Full text of "General surgery"

See other formats

Google

This is a digital copy of a book that was preserved for generations on library shelves before it was carefully scanned by Google as part of a project

to make the world's books discoverable online.

It has survived long enough for the copyright to expire and the book to enter the public domain. A public domain book is one that was never subject

to copyright or whose legal copyright term has expired. Whether a book is in the public domain may vary country to country. Public domain books

are our gateways to the past, representing a wealth of history, culture and knowledge that's often difficult to discover.

Marks, notations and other maiginalia present in the original volume will appear in this file - a reminder of this book's long journey from the

publisher to a library and finally to you.

Usage guidelines

Google is proud to partner with libraries to digitize public domain materials and make them widely accessible. Public domain books belong to the
public and we are merely their custodians. Nevertheless, this work is expensive, so in order to keep providing tliis resource, we liave taken steps to
prevent abuse by commercial parties, including placing technical restrictions on automated querying.
We also ask that you:

+ Make non-commercial use of the files We designed Google Book Search for use by individuals, and we request that you use these files for
personal, non-commercial purposes.

+ Refrain fivm automated querying Do not send automated queries of any sort to Google's system: If you are conducting research on machine
translation, optical character recognition or other areas where access to a large amount of text is helpful, please contact us. We encourage the
use of public domain materials for these purposes and may be able to help.

+ Maintain attributionTht GoogXt "watermark" you see on each file is essential for in forming people about this project and helping them find
additional materials through Google Book Search. Please do not remove it.

+ Keep it legal Whatever your use, remember that you are responsible for ensuring that what you are doing is legal. Do not assume that just
because we believe a book is in the public domain for users in the United States, that the work is also in the public domain for users in other
countries. Whether a book is still in copyright varies from country to country, and we can't offer guidance on whether any specific use of
any specific book is allowed. Please do not assume that a book's appearance in Google Book Search means it can be used in any manner
anywhere in the world. Copyright infringement liabili^ can be quite severe.

About Google Book Search

Google's mission is to organize the world's information and to make it universally accessible and useful. Google Book Search helps readers
discover the world's books while helping authors and publishers reach new audiences. You can search through the full text of this book on the web

at |http: //books .google .com/I

!bf£l^a«Sl

HAND-BOOK

VETERINARY SURGERY

AND

OBSTETRICS

WITH CO-OPERATION

Prof. Dr. ALBRECHT (Munich), Staff Veterinarian BARTKE
(Stettin), Prof. DE BRUIN (Utrecht), Prof. CADIOT (Alfort),
Prof. Dr. EBERLEIN (Berun), Prof. Dr. GMELIN (Stuttgart),
Staff Veterinarian HELL ( Altona), Prof. HENDRICKX (Brus-
sels), Prof. Dr. HESS (Bern), Prof. Dr. HIRZEL (Zurich), Staff
Veterinarian KONIG (Konigsberg). Prof. LANZILLOTTI-BUON-
SANTI (Milan), Docbnt LUNGWITZ (Dresden), Prof. Dr.
OSTBRTAG (Berun), Prof. Dr, PFEIFFER (Giessen), Prof. Dr.
SCHINDELKA (Vienna), Dr. SCHMIDT (Vienna), Late Prof.
Dr. SIEDAMGROTZKY (Dresden), Prof. Dr. VENNERHOLM
(Stockholm), Prof. Dr. ZSCHOKKE (Zurich).

EDITED BY

Professor Dr. JOS. BAYER and Professor Dr. EUG. FROHNER
Vienna Berlin

VOL. II.

GENERAL SURGERY

BY
Dr. EUGEN FROHNER

THIRD EDITION
1905

GENERAL SURGERY

DR. EUGEN FROHNER

PROFESSOR IN THE ROYAL VETERINARY COLLEGE IN BERUN

Authorized Translation From

THE THIRD REVISED EDITION

D. HAMMOND UDALL, B. S. A.. D. V. M,

ASSOCIATE PROFESSOR OF SURGERY AND OBSTETRICS

COLLEGE OF VETERINARY MEDIQNE

OHIO STATE UNIVERSITY

Columbus.

• • • ' : :•'•'*. 't /* ; -,

* *■* *

TAYLOR fit CARPENTER

ITHACA. N. Y.

1906

Registered at Stationers' Hall
LONDON, ENGI^AND

• •

PREFACE TO THE FIRST EDITION.

In the following hand-book of veterinary surgery and ob-
stetrics the general surgery, as well as the operative surgery,
forms a separate, independent work. In a sense they serve as
an introduction to the following third and fourth volumes of
special surgery of the different organs.

Any text-book of general veterinary surgery must depend
on the investigations and text-book^ of human medicine.
While I have kept this point in view in the development of
the following plan, I think I have clearly drawn the relations
between the general surgery of man and animals. I also
admit that in the writing of this book I have followed princi-
pally the plans which Billroth, and recently Tillman, have
used in their text-books of human and general surgery.

The reader will readily note that the following work is not a
mere compilation of the books mentioned on human medicine.
In many particulars veterinary surgery, like pathology, phar-
macology and therapy, has developed independent lines. Many
chapters on human surgery have no connection with veterinary
surgery ; other divisions that are very important in human
surgery are of little or no importance in veterinary science.
Tuberculosis of the bones and joints, for example, belongs to
one of the most important divisions of human surgery ; in
veterinary surgery it is practically never the occasion for
surgical interference.

Conversely, actinomycosis and botryomycosis is of great
importance in veterinary surgery, the latter is almost unknown
in man. In man osteomyelitis is the most important form of
inflammation of the bones ; in the horse periostitis is the most
important form. Erysipelas, so frequent in man, appears to
be very rare in animals. It is obvious that resection of joints,
as well as most amputations of limbs, cannot be employed on

(V)

VI Preface.

domestic animals. The aseptic method, which is so important
in human surgery, seems to be of little importance in veteri-
nary science because of purely external causes. Even bone-
fractures present an entirely different surgical problem in large
animals than in men. Firing, and the application of blisters
for chronic inflammations of bones, tendons, and joints, are
special surgical methods of veterinarians.

On the other hand, the following work is not a compen-
dium of other surgical text^books on veterinary surgery. On
the basis of many years of surgical and clinical activity, I
think I have had suflScient experience to elucidate the follow-
ing subject from my own point of view. In many chapters,
namely, those on fractures and tumors, I was in a position to
insert my own investigations. I was also careful to arrange

the material purely from a veterinary standpoint, and only for
the object of veterinary practice. On this basis the reader will
find, for example, many references in this book to forensic
veterinary science (age of wounds, fractures, fissures, muscular
atrophy ; curability or non-curability of bone-fractures in
horses and cattle ; abnormal fragility of bones ; prophylaxis
of bone-fractures, etc.). Foreign bodies, parasites, and con-
genital new- formations, which are of great . surgical import-
ance, have been given special attention.

General surgery has numerous and important relations to
general pathology and pathological anatomy. Unfortunately
we have no text-book of general pathology in our veterinary
literature. On the other h&nd we have recently come into
the possession of a very important hand-book of veterinary
pathological anatomy. I am under great obligations to this
excellent book of Kitt's for valuable suggestions and informa-
tion. General surgery is also closely related to anatomy. I
have found a deficiency in the descriptions of tendon-sheaths
and fasciae in most veterinary text-books on anatomy ; these
are very important from a surgical standpoint, the descriptions
are usually incomplete and indistinct. With reference to the
relation of general surgery to bacteriology, it must be acknowl-
edged that the latter has contributed largely to the problem of
suppuration and inflammation, as well as to the combating of

Preface. VII

these processes by means of antiseptics, from a standpoint of
both scientific and practical surgery. On the other hand, one
must not overestimate the importance of bacteriology to general
surgery and overlook everything else for bacteria. Many
surgical inflammations have nothing to do with bacteria ; this
is especially true of the purely traumatic, aseptic inflammations
of bones, joints, tendons, tendon-sheaths, and muscles. At
suitable places I have considered it my duty to repeatedly
refer to this obligation. From a diagnostic standpoint also,
bacteriology should not be given too great weight in surgery.
Pus-cocci, in particular, are of little practical diagnostic impor-
tance ; this is especially true where the candidate, unfortu-
nately, is overenthusiastic concerning the significance of a
bacteriological examination, to him the presence of pus- forming
bacteria in pus from bones may form the principal evidence for
the presence of a bone-fistula. The bacteriological confusions
that have occurred concerning wound -erysipelas receive atten-
tion in the ciiapter on this subject.

There is no claim of completeness for the bibliography at
the end of each chapter. My principal object was to divide
the literature on human medicine from that of veterinar>' sci-
ence and, above all, also to indicate to students the funda-
mental investigations that have been made in human medi-
cine ; only the most important and recent works have been
mentioned.

The book contains no illustrations. I am opposed to the
usual custom in veterinary science of appropriating illus-
trations from works on human medicine, either unchanged or
specially modified. I maintain that it is not admissible.

KissiNGKN, August, 1896.

PREFACE TO THE THIRD EDITION.

The new, third edition of general surgery is improved and
enlarged in many respects. The individual changes are as
follows : The chapter on the etiology of tumors has been re-
written, and many additions have been made to the casuistry
of this group ; unfortunately the recent etiological works on
tumors are largely speculations. The chapter on botryomy-
cosis has been newly written to harmonize with the most re-
cent investigations on this subject ; there is hardly a doubt
that in this wound infection we have to deal, not with staphy-
lococci, but with an infectious disease sui generis. Regardless
of the objections of critics, the chapter on tuberculosis has
been retained and even enlarged ; the motive for following this
plan is explained in that chapter. I have supplemented the
important chapter on chronic deforming arthritis with the re-
sults of recent investigations made in my clinic upon ringbones
chronic gonitis, and omarthritis. This is also true of primary
infectious osteomyelitis the occurrence of which in the horse,
according to our recent investigations, can be no longer
doubted. Recent investigations on myositis, neuritis, healing
of fractures, necrosis bacilli, pseudo-edema bacilli, and foal-
lameness have also been considered. On the subject of asepsis
against antisepsis it may be definitely stated that now, even in
human therapeutics, all have returned to antisepsis In the
first edition of this book I recommended antisepsis for the vet-
erinary surgeon. Even for the disinfection of fresh wounds
the application of pure carbolic acid, as well as the hot iron,
has been recently recommended in human surgeries.

What a change within one decade !

Berlin, December, 1904.

Prof. Dr. Krohner.

(VIII)

TRANSLATOR'S PREFACE

The translation of the third edition of Frohners " General
Surgery " has been undertaken to supply a well classified pre-
sentation of the fundamental principles of surgery. It is hoped
that it may assist the beginner in obtaining a clear perspective
of the mass of surgical diseases with which he must come in
contact.

That portion of the text dealing with bibliography has
been omitted in the translation as it is practically unavailable
to most English readers. Otherwise the text has been closely
followed, no additions or other changes having been made.

The translator of this work is especially indebted to Pro-
fessor David Stuart White who has rendered valuable assist-
ance in reading the proof sheets. He is also indebted to Drs.
A. D. Fitzgerald and James McI. Phillips for suggestions that
have materially reduced the list of errors.

The translator wishes to express his gratitude to the firm
of Taylor & Carpenter who have procured the authorization
of this translation from the German publishers, assumed all
financial responsibility, and shown every possible courtesy and
assistance in furthering the progress of the work.

D. H. UDALL.
Columbus, Ohio, July, 1906.

(IX)

CONTENTS

PAGE

Preface v

Contents xi

Wounds i

I. Definition, Classification, and Symptoms i

II. Incised, Stab, Contused, Shot, Lacerated, and Poisoned

Wounds 6

III. Control of Hemorrhage 12

IV. Anatomical Changes in Wound Healing 17

V. Wound Infection Diseases 25

1. Suppuration 25

2. Phlegmon 28

3. Abscess - 34

4. Wound Fever 37

5. Septicemia 40

6. Pyemia 44

7. Other Wound Infection Diseases 46

VI. Treatment of Wonnds 55

Subcutaneous Injuries of Soft Parts, (Contusion, Rupture) 64

I. Contusion _._ 64

II. Rupture 70

Inflammation 72

I. Nature and Causes 72

II. Kinds, Symptoms, and Course of Inflammation 76

III. Treatment of Inflammation 79

Ulcer, Fistula, Gangrene 84

I. Ulcer 84

II. Fistula 86

III. Gangrene 91

Tumors 98

I. Tumors in General 98

II. Special Kinds of Tumors __ 107

(XI)

XII CONTENTS

A. Connective-tissue A- fw Formations 107

1. Fibroma 107

2. Lipoma 113

3. Myxoma 116

4. Chondroma ._. _ 117

5. Osteoma 119

6. Myoma 120

7. Neuroma 121

8. Angioma 122

9. Lymphoma 124

10. Sarcoma 125

B. fipitheiial Nezu Formations 133

1. Carcinoma 133

2. Papilloma 144

3. Adenoma 147

C. Cystic TuWrOrs ._ 149

D. Infectious Tumors 152

1. Actinomycoma 152

2. Botryomycoma 161

3. Tuberculosis __ 166

Concrements and Foreign Bodies 174

I. Concrcments 174

II. Foreign Bodies .._ . 178

Hernia and Prolapse 185

I. Hernia 185

11. Prolapse 188

Diseases of Bones . 190

I. Fractures 190

II. Inflammation of Bone. Periostitis. Ostitis. Osteomyelitis 21b

1. Inflammation of the Periosteum. Periostitis 217

2. Inflammation of the Bone Substance. Ostitis 220

3. Inflammation of the Bone Marrow. Osteomyelitis 221

III. Necrosis, Atrophy, and Hypertrophy of the Bones 226

1. Necrosis of the Bones _ 226

2. Atrophy of the Bones 228

3. Hypertrophy of the Bones _. 229

IV. Rachitis and Osteomalacia 229

Diseases of Joints 232

I. Inflammation of the Joints. Arthritis or Synovitis 233

1. Serous Inflammation. Arthritis Serosa 234

2. Suppurative Inflammation. Arthritis Purulenta 236

3. Deforming Inflammation. Arthritis Deformans 238

CONTHNTS XIII

4. Tubercular Inflammation. Arthritis Granulosa 243

II. Chanj?e8 in Position of the Joints. Luxation, Distorsion,

Contusion --- 247

1. Luxation or Dislocation 247

2. Distorsion or Sprain _.: _ _ _. 252

3. Contusion or Bruise of the Joint 253

III. Anchylosis and Contracture 254

1. Anchylosis or Stiffness 254

2. Joint Contracture (Still-Foot). 256

IV. Joint Bodies. Corpora Libera 258

Diseases of the Tendons, Tendon-Sheaths, and Mucous Bursae 259

I. Diseases of the Tendons ._ 264

1. Inflammation of the Tendons. Tendinitis. 264

2. Tendon Rupture _.. _ _ .. 267

3. Tendon Necrosis ___._ 270

II. Diseases of Tendon-Sheaths _._._ 272

1. Inflammation of Tendon-Sheaths Tendo- Vaginitis.. 272

2. Distension of Tendon-Sheaths. Hydrops 275

III. Diseases of Mucous Bursae ._ . 278

1. Inflammation of Mucous Bursae. Bursitis 278

2. Hygroma of Mucous Bursae 280

Diseases of the Muscles, Fasciae and Nerves 283

I. Diseases of the Muscltrs _ . .. 283

1. Inflammation of Muscles. Myositis 286

2. Muscle Rupture 293

3. Muscle Atrophy. .. .. 295

II Diseases of Fasciit .._.. _ 297

r. Necrosis of Fasciit- _ _ 297

2. Rupture of the Fasciie.. 298

III. Diseases of Nerves _ .. 299

1. Paresis and Paralysis __. 299

2. Inflammation of Nerves. Neuritis. . . .. 302

Diseases of Vessels ..- — 305

I. Diseases of Arteries __ 305

1. Inflammation of Arteries. Arteritis 305

2. Dilitation of Arteries. Aneurysm i 306

3. Rupture of Large Arteries... 311

II. Diseases of Veins 313

1. Inflammation of Veins. Phlebitis 313

2. Dilitation of Veins. Varix. Phlebectasis 314

HI. Diseases of Lymph-Vessels. 316

XIV CONTENTS

i. Inflammation of Lymph-Vessels 316

2. Dilitation of Lymph-Vessels. Lymphangiectasis 317

DUeatet of Glands 317

I. Inflammation of Lymph-Glands. Lymphadenitis 318

II. Inflammation of the Mammary Glands. Mastitis 320

Surgical DUeatet of the Skin and Mucout Membranet 323

I. Surgical Diseases of the Skin 323

1. Inflammation of the Skin. Dermatitis 323

2. Burns Combustio 325

3. Freezing. Congelatio 328

II. Surgical Diseases of the Subcutaneous Tissue 330

1. Edema ._ 330

2. Emphysema .__ 331

III. Surgical Diseases of the Mucous Membranes 332

IV. Surgical Diseases of the Pododerm 333

Appendix. Congenital Malformationt of Surgical Importance 334

Index 339

WOUNDS

I. GENERAL REMARKS CONCERNING THE NA-
TURE, SYMPTOMS, AND CLASSIFICATION

OF WOUNDS.

Definition. — A wound, in a restricted sense, indicates
any injury accompanied by a breach in the continuity of the
skin or mucous membrane. Wounds may also be defined as
open, hemorrhagic injuries, in contrast to lacerations and
fractures which occur in the subcutaneous tissues and are not
characterized by a breach in the continuity of the outer cov-
ering. The latter are closed to the presence of air, they are
aseptic ; that is, protected against the entrance of infectious
irritants. Wounds, on the other hand, are open to the entrance
of septic infection. The symptoms, course, prognosis, and
treatment for both are, therefore, extremely variable. For
this reason the open and subcutaneous injuries must be
considered under separate headings.

An ulcer is differentiated from a wound by its tardiness in
healing ; it may be considered as a wound which will not heal.

General Symptoms of Wounds. The most important
symptoms of fresh wounds are hemorrhage, pain,
gaping, and disturbed function.

I. Hemorrhage varies according to the size and con-
dition of the wounded vessels. One recognizes arterial, venous,
parenchymatous, and capillary hemorrhage. Arterial hem-
orrhage is that which results from injuries to individual
arteries, it spurts from the wound and is bright red in color. In
venous hemorrhage large veins are involved, dark red blood
flows from the peripheral ends in a continual stream as from
a spring. Parenchymatous hemorrhage includes both

2 WOUNDS

arterial and venous (mixed hemorrhage) ; the incised vessels
are small, the blood is medium-red in color and flows from
all portions of the wound similar to being squeezed from a
sponge (tumors, swollen parts, muscle) . Capillary hemor-
rhage follows slight injuries to the skin and mucous mem-
brane, the blood flows in drops from the incised capillaries.
As a rule, transverse wounds to vessels bleed more freely
than those in a longitudinal direction because the gaping is
greater (therefore an incision should be longitudinal when
operating). In contused wounds the hemorrhage is occasion-
ally very slight, the adventia constricts, the intima and
media are retracted inwards, this results in mechanical closure
of the vessel similar to that which occurs in torsion (ecraseur,
emasculator). Penetrating wounds of large vessels usually
close spontaneously (penetrating injury of the jugular from
intravenous injection, an occasional penetrating injury to the
carotid during the same operation). In previous anastomosis
formation vessels bleed from both ends (carotid, large veins,
thyroid gland).

The following symptoms are observed after severe hem-
orrhage : general anaemia which is especially characterized by
paleness of the visible mucous membranes ; coolness of the
skin ; as well as weak pulse and heart-beat which results from
sinking of the blood pressure and weakness of the heart.
Death from hemorrhage is further preceded by general weak-
ness, tottering, vertigo, loss of consciousness, dyspnoea, dili-
tation of the pupils, disappearance of the corneal reflex action,
involuntary urination and defecation, as well as convulsions.
Death is more certain when the loss of blood is
more than a third of the total amount. The
The total amount of blood in a horse is equal to about one
fifteenth of the total body weight. A horse weighing 450 kg.,
for example, (blood contents =^ 1/15 = 30 kg. or litres) dies
after a loss of more than 10 kg. (litres) of blood. Loss of a
third of the blood is followed by pronounced heart weakness
and sinking of blood pressure, it is possible, however, for
regeneration of the blood to take place from the parenchyma-
tous fluids. l/OSS of a fourth of the total amount of blood is

only followed by decreased blood pressure (phlebotomy).
Regeneration occurs tbrough the absorption of water from the
lymph of the tissues as well as from the fluid contents of the
stomach and intestines (hydraemia); this is followed by an
increase in the formation of the white blood corpuscles (leuco-
cytosis); finally the red blood corpuscles gradually increase
in number.

Injuries to large lymph vessels, joints, and tendon fiheaths
result in a discharge from the wound of 1 y m p h, synovia,
and tendon-sheath fluid respectively: saliva is dis-
charged from wounds to the salivary glands, salivary ducts, and
esophagus ; food or feces from perforating injuries to the
stomach or intestines; milk from wounds to the udder;
n r i n e from lesions to the bladder or urethra. Hemorrhage
is absent in corneal wounds.

2, Pain is due to cutting, bruising, or tearing the sen-
sitive nerx'es. The so-called primary pain should be distin-
guished from secondary wound pain due to inflammation
(nailing !). The pain of wounds is in direct proportion to the
nerve supply of the aflTected tissues. Wounds of the skin,
pododerm, periosteum, mucous membranes, cornea, or peri-
pheral uerve endings are more painful than those of bone, car-
tilage and tendon, connective-tissue, or brain substance. The
blunter the cutting instrument, and the slower the separation
of the tissue, the greater the apparent pain (experience in opera-
tions). The sensitiveness of different animals
varies according to the individual, age and sex, as well as
the race and species. Many horses are very sensitive to
neurectomy while others remain quiet during the operation.
Many horses will sland without narcosis for trepanation and tra-
cheotomy, as well as similar operations which require restraint,
whiie others must be cast and restrained for operations that
are far less painful. In general horses are more sensitive than
cattle; dogs and cats more than horses. Horses that belong to
the warm blooded races frequently show more sensitiveness
than those of the cold blooded race (e. g. castration). Mares
and stallions are usually more sensitive than geldings. The

4 W0X7NDS

following appear least sensitive : old horses, phlegmatic horses^
and those affected with blind staggers.

In comparison to man, all domestic animals appear to be
less sensitive to wounds. Many animals, after a severe in-
jury, show a certain amount of resignation similar to man
(trained dogs).

Complete insensibility follows deep narcosis (chlo-
roform, cocaine); is present in dead tissues ; and occurs after
neurectomy, so that nail puncture in the hoof, for example,
does not cause pain.

3. Gaping of wounds depends on the character of the
incised tissue, as well as upon the direction of the wound.
Gaping is most pronounced in those places where the skin is
widely separated as a result of transverse muscle and tendon
wounds.

4. Disturbed function occurs after wounds of the
hoof, tendons, joints, and muscles, where it is characterized by
lameness ; wounds of the tongue result iu deranged mastica-
tion ; blindness may follow corneal wounds ; wounds to the
motor or sensory nerves may produce paralysis or anesthesia.

Very painful wounds in the horse result in a diminution
or complete loss of appetite, this is frequently observed
after horses have been operated under restraint. Genuine
shock or wound shock (sudden paralysis of the vasomotor cen-
ter with anemia of the mucous membranes, retardation and
paralysis of the activity of the heart) is very rare in animals.
Perforating abdominal wounds in the horse are frequently fol-
lowed by colic (peritonitis). The following conditions fre-
quently follow injuries to large nerve branches (neurectomy):
stagnation edema, inflammatory conditions, ulcer formation
and necrosis of the skin and pododerm, inflammation of the
periosteum, bone, and joints, exungulation, atrophic changes,
fractures, tendon ruptures, etc. (See chapter on diseases of the
nerves.) Occasionally sudden death follows the introduction
of air into the jugular vein (operation on shoulder abscess,
phlebotomy); this is partly due to paralysis of the lungs (air
emboli in the pulmonary capillaries), partly to paralysis of
the heart (air in the chambers of the heart, air emboli in the

coronary arteries), partly to paralysis of the brain (air em-
boli in the capillaries of the braia). The aspiration of aif
into the abdominal cavity (gurgling sound), sometimes ob-
served in the castration of stallions, is usually harmless.
Pinally, any wound may be followed by wound fever. Two
forms are recognized, aseptic and septic wound fever. Aseptic
fever is due to the resorption of degenerated blood products
without the presence of bacteria. It is characterized by a
slight elevation of temperature without severe disturbances
of the general system (see chapter on wound fever;. Septic
fever, ou tlie other hand, depends on the presence of specific
infectious material which gains entrance to the wound and
finally enters the blood stream. It is characterized by a
marked elevation of temperature and severe derangement of
the general system (see chapter on septicaemia and pyaemia).

Classification of Wounds. ^According to the causes
wounds are classified as follows: incised, punctured,
lacerated, contused, stab, shot wounds, and bites.
In addition to wounds due to mechanical force one must con-
sider injuries produced by chemical irritants (caustics), and
thermic influences (burns, freezing), which are classified as
caustic wounds, necrotic wounds, etc.

According to the condition of the wound they are
classified as simple or non-contused (incised, punc-
tured), and complicated or contused wounds (con-
tusions, shot wounds, bites), wounds with and without
loss of substance, flap or skiu wounds, clean,
unclean, (hair, dirt, dust), infected and poisoned
superficial, deep, and perforating or peuetrat
in g (abdominal cavity, thorax, joints), slight, severe
and fatal, fresh and old, hemorrhagic, suppura
tive, granulating and cicatrized wounds.

According to the seat and tissues involved they are
classified as wounds of the head, thorax, throat, ab-
domen, skin, mucous membranes, muscles,
bones, cartilage, joints, tendons, brain, cor-
□ ea, stomach and intestines.

6 INCISED AND STAB WOUNDS

Shock in Akimai^.— Beck has observed one case of paralysis of
the heart in a calf as a result of castration (Wochenscbrift fiir Tier
heilknnde. 1901). The animal bellowed very loud after the remoya>
of the first testicle (pain, fear, terror), collapsed and died immediately.
The results of a post mortem were negative.

II. INCISED, PUNCTURED. CONTUSED, SHOT.
LACERATED AND POISONED WOUNDS.

Incised and Stab Wounds. — These are due to injur-
ies from surgical and ordinary knives, hay knives, hoof knives,
butcher knives, case knives, shears, glass, pieces of iron,
scythes, sickles, sabers, hatchets, etc. The characteristics
of incised and thrust wounds consist in their straight dir-
ection, longitudinal form, as well as sharply de-
fined, smooth, non-contused edges. Hemorrhage
and retraction of edges are more pronounced than in the other
forms. They are most often seen in horses, dogs, and cattle
on various parts of the body, especially the limbs. According
to depth they may be termed wounds of the skin, muscle,
tendon, bones, and perforating wounds. The prognosis is
favourable when the skin only is involved (suture). From a
forensic standpoint it should be observed that many lacerat-
ed and contused wounds present edges similar to those of in-
cised wounds (wire, sharp edge of the hoof).

PuNCTURKD Wounds. — Punctured wounds are caused by
manure forks, hay forks, nails, needles, pointed knives, and
shears, lances, bayonets, harrows, splinters of wood, etc.
Penetrating wounds in horses are most often due to manure
and hay forks, as well as treads on nails and nailing. In the
German Army the lance is a frequent cause of wounds on ac-
count of its wide use in the cavalry. During operations
punctured wounds are often produced by means of the injection
needle and the trochar (subcutaneous, intravenous, intra-
peritoneal, parenchymatous, intraocular, subconjunctival, sub-
dural, intracranial, and even intracerebral injections, paracen-
tesis thoracis, paracentesis, abdominis, harpooning the udder^

BITES, LACERATED AND CONTUSED WOUNDS

Inmbar puncture). Punctured wounds are usually small,
round, slightly hemorrhagic, and frequently lead to a.
fistulous canal. Perforations into joints, tendon sheaths.
abdomen, thorax, eyes, etc., are common. Experience with
injections and puncture has demonstrated that perforating
wounds with sharp, clean instruments are harmless when they
penetrate body cavities, the rumen, intestines, or a large
blood vessel (jugular, carotid). All unclean objects, however,
especially manure forks, unclean injection needles, old nails
and harrow teeth, are liable to result in suppurative and septic
infection (phlegmon, abscess, fistula formation, septicaemia,
malignant edema, tetanus). Punctured wounds of the hoof
(treading on nails, nailing) are frequently followed by tetanus.
Contused Wounds. — Contused wounds are injuries caus-
ed by blunt objects, treads on the coronet, kicks, falls, col-
lisions, running into objects, being run over, falling into holes,
remaining in a recumbent position for a long time. Con-
tused wounds are usually irregular in outline, possess
jagged, unclean margins, are swollen, often have a
loss of substance, and the contused tissue has a tend-
ency to become necrosed. Occasionally hemorrhage is
slight or fails entirely even in large contused wounds. One
can differentiate superficial (excoriations, abrasions of the
■flkin) and deep contusions, with and without loss of substance.
y(8ee chapter on contusions.)

Lacerated Wounds. — Lacerated wounds have some of

lihe characteristics of iucised wounds, they are also similar to

bcontused wounds. They are caused by catching on or getting

against hoolcs and nails, by sharp calks, running into wagons,

machinery, etc. In horses they are most often seen on the

head (false nostril, eyelid), on the thorax, buttocks, and pos-

I terior limbs. Special lacerated wounds are observed on the

l-Coroea in dogs (scratches from cats). Lacerated wounds are

■frequently iu the form of flap wounds with angular forma-

I'tions, the margins of the wound may be regular or torn.

BiTKS. — Injuries caused by bites from dogs, horses and
I'Otber animals present various characteristics : they may be
onctured, contused or lacerated. They most frequently

POISONBD AND GUN SHOT WOUNDS

occur in dogs and horses, seldom in cattle or other animals.
Dog bites frequently restilt in severe phlegmon and com-
plicated bone fractures ; bites from horses in extensive
necrosis of the skin on the sides and top of the neck (bites
from animals standing in the same stall at night.)

Poisoned Wounds. — Under this term are included
injuries, especially to animals at pasture and hunting dogs,
due to snake bites, bee and wasp stings, as well as infected
wounds (rabies, anthrax, glanders, tetanus, septicaemia).
With reference to the specific diseases thus produced one must
consult text books on toxicology and infection (seechapter on
wound infection diseases).

Shot Wounds.— These belong to a special type of con-
tused wounds and maybe termed conlused-lacerated wounds.
They are characterized by an external opening with smooth,
contused, angular or lacerated margins, a tubular shot canal,
and an exit opening. When the latter fails it is termed a
blind shot canal. When the shot is fired near the seat of in
jury the wound edges are burned. Superficial, long, gutter-
shaped injuries of the skin are observed in furrowed gUH'
shot wounds, contusions of the subcutaneous tissues without
injury to the skin in gunshot contusions. Shots which per-
forate only beneath the skin are termed seton shots. In the
bones there exists either a shot hole, that is, a round, somewhat
tube-shaped shot wound without splintering of the bones, or
comminuted fractures, that is, comminuted bone frac-
tures with splintering and crushing of the bones ; gun-shot con-
tusions may be characteri/.ed by subcutaneous (simple) frac-
tures. Unfortunately the literature of the German veterinary
surgeries concerning gun shot wounds of horses in the earlier
campaigns is worthless. According to the statistics of Jewse-
jenko collected in the Russo-Turkish War, from a total of 211
horses shot, 41 involved injuries of the bone (equal to 20 per
cent). Healing frequently follows encapsulation, especially
small shot, the latter seldom change position (wandering).
When other bodies, however, enter with the bullet ; namely,
dirt, hair, portions of the covering, of the tugs, etc.. there
develops a suppurative or ichoric inflammation in the vicinity

GUN SHOT WOUNDS

of the shot canal. Shot wounds in horses are of importance in
war : otherwise they are seldom observed (hunting dogs, cats).
Guns and Pkojbctii,ES. — Shot injnries ace produced, either by
band weapons (ranskets, revolvers, pistols, bhibII rides), or cannon
(Bbells, schrapnel, solid shot). Injuries caused by small shot are rela-
tivelj slight, experience has demonstrated that in doge they tna; hekl
without reaction. Injuries caused by tDUsket balh are ot more impoT-
tance. While these balls were formerly manufactured from lead, were
round, und tolerably large in diameter, the bullets of modern weapon*
of war, especially the eight millimeter gan, have a very small diameter
(eight millimeters), a cylindrical, long form, as well as a very batd
steel jacket over a core of lead. Oa account of the steel jacket and
small diameter these bullets retain their form, while the earlier bulleta
were flattened or shattered when they came in contact with a bone,
causing severe injuries, especially to the soft tissuea Modern pro-
jectiles exert, however, on hard bodies, especiatlr
bone, more active splintering force, and in addition to

According to Kochec ( Zot Ijcbre von den Schutswnnden durch
Kleincalit)ergeschosse. 1895) the force of modern projecliles is a blow in
the direction of their flight (penetrating i n f 1 u c n c e on tbe one side,
and an explosive effect (lateral i ni pac li o n) on the other. As a result
of the penetrating as well as the explosive effect the tissues involved
are either lacerated or contused (explosive effect ). or torn away (pene-
trating force). The slower the speed of the bullet, the lighter the
explosive effect: penetration and explosive effect stand,
therefore, in an inverse ratio to each other. If tbe pro-
jection force is less than the cohesion strength of the involved parti
they become stretched and contused : when both are equal there exist*
a wedge-shaped perforation : if the force of the shot is greater than the
cohesion of the parts the tissues are ruptured. In the first ca.se the
involved tissues are stretched ; in the second tliey are poshed forward
or to one side ; in tbe third, lacerated. The degree of rupture
depends on the diameter of the shot and the character of the tissues.
An increase iu the diameter of the missile is constantly occurring, this
increases tbe surface of contact (oblique exit, change in the fonu of
the shot I. There exists a "reciprocal" influence between
the target and the shot, in which the increased resist-
ance of the target increases the explosive effect of the
bullet, Ibe explosive effect is also intensified by increasing the speed
of the bullet. With increased resistance and explosive force there is*
poiallel diminution in the speed of the bullet (beating, deformation), A
decrease in calibre and increase in tbe strength of the
jacket results in decreased explosive force for elastic
bodies, muscle and epiphyses of bone. Small calibre shot*

GUN SHOT WOUNDS

from a short distance produce the following effect on cortical bone :
laceration Btid contusion, splinteriitg. and a bullet-shaped enlargement
of the eiit wound ; large calibers produce very severe lacerations witll
enlargement of the entrance wound ; with ou increased velocity stuall
bullets may produce the same results. Tlirough iiiternational agreement
a calibre of not more than six millimeters has been adopted, the bnlletft 1
to be covered with a hard jacket, bo that they do not become deformed f
by spreading, lacerations are prevented as much as possible and the J
prognosis from shot injuries very much improved.

The effect of the German eight millimeter gun on men and
has been demonstrated by experimental iuvesttgations (Preusaischeft I
Kriegsniinisterium, v. Bruns, Kocher, Kohler and others). Accordii^ f
to the investigations of EUenberger and Baum {Berliner Archiv. 1893) I
on the horse it has a very variable action on different parts of the body ]
at a distance of 250 tt

t. The skin had, as a rule, a smooth-margined entrance wonnd |
which was usually smaller than the diameter of the buUet.

wound i

the akii

alw

! lai

wound. It was especially large when the shot had penetrated bone* I
and the wound was torn by bone splinters.

i. Injuriesto muscle vary accordingtotheirthickness. Insmooth,
stretched muscle the wounds are in the form of a slit, have smooth edge* j
and are smaller than the diameter of the bullet : those in thick muscles ]
are larger and more lacerated. The track of the bullet grai
ally enlarges, thereby increasing the laceration so that |
the enit wound is about double the siie of the enlrance
wound and severely lacerated. Spent bullets (rebounding
shots), as wcU as bullets which have passed through bone, produce
severe tearing of the muscles. It is remarkable that xn such cases
vessels and nerves sometimes remain intact. Wounds in the fascia and
connective tissue are in the form of a slit, frequently they are recognised
with difficulty. Tendons are split with a slight retraction of the edges.

3, The epiphyses of the long bones frequently pre-

epipby sis is less frequently disunited. Shots in the diaphyses. on
the other hand, are usually cbaracteriied by complete
fracture, or at least accompanied by pronounced splin-
tering: even with gracing shots the bones, as a rule, ate completely
comminuted. Gmzingshotson the epiphyses lend to splintering. Shot*
in the center of short bones (carpus, tarsus, vertebrae) usually

shot hole with a round, small entrance wound, and a larger wound
of exit which produces fissures and slight splintering. When the
ribs are hit in the middle there exists b shot hole the suit of the bullet's
diameter, with longitudinal laceration and slight splintering at the

n the loagitudinBl

GON SHOT WOUNDS

•oroewhat enlarged wound of exit. Grazing aholB i
direction of the body fracture the ribs. TransTerEC shots
throni^h the thorax penetrate the entire horse. When
the bullet comes in contact with a rib at the entrance wound, one is also
fractured at the nouud of exit, it is a complete bcealc in the continuity.
On the bones of theslcull there is produced a shot hole
with splintering and sometimes crushing of the bones.
The base of the skull is shattered. Gunshot wounds of the cartilage.
on the other hand, are relatively small, they are often in the form of a
smooth split.

4. The 1 u n K a are severely lacerated, the shot track usually contains
splinters of bone, near the wound of exit the track increases in diameter.
Also in the heart, one finds litcerated. Hap, gaping wounds : seldom small
round openings. In the small intestines there usually exists a small
shot hole : in the large intestines, on the other band, the wouod is
nsually broad, flap-like and lacerated.

The French Weapons, according to Gabeau (Recneil v^t. 18951 in
experiments on the cadaver of the horse, result in severe injuries which
are always of a complicated nature. At a distance of 100 to 200
meters all bullets penetrated the body of the horse.
In the skin the entrance wounds are circular, as though penetrated with
a punch ; the skin itself is not changed. In soft parts the exit wound
is oval in form ; skin overlying bones on the other hand, is lacerated
and notched. In muscles the wound canal is much larger
than the diameter of the bullet; it contains fleatiy, bloody
masses and dilates in the direction of the exit wound. The muscle
fibers appear to be torn in the direction of the rotation of the bullet.
The aponeuroses and flat ligaments present linear wounds; tendon
wounds are twice the width of the bullet, their fibers appear to be torn and
lacerated. Long bones are broken or split and present oblique frac-
tures with extensive splintering ; short bones are crushed into splintere;

hon

The joi.

shed

frt

i of

pulp;

1 thri

The e

ind of joint shots is very large, the skin
istom in shreds. The lungs have cylindrical shot canals. lu the
liver the entrance wonnd is much larger than the bullet, the wound
canal is very wide, the tissue of the liver is ground to pulp for a distance
of three or four centimeters. In the stomach and intestines
the entrance and exit wound are seemingly equal in size. In the
hoof the entrance wound is hardly one mm. in diameter, almost
inTisible ; the penetration of the hoof is complete.

The explosive effects of the so-called dum dum bullets is extremely
active. These are small caliber bullets from which the steel point baa
been removed (expansive buUetsi. .\ccording to Walker iThe Veter-

12 ARRBST OP HEMORRHAGE

inarian. 1899) the entrance and exit wounds are small ; the shot expandi
in the tissues and lacerates the bones and soft tissues.

III. ARREST OF HEMORRHAGE.

Spontaneous Arrest of Hemorrhage. — This is a
cessation of hemorrhage of itself in contrast to artificial arrest
by means of therapeutic agents. The so-called ** stopping"
of hemorrhage occurs in capillary and parenchymatous hem-
orrhage, as well as from that due to injuries to small arteries
and veins.

The causes of spontaneous arrest of hemorrhage are, first
of all, the small amount of blood, in addition one finds
a retraction of the vascular walls with a narrow-
ing of the lumina of the vessels. Coagulation of the exposed
blood results in the formation of a thrombus which closes the
opening and lies partly within the lumen of the blood
vessel. Because of slight blood pressure in the capillaries and
veins thrombi form in them in a very short time, thus arresting
hemorrhage. In large vessels, on the other hand, especially
in arteries, thrombus formation fails to occur, or exists only
after the loss of a large amount of blood with resulting heart
weakness and decrease of blood pressure, so that the blood
coagulum is no longer forced away by the blood stream.
After the loss of large quantities of blood it is made more
coagulable by the addition of white blood corpuscles, thus aid-
ing in the arrest of hemorrhage. This explains, for example,
a fact which has been demonstrated by experiment, that stal-
lions castrated without any precautions finally recover after
severe hemorrhage. In general, as already remarked, the
loss of blood must not exceed a third of the total amount, oth-
erwise, there occurs a fatal paralysis of the heart and brain.
Quantitative regeneration of the blood seems to take place
rapidly through resorption of lymph from the tissues, as well
as fluids from the stomach and intestines. The newly formed
blood is, however, at first, very rich in water, the red blood
corpuscles, on the other hand, are deficient, they are formed
only after a long time.

ARKBST OF HBHORRBAGE

The exact phenomena of thrombus formation are
not fully understood. The principal factor in arrest of hem-
orrhage is the formation of a so-called white thrombus,
which is composed of white blood corpuscles and the blood
plates discovered by Bizzozero. This must be differentiated
from the fibrinous coaguluni which is the ordinary pro-
duct of coagulation within the cadaver or outside the body.
In contrast to the white thrombi, which to a certain extent are
the result of physiological processes in normal living bodies,
the so-called red thrombi are formed as a pathological pro-
cess. The latter are made up of red blood corpuscles and fibrin
and are formed during life in the vessels of animals suffering
from septic affections, as well as from a general marasmus
fmarasmatic thrombi). These red thrombi are formed by a
process of coagulation and death, similar to the formation of
blood coagula in cadavers, they possess, therefore, an essen-
tially different composition and importance. When both white
and red thrombi exist at the same time they are termed a
mixed thrombi.

The course of white thrombi varies according to
the presenceorabsence of infectious material. When the throm-
bus remains free from infection, so-called organization
occurs ; that is. it develops into indurated, vascular, connective
tissue, whereby the injured vessel contains a solid and perma-
nent cicatricial obstruction.- If infectious material gains en-
trance to the thrombus, however, there occurs a suppurative and
ichoric softening of the thrombus with subsequent emboli.

I. The so-called organization of the thrombus con-
sists in a replacemeut of the same by connective tissue. The
cells of the thrombus itself do not undergo active division, the
thrombus plays more of a passive role in that it is gradually
pushed away by the newly formed tissue. The new con-
nective tissue is produced by proliferation of
the vascular epithelium. The endothelial cells of the
intima of the vessels proliferate and are transformed into
spindle-shaped and polymorphous formative cells, which
advance towards the center of the thrombus, they penetrate
and surround the same and are transformed later into fibrillar

14 ARREST OP HEMORRHAGE

connective-tissue cells ; so that the thrombus, under the influ-
ence of the firm connective tissue, is finally pressed away and
replaced. Vascularization of the thrombus oc-
curs at the same time by means of a budding
process from the vasa vasorum. In about four
weeks the thrombus, when formed in small vessels, is made up
of a cicatricial mass of connective tissue penetrated by capil-
laries ; subsequently this becomes harder as a result of atrophy
and retraction of the capillaries. Calcification or cretefaction
of the thrombus is rare (so-called vein-stone or phlebolith).

The re-establishment of the circulation, which was broken
by the thrombus, is made possible by the formation of a
collateral circulation, in which the central and per-
ipheral branches of the artery given off at the thrombus, as
well as the vasa vasorum, are dilated. Occasionally the blood
stream afterwards passes through the center of the thrombus,
which becomes pervious ; or it may pass through dilated
cicatricial vessels.

2. Softening of the thrombus is due to the entrance of
bacteria, which produce a suppurative liquefaction and ichoric
disintegration of the thrombic mass and thereby the danger of
embolic processes and general infection of the body (compare
with the chapter on pyaemia and phlebitis).

Determination of thk Aok of a Thrombus. — This is of impor-
tance to the veterinarian from a forensic standpoint (thrombus of the
arteries of the liml>s and pelvis in the horse i. Unfortunately, exact
experimental investigations on the horse are wanting. In j^eneral
thrombus formation is more rapid in small vessels than in larj<e ; pro-
ceeds more rapidly in young animals than in old. Thrombus formation
in chronic endarteritis in the horse seems to take place especially slow.
In dogs it has been demonstrated cx]>erimentally that the thrombus is
vascularized in from seven to fourteen days after injuries to small ves-
sels, it is also composed of soft tissues ; after three to five weeks a
complete vascular cicatrix is present. Occasionally organization of the
thrombus requires a much lonj<er time. In old ajjje calcified thrombi
are observed. In general the age is determined by the consistence and
color of the thrombus, which finally becomes hard and clear, as well as
by the changes in the vascular walls.

Artificial Control of Hemorrhage. — This consists
of closure of the bleeding vessel either by means of pressure or

ARREST OP HBMORRHAGE

coagulaliou. The following are the most important methods:

1. Ligation of the bleeding vessel. The ligature is
the surest means of controlling hemorrhage from large arteries
and veins. The bleeding vessel is grasped with a good pin-
cette and then ligated with silk. When the isolation is not
complete the snrrounding tissue is also included (ligainre en
masse) after having passed around the parts with a needle.
If none of these methods are applicable on account of the
depth of the bleeding vessel the spurting artery must be ligated
at a centripetal point (ligation in the continuity), for example,
the carotid is ligated after an injury to the internal carotid.

2. Compression of vessels by knots and band-
ages is indicated in capillary and parenchymatous hemor-
rhage. Occasionally strong pressure may be brought to bear
on the bleeding vessel by means of a tampon in the wound.
Momentary and provisional relief from hemorrhage may be at-
tained through pressure with the finger or hand (digital
compression), the application of an elastic bandage (Es-
march's bandage), or a rubber bandage (Martin's
bandage) ; pressure should be applied between the wound
and the heart. A special method employed by the veterina-
rian for the control of hemorrhage consists in the application
of clamps for the castration of stallions. The formerly em-
ployed tourniquets (pad in the form of a girth) as well
as the so-called acupressure are very seldom used at the
present time.

3. T o r s i o n of the bleeding vessels results in loosening
and rolling up of the intima and media, as well as retraction
of the adventia, thus closing the Inmen of the injured vessel.
Torsion is either applied to the bleeding vessel alone, when it
is grasped with the pincette and twisted on its axis for a long
time, or the surrounding soft tissues maj- be included (torsion
of the spermatic cord). From many castrations of horses I am
convinced that regular torsion of the spermatic cord is a surer

■ means for the prevention of hemorrhage than either clamps or
the ligature ; from a standpoint of simplicity or asepsis torsion
and clamps, especially the latter, are not preferable.

1 6 ARRBST OP HBMORRHAGB

4. H e a t in the form of a red hot iron or cautery is effi-
cient in many forms of parenchymatous hemorrhage. It forms
an eschar over the ends of the bleeding vessels which performs
the function of an aseptic bandage (searing the tail after
amputation). The application of cold (ice-cold water, spray
of ether) is less effective. Its action is due to the contraction
and narrowing of small vessels. Hot water is employed
at a temperature of 45-50 C. as a styptic for parenchymatous
hemorrhage of the uterus. Even steam at a temperature of
100-120° has been employed recently in the human family for
persistent cases of uterine hemorrhage (vaporization of the
uterus, so-called atmocausis and zestocausis).

5. The following t h era pen tic a gen t s exert a styp-
tic influence, active only in capillary and parenchymatous
hemorrage : liquor ferri chloridi, concentrated or com-
bined with collodion, with surgeons cotton or in aqueous
solution. This causes coagulation of the blood with simul-
taneous constriction of the blood vessels. Other agents are
alum, tannin, creolin, sugar of lead, nitrate of silver, oil of
turpentine, gelatine (subcutaneous), ergot or hydrastis
is employed to control hemorrliage that cannot be treated

surgically.

Hemophiij A. — Hemophilia .blood disease) is a congenital tendency
to hemorrhage (hemorrhagic diathesis) which presents the following
characteristics in man: uncontrollable hemorrhage after
very slight wounds. This disease also occurs in the horse ( Kohne ,
Siedamgrotzky, Dreymann, Otto, Zschckke, and others). The following
examples have been observed : after enlarging castration wounds, after
the removal of setons, after splitting fistulous canals, after the extraction
of teeth in dogs ; hemorrhage has continued for hours and days regard-
less of all preventatives. Not all reported observations from veterinary
sources are free from exception ; I have never seen a case of hemophilia
in the dog or horse. The real cause is unknown (abnormal condition
of the blood? failure to coagulate? deranged nourishment of the vas-
cular walls?). According to Schindelka many descendants of the thor-
oughbred stallion "Gunnersbury" suffer from a hemorrhagic diatheses
(epistaxis) (transmission as in man ?).

KINDS OK WOUND HEALING 17

IV. ANATOMICAL CHANGES IN WOUND HEALING.

Kinds op Wound Healing. — The anatomical changes
in the healing of wounds, which have been demonstrated by
the exhaustive investigations of Thiersch, are extremely
variable. They depend upon the following conditions : whether
the wound is clean or infected, sutured or open, incised or
contused, with or without loss of substance. The following
forms of wound healing may be recognized :

1. Healing by first intention.

2. Healing by second intention.

3. Healing by third intention.

4. Healing under scab.

5. Ab normal granulation and cicatrization
Healing by Primary Intention. — Healing by first

intention consists of a direct union of the margins
of the wound through immediate agglutina-
tion without suppuration. Healing by primary
union depends on the following conditions : fresh, non-infected
(aseptic) wounds, fresh incised wounds with even margins
and. when possible, without loss of substance ; when infection
has occurred careful disinfection must be employed (antiseptic
treatment); the margins of the wound must be brought iu
close apposition by means of sutures : all foreign bodies (hair,
dirt, blood, etc.) must be removed ; application of an aseptic
bandage. In the domestic animals these conditions are
nsualiy applicable only to operation wounds, and then only
when possible to afford protection by means of a bandage.

M acroscopicall y healing by primary union first
presents an agglutination of the edges of the wound with blood,
afterwards a lymph-like plasmic fluid (so-called wound cement)
exerts the same influence. The surface of the wound remains
dry. About the second day the margins of the wound are
slightly swollen, sensitive, and red. After about a week (four
to eight days) definite union results with the formation of a
small cicatrix. Microscopically one soon observes emi-
gration of the white blood corpuscles from the neighboring
blood vessels to the margins of the wound and to the wonnd

IIHALING BY FIRST INTENTION

filtration of tbe|
lite blood corpus

cement. This c e 1 1 u 1 a
wound with wauderii
cles is considered a pi
Wandering of the white blood corpuscles is due to a traumatic
irritant (traumatic, aseptic infianiniation) and is to be consid-
ered, therefore, as a reactive manifestation on the part of the
injured tissue. According to recent investigations bacteria.|
which gain entrance to a wound that lieals by primary union'
are soon rendered harmless and partly resorbed ; this is prin^
cipally due to the bactericidal properties of the blood serum
(antitoxins, alexins) wfaich is one of the constituents of wound'!
secretions. The infiltration of the wandering cells (leuco-'
cytes) in the wound cement and margins of the wound reach*
its height on the third day ; from that time they degeneral
or return to the vessels.

The wandering cells take no part in the formation of the!
definitive cicatrix, a former erroneous supposition. The'
cicatricial tissue develops from the so-called'
fibroblasts; these are round cells which ariai
from the proliferation of the fixed (autoch-
thonous) connective tissue cells and the.
■endothelium of the vessels. The fibroblasts gradn-
ally enlarge ; large epithelioid, as well as long, spindle, and
club-shaped cells are formed ; these are afterwards transformed
into fibrillar, connective tissue cells when they form genuine
cicatricial tissue. Simultaneously there occurs a
budding process from the walls of the incised
capillaries, new vessels are thus formed be-
tween the m a rg i n s of the wound. The fibroblasts
in combination with the newly formed vessels form the so-called
germinal tissue (granulation tissue); this is a cellular and
vascular new formation. After the transformation of the
fibroblasts into connective tissue cells the granulation tissue
contracts so that the newly formed vessels atrophy again; thus
the formation of the genuine cicatricial tissue is com*
plete. Finally the cicatricial tissue is com-
pletely covered by proliferations from the
epidermal cells (rete Malpighi, epithelium

BBAXING BY SECOND INTBNTION ig

of the dermal glands) at the margins of the
wound. This completes the process of healing by primary
union.

Healing by Second Intention. — This mode of
healing occurs with suppuration as a result
of infection with ordinary pus cocci. It is
characterized by the formation of an abun-
dance of granulation tissue. One finds this form of
healing in old wounds, wounds that have become infected,
those that have not received aseptic treatment, contused
wounds, wounds with a loss of substance, or those which can-
not be sutured.

Macroscopically. within the first twenty-
fouT hours the individual tissues and blood may be readily
differentiated on the surface of the wound. A serous, lym-
phatic, reddish-yellow secretion is formed after one or two
days, giving the surface of the wound a gelatiuous appear-
ance. From the second to the third day the sur-
face of the wound presents a granular ap-
pearance (granulations), pus begins to form.
During the course of the suppuration the necrosed tissue ia
sloughed off. the wound is "self-cleansing," Later, the gran-
ulating wound surface is gradually covered with epidermis
from the margins of the wound, the newly-formed epidermis
surrounds the margins of the granulations in the form of a
light colored fringe. The granulation tissue contracts and ia
completely covered, there finally remains a broad, firm,
tendonous cicatrix. The microscopic changes
are identical with those which occur during
healing by first intention. The only points of dif-
ference are that in healing by second intention infection takes
place. The wound is irritated by bacteria and
their products, which results in the forma-
tion of large quantities of granulation tissue,
this being the product of a suppurative inflammation it fur-
nishes 3 purulent exudate. Healing, therefore, re-
quires a much longer time (two or more weeks). Cellular in-
filtration of the edges, formation of the fibroblasts, budding of

20 HEALING BY THIRD INTENTION

the capillaries, and transformation of the fibroblasts into con-
nective tissue proceeds exactly as in healing by first intention.
Further, suppuration does not form an abso-
lutely necessary condition for healing by
secondary union. The essential condition is the abund-
ant formation of granulation tissue, which may occur without
suppuration (aseptic granulations).

Granulation tissue formed during healing
per secundam serves principally as a com-
pensation for the loss of substance. In ad-
dition it forms an important protection
against the entrance of infectious irritants
into the blood stream. The entrances to the lymph
streams are mechanically closed by the granulation tissue, the
pus also contains bactericidal properties (pus serum, like blood
serum ; pus corpuscles, like white blood corpuscles). This
explains the long known surgical fact, that with the formation
of granulation tissue the danger from general infection is
greatly diminished after the third day. Experimental inves-
tigations upon sheep have also demonstrated that granulating
wound surfaces are not permeable for anthrax bacilli or for the
toxins of tetanus. The protective action of granulations is of
great importance, therefore, in veterinary science, as healing
by primary union is seldom attained. Above all, the granula-
tions supply the loss of substance when healing
by primary union is impossible. Many wounds cannot heal
except through the formation of granulation tissue (wounds
of the cartilage and cornea).

Healing by Third Intention. — This consists in the
artificial union of wound surfaces that are
alre:^dy granulating and suppurative. It
sometimes follows careful disinfection and exact suturing of
suppurative granulations. Healing by third intention should
not be confused with scarification and suturing of granulating
wounds (same as healing per prima). Healing by third in-
tention is of considerable importance in veterinary surgery as
certain forms of purulent lacerated wounds may be brought
to rapid healing by this method. This is especially true of

aSALING UNDBR AN ESCHAR

those about the he&d (false nostril), permanent union result-
ing in wouads a week or more old. Healing by third inten-
tion should always be given a trial, especially in the horse,
when healing per prima cannot be expected from scarification
of the wound surfaces.

Healing Under an Eschar. — This isaform ofpri-
mary wound healing. The blood dries on the surface
of the wound and leads to the formation ol a protective coat.
In small wounds cicatrization without suppuration takes place
rapidly beoeath the eschar, new epidermis is quickly replaced
from the margins of the wound. In veterinary surgery this
method of healing is of great importance as many wounds can
be neither sutured nor bandaged, the dry scab taking the
place of the latter. It may be applied artificially by means of
a hot iron, production of a necrotic covering (wounds
of the ear, tail, joints, extirpation of small tumors from the
backs of dogs), or by the application of tannin, tanno-
form, glutoj, amyloform, argentum nitricumor
other disinfecting agents that produce an eschar.

.\bnormal Granulation and Cicatrization. — While
the various forms of normal wound healing by the processes
of granulation formation and cicatrization lead, as a rule, after
more or less time, to the formation of a typical cicatrix.
many wounds form an exception to this rule. The granulation
and cicatricial process appears abnormal. This is true when
foreign bodies or necrosed pieces of tissue remain in the
wound, when there is great loss of substance, when continued
infection or irritation occurs in fresh or healing wounds, when
the injured animal is suffering from certain infectious dis-
eases fsee below).

I. Granulations are especially abnormal when the
granulation tissue forms too rapidly and in large quantities ;
exuberant proliferations, fungus-iike granulatioug
(granuloma, caro luxurians, proud flesh). Excessive granu-
lations are observed in treads on the coronet ; fistulous
withers or saddle galls when necrosed pieces of tissue are re-
tained and act as a constant irritant to the part ; in skin
wounds on the flexor surfaces of the joints (carpus, tarsus)

ABNORMAL WOUND HEALING

when continually irritated by flexion and extension move-
ments of the limbs ; in muscle prolapse as a result of c
striction and continued irritation of the exposed part aftei^fl
injury to the fascia of the limbs, in intensive suppurative infec-T
tiou. Other diseased forms are : erethistic granulations,]
that is, sensitive, dark-red, easily hemorrhagic, and very paia-J
ful granulation tissue ; atonic (torpid, asthenic) weak i
deficient, as well as unequal granulation, and gangres-fl
ens degeneration of the grauulation tissue (diphtheria o^
the granulations).

2. Cicatrization may become abnormal in varioui
ways. Great loss of substance results in an incomplete
cicatrix ; suppurative decomposition in the formation of i
ulcer or fist u la. In horses there is frequently observed'fl
on the cicatrix an abundant accumulation of horny epidermal!
cells (horny cicatrix). Occasionally one observes a tumor-fl
like proliferation of the cicatricial tissue (cicatricial keloid,!
cicatricial hypertrophy). This is seen in horses in the flexorfl
regions of the fetlock and coronet (compare with chapter on'l
keloids, under tumors). So-called painful or sensttive'l
cicatrices (neurectomy, throat, shoulder) are rare in the!
horse. A cicatricial contracture occasionally results 1
from extensive destruction of the skin, that is, cicatricial con-f
traction of the neighboring skin leads to change in position of I
parts of the body (caput obstipura from contraction of the I
tissues of the neck ; stilt foot in necrosis of the skin on the I
posterior surface of the carpus and metacarpus ; ectropiutn I
from extensive wounds of the eyelids).

The causes of atypical wound healing are I
both local and general. Under local causes are mechanical j
lesions of the tissues (contusions, constant irritation from
foreign bodies, licking, rubbing, and movements); irritation j
of the wound through chemical irritants (antiseptics,
decomposing secretions, necrosed particles of tissue); infec-
tion of the wound through specific infiammatory irritants-
(botryomyces fungi, glanders, necrosis bacillus), or by means |
of various other especially virulent, pus forming bacteria ; I
deranged circulation (anaemia, hyperaemia, throm-
bosis). Neurectomy, as a local cause of deranged circula- ]

WOUND HEALING IN DIFFERENT TISSUES

ormal wound healing
i of disturbed wound

tion and nourishment, may influence 1
(injuries to the hoof). General cause
healing are: febrile general diseases; chloroform
(reduced activity of the white blood corpus-
cles; weakening of the activity of the heart);
old age; general weakness and conditions of
exhaustion: weak constitution; faulty breed-
ing, care and food; diseases of the kidneys;
hydraemia; cancerous cachexia; diabetis.
Also the race and species, as well as the condition of the
stable, temperature, season, climate, etc.. all have an influence
on the healing of wounds. Finally, many animals have
idiosyncrasies whichinlerfere with normal wound healing
and favour the entrance and multiplication of infectious ma-
terial. On the other hand, many animals appear to have
congenita! immunity against wound infection diseases;
wounds on native born Algerian horses, for example, heal
without suppuration and without treatment.

Wound Hbaung ani* Regknrrativk Ability- of Different
TiSSUES.^i. Wound healing in the akin, pododerin and muco««
metnbrane takes place according to the previously described methods.

epidermta, skin and pododerm (formation of horn),

the connective tissues.

2. Muscle wounds do not beal by regeneration of muscle fibers,
but by means of a fibrillar, connective-tissue cicatrix. The regen-
erative ability of muscle is very slight. Proliferation aud
enlargement of the muscle cells occurs only m the vicinity of con-
nective tissue cicatrices, as well as in small, superficial injuries to the
muscle, even here the formation of new muscle fibers is limited.

3. Tendon wounds heal principally through ptolife ration of

ellfl of t

tb, of the

nd the

tfa:

cula

atendii
the

genuine

tendon cells of the tendon stump also take part. The granulation tissue
that results from this proliferation unites both ends of the tendon and
gradually changes into genuine tendon tissue (compare vdth the chapter
on rupture of tendons).

4. Wounds of the bone heal in the seme manner as fractures,
through ossification of the gianulation tissue (callns); this
is formed from the periosteuin and bane marrow, as well as the bone

itself (peri

(compare with chapter on healing of bone fractures) .

elil

iifi<

IS)

WOUND HHALING IN DIFFERENT TISSUES

5. Cartilage wounds tbat ore coveted with perichondrium (lateral
caitilage, ttscfaea, muscles of the ear) heal, similar to bone wonnda,
through proliferation of the perichondrium with the
formation of a callus that is at first fibroas and afterwards
ossified. The cartilage cells that fall directly into the cartilage
wonnd undergo fatty degeneration. Synchronous with the prolifera-
tion of the perichondrium there occurs a multiplication of the neigh-
boringcartilagecells with a new formation of cartilage tisBae. .
In non-TascuUr articular cart 1 lage, however, the relaiioo is very 1
different. Aseptic, clean, cartilage wonnds in the joint |
never heal, they remain as a jtermaneot defect. Infected, articular-
cartilage wonnds, on the other hand, heal completely. Severe irritation |
of the non-vascular tissue of the wound leads to the formation of
granulations and a connective-tissue cicatrix. Afterwards the 1
tissue cicatrix may be even partly transformed to hyaline '

6. The peripheral ner ves, when injured, jios!

applied rep1a.i

of I

: fibe

I fri

; fibe'

of the

ipheral stump. When the ends of the i
at least one centimeterapart (neurectomy) the peripheral porl
of the incised nerve degenerates, while the central t
•tump anastomoses with neighboring nei
conductivity ia again established. At the saii
sprout from the central stum]), which fill in
ends, and extend along the course of the pe
manner the nerve is replaced, when degent

fusion may occur when the fibers are still intact (chemotatic influence
of the products of degeneration of the old nerve fibers on the growing
central nerve cylinder). As a result of constant irritation (neuritis) the
central nerve end undergoes a new formation of nerve fibers and con-
nective tissue, ihia results in a club-shaped swelling I neuroma j.

7. In the brain and spinal-marrow— in contrast to the per-

the defect between the
ipheral portion. In thia
plet

; there
that which occu

8. In the
that in vascular

1 foi

tissue cicatrix
. regeneration of muscle.

vascular cornea healing of wounds is similar
les. One first finds migration of white blood ci
ighboring conjunctiva and scblers, as well asa si.
seqnetit autochthonous cellular proliferation with the formation
fibroblasts and the successive transformation of these into fibrillar cc
nective-lissue. The formation of new vessels in the corne
■. d.

iUrto

eds fri

1 of the

WOUND INFECTION DISEASES 25

V. WOUND INFECTION DISEASES.

Definition. — The term wound in f e'c t i o n d i s-
casesor accidental wound diseases embraces the
general surgeiy of a long list of affections due to wounds
which depend on the entrance of microorganisms or
their products (toxins). The bacteria gain entrance to
the wounds by contact or through the air. They maintain
local disease processes in the wound or some form of general
derangement. In a narrow sense the most important wound
infection diseases are : i. Suppuration, 2. Phlegmon, 3. Ab-
scess, 4. Wound Fever. 5, Septicaemia, 6. Pyaemia. The
following diseases may also result from the wound : inflam-
mation of the lymph vessels (lymphangitis), inflammation of
the veins (phlebitis), as well as erysipelas. In a broader
sense wonnd infection includes tetanus, glanders,
rabies, bo t ryo ra y cosis, actinomycosis, tuber-
culosis, malignant edema, strangles, anthrax,
black leg. and Wildseucbe. The following in-
cludes a description of the wound diseases in the narrow sense.

I. Suppuration of Wounds.

Causes. — Suppuration which accompanies healing by
second intention is a product of inflammation caused by infec-
tion of the wound with pus cocci. The following
have been found most often on bacteriological examination :
staphylococcus and streptococcus (staphylomycosis, strepto-
mycosis). The following are the most important pus forming
bacteria .

a) Staphylococcus pyogenes aureus is the
most frequent pus coccus in animals, especially the horse.
They are in the form of small, round, non-motile cocci ; ar-
ranged as lobules, clusters, or as diplococci ; on potatoes,
agar, and gelatine they form orange-yellow cultures. Experi-
ments have demonstrated the fact that their action is due to
the production of toxins which act as an irritant and produce
iofiammation. Subcutaneous injection of a pure culture usually
resnlts in the formation of an abscess; intra-abdominal

PUS-FORMING BACTERIA

injection in fatal suppuration ; injection into the blood, pyae-
mia as well as ulcerative endocarditis. Repeated injections
have resulted in the seemingly rapid formation of amyloid
degenerations (liver, kidneys). Staphylococcus pyogenes
aureus is especially common in circumscribed, localized |
suppuration, in pyaemia, and in the pyaemic form t
foal lameness.

b) Staphylococcus pyogenes albus is less^
common. It is distinguished from the preceding form by its I
less virulent pathogenic action, and white, varnish-like cul-
tures. According to some, it is the cause of moon blind- ]

c) Staphylococcus pyogenes citreus is lare.
It is characterized by the citron-yellow color of its cultures, j

otherwise it is identical with the preceding.

d) Streptococcus pyogenes is next in importance I
to staphylococcus pyogenes aureus. It forms cocci arranged i
in the form of a chain ; it does not grow on potatoes, on I
gelatine it forms very small white colonies. Streptococctis I
pyogenes is a special cause of progressive phlegmon-
ous suppuration with subsequent septicaemia. It
is found, therefore, in the septic form of foal lameness.
It also appears to be identical with the streptococcus of erysip-
elas, strangles, contagious pleuro pneumonia, acute articular
rheumatism, and petechial fever (?).

e) Bacillus pyogenes appears to be the most im-
portant cause of pus formation in cattle and swine ; see
page 36.

f) Bacillus pyocyaneus — the bacillus of blue j
and green pus — forms small, slim, very motile bacilli. They
frequently possess four to six flagella. Through the decom-
position of albumen they produce a blue and yellowish-green
coloring material (pyocyanin, pyoxanthin) similar to the
bacilli of blue milk. Chemically this is closely related to
anthracine, it also belongs to the benzol group, and colors the
pus and bandage blue or greenish-yellow. While the coloring
material is harmless, the bacilli and their toxins have a patho-
genic action towards experimental animals, producing an

PROPERTIES OF PUS 2^

edematous and suppurative inflammation at the point of in-
jection. Bacilli with red coloring material are also found in
pus.

Colon Bacillus. — The colon bacillus (Bacillus coli commnnia,
Bacterinm coli conminne) is found in various varieties in the normat
intestinal canal. It is present in many species and races, and is usually
a harmless organism because its very poiaonons toxins are neutralized tu
healthy animals by the action of the gall. Under certain unknown con-
ditious the colon bacilliia in the intestinal canal becomes highly viru-
lent (calf diarrhoea, calf septicaemia, enteritis, peritonitis, cystitis,
pyelonephritis, hepatic abscesses, endometritis, septicaemia pnerperalis,
polyarthritis and omphalo- phlebitis in the calf, malignant head catarrh in
cattle, croupous enteritis in cats, as well as various other "colon bacilli"
infections). In the subcutaneous connective- tissue it causes suppura-
tion with more or less serious phlegmons (septic and gas phlegmon).
It is alleged to be identical with Bacterium phlegmasiae uberis. bacillus
foetidus, neapolitanus and lactus aerogenes.

The following microorganisms may also cause suppumtion under
certain conditions: actinomyces and botryomyces fnngi ; the bacillus
of glanders ; the streptococcus of strangles ; the cocci of contagioua
pleuro pneumonia : the micrococcus pyogenes tenuis and tetiagenes ;
the copsule coccus (diplococcus) ; the bacillus pyogenes foetidus; the
staphylococcus cereus, albus, Havus ; proteus vulgaris, and others.
Finally, the courses of many infections diseases ; namely, suppurations
of tuberculosis and actinomycosis are, frequently accompanied by
mixed infections of ontinary pua bacteria. For further informa-
tion on suppurution, iu regard to pua bacteria found in individual do-
mestic animals, as well aa on the development of so-called aseptic
inflammation (injections of oil of turpentine, sublimate, nitrate of
silver) compare with the chapter on inflammation.

Properties of Pus. — Under ordinary <
forms a thick, creamy, yellowish or greenish
non-coagulab!e fluid (pus bonum et laudihle).
infection with bacteria which produce a
pus may be green or blue, seldom yellow
frothy, odorous pus indicates the preseuce of decomposition as
a result of colonization of septic bacteria in the wound. The
condition and quantity of the pus varies with the size and age
of the wound, the blood supply and consistence of the wound,
the species, quantity and virulence of the bacteria, tempera-
ture and season, climate, breed, etc. Pus from the horse is
usaally yellowish and cream-like ; that of cattle and birds is
often caseous ; that of swine tenacious and green.

ions pus

■odorous,
result of
xjlored secretion the
Thin, mucous-like.

PHLEGMON

When pus remains for a long time in a vessel one observes
two layers. The upper is a thin, apparently clear, and yel-
lowish fluid ; it forms the so-called pus-serum. The under
layer is thick and slrawyellow ; it contains the pus-corpus-
cles. The pus-corpuscles are formed princi-
pally from the white b 1 o od co rp u scl es that
migrate from the blood vessels (Cohnheim).
Part of them, however, are descendants of the fixed connec-
tive-tissue cells, as well as the degenerated connective-tissue
substance of the tissue. Upon microscopic examination one
finds, in addition to the pus corpuscles, various forms of pus
cocci which are occasionally enclosed within the pus corpus-
cles. There are also observed various other bacteria, red
blood-corpuscles, tissue cells, drops of fat, crystals of fatty
acids and cholesterin. The recognition of cartilage cells and
giant cells in the pus are of special irapmrtance in the diagnosis
of cartilage and bone fistuhc. The peptone contents of the
pus is due to the transformation of the fibrinogen through the
activity of the pus forming microorganisms ; absence of fibri-
nogen in the pus accounts for its non-coagulability.

When the suppuration does not remain confined to the
wound, but involves the neighboring tissues in a suppurative
inflammation, it leads to the development of a diffuse suppu-
rative inflammation of the subcutaneous and submucous cellu-
lar tissue (suppurative phlegmon), a circumscribed
accumulation of pus (abscess), a suppurative inflammation
of the lymph vessels (lymphangitis), lymph glands
(lymphadenitis), and veins (phlebitis), as well as the
entrance of pus cocci and their toxins into the blood
(wound fever, septicaemia, pyaemia). Compare
with the subsequent chapter.

2. The Phlegmons.
Definition. — Phlegmon, phlegmonous inflam-
mation, or inflammation of connective tissue
are terms used to indicate an infectious, serous, or suppurative
inflammation of the connective tissue and all its parts : namely,
the subcutaneous, submucous, subfascial, intermuscular, peri-

PHLEGMON

osteal, perichondral, tendo-vaginal, and interglandularconnec-
tive-lissue. One speaks, then, of a subfascial or intermuscu-
lar phlegmon, of a phlegmon of the subcutis, Ihe perichon-
drium, the tendon-sheaths, the udder, etc.

Causes and Forms. —Phlegmonous inflammation is due
to the same bacteria that are found in suppuration. The
streptococcus pyogenes and staphylococcus
pyogenes aureus are the most frequent causes of phleg-
mons (phlegmone streptococcia or strep tomycosis ; phlegmone
staphylococcia or staphylomycosis). The pus cocci usually
gain entrance to the connective ti.-viue through wounds ; punc-
tured, contused, and lacerated wounds form the ordinary
sources of phlegmons. Very often the previous wounds ate
very small or entirely healed so that they can no longer serve
as a source of entrance to pus forming bacteria. Formerly, th^
erroneous term of so-called spontaneous phlegmon was given
to this condition. Phlegmon may occur at a point more or
less removed from the point where the pus cocci gain entrance ;
they being carried to this point through the lymphatic circu-
lation. It may also occur that the infection of the connective
tissue proceeds, not from without, but from the blood stream
(metastatic or symptomatic phlegmon of pyaemia,
strangles, contagious pleuro pneumonia, glanders). Hemor-
rhage and lacerations of connective tissue as a result of con-
tusions predispose to phlegmons.

Surgically there are various forms of phlegmon.
Classified from an anatomical standpoint we have — subcu-
taneous, submucous, subfascial, intermuscu-
lar. It is also spoken of as superficial and deep (e. g.
subfascial), or circumscribed and d i f f n se phlegmon.
The circumscribed form confines itself to a phlegmonous swel-
ling in the vicinity of the wound and frequently leads to the
I formation of an abscess (phlegmonous abscess). Diffuse
I phlegmon consists of an inflammatory infiltration
[ of large areas of connective tissue and frequently results in
I Decrosis of the skin, subcutem, fascia, tendons, tendon sheaths
I (gangrenous phlegmons), whereby other bacteria may
I also play a part (necrosis bacillus).

PHLKGMON

Septic phlegmoD, in contrast to the ordinary form, is
especially virulent. Itis also termed progressive phleg-
mon, progressive inflammation of the cellular tissue, or gan-
grenous erysipelas. It is due to a mixed infection of pus cocci
and specific septic bacteria ( streptococcus septicus, micrococ-
cus tetragenes, colon bacillus, and others^. Itis character-
ized by a rapid, extensive, ichoric suppuration of the cellular
tissue, with a severe, often fatal general infection. The so-
called gas phlegmon is a mixed infection composed of gas-
forming bacteria (bacillus phlegmonse empliysematosEe, colon
bacillus). The ordinary suppurative phlegmon is termed
simple in contrast to the specific phlegmons. The latter
are not due to pus cocci, but to certain other bacteria, espec-
ially the bacilli which cause malignant edema and e r y-
-fii pelas (compare with the chapter on these subjects).

General Symptoms of Phlegmon .-C ircum scribed
phlegmon is characterized by swelling, high temperature,
and pain over a small area of the skin. At first the swelling
has a well defined boundary ; on palpation it maybe hard and
firm, or soft and fluctuating. Af- a result of the swelling and
tension the skin cannot be raised. Circumscribed phlegmon-
ous swellings frequently result in the formation of an abscess ;
it is characterized by fluctuation, a reddish-blue or dark
grey color of the skin, and fever. Spontaneous evacuation
may occur after necrosis of a small portion of the overlying
slcin. Healing follows by the formation of granulation tissue,
when not evacuated artificially it may result in burrowing of
pus as well as in progressive phlegmon. Suppurative lym-
phangitis, lymphadenitis, phlebitis, as well as pyaemia and
septicaemia may also occur.

Diffuse phlegmon is characterized by extensive
swelling of the skin — especially on the limbs — fever, and pain
(lameness). Subfascial phlegmon is accompanied by
especially high fever and severe pain, when the deeper layers
are affected the skin may remain unchanged, or presents a
slight, edematous, doughy swelling. Intermuscular
phlegmon is similar in appearance. All diffuse phlegmons
frequently lead to extensive necrosis of the skin, subcutem.

PHLEGMON

fascia, muscle, etc. They often result in fatal septicaemia or
pyaemia.

Septic phlegmon is very acute, spreads rapidly, and
usually terminates in death. It is characterized by a high
septic fever, extensive gangrenous destruction of the subcutem
and neighboring soft parts, namely, the muscles, which are
transformed into a discolored, odorous, punk-like, fatty mass,
or a thin, icboric discharge. The diseased parts may crepitate
as a result of the formalioa of foul gases {gas phlegmon, septic
emphysema).

Thrmination. — The course of phlegmons varies ac-
cording to their character and extent, as well as with the genus
of the animal.

1. Circumscribed and diffuse phlegmons are followed by
healing through resorption. The latter, especially, frequently
heal without necrosis or abscess formation.

;. Abscess formation may result from any kind of
phlegmon. The prognosis is more favourable when the phleg-
monous inSammation is situated near the surface. Subfascial
and intermuscular abscesses are a source of danger, they may
be in the form of numerous, small pus foci, or converge to
form a large abscess, general infection is liable to occur.
Occasionally subfascial abscesses rupture spontaneously on
the surface.

3. Necrosis may result from any form of phlegmon. It
most often results from septic, subfascial, intermuscular, peri-
osteal, and perichondral phlegmons, especially when there
occurs a simultaneous influence of the necrosis bacillus (fistu-
lous withers, poll evil, quittor, phlegmon of the planter
cushion). Necrosis often forms the source of septicaemia
and pyaemia.

4. Encapsulation of abscesses is most often ob-
served in intermuscular phlegmon (shoulder abscess). In dif-
fuse, subcutaneous phlegmons on the posterior limbs of the
horse the phlegmonous process is occasionally suspended for a
long time, healing is only apparent ; sooner or later the phleg-
mon returns. Possibly this recurrence explains a previous
encapsulation-isolation of individual disease foci, with a sub-

32 PHI^EGMON

sequent spreading of the inflammatory process as a result of
rupture, laceration, or liquefaction of the capsule.

5. Chronic induration or sc h 1 e ros i s oc-
curs when a diffuse, suppurative phlegmon terminates in a
chronic connective-tissue proliferation of subcutaneous, inter-
muscular, subfascial, and perichondral tissue. Schlerosis oc-
curs on the posterior limbs after phlegmons (elephant leg),
grease, or on the head (glanders), and leads to pronounced
thickening of the skin ; it is termed elephantiasis,
pachyderm a, or schleroderma. Compare with
the chapter on elephantiasis.

Treatment. — When there is no evidence of abscess for-
mation and resorption is possible, treatment consists in the
application of moist, hot fo mentations (Prieznitz),
or disinfecting bandages (spirits of camphor
bandage); antiseptic lotions, warm baths or
cataplasms; ointments of camphor, iodoform,
tar, carbolic acid, creolin, grey mercury; as
well as subcutaneous injections of disinfec-
tants. In subacute, and in chronic phlegmons especially,
resolution or accumulation of tlie pus in a circumscribed cavity
may be attained by the application of a severe counter-
irritant in the form of tincture of iodine or u n-
guentum hydrargyri cinercum. Arecolin is a
very good internal resorbent.

All abscesses, on the other hand, should be treated early
by means of a free incision. Experimental investigations
as well as practical experience have demonstrated that early
evacuation of the pus by means of open inci-
sions is the most satisfactory treatment (disinfectant activity
of the oxygen of the air). One may also irrigate the abscess
cavity with antiseptic fluids and provide drainage.
All necrotic tissue must be removed f amputation of the tail
and claws ; resection of the lateral cartilage and the flexor
tendon at its point of attachment to the os pedis). The
application of massage is contra -indicated,
especially for acute phlegmons.

Occurrence. — Most phlegmons are subcutaneous.

PBLBGMON

Phlegmonous inflammations of the subfascial, intermuscular,
and perichondral connective tissues, as well as the tendon
sheaths are common, especially in the horse. Septic phleg-
mons are very common in horses and dogs. The following
phlegmons are of special practical importance ;

1. Subcutaneous phlegmon of the soft parts of the
head (lips, eyelids, zygomatic region, pharynx); throat,
and shoulder (subcutaneous injections);

2. Submucous phlegmon of the mucous membranes
of the mouth and throat (stomatitis, glossitis,
pharyngitis):

3. Subfascial phlegmon of the fasciae of the throat,
shoulder, and back (poll-evil, fistulous withers):

4. Phlegmon of the muscles of the throat shoul-
der, elbows, gluteal region, and abdomen in the
horse (deep wounds);

5. Subcutaneous phlegmons of the posterior limbs
of the horse in both forms: the ordinary simple and
the rare, characterized by abscess formation;

6. Subcoronary and perichondral phlegmons at
the coronet (treads on the coronet), and the lateral carti-
lages (fistulae of the lateral cartilages), as well as phlegmon
of the planter cushion in the horse (nail punctures);

7. So-called panaritium of the claws of cattle and
dogs, corresponding to the subcoronary phlegmon of horses
(see below);

8. Subfascial phlegmon of the fascia lata and the
tibial fascia in the horse (punctured injuries, wounds
from blows);

9. Phlegmon of the tendon-sheaths of the flexor
tendons in the horse (traumatic, suppurative, and metastatic);

10. Subcutaneous and intermuscular phlegmon of the
tail in cattle (lung plague injections, so-called tail worm),
dogs (contusion), and horses (amputation);

11. Phlegmon of the sheath and scrotum in the
horse (wounds, castration, glanders);

12. Phlegmon of the udder in cattle (small wounds,
erysipelas, and furunculosis);

34 PANARITIUM

13. Puerpural phlegmon in cattle (septic gas- phleg-
mon, so-called puerpural blackleg) from small contused

wounds of the vulva and vagina at birth.

Panaritium. — This name (derived from paronchium — inflammation
of the bed of the nail — matrix unguis — ) indicates a circumscribed
phlegmon of the phalanges. In man, it applies to a special
circumscribed, suppurative inflammation of the subcutaneous connec-
tive tissue on t^^e volar surface of the finger. The word is derived from
human medicine, and in veterinary science the application is somewhat
false. In man the anatomical structure of the subcutis predisposes to
the existence of panaritium. The subcutaneous tissue on the volar
surface of the finger is very thick, and its connective-tissue fibers aze
not parallel with the finger, but run perpendicular to it. Upon the
entrance of pus cocci there first occurs a circumscribed inflammatory
focus surrounded by fixed connective-tissue fibers (panaritium). The
phlegmonous process extends from here to the tendon-sheaths, the
periosteum, the joint, and the bone, there exists a progressive phleg-
mon (panaritium tendonosum, periostale, articulare, osseum) which may
lead to necrosis of the bones, suppurative inflammation of the joints and
tendon-sheaths, to necrosis of the tendons, and death of the entire
phalanges, even to fatal septicemia and pyemia. Very similar pro-
<:esses occur on the hoof of the horse, the claws of cattle, sheep,
and dogs. All the above forms of panaritium can be observed in the
sheep and dog especially. In cattle one can distinguish panaritium of
the toes, panaritium between the claws and between the balls. The
term phlegmon is more often employed. Subcoronary phlegmon of
the horse is analagous to panaritium when it is complicated with
phlegmon of the planter cushion, of the ]>erichondrium, of the bursa of
the navicular bone, as well as with necrosis of the flexor perforans,
with fistula of the cartilage of the hoof, and suppurative inflammation of
the pedal joint.

3. Abscess.

Dkkinition and Causes. — Abscess (abscessus, apos-
tema) is an a c c u m u 1 a t i o n of pus which is usually the
product of a suppurative inflammation; it may de-
velop from suppurative phlegmons, suppurative wounds, puru-
lent hematomata, or metastatically through the blood. Pus
bacteria, are the most frequent causes of abscess formation
(staphylococcus and streptococcus pyogenes). Abscesses in
horses are very often due to the streptococcus of stran-
gles and the b o t r y o m y c e s fungus. In other cases
the abscesses contain diverse bacteria ; occasionally the mi-

crococcus tenius, the bacillus pyogenes fetidis, the colon
bacillus, and other bacteria are the causes of abscesses. Oc-
casionally abscess formation is due to a mixed infection
with various microorganisms (tubercular and actinomycotic
abscesses). In addition to pyogenic bacteria gas-forming or-
ganisms may gain entrance, for example, bacillus phlegmonae
emphysematosae, thus the so-called gas abscesses exist.
I'lrs Bactehia is Diffkrent Dombstic Animals. — In Horsbs
staphylococci and streptococci, aa wellaa botryomyces, are the most fre-
quent cauaea of supparation. According to Hell there are no poMtive
differential chsntcteri sties between the coccus of contagious pleuro-
pneumonia and pus cocci : the former may result in pus formation.
Fotb found streptococci of strangles and staphylococcus aureus in a
Strang les-abscess in the horse ; he is of the opinion, that under certain
conditions, suppuration occurs in horses not affected with strangles, as a
result of the activity of a streptococcus that cannot be differentiated
from that of strangles by meaus of our present bacierio logical methods.
Schuemacher and Willach found a diplococcus in pus taken from a
wound on a horse : they were unable to discover any differential char-
acteristics between this and the cause of contagious pleuro pneumonia.
They thought that mauy auppurative processes were related, therefore,
to contagious pleuro pneumonia. For shoulder abscess in the horse
Bossi named a special pus-organism | micrococcus myositidis equi aureus
and albus) . According to Baldoni the cocci of shoulder abscess in the
horse are identical with the pus cocci of man, except that they are more
virulent. According to Jeiisea bolryoroyces fungi arc the priucipftl
organisms in shoulder Bl>sceB8. Schmidt found strangles cocci in a
shoulder abscess. I, myself, found botryomyces fungi in 25-30'!^ of
shoulder abscesses; ordinary pus cocci in 50-75''!,; occasionally strep-
tococci of strangles were found. Lucet and Nocard maintain that
abscesses in Cattlb are caused by special pus-organisms that have
not yet been described, that they have demonstrated them bacteiio'
logically and given them special names as follows : streptococcus,
staphylococcus, and bacillus pyogenes bovis ; bacillus liquefaciens pyo-
genes bovis, and bacillus crasus pyogenes bovis. The bacillus pyogenes
bovis is identical with bacillus pyelonephritidia. In Swisk, ac-
cording to Grips, the bacillus pyogenes suis is a specific pus-forming
bacterium that can be demonstrated in nearly all abscesses. Kiiuneman
found a special bacillus in ^% of all processes in cattle, which he named
bacillus pyogenes bovis ; this is not identical with Lucet's bacillus.
Pure cultures of this organism produce subcutaneous abscesses in cattle,
in the vagina they cause a suppurative vaginitis. According to Glage
the bacillus pyogenes suis and bovis are identical; it forms the most
frcqaeut pus-organism in swine and cattle, and is apjiarently transmitted

36 ABSCESS

to swine through the milk of cattle suffering from disease of the udder.
Jensen found the colon bacillus in prostatic abscesses in the DoG, he also
found the same organism in suppurative peritonitis^ cystitis, and pyelo-
nephritis in the same animal.

Forms of Abscess. — The following forms of abscesses
are recognized: hot or cold (caused by acute or chronic
suppurative inflammation). Cold abscesses are usually of
tubercular, actinomycotic, and botryomycotic origin. Other
classifications are: superficial and deep, primary
and secondary, symptomatic or metastatic
(strangles, pyaemia, tuberculosis, glanders), simple and
multiple, congestive or wandering (wandering
abscesses either pass downward from their own weight, or
upward in the hoof, passing in the direction of least resist-
ance), subcutaneous, subfascial, intermuscu-
lar, strangles, bone, or hoof abscess. One also
speaks of a fecal or urinous abscess.

Occurrence. — Abscesses occur in all domestic animals,
especially in horses, dogs, and cattle. Avian abscesses have
a peculiar, dry, caseous appearance. Abscesses are usually
found in the subcutis, lymph glands, beneath fascia, in
muscles, and in the mammae ; bone-abscesses are rare. In
the horse they are most often found in the following parts :
pharynx (abscess of the lymph glands), at the coronet (coro-
nary abscess), throat (subcutaneous injection), shoulder
(shoulder abscess), saddle positions, gluteal region, the leg.
the anterior surface of the carpus, and the inner surface of the
metacarpus. In the dog their favorite seat is on the head and
throat (bites). Abscesses in old cattle usuall}- develop slowly
(cold abscesses).

Symptoms. — A subacute abscess has the appearance of a
circumscribed, hot, painful swelling. It is fluctuating
at the center and firm at the periphery. The skin is adherent
over its surface. In the absence of pigment one observes a
reddish-blue or grayish discoloration of the skin, it also has a
glistening appearance. Fever often exists at the same time.
Deep, or subfascial abscesses are characterized by a diffuse
swelling without fluctuation.

WOirND FEVER

oue must distinguish
Is, and new formations.

between hematomata. phlegmon;

An abscess is diagnosed as follows : it develop

ally under inflammatory conditions, it f!uctu

the

ski

able

ithe

irfac

olo

ati

white-skinned horses. Fever may also exist. To diagnose
a deep or subfascial abscess it may be necessary lo use an
exploring needle. Sometimes deep abscesses are char-
acterized by a high, septic, continuous fever, and by an
intense, diffuse, very painful swelling.

Treatment.— The treatment of abscesses is purely
surgical. It consists in early and complete in-
cision with subsequent antiseptic irrigation.
The formerly used "expective" treatment — waiting for spon-
taneous discharge of pus — is no longer considered good surg-
ery. The skin becomes necrotic, the process is prolonged,
suppuration is more extensive, especially in subfascial
abscesses, when the life of the patient is in danger. Very
large abscesses, especially subfascial, should be drained.
Caution is required when opening deep abscesses in the vicinity
of the larynx ; only the skin should be incised with a knife,
then bore with the fingers or some blunt instrument (sound,
blunt pointed scissors) to the depth of the abscess. The
opened abscess should not be tamponed, but
treated as an open wound and drained. Cold
abscesses may be treated with extirpation of their capsule
(shoulder abscess), sutured, and then drained. Subfascial
abscesses with pronounced estention, and necrosis of the
neighboring fascia and muscle (fascia of the withers in the
hoise as a result of fistulous withers) are occasionally incurable
(septicaemia).

Wo-

1 Fever.

Nature and Causes. — The term fever indicates a role
of symptoms that are complex in character; they are the re-
sult of various derangements of the general system. The most
important are : elevation of temperature, increased
frequency of the pulse, derangement of the distribution of the

WOUND FEVER

blood and blood pressure, as well as alteration in its
composition. Tlie digestive, respiratory, and nervous-
system are also deranged. Elevation of temperature is, not I
the only symptom of fevei

The exact changes that take place during the existence of
a fever are not yet fully understood. The most important
changes, on the one side, seem to be increased assim- I
i la t io n, especially of albumen, as a result of changes in the
blood ; on the other side, the heat center of the brain
appears to play a part. This center regulates the distribution
of the heat as well as the developni
(caloric center). When the heat c
of the temperature occurs : when it
the body temperature be
the heat center with a subsequent i

■nt of the heat in tlie body
ritatcd, elevation
led or paralyzed,
ubnormal. Irritation of
e of temperature may be

produced in various ways. Traumatic injuries from some
instrument or as a resullof other injuries (burns), or thermic
through a high degree of heat (heatstroke, sunstroke), num-
berless chemical agents (toxins, ferments, mallein, tuber-
culin), reflex action as a result of pain (.so-called nervous
fever). Conversely, (he heal center may become weakened
or paralyzed with a subsequent fall of temperature. The
factors which cause this condition maybe traumatic (de-
struction of the beat center), thermic (cold), chemical
{antifebrin, antipyrin).

