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CATECHISM
OF THE
Principles of Veterinary
Surgery Or OR
Vy
a “By \e
xe 5
W. E. A. WYMAN, MDV,, VS.
Avtnor or “Tux CrrnicaL Disenosis or LaMENEss IN THE HorsE,”
‘¢TrBI0o-PERONEAL NEURECTOMY,” TRANSLATOR OF
De Bruin’s ‘‘ Bovine OBSTETRICS,” ETC,
New Yorr
WILLIAM R. JENKINS
VETERINARY PUBLISHER AND BOOKSELLER.
851 anp 853 SrixtH AVENUE
1905
2D
No B51
Copyright, 1905, by Witt1am R. JENKINS
All righis reserved
PRINTED BY THE
PRESS OF WILLIAM R, JENKINS
PREFACE.
Nosopy can diagnose, treat and prognose a surgical case
intelligently unless thoroughly acquainted with the scientific
principles involved in any particular case. The student is
obliged to gain his knowledge of the various surgical
““ologies ” by lectures, and after all by the perusal and study
of works written for the human practitioner. The former is
insufficient and the latter obviously wrong.
The principles applicable to human surgery and those of
veterinary surgery, while in a great many instances closely
related, nevertheless differ materially. For instance, asepsis,
a condition sine qua non to the human surgeon, as a rule
exists in veterinary surgery only in theory, although lately
some of the leading surgeons in human surgery lean strongly
toward antisepsis, In human surgery, periostitis plays an
unimportant réle, while it is of vital importance to the equine
practitioner. Notice the difference in the prognosis and
treatment of fractures. How many human surgeons apply
the firing iron and blisters? This work is purely for the
veterinarian. As a former teacher of veterinary students, I
am fairly conversant with their needs. It has been my most
earnest desire and effort to supply a work which, while
scientific and modern, is free from matters of doubtful in-
terest to the American student.
lv PREFACE
The ‘student requires a work which explains; it is for
this reason that I wrote this work in questions and answers.
Depending on the importance of the subject from a practical
standpoint, a more or less exhaustive discussion has been
indulged in, exemplified by every-day cases.
Occasionally the therapeutic part of this work has become
a little more extensive than probably permissible in a work
onthe Principles of Surgery. The only apology which I offer,
if such is necessary, consists in the desire to supply the stu-
dent with certain reliable facts which he cannot find in print
elsewhere.
In arranging and classifying the various subjects, I fol-
lowed Prof. Dr. Eug. Fréhner’s masterly exhibition on _
General Surgery, which Prof. Fréhner kindly permitted me
to do and for which I herewith extend my best thanks,
Illustrations are omitted, as the clinic, the histological,
pathological and anatomical laboratories should supply the
student with the real thing,
W. E. A. Wyman,
CONTENTS.
GENERAL SURGERY..........005 Sinza ora ulate a/e/ehalaipra sist ipatnase aie oie vials et
ARREST OF HEMORRHAGE............ eSiie’s ox'¥'s shiakiepeaien SE Ce va
THE HEALING OF WOUNDS...... dishereyaiare eeeelda eee ae eae abminete sieve coee 18
ABNORMAL GRANULATIONS AND CICATRIZATION......cccccecececseces 17
REGENERATION OF THE VARIOUS TISSUES....... 2.0.0. Minna inars erate Ag
TRAUMATIC INFECTIOUS DISEASES. ......eeveeees eiayocaravend rs jateeiniats eooese SL
SUPPURATION OF WOUNDS....cccccscecsccsccccececssscsevccceesesccs 21
CELLULITIS........0055 sioioscielale’sla\e sieuoue tious naciene’a ee seaees siplere eet aie -. 28
TRAUMATIC FEVER. ....csec08 cee bie ia! Sialbsiwtarem@niae vows Sbtsiid tease - 28
SEPTICHIMIA... 2... cee eseeeee eee 10859 8AaH SHEMET ETHAN Gane ee cee «289
PY AIMIAG sedis aie aieiescni cane boasaenmeteals iv erations aa buisis Hueeoedaee 32
SprEcIFIC TRAUMATIC INFECTIOUS DISEASES..... auiieiesstiia’s'e'e's Gata’ sees 84
Malignant Gidema........ eaeietets saeaceune ee es weemeed Seba eases 34
Tetanus: ssasnreea ess as secre eesins soniennenawervae ys oa 6 escens 85
THE TREATMENT OF WOUNDS.......0ccecccesstcccesaceccceetseenens 39
THE TREATMENT OF SPECIFIC WOUNDS......0.-csccesccccsaccesceces 43
CONTUSIONS | sips es wielvie vie 'sainin ska! oa Risineas 8 Etec eeeleleh oie’ stags seas 47
SUBCUTANEOUS RUPTURES...... oi sistayeisrtietatalateialelele’staty wisldibianie wie rere, IO
Ruptures of Muscles.........eceeeeees errr errr rere ere eee re 52
Ruptures of Tendons..... eareile g's saieeornse tiw's aed Warn Re ERT NS -- 53
ENFLAMMATION, ....00ee000- hisinaw Dace Ss eee eae ss attaietaleccsatcrevastiouesecsies'6 55
Causes..... Seunphaals i gcd aieyovarieeasafavalere Saar aac ais aie tsyavepapavecarereueersis te 56
Varieties......... sayesieis ovale etcyialeesatiugtiesexe hiccbey atery ate tee la atetaiete whe 57
Symptoms...........0- oe sigieikjs o's 0:0 eieieiereinnpeiere levels se ’s ssa sie eie 59
Course and Termination.........cccreccceccecesccccseeces «see 60
Treatment........-. ida eae ates des cMenaaiaweatse sss <5 sia fenahaete 62
AABSCESS......00- eee eeenene eeeeee weve retieesvecceoene, cece eee tenes
vi CONTENIS
PAGE
ULCER {36.0% See tak ca ceniineew ice as ape ae r oa Geese Res en 73
FISTULA. .......6. ibicleibinacts Gb nerve Vw sedlelecdcbawieinelaees ee ae MRNAS vig
GANGRENE. 2... cc ceccocccecccence crnee oan dis 6 @ bie wisie celaioins een eee sisee 81
TUMORS 8 606i os icc aee sewmwewanens teen e eee e eee eenes Soiaasenesesecceye 86
Connective Tissue Tumors......eeeeeoeseeees Witiwaesemese’ 90
Fatty Tumors......- PERLE S TOES TMD D ES eee bE Senet eSS OEE 95
Mucous Tumors.... .....eceeccee cece e cree cnc eereeceaenece ae «696
Cartilaginous TUMors..........eeeeeeceee sere eens ghee ceseee 98
Osseous TUMOSLS....cccceee coc cverercceenceneeeee seeeceesees . 99
Muscular Tumors.......... webs a Havslcovbcia sae Apaletaatene 3 itwcce 99
Nerve Tumors. ...........000% Sis halaiha tie esanauseacangretee lees elw oater were 100
Vascular Tumors........50-... ediiieteeee-as NOMI a ee ete eee EES - 102
Lymphatic Gland TUMOrs...... cs eee ee cece seen nen ereneeenees 103
Sarcoma......... LOU Gie RL BRUINS ace wawigt ae sinaan Ree esl CORY aera ere tes, 104
Carcinoma.......sceeeeeee te Seas tae a ateheieteicierse oie eisie lait eee 108
Papilloma....c...cseccscceeccccenvee o coceeees iialla:ataverw Oye waiseavelate 115
SCLONA OTE occ siniasece'e, s26 base's acesavese tw line 6 v0.6 diwiete: aia telele Oaie eae Mieveetate 117
CY BUG sng xceceal eshte siete: tare aibady Sarg e'be gos soit wane aia asa ea eceis ye Gis 118
Actinomycoma.........eceeeeeeeeee sisi te Saiaie's Bistansae 8 Wis Meigtweigies 121
Botryomycoma.......cseeeecssccees Assia sacs slob aiisteus sole als woes 125
PUBERCULOSISs ss vssien Feswane ares ce eaiotnseieniaaes's 4 Aeeweeda a ese see - 128
CONCRETIONS AND FOREIGN BODIES............ aes aleveiete Meseud na arene 132
HERNIA AND PROLAPSUS..........+0- sikie sicaasids wince seal emaey 141
DISEASES OF BONES............ ia sieieieare veins aed Sees oe 8 FS soveee 151
PPACUUITES so srerecxenc aad esi ecisiecewnie ee destésevereincete Risiaiecsg srocssargyaleiaieloree 151
Inflammation............ccceceee weeeeencacs ngiena ieee alent Gases 178
“PGLIGSTIEIS sacsa.s cians divie's S5 si bia tiara gale oie'e'e wees See eueese vemnapwates 179
Osteomyelitis..........ccceee ceeees Pea oi wlan dea a wave wise 184
Necrosis......... .eees APOE Po Loe, adie wemveeenelans ddaaeees 185
Atrophy......seeees edaea eae Sepbss ia Dakiaele, Bye iPibieieis sare Oe slagedeiere a 189
Hypertrophy......... sate sbevacay/“ehet ave duane: aieia'e's ws baw dene daaeeeares 190
Rachitis (Rickets)............. aihdestaleialens ised er ey ewes secase 191
Osteomalacia.......65. ceeceeee siebae a sine SSabaN eta adiewenens) LOS
CONTENTS Vil
PAGE
DISEASES OF ARTICULATIONS....... areciaine ae lates Sis ad slafeinvei@r accesses eaiate . 195
Arthritis...... Saie-a sae setaeees aa area ses sievd bse cea eeears 195
Luxation....... Stesi¥ss SS aier Brel Sie wie ion setae vie 4 ena sineis Sloane seslentgae. -M20D
Distortion......... ecgledionaeiaravate maha gverdie wiuie’ Wistaie? Se 0: ihe e éisiseteis We. 6 4-2 209
Contusion..... sia iaistete'd sieaualopaueae eiee's va) “creer seeweerversesnd 212
Anchylosis........ oye $bilote aa. da einai ee eo earete derivates socesee 218
ContractUres « s scsicsaess isteesavins SOC ree braids seus se ee alee enee - 215
‘ Loose Bodies in the Joint...... Scere fies insevetoares avaues cise bYateiate's oveieay AOL.
DISEASES OF TENDONS.......ccceccccccessseucees ei hce tae Wiwie Did 'e sja'aiays 219
Tendinitis ............6 sidlecnewseni’ iene vais + seers seietaly Bb eaeae eee LD
RUPtULOsiasaenns sas eneaanwn one tect SeTaTEa Gia StS wine imvaieie rete oiaraietnte 225
Necrosis :........ ieee Sore siatinalave eousyres slaatecsvers aaiecislowrenaireaie 228
DISEASES OF SYNOVIAL SHEATHS OF TENDONS......cseeees evioiate aia’ . 230
Trp fl eer th Os ssiscs is ious 6: ses aceies setae ais cae ee ¥ QS Teese Bee eesiee 230
Galls....... Sawin swale ay aeeneiwee ee sis baw eae haya wiser aeteee: BOR
DISEASES OF THE MUCOUS BURSA......ccseeeeeeee © i eotetavexetarssseieialsnt os 236
Bursitis: 2 a/2iiw eects x dawehewaneaiaws, 06 aiolasd ar eravedai aiosovemees ogee 236
Dropsy.......-. (Sieh aeesenes isipreie's Wiel piece Sernecore nitowarcureiec'se 238
Myositis... ....e.eeeeee ebaisiaig seuss were ees Siiwahorpspers seis Senate 239
Rupture........ eens . eer co wren eecsceesonsesess +. 246
AtTOPLY, 6.8 00s 8608 aeencavene aes ebisree 8 sass iewsanesayss 248
DISEASES OF APONEUROSES. ..- ossesessoes Sars Susiaientysse oo gieeeads Sloacsssatiase 51
DISEASES OF NERVES .......-+006 Bieaietere wae ais ealeiele wre eanGiens wacees 204
DISEASES OF ARTERIES........000 Wie hs ¥ vind HW iio Wiaie.8 eis ele aepapeiwiele Rieinzeiends « 262
ANTLOEILIS,, 5 dveenwiesid § elec ees wheel esate eanen Bae aes coreyaloteslaereeniaiass 262
AMNCUTISM .osseciee secon eanes cove Petr err Ee re re ror 264
Rupture... .....eceeeeeeee aie ovetessiere tees miedmecewisiale a6 diehiseneReas 268
DISEASES OF VEINS.........eeeseee oleae elataiavers sislisiatsieteiete’s a diplaeisies snare oO!
