Hctets ibn t a i hseeuats “i vesieei Bia Bia SEN ne nate LBs sistent iis te SS es ii inet ite nines De etianehe tee Lina esis att ad: —— me iat chibi is eee Tamaya ae ried oie aehvoenbien fy tient bh 4 rhe Huet Welle lett Serger as Aig Woe Zs [wove Se wie mich i ctitateoeheretvine eneraeeer a i i vine Rea "e fe nit elie cs Swi tC aaliy rar . ii i scenes im i iste ie rit vier " VA rt LA ret iy Toeaener gy aan meine e ee \ be et sayehetoid fle Meche da Es a Sennen rH Chest ereTyisr TT ett erate bi isyd Bren aa be b ie Sieh, rise Ae tite atti eat esa ‘ RES erien tere ee pie sepa tas tle 9 ti i iy ri mete Soh Pace es se ate Tite aes soak a rents ie imaass My ret Hie pid aries gana Wgelnrts robe at a fae eh «Ff oD eas Feiner ts ee si ae Nairn ny si Sens at Penis * spirits ee sees eal gles fretted at iis : Madr pulse i i i iH i ae Arnone fittnt sprees ‘ab fptiais aa una fregerey" en iets iis ieee isksisich ta =a: fof fore apein Vesennle Sena /Dabvslnyale dws seal Si sae serena ein ctbaae ra bay alibi Rhudieemroe Pere ener: THIS BOOK IS THE GIFT OF Roswell P. Flower oe, p % ; H Le, — AWA Aw; A TTT Date Due | AR Po 4 Cornell University Library The original of this book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www. archive.org/details/cu31924001131832 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.