In wound fever increased assimilation is combined
with alterations in the blood, derangeoienl of the heat regu-
lators, and irritation of the heat centers. Apparently this,
is due to the resorption of dissolved bacterial
toxins, a.s well as certain chemical agents
found in the wound secretions. Wound fever may
be termed a resorption fever. If the resorbed material
is of bactericidal origin — bacteria or their toxins — it is termed a
septic or bacterial fever (infection-fever, intoxication-
fever, septicemia, pyemia). In a great many cases fever
accompanies mild wounds, for example, after castration, or
non-infected wound.s, .subcutaneous bone fractures, blood ex-
travasations. The fever is apparently caused by the resorption

WOUND FEVER 39

of ferment-like products produced by degeneration of the
blood and tissues. Their action on the blood and nervous
system is similar to thai of the toxins of bacteria. Fever thus
produced is called aseptic or ferment fever. The
chemical agents thus generated are ferments of the blood and
tissues (fibrin-ferment, histozyme), organic material from the
degeneration of cellular tissue (nucleiu from the nuclei of
white blood corpuscles, free hemaglobiii), and occasionally
glandular secretions. One observes aseptic fever after the
transfusion of blood, as well as in horses that have been
restrained.

Symptoms — Elevation of temperature inwound
fever varies according to its intensity and course. In the dog
and horse it is classified as mild (39. 5° C) : medium ( 40,5° C) ;
high (41.5° C). Wound fever is sometimes continuous (sep-
ticemia), sometimes remittent, usually however, atypical.
It is seldom intermittent (pyemia). Aseptic wound fever
is not characterized by pronounced general symptoms, for
example, that following castration in the horse. In septic
wound fever, on the other hand, one observes: eleva-
tion of temperature, derangement of the appe-
tite, digestion, and activity of the heart; ema-
ciation; psychic derangements, etc. Septic wound
fever is often followed by septicemia and pyemia.
(See chapter that treats these subjects).

Treatment. — The main therapeutic problem consists in
the local treatment of the wound. In aseptic
wound fever it is usually sufficient to change the band-
age, thoroughly remove the pus, and disinfect
the wound. The drainage of wounds and incision
of abscesses produces the same result.

Septic wound fever, in addition to the above, should be
treated internally with febrifuges. The most active surgical
antipyretics (especially with synchronous weakness of the
heart) are camphor and alcohol, they are best adminis-
tered in the form of subcutaneous injections of spirits of
camphor.

40 septicemia

5. Septicemia.

Definition and Causes. — Septicemia (sepsis,
blood poisoning, putrid fever) is a severe wound infec-
tion disease characterized by the presence of bacteria and
their products of degeneration in the blood. Unlike pyemia,
it is not accompanied by internal or external local affections
(metastasis) , but by general changes in the structure
of the internal organs. This is especially character-
ized by swelling of the spleen, and parenchy-
matous in flammation of the liver, the kidneys,
the heart, and the other internal organs. It
often occurs that septicemia and pyemia are combined (sep-
tico-pyemia, pyo-septicemia).

From an etiological standpoint two principal forms of sep-
ticemia are recognized : one due to the action of bacteria,
the other to that of ch e mica 1 poisons (toxins). That
due to bacteria is termed bacterial septicemia, bac-
teriemia, or septic infection; that which results
from toxins is termed septic intoxication. The former
may be transmitted through the blood to other animals,
while the blood of the latter is not infectious. Between the
two there are transitional forms and combinations (mixed in-
fection). If no cause can be found for the existence of sep-
ticemia, it is termed cryptogenic septicemia.

I. Septic infection is caused by several bacteria,
they may be cocci or bacilli. One can differentiate, therefore,
between a coccidial and a bacterial septicemia.
Some of the cocci which may produce septicemia are the
streptococcus septic us and the micrococcus te-
t r a g e n e s; the cocci which produce pyemia, namely, strep-
tococcus pyogenes and staphylococcus aureus
are also able to cause septicemia. The experimental inves-
tigations of Koch have demonstrated the pathogenic action
of the following bacilli : the so-called bacillus of mouse
septicemia, as well as the bacillus of rabbit
speticemia, the group futher includes the colon bac-
illus and the bacillus enteritidis. Specific

SePTICBMIA

speticemias, in contrast to the simple forms, may be
caused by malignant edema, anthrax, blackleg, the organism
of erysipelas, and hog cholera, the septic form of so-called foal
lameness, calf septicemia, septicemia hemorrhagica (.wild-
seuche), chicken cholera, and chicken plague.

2. Septic intoxication is due to (he entrance of
the poisonous products of bactericidal metabolism. These
products are termed toxins, ptomaines, putrid vims,
cadaver or septic poisons, and meat poisons,
their chemical structure is extremely variable (toxalbumen ;
albnmoses, organic bases namely, amine and nuclein bases,
fatty acids, and aromatic products). Usually these toxins are
absorbed from a purulent focus on the surface of the body, or
they may be absorbed from the uterus, intestines, lungs, or
liver. As a rule il is the above named pathogenic bacteria
that colonize in ichoric wounds, in retained decomposing sec*
undines 1 puerpural septicemia), or in ichoric foci in the in- ■
testines and lungs, and whose products of metabolsim are re-
sorbed. Other organisms, especially the bacteria of put-
refaction, can gain entrance to wounds and pus foci in the
body. They result in putrid decnmposition of animal
tissues, from which are formed strong chemical poisons, which
are resorbed and cause general intoxication. That form of
septicemia due to the products of metabolism of putrefactive
bacteria (saprophytes) is termed sapremia. Proteus
v ulgaris and theclosely allied bacillus ce 1 1 u 1 e f orm ans
(flesh poisoning) are especially dangerious iu this connection.
Migration of the saprophytes, themselves, to the blood, was
formerly supposed to be a cause of septicemia ; according to
recent investigations this appears to occasionally take place.

Pathology. — On post mortem examination of animals
that have died from septicemia, (he following conditions are
noted; The blood is of a tar-like consistence and has the
appearance of varnish. The blood as well as the solid organs
of the body manifest a tendency to putrefy. In septic
infection a microscopic examination of the blood reveals the
concerned bacteria, which have led to a decomposition
of the white and red blood-corpuscles. The

SEPTICEMIA

white blood -corpuscles, in particular, are transformed to form-
less colonies of bacteria as a result of the numberless organisms
that have gained entrance. As a result of parenchymatous
disease of the vascular walls, there occurs a hemorrhage
into the mucous membrane, beneath the serous membranes —
especially beneath the endocard ium— into the mcsome-
trium and omentum, kidneys, spleen, and liver.

The spleen, liver and kidneys usually show par-
enchymatous swelling, the heart-muscle, and
occasionally the skeletal muscles, have a cooked ap-
pearance. In many cases there also exists an ulcerative
endocarditis; a catarrhal, hemorrhagic, and even diph-
theretic enteritis; as well as a pareucbyniatous and hem-
orrhagic nephritis. In very acute cases of septicemia
these changes are not pronounced. This is especially true of
the toxic form, where, similar to poisoning, post mortem may
give negative results, (Caution in the inspection of meat !).

Symptoms. — Septicemia is the most important and the
most frequent general wound infection disease. It is found in
the horse after traumatic, pyo-ichoric inflammations of the
joints (pedal joint, tarsal joint) and the tendon-sheaths, as
well as in severe septic, subfascial and intermuscular phleg-
mons. In the cow and bitch septicemia frequently follows
parturition (puerperal septicemia). Comparatively speak-
ing, swine are very resistant to septicemia (castration). Ac-
cording to the seat of origin, the local changes are extremely
variable.

I. Septicemia in the horse is characterized by a septic
phlegmon around the margin of the wound. Sometimes local
wound changes are absent (peracute cases). The general
symptoms usually begin with severe febrile indications.
The temperature may go to 43 C, and over, occasionally it is
accompanied by chills, the pulse is frequent, small, and
finally imperceptible, heart weakness is pronounced.
In many forms of septicemia, elevation of temperature may
fail. One occasionally observes severe general symp-
toms: complete loss of appetite (occasionally horses eat a
quarter or half ration to within a short time of their death) ,

SEPTICEMIA 43

pronounced emaciation and vreakness, beaviness of the
sensorium. trembling, sometimes paralysis of the posterior
limbs, profuse and continued perspiration, dirty -red
or icteric coloration, and echymosis of the mucous
membranes, discolored, albumenous urine, and towards
the end, profuse diarrhea with symptoms of colic.
The duration of the disease is extremely variable ; it may ter-
minate fatally within twenty-four hours, it usually continues,
however, several days, and may exist for several weeks (in-
flammation of the pedal joint).

2. In cattle puerperal septicemia is the most
frequent form (septic form of puerpural fever). Clinically,
both forms of septicemia may be recognized ; infection and
intoxication. Puerperal infection is characterized,
either by a puerperal phlegmon, a septic metritis
(fever, straining, groaning, pain on pressure over the abdo-
men, stinking, chocolate colored discharge from the uterus,
diphtheretic changes on post mortem) ; or by an acute
puerperal septicemia, which is differentiated from
the preceding by general septic conditions ( sudden loss of ap-
petite and lacteal secretions, high fever, yellow mucous mem-
branes, and weakness). As a rule it leads to death in from
one to three days, and the post mortem changes are frequently
slight or imperceptible. Puerperal intoxication ex-
ists, either in the form of a parturient paresis (para-
lytic calf fever, auto-intoxication), or slight symptoms of dis-
ease (weakness, gastric derangement, normal temperature).
Retention of the after-birth, especially, is a cause
of a mild form of sapremia; sudden paralytic conditions
with death after a few hours are rare (De Bruin).

Treatment,— As in a wound-fever, so in septicemia,
local antiseptic treatment of the wound is of
greatest importance. Apply powerful disinfectants, carefully
remove stagnated wound-secretions, give thorough drainage,
incise early all fluctuating spots. A puerperal uterus should
be thoroughly irrigated and any retained placentae removed.
The internal administration of febrifuges is of secondary im-
portance. Those agents which have been of greatest service

are: camphor, alcohol, and quinine. Argentua
c o 1 1 o i d a 1 e as well as quicksilver in the form of small
doses of calomel are employed internally. Antistrepto-
coccic serum, on the other hand, has not proved satisfactory.

6. Pyemia.
Definition and Causes. — Pyemia is a general wound-^
infection disease ; in contrast to septicemia it is characterized']
by the formatioD of suppurative foci of disease i
the body (metastases). The bacteria of pyemi.
are essentially those of septicemia. The mo!
frequent causes of pyemia are pus-cocci, especially,
staphylococcus pyogenes aureus, and strept
coccus pyogenes. These are found in any abscess, and
are the ones usually involved in metastasis (staphylomycosis
multiplex, staphyloheraia, pyemia metastatica). They enter
the blood from a primary pus-focus, coloDi^e in the various
internal organs, where they multiply and cause suppuration.
An acute or chronic pyemia depends on whether the pua
cocci enter the blood stream suddenly, and in large numbers ['
or gradually, and in small numbers. In general, pyemia is.'
much less common than septicemia. In the horse it is usually
the result of a septic, degenerating tl
phlebitis arising from wounds of the hoof, umbilicus, of'
the jugular vein, following injuries of the bone as well as from.
resorption of internal pus foci (strangles). Pyemia of foals
and calves which develops from a suppurative thrombo-'
s of the umbilical cord (pyemic form of the so-called
■ calf lameness) is of practical importance ;
s possess no bacteriological individualities, in foal
:, especially, staphylococci as well as streptococci have
been demonstrated as a cause of the disease ; in calf lameness
the colon bacillus has been recognized. In cattle, pyemia
usually develops from the internal organs, especially from the
uterus (pyemic form of puerperperal fever), when it originates
from a suppurative ihrombo-phiebitis of the uterine veins, it
seldom results from traumatic gastritis. Strangles
in the horse is a specific type of pyemia ; the same is true

phlebiti
foal 1;
these di

of so-called dog distemper (suppurative folliculitis of the lips
with secondary lymphaugitis. lymphadenitis, and metastatic
formations). Occasionally the origin of pyemia cannot be
determined (cryptogenic pyemia).

In many cases it is impossible to distinguish between sep-
ticemia and pyemia, they both exist at the same time ; one
then speaks of a pyo-ceplicemia. From a standpoint
of practical surgery it is essential, however, to differentiate
between cases of pure pyemia and septicemia.

Pathology. — The anatomical characteristics of pyemia
are a greater or lesser number of suppurative inflam-
matory foci (metastatic processes) in the internal and
external organs (lungs, liver, spleen, kidneys, brain, heart,
skeletal muscle, joints, tendou-sheatbs, etc.). In foal lame-
ness, suppurative inflammation of the synovial tissues of
the joints is the main characteristic (polyarthritis pyemica).
One also obser\'es, suppurative inflammation of
other serous membranes, the peritoneum, the pleura, the
meninges ; as well as suppurative inflammation of the eye
(suppurative choroiditis and panophthalmia). Occasionally,
one also observes, as in septicemia, an ulcerative endo-
carditis and numerous circumscribed hemorrhages on
the serous membranes, in the skin, in theeyes, and in themus-
cles. Anatomical changescharacleristicof septicemia may also
be present (septico-pyemia). Finally, the local changes
are sometimes very characteristic ; for example, as a result of the
colonization of numerous bacteria in the venous walls of the
wound (umbilical wound ), there occurs a suppurative inflam-
mation of the vascular walls with suppurative degeneration of
the organized thrombus (suppurative thrombo-phle-
bitis). This forms a source of the suppurative embolic foci
within the body, as well as a point of origin for many bacteria
that are present in the blood and inner organs (micrococci).

Symptoms. — Pyemic wound infection is ushered in with
a varying, frequently intermittent, very ir-
regular fever, and occasionally with ch il Is. After this
there develop symptoms of metastatic inflammation
of the lungs, orsymptomsof abscess formation ic

46 THE REMAINING WOUND INFECTION DISEASES

the liver, kidneys, or brain, pyemic polyar-
thritis, tendovaginitis, pleuritis, meningitis,
«tc. Occasionally, one further observes multiple, sub-
cutaneous pus- foci, which often develop suddenly in
large numbers in the form of phlegmonous swellings in
various parts of the body. Pyemia usually runs a longer
course than septicemia ; usually from a few days to a few
weeks, depending on the seat and course of the metastasis.
It may develop into a chronic pyemia with pronounced
-emaciation of the animal. Recovery is more frequent than in
septicemia, although it is uncommon, and convalesence oc-
curs only after a long time.

Puerperal pyemia (pyemic form of puerperal
fever) is characterized by a febrile polyarthritis on the
carpal and tarsal joints, mastitis, osteomyelitis,
and tendovaginitis of the flexor tendons, as well as
chronic parametritis (multiple abscess in the pelvic
connnective tissue, chronic emaciation). It occurs in cattle,
but is rare in horses.

Strangles-pyemia (so-called wandering strangles)
develops principally in the form of abscesses of the lymph
glands in various parts of the body (superior, middle, in-
ferior cervical glands, axillary glands, bronchial glands, omen-
tal glands, pubic glands, lumbar glands, popliteal glands) as
well as abscess formation in the brain, spinal marrow,
omentum, udder, kidneys, pancreas, orbit, etc.

Treatment. — As in septicemia, the principal treatment
consists in careful local disinfection, drainage, and
incision. On account of its specific action as a febrifuge,
quinine may be tried.

7. The Remaining Wound Infection Diseases

Ervsipbi«as. — In man, this disease is a specific, infectious
inflammation of the skin and subcutem; it involves the
rete Malpighi and the papillary bodies. Through the medium of the
lymph stream it rapidly spreads over large areas of the skin, and
leads to severe general infection; the local changes,
however, are usually slight. A superficial wound is usually the point of
origin of the infection. The bacteriological investigations with

B REMAINING WodwD INFECTION DISBASBS

refercDce to the bacteria which cause erysipelas are very contiadiclory.

It was formerly thought to be entirely due to the streptococcus
erysipelstis. a specific orgamsm discovered by F e h lei sen, Ac-
cordiag to recent investigations ( Baumgarten, Fraenlcel, and othera),
the specific action of the coccus of erysipelas, on the other hand, is very
doubtful; this organism appears to be identical with streptococcus
pyogenes. The theory has been advanced, therefore, that erysipelas
is not a specific wonnd infection disease, but a localized form of
septicemia in the skin. According to its virulence, each strep-
tococcus may cause suppuration, erysipelas, phlegmon, abscess forma,
tion, pyemia, and septicemia (Martnorek ). It is also claimed that
erysipelas may be caused by staphylococci and typhus-
bacilli. In man, therefore, according to the etiology, two forms of
erysipelas are recognized: the primary, genuine type, due to strei)-
tococci ; and tlie secondary type, which occurs during the course of
various infectious diseases.

The symptoms of erysipelas in man consist in the appearance
of a diffuse red swelling in the vicinity of the wound ; the swelling
spreads very rapidly, and frequently along the course of the lymph
streams (migrant erysipelas, ambulant erysipelas.) In other espies new
inflammatory foci arise in several distant places, they are manifestly
metastatic (erysipelas multiplex). Corresponding to the extension of
the erysipelas, there is observed a rnpidly developing, high grade
fever. As the result of an active serous ejiudation, blisters are formed
in many places on the Enrtace of the skin (erysipelas bullosum |. As a
rule, the erysijielas heals with rapid sinking of the fever and desquama-
tion of the skin. In typical cases the healing is as rapid as the develoj}-
ment (simple, typical, non-complicated erysi]>elBS|. In other cases
phlegmonous and gangrenous processes are present (erysipelas phleg-
toooosum and gangrenosum 1. Other complications are: erysipelatous
pneumonia, pleuritis, endocarditis, pericarditis, myocarditis, diphtheria
of the pharyngeal ' mucous membranes, enteritis, intestinal ulcers,
nephritis, inflammation of the brain, neuritis, peripheral paralysis of the
nerves, suppurative panophthalmia, otitis, parotitis, as well as septicae-
mia, and pyaemia. In individual cases it li:is been observed that new
formations (caninoma, sarcoma, lymphoma, lupus) disappear after an
accidental infection with erysipelas. Based on this experience, the un-
safe experiment has been made of artificially producing erysipelas on
the new formations mentioutd by means of injections of erysipelatous
cocci ; the object being, to cause healing (erysipelas inoculation, cura-
tive, artificial erysipelas). Treatment of erysipelas consists in epi-
dennatic and endermatic (parenchymatous i applications of disinfectanta
(carbolic acid, creosote, creolin, lysol, tar, ichthyol, tincture of iodine,
sublimate], incisions of the skin, with antiseptic irrigation, application
of pressure to the healthy margins (collodion, strips of sticking-plaster),

THE REMAINING WOUNi) INFECTION DISBASBS

u ncll u cold. Recently the antistreptococcic senim has been applied.
The fever is treated with camphor.

CoiicerniiiR the Occ^•RR^^■c^: of Ervsipelas is .^simals def- |
ttiite knowledge is scarce. This is partly due to (he fact, that the
most chanctcrrelic Bymptooi. (he ledness of the skin, is wanting in
animak on account of the pigment formation and hair. On the other
hand, genuine, typical erysipelas appears to be much
less common in domestic animaU than in man. For
thig and other reasons, it is better not to use the word erysipelas in vet-
erinary surgery, but in general, to speak of inttammatory edema, i
III CATTi.r. ■■erysipelas of the udder," an erysipelatouB, in- I
fectiooB inflammation ol the skin, is seen in the udder before and after
parturition. The skin, on the posterior quarters of the udder in partic-
ular, and occasionally on the inner surface of the tibia, is very red,
painful, and swollen. It is alleged that this affection is frequently
complicated with phlegmons of the subcutem, and either lead* to
deK[uaniation and healing, or permanent schlerosis of the skin. A fatal
tenaioation is never observed. In the Horse, phlegmon of the poster-
ior lltnbs is considered erysipelas by many: Kitt, for example,
definesitaaa dermatitis erysipelatosa, while Schindelka claseifies
it with the phlegmons. It is very questionable if the so-called erysip-
elatons form of scratches is genuine erysipelas. Maize w |Zur Aetio-
logie der Mauke. Inaugeral-Dlsseration. Dorpat, 1H99I sustains the
theory, that with few exceptions, those inflammations of the fetlock
region, known as scratches, are genuine erysipelas. In scratches of the
horse he claimed to have found regular streptococci, which were identi-
cal with those of erysipelas. Also, according to his exi>erimeuta,
eryaipeUs could be successfully transmitted from man and dog to the
•kin on the fetlock region of the horse. Considered from the stand-
point ; that specific erysipelatous cocci do not exist (see above); that
these cocci are found much more often in non-eryaipelatons, simple,
suppurative inflammations of the skin ; that the disease is neither gen-
eral, nor has a tendency to spread ; the erysipelatous nature of scralches
is not a well supported fact. On the other hand, perhaps the case
describedby Semmer (Oesterreichische Monatshefte. 1S95. S3S9) was
one of genuine erysipclna. Three horses showed BweUing of the lips
after transportation in severe cold ; this sjiread rapidly to the region of
the checks, the pharynx, the throat, and Hie anterior part of the thorax.
All three lioises died after a short time. I'ost mortem examinations
revealed the following condition : an exudate in the swollen portions of
the skin that was sero-fibri nous, partly fluid, and partly gelatinous in
character; the pleura, pericardium, and jieritoneum presented hemor-
rhagic inflammations : in the thoracic and abdominal cavities, as well as
in the pericardial cavity, there was an abundance of dirty-red fluid ; on
the omentum, and under the pleura of the lungs, there was an abundant

MALI

exlravasaie of blood: the spleen was enlarged. A pure culture of
staphylococci were secured from the seroas exudate of the swollen skin.
Bxperiniental cutaneous and subcutaneous injections of these in horses
resulted in large, erysipelslous swellings at the jjoint of injection
(shoulder I, wbich spread downwards to the carpus; fever and loss uf
appetite were also noted, in Dons, among 70,000 cases of disease, I
have observed symptoms referable to erysipelas in only four cases ; I
have described one case in the Wochenschrift fiir Tierheilkunde [ 1894 |,
Schindelka's rHautkranltbeiteii. 1903) experiences are identical
with mine ; he has observed only three eases of erysipelas in the dog.
Miille r , also, (Lehrhuch der Chirurgie. 1S93) has only occasionally
observed typical erysipelas in the dog. In SwisE, on the other hand,
erysipelas is much more common in the form of erysipelas of the head ;
it may also be transmitted by inoculation to other swine (Fehlei-
seti). Nothing definite is known concerning genuine erysipelas in
sheep, cats, and birds.

M ALIGN AM T Edema. — Malignant edema is a specific pbleg-
moD: it may be termed a sero - he m o r rh a g ic iniiltration of
cellular tissue with gas formation. Apparently, the cause of the
disease may be due to several bacteria. The most important is the
malignant eilema bacillus (bacillus eilematis maligni) dis-
' covered by Koch. The bacilli of malignant edema form spores ;
they are very motile; liquefy gelatine; take Gram's stain ; they
arc anaerobic rods 3 to 5 micro-millimeters in length, and one
mirco-millimeter broad ; tbey are four limes as long as broad and a
trifle slimmer thun the anthrax bacillus. Several rods become adherent
to form t breads 10-40 micro-millimeters in length. After the
death of the animal the edema bacilli increase rap-
idly in lengtli. and form threads which are partly
straig.ht . partly curved, and partly twisted; they are
arranged in such a manner as to give one the impression of bacilli
Arranged u[)on one another in rows. Spores are afterwards formed from
these threads. In cadavers of asphyxiated individuals tbal have been
kept tor 34 hours at a temperature of 38'' C. large numbers of malignant
edema bacilli are found in the blood, especially in that of tbe jiorlal
vein 1 migration from the intestines). By the same method, the so-
called cadaver-bacilli are constant in the blood of the liver and
in the spleen after 11-24 bonis, in the general circulation of
our domestic animal cadavers sooc after, as the result of
death due to dyspnea, especially from colics, when they remaini un-
opened for some time in a warm place (confusion with anthrax bacil-
lusl). There are also vorions forms of paeudo -edema bacilli
(earth bacilli).

The edema bacillus is extremely abundant in nature. It
is eipecially numerous in the upper Uyen of the earth. If a small

MALIGNANT BDBMA

amount of ordinary garden aoil is brought beneath the skin of a rabbit,
the animal diei> from malignant edema in from 14-36 hours. The spore*
of malignant edema are also found in horses that are entirely oormal, in
the saliva and in the f e cea, so that infection may readily occur in
the oral cavity and in the vicinity of the anus. For this reason, infec-
tions are very common iii the vagina and in the puerperal

of 1

< of s

, fe

va, da

illu

nlo

ue. The e
1 comparatix

trance of this organ ism i
^ly harmless because the 1

to the circu-
lygea of the

latiiig blood i

blood is fatal to anaerobic bacteria. Inoculation of the
cutis also, produces no results (oxygen of the air). It is oloo
di£Bcult for the bacilli to enter granulating wounds. Moreover, the
subcutaneous and submucous connective tissue must be previously
weakened by means of previous contusions, the entrance of foreign
bodies, ulceration, etc.. before the edema bacilli gain entrance. This
depends, first, on the existence of a nourishing media for the bacilli
(serum, lymph, blood). Then the infectious material must be as free
as possible from tlie oxygenated blood, as the oxygen of the blood i<
fatal to the bacilli. The greater the interruption of the circ il-
lation in the infected area, the more favomble are the condition* for
the growth of the edema bacillus. According to recent investigation
(Resaou), genuine spores of the edema bacillus cannot develop in the
healthy tiseuea of living animals (phagocytosis). Their development
much more dependent on association with otber bacteria
[microbes favorisants) cspeuially with stapbylo cocci. This conditioii
■eiplains, as in tetanus, that, regardlessof the frequency of Uie occurrence
■o{ the edema bacillus (ubiquity ), cases of sickness from malignant
edema are relatively uncommon in animals.

Since Kitt has demonstrated that malignant edema could be ex-
perimentally transmitted to domestic animals, numerous cases have been
observed in cattle, horses, and shee p ijenson and Sand, Reuter,
Attinger, Elmenhoff , Nielson, Priis, Mesnard, Besson, Home, dc Bruin,
Willacli. Albrecht, Kitt, Gilruth, Reakes, personal observations). The
causes are due to injiiries, for example, subcutaneous injertions of
eserine, injuries of the tongue by means of food, foreign bodies, bites,
and perforating wounds; injuries to the uterus, the vagina, and the vulva
(so-cslled puerperal blackleg which may also be caused by the pseudo-
edema bacillus and the genuine blackleg bacillus), operations with un-
clean instruments, castration of sheep nnd goats, amputation of the tail.
In the Province of Brandenburg, in 1S97, from 600 freshly shorn sheep,
50 died from malignant edema ( Lembcken ); in New Zealand, in 1900,

t ii'.-- £:c:i

TETANUS

among 4,(XK> short! sheep. 300 died from malignant edetna. In one case
ill a horee, I observed a twelve-hour period of incubatioii. Obviously,
malignant edema baa been known for a long time in veteriiiarj science
bill under other names (flying necrosis, black necrosis, fire, progressive |
cellular inflammation ), and formerly as blackleg, sometimes as anthrax
and erysipelas, as well as witdseuche and cattle plagtie.

s of malignant edema consist of a spelling itl

of the

poll

of iufe.

Thii

elo

., dou

BudcJenly, is

spreads rapidly lo the neighboring tissues, and fre-
quently crackles on palpation. The favorite seats of the
edematous swellings are in the following places : the tongue, pharynx,
laryngeal and parotid regions, the head, throat, and upper limbs, the
iumljat and sacral regions. The center of the swelling is usually cool,
relaxed and painless ; while the periphery is tense, hot, and sensitive.

tissue, is filled with a gelatinous exadate, and a foal
smelling gas. The yellowish-red edematous fluid contains
many characteristic edema bacilli and IhreadN, which are not
present in the blood during life, and are only occasionally found
in the blood after death. In many cases, however, the local symptoms
are absent. One also notes high grade dyspnea (edema of the lungs),
ah well as severe gastric derangements (inflammation of the c
membrane 1. The disease usually runs its course in a short time
to three days), terminating fatally with severe febrile sympt
When the disease is confined to the head, recovery sometimes o
On post mortem the spleen, liver, and kidneys are usually ii

pie
The

cula

all:

cut,

ions — admi
p to V i de drainage
tionof Attinger.
they favour the extei

phlegmons, couaists in making free incia-

-the most active opponent of anaerobic bacilli ;

apply antiseptics. According to an observa.

11 fomentations appear to be contra-indicated ;

of the edema. With reference to the liter-

ature on maligoaut edema Cf: Friedbei^er and Frohner, "Spec-
ial Pathology and Therapeutics". Sixth Edition. 1904. Vol., II. Also
Kitt: Monatshefte fiir praktischeTierheilkuude. Bd. Vlll.

Tetani.\s, — This was formerly considered a disease of the nerves
characterised by trismus. As a result of the investigations of
Nikolaier and Kitasato it was found to be a genuine wound-

ittte

ed by I

of I

It ia most frequently observed in the horse after injuries lo the hoof
(nail pricks, nailing, treads on the coronet) , the posterior limbs and the
head, after castrations, after operations on the tail (amputation, setting
op), subcutaneous injections, removal of setons, entrance of foreign
bodiei (kernels of grain ) into the guttural poaches. It is also observed

^ . TETANUS

tu % i( ( U< v<^li^**^^** imrrperalis after injuries to the vagina and uterus.

..bMiwkUoii, iiiiihttu'al wounds in calves), sheep and goats (castra-

ii^uk nii'tuluuiu, iirlon, umbilical wounds). In dogs, however,

u i.kiot. ij *^u* n»*lv u\Tv : two cases have been observed by Moller.

\»u,'ii», .i..Ksnlim'.**r»l «l«)KH, I have never seen a case of tetanus ; the

^.. I iiu lu t) »niiiuUtu>nH of j^arden soil into dogs by Nikolaier also

.X. u, >.^M\% n'mih* K itt, on the other hand, was able to produce

K, ...ti ».t .»»».'.»* I«\ iiM*'»<>»»K pure cultures.

Ms 1 , t I u u t ti It i' 1 11 u s (bacillus tetani) is in the form of a rod,

,,. ij.K. » .,u K i»ui. niiwic note, or cooking ladle : the end contains

, . , . u tJ iiMiml rvrry where, especially in garden soil, as well as

, , , <i y\ss\ U\m hciMi oovcri'd with horse manure, it is also

..I ..,*»•. .u»i»i*i»i h»>ise 8talls. As experimental inoculations

,, . A^%^%\\ k.u*U'u •»oil iuivc proved, infection usually re-

, ,.1,1 {Us » u 1 1 u n o e o f b a c t e r i a 1 e a r t h ; other ob-

i I t . lull itMi ihulf nirriersof the tetanus bacillus (horse-shoe

,1 ^^,.,Ml. nirttiumi'nts. dust of hay, manure, kernels of

x^. J.,. V omjIiIuiiim for the infection are made more favora-

...i»i»i »»u »•»«"»•*>'•*«'»*'*' ^f ^^^^<^'r microorganisms, especially

iittU((>( iinu'iobos favorisants). In contrast to the

, . . , %\\\.% .»nd |»^ «inia. the tetanus bacilli do not enter the

.ii«M( M tU» point »)t intVotion where they develop a

J », , I ,, s I II th'taiintox-albiimen ., which is resorbed

,»i. i.ttui III li'liinospasinin il produces convulsions as

...... .«.i ili« ipiuiil Ml irr<jw. This toxin contains an un-

, .. . .1 .liuir i»l o.»K)0?5 K»"«"is. equal to '4 uig , equal

»..,i.ln, 1 H il« '»lh m the li^rse : it is a thousand times

^ »,un«i .l»ll>.«l tlof^^' for the horse- -0.25 grams).

I «.^ \\\y iiiih',tiHire of the axis cylinders of the peri-

.,.1. .» »»• tl»«' <«'"trMl nervous system. Tetanus.

.(.,«, I .%M .til inlertitms disease, in which a general

,«.!*, Ixii.tl point of infection. Occasionally one

».*»i* 11% I »od of incubation, several days

x^a »»i uimI !■ I"»«" 4 2t)days). in which tetanus

.,x. » * \\%\\\\ diMiiilei tion and bandaginj; of the

. ,, wxA 1 1» Mtn.;»ti«>n are complete. I have ob-

,,. .!« ^^^ % M II toll V jlaysin a horse (Monatshefte

I. "■•" •

», I oom I »»«»•*'»*< tn loekinj; of the jaws 'tris-

.,» ,»-i*»i» oJ th»' head, throat, and l)ack ^ortho-

I . » »» ^MtvAtior ol liio throat (Opisthotonus and

-*\\»'U«»- UV%* jHiMition of the limbs; stiff,

I . \k\\ Hii'l «•«»•• . pioiioiinced contraction of the

.M .»u il d\ Npiiofrt mjHWUiH of the inspiratory mus-

X ».\ unub»l»tv. timidity; and perspiration. In

. , t^ vUUiM vorv inpitl l«U'«th after one to three

WOUND DIPHTHERIA

days), or acute (death after four to ten daya)
ially in the non- frequent cases of recovery, i

cbrouic courst^ is observed i mau; weeks). One
contagious-like outbreak of tetanus (experience

1 clinics). The moital
nst mortem is apparently
itisfactory (local disinfection ;
ition of the tail, for example ,

horses ia from 50-S
negative. Treatment is
removal of the foci of infecti
removal of external excitat

531

I other cases, espec-
ibacute and even «
laliy observes m
tary horses

The
not very

tics f. Administration of chloral hydrate, bromide of potash, morphine.
The Ireatmeut of horses suffering from tetanus with tetanus antitoxin
has not proved satisfactory. Antitoxin, on the other hand, has proven
aseful as prophylactic previous to operations (Nocard, Labat). With,
reference to the lite rat nre on tetanua see : Friedberger and
Frbhner, "Special Pathology". Sixth Ed, 1904, Vol. II,

WovNQ Diphtheria, — The name wound diphtheria (hospital gan-
grene, gangrena nosocomialisi indicates a wound infection disease
which was formerly very lommoD, but which has become infrequent
tinder the influence of modem antiseptic*. It consisted of a coagu-
lation necrosis of the granulations as a result of the action
of specific bacteria (necrosis bacillus). The granulalions are trans-
formed into a yellowish-red, suppurative, ichorous pulp (croupous and
diphtheritic form) ; or into a grey, pnlpy, gangrenous mass (ulcerative
(onn) ; or into a stinking, putrid and soft mass similar to the pulp of a
spleen 1 pulpy form). Treatment consists of burning early, or canteri-
'ation of the wound with chloride of zinc. Bayer has described a case
in the horse. The tissue in the region of the parotid glands was trans-
formed into a greenish- brown, fetid mass: the process was accompa-
nied with the formation of the gasses of degeneration, which had pro-
duced an emphysematous condition of the neighboring tissues. I have
observed similar cases in the horse.

Glanders. — In rare cases, wounds in the horse become infected
with the bacillus of glanders (primary glanders of the skin). This
occurs, especially, on the extremities, abdomen, thorax, shoulders, and
head- There then develops from the wound, a craler-like glanders
ulcer; it is cliaracteriied by tenacious, discolored, frequently hemor-
rhagic secretions; from the ulcer, wreath-like swollen lymph vessels
extend to lymph glands which are also swollen iglandulat lymphangitis
and lymphadenitis). Lameness exists according to the location of the
glandular processes. Occafiionally there also develops a chronic
glandnlar phlegmon, which may finally lead to elephantiasis
of thi^ extremities and head (glandular pachyderms). I have described
one case of this kind in the horse < Report 1883), Richler haa
described a case of glanders of the eye I glandular keratitis) (Zeit-
schrift fiir Veterinaerkunde, 1896). For further information concerning
glanders, especially with reference to differential diagnosis of the same,
refer to text-books on special pathology.

RABIES

Rabies. — RabicK is a genuine wound infection diBeai^ : the cause i
of the infection has not yet been discovered ; infection gains entrance f
from the sali\'a through the medium of wounds caused by bitea, ,
and then passes into the body. The bites, tberoselres, present no ]
special c Israel eristics, as a rule thej heal similar to Ihe wounds of
tetanus. The acquired virus is sufficient for the development of ttte
disease, the appearance of the first visible symptoms may requite
weeks, nnd even months (long period of incubation). According
to paragraph 35 of the government laws which refer to animal plagues, ,
no attempts can be made to cure animals affected, or supposed to be I
affected, with rabies; animals affected with rabies must be killed I
immediately (paragraph 37): those supposed to be affected must be- I
killed or confined ( iiaragrBphl34). In man, treatment consists in cauter- T
ization, cutting out the wound, as well as in the application of strong 1
disiafectantK (sublimate, creolin, aqua chlorata, calcium ]]ermanga|jate,
etc., carbolic acid is uuetfioient ).

Blackleg, — This is also a wound infection disease in which Ihe
blackleg bacillus gaiia entrance to the wound only through inju-
ries to the slcin and mucous membranes (the subcutis and submuco&a).
Blackleg, therefore, may be considered as a specific phle
of cattle, similar to malignant edema. It is characterized by edema- |
tons swellings of the akin which develop rapidly and crepitate, the c
ters of these swellings undergo necrotic degeneration, tbey are
located on the upper parts of the limbs, the throat, the shoulders, the
inferior surface of the thorax, etc, the motions of the animal are sImv
deranged ; there are swellings in the regional lymph glands ;
general symptoms, and high fever are present. The course of the dis-
ease is usually rapid, terminating fatally in from one to three day*. ]
Treatment of the area of infection is usually torj late ( incision. disinfeO' I
lion amputation, ligature). The so-called puerperal blacl
of cattle is usually, not a case of genuine blackleg, but partly
phlegmon, partly a malignant edema (Cart) ; sporadic cases of genuine
puerperal blackleg have been identified by R i e v e 1, O 1 1. and
Ostertag. For further information cuaceruing blackleg see text- |
books on special pathology, as well as Kitt, Monatshefte fiir praklisc
Tierhietkunde, Vlll.

Anthrax. — In contrast to man, anthrax is rarely a wound infection
disease in animals. In addition to the ordinary infection through the (
intestines, one occasionally observes sporadic cases of ■
anthrax bacilli through wounds in the skin an
branes, after previous ojierations (castration), bites, or punctures from
insects. There exists, first, a local inHammatory focus in Ihe skin and
mucous membranes (anthrax carbuncle, anthrax edema)
this is followed by a rapid general infection, which usually has.
. a fatal termination. Cases of anthrax of the skin and i
btanes were formerly described under the names, carbuncle disease, boil

tn of wildseucbe
laterial into small

from the Iwitch.

wound infection

TREATMENT OF WOUNDS

fever, anthrax of the tongue, anthrax of the g
carbuncularis.

WiLDSF.rCHE.— The so-called exanthematic fo
exists apparently through the entrance of infections
noonda of the skin or mucous membranes (injurie
accidental injnriesl. and is. therefore, considered b
disease. It ia chatacteri/.ed by pronooticed edematous swelling of the
■kin and mucous membrane, as well as the aubcatis and submucosa of
the head, the oral cavity, the sabmaiillary region, throat, etc., there
also develop aymploms of septicemia hemorrhagica. Death usuallj'
occurs after 12-36 houtn. Details concerning wildseuche rosT he found
in text-books on special pathology,

Strangles. — Strangles usually develops from the mucous mem-
branes of the respiratory and digestive apparatus. Occasionally there

regional lymph glands are involved first. A case of this type has been
described by Litfas (Berliner lierarztliche Wochenschrift. 1895 |. 1,
myself, have obaeired two cases.

With reference to other wound infection diseases (actinomy-
cosis, Lotryomycosis, tuberculosis, lymphangitis,
phlebitis, petechial fever) compare with the chapters on these '

WoiTNO Infection Diseashs of thh VETaniNARiAN.— The fol-
lowing are the various wound infection diseases against which the vet-
erinarian should be guarded : phlegmotis. lymphangitis, and
erysipelas, septicemia and pyemia, e c 7. e m a on the
hands and arms (o b st e t r i csl, anthrax, glanders, ra-
bies, botryomycosis, tnberculosis. ,\mong 365 officials
in the Berlin Abbatoir aud Stock Yards (veterinarians, butcbera, etc.). 7
had inoculations with tuberculosis on the hands, j had questionable
nodules (Lassar),

VI. TREATMENT OF WOUNDS.

Antiseptic and Aseptic Trkatmfnt of Wounds. —
Lister is the founder of the modern treatment of wounds.
Working on the theory that wound infection might be pre-
vented by the application of antiseptics, as well as careful
bandaging, he employed, in 1867, carbolic acid with a band-
age : the latter being termed a Lister Bandage. This Lister
bandage is applied as follows : irrigate the wound with a
3-5% solution of carbolic acid ; spray the surrounding air

RAnn>.
of the infect;-
from the s.i\
and then p.-
special clia;
tetanus. Ti:-
disease, thf
weeks, anrl •
to pani^raj't
no attempt-
affected . w .
iinmediati-I
killed or < ■•■
i/iition, rvi"
disinfect:i".
etc.. rarhoii

Bi.At ••.■
black K- •.'
rifS to til'-
Black lt*>i, '.
of catt;
tons SWfl'-
ters ol t
located <••
inferior s-
deraiigfil
gent-ral -v •
ease i** i-.
Trealni! ••
tion am.
of call!'
]ihlf*;4Th*.
piier].< r:
Ost» r!
hciok*- <•..
1 If rim :

An
disca<'
nitesli !
a 11 1 h !
bmnt.'.^.
inserts
111 11 coil
this !•-
a latal •
brane- "

: • 'ivA with a piece of
X .: cotton protective :
:ei gauze or other car-
::r.nernieable laver oi"
,'.t :> retained by means
,: Between the years
-rreral use in Germ an v.
:rd the .simple bandage
uk supplanted the use
• er disinfectants have
*u'''limate. creolin. ly.sol.

^yiics in human surgery

: • >uspended. S c h i m-

v::en a wound has been

:": :::ere is no certainty of

..ucis There is no ob-

•.i it is even harmful,

-..e wound secretions are

'.:>. therefore, given way

^ rrxd out as follows : the

. ::: the use of a .sterilized

,- anti.*>eptic fluids : it is

;- <:erili/.ed physiological

- .\::h a sterilized bandage.

. prepared aj^paralus, it is

,o' C. lor a period of

,:-:s are sterilized in the

. -e in a one or two per

.^- —cthods of sterilization.

- /.sintection ol the hands

^ x^-j thoroughly removed

. V with soap and water,

x*':c. or creolin water, and

H-'-o'.'.*-". ^^ alcohol and soap

„ x^ rendered aseptic : the

. •* r.c oi the patient, oper-

" \--< that are used, as well

I as the operatiu;

ANTISEPTICS

as the operatiug field in the vicinity of the wound. Even
operating gloves, and masks for the mouth and nose are em-
ployed as aseptic protect ives.

The aseptic treatment of wounds in human surgery
has many advantages. Healing follows the natural self-pro-
tectioo of the tissues ileucocyles, blood-serumj. and there are
only slight changes from external interference. Recently,
many surgeons have changed from the purely aseptic method
to the antiseptic; since Henle and others, contrary to the
conclusions of Schimmelbusch, have denionstraled by meansof
statistics that local disinfection of the wound is possible within
the first few hours, and that the results of the aseptic method
are no more satisfactory than those of the antiseptic, B r u n s
even employed pure carbolic acid to disinfect the wounds.
Kiister used the hot iron (Berlin Surgipal Congress, 1901).
Antiseptic surgery involves the very difficult, or impossible,
disinfection of the hands, which is not improved by the use of
sterilized operating gloves (Berlin Surgical Congress. 1898).

Up to the present time aseptic surgery in
veterinary science has received a very lim-
ited use. I have already nieutioned this fact in the first
edition of this book. The veterinarian deals mostly with old.
infected wounds, in which, not asepsis, but thorough antisep-
sis, is necessary. Even fresh operation wounds can seldom
be given aseptic treatment, for example, in a clinic. Even
in a well equipped veterinary hospital the aseptic surgical
treatment of horses offers the greatest difficulties. Bandages
can be applied only to a limited extent, in some cases it is
almost impossible to prevent infection during the operation.
When compared with human surgery, infection through the
a i r plays a more important part (dust, hair), against
which a.sepsis is of no use. For these reasons, the
antiseptic method is to be preferred to the
aseptic in veterinary science.

Antiseptics. — In selecting and deciding upon the various
therapeutic agents to be used in the treatment of wounds, a
general point of view comes into consideration. In the first
place, besides the disinfecting properties of the various ma-

58 ANTISEPTICS

terials, we must consider the resistance of the organisms in the
wound. This resistance lies, as 1 have fully explained else-
where (Lehrbuch der allegemeincn Therapie). about midway
between the very resistant anthrax spores, and blackleg bacilli
at one extreme ; and the easily destroyed anthrax and swine
erysipelas bacilli at the other. The streptococci and
staphylococci, especially, should notbe fought
with weak disinfectants; their destruction re-
quires stronger antiseptics (sublimate, creo-
lin, lysol, tannofortn, carbolic acid, solution
of aluminum acetate, nitrate of silver). The
toxic action of the antiseptics must also be considered, their
irritating action on the wound, their decomposition by the
secretions of the wound, their strength and form, the price,
and the state of healing. In general the following rule should
be adopted : employ disinfectants which are ac-
tive, not too irritating, not easily decomposed,
□ on-poisonous, reasonably active in aqueous
solution, prompt in their action on the wound
(tan no form). Actual disinfection should be preceded by
careful irrigation. The following descriptions refer
to the more important disinfectants (detailed descriptions are
found in my Lehrbuch der Arzneimitellehre, f>. Aufl.).

SUBI.IM.\TK.— This is onr most powerful aod poisoouus dia-
iufectant. A i-jooo sublimate solnlioii quickly deslroyo
all bacteria involved in wound infection. With the <:x-
ceptioii of ruminantB it can be employed on all domestic animals. In

one must be guarded in its use. When combined uith albumecoue
wound secretions it partly precipitates in the form of an albumenate of
mercury, partly decomposes (formalion of oiychlorlde ol' mercury).
The decomposition has no materiel influence on iIs antiseptic action ;
decomposition may be prevented by the addiliou of scidium chloride
(paatilof sublimate). The advantages of sublimate are : its strong
antiseptic properties, non-odor, cost, convenience (sublimate tab1ets|.
The disadvantages of sublimate are; pronounced toiicity. espe-
cially for cattle; irritability, especially on the mucous membranes of
the eye (ophthalmology), and the uterus lobstetricsi; it also rapidly
amalgamates the instrumeuts. In France, in the place of sublimate,
hydraigyrnm hiniodidum rubrum is employed in a solution of

•iics 59

; I \ e and less irritating. Many also
. Ti to sublimate because it does not

. ..i) OTHER CrKSOL COMBINATIONS. —

~t.U is pronounced and rapid. A 3%

<i infection organisms. The dis-

jre api>arently stronger than those of

>^fs deodorizing properties; it is

I inexpensive, its disadvantages are:

: run^ solutions on the mucous membranes,

• >u rubber tubes, cloudiness of the solutions.

- :ictiun is relatively strong. Most bacteria

lit: in a 3 % solution. The official carbolic

-:i a 4",, solution. The action of carbolic acid

Li'ls the infectious material of tetanus, rabies, the

: the spores of anthrax. Castration clamps, for

. iftiiiius after eighteen months, notwithstanding

'.-re placed in a 4% solution of carbolic acid for five

■ :. Advantages : its strength is constant and it does

; 'i sac {vantages : cost, odor, irritating and toxic action,

.WT, for cats.

This is an excellent, mild stimulator of granulations ;

-'ihorial solutions 1:5-10). Disadvantages: odor,

:'>r I logs (licking), insolubility in water. The following

iiMtious from iodine are expensive ; for this reason they are

;ii|iloyed in veterinary surgery: lorentin, losophan, iodo*

!ien, aristol, iodoformin, iodoformogen, iodol, iodtrichlorid

ttnposed). In actinomycotic infections, iodine and iodide of

aqueous solution (Lugol's solution) is a specific for

otic infection.

\i>i(>RM. — At the present time this is our best aseptic cov-

and dry antiseptic. Applied early to cuts, it checks

; nation (healing under an eschar). In horses it is preferable to

:"rni on account of being a more active and non-odorous antiseptic.

■r formaldehyde preparations are: glutol, amy loform, and

. -is : they are more expensive and their action is less constant than

■ t of tannoform. Formaldehyde, itself, in a i to 2% solution is a

miig disinfectant, it irritates the wounds however ; it is very caustic

' iun concentrated (caution I ).

Nitrate of Silver. — This is an excellent wound dress-
' •\i^. It is a strong disinfectant (a i : 100 solution is fatal to pus cocci).
it is a valuable regulator of abnormal granulations, and leaves a pro-
tective covering in the form of an eschar (eschar of silver). The same
is true of the more recent but very expensive preparations of silver
^argentum lacticum and citricuni, actol, itrol. protargol,
ichthargan).

■'»i

ANTISEPTICS

Solution of Aliminum AcetaTk.— This is an excelleni
xic antiseptic in a 3-8^ (Uiu«oui ^ution (also contained ii
■ of the expense it is preferable to the
imnol. tanoal. gallal, sozat, horal. salmtiin,

row's solutioul; becant
costly substitute!; a]

BtSMiiTH Salts.— These are absoching. astringent, dry
antiseptics; their action is similar to tan no form, they seem to be
more expensive, however. The following are most often employed :
bismuth subnitricum. subsalicylicum, gallicnn (denuatol),
dithioBalicj-licum^thioforml, airol(iodidof dermatol). The latter in the
form of Airol PasTH is an excellent aseptic protective covering fo<
wounds: it is no n- irritating, easily applied, dries rapidly, and ia very
adherent.

Alcohol.— This is an important agent for disinfecting
the bands of the operator and the skin of the operating
field. It is best employed in the form of a 50% aqueous solution or
aqneons solution of sablimate (absolute alcohol has only a weak anti-
septic action). Alcoholic soaps are also employed. Alcoholic
Tincture op Aloes stimulates granulations on old wounds and is an
active antiseptic. Tincture of Iodine is an excellent disinfectuit
for infected wounds that have a tendency to necrosis.

Salicylic Acid.— A weak an t isept ic, i t is non-poieon-
oQH however, odorless and Don-irri[ating. It finds ap-
plication in ophthalmology, in irri;^ation of the internal organs of the
body, and in the treatment of cats. Tbioform (bismuth dithiosali-
cylate) is a substitute for iodoform. It is especially employed because
of its non-odor and non-toxtcity (very expensive !).

Boric Acid —A mild, non-toxic, and odorless anti-
septic; its action is slight {ophthalmology, irrigation of the
utemsl. The following, with other solutions of boric acid, possess ft
similar action : borax and borate of magnesia, boral, ftti>
tipyonin, rotterin, antiseptin, borol.

CHLORinE OF Zinc— A caustic antiseptic i3-»% solu-
tion), its action as an antiseptic is relatively weak
(common agent for abnormal granulations).

CvLClirM PBRUANGANATH.^Weak antiseptic. Specific against
• nake bites and the toxin of rabies.

Camphoh.— A powerful antiseptic, especially for torpid gran-
ulations, phlegmons, and necrotic processes (spirits of
camphor bandage). Those agents which have a similar action are:
oil of turpentine, turpentine (old boof remedies), thymol
oil of eucalyptus, balsam of Peru, and other etherial oila.

Tar.— An excellent antiseptic, especially for wounds of the hoofs
«od claws. Wood tar is preferable to coal tar.

Aqua Cklorata. — S t r o n g antiseptic. Specific for rabies
and snake biteH. Employed in ophthalmology.

OPEN WOUND TREATMENT AND BANDAGING

ctive antiseplia Disad vantages : blue color.
HEAT.^By means of high temperature pus bacteria die in
ten minutes at a temperalnre of sS-i'^", the streptococcus of Btrangles
at Ijo", the telanus bacillus at 75°. the spores of tetanus at 100°.

Open Wound Treatment and Bandaginc;. — If a wound
is aseptically orantiseptically haodled, and eventually sutured,
a bandage should be applied wherever possible. It protects
the wound from the entrance of infection (air, and contact
infection), as well as irritants. The bandage should be dry-
Such a bandage is termed a dry. aseptic wound band-
age A moist antiseptic bandage is better for ex-
tensive wounds, pronounced suppuration, phlegmons, prepa-
ration of certain portions of the body for operating, etc. The
moist baudage combines protection with a continued antiseptic
action ; it neutralizes the action of the wound secretions ; the
moist warmth assists granulation and cicatricial formation.
Through maceration of the skin and horn it may occasionally
become injurious. When a bandage is not changed for a long
time it is termed a permanent bandage. Other forms
of bandages are: simple. Lister, pressure, dry
dressings, ointment and tar bandages, iodo-
form bandages, antiseptic tamponade, etc.
With referance to bandage materials and bandage technique
see ; Bayer. Operation sleh re. Only the most important rules
for bandaging are given here. These are: i. Every
wound, when possible, should be bandaged. 2. The bandage
should, after aseptic operations, remain in position as long as
possible (following resection of the lateral cartilage, for ex-
ample, fourteen daysj. .v The bandage must be changed,
however; (a) when it becomes saturated with pus, wound se-
cretions, or filth ; (b) when improperly applied ; (c) when
there is pain or pronounced swelling in the vicinity of the
wound, or when fever exists.

In veterinary practice the open treatment of
wounds must often replace bandaging. This is especially
true of horses and cattle, in which the application of a bandage
in various parts of the body is impossible (gluteal region, up-
per limbs). In such wounds the oxygen of the air acts as a

62 TREATMENT OF DIFFERENT KINDS OF WOUNDS

disinfectant ; it is of special value in malignant edema. For
this reason, the suturing of old or large
wounds is contra-indicated. The aseptic wound
bandage is most readily applied to dogs. When a bandage
cannot be applied healing under eschar may occur
(dry or moist blood-eschar ; necrosed eschar ; one formed by
tannoform, tannin, silver nitrate, dry dressings, etc. ). Oint-
ments may take the place of a bandage (boric acid, silver
nitrate, decubital salve, etc. ). Adhesive remedies per-
form the same function (airol paste, iodoform -colodion, zinc
paste, bismuth paste, adhesive plaster). In many cases, as in
human surgery, permanent irrigation is employed
with good results, that is, the wound is irrigated for a long
time with an antiseptic fluid. Immersion (water bath) has a
very limited field of application (hoof baths, baths for mange).
Antiseptic cataplasms are employed to encourage the
sloughing of necrotic tissues in hoof injuries, fistulous withers,
etc., (linseed meal bandage with creolin water). The appli-
cation of linseed meal to any wound is not considered good
surgery at the present time (Translator).

Trkatment of the different kinds of wounds.— I. Fresh
incised, punctured and lacerated wounds or bites are
treated as follows : arrest the hemorrhage ; irrigate ; disinfect ; and
drain ; apply an aseptic tampon ; suture as much as possible ; and when
practical, apply a bandage.

2. Contused and old, especially suppurating wounds, are not
sutured; otherwise they are treated as fresh incised wounds. In
many cases of small, old, suppurating wounds, heal-
ing by third intention is possible; the modus ope-
randi is as follows: trim the margins, irrigate care-
fully for a long time, disinfect, remove all necrotic
portions, bring the margins of the wound in close
apposition by means of sutures i wounds of the head in the
horse ). When removing foreign bodies or destroyed tissues from con-
tused wounds care should be taken not to remove the sound tissue also.
This is particularly true of flap wounds (treads on the coronet) , where
the retention of small flaps of skin is of greatest
importance. Contused wounds with pronounced suppuration and
tissue necrosis are best treated by means of moist bandages; as
open wounds; or with permanent irrigation.

3. Shot wounds are treated according to the same rules of asepsis
and antisepsis as those employed for the treatment of ordinary wounds.

TRANSPLANTATION

Probing of the wound is also superilu
not carefully disinfeeled it is even i
»nd probe away I. Shot wounds i

bullet (V. Bergtnan, Kocheri-
as ; when the finger or probe are
ingeroua to life (keep the finger
e best treated es follows : a n t i-

epti.

and

: followed by a bandage. I f for certain reasons it
seems necessary to eittmct the bullet (phlegmons, pain, high (ever,
etc.)i a simple incision is often all that is necessary ; employ foteigo-
body forceps, curette, etc. , in place of special bnliet forceps,

4. Joint wonnds, when fresb, should be carefully disin-
fected: sutured; and when possible, covered with an aseptic
occlusive bandage. It is not always possible to bandage perfo-
rating joint wounds in horses and cattle ; in those cases one may use
iodoform-collodion. airol paste, and other adhesive matehals. the cau-
tery may be used lo close the wound with a necrotic eschar, per-
manent irrigation is also employed. The earlier employed caustic ap-
plicationa in the vicinity of the joint (closure of the wound by swell-
ing) are of little value. Suppurating joint wounds in dogs may be
drained, irrigated, incised if necessary, and packed with an antiseptic
tampon. In horses and cattle they are frequcutly incurable.

5. Perforating abdominal wounds require careful
antisepsis; reposition of the intestines after thorough disinfection ;
ligation and removal of the prolapsed omentum, as well as a double

6. Poisoned wounds (snake poison, rabies, etc.l may be ex-
cised ; cauterized ; burned ; or treated with s]>ecific diainfectanta ; po-

chloridi. and calcium bichromate in the form of sub-
cutaneous injections.

jranulating ab normally are

ife,.

treated with the k
chloride of i^inc
mcnt of ulcers.

Transplantation.— This was first employed by Rcverdin, in
the year 1870. It was employed in human surgery to provide a mpid
covering for granulating wound surfaces. Thiersch also bad a
broad eiperienee in the transplantation of epidermis. Formerly, pieces
of skin, the entire thickness of the epidermis, were transplanted. At
the present time the modus operandi is as follows : the rules of asepsis
'v carefully observed ; very thin, superficial sections of the skiD
uoved with a rasor, they extend, however, to the papillary bodies ;
Bme section! are about the length and breadth of one's finger, (hey are
imoved from the upper arm or limb, and are transferred from here to
ttie giMiiilatiotis. The grannUtions have been previonsly freshened

64 SUBCUTANEOUS INJURIES OF THE SOFT PARTS

with a curette, the flaps of skin are applied without coming in contact
with any antiseptics (necrosis of the epidermis), they are carefully re-
tained in position by means of sterilized tin foil, a dry or moist band-
age (salt solution) is employed for protection. If the transplantation is
successful the pieces of skin heal to the granulations by first intention ;
about the third day they are vascularized by vessels from the granula-
tion tissue ; and the wound is covered through the formation of new
epidermis from these artificial islands of skin. A simpler method con-
sists in the removal of the epidermis only, from the healthy skin, this
being placed on the granulations. It is also possible to transplant mucous
membrane on mucous membrane, as well as pieces of bone with perios-
teum and marrow from living young animals to man. On the other
hand, the transplantation of nerves, muscles, and tendons, from animals
to man has not vet been successful.

The difficulties of transplantion consist in the prevention of death
of the removed piece of skin on the one hand, and the difficulty of
fixing it to the granulation tissue on the other. The latter is especially
difficult in animals. Mamadyschski has been successful in horses
and dogs with Kra use's method of transplantation. Querruau
has successfully treated saddle pressure in the horse by means of trans-
plantation. Bayer, on the other hand, has repeatedly employed trans-
plantation in horses without results ; the great mobility of the skin of
the horse hinders exact fixation of the flaps, while the firmness and
non-vascularity of the same does not favour rapid growth. Bayer has
even retained the Haps by means of sutures and needles without re-
sults. Also, the hair on the skin of animals often retards growth. On
the other hand, the transx^lantation of skin and mucous membrane from
animals to man is successful ; the same is true of the transplantation of
spurs to the comb of a cock.

SUBCUTANEOUS INJURIKS OF THE SOFT PARTS

(CONTUSION, LACERATION).

r. CONTUSION.

Definition and Causes. — In contrast to wounds of
the skin and mucou.s membrane, which are always accompa-
nied by a breach in their continuity, a contusion is an
injury to the soft parts without an external
wound. It is caused by pressure from a blunt instrument,
the skin, because of its elasticity, remaining uninjured, while
the underlying soft parts, especially those covering bone are
torn. Contused wounds and contusions are due to the .same

GRASS OF CONTOSION 65

causes. In every other way they are different, namely, symp-
toms, course, treatment, and prognosis. This is due to the
fact that contused wounds are open to infection, while in sub-
cutaneous injuries of the soft tissues the paths of infection are
closed.

The causes of contusions in the domestic animals are
various. In horses they are caused by pressure from the
harness, saddle, bit. shoe, faulty nailing of shoes (corns,
nailing), calks, kicks, blows, and falls, entering doors, self-
inflicted injuries from treads on the coronet, decubitis, etc-
In cattle they are caused by horn-thrusts. Bites and chastise-
ments frequently produce contusions in dogs.

Grade of Contusion.— According to the severity and
extent of subcutaneous injuries, different grades of contusions
are recognized ; differentiation being based on the injuries to
blood-vessels. The simplest division is that which separates
a contusion with preservation of tissue from one that
results in necrosis. According to the extent of hemorr-
hage the first may be further subdivided into contusions with
slight or severe hemorrhage. In general, therefore,
three grades of contusion are recognized r

1. Contusions of the first grade are character-
ized by a slight amount of hemorrhage. The extravasate may
be evenly distributed through the contused tissues (bloody
infiltration), or il may occupy small circumscribed foci
(ecchymosis. petechia),

2. Contusions of the second grade lead
either to targe subcutaueous accumulations of blood ( h e m a-
tomata ), there are also alleged to be circumscribed effu-
sions of large quantities of lymph (ly m ph- ex t rava-
sate), or to a superficial accumulation of a large amount of
blood (suffusion).

3. Contusions of the third grade result in
gangrenous death ol the involved tissues (necrosis, mortihca-
tion). The cause of death is due to the deranged circulation
brought about by extensive injuries to the blood-vessels (pri-
mary anaemic necrosis). Necrosis may also be due to en-
trance of infection from without or through the blood-stream

66 SYMPTOMS

(secondary septic necrosis). Experimental investigations

have proved that the contusion of itself does not cause necrosis.

Complete crushing of the contused parts is sometimes

termed a contusion of the fourth grade.

Microscopic Chani^ks in Contusion's. — The following condi-
tions are found in contusions that are experimentally produced in ani-
mals : In contusions of the first grade only a laceration of the loose
connective tissue, that which is supplied by the smallest blood-vessels.
In contusions of a severe grade there is also laceration of the intercellu-
lar substance of the tissues, so that the cells are separated from one an-
other. In the severest crushing of the tissues, however,
the cells usually remain unimpaired. This explains the
fact that crushing, alone, does not result in necrosis (Gussenbauer).

Symptoms. — Swelling, due to hemorrhage, is the most
important symptom (contusion swelling). In contusions of
the first grade (bloody infiltration) the swelling is small and
diffuse. Large circumscribed swellings characterize second
grade contusions (hematomata). Hematomata on the hind
limbs of horses become especially large (larger than one's
head) : I observed one case in the region of the udder in a
horse in which the hematoma contained 25 liters. Contusions
may occur in the following places : skin, mucous membrane,
subcutem, subfascia, intermuscular tissues, in the vicinity of
joints, within joints (hemarthrosis), in the tunica vaginalis
(hematocele, etc.). Superficial excoriations sometimes occur
on the skin over the contused area. As long as the contused
swelling contains nothing but extravasate, without any mate-
rial injury to the skin, and no infection from without, inflam-
matory symptoms are absent. This is true of hematomata and
is an accurate means of differentiating between a hematoma
and an abscess. The consistence of the swelling is usually
softer, fluctuation is pronounced, on palpation crepitation may
be noted (coaguhim of blood). When the contused tissues
are rich in nerves, pain may accompany the swelling. This
causes lameness when the seat of injury is in the following
regions or tissues : hoof, periosteum, muscles, and nerves.
Severe contusions of the nerves, spinal cord, and brain lead to
paralysis, insensibility, and unconsciousness. A reflex paraly-
sis of the central nervous system may result from severe peri-

COURSE 67

pheral contusions (so-called shock). General symploms are
usually absent. Symptoms of ansemia are observed only in
rupture of large blood-vessels. Resorption of extravasate from
severe contusions may be followed by febrille symptoma (asep-
tic resorption fever), and swelling of the lymph-glands. Fat
emboli of the lungs have occurred in man. Inflammation as a
result of contusion may result in suppuration and necrosis, it
may also assume the form of septicemia.

Course. — The termination of the blood- ex travasate de-
pends upon its sixe, the degree of contusion, and the infection
or non-infection of the wound, it is, therefore, variable. The
blood may become resorbed, or encapsuled, orga-
nization, suppuration, or necrosis may also occur,

1. Resorption, that is, the absorption of the ex tra-
vasate through the lymph- vessels, usually follows subcutane-
ous contusions of the first grade ; small hematomata are occa-
sionally absorbed in the same manner. The component parts
are resorbed in the following order : the blood-serum, the dis-
solved fibrin, the degenerated white blood-corpuscles, and
finally the red blood -corpuscles ; the latter are resorbed partly
in toto, partly in a degenerated condition. The resorbed red
blood- corpuscles sometimes accumulate in the lymph-glands
to such an extent that the latter have an appearance of dark-
red swellings. Red blood- corpuscles which remain in the con-
tused areas undergo granular degeneration and give oS tjieir
coloring matter. The latter is diffused in the surrounding
tissues and is transformed into a crystalline hematoiden
or a soluble choleglobin out of which are developed color-
ing matters similar to those found in the gall ; green, red, blue. -
and black (melanin) (Latschenberger). These are visible
only in unpigmented skin where they appear in the form of so-
called black and blue spots. Later they are resorbed and dis-
appear.

2. Organization and encapsulation, so-called,
occur in relatively large hematomata. In the vicinity of the
hemorrhagic focus there exists, as a result of proliferation of
the autochthonous tissue cells, a cellular infiltration with the
Ibrmatiou of fibrous connective tissue. This gradually dis-

DIFFBRHNTIAL DIAGNOSIS

places the extravasate and, similar to the so-called organiza- '
tion of a thrombus, forms a connective-tissue indu-^
ration as the product of an aseptic, interstitial in6amma-
tion (tumor fibrosus). When the connective -tissue ■
mass does not displace the extravasate, but the inflammatory
process runs a chronic aseptic course around its periphery-, as
around foreign bodies, the extravasate finally becomes encap-
suled by a connective- tissue membrane (blood- cyst,
hygroma). This process of cystic formation is frequently
observed in dogs. I have observed one case in which the
capsule developed in fourteen days. In the horse one occa-
sionally finds small, moveable blood-cysts located subcutane-
ously in the region of the withers, as well as subcutaneous
bygromata with free bodies (corpora libera). Caseous in-
crustations, even cartilaginous and osseous
degenerations, may result from the organization of a
hematoma (othematoma in dogs, subperiosteal bematomata).

3, Suppuration and ichorous ulceration in
contused swellings is only the result of the entrance of infec- ,
tious materia) into the blood- extravasate. A hematoma then,
may terminate in an abscess, under certain conditions the
abscess may become encapsuled (shoulder abscess). Didust
bloody infiltrations terminate in phlegmons, necrosil
may develop during the course of the latter and, in case offl
complications, pass into septicemia or pyemia.

DiiFERENTiAL Di.\GNOsis. — Contusions run an
tremely variable course, they may become complicated with I
wound infection diseases, and they are often confused with J
other surgical affections. One must consider tumors, ]
phlegmons, hernia, and fractures (crepitation).
It is of great practical importance to differentiate betweeo I
bematomata and abscesses. One must remember that hem
tomata develop suddenly over their entire area ; abscesses de- I
velop slowly. A genuine hematoma is not characterized by I
inflammatory symptoms nor general febrile conditions. The ]
periphery of an abscess is hard, that of a hematoma is fluctu-
ating. In doubtful cases one may use the exploratory probe.

TRBATMBNT

Treatment. — The treatment of contused swelliogs is^
variable ; it depends on the degree of the contusion.

1. Slight, circumscribed blood ■ extrava-
sates may be treated with massage, moist heat, and com- ,
pression, as well as counter-irritants. The object being to
bring about resorption.

2. Large hematomata are best treated by means
of an incision, this should not be made too early. Extirpate
encapsuled blood-cysts ; Jaspiration, with a subsequent injec-
tion of tincture of iodine is sometimes effectual. Encapsuled
hematomata and bygroraata may occasionally be ruptured
with force.

3. Necrosis, phlegmon and abscess forma-
tion should not be treated with massage. Suppurative and
necrotic inflammations are treated according to the rules of
antisepsis ; incise, remove the necrotic tissue, drain, and dis-
infect.

The most Important Contusions of Domestic Ani-
mals. — The following affections are of special practical im-
portance ;

1. Contusion of the neck, withers, on the sad-
dle position, point of the sbonlder, on the ster-
num, and in the vicinity of the shoulder in the horse (poll-
evil, fistulous withers, saddle galls, sternal
and shoulder abscess).

2. Contusions of the upper and under lips
(twitch), the skin at the angle of the mouth (bit), and
the mucous membrane of the interdental space of the infe-
rior maxilla in the horse.

3. Contusions of the external angle of the ilium, orbital,
process, zygomatic region, etc., especially in horses and cattle
(dec u bit is).

4. Hematomata in the gluteal region, especially in
the region of the buttocks, on the anterior surface of the
carpal joint, and on the inner surface of the metacar-
pus in the horse.

5. Bursitis inteTtubercnlaris and t roc ban-
ter ica in horses.

70 I^ACERATION (RUPTURE )

6. Contused swellings on the elbow in the horse and dog
(shoe- boil). In dogs they may occur on the neck, or at
the tuberosity of the ischium.

7. Contused swellings on the anterior surface of the car-
pal joint in horses and cattle, especially in working oxen
(knee tumor).

8. Contused swellings over the tuberosity of the os calcis
in horses (capped hock); the same on the posterior sur-
face of the OS calcis (curb).

9. Treads on the coronet, contusions of the
pododerm at the angle of the sole (corns), as well as
contusions of the balls of the hoof (sore heels).

10. Hematomata in the vicinity of the udder, anterior
and posterior in cattle (milk- vein, posterior abdominal vein).

11. Hematomata and blood-cysts on the throat and back
of dogs.

12. Hematomata on the inner surface of the ear muscles
in dogs (othematoma, hematoma auris).

lyYMPH ExTRAVASATE. — This name applies to contused swellings
which are not filled with blood, but with lymph ; they are due to lacera-
tion of large lymph- vessels (lymphorrhea). According to Gussenbauer
they occur when, as the result of a contusion, the skin is raised from the
underlying parts (fascia) and slides over the firm subcutaneous struc-
tures. In contrast to hematomata, lymph-extravasates result in swellings
which develop slowly, so that growth is observed for weeks and even
months. The effusion of lymph does not coagulate as long as the skin
remains intact. On account of chronic development and inability of
thrombus formation, as well as resorption, the prognosis is unfavorable.
Hoffman has described two cases in the horse (buttocks) ; he also men-
tions having observed one case in the cow and dog (ear). Hoffman
further refers the so-called knee tumors in horses and cattle to extrava-
sations of lymph. Moller and Bayer contradict the occurrence of pure
lymph-extravasates on the posterior limbs of horses and on the ear
muscles of dogs ; they point out the possibility of a confusion with hem-
atomata. I, myself, have not yet observed a lymyh-extravasate in
either the dog or horse.

II. LACERATION (RUPTURE).

Muscle Rupture. — This term indicates a subcutaneous
break in the continuity of individual muscles as a result of

TBNDON RDPTURB

severe stretching and tension of the muscles, it is due to blunt
forces from without, or pronounced muscular contraction
(spontaneous rupture) ; distinguish between this and open
muscular wounds. The rupture may be complete or incom-
plete. Diseased muscles are predisposed to rupture (idio-
pathic muscle-rupturej. The symptoms are deranged mobil-
ity, the presence of a space or blood-extravasate at the point
of rupture, and a hernia (abdominal muscles). Healing fol-
lows through resorption of the blood-extravasate and the
formation of a connective- tissue cicatrix ; there frequently
remains a shortening of the muscles (muscle-contracture).
Ruptures uf abdominal muscles in large animals are usually
incurable (ventral hernia). Treatment consists in the applica-
tion of B pressure bandage whenever possible. In dogs a skin
incision may be made and the muscles sutured. Muscle-rup-
ftires are usually seen in horses and cattle. They mo6t fre-
quently occur in the following places ; the tibialis anti-
cus, the rectus, obliquus and trans versus ab-
dominis; the quadriceps femoris (especially
the vastus lateralis); the gast rocfanemi us ;
gluteal; the biceps brachii and femoris; the
anconeus: the levator humeri; pectoralis
minor; longissimus dorsi; psoas; gracillis;
infraspinatus; and tensor fascia lata.

Tendon RtiirimE. — Tendon- ruptures also, should be dis-
tinguished from tendon-wounds, they are subcutaneous breaks
in the continuity. The causes are identical with those which
produce muscle-rupture. As a rule they are of external origin
(overexleusirju). They may, however, ba due Co an inner
predisposition, such as diseased tendon following inflamma-
tion, deranged nutrition, or necrosis iidiopathic ruptures
of tendons during the course of suppurative inflammations ot
tendon-sheaths, or ontagious pleuropneumonia). Complete
and incomplete (partial, fibrillar) ruptures are recognized:
with reference to the latter, see chapter on inflammation, this
being the most frequent cause. Complete tendon-ruptures in
the horse most frequently occur in the flexor pedis pe r-
forans, flexor pedis perforatus, flexors of the

72 INFLAMMATION

metatarsi, and suspensory ligament; the ex-
tensor pedis and acbilles tendon are seldom rup-
tured. In cattle and dogs the flexor metatarsi and
achilles tendon are most often ruptured. The symptoms
of tendon-rupture consist in a peculiar lameness, as well as the
occurrence of a space between the ends of the ruptured tendon
(this is not present in rupture of the tibialis, and flexor pedis
tendon in the hoof). On anatomical examination one finds a
blood -extra vasate in the vicinity of the rupture, the ends of
the ruptured tendon are fibrous, and covered with blood.
Healing follows resorption of the blood, through the formation
of a connective-tissue cicatrix from the tendon-sheaths, the
paratendineum, and the interfasicular connective tissue ; this
afterwards takes on the character of tendon-tissue and" may
finally lead to tendon-contracture. Treatment consists in the
application of a plaster-of- Paris bandage ; in dogs a tendon-
suture may be applied (compare with the chapter on diseases
of the tendons).

Rupture of Fascia. — Subcutaneous rupture of fascia
may lead to the formation of a so-called muscle hernia,
that is, to the protrusion of a portion of the muscle through
the rent in the fascia. I have observed many cases in horses
on the posterior limbs, on the neck, and on the shoulder (her-
nia of the semimembranosus and levator humeri). With ref-
erence to rupture of vessels, nerves, and articular
ligaments refer to the chapter on diseases of the vessels,
nerves, and joints.

INFLAMMATION.

I. NATURE AND CAUSES.

Nature. — Inflammation is a highly complicated reac-
tive process in irritated tissues. According to
the investigations of Cohnheim, v. Recklinghausen,
P f e f f e r, M e t c h n i k o f f, and others, the principal changes
are as follows :

I. The irritation of peripheral centers of
circulation produces, reflexly, a vasodilitation

THBOKISS OP IN7LAHH&TION

73 A

(vasodilators) of the arteries, veins and capillaries of the in-
volved tissues ; this is the first change that occurs.

2. Acceleration of the blood-stream occurs with the vaso-
dilitation. This is soon followed by a diminished ve-
locity in the flow of the blood; finally the flow of
the blood is entirely suspended (stasis).

3. When retardation of the bloodstream occurs, the
white blood-corpuscles are arranged next to
the vessel walls, especially in the veins; while the
red blood -corpuscles occupy the center of the stream. At this
period the white blood -corpuscles pass through the walls of
the vessels ( Migration) in the direction of the irritant (c h e-
motropismus, chemotaxis, phagocytosis),
whereby cellular infiltration of the inSamed tissue
occurs.

4. As a result of changes in the vessel walls
there occurs an active transudation of blood-
serum through the diseased walls of the vessels (in flam-
matory transudate, exudate), occasionally there ia
also a passage of red blood-corpuscles through
the capillary walls (dia ped esis). In this way the so-
called inflammatory swelling is produced.

5. Finally, in addition to the emigrated white blood-cor-
puscles, the fixed autochthonous connective-
tissue cells proliferate (division, proliferation) and
take part in the inflammatory process, especially in the cellular
in nitration.

Theories of Inflammation.— According to recent theories on
inSammatioii the primary process 13 Ihe irritation of the
local vasomoCgt nerves; the secondary process is the migmtion
of the ivbite bloo'l-coipuscles aicording to the Ian of cbemotaxiB, as
well as the changes which take plaice in the vassel walls (v. Reck-
linghausen). The importance of cb e mota zls for the process of
emigration of the white blood-corpuscles lias been clearly demonstrated
by Hfef fer. Formerly the primary, essential processes were supposed
to be the cbanfres in the walls of the vessels, the iollammatory exuda-
tion, and the migration of the white blood -corpuscles (emigration
theory of Cohnheim). Metchnikoff demonstrated the pbago-
cytic theory whereby the white blood -corpuscles form a protection
against the entrance of inflammatory irritant!) I>y migrating and de-

74 CAUSES OF INFLAMMATION

stroying them (devouring cells). According to Metchnikoff inflamma-
tion is merely a ''phagocytic reaction" with certain attendant
symptoms. Among the old theories of inflammation, the humoial,
cellular and neural theories are of historical interest. Virchow es-
tablished the cellular theory of inflammation, according to which, the
inflammatory stimuli irritate the cells of the tissues, these hypertrophy
and proliferate thus drawing large quantities of fluid nourishment from
the blood (attraction theory, nutritive stimuli). The
humeral theory of inflammation accounts for the nature of inflammation
in changed conditions of the blood (dyscrasia) . According to the neural
theory the nervous system plays the principal part in inflammation
(paralytic and spasmodic theories of inflammation by Briicke,
Stilling and others).

Causes of Inflammation. — The inflammatory stimuli
that are operative on animal tissues are extremely variable in
their nature. Mechanical, chemical, thermic and
infectious causes may prepare the tissues for inflammation.
In general inflammation according to causes may be divided
into two, practical, very important groups. One group may
be termed an aseptic or non-bacterial (non-infec-
tious) inflammation ; it is caused, not through the action of
bacteria, but as a result of mechanical, thermic, and chemical
influences (traumatic inflammation, burning, acrids). The
other group includes the septic or bacterial (infec-
tious) inflammations ; they are due to the activity of micro-
organisms. The following are the most important causes of
inflammation :

1. Mechanical irritants (wounds, pressure, con-
tusions, strains, ruptures) produce the so-called traumatic
inflammations : wound healing by first intention, healing of
subcutaneous bone-fractures, muscle and tendon-ruptures, that
form of inflammation of the pododerm known as laminitis,
non-infectious inflammations of the joints (spavin, ringbone,
chronic deforming gonitis, omarthritis and coxitis, chronic
podotrochlitis), tendons, tendon-sheaths, mucous bursa?, and
bones. A purely traumatic aseptic inflammation may combine
with one that is bacterial and infectious in character (healing
per secundam, healing of compound bone-fractures).

2. Thermic irritants in the form of heat and cold.
Purely aseptic inflammations of this kind are burns (red-

CAUSES OP INFLAMMATION

ncBS. vesicles) and rheumatic inflammations, especially m u s-
cnlar rheumatism ( oon-bacterial inflammation of mus-
cle dae. simply, to irritation from cold). These thermic
aseptic inflammations may afterwards combine with one that
is infectious in character (suppurative infection of blisters).

3. Chemical irritants may produce various kinds and
grades of infiammatioD without the aid of bacteria, especially
suppurative inflammations. Experimental subcutaneous in-
jections of sterilized chemicals foil of turpentine, creolin,
nitrate of silver, ammonia, and leguminj under aseptic precau-
tions, produce an acute suppurative inflammation in the ab-
sence of bacteria f Grawitz, De Bary and others). Inflamma-
tion due to chemical irritants is of practical importance in ther-
apeutics : through the application of irritants to the skin
various grades of iuflammatiou are produced for the object of
healing (rubefacients, vesicants, pustulants, suppurants).

4. Infectious inflammations are caused by the en-
trance of microorganisms into the tissues. There are a great
many kinds of bacteria that may cause bacterial or septic in-
flammations ; namely, staphylococci, streptococci, edema
bacillus, tubercle bacillus, glanders bacillus, anthrax bacillus,
botryouiyces and actinomyces. Examples of infectious in-
flammations are : suppuration of wounds, phlegmons, suppu-
rative arthritis, tendovaginitis and pododerniatitis. None
of these organisms are mechanical irritants;
inflammation is due to their chemical pro-
ducts of metabolism (toxins). Leber was the
first to discover that infectious inflammation was due to chem- ■
ical irritants. From a culture of staphylococcus be isolated a
crystalline chemical substance fphlogosin) that has the pro-
perty of inducing inflammation. The so-called parasitic
inflammations (sarcosporidia) are of slight significance from a
surgical standpoint ; they also appear to be due to the action
of chemical bodies (sarcozystin).

Finally, certain factors of the disposition have an
influence in the production of inSammation (constitution, idio-
syncrasy, immunity).

' INFLAMMATION

II. KINDS, SYMPTOMS, AND COURSE OF INFLAMMATION.

Kinds of Inflammation. — According to the character
of the exudate various kinds of inflammation are recognized :

1. Serous inflammation is characterized by a
serous, watery. lymph-Hke exudate containing very few white
and red blood-corpusctes. It is the slightest grade of inflam-
mation ; the blood-vessels are only slightly changed. It occurs ^
in the skin and subcutura (inflammatory edema, blisters,,
dermatitis bullosa) ; on the serous membranes ofl
the joints, tendon-shea I hs. and mucous bursa* I
(serous arthritis, tendovaginitis and bursitis ; hydrops of the |
joints, tendon-sheaths, and mucous bursBc) ; as well as on the J
mucous membranes (catarrhal inflammation).

2. Fibrinous or cr o u po u s inflammation'is char- J
acterized by the formation of an exudate that is very rich i
fibrin and white blood -corpuscles. As a result of this,
croupous membranes (so-called fibrinous pseudo-membranes)
are deposited on the inflamed tissues ; leucocytes and fibrin
threads make up the essential composition of these mem- J
branes. If a serous exudate is present at the same time it Ul
termed a sero-fibrinous inflammation. Fibrinous in- 1
flammations most frequently occur on the serosa of the joints,
tendon-sheaths, and mucous bursa; (arthritis, tendovaginitis,
bursitis fibrinosa), on the mucous membranes (membranous
conjunctivitis, as well as on the iris (fibrinoas iritis of moon- J
blindness). M

3. Suppurative inflammation is a special fonnn
which is usually due to an infection with pus-forming bacteria
(streptococcus and staphylococcus pyogenes). The suppura-
tive exudate is composed partly of emigrated white blood-cor-
puscles, partly of proliferated fixed connective-tissue cells,
A circumscribed collection of pus in a tissue is termed an
abscess. A diffuse suppurative inflammation is termed &
suppurative infiltration; an accumulation of pus ii
joints, or in the cavities of the head, is termed empyema
suppurative inflammation of the mucous membranes, suppu-
rative catarrh; of the mucuous membranes of the eye.

SYMPTOMS OF INFLAMMATION

blennorrhea; the skin of the external auditory canal, otorr-
hea; purulent vesicles on the skin are termed pustules.

4. Diptheritic iufjammatioa consists of a coagula-
tion necrosis of the' mucous membranes ; that is, in a deposit
of fibrin in the tissues with necrosis of the cells. It leads,
either to the formation of a so-called diptheritic pseudo-
membrane, or to a loss of substance (diptheritic
ulcers).

5. Hemorrhagic inflammation is characterized by
the presence of large numbers of red blood -corpuscles in the
exudate, which have left the vessels either per diapeiiesis of
per rhexin. This form of inflammation always involves severe
alterations in the wails of the blood-vessels.

6. Necrotic or gangrenous (ichorous, putrid)
inflammation is characterized by a discolored exudate under-
going putrid degeneration (mixed infections with septic bac-
teria and putrefactive fungi, )

7. Productive or proliferative (hyperplastic)
inflammation runs a chronic course, and results in new forma-
tions of tissue (thickenings, adhesions). According to the
character of the new tissue it is termed indurated,
schlerotic, ossifying, deforming, adhesive,
pannous, fungous, verrucose, etc.

8. Specific inflammations correspond to specific in-
fectious diseases (tuberculosis, glanders, actinomycosis, botry-
omycosis, strangles, anthrax). With reference to erysipela-
tous and phlegmonous inflammations see pages 28 and 46.

Symptoms of Inflammation. — The cardinal symptoms
of inflammation are: heat (calor), redness (rubor),
swelling (tumor), and pain (dolor); disturbed function
(f n nctio laesa) may be added as a fifth symptom.

1. Increased heat is most pronounced in acute inflam-
mations. In veterinary science it forms an important sign for
the determination of the existence of inflammation, as the in-
flammatory redness is frequently invisible. Heat is due to an
increased blood-flow, not to an increase in the production of
local warmth in the inflamed tissue.

2. Inflammatory redness, in most animals, is usually

78 TERMINATION OF INFLAMMATION

invisible in the skin on account of the hair and pigment in that
tissue, on the mucous membranes, however, it is readily ob-
served. Redness is due to the dilitation and pronounced fullness
of the vessels (inflammatory hyperemia). One distinguishes

between injection redness, where only individual vessels ap-
pear to be stroogly injected, and diflfuse inflammatory redness.

3. Swelling is the result of an increased blood-supply
and an inflammatory transudate. According to the character
of the exudate and the kind of tissue in which the disease is
located, the consistence of the swelling on palpation is ex-
tremely variable : soft, firm, fluctuating, (abscess, hydrops of
the joints and tendon-sheaths), or crepitating (fibrinous arth-
ritis and tendovaginitis). ySwelling is most pronounced in the
widely reticulated tissue of the subcutis, in inflammation of
the tendon-sheaths, joints, and glands.

4. P a i n is due, partly to the pressure of the inflamma-
tory swelling on the ner\'es, partly to the involvement of the
nerves in the inflammatory process (neuritis). Acute inflam-
mations of organs that are provided with a rich nerve-supply
are extremely painful : skin, pododerm, periosteum, joints,
eyes ; chronic inflammations are usually less painful. Sudden
relaxation of pain in an acute inflammation indicates a bad
prognosis (necrosis of the pododerm).

5. Disturbed function is characterized by lame-
ness, suspension of the glandular secretions, opacity of the
cornea, etc. There is also a disturbance of the general condi-
tion ; this is partly due to the pain, partly to the absorption of
febrile producing irritants.

Course and Termination of Inflammation. — One
recognizes an acute (existing for a few' days), and a
chronic course (longer duration, at least four weeks), occa-
sionally a peracute (existing a few hours), and a suba-
cute (existing for one or two weeks). With reference to
the extent of inflammations, they are classified as superfi-
cial, and deep (parenchymatous, interstitial,)
local or circumscribed, and diffuse or progres-
sive. Finally we have inflammatory primary and
secondary foci (metastatic, embolic, general-

THERAPSUTIC METHODS

ized, that is, aa inSammation spread over the entire body
through the medium of the biood-stream). The following are
the most important terminations of inflammation ;

1. The inflammatory product gradually disappears (res-
olution) as a result of the resorption of the inflammatory
product through the lymph-stream under the influence of the
white blood- corpuscles (phagocytosis, hystolysis).

2. The retention of inflammatory new forma-
tions in the form of thickenings, indurations, and adhesions
(schlerosis, elephantiasis, tendon callus, exostosis, dermatitis
verrucosa, etc.).

3- Gangrene may result from severe disturbances in
the circulation or complications with septic infection.

With reference to inflammations of individual organs see
chapters on inflammations of the bones, joints, muscles, ten-
dons, nerves, vessels, glands, skin, etc.

III. TREATMENT OF INFLAMMATION.

Therapeutic Methods. — Those processes which take
place in the tissues under the name of inflammation are con-
sidered necessary reactions of the body whereby external irri-
tants are expelled, and the body again assumes its normal
condition through the expulsion of these derangors of its func-
tion. Therefore, the inflammatory process, as
such, should not be combalted. The essential
problem of surgical therapeutics consists in the support of the
body in its endeavors towards self- protect ion and natural ad-
justment, rather than in derangement of natural healing by
means of improper treatment. Direct etiological methods of
treatment are possible only in cases of septic inflammation
(antiseptics). In all aseptic inflammations — those not due to
bacteria — indirect, symptomatic therapeutics are the only
ones to be considered. These consist in the application of
rest, heat and cold, massage and cutaneous

Rest. — Rest for the affected part is the fundamental
treatment for nearly all painful inflammatory conditions.

Mere

from many i
sions of the joii
chronic deformii
bone, gonitis

all that is required for recovery
nfl animations. This is true of distor-
ts, aseptic inflammations of the hoof, and all
g inflammations of the joints (spavin, ring-
larthritis). In any case, rest supports the
action of other remedies. Motion is seldom indicated : chronic
inflammation, for example, chronic muscular rheumatism.
Rest, from a therapeutic standpoint, involves the removal
of the cause of i n f 1 a m m at io n— the inflammatory
i r r i t a n t — the shoe or nail in inflammation of the pododerm :
the saddle, harness, and check-rein in inflammatory conditions
of the withers, saddle position, and jaw ; irritating foreign
bodies from beneath the lid in conjunctivitis ; removal of
loose pieces of necrosed cartilage and bone in chronic inflam- '
matory processes (fistula of the lateral cartilage, bone- fistula).
Heat, — Heat is indicated in all aseptic forms of in-
dammation, hut especially for the subacute and chronic
inflammations. Heat favors resorption of the inflammatory
exudate. This is due to stimulation of the circulation, diffu-
sion and migration of the phagocytes, as well as to softening
and breaking down of the inflammed tissue. Heat also re-
lieves pain by means of relaxation. Moist heat is especially
useful in the form of frequently renewed Prieznitz ban-
dages. The bandage is applied cold, this produces at first
an active contraction of the vessels which is soon followed by
pronounced dilitat ion . Frequent application of this bandage —
every three to six hours — regulates the deranged circulation
and has a favorable influence on the disturbed general condi-
tion (temperature, blood -pressure, activity of the heart, dis-
tribution of the blood, and nervous system). Warm poultices
(cat aplasms) exert a similar action ; they are more diflS-
cult to apply to animals (antiseptic cataplasms in inflammation '
■ ofthehoof). Recent methods of beat therapeutics in
man are the hot-air treatment, the hot-engorge-
ment (Bier), and the therapeutics of light (thermic
action of red rays, chemical, bactericidal action of blue rays),
A new heating apparatus with constant action has been in-
vented by Ullman under the name hydro- thermo-

COLD 8 1

regulator; Bayer has recommended its use for
the horse. The application of heat is con-
tra-indicated in all septic inflammations,
especially in septic phlegmons, as well as
malignant edemas; it favors the extension
of the process and the multiplication of the
infectious material.

