OPERATIONS ON THE FOOT. corn of the wall, or laminated, that which has its seat in the laminze which unites the wall to the tissues underneath, viz., in the keraphyllous and podophyllous tissues of the heels and bars, and a corn of the sole, or velvety, that which has its seat in the velvety tissue which unites the sole to the fleshy parts. The laminated corn corresponds exactly to the “natural” of Lafosse and to the “essential” of Bouley. It is due to lacerations in the movements of expansion of a badly-made foot. The other is due to contusions. Whatever may be the adopted divisions, we, with Girard, and as admitted in practice, recognize in each category, the dry, the moist and the suppurated corn. Il. Htiology.—All feet are exposed, but not all predisposed to corns. They are more frequent in heavy feet, with those where the heels are high or contracted in which there is a motion of re- traction of the hoof which interferes with the displacement back- ward of the third phalanx at the time of rest, and hence the lacera- tions are easy; besides, there is a continual pressure upon the living parts of the posterior region of the nail. Corns are fre- quently observed in excessively long feet where the hoof does not receive the moisture necessary to its elasticity ; it then losses its suppleness and fails to assist the internal motions of the parts contained within. It is seen whenever the hoof is too dry, the posterior diameter of the feet being then diminished. Corns are seen on weak feet, on which the hoof is too thin to resist the dilating effect of the internal structure, and spreads excessively. Wide and flat feet, with low heels, in which the interior surface of the branches of the sole is on a level with the plantar border of the quarters and bars, are very often affected with corns. The pres- sure of the shoe or the roughness of the ground produce these bruises through the sole. Here the conditions are unfavorable to the normal dilatations of the hoof; the ungeal phalanx, being unsupported by the convexity of the sole, has a tendency to drop down lower, the tissues are easily lacerated and bruised in its dis- placement at the time the foot rests on the ground. The most serious causes of corns arise from the shoeing, which not only sometimes gives to the hoof a shape predisposing to that disease, but also very often is a determining cause itself of these injuries. “As long,” says Hartmann, “as horses will have corns, horse-shoeing cannot pass as an art, and their too frequent pres- ence is an evident proof of our imperfect means of protection to DISEASES. 609 the hoof.” Without shoeing there would be no corns, and it is in its irrational methods that the true causes of these accidents originate. It is by the greater or less frequency of corns that one may judge of the state of that art in a country. The faults are found, 1st, in the manner in which the foot is pared, or in the shape which it receives ; 2d, in the fitting of the shoe; 3d, in its application. In paring the foot, the sole is often weakened and thinned too much; it does not resist the pressure, and, at the time of resting the foot, all the weight of the body is thrown upon the point of union of the sole with the wall. Ordi- narily too much has been cut away from the frog, and this not resting any more on the ground, no longer resists the pressure, and the lowering of the branches of the sole is then extreme, as proved by the experiments of Leisermg. The custom of cutting the corns, and of cutting the hoof at the heels, acts in a similar manner; the posterior half of the foot is weakened, and that is the part which must carry the greatest part of the weight. One needs only to compare a foot from which the shoer has removed much horn at the sole, frog and bars, with one in which the hoof has been left alone for a long time. In making a vertical and tranverse section of the two in the middle of the frog, a little in front of the angles of the sole, he will see at once how weak the point of reunion of the sole with the wall has become, the means of resistance to the pressure of the weight of the body through the third phalanx being thus diminished, and consequently a pre- disposition to bruises created. The shape of the shoe also contributes to corns ; an excess of concavity ; a shoe which from the last nail-hole is not flat to the heels, whose branches are too much inclined, contributes to the lateral contraction of the foot and givesrise tocorns. In this case the shoe resists the play of the horny box, and by itself, through the sole, exercises a great pressure upon the tissues underneath. Too high caulks, in preventing the resting on the frog, cause an excessive pressure on the inside of the foot, and compel it to rest on the heels and the branches of the sole, which are too much lowered. The opposite excess, when the shoe is thin at the heels, as in the Coleman shoe—which is thick at the toe and thin at the heels—produces a similar result, because in increasing the pres- sure on the heels, it gives rise to bruises of the tissues through the retrossal processes, which comes down too heavily. A very 610 OPERATIONS ON THE FOO". wide shoe, too thin, may also contribute to the genesis of corns, because, then, the shoe helping, with the intensity of the reactions on the pavement or on too hard and stony roads, the shoe soon gives under the foot, and compresses the sole and tissues beneath, The manner in which the shoe is put on may also be a cause of corns ; the shoe ought to rest exclusively on the inferior border of the wall, and not touch the sole; when it is too narrow it may be a cause of contusion or of contraction; if too wide it prevents the natural expansion. It is upon horses long shod that the wrong application of the shoe as a cause of corns is observed. As a con- sequence of the growth of the hoof, the shoe no longer sufficiently _ protects the plantar border of the foot, the heels of the shoe being inward and pressing on the branches of the sole ; this is especially the case when the shoe is thinned by wearing ; it yields, and easily bruises the parts of the sole on which it rests; high caulks, on a branch already too short, or too thin, act the more injuriously be- cause, not being concentrated on the projection of the caulk, the branch gives away sooner, and presses still more on the heels. The shoe becomes an indirect cause of corns, when hard sub- stances, as stones or dry earth, are found between its superior and inferior face on the sole, or between the frog and the internal bor- der of the branches of the shoe; this is a secondary cause, which was formerly considered of great importance. The work of horses has a great influence, corns being very fre- quent in horses which work on pavements and stony and hard roads. They are rare in country horses, but common in those of great cities; a rapid gait contributes to their development on account of the great pressure on the ground. The seasons have also an influence, dry and warm weather depriving the hoof of its moisture, and by preventing its elasticity of motion, increasing the effect of pressure upon the tissues. Emigration has been considered a cause of corns. Horses coming from the north of Germany are mentioned as having been rapidly affected by them after being in large cities. But if the change too suddenly made from soft to dry bedding is an effective cause, the mode of shoeing can also be considered as a stimulating cause. The same is true with respect to the African horses, which are generally free from the disease in their native country, but frequently suffer with them when brought to France, and submitted to a mode of shoeing so different from that of the Arabs. DISEASES. 611 ITI. Symptoms.—The ordinary symptoms of corns are noticed in the abnormal position of the leg at rest, in the lameness and the sensibility of the region. When lame with a corn the horse carries the leg forward of the plumb line, and keeps it semi-fiexed at the fetlock; he tries to relieve the painful region by resting ; sometimes he manifests his pain by pawing and moving his feet from forward backward, pushing his bed under him. The lameness is not characteristic ; it varies greatly in intensity, from a slight soreness to lameness on three legs. It is generally proportioned to the intensity of the disease. However, there are horses so accustomed to their corns that they do not go lame, while others are very much so for a trifling injury. Sometimes it is intermittent, and diminishes when the suppuration has made its way between hair and hoof. The sensibility of the heel—seat of a corn—is discovered by an explo- ration with the blacksmith’s nippers. Sometimes it is made known by pressure of the fingers, the cases varying, of course, according to the severity of the disease. There is often heat, especially at the coronet, which may be tumified, particularly so when the corn is of a complicated suppurative character. To obtain an accurate view of the disease the foot should be well pared, and this opera- tion may be greatly facilitated by the application of poultices for twenty-four or forty-eight hours previously. It is only by the objective examination and the pathological anatomy, so to speak, of the corn that the moist or suppurative variety can be distinguished from the dry, and we shall find either a simple ecchymotic spot, or a complete disintegration of tissues. IV. Pathological Anatomy.—The lesions vary according to the severity of the disease. In dry corn, we find an infiltration of blood in the horny structure. This is blood which has transu- dated through the laminated or irritated velvety tissue from the injured blood vessels. This blood gives to the hoof various tints, more or less pronounced, not unfrequently yellowish, according to the intensity and duration of the disease. The hoof sometimes loses consistency and becomes brittle; at others, it is hard and dry, and then resembles healthy hoof minus its coloration. If the ecchymotic spot involves the whole thickness of the horn, from its surface to its depth, it is an evidence of the continued activity of the cause. A deep mark indicates a recent injury; a superficial one is an evidence of an older corn, which disappears, 612 OPERATIONS ON THE FOOT. and then it seldom produces lameness. Sometimes the marks are arranged in layers, the healthy horn being alternated with others which are infiltrated with blood. This is a proof of the intermit- tent character of the acting cause which has originally produced the corn. The ecchymosis, however, is not the actual seat of the corn, which is more in the velvety and especially in the laminated tissues, which are torn or bruised, the blood escaping through the sole simply by the action of the laws of gravitation. It is rarely that this lesion is looked for in the case of dry corn, and it is usually ignored ; but in the confirmed corn, a true alteration of the laminz of the keraphyllous tissue is observed. This is re- placed by a horny tumor, a kind of keraphyllocele, analogous to that of chronic laminitis, due to a union of the lamine under the influence of the fibro-plastic exudation resulting from the inflam- mation, which is of varying size, and presses more or less on the sub-horny tissues. In some cases, this horn breaks up little by little, and gives rise to quarter crack. The ecchymotic spots of the dry corn may vary in size; they may range from the size of a pea to that of a ten-cent coin. At other times they may occupy the entire space between the bars and the walls of the foot. In moist corn, there is not only hemorrhage, but also inflam- mation proper, with serous exudation. The hoof is colored, as in dry corn, of a brownish tint, due to the infiltration of blood which occured at the start; on searching deeper, one will discover be- tween the hoof and the living tissues beneath a separation of varying dimensions, filled by citrine serosity. Most frequently this separation takes place at the line of the sole with the wall, and extends under both. The horny substance is then more or less impregnated with this serosity, and then has a charcteristic yellow appearance and a waxy consistency. In suppurative corn, or more properly, suppurating, the in- flammation ends in suppuration. The pus is secreted by the vel- vety and laminated tissues. It makes room for itself by gradually separating the hoof as its formation progresses. Before long it passes between the podophyllous grooves of the bars and of the quarters, the horny are lossened from the fleshy laminz, and in its ascending progress the pus soon makes its appearance between hairs and hoof at the quarter, at the heels, or at the glomes of the frog. Itis not common for the pus to make its way through a hoof of too thick or resisting a nature, unless it has first been DISEASES. 613 sufficiently softened by poultices and thinned down with the knife. This suppuration, in the generality of cases, brings on serious complication, by the excessive pressure to which the sub-horny tissues are then subjected. Gangrene of the velvety tissue near the branches of the sole and of the podophyllous grooves which have been lacerated in the suppuration, are very common compli- cations. If the pus remains long in the hoof its gangrenous re- sults may extend to the os pedis, the laternal cartilage, the plantar cushion, and even to the plantar aponeurosis, and give rise to necrosis or caries of the bones, or to quittor, to a more or less variable extent. This sub-horny suppuration, which may some- times be considerable, as well as the complications accompanying it, are detected with the probe. V. Termination and Prognosis.—Resolution is a common termination of corns. But their relapse is common also, especially in feet predisposed to them by bad conformation. A kind of chronic condition of the disease, and one which is more liable to become serious than the accidental. variety, is the ordinary ter- mination in this case. The mere extent of the disease is of less importance in the diagnosis than the predisposing conditions. Generally the dry corn is less serious than the moist one, and especially less than the suppurative. Complicated corns, princi- pally in flat, wide feet, with low heels, by reason of uncertain, protracted and expensive treatment, are in general fatal, and necessitate the destruction of the patient. VI. Treatment.—The largeness of the space we have consumed in considering the etiology of corns will compel us to be brief in our remarks upon the preventive treatment. Shoeing, which is so often the cause of corns, may also be made a means of preventing them, even upon predisposed feet, if performed with intelligence and proper observation, based upon the anatomy and physiology of the foot. Generally speaking, one must not proceed rashly by changing too suddenly the mode of shoeing. We do not think that any one specified system of shoeing will with certainty pre- vent corns, but we do believe that each case demands its special study and care. Usually, a flat shoe, and which has the heels rather thin but resisting, and which rests on the wall proper, even of the diseased one, if not too painful, is to be preferred. If the shoe is for a low-heeled foot, the heels of the shoe should be thicker in order to supply their insufficient height and to offer 614 OPERATIONS ON THE FOOT. more resistance to the weight of the body. Sometimes the pro- tecting effect of the shoe must be completed by the use of a plate of gutta percha or leather between the foot and the shoe; india rub- ber does not answer, as by its elasticity it interferes with the re- sistance of the shoe. It is absolutely necessary to preserve the hoof in a sufficiently supple condition, to effect which tar, hoof ointments and other greasy substances are used. Flaxseed meal, poultices of cow manure and salt water, a damp bedding, tallow in the hollows of the heels, all are very good preventives and even curative means, which a careful hostler will not neglect. Paring the feet thin, as practiced by some, is very objectionable, and is a serious obstacle to the extirpation of corns. The feet should be pared as little as possible, especially at the heels or in the lacune. As for the curative treatment, there are, according to H. Bou- ley, four indications to follow: First, remove the acting cause; second, treat the injury it has produced; third, relieve the pres- sure upon the diseased region, until it has returned to its healthy condition; fourth, prevent the return of the injury. The first indication is easy to fulfill with the accidental corn, but often nearly impossible in that due to a bad conformation of the feet. The second indication varies according to the extent of the disease. Generally it is advised to thin down the hoof at the bruised part and its surroundings, so as to relieve the pressure on congested or inflammed parts. Still, we are not in favor of too much thinning of the hoof, and except under peculiar conditions, would practice it very slightly. Even in the moist corn, we be- lieve in leaving to the hoof a certain protective thickness. The pressure can be sensibly diminished by the application of chloro- formed.oil, or of tincture of creosote; they very readily penetrate the hoof, and act directly upon .the inflamed parts. We believe that excessive paring, the “cutting out of the corns,” to use the shoer’s expression, is injurious, and predisposes to new corns, by weakening the region and promoting a more rapid desiccation and contraction of the hoof. In all cases of dry and moist corn, one must avoid making the parts bleed, the exposure of the soft tis- sues, and all unnecessary cutting. Thinning is necessary in sup- purative corn, and has to be done over the whole extent of the separation of the horn, and a wide channel of exit made for the pus on the side of the sole. Itis a wise plan not to remove the i 4 : : DISEASES. 615 entire mass of the loosened hoof, as by this the dressing will be much facilitated. Cold baths are useful in all cases of corns; at other times poultices of bran or other material are preferred. Sometimes sulphate of iron or of copper are added to the bath, especially in the moist corn. In the suppurative kind, when the suppuration is irregular, and when complications are likely to follow, warm and slightly aromatic baths are better, and after this, a dressing with tincture of creosote, renewed the same day or the next. Later, cold iron or copper baths may be used again; if the suppuration has broken out between hairs and hoofs, injections of Villates’ solution, after free escape of the pus by the plantar surface, are indicated. In the complicated suppurative corn these means are iusuffi- cient. We must cut deeper, and for this the animal must be thrown. Then, when the diseased tissues are exposed by the removal of the loosened hoof, the nature of the lesion must indi- cate the requirements of the treatment. The velvety and podo- phyllous tissues, if gangrenous, must be excised as far as their diseased condition extends; carious bone is to be scraped, the fibrous and fibro-cartilaginous structures, if necrosed, are to be excised or cauterized, or sometimes left alone and watched, ac- cording to the peculiar character and extent of their lesions and the extent to which they exist. Once operated on, a dressing with plates and bands is applied, and the animal allowed to rise. It is by a peculiar shoeing that, for some time, the painful heel must be relieved from supporting its part of the weight of the body, and protected from outside pressure. This is the “bar shoe.” By the transverse bar, which unites both branches, it pre- sents a support to the frog and protects the heels. The resting of the shoe takes place equally upon the wall of the toe and of the quarters, especially the external, and it does not rest on the diseased heels which may have been first cut away. Some veter- inarians prefer the truncated, or the oblique bar shoe, or that with a bar forming an acute re-entering angle. Hartmann recommends the first; Mayer prefers the bar shoe in which the bar heels have been thinned down, and even hollowed, to avoid as much as possi- ble the pressure on the diseased part; this shoe has sometimes given us good results in horses with a weak frog. In many cases ordinary shoeing answers ; then the diseased hoof is pared down. 616 OPERATIONS ON THE FOOT. The branch of the shoe in this case requires a greater thickness. Whatever may be the mode of shoeing used much advantage can be obtained by the application of a sole of leather or of gutta percha. SANDCRACKS. Seime of the French; Hornspalt of the Germans; Fissura of the Italians—are fissures or solutions of continuity observed on the walls of the foot, ordinarily very narrow, which follow the direction of the horn. Principally observed on the hoof of soli- peds, it has been seen also in ruminants, but rarely, and of little importance. I. Division.—They may exist on every part of the wall. On the median line of the nail they are called toe-crack, and then are more frequent on the hind feet. They are rarely found on the outside or inside toe (the mamelles of the French), but commonly met with on the quarter (quarter-cracks), then situated on the lateral parts of the wall, toward the heels, and more frequently on the fore feet, especially on the inside. They are sometimes oblique, relatively to the thickness of the wall. Cracks are superficial or deep, according to the thickness of the wall involved. They are complete when they extend from the coronary band down to the plantar border ; incomplete when more limited. In this last case, those which do not extend up to the skin are the more disposed to recovery, and will grow down with the growth of the wall, while those which extend to the coronary band are more serious, being continually aggravated as the growth of the hoof progresses. According to the date of their formation, they are called recent and old. Simple cracks are those which only involve the wall; they are complicated where there is more or less serious lesion of the tissues beneath, such as inflammation of the laminz, hemor- rhage, or caries of the bone. A serious complication is that of keraphylocele. II. Symptoms.—Often the solution of continuity is the only one observed, and it is the special characteristic of the disease. But the fissure may be masked, either accidentally or by design. It may be concealed by the hairs, by the mud, or covered by hoof- ointment, tar, wax, or even a putty of gutta-percha. Concealed internal cracks have sometimes been discovered, such as fissures involving the internal face of the wall, which, consequently, were DISEASES. 617 not noticed from the outside, or showing but a slight depression on the surface of the wall. These cracks are only discoverable when the foot has been well pared down. As slight as the solu- tion of continuity may be, it participates in the motion of dilata- tion of the foot, and it is better detected when the foot is raised than when it rests on the ground. Thisis the case when it is a toe- crack, but on the contrary, the quarter-crack is more open when the animal rests its weight on the leg, in which case, the sepa- ration of the borders of the cracks may be from two to four milli- metres, and may expose the bottom of the fissure. Ordinarily, cracks appear first at the coronet, and there is then but a slight opening, but as they become older, and grow down, they have a tendency to become deeper and more complete. When of old standing, their borders are rough and scaly, having between them an ulcerated tissue and sometimes a fungus growth, from which escapes a sanious fluid. In other cases, as of quarter-crack, the edges have a tendency to cover each other. Superficial cracks are not always attended with lameness; it is, on the contrary, often very severe when they are deep. The pain is generally in proportion to the depth and degree of opening of the fissure, and also especially to any complications which may exist in the tissues beneath. The lameness seems at times to be due to the injury of the deep, soft tissues, and to be caused by the motions of the horny box when they become pinched, irritated and bruised. The affected animals are especially lame when the foot rests on the ground, and the lameness is greater on a hard than on a soft surface. If an animal suffering with toe-cracks is moyed on descending ground, the lameness is greater than on ascending a hill, the weight of the toe in the latter case producing less opening of the edges of the solution of continuity. In quarter- cracks, the severity of the lameness is always in proportion to the rapidity of the gait; many horses which are but slightly lame on a jog, become much more so when the gait is accelerated, the dila- tion of the heels being greater, and the separation of the b_rders of the crack increasing in proportion to the speed. When there is lameness, there is naturally an increase of heat and sensibility of the foot, especially at the seat of the crack. This is often dis- covered by feeling with the hand; old cracks are generally accom- panied bya thickening existing at a corresponding point of the hoof. A deep, but recent crack, is apt to be accompanied with 618 OPERATIONS ON THE FOOT. hemorrhage ; there is blood which sometimes exudes between the borders of the crack, and flows in abundance when the movement is rapid; and old crack, in similar circumstances, may show pus, sometimes mixed with blood. A misstep, a sprain, may give rise to hemorrhage in cracks which are ordinarily dry. In toe-crack, _the solution generally involves the thickness of the wall, through which it runs in a line almost parallel to the median plane of the body, while in quarter-crack it is often oblique and irregular, not exactly following the direction of the fibres, but following the thickness of the wall obliquely in such a way that the external solution of continuity is more posterior than the external. If the crack is rather old, and the foot where it exists is contracted, itis generally incurvated, one border covering the other, and some- times they seem to be moulded on each other, so as to cover and conceal the true crack. III. Complications—Among these we may first mention the inflammation of the recticular tissue, which is first pinched and injured. This may be followed by suppuration and local gangrene. Very often the disease is followed by necrosis of the os pedis, and caries of varying depth. In toe-crack cases have been seen of caries of the tendon of the anterior extensor of the phalanges, and even arthritis, though rarely occuring, have been observed. In quarter-crack, one may have cartilaginous quittor and suppurative corns. As before stated, these lesions are indicated by the severity of the lameness, the presence of the blood or pus through the crack, and the extreme sensibility of the part. It is especially when, in the course of treatment, a part of the hoof has been removed, that the keratogenous apparatus has been exposed, that the abnorma- coloration of the podophyllous tissue is seen, in its swollen condi- tion and its sensibility to pressure, accompanied with the presence of the pus or sanious discharge; and at times the necrosis of the bone. Sometimes, also, foreign substances, as dirt or gravel, may be found introduced in the cracks, and acting as causes of irrita- tion to the sensitive tissues below. A complication, not so frequent, however, according to some authors, is that known as Aeraphylocele, and which consists in an hypersecretion of horn, from the coronary band on the inside of the crack. Sometimes the horny growth remains separate from the borders of the crack, and is adherent to the wall only by its base, towards the coronary band; this is especially the case when DISEASES. 619 the wall has been thinned down or partly removed. In other cases it is adherent to the two borders of the crack, and this forms a natural cicatrix. This horny column, of varying length and strength, according to its age, presses upon the tissues beneath, and gives rise to severe lameness. With time there is correspond- ing atrophy of the podophyllous tissue, or even of the os pedis. This is often followed by a marked deformity of the hoof, and especially a deep fissure, parallel to the direction of the crack. The soft tissues under the keraphyllocele often in time become harder, in consequence of the disappearance of the papille; the hoof then is no longer adherent to the tissues beneath, and so incurable cracks are the result. A double wall or false quittor have often also been observed. Thus deformed, the footis always subject to lameness, even if the crack is cured. Contraction or atrophy of the frog have been observed with quarter-crack.. IV. Progress, duration, termination.—Ordinarily, cracks once existing become worse. From being superficial and imperfect they become deep and complete as a natural result of the ordinary motions of the foot. If rest and some hygienic attention can be given, they may recover spontaneously, and disappear by the nat- ural downward growth of the hoof. This fortunate termination, however, is principally obtained when the crack is due to acci- dental causes, without deformity of the foot. V. Prognosis.—Simple cracks, superficial and incomplete, especially arising from the plantar border, almost always recover under rational treatment, which has for its principal aim the pre- vention of increase in the size of the fissure. Cracks starting from the coronary band are always of a more serious nature, with a ten- dency to increase easily. Still they are no longer to be consid- ered incurable. Cracks in which the borders are much separated by the motion of walking; those which are oblique ; those whose edges are incurvated inward ; those where a portion of the wall is loose ; those which bleed, and those where there is a continued irritation of the sub-horny tissues, are the most serious; and so much so, that they may require quite serious surgical interference, and after all baffle the best skill of the operator. VI. Etiology.—The causes of cracks vary greatly, and are often multiple in a single case. Seldom the result of accident, they are most commonly the combined effect of both a predispos- ing and an extraneous cause. A frequent one among others is 620 OPERATIONS ON THE FOOT. the relative dryness of the hoof, which then becomes excessively brittle. We have seen the conditions in which the hoof loses its natural flexibility, and shall here only state that alternate changes from dampness to dryness have as much influence as the dryness alone. Cracks are more frequent in animals working along damp than in those pulling in dry and stony roads. They are common in animals which after being kept in pastures are placed in good paved stables, with dry bedding. It is principally in these condi- tions we find the quarter-crack. During some seasons, while a term of dryness follows continued wet weather, the conditions are favorable to their formation, and they often assume an epizootic form. Emigration to dry climates is a frequent cause, by produc- ing the contraction of the ungueal structure. This last circum- stance explains why cracks are more common in army horses, which are called to go on long journeys during the warm days of summer. Butif the European horse taken to Africa suffers less from the disease, a similar result occurs to the African horse when brought to our climate. The Arabian horse readily contracts quarter-cracks in our stables, and with our shoeing. Animals with small feet, or with hard and thick hoofs, have a natural predispo- sition, which is also found in Hungarian, Russian or Tartar ani- mals. Feet excessively large are also easily affected with the disease, especially those which have canker or grease. Unskilful shoeing may predispose to cracks, and this is princi- pally the case if the wall is thinned or rasped down too much ; the same result is obtained from shoes which are too wide or too heavy, or which are kept on by too heavy nails. Feet with toes turned outward are predisposed to it, as in these the weight of the body rests more on the internal quarter, which being thinner than the external, give way the easiest. Con- tracted feet are subject to it.. Quittor, suppurative corns, and some other diseases, are also predisposing causes. Among occa- sional or accidental causes may be mentioned traumatism, contu- sions of the foot and blows during work. The service of heavy trucking for heavy horses exposes the hind feet to toe-crack, especially if the pulling is done in going up hill or on slippery pavements; mules’ feet are very subject to it, and heavy falls in jumping and external blows are occasional causes. TTeredity in cracks has been mentioned. We do not admit this, except so far as it belongs among the predisposing causes DISEASES. 621 which may be transmitted, and we should object to an animal for breeding purposes though otherwise well-formed, if he were affected with cracked feet. Vil. Zreatment—Prophylaxy ought to be the principal treat- ment of cracks. It is not always easy, however, to prevent them, and it becomes important therefore, to treat them as soon as they appear. One ought at least to try to prevent them from becoming complete and deep. This form of treatment may be called the hygienic, as it is not properly curative, and so long as the crack is not yet completely formed, the animal may be kept at work as if everything was normal. Curative treatment is that which is applied to the deep or complete disease, more or less complicated, and it most commonly consists in removing that portion of the wall which bruises and irritates the tissues beneath, and in equal- izing the wound. In general, there is no necessity for haste in operating, the hygienic treatment being often sufficient to obviate the need of serious operations. The distinction between the hygienic and curative treatment is not, however, always definitely marked, and quite often the two modes of treatment must be combined, both the hygienic and the curative being necessary. The prophylactic treatment consists specially in the applica- tion of tonics, with the object of preventing the hoof from drying. Its normal hyrogoscopic condition must be preserved, and it must be prevented from taking up too much of the dampness of the ground upon which it travels, as well as from losing that which keeps up its flexibility. At times it must be rendered more moist and, according to the requirements of the case, recourse must be had to hoof ointments and other greasy substances, glycerine and astringent poultices. At the same time the shoeing must be care- fully attended to; the shoe must not be too heavy nor too wide, and should be secured by nails of a proper size. The hygienic treatment has for its first and principal indica- tions to prevent the solution of continuity from increasing, from extending through healthy structure, and especially to new hoof, as this is secreted by the coronary band. The borders of the cracks must be prevented from separating in the movements of dilatation of the foot. The normal suture of the wall not being produced by the natural process, or at least producing it only in keraphyllocele, which is likely to be as injurious as the crack it- self, the borders of the crack must be brought together artificially. 