TUFTS UNIVEHSI 9090 014 532 408 Webstsr hamiiy Library of Veterinary Uddloau Cummings School of Veterinary IVledicine at Tufts University 200 Westboro Road North Grafton, MA 01536 IVIANUAL OF OPERATIVE VETERINAfiy SURtEl!!, BY A. LIAUTARD, M.D., V.M. Principal and Professor of Anatomy, Surgery, Sanitary Med- icine AND Jurisprudence in the American Veterinary Col- lege ; Chevalier du Merite Agricole de France ; For- eign Corresponding Member of the Societe Cen- trale de Medi^cine Veterinaire (Paris); Hon- orary Fellow of the Royal College of Veterinary Surgeons (London); Hon- orary Member of the Societe Veterinaire d' Alsace-Lor- raine, Etc., Etc., Etc. Author of '-'Fade Mecum of Equine Afiatofny /' ''How to Tell the Age of Domestic Animals •''' "-Animal Castration ;'' '•'•Lameness of Horses ;' Translator of "• Bouley on Hydrophobia r of '■'■ Zundel ofi Diseases of the Foot;'''' Editor of the ''■Ameri- can Veterinary Review?^ WITH NEARLY 600 ILLUSTRATIONS. NEW YORK WILLIAM R. JENKINS VETERINARY PUBLISHER AND BOOKSELLER 851 AND S53 Sixth Avenue -52 8^1 COPYRIGHTED, 1891, By a. Liautard, M.D., V,M. All Rights Reserved. TO Dr. a. CHAUVEAU, Member of the Institute (Paris'), General Inspector of tJie Veterinary Schools {France), Professor to the Museum of Nattiral History (Paris), As a humble token of the high appreciation of his scientific labors in behalf of Veterinary and Comparative Medicine, this work is, with kind permission, dedicated by THE AUTHOR. PREKACK. If an apology should be deemed necessary for any apparent tardiness in the execution of the special undertaking of which the present work is the result, it will not be very far to seek, but may be readily found by a reference to the various and unceasing vocations in which the author of the Manual of Operative Veterinary Surgery is habitually engaged. The labor of its preparation has, in fact, been alternated and shared with that of other literary engagements of an imperative and unremittent char- acter, and the onerous and exhaustive duties pertaining to his collegiate functions, to say nothing of the demands of an extensive practice. Engaged for years in the work of teaching this special department of veterinary medicine, and having abundant opportunities, which have not been neglected, of realizing the difficulties which the student who earnestly strives to perfect himself in his calling is obliged to encounter, I formed the determination long since to do what lay in me to facilitate his acquisi- tion of knowledge; and it was then that I projected the present volume, and began the accumulation of material by the compilation of data and arrangement of memoranda, with the recorded notes of my own experi- ence, the fruit of a long and extended practice before referred to ; and of course a careful study of the various authorities who have illustrated and organized our copious veterinary literature. Moreover, haste in the pub- lication, and a thorough digestion of the subject and the systematic order- ing of material, could not be very easily combined, and a little delay in the issue will prove no detriment to the value of the book. With his own kind permission, the work is dedicated to Professor A. Chauveau, General Inspector of the Veterinary Schools of France, as a token of my high appreciation of his services as a scientist, and in recog- nition of his standing among the lights of our profession ; and especially of ray estimation of his excellent book on anatomy, in which he so ably lays the foundation of the knowledge which constitutes the indispensable condition of all success in surgical practice. I have been liberal with European authors, not only in freely cred- iting them with their discoveries and theories, and in many cases quoting literally their opinions and arguments, but especially so in adopting their illustrations and enriching the work with the artistic representations orig- inating in their's— an emphatic manifestation of my high estimate of their value and the skill of their execution. And it is thus that the names and accomplishments of Rigot, Bouley, Qourdon, Peuch, Toussaint, Cadiot and Zundel, of France ; of Brogniez and Degives, of Belgium ; of Hert- wig, Hering, Moller and Hoffman, of Germany; of Lanzillotti-Buonsanti. of Italy; and of Williams and Fleming, of England, will become famil- iarly known to our readers. But while I have in great part been guided in my work by the char- acter of that of our predecessors, I have not restricted myself to the lines observed by them, or exclusively respected the authority or prece- dents of European surgeons, but have sought to do justice to the progress of American veterinarians by honoring the contributions they have made to our surgical knowledge ; and it is due to accident alone, and to no in- vidious design, if any omission or oversight has been committed, by which any to whom credit should be awarded have failed to receive it. The chapters of the Manual which treat respectively upon "Frac- tures" and upon "Operations on the Foot" are reprinted from my own previous writings. Thus, in the first instance, the remarks upon frac- tures, with the kind permission of the Hon. Jeremiah M. Rusk, Secretary of the Department of Agriculture, are extracted from an article published in " The Special Report on Diseases of the Horse;" and in the second in- stance, touching the subject of operations on the foot, I have not hesitated to utilize my own translation of Zundel, produced as long ago as the year 1881. In both cases improvement has been made upon the previous treat- ment of these topics by the addition of numerous illustrative plates which accompany the text. In the chapter upon operations on the genito-urinary apparatus the reader is referred to my special work on the subject of " Castration," which is not included in the present volume. In completing the task undertaken in the preparation of the Manual, however perfect or imperfect may be the manner of its execution, while I have been influenced by a desire to effect something for the benefit of all classes of practitioners, including those of recent graduation, my ob- ject above all has been to facilitate the labors of the young student while industriously and anxiously toiling for the knowledge which is» to qualify him for a successful career in a useful and honorable profession ; and if I shall have succeeded in this object, and the success shall be certified by the verdict yet to be pronounced, I shall feel fully satisfied and more than ever encouraged to persevere in my efforts to elevate the standard of vet- erinary science in America. No toil has been spared, no effort relaxed, in the prosecution of the design and desire to compel the approval of the judicious, and even to escape the strictures of the critical, and I have not failed to seek for aid and counsel from competent coadjutors. The entire text has undergone revision, with a view to the improvement of its idiomatic structure, by my esteemed friend, H. D. Holt, M. D., of Jersey City, N. J., to whom I am also indebted for the favor of supervising the proof and overlooking the issue and arrangement of the various chapters; and my publisher has exercised a true liberality in providing an external garment and garni- ture for the contents of the book, in all respects correspondent with their value and interest. To that gentleman, therefore, are due my warmest acknowledgments for whatever of internal and external attractiveness may characterize the Manual of Operative Veterinary Surgery, and they are cordially and freely tendered. I have now only to express the hope that this contribution to the cause of veterinary progress may be as kindly received and favorably judged by my colleagues as it is honestly designed to effect its object by me, and that any shortcomings in the execution of the work may be len- iently regarded. And so it goes into the hands of the public, to share the fate of all human ventures, for better or for worse, as its fate may be. THE AUTHOR. CONTENTS. H Operations on the Skin and Cellular Tissue — Continued. page. Exutories 186 Setons 188 Tape Seton 188 Regions to apply Setons 193 Rowel Seton 197 Trochiscus 198 Accidents or Sequelae of Setons 198 Ablation of Tumors 200 Excision 201 Ligature 205 Elastic Ligature 210 Removal by Tearing 211 Puncture 211 CHAPTER VI. Opbeations on Bones. Fractures. (Generalities) 212 Fractures of Different Bones 229 Dislocations 262 Amputations 266 Amputation of Members 268 " " Horns, 2T4 " the Tail 277 Trephining 283 Periostotomy 291 Resection of Bones 293 CHAPTER Vn. Operations on Muscles and their Annexes. Caudal Myotomy 296 Caudal Myotomy by Transverse Incisions 299 " " " Longitudinal " 300 " •' " Mixed " 301 " " " Subcutaneous " 802 Accidents following Caudal Myotomy 306 Crural Myotase. Crural Myotomy 30S Complications of Crural Myotomy 311 Operations iipon Fibrous Tissues 312 XU CONTENTS. Operations on Muscles and their Annexes— Continued. page. Tenotomy 312 Plantar Tenotomy 312 Accidents Following 320' Carpal Tenotomy 321 Anti-Brachial Tenotomy 32C Tarsal Tenotomies 32.^ Cunean Tenotomy 3~;j Peroneo-Phalangeal Tenotomy 32G Tenotomy in Birds 327 CHAPTER VIII. Operations on the Digestive Apparatus. On the Teeth 32S Operative Dental Surgery SS'j Leveling of the Teeth 335 Extraction of Teeth 343 Filing Teeth 35a Canine Dentistry 356 Operations on tlie Tongue 3'8 Suture 36a Amputations. Glossotomy 361 Operations on Salivary Glands 361 Adenotomy 361 Maxillary Adenotomy 36C Operations on the (Esophagus 364 (Esophageal Catheterism 366 The Taxis 370 Crushing the Foreign Body 372 (Esophagotomy 373 Accidents Following 377 Qastrotomy. Rumenotomy 377 Incision of the Rumen 378 Enterotomy 380 Paracentesis 383 Hernia 385 Inguinal Hernia 394 Recent Inguinal Hernia 397 Accidents Following 411 CONTENTS. XIU Operations on Salivary Glands— Continued. page. Old Inguinal Hernia 411 Inguinal Hernia in Geldings 418 Crural Hernia 420 Perineal " 421 Pancreatic " 421 Pelvic or Internal Hernia of Oxen 421 Umbilical Hernia 425 Diaphragmatic Hernia 439 Ventral Hernia 443 Eventrations 447 Laparotomy 449 CHAPTER IX. Operations on the Respiratory Apparatus. On the Guttural Pouches. Hyovertebrotomy , 452 Arytenectomy 462 Fleming Method 463 Cadiot Method 468 Tracheotomy 477 Accidents Following 486 Thoracentesis 488 CHAPTER X. Operations on the Cirotilatory System. Bleeding. Venesection 492 Phlebotomy 493 Phlebotomy in Solipeds 496 " at the Jugular 497 at the Cephalic 499 " on the Subcutaneous Thoraciq 501 " at the Internal Saphena oOl *' on other Superficial Veins 501 '• in Large Ruminant.s 503 '* on the Juaiular 504 ** at the Subcutaneous Abdominal 504 " on Small Animals 505 Accidents Following Phlebotomy r 50(5 XIV CONTENTS. Operations on the Circulatory System.— Coutinued. page. Arteriotomy 514 Arteriotomy at the Transversal of the Face 514 " " " Posterior Auricular 515 " " " Median Caudal 516 Capillary Bleeding 517 Bleeding at the Palate 520 " " ." Coronet 531 " " Foot 522 Surgical Hemostasia 523 Temporarj'^ or Preventive 524 Permanent or Definite 528 JPhysico-Chemical Hemostatics 526 Surgical Hemostatics 530 CHAPTER XI. Opbrations on the Nervous Apparatus. Plantar Neurotomy 541 CHAPTER XII. Operations on the Genito-Urinary Apparatus. Catheterism of the Urethra 558 Urethrotomy 558 Preputial Urethrotomy 561 Scrotal " 561 Ischial " 563 Cystotomy 565 Lithotrity 565 Amputation of the Penis 569 CHAPTER XIII. Operations on the Foot. Anatomy 576 Diseases and Defectuosities 583 Vices of Conformation 583 Instruments 5S9 General Operations 590 Dressings . . 591 CONTENTS. XV Operations on the Foot— Continued. page. Diseases. Canker of the foot 591 Corns 607 Sandcracks 616 Calk , 637 Punctured Wounds of the Foot 629 Contracted Heels. Hoof Bound 640 Diseases of the Frog 665 Keraphyllocele 668 Laminitis 669 Navicular Disease 694 Quittor 703 Cutaneous Quittor 703 Tendinous Quittor 706 Sub Horny Quittor 711 Cartilaginous Quittor 714 CHAPTER XIV. Opeeations on the Eye and Eae. On the Eye. Operations on the Accessory Ocular Organs 739 Traumatic Lesions 740 Solutions of Continuity 740 Defective Congenital Conformations 741 Pathological Growth and Caries of the Membrana Nictitans. 743 Operations on the Lachrymal Apparatus 743 On the Caruncula 743 On the Lachrymal Ducts 744 On the Lachrymal Canal 745 Operations on the Essential Organs of Sight 746 Extraction of Foreign Bodies on the Surface of the Globe ... 748 Paracentesis of the Cornea 748 Staphylonna 749 Cataract 749 Amputation of the Eye 754 Ocular Prothesis 755 On the Ear. Amputation 756 XVI CONTENTS. CHAPTER XV. PAGE. Diseases of the "Withees 759 Excoriations 765 Warm (Edema 765 Hematoma 766 Core or Stickfast 766 Abscess 769 Wounds. .'. 770 Diseased or Fistulous Withers 771 Terminations of Diseased Withers 774 Diseases of the Poll 779 Excoriations, (Edematous Swellings, Core, Bloody Tumors. . 781 Cyst 781 Abscess 783 Poll Evil 784 INTRODUCTION. Under the designation of operative surgery is understood that department of medical science and practice which includes the external and instrumental manipulations required in the treat- ment of surgical diseases and accidental injuries or deformities:. or perhaps it might be succinctly defined as surgical science vie- chanically applied. The two branches — the science and the art — which constitute the study of operative surgery cannot, of course, be dissociated in a treatise on the general siibject, and it will therefore be neces- sary, as we proceed with the detail of our observations, to give due consideration to the setiology, the symptomatology, the pathol- ogy and other characteristic features of certain diseases, in their relations to the indications of treatment and the manipulations which they involve at the hands of the surgeon, Viewed from the standpoint of comparative importance in re- spect to the value of the results of human and veterinary surgery, as relating to the vital status of the patients who become respect- ively the subjects of both — the human being and the quadruped races — veterinary surgery must of course consent to occupy the subordinate place; a fact, however, by no means tending to dis- parage the value or the just estimation of the calling of the scien- tific veterinarian. In human surgery the one paramount result held up to view is the prolongation of the life of the patient. This is a consum- mation to be achieved regardless of any considerations of cost or trouble, while in veterinary surgery the prime motive is the res- toration of the patient's interrupted ability to fulfil his function as an animated machine for supplying a certain amount of valu- able force. For these reasons the scope of veterinary practice is *A INTRODUCTION. a circumscribed one, in comparison to that of human surgery, by having the aim and being brought to the test of mere economic utility. While the human Hfe is prolonged at any cost, moreover, the treatment of the animal is always suj)plemented and influ- enced by the consideration that if curative eiforts fail, the suffer- ings of the patient may be terminated by the administration of a prescription which will at once release him from pain and de- prive him of life, with the full sanction both of self-interest and benevolent feehngi Another element which operates to define the sphere of the veterinary surgeon is the natural disinclination of the owner of a sick or disabled animal — perhaps a man of limited pecuniary resources — in a tedious and unpromising case, to add to the ex- pense of surgical attendance the cost of the unremunerated "keep" of his disabled and improductive servant. It ought to be true, as a matter of course (perhaps it is so in point of fact), that no man of intelligence and integrity will as- sume the duties and i*esponsibilities of surgical practice without the due preparation and equipment, which is only to be acquired by conscientious study and comjDetent knowledge of medical science at large. Especially and indisj^ensably a surgeon must be an accomplished anatomist. His knowledge must be thorough and practical in the several di\dsions of anatomical science — he must possess a familiar acquaintance with clescrij^tive anatomy ; he must be fully instructed in surgical anatojuy or the anatomy of regions ; he must have mastered the last chapter in pathologi- cal anatomy ; and if there are any other kinds of anatomy, he must master them all, and then he will have become an anatomist in fact, and qualified to practice surgery. Yes; a surgeon must be an Anatomist. And it ought to go without saying, that only a surgeon should practice surgery, whether his patient be biped or quadruxDed. No untrained layman should presume to wield the knife and the cautery with their associated arsenal of weapons and other appli- ances for the subjugation of the enemy whose assaults it is the special province of the surgeon to repel. An ignorant operator may easily become, himself, a more dangerous " lesion " than some of those which he presumes to treat. The man who can cut into the living, and usually hypersensitive, flesh of a suffering animal, without knowing what tissue or organ he is attacking, what artery INTEODUCTION. 3 he is likely to sever, what nerve to wound, what organ to lacerate, what function to paralyze ; who would essay the operation of neu- rotomy without knowing where to look for the plantar nerve ; who would undertake a case of vaginal spaying in ignorance of the location of the flying ovaries; or who would operate for strangu- lated hernia unaware of the mode of avoiding the infliction of injury upon the posterior abdominal artery — such a man, if to be found, should simply be subjected to an odium which should ostracise him from honorable and equal association with others of his species, besides being held criminally amenable to the law providing penalties for the perpetrators of cruelty to animals These reflections may be unnecessary, but it is all too true that om- domestic animals too often become the victims of worse than brutal masters, who take advantage of their helplessness and inferiority to inflict upon them cruelties so gross and aggravated that right-feehng men are often compelled to blush to call them feUows. It is no excuse for this that it is done through the agency of a pseudo-surgeon : such a plea merely doubles the number of the wrong-doers. In offering these suggestions, and in formulating the informa- tion which follows, derived from the experiences of many studious and observant men, and which in their aggregate and connected form constitute the substance of this volume, it is assumed that it is only from competent and qualified minds that the apprecia- tion which it hopes to merit and to receive must come, and we trust that to the extent of its justice and truth it will not be withheld. With the skill of the expert anatomist must be associated, of course, the necessary mastery of tlier^ procedure is meant the special modifications and successive stages by which the manipulations of the operation itself are regulated. For ex- ample, in the removal of a vesical calculus there is one method by hthotrity and another by extraction, and with both are involved the insertion of instruments into the urethral canal, one being the jiTocedure with the catheter, and the other the procedure by the injection of tepid water. Castration with clamps is a method, when compared to double subcutaneous twisting {Mstournage) or to torsion; and it is performed by two procedures, that by covered and that by uncovered testicles. There are several important points which demand special at- tention at the hands of the surgeon before beginning an operation. Having finally reviewed the situation, and especially having men- tally rehearsed the anatomical disposition of the region and the 10 INTEODUCTION. pathological character of the lesion, with the necessary details of the work before him, not forgetting to anticipate possible acci- dents and coni]DHcations ; and being assured that his arsenal of instruments, dressings, etc., is ample and in good and available order, with a liberal provision of sponges, antiseptics, etc., and duplicates of such of the instruments as are liable to be broken or otherwise disabled, the condition of the patient should then be ascertained. It will, of course, have been thoroughly understood by the surgeon previously, but it is always among possibilities that even at the appointed moment for operating, some changes may be discovered or some new circumstances developed which may modify or contraindicate the entire proceeding. Some final preparation of the patient is always necessary. One item of this consists in clipping the hair from the skin over the seat of the operation, and thoroughly cleansing the part. In some cases it is necessary to soften the tissues by means of poul- tices, baths or wet bandages. There is also a constitutional and general preparation which must not be neglected, with a \T.ew to so modify the organism as to improve the ability of the animal to withstand the shock of the operation. If weak and debilitated, his strength and condition must be improved; if of an irritable and nervous disposition, precautions must be taken to control it. A comparatively low diet is almost always a salutary measiu*e, and sometimes even complete diet an essential preliminary to an operation, and the surgeon must assure himself that they have been properly taken into consideration. In many cases the surgeon needs the co-operation of assistants, either professional men or laymen. The aid rendered by a profes- sional brother or by a student of mediciue will of course be such as will be assigned to him by the responsible surgeon, and cannot be specified here — it wiU vary with every case. The facility and success of an operation wiU be greatly promoted by their intelli- gent and sympathetic aid, which will be quite of an indispensable character. In enlisting laymen as assistants, it will of coiu'se devolve on the surgeon to instruct them as fully as jDOSsible in the nature of the services expected from them ; and in making his selection of indi^dduals it will be an important point gained if he can obtain those who are accustomed to the management of ani- mals, and who are expert in handling and successful in controlling them. INTRODUCTION. 11 There is still another party to be considered while referring to the study of " j)reparation." It is neither the animal, the surgeon, the assistants, the instrument case, nor the lint and bandages. It is the owner of the ailing animal. And to " prepare " him for the event is oftentimes a performance requiring a larger amount of judgment, tact, knowledge of human nature and patience than the average man possesses. On the one hand there are those of the optimist class who have quite an unwarranted opinion of the power of surgery, and who, in despite of the most unfavorable prognosis, insist upon a resort to the knife, even upon inadequate occasions. And on the other hand are those who interpret any suggestion which involves a solution of continuity professionally proposed, however artistically consummated, as only a mild form of sentence of death to the patient. But however antipodean may be their views in other respects, they are in common quite assured that for an operation which fails to restore the dilapidated patient to a condition a little better than new, whatsoever may have been the accident or lesion which he may have encountered, and whatsoever may have been the skill and inteUigence exhibited in the treatment of his wounds or ailments, the only legitimate and orderly conclusion is a suit at law for malpractice. It is the function of the doctor to cure disease ; if he treats disease without curing it, he is an incompetent; this is the irrefragable logic! Though the living animal had failed to return any remuneration for his subsistence, and for the care lavished (?) on him diu'ing the period of his disability, yet when reduced to the state of a cadaver he should be compelled, if possible, in an indirect way to net his bereaved owner a sum Kkely to prove largely anodyne to the poignancy of the grief which the loss of so much property had excited. But aside from this, the owner of the living property, the value of which is about to be jeopardized, is entitled to a full and candid statement of the nature of the case, with its possibilities and its dangers, and it is in the interest of the surgeon himself to observe perfect frankness with his employer — not, however, to the extent of compromising his position as doctus in the case, or foregoing his self-respect by making concessions upon points of scientific acquisition to a layman, however generally intelligent or specially interested. The surgeon must assert himself as the representa- tive and exponent of an honorable and learned profession, able 12 INTKODUCTION. and prepared to acquit himself of his just responsibilities; and, indeed, it is in this assumption by him, with the conceded assent of the owner, that the vii'tue of the contract lies, which binds the two parties with equal force, moral and legal. This point, being understood and settled, should be looked upon as furnishing the best preparation which the owner can ac- quire, and he will need no other when he is thus made to under- stand that he must have full confidence in the skill which he has called into requisition, and must be guided by its impUed guar- antee that every possible precaution will be taken to carry the patient through his trouble ; and that if accidents of any nature should occur, when not incurred thi'ough carelessness or error, the risk is the owner's, and he alone must assume it. Such an understanding on the part of the owner will impose upon the honorable sm-geon an imperative sense of the conscientious care with which his task should be performed, while at the same time it will relieve his mind from the pressure of a possibly embarrass- ing anxiety while engaged in his work, and it cannot fail to be of advantage in various ways to all the parties concerned. Minor matters, such as the condition of the weather, the time of day, the selection of a place, the position which the oper- ator must assume for himself, with that which he assigns to the patient — these are points which are also to be carefully taken into consideration. They have, one and all, more or less influence on the facilities of execution of an operation, and perhaps also on the results that may follow it. CHAPTEE I. MEANS OF RESTRAINT. The final preliminary before operating upon animals, is to place the patient in such a condition of restraint as will assure the entire safety of the surgeon and his assistants from injury likely to result from the violent struggles of the terrified and suffering creature. The severity or the duration of the operation fiirnishes no accurate measure of the necessity of the restraint, or of its continuance or degree. Any unusual or violent aggressive treatment will excite his fears, and consequently his opposition, and whether the occa- sion be a painfiil and protracted dissection, or the simple applica- tion of a dressing, the surgeon may usually rely on the strenuous resistance of the patient. It is of Httle account that there are differences of dispositions in horses, as in men. "With any un- reasoning animal the case is the same, and with the excitement, the anxiety, and no doubt, a vague terror of something unknown impending, too often quite explainable by the treatment to which he has been long accustomed at the hands of an unfeeling owner, he is prompted by the mere instinct of self-preservation to defend himself with such means as nature has taught him to use. The necessity of enforcing a passive condition in the animal being thus ajjparent, it ought not to be necessary to say that the means of accompHshing it should be employed with reserve and moderation, especially when they are painful in themselves, and that no man claiming to be the possessor of humane instincts will permit himself to increase the severity of theu' application by supplement- ary ill treatment, in the infliction of "punishment," upon the alarmed and suffering brute, a course which is quite likely, more- over, to be as HI judged as it is otherwise reprehensible, from the fact that in most instances its effect is contraiy to its intention, in aggravating the evil it would remedy. It should never be forgotten how easily the most fractious and timid animal may sometimes be controlled by kindness and patience, and his agitation soothed by 14 MEANS OF RESTRAINT. the sound of a familiar voice witli whicli he has become accustomed to associate acts of gentleness and friendliness. Under any cir- cumstances, a habit on the part of the surgeon, of brutal treatment, the exhibition of a bad temper, in the indulgence of fits of anger, leading to acts of cruelty in the infliction of unnecessary pain on his dumb and helpless victim, is not only in every way useless, as being of no possible advantage in any direction, but tends to a degree of moral harra in those who are thus cvilpable for which no cormterbalancing benefit can be imagined, and which certainly can never facilitate the remedial effect — but quite the reverse — of the pending operation. A benignant method of controlling animals for the special purpose for which treatment by the surgeon is invoked, is not, however, alone sufficient, and it is thus that a resort to efi"ective means of physical restraint becomes unavoidable. These are of two kinds : one consists in inflicting upon some given part of the body, more or less remote from the seat of the operation, a severe and continuous pain, which, by a process of derivation, reduces that which is incident to the steps of the operation, by distracting or diverting the consciousness from the influence of the new suffering, against which he feels resistance would be in vain, to that of which he is sensibly cognizant, and thus the animal submits himself, with a comparatively voluntary sm-render. The other kind consists of restraints proper, and are constituted of mechanical dcAices for securing immobihty by the process of overcoming opposition by means of a dominating physical force. Their use is not affected by the position of the subject, and they are therefore applied in both the upright and decubital posture. The first comprehends the derivative or j^ainful method of Peuch and Toussaint's division ; the second, the method by direct 7ne- chanical restraint. MEANS OF SECURING SOLIPEDS. A. — Derivative or Painful Method. This method is in very common use, and usually proves to be sufficiently efiective to secui'e a degree of quiet and passivity in the patient for the safe performance of many Ught ojDerations. Under some circumstances it is used in connection with the means SECUKING SOLIPEDS. 