Cold. — This is indicated only in septic, as well as in
thefirst stages of acute and very painful inflammations (tendon,
joint, and hoof inflammations). Its action consists principally
in a contraction of the dilated blood-vessels (anesthetic and
hemostatic action) ; it also has an antiseptic action on the
microorganisms that cause inflammation. Cold retards the
motility of white blood -corpuscles and even stops their migra-
tion. The application of cold according to a
set of fixed rules is more harmful than use-
ful in aseptic inflammations, because the nat-
ural healing process of phagocytic reaction
is destroyed.

According to experiments made by Bayer wilh employed
methods of application of cold, the most pronounced action
resulted from permanent irrigation of a shaved area
with cold flowing water (water tubes); at the end of one hour
the temperature had fallen 20°. A spray of ether
reduced the temperature fifteen degrees in ten minutes ; fifteen
minutes after the spray had been removed the temperature
had returned to normal. Seven to eight degrees was the
maximum reduction of temperature from the application of
ice bags and Leiler's tubes. The action of cold
baths and cold bandages is very weak ; when changed
every 6ve minutes the temperature dropped 3 to 5 degrees in
favorable cases ; ordinarily the temperature drops only dur-
ing the first two or three minutes and then rises again .
Cold baths must be frequently renewed, or cold maybe
applied in the form of a stream. Applications of clay,
vhich were extensively used at one time are entirely insuffi-
cient ; like cold baths the temperature is slightly reduced after
a few minutes, but soon returns nearly to normal. Thefol-

82 MASSAGE

lowing is an experimental case : the subcutaneous temperature
was 35.7° C, a clay pack of 12.5° C. was applied, the tem-
perature sank in five minutes to 32.5° C. In thirty minutes
it returned to 34.5° C, and after sixty minutes to 34.9° C.

Massage. — Massage is a very important form of treat-
ment in subcutaneous, and chronic aseptic inflammation oi
tendons, joints, muscles, bone, and skin. It is
•contra-indicated in septic, infectious, suppu-
rative inflammations, especially phlegmons,
as it favors the spreading of the disease pro-
cess. It is also contra-indicated in painful acute inflamma-
tions. Four kinds of massage are recognized :

I. ^Stroking (effleurage).

2.' Rubbing (friction).

3. Kneading or malaxation (petrissage).

4. Tapping (percussion).

Constant pressure (compression) may also be
considered a form of massage. The action of massage con-
sists in the removal of the exudate from the diseased and in-
flamed tissue ; it is mechanically forced into the lymph
channels and thus prepared for resorption. The distension
and swelling of the inflammatory enlargement are overcome,
thus reducing the pain. The circulation, nourishment, and
innervation are stimulated.

Cutaneous Irritants. — The so-called counter-irritant
method is of great importance in veterinary science in the
treatment of chronic inflammations. Blisters and
firing are the most important cutaneous irritants. These
are especially useful in chronic inflammations of the tendons
and joints, where the results are very satisfactory. Their ac-
tion is due to the transformation of a chronic to
an acute inflammation, which makes possible the
resorption of the inflammatory product. The cutaneous
irritants mentioned produce the following changes in tissues
affected with chronic inflammation : dilitation of the blood-
vessels ; inflammatory transudation of the blood-senam ;
migration of the -white blood-corpuscles (phagocytosis) ; for-
mation of ferments (enzymes) out of the white blood-corpuscles.

AGENTS THAT OPPOSK INFLAMMATION

by which the albumenous bodies in the chronically inSamed
tissue are digested in the form of albumenoses (propeptones),
and the solid products are softened, thus passiug into solution
(histolysis). An actual cutaneous irritant exerts a deep influ-
ence on tendons, bones, and joints. This has been demon-
strated by microscopic examination of tissues following the
application of tincture of iodine to the skin. A few hours
after the application there occurs an extensive transudation,
and emigration of the white blood -corpuscles into the skin and
subcutem, as well as into the iuteruiuscular tissue and perios-
tenm of the underlying bones. These acute inSammations
may even reach to the bone-marrow and lead to loosening and
solution of the cartilage at the epiphyses (Volkmau).

Agents that Oppose Infl-^^mmation. — As many in-
flammations are of an infectious nature they may be effectually
combated with antiseptics. In the treatment of deep
inflammations (phlegmon, strangles, tendinitis) antiseptics
which penetrate the skin mu.st be employed (camphor, car-
bolic acid, tar, iodoform, mercurj', etc.). Other drugs which
find use are the metallic and vegetable astringents; they
constrict the blood-vessels, form a protective dry covering,
and at tbe same time disinfect (silver nitrate, sugar of lead,
acetate of lead, alum, sulphate of zinc, lime water, tannin,
and tannoform). Tbe so-called protective materials have a
purely mechanical action (oils, salves, collodion, plaster).
Potassium iodide is a speci6c for antinomycosis.

The serum treatment for inSammation and wound
infection diseases ( an ti streptococcic serum) has not proved
satisfactory.

Operative Treatment of Inflammation.— In many
forms of inflammation, especially the infectious (abscess,
phlegmon, ichorous inflammation), incision with subsequent
irrigation and drainage is preferable to any other treatment.
Against chronic hygromata (capped-hock) injections of pure
cultures of staphylococcus pyogenes have been employed ; this
results in the formation of an acute abscess which is treated as
such (?). In gangrenous inflammation tbe necrotic
portions must be removed, it may be necessary to

84 ULCBR, FISTULA, GANGRKNB

amputate (tail, teeth, udder, ear, wings, limbs of dogs).
Other operations are scarification, that is, the local draw-
ing of blood by means of incisions or punctures ; phle-
botomy, at the present time this is employed surgically only
in that form of acute, aseptic inflammation of the pododerm
known as laminitis. Periosteotomy (artificial accelera-
tion of anchylosis formation by means of spavin operation ) was
frequently employed at one time for spavin, and chronic
periostitis on the metacarpus.

ULCER, FISTULA, GANGRENE.

I. ULCER, ULCERATION.

Definition. — From a surgical standpoint an ulcer may
be defined as a wound that has no tendency to
heal (Billroth). It may also be termed a chronic, sup-
purative inflammation with a tendency to degeneration of the
tissues ; as a continual suppurative degeneration of the granu-
lations of the wound. Ulcerative degenerations also exist in
tumors as a result of suppurative infection of the new growths
(carcinoma). From a standpoint of pathological anatomy an
ulcer may be defined as a tissue defect due to necrosis or
suppuration.

Causes. — The causes of ulcers are partly local, partly
general. Two main groups of ulcers are recognized :

1. A primary and idiopathic ulcer is due to the
influence of a continuous inflammatory irritant on the wound.
It may be due to shaking the ears after injuries, constant lick-
ing of the wound at the point of the tail or on the limbs in
dogs. Other causes are irritation due to the presence of
foreign bodies in wounds, retained masses of pus, pieces of
necrosed bone, cartilage and teeth, continued irritating influ-
ence of carious teeth on the neighboring gums.

2. A secondary or symptomatic ulcer is the
result of a complication with a suppurative inflammation. To
thisform belong cancerous ulcers; thoseof glanders,
tuberculosis and actinomycosis; the corneal

FORMS OF ui/:brs

the

ulcers of dog distemper and diabetis mellitus ;
genital ulcers of dourine.

The so-called varicose ulcers of man, which occur on the
tibia, do not exist in the lower animals : they are due to an
inflammator)' vascular engorgement induced by
a dilitatiou of the veins of the skin, and are very common.
On the other hand, the so-called trophoneurotic ulcers,
which develop in man after severe neural disturbances, are
also seen tn the lower animals (corneal ulcers following paralysis
of the trigeminus).

Forms of Ulcers. — According to the character of the
granulations ulcers are termed indolent (atonic, torpid,
painless), and irritable (erethistic, inflamma-
tory, painful), .\ccording to the character of the margins
ulcers are termed smooth and callus, that is, they have wall-
like, firm, cicatricial margins. With reference to the depth
they may be superficial, deep, or sinuous (sinuate,
undermined), or tube-shaped and fistulous (fistula).
Superficial ulcers on the mucous membranes are termed
catarrhal or erosioa ulcers. According to Ibecharacter
of the surface of the ulcer it is termed hemorrhagic,
ichorous, gaugrenous, necrotic, diphtheritic,
fungoid, (hypertrophic, luxnriative), and pbagadenic
(cancerous, increasing rapidly in diameter). Serpiginous
ulcers (creeping) are those which move from place to place,
healing in one place and extending in another. The following
classification is made with reference to the size: miliary
(size of a millet seed), lenticular (size of the crystalline
lens), those the size of peppers, peas, dollars, etc.
With reference to the form, ulcers may be round, oval, or
irregular.

Treatment. — Many ulcers heal simply as a result of
rest, that is, after the removal of the irritating cause.
Ulcers at the ends of dogs ears, for example, heal after the
application of a bandageor ear-cap which prevents the shaking
of their ears. The same is true of ulcers at the point of the
tail, on the extremities, and on the eyes (cocaine).

Other methods of treatment are extirpation, cur-

86 fistula"

rettage, firing, or cauterization; they are thus
transformed into fresh wounds. The application of such
agents as the knife, curel, cautery, chloride of zinc, sublimate,
chromic acid, and other caustics is preferable to the use of
weaker antiseptics and irritants.

Todid of potash is an internal specific for actinomy-
cotic erosion ulcers of the oral mucous membranes ; necrotic J
ulcers due to a general diseased condition may be treated with j
arsenic. Ulcers of glanders are not treated.

Thk most Important Ulcers in Domestic Akuiau. — Ulceis ^
of sDrgical importiiDCc ar« far less common in animals Iban in i
The following are of practical importance :

I, Ulcers at the point of the ear in dogs.

3. Ulcers at the point of the tail in dogs and cattle.

3. Corneal nlcers in dogs affected with distemper.

4. Hoof ulcers in horses (sole or wallt.

5. Decnbital nlcers as a result of lying.

6. Stomatitis nlcert in dogs.

7. Cancerous nicer* witb carcinoma of the skin in horses
and dogs.

8. L'lcers oftbe tongue and lips in horses and cattle.
.4I50, many badlj gTRDtilatiiig vonnds.ae well as many treads

on the coronet, and pressure injuries in the region of the
saddle, on the withers and on the neck of the horse, may be cotisidered

Definition. — In surgery many diseases are recognized
under the term fistula. One must differentiate between two
different processes,

I. Pus fistulae may be regarded as tube-like or
sinuous ulcers ; they result from inilammatory suppurative
foci that form in the depths of the skiu, subcutem, muscles,
bone, cartilage, and glands, and which reach the surface by a
process of gradual ulceration (Billroth). They are, there-
fore, the product of a chronic, suppurative, destructive inflam-
mation in the depths of the tissues. The inflammation is
frequently sustained by the presence of fragments of necrosed
tissue (cartilage, bone),occasionally it is supported by the pres-

PUS nsTuiAB

ence ofspecific microorganisms (botryomyces); the suppurative
exudate being discharged through a tube-shaped canal. The
following are examples of fistulae ; fistula of the lateral
cartilage, fistula of the spermatic cord,
tooth fistula, fistulous withers, poll-evil,
phlebotomy fistula, fistula of the fetlock,
coronary fistula, gluteal fistula, sternal fis-
tula, pelvic fistula, costal fistula, and other
bone fistulae.

2. Secretion and excretion fistulae imply a
pathological relation of deeply seated secretory organs (glands)
and excretory organs (stomach, intestines, bladder) with the
external surface of the body. To this class belong salivary
fistulae, lachrymal fistulae, milk fistulae,
gastric fistulae, intestinal fistulae, ear fistu-
lae. and fistulae of the uterus. They are due,
either to traumata, and inflammations (acquired fistu-
lae), or they may have a congenital origin (ear fistula,
fistula of the intestines, urinary fistula). When the canal has
a free communication with the excretory organ and the exter-
nal surface it is termed a complete or communicating
Sstula, when the canal ends in the tissues it is termed a
blind fistula. According to the form of the fistulous
tract it is termed a canal, funnel, or lip-shaped fistula. Other
forms are skin, mucous membrane, corneal, serous, and tendon-
sheath fistulae.

Pus Fistulae. — The symtoms of pus fistulae are
variable according to their location. The fistulous opening is
about the same in all forms ; it is usually small, constricted,
indurated, pus in various quantities is discharged from it.
The walls of the canal may be hard or smooth ; occasionally
it is filled with torpid granulations. At the bottom of the
canat one can usually feel a rough, hard mass of tissue
(necrosed piece of cartilage or bone). Fistulae are usually
painless, as they are the product of a chronic inflammation.
They may, however, become complicated with an acute in-
flammation — an acute phlegmon for example — under the influ-
ence of an injury or an improper operation.

SECRETION AND EXCRETION FISTDLAH

The treatment of pus fistulae is analagous to that of
ulcers. The suppurative ulcerative, and badly granulating
walls of the smooth, indurated and encapsuled fistulous tract
are transformed into clean wound surfaces. One should be
particular to remove the necrosed tissue at the fistulous canal.
An operation, therefore, is the best treatment for a pus
fistula ; open freely to the bottom, remove the necrosed tissues
(cartilage, bone, teeth), extirpate the indurated walls and ■
remove the granulations. For this purpose one may use the
scalpel, scissors, curet, bone-forceps, chi.sel.etc. To merely
split the fistula or cut around it, is usually '
insufficient. After splitting, the essential treatment is '
unperformed : this consists in the removal of the chronically ,
inflamed fistulous walls, and the ulcerative surfaces at the
bottom. When operating a pus fistula strict
antisepsis is necessary to prevent infection
of the fresh wound surface from the old sup-
purative foci. When these principles — ^upon which Bayer
placed special emphasis — are not observed, or when splitting
of the fistula is not followed by careful removal of the necrotic,
pus-infiltrated tissue ; the operation is easily followed by an
acute suppurative infection of the previously healthy tissue, an
extensive phlegmon is especially liable to occur. One should
observe the converse precaution : that, frequently, the
operative removal of a fistula appears to
CO n t ra -ind ica t ed as long as there is an acute |
phlegmonous inflammation in its vicinity.
such cases the operation must be deferred until the phlegmon |
has subsided. MoUer placed special emphasis on this surgical *
principal in the operative treatment of fistula of the lateral I
cartilage, it is necessary to coincide with his view on this ]
subject.

When a fistula cannot, or should not, receive operative]
treatment it may be fired or cauterized, an operation f
is more rapid and effectual. The mere application
antiseptics is seldom effective.

Secretion and Excretion Fistulae.— These are
readily distinguished from pus fistulae by the fact that, instead

PUS FISTULAE 89

of pus, various secretions aud excretions are discharged from
the opening ; saliva, milk, urine, food, gastric contents, intes-
tinal contents and feces. Their healing is much more
difficult than that of pus fistula e. The conditions
which produce an unfavorable prognosis are : continual pres-
sure from the discharging glandular secretions, operations on
the stomach and intestines (gastric 5stula, intestinal fistula)
lead to an opening of the abdominal cavity, when a fistulous
process exists this is doubly dangerous. Operations intended
to bring about removal of secretion and excretion fistulae are
of a plastic nature, they consist in an artificial scarification
and suturing of the fistulous openings. Firing and caustics
are seldom effective. In many cases radical treatment is the
only method of healing secretion fistulae, such as extir-
pation of the secretory gland (extirpation of the
parotid in the horse),

Thh Most Important Prs Fisti-lae in Domkstic Animals.—
Tbe following are of practical importance :

1. Fistula of the lateral cartilage inihe horse. This is
a circumscribed accrosiB of the cartilage which usually develops from a
paracbondral phlegmon and induces a chronic ulcemtive condition with
one or more &3tu!ous canals leading to the coronet. Treatment; Extirpa-
tion of the lateral cartilage (Bayer's method | .

2. Pistnla of tbe spermatic cord in the hoise is doe to
a chronic, suppurative, indurative i 11 fl animation of tbe spenuatic cord
(funiculitis chronica) and the tunica vaginalis. It is caused partly by
(he bolryomyces fungus ( botcyomycesof the spermatic cord), partly by
ordinary pus cocci. Treatment: Extirpation of the degenerated sper-
matic cord (ligature, ema.'iculator. ecisseur|.

3. Toolb fistulae occur in horses, especially on the premo-
lars of the iuferior maiillae ; in dogs they are more frequently seen on
the upper jaw. They are the remit of a suppurative alveolar periostitis,
ostitis, and osteomyelitis. Treatment ; Extract the tooth.

4. Bone fistulae develop from a Buppuiative, especially
necrotic, periostitis, ostitis, and osteomyelitis, .\ccording to their seat
they are classified as follows : sternal tistula, pelvic fistula, costal liBtula,
inferior maxillary fistula (false tooth fistula), fistnlaof the tail, (istulae
of the round bones, etc. Treatment ; Removal of the necrotic piece of
bone (sequester) by means of chiseling, trepanation, curettage, and
firing. Because of tbe deep seated position of the bone sternal fistulae
beal »4th great difficulty.

5. Flstnlous withers and poll-evil exist in the horse aa

SECRETION .

> EXCRHTION FISTULAE

& resnlt of coutuBions ; the conttiEiotis are followed by phlegmon and
necrosis of the skin, subcntem. bursae, fasciae, muscles, and boDes, on
the withers, in the saddle position, and in the rtgion of the neck.
Treatment : Operative removal of nil necrotic portions, antiseptic d rain-
age and irrigatiou,

6. Phlebotomy fistnlae are supported by a snppaiative thrombo-
plebititis of the jugular vein. Treatment ; Double ligation and extirpa-
tion of the diseased vein.

The most Important Sscrbtion and EzcrhTion FisTIilae. —
The following are of practical importance :

1. Milk fistulae in cows are due to injtirieB, followed by in-
flammation of the uilder and abscess formation ; thej usaalty occnt
during lactation ; occasionally they are congenital. One distinguishes
between a fistula of the gland and one that leads to the milk dnct.
Treatment ; Scarification and suturing, firing, c:anteri7.atioii, application
of a milk catheter, healing is often possible only during the 6ry period.

2. A salivary fistula is rtue, either to an injury from without
(wounds), or within (salivary calculi), tt may be either a fistula of the

Ligat

gland or duct. Treatment
extirpation of the gland.

3. Har fistula {cervical fistula,
horse is a congenital branchial-cleft
which contains a tooth (tooth- follicle cyst,
-with the chapter on teratomata. Treatment

4. Pharyngeal and e so phages
external and internal injuries, as well as
Treatment : Suture.

5. Gastric and intestinal fistulae are the result of ex-
temal and internal penetrating wounds. According to the seat, and
species of animal they are classified as follows: Pislula of the

1. scarification and auturing. firing,

branchial fistula) in tilt
at the base of the ear,
tatic tooth). Compare:
itirpation.

fislnlae are due to
perforating abscesses.

all i

. la

intestine, and rectum. A very large intestinal fistula is termed
anus praeternaturalis — artificial anus — ; vsgino-rectiil fistula ia
termed cloaca (anus vaginalis, recto-vaginal fistula) ; a fistula uniting
the bladder and tectum is called an anus vesicalis. Treatment:
rlastic operation,

6. Cystic and urethral fistulae are both termed nri-
umry fistulae. They are acquired (traumatic) or congenital. The
following ar« special forms: vesico-vagi:

al.

In .

fit

(dropping of urine from the nav
from the urachus because the fund

Other forms of fistulae are
fiBlnlae, fistulae between the 1

:1) the urine discharges continually
IS of the bladder is not closed,
achrymsl fistuUe. corneal

OANGSBKB

GANGRENE. NECROSIS.

Definition and Kinds. — The term gangrene (necrosis,
mortification) indicates death of groups of tissues, as well as
local tissue death. In surgery various kinds of gan-
grene are recognized, in especial, dry gangrene (gan-
graena sicca ) or ni u m m i f i c a t i o n , and moist gangrene
(gangraena bumida) or maceration (liquefaclive degeae-
ration). When accompanied by symptoms of inflammation it
is termed hot, otherwise, cold gangrene (sph ace 1 lus).
The colonization of putrefactive organisms (saprophytes) on
moist gangrene results in p u t r i d gangrene (pu Ire sen ce).
Ichorous or phagedenic (phagedena) gangrene is
termed putrid, progressive gangrene. Gas gangrene
(gangrenous emphysema) is caused by a mixed infection with
gas-producing bacteria (bacillus phlegmonae emphysema-
tosae, gas- generating varieties of bacterium coli). A circum-
scribed bone necrosis is termed a sequester; certain lique-
factive processes on the bones and teeth are termed caries.
Gangrene of the mucous membrane is termed diphtheria.
Superficial, dry, gangrenous areas are termed eschars.
So-called coagulation necrosis is a special anatomical
form of gangrene.

One further differentiates: gangrene of the skin, podo-
derm, subcutem, bone, muscles, tendons, mummification and
maceration of the fetns, a circumscribed and progressive, an
infectious and non- infectious (septic and aseptic) gangrene.

Causes of Gangrene.— i. Mechanical inter-
ruption of the circulation is one of the most fre-
quent causes of gangrene. Uninterrupted compression, or that
which is combined with destruction of the tissues (pressure,
contusions, strangulations, incarcerations) causes gangrenous
death as a result of anaemia, especially when combined with
injuries to blood-vessels {pressure necrosis, decubitis). The
statement has already been made under contusions, that
mechanical destruction , alone, does not result in cellular death.
Ligatures, thrombus formations, emboli, as well as diseases of
the walls of arterial vessels produce results similar to those of

' GANGRSNB

compression ; they cause an interruption in the exit of the
venous blood (anaemic necrosis). Death of the skin
and muscle occurs in from ten to twelve hours after the circu-
lation has been stopped ; anaemic necrosis of the intestines
follows complete interruption of one or two hours (incarcerated
hernia). Bone aud cartilage are the least sensitive. Derange-
ment of the circulation due to hyaline thrombosis of the
branches of the peripheral arteries may result from gangrene
(mummification of the extremities) due to ergot- poisoning
(ergotism).

2. Chemical causes of necrosis include the caostics.
Their action is variable. The metallic caustics (sublimate,
chloride of zinc, chromic acid, sulphate of copper) destroy the
tissue cells through the formation of a precipitate of metallic
albumenates, and freeing of the acid compounds. The caustic
acids (nitric acid) produce an eschar formation through the
coagulation of albumen : they also destroy cells by absorption
of water (sulphuric acid). The alkalies (caustic potash, lime,
ammonia) transform the albumen of the tissues into a slimey,
pulpy mass (alkali albumenate). Formaldehyde produces a
dry, horn-like, very deep necrosed area. Snake poisons, as
well as many infectious materials, may produce necrosis by
their chemical action.

3. The following thermic influences are classified
as causes of necrosis : high degree of heat (burning, com-
bustion), and cold (freezing, f r ost - ga n gre n e,
congelation ). The so-called third grade of burning and
freezing is nothing but necrosis. There is a great difference
in the susceptibility of different tissues to thermal influences,
a loop of intestine, for example, dies in a few hours when ex-
posed to an increased temperature of 8° C.

4. Many infectious irritants cause so-called
gangrenous inflammations. Death of the tissues is
due partly to the chemical action of bacterial toxins, partly to
their derangement of the circulation. The ordinary pus-
forming bacteria — streptococci and staphylococci —
have the ability during the course of a suppurative inflamma-
tion, namely, pbleg^mon, to produce necrosis (necrosis of the

I
I

I late

r The

NECROSIS BACILLUS

lateral cartilage during the course of a paracbondral phlegmon).
The necrotic action of the following septic bacteria is especially
strong; necrosis bacillus, anthrax bacillus,
blackleg bacillus, edema bacillus, glanders
bacillus, the bacteria of hog cholera, swine
plague, and swine erysipelas (necrosis of the skin
in swine), malignant foot rot, gangrenous
eczema, gangrenous pox, the so-called gan-
grenous erysipelas of sheep and swine, infec-
tious diseases that are characterized by diptheria of the
mucous membranes, as well as many cases of p e t e-
chial fever in the horse (necrosis of the skin, mucous
membranes, the nasal septum, the prepuce, and even the
articular cartilage.)

Also many fungi (necrosis fungi), especially tilletia
caries, ustilago carbo. ustilago maidis, and polydesnius exi-
tiosus. produce necrosis on the skin and mucous membranes of
cattle, horses, and sheep. The buds of buckwheat seem to
produce gangrene in a similar manner (fagopyrismus), the
same is true of hipinosis in horses, and clover disease, as well
as the so-called gangrene of white spots. Necrosis of the skin
and mucous membranes has been observed in the horses ol
Batavia as a result of the colonization of a mould (hyphomycosis
destruens equi),

5. Frequently several causes are operative
at the same time. Pressure necrosis in horses
and cattle may follow relatively slight mechanical insults when
a severe general disease exists at the same time. This is
especially true of diseases of the circulatory apparatus (fever,
septicemia, diseases of the blood, anaemia, cachexia, cardiac
diseases, general exhaustion). The following types of gan-
grene present similar conditions : gangrene of old age (g a n-
graena senilis), the so-called sugar gangrene (gan-
graena diabetica), and that which follows diseases of
the spinal marrow, so-called symmetrical gangrene.

BACiLLiiS,— Under this name Ban g described a bacilln*
that bad already been observed by L<> f f le r and Sc hmorl ; it occurs
in a great namt>er of disease processes, partly as b cause, partly H a
concnrrent symptom (mixed infection). It is an ubiquitous bBCterium,

especially in the i

the

n tliB tissues it ci

guU

filiform bacteria ("streptothri:
the form of rods, partly as a
filametits—as long a
or cylindrical spaces. Itisananae
flagellae ( Enist ). With Loefflers solul
methyelltie blue, recognition is easy
method. It gro(V9 best in coagulated
t 39° C.

s, the feces, in dust and
ion necrosis, and d iph-
ioni. It belongs to the
ta"), and develops, partly in
. partly in the form of long
lining it presents clear, round
.be. non- motile, and witbont
1 of methyeline blue orcarbol-
it is decolorized by Gram's
Tum as well as in Eemi-solid

media at 39° C. House mice are specially sensitive to inocnladoti ;
after subcutsueona injection there develops an extensive necrosis
of the tisanes, which results in death in the course of a week. The fol-
lowing conditions are caused by subcutaneous iajections into tlie ear of
a rabbit; extensive necrosis with thrombus formation in the large
veins, embolic foci in the lungs, secondary pleuritis, occasionally
necrosis in the heart anil other organs. Injections iu cattle, sheep, and
swine result only in local swelling and abscess formation (Hrnst).
Bang and Jensen have found the necrosis bacillus in the following

t. In the HORSB as * cause of gangrenous dermatitis
(grease), fistnlae of the lateral cartilage. coronBry fi»-
tnlae, and in dtptheiia of the mucous membrane of the

3. In CATTLB asacBuse of panaritium, gangrenous poz,
diphtheria of the uterus and vagina lalso demonstiated hf
Ellinger]. in necrotic inflammation of jfrannlating
wounds, in calf diptberia, in uectosi^ nodosa multiplex of the
liver, abscesses of (he liver, and embolic necrosis of the lungs and heart
iphlheria of the

branes, as well asiu necrotic foci of intestines and lungs in swine
plague.

4. In RABBITS Schmorl has observed a contagious, progressive,
necrotic iuHammalion caused by the necrosis bacillus. It was ushered
in with pronounced swelling of the head (under lip) which extended to
the neck, thorax, and abdomen, and terminated fatally in from ti to t6
days.

Symptoms. — Dry gangrene is characterized by dryness
of the dead tissues. The necrotic skin appears to be covered
with dried secretions, it is scabby, leathery, parchment- like,
sometimes as hard as horn, from brown to black in color, cool
and non-sensitive. Dry gangrene is most often seen in the
following places : on the back from saddle pressure, decubital

SYMPTOMS 95

^n^rene on tbe external angles of the ilium, zygomaticus,
«tc., at tbe point of the tail in dogs, on tbe claws of cattle, on
the cornea, following cauterization with nitric acid and formal-
dehyde, after death and drying of the fetus in the uterus
(mummificationj.

Moist gangrene presents the following symptoms : the
necrosed tissue has the appearance of a slimey, soft, slushy,
pulpy or ichorous, bloody mass; in color it may be grayish-
yellow, grayish-brown, dark-yellow, dark-brown, brownish-
green, grayish-green, violet, or black. A necrotic lateral
cartilage is of a beautiful light-green color (bacteria which
form coloring matter). The necrotic masses of tissue are
usually cool and non-sensitive (cold gangrene). When inflam-
mation exists at the same time they have a warm sensation
(hot gangrene). Stinking, putrid gases occasionally develop
in the dead tissues (sulphide of hydrogen, hydrocarbons,
hydrogen, ammonia, carbonic acid), they cover the external
skin in the form of blisters, or produce a frothy condition of
the ichorous mass (gangrenous vesjcli^s, gangren-
ous emphysema, emphysema septicum).

The gangrenous dead part is separated from the sound tis-
sue through a reactive, suppurative inflammation under the for-
mation ofgranulation tissue (demarking inflammation,
line of demarcation, zone of uecrosis). When
the gangrenous process extends to the walls of the large ves-
sels it may result in a gangrenous erosion of the
V e s s e I ■ w a 1 1 and lead to severe arterial and venous hemor-
rhage. The general condition is also frequently affected (septic
and pyemic affection).

Moist gangrene is most often found during the course of
septic phlegmons, on the pododerm, coronet, flexor surface of
the fetlock (gangrenous eczema), in the saddle, withers and
neck region, on the lower parts of the extremities, on the
inferior margin of the lower jaw and tongue in the horse ;
■on the udder of the cow, sheep and goat, on the scrotum and
tail of cattle and dogs, as well as on the fetal membranes
(putrid degeneration following retention), and in the fetus
^putrid emphysematous and macerated fetus).

TSBATHBNT

Treatment, — Treatment of necrosis consists in oper-
ative removal of the necrosed part (knife, scissors,
curet, forceps, chisel, trephine, etc); occasionally amputa-
tion of an entire organ of the body is necessary (tail, end of
the tongue, penis, udder, claws, ears, limbs of dogs). Slough-
ing of the dry gangrenous masses may follow the application
of antiseptic cataplasms. Above all, thorough and con-
tinuous disinfection is necessary. To prevent decubitis
in horses and cattle useplenty of soft bedding (tan-bark, sand).
Atrophv. — Atrophy is a reduction in the size of organs, u well
aa individnal cellular elemeots : it ia due lo deranged nutrition and
palhologiciil retrogresBion, (Aplasia is complete failure of organs, the
testicles, for example). l''rom an etiological standpoint the following
kiodb of atrophy are tecoKoi/ed in surgery :

1. Atrophy of inactivity is the result of inactivity of
organs, especially the muscles and glands. Tlie tielh, because of inac-
tivity, cease to assimilate (active atrophy). Compare with chronic
lameness in the horse that is usually accompanied by active muscular
atrophy, as well as atrophy of tbe [leuiB in phimosis (high nrinator).

2. Pressure atrophy is the result of continued compression of
organs, for example, from new fonnations (passive atrophy). This is
seen on the os pedis as a result of keratoma.

3. Degenerative atrophy is due to deranged nutrition accom-
panying the course of an indammatory process, for example, in the
udder and eye (atrophy and phthisis bulbi in moou blindness and sup-
purative panophthalmia) ; in muscular inflamination of the quadricejts,
anconeus, and longissimus dorsi (inflammatory atrophy): it
may also follow paralysia of the nerves, for example, the suprascepu laris
(muscles on tbe external surface of tbe scapula), the trigemfnus (mus-
clea of masticatioo), the spinal marrow (posterior ]imt>s) (neurotic
atrophy). This ia not usually a form of simple atrophy: degenera-
tive changes usually occur. Ut her forms are senile atrophy, tbe so-
called lipomatous atrophy of tbe muscles (obesity), atid the odder
(fleshy udder). For further data concerning Ktrophy compare with th*
chapter on diseases of tbe muscles and bones,

Atkesia. OHMTRRATiON.—Tbeseterms indicate the closure or
growing together (adhesion ) of body openings and canals.

in animab in the following places : rectum (atresia ani) , on the eye lida
(atresia palpe b ra r n mj, in tbe mil Ic canal and milk cy stem, as
well as in tbe lachrymal duct.

a. Obliteration is an acquired cicatricial adhe-
sion; it results fromwounds and in flammalory processes

STENOSIS

a fanu of

of the teat, in the com-

in thrombua format ion,

In the female genital canal

in the vagina, on th(
inissureof the lids, a

there occasionally occur adheEions in the vulvo
icB during coitus and parturition. Adhesions at the mouth of the teat
and in the milk cj stern with the formation of (olds in the walls are more
common ; they are caused by injuries, eczema, contagious aphtha, aud
catarrhal mastitis. Treatment of atresia and cicatricial adhesions is
operative (performtion, teal probe, milking tube, bougies).

Sthnosis. — Stenosis is a narrowing of the canals and cavities of the
body, especially the (ollowing : esophagus, trachea, urethra, vagina, in-
testines, milk ducts, salivary ducts, nasal cavities, maxillary sinuses, the
frontal sinuses, and intestines. According to the cause the following
forms of stenosis arc recognijed :

I. Compression stenosis. This is due to pressure of new
fonoations or abscesses from without on neighboring canals; for ex-
ample, the trachea Igoitre ) ; on the esophagus (tuberculous new forma-
tions in its vicinity ) * on the rectum (paraproctal abscesses and new
formations, tumors of Ibe prostate ).

3. Ubtnration stenosis consists of a narrowing or stenosis
of the canal from within through foreign bodies or new formations.
Examples of this are : obliteration of the esophagus from the retention
of food i pieces of turnips or potatoes) ; obstruction of the urethra by
calculi ; of the salivary doct by salivary calculi ; of the intestines by
intestinal calculi ; narrowing of the lumen of the trachea after fracture
of its cartilage (infraction) ; stenosis of the teat canal in cattle from
wart-like new formations, connective tissue, and epithelium, frequent
ring-like growths of the mucous membrane iso-called hard milkers) ;
stenosis of the lachrymal duct as a result of catarrhal swelling of the
mucous membrane ; stenosis of the na.sal, frontal, and roaxillary cavities
by new formations by which they are occasionally entirely filled;
stenosis of the external auditory canal tn dogs by papillomata.

J. Cicatricial stenosis or atricture is due to a cicatricial
retraction following a previous injury or inflammation. It is seen in
the trschea after tracheotomy, in the esophagus after esophagotomy, in
tbc urethra after urethrotomy, in the vagina following injuries due to
coitnsand parturition, in the teat canal as a result of wounds and chronic
mHommation (chronic mastitis), in the false nostrils following injuries
with a severe loss of substance.

4. Congenital stenosis is seen, especially in cattle, in the
teat canal and at the passage from the milk cystem to the teat canal ;
occasionally all four teat canals are abnormally narrow (bard milkers).
In cows one also occasionally &nds congenital stenosis of the vagina
(dystocia). A similar condition is observed in the lachrymal duct of
the boi«e.

98 TUMORS

Spasmodic stenosis is very uncommon (spasmodic contraction
of the esophagus).

Ectasia. Dilit^Tion. — These terms indicate an enlargement of
canals and body-cavities ; the condition is exactly opposite to that pro-
duced by stenosis. According to the anatomical form the following
varieties are recognized : diffuse and circumscribed (di verticu-
lum), cy lind rical, spindle-shaped, and sac-like. There
is also a genuine and a false ectasia. Prom an etiological stand-
point the following are recognized :

1. Pulsion-diverticulum formed by outward pressure from
an object within the canal : food above a stenosis of the esophagus
retained urine from a stenosis of the urethra. Here also belong dilita-
tions of the cavities of the head in hydrops.

2. Traction-diverticulum is due to a retracting cicatrix
from without. To this class belong macrostomia as a result of extensive
injuries to the angles of the mouth.

TUMORS.

I. GENERAL CONSIDERATIONS.

Definition. — From a surgical standpoint, in a restricted
sense, one usually understands a tumor to be an atypi-
cal new formation not the result of inflamma-
tion; it has no assignable cause nor physio-
logical termination; it has no anatomical
type, that is, it varies from the type oftissue
from which it develops (Cobnheim, Liicke).
This definition does not include the inflammatory new forma-
tions of tissue (hyperplasia), or the so-called infectious granu-
lation tumors (tuberculosis, actinomycosis, botr^omycosis,
glanders). A complete understanding of the nature of tumors
has not yet been acquired.

Classification. — From a clinical standpoint one first
differentiates between malignant and non-malignant
tumors. Carcinoma and sarcoma belong to the malignant
type. They are malignant for the following reasons : they
develop rapidly with a destruction of the neighboring tissues,
they have a tendency towards ulcerative degenerations, and
they are especially distinguished for the formation of metas-
tases in distant organs. The metastatic formations are pro-

CONNECTIVE-TISSUK TUMORS 99

<iuced in the following manner : small portions of the tumor
(cancer cells) first enter the lymph-channels (local lymph
gland metastasis) and from there find their way into the
blood-stream (general metastasis of the lungs, liver, and other
internal organs). Occasionally the cancer cells enter directly
into the yeins that are located in the* tumor (jugular) and
thereby gain entrance to the blood- stream. Aside from meta-
stasis, malignant tumors may spread by continuity, contiguity,
and dissemination (proximity, contact, becoming detached
and forming new colonies).

The histological classification of tumors depends
upon their microscopic condition. Tumors are composed of
cells, connective tissue, and blood-vessels. Various groups
and varieties have been formed with reference to the cells
which go to make up the principal parts of the tumor. Fol-
lowing this classification according to Waldeyer they fall
into two large groups :

1. Connective-Tissue Tumors, (desmoid growths
of Waldeyer, histoid growths of Virchow). They
are composed principally of cells from the middle germ
layer. They may possess the structure of connective
tissue (fibroma, sarcoma), of fatty tissue (lipoma), mucous
tissue (myxoma), cartilage (enchondroma), bone (osteoma),
muscles (myoma), the vessels (angioma), or the nerves (neu-
roma). Frequently these tumors have no typical structure,
but are a mixture of various types, so-called mixed tumors.

2. Epithelial Tumors, (epithelial growths of
Waldeyer, organoid tumors according to Virchow).
They are composed principally of epithelial cells from the
inner or outer germ layer. Carcinomata and adeno-
mata are the principal representatives of this grou p.

Histological Classification of Tumors.— Virchow divided
the tumors in general into extravasation or exudation tumors
(hematoma, hygroma), retention tumors (mucous cysts, athero-
mata) and proliferative tumors, or tumors in the narrow sense.
The tumors, in the narrow sense, regardless of whether they contained
one or several varieties of cells, were classified by him as follows : (a)

lOO CAUSES

HISTOID tumors : fibroma, lipoma, enchondroma, osteoma, myxoma>
myoma, neuroma, angioma, sarcoma; (b) ORGANOID tumors: carci-
noma ; (c) TERATOID tumors : dermoid cysts.

Cohnheim, with whom Tillman and others coincide, distin-
guished: (a) tumors formed according to the type of connective-
tissue substance (desmoid tumors according to Waldeyer) :
fibroma, lipoma, myxoma, chondroma, osteoma, angioma, lymphan-
gioma, endothelioma, lymphoma, sarcoma, and mixed tumors of the
types named ; ( b) tumors of the type of muscle tissue (myoma) ;
(c) tumors of the type of nerve tissue (neuroma, glioma); (d)
tumors of the type of epithelial tissue (epithelial growths ac-
cording to Waldeyer): carcinoma, adenoma, cystoma, epithelioma,
onychoma, teratoma.

Causes. — Nothing definite is known concerning the

origin of tumors. Among the numerous theories of

tumors the following are worthy of mention.

1 . According to the EMBRYONIC THEORY of C o h n-
h e i m the existence of tumors, especially cancer, may be referred
to proliferation of embryonic tissues; there is an
excessive formation of this tissue during fetal development, or
an aberration of its physiological coherence whereby it is
changed into other tissue. These embryonic cells remain un-
developed in most individuals ; in others growth may be
stimulated as a result of injuries, mechanical or chemical irri-
tants, hyperemia, or inflammation.The inheritance of many
tumors, as well as the existence of desmoid cysts in the inner
organs (misplaced epidermal cells in the ovaries), are best
explained by this theory. R i b b e r t has modified the theory
as follows : the cells or cell groups loose their cohesion, not
only before but also after birth, become isolated and finally
develop into tumors.

2. The IRRITATION THEORY depends upon a previ-
ous inflammation, as well as traumatic influences. The exter-
nal irritant causes a mechanical looseniugof the cells and results
in an inflammatory proliferation of the connective tissue. The
detached cells (epithelial cells for example) may proliferate un-
restrained into the lymph-spaces. Chemical irritants and para-
sites also cause loosening of the cells through the production
of connective- tissue proliferations ; the cells become isolated
and proliferate. The development of papillomata after inflam-

BTIOLGY OF T0MORS TN ANIMALS

malions of the 'skin, of sarcomata after bone fractures and of
cancers from a cicatrix, are cited as examples of this method of
tumor formation.

3. According to the INFECTION THEORY, either
microorganisms are the direct or essential causes of the tumor
(carcinoma, sarcoma, papilloma), or through certain influences
the sound tissue cells take on an infectious character. The infec-
tion theory is supported by the analagous infectious tumors :
experimental inoculation (sarcoma, carcinoma), as well as by
the proce.ss of metastatic formation. Unobjectionable
proof of the relations between microorganisms
and tumors has not yet been present ed; this is
especially true of sarcomata and carcinomala.

4. According to the AGK THEORY of Thi e rsch, age
has the following relation to the existence of tumors : In old
age the resistance of the connective-tissue
stroma is less than that of the proliferating
epithelial cells. Cancer is the result of a "shifting of
boundaries, and a boundary war of the epithelium agaiust the
connective tissue" (Boll). The change of the cell char-
acter (anaplasia), due to a stimulus of the prolif-
erative force of the cells, results from the fact that in
old age the dependence of individual cells upon their sur-
roundings (altruism) is diminished ; they become similar to
the original, non- differentia led germinal cells (Hanse-
mann). For further information concerning the etiology of
cancer compare with the chapter on carcinoma.

Etiologv of Tumors ik Animals.— Upon this sabject little is
known. Many theories of medical science find place, with nothing
furttaeT to support their claims, in veterinary science. Thus Plicq ue
main tains thai pressure from the bit causes carcinomata on the lipB
of horses : that they are caused in cats by the repeated bites of smaller
animals ( I ! ). In Germatiy these observfltions have not yet been made.
Also the further theory, that subcutaneous fibromata are often the
result of pressure from the sadi3le does not seem lo be proved, it is not
a genuine tumor, but a contused swelling (tumor Ebrosual. Smith
and Washburu attempted to produce infection in eleven bitches by
means of coitus with a dog affected with sarcoma of the penis: it is
alleged that the experiment resulted in sarcomatous nodules in the
vagina. They have also transmitted sarcoma to other animals by means

I02 CUNICAL SYMPTOMS

of subcutaneous injections ( ? ). With reference to the professed
heredity of melanoma in horses, and cancer of the mammae in dogs»
nothing definite is known. On the other hand, on the basis of my own
experience, I am able to confirm the allegations of Plicque, that
young dogs seldom or never suffer from carcinomata, while old dogs are
frequent sufferers from this affection. In at least 262 carcinomata in
dogs I have never seen one in an animal less than two years of age.
Also the 49 cases of carcinomata claimed to have been demonstrated in
cattle ( inner canthus of the eye ) by L o e b and J o b s o n were con-
fined exclusively to animals over six years of age. With reference to
the influence of nourishment it may be said that animals fed on a
meat diet are possibly predisposed to carcinoma. According to our
experience dogs suffer from cancer more often than swine or cattle.
Carcinomata are also common in horses. The claim of Trasbot, that
cancer can be experimentally produced by feeding nourishment rich in
albumen, is more than problemetical (compare with the chapter on car-
cinoma).

Clinical Symptoms.- -According to the character of the
tumor and the various stages of its development, these are
extremely variable. Cf: **Special Forms of Tumors." The
development may be rapid or slow ; it may proceed from the
center of the growth (concentric development, growth by in-
tussusception) ; or from the periphery (eccentric growth^
growth by apposition). In the first case the tumors are cir-
cumscribed, in the latter they are diffuse or accompanied by
daughter tumors. Tumors are often observed undergoing
changes known as regressive metamorphosis;
namely, fatty degeneration, caseation, calcification, cornifica-
tion, chondrification, and ossification, mucous, colloid, and
cystic softenings, deposits of cholesterin, amyloid degenera-
tions, and pigment formation. When tumors become infected
they react as do other tissues, becoming inflamed, ulcerative^
necrotic, and ichrous. The general condition is not affected in
non-malignant new formations (fibroma, lipoma, papilloma,
osteoma, etc.). Malignant tumors on the other hand, espec-
ially carcinomata, in addition to metastatic formation
result in a general derangement of the nutrition ; this is char-
acterized by emaciation, anaemia, hydraemia (cancerous
cachexia), in which important nourishment is removed
from the body on the one side, and toxic materials are taken
up by the blood on the other (auto-intoxication). As

DIAGNOSIS 103

a result of ulceration of their surfaces many growths are
hemorrhagic: chronic epistaxis in ulcerative angioma,
adenofibroma, and carcinoma of the nasal septum of the horse ;
chronic hematuria in carcinoma of the bladder in dogs.
Finally tumors maj' cause secondary derangements of
neighboring organs by compression (melanoma of the parotid
region, of the rectum, on the tail; tumors in the air passages,
in the brain, in the spinal marrow, in the vicinity of large
vessels).

Diagnosis. — The diagnosis of a tumor as
such, that is, diflferentiation from other swollen conditions,
especially inflammatory, is not difficult. Tumors usually
develop slowly and without inflammatory
symptoms (pain, increased heat). Hema-
tomata are differentiated from new formations by their
rapid, sudden formation. In contrast to a phlegmon or
abscess, inflammatory symptoms usually fail in the devel-
opment of tumors, this is especially true of pain and in-
creased heat. Only chronic hyperplastic inflammatory pro-
cesses are able, under certain conditions, to simulate tumor
formation to such a degree that diagnosis becomes extremely
difficult. Examples of this are seen in the wart-like forma-
tions which follow dermatitis chronica on the flexor surface ol
the fetlock (dermatitis verrucosa), in the formation of exos-
toses after periostitis, as well as in keloids in a cicatrix.

Differential Diagnosis. — The differential diag-
nosis of individual tumors is more difficult. A
classification of tumors can seldom be made on their macro-
scopic appearance; a microscopic examination is more
valuable for making the special diagnosis. For making a
purely clinical macroscopic examination the following points
are of value :

I. The seat of the tumor with reference to the nature
of the tissue involved is often an index to its character.
According to experience, the penis, the testicles, and the
mammae are frequently seats for the development of carcino-
ma, sarcoma, and adenoma ; the periosteum for osteoma and
sarcoma ; the spermatic cord for botryomycoma ; the skin for

I04 DIFFERENTIAL DIAGNOSIS

fibroma, carcinoma, and papilloma ; the subcutem for lipoma
and fibroma ; the nasal cavities for myxofibroma and adeno-
fibroma ; the maxillary and frontal sinuses for sarcoma and
carcinoma ; the nerves for neuroma.

2. Occasionally the size and development of the
tumor is an index for its diagnosis. The malignant tumors
are usually larger and develop more rapidly than the non-
malignant. Sarcoma and botryomycoma in the horse some-
times develop very rapidly and attain an immense size. In
the horse many sarcymata of the eye have a formidable devel-
opment. Soft fibromata are characterized by a relatively rapid
growth. Occasionally it is important to note whether the
tumor is single or developing in several places. Papilloma
and fibroma have a tendency to the production of multiple new
formations (papillomatosis, fibromatosis), this is also true of
botrvomvconia. Sarcoma, carcinoma, and actinomvcoma are
multiple when metastatic formation results in gen-
eralization (sarcomatosis, carcinomatosis).

3. The surface of the tumor is rough in papilloma,
botryomycoma, and carcinoma ; lobulated in lipoma ; compara-
tively smooth in many sarcomata and fibromata.

4. The consistency is softest in round-celled sar-
comata, soft fibromata, lipomata, and myxomata, as well as in
many cysts ; carcinomata and hard fibromata are more firm ; en-
chrondromata and osteomata are as hard as cartilage and bone.

5. The relation of the tumo,r to the skin
or to the neighboring tissues, is of great diagnostic
importance in malignant new formations (sarcoma, carcinoma)
as they have a strong tendency to include the surrounding
tissues in their processes of degeneration. They are, there-
fore, less sharply defined than the non-malignant tumors
(fibroma, lipoma, papilloma) ; carcinomata frequently present
superficial ulceration. Carcinomata and sarcomata frequently
attack deeper underlying tissues, even involving the bone.

6. Under certain conditions the race may be of im-
portance. In cattle actinomycotic and tubercular new forma-
tions are common ; in horses, botryoniycomata ; in dogs, car-

STATISTICS

'05

cicoiuata. Grey horses are frequently affected with
melanosarcoina.

7. In doubtful cases age may be of importance in the
diagnosis of cancer ; young animals are seldom affected with
cancer, on the other hand, they are frequent sufferers from
sarcoma, lipoma, and papilloma.

8. Swelling of the neighboring lymph
glands is characteristic of malignant new formations, this
is especially true of cancer and sarcoma (metastasis).

Statistics.— With tbe assistance of the statistical publications of
J oh ne and myself.as well as tbe clinical annuals of the veterinary schools
at Berlin, Munich, and Dresden, Casper has arranged statistics on
tumorsiti the domestic animals from various ]>oints of view (Pathologic
dei Gescbwiilste bei Tieren, 1899). Among 86,000 diseased horses, 1131
(i.j per cent ) were affected with tumors ; among 85.000 dogs, 4019 U-7
per cent) were similarly affected ; among 5,000 cattle, joa (i per cent)
were affected with new (ormationi. lu the years 1S86-1894, I operated
on 64j new formalions in dogs. Of these, 263 {40 per cent) were
Cftrcinomata and adenomata; 97 (I3percent) fibromata;
65 110 percent) papilloma ta ; 44 (7 per cent) sarcomata; 39 ;6
per cent) lipomata; 3 (0.3 percent) angiomata. In the years
1S95-190Z. I operated on loo cases of new Formations in the horse ; 25

eaicoma. bolrjomycoma. fibroma, and carcinoma are
the most frequent tumots in the horse. These four kinds
of Inmors fonn threc' fourths of all new formations in the horae. They
are more frequent than cicatricial keloids, keratomata and
papillomata. The following are the least common: lipoma,
genuine osteoma, atheroma, adenofibroma and myxo-
ma of the nasal mucous membranes. The statistics of ihe
Pathologicalliistitute (Casper. Johuel. which include new forma-
tions of the internal organs that are not observed by tbe surgeon,
afforded facts in accordance with clinical observations ; that carcinoma
is much more frequeut in dogs than in horses or catttle ; and that in the
two latter species sarcoma is more frequent than carcinoma. Among 133
new formations in the horse. 00 were sarcomata 147 per cent), »8 car-
la per cent] ; among 93 new formations in Ihe dog, 48
1 ( 52 per cent) , 2b sarcomata ( iS per cent ) ; among 104
formations in cattle, j6 were sarcomata (35 per cent ). 18 angloi
pCTcentl. 8 carcinomata {S per cent). With reference to the topo-
grspUical distribution of tumors the following ol>servations
were made : carcinomata were most often found in the kidneys,

Io6 TREATMENT

the mammae, the maxillary sinuses, the thyroid glands, the skin, the
lymph glands, and the testicles ; sarcomata were most often found
in the lungs, the liver, the lymph glands, the thyroid gland, the mammae
and the kidneys. Compare with statistics on carcinoma.

Treatment of Tumors. — In many cases, especially in non-malig-
nant forms, treatment is superfluous (blemish). When treatment is
indicated they should be operated at the earliest possible moment.
Operation consists in removal with the knife, scissors, or curet. Early
operation is especially indicated in sarcoma, carcinoma, and botrj'omy-
coma (fistula of the spermatic cord). When an operation is followed by
a recurrence of the tumor it indicates that small pieces of the tumor
remained. Pedunculated new formations, as well as tumors in the body
cavity (polypi of the nose, vagina, and rectum) may be removed by
tearing and twisting, by means of a ligature (ligation of the
neck of a tumor), or with the ecraseur. The galvanocautery loop,
employed in human surgery, is too complicated for veterinary use. In
many cases the firing iron is indicated, especially the thermo-
cautery, this acts as a hemostat during the operation, healing follows
under an eschar which lakes the place of a bandage. The earlier ex-
tensively employed drugs should only be used in those cases where
an operation is impossible, or for econimic reasons is not practical (for-
maldehyde in many cases of cancer of the hoof). The recent treatment
of certain tumors with iodid of potash is of some importance. It
is a specific for goitre, as well as actinomycosis of cattle (not, however,
against botryomycosis of horses). Iodid of potash may either be admin-
istered internally, or applied externally in the form of Lugol's solution ;
tincture of iodine is active when applied externally or by means of in-
jections. The internal administration of arsenic has a similar influence
on papillomata. The parenchymatous injection of other remedies
(alcohol, acetic acid i is of doubtful efficacy, the same is true of treatment
with the aneline dyes ; the siime may also be said of the artificial pro-
duction of erysipt-'las for the relief of carcinoma, a few examples of
which have been followed by success in human medicine. Concerning
the importance of the serum therapy compare with the chapter on
"carcinoma." Finally, the recently employed artificial inocculation of
malaria is of very (jnestionable value.

SPECIAL KINDS OF TUMORS IO7

II. SPECIAL KINDS OF TUMORS.
A. Connective-Tissue New Form ations.

I. fibroma.

Forms. — A fibroma or fibroid (connective-tissue
tumor) is a desmoid tumor composed largely of connective
tissue. Two forms are recognized: i. Hard fibroma
(fibroma durum, desmoid) is characterized by a hard, firm
consistency ; when cut it presents a white, tendinous, glistening
surface ; microscopic examination shows it to be composed
principally of straight, stratified, or crossed connective- tissue
fibers with a very few cells.

2. Soft fibroma (fibroma molluscum) is less common ;
it is soft in consistency ; when cut it presents a light-grey
transparent surface ; under the microscope it is seen to be
composed of loose moist connective tissue with very many
connective-tissue cells. Between the soft and the hard fibro-
mata there are many transitional forms. One also differentiates
circumscribed and diffuse, simple (solitary) and
multiple fibromata (fibromatosis). Pedunculated fibromata
on the mucous membranes are termed polypi (fibroma
pedunculum) ; similar fibrous new formations on the skin and
subcutem are termed cutis peudula (see below). Fibrous
proliferations in cicatricial tissue are termed keloids. M y-
cofibroma is a special infectious form due to the activity of
the botryomyces fungus (botryoraycoma). Finally, mixed
tumors with other new formations are very frequent, for
example, fibrosarcoma, fibrolipoma, fibromyxo-
ma, f i bron eu rom a , fibroadenoma.

With reference to the causes of fibromata nothing
definite is known. Recently it has been attempted to associate
their development with traumatic and inflammatory influences.
Their relation to inflammatory cicatricial tissue, especially
the cicatricial keloids, as well as to the inflammatory connec-
tive-tissue hyperplasias (elephantiasis, tumor fibrous) has been
considered. At the most, repeated injuries or chronic inflam-

I08 OCCURRBNCB

mations are only occasionally the cause of fibroma formation.
The principal cause, for the want of better knowledge, seems
to lie in a fibromatous predisposition. This explains the cases
of congenital fibroma (congenital anlage of fibromata). The
multiplicity of cutaneous fibromata in dogs and horses also
speaks for the presence of an internal predisposing cause.

OccuRRKNCE. — Fibromata are benign, develop
slowly, are usually roundish, circumscribed,
nodular, smooth on the surface, firm, non-
hemorrhagic painlessnewformations ofauni-
form consistency. They are very common in the domestic
animals and may develop in any organ that contains connective
tissue. Their favorite seats, therefore, are in the sub-
cutem, the submucosa, the periosteum, and the subfascial and
intermuscular connective tissue ; they are also common in the
uterus and in the nerves (so-called neuromata are nothing more
;han fibromata of the nerves). The following forms are
of surgical importance in the domestic animals :

I . Fibromata of the skin and subcutem are most
frequently observed in horses and dogs. In the horse they
are especially frequent on the head, shoulder, and region of
the withers, as well as in the sheath. Ordinarily they are soli-
tary, sharply circumscribed, from the size of a pea to that of a
fist. Occasionally they are multiple, as many as one hundred
have been seen on a single horse (Siedamgrotzky) .
Subcutaneous fibromata average about the size of a goose-egg ;
sometimes they lie in a capsule from which they may be re-
moved after a skin incision has been made (Moller). In
rare cases fibromata are found in the shoulder region in the
form of so-called shoulder abscesses (personal observations).
Bayer has observed fibromata on the scrotum of a horse that
were multiple, soft, and recurrent after removal. Many fibro-
mata of the horse are not genuine fibromata, but mycofibro-
mata (compare with the chapter on botryomycoma). Many
inflammatory connective-tissue hyperplasias are erroneously
termed fibromata ; to this class belong those found in harness
positions in horses and cattle (see below). According to my
own experience cutaneous fibromata are very common in dogs.
They are often multiple, especially on the thorax, on the ex-

OCCDRSBNCB I09

tretnities, on the ears and eyes, on the back, on the tail, and
in the mammae. As in horses, hard fibromata are most com-
mon : the soft form are seldom found. Their siite is variable ;
as a rule they are small, sharply circumscribed, hard, smooth,
and intact on the surface. Pendulous fibromata are occasion-
ally observed. In cattle myxomatous fibromata are occasion-
ally seen on the tail ( M a y r ) . Peter has described a fibroma
on the head of a cow ; the tumor weighed 1 1 J-i kg. , was pen-
dulant, and combined with cutaneous horn. On the other
hand, the subcutaneous, calcified, new formations of fibrous
tissue in the vicinity of dead larvae are not genuine fibromata
(hypodermoliths of CapariniJ.

2. Fibromata of the mucous membranes are either
flat, circumscribed proliferations with a broad base, or pedun-
culated tumors (polypi, polypoid fibroma); their
consistency is soft. Not all polypi of the mucous membranes
described in the literature are genuine fibromata. Many other
tumors of the mucous membrane have a pedunculated form ;
for example, lipoma, actinomycoraa, and sarcoma. According
to the seat, one speaks of nasal, pharyngeal, laryngeal, vagi-
nal, cystic and rectal polypi.

In the nasal cavities the flat and polypoid fibromata
(myxofibroma) of the nasal mucous membranes are of
special importance in the horse ; this is due to the fact that so-
called nasal polypi produce a stenosis of the nasal pas-
sages, causing dyspnoea, chronic unilateral nasal catarrh, and
in ulcerative degeneration, an ichorous, fetid nasal discharge
with unilateral swelling of the glands (suspected glanders).

In the uterus and vagina of the horse, cow. dog,
and pig. pure fibromata and mixed tumors (fibromyoma,
fibromyxoma. fibrolipoma) occur in various forms.

Fibromata of the vagina are frequently pedunculated
(vaginal polypi). Typical fibromata from the size of a
cherry to that of a walnut are found in the vagina of the dog.
These vaginal polypi have a firm, hard consistence, occasion-
ally they are long and bottle-shaped ; they present no inflam-
matory symptoms. They are readily differentiated from those
< chronic inflammatory swellings of the mucous membranes
rwhich also develop in the form of pedunculated new forma-

I lO TREATMENT

tions f so-called plicae polyposae) . Fibromyomata in the uterus
of cattle and swine sometimes reach an enormous size (50 to
200 pounds) . In such cases the uterus extends into the abdomi-
nal cavity. Tumors which extend through the os uteri into
the vagina are smaller. Polypoid fibromata may also develop
in the pharynx or larynx (the so-called laryngeal polypi
in cattle are usually of an actinomycotic nature), in the gut-
tural pouches, in the bronchi (polypi which follow
tracheotomy in the horse are usually granulomata or botryo-
mycomata), in the rectum, bladder, urethra, and
teat canals .

3. According to K i 1 1 , fibromata of the udder are
characterized by hard, nodular, sharply circumscribed swell-
ings ; in the dog they are from the size of a dove's egg to that
of a man's fist. They are composed of a mucoid and gelatin-
ous substance (myxofibroma). Occasionally, in addi-
tion to proliferation of the connective tissue, the glandular
tissue also proliferates (adenofibroma). Similar fibro-
mata are found in the testicles of dogs and horses.

4. In the internal organs fibromata are seldom ot
surgical importance. K i 1 1 has observed a fibroma on the
tongue of a cow ; it was hard as a board, sausage-shaped,
16 centimeters long and 10 centimeters wide. Juredieu
has described a fibroma of the pelvis of a dog ; it was as
large as a hen's egg. It is not known whether fibromata
develop in the vertebral column of the domestic animals, thus
causing paralysis from pressure on the spine (lumbar
paralysis), similar to lipoma, sarcoma, and other new
formations. The}- are found, however, in the form of osteo-
fibrouiata in other osseous cavities, for example, the tym-
panic cavity of the horse ( F r e t j a n o w ) .

Treatment. — Treatment of fibroma consists in operative
removal by means of the knife, scissors, ligature, etc. Large
fibromata are extirpated with the scalpel and the wound
sutured ; small tumors may be removed in the same manner.
In the latter, healing may be produced under an eschar by
means of cauterization. Very large, diffuse fibromata, which
cannot be entirely removed at one time may be operated on at
different times ; repeated partial operations until the enlarge-

meut is entirely removed. Operations upon polypoid
fibromata are very difficult. When one can reach
them with the hand (vagina, rectum) they may be ligated ;
ligation is more reliable when a double suture is passed through
the neck of the polypus and tied ou both sides. Polypi that
cannot be so easily reached may be removed with the ecra-
seur , this applies especially to nasal polypi. In many cases
they must be torn or twisted away with the hand or forceps.
Keloid. — A keloid is a tumor-like, fibrous, hard proliferation of
ttaeBkinaiidsubcutetQ ; it usually develops from cicatricial tissue ( cica-
tricial keloid). Incoutrasltothis. a sponlEineoDs (genuiDc)
keloid has beeu differentiated. According to recent investigations the
cxistEiice of a "spontaneous" keloid is qaestionabte ; this is due to the
(act that eiperience has demonstrated that keloids usually develop after
traumatic or ia flam matory piocesaes in the stin. The causes of keloid
formation are not yet fully understood. Some maintain that itsdevelop-
ment depends on a specific iufection of tbe wound, they claim
that this accouuts for its recurrence following operations ; according to
others, the existence of keloids depends on an individual fibroma-
Ions dispositrou of the body. In the domestic animals keloids
are most often met with in Ihe horse. They follow injuries to the
coronet, tbe bal Is oftfaeheel. the flexoraurfaceoftbe
fetlock joint, the flexor surface of the tarsal joint, as
well as to the region of the tendons; occasionally they develop
kfter gangrenous dermatitis (grease ), after firing, and after tbe applica-
tion of blisteis. They form circumscribed, bard, fibroma-like new
formations that are usually extensive iu size ; tliey are relativtly rich in
blood-vessels ; in contrast to normal cicatricial tisane, they are covered
with a thick layer of epidermis. To a certain degree they arc a highly
developed form of the so-called hypertrophic cicatrix (see page laj.
According to my own observations the continual movement and irrita-
tion of a wound that is often very insignificant appears to be one of the
principal factors on which keloid formation depends. I have never
observed recurrence following operations. According to Labat,
t. e b I a n c , and others, on the other hand, many keloids are recurrent
after excision ; they caution, therefore, against the operation, aud em-
ploy the elastic ligature (?) in combination with a disinfectant bandage
applied daily. Johne has described a cicatricial keloid of tbeflexor
tendons of a horse ; this was in the form of a hard, tendinous oval
tnmor, 37 centimeters long and 18 centimeters wide, it was fungus-like,
proliferated from the tendon cicatrix, and adhered to the tendon-sheath
and skin. 1 have observed many similar forms of tendinous keloids on
tiie extensor tendons of the coronet following treads on the coronet.

1 1 2 ELEPHANTIASIS

Blbphantiasis. — The name elephantiasis, (schleroderma^
schlerosis, pachy derma) indicates a connective-tissue hyper,
plasia of the skin and subcutem, which results in a pro-
nounced thickening of those parts of the body involved. It is very rare
that elephantiasis is caused by a genuine fibroma; in such cases it
assumes the form of a diffuse fibromatosis. In the horse it is
usually the product of chronic inflammation of the skin or
Bubcutem (chronic indurative dermatitis and phlegmon following
scratches and p h 1 e g m on : so-called thick leg, elephant leg ) ; or
specific, chronic inflammatory processes in the vicinity of the lymph-
vessels (glanders). Elephantiasis may also be caused by chronic
edema in the vicinity of the veins, as well congenital
dilitation of the lymph-vessels. In man the principal causes
of elephantiasis are leprosy and filaria sanguinis; according
to the condition of the skin the following forms are recognized : ele-
phantiasis glabra, verrucosa, ulcerosa, papillaris. Occasionally there
seems to be an individual predisposition to fibrous hyperplasias (ele-
phantiasis). La bat observed this in a horse on which a blister
(|x>tassium bichromate) had been applied after firing; this was followed
by an extensive (60-70 centimeters large) fibrous new formation on the
limbs. Similar observations have been made by Rabe and Lustig.

TvLOMA. — Tylomata are fibrous dermal prolifera-
tions (continual pressure from the saddle) that develop
from the subcutaneous tissue; they are the result of a
chronic, hyperplastic inflammation. They belong, similar
to elephantiasis, not to the genuine new formations, but are to be con-
sidered as chronic, inflammatory, connective-tissue hyperplasias. In
contrast to the circumscribed fibromata they are diffuse hard thicken-
ings of the skin and subcuteui, they are found at the seat of the collar
in horses, on the carpus in cattle, on the elbow and ischial tuberosity in
dogs. They are sometimes so heavy as to cause a suspension of the
fibrous thickenings of the skin (cutis pendula). Occasionally they are
circumscribed, when it is very difficult to differentiate between them
and genuine fibromata. Callosities of the skin, in contrast to
tylomata, consist of a hypertrophy of the epidermis, there is always
present, however, a chronic, connective-tissue hyperplasia of the cutis.

Rhinoschi^eroma. — According to Hebra (1870) rhinoschle-
r o ma in man is a specific tumor-like disease characterized by the forma-
tion of hard nodules in the skin and mucous membranes of
the nose, they afterwards extend to the lips, the superior
maxillae, the nasal cavities, the pharynx , etc. The course
is chronic and incurable, it occurs only in certain environments
and countries (Southern Russia, Eastern Provinces of Austria, Central
and South America). The principal symptoms consist of cartilaginous,
painful thickenings of the nose which extend into the deeper tissues^

LIPOMA

SB well as on the surface : ulcerative degene ration lets in, and they are
6iia11y transformed into coo nective- tissue folds. This resnltsin stenosis
and deformity of the nose, mouth, gums, and pharynx.
The ihinoschleromtL bacilli have been discovered as the cause
of this peculiar affection; they are found in the large, swollen, non-
nucleated cells of the diseased tissues. Transmission of tbia
bacillus to other animals has aot been followed by

In veterinary literature various affections of tbe horse have
been described under tbe name rbinoschleroma (Grawitz, Dieck-
erhoff,RBbe.,Schul7. and othersl; in many essential points
llicy are different from the disicase described under that beading in
man. In the horse it is manifestly an entirely different affection.
Mi>ller and Johne also maintain that this is an incorrect term for
nasal tumors in tbe horse. Ac^cording (o Kill the process is an
ade n o f i b ro US h y p e rp 1 n s i a of the nasal mucousmem-
branes ( ad enof ibro ma | . Under tbe microscope one finds
fibrose hyperplasia and amyloid induration of tbe connec-
tive tissue, pronounced proltferHtion of tbe mucous glands, as
well as new formalion, and dilitation of Ihe vessels. Because of the
rich blood-supply it may he easily confused with angioma. The new-
formations consist of hard, nodular, lobulated, smooth, flat, lar-
daceo us , transparent proliferations located close together ; ordinarily
they are found only in the lower third of the nasal cavity (pavement
epitbeliuiii) : they are usually bilateral, and are hemorrhagic on the
■nrface (epietaiiai, Ulceration, dried blood, and cicatricial formation
may be present {confusion with glanders). I have operated
several esses in the horse with good results.

II. LIPOMA

FofiMS.^Lipouia ta or fatty tumors are composed
principally of fat-cells which lie in a framework of conuective
tissue. In slruclwre they are similar to normal fatty tissue,
they may occur io any part of the body where that tissue is
present, especially when it exists with connective tissue. They
are usually located, therefore, iu the subcutaneous, submucous,
subserous, subsynovial, and intermuscular connective tissue.
If the fat-cells are in excess it is termed a soft lipoma;
when more connective tissue is present it has a firm consistence
(hard lipoma). Occasionally lipomata are pedunculated
(lipoma peudulans. lipoma polyposum). Lipoma
aborescens is a special form that develops in the vicinity

114 LIPOMA

of joint-capsules, after rupture of the capsule the lipoma pro-
liferates in the form of a tree- like growth. Like fibromata,
mixed forms are common : lipofibroma (lipoma fibroma-
tosum, steatoma), lipomyxoma (lipoma myxomatosum).

Occurrence. — Lipomata are not common. They form
circumscribed, roundish or oval tumors; occa-
sionally they are pedunculated and there fore
pendulant; some are small, others attain an
enormous size; they are nodular, lobulated,
and occasionally very soft; they crepitate ina
peculiar manner, apparently fluctuate on pal-
pation, and develop very rapidly. Other forms
are hard, develop slowly, are usually solitary,
but are sometimes multiple. They are non-
malignant tumors and never spread by metas-
tasis. It is a peculiar fact that they are not confined merely
to well-nourished animals, but often accompany anemic condi-
tions ; when the animal is affected wath general emaciation
their size does not decrease. They may undergo caseous de-
generation. When injured, suppuration may occur ; occasion-
ally they are congenital.

Of those lipomata which occur in domestic animals the
following are of importance :

I. Subcutaneous lipomata are especially common in
horses and dogs. In the horse they occur on the sheath, tail,
and anus (Bayer), also on the walls of the thorax and
abdomen, and on the posterior limbs ; they are often multiple.
The vicinity of the biceps and kliee-joint seems to be
a favorite seat for their congenital appearance in foals (per-
sonal observations) ; in this case they are circumscribed and
develop very rapidly. M oiler observed a lipoma in the
vicinity of the lower end of the biceps femoris that weighed
25.5 kilograms, Rhode observed one about the size of two
fists just above the patella on the external surface. In dogs,
where lipomata occur principally on the inner surfaces of the
limbs, on the thorax, and on the shoulder, I have observed
twelve cases. Their form is round or cylindrical, the size is
extremely variable, occasionally attaining that of a man's

I.IFOHA 115

bead. They develop slowly, have a laidaceoas consistency,
lobulated structure, and many times a pedunculated form
(pendulant). One also occasionally observes wandering lipo-
mata.

2. Pedunculated Lipomata and lipofibromata are some-
times found on the mucous membranes of the horse in
the upper portions of the nasal cavities; they originate
from the nasal septum, the turbinated bones, or the ethmoid
bone f G u r 1 1 } . Occasionally they develop in the larynx;
F r ! c k e r has described a case of lipoma on the anterior sur-
face of the epiglottis in a horse {laryngeal polypus),
the tumor was as large as a potato. Submucous lipomata in the
rectum cause obstruction and colic (Brose, Lessa).
Vaginal polypi are occasionally found in the mare on the vaginal
fioor. Polypi are also found on the mcmbrana uictataus
in dogs (personal observations).

3. Subperitoneal lipomata of the abdominal
cavity are relatively frequent in the horse; they constrict
the small intestines or rectum and lead to fatal colic. The
new- formations have a long neck, are peudulant. and originate
from the omental attachment ; they possess no surgical im-
portance. Werner, in cattle, has diagnosed a lipoma per
rectum ; the tumor was the cause of colic, and removal
through the flank resulted in a satisfactory termination. On
rectal exploration of a horse suffering from colic Sommer
recognized the presence of a tumor anterior to the bladder ;
on post mortem this proved to be a lipoma.

4. Lipomata are seldom found in other organs.
Occasionally they develop from the dura; at other times
from thepia(Kiihnaeu). Pfister published the records
of a case where a lipoma was found to be the cause of lumbar
paralysis in a cow : the tumor was located in the lumbar
region of the vertebral column. Ebinger has described a
similar case. According to Stockfleth they are occasion-
ally found in the udders of fat bitches. Esser removed a
lipoma that weighed four kilograms from the left half of the
udder of a mare. According to Montfallet lipomata in
the udder of the bitch are usually perimammary, seldom inter-
glandular.

1X6 MYXOMA

Treatment of lipomata consists in extirpation with
the knife ; pendulant lipomata may be removed by means of a
ligature.

III. MYXOMA.

Definition AND Occurrence. — My xomata (mucous
tumors) are composed of a gelatinous mucous tissue, with
stellate, branched, connective- tissue cells, an abundance of
mucous substance is also interposed. Their independent exist-
ence as tumors is disputed. Apparently they are
nothing more than edematous fibromata or
lipomata (Koster). The soft, edematous, gelatinous,
swollen lipomata and fibromata are better termed m y x o f i -
b r o m a t a and myxolipomata. Other mixed forms are :
myxomyomata, myxochondromata, fibrosarcomata, and other
muco-edematous forms. Myxomata, like fibromata and lipo-
mata, are non-malignant tumors ; they develop in thesubcutis,
submucosa, subserosa, on the periosteum as well as beneath the
fasciae. Occasionally they become sarcomatous.

Myxomata and myxofibromata appear, relatively, to be most
frequent in the nasal cavities of the horse, where they
result in the formation of so-called nasal polypi (Mol-
ler. Hamburger, personal observations) . Pedunculated
myxofibromata are also observed on the floor of the rectum in
the horse, they are in the form of bean-shaped rectal polypi
the size of a child's head (personal observations.) According
to Kitt myxomata occur in cattle in the sinuses of the
head where they may become three times the size of a man's
fist ; they are smooth, nodular or lobulated, and are composed
of glassy, swollen, mucous vesicles containing masses of connec-
tive tissue. Myxomata have also been seen in the sinuses of
the head in sheep (Cagny); and in the bladder in cattle
(Leisering). Myxomyomata, myxofibromata, and fibromyx-
osarcomata have been observed in cattle in the uterus (Kitt);
in the mammae of mares and bitches (Kitt, M'Fadyean);
in the subcutis of the horse (Ehlers); in the cutis of calves
in the form of soft tumors the size of hens' eggs on the inferior

CHONDROMA 11?

surface of the abdomen (M oiler) ; as well as beneath the dura
of the spiual marrow thus causing spinal paralysis (Brats-
chikow, Holzmann). Finally, myxoma has been
observed in the placenta ( D e B r u i n ).

Treatment of myxomata of the nasal mucous membranes
consists in tearing out, and twisting off, as well as extirpation
after previous trepanation of the nasal cavities.

Mi'cors Degenerations of the Tiirbinated BoNHs.^Uader
thisheading Sand {Monatshefte (urTierbeilkunde. 1893) has tiescribed
■ tumor-like swelling of tbe facial bones of foals: it was charac-
terized hy dyspnea and nasal discliarge, as well as mucous softening of
Ibe turbiuBled hones, and the OBseous walls of the superior maxillacy
and frontal sinuses. The latter become dHaled, and are affected with
hydrops and empyema. I have ot)serve() similar cases.

Mvxsu&M.^. — The following symptoms have been observed follow-
ins disease or r«iaoyal of the thyroid gland in man : edematous swell-
ings of the skin of the face and extremities (colIectioDB of mucin),
with pronounced general decrease in nonriabmenl, (Eren^tli, and psychic
activity (cachexia atnimaprivB following thyroid operations : related to
ctetinisni). Recently myxedema has been successfully treated in man
by Ibe administration of thyroid-gland substance and tbyroid'gland
preparations (iodothyrin). The existence of myxedema is explained as
follows : it is the function of the thyroid gland tn prevent tbe formation
of mucin in the body ; in myxedema this function is destroyed flj.

Nature and OccoRRENCE.^Ch ondroma (eiichon-
droma, ecchondrosis, cartilaginous tumors) is a name applied
to tumors composed largely of cartilage ; this form of new-
formation is apparently rare. Hyaline cartilage is the principal
component (large or small cells). They ere found in the fol-
lowing places :

a) in cartilage (ecchondrosis or hyperplastic Chon-
droma) ;

b) in bones, on the ribs, in the pelvis, on the vertebral
column, on the first phalanx, on the ethmoid bone, and sphenoid
bone ;

c) in the udder, testicles, thyroid gland, in
the parotid, in the subcutem, ami in other organs
that are normally free from cartilage (enchondroma in tbe nar-

Il8 CHONDROMA

row sense; heteroplastic chondroma). The occurrence of
chondromata in these organs is partly due to a metaplasia
(metamorphosis) of connective-tissue cells and endothelial cells
into cartilage cells, partly to aberration of germinal cartilage.

Chondromata are b e n i g n tumors, they are usually
solitary but occasionally multiple; they are
spherical in form (udder), and occasionally
very large. They are nodular, elastic, firm,
and painless. Chondromata are usually observed in com-
bination with other tumors (chondrofibroma, osteo-
chondroma, chondrosarcoma); they may undergo
softening, cystic degeneration, calcification and ossification.
An osteochondroma is composed of material similar to
non-calcareous (osteoid) bone tissue.

In the domestic animals chondromata are most often found
in the mammae of the bitch; they are from the size of a pea to
that of a man's fist, round, firm, painless, and sharply circum-
scribed from the normal glandular tissue ; they are nodular
and are not adherent to the skin. Cartilaginous, nodular,
sharply circumscribed chondromata are repeatedly found in the
testicles of the horse (Kitt). They are also fre-
quently found on the costal cartilages of the horse and
ox ; in this case they may possibly have a traumatic origin
(Bruckm'iiller, Kitt, Hahn, personal observations) .
Chondromata are found in the vicinity of the thyroid
gland ( Sied a mgrot zky , Zahn). Seidamgro-
t z k y described a chondroma that was twice as large as a
man's fist, it was located on the first phalanx of a cow. They
have also been found on the maxillae and in the nasal
cavities of horses and dogs (Gurlt, Kitt); on the verte-
bral column of a dog with spinal paralysis (Smith); in
the vicinity of the ear in cattle ; at the base of the second and
third cervical vertebrae, hard tumors weighing 4^^ kilograms
and as large as a man's head (Morot); in the subcutis ot
cattle, horses, and dogs (Janson, Morot, Leisering,
Ostapenko); on the vocal cord of a horse (Lee); as
well as in the crystalline lens of a foal (Renner).

Treatment consists in extirpation ; when large chon-

OSTEOMA 119

dromata are present in the udder it should be amputated. In
my experience many cases of chondroma of the udder in dogs
do not require treatment ; this is due to their stability and
non-malignant character.

V. OSTEOMA.

Nature and Occurrence. — An osteoma or bone
tumor is composed largely of osseous material. It is analo-
gous to chondroma. With reference to their occurrence they
may be arranged as follows :

a) Those occurring in bone (hyperplastic osteoma);
they develop partly from the periosteum, partly from the tela
ossea, and partly from the bone-marrow. They are known by
various terms : exostoses, osteophytes, hyperos-
toses, enostoses. To this class also belong new for-
mations of bone due to inflammation (exostoses).

b) Osteoma may also occur in the following organs,
although they contain no bone-cells : the mammae,
parotid, brain, muscles, and other organs that nor-
mally contain no bone-cells (heteroplastic osteoma) ; they are
either due to metaplasia, or aberration of embryonic tissue.

According to the consistency one speaks of an osteoma
durum or eburneum (hard as ivory), spongiosum
(spongy), and meduUare (composed largely of marrow) .
According to the covering it is termed a cartilaginous
exostosis (covered with cartilage), or a bursal (located
beneath a mucous bursa). Mixed forms of osteomata are also .
frequent: osteosarcoma, osteofibroma, and osteo-
chondroma. Osteomata with broken attachments so that
they lie free in the cavities of the head are termed dead osteo-
mata. Unattached osteomata are located in tendons and
muscles away from the bone.

Osteomata form very hard, bone-like, painless,
benign tumors ; they are more or less sharply
circumscribed, partly multiple, partly sol-
itary, and are usually located beneath the
skin. In the domestic animals they are more frequent than

I20 MYOMA

chondromata. The following forms are of practical importance :
osteomata that frequently occur on the inferior maxilla
and metacarpus, and are usually due to an ossifying
periostitis, occasionally, however, they are genuine tumors
(pedunculated fungoid and knob-like osteomata on the free
margin of the inferior maxilla) ; osteomata of the udder and
testicles in horses, cattle, and dogs ; of the crystalline lens
in the horse ; as well as those which occur in the cavities of
the head of both the horse and cow. The latter apparently
develop from rudimentary cartilaginous areas of the sphenoid
and ethmoid bones and occasionally form so-called total osteo-
mata (ossified brain) . Odontomata and dental osteo-
mata of the teeth, on the maxillae, and on the petrous por-
tion of the temporal bone, are special forms.

Treatment consists of removal by means of the saw,
chisel, or trephine.

VI. MYOMA.

Nature and Occurrence. — A myoma or muscle-
tumor is composed of muscle-fibers. According to the
character of the fibers they are classified as follows :

(a) Leiomyomata (myoma laevicellulare), themorecom-
mon form, are composed of non-striated muscle-fibers. They
are usually found in the stomach, intestines, uterus, in the
bladder, as well as metaplastically in tumors of the kidneys,
testicles, and ovaries ; occasionally they are combined with
other tumors (myofibroma).

(b) Rhabdomyoma (myoma striocellulare) is rare ;
it is composed of striated muscle-fibers, and is occasionally
found in mixed forms (myosarcoma).

Myomata are of slight surgical importance as they are
usually found only in the internal organs. Kitt has de-
scribed a subcutaneous leiomyoma of the crural muscle, it
weighed 250 grams. Gratia has described a rhabdomyoma
which had its seat on the vagus at about the middle of the
cervical portion in the horse Mo nod has operated an
encapsuled rhabdomyoma as large as a goose-egg in the

NBUKOHA 131

vicinity of the shoulder in the horse. S i ed amgrot xky
has observed a leiomyoma of the testicles; Kolesnikow
observed a rhabdomyoma of the tail. Leiomyomata of the
uterus are far more frequent (Kilt, Frank, Johne,
Eber, Gratia, Harms); the same is true of peduncu-
lated leiomyomata of the vagina that cause sterility (De
Bruin) ; leiomyomata that lead to stenosis of the intestines
(SchutE, Tetzner. CadeacJ and stomach (Rabe,
Lotbes); ss well as those of the bladder (van Tright,
Lienaux, Voirin. personal observations), and
kidneys (Johne). With reference to the treatment, myomata
of the uterus are experimentally treated, as in the human
family, with internal administration of ergot.

VII. NEtJEOMA.

Nature and Occurrenck.— Two varieties of new for-
mations are described under the term neuroma, ornervous
tissue tumors.

(a) Genuine neuromata are a new formation composed
essentially of nerve-fibers: they maybe medullated (neuroma
myehnicum), or non-medullated (neuroma amyelinicuni).
This form is very uncommon in man, and has not been ob-
served in the domestic animals.

b) False neuroma is a fibroma or myxoma of the
nerves (neurofibroma, neuromyxoma). It develops from the
connective tissue of the perineurium, and is composed princi-
pally of connective tissue or mucous tissue. These neurofibro-
mata in the horse occasionally develop as a result of neurec-
tomy when the operation is followed by a neuritis, ihey also
occur in saddle horses on the internal tibial nerve. Analogous
to the amputation-neuromata in man, they form spindle-
shaped or oval enlargements on the central end of
the nerve ; they are white in color, from a bean to a
5 egg in size, and cause lameness. They
I have been seen on the median nerve (Mbller. Trasbot
[ and others, personal observatious) ; on the volar and planter
taerves ( Ha rdy , Brauel, Rey &nd others, personal obser-

122 ANGIOMA

vations) ; also on the peroneus (Bayer), and tibialis
(Becker) . That form of false neuroma recognized in man
under the name helicine neuroma (plexiform neuroma)
has been repeatedly observed in cattle (Morot, Ostertag,
Tiemann, Matschke); it is multiple and develops in
the form of nodules and cords. Its favorite seat seems to
be in the brachial plexus, the cervical, thoracic, and abdomi-
nal gangliae of the sympathetic, as well as on the intercostal
nerves. In one case, multiple neurofibromata produced symp-
toms of paralysis in the ox (Matschke). Zietschmann
described two other cases of multiple neuroma formation and
chronic interstitial neuritis of the brachial plexus in cattle,
there were no special symptoms of paralysis, the enormous
anatomo-pathological bhanges were remarkable when contrasted
with the clinical symptoms (slight motor weakness. ) One case
of helicine neuroma has also been observed in the horse
( Leisering) .

G 1 i o m a t a are a result of proliferation of the neuroglia
cells (supporting cells) of the brain and spinal marrow, they
are of no importance from a surgical standpoint. So-called
glioma of the retina is a sarcoma (gliosarcoma).

Treatment of neurofibromata consists of free exposure
and extirpation, recurrence is possible and the neurectomy
may have to be repeated.

VIII. ANGIOMA.

Forms. — Angiomata or vessel-tumors either
originate from blood-vessels (hemangioma, angioma
in the narrow sense), or from the lymph- vessels
( lymphangioma). Angioma is a collective term for
various tumors which are composed principally of dilated
hypertrophic, abnormally twisted, and newly-formed vessels.
The following forms are recognized :

a) Angioma simplex (teleangiectasis, naevus, naevus
vasculosis, birth-mark, fire-mark) is composed of dilated and
newly-formed capillaries of the skin.

b) Angioma cavernosum (tumor cavernosus) is

ANGIOMA 123

a venous new-formation of the skin, mucous membranes
(nasal mucous membranes), bones, liver, etc. It is a cavern-
ous-like body containing large spaces that communicate with
one another.

c) Angioma racemosum { helicine angioma) is char-
acterized by its serpentine structure.

d) Angioma ly mphaticu m (lymphangioma, lyniph-
angiectasis) is a rare form ; it is composed of dilated and
newly-formed lymph -vessels. It occurs in the skin (congeni-
tal elephantiasis), the tongue (macrogJossia), and the lips
(macrocheilia). It develops in the form of an angioma sim-
plex, cavernosum. and cysticnm.

e) Fungus vasculosus (fungus hematoides) is not a
genuine angioma, it is a term that indicates various extremely
hemorrhagic new-formations.

OccURKENCB, — In the domestic animals angiomala are
observed in various parts of the body. The most important
are the superficial angiomata in the form of edematous areas on
the nasal mucous membranes of the horse, they
are usually cavernous, seldom simple, and lead to epistaxis.

ulcerative formations, dyspnt
Deigendesch described a
years caused periodic epistaxis.
angioma of the mucous me
eyes in
that even

and suspicion of glanders.

ise of angioma which for ten

Liibke saw a case of cavernous

branes of the nose and

horse ; there was hemorrhage from these organs

ttended to the lachrymal duct. S c h u 1 7. observed

angiomatous ulcers on the nasal mucous membranes as large
as a man's hand. Finally, angtomata of the nasal mucous
membranes are many times confused with other hemorrhagic
new-formations, especially the adenofibrous hyperplasias in the
same region (see page 1 13).

According to Zschokke osteoangiomata at the base
of the tail in cattle are not uncommon. They form tumors
twice the size of one's fist, which grow entirely through the
body of the vertebra;, are composed of numberless dilated
blood-vessels, and are made up of a reticulated, spongy, bone
substance. Roscnbaum observed a similar very hemorr-
hagic new-formation on the tail of an ox. Angiomata ot the

124 LYMPHOMA

skin and snbcutem are less common in animals (Bon-
net, Leisering, Johne, Moller, Siedamgrotsky ,
personal observations). Grebe has observed a
cavernous angioma as large as a fist on the gums and lips of a
horse; the animal died during operation. Zschokke has
described an angioma at the base of the skull in a cow ; it
developed along the nerves which supply the external ocular
muscle, causing its paralysis and strabismus convergens exter-
nus. Francesco has described an angioma on the penis of
a horse ; it was the cause of frequent and severe hemorrhage.

Leisering and Eggeling have seen angiomata of
the vaginal mucous membranes in cows. Stenzel has in-
vestigated four cases of angioma of the udder in cows.
Schindelka has described a lymphangioma of the mamma
in a cat. Angiomata of the liver, which occur frequently
in cattle and other animals, are of no surgical importance.

Treatment. — Healing of angiomata of the nasal cavities
in the horse cannot often be attained because of their deep
situation. Superficial angiomata of the skin are occasionally
very difficult to extirpate on account of their size and extent.
In human surgery the following methods of therapy are em-
ployed : Ligation of the blood-vessels which supply the part,
cauterization, firing, puncture with the thermocautery, appli-
cation of the galvanocautery, as well as the injection of liquor
ferri chloridi, alcohol, tincture of iodine, and extractum
secalis.

IX. LYMPHOMA.

Nature. — L y m p h o m a (tumor of a lymph-gland) is a
name used to indicate various disease processes of the lymph-
glands.

a) Leukemic lymphoma during the course of
leukemia.

b) Malign lymphoma during the course of pseudo-
leukemia.

c) Lymphosarcoma, lymphadenoma, car-
cinoma and other genuine new formations in the lymph-
glands.

SARCOMA IJ5

d) I n f 1 am m a to ry hyperplasia of the
lymph -glands following chronic inflammatory processses
of neighboring organs (catarrh, strangles, glanders, tuber-
culosis, actinomycosis).

The so-called malign lymphoma (progressive hyper-
plasia of the lymph-glands, lymphadenia, lymphomatosis ma-
ligna. Hodgkin's disease, pseudo- leukemia) which frequently
occurs in man, is also seen in cattle, horses, and dogs. Like
leukemia, without however, a marked increase iu the number
of white blood corpuscles in the blood, it is cbaracterired by
the enlargement of groupsof lymphaticglands. orenlargement
of the entire lymphatic system of the body. They are arranged
in the form of multiple, nodular or clump-like,
lardaceous, soft or hard, painless, often very
large tumors in the vicinity of the inter-
maxillary glands, the superior, middle, and in-
ferior cervical glands, the inguinal, knee,
and pelvic glands. On account of the generalization
of this disease surgical interference is of no use ; treatment
is confined to the internal administration of arsenic oriodid of
potash. Solitary lymphomata in the intermasillary space in
the horse may be extirpated without difficulty. Operative re-
moval for diagnostic purposes may be indicated (suspected
glanders).

X. SARCOMA.

Nature.— A sarcoma is a desmoid tumor which maybe
termed an atypical proliferation of the embryo-
nic connective tissue. It is a malignant con-
nective-tissue new- formation in which the
I cells (round-cells, spindle-cells, gianl-cells,
dotbelial cells) are far in excess ofthein-
I tercellular substance. They often develop very
I rapidly, when they are usually associated with metastatic for-
\ mation through the medium of the veins. Sarcomata develop
I linywbere in the body where connective tissue is present . Their

1 26 SARCOMA

favorite points of development are the periosteum, the bone-
marrow, the lymph-glands, the cutis, the subcutaneous, sub-
mucous, and subserous (subperitoneal, subpleural) tissues, the
eyes, the glandular tissues (testicles, mamma, thyroid), as well
as the vessel- walls. Sarcomatous cellular activity is often
followed by regressive conditions ; these are softenings, cystic
formations, hemorrhage, ulceration, and suppuration. As in
other tumors, mixed forms are common ; for example, f i b r o -
sarcoma, chondrosarcoma, myxosarcoma, osteo-
sarcoma . With reference to the causes nothing definite is
known. Recent theories concerning bacterial and protozoan
irritants have not been sustained.

Forms. — Sarcomata are characterized by many different
forms. According to the structure and the forms of the con-
nective-tissue cells the following principal types are recognized :

a) Round-celled sarcomata are composed of
large or small round-cells (large and small round-
celled sarcomata). The small round-celled sarcomata
are especially malignant. They consist almost wholly of
small round-cells, similar to white blood-corpuscles ; occa-
sionally they are combined with ameboid connective-tissue
cells which multiply very rapidly. The consistency, there-
fore, is soft, marrow-like (medullary sarcoma), and the
growth is very rapid.

b) Spindle-celled sarcoma is composed essen-
tially of spindle-cells ; it often develops from a fibroma
(fi b rosarcoma).

c) Giant-celled sarcoma is very malignant;
it is usually found in the bone-marrow (myelogenous
sarcom a, myeloid).

d) Stellate or ** Ne t zzel len *' sarcomata
usually arise from myxomata (myosarcoma).

e) Sarcomata with polymorphous formation
are composed of various forms of connective-tissue cells :
round-cells, spindle-cells, giant-cells, retic-
ular cells; there are many combinations of these cells
(combined sarcoma).

f) Alveolar sarcoma is characterized by a gland-

ARCOMA

127

and cancer-like alveolar structure ; under certain conditions it
is difficult to differL-ntiate it from carcinoma. The alveolar,
small and large round-celled sarcomata are of special import-
ance ; lymph osarcomata are examples of the former.
In contrast to carcinomata of a similar alveolar structure, the
alveolar sarcomata show an intercellular substance among their

g) Angiosarcomala or eiidotheliomata
(endotheliosarcoma, endothelial cancer, plexiform angiosar-
coma, plexiform angioma, cylindroma, perithelioma) are
angiomata with a sarcomatous proliferation
of the cells of the vessel-walls. They develop
from the following sources : the endothelial cells of the intima
and perithelium (adventia) of the blood- and lymph-vessels,
the lymph-cells of the connective tissue, as well as the endo-
thelium of the pleura, the peritoneum, the dura, and the pia.
They have been recently differentiated, then, as li e m a n g i o-
sarcomata (angiosarcoma of the blood-vessels) and
I ymphangi osarcomata (of the lymph -vessels). De-
pending on their origin on the inner or outer wall of the
vessel they are termed intravascular (endothelial), and
perivascular (perithelia!). Angiosarcomala are very
malignant ; they show a tendency to hemorrhage and hyaline
degeneration. They are easily confused with carcinomata.
They are characterized by pronounced thickening of the
vessel-walls, of hyaline appearance, and are frequently of
cylindrical form.

The following belong to the angiosarcomala or endothe-
liomata : cholesteatoma or margaritoma on the
venous plexus of the brain of the horse (endothelioma with a
deposit of cholesterin crystals), psammomata or sand-
tumors of the brain (endothelial tumors with a deposit of car-
bonate of lime), and xanthomata or xanthelasma (fatty
endotheliomata, endothelioma lipomalosum ; according toothers
a form of lipoma).

h) Mel anosarcom a or melanoma (pigmentsar-
coma) is a brown or black, pigmented tumor that is often very
malignant ; it develops rapidly and is frequently recurrent. It

128

spreads by tnelaslasis and is most often seen in grey horses, it
may, "however, occur in dark horses (brown, chestnut, black),
as well as in cattle, sheep, and dogs. Histologically melano-
sarcoma is partly round-celled and alveolar (soft, malignant
new-fornialioD), partly spindle-celled or fibrosarcoma (firm,
relatively benign tumor). Formerly the pigment was sup-
posed to be the coloring matter of the blood. According to
recent investigations, however, the pigment (hippomelanin)
frequently contains no iron ; it arises from specific embryonal,
pigment-forming cells, the melanocytes (Berdez and
Nencki. Lieber). According to Ribbert pigment
tumors are formed from the chroniatophores. Accord-
ing to Joss the pigment is developed from the albumenous
material of the blood through a specific, metabolic activity ot
thesarcomatouscells (high percent of sulphur). Melanosis
is diSerentiated from melanoma by pigment infiltration, with-
out tumor formation, in the subcutem, in sheaths of muscles,
and in internal organs (calves, cattle, horses).

Occurrence. — Sarcomata are very common in the domes-
tic animals ; they are especially common in cattle, horses, and
dogs. Among 54 sarcomata observed by Semmer, 30 were of
thedog, 12 of the horse. 4 of cattle, and z of swine. Among
643 new formations that I have operated upon in thedog, 44
were sarcomata ; among 200 new formations operated upon in
the horse. 50 were sarcomata. From a surgical standpoint the
following sarcomata are of importance :

I. Sarcomata OP THE Bonks. — These arepartly periosteal,
partly central (niyelogeuous) sarcomata, partly osteosarconiata.
They are found in horses and cattle, especially in the nasal
cavities and maxillary sinuses, where they may
develop from the ethmoid bone, the turbinated bones, the nasal
bones, the zygoma, or the superior maxillary bones. They
give rise to stenosis, cause chronic catarrh, and may
extend into the frontal sinus, the oral cavity, the
orbit, the cavities formed by the sphenoid
bone, and to other bones of the head. In dogs
they are most often lound in the oral cavity, and on the
superior maxilla, less frequently on the inferior maxilla.

SARCOMX 129

They develop on the gums in the form of proliferations that
are nodular, circumscribed, compact, as hard as bone or carti-
lage, and painless ; the surface is rough, irregular, granular.
or lobulated ; they cause the teeth to become loosened, dis-
placed, raised, and crowded apart (epulis). Central osteo-
sarcomata also occur in horses, dogs, cattle, and swine ; they
may be solitary or niuiiiple. at times generalized ; they occur
on the humerus, the scapula, on the femur, on
the tibia (lameness), the frontal bone, the petrous
portion of the temporal bone (facial paralysis),
on the bones of the cranium, neck, and verte-
bral column. Kammerman saw a case of spindle-
celled sarcoma in the cow : it passed through the intervertebral
foramen of the atlas to the cervical marrow. Dieck erhoff
and Frdhner have observed diffuse myelogenous sarcomata
in horses and dogs. A sarcoma of Ihe guttural pouch caused
hemiplegia by penetrating the vertebral canal of a horse ; an-
other iu the same place caused paralysis of the tongue ( H a 1 -
lander ) . Spinal paralysis is caused in horses, cattle, and
dogs by pressure on the spinal cord from hard sarcomata
(Dorrwachter, Dexier. and others). In swine a
form of so-called sn n f f 1 e-disease is caused by sarcoma
of the facial bones.

2. Lymphosarcoma. — This is most often found in
horses and dogs. In horses, according to my experience, they
are soft, sometimes fluctuating and cystic tumors. They vary
in size from a hen's egg to that of a man's head ; they are often
multiple, and are found in the intermaxillary region
(suspected glanders), in the region of the larynx
(goitre- like tumors), on the neck, in the region of the
shoulder (a form of shoulder abscess), on the anterior
portion of the thorax, in the pelvic glands, on both
sides of the sheath, etc. In one case in a horse that was suf-
fering from "intermittent lameness" I found a lymphosar-
coma that involved the left iliac and femoral arteries ; it was
as large as a man's fist. I have also found lymphosarcomata
in dogs, especially on the neck and iu the region of the pubis ;
they are often multiple. In cattle lymphosarcomata as large

I30

SARCOMA

as one's fist are found in the thoracic region, in the flank, and
in the sacral glands (Poncet). Strieker succeeded in
transmitting lymphosarcoma of a dog lo thirty-one other dogs
by means of subcutaneous and intraperitoneal injections.

3- Sarcomata of the Skin and Mucous Membranes.
— These form circumscribed and multiple, or diffuse and ex-
tensive tumors of soft or hard consistence. They may appear
nodular, lobulated, fungus-like or villous. In cattle and
horses they are found in the cervical and shoulder regions ;
in these places they form exteusive tumors which may lead to
passive edema or suppuration ; they may extend to the
thoracic cavity and cause asphyxia from pressure on the
trachea ; generalization with metastatic formation in the in-
ternal organs is common. They also occur in other parts of
the body : namely, on the extremities of dogs ; on the lips,
tongue, rectum, sheath, and fleshy-frog of the horse; on the
vulva and vagina of cows (cause of dystocia). Eberlein
has described a pendulous sarcoma on the inferior maxilla of
a horse. G i r o 1 1 i observed a myxosarcoma on the umbilicus
of a calf. Gorig has described a multiple sarcoma on the
throat and thorax of a hen.

4. Sarcomata of the Eybs. — These are most often seen
in horses, dogs, and cats. They occur either in the form of a
round-celled sarcoma of the orbit where they cause strabis-
mus (squint) and exophthalmos, as well as degeneration of
the neighboring bones, and even press into the frontal sinuses,
the maxillary sinuses, and the cerebral cavity (Emmerich,
personal observations), or a round-celled sarcoma (gliosar-
coma) of the retina, or as a melanosarcoinaof the choroid
(Bayer).

5. Sarcomata of the Testicles, Udder, Thyroid
AND Parotid Glands. — These result in a circumscribed en-
largement, or enlargement of the entire glands, occasionally
the enlargement is enormous. According to my experience
they are relatively most frequent in displaced testicles, and
in the mammae of bitches, as well as in the thyroid glands of
the horse, W a 11 e y found in a horse (cryptorchid) a round-
celled sarcoma of the testicles that weighed 35 kg. I have

SARCOMA 131

likewise diagnosed and removed from two stallions, two small
round-celled sarcomata of the testicles as large as a child's
bead. Schuemacher has observed a similar sarcoma of
the testicles in a stallion. Gariuo has described twelve
cases of fibrosarcoma of the testicles in breeding animals
(eleven were unilaterial, one was bilateral) ; the testicles were
enlarged three or four times their usual size, 2><-3 kg., the
spermatic cord was thickened as far as the inguinal ring.
Sarcomata also occur in the ovaries and kidneys. Resow
described a primary round-celled sarcoma of the udder of a cow.

6. Subperitoneal and Sobplrukal Sarcomata. —
These are apparently common in cattle, horses, and dogs ; thi»
is especially true of sarcoma of the abdominal cavity, the
pelvic cavity, and the intestines. As a rule they cannot be
operated and are of no surgical importance. It is a peculiar
fact that many times they cause no obvious external
symptoms. They are usually first discovered during a post
mortem. In other cases they are the cause of colic (stenosis
of the small intestines), and general emaciation, as well as
cachexia. Sarcoma of the pelvic cavity may result in an in-
curable obstruction to parturition ; this is due to adhesions, or
to compression of the uterus and vagina. Primary or metas-
tatic sarcomata of the lungs, liver, spleen, kid-
neys, brain, heart, bladder, inner lymph-glands,
etc., are of uo surgical importance.

7. Melanosarcoma. — This is most often seen in horses ;
it also occurs in asses, oxen, sheep, dogs, and goats ; it may
be isolated, multiple, or generalised. It is most often seen in
old grey horses. They are usually found in the following
places: in the vicinity of the anus, the vulva, the
vagina, the tail, the sheath and the penis, the
shoulder region — especially at the point of attachment
of the serratus to the scapula — the eyelids, the
lips, as well as the region of the cheeks, the masse*
ters, and the parotid. They may arise in any organ or
in any part of the body. They have been found by others in
mascles, bones, and lymph-glands. Mauri has
described a case of melanoma on the body of the third lumbal

133

vertebra, which led to pressure of tlie spinal marrow with a
subsequent spinal paralysis. V a c h e has observed a similar
case of pressure atrophy of the lumbar marrow in a seventeen-
year-old mare. In other cases compression of the brain, in-
dividual cranial nerves (facial), the ischiadicus, and the
femoral artery, leads to paralytic conditions. I observed a case
of fragilitas ossium (multiple fracture of the pelvis and ribs)
in a horse affected with general melanosarcomalusis. In several
others, int-Sanosarcoma in the perirectal connective tissue was
the cause of chronic colic due to obstruction. Roder observed
a case of stenosis of the urethra in a horse caused by melano-
sarcoma of the pelvis. Many melanosarcomata have a tendency
to ulceration and suppuration, so that, for example, cancer-like
ulcers are present on the skin, hemorrhage occurs in the nasal
cavities (personal observations). Internal melanosarcomata
may rupture and terminate in fatal hemorrhages. Generaliza-
tion is very frequently observed. Metastases develop in the
lungs, liver, heart, in the lymph-glands, etc.
With reference to the prognosis it may be remarked that in a
great number of cases, even in the general-
ized form, general derangements are not
observed . Melanosarcomata are usually of incidental im-
portance in slaughtered horses that are otherwise normal. In
St. Petersburg in the years 1892-93. from 7000 slaughtered
horses, 36 cases of melanosarcoma, of which 8 were general-
ized, were observed (Sawaitow). Budnowski found
12 per cent of the First Sovereign Hussar Regiment (only
grey horses I ) affected with melanoma ; in 63 horses the
melanoniata were from the size of a pea to that of a hazel
nut; complications dangerous to life had occurred only four
times in the regiment (seat in the pelvic cavity, on the omen-
tum, beneath the vertebral column, in the parotid). In other
cases melanomala are very malignant, they undergo ichorous
degeneration and chronic hemorrhage : the patient suffers from
anemia and general cachexia. The soft, pigmented, round-
celled sarcomata have a special tendency to result in the latter

TREATMENT.^Sarcomata should be extirpated as early
as possible. Treatment is unavailable when metastatic

CA&CINOMA . 133

formatioo has already commenced. In the latter case especially
the prognosis of melanosarcoma is ver>' unfavorable : satisfac-
tory resnlts are obtainable only in solitary, firm, benign melano-
mmta. The various conflicting statements concerning the value
of operative treatment for melanomata are explained by the
great variations in character of these tumors : benign ; very
malignant degree of extension. When the removal of the
tumor is incomplete, remnants of the sarcoma remain and
furnish a source for recurrence. Melanosarcomata are operated
exactly like other sarcomata : I have successfully extirpated
them in the horse. Delamotte, to prevent recurrence fol-
lowing extirpation with the knife cauterized the wouud and
then covered it with arsenic : this possesses an aflinity for sar-
comatous cells ( ? ).

B. EPITHELIAL NEOPLASMS.

I. CARCINOMA.

Nature. — Carcinoma or cancer is an atypical
epithelial neoplasm: it has the property of
unlimited growth. All carcinomata are formed essen-
tially of epithelial cells, which lie in a connective- tissue stroma
(cancer-Strom a) in the form of cancer-plugs, cancer-nests, or
cancer- nodules. They proliferate into the neighboring tissues,
break down the lymph-vessels and blood-vessels thus leading
to metastatic formations. At first the metastasis is
confined to the neighboring lymph- glands, afterwards it de-
velops in the form of a generalized carcinomatosis of the in-
ternal organs of the body. General derangement of the
nutrition thus produced — so-called cancerous cachexia
— is due to a form of auto-intoxication, that is, a general
chronic poisoning derived from the cancerous new -format ion.
All carcinomata are derived from epithelial
tissues (Thiersch, Waldeyer). Virchow thought
that connective- tissue cells were transformed into cancer-cells,
this theory has not yet been demonstrated.

134 CARCINOMA

Forms. — According to the different varieties of epithelium
(squamous epithelium, cylindrical epithelium, glandular epi-
thelium) the following forms are recognized :

(a) Squamous-celled carcinomata or can-
croids are found on the skin, oral mucous membranes,
mucous membranes of the pharynx and esophagus, conjunctival
mucous membrane, mucous membranes of the vagina and blad-
der, of the sheath, and of the penis.

(.b) Cylindrical-celled cancer is found on the
mucous membranes of the stomach, intestines, and uterus.

(c) Glandular-celled cancer develops in the
testicles, mammK. thyroid gland, thymus gland, parotid,
prostate, in the sudoriferous and sebaceous glands of the skin,
in the mucous glands of the mucous membranes, in the liver,
in the pancreas, in the kidneys, and the suprarenal glands.

According to the consistence and form they are classified
as follows : hard, firm carcinomata with an abundance of con-
nective tissue (schirrhus, f i b rocarc i uom a); soft,
carcinomata of the consistence of the brain or spinal marrow
(medullary cancer, medullary carcinoma);
mucous and gelatinous cancer (carcinoma myxomato-
sum and gelatinosnm); pigmented cancer (m e 1 a n o-
carcinoma); villous cancer (carcinoma papilloma-
tosum or villosum) and others.

Etiology. ^The origin of carcinomata is no better un-
derstood than that of other tumors. A series of etiological
factors has been advanced to explain their occurrence in man ;
the same factors, with nothing added, have found place in
veterinary science (see below).

1. Age, sex, nutrition, and heredity are con-
sidered predisposing influences for the development of cancer.
Experience among men has taught that carcinoma pre-
ponderates among those advanced in age. It
may develop in any period of life but is seldom seen in a
person under forty years old. It is roost often seen in people
between the ages of forty-five and sixty-five (50 per cent of
all cases). In animals (dogs) on a basis of material composed
of 162 cases I have observed that old dogs were the only ones

CARCINOMA

'35

affected with carcinoma ; I have never seen a case of cancer in
a dog under two years of age. Of the dogs affected eighty-
seven per cent were over five years old, fifty-four per cent
were over seven years. Carcinoma forms a contrast to sar-
coma ; the latter frequently occurs in young puppies. Similar
conditions have been observed in American cattle by Loeb
and Jobson; of the forty-nine cases published ail were in
cows over six years old For an explanation of the influence
of age on the existence of caocer {diminished resistance of the
connective-tissue stroma in contrast to the proliferating
epithelial cells) see page loi.

With refcFence to the influence of sex. it has been main-
tained that in the human family the increased functional
activity of the sexual organs, especially the uterus and
mammae in females, predisposes to carcinomatous disease of
these organs. The relation appears to be similar in the dog,
where carcinomata of the mammae are seemingly frequent.
This theory cannot be applied to cows, however, where for
economic reasons, glandular activity and milk production ate
most highly developed. Carcinoma of the udder and uterus
of the cow has apparently been observed in only a very few
cases (up to 1 898 1 have counted only three cases in the litera-
ture ; G u i 1 1 e b e a u has recently published records of seven-
teen casesj although these organs are carefully examined in
abbatoirs.

Nourishment exerts an influence on the develop-
ment of cancer, in that it develops more frequently in those
who eat meat than in vegetarians (observations in England).
The same comparison has been made iu the lower animals ; in
. animals (cats, dogs) carcinomata are very
: iu herbivora (cattle, horses) cancers are prac-
This theory is valid only in dogs, which, ac-
Dwn experience, are the roost frequent sufferers
I from carcinoma. The majority of the neoplasms in the dog
belong to this class. On the other hand, the statement that
the horse, as a carniverous animal, practically never suffers
from cancer is incorrect ; in the years 1895-1902 I operated on
twenty-five cases of cancer in the horse. Swine, on the other

136 CARCINOMA

band — omniverous animals that consume flesh— are seldom
affected with carcinoma ; this has been demonstrated by ex-
perience in the abbatoir. Therefore, for the want of a better
cause, it is not so much the nourishment, as the species of
the animal that has a predisposing influence on the develop-
ment of cancer. Concerning the importance of heredity
in animals, which by many is considered the principal etiological
factor in man (compare with Cohtiheim's theory of the scat-
tered embryonic cells, page 100), nothing definite is known.
Notwithstanding the fact that carcinomata develop only in old
animals, the possibility of heredity among them should not be
forgotten. For this reason caution should be employed in the
use of breeding animals that suffer from cancer.

2. Traumatic and chemical irritation have
recently been placed in the foreground as etiological factors for
the production of cancer in man. This theory is supported by
the appearance of cancer in the lollowiug places ; the so-called
cicatricial cancer which develops in a cicatrix under the in-
fluence of a chronic inflammation ; the frequency of cancer of
the gall-bladder when under the influence of mechanical irrita-
tion from gall-stones; the appearance of cancer on the lips,
tongue, and larynx of tobacco- smokers ; as well as upon the
skinof chimney-sweeps, workersin tar, paraffine. etc. Accord-
ing to Brosch continual irritation of granulating cutaneous
wounds with xylol developed artificial proliferations of the
epithelium in guinea-pigs : it was alleged that these could not
be difi"erentiated from incipient carcinomata of the skin {?),
According to M'Fadyean cancer of the skin occurs in Austra-
lian cattle after branding (j? ), According to Eggeling cutane-
ous cancer of the inferior maxilla occurs in swine in an enzo-
otic form as a result of feeding Irom troughs (?).

Cancer has not yet been experimentally produced by the
influence of continued mechanical or chemical irritanls, for
example, applications of tar to dogs and rats (Hanau).
Probably the irritants are only able lo cause cancer when there
exists a primary local or general predisposition ; they are not
essential etiological factors, but exert an accessory influence.
The fact should also he noted that carcinomata frequently de-

CARCINOMA

137

velop in organs that are protected against external irritation
(prostate and thyroid gland of the dog. cavities of the head,
thoracic cavity, abdominal cavity in the horse). The theory
that cancer of the lips and tongue of ani-
mals frequently develops from external iri-
tants is also wrong from a veterinary stand-
point. On the contrary, they are very seldom produced in
his manner. I have seen only one case, and have found only
two eases mentioned in literature.

3. P a r a s i t i c" i n f e c t i o n has in recent years been
frequently considered a cause of cancer. The parasitic
nature of cancer has not yet been satisfac-
torily demonstrated; its existence is improb-
able. Bacteria have also been credited as the cause of
cancer (cancer- bacillus of Sc h eu erl en) ; so far they have
all proved to be inocuous accidental saprophytes (protens
mirabilis). The cancer-bacillus recently described by
S c b u 1 1 e r has proved to be a contamination of the prepara-
tion with cork-cells. Also the protozoa or coccidia,
which, according to Pfeiffer, Thoma, Adarakiewicz,
T. Leyden, and others, existed in a special form within
the cancer-cells, have proved to be degenerated forms
of epithelial cells, as well as degenerated
nticlei and nuclear bodies. The following condi-
tions when examined under the microscope may be conl'nsed
with coccidia ; endogenous new-formations of cells ; incom-
plete cellular division ; invagination of individual cells into
each other ; the presence of red and white blood- corpuscles in
^cells ; pathological nuclear division ; mucous, colloid, hyaline,
ind vacuolar degenerations of the cell -protoplasm, pathological
li&cation ; degenerations of the nucleus, the nuclear
bodies, and the nuclear membrane.

Metastasis, which is common in cancer, as well as an
occasional successful artificial transplantation of
the cancer in both men and animals ( H an a u, G_eiss-

, Hahn, v.Bergmann, Wehr, Cornil, Jensen)
e cited as examples of the parasitic nature of the caucerous

alasm. In contrast to the few successful cases mentioned

138 CASCINOUA

are the uasuccessful attempts at transmigsiou of many other
investigators ( K I e b s , Tillman, Israel. Sbattock
and Baliance, Alberts. Putz, Trasbot, Du-
play, Cazin, Cadiot, Gilbert. Gratia, Li&n-
aux, English Cancer Commission, and others) ,
the parasitic nature is in no way proved by the artificial trans-
mission of cancer. The successfnl results of inoculations are
in reality nothing more than transplantations, or artificial
metastatic formations ; the specific pathological epithelial cells
have been transplanted, not the parasite of carcinoma, the new
cancer- proliferation develops from these cells. It has also
occurred that, in inoculation experiments carried on in man,
self-infection has taken place in those already affected. In
these cases the principal factor, a predisposition, was present.
Cancer in Mice.— J en sea (Eiperimenlelle Unteraucliungen
iiber Kiebs bei Maaseo. ZentralbUtt fur Bakteriologie, 1903, Bd.
XXXIV, S. a8) has recently tranimitted a carcicomHtooB tumor in a
monse over nineteen generations of white and grey mice (not, however,
to other animals). The transmission nasa simple transplantation.
Mere crushing of the cells of the tumor produced negative resulta.
Proof of the parasitic nature of the carcinoma conld
not be found. On (he other hand, therapentic esperimenta with
blood-serum from vaccinated rabbits produced good results in
diaeaaed mice. The preparation of a serum to produce immunity ia very
difficult; the results are aUo uncertain. Jensen, »t least,

of hope from the serum-treatment of cancer in man-
Pski;do-C\rcinoma.— Zachok ke has observed two cases of a

cancer-like tumor on the upper lips and intermaxillary epsce in horses ;
it was caused by a fibrillar fungnti lactinophyloBis). and was as large as
one's fist (tSchweizei Archiv. 1903 )■ It consisted of a conntctive-tissne
alroma with compartment- like enclosures (carcinomatous structure) ,
these contained foci of leucocytes, and peculiar fungiform
structures with filiform processes |degenerated filimentary fnngl).
In all probability the infection occurred from without through wounds
and epithelial defects in the ural mucous membrane. The fungus re-
sembled the Bcliuomyces fungus, it varied from it, however, in certain
respects.

OtcuKKENCK. — Localization of cancer is different in ani-
mals than in men. Horses and dogs are the only animals
of essentia! importance ; in cattle, sheep, goats, swine and

CARCINOMA 139

cats, carcinomata are only occasionally of surgical impottance.
The followiug are the most important special forms:

1. Carcinoma of the Skin. — This is most often found
in dogs ; according to my experience it most frequently
occurs in the following places: on the head (ears and
eyelids), on the back, on the tail, ou the prepuce,
scrotum, in the vicinity of the auus and ou the liraba.
la the horse the favorite places for the development of
caucer appear to be ou the glans penis, the vulva and
clitoris, on the tail and sheath, as well as in the
region of the bulbs of the fool. Carcinomata
of the penis form tuft-like, villous, often suppurative
tumors; they usually attack the prepuce and lead to metas-
tases in the iuguiual glands (Leisering, Moller, per-
sonal observations). Macroscopic appearance of carcinoma
is extremely variable according to the age and location of
the tumor. Carcinomata of the skin usually present the fol-
lowing appearance : they are attached to the skin,
have a tendency to ulceration and infiltration
of the adjacent tissues, and are firm lu con-
sistence; the surface is nodular and rough;
the margins of the ulcers are wall-like and
firm; nodular formation is present in the
vicinity; there is a secondary swelling of the
tieigh boring lymph-glands. The neoplasms may be
circumscribed or diffuse ; large areas of the skin may become
ulcerative, nodular, thick, lardaceous, ichorous, and trans-
formed into immense tumor-masses that are foul in appear-
ance and odor. On the penis, carcinomata form tumors that
are papillomatous, villous, fissured, and often very large.

2. Carcinoma of the Mucous Membranes. — These
are often found in superior maxillary sinuses of
the horse. According to my observations ihey form firm,
lobulated, hemorrhagic, very rapidly developing tumors. The
neoplasms are permeated with hemorrhagic foci and contain a
fluid similar to that found in the medullary substance of the
brain ; they usually arise from the mucous membranes of the
oral and pharyngeal cavities (squamous-celled cancer

140 CARCINOMA

of the hard gums) and lead to looseDiog of the teeth,
penetration to the nasal cavities, maxillary sinuses, and even
the frontal sinus, they also result in swelling of the intermax-
illary lymph-glands (metastatic formation). Similar tumors
have been observed in the nasal cavities of the horse :
in this case the squamous-celled cancer originated from the
squamous epithelium of the lachrymal duct ( M o n t f a 1 1 e 1 1).
Carcinomata are further found in the pharyngeal cavity of
the dog, as well as iu the turbinated bones and
esophagus of the horse. In the latter place, under certain
conditions, they may lead to perforation and fatal pleuritis ; a
case of this kind has been described by I^orenz. Carci-
Qomata are further observed on the mucous membranes
of the eyes iu horses; they either involve simply the
membraua nictatans (personal observations), or the
conjunctival schlera (Bayer), or penetrate the
entire orbit destroying the neighboring bones, especially
the frontal bone, the superior maxillary bone, the zygoma,
and the laclirymal bone, even penetrating into tlie frontal and
superior maxillary sinuses (Lei serin g, Moller, Eichler,
personal observations). Among two and one half million
cattle slaughtered in Chicago iu 1899 Loeb and Jobson
claim to have found forty-eight cases of squamous-celted cancer
of the lachrymal caruncle (at first it is about the thickness of
one's finger and papillomatous ; it afterwards becomes exten-
sive, fissured, and covered with blood-coagulum.

Carcinomata are also frequently found in the vagina,
on the clitoris (Hberlein, Hennig, Naudin),
in the uterus (Guillebeau), in the bladder, as
well as on the skin and mucous membranes of the
prepuce of dogs, horses and cattle. Olt has described a
case ot cancer of the rectum in the horse (squamous-
celled cancer, congenital wandering of squamous epithelium
to the mucous membrane of the rectum). Carcinomata
of the bladder are usually in the form of villiform can-
cers ; they present cauliflower-like, villous, tufted, fissured
proliferations of the consistence of mucus, and have a firm
base. They lead to hemorrhage and ichorous degenerations,

CARCINOMA

141

as well as to nodular formatioDS in their immediate vicinity
(hemorrhagic, ichorous, fetid, sedimentous urine) ; occasion-
ally they extend to the peritoneum and the abdominal viscera,
or result in a fatal perforating peritonitis (Siedamgro-
tzky, Kitt, Pflug, Esser, Bang, DenieurJsse.
Bollinger, and others). A case of cancer of the tongue
has been observed in a iwelve-year-old cat (M'Fadyean ) ;
he found a cancerous ulcer on the ventral surface of the tongue,
from here plug-like carcinomatous proliferations penetrated
the entire tongue. Pflug and Lefalanc have described
a case of cancer of the tongue in cattle, and cancer of
the lips in a dog. In the larynx (epiglottis) only one
carcinoma has been observed (Casper). Cancer of
the stomach is far less common in animals than in man ;
veterinary literature contains records of only a very few cases
in the horse and dog (Oltmann, Roloff. Kitt,
Eberlein. Diirbeck).

3. Carcinomata oi' Glands. — These are most frequently
observed in the mamiiiii' of the bitch ; I have operated eighteen
cases. Their consistence and size are extremely variable ;
pain and heat are usually absent ; the skin is either intact,
or possesses ulcerative foci and undergoes cancerous infiltra-
tion; the adjacent lymph-glands are frequently swollen. Carci-
nomata of the manimjc are sometimes soft, and may even fluctu-
ate as a result of cystic degeneration. Many cases have been
observed by Bang, Kitt, Rabe, Johne, Moller,
Piitz, Pflug, Stennel, and others. In cattle, horses,
and swine, on the other hand, cancers of the mammse seldom
occur ( C a d i o t ) .

Carcinomata of the testicles are common in horses
and dogs : they often result in a marked enlargement of the
testicles (one form of so-called sarcocele), infiltration of the
Spermatic cord, swelling of the inguinal glands, carcinomatosis
of the peritoneum, as well as metastatic formation ; they are
occasionally observed in cryptorchids, and are not uncommon
in the laterally displaced testicles of the dog. Cases of cancer
of the testicles have been described by Leisering. Stock-
fleth, Riill, Guillebeau, Siedamgrotzky , Hol-
ier, Frohner. Trasbot, Cadiot, and others.

142 CARCINOMA

Carcinoma of the thyroid gland occurs most fre-
quently in horses and 'dogs; it occurs in the form of
goitre (struma maligna, struma carcinomatosa).
It is characterized by rapid development, emaciation and
cachexia of the animal, as well as metastatic formations in the
lungs (breaking down of the jugular) and other internal
organs, followed by a fatal termination (Johne, Kitt,
Siedamgrotzky , Moller, Zschokke, Hutyra,
Cadiot, personal observations). In dogs thyroid-gland
cancers may reach the size of two fists ; in horses they may
attain twice the size of a man's head. They often embrace
the trachea and esophagus, and occasionally extend as far as
the thoracic cavity.

Cancer of the prostate in dogs is of special importance
as it can be diagnosed per rectum, it often forms a tumor as
large as one's fist, and is the cause of habitual constipation
(personal observations). Only one case of cancer of the pros-
tate in the horse has been described (Cadiot). Carcinomata
of the anus are very common in dogs ; they originate from the
anal glands (compared with these, carcinomata of the rectum
are very rare). They form uneven, nodular, warty, cauli-
flower or fungus-like neoplasms ; they are fissured and lobu-
lated ; occasionally they are also pedunculated, soft, and
painless.

Siedamgrotzky has described a cancerous neoplasm
that originated in the thymus gland of the horse ; it led
to metastatic formation in the inferior cervical glands, the
principal lymph-vessels, and the retro- pharyngeal and sub-
maxillary Ipmph- glands, as well as to extensive schlerosis of
the subcutaneous and intermuscular connective tissue. It
presented the clinical appearance of a high-grade edema of the
skin on the dependent portions of the head, neck, and thorax.

Hinrichsen observed a multiple cancer of the
lymph-glands of the head (medullary carcinoma) in two
horses, it was characterized by metastases in the internal
organs, in the glands in the vicinity of the shoulder and arm,
and the axillary glands ; pronounced edema was also present
in the same vicinity. Similar cases of primary cancers of the

CARCINOMA 143

lymph-glands in horses and dogs have been described by
I,eisering, Casper, Kitt, and Frohner. Petit
has observed one case of carcinoma of the parotid in the cat.
4, Carcinoma of the Internal Organs. — They often
occur in horses, dogs, and cattle, but are of trivial surgical
importance. Tliey are often found on the pleura, on the
peritoneum, in the omentum, and in the mediastinal,
mesenteric, and lumbar 1 y m p h - gla n d s, where
they are often multiple, characterized by secondary metastases,
and more or less generalized. Enormous masses of tumors are
often formed, they involve the lungs and other adjacent vis-
cera, and even penetrate the walls of the thoracic and abdomi-
nal cavities. Carcinomata have also been observed in the
liver, in the kidneys, in the suprarenal glands,
in the ovaries (10 to 20 kg. in weight, occasionally fatal
through hemorrhage and peritonitis), in the rumen, stom-
ach, intestines, in the lungs, in the brain, and
Spinalmarrow (metastases). A cancerous metastasis in
the horse has led to pressure- paralysis of the spinal cord
(Alfort Clinic).

Treatment. — As in sarcomata, so in carcinomata, the
earliest possible extirpation forms the basis for
successful treatment. Caustics are rarely indicated. Opera-
tive removal of the following forms is relatively simple ; car-
cinomata of the skin and anus, as well as carcinomata of the
membrana nictitans and eyelids. Carcinomata of the mammae,
penis, and testicles are removed by amputation, or cas-
tration. It is more difficult to treat proliferating carcino-
mata in the cavities of the head (trepanation). Extir-
pation of cancer of the thyroid gland is especially difficult
(severe hemorrhage, cachexia strumapriva). All internal
carcinomata are incurable (pleura, peritoneum, lungs, internal
lymph-glands, liver, kidneys, bladder, stomach, intestines,
etc.); tbesameis true of generalized carcinoma tosis. Arsenic.
I which was formerly administered as an internal specific, acts
^only as a stimulant to metabolism and nourishment, Inocu-
Q of the cancer with erysipelas has occasionally been fol-
wed by recovery in man, it is seldom employed at the pres-

144 PAPILLOMA

ent time as it endangers the life of the patient. Serum-

theraphy (injection of blood-serum from animals affected

with cancer, or from animals into which masses of cancer

have been inoculated) has not proved a success (Cadiot,

and others). This serum seems to possess a specific action

for experimental animals (mice) (Jensen). Recently,

Rontgen rays and radium rays have been employed to cure

cancer ( this method results only in the destruction of the

cancer- cells).

Statistics of Canckr in Animals. — Sticker has coUected re-
ports from veterinary literature on 12 17 cases of cancer (332 horses, 76b
dogs, 78 cattle, 21 cats, 12 swine, 8 sheep and goats). According to fre-
quency they were arranged as follows :

1. Horse: penis, nasal and adjacent cavities (52 cases), kidneys
(29), skin (22), vagina (18), eyes and urinary bladder (14), lungs and
testicles (13), gingiviL* (11), anus, stomach, thyroid gland, uterus (S),
larynx (7), etc.

2. Cattle: uterus (16), kidneys (10), bladder (9), ovaries and
stomach (6), liver (4), vagina and lungs (3), etc.

3. Dog: niammm (341), skin (166), anus (89), thyroid gland and
lungs (10).

4. Cat: skin (6). mammie(5), lungs (3), liver (2).

5. Swine: kidneys (7 ■, skin (2).

II. PAPILLOMA.

Nature and ForMvS. — Papilloma was formerly considered
a connective-tissue proliferation of the papillary body, and
classified with the fibromata (papillary fibroma);
recently it has been placed with the epithelial neoplasms
(papillary epithelioma) and is considered a mixed
tumor (fibro-epithelial neoi)la.sm). It consists of a
hyperplasia of the epithelium of the skin and
mucous membranes with a simultaneous pro-
liferation of the papillary body (connective-tissue
and vascular new-formation). Two forms of papillomata are
recognized :

a) Warts (verruca) are hard, dry, horny papillomata
derived from the epithelium of the skin.

b) Condyloma (fig-wart) is a soft non-cornified, vascular

PAPILLOMA 1^5

proliferating papilloma of the skin and mucous membrane
(pointed, broad condyloma : it is moist on the surface £^-
wart. moist wart . and has the appearance of cauli-ower or
cockscomb.

ETiOiXKJY. — Chronic i c f 1 a m m a r o r y irritants p'ay
an important part in the develor ment of rapil-omata. The
so-called verrucose firm of scratzr.es ir. t:.e hcrse is a mu'.t:r'-e
wartv formation en the skin o: the ft:', i/ik it is the triiuct
of a chronic r:ern:at:tis .r in:'ec:i:ns :nr.-in:n:at:cn f the
skin. They have I'.sj L-een seen :n the !::=• of hirse? ani
cattle that have beer, r^-tnred ::: £_-li- ■:■: stuille: such
cases are d je to infiam-nitvry ;rore5-ts :n t/.e skin mi n-.-icns
membranes. Chron:: irritant > fcxcrtti.r-.- in the v:::n:ty of
the vulva and an -s niiy i.sj d-j j vn^iie'r : zzisi.zL^'. cansts
of papi'-'iOmatDUS ne:: 'i-rrr-.i Sjn.e 'jrlitve t'.it '. iril'.cma-
tous tumors are coiiti^iij- M e j n i n 'e^irL'.-e 1 i"".e^el in-
fectious pap:!*.' rr.ata m :':.-r !.'s ::' lan.'r.s ::: '.v!.::h be en:cn-
strated spheri za. 7 i :h '. 1 ^r . : , 1 : . . : : r -r t: 27.:- r. s M r 1 d y e a n
and Hobday h 2 ve - j : i-r s - ;" : ! '. ; :r in •; r:. : :t . -. r i - :! ! on. s:i :'r : m
one dos: to another. A .: ':. t - : 1::". .::-er- jii'r :":^erei
tran 5 mis^i jn fr . m cot\> t :: . .- r. T :. : r. : u 1: : : n e >: 1 1 r i n: i n : s

of G r a t i a . on t::e otl.tr h ir. 1 v.-.-r-r nr.- .: : le-^sij!.

I* • ■ ■ - • -

M »-^_-^ »•••'•.. « ••'.■^ •^^• — •• •- •.^■»i.. •■,:. '-.^^•--•" •

he r e 'I i t v a^ an *=■••* ---"■'.-• - •- -'■;.- ^ ■■ •--«'--.-■'.

loniA*a •"Ti^* h— ' '.** i -_ - '• '- - ^ ' ,-^- ". ^ ;.,..^ -."..-_•- . , - ' ^

calves, and do;: s 7. ■ ; i i ' , :".:i: 'i ar . ' '.n / r r. : ': '. .
in hereditary tr=::-r:.:^r:. ::. J: t!.e--- ::^es :
excluder; as 2n e:i:l' .:\.! r^^::' ■ ::.e ' :^:« : :'
lie in an emory::::: : r.!.: :r:: \ :^ : e .■-'/.".

dogs, h o r se 5 a:: ^ : a : t '. '.-

Mjii.v \-l!eve

I. In d o t ??

ment are the l.ps tr.r mic..:? r-.t::. r:.n.s .: ::.^- r:. n:h l.is.
gingivae, ton ^'ue t r. •: *.- ;. e ! : > t :. e e i r ?r v - :. t . . _ 1 ;. : h t ex : em al
auditory canal, the 'ri..'^' re^'. ^n. : r-:: i :.- p-rn- t::e anus and
vagina, as well a^ t::e extren::::e^ ? a p i 1 1 o :n a t a are
characterized by t h e : r r ■'. u ;: h and 1 ', ":, i: 1 a t c d s t: r f a c e : t h ey
are similar in appearance to strawberries, rasp-

146 PAPILLOMA

berries, blackberries, cauliflower, cockscomb,
etc. They usually have a sharply defined margin, occasionally
they are pedunculated ; they vary in size from a lentil -seed to
that of a pea or a walnut ; they may be dry or moist on the
surface. General papillomatosis is common.

2. In cattle papillomata are often multiple so that
the entire skin appears to be covered with warts. They are
especiall)' numerous on the head, throat, on tlie shoulders,
udder, abdomen, on the penis, and on the limbs. They form
rough, granulation-like, lobulated, painless neoplasms ; they
are often fissured, and are broad or pedunculated ; they are
firm in consistence, and yellowish-white in color, they become
confluent and attain the size of a man's fist, sometimes even
that of a man's head. Papillomata are extremely variable in
form ; at times they lead to an extensive thickening of the .skin,
and they may attain a weight of fifty pounds. Thierfelder
observed a papillomatous tumor that extended from the withers
to the root of the tail in a three-year-old heifer ; it was from
30 to 40 centimeters broad and 15 to 20 centimeters thick ;
from a distance it had the appearance of the horny covering of
an immen.se tortoise ; nearby it was similar in appearance to
the quills of a porcupine. W e h r n e r has described a case
of papillomatosis with a mane- like covering of hair (hypertri-
chosis) on the neck. In many cases the udder is the seat of
numerous papillomata ; the dry form is especially common on
the teat s, occasionally the teats are the seat of soft, villiform
warts. In addition to these cutaneous papillomata, others
are frequently observed on the mucous meml>rane of the
p h a r y n x and esophagus, occasionally they are seen
in the omentum and bladder. In lambs, warts are
very often found on the lips.

3. In the horse, especially in foals, warty growths
are found in the region of the lips, the nose, on the eye-lids,
ears, on the sheath, etc. In older honses they are found on
the following places: in the region of the saddle and
harness, on the coronet (personal observations) , as well
as subsequent to .scratches on the fetlock (dermatitis
verrucosa so-called "Straubfuss" bristle-foot). They are

ADKNOMA 147

very rare in the bladder where they form one variety of so-
called villiform cancer. Canker of the hoof (canker
of the frog) is a papilloinatous neoplasm ; it is characterized
by pronounced proliferation of the papillary body and rete
mucosum ; in this disease the growth of the horn is suspended
(infection?).

Treatment. — Treatment of papillomata consists in sim-
ply cutting away with scissors, or twisting ofl with
the fingers. Caustics (concentrated nitric acid and other
acids) are not indicated, with the excei)tion of papillomatosis
of the frog ; in any case they should be applied with great
caution in the vicinity of the eyes and mouth. Papillomata
on the lids, because of the possii)ility of transformation, must
be thoroughly treated, that is, extirpate the entire tumor by
removing a keel-shaped section of the lid. In young animals,
the internal administration of arsenic has occasionally been
followed by good results. Papillomata often disappear with-
out treatment. Spontaneous healing of cancer of the frog has
occasionally been observed after recovery from contagious
pleuropneumonia.

III. adi:n(^ma.

N.VTURK. — An adenoma is a n o n - c a n c c r o u s, be-
nign, epithelial neoplasm of glandular type.
Adenomata are termed t u 1) u 1 a r, acinous, or alveolar,
according to the type of the gland from whi^-h they are de-
rived ; they are also classified according to the nature of the
gland, adenoma of the thyroid gland (struma),
m a m m a r y , hepatic, sudoriferous and s e b a c e o u s
adenomata. When an adenoma consists largely of con-
nective tissue it is termed a f i b r o a d e n o m a ; when the
converse is true it is termed an a d e n o f i b r o m a (so-called
f i br o e p i t h e 1 i a 1 neoplasms). Adenomata, regardless
of their benignity as epithelial neoplasms, occasionally have a
tendency towards carcinomatous transformation (m a 1 i g n a n t
adenoma, adenoid).

OccuKRENCE. — It is most frequently seen, especially in

SPITHBUOMA

mple hyperplastic struma) —
t is less comtnoD in the horse
e i [ f e r, personal observa-

14S

puppies, in the form of goitre (si
adenoma of Ihe thyroid glands — it
{Lanzillotti. Markus, Pfe
tions). A d en o fibroin at a of the nasal mucous mem-
branes are relatively frequent in horses (firm, rough, mul-
tiple, readily hemorrhagic, usually bilateral neoplasms on the
lower third of the nasal mucous membranes ; formerly they
were erroneously termed rhinoschleronia). Adenomata are
not rare in Ihe mammae of the bitch. Only a portion
of these neoplasms, however, are pure adenomata, they are fre-
quently fibroadenomata, adenofibromata and myxoadenomata
(Leblane). An adenoma of the mucous membranes of Ihe
larynx has been observed in a cow by Johne; sebaceous
adenomata and sudoriferous adenoniala have been observed in
the skin of dogs, especially in the vicinity of the anus (perineal
glands') (Kitt, Siedamgrotzky, Moller, and others).
Adenomata of the Harderian glands of the membrana
nictatans have been observed in the dog by S c h i ui m e 1 and
myself. Adenomata also occur in the rectal mil cons
membranes (glands of Lieberkubn) of horses in the form
of cysts and polypi (personal observations). Adenomata of the
liver, las well as of other inner organs, are of no surgical
importance.

Bpitdeuoua. — lu CeTmany this lenn is applied to a benign,
circnmscTibed neoplasm of the epidermis on the skin
(in I'mnce, epithelioma indicates a carcinoma). It is partly due to con-
tinual trritauon of the 5kin by pressure (callosities, clavus,
t y loma). partly cairsed by parasitic infection (epithelioma grc-

CoRNT) Ci'TANKUM.— This IS ao epiibclUI neoplasm similar to
epithelioma (corou cutaneuni. keratosis, keratoma). II is
a circumscribed outgrowth of newly-formed, horny, epidermal celts.
They are often found in cattle on Ihe neck, in the interaiarillary space,
on the head, on the abdomen and udder ; occasionally they occurin tho
form of hom-like sttuctutes one-fonrth to one-half meter in length ; at
times they are of actinomycotic origin iSchreibei): they may also
occur in birds as a symptom of tuberculosis of the skin (Eberlein
hasdescribed a typical case in a parrot), they are found in horses ( fet-
lock, ear), sheep, dogs, and goats.— Kes atom AT a [tumor-like, nsually,
however, inflammatory hyperplasias of the hoof-hom ) are similar pro-
liferations; the same is trne of onycboaia (hypertrophy of the

CYSTIC TUMORS 1 49

tistne of the nail), ichthyosis (congenital or horn-like thickening
of the entire akin, especially in calves), as well as hystriciasis
(congenital bristle-like erection of the hair and thickening of the skin).
CystomaTa. — These are epithelial neoplasms in glands,
with cystic formation. They maybe defined as cystic adeno-
mata. They are most often found in the ovaries (ovarian cysts) , in the
thyroid gland (cystic goitre), in the nianimic, parotid, and in the supe-
rior maxilla of the horse. In contrast to ordinary cysts, cystomata are
genuine, proliferating cysts (see page 150).

C. CYSTIC TUMORS.

Definition.— A cyst is a sac-like, spherical, or bladder-
like tumor ; it contains fluid and is surrounded by a capsule.
The development of cysts is extremely variable. The following
forms are recognized.

1. Retention-cysts.

2. Dermoid cvsts.

3. Genuine cysts (cystoma ).

4. Extravasation- and e x u d a t i o n-cysts.

5. Cystic degeneration.

Rktkntion-cvst. — A retention-cyst is Ibrmed by a re-
tention of the secretions of a gland. Various
types of retention-cysts are recognized.

a) So-called mucous cysts develop from the mucous
membranes as a result of retention of the secretions of the
mucous glands. They are especially common in the oral cav-
ities of dogs, cattle, and honses ; they are situated at the
lateral and ventral surfaces of the tongue in the form of so-
called ranulae (retention-cyst of the .sub-lingual gland;
according to others a dermoid cyst); in the intermaxil-
lary region and region of the larynx in the form of
so-called meliceris; on the mucous membranes of
the lips, especially on the upper lip in the horse;
in the nasal cavities; at the base of the epiglottis;
and in the trachea of horses and cattle. They are found in
the vestibule of the vagina in cows (retention-cysts
of both glands of Bartholin, or of Gartner's duct),

150 DERMOID CYSTS

as well as in the rectum in horses (glands of lyieberkiihn).

b) So-called a t h e r o ni a t a (pultaceous cysts, encysted
tumors) occur in the skin, especially that of horses (base of
the false nostril, inner canthus of the eye, base of the auricu-
lar cartilage), swine (teats), and dogs (back); they are
usually solitary. Multiple atheromata are rare (V e 1 ni e 1 a l: e
has described a case in the dog ). Formerly tlic^' were nil con-
sidered retention-cysts of the sebaceous glands. Recent investi-
gations have demonstrated that they are partly tlue to aberra-
tion of epidermal cells, such cases must be claHsiiied with
dermoid cvsts.

c; Retention-cysts of large glands, especially the
udders of milch cows are due to an obliteration of an individual
milk-duct, or the common milk-canal.

Dekm(HI) Cysts. — This name indicates neoplasms which
belong to the teratomata. They are due to an embry-
onic wandering of germ -cells of the skin
or mucous m e m b r a n e s ; these may pass into the
inner organs (subcutis, ovaries, testicles, brain), so that,
under certain conditions, the walls of the C3\st contain all the
different elements of the skin or mucous membrane, namely,
epidermis, papillary body, hair and feathers, sebaceous, sudo-
riferous, and mucous glands. To this class belong the so-
called tooth -follicle cysts; these occur in horses and
cattle in the vicinity of the parotid glands( so-called ear- fistula);
they are branchial-arch teratomata, that is, derivatives of a
primative tooth-fold of the epithelium of the oral cavity, they
are a result of the presence of the branchial arches. One
usually finds a small opening at the base of the ear, the sur-
rounding hairs are matted by a tenacious, slimy fluid ; on
passing a probe it enters a blind canal or cystic hollow space,
at the bottom of which a molar tooth is found. About one
hundred cases of branchial-arch teratomata in horses and cattle
have been recorded. Dermoid cysts also include the very rare
t o o t h - 1 e r a t o m a t a on the superior and inferior maxilla
of the horse ; these are large tumors which contain hundreds
of teeth in all stages of development (Ostertag, Lolioof).
By many, ran u la is considered a dermoid cyst. Dermoid
cysts of the ovaries are very rare (hair, teeth, bones).

EXTRAVASATION- AND EXUDATION-CYSTS I5I

Genuine Cysts. — Genuine cysts are also termed cy sto-
mata; they are gl an d u 1 a r , epithelial neoplasms
(cystoadenoma) (see page 14S). They are most often found
in the ovaries and in the thyroid ;^ 1 a n d s. They are
the ordinary cystic formation (single sac, or multiple hollow
spaces) in the ovaries of cattle, horses, and dogs ; occasionally
they become very large. Stockfletli has observed a
cystic ovary that weighed 125 pounds, in a cow; A 1 b r e c h t
has observed one that weighed So, and another that weighed
50 pounds in the horse. I observed a case in which a cystic
ovary as large as a child's head constricted the rectum and
caused fatal colic in a mare. Finally, genuine cysts occur in
the superior maxilla of the horse (detached epithelial
foci) ; occasionally they press through the superior maxillary
sinuses into the nasal cavity (pseudo-hydropsof the maxillary
sinusj.

Extravasation- and Ivxudation- cysts. — Hematomata
due to contusions may become encapsuled as a result of a.septic
inflammatory processes in their vicinity ; they form swellings
having a cavity filled with serum, and are termed e x t r a v a-
sa t io n - cy s t s' or blood- cysts. They are frequently
observed on the anterior surface of the carpal-joint in cattle
(so-called knee-boils), and on the neck and back of the dog.
Their existence is analogous to capsule formation around for-
eign bodies and parasites (foreign- body cysts, parasitic cysts).
Blood- and lympli-cysts, the result of gradual dilitation of
blood- and lymph- ves.sels (dilitation-cysts), are less common.
Exudation -cysts are formed in a similar manner as a
result of inflammation of mucous membranes and tendon-
sheaths. To this class belong hygromata of the mucous bursae
over the point of the elbow (so called shoe-boil) and os calcis
(so-called capped-hock ) in horses and dogs, as well as hygroma
proHferum on the carpus of the horse and ox (one form of
knee- boil).

Dkgenkratkd Cysts. — These are cystic degener-
ated neoplasms (cystoid degenerations) ; they most often
occur in sarcomata and in carcinomata (cystosarcoma, cysto-
carcinoma, cystofibroma) .

152 ACTIONOMYCOMA

Treatment. — Treatment of cysts consists in extirpa-
tion of the sac. Simple puncture or incision is
usually insufficient ; this is especially true of mucous cysts
and atheroraata. On the other hand, puncture with a subse-
quent injection of tincture of iodine is effectual -in many
forms of extravasation- and exudation-cysts (hygroma, shoe-
boil); it is necessary to incise and remove the necrotic sac.
When removing; the sac care should be taken to remove all the
parts ; no portion of the proliferating tissue should remain
behindn Special difficulty is encountered in the total extirpa-
tion of ranula ; this is also true of many mucous cysts in the
throat of the dog. On the other hand, teratomata are usually
operated without difficulty. In tooth -follicle cysts the teeth
are removed from the temporal bone with hammer and chisel,
and the mucous membrane of the cystic sac is carefully curetted.
Cysts of the ovaries in cattle may be crushed per rectum with
the hand.

D. INFECTIOUS TUMORS.

I. ACTINOMVCOM.X.

Ktioi.oc^iV and Pathogenesis. — Actinomycoma is a
swelling caused by the ray -fungus or actinomyccs. This
fungus, which belongs to the schizomycetes (cladothrix), was
described by Perroncito, Rivolta, Hahn, and Bol-
linger in the years 1868-1877. Macroscopically it forms
sulphur-yellow, sand-like kernels. Under the microscope
they have the appearance of glands, with a branching, rosette-
like arrangement, composed of club-shaped, thick threads.
Entrance of the actinomyces fungus into the
body seems to occur in various ways. It usually gains en-
trance through the digestive tract (mouth cavity,
pharynx, stomach, intestines). Their primary seat is on the
fragments of plants ; the}' have been especially demonstrated
on beards of grain, in the tonsils of swine, and in the
tongues of cattle. It is thought that transmission occurs as

ACTIONOMVCOMA

153

follows ; at first the fungus gains entrance to small wounds of
the mucous membranes, or passes into tlie excretory ducts of
glands, possibly it colonizes in the alveoli of diseased teeth, or
those that are changing ; its further extension is from these
points. In cattle, especially, beards of grain
covered with fungi appear to penetrate be-
tween the teeth and gums, as well as into the
tongue. When they once gain entrance removal is difiBciilt
because of the peculiar arrangement of the hairs on the beards ;
a similar phenomenon is observed with rye-beards, for example,
when they become attached to one's coal-sleeve. A favorite lo-
cation for actinomycosis of the tongue is on the dorsal
surface where it begins to form the point. Epithelial
defec t s are present at this point in many cattle (9 per cent),
thus favoring the introduction of an actinomycotic infection
(Hcntschel and Falk). According to Brener the
folds of the dorsal surface, especially in old cattle, where
they are well developed, predispose to the retenlion of
fungus-covered vegetable fibers. Boslrora thought that the
ray-fungus developed exclusively on grain, especially in barley,
and that actinomycosis could he caused only by ingestion of
portions of these infected plants. Symmetrically arranged air-
spaces are found in dry grain-heards, these communicate
freely with the surface ; within these spaces the fungus is
able to live in a dried condition for more than a year ; when
the beards gain entrance to animal tissue proliferation is again
active. Dry fodder, therefore, appears to be the principal
source of infection in cattle ; perhaps simultaneous shedding
of the teeth also has an influence (Immiger, Clausl.
Entrance to the lungs may take place by aspiration of the
fungus from the air ; wounds of the skin, especially
castration wounds and umbilical wounds
allow entrance ; it may also enter through the open-
ings in the teats. In swine, infection of the snout from
the straw seems to be frequent. In a large number of cattle
treated with setous a majority of the wounds showed actino-
mycotic infection tGooch). General extension (general-
ization) over the entire body by means of the blood stream

154 ACTINOMYCOMA

also occurs, similar to tuberculosis, though far less frequently.
With reference to the rapidity of growth of actinomyconia, the
following observation has been made by Anderson:
twenty cows were turned to pasture on the first of July ; small
and large tumors had developed on seventeen by the first of
December (five months).

Actinomycosis is a specific inflammation; domes-
tic animals are affected with three grades of the disease : i .
A degenerative granulo- fibrous inflammation (tongue).
2. A progressive purulo-granular inflammation (cold
abscess). 3. Fungoid actinomyconia (pharynx, skin). In
the vicinity of glands in which the fungus is active, there first
develops a granulation- like growth, the result of a
reactive inflammatory process. This leads to the formation of
tubercle- like nodules, larger round or lobulated swellings, and
tumors, which are termed actinomycomata. Sometimes
they are very soft, of a sarcomatous consistence, and yellow-
ish-red in color ; others are apparently firm and solid, of the
consistence of a fibroma, and greyish-white in color ; occasion-
ally they are spongy. They consist of a connective-tissue
stroma permeated with many nodules the size of a millet-seed
to that of a pea ; on the surface of the swelling these ncdules
present a shiny appearance. The nodules have the microscopic
structure of a granuloma (round-celled infiltration with the
formation of giant-cells), they contain the sulphur-yellow,
sand-like actinoniyces fungi, they may also become confluent
and form larger nodules. In purulent degeneration of actino-
omycoma (mixed infection with pus-bacteria) so-called cold
absce$ses are formed, these may be small or large and are
surrounded by very soft granulation-tissue.

BAC'rKRioLO(;v. — According to Bostrom, pure cultures of actin-
otnyceB are best obtained by pulverization of the gland, and cultivation
upon coagulated blood-serum. They present the following character-
istics : first there are developed thin, gelatinous membranes, they are
formed of fine, transparent threads, and through a deposit of small white
particles containing numberless cocci and fibrillin they assume an appear-
ance of having been dusted with chalk. After two weeks the
centers of the white particles become yellowish, red, or brick-
red, the particles themselves become confluent; the periphery growa

ACTINOMYCOMA I55

in the form of a transparent greyish-white layer. Old cultures become
wriukled and hard. The fundus grows in a similar manner on agar»
glycerin-agar, and gelatine ; on potatoes it forms grey, yellowish, and
finally white granules. It also ^j^rows in the absence of air t^ facultative
anLLTobic fungi i. Inoculation of the cultures into animals is not usually
followed by results. Wolff. Israel, and Johne are the only ones
that have devt^loped inoculation-actinomycosis from cultures.

According to recent investip^ations actinomycosis occurs in several
varieties in both men and aninuils. (Vaspe rin i was the first to demon-
strate that actinomycosis in cattle could be produced by various varie-
ties of the fungus I sulfurens, albus, luteo-roseus^ According to I<ig-
nicres and Spitz in Ariicntina there occurs an actinobaci llosis
in addition to ^;enuine actiuomyrosis. The bacillus does not take
Gram's stain ; clinically it is characterized by disease of the
lymph-glands (which is seldom seen in the genuine form), and a grayish-
white color of the glands in contrast to the yellow). Jelenewski
has discovered a specitic "Actinumyccs labiatusbovis" in actinomycoma
of the lips. Levy, Bruns, and others have furtlier claimed that
several varieties occur in man ( icrnbic and aniLTobio, and that actin-
omyces bo vis and hominis. espcc ial ly, are not identical.
According to Wolff and Israel, howt-ver, the acceptance of various
ray-fungi is incorrect; they explain the difference in size, etc. , by
variations in age. and the duration of the disease.

OccuRRKNCE. — One most frequently finds actinomycoma
in cattle in the mucous m c m b r a n e s of the m o u t h
and pharynx, in the tongue, in the maxillary
bones, in the skin, in tlie parotid inlands, and in
the udder. Occasionally actin()m>cosis appears in a gen-
eralized form. The disease is most frequent in cattle;
horses, swine, and sheep are occasionally afTccted ; it is less
frequent in cats and dogs.

AcTiNOMYCOM.v OF THK ToNC.i'K. — In the tongue acti-
nomycosis is usually multiple and disseminated ; connective-
tissue proliferation is abundant (indurative, and acti-
nomycotic glossitis, actinomycotic schlero-
s i s or m a c r o g 1 o s s i a, so-called w o o d e n - 1 o n g u e ) .
The tongue is very much enlarged and deformed, occasionally
it is shapelessly swollen, and of a very firm, hard consistence.
On the mucous membranes of the inferior and lateral surfaces
one observes sharply c i r c ij m s c r i b e d , somewhat
prominent brownish spots, spherical in form;

156 ACTINOMYCOMA

through these there shine very small yellow-
ish nodules. Actinomycotic nodules are also
present in great numbers within and beneath the
mucous membranes, as well as between the
muscular fibers, they are firm, fibrous, round-
ish nodules, and vary in size from a millet-
seed to that of a pea ; in the center they consist of a suppura-
tive, caseous, calcified, or mortar-like mass. When cut the in-
durated connective tissue of the tongue is found to be lardaceous,
hard, and even crepitating. The lymph-glands of the
tongue also contain the above described nodules, as well as
abscesses in the form of yellow, sand-like, antinomycotic foci
containing pus. Actinom3'Cotic erosions are also occa-
sionally found on the dorsal surface of the tongue, they form
epithelial defects where the body of the tongue passes over
into the point. Brownish actinomycotic nodules occur on the
gingivae as well as on the inner surface of the lips
(K 1 e p z o w) . On the ventral surface of the oral cavity actin-
omycotic proliferations of the mucous membranes occasionally
present the appearance of a ranula (Hohenleiter). A
few cases of actinomycosis of the tongue have been observed
in the horse (Truelsen, Gruber, Zschokke,
Novotny, Struve, and others). Schilling has de-
scribed one case in swine.

Actinomycosis of the Maxillary Bones. — Actin-
omycotic ostitis of the superior and inferior maxillae
was formerly known as **winddorn" "spina ventosa,*'
**bone-worni," "maxillary tumor." It arises from superficial
granulations on the gums and mucous membranes in the
vicinity of the teeth. At first there exists an actinomycotic
periostitis ossificans with the formation of osteo-
phytes. If the aclinomycoma also involves the bone-marrow,
there develops an actinomycotic granular osteomye-
litis and rarefy ingostitis (myelogenic actinomycosis) ,
with atrophy of the osseous framework and the formation of
great hollow cavities. Both processes lead to severe swell-
ing of the superior and inferior maxillae.
Frequently the actinomycotic granulation-tissue assumes the

A.CTINOMYCOMA 157

form of a sarcomatous proliferation ; it may then pass in the
direction of the gums, the molar teeth, the skin, as well as
into the maxillary and frontal sinuses. In the horse central
actinomycoma occurs in the inferior maxilla with loosening of
the teeth. The disease also occurs in the form of an epulJs-like
extensive actinomycoma of the dental alveoli in the inferior
and superior maxilla; (Pilz, Geiger, Schwarz, and
others). Central, myelogenous actinoniycoma is also ob-
served in other bones i in the sterum, in the dorsal
vertebrae, cervical vertebrae (spinal pressure-
paralysis in thecow}, in the ribs, in the tibia, in the
metatarsus (lameness).

ACTIMOMVCOMA OF THE PUARVNGKAL CaVITY. — In this

place it forms fungus-like, polypoid, soft tuber-
cles or nodules: they are attached by short
pedicles, and vary in size from a pea to that of
one's fist. They usually prohferate from the pharyngeal
mucous membranes on the superior wall beneath' the sphenoid
bone (anterior pharyngeal actinomycoma). they may arise
from the posterior wall of the pharynx in the vicinity of the ep-
iglottis (post e rior pharyngeal actinomycoma). They may
lead lo dyspnea or asphyxia. Formerly they were termed
"pharyngeal Imyphomata" or "esophageal fibromata. " Simi-
tar nodules are found on the mucous membranes of the esoph-
agus, in the larynx, in the trachea, and on the rau-
cous membranes of the trachea, nose, and vagina,
as well as on the mucous membranes of the digestive appa-
ratus. In Russia actinomycoma of the lips is es-
pecially frequent (more than 40 to 80 per cent of all cases)
(Jelenewski).

LvMPB-GLAND ACTINOMYCOMA. — This IS B Secondary,
metastatic process, a sequela of primary affection of the oral and
pharyngeal cavities. The subparotid and intermax-
illary lymph-glands are most often affected in the form
of round or oval, firm nodules ; they are painless and vary in
size from a walnut to that of one's fist. In horses these actin-
omycomata occur in the intermaxillary lympb-glands where
they attain the size of ahen'segg or goose-egg; when unilateral

158 ACTINOMYCOMA

they give rise to suspicion of glanders (Baranski, Pilz,
Rasmussen, Schmidt, Hartl). In a case described
by Schmidt all the lymph-glands of the head and neck, as
well as the bronchial glands, were swollen as large as a fist
and permeated with actinomycotic foci. In a case of suspected
glanders in the horse Hartl found the entire intermaxillary
region filled with a firm, flat swelling, it even extended to the
cheeks ; a finger-thick lymph-vessel cord extended to the
angle of the mouth, hard nodules were present at intervals
along the cord, they were from the size of a nut to that of an
egf^ ; hard nodules the size of a bean were also found in the
upper lips and in the region of the parotid. Microscopic ex-
amination of the extirpated gland revealed masses of ray-fungi.
The salivar}' glands are also occasionally affected.

ACTINOMVCOMA OF THE SkIN AND vSUBCUTKM. — These

are primary (infection through a skin-wound) and secondary
(outward penetration of deep foci), on the head, neck, ud-
der, scrotum, in the region of the elbow and shoulder, as well
as on the abdominal wall. They either form nodules from the
size of a hazel-nut to that of one's fist, or fungoid, fleshy-
red, soft granulation masses ; the latter are either covered with
pus, or with dry brownish crusts. Occasionally the adjacent
skin undergoes an extensive phlegmonous swelling and schler-
osis. Daughter-nodules frequently form in the vicinity of an
old focus. Keratogenous formations are less common (S c h r e i-
ber). Subcutaneous actinomycoma is accompanied by the
presence of fistulous openings. In a case described by Hartl
a horse suspected of having glanders presented the following
symptoms : subcutaneous swellings in the flank and on the
ventral surface of the abdomen ; these areas were covered
with ulcer formations, abscesses and sanguino-purulent secre-
tions ; numerous actinomyces fungi were found in the indurated
abdominal muscles. Meier observed actinomycotic cutaneous
nodules as large as a hazel-nut in the saddle region of a horse.
Occasionally actinomycotic proliferations are observed on the
anterior surface of the carpal-joint in cattle (one form of so-
called knee tumor in working oxen). Actinomycoma has also
been found in castration wounds of both male and

ACTINOMYCOM A 1 59

female pigs, as well as in the spermatic cord of castrated
horses and cattle ( R a s m u s s e n, M a z z a r e 1 1 a) . Accord-
ing to Burke the so-called Madura-foot of elephants is an
actinomycosis of the skin.

AcTiNYOMCOSis OF TiiK Udder. — This form is most often
seen in swine, it is also observed in cows. In the udders
of swine one finds numerous nodules, thev are imbedded in a
firm, fibrous tissue ; in size they vary from a pea to that of a
walnut ; they may contain pus, or form large abscesses which
occasionally break through the skin. In cattle one observes
soft purulent nodules with fibrous induration
of the surrounding tissue; they vary in size from a
pea to that of a goose-egg, they may be confined to one or
more quarters, and occasionally they break through the skin
forming ulcers and fistulous tracts. Disseminated actinomy-
cosis of the udder is less common, in this case the entire udder is
severely swollen, and becomes hard and rough ; the cut surface
reveals numberless soft yellow flecks which vary in size
from a millet to a heinp-secd. they contain small ])urulent foci
in reddish nodules C I^ a n g, Jens e n, R a s in u s s e n, K i 1 1) .

Actinomycosis of the muscles is of secondary origin
from penetrating cutant- ouh actinoniyconia ; R a s s m u s s e n
has described one case of actinomycotic disease of the muscles
of the elbow and shouMcr. ("iiirig has observed a case of
actinomycosis of the tc-stick-s in a bull, which devtrlojicd after
an injury to the scrotum. In do;^s, local actinomycotic affec-
tions (tumors, abscessL'S, fistul:u) often accoinjany ])ieuritis
and peritonitis ( B a h r). Actinoniyconia of the internal or-
gans (1 u n g s, liver, s ]) 1 e e n , k i d n e y s, b r a i n . d i a-
p h r a g m, u t o r u s, b 1 a d d e r) is of no surgical importance.

Trr AT.MicxT. — Where operation is ])ossible. extirpa-
tion with the knife is the best treatment, the same as in
other tumors. Actinoniyconia of the tongue, as well as
deeply situated actinoniyconia of the ])harynx resy)onds to the
external or internal administration of io d i n e, which is con-
sidered a specific for the disease. The action of iodine seems
to be directed to the tissues which surround the growth, as
actinomyces fungi flourish on media containing iodine. Ex-

l6o ACTINOMYCOMA

ternally, iodine is administered in the form of tincture of
iodine, or as Lugol's solution. The former may be painted
on the surface of the tongue, while Lugol's solution may be
employed in the form of parenchymatous injections into the
tissues of the tongue ; many scarify the tongue and then paint
with iodine solutions. For tumors that cannot be operated
iodid of potash administered internally is also alleged
to be a specific remedy.

According to Thomassen who, in 1885, was the first
to recommend the internal treatment with iodine, the following
results were obtained : for fourteen days the cattle were given
'daily doses of six grams of iodid of potash dissolved in one-
half liter of water ; with a beginning of improvement the dose
was reduced to four or five grams. When the disease was
confined to the tongue and surrounding soft tissues, healing
averaged to occur at the end of fourteen days, improve-
ment was visible at the end of eight days. Numerous
demonstrations of the specific action of iodid of potash
have been made. (Fiirthmeyer, Bass, de Jong,
Ostertag, Deslex, Reeks, Perinui, Havas, Sou-
cail, Hoh enlei t ner, Krug, Nocard, Schwabel,
Walther, Ehrhardt, Salmon, Bang, Jensen, and
others). In many cases iodid of potash is ineffective
Cimmiger, Frick, Bouchet. and others). Bouchet,
for example, treated a horse an entire year with iodid of potash
( 1 500 grams in all ) without results. In addition to the internal
administration of iodid of potash, it may be employed exter-
nally in the form of tincture of iodine, or Lugol's solution,
either in the form of painting on the surface, or parenchyma-
tous injections. The fact should not be overlooked, that
spontaneous reduction of actinomycoma, without previous
treatment, has occasionally been observed. Under certain
conditions, mere incision of the actinomycoya appears to be
followed by healing. B o s s i has observed complete healing
in two cases of actinomycosis of the tongue in cattle that were
treated as follows : simple deep incisions of the tongue re-
peated three times at intervals of ten days,

flOTRYOMVCOMA

BOTRYOMYCOMA,

Etiology. — The name botry omy coma or ruyco-
fibroma indicates a cbronic inflaitimatory pioliferatioii of
the connective tissue ; it is due to the bo I r y o m y ces f u n-
gus that was discovered in 1884 (botryococcuB, micro-
coccus ascoformaus, micrococcus botryogenus). It is a fungus
formed of roundish cocci arranged in black-
berry-like clumps; it has received specialinvestigation
from Rivolta. Johne, Rabe, Bollinger, Jensen,
Kitt. Hell, dejong, Poncet audDor, Parascan-
dolo, and others. Botryotnycoma is a neoplasm that very
frequently occurs in the horse. Because of its size and ma-
lignancy it possesses as great surgical importance as actinomy-
cosis in cattle. I have, for example, operated not less than
400 cases in the years 1895-1903 in a surgical clinic of 8coo
diseased horses. These included 175 shoulder tumors, 150
SstulEe of the spermatic cord, and 75 other forms of botryomy-
coma. Botryomycosis, similar to actinomycosis, may be con-
sidered a wound infection disease in which the botryoniyces
fungus gains entrance through small wounds in the skin, es-
pecially operation wounds (castration). Generalization is far
less common than in actinomycosis. Botry omy com at a thai are
very important from a surgical standpoint are most often found
in the following places: botryomycoma of the skin and
subcutem. of the spermatic cord, of the udder,
of the nasal mucous membranes, and in the mus-
cles, it is less common in bo ues. In addition to occurrence
in horses, botryomycoma has occasionally been observed in
cattle and swine, as well as recently in mau.

Bactkb 101,00 V. — Formerly the botry omyces fungus was considered
identical with ordinary pus-cocci, sUphyloccus pyogenus aureus (Hell,
dejong, (ialli- Vale rio, Kitt). According to recent investigii-
tions of Parascandolo, and Poncet and Dor, the specificity
of the botryom^ces fungus seems to be demonstiated. The inocutatiotl-
experiments in horses, as well as the various bacteriological, physio-
logical, biological, and sero-diagnostic relations of both organiBma
•upply evidence against their Jdentitj. The botryomyces orgaii-
ism can even posBcss pyogenic propertiea — ■blllty to

1 62 BOTRYOMYCOMA

produce mycofibromata — that are never possessed by
the staphylococcus. The staphylococcus forms goldish-yellow
cultures in any temperature ; the botryomyces organism, however,
develops cultures only at a temperature of i8°. Bacteriologically they
are alike in form ; they take the same stain with aniline dyes ; and their
grape-like arrangement in clusters is the same. Their development on
gelatine is not the same, their properties of immunization are also very
different. The pyogenic — not, however, the botryogenic — properties
are identical.

BOTRYOMYCOMA OF THE Skin. — This occurs in the form
of tumors that are partly solitary, partly multiple, and occa-
sionally scattered over the entire skin. It most often develops
in the saddle and harness regions, on the el bows,
tail, fetlocks, lips, and eyelids, in the region ot
the pi rot id, at the tarsal -joint and scrotum. Their
size is extremely variable ; very often they are only the size of
a pea to that of one's fist, occasionally, however, they assume
an enormousextension becoming larger than any other
tumor. At the elbow, in the region of the shoulder, as well
as at the fetlock, tumors have been repeatedly found that were
as large and larger than a man's head. Occasionally many
small nodules are arranged around a primary large nodule.
Their consistence is usuallj' firm, at other times they are soft,
and may even show circumscribed areas of fluctuation ; occa-
sionally fistulous tracts lead into the substance of the tumor.
On the cut surface one finds sand-like deposits of botryomyces
fungi, as well as areas of liquefaction containing torpid gran-
ulation-tissue and small pus-cavities ; the latter are enclosed in
a tendinous, firm, schlerotic connective-tissue proliferation.
Large tumors proliferate from the skin into the subcutem and
into the organs that are more deeply situated. I observed one
case of actinomycoma on the back in the form of a fistula
of the withers.

BOTKVOMYCOSIS OF THE SPERMATIC CORD. — MoSt CaseS

of so-called fistula of the spermatic cord in the
horse are to be regarded as funiculitis botryomycotica, specifi-
cally, as botryomycoma of the spermatic cord. Infection of
the castration wound takes place through the dust. The
stump of the spermatic cord begins to proliferate ; the tunica

BOTRYOMYCOMA 1 63

vaginalis undergoes a chronic induration, and adhesion takes
place between the two. They form a hard tumor that
varies in size from a man's fist to that of a
man's head; in form it is shaped like a walnut.
The tumor may extend to the inguinal canal ; occasionally it
presents fungoid proliferations between the margins of the
wound (so-called champignon); it frequently encloses
one or more fistulous tracts, the latter open below in one or more
funnel-like, constricted, fistulous openings. The
fistulous openings discharge a purulent mass containing botry-
omyces fungi. In many cases the botryoraycoma extends
from the spermatic cord to the sheath, the adjacent skin of the
limbs, and the ventral surface of the abdomen, so that there is
formed an enormous tumor several times the size of a man's
head. Bilateral fistula of the spermatic cord is common. In
extirpated preparations one notes the fatty, firm, ten-
dinous, light-grey, cut surface ; on this surface are
y ello wi sh - br o w n , torpid, m uco-pur ul en t
areas of liciuefaction; these areas contain the yel-
lowish-white, sand -like botrj'omyces colo-
nies, they may be seen with the naked eye.

BoTRYOMYCosis OF THE Udder. — This form is common
in the mare (Moller, vSand, Vennerholm, personal
observations) . The udder is swollen, hard, shows
nodular induration, and fistulous openings,
as well as circumscribed abscess formation.
Typical botryomyces colonies may be recognized in the pus of
the fistulous tracts. According to my experience botryomy-
coma of the udder is a very malignant tumor. Operative re-
moval is liable to be followed by recurrence : for this reason
total amputation of the udder is recommended when the dis-
ease is confined to one half of the udder. They also have a
strong tendency to extend to the abdominal wall and to the
inner surface of the limb, extension is apparently rapid. I
have observed one case of this kind in which one half of the
udder was amputated two years before and the affection appar-
ently healed. Unterhos.sel has described a botryomycotic
neoplasm that weighed 35 kilograms ; it was located on the
udder of the mare.

BOTRVOMYCOMA OF MtSCLE. — Botr>omycotic myositis is
especially common in the levator humtri in the form of so-
called shoulder abscess; it is also observed in the
abdominal muscles, the intercostal muscles,
and the lumbar muscles. Botryomycosisof the bones,
on the other band, is apparently rare. In the case described
by Kitt. an adjacent botryoniycoma was the cause of a rib
being transformed into a fungoid, osteoporotic mass. S torch
has described a botr\omycoma that (xltidtd fit m Ihe m a x-

w-formation arose from the

ilhs had reached the size of

ind asynietry of the maxil-

well as dyspnea and uni-

iilary sinus of a horse ; the
mucous membrane, and in two ii
a child's head ; it caused swellin
lary sinuses and frontal region,
lateral nasal discharge.

Genekalizkd BoTRVOMYCosis. — In comparison with
actinomycosis this is very rare. In a case of fistula of the
spermatic cord of the horse ob.served by me botryomycolic
proliferations similar to the nodules of pearl-disease were
present in the lungs. Tempel and Bedel have observed
similar cases of meta.static formation on the diaphragm and in
the lungs (a botryoniycoma of the uterus was the point of
origin in the former case). M'Faydean describes three cases
of generalized botryomycosis in horses affected with fislulse of
the spermatic cord (lungs, spleen). Kitt has observed a very
interesting case of botryomycolic endocarditis. H i 1 br a nd
observed a case of botryomycosis of the kidneys (large tumor
in the vicinity of the right kidney, it was adherent to the colon
and rectum and filled with abscesses the size of hens' eggs),
with numerous botryomycolic abscesses the size of tbe head of
a stick pin in the liver of a horse. Kofl-er saw a primary
botryomycosis of the spermatic cord followed by metastases in
the lungs, in the muscles of the shoulder, tbe maxillary
muscles, and the kidneys. Tiirnau, when inspecting tbe
flesh of a horse affected with fistula of the spermatic cord,
found metastases in the lungs and liver.

Primary or secondary (metastatic) botryoniycomata in the
lungs and other inner organs are seldom of surgical impor*
tance. A trauspiantation of botryomycoma of. the lungs to

DOTS YO MYCOSES IN MEN 165

the parietal pleura, and from there to the ribs has occasion-
ally been observed in cattle ; it led to granular ostitis, with
rarefaction and formation of costal fistnla;. Babe has described
a botryomycoma of the pelvic cavity that weighed i,"; kilo-
grams ; it was complicated with fistulse having external open-
ings, as well as openings in the direction of the bladder.

BoTRVOMVCOsis IN Mkn". — In the past (ew years Several cases hsTC
been observed in men. Poncet and Dor (Paris Surgical Congms.
1897) reported four cases; they were in the form of tamois on the
fingers, the thorax, and the elbovfs, they presented the following char
acteriatic^ : from a pea to that o( a tiui in size, pedunculated, fungoid, and
infiUrated with blood. Ten Siethof (Ref. Miinch. medWoch. 1898.
No. IS) saw in a man, who had been caring for a horse

ease of the palpebral conjunctiva that bad the appearance o£ actinomy-
cosis ; it was accompanied by swelling and nodular formation. Typical
colonies o[ butryomycocci were found in the pus of these nodules.

Other cases have been described by Legrain, Sabraz 5s.
Lsnbi^, D<51or. Gslli. Valerio, and Lenormand.

Treatment. — When possible, botryomycoma receives
operative treatment, the same as actinomyconia, this should
be as early as possible, and in the form of extirpation.
should be carried a
that is known to be
is so multiple or so
is impossible. Such
S jedarugrotzky,
botryomycoma from
the skin of a horse during six operations which covered &
, period of three monllis. I have employed similar partial op-
I «rations. There are also cases which, on account of enormous
I «ze or generalization, cannot be operated.

odid of potash has been employed as a specific for

I botryomycosis, the same as actinomycosis. Thomassen

I ^ave horses daily doses of lo grams of iodid of potash, the

I spermatic cord was treated locally with tincture of iodine, after

a month the tumors were markedly smaller. Siegmund

,gave doses of 12 to 15 grams of iodid of potash three times

per day, so that the horse had 800 grams in all, 1200 grams

were given to another ; he reported satisfactory results.

To guard against recurrence the
certain di.stauce from the tumor in tissi
normal. Occasionally a botryomycon
large that operative removal at one tim.
cases may be operated at different times.
for example, removed a large multipli

I66

TUBERCULOSIS

Ostertag. Malkmus, and others, report similar results
from the use of iodid of potash . According to my own
experience and experiments the beneficial
action of iodid of potash has not been sup-
ported. In a horse affected with botryomycosis of the sper-
matic cord, the skin, the abdominal muscles, and the lymph-
glands, neither the internal administration of 325 grams of
iodid of potash, uOr the subsequent intratracheal injection of
3 10 grams of iodate of soda, produced visible improvement.
The disease process had rapidly extended regardless of the
iodine treatment. Another horse with botryomycosis of the
spermatic cord was given 750 grams of iodid of potash during
a period of five months without visible improvement ; on the
other hand, he soon developed symptoms of chronic iodism.
The horse was operated and soon healed, Vennerholm,
Konig, and Winter have recorded similar failures of
iodid of potash in the treatment of botryomycosis of the udder.
Topper has also spoken against the iodid of potash treat-
ment ; he maintains that a trial is only indicated when the
diseased tissue cannot all be removed by
means of an operation. In any case it is not
correct to advise the owner of a horse against
the employment of an operation for the re-
lief of botryomycosis of the spermatic cordi
in preference to the iodine treatment, a more
certain and rapid healing results from oper-
ating as early as possible.

III. TUBERCULOSIS

Surgical Importance. While in human surgery tuber-
culosis of the bones, joints, and other external organs is of
great practical therapeutic importance, the same form in
domestic animals Is of less significance. This is explained by
the fact that tuberculosis of the external organs is far less
common in animals than in man. Many valuable surgical
operations employed upon man — resection of tubercular joints
for example — are not practical in the lower animals. Finally.
tuberculosis is found principally in slaughtered animals (cattle,
swine); localized external tuberculosis is of slight importance

TUBRRCULOSIS 167

to the animal ; that form of external tuberculosis which is
secondary to a generalized type is incurable.

If, regardless of previous statements, tuberculosis of cattle
from a surgical standpoint is somewhat exhaustively consid-
ered in the following pages, it is due to the fact that such a
classification has never found place in text-books on veterinary
surgery. Like so many other chapters of surgical publications,
the one under consideration has been sadly neglected. If
tuberculous animals are excluded from surgical treatment, as
has already been explained, the diagnosis of tuberculous
changes, in itself, is of greatest importance, because of the

cesses that

following :

of mastitis an

dovaginites ascaut

as spinal tuberculosis a

these cases an early d

tion as tuberculo

ty of many tubercular affections to disease pro-

ly receive successful surgical treatment. Only the

mentioned here : differential diagnosis

s and metritis, tubercular arthrites and ten-

5 causesof different forms of lameness, as well

:ause of paralysis. In all

osis of a surgical affec-

nd therefore, incurable,

is of interest for the rapid repression of contagion (Oster-
tag's method of repression), as well as of economic interest
to the agriculturist. With reference to the eliology and
pathogenesis of tuberculosis (tubercle bacillus) see text-books
on special pathology.

Tuberculosis of the Udder,— In cattle this is usually
secondary, due to emboli ; it is seldom primary (entrance ol
bacilli through the teats). Anatomically it may be a dissemi-
nated miliary tuberculosis, a tubercular icaslitis, or a localized
tuberculosis. It usually presents the following symptoms : a
diffuse, symmetrical, painless, seemingly firm
swelling of the posterior quarters, with
swelling and enlargement of the supramam-
mary lympll-glandB. Later the swollen parts contain
large or small firm nodules, on palpation these appear
to be very hard. Other parts of the swollen udder gradually
become as hard as a board or stone. Occasionally the udder
becomes extremely large, the disease may extend from the
posterior to the anterior quarters. Diminution iu sl^e of the

1 68 TUBERCULOSIS

udder, as shown in other chronic forms of inflammation, is
never seen in tuberculosis of this gland (Rabe). In con-
trast to other inflammations of the udder, the milk is at first
normal ; later it becomes thin, watery, mixed with floculi, and
frequently contains bacilli (Bang). Diagnosis is confirmed
by harpooning the udder (Nocard, Ostertag). Tuber-
culosis of g o a t s is far less frequent. As yet only one case
has been observed in the horse (Parascandolo and de
Meis).

Tuberculosis of the Lymph-Glands. — Infection of
the lymph-glands occurs partly through the lymph -stream,
partly from the blood . Swelling and induration of
the tubercular lymph-glands is due to the deposit of tubercular
nodules, which afterwards become calcified, as well as to pro-
liferation of the interfollicular connective tissue. The follow-
ing glands produce forms of external surgical tuberculosis : on
the head, the lymph-glands in the vicinity of
the parotid; on the neck, the superior (retropharyn-
geal), middle, and inferior cervical glands; on
the anterior extremities, the shoulder and axillary
glands (shoulder lameness) ; on the posterior limbs, the
inguinal and popliteal glands; on the udder, the
pubic glands (supramammary glands) ; on the hips, the
external iliac glands. Tuberculosis of the following
glands belongs to the realm of inner pathology : those in the
thoracic cavity, bronchial, and mediastinal, as
well as intercostal and sternal lymph-glands;
those in the abdominal cavity, omental glands, lumbar
and sacral glands, as well as the glands of the
liver, spleen, and kidneys. Extensive enlargement
of the bronchial and mediastinal glands may lead to symptoms
of surgical importance when they press upon the esophagus,
causing symptoms of esophageal stenosis (chronic
tympany). The other internal glands are of no surgical sig-
nificance. Brtickmuller has observed a case of tubercu-
losis of the thyroid gland in cattle.

J o h n e and R 6 d e r have described a case of tuber-
culosis of the glands of the shoulder in a horse,

TUBERCULOSIS

169

it was in the form of a shoulder abscess. Nocard has dem-
onstrated, through extirpation and bacteriological exaniina-
tion, one case of tnbercular disease of the intermaxillary
gland in a horse that was suspected of having glanders.
Ra be observed a case of tuberculosis of the intermaxillary,
subparotid, and superior cervical glands, with compression of
the larynx and high-grade inspiratory dyspnea : the tubercular
tumor weighed 3ji kilograms.

TuBHRCUi-OSis OF THE Skin AND SuBCUTEM. — This form
ia very frequent in parrots, as a rule it is primary, in fifty per-
cent of all cases only the skin is involved (Eberlein)-
Tuberculoma is found in the angle of the lids, on the eyelids,
and on the top of the head. Upon and beneath the skin they
form soft tumors from the size of a stick-pin to that of a hen's
egg, in form they are oval or round, they may also form kera-
togenons structures in the skin that are easily broken.
Occasionally one also finds small and large tuberculous
ulcers on the skin, in which large numbers of tubercle bacilli
are demonstrated. Cadiot observed an interesting case of
nasal tuberculosis in a cat, it was accompanied with extensive
ulcerous destruction of the skin, of the mucous membranes, and
the nasal and turbinated bones (Cf. \'ol. III. Fg. 209 of this
hand-book). Tuberculosis of the skin is not common in cattle.
A few cases have been observed in cattle ; they were character-
ized by the formation of caseatcd or calcified nodules on cir-
cumscribed areas, or by the appearance of swellings the size of a
hazel-nut to that of a walnut or a man's fist over the entire sur-
face of the body. Afterwards these swellings became soft and
caseous, their contents contained tubercle bacilli fHiittner,
Langdon, Degive, Stubbe, Lacaze, Hanozat,
Mischkin. Winter, Mackel. aiidothers). Godbille
and Nocard observed the following caseoftuberculosisof the
subcutem in an ox : tubercular lymphangitis, with irregular,
subcutaneous tumors arranged in rows ; they were about the
size of a man's fist, and became fluctuating and ruptured on
the external surface of the right anterior foot. In a dog
Moller found a tuberculous ulcer on the throat, it was accom-
panied by swelling of the lymph-glands. In a cat he observed

TUBBRCDLOSIS

subculaneous tubercular uodules with swelling of the axillary
glands. Tubercular castration-cicatrices have been repeatedly
observed in swine (infection from men?).

T0BERC01.0S1S OF THE Mucotis Membranes. — This is
most often found in cattle in the larynx and in the
trachea in the form of tuberculous neoplasms, ulcers, and
nodular hyperplasias of the mucous membranes, or tubercular
infiltration and abscess formation of the submucosa, the para-
chondrium. and the adjacent musculature. Tuberculosis of
the mucous membrane is common in parrots, it affects the
oral mucous menibranes and conjunctiva in the

if the

form of tumors and ulcers, Occasionall;
an ulcerative, tuberculous s t o m a t i t
(Moussu). as well as tuberculi
membranes in the form of 1
nodules on the nasal septum ; they vary
of a stick-pin to that of a pea, and are ac
discharge and dyspnea (Zimmerman,
linger, Kitt, audothers'), Jobne
scribed a case of tuberculosis of the muc(
the prepuce of an ox.
tuberculosis of the tongue

; observei in cattle
and glossitis
nasal mucous
conglomerate fatty
11 size from the head
impanied with nassi
3irerathy, Bol-
nd Hber have de-
is membrane of
f a 1 1 e I described a case of
'ioe. Tuberculosis of the

mucous membrane of the uterus in cattle is very common,
that of the vagina is less frequently affected. Tuberculosis
of the uterus presents the following appearance : the mucous
membrane is covered with yellowish-white tubercles, ulcers,
caseous foci, and abscesses ; the uterus contains a cloudy,
greyish-red, ichorous fluid (identical with a bacilli-containing
vaginal discharge), the serosa is covered with villous prolifer-
ations : occasionally tlte uterus is very much enlarged, the
walls of the horns in particular become very thick, hard,
nodular, and covered with ring-shaped constrictions ; the ovi-
ducts often become thickened to the size of one's finger. The
sacral glands are usually enlarged and indurated. Tuberculosis
of the vulva usually exists at the same time : on the inner
surface one finds numerous indurated nodules the size of a
stick- pin. as well as ulcers the size of beans (Hess). Tuber-
culosis of the uterus is usually the result of tubercular peri-

TUBERCULOSIS IJI

tODJtis, it is rarely embolic ; and is seldom the result of infection
at the time of copulation (DeBruin).

Tuberculosis op the Bones and Joints. — Tubercu-
losis of the bones is usually an iucideiital symptom of general-
ized tuberculosis, and is, therefore, embolic. In most cases
the primary seat is in the bone-marrow (osteomyelitis
granulosa, caries centralis tuberculosa): it is
characterized by the formation of greyish-red granulating foci
and lacunar liquefaction (caries) of the osseous tissue, with
central cavernous formation and caseation. In cattle aud
swine tuberculosis of the bones is often found in the following
places : the dorsal vertebrae, lumbar vertebrae,
cervical vertebrae (especially the first and second
cervical vertebriv as a result of tuberculosis of the adjacent
retropharyngeal lymph-glands), the petrous portion of
the temporal bone, the sternum, and the ribs;
it has also been observed in the ethmoid bone, frontal
bone, occipital bone, humerus, pelvis, femur,
on the tibia, and in other bones. A peculiar form of tubercu-
losis of the middle ear (tubercular otitis media and in-
terna) is observed in swine, it penetrates towards the brain,
and develops from an infection of the pharyngeal cavity
(Schiitz, Siedamgrot zk y I. The tubercular inflamma-
tion extends through the Eustachian tube, and then over the
tympanic cavity ; it develops a tubercular periostitis, ostitis,
and osteomyelitis, with rarefaction and necrosis of the bones,
in this manner the process may extend to the cerebral men-
inges, the cerebellum, and the medulla oblongata. Tlie tuber-
cular affection may extend to the external auditory canal,
which becomes filled with a tubercular tumor. A secondary
tuberculosis of tlie brain may develop in cattle in a similar
manner from primary tuberculosis of the frontal bone ( K ii n-
nau. Moussu). Tuberculosis of the petrous portion of the
temporal bone in a dog has resulted io unilateral facial paraly-
sis (Mo Q t fal le t). Hess has described a case of kyphosia
ip a steer caused by tuberculosis of the lumbar verlebrse.
R i e c k observed a case of paralysis of the hind parts in a bull
caused by tuberculosis of the sixth cervical vertebra, it resulted

172

TUBERCULOSIS

in severe swelling and compression of the cervii
Knoll has observed two cases of sacral paralysis in swine
following tuberculosis of the lumbar verlebrse. Teetz has
observed a case of paralysis in swiue as a rcsuU of tuberculosis
of the first cervical vertebra, H e y c e has observed a similar
casein a cow (seventh cervical vertebra, first dorsal vertebra).
Schmidt saw a cow collapse with sitddeo paralysis ; it was
necessary to kill the animal, post mortem revealed tuberculosis
of a lumbar vertebra and the adjacent spinal marrow. H a u g
has described a similar case. Tuberculosis of the bones is
common in birds, Cases of tuberculosis of the lumbar verte-
brie, ribs, etc . have been observed iu horses, sheep, and goats
(Walley, Rasmussen, Magin).

Tubercular arthritis is occasionally found in cattle
in the hip-, elbow-, knee-, and carpal-joints (arth-
ritis pannosa, granulosa, and caseosa), compare with the
chapter on arthritis. It is raost often seen in birds, especially
in the joints of the feet and wings; it also occurs in
Bwine in the tarsal- and carpal-joints. By feeding tubercu-
lous milk Nocard produced tubercular arthritis experimen-
tally in a cat. C a d i o t observed tubercular gonitis in a dog.
With reference to tubercular tendovaginitis and bur-
sitis at the carpal-joint (extensor carpi radialis), and knee-
joint (extensor digitorum pedis longus) of cattle, compare with
the chapter on tendovaginitis and bursitis.

Tdbkrculosis of the Musculature. — This is mostly of
an embolic nature (generalized tuberculosis), it is not common
and has no surgical importance. Inthe abdominal, thor-
acic and appendicular muscles one finds round,
firm, sharply circumscribed greyish-brown nodules ; occasion-
ally they are arranged in rows ; they may be miliary in form,
or attain the size of a lentil or bean. Tuberculosis of the
tongue in parrots is m^re common, where it not infrequentljr
leads to active tumor fomation in this organ. Tuberculosis
of the tongue in cattle is less frequent ( Laquerr i^re .
Godbille. and others); according to Ostertag only one
■case was fouud during a period often years in the abbatoirs in
Berlin.

Tuberculosis of the Eves. — While tuberculosis of the
lids and conjunctiva is common in parrots, in cattle tuberculo-
sisof the eye is relatively rare. It usually develops in the form
of an embolic tuberculosis of tbe iris and choroid,
and leads to destruction of the bulb, and transforma-
tion of the same into a granular or caseous mass.
In a three- year- old cow that was affected with tuberculosis of
the lungs, Uoder found tuberculosis of the right eye. Hess
observed the following condition in a cow that was a&ected
with tuberculosis of the lungs : symptoms of suppurative con-
junctivitis, blindness, and atrophy of the bulb, first the left
and then the right eye became affected. Post mortem revealed
numerous while points in the anterior chamber, as welt as
fibrinous iritis, and white caseated nodules the size of a millet-
seed. In a slaughtered tuberculous cow Winter found the
entire inner eye filled with a caseous mass ; uodutes from the
size of a lentil to that of a pea were found on the schlera and
cornea, where they were arranged in inasses.

In another case lentil-sized, yellow nodules were found on
tlie anterior surface of the iris, it was also covered with yellow
foci the size of the head of a stick-pin, tbe latter were arranged
on the inferior margin of tbe iris, and were adherent to the
cornea. In a third case the retina was covered with numerous
tubercular nodules. Edelmau has described a tuberculous
neoplasm that was located within the bulb of a tuberculoaa
ox, it pressed the lens out of position and caused atrophy of
tbe vitreous humor ; the neoplasm possessed the consistency
of a sarcoma, it was divided into cavernous spaces which were
filled with a muco-purulent mass. Similar cases have been
described by Moncet, Matthieu, Hess. Ripke, and
Schmidt. Amaurosis resulting from pressure on the
optic nerve from tubercular new- formations is less common
(Fumagalli).

Tuberculosis of the Thsticlks. — Many cases of this
type have been demonstrated in cattle and swine in the
form of enlargement of the testicles, and deposits
of numerous tubercular nodules, the nodules vary in size from
a millet-seed to a walnut (Perroncito, Lydtin, Kitt,

174 TUBERCULOSIS

Johne, Fambach, Goring, Arens, Schmidt, and
others). In one case in swine the right testicle weighed 3^^
kilograms, the left 10 kilograms. Jensen has described a
<:ase in the cat. Hess has observed a tuberculous tumor as
large as a goose-egg upon the e p i d i d y m u s of an ox.
Meyer and others have described cases of tuberculosis of the
spermatic cord, vaginal tunic, and vesiculae
seminales. Cadiot and Frauenholz have reported
cases of tuberculosis of the prostate in cattle and dogs.
The numerous cases of tuberculosis of the oviducts belong
to the domain of inner pathology.

Tuberculosis of the Brain and Spinal Marrow. —
Tuberculosis of the brain is not rare in cattle ; it occasionally
develops with symptoms of paralysis and conditions
which are of surgical interest from a standpoint of differential
diagnosis (paralysis of the facial, oculomotor,
optic, trochlearis, hemiplegia, staggering
movements, torticollis). Symptoms of sacral
paralysis and ataxia have been observed in tuberculosis
of the spinal marrow, tubercular neoplasms in the lumbar
marrow have been demonstrated by Johne, S t e u d i n g, and
others.

With reference to the treatment of tuberculosis, experi-
mental extirpation of the diseased portion may be employed,
as in man, (castration, ovariotomy). One may also experi-
ment with aseptic injections of sterilized iodoform, emulsion
of iodoform glycerin (10 per cent). These are injected into
the diseased organs, for example, into dogs.

CONCREMENTS AND FOREIGN BODIES.

I. CONCREMENTS.

General Considerations. — The name concrement is
used to designate hard, stony excretions composed of the saline
and organic constituents of the secretions and excretions of the

URINARY CALCULI 1 75

animal body. Only a small number of these concrements are
of importance in veterinary surgery. The majority, namely,
intestinal stones of the horse, hair balls in the rumen and
reticulum of ruminants, gall-stones, renal stones, and pan-
creal stones are essentially conditions of inner pathology ; as a
rule they produce only symptoms of internal disease, and,
with few exceptions, are not amenable to surgical treatment.
The following will receive brief mention :

1. Urinary calculi.

2. Intestinal calculi.

3. Salivary calculi.

4. Milk calculi.

5. Preputial calculi.

6. Free bodies in joints and tendon-sheaths.
Urinary Calculi. — These either exist in the kidneys

and the pelvices of the kidneys (renal calculi), or in
the bladder (cystic calculi), they frequently become
lodged in the urethra (urethral calculi).

They are formed from the urinary salts, and are composed
of calcium carbonate (carbonates), calcium oxalate (o x-
a 1 a t e s ) , salts of silicic acid (silicates), uric acid and
uric-acid salts (urates), and phosphates of ammonia and
magnesia (triple phosphates). The formation of uri-
nary calculi is favored by the presence of foreign bodies on the
one hand, especially the organic albumenous products of
inflammation of the mucous membranes of the bladder and
pelvices of the kidneys, around which, as a nucleus, the urinary
salts are deposited, and bacteria on the other hand, these cause
degeneration of the urinary products to ammonia (amnioniacal
urinary fermentation), thereby making possible the formation
of triple phosphates.

In the horse urinary calculi are composed largely of
calcium carbonate with traces of calcium oxalate, and iron.
Cystic calculi form egg-shaped or flat, hard, yellowish stones,
the surface is smooth, mulberry-like, or has the appearance of a
gland ; in size they vary from that of a walnut to one's fist
or larger. Frequently a few, and even many small calculi
are present in the bladder. By constant wear they produce

facet-like surfaces on one another ; in addition to these one
also finds a gravel- or sand-like sediment (urinary gravel, uri-
nary sandj. The weight of cystic calculi varies between
lo and looo grams. Urethral calculi are similar in character
but smaller, they vary in size from a hazelnut to that of a
chestnut, and average from lo to [5 grams in weight. They
are usually situated in the vicinity of the posterior border of
the ischium.

Cystic calculi in cattle possess the following character-
istics : they are usually numerous, small in size, from a lentil
to a pea, pearl-like, of a metallic goldish-yellow or goldish-
brown lustre, and covered with facets. In oxen and steers
they are usually found lodged in the S-shaped curve of the
urethra. They are composed of the carbonates or oxalates of
lime, or of silicates.

In dogs the cystic and urethral calculi are usually small,
from the size of a grain of sand to a pea, and they often
exist in large numbers. Solitary cystic calculi, from the
SIM of a hazelnut to a chestnut, are less common. From lying
against one another their surfaces are frequently smooth and
covered with facets similar to the cuboid, one often fiuds, how-
ever, a rough, gland-like, warty surface. Urethral calculi in
dogs usually become lodged in the gutter of the bone of the
penis, so that the entire urethra as far as ihe bladder is filled.
Occasionally one finds a sand-like incruslralion of urinary sed-
iment on the mucous membrane of the urethra. The urinary
calculi of the dog are composed largely of urates, triple phos-
phates, and oxalates.

The treatment of urinary calculi is purely operative ;
it consists in incision of the bladder (cystotomy), and the
urethra (, urethrotomy ).

Intestinal Calculi. — In the horse these are formed in
the large intestines, by getting lodged in the rectum, or at the
point where the colon terminates in the rectum, they become
the cause of so-called calculous colic. They consist essentially
of the triple phosphates which are derived from the
phosphates of magnesia in the food (bran) and the ammonia
in the air of the stall. The phosphates of ammonia and mag-

A LI VARY CALCDLI

177

nesia frequently crystsHze around an oat. a nail, a button, a
grain of sand, etc. , which serves as a nucleus. Their si/.e is
variable, the large ones reach the size of a large nine-pins ball
and weigh from 5 to 10 kilograms. Intestinal calculi are of
surgical importance when they can be reached per rectum.
Operative removal by means of laparotomy and intestinal in-
cision is as good as hopeless. Feliret successfully removed an
intestinal calculus by this method ; on the other hand those
cases in the horse terminated fatally that were operated on by
Dollar, Rickards, and Hall.

H a i r - b a 1 1 s (bezoare, phytobezoarc, asgagropila) in the
rumen and reticulum of ruminants are composed of matted
hairs and plant fibers. In cattle they reach the size of an apple
to that of one's fist. Wheu rcEurgitated they occasionally ob-
struct the esophagus producing symptoms similar to those of
foreign bodies in the esophagus (tympany^. In these cases
operative treatment is indicated (probang, esophagotomy).

Salivary Calculi. — In herbivora these are found in
Sleno's dnct (horse, cow, ass). They consist largely of the
salivary salts, namely, calcium carbon at e (80 to 90 per
cent), besides phosphate of lime and organic material ; they
have a chalk-white or yellowish -while color and occasionally
reach a considerable size, when they become as large as a
goose-egg and weigh 500 grams. Solitary calculi are oval or
sausage-shaped, they are covered with numerous facets. A
foreign body is usually found in the center of the calculus (oat,
etc.). They are removed by means of an operative opening in
the salivary duct, or through the moulh. The so-called dental
calculi on the teeth of horses and cattle are composed of the
same materials as salivary calculi, calcium carbonate is the
main constituent — Calcareous concrcments in the tonsils are
very rare.

Frhb Bodies. — The name free body (corpora
libera, corpora oryzoidea, rice-like bodies,
chondroids, joint-mice) indicates an organic structure
in joints, tendon-sheaths, mucous bursae,
subcutaneous hematomata, and the guttural
pouches of the horse; these structures are variable in

1 78 FOREIGN BODIES

character. More than a hundred chondroids have frequently

been found in the guttural pouch. They are composed partly

of coagulated, inspissated, hardened, calcified products of

inflammation, partly of constricted neoplasms or desquamated

bone or cartilage. Sec chapter on diseases of the joints.

Milk-Calculi. — This is a name that indicates concrements in the
milk-cy sterns or in the teats. They are variable in form, yellowish- white
or grey in color, and about the size of an oat or bean. They consist of
calcinm carbonate (90 per cent ) , casein, and fat. W e i 1 1 e has
described a case in a heifer in which 22 milk-calcnli were removed at an
operation, their collective weight was 72 grams. — The so-called pros-
tatic calct^li are similar concrements which are formed from the
sedi mental deposits from the secretions of the prostate. — Preputial
Calculi. Concrements known as preputial calculi, or calculi
of the glans penis, are found in the preputial sac of horses and
boars. They are oval or lenticular in form, smooth or sharp, rough,
and formless. They consist largely of inspissated smega, occasionally
they cause retention of the urine (urinary colic).

II. FOREIGN BODIES.

General Considerations. — Aside from foreign bodies
that are formed within the animal body itself (concrements)
many other foreign bodies from without gain entrance to
numerous portions of the body. In some ways they are of
more importance to internal medicine than to surgery, namely,
foreign bodies in the anterior stomachs of the ruminant (trau-
matic inflammation of the stomach, diaphragm, and heart).
In many cases they produce conditions that necessitate surgical
interference. To this class belong foreign bodies of the
mouth-cavity, the pharynx, esophagus, stom-
ach, intestines, the nasal cavities, the con-
junctival sac, skin, subcutem, muscle, and hoof.

Foreign Bodies of the Mouth Cavity. — These arc
most often observed in dogs, cats, and horses, where they
cause symptoms of salivation, stomatitis, and difficult mastica-
tion ; in dogs, under certain conditions, they even produce
symptoms similar to those of rabies. When such symptoms
exist in these animals careful examination of the mouth cavity
should not be omitted. The following bodies are found

; BODII

179

between the teeth, in and under the tongue, in the gums,
in the mucous membranes of the cheeks, at the openings
of the secretory ducts of the salivary glands, etc.: pieces of
bone -splinters, grain, pieces of wood, needles,
particles ofstraw, and other sharp bodies. Sometimes
the tongues of cats and dogs, as well as birds, become ligated
with pieces of string or hair, they may also become con-
stricted with pieces of the trachea, transverse sec-
tions of the aorta, rubber tubes, and iron
rings. In cattle, even green stalks of sharp, pointed barley
with long roots have been observed upon the tongue. Oats,
rye, awns, and particles of straw have been found in the ex-
cretory ducts of the salivary glands. These foreign bodies
pass out of the mouth cavity and sometimes follow a peculiar
course. Needles and grain-awns have been found in the cra-
nial cavities of horses aud swine ; a piece of metal was found
in the Eustachian tube of a dog ; blades of straw and kernels
of grain in the orbital cavity and temporal fossa of a horse.

Foreign Bodies in the Ph.\rynx and EsorHACus. —
These are especially frequent in horses and cattle, where they
cause symptoms of pharyngitis, difficult deglutition, stenosis of
the esophagus, and even perforation of the esophagus. The
most important foreign bodies are bones, pieces of meat,
fish-bones, bacon-rinds, masses of fat, pieces
of tendon, potatoes, beets, apples, pears, pieces
of linseed cake, balls of food, eggs, sauerkraut,
plum-stones, pieces of wood, needles, pills,
teeth, forks, knives, spoons, coins, pieces of
cloth, hair-balls, broken pieces of whip-han-
dles and probangs, balls ofoaktim, and remains
of the afterbirth. Their removal is often very difficult.
Treatment consists in the administration of emetics (apomor-
phine, veratrinj. agents which stimulate the secretions of the
salivary gland* (arecalin, pilocarpin), passing the probang
and esophagotomy. Those cases in which the foreign body has
penetrated the thoracic portion of the esophagus are incurable
(pleuritis) : occasionally a foreign body causes an injury to
the anterior or posterior aorta resulting in internal hemor-

l8o FOREIGN BODIES

rhage, or an aneurysm of the aorta. — In the guttural
pouches of the horse, aside from the chondroids which
reach the size of a chestnut to a hen's egg, there may be found
necrotic portions of the bone (os hyoides), as well as pieces of
food which occasionally fill the entire sac. In one case a
musket-ball three centimeters thick was found in the guttural
pouch of an old military horse (R i go t). In another case
fungoid growths of aspergillus fumigatus were found in the
guttural pouches (Ries).

Foreign Bodies in the Stomach and Intestines. —
The greatest variety of blunt and pointed foreign bodies are
found in the anterior stomachs of the ruminant, especially
in the reticulum of the ox. Pointed foreign bodies
penetrate the gastric wall, the diaphragm, pericardium, and
heart, causing a characteristic disease marked by chronic indi-
gestion and severe cardiac symptoms (traumatic carditis and
gastritis). In their wanderings the foreign bodies often pass
outwards through the skin, their passage is characterized by
the formation of phlegmons, abscesses and fistulae of the
thoracic and abdominal regions. The most common sharp
foreign bodies are: nails, pins, darning-needles, hair-
pins, sewing-needles, cobbler's needles, pieces of wire, sharp
remnants of iron and metal plate, screws, knives, shears, forks,
pieces of glass, splinters of wood, pieces of stone, sharp angular
pebbles, sharp pieces of lead, pieces of thorns, branches of
vines, steel umbrella-ribs, and broken umbrella-sticks. The
most common blunt foreign bodies are : stones, pieces of brick,
gravel, sand, coal, pieces of wood, cork, cabbage-stumps,
apples, pears, hair-balls, bullets, spoons, pieces of coin, leather
straps, soles of shoes, pieces of cloth, pieces of clothing, neck-
ties, strings, laces, buttons, frogs, toads, striped snakes, adders,
and poisonous plants. Surgical treatment of these foreign
bodies consists in the much-employed laparotomy and gas-
trotomy (incision of the rumen). Foreign bodies in the stom-
ach and intestines of dogs (bullets, coins, stones, cork, hair-
balls, pieces of teeth) are occasionally removed by means of
emetics and purgatives. Otherwise, when symptoms of death
appear, they must be removed by means of laparotomy. The

FORHIGN BODIES

prognosis of enterototny in the dog is not unfavorable : it has
been employed with good results by S i ed a m grot z It y,
Frohner, Degive, P16sz, Krause, and others. Occa-
sionally foreign bodies in dogs and horses pass away spon-
taneously (champagne -cork in a dog, curb-chain in a horse).
It sometimes occurs that foreign bodies, especially coins,
remain in the stomach of a dog for a long time, even years,
without causing trouble. A five-frank piece remained in the
stomach of a dog for twelve years without giving rise to in-
jury, a top for one year (N i ch oux , Cadiot). In addition
to the above foreign bodies, one finds the following in the
rectum of the dog and cat : hard feces, fish-hooks, ker-
nels of grain, and other bodies which gain entrance Irom
without. In the urethra, kernels of grain and broken pieces
of catheters have been observed ; artificial ligatures have
been observed around the penis in dogs (ribbons, etc.).

Foreign Bodies in the Respir.\tory Tract. — The
following have been observed in the nasal cavities and
superior maxillary sinuses of the horse : pieces of
food and bone, sponges, wisps of straw, oakum, tampons,
pieces of wood, blackberry twigs, hog's bristles, apples, pieces
of bandage, and moulds (mucor spinosus). In the larynx
and bronchi have been fouud pieces of cartilage, as well as
portions of a tracheotomy- tube, aspirated stones, and grain-
awns. Rhinoliths are rare ; this type is usually seen in the
guttural pouches in the form of corpora oryzoidea.

FoRKiGN Bodies in the Eye and Ear. — ^Foreigu bodies
in the conjunctival sac, especially beneath the raem-
brana uictitans (kernels of grain, awns, pieces of wood), are
the cause of a unilateral purulent conjunctivitis. When a
unilateral blennorrhea exists, careful examination of the entire
sac for the presence of foreign bodies should not be over-
looked. Treatment consists in removal under the inSuence of
cocain. Foreign bodies in the external auditory
canal are usually in the form of parasites ; occasionally they
gain entrance to the middle ear (tympanic cavity ), bird-mites,
in cattle, mange-mites in rabbits, larvse of fleas, and fleas

FOREIGN BODIES

, SUBCUTEM. MOSCLHS,

, needles.

(simulium) in animals at pasture. In addition to these.
masses of secretions from the cerumioous glands, water, sand,
splinters, beards of grass, and gravel stones have been found.

Foreign Bodies in the Hoof. — Nails and fragments
of glass are most frequently found. They usually enter at
the lateral or median cleft of the frog. Nails sometimes pene-
trate the soles of cats and dogs.

Foreign Bodies in the Skin,
Bones and Internal Organs. -
splinters of wood, and other foreign bodies enter the
body through the skin. By acting as carriers of filth, dirt,
and other unclean material rich in bacteria, they set up sup-
purative and septic inflammations (phlegmons,
abscesses); when the foreign bodies are aseptic healing occurs
without reaction, especially without suppuration.
The latter is especially true of shot and bullets, which may
become encapauled and remain in the body without causing
injury. Foreign bodies that are soft and composed of animal
tissues are resorbedby means of phagocytosis and liquefaction
(catgut, pieces of lung, liver and kidneys that are experi-
metally transplanted into the abdominal cavity).

Other foreign bodies would include the entrance of air
into the veins and heart, as well as phlebotomy instruments
that gain entrance to the heart by passing through the wounds
in the vein (funnel, blades of a lancet). It is a peculiar fact
that heart-muscle is relatively non-sensitive to injuries from
foreign bodies : this is demonstrated in those cases of traumatic
carditis in the ox, where the function of the heart is not sus-
pended for weeks and months, although severe chronic changes
are taking place. With reference to retention of the
afterbirth see text-books on obstetrics,

Parasiti*s. Tbe following pa.rasites, which msy be considered aa
liTitig foreign bodies, ate of surgical importance :

1. Coennriii cerebtalis (the woim which causes itaggen)
develops in sheep and cattle, occasionally in horses, dogs, and goats.
In the brain they result in symptonia of paresis, and occusionally pro-
duce local sytDploiQs ( amaurosis) ; in the spiual mariow they may cauae
symploma of sacral paralysis. Treatment of the cerebral bladder-worm ia
operative (trepanation, puncture).

FOREIGN BODIES

catarrh of the nasal c
( diBease caustd by the

J, Gastrophilis Ian
rectum of the horse, the; seldi

petted glanderal.

sitic in the nassl cavities

gad-Bj) in aheep causes syDiptotiis of chronic
ities. and the frontal and maxiUary sinnses

DL-casionally produce proctitis in t!
luse injury in the pharyngeal cavil
rare in horses (nasal discharge. si

symptoi

idea llicigu'ata tienoides) is pan-
s of the dog liarely in hones). They cause
inguino-pumlcnt rhinitis.
Hypoderma bovis (cestrns hunianis] lives in the larva]
form in cattle, where it causes boil-like swellinKB aa large as a walnut in
the ikin (uestrus abscesses). These are aubcotaneaus abscesses, and
they communicate with the sorface of the skin by a small opening,
through which the larvs finally pass out. llCstrus abscesses hove also
been observed in military horses and English sale-horses in the follow-
ing places : in the saddle-region, on the withers, on the buttocks, an
the neck and abdomen (Hell and others). In a case described by
Ducsase he found a larva of hypoderma i bovis? ) one and one half
centitueter in length in the medulla oblongata of a horse affected with
paralysis. Treatment consists in incision of the abscesses. Chronic
connective -Tissue proliferations occasionally develop around the dead
larvit:, their consistence is very hard and they finally become calcified
(hypoderniolithsof Caparini).

6. Pilaria papillosa lives para.iitically In the horse in the
anterior chamlier of the eye, where it causei a severe inflammaUon of
the iris and cornea. Il may be removed through an incision in the
cornea (Vandeveldc, Monatshefte fiir praktische TJerheilkunde. 1S95).
The same parasite is foand in the hoiae in hydrocele, ascitea, and
cryptorchids.

7. Pilaria lachrymalis is a harmless parasite found in the
cxcietory ducts of the lachrymal j^lands. occasionally it appears to cause '
a conjunctivitis of the lids.

cause of tendinitis of the suspensory ligament, it causes an incurable
lameness (Maori], Occasionally they cause a fibroma-like neoplasm
in the vicinity of the flexor tendoni, which reaches the size of a hazelnut
to a dove's egg [Frohner, Bartels). They are also found in the
tendon-shea Ihs of the flexor tendons, in the walls of the tibial artery.
and in the ligamentum nuch^ ( I once found them in the latter place
when operating fistula of the withers). One case has also been observed
in the subcuiem of the horse ( liasai j.

9, Filaria hemorrbagien (filaria irritaos) develops in horecs
at pasture, especially in Russia and Hungary. It is found in various
ptrts of the body ( withers, shoulder, neck ), where it forms hemorrhagic

184 FOREIGN BODIES

cQtaneous nodules the size of a pea, so-called y^ranular dermatitis. The
{Mirasite lives in the subcutaneous tissue and can be demonstrated by
means of an incision. In general, treatment is superfluous. ( For details
concerning this organism see ''Special Pathology and Therapeutics,"
Priedberger and Frohner. Sixth Ed., 1904, Vol. I).

10. Filaria mediuensis occurs, as in men, in the subcuta-
neous connective tissue of horses and dogs (Africa, India, Brazil).

11. Cysticercus cellulosae (measles) is occasionally seen in
the eyes of swine. In one case they were found in a tumor on the knee
of a dog (Meyerstrasse). — Echinococci in the frontal sinuses of
the horse cause symptoms of empyema (Preuss. Mil. Vet. Bericht. 1898).

12. Strongylusarmatus is found in the thickened nasal mucous
membrane of the horse (Lammers). It also causes peri tonitic pro-
liferations on the tunica vaginalis of the testicles (Hinrichsen), and
is not rare in cryptorchids (personal observations). Strongylus-like
nematodes have also been observed in the membrana nictatans of pup-
pies in Prance and America, where they were the cause of a contagious
inflammation of the eyes ^Kmmerz, M^gnin).

13. Spiroptera sanguinolenta produces cysts in the walls
of the esophagus in the dogs of Java, this results in stenosis.

14. Distomum hepaticum is occasionally observed in the
scrotum of the horse as an incidental condition during castration
(Hiller).

15. Sarcosporidia (psorospermia, Miescher's tubuks) cause
symptoms of myositis in the horse ; compare with the chapter on diseases
of the muscles.

16. Horse-leeches (hemopit vorax) are occasionally found in
horses and cattle in the mouth-cavity, pharynx and larynx (pharyngitis,
laryngitis, chronic marasmus).

17. Ixodes ricinus (mites) induce circumscribed inflammation
of the skin of dogs; one case of acarus of the conjunctival sac has
occurred in dogs (lower border of the cornea) , it caused severe conjunc-
tivitis (Tierarzneischule in Pisa; Clinica veterinaria. 1S97).

18. Simuliuni maculata, and Simulium ornata and
reptans cause inflammation of the skin and mucous membranes of
the head with severe swelling (dyspnea, asphyxia, poisoning) in animals
at pasture. According to Bergman n the best protective is creolin
in oil or fish-oil (i to 20).

CHANGES IN POSITION OF VISCERA.

HERNIAS. VISCERAL HBRNIAS.

Nati'RE. The term hernia indicates Ihe passage of
viscera from body -cavities without an injury
to the skin or mucous membranes. Changes in
position of the viscera which are accompanied by a rupture of
the covering skin or mucous membrane so that they are exposed
to the air are termed prolapse. While in a broad sense
the term hernia appli«s not only to abdominal viscera, but also
to lungs, brain, and muscle; in a narrow sense one under-
stands by the term hernia, a change in position of the abdominal
viscera. According to the seat they are named as follows :
umbilical hernia, inguinal hernia, scrotal
hernia, ventral hernia, hernia of the flank,
femoral hernia, perineal hernia, rectal hernia,
vaginal hernia, diaphragmatic hernia, and
other internal hernias.

In every hernia the following parts are recognized : i.
The mouth (hernial opening), that is, the opening in the
abdominal wall through which the viscera pass ; 3, the hernial
sac, that is, the sac-shaped, protruded peritoneum covered
with skin or mucous membrane ; 3, the contents (intestine,
omentum, bladder, stomach, liver, uterus}. The margin of
the mouth of the hernia is termed the hernial ring. The
hernial sac consists of a mouth, neck, body, and fundus.
According to the contents of the hernia one speaks of an
euterocele (intestinal hernia), epiplocele (omental
hernia), gastrocele (gastric hernia), en tero-epi pie-
ce le, cystocele, hyslerocele (hernia of the uterus),
hepatocele. oopherocele. In addition to the essential
contents hernias contain a serous fluid, hernial water.

With reference to the mobility of the hernial contents,
they are classified as reducible (moveable, free), that is,
they may be pushed through the hernial mouth into the
abdominal cavity ; and irreducible (immoveable), that is,
a hernia that cannot be returned. The immobility is due.

1 86 SYMPTOMS

either to adhesions between the hernial contents and the
hernial sac, which is especially common in omental hernias
(immobility of the omentum); or to incarceration
(constriction, strangulation) of the prolapsed viscera, this is
especially frequent in intestinal hernias.

With reference to the causes of hernias, they may be
congenital or acquired (traumatic) .

Symptoms. — i. A reducible hernia is characterized by
a large or small hernial swelling which occupies a char-
acteristic seat in the umbilical or inguinal region, etc. The
swelling is painless, is not characterized by a rise of tempera-
ture, and has a soft peculiar consistence ; the skin is moveable
on the surface, occasionally one may easily palpate intestinal
loops or pieces of omentum at its base. Percussion occasion-
ally gives a tympanitic sound fair in the intestinal loops); on
auscultation one can occasionally hear rumbling or gurgling
peristaltic sounds. On pressure the swelling be-
comes smaller and finally entirely disappears
in the abdominal cavity. Palpation of the abdominal
wall reveals the hernial mouth, it varies in size from a pea to that
of one's fist; in form it is round, oval or elongated, whenever a
hernia has existed for a long time the free margin of ring
becomes firm and tendinous. In rare cases the abdominal
sac becomes ossified in cattle.

2. Incarcerated hernia, especially in horses, is
first recognized by colic (strangulated inguinal hernia of
stallions) ; in dogs and swine one further observes vomiting,
and even stercoraceous vomiting; constipation is pres-
ent in all animals. On local examination one finds an
inflammatory swelling at the seat of the hernial
sac ; attempts to return the hernial contents are unsuccessful.

Treatment. — One must differentiate between the treat-
ment of a reducible and an irreducible hernia; the
reducible form may receive cither provisional (palliative)
or definitive (radical) treatment. It should also be obser\'ed
that many forms of hernia, especially those of the umbilical and
ventral regions in horses and cattle, heal spontaneously
(cicatrization;. On the other hand, many forms with a very

TREATMENT

187

wide mouth (ventral hernia) are i n c u r a b 1 e, especially in
horses and cattle. Finally, many forms of non- incarcerated
hernias, especially those of the umbilicus, require no treat-
ment as they do not usual! v result in diseased conditions
(colic, etc.).

1. The palliative treatment of no □- incarcerated
hernia consists in the application of an abdominal band-
age, this is especially useful for umbilical and ventral hernias
of dogs, foals and mares. The prolapsed viscera are pressed
back into the abdominal cavity by the abdominal bandage,
this is followed by a gradual diminution in size of the hernial
mouth.

Palliative treatment is further employed in the form of
return of the hernial contents by means of pressure and reduc-
tion of the hernial sac by means of artificially devel-
oped inflammation and cicatricial formation
in its vicinity. For this purpose the following agents have
been employed; bt i s ters (calcium dicroniate 1-8 or 10),
firing the skin of the hernial sac, applications of sulphuric
acid, nitric acid, chromic acid, as well as subcu-
taneous injections of alcohol, salt, and other
irritating materials. The eiSciency of this method is still
questionable. At any rate it is not without danger. Gan-
grenous necrosis of the skin with prolapse of the intestines has
followed the application of acids ; subcutaneous injections
have been followed by severe phlegmons and fatal peritonitis.
Other palliative remedies are ligation, clamping, and
suturing of the hernial sac.

2. The radical operation consists in exposure of the
hernial sac (herniotom y). The mouth of the hernia is
sutured with, or without, sub.sequent extirpation of the hernial
sac (inverted into the abdominal cavity). Herniotomy is the
surest method of treatment of a hernia because it not only
removes the hernial sac but obliterates the mouth. Experience
has taught that mere suturing, clamping, or binding the
hernial sac is occasionally followed later by the passage of
viscera through the remaining hernial mouth, this results in
the gradual formation of a new sac.

1 88 PROLAPSE

3. Treatment of an incarcerated hernia
consists first in the return of the strangulated viscera (taxis)
through manual reposition, dorsal position, combined attempts
from without and inside the rectum, placing the hind limbs in
a special position to favor enlargement of the inguinal ring, as
well as deep narcosis of the animal by means of chloroform.
If reposition is not successful by this method, the constricted
hernial moth (implication of the tunica vaginalis) must be
enlarged by means of a hernial incision (herniotom y ) ,
taxis may then be successfully employed. The return of the
strangulated hernia must be preceded by careful disinfection,
as well as resection of any necrotic portion ( intestinal suture).
In stallions, herniotomy of an incarcerated
inguinal hernia is usually followed by castra-
tion with the use of clamps and the covered
operat io n.

II. PROCIDENTIA. PROLAPSUS.

Definition. — Prolapsus (prolapse) is a free
passage of viscera through natural or arti-
ficial body -openings without a covering of the skin
or mucous membrane. As a rule the causes are traumatic in
nature. Thus, rupture of the abdominal wall results in pro-
lapse of the intestines and other abdominal viscera ; severe
efforts at abdominal pressure, prolapse of the rectum ; stretch-
ing and relaxation of the uterine ligaments, prolapse of the
vagina and uterus ; i)enetrating thoracic wounds, prolapse of
the lungs ; severe wounds of the skull are followed by pro-
lapse of the brain ; bites of the eye, prolapse of the bulb ;
rupture of the vaginal wall, prolapse of the bladder ; paralysis
of the penis and tongue, proplase of these organs.

Prolapse should not be confused with e v e r s i o n (in-
version, inflexion) of a hollow organ (bladder, uterus),
or with intussusception (i n vagin a t ion) of a sec-
tion of the intestine or vagina into itself. Prolapsus vesicae
is a prolapse of the bladder through the ruptured vaginal floor
into the vagina, or outwards through the vulva ; inversio

vesica; is an outward in
of the bladder and the
nature of prolapsus, inv«
sharply distinguished.

:ethi

So-c

LAPSE 189

of the bladder through the neck

veterinary- science the

1, and invagination is not always

lied prolapsus recti is often pro-

.pse of the rectum with invagination : so-called prolapse of

the uterus and vagina, an inveisio uteri and vaginas with

prolapse.

Symptoms. — The syniptonis of prolapse are extremely
variable according to the organs aflected.

1. Prolapse of the intestines consists in the pro-
trusion of portions of the small intestines, colon, and even
caecum, through penetrating abdominal wounds, through the
inguinal canal after castration, or through a hernial ring afler
herniotomy. It is always a very dangerous accident. Reposi-
tion must be accompanied by careful disinfection of the pro-
lapsed intestines, taxis is followed by accurate suturing, cas-
tration by the covered method may be necessary.

2. Prolapse of the omentum most often occurs
after castration, or following perforating abdominal wounds.
It is far less dangerous than prolapse of the intestines. Treat-
ment consists in careful disinfection, ligation, incision of the
stump, return of the stump, and careful suturing of the wound.
Castration by the covered method may be employed.

3. Prolapse of the rectum is partly a prolapsus
ani, partly a prolapsus recti, with or without invagination. It
is a result of abdominal pressure from straining, chronic
diarrhea, rough exploration, etc. It is most frequently ob-
served in dogs, cats, and swine, less often in horses. The
prognosis should be made with caution, reposition, regardless
of sutures, ts frequently of no permauent value, so that one
must employ amputation of the prolapsed parts.

4. Prolapse of the vagina occurs in cattle as an
inversion of a portion of the vagina (incomplete prolapse), less
frequently in the form of an invagination of the entire vagina
with a simultaneous prolapse (complete prolapse). It may
follow traumatic influences as a result of parturition. A pos-
terior displacement of the uterus when accompanied by atony
of the uterine ligaments, so-called habitual prolapse, may occur
in cows which occupy positions with the hind parts the lowest.

IQO DISEASES OF BONES

5. Prolapse of the uterus is especially common
in cattle, it is caused by rough manipulations at the time of
birth ; inversion with prolapse is also due to continued strain-
ing. Reposition, and retention especially, is occasionally
diflicnlt, so that amputation is sometimes required.

6. Prolapse of the penis is observed in paralytic
conditions, as well as iu paraphimosis. Prolapse of the
tongue is either the result of rupture of the muscle, or
paralysis (it should not be confused with the ordinary blemish
in which the tongue is protruded). Prolapse of the bulb is
most often observed in dogs fpugs) as a result of bites ; treat-
ment consists in reposition or amputation. Prolapse of the
membrana nictitans is observed in tetanus. In ad-
dition to these are inversion and prolapse of the bladder,
prolapse the of pododerm, prolapse of the iris, prolapse of
the posterior corneal membrane through a corneal ulcer (k e r a-
t o c e 1 e ) , forward protrusion of the cicatricial cornea
(corneal staphyloma).

The following internal changes in position of viscera are
of surgical importance : torsion and anteversion of
the uterus in cattle, twisting of the left colon on
its axis in horses. Twisting of the stomach on its axis
is occasionally observed in dop^s, as well as luxations and
torsions of the spleen in swine. With reference to changes
in position of the uterus, and abnormal ])ositions of the
fetus, see text-books on obstetrics.

DISEASES OF BONES.

I. BROKEN BONBS. FRACTURES.

Prrumixarv Remarks on Anatomy and Piivsiologv. — Normal
bone is composed of three principal couititnents : the periosteum, the
genuine bone-substance (tela otsea), and the bone-marrow. Prom a
surgical standpoint the periostenm is of greatest importance in diseases
of bone, this is especially true of fractures. The bone-marrow
(endostenm), from a standpoint of veterinary surgery, stands next in
importance. In diseases of the bone the tela ossea plays a lest
important part.

FRACTURKS Igl

For an midcistandini" of the jirocegses of healing, as well as various
pBthological procesBM in the bone, it is necessarj to have a knowledge
«( the physiological developmeiiL ■■ it occars in the normal growth
o f b o n e. Asa result of the embryo logical and histological investiga-
tions of Kollilcer, Gegeubauer, Waldeyer, and others, it has
been demoiislmted that bone may develop from periosteum,
bon e-raarrom , or cartilage. One distingnishes, then, ■ peri-
osteal, a myelogenic or endosteal, and an enchondra] formation
of bone. The organt mentioned supply, finit of all, a soft germ-tissue,
the marrow-tissue (osteoid tisane ) in which the osteoblasts, that is,
the specific bone-forming celts, then develop. The most important pro-
cesses are as follows :

1. Periosteal bone foimatiou ia timilar to the perichondral
form which occurs in the felus, that is, it develops from the inner osteo-
blastic cell-layer of the periosteum ^so-called cambium or formative
lajerj ; the outer layer of the periosteum has few vessels or cells, it is
rich in connective -tissue fibers, and plays no part in the development of
bone. The formative layer of the periosteum contains mairow-apaces
which have a rich cellular and vascular supply, A part of the former
are transformed into osteoblasts; calcinm saltsare deposited around
them and there is formed lamellar-like bone-tissue in which these cel-
lular elements are confined in sac-like cavities and are retained as so-
called bone cells.

2. Myelogenic or endosteal bone formation follows in a
similar manner, the bonndary between the marrow and the tela ossea is
first supplied with osteoid tissue from the bone-marrow, this is followed
by the formation of osteoblasts and bone-tissue,

3. Knchondral bone formation is observed on the epiphyseal
cartilage of fetal bones; it develops from the osteoblasts and marrow-
cells of the marrow -cavities in the cartilage. If the epiphyseal symphisis
is continually irritated (chronic inflammation, compound fractures,
blows (torn sticks) developing bone becomes abnormally long ( B e r g -
mail, Tillman, and others).

In contrast to the bone-forming activity of the osteoblasts, there
■lands the resorbiog activity o( the osteoclasts ; this is constdntly
present in normal bone. The origin o( these bone>solving, mullinti-
clear, gianl-cells has not yet been demonstrated by any method free
from objection (descendants of the osteoblasts? the white blood-cor-
puscles t the endothelial cells of the vesnels f the adventitia or perithelial
cells?). According to Tillman the activity of the osteoclasts isas
follows ' apparently they cau^e a solution of the calcinm salts of the
bone by the formation of free carbonic acid, thus resorbjng the osseona
matrix, in this manner small cavities or lacunae are formed in the bone
(lacunar bone reiorptioo, Howship's lacntiac).

192 FRACTURES

Nature and Causes. — Broken bone or fracture
is a division of the continuity of the bone ; in contrast to a
bone- wound the external skin usually remains intact.

The causes of fracture are either external or internal.
Most fractures are due to external causes (kicks, blows,
falls, contusions). One also differentiates between direct and
indirect bone fractures. A direct fracture occurs at the seat of
the trauma. An indirect fracture occurs at a distance from
the seat of the traumatic injury. Contusion- and com-
press i o n- fractures belong to the indirect form (fracture of
the vertebra? from falling on the hind parts); this is also true
of fractures due to torsion and bending (straining of
the first phalanx when caught in the rails, fracture of the
vertebrae when cast), and traction- or strain- fracture
(fracture of the calcaneum due to pulling of the achilles tendon
when falling upon the strongly flexed hind limb). Frac-
ture bycontrecoup or contra-fracture is classified among
the indirect forms, it occurs according to the principle of
contra- fissure (fracture of the sphenoid bone by falling on the
mouth, fracture of the internal angle of the ilium by falling on
the tuberosity of the ischium).

Fractures may occur in the absence of all external trau-
mata, merely through internal causes, especially as a
result of increased muscular contractions. So-
called spontaneous bone-fracture is most frequently observed
when casting horses ; it is due not merel}' to falling, but occurs
as a result of pronounced muscular contraction while the
animal is lying or balancing ; contraction of the longissimus
dorsi results in a dorsal or lumbar fracture ; severe exertion of
the retained hind limb, fracture of the femur, tibia, or meta-
tarsus ; severe struggling against retention of the anterior
limbs may result in a fracture of the scapula or humerus.
Spontaneous bone- fractures occur even in horses that are
standing ; the lumbar vertebrae may be fractured by suddenly
stopping or turning a horse (Trasbot), violent kicking with
both hind feet (H a u b n e r), while galloping ( W i 1 1 m'a n),
when rising (M o u s s u) ; the humerus when traveling rapidly,
sudden turning of the horse by the rider, and heavy pulls

ABNORMAL FRAGILITY

(Flook, Penberthy. Ernes, Lagrifoul); the pelvis
and tarsus by supporting the body weight on one hind iinib
when slipping (personal observations); other bones ol" the
hind limbs as a result of severe coatraction of the extensors
when kicking (Joly); the pisiform bone in heavy draft-horses
(Mbller): the lumbar vertebrie, femur, and tibia dur-
ing extraciion of the teeth while the animal is standing
(Eberlein).

In many cases neither external nor internal influences can
be demonstrated as causes of hone- fracture. The so-called
i d i o p a I i c fractures must be explained by an abnormal fra-
gility of the bones (fragilitas ossium, osteopsathyrosis).
Idiopathic fractures are not uncommon in horses and cattle.
The fragility is due either to certain pathological con-
ditions of the hones, especially osteomalacia, rachitis,
rarefying ostitis, hone caries, sarcoma (nielanosarcoma), and
tuberculosis ; or to certain predisposing influences, old age
(senile atrophy), standing in the stall for a long time
when convalescent from some disease (atrophy of inac-
tivity); extreme youth (juvenile bones, intra-
uterine fractures); disease of the nervous system, es-
pecially that form which occasionally follows neurotomy
(trophoneurotic bone - a t ro p h y) ; restricted mo-
bility in the joints (anchylosis of the vertebral
column in the horse sometimes results in fracture of the
vertebra;). Occasionally no cause for the fracture can be
found, regardless of a careful examination. These cases one
must account for by individual variations in the solidity
and elasticity of the bones of different animals. A heredi-
tary fragility of the foals of certain mares has also been
observed, it is characterized by numerous fractures.

irdle

DRMAL Fragilitv.— Without the acre
ses in veterinnry practice are uneipL
e of those frBctores of the spinal colon

etui I

nee of this condition
ible. This is e«pec-
n hones, which, re-
ODS, frequently

occur when the auimal is being cast: they are more com-
mon than ii genErally supposed or pabhshed. Bxpetience has shown
that old borsci are especially predisposed lo this form of fracture (cast-
ing for operatioDB on the teeth, extirpation of Ibe Utersl cartilage). If

194 FRACTURBS

these fractnres are less frequently observed in many countries and
clinics than in others, it is, according to my judgment, due not only to
the various methods of casting but to the differences of race and conditions
of nourishment. Further, this class includes those cases of multiple
fracture in one and the same animal. In a cow affected with osteoma-
lacia the pelvis was fractured no less than fifteen times (Maris). In a
sound horse that suddenly became lame after a few jumps when gallop-
ing, the sesamoid bones were fractured in all four limbs (Rutherford).
A stallion fractured both femurs during a castration (Haselbach ).
One horse fractured all four of the second phalanges at the same time
( Henon ) ; another fractured three suffraginal bones ( R od e r ) ; many
others have fractured two of the first or second phalanges (Wend-
worth, Moller, personal observations). An abnormal fragility of
the ribs and vertebrae has also been repeatedly observed in horses
(Degive, Thiimmler, and others).

The causes of abnormal fragility of bones in old horses are usually
considered to be a senile atrophy of the bones, and in young
horses a rarefying ostitis. Recent investigations by French veter-
inarians have resulted in an explanation of this problem. J o 1 y and
Vivien (Recueil. 1901) found the typical changes of rarefying ostitis
in a first phalanx that was fractured while the animal was going at an
ordinary trot. On macroscopic examination a rapid, artificial solution
of the lime salts of the fractured bone was easily recognized when com-
pared with the corresponding bone of the other foot. Microscopic
examination of the fractured bones revealed numerous and extensive
dilitations of the Ilaversion canals (rarefying osititis); the articular
cartilage was secondarily involved (atrophy, penetration of the cartilage
with vascular loops ) . In two cases of fracture of the lumbar vertebrae
in horses Jacoulet and Vivien found rarefying ostitis with vascular
dilitation (redness), liquefaction of the fatty substance (fioat in water)
and porosity.

Classification. — From a practical standpoint the
most important division is into simple (subcutaneous) and
com p ou nd (open) fractures. Simple, subcutaneous frac-
ture is a fracture of the bone without an injury to the skin.
In contrast to this a compound fracture is accompanied by a
skin- wound, so that the bone is exposed and entrance of
infection is possible.

Further, a classification into complete and incom-
plete fractures is important. In the former the bone is
broken across its entire diameter at the point of fracture, so
that the ends are not attached to each other. The separation
is only partial in incomplete fracture, there is only a cleft or

the ribs:
are often

e distin-

FRACTUBES I95

fissure, that is. a split in the bone (fissure. longitudinal
fracture), or an infraction or bending (i n fraction, im-
pression, depression, subperiosteal fracture,
green -stick fracture). Fissures most frequently occur
on the Brst phalanx and on the tibia ; infractions,
impressions, on the bones of the skull. Fissun
transformed later into compound fractures.

According to the direction of the broken lint
guishes transverse fractures (fractura transversa);
oblique fractures (fractura obliqua); longitudinal
fractures (fractura longitudinalis) ; spiral fractures
with a wound-line that takes the form of a screw ; fractures
in the form of the mouth-piece of a clarionett (fracture en
bee de flute); Y-shaped fractures; and T-sh&ped
fractures (ou the first phalanx).

According to the position of the broken fragments in
complete fractures various kinds of dislocation are recognized ;
namely, dislocatio ad axJn (angular frKctute); ad
latus (lateral or transverse displacement); ad periph-
e r a m (rotation ); ad longitudiuam, either with i m p a c-
tion (shortening), or separation (increase in length).
Impaction is likewise a form of longitudinal dislocation
with contraction ; diastasis is an opposite condition.

Further, in contrast to a simple fracture, in which the
bone is broken only once, one speaks of a multiple fracture
(fractura multiplex), double fracture, triple fracture.
etc. They are observed especially on the first and second
phalanges and on the epiphyseal ends. When the bone is
broken into small fragments it is termed acomminuted or
spl i n te r - fracture (fractura comminuta); when a splinter-
fracture is characterized by complete crashing of the bone it is
termed a conquassion fracture (fractura conquassata). The
latter occurs, for example, in vertebral fractures when casting
horses.

Partial bone fracture, which is not uncoumion in vet-
erinary practice, ts of importance. Certain portions of the
bone are broken, not the entire bone. These occur in the fol-
lowing places : on the lateral tubercles and tuberosities of the

196 FISSURES

humerus ; on the trocanters of the femur ; the spine of the I
scapula ; and the oblique and transverse processes of the ver-
tebrre, especiaiUy the cervical and lumbar vertebrce.

FiasuRKS.— These are of great practical imporlance, becanse in
horses their occurrence is especially frequent, diagoosis is very diffi_
cult, and many cases are finally ttansforiued into complete fractures.
In addition to ihe first phalanx and tibia, fissures are found in the
Tertebrx, in the scapula, humerus, radius, metacarpus and metatanus,
Eemiir, second phalanx, os pedis, in the ulna. etc. Fissures are fre-
quent in the vicinity of gun-shot-fractures (penetrating shots). A
peculiarity of fissures is that after a certain time, often several days,
they are transformed into complete fractures, this has been repeatedly
observed in practice. Usually it is unexpected, and occurs during the
night, when the animal is rising or lying down, on raising Ihe hoof to
be shod, etc.. this is especially true of the tibia and first phalanx.
Fractures due to kicks on the inner side of the tibia ia the horse may
be transformed into complete fractures after weeks or months { in two
cases one went for seventy days, the other for one hundred twenty-
eight days). Also in other bones, fractures occur which are transformed
aftera time into the complete form. Especially remarkable

which occur after casting or falling, complete fracture tsJtiag
place after several hours or a few days, even after weeks. They
• re characterized by sudden paralysis of the hind
parts. Occasionally these occur in horses that have
been used for saddle or driving purposes regardless
of the fissure. According to the records of the veterinary li tcim-
tnre cases of Ihiskind arenot uncommon (Spinola, Dieckerhoff,
Moller. Straube, Giitzlaff, Flatten. Wiirgler, perBoaal
observations). I have, for example, observed that after the casting of ft
thorough-bred stallion complete fructure developed from a fissure after
foot weeks (twenty-nine daysi. During this time the animal was in
perfect health and stood on all four limbs. In similar cases fissures is
the horse have developed into fractures after a long time, even weeks;
fiftctnres of the metacarpus {Ban e rl. humerus (Philippi, personal
observations), and radius (Free r, Giinther, Schmid). Fotrefer-
ence to old fissures from a forensic standpoint see page no.

Frequency and Occurrenck. ^Fractures of bone tuost
often occur in horses and dogs; they are not infrequent
in cattle, birds and swine. In cats fractures are
relatively uncommon ; becauseof their elasticity they may fall
a considerable distance (several feet) without being injured.
In the horse the ordinary causes are falls, running into objects,

FRACTURES

197

collisions, kicks from horses, casting ; in dogs, kicks, bites,
being run over, squeezed, fails, and stones. Bone-fractures
in horses and dogs are most often ^een in large cities:
in the former it is due to slipping and falling on hard smooth
pavements, especially on asphalt when it is covered with
smooth wet ice ; dogs are run over with street cars, hacks,
and other vehicles. According to luy experience in Berlin
dogs suffer most often from fractures on Sundays (picnic
parties), for that reason Monday's clinic is supplied with an
abundance of material ; the same condition follows any inter-
ruption in traffic. Fractures in war are usually caused by
projectiles.

The statistics of the Prussian Army afford valuable material
relative to the frequency of fractures in horses.
Among 30,000 horses, 400 fractures a year occur daring times
of peace. The total number of fractures, covering a period of
five years (1891-1S95) in the Prussian Army was zooo. The
following regions are most often affected ; pelvis, tibia,
first phalanx, bones of the head, the radius,
the metatarsus, and the vertebrae. Fractures
of the tibia, pelvis, and the first phalanx
cover about fifty per cent of all fractures in
the horse.

With reference to the frequency of fractures in the dog,
my own published statistics covering a period of nine years
(1886-1894) and 70,000 diseased dogs, show the following
results r about 1700 (1693) suffered from fracture, this amounts
to 2.3 per cent of the total number of diseased dogs. In
Berlin, one in forty ol" all diseased dogs suf-
fers from fracture. Luxations, in contrast to fractures,
are less frequent in dogs, occurring about one 6fth as often (I
have seen only 344 cases in all, equal to .5 percent). Accord-
ing to my experience the most frequent fractures in the dog
are of the fern ur (17 per cent), the radius and ulna (15
per cent), the tibia and fibula (13 per cent), and the
humerus (5 per cent). In the dog ninety per cent
of all fractures involve the bones of the ex-
tremities. The following bones are least often fractured :

198 STATISTICS

Sternum, bones of the cranium, the vertebral column, the
patella, the ribs, and the scapula.

In cattle, fractures most often involve the head of the
femur, pelvis, scapula, tibia, metatarsus, and
bones of the tail. Recorded statistics are wanting.

With reference to the frequency of fractures in
swine, information is found in the work of Charpentier
and Lafourcade. Fifteen per cent of all slaugh-
tered swine show fractures of the ribs in vari-
ous stages of healing. Transportation in narrow^
quarters explains this condition.

Frequency of fractures in birds is furnished by the statis-
tics of Larcher who has treated 250 cases. According to
C a d i o t the following bones are most often fractured :
humerus, tibia and femur; the radius, ulna,
scapula, and ribs are less frequently fractured. I, my-
self, have treated 137 fractures in birds, 64 were in large birds
(hens, swans, parrots), and 73 in small (song and ornamental
birds). Wings and limbs were most often fractured.

Statistics. — i. B a r t k e has collected the following statistics on
the horse from the records of the Prussian Army : in a period cover-
ing ten years from 1886-1895, of 280,000 diseased animals, bone fracture
occurred in 3473. Of 3000 recorded fractures, 1800 — equal to 60 per
cent — involved the limbs ; 1000 — equal to 30 per cent — involved the
body and vertebral column ; 200 — equal to 10 per cent — involved the
bones of the head. Individual fractures were as follows : ^

Tibia 557 times 18 per cent.

Pelvis 491 ** 16

First Phalanx 404 '* 13

Radius 239 ** 8

Cervical Vertebrae 237 " 8

Metacarpus 210 '* 7

Lumbar Vertebrae 87 *' 3

Dorsal Vertebrae 75 '* 2.5

Humerus 72 ** 2.5

Ulna 70 ** 2.5

Ribs 68 ** 2 **

Femur 59 ** 2 **

Second Phalanx 53 ** 2 **

Third Phalanx 52 ** 2

Occipital Bone 52 ** 2

II
(I
t <
II
(I
II
II
II

II
II

ffTATISTI CS

199

Sphenoid Bone 43 times 1.5 per cent.

Scapula 35 " I "

FrontBl Bone 33 '■ t "

Superior Maxilla _ 3* " 1 "

Inferior Maiilla 31 " i "

In the years 1895-1902 at the Snrgical Clinic of the Berlin Veteri-
nary School I treated 30S fracturet from a total of 7000 diseased horses.
Of these, loj involved the pelvis. 43 the bonea of (he head. 38 the first
phalnnx, at the vertebra, 14 the acapnia, 14 the humerus. 13 the tibia,
13 the second phalanx. 11 the femur. 9 the third phalanx. 6 the navicular
bone. 5 the ulna, 4 the ribs. 4 the radius, 3 the metatarsus, 3 the sacrum,
I the tarsus. 1 the carpns, i the patella, and i the sternum.

.According to Cadiot | clinic in Alfort ) 159 fractures of the
extremities of the horse were distributed as follows : tibia 33, pelvis 30,
first phalanx 14, radius 17, metacarpus 15. humerus 13. femnr and ulna
6, scapula 5, second phalanx 4. carpus 3, third phalanx 3, calcaneum and
trochlea 1. Morkeberg at the Copenhagen Clinic has treated 69 frac-
tures in the horse in the years 189&-1900. The fractxires were distributed
as follows: pelvis 31, first, second, and third phBlnnges 15, bones of the
head 7. ribs s times. According to V e r 1 i n d e 42 fractures occurred
in twelve years in three Belgian Cavalry Regiments, They were dis-
tributed as follows : femur 2t, third phalanx 2. navicular, first phalanx,
and second phalanx [.

a. I have observed 1693 cases of fractures in do^!^ ( 548 in the
hospital clinic, 1145 in the polyclinic], 1145 fractures in the polyclinic
were distributed as follows : head ai, trunk 60. anterior limbs 434, po«.
lerioe limbs 537. Individual fractures compiled from 915 cases were
distributed as follows:

Femur 188 times

Radius and I'lna.. __ 170

Tibia and Fibula 145

Metatarsus 47

Metacarpus 40

Carpus 38

Anterior Phalanges 39

Posterior Phalanges 35

Pelvis ___ -... 30

Tarsus a?

Coccygeal Vertebrse a6

Scapula 17

Ribs _ _ 16

Inferior Maxilla 16

Lumbar Vcrtebne ti

Dorsal Vertebrae 5

Patella ..-„ 3

perce;

17.0

200 SYMPTOMS AND DIAGNOSIS

With reference to the resistance ( resistance to pressure ) of bones in
different races and species, information has been supplied by the recent
investigations of Hoffman (Berl. tieraertl. Wochenschr. 1901). Of
the long bones of the extremities in the horse, the metatarsus was the
most resistant. A difference in breed was not observed ; age, on the
other hand, resulted in variations. The bones of cattle were far leas
resistant than those of horses.

Symptoms and Diagnosis — The symptoms are ex-
tremely variable according to the nature of the fracture. While
the complete fractures, especially the complicated, are easily
recognized, the diagnosis of fissures is often very difficult. In
general the following symptoms are characteristic of fractures
in the domestic animals.

1. Inability to support weight, as well as pain
when the animal is at rest or in motion, are the first visible
symptoms of fracture of the bones of the extremities. Any
sudden high-grade lameness in the horse, standing and trav-
eling on three limbs, should cause suspicion of fracture.
Horses and dogs stand and travel upon three limbs ; horses
either refuse to move or travel with great difliculty ; palpation
causes crying in dogs. Many fissures are characterized by a
line of pain along that of the fracture (p a i n - 1 i n e in fissures
of the first phalanx). Pain and disturbed function are often
absent in fractures of the pelvis and ribs, in many fractures of
the skull, as well as in fissures of the vertebne. Total para-
plegia and anesthesia are observed in fractures of the vertebral
column.

2 . Abnormal mobility of the broken bones and
limbs at the point of fracture is the most characteristic symp-
tom. Abnormal mobility may be visible (pendulant position
of the limbs, abnormal positions and relations), it may also be
determined by palpation (fixation of the superior and inferior
fractured ends). Abnormal mobility is usually absent in all
incomplete fractures, as well as in fractures of the pelvis and
vertebral column ; in other cases the normal mobility of the
limb may be restricted or suspended (impaction).

3. Crepitation at the point of fracture, that is, a
rough rubbing sound on palpation and passive movements of
the fragments, is very characteristic : this is often a direct

RACTURES

pathognomonic sign of the existence of a fracture, especially a
splinter- fracture. (One should be careful not to confuse this
with arthritis and tendovaginitis crepitans). Crepitation fails
in all incomplete fractures of the vertebral column, and in
many fractures of the pelvis, as well as in marked dislocation
of the fragments.

4. Swelling in the vicinity of the broken ends is
characteristic of simple fractures, it is due to rupture aud sub-
sequent hemorrhage in the adjacent soft tissues. Callus for-
mation results in swelling in old and complicated fractures,
especially when there is a phlegmonous infiammalion of the
soft tissues. Swelling is often absent in incomplete fractures.

5. Injury to the skin, as well as a subsequent
suppuration and fistula formation occurs only in com-
pound fractures ; subcutaneous fractures seldom result in sup-
puration, it may occur through the blood by means of a pyemic
infection (strangles).

6. Derangement of the general condition
seldom occurs in simple fractures ; subcutaneous fractures
that are characterized by severe hemorrhage and injury to the
soft tissues may lead to a slight rise of temperature
without other general derangement. The rise of temperature,
which also occurs in animals, is termed an aseptic fever
(in man subcutaneous fractures are usually followed by a tem-
perature of 38.5-39,5). This is explained by the presence
of a ferment-like febrifacieut formed from degenerated blood-
corpuscles at the seat of fracture, this material is resorbed
(v. Bergmann, v. Bruns. aud others). Fever which
follows complicated fractures, on the other hand, is usually
septic because of the presence of pus cocci. Rupture of
large blood-vessels by fragments of bones is followed by symp-
toms of internal hemorrhage, this is especially true
of pelvic fractures ; severe crushing of the bone-marrow is
followed by fat-emboli in the lungs and brain.
In man, in addition to lipuria, albunie n uria , and
cylind ruria- resulting from fracture, there have been ob-
served brown cylinders, increase in the urobilin contents of
the urine, and even hematogenous icterus as a result of the
absorption of coloring matter from degenerated blood.

202 PRACTURRS

7. For many fractures certain specific individual
symptoms are of diagnostic importance. Fracture of the
nasal bones produces visible impressions, epistaxis,
stenotic sounds, and even permanent stenosis with
dyspnea. Costal fractures lead to hemoptysis,
pneumonia, pleurisy, and injuries to the inter-
costal arteries. Fracture of the sphenoid bone,
under certain circumstances, results in amaurosis, and
d y s p h a j; i a ; fracture of the bones around the eye, phleg-
mon of the orbit; fracture of the hyoid bone and max-
illary hotifs, j^lossolysis, difficult mastication,
and (1 y s j)li .'I j; i a . Chronic catarrh of the guttural
p o II c h (! s has bfeii ()})scrved after fracture of the hyoid bone
rS i cmI a in j^ r t z k y , R u p p r e c h t ). Severe fractures of
the cranial bones are followed by insensibility, nys-
taj^inus, hemorrhage from the ear (fracture of
the base of the .skull and the temporal bone), as well as fatal
paralysis <>f the brain; fracture of the cervical verte-
bra*, by paralysis of the diaphragm; fracture of
the dorsal or lumbar vertebrae, by fatal paraplegia, this
is introduced by a sharply circumscribed motor and sensory
paraly.sis, later it gradually becomes generalized. Healed
fractures in the vertebral column produce deformities
through the formation of anchylosis and synarthrosis (torti-
collis, lordosis, kyphosis, scoliosis). Fractures of the last
rib in the horse have occasionally resulted in injuries to
the stomach and diaphragm (Grosswendt and
others). Paralysis of the larynx resulted from a fracture of
the first left rib in a dog (Frick). Laceration of the
obturator artery is common in fractures of the pelvis ;
it results in internal hemorrhage. Fractures in the vicinity of
the foramen ovale may result in permanent paralysis of
the obturator, which leads to paralysis and atrophy of
the adductors ; the nerve becomes involved in the callus
(Thorn m asse n ). Fracture of the external angle of the
ilium in a horse resulted in fatal laceration of the cir-
cumflex artery (Kemp). Fatal laceration of the in-
ternal thoracic artery in a horse has resulted from fracture of

PROGNOSIS

203

the sternum (Sand). In another horse with Tracture of the
eighth and ninth dorsal vertebra there was pronounced per-
spiration of the anterior regions which slopped in the
immediate vicinity of the fracture (Boiirgoinj. In other
horses with fractures of the vertebrie there are girth-shaped
areas of perspiration in the Junibar region fRoder; personal
observations). A horse with fracture of the right external
angle of the ilium showed severe and permanent perspiration,
as well as non-sensitiveness of the sktn beneath the right hip
(Delacroix ).

RosTGHN RAVs.^The use of Rontgen Rays which
has recently become of diagnostic value in the illumin-
ation of fractures in man has been experimentally em-
ployed in veterinary science (Bayer, Eberlein. Pfeiffer,
Jensen, Hoffman. Troater, Kriiger, and others).
In tbe latter ca.se it is not of general practical importance. The
application of rays in living animals is frequently associated
with great difficulties on account of the restlessnes of the
animal. In addition to this is the high price of the apparatus
(a Vol tohm -apparatus for illumination of the horse costs 2500-
2800 marks), as well as the complexity of manipulation. On
the other hand, Rontgen rays may be employed in clinics,
especially upon small animals (foreign bodies), as well as for
the diagnosis of fissures and fractures of the bonea of the
extremities (first, second, and third phalanges). (For details
concerning the application of Rontgen Rays in veterinary
science see my "Chirurgische Diagno.stik der Krankheiten des
Pferdes. ■' 1902).

Prognosis. — When judging a fracture with reference to
its healing or non-healing propensities the following factors
are brought into consideration :

I. The species of the animal is of first importance in
giving a prognosis. In horses and cattle fractures,
usually heal more slowly than in the smaller
animals. The cause is due, on the one side, to the fact that
it is either very difficult or impossible to apply a bandage on
a horse or a cow, the attempts at reposition and retention ol
the fragments are frustrated. On the other hand, as a result

204 FRACTURES

of Standing for a long time upon three limbs, severe inflamma-
tion of the pododerm often develops in horses and cattle ; it
begins with increased arterial pulsation and severe pain, and
terminates with sinking of the os pedis and necrosis of the
pododerm with a subsequent septicemia (pressure laminitis).
Remaining for a long time in the recumbent position also pro-
duces contusions and decubital gangrene of the skin with
general sepsis because of the great body-weight of these
animals. According to the experience of the Prussian Army
only 20 to 25 per cent of all bone- fractures in the horse are
curable ; of 3473 covering a period of ten years from 1886-
1895, 744 healed : equal to 22 per cent. On the other hand,
according to my experience among dogs, the total number of
healed fractures amounts to about 85 per cent. The prog-
nosis of fractures in the dog, therefore, is four
times as favorable as in the horse. The per-
centage of healing in birds is still higher. Also in swine, rib-
fractures especially, appear to heal very rapidly. The time
required for fractures to healin horses and
cattle averages from one to three months; in
the dog and sheep, three to four weeks; in
birds, fourteen days.

2. The bone itself, from a prognostic standpoint, is of
great importance ; one bone may heal very readily, another
with great difficulty, many seldom heal. In fully developed
horses and cattle the following fractures are usually incura-
ble: fractures of the cervical vertebrae, dorsal vertebrae, and
lumbar vertebrot when the body or arch is involved and leads
to injury of the spinal marrow ; complicated (in most cases the
simple also) fractures of the femur, tibia, scapula, humerus,
and radius ; comminuted fractures of the first and second
phalanges, as well as many fractures of the pelvis. Fractures
of the metacarpus and metatarsus heal with great dif-
ficulty. The following, however, are relatively cure-
able: fissures, simple fractures of the ribs, fractures of the
external angle of the ilium, those in the vicinity of the eye,
simple fractures of the first and second phalanges, and caudal
vertebrae, as well as the vertebral processes.

froi

3. The k i n c

I a prognostic s

fractures,

prognosis

PROGNOSIS 205

of fracture Is also of great importance
ndpoint. In general the folio w-
avorable: comminuted fracture,
complicated fractures, aswellas
involve a joint or occur in its
/icinity (glenoid cavity). Simple
B Other hand, are relatively favorable. The
unfavorable in non-recent fractures which are
first brought for treatment some lime after they occurred.
Fractures of the diaphyses heal more readily than those of the
epiphyses ; transverse fractures more readily than the oblique.
Healing is delayed when the patient suffers from internal
disease. Fractures in the vicinity of the joint occasionally lead
to anchylosis (fetlock joint, coronary-joinl. pedal-joint). The
prognosis of partial fractures is especially favorable, for exam-
ple, fracture of the lateral tuberosity of the humerus, or the
oblique processes of the cervical vertebra. In general, fissures
are more favorable than complete fractures. The prognosis
of many fissures, on the other hand, has been found to be
unfavorable. The process of healing seems to be very slow,
especially in fissures of the first phalanx of the horse (six to
twelve weeks and over). Fissures of the vertebral bodies are
mainly incurable.

4 , The a g e of the animal has an inSuence on the prog-
nosis, experience has shown that the healing of bones
proceeds more slowly in old animals than in

young. Young
without danger,
years.

Finally, in h
■Iready discussed.

for a longer tii

thai

thoi

or recumbent,
advanced in

es and cattle, in addition to the points
e must decide whether the patient is worth

treatment from an economic standpoint, or whether it would

not be better to slaughter the animal.

CiTRABlLITV OR iNCURAHlLI'n' OF A. FracturB- — The Biiawer to
thi* question belongB to one of the uost difficult problems with which
the practicing TCterinarinn has lo deal. Becanae the question mast fre-
qncntly receive an immediale answer (on the race-track for in»t»nc« ) •
carefnl consideration of the previou&ly considered indnences is necea-
sary. In particular, one must not forget to compair the value of the

206 PROCESS OF HEALING

patient with the cost of treatment — that is, the resulting permanent
diminution in the usefulness of the animal. In doubtful cases, espec-
ially in cattle, one should advise slaughter. In certain cases, when the
patient is a valuable breeding-animal, treatment until birth of the
young may be advised. Cows advanced in pregnancy may be killed
when suffering from incurable fractures of the pelvis : perform lapa-
rotomy immediately after slaughter and extract the young through an
incision in the uterus (Cesarian section ).

From a forensic standpoint also, it is often difficult to render
an opinion with reference to the curability of a fracture. In Prusaia
many verdicts are rendered through the knackers privilege by
which the knacker has the right to reclaim for himself incurable
cattle. Occasionally these questions must be decided with carefnl ref-
erence to the existing conditions, especially to the seat and kind of
fracture. In general the previously explained conditions are sufficient.
One's verdict is controlled by the average statistics furnished by expe-
rience ("as a rule" curable or incurable).

It has been observed many times in horses and cattle, that, excep-
tionally, fractures with a very unfavorable prognosis may heal. Finally,
not all cases recorded in veterinary literature are free from exception :
Poschl healed a complicated fracture of the inferior third of the
femur in a thorough-bred stallion in eight weeks (?). A complicated
fracture of the ])atella, which was broken in three pieces, healed in a
horse in two months with the formation of a bony callus ; lameness re-
mained which was severe when the animal trotted and slight during
walking movements (Andrieu). A jK'lvic fracture, which involved
fracture and displacement of the acetabulum healed in a cow (Be rd ez).
A separation of the pubic symphysis after difficult parturition in a cow
healed in four weeks, and twice afterwards the cow gave birth to calves
(H e n n i n jj; e r ). A bilateral complicated fracture of both inferior
maxilliL* at the interdental space healed in fifty days in a horse (Pas-
se r i n i ) . A fracture of the trocanier of the femur healed in a two-
year-old foal (Xeuberger). I, myself, have observed healing in
two different cases of fracture of the lateral tuberosity of the humerus,
as well as in two fractures of the scapula, in fully developed horses. A
transverse fracture of the metacarpus of the horse healed in sixty-six
days ( P u j o s ) ; complete healing occurred in a similar manner in
fracture of the radius of a horse (Schafer, Salchow, and others).
In a four-year-old colt healing of a complicated fracture of the femur
took place in the slings in four months without the use of a bandage ; a
piece of the middle trocanter w^as discharged from an abscess (B r a u e r).
A fracture of the metatarsus in a colt four days old healed under a plas-
ter bandage in five weeks, similar healing occurred in a fracture of the
radius and ulna in a foal eight weeks old (Frank ).

Process of Hsaung in Simple Bone Fractures. —

FRACTURES ao?

Healing of simple subcutaneous bone- fractures occurs through
an aseptic inflammation very analogous to that of primary
healing of skin wounds. The uniting of the broken ends of
bone is due. partly to the regenerative activity of the peri-
osteum, partly to that of the bone-marrow. The
essential portions involved in callus formation are only the
connective-tissue, soft portions of the bone (periosteum, end-
osteum); the tela ossea plays no part. Also the effused blood
at the point of fracture, as well as the neighboring soft tissues
are not involved in the process of healing. The union of the
fragments follows the formation of granulation-tissue, which
subsequently ossi&es, the so-called callus, the granulation-
tissue is formed from the periosteum and bone-marrow. The
bone-callus is the product of an ossifying
periostitis and osteomyelitis. In this formation
one distinguishes various forms of callus :

I. The external callus or periosteal callus
is due to the activity of the osteoblasts situated in the deep
layer of the periosteum,

2. The inner callus or marrow callus (endosteal
callus, myelogenous callus) is an analogous product of the
osteoblasts of the bone-marrow.

3. The middle or intermediate callus lies mid-
way between the external and inner callus, and is considered
as principally a continuation of the external callus, secondarily
a product of the vessels of the Haversian canals (endothelial
proliferation).

Finally, one distinguishes between a provisional and
definitive callus. The provisional callus forms a rela-
tively soft, spongy, extremely voluminous, newly-formed mass
of bone. The definitive callus is tbniied later from the provi-
sional callus as a hard, small, bony cicatrix.

Microscopic Ch,\ngbs of Callus Formation, Ac-
cording to histological and experimental investigations especi-
ally those ofVirchow. Billroth, v. Volkmann,
P. Bruns, Z i e g 1 e r, and others the following changes
occur : as in primary aseptic healing of wounds, there first
occurs a cellular infiltration at the seat of fracture, as well as

2o8 FRACTURES

the formation of a cellular and highly vascular enibrj'onic or
granulation-tissue (the callus), this proceeds from the perios*
teum as well as from the bone-marrow. During the process
two phases are recognized ; namely, the stage of ossifica-
tion of the callus, and the stage of retrogression
of the callus.

I. Ossification of the callus, the result of the
ossifying periositis and osteomyelitis, proceeds, according to
recent investigations, as follows : a cartilaginous cal-
lus is first formed from the inner layer of
the periosteum, this is ossified as the result
of a direct transformation of the cartilage
into bone. ( The osteoblasts play only a secondary role in
this process). Within three or four days after the
fracture small foci of osteoid tissue begin to form in the
embryonic tissue in the vicinity of the fracture, they form a net-
work of osseous trabecuUt with inclosed marrow cavities. In
the second week the periosteal callus is a reticulated and
tolerably soft tissue. From the end of the third week it
develops into a firm, spongy callus-substance, rich in marrow,
the provisional callus.

2 Retrogression of the callus begins in the
fourth to the fifth week with obliteration of the
newly- formed vessels. The resorbing activity of the osteo-
clasts (CO.j) liquefies the bone in the form of small spaces.
Small foci of necrosis occur in simple bone-fractures as a result
of derangements in the circulation at the line of fracture and
its immediate vicinity, this necrosis must also be removed by
lacunar resorption. At the same time the soft and uneven
provisional callus is reduced to a hard, smooth, bone-cicatrix —
the definitive callus — so that the previously thickened surface
of the bone is apparently smooth again at the point of fracture,
and the bone-cicatrix can hardly be seen, or recognized by
palpation.

Callus formation is assisted by the administration of small
doses of phosphorus (horse, centigram ; dog, milligram). These
■ mall, continually administered doses of phosphor.
us produce a specific formative stimulus on the
bone-titsue which results in an acceleration of its

ABNORMAL CALLUS FORMATION 209

th. The Exact chaciges wbich occur have been experimentally
demonstrated hy Wegener (Virchow's Archiv. 1872) through the
coulinufll teeding tor months of milligram doses of phosphorus to
young rabbits, Uetig, cat«, dogs, and calves, as well as to artnll animalB.
The following are thi; changes which occur ; at areas where the cartilagi;
normally developed into reticulated spongy substance, with abundant
red marrow-tissue and rich blood-supply, there was formed compact,
firm and hard bone-tissue with tapid transformation ol cartilage to bone-
cells ; this was especially true ot the long boncB, vertebra, nbs, pelvis,
and the bones of the carpus and tarsus. The cause is due to a narrowing
(schlerosis) of the smallest bone-cauala (caualicuH) : the result la a
thick, firm, schlerotic bone-cortex. The development of the periosteum
is also accelerated, the product, likewise, ot a firm schlerosis. The
intermediate epiphyseal cartilage undergoeit more rapid ossification.
Finally, the marrow cavities become steiioned and eventually disappear.
Wegener's theory was investigated by Kissel (Virchow's Archiv.
1896) ; it was coDfirmed, however, by Stubenraacfa (Berlin Surgical
Congress 1900).

Abnormal Callus Formation. — i. Retardation of
the previously described callus formation results from splinter-
ing of the bone, pronounced dislocation of the broken ends,
interposition of the soft tissues, contioued movement of the
broken fragments (faulty bandage or lack of bandage), general
disea.ses {osteomalacia, rachitis, infectious diseases, constitu-
tional weaknessj, as well as infection of the broken areas
(compare with healing of compound fractures). Subcutaneous
splinter- fractures usually heal, small splinters may even be
completely resorl>ed. necrosis occurs only as a result of subse-
quent infection (formation of a sequester).

When callus formation fails to produce firm union between
the fragments, there exists a so-called false joint (pseudo-
arthrosis), that is, a permanent moveable union between
pieces of bone. This is especially observed on the head and
neck of the femur, on the first phalanx, and on the posterior
false ribs.

2. A callus which is abnormally large is termed
a hypertrophic callus or callus luxurians.
Hypertrophic cicatrix and callus luxurians correspond to ex-
cessive wound granulations ; the so-called callus tumors
have tbeir analogues in the keloids and are usually osteomata
or enchondromata, seldom osteosarcoma t a. When two bones

210 FRACTURES

lyint^ parallel to each other are firmly united by a callus forma-
tion, as is observed in the fracture of two ribs, there exists a
synostosis. The bony, immobile union of two bones in a
joint is termed anchylosis anchylosis ossea-. If the
callus is not composed of bone-tissue, but of connective tissue,
failure of ossification of the periosteal and myelogenous ger-
minal tissue, it is termed a callus fibrosus. This is
obvjrvd in the fracture of short, non-vascular bones. esp)ecially
the patella, navicular bone, sesamoids, the olecranon, calca-
neiim, pisiform bone, the body and coronoid process of the
interior maxilla, and the false ribs.

TkR. MI NATION OI- FlSSr.RKS AND PRACTURES OF LONG SXAJfD-

IN';. -In the li;<ht of previous statements it is not difficult to imagine a
fresh fracture resulting from an old fissure. For a
foTfusic vrrdict it should be remembered that a fracture is preceded bj
an old fissure or fracture only when granulation-tissue or callus forma-
tion is present at the margin of, or in the vicinity of the fracture. The
a/e is deterniinerl according to the condition of the callus (see abovej.
J'Tf-hh fissures and fractures present no callus formation but hemorrhage,
and thf- appearance of a fresh, aseptic inflammation. It is further ob-
•i-rvcd that a fissure, s^^metimes very early, at other times only after a
long p<-riod, may be transformed into a fracture. The smooth or uneven
condition of the broken surfaces is of slight importance for the determi-
nation of the age of a fracture. A smooth broken surface, without
other symptoms, does not inrlicate an old fracture ; experience has
Hhown that the surface, and edges of the broken surface may be worn
snifK^th within the first half hour after the occurrence of the fracture
r(; ii n t h e r i. Trasbo t treated a case of fracture of the tibia in a
horse which first became a])parent seven days after the occurrence of
the fissure ; a two or three mm. thick layer of young, very vascular,
spongy bone-tissue was present on the broken ends. The bone-marrow
was strongly injected, the compact bone-tissue could be easily cut.
On microsco])ic examination the Haversian canals were found dilated
and filled with round-cells. I investigated a case of fissure of the ver-
tebra in a horse in which only soft granulation-tissue had formed at the
neat of fracture after twenty-nine days, there was no callus formation.

Pkockss of Hkaijno in Complicated Bone Frac-
TPKics. — While the simple, subcutaneous bone-fractures heal
per prima through an aseptic ossifying periostitis and osteomye-
litis, complicated fractures lead to suppuration of the broken
ends with callus formation. The prognosis of a complicated
fracture depends upon the following conditions : duration of the

TREATMENT

active influence of the pus-bacteria, age of the fracture, the
extent of injury to tlie skin and surrounding soft tissues, as
well as the extent of bone-splintering. With slight injury to
the skin and soft tissues combined with careful disinfection of
the wound, healing proceeds nearly as fast as in simple bone-
fractures. With reference to the severity of a complicated
fracture, the splintering is of less importance than the degree
of injury to the soft tissues. A smooth fracture with-
out splintering of the bone, but with a large
skin -wound and extensive injury to the so ft
tissues is far more severe than extensive sptia-
tering with only slight injury to the soft
parts (.Tillmanns).

The local changes in the broken area of a complicated
fracture, consist, in addition to the changes described under
callus formation, in inflammatory swelling, sup-
puration, burrowing of pus, phlegmon, phle-
bitis, lymphangitis, septic processes, ichor-
ous changes in the soft tissues, suppurative
periostitis and osteomyelitis, necrosis of the
bone (sequest rat ion) and fistula formation; as
a result of general infection septicemia and pyemia may follow.

Treatment of Simple Bone-Fractures.— The first
surgical problem consists in reposition (reduction) that is,
rearrangement and replacement of the dislocated ends in their
normal position by means of a pull (ex ten sio n) and a
counter-pull (contra-extension): the second consists in
retention, that is, fixation of the arranged fragments by means
of a bandage. Callus formation only follows accurate reposi-
tion and complete rest for the broken ends. In many of the
large animals, and in many fractures (ribs, pelvis, heads of
bones), it is impossible to fulfill both conditions ; certain frac-
tnres, however, heal in the absence of reposition and retention
simply through natural healing, this is especially true of rib-
fractures and many fractures of the pelvis. In small animals,
on the other hand, especially in dogs, reposition and bandaging
is usually possible.

The application of the bandage in simple bone- fractures.

212 FRACTURES

as well as the materials employed for this purpose have already"
been described in a previous hand-book (Bayer, *'Operations-
lehre'*). I, myself, employ plaster-of- Paris bandages exclus-
ively in horses and dogs, and consider other forms of bandaging-
material (tripolith, silicate-of- potash, gutta percha, lime, rub-
ber, starch, dextrin, pitch, paste-splints, wooden splints,
splints of iron and celluloid), as, at least, superfluous. Under
certain circumstances they may be employed as an emergency
bandage. The plaster-of- Paris bandage is applied as follows :
after reposition is complete the broken ends of the limb are
firmly fixed above and below by one or two attendants ; thin
layers of padding are applied, especially at the seat of frac-
ture, so that the broken ends are well bolstered ; a cambric or
flannel bandage is applied over the whole. For horses the
application of padding may be omitted. Over this bandage
are then applied the turns of plaster bandage which have been
previously prepared from fresh plaster and soaked for a short
time in warm water. It must be applied in such a manner
that a uniform and extensive layer of plaster comes in contact
with the broken area and its vicinity. The bandage may be
strengthened by applying some of the prepared plaster in the
form of a paste. The following general rules must be
observed when applying a plaster bandage :

1. The bandage must not exert too great
pressure nor form cord-like constrictions.
One should also observe that the folds of the plaster bandage
are not too large or unequal.

2. The bandage should be inspected daily
with special reference to pressure and con-
striction. In dogs the paw of the involved limb should
receive special attention with reference to swelling, blue color-
ation, and necrosis. In these cases the bandage must be
loosened, or entirely removed.

3. The bandage, on the other hand, must
not be applied too loosely. The swelling which
occurs the first few days after fracture disappears as a result
of the resorption of the exudate ; the bandage, though properly
applied, becomes loosened, and must then be renewed. In

FRACTURE

such cases a provisional bandage r
few days, until the swelling has d

lay be emplojed for Ihe first

dogs. In the following areas there is great danger from
pressure necrosis as a resiiU of faulty padding : the skin over
the olecranon and OS calcis, as well as upon the bony processes
of the carpus and tarsus. Necrosis is characterized by fetid
odor and fever, as well as general disturbances. In such cases
the bandage must be immediately removed and the contused
area treated with antiseptics,

5. The retention of bandages to the ex-
tremities of dogs is maintained by passing a
plaster-saddle over the back or thorax so that
it passes down on the opposite side. This
method prevents falling down and tearing of the bandage.
The piaster-saddle is especially useful in fractures of both
anterior and posterior limbs.

6. When possible, the neighboring joints
above and below the fracture are included in
the bandage. This favors immobility of the fractured
area.

7. After the application of the bandage
the animal is kept as quiet as possible until
time for removal. Horses are best retained in slings or
tied high, and given plenty of soft bedding : dogs are locked
ap. Cagny healed many fractures in dogs by merely lock-
ing, without bandage, in a very narrow cage. The bandage
may be removed from dogs after three or four weeks ; upon
horses it should remain six to twelve weeks.

Applicstion of bandajfCB tecently employed
which the patient may move about, and thus pi
atrophy aad general dec
mals. Callus fonnaiior
lower animak by the i
horse Ihe dose is one ot
the dog, one half to Iwi
may be employed when
fiiBt. second, or third phalanx.

Dan by means of
severe muscular
ngements, nre not applicable to the lower ani-
on the other hand, may be promoted in the
ternal adminislratioa nf phosphorus. In Ihe
•hundredth to five one-hundtedtbs grams ; in
milligrams. Neurectomy as a last resort
lameness reEiiains as a result of fractnre of Ihe

214 TREATMENT

Treatment of Compound Fractures. — Because of
the existence of an open wound, treatment is essentially dif-
ferent from that of a subcutaneous fracture. In contrast to
the pre-antiseptic times, with the introduction of aseptic and
antiseptic methods, and with the results of experience ob-
tained during the past ten years in the surgery of war
(v.Bergmann and others) the prognosis of compound
fractures, which were formerly treated almost exclusively by
amputation, has become far more favorable. In human sur-
gery, from a therapeutic standpoint, one distinguishes four
varieties of compound fracture :

1. When there exists only atrivial, fresh
perforation of the skin by a pointed fragment
of bone (penetrating fracture) a so-called asep-
tic, plastcr-of-Paris occlusive bandage is
applied. Aseptic occlusion is produced as follows : careful dis-
infection of the skin, reduction of the perforating fragments of
the fractured bone, application of an evenly applied aseptic
bandage over the fractured area, the whole is then enveloped
in a plaster bandage which remains in position until healing is
complete.

2. Plaster-of- Paris bandages cannot be applied in the
following cases : recent compound fractures with
extensive injury to the skin or soft parts,
especially with splintering, or fractures
which produce an open joint. Such fractures are
treated as follows : carefully disinfect according to the rules of
antisepsis ; remove all lacerated tissue, blood clots, bone-
splinters, and foreign bodies, very sharp fragments may
be removed with the forceps ; ligate bleeding vessels ; enlarge
the skin-wounds until the broken ends are freely visible ;
carefully irrigate the cavity of the wound,
provide drainage, and insert a tampon of iodo-
form gauze; in certain cases the skin may be partially
sutured, an aseptic bandage is then applied,
this is changed according to the demands
of each case. A plaster bandage should be
applied only after complete healing of the

PRACTUBBS 215

wound. A plaster bandage with a window is applicable
only to small injuries; through the window in the cast the
wound is treated with aseptic bandages.

3, Old — more than one or two days — suppu-
rating, complicated fractures, especially those in
which there exists an ichorous wound secretion, gangrenous
decomposition of the tissues, as well as septic phlegmon in the
vicinity of the fracture, must be treated with energetic disin-
fection. When necessary open incisions may be made,
they are best treated with permanent antiseptic ir-
rigation.