622 OPERATIONS ON THE FOOT. It has been supposed that this could be done with the putty of Defay’s, a mixture of gutta-percha (2 parts) and gum ammoniac (1 part), introduced into the well-cleaned fissure, and pushed in as deeply as possible by a warm iron plate or a spatula. This putty is excellent for superficial cracks, but is insufficient to bring the borders together when the fissure is somewhat deep, or especially if it is irregular and sinuous. A better way, at least for toe-crack, is that which consists in suturing the edges of the solution of continuity by metallic clasps, which immobilize the hoof. This mode is always preferable to circular ligatures of wire or cord, which have the effect of interfer- ing with the natural elasticity of the hoof. Clasps only fix the hoof locally, and are an old means of treatment, having been used by Solleysel and Garsault. It was advised to perforate the horn through and through with a small punch, and pass a wire, which was bent over the crack, or twisted together at the ends. The same authority recommends the driving of a nail through both edges, and securing it tightly, as in the application of the nails of the shoe. This treatment was recently recommended by Haupt, Lafosse and Rey. The first of these professors takes an ordinary nail, with a small head, drives it through one edge of the crack, so as to come through the other at an equal distance from the point of entrance; the nail being thus driven to the head the borders of the crack are then brought together, and the nail secured in the ordinary way. Two or three of these clasps are employed, according to the extent of the crack. Lafosse makes a groove on each side of the fissure about one centi- meter from the border, in a direction transverse to that of the fibres of the wall, which limits the passage of the nail. The nail is then introduced and secured as in the first instance. Rey makes a track for the nail first, by drilling a hole through the borders of the crack. The animal must be cast during these operations. The best kind of clasps or hooks are undoubtedly those of Vachette, which require-special instruments for their application, but give a real solidity to the means of fixing the position of the parts. The clasps are all prepared, made of strong wire, bent at both extremities, and slightly sharp inwardly (Fig. 489). These are secured on the foot by a special nipper or forceps (Fig. 490) in the notches made on the wall with a special cautery (Fig. 491) ; DISEASES. 623 this cautery has its extremities flattened, the width of the clasp, apart from each other. The forceps used to secure these is strong ; its branches are flattened from side to side, and grooved inward, and sufficiently apart from each other, while it is open, to receive the clasps between its border; these branches, with the clasp, are exactly fitted to the notches made in the wall with the cautery. Fig. 489,—Clasps. Fie. 491—Cautery of Vachette. UTE FIG. 492.—Clasps applied in the Thickness of the Wall. Fig. 490.—Forceps of Vachette. It is sufficient to press the branches of the forceps to close the teeth or extremities of the clasps, and bring firmly together the borders of the cracks. The number of clasps varies according to the case under treatment. A very simple mode of effecting reunion of the borders of the if ih i Fig. 4938.—Toe Crack secured Fig. 494.—Quarter Crack secured with Clasps. with Clasps. 624 OPERATIONS ON THE FOOT. crack is that of Hartmann. It consists in applying upon the wall a sheet of iron, adapted to its outside, and secured on the foot by two small screws. Clasps are of a certain utility for toe cracks, but they often fail in quarter cracks, on account of the thin condition of the wail, which is particularly well marked in some feet. If the living tis- sues are encroached upon, the clasp may give rise to complica- tions, and still it is in that region that the effect of the motion of the hoof must be prevented, and where immobility is essential, to prevent the separation and spread of the edges of the crack. Castandet has indicated a mode of treatment which has proved very successful, and which may be applied to both toe and quarter crack, where the fissure of the wall extends from the coronary band to the lower border of the foot. It consists in making a groove at about one centimeter on each side of the crack, which in depth extends to its bottom, which, when reached, is white. If the solution does not go to the lower border of the foot, these grooves are made obliquely, and so as to meet together at their lower termination, and form a V-shape. Thus the crack cannot increase, and it grows down without injury to the soft tissues. Castandet, after this operation, cauterizes the coronary band. The transversal groove, recommended by Levrat, which cuts the tissues in two and extends beyond the crack on each side about three centimeters, which goes down to the soft tissues of the foot and not beyond them, has for its object to diminish the effect of percussion produced by the contact of the foot with the ground. It, however, does not prevent the edges of the fissure from sepa- rating, as the groove of Castandet does. It is chiefly useful when there is a separation of the wall, or false quarter. At times a transverse groove has been made to prevent an incomplete fissure, starting from the plantar border, from spreading to the coronary band. According to Hartmann, a single hole drilled through the wall is, in most cases, sufficient. Shoeing is of much assistance in the hygienic treatment of cracks. In toe cracks, the toe should be spared as much as pos- sible while the heels are lowered by paring, or by the application of a shoe thicker at the toe, or by the removal of the calks at the heels. While Defays holds that the shoe ought to lie close and tight to the plantar regions of the crack, Hartmann, on the con- trary, advises the paring of that surface at the toe, so that the shoe oe. fy ats ’ _ DISEASES. 625 cannot rest on the crack, and recommends the application of two clips on each side of the toe. In quarter cracks, it is recommended to lower the toe, to save the bars and the frog ; and when the crack is incomplete, and not accompanied with lameness, Defays recommends not to lower the diseased quarter, and to have the heels resting well on that branch of the shoe which shall be thick and straight. Schrebe advises a calk on that side. If the crack is deep, with excessive lameness and deep lesions, the quarters and heels must be pared down as much as possible, and a bar to be then put on, resting on the frog, if need be. An ordinary shoe, with a thick branch, may be sometimes employed. As part of the hygienic treatment, we may consider the means recommended to increase the secretion of the coronary band. It is known that a slight irritation at that part of the foot is accom- panied with an increased secretion of hoof, which is sometimes sufficient to give rise to a new growth of healthy horn. One of the most common methods is to slightly cauterize the coronary band with the iron. This was already known by old practitioners, who employed an S cautery; but they committed the error of burning the hoof too deeply instead of simply cauterizing the cor- onary band. Solleysel speaks of the cauterization of the band. Garsault mentions only the burning with three §S’s across the crack. Such cauterization could have no useful effect, and the deep application of the cautery might be followed by serious com- plications. For these reasons Lafosse objected to them. In our days it isabandoned, and the coronary band only is touched by the cautery ; Castandet and Rey also employ it. Chemical cauteries have also been recommended, nitric acid by Laguerriniere, and more recently by Lafosse. Putty of corrosive sublimate and ointment of oxide of mercury are also in use, but have no marked advantages. Blisters prove very beneficial, and also turpentine, as recommended by Lafosse and Rey, and the oil of Cade by Maury. Defays advises the putty of gutta percha, which is also used to conceal the clasps. The curative treatment is necessary whenever any complication attends the crack. If it is recent, antiphlogistics and rest should be first tried; cold bathing, blisters combined with hygienic treat- ment may then be sufficient. A single groove at the upper part of the crack, near the coronary band, is often sufficient, or a re- 626 OPERATIONS ON THE FOOTY. moval of a V-shaped portion of the hoof, extending more or less deeply, accord- ing to the condition of the crack, care being observed to avoid the growth of vascular granulations between the edges of the crack. 'There are cases where it is not necessary to remove the segments of the hoof entirely down to the soft tis- = sues, but only to thin them down and to F1G. 495.—Operation of simple apply over it a dressing of oakum, se- Too Crack by the process of thin- eyyred by several turns of roller band- ning down the wall in V-shape. ages. In all casesa bar shoe must be applied to relieve the pressure on the quarter where the crack exists, This is principally recommended by Prevost, Girard and others. If there are deep iesions of the sub-horny tissues, a piece of the wall must be removed, and the operation for radical cure be performed. It is an old operation, by which all diseased tissues are exposed. As little of hoof as possible isremoved. In operating, two grooves will be made alongside and at some distance from the solution of continuity. The wall between is removed so as to expose the podophyllous tissues from the coronary band down to the sole, care being taken to avoid the tearing of the structure of the coronary band, and the diseased tissues are thenremoved. If the podophyllous tissue, it is excised with the sage knife; if the bone is carious, it is scraped with the drawing knife. The whole Fic. 496.—Operation for Com- plicated Toe Crack B, by removal of a piece of the toe of the wall. A A.—Oblique grooves limiting the size of the piece to remove. Fic. 497.—Dressing for Complicated Toe Crack. DISEASES. 627 is then dressed up with a shoe having the toe thinned down, and extending somewhat beyond the border of the foot. The cicatrization does not take place from the coronary band alone, but also from the horny secretions of the podophyllous tis- sues. The repairis then quite rapid. The first dressing is re- moved after eight or ten days, and if everything goes on well need not be changed more than once a week. The animal is not to be put to work until the hoof has obtained a certain consistency. The operation for quarter crack is similar, except that only one groove is required in front of the crack, the tissues being exposed as in the operation for the removal of the lateral cartilages of the foot. CaALK. Synonyms.—Kronentritt (Ger.)—Atteinte (Fr.)—Thus is called a contusion, with or without wound, that the animal receives on the coronet, from the shoe of another foot, or from a foreign body, or by another animal walking behind or alongside him. The skin of that region is very thick, slightly extensible, not easily yielding to the imflammatory swelling ; there is commonly sloughing and mortification of tissues, accompanied with violent pain. It is frequent in animals that forge, also in very young horses or those which are weak in the lumbar region, and which interfere and cut themselves in walking. This lesion is also very common in the districts where horses are shod with high calked shoes, when the wound resulting from it is made by the internal branch of the shoe, which lacerates the skin of the coronet. Horses shod to travel on ice are commonly affected with it; the injury being more or less serious according to the size and sharp condition of the ealk. Horses ridden in ridding schools are often affected with it dur- ing the various evolutions of the haute école. It is called single when the wound is slight; concealed when the pain is great and continued, as in the case where it takes place on the tendon, near the heels or the quarters; horny when the contusion has taken place on the wall or at the coronary band ; complicated, when it is very serious and accompanied with other more severe lesions. It is always a horizontal wound or a tumor by contusion. 628 OPERATIONS ON THE FOOT. I. Symptoms.—It is ordinarily recognized by the wound or swelling which exists upon the parts. Often the horse is lame, and the affected part warm and painful; sometimes the hairs are cut, the skin scratched or torn. There may be a slight bleeding at the seat of the wound. When the wall has received the con- tusion, the vascular network underneath may become inflammed, and then pus is formed between the teguments and the hoof, which then become separated. Sometimes even the lateral fibro- cartilage of the foot becomes irritated and swollen, and ulcerates, especially when the contusion has taken place on that part where the cartilage is; in this case the injury may be complicated with cartilaginous quittor. In severe cases, one may recognize a furuncular calk, charac- terized by the mortification and sloughing of a portion of skin at the place where the contusion took place; it is the cutaneous quittor of old hippiatry, with formation of a core; this is always very painful, and the inflammation generally spreads underneath the wall. Bouley calls it gangrenous when there is unlimited similar mortification of the tissues; in this case the slough in- volves large portions of the skin. At times it may be called pAleg- monous, When an abscess forms itself under the skin, then. the coronet is warm, thick and inflamed, and the pain is extreme. — Then if an incision be made through the dermis in its entire thick- ness, an abundant bleeding takes place, generally followed by the resolution of the disease ; if there is already suppuration, it is at the same time immediately allowed to escape. Il. Vreatment.—lf the injury is slight or recent, whether with or without wound, very cold water and the removal of the cause by taking off the shoe, are sufficient to bring on a cure. But if the contusion has been great and deep, recovery is more diffleult to obtain on account of the suppuration which will follow. Then the application of poultices is indicated ; if there is formation of a core, and mortification of tissues, poultices of honey are espec- ially indicated ; in case of phlegmon, the poultice must be warm, and then incisions and counter opening must be made for the escape of pus; afterward dressings are made with oakum saturated with tepid wine or tincture of aloes. When the caulking is horny, the use of emollient topics is in- sufficient ; an excellent way then is to obtain the required slough- ing of the tissues by actual cauterization—the iron heated to white DISEASES. 629 heat ; by thus destroying a portion of the hoof and the soft tissues one will avoid the excessive pressure at the coronary band; this may also be prevented by the thinning down of the wall with the sage knife; but one must be careful not to remove too soon the portions of horn which may be detached. When the calking takes place at the heel, it is good—so as to prevent other complications—to pare the foot down, especially at the heel, to remove the divided hoof and transform the wound to a simple one which can be dressed, as already stated, or with digestive ointment secured by several turns of a roller. When there are wounds of the teguments, it sometimes hap- pens, if the immediate union has not been obtained, that the por- tion of skin forming the inferior edge of the wound turns down and that the granulations protrude, tending to form a kind of fungoid growth. Chabert says that these must be cut off and dressed with oakum soaked in alcohol. Calking at the hind feet being the most severe, and those which are followed by the most serious complications, on account of the urine and droppings of the animal, which impregnate the wound, one can never be too particular in keeping them clean and dressing them well. When they end in cartilagious quittor, they must be treated as that disease usually is. As to the means of prevention, they consist in not placing the horses too close to each other in stables, fairs, etc., in not forcing them too much in their gait, in shoeing properly those which forge or interfere, and in placing or riding them in such a way as to avoid the possibility of their wounding each other. PunctureD Wound or THE Foor. Synonyms.—Naglebritt (German)—Nail in the foot (English)— Clou de rue (French).—In veterinary science this designation has been given to a punctured wound, often with laceration, some- times with contusions, either at the sole or frog of the foot of the monodactyles, and produced by sharp or cutting bodies, most commonly nails, upon which the animal steps. The form of these bodies, the direction they take, the force with which they pene- trate, and the part of the sole they enter, give rise to various lesions of varying gravity as they are older or as the injured part enjoys a greater sensibility. Etiology.—Nails, stumps of nails, are most often those which 630 - OPERATIONS ON THE FOOT. are picked up in the streets; at other times it is a metallic sub- stance elongated and sharpened; again, there are pieces of glass, or other substances, such as bones or sharp stones, which are picked up and produce the wound. It is principally in-the streets of populous cities, in the yards of builders, or on the grounds where buildings are pulled down, that horses are liable to receive these injuries. In rural districts they are rare, comparatively, to what they are in cities. It is evident that horses with wide, flat, thin, softened hoofs are more exposed than those which are of different structure. I. Divisions.—Punctured wounds of the foot may be simple or superficial, deep or penetrating. One of these bodies piercing into the frog requires to go in deep to be serious, as above the frog (which is itself quite thick, though formed by a soft and flexible horn) is the plantar cushion, a fibrous, soft and elastic mass, which offers a great resistance. If, however, the injuring body is a very long nail, which runs per- pendicularly in through the frog at the plantar cushion, it may reach the terminal extremity of the perforans tendon, situated immediately under the plantar cushion, and penetrate the sesa- moid sheath. It is known that this sheath forms a sac of some dimensions, that it extends above and below from the inferior half of the coronary to the semi-lunar crest, and in its transverse axis extends from one retrosal process to the other; the inferior portion of this synovial bursa covers the plantar aponeurosis in its whole extent. Sometimes, again, the puncturing body pene- trates as far as the bone; sometimes the navicular; at others the os pedis, and sometimes even penetrates into the articulation. II. Symptoms.—They vary according to the seat of the lesion, its depth, the mode of action of the penetrating body, length of time it has remained in the wound, and the nature of the lesions it has made ; all conditions which may change the character of the disease from a first degree, when the animal shows no evi- dence of pain, to the extreme point, where its life is in danger, and evens ends in death, by the excessive local alterations and the sufferings accompanying it. Often the first point which assists in the diagnosis of the case is the history. The driver has seen the horse become suddenly lame, has examined the foot, and found a nail more or less deeply imbedded; or it is the surgeon who finds the nail in its hiding- eo Wa jie es PS Sa Ya se y NA TS a 1 MRP Teme eon ORAM ah hyp ca nT at beter ui ie DISEASES. | 631 place. The exploration of the part shows with certainty the nature of the lesion, the direction and depth of the wound, as well as the physical condition of the body which has made it, and all cireum- stances which allow a positive diagnosis to be made. Quite often the nail is no longer in the foot; sometimes it has left its mark—an opening which can be explored; often this is not visible at first sight, though the wound may be even deep; this is when the injury to the hoof has been very slight, and when the hoof has retracted on itself by its elasticity or when the open- ing is concealed by the dirt of the streets. It must be remem- bered that sometimes the penetrating body remains broken in the soft tissues after its entrance through the hoof. If the accident is recent, only a little blood may be found—liquid or coagulated —over the wound ; later, some serosity, more or less purulent, is observed ; the pus is white or black, sometimes mixed with syno- vial fluid ; sometimes there are granulations on the bodies of the wound which protrude over the edges, commonly called proud flesh. Such are the first objective symptoms obtained by the exploration of the parts. Ordinarily they are insufficient, for it is not always easy to probe the wound. It then becomes neces- sary at the beginning to pare off the hoof all around the wound, and sometimes to hollow it at the point of injury, without going to the sensitive structure, however. In this way the exploration and the probing of the wound are rendered much easier. The pain, expressed by the lameness, is almost always mani- fested ; it varies according to the seat of the lesion and its depth. At first the intensity of the lameness does not give the exact measure of the disease, and often one may be led into error by it; but it gives an exact value of the lesion when a few days have elapsed since the injury was received; if the pains are slight or absent, they indicate that the reparative process is going on well ; it is, on the contrary, interfered with by complications when, as time goes on, the lameness increases instead of becoming dimin- ished. Generally one can say that the injury will amount to nothing when the lameness is slight, while, on the contrary, seri- ous complications must be always looked for when it is great and remains on long, even when the first lesion has been slight and superficial. The wound, which has penetrated through the hoof only, has no symptoms, no sequel ; the animal is not lame from it, or if he be the lameness is very slight, the foot resting entirely 632 OPERATIONS ON THE FOOT. on the inferior surface ; when the resting takes place only on the toe, ordinarily the tendon is injured, possibly the synovial sheath ; in cases where high inflammation exists the pain is very great, the animal walking on three legs only. The anatomical examination of the injured part teaches that the most serious punctured wound of the foot is that of the cen- tre of the foot, where the tendon, synovial sac, and where the articulations may have been injured. Forward of this the wound is less serious, even if it involves the bone. Posterior to it, it can only injure the plantar cushion. Under this condition the plantar region of the foot is divided into three zones ; one, ante- rior, from the toe to the point of the frog; one, middle, extending from the first to the median lacunze of the frog; and the third, anterior, covering the space left back of this to the heels. The most serious of the injuries to which the foot is liable are those caused by foreign bodies which penetrate the middle zone, that being the most complicated portion of the structure. The symptoms will vary, according as the wound extends to the plan- tar aponeurosis, or only as far as this membrane ; or lacerates the soft surrounding tissues without touching it; or it goes beyond this and injuries the small sesamoid sheath, or even going deeper, severs the nayicular bone, or its ligamentous attachment to the os pedis ; or reaches the last phalangeal articulation. A wound of the plantar aponeurosis is always very painful, especially when complicated with necrosis, in which case there is no weight put on the diseased leg, and continual lancinating pains and reacting fever are socn observed. The wound is then fistulous in character, and the suppuration then flowing from it meets with difficulties in its escape, which gives rise to a state of general inflammation, and the foot becomes hot and very painful If the necrosed scar becomes loose and sloughs off, being de- tached by suppuration, improvement soon ensues, but as the ne- crosis of the tendon has generally a tendency to spread, there is an increase in the character of the symptoms. If the wound extends to the sesamoid sheath from the start, the synovial fluid is observed escaping, first pure, but soon becoming milky and purulent in aspect, if the sheath has become inflamed, and easily coagulated in yellowish clots. The pain is then very great, much more so than when the aponeurosis alone is diseased. At times, by rapid closing of the plantar wound or obstruction of the fis- DISEASES. 633 tula, a warm swelling forms itself in the back of the coronet, which raises the skin by degrees and becomes elevated, prominent at one point, and giving a feeling of fluctuation. This swelling ends in ulceration, and allows the escape sometimes of an abundant synovial, purulent discharge. The wound of the small sesamoid and of its ligament adds nothing to these series of symptoms. The probing of the tract will only determine it by the sensation of roughness which it will give; but generally one must be careful in using the probe, es- pecially when the flow of synovia is absent. If the foreign body has pierced through the ligament, or has penetrated in the coffin joint, phalangeal arthritis is the consequence. The same result is likely to follow excessive inflammation of the foot and the macer- ating effect of the suppuration, in which case the tendon may soften down and give way. It may then also happen that this tendon retracts by the contraction of the muscular fibres, and can then be traced upward to the back of the coronet, or of the fet- lock, according as the giving way has taken place higher or lower. With arthritis there is a hot, painful swelling of the whole cor- onet, with diffused oedema above the fetlock and the cannon, and extending upward to the whole leg, complicating the lesion by lym- phangitis, and painful swelling of the lymphatic glands. Then sub- cutaneous abscesses are found round the coronet, with gangrene of the tissues ; while, again there may be only an extensive fibro- plastic exudation, which ends in calcarious organization and anchy- losis. In the anterior zone the only serious lesion met with is caries of the os pedis, characterized by great pain, continual lancination, loss of the use of the leg, and high reacting fever. There is abundant bloody and fcetid suppuration, and the probe gives the sensation of the soft resistance of the bone, of its rough condition, and its partial fragility. The caries having most generally a pro- gressive march, complications of separation of the hoof, to a vary- ing extent, are often seen; the pus arrives at the surface between hairs and hoof; and diffused gangrenes are also often seen, which extend as well to the podophyllous as to the velvety tissues. In the posterior zone, the only serious wounds are the lateral ones, which may injure the fibro-cartilage and become complicated with their caries or quittor and fistula down to the lacunz of the frog, as we have seen in suppurating corn. 1B PAL he Orbos Ca Pe See eee ete 634 OPERATIONS ON THE FOO’. Nails may penetrate the posterior zone through and through, coming out behind the coronet, without danger. The sub-horny suppuration may detach the frog and be the only serious compli- cation to be met with. As terminations of all these injuries we may see resolution, sup- puration, gangrene, softening of the tendons and phalangeal arth- ritis, and as sequelze, bony tumors of the coronet, and anchylosis. The most serious complications are the dropping of the entire hoof, the rupture of the tendons, tendinous and cartilaginous quit- tors, for the injured hoof, and chronic laminitis for the opposite one. : IV. Prognosis.—This varies according to the seat of the wound. Less serious in the posterior than in the anterior zone, it is less in the last than in the middle, where the region is so complicated and the nature of the tissues so different. The depth of the wound has also some influence on the prognosis. Wounds of the plantar aponeurosis are more dangerous than those of the plantar cushion; those of the sesamoid sheath are more so than those of the aponeurosis; they are still more serious if the bones are affected ; the worst of allis that of the joint. The direction of the foreign body and its simple or complicated action, will also influence the prognosis. This, we have already said, can be established by the severity of the lameness. The nature of the foreign body must also be taken into consideration; if blunt, which crushes the tissues, it is more dangerons than if sharp and pointed. In a flat or convex foot, punctured wounds are more serious than in a well-made foot. They are less serious in heavy than in light draught horses, as the former, though they may remain lame, are still useful. The excitable condition of a patient will also alter the prognosis. Wounds of the anterior feet are more serious than those of the posterior. V. Treatment.—tIn all cases, the first indication is to obtain a natural cicatrization and natural repair, always more rapid and perfect than that which is gained by surgical interference. This is generally easily secured, and for this reason it is important to avoid too severe manipulation upon the injured foot. One must watch the progress of the disease, give the foot as much rest as possible, remove the shoe, thin down in its whole extent the plan- tar hoof, so as to avoid any pressure, and keep the foot in a cool- ewe ee ee pismiens. 635 ing bath—ordinary cold water, to which often is added acetate of lead, sulphate of iron, or common salt, very beneficially. Poultices, cold preferable to hot, give excellent results. By this treatment, the progress of the inflammation is checked, and very often deep and. serious wounds, even those where the tendinous sheath has been injured, are easily cured. If the lameness gradually diminishes, the case rapidly gets well; at any rate, by this treatment, the inflam- matory process is diminished, and the painful pressure of the hard- ened and thick hoof is avoided. In the winter, when cold baths are of difficult application, chloroformed or carbolized compresses may be applied round the foot. The hoof is thus softened and the pain reduced. At other times a blister is applied round the coronet. If the lameness remains, or seems to increase, it is due to ten- dinous necrosis or caries, and it becomes necessary to operate. Must the surgeon then have recourse to an operation, and make a simple wound with his sharp instrument? Or, is it still better to merely depend on natural resources, and assist them ? St is difficult to lay down any special rules. If the disease is old, if the necrosis has progressed and is still increasing, a serious operation becomes necessary. If the necrosis is recent, one must be guided by external indications. Notwithstanding (Renault remarks) one should not be too hasty, as the animal must neces- sarily be laid up for several months afterward. It is often suffi- cient, in a recently punctured wound, in order to avoid complica- tions, to modify the conditions of the fibrous tissues in the whole extent of the lesion, by applying substances simply antiseptic, or still better, slightly caustic. Rey employs the cold bath, in which he dissolves a pound of sulphate of copper for ten or fifteen quarts of water; by this means he has secured the speedy recovery of severe punctured wounds. For a long time, and with the same object, we have been using a mixture of equal parts of sulphate of copper and sulphate of iron, having first hollowed the foot downward around the source of the puncture, and the sole being . pared down as thin as could be borne. H. Bouley prefers the application of pulverized corrosive sub- limate; after tracing the wound to its bottom, he fills it well with the powder. This remedy was already recommended by Solleysel, who used it in caries of the os pedis. Other practitioners prefer phenic acid, and claim for it great advantages. By the action of 636 OPERATIONS ON THE FOOT. the caustics upon the fibrous tissues exposed to necrosis, or already in that condition, a double salutary result is obtained ; first, the transformation of the part, which is the seat of a pro- gressive gangrene, into a chemical eschar; and, again, promoting the more active vascularization of the surrounding parts, and con- sequently their increased power of healthy reaction ; conditions twice favorable to the sloughing of the eschar, and the process of repair following it. When the wound has reached the os pedis, and this has become carious, a portion of the sole is removed, so that the suppuration can escape, the bone is scraped off, and a dressing of carbolized alcohol applied, kept on by a thin shoe or slipper, with tin plates. When there is a fistulous wound, through which synovia escapes, yet not purulent, caustics are recommended. Solleysel preferred these, but blacksmiths used them so carelessly that they soon were discarded. Since, however, they have been employed again, not in powder, but as trochiscus. Rey recommends the corrosive sublimate in conic pencils, introduced to the bottom of the fis- tula; by them he obtains an eschar, a solid clot, from the synoyia, which closes up the wound and prevents the synovial flow, at the same time stimulating the granulations which close up the fistula. We have already said that these measures must be used only when the synovia is not purulent, as then the escape of morbid liquids may be prevented. It is not then uncommon to see abscesses forming at the back of the coronet; generally not so serious as is usually believed; not as much as those which take place in front and which are due to suppuration of the articula- tion. After the running out of those abscesses, sometimes the wound of the foot assumes a better aspect, the symptoms im- prove, and the animal recovers rapidly. Injections of a very weak solution of tincture of iodine, as well as the baths of copper or iron, are then very advantageous. Hertwig advises the introduc- tion of a seton through the sesamoid sheath. This treatment is not always sufficient, especially where the lesions are deep. All the diseased structures must be then ex- . posed, and they must be removed and the wound changed into a simple one, which, well dressed, will heal without difficulty. The operation is required in proportion to the extent and nature of the lesion, and if this is recent and comparatively superficial, if a piece of the foreign body yet remains in the wound, or if its re- DISEASES. 