PRICDIUIB ess cial wesw oa cee tewWaaw 4.6 eke aisoaeReses wielare alsteleteaisievaiets 270
Wark... o.scisie silted eee e cartyentes Sib wales Srisiaariaeaueeles Segabdsteeia, Deee
DISEASES OF LyMPH VESSELS..... debe De these Aduhaawad seas cavnees 273
Lymphangitis.........066. ais Sia a a'G Ae aisisisyene edivaicie es aaeewn's.e 273
Lymphangiectasis.......6..+sseeee cece eee eecereeeeeeenes soeee 276
Vili CONTENTS
DISEASES OF GLANDS... ...eseeee a niaisieidisle S'eerialsteeiler
Lymphadenitis.......-..++++ +. Perri reer eer ere saeienerie
Mammiitis—Mastitis.....cccccsccscssecccccccoceessers
Emphysema....... SO COE IT CT RI Er ees
CONGENITAL MALFORMATIONS. ..cscceecce cece sosccesovetcecses sues
PRINCIPLES OF
VETERINARY SURGERY.
GENERAL SURGERY.
Define a wound.
A breach of continuity of the skin and mucous mem-
brane by sudden mechanical force.
W hat two headings may wounds be classed under ?
1. Open wounds, where the break in the surface is about
equal in extent to the deeper injury.
2. Subcutaneous wounds, where the break in the skin is
either wanting or very limited as compared with the deeper
lesions,
Depending on the cause, what kinds of open wounds are
recognized ?
(1) Incised or clean cut; (2) punctured or pierced ; (8)
lacerated or torn; (4) contused or bruised; (5) gunshot or
punctured-lacerated-contused.
What qualitative classification of wounds may be made ?
Simple and complicated, flap wounds, clean, dirty (dust,
shavings), infected, poisoned, deep, perforating and super-
ficial, fresh and bleeding, old granulating and suppurating.
‘wounds,
1
-
2 PRINCIPLES OF VETERINARY SURGERY
According to the seat of tissues involved, what wounds are
recognized ? 1
Abdominal, thoracic, cervical, etc.; muscular, bony, ©
corneal, intestinal, skin wounds, etc.
Name the most important general symptoms of a fresh wound ? |
Hemorrhage, retraction of the edges (gaping), pain,
disturbed function, systemic disturbance.
To what is the pain in a fresh wound due ?
The so-called primary wound pain, which must be differ-
entiated from the secondary wound pain setting in later on
and due to inflammatory changes, depends on the cutting
and tearing of sensitive nerve fibres, and the richer the
injured part is endowed with nerves the greater the pain.
Are the wounds of all tissues equally painful ?
Injury of the cranial contents, bones, cartilage, tendons
and connective tissue are less painful than wounds of the
cornea, periosteum, skin, mucous membrane (especially
marked when the cutting agent is dull and its action
delayed).
To what extent do the various animals react to pain ?
There is a great difference, depending on the age, sex,
breed, species and temperament. Dogs are more sensitive
‘than horses, and these more so than the ox. The individual
disposition also plays an important réle. Thus some horses
can be fired without reacting perceptibly while others plunge
about violently.
What kind of hemorrhages are met with in wounds ?
1, Arterial hemorrhage: the bright red blood appears
in jets synchronously with the pulse beat.
GENERAL SURGERY 3
2. Venous hemorrhage: dark-red blood in a continuous
stream flows from the vessel.
3. Parenchymatous hemorrhage: this is a mixed hemor-
rhage, as arteries and veins of small calibre are cut, the
blood drips from the wound about in the same manner as
water would from a sponge, and is of dark-red color.
4. Capillary hemorrhage : the blood drips in small drops
from light wounds of the skin and mucous membrane, the
capillary blood-vessels being cut.
What else besides blood may flow from wounds ?
In case a large lymph vessel is cut, lymph; injury to
articulations and tendon sheaths, synovia; injury of salivary
glands, stenos duct and csophagus, saliva; injury to
stomach, food ; injury to intestines, feces ; injury of udder,
muk,; injury of bladder and urethra, wrine.
What is understood by gaping of the wound ?
Tissues possessing more or less elasticity, the edges of
a wound retract. The amount of gaping depends on the
nature of the cut tissues and the direction of the wound;
thus wounds cutting across the fibres of muscles or tendons,
or where the skin is especially tense, gape most.
What is understood by disturbed function ?
‘The part wounded suffers more or less loss of function.
Wounds of the hoof, tendons, articulations, muscles, cause
lameness; those of the cornea disturb sight; those of the
tongue interfere with feeding.
To what extent do wounds influence the general health ?
Very painful wounds depress the animal to such an
extent that it refuses food, more noticeable in the ‘horse and
can i
4 PRINCIPLES OF VETERINARY SURGERY
dog. True shock as seen in man (vasomotor paresis, the
blood accumulating in the abdominal vessels; shallow res-
piration; weak, compressible pulse; clamy, profusely per-
Spiring skin ; absence of mental originating power) is rarely
met with in animals; while following serious loss of blood
pale mucous membranes, weak pulse, depression, etc,
(anzmia), are observed. Occasionally sudden death follows
the aspiration of air from an injured jugular vein, death
being explained by air embolism of the pulmonary capil-
laries, filling of the cavities of the heart with air or. air
embolism of the capillary vessels of the brain.
What two forms of traumatic fever may produce systemic
disturbances ?
1. Aseptic wound fever : here a slight rise of temperature
without detectable systemic disturbance follows the absorp:
tion of pyrogenous material from the wound. ;
2. Septic fever. High temperature and decided systemic
disturbance due to the entrance of some specific infectious
material into the wound and later into the general cir-
culation.
How would you describe any wound ?
(1) Region of the body (neck, thorax, leg, etc.); (2)
length, width, depth, shape, direction ; (3) edges of the |
wound (sharp, lacerated, flap, swollen, inverted, etc.); (4)
secretion : odor, quantity, consistency, color; (5) by palpa-
tion with finger or probe the presence of foreign bodies and
‘depth are learned. Fresh and deep wounds of the articu- |
lations, abdominal, cranial and thoracic cavities, tendon
sheaths, and those where deep and serious hemorrhage was
arrested, should not be probed.
GENERAL SURGERY 5.
Describe incised wounds:
. Cause—Sharp cutting instrument, as surgeon’s knife,
glass, pieces of tin, sabre.
Characteristics—Straight, oblong shape, gape widely, asa.
tule bleed freely, clean cut edge; according to depth, they
are tendinous, muscular, bony or skin wounds.
Prognosis—Favorable in skin wounds, otherwise the
question of economy, the amount and kind of tissue des-
troyed, must be decisive.
Describe punctured wounds.
Causes—Pointed instruments, as dung forks, nails,
needles, harrow teeth, splinters, bayonet, trocar, hypodermic.
needle,
Characteristics—Small roundish opening, leading into a
canal of more or less depth, with limited hemorrhage unless.
a larger vessel has been pierced; they may be perforating
and communicate with a joint, tendon sheath, abdominal or
thoracic cavity, etc.
Prognosis—Surgically clean instrument, even when caus-
ing a perforating wound, entitles to a favorable prognosis,
while the introduction of septic material, as by manure forks,
nails, etc., may lead to fatal complications. Punctured.
wounds of the hoof may be followed by tetanus, while this.
form of injury of the softer tissues may in turn produce
septic cellulitis, septicemia, pyzmia, etc.
Describe lacerated wounds.
Causes—Tearing of tissues by nails, hooks, caulks, etc.
Characteristics—Slight hemorrhage, moderate gaping ;
edges may be smooth or lacerated ; frequently a flap wound
and then usually an angular tear.
6 PRINCIPLES OF VETERINARY SURGERY
Prognosis—Depends on the part involved and extent of
the lesion. Since there is more or less tendency to necrosis,
this fact must be borne in mind in making a prognosis.
What part of the body is often involved ?
In the horse, the eyelids, croup, breast and hind legs and
false nostril ; in the dog, the cornea when fighting with cats.
Describe contused wounds.
Causes—The action of a blunt instrument, as kicks, falls,
running against unyielding objects, coronary caulks, lying
for some time on hard and rough ground ; rope burns.
Characteristics—When of a superficial nature the upper
layers of the skin only are removed: abrasion, excoriation.
Deep contused wounds exhibit little or no bleeding, as the
separation of the intima and media from the adventitia of
the bleeding vessel closes the lumen of the vessel on the same
principle that the emasculator or ecraseur prevents bleeding..
The edges are irregular, discolored, feel cold; the neigh-
borhood is swollen; the wound contains partially detached
tissue and bloodclots.
Prognosis—There is always sloughing, and the prognosis
is based to a great extent upon the possibility of securing
perfect drainage and thus preventing septic infection.
To what class of wounds do those created by the teeth of ee
animals belong ?
The bites of dogs and cats are more common than those _
of the horse or ox. Such wounds are either punctured, |
contused or lacerated, or a combination of the above. Dog
bites quite often cause complicated fractures,
Describe gunshot wounds.
Cause—Projectiles, as buck and bird shot, pistol and
rifle balls.
ARREST OF HEMORRHAGE 7
Characteristics—It is a contused, lacerated wound ; there
is a wound of entrance and possibly a wound of exit. The
wound of entrance is smaller than the ball, because the skin
is stretched as the ball hits it; should it be larger than the
ball, a foreign body has been carried in with it. "With the
shot fired close to the animal, the hair is singed by the
powder; when the ball grazes the surface a friction burn
results. The wound of entrance has either smooth, frizzled
or lacerated and depressed edges. Hemorrhage is wanting
unless a larger vessel has been cut. The wound of exit is
larger than the ball, irregular and everted.
Prognosis—Unless septic material has been carried in by
the missile, the probe or the surgeon’s finger, or vital parts
destroyed or injured so as to interfere with the future use-
fulness of the animal, the prognosis is good.
Which animals are most exposed to gunshot wounds ?
In times of war, the horse; during hunting seasons, all
domestic animals get their share; otherwise, hunting-dogs
and cats.
Define poisoned wounds.
Wounds in which a poison has been introduced, as by
snake-bite, bee or wasp sting, or which have been infected by
glanders, rabies, anthrax, tetanus.
ARREST OF HEMORRHAGE.
How is bleeding stopped ?
(1) Spontaneously ; (2) artificially.
How does spontaneous arrest of hemorrhage take place ?
It is mostly seen in capillary, parenchymatous hemor-
rhage and when small veins are cut; a clot (thrombus)
8 PRINCIPLES OF VETERINARY SURGERY
forms, also retraction and contraction of the cut end of
the vessel. When a large blood-vessel is cut, spontaneous
arrest of hemorrhage is due to retraction and contraction
and thrombus formation at the cut end plus enfeebled heart
action and changed composition of the blood.
Why does spontaneous arrest of hemorrhage in small vessels
readily occur ?
Because blood pressure is very limited in capillaries
and small veins, thus favoring the formation of a clot
(thrombus).
How does the changed composition of the blood following
serious bleeding encourage clot formation ?
The changed composition of the blood mainly consists in
a decided increase of tha white blood cells, by which its
coagulability is greatly increased.
How much blood may an animal lose before succumbing to
fatal cardiac or cerebral syncope ?
Not over one-third of the total amount of blood.
How quickly does the blood regenerate after a hemorrhage ?
The quantity of the blood is quite speedily replaced by |
resorption of the lymph of the tissues and the liquids of the
stomach and intestines; the quality of the blood is at first _
very watery, regeneration of the red blood cells being a slow
process.
How is a thrombus formed ?
There are two kinds, the white and the red thrombus.
The former is met with in the healthy animal, the latter is
seen in septic states. At the same time both may exist |
together, and the thrombus is then termed a mixed thrombus, ] ! | | |
Hit
ARREST OF HEMORRHAGE 9
The white thrombus is formed by the white blood cells and
Bizzozero’s blood plaques, and is, so to speak, a physiological
product and not a coagulum. The red thrombus is a patho-
logical product, consisting of a fibrin constituted coagulum
plus red blood cells met with in the vessels of animals
suffering with septic disease.
What becomes of the white thrombus ?
When aseptic, it organizes ; when infected, it softens and
breaks up into emboli.
What ts understood by organization of a thrombus ?
Its replacement by connective tissue. The new con-
nective tissue formed results from proliferation of the endo-
thelial cells of the vessel; the thrombus itself only plays
a passive réle. The endothelial cells of the intima of the
vessel take on a spindle shaped and multiform character,
advance, perforate and surround the thrombus, developing
later into fibrillar connective tissue cells, thus replacing the
thrombus by connective tissue ; while this occurs new blood
vessels are formed from the vasa vasorum. This is termed.
the vascularization of the thrombus.
How much time is consumed in the process of organization.
and vascularization ?
About four weeks.
What else may become of a thrombus ?
It may calcify and form a phlebolit (vein stone).
How is the circulation interrupted by the thrombus re-
established ?
A collateral circulation forms. The vasa vasorum be--
come larger and the central and peripheral arterial branches
of the thrombus meet.
10 PRINCIPLES OF VETERINARY SURGERY
W hat is understood by softening of the thrombus ?
When bacteria invade a thrombus it becomes infected
and breaks up into little particles (emboli), which on entering
the general circulation cause a general infection of the
body (pyzemia).
Define artificial arrest of hemorrhage.
The application of means which encourage coagulation
or close the bleeding vessel.
How do you check hemorrhage ?
(1) By ligation; (2) compression; (3) torsion; (4) cautery;
(5) heat; (6) cold; (7) remedial agents; (8) constitutional
treatment.
How is hemorrhage arrested by ligation ?
It is the only safe means when large arteries or veins
are cut. If possible, grasp the bleeding vessel with the
artery forceps, draw it out ‘of the wound, isolate it from
the surrounding tissue, and with a surgical knot tie both
extremities of the vessel. When tying this knot, do not tie
the second one too tight, as it loosens the first one. If the
bleeding vessel cannot be caught, it may be necessary to
cut down onto it, or the less desirable method of carrying
a curved needle underneath the vessel and tying it and all the
tissues enclosed by the ligature. Avoid tying in a nerve.
At times for anatomical reasons the bleeding vessel ought
not to be ligated at its cut end, but ligation in continuity
is indicated, as, for instance, injury of the internal carotid i
requires ligation of the carotid artery, or injury to the inter-
osseous artery demands tying of the radial artery.
W hat material is used to ligate bleeding vessels ?
Aseptic silk or catgut.
ARREST OF HEMORRHAGE 1L
How do you check hemorrhage by compression ?
It is employed in capillary and parenchymatous bleeding
and when small vessels are cut. An exception to this rule is
made in very dangerous hemorrhages, when the course of the
vessel is either compressed with the finger (digital compres-
sion), or anything which is readily accessible is temporarily
crowded into the wound to compress the vessel. In these
cases, when possible, a string or rope, cloth, etc., is tightly
wound around the parts to constrict the whole member until
ather means can be employed, as far as possible observing
antisepsis.
What material is used to compress the bleeding parts ?
Sterilized oakum, absorbent cotton, bandages.
What is torsion and how does it act as a hemostatic ?
It consists in seizing the vessel with an artery forceps
and twisting it six to eight times; asarule, it is used only
in smaller vessels. By twisting.the vessel around its own
axis the intima and media become detached and curl up,
while the adventitia becomes twisted; the lumen of the vessel
thus becoming smaller or closed.
How does the actual cautery act as a hemostatic ?
In smaller vessels the mere radiation of the dull-red
cautery causes coagulation, while an eschar is formed when
the cautery touches the bleeding end. It is mainly employed
in parenchymatous bleeding and hemorrhage from smaller
vessels.
Why is the actual cautery not a safe hemostatic in case @
larger artery is cut ?
- Because the blood pressure against the eschar is greater
than the adhesive qualities of the eschar.
12 PRINCIPLES OF VETERINARY SURGERY
Why should the actual cautery be employed at a dull-red heat
At a white heat the eschar formed is completely car-
bonized and would not stick ; when a black heat is applied to
the parts the eschar formed will adhere to the cautery.
Describe the use of cold and heat as a hemostatic.
Either one produces contraction and coagulation, but is:
of use only in hemorrhages from small vessels and oozing
from latger surfaces.
What remedial agents—that is, styptics—are employed in the:
arrest of hemorrhage, and how do they act ?
These chemicals when brought into immediate contact:
with the bleeding part, produce coagulation and contraction.
of the vessel. They are either applied directly to the parts.
or a tampon is saturated with them and held against the-
bleeding surface by some compressing agent. Modern.
surgery objects to their use, as they form a repugnant clot,
- favor infection, and act as an irritant. Those more fre-
quently employed are: tannoform, tannic acid, alum, vinegar-
and tincture of iron.
What constitutional treatment is indicated in hemorrhage ?
Unless an exhaustive hemorrhage occurred, rest is all
that is required. In serious bleeding, rest, the application of
heat to the body surface, and stimulants and the infusion of
a normal saline solution per rectum, or in very urgent cases:
intravenously. In cases of internal bleeding, where the
leaking vessel cannot be secured, the best agent is fid. extr..
hydrastis canadensis.
Describe hemophilia.
A congenital tendency to persistent hemorrhages from
the slightest wound.
THE HEALING OF WOUNDS 13
In what animal has hemophilia been seen ?
It has only becn observed in the horse,
THE HEALING OF WOUNDS.
Name the various modes of repair by which destroyed tissues
are replaced.
(1) Healing by first intention (per primam intentionem);
(2) by second intention (per secundam intentionem); (3) by
third intention (per tertiam intentionem); (4) healing under a
sscurf ; (5) abnormal granulation and cicatrization.
WDefine healing per primam intentionem.
_ A primary union by cementing of the wound edges
~without pus formation.
Under what conditions is primary union most likely to occur ?
When the hemorrhage is arrested, bloodclots and foreign
“bodies removed (dirt, hair, splinters, tissue shreds), when the
‘wound is aseptic or rendered so, when the edges are smooth
cand straight and closely approximated, and when the wound
is protected by an antiseptic dressing against secondary
‘infection.
‘What kind of wounds may be readily healed by first intention .
in animals ?
Surgical wounds, provided an antiseptic protective dress-
‘ing can be applied.
Describe the macroscopic changes seen in healing by first
intention.
First, the edges of the wound are united by blood, to be
weplaced by the so-called wound cement (a lymphoid plas-
matic liquid). About the second day the edges are red,
14 PRINCIPLES OF VETERINARY SURGERY
painful and somewhat swollen. In about one week per-
manent union takes place, with a little cicatrix at the site
of incision.
Describe the microscopical changes in healing by first intention. —
White blood cells emigrate from the neighboring vessels
and invade the edges and wound cement. This cellular
infiltration is due to the traumatic irritation of the parts, and.
is not the result of the presence of bacteria, as is the case in
healing by second intention. In healing by first intention it.
is an expression of reaction by the injured tissues, while in
healing by second intention it represents a purulent inflam-
mation. The greatest number of leucocytes in the wound
edges are met with on the third day; after that they either
return to the blood vessels or die.
Describe the process of cicatrization.
The fibroblast produces the scar tissue. These are
roundish cells which arise through proliferation of the
endothelial cells of the vessels and those connective tissue
cells which are present. The fibroblasts increase in size, and
epithelioid, spindle and club shaped cells form ; these again
change into fibrillar connective tissue cells, which in turn
form the scar tissue proper. Vascularization of the wound
edges takes place at the same time, the new vessels being
formed by a process of budding from the walls of the cut.
capillaries. The young tissue formed by the fibroblasts plus
the newly created blood vessels is termed granulation tissue,
which shrinks as soon as the fibroblasts change into con-
nective tissue cells, the capillaries close, at which moment
scar tissue proper is formed. The last step in healing by
first intention consists in the skinning over of the scar tissue,
the cells springing from the epithelial cells upon the edges. —
THE HEALING OF WOUNDS 15
Define healing by secundam intentionem.
The filling of a wound-gap by granulations with pus
formation.
What wounds usually heal by second intention ?
All those where the fundamental principles upon which
the healing by first intention is based have been disregarded.
Therefore, infected wounds, those with wanting close approxi-
mation of the edges, contused wounds, etc.
Describe the macroscopical changes seen in healing per
secundam.
During the first forty-eight hours the various tissues can
be recognized ; at this time the surrounding neighborhood
begins to swell, is reddened, exhibits increased heat and pain.
About the second day the wound surface looks gray, due to a
thin layer of coagulated plasma coming from the cut lymph
vessels. During the next few days swelling and pain increase
some more, the wound surface having a jelly-like, grayish-
red look. About the fourth day the discharge fromthe wound .
is yellowish and opaque; at this time the coagulated plasma
resting upon the wound surface breaks up and, together with
necrotic tissue shreds, is carried away in the wound discharge;
now little red points are seen everywhere provided the wound
is first cleansed by irrigation. The fifth to sixth day these
red points, which are granulations, have grown higher and
are covered with thick grayish-yellow pus. Up to the eighth
day these granulations become larger, so as to fill the gap
between the wound edges pretty well. About the eighth day
the wound surface decreases and the edges approximate.
Whenever the granulations are even with the level of the skin
the granulating surface becomes smooth and glistening and
no further granulations are formed. Next, the periphery of
16 PRINCIPLES OF VETERINARY SURGERY
the wound shows a dry pinkish seam moving toward the
centre of the granulating surface, being followed by a bluish
dry seam upon the pigmented skin; this process continues
until the whole granulating surface is skinned over.
Describe the microscopical changes in healing by second
intention.
On the whole there is but little difference in those
observed in healing per primam and those per secundam
intentionem. The main point of difference lies in the fact
that on account of the presence of pus-producing cocci decided
irritation of the tissues is produced, as a result of which large
numbers of leucocytes emigrate. Otherwise the infiltration
of the wound edges, the formation of fibroblasts, vasculariza-
tion—that is, the budding of the capillary vessels—the chang-
ing of the fibroblasts into fibrillar connective tissue, is in no
wise different from healing by primary union.
Define healing by third intention.
It consists in the union of two suppurating granulating . 1:
surfaces.
What steps are necessary to secure healing per tertiam ?
Absolute disinfection of the granulating surface with
perfect coaptation of the wound edges held in place by an
exact suture.
To what extent is healing per tertiam applicable ?
It is a most valuable method and should always be
attempted, to bring about rapid and permanent union.
How long after the primary injury occurred, may healing per
tertiam be possible ?
To avoid ugly scars—for instance, about the head of
valuable horses—a wound of a week’s standing can be healed
by third intention.
ABNORMAL GRANULATIONS 17
Define healing under a scurf.
This is a.form of healing by first intention, by exsciccat-
ing the blood upon the wound by means of chemical agents,
as the result of which a firm adhering scab representing an
aseptic dressing is produced.
How does healing under a scab take place ?
The new epidermis is supplied by the epithelial cells
along the edges of the wound, these young epithelial cells
‘being protected by the artificial scurf.
Why is healing under a scurf of importance ?
At times neither suturing nor bandaging the wound is
possible, the scab then taking the place of an aseptic dressing.
What agents are mainly employed to produce a dry scab?
By dusting the wound with tannoform, tannic acid,
iodoform, aristol, europhen, xeroform.
ABNORMAL GRANULATIONS AND
CICATRIZATION.
Under what circumstances is the normal process of granulation
and cicatrization likely to become abnormal ?
In wounds with decided loss of tissue, presence of foreign
‘bodies, continuous irritation and infection of the parts under-
going healing, certain systemic disturbances.
Define caro luxurians.
It represents excessive and rapidly growing granulations,
commonly termed proud flesh.
18 PRINCIPLES OF VETERINARY SURGERY
What part of the body is mainly exposed to exuberant
granulations ? .
All those where the healing process is interfered with by
more or less continuous irritations, as wounds in the flexion
surface of the hock, pastern ; here the continuous flexion and
extension irritates the wound. Also in fistula of the withers
and saddle pressures when necrotic tissue is located at the
bottom of the wound, thus irritating the parts constantly ;.
also in muscular hernia, nicely seen in deep peroneal neurec-
tomy when the muscles protrude from an incision made into
its surrounding aponeurosis ; here the pinching of the parts
by the slit in the fascia keeps up the irritation.
Name some other forms of abnormal granulations.
Torpid, irregular, weak, pale.
What are erethistic granulations ?
Those which bleed very easily, are dark-red and very
irritable and painful.
Explain coagulation necrosis of granulation tissue.
Following obstruction of the capillary vessels by inflam-
mation or their imperfect development, the wound is covered
with a diphtheritic-like membrane representing death of the
upper layers of the granulation.
When is a cicatrization likely to become abnormal ?
In wounds with great loss of substance cicatrization
becomes incomplete and the result is an ulcer, or the scar
shows an undue accumulation of cornified epidermic cells.
W hat is a keloid ?
A hard fibrous growth ari-ing ia scar,
REGENERATION OF TISSUES 19
Which is their favorite locality ?
In the horse, they are usually seen in the flexion surface
of the pasterns, following barb wire cuts or a brush burn
(rope or halter burn), and around the coronary region
folowing calking.
How may excessive scar contraction affect a part ?
The great contractile power of the cicatricial tissue in
extensive scars by puckering up the tissues surrounding the
original wound may produce decided deformities, as in larger
injuries of the eye-lid it may become everted (ectropium).
REGENERATION OF THE VARIOUS TISSUES.
How does the regeneration of the skin and mucous membrane
take place ?
As described under ‘‘The Healing of Wounds.” The
epidermis and epithelium of mucous membranes are rapidly
replaced.
How do muscular wounds heal ?
The power of regeneration of muscles is very limited,
only taking place in slight injuries, the rule being a connec-
tive tissue scar in a muscle wound.
' How do tendon wounds heal ?
Cells are thrown out from the tendon sheath and sur-
rounding tissue; the granulations thus formed invade the
blood-clot which at first was created between the two ends of
the tendon. This clot is absorbed, the granulation tissue
unites the ends of the tendon and is gradually changed into
connective tissue until it is finally difficult to tell the difference
between the new and the old tendon fibres.
“20 PRINCIPLES OF VETERINARY SURGERY
How do bone wounds heal ?
Same as fractures, through an ossifying granulation
tissue, involving the periosteum, bone. and marrow (see the
“¢ Healing of Fractures”).
How do cartilage wounds heal ?
By proliferation of the perichondrium. In the wound is
first seen a fibrous deposit, which later changes into an ossify-
ing callus. When proliferation of the perichondrium starts,
new cartilaginous tissue is also formed by cartilage cells
adjoining the wound, while those cartilage cells close to the
cartilage wound undergo fatty degeneration.
How do peripheral nerves heal ?
The powers of regeneration of peripheral nerve tissues
are good. Provided the ends have been united artificially,
new nerve fibres formed by the old nerve fibres of the central
-stump grow into the peripheral stump. OH BP o BW
Describe degeneration cysts.
These are cysts arising in pre-existing tumors, due to
fatty, mucoid, etc., degenerations taking place in the tumor.
These cysts contain mucoid or fatty, etc., fluids,.and are
usually observed in sarcomata and carcinomata,- and then
called cysto-sarcoma, cysto-fibroma, etc.
Describe the eaudation and eatravasation cysts.
When a soft part is exposed to a contusion of sufficient
severity, a hematoma or lymph extravasation occurs. Asa
result of the aseptic inflammation which follows, this fluid
becomes encapsulated, and a hollow neoformation containing
serum is the result, being in this instance an extravasation of
blood cysts.
The exudation cyst is the result of excessive secretion into
a closed cavity, as a bursa, tendon, sheath, etc., usually the
result of a previous inflammation.
Give examples of both.
The extravasation cyst is seen about the neck and back of
dogs after bites or on the haunch of the horse after blows.
The exudation cyst is seen in the capped hock and capped
elbow of the horse.
120 PRINCIPLES OF VETERINARY SURGERY
Describe the retention cyst ?
These are the result of the retention of the secretion of a
gland.
What forms of retention cysts are recognized ?
1. The sebaceous or atheromatous cyst, due to the dilata-
tion of a sebaceous gland. Seen in the skin of the horse above
the false nostril and internal canthus of the eye; in the dog,
in the skin of the back.
2. Mucous cysts are due to the dilatation of a mucous
gland. They may occur wherever a mucous gland exists, In
the horse, ox, nd dog the retention cyst of the sublingual
gland below or on the side of the tongue is termed ranula;
retention cysts are further observed in the vagina of cows
(Bartholinine’s gland); also on the lips in the trachea nasal
cavity.
Retention cysts of large glands, due to the closure of a
number of ducts or of the main duct, especially seen in the
mammary gland of the cow, is termed a lacteal cyst.
Describe the congenital, or dermoid, cyst.
These are due to the inclusion of a bit of the epiblastic
layer in the mesoblast ; the wall of such a cyst may show all
the histological features of the skin. Dermoid cysts are met
with at the base of the ear of horses and cattle. A little
fistulous opening with a glairy discharge is seen ; the opening
leads to a cystic cavity containing a tooth.
Describe the genuine cyst.
These, also termed cystomata, are epithelial neoformations
in glands with cyst formation. They have been observed in
the parotid, mammary gland, thyroid gland and ovaries,
TUMORS 121
Give the treatment of cysts.
The essential feature is the removal of the lining sac. If
any part remains it will simply proliferate, and the trouble
returns. This holds good especially with the sebaceous and
mucous cysts. The operation for dermoid cysts consists in
the removal of the tooth, if necessary with hammer and chisel,
and a thorough curetting of the cyst walls.
Infectious Neoformations.
ACTINOMYCOMATA.
What is an actinomycoma ?
It is an infectious new-growth, caused by the ray fungus
or actinomyces.
What organs are subject to actinomycotic infections ?
Any part of the body may become infected. In America
the seats of predilection are the upper and lower jaws, the
parotid gland and the region of the throat ; in England, the
tongue; in Denmark, the soft parts of the head; and in
Germany, the pharynx and bones of the jaw.
Describe the diagnostic features of the actinomyces fungus.
Imbedded in the soft part of the tumor or in the abscess
they appear as pale-yellow to sulphur-yellow minute grains
macroscopically. With a magnification of 250 diameters, the
grains are seen to consist of roundish masses of club-shaped
bodies radiating from the centre.
Describe the actinomycoma.
Upon the part attacked depends the amount of connective
tissue it possesses. The consistency of the tumor may be
firm or soft. The growth of the tumor is slow. When
arising in the soft parts of the head, a rather firm swelling
122 PRINCIPLES OF VETERINARY SURGERY
is seen, from which one or more nut to egg sized tumors pro-
ject. These tumors eventually break through the overlying
skin and appear reddish, fungoid-like masses. Then, again,
the original swelling becomes an abscess, bursts, discharging
a creamy pus, the abscess cavity later filling with a fungus-
like growth, eventually projecting beyond the opening
through which the pus was emptied. The tumors seen in the
pharynx are either pedunculated or have a broad basis, inter-
fering with respiration and deglutition. When invading the
bone, the latter enlarges decidedly. The actinomycotic
growth may grow outward, break through muscle and skin,
and appear as a mushroom-like mass, or the growth may take
an inward course and appear in the mouth.
What forms of actinomycosis are observed ?
External, internal and generalized—the latter very rare.
What animals are liable to actinomycosis ?
Primarily, cattle ; at times, horses, swine and sheep.
How are animals infected ?
Usually through the ingestion of actinomyces-bearing
food coming in contact with wounds of the mucous mem-
brane of the mouth.
Describe actinomycosis of the bones,
Maxillary bones of cattle: The disease takes its start in
the gums near a tooth, leading to an ossifying periostitis with
formation of an exostosis. In those cases where the actino-
mycoma spreads to the marrow, a rarefying osteitis results.
In both the ossifying periostitis and rarefying osteitis, the
superior and inferior maxillary bones become greatly en-
larged. After having invaded the bone, the actinomycotic
granulation tissue may appear in the mouth, loosening teeth,
or may even extend into the maxillary or frontal sinuses.
TUMORS 123
Of other bones, the following have been reported ag
actinomycotic : Sternum and ribs, vertebra of the back and
neck,
Describe actinomycosis of the pharyngeal cavity.
‘These soft tumors may resemble a polypus, being
pedunculated, hanging from the mucous membrane; are of
pea to egg size, or they may have a broad base and be of
fungoid.shape. Similar neoformations are seen upon the
mucous membrane of the larynx, trachea, vagina, intestines
and nasal cavity.
Discuss actinomycotic lymph glands.
Those most frequently involved are the subparotid and
submaxillary glands. Actinomycosis of lymph glands is.
never primary, but always of metastatic—that is, secondary—
origin. The gland enlarges, is firm, oval or round, and
painless, varying in size.
Actinomycotic salivary glands are also seen occasionally,
Actinomycotic submaxillary lymph glands have been
seen in the horse.
Discuss actinomycosis of the skin and subcutis.
More commonly seen about the head, udder, neck,
abdomen, etc. They are both primary or secondary, the
former arising from an infected skin wound, the latter from
deeply seated actinomycotic processes which have broken .
through. They appear in the shape of nut to fist sized —
tumors, or as soft, reddish, fungoid masses. Fistulous open-
ings may be present. Actinomycomata have been seen in .
castration wounds of pigs and in the spermatic cord of oxen
and geldings.
Discuss actinomycosis of the mammary gland.
Those of the sow, where they are oftenest seen, appear. as
124 PRINCIPLES OF VETERINARY SURGERY
pea-sized nodules, containing pus and detritus, the nodule
being surrounded by a zone of firm connective tissue. Instead
of the nodules, abscesses may be met with.
In the cow one or more quarter of the udder is hard, due
to fibrous proliferations of the interstitial tissue, soft, pus-
containing nodules being found here and there in the hyper-
plastic quarter. Actinomycosis of the whole udder is com-
paratively rare. Such an udder is hard and knobby, enlarged
as a whole. When cut into, the surface exhibits numerous
little yellowish spots, each spot containing-a trifle pus,
Discuss actinomycosis of the muscles.
Statistics furnish one case where the elbow and shoulder
muscles were actinomycotic. They are of metastatic origin,
following skin actinomycosis.
Discuss actinomycosis of the tongue.
This form is quite rare in America, being quite prevalent
in England and Germany. As a rule, the tumors are
multiple, invading the whole organ. They produce marked
induration, the result of severe connective tissue proliferation
(Glossitis indurativa actinomycotica). Such a tongue is
deformed, greatly enlarged and feels hard, for which reason
it is termed ‘“‘ wooden tongue” in Germany. Somewhere
upon, below or on the side of the tongue (usually the latter),
one sees brownish spots, which are circumscribed, containing
minute yellowish nodules.
In between the muscle fibres and beneath the mucous
membrane are firm, fibrous actinomycomata of pea to nut
size, which, when cut into, are seen to be filled with a cheesy,
yellowish material, As a rule, the regional lymph glands
show metastatic changes.
Actinomycosis of the internal face of the lips is character
TUMORS 125
ized by brownish actinomycomata. A very few cases of
lingual infection in the horse are on record.
Describe the treatment of actinomycosis.
Those tumors which can be removed with the knife should
be attended to in that way, otherwise the excellent results
obtained by the specific action of iodide of potassium demands
its employ.
BOTRYOMYCOMA
What is a botryomycoma ?
An infectious new-growth caused by the invasion of
‘botryomyces.
Under what other names are the botryomyces known ?
Botryococcus, micrococcus bitryogenus, micrococcus
ascoformans.
Do all investigators agree upon the botryomyces as the cause of
botryomycomata ?
They do not. Some claim that the micrococcus ascofor-
mans is not a specific germ, but simply a pus coccus.
What is the nature of the botryomycoma ?
This neoplasm, also termed mycofibroma, represents a
chronic inflammatory connective tissue proliferation produced.
by the botryomyces.
What animals are subject to botryomycosis ?
Primarily, the horse ; occasionally, the ox and swine.
What mycofibromata are of interest to the surgeon ?
Those in the skin and subcutis, muscles, mammary gland
and spermatic cords.
126 PRINCIPLES OF VETERINARY SURGERY
Describe the botryomycoma of the skin ?
They are either solitary or multiple, from pea-sized
nodules up to man’s-head size, the largest ones being almost
always met with in the scapulo-humeral articulation and
about the elbow. The tumor is of firm consistency, but may
show soft portions here and there, with fistulous tracts
extending into its interior. It cuts quite hard, the knife
creaking as it passes through. The cut surface has a fibrous
appearance, and shows here and there little cavities filled with
a yellowish mucoid fluid and pockets filled with pus.
What cutaneous regions are principally involved ?
All parts exposed to harness pressure, elbow, point of
shoulder, tail, lips and fetlock.
Does the skin botryomycoma confine itself to the skin only ?
The larger tumors of this sort after developing in the
skin invade the deeper organs. - if
Describe the botryomycoma of the spermatic cord.
This condition is commonly termed scirrhous cord or
champignon. At the time the animal is castrated, the castra-
tion wound becomes infected with the botryomyces and a
funiculitis botryomycotica is the consequence. It sets in by
not healing of the castration wound, which continues to
discharge pus. Now and then an acute cellulitis follows,
alarming the owner, who usually at this stage seeks profes-
sional advice. This cellulitis always sets in when the opening
through which the pus is discharged closes up, to disappear
as soon as a new perforation is established allowing the pus
to escape. This condition may persist for years without
leading to serious consequences. The spermatic cord as a
whole, or only its distal end, shows a rather painless, hard
swelling. The vaginal process and the cord and surrounding
TUMORS 127
‘tissues all form one solid mass, the skin at the most dependent
part showing fistulous openings leading into tracts of various
depths.
On section, the surface is grayish white, showing here
and there softened foci containing a muco-purulent semi-
fluid holding the botryomyces.
Describe the botryomycoma of the mammary gland.
This is of rather malignant disposition, very likely to
recur after excision, and has a decided tendency to invade the
surrounding tissues. The part of the udder involved feels
hard and nodular; there may be fistulous openings and
abscesses present, the affection occasionally spreading to the
abdominal parieties and thigh.
Describe the botryomycoma of muscles.