4. With extensive crushing and brui sin g of the
entire fractured area, as well as with imminent septic general
infection from an extensive, suppurating and ichorous frac-
tured wound, when local treatment cannot be employed be-
cause of danger to the life of the patient, amputation of the
entire limb remains as a last resort. In general, amputation
is indicated in both the above named conditions. In veteri-
nary practice its use is restricted to dogs.

fixation of the fragments with ivory nails or by means of
bone-sutures, employed largely in human surgery, are also
applicable to small animals, as well as to fractures of the
inferior maxilla in the horse.

pROPKVtAXis OF BoNH Fracti'res, — lu horses, prevcnlion of

problem. Fractures of the vertebral column, femur, ot pelvis may
occDt. While the pathogenesis of these individual I'raclutes 19 treated
in text-books of special surgery, the following remarks concerning thetr
preveution find place here :

I. Fractures o( tbe vertebrae occur most often while cast-
iogold horses and thaioushbreds. In old horses the causes ate due to a
senile atrophy of the t>oue, a rarefying ostitis, or an anchylosis of tbe
vertebral joints. While palliative methods are not applicable, one
ahould observe the following principles: when possible, operate
old horses standing; (tooth operations), cast Ibe animal
only when absolutely necessary. In tboroughb red animals
casting for castration, especially, affords an opportunity for the existence
of spontaneous fractures as a result of excessive contraction of the longla-
eimuB dorsj and ileo psoas, thereby producing excessive flexion of the
■ Tettebral column. Prophylaxis consists in a previous weakening

2l6 INFLAMMATION OF BONE

of the animal: light diet, exhaustion by high-tieing and over-
exercise, administration of laxatives (arecalin, eserine) , subcutaneous
injections of morphine, clysters of chloral hydrate (75-150
grams); further, the application of a dorsal girth previous
to casting, with the greatest possible extension o f the neck and
head while in the recumbent position ; in prevention of lateral
movements by the application of a crupper and fixation of the head,
in the application of a twitch or the use of chloroform.

2. Fracture of the femur is favored by struggling in the
hopples, firm fixation of the upper limb in an abdominal girth, as well
as permitting the limb to pass too far forward. Struggling against
fetlock straps is prevented by a twitch on the limb. When tieing the hind
limb it should be excessively flexed (Danish method), or allowed
a certain amount of mobility (Berlin method). Care should
be taken that the foot is never carried forward and
outward over the elbow -joint. Further, one applies a nasal
twitch, or chloroforms nervous horses.

3. Pelvic fractures are caused by throwing on hard ground.
They are easily prevented by providing a thick layer of straw.

From a forensic standpoint the facts mentioned are of gn^at im-
portance. If an operator is able to maintain that previous to casting and
during the operation, the above named prophylactic methods were ac-
curately and thoroughly carried out, that he employed suitable casting-
apparatus, and gave accurate instruction to the attendants, he is in no way
responsible if fractures do occur. Such fractures occur re-
gardless of the most careful prophylaxis, and without
any fault or responsibility on the part of the operator.
My experience has demonstrated that special precautions by means of
a girth along the back, Bernadot and Butel's apparatus
do not always prevent fracture of the vertebra;. I must, therefore,
contrary to the statements of others, coincide with M o 1 1 e r '9
opinion that casting horses is always associated with
a certain amount of danger.

II. INFLAMMATION OF BONK, PERIOSTITIS, OSTITIS,

OSTEOMYELITIS.

Classification. — Inflammation of bones, as well as in-
flammation of other organs, may be classified from various
standpoints. The following forms are differentiated : accord-
ing to the course, acute and chronic ; according to the
cause, traumatic, spontaneous, hematogenous,

PERIOSTITIS

217

and specific (tubercular, actinomy colic, bolryomy colic,
pyemic, glandular), primary and secondary (symp-
tomatic, metastatic) ; bacterial (septic), and non-bac-
ter i al (aseptic) ; finally, according to the character of the
iDflainniatory product — suppu r at i ve , oss if yin g ,
fibrous, granular, and necrotic infiammalioti of
the bone. From a standpoint of practical surgery thty are
classified from an anatorao-physiological standpoint with refer-
ence to inflammation of the periosteum, genuine bone-sub-
stance, and bone-marrow. While in man, hematogenous infec-
tion and inflammation of the bone-marrow is by far the
important form of inflammation of the bone, in veterinary
science this is not true. In animals, inflammation
of the periosteum holds the most important
position. This is especially true of horses where the
periosteum, as an external covering of the bone, is exposed to
many traumatic insults.

In text-books of veterinary surgery osseous inflammations
are arranged as follows in the order of their importance :

I. Inflammation of the periosteum (peri-
ostitis).

a. Inflammation of the bone-
(ostitis).

3. Inflammation of the bone-marroi
{osteomyelitis).

I. INFLAMMATION OF THE PERIOSTEUM, PERIOSTITIS.

Forms. — According to the causes, course, and inflamma-
tory products, and above all, with reference to the treatment.
the following forms of periostitis are recognized :

a) Acute non-suppurative periostitis, which
is also termed aseptic, traumatic inflammation of
bone. It is not due to the action of bacteria, but to mere
traumatic irritants (contusions, pressure, blows) acting subcu-
taneously. An acute, aseptic periostitis develops, for example,
as the" immediate result of a subcutaneous bone- fracture. The
ordinary causes in horses are kicks, blows, treads on the

2l8 PERIOSTITIS

coronet, pressure on the interdental space, and collisions ; the
inflammation, therefore, is usually circumscribed. As the
periosteum is a membrane having a very rich nerve-supply,
recent cases of inflammation are characterized by extreme
pain on palpation, lameness, a circumscribed semi-soft
swelling, and heat. Treatment consists in the appli-
cation of moist warmth, Priessnitz bandages, massage,
application of camphor, iodoform, and iodine ointment or
grey mercurial ointment. Ordinarily the acute form passes
into the following form ; into a chronic ossifying periostitis.

b) Chronic ossifying periostitis develops from
the preceding. It is located in the deeper layer of the perios-
teum, through the ossifying activity of this layer the inflam-
matory product is transformed to bone. Callus formation in
simple bone fracture is a typical example of ossifying perios-
titis (see page 206). In the same way there develop from
the circumscribed, acute, non-suppurative periostitis, chronic
inflammatory new formations of bone which are termed
osseous proliferations or exostoses (osteophytes,
hyperostoses, supraossa). In the horse this is the most im-
portant form of inflammation of the bone, and one of the tnost
frequent of bone diseases. It is especially frequent on the
inner surface of the metacarpus, in the region
of the coronary -joint (ringbone, pseudo-ringbone;
the exostoses correspond to the attachments of capsular and
lateral ligaments), in the region of the tarsal -joint
(spavin, lateral exostoses), as well as on the inferior
maxilla (pressure on the interdental space; pressure
from the manger on the inferior margin). In all
these cases the exostoses are due to chronic, frequent-
ly-repeated, traumatic irritation of the periosteum, as in
ringbone caused by a continual unilateral strain on the
ligaments due to an abnormal position of the hoof. The fre-
quent occurrence of exostoses on the inner surface of the met-
acarpus is partially referable to a unilateral strain on the
periosteum between the metacarpus and splint bone. Of 784
exostoses, not less than 651 (83 per cent) were on the inner
surface C374 left, 277 right ; Preussische Militar-Veterinar-

PERIOSTITIS 219

Berichte 1886 lo 1895). According to Zschoklce seventy-
five per cent of all adult horses suffer from exostoses on the
metacarpus, ninety-three per cent are located on the inner
surface. In a similar manner Zschokke found that sixty
per cent of all adiill horses are affected with exostoses at the
fetlock (pseudo-ringbone). One also finds exostoses on the
humerus in chronic bursitis intertubercularis, in the alveoli
of the teeth in chronic alveolar p e r iost i t i s (adhe-
sion between the teeth and the alveolar wall, difficult tooth-
extraction), as well as on many bones in the form of so-called
multiple, symmetrical exostoses and hyper-
ostoses. A multiple exostosis formation in dogs has been
described by K i 1 1 ; many of the bones, especially the inferior
maxilla, the radius, and the bones of the lower limbs presented
bony exostoses which clearly corresponded to muscular attach-
ments. He considered it a multiple hyperplasia of the bones
of myopathic origin, caused by muscular strain, and apparently
influenced by a pathogenic predisposition. Occasionally exos-
tosis formation leads to anchylosis — that is. osseous
adhesion between two joints (spavin, ringbone, vertebral col-
umn), as well as to synostosis (bony adhesions between
the metacarpus and splint bones). Treatment of ossifying
periostitis consists in the application of blisters, firing, perios-
teotomy, and neurotomy. Many exostoses gradually
diminish in size, occasionally they completely
disappear.

c) Acute suppurative periostitis is usually due
to an external injury (bone-wound, compound fracture)
whereby pus-forming bacteria gain entrance to the periosteum.
The cause of the infection rarely gains entrance through the
blood-stream (metastatic), or extends from a suppurative
inflammation of the bone-marrow ; in the latter case there exists
a so-called subperiosteal abscess. Treatment
consists in incision and antiseptic irrigation.

d) Chronic suppurative periostitis develops from
the preceding. It often leads lo osteomyelitis, necrosis of the
bone, and fistula formation. It is most frequently observed as
a sequela of a complicated fracture (fistula of the rib. pelvic

fistula, sternal fistula), as a result of pressure on the inter-
dental space, as well as in alveolar periostitis (tooth -fistula.
empyema of the superior maxillary sinus) . Treatment is
operative (incision, curettage, trepanation, looth-ejttraction).

The chrouic fibrous perioBtitis is a chronic inflammation of
the external, connective-tissue layer of the bone, which, in contrast to
the deeper layer of the periosteuui, contains no osteoblasts. It leads to
the formauon of so-called periosteal callosities with a subse-
cjuent atrophy of the bone. It occurs in the hocse on the liridge of the
nose as a result of pressure from the nose-band, it also results from
pressure on the interdental space.

INFLAMMATION OF THE BONH-SDBSTANCE, OSTITIS,

Forms. — Inflammation of the tela ossea occurs in the
marrow tissue and iu the vessels of the Haversian canals, as
well as in the bone -substance lying directly over these areas ;
it may also occur in the marrow spaces of the spongy bone.
The ostitis is usually chronic and is due, either to external
irritants, especially pressure and contusion (spavin, articular
ringbone), as well as compound fractures ; or to specific
inflammatory irritants (actinomycosis, glanders). It may also
result from extension of inflammation from the periosteum or
bone-marrow ; it is seldom of hematogenous origin. The
following forms are recognized :

a) Rarefying ostitis, that is. an inflammation of the
bone characterized by atrophy of the bone- substance (oste-
oporosis) with the formation of hollow spaces (lacunse).
The atrophy of the bone is the result of a lacunar boue-
resorption. The initial stages of spavin and ringbone are
typical examples of rarefying ostitis in the horse, it is due to
severe, contiuued contusion of the bones of the tarsal-joint,
and the bones of the first and second phalanges as a result of
overexertion of the horse. Rarefying ostitis has been recently
demonstrated as a cause of idiopathic fractures of the first
phalanx, second phalanx, and other bones (fragilitas ossium)
of the horse (ostitis of fatigue). Actinomycosis of the interior
maxilla in cattle presents a combinationof rarefying ostitis and
ossifying periostitis, The transformation from a provisional to a

OSTEOMYELITIS

deGnittve callus in fractures is characterized by a rarefying
ostitis. Deraarking inflarnniatiou of the bone in sequestration
is a similar process. Finally, many consider osteomalacia a
chronic rarefying ostitis with a consecutive decalcification oi
the bone.

b) Condensing ostitis is a process directly opposite
to the preceding. Instead of atrophy it leads to new forma-
tions, induration, and thickening of bone (osteoschlerosis,
schlerotic ostitis, eburnation). It is observed as
a form of cicatrization at the termination of callus formation,
in the latter stages of spavin, in the vicinity of bone-fistulee
and bone- sequesters (inferior maxilla), as well as after the
administration of small amounts of phosphorus.

c) Granular or fungoid ostitis is characteristic
of tuberculosis of the bones. It is of a hemato-
genous origin and in combinaliou with a granular osteomye-
litis leads to the formation of tuberculous granulation-tissue
and lo a suppurative liquefaction of the bone (caries). For
details concerning tuberculosis of the bones see page 171.
Many forms of arthritis and glanders of the bone lead
to similar processes. Zschokke has observed a case of
glandular ostitis of the sternum with chronic fistula formation
and perforation of the sternum (pleurilis).

Deforming ORtitis is a chronic inJlamiiiBtioa of the bone. In men
the following iKines arc most often diseased : long bones, the
cranium, the vertebr.t. and the [>clvi9. The disease may be painful or
painleiis, it leads to hypertrophy, softening, and bending of the bones.
Spavin in the horse may be termed a deforming ostitis.

INFLAMM.\TION OF THE BONE-MARROW. OSTEOMYELITIS.

Forms. — One recognizes, as in periostitis, au ossifying
and a suppurative osteomyeUlis. The first occurs
during the process of callus formation in simple fractures ; the
second in healing of compound fractures. In addition to
these, suppurative iuflammation of the bone marrow may have
hematogenous origin through the entrance of pus-bacteria
from the blood (pyemia, foal-lameness, chronic swine-er^'sipe-
las, leukemia, intravenous injections of streptococci, cocci of

222 OSTEOMYELITIS

contagious pleuropneumonia, bacteria of chicken-cholera, etc.,
in scrum horses) . Granularosteomj'elitisin tubercu-
losis of the bones is an example of this form. One further distin-
guishes a non-suppurative inflammation of the bone-
marrow (serosa, album enosa, or mucinoid
non-purulent osteomyelitis) with a non-suppu-
tive but sanguino-serous, muco-viscid, synovial-like exudate,
which may be due to various causes. In animals one most
frequently observes a suppurative inflammation of
the bone-marrow after compound fractures
of the long bones, as well as in connection with sup-
purative alveolar periostitis , it leads to the formation of
bone fistulae, bone-abscesses, and necrosis
of the bone.

Primary Osteomyelitis in Man. — In men. acute
primary infectious osteomyelitis is the most
important form of inflammation of bone. This is also termed
a spontaneous diffuse osteomyelitis or bone typhus. It is
found especially in young individuals and has been recently
considered a pyemic osseous affection of developing
bones, or as a phlegmon of the bone-marrow.
Bacteriological investigations have demonstrated that it is due
to no specific infectious disease, but that it may be caused by
any pus- forming organism, it may be caused, therefore, by
many bacteria, especially in the form of mixed infection. The
infectious irritant is most often found to be the staphylo-
coccus pyogenes aureus (staphylomycosis of the
bone-marrow). In other cases one of the following has been
demonstrated as the exciting cause : staphylococcus pyogenes
albus and citreus, streptococcus pyogenes, micrococci, colon -
bacterium, pneumococci, and even the typhus-bacilli. The

infectious material named has various paths of entrance to the
blood (intestines, tonsils, lungs, skin) and develops a

hematogenous osteomyelitis. This is usually primary,

that is, it runs an independent course ; it may, however, occur

as a secondary affection in connection with other infectious

diseases. Frequently only one bone, the femur, is affected ;

^t other times several bones may be involved. On post mortem

YHLITIS

223

■examination the following changes are found: multiple,
confluent pus-foci in the bone marrow, and
even total suppuration and ichorous ulceration
of this tissue; there also occurs a suppurative periostitis,
necrosis of the bones, bending and curvature of the bones, as
well as pyemia and septicemia. Severe types of the disease
present the following clinical symptoms; very high
fever, pronounced local swelling and pain,
■as well as severe general disease which occasionally
leads to death in a few days (type of typhus). In
other cases the disease presents the symptoms of an acute
articular rheumatism. One also observes a chronic course ;
it often occurs that healing results from early operative treat-
ment (removal with a chisel, curettage, resection, amputation).

Primary Osteomyelitis in Animals. ^Are domes-
tic animals also affected with an acute infec-
tious osteomyelitis? Asa result of experience with
pyemia, foal -lameness, swineerj'sipelas, and serum-inocula-
tions, its occurrence cannot be disputed. Osteomyelitis has
been experimentally produced in growing rabbits by intraven-
ous injections of staphylococcus pyogenes aureus (Lexer,
Rodet). Spontaneous cases, however, with the excep-
tion of two in the horse described by myself and Kiirnbach
(Monatshefte fiir praktische Tierheilkunde, 1903), have not
been recorded from reliable sources lu veterinary literature.
In both these cases staph ylococci were demonstrated as
the cause ; the paths of entrance are through injuries in the
skin, especially those resulting from gangrenous dermatitis
(grease). At the same time a contusion occurred as a
predisposing cause of the disease. In both horses only short.
spongy bones were affected, especially the first and third
phalanges.

The clinical appearance of osteomyelitis consistE
of the following symptoms, which are very important from a
diagnostic standpoint : the first symptom of osteo-
myelitis in horses consists of a suddenly
developing lameness in the diseased foot.
From the very first this may be bo pronounced that the animal

OSTEOMYELITIS

will be unable to bear weight on the limb ; the degree of
lameness may be very slight at first so that recovery is appar-
ent, this being followed in a few days by a sudden and pro-
nounced reappearance of the symptoms. If the seal of the
disease is in the phalanges the animal holds the limb in an
attitude of pronounced flexion. Every attempt to extend
the toe results in severe pain. Pronounced swelling
of the involved extremity soon follows the high-grade lame-
ness. The swelling is relatively painless, and it
is further characterized by the fact that it is present only
in the vicinity of the diseased bones. After the
disease has existed for a long time thickening of the
bone can be easily recognized. In osteomyelitis, especially,
the disease process soon involves the periosteum. The peri-
osteal osseous new-formation is either confined to
the affected area, or ex lends over the entire length of the bones.
This thickening, which is characterized by its hard con-
sistence, may be recognized by careful palpation combined
with pressure. Finally, after more or less time, pronounced
fluctuation with abscess and fistula forma-
tion appears on the surface of the swelling. Under certain
circumstances incision of the abscesses, as in man, leads to a
confirmation of the diagnosis, when the discharged pus con-
tains free drops of fat. when a probe comes in contact with
rough bone, or when a canal passes into the bone. The
diagnosis in the incipient stages of the disease
offers the greatest diEBculilies if no characteristic indications
are present. In this case, the differential diagnosis
of several diseases comes into consideration, they are easily
confnsed, this is especially true of the following : inflamma-
tions of joints, periostites, fissures and fractures, phlegmons,
botryomycosis, etc.

The prognosis of osteomyelitis in the horse is as
unfavorable as in man. If the osteomyelitis, itself, ter-
minates, the termination of the affection is relatively favorable
through encapsulation of the focus of disease. Such an
abscess of the bone, however, ai experience has taught in
man, may be a constant source of further pain and lameness.

OSTHOMYHLITIS 2 2^

As a result of concussions the process may become acute and
again assume the form of ostenniyelitis. Outward pene-
tration of the pus is another tertui nation. It first forms
a subperiosteal phlegmon, after the periosteum has
been broken down by the pus there is formed a phlegmon
of the subcutem aud muscles that surround the bone,
this eventually results in the forniaiion of multiple fistulie.
When the abscess is situated in the vicinity of articular surfaces
(as occurred in the horses described), which is the rule in man
(embolic iularcts of the epiphyseal vessels of the articular ends
according to Lexer), the contents may break into the joint-
cavity and lead to suppurative inflammation of
the joint. The prognosis of such a secondary suppurative
arthritis is always bad in horses. Finally, pressure laminitis
may occur in the normal foot, general pyemia may also develop.
With reference to the treatment of osteomyelitis it should
be remarked that from an economic standpoint the animal
should be slaughtered as soon as the diagnosis is confirmed.
Operative opening of the diseased bone with the hammer and
chisel followed by curettage of the pus-foci should be experi-
raentaliy employed only in very valuable horses.

One oise described by Haas as"tiifectious Osteomyelitisin Cattle''
may possibly have been a genuine case of primary infectious osteotnye-
lilis as recogDiied in honian surgery. A Swiss cow, (rom a line milk-
type, which had not been sick for the past three years suddenly became
ill, preaentitig the following ey mptoma : rise of tempeiatnre (40. i C ) ; a
hot, painfal, hard swelling ou the right fore-arm beneath the elbow-
joint on which no tujury to the skin was visible. At tint the case was
diagnosed as phkgmon. After ten days of frdilless treatment, during
which the swelling gradually enlarged, the diagnosis of pble};inon was
discarded for that of periostitis. A few days later a softening was de-
tected in the depths of the swelling, this was incised and a small amount
of pus escaped through the opening ; a fistulous canal leading towards
the radius was discovered. Improvement was rapid for a time, when
the condition suddenly became worse, the temperature was high aud
the animal fell off rapidly in condition. There occurred burrowing of
pus, thickening of the periosteum, the surface of the bone became
rough, and small sloughed pieces of bone were found in the pus, A
few days later there appeared a fluctuating swelling as broad as two
hands at the left hip-joiut, this was soon followed by a second (pyemic
As healing was now impossible the cow was killed. On

226 NECROSIS OF BONE

post mortem the following changes were noted : the bone-marrow
was very red and contained suppurative foci as large
as the head of a pin. The tela ossea, also, was affected with
suppuration and necrosis, the periosteum was swollen and loosened
as the result of a serous exudate, it could be easily raised. The pus
of the bone-marrow contained staphylococcus pyo-
genes aureus and albus.

l/ucet has described an acute, infectious osteoarthritis in young
geese ; staphylococcus pyogenes aureus was found in the pus. Suppu-
ration of bone was produced experimentally in animals by injecting
cultures of the coccus.

The cases described by Frank, Osterman,Jan8on, Schick,
and others under this heading remain open to question. A classification
of the pathological changes in the bone-marrow in different diseases of
the horse has been arranged by Sticker.

III. NECROSIS, ATROPHY, AND HYPERTROPHY OF BONKS.

I. NECROSIS OF BONES.

Causes. — Necrosis, that is, gangrenous death of par-
ticles of bone or entire bone, is usually the result of disturbed
circulation in the bones (anemic necrosis). Necrosis
may be due to traumatic influences, in which circum-
scribed portions of the bone are splintered by wounds or com-
plicated fractures and thus cut off from nourishment ;
if wound infection occurs at the same time the splinters become
necrotic, while small aseptic pieces of bone are resorbed. One
frequently observes this form of bone necrosis in horses on the
inferior and superior maxilla* (bone fistula), sternum (sternal
fistula), on the ribs (costal fistula), and on the pelvis (pelvic fis-
tula). In other cases the necrosis is of inflammatory
origin: especially as a result of suppurative perios-
titis and osteomyelitis, or it may develop in the
vicinity of strangles abscesses, as well as by exten-
sion of a neighboring inflammation to the bone-marrow (pus-
bacteria, necrosis bacillus). In this manner
necrosis of the turbinated and ethmoid bones may result from
chronic inflammation of the nasal mucous membranes ; necrotic
pododermatitis may lead to necrosis of the os pedis ; necrosis

NBCKOSIS OF BONK

of the tendon, to necrosis of the navicular bone ; phlegmon of
the neck, withers, or tail, to necrosis of the cervical vertebrae,
the dorsal spines, or the coccygeal vertebrse. Necrosis of the
cartilage occurs in a similar manner (fistula of the lateral car-
tilage. ) Bone-caries is a special form of necrosis of the
bones. It is usually the result of a granular, tubercular ostitis
and osteomyelitis, which leads to the death of portions of the
bone, and to lacunar liquefaction and progressive softening,
with partial resorption of the necrotic portions (Cf : Tubercu-
losis of the Bones, page 171). When pieces of bone are
sloughed off during the course of caries it is termed necrotic
caries. A similar form of caries affects the teeth, especially
the molar teeth of horses, so-called tooth-caries. This
consists in a progressive degeneration of the cement and the
dentine-substance caused by the decomposition bf masses of
food, and the entrance of bacteria through spaces in the enamel
(rasping!) into the substance of the tooth. Embolic
ery rare in the domestic animals (primary embolic
is of the first and third phalanges, see page 223 ; embolic
s of the sphenoid bone in contagious pleuro- pneumonia).
Phosphorus necrosis of the maxillary bones as
seen in man, has been observed only in experimental ani-
mals (rabbits) after the inhalation of fumes from phosphorus.

Forms. ^One recognizes a partial (circumscribed)
and total (diffuse), a simple and multiple, as well
as a superficial and deep necrosis.

The latter classification is of special practical importance.

a) Deep necrosis is usually circumscribed. The
necrosed piece of bone is termed a sequester, the pro-
cess of sloughing is termed sequestration. The
sequester is separated from the sound bone byademarking
ostitis, its surface becomes corroded and liquefied as a
result of lacunar bone resorption (osteoporosis, ero-
sion) at the same time there develops a wall of newly-
formed osseous tissue around the line of demarcation in the
form of a bone-capsule (bony case, dead covering). From
the bony covering a canal frequently leads to the surface
( bone- fistula), the sequester frequently passes through

228 ATROPHY OF BONE

the canal and is cast off. Occasionally the entire bone is
thickened during the process of sequestration. Total necrosis
of a large bone is very rare — for example, the scapula of a
horse (necrosis formation extending from the periosteum).

b) Superficial bone-necrosis is frequently characterized
by exfoliation.

Treatment. — As in treatment of other organs, treatment
of bone-necrosis is purely operative. It consists in removal of
the necrotic portion — the bone-sequester, which sustains the
bone fistula, by means of curettage, the bone-chisel, and
trephine, and the removal of the sequester with bone-forceps
(sequestrotomy, necrotomy). The injection of
caustics, as well as cauterization of the fistulous tract, seldom
results in healing.

2. ATROPHY OF BONE.

Forms. — One recognizes a concentric atrophy, that
is, one extending from without inwards, which is also termed
erosion atrophy of the bone; and an excentric. one which
proceeds from within outwards (osteoporosis). A classi-
fication according to causes is more important. According to
the latter classification the following forms are recognized :

a) Inflammatory atrophy or osteoporosis
occurs during the course of a rarefying ostitis (initial stages of
spavin, actinomycosis, osteomalacia, leukemia).

b) Pressure atrophy or erosion occurs on the os
pedis through pressure from the horny sole ; on the navicular
bone during podotrochlitis ; on the vertebral column as the
result of an aortal aneurysm ; on the nasal bones through
tumors within or external to the nasal cavities ; on the maxil-
lary and frontal bones through new-formations in the maxil-
lary and frontal sinuses ; coenurus cerebralis may cause atrophy
of the bones of the skull.

c) Atrophy of inactivity occurs with muscular
atrophy in chronic forms of lameness (spavin, ringbone),
especially on the tarsus, metatarsus, and metacarpus.

RACHITIS AND OSTEOMALACIA

229

d ) Senile atrophy may lead to fracture of the vertebrae
during the act of casting old animals.

e) Neurutic atrophy during the course of diseases of
the nerves (neuroparalysis), and subsequent to incisions ot
the nerves.

3. HYPERTROPHY OP BONE.

Forms. — One recognizes a circumscribed (exosto-
ses, osteophytes), and a diffuse hypertrophy of the bones
(hyperostosis). There is also a form of hypertrophy that
occurs within the bone itself, this is termed osteoschlero-
sis or eburnation. All these three forms are of inflam-
matory origin. In contrast to these there has been obBer\ed a
congenital hypertrophy of bone, which is especially seen
in horses and dogs on the bones of the skull and face (1 eon -
tiasis ossea, big-head). Congenital hypertrophy of
different extremities, the toes for example, is termed mac-
rodactylia: congenital hypertrophy of bone, with a simul-
taneous hypertrophy of the soft parts, is termed acromega-
lia; acromicria is an opposite condition.

APPENDAGE. RACHITIS AND OSTEOMALACIA.

Definition. — The nature of rachitie and osteomalacia aa well aa
the retatiou of both to each other has not yet been dclenuincd iti a
msiiner entirely tatilFactory and consistent. Urdinarily ruchitis is de-
(ined as a bone-dlaease which affects j« u n g , still developing
bones; as a result of the disease they do nol ossify, but eontinne in a
form of cartilaginous development. In contrast to this, oaleomalacia
OT bone-fragility, 19 a disease of old, developed bones which is
characterised by the loss of bone salts (halistercBis). The following
Bie classified among the causes of Ijotb diseases: specific infectious
inflammations of bone (epi^iootic development, infiammation
of bone similar I0 that caused by phosphorus poisoninfi;) ; deficiency
of lime in the food (experimental development of rachitis iu young
animals as a result of living on food deficient in lime salts, rachitiB in
pigB and do^s kept on an exclusive diet of potatoes and bread, osteoma-
lacia in anemic milch cows whose diet ia poorin lime). For furtlier
iaforniBtioo see Ffiedberger andFrohner: "Special Pathology
and Therapeutics." 1904, Sixth Ed. Vol. I.

230

RACHITIS

Rachitis, — Rachitis {softening of the bone] most frequently occi
■n young pigs and poppies, as well as in birds. It is seldom seen in
foals and calves. According to Kassowiti rachitis is characterized
anBtomically by a pathological v a sc u 1 d ri z b ti o n of the
ho ne- form i ng tissue in the form of a chronic hyperemia Bnd
inflammation at the seat of appoEitioll | epiphyses, periosteum, anil
bone marrow i. Thia results in the following changes:

1. Proliferation of the cartilage at the epiphyseo.

2. Lacunar li<[uefact ion (halisteresis) of the formed bone,

3. Irregular deposits of lime in the dcTclopitig

In general the anatomical changes in the bone are as follows ; lite-
periosteum is hypcrcmic and presents, on the inner side, a pro-
nounced proliferation and thickening of the bout-forming layerst
whereby the newly developed tissue is not ossified, but. for the
most part, remains soft. Ossification of this tissue occurs later, Ihia
gives the bone a thick, plump appearance, a circumscribed eulargemeiit
is recognijed. The periosteal proliferations are most often seen at the
mnscnlar attachments ; in swine at the femoral attachment of the psoas
magnus and internal iliacus, very often at the tuberosity of the calcsn-'
eum ; in certain cases the thickened periosteum may be toni away from
bones by muscular contraction, ici swine from the scapula. The principal
changes in rachitic bones occur at the boundaries of the epiphytes and
consist in an abnormal proliferation of the epiphyeeal
cartilage without suflicient calcification. Normally the cartilage
between the epiphyses and diaphyses is composed of two, thin, paral-
lel layers ; the proliferating and the ossifying layer. lu rachitic bone»
the proliferating layer is overdeveloped, while the ossifying layer U
abnormally small ; instead of being parallel they are now irregular.
This abnormal proliferation of the epiphyseal cartilage leads to a thick-
ening and swelling of the epiphysis which ossifies only
when the disease has run a long course; it leads to a curving and
bending of the long bones, and finally to a dislocation of the
epiphyses whereby the attachment between the epiphyses and
diapyses becomes loosened.

The most important symptotns of rachitis consist in a swelling
and enlargement of the epiphyses of the bones in the vicinity of the
joints (double-jointed); in a bending and curvature of the bones,
of the extremities (shaped like the limbs of a badger
hound, or like a sa bre ); the vertebral column is curred down-
wards (lordosis), upwards ( ky phosis). or laterally (scoliosisl.
Swcllinga occur at the articulations of the ribs and costal cartilages
(rachitic beads); the pelvis becomes deformed (rachitic
pelvis ) : the coronary joint presents exostosis formation ( rachitic
ringbone); asymmetry occurs in the formation of the skull ; forma-
tion of a so-called chick en- breast, etc.

OSTHOMALACIA

cause I cbsnge ol
the borae, one I
They should rcc

OSTKOMALAl

of rachitis

iF food), in the admini

n additi

of 1

a the removal of the
hoEpborus ; for

> two milligra

ifcho
infia

ntigratns ; dog, oi
:adietof bone-meal.

— Oaterjmalacia. or lione-frngility, is most often
a, especiHlly during the period of lactation or preg-
ionally seen in horses I bran-disease, osteoporosis),
rnint; the nature of the di»ease are extremely variable.
and others consider it a chronic, parencby-

adults. A9 a resnlt of accelerated t:
on tlie one side, a new-formation of si
a lacunar resorption (haiisteresis).

■ular proliferKlio

haliate
the bones without i

eai»— that i
iflammatory

simple decalcificn
formation.

3. I'eptrone has defined bone-fragilfty as an infectious
disease due to a specific bacterium (nitrification).

The anatomical changes in the boQes, which are especially promi-
nent in those of the trunk and upper limbs, are as follows : in the early
stages of the disease and in light attacks, if one examines carefully,
an increased blood-supply is visible in the diseased bones.
There is a dilitalion of the vessels and the canals through which they
pass. .A section of the bone brings into sight small hemorrhagic points,
the marrow is infiltrated with many small e xtra vasal es, the bone tissue
in the vicinity of tile dilated Haversian canals presents slight changes.
In a more severe type the hyperemia is pronounced ; the external
surface of the matrix, as well as a cut surface of the bone, present .
highly colored points, the marrow is very hyperemlc and fillecl
with hemorrhagic areas. The marrow cavities are dilated.
In the diploe and on the inner surface of the matrix one finds many
small pieces of bone that have bei:ome loosened from the surrounding
tissue. The bones are easier to saw or cut. their tune is
not so clear. Microscopically the homogeneous structure of the bone
Bubstance is atrophied ; in certain areas it appears more transparent, the
bone- corpuscles arc enlarged and transparent, in fottn they become
oval, round, end even polyhedral, their processes disappear. The
bone-cells gradually undergo fatty degeneration.
The entire process is o tra n sf o r ma t i o n of certain areas
of the bone-BubBtance into osteoid, and finally into
narrow tissue. In the most severe types of osteomalacia
nd marrow is still more pronounced.

ofti

ubatai
r; the I

ngy .

fr:

ible

ind diploe become smaller and smaller ; the
a s e s. The matrix is displaced from within

232 DISEASES OF JOINTS

outwards, and is removed, even at the epiphyses; fractures of the
bone occur. When there exists a general derangement of the nutrition,
the marrow itself becomes softened, gelatinous, even watery, and pre-
sents a dirty-yellow color. The specificgravity of the bone
diminishes until more than half of the lime salts have disappeared ;
it contains, however, more water.

The symptoms of osteomalacia in cattle are as follows: severe
derangement of the nourishment, emaciation, weak digestion , symptoms
of opsomania, hardening of the skin, cachexia, lameness, b o n e -
fractures, infractions, and distorsions. Fractures of the
pelvis and ribs are especially frequent, they often result from the slight-
est provocation (rising, lying, twisting, parturition), and are often
multiple.

Treatment consists in a change of food (food containing lime) ,
administration of bone- meal or phosphates of lime, as well as, above all,
in the internal abministration of phosphorus (1-5 centigrams per
cow) in oil. Ovariotomy (castration) has been followed by good results
in man, it may be experimentally employed in cattle.

DISEASEvS OF JOINTvS.

Anatomicai, Const dkratioxs. — From a surgical standpoint the
synovial structures (joint- capsule, synovial membrane ) are the
most important anatomical portions of the joint. In comparison with the
capsular ligament, the other ligaments of the joint, especially the lateral
ligaments, anterior and posterior ligaments, etc., arc of secondary
importance from a surgical standpoint. By most authors the
synovial membrane is considered a serous structure
which has its analogue in the peritoneum and the pleura. Its inner
surface is covered with a simple endothelial layer which covers
the processes — the diverticuli and villi of the synovial membrane — but
does not coyer the cartilage, (^nly in the ftftus, as well as after a long
period of rest for the joint, does the synovial endothelium partially
cover the cartilage. The external layer of the synovial membrane,
which serves as its basis, is composed of a net-work of connective-
tissue and elastic fibers. ^Others consider the synovialis, not a serous,
but a fibrous membrane).

The villi of the joint form fine, hair-like proliferations
directed from the synovial membrane towards the cavity of the joint,
occasionally daughter- villi are present. According to their histological
characteristics they are classified as follows: mucous villi, fat-
villi, cartilaginous villi, and fibrous villi, between these
there frequently occur transitional forms. According to Tillmanns
the synovia is formed principally from the mucous and fat- villi,
partly through secretions, partly through a solution of their cellular

ARTHRITIS

233

«Ietiteiits. Schn f ide tn iih 1, on the other hand, supports Ihe ttlepry
that Till man us' classificatioii depends on a pathological condition, and
that the synovia is not formed by a coiilinual disintegration of the
endothelial cells, bnt, as in other serous cavities from an independent
secretion. The secretory activity forma, therefore, the
principal function of the endothelium of the joint.
The villi of the synovial membrtine and joint are extremely rich in
v*Ksels especially in 1; m p h - vesse Is , which apparently communi-
cate directly with the joint-cavity through open storaaia; thia«iplain»
the great resorptive ability of the joint-capsule. The hyaline
cartilage, which covers both ends of the bones, is only apparently
homogeneous, normally it is composed of small fibers, this explains the
fibrillation found in various pathological conditions I, Till manna).

OF JOINTS. ARTHRITIS OR SYNOVITIS.

Classification. — According to the causes, ana-
tomical characteristics, and course, inflatDtnatioti of the
joints (synovilis) may receive various classifications.

From an etiological standpoint, one distinguishes,
above all, a non-infectious (aseptic), and infec-
tious (septic) inflammation of the joint. Traumatic
arthritis is the most conmioB. that is, an arthritis due to
injury, it may he aseptic or septic. There is also recognized
a primary and secondary inflammation of joints. The primary
develops direct, at the seat of action of the inflammatory irri-
tant. The secondary develops through extension from a
neighboring inflammatory process ; for example, inflammation
of ihe joint extending from the bone, or hematogenous
through the medium of the blood. Hematogenous arthritis
has been termed symptomatic or metastatic. It
occurs during the coiir.se of infectious diseases (acute articular
rheumatism, pyemia, septicemia, contagious pleuropneumonia,
infectious abortion, foal-lameness, petechial fever, malignant
head-catarrh in cattle, strangles, swine- erysipelas, swine-
plague, dog-distemper, glanders, tuberculosis, intravenous
injections of streptococci, etc., and in serum horsea), it is
occasionally seen in cattle as the result of abortion, retention
of the fetal membraaes. and metritis (puerperal pyemia), as
well as in lameness in calves (polyarthritis ) ; in goats during

234 SEROUS ARTHRITIS

the course of an infectious agalactia ; finally, as the result of
certain constitutional diseases (gout). When several joints
are diseased at the same time it is termed polyarthritis
(rheumatic, septic, uric, pyemic), in contrast to traumatic
monarthritis. Symptomatic inflammations of the joints
include the specific forms of arthritis (tuberculosis, glan-
ders, actinomycosis). — In cattle, even certain physiological
forms of arthritis are observed, those occurring with change
of teeth and development of bone ''dentition arthritis" (?).
According to the course, arthritis is classified as acute and
chronic.

According to the anatomical character of the in-
flammation, one distinguishes an exudative and a dry
inflammation of the joint (arthritis sicca). According to the
character of the exudate and the product of the inflammation
one further distinguishes the following forms: serous, sero-
fibrinous, fibrinous, suppurative, hemorr-
hagic, ichorous, deforming, caseous, catarr-
hal, pannous, fungoid, granular, erosive,
and ulcerative arthritis.

In the domestic animals the following are the most im-
portant and most frequent forms of arthritis, because of their
practical importance they are fully described :

1. Serous arthritis.

2. Suppurative arthritis.

3. Deforming arthritis.

4. Tubercula r arthritis.

I. SEROUS INFLAMMATION OF JOINTS. ARTHRITIS SEROSA.

Causes. — S e r o u s arthritis is most frequently observed
in dogs and horses as a traumatic, aseptic inflamma-
tion resulting from contusions and distorsions. It may occur,
however, as a symptomatic arthritis, especially in acute
articular rheumatism (polyarthritis serosa), less frequently in
pleuropneumonia, as well as metastatically in cattle as a
result of retention of the afterbirth ; it may also occur during
the course of mastitis (hip-joint, knee-joint, tarsal -joint).

5BKOOS ARTHKITIS

235

Symptoms. — Serous inflammation of the joiiits occurs in
two forms : acute and chronic.

a) Acute, serous arthritis is usually a traumatic
inflammation of the tarsal-joint, fetlock -joint, knee-joint, car-
pal-joint, or hip-joint, without injury to the joint-capsule.
It develops suddenly and presents the following symptoms:
a circumscribed and fluctuating swelling,
intense pain, lameness, and increased tem-
perature of the involved joint, there is not usually a
general rise of temperature. High fever is present
only in symptomatic arthritis. Acute serous arthritis termi-
nates in resorption of the fluid exudate followed by healing,
or, if resorption fails, it passes into the chronic form. lu the
latter case the prognosis is unfavorable.

b) Chronic serous arthritis, also termed
chronic hydrops or joinl-gall, develops from the
acute form, or it may be progressively chronic in nature. Id
the latter case it is often supported by a hereditary predisposi-
tion in the form of an atony or slight vulnerability of the joint.
In contrast to acute arthritis, the swelling of a chronic hydrops
is painless and retains a normal temperature: inter-
ference wiib movement is absent or slight. Occasionally this
form is inlermictent in character.
horses and cattle in the fori
tarsal-, or knee-joints.

Treatment.-— Acute serous arthritis in the early stages
is treated as follows : rest, moist heal. Priesnilz com-
press, compression, plaster-of- Paris bandage, and massage ; in
the latter stages, with irritating applications (tincture of iodine,
cantharides-coUodion). The often incurable, chronic serous
arthritis may be treated with blisters and firing. The method
of treatment successfully employed in human surgery, where
the joint is punctured in an aseptic manner
and followed by antiseptic irrigation, is not indi-
cated in the treatment of the horse where a bandage can be
applied only with difficulty or not at all. In the treatment of
dogs this method may be experimentally employed. From a
prophylactic standpoint horses with joint-galls may be excluded
for breeding purposes.

It is especially common in
o-called galls or the fetlock-,

236 SUPPURATIVE ARTHRITIS

2. SUPPURATIVE INFLAMMATION OF JOINTS, ARTHRITIS

PURULENTA.

Causes. — Suppurative or pyo-ichorous arthritis is due to
the entrance of pus- forming bacteria into the joint.
As a rule they gain entrance through perforating joint-
wounds. In other cases a suppurative inflamma-
tion in the vicinity extends to the joint (subcoronary
phlegmon, suppurative podotrochlitis and pododermatitis,
phlegmon of the fatty frog to the pedal-joint). Pus-bacteria
may also gain entrance to the joint through a hematogenic
course ; this is the most often seen during the course of a
pyemic polyarthritis in foals and calves. In horses, the
severe, acute suppurative arthritis which usually terminates
in septicemia is most often caused by staphylococcus pyo-
genes aureus ; the subacute type, by streptococcus pyogenes
(Bo si). Staphylococcus pyogenes aureus (Sohnle) and
streptococcus pyogenes (O s t e r t a g) have also been found
in suppurative and sero- purulent polyarthritis of foal-lameness.
In polyarthritis of calves, on the other hand, the colon bacillus
seems to play the principal part (Zschokke).

Pathological Condition. — In a suppurative and ichor-
ous arthritis one finds greyish-yellow or light-yellow, cream-
like, and viscid contents in the joint (suppurative arthritis) ;
or an ichorous, discolored, brownish, chocolate-colored, grey-
ish-brown, or dirty-green fluid, which is fetid and filled with
bubbles of gas (ichorous arthritis). The synovial membrane
is swollen, highly reddened, markedly thickened (as much as
one-half centimeter), and similar to an abscess- wall ; the inner
surface is covered with villi form, soft, reddish- grey granula-
tions. The slightest changes appear to be in the articular
cartilage. Marked erosions and ulcerous defects
are usually absent ; occasionally the trartilage is somewhat
rough and cloudy (glistening is absent), in many places it is
more or less thinned and softened. Abnormal color is the
most pronounced characteristic (light- grey, greyish-blue,
greyish-green, bluish- white). In the ends of the bones.

SnPPl'RATlVE ARTHRITIS

when the process has existed for a lotig lime, one finds osteo-
myelitic processes, inflammmalory osteoporosis and necrosis.

The tl^nsf^' anatomical changes are usually of a
septicemic nature (inflammatory swelling of the liver,
spleen, pancreas, heart, gastric glands, edema of the lungs
and glottis, hemorrhagic laryngitis and pharyngitis). Pyemic
changes are less frequent ; this is also true of genuine metas-
tases, especially in the lungs in the form of a multiple,
focus-like gangrenous pneumonia fuecrosis
bacillus).

Symptoms. — Suppurative arthritis (empyema of the
joint), in contrast to serous inflammations of the joint, is char-
acterized by fever, symptoms of severe general
disturbance and severe lameness, as well as
a circumscribed, diffuse, circular, hot and
painful swelling of the joint (parasynovia! phlegmon
and suppuration), occasionally periarticular abscesses are pres-
ent. If this condition is accompanied by a penetrating joint-
wound a suppurative discbarge flows from the joint
into which one may pass a finger or probe. In the horse
the suppurative and pyo-ichorous forms of
arthrites of the large joints, seem, as a rule,
to run a rapidly fatal coarse as the result of
septicemia or septicopyemia, In suppurative
inflammation of the small joints, especially the hoof-joint, the
fatal termination is soniewiial delayed (one or two weeks).
Suppurative inflammation of the small joints in the horse is
occasioually followed by healing and anchylosis forma-
tion. This is especially true of the lower rows of the tarsal-
joints (intertarsal joints, tarsometatarsal joints) when the
point cautery has been used for the treatment of spavin, of
the lower rows of the carpal -joints, of the fetlock -joint, and the
pedal-joint. It is a peculiar fact that the ass and mule, in
comparison with the horse, are less severely affected with sup-
purative arthritis (Bosi) . One occasionally observes a
chronic form in cattle, this is especially true of the hip-joint.

Treatment. — The following forms are usually Incur-
able in the horse; purulent and pyo-ichorous arthritis of

238 DBFORMING ARTHRITIS

the hip-, knee-, tarsal-, shoulder-, elbow-, coronary-, and
pedal-joints. In* all these cases, therefore, from an economic
standpoint, it is usually best to advise early slaughter. Occa-
sionally they can be treated, as in human surgery, with
puncture and incision, an tisep t ic cle ansing,
drainage, and permanent irrigation of the sup-
purating joint. I have observed healing in the horse in four
cases of suppurative arthritis of the fetlock -joint, as well as in
many cases of suppurative arthritis of the pedal-joint (perfo-
rating nail punctures, resection of the perforans tendon).
L u t z has also described a case of healing. Treatment for
the dog, on the other hand, is more often indicated as bandag-
ing is more easily employed ; in certain cases, one may resort
to resection of the joint and amputation. In two
cases I have resected a suppurative maxillary-joint in the
horse with good results.

3. DEFORMING INLAMMATION OF JOINTS. ARTHRITIS

DEFORMANS.

Definition. — In human medicine '^deforming*'
inflammation of the joint indicates a chronic, aseptic,
senile arthritis (malum senile), which leads to per-
manent and severe changes in the entire
joint; it is not combined with suppuration. Its occurrence
may be spontaneous or traumatic ; it may be either mono- or
polyarticular ; its favorite seat is in the hip-, knee-,
shoulder-, and elbow- joints, and in the fingers and vertebral
column ; ordinarily it continues during life, is non-febrile, is
ushered in with stiffness, crepitation, and slight sensitiveness
in the involved joints ; finally, it leads to deformity of the
entire joint. Anatomically it is characterized by de-
generative as well as newly formed processes
in the ca rt i lage, bones, and joint-capsule.

a) In the articular cartilage one finds, on the
one side, changes which are typical of a chronic, ulcera-
tive, dry arthritis; namely, fibrillation of the super-
ficial layers, foci of disruption and softening in the deeper lay-

DBFORMING ARTHRITIS

2J9

trs, erosion and even complete atrophy of the cartilage with
tbe formation of smooth, polished surfaces ; on the other side,
there occur active proliferations of the cartilage in the form of
nodular swellings.

b) In the bones there exists a subchondral inflam-
matory osteoporosis with lacunar atrophy of the bone,
in addition to bony new-formations,

c) The joint-capsule shows proliferation,
thickening, and shriveling, one also occasionally
observes the formation of free joint-bodies.

These combined changes result in pronounced deformities
in the involved joints, whereby their mobility is either re-
stricted or entirely suspended, or it may result in an excessive
mobility of the joints (luxations, loose joints).

OccUHHKNCE IN ANIMALS. — The following diseases may
be classified under chronic deforming infiammation of the joint :
spavin and articular ringbone in the horse; certain
forms of gonitis that are characterized by severe swelling
of the joint ; omarthritis (inflammation of the shoulder-
joint); and coxitis (inflammation of the hip-joint) in dogs,
horses, and cattle. Chronic, deforming inflammatory pro-
cesses are also frequent in the pedal-joint (so-called ringbone
of the pedal-joint), and in the carpal-joint (so called spavin of
the carpus) of the horse. So-called chronic lameness
of the pedal-joint (bursitis podotrochlearis) and sesa-
moid lameness in the horse, show a certain analogy to
arthritis. One also observes deforming arthritic changes in
chronic articular rheum at is in. Sticker described
a case of polyarthritis deformans in the horse which showed
cauliflower- like, cartilaginous and osseous growths around the
margins of the joints, thickening and villous proliferations on
the synovial membrane, as well as an increase in the amount
of synovia.

The relation of spavin and ringbone, as well as
chronic gonitis and omarthritis in the horse, to de-
forming arthritis, is of special importance.

I , In the text-books on surgery spavin is usually defined
as a chronic deforming arthritis tarsi. In this

240 DEFORMING ARTHRITIS

form the term is not entirely correct. According to the excel-
lent investigations of Gotti, whose accuracy has been
proved by Bayer, Eberlein, and m y s e 1 f, spavin, in
many cases, is not a primary disease of the cartilage ; the
bone forms the primary seat of the disease. Spavin is
primarily an ostitis of the cuneiform magnum
and medium, as well as the metatarsus; de-
forming inflammation of the tarsal-joint is a
secondary disease which develops from the
ostitis. **Ost eoarthr i ti s chronica deformans",
therefore, is a more accurate term for spavin. According to
Gotti spavin is a slowly developing inflammatory process in
the bones, it is characterized by decalcification (inflamma-
tory osteoporosis, rarefying ostitis) whereby
numerous small or large spaces become visible in the bone ; in
these spaces one finds soft, reddish masses which resemble
granulation-tissue. This rarefying ostitis may be replaced by
a condensing ostitis (ost eoschle rosis). In
many cases, especially in the initial stages, these pathological
changes in the bone (rarefying and condensing ostitis) are
the only ones present in spavin, the cartilage and periosteum
are intact. Later in the course the ostitis may either extend
in a central direction towards the joint, involving the articu-
lar cartilage; or it may take a peripheral direction, that
is, extend to the periosteum (both processes frequently
occur at the same time). In the first case there exists a
secondary disease of the articular cartilage with degenera-
tion of the cartilage, active proliferation of the carti-
laginous cells, and the formation of an inner anchylosis.
If the inflammatory process extends from the bone- substance
to the periosteum it leads to an ossifying periostitis
with the formation of osteophytes and an ex-
ternal anchylosis. The bones of the tarsal-joint have
then become partly osteoporotic, partly schlerotic masses
of osseous tissue. It is very rare that the inflammation
extends to the bursa of the tibialis anticus (compare with
Eberlein, '^Der Spat der Pferde." Monatshefte fiir praktische
Tierheilkunde. 1 898) .

DEFORMING ARTHRITIS

241

2. Ringbone is a collective term for various chronic,
aseptic inflammatory processes at the coro u ary-j oint .
One must differentiate, above all, between articular and
periarticular ringbone. In periarticular ringbone the
joint itself is not involved, it consists of a periarthritis, that
is, a chronic ossifying periostitis at the attachments of the
lateral ligaments or the capsular ligament (lateral, bilateral,
circular ringbone). Articular ringbone, on the other
hand, similar to spavin, is an osteoarthritis chronica
deformans of the coronary-joint originating from
au inflammatory osteoporosis of tliC subchondral
bone of the first and second phalanges. There is an exten-
sion of the primary inflammatory process in the subchondral
portions of these bones, which leads to a secondary d e g e n -
eration of the articular cartilage, to an ero-
sion of the cartilage, and fiualty to the formation of an an-
chylosis. This process is accompanied by a regenerative
process in the bones (ostitis condensans). If the subchondral
osseous inflammation extends in a centrifugal direction — in the
direction of the periosteum — there further occurs an ossifying
periostitis with the formation of osteophytes in the vicinity of
the joint, that is, in addition to the articular, there is also a
periarticular ringbone. As a rule, old cases of ring-
bone are a complication of the articular with
the periarticular form. This also results in the de-
velopment of an external anchylosis. Microscopic-
ally the first changes in the diseased bone consist of a dilita-
tion of the Haversian canals, lacuuar formation, the formation
of red granulation-tissue, as well as atrophy of the bone-cells.
(Cf; Udriski, "Die Krongelcnkschale des Pferdes."
Monatshefte fiir Praktische Tierheilkunde. igoo).

The same changes are found in the fetlock-joint ( ring-
bone of the fe t loc k- j oin tj . and pedal-joint (ring-
bone of the pedal -j oint ) . (Cf: Karnbacb,
"Die Hufgeleukschale des Pferdes. " Monatshefte fiir prak-
tische Tierheilkunde. 1900).

3. Chronic gonitis of the horse, likewise, is usually an
osteoarthritis, seldom a pure arthritis chronica

242 DBPORMING ARTHRITIS

deformans. It usually attacks the medial portion of the
knee-joint, and in most cases has its origin in the bones
(tibia, femur) in the form of a primary rarefying ostitis.
The inflammatory osteoporosis then extends in a central direc-
tion to the articular cartilage (erosion of the cartilage),
in a horizontal direction to the periosteum of the bones
on the sides of the tibia and the femur (formation of
osteophytes), and finally to the joint-capsule (prolifer-
ation of thearticular villi, hydrarthrosis, free
joint-bodies). Chronic gonitis in the horse less frequently
begins in the form of a primary chondritis (proliferation of the
cartilage-cells, fibrillation and degeneration of the intercellular
matrix), involving the bone in the form of a secondary pro-
cess. (Cf: Zalewsky, ' 'Die Gonitis chronica deformans des
Pferdes." Monatschrift fiir praktische Tierheilkunde. 1901).

4. Chronic omarthritis in the horse is the most impor-
tant cause of so-called chronic shoulder lameness. Its seat of
origin is also usually found in the subchondral osseous tissue
(medial half of the joint, marginal portion of the scapula) in
the form of an inflammatory osteoporosis with a
subsequent osteoschlerosis. As a result of extension to
the articular cartilage there exists a chondritis with incur-
able cartilaginous erosion; nodular, warty, or crest-like
exostoses form at the margins of the joint, occasionally
these lead to a subsequent anchylosis formation;
inner anchylosis, similar to spavin and ringbone, does not
appear to occur. The joint-capsule is thickened, the
articular villi are enlarged ; occasionally it also leads to the
formation of free joint-bodies. (Cf: Karnbach, Die
Omarthritis chronica deformans des Pferdes. Monatshefte fiir
praktische Tierheilkunde. 1903).

The treatment of chronic deforming arthritis consists
in allowing the natural process of healing to run its course
(condensing ostitis), or in artificial adhesion (anchylosis) of
the joint by means of rest , firing, or blisters. Neu-
rotomy remains as a last resort.

TUBERCULAR ARTHRITIS 243

4. TUBERCULAR INFLAMMATION OF JOINTS. ARTHRITIS
GRANULOSA.

Occurrence. — In catllc, swine, an
in dogs, there occurs a tubercular
man, during the course of tuberculosis
anatomical characteristics it is termed g r
spongy, and caseous arthritis, or

birds, occasionally

arthritis, as in

According to the

nular. fungoid,

)f the joint ;

(tumor albus and fungus belong to older classifications).
cattle it is found in the knee-joints, hip-, elbow-, and carpal-
joints ; in swine in the carpus and tarsus ; in birds in the joints
of the feet and wings ; one case has also been observed in the
knee-joint of the dog (C a d i o t).

Anatomical Changes. — Tubercular arthritis is charac-
terized by a granular inflammation with tubercular prolif-
erations on the synovial membranes, cartilage, and bone ;
when continued for a long time there occurs a tubercular soft-
ening and liquefaction of the ends of the joints (caries), as
well as caseation: occasionally the changes are typical of
a deforming arthritis. Tubercle-bacilli are present in the
proliferations and in the pathological synovia.

According to Guillebeau two forms of tubercular
arthritis exist in cattle. Ordinarily the distended joint capsule
contains fibrin, the synovial papillae are enlarged, sometimes
to the size of a hazelnut or plum ; many times they are fiat.
several centimeters in length and breadth, and of the nature
of a pannous membrane. In the vicinity of the proliferations
the articular cartilage is destroyed (ulcer-like defects); the
articular epiphyseal ends of the bones are also eroded with the
tubercular grauulation tissue. Edema exists in the vicinity
of the joint. Caseated tubercular nodules are less frequently
observed in the synovial membranes and at the ends of the
bones. One occasionally observes processes of healing (de-
crease in the fibrinous exudate and the hyperplastic membrane,
formation of a cartilaginous cicatrix).

Symptoms. — According to Hess tubercular arthritis oc-
cars In cattle several weeks after parturition, as well as after
mn abortion. Its favorite seat is in the knee-joint (communi-

244

ARTICULAR KHEITUATI5H

catioD with the tendon- sheath of the iong extensor of the toe]^i

aticl in the elbow-joint. The disease frequently begins with a,
severe lameness and in most cases runs a chronic col
a rule it is i n cur a bl e and is associated with proDoum
muscular atrophy. The diagnosis can be confirmed b;
means of a tuberculin injection

ARTHRFTiii FjBRiNOSi. — ^Fibriiioua or croupous inflammation of the
joint ischarscterized by aserous exudate rich ill fibrin, for this reason
it is also tcnuEd a se ro-f ibriuo ub arthritis. Un palpation the
flbrin is tecogui^ed by a fine, crepitating wjuiid (arthritis crepi-
ta n !>i. By many, fibrinous inflammation of the joinl is termed catarr-
bal arthritis (increased desquamation of the mucous villi), and
sidered a mild type of suppurative arthritis i Vo Ik maun). It frequently
leads to anchylosis, occasionally to the formation oE joint-bodiea,
found in tubercular arthritis of cattle ( see above ).

Arthkitis Fan'nosa. — Panuous inflammation of the joisl
(arthritis chronica p roll fe ran s, or arthritis hype
plastics laevis) is a chronic arthritis characteriied by the presence
of newly formed vascular granulat
surfaces of Ihe arlicular cartilage. It is seen in chronic
hydrops, during the course of a chronic articular rheumatism, and in
tubercular arthritis of cattle (see above). Occasionally it leads to the
formation of free joint-bodies (corpora libera), as well as to • fibroua
anchylosis.

the joint jarthri tis
after a chronic lainene!
joint ; it is seen after a
a deforming erlhritis.

as the result of a

on of the articular c
e most frequently affected.
LAR Rheumatism.— This is a febrile.

I Sicc.^, — Dry or ulcerative inflammation of

ronica ulcerosa) is observed in the horse

1 long period of rest for the

ti, as well as in the early stages of

ized by fibr

rticular cartilage. Horaeaf
Bed dogs •■

■ ■ - sns dii-1

ease accompanied by a serous polyarthritis; it ocean' I
most frequently in cattle, less frequently in goats, swine, dogs, and '1
horses. Usually several joints are suddenly affected with a very paia-l
ful serous arthritis ; its favorite location is in the carpal-, tarsal-, a
knee-joints; it results in severe lameness. In cattle, especially, Tbenti^-J
atism of the joints is accompanied with inflammation of the lendoD- 1
sheaths. As in man, the development of endocarditis ^valvular diseoae) J
forms an important complication. Though usually beginning as on 1
acute or pcracute disease, it ordinarily rnns a chronic course. The J
anatomical changes in tihe joinits consist largely of a
or sero-fibrinous synovitis, as well as in iuflammalory degen- 4
erative arttcolai changes

PYEMIC AND SEPTIC ARTHRITIS i.|;^

nosa and deformans^; a suppurative nynovitinii* ^oM«>iiio)>fiorvr«l.
Asa rule the attack is si in ul t a n c o us i n sc vc ml Jtii nif*.
In the acute course one finds the synovial nirmhmne hi^hlv teitilcnrd,
«ven hemorrhagic, turbid, swollen and thiokcnvd. the nrtiiMilur |>i«|>illi«*
are vascular and enlarged. The amount of the ftyiinviitl fluid in in
creased, reddish in color, and often cloudy. In the rnrlv stupes tliv
articular cartilages are very red ; later they become yrllnw nnd present
a rough, velvet-like surface. The tissues in the virinitv of the joint
also present an injected appearance, thepr arc pernieatrd with lirtnor-
rhages and infiltrated with serum ({yeriurthritis); the eonneetive timne.
especially, is affected with a gelatinous swelling, the adjueent nitisrlr^
are edematous and soft. The articular enils of the bone are hyprremle
and even infiltrated with hemorrhages; the sume is trtie of the bone
marrow. In the chronic type the synovial membrane iMM'omes mnrkrilly
thickened, and the inner surface of the joint is eovered with n vmtruliit
conneclivetissue layer (arthritis \ianuofVi)\ the articular (attila){e tin
dergoes fatty degeneration, presents ulcerative losnes of ftubntatire, atwl
becomes partly loosened. In other cases there develojis, an in nittti, »i\
arthritis deformans. In dogs suffering from articular rhriini(t(i«tn tlifr9<
have been observed adhesions between thf* bontrs of th** r.-arpii* ntid
metacarpus, as well as irregular osteophytic formations, f'ttwri*]
changes occasionally occur in the l>ody in the form of an endorarditis.
plenritis and peritonitis. Treatment in internal. If comii«t« in fh^
administration of large rloses of natrium sa 1 1 c y 1 i c ii m ' horM*«; nnd
cattle loo grams, dogs 2 to 8 grams, ]ftr day . , s a 1 o }, a n f f f r b r 1 n,
antipyrio, salipyrin, etc. nee uriUMlur rh'riinia'ip.m I' r 1 *■ 'I
berger and J'rohner, ••Si>ec:al ratholo/y o; »).«• lf',m-nU* An;
maU," 1904, 6 Ed., Vol. I .

PVBMIC AND SkPTIC AUTHft'I-'i ffp Vo' ;.'* A'.ff>. r,-, t'y^Ut.t

and septic f/olyarthrit:t. iorm^.Tly knowr. 5*^ •v/Jr; ,fim*'r.'-^ 1*^1%
calwfzs. \zTrM':jA. pigs, puppies 'I'rv*-Ioj/s iTiT'^i^tAtJ'.-^.i/ fr'/?;. ^ ♦* x ' •'♦.-'*'
tioa of the navel-wound : :t is 'h^ r^vjl* of :::,;/To;/*r rstr* *,f *;,* r,a *,
ataphjIocy-i-Es pyo'^*:r.es i»-r*:':» Sohr. I*: . Jrr.'I ^*r*rp*^^/^/ .» ;, '^
ges^s <'^st*rtig havT '^•rr. 'i-rx.'fT.s*'^.^*:''. w *r.* ;r,'^ '*://•.*.*?, ♦at.
A ffw -iaj* or w*^i:^ ni*tr •>:z*.r, thftr* ".r-.'-'.^r.A ^r. o rr. p h * i ; t ; t *• * ?,
s c z. r- - r i : : 7 * •. h r o m % o p r. 1 * v : • : t *-. 1 * r. ", rr, J-, o * r * • ? , ♦ » »

p T e z: : a , Aft.*r ^.--rTio -. % f* '/r. .* 17 rr. '.^'f/rr.A ',: k y*'.*r^, ". ^* ,r'Ar '^,
s ■» * 1 1 : r. ;f ^ i* ■ * 1.',^ rt v. "t 1 ▼ %r^ * rr. -. ! -^ - ^/'.~. a . ■> or. **->• -:» . -or r. *4
ntcJtV.j tie -.a .-7.-.^ '-*r^-:4. V-** *1V,-^ ir..". .*.;> *-* ♦■»* . -.flf.* ^"-t
c-.r-si-^-.e': -.7 --t—.*-*'* »-". f.-.*-l7 >*-: v. *'^.->« W-wAf-.^i-r. \f^^*
ila i:* :r. '.'.< V/"r** ',f T»o %r .-.-** '•*ei'4 f ",r.-. « • > ■ : ' *: : * -
tz.*\ --r ;r. r*-aa. >;■*—:- »*t»***»*i '.:*. ^ ^ » * n: % r • » :ti
<&ai* r.7.r:«% >i;-,-'^ *,:' t tii^c;.'ir. ■>> ;it- > v. ". .^" • o" vi-v-. .•' v^'w
pr.i7 t.-rJir.r -* . : ii-.i-. : :. .',r. v^ - -Jt - / *i ■ .-.Ar*.- v ^ir .- -,'^ ;>7 * r, -• -,•">• '•:vw»^

246

PERIARTHRITIS

c e m i a (septic forml. When the navel-woiiiid ii not already healed
it ebows traces of inflammBtion and suppuration, the umbilt*
cal card and the tissues Einrounding the umbilicus are awoUcii, the
margins of the umbilical ring present ulcerative thicketiiiigB, abscess
formation has taken place wilhin the umbilical ring, drops of pus
may be pressed out of the umbilical opening. In addition to this
o m pb al i t i B, which may also heal, so that it presents no

deeper tissue* a supBur
thromboarteritis umbili
portal vein and its hepatic 1
the joints are iujectcd, swol!
jointsare cloudy, increased in am
and are often purely aupptiralive
the articular cartilages

the

of the

The synovial meuibranes of ]
ud thickened; the Huida of the
mixed with a doculent coagnlum,
(empyema of the joint);

iches.

icbai

iider

occasionally the joint-capsules are perforated. Sup-
purative osteoroyelitic foci are fouud in the bones. Abscesses form
between the muscles and tendons in Hie vicinity of the joint, the
muscles may even undergo suppurative liquefaction. The mutcleft
over the diseased joint are affected with fatty degeneiatiou. The
most typical examples of this disease are seen in the knee-, tarsal-,
and occipito-atloid articulations. In addition, post mortem exajnina-
tion reveals metastatic foci in nearly all the organs, especially
in Hie liver, lungs, and brain, the kidneys, in the muscles,
and in the subcutaneous cellular tissues. In the liver these
foci are from tbe size of a miUet-aeed to that of a cherry and larger, in
the lungs from the siie of a millet-seed to thai ol^a ben's egg; in the early
stages they are dark-red, afterwards becoming yellow (so-called suppura-
tion of the lungs). The following disea&es tiave also been observed :
pleuritis, endocarditis, pericarditis, bronchopnen-
monia, inflammation of the tendon-sbeatbs, peri-
tonitis. cystitis, suppurative iritis, panophthalmia,
leptomeningitis, etc.— Tre a tme n t is essentially prophylactic:
disinfection of tbe umbilicus and stall, ligation of the umbilicus. (For
further information see: Friedberger and P r tihner, "Special
Pathology of the Domestic Aaiinala". 1904, ft Hd., Vol. I).

ARXHRiTts Urica. — This is an arthritis due to the presence of
urates in the joints (gout ). It is a metabolic process the nature of
whicb is not yet fnlly understood ; it occurs in man and birds, and

illy ii

PHRIARTHRITI

■rounding Ibe joi

—Periarthritis is an
.. especially the pc

inamniation of tbe soft tissnea

the neighboring tendon-sheaths , and

bnrsae, as well as th»

LUXATION 247

p««synovial cotitiective tissue, A fonn of periarthritis which Is of
great practical importance in the horse is that type which frequently
attacks the inaertlons of the lateral ligaments and the capsular ligament at
the coronary joint, designated as so-caJIed periarticular or false
ringbone (see [lage 141): the carpal tumors (false tumor albus),
described as a schlerotic inflammation of the periarticular conn ective
tissue, the tendon -sbeat ha, and the subcuHa of the carpal-joints of cattle ;
as well as many alleged in flam mat ions of Ihe tarsal-, fetlock-, coronary-,
and pedal-joims in the horse. According to Siedamg rotzky
ninety per cent of all cases diagnosed as inflammation of the phalangeal
joints are periarthritis — that is inQammation of individoal groups of ligs-
menta ivithout involving the synovial membranes or the articular snr-
fuces. The following groups are frequently implicated ; the internal and
external lateral ligaments of the pedal-joinl, the e»teroal and internal
suspensory ligaments of the navicular bone and lateral cartilages, tbe
lateral navicular ligaments, the lateral ligamenla of the second phalanx,
as well as the suspensory apparatus of the Srst phalanx. Karnbach ha*
detnonstmled that genuine chronic deforming arthritis of the pedal-joint
(ringbone of the pedal-joint ) is n

II. CHANGES IN POSITION OF JOINTS. LUXATION.

DISTORSION, CONTUSION.

I. LUXATION OR DISLOCATION.

Definition.— Luxation or dislocation is a persistent
separation uf both articular ends after over-
coming Ihe restraining mechanism. If the dis-
location is only partial so that the articular surfaces are not
completely separated, it is termed a subluxation or in-
complete luxation. t\ simple dislocation, in contrast
to a complicated, is not accompanied by severe injuries,
especially fractures. One further recognizes a recent and
old, as well as recurrent or habitual luxation. Dias-
tasis is a term which designates a luxation of a false joint or
half-joint, for example, the sacro-iUac joint in cattle. For-
merly a change in position of the lens was termed luxatiolentis ;
that of the bulb, luxatio bulbis.

Causes. — One distinguishes traumatic, spontane-
ous or pathological, and congenital luxations.

248 LUXATION

a) Traumatic dislocations are due to the influence
of external forces ; they may be indirect through abnormal
flexion, extension, or rotation of the articular ends by means
of a leverage ; or direct, as the result of kicks and blows.
Occasionally luxations in horses are due to muscular force,
for example, the patella may be dislocated upwards as a result
of severe contraction of the quadriceps femoris when the
animal is kicking. One most frequently observes traumatic
luxations of the hip-joint in dogs and cattle (less frequently
in horses); of the cervical vertebrae in horses and dogs ; of the
patella in horses ; of the inferior maxilla in carnivora, as well
as of the elbow-joint in puppies. Dislocation of the fetlock-
joint in race-horses is seemingly rare.

b) Spontaneous or pathological luxations are
due to disease or inflammation of the joint, atony or abnormal
stretching of the joint-capsule and articular ligaments, hydrops
of the joint, flattening of the articular condyles, as well as
deforming arthritis. Habitual luxation of the patella in the
horse is an example of this class. In human surgery various
forms of pathological dislocations are recognized: disten-
tion-luxation occurs in hydrops of the joint as a result
of stretching and atony of the joint-capsule and articular
ligaments ; destruction-luxation after suppurative
liquefaction of the articular ends (joint-caries); deforma-
tion-luxation as a result of deforming inflammation ot
the joint (loose- jointed).

c) Congenital luxations are usually due to arrested
development ; they seldom occur during birth as a result of
faulty manipulations. In many cases it is diflficult to deter-
mine whether luxation of the patella in the horse is due to a
congenital or acquired flattening of the articular surface of the
internal condyle of the femur, or to congenital and acquired
overextension and atony (d i s t o r s i o n) of the joint-capsule
and articular ligaments, with enlargement of the articular
cavity.

Symptoms. — Luxation of the joints of the extremities is
characterized by lameness, as well as by restriction,
or abnormally free movement of the dislocated

LUXA'

249

JDJut. In upward luxation of the patella, for example, the
knee-joint is abnoniially extended and cannot be flexed ; ex-
ternal luxation, on the other hand, results in excessive flexion,
the limb is unable to support weight. Luxation of the inferior
maxilla in dogs is characterized by inability to close the mouth.
Upward luxation of the femur results in shortening of the
affected limb. In dogs the decrease in length may be easily
determined as follows : with the animal in the standing posi-
tion extend the knee-joints equally aud compare the positions
of the tarsi or the paws. Inspection and palpation
of the art icular ends and comparison with the normal
joint of the opposite side are also important diagnostic meth-
ods. In upward luxation of the right femur of the dog, the
trocaiiters, especially the greater trocanter, are higher than
those of the opposite side ; this is readily determined by
inspection or by palpation with the thumbs. The other
changes in the form of the joint, as well as
the changed position of the dislocated bones,
and the changed position of the entire limb, may indicate the
presence of a dislocation. In general a dislocation may be
diSereiitiated from a fracture by the absence of crepitation.

Complicated luxations maybe associated with frac-
ture of the dislocated bones, especially the glenoid margins
of the hip-joints, the cervical vertebree, and the occipital bone ;
or with severe injuries to vital organs, especially the spinal
cord in luxation of the vertebral column ; or finally, with
laceration of the skin aud the soft tissues surrounding the
joint. In animals rupture of the skin seems to be uncommoo.
Smith describes a case of luxation of the fetlock-joint in the
horse in which the metacarpus penetrated the skin and was
driven into the ground to a depth of four inches.

Diastases are observed in cattle at the sacro-iliac joint
and at the pubic symphysis, and in the vertebral column of
horses as a result of rupture of the intervertebral ligaments.
Complete diastasis of the sacro-iliac joint results in a detach-
ment of the tense, almost immoveable union between the sacrum
and the ilium, so that the sacrum sinks downwards and results
in stenosis of the pelvic canal. On rectal examinations the

aso

LUXATION

promontory 19 found to be directed downwards ; viewed from
without the vertebral column seems to have dropped while
the internal angles of the ilium are abnormally prominent.
Diastasis of the pubic symphysis may also be recognized from
the rectum, In horses rupture of the sacro-iliac ligaments
results in a form of so-called sacral weakness or sacral paralysis.

Anatomical Changes, — Luxations, with the exception
of the patella, usually result in laceration of the cap-
sule, and partial or complete rupture of the lateral and
accessory ligaments. Luxations of the hip joint are
characterized by rupture of the capsular ligament and
usually a rupture or tearing away of the round ligament.
Rupture of the joiut-capsule leads to hemorrhage withio
and around the joint; rupture and hemorrhage may
also occur in the neighboring soft tissues, muacles, connective
tissue, etc. Fractures are also observed, especially on the
acetabular margins of the hip-joint. Spontaneous luxations are
characterized by chronic inflammatory changes in the joint.

If reposition of the dislocated joint-surfaces is not pro-
duced a new joint is formed in the vicinity of the dislocated
ends (nearthrosis). In the vicinity of the hip-joint,
especially, the proximal extremity of the dislocated femnr is
surrounded by an inflammatory tissue formation which is
very similar to a joint-capsule ; at the same lime a new aceta-
bulum with a cartilaginous covering results from proliferation
of the periosteum of the pelvis. Nearthrosis formation is
most frequently observed after dislocation of the hip-joint in
dogs ; it is occasionally observed in horses. In a horse
affected with chronic hip-lameness K i 1 1 found the following
conditions ; A loose, one half to two centimeters thick, con-
nective-tissue sac, which performed the function of a joint-
capsule in the region of the acetabulum ; enlargement of the
joint-cavity in the direction of the shaft of the ilium ; the
articular surface of the femur was worn smooth.

Treatment.— As in fractures, treatment of dislocations
consists on the one hand, id reposition; on the other, in
retention of the dislocated ends. Healing depends on these
fundamental principles. Recent simple luxations heal rapidly

LUXATION 251

whea both conditions are fulfilled ; the ruptured capsule is
soon closed, the intra- and extracapsular hemorrhage is rapidly
resorbeil. Unfortunately, with the exception of a dislocated
patella, reposition and retention is more difficult in animals
than in man. Reposition of the hip-jomt, in particular, is
very difficult in well muscled horses and cattle, even with a
set of pulley- blocks it is not always possible to overcome the
mechanical resistance ; the application of a retentioa bandage
is also more difficult than for fractures. Retention of a reduced
hip-joint is not easy to accomplish eveu in dogs, as they will
not remain quiet. Relatively speaking the following luxations
are most easily reduced : the patella and first phalanx in the
horse, and the inferior maxilla in the dog. In all old luxations,
of which luxation of the hip-joint in the dog is a frequent
example, no experiments with reposition and retention are
made ; even apparently severe dislocations of the articular
head develop very rapidly into a nearthrosis, so that the limb
can be used again in a relatively short time. I have also
observed one case of spontaneous healing in luxation of the
hip in a horse. Arthrotomy and resection of the
joint, as employed in human surgery, is not usually applicable
for domestic animals (in the horse I have twice performed
resection of the maxillary-joint with good results). The suc-
cess and results of separation of the internal lateral ligament
of the patella, for upward dislocation of that bone, are yet to be
demonstrated.

STATis-rtcs 07 Lt'XATioNS.— I. lathe horse the number of Inxa-
tlonsu small when compared with olher Bbnormal iiositions of Ibe joints,
especially distoraions: the same istrae when cotupared with other diaeages
of (he joints. There is an average otabuut ooelusationto
fifty distoTsions. In a Ihousand cases of diseases of
the joints, there is about one luxation. The folio nitig
statistics are compiled from the military records of the Prussian Army; In
ten years, 1SS6-1S97, of joo,oixi diseased horses in the service, over 36.000
tuded affections of the joints; of these. 15.000 were dii-
torsions, while only 310 wer^ luxations. With reference to the
occurrence of Imations in different joints, statistics
indicate that the patella is by far the most frequent seat. The
f«t lock- joi Q t is second. Of 7,000 horses brought to the Berlin
Surgical Clinic, I have observed only five luxstiona of the femur, aa
■a nell as two luxations of the patella and fetlock -joint.

252 DISTORSION

3. Luxations are much more frequent in dogs than in horses. Of
the 70,000 dogs treated by me in the Berlin Dog Hospital during a
period of nine years (1886-1895) there were 344 luxations (equal to 0.5 per
cent of all the cases) and 579 distorsions (equal to 0.8 per cent of all cases).
As a rule, in dogs the dislocation is at the hip-joint.

2. DISTORSION OR SPRAIN.

Nature and Symptoms. — A distorsion or sprain is a
momentary separation of two articular surfaces in con-
trast to a permanent deviation of a luxation. As in luxations,
they are designated as simple and complicated, that
is, combined with severe injuries, especially fractures.

The causes of distorsion are the same as those of
dislocation, they vary only in degree, less force is exerted.
The a n a.t o m i c a 1 changes in the joint are essentially the
same as those accompanying dislocations. Simple distor-
sions lead to stretching and even laceration
of the joint-capsule and the ligaments of the
joint, as well as to hemorrhage within and out-
side the joint. These conditions often account for the
chronic course of many distorsions ; if a fracture also exists
the distorsion may be incurable as joint- fractures are not
amenable to treatment.

The symptoms consist in sudden lameness, as
the causes are usually due to an overstretching or forcible
rotation (oblique position, knuckling over, being caught in the
rails, etc.). Palpation of the joint by means of passive
movements, especially rotation, produces severe pain; in
addition, there is increased heat and swelling in
the joint (very frequently this is visible only after twenty-
four hours). Because of these symptoms, which are also
characteristic of inflammation of the joint, the case may be
diagnosed as arthritis instead of distorsion. Crepitation and
abnormal mobility, as well as permanent changes in position
are not present in simple distorsions ; on the other hand,
crepitation may accompany complicated distorsions.

The course varies according to the severity of the
anatomical changes. If there is only a slight overextension

■ONTL'SION

255

ot the joint-capsule and articular ligaments, witlioiil a ruplurc
of the same, lameness may disappear in a few days. If, how-
ever, the joint-capsule is severely ruptured, the articular carti-
lage bruised, and extensive hemorrhage has taken place within
and outside the capsule, healing requires several weeks or
even months. There develops a chronic, partly ulcera-
tive, partly deforming arthritis (ringbone for
example), and even anchylosis of the joint so that
healing becomes impossible. As has been remarked, compli-
cated distorsions are often incurable. For these reasons
the prognosis of any distorsion should be
given with caution.

Treatment. — Recent distorsions are treated with rest,
moist heat in the form of Priesnitz compress,
massage, compression, and pi aster-of- Paris
bandage. If the healing of distorsions is delayed, two or
three weeks for example — if the lameness still remains —
blisters and firing may be employed. Neurectomy
remains as a last resort for incurable cases.

Statistics of Distorsions. ^In horses, distorsions of the joint
form one of the moRt freqneot of joint-diseases. Abont taaK of all
joint-diaeagCH are d is t o is i o n s, [11 the horse I he fetlock-
joint and coronary-joint are most frequently sprained. Accord-
ing to the statistics of the Prussian Army, which are in harmony
with the estimates of Slock fleth and Bayer, dislorsioni of
the fetlock-joint are far more frequent tlian those
of the coro nar y -joi nl. According to the Prussian Military
Reports, in the years 1890-1897, there were 6000 distorsions of tbe fet-
lock-joiiil and only 3100 of the coionary-joint. In the year 1900, «f
1900 cases of distorsion, iioo involved the fetlock-joinl and 600 the
coronary -joint. In the year 1901 there were 940 distorsions of the
fetloci -joint and only 611 of the coronary-joint. In contrast to this,
r and Frick maintain that distorsions of the coronary-joint
• frequent. .According to my own eiperience. distorsions of

[ the fetlock are more frequent than those of the coronary-joiut ; of 120
distorsions examined 1 1895-1898) , 70 were ot the fetlock-joint, 50 of the

L coronary -joint. Both joints are often involved at tbe same time.

CONTUSIONS OR BRUISES OF THB JOINT.

Natore \sd Symptoms. — A joint contusion is a bruising
I of the joint ; it may occur directly by means of pressure,

254 ANCHYLOSIS AND CONTRACTURE

blows, and kicks directly over the joint, or indirectly by
means of concussions and shocks which are operative at some
point below the joint and result in compression of the articular
surfaces. In the first case there exists a contusion and
inflammation of the capsular ligament and the periarticular
tissue ; in the latter, a contusion of articular cartilage, which
in severe cases may be associated with a fracture of the articular
^nds.

The symptoms of joint contusion are similar, though
lesser in degree, to distorsions. The lameness in particular,
and the amount of pain shown on palpation, are less than
in luxation. On the other hand, contusions usually lead
to severe hemorrhage into the joint (hemarthrosis), as
well as to a large fluctuating swelling in the vicinity of
the joint (contusion-swelling of the skin and subcutis).

The course is usually more favorable than that of dis-
torsions ; ordinarily resorption of the blood-e3rtravasate in
the joint is rapid ; function is entirely restored. At times a
hydrops of the joint may remain (joint-gall). The course is
unfavorable only when the contusion is complicated with a
fracture or joint-wound.

Treatment. — Early massage and compression
of the joint by means of a permanent or elastic bandage is the
most appropriate treatment for contusions of the joint. Re-
sorption may be favored by moist heat, and later with
slight exercise.

III. ANCHYLOwSIS AND CONTRACTURE.
I. ANCHYLOSIS OR STIFF JOINT.

Definition. — Anchylosis is an adhesion between two
articular surfaces ; it results in stiffness and immo-
bility of the joint. In contrast to contracture of the joint,
in which the mobility is only restricted, anchylosis implies a
complete suspension of the motion. According to the char-
acter of the connective substance at the point of adhesion,
anchylosis is designated as follows : osseous, cartilagi-

ANCHYLOSIS

nous, and co

■ tl:

anchylosis (anchy-

losis ossea, carlilaginea, and fibrosa). Ancby-
loaiaossea is sometimes erroneously leriiied synostosis. Ac-
cording to the location of the anchylosed masses within or out-
side the articular capsule, it is termed inner and outer
(intracapsular and extracapsular) anchylosis.
There is also a genuine and a false (appareut) anchylosis.

Causes. — Anchylosis formation is either the product of a
chronic arthritis, especially the deforniing, pannous
and granular types, or it is the result of a fracture involv-
ing the joint. It is most often seen during the course of a
deforming arthritis (spavin, ringbone); in ossifying periostitis
in the vicinity of joints ; as a result of periarthritis at the
carpal-joint ; following ossification of the intervertebral carti-
lages in old horses (causes of constrained movement in the sad-
dle-region and of fractures of the vertebra); as a result of poll-
evil, which leads to adhesions between the cervical vertebrae
and permanent stiffness of the neclc ; ami in chronic inflam-
matory conditions of the inferior niaxiilary-joint. Occasion-
ally one finds the inferior surface of the vertebral column
of the horse covered wiih osseous proliferations from the size
of a hazelnut to that of a hen's egg ; they are so closely bound
together that the vertebra form a strong, immoveable column
(saddle constraint). Adhesion between the eyelids, which is
analogous to that between joints, is termed anchyloblepharou.

Treatment, — In tlie domestic animals anchylosis is
usually incurable. When a joint is anchylosed the mo-
bility, pain, and lameness are suspended : forthis reason, in
veterinary medicine, certain chronic inflammations of the
joint, especially spavin and ringbone, are treated with blisteri
and the cautery in an attempt to produce artificial anchy-
losis of Ihe joint. In man, anchylosis is treated in the
early stages with massage, passive movements and extension
of the joint under the influence of narcosis in an attempt to
prevent permanent stiffness. Complete anchylosis ts treated
with resection of the joint, arthrotomy and osteotomy.

256 JOINT CONTRACTUKB

2. JOINT CONTRACTURE (STlLT-FOOT).

Definition. — The expression "contracture" desigoates
an abnormal position of thejoint in which f r e e-
dom of movement is permanently restricted
(knuckling of the joint, stilt-footj. This should not be con-
fused with contraction, that is, excessive muscular contraction.

Causes and Forms.— Restriction of the mobility of the
joint may be due to the following causes : diseases of the
joints, tendons, muscles, nerves, and skin, or it may be con-
genital. One designates, therefore, the following forms of
contracture : articular, tendinous, myogenic,
neurogenic, cicatricial, and congenital con-
tractures.

a) Articular contractures are due to pathological
conditions of the joint itself, there is a restriction of the free
mobility of the joint (articular stilt-foot). It may
result from any of the followiug conditions : exostosis forma-
tion and irregularities on the articular surfaces, inflammatory
new- formations in the joint itself, arthritis deformans, free
joint bodies, first stages of anchylosis. In the horse one most
frequently observes an articular contracture (articular stilt-
foot) during the course of an articular ringbone, the osteophy-
tic enlargements on the first and second phalanges, as well as
the first stages of anchylosis, mechanically restrict free move-
ment in the coronary- joint. The same condition is observed
in unilateral chronic arthritis of the maxillary-joint which
results in imperfect mastication on the side involved.

b) Tendinous contractures are due to contraction
and adhesion of the flexor tendons ; they follow a tendinitis
(tendinous stilt-foot). In adult horses tendinous
contractures are most often observed at the anterior fetlock-
joint (knuckling in a narrow sensej as a result of chronic
inflammation of the perforans tendon.

c) Myogenic contractures are due to cicatricial retrac-
tion of muscles as a result of previous ruptures and inflamma-
tions. Contracture of the internal and external flexors of the
carpus (flexor, and extensor carpi ulnaris) produces so-called

JOINT CONTRACTURE

257

d) Neu

rogen

ments of the

nusciil

paralysis and

n use 111

contracture),

r to c

■u rogen]

"knee sprung" in horses. Contracture of theniastoideohumer-
alis results in an oblique position of the neck (caput obstipum).
Unilateral contracture of the lateral coccygeal muscles causes
the tail to be held to one side. Apparently many cases of
acquired stilt-foot in coUs are referable to a myogenic cause
(rheumatism, rachitis).

ic contractures result from derange-
r innervation, they are due. either to
ir weakness (^ paralytic neurogenic
ramps in certain groups of muscles
c contracture). Congenital stilt-foot in
foals (so-called knuckling) is due to a paralytic contracture
(congenital weakness of the extensor muscles). This hypoth-
esis explains the rapid recovery from stilt-foot in foals under
proper treatment. The relative ease with which it may be
cured does not sustain Johne's hypothesis. He maintains
that stilt-lbot in foals is a tendinous contracture resulting from
a faulty position of the flexor tendons iu utero.

e) Tissue or cicatricial contractures result from
tissue-contraction following a wound, burn, cauterization and
necrosis of the skin on the flexor surfaces of joints, as well as
on the neck {caput obstipum). Therapeutics of this affection
involves the same treatment as that employed in ihe operative
treatment of entropion in dogs ; cutting out a piece of skin
(blepharoplasty).

fj Congenital contractures depend, either upon a
congenital mu.scular weakness (stilt-foot in foals), or upon a
deranged development of the joints of the fetus. The latter
conditions in domestic animals do not receive surgical treat-
ment because young animals thus affected are not allowed to
live. Tiie following congenital forms of club-foot are
recognized in man: (pes varus) an arthrogenous supination-
contracture of the foot ; flat-foot (pes valgus or planus),
an abnormal dorsal tlexion of the foot ; horse-foot (pes
eqninus), an abnormal planter flexion of the foot. Genu
valgum (x- formed limb) also occurs.

Treatment — Many cases of contracture are incurable ;
by means of an operation many are partially curable. This is

26o

DISEASES OF TENDONS AND TENDON-SHEATHS

dies : epitendineum ia a loose conaective-tisane layer containing a few
blood-vessels. The secondary bundles are combined in n similar man-
ner to form tertiary lendon-btindles out of which the tendon is
composed. The Burface of the tendon is covered with paratend-
i n e u m , a loose connectire-lissne la^er. From a surgical standpoint
the foiloniug tendons are of grpat practical importance: the flexor
tendons of the phalanges ; namely, the snspenBory ligaments
(superior sesamoid liKsmentK the fleior pertorans and per-
foralus. The atialomy and physiology of the tendons under con-
sideration, which may be regarded as supporting ligaments of the
phalangeal joints, are of great importance for an iindcrstaading of the
pathogenesis, symptomatology, and therapy of diseased tendons. A
valuable contribution to this knowledge has recently been supplied by
Stoss (Anatomie und Physio logie der Phalange n bander des Pferdes.
Monatshefte fiir praktische Tierheilkunde, 1895). According to this
article the flexor of the first phalanx ( so-called superior
sesamoid ligament ) is primarily a volar interosseous muBcle. flexor of
the first phalanx, and the most highly developed type of supporting
ligament, it prevents overextension of the fetlock-joint (so-called dorsal
flexion of the fetlock-joint). The flexor of the first phalanx is attached
tothe postero-superior extremity of the metacarpus at one end and to
the sesamoid hooea at the other. In the same manner the flexors of
the second and third phalanges form supporting ligaments
for the coronary-and pedal-joints. The so-called check ligaments
of the same prevent overstretching of the flexor muscles from the body
weight, and perform the same function for the coronary- and pedal-
joints as that performed by the suspensory ligament for the fetlock-
joint. The check ligament of the flexor perforans arises from the
thickened posterior capsule of the carpal-joint ; that of the flexor
perforatuB from the radius above the carpal-joint.

Tendon-Shkaths ani> Mlcods RuRS.e. — For surgery, the anat-
omy or tendon-sheaths and mucous bursse is extremely important In
most text-books on veterinary anatomy the arrangement is neither
detailed nor distinct. The following is a short description of the most
important relations in the horse according to Bichbaum (Berlin
Archiv. 1883I. The physiological function of tendon-sheaths and
mucous buts:e consists in facilitating the gliding movements of the
tendons, muscles, and skin, especially where they pass over projecting
areas. The physiological fanction has a common relation to the
anatomical and histological struclnre ; they vary only in external form.
They may fuse with one another, they have no constant structure, and ■
they may communicate with joints (for example, the tendon-sheath of
the extensor digitorum commanis with the knee-joint |: furthe
hnrsie may develop into tendon -a heaths.

DISEASES OF TENDONS AND TENDON-SHEATHS

Z6l

The te n do n - she 3 1 h 5 (burs% vaginalis, vaginEe tendineuin)
form cylindrical sscb «hich isolate the teiidoos by means of sheoth-like
coverings al points where they pas? oTSr extensor or flexor surfaces of
articulations, OccaaionallT several tendons are enclosed in one sheath,
namely, the tendons of the perforans and perforalus at the posterior
surface of the carpus and metacarpus. Similar to joint-capsules the ten-
don-sheaths are lined on their inner surfaces with synovial niem-
brane* [seroue sheath, mucous sheath), which represent serous
membrane, in thai they are lined with a single layer of endo-
thelium (by others, they are regarded as glandular, mucus
secreting organsj. The eitemal layer of the tendon-sheath has •
fibrous covering which is bound to the synovial membrane by means of

The m u c o u s- b ur s a e (burs.i! mucos^t) form round sacs flat-
tened laterally; they are situated beneath tendons, muscles, and sl^in ;
their inner walls are usually smooth, sometimes rough and net-like from
papilte and projecting tendon-fibers or they have the appearance of a
fenestrated membrane. Two forms of mucous burs:L- are recognized.
I. Bursae mucosae sn bt e nd i uae (burs.-t subtendin:e ), which,
because of their seemingly constant occurrence, are. also termed ■'typi-
cal"" mucous bursie. They are situated at the points of origin and in-
sertion of muscles and tendons, beneath these organs and in close con-
tact with tlicm. Like tendon sheaths, their inner surfaces are covered
with a layer of endothelium ; in old horses they frequently communi-
cate with tendon-shentbs and joints, in these cases they form a blind,
sac-like protrusion of the joint-capsule ^^^rs:e synovialisl. The exist-
ence of this combination is ot great importance in certain surgical
affections (galls). Burss subtending are usually present in foals. The
following are of special surgical importance : the tiursa intertubercnlaria
ot the biceps in front of the shoulder-joint, and the subtendinons bursa
of the Heior pcrforatus at the calcaneum. 2. Buisae mucosae
aubcutanae (burss subculanxl, because of their inconstant occur,
rence, are also termed "'atypical" mucous buraa:- ; they develop after
birth ; '"acquired" mucous bnrsK | and increase in number with the age
of the animal. Apparently their origin is due to ntptures of the sub-
cutaneous connective tissue ; this is produced by extension and flexion
of the joint, especially through laceration of the subcutis over osseous
tuberosities: laceration leads to encapsntalton. The inner surfaces of
these acquired mucous bursae contain, therefore, in most cases, no
endothelial layer. They are found in all places where the skin is
moveable over o^eous tuberosities, especially on the olecranon ishoe-
boil), calcaneUm (capped-hock), and on the external angle of the ilium.
They are less frequently seen in the following places : on the patella,
malleoli, withers, sacrum, and on the extensor surfaces of joints.

The following niuco us bn r sac and tendon-sheaths

: of

al i

26a

DISEASES OP TENDONS AND TENDON-SHEATHS

I. Head.— The subcutaneouB bursae on the crcRt
the occipital bone (neck-tumors in do^).

II. Neck.— The barsa mnco.a beneath the origin
the ligament um nuchae, between the cervical ligament «
the superior surface of the atlas and its capinlar ligament.
vanes in length from three to ten centimeters, is oval in form, and
bounded laterally by the middle extensors of the head. A
buraa mucosa is sitaated beneath the cordiform port
the ligBmeiitnm nuctiae in the region of the second cervii^al
vertebra; it is about the size of an apple, and lies between the cordi-
form portion of the cervical ligament and the points of attachment of

_ the lamellar portions of the cervical ligament to the crest of the second
cervical vertebra. It is bounded on both sides hy the complexns
muscles (poll-evil in horses I.

III. Trl'nk.—A mucous bursa lies above and on both sides
of the withers {fifth to seventh dorsal vertebrae, fistulous withers).
There is a m neons bursa over the external angle of the
i I i u in — b ursH iliaca laterali s^botta upon the superior and the
inferior tuberosities of the same; the superior is ten centimeters long,
andfourto five centimeters u'ide. A third mucous bursa lieson
the tuberosity of the iscb i u m— bu rsa tuberis ischii —
it is the size of a walnut [hygroma formation).

IV. Anthkior ExiRBMiTtBS. — A subtendinous bursa lie»
under the insertion of the infraspinatus muscle ibursitia infra-
spiuati). A bursa mucosa lies between the tendinous origin of the
b iceps b ra c hi i and tlie trochlea of th e h u m e ru s— bu rsa
intertuberculari 3 — (bursitis intertubercularis). A very important
buna mucosa lies on the posterior surface of the olecranon procea*
of the ulna, bursa oiecrani; it is very common, from the siie of a
walnut to that of an apple, it has vaj^inal walls and several compart-
ments ; occasionally it is situated more on the lateral side of the olecra-
non process of the ulna (shoe-boil). The foltowinij are important : the
tendon-sheath of the extensor pedis on the anterior surface
of the carpal-joint; the t e ndo n-sheath of the extensorsnf-

fti

1 (at the f

the

liddle

ndon
; tlie

heath o f tfa
endon-sheal.

al fie:

I subc

r of the

a (M, .

1 bur.

r surface of the carpal -joint in caUle (,"knee tumor"); the
tendon-sheath of the perforana and perforatas, thi»
IB very large, situated largely in the carpal sheath, it begins about ten
centimeters above the carpal-joint and pasRes downwards as far as the
point of attachment of the check ligament to the perfotans tendon (galls
of the flexors at the carpus], tenotomy should be performed below this.
tendou-sheath ; the te ndon - shea th of the flexor of the

Bbeath of the flexor perforaus and perforatus, it

begins ten centimeters above the fetlock-joint, passes ovei the posteriot
inrface of the siipenor EesBtuoid ligament, the segHmoid bones, the first
and second phalanges, and ends at about the middle of the second
phalanx (perform tenotomy above this lendon-sheath); the bnrsa
mncoaa aubtendtnea on both taletal surfaces of the fic^t phalanx,

Fiually, the bursa pod otro c hi e ati s is of gieal importance,
this isamucons bursa beneath the insertion of the pecforans
tendon; it begins at tbe posterior margin of the navicular bone and
reaches Id the pedal attachment of the Heior pcrfotaos. It forms a closed
SBC that does not communicate with the pedal-joint ; the anterior wall
covers the posterior surface of the navicular bone, while the posterior
wall is in contact vHih the flexor tendon (bursitis podotrochlearis) .

V. Posterior Extremities.— The bursa glutei medii (tro-
chanterics! is a mucous bursa beneath the end insertion of the
gluteus medius and maximus on the middle trocantcr; it
fonua H circumscribed sac on tlie outer smooth surface of the middle
trocanter (bnisitis trocanterica). At the Icoeejoint is situated the

prepatellaris), it is present in only tifly per cent of aU hoiees, and
varies in size from that of a bean to that of a walnut. It is located on the
anterior snrfaceof the patella, usually on the projecting upper
half, anil occasionally extends to the lateral borderot the patella tbursitii
prepatellaris). There is also a mucous bursa on the tibia beneath
the insertion of the middle straight ligament of the
patella, bursa subpateUaris ( bursitis subpatellaris). The follow,
ing are of practical importance : the synovial bursa beneath the
ori^n of the flexor metatarsi and long extensor of the
toe, at)out fourteen centimeters long, large, it ii located immediately
below the knee and communicates vrith the knee-joint: the bursa
mucosa subcutanca above the tuberosity of the calcan-
eum— bursa calcanei, tliis is very common, though r
oval in form, four to live centimeters long, three to four centimeters
wide, and lies on the posterior surface of the upper end of the calcaneum
(capped- hock ) ; the te n do n - shea t h of the lateral extensor
of the toe, this begins two to four centimeters above Ibe lateral
tnaleolus and teruiit^ates on the upper surface of ihe metatarsus i, string-
halt operatiou); the teudon-she ath of the long eitetisor
of the toe pa^es over the anterior surface of the tarsal-joint to the
point of attachment of the lateral extensor to the long t

unde

nch (

anticus is roundish in form, the inner wall c

of the cuneiform bones and pyramidal bone, the o

264

DISEASES OF TENDONS

the branch of iBseition (spaviu-operation): the teodon-shea t h of
the flexor perloraiis begins about the widlh of three fingers
above the medial maleolus, paBses down the posterior surfRce of the tibia
and the tarsal-jornt. and ends just above the point of attarbment of the
Uteral flexor to the teudoii of the flexor perforans ( in <1 am mat ions,
galls) ; the t eodo n -she a t h of the lateral f 1 e x t, i arises
at the middle of the tibia on the uiediul side, it is from thirty to
thirtv-five ceutimeters in length, passes down the medial surface of the
taraal-joiut to the pyramidal bone and terminates at the point where this
tendon is attached to the perfiirans; the t e ndon-sbea t h beueath
the tendon of the perf oral us lies between the cap-like expan-
aion of the latter und the c-Llcaneum. it terminates at the middle of the
calcaneum (curb).

I DISEASF.S OF TENDON

I, INFLAMMATION OF TENDONS. TENDINITIS. TENONITIS.

Causes. — iDflammations of tendons occur most frequently
in horses : they are caused by strains, overexten-
sions, and partial ruptures of the tendons as a result
of overexertion in race-horses, trotters, and heavy draft- horses.
Direct contusions of tendons from blows are uncommon. In
most ca.ses tendiuiiis is primarily traumatic in character ;
as it is not accompanied by an injury to the skin, it is not
under tbe influence of bacteria and is, therefore, aseptic.
It has its analogues in the similar traumatic and a.septic bone-
iissures, tbe processes of healing are similar. Tbe following
conditions predispose to tendinitis: abnormal positions,
especially too long and too weak fttlocks ; low heels and long
toes ; imperfectly developed tendons : deranged nourishment of
the tendons as a result of some previous disease, or standing
for a long time.

In other cases the inflammatory process pro-
ceeds from neighboring tissues to the tendons.
Primary inflammalioD of the tendon-sheaths (contagious
pleuropneumonia ) often results in a secondary tendinitis,
la a similar manner phlegmonous inflammations of the tendon-
sheaths from phlegmon of the fatty frog may lead to tendinitis,
it may also occur during the process of bursitis podotrochlearis
and sesamoid lameness (suppurative and necrotic ten-

TENDINITIS 265

dinitis). Tendinitis resulting from ioflatnniation of the tendon-
sheaths, wheu the latter is secondar}' to infectious diseases
(contagious pleuropneumonia), is erroneously termed metastatic
tendinitis.

Filaria cincinnata (spiroptera reticulata)
is rarely the cause of tendinitis. It is seen in the suspensory
ligaments of Russian and Italian horses, and occasionally
results in inflammation and lameness, as well as in fibroma-
like new-formations (see page 183J,

Pathology. — In recent traumatic tendon-inflammations
one first finds a partial fascicular rupture of the ten-
don-fibers with a trivial extravasation of blood, or a
sanguiuo-serous infiltration of the interfascicular connective tis-
sue. The inflammatory reaction which soon follows is char-
acterized by hyperemia, bloody infiltration, and new-formatioD
of blood-vessels and connective tissue (tendinitis fi-
brosa). Granulation tissue is formed from the following
structures: the paratendineum, the adjacent tendon-sheaths,
the interfascicular connective tissue (epilendineum J. in part,
also from the genuine tendon-cells of the ruptured tendon-
fibers. The voluminous, vascular, semi-solid granulation tissue
undergoes a partial atrophy of the tendon-fibers ; the soft
embryonic tissue is transformed into hard, crepitating, nodular
connective tissue, which is partly cartilaginous and osseous and
which forms a typical tendon-cicalrix (tendon-callus,
schlerosis tendiuum). At the same time there may
occur a contraction, and adhesion of the tendon to the
adjacent structures. Necrosis may readily follow suppura-
tive inflammation of tendons.

Symptoms. ^Tendinitis occurs principally in the flexor
tendons (perforatus, perforatis, and suspensory ligament);
it is much more frequent in the anterior limbs. In horses it is
characterized by lameness, which develops suddenly, or
gradually increases in severity, volar flexion is pro-
Dounced. There is pain on palpation, increase of local
temperature, and in the early stages a semi-solid
swelling on that part of the tendon involved, the skin is
moveable on the surface. Later there is an increase in the

TENDINITIS

consistency of the swollen tendon. If resolution does not take
place in the swelling, there remains, after the inflammatory
symptoms have disappeared, a firm, hard, tendon- nodule
or a diffuse thickening of the tendon. The lameness
gradually disappears, it may, however, become chronic. When
a tendon has once been diseased it is predisposed to relapse;
thii is especially true of race-horses, saddle-horses, and heavy
draft-horses. Severe inflammations finally lead to adhesion
between the tendon and the surrounding structures, as well as
to the formation of a tendon-contracture (tendon
stilt-foot).

Treatment. — In addition to complete rest, very recent
tendinitis characterized by severe pain and pronounced swelling
can be treated with a cold compress, cold baths, or per-
manent irrigation. In general it is better to immediately
employ moist heat in the form of a Priesnitz
compress. Massage, and pressure bandage
(silicate-of- potash bandage) are occasionally indicated. The
methods employed are for the following object : resorption of
the hemorrhagic extravasate and lo support the natural pro-
ceas of healing, that is, the reactive, aseptic, inflammatory
new- formation. It is also important to regulate the shoeing.
The toe-calk is removed and excessive length of toe is short-
ened, this removes strain from the flexor tendons and is of
special importance in iufiamniation of the flexor perforans, the
heels may be raised by adding heel-calks.

If the methods described are not followed by healing or
improvement after three or four weeks, especially when com-
bined with methodical massage, counter-irritants are
indicated. The variety and form of the remedy employed is
non-essential, the manner of application of the blistering oint-
ment or plaster is, however, of great importance. After having
thoroughly tested the following method of application, which
I learned in the Imperial Stables in Vienna, I can highly
recommend it : The hair is clipped previous to the application^
the skin is also thoroughly washed and disinfected, then apply
biniodid of mercury ointment ti:4~5)p *his is rubbed in
thoroughly for fifteen minutes, covered with an ordi-

TENDON-RUPTURE

267

, and allowed

to remain in position for two weeks. After twenty-four hours
the bandage becomes moistened with an extensive exudate
which soon dries ; the horse's head is tied up for the first few
days.

By employing the method described the application of the
cautery for chronic tendinitis becomes unnecessary, the
cautery may be employed in the form of line-firing. The
action of the cautery is like that of blisters : it causes an arti-
ficial acute inflammation of the skin and the subcutaneous
parts ; the blood-vessels are dilated ; the white blood-corpus-
cles pass out of the blood-stream and become phagocytic ; the
solid masses of exudate are liquefied (peptonized) and resorbed
(histolysis), this is due to the formation of ferments from the
degenerating white blood-corpuscles.

If hard, painless, nodular thickenings remain in the ten-
don after the course of a chronic inflammation they cannot
be removed any more than other cicatricial formations.
Tenotomy may be successfully employed to counteract
retraction of the tendon.

The suppurative and necrotic forms of tendinitis must be
treated with incision, antiseptic irrigation, and
evenitially with resection.

Statistics op Tkndinitis.— Tendinilia is tlie most frequent form
of diieaie of the teniloiis, it is one of the most frequent surgical affec-
tions iu the horse, lu the years 1SH6-139S, 36,130 horses were treated
in the I'russian .A.rniy for inflatnmation of the lendons and tendon-
sheatlis. The affection most often involved both the perforans aiul
the perforatua of one limb (70 pet oent|; then followed the suspensory
ligament with 20 per cent. The right anterior limb was most often
affected (43 per cent), then followed the left anterior limb (36 percent)
{Bar tkej.— Inflammation of the tendons is far less common in doga.
Among 70,000 diseased dogs (1886-1895) I have ob^rved only twenty-
three cases of tendinicib ; the achilles tendon was most frequently
affected.

, I

TENDON-RUPTURE.

Causes. — I
lar, fascicular)

ncomplete tendon-rupture (partial, fibril-
;as described under inflammation of tendons.

268 TKNDON-RUPTURK

Complete (total) tendon-rupture forms another, independ-
ent, affection. In contrast to open wounds and incisions of
tendons (tendon-wounds), ruptures are usually subcutaneous.
The causes are usually external and, like traumatic tendinitis,
are ordinarily due to overexertion and overstretching. They
are less frequently caused by contusions. As in tendinitis, i n-
ternal predisposing factors are common (so-called spon-
taneous tendon-ruptures); these may be due to suppurative
inflammation, necrosis, previous infectious diseases (contagious
pleuropneumonia, petechial fever), and other derangements in
the nourishment (osteomalacia, neurotomy) which cause a
loss of resistance. The following conditions especially predis-
pose to tendon-rupture tsuppurative tendovaginitis at the
fetlock- and tarsal-joints, phlegmon of the fatty frog (nail
pricks), and bursitis podotrochlearis. It is especially liable
to occur as a result of prolonged standing on three limbs, the
well foot becomes affected with painful pressure laminitis, so
that the horse is obliged to again bear weight on the diseased
foot. In many cases it is not possible to determine the cause
of tendon-rupture (simultaneous rupture in several limbs).

Occurrence. — In horses the following tendons are most
often ruptured : flexor metatarsi, flexor per fo ran s,
flexor perforatus, and suspensory ligament,
in cattle and dogs the achilles tendon and flexor meta-
tarsi are most often involved. In general, total rupture of the
tendon is less common than other tendinous affections. For
example, in the Prussian Army in the years 1 889-1 895, thirty
thousand horses were affected with inflammation of the tendons
and tendon-sheaths ; during the same time there were about
three hundred cases of tendon-rupture. One case of total
tendon-rupture occurs to a hundred of tendinitis and tendo-
vaginitis. As a rule only one tendon is ruptured ; in race-
horses and in spontaneous ruptures one finds, however, two or
three, and even all four limbs simultaneously involved. For
the process of healing see page 71.

Symptoms. — The symptoms of tendon-rupture are vari-
able, they depend on the tendon affected.

a) Rupture of the flexor metatarsi occurs in

TENDON-RUFTUKB 269

horses, occasionally in cattle, after over-stretching of the ten-
don from excessive extension of the tarsal-joint (kicks, slips).
It is characterizet! by a dangling movement of the
lower part of the hind limb which comes on sud-
denly, and a peculiar lameness in which the tarsal-jojn t
is abnormally extended. Loss ot resistance in the
flexor metatarsi is easily recognized when the limb is raised in
a position for shoeing, carrying the limb backwards results in
tripping, at the same time the achilles tendon appears relaxed
and lies in folds. Apparently the prognosis is favorable,
healing without treatment usually takes place in one or two
months.

b) Rupture of the flexor perforans and sus-
pensory ligament is observed as follows : on the anterior
limbs of race- horses, as well as during the course of a chronic
inSammation of the pedal-joint, as a result of phlegmonous
processes in the tendon-sheaths and the fatty frog. It is
characterized by a lameness which develops rapidly with
abnormal dorsal flexion of the fetlock-joint: on
palpation one may locate a depression in the tendon at
the point of rupture. In rupture of the flexor perforans the
toe is raised. Ruptures of the flexor perforans and sus-
pensory ligament in the region of the metacarpus usually
require two or three months to heal ; ruptures which result
from necrosis are. however, nearly always incurable. Treat-
ment consists in the application of a plaster-of-Paris bandage.

c) Rupture of the achilles tendon is frequently
observed in cattle. It is due to abnormal QexJon of the tarsal-
joint and excessive stretching of the tendon by means of falls,
slips, and jumps, or to severe contraction of the gastrochnemius
during extension of the joint. It is characterized by a
severe lameness which develops suddenly, excessive
flexion of the lower part of the limb, kuuck-
ti u g, and inability to support weight : the achilles tendon is
thereby relaxed so that a space may be recognized at the
point of rupture. In dog.s the prognosis is relatively good
(plaater-of- Paris bandage, tendon-sutures), in cattle and horses
it is unfavorable fslings). Those cases in which the tendon

370

NECROSIS OF TENDONS

puUa away the periosteum and particles of bone from the point
of the OS calcis are usually incurable.

Tkn DON- Luxation. This 19 occasionally observed fn the hone at
the expansion of the pertoratu* wlaere it passes over the o<i calcis. The
dialocation may be either to the external or the internal side. The
gliding movements of the dislocated tendon may be seen at the os calciB
with every extenaion. At the same time one obaenes local swelling
and an nncertain atumbling gait. The prognogis is grave, as a rule the
luxation is incurable.

NHCRCSIS OF THND0N5.

Causes. — Neci^sis of tendons is due to a previous sup-
puratire tendinitis, which usually results from extension of
phlegmonous processes from adjacent structures to the tendons.
As the genuine tendon-tissue is not a vascular structure
necrosis may easily occur and extend very rapidly. Necrosis
is moat frequently observed in the perforans tendon at the
navicular bone, due to phlegmon of the fatty frog resulting
from nail-punctures. The suppurative process in the frog
extends to the bursa podotrochlearis, or, in perforating wounds,
it may originate in this bursa and develop into a suppurative
bursitis enveloping the perforans tendon in a sac of pus, which
results in its rapid necrosis. Necrosis of the sos-
pensory ligament of the bulbs and the navi-
cular bone, as well as the ligament which passes
from the lateral cartilage to the first phalanx
often results from a suppurative stone-bruise in the augle of
the sole. As these ligaments unite the perforans tendon to the
fatty frog, and the bulbs to the lateral cartilage, they fre-
quently convey the necrotic inflammation from one of these
structures to the other. (Com.: Pfeiffer, Monatshefte
fiir praktische Tierheilkunde. 1897).

Symptoms. — The necrosed particles of tendon present a
green, greenish-yellow, or yellow appearance.
They appear to slough away rapidly from the sound tendon,
so that the smooth, soft, relaxed, greenish-colored membran-
ous structures may be removed from the cavity. Experience
has demonstrated that tendou-necrosis may seemingly develop

NECItOSlS OF TENDONS

v«ry rapidly. I have seen diEEuse, green necrosis of the flexor
teudon develop within a week after the nail-puueture. The
other symptoms of necrosis of the flexor perforans are like
those of phlegmon of the fatty frog and suppurative bursitis ;
namely, severe supporting- leg lameness in which
the diseased foot bears either little or no weight, pronounced
volar flexion, marked swelling in the frog and
cleft between the balls, pronounced pain on
dorsal flexion of the hoof, as well as a general
febrile conditiou.

Treatment. — Treatment of teudon- necrosis is entirely
operative. It consists in a free exposure of the tendon and
removal of the necrotic particles. When a uail-punclure is
followed by the previously described symptoms an early opera-
tion renders the prognosis more favorable. The frequency
of incurable tendon -necro sis following nail-
punctures is largely referable to delay in the
operative treatment. The operation may be per-
formed in various ways. I employ the following technique :
removal of the frog and fatty frog as far as the tendon by
means of a three-cornered incision ; cut out that portion of the
perforans tendon which lies between the superior border of the
navicular bone and its pedal attachment ; carefully curette the
walls of the bursa, especially that which covers the navicular
bone, and remove all necrotic particles that may be attached to
it ; thoroughly irrigate the funnel-shaped operative wound,
and provide drainage by means of an incision in the vicinity of
the bulbs ; pack with a loose tampon of iodoform gauze, and
bandage the entire hoof. When this oi>eration is employed
early and the entire terminal portion of the necrotic tendon re-
moved, healing usually occurs in one to two months if the
pedal-joint is not involved.

272 INFLAMMATION OF TENDON-SHKATHS

II. DISEASES OF TENDON SHEATHS.

I. INFLAMMATION OF THE TENDON-SHEATHS.
THNDOVAGINITIS,

Forms. — Inflammation of the tendon -sheaths
(tendovaginitis, tendosy novi tis , tendinous
buTsitiE, tenalgia) occurs, similar to inflammation of
the joints, in various forms. One distinguishes here, also,
traumatic (non-bacterial, non-infectious, aseptic), infec-
tious (septic, bacterial), and rheumatic inflammation
of the tendon-sheaths ; one further distinguishes a primary
and a secondary form ('symptomatic, metastatic),
acute and chronic, tubercular, etc. The various
anatomical characteristics of tendovaginitis are of importance.
The tendon-sheaths are covered on Iheir inner surfaces with a
layer of endothelium which is identical in structure with that
lining the synovial membranes of joints, they are also covered
with a serous membrane analogous to the pleura and peri-
toneum. One distinguishes here, then, the following types of
tendovaginitis : serous, serofibrinous, fibrinous
(croupous, catarrhal, crepitating), suppurative, icho-
rous, and chronic fibrous. From a practical surgical
standpoint it is important to distinguish between the following :
acute serous and acute suppurative, as well as tuberculous.

Serous Tendovaginitis.^ — The causes are to be
found, either in external mechanical influences (overexer-
tions, contusions), or in interna! infectious diseases (contagious
pleuropneumonia, septicemia, articular rheumatism, contagious
abortion), or cold (rheumatism of the tendon- sheaths). Pri-
mary, traumatic tendovaginitis usually affects only one tendon-
sheath ; the secondary, symptomatic or metastatic inflamma-
tions, usually attack several sheaths at the same time.

The symptoms consist in lameness, high temperature,
more or less pain, and a soft, either fluctuating (T. serosa) or
crepitating (T. serofibriuosa) swelling in the vicinity
of the diseased t e n d o n - sh eat h . If the exudate is
not resorbed there develops, either a chronic hydrops

INFLAMMATION OF TENDON-SHEATHS

273

(tendon-s heath gall), or a chronic connective -tissue
new-fonnatioQ with pronounced thickening and schlerosis of
the walls (tendovaginitis chronica fibrosa, in-
durated tendou-sheath galls). In general the course of simple
traumatic forms of tendovaginitis is more favorable than the
symptomatic ; this is especially true of inflammations of sheaths
that occur during the course of contagious pleuropneumonia,
which are often chronic and remittent in character. Tendo-
vaginitis of the extensor tendons is more favorable than that of
.the flexors.

The treatment of serous or serofibrinous tendovagi-
nitis consists in the application of moist warmth in the form of
Priesnitz compress, as well as massage, further, in the
application of a pressure bandage and absolute rest for the
animal. Cold, operative treatment, and firing
are con t ra- i ndicat ed . When the resorption is de-
layed and there is a tendency for the process to become
chronic, a stimulating application or iodine may be applied.

Suppurative Tendovagikitis. — This follows open-
injuries to the tendon-sheaths; it is the result of the en-
trance of pus-bacteria from without (punctured wounds at the
tarsal-joint j ; it may also be due to the extension of a
suppurative phlegmonous process from neigh-
boring structures to the teudon-shealhs (fatty frog) ; finally,
it may have a hematogenous origin in pyemia and
strangles.

It is characterized by the following symptoms: a
phlegmonous swelling which is very exten-
sive, spreads rapidly, is painful, and is occasionally
accompanied by abscess formation. The animal is very
lame and often has a high fever. It frequently leads to
necrosis and rupture of tendons ; to opening of neigh-
boring joints with a subsequent ichorous and suppurative
arthritis, especially in the knee-joint (the tendon-sheath of the
extensor pedis communicates with the joint-capsule), the
tarsal-joint, the fetlock -joint, and the pedal-joint ; as well
as to septic and pyemic general infection.
Occasionally the course is very chronic, several months ; the

1-J4

INFLAMMATION OP THNDON-SHEATHS

condition is alternately improved and aggravated for a period
of several weeks, relapses are common after the disease has
apparently been cured.

Treatment consists in the application of antisep-
tic s . In the early stages one opposes the inflammatory pro-
cesses by means of antiseptic bandages, baths, and applications
(iodoform gauze, camphor oiuluient, spirits- of- camphor
bandage, grey mercurial ointment). This method of
treatment, however, must not be continued
too long. When it is once demonstrated that there is pus
in the tendon-sheath or that the tendon is affected with
necrosis, an operation must be performed immediately. This
consists in incision, antiseptic irrigation, drain-
age, resection of the necrotic particles of tendon, and
the application of an antiseptic tampon covered with
an aseptic bandage. In such cases one does not
hesitate to open the sheaths of flexor ten-
dons of the horse. The only rational method of treat-
ment consists in an early free incision and a thorough disin-
fection of tlie suppurative tendon-sheath, with removal of the
pus and necrotic particles of tissue.

Tubercular Tendovaginitis. According to Hess
and G nil lebeau this is very common in cattle, it is partly
a primary affection, partly secondary to generalized tubercu-
losis. The tendon-sheath of the extensor metacarpi
(M, extensor carpi radialis) on the anterior surface of the
carpus is most frequently affected, it may be unilateral or
bilateral. Along the course of the named tendon-sheath, oc-
casionally along the entire length of the forearm, there exists
ft diffuse, hot, firm, painful swelling ; it may be as large as a
man's arm, at times crepitation is present (tendovaginitis
fibrinosa). It is characterized by severe lameness, rapid mus-
cular atrophy at the shoulder, and general emaciation. The
animal is usually slaughtered as the condition is seldom cur-
able ; the tendon-sheath presents marked thickenings, is hyper-
emic and covered with fibrin, occasionally it contains numer-
ous corpora orj'zoidea (hygroma proliferum). Inoculation of
guinea-pigs with the exudate produces tuberculosis.

HYDROPS C

■ TENDON-SHBATHS

275

A similar tubercular tendovaginitis occurs in cattle in the
superior tendon sheath of the long extensor of the toe

(M, extensor digitorum pedis longus); occasionally the disease
is simultaneous with that of tuberculosis of the knee-joint
(communication ) .

2. TENDON-SHEATH GALI^. HYDROPS OR HYGROMA
OP THE TKNDON-SHKATHS.

Causes, — A tendon -sheath gall is a condition
characterized by the accumulation of a serous
fluid in the ten don -shea ths, the walls of the
sheath are dilated and are usually thickened,
pain and other inflammatory symptoms are
absent, it is termed a chronic hydrops or hygroma
of the tendon-sheaths. It usually develops from a chronic,
repealed, serous tendovaginitis resulting from severe exertions,
it is, therefore, more common in old horses than in young.
The iuflammatory irritant is found in the mechanical rubbing
of the tendon on the walls of the tendon-sheath ; the process
is aseptic; that is, it develops without the influence of
bacteria. Tendon-sheath galls as a result of contagious
pleuropneumonia are less frequent (among 1400 horses
affected with pleuropneumonia in the Prussian Army in 1895
only five cases were observed).

Occurrence. — Hygromata of the tendon-»heaths are
most often observed in horses and draft-oxen. They are
usually classified as hygromata of the flexor ten-
don-sheaths and hygromata of the extensor ten-
don-sheaths; the former, because of their size, frequency,
and difficulty in healing, are more important than the latter.

aj The most important flexor tendon-sheath
hygromata in the horse are on the anterior limbs. The
flexor tendon-sheath hygromata at the pos-
terior surface of the carpus (the common tendon-
sheath of the flexor perforatus and perforans at the posterior
border of the carpal-joint, the hygroma originates about ten
centimeters above the joint and forms a long swelling which

terminates at the second third of the metacarpus). The
flexor tendon-sheath hygroraata at the pos-
terior surface of the fetlock, or windgalls (inferior
tendon-sheath of the perforatiis and perforans, the hygroma
forms two long swellings placed at the sides of the tendon of
the flexor perforans, behind the metacarpus and above the
fetlock -joint). On the posterior limbs, in addition to those
mentioned above, which are frequently indurated in the region
of the fetlock ; there exist hygromata of the flexor
tendons in the region of the tarsal-joint
[_tendon-sheath of the flexor perforans on the postero- internal
surface of the tarsal-joint, swelling as large as a child's head on
the inner surface, as large as a hen's egg on the posterior sur-
face — curb). Also at the summit of the os calcis (tendon-
sheath of the flexor perforatus where it passes over the achilles
tendon, it originates twenty centimeters above the summit of
the OS calcis and forms two long swellings on the inner and
outer sides of the achilles tendon, it terminates just above the
summit of the os calcis).

b) The most important extensor tendon hygro-
mata of the anterior limbs are, 6rst, those on the anterior
surface of the carpal-joint, lour so-called carpal
tendon-sheath galls. They are arranged as follows from the
lateral to the medial surface: i. Hygroma of the sheath of
the extensor suffraginis (M. extensor digit i minimi),
a swelling about the size of a goose-egg which begins at the
side and above the carpal-joint; 2, distention of the tendon-
sheath of the extensor pedis (M. extensor digitorum
communis), a swelling that extends from the lower end of the
radius over the anterior surface of the carpal-joint, to the
upper end of the metacarpus ; 3, hygroma of the sheath of
the extensor metacarpi (M. extensor carpi radialis)
in the middle of the anterior surface ; 4, distension of the
sheath of the oblique extensor of the carpus
(M. abductor poilicus longus), a swelling which passes ob-
liquely downwards and inwards from the supero- external
region of the carpus. On the anterior limbs there also occur
hygromata of the extensor tendons at the fetlock (mucous

HYGROMATA OF TENDO.V-S HEATHS

bursa, or tendon-sheath of the long extensor of the toe on the
anterior surface immediately over the fetlock-joint : swelling
the size of a goose-egg). On the posterior limbs, iu addition to
those already mentioned around the extensors of the fetlock, the
Gheaihof theperoneus tendon at the tarsus
may also become distended. It forms a hydrops about the size
of a walnut on the infero-Iateral surface of the tarsal-joint.
Finally, although uncommou and seldom large, there occurs
an extensor tendon-sheath hygroma on the
anterior surface of the tarsal-joint, that is, a
tendon-sheath hygroma of the extensor pedis in the
middle of the anterior surface of the tarsal-joint.

The walls of these hygromata occasionally undergo pro-
nounced thickening, this is especially true of those on the hind
limbs (tendovaginitis chronica fibrosa"). Corpora oryzoidea
are occasionally observed within the distension (hygroma
proliferum).

Treatment. — Hygromata of the tendon-sheaths are
usually i ncurabl e . Ordinarily they are not accompanied
by lameness and are of little importance (blemishes). In
cheap horses their removal should not he considered. Opera-
tive treatment, on the other hand, which is the only method
whereby results may be obtained, is not without danger be-
cause of the difficulty of applying an aseptic bandage. For
this reason treatment is not usually adopted.

When it is decided to employ operative treatment
for tendon-sheath hygromata, the only rational method is to
make free incisions, irrigate with antiseptics,
curette or extirpate the thick, fibrous wall, provide
drainage for the tendon-sheath and apply an aseptic
bandage. The object of the operation is to obliterate the
tendon-sheath by producing adhesions between the walls of
the sheath, and healing per prima of the incised wound. The
danger lies in the difficulty of obtaining asepsis ; infection may
lead to suppurative and ichorous tendovaginitis with a conse-
cutive septicemia and pyemia. However, the operation has
been successfully performed several limes, Puncture of
the hygroma with a subsequent injection of an aqueous

278 DISEASES OP MUCOUS BURSAS

solutiou of iodid of potash (i: 100-200) is a safer
operation, but the results are less certain. Regardless of a
few successful cases, puncture with the cautery
cannot be regarded as a safe operation. In chronic hygromata
ordinary point and line-firing, as well as applications of blis-
tering ointments or plasters, produce no results.

III. DISEASES OF MUCOUS BURSAE.

I. INFI.AMMATION OF MUCOUS BURSAE. BURSITIS.

Forms. — Diseases of the mucous bursae may be classified
like those of the tendon-sheaths and joints, namely, serous,
fibrinous, suppurative and hemorrhagic. They
may be further designated as traumatic and infectious,
acute and chronic, as well as tuberculous and
botryomycotic. According to the seat of the mucous
bursa, one further speaks of a bursitis podotrochlearis,
intertubercularis, trocanterica, prepatel-
laris, olecrani, calcanei, and infraspinati.
It is of special practical importance to distinguish between an
acute serous or sero-fibrinous, and an acute suppurative
bursitis.

Serous Bursitis. — The causes of acute serous in-
flammations (acute hygromata) of the mucous bursae are
usually traumatic. They consist in contusion of the
bursa by means of pressure, blows, or kicks, with a subsequent
extra vasate of blood (bursal hematoma) and a circumscribed
inflammation. For example, bursitis olecrani in the horse is
due to pressure on the elbow from the heel-calks when the
animal lies with the limbs folded under the body (shoe-boil).
Bursitis calcanei is due to contusions of the bursa over the os
calcis, due to kicking. It has not yet been clearly demonstrated
whether metastatic bursitis occurs, as in inflammation of the
tendon- sheaths. It is claimed that bursitis podotrochlearis
may have a metastatic origin during the course of contagious
pleuropneumonia, and that supra-atloid bursitis may result in
the same way from strangles (so-called poll-evil).

SUPPURATIVE BURSITIS

279

The symptoms of traumatic bursitis are as follows :
swelling which usually develops rapidly fover night),
local pain and heat : the consistency of the swelling is variable
(semi-solid, fiuctualing, crepitating ). The contused skin may
be partially involved. If resorption does not occur during the
course of three or four weeks, there develops a chronic,
hyperplastic inflammatory process in the walls of the bursa
(chronic hygroma of the bursa ).

Treatment of acute serous bursitis consists in mas-
sage, Priesnitz compress, application of iodo form-collo-
dion, as well as thoroughly applied ointments of iodoform,
camphor, or mercury. Incision is conlraindicated.
It leads to the danger of a suppurative bursitis as an occlusive
bandage is difficult to apply.

Suppurative Bursitis. — This is obsen.-ed in contusion*
that are accompanied by an injury to the skin and combined
with an opening into the bursa ; it also results from incisions
in serous bursitis. It is characterized by an extensive phleg-
monous swelling, as well as a purulent discharge.
It often responds very slowly to treatment which consists
in antiseptic irrigation, and drainage, as well as operative
extirpatiou of the infiltrated purulent bursa.

TuBERCVLAR BuK,«iTis. — The subcutaneous bursa on the
anterior surface of the carpus in cattle is occasionally the
seat of a tuberculous inflammation (bursitis fibrinosa). The
mucous bursa is transformed into a sac as large as the head of
a child ; from this a form of carpal tumor, a tuberculous
hygroma, may develop (Hess, Guillebeau).

Bursitis Podotkochlsaris.— This is a chronic inflammation
of the lendou-ahealh of the fUxor perfoTBnH in the
Ticinity of the navicular hone. »nd jn«t above the altach-
ment of the tendon to the 09 pedit. It ii also known a« podolroch-
litis,' inflammation of the pulley of the foot, chronic
lauienesa of the pedBl-joinl, or n a v i c a 1 a r disease- It
is especially common la narrow anterior feel of high-spirited horses.
The bursa just beneath the navicular bone is exposed to continual strain
1 from the descent of Ihe bone ; this leads to a bursitis

cuUal podolrachiLliU

HYGROMATA OF MUCOUS BURSAE

which develops very slowly wltb symptoiie of a chronic arthritis
deformans (ulceration and erosion of the cartilage of the inferior
surface of the navicular bone, with granular and rarefying ostitis and
even fracture of the uavicnlar bone, thickening of the bursa, fibrillation
and laceration of the pertorans tendon). The disease result* in a
chronic, usually incurable lameneas with conlraction of the hoof. As a
rule neurectomy is the only method of overcoming the lamenesi. —
There it alao an acute suppurative bursitis podolrocblearis due
to nail punctnres.

2. HYGKOMATA OF MUCOUS BL'RSAE (CHRONIC HYDROPS).

OccURHHNCE. — Hygromata of mucou;
velop from a chronic bursitis thn
influence of traumatic injuries; fore
tion of so-called tumors of the elbow i
on a hard surface with the anterior 1

bursce usually de-

igh the continual

example, the forma-

the horse from lying

.lbs folded under the

body, or from contusions of the bursa olecrani when the animal
is rising, or the so-called carpal lumors in cattle (contusion of
the bursa precarpalis when the animal is rising or lying down).
In cattle, a few hygromata are of tubercular origin, espe-
cially on the carpus. Tumor-like processes (cysts) appear to be
typical of many bursal hygromata. Like the fibrous hygromata
of the tendon-sheaths, chronic fibruns bursitis of the mucous
membrane may result in thickening and induration, even cal-
cification of the walls (capsule f o r m a 1 1 o n) , as well as the
production of corpora oryzoidea on the inner surface (hy-
groma proliferum, ganglion crepitans). The
neighboring connective tissue also, is involved in the forma-
tion of the capsule in the form of a chronic peribursitis. The
following are the most important bursal hygromata :

a) Hygroma of the bursa olecrani. so-called shoe-
boil, forms a circumscribed, round or oval swelling at the
olecranon process. In the horse it is the size of a fist to that
of one's head ; in dogs from that of a ben's egg to that of an
apple. In contrast to acute bursitis, it is painless, usually of a
firm, hard consistency, and the skin is more or less moveable
on the surface. It frequently occurs on both elbows in horses
and dogs without causing lameness. In well developed cases
it may be considered, not a bursitis, but a product of bursitis.

HYGROMATA OF MUCOUS BURSAE

b) Hygroma of the bursa calcanei, so-cailed
capped-hock, forms a painless, circumscribed, roundish swell-
ing at the seat of the subcutaneous bursa over the tuberosity
of tbe OS calcis. It is about the size of an apple, elastic, and
is not usually accompanied by lameness. This should be dif-
ferentiated from other pathological changes in the same region
that are also included under tbe term capped-hock ; namely,
inflammation and hygroma of tbe tendon-sheath of tbe flexor
perforatus (cap-like expansion), contused swellings of tbe skin
and subcutem, as well as osteopbytic formation on tbe
calcaneum.

c) Hygromata of the subcutaneous bursae over the
tuberosities of the ischia, and over the occipital
bone are especially common in puppies in the form of pain-
less, circumscribed enlargements from the size of a dove's egg
to that of a goose-egg ; they are firm and smooth, and the skin
is moveable on the surface. In cattle, also, one frequently ob-
serves hygromata at the tuberosities of the ischia, occasionally
they become very large (sizeofa head). In horses, hygromata
of the same size are occasionally observed on both sides of the
withers.

d) In cattle there is frectuently observed a subcutaneous
hygroma on the anterior surface of the carpus (bursa pre-
carpalis). It is in tbe form of a firm sac and may reach the
size of a man's head (carpal tumor), it is usually traumatic
(rising) seldom tuberculous in origin. This form is not
common in horses.

Trhat.ment. — Treatment, like that of hygromata of the
tendon-sheaths, is seldom indicated in bursal hygromata
as they rarely cause lameness or other functional derange-
ments. Operative treatment of tbe so-called capped-hock is
not entirely free from danger, especially when it is in tbe form
of a hygroma of the subtendinous bursa of the flexor perfo-
ratus. In all well-developed bursal hygromata
the application of blistering ointments and
plasters, as well as tbe use of the cautery
is of little influence. Mere puncture is rarely fol-
lowed with favorable results. Better results, especially in the

282 HYDROCBLB

treatment of shoe-boils, appear to have been attained by
means of pun ctu re, and injection of tincture of
iodine, with a subsequent incision in the skin and re-
moval of the necrotic sac (Kallmann); this method has
also been employed for carpal cysts in cattle ( Z e h 1 ) . If the
hygroma is entirely detached, it only requires operative
removal, that is, complete extirpation of the cyst (not mere
incision) with the knife. The operation, especially in capped-
hocks and shoe-boils, usually requires a long period of after
treatment. Continual movement and inability to apply an
occlusive bandage prolong the process of wound healing. In
the treatment of capped-hock the rapidity of healing is in-
creased under the influence of a Bayer's tension- suture, in
certain cases it may heal by first intention. Operative treat-
ment is frequently followed by the return of the hygroma
as the cause is not removed. Small hygromata may be treated,
as in man, by subcutaneous rupture. The long-
employed ligature is applicable only to pedunculated hygro-
mata. The application of counter-irritants cannot be recom-
mended. Whether the recently employed injection of pure
cultures of staphylococcus pyogenes aureus with subsequent
incision of the artificially developed abscess is of practical
importance, remains to be demonstrated.

Hydrocele. — This term indicates a chronic hydrops of the
vaginal sheath (processus vaginalis) in which the serous fluid
either lies free in the cavity of the fibrous portion of the tunica vaginalis
( hydrops ascites ), or is found as a circumscribed swelling between the
duplicatures of the tunica propria (hydrocele of the spermatic cord).
The first form is common in stallions and is occasionally observed dur-
ing the castration of these animals ; it is the product of a serous peri-
orchitis. The second form, on the other hand, while common in man»
is seldom seen in animals. Treatment, when one wishes to avoid castra-
tion, consists in the extirpation of the tunica propria. Disinfect, make
a free incision in the tunica vaginalis and expose the spermatic cord»
suture and apply an aseptic bandage.

DISEASES OF MUSCLES 283.

DISEASES OF MUSCLES, FASCIAE AND NERVES.
I. DISEASES OF MUSCLES.

RBMARKS I

I ANATOMY.

MfsCLES. — Discuses of muscles, c
tissue*, are confined, partly t
intra- and iiitcrmiiscular con

especially infl annual ions of Ibese
m nscle -fibers, partly to the

terniim end externum, as well as the fasciae and the aub fascial
spaces. The fasciae play an imporlaiit part in the surgery of
niiiscles. As the fasciie have not been ;;iven aullicient spprecintioii 111
many anatomical text-books, the following description according to
Bichbaum will bf briefly considered; "(Die Fasiien des I'ferdea."
Berliner Archiv. 1S8S and 18S9).

Fascia. — Fasc ia or uiuscle-liganient is considered a form
ot aponeurosis. This firm cotinective tissue memhrnne is interwoven
with elastic Gbers. Its ftmction is to enclose or separate muscles or
groups of muscles in B sheath-like raanner. It consists lar^^ly of
connective-tissue fibers with a few blood-vessels and nerves, this ac-
contits for its tendency lo necrosis. Interfascicular spaces arc located
between the fascist ; phlegmonous processes extend very easily and
rapidly within these spaces. The fasciae support the mnsclei in their
activity by performing the functions of a physiological pump, they
favor tlie circulatory movemetits of the blood and lymph during con-
traction and relaxation of the muscles. Ruptures of fascia; result in the
formation of muscle -hernia*, and dislocalion of muscles ^ biceps femoris
in cattle). On account of their firmness they are not often affected
with inflammation: occasionally they form a wall against outward or
inward progression of an inflaromation. On the other hand, they favor
n of subfascial phlegmons. The question of the relation of
s of the fasciae to the development of siringhall is still
open for accurate scientific demonstration.

I. FascijE OF THB Head AND Neck,— i. The snperficial
fascia of the neck (F. super6cialis colli) is in cotnbinatioa with
the cutaneous muscle in the horse (aponeurotic portion of this muscle) .
It forms two lamellx, and extends from the ventral margin of the neck
over the lateral surfaces, terminating on the dorsal margin (cervical
ligament). A median septum passes downwards in the median line of
the inferior cervical border.

3. The deep fascia of the neck (F. profunda colli )
passes over the anterior and lateral surfaces of the trachea, and forms
the cajaule of the thyroid glands above, as well as the external surface
of the guttural pouches. The jngular vein, surrounded by loose con-
nective tissue, lies between the superficial and the deep cervical fascia.
At the thoracic inlet this fascia covers the inferior tracheal glands.

284

DISEASES OF MUSCLES

encloses the tracl

J. The fascia propria of the
in the form of a sheath.

4. The nuchal Fascia (F. nuchi-) borders posteriorly tlte
subcutaneons cervical fascia, and is 10 be comidered as a lateral continu-
ation of the cordiform portion of the ligamentum nucha?. It is located in
the region above the shoulder, and is covered with the superficial cervickl
faacia. In the vicinity of the superior cervical border it is very thick
and contains the so-called fatly crest.

5. The fascia of the parotid and masseters (F. paro-
tideo-massclerica ( lies between the auricular, parotid, iuierniaxillary,
facial and niasseter surfaces. The pharyngeal fascia extends
over the entemal surface of the pharyngeal muscles.

6. Tenon's fascia (Tenon's capsule) originates on the corneal
nutrgin of the orbit, passes over the anterior portion of the schlera, and
from there to the retractor hulbi, finally enclosing the optic nerve.

II. Fasci.C of THKTHt-NK Jl.sd PELVIS. — I. The superficial
fascia 1 F. superficialis s. subcutanea) lies below the thoracic and
abdominal pannicnluB camosus, and becomes altaclicd to tlie lines alba
in the median line. Posteriorly it forms the basis of the knee-fold, as
veil as the superficial layer of the fascia of the prepuce, cavers the
inguinal ring as well as the pudic glands, and encloses the lesticlei
in tbe form of the muscular^dartoa.

2, The dorsal fascia ( dorso-Iumbar fascia. F. lumbo-dorsalis)
is divided into a supterlor. superficial layer, which covers the longiaeimus
dorsi muscle, and an inferior, deep layer, which lie^ between the lost
rib and tbe anterior margin of the ilium. Between the superficial fascia
(I) and the dorsal fascia there lies an interfascial space filled with loose
connective tissue lof surgical importance with reference to fistulons
withers and saddle- pressure ) ; similar spaces are located between the
layers of the dorsal fascia, as well as between the superficial layer of the
dorsal fascia and the longissimus.

3, The yellow abdominal tunic covers the external ob-
lique muscle. .\ continuation of this goes to form the fascia of the penis,
or the supporting ligament of the udder : in combination with tbe
terminal aponeurosis (Poupart's
muicle it forms the inguinal fold aur
femoralisl.

4, Thelumbo-iliac fascia (
the inferior surface of the iliopsoas in
continuous with the pelvic fascia.

5, The tranaverse abdomii
transversalis abdominis 1 lies between '
and the [leritoneum. Tbe tunica vagin
of this fascia.

6, The pelvic fascia (F. pelv
of the walla of the pelvic cavity.

'. iliaca B. lumbo-iliaea) careis
the lumbar region Bind becomes

DISEASES OF MUSCLES 285

7. Tlie perineal fascia (F. perineij ia divided into a super-
ficial layer {F. perinei snperficialxsl, a continuation of the snbcutaneoni
fascia of the hipi, and a deep layer iF. periaei propriai, a continuation
of the fascia of Ibe hip.

III, Fascia of the Asterior Limbs, i. The Buperficial
fascia (F. superficialiii Ilea beneath the panniculus camosusag far as
the elbow-joint, it is thin and transpiarcnt and extends as far as the
fetlock- joint,

a. The scapulo. humeral fascia ( F. brachii) lies beneath
the preceding on the exlernsl surface of the sea pillo-h a meral region,
and consists of ■ superficial ami a deep layer; the first becomes con-
tinuouB with the superficial layer of the sheath of the biceps brachii.

3. The true or deep fascia of tli e forearm (F. anti-
brachii) pa.«f;ea, in the form of a firm band, over all the muscles of
the forearm a« well as the median surface of the radius. At the carpus
it forms the deep carpal sheath IF, carpi profunda ), on the volar
surface of the carpus it forms the transverse ligament of the
carpus, it terminates al the middle of the flexor tendons in the form
of a semilunar margin. It forms several intermuscular ligament!
between the extensors and flexors of the forearm.

4. The fasciae of the foot (F. plantaris) tona broad or
small ligaments which hold the tendons in position and strengthen the
articular ligaments.

IV. The FASC1.E OF THE Posterior Limbs.— The superficial
fascia |F. superficialis) is formed from a continuation of the aponeuro-
sis of the abdominal panniculus ; it covers the muscles of the hip. the
biceps and semiteodiaosns, as well as the sartorioas, gracillis, and semi-
membranosus at far as the region of the knee ; it terminates at the

2. The fascia of the hip 1 F. gluteii) lies beneath the pre-
ceding, and is a continuation of the dorsal fascia, it covers the muscles
of the hips and buttocks, and becomes continuous with the fascia lata
at the femur. Passing downwards it is transformed into a fascia which
encloses the muscles of the femur (tensor faci* lata, biceps, semitendin-
osu^l; passes the tibia, and may be traced as far as the tarsal-joint. It
also forms numerous intermnscular septa between the muscles of the
hip and the femur.

3. The femoral ligament or broad crural ligament
(F. lata) is a continuation of the aponeurosis of the external oblirjue
muscle on the inner surface of the limb, it fuses with a projection of the
gluteal fascia on the anterior and posterior margins of the upper part of
the limb. It forms a ring for the entire musculature of the femur.

4. The tibial fascia (F. cruris) covers the mnsclei of the tibia
in the form of a very strong aponeurosis, and extends downwards over
the tarsal-joint and the metatarsus. It consists of a superficial (contin-
uation of the crural fascia), and a deep layer (formed from the tendon

"286 INFLAMMATION OF MUSCLBS

^f the biceps, semimembranosas, semitendinosus and gracillis), as well
as the common sheath of the tibial muscles. The last named mnscle-
sheath encloses the muscles and is in immediate contact with them, it
is divided into three parts: i. The muscle-sheath for the flexor
metatarsi, anterior tibial muscle and long extensor of the toe ; 2.
The tendon-sheath for the flexor perforans and popliteal muscle ;
3. The tendon-sheath for the lateral extensor of the toe.

I. INFLAMMATION OF MUSCLES. MYOSITIS.

Forms. — According to causes, the following forms are
recognized : traumatic ( contusions ), rheumatic
(cold, muscular rheumatism), infectious (bacteria), and
parasitic myositis (sarcosporidia, trachina). The follow-
ing specific infectious and parasitic types
-of myosit i s are also recognized: actinomycotic,
botry om y CO ti c, sarc ospor idic , trichinous,
tubercular, and glandular myositis. According
to the course one distinguishes an acute and a chronic;
according to the character of the inflammation, a serous,
suppurative, interstitial or fibrous, paren-
chymatous, and ossifying myositis. Finally, inflam-
mation of muscle may* be classified as primary and secondary
(symptomatic, metastatic). The latter is observed during the
course of pyemia, strangles, tuberculosis, etc. The following
are of practical importance :

a) Traumatic myositis.

b) Muscular rheumatism .

c) Parenchymatous myositis.

d) Suppurative myositis.

e) Interstitial myositis.

f) Ossifying myositis.

Traumatic Myositis. — This most often occurs in horses
as a result of contusions and exists in the form of an aseptic
inflammation, it may also result from overextension, strain, or
partial rupture of muscles. It is partly hemorrhagic, partly
serous (myositis hemorrhagica and serosa). It
if especially observed in the region of the shoulder as a result
of blows and collisions. It is a cause of one form of so-
-called shoulder lameness which is characterized by well

INFLAMMATION OF MUSCLBS J87

pronounced hanging-leg lameness and dragging of the limb;
it is usually due to an inflammation of the lower end of the
maatoideo humeralis or the biceps muscle. Local examination
reveals a circumscribed area of pain, swelling, as well
as increased h.ea t in the part on palpation. In contrast to
rheumatic myositis, the area of pain has a definite local bound-
ary, and is not wandering ; ordinarily the anamnesis furnishes
evidence of the traumatic origin. Traumatic myositis is also
observed on transports as a result of improper treatment
and narrow stalls, especially in cattle and swine in the follow-
ing places : muscles of the shoulder, thorax, and gluteal

e slaughtered the following
and hemorrhagic, gelatinous
ternal perimysium, softening,
of the muscular bundles, as
d other degenerative
Traumatic myositis usually
especially observed in those

regions. When the animals
conditions are observed : seroi
infiltration of the internal and
discoloration, and degeneratio
well as loss of transverse stri
changes in the muscular fibers,
runs an acute course; this is
cases of shoulder lameness in the horse due to muscular con-
tusions. In many, resorption is rapid and recovery is complete
in a few days. In other cases there is a connective- tissue
development between the muscle-fibers at the seat of the con-
tusion as the result of a chronic aseptic inflammation (inter-
stitial myositis : schlerosisofmusclesi. Treatment consists
in rest and massage, as well as in the application of moist
warmth iu the form of P r i e s n i t z compress.

Muscular Rheumatism. — Rheumatic myositis i3ue to
cold is most often observed in horses, dogs and cattle. The
anatomical changes are as follows: hyperemia, serous
and small-celled infiltralioii of the perimystum internum
(polymyositis serosa), softening, discoloration and de-
generation of the muscle-fibers (cloudy swelling, and fatty
degeneration) ; multiple hemorrhagic foci are less common
(polymyositis hemorrhagica). When the disease runs
a chronic course, rheumatic muscular cicatrices form as a re-
sult of new formations of connective tissue (interstitial
myositis) and atrophy of the genuine muscle substance.
The symptoms consist of lameness which develops

288

INFLAMMATION OF MD5CI.HS

suddenly after a previous cooling (rheumatic shoulder lameness,
Theuniatistii of the shoulder, oraodynia, rheumatic sacral lame-
ness, lumbago), oblique position of the neck (lorticolis),
occasionally dyspnea (pleurodynia). Shoulder lameness may
be caused by a myositis of the mastoideo humeralis, lameness
ia the sacral region by myositis of the psoas muscles. These
muscles are painful on palpation, this is especially true of
the psoas muscles in lumbago of the clog. Hemoglobinuria
(lumbago, axoturia) of the horse is considered a rheumatic
myositis of the lumbar muscles, in contrast to traumatic myositis
the rheumatic form is often wandering and recurrent ;
it often temporarily disappears entirely when the animal is
moved for some time. It also has a much greater tendency to
run a chronic course. Treatment consists in the external
application of moist warmth, massage and stimulating appli-
cations (spirits of camphor), as well as the internal adminis-
tration of salicylic preparations (horses loo grams, dogs 2 to
8 grams, of salicylate of soda per day), antifebrin or anlipyrin.
In very obstinate cases of rheumatic shoulder lameness in the
horse one may also employ subcutaneous injections of veratrin
(0.05 grams veratrin in 5.0 grams spiritus). Very painful
omodynia in the horse, and lumbago in the dog, are often
rapidly improved by subcutaneous injections of morphine
(o.oa-0.05 grams). The combined application of atropin and
morphine in shoulder lameness of the horse, on the other hand,
is not safe (fatal colic).

PARENCHVMATors MYOSITIS. — As a result of excessive
muscular exertion, and pronounced exhaustion of the muscu-
lature of the body, especially from overheating as a result
of riding for a long distance, running on the
track ("race-track disease"), after slanding for a longtime
in the cars ("shipping-disease" of cattle), after tying
horses high in the stall for a long time, after driving cattle
long distances, after casting, as well as a result of severe at-
tacks of hemoglobinemia (azoturia), there develops in
horses, occasionally also in cattle, an acute, parenchy-
matous degeneration of muscles, with symptoms
of parenchymatous myositis. The following groups of muscles

INFLAMMATION OF MUSCLES 289

are most oflen affected : the dorsal and j^luteal muscles, those
of the psoas group, the quadriceps and the anconeus. On ex-
ternal examiuatiun of these muscles, especially the longissimus
dorsi and the glutei , one finds in the early stages, a hard
swelling and severe pain on palpation, the back is
carried stiffly; occasionally one also observes symptoms
of colic, hemoglobinuria, and high fever.
According to the degree of extension and localization of the
muscular degeneration one further observes, either a general
or sacral paralysis fsacral weakness), or a paralysis
confined to the extensors of the knee and elbow
( falsely so-called crural and radial paralysis) ; it may be uni-
lateral or bilateral. The macroscopic anatomical changes
are as follows i pale, light-grey color of the muscle, occasion-
ally it is colored like the flesh of fi»h, is abnormally friable,
and has a cooked appearance. Intramuscular hemorrhage and
rupture are sometimes observed. Microscopically, in addition
to the symptoms of secondary inilaramation, various forms of
muscular degeneration are seen: cloudy swelling (al-
bumenoid), fatly, hyaline or amyloid degenera-
tion. The termination is variable. At times the
animal dies suddenly as a result of general paralysis. la
other cases degenerative atrophy of the involved
muscles may occur, it is partly cbronic, partly acute and is
characterized by symptoms of paralysis and weakness.
Treatment consists in the use of slings, massage, and elec-
tricity, as well as subcutaneous injections of caffein and
camphor.

Since the year 1896 when I first refsrred to the pareochyma-
tuua form of rayositis, which results froiD overbeatitig, aud
casting of horses, and called attention to the relation between
this and hemoglobinuria, many similar cases have been observed
iu taorsea and cattle. A honie that was thrown for neurectomy
became very uneasy, on the following day thtre developed symptoms of
hemoglobinemia. The post morteiii revealed parenchymatous poly-
myositii (I'reiiss. Stat. Militar-Vetetiniirbericht pro 1900). .\ homo
showed all the iyniptoms of hemoglobinuria after an operation that
laited an hour and a quarter, daring the operation the animal stinggled
violently (Dages). A. hone that nas operated showed symptoms of
paralysis three days after being cast, bemoglobiuuria became evident

on the foarth : postmortem reverfled myositis of themusclesot the limbs.
A two-and-one-lialf year old colt was led go kilometers [55 mile*], after
which it stood a half day ia the market. It ahowed genentl mnscuUir
paralytia, acute degenerative bilateral muscalar atrophy in the gluteal
and femoral regions, as well as hemoglobinuria ; it was two motitha be-
fore the animal wa* able to stand (Warncke). Hemoglobineinia
occurred In a con as a result oF overexertion during trauaportatii
pOBt moitetn revealed paleness of the musculature and rupture of the
right extensor of the patella (Rijegg). Villagio considers "shipping
diaease" in cattle as a ptimaty larenchvmalous myositis due to over-

SopptiRATivE Myositis. — This occurs in infected muscle-
wounds, either in the form of a phlegmonous myositis,
or muscular abscess; it leads to suppurative liquefac-
tion and necrosis of the muscle aud its fascia, to hstula forma-
tion, burrowing of pus, septicemia, and pyemia. In other
cases interstitial myositis leads to encapsula-
tion of the suppurative foci. The latter form is
especially observed in the so-called shoulder abscess of
the horse. It is partly due to infection with streptococcus
and staphylococcus pj'ogenes albus, partly to that of the botryo-
myces organism ; it results in a circumscribed suppurative.
myositis of the mastoideo humeralis, the infection gain-
ing entrance through superficial contused wounds in the skin
assisted by the lymphatic system. In one case observed by
Johne the tubercle-bacillus was the cause of a shoulder
abscess in the horse. Multiple abscess formation of the
muscle (myositis apostematosa multiplex) may have a meta-
static origin as a result of the activity of pus-forming bacteria,
or it may be caused by the streptococcus of strangles, it is
observed during the course of pyemia and strangles. Treat-
ment of suppurative myositis consists in free incision, or
extirpation of the encapsuled abscess in shoulder tumors. The
treatment of shoulder abscesse* by means of parenchymatous
injections of concentrated salt solution cannot be recommended
<Schmidt); according to Schilling a horse treated by
this method died in four days as a result of gangrene and
sepsis; Esser has employed it two different times with
unsatisfactory results.

Interstitial Myositis,— Intcrst it ial fibrous myo-

INFLAMMATION OF MUSCLES 29I

sitis(schIerosis of muscles) is a chronic inflammation of muscles
characterized by a new formation of connective tissue, it leads
to induration and contracture of the muscles, and may be
caused by various inflammatory stimuli. It is
observed during the course of chronic muscular rheumatism ;
after traumatic, suppurative, actinomycotic (wooden-tongue),
tubercular, and botryomycotic myosites ; in muscular paralysis.
and muscular atrophy. In some cases the inflammatorj- irri-
tant is not recognized. In most cases, however, it originates
from the activity of bacteria or parasites. Many cases of
so-called rigidity of the os uteri in cattle may be designated as
chronic interstitial myositis of the cetvix uteri. Pal at has
described a peculiar case of multiple interstitial
myositis in the horse. In an omnibus horse there occurred,
without visible cause (encysted muscle parasites?), hard swel-
lings on the throat, shoulder, thorax, and hips, as well as on
the buttocks ; this was soon followed by a slowly developing
general muscular weakness so that it was necessary to destroy
the animal. On post mortem examination he found con-
nective-tissue new-formations between the muscle-fibers of the
groups named ; nodules were scattered through these areas ;
in character they were fatty, calcified, and cartilaginous.
Fibrous myositis is incurable unless actinomycotic in character
(incision and iodin for wooden- tongue).

Ossifying Myositis. — Osseous formation during
the course of inflammation of muscle has been frequently ob-
served in horses, dogs and swine (Kitt, Cadiot, Con-
stant. Stephenson, andothers). The causes arc extremely
variable. Part of the cases are due to multiple
exostosis formation at the seats of muscular
attachments, ossification of the muscles is a
secondary process. An interesting case of multiple
hyperostosis formation in the horse has been described by
Constant; it was identical with a form which is occasionally
seen in young people, where it is termed myositis ossifi-
cans multiplex progressiva. Because of chronic
incurable lameness the patient was destroyed. On post mortem
it presented the following characteristics: the attachment of

2^2 INFLAMMATION OF MfSCI.ES

the middle gluteal muscle was ossified, in the beUj of the
muscle there was located au osseous tutuor the size of one's
fist, adhesioas had taken place between the muscle and the
pelvis ; the pectineus and adductor longus muscles were also
adherent to the pelvis and ossified. The internal obturator
muscle formed a bony tumor (osteoma) on the inner margin
of the obturator foramen - finally, the ossified muscular attach-
ments projected from the trocanteric fossa in the form of bony
stalactites. — In other cases the ossifying myositis assumes the
form of a tumor-like process i osteoma i or it may orig;i-
nate from callus formation as a result of fractures. In man
ossifying inflammation of the muscles is occasionally observed
after continued traumatic influences (exercise of the biceps,
rider's bone in the gracillis). Similar changes have been

foaod in the biceps bracbii of the horse i
intertubercularis,

:sult of bursitis

MvosiTis
wandering of lacc
tubttUs, Kiega
iheep, and faones (i
spores Brian(;ed in ca[
formed into wandering

nof D

!■ especially [observed i
and hetbivora!. These
vben the capsule rupture
lis whicb penetrate the adjac

s due to the

wine, cattle,
sicle-ahaped ■

maBcnlatui* I

in the form of an inflammatory ioHltretion. In the shoulder and doraat ]
mnsclea of the horse ihey occasionally lead to the formation of aari
sporidia-Bwelltn^^ aa lari^e ai one's fi«t, hard, and uhite or grej
in color. Id sheep they lead to the formation of encapsaled sercOBpo- |
ridia-cysts in the mnsculature of ihe esoplia>ruB, they reach the size of a
pea. A» a rule, however, the non-ruptured capsule is harmless, and it
it a frequent condition. It is tuosl often fonnd in ihe muaclea in
Ihe vicinity of ihe oral and pharyngeal cavities, as well as thoae of
the esophn^^us, in the tongue, in the masseter, buccinator, laryn-
geal, BDd pharyngeal mtiscles. Occasionally their presence in muscl*
leads to inlerititial myositis with atrophy and cellular infiltralion of the
connective tissue of the adjacent muscular fibers. In other cases tb«
flesh i>f cattle is clear and has an appearance of the flesh of calves, this
la due to the presence of targe numbers of sarcosporidia. In old
horaes, as well as buffaloes. sarcoHporidia appear to
be constantly present, in swine, also, they were found in a
fourth of those examined by Ferroncito. .\mong a hundred casea
of cachectic sheep examined by Moul^, sarcoaporidia were found
in sinety-nine. M i as c h e r ' s tnbulea are very common in Ihe moa-
dea of herbivorona domestic animals, they seldom canae diaeaee in the

RUPTURE OF MUSCLES 293

Host; only in very rare cases have symptoms been observed which
were dne to ieflammalorj changes in the tnnsclc as a result of the pres-
ence of targe Dnmbers of saTCOSporidia. Hodich hat desctibed an in-
terestin;; case of (Eloasilis chronica sarcoaporidica in a hoiae ; it was char-
acterized by pronounced thickening of the tongue, deranged prehension
of food, as well as emaciation. Dam man u and t, N'iederhausen
observed dyspnea in a sheep and a goat a* a result of inflammation
of the pharyngeal and laryngeal mnaclei. Br<.>uwier and Toka-
renko obaerved difficulty in walking and standing, even complete
muscular paralysis in steers. \' t r c h o w saw [>aialysts of the posterior
extremities in swine. In two swine Brsc bosnio wsk i observed
loss of appetite, continued recnmbent position, pain on pressure in the
muscle, arched back, irregular movements of the hind parts, hoarse
voice and fever (suspected Irichino^ia) ; after slangliter the musculature
was found to be watery, cloudy, and penueated with nnmerous sarco-
sporidia. For further information concerning the literature and devel-
opment of aarcosporidia compare with symptoms of myositis Irichinosa.
(Cf: Friedberget and Prohner. Special Pathology of the
Domestic Animals. 1904, 6 Ed., Vol. I.).

2. RUPTURB OF MUSCLES.

Causes. — ^Muscle- rupture occurs most often in horses and
cattle, partly as a result of contusion and rupture from with-
out, partly from overstraining and excessive muscular con-
traction. As in tendon -rupture, in addition to ordinarj* trau-
matic causes, so-called spontaneous ruptures may occur as a
result of diseased changes in the muscle. In general muscle-
ruptures are not common ; in the years 1888-1896 about 1800
cases, 300 a year, were treated in the Prussian Army for
contusion and rupture of muscles. As a rule the ruptures
involved the fiexor metatarsi (30 cases per year). In the
years 1886-1895 I found only twenty cases of muscle-rupture
among 70,000 diseased dogs.

Occurrence. — Muscle-ruptures are moat frequently ob-
served in the following places: abdominal muscles
(blows and overstretching during the course of pregnancy in
cattle, lesB frequently from casting horses); muscles of
the posterior limbs ( overstretching from slipping, strug-
gling when fettered, abnormal contraction when kicking): as
well as in the cervical, shoulder, and thoracic muscles

aUPTDRB OF MUSCLES

(caused in the horse from ruoning against wagon poles). Th
individual muscles most frequently involved ate the tibialis
anticus: rectus, obliquus, and t ransversa 1 is
abdominis: the quadriceps femoris; the glutei,
and gastrochnemii; the biceps femoris andJ
brachii : the mastoideo humeralis, and pect oralis,!
Symptoms. — According to the physiological activity oi^
the ruptured muscles one observes various derangements ia
function in the vicinity of the muscular apparatus, namely,
lameness, symptoms of paralysis, and prolapse.
At the seat of rupture one can frequently recognize a space
or cavity on the edges of which one may palpate tfae
ruptured and afterwards swollen muscle ; occasionally there
exists a fluctuating swelling at the seat of rupture due to the
formation of a hematoma following rupture of blood-
vessels. The most important muscle-ruptures present the
following symptoms :

a) Rupture of the tibialis anticus muscle results
in abnormal extension of the tarsal-joint with severe bangiag-
leg-lameness. dangling movements of the limb, and relaxation
(folds) of the achilles tendon. On account of the muscles
being covered with the fascia of the limb and the extensor .
pedis, there is not usually visible, either depression, hematom*
formation, or swelling. The prognosis is not unfavorable ;
healing occurs in from one to two months.

b) Rupture of the gast roc hnemi u s produces the]
following symptoms : relaxation of the achilles tendon, andina-
bility to support weight at the knee or tarsal joints, such 1
attempts being followed by excessive flexion. A space is usually I
present in the course of the gastrochnemius muscle. The I
prognosis is very unfavorable ; healing in horses and cattle is J
rare.

c) Rupture of the quadriceps femoris isfollowe<lj
by symptoms of paralysis of the quadriceps, namely, inabilitjrf
to support weight at the stifle (sudden flexion),

d) Rupture of the abdominal muscles is occa- I
sionally followed by an abdominal rupture (hernia abdomi- 1
nalis), this is especially true of cattle.

ATROPHY OF MUSCLES

195

e) Rupture of the mascoideo-humeralis results in the
following s>Mnptoms: hangiug- leg-lameness of the involved
anterior limb, hematoma formation, occasionally abscess for-
mation at the seat of rupture,

Treatment.— Reposition of the ruptured muscle ends
by means of the muscle suture is not practical in large domes-
tic animals. Treatment consists in providing rest (slings,
high lieing), in certain cases massage may be employed.
Healing of the ruptured area occurs through the formation of
a cicatrix as the result of an aseptic interstitial myositis ; oc-
casionally cicatrization leads to contracture of the muscles and
permanent shortening (torticollis after rupture of the mastoi-
deo-humeralis).

Luxation of Mltsclks. — This name signifies a cliange in position
(dislocation) of certain mtiscles. The bleep* femom in cattle is occa-
sionally involved u a result of slippitig ; the uppier insertion of (hia
muscle becomes detached trom the trocanter and is displaced back-
wards ; it results in sudden lameness with extension of the entire limb
and inability to fleic the joints. TreHtment is operative (myotomy). It
is stated that luxation of the biceps femoiis »nd bmcliii is occasionally
observed in the horse (Feger. Dominik).

ATROPHY OF UUSCLBS.

Causes and Forms. — Muscular atrophy is a symptom
of various pathological conditions. The following forms are
recognized :

a) Simple muscular atrophy consists in diminution
in the size and number of muscle-fibers without degenerative
chauges. It is observed in the form of so-called atrophy
of inactivity, it is a constant symptom of
chronic lameness, it is most often found in connection
with spavins and ringbones in the horse, and during the
healing of bone fractures. The forensic importance of mus-
cular atrophy for the determination of the duration of
lameness is usually overestimated. Regardless of the fact
that very often the relation between a lameness and an existing
muscular atrophy is not sufficiently demonstrated, experi-
ence has proved that a visible atrophy of the
muscles of the gluteal or shoulder region*

296 ATROPHY OF MUSCLES

may develop much more rapidly than is gen-
erally supposed. Atrophy develops more rapidly when
the animal is in good condition and very lame. The princi-
ples maintained byGerlach in his standard veterinary
medicine (1872) are still in force. According to his work the
parenchymatous fluids of the soft tissues may become visibly
diminished in a very few days. In very painful cases of
lameness the fatty tissue is visibly diminished after eight
days; in very fat animals this may result in extensive atrophy
of the limbs within two to three weeks. In mus-
cular animals the flesh and cellular tissues
have undergone visible atrophy in three
weeks. Tendon becomes atrophic after a few months ; the
bones and hoof become visibl^*^ smaller after three to six
months.

b) Degenerative muscular atrophy consists in
cloudy swelling, fatty, wax-like or hyaline, and amyloid de»
generations, as well as disintegration of the muscle-fibers. It
develops after inflammation and paralysis of muscles. It is
most often observed in the horse as a result of parenchymatous
myositis of the longissimus dorsi, the gluteal, the quadriceps,
and anconeus muscles in azoturia ; it may also occur after
overheating and casting. In this manner a very rapid form of
atrophy may occur, so that high-grade muscular atrophy
may be visible on the back and hips in a few days (even
entirely unilateral). It is also observed after paraly-
sis of the suprascapular nerve (atrophy of the
spinati muscles), the radial nerve (atrophy of the anco-
neus), the trigemminus (atrophy of the masseters), as
well as the recurrent (atrophy of the left laryngeal mus-
cles ; roaring). It is also seen in muscular rheuma-
tism, in diseases of the dorsal marrow, as well
as in chronic lead poisoning (atrophy of the laryngeal
muscles; roaring).

c) Lipomatous atrophy or pseudo- atrophy (lipo-
masia) of the muscles consists of an interstitial fat-cell pro-
liferation with displacement of the muscle-fibers.

Treatment. — Degenerative atrophy is usually an incur-

NECROSIS OF FASCI.1i

able condition. From a prophylactic standpoint, to prevent
development, one may employ exercise, massage, vola-
tile applications, and electricity, as well as inter-
nal stimuli (strychnine, veratrin , caffein).

HvPERTBOPBv OP MrscLH. — This term signifies a Condition
opposite to that of muscular atrophy, it ts usually the result of increased
activity (training). When horses are checked high tliere also develops
a hypertrophy of the steruo-maxillariB. and sterno- thyro-liyoideua
muscles as these are especially involved ; occasionally they present
i^ymptoms of myositis. Sometimes one finds unilateral hypertrophy of
the mastoideo- humeral is in normal horses.

II. DISEASES OF FASCI.E,

NECROSIS OF FASCI.E,

Cai'SBS. — Necrosis of the faacia is of special importance in
the horse ; either its presence is unrecognized or its importance
is underestimated. It results, either from a suppurative
muscie-wound or from intermuscular attd subfascial
phlegmons. lo both cases the fascia easily becomes
necrosed because of its non- vascularity. On account of the
firm structure of fascia, and because of the deep position and
horiKontal extension of many fasci:c, spontaneous sloughing
and removal of the necrotic part is either very difficult or impos-
sible. Necrotic portions of the fascix- lead to chronic suppura-
tive processes and fistula formation which can only be removed
by operative means, that is, the oecrosed tissue must be cut
out.

Symptoms, — That class of pus fistula; described in veteri-
nary surgery under the names fistulous withers,
shoulder fistula, fistula of the buttocks,
fistula of the fetlock, and coronary fistula
are often maintained in the following manner : as a result ol
suppurative and phlegmonous processes, necrosis of the fascia
is caused in the depths of the dorsal, shoulder, and gluteal
muscles, as well as in the fascia of the foot ; this necrosis
maintains a chronic suppurative condition. The necrosis is
usually circumscribed ; it may, however, become very exteu-

398

RnPTURE OF FASCIA

sive. for example, a diffuse subfascial phlegmon along the-
course of llie lougissimus dorsi may cause septicemia and ter-
niiuale fatally. I have observed one example of this in a case
of fistulous withers in the horse.

Treatment. — When necrosis of the fascia is supposed to
form the foundation of a fistula, one should not he.sitate to-
expose the dead pieces of fascia by means of exleniive,
deep, long, and broad incisions, through which all
the necrotic portions are removed by means of the
scalpel or scissors. In this maoner fistulae of the
withers, shoulder, and gluteal regions that
have been in existeuee for months may be
healed in a few weeks. One had better remove too
much thaa too little from the diseased muscle and fascia*
otherwise it will be necessary to repeat the operation. First
make long, deep incisions, through which,
under certain circumstances, pieces of ftesh
as large as a pound may be removed, excise
the fascia regardless of its extent; by follow-
ing this method of treatment I have been able
to cure many cases of fistula in the horse. The
after-treatment consists in preventing stagnation of the wonnd
secretions in the depths of the fascia and muscles. This may
be accomplished, either by means of open-wound treatment or
drainage ; when practical it is best to employ permanent anti-
septic irrigation of the operation wound for several days.

«
I

RUPTURH OF FASCIjE.

Results. — When the superficial fascia, not the mnscle j
itself, becomes ruptured subcutaneously by means of blows or 1
kicks, the soft muscular structure sometimes projects through
the rent in the fascia. The involved area presents a visible,
circumscribed swelling. So-called muscle-hernia is
caused, especially in the horse, by kicks or pole-thrusts
and occurs on the muscles of ihe limbs or neck. In the
horse I have several times observed hernias of the semimem-
branosus, of the mastoideo-humeralis, and of the anconeus. On
palpating such a hernia one feels the sharp firm margin of

PARALYSIS OF NBRVES 299"

the fascia, and a soft area in the center. It is best to allow
hernia of the muscle to recover without treatment ; when the
condition is aseptic and lameness is absent, incision of the
skin with subsequent suturing of the torn fascice is superfluous.
le t«rmitringtialt tiignifies apecaliarderauRemeiit
axial of the horse which is characlerlied by a
sudden, jerking, involnnlary. eacessive flexion of all the joints of the
hind limb. The causes have not been satisfactoril? explained. An
idiopathic form of atringhalt ii recogniied ; by some it i« considered
a coalracHoD of the tibial fascia, a retraction of the lensor
fascia lata, or the tendon of the peroneus; bj others, a shortening of
the transverse ligaments of the patella ; while some refer it to a nervous,
affection (disease of the ipinal cord, periphera] aeuritis, teSex nenro-
sisl. The treatment, therefore, is extremely divergent ( incision of the
tasciit. articular ligaments, tendons, nerves). Symptomatic string-
halt forms one of the symptoms of spavin, ringlione and scratches, as
well as varions affections of the tarsal and pedal-joints (treads on the
coronet, nail-pricks, clefts in the horn I ; they produce reflex symptoms
which may be compared with the twitching movements observed in
people suffering from gout.

III. DISEASES OF NERVES.

I. PARALYSIS OF NERVES. PARESIS AND PARALYSIS.

Forms. Various forms of paralysis of the nerves arc
recognized according to the grade, origin and extent. First,
one recognizes two grades of paralysis, namely, simple
weakness, paresis or incomplete paralysis ; and com-
plete paralysis. According to the origin the different
forms of paralysis are classified as cerebral, spinal,
and peripheral, with reference to the seat of the disease
in the brain, spinal column, or peripheral nerves. One also
diSerentiates motor and sensory, neurogenic and
myogenic paralysis. Finally, with reference to the extent
of the paralysis, it is termed monoplegia when only one
limb or group of muscles is involved, when one entire side of
the animal is affected it is termed hemiplegia; when bilat-
eral, it is termed paraplegia. The division into atonic,
spastic, organic, and functional paralysis is of slight import-
ance in veterinary science.

300

PARALYSIS OF NERVES

Causes. — The causes of paralysis of nerves are extremely
variable. Cerebral and spinal paralysis may be due to the
following causes : disease of the brain or spinal marrow, trau-
mata, infectious diseases, and poisons ; peripheral paralysis
results from rapture, laceration, compression and inflammation
of the peripheral nerves.

DiFFERKNTiAL DIAGNOSIS. — It is casy to differentiate
between cerebral, spinal, and peripheral paralysis. Paralysis
due to an affection of the brain is usually characterized by
monoplegia and hemiplegia. Freciuently one of the cranial
nerves is involved, and it is often accompanied by derangement
of the consciousness. There are several symploms by which
spinal paralysis may be differentiated from cerebral. Ordi-
narily it results in paraplegia, while the cerebral produces
mono- or hemiplegia. This may be explained by the small
size of the spinal marrow in comparison with that of the brain ;
the pathological process usually affects the entire transverse
diameter of the organ. For this reason the paralysis is both
motor and sensory (anterior and posterior horn s^ This results
in paralysis of all the muscles situated posterior to the diseased
area in the spinal cord. Psychic derangements are usually
absent in spinal paralysis, the cranial nerves usually remain
unaffected, in cerebral paralysis they are usually involved.
Simultaneous paralysis of the bladder and rectum indicates a
Spinal affection. Spinal paralysis usually extends forward
from the primary seat, ascending. Finally, trophic derange-
ments in the paralyzed structures (muscular atrophy) are
especially characteristic of spinal paralysis. Peripheral
paralysis involves only individual muscles or groups of mus-
cles without cerebral or spinal complications. Occasionally it
is very difficult to differentiale between neurogenic and
myogenic paralysis. That form of parenchymatous myositis
of the anconeus and quadriceps group, which is especially fre-
quent in the horse, may possibly be falsely termed radial and
crural paralysis.

Symptoms of Peripheral Paralysis. — While cerebral
and spinal forms of paralysis produce symptoms of motor and
sensory depression of the brain and spinal marrow, disease of

ARALVSIS OF NHRVE;

the peripheral nerves results in symptoms which vary ac-
cordiag to the function of the nerve involved. In veterinary
medicine the most important forms of peripheral paralysis
result in the following symptoms:

i.) Facial paralysis results in a unilateral par-
alysis of the muscles of the face. The upper lip
and the point of the nose are drawn in the
direction of the normal side, the under lip is dis-
torted in a similar manner or hangs downward. Food ac-
cumulates between the cheeks and the teeth. The nasai
openings are constricted (peripheral paralysis). The ani-
mal js unable to close the e y e on the afTected side, tears flow,
the upper eyelid also hangs downward (ptosis). The ear
may also be paralyzed (central paralysis).

b) Trigeminal paralysis, caused by patalystsofihe
motor branches of the trigeminus, results in a paralysis of
the muscles of mastication. It causes difBcuIt pre-
hension of food, salivatioD, dropping of the in-
ferior maxilla, and atrophy of the muscles
of mastication.

c) Paralysis of the saprascapul&ris is char-
acterized by a peculiar form of shoulder lameness in
which the shoulder springs outwards when weight is
placed on the foot of the involved side ; a space variable in
size is present between the thorax and the elbow. There after-
wards develops a pronounced atrophy of the spinati
muscles and the rotaters of the shoulder.

d) Paralysis of the radial nerve, which
innervates the extensor muscles of the forearm and limb,
especially the extensors of the elbow (anconeus), is only in
part a general paralysis of the nerves, In other cases it is
a myogenic paralysis of the anconeus (hemaglobinemia,
myositis after calling). It is characterized by in-
ability of the involved limb to support the
body weight. All of the joints of the foot are flexed,
they cannot be extended to support the weight of the body.
By pressing backwards on the carpus, the limb may he main-
tained in a position to support weight. The paralyzed muscles
feel relaxed, finally they undergo atrophy.

:302 INFLAMMATION OF NBRVBS

e) So-called paralysis of the cmral nerve is
usually not due to paralysis of the nerve, but to that of the ex-
tensors of the knee (quadriceps femoris) ; it may follow azoturia
or casting. It results, when supporting weight, in an abnor-
mal flexion of the knee-joint; as a result of par-
alysis of the extensor muscles extension of the knee-
joint is impossible. Chronic paralysis is followed by
liigb-grad-e atrophy of the muscles of the
knee .

f) Obturator paralysis results from pelvic frac-
tures in the vicinity of the obturator foramen (inflammation
and compression of the nerve through callus masses). It is

* characterized by abduction of the involved limb as result
of paralysis and atrophy of the adductors.

Treatment. — Therapy of nerve paralysis consists in the
application of massage, cutaneous irritants, elec-
tricity, methodical movements, as well as the sub-
cutaneous injections of strychnine and veratrin.
Among the peripheral forms of nerve-paralysis the following
have a relatively good prognosis : the facial and the radial,
paralysis of the suprascapularis and quadriceps is frequently
incurable.

2. INFLAMMATION OF NERVES. NEURITIS.

Causes. — Inflammation of nerves is of slight importance
in veterinary surgery, it is very rare on the one hand, and on
the other it is very difficult to recognize subjective symptoms
on the part of the animal. The causes, as in man, are of a
traumatic, infectious, rheumatic, and toxic
nature. Traumatic neuritis occasionally develops at the central
nerve-stump after resection of a nerve, this occurs as a result
of inflammatory processes in the immediate vicinity which
extend to the nerve. Inflammation of the planter nerves has
also been observed in the horse after interfering. Thom-
m a s s e n has described a neuritis of the sacral plexus
apparently due to rupture of the nerves from jump-
ing. Hemiplegia laryngis (roaring in horses) is of special
importance with reference to its relation to contagious

INFLAMMATION I

303

plearopneumon ia. It occurs as a sequella of this dis-
ease, and by many is considered a neuritis of the recurrent
nerve which lies in the left pleural sac and is caused by an
extension of the inflammatory process from the pleura to the
nerve at the point where it passes arouad the posterior aorta ;
this leads to unilateral paralysis of the laryngeal muscles.
Also, paralysis of the laryngeal muscles which occurs in horses
during the course of chronic lead poisoning is con-
sidered by Thomassen as merely the result of a primary
chronic neuritis of the recurrent characterized by connective-
tissue new-formation and degeneration of the nerve. Accord-
ing to recent investigations of von Marek, dourine in
the horse is not an affection of the spinal marrow, but an
infectious polyneuritis. He found round-celled infiltration
and connective-tissue new-formation, especially in the ischi-
adicus, tibialis, and crural nerves, to some extent, also, in the
median, infraorbital, tarsal, and intercostal nerves ; according
to him the symptoms of paralysis in dourine are of a peripheral
nature. An infectious, multiple, peripheral
neuritis occurs in animals and men in Dutch-India as a
result of eating clodded rice, it is known as bcri-beri-
•disease. According to some stringhalt in the horse is due
to a neuritis of the ischiadicus (? ). In the domestic animals
one often observes inflammatory processes in the optic nerves
and the retina : neuritis retrobulbaris, papillitis, and retinitis.
Anatomical Changes. — As in inflammation of other
organs, the following forms of neuritis are also recognized :
suppurative and interstitial ; the first is an acute,
the second a chronic form of neuritis. Macroscopically.
acute neuritis is characterized by redness, swelling, and a
serous or suppurative exudate between the fibrous bundles.
Microscopically one finds dilitation of the blood-vessels, small-
celled infiltration, nuclear proliferation of the aheath of
Schwan, as well as degeneration of the marrow, and axis-
cylinders. In chronic neuritis one finds connective-tissue
new- formations (induration, schlerosis) with a subsequent de-
generation and atrophy of the nerve-fibers. In the case of
neuritifl interstitial is proliferans of the sacral plexus described

INFLAMMATION OF NERVES

imes as thick as normal
tissue proliferatioD with

304

by Tbomasseti the plexus
and presented high grade
secondary atrophy of the nerve fibers.

Symptoms. — Neuritis of the sensory nerves is charac-
terized by severe pain in the involved area, and paralysis
and atrophy of the groups of muscles supplied by
the affected nerves. Interstitial neuritis of the sacral plexus
results in unilateral, severe muscular atrophy of one side of
the hip, and one limb (glutei, biceps femoris, seml-tendi-
nosus). In general, the clinical symptoms are very slight,
regardless of enormous pathological changes. Zietsch-
m a n n observed two cases of chronic interstitial neuritis of the
axillary plexus with neuroma lorniation in cattle, it resulted in
pronounced connective-tissue proliferation, no genuine paraly-
sis, but only slight muscular weakness of the affected limb.
Treatment consists in the application of nervines (morphia,
cocaine, strj'chnine, veratrin), as well as counter-irritants to
the skin, massage, and electricity. As a last resort for neuritis,
sensory nerves may be severed (neurotomy), or a section may
be cut out (neurectomy), or extracted (neurexairesis).

Nei;R0TOUV. — For certain incurable, painful forms o[ lamenras in
the borse (UmeneM frum ringbone, chronic navicular disease, con-
tracted hoof, chronic tendinitis, etc. I severing Ihe nerve is a valuable
pallintivB remedy. Anitoals that are othenvise use lets are reBtored to
a certain amount of ntililv. For indicaiioiis of this ojieration kc
Bayer's article in Volume I. of this hand-book. The changes
that occnr in a nerve that has been severed consist In
fatty and gtannlar degeiieration of the entire periphery from the severed
end of the cut section to its finest branches (descending degeneration).
At the same time, bowever, there begins a collateral anastomosis for-
mation with regeneration of the nervc-tissne from the central end, new
nerve-fibera sprout from thiaatump, extend over the defect, and grow into
the xieripheral channels so that the function of the peripheral nerves i*
restored again after a certain length of time. In soppurative infection
of the operative wound, as well as in continn«d traction on the central
end of the severed nerve, there develops a chronic interstitial inflamma-
tion of the central stump with the formation of a neuroma (seepage

DISEASES OF VESSELS

DISEASES OF VESSELS.
DISEASES OF ARTERIES.

-AMMATION OF ARTEBIHS. ARTHl

Forms. — One recognizes, first, an endarteritis, mes-
arteritis, and periarteritis according to the location of
ttie disease in the inner, middle or outer coat of the arterial
wall. Accoiding to the causes and course, one further
recognizes an aseptic, and septic or suppurative,
a traumatic and bematogeuic, an acute and
chronic, as well as a deforming, ossifying, and
obliterating arteritis ; the latter is characterized by clos-
ure of the vessels. The acute suppurative and chronic deform-
ing forms of arteritis are of special practical importance.

a) Acute suppurative arteritis is the result
of an infection of the arterial wall with staphylococci or strep-
tococci. It either originates in the advenlitia (periarleritis
purulenta), or it may extend from the injured intima (suppura-
tive thrombo-arteritis), or it may result from an embolism in
the blood (pyemic metastasis). Suppuration of the intima
results in a loss of the endothelium (suppurative necrotic
endarteritis).

b) Chronic deforming arteritis or a rter lo-
se hie ro sis (atheroma or atherosis of the vessel) is a mul-
tiple, focus-like, ulcerative endarteritis with connective-tissue
thickening of the intima ; the latter becomes necrosed and
defective (so-called artheromatous ulcers); it is followed by
fatty degeneration and calcification of the media. It leads
to induration, stenosis, and obliteration, or dilitation and
rupture of the diseased vessel-walls. While it is very frequent
in man (symptom of old age. alcoholism, etc. ), it is rarely a
surgical defect in animals (iliac arteries, femoral arteries,
axillary arteries). Endarteritis and dilitation of the anterior
mesenteric artery as a result of strongylus annatus is of far
greater importance for internal pathology. Cattle appear to be
more predisposed to Kiterioschlerosis (endaortitis oisificans).

306 DILITATION OF ARTERIES

Atheroma of the aorta with a subsequent meningeal embolism is
occasionally observed in horses.

2. DILITATION OF ARTERIES. ANEURYSM.

Forms. — Aneurysms are divided into diffuse and cir-
cumscribed. The circumscribed forms are either c j' 1 i n-
drical (aaeurysma cylindriforme), or spindle-shaped
(A. fusiforme) or s a c - 1 i k e (A. sacciforme). A diffuse aneu-
rysm is also termed angioma arteriale racemosum
(aneurysma racemosum, anastomoticum, cirsoideum); it is a
variety of new-formation, namely, angioma arteriae plexiformae
(angioma racemosum). Aneurysma arteriovenosum
(varix aneurysm aticus, varix arterialis, arteriophlebectasia)
is a special form due to the union of an artery and a vein
(phlebotomy, castration of cattle) . Aneurysma dessi-
c a n s results from rupture of the intima and media, the
adventia is raised by the pressure of blood (so-called false
aneurysm). In rare cases the walls of the aneurysm are
formed in the liver, intestines and other organs.

Causes. — In the horse the most frequent cause is the stron-
gylus armatus, it is most active in the anterior mesenteric artery,
where it produces a chronic deforming endarteri-
tis. A similar cause results in dilitation and thrombosis of
the femoral and iliac arteries as well as the axillary arteries.
In other cases the aneurysm may have a traumatic origin
(punctured wound), it may result from emboli, or from
degenerative conditions of the vessel-walls when
such conditions are exposed to the influence of concussions
(blows, kicks) or strong muscular exertion (increased
blood -pressure.)

Occurrence. — When compared with man, surgical forms
of aneurysm are very rare in the domestic animals (infre-
quency of arterioschlerosis). In the horse they have been
most frequently observed in the following places : the aorta,
the femoral and internal iliac arteries, in the
carotid, the bracial, the femoralis, the popliteus,
ischiadicus, facial, palatine, nasal, and internal

DILITATION OF ARTERIES 307

maxillary arteries. Aneurysma arteriovenosum has been
observed in cattle in the vessels of the spermatic cord (sperm-
atic artery and vein ) , following phlebotomy in the horse
(jugular and carotid), as well as after injuries in the vicinity
of the raasseters (masseteric artery and vein).

Symptoms. —Those that have a superficial location are
characterized by a pulsating swelling, on compression
of the artery by which it is supplied it either diminishes in
size or entirely disappears. On palpation and ausculta-
tion of the tumor friction sounds may occasionally be
recognized in the form of a buzz or hiss on the inner wall of
the aneurysm. Pressure on the neighboring nerves occasion-
ally results in continued and severe pain. One also observes
erosion of neighboring organs, even atrophy of the dorsal
and cervical vertebrae or the sternum. Aneurj'sms frequently
lead to rupture and hemorrhage, or to sudden
death from thrombosis and emboli. Spontaneous
healing by means of obliteration and calcification is seldom
observed. The most important forms of aneurysms in veteri-
nary science are characterized by the following symptoms :

a) Aortal Aneurysm results in a dilitation of the sinus
of Valsalva at the origin of the aorta. In a horse they become
larger than a man's head. Aneurysms in the abdominal cavity
may become adherent to the neighboring organs (stomach,
colon, small intestine); they also involve these organs and
may lead to an erosion of the vertebral column. In most cases
ihey produce no visible symptoms of disease for
a long time or during the life of the animal ; other cases
suddenly terminate in death as a result of in-
ternal hemorrhage, previous marked symptoms being
absent. Death from internal hemorrhage often follows con-
cussion (casting, falls), or it may suddenly follow severe exer-
tions ; the animal quivers, is very dyspneic, tumbles down
and dies in a very short time. Peculiar paroxysmal
symptoms without immediate death as a direct result have
also been observed. Lustig observed the following symptoms
in a horse after severe exertion: weakness in the hind parts,
sudden falling, pronounced dyspnea, as well as epilepti-

308 DILITATION OF ARTERIES

form cramps in which the head and neck were curved '
backwards and the feet extended, the animal rose again after
ten or fifteen minutes. Symptoms of vertigo were constant
in another horse that was affected with aneurysms in the pul-
monary arteries. Barrier observed the following symptoms
in a dog affected with aneurysm of the posterior aorta : emaci-
ation regardless of a good appetite, pronounced debility,
severe dyspnea on slight movement, and finally paralysis of
the hind parts (symptoms of heart weakness). In a horse
with an aneurysm the size of a man's bead in the thoracic i
aorta, Schmidt found a buzzing tone over th«.B
vertebral column that was synchronons with the actioii I
of the heart : the animal wds uoable to take food, and traveler
with a straddling and stiff gait in the hind limbs. Rupturftfl
of the aneurysm into the stomach (Vogel), and into thrt^
rectum CLabat, Cadeac, Ducbene) has occasionally-!
been observed. Mettam saw roaring (paralysis of the i
current) in a mare as a restilt of an aortal aneurysm the size a

b) D i 1 i t a t i o n and t h r o m b o s i s of the femoral and
internal iliac arteries (seldom axillary) in the horse may be due
to the following causes : diseasesof theinnerlayerof theartery ,
(endarteritis) with the collection of a fibrinous coagulu;
the surfaceandstenosis ofthe lumen, or embolic obli
ation of the aortic branches from thrombi dislocated from*
the heart or from aneurysms. One most frequently fiads9
thrombi in both external iliac arteries, or in the femoral arteries, J
and in both internal iliac arteries. They are less frequently!
found in the axillary or brachial arteries, and rarely in thel
lumbar arteries. The terminations of the aorta and the origin I
of the arterial branches are usually dilated; the walls a
thickened and affected with atheromatous degener--]
atiou; the intima is fatty, cloudy, calcified, and covered!
with ulcers. Within the vessel there is located ■ strati- 4
fied and organized firm thrombus, clear in color, the lumea I
is more or less stenosed, often there remains only a narrow canal, f
Frequently the thrombus extends forward towards the aorta or I
backward into the arterial branches, it may be confined to the 1

DILITATION OF ARTERIES

309

aortic bifurcation. Occasionally the external or internal iliac
arteries of one side are completely filled with the thrombus.
In addition to the thrombus there frequently develops a second-
ary compensatory hypertrophy of the heart. As a result of
softening of the thrombus, emboli may pass into the peripheral
arteries of the extremities. The described thrombi usually
present no symptoms of disease while the animal is at rest.
The very peculiar, characteristic symptoms of this disease are
first observed after light or severe exercise in the wagon,
tinder the saddle, or on the (raining ground.

In thrombosis of the femoral and internal iliac
arteries which usually occurs in horses, seldom in cattle,
one first observes a progressive weakness in one or both poste-
rior limbs. The animal presents a characteristic p a r a 1 y s i y
which develops very suddenly. It usually involves one side,
the animal has a staggering gatt, strikes the affected
hind foot against that of the opposite side, either brings the
weight to bear only on the toe or drags the lirab, trembles,
fails down and lies jerking the limbs for a few
minutes, and then lies back exhausted. At the same time the
frequency of the respiration is very rapidly
increased, the heart beat is bounding and ac-
celerated, the visible mucous membranes are strongly injected,
perspiration breaks out over the entire body. The temperature
of the paralyzed extremity is usually subnormal, pulsation is
frequently absent in the tibial and planter arteries. After a
few minutes the animal rises again, the symptoms of paralysis
gradually disappear, after which recovery is soon complete.
From a diagnostic standpoint, the fact that the disease can be
produced experimentally by forced exercise is of great import-
ance. On rectal examination of the thrombosed
area one finds the following condition : the aorta and its
arterial branches are dilated, thickened, unyielding, filled with
a long firm substance and non-pulsating on the affected side.
In rare cases thrombus formation results in the production of
emboli in the peripheral arteries and results in gangrene
of the limbs.

Thrombosis of the axillary arteries, a less frequent condi-

3IO DILITATION OF ARTERIES

tion, is introduced by simple lameness of the involved
side. The animal begins to stumble when moving, makes
false steps, trips, drags the toes, is unable to raise the limbs,
quivers on the affected side, and finally falls down. Deranged
respiration, accceleration of the heart beat, and congestive
conditions are not usually observed. After a short time the
function is again restored.

c) Aneurysma arterio-venosum of the sper-
matic cord occasionally follows castration of bulls. Along
the course of the spermatic cord there develops a prominent,
soft, cylinder-like swelling, following ligation, twisting, or tear-
ing of the cord. It is due to fusion between the sper-
matic artery and vein, so that the blood passes from

■the former into the latter (Gurlt, Collin, Kitt).

d) Aneurysm of the anterior mesenteric arter>- is of
DO surgical importance ; see text-books on special pathology.

Treatment. — The radical treatment of aneurysms that
are accessible consists in extirpation of the dilated vascu-
lar portion after carefully ligating the afferent and efferent i
vessels. Under certain conditions, however, the opera-4
tion is very dangerous as it frequently results in anemici;
necrosis of organs located peripherad to the ligature. Theyl
have in man, therefore, been treated as follows : methodica]!
compression; injection of irritants (liquor ferri chloridi.M
extract of ergot, alcohol) ; acupuncture and fili|
tare (application of a copper suture, silver suture, iroa^
suture, suturing with a horsehair): as well as galvano-fl
puncture or electr opu n c t ure (galvano-causti^
punctures with needles).

Casuistic— Steinmeyer has described an aneurysm of the rigl
carotid at t!ie heighth oE the sixth cervical vertebra : it occnmd ii
an eighteen- year-old horse tbat died very antldenly. There was Bsweltf
ing on the ventral surface of the throat as large as a man's head, he I
found it to be a apindle -shaped aneurysm four and one-half centimetecv I
in length with a tiansveise rupture thiee centimeters long, the il
this spot u-BB rough and covered with thrombi. M ouq ue t has observed I
a similar aneurysm of the left carotid in the pectoral region Icomprc*-!
•ible lumor with friction sound). — .\n aneurysm of the facial a
and its branches in a Simcntbalcow has been observed by VogeL Itl
extended from the region where the artery winds aroand the face U

BUPTURB OF LARGE ASTEHIES

end of the angular artei? of tlie eye ; it was smtious in its coune and

presenled sac-like dilitations, pnlgatioos were well marked, on ansculta-
tion bu/iing and hissing sounds were recognized. An aneutyam of the
posterior tibial artery in an ox has been described by F urlH-
^ e tt o : it formed an elastic, painless, pulsating, conical swelling on the
inner surface of the tibia, it was tifteen centimeters in length and par-
allel to the saphenic vein. Blaise observed an aneurysm of the
pharyngeal artery in a horse, fatal rupture occurred resulting in
symptoms of angina. Nouquet hsa observed an aneurysm of ths
artery that runs parallel to the saphenic vein : it was the result of phle-
botomy and teruiinated in fatal hemorrhage. An aneurysm of the an-
terior tibial artery with calcification of the nails has been extir-
pated by S t r a u b e. Many casea of aneuryBma racemosum on
the under anrfuce of the tail in cattle have been recognized by Sand.

3. RUPTURE OF LARGE ARTERIES. VASCULAR RUPTURE.

Causes. — Rupture of large arterial brauches is due to a
direct injury, or it may have an indirect origin by means
of concussion, fails, excessive muscular exertion — ^difScuIt
pulls, during severe exertion while the animal is cast, in the
act of vomiting, etc. In the last named cases of so-called
spontaneous rupture, predisposition to rupture is occa-
sionally present in the form of pathological changes
in the arterial walls. The following are among the
pathological conditions that may occur: aneurysms, arterio-
schlerosis. adipose degeneration of the vessel-wall, as well as
erosion of the latter through new- formations. In many cases
of spontaneous rupture of the aorta in the horse no visible
microscopic changes are present in the vessel-wall.

OccuRRHKCE. — Rupture of the large vessels is most often
observed in the aorta and its branches as well as in the pul-
monary arteries. The symptoms of internal hem-
orrhage are as follows ; staggering, tumbling, sudden col-
lapse, paleness of the visible raucous membranes, cold ex-
tremities, as well as a weak and finally imperceptible pulse,
occasionally one also observes cerebral convulsions, and amau-
rosis (anemic adipose degeneration of the retina), as well as
vomiting.

Ruptures of the aorta usually occur at its origin
immediately behind the semilunar valves in the vicinity

312

ruptdrs of lasgb arteries

of the sinus of Valsalva ; at this point the blood-pressure is
greatest, the walls are apparently thin and in most cases some-
what dilated ; these regions form, therefore, an area of predilec- i
tion for the formation of aortal aneurysms. Rupture of the
aorta occurs most frequently in horses ; it is observed after
casting, jumping, and faUing. The blood flows into the peri-
cardium which is found distended with blood on post mortem.
Rupture of the anterior aorta is often caused by wagon poles J
that penetrate the tissues.

Ruptures of the pulmonary arteries, likewise, are
observed in horses after casting. Severe hemoptysis (cough-
ing blood) as a result of the rupture of an aneurysm of the .
pulmonary artery into a large bronchus was observed in one i
case. Other ruptures that may be mentioned are ; rupture of I
the femoral arteries and obturator arteries in f
fractures of the pelvis ; the internal iliac arteries
fracture of tlie last lumbar vertebra ; tlie renal arleri
from concussions ; the colic arteries, when dilated with 1
aneurysms, from casting ; the cecal artery as a result of \
a sarcoma ; the diaphragmatic artery from blows;
the carotid artery as a result of erosions from strangles
abscesses; the posterior aorta through erosions from 1
sarcomata : the axillary artery from a severe pull ; the '
left cervical artery, etc.. from fractures.— Treatment of these
ruptures is not usually possible. Ruptures of the palatine j
artery, internal carotid artery, etc., must be treated by ligation 1
of the carotid artery.

Obliteration. — Adhesion and oblileiBtion of the vessels as the
result of endarteritis ohlilerans is .seldom observed in the domestic ani-
ujalg. Pirl has obsen'ed an obliteration of the posterior aorta
in the hofse. The aorta formed a solid cord between two aneurrsms, it
was about the thickness of one's finger; anterior to the area of adhesion
there branched finger-lhick, newly formed collateral vessels. Bligio
has described an obliteration of the iliac artert' with symptoms of
paralysis. I have recently (1904) observed a case of GtenosJB of
the aorta in a horse [apparently congenital) that resulted in clin-
ica] symptoms of thrombosis of the internal iliacs.

EMBOl,l.^These result from a solution of thrombic maMfia in
the heart, in the aueurysmatically dilated anterior mesenteric artery,
femoral artery, etc., especially in the horse. Emboli in the pododerm

INFLAMMATION OF VEINS JI3

ud to necrofis and loss of the horn capsule ; emboli of the middle
eclal artery to parelysia of the rectum (Casper) ; eiuboli of the ophthal-
lic arterf to sudden blindneu (Arnold),

rr. DISEASES OF VEINS.

I. INFLAMMATION OF VEINS. PHLEBITIS.

Forms. — As in arteritis, one also dislingnishes in inflam-
mation of the veins, an endophlebitis, mesophleb-
i t i s , and periphlebitis; an acute and chronic;
an aseptic and septic (suppurative) phlebitis.
Suppurative necrotic phlebitis, or suppura-
tive thrombophlebitis is of special practical import-
ance. Il either occurs during the course of a phlegmon or from
suppurative infection of venous thrombi through the entrance
of pus-forming bacteria from without, or in pyemia from
within, that is, from the blood {embolic, pyemic, metastatic).

Symptoms. — Phlebitis is characterized by a c o r d - 1 i k e,
nodular, firm thickening and induration along
the course of the veins ; passive edema also develops in
the vicinity of the diseased vein. The nodular formation is
due to localization of the inflammatory process at the valves
as a result of retardation and engorgement of the blood at
these points. Induration of the veins is the result of throm-
bus formation in the blood and thickening of the walls.
Through the release of infected portions of the thrombus
suppurative metastases of distant organs may result,
this ij especially true of the lungs (pyemia).

With reference to the occurrence of phlebitis in the
domestic animals it may be remarked that formerly, especially
in the horse, it was more frequently observed than now
(phlebitis of the jugular following phleb-
otomy, so-called phlebotomy fistula). Suppura-
tive omphalophlebitis of foals and calves (suppurative
thrombophlebitis of the spermatic vein with consecutive pyemia ;
so-called foal- lameness) is less common since the introduction
of umbilical antiseptics. On the other hand, the recent em-
ployment of intravenous injections of chloral hydrate

314 DILITATION OF VEINS

in the horse has again introduced thrombosis of the veins and
phlebitis of the jugular. Phlebitis in the vicinity of wounds
and phlegmons is also of practical importance ; inflammation
of the saphenicvein in the course of phlegmons of the
posterior limb ("Einschuss" ) is not very common, the same
is true of the internal iliac and femoral veins, the
vena digitalis interna, radialis, brachialis
and cephalica, as well as thrombophlebitis of the nasal
mucous membrane which occasionally leads to suspision
of glanders in the horse. According to Zscbolcke the
latter is characterized by the following symptoms : the*eptum
nasi is dark-red in color ; it is covered vrilh stratified, light-
yellow or reddish -grey wreath-Hke nodules, or cord- like eleva-
tions from one-half to two mm. in diameter ; they consist of
white venous thrombi that have their origin in a primary
phlebitis. Ulcer formation as well as a suppurative or caseous
exudate is wanting, this differentiates the condition from
glanders.

DILITATION OF VEINS. VARIX. PHLEBHCTASIA.

Causes. — Similai
phlebectasia) of the
of the walls of the '
en dophlel

anetiTysms, dilitalions (varices,
veins are found. Chronic inflammation
veins, especially the intima ( c h r o n i c
is the most frequent cause. In addition,
traumatic influences, as well as ulcerative and con-
genital dilitations of the veins must be considered. They
are favored by local and general vascular engorgement.

Symptoms. — Varices are present either in the form of
circumscribed nodular (spindle-shaped, sac-like, cyl-
indrical), or diffuse swellings along the course of the veins
of the skin and raucous membranes. They have a tendency
to become hemorrhagic and form ulcers (periphle-
bitis), they also result in thrombus formation i,sup-
purative thrombophlebitis, pyemia) , and in rare cases
in calcification and caseation (so-called vein stones,
phleboliths) . In comparison with man varices in animals are
very rare. Varices of the mucous membrane of

DILITATION OF VEINS

Tectum, known as hemorrhoids, are

■ery

uterus on the
than in animals,
brane (genuine
observed iu horse

uncommon in animals. The same is true at
dilitations of the veins of the lower limbs
following repeated pregnancy (so-called vari-
cose veins). As a rule the diagnosis of such conditions
is erroneous, for example, in the dog that condition recog-
nized as hemorrhoids is usually a pathological condition of
the anal glands ; varix of the saphenic vein in the horse
(so-called blood-spavin) hardly ever exists. The cause of this
variation between man and animals is due to the fact that
chronic inflammatory conditions of the veins are far less com-
mon in animals than in man. In man man}- aftections of the
heart and chronic pulmonary diseases, as well as the upright
position of the body, and pregnancy (pressure of the pregnant
induce venous congestions more readily
rices of the rectal mucous m e m-
niorrhoids) have only occasionally been
rattle, and dogs. Eckart found the
following conditions in a horse : numerous nodules and cysts
at the margin of the anus and termination of the rectum, they
varied in size from that of a pea to that of a cherry, were smooth
on the surface, slightly bluish in color, paiulul and hemorrhagic.
Varices also occnr in the spermatic cord (so-called vari-
cocele), in the milk-veins of cows (hemorrhagic swellings
about thesize of a hen's egg, Liebl); in the vicinity of the
anus and scrotal covering in dogs (characterized by
ulcer formation and hemorrhage ; Moller, personal observa-
tions); in the vesical mucous membranes of the dog (chronic
hemorrhage of the bladder, Frick); on the anterior margin
of the masseter muscle in the form of a varix of the facial vein
in a remount horse (Preuss. Mil.-Ber. 1897); on the exter-
nal mammary vein of the horse (personal observation) ;
on the saphenic vein of the horse (Teply); as well as
congenital new-formations of the skin of foals
(W. Eber). Varix aneurysm aticus in the form of
an opening of the spermatic artery into the spermatic vein
after castration of bulls has been seen by several observers
(Gurlt, Prinz, Meyer, Wagenfeld. Collin, and

3l6 INFLAMMATION OF VESSELS

others); it produces a pulsating, buzzing swelling in the cord.
Treatment. — This consists in operative removal, or
ligation. In addition to these methods, those used in hu-
man surgery may be employed ; namely, removal with the
cautery, ignipuucture (perforation with the Paque-
lin), the injection of medical agents (ergot, alcohol, con-
centrated carbolic acid), as well as methodical compression.
The latter methods may be experimentally employed.

Rupture of Largh Veins.— The following rnptureB with /atal in-
ternal hemorrliaKC have been observed, especially in the horse : rupture
of the portal vein, the pre- and post cava, and the tucBeti-
leric vein. Ku pin res of the jugularis, axillary vein, vena
cepha H c a and sap he n a are not rare.

III. DISEASES OF LYMPH-VESSELS.

I. INFLAMMATION OF LYMPH- VESSELS, LYMPHANGITIS.

Causes. — InSammation of the lymph-vessels is usually
due to a wound infection disease induced by the
entrance of pus-forming bacteria into the open lymph -vessels.
It is most often found, therefore, in the following places : in
the vicinity of infected, suppurative wounds; in phleg-
mons; following too early incisions of hematomata in
the region of the buttocks and limbs ; as a result of f i s t u 1 k e
of the neck, fistulous withers, and injuries from
saddle-galls. There also exist specific forms of lymphan-
gitis ; namely, in horses during the course of g la nders and
strangles, as well as so-called pseudo-glanders
(lymphangitis ulcerosa sui generis, mallei-
forme lymphangitis); in cattle as a symptom of
tuberculosis of the skin ; in dogs during the course of
so-called dog-distemper. A plague-like infectious
lymphangitis with symptoms similar to glanders, but with a
benign course, is observed in horses and mules in the French
Army in Africa (Farcin d'Afrique, Lymphangite
farcinoide); the lymph-vessels of the skin swell into
cords and are covered with granulating ulcers, from the ulcers
there is a discharge of normal pus. This "African" glanders

DISEASES OF GLANDS 317

is also frequently observed in Soitthern France, Italy, Egypt,
Russia, Japan, among American horses in the PhiUppiues,
etc. It is caused by a fungus-like parasite, saccharomyces
fcryptococcus) farcinosus (lymphangitis saccharo-
mycotica,fungus-lymphangitis^. So-called worm
in cattle is a similar disease (Farcin du boeuf).

Symptoms. — -Lymphangitis is characterized by bead-
like swellings along the course of the lymph -vessels, that is, a
cord-like swelling interrupted by nodules. It is frequently the
result of inflammation of neighboring lymph-glands (lymph-
adenitis). Along the course of the bead-like swellings
there occasionally develops, especially at the seat of the valves,
numerous small abscesses (horse- distemper, dog-distemper).
Chronic lymphangitis leads to pronounced thickening of the
skin (elephantiasis in glanders of the skin). —
Treatment consists in incision of the abscesses, as well as
in the application of antiseptic fluids and ointments.

2. DILITATION OF LYMPH-VBSSBLS. LYMPHANGIHCTASIS.

Causes. — Lytnphangiectasis is usually congenital
and belongs in part to the chapter on tumors. It includes
the so-called congenital elephantiasis, macroglossia, and ma-
croscelia (see page 123). In contrast to this form there is.
however, an acquired dilitation of lymph-vessels ; it is espe-
ciallyobserved after chronic recurrent inflammations of the skin
and .subcutaneous tissue (in6ammatory form of elephantiasis).
So-called lymph-cysts — cystic dilitations of the lymph-
vessels — are a special form ; these must not be confused with
lymph-extra vasales, that is, effusions of lymph as a
result of subcutaneous rupture of lyraph-vessels ; or lymph
fistulae, permanent ulcer-like openings in the lymph-
vessels following injuries.

DISEASES OF GLANDS.

General Remarks. — The general surgery of glandular
affections in veterinary science is of importance only as applied

3'8

nON OF LYMPH-GLANDS

to certain glands, namely, the lymph-glands and the milk-
glands which present a group of important diseased conditions.
From a surgical standpoint inflammation of the glands
moat frequently demands treatment. Glandular inflammations
(lymphadenitis, mastitis) may be due to various causes and
present extremely variable forms. From an etiological stand-
point the following forms are recognized: traumatic, in-
fectious, and rheumatic inflammalionof the glands. In
addition, there occurs a primary or independent form
in contrast to a secondary or symptomatic form the
latter is only a partial symptom of general disease (lympha-
denitis in straugle.s, glanders, tuberculosis ; mastitis in foot-
and-mouth disease). According to the path of infection
the following classification is obser^'ed : hematogenous.
Ij-m phogenous, and galactogenous inflammations
of the milk-glands. According to the cour.se inflammation of
glands is classified as acute and chronic. The classifi-
cation according to the anatomical character of the inflamma-
tion is of special importance. According to this classification
the following forms are recogniz.ed : parenchymatous,
interstitial, suppurative, phlegmonous, catar-
rhal, and specific, Parenchymalous inflammation in-
volves the genuine secreting glandular substance ; the inter-
stitial form applies to the interglandular connective tissue ; the
catarrhal to the excretory ducts aud the collecting mechanism
(milk-cystcrns) of the glands.

In the following will be described only inflammation of
the two most important types of glands from a surgical stand-
point, namely, the lymph-glands and the milk-glands. The
description is brief and from a general standpoint.

T. INFLAMMATION OF LYMPH-GLANDS.
I, Y M PH ADB N I TI5 .

Causes. — Inflammation of lymph-glands is usually in-
fectious in character. The infectious material enters
either through a lymphogenous path, from without to within
through the medium of the lymph-vessels (concentric lymph-

INFLAM.

■ LYMPH-GLANDS

3^9

'angilis), or hematogenous, carried to ihe lymph-glands by
the blood. Lymphadenitis is most frequently observed as a
result of the following conditions: infected wounds and
phlegmons, nasa! catarrh, suppurative alveolar periostitis,
empyema of the sinuses of the head, pharyngitis, etc., it may
further develop in a specific form in strangles, glanders,
tuberculosis, actinomycosis, and botryomy-
cosis. From an anatomical standpoint one recognizes a
parenchymatous, interstitial, and suppurative lymphadenitis.
Perilymphadenitis is not uncommon, that is, an in-
fiammation of the connective tissue in the vicinity of the gland
that leads to adhesions between the latter and the surrounding
tissues (inferior maxilla). In the horse lymph act eoites are
most often observed in the intermaxillary lymph-
glands; in cattle in the lymph-glands of the neck and
ndder.

SvMPTOMs. — a) Parenchymatous lymphadenitis
is charade rined by swelling of the gland, it is usually
acute in development and is accompanied by slight degree ot
pai n . Afterwards the swelling either becomes resorbed, or
the parenchymatous lymphadenitis changes into the suppura-
tive or chronic form. It is most often observed as a wound in-
fection disease following injuries, as well as subsequent to
catarrh of the mucous membranes.

b) Suppurative lymphadenitis is especially ob-
served during strangles in the horse. It ts characterized by
severe swelling and pain as well as fever ; Jl usually
terminates in fluctuation and abscess formation. If
the pus is not discharged outwards it becomes thickened
(caseation), or it is resorbed by the blood (pyemia, septice-
mia, petechia] fever).

c) Chronic interstitial lymphadenitis is char-
acterized by the following lymptoms: a painless, hard,
circumscribed swelling of the gland ; occasionally it be-
comes adherent to the nnderlyingtissues, and it
may contain hard nodules (glanders, tuberculosis, chronic
catarrh).

Trbatment. — Chronic interstitial lymphadenitis is in-

320 INFLAMMATION OF THE UDDER

curable, occasionally it is necessary to extirpate the enlarged
gland for diagnostic purposes. Suppurative inflammations are
treated by means of incisions and antiseptic irrigation.
The parenchymatous form is treated with moist warmth,
parenchymatous injections, camphor oint-
ment, iodoform ointment, grey ointment and
other resorptives.

2. INFLAMMATION OF THE UDDER. MASTITIS.

Causes. — In cattle, infections are the most frequent
causes of mastitis, it is seldom of traumatic or rheumatic origin.
The infection may have a galactogenous,
lymphogenous, or hematogenous entrance.
As a result of bacteriological investigations in recent years, in
addition to tubercle-bacilli, actinomyces and botryomyces
fungi, a number of specific organisms have been
found to cause mastitis. Ordinarily they gain entrance through
the duct of the teat (galactogenousinfection) . The
following are the most important :

a) Bacterium phlegmasiae uberis, identi-
cal with the colon bacillus.

b) Streptococcus agalactiae contagiosae
and other streptococci.

c) Staphycococcus mastitidis.

d) Staphylococcus mastitidis gangrae-
nosae.

e) Galactococcus versicolor, fulvus, etc.

f) Bacillus pyogenes.

g) Micrococcus tetragenes.

Forms. —I. Parenchymatous mastitis is partly
galactogenous through the entrance of bacteria of mastitis
from without, partly hematogenous, for example, during the
course of foot-and-mouth disease (symptomatic mastitis), it
affects the columnar epithelium of the alveoli and small milk-
ducts. It leads to a firm, painful, febrile swelling and pro-
nounced enlargement of the inflamed quarter of the udder.
Milk from the affected part contains a flocculent coagulum and

INFLAMMATION OF THE UDDER

321

fibrin, sometimes it is even yellowish and wheyish, or even

colored with blood, finally the milk -secretion is entirely sus-
pended. If resorption does not occur there develops,
either a permanent inflammatory hypertrophy of the
udder with marked enlargement and induration, or an atro-
phy with shrinking and permanent diminutioQ in size of
the affected quarter. la other cases it passes into a sup-
purative and even gangrenous form of mastitis.

2. Catarrhal inflammation of the udder (catarrh of
the udder) is localized especially on the mucous membranes of
the teat-cana! (squamous epithelium), the milk-cysterns and
large milk-ducts (columnar epithelium). In the beginning the
gland itself is either slightly swollen or normal in size. It is
characterii^ed by the watery, fiocculent, wheyish condition of
the milk. Afterwards it leads to induration, stenosis
and obliteration of the teat-canal, as well as to the for-
mation of connective-tissue septa in the milk-cysterns which
lead to hard milking, drying up of the milk (agalactia), and
atrophy of the affected (quarters. In other cases catarrhal
inflammation extends to the interstitial tissue and results in
chronic induration with permanent increase in size
(pseudo-hypertrophy) of the diseased quarters. Occasionally
it assumes a contagious form("gelber Gall," agalactia
catarrhalis contagiosa).

3. Phlegmonous mastitis (inflammatory
edema of the udder) is an infectious inflammation of
the skin and subcutem, as well as the interglandular connec-
tive tissue of the involved quarter. It is characterized by a
firm, painful, diffuse, hot. febrile swelling of the affected quarter
without qualitaii%'e changes in the milk in the early stages of
the dise.ise. It is a result of infection from without (traumata).
or within (accompanying symptom of parenchymatous mas-
titis) and should not be confused with the non-painful and
non-febrile, physiological stagnation edema of cows advanced in
preguancy. The chronic course results in chronic induration
and atrophy of the diseased quarter.

4. Chronic interstitial or indurative mas-
titis consists in an inflammatory new-formation of connec-

322 INFLAMMATION OF THE UDDER

tive tissue with atrophy of the genuine parenchyma of the
udder. It may develop independently as a chronic inflamma-
tion during the period when the animal is not giving milk,
when it leads to a painless, hard, often very pro-
nounced enlargement of an entire quarter of
the udder; the milk is watery and flocculent. It often re-
sults from a previous acute, catarrhal, parenchymatous, or in-
terstitial, as well as a tubercular and actiuomycotic mastitis ;
in the latter cases the nodular swellings are frequently
painful during the early stages of the disease.

5- Suppurative inflammation of the udder, abscess
of the udder (suppurative, apostematous, stereptococcal,
staphylococcal mastitis) is a circumscribed suppurative liquefac-
tion of the parenchyma of the udder during the course of pa-
renchymatous and catarrhal mastitis. It is characterized by
high fever, fluctuating areas on the udder, as well as a puru-
lent condition of the milk, it occasionally leads to the forma-
lent of mi!k-fistu!as.

6. Necrotic inflammation of the udder is especially
common in sheep through the influence of specific microorgan-
isms (micrococcus mastilidis gangraenosre) ; it is less frequent
in cows where it occurs during the course of severe parenchy-
matous mastitis of a putrid character. During the course of a
suppurative mastitis necrotic portions of tissue may be
sloughed off (sequestration, mortification or mummification of
the udder). In these cases the milk is fetid and ichorous in
character; the necrotic portions of the udder are discolored
and sloughed off.

With reference to tuberculosis, actinomj'cosis,
and bot ry om y cosis of the udder see pages 167, 159 and
163.

Treatment. — Treatment varies according to the form of
mastitis. In general the following methods are important :
frequent milking, the application of antiseptic agents
(ointments containing borates or salicylates),
early incision of abscesses, removal of necrotic por-
tions, amputation of single quarters, operative treatment
of stenoses and partitions in the teat-canals and milk cystcm

IKFLAMMATION OF THH SKIN

Massage is contraindicated in all forms of infectious mastitis.
For further details compare with texl-books on special surgery
and obstetrics.

SURGICAL DISEASES OF THE SKIN, SUBCUTEM

AND MUCOUS MEMBRANES.

I, SURGICAL DISEASES OF THE SKIN.

1. INFLAMMATIOX OF THE SKIN. DERMATITIS.

Causes. — The causes of inflammation of the skin are
traumatic, chemical, thermic, infectious, and specific in char-
acter (dermatitis traumatica, caustica. combus-
tionis, er y si pela tosa, suppurativa, mallcosa).
According to the course and extent one recognizes a circum-
scribed and diffuse, superficial and deep, acute and chronic
dermatitis.

Forms. — From a practical standpoint it is important to
differentiate between the following anatomical forms of in-
flammation of the skin :

a) Erythematous dermatitis or erythema
of the skin consists of an inflammatory hyperemia of the
skin. According to the causes the following forms are recog-
nized : erythema traumaticum (pressure, rubbing);
toxicum or ab acribus (irritating chemicals, black
soap in dogs) ; c a 1 o r i c u m and s o 1 a r e (heat, burning of
first degree, action of the sun) ; as well as e x anthemat i-
cum (symptomatic erythema in swine- erysipelas). Small,
circumscribed erythema is termed macula; the multiple
form is termed exanthematous roseola. Inflammatory ac-
tive hyperemia mu.st not be confused with passive hyperemia
or vascular engorgement (livid, cyanotic) ; the former is
characterized by a clear, arterial color of the reddened skin.

b) Serous dermatitis, when diffuse, is termed
inflammatory edema (serous infiltration of the cutis) ;
while the circumscribed form i.s termed vesicular eczema
(multiple vesicles), and bullous dermatitis (large

3*4

INFLAMMATION OF THE SSIN

vesicles beneath the epidermis) ; urticaria or pomphus
indicates a circumscribed serous infiltration.

c) Suppurative dermatitis is the result of an
infection of the skin with pus-bacteria. It is either superficial
or diffuse (suppurative dermatitis), or assumes the
form of a circumscribed collection of pus beneath the epidermis
(pustular dermatitis, pustule, pus- vesicl e).
Acne and furuncle is a multiple, suppurative inflamma-
tion of the skin confined to the hair- follicles (suppurative
folliculitis).

d) Hemorrhagic dermatitis occurs symptomal-
ically in anthrax, either diffuse in the form of hemorrhagic
edema, or circumscribed in the form of carbuncles,
Hemorrhagic dermatitis may also have a traumatic origin
(contusion), or result from a complication of infection with sim
pie hemorrhage (petechia, vibices, ecchymoses, hematoma,
sulTusion).

e) Gangrenous dermatitis or necrotic der-
matitis (necrosis, gangrene) follows burning and freezing,
application of caustics, and contusions, as well as the action of
certain infectious materials (necrosis bacillus) ; compare with
the chapter on gangrene. Ulcerative dermatitis is a
simitar form ; compare with the chapter on ulcers.

f) Chronic hyperplastic dermatitis occurs
partly as a chronic indurative dermatilis or schlerosis
(schlerodcrma, pachyderma, elephantiasis, tyloma), partly as
a verrucose dermatitis ("Straubfuss" bristle foot,
"Ingelfuss" hedgehog-foot), partly as a squamous in-
flammation (callosities, squamous eczema).

The treatment of dermatitis of the skin consists in
the application of antiseptics, astringents, protective agents, etc.
Acne and Fcrunculosis.— It h cnslomary to employ these lerais
lo indicate that fonn of snppnrative deniiatitis which is confined to the
follicles of the akin (snppurative folliculitis). The smaller
□odnlea are termed acne ; the larger, pustule-like nodules which lead to
necrosis of the follicles are termed furnncles. They are most often
found in the region of the saddle and girth in the horse {Ki-called aaddle-
mange, calloBitj. nodular enlargement, lichen), as well as on the akin
over the bridge of the nose in dogs (muzzle, pustular form of acartis

BURNS 3*5

mange): they have also been observed in cattle (udder), and theep
(abitomen). Trealmentia purely surgical (incision, curettage, excision). —
In contrast to furuncle, carbuncle forms a specific, sanguino-^n-
grenous, circnmRCribed in(!animation of tbe skin and mncous merabranes
dne to the anthrax bacillus. ( In man, several furuncles arranged in a
group are also termed carbnncle) .

Eczema, and Exanthema. —Eczema is a multiple dermatitis
caused by external irritants; il mns a typical coDme and assumes
various forms; namely, ac/.ema erythematosum. vesiculosum. papulo-
sum, pustulosum, msdidans, crustosum, impeti^enosum,aDd squamosum.
That form of dermatitis found on the volar surface of the fetlock , desig-
nated as scratches, is of special surgical importance. According to the
degree of inflammation it is termed eciema etythematosnm. martidans,
crustosum, impetigenosum, scjuamosum, etc., and may be designated re-
spectively as dermatitis erythematosa, suppurativa, gangrenosa, etc.
Exanthema, likewise, is a multiple inflammation of the skin; il is,
however, ouly a symplom of internal disease, and i« not, therefore, of
surgical importance (vesicular exanthema in foot-and-mouth disease,
exanthema of small- pox, exanthema of swine -erysipelas, strangles, dog-
distemper, etc.), Bxaothema of the mucous membrane is termed en-
anthema. ( I'or further details concerning exanthema and eciema
see: Fri edberger and Fro hner, Special Pathology. Sixth Ed.,
Vol. 1-).

2. BURNS. COMBUSTION.

Causes. — Inflannnation of the skin as a result of burns
(dermatitis combust ioni s) is rarely observed in the
domestic animals, except when heat is used as a therapeutic
agent. In horses and cattle it is usually due to fires in the
stable, burning the pododerm with a hot iron, contact with
electric wires (street railways), hot inhalations, apd taking
hot food. Cats and dogs are burned with boiling water
or hot milk. In horses, in addition to burns of the skin aud
pododerm. the mucous membranes of the respiratory apparatus
are burned by inhalations of hot air during conflagrations.
Extensive burning of the skin and mucous membranes is very
dangerous.

Degrbe. According to the duration and intensity of the
caloric influence, three degrees of burning are recognized :

aj The first degree is characterized by a mere red-
ness of the skin (dermatitis com bust ion is erythematosa))

3*6 BURNS

which may be combined with a slight serous infilt ration.

b) The second degree is characterized by the for-
mation of bl isters (dermatitis combustionis bullosa) ; there
is a circumscribed collection of serous exudate between the
epidermis and rele Malpighi ; a croupous inflammation
exists on the mucous membranes.

c) The third degree consists in the formation of an
eschar (dermatitis combustionis escharotica t, whereby the
burned portion becomes necrotic (dry gangrene) ; afterwards,
as the result of a suppurative, demarking inflammation it is
sloughed off. Necrosis of the pododerm in horses is especially
dangerous (exungulation). Complete charring of an
organ has been termed burning of the fourth degree.

In addition to local changes, extensive burning is also ac-
companied by severe general disease and fatal re-
sults. Experience in men has demonstrated that death is
certain when more than half of the surface of the body is in-
volved, even when in the form of the first degree. The result
is usually fatal when a third of the surface of the body is
burned. I have learned by personal observations on horses
that, under certain conditions, burning may be fatal when
only a fifth or a tenth of the surface is affected ; the animal
suffers from an attack of hemoglobinuria. These results are
especially common when the raucous membranes of the respi-
ratory tract are simultaneously affected from inhalations of hot
air. Such cases present on post mortem, in addition to the
changes on the skin, fibrinous laryngitis, bronchitis, and
pharyngitis, glossitis and edema of the lungs, hemorrhagic
gastroenteritis, hemoglobinuria, infarcts of hemoglobin in Ihe
kidneys, hemorrhages in the spleen and heart, as well as
parenchymatous hepatitis and myocarditis.

There are various explanations of the causesofdeatb
in the severe, rapidly fatal cases of burning. It is considered
partly a poisoning, partly a derangement in the
circulation, partly a paralysis ofthe nerves as a
direct result of the burn, According to the toxic theory the
burning of the blood in the cutaneous capillaries results in a
decomposition ofthe blood and leads to h e m o g I o-

b i n e ra i a , which determines the fatal course ; carbon dioxide
poisoning results from a diminution of the supply of oxygen
taken up by the red blood -corpuscles. In a shorftime
large quantities of hemoglobin circulate
freely in the blood; it causes hemoglobi-
nuria, infarcts of hemoglobin in the kid-
neys, as well as hemorrhages in the spleen
and gastric raucous membranes with sec-
ondary necrosis (diphtheria) of the latter.
In addition to free hemoglobin, the influence of a high degree
of heat on the blood apparently gives rise to other toxic bodies
(ammonia, pyriden bases, prussic acid, ptomaines). On the
other hand, materials formed by the decomposition of white
blood -corpuscles have been found. According to the nature ot
fibrin ferment, the.se lead to coagulation in the capillaries
of the inner organs, followed by severe derangementsin
the circulation and necrosi s, especially in the mu-
cous membranes of the intestines (Silberman, and Welti).
The earlier supposition, that death was due to cooling of
the body, cannot be maintained : experience has shown that
death occurs in man when the burned are permanently placed
in warm baths. In many cases a reflex paralysis of the
nervous system as a result of excessive irritation of the
nervous system and overheating of the blood (44 C, ) may
be accepted as a cause of suddeu death from burning. When
the disease exists for some time, death results from a sub-
sequent affection: especially through a septic
infection of the blood as the result of resorption of septic,
putrid, and toxic materials from the gangrenous areas in
the skin, pododerm, and mucous membranes (septicemia).
Treatment. — The local treatment of burns is essentially
the same as for other wounds ; apply an aseptic bandage to
fresh wounds as soon as possible to prevent the entrance of
infectious material (pns-bacteria). If infection has already
taken place, antisepsis must replace asepsis. Nitrate
of silver is the best antiseptic for burns. This
possesses, in addition to strong disinfecting properties, a pro-
tective (eschar of silver) and anesthetic action, it is employed

328 FREEZING

in the form of a 5-10 per cent aqueous solution, or ointment.
Other antiseptic protectives are bismuth salts, oxid of zinc,
iodoform in combination with talk or amylum as a dusting
powder, etc. Recently, sodium bicarbonate in the
form of a dusting powder, as well as picric acid (bandage)
has received special recommendation. Among the older reme-
edies may be mentioned so-called lime liniment (lini-
mentum contra combustiones), a mixture of equal portions ot
lime water and linseed oil. Amputation is indicated in severe
burning of the extremities (tail, ears, toe-joint). Injuries
due to caustics are treated similar to burns.

3. FREEZING. CONGELATION.

Degree. — In freezing, also, one recognizes three degrees :
redness, vesicles ( con gelatio bullosa), and necrosis
(congelatio gangrenosa). In contrast to arterial hyperemia of
burning of the first degree, the redness of freezing is due to a
passive, venous hyperemia. The second degree is an inflam-
matory reaction of the body in the course of which it leads to
the formation of thrombi and severe disturbances in the circu-
lation. The third degree of freezing leads to gangrene, which,
in contrast to the dry gangrene of burns, is moist. Death fol-
lows extensive freezing as a result of pronounced falling of the
body temperature, in other cases, as in burns, fatal septic
diseases develop afterwards.

Occurrence. — The domestic animals, especially the
horse, are very resistant to cold (winter coat). Usually the
injurious influence of cold in winter involves the pododerm, as
well as the skin of the coronet, the fetlock, and the pastern.
In the Russio-Turkish War (winter 1877-78) the Russian
army horses were repeatedly affected with a necrosis of the
pododerm similar to that which results from burns (Jews e-
jenko). The African and Arabian horses seem to be very
resistant to cold. According to C a d i o t these horses in the
Franco-German War (1870-71) were more resistant than the
French horses. In the Crimean War (1854-56) the African
horses were also able to endure more than the English. Dur-

FREEZING 329

ing the French Expedition against Algeria in the winter of
1845-46 the African horses remained well, while 25 per cent
of the army were frozen to death. Freezing of the scrotum is
common among the cattle of Denmark (Bang). Treat-
ment of frozen tissues is the same as that of burns.

Lightning-strokes. — Large animals are the most frequent suffer-
ers from this affection, this is especially true of cattle at pasture and
military horses. In stables, the standing and large animals are espe-
cially exposed ; for example, among nine horses in a stable only the five
that were standing were struck (Ziegenbein). The action of the
stroke is variable ; sometimes the skin is burned; the soft parts may
undergo mechanical rupture; the nervous system may suffer from
electric concussion and pa raly si s ; at other times the action
is chemical in nature, the red blood-corpuscles are de-
composed (lightning-figures caused by the solution and diffusion of
hemoglobin in the region ). The burns of lightning are either superfi-
cial (singeing of the hair) , or deep enough to involve the muscle. In a
horse that was killed by a lightning-stroke, lines one half cm. broad
extended from the inferior surface of the thorax down the inner sides of
both anterior limbs as far as the hoofs, the hair on this strip was singed ;
the subcutem in the same region was strongly infiltrated with blood
(Sachs. Jaresbericht. 1894). A horny cicatrix remained in one horse
after healing had occurred (Miiller). In cows spotted with black the
stroke caused circumscribed areas of necrosis in the vicinity of white
hairs (Urbain). Experience has shown, that in light-
ning-paralysis the prognosis is relatively favorable.

Strong electric currents have an action similar to that of lightning.
According to C a d i o t and A r 1 o i ng a horse dies only after a long
time— several minutes — when exposed to a stream of 500-550 volts.
Horses only fall under the influence of 200-400 volts, 100 volts causes
slight trembling and collapse at the knees. 550-700 volts, when applied
for a short time, does not always result in death. The injuries in the
killed horses are partly in the form of circumscribed necrotic wounds,
partly the result of falling, rolling, and kicking. The horses that are
not killed often present nervous derangements (stupor, weakness),
these symptoms usually disappear, occasionally the paralysis is perma-
nent (effusion of blood in the brain ). In a horse that came in contact
with the wire of an electric lamp the death was lightning-like in its
rapidity. Post mortem merely showed large quantities of blood in the
lungs and brain, as well as relaxation of the heart-muscle. Another

horse became rigid, the muscles quivered for several hours. (Wo h e r-
1 i n g). I observed a case in the horse in which there occurred burning
of the second degree.

Sun-stroke and heat-stroke are of no surgical importance.

330

CtlTANE'

Sun-Stroke iaa disease of tbe brain and medutU oblongata (hyperemU,
infiammatiou, apopleiy. paralysis) ; heat*sttoke is a hyperthennia of the
body (overheating, dissolution of the blood, derangement of the heal
regulators). For farther information see : F rie d be rg e r and Froh-
ner, Special Pathology. 1904, Vol. II).

II. SURGICAL DISEASES OF THE SUBCUTEM.

1. EDEMA.

Forms, — The term edema indicates a serous infil-
tration of the subcutaneous connective tissue. According
to the causes the following forms of edema are recognized :

a) Inflammatory edema (acute edema of the
cellular tissue) is a serous inflammation of the subcutis and
cutis; it is. therefore, characterized by rise of temper a-
tnre, pain, swelling that often develops rap-
idly, active hyperemia, and pronounced dis-
tension of the skin. It is most often found in the
horse in the form of so-called "Einscbuss" [special form of
phlegmon of the hind limbs] . It also occurs as so-called c o 1 -
late real edema in the vicinity of suppurative inflammatory
foci (abscesses). The following are specific forms of inflam-
matory edema: malignant edema, hemorrhagic
edema (anthrax), and blackleg.

b) Stagnation edema (edema of the cellular tissue)
occurs through hydropic infiltration of the subcutis after slag-
nation of the venous blood or lymph. The edematous swell-
ing, therefore, is cool, painless, more or less soft,
doughy, and occasionally it retains depres-
sions made withthefiugers. In contrast to the clear
artrialrednessofinflammatory edema, it presents a reddish-blue,
cyanotic or livid color. It is found as follows : in old and
atonic horses that remain standing for a long time ; in preg-
nant mares and cows, on the abdomen, udder, (edema of the
udder), and on the posterior limbs ; when the head is held
down for a long time ; following venous thrombi and phlebitis.
Hydremic edema (anasarca) is a special form of
stagnation edema due to chronic diseases of the heart, lungs,

CUTANEOUS EMPHYSEMA 33I

liver, kidneys, and diseases of the blood (hydremia) ; it is
found cougenitally in the form of so-called water-calves (water-
moles, lard or moon-calves).

Treatment . ^The therapy of the different forms of edema
is extremely variable. Treatment of inflammatory edema
consists in antisepsis, hydrotherapy, in the application of an-
tiphlogistic remedies, incisions, and injections ; stagnation
edema is treated with massage, and compression, as wel! as
internally.

2. EMPHYSEMA.

Forms.— This is a
subcutaneous connective
recognized : t r a u m a t i

a) Traumatic

accumulation of air in the
issue (pneumatosis); two forms are

and septic emphysema,
mphysema occurs, either after the
entrance of air through external injuries in the skin, espe-
cially in the vicinity of the thorax, throat, and orbital cavity ;
or after internal injuries to the thoracic walls and lungs
(coughs in cattle), after rupture of the esophagus, perforation
of the rectum and subcutaneous fractures of the tracheal
rings through which air passes from within to without. Ac-
cordingto the origin there is recognized an expiration-
emphysema (injuries to the trachea and the lungs), and
an inspiration- emphysema (aspiration through
pumping movements of the thorax, the abdominal walls and
the extremities). Under certain influences the accumulation of
air under the skin produces the following conditions : the en-
tire back is extensively s w o 1 1 e n, t h e swelling is soft,
puffy, crackling, painless, and not accompa-
nied by local heat, it is characterized by a
tympanitic tone on percussion; the animal often
has a deformed appearance. In general the prognosis of trau-
matic emphysema is favorable, the air is gradually resorbed
through the blood- and lymph-vessels, and the general condi-
tion is not usually disturbed. It is a peculiar condition, that
inflammation of the subcutaneous connective tissue is usually J
absent although infectious material must gain entrance withfl

332 DISBASES OF THE MUCOUS MEMBRANES

the air. Treatment consists in massage and compression ;
frequently this is unnecessary.

b) Septic (gangrenous, spontaneous) emphysema is
due to the entrance of gas-forming bacteria into the subcutis,
namely, bacillus phlegmonae emphysematosae (gas-phlegmon),
a gas-forming variety of the bacterium coli, and other micro-
organisms. The gas beneath the skin is not composed of air,
as in traumatic emphysema, but of putrefactive gases
(carbureted hydrogen, sulphureted hydrogen, hydrogen, car-
bonic acid). In contrast to traumatic emphysema, one finds
symptoms of septic inflammation in the skin and subcutem, the
general conditions frequently undergo severe changes (septi-
cemia). Blackleg is a specific form of septic emphysema.
Following death of a fetus, there develops as a result of decom-
position, a subcutaneous, intermuscular, and subserous emphy-
sema (so-called emphysematous fetus or *'dunst-
kalb'' vapor-calf).

The treatment of septic emphysema consists in mak-
ing extensive incisions, removal of the gas, thorough disinfec-
tion of the subcutis, as well as eventual amputation of the
diseased parts (tail).

T\'MPANiTis. — The accumulation of air in body cavities and hoUow
organs (tympanitis, meteorism) is occasionally of surgical importance;
it may follow injuries (pneumothorax following perforating tho-
racic wounds), and frequently receives operative treatment by means of
puncture (tympanitis of the rumen, meteorism of the
intestine). Tympanitis of the guttural pouch in foals
is a peculiar affection, it is due partly to the entrance of at-
mospheric air, partly to the development of putrefactive gases. Occa-
sionally one also observes the entrance of air into the abdominal
cavity (castration ) and into the veins (aspiration of air, see page 4).

III. SURGICAL DISEASES OF THE MUCOUS

MEMBRANES.

Inflammation. — Inflammation of the mucous membranes
presents the same causes and forms as inflammation of the
skin. The following are of special surgical importance : in-
flammation of the oral mucous membranes (stomatitis),

DISEASES OP THE POt>ODERM

lembranesof thenose (rhinitis), eyes fco nj ii nc-
tivitis), pharynx (pharyngitis), vagina (vaginitis,
colpitis), uterus (endometritis), bladder (cystitis),
and rectum (proctitis). The following forms of inflam-
mation occur on the mucous membranes named :

1. Erythematous inflammation of the mucous
membranes.

2. Catarrhal inSammation of the mucous membranes.

3. Suppurative inflammation of the mucous mem-

branes.

isicular,

phlyctenular) inflammation.

on of the mucous membranes.

if the mucous membranes.

membraDous) iuflammation

4. Aplhous (

5. Pustulous

6. Ulcerative

7. Croupous (fibrinoi
of the mucous membranes.

3. Diphtheritic infli

9-
branes.

10. Chronic hyperplastic (granular, vcrrucose,
polypous, cystic, fibrous, follicular, etc.) inflammation of the
mucou.s membranes.

There are also specific inflammations of the 1
membrane.s (actinomycosis, tuberculosis, glanders, etc.).

Treatment consists in the application of disinfectant
tringent, and protective materials.

nation of the mucous r

Phlegmonous infiammation of the mucous mem-

IV. SURGICAL DISEASES OF THE PODODERM.

Infl.-\MM.\TON. — Inflammation of the pododerm (pododerm-
atitis) presents the same general causes and forms as iuflam-
mation of the skin. The following special construction, how-
ever, causes variations : the resistance of the protective horn-
capsule (hoof, claws) ; failure of the subcutis over the third _
phalanx, the pododerm occupying the relation of the perios-
teum : as well as the exaggerated development of the papillary
body and the rete mucosum. The following forms are recog-
nized : superficial and deep; acute and chronic;

334 CONGENITAL MALFORMATIONS

serous, suppurative, hemorrhagic (corns),
and gangrenous or necrotic; infectious (nail-
pricks) and non-infectious or aseptic (laminitis) ;
chronic productive (keratocele, chronic laminitis) ; as
well as circumscribed and diffuse pododermatitis.
Because of failure of the subcutis over the third phalanx
phlegmonous inflammation occurs only at the coronet
(subcoronary phlegmon), in the vicinity of the lateral
cartilage (para chondral phlegmon), as well as in the
fatty frog (phlegmon of the fatty frog).

APPENDIX. .

CONGENITAL MALFORMATIONS OF SURGICAL IMPORTANCE.

General Considerations. — Aside from mere patholog-
ical and anatomical considerations, congenital cases of malfor-
mations are of less interest in animals than in man ; they are
seldom of practical surgical importance, as new-born animals
with extensive malformations are usually killed. Still there
are a considerable number of congenital malformations in vet-
erinary surgery that are amenable to plastic operations. These
are anomalies of the genital and digestive apparatus, eyes,
udder, skin, and extremities.

Congenital Malformations of the Genital Appa-
ratus. — In male animals cryptorchidism, that is, re-
tention of one or both testicles in the abdominal cavity (ab-
dominal cryptorchid), or in the inguinal canal (inguinal cryp-
torchid) is of greatest practical importance, it most frequently
occurs in stallions. With reference to treatment see : Opera-
tionslehre by Bayer (Bd. I), [or : "The Castration of Cryp-
torchid Horses and the Ovariotomy of Troublesome Mares'*
Hobday*]. Failure of one (monorchid), or both testicles
(a nor chid) is rare, aplasia of one or both testicles is of
great importance in the castration of cryptorchids (failure to
find the testicles). In exceptional cases, three testicles (t r i-

'Translator's reference.

CONGENITAL MALFORMATIONS

335

orchid) have been observed. Ao occasional forward dis-
location of the testicle, lateral to the penis, is peculiar to
dogs ; in these animals there also seems to be a predisposition
to the development of new formations in the testicles. Con-
genital fissures are also found in the urethra, the urethra does
not form a closed canal opening at the end of the penis, but
maj- have a dorsal opening (epispadia), or a ventral open-
in to the sheath (hypospadia). It mayevenformaseinj-canal
or fistula, opening at the scrotum and perineum. Congenital
stenosis of the prepuce (phimosis) sometimes occurs.
One frequently observes new-born foals in which there is an
opening in the urachus from which urine is constantly drop-
ping (fistula of the urachus): the following
have also been described: cystic urachus, ectopia
of the bladder as a result of eitstrophy, as well as
cystic diverticulum after obliteration of the urethra,

In female animals one frequently observes congenital
cystic ovaries, congenital closure of the vagina (atre-
sia vaginae), abnormally large development
of the hymen, failure or incomplete development of the
cervix and uterus, atresia and obliteration of the tubes.
There further occurs the formation of hermaphrodites,
and apparent hermaphrodites (pseudo-hermaphrodites) ; I
have operated two cases of pen is- form at ion in the
vagina of mares. Finally, the fo r m a I ion of rudimen-
tary teats (after-teats) is not uncommon on the scrotum
or in its vicinity in bulls, oxen, goats, and rams.

Congenital Malfokmations in the Digestive Api'a-
RATtis. — Fissures in the lips and intermaxillary bones (hare-
lip, labium leporinum j, as well as the palate ''cleft pal-
ale, wolf's jaw. palatoschisis) are especially observed in pup-
pies and foals as well as cattle. They are seemingly
Dncommon ; in 70,000 cases of diseased dogs I have ob-
served only three cases of cleft palate, and only one case of
hair-lip. Congenital shortening of the frenum lingua has btta
observed in calves. On the maxillfe. especially in the hone,
it frequently occurs that the jaw is abnormally long and pro-
jecting (progn athism), or abnormally short and recediag*

336 CONGENITAL MALFORMATIONS

(brachygnathism). These are frequently the cause of so-
called pike- and carp-mouth (brachygnathia superior and in-
ferior.) Many anomaliesoftheteeth are also con genital,
especially the disposition to shear- mouth due to narrowness be-
tween the rows of teeth in the inferior maxilla ; the persist-
ence of the incisor milk-teeth ; the occurrence of supernumer-
ary teeth (polyodontia), and canine teeth in mares. The fol-
lowing may also be mentioned : congenital dilitation of the
guttural pouches in foals which results in catarrh of
the guttural pouches ; congenital diverticulum of the
esophagus in horses as a result of aberation at the second
branchial cleft; congenital hernias in horses, dogs, and
swine, which occur in the form of umbilical, inguinal, and
perineal hernias. Perineal hernia (hernia perinealis, vesicalis,
cystocele) in dogs is due to a protrusion of the recto- vesical
excavation ; in bitches to a protrusion of the vesico- vaginal
excavation. Congenital adhesions of the anus and rectum
(atresia ani, atresia recti) have been seen in dogs
and swine. The formation of a cloaca (common opening
for the rectum and vagina, or bladder and urethra) is fre-
quently congenital in animals. According to M a y r one
must differentiate between typical and atypical forms, as well
as between cloacas that have, and do not have, fissures in the
bladder. The following are the most important of the latter
forms : atresia ani simplex, atresia ani vesicalis,
(anus vesicalis), atresia urethralis (anus urethralis),
atresia ani vaginalis (anus vaginalis), atresia ani
with cloaca formation at the vestibule of the
vagina (anus vestibularis), as well as anus vulva lis,
perinealis, and scrotalis.

Congenital Malformations of the Eye. — D e r m o i d
of the cornea is a congenital anomaly that is relatively
frequent in dogs and calves, it is also seen in horses, sheep,
and swine. It consists of a spherical projection of the skin
over the cornea at the external angle of the lid; Schindelka
has collected statistics on twenty-nine personal and reported
cases, nine of these were in cattle, eight in dogs ; I have
observed and operated fourteen cases in dogs. The following.

CONGENITAL MALFORMATIONS

337

also, are not rare in dogs and horses : coloboma, that is,
congenital Assure and defect of the iris and tapetum ; congen-
ital cataract (cataracta congenita) , and atrophy of the
retina (amaurosis); hyperthrophy of the uveal
bodies in the horse : congenital closure of the lids in dogs
(atresia palpebrarum congenita): congenital atro-
phy of the entire eye in dogs and foals (microphthalmus);
retention of portions of the pupillary membrane (membrana
pupillaris perseverans), as well as the vitreous artery
(arteria hyaloidea persistans); finally, atresia of
the lachrymal duct at its nasal opening.

Congenital Malformatioks of thk Uddkr. — Aeon-
genital sinallness of one or more quarters of the udder in com-
parison with the others (micromania) is common in cows.
Abnormally large development of the milk-glands (macro-
mazia) in male animals, especially In billy-goats, forms an
opposite condition. Complete failure of an udder in female
animals (aplasia or hypoplasia of the udder} is
rare. Congenital closure (atresia) of the openings of the
teats, as well as congenital stenosis of the teat-canal (steno-
sis) is occasionally observed in cows. Cows frequently have
an excessive number of leats or after-teals (six instead of
four) , and d w a r f - t e a t s, as well as failure of the fourth teat
(congen i tal I y th ree - 1 ea tedj.

Congenital Malform.\tions of the Skin. — In addi-
tion to dermoid cysts in the skin and subcutem (occurring
in dogs partly in the form of multiple furunculosis), horses,
cattle, and goals are frequently affected with a congenital
baldness (atrichia, alopecia); the opposite of this
condition, excessive growth of hair (hypertrichosis),
occurs in horses on the mane and tail. An abnormality that
is frequent in fully developed dogs consists in an excessive
growth of the claws, especially the after-claws (hy peron y-
chia). with excessive bending (onycbogryposis) and
growing into the skin (paronychia); according to my ex-
perience one per cent of all diseased dogs f540 cases in 70,000)
are thus affected. So-called '"hornsaule" keratocele of the
born-capsule is an abnormality that is sometimes congenital in
the horie.

338 congenital malformations

Congenital Malformations of the Skeleton and
Limbs. — Abnormal smallness of the entire skeleton, in part a
result of fetal rachitis, is termed dwarf formation (micro-
somia or acromicria); the opposite condition, excessive
development of the limbs, is termed macrosomia, acro-
megalia, leontiasis ossea, etc. According to
Zschokke, restricted growth of the bones that depends on
a derangement in the development of the cartilage (achondro-
plasia) is termed cretinism ; that which depends on a de-
ranged ossification is termed rachitis. A surplus number
of entire extremities (polymelia) in the domestic ani-
mals is less frequently observed than an excessive number of
toes and claws (polydactylia); the latter anomally on
the anterior feet of swine, as well as on the inner surface of the
metacarpus in the horse, has been frequently described and
successfully operated. The same is true of adhesions between
the claws to form a single claw (syndactylia) in swine.
Double formations also occur, especially in calves ; I have
operated one such case of omopagus parasiticus.
Failure of entire extremities (a m e 1 i a), or single toes (p e r-
odactylus) is observed in new-born animals. Finally, one
occasionally finds congenital fissure formation in the bones of
the skull (cranioschisis), and the vertebral column
(spina bifida), the former is occasionally combined with
protrusion of the brain (encephalocele), as well as con-
genital curvature of the vertebral column of the horse and deer
(kyphoscoliosis).

Congenital Malformations of thf Respiratory
Tract. — An abnormal enlargement of the bones
occasionally causes dyspnea and chronic nasal catarrh in
foals. Congenital deformities also occur in the trachea
in the form of stenosis, dilitation, and sabre-scabbard-like
flattening, it may also roll on its axis or assume the form of a
spiral. Goitre is very often congenital in puppies. The
following congenital malformations are also of importance :
ear-fistula (see page 90) and congenital deafness; I
have observed the latter several times, especially in Dalmation
dogs, when it was without doubt a hereditary affection.

INDEX.

Abnormal fragility 193.
Abnormal granulations 21.
Abscess 34.
Acaras 184.

Accidental wound infection] dis-
eases 25.
Acne 324.
Acromegalia 229.
Acromicria 229.
Actinobacillosis 155.
Actinomyces 153.
Actinomycoma 153.
Actinomycosis 153.
Actinophytosis 138.
Actol 59.
Acuepressure 15.
Adenofibroma 113.
Adenoid 147.

Adenoma 147.

.^gropila 177.

African glanders 316.

Airol paste 60.

Alcohol 6a

Aloes, tincture of 60.

Alopecia 337.

Aluminum acetate 60.

Alveolar sarcoma 127.

Amelia 338.

Anchylosis 254.

Aneurysm 306.

Angioma 122.

Angioma racemosum 123.

Angiosarcoma 127.

Anorchid 334.

Anthrax 54.

Antiphlogj sties 83.

Antiseptic treatment of wounds 55.

Anns vaginalis 336.

Anus vesicalis 336.

Aortal aneurysm 307.

Aortal stenosis 312.

Aphthae 333.

Aplasia of the udder 337.

Aplasia of the testicles 334.

Apostema 34.

Aqua chlorata 60.

Argentum nitricum 59.

Arrest of hemorrhage 12.

Arteries, 305.

inflammation of, 305.

dilitation of, 306.
Arterioschlerosis 305.
Arthritis 234.

deformans 238.

fibrinous 244.

granular 243.

pannous 244.

purulent 236.

pyemic 245.

serous 234.

sicca 244.

ulcerative 244.

uric 244.
Aseptic treatment of wounds 55.
Athermoa 150.

of the vessels 305.
Atherosis 305.
Atmocausis 16.
Atresia 96.
Atrichia 337.
Atrophy 96.

Bacillol 59.

340

INDEX

Bacillus cellulseformans 41.

pyocyaneus 26.

pyogenes 26.

tetani 52.
Bacterium coli 27.
Bacteremia 38.
Bacteria of pus 25.
Bandage 61.
Bezoare 177.
Birth-mark 122.
Bismuth salts 60.
Bites 7.
Blackleg 54.
Bleeding i.
Blood -disease 16.
Blood-extravasate 65.
Blood-cysts 151.
Bone, atrophy of 228.

diseases of 190.

formation of 191.

fractures of 190.

glanders of 221.

development of 191.

hypertrophy of 229.

inflammation of 220.

necrosis of 226.

tuberculosis of 171.

wounds of 23.

tumors of 119.
Bone-caries 227.
Bone-callus 207.
Bone-fistulse 87.

Bone-marrow, inflammation of 221
Boric acid 60.
Botryomyces 161.
Botryomycoma 161.
Brachygnathism 336.
Bullous dermatitis 323.
Burns 325.

Burrow's solution 60.
Bursiu 259.
Bursitis 278.

Calcium permanganate 60.
Calf-lameness 245.

Callosity 112.

Callus 207.

Callus tumors 209.

Camphor 60.

Camphor spirits, bandage of 32.

Cancer 133.

Cancroid 134.

Carbolic acid 59.

Carbuncle 324.

Caries 91.

Carcinoma 133.

Caro luxurians 21.

Cartilage-tumors 117.

Cartilage-wounds 24.

Cataplasm 80.

Caustics 92.

Cellular theory 74.

Chemotaxis 73.

Chloride of zinc 60.

Cholesteatoma 137.

Chondroids 118.

Chromatophores 128.

Cicatrix 119.

Cicatricial contracture 22.

hypertrophy 22.

keloid III.

stenosis 97.
Cicatrization 19.
Clavus 148.
Cleft-palate 335.
Cloaca 336.
Club-foot 257.
Coagulation necrosis 91.
Coenurus cerebralis 182.
Cold 81.

apparatus for application.of 81,
Coloboma 337.
Colon-bacillus 27.
Combustion 325.
Comminuted fracture 195.
Compound fracture 194.
Compression 15.
Compression stenosis 97.
Concrements 174.
Condyloma 145.
Congelation 328.

Conitenitftl malformation* 334.
ConKeaital stenotis 97.
Connective-tlBsue tnmora 99.
Connective tissue,

inflammation of sS.
Conlra-fractnre 93.
Control of hemorrliage 13.
Conquasiion fractare t9S'
ConluBed wOunds 7.
CoTTliision '14. 353-
Cooling apparatns 81.
Corpora libera 177, 358.
Corpora oryzoidea 177, 358.
Crarioscliisi! 338.
Creolin 58.
Crepitation aoo.
Cr«aoIS9.

Crnral paralysis 30a.
Cryptogenic septicemia 40.
Ciyptorchidism 534-
Cutaneout Irritenta 83.
Cnlaneons horn 148.
Cylmclticnl -celled cancer
Cylindroma la?.
Cysticercus cellnloau; 184.
Cystic calculi 175-
Cystoma 151.
Cy«s 149

Denftiess 338.
Deforming arthritis 138.
De (generative atropby 96.
Degenerative cysts 151.
Decnbitis 91.

Decompoaition, bacteria of 39.
Demarcation, line of 95.
Depression 195.
Dermatitis 333
Dermatol 60,
nvimolilariBi83.
Dermoid of tbe cornea 33^.
6ermoid cysts loo
Dermoid ^rowtb 99.
Diapedesis 73-
Uiaslasis 349.

'34.

Digital compression 15.
DilitatioD 98.
DiphLherio 93,

UislocaUon of fragmants 195.
Distomum hepaticnm 184.
Distorsion 353.
Diverticulum 98.
Dumdum bullet 11.

Bar-fistnla 90.
Ebumation 331 , 339.
Bcchondroma 1 17.
Bcchymosis 65.
Ectasia 98.

Bctopia of the bladder 337.
Eczema 335.
Edema- bacillus 49.
Edema, it)flammator7 330.

malignant 49.
Elephai

Elect

tiHuei

: 3a9-

' Embryonic theory loo.

Emigration 73.
1 Emphysema 331.
! l^mpliyseuiatous fetaa 333.
j Enantbema 313.
I Bncepbulocele 338.
i Enchoiidroma 117.

Endarteritis 305,

Endosteum r9i.
, Hnilotlielioma 117.

Kiidutbclisl cancer 137.

Enostoses 119.

Epispadia 335.
; Epithelial growths 99.

Epithelioma 148
I Erosion 317.

Erysipelas 46.
I Erythema 313

Eschar 91.

healing under Ji,
1 Bxauthema 335.
I Exfoliation 328.
I Excretion -fistula 87.

342

INDBX

Exostosis 119.
Expiration-emphysema 331.

Exudate 86.
Extravasate 65.
Extravasation-cyst 151.
Exudation-cyst 151.

Facial paralysis 301.
False joint 209.
Farcin d'Afrique 316.

du boeuf 317.
Fascise 283.

necrosis of 297.

rupture of 298.
Fatty tumor 1 13.
Ferment fever 39.
Fever 37.
Fibroblasts 18.
Pibro-epithelial new-formations

144.
Fibrocarcinoma 134.

Fibroma 107.

Fibroid 107.

Fig-wart 144.

Filaria cincinnata 183.

hemorrhagica 183.

irritans 18^.

lachry mails 183.

medinensis 184.

papillosa 183.

Fire-mark 122.

Fissure 196.

Fistula 86.

Fistula of lateral cartilage 88.

Flat-foot 257.
Foal-lameness 245.
Folliculitis 324.
Formalin 259.
Fractures 190.
Fragilitas ossium 193.
Free bodies 177.
Freezing 328.
Foreign bodies 178.
Fungus hematoides 123.

vasculosus 123.
Furunculosis 524.

Gelactococcus 320.

Galls 275.

Gangrene 91, 95.

Gangrena nosocomiidis 53.

Gangrenous emphysema 95.

Gas-gangrene 95.

Gas-phlegmon 31.

Gastric fistula 90.

Gastrophilus 183.

Genuine cysts 151.

Germ theory 100.

Giant-celled sarcoma 126

Glanders 53.

Glands, inflammation of 318.

Glandular-celled cancer 134-

Glioma 130.

Goitre 147.

Gonitis 241.

Gout 246.

Granulation 119.

Granuloma 21.

Gregannae 292.

Gun-shot wounds 8.

Hair-balls 180.
Hair-lip 335.
Halisteresis.
Healing per primam 17.

per secundam 19.

per tertiam 20.

under an eschar 21.
Heat 80.
Heat-stroke 329.
Hemangioma 122.
Hemangiosarcoma 127.
Hematoma 65.
Hemiplegia 299.
Hemoglobinemia following bums

Hemophilia 16. [326.

Hemopis vorax 184.

Hemorrhage i.
arrest of 12.

Hemorrhoids 315.

Hermaphroditism 335.

INDEX

343

Hernia 185.

Histoid tumors 100.

Heat-stroke 329.

Hodgkin's disease 125

Horn, cutaneous 14S.

Homy cicatrix 22.

Horse-leech 184.

Hospital-gangrene 53.

Hydrocele 282.

Hydrops of tendon-sheaths 285.

Hygromata of mucous bursas 28a
of tendon-sheaths 275.

Hyperonychia 337.

Hyperostoses 119.

Hypoderma bovis 183.

Hypodermoliths 183.

Hypoplasia of the udder 337.

Hypospadia 335.

Hystriciasis 149.

Ichorous inflammation 77.

Ichthyosis 149.

Incised wounds 6.

Idiopathic fractures 193.

Impaction 195.

Impression 195.

Inactivity, atrophy of 96.

Incised wounds 6.

Infectious tumors 152.

Infection, septic 40.

Inflammation 72.

Inflexion 188.

Infraction 195.

Inspiration-emphysema 331.

Intestine, fistula of 87.
calculus of 176.

Intestinal hernia 185.

Intestinal prolapse 189.

Interstitial myositis 286.

Intoxication, septic 41.

Invagination 188.

Inversion 188.

Iodoform 59.

Irrigation, permanent 81.

Itrol 59.

Ixodes ricinus 184.

Joint-bodies 258.
Joint, caries of 243.

contracture of 156.

contusion of 253.

diseases of 232.

distorsion of 253.

empyema of 237.

galls of 235.

hydrops of 235.

inflammation of 233.

luxation of 247.

rheumatism of 244.

sprain of 252.

stiffness of 254.

villi of 232.

Keloid rii.
Keratocele 148.
Keratoma 148.
Keratosis 148.
Kyphosis 258.

Labium leporinum 335.

Laceration 70.

Lacerated wounds 7.

Laryngeal tuberculosis 170.

Lateral cartilage, fistula of 88.

Leiomyoma 120.

Leontiasis 229.

Ligature 15.
I Lightning-stroke 329.
' Lipoma 113.

Lipomasia 296.

Liquefactive degeneration 191.

Longitudinal fractures 195.

Lordosis 258.

Lugol's solution 59.
I Luxation 247.
' Lymphadenia 125.

Lymphangioma 123.

Lymphadenitis 318.

34*

Lymphsdenoina 124.
LytnphiLiigiosarcomB 137.
Lymphangitis 316.
Ljntph -glands, inttamnmtion

of 318.
LymphotDa 134.
Lymph-cysts 317.
LyK>l 59-

Maceration 91:
Macrochelia 134.
Wac rod acty lift 339-
:Macroglossia 34.
Macromazia 337.
MacTOBomia 338.
Macula 333.

'Mai

s 334-

_ _ iligoant edema 49.
Malignant lymphoma 124

MHrgarilOina 127.

Massage 83.
Mastitis 320.

Mednllary cancer 134-

Melanocyst^ jS.

Melanosarcoma 137. 131,

Melanosis 127.

Meliceris 149.

Membrana papillaris petseverana

337-
Mesarte litis 305.

Meteorism 333.

Micrococcus ascot'ormans 161.
Microphthalmus337,
MicNcher's tubules 184, 393.
Milk-calculi 178.
Milk -fistula 90
Microtnazia 337.
Mictophthalmus 337.
.Microsomia 338.
Monoplegia 399.
Monorcbidi.!! jj),
Hortiti cation 95,
Mucous bursal: 360.

iiiilammatian oF 176.
Mucous degeneration o£ the tur-
binated bones 117.

Mucous tnmora 116.
Mucons membrane, in

tion ot 333.
Mucous cvsts 149-
Mummification 95.

Muscles 383.

atrophy of 295.
diseases of 383.

hypertrophy of 397.

inflamutation of 386.

luxation of 29S.

rheumatism of 387.

lupturesof J93.

tumors of no.

Hounds of 33.
Myeloid 136.
Mycoiibroma 161.
Myoma i3o.
Myositis 386.
Myxedema 117.
Myxoma 116.
Mvxoscarcoma i36.

Nasal polypi 109.
Nearthrosis 350.
Necrosis 91, 95.

paralysj? of 399.
tumors of I3i.
wounds of, 24.

Obliteration 96.
Obturation'Sten<
Odontoma 15a

(ICstrus ovifl 183.
Oniarthritts 242.
Omentum, prolapse of il

INDKX

345

Omapagns parasiticus 338.
Omphalitis 245.
Onychogryposis 337.
Oaychoma 148.

Open treatment of woands 61.
Organization of hematomata 67.
Organization of thrombus 13.
Organoid tumors 100.
Ossifying myositis 291.

periostitis 217.
OsteobLists 191.
Osteoclasts 191.
Osteoma 119.
Osteomalacia 229.
Osteomyelitis 216.
Osteophytes 119.
Osteoporosis 228.
Osteopsathyrosis 193.
Osteosarcoma 128.
Osteoschlerosis 221, 229.
Ostitis 220.

Pachyderma 112.
Palatoschisis 335.
Panaritium 33.
Papilloma 144.
Paralysis 299.
Paraplegia 299.
Parasites 182.
Paresis 299.
Paronychia 337.
Pentastomum tienoides 183.
Percussion 82.
Periarthritis 246.
Periostitis 217.
Perithelioma 127.
Perodactylus 338.
Pes varus 257.
Petechia 65.
Phagedena 91.
Phagocytes 73.
Pharyngeal lymphomata"i57.
Phimosis 335.
Phlebectasia 314.
Phlebitis 313.
Phleboliths 14.

Phlegmon 28.

Phytobezoare 177.

Pigmented sarcoma 127.

Plaster-of- Paris bandage 212.

Pneumatosis 331.

Pododermatitis 338.

Podotrochlitis 279.

Poisoned wounds 8.

Polyarthritis 234.

Polydactylia 338.

Polymelia 338.

Polyodonlia 336.

Polypi 109.

Pomphus 324.

Preputial calculi 178.

Pressure atrophy 96.

Pressure necrosis 91.

Priesnitz bandage 80.

Prognathism 335.

Prolapsus 188.

Prostatic calculi 178.

Proteus 41.

Psammoma 127.

Pseudo-art hrosis 209.

Pseudo-carcinoma 138.

Pseudo-glanders 316.

Pseudo-hermaphrodite 335.

Pseudo- leukemia 125.

Psorospermia 184.

Ptomaines 41.

Puerperal blackleg 54.

Puerperal pyemia 44.

Puerperal septicemia 43.

Pulsion-diverticulum 98.

Pultaceous cysts 150.

Punctured wounds 6.

Pus 27.

l)acteria of 25.

Pus bonum 27.

Pus-cocci 25.

Pus-fistulie 87.

Pustule 324

Pulresence 91.

Pyemia 44.

Pyemic arthritis 245.

Pyocyanin 26.

346

INDEX

Pyoktanin 6i.
Pyoxanthin 26,

Quittor 88.

Rabies 54.
Rachitis 230.
Radial paralysis 301.
Ranula 149.
Ray-fungus 152.
Regeneration of tissue 23.
Renal calculi 175.
Reposition of bone-fractures 211.
Retention of bone-fractures 211.
Retention-cysts 149.
Rhabdomyoma 120.
Rhinoschleroma 112.
Ringbone 241.
Rontgen-rays 203.
Roseola 323.

Round-celled sarcoma ia6.
Rupture 70.

Salicylic acid 60.
Salivary fistula 90.
Salivary calculi 177.
Sapremia 41.
Saprophytes 41.
Sarcoma 125.
Sarcosporidia 184.
Scab, healing under 21.
Schleroderma 112.
Schlerosis 112.
Scirrhus 134.
Scoliosis 258.
Secretion-fistula 90.
Senile atrophy of bone 229.
Septicemia 40.
Septicopyemia 40.
Septic phlegmon 30.
Sequester 91 .
Schleroderma 112, 324.
Schlerosis 112.

Shot-woiinds 8.

Silver nitrate 59.

Skin, inflammation of 323

diseases of 323
Spavin 239.

Spermatic cord, fistula of 162.
Sphacellus 91.
Spina bifida 338.
Spina ventosa 156.
Spindle-celled sarcoma 126.
Spiritus 60.

bandage of 32.
Stab-wound 6.
Spontaneous bone-fracture 192.

luxation 248.
Spiroptera sanguinolenta 184.
Splinter-fractnre 195.
Squamous-celled cancer 134.
Stagnation edema 330.
Staphylococcus 25.
Stasis 73.
Steatoma 1 14.
Stilt-foot 256.
Stenosis 97.
Strangles 55.
Streptococci 26.
Streptococcus septicus 40.
Stricture 97.
Stringhalt 299.
Strongylus armatus 184.
Struma 147.
Sublimate 58.
Suffusion 65.
Sun-stroke 329.
Suppuration 25.
Syndactylia 338.
Synostosis 210.
Synovitis 233.

Tapping 88.

Tannoform 59.

Tar 60.

Teeth, anomalies of 336

Teleangiectasis 122.

Tendinitis 264.

Tendons as 9.

diieaseE of 364.

iaHammation of 164.

luiatioQ of 370.

necrosii of 37a.

rDptnre of 367.

wounds of 13.
Tendon-sheath 160.

^lUof 275.

inflstumatuit] of 372.
Tendinous still-foot 366.
Tendovaginitis 373.
Tenonitis 364.
Teratoid tumon 100.
Teratoma 100.
Tetanus 51.

bacillus of 53.
Thiofonu 60.

Thrombosis of femoral arteriw
Thrombus 13.
Ticks 184.

Tooth- follicle cyst 150.
Too(h-fi«tula 89.
Tooth- teratoma 150.
Torsion 15.

Trflctiou-dtveriiculiirngS.
Transplantation 63.
Trigeminus, paralysis of 301.
Triorchid 334.
Triimns 51.
Tubcrc-ulosis 166.
Tumor gS.
Tnmor albus 343.
>33-

fibrosus 68.
Tympanitis 33a.

Udder, actinomycosis of 159.

botryomycosis of 163.

tnbcrcnioeis of 167.
Ulcer 84.

Ulceration 84.
Urachna, cystic 335,

GatDla of 335
Uriaary fistula 90.
Urinary calcnlns 175.
Urticaria 3J4
Uterus, prolapse of 190.
tuberculosis of 170.

Vagina, prolapse of 189.
Vaporization of nterus 16.
Varix 314.
Veins, dilitation of 314.

inflammation of 313.
Venous calculi 14.

Warmtb 80.
Watts 144-
Wildsenche SS-
Wtnddom 156.
Witherfl, Astnta of 89.
Wolf ■■ jaw 33s.
Wooden -tongue 155.
■\VoQndB .

bandaging of 61.

diphtheritic 53,

healing of 17.

treatment of 55.
Wound fcTer 37.
Wound infection diseases 35.

Xanthoma 137.

Zestocanais 16.

The Pathology and Differential Diagnosis of
Infectious Diseases of Animals

By Veranus Alva Moore, B.S., M.D., Professor of Comparative
Pathology, Bacteriology and Meat Inspection, New York
State Veterinary College, Cornell University, Ithaca, N. Y.
With an introduction by Daniel Elmer Salmon, D.V.M., For-
mer Chief of the Bureau of Animal Industry, United States
Department of Agriculture.

The Profession will gladly welcome this new book, which brings the
subject right up to the present state of the wonderful progress made in
the study of infectious diseases. * * The book deals with the impor-
tant infectious diseases of animals that occur in this country.

•*Am. Vet. Review."

Dr. Moore has rendered an invaluable service in bringing together
in convenient book form a lucid, interesting and accurate account of
the infectious diseases of Animals. ''Am. Med."

Second Edition. Revised and Enlarged.

$4.00 net

TAYLOR & CARPENTER
VETERINARY PUBLISHERS AND BOOKSELLERS

ITHACA, N. Y.

Veterinary Medicine

By Professor James Law, F.

Director N. Y S. Veterinary College, Ilhaca, N. V.

VOL. I. General Pathology Diseases of the Respira-
tory and Circulatory Organs. pp. 566. 8 vo. 2nd Ed.
Revised and enlarged. Price. $4.00.

VOL. IL Disea.ses of Digestive Organs, Liver, Pan-
creas and Spleen, pp 595. 8 vo. and Ed. Revised and
enlarged. Price, $4.00.

VOL. IIL Diseases of Urinary and Generative Organ*,
Skin, Eye and Nervous System, pp 611. 8 vo. ind Ed.
Revised and enlarged. Price. $4.00

VOL. IV. Infectious Diseases, Sanitary Science and
Police, pp. 675. 8 vo. 2nd Ed. Revised and enlarged.
Price, $4.00

VOL. V. Parasites and Parasitism. ist Ed. pp. 531.
8 vo. Price, $4.00.

Destitied to become b alandard authority, — "Am. Vet. Review."
No better book of reference could be. — "Veterinary Record."
Of Professor Law's latesl volume (IVt, we can speak in terms of
warm praise. With its companion volumes, will form a valuable addi-
tion to the literature of veterinary medicine. — "Jour, of Comp,, Path,
and Therapeotics. ' '

Published by the author Sent, express prepaid, on
receipt of price.

General Surgery

BY DR. MED EUGEN FROHNER— Professor in the
Royal Veterinary High School in Berlin, Authdrized
Translation from The Third Revised Edition, bv D.
HAMMOND UDALL, B.S.A., D.VM , Associate Professor
ofSurgery and Obstetrics. OhioState University. Columbus, O.
The translation of Friihner's General Surgery has been
undertaken to meet the need of an English text-book on the
subject. This text-book is Vol. II, of a hand-book of seven
volumes written by various authors and edited by the late
Prof. Joseph Bayer, of Vienna and Prof, Engen Frbhner of the
Berlin Veterinary School, One other volume of this hand-
book. De Bruin's Obstetrics, is already well known to English
speaking veterinarians.

The reputation of Prof. Frohner as a writer of text-books
is too well known to require explanation. This translation is
from the 1905 edition ; the subject is presented in a scientific
manner ; is both concise and complete, and based on the
experience of many years of carefully prepared statistics from
the largest clinic of its kind in the world. S-i,oo net,
TAVLOR & CARPENTER
VETERINARY PUBLISHERS AND BOOKSELLERS
ITHACA, N. Y.

BY PIERRE A. FISH, D.Sc., D.V.M. Professor of
Veterinary Physiology and Pharmacologj-, New York
State Veterinar>' College, Cornell University. Ithaca, N. Y.

Veterinary Doses and Prescription Writing

A full list of drugs with their doses for the different do-
mestic animals. Therapeutic terms and a list of terminations
of medical terms applicable to Veterinary medicine. Pre-
scription writing is discussed in some detail, with illustrative
prescriptions. Thermometric equivalents. Weights and
measures. Latin words and phrases used in prescription
writing. Incompatability. Poisons and their antidotes.
Classification of medicines according to their physiologic
actions. Pages for selected prescriptions.

Red Leather Flexible Covers, i6o pages, $i.oo net.

* * * A small volume which will be of indispensable value to
practitioners and students. ♦ « ♦ it will return the investment with
interest every other day. ** American Veterinary Review.*'

Elementary Exercises in Materia Medica and

Pharmacy

A laboratory manual treating of the more commonly used
inorganic and organic drugs. Charts are included, upon
which are to be plotted physiologic action of many of the
drugs. The pharmaceutical .section includes examples of the
diflferent preparations in the U. S. Pharmacopoeia.

Second Edition. Revised and enlarged. $1.50 net.

There are features in this book which betoken a grateful advance
in the medical and pharmaceutical professions. We congratulate Prof.
Fish on his work. **Alkalodial Clinic."

Exercises in Physiology

A laboratory manual. Part I., Chemical Physiology.
Part II., Experimental Physiology.

Second Edition. Revised and enlarged. $1.50 net.

The work is modem. Its directions are admirably concise and
clear. It will aid teachers as well as students.

"Jour, of Applied Microscopy and Laboratory Methods."

TAYLOR & CARPENTER
VETERINARY PUBLISHERS AND BOOKSELLERS

ITHACA, N. Y.

LAXE MEDICAL LIBRARY

To avoid tine, this hook should he returned on
or hefore the date last stamped helow.

Internet Archive Audio

Featured

Top

Images

Featured

Top

Software

Featured

Top

Books

Featured

Top

Video

Featured

Top

Mobile Apps

Browser Extensions

Archive-It Subscription

Save Page Now

Full text of "General surgery"

See other formats