15 of direct restraint. The instruments mostly employed in the first method consist of the twitch, the old fashioned barnacle, and the gag. Pig. 1.— The Twitch. The twitch is the instrument most commonly used and, un- fortunately, too commonly abused. In horses, it is sometimes apphed on one of the ears, and sometimes on one of the hps ; and is very severe in its action, wherever applied. In applying it, the operator, passing his right hand through the loop of cord of the instrument, grasps the tip of the upper or the mass of the lower lip, leaving the loop to slip over his fingers close to the skin which it then encloses, and with his left hand turns the handle of the instrument until the cord is sufficiently shortened to form a true ligation of the tissues which it cu'cum- scribes. The j)ain caused by this constriction may be graduated by the rotation of the handle of the instrument. "When in place it is either held by an assistant or tied on the halter. If the animal proves to be especially refractory under the infliction, the assistant should be cautioned against aggravating the trouble by forcibly dragging upon or jerking the instrument, violence of that nature becoming in some instances the cause of severe injuries to the muscular or nervous structures of the lips. We have ourselves met with several cases of labial paralysis resulting from such an improper and repeated application of the twitch. Some- times the length of the wooden portion of the instrument is con- siderably reduced, varying in its apj)lication in such a way that when the open loop is placed on the lip the wooden part which takes the place of the handle is placed on the lips through it, and the cord is twisted by turning it. The barnacles are formed of two articulating branches, made of either wood or iron, with sundi-y notches at one end and a ring at the other to fit into the notches. The degree of pressure re- q^uired is regiilated by shifting the ring until the proper notch is 16 MEANS OF RESTBAINT. Pig. 2.— Short Twitch. ascertained. The iron instrument is severe in its effects, probably more so tlian the twitch, but is less easy of appHcation. In apply- ing the barnacles, the surgeon grasps the upper Hp, and placing Iron Barnacles. each of the branches severally on opposite sides of the organ, brings the ends together, immediately fixing them in place at the desu-ed point of pressure, and secures them by fitting the ring into the proper notch. Fig. 4.— Wooden Barnacles. The tdooden barnacles are made with cu'cular sharp ridges cut in both branches in order to intensify the pain, the ends, when they are approximated, being secured by means of cords. The gag is a means of derivation used principally in Central Europe. It consists of a cord about one-quarter of an inch in diameter, which is placed in the mouth, and passing upward on each side of the face, is tied on the top of the head. This is twisted to any degree of tightness by means of a small, round piece of wood, which is passed between the cheek and the cord, the result being excessive traction upon the commissure of the lips and great SECURING SOLIPEDS. 17 Pig. 5.— The Gag. pain to the animal. Lacerations of the commissure, or wounds of the skin at the poll are to be anticipated if this manner of pvmish- ment is not guardedly used. There are besides these some milder appHances which must not be overlooked. Among them is the repeated pricking of the tip of the nose with a pin, and the introduction of foreign bodies, such as musket balls in the ears. The origin of this last method dates back to 1607, when Httle round stones were recommended for the same object. When musket balls are used, holes should be di-illed through them for the insertion of a string, in order that they may be withdrawn when necessary. B. — Mechanical or Restraint Method. The means employed in this method vary according to the po- sition, whether upright or recumbent, in which it is desirable to confine the animal during an operation. STANDING POSITION. The necessity of imposing restraint upon the patient while under treatment in the standing position arises not alone from the danger of injury to the operator and his assistants, from the biting and kicking of the excited animal, but because he is so thoroughly impartial in the distribution of his attentions that he even requires protection from his own violence, and his own flesh must be guard- ed from the contact of his own teeth. They are usually resorted to in order to facilitate operations of comparatively trifling importance, and which are not of a par- ticularly painful nature, or are of easy and rapid execution, or 18 MEANS OF KESTEAIXT. under circumstances when the animal can be controlled by being merely held by the head against a wall, or with the hind quarters in a corner, or perhaps tied to a wall, a post, or a tree. Certain minor precautions are necessary on these occasions. For exam- ple, the ground on which they stand must be smooth, though not slippery ; of a good holding character, and neither too hard or too damp, in order to avoid falling, or sUpping, or other possible ac- cidents. Attention to these matters will be of great benefit to the operator by leaving him a good foothold, with facilities for free- dom of movement, and more at hberty to guard himself against his patient, unexpected changes of attitude. The means by which the movements of the head are kept under control are the halter, the bridle, the hridoon and the cavesson — instruments which need no description here. If the animal is left unconfined, the assistant having passed the rope of the halter or bridoon through his mouth, holds him close to his head, places himself in front of him, or sUghtly on one side, and being atten- tive to every movement the animal may attempt, anticipates it, by pnlling the head downwards if the animal is about to rear, or rais- ing it upwards to prevent him from kicking with his posterior legs, or inchning it to one side or the other, as the animal moves it in one or the other direction. An animal should never be tied with the halter-rope in his mouth or over his nose. There is danger in both methods of se- rious accidents, in case of a violent backing or jerking of the head. In one case the result might be a section of the tongue, and the other might involve a fracture of the maxillary. For simi- lar reasons the bridle is also dangerous. The height at which the head should be secured must vary with the movements attempted by the horse. Thus, to prevent him from rearing or striking with his fore legs, it should be placed low, but high when it becomes necessary to guard against his elevating his posteriors in order to kick with his hind legs. To protect his head against possible self-inflicted blows result- ing from his defensive struggles, and to prevent him from seeing surrounding objects likely to alarm him, are precautionary items of not a httle importance, and the employment of the mask or cap (Fig. 6C) is very effectual for that purpose. Fractious patients, dangerous to handle and difficult to control, often become perfectly quiet and thoroughly docile on finding themselves involved in dark- oECUllING SOLIPEDS. 19 tho Cap. O, th9 Cradle. ness, and submit to the necessary manipulations of the surgeon with- . out further resistance. When a proper cap is unobtainable a bridle with blinders can be substituted, or a blanket placed over the head. Biting the attendants may be prevented by applying a muzzle. Fig. 7.— Thef^irlnBar. 20 MEANS OF EESTRAIXT. and he may be protected from his own teeth by the use of the cradle (Fig. 60) or beads, or the side bar (Fig. TAB). With the -cradle around his neck, the horse is prevented from carrying his head on either side ; its use, however, must be carefully watched lest the friction of the cord, which secures it in place upon the superior border of the neck, should cause severe comphcations by chafing or even cutting through the skin. Peuch and Toussaint liave reported one case of fatal tetanus from this cause, but no such accident ought ever to occvu-, for the means by which it may be avoided are easy and obvious, protecting the border of the neck with pads. The side bar prevents the flexure of the neck toward the side upon which it is placed, and when in use during an operation is appHed on the side occupied by the operator. It is used both singly (on one side only), and doubly (on both sides). The danger of accidents arising from the unrestrained mobility of the head of the animal being thus guarded against, those which may be caused by striking and kicking with the feet are next to be considered. In many instances it may be sufficient to simply raise the foot from the ground, and to keep it thus suspended by holding the leg in a position of flexure (Fig. 6). No -^T^olent measures are necessary in order to obtain such con- trol over the movements of the horse as are consequent upon com- peUing him to support his weight on three legs only. The method of raising the foot and keeping it off the ground is a matter too familiar to every stable hand to need detailed instructions. But a little art may be necessary, with a httle compulsion added, to induce him to continue to sustain the role of a tripod long enough for the purpose of the operator. But this cannot always be de- pended on, and therefore when he betrays an evident unwilling- ness to submit quietly to such a confinement of the foot, the com- pulsion of the ropes or straps must be resorted to. For the fore leg the strap is attached below the fetlock and passed around the forearm, and either buckled or held in place by an assistant. "When the rope is used it is passed around the coronet, the leg flexed and the rope either passed round the forearm and secured in the same manner as the strap, or thrown over the withers and held by an assistant on the opposite side of the horse. For the hind legs the rope, plaited rope or plate-lonye, is necessary with the hobble. These are applied in difierent ways. SECURING SOLIPEDS. 21 Fig. 7a.— Plaited Kope. In the first method a hobble is placed on the coronet of the foot to be raised, with the buckle outward, and the ring looking backward; then a loop made at the flat end of the j)late-longe is Fig. 8.— Securing the Hind Foot with Eope and Hobble. passed around the neck ; the rope is then carried along the back, and with a single turn around the tail, is passed through the ring of the hobble, from within outward. PuUing on the rope raises the foot and carries it backward, where it is held by the assistant. Second. — Sometimes the hobble is dispensed with, and the rope is passed from the neck straight to the coronet, where a double twist is made, and the foot controlled as before (Fig. 9). Third.— In other cases, the plate longe is secured to the tail, instead of around the neck, conditioned of course upon whether the tail is sufficiently long and furnished with haii- of the strength 22 MEANS OF RESTRAINT. Fig. 9.— Securing one Hind Leg with Rope only. necessary. Wlien matters are favorable in this respect, the operator proceeds as follows : a loop being made at some distance from one end of the rope, it is laid flat on the top of the tail, close to its origin, and the short end being twisted around that extrem- FiG. 10.— A, The Twitch. B. Side Bars. C, Surcingle. D, Securing Hind Foot. E, Fixing the Eope ou the TalL SECURING SOLIPEDS 23 ity with from two to four turns, and the remaining portion passed through the loop, and the other, or longer portion of the rope, drawn taut, the knot is tied and the plate-louge thus firmly secured. As in the two previous methods, by drawing upon the longer end of the rope the foot can readily be raised and held in position, either with or without the hobble. There are occasions, when, although it may not be required to have the leg and foot held up for the purposes of the opera- tion, it still becomes necessary to do so in order to prevent the animal from using his feet as weapons of combat, or to restrain him from motion. The plate-longe, and the single or double side-line, with one or two hobbles, are then put in use, for the purpose of either raising the leg from the ground and compelling the animal to stand on three, or again to prevent motion in the posterior biped. For example, in one case the flat part of the plate-longe is Fig. 11.— Another Means of Using the Rope. passed with a loop around the coronet of the leg to be kept steady, the rope is then carried forward between the fore legs, then on the side of the neck opposite to that of the leg to which the plate-longe is fixed, over the withers, back to that side, and twisted arotmd itself behind the elbows, as it passes between the fore legs (Fig. 11). 24 MEANS OF i:i:STRAINT. In otlier cases a large loop of the j)late-longe is thrown over the neck, and the rope carried back to the coronet of the foot to Fj'.S. 13.— Securing both Uind Legs with Uobbles. SECURING SOLIPEDS. 25 be secured, and by one or two twists around itself, is brought backward, where it is held by an assistant. Sometimes a single hobble is placed on the coronet, and the rope of this side-line rims through its eye, which is turned forward (Fig. 12). To prevent the animal from kicking with both hind legs, a King hobble, carrying the chain, is put on one leg, and the chain passed through the eye of another hobble placed on the other hind leg, and the rope carried forward and secured as in the case of raising one single foot, viz., between the fore legs, on either side of the neck, over the withers and then after being twisted around itself back of the elbow, held by an assistant (Fig. 19). In some instances a double side-line is used, the loop being thrown over the neck, and the ropes carried backward, one towards each hind leg, and passed through the eyes of hobbles placed on them, and returned forward, where they are secured with a slip-knot to the loop of the side-line on each side of the neck. For the same purpose, of securing the two legs of a biped, whether anterior or posterior, LeGoff has invented a peculiar apparatus, consisting of a Y-shaped roi:)e, single at one end and bifurcated at the other, each of the three ends having a running noose or loop. If the two hind legs are to be secured the loops of the bifurcated portion are placed on the coronets of these legs, and the loop of the single portion secured on one of the fore legs. If on the contrary, the fore legs are to be confined, the arrangement is simply reversed. Another excellent method of limiting the movements of the animal to prevent him from kicking, and keep him quiet, is to take a plate-longe, and beginning on one of his sides, at the girth, for example, pass it forward across one forearm, a little below the elbow, in front of him, on the other side across the other fore- arm ; then backward across the thigh, or a little below it, then passing it back of the animal, to the first side across the other thigh, to return to the starting point (Fig. 14). Passing the rope through the eye of the flat extremity of the plate-longe, the legs can be comparatively well kept together. To prevent the rope from dropping too low, it is thrown over the back and secured on itself on the other side by a knot. This part of the rope over the back supports the two horizontal portions which run on each side of the animal and keeps them in place. This mode of restraint is but a simplification of the apparatus 26 MEANS OF BESTRAINT. Fig. 14.— Securing all the Legs, with Eope all around the Animal. invented by Kaabe and Lunel — the hippo-lasso (Fig. 15). This ajjparatus is called the straight jacket for horses, by the inventors, and is composed of a strong breast-piece or Dutch collar, and a breeching, placed over the withers and the croup. The breeching carries on each side, firmly sewn on, a long strap, and at each point, B, an iron eyelet. The breast-piece at B, carries also on each side an iron eyelet, and on the front strap a strong buckle. To place it in position, the Dutch collar is thrown over the neck and the breeching laid over his rump. Both straps of this part of the hippo-lasso are passed forward through the iron eyelet of the breast-piece at B, back through that of the breeching at B, and then forward again to be buckled, more or less tightly, at b. The length of the strap of the Dutch collar piece which passes over the neck, and that of the croup, must be regulated in such a manner that the horizontal position of the lasso is for the fore legs, but a little below the forearm, and between the stifle and the hock for the hind legs. The hippo-lasso is an excellent means of restraint, and may even be utilized for vicious animals upon which operations would otherwise be impossible, except by throwing them. In shoeing SECURIXG SOLIPEDS. 27 Fig. 15.— Hippo-lasso of Raabe & Lunel. vicious and clipping nervous horses it has given most excellent results. Among other varieties of apparatus used for controlling animals in the standing position, are the various machines known as stocks or travis. They are of many forms, and consist of heavy wooden frames, firmly secui-ed in the ground, with peculiar arrange- ments for supporting the animal in slings, if necessary. They are padded on the inside, for security against injuries and have on one of their narrow sides a system of iron bars, against which to secure the feet when the animal is raised from the ground. The stock illustrated in Peuch and Toussaint's work (Fig. 16), will give a good general idea of one of the most approved forms of this means of restraint. The stock of E. Winsot (Figs. 17, 17a and 18) is another form, which can be used for securing the animal in either standing or laying position. RECUMBENT POSITION. Notwithstanding the many advantages attending the appHca- tion of the means already described, devised for securing the immobihty in the standing position of animals undergoing sur- gical treatment, there are circumstances in which their efficiency becomes wholly lacking. Sometimes it is because of the invincible restiveness of the animal, but more often because of the serious nature of the pending operation, which may require for its safe MEANS OF BESTKAINT. Fig. 16.— The Stock. performance a degree of deliberation and an amount of dissection of the most painful character, with which only the most absolute passivity, if not complete unconsciousness, is compatible. In this class of cases the recumbent position in the patient becomes sim- ply an indispensable requii'ement. To throio or cast a horse signifies simply to apply the force necessary to compel or induce him to He down, and to continue in that position during the pleasure of the surgeon. The forms of compulsion by which the desired result is to be effected are next to be considered. It would be improper to construe the word "throwing" as SECURING Sr.LiPEDS, Fig. 18.— Laying a Horse Down with Winsot's Stock. 30 MEANS OF KESTRAINT. literally designating the act of violently casting down, as in a wrestling match. On the contrary, it must be qualified as refer- ring to a method of so manipulating the patient and directing his movements as to bring about a change of posture with all the appearances of a voliintary act on his part, which indeed it essen- tially becomes. The preparation of the bed upon which the animal is thrown, and of its location, will require some judicious attention from the surgeon. A convenient place, with sufficient space to allow per- fect freedom of movement about the patient, such as a large yard, a barn or an open field will fulfil the requirements. The ground should be smooth, and, if possible, soft — a pasture lot or farm- yard, or a manure heap often offering good facilities for the pur- pose in country practice. In any case it should always be covered with a layer of straw, sawdust or tan bark of sufficient thickness to prevent a violent concussion when the patient falls, and ought to be sufficiently wide to aUow him to fall as nearly in its center as possible. Its dimensions should be approximately from nine to ten feet square. An important point in its construction is that it should be free from any hard foreign substances, such as stones, bones, pieces of wood or iron, etc., for fear of contusions or other similar lesions against any parts of the body of the patient. Several methods are in use for throwing a horse, among which are the peculiar apparatuses known as the hobbles. The ropes and the operating tables are also used. The previous preparation of the animal for the operation ought not to be forgotten. This usually consists in a fast of not less than twelve hours, and will always be found to be a good measure. A. — Casting loith Hobbles. These are of various kinds. Some are made of leather, others of rope, but they are aU constructed upon the same principle. The English style, invented by Bracy Clark and afterwards improved, which are in most general use, present so many advantages in theu- f acihty both of apphcation and removal from the legs after the op- eration, that we shall limit oxoc consideration to them alone (Fig. 19). A set is composed of four hobbles, a chain and a spring hook. Each hobble is formed of two straps of leather of unequal length, the shortest (a) having attached on one end a strong buckle (i), SECUKING SOLIPEDS. 31 Fig. 19.— English Hobbles. A, Hobble Unbuckled. B, King Hobble. C, Hobble In Position, with Rope through the Eye. and at the other an iron eyelet, narrow and somewhat elongated (n), the eyelet of the longest (b) being somewhat square in form (e), in order to aUow the ring (n) to pass through it, and having in its Fig. 19a.— Self-locking Hobbles of Prof. Barker. 32 MEANS OF RESTRAINT. length a number of holes to allow it to be buckled with the short strap. Three of each set are of this construction. The fourth, which is the tnain, chief or king hobble, differs from the others in the form of the iron eyelet of the shortest strap. In this hob- ble it is made of a peculiar shape, and with a small slot, through which the chain is passed and secured by a pin screw running through it. The chain belonging to this set measures four or five feet in length, and has spliced at one end a casting rope some fifteen feet long. At the other end the link of the chain is flattened and made to slip easily through the slot of the main hobble. Fig. 20.— Spring and String-IIooks. There are many forms of spring-hooks used. In our own practice we use two strong spring padlocks, as being of easier apphcation and less liable to liberate the animal by becoming loosened or breaking. Besides the set of hobbles, a long plate-longe and a Bernardot & Buttel apparatus are necessary. This consists of a wide and strong surcingle, having on both sides two straps, joined together in front, and a strong halter, which from the nose-band carries another strap, which passes in front of the head, between the ears, through an iron ring on the pole-band of the halter, and is to be buckled to the single strap of the surcingle. By shortening this strap, the head and neck are placed and kept in as much exten- sion as may be desired. PreUminaries being completed and instruments ascertained to be in efficient condition, the horse is placed at the side of the bed ; and we may here repeat that the manipulations which are next to succeed are not designed to throw him off his feet with a violent SECURING SOLIPEDS. 33 Fig. 21.— Bernardot & Buttel Apparatus. shock, but simply to place him in a posture of such discomfort, and so to disturb the center of gravity that lying down becomes an instinctive act, and is done voluntarily, in order to avoid the act of falling ; it may be termed a voluntary compulsion. When brought to the bed, a cap is placed over his head, and all the hobbles are applied, simultaneously if possible, by four assistants acting in concert. They should carefully obsei've that the large buckle of each hobble is placed on the outside of the leg, and that the eyes of the straps are turned toward the center of gravity of the animal, those of the front hobbles looking back- ward, and those of the hinder hobbles looking forward. The chief hobble must be placed on the fore or hind leg of the side opposite to that on which the animal is to he. The application of the hobbles on a timid and restive horse is not always an easy matter. Kemembering, perhaps, some similar experience at some former period, he rebels, resists and kicks as a natural consequence. If speaking soothingly and kindly, and employing the usual tranquihzing and assuring processes, with the raising of one of the fore feet, fails to quiet and control him, a twitch is placed on his nose and left on until, at a preconcerted moment, the hobbles are put in place ; quickly, but as noiselessly as possible, the chain is passed through the ring of the chief hob- ble— on, say the fore leg for facility of description — then through the ring of the other fore leg, back to the ring of the hind leg of 34 MEANS OF RESTRAINT. the same side, through the ring of the other hind leg, and back to the slot of the main hobble, where it is secured by the pin- screw. The Bernardot & Buttel apparatus is then put in place and buckled by an assistant, wdth the surcingle on the side of the patient opposite to that on which he is to be made to lie. Previ- ous to this, another assistant will have passed a long rope around the body of the animal a little back of the withers, and with still another holds it on what will be the under side when the patient hes down. Still another assistant is placed at his head, to aid the one who holds it, while yet another grasps the tail, and two others seize the casting rope. The second step of the operation is to reduce the animal's base of support as much as possible, by bringing the four feet together. To do this, the operator, standing in front of the as- sistants who hold the casting rope, has each hind leg in succession raised sHghtly from the ground and carried forward by the assist- ant having it in charge, a gentle traction being made at the same time upon the casting roj)e, in order to shorten the length of the chain passing through the hobbles, the assistants at the head meanwhile gently backing the animal still more to reduce his area of support, vuitH the equilibrium is so nearly lost that the animal Fig. 22.— Horse about to be Cast. SECURING SOLIPEDS. 35 instinctively abandons tlie effort to keep his feet, and assumes the recumbent posture in order to avoid the shock of a heavy fall. H. Bouley recommends that the first movement in this final step should be an attemj)t to back the horse, in order to move the fore legs first, and then to bring the hind legs forward, if the base of support is stni too broad. The twitch should now be removed ; in fact, the most prudent plan would be to remove it the moment the hobbles are in place The final step of the act of Hteral throwing or casting being accomplished, the last indication remaining to be fulfilled is to secure the patient in the most favorable i:)Osition for the surgeon to perform the important work of which all that has been iinder- taken has been but preliminary. It is properly the permanent (for the time being) adjustment of the body in such a manner as to allow the surgeon the best possible access for all his manipula- tions to the region which is to be the seat of his dissections and other operative movements, without any unsteadiness or opposition. Bouley's directions for this purpose are that the operator, watching for the right moment, as the horse begins to totter, gives orders to the assistants having charge of the ropes acting on the body, the tail and the head, by a prompt and simultaneous action, to pull in the direction of the side on which the animal is to lie, and to those at the casting rope to pull firmly but not harshly in the opposite direction, while he himself pushes the body of the animal towards the bed. By this arrangement of opposing tractions the casting is easily efi'ected ; but unless the assistants act in perfect concert, and especially if the casting rope be draT\Ti too rapidly and suddenly, the animal will be raised from the ground with a sudden lift, to fall so heavily on the bed as to possibly subject him to the risk of sustaining severe injuries. Bouley remarks on this point: "An animal is properly cast only when, bending his knees, he lies down softly and easily on his side, bringing to the ground successively the shoulder, the ribs and the hind quarters; or again when, the fall beginning from behind, the order is exactly reversed." Once down, the forcible traction upon the chain brings the four legs in close proximity, the spring hooks or padlock passing through the link nearest to the ring of the hobble through which the chain passes, coming out last. To provide against the possi- 36 MEANS OF RESTRAINT. ble breaking of that portion of the chain which embraces the four hobbles, Peuch & Toussaint advise the passing of the casting rope and chain a second time through the rings of every hobble before it is secured with the spring hooks. The animal being down, the straps of the Bernardot & Buttel apparatus are buckled, and the head well extended on the neck. The use of this apparatus con- siderably diminishes the difficulties involved in the contention of the head. Before its introduction, two assistants were required to keep it in extension and comparatively motionless ; and even then the results were not always easily reached nor accidents avoided, whereas, with this halter and surcingle arrangement a single strong assistant is sufficient to secure control of the head ; FlO. 33.— Horse Thrown and Secured by Bernardot & Buttel Apparatus. SECURING SOLIPEDS. 