637 moval has resulted in the sloughing of a small piece of dead tis- sue, it may be sufficient, the foot being pared thin, as already ad- vised, to simply make an infundibuliform opening, various in size, so as to expose the bottom of the wound. For that purpose, the drawing knife or the sage knife is used, a light shoe is put on, and a dressing of digestive ointment, zegyptiacum, or simply alcoholic mixtures, are kept on by plates. At times it is advantageous to assist the process of sloughing by the use of caustics, sulphate of copper, Villate’s solution, tincture of iodine, ete. If the wound is near or at the heels, the branches of the shoe are shortened and an appropriate dressing is put on. Subsequent dressings require the same care. Cicatrization goes on and the hoof soon returns to its normal condition. Sometimes the surgeon is called only when the inflammation is far advanced and suppuration already established. This peculiar condition is manifested by the swell- ing and heat of the parts, the acute pains, and often the high fever. The wound then must be at once enlarged and the pus allowed to escape, and this is the true operation for deep punctured wounds. The operation becomes more serious if there is separation, partial or total, of the sole or frog, with a more or less advanced disorganization of the tissues underneath. If there is escape of purulent synovia, extensive cuttings are to be made. In olden times, to perform the operation of the deep punc- tured wound, the entire removal of the sole was performed, with- out distinction or exception and notwithstanding the severe pain following it. In our day, a portion of separated sole or frog only is taken off. This is done by slices, and only so far as neces- sary for the other steps of the operation. This operation is indicated when there is great pain, continu- ing without regard to what treatment has been followed. It is also when the plantar aponeurosis has assumed a greenish tint, diffused in its extent, without indication of a repairing process, with the marks of sloughing of the dead structure. The instru- ments needed are various: sage knives, single and double; draw- ing knives of various sizes: a directory, bistoury and forceps. The animal, properly secured, and placed under anesthetics, if too irritable (Bouley), the horny structures are removed where- ever the suppuration has separated them from the soft tissues be- neath, or the sole is only pared down thin, as well as the horny frog in its whole extent. 638 OPERATIONS ON THE FOOT. This first step of the operation completed, the operator intro- duces a director into the whole tract of the fistula, and with a sharp sage knife a longitudinal incision is made, following the canula of the directory as a guide, above and below the fistulous opening, and in the direction of the antero-posterior axis of the foot. This done, with the sage knife held in full hand, with one cut the surgeon, by a deep incision, removes the greatest thick. ness of the tissues all around the longitudinal cut he has just made, transforming the fistulous tract into a conical infundibu- lum, whose apex is at the bottom of the wound. If then the apo- neurosis is not yet exposed, the operator removes with the for- ceps and bistoury whatever tissues still cover it. Then follows the excision of the aponeurosis. This is meas- ured by the extent of the necrosis. As a rule, it must reach a little beyond the diseased part, and by that operation the puru- lent synovia finds a free chance to escape. If the sesamoid is sound, it must be left alone, but if the diathrodial surface is roughened, ulcerated and on the way to desquammation, it must be scraped off with the narrow and long drawing knife. The complications of arthritis cannot be interfered with by the surgeon. Itis by general antiphlogistic treatment, and by local and external applications that they must be treated. The operation ended, the dressing follows, and becomes one of the most important parts of the means of recovery. As light a shoe as possible is placed on the foot, a coat of hoof ointment, Venice turpentine, or tar, is applied upon the thinned sole; pads of oakum, wet with alcohol, carbolized or not, are then carefully laid on the soft parts. Some practitioners cover them with cegyptiacum (Mandel) ; others simply with Venice turpentine (Lafosse). The pads or balls of oakum must not be too thick or hard, as no pressure is needed. The whole dressing is retained by plates, and several circular straps of tape above the coronary band. Cold water baths are always good afterward. In the subsequent dressings one must bear in mind that the work of repair, the granulating, is more rapid in the tissues of the plantar cushion and fleshy sole than upon the bone and tendinous tissue ; and that in this case itis longer than upon bone if this has been scraped. The result of this is a wound which presents DISEASES. 639 various aspects in its progress of cicatrization. It often has a handsome granulating appearance over its entire surface, while at the bottom there may be a clot of coagulated synovia covering the surface of the sesamoid and the edges of the wound of the plantar aponeurosis. A free escape of synovia must always be facilitated, and often the development of the granulations has to be con- trolled. If the cicatrization proceeds well and regularly, dress- ings need be changed but seldom, being satisfied with the cold bath, with copper solutions. Dressings can be made with tincture of myrrh or aloes; some- times in the centre with tincture of iodine. At times caustics are again used, while at others, fragments of bone or of tendon have to be excised. The entire closing of such a wound may sometimes take place in a month; but often, even without complications, two or three are required. Complications may easily make their appearance and interfere with the cicatrization. Sometimes pieces of necrosed tis- sues which remain at the bottom of the wound give rise to fistulous tracts, until they are entirely removed. In this case, twice as long a time may be necessary to a cure. The pain and intensity of the lameness after the operation do not accurately indicate the nature of the disease; the general phlogosis, especially the synovial in- flammation, always causes a special acute pain, which for from three to six weeks may prevent the animal from resting his foot on the ground. This pain is entirely independent of the process of repair, and must not alarm the veterinarian. While the react- ing fever is absent, and there is a good appetite and no swelling in the region of the coronet, the progress may be considered sat- isfactory. After the cicatrization of the plantar wound made during the operation, the parts may return to their physiological condition, or nearly so; or, on the contrary, remain in an entirely abnormal condition. Often, indeed, the sesamoid sheath may become oblit- erated, the diarthrodial surface has lost its smoothness and there is no more sliding upon it, the tendon having become united toit. The animal then remains lame, and cannot be utilized except in walk- ing; if coronary anchylosis, ringbones are detected, and the appli- cation of firing is indicated. Sometimes neurotomy gives excellent results. 640 OPERATIONS ON THE FOOT. ContracteD Hrrxts—Hoor Bovunp. Synonym: Zwanghuff, German; Fncasleture, French; Incas- tellatura, Italian; H/ncatenadura, Spanish. : This name has been given to a defect of the horse’s foot, by which it becomes characterized by its general narrowness, more marked, however, in the posterior than the anterior part. It is especially marked by the diminution of the lateral diameter of the horny box, the deformity consisting in a greater or less contrac- tion of the heels and of the quarters. It is principally observed in the fore feet, and it is there only that it presents the characters we are about to describe. This is due to the fact that in the fore legs there is need of a certain ex- pansibility in the posterior part of the foot, which, especially during the action of locomotion, receives the weight of the body; while the contraction of the hind feet gives rise only to an ordinary form of lameness. Sometimes one of the anterior legs only is affected; sometimes both, and in this latter case the alteration is usually greater in one foot than in the other. Some horses are also seen whose feet are contracted ae on one, usually the inner side, while the other preserves its normal form and directions. Sometimes “hoof-bound” is only a simple deformity, without lameness and without serious result. But in most cases, it consti- tutes a very serious affection, which renders many horses useless and almost without value. It is of more common occurrence than is generally admitted, and gives rise to many other affections of the foot. Cases of lameness treated as located in the shoulder, or as navicular disease, are very often nothing but the result of com- mencing contraction of the heels. True navicular arthritis and hoof-bound are closely related. Whether the disease of the sesa- moid sheath, arising primitively, brings on the subsequent con- traction; whether the contraction already existing gives rise to the alteration of structure which constitutes the disease so named, cannot always be determined. Hoof-bound was known in old times, and the oldest hippiatrics have proposed means to cure it. Riders especially have studied it, because the disease is most com- mon in fine saddle horses, whose feet are small. It is frequent in Turkish and Spanish horses, and animals from the Pyrenean dis- tricts, but common horses are not exempt from it. s = = ‘ " Ss « ees ee SS fe DISEASES. 641 H. Bouley describes two forms of the disease, the trwe and the pretended or false contraction. In the first, the hoof is very nar- row, sometimes even concave on its lateral face, to such an extent that its antero-posterior considerably exceeds its tranverse diame- ter; while at the same time its wall is more vertical, and the heels considerably higher than normal, and the foot looks like that of a mule, of which this is recognized as the normal appearance. In the false contraction, there is merely a diminution of the transver- sal diameter of the horny box in its posterior parts, the foot being narrow and contracted at the heels only. We prefer to recognize a total contraction where the whole foot is contracted, and is smaller than its fellow, atrophied, so to speak, consisting in a contraction of the quarter—when it is principally narrow in those quarters, the condition extending back to the heels—and a contraction of the heels when this is well marked from the quarters to the heels only. sulphate of iron. Itis often the case that after some interval fol- lowing sloughing of the bowrbillon, the wound continues to dis- charge a liquid secretion, which is an evidence that there is a ten- dency to accumulation of matter toward the lateral cartilage, or under the wall, in the laminz; or that there is some carious spot existing. In the first, if probing horizontally, a cavity is de- tected, it is convincing evidence that a cartilaginous quittor is in course of development; in the second case, the pressure and col-. lection of the matter increases the inflammation of the lamina, separates the wall, and complicates the disease, necessitating the operation of the sub-horny quittor. The removal of the portion of the hoof which covers the lesion, DISEASES. 713 must, however, include more than the purulent center, so tnat the diseased tissues may be well exposed and the suppurative process detach them readily. This removal, always proportioned to the internal lesions, is made either lengthwise, following the direction of the horny fibres, or crosswise. In that case, it will attack only a portion of the wall toward its point of union with the skin, This latter method, it is true, requires less cutting, but it has sev- eral quite serious objections and often necessitates a second oper- ation. Even in cases where the growth of the granulations can be controlled, and where a good return of the horse is obtained, the horse only recuperates its perfect integrity by the slow growth downward of the wall. In some circumstances the operation is completed by the removal of a portion, or even of the entire mass of the sole, when it is separated from the velvety tissue. The removal of a portion of the wall must be accomplished in the manner which will be indicated for cartilaginous quittor, in carefully avoiding the injury of the coronary band and of the podophyllous tissue. The diseased tissue beg exposed, all that is of bad appearance is removed, the carious portion being freely taken off. An ordinary dressing of oakum with diluted alcohol, or any other drug, kept in place with a light shoe or slipper, en- tire or truncated, as the case requires, is then applied. As for all wounds of the foot, the dressing needs only to be changed when the pus accumulated under the oakum, or other peculiar conditions indicate it. It is true that changing the dress- ing is an effective means of cleansing the wound, but it has the inconvenience of also irritating it, and especially at the begin- ning may tend to interrupt the natural process of repair. It is of advantage, after the first dressings, to change them as infrequently as possible. In this way hemorrhages, which may always be looked for, are avoided. This is a point of the first importance. It has been proved that even in operations where a portion of the wall has been removed, a dressing left on for from fifteen to twenty days without removal, was followed by rapid recovery, the new hoof growing under the oakum without suppuration. It is useless to probe or wipe out the surface of the wound. On the second dressing, that is, after a few days, the parts begin to be covered with numerous white points, which are so many rudi- ments of hoof. These, which at first are soft, white, and isolated, gather together by degrees, and first unite into a thin layer, soft 714 OPERATIONS ON THE FOOT. and yellowish, which becomes hard and thick; it is the hoof secret- ed by the lamine, which, little by little, unites with that coming from the coronary band. Excessive granulations or proud flesh are removed in the ordinary way. D. Carrizacinous Quirtor.—Hufknorpelfister (German)— (improperly called sub-horny quittor, by Lafosse, Jr., coronary quittor of Vitet; 7ibro chrondritis of the third phalanx, by Vatel; sub-horny cartilaginous quittor of Girard; quittor proper of Del- wart). This form of quittor is peculiar to solipeds, they being the only animals which have fibro-cartilage on the os pedis. Fic. 523.—Cartilaginous Apparatus of the Hrrse’s Foot. a.—Lateral fibro cartilage. b.—The superior border. c.—Its posterior border. d.— Anterior lateral ligament. e.—Flexor tendons. #.—Extensor tendon. g.—Os pedis. h.—Retrorsal process. These fibro-cartilages (Fig. 523) are two pieces, which, with the plantar cushion, complete the os pedis and form the base of the heels, each representing a piece flattened sidewise, a parallelo- gram in shape, and extending posteriorly to the coffin bone. Their external face is convex and pierced with foramina for the passage of veins, and slightly overlies the surface of the bone of the foot. It is separated from the skin by a very rich vascular plexus. The internal face, concave, is hollowed by vascular erooyves, and covers (forward) the articulation of the foot and the cul-de-sac of the synovial sac which protrudes between the two lateral ligaments of that joint. Downward and backward it is united to the plantar cushion, either by continuity of tissue, as | Zz DISEASES. (ole -near the inferior border, or by fibrous bands running from one to the other. The superior border, either convex or straight, is thin and separated from the posterior by an obtuse angle in front of which it presents a deep notch for the passage of the blood ves- sels and nerves. The inferior border is attached, forward, to the basilar and retrosal processes of the os pedis. Behind this it re- flects inward, to continue to the inferior face of the plantar cush- ion. The posterior border, oblique, backward and downward, is slightly convex and unites with the preceding. The anterior border, oblique in the same direction, is more intimately united to the anterior lateral ligament of the articulation and can be sepa- rated from it only by artificial dissection. It sends upon this ligament and upon the anterior extensor of the phalanx, a fibrous extension, which unites with that of the opposite side. In their structure, the fibro-cartilages comprehend a mixture of fibrous and cartilaginous tissue, a mixture which is far from being homogeneous and even in the various parts. The more it is examined forward and near the base, the more its substance is seen to resemble that of cartilages proper, being white, flexible, brittle, and homogeneous. Toward its posterior part it loses its character of homogenity, becomes less brittle and presents in its thickness a greater amount of fibrous texture. More posteriorly again, the fibro-cartilaginous structure is more marked. By close attention it seems to show cartilaginous nuclei, isolated, and sur- rounded with an entirely fibrous substance; and again, at its pos- terior extremity it becomes fibro-greasy with much cellular tissue and unites with the plantar cushion. The vitality of the cartilage is in inverse ratio with its density and consequently is greater in its posterior part than toward the base and its anterior extremity. This fibro-cartilage may easily and more or less completely be- come ossified; old horses are those which most commonly present this condition, and draught horses are more subject to it than those used to the saddle. It assumes various forms. At times it occupies the entire extent of the cartilage, and at others only at its base; sometimes the external surface is ossified, while the internal remains in its normal structure; then again, the ossification exists only anteriorly while the posterior is cartilaginous, and it more rarely happens that the process consists in bony lamellee, which, starting from the base, spread toward various points of its cir- cumference. 716 OPERATIONS ON THE FOOT. These fibro-cartilages are generally more developed in the an- terior than the posterior extremities. They also present, in one foot, this slight difference, that the internal stands a little higher than the external. Cartilaginous quittor is a serious affection, characterized by the partial caries of one of the fibro-cartilages; it is a partial gan- grene whose character is to slowly spread into the cartilaginous structure upon which it starts. To be treated with success, it re- quires a very regular attendance, and often an operation, which consists in the removal of the cartilage. Sometimes this opera- tion is indispensable, and its study is interesting, especially be- cause, though not as commonly performed as at the beginning of this century, it is one which requires a high degree of surgical skill for its success. I. Symptoms.—A division has been made of an acute and chronic form of this disease. Under the first name, is considered the earlier period of the affection, that in which there is inflam- mation of the cartilage and painful swelling of the part, and when the caries or necrosis of the fibro-cartilage is not yet established; or if there is a wound, when it does not yet granulate, and the suppuration, if it exists, is very slight. Chronic javart would be that in which the partial and progressive mortification of the fibro-cartilage exists; for, as Renault has said, itis the ordinary termination of fibro-chondritis. When free from serious complication, the disease is generally accompanied with but little lameness ; sometimes there is almost none, and animals can be kept at work, especially at a slow gait; but if made to trot, the horse will show lameness. It is especially when the quittor exists in the posterior parts, that the inflamma- tion and the pain are not excessive, because there is then an abundance of soft, fatty tissue. But when the caries is more for- ward, and is situated more deeply, in a point nearer the articular surface, the lesion then affects the fibrous tissues and the pain is greater. It is sometimes excessively acute. Upon the lateral part of the coronet, toward the heels or the quarters, more or less tumefaction appears, more or less painful, according to the duration of the disease, and in this case more or less indurated. In the centre there exists a granulating fistu- lous wound. There are one or several fistule (Figs. 524, 525, 526) whose openings show granulations, bleeding easily, their course DISEASES. 717 Fies 524, 525, 526.—Cartilaginous Quittor. Various Spots of Necrosis. 718 OPERATIONS ON THE FOOT. always forward, running at times in straight lines, at others ir- regularly. The tracts frequently communicate and discharge a granular, serous and thin pus, of pale greyish color, generally odorless, or slightly sanious, containing greenish particles, which are but pieces of diseased fibro-cartilage. The pus dries up on the surface and adheres to the hoof and to the hair, and some- times irritates the surface of the skin. If one of these fistula be- come cicatrized, a fluctuating tumor soon appears, close to it, which rapidly ulcerates, and then gives rise to another fistula. If the disease is quite old, the hoof of the quarter corresponding to the necrosed cartilage, loses its perioplic band, becoming rough, ramy and cracked, and the wall is thickened, because the irritation of the coronary band has stimulated its growth. This change in the condition of the wall varies with the length of time the dis- ease has existed, and consequently, it indicates its duration quite accurately, when one remembers that the hoof grows downward about one centimeter in each month. When cartilaginous quittor is the sequelae or complication of the suppurative corn, of a punctured wound by a nail of the shoe, or any other affection of the foot, the symptoms proper to these diseases are first observed, though the lameness is greater, and the fistule of the quittor is evident. Often, however, this, instead of being external and on the coronet, is situated at the in- ferior part of the foot, at the internal face of the inferior border of the wall, upon the sole, and sometimes connected with the wound of some of those affections of the foot. II. Pathological Anatomy.—When one examines the cartil- age affected with the necrosis proper of quittor, he always finds lesions in proportion to the intensity and the age of the disease. It is seldom, however, that the portions of the cartilage which have undergone the green degeneration, constituting the caries, reaches more than one centimeter in extent; they have the form of a small plate, of a green color, ordinarily elongated, and adhe- rent to the healthy parts of the cartilage by one of its extremities, that which is more forwardand the deepest. Others have com- pared it to the green growth of a seed in germination. The points of the fibro-cartilage which are in immediate contact with the carious portion, have also a slightly pale greenish hue. These are already diseased; there is already a beginning of necrosis; in the remainder of its extent the exfoliation is separated from the ye it »: . ‘ : : es DISEASES. 719 cartilage by a reddish, soft tissue, which also lines the inside of the fistulous tract. This fistula, which extends from the necrosed spot to the skin, is but the hollow tract left by the diseased proc- ess upon the cartilage, while gradually destroying its substance. Always lined with a pseudo-mucous membrane, by a true pyro- . genic apparatus, the fistula is often narrow, sinuous, irregular in its course and extent, especially if the disease is of some standing. Renault, and after him Lafosse, have mentioned a special al- teration of the fibro-cartilage which is sometimes met, and which Lafosse looks upon as a step toward recovery. It is a softening of the tissue, anatomically characterized by a loss of the consist- ency of the cartilage, resembling the case of the cellular tissue becoming indurated, or that of bones deprived of their earthly salts after soaking in weak acids; its yellowish color is then char- acteristic. It may be noticed during life, and is recognized by a softening in the region of the cartilage, which then yields, giving easily to the pressure of the finger; besides this, a probe intro- duced into the fistulous tract readily penetrates into the softened substance. But the true way to diagnosticate this change con- sists in raising the coronary band or after thinning the wall; then one will see and may feel the true nature of the transformation. Lafosse adds that, in presence of this alteration, the removal of the cartilage is no more necessary, for then the cicatrization is readily obtained by stimulating the sloughing of the necrosed tis- sue or by removing it. With cartilaginous quittor there is always plastic infiltration of the cellular tissue surrounding the cartilage. Very often the wall of the synovial capsule of the articulation of the foot is some- what thickened, and in that case there is less risk of injuring it during the operation.—(Rey.) Il. Progress, Duration and Termination.—Left to itself, the caries of the fibro-cartilage may last for a long time, through difficulty in determining its true nature. Spontaneous cure, how- ever, is not impossible, as Renault proved it, and as many practi- tioners have seen it, especially in young and healthy subjects, when the disease is mild at its outset and effects parts of the or- gans where the fibrous element predominates, as in the posterior portion of the cartilage. This fortunate result follows the slough- ing of the “bourbillon” which makes its appearance under the shape of a greenish particle. 720 OPERATIONS ON THE FOOT. But, ordinarily, the disease progresses slowly, destroying the cartilage by degrees, and the diseased process ceases only when the caries has reached the ligament of the joint, which it some- times also attacks. The tissue of the fibro-cartilages has not the force of reaction possessed by other inflamed structures, and which is so well marked in cellular tissue. A process of suppura- tion, such as rapidly eliminates the mortified structure, cannot very readily take place in it, and when by natural forces the cari- ous spot is eliminated and pushed outward, the surrounding tis- sues are most commonly already affected. These undergo the same alterations, and are eliminated in the same manner until the entire cartilage is destroyed. This process of caries by repe- tition may last a year. In its progressive stage, the disease may spread to surround- ing parts, such as the os pedis, the plantar aponeurosis, the liga- ment of the joint, or the sesamoid sheath, all of which may be- come the seat of inflammation. They are diagnosticated by the greater pain and more marked lameness, symptoms which are comparatively light in the simple necrosis of the cartilage. Finally, as a possible complication of cartilaginous quittor, one may observe an entire emaciation of the animal, an alteration of the fluids due toa putrid or purulent infection; some authors claim to have even seen glanders and farcy follow it; this is inad- missible. IV. Diagnosis. — Cartilaginous quittor is recognized only when there is a wound from which escapes the product of the suppuration and of the necrosis. This pus has nothing charac- teristic, notwithstanding what has been said. If it is thinner than that of a simple solution of continuity of the region, or that of simple quittor; if itis less foetid than that of bony caries, it has, however, of itself some special characters, varying according to the subject and the degree of the disease, and especially resem- bling much that of sub-horny quittor. If the escape of the pus is slow, and it is desired to carefully examine it, a simple pad of oakum, kept by a few turns of bandages on the fistulous opening, will, when removed, give a sufficient opportunity to recognize its nature. The probing will often assist in distinguishing the cartilagin- ous from the simple or sub-horny quittor. In these last, the fis- tula is less profound, and does not reach the thickness of the DISEASES. 721 cartilage; but, as in cartilaginous disease, the fistula is often sin- uous, it is better to use a soft, flexible instrument, such as a fine probe made of lead. The injection of liquid may take the place of the probing; injected in a superficial tract, it returns outward directly, while in deeper and irregular fistule, it will penetrate more readily. The induration of the coronet, the rough and ramy appearance of the hoof of the quarter corresponding to the fis- tula, indicate generally a necrosis of the fibro-cartilage; these characters are missing in the furuncle. V. Prognosis.—In consequence of the tenacity of the disease, this form of quittor is always serious; though this gravity has, in our days, greatly diminished, on account of the means of treat- ment now in use, which were unknown some thirty years ago. Now, this affection, which was considered. by all hippiatrics as al- most incurable and which more recently was treated by an opera- tion which rendered the animal unfit for work for several months, can in the majority of cases be cured in about fifteen days. The prognosis, however, varies and depends on the complica- tion. When there is caries of the ligaments, inflammation of the articulation of the foot, or of the sesamoid sheath, the extirpation of the cartilage itself, done with the greatest dexterity, is not even a warranty of recovery. It remedies only the necrosis of the cartilage, but leaves the other diseased processes to progress in such a manner that the animal remains worthless if he has not to succumb to them. The pain is, besides the other signs, one of the most important points to consider: very acute, it is generally a discouraging omen, and points to the existence of serious com- plications. VI. Etiology.—Heavy draught horses are more frequently af- fected, on account of their peculiar work. The most common cause is a bruise, a blow, a burn, a prick, any wound exposing the cartilage; it is most common in horses drawing trucks loaded with stones, which may drop on their feet and crush the fibro- cartilage. The same cause exists for horses working in extensive works of buildings, in the construction of railroads, and in the shops of mechanic construction. Owing to these conditions, it is also more common in large cities than in the country, and more frequent in stony and tem- porary roads than in those which are smooth and flat. Flat feet, with low heels, are more exposed than others, as well as those 722 OPERATIONS ON THE FOOT. whose hoofs are soft. Quittor is more frequent in the fore than the hind feet, the fibro-cartilages of the fore feet being more de- veloped and more flexible, and because their heels are generally lower than in the hind legs. In some, it is more common on the internal than the external quarters, while with us, it has been the contrary. It is often a complication of suppurative corn; of punctured wounds of the foot, of canker, of simple and sub-horny quittor, of grease, etc., which are then the determining causes of the disease. VII. Zreatment.—When the disease is recent and the quittor acute, and antiphlogistic treatment may be attempted and resolu- tion looked for, baths and emollients are generally beneficial. A good blister has sometimes proved advantageous, and when it is used, limited suppuration, with the formation of a simple slough, may take place. Tf necrosis is well established, it is an indication of the neces- sity of a recourse to more energetic treatment, in which case sey- eral measures are recommended, including the actual and poten- tial cautery and the removal of the cartilage. In actual cauterization, the necrosed spot is destroyed by a cautery brought to a white heat, applied directly upon it, after it has been exposed by a freeincision. It is a simple treatment, and one that has been successful in cases of posterior necrosis where much fibrous tissue was diseased, and principally in young and well-conditioned animals (Lafosse, Sr., Girard, Vatel, Mangin, Renault). Still, this treatment not only often fails, but may even become a means of irritation of the fibro-cartilage, and cause an extension of the necrosis. (Hurtral, D’Arboval, Lafosse). In our day, this treatment is almost entirely ignored by good practition- ers, and the potential cautery more generally adopted. This had already been employed by hippiatrics. Solleysel principally recommended the use of corrosive sublimate mixed with aloes; Girard, Barreyre and Bernard also mentioning it. English veterinarians recommended their use very strongly. (White, Blaine, Riding, etc.).. These practitioners all used the solid caustic, either in the form of trochiscus or in powder, and if they obtained good results, it required a much longer time than that required in our day by the use of the liquid forms of caustics which are at our command. With the solid form, the action was of limited extent, and scarcely more effective than that obtained 4 aa 4 7 4 : DISEASES. 723 by the actual cautery; moreover, they frequently injured the healthy structures by irritating them and increasing the inflam- mation, and thus resulting in serious complications. As we haye said, liquid caustics are largely used to arrest the spread of the caries; they modify the process of decomposition, dry up the suppuration and stimulate the tissues without injuring the healthy structures. This mode of treatment must be credited to Mariage, who in 1847 established the unfailing efficacy of re- peated injections of Villate’s solution; one of sulphate of copper and sulphate of zinc, 64 grammes of each in 1 liter of vinegar, and decomposed by 125 grammes of Goulard’s extract. It is really simply a solution in vinegar of acetate of copper and zine, holding sulphate of lead in suspension. Villate himself had al- ready used his solution with success by injecting it in cartilagin- ous quittor as early as 1829, since which time Burgniet, Verrier, Sr., Collignon and others have recognized the benefit of liquid escharotics in the treatment of the same disease. Villate’s solu- tion is not a specific, and cartilaginous quittor has been cured by the injection of tincture of sublimate with solution of nitrate of silver (Bernard), with the perchloride of iron, chloride of copper, sulphate of copper and zine, nitrate of lead, more or less concen- trated mineral acids, and especially the Rabel water (Collignon). It is difficult to say which is the more useful of these drugs and which has been more successful. Success has also been ob- tained with injections of tincture of iodine, phenic acid and even petroleum. It is less the nature of the drug that insures the ef- fect than the mode of using it. We ought also to say that, ad- vantageous as this mode of treatment is, it is not infallible, though Mariage and others so consider it. It is not to be preferred to the extirpation of the cartilage, an operation which proves suc- cessful when all other means have failed. To obtain a cure by the use of liquid applications it is essen- tial to make injections every day, and even several times daily. These are made with a syringe, carefully adapted in respect to size, with a small canula. The injection must be pushed well in, but must be allowed to escape freely after coming in contact with all the diseased surfaces which it is designed to modify. To effect this, it becomes necessary, as the fistulee are sometimes very nar- row, and even irregular, to enlarge them, or to make counter openings. Mariage had originally insisted that these precautions 724 OPERATIONS ON THE FOOT. were essential to the success of the treatment. H. Bouley and Viseur also strongly insisted upon the same point, viz., that of en- larging the fistula in order that the liquid should not be allowed to remain at the bottom of the fistulous tracts, by which all possi- bility of the extension of the disease from that cause might be avoided. These enlargements of the fistula, or counter openings, close, however, very rapidly; as a remedy to which, Hivernat has suggested the introduction into the tracts of little wedges of wood pointed like pencils, for the purpose of lacerating the walls of the fistula, followed by the insertion in them of small setons, moist- ened with Villate’s solution. Guerrapain introduced a fine meche of oakum, a seton in the tract, by means of a curved needle. If the fistula runs downward its bottom is under the wall, and he thins this down and makes a counter opening through the hoof thus thinned. This seton prevents the closing of the counter opening, and enables the operator to push through the injection regularly. Other precautions are also necessary. One, especially, is rest. The animal must not be put to work. Lafosse says that these liquid caustics act with regularity and cure with certainty. A bar shoe, not pressing on the diseased quarter, is also useful. Emol- lient poultices are sometimes necessary after the injection, to diminish the irritation. Mariage also recommends them. If the fistula extends under the coronary band, or the podophyllous tis- sue, it becomes necessary to thin, or to remove altogether, the hoof of the diseased quarter. After fifteen days of this treatment, the exfoliation often takes place, and recovery follows. Often, however, twice this length of time is necessary. After the first eight days the pus becomes more abundant, white and laudable; the tumor softens and dimin- ishes, as the pain subsides. Later, the injections penetrate with greater difficulty, which is a good sign. The injections constantly attack the germ of the disease and leave it without chance to re- form or to spread; the gangrenous structure which develops in the cartilage is changed into an inert substance; the pyogenic membrane of the fistulous tract is stimulated; the process of granulation becomes more rapid; the wound becomes more and more healthy, and the diseased process ceases. If, however, it continues, the wound changes its character, large granulations develop themselves, and in their center the openings of the fistu- ~ ae DISEASES. 725 lous tracts, which open on the cartilage, make their appearance. At times the wound closes ; but, after a short interval, opens again, or another forms at another point. There is then a repetition of the same course of treatment by caustic applications—but gener- ally this indicates a complication, and suggests the propriety of an operation. The injections are generally successful, however, and most certainly so if the caries occupies the posterior parts of the cartilage. They may even succeed in the anterior parts, when the animal is young and of good constitution. But if the cartil- age has already become partly ossified, the caustic is irregular in its action, and the result becomes doubtful. If the caries is deep and extensive, and especially if the necrosis extends through and through to a point corresponding to the synovial capsule of the articulation of the last phalanx; or if the necrosis exists on the internal face of the cartilage, where it covers that structure, then the repeated injections of Villate’s, gr of any other caustic, may be followed by serious complications. An old or complicated caries will offer an increased resistance to the treatment by liquid caus- tics, in proportion as there is more or less difficulty in bringing them in direct contact with the necrotic points. The third method of treatment is that of the removal of the cartilage. This operation, first recommended by Lafosse, Sr., in 1754, was often performed by his son, and may be considered one of the most valuable results of the application of anatomical knowledge to the practice of veterinary surgery. This operation was also performed by Bourgelat and his students, by Girard, Hurtrel, D’Arboval, and was principally studied and described by Renault. In Germany, notwithstanding the writings of Langen- bacher, Dieterichs and Hertwig, it did not meet with approval, and English veterinarians seldom, if ever, resorted to it. At pres- ent, even in France, it is seldom performed, except in case of fail- ure by the caustic injection treatment, and this is often the case where the disease is situated in the anterior part of the fibro- cartilage, where the cartilaginous tissue predominates, or where the vitality is diminished, and above all, where ossification has taken place. It is an operation of the greatest delicacy, and ac- companied with great risks on account of the proximity of the joint of the foot, and it requires an experienced operator and thorough practitioner to justify a hope of successful results. It consists in the excision, by layers, of the diseased cartilage, and 726 OPERATIONS ON THE FOOT. in avoiding injury to the coronary band, and to the podophyllous. tissue, which are essential elements of the organization of the foot. It is also essential to avoid injury of the lateral ligament of the foot joint, which is close to the cartilage, and above all, of the synovial capsule of the joint, which is directly covered by the cartilage. The partial or entire extirpation of the cartilage can be performed. In the first case, only a portion of the necrosed fibro-cartilage is removed. Vatel, Sanstas, Renault, Bell and La- fosse have reported many cases of recovery by this mode of oper- ation, but it is not likely to be thoroughly successful, unless in circumstances as favorable as those accompanying the treatment by liquid caustics. It is generally much better when the operation is decided upon to perform it by excising the entire structure, and removing all the carious elements. The partial removal is to-day entirely abandoned, and entire extirpation accepted as the true and only operative procedure. The best method of performing it is that recommended by Renault and adopted in our colleges. We shall make it the subject of description with all necessary details, and with various modifications as performed by other practitioners; we shall also offer some observations upon various other modes of performing the operation in question. The operation includes two principal steps: first the removal of the part, or the whole of the wall corresponding to the diseased cartilage ; and second, the extirpation of the cartilage itself. The opinions of surgeons vary as to the amount of hoof which should be removed, and the extent of horny tissue to be taken off. In respect to the length of the superior border of the portion requir- ing removal, it is generally agreed that it must extend from the anterior extremity of the cartilage backward, that is, the two pos- terior thirds of the space reaching from the toe to the heels, or one-third of the circumference at the coronary band. But opinion continues divided as to the lower border (Fig. 527). Lafosse, Sr., left it longer than the superior, and made the direction of the division of the groove correspond to that of the fibres of the hoof. Lafosse, Jr., accepting the idea of Solleysel and of Dieterichs, did not reach the sole with its groove, and removed only a portion of hoof parallel to the coronary band. Renault prefers crossing the fibres of the hoof with the groove, and brings the lower end of it to one-half the dimensions of the upper border, its groove running backward. Rey considers this to be running too far back and DISEASES. TAG E B Cc D FIG. 527.—Direction the Groove should take to remove the Quarter in the Operation for Cartilaginous Quittor. A B.—According to Lafosse. A C.—According to Rey. A D. —According to Renault. A H.—According to Lafosse and Dietericths. too near the heel, and recommends the groove to be so made that the lower border will have the same length as the upper, and for that reason advises that it be as nearly parallel as possible with the line of the heels. Lafosse, Sr., removes too large a portion of the hoof. Lafosse, Jr., leaves a portion of hoof which not only is useless, but which interferes with certain steps of the operation, when with the double sage knife, the skin is separated from the external surface of the cartilage, and also, when this is removed; and again, there is a separation between the severed portions of the quarters much greater than occurs in the process of Renault, which, like that of Rey, exposes the entire cartilage, and greatly facilitates the operation. It is to be understood that the foot has been prepared; that the hair has been clipped over the skin covering the cartilage; that the sole has been pared thin, down to the blood, as well as the bar corresponding to the diseased cartilage, so that the quarter has been allowed to project below the sole, to facilitate its ever- sion. The foot has been, moreover, well prepared by two or three days of poulticing, to render the hoof easier to be cut by the in- strument, and the operation easier to perform, and therefore shorter in its various steps, beside placing the patient in the best condition for the endurance of so serious an operation. After casting the animal upon a good bed, and fixing the feet, placing a temporary hemostasis, by the use of a strong cord, simi- lar to a tourniquet, around the coronet, a groove is made, using various-sized drawing-knives, running from the anterior angle of the lower border of the cartilage downward to the sole, following 728 OPERATIONS ON THE FOOT. the direction recommended by Lafosse, Sr., Rey, or Renault. This groove, made first with the widest, and finished with the narrow- est of the drawing knives, must not touch the podophyllous tissue, and still must run through the entire thickness of the wall, with- out producing hemorrhage. In this step of the operation, as Girard correctly observes, short cuts of the knife are always bet- ter and quicker than those made by scraping or dragging with the instrument. It is also important to come down to the soft tissue at the coronary band first, and successively downward to the inferior border of the wall, as otherwise, as the instrument is moved from above downward, with a certain amount of force, it might slip and cause a serious division or laceration of the podo- phyllous tissue. The separation is then made of the wall from the sole by another groove, extending from the end of the groove already made, on the quarter, back to the heels. This is done without difficulty, with a small drawing-knife, when the foot has been properly prepared. There is, however, one point which usually offers more or less resistance when the quarter is removed, It is that where the wall is continued to the bars. This resistance is sometimes so considerable that if much traction is made, the wall will break more or less in front of the heels, where it is com- paratively thin, and it may consequently become necessary to re_ move, by itself, the portion which has remained attached. This little accident, however, can be avoided by ascertaining certainly before the extraction of the wall is effected, that the continuity of the wall and bars has been cut off. This being the case, the com- plete separation of the wall from the sole is made by running the sharp edges of the double sage knife through the structure of the living tissue underneath. The resection of the quarter can then be proceeded with. For this purpose, a properly constructed lever is carefully in- troduced into the groove before mentioned, at the wall and sole of the foot. The inferior and anterior angle of the hoof at this point being then carefully raised, an assistant grasps it with the nippers, turns it back and tears it-slowly, while the surgeon, with such a motion of the lever as may be necessary, assists in the tearing off of the portion of the quarter requiring removal. If adhesions remain, interfering with this manipulation, they are removed by cutting with asharp instrument. As this separation of the wall reaches about to the coronary band, the separation is very easy, 5 ne “oe DISEASES. 729 and no fear of lacerating the soft structures need be entertained. Care is necessary at this step, however, to avoid injuring the cor- onary band, and the podophyllous tissue; to prevent which it will be prudent on the part of the assistant to press upon the band as the separation takes place. This being accomplished, the edges of the wound are carefully examined; any projections remaining are removed, and the blood is sponged off. The double sage knife is then carefully plunged, with the convexity turned upward (that is, toward the skin), be- tween the external surface of the cartilage and the internal face of the skin, below the border of the coronary band, and then carried forward and backward, or as required, until the separation of the skin and the cartilage is completed and the external surface of the cartilage is exposed. In moving the instrument backward, it is necessary to be very cautious, especially while carrying the sharp edges downward and inward, in order to avoid injury to the cor- onary band and the skin, of which, however, there can be but little danger, when the knife is carefully held and properly directed. The succeeding step is to separate the skin from the cartilage; it is to be carefully raised and separated from its attachments under- neath, which is sometimes a process quite difficult to accomplish, as the skin has always become more or less tumefied, and there- fore has lost much of its natural flexibility and suppleness. Some operators, in order to avoid these difficulties, and overlooking the functions of the coronary band, cut it, and remove it, with those portions of the skin which cover the cartilage. Others, more con- servative (Herting, for example) cut it only through the middle, until they reach the superior border of the cartilage, and then, raising the two fiaps of the skin, accomplish the same result with less cutting. , The destruction of the principal organ of the secretions of the hoof having been involved in the first method, and having now taken place, it can never be restored to a healthy condition, and the animal continues to be exposed to the frequently serious com- plications of ‘‘false quarter.” By the second method, the produc- tion of a new wall is nearly always accompanied with the forma- tion of a “quarter crack.” The recovery is slow in either case, and more or less deformity is likely to follow. It is, then, the better and wiser plan to separate the skin from below, and to avoid the division of the coronary bands or of the teguments. 730 OPERATIONS ON THE FOOT, The next step is the removal of the cartilage altogether. This is done with the single sage knife, held firmly in the hand, either the left or the right, always, however, that corresponding to the side of the heel to be operated upon. Taking a point of rest with the flat of the thumb upon the plantar surface of the foot, the in- strument is pushed between the skin and the cartilage, and the sharp edge turned backward, with a firm rotary motion, down- ward and forward. The detached portion of cartilage is then seized with a pair of bull-dog forceps, and brought outward, and the sage knife is brought forward, downward and outward, from under the cartilage. It is a good plan, in order to make more room for working, to raise the skin and coronary band with a blunt tenaculum. The operation should always be commenced at the posterior part, in order to avoid the articular synovial cap- sule, which might be opened if the removal of the cartilage was begun forward. As the operator reaches the anterior part of the cartilage, which is situated almost over this capsule, it is prudent to hold the foot in excessive extension, and thus avoid injury to the capsule. This is an important point to consider in the oper- ation. The sharp instrument being carefully handled, every por- tion of the cartilage is taken off, either at once, or better by layers. successively, until the whole is removed. It is thus accomplished in three or four pieces. In some instances the anterior portion is. cut off by a longitudinal incision, made with a straight bistoury,. following the direction of the posterior face of the coronet, the object, in this case, being simply to render the operation easier. The cartilage is thus removed, great care being taken to avoid opening the capsular articular burs. It is essentially necessary to remove the whole of the diseased tissues, in order to bring the parts into the condition of a simple wound. Still, there need be no alarm if some small portions remain, more fibrous than cartilag- inous, which, deep as they are, may protect the synovial capsules or the ligament; and moreover, they often slough off by them- selves, with the abundant suppuration which follows. To operate with the greater facility, it is well to have two forms of sage knife, one right and one left-handed, and some of extra streneth, with which toremove the larger particles of cartilage, the others being small, thin and light, being adapted to the more careful dissection necessary toward the lateral ligament, and about the synovial bursz of the joint. ‘A pes eg ye Ms "5 ae DISEASES. 731 Toward the end of the operation, the surgeon will, with the finger, carefully explore the condition of the parts, to insure him- self that the cartilage is entirely removed; that the articular syn- ovial sac has been preserved intact; that the ligament of the joint remains perfect, and that the parts are well washed, and ready for the dressings. Although in the absence of possible complications, the operation is now finished, it may yet be followed by some serious sequelz, which we will next consider. The operation may become complicated by a variety of atten- dant and accessory circwmstances. Among these are, the opening of the articular capsules; the wounding of the anterior lateral ligament of the articulation; the ossification of the fibro-cartilage ; caries of the os pedis; and the alteration of the coronary band and of the reticular tissue. The opening of the articular capsule, either during the oper- ation, or by ulcerative process, is not so serious an accident as it was originally thought to be. Still, however, it requires some at- tention. It only becomes dangerous when the ulceration is ac- companied by serious disorganization, and especially when it is associated with purulent arthritis. (Renault, Hurtrel, D’Arboval, Bernard). It is treated by simple pressure, camphorated paste, a little corrosive sublimate mixed with starch, or better, with Egyptiacum ointment. The wound of the ligaments has also been considered a very serious accident, which, according to Girard, cripples an animal permanently. But Lafosse thinks this an exaggerated notion, and claims to have witnessed the radical recovery of animals after the necrosis and sloughing of the ligament. If ossification of the cartilage is discovered during the opera- ' tion, the removal of all the unossified portion is first proceeded with, in order to prevent a recurrence of the disease. The extir- pation of the osteo-cartilaginous portion is then effected, either with a small drawing-knife, or the gouge, or the bone forceps. The removal is made as far as the ossification is found to be com- plete, the operator making sure that every portion of cartilage is thoroughly destroyed. If the ossification is but partial or irregu- lar, the surgeon must be guided by the condition of the parts. When the entire cartilage has undergone ossification, its suscepti- bility to caries has ceased. When caries of the os pedis exists, the part must be destroyed 732 OPERATIONS ON THE FOOT. with the sage knife, the gouge, or the chisel, according to the existing conditions. But in this case, portions of the reticular structure require removal, of which, however, as little as possible should be destroyed. It may happen that the portion of the coronary band covering the cartilage may be destroyed, either wholly or in part, either as an effect of the disease, or by accident during the operation. In the first case, if the entire band has been destroyed, there is noth- ing to be done. But in the other case, if any portions of it re- main, care must be taken to insure their preservation, as they may supply the necessary elements for a new, healthy secretion of hoof, and the quarter may grow again, more solid and less de- formed. If the wound of the coronary band consists merely in a simple division of limited extent, the wisest course will be to at- tempt to obtain union by immediate adhesion, or first intention, by bringing the edges of the incision together and maintaining the contact by careful dressing. When the alteration of the re- ticular tissue alone, is present, it is very essential to avoid the ex- cision of the injured lamin. It is, in fact, the better course to avoid wholly the use of sharp instruments, and to leave to the natural process of suppuration the removal of the disorganized parts. Renault having observed how their removal interfered with the reparative process, has often left them undisturbed, even when their dark color and softened condition indicated the small- ness of their chance of conservation. The success of the opera- tion after a first dressing, has shown the wisdom of the plan of non-interference; they were found covered with a new layer of yellowish hoof; and D’Arboval has on several occasions observed the same result. The dressing must be methodically and carefully applied. Done well, a dressing greatly assists in the recovery, while many, when badly performed, have been the cause of serious complica- tions, which have greatly hindered the repairing process, and of- ten, indeed, rendered a disease incurable, which need not have been beyond remedy. in the application of the dressing, two points are important to consider: first, we must dress the subcu- taneous wound, resulting from the separation of the skin and the extraction of the fibro-cartilage; the other, that of the sub-horny wound, produced by the removal of the portion of the quarter. Both are important, but the second requires the greater care, and DISEASES. 733 is more difficult and more important than the former; any excess in the sanguineous circulation must be prevented, and excessive granulations must be kept under control. The dressing, then, must be somewhat compressive, without being excessively rigid, in order to obviate possible danger of excessive inflammation ; not too loose or so soft as to allow hemorrhage, or the undue pro- liferation of granulations. It must be both supple and firm, and of an even and uniform pressure. The proper material is balls of oakum for the subcutaneous wound, and pads of the same mate- rial for the sub-horny, the first being moistened with alcohol, while the others are made dry. It is in question whether we should aim to obtain immediate adhesive union of the wound resulting from the removal of the cartilage, or in other words, whether it is good treatment to in- troduce some material of dressing between the skin and the bot- tom of the wound. Here opinions vary. Our belief is, that this union is by no means easy to secure; and that the removal of the cartilage, more or less altered, prevents it at various points. Still, we must not raise the skin too much, and choosing a middle course between, only a small, soft ball of oakum is now placed in the deepest part of the wound, or a thin pad is placed between the two parts, sufficient to represent about the natural form of the part, being enough, however, to prevent the immediate reunion from taking place. A light, thin shoe having been prepared (Figure 528), adapted to assist the application of the dressing and its holding prop- erly, it is put on with one of its branches cut off short on the side where the operation has been performed, while the other branch projects backward beyond the heel, to support the rollers of the bandage of the dressing. Des- plas had thought to turn up that long branch of the shoe (Fig. 529) in the shape of a hook to assist in Fia. 528.—Truncated Shoe for Dressing : ; : in case of Cartilaginous Quiftor or Com- holding the dressings. This is plicated Corn. 734 OPERATIONS ON THE FOOT. Fic. 529.—Desplas’ Shoe for Dressing after Operation of Cartilaginous Quittor and Complicated Corns. useless. Some veterinarians leave the animal unshod, but the bandage is more likely to slip off. The shoe must be put on while the animal is down, and before the application of the dressing. With some practitioners, that is the moment for the removal of the tourniquet or cord, which had been applied at the beginning of the operation in order to prevent the bleeding. This is an un- necessary precaution, and only renders the application of the dressing more difficult. First, balls of oakum are placed over the coronary band, then, upon the points of union of the preserved wall and of the podophyllous tissue, and then all over the wound. We must endeavor, as Renault says, to give the dressing a cylin- drical form, or rather, according to Rey, hemispherical, after which the whole is covered with pads and rollers. These must be put on in abundance, the rollers passing over the branch of the shoe on the sound side, and running successively from above down- ward, and generally from before backward (Figs. 530, 531, 532, 583). Flat feet require special care in dressing, and the fore feet are generally more difficult to dress than the hinder. When all is finished, the animal has to be watched for several days. Ordi- narily, after the operation, there is abundant hemorrhage, occur- ring within some fifteen minutes, and oozing through the dress- ings. This requires no special attention, and generally ceases spontaneously, or by the pressure of the dressing, or by the use of the cold bath. If the dressing seems to be too tight, and the animal shows signs of acute pain, with strong reactive fever, itis | not therefore necessary to remove the dressing, but may be suffi- cient simply to loosen the bandage. The animal should be placed in a wide stall, or box, if possible, where he may move freely, and DISEASES. 735 WARIOUS STEPS IN THE APPLICATION OF THE DRESSING AFTER OPERA- TION FOR CARTILAGINOUS QUITTOR. a Fig. 531.—2d Step - ted Fig. 532.—3d Step. Fic. 533.—Dressing Completed. lie down easily; and he must be prevented from tearing off the dressing by the application of a neck cradle. A low diet is neces- sary for several days, in some instances mashes being the only food allowed. Still, a good appetite and lively condition are always good signs. The interval of time which should be allowed to elapse be- tween the operation and the removal of the first dressing, should be judged by the amount of pain which the animal seems to suf- fer; by the temperature of the atmosphere; and by the amount of liquid discharge found oozing from the wound and moistening the dressing which covers and protects it. Generally, the dress- ings should be disturbed as late and as seldom as possible. Cir- cumstances will sometimes occur, however, which necessitate their removal earlier, as for example, the extreme heat of the weather; 736 OPERATIONS ON THE FOOT. the extremely offensive odor proceeding from the diseased parts ; and a sudden and evident increase of pain in the wound, without any known cause. Under these circumstances, which, however, are of rather infrequent occurrence, it is sometimes necessary to remove the dressing as early as the third day, although at this time, as suppuration is not yet well established, the operation is quite painful, and may be accompanied by free hemorrhage. But if the weather is not excessive; or the dressing remains dry on the outside, and matters seem to be generally in good condition, the better course is to wait from eight to ten days, before the dressing is renewed. Indeed, numerous cases are on record when a still longer period has been allowed to elapse, and the re-dress- ing has been deferred to the extent of three weeks, or longer. In any event, great caution must be exercised in the removal of the dressings, and the surgeon should be careful to have all his ap- pliances ready in advance, in order that the wound may be ex-. posed to the air for the shortest possible space of time. When exposed, the wound should be of a red color, with commencing granulations, and a temporary hoof, soft and whitish in appear- ance, should be visible on the podophyllous tissue. A dressing is then applied of tincture of aloes, or a weak solution of iodine. At a later period the dressings are changed at intervals of about eight days, and an application is made of pulverized sulphate of copper, in order to facilitate the drying and hardening of the soft hoof, Baths of sulphate of iron, with a small portion of sulphate of copper are of service in promoting and hastening the cicatriza- tion. About the thirtieth or fortieth day after the extirpation of the cartilage, the animal may be put to light work. But three or four months, if not a longer period, must elapse, before it will be safe to task him with heavy labor. . Toward the end of the assigned term he should be fitted with a bar shoe, shortened on the side where the quittor has existed. If the dressing is skillfully applied and proper care is exercised, the diseased foot may be sufficiently protected, and the animal made to resume his work with safety. In time, the portion of hoof secreted by the coronary band unites with that of the podophyllous tissue, and after a few months, no remains of the operation are visible. But if the cor- onary band has ulcerated; if the skin has been divided; if by contact of the firing iron, or application of caustics, it has been DISEASES. | 737 destroyed; the quarter then presents irregularities, and some- times divisions, which may be of long continuance, and give rise to a lameness which may, perhaps, become permanent. This danger indicates the necessity of exercising the utmost skill and caution in operating, in order to avoid possible injuries to the coronary band. Several modifications of the ordinary mode of operation have been proposed. Some have had for their principal object, the prevention of the extraction of the hoof, with a view of thus re- turning the animals to their work at the earliest period practic- able. It is thus that Hazard, Jr., proposed to make a crucial incision upon the skin covering the fibro-cartilage; the four flaps being so dissected as to expose it, and then removing it with the sage knife. In this process, the extirpation of the entire cartilage becomes extremely difficult without inflicting injury upon the lat- eral ligaments and the synovial capsules. Pagnier has proposed to merely thin down the quarter, to make an incision in the skin along the superior border of the car- tilage, and through this to remove the organ. But in this opera- tion, however thin the hoof may be, it always interferes with the entire extirpation of the cartilage. Bernard, following the idea of Lafosse junior, who only re- moved the superior border of the wall, proposed a mode of pro- ceeding which is principally useful in cases of separation of the hoof. Instead of removing the band of hoof parallel with the coronary bourrelet, Bernard pared it down with the drawing- knife, the sage-knife, or the rasp, in order to make it as thin as possible, while avoiding the injury to the sensitive lamin. This done, an incision is made along the coronary band, below it, de- stroying its union with the laminz. At this step of the operation, the indications are the same as in the ordinary modus operandi, except that the coronary band being covered with a certain thick- ness of hoof, is less flexible. This, however, is easily removed, as soon as it becomes softened. The remaining steps of the opera- tion are the same as in the ordinary, old way. That is to say, the posterior part of the cartilage being well defined, the sage-knife is used in the same manner. In this method, however, as the sage-knife works more flat-wise, there is less danger of wounding the ligaments or the synovial capsules. If any part of the car- tilage remains near these organs, some care must be used in 738 OPERATIONS ON THE FOOT. removing it, and it must be done by degrees, and in very small portions. The advantages of this process are: Ist, the avoidance of ex- tensive wounds, and of the extreme pain produced by the extirpa.- tion of the quarter. 2d, to keep the foot shod, and to allow the animal to resume his work as soon as the first pain has subsided, which may occur at quite a considerable interval in advance of the perfect cicatrization of the wound. 3d, to avoid long and fre- quently-repeated dressings. In this method, however, the quarter left intact sometimes in- terferes with the operation, and the excision of the cartilage is more difficult, being only practicable, indeed, in cases where there is a separation of the wall. Maillet has modified the method of Bernard, so that, instead of thinning down the band of hoof, he only applies the rasp upon the quarter, and thins down with it all that portion which is ex- tirpated in the process of Renault, and availing himself also, of the drawing and sage-knives. The remaining details of the oper- ation are like those of the ordinary processes. An objection to this mode is that it can be put in practice only in cases where there is already a separation of the wall. It is objectionable from its tendency to weaken the foot too much, by interfering with the firm and solid adjustment of the shoe, as well as retarding its application to the hoof. CHAPTER XIV. OPERATIONS UPON THE EYE AND EAR. ON THE EYE. Ophthalmology, though it has made appreciable progress in vet- erinary practice within a few years, has not yet reached a position corresponding with that which it occupies in human surgery, and probably will not for years to come, if ever. The difference in value and importance between the functions of the organ of sight in the man and in the horse is too measureless to induce or re- quire an equal amount of interest and study in the optical path- ology of the two animals, the human and the equine. It is in- deed, a fact that many of the forms of disease which affect the eye of the horse have not yet been recognized and investigated by students of veterinary medicine. For these reasons the contents of the present chapter will be limited to those affections in which, strictly speaking, special sur- gical interference has been so imperatively needed as to compel the attention of scientific veterinarians, by considerations of both duty and interest. We shall consider the subject under two principal divisions, or heads, viz., operations, performed on the accessory, and those pertaining to the essential organs of the ocular apparatus. 1.—OperraTIons PERFORMED oN THE AccEssory OcuraR ORGANS. On the EKyelids.—These constitute the two cutaneo or mu- cous veils, which are situated in front of the organ, and are divided into superior and inferior, uniting at their extremities to form the angles or commissures of the eye. Besides these, there is a pecu- liar apparatus situated on the internal or nasal angle, known as a third eyelid, or menbrana nictitans. This is a small cartilage, thinned out on its free border, continued on its posterior portion with the adipose cushion of the eye, and covering it in front, Wiping, as it were, its corneal surface, whenever the ocular globe 740 OPERATIONS UPON THE EYE AND EAR. is drawn back into the orbital cavity. On the internal commis- sure are found the caruncula lachrymalis, showing on the upper and lower lids the lachrymal puncta, both of which empty into the lachrymal sac, which is itself continuous with the lachrymal canal, and through the lachrymal duct empties at the lower com- missure of the nostril by the lachrymal opening. Among the surgical diseases of the eyelids must be mentioned traumatic lesions, pathological growths, defective congenital con- formations, and specific diseases of their elements. A.—Travumatic Lestons. Bruises of the eyelids are specially common in horses after kicks and blows in that region, and may also be the result of fric- tion and chafing from the harness. If the cause has been severe, cedema of the lid is the result, as well as more or less flow of tears, and, possibly, irritation of the cornea. These accidents are generally of no great severity so long as the globe of the eye re- mains intact, but if this is injured serious complications ensue. The indications of treatment are those of all similar injuries of a local character, consisting of cooling astringents, with local bleeding, which generally bring rapid relief. B.—Souvutions oF ConrinuIty. These are very common with all our animals. They are sel- dom simple, but are more commonly complicated with lacerations of the tissues, by nails, hooks, etc., or even the teeth of other animals. Clean wounds by sharp instruments are rare, and are easier to treat than those having torn and irregular edges. They may be superficial, and may involve the thickness of the lid alone, but they may also be deep and complicated with wounds of the globe of the eye itself. The condition of the wound in this re- spect is important to know, and should be ascertained as early as possible. The raising of the eye with the elevator palpcebrum (Fig. 534) greatly facilitates this examination, and the animal sel- dom offers any serious resistance to it. Fic. 534.—Eyelids Elevator. SOLUTIONS OF CONTINUITY. 741 Simple lacerations of the lids commonly heal without any treat- ment beyond mere cleanliness—a soft sponge and a little clean water. But the application of the pin or twisted suture, in con- nection with antiseptic measures will greatly promote cicatrization by the first intention. Care must be taken to confine the animal’s head in such a manner as to prevent him from rubbing the wound until cicatrization is well established. C.—DeErFeEctTIVE CoNGENITAL CONFORMATIONS. Under this head we shall consider the deviation of the lids, either outwardly or inwardly, from the convex lines of the cornea, with which they should be parallel. A deviation in the growth of the eyelashes, or ciliz, is another annoying irregularity of the same region. The outward deviation of the eyelid is called ectro- pion; the inward, entropion. The deviation of the eyelash is known as trichiasis. 1. Hetropion.—The two principal causes of this abnormal condition are an excess of mucous membrane or deficiency of skin. Again, the ectropion depending upon paralysis of the orbic- ularis palpcebrum, is of a different nature. Ectropion occurs more frequently in the lower than in the upper lid When depending on a want of skin, it is generally the result of a wound or a burn, or possibly of an abscess, and is a cicatricial ectropion, in which the retraction of the cicatricial tissue has carried the lid with it. Paralytic ectropion is the result of age, and is more or less peculiar to old animals. It may also result from a diseased condi- tion of the conjunctiva, or of some of the organs of the orbital cavity. A The treatment of a case of this affection should be modified by the nature of its cause. If it is due to excess in the mucous membrane, the redundancy must be reduced. If caused by want of cutaneous surface, the remedy must be applied to that surface. If a hyphertrophied, mucous membrane is the trouble, astrin- gents, caustics, and scarifications must be employed; or even the removal of portions of the conjunctival mucous membrane, with the scissors or the bistoury. If, on the contrary, the deformity results from the condition of the skin, blepharoplasty or blepha- rortapy must be resorted to. The simplest manner of operating consists in amputating a V-shape portion of the eyelid and uniting the edges with stitches. 742 OPERATIONS UPON THE EYE AND EAR. 2. Entropion.—This is a malformation in which the border of the lid is turned inward. While in an ectropion the skin is in excess, the reverse condition is discovered here, where it is defi- cient. It is often the result of ophthalmic attacks, and it may also follow a loss of substance in the conjunctiva, after ulceration, or the removal of foreign growths. According to Leblanc and D’Arboval it may follow some eruptive fevers, or parasitic dis- eases. In entropion there is an increased flow of tears, abundant muco-purulent secretion, keratitis, which may become ulcerative, and loss of sight. The treatment consists in the excision of all the inverted por- tion of the deformed lid, which is accomplished by raising it from the globe with a forceps, and separating it with a single cut of the curved scissors, the protruding portion being then amputated. The hemorrhage is stopped with cooling lotions. Another mode of operating consists in cutting off only a por- tion of the skin of the lid, and unfolding it by passing the finger under the inverted border. Then a fold of skin is amputated near the free border of the lid, and the edges brought together by twisted pin suture. 3d. The deformity of trichiasis, or abnormal growth of the lashes has been observed by Leblanc in sheep, but in our domestic animals is a rare disease. Amputation of a portion of the skin; pulling out the eyelashes, followed by cauterization, and extirpation of the free border of the lids, have all been recommended against this abnormality of cutaneous secretion. D.—ParHotoaicaL GrowrH AND CARIES OF THE MEMBRANA NIcTITANS. Acute inflammation of the third eyelid, either as a symptom of ophthalmia, or resulting from direct traumatism, such as blows, or the presence of foreign bodies, terminating in caries of the constituent cartilage of this delicate organ, or the formation and development of epithelioma of the mucous membrane, are condi- tions often seen in our domestic animals, principally in horses and dogs. We have often noticed this peculiar affection, so easily recognized by the presence at the nasal angle of the eye, of granu- lating masses of various sizes, protruding at their internal commis- sure of the lids, and over the surface of the cornea, accompanied \ ee ee ee DISEASES OF THE MEMBRANA NICTITANS. 743 with more or less suppuration, lacrymation and ectropion of the lower lid. The epithelial growths, when small, will sometimes disappear under the application of caustics, or can be removed with the ligature, or by direct amputation with fine scissors. In some cases they assume very large dimensions, the mucous membrane becoming more or less ulcerated, and the cartilage itself diseased, and amputation of the entire cartilage becoming necessary. This operation is not of recent origin, having been per- formed, within our knowledge, some years ago, though entirely upon empirical grounds, in tetanic cases, from the fact that the protrusion of the membrana nictitans over the inner side of the external surface of the ocular globe, quite out of its nor- mal position, had often been noticed among the symptoms of lock-jaw. The removal of the “ hawck,” as the operation was then called, has never, however, for the reasons which were them ac- cepted, become legitimized among the therapeutics of the scien- ° tific veterinarian. The removal of part, or what is more effectual, of the whole of the membrana nictitans requires three instru- ments, a speculum oculi, a special forceps, like that of Snellen, and a pair of curved blunt scigsors. The animal must be thrown, and the eye being anestheticised with cocaine, and the lids kept well apart with the speculum, the organ, with the mucous membrane which covers it, is drawn out with the Snellen forceps, and by degrees severed in its continuity. When it is loosened sufficiently to be brought entirely out of the orbital cavity, it is separated with the scissors from all its attach- ments. The adipose mass which was then slightly protruding re- turns to its position and the operation is concluded. There is always a little hemorrhage accompanying the dissec- tion, which, however, is readily subdued by means of a simple compress of cold water. No special subsequent attention is neces- sary. II.—OPperraTIons ON THE LACHRYMAL APPARATUS. A.—On the Caruncula Apparatus. The caruncula lachrymalis is sometimes the seat of hypertro- phy, as commonly seen in cattle, the vague designation of Hnean- this being given to all such lesions of the caruncula lachrymalis, whatever may be their origin or nature. 744 OPERATIONS UPON THE EYE AND EAR. It is an affection which is quite frequent in dogs, as the result of localized chronic conjunctivitis. It is characterized by a tume- faction of the organ, more or less developed, pedunculated, pro- truding in the inner commissure of the lids, and accompanied by lachrymation, caused by the obstruction of the lachrymal puncte. ; While at the outset anodynes and astringent collyria may some- times control its development, there are many cases in which its removal by ligature or excision is indicated. Silk is recommended by Leblanc as the best material for a ligature, but elastic thread is in our judgement much to be preferred. Excision is far preferable. The operation is a simple one, con- sisting in merely severing the peduncle with a curved scissors or Fa. 535.—Bistoury for the Excision of the Encanthis. a bistoury (Fig. 535), ad hoc. The comparative abundant hemor- rhage that follows is controlled by cold water applications. The wound which remains is treated on general principles. B.—On the Lachrymal Ducts. The occlusion or obliteration of these little canals by foreign bodies, or as the result of inflammation of their mucous membrane, sometimes occurs in horses. Its characteristic symptom is an abundant and continual lachrymation, and it is only by careful examination of the condition of the orifices of the lachrymal punc- tee, that a correct diagnosis can be assured; a thick, muco-puru- lent discharge sometimes oozing from them. Though this diffi- culty often subsides by resolution of the inflammation, or the use of washes and collyria, there are cases where surgical interfer- ence, of the nature of a true catheterism of the duct, with possi- bly an enlargement of its canal with the bistoury, cannot be dis- pensed with. The probe of Bowmann (Fig. 536), and the knife of Weber (Fig. 537), answer the purpose very well. The animal is placed in the decubital position, the grooved probe introduced into the duct, and its wall divided with the knife, guided by the groove of the probe. ON THE LACHRYMAL APPARATUS. 745 SSS) Fia. 536.—Probe of Bowmann. Fig. 587.—Knife of Weber. C.—On the Lachrymal Canal. The obliteration of the lachrymal canal may become necessary in consequence of changes in the structure of its walls, or the pressure made upon it by the surrounding parts. In the first case, it occurs as the result of traumatic lesions, or of inflamma- tion of the mucous membrane, the exudates accompanying it, and the accumulation of thick secretions in the channel of the canal. In the second case, it is due to severe rhinitis, swelling of the in- flamed mucous membrane of the nasal cavities, polypi, bony growth - of any kind, or in cases of dental caries. The symptoms are: Lachrymation, filling up of the canal, its inflammation, and arrest of the flow of the tears through the lachrymal opening at the nose. According to Professor Leclainche, there are four modes of treatment for the relief of this trouble. 1st. Opening of the natural tract and removing the cause of the obstruction.—This is done by the catheterism of the canal by means of fine probes, or by detersive injections forced through the inferior opening in the nostrils; or, again, as practiced by Director Trasbot, by insufflation. 2d. Making an Artificial Tract.—If the point of obliteration is situated near the lower opening of the canal, an artificial open- ing can be made above it. To do this, Leblanc recommends the in- troduction of a whalebone probe through the superior lachrymal opening into the canal until the place of obstructionisreached when a counter opening is made with a fine bistoury through the walls of the canal. Two or three silk threads are then introduced into the new passage between the two openings and left in place for about twenty days. If the obliteration is in the bony portion of the canal, and cannot be overcome with the silver probe, the perforation of the lachrymal bone and an artificial fistula must be made. 746 OPERATIONS UPON THE EYE AND EAR. Neither of these operations is often followed by successful re- sults, although the perforation of the bone enables the tears still to escape in the nasal cavities. The formation of a fistula fur- nishes a channel for the flow of the tears over the lachrymal sur- face of the face. 3d. Obliteration of the Natural Tract.—The intention of this operation is to effect the entire obliteration of the duct from the lachrymal puncta and the lachrymal duct down. It is obtained by the cauterization of these parts, either alone or inclusive of the obliteration of the lachrymal sac. Tincture of iodine often pro- duces the same effect. As the result of this treatment, the flow of the tears takes place over the face. 4th. Hatirpation of the Lachrymal Gland.—This is not re- ferred to as a practicable measure, but only because it is some- times mentioned in the way of theorizing. The situation of the gland in our domestic animals renders the operation an impossi- bility. ITI.—Oprrrations oN THE EssentTIAL OrGANS OF SIGHT. On the Globe.—The essential organ of vision, or ocular globe, is a membranous ball, completely closed, and filled with transpar- ent fluids of different densities, and popularly known as the humors (or media) of the eye. This ball, nearly spherical, flattened from backwards in front, has its greater convexity in front, where it is closed by the cornea, a transparent expansion, thick and resisting; the glass of the eye. Posteriorly, it is composed of three capsular, concentrical sheaths, proceeding from without inward. These are the fibrous sclerotic, the choroid and the retina (Fig. 538). In the cavity of the globe one of these membranes—the cho- roid—throws out, perpendicularly to the great axis of the organ, a septum, the éris, a kind of contractile diaphragm, perforated in its center by the pupil. The retina is a membrane of special nature, being an expan- sion of the optic nerve, and performs the function of receiving the impressions of light, and transmitting its impressions and images to the brain. The humors of the eye are three, considered from before back- ward, the most anterior being the aqueous, the most posterior the vitreous, with the crystalline lens in the intermediate position. ON THE ESSENTIAL ORGANS OF SIGHT. 147 Fag. 538.—Theoretical Section of the Horse’s Eye. a.—Optic nerve. b.—Sclerotic. ¢c.—Choroid.—d.—Retina. e—Cornea. f.—Iris,— gh.—Ciliary circle (or ligament) and processes given off by the choroid, though repre- sented as isolated from it, in order to indicate their limits more clearly. 7.—Insertior of the ciliary processes on the crystalline lens. j.—Crystalline lens. &.—Crystalline capsule. /.—Vitreous body. mn.—Anterior and posterior chambers. o.—Theoretical indication of the membrane of the aqueous humor. pp.—Tarsi. qq.—Fibrous mem- brane of the eyelids. +.—Elevator muscle of the upper eyelid. ss.—Orbicularis muscle of the eyelids. ¢.—Skin of the eyelids. uw —Conjunctiva. v.—Epidermic layer of this membrane covering the cornea. 2.—Posterior rectus muscle. y.—Superior rectus muscle. 2.—Inferior rectus muscle, w—Fibrous sheath of the orbit (or orbital mem: brane). To this essential organ are added as accessories, first, a mus- cular apparatus, constituted by seven muscles—a posterior straight or retractor, four others, also straight, the superior, inferior, ex- ternal and internal; and two oblique, or rotators, the great and small, or external and internal oblique, second, an adipose pad; third, an apparatus of lubrication, composed of the lachrymal gland and its means of conducting the tears, the product of its secretion, viz., the hygrophthalmic canals, the puncta lachrymalis, the caruncula lachrymalis, the lachrymai ducts, the lachrymal sac, and the lachrymal canal. The whole mass of this apparatus is enclosed in a conical fibrous sac, the ocular sheath, which forms a membranous lining, as it were, to the orbital cavity, or bony box, which is anteriorly open, except when closed by the eyelids. Our design in the present chapter is to confine our considera- tion entirely to such portions of surgical ophthalmology as are likely to demand the careful and practical attention of the vet- erinarian. 748 OPERATIONS UPON THE EYE AND EAR. A.—Txe Exrraction oF Forrian Bopies oN THE SURFACE OF THE GLOBE. The presence of a foreign body between the lids and the globe of the eye is just as painful to animals as to man, and may, if allowed to remain, give rise to symptoms of irritation and inflam- mation which, unless promptly relieved, may induce severe attacks of diseases which may compromise the usefulness of the organ. Dust, insects, and small seeds of various kinds may indeed find a lodgment in the eye, and resist the efforts made for their removal, notwithstanding the excited function of the membrana nictitans, or the super-excited flood of tears stimulated by their presence. Immediate removal is the first iNaiencont This may some- times be effected by bringing the lids together and keeping them temporarily closed until the stimulated collection of tears washes out the offending substance. If this fails, cocaine must be applied upon the eye, and when its full effect is obtained, careful examination must be made, if necessary, with the assistance of a loup, by everting the lids, in order to bring the entire surface of the cornea into view The irritating body may be wiped out with the finger, a piece of cloth, or a soft camel hair brush, or when the object is hard and angu- lar, as a particle of metal or stone, which has become partly im- bedded in the cornea, the forceps may be necessary. B.—Puncturt, oR PARACENTESIS OF THE CORNEA. The object of this operation is to empty the anterior chamber of the eye of its aqueous humor, of a collection of pus, or to effect a release of a living intruder from the cavity of the eye, as, for example, the parasitic jilaria ocult. The operation is simple, but the use of cocaine cannot be omitted. The instruments necessary are a cataract knife, or a lanceolated bistoury (Fig. 539). It is introduced obliquely through the cornea, at a very short distance from the sclerotic, and its in- Fic. 539 —Lanceolated Bistoury. a ee Me SS eee ee ON THE ESSENTIAL ORGANS OF SIGHT. 749 troduction of course causes the immediate evacuation of the fluid contained in the anterior chamber, and the dropping or collapsing of the cornea, which assumes a rough and shrunken appearance. In a few hours, however, it resumes its normal condition, the secretion of the humor having taken place, and the wound of the cornea being closed. Compresses of cold water, and the application of a weak solu- tion of atropine will obviate severe symptoms. C.—STAPHYLOMA. This designation applies to a deformity or distension of the cornea, consisting in its protrusion beyond its normal and sym- metrical convexity. It varies in shape, and may be round or pointed. It is very common in dogs, especially in young ones, and if not discovered and attended to in its first stage becomes very rebellious to treatment. If overlooked and neglected ulcera- tion of the cornea and destruction of the eye is certain. Cauterization, with nitrate of silver, the ligature, and complete excision with the scissors are recommended, but the chances of success depend on the length of time it has existed and the size it has attained. D.—CaTARACT. The opacity of the crystalline lens, or that of its capsule, or that of the humor of Morgagni, or of these three conjointly, pro- duces loss of sight, and for its re-establishment the operation called “of the cataract” is, in some exceptional cases, attempted on horses and dogs. The object in view is the extraction of the opaque lens; its division into fragments that may be resorbed; or its dislocation from its normal position. It is not often performed in veterinary practice, but successful attempts have been credited to Vatei, La- fosse and others, while still others, as Gohier, Brogniez, H. Le- blanc, Haubner, Hertwig and Hering have reported their results as sometimes successful and sometimes otherwise. The animal is to be placed in the decubital position, and the dilatation of the pupil is to be obtained by the application of a solution of sulphate of atropia or extract of belladonna. Among the difficulties connected with this operation is the peculiar anatomy of the globe of the eye, which by the action of 750 OPERATIONS UPON THE EYE AND EAR. the posterior rectus muscle is drawn back in the orbital cavity, a displacement which not only renders the action of the instruments more difficult, but also stimulates the motion forward, over the cornea, of the membrana nictitans. The immobility of the eye is one of the first points to be secured. There are two ways of securing it, one fixing it from the front, the other from behind. It can also be fixed from the front in two ways—that of Le- blane and that of Brogniez. Leblanc uses a tricuspid stylet (Fig. 540), which has three branches, two of which are applied on the Fic. 540.—Tricuspid Stylet of Leblanc. sclerotic at the internal angle of the eye, the third, which is moy- able, resting also on the same membrane at its inferior part. The first two keeps the membrana nictitans from the cornea, and all three, implanted into the sclerotic, keep the globe immovable. Brogniez uses a special instrument, which he calls a “diapta- tor” (Fig. 541), which is a metallic rod, having three or four Fic. 341.—Brogniez Diaptator. points, twisted like those of a cork-screw, which by a slight pressure, combined with a little twist of the instrument, com- pletely fixes the ocular globe. To fix the globe from behind, Hayne, Dieterichs, Prinz and Bleiweiss make an incision through the skin behind the orbital arch, and an assistant, with one of his fingers passed through it, keeps it in place by direct pressure. General anesthesia is always indicated. Peuch and Toussaint recommend the use of the Waldon forceps (Fig. 542) to immobil- ON THE ESSENTIAL ORGANS OF SIGHT. 755 FIG. 549.—How to Protect the Eye. OctLarR PrRoTHESIS. The animal which has undergone the preceding operation is considerably deformed, but the difficulty is easily remedied by the insertion of an artificial eye. Artificial eyes for horses were first introduced by Schmidt in 1850. They were originally made of glass, but many varieties of material have since been used, and to-day all instrument-makers probably keep them in stock, of hard rubber and gutta-percha, etc. By the skillful use of pigments the artificial organ can now be made to so closely match its living companion as to be undis- tinguishable from that which the animal has always carried (Figs. 550 and 551). But the artificial organ must not be introduced into the orbital Fies. 550, 551.—Artificial Eye—side and full view. 756 OPERATIONS UPON THE EYE AND EAR. cavity until all granulations, suppuration and inflammatory proc- esses in and about the wound have ceased. To put the artificial eye in place the upper li is raised and the ; the border of the artificial organ placed underneath it; in the meanwhile the lower lid is drawn downward and the correspond- ing border of the eye pushed on its internal face. The eye is in place, especially if after its introduction the animal makes a few motions with his lids, all the folds of which are soon removed. To remove the eye the lower lid is drawn downward, and it is dis- lodged by passing a blunt probe under it toward its posterior face. The artificial eye will not need removal oftener than once in eight or ten days. If worn too long there might be danger, with cer- tain materials, of softening. The advantage of having an alter- nate eye will, upon reflection, become obvious. : ON THE EAR. AMPUTATION. Usually, only horses and dogs are subjected to this opera- tion. | With the horse, the object is commonly either the correction of a deformity, or the cure of disease or injury. When performed upon the dog, it is principally as an opera- tion of fashion—so-called—or in compliance with some prevalent caprice relating to a supposed improvement in the appearance of the animal. Yet with these it must at times, of course, become necessary for the repair of anaccident. It should be understood that the seat of the operation is in all cases the cartilage of the concha. Amputation in Horses.—The amputation may be either partial or complete. One ear may exceed the other in size, and it may become necessary to trim down the larger for the sake of estab- lishing symmetry between the mismatched pair with the knife. Or both may be similarly misshapen, and a partial amputation of both may be, therefore, indicated, for the same esthetic reason as that which influenced in the other case. This operation is seldom, if ever, performed at the present time. The complete amputation is indicated in cases where the cartilage is affected with pathological degenerations, and especially when these exist toward its base. rr. or AMPUTATION OF THE EAR. Tene Partial amputation may be performed with the patient in any posture, and may be considerably simplified by using Brog- FIGs. 552, 553.—Brogniez Apparatus for Amputation Fic. 554.—Apparatus of Brog- of the Ear. niez in Position. niez’s apparatus. This consists of a wooden model of the inside of the cartilage (Fig. 552), and of metallic en- yelopes or patterns of the outside (Fig. 553) of which there should be separate ones for each ear. Both the wooden model and the metallic pattern are held in place by a systematic screw (or wood screw) like those usen by cabinet-ma- kers in gluing wooden joints together. The ap- paratus is adjusted as shown in Fig. 554, and the excision of the protruding cartilage is made with the bistoury. Amputation with the nippers of Garsault (Fig. 555), or that with the bistoury do not give equally satisfactory results. Complete amputation, according to Peuch and Toussaint, is best performed with the ani- mal under complete anesthesia. We have had opportunities of operating without it, but it cannot be questioned that it furnishes power- ful assistance, when it becomes necessary to ap : : FIG. 555.—Ni keep the head in place, as in this case. ‘Ganecle a 758 OPERATIONS UPON THE EYE AND EAR. We consider the operation to be comparatively a simple one, though delicate handling is required. A conyex bistoury or scalpel, dissecting and artery forceps and needles and thread are the instruments required. A circular incision is made always, if possible, by one stroke of the knife, toward the base of the cartilage, beginning at about the lower commissure of the external opening of the concha; then carefully avoiding the division of the bifurcation of the parotid gland, the insertion of the muscles attached upon the concha is divided, the posterior and anterior auricular arteries are ligated, the adhesions with the surrounding cellular tissue are lacerated with the handle of the scalpel, and the ligament which unites the concha to the annular cartilage is severed, the little prolongation of the former can then be easily followed to its end, and the con- cha be readily extirpated by lacerating its cellular attachments. The wound is closed with sutures, and treated in the usual way. Amputation in Dogs.—Although, as we have remarked, this is principally an operation of fashion, there are still conditions in which it is rationally indicated. It is commonly performed with scissors, curved or straight, with which the required portions of the concha are amputated by a single cut of the instrument. Instruments have been invented to insure a more certain suc- cess in the operation, and a neater finish after the wounds have Fig. 556.—Nippers to Amputate Dogg’ Ears. healed. The limitation forceps, represented in Figure 556, pos- sess some advantages in these respects. In any mode of operation, the flap of skin first excised be- comes the only true pattern by which to shape the second. The operation is generally followed by some hemorrhage, but this either subsides spontaneously, or by the application of local hemostatics, and the cicatrization proceeds without help under the scab, which after a day or two covers the edges of the wound. CHAPTER XV. DISEASE SHOP LIE Wit BERS: The withers is the region of the body which, of all others, is most exposed to lesion, the injuries to which it is subject being of every form, nature and degree of severity. From its very loca- tion it is especially liable to all kinds of external traumatisms, and is peculiarly apt to suffer from blows, bruises, bites, contusions, pressures and frictions by the harness, etc., and these give origin to bloody or serous tumors; cold and warm cedemas, abscesses superficial or deep, and various wounds of the surface, with or without injuries of the subjacent tissues; and these again may be followed by necrosis of the dorso-cervical ligament, and of the apex of the dorsal vertebrze, accompanied with purulent filtrations, in various localities, the formation of fistulous tracts, and possibly the extenston of the diseased conditions to the ligamentum nuche, © ending with the disease of the neck, with all its unfortunate sequel. With the consideration of such a multiplicity of pathological evils before us, an orderly and systematic arrangement of topics is especially necessary, and we shall, therefore, in our treatment of the diseases of the withers, adopt the classification of Bouley aud Nocard. And this introduces us successively to the study of excoriations, coedemas, hematoma, core or stickfasts, cysts, abscesses, wounds, and the “diseased withers” proper, or what is generally understood as ‘‘the persisting lesion, fistulous in its character, and whose condition of formation and duration is due to the mortification of the fibrous, yellow or cartilaginous tissue of the apex of the spinous processes of the anterior dorsal vertebree.” Considered from an anatomical point of view, the withers form a very complex region. Its skeleton is formed by the superior spinous processes of the anterior dorsal vertebree, and it is sur- rounded by muscles arranged in layers, intersected by fibrous 760 DISEASES OF THE WITHERS. aponeurotic bands or sheaths. The vertebre give attachment by the cartilaginous nucleus, which is at their apex, to the pos- terior portion of the yellow, elastic cord, which is part of the funicular portion of the ligamentum nuche, and are also united by the interspinal ligament. The muscles which rest upon the ver- tebree form six different planes, thus divided: 1st. The skin, lined inside by cellular tissue, more condensed toward the median line than on the sides, where itis loose; 2d. The trapezium muscle, thin and aponeurotic inferiorly, but thicker in its upper portion, ea Fic. 557.—1st and 2d Layers of the Region of the Withers. P.—Skin folded down. pf.—Funicular portion of the cervical ligament. tc.—Cer- vical portion of the trapezium. td.—Dorsal portion of the same. ea.—Acromion spine which is muscular (Fig. 557), and lying over the external surface of the scapula and its cartilage of prolongation. 3d. The rhom- boideus muscle, which is separated from the second plane on its external surface by a layer of loose cellular tissue (Fig. 558), and is lined in its internal face, by a yellow elastic band, inserted on the inside face of the cartilage of prolongation of the scapula. ee ea eS SS DISEASES OF THE WITHERS. 761 Fic. 558.—3d Layer of the Region of the Withers. cb.—Cartilage of the scapula. pf.—Funicular portion of the cervical ligament. rh.—Rhomboideus muscle. a.—Angularis of the scapula. S.—Splenius, Fig. 559.—4th Layer of the Withers. sc.—Section of the scapula and surrounding muscles. ap.—Its aponeurosis. da.—Anterior small serratus. gd.—Great serratus. pf.—Funicular portion of the cervical lig- ament. s.—Inferior attachment of the splenius. ad.—Ramifications of the dorsal artery. gc.—Great complexus. pce.—Small complexus. scapulez. a,—Section of the angularis 762 DISEASES OF THE WITHERS. This band is specially liable to attacks of necrosis. 4th. The su- perior portion of the anterior small serratus muscle, which is formed by a broad aponeurosis, attached to the superior extrem- ity of the spinous processes of the vertebre (Fig. 559). 5th. The SS Fic. 560.—5th Layer of the Withers. pl.—Lamellar portion of the cervical ligament. pf.—Funicular portion of the same. ac.—Superior cervical artery. te.—Transversal spinous of the neck. bs.—Superior branch of the spinalis. bi.—Inferior branch of the same muscle. ic.—Common inter- costal. ad.—Dorsal artery. gd.—Great serratus. si.—Inferior scalenus. it.—Inter- transversalis muscle. anterior portion of the ¢/io-spinalis muscle (Fig. 560). The 6th and the deepest of these planes, resting on the faces of the long spinous processes of the vertebree, is formed by the transverse spinal muscle of the back. (Fig. 561). To these are to be added the posterior extremities of some of the muscles of the neck, covered by the internal face of the scapula, the ramification of the large blood vessels, branches of the anterior aorta, and the dorsal and superior cervical artery with the spinal nerves which are distributed in that portion of the body. If we map all this distinctly in our minds, we shall have the material for forming an idea of the structure of the withers, and the intricate and inter- esting arrangement and disposition of its many parts, with their relation to the ailments whichattack them. This will be facilitated by an inspection of the illustration (Fig. 562), representing a transverse section of the entire region involved. The drawing exhibits the obliquity of the direction of the various muscular layers, and demonstrates the tendency of the purulent gatherings, by gravitating and collecting between them, to contribute to the ‘ 4 . DISEASES OF THE WITHERS. 763 Fié. 561.—6th Layer of the Withers. pl.—Lamellar portion of the cervical ligament. pf.—Funicular portion. te.—Trans- verse spinalis of the neck, ac.—Spinous processes of the dorsal vertebra. t.—Tuber= osities of the same. te.—Transverse spinalis of the back. ie.—Common intercostal. c.—Ribs. gd.—Great serratus. it.—Inter-transversalis. i.—Externai intercostal mus- cle. 1.—Inter-spinalis ligament. formation of the ailment recognized as a true “ diseased withers,” with the habitual severity which is its characteristic. The originating causes of the diseases of the withers may be divided into the predisposing and the occasional. Among the first are to be noted a defective anatomical conformation of the region; the kind of work performed by the animal, and the degree of care he receives. For example, when the withers are low, thick and fleshy, as in heavy draught horses, the saddle of the harness has a tendency to slip forward and cause chafing and excoriation, an accident from which, however, animals with high, sharp withers are by no means exempt; for though, for the reason stated, they are less liable than those of the other conformation, the advantage is offset by the fact that the skin is exposed to a more unequal pressure, especially if that part of the harness is not properly padded and fitted, and presses irregularly on the soft tissues, upon which it rests. 764 DISEASES OF THE WITHERS. ft N i } i VN == SSS SS SSeS? QML —= SSS = ; —S=SS= Fic. 562.—Transverse Section of the Region of the Withers. p.—Skin. fe.—Fibre elastic tissue. t.—Dorsal trapezium. r.—Rhomboid muscle. -cp.—Cartilage of the scapula. is.—Ilio spinalis. v.—5th dorsal vertebra. gd.—Great serratus. ss.—Sub-scapularis. s.—Scapula. sSe.—Antea-spinatus. sh.—Scapulo- humeral joint. pf.—Deep pectoral. pt.—Thoraciq walls. Saddle horses are for the same reason peculiarly apt to become sufferers from the lesion of which we are speaking. The self- inflicted bites and the scratching and rubbing of animals suffering from parasitic affections, in their efforts to relieve themselves, may also result in placing them in the category of the predisposed. To enumerate all the occasional causes would be to make a catalogue of casualties, which would be best done by copying from the accident columns of the daily press, and we shall merely refer to a few of a kind which may possess some special characters and notable features, not too obvious or common and familiar Contusions of any kind, resulting from the causes stated, or even little abrasions from the simple misfit of a blanket kept in place by a surcingle too tightly buckled—anything, in fact. which may give rise either by its immediate effect or by its continuance, ee DISEASES OF THE WITHERS. 765 to the slightest form of pathological change, may serve as a spark which may kindle into the most serious case of fistulous, diseased withers. (a) EHxcoriation.—This is the simplest of the lesions of the skin covering the withers, or any portion of the body. It is most com- mon in summer, when it appears in the form of a red spot, becom- ing rapidly covered with an abundant serous exudation, which rapidly forms a yellow or brownish crust, adherent to the under- lying tissues. This is always painful, especially in summer, when it excites a violent pruritis, which may degenerate into a lesion of a serious nature. Excoriations, however simple, ought never to be neglected, and precautions should always be taken against them. When they do occur, local healing applications, usually simple ones, are sufficient, and should be made without delay. (6) Warm G?dema.—This is the result of the laceration of the subcutaneous cellular tissue and its subsequent inflammation. Saddle horses suffer from it, especially in summer and after long journeys. At such times, the skin becoming more or less adher- ent to the saddle, the motion of the animal, together with that of the skin, is communicated with every step to the subjacent cellular tissue (a sort of rubbing, to-and-fro motion); and this vio- lence, though slight, produces by its long continuance the natural effect of inducing an inflammatory state in the tissue. This edema is characterized by a tumefaction of the parts, warm and pitting under pressure, more or less painful, and having a tendency to spread toward dependent structures. It disappears by resorp- tion in two or three days, but leaves a slight thickening of the cellular tissue, sometimes difficult to detect. This resorption takes place if the originating cause has, within a moderate period, ceased to operate; but if, on the contrary, it has been permitted to keep up its irritating action, the cedema will increase, and in due time the condition will be changed to that of suppuration—a termination to be, if possible, by all means anticipated and pre- vented. The removal of the cause, sometimes accomplished by merely giving the patient a season of rest, is the most important item in the treatment. The resorption of the cedema can be accelerated by means of massage, cold compresses, astringent lotions, weak stimulating frictions of an alcoholic nature, or cold irrigations. 766 DISEASES OF THE WITHERS. (ce) Hematoma, or Bloody Tumor.—This lesion is produeed by a violent traumatism, such as a blow, a contusion, or a violent bite by some other animal. It develops immediately upon the oc- currence of the cause, resulting from the laceration of the super- ficial blood vessels. It is characterized by a swelling, varying in size according to the nature of the producing cause. It is at first somewhat warm and fluctuating, then becoming puffy, and when the blood has coagulated, hard, tense and crepitating. Ordinarily it is not very warm or painful, but it becomes so after a few hours, and then there is danger of its assuming a suppurative character. Yet in other cases it may maintain that condition for two or three weeks, undergoing the process of resolution, the resorption usually becoming complete in that period. The correct diagnosis of this condition, and of any occurrent changes, some of which it is im- portant to know, can be more satisfactorily established by explor- ation. Left without interference and in the absence of irritating causes, the hematoma will usually subside by spontaneous action. In their treatment, cold applications are indicated during the first days of its existence, but at a later period, when the tumefaction has be- come of a denser consistency, absorbent and stimulating local medication is indicated, such as blisters of cantharides, or of mer- curial preparations, or of the iodine compounds. These applica- tions, however, must not be too hastily resorted to, lest the exces- sive or premature stimulation should end in the formation of abscesses. Except when there is positive evidence of suppuration, pressure by bandaging and the opening of the tumor with the bistoury are always contra-indicated. (d) Core, or Stickfast.—'This is caused by the immediate mortification of a portion of the skin, and often of the deeper tissues. It is a hairless scab of a blackish color, having the ap- pearance of tanned leather. It is at times. superficial, and has a tendency to extend to the subjacent structures. It is rigid and inflexible, and its pressure upon the deeper tissues tends to in- crease mortification. The tissues surrounding it are inflamed and their sensibility increased, and at a later period a process of elim- ination by suppuration takes place all around its edges. But this pus does not very readily escape, and there is always a portion remaining in the bottom of the sloughing surface which becomes fistulated with the formation of collections. If the core should DISEASES OF THE WITHERS. ~* 767 extend to the dorsal ligament or to the bones, the result will be necrosis and caries, and a true diseased wither will be the conse- quence. With these conditions, lymphangitis, leucophlegmasia, and deep abscesses may be expected, and usually supervene. The sloughing of the mortified structure is always slow, espe- cially when the deeper tissues are involved, but the wound which remains after the casting off of the core is not uniform in its sub- sequent action. When it is superficial it heals quite rapidly, but recovers only with great difficulty when it is deep-seated, and in- volves fibrous, cartilaginous and bony structures. The prognosis of this lesion of the withers varies according to the thickness of the tissues which are involved; but it also varies according to its location, those which are situated on the lateral faces of the withers being less serious than those which occur on the median line. The treatment indicated is strictly local. The first indication is to discontinue, or obviate, the irritating cause, by changing the harness, by chambering it, or, what is better, by refraining from working the animal until he has entirely recovered. The second indication is to hasten the sloughing of the mortified tis- sue, and allay the irritability which the animal betrays upon the slightest touch of the hand, or other object, upon his back. Top- ical remedies in the form of ointments, lotions or poultices, are in- dicated for this purpose. As soon as the process of sloughing begins it must be stimulated and encouraged. Warm compresses, antiseptic lotions, glycerine, phenial mixtures are then beneficial. The maintenance of simple moisture, by means of phenicated or creolined mixtures has, in our own experience, been of great ad- vantage. If during the process of the elimination of the core the suppuration seems to be abundant with a tendency to accumulate instead of escaping, care must be taken to facilitate its removal by means of oakum, absorbing cotton, sponges or drainage tubes. Sometimes the core is of unusual size, with roots reaching deeply into the tissues beneath, but although this may be the case, no attempt should ever be made to tear them forcibly away. They must be permitted to drop away by spontaneous action. If the edges are very wide they may be trimmed off with the scissors or bistoury, but interference beyond this is never permissible. When they have entirely sloughed away there remains but a simple granulating wound, which ordinarily requires but mild forms of 768 DISEASES OF THE WITHERS. treatment. The animal, however, ought not to be made to re- sume work until it is entirely healed. (e) Cyst, or Hygroma.—These terms designate a tumor which usually forms on either the middle or the lateral face of the withers, originating in the dropsical condition of a serous bursa. On whatever part of the withers it may make its appearance, the originating cause is the same, and it is the effect of friction, or of the slight but long-continued irritation produced by an ill-fitting harness, inflicted while the animal is suffering from parasitic dis- eases. In these cases the connective areole of the bursa become the seat of an amount of secretion in excess of that which is re- moved by the act of resorption, and the accumulated hyper- secreted fluid gathers into the cavity, to form the serous cyst. When located in the median line, the hygroma constitutes a soft tumor, of varying size, from that of a pigeon’s egg to that of a child’s head—bilobulated, always soft, fluctuating, without heat, and painless; even transparent, when the skin is pigmentless. It always presents the differential characters of being well defined in its outlines, and without inflammatory peripherical infiltra- tion. When the cyst is on the side of the withers it may present some similar characters, but when it is deep, under the apone- urosis of the trapezium, or even under the rhomboideus, an ex- ploration becomes necessary to establish the differential diagnosis from abscess, as upon the true nature of the tumor depends the immediate indications of treatment. Hygroma of the withers may retain their characteristics for a long time, but many change in their nature under the influence of external irritations, bruises, contusions, improper treatment, etc. In that case the cyst is transformed into an abscess, or rather a suppurating cyst. In respect to the treatment of cystic withers, the first indica- tion is to remove the cause, and with this not only will the accu- mulation of the serosity cease, but the possibility of its trans- formation into the abscess form will be removed. When the cyst is small and of recent formation, resolvent treatment is in order, as cantharides ointment, bichloride or biniodide of mercury pomatums, ete. Actual cauterization, in lines or in points, has given satisfactory results in chronic cases. In- jections of tincture of iodine have also been recommended. Our en eT DISEASES OF THE WITHERS. 769 own experience warns us that it is not without danger, from its liability to be followed by a severe form of diseased withers. Bouley and Nocard, in relation to this mode of treatment, say “it is better to empty the cyst with a capilliary trocar, or by the aspirator, to wash its cavity with an antiseptic preparation, slightly irritating (5 per cent. solution of phenic acid), to repeat this injec- tion several times, until the liquid taken out of the cyst is per- fectly limpid, and then apply over the entire surface of the skin a thick coat of blister.” The purulent cyst is treated as an abscess. (f) Abscess.—A phlegmon of the withers may rise suddenly under the influence of a severe traumatism, or become the sequel of a hematoma, or of a cyst. It appears most commonly on the superior part of the withers; sometimes on the sides, as a tumor more or less warm and painful, first uniformly hard and tense, and afterward soft, with a fluctuating center, and surrounded by an cedematous infiltration, more or less developed. If the abscess is superficial, ulceration of the skin soon takes place, followed by the escape of thick, white and creamy pus. If, on the contrary (and this is often the case), the abscess is deep, developing itself under the the aponeurosis of the great dorsal, or of the rhomboideus muscle, or even deeper, under the cartilage of the scapula, or the thickness of the ilio-spinalis, the symptoms then, however, being less defined. The tumefaction is less characteristic, the heat less marked, the fluctuation not detect- able, and the only sign which guides the surgeonis the excessive pain manifested upon the slightest pressure on the tumor, and from which the animal shrinks in fear. This sorenessis in fact so great that in some animals it interferes with the action of the leg on the side affected. The appearance of general febrile symptoms is not uncommon at this period, with elevation of temperature, increase in the circulation, anorexia, excessive thirst, etc. At this period, also, it becomes important to be certain of the diagnosis, or at least to be sure of the existence of the suppuration, and its loca- tion must be accurately made out, in order to prevent the severe disorders that may be caused by the presence of the pus; a prob- lem which can be only solved by repeated capillary exploring punctures, made at various points, and at given depths, according to the dimensions of the phlegmonous enlargement. The prognosis of abscess of the withers depends altogether on 770 DISEASES OF THE WITHERS. the seat it occupies. If superficial, and on the lateral faces of the region, it is not serious, If on the median line, it assumes a more severe character. If deep, it is also of a dangerous nature, unless it is simple or limited; but, on the contrary, if the quantity of the pus has continued to increase, and infiltration has taken place into the cellular tissue separating the muscular layers; or the sup- puration has penetrated under the cartilage of the scapula; it will have assumed the most complicated form of the disease, with chances of recovery of a very doubtful character. When the pres- ence of the pus has been detected, the immediate indication is to assist its discharge by a free incision down to the bottom of the cavity. The incision must be made on the most dependent part of the tumor; in such manner as to prevent the collection from settling in a cul-de-sac. A means of drainage must be provided, and the tube is preferred to the tent of oakum, or even to the seton, as more sure to reach all parts of the collection, and the more thoroughly to wash out the cavity. If, however, the suppuration has not been detected, the appli- eation of local stimulation is indicated by means of warm com- presses, hot poultices and the like ; a constant watchfulness being maintained, meanwhile, in order to detect the presence of the pus at the earliest moment of its formation ; when it must be immedi- ately evacuated. (g) Wounds.—Resulting from every variety of traumatic agencies, these injuries will necessarily vary in their extent and the nature of the tissues which are involved. They therefore extend from the most trifling hurt of the skin to the severest lacerations of the important ligamentous, cartila- ginous and bony structures contained in the region under con- sideration. With such a diversity in their form and nature there must also be a corresponding range in the character of the prog- nosis to be announced, from that of rapid spontaneous recovery, without interference, to the gravest of terminations. One of the principal indications in the treatment of wounds of the withers is to prevent as much as possible the filtration and deposit of pus through the various layers of the region, and facili- tate the cicatrization, by placing them in a state of immobility, and according to Bouley and Nocard, the best method of securing this suspension of movement is to apply a broad blister all around the wound, and to repeat the application after a few days. The DISEASES OF THE WITHERS. TEL pain caused by this compels the animal to abstain from all move- ment, and besides this the inflammatory swelling resulting from the blister promotes the cicatrizing process by stimulating the proliferation of the cells of the repairing tissue. Aside from this special direction, the treatment of wounds of the withers involves no methods or indications different from those of similar hurts in other parts of the body. In most cases the surgeon must trust his experience and knowledge of general principles for guidance. (h) ‘Diseased Withers” proper: Fistulous Withers.—As we have before stated, this denomination belongs to “a persisting lesion, fistulous in character, due to the mortification of the tis- sues of the withers, fibrous, yellow, cartilaginous or bony.” It is necrotic in its nature, and while it may attack but one, it may also exist in all of these organs. Whatever this condition may be, however, the necrosis is always manifested externally by an indicator, in the form of a fistula giv- ing exit to an abundant, thin pus, serous, sanious, grayish in color, adhering to the hair, and irritating and excoriating the skin upon which it flows. At first it is odorless, and nearly homogeneous, but it soon becomes fcetid in odor and loaded with the detritus of necrotic tissues, more or less abundant, varying in thickness and in color, according to the nature of the tissue from which it is formed. | One or several of these fistulous openings may exist on one or both sides of the withers leading from the same or from different necrotic centers. Their number is not limited. Several of them may be in existence at the same time, especially when the disease has maintained its hold on the system for a period of three or four months without being checked or cured; a state of things not infrequently witnessed. Their formation is explained by the constant accumulation of the pus in the sinuosities of the original tract, which by degrees overcomes the resistance of the surrounding structures, and es- tablishes a channel for itself by the same process as that by which the first outlet was formed. It may sometimes happen that the opening of new canals becomes the cause of the closure, or perhaps only the constriction, of the original channel, and a new exploration becomes necessary to ascertain the new routes of the fluid. In this case their direction will be best made out by the injection of liquids through their open mouths. 772 DISEASES OF THE WITHERS. The presence of one of these canals at the bottom of a wound may sometimes be detected by the appearance of large, fleshy, cone-shaped granulations, of a purplish color, from which an ooz- ing of pus takes place upon the application of pressure. But in another case, the orifice of the fistula may be directly on the skin, surrounded with granulations, protruding, soft and bleeding upon the slightest touch, with an escape of sanious pus between them; these granulations at a later period, flattening, as the wound contracts, until the thinned skin seems to be continu- ous with the smooth, reddish membrane which lines the internal face of the tract. It may even happen that a process of cicatriza- tion taking place around the opening will transform its external outlet into a narrow strait which opens in the bottom of a cavity formed by the skin drawn inwardly by the cicatricial retraction of the indurated peri-fistulous tissue. The direct exploration of the fistula is the best mode of ascer- taining its existence, direction, extent and depth, and also the lesion which gives rise to it. This exploration ought to be made. by the taxis, since it is obvious that no instrument can communi- cate an impression such as can be obtained by the touch of the finger. By the hand, therefore, must be ascertained the course and sinuosities of the fistula, its diverticulum, the nature of the necrosed tissue, and the extent of the mortification. But this manual exploration is not always possible, either because of the deficient caliber of the passage, or of its sinuosity, or its length. Resort must be had to the various probes and directors in use. When the necrosis occupies the apex of one or more of the spinous processes, and the fistula is superficial, a slight incision will expose the diseased spot to ocular inspection, and the condi- tion of things may be at once fully realized. When the lesion is limited to the cervical ligament, the eschar or slough will have an olive-greenish color, and will be of soft, pultaceous consistency, with a peculiar foetid odor, from its maceration in the pus. If the necrosis has attacked the cartilages of the vertebra, the morti- fied part assumes a yellow color, with a tint of pale green. In all cases, however, it is more or less loosened at its borders, and differs materially from that of the healthy tissue. And while at the point of separation it is covered with a layer of granulations, highly vascular, yet the continuity of the fibres between the healthy and the diseased tissues still exists in the parts which are See se ee ee DISEASES OF THE WITHERS. ie deeper and more central, where the connection is maintained by a sort of peduncle of varying size, through which the necrosis con- tinues to be propagated. If the disease is of sufficiently long standing the necrosis may involve the entire thickness of the carti- lage. In this case the spongy tissue of the vertebrze is exposed, covered with the healthy granulations, which contribute to the cic- atrization. This, however, is a rare termination, the bone, ordi- narily, becoming necrosed or carious, the necrosis being indicated by its brownish color, its dryness, its roughness and its sonority on percussion, while the caries is recognized by its friability, its red and yellowish color, the foetid suppuration which oozes from its areola and the facility with which it yields to the edge of a sharp cutting instrument. This condition of mortification may affect but a single verte- bra, but it is not uncommon to find several, or possibly all, the spinous processes of the region affected. While the fistula may be considered as the essential physical symptom of this ailment there are other symptoms coexisting. There is accompanying it an external swelling, sometimes diffuse, sometimes compact, and more or less indurated, according to the duration of its existence; very painful on pressure, and of which the form, direction and extent so perfectly correspond with those of the fistula, that it may be viewed as accurately representing the extent and limits of the lesion itself. This induration increases in consistency, and may with time become infiltrated with calcareous deposits, or even bony growths, attached to the spinous processes. The diagnostic and prognostical importance of this induration is very great. So long as there is no perceptible decrease in its dimensions, no apparent improvement in the external wound or modification in the nature and amount of the discharge can be of any favorable signification, and the surgeon may feel thoroughly assured that the disease continues unchanged in extent and char- acter. As it diminishes it indicates that the necrosis is also con- tracting its limits, and it becomes certain that the sloughing has taken place and the wound is once again assuming its character of original simplicity. And when the swelling disappears, and the tissues have resumed their normal integrity, questions as to the depth of the fistula, or the extent of its sinuosities, and abun- dance of the discharge will cease to be of any significance. 774 DISEASES OF THE WITHERS. In the beginning of the necrosis, while the parts are very sensitive, the exaggerated sensibility is not at all in proportion to the apparent extent of the disease. The animal shrinks from the manipulations of the touch, and this is a symptom which should be carefully considered in its relation to the progress of the dis- ease, from the fact that in these manifestations it is passing through the same phases as those which marked the progress of the induration, running a sort of parallel with the duration of the necrosis, and diminishing as the sloughing proceeds, the interior situation being interpreted by the exterior phenomena, with some exceptions. For there are cases in which it diminishes, while the disease continues without change, to exhibit the same severe symptoms. One effect of the abundant suppuration accom- panying diseased withers, and the febrile symptoms which accom- pany it, is a rapid loss of flesh by the suffering animal. The disease is always of long duration, and even when treated in the most rational manner. Its persistency will naturally cor- respond with the slow process of the sloughs and repairs of the tissues involved, themselves of comparatively low vitality and slow of change. But as soon as the separation of the diseased parts has taken place, however deep the wound may have been, or whatever the number and depth of the fistule, the cicatriza- tion proceeds rapidly, and is completed in a comparatively short time. The terminations, which are to be looked for, are classified by Bouley and Nocard under the following heads: Ist. Resolution.— This is very rare if the disease has been neglected, and only occurs when it has been of a circumscribed extent and seated in a region favorably situated for the elimin- ation of the mortified tissue, as when it escapes through large openings, without lying long enough in the midst of the muscular substance to produce the effects of the long confinement of the pus in the deeply situated regions. 2d. Disease of the neck, when the necrosis has spread as far forward as the cervical portion of the ligamentum nuche. This forms the more common termination, and is as serious and fatal as the original disease itself. It is too often met with, especially in low-bred animals of lymphatic constitution. 3d. Death, too frequently. 4th. Putrid infection, due to purulent fermentation and the absorption of septic principles. —— a ee ne DISEASES OF THE WITHERS. 775 5th. Purulent infection, zt. e., consecutive with the caries of the vertebree and with the phlebitis of the veins of the region. 6th. Purulent pleurisy, resulting from the passage of the pus into the thoracic cavity through the intercostal muscles. Tth. Hxhaustion, in consequence of the uncompensated loss of substance by the abundant continued suppuration, and its ac- companying severe and persistent fever. Fistulous withers is always a serious disease, not only because of its progressive tendency, but also because, however intelligent and proper may be the treatment it receives, it can never be relied on to prevent the spreading of the necrosis, and assure a healthy cicatrization. The degrees of severity nevertheless vary, accord- ing to circumstances. It is less serious when the necrosis is on the median line, and the prognosis is still more favorable when it is on the posterior part of the region. When situated forward it seems more tenacious, and the danger of its extending to the neck is greater. But it is principally when its seat is in the an- terior part of the withers that the prognosis becomes alarming, as there the spinous processes are less prominent, the muscles thick- er and more complicated in their arrangements, and the cartilage of the scapula nearer, all these being conditions which render the discharge of the pus more difficult and the purulent infiltrations more likely to take place, and where also counter-openings are made with more difficulty, and indeed become almost impossible if the purulent accumulations are situated on the inside of the scapula or its cartilage of prolongation. It may be said, in fact, that the most important factor in the prognosis of this disease is the distance which separates the apex of the spinous processes of the vertebre from the superior border of the cartilage of the scapula; the chances of recovery being in the ratio of the distance between those two points. It is thus that it becomes less grave in well-bred animals, with elevated pro- jecting withers, than in low draught horses in which that region is depressed and thick, and the projection of the dorsal processes often replaced by a deep groove, bound on each side by the pro- jection of the muscles and of the border of the scapular cartilage. The disease is also of less gravity in young animals, except when they are under the influence of distemper. The treatment required in fistulous withers includes two prin- cipal indications: Ist. To facilitate the escape of the pus and 776 DISEASES OF THE WITHERS. obviate its action upon the tissues with which it comes in contact and prevent its necrosing influence, and second to accelerate the elimination of the necrosed parts. The first indication is fulfilled in enlarging the fistulas to the greatest extent possible. This is done with the straight bistoury carried in the groove of the director or of the S probe, introduced into the tract as far as possible. But when the fistula runs ob- liquely downward and inward, and has become complicated with diverticulums which run into the depths of the tissues, this en- largement of the fistula is more difficult, inasmuch as it necessi- tates too extensive a division of tissues for safety. This difficulty is obviated by establishing counter-openings at points correspond- ing with the bottom or cul-de-sac of the fistula. The situation of these counter-openings must be carefully cal- culated in order to make the drainage perfect. The instruments most suitable are the dog seton needle, a curved trocar, or prefer- ably the S probe, and a straight bistoury. The openings must be liberal to assure the best results, and they must be prevented from contracting or too rapidly closing, and so checking the pur- ulent flow either by the introduction of a tent of oakum or other permeable foreign substance, or, and it is much the better method, by the use of a drainage tube similar to the India rubber irriga- tion tube. This implement, besides fulfilling all the other indica- tions desired, possesses the additional advantage of facilitating the injection of fluid detergents or curatives into the fistulous tract. When the drainage has become well established irrigations must be made two or three times daily as long as may be neces- sary. The fluids best adapted as being both detergent and cura- tive in their nature are pure tepid water, phenicated water (five per cent. solution), or permanganate of potash solution (one to two per cent.), or again simple alcoholic water. The irrigation can be made with an ordinary syringe. Peuch and Toussaint, however, say “ that when the circumstances allow it cold water in continued irrigation constitutes the best medication and that which prevents most certainly all complications. On that account they cannot recommend it too strongly.” While this form of treatment is usually successful in cases of lesser severity, there are many instances in which they become powerless, and other means become necessary for the removal of the necrosed part. In times gone by caustics, in both the solid DISEASES OF THE WITHERS. 777 and liquid form, were held in high repute, even in the form of actual cauterization, as recommended by Lafosse. In later times, however, the serious effects which followed their application caused them to be ignored. Preparations of lesser severity were then recommended, among which were Villate’s solution; those of the sulphates of copper or of zinc, in various degrees of strength; of tincture of iodine, of spirits of turpentine, of nitrate of silver, and even of tartar emetic, and their use was followed by good results. Cantharides ointment, applied externally over the swelling, and by injections into the fistulous tract, after being diluted with tincture of cantharides, is also reeommended. When the pus has filtrated inside of the shoulder, Bouley and Nocard suggest the propriety of ‘attempting to lacerate with a me- tallic rod the cellular tissue of the internal face of the shoulder, so as to produce an abscess by congestion, whose opening, which must be made wide, would allow the escape of the pus, and the possible frequent cleansing of the enormous fistula thus formed. By this process one might avoid the serious accidents likely to result from the sejourn of the pus, and its fermentation from the contact of the tissues.” For cases like these Lafosse recommended the trephining of the scapula—a very serious operation. It is said to have been successful with him, but it must be a difficult matter to perform it properly in such a manner that the trephine is applied at a point on the surface exactly corresponding to the bottom of the fis- tula. When all means of so stimulating the action of the parts as to effect the arrest of the necrosis, and the sloughing of the morti- fied structure have failed, there is but one alternative left, and that is the direct amputation of the apex of the spinous process, and the excision of the diseased portion of the ligament. But this operation, indicated by Lafosse, is possible only when the disease is limited to the apex of the most prominent spinous pro- cesses. It is positively contra indicated in low and thick withers, in which the wound left after the operation would be a hollow, cup-shaped depression, from which the pus would naturally gravi- tate and filtrate in all directions. The instruments necessary for this operation are: A grooved director, curved and straight bistouries, sage-knives, sharp draw- 778 DISEASES OF THE WITHERS. ing knives, bull-dog forceps, and an amputating saw; and with these the appliances usually needed in the way of hemostatics, and the necessary dressings, artery forceps, oakum, sponges, drainer-tubes, dog seton needles, etc. The various steps of the operation are thus described by Peuch and Toussaint : “Everything being ready, the operator enlarges the fistulous. tract, simple or ramified as it may be, so as to expose the ne- crosis. In making this special attention must be taken to give the incision a direction favorable to the escape of the pus. This first step of the operation is accompanied with abundant hemor- rhage, which must first of all be arrested either by ligating the divided blood vessels, or by plugging the wound with oakum moistened with a solution of perchloride of iron. The hemor- rhage stopped, and the necrosis exposed, the second step, and the important one of the operation, is proceeded with. To effect this the necrosed surface is limited by a double incision, made with a sharp instrument, straight bistoury, or sage-knife. This incision involves the entire thickness of the cervical ligament and the fibro- cartilage covering the apex of the spinous process and passing under this cartilage. In making this incision the operator must be careful not to injure any of the other processes if they are not diseased. This done, with the sage-knife the deepest layers of the cartilage are excised, and then, with the drawing knife, the bony tissue underneath is resected so as not to leave the smallest particle of necrosed tissue. Here, as in some cases of foot opera- tion, not only must all the diseased tissue be removed, but some of the healthy structures. The resection of the apex of the ne- crosed processes can be made with the saw instead. of the draw- ing knife. But this instrument is preferable, as it is easier to manipulate and it always leaves a smooth wound.” The subsequent treatment is of the routine kind. The parts are, of course, thoroughly cleansed; the hemorrhage is controlled by pressure, a drain tube is secured at the lower angle of the wound, and the edges are brought together by quilled sutures. Repeated injections of phenicated water are passed through the drainage tubes, and the patient is watched in order to prevent him from injuring himself by rubbing. If the season and the cireum- stances permit, continued irrigation is established. Toward the fourth or fifth day the sutures are removed and the dressing changed. The granulating process is carefully DISEASES OF THE WITHERS. 779 watched, and its progress kept under control by mild caustic ap- plications, or by pressure, to prevent an uneven and too rapid cicatrization During the treatment the animal must be kept quiet, and even in some cases it will be prudent to hobble his fore legs in order to limit his movements and prevent the filtration of the pus under the shoulder. He is to be kept on light and nutritive diet, to compensate for the losses resulting from the abundant suppura- tion, and when the disease has disappeared, and there is only a superficial wound remaining, and no more fear of returning com- plications or relapses, the animal can be returned to his labors, but must make his adieus to the bulky collar which has weighed so heavily on his neck, and substitute for it the equally efficient and far more sightly Dutch collar, which has never yet in any way contributed to bring upon its wearer the calamity of diseased withers. ; DISEASES OF THE POLL. This region of the neck is the seat of lesions, frequently occur- ring, and of varying nature. They include excoriations, cedema- tous swellings, cores, cysts, bloody tumors, abscesses, bruises, wounds, etc., any of which may become complicated, and termi- nate in poll evil, or the necrosis of one of the fibrous, elastic, or bony elements which enter into the composition of that region. In considering the anatomical structure of the portion of the neck in question we find on the top a mass of hair, separated from that of the superior border of the neck by a surface which has become callous by the constant frictions of the head-strap of the halter or of the bridle; the skin (Fig. 563), thick on the median line, thinner on the sides, but always loosely connected with the subjacent tissues; a thick layer of connective tissue, more or less infiltrated with fat, and lardaceous in low-bred horses; the cord of the ligamentum nuche, which is attached to the occipital bone, and more or less covered by the cervico-auricularis muscles; on each side, and on the same level, the terminal insertion of the splenius muscles, and forming an elevation which is covered by the aponeurosis common to that muscle and the small complexus, which itself makes an apparatus of retention of great resistance to the organs of the region; then another layer, composed of the large tendon of the great complexus, the small oblique muscle of 780 DISEASES OF THE POLL. Fa. 563.—Section of the Neck on a Level with the Poll. p.—The skin. tc.—Lardaceous connective tissue on the top of cervical ligament. gce.—Superior extremity of the great complexus and small oblique muscle of the head. lc.—Ligament nuche. dp.—Posterior straight muscles of the head. 1lao.—Atloido- occipital ligament. 1s.—Superior part of the atlas. sm.—Rachidian dura mater. m.—Spinal marrow. ta.—Adipose tissue of the rachidian canal. a.—Atlas. ph.— Pharynx. go.—Section of the great oblique muscle of the head. ao.—Section of odon- toid process of the axis. p.—Parotid gland. sm.—Sub-maxillary gland. da.—Anterior straight of the head, o.—(sophagus. the head, the great oblique, and under them, the posterior straight muscles of the head; a serous sac, assisting the gliding of the cord of the ligamentum nuche over the atlas, which is very small in young animals, assumes larges dimensions in old subjects; and, finally, a skeleton of the region, the atlas, the axis and the occi- pito-atloid and atloido-axoid articulations. Two large arteries are distributed throughout the locality, the occipito-muscular and the atloido-muscular. The causes in which diseases of the poll originate are numer- ous. Among them may be mentioned first, bruises, from blows given with the handle of a whip, or of a fork; contusions and continued frictions against hard substances, as the manger; the pressure and rubbing of the parts of the harness (the bridle, etc.), which pass over that region; the repeated rubbing which the ani- mal inflicts upon himself when he is affected with parasitic cuta- neous disease; the blows which he receives when in tossing his head, he brings it in contact with the ceiling of his stable, when this is too low, and he has formed the habit of pulling back on the halter; the spreading of diseases of the neck by the extension of the necrosis of the cord of the cervical ligament, all these are a B — oe DISEASES OF THE POLL. 781 considered to be so many active agencies in the etiology of poll evil. In cattle it is most commonly chargeable to the pressure and frictions of the yoke. Hertwig, with other German authors, con- siders it, and particularly the sus-atloid hygroma, as the local mani- festation of a diathesic condition, such as rheumatism and dis- temper. They also admit that the true poll evil may develop itself spontaneously, and independently of all other traumatic causes. In considering the various forms which the disease may assume in this locality we shall adopt the division sanctioned by Bouley, who has thus arranged them. ~ A—Excoriations; B—Qiprematous SwELuinas; C—Core; D—Buoopy Tumors. Diseases of the poll, in horses, exhibit too close a resemblance in their type and general history to escape notice, and the ther- apeutic indications exhibited in them are the same. And it must be borne in mind that however shght they may appear to be, and whatever may be their nature, they always require immediate at- tention and careful watching, and in all cases the use of the bridle and the halter must be suspended. E.—Cysr. Cysts of the poll are divided into superficial and deep. The former, which are of uncommon occurrence, have their seat in the subcutaneous cellular tissue, and possess features in common with those which appear at the withers. The latter is an abnormal dilatation of the serous sac which facilitates the gliding of the cervical cord upon the atlas; it is also known as the atloid hy- groma. It generally begins suddenly, and is manifested by the presence of a soft tumor, fluctuating, spherical, or bilobulated by the median pressure of the cervical ligament. It is usually pain- less, except when it is the result of acute violence, in which case it may be accompanied with inflammatory symptoms, which may extend to suppuration, but in such cases, which, however, are in- frequent, there is also a degree of fever corresponding in intensity with the other features of the case. The fluctuation is at first uniform, and easily detected, but at a later period, as the secre- tion becomes more abundant, and the tension of the pouch be- a4 782 DISEASES OF THE POLL. comes greater, and the thickening of the walls progresses, it be- comes obscure. In the stable the animal is very quiet, standing with the neck extended and the head carried downward; he moves with difficulty, without raising the head, and avoiding all movements of the muscles of the neck, and especially of the extensors. At times the distension of the walls of the cyst may be so extreme that the capsular ligament of the occipito-atloid joint is pushed in- ward in the rachidian canal, and when this occurs nervous symp- toms appear, caused by the pressure of the rachidian bulbs. If unremedied, it assumes a chronic condition, with progres- sive distension, which may end in death by pressure upon the bulb. Purulent transformation, and poll evil proper, are also the possible terminations of the atloid hygrcma; indeed, it is only in rare instances that it is known to subside by resolution or resorp- tion. In cases of doubtful diagnosis as to the formation of cystic or purulent collections, exploration will relieve the doubt, and at once settle the question of treatment. Blistering and absorbing applications, often repeated, and combined with aspiration, have often relieved the atloid hygroma. Cauterization in lines or points, both superficial and deep, are also recommended. Injections of tincture of iodine have also their supporters, but they are sometimes liable to give rise to vio- lent irritation, ending in purulent collections, and perhaps necrosis possibly of the cervical hgament. F’.—Asscess. This is the most frequent lesion of the poll, forming at once, when the exciting cause is sufficiently active, or when originating in the manner already described. It consists at first, of a diffused, not well defined, swelling of the abundant cellular tissue which separates the muscles of the region, to coalesce at a later period, to form a single purulent gathering, but not until it has macerated and destroyed all the intermediate tissues into which it had become infiltrated, and this destructive process advances so actively and persistently that when it reaches the surface, instead of closing up, the abscess has be- come transformed into a fistulous center, with a constant dis- charge of mortified, fibrous, elastic, or bony structure. DISEASES OF THE POLL. 783 The establishment of the suppurative process, even before any local symptoms have been manifested, is betrayed by the changed appearance of the animal. As described in the previous pages, he becomes listless and dull, standing quietly with the neck extended and the head resting on the manger; refusing to move, or if doing so, never raising his head, and by grunts and moans betraying the great pain he is suffering. If his head be raised by force he rebels against it, struggles, goes backward, strikes with his fore feet, and perhaps rears. By bringing the animal under control and restraint, as by throwing him, the abscess may be easily discovered, on one side of the neck, as a diffused swelling, tense, warm, and so excessively sensitive to the slightest contact, that it is with the greatest diffi- culty that an obscure and deep fluctuation can be detected. The positive nature of this tumor must then be made out as early as possible, by repeated capillary explorations, since if discovered to be unmistakably of a suppurative nature, a free exit to the pus must be at once established, to avoid its necrotic tendency ; while if it be a cyst, there is danger in opening it, arising from its lia- bility to be followed by necrosis of the cervical ligament. The prognosis of this abscess will vary according to the length of time which may have elapsed between its inception and its detection. The serious nature of this prognosis is explained by the fact of the incompressibility of the pus and the inextensi- bility of the aponeurosis of the splenius and complexus muscles, which resist the swelling of the inflamed tissues, and by their compression and strangulation, become the cause of gangrene. If a diagnosis of abscess is made, and it is immediately opened, the cavity may assume the character of an ordinary abscess, and close entirely; but this is a rare termination. More ordinarily, the incar- ceration of the infiltrated pus between the muscular layers is an obstacle to its free and complete discharge, and it remains infil- trated, gathering into cul-de-sacs, and migrating irregularly be- tween the muscles. Hence the formation of so many fistulous tracts, opening at diverse points on the skin, which are generally the result of the necrosis of the ligamentum nuche, or of the fibrous tissue of the tendons, or even of that of the atlas, or possibly of the occipital bone. All the dangers which are likely to follow the existence of an abscess at the poll, demonstrate the necessity for prompt surgi- 784 DISEASES OF THE POLL. cal interference. Whenever the presence of the pus is established the abscess must be opened, and opened very freely. This must be carefully done. The puncture must be made in the center of the tumor, and after the evacuation of the pus it must be ex- tended with the bistoury, introduced with the aid of a grooved director, and making, of course, a counter-opening at the most dependent point. This incision should be made parallel with the cervical ligament, and must be carefully made, in order to avoid wounding the capsular ligament of the joint, or the occipito-mus- cular artery. The hemorrhage which accompanies this operation is easily controlled by pressure. Antiseptic dressings, with the use of a drainage tube constitute the after-treatment, which must be similar to that of the same diseases at the neck and at the withers, with the difference, perhaps, that the dressings and cleanings must be oftener renewed. If no complications arise the wound will heal without diffi- culty, and the animal may be able to resume work after two or three weeks’ recuperation. Pott Evu. But if, on the contrary, the animal is suffering with the per- sistent and tenacious lesion which consists in the necrosis of the yellow or white fibrous tissue of the region, or a diseased condi- tion of the surrounding bones, we are confronted with the very serious affection commonly known as poll evil. This disease originates, ordinarily, in one of those already con- sidered, and yet it may appear spontaneously, if the instigating traumatism from which it grew has been sufficiently severe or violent. And, again, it may be a sequel or extension of a similar diseased process in the neck. Its characteristic appearance is that of a large induration, de- veloped around one or several fistulous tracts, from which escapes a thin, sanious pus, of foetid odor. Upon being explored these fistulas are found to vary in their direction, in their depth, and in the tissue on which they terminate. Exploring with the probe, or, more certain, with the finger, a cavity is found more or less filled with pus, with granulating walls, in the bottom of which the cervical ligament is felt, isolated, roughened and more or less escharrified, or, if this chord has remained intact, it will indicate DISEASES OF THE POLL. 785 that the seat of the lesions is the tendon common of the splenius, or of the complexus, or, perhaps, of the oblique or posterior straight muscles. - At an advanced period, when the progress of the mortification has been for some time unchecked, and the bony insertions of the ligament, or of the tendons, have become affected, the surfaces of these bones also become affected and their roughened or possibly necrotic character is readily recognized by the exploring finger. It may also happen that the capsular ligament of the joint, constantly macerated in the pus, softens and yields, and the pene- tration of the discharge into the vertebral canal soon ends the case by the rapid development of suppurative cerebro-spinal men- ingitis. Hertwig and Lafosse have reported instances where anchylosis of the occipito-atloid joint had taken place. There is in the museum of the American Veterinary College a preparation of an anchylosis of the occipito-atloid articulation which undoubtedly is the result of a case of chronic poll eyil. The prognosis of this ailment is always serious. A slight lesion may grow and develop into a case, with all its dangers. For this reason a cautious expression of opinion on the part of the surgeon is equally due to considerations of policy as to the obligations of truth. The treatment is essentially and exclusively surgical. In the simplest cases free openings and ample drainage of the wound, with plenty of washing and antiseptic attention will con- trol the trouble. In more severe cases, where the presence of the fistulous tracts is stimulated by the induration of the parts, and the con- stant movements of their walls, the external application of a strong blister and the injection into the fistule of tincture of iodine, or of cantharides, or of solutions, more or less concen- trated, of tartar emetic, nitrate of silver, chloride of zine, etc., will contribute to immobilize the parts and stimulate the granu- lating and healing process. The section of the cord of the ligamentum nuchee is indicated when the tension of the region becomes too rigid, and the pain inor- dinate. This alleviating measure was first instituted by Langen- bacher and Hertwig in Germany; then by Lafosse and Rey in France, and it has always given excellent results. It relieves the 786 DISEASES OF THE POLL. pressure and the pain, obviates the danger of gangrene, facilitates the examination of the wound, and greatly aids the excision of the soft, necrosed tissues, and the scraping of their bony attach- ments. The operation is simple. The patient is thrown, and a straight bistoury, or in preference, a blunt curved tenotomy knife are the instruments. With the latter, the division of the skin is avoided. The ligamentous section is subcutaneous, the instrument being introduced under the cord, and the division made from within outward. When the section is made, the ends of the ligament draw apart. If it is necrosed, the anterior stump is removed down to its insertion in the occipital bone, which may also be scraped. The same treatment is applied to the tendons of the muscles. In fact, the opening is cleared from all mortified substances, and treated as a simple wound. After the operation, the animal carries his head low down and vertical, but when the wound becomes cicatrized, and continuity is re-established between the stump of the ligament and the ceryi- cal tuberosity, the head becomes by degrees elevated, and is event- ually restored to its normal position and natural liberty of motion. INDEX —_—— A Abdomen, bandage for the, 116 seton on the, 196 Ablation of tumors, 200 Abnormal deviation of the tail, 307 Absorbents, 528 Abscesses, 199, 278, 382, 307, 709 782 Accidents after gouging teeth out,353 cesophagotomy, 377 of firing, 184 of general anesthesia, 75 of means of restraint, 76 of phlebotomy, 506 of plantar neurotomy, 541 of setons, 198 Actual cauterization, 158, 529 after-cares, 163 deep, 175 effects of, 166 immediate, 159 instruments for, 160 mediate, 159 penetrating, 160 primary effects, 166 secondary effects, 166 subcutaneous, 160, 180 superficial, 159 transcurrent, 160 various degrees of, 165 cautery, puncture with, 142 Acute hernia, 392 Adenotomy, 361 maxillary, 363 parotid, 362 Adhesive reunion, 143 plaster, 145 Administration of chloral, 74 After cares in amputation, 272 in caudal myotomy, 303 in tenotomy, 319 in trephining, 291 of actual cautery, 168 of setons, 192 treatment in hernia, 415 Air in veins, 513 Amputations, 266 in contiguity of bones, 270 after-cares in, 272 in continuity of bones, 270 of ear, 750 of horns, 274 of penis, 569 of tongue, 361 of tail, 277 modus operandi, 279 of wings, '758 of wings.of birds, 274 Anal fistula, 307 Anatomy, 2 of foot, 576 of guttural pouch, 452 of inguinal region, 396 of poll, 779 of withers, 760 pathological, in canker, 597 in corns, 611 of cartilaginous quittor, 718 of contracted heels, 644 of laminitis, 681 of navicular disease, 697 Anesthesia, 66 accidents of, 75 duration of, 73 general, 70 local, 67 surgical, 66 788 Anesthetic, pulverization of liquid, 68 Animal, preparation of the, 11 Anti-brachial tenotomy, 323 Antiseptic dressings, 100 Application, local, in hernia, 429 of dressings, 91 of sutures, 147 Arm, fracture of the, 246 Art in surgery, 1 Arteriotomy, 514 Arthrosis, pseudo, 218 Asphyxia, 80 Assistants in operation, 10 Astringents, 528 B Bad aspect of the stump, 282 cicatrices, 186 Bandages, 103 binocular, 107 compound, 106 double, for the eye, 107 for abdomen, 116 back, 114 breast, 118 cannon, 123 chest, 116 croup, 114 ear, 108 elbow, 119 forearm, 120 hip, 114 hock, 123 inguinal region, 116 knee, 121 leg, 122 loins, 114 maxillary region, 108 ~ neck, 110, 112 parotid, 109 perineum, 116 shoulder, 118 joint, 119 stifle, 121 throat, 109 INDEX Bandages for withers, 113 in umbilical hernia, 428 _mechanical, 123 monocular, 107 roller, 105 single, for the eye, 107 single frontal, 105 uniting, 144 Barnacles, 15 iron, 16 wood, 16 Bar hobbles, side, 44 side, 20 ‘ Beads, 20 Bed to cast, 30 Birds, tenotomy in, 327 Bistouries, 126 methods to hold, 128 puncture with, 140 Bleeding at coronet, 521 at foot, 522 at median caudal, 515 at palate, 520 at posterior auricular, 515 at transversal of the face, 514 capillary, 517 in swine, 516 white, 506 Bloodless operation, 7 Bloody operation, 7 tumors, 780 Bones of the extremities, fracture of, 78 face, fracture of, 230 pelvis, fracture of, 239 resection of, 293 Bovines, securing of, 54 Breast, seton in the, 193 Bridoon, 18 Cc Cadiot’s method, 468 Calk, 627 symptoms of, 628 treatment of, 628 varieties of, 627 Canine dentistry, 356 Canker of the foot, 591 complications of, 596 Cannon, bandage for, 123 Capillary bleeding, 517 Caprines, securing, 62 Cardiac syncope, 75 Caries of membrana nictitans, 742 Cartilaginous quittor, 714 Caruncular apparatus, 743 Cast, bed to, 30 - Casting bovines with hobbles, 61 ropes, 62 on operating table, 47 with double side lines, 47 hobbles, 30 ropes, 44 single rope, 45 Cataract, 749 Catheterism, cesophageal, 366 of urethra, 555 in females, 557 in males, 555 Caudal myotomy, 296 complications of, 306 Causes of diaphragm hernia, 440 dislocation, 262 furuncle of frog, 667 hernia, 392 inguinal hernia, 412 poll evil, 780 umbilical hernia, 425 Caustics, potential, 529 Caustic treatment of hernia, 429 Cauterization, 159 accidents of, 184 bad cicatrices after, 186 after-cares, 168 ala Gaulet, 171 deep actual, 159, 175 effects of, 166 immediate, 159 inherent, 178 in large animals, 188 in other animals, 183 in points, 171 mediate, 159 INDEX 789 Cauterization, objective, 174 penetrating, 160, 180 primary effects of, 166 secondary effects of, 167 subcutaneous, 160 superficial actual, 159 transcurrent, 160 various degrees of, 165 with thermo-cautery, 182 Cautery, actual, 158 Cavesson, 18 Cellular tissue, operation on, 758 Cephalic vein, bleeding at, 499 Chabert’s method, 522 Cheeks, seton on, 196 Chest bandage, 116 seton in, 793 Chloral, administration of, 74 Chloroform bag, 72 manifestation of, 72 — Chronic hernia, 392 Cicatrix, bad, 186 Cicatrization, incomplete, 276 Circulatory system, operations on, 492 Cito, tuto et jucunde, 5 Clamps, 438 Classical modus operandi, 481 Club foot, 585 Comminuted fractures, 212 Common bone, fracture of, 255 Complicated operations, 7 Complications of amputations, 273, 275, 282 canker, 596 contracted heels, 644 fistulous withers, 773 fractures, 217 hernia, 893, 414 herniotomy, 410 laminitis, 674 plantar neurotomy, 320 sand cracks, 618 umbilical hernia, 431 ventral hernia, 446 Complete fractures, 212 Compound fractures, 212 790 Compound fracture bandage, 106 incisions, 135 Compresses, 103 Compression as hemostatic, 580 by circular ligature, 525 by tourniquet, 525 Esmarck’s method, 525 Compressive dressings, 99 Congenital defective conformation, 741 hernia, 393 Contiguity of bones, 270 Continuity of bones, 270 Contracted heels, 640 complications of, 644 division of, 641 etiology of, 646 pathological anatomy of, 644 prognosis of, 645 symptoms of, 641 synonym, 640 treatment of, 650 Contractions, spasmodic, 75 Contra-indication of sutures, 147 Core of poll evil, 780 of the withers, 766 Corns, 607 division of, 607 etiology of, 608 pathological anatomy of, 611 prognosis of, 613 symptoms of, 611 treatment of, 613 Coronet, bleeding at, 521 fracture of, 258 Cough, 75 Counter-indications of neurotomy, 547 Cox’s chloroform bag, 71 Cranial bones, fracture of, 229 Crooked foot, 586 Cross-hobbles, 44 Croup bandage, 114 Crucial incision, 136 Crural hernia, 420 Crural myotase, 308 myotomy, 308 INDEX Crural myotomy, complications of, 311 Crushing of foreign bodies, 372 Cunean tenotomy, 823 Cupping, 518 Curative treatment of sand cracks., 628 Curved incision, 735 Cyst of the poll, 781 of the withers, 768 Cystocele, 392 Cystotomy, 565 D Daviau’s operating table, 48 Deep actual cauterization, 159, 175 Defections of the feet, 576 Defective congenital conformations,, 741 Definition of fracture, 212 of operations, 6 Dental surgery, 335 arches, leveling of, 335 Dentistry, canine, 356 Derivative method, 14 Determinate operations, 8 Diagnosis of cartilaginous quittor, 720 of fracture, 217 of quittor, 708 of ventral hernia, 445 surgical, 81 Diaphragmatic hernia, 439 causes of, 440 diagnosis of, 445 prognosis of, 442 symptoms of, 440 Dieresis, 125 Dieulafoy’s aspirator, 87 Differential diagnosis of laminitis,. 685 Digestive apparatus, operation on, 328 Direct taxis, 404 suture of the ring, 438 Disease, navicular, 694 INDEX Disease, navicular, diagnosis of, 698 duration of, 697 Diseases of the frog, 665 of the feet, 576 of the teeth, 328 symptoms of, 329 of the poll, 779 of the withers, 759 Dislocations, 78, 262 causes of, 262 of the hip, 264 of the shoulder, 264 prognosis of, 263 special, 264 symptoms of, 262 treatment of, 263 Dissection, 137 by slices, 138 Division, 125, 425 of contracted heels. 641 of corns, 607 of laminitis, 670 of punctured wounds of foot, 630 | of quittor, 702 of sand cracks, 616 Docking, 277 complications of, 282 instruments for, 278 modus operandi, 279 Dossiled suture, 153 Double bandage for the eye, 107 ligature, 205 roller, 94 side line, 23 tenotomy, 316 Drainage, 105 Dressings, 90, 591 antiseptic, 100 applications of, 91 compressive, 99 definition of, 90 dividing, 99 effects of, 90 expulsive, 99 in amputation, 27 in foot operations, 591 in fracture, 227 791 Dressings, instruments for, 100 in tenotomy, 318 in trephining, 290 material for, 93 removal of, 97 retentive, 98 suspensory, 99 uniting, 99 Dry operation, 7 Duration of anesthesia, 73 cartilaginous quittor, 719 canker of the foot, 596 quittor, 708 E Ear, amputations of the, 756 bandage, 108 operation on the, 756 Effects of cauterization, 166 dressings, 90 primary cauterization, 166 secondary cauterization, 167 setons, 192 superficial points firing, 172 Elastic suture, 154 ligature, 210 Elbow, bandage for, 119 Elementary operations, 125 Elliptic incision, 136 Emphysema, 487 Enterocele, 392 Enteromphalus, 425 Enterotomy, 380 instruments for, 380 Epiplocele, 392 Epiplomphalus, 425 Esmarck’s method, 525 Etiology of canker, 600 eartilaginous quittor, 721 contracted heels, 646 corns, 608 cutaneous quittor, 703 diseases of poll, 780 withers, 763 fracture, 214 laminitis, 685 792 Etiology of navicular diseases, 698 punctured wound of foot, 629 sand cracks, 616 subhorny quittor, 712 tendinous quittor, 709 Eventration, 447 diagnosis of, 448 symptoms of, 447 treatment of, 449 Evulsion of teeth, 348 Exaggerated elevation of tail, 807 Exaggeration of extension, 321 Excision of tumors, 201 with bistouries, 201 ecraseur, 203 scissors, 201 thermo-cautery, 205 Excoriations of the withers, 765 on the poll, 781 Exomphalus, 425 Exploring needles, 87 Expulsive dressing, 99 Extirpation of the eye, 754 Extraction of foreign bodies, 748 Extraction of teeth, 348 Extremities, amputation of, 268 Exutories, 186 F Facial bones, fracture of, 230 Fashion, operation of, 8 Femur, fractures of, 250 Fibrous tissue, operations on, 312 Filing teeth, 356 Finger used as director, 134 Fire, regions to, 167 Firing, 159 accidents of, 184 & la Gaulet, 171 A la Manzio, 184 effects of, 178 ‘ inherent, 178 indications, 159 in lines, 162 instruments, 160 needle, 175 objective, 174 INDEX Firing on the surface, 171 superficial points, 172 First phalanx, fracture of, 256 Fistula, 274 anal, 307 Fistulous withers, 771 Fleming’s method, 464 Foot, bleeding at the, 522 canker of the, 591 club, 585 crooked, 586 diseases and defectuosities, 583 flat, 584 instruments to operate, 589 operations on, 576 pumiced, 584 punctured wound of the, 629 rammy, 587 seton in, 196 vices of conformation, 583 with hard hoof, 587 Forearm, bandage for, 120 fracture of, 247 Foreign bodies, crushing, 372 extraction of, 748 Fungosities, 200 Furrier, suture of the, 155 Furuncle of the frog, symptoms, 666 causes, 667 treatment, 667 Fracture of bones of extremities, 78 cannon bones, 255 coronet, 258 cranial bones, 229 facial bones, 280 femur, 250 first phalanx, 256 forearm, 247 hock, 255 humerus, 246 knee, 250 lower jaw, 232 os innominata, 240 os pedis, 259 patella, 2538 pelvic bones, 78, 289 pre-maxillary bone, 231 Fracture of ribs, 78, 238 sacrum, 239 scapula, 243 sesamoids, 259 tibia, 253 vertebrae 285 vertebral column, 76 Fractures, 76, 212 diagnosis, 217 comminuted, 212 complete, 212 complicated, 217 compound, 212 definition, 512 dressing in, 227 etiology, 214 incomplete, 212 longitudinal, 213 mode of repair, 218 oblique, 218 reduction in, 224 retention in, 227 simple, 212 special, 229 symptoms, 215 transverse, 212, 213 treatment of, 224 with displacement, 213 without displacement, 213 Free dissection, 138 Frontal single bandage, 105 Frog, diseases of, 665 furuncle of, 666 seton, 196 G Gag, 16 Gangrene, 199, 276, 283, 306, 311 Gastrotomy, 377 Gaulet, firing 4 la, 171 Gelding, inguinal hernia of, 418 General anesthesia, 70 accidents of, 75 consideration on hernia, 386 operations on the foot, 590 Genito-urinary apparatus, 555 INDEX 793 Globe of the eye, operations, 746 Good surgeon, qualities of, 5 Gouging teeth out, 353 Granulations, union by, 148 Growths on membrana nictitans, 742 Glossotomy, 361 Glover’s suture, 152 Guttural pouches, operations on, 452 anatomy of, 452 H Halter, 18 Hearing in surgical diagnosis, 88 Heels, contracted, 640 Hemorrhage, 185, 198, 273, 275, 282, 306, 311, 320, 487 Hematoma of the poll, 781 of the withers, 766 Hemostasia, compression in, 525, 530 by digital pressure, 524 Esmarck’s method, 525 immediate ligature, 534 ligature, 533 mediate ligature, 537 torsion, 538 tourniquet, 525 permanent, 526 physico-chemical, 523 surgical, 523, 530 temporary, 524 Hernia, 385 acute, 392 causes of, 392, 412 chronic, 392 complications, 393 complicated, 411 congenital, 392 crural, 420 diaphragmatic, 439 causes, 440 prognosis, 442 symptoms, 440 general consideration on, 386 inguinal, 394 of geldings, 418 symptoms, 419 794 Hernia, inguinal, treatment, 419 intermittent, 411 irreducible, 391-3893 old inguinal, 411 operatious, 415 pancreatic, 421 pelvic, of oxen, 421 perineal, 421 permanent, 411 recent inguinal, 397 reducible, 391-393 simple, 411 symptoms, 392 umbilical, 425 bandages in, 428 causes, 425 caustic treatment, 429 clamps in, 433 division, 425 ligature in, 4382 local application in, 429 INDEX History of laryngotomy, 462 plantar neurotomy, 550 Hobbles, 30 casting bovines with, 61 cross, 44 side bar, 44 Hock, bandage for, 123 Hodgson’s operating table, 53 Holding a bistoury, 128 Horns, amputation of, 274 How to east, 29 Hygienic treatment for sand cracks, 621 Hyospondylotomy, 452 Hyovertebrotomy, 452 proper, 457 instruments for, 457 operation for, 458 I subcutaneous injection, 431 | Immediate actual cautery, 159 surgical operation, 432 suture in, 434 symptoms, 425 treatment, 428 various forms of, 388 ventral, 448 causes, 444 complications, 446 diagnosis, 445 symptoms, 444 treatment, 446 Herniotomy, 405 after treatment, 410 complications of, 410 instruments for, 405 modus operandi, 405 High neurotomy, 550 instruments for, 551 modus operandi, 551 Hip, bandage for, 114 bone, fracture of, 240 joint, dislocation of, 264 seton on, 195 Hippo-lasso, 26 History of canker of the foot, 592 ligature, 534 reunion, 148 Incision of rumen, 378 Incisions, 125 by seraping, 135 by slices, 185 compound, 1385 erucial, 1386 curved, 135 definition, 125 from within outwards, 132 from without inwards, 131 how to make, 131 L-shaped, 136 semi-lunar, 136 simple, 1385 straight, 135 subcutaneous, 134 T-shaped, 136 V-shaped, 136 with director, 133 without director, 182 Incomplete fracture, 212 Indications for amputation of penis, 569 INDEX Indications for crural myotomy, 308 cunean tenotomy, 323 enterotomy, 380 exutories, 187 firing, 159 cesophageal catheterism, 366 operations on tongue, 358 plantar neurotomy, 546 plantar tenotomy, 312 resection, 295 sutures, 147 thoracentesis, 488 tracheotomy, 479 treatments, 221 trephining, 283 urethrotomy, 558 Indurations, 200 Inguinal hernia, 294 of geldings, 418 old, 411 recent, 397 ring, bandage for, 116 Inherent firing, 178 Injections, subcutaneous, 431 Injuries to nerves, 79 to soft tissues, 79 Instruments for actual cauterization, 160 amputation, 267 applying torsion, 538 docking, 277 dressings, 100 extracting teeth, 343 general operations on foot, 589 herniotomy, 405 hyovertebrotomy, 457 laryngotomy, 464 leveling teeth, 3385 lithotrity, 565 needle firing, 175 cesophageal catheterism, 367 periostotomy, 291 phlebotomy, 492 points firing, 172 resection, 294 setons, 189, 197 sutures, 148 795 Instruments for thoracentesis, 488 tracheotomy, 479 trephining, 283 Intention, reunion by first, 143 Intermittent hernia, 411 Inter-muscular abscess, 311 Internal saphena vein, bleeding at, 501 Interrupted sutures, 151 Introduction, 1 Tron barnacle, 16 Irreducible hernia, 391, 393 Irregular operations, 8 Ischial urethrotomy, 562 J Jacket, straight, 26 Jaw, fracture of lower, 232 Joint, dislocation of hip, 264 Jugular, phlebotomy at, 497 K Keraphylocele, 668 symptoms of, 669 treatment of, 669 Knee, bandage for, 121 fracture of, 250 Knowledge required, 2 L Laceration of muscles, 79 Lachrymal apparatus, operations on, 743 canal, operations on, 745 ducts, operations on, 744 Laminitis, 669 complications, 674 differential diagnosis, 685 division, 670 etiology, 685 pathological anatomy, 681 prognosis, 685 symptoms, 670 synonym, 669 796 INDEX Laminitis, termination, 674 Means of restraint, 13 treatment, 685 Mechanical bandages, 123 Lancet, puncture with, 139 restraint, 17 Laparotomy, 449 Median canal, bleeding at, 515 modus operandi, 450 Mediate cauterization, 159 Large ruminants, cauterization in, ligature, 537 183 Membrana nictitans, operation in, bleeding in, 503 742 ° Laryngotomy, 462 caries of, '742 Cadiot’s method, 468 Metallic suture, 156 Fleming’s method, 464 Method, Cadiot’s, 468 history, 462 derivative, 14 Leeches, 519 Fleming’s, 464 Leg, bandage for, 122 painful, 14 Leveling of dental arches, 335 subcutaneous, 302 Ligatures, 206, 482, 533 Methods for holding a knife, 128 double, 205 in making incisions, 131 elastic, 210 in operation, 9 immediate, 524 various, 485 mediate, 537 Modes of securing, 38 multiple, 206 Monocular bandage, 107 simple, 205 frontal bandage, 107 subcutaneous, 208 Modus operandi of amputation of Light operations, 7 ear, 756 Limited dissection, 188 of extremities, 268 Lithotrity, 565 of horns, 274 instruments for, 566 of penis, 571 modus operandi, 568 arteriotomy, 514 Local anesthesia, 67 cataract, 751 applications, 429 Cadiot’s method, 468 Loins, bandage for, 114 erural myotomy, 811 Longitudinal fracture, 213 cunean tenotomy, 325 incisions, 300, 485 docking, 279 Looped suture, 152 enterotomy, 382 Lower jaw, fracture of, 232 excision of tumors, 201 Low neurotomy, 551 with ecraseur, 203 modus operandi, 551 extirpation of the eye, 754 L-shaped incision, 136 extracting teeth, 345 Luxations, 262 firing, 164 Fleming’s method, 465 M Z gouging teeth, 354 herniotomy, 405 Manifestation of chloroform, 72 hyovertebrotomy, 458 Material for dressings, 93 ischial urethrotomy, 562 Maxillary adenotomy, 363 laparotomy, 450 fracture of pre-, 231 leveling teeth, 337 Means of drainage, 105 ligature, 535 Modus operandi of lithotrity, 568 neurotomy, 550 cesophageal catheterism, 369 csophagotomy, 374 paracentesis, 384 periostotomy, 291 phlebotomy, 495 plantar tenotomy, 313 resection, 295 setons, 190, 198 sprung knees, 322 thoracentesis, 489 torsion, 538 trephining, 288 Muscles, laceration of, 79 Multiple ligatures, 206 Mode of repair of fracture, 218 of reduction of fracture, 224 Multiple abscesses, 282 Myotomy, caudal, 296 Mixed incisions, 301 Myostase, crural, 308 Myotomy, crural, 308 N Nanzio, firing 4 la, 180 Navicular disease, 694 diagnosis, 698 duration, 697 etiology, 698 pathological anatomy, 697 prognosis, 698 symptoms, 695 synonym, 694 termination, 697 treatment, 700 Necessity, operations of, 8 Neck, bandage for, 110 setons at the, 196 Necrosis, 273 Needle-holder, 150 Needles, 149 exploring, 87 firing, 175 Riverdin’s, 150 Simpson’s, 150 INDEX Nerves, wounds of, 320 é 97 Nervous system, operations on, 540 Neurotomy, 541 accidents, 542 contra-indications, 547 high, 550 history, 541 indications, 546 instruments for, 550 low, 550 modus operandi, 551 objections against, 542 plantar, 541 Nose rings, 56 cup, 71 Non-vascular organs, wounds of, 506 oO Oakum, 102 Objections to neurotomy, 542 Objective firing, 174 Oblique fracture, 213 (Edematous swelling, 781 (isophagotomy, 373 Old inguinal hernia, 411 Omphalocele, 425 Operate, time to, 8 Operating tables, 30 casting on, 47 Operations, assistants in, 10 by longitud. incision, 300, 485 mixed incisions, 301 transverse incisions, 299 for hernia, 415 in complicated cases of hernia, 439 of fashion, 8 of necessity, 8 on accessory ocular organs, 739 bones, 212 caruncular apparatus, 743 cellular tissue, 158 circulatory system, 492 digestive tract, 328 ear, 756 essential organs of sight, 746 798 INDEX Operations on eye and ear, 739 eyelids, 739 fibrous tissue, 312 foot, 576 genito-urinary apparatus, 555 globe of eye, 746 guttural pouches, 452 lachrymal apparatus, 743 ducts, 744 canal, 744 muscles, 296 nervous system, 540 cesophagus, 364 respiratory apparatus, 452 skin, 158 teeth, 328 tongue, 358 young ruminants, 276 preparations for, 10 Operative dental surgery, 335 Ophthalmoscope, 85 Optional time, 9 Os pedis, fracture of, 259 Ossa innominata, fracture of, 240 Other superficial veins, bleeding at, 503 Owner, preparation of, 11 Pp Painful method of restraint, 14 Palliative operation, 8 treatment of sanderacks, 621 Pancreatic hernia, 421 Paracentesis, 388 of cornea, 748 Parotid, 3862 bandage for, 109 Patella, fracture of, 253 Pathological anatomy of canker, 597 cartilaginous quittor, 718 contused heels, 644 corns, 611 laminitis, 681 navicular disease, 697 growths on memb. nictitans, 742 Pelvic bones, fracture of, 78 Pelvic hernia of oxen, 421 Penetrating actual cautery, 160 Perineal hernia, 421 Perineum, bandage for, 116 Periostotomy, 291 instruments for, 291 modus operandi, 292 Permanent hemostasis, 526 hernia, 411 Peroneo-phalangeal tenotomy, 326 Phalanx, fracture of first, 256 Phlebitis, 408 symptoms, 509 treatment, 510 Phlebotomy, 493 accidents of, 506 at the cephalic vein, 499 at the internal saphena, 501 at the jugular, 497 at the subcutaneous thoracic, 501 in solipeds, 496 instruments, 493 modus operandi, 495 on large ruminants, 503 on other superficial veins, 503 on small animals, 505 Physico-chemical hemostaties, 526 Plantar neurotomy, 541 accidents, 542 contra indications, 547 high, 550 history, 541 indications, 546 low, 550 modus operandi, 551 objections, 542 tenotomy, 312 after cares, 819 complications, 320 dressing, 318 indications, 312 modus operandi, 315 Plaster, adhesive, 145 Plate ionge, 20 uses of, 21 Plates on shoe, 104 Points of selection, 9 INDEX Poll evil, 784 symptoms of, 784 treatment of, 785 Position of wounds in reunion, 144 recumbent, 27 securing the legs in, 38 standing, 17 Potential caustics, 529 Preparation for operation, 11 of animal, 11 of owner, 11. of patient, 10 Preputial urethrotomy, 561 Pricking, 297 Primary effects of cautery, 166 Procedure in operation, 9 Prognosis of canker, 597 cartilaginous quittor, 721 contracted heels, 645 corns, 613 dislocation, 2638 eventration, 448 fistulous withers, 773 fracture, 221 hernia, 401 laminitis, 685 navicular disease, 698 sand cracks, 619 subhorny quittor, 712 tendinous quittor, 708 Prothesis, ocular, 755 Pseudo arthrosis, 218 luxation of patella, 264 Pulverization of anesthetic liquid, 68 Pumiced foot, 584 Puncture, 138, 211 with actual cautery, 142 bistoury, 140 lancet, 188 trocar, 140 of the rumen, 377 Punctured wounds of the foot, 629 division, 630 etiology, 629 prognosis, 634 symptoms, 630 synonym, 629 treatment, 6384 Q Qualities of a good surgeon, 5 « Quilled sutures, 753 Quittor, 507 cartilaginous, 714 diagnosis, 720 duration, 719 etiology, 721 799 pathological anatomy, 718 prognosis, 721 symptoms, 716 termination, 719 treatment, 722 cutaneous, 703 etiology, 704 symptoms, 703 treatment, 705 division, 702 subhorny, 711 etiology, 712 prognosis, 711 symptoms, 711 treatment, 712 synonym, 702 tendinous, 706 diagnosis, 708 duration, 708 etiology, 709 prognosis, 709 symptoms, 707 termination, 708 treatment, 709 R Rammy foot, 587 Recent inguinal hernia, 397 Recumbent position, 27 Reducible hernia, 391, 393 Refrigerants, 527 Regions to apply setons, 193 Regions to fire, 167 Regular operations, 8 Removal of dressings, 97 of sutures, 156 of tumors, 211 800 Removal of tumors by bistoury, 201 ecraseur, 203 excision, 201 ligature, 206 scissors, 201 thermo-cautery, 203 tearing, 211 Repulsion of teeth, 353 Resection of bones, 293 Respiratory apparatus, operations on, 452 Respiratory syncope, 75 Restraint, means of, 13 mechanical, 17 Retention in fracture, 227 Retentive dressing, 98 Return of deformity, 321 Reunion, 125, 142 adhesive, 143 by first intention, 143 by granulations, 143 immediate, 143 position of wound in, 144 Ribs, fracture of, 238 seton on, 193 Riverdin suture needle, 150 Roller bandage, 105 Ropes, casting with, 44, 62 single, 45 Rowel seton, 197 Rumen, incision of, 378 puncture of, 377 Rumenotomy, 377 Rupture of viscera, 79 Ss Sacrum, fracture of, 239 Sage knives, 127, 589 Sand eracks, 616 complications, 618 division, 716 etiology, 619 prognosis, 619 symptoms, 616 synonym, 616 termination, 619 treatment, 621 INDEX Scabs, tearing of, 185 Scapula, fracture of, 243 Scarifications, 518 Science in surgery, 1 Scissors, 127 Scrotal urethrotomy, 561 Secondary effects of casting, 167 Section of skin, 185 Securing caprines, 62 dogs and cats, 64 in casting, 38 legs, 23 other animals, 54 ovines, 62 swine, 62 Selected time for operation, 9 Selection, points of, 9 Septicemia, 377 Sesamoid, fracture of, 259 Setons, 188 after cares of, 192 effects of, 192 instruments to apply, 189 modus operandi, 190 on abdomen, 196 brain, 193 cheeks, 196 chest, 193 frog, 196 hip, 195 ribs, 193 shoulder, 199 stifle, 195 thigh, 195 regions to apply, 193 rowel, 197 sequel of, 198 Shoulder, bandage for, 118 dislocation, 264 Side bar, 20 hobbles, 44 Side line, double, 23 Simple bandage for the eye, 108 fracture, 212 frontal bandage, 105 hernia, 411 ligature, 205 INDEX Simple operations, 7 suture, 151 tenotomy, 316 Single roller, 94 rope, casting with, 45 side line, 28 Stifle, bandage for, 121 Simpson’s suture needle, 150 Skin, operations on, 158 Sloughing of the skin, 185 Solution of continuity of eyelids, 740 Spasmodie contraction, 75 Special dislocations, 264 Special fractures, 229 Splints, 104 Sprung knees, 321 Standing position, 17 securing the legs in, 23 Staphyloma, 749 Stocks, 27 Straight jacket, 26 Strangulated hernia, 394 Sub-cricoid tracheotomy, 485 Subcutaneous actual cauterization, 160, 180 incision, 134 injections, 69, 431 ligature, 205 method, 302 Superficial actual cauterization, 159 points firing, 172 Surface, firing on the, 171 Surgical anesthesia, 67 diagnosis, 81 hearing in, 88 sight in, 81 smell in, 88 speculum in, 82 taste in, 89 touch in, 86 hemostasis, 523, 580 therapeutics, 90 Suspensory dressing, 99 Sutures, 146, 151 dossiled, 153 elastic, 154 Glover, 152 801 Sutures, interrupted, 151 looped, 152 metallic, 156 of the furrier, 155 quilled, 153 removal of, 156 single, 151 single pin, 154 T, 156 uninterrupted, 152 X, 156 zigzag, 155 Symptoms of calks, 628 canker of foot, 593 cartilaginous quittor, 716 contracted heels, 641 corns, 614 cutaneous quittor, 703 diaphragmatic hernia, 440 diseased teeth, 329 dislocations, 262 eventration, 448 fractures, 125 furuncle of frog, 666 hernia, 392 inguinal hernia, 397 keraphylocele, 669 laminitis, 670 navicular disease, 695 phlebitis, 509 punctured wounds of foot, 630 sand eracks, 616 subhorny quittor, 711 tendinous quittor, 707 umbilical hernia, 425 ventral hernia, 444 Syncope, 75 cardiac, 75 respiratory, 75 Synthesis, 125 T Tape setons, 188 Taste in surgical diagnosis, $9 Taxis, 370 direct, 404 802 Taxis, indirect, 402 Temporary hemostasis, 524 Tenotomy, 312 after cares, 319 complications, 320 cunean, 323 double, 318 in birds, 327 indications, 312 modus operandi, 315 peroneo-phalangeal, 326 plantar, 312 simple, 316 tarsal, 323 Termination of canker, 596 cartilaginous quittor, 719 fistulous withers, 774 laminitis, 674 navicular disease, 697 sand eracks, 619 tendinous quittor, 708 Tetanus, 283, 307. 877 Thigh, seton on, 195 Thoracentesis, 488 Thrombus, 507 Tibia, fracture of, 250 Tiffany’s operating table, 53 Time to operate, 8 optional, 8 selected, 9 Torsion, 538 modus operandi for, 588 Trachea, obstruction of, 487 Tracheotomy, 477 compheations, 486 indications, 479 instruments, 479 sub-ericoid, 489 Transcurrent cauterization, 160 Transverse fracture, 212 Traumatic lesions of the eyelids, 740 Treatment of calk, 628 canker, 601 contracted heels, 650 corns, 613 dislocations, 263 eventration, 449 INDEX Treatment of fractures, 224 furuncle, 667 hernia, 402 inguinal hernia, 418 keraphylocele, 669 laminitis, 688 navicular disease, 700 phlebitis, 510 punctured wounds, 634 quittor, 705, 708, 709, 712, 719 sand cracks, 621 umbilical hernia, 425, 428 ventral hernia, 446 Trephining, 283 dressing, 290 indications, 283 instruments, 283 modus operandi, 288 Trochiscus, 198 T-shaped incision, 136 Twitch, 15 U Umbilical hernia, 425 bandage in, 428 causes, 425 division, 425 subcutaneous injection in, 451 symptoms, 425 treatment, 428 Uninterrupted suture, 152 Uniting bandage, 144 dressing, 99 United fracture, 218 Urethra, catheterism of, 555 Urethrotomy, 558 indications, 558 preputial, 561 serotal, 561 ischial, 562 modus operandi, 563 Urgent operation, 8 Uses of plate longe, 21 of speculum, 82 INDEX 803 V Withers, excoriations on, 765 cedema of, 765 core of, 766 hematoma of, 766 cyst of, 768 abscess of, 769 wounds of, 770 fistulous, 771 Wooden barnacles, 16 Wound, punctured, of the foot, 629 Wounds of vertebrae, 306 nerves, 320 skin, 320 tendinous burse, 320 blood vessels, 377 non-vascular organs, 506 the carotid, 512 Varieties of sand cracks, 627 Various degrees of cauterization, 163 modes of taxis, 371 forms of hernial sacs, 388 sutures, 435 Veins, air in the, 513 Ventral hernia, 443 causes, 444 symptoms, 444 ~ diagnosis, 445 complications, 446 treatment, 446 Vertebre, fracture of, 235 wounds of, 306 Vices of conformation, 583 Vigan’s method, 59 Vomiting, 75 V-shaped incision, 136 x X suture, 156 WwW Z Withers, anatomy of, 760 diseases of, 759 Zigzag suture, 155 bandage for, 113 Pwr ay ©. hid we 7 4) se) ‘i ae } Viv, ¥ Sh , . : 1 Wal 4 | AE il hy 7 f i a \ La ab ' - . . \ - © - _ CATALOGUE OF WILLIAM R. JENKINS’ Works Concerning HORSES, CATTLE, SHEEP, SWINE, Etc. 1906 (*) Single asterisk designates New Books. (**) Double asterisk designates Recent Publications ANDERSON. ‘Vice in the Horse” and other papers on Horses and Riding. By H. L. Anderson. Size, Sexo cloth. Miustrateda cas seis oanieeeiee cer See LO ARMSTEAD. “The Artistic Anatomy of the Horse.” A brief description of the various Anatomical Struc- tures which may be distinguished during Life through the Skin, By Hugh W. Armstead, M.D., F.R.C.S. With illustrations from drawings by the author. ClothroblonaselO xa ere seein ieee se eines 3 75 BACH. ‘How to Judge a Horse.” A concise treatise as to its Qualities and Soundness; Including Bits and Bitting, Saddles and Saddling, Stable Drainage, Driy- ing One Horse, a Pair, Four-in-hand, or Tandem, etc. By Capt. F.W. Bach. Size, 5x73, clo., fully illus.1 00 (*)BANHAM, ‘Anatomical and Physiological Model of the Cow.” Half life size. Composed of superposed plates, colored to nature, showing internal organs, muscles, skeleton, etc., mounted on strong boards, with explanatory text. Size of Model opened, 1Oit. xa the, eloped tess TAI to opps ie ca canes 7 50 — ** Anatomical and Physiological Model of the Horse.’ Half life size. By George A. Banham, F.R.C.V.S. SIZEIOl Mode BB GAM ss crstetstets sores vieisielsivie/siewsiets 7 50 2 Veterinary Catalogue of William R. Jenkins BANHAM (continued) — “Tables of Veterinary Posology and Therapeutics,” with weights, measures, etc. By Geo. A. Banham, F.R.C.V.S. New edition. Cloth, size 4 x 51-2, 192 BAUCHER. ‘‘Method of Horsemanship.” Including the Breaking and Training of Horses. By Hi.’ BaucGherss... 0. seers ete ee rhe osteraysie Sean 1 00 (*)BELL. ‘The Veterinarian’s Call Book (Perpetual).” By Roscoe R. Bell, D.V.S., editor of the American Veterinary Review. Revised every year. A visiting list, that can be commenced at any time and used until full, containing much useful informa- tion for the student and the busy practitioner. Among contents are items concerning: Veterinary Drugs; Poisons; Solubility of Drugs; Composition of Milk,Bile, Blood, Gastric Juice, Urine, Saliva; Respi- ration; Dentition; Temperature, etc., etc. Bound in flexible leather, with flap and pocket ........... 1 26 BITTING. ‘*Cadiot’s Exercises in Equine Surgery.” See ‘‘Cadiot.” BRADLEY. ‘*Qutlines of Veterinary Anatomy.” By O. Charnock Bradley, Member of the Royal Col- lege of Veterinary Surgeons; Professor of Anatomy in the New Veterinary College, Edinburgh. The author presents the most important facts of veterinary anatomy in as condensed a form as possible, consistent with lucidity. 12mo. Complete in three parts. PARE J, DLhesErmbs (cloth)i ces oes oaee eee 1 25 PART II: he Drinks: (paper) se oe cemet eeeiete cee 1 25 PaRT II',: The Head and Neck (paper).......... 1 25 THE SET COMPLETE... ..sscecce i gacewemealen on ee 3 26 851-853 Sixth Avenue (cor. 48th St.), New York. 8 CADIOT, “Exercises in Equine Surgery.” By P. J. Cadiot. Translated by Prof. A. W. Bitting, D.V.M. Edited by Prof. A. Liautard, M.D.V.M. Size,6x94% Globhydlltistrated ane casita c oie terion - 250 — **Roaring in Horses.” Its Pathology and Treatment. This work represents the latest development in oper- ative methods for the alleviation of roaring. Each step is most clearly defined by excellent full-page illustrations. By P. J. Cadiot, Professor at the Veterinary School, Alfort. Translated by Thos, J. Watt Dollar, M.R.C.V.S., ete. Cloth, size 51-4x 71-8, quepagessillustratedsn cm qace star ce eete se ves 75 — **Studies in Clinical Veterinary Medicine and Surgery.” By P. J. Cadiot. Translated, edited, and supplemented with 49 new articles and 34 illustrations by Jno. A. W. Dollar, M.R.C.V.S. Cloth, size 7 x 93.4, 619 pages, 94 black and white illustrations,................. 5 25 (*)}—**A Treatise on Surgical Therapeutics of the Domestic Animals.” By P. J. Cadiot and J. Almy. Translated by Prof. A. Liautard, M,D.,V.M. I. General Surgery.—Means of restraint of animals, general anesthesia, local aneethesia, surgical anti- sepsis and asepsis, hematosis, cauterization, firing, II. Diseases Common to all Tissues.—Inflammation, abscess, gangrene, ulcers, fistula, foreign bodies, traumatic lesions, complications of traumatic les- ions, granulations, cicatrices, mycosis, virulent diseases, tumors. ; III. Diseases Special to all Tissues and Affections of the Extremities.—Diseases of skin and cellular tis- sue, of serous bursae, of muscles, of tendons, of tendinous synovial sacs, of aponeurosis, of arteries, of veins, of lymphatics, of nerves, of bones, of articulations. Cloth, size 6 x 9, 580 pages, 118 illustrations..... 4 50 CHAPMAN. ‘Manual of the Pathological Treatment of Lameness in the Horse,’’ treated solely by mechanical means. By George T. Chapman. Cloth, size 6 x 9, 124 pages with portrait................ 2 00 CHAUVEAU. ‘The Comparative Anatomy of the Domesticated Animals.” By A. Chauveau. Revised by G. Fleming, F.R.C.V.S. 8vo, cloth, 585 illus..6 25 4 Veterinary Catalogue of William R. Jenkins CLARKE. ‘Chart of the Feet and Teeth of Fossil Horses.”? By W. H. Clarke. Card, size 91-2 x12.. 25 —** Horses’ Teeth.”? Fourth edition, re-revised, with second appendix. Cloth, size 5 1-4 x7 1-2, 322 pp., illus..2 60 CLEAVELAND. ‘‘Pronouncing Medical Lexicon.” Pocket edition. By C. H. Cleveland, M.D. Cloth, size 3 1-4 x 41-2, 302 pages.......c.ceccssseedecess 75 CLEMENT. ‘Veterinary Post Mortem Examina- tions.”’> By A. W. Clement, V.S. The absence in the English language of any guide in making autopsies upon the lower animals, induced Dr. Clement to write this book, trusting that it would prove of prac- tical value to the profession. Cloth, size 5 x 7 1-2, 64 pages, illustrated............... ays sta "sh oie oleae ee 75 (**)COURTENAY. ‘Manual of the Practice of Veterinary Medicine.” By Edward Courtenay, V.S. Revised by Frederick T. G. Hobday, F.R.C.V.8. Second edition. Cloth, size 5 1-4 x 7 1-2, 573 pages .............. 2 75 COX. ‘“‘Horses: In Accident and Disease.” The sketches introduced embrace various attitudes which have been observed, such as in choking ; the disorders and accidents occurring to the stomach and intestines ; affection of the brain ; and some special forms of lame- ness, etc. By J. Roalfe Cox, F.R.C.V.S. Cloth, size 6 x 9, 28 full page illustrations... ...............06 1 50 CURTIS. ‘Horses, Cattle, Sheep and Swine.’ By Geo. W, Curtis, M.S.A. Cloth, size 7 1-4 x 10, 343 pages, 117 illustrations. ..-0-crci ne oe eee 2 50 (**)DALRYMPLE. “Veterinary Obstetrics.” A compen- dium for the use of advanced students and Practi- tioners. By W. H. Dalrymple, M.R,C. V.S., principal of the Department of Veterinary Science in the Louisiana State University and A. & M. College; Veterinarian to the Louisiana State Bureau of Agriculture, and Agricultural Experiment Stations. Cloth, size 6 x 9 1-4, 162 pages, 51 illustrations...2 50 851-853 Siath Avenue (cor. 48th St.), New York. 5 DALZIEL, ‘Breaking and Training Dogs.” Part I, by Pathfinder. Part II, by Hugh Dalziel. Cloth, BLS URS DOM aca st ead SS Hower biegte pits wmraaneens 2 50 — “The Collie.” By Hugh Dalziel. Paper, illustrated.... 40 — “The Diseases of Dogs.” Causes, symptoms and treatment. By Hugh Dalziel. Cloth, illustrated............. 1 00 — ‘Diseases of Horses.” Paper ...........ccceeceeees eevee 40 — ‘*The Fox Terrier.” By,Hugh Dalziel. Paper, 40; clo.1 00 — “The Greyhound.” Cloth, illus..... ............ dewseadk, OO — “The St. Bernard.” Cloth, illustrated.......... Bee ora 00 DANA. “Tables in Comparative Physiology.” By Prof. Ost; Dana, MD. a Chartel i xollccdes ces ces cies ae DANCE. “Veterinary Tablet.” By A. A. Dance. Chart, 17 x 24, mounted on linen, folded in a cloth case for the pocket, size 3 3-4x 61-2. Shows ata glance the synopsis of the diseases of horses, cattle and dogs; with their cause, symptoms and cure.............. 75 (*)DE BRUIN. ‘Bovine Obstetrics.” By M. G. De Bruin Instructor of Obstetrics at the State Veterinary School in Utrecht. Translated by W. E. A. Wyman, formerly Professor of Veterinary Science at Clemson A. & M. College, and Veterinarian to the South Carolina Experiment Station. Cloth, size 6 x 9, 382 PAPO Gf TN MGEERIAOMA base oe > 6s W'alae’s ies 5 00 Synopsis of the Essential Features of the Work 1. Authorized translation. 2. The only obstetrical work which is up to date. 3. Written by Europe’s leading authority on the subject. 4, Written by a man who has practiced the art a lifetime. 5. Written by a man who, on account of his eminence as bovine practitioner and teacher of obstetrics, was selected by Prof. Dr. Frodhner and Prof. Dr. Bayer (Berlin and Vienna), to discuss bovine obstetrics both practically and scientifically. Ra : ee 6. The only work containing a thorough differential aiag- nosis of arte and post partum diseases, 6 Veterinary Catalogue of William R. Jenkins DE BRUIN, ‘ Bovine Obstetrics " (continued) 7. The only work doing justice to modern obstetrical surgery and therapeutics. 8. Written by a man whose practical suggestions revolu- tionized the teaching of veterinary obstetrics even in the great schools of Europe. ; 9. The only work dealing fully with the now no longer obscure contagious and infectious diseases of calves, 10. Absolutely original and no compilation. 1l. The only work dealing fully with the difficult problem of teaching obstetrics in the colleges. . The only work where the practical part is not over- shadowed by theory. . . . Aveterinarian, particularly if his location brings him in contact with obstetrical practice, who makes any pretence toward being scientific and in possession of modern knowledge upon this subject, will not be without this excellent work, as it is really a very waluaite treatise.—Prof. Roscoe R. Bell, in the American Veterinary eview. In translating into English Professor, De Bruin’s excellent text- book on Bovine Obstetrics, Dr. Wyman has laid British and American vetérinary surgeons and students under a debt of gratitude. The works represents the happy medium between the booklets which are adapted for cramming purposes by the student, and the ponderous tomes which, although useful to the teacher, are not exactly suited to the requirements of theeveryday practitioner . . . Wecanstrongly recommend the work to veterinary students and practitioners.—-The Journal of Comparative Pathology and Therapeutics. ()DOLLAR. ‘Diseases of Cattle, Sheep, Goats and Swine.”’ By G. Moussu and Jno. A, W. Dollar, M.R.C.V.S. Size6 x 9 1-2, 7385 pages, 329 illustrations in the text and 4 full page plates.......... sieielevelem Ounen (**)— ‘A Hand-book of Horse-Shoeing,” with introductory chapters on the anatomy and physiology of the horse’s foot. By Jno. A. W. Dollar, M.R.C.V.S., with the collaboration of Albert Wheatley, F.R.C.V.S. Cloth, size 6 x 8 1-2, 433 pages, 406 illustrations ..4 75 — ** Operative Technique.’ Volume 1 of ‘‘ The Practice of Veterinary Surgery.” Cloth, size 6 3-4 x 10, 264 pages, 272 illustrablonsery.crr. cs ecrkes setae eae ue eben sve aelane 3 75 — **General Surgery.”’? Volume 2 of ‘‘ The Practice of Veter inary Surgery.” In preparation. (*)—* Regional Veterinary Surgery.” Volume 3 of ‘The Practice of Veterinary Surgery.” By Drs. Jno. A. W. Dollar and H. Méller. Cloth, size 61-2 x 10 853 and xvi pages, 315 illustrations................. 6 26 851-853 Siath Avenue (cor. 48th St.), New York. 7 —— DOLLAR—(continued) — **Cadiot’s Clinical Veterinary Medicine and Surgery.” See ‘: Cadiot.” — **Cadiot’s Roaring in Horses.” See ‘** Cadiot.” DUN. ‘Veterinary Medicines, their Actions and Uses.” By Finlay Dun, V.S., late lecturer on Materia Medica and Dietetics at the Edinburgh Veterinary College, and Examiner in Chemistry to the Royal College of Veterinary Surgeons. Edited by James Macqueen, F.R.C.V.S. Tenth revised English edition. ClOunSYSIZOWD PRI Ore 5, ds *acacie es Canoe ects es 3 75 DWYER..- *‘On Seats and Saddles.” Bits and Bitting, Draught and Harness and the Prevention and Cure of Restiveness in Horses. By Francis Dwyer. Cloth, size 6 x 7, 304 pages, gilt, illustrated............. 1 50 FLEMING. ‘Animal Plagues.” Their History, Nature, and Prevention, By Geo. Fleming, F.R.C.V.S8., ete. First Series. Chronological History from B.C. 1490 to A.D. 1800. Cloth, size 6 x 9, 548 pages........ 6 00 Second Series. Chronological History from A.D. 1800 to 1844. Cloth, size 6 x 9, 539 pages........ 3 00 — **The Comparative Anatomy of the Domesticated Animals.”’ By A. Chauvyeau. Translated by Dr. Fleming. See ‘* Chauveau.” — ‘The Contagious Diseases of Animals.” Their influence on the wealth and health of nations and how they are to be combated. Paper, size 5 x 7 1-2, 30 pages..... 25 — ‘*Human and Animal Variole.” A Study in Comparative Pathology. Paper, size 5 1-2 x 81-2, 61 pages... 25 — ‘*Parasites aud Parasitic Diseases of the Domesticated Animals.” By L. G. Neumann. Translated by Dr. Fleming. See ‘‘ Neumann.” 8 Veterinary Catalogue of William R. Jenkins FLEMING (continued) — “Qperative Veterinary Surgery.”’ Vol. I, by Dr. Geo. Fleming, M.R.O.V.S, This valuable work, one of the most practical treatises yet issued on the subject in the English language,is devoted to the common opera- tions of Veterinary Surgery; and the concise descrip- tions and directions of the text are illustrated with numerous wood engravings. Cloth, size 6 x 9 1-4, 285 and xviii pages, 343 illustrations......,........-- 2 76 (*)Vol. II, edited and passed through the press by W. Owen Williams, F.R.C.V.S. Cloth, size 6 x 9 1-4, 430 and xxxvii pages, 344 illustrations............ 3 25 — ‘Roaring in Horses.” By Dr. George Fleming, F.R.C.V.S. Its history, nature, causes, prevention and treatment. Cloth, size 5 1-2 x 8 3-4, 160 pages, 21 engravings, 1 colored plate...........scccsceenss 1 50 — ‘Tuberculosis. From a Sanitary and Pathological Point of View. By Geo. Fleming, F.R.C.V.S. Paper, size 5-1-2 x 8 1-2, 39 pages........... ane ee eae eee 25 — ‘Veterinary Obstetrics.” Including the Accidents and Dis- eases incident to Pregnancy, Parturition, and the Early Age in Domesticated Animals. By Geo. Fleming, F.R.C.V.S. Cloth, size 6 x 8 3-4, 758 pages, illus.6 25 ()\GOTTHIEL. ‘A Manual of General Histology.” By Wm. S. Gottheil, M.D., Professor of Pathology in the American Veterinary College, New York; etc., etc. Histology is the basis of the physician’s art, as Anatomy is the foundation of the, surgeon’s science. Only by knowing the processes of life can we under- stand the changes of disease and the action of remedies; as the architect must know his building materials, so must the practitioner of medicine know the intimate structure of the body. To present this knowledge in an accessible and simple form has been the author’s task. Second edition revised. Cloth, size 5 1-2 x 8, 152 pages, 68 illustrations. ..1 00 851-853 Sixth Avenue (cor. 48th St.), New York. 9 GRESSWELCL. ‘ The Bovine Prescriber.” For the use of Veterinarians and Veterinary Students. Second edition revised and enlarged, by James B. and Albert Gresswell, M.R.C.V.S. Cloth, size, 5 x 71-2, 102 — ‘The Equine Hospital Prescriber.” For the use of Veter- inary Practitioners and Students. Third edition re- vised and enlarged, by Drs. James B. and Albert Gresswell, M.R.C.V.S. Cloth, size 5 x 71-2, 165 PPREL Accie6 Sopa coo cane OeemanonnO Soo DoD Asoc ard oor 75 — ‘*Diseases and Disorders of the Horse.” A Treatise on Equine Medicine and Surgery, being a contribution to the science of comparative pathology. By Albert, Jas. B. and Geo. Gresswell. Cloth, size 5 3-4 x 8 3.4, BAVMAeess Wlustravedsctcyssccoccr.cslcchia sw cie cit nets 1 75 — Manual of “The Theory and Practice of Equine Medicine.” By James B. Gresswell, F.R.C.V.S., and Albert Gresswell, M.R.C.V.S. Second edition revised. Cloth, size 5 1-4 x 7 1-2, 539 pages................ 2 75 — “Veterinary Pharmacopexia and Manual of Comparative Therapy.” By George and Charles Gresswell, with descriptions and physiological actions of medicines, by Albert Gresswell. Second edition revised and enlarged. Cloth, 6 x 8 3-4, 457 pages............ 3 60 HASSLOCH. ‘A Compend of Veterinary Materia Medica and Therapeutics.” By A. C. Hassloch, VS., Lecturer on Materia Medica and Therapeutics, and Professor of Veterinary Dentistry at the New York College of Veterinary Surgeons and School of Compa- rative Medicine, N. Y. Cloth, size 51-4 x 71-2, 225 HEATLEY. ‘“ The Stock Owner’s Guide.’ A handy Medi- cal Treatise for every man who owns an ox or cow, By George S. Heatley, M.R.C.V.S. Cloth, size Bidint th, We Nea iclaids a'eie que a a'ca'e vedic enais mea Sia 1 26 10 Veterinary Catalogue of William R. Jenkins *\HILDE. **The Diseases of the Cat.”? By J. Woodroffe Hill, F.R.C.V.S. Cloth, size 51-4 x 71-2, 123 pages, illustrated By George G. Van Mater, M.D., D.V.S., Professor of Ophthaimology in the American Veterinary College; Oculist and Aurist to St. Martha’s Sanitarium and Dispensary; Consulting Eye and Ear Surgeon to the Twenty-sixth Ward Dispensary; Eye and Ear Surgeon, Brooklyn Eastern District Dispen- sary, etc. Illustrated by one chromo lithograph plate and 71 engravings. Cloth, 6 x 91-4, 151 pages...3 00 - . . We intend to adopt this valuable work as a text book.—E. J. Creely, D.V.S., Dean of the San Francisco Veterinary College. VETERINARY DIAGRAMS in Tabular Form. Size, 284 in. x 22inches. Price per set of five... 4 00 Mounted and folded in case..................3..% €0 No.1. ‘The External Form and Elementary Ana- to.ny of the Horse.” Eight colored illustrations— 1. External regions ; 2. Skeleton ; 3. Muscles (Superior Loyer); 4. Muscles (Deep Layer); 5. Respiratory Ap- 851-853 Sixth Avenue (cor. 48th St.), New York. 19 VETERINARY DIAGRAMS (continued). paratus; 6. Digestive Apparatus; 7. Circulatory Ap- paratus ; 8. Nerve Apparatus ; with letter-press descrip- LET) aan Sey SS ee yo eS ee, Sea 1 25 No. 2. ‘*The Age of Domestic Animals.” Forty-two figures illustrating the structure of the teeth, indicat- ing the Age of the Horse, Ox, Sheep, and Dog, with MUU eSe ni PulON 9.75 5 oss eso Sig cke cs eelee oe eee oe See 75 Mounted on roller and varnished..,.............. 2 C0 No. 3. ‘‘The Unsoundness and Defects of the Horse.’ Fifty figures illustrating—1. The Defects of Confor- mation; 2. Defects of Position ; 3. Infirmities or Signs of Disease; 4. Unsoundnesses; 5. Defects of the Foot; WIL MU EOSCHIP hl ON cet .tey> aoe bt cas's See rsinaiow aie ees 75 Mounted on roller and varnished,................ 2 00 No.4. ‘The Shoeing of the Horse, Mule and Ox.”’ Fifty figures descriptive of the Anatomy and Physio- logy of the Foot and of Horse-shoeing............. 75 Mounted on roller and varnished................ 2 00 No.5. ‘The Elementary Anatomy, Points, and But- cher’s Joints of the Ox.” Ten colored illustrations —1. Skeleton; 2. Nervous System; 3. Digestive System (Right Side) ; 4. Respiratory System ; 5. Points of a Fat Ox; 6. Muscular System ; 7. Vascular System; 8. Digestive System (Left Side); 9. Butcher’s Sections of a Calf; 10. Butcher’s Sections of an Ox; with full GCHOPIHaH Ee ante sok, taste gs Sielols o wa dete eas as Ws eed ab Mounted on roller and varnished................ 2 25 WALLEY. ‘Four Bovine Scourges.” (Pleuro-Pneumonia, Foot and Mouth Disease, Cattle Plague and Tubercle), By Thomas Walley, M.R.C.V.S. With an Appendix on the Inspection of Live Animals and WL Gry bea CURL Os CLODH ee nta\0c'o 2's ce dels ove o-s.0\s 12 visiernie 6 40 20 Veterinary Catalogue of William R. Jenkins WALLEY (continued), (*)— ‘*‘A Practical Guide to Meat Inspection.” By Thomas Walley, M.R.C.V.S., late principal of the Edinburgh Royal (Dick) Veterinary College; Pro- fessor of Veterinary Medicine and Surgery, ete, Fourth Edition, thoroughly revised and enlarged by Stewart Stockman, M.R.C.V.S., Professor of Pathology, Lecturer on Hygiene and Meat Inspection at Dick Veterinary College, Edinburgh. Cloth, size 5 1-2 x 8 1-4, with 45 colored illus., 295 pages..... 3 00 An experience of over 30 years in his profession and a long official connection (some sixteen years) with Edinburgh Abattoirs have enabled the author to gather a large store of information on the subject, which he has embodied in his book. While Dr. Stockman is indeed indebted to the 3 old for much useful information, this up-to- ‘ date work will hardly be recognized as the old ‘¢ Walley’s Meat Inspection.” 1 WILCOX. ‘Handbook of Meat Inspection.” By Robert Ostertag, M.D. See ‘* Ostertag.” WILLIAMS. “Principles and Practice of Veterinary Medicine.” Author’s edition, entirely revised and illustrated with numerous plain and colored plates. By W. Williams, M.R.C.V.S. Cloth, size 5 3-4 x 8 3-4, S68) PAGES’. s/o viales cusses oceie ois Coan Lolcbene ote reiohe teen eaten 7 50 — ** Principles and Practice of Veterinary Surgery.” Author’s edition, entirely revised and illustrated with numerous plain and colored plates, By W. Williams, M.R.C.V.S. Cloth, size 61-2 x 91-4, 756 POLES Sees caccscsscesnouegescemaae ates winced Cae Cen 851-853 Sixth Avenue (cor. 48th St.), New York 21 THE MOST COMPLETE, PROGRESSIVE AND SCIENTIFIC BOOK ON THE SUBJECT IN THE ENGLISH LANGUAGE (*)WINSLOW, ‘Veterinary Materia Medica and Therapeu- tics..> By Kenelm Winslow, B.A.S., M.D.V., M.D., (Harv.); formerly Assistant Professor of Therapeutics in the Veterinary School of Harvard University ; Fellow of tiie Massachusetts Medical Society ; Surgeon to the Newton Iospital, ete. Third Edition, Revised 1905 Cloth, size 6 1-4 x 9 1-4, viii + 804 pages.......... 6 00 Your letter received and I am pleased to know that we are to have an American Materia Medica.—J. H. Wattles, Sr., M.D., D.V.S., The Western Veterinary College, Kansas City, Mo. . . Amdelighted with it. It is remarkably correct, complete and up-to-date and is bound to supersede any other work on the same subject heretofore before the profession. No practitioner’s library is complete without it and it will be indispensable for students, as it does away with the necessity of their having a number of collateral books on the subject. _ It will be adopted as the text book in the Chicago Veterinary College.—Dr. E. L. Quitman, Chicago Veterinary College. The book is of admirable merit and full of valuable informa- tion from beginning to end, very explicit, rich and interesting, and should be in the hands of every student as well as practitioner of the art of Veterinary Medicine.—Thurston Miller, M.D., Professor of Materia Medica, Therapeutics and Chemistry, San Francisco Veteri- nary College. I consider it the only work on materia medica and therapeutics suitable to the American veterinary practitioner. It deserves a wide distribution among veterinarians. I have recommended it to my students.—John J. Repp, V.M.D., Iowa State College, Ames, Iowa. Cs) © Veterinary Catalogue of William R. Jenkins. (*)VWYMAN. ‘Bovine Obstetrics.» By M. G. De Bruin. Translated by W. E. A. Wyman, M.D.V.,V.S. See also ‘‘ De Bruin.” (*)— **Catechism of the Principles of Veterinary Surgery.” By W. E. A. Wyman, M.D.V.,V.S. Cloth, size 6 x 9, GLI PAGES se ccenictat seer a Wieisicteis ste pustateleeains 3 50 Concerning this new work attention is called to the following points: .—It discusses the subject upon the basis of veterinary investigations. -—It does away with works on human pathology, histology, etc. 3.—It explains each question thoroughly both from a scientific as well as a practical point of view. : .—It is writen by one knowing the needs of the student. .—It deals exhaustively with a chapter on tumors, heretofore utterly neglected in veterinary pathology. .—The only work in English specializing the subject. .—The only work thoroughly taking into consideration American as well as European investigations. .—Offering practical hints which have not appeared in print, the result of large city and country practice. 1 2 4 5 6 7 8 (**)— “The Clinical Diagnosis of Lameness in the Horse.” By W. E. A. Wyman, D.V.S., formerly Professor of Veterinary Science, Clemson A. & M. College, and Veterinarian to the South Carolina Experiment Station. Cloth, size 6 x 9 1-2, 182 pp., 32 illus....2 50 (*)— ‘* Tibio-peroneal Neurectomy for the Relief of Spavin Lameness.”? By W. E. A. Wyman, M.D.V., V.S. Boards, size 6 x 9, 30 pages, illustrated........... 50 Anyone wanting to perform this operation should procure this little treatise; he will find it of considerable help.—The : Veterinary Journal. ZUNDEL. ‘The Horse’s Foot and Its Diseases.” By A. Zundel, Principal Veterinarian of Alsace Lorraine. Translated by Dr. A. Liautard, V.S. Cloth, size 5 x 7 3-4, 248 pages, illustrated.................. 2 00 ZUILL. ‘Typhoid Fever; or Contagious Influenza in the Horse.” By Prof. W. L. Zuill, M.D:,D.V.S. Pamphlet, size 6 x 9 1-4, 29 pages................. 25 Any book sent prepaid for the price WILLIAM R. JENKINS, 851 and 853 Sixth Avenue, NEW YORK. ae re r a”: vhs 4) or nt ‘ v x an at) a 5 o's