These are quite often seen at a point where the mastoido
humeralis covers the point of the shoulder, representing a
form of the so-called shoulder abscesses. They differ but
‘little from those described under botryomycoma of the skin.
Other muscles in which they are observed are those of the
belly, intercostal muscles. Botryomycosis of bones seems to
be very rare. One case is on record where the tumor
developed from the maxillary sinus, This tumor, springing
from the mucous lining, became as large as a child’s head in
two months, causing a bulging of the maxillary and frontal
bones, unilateral nasal discharge and nasal dyspnea. Gen-
eralized botryomycosis has been described once; it was a
mare, the primary point of infection being the uterus. Those
botryomycomata found in internal organs have no practical
surgical interest.
How do you treat botryomycomata ?
They are best excised, carrying the knife well into the
128 PRINCIPLES OF VETERINARY SURGERY
healthy tissues to prevent recurrence. In case the mammary
gland is involved, it is best to amputate the whole gland.
The same is done with the scirrhous cord. Those cases where
a multiple botryomycosis is present, are operated from time
to time, as it would be out of the question to remove all
neoformations in one sitting. More recently medication with
iodide of potassium and external applications or injections of
tincture of iodine are reported to have given very satisfactory
results,
TUBERCULOSIS.
W hat is tuberculosis ?
An infectious disease due to the presence of the bacillus
of tuberculosis in the tissues of the body.
Is tuberculosis of the domestic animals of much surgical
interest ?
It is not, for various reasons. First, tuberculous disease
of the external organs of animals is not of frequent occur-
rence. Second, those operations of great value in man, as, for
instance, resection ofa tubercular joint, are not to be thought
of in animals. Third, those animals where tuberculosis is
more frequently encountered (ox, swine) are for slaughter,
the tuberculous lesions exhibited by them being either of a
localized, external description, and then of little practical
moment, or the lesions are secondary and the result of
generalized tuberculosis, in which case they are incurable.
Which forms of tuberculosis are of practical surgical interest ?
Tuberculosis of the mammary gland, lymph glands, skin
and subcutis, mucous membranes, bones and joints, muscles,
eye, testicles, brain and spinal cord.
we
TUBERCULOSIS 129
Describe the tubercular mammary gland.
The diseased process consists either of a localized tubercu-
losis, tuberculous mastitis or diffused miliary tuberculosis.
The bacillus rarely enters through the teat, thus creating a
primary tuberculosis ; in most cases it is of embolic origin—
that is, secondary. Such an udder, of which usually the
posterior quarter is at first diseased, shows a diffused, hard
swelling, which is little painful, with enlargement of the
regional lymph gland and supra-mammary lymph glands.
As the disease advances, hard nodules develop in the swollen
quarter ; finally the whole udder may attain a large size and
show the same symptoms just mentioned. In regard to the
lacteal fluid, it must be said that in the earlier stages it under-
goes no visible changes, only later it becomes watery and
flocculent, containing the specific bacillus.
Describe tuberculosis of the lymph glands.
The affected lymph gland enlarges and becomes hard,
explained by the process of calcification the tubercle under-
goes and the proliferation of the interfollicular connective
tissue of the gland. Infection of the lymph gland takes place
both by the blood and lymph vessels.
Name the lymph glands most commonly involved.
Those in the intermaxillary space and those near the
parotid gland, the retropharyngeal; those of the cervical
region, the prescapular, axillary, and those near the elbow,
the inguinal, popliteal and precrural, the supra-mammary
glands. Of the lymph glands of the internal organs, the
bronchial ones alone are of interest, as, by becoming enlarged,
they may compress the cesophagus and produce tympanitis.
Describe tuberculosis of the skin and subcutis.
This is but occasionally seen in cattle. They appear at
130 PRINCIPLES OF VETERINARY SURGERY
first as swellings from nut to fist size, become soft and exhibit
a cheesy material containing the tubercle bacillus. In the
dog, ulcers on the neck involving the regional lymph gland
have been observed.
Skin tuberculosis has been frequently observed as a
primary lesion about the head, and here especially about the
eye and commissure of the beak of the parrot. They are
either soft tumors from pinhead to egg size, of globular shape,
or skinhorn-like excrescences in the skin; tubercular'ulcers
containing the bacillus are also observed.
Describe tuberculosis of the mucous membranes.
In the shape of ulcers or mushroom-like mass, it is
observed in the larynx and trachea of cattle. Upon the nasal
mucous membrane of cattle one sees occasionally an aggrega-
tion of small, lardaceous looking nodules, which may become
confluent and‘form an ulcer, there being also nasal dyspnma
and discharge. Uterine tuberculosis (endometritis caseosa
tuberculosa) is not rare. In the parrot, tubercles and ulcers
are seen upon the mucous membrane of the mouth and eye.
Describe tuberculosis of the bones and joints.
Tuberculosis of the bones is usually secondary, that is, it
is caused by a tubercular embolism ; therefore, starting in the
marrow, an osteomyelitis granulosa is the result.
The bones more frequently involved are the- temporal
bone, sternum, cervical, dorsal and lumbar vertebre, and ribs.
In tuberculosis of the middle ear (otitis media and interna
tuberulosa) in swine, the infection takes its origin in the
pharyngeal cavity and reaches the cavity of the middle ear via
the Eustachian tube, creating here a tuberculos osteomyelitis,
next periostitis and rarefying osteitis, necrosis of the bouo
now reaching the meninges, and finally brain. In goats,
tidiiaaie
TUBERCULOSIS 131
sheep and horses, tuberculosis of vertebres and ribs has also
been reported. In fowls, tuberculosis of the bones is not a
rare occurrence.
Tuberculosis of articulations has been most frequently
observed in fowls, that of the carpus and tarsus in swine;
while in cattle, tuberculosis of the hip, stifle and knee joints
are less frequently seen.
Describe tuberculosis of muscles.
This form is of little surgical moment, being, as a rule, of
an embolic nature, therefore the result of generalized
tuberculosis. They appear as brownish nodules, of pinhead
to bean size, usually circumscribed and arranged in rows, the
muscles usually involved being the abdominal, thigh and
pectoral muscles. Tuberculosis of the tongue is seen in
parrots and at times in cattle.
Describe tuberculosis of the eye.
This is also an embolic form, and of rare occurrence in
the ox, attacking the iris and choroid, eventually destroying
the eye and changing it into a cheesy or granulating mass,
Discuss tuberculosis of the testrcles.
This leads to enlargement of the glands. On section, pea
to nut sized tubercles are seen. Tuberculosis of the spermatic
cord, tunica vaginalis and prostate gland have also been
observed. All these are comparatively rare; those of the
testicles are reported in the bull and boar, that of the prostate
have been observed in the bull and dog. Tuberculosis of the
ovaries seems to: be quite frequent. :
Discuss tuberculosis of the brain and spinal cord.
These are of interest from a standpoint of differential
diagnosis, as they give rise to symptoms ‘of paresis or
132 PRINCIPLES OF VETERINARY SURGERY
paralysis, while tuberculosis of the spinal cord may produce
locomotor ataxia or paraplegia.
Describe the treatment of tuberculosis ?
Generally speaking, such patients are not treated, for
obvious reasons ; while in disease of the testicles or ovaries
castration or spaying may be attempted.
CONCRETIONS AND FOREIGN BODIES.
W hat is a concretion ?
A stone-like mass, a sediment of an earthy basis from
retained secretions or excretions of the body.
Enumerate the concretions of surgical interest, ,
1. Renal calculi. 2. Intestinal calculi. 3. Salivary cal-
culi. 4. Lacteal calculi. 5. Preeputial calculi. 6. Rice
kernel calculi.
Where do you find renal calculi ?
In the kidney, pelvis of the kidney, bladder and urethra.
W hat is their composition ?
Silicates, urates, triple phosphate, carbonate and oxalate
of lime, etc.
How are they formed ?
1. As a result of disease of the renal mucous membranes,
colloids (mucus, epithelium, blood, pus) are present. These
colloids form a nucleus around which the earthy salts of the
urine are precipitated, eventually becoming calculi.
2. Through the agency of bacteria, which, by producing
an ammoniacal fermentation, bring about precipitation of
triple phosphate.
CONCRETIONS AND FOREIGN BODIES 133
Describe the urinary calculi of the various animals,
Horse: There are two kinds, those of the bladder and
those in the urethra. Their composition is about the same,
consisting of traces of iron, oxalate of lime and a greater
amount of carbonate of lime. The vesical calculi are of nut
to fist size, are hard, either egg or disc shaped, with a smooth
or mulberry-like surface and of yellowish color. One or
several stones, as well as a finer sediment (‘‘ gravel”), may be
found. The urethral calculi are usually found at the ischial
curvature and are of pigeon egg to chestnut size.
Cattle : These are composed of carbonate and oxalate of
lime. Asarule, a number of round or disc-shaped pea-sized
stones, glistening and yellowish, are found at the curve of the
urethra.
Dog: These are usually small, of pea size and present in
numbers. The surface may be rough or by continuous rub-
bing may have become smooth. They are composed of
oxalates, urates and triple phosphate, filling the whole urethra,
being wedged at the incurvated portion of the penial bone.
Describe intestinal calculi.
These are also known as enteroliths in the horse and are
of little surgical interest unless they can be reached from the
rectum. They are found in the caecum and colon, causing
obstruction and colics. They are primarily composed of triple
phosphate, formed by the precipitation of the phosphate of
magnesia (coming from the food ; bran, for instance) by the
ammonia found in any barn. The ammoniaco-magnesium
phosphate and calcium phosphate—that is, the triple phos-
phate—crystalizes around a kernel of oats or any other foreign
body, and the foundation to a calculus is laid.
In cattle the so-called hair balls are quite often found in
the rumen. These are also called bezoars and are made up of
134 PRINCIPLES OF VETERINARY SURGERY
plant fibers or hairs. Asa rule they cause no inconvenience,
but may, when regurgitated, become lodged in the cesophagus
and give rise to symptoms of choke.
Describe salivary calcult.
They are seen in horses and cattle, especially in Stenog
duct. Single stones are of oval shape, while multiple ones
are variously shaped as the surfaces which are in contact with
each other are ground down. In the center there is usually
some foreign body, as a bit of straw or an oat kernel, which
forms the nucleus to the whole. They vary from pea to egg
size and are composed mainly of carbonate of lime, some
phosphate of lime and organic ‘substances ; they have a white
to pale yellow color.
Describe lacteal calculi.
These concretions, found in the teat or milk cistern of the
udder, are made up principally of carbonate of lime with.
some fat and casein. They are of variable shape, may
become as large as a hazel nut and range in color from pale
yellow to gray. Clogging the channel through which the
milk is emptied, it becomes of surgical interest.
Describe preputial calculi.
These are observed in the urethral sinus of the penis and
in the prepuce proper, the former being commonly termed
“beans,” which when attaining a certain size may obstruct
the flow of urine. They are smooth, oval concretions mainly
consisting of inspissated smegma.
Describe the rice kernel bodies.
These peculiar formations, also known as corpora libra, -
chondroids, are of organic origin, representing coagulated or
inspissated or calcified products of inflammation or bits of .
CONCRETIONS AND FOREIGN BODIES 135 |
neoformations, bone or cartilage. They are found in the
guttural pouches, tendon sheaths, burs and articulations.
How do you treat the various calculi ?
Urinary calculi are subject to operative measures—
namely, by cystotomy and urethrotomy. Intestinal calculi
in horses are, as a rule, beyond reach, if not beyond a positive
diagnosis. Hair balls in cattle, when giving rise to choke,
are treated as such. Salivary calculi areremoved by opening
the salivary duct and extracting the stone. The same refers
to lacteal calculi. Preputial calculi can be easily removed
by hand. The treatment of corpora libra is discussed under
its respective head.
Foreign Bodies.
What are forergn bodies ?
Any irritant entering the tissues of the body from with-
out.
In what parts of the body are foreign bodies of surgical
anterest ?
Buccal cavity, pharynx and csophagus, stomach and
intestines, respiratory apparatus, eye and ear, hoof, skin, sub-
cutis, muscles, bones and internal organs.
W here do you find foreign bodies in the mouth ?
In, beneath and around the tongue, between the teeth,
mucous membranes of the cheeks, palate, openings of the
ducts of salivary glands.
What symptoms are they likely to produce ?
Ptyalism, chewing motions, quidding of food (difficult
mastication), stomatitis and rabiform attacks (dogs).
136 PRINCIPLES OF VETERINERY SURGERY
Enumerate some of the foreign bodies met with in the mouth,
Splinters, needles, pieces of bone, fish hooks, rubber
bands, sprouting seeds (a regular lawn was seen upon the face
of the tongue of acow). In the ducts of glands, bits of straw,
kernel of oats, barley.
A dog is on record with a piece of metal in the Eustachian
tube and a horse with a piece of straw, having worked itg
way up the lachrymal duct.
What animals are more commonly the subject of foreign
bodies in the mouth ?
Dog, cat, cattle ; less frequently the horse.
What symptoms do foreign bodies of the pharynx and ewsoph-
agus produce ?
Difficult deglutition, pharyngitis and choke.
What foreign bodies are usually met here ?
In horses: Corn cobs, potatoes, turnips, apples, food
boluses, pieces of a whip ; in the guttural pouches, accumula-
tions of food.
Cattle: The above and also hair balls, tin cans, pieces of
metal, cloth, pieces of afterbirth, bacon rinds, beefsteaks
(given empirically as an artificial cud).
Dog: Bones, needles, fishbones, large pieces of meat ; in
playful dogs, spools, stones, etc.
W hat serious sequels may these produce ?
Perforation of the pharynx, rupture of the cesophagus
and consequent internal hemorrhage from injury of the
aorta, or pleurisy.
What foreign bodies are seen in the stomach of cattle ?
An endless variety; all the way from horse rake teeth
down to needles, nails and stones,
CONCRETIONS AND FOREIGN BODIES 137
What effect do they have upon cattle ?
As a rule they do not cause any inconvenience, only when
sharp and long enough they perforate the wall of the organ
holding it ; thus they perforate the diaphragm, pericardium,
and injure the heart, causing serious disease of the digestion
and heart (traumatic gastritis and pericarditis).
What foreign bodies are observed in the stomach and intes-
tines of the dog ?
Bullets, balls, coins, spools, etc.
What symptoms do they give rise to ?
Sometimes none at all ; then again more or less anorexia,
emesis, constipation, great restlessness, or great dejection ; in
other words, symptoms suggestive of intestinal obstruction.
What foreign bodies are seen in the rectum and urethra ?
In the rectum of the dog any of the previously-mentioned
foreign bodies may be seen ; in the horse, pepper, lumps of
salt herring (introduced by empirics). In the urethra of the
horse I found a piece of a catheter.
W hat foreign bodies are found in the respiratory apparatus ?
Accumulations of food in the maxillary sinus ; in the:
nasal cavity, food, sponges, cotton, etc., placed there by jib~
bers to hide nasal discharges of the horse. In the trachea,
pieces of cartilage aspirated during tracheotomy, pieces of the
tracheotomy tube, oil, especially when drenched through the
nose.
W hat symptoms do they produce ?
Purulent nasal discharge, usually unilateral when the
sinus is affected, or violent fits of coughing at first, with
subsequent symptoms of a foreign body pneumonia in case
the foreign body entered the trachea.
138 PRINCIPLES OF VETERINARY SURGERY
What symptoms do foreign bodies of the eye and ear give
rise to ?
Eye: Depending on the nature of the irritant (bits of
straw, hay seeds, etc.) and length of time they are present,
the symptoms of a chronic purulent conjunctivitis are there,.
especially so in the horse when the foreign body is beneath
the membrana nictitans.
Ear: The offending agent is usually a parasite, as lice or
mange parasites,
W hat foreign bodies most commonly enter the hoof ?
Nails and glass.
W hat portion of the hoof is more frequently involved 2?
The commissures of the frog.
W hat symptoms do they give rise to ?
Lameness, the result of pain due to pododermatitis,
Describe the actions and results of foreign bodies in the skin
and in underlying parts.
Such foreign bodies may be bullets, shot splinters, etc.
The most important feature lies in the fact whether they carry
infection into the tissue which they enter or whether an
aseptic wound is produced. Bullets, unless carrying bits of
the harness or hair into the deeper parts, may become encap-
sulated, creating no further sequels. Those causing infection
of the parts give rise to pus production, as abscesses or more
or less serious cellulitis, Foreign bodies of animal origin and
introduced by the surgeon (catgut) become liquefied and are
absorbed.
Of what surgical interest is air as a foreign body ?
When animals are bled (phlebotomy), it is possible that
CONCRETIONS AND FOREIGN BODIES 139
air may enter the vein and when of sufficient amount may
produce death by arresting the heart.
Outline the treatment for foreign bodies.
Those in the mouth are simply extracted with the fingers
or forceps. Those in the pharynx of horses and cattle I have
frequently removed by directing a stream of water from a
handpump against the wedged masses (with proper care and
judgment). In the dog, they are removed with a forceps or
an emetic (apomorphine). In the horse, sialagogues, as areco-
line and pilocarpine, may also be used. Those which are in
the cesophagus are pushed into the stomach with the probang
(an easy thing in the ox but much more difficult in the horse).
At other times cesophagotomy or modifications of that opera-
tion are indicated. Of course those cases where the pharynx
or csophagus are perforated are beyond remedy. Foreign
bodies in the guttural pouches are best removed by Merillat’s
operation (opening the pouch through the soft palate). Those
in the stomach—that is, the rumen—of the ox may at times
be removed by rumenotomy. Those in dogs, unless they
come away with an emetic, or, if in the bowels, with a purge, |
may be removed by enterotomy, which when properly done is
borne very well by the dog. Those in the respiratory appar-
atus (the nasal cavity) can be removed with the fingers or ,
forceps. Those in the sinuses by trephining them. Those in ,
the trachea are usually beyond reach. Those in the eye may
be washed out with a soft rubber syringe or picked up with a
forceps. Those of the ear usually require an antiparasitic
treatment. Those of the hoof are simply pulled out when
present and good drainage and antisepsis are employed.
Those in the skin and underlying parts are removed when in
situ, unless it is reasonable to presume that an aseptic pro-
cess of healing is possible, as in some gunshot wounds.
140 PRINCIPLES OF VETERINARY SURGERY
Which foreign bodies of parasitic origin are of interest to the
surgeon ?
In the horse: 1. Filaria Papillosa. Found in the anterior
chamber of the eye, giving rise to iritis and keratitis. Treat-
ment consists of operative measures. This parasite has also
been found in cryptorchids and hydrocele. 2. Filaria cincin~
nata. Occasionally causes a tendinitis in Russian horses,
3. Filaria medinensis. Seen in the subcutis of horses in
tropical countries, as East India, Africa, etc. It causes qa
form of elephantiasis (strongulus armatus). Has been found
in the hypertrophied nasal mucous membrane. 4. Sarco-
sporidia, When present in great numbers give rise to an
interstitial myositis.
In cattle : 1. Cenurus cerebralis. Produces symptoms of
brain disease, as vertigo, wabbly gait, blindness, even para.
plegia. Treatment by trephining. 2. Hypoderma bovis:
Forms nut sized tumors, each tumor representing an abscess
containing the larva. Treatment: Split the abscess and
squeeze out the contents.
In sheep: 1. Coenurus cerebralis. Same as in cattle,
2. CHstrus ovis. Located in the nasal and maxillary sinuses,
giving rise to a chronic catarrh of the mucous membranes of
those parts. Treatment consists in blowing some mild irri-
tant into the nasal cavity, or for those in the’ sinus by
trephining, with subsequent irrigation of frontal sinus,
In swine: The Cysticercus cellulose has been found in
the eye.
In the dog: 1. Pentastomum tenioides. In the nasal
cavity and frontal sinus, causing a purulent rhinitis. Treat-
ment: Trephine frontal sinus and inject benzine. 2. Filaria
medinensis. In the subcutis, producing a form of elephan-
; tiasis in dogs of tropical climes. 3. Spiroptera sanguino-
e
HERNIA AND PROLAPSUS 141
denta. Seen in Java, producing cysts in the walls of the
cesophagus.
HERNIA AND PROLAPSUS.
W hat ts a hernia ?
A protrusion of viscera through normal and abnormal
openings in the walls of the cavity holding it without injury
of the skin or mucous membrane covering it.
Speaking of a hernia, what is ordinarily meant by it ?
A protrusion of the abdominal viscera through abnormal
openings of the abdominal muscles,
W hat other kinds of hernia are spoken of ?
When a muscle protrudes through a rent of the fascia
covering it, one speaks of a muscular hernia ; in the same way
of hernia of the brain, lungs, etc.
In regard to position, what varieties of hernia are known ?
Umbilical, inguinal, ventral, scrotal, perineal, dia-
phragmatic, femoral, vaginal, pelvic.
Describe the make-up of a hernia.
(1) The opening in the abdominal cavity, termed the
**mouth ;” through this protrudes (2) the sac with its (3)
contents,
Describe the sac.
The sac is the pouch covering the bowel or omentum.
That part external to the mouth of the hernia, or the main
part of the sac, is termed the body, while the part constricted
by the mouth is known as the neck.
142 PRINCIPLES OF VETERINARY SURGERY
Classify hernias according to the contents of the sac.
Enterocele contains intestines only.
Epilocele contains omentum only.
Entero-epilocele contains both of the above.
Cystocele contains the bladder.
Gastrocele contains the stomach, etc.
Name the clinical varieties of hernia,
1. Reducible. The contents of the sac can readily be
returned into the abdominal cavity. :
2. Irreducible. The contents cannot be returned, due to
incarceration or inflammatory adhesions. z:
3. Incarcerated. The contents of the bowel on an
obstruction to the return of the bowel into the abdomen.
4. Strangulated. An arrest of the circulation of the pro-
truded bowel, due to severe constriction at its neck.
How are hernias classified as to their origin ?
(1) Congenital ; (2) acquired or traumatic,
Give the symptoms of a reducible hernia,
In the so-called hernial region (region of the umbilicus,
inguinal canal) a swelling is found, which is soft, regular,
round and smooth. As a rule, there are no symptoms of
inflammation, as heat, pain, swelling of the adjacent tissues.
The integument over the tumor can be displaced. The con-
tents of the sac either slip from under the palpating fingers
or have a doughy, uneven feel. In the former it contains
bowels only; in the latter, omentum. Of course both may be
present together. On placing the finger against the tumor
and pushing it toward the wall of the cavity from which
the tumor comes, the rent in the wall or the dilated state of
the natural canal through which it came (inguinal canal)—
that is, the mouth of the hernia—can be felt. This varies in
HERNIA AND PROLAPSUS 143
size, may be round or show a split. The edge of this mouth,
in old hernias also termed the ring, has a firm, fibrous feel.
In cattle this ring has been found ossified. The palpating
fingers can reduce the hernia; that is, can push back part
or all of the contents of the sac into the abdominal cavity if
the hernia be a ventral one. Percussion of the sac in case it
contains bowels gives rise to a tympanitic sound.
Give the symptoms of an incarcerated hernia.
In the obstructed hernia most of the symptoms just men-
tioned above are present, but there is this difference : in the
sac, doughy feces, gases and liquids can be felt, the tumor is
larger than ordinarily and cannot be reduced by taxis. There
is abdominal pain. In dogs and swine, besides these symp-
toms there may be slight vomiting. I have had two patients
(geldings) for several years who invariably had nasty colics
from incarcerated inguinal hernia whenever they were
allowed to stand in the barn for a few days in succession.
Both of these animals died subsequently, the post mortem
examination revealing the fact that the incarcerated hernia
had become strangulated, which diagnosis had been made at
the time of their last illness.
Give the symptoms of strangulated hernia.
More often seen in old hernias than recent ones. In the
horse—usually the stallion of mature age—they are ushered
in with colicky symptoms. The hernial sacis painful on pal-
pation, and shows increased heat and cannot be reduced.
The tumor feels tense, the animal stretches same as they do
before stalling, or take a dog-sitting position or show other
symptoms suggestive of intestinal obstruction ; the pulse is
rapid and soon becomes wiry ; the facial expression is one of
great anxiety, etc.
144 PRINCIPLES OF VETERINARY SURGERY
Dogs and swine show abdominal pain, vomit ; symptoms
of collapse soon follow ; otherwise the hernial tumor exhibits
the same conditions as in the horse.
How do you treat a hernia ?
There are two methods: 1, palliative ; 2, radical.
Describe the palliative treatment.
Only employed in reducible hernia. Here by means of
a truss the protruded mass is retained in its cavity, as a result
of which sometimes the hernial mouth becomes so small that
the gut no longer can protrude. This method is at times of
value in young dogs, colts and brood mares, At the same
time it must be remembered that in the young a hernia may
disappear spontaneously, as the bowels quite rapidly enlarge
and become too large to pass through the hernial mouth,
Some practitioners advise the application of blisters and.
caustics, as sulphuric acid, the actual cautery. Others, again,
advocate the hypodermic injection of a salt solution or
alcohol—all with a view to produce artificially an inflamma-
tion and scar formation around the rent in the wall of the
cavity from which the contents protrude. These latter
methods are of doubtful value and not without danger, as it
-is known that the integument covering the hernial sac
sloughs off, thus causing a prolapsus ; while the hypodermic
injections have as sequels peritonitis and septic cellulitis.
Describe the radical treatment.
Unless the mouth of the hernia is too large (say, exceeds
five inches in length), the hernial sac may be obliterated by
tying it off by means of an elastic ligature, as a rubber tube
or even a common string (do not apply it too tight or the skin
will slough off too soon and a prolapsus may follow); or by
stitching off the sac—that is, ligate it in sections. This latter
age
HERNIA AND PROLAPSUS 145
form I prefer. The above treatment has the advantage that
the peritoneal cavity remains closed and the dangers of a
peritonitis are done away with, and on the whole it can be
looked upon as a safe and reliable means. The most surgical
treatment is herniotomy. Here of-course asepsis and chloro-
form narcosis are essentials, otherwise peritonitis is likely to
follow. Herniotomy in the dog gives very nice results, while
in the horse the nature of the tissues, as well as the difficulties
accompanying asepsis, render it of doubtful value, at least in
every-day practice. That herniotomy can be executed suc-
cessfully in the horse, especially in the colt, has been
demonstrated.
Give the treatment of incarcerated hernia.
Attempt to reduce the hernia by hand (taxis). If neces-
sary, put the animal into the dorsal recumbent position,
assisting it by exerting traction upon the gut from within,
that is, through the rectum. In cases of inguinal hernia in
- the horse, since he most likely will have to be operated, put
him upon the back and chloroform him ; abduct and bring
well back the hind leg of the affected side. Should all this
fail and the danger of strangulation become apparent or
strangulation is already present, operate. Instead of widen-
ing the hernial ring with the knife right away, puncture the
loop of intestine presenting itself with a fine trocar and
canula, such as is found in our hypodermic syringe cases,
thus allowing the escape of a considerable amount of gas and
liquid. In this manner I have succeeded frequently in re-
ducing a strangulated hernia. When this fails, split the
hernial ring, and re-position of the sac’s contents becomes
easy. In stallions, this is to be followed by castration by the
covered method, while in geldings the tunica vaginalis is to
be searched for and dissected from the bowels, which usually
146 PRINCIPLES OF VETERINARY SURGERY
are connected with it by adhesions ; next the tunica is twisted
once or twice around its axis and a small curved clamp
applied over it as high as possible.
What varieties of hernias are more commonly met with in
our various animals ?
Ventral hernia: Cattle and horses,
Umbilical hernia: Dogs and horses.
Inguinal hernia : Horses and swine.
Describe the individual hernias.
Ventral hernia: The causes are traumatic ones, such ag
kicks, falls upon blunt objects (tree stumps, etc.). The
hernia may be located at any part of the abdominal parietes,
usually about the flanks or along the linea alba. Their size
varies, but may be very large. My experience with these
ruptures is, that when the mouth of the hernia exceeds eight
inches they are incurable. From a standpoint of differential
diagnosis, at least in recent hernias, one must remember
abscesses and hematomata. In small animals herniotomy
gives nice results, while in the larger ones the clamp or
ligature is preferable.
Pelvic hernia (gut tie): Seen in the ox; mainly due toa
peculiar method of castration, consisting of tearing the
spermatic cord through or tearing it out by sheer force. In
consequence of this the parietal peritoneum is lacerated and a
pouch results; an intestinal loop may enter it and become
strangulated. There are colicky symptoms. By rectal pal-
pation under right or left transverse process of the sacrum
the constricting cord and incarcerated intestine can be felt.
Treatment consists of laparotomy or re-position of the in-
carcerated loop by hand per rectum.
Umbilical hernia: Seen especially in young animals.
Heredity seems quite an etiological factor; the animal is
HERNIA AND PROLAPSUS 147
either born with the hernia or it appears soon afterwards.
The contents of the sac are usually the colon or caecum. The
mouth of the hernia is represented by the umbilical ring. On
the whole, small umbilical hernias are of little consequence,
often disappearing voluntarily, the bowels becoming rapidly
too large to pass through the abdominal opening. For this
and other reasons this variety of hernia rarely incarcerates.
The treatment in younger animals should be an expectant
one unless the hernia is large. In older animals and in large
hernias of the young animal, operative measures are indi-
cated, as herniotomy (in the dog and colt, in the latter only
when the ligature or clamp has failed); in older and larger
animals the clamp or ligature are safest.
Inguinal hernia: This may be looked upon as a danger-
ous hernia, as, by reason of its location, incarceration of a
descended intestinal loop quite frequently occurs. It is of
most interest in the horse, and productive of the symptoms
of an obstruction colic. The treatment consists in herniotomy.
After return of the intestinal loop into the abdomen the
animal is castrated by the covered method, the tunica
vaginalis being twisted several times around its axis. Nowa
small and curved clamp is placed over the tunica vaginalis
and cord and placed as near to the inguinal opening as
possible. An important feature lies in leaving the clamp in
position as long as possible, in order to obtain adhesions
between the cord and tunica vaginalis, thus preventing the
intestines from descending.
Prolapsus.
What is a prolapsus ?
A protrusion of viscera into the external air, through
normal or abnormal openings of the body.
148 PRINCIPLES OF VETERINARY SURGERY
W hat is the difference between a hernia and a prolapsus ?
In the hernia, the integuments, as skin or mucous mem-
branes, are not injured and the protruded viscera are not
exposed to the external air, while in the prolapsus the integu-
ments are injured and the viscera are in actual contact with
the external.air.
W hat two terms are often confounded with prolapsus ?
Inversion and invagination of a hollow organ.
W hat does inversion and invagination respectively mean ?
In inversion things are turned inside out; for instance,
in inversion of the bladder the organ is turned inside out,
appearing externally through the urethra but not through a
rent of the mucous membrane of the vaginal wall, as is the
case in prolapse of the bladder. In invagination, one part of
a hollow organ is drawn into another part; in other words;
the parts become telescoped.
Name the causes of prolapsus.
Traumatisms, as penetrating wounds extending into the
abdomen or chest, resulting in prolapsus of the bowels or
lungs; lacerations of the vaginal walls, prolapse of the
bladder, paralysis of the penis, prolapse of the penis, relaxa-
tion of the broad uterine ligaments, prolapse of the vagina or
uterus, constipation and consequent severe straining by the
muscles concerned in defecation, prolapsus of the rectum, etc.
Are all cases of prolapsus pure and simple those of a prolapse?
They are not. In many instances it represents a com-
bination of prolapse with invagination; in other instances
it is a prolapse with inversion.
Give an example of both.
Prolapsus of the rectum is usua!ly a prolapsus of the rec-
HERNIA AND PROLAPSUS 149
tum plus invagination of the rectum. Prolapsus of the
vagina is frequently not only a prolapsus of the vagina, but.
at the same time an inversion of that organ.
Describe the prolapsus more commonly encountered.
Prolapsus of the Intestines. Follows penetrating wounds.
about the abdomen, The protruding bowels are usually the
large, the small colon or the caecum. Another cause is the
castration of ridglings (cryptorchids) through the inguinal
canal, the bowels prolapsing either immediately or shortly
after the animal rises, Finally, the bowels may protrude .
after herniotomy has been performed. In all these cases,
excepting perhaps the prolapse following herniotomy (pro-
vided proper aseptic precautions have been taken previous to-
the operation and afterwards), the danger of septic complica-
tions is great. The treatment consists in asepticizing the
parts, thoroughly suturing the lacerated parts and applica-
tion of a retention bandage wherever possible.
Prolapsus of the Omentum. Follows penetrating wounds:
and ridgling castration. The treatment is the same as in
prolapse of the bowels, but there is decidedly less danger.
The protruding mass of omentum is ligated and cut off, the:
stump returned into the abdominal cavity. Since it is practi-
cally impossible to stitch up the inguinal canal, I have had
good results by firmly packing the cavity as high up the
inguinal canal as possible with aseptic oakum and stitching
the cutaneous wound.
Prolapse of the Rectum, Follows empirical exploration
of the rectum, prolonged diarrhcea, constipation—in fact,
anything calling the muscles concerned in defecation into
excessive play. Quite rare in the horse, it is seen in the cat,
dog, and especially swine. As previously stated, it is often’
combined with invagination of the prolapsed parts. The:
150 PRINCIPLES OF VETERINARY SURGERY
treatment for prolapse of this sort is not always successful, ag
the parts will continue to appear externally, and amputation
may become necessary.
Prolapse of the Uterus. Most frequently seen in the cow,
It follows almost invariably anything which induces the
animal to strain persistently, such as rough empirical traction
during labor, the weight of the partly detached footal placenta
hanging from the vulva, etc. Sometimes considerable trouble
is experienced in retaining the parts after they have been
returned : so much so, that amputation of the uterus may be
required.
Prolapse of the Vagina. Most frequently seen in the cow
and bitch. As causes may be given relaxation of those organs
which fix the vagina, as, at the latter stage of pregnancy,
cows standing on floors sloping downward, difficult labor
with traumatic lesions of the vaginal canal. The treatment
consists in reposition of the parts and retaining them by a
variety of trusses.
Prolapse of the Penis. In cases of paraphimosis the
penis cannot be retracted and therefore becomes prolapsed ;
as also in paralysis of the penis. This form of prolapsus is
most frequently seen in the horse and dog. The treatment
consists in attempting reposition of the organ by hand, next
by antiphlogistic measures, and when they fail, in amputating
the prolapsed portion. ae
Prolapse of the Tongue. Follows paralysis or lacera-
tions of the muscles. Treatment is unsatisfactory.
Prolapse of the Bulb of the Eye. Seen in large-eyed
dogs, as pugs, following bites, etc. Treatment lies in reposi-
tion, or, in case the life of the tissues is destroyed, in
amputation.
DISEASES OF BONES 151
DISEASES OF BONES.
Fractures.
W hat is a fracture ?
A sudden forcible separation of the continuity of a bone.
W hat are the causes of fracture ?
1. Exciting or immediate causes.
2. Predisposing causes.
Describe the exciting causes.
Fractures of this last class are subdivided into (a) frac-
tures by external violence, (b) fractures by muscular action.
In those due to external violence, as a blow, kick, etc., the
fracture occurs at the point struck, or through transmission
of the force by a bone or chain of bones at a distant point
with more or less damage to the overlying soft parts. In.
those due to muscular action the bone is broken by sudden
and violent contraction of muscles directly or indirectly
attached to the bone. Again, those the result of external
violence may be by direct violence or indirect violence ; the
former occur at the point struck, the latter at a distance from
the point of application of the torce, the blow being trans-
mitted through a bone or chain of bones.
Exemplify the direct causes of fractures.
Direct external violence: Fracture of the metatarsus
from a kick.
Indirect external violence: The animal falls and sits
down like a dog, followed by fracture of some portion of the
vertebral column, The animal’s hoof is caught in a street
152 PRINCIPLES OF VETERINARY SURGERY
rail; in trying to free itself the animal twists the incarcerated
hoof, resulting in fracture of the os corona, etc.
Muscular action: Horses when cast in a narrow stall in
their vain efforts to rise strain the muscles of the back to the
utmost, executing at the same time all sorts of torsion move-
ments, resulting in fracture of the vertebral column. ..........00e ee 21
Actinomycosis of the mammary
CHANG. so cawsic cece aren dees 128
— of the muscles............... 124
== OF the Skits. sda aie series 123
— of the subcutis.............4- 123
— of the tongue............+..- 124
Actinomycotic mammitis....... 284
— lymph glands.... ......-..-- 123
Actual cautery as a hemostatic.. 11
Acute arthritis...........0-0.005 ae
7
= BDSCOSSiis ci artists aceidiesa or Se Dees
ANPCOM Ans oes ses 04s desee nee 102
Angiosarcoma ............. 2.005 105
AMEM IB, ase se Vdc sigae Basan 4
Aneurism ............ 0000. 0008. 264
HS BOLIC sis siculoim aarta eu sae ye ets 265
SS CIUSOId ss swine: oho vsxeecaae 264
PASO. ag secwde oes welescn lek 264
— sacculated ..............0.4. 264
— treatment of.................. 267
= bUbU ary) ecws os amdmonous end - 264
Aneurismal varix................ 265
ANGHPAK 6a: assmaaaewis cre seaee 21, 30
Antiseptic drugs................ 41
Aortic aneurismS................ 265
Aponeuroses, diseases of......... 251
— MN@CTOBIS Of .......ceceeeceenes 251
— rupture Of 0.6605 sseeseiia: 253
Arrest of hemorrhage........... ?
Arterial hemorrhage ............ 2
Arteries, diseases of.... ........ 262
Arteries, rupture of ....... ..... 268
APCSTITIS 55 pros wea Gaee sees eee 262
Arthritis, acute.............00. 195
= ASC PU Cis 'sssaseamwanns tears Cie 195
= ChHLONICS as bocce ntignad depose 195
— deforming.......... cece eens 199
— fibrimous...... ccc cece eee eee 201
— fFUNQOUS... 2... ccc e ee eeee 202
— SOULY .. cece cee ence eee 204
— PANNEOUS ......-. eee eee vee 201
— purulent,.......ceceeeeeeeeees 198
— PYCMIC ... eee cece eee eee eee 208
312 INDEX
PAGE PAGE
Arthritis, septic ..........06 195, 208 | Callus, permanent ...........-+-- 163
— specific ......sscceeeeeeereeee 196 | — provisional ........ 6. eeeeeeee 163
= trauMatiCiaesosss seeeeeaan -... 195 | Cancer, encephaloid ......-.-.+- 108
Arthrogenous contracture....... 215 | — scirrhous.........-.ee eee eee 108
Articular contracture .........-.. 215 | Cancerous cachexia......-+...ee 108
— CONTUSIONS ........ cece teens 213 | Capillary hemorrhage........... 3
— rheumatism...............--- 202 | Carcinoma of the mucous mem-
Articulations, diseases of ....... 195 PEANGS wdeedenudaue aeseesesers 113
Aseptic arthritis ........-.....+- 195 | — of the skin ........ 2. eee eeee 113
— wound fever........eee eee eee A | Caries...... ccc cece crete eereeee 186
Atheromatous CySt........eeeeee 120 | — dental 1ChOrous sgiveeie esas acdsee tess 81 | — incarcerated ................. 148
Moist oss sacteer ssa ceeewca yes 81 | — inguinal..................08. 147
— phagedenic ...............56- 81 | — make-up of a..............60. 141
— putrid... 0c. e eee ee 81 | — muscular..............020 eee 141
— treatment of........ ...... . 85 | — of the brain.................. 141
Gangrenous inflammation....... 58 | — pelvic nic. ceisveitwawer seas 146.
— mammitis.................06- 283 | — reducible ..............2....- 142
Gaping of wounds.........-..... 3 | — strangulated................. 143
Gaseous cellulitis ............... 24 | — treatment of...........+..06. 144
General surgery...........+---+- 1 | — umbilical..........-....-.0- 146
Giant-celled sarcoma...........- 105 | — varieties of.. ............. 141, 146
Glandersic: sss cmess ac ede cas oomes 21, 88 | — ventral......... ce eee eee eee 146
316 INDEX
PAGE PAGE
Hy srOMiay..e cs 66.4 enesaseas aupes 288 | Intestinal wounds.............. 2
Hyperostosis. ..........0..0 eee 190 | Intoxication, septic ............. 30
Hypertrophy of bone............ 190 | Invagination ........ cee ease eee 148
Hypoblastic tumors ............. 108 | Inversion .........ceee cere ee eeee 148
I K
Reeloids: «vs sa: state: < asraencwie e's see's 18, 91
Ichorous gangrene............-- 8l | Keraphyllocele.. ........s0cee0s 300
= PUSs ss aissieliar sed ew se aac 22 Kryptogenetic septicemia....... 30:
Immersion..... 0... cece eee eens 63
Impaction displacement ........ 155 L
Impaired function ............-- 60
fee hernia......5....66 143 | Lacerated wounds REESE OI DONTE: S 5
TGisAd WVOUTOSE. ce celos eueoeehs 5 Lacteal calculi site B86 8 Aa eS 184
Incomplete fracture............. 153 | Laminitis ......-.+...seeere seen 800
Infection, parasitic..........+64: 112 Leontiasis OSSOE oe Sods a icarscaretastidicens 191
Infectious arthritis.............. 195 | Ligation of blood vessels ........ 10
2 = gollaitias ves arseauadieca ss ag | Ligatures...........seeeeeee eee 41
— diseases, traumatic..... .... 21, 34 Lipoma sees AN Stee Ce ee Ps anaes 95
=a ao rOrMAtiONs's cvaceaorn die fs 421 | Lipomata, etiology of ........... 96
Inflammation .............eeeaee 55 | Lipomatous atrophy.....+++..++- 250
— ADSCESS 2... cece ceeeeereceees 58 | Liquor puris.........ssseeeeeees aa
COREA Olle oavtonnd civeneer ae 56 | Loose bodies in the joint ........ 217
= diphtheritic OPN Dts Gmc es Uh 58 Luxation of a joint re ee a 205
es f Piin uses oes be eee 57 Lymphadenitis..............05- 276.
— gangrenous...........eees008 58 | — parenchymatous............+. 277
— hemorrhagic...........00.005 58 | — purulent ities 4 Uaioe es 278
SHOE DOHA st ansaid eadommanee .... 178 | — Specific ...... en neseeeeeneens ait
— of mammary gland........... 279 Lymphangiectasis piribenesauewealets 276
— of osseous tissue...........0.. 18g | Lymphangitis...... ..-.+.-.+.4 273
— Of VEINS. nic des acinean anaes 270 | — specific ....-- +s. eee sees eee a4
— phlegmonous...........20.005 93 | Lymphatic gland tumor......... 103
— productive..........c. cece e ee 59 | Lympho-sarcoma .........+.+-++ 105
<= pupulethy secede eet sed odeaive 58 | Lymph vessels, diseases of....... 273
= BETOUS ies ssansawniew eee veaee aes 57
— SPecific ... ccc cee ece ee ceeeees 59 M
— treatment of................. 62 | Malformations, congenital ...... 3805
Inflammatory edema...........- 301 | Malignant lymphoma ........... 103
Inguinal hernia................. 146 | Malignant cedema.......... 21, 30, 84
Instruments ............... shantas 41 | — definition of ................- 34
Interstitial lymphadenitis....... 278 | — post-mortem changes of...... 35.
— mammitis.................... 283 | — symptoms of....... seeseeeee 35,
— myositis.......... cece eee 244 | — termination of.............6- 35
Intestinal calculi................ 133 | — treatment of........cee cece 35
INDEX 317
PAGE
Malignant tumors.... .......... 86 Metra dean sinsuyyeorencdaces, BAD
Mammitis........0........0.. 279-285 | Neurofibromata .............0005 101
— botryomycotic.... .........05 285 | Neurogenous contracture........ 216
— gangrenous... ...........0..- 283 | Neuroma, false...............60. 100
Massage: see ae xs ea cacweaet ae ee ke 66 | Neuromata..............ce ees 100
MaStitiSi 3.44. c.dade'e omy arcgaien cwshiuaan 279
Melanotic sarcoma........... 105, 107 oO
Metastatic abscess............... 71 | Odontoma ...... ccc eee eee ee eee 99
> Gellilitists.aidonecee sc Acuboirencs < 24 | Cidema bacillus................ 34
Mixed celled sarcoma............ 105 | Open wounds...............000e 1
Moist gangrene................ 81, 84 | Opisthotonos...............00 eee 37
Monarthritis ............ ....05. 196 | Orthotonos...... 6.6. ...... eee 37
Monday morning disease ........ 27 | Osseous tumor ..............0 0 ee 99
Monoplegia..........e0...+0005- 254 ) Ossification of callus............ 165
Monorchids........... .....00055 305 | Ossifying myositis............... 244.
Mortality in tetanus............. 88: || COSESILIS. tie aes da ctanb seeieatamiadetots 178
_ Mucous membranes, diseases of.. 800 | — Causes Of.......... cess ee ee eee 182
Mucous tissue.................6- 96 | — Course Of...........0 eee eee eee 182
Mucous tumor........ 0.2.2.2... 96 | — deforming ................06- 184
‘Multiple fracture. ............... 154 | — fumgous.......... eee eee eee 184
- Muscles, rupture of........... 52, 246 | — ossifying .........-.-ee eee 183
=. atrophy Of savonesr sans aoeins 248 | — rarefying...........0. 0c eee eee 183
Muscular atrophy............ 248, 250 | Osteoclasts . ........6 cee ee ee eee 164
~ rheumatism ..............0405 245 | Osteoma, dental............-...- 99
SEP aI Bake Waies avin gevienbaniee g9 | Osteomalacia..............-05-5 192
Be OUN dS ace.s «sc c ecveeisiate x apes oot 2,19 | — causes Of........ 66. cere eee 192
Mycofibroma........-...--...05- 91 | — definition of ...........eeeeee 192
Myelinic nerve fibres............ 100 | — symptoms of........... einige tse 198
Myogenous contracture......... 216 | — treatment of........... eee ee 193
MY OMA ps. aiscasouneteeatesdaks gg | Osteomyelitis.............ee eee 178
J Myositis nmregcarcaceutoes eed 939 | Osteophytes........+eeeeee tees 190
— ossifying 6.0.0... ceeeee eee ees 244 | Osteoporosis.... .....eeeeees 183, 198
+ purulent.........0eeeee ee eee 249 | Osteosclerosis..........+-seeseeee 190
eer ee a45 | Over-riding displacement ....... 155
Myxoma........60 cee eee ee eens 96 Pp
N Panneous arthritis .............- 201
Necrosis. ..... ere 27, 49, 186 | Papilloma.........--0++ cee eeeee 115
— of aponeuroses ......-..---+65 251 | Paralysis..........0eeeeee cee eeee 254
Necrotic carieS........eeeeereeee 187 | — facial... .... cece eee ere eee ees 259
— paralysis... ...cee cece eee ees O58 | — NETVO ss seidemewee veces eweee .. 258
— tUMOTS ..... eee ee eee ee 100 | — peripheral..........-:0eeeeeee 258
Neoformations, epithelial ....... 108 | — radial ......... eee eeeeee eee 259
Nerves, diseases Of.......-.+-00+ 954 |= Spittal .oj.ccavare cress eases 258
cet
318 INDEX
PAGE PAGE
Parasitic infection............... 112 | Purulent bursitis. ............-. 287
Parenchymatous hemorrhage.... 3 | — fistula.......... cc. ee eee eee ee 78
— lymphadenitis................ 277 | — infiltration................006 58
ParesiS:s.23.410 et Gaw MaweeGes es ecu 254 | — inflammation .............66. 58
Pelvic hernia.............e eee eee 146 | — lymphadenitis................ 278
Pentastomum taenoides......... 140 | — myositis.............2.-..0005 242
Periarthritis..............06 196, 205 | — tendovaginitis ........ ...... 232
Periarticular ringbone.......... . 205 | Pus, constituents of ............ 22
Perilymphadenitis............... 277 | — ichorous ......... cece e sees 22
PROTOS LUIS sy es-cidees: adiecsnn ie nlainnnetre © LO | = SANIOUS ssccecs ode evs adeemione 6 22
— acute aseptic................ 179 | Putrid gangrene ............... 81
— acute purulent.... .......... 181, | Pyemiasiorie os vecawoseed esac 21, 32
— chronic fibrous............06 182 | Pyemic arthritis ............ 203
— chronic purulent............. 181
Peripheral paralysis............. 258 R
Permanent callus..............- 163 Rabi
Persistence of the urachus...... 306 See tote et erenen ret eae oe
Plipedente Sanerene, .... 0004 <0: 81 Rachitis, causes OE Rens Ziaemina 191
RNS SRAM Ree en area eed FEN ny | characteristics of............. 191
Piaiineals) n uaguoasipevanvasac cre il fo Shc ease Oe
ie teal pe secodninrcdaees Bh | Nee RE ble mer onesie 198
Plilsemontiaa iufletanmation,.. i. 93 Radial paralysis...... petttteeees 259
PHIOPOSIE <4. 5 c4ds eevee ded ateann 57 Reaation of desonenaliones:: ++, ab
Ploanastiebongs.... ..ccaok, 37 Reduction of fractures........... 167
Pododermatitis.....0..0.. 0.00005 gag: | REBCHE RAEN OS Plat adams seen
Poisoned wounds.............005 " Ee eepenauion RE UIST nace sinew is
Polyarthritis.......0..c0cc08 vee ry ta enone ea tag seg ABE
Poly DUS i526 caldimmabnee was 91 Reventon oe Paes cae nies 138
Preputial caleuli................ 184 Eeeracoian is age aponeurosis.. #08
Priessnitz fomentations......... 65 Rheumag mayoritis Seed ay ok ik
Prolapsus ..........0cee cece 147 Ebeumatism; artenlar Baicitanmicts eee
— of the bulb of the eye........ 150 Rice kernel bodies............... 134
— of the intestines.............. 149 HiSk pes hea ppt ne haat 191
— Of tha oMentit ccc... 149 Ringbone, periarticular ......... 205
— of the penis ...............0.. 150 Rotary displacement ............ bea
= OP Eb FOCEUER cc casos.ouvoonee 149 Round-celled sarcoma........... 105
— of the tongue ............... 150 RUDOM sia icscasie cae oa hAvherducdee gs 59
5 BEG GRar ties de saex-