37 and it has the advantage, besides, of " preventing fractures of the vertebral column, ruptui-e of the diaphragm, and rupture of in- ternal viscera." In some exceptional cases the surgeon will be obHged to im- provise his hobbles. This may be done by fastening four ropes of suitable length around the coronets, allowing sufficient room for the passage of the casting rope between the hobbles and the Bkia, or again placing an iron ring through these loops of rope, which are secured by a knot on the outside of the leg, as suggest- ed by 'Mi: Dneubourg. The removal of the hobbles and of the other aj)paratus em- ployed ui casting the animal, demands similar care and attention to that which was requu-ed to put them on. "While the Bernardot & Buttel surcingle is unbuckled, the assistant loosening the U^'.il,.M, ,,,/M/i,. Fig. 24.— Improved Hobbles of Dneubourg. straps of the cap, and ready to remove it at a moment's notice, the operator placing himself facing the soles of the feet, in order to be out of dangei', cautiously unscrews the screw-pin which fastens the chain to the principal hobble, and removes it, when aU the hobbles becoming loose, are removed, and the animal being freed from all restraint, is allowed to rise. While the animal is rising it will be but prudent in the by- standers to allow him all the scope he may choose. The action is sudden and somewhat violent, and he may move his hind legs 38 MEANS OF KESTKAINT. with a sudden jerk which may throw the hobbles off with force suf- ficient to severely hurt some unguarded spectator upon whose per- son they might infringe. We have been witness to such an oc- currence, when they were thrown a distance of twenty feet, with violence sufficient to inflict, possibly, dangerous injuries. An animal thrown and secured as has been described is in a suitable position for the majority of operations, such as those about the head and neck, of the body, or of the up^Der part of the legs. But in many cases, it is necessary to fix a leg in a peculiar position either to expose a given region of the body, or when the limb itself becomes the seat of operation. The action of se- curing the animal in the recumbent position is one of great im- portance, and none of its details ought to be overlooked. And there are several points to which we have already referred in our introduction, which may be again noticed with advantage. Bear- ing in mind the accidents which may result from keeping the horse in a state of painful passivity, and his instinctive struggles to free himself, not to mention the painfulness of the constrained posture itself, the inference is palj)able that it is incumbent on the surgeon to release the suffering patient from his trying constraint at the earliest moment consistent with the proper completion of the OiDeration. Again, in securing the legs, care must also be taken that, although a given position of a leg may facilitate the movements of the operator, it is not justifiable if there is another mode of securing the same object by means more comfortable and less dangerous to the patient, as well as easier for the surgeon. An experience of many years has taught us that six principal modes of fixing an animal's leg, fulfil all necessary requirements, and that the special purposes and effects of these are such as to forbid their modification. In considering these six specific modes, it will promote facility of description if the reader will follow our references to the dif- ferent legs on a sort of mental diagram which by a mode of ab- breviation by initials will designate — supposing the animal to be thrown on the near side — the near anterior as N.A.; the off anterior as O.A.; the near hind as N.H.; and the off hind as O.H. First 'position — Exposing the inside of the N.A. leg. — A loop of the plate-longe is secured on one of the fore legs, above the knee, say the off leg, carried in front of the near leg, imder it, back and between the fore legs, always above the knee, to return SECURING SOLIPEDS. 39 Pig, 25.— 1st Position. Neurotomy. to the starting point, around the off leg again, back to and be- tween the legs, thus forming a complete figure 8. This is re- peated twice or three times, when a turn around all the crossings of the rope between the legs ties up all the twists of the rope and a double slip-knot is made on the forearm of the ofi' fore leg. Both legs thus secured, the near leg is released from the hobble, and carried forward by an assistant pulling on it with a rope tied around the foot. For reasons already stated, we consider this position as the only one justifiable for neurotomy on the inside of the off leg, or for tenotomy. Firing on the inside of the coronet for ringbone, or along the tendons, might also be performed in this position. Second position — Securing the off/ore on tlie off hind leg. — The loop of the plate-longe is placed on the O.A. leg about the middle Fig. ae.— ad Position. Ist Step. 40 MEANS OF RESTRAINT. of the cannon region, from there carried backwards over the O.H. leg, above the hock, between both hind legs, and forward, be- tween the fore legs and reflected back over the forearm, about its middle, when it is given to an assistant stationed at the back of the animal. An assistant is placed in front of the animal, kneeling on the bed, and prevents the rope which passes in front and over the forearm from slipping down too rapidly. The leg being released from the hobble, the operator holding it carries it backward, while the assistant at the back pulls slowly but steadily on the rope, the action of this lever of the first kind, with its fulcrum on the O.H. leg, the resisting power at the foot of the animal and the moving power at the forearm of the off, moves and draws the leg backward until it reaches the cannon bone of the hind leg. At that moment, steadily holding every- thing in place, the rope that is passing above the hock on the near hind leg is allowed, cautiously, to slij) below the hock, and the near fore leg is then brought to the middle of the near hind cannon bone, where it is secured with a double figure 8. Other sur- geons secure the fore leg above the hock as in the plate we borrow from Peuch and Toussaint (Fig. 27). The danger of injury to the tendo- Achilles has caused us to change that position to the one Fig. 27.— 2d Position. 2cl Step. SECUKING SOLIPEDS. 41 above described. In this position the inside of the N.A. leg is ex- posed, and it can be fired, either for disease of the knee or of the tendons and bursse. All operations upon the foot of the O.A. can be performed except those required on the inside of that foot, such as those for inside quarter-crack, complicated suppurating corn or inside cartilaginous quittor. Fig. 28.— 3d Position. Securing Upper Hind to Upper Fore Leg. Third position. — Securing the off hind tiponthe corresponding fore leg. — In this the rope is first secured in the middle of the off hind cannon region, carried forward and over the forearm, above the knee, in front of the forearm, back between the fore legs, between the hind legs and over the near hind leg, above the hock, to the assistant stationed at the back of the animal. Re- moving the leg from the hobble, and pulling on the rope the near hind leg is brought, by the- same method, to the middle of the off fore cannon, where it is secured with a figure eight twist of the rope. In this operation the inside of the near hind leg is ex- posed from the hock down, and in that position, operations on the inside of the hock can be performed, such as firing for spavin, thorough-pins, curbs, and cunean tenotomy, as well as fii'ing on the inside of the tendons, or even tenotomy. As far as the off hind leg is concerned, only operations on the foot are justified, with the exception of those on the inside of that part of the leg. Fourth piosition — Securing the near fore on the off hind leg. — The rope is secured by a loop on the middle of the cannon of the near fore leg, which rests directly on the bed, carried backward over the off hind leg above the hock, back between the hind legs, 42 MEANS OF RESTRAINT. Fig. 29.— ith Position. Securing Under Fore on Upper Hind Leg. forward ^mder the forearm of the near fore leg, between the fore legs and back to the assistant at the back of the animal. In this action it again becomes a lever of the first kind, with the fulcrums above the hock, the resistance at the lower part of the near fore leg and the moving power at the forearm. The leg is drawn from its deep position to a superficial one, and secured with a figure eight on the middle of the near hind cannon, and not above the hock, for reasons already considered. This posi- tion is only justifiable for operations on the inside of the near fore foot, such as complicated quarter- crack, complicated suppu- rative corns, inside cartilaginous quittor, and the like. The pe- culiar awkwardness of this position, in which the leg is carried in excessive adduction subjects the animal to the danger of severe Fig. 30.— 5th Position. Securing Under Hind on Upper Fore Leg. SECURING SOLIPEDS. 43 lesions in the axillary region, and it is justifiable only in the cases specified. Fifth position — Securing the near hind on the cannon of the off fore leg. — The rope is first tied up by a loop on the middle of the near hind cannon bone, forward over the forearm of the off fore leg, between the fore legs, and back to under the near hind leg, between the hind legs and to the back of the animal, where it is held by an assistant. The leg is again drawn from under him, is steadily brought to below the knee of the off forearm and secured as in the other positions. In this position the only operations to be performed are those on the inside of the digital region, or rather of the foot of that leg. Fig. 31.— 6th Position. Sixth position — Securing the off hind leg near the neck or shoxdder of that side of the body. — The rope is tied up by a loop around the coronet of the off hind leg, that is below the fetlock, carried forward toward the superior border of the neck, under the neck and then toward the inferior border of that region, back over the whole length of the animal to the front of the hind legs, between these and over the tibial region of the off hind leg, where an assistant holds it to the back. Other assistants, pulling on the rope, and making it sHde as it passes on the borders of the neck, 44 MEANS OF KESTKAINT. the operator carries the leg forward until it reaches the outside sur- face of the shoulder, or the lateral parts of the neck, where the rope is secured by a double twist and knot around the coronet of the near hind leg displaced. This awkward and painful position is for operations in the inguinal region, including castration, in- guinal hernia, removal of champignon, amputation of the jDenis, or removal of tumors. When the operations which have necessitated these various positions have been completed, the leg which has been restrained should be returned into its proper hobble, and this should be done slowly and carefully, avoiding any unnecessary motions or noises, and the animal relieved of his means of restraint as in all other operations. Fig. 32.— Side Bar Hobbles. In a few instances, however, aside from these various modes of securing individuals, the surgeon has recourse to the side bar hobbles, which carries a hobble of its own at each end, one hobble being fixed on a fore, the other on a hind leg. Some of the Enghsh veterinarians are using the cross hohhles, which has the advantage of being adapted for use upon legs diametrically opposite, such as the near fore and the oflf hind legs, and vice versa. B. — Casting with ropes. The hobbles are not the only kind of apparatus devised for throwing horses, nor are they all made according to the English pattern, although the same general princij^les pre- vail in all. Eopes in the form of side lines, either single or SECURING SOLIPEDS. 45 double, are often substituted for hobbles, and for many varieties of these special claims are made by their inventors, or by those who give them their jDreference, and use them in their practice. Without entering into the consideration of the comparative merits of these various methods, which vary, not only in nearly every country of the world, but even in different sections of the same country, there is a mode of their application, upon which we have a word of comment to offer. This is the mode with a single, and that with a double rope. (1st.) With a single rope. — This is the simplest mode of casting, but it is also the least safe. It is the oldest of the methods in use, but has in our days been more or less modified and improved. The method of Rohard seems to be as perfect as any of them. In this, a rope from twenty to twenty-five feet in length is necessary. The horse being placed near the bed where he is to be thrown, is held in the ordinary manner. If he is to he on the near side, the operator is placed on the right, near the shoulder with the rope, in which is a knot about six feet from its end, which Rohard calls the ring knot (a), and immediately below it is another, called the stoj^j^hig knot (b), through which the rope will run. "In this way," says Rohard, "there is a large loop FIG. 34.— Applioatuu of too Kohard Method. 46 MEANS OF EESTKAINT. formed, wliicli is thrown over the neck, while both knots made he a httle below the point of the shoulder." Taking with the free portion of the rope, a twist round both forearms, passing behind them first, then forward across the near fore leg, in front of both fore legs, and backward across the off fore leg, over the rope, it is carried across the abdomen, to the near hind coronet, which it surrounds from without inwards, to be brought back to the posterior part of the withers on the near side, where the operator takes hold of it. Then by degrees slowly puUing on the rope, and making the animal raise his near hind leg by quietly urging him, this leg is carried forward, with a uniform movement, until at one moment, the animal attemj)ting to resist or struggle, the assistant at the head carries it toward the bed, the operator pressing with his body against that of the animal, until he slowly settles down without injui-y on his side. To fix the leg definitely. Fig. 35.— Animal Secured by the Rohard M-ethod. one begins by the near hind leg. Making a double twist of the rope around the coronet of that leg, this is carried towards the loop which passes around the neck, and is there secured by a double knot (a), and carried back to the off hind leg, which is then carried far forward and secm-ed to the same collar loop, with a single knot (h). To release the animal, it is merely necessary to tmtie the stopping knot, when the rope becomes loosened from the legs. SECURING SOLIPEDS. 47 (2d. ) With double side lines, or two ro2)es. — This is dene by means of a long rope, doubled in its middle, and having a knot made in such away as to form a loop large enough to be drawn over the head and neck of the animal ; the two ends below the knot are then passed in front of the chest and between the fore legs, carried, one to each hind leg, aroiind the coronet, turning it once around the main roj)e, and passed on the collar loop from within outwards, to strong assistants standing on each side of the animal. By steady pulling both hind legs are carried forward, until the animal loses his balance and settles on his haimches, when a strong efibrt of the assistant at the head brings him down on the bed. The hind legs are secured to the collar loop with the ends of the rope, and the fore to the hind legs in the same manner. The various methods of casting which we have been consider- ing, with hobbles and with ropes are, as we have before said, not the only plans recommended. Almost every country < f EurojDe, while also using the hobbles, has a fashion of its own in which the ropes are utilized, and as to the fact of their widespread, if not universal use, it would seem that not a few veterinarians of exten- sive practice have originated and employed special methods of their own devising, for which they claim more or less superiority. Among those recommended in this country, we may mention the apparatus of Mr. IVIiles, which he has used for years in his exten- sive practice as castrator. Dr. Wm. Dougherty, of Baltimore, has sent us a set of rope-hobbles and side-line, which upon personally testing we are able to recommend as possessing important points of excellence, especially in casting young colts for castration. For further light and broader information on this subject we must refer our readers to the standard authors by whom it has been discussed in the French, German, Danish and Russian tongues, feeling at the same time quite confident that the general rules which we have suggested and illustrated for the performance of the operation of casting are sufficient to guide any intelhgent oi^erator through all the steps of the proceedings. C. — Casting on the Operating Table. The necessity of employing such a number of assistants in throwing a horse, with the difficulties often encountered in con- ducting all the steps of the operation, and the accidents which 48 MEANS OF EESTEAINT. too often accompany its execution, have led to the invention of other means of accompHshing the object in which the objections to the old method are sought to be obviated. It was with this view that the operating-beds of Lafosse in France and Hart in Wurtem- FiG. 36.— Wall-bed of Fromage de Feugre burg were contrived. The wall-bed of Fromage de Feugre pos- sessed many advantages, but was abandoned on accoimt of its complicated structure. Of late years, however, several other forms of operating tables have been devised, of which one espe- cially is highly commended by Eui'opean authors. It is that of Mr. J. Daviau which consists of a broad and heavy table, furnished with pads, surcingles, hobbles, ropes and other necessary appurten- ances for seciu'ing the animal, and which is moved by a pecuhar crank arrangement which permits its adjustment in any required position, from the horizontal to the vertical, and by which it may be turned down flat upon an u^on frame. The apparatus is placed solidly on the ground, or can be made movable by a set of low wheels attached to the heavy wooden frame upon which the table and the crank are supported. Mr. Daviau claims for his invention: 1st. That it obviates "aU the comphcations " accompanying the ordinary system of throw- ing. 2d. It allows " the easy and comfortable rising of the horse " after the operation, without danger. 3d. It gives entire security to the operator, who can perform his task alone and without the SECUBING SOLIPEDS. 49 50 MEANS OF RESTRAINT. SECURING SOLIPEDS. 51 52 MEAJNS OF RZSTRAI>'T. FIG. 40. -Hodgson & Magee'e Table. Back View ; showing the working of puUey to draw the table down. SECUKINfi S(JLIPEDS. 53 need of assistant. 4th. No assistants are needed to be exposed to danger, and the responsibility of the operator is diminished. 5th. Economy of time. 6th. Economy of material and space for the performance of the ordinary operation of casting. In this country several forms of tables are in use. Those of Dr. Tiffany, Price and others, all of which are constructed somewhat upon the same principles with respect to the action of an iron crank to control the position of the table. Doctors Hodgson & Magee, both veterinarians of New York, have invented a table which for simplicity seems to siu*pass any one we have yet seen (Fig. 40). Like the others, it has slings, ropes, hobbles, pads, etc., but dif- fers from them in two important particulars. The first is the manner in which the table is lowered and raised ; the second, the manner in which the hobbles are secured and made immovable. In the middle of the superior border of the table, and directly below it on the posterior face, are two solid iron rings. In the ceiling of the operating room, or on the cross-piece of the frame in which it is enclosed, and directly opposite that in the border of the table there is another. Another is fixed in the floor some dis- tance back of the frame upon which the table rests when in a horizontal position. To these rings two systems of j)ulleys are attached, one connecting that in the ceiling with that in the bor- der of the table ; the other connecting the ring on the posterior face of the table with that in the floor. Besides this, under the table are two strong u'on eyelets through which chains are passed, which at one end are secured to the hobbles by openings through the table, and at the other are secm-ed from slipping through the ring by a wide T arrangement, secured on the last link. These chains measure the distance which exists between the rings on the floor and the table when in a horizontal jDOsition. When the horse is brought alongside the table and tied up with the sHngs, the halters and head-straps securing him, and the hobbles being in place, the rope of the upper piilley is pulled by an assistant, and the table moved slowly into the jjroper position. The rope being then fastened to the ring in the floor, the table is immovable. Upon the completion of the operation the rope is gradually slackened, while an assistant pulls on the rope of the base of the table which is thus restored to the vertical position. 64 MEA^'S OF KESTRAINT. MEANS OF SECURING OTHER DOIVIESTIC ANBIALS. (a) BoviNEs. — With these animals benignant measm-es are of little avail. Kindness may in some possible cases — but they will be rarely met with — succeed to a hmited extent, but to trust to the influence of the treatment so often effective with an intelligent and docile equine, such as the petting caress, the soothing tone of voice, or the kindly glance of a human eye, with even the placid and mild-eyed milch kine, wUl be only an act of misplaced con- fidence. To blind them, to induce dizziness by turning them rapidly in a small cu'cle, may at times produce good results, but even then these measures will be more reliable if combined with more palpable agents of restraint. Cattle may be kept quiet in the standing position by raising their heads, by passing the index finger and thumb of one hand into the nostrils, with the arm over the face, and raising the tip of the head upward, while the other hand, grasping one of the horns, moves the top of the head downward, the resistance of the animal being overcome by pinching the nose with the hand which grasps it with more or less force. By this means the head of the animal is fixed, and the operator guarded against injury from the horns, and the movements more or less hmited. While maintain- ing this position, the cavity of the mouth can be examined and even short and simple operations rapidly performed. Another device for preventing the animal from using his horns as a means Fig. 41.— Securing Cattle. SECURING OTHER DOMESTIC ANIMALS. 55 of contention is to tie a long rope around their base, passing it along the neck and the back with one loop around the ribs and another further back around the flanks, and when reaching the tail securing it there by a knot at the base of that member. The head is thus kept elevated, and he is restrained from motion by the pain experienced by the tail when the rope is tightened by his attempt to flex it. This assures his passiveness (Fig. 42). The practice of shielding the sharp jjoints of the horns with smooth, metallic balls is one which tends largely to diminish the power of the animal for doing harm, by obviating to a great ex- tent the danger from pimctured wounds to which those who han- dle them are exposed. The best mode, however, of securing cat- tle while standing, is by tying the head up to a post or a tree, or again by yoking an individual with his mate or another animal of the same species. Kicks must also be guarded against. Those by the fore legs are avoided by raising one foot and tying it on the forearm, thus compelling the animal to stand on three legs. But the hind legs of cattle are the most dangerous from their ability to kick in so many directions, whether backward, forward or outward. Several methods are recommended by which to guard against this form of danger. Among these may be mentioned the passing of the tail forward between the hind legs and then outward, car- rying it towards the stifle of the leg from which the -kick may pro- ceed, and holding it firmly with a backward pull ; thus surroimd- FIG. 43.— To Prevent Cattle from Kicking. 5G MEAXS or RESTRAINT. ing or tj'mg the leg with the tail. Again, to pass a twitch rotmd the leg above the hock, and to turn it until the tendo- Achilles pressed upon, is brought in contact with the posterior face of the leg. A loop of rope twisted upon a stick will answer the sarae purpose. The use of hobbles, single or double, or of the side lines to secui-e the hind legs, has also been recommended, as with solipeds, with the difference that the horns furnish a strong means of support, which is entirely lacking in the soliped. A method approved by some of controlling the motion of the animal is to pass a rope on one hind leg above the fetlock, and to carry this leg well forward, or even to raise it from the ground and to tie it by the rope to the forearm of the same side above the knee or around the horns. The use of a long bar of wood held under the abdomen by two assist- ants in front of the stifles ; keeping the animal pressed against a wall by means of a wooden bar, with which an assistant pushes firmly against the stifle of the side opposite to that upon which the operator stands ; binding the animal against a wall with a rope fixed to a ring in front of the chest and one behind the hind quar- ters— all these are simple means employed to keep cattle quiet in the standing position. Some individuals, however, and especially bulls, are altogether intractable, and require more severe and effectual modes of pun- ishment. These are appHed upon the muzzle of the animal in his nasal septum by nippers or clamps, or with rings. Nippers are of divers forms. One true, single clamp is commonly used in Italy, and has been modified in England ; another is in use in Hol- FiG, 43.— Italian Noae Clamp. Fig. 44.— Modifled English Nose Clamp Figs. 45 A and B.— Modifled English. Nose Clamps. SECUKING OTHER DOMESTIC ANIMALS. 57 land, "which is a true screw-clamp ; another, which is preferred in France — are a few among the varieties of this single instrument for the ap2:)lication of pressure upon the septum nasi. They are generally secured on the front of the face by ropes or straps. They are effectual appliances, and by their aid the head can be kept uj) and the animal controlled without difficulty. Among the rings the simplest are most commonly in use. They are made in two parts, articulated at one extremity, and united at the other when in place by a rivet or screw. They vary much both in form and size. Some (though still known as rhiffs) are square ; others Fig. 46.— Square (?) Rings for Cattle, are round and elhptical. The ring of KoUand, the Alsace ring, and some of simpler construction carry an auxiliary ring at some part, of their circumference with which to secure them on the face of the animal by means of ropes or straps. These rings are apphed after the perforation of the nasal septum with a trocar or a punch-nip- pers, making an opening of a size corresponding to that of the ring. Sometimes the perforation is made with a hot ii'on, the Fig. 47.— Ring of RoUand. animal being properly secured and tied to a tree, or placed in a yoke with the head elevated, the operator making a quick pimc- ture through the cartilage, and introducing the ring and riveting it. The hemorrhage soon ceases spontaneously. In order to dispense with the punch, trocar, and the pvmcture with the hot iron, rings of a special construction have been in- vented. These also consist of two parts, and are also articulated, 58 MEANS OF EESTKAINT. Fig. 51.— Rings with Toints. SECUEING OTHER DOMESTIC ANIMALS. 59 one of the joints having a sharp point with which the ring is pushed through the cartilage. A simple form represented in Figure 51 shows the point passing thi'ough an eye at the other extremity of the ring to be bent over it in order to close the in- strument. The ring used in some parts of France is contrived Fig. 52.— French Rings. somewhat on the same plan, but is more complicated. That of Rueff is a kind of broken circle, which, when closed, forms a per- fect ring in which the branches are kept together by a small screw. Fig. 53.— Ring of Rueff. The rope which is attached to the nasal ring is not always suffi- cient to drive or control buUs, and conductor sticks armed at the end with iron hooks of various shapes are recommended. The apparatus of Vigan is a very simple one, but it fulfils all require- ments and suffices for the restraint of the most vicious animals. It consists of a wooden pole with an ii-on prolongation having a wide ring by which to hold it, and at a short distance from this a hook to be inserted into the nose ring. Back of this is a strap to secure around the horns the bar over the top of the head as it passes between the horns. At the other extremity is an u'on stifle through which a surcingle is passed to be tied around the body of the animal. Painful, and still easy to apply, this apparatus is not only a powerful means of restraint, but is sufficient to jorevent any motion of the head. 60 MEANS OF KESTEAINT. Fig. 55.— Vigau's Apparatus. SECURING OTHER DOMESTIC ANIMALS. 61 Fig. 56.— Steer Placed in Stock. The use of stocks for the control of bovines is often also re- quired. These are used principally in shoeing oxen, but are available for some operations which require greater passiveness than can be obtained by the applications of the simpler means above described. It is only in exceptional cases, and when an operation is likely to be unusually painful and prolonged, that the recumbent position is required with bovines. The casting of cattle may be effected with or without hobbles, but in either case special care is necessary to provide a sufficiently thick bed to protect the head, and guard against the possible danger of fracturing the horns. A long board placed transversely across the neck, with an assistant seated on each end, affords an excellent means of controlling his efforts and struggles. "When hobbles are used, they must be of smaller size than those used for horses, and should be placed above the fetlocks. To cast bovines without hobbles, either of two methods, one invented by Eueff of Germany, and another described by Gwell and Hertwig, will answer the purpose. In the first, the Kueff raethod, a rope some thirty-six feet long is required, in the middle of which a loop is made and fixed round the base of the horns. The two free ends are then passed between the fore and the hind legs, each beiag twisted from within outwards, around one of the coronets, and brought back to the loop at the base of the horns, through which they are passed to assistants, one on each side, with directions to pull backwards. The feet are thus brought close together, and the animal seats himself on his hind quarters. 62 MEANS OF RESTRAINT. and finally stretches himself on the bed. If he struggles, the traction on the ropes only expedites the fall. If he pushes for- ward, or attempts to kick or even only moves his feet, the running of the rope is so much more facilitated. In the other mode, a roiDe about the same length and carrying in one extremity a loop which is thrown over the horns, is passed backwards along the superior border of the neck, as far as about its middle, where a loose loop is made ; then carried backwards at the side of the vertebral column, where another loop is made, be- hind the shoulders, and a third one around the abdomen, on a level with the flank, where an assistant holds it backwards by the side of the sacrum. If the animal is to be thrown on the left side, the rope must pass on the right of the base of the tail, and vice versa. Two assistants pull on the rope, while another holds the head and tries to bring the animal down. The traction on the roj)es tight- ens the three loops, and under the effect of this force the animal is made to lie down qiiietly. It facilitates the operation to lubri- cate the rope with a little grease or soap. In order to avoid complications from lacing the ropes too tightly about the body, it is always indicated to subject the j)a- tient to a moderate fast previous to casting by this mode. (b) OviNES AND Caprines. — Although these animals are timid and. comparatively lacking in strength, they are at times caj^able of struggling violently and becoming dangerous, and they can- not be subjected to surgical treatment without being cast. This is done by grasping both legs of one lateral biped, the right fore and hind legs, for instance, and laying him over on the opposite side, the left, and vice versa. If all the legs are to be secured, those of each lateral biped are first tied, and with the two cords a straight knot is made, binding all together. If the seat of operation is the head, the animal is held by an assistant, who sits with the body of the animal between his legs, with its back close to his own body, holding the fore legs with his hands, and controlling the hind quarters between his legs. In some cases when the operation is light, the operator holds the an- imal himself without help. (c) Swine. — Securing a good hold of this animal is not always an easy task, and it sometimes requires not a httle skill and cun- ning to do so. '\\Tien seized, two assistants are necessary to cast him, especially if he is of large size, and when down, either a muz- SECURING OTHEE DOMESTIC ANIMAXS. Fig. 57.— Twitch for Swine. zle must be put on his snout to prevent Ms biting, or a peculiar twitch, placed between his jaws and twisted over the upper one. If an examination or operation is to be made about the mouth, a wooden gag placed between the jaws and held with cords, will be found of great utility. The various operations performed upon Fig. 58.— Gag for Swine. the noses of swine, to prevent them from digging the ground, may be considered to some extent as means of restraint. The incision of the snout, which consists in making several transverse cuts through it; the nasal tenotomy, though not so successful; the application of rings through the nose, by the same methods as To Prevent Swine from Digging. 64: MEANS OF BESTEAINT. Fig. 59a.— Another Mode. those used in cattle, are simple means whicli only need mention, be- ing more frequently performed in fact by raisers and breeders of swine, and indeed rather belonging to their special domain than to that of the professional veterinarian. -To Prevent Dogs from Biting. (f?) Dogs and Cats. — Dogs can be prevented from biting by muzzhng them, or with a cord or band wrapped first around the lower jaw, and then around both, and secured over the neck behind the ears. To examine the mouth in the absence of a speculum, as the one represented in Figure 61, the mouth may be held open by cords passed around each jaw behind their tusks, and pulling them apart. If the animal is dangerous or ugly, the collar nippers SECURING OTHER DOMESTIC ANIMALS. 65 Fig. 63.— Collar Nippers for Dogs. become very handy, in order to hold them by the neck and keep them under control, whether for operation or for administration of medicines. Cats are most difficult to handle. They bite and they scratch, and they are often unconquerable until they are fully subjected to general anesthesia. In many instances, the co-operation of a good assistant, accustomed to handling them, may be found necessary. They may sometimes be made amenable to treatment by grasping them by the neck behind the ears, and close to the head with one hand, and securing the fore paws with the other, while a second assistant holds the hind legs, or it may become necessary to have the four paws tied tightly together, and only the head held by the assistant. We have heard of the utilization of a man's boot as a means of feline restraint, particularly in the castration of the male, or " Tom," the head and body of the animal being thrust into the leg 6G MEANS OF RESTEAINT. of the garment, leaving only the posteiior portions exposed and accessible to the operator. This may not be a scientific device, but its effectiveness can hardly be doubted. SUKGICAL ANESTHESIA. A resort to the various means of restraint, which we have been considering, is sufficient in a majority of cases to bring under perfect control such animals as require to be subjected to surgi- cal treatment. But there is a class of cases in which they become inadequate to meet the great requirements of inducing in the pa- tient a condition in which a great diminution, or the entire suspension, of sensibility and consciousness, with all power of muscular reaction, is established throughout the organism. This result is obtained through the characteristic action of the special therapeutical compounds, known as anesthesia. It is not merely as a more effectual means of securing control over refractory patients that their administration is justified. It is also prompted by a proper humanitarian feeling in cases in which severe and prolonged suffering accompany the operation. In veterinary surgery, the indication for anesthesia, has not, to the same extent as in human, the avoidance of pain in the patient for its object, and though the duties of the veterinarian include that of avoiding the infliction of unnecessary pain as much as possible, the administration of anesthetic compounds aims prin- cipally to facilitate the performance of the operation for its own sake, by depriving the patient of the power of obstructing, and perhaps even frustrating its execution, to his own detriment, by the violence of his struggles, and the persistency of his resist- ance. To prevent these, with their disastrous consequences, is the prime motive in the induction of the anesthetic state. That it per- fectly succeeds in fixing the patient in the attitude most favor- able for the sui'geon in the execution of the various parts of his task, needs no affirmation, nor need we attempt to measure the value of the discovery, which has proved itself to be such a price- less benefaction to the world. There are special cases where anesthesia is more particularly necessary than in others, and where absolute immobility of the patient is essential, and entire muscular relaxation indispensable. Thus it is indicated in the reduction of fractures or dislocations in SURGICAL ANESTHESIA. 67 the large domestic animals ; in cases of delicate manipulation and dissection with sharp instruments, as in the operation for strangulated inguinal hernia; in the reduction of other hernial tumors, in the performance of neurotomy; in operations upon the eye, and in the removal of tumors of certain kinds. It is also indicated in certain oj^erations upon the foot, which are always accompanied with great pain, such as that for the extirpation of a portion of the quarter of the foot, in the removal of the cartilage affected with necrosis (quittor); or again, in deep punctured wounds of the sole, where the resection of the plantar aponeurosis becomes necessary, or the bones are scraped with the knife. The anesthetic condition is also very favorable for the reduc- tion of displaced organs, as of a prolapsed rectum, or uterus, or bladder. In operations upon the teeth, in some cases of parturition, in castration, in firing, or even in the application of hobbles, the induction of the anesthetic state has often been of great benefit in quieting nervous animals, and subduing them to a condition of passiveness, which relieved the movements of the surgeon frorn all embarrassment and uncertainty. As with human patients, anesthetics are contra-indicated in animals subject to diseases of the heart or of the lungs. A fuU stomach is also always a contra-indication of their administration, especially in solipeds, which are lacking in the abihty to reheve it of its contents by vomiting. Anesthesia may be either local or general, according to the area of its efiects. Local, when apphed to the skin over a limited surface, to which its efiects are confined ; and general, when ad- ministered by inhalation, and through the respiratory organs in- fluencing the entire economy. In local anesthesia the efl'ects are obtained either by the pulveri- zation of the proper substance upon the region where it is required to take effect, or by the subcutaneous injection of special agents. General anesthesia is usually produced by the inhalation of the vapors of ether or of chloroform. LOCAL ANESTHESIA. The special indications for this are so numerous that they may almost be considered as general, if not universal, and its applica- tion is so simple and easy a process, and its effects usually so cer- 68 MEANS OF KESTRAINT. tain, that it ^vould become tlie practitioners of our day to utilize it more frequently and extensively than they do. It is available as well as useful in the simplest operations, and may be employed in the opening of abscesses and cysts ; in the puncture of cold abscesses with the hot irons; in the puncture of the cornea; in neu- rotomy ; in simjjle incisions of the skin ; in the removal of small tumors, etc., etc. We have used it with the best results inui-eth- rotomy, in caudal myotomy, in amputation of the tail, and the removal of mammary tumors in dogs, etc. Bouley long ago rec- ommended its application to surgical diagnosis, in cases of doubt- ful lameness, an expedient which has recently been introduced into this country by several veterinarians, for the differential diagnosis of shoulder and foot lameness. We have remarked that the anesthesia can be produced in several ways, though two are principally in use. Among these properly termed minor and secondary expedients, are the apj)lica- tion of cold water or ice, and cooling or freezing mixtures, and pressure upon the blood-vessels and nerves, which have for years been among the adjunct and agencies of surgical practice, but have given place in recent times to methods more potent and more certain in their effects. Notwithstanding this, however, some mention of theu' nature and qualities, and the methods of utihzing them will not be out of place, if only as a matter of gen- eral reference, and a case might arise in practice when the infor- mation might become practically valuable. 1st. Pulverization of an Anesthetio Liquid. — The apparatus employed for this process is the invention of Dr. Richardson, and though the spraying tube has been from time to time more or Fig. 64.— Richardson Atomizer. LOCAL ANESTHESIA. 69 less modified, the mode of its employment continues unchanged ; though any substance susceptible of easy pulverization may be employed. Ether is the agent most frequently chosen. Kigolene has given us great satisfaction in our own practice. In impingiag upon the skin in a state of excessive division, the rapid evaporation of the liquid lowers the temperature of the surface with which it comes in contact, and it is this process of refrigeration which diminishes the local sensibility, and, as the effect increases, overcomes it entirely for the time being, or so long as the spray continues to be thrown upon the part. Some slight objections, however, may be alleged against this mode of producing insensibility, arising from the special proper- ties of the fluid employed, and for this reason the mode by sub- cutaneous injection is somewhat to be preferred. 2d. Subcutaneous Ivjections. — Both ether and chloroform have been recommended, and extensively used, in this manner, but without doubt the salts or compounds of cocaine possess ad- FiG. 65.— Syringe of Pravaz. vantages over either of them. An epidermic syringe, or that of Pravaz, is generally used for the purpose, with a solution of from four to twenty per cent, strength, according to circumstances. If used on a tumor a certain quantity of the solution, perhaps twenty drops, is injected under the skin at two or three points arovmd its cu'cumference, the desired effect following, and the parts being ready for the operation within from eight to ten minutes, more or less, according to the strength of the dose administered. Either of these modes of local anesthesia is harm- less, and may be employed without risk or fear of complications. 70 MEANS or RESTRAINT. GENEEAL ANESTHESIA. The three principal agents which recommend themselves by the efficiency and certainty of their action in producing general anesthesia, are ether, chloroform and chloral hydrate. Theu' adaptation varies, however, with the animals subjected to theu' administration. Chloroform and chloral are chiefly used for the larger animals, principally horses, while chloral and ether are re- served for the smaller kinds, with which chloroform is so generally dangerous, and even so often fatal, that its use with them is almost entu"ely discarded. Insensibility by Anesthetic Vapors. — The modes adopted for the inhalation of the vapors of chloroform are numerous, but among them all the merit of simplicity should probably be award- ed to that which is recommended by Bouley. This consists in the introduction into each nostril of a small sponge, or a ball of oakum, saturated with the ether or chloroform, and held in place by the hands of assistants. The inhalation of the vapors, which are thus mixed with air, proceeds rapidly, the sponges being recharged as soon as they become exhausted, and returned to the nostrU, until the object in view is accomplished. But while this mode is a very convenient one, we conceive it to be liable to certain objections. Fu'st, unless the pouring of the liquid is very carefully per- formed and in such quantity that the sponge is not over-saturated, there is danger that a large portion of it may be wasted, by run- ning off, either on the bed, or possibly, into the nostrils, causing, in the latter case, great irritation of the mucous membrane. And if the anesthesia is to be continued for a considerable length of time, the eifect produced ujDon the delicate membrane of the nose may be sufficiently serious to end in the sloughing of the parts. It must certainly have been with the view of avoiding this complication that Defays invented the inhaler shown in figure 66 with its wide range of aj^pHcation, from the dog to the horse. Many veterinarians have adopted an arrangement consisting of a strong leather muzzle with large openings at its bottom and sides for the free admission of the atmospheric air, the sponge or oakum chai'ged with the chloroform or ether being placed in the bottom of the muzzle, which is fixed upon the animal's head in the GENEKAL ANESTHESIA. 71 Fig. 66.— Apparatus of Defays. ordinary way. This is a very convenient, though quite a simple contrivance, but Enghsh veterinarians, and among them Mr. E. Cox, recommend in preference a chloroform-bag, in the form of an ordinary bag, made of strong canvas, both ends of which can be closed by a running string, one being tied around the nose Fig. 67.— Cox's Chloroform Bag in Position. while the bag is secured by cords to the halter or to the straps of the cap. The chloroform is introduced into the bag by means of a thin j^iece of cloth saturated with the liquid. The chloroform nose-cap recommended by Mr. Gresswell also answers a very good purpose, and in fact, possesses advantages which render it superior to the apparatus of Mr. Cox. It is not so portable in its form, but is more durable ia its construction. In. fact, it produces the features of the ordinary stable muzzle which we have already mentioned. The apparatus of Carlisle is also one of English invention, for which great merit is claimed. We have used it, and the trial has shown it to possess many features of marked superiority over the others. The quantity of liquid required to bring a large animal under complete general anesthesia cannot be positively ascertained. 72 MEANS OF RESTRAINT. Fig 68 — Gi esswell 8 Chloro- form Nose-Bag. Fig. 69.— Carlisle's Chloroform Inhaler. While it has often been induced by the inhalation of a single ounce, there are cases in which two, three, or even more have been necessary. An essential point to consider is that the chloroform should be absolutely pure. Mixtures of two or more drugs have also been employed, usually ether and chloroform, with or without the addition of alcohol, but the result of all ex- perimental tests has been, with us, to establish the conviction, that as yet, chloroform used singly has proved itself to be the most effective and the safest of all. The administration of chloroform of course pre-supposes, besides all the other conditions and preliminaries of an operation, siich as previous fasting, the preparation of the bed, and other incidental steps, the act of throwing the patient. When the effects of the inhalations begin to become manifest, the first physiological change noticed is an extreme agitation, accompanied with coughing. The animal struggles more or less violently, the ii-ritation and tickhng of the thi'oat produced by the vapors upon the laryngeal mucous membrane, giving rise to a spasmodic motion of the glottis, and whether the patient be a GENERAL ANESTHESIA. 73 large or a small animal, he exerts his strength to rid himself of the apparatus and regain his freedom of motion. These manifestations are, however, but of short duration, and are soon followed by a state of passiveness, the respiration be- coming easier, the cough disappearing and his energy subsiding ; and in short, he is subdued. The eye then assumes its character- istic expression, its brilliancy is lost, it is wide open, the pupils slowly dilate, the gaze becomes fixed, the sensibility of the cornea is lost, and the light ceases to effect it. The mouth becomes more or less loaded with saliva; the pulse, which must be carefully noted by an assistant, becomes slow and weak, the respii-ation returns to its normal condition ; the state of complete anesthesia has been reached, and the patient, in happy unconsciousness, is ready for the surgeon. The time required to reach this condition varies with the sub- ject, and especially with the quality of the drug administered. The average period is from one to five minutes in small animals, and from ten to fifteen in the large. In some few cases, however, half an hour may elajDse before complete insensibility is produced, and again animals are encountered with peculiar idiosyncrasies, which remain entirely refractory, and successfully resist every attempt to reduce them to insensibility ; a statement equally true when applied to human patients. The duration of the Anesthesia. — Some animals remaining under the influence only for a few minutes, sometimes from fifteen to thirty or forty, it becomes necessary to prolong the insensibil- ity by renewing the inhalation, and the}' must, therefore, be con- tinued until the completion of the operation. Recovery from the anesthetic state does not always take place immediately and per- fectly. As the effect begins to subside, the animal, having parti- ally regained his senses, begins to move his eyes, raises his head, perhaps allows it to fall back slowly on the bed, lying flat on his broadside ; then his legs begin to move, and presently he attemj)ts to spring suddenly to his feet. He may succeed in doing so, but again, his muscles may not have yet recuperated their power of full action, and there may be danger of his experiencing a heavy fall on the bed. His condition is one of drunkenness, and he re- quires to be watched, and, if necessary, aided, in order to prevent him from injuring himself by efforts beyond his strength while in a state of weakness of which he is unaware. 74 MEANS or KESTKAINT. The symptoms of general anesthesia by chloroform, which we have detailed, are those of ordinary cases. There are, however, other symptoms which the vigilant operator will not fail to look for, which are of great importance as indicative of the dangers, and premonitory of some of the casualties incident to the situ- ation. These we reserve for subsequent consideration. Anesthesia hy, the Administration of Chloral. — While this drug and its compounds, as sometimes used, produces in some cases a condition of insensibility quite as complete as that ob- tained by chloroform or ether, yet there are cases in which only a less complete degree of success can be secured, though still suffi- cient to be of great assistance to the surgeon as well as of rehef to the patient. That the intra- venous injection of chloral has been shown to be the best of all modes of obtaining anesthesia, is an admitted truth, but unfortunately it is a method of introducing it into the system which will scarcely ever become sufficiently prac- ticable to be available outside of the laboratory. Efforts to over- come the difficulty referred to have not been wanting, however^ and Messrs. Cadeac and Mallet have experimented with chloral by combining its action with that of muriate of morphine. By first injecting subcutaneously a certain quantity of a solution of mor- phine, and following it after a few minutes by a rectal injection of a solution of chloral, they have obtained complete anesthesia in a very short time. For a horse they have used eighty centi- grammes to one gramme of the morphine, and from eighty to one himdred grammes of chloral; and, for a dog, ten centigrammes of morphine and twenty grammes of chloral The administration of chloral in the form of balls, as commonly practised by many veterinarians, in doses varying from one to one and a half ounces, given on an empty stomach, and from one to two hours before the operation, is undoubtedly good practice. We have not personally had the opportunity of testing it in cases of long and tedious dissections, but the benefit we have often de- rived from it in short, though painful operations, justifies us in recommending it, not only for this very object, but in any case, where, from any possible cause, an animal is likely to receive severe injuries during his struggles to liberate himself. ACCIDENTS OF GENERAL ANESTHESIA. 75 ACCIDENTS OF GENERAL ANESTHESIA. Notwithstanding the caution observed in the use of ether or chloroform, and however pure these articles may be, accidents must be expected during their administration. They are not always of a serious nature, but they may at times have fatal results. Among those of minor importance is the cough which becomes at times quite troublesome, but may be readily subdued by a tem- porary arrest of the inhalation ; vomiting, which often occiu's in small animals, but which can be guarded against by causing the patient to fast long enough to insure an empty stomach before being etherized, and spasmodic contractions, of which the exis- tence, when undoubtedly present, is often overlooked. Among those of more serious nature are syncope, either cardiac or res- piratory. Cardiac syncope is a very serious accident, and in a majority of cases proves fatal, especially in large animals. It is sudden in its manifestation, and often unobserved until at too late a period of the operation. It is due to a gradual diminution, followed by an arrest of the muscular contractions of the heart, and as far as our observation extends is always associated with pre-existing heart disease. The apphcation of cold douches, of heart stimu- lants, ammonia given by inhalation or internally, are the first in- dications in these cases. Respiratory syncope, which is far less dangerous, arises from the influence of the laryngeal nerves upon the activity of the res- piratory centers. Its access is sudden, being caused by the arrest of the respiration. There is no, convulsion, though the intoxica- tion produced by the anesthetic vajDors is sudden in its effects, and is generally detected only by careful watching. The apphcation of electricity, that of the electro-puncture, and especially persevering eiforts to effect artificial respiration, may sometimes save the animal, provided the trouble is not connected with the complete arrest of the contractions of the heart. In view of these possible incidental conditions, some general rules suggest themselves tending to their avoidance. Great care and exactness in gauging the doses of the anesthesia, with such caution in their administration as to j)roduce a slow and gradu- ated eifect, is one point. Free allowance for the introduction of air with the vapors inhaled ; close attention to the state of the 76 MEANS OF RESTKAINT, circulatory and respiratory apparatuses, and the manner in which their functions are executed, by noticing the heart-beat and watch- ing the pulse and the movements of respiration at the flanks, are other points of importance. Another point is the need of bearing in mind that an animal submitted several days in succession to general anesthesia be- comes more and more susceptible to its effects, and therefore more exposed to the dangers they imply. ACCIDENTS INCIDENTAL TO THE USE OF ]MEANS OF RESTRAINT. "We have already considered some of the accidents which are likely to interfere with the successful apj)lication of the means of restraint, and especially with reference to the final act of the pre- liminary series which occur at the moment of throwing the animal and depositing him on his bed, particularly such as may follow the neglect of properly protecting the head with the cap or blinkers, or by an unnecessarily prolonged use of the twitch, or from the sudden and violent movements of the animal himself. These can usually be obviated by projper forethought and watch- fulness. But the most careful attention cannot always assure immunity from miscarriage and casualties. Thus, a common mis- hap, and one which cannot be anticipated nor prevented, is the sudden and heavy fall of the animal just as his equilibrium is lost. The lesions which may follow this casualty may have their seat either in the hard or soft structures, and are of the most serious character, not only including, at times, fractures and dislocations, and lacerations of the soft tissues, including the muscles, but may affect the viscera, and even the blood vessels and the nerves — in this last case involving the parts in all the evils of local paralysis and its disabilities. (a) Feactukes. This form of injury may have its seat in the vertebral column, the ribs, and the bones of the extremities. 1st. Fractures of the Vertebral Column. — In the list of frac- tures, those of this region of the body are the most frequent. The numerous reports of cases which are made public by veterin- ary wiiters f ui-nish sufficient evidence of the f acihty and frequency of theii- occurrence, even when the most careful attention has been ACCIDENTS DUE TO KESTRAINT. 77 bestowed on all the details of the work of casting. The very peculiar ch-cumstances under which these spinal fractures some- times take place, baiiiing calculation, and occurring when least expected or prepared for, illustrate the responsibihty which the veterinarian assumes, and the culpability with which he would become chargeable b}' undertaking the work without due caution and preparation, or without notifying the owner of the animal of all the hazards and difficulties attending the case in all its steps and stages. As will be seen when we come to the consideration of this special lesion in the chaj)ter on fractures, the symptoms which accompany this accident are distingmshed, as to one feat- ure, by the suddenness of their appearance, which takes place at the moment of the infliction of the injury or immediately after. But the most important of the characteristics of the case is the grave fact that the fracture is almost always of the comminuted kind. This is held to be due to the excessively powerful mus- cular contraction, resulting in the over-arching of the vertebral column simultaneously with pressure from the abdominal organs, caused by the sudden extension of the anterior and posterior . bipeds, bound together with hobbles, the violence of the struggle so powerfully pressing the vertebrae together as to result in the yielding of theu^ spongy structui'e; and the crushing or grinding of the bone is the consequence. This theory of the production of fractures of this character has been adopted by the majority of European veterinarians, es- pecially by those of France, where it is understood as "Bouley's Classical Theory." In 1889, however, another theory was pro- pounded and defended by Mr. Moussel, of Alfort, differing en- tirely from that of Bouley, in which he claims that the kind of fracture in question is not caused by an over Jiexion of the spine, but, on the contrary, is the effect of an excessive extension! result- ing from greater contraction of the ilio-spinahs muscle. According to Dickerhoft, " three factors are active in the cau- sation of these fractures. In the first place, the animal must have some object as di, point (V appui for one hind leg; that point must be connected with either one of the other extremities or directly with the trunk. * * * Secondly, the horse must make his vertebral column teuse by the contraction of the spinal extensor muscles. * * * Thirdly, the horse must, simultaneously with the extension of the hind leg and that of the vertebral column, draw its pelvis 78 MEANS OF RESTRAINT. to one side. * * * But no one of these three elements, in itself, will produce a fracture; they must all concui'." Whatever may be the value of these theories, the fact that at post-mortem examinations fractures have been discovered, in some cases in the annular portion, and in others in the body, seems to prove that any one of them is equally apphcable with another. To prevent these fractures, therefore, becomes the principal object of the surgeon at the critical moment when the animal is thrown. This involves a strict attention to the rules which we have laid down for his guidance in the various stejDS of the act of casting; and, moreover, to have recourse, as often as jDossible and as the indications suggest, to the aid of anesthetic agencies, and by no means to ignore the value or neglect the use of the appa- ratus of Bernardot & Buttel. 2d. Fractures of the liibs. — These fractures are undoubtedly frequent, as the result of heavy falls upon a badlj'-made bed — too hard or too thin, or perhaps concealing hard substances, as stones or the like. 3d. Fractures of the Pelvic Bones. — There are but few cases on record of this kind of injury, but they are possible, as the re- sult of carelessness in the preparation of the bed or improper casting, or powerful muscular contraction. 4th. Fractures of the Bones of the Extremities. — Though prob- ably less common than those last referred to, these lesions are not unknown in veterinary practice. They occur principally in the diaphyses of bones, or near to, or at the epiphysis, and are often in- complete in their nature. Delafond describes a case of fracture of the femur taking place during the application of the clamjDS while undergoing the operation of castration ; and another case is recorded of which the trochanter of the femur was the seat. Key has reported a case of fracture of the cubitus taking place as the animal, when freed from the hobbles, made a violent effort to spring from the bed upon which he had been thrown to be fired for a chronic enlargement. These fractures of the extremities may be avoided by careful attention, not only at the time of throwing the patient, but in placing him in position and in properly securing him, and giving him judicious assistance in regaining his feet. 5th. Dislocations. — These accidents are of very rare occur- rence. One case, however, is recorded of a dislocation backwards of the humerus, compHcated with fracture of the cubitus. INJURIES TO SOFT TISSUES. 79 (b) Injuries to Soft Tissues. 1st. Lacerations of Muscles and their Annexes. — These are the result of the distorted positions into which the extremities are forced while undergoing operations. They may be discovered immediately, or may be developed a few days after the operation. Inflammation of the olecranean and pectoral muscles, of those of the croup, and of the anterior part of the shoulder have been re- ported. Bouley has seen a ruj)ture of the aponeurosis of the great and of the small oblique muscle of the abdomen, and one rupture of the flexor metatarsi. A case of laceration of the diaphragm is recorded by Bouley, Jr. In one of our own patients, laceration of the olecranean muscles was followed by such severe complications, that it became necessary to destroy the patient. 2d. Ruptures of the Viscera. — These are of rare occurrence, being generally prevented by the precaution of refraining from throwing the animal, until assured of an empty digestive canal by previous fasting. Accidents, however, have been witnessed by Gohier, who has noticed their occurrence upon the rectum near the anus. This horse had drunk freely of water before being cast. Bouley, Jr., has seen a case of rupture of the diaphragm. Eey has known one of the heart, Schaak one of laceration of the humeral artery, and even the giving way of the vena cava, in a case of a nervous animal upon which means of restraint were being applied to dress a small wound. The patient suddenly fell, and, struggling violently, died ; and at the post-mortem the abdomen was found full of blood, and the vein torn back of the kidneys. 3d. Injuries to Nerves. — These are accompanied with loss of power, usually temporary, but sometimes permanent. The posi- tion in which it is sometimes necessary to fix an animal, as in the diagonal, is that in which they are most likely to occur. The symptoms of paralysis which are then manifested, betray them- selves when the animal has just risen from the bed, when, upon being called upon to move, the leg is discovered to be unable to carry its weight, flexing upon its various bony levers, and render- ing locomotion impossible. Sometimes these symj^toms are of but short continuance, and disappear under the influence of strong stimulating frictions. The leg was, according to the popular phrase, "■asleep,'" because of a temporary arrest and sluggishness of the circulation. But in other cases, the condition is brought 80 JIEANS OF EESTKAINT. on by a true lesion of the nerves, the brachial, the lumbar plexus, or some of their branches having undergone some traumatic hurt which may prove more or less refractory to treatment. 4th. ^Isphi/xla. — According to Peuch and Toussaint, this ac- cident may result from the ignorance of assistants, who, in con- trolling the animal and keeping him down on the bed, have com- pressed the nostrils too tightly ; or again it may be caused by the excessive pressure .of the throat straj^s of the halter, or of the rope which encircles the neck when a horse is placed in position for castration. To explain the causes of this accident should be, with an intelligent operator, sufficiently to hint the means of prevent- ing its occurrence. Conclusions. — A review of the matters we have been considering in this chapter may not be out of place, nor unprofitable, even at the risk of being, perhajDS, a little repetitious. In view of the oc- currence of these accidents, and aj)]Dreciating the responsibility assumed by the surgeon when about performing an operation upon a more or less valuable animal, he cannot but be conscious of the obligations which impose themselves upon him to take every precaution to avoid them. He should therefore guard against their eventual contingency, by closely inquiring concerning the condition of his patient, and by satisfying himself that every part of the ajDparatus of restraint is in good order ; should avoid rough treatment and employ anesthesia when possible, and never put an animal in a constrained position for treatment when an operation can be otherwise performed more advantageously and easily and comfortably to his patient, and he should never allow him to re- main in his restrained and compulsory recumbent position longer than is strictly necessary. And above all, he should never under- take an operation without having fully acquainted the owner of the animal of the possibility of accidents. The fact of thus ex- plainiag matters to an owner, and of obtaining his intelligent con- sent does not, of course, relieve the siu'geon of his responsibility, but rather, on the contrary, confirms and increases it by thus add- ing a new, though an implied pledge to his employer to devote his most conscientious endeavors and exercise his best skill in the matter, in token of his appreciation of the confidence placed in his skill and faithfulness. CHAPTEK II. SURGICAL DIAGNOSIS. The first query to be settled in examining a diseased animal is whether the ailment with which he is attacked is merely a case of disordered function, requiring only the administration of the proper drugs to restore the usual order of things, or a case de- manding the operative skill and expert ministrations of the sur- geon, with bistoury and cautery and sutiu'e. The decision of this query involves a thorough knowledge of anatomy, and is compara- tively more difficult, as well as more imi^ortant, than the mere medical diagnosis of diseases pertaining to internal pathology. Errors in surgical diagnosis are always both more dangerous and more important than those of a mere medical character, inasmuch as they are likely to be more readily exposed, and to involve a greater amount of responsibihty on the part of the surgeon. To insure the certainty of his diagnosis, the surgeon must caU into exercise all his resources of knowledge and experience, and employ all his faculties of observation and discrimination, with such instrumental aid as may serve to facihtate and confirm his conclusion, as to the nature of the cases before him. He must especially employ all his organs of sense in the investigation. A single sense is sometimes sufiicient to diagnosticate the character of some special lesions, but more commonly each sense is an auxiliary of the others, and all are comj)lementary to each. In fact, the surgeon is not justified in reaching a conclusion as to the detection of an affection, which is discovered by the sight, or touch, or smell, or hearing, alone, but to escaj^e the possibiUty of error, he is bound to confirm his discovery by the corroboration of another, or what is still better, of all the others, if possible. In these cases, as in others, the eye is the most valuable and comprehensible of the organs. 1st. Sight. — Visible changes of contour, or color, or other deviations from the usual appearance of tissues, or of regions, are of coiirse first made known through the sight of the eye. De- formities, unless of very minute dimensions, with abnormal 82 SURGICAL DIAGNOSIS. growths, prominent swellings and changes of direction in the bony levers, belong to the same category, and if these are not suf- ficiently distinct or conspicuous, and seem likely to escape the visual observation of the surgeon, a careful measurement may de- cide the point. The eye must also discern the changes occurring in the various visible membranes, as for example, the heightened redness of a congested membrane, and the paleness of an anaemic subject. Again, if there is abnormal motion in a part, as in fractures and dislocations, it is to the eye that the disclosure is first made. This application and study of the use of his eye will be very serviceable to the surgeon in the examination of the external sur- face of the body, but when examinations ^fvithin the organism, or within its cavity, become necessary, however strong a hght he may have at his disposal, he will be compelled to have recourse for assistance to the speculum, to hold the parts open. There are many forms of this instrument. The speculum oris, for the mouth, has very numerous shapes, some of them very simple, as in Figures 70 and 71, and some com- FlGS. 70 & 71.— Simple Speculum Oris. Fig. 72.— Brogniez Speculum Oris. phcated, as in Tig. 72, the speculum of Brogniez. Green's spec- ulum is an American invention, simple, safe, comfortable to the patient, and of easy manij)ulation (Fig. 73). Grange's mouth speculum is rather clumsy and heavj' (Fig. 74). These instruments are generally employed for solipeds. Placed between the jaws, they open the mouth forcibly, and keep it so as long as they con- tiaue in place. Sometimes, however, the mouths of these animals, as well as those of ruminants, can be held open without them, by putting 83 Fig. 74. — Grange's Speculum. the tongue out of one side of the mouth with one hand, while the cheek is pulled out in the opposite direction with the other. This same manipulation may answer for large ruminants, provid- ing the head is kept elevated by an assistant. In swine, a gag (See fig. 58) made of wood, is often used, and the speculum rep- resented in figure 61 answers well for dogs. At other times, however, with these animals, the mouth is kept open by separat- ing the jaws with tapes passed around each, and pvdled apart. 84 SURGICAL DIAGNOSIS. Fig. 75.— Reynara Mouth Kefleotor. Keynal is tlie author of an instrument whicli facilitates the examination by the eye of some parts of the mouth. It is poHshed on both surfaces, and acts as a reflector, and, when in- troduced on the inside of the cheek, will helj) to detect diseased spots on the teeth, which would otherwise escape discovery. The l''i<^. 76.— Nose Speculum. speculum to dilate the nostrils and examine the nasal cavities, also acts as a reflector, but fails, we think, to fulfill the object, for lack of sufficient dimensions. It is made somewhat on the principal of the vaginal speculum used in human medicine, and acts in the same manner. FlO. 77.— Eye Speculums SIGHT. 85 Fig. 78.— Ophthalmoscope. The speculum to keep the eyelids apart will be found of great assistance in the examination of that organ, so sensitive to the light when in a state of disease, and so constantly kept closed on that account. It is, in fact, this speculum which renders the use of the ophthalmoscope practicable for the examination of the in- ternal structures of the ocular globe. Some of the various patterns of the speculum used in human -Examination of Dog's Ear. 86 SURGICAL DIAGNOSIS. surgery for the ear, will be found available in the examination of the external auditory canal, especially in dogs. The dilatation of the vagina and the anus is scarcely ever needed in veterinary surgery, and instruments are there- fore not required; nor is the endo- scope, so useful in human sur- FiG. 60.— Vaginal Speculum. gery, of any value in veterinary practice from the impossibility of using it upon animals. To realize the value of these optical aids in the examination of cavities, a strong light is indispensable. Sometimes the ordinary solar rays will be sufficient, but at others reflected and concen- trated artificial light will be necessary, as in the use of- the oph- thalmoscope to examine the eye, or to detect the conditions of the deep posterior parts of the nasal cavities. (b.) Touch. — The taxis is the surgical seuse par excellence, and is probably the more valuable and rehable of all the means of investigation possessed by the surgeon, the sight itself not ex- cepted. Nothing else so accurately detects the changes in the proportions, in the consistency, in the elasticity, or even in the nature of tissues, and its discoveries may be made serviceable at every stage of an operation of importance and delicacy. But to attain a reliable certainty in the exercise of this tactical skill, the finger ends must, equally with the eye, be thoroughly educated to perform their functions with accuracy and discrimination. A change in the aspect, form and contour of a region which easily escapes detection by an ordinary observer, will become instantly evident to the well-drilled digital extremities of the ex- perienced operator. The object requiring examination is not always, however, within reach of any ])ortion of the hand, and resort must be had to instrumental aid in the exploration of parts deeply situated, or of fistulous tracts, and for this purpose the prohe is brought into requisition. It is usually of metallic material, generally silver, or of lead, or may be made of gutta percha or whalebone, or other 87 Fig. 81.— Straight, curved Directory— Silver Probe. suitable, flexible substance, and either straight or curved as the S probe. The director is also a probe, heavier than the ordinary kind, and having a small groove running its length on one side. It is used as a kind of guide to prevent the deviation of the bis- toury from its proper course, and to conduct it to the bottom of a wound. Exploring needles are used with advantage in the detection of the natiire of abnormal growths, the small and narrow wound which they make being sufficient to ascertain the nature of the liquid which may be present, without danger of complications. The Dieulafoy aspirator affords another means of exploration and discovery of deep-seated parts, inaccessible in the ordinary way. Fig. 82.— Dieulafoy'8 Aspirator. 88 SURGICAL DIAGNOSIS. (c) Hearing. — The indications obtaiaed through the media of the sight and the touch may be usefully supplemented, and are often completed by those which address the sense of hearing- The gurgling sound in Hquid or gaseous tumors, the peculiar bruit in aneurisms, caused by the current of the blood; the con- tact of a stone in the bladder when touched by the exploring catheter; the peculiar glou-gloxt of the entrance of air into a vein; the characteristic crepitation of fractures, and the whistling of a roaring horse — these, and other signs, convey their information with unmistakable distinctness to the auricular sense. {d) Smell. — The exercise of the olfactory sense in the formation of a surgical diagnosis is more limited than those just con- sidered, and yet there are conditions in which it may be of great importance. The odor, sul generis, of gangrene and of necrosis are promptly detected, and at once recognized, and the existence of other pathological conditions, as of urinary or stercoral fistulous tracts, and certain afi'ections of the feet, are betrayed by the pungent and aggressive appeal to the olfactory organs. (e) Taste. — As free from anything Uke fastidiousness in respect to offensive contacts and surroundings, as the sm-geon must unavoidably become, he draws a line ; he insists upon a strict monopoly of his gustatory sense for his own internal uses, and only investigates the domestic animals in an ahmentary way, when entirely healthy individuals are reduced to 2i, post-mortem condition by the butcher, and served in the form of beef, mutton and pork, properly cooked. But if the surgeon should desire much valuable aid from the exercise of the physical senses in form- ing his diagnosis, he will commit a serious error if he allows himself to be entirely and exclusively guided by them. Strictly speaking, a direct diagnosis may sometimes be arrived at by a care- ful collation of the results of his researches, but he will often, also, be obhged to modify or go beyond these conclusions, and make an indirect diagnosis besides. There are two ways of making a positive surgical diagnosis one which may be called the du-ect, or diagnosis by confirmatioii another known as indu'ect, or by exclusion. The former is by ulterior investigations, confirming a previous diagnosis made upon the basis of a single and prominent symptom ; the latter by the elimination of aU diseases, which, though they may have some TASTE. 89 resemblance to that wliich has been suspected, yet are excluded by the presence of some specific and incompatible symptoms. It is only by careful induction and cautious reasoning, that the surgeon can settle the question of his diagnosis, and insure such a true and tangible conclusion, as can only be reached when there is a perfect correspondence between the suggestions derived from the testimony of the physical organs, and the calm deduc- tions of the logical faculty, aided by a disciplined and well fur- nished memory. CHAPTEE in. SURGICAL THERAPEUTICS. This title refers to one of the most extensive and important departments of surgical practice, upon which, indeed, as to its proper administration, depends in a great measure the success of the operative skill, of which it is the supplement and consummation. It comprehends the bandaging and dressing of traumatic injuries. DRESSINGS. Gourdon says that " a dressing is a mode of local, periodically repeated, treatment, producing a continued action, following or- dinarily the performance of operations, and consisting in the methodical appUcation upon the surface of wounds of special apparatuses, which complete the effect of the operation, and co- operate in the recovery." The value of the skill and proficiency to be acquired by dili- gent study and observation in this comprehensive and indispen- sable art, need not be stated ; that it is entitled to be so denomin- ated no one acquainted with the niceties of its details and the judgment and experience entering into their performance, need be told. Nor can the dependence of the surgeon, for the good results which he hopes to secure in his department of duty, upon the faithfulness and intelligence of the nurse, who is to co-operate with him in perfecting the healing process, be easily overrated. An incompetent or unfaithful nurse, may spoil the best work of a good surgeon. To protect a wound from immediate contact of surrounding bodies, to shield it from injurious atmospheric effects, malarious or otherwise; to keep aloof all putrid and virulent mat- ters ; to secure the absorption and neutralization of their morbid products; to control the cicatrizing process in the ulcerated parts ; to apply topical treatment, according to indications, as the curative processes develoj) ; to produce a mechanical action, such as dilatation or compression, according to the instructions DRESSINGS. 91 of the surgeon, and the indications of the case. Such is a fair, though brief synopsis of the duties of the niu'se, upon whom it devolves to give effect to the rules of surgical therafpeutlcs. A well-ai:)pLied di-essing may become the first stej) toward assuring the success of an operation, those following it — even when only methodically executed — being mere continuous degrees of the one well begun action. A well-apphed dressing may sup- ply the defects and amend the errors of an improperly performed operation; and, on the other hand, a bad dressing may jeopardize the success of a well-executed operation by interfering with the process of cicatrization, and in other ways delay the recovery of the patient, and even prevent it entirely, by causing unfavorable complications. The application of all dressings is subject to certain general rules, from which no deviation is allowable. As in every action in life, the first step should be that of preparing all the necessary means and apphances for the work, and the last, before beginning the actual manipulation, should be to ascertain that nothing more remains to be provided, at the risk of a serious interruption and delay, and loss of time in a search for some missing article of necessity. On such a point the merest hint should be sufficient, and, indeed, even a hint should be unnecessary with a practical and thoughtful person; but, unfortunately, all persons are not practical and thoughtful. The next step for the surgeon is to secure for himself and his patient a favorable arrangement in resj^ect to hght and room. There must be nothing interposed before the eye, or that can limit the free movement of the hand and the arm — a most obvious sug- gestion. Before applying a dressing, the wound should be thoroughly cleansed and freed from blood, pus, the remains of previous dressings, and, in a word, of any foreign or other substances capable of becoming sources of irritation. This is best done with water alone, but its effect is frequently greatly improved by combining with it some of the compounds, such as carbolic acid, sanitas, creoline, etc., which have proved their value as antiseptic agents. It may be applied by carefully passing a fine sj)onge or a ball of oakum over the siu'face of the wound, or it may be used more freely in larger ablutions. Crusts or scabs, if any, may be removed with the scissors or scraped away with the spatula, but 92 SUEGICAL THERAPEUTICS. the finger-nails must by no means be used for such a purpose, for the twofold reason that it is both filthy and dangerous. Handle the wound only as much as is necessary; all needless taxis irritates — the inference is obvious. If the wound is deep, injections can be combined with the lotions in cleansing it. With the first dressing, there is probably only blood to wash away, and that should be done thoroughly, not overlooking any portion that may have dried in the haii- and on the skin. The essential condition of cleanliness applies not only to the wound, but also to the material used for the dressing, and soiled cloths or bandages, and dii'ty tow or oakum must be rigorously rejected. And, while insisting on strict cleanhness in the instruments and dressing material, it will hardly be decorous to the surgeon to omit him from the category, and to remind him of the propriety of looking to his own condition, and especially to that of his hands. In all his manipulations it should be a matter of conscience with the surgeon to treat his patient kindly. Rough handling, loud scolding, threatening or jerking, with a restless animal, to pimish him for an instinctive and natural attempt to move under the infliction of pain, will not only be of no service, but, on the contrary, will increase his fright and render him all the less docile and willing to submit in quietness. In applying the various parts of the dressings, unnecessary pressure should be avoided, esjpeciaUy on soft tissues ; and when it is indicated, it should be apphed by slow degrees, and as imi- formly as possible, packing the wound upon its entire surface, and completed only as the dressing is nearly ended. Assistants should be enjoined to observe the same rules. The dressing should be apphed, not hastily, but rapidly; not with the idea of saving time, simply with a view to lose none. The fact of avoid- ing any waste of time, by working without needless pause, has, moreover, the excellent effect of curtailing the sufferings of the patient, and sparing him much needless j)ain. It is always important to watch the effect of the various arti- cles of dressing as they are apphed, in order to be certain that they cause no pain either at the time, or at a later period by their shape, the roughness of their surface, or their unskillful apjolica- tion ; and above aU, that they cause no interference with any of the essential functions of the economy, as the respii-ation or cu-- DRESSINGS. 93 culation. This last especially may be impeded by excessive pres- sure. To avoid this, bandages apphed upon one of the extremities of the body should be so placed as to dii-ect the pressure from the periphery toward the center. If applied in the opposite direction, more or less strangulation might result, causing considerable swelliug below the bandage. In fact, all unnecessary or exag- gerated pressure is liable to cause inflammatory swellings, erysip- elous engorgements, or local gangrenes. The maintenance of an equal and regular pressiu'e will obviate all danger of deformities of parts, and when methodically applied upon ii'regular wounds, wherever needed, will serve to restore or preserve them in the natural contour of the region. Neatness and finish should be studied as much as possible, but not, of course, at the expense of any of the special and essential objects of the dressing. Besides these general rules there are others relating to minute points and touching the various elements, which, as a combined whole, constitute the completed transaction, such as those relating to the topical treatment, to the material used, to the rollers or bands, and to the bandages proper. The medicinal compounds used for topical treatment are either appHed alone or through the medium of other materials. They are of various natures and con- sistencies, from that of the almost impalpable vapor used for spraying, to the hquid forms in the numerous watery solutions, alcoholic tinctures, and oils or hniments, to the hard and other soHd compounds in the various astringent, absorbing, stimul- ating or caustic powders, or the soft pharmaceutical mixtures, the cerates, the pomades, the ointments, the plasters, poul- tices, etc. The apphcation of the material used should receive attention from the surgeon. An invariable rule should be to avoid all ir- regularity, roughness and unevenness, and to be careful that the exterior application rests upon a regular and uniform surface. For this reason it should be the order, hi applying this material, always to begin by using the smallest portions, increasing gradu- ally to the largest, thus filling first the smaU infractuosities and making an even surface, to be covered with larger ones and thin pads, then with thicker ones, and finally with those of the widest dimensions, which should bear a margin extending somewhat be- yond the outlines of the wound. The entire dressing is to be 94 SUEGICAL THERAPEUTICS. maintained in position by means of compresses, rollers or band- ages, as the case may require. Kollers are long bands of muslin, linen, or ticking, or broad tapes, which, are used principally in dressing wounds of the ex- tremities, or of regions liable to much motion. Their length and width vary, according to the requirements of the case. The sur- geon will do well to assure himself of the dimensions of these, and to ascertain that the rollers are of ample length, with some- thing to spare, which excess in length can be cut off. Deficiency in the length of a roller will interfere with a perfect completion of its application. If too wide, it may prove difficult to ajpply it neatly, while if too narrow it may have a tendency to act like a hgature, and make even pressure difficult, besides being more liable to slip and become loosened. Kollers are appHed either dry or moist. When moist, they become loose in dri^-ing, and their action becomes insvifficient. Dry rollers ought, therefore, to be preferred. Bands or rollers are prepared in two ways, either by being rolled on one or on both of their extremities, and are therefore called the single or the double roller. In a^jplying it, the extrem- is ui. 83.— Single and Double Roller Bandage. ity is first folded tightly to make a small cylinder, which is held by its extremities between the thumb and index finger of the left hand, resting by its width between the same fingers of the right ; and while the fingers of the left hand turn the small central cylin ■ der, the band is rolled upon it to its end. Kolling on both ends is done in the same manner. When half of it is rolled, a pin will secure it and prevent it from becoming slack until the other half is made ready to be used. In rolHng the bands, slight traction should be made at intervals by the thumb of the right hand, while the fingers of the left keep the central cylinder steady — the object of which is to have the roller firm, hard and solid. In large establishments, or even in jDrivate practice where great numbers may be required, the use of the smaU apparatus represented in Figure 85 will be found very advantageous, the 95 Fig. 84.— Manner of Roliug a Bandage. band being rolled upon the central rod with facility, and when removed having the necessary qualities of a well-rolled bandage. The general manner of applying a roller bandage is very simjjle. Placing with one hand the end of a single roller, or the middle of a double one, upon the part to be covered, and keeping it steadily in position, the other hand holding the mass of the bandage with Fig. 85.— Bandage Roller. 96 SURGICAL THEBAPEUTICS. the roll turned upwfird, gently draws on it away from the start- ing point, unrolls it, and with it surrounds the entire region in retiu-ning to the starting point. This process is continued until the band is exhausted, when it is secured by j)ins or by strings. Thus appUed, it may be laid in a circular manner, when the turns rest exactly upon each other, or in a spiral manner when they overlap each other in part of their width, or in a crossed or figure of eight manner, when the turns cross each other to meet always at a given point. If they are applied upon cylindrical surfaces, the folds generally He smoothly and evenly upon each other as they are successively formed, but if the region is of conical shape or otherwise irregular in form, one of the borders will adapt itself more readily to the parts than the others. Hence the formation of bulging parts or pockets, which render the smooth and proper apphcation of the bandage very difficult, and may interfere with its sohdity. This is avoided by giving to the roller an obUque half twist, which, while it changes the gaping border in its posi- tion, prevents the slackening of the bandage and removes the pocket. This is principally required in the bandaging of the lower part of an exti-emity (Fig. 86). The apphcation of bands on double roUs is also subject to the Fig. 80.— Uow to Apply a Bdndage. DRESSINGS. 97 rules we iiave given. The completion of the process by the appli- cation of the final dressings and proper finishing steps can scarce- ly be subjected to rules which could not well be framed to meet the varieties in the features and circumstances of the diversified cases constantly occurring in practice. The only strictly general rule that can be established, is, that when a bandage is placed on the outside of a dressing, it must always, first of all, be fixed at the points which are the most essential to secure it and maintain it in its proper place. The proper time for the removal or change of a dressing, is a question which depends for an answer upon the consideration of the nature of the wound, the season of the year, the age and con- dition of the j)atient ; in fact upon all the various circumstances which in the judgment of the surgeon may influence the progress of the cicatrization. On general principles, the first di-essing is not to be removed until the sujopurative process is thoroughly established, which is towards the fourth or fifth day. But there are cases where special circumstances indicate an earUer or a later removal. For examjDle, if the dressing has been applied to control the hemorrhage of a divided blood vessel, from twenty-four to thirty-six houi'S are generally sufficient to obtain the obHteration of the vessel. Again, while it is justifiable to leave the dressing of a foot, which has been subjected to an operation, for eight, fifteen, twenty, and even twenty-five days without changing, and especially in these days of antiseptics when so much is possible in the way of com- bating the suppurative process, there are no doubt cases where it must be looked after earher, as where there is an exhibition of increased pain, instead of the abatement which might be justifi- ably looked for if the operation and the dressing had been properly executed; the increase of pain indicating some compli- cations which early exposure might easily have controlled. There are, however, conditions where the removal of a dressing is in- dicated in some more than in others, as, for instance, when sup- puration is abundant. In these cases, to prevent the retention of the pus in the wounds, and to diminish the danger of its pres- ence, or of its absorption, or facilitate its escape, di-ainage tubes must be used, or the dressing changed. The removal of a first dressing usually involves an attention to minute details not subsequently required, the various parts 98 SURGICAL THERAPEUTICS. which compose it being often impregnated with blood and glued together by concreted pus, causing, if removed carelessly, the laceration of tissues, tearing of granulations, hemorrhages, etc. It must especially be ascertained whether adhesions exist between the material of the dressing, and if they are present they must be thoroughly soaked by means of compresses wet with tepid water, or a warm water bath, if the dressing is upon a region which allows it, as, for instance, one of the extremities. When this is done, the various constituents of the dressings may easily be removed, one by one, but care and deliberation will still be necessary. The smaller particles should be removed with the forceps, not the fingers. If the location allows it we even prefer to wash these away by irrigation, with a stream of luke-warm water, or by soaking thoroughly in a foot bath. The wound is to be cleaned out carefully, by soaking or sopping away the pus with fine sponges, avoiding all rubbing upon the granulations or caus- ing them to bleed. Then studying all the indications, to be dis- covered in the condition of the wound, and avoiding aU unneces- sary manipulations, and attentively removing all causes likely to interfere with the repairing processes, the di'essing is to be re- placed with all the original precautions. As little time as possi- ble, consistent with thoroughness, should be occupied in this process. The wound should be uncovered only as long as necessity requires, the materials for the dressing being all easily accessible without delay or hindrance, being prepared in advance and carefu^Uy inspected. The effects looked for in the application of dressings can be divided into general and special, these varying in their natin'e, according to the object which the surgeon has in view. The first and principal object is to protect the wound from exposure to the action of the atmosphere, and also against contact with foreign bodies, thus to relieve the pain, diminish the inflammatory irritation, and accelerate the cicatrization. It also prevents the retention, by their absorption of the suppuration and serosity which form on the surface. They also expedite recovery b}' maintaining the natural warmth of the body in the region. The sp>ecial effects of dressing, vary according to the special action produced by their application, and these may be considered under several heads. {a) Retentive dressing. — This is designed to keep parts in their RETENTIVE DRESSING. 99 normal condition and situation, and tlius aid in tlierr union or con- solidation, without deformity. It is principally applied xa cases of fractures or dislocations, but finds also its main indication in maintaiuing in. their proper place the mediciual substances which are the active agencies of cure. (b) Uniting dressing. — That which is made with sutures or adhesive plaster, to hold the parts in their proper position, and maiatain their perfect co-aptation. (c) The suspensory dressing, which is a variety of the reten- tive dressing, and serves to support organs of soft textiu-e in some parts of the body, such as the testicles, or the mammae, which by their position are exposed to traumatism by their sit- uation, their weight, and by pulling and bruises. Susjyensories, is the name given to these special bandages ; they are commonly used in diseases of the testicles, and of the udder. {d) Compressive dressings. — These are devised to produce more or less active pressure upon a too active granulating sur- face ; to arrest hemorrhage, to change the vitaHty of some tissues of a morbid nature, or to control the projection of abnormal bony growths. (e) The dividing dressing is the opposite to the uniting. It is of common use ia cases where too rapid closing of wounds is to be prevented. It is applicable in infundibuliform surfaces, ia deep fistulous tracts, and in wounds which are the seat of foreign elements, pathological or other. It operates by keeping the superficial opening of the wound dilated, by means of tents, sponges, etc. (/) Expulsive dressing. — The object of this dressing is to assist the exit of pus from the surface of wounds. A simple dress- ing, by its absorbing properties, is somewhat of an expulsive na- ture. The presence of a single tent of an absorbing quality, as small balls, or padding of absorbent cotton; the application of drainage tubes ; all these facilitate not only the escape of the secretions, but also the discharge of the morbid products. The drainage is obtained by the introduction into the wound of India rubber tubing, of various dimensions, perforated at intervals upon their length, and kept in position by safety pins inserted through them and the skin, at suitable points. These tubes, when extend- ing through the depth of a wound, embracing its whole length, and projecting through a counter opening, as well as through the 100 SUKGICAL THERAPEUTICS. Fig. 87.— Safety Pins. natural ones of the wound, form an excellent means for contin- uous ixTigation, in the treatment of fistulous withers, comj)Hca^ ted poll evil and other diseases. (ff) Antiseptic ih-essiiig. — Is intended to prevent the entrance of micro-organism into wounds, to neutralize their morbific ef- fect, to check their development, and thus prevent their septic in- fluences from taking effect. The apj)lication of the Lister dress- ings, with the care required in the preparation and application by the surgeon ; of the instruments and materials included in the arsenal of pharmaceutical resources, comprising the antiseptic sprays ; the various acids, boracic, carbolic, and salycilic ; the alkaline sulphites and hyposulphites; joermanganate of potash; solutions of bichloride of mercury and of creoline; antiseptic gauze and absorbent cotton — all these, and more constitute dress- ings essentially germifide, which cannot be too confidently recommended to the attention and adoption of the veterinary surgeon. The apphcation of the wadding dressing, so highly recom- mended by some, has given, in our hands very satisfactory results, in many cases. Wadding well prepared and properly appHed, forms an almost invincible obstacle to the introduction of micro-organisms, and according to Pasteur, by its direct action upon the pus renders fermentation impossible. The instruments necessary for the adjustment of dressings, are generally speaking, numerous and varied. They consist of forceps of all kinds, the ordinary dissecting, the buU-dog, the straight, and the curved dressing forceps; scissors, directors. ANTISEPTIC DRESSING. 101 Fig. 88.— Dissecting Forceps. Fig. 92.— Syringi; f-r Uresbing. spatulas, the 8. probe, and others ; syringes, and sometimes atomizers, and also razors, enter into the list of those generally needed. The materials used to form the base of the dressings vary : charpie, wadding, wool, moss and sponges, are employed. Their costliness as respects their commercial value, is probably the reason why they are not more generally adopted in the practice of veterinarians. Oakum is the material, par excellence, 102 SURGICAL THERAPEUTICS. for the application of dressings in veterinary surgery, and is even commonly used in human surgery. We are almost tempted to claim for it the distinction of having been especially created for the benefit of wounded horses, its various and valuable qualities so obviously fitting it for the uses to which it is appropriated in the equine chnic. It is excellent as a defense against the contact of external bodies, and in preserving a uniform temperature in the parts covered by it. From the sponginess of its consistency it readily soaks and absorbs the fluids which form uj)on the surface of a wound, while the tar with which it is more or less imi^regnated confers upon it slight antiseptic properties, which assist in the stimulation, and ai'e in themselves favorable to all the processes of cicatrization. To be of good quality, it must be clean, soft to the touch, and free from any foreign substance. Sometimes it is cut into small portions for use, but more generally in strips, or in such other special shapes as may be required. It is made into balls by spreading out little masses of the fibres, which after being separated from each other, are rolled between the hands, into the required forms and sizes. They are exceedingly convenient in Pig. 93.— Ball of Oakum. constituting the first steps of this aj)plication of a dressing. It is also made into ^:)ar?s or cushions, by stretching the fibres parallel, into any given width and length, and folding them into the simil- itude of a small mattress. This must be soft, and free from lumps, or fragments of wood, and of an even thickness through- FiG. 94.— Pad of Oakum. out. These are made also of various dimensions, the widest and thickest being used to cover the outside of the wound. It is also shaped into dossils, rolls, and tents, or 2:)liigs, the adaptation of which remains yet to be considered. 103 BANDAGES The catalogue of means and appliances for di-essing is by no means exhausted in those already mentioned. Among them are the various forms of compresses, the rollers, the splints, the plates and the means of drainage, with the various forms of rolled ban- dages, wide bandages and mechanical bandages. (a) Coinjoresses. — These are pads made of linen, of various sizes and shapes, and folded to any degree of thickness required, which are sometimes aj^plied immediately upon the wound, but usually uj)on the oakum. They are not, however, of frequent use in veterinary surgery, excej)t under special indications. They may be square, long, triangular, shaped like a neck-tie, or like a Maltese cross, either complete or half, double or treble-tailed, and generally patterned and graduated according to the form required wii -Square Compress. Fig. 96.— Long Compress. Fig. 97.— Triangular Compress. Fig. 98.— Neck-Tie Compress. Fig. 99.— Maltese Cross Complete. Fig. 100.— Half Maltese Cross Complete Fig. 101.— Double Compress. Fig. 102.— Treble Compress. 1 '^"*'- a ihnr :'..< r ilx«a»> . t..-« ^ rsp*Tifor part* f i^.* U>iJj, of Unl laAlktc. pMto. \;M\Mia»d m yom^tam by . U . »r * iM»«f Mid I. FA 105 9 their BiirfACM. They cotiRUit nf k. . Benting together the entire i»u on each KiJe, between the foul iui»i a thinl onJ narrower Motion, introiii and the >.' . . < . . fore a|>i ' anil thf - with till crt»-~ f f>rrt(rufq. . T\U'i- I'arts or sections, repre- •^ole, one section sliding ■lud lire kept in plme by niusvi-rsily between them lit to ascertain, be- ^ between the sole Hi huch close contact I he introduction of the ! .t most commonly used is iitn)duced into wounds ;her chsclmrges, and to various dimensions, as !e thoKe of the purulent iigh«»ut their length, in ■ K that may be jjresent. sometimes introduced . Loig the imi)urities, and to a Vi; to I keep theiu m a cleanly •tat<> to the length and r may be uacd wuh iid\:intal varieties of the wide ban- dage, we ahall borrow from the tcellent work of Peuch and Touaaaint Our reference will be i lat SimpU Frantal. — This isc piece of cloth covering the p-catcr part of the forehea4.1 and \A summit of the head or poll, simitlcHt of btuidagcs. ■ Scabs. — This is the result of careless and in- secure dressing, and in omitting to provide efiective safeguards for preventing the patient from reaching the wound with his own teeth, or rubbing it against some hard object. Suppurating wounds of various dimensions are often the result of this inad- vertency, requiring careful treatment, and sometimes leaving bad blemishes to be regretted. (d) Sloughing of the Skin and Subcutaneous Tissues. — This accident is not uncommon, and like that just mentioned, is the effect of the improper application of the cautery, though less the effect of the firing than of burning the parts, and it is character- ized by all the conditions of ordinary burn wounds. Among specific causes, however, may be mentioned too strong a firing, or firing with lines too near together, or touching each other at some angle, or in crossing, or when too large an iron is used, or one brought to a radiating heat, or too high a temperature; or when greasy substances have been applied in the lines, or the skin submitted to long frictions. All these causes tend to the disorgan- ization of the skin, with mortification and sloughing, and its separa- tion in large patches, leaving after healing, broad, ugly blemishes. #y; 184 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. tions, and because when they become sei'iously disabled, instead of subjecting them to expensive surgical treatment, a wise pecu- niary policy consigns them to the shambles where they may still claim an unimpaired market value ; while a dead horse is (in popular estimation, at least) held to be of no particular worth in theory, that is, whatever may be the unconscious practice of un- inquiring- eaters of "beef." It has been applied, however, in very numerous instances, by Cruzel, Roche, Lubin, Festal, and especially by Lafosse, who rec- ommended its apphcation in articular, muscular and tendinous lameness ; for synovial dilatations, bony growths, anchylosis and luxations, and also in nervous affections, epilepsy, paraplegia, va- rious paralytic cases and amaurosis. The modus operandi is the same as that already described for solipeds, although allowance must be made for the thickness of the skin, which requires a deeper application, and necessitates the repetition of the firing from twelve to fifteen times in the same line, in order to obtain an ordinary effect. The scabs of the firing generally separate in from fifteen to twenty days, and leave pale rose wounds, followed by cicatrizations with a smooth sur- face. The swelling of the parts, and the reactive fever following the operation, is more severe, but subsides quite readily. The animal must be prevented from rubbing or Hcking himself in order to obviate the danger of secondary wounds with their trou- blesome comphcations, as with soHpeds. In smaller animals cauterization is seldom resorted to. In dogs, however, its apphcation is sometimes indicated in lameness of the elbow, the stifle, and even the hip joints. Superficial firing by points has been advantageously applied, and is recommended by Peuch and Toussaint. Accidents or Actual Cauterization. To a great extent, the accidents and failures following the use of the cautery result from the non-observance of the rules estab- lished for the regulation of the operation, and subsequent care- less and incompetent nursing. The remedy for these is too obvi- ous to need mention. (a) Section of the Skin. — This is a very common accident, usu- ally chargeable to the carelessness or incompetence of the sur- EXUTORIES. 187 first description of the seton and its effects was given by Markam, in 1556. But even after that date we read of the use of irri- tating soft pencils, or candles composed of various ointments, melted or mixed together, and introduced under the skin, incised for the purpose, and more or less massed or bruised with some hard substance. But the accidents which were apt to accompany some of these energetic forms of treatment were of so serious a nature that they gradually fell into disuse, and to-day this class of principal exutories includes only the seton in its various forms, the trochiscus and the vesicating preparations. Exutories act as counter irritants, resolvents, and alteratives. The irritation which follows their contact with the living tissues excites the purulent secretions, and the activity in the process of interstitial resorption, which they stimulate, render their adoption and frequent use a source of much benefit and great satisfaction to the veterinary practitioner. The list of ailments in which their value is manifest and unquestioned is a long one, and com- prehends affections of the chest, catarrhal inflammation of the air passages, and affections of the abdominal organs, with those of the eye, and in dogs of the ear. They stimulate the resolution of local afiections having a tendency to chronicity, for example, oedematous swellings of the extremities, and they are frequently indicated in diseases of the locomotory apparatus, in certain af- fections of joints, and in rheumatic lameness, and also to excite the resolution of soft tumors, especially those of the synovial structures. The most ehgible of the forms in which exutories are prepared, especially when they are designed to act as a means of drainage, or to prevent the accumulation of pus in anfractuous cavities, is the seton. It is recommended in nervous affections and in paralysis, and also for the relief of atrophied regions, and, according to Bouley, it may often become a means of diagnosis, as well as of prognosis. In an acute disease having a tendency towards recovery, a seton will have an ii'ritating effect, and give rise to a phlegmous swelling about its tract, while in the same disease, if the tendency be toward a fatal termination, the artificial suppuration which it causes will soon cease to flow, and the tract will remain compara- tively dry. There have been those who have made the seton a prophylac- tic agent, or insurance institution, to be made use of at certain 188 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. special periods or seasons of the year, and have thus invented the seton of prevention or of precauiion, but without satisfactorily demonstrating what is to be prevented, or what anticipated. The theory, if any, in which such an assumption originates cannot be certified, and honest veteriaarians cannot themselves identify it with such a practice or pretext. If exutories are a frequent resort, and are highly appreciated in veterinary surgery, and their general use is commonly unat- tended with danger, yet they are not always so absolutely harm- less that they may be trifled with, and prescribed without due consideration of the peculiar conditions under which their use is contra-indicated. It cannot be rationally supposed that the potency to which they owe their beneficial effect when rightly du-ected is to vanish when it is erroneously applied, and that it can be made innocuous by misdirecting it. Animals debilitated by hea\'y work or by disease ; those affected with chronic organic ailments; those threatened with eruptive diseases, or suffering with septic complaints; none of these are fit subjects for the application of exutories. SETONS. A seton is a form of exutory which consists in the introduction of a foreign substance under the skin, ordinarily a band of linen tape, or a leather ring. The former is known as the tape seton, while the second is more appropriately termed a rowel. Tape Seton. This is usually merely a piece of clean, white tape, of suitable width and length as required by the case. In some circumstances, however, cords or braids of lint or horse-hair are substituted. The seton may either be introduced under the skin alone and dry, or it may be saturated with some irritating fluid, or covered with a stimulating ointment, to increase its effect and promote the purulent secretion. The operator must not fail to allow a suffi- cient length to securely tie the ends which pass out at the two openings of the tract through which it is drawn. Yet they are not always secured by an ordinary knot, but are quite generally united by a species of twist upon their extremities, which can be readily loosened when it becomes necessary. This knot must be sufficiently wide and strong to prevent it from sHpping thi-ough SETON NEEDLES. 189 Fig. 316.— Seton Knots. the incision. In some cases, instead of making a knot on tlie tape, small wooden pins are secured at the extremities, and answer the same purpose. The essential instrument required to apply a seton is the pecuHar needle known as the seton needle. It is, of course, made various lengths, some consisting of but a single piece (Fig. 218); I i Pig. sir. Fig. 218. Fig. 219. SETON NEEDLES. Fig. 220. Fig. 221. '■ 190 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. while others are in two or three sections, connected by screw joints (Figs. 219, 220, 221), and in some few instances fitted to handles (Fig. 217). But however they may otherwise vaiy, they are in the general form of a stiff, iron rod, with one lanceolated extrem- ity, both edges sharp, and a large eye at the blunt end to receive the tape. The lanceolated portion is slightly curved on the flat side. There are also other forms designed for special objects, among which may be mentioned one which is used for passing a seton through the frog of the foot, and is therefore known as the frog seton-needle. Fig. 222.— Frog Seton Needle. For small animals, such as the dog, the smaller sized straight needles are often suitable, and the one which is used for making the quill-suture is very convenient. Besides the seton needle proper, in its authorized and usual patterns, occasions sometimes occur when to meet special require- ments, a straight, pointed bistoury and a pair of scissors are re- quired as adjuncts. Fig. 223.— Quill Suture Needle. The operation of setoning is comparatively a bloodless one, and the division of the cellular tissues through which the needle passes is very often made without any hemorrhage. Yet there are regions where more or less blood may subsequently escape. A region, therefore, where the cellular tissue is abundant and loose, is that which is most favorable for the introduction of setons. The modus operandi is simple. The hair must be closely cHpped from about the points selected for the two prehmiuary punctures, one for the entrance and one for the exit of the needle, ssvAV- SETON NEEDLES. 191 -.ind tlie patient must be properly secured. Certain nervous ani- mals may oblige the surgeon to place them in the recumbent posi- tion, but oiu' experience has taught us that the cases in which this is necessary are very exceptional, and that in the great majority •of operations, the simplest means of restraint, a twitch, with the raising and securing of one or two of the extremities, is all that is required. The apphcation of local anesthesia, so far as it may be practi- cable, is also a measure which is in all respects judicious and com- mendable. With the spraying api^aratus, any part of the body can be reached with great facility. In introducing the needle, many veterinarians pass it dh-ectly through the skin, which is raised in a fold, and drawn away as far as possible from the deeper tissues. This maybe readily practica- ble in regions where the cellular tissue is very loose and abimdant, as under the chest ; but it is much less so, and more dangerous where the skin is thick, and the subjacent connective tissue is de- ficient or scant, and especially if the edges and point of the needle are not perfectly sharp. For this reason the method preferred by many is more judi- cious, of making an incision with the straight bistoury through the skin at each of the two extremities of the proposed tract through which it is intended to pass the seton. The manipulation is sufficiently easy and simple, the operator holding the skin in a fold with one hand, while with the other he guides the needle under the skin and parallel with it, through the cellular tissue, entering through one of the punctures made with the bistoury, and emerging through the other. The point most important to observe here is that of so guiding the needle in its motion that it shall neither plunge into the deeper tissues nor emerge outwardly at the wrong place. At this point the scissors may be utilized by laying blades flatwise over the place of exit, and pressing down the sm-face. Directions are sometimes given, as the next step, to insert the tape into the eye of the needle, but it would seem that the safer plan would be to have the tape already in place when the needle is introduced. After the tape has been drawn through, and the needle disengaged, the next and final step is either to vmite the ends of the seton by a knot, or, without tying, to secure them separately by the twisting or plaiting already described, and leave them free. 190 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. while others are in two or three sections, connected by screw joints (Figs. 219, 220, 221), and in some few instances fitted to handles (Fig. 217). But however they may otherwise vary, they are in the general form of a stiff, iron rod, with one lanceolated extrem- ity, both edges sharp, and a large eye at the blunt end to receive the tape. The lanceolated portion is slightly curved on the flat side. There are also other forms designed for sjDecial objects, among which may be mentioned one which is used for passing a seton through the frog of the foot, and is therefore known as the frogf seton-needle. Fig. 222.— Frog Seton Needle. For small animals, such as the dog, the smaller sized straight needles are often suitable, and the one which is used for making the quill-suture is very convenient. Besides the seton needle proper, in its authorized and usual patterns, occasions sometimes occur when to meet special requii-e- ments, a straight, pointed bistoiuy and a pair of scissors are re- quired as adjiincts. Fig. 223.— Quill Suture Needle. The operation of setoning is comparatively a bloodless one, and the division of the cellular tissues through which the needle passes is very often made without any hemorrhage. Yet there are regions where more or less blood may subsequently escape. A region, therefore, where the cellular tissue is abundant and loose, is that which is most favorable for the introduction of setons. The modus operandi is simple. The hau' must be closely cHpped from about the points selected for the two preHminary punctures, one for the entrance and one for the exit of the needle, APPLICATION OF TAPE SETONS. 103 wound be neglected because the seton has been removed, but it must receive needed attention for several days. The openings of the tract will still require cleaning, and the residue of the pus will still requu'e the aid of pressure to effect the final emptying of the wound. Tape setons are applied upon all parts of the body, but more frequently, of course, in regions where their therapeutic effects are most needed, for which reason they will be most commonly found on the breast, the ribs, the shoulder, the hip, the thigh, the stifle, the abdomen, the neck, the cheeks and the foot. (a) The Breast. — This is a very common location for the setons. In inserting it the animal is secured in the usual w\ay, but to pre- vent his striking the operator with his fore feet it will be necessary to have one of his hind legs raised and firmly held. If there is but one seton it must be introduced on the median line ; if two, one on each side of it. The position assumed by the operator varies, according to the ability he possesses, and the hand with which he operates. If ambidexter, and but a single seton is to be introduced, he can operate from either side of the animal, and if two are to be insert- ed, he can change the needle from one hand to the other, to suit his convenience, without change of position. This seton is to extend from the anterior extremity of the sternum downward and backward, under the chest, or between the fore legs, backward beyond the elbow. When the incision of exit has been made, and the tape introduced into the eye of the needle, the instrument must be drawn away in the direction op- posite to that in which it was introduced, to avoid the possibiHty of doing injury with the point or the edges. {Jjl) On the Ribs or the Chest. — Setons are used in these regions for the treatment of diseases of the thoracic organs. Sometimes as many as three are applied, either on one or both sides of the chest. They should be placed in a slightly oblique dii'ection from before backward and from above downward, beginning about the middle of the side of the thorax, and ex- tending as far as the lower border of the chest, occupying, there- fore, the lower half of the thoracic cavity. The manner of insert- ing the seton in the tract made by an incision with a bistoury through a fold of the skin has been already described, and a repetition in minute detaU becomes iinnecessary. 194 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. Care must be taken wliile operating in tliis region to avoid wounding the spur vein, wliicli can be done by raising the skin well from it when the point of the instrument has reached its course, by which movement the needle passes outside of the vein and can be brought outside on the inferior border of the thorax. The tape is then placed in the eye of either the needle or the blade as already frequently described. Our own practice is to secure the taj^e through the eye of the blade, and draw the tape into position by removing the needle from below upward, considering this j^lan to be both more convenient and less dan- gerous. (c) At the Shoulder. — Setons are often applied in this region against lameness of old standing; at times only one, at others two, or even more, according to the extent and location of the dis- eased region. When aj)plying more than one, they are commonly placed parallel with each other. Many practitioners place them crossing each other, meeting in the middle of their length, with then- point of meeting on a level with the center of the scapulo- humeral joint. In placing them, the compound, or three-jointed needle, somewhat flexible (already described), will be necessary, as being capable of adapting itself as much as possible to the convexity of the joint. Some care is required in the selection of a proper place for the puncture, and the animal must be kept in the standing position as much under restraint as possible. There is probably no special rule for the location and direction in which setons should be applied, the discretion of the operator, in many cases, furnishing the only guide. This is well illustrated in the application of the monstrous " seton a la Gaulet^^ so called from its inventor, and which consisted in surrounding the entii-e scapular surface with one immense seton, beginning at the cer^dcal angle of the scaiDula, running along its anterior border to a point below the shoulder, passing in front of the breast to the axilla, through that region, horizontally back on a level with the elbow, to return outward and then upward to the dorsal angle of the scapula, where it ended. This form of exutory is no longer toler- ated, the dangers attending it, from the severe and exhausting drainage of the organism having brought it into discredit, with the resvdt of its dismissal from general practice. A seton at the shoulder requu-es special protection from the animal, by means of the cradle or the side bars, its location APPLICATION OF TAPE SETONS. 195 making it too easily accessible to his teeth to be suffered to re- main long in place without such a defence. (d) Setoii at the Ilijy-J'oint. — Lameness of this region is fre- quently treated by the tape seton, the conditions of their applica- tion being nearly identical with those reqviired when the shoulder is the region involved. They are placed, whether single or dou- ble, directly over the articulation, or crossing each other in the X form, and also over the center of the joint ; and care must be taken that they are not inserted so obliquely as to interfere with the free flow of the pus. A needle similar to that used with the shoulder will be found convenient, and for a similar reason, the thickness of the skin, and the closeness of its connection with the sub-tissues, will render necessary the preliminary incisions with the bistoury to facihtate the entrance of the needle ; and the con- trol of the animal, as he is to be treated on his feet, should be secured by supplementing the restraint of the twitch with that of the side lines, and raising one of the hind legs. (e) Setons at the Thigh. — These are prescribed in chronic swelling of the hind legs. The region they should cover extends from a level with a point a little below the inside of the ischial tuberosity to the superior third of the shank, and they should be placed in a slightly obUque direction from without inward. It is necessary while operating here, as in the hip-joint, to have the animal well secured, and not only the twitch and the side-lines, but sometimes the raising of one of the fore foot will be required ; as of all setons, this is probably the most painful to insert, in con- sequence of the division of branches of the sciatic nerves, which He in the course of the needle. The steps of the operation do not in any way vary from those in other regions, and therefore do not call for a redescription excepting perhaps to specify that in placing the tape the convexity of the blade must be turned in- wardly, and an assistant will be needed to hold the tail aside. The tying of the tail to the surcingle on the opposite side of the body will prevent its becoming soiled with the discharge of the seton, and render the subsequent care of the patient easier. {f) Setons at the Stifle. — This seton is recommended by Peuch and Toussaint in lameness of that region which has resisted vesi- cating liniments and blistering applications. They recommend the recumbent position for the safety of the operator. A convex bistoury and the ordinary seton-needle are required. The animal 196 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. while lying down has his hind leg extended by the traction made upon it by assistants with a rope. An incision is made above with the bistoury, and the needle introduced through it, it is pushed downward in front of the joint, carefully i-aising the skin as it progresses, to avoid injury of the femoro-patellar articulation () With the Bistoury. — A\Tien the tumor is comparatively small, with a narrow peduncle, its removal is effected in the same manner as with the scissors, the only change being in the stroke of the instrument. Usually a single stroke of the bistoury is suf- ficient. But if the tumor is of large dimensions and covered by the skin, the operation becomes more complicated and requires more time and care. It is ordinarily divided into three steps, viz. : the incision of the skin, the dissection of the tumor, and its extir- pation. The form and size of the incision must of course correspond to those of the tumor, which must be considered in reference to its basis, connections, adhesions and surrounding tissues, as well as the healthy or morbid condition of the teguments. The straight incision is ajiplicable to subcutaneous tumors, free from adhesions or comparatively loose and susceptible of enucleation, while that made through a fold of the skin is better adapted to encysted growths, which it would be dangerous to open. The elliptic incision is used when aj)ortionof the skin is to be removed, because of its being diseased or too thin, and its closing up would be too difficult; or when the extent of the skin exceeds that of the wound it covers. Crucial incisions, or those of the T or Y shape, are indicated when a tumor of large size is to be exposed, 202 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. while it is necessary to preserve the skin which covers it. "^Tiat- ever form of incision may be used, it must always extend beyond the base of the tumor to allow a free dissection and an easy removal of all the diseased tissues. The convex bistoury is preferred in this step of an operation and must be applied with light pressure, and a very guarded motion, to avoid any subcutaneous blood ves- sels that may run over the surface of the growth, and which may be of large size. The incision is followed by the dissection, which is done with the scalpel or the bistoury, by separating the tumor from the teg- uments, carefully avoiding surrounding structures, which should be held aside with the forceps or tenaculum, in order to keep the wound open and accessible. Instead of the scaljiel or bis- toury, the blunt end of the scissors sometimes becomes the in- strument by which the adhesions of the cellular tissue covering the tumor are most easily destroyed. In the third step, or the extirpation of the tumor, either the bistoury, the scalpel or the sage knife may be the most eUgible in- strument, according to the consistency of the tumor, whether hard, cartilaginous or bony If it is of sufficiently small size, by steady- ing it with the forceps or tenaculum, it may be excised with a single stroke of the instrument. If too large for this, it may be controlled by passing a loop of ribbon or tape through it, by which its position can be changed at pleasure, to facilitate its com^Dlete dissection. The hemorrhage following may be arrested by any of the usual hemostatic measures. When the tumor is of large di- mensions this last step of the operation will require great care in the execution, and the blood vessels which may run through its base must be securely Hgated before the tumor is entirely excised. Fig. 226.— Ecraseur of Chassaignac. ABLATION OF TUMORS. 203 (c) With the Ecrai^eiir. — The instrument used iu this method has received its name from the fact of its crushing action ujoon the tissues upon which it is apphed and for which it was invented by Chassaignac. The original form of the instrument of Chassaig- nac has been subjected to various modifications, some being made to use with a chain alone, others to carry a wire, and others again to carry a chain or a wire alternately. Others like that of Beynal, of IVIiles, of Smith, and many others, vary also in shape or in size, but without differing in their general principles, and whether employed for the removal of tumors, or in special operations, as Fig. 227.— Ecraseur with Wire. Fig. 228.— Ecraseur with Chain or Wire. those ot castrations in males, or spaying in females, the modus operandi remains the same. This consists in enclosing the base or peduncle of the tumor with the chain or wire of the instru- ment, and tightening it more or less rapidly at the discretion of the operator, by means of the screw in the handle until it is com- pressed, strangulated and crushed, and at last entirely separated. The action should be more or less gradual, according to the size of the parts and the consistency and vascularity of the tissues. A 204 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. Fig. 229a.— Haussman Ecraseur. slow movement of the ecraseur is essential to avoid hemorrhage, but although this rule is recommended by Eiu-opean authors, it does not seem to be as important as it is reported to be, if we may judge by the results obtained by American practitioners, in view of the manner in which they use this instrument in the operations of castration. Our experience, however, justifies a slow and careful application of the crushing process, especially in the removal of tumors where blood vessels of large size or in a state of disease may be known to ramify, and particularly in the ablations of the champignon of castration. ABLATION OF TUMORS. 205 {(I) With the Thermo- Cautery. — The ablation of tumors can also be performed with the flat i^latinum cautery of Paquelin, well heated, by following the same rules as with the bistoury, both when either the growths are small, or the incision of the skin and dissections of the tumor have been previously performed. The advantages gained by the use of the red-heated cautery in controlling the hemorrhage while the incision goes on, is too ob- vious and important to be ignored or depreciated. 2d. — Ligature. The ligatiu'e operates on the tumor in its o^vn peculiar and effective way, by circumscribing the base and deiDriving it of its nutriment by occluding the circulation and leaving it to undergo the process of gangrenous dissolution and sloughing, with the ad- vantage of obviating any apprehended danger of subsequent hem- orrhage. The kind of ligatures used for this purpose will vary with the choice of the practitioner. In veterinary surgery, the material is variously flax, hemp, silk, catgut, india rubber cords, or metaUic wire. Whipcord or fishing line is often used, when a powerfvd constriction is to be apj)lied, and their efficiency is in- creased by being waxed or soaped. There are various ways of aj)plying a ligature, but they are all subject to the following rules: the size of the ligature must be proportioned to that of the parts to be Hgated, and to their resistance ; it ought to be ajiplied only upon a Hniited portion of the tissues, and the skin ought never to be included, except when the peduncle is very narrow, or the skin already ulcerated. Mrst Method, Simple Ligature. — A cord or band is affixed around the base of the tumor, and tightly tied by a single knot. Sometimes the bleeding knot or double clove-hitch is preferred, drawn tightly and secured by a simple knot. The mortification of the growth may be accelerated, if thought proper, by covering the ligature with some caustic jDreparation, such as an ointment of sulphide of arsenic, or also by adding to the effect of the hgature that of the actual cautery. Second Method, Double Ligature. — This is brought into requisition when the peduncle of the tumor is too large to be easily embraced by a sin- gle ligature. It is made by i)iercing the l^ase of the j,j^_ ssa-Tapeetry growth thi-ough the centre, by means of a straight Ligature. OPEEATIONS UN THE SKIN AND CELLUI^B 5«tTX. needle with a double tUrea.1 or cord, thus uid out at the other sie; then, Ora ^ ing out the first, two double ligatures are left, c one for eac quarter of the tumor. .Ul that then remains is le tying of tne four knots. ^ 1 in To describe it more iu detail, tbo female needi is insertea i •i •V*- -^ 1A'-«V«^«\%^^%^ 201 Fto. m.-lM Slop of the Uotar bj Four. Fio. flB.-M nu»p of Uio Lljranirt' br Four. lilt- {^rrowtb until the . is introiluctHl ut u ri;,-; as ill Fig. 234, to !><• Jr;i .. :. ciin-viijg the ligiituroM wjtli i! In the iMH'uiul Ht<'|) »>f tl • ueedlf through the tuin-»r \\ . jiiul hy the wjtiinition of th- thrimln Jire left Iijoho. Tin f the tumor, when one of tin t i «tfj) being r.itiiiil. t..,) l,v i ;lie «entre, whi-u the nude ueeiUe it, iiud pusHetl through the eye, a the op|X>8itc Biile of the tuuior 1-. 2:ir>). I < ration, the pannage of the iiiije :lie ilouhU* hgaturo iH compUtetl, • He from one of the thnjuln, two lie ne«'tlle in then j»ushetl througli (Is iu cut otr (Fig 230) ; the fourtli ' the femiile ntHulh' drawn back Fia. 298. -9d au»p of Uie Ugaturr* bjr Four. .—1th St«»p of tho Ligature by Four. through its original tract -wit the last threads or loop (Fig. 237), and when the needle is fiuidly parated, it leaves the tumor di\-ided into four segments by four treads, whose extremities are di-awn and tightly secured by a sin-z: knot (Figs. 238, 239). 206 OPERATIONS ON THE SKIN AND CELLULAE TISSUE. needle with a double thread or cord, thus dividing the growth into separate halves, each having its own distinct ligatiu'e, tied on opposite sides of the peduncle. Third Method, Midtiple Ligature. — At times, the tumor may have a sufficiently wide base to require the addition of a third ligature in order to secure a sufficient amount of constriction to slough the entire mass, in which case special needles become necessary. These are longer than the ordinary ones, though more or less flexible, and with an eye in the centre, additional to that at the extremity, according to indications. When the tumor is to be divided into three j)ortions two needles are necessary, and a correspondingly long thread. The needles being passed together through the base of the tumor, with sufficient intervals between to divide it into three nearly equal Fig. 231.— Treble Ligature. parts, leave, when drawn through, three hgatures with which to enclose separately the central and two lateral portions of the l^eduncle. If it becomes necessary to aj)ply four ligatures, two different needles are necessary, one (female) long, having an eye in the Fig. 232.— Female Needle. Fig. 233.— Male Needle. centre, and another (male) of the ordinary form, with the eye at its extremity, but of a size which will permit its passage with a double thread through the central eye of the other. This male needle is to carry a long, double thread. The manipulation is very obvious. The first needle is inserted far enough to bring the central eye half way through the growth, and the second needle is passed through it, and out at the other side; then, di-aw- ing out the first, two double ligatures are left, or one for each quarter of the tumor. All that then remains is the tying of the four knots. To describe it more in detail, the female needle is inserted in ABLATION OF TUMOKS. 209 Fig. 242.— 2d Step. Fig. 243.-3(1 Step. extremities come out by the same opening (Fig. 243), while a sec- ond thread, f f, is free between the superior and the two lower thii'ds of the tumor (Fig. 244). The manipulations for the superior third of the growth are repeated for the lower third, with another thread, and the middle third is then surrounded by two parallel threads A, B and C, D (Fig. 245). Fig. 244.— 4th Step. Fig. 245.— 5th Step. Both of these two threads are passed into the curved needle, and it then becomes easy to carry under the skin the extremity of the thread B to the opening D, and the thread A to the opening C, where it will be tied to thread B. AU the threads A, B, C, D will thus form a loop embracing the middle third of the growth, as the other threads wiU surround the upper and the lower thirds. All the ligatures can be then tied to the required degree and the operation is completed (Figs. 246, 247). Fig. 216.— The Ligatures in Position. Fig. 247.— The Ligature Secured. When the ligature that is to apply the necessary constriction upon the base of the tumor is in place, it must be tied more or 210 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. less suddenly and firmly, but never with sufficient force to pro- duce an immediate section, an operation which could have been more easily performed, and with less pain, with the bistoury. To avoid this section, apply the constriction slowly, and in accordance with the effects produced, and the resistance encountered by the ligature. If the tissues are soft and frangible, it would be unsafe to comjolete the constriction at once, and it should be deferred to a later period ; if, on the contrary, it is hard and resisting, the ligature may be drawn tightly, and firmly tied at once. Ordinary traction on the ligature may be made with the hands only, but when extra strong and steady traction is required, wooden holders will prove of great assistance. These means of securing the Hga- ture on the tumor are successful so long as it is comparatively superficial, but if it is situated at a certain depth, special instru- ments are required. Among these is one particularly adapted to the removal of growths from the natural cavities, such as the nasal, rectal, vaginal or inguinal regions. It consists of a wooden or metallic tube, of variable length, through which the loop of a double, strong, waxed hgature can be introduced into the cavity Fig. 248.— Ligature Carrier. and adjusted around the base of the tumor, and when in position, tightened by traction on the thread at the mouth of the tube, and so secured that the constriction can be maintained at any degree of tightness, and increased or relaxed at pleasure. 3d. — Elastic Ligature. This is but a variation from the ordinary ligature, in which an india-rubber cord or tubing of suitable diameter is substi- tuted for the other means of constriction. It is applied like the others at the base of the tumor, and secured in the same manner. The peculiarity of its action arises, of course, from its elasticity, the result of which is a constant unrelaxing, self-regulating con- striction, which continues automatically until the ablation is eifected. The growth upon which the elastic Hgature is apj)Hed soon begins to undergo changes, which may be at first unnoticeable. ABLATION OF TUMORS. 211 But presently it becomes cooler, the skin becomes soft, flabby, and of a dark brownish color ; the mass becomes dry and con- tracted, and in from fifteen to twenty days it drops off, leaving a wound which heals in the usual manner. The use of this Hgature is, we believe, principally advantage- ous for small growths, and we have obtained good results from it in the castration of medium or small-sized animals, as weU as in the treatment of small and superficial tumors, as warts, and the like. But in respect to large growths, such as the fibromas of the elbow joint, from the enormous size of the wovmd which follows, and the excessive length of time this requires to heal, we cannot feel justified in recommendiag it ia similar cases. 4th. — Removal by Tearing. This is a method of extirpating tumors by mere force, grasp- ing them with one hand or with the forceps, and with the other they are simply — with a twisting motion — torn from their connec- tion. Of course it can only be practiced on small growths, but it has the advantage of preventing hemorrhage, and can be performed with the hands alone, or Avith the assistance of special forcej^s or nippers. The princii^al objection is that it sometimes fails to remove the fundamental element of the growth, and a renewal of the trouble may be looked for. 5th. — Puncture. This subject has already been partially considered. It is per- formed with either the bistoury, the lancet, or the trocai", but it is princiiDally appHcable to soft tumors only, and as by its un- aided action it is ordinarily insufficient to effect their complete disappearance, it becomes necessary to resort to instrumental help, in which cauterization with the pointed red iron, blistering applica- tions, or the injection of irritating or modifying compounds, as solution of tincture of iodine, become the efficient adjuncts, if not in truth the actual cm-atives. CHAPTEE VI. OPERATIONS ON BONES. FEACTURES. In technical language a fracture is a '• solution of continuity in the structure or substance of a bone," and it ranks among the most serious of the lesions to which the horse — or any animal — can be subject. It is a subject of special interest to veterinarians, and to horse owners as well, in view of the variety of forms in which it may occur, as well as of the loss of time to which it sub- jects the patient, and the consequent suspension of his earning capacity. Though of less serious consequence in the horse than in man, it is always a matter of grave import. It is always slow and tedious in healing, and is fre- quently of doubtful and unsatisfactory result. This solution of continuity may take place in two principal ways. In the most numerous in- stances it includes the total thickness of the bone and is a compUte fractiu-e. In other cases it in volves a portion only of the thickness of the bone, and for that reason is described as incom2')lete (Fig. 250). If the bone is divided into two separate portions, and the soft parts have received no injury, the fracture is a simj^le one ; or it becomes comjyound if the soft parts have suffered laceration, and comminuted if the bones have been crushed or ground into fragments, many or few. The direction of the break also determines its further classification. Broken at a right an- p-le, it is transverse (Fig. 251) ; at a Fig. 249.— Complete °' ° Fracture different angle it becomes oblique FRACTURES. . 213 (Fig. 252), and it may be longitudinal or lengthwise. In a com- plete fracture, especially of the obHque kind, there is a condition of great importance in respect to its effect upon the ultimate re- sult of the treatment, in the fact that from various causes, such as muscular contractions or excessive motion, the bony fragments do not maintain their mutual coaptation, but become separated at the ends, and this fact has made it necessary to add another descrip- tive term in the words — loith displacement. And this term again suggests its negative, and introduces the fracture loithout displace- FiG. 251.— Transverse Fracture of the Radius. Fig. 252.— Oblique Frac- ture of the Femur. 214 OPERATIONS ON BONES. me7it, when the facts justify this description. Again, a fracture may be intror-articular or extra^artlcular, as it extends within a joint or otherwise, and once more, intra-periosteal, when the j)eri- osteum remains intact. And, finally, there is no absolute Hmit to the use of descriptive terminology in the case. The condition of displacement is largely influential in deter- mining the question of treatment, and as affecting the final result of a case of fracture. This, however, is dependent npon its loca- tion or whether its seat be in one or more of the axes of the bone, in its length, its breadth, its thicknsss, or its circumference. An incomplete fracture may also be either simple or comminuted, the periosteum, in the latter case when it is intact, keeping the frag- ments together, the fracture in that case belonging to the intra- periosteal class. At times there is only a simj^le fissure or spht in the bone, making a condition of much difficulty of diagnosis. Two varieties of originating cause may be recognized in cases of fracture. They are the predisposing and the occasional. As to the first, different species of animals differ in the degree of their liability. That of the dog is greater than that of the horse, and, in horses, the various questions of age, the mode of labor, the season of the year, the portion of the body most exposed, and the existence of ailments, local and general, are all to be taken into account. Among horses, those employed in heavy draught work or that are driven over bad roads, are more exposed than light-draught or saddle horses, and animals of different ages are not equally liable. Dogs and young horses, with those which have become sufficiently aged for their bones to have acquired an enhanced degree of frangibility, are more Hable than those which have not exceeded the time of their adult prime. The season of the year is undoubtedly, though in an incidental way, an imj^ortant factor in the problem of the etiology of these accidents, for though they may be observed at all times, it is during the months when the shppery condition of the icy roads renders it difficult for both men and beasts to keep their feet, that they occur most frequently. The long bones, those especially which belong to the extremities, are most frequently the seat of fractures, from the circumstance of their superficial position ; their exposure to contact and collision, and the violent muscvdar efforts involved both in their constant rapid movement and their labor in the shafts or at the pole of heavy and heavily laden carriages. FEACTUEES. 215 The relation between sundry idiosyncrasies and diatheses and a hability to fractvires is too constant and well established a path- ological fact to need more than a passing reference. The history of rachitis, of melanosis, and of osteo-porosis, as related to an abnormal frangibility of the bones, is a part of our common medi- cal knowledge. There are few persons who have not known of cases among their friends of frequent and almost spontaneous fractures, or at least of such as seem to be produced by the sHghtest and most inadequate violence, and there is no tangible reason for doubting an analogous condition in individuals of the equine constitution. Among local predisposing affections, mention must not be omitted of such bony diseases as caries, tuberculosis, and others of the same class. Occasional or "efficient" causes of fracture are in most instances external traumatisms, as violent contacts, collisions, falls, etc., or sudden muscular contractions. These external acci- dents are various in their character, and are usually associated with quick muscular exertion. A violent, ineffectual effort to move too heavy a load ; semi-spasmodic bracing of the frame to avoid a fall or resist a pressure; a quick jump to escape a blow; stopping too suddenly after speeding; struggling to liberate a foot from a rail — perhaps to be thrown in the effort — all these are familiar and easy examples of accidents happening hourly, by which our equine servants become sufferers. "We may add to these the fracture of the bones of the vertebrae, occurring when a patient is cast for the purpose of undergoing a surgical opera- tion, cpiite as much the result of muscular contraction as of a j^re- existing diseased condition of the bones. A fracture occurring under these circumstances may be called with jDropriety hidirect, while one which has resixlted from a blow or a fall differently caused is of the direct kind. The symptoms belonging to the existence of fracture vary ac- cording to the site of the lesion. In case of its being on a bone of the extremity there is irregularity in the performance of the functions of the apparatus to which the fractured bone belongs, and as a necessary consequence of the existing lesion, lameness more or less marked. If the broken bone belongs to one of the extremities, the impossibility of the performance of its natural function, in sustaining the weight of the body and contributing to the act of locomotion, is usually complete, though the deo-ree of 216 OPERATIONS ON BONES. powerlessness -svill vary according to tlie kind of fractui-e and tlie bone wliicli is injured. For example, a fracture of the cannon bone without displacement, or of one of the phalanges which are siH"rounded and sustained by a complex fibrous structru'e, is, in a certain degree, not incompatible with some amount of resting of the foot. But, on the contrary, if the shank bone, or that of the forearm be the impHcated member, it would be vei-y difficult for the leg to exercise any agency whatever in the support of the body. And in a fracture of the lower jaw, it woiold be ob\dously futile to expect it to contribute materially to the mastication of food. A fracture seldom occurs which is not accompanied with a degree of deformity, greater or less, of the region or the leg affected. This is due to the exudation of the blood into the meshes of the surrounding tissues and to the displacement which occurs between the fragments of the bones, with subsequently the swelling which follows the inflammation of the surrounding tissues. The character of the deformity will mainly depend upon the manner in which the displacement occurs. In a normal state of things the legs perform their movements with the joints as their only centres or bases of action, wath no participation of intermediate points, while with a fractm'e the flexibility and motion which will be observed at unnatural points are among the most strongly characteristic signs of the lesion. No one need be told that when the shaft of a limb is seen to bend midway between the joints, with the lower portion swinging freely, that the leg is broken. But there are still some conditions where the excessive mobility is not easy to detect with certainty. Such are the cases where the fracture exists in a short bone, near a movable joiut, or in a bone of a region where several short and small bones are united in a group, or even in a long bone where its situation is such that the muscular covering prevents the visible manifestation of the symj)tom. If the situation of a fractui'e precludes its discovery by means of this abnormal flexibiUty, other detective methods remain. And after all there is one decisive sign which, though it may not avail in every case, as it does not, is in cases where its testimony can be secured absolute and positive beyond question. This is crep- itation, or the peculiar effect which is joroduced by the friction of the fractured surfaces one against another. Though discerned FRACTURES. 217 by tlie organ of hearing-, it can scarcely be called a sound, for the grating of the parts, as the rubbing takes place, is often more felt than heard, but thei-e is no mistaking its import in cases favorable for the apphcation of the test. The conditions in which it is not available are those of incomplete fracture, in which the mobility of the i:)arts is lacking ; and those in which the whole array of phenomena are usually obscure. To obtain the benefit of this pathognomonic sign requires deliberate, careful, and gentle man- il^ulation. Sometimes the slightest movements will be sufficient for its develoj)ment, after much rougher handling has failed to discover it. Perhaj)s the failure in the latter case is due to a sort of defensive spasmodic rigidity caused by the pain resulting from the rude interference. More or less reactive fever is a usual accompaniment of a frac- ture, and an ecchymosis of the j)arts is but a natural occurrence, more easily discovered in animals possessing a light-colored and delicate skin than in those of the opposite character. There are difficulties in the way of the diagnosis of an incom- plete fracture, even sometimes when there is a degree of impair- ment in the function of locomotion, with evidences of pain and swelling at the seat of lesion. There should then be a careful examination for the evidences of a blow or other violence sufficient to account for the fracture, though very often a susj)icion of its existence can only be converted into a certainty by a minute his- tory of the patient if it can be obtained up to the moment of the occurrence of the injury. A diagnosis ought not to be hastily pronounced, and where good ground for suspicion exists it ought not to be rejected upon any evidence less than the best. Serious and fatal complications are too often recorded of the results fol- lowing careless conclusions in similar cases, among which we may refer to one instance of a complete fracture manifesting itself in an animal during the act of rising up in his stall after a decision had been pronounced that he had no fracture at all. Fractures are of course liable to comphcations, those esj)ecial- ly, from the nature of the case, which are of a traumatic character, such as extensive lacerations, tearing of tissues, punc- tures, contusions, etc. But unless these are in communication with the fracture itself, the indication is to treat them simply as independent lesions uj)on the other parts of the body. A traumatic emphysema will at times cause trouble, and abscesses, 218 OPERATIONS ON BONES. more or less deep and diffused, may follow. In some cases small bony fragments from a comminuted fractm-e, becoming loose and acting as foreign bodies, may give rise to troublesome fistulous tracts. A frequent complication is hemorrhage, which often be- comes of serious consequence. A fracture in close proximity to a joint may be accompanied by dangerous inflammations of im- jjortant organs, and may induce an attack of pneumonia, pleurisy, arthritis, etc., as well as luxations or dislocations, and the more so if situated near the chest. Gangrene, as a consequence of contusions or of hemorrhage or of an impediment to the cii'cula- tion, caused by unskillfully applied apparatus, must not be over- looked among the occasional incidents ; nor must locJcjaw, which is not an uncommon occurrence. Even laminitis has been met with as the result of forced and long-continued immobihty of the feet in the standing posture, as one of the involvements of una- voidably protracted treatment. When a simple fracture has been properly treated, and the broken ends of the bone have been secm-ely held in coaptation, one of two things will occur. Either — and this is the more common event — there will be a union of the two ends by a solid cicatrix, the callus, or the ends will continue separated or become only partially united by an intermediate fibrous structure. In the first instance the fracture is consohdated, or united, in the second there is a false articulation, or 2)seudo-arthrosis. The time required for a firm union or true consolidation of a fracture will vary with the character of the bone affected, the age and constitution of the patient, and the general condition of the case. The union will be perfected earlier in a young than in an adult animal, and sooner in the latter than in the aged, and a general healthy condition is of course, in every respect, an advantage. The mode of cicatrization, or method of repair in lesions of the bones, has been a subject of much study among investigators in pathology, and has ehcited various expressions of opinion from those high in authority. But the weight of evidence and pre- ponderance of opinion are about settled in favor of the theory that the law of reparation is the same for both the hard and the soft tissues. In one case a simple exudation of material, with the proper oi'ganization of newly formed tissue, Avill bring about a union bv the first intention, and in another the work will be ac- FRACTUKES. 219 companied by suppuration, or the union by the second intention, a process so familiar in the repair of the soft structures by granulation. Considering the process in its simplest form, in a case in which it advances without interruption or complication to a favorable result, it may probably be correctly described in this wise : On the occiuTence of the injury an effusion of blood takes place between the ends of the bone. The coagulation of the fluid soon foUows, and this, after a few days, undergoes absorption. There is then an excess of inflammation in the sm-rounding structure, which soon spreads to the bony tissue, when a true ostitis is estabUshed, and the compact tissue of the bone becomes the seat of a new vascular organization, and of a certain exudation of plastic lymph, Fig. 253.— Fracture of the Common Bone, with Callus. 220 OPERATIONS ON BONES. appearing between the periosteum and the external surface of the bone, as well as on the inner side of the medullary cavity. After a few days the ends of the bone thus surrounded by this exudate become involved in it, and the lymph, becoming vascular, is soon transformed into cartilaginous, and in due time into bony tissue. Thus the time required for the consolidation of the fractiu'ed segments is divisible into two distinct periods. In the first they are surrounded by an external bony ring, and the medullary ca\dty is closed by a bony plug or stopper, constituting the joeriod of the provisional callus. This is followed by the period of perinanent callus, during which the process is going forward of converting the cartilaginous into the osseous form. The restorative process is sooner completed in the carnivorous than in the herbivorous tribes. In the former the temporary callus may attain sufficient firmness or consistency for the careful use of the limb within four weeks, but with the latter a period of from six w^eeks to two months is not too long to allow before removing the supporting apparatus from the Hmb. This in general terms represents the fact when the resources of nature have not been thwarted by untoward accidents, such as a want of vigor in the constitution of the patient or a lack of skill on the part of the practitioner, and esjDecially when, from any cause, the bony fragments have not been kept in a state of perfect immobility and the constant friction has prevented the osseous union of the two portions. Failures and misfortunes are always more than possible, and instead of a solid and practicable bony union the sequel of the accident is sometimes a false Joint, com- posed of mere flexible cartilage, a -poor 2^seudo-arthrosis. The ex- planation of this appears to be that, first, the sharp edges of the ends of the bone disappear by becoming rounded at their extrem- ities, by friction and polishing against each other. Then follows an exvidation of a plastic nature, which becomes transformed into a cartilaginous layer of a rough articular aspect. In this, bony nuclei soon appear, and the lymph secreted between the segments thus transformed, instead of becoming truly ossified, is changed into a sort of fibi'O-cartilaginous pouch or capsular sac, in which a somewhat albuminous secretion, or pseudo-synovia, permits the movement to take place. Most commonly, however, in our animals, the union of the bony fi-agments is obtained wholly through the medium of a layer of fibrous tissue, and it is because , FEACTUKES. 221 the imion has been accomplished by a ligamentous formation only, that motion becomes practicable. The prognosis in a case of fracture in an animal is one of the gravest vital impoi't to the patient, and therefore of serious pecu- niary concern to his owner. The period has not long elapsed when to have received such a hurt was quite equivalent to under- going a sentence of death for the suffering animal, and perhaps to-day a similar verdict is pronounced in many cases in which the exercise of a little mechanical ingenuity, with a due amoimt of careful nursing, might secure a contrary result and insure the re- turn of the patient to his former condition of soundness and use- fulness. Considered per se, a fracture in an animal is in fact no less amenable to treatment than the same description of injury in any other hving being. But the question of the propriety and expediency of treatment is dependent upon certain specific jjoints of collateral consideration. First. The nature of the lesion itself is a point of paramount importance. A simple fracture occm-ring in a bone where the ends can be firmly secured in coaptation, presents the most favor- able conditions for successful treatment. If it be that of a long bone it will be the less serious if situated at or near the middle of its length than if it were in close proximity to a joint, from the fact that perfect immobility can rarely, in the latter case, be secured without incurring the risk of subsequent rigidity of the joint. A simjjle is always less serious than a compound fracture. A comminuted is always more dangerous than a simple, and a trans- verse break is easier to treat than one which is oblique. The most serious are those which are situated on parts of the body in which it is difficult to secure perfect immobility, and esi^ecially those which are accompanied by severe contusions and lacerations in the soft parts ; the protrusion of fragments through the skin ; the division of blood vessels by the broken ends of the bone ; the existence of an articulation near the point to which inflammation is likely to extend ; the luxation of a fragment of the bone ; lacer- ation of the periosteum ; the presence of a large number of bony particles, the result of the crushing of the bone — aU these are cir- cumstances which discourage a favorable prognosis, and weigh against the hope of saving the patient for future usefulness. Fractures which may be accounted curable are those which are 222 OPERATIONS ON BONES. not conspicuously visible, as those of the ribs, where displace- ments are either very limited or do not occur, the parts being kej^t in situ by the nature of their position, the shape of the bones, the articulations they form with the vertebrae, the sternum, or their cartilages of prolongation ; those of transverse jDrocesses of the lumbar vertebrae ; those of the bones of the face ; those of the ili- um, and that of the coffin bones. To continue the category, they are evidently curable when their position and the character of the patient contribute to aid the treatment. Those of the cranium, in the absence of cerebral lesions ; those of the jaws, of the ribs, with displacement, of the hip, and those of the bone of the leg in movable regions, but where their vertical position admits of per- fect coaptation. On the contrary, a compound, complicated, or comminuted fracture, in whatever region it may be situated, may be accounted incurable. In treating fractures, time is an important element and " de- lays are dangerous." Those of recent occurrence unite more easi- ly and more regularly than older ones. Second. As a general rule, fractures are less serious in animals of the smaller species than in those of more bulky dimensions. This influence of sjiecies will be readily appreciated when we real- ize that the difficulties involved in the treatment of the latter class have hardly any existence in connection with the former. The difference in weight and size, and consequent facility in handling, and making the necessary applications of dressings and other aji- pHances for the purj)ose of securing the indisjDensable immobility of the parts, and usually a less degree of uneasiness in the de- portment of the patients are considerations in this connection of great weight. Third. In respect to the utilization of the animal, the most obvious point in estimating the gra^'ity of the case in a fracture accident is the certainty of the total loss of the services of the pa- tient dm-ing treatment — certainly for a considerable period of time, perhaps permanently. For example, the fracture of the jaw of a steer just fattening for the shambles will involve a heavier loss than a similar accident to a horse. Usually the fracture of the bones of the extremities in a horse is a very serious casualty, the more so proportionately as the higher region of the limb is affected. In working animals it is exceedingly difficult to treat a FRACTUllf:S. 223 fracture in such a manner as to restore a limb to its original per- fection of movement. A fracture of a single bone of an extremity in a breeding stallion or mare will not necessarily impair tbeii* value as breeders. Other specifications under this head, though pertinent and more or less interesting, may be omitted. Fourth. Age and temper are important factors of cure. A young, growing, robust patient, whose vis vitm is active, is amen- able to treatment which one with a waning constitution and past mature energies would be unable to endure, and a docile, quiet disposition will act co-operatively with remedial measures which Avould be neutralized by the fractious opposition of a peevish and intractable sufferer. The fulfillment of three indications is indispensable in all frac- tures. The first is the reduction, or the replacement of the parts as nearly as possible in their normal position. The second is theii* retention in that position for a period sufficient for the formation of the provisional callus, and the third, which in fact is but an in- cident of the second, the careful avoidance of any accidents or causes of miscarriage which might disturb the curative process. In reference to the first consideration, it must be remembered that the accident may befall the patient at a distance from his home, and his removal becomes the first duty to be attended to. Of course this must be done as carefully as possible. If he can be treated on the spot so much the better, though this is seldom practicable, and the method of removal becomes the question call- ing for settlement. But two ways present themselves — he must either walk or be carried. If the first, it is needless to say that every caution must be observed in order to obviate any additional pain for the suffering animal, and to avoid any aggravation of the injury. Led slo\vly, and with j^artial support if j^racticable, the journey will not always involve untoward results. If he is carried it must be by means of a wagon, a truck, or an ambulance ; the latter being designed and adapted to the pm-jjose, would, of course, be the preferable vehicle. As a precaution which should never be overlooked, a temporary dressing should first be applied. This may be so done as for the time to answer all the purpose of the permanent adjustment and bandaging. "Without thus secur- ing the patient, a fracture of an inferior degree may be trans- formed to one of the severest kind, and, indeed, a curable changed to an incurable injury. We recall a case in which a fast trotting 224: OPERATIONS ON BONES. horse, after running away in a fright caused by the whistle of a locomotive, was found on the road limping with excessive lame- ness in the off fore leg, and walked with comparative ease some two miles to a stable before being seen by a surgeon. His imme- diate removal in an ambulance was advised, but before that vehi- cle could be procured the horse laid down, and upon being made to get upon his feet was found with a well-marked comminuted fracture of the os suffraginis, with considerable displacement. The patient, however, after long treatment, made a comparatively good recovery, and though with a large bony dej^osit, a ringbone, was able to trot among the forties. The two obvious indications in cases of fracture are reduction, or replacement and retention. In an incomplete fracture, where there is no displacement, the necessity of reduction does not exist. With the bone kept in place by an intact periosteum, and the fragments secured by the uninjured fibrous and ligamentous structure which surrounds them, there is no dislocation to correct. It is also at times ren- dered imjDOSsible by the seat of the fracture itself, by its dimensions alone, or by the resistance arising from the muscular contraction excited by the surgical manipulation. This is illustrated even in small animals, as in dogs, by the exceeding difficulty encountered in bringing the ends of a broken femur or humerus together, the muscular contraction being even in these animals sufficiently for- cible to renew the disi^lacement. It is generally, therefore, only fractures of the long bones, and then at 2:)oints not in close proximity to the trunk, that may be con- sidered to be amenable to reduction. It is true that some of the more superficial bones, as those of the head, of the pelvis, and of the thoracic walls may in some cases require special manipulations and appliances for their retention in their normal positions, but the treatment of these and of a fractured leg cannot be the same. The methods of accomplishing reduction vary with the features of each case, the manij^ulations being necessarily modified to meet changing circumstances. If the dis^Dlacement is in the thickness of the bone, as in transverse fracture, the manipulation of reduc- tion consists in applpng a steady pressm-e vij)on one of the frag- ments, while the other is kept steady in its place, the object of the l^ressure being the re-establishment of the exact coincidence of the two bony surfaces. If the displacement has taken place at an FRACTURES. 225 angle it will be siifficient in order to effect the reduction to press upon the summit or ajiex of the angle until its disai^ijearance in- dicates that the parts have been brought into coaptation. This method is often practiced in the treatment of a fractured rib. In a longitudinal fracture, or when the fragments are pressed together by the contraction of the muscles to which they give insertion until they so overlap as to correspond by certain points of their circumference, the reduction is to be accomplished by effecting the movements of extension, counter-extension, and coaptation. Extension is accomphshed by making traction uj^on the lower por- tion of the limb. Counter-extension consists in firmly holding or confining the upper or body portion in such a manner that it shall not be affected by the traction ai^i^lied to the lower; in sim- pler language, holding it motionless against the force exercised in the extension. In other words, the oj^erator, grasping the limb below the fractiu'e, draws it down or away from the trunk, while he seeks, not to draw away, but simply to hold still the upper por- tion until the broken ends of bone are brought to their natural relative positions when the coaptation, which is thus affected, has only to be made permanent by the proper dressings to perfect the reduction. In treating fractures in small animals the strength of the hand ' is usually sufficient for the required manipulations. In the fracture of a forearm of a dog, for example, while the uj^per segment is firmly held by one hand, the lower may be grasped by the other and the bone itself made to serve the purpose of a lever to brin<>' about the desired coaptation. In such a case that is sufficient to overcome the muscular contraction and correct the overlapping or other malposition of the bones. If, however, the resistance can not be overcome in this mode, the upper segment may be committed to an assistant for the management of the counter extension, leaving to the operator the free use of both hands for the further manipulation of the case. But if the reduction of fractures in small animals is an easy task it is far from being so when a large animal is the patient, whose muscular force is largely greater than that of several men combined. In such a case resort must be had not only to superior numbers for the necessary force, but in many cases to mechanical aids. A reference to the mode of proceeding in a case of fracture with displacement of the forearm of a horse will illustrate the 226 OPEEATIONS ON BONES. matter. The patient is first to be carefully cast, on the uninjured side, with ropes, or a broad leather strap about 18 feet long, ^^assed under and around his body and under the axilla of the fractm-ed limb and secured at a point opjiosite to the animal and toward his back. This will form the mechanical means of counter extension. Another roj^e will then be placed around the inferior part of the leg below the point of fracture, with which to j^roduce extension, and this wiU sometimes be furnished with a block or pulleys, in order to augment the power when necessary ; and there is, in fact, alwaj'S an advantage in their use, on the side of steadiness and uniformity, as well as of increased power. It is secured around the fetlock or the coronet, or, what is better, above the knee and nearer the point of fracture, and is committed to assistants. The traction on this should be firm, uniform, and slow, without relaxing or jerking, while the operator carefully watches the process. If the bone is superficially situated he is able to judge, by the eye, of any changes that may occur in the form or length of the parts under traction, and discovering at the moment of its hapj^ening the restoration of sj^mmetry in the disturbed region, he gently but firmly manipulates the place imtil all apj^earance of severed con- tinuity have vanished. Sometimes the fact and the instant of res- toration are indicated by a pecuhar sound, or " click," as the ends of the bone shp into contact, to await the next step of the restora- tive procedure. The 25rocess is the same when the bones are covered with thick muscular masses, excepting that it is attended with greater diffi- cidties, from the fact that the finger must be substituted for the eye, and the taxis must take the place of the sight, and the result natm-aUy becomes more uncertain. It frequently happens that perfect coaptation is prevented by the interposition between the bony surfaces of substances, such as a small fragment of detached bone or a clot of blood, and some- times the extreme obhquity of the fracture is the opposing cause, by permitting the bones to slip out of x^lace. These are difficulties which can not always be overcome, even in smaU-sized animals, and still it is only when they are mastered that a correct consoH- dation can be looked for. Yet without it the continuity between the fragments will be by a deformed callus, the union will leave a shortened, crooked or angular Hmb, and a disabled animal. If timely assistance can be obtained, and the reduction ac- FEACTURES. 227 complished immediately after the occurrence of the accident, that is the best time for it. But if it cannot be attended to until in- flammation has become established and the parts have become swollen and painful, time must be allowed for the subsidence of these sj-mptoms before attempting the operation. A spasmodic muscular contraction, which sometimes interjooses a difficulty, may be easily overcome by subjecting the patient to general anesthesia, and need not, therefore, cause any loss of time. A tendency to this may also be overcome by the use of sedatives and anti-phlo- gistic remedies. The reduction of the fracture having been accomplished, the problem which follows is that of retention. The parts which have been restored to their natural position must be kept there, with- out disturbance or agitation, until the perfect formation of a callus, and it is here that ample latitude exists for the exercise of ingen- uity and skill by the surgeon in the contrivance of the necessary apparatus. One of the most important of the conditions which are available by the surgeon in treating human patients is denied the veterinarian ia the management of those which belong to the animal tribes. This is 2)ositlon. The intelligence of the human patient co-operates with the instructions of the surgeon, but with the animal sufferer there is a continual antagonism between the parties, and the forced extension and fatiguing posi- tion which must for a considerable period be maintained as a con- dition of restoration require special and effective appliances to insure successful results. To obtain complete immobility is scarcely possible, and the surgeon must be content to reach a point as near as possible to that which is unattainable. For this reason, as will subsequently be seen, the use of slings and the re- straint of patients in very narrow stalls is much to be preferred to the practice sometimes recommended, of allowing entire freedom of motion by turning them loose in box stalls. Temporary and mova- ble apparatus are not usually of difficult use in veterinary j^i-actice, but the restlessness of the patients and their unwilhngness to submit quietly to the changing of the dressings render it obliga- tory to have recourse to permanent and immovable bandages, which shovild be retained without disturbance until the process of consolidation is complete. The materials composing the retaining apparatue consist of oakum, bandages and spHnts, with an agglutinating compound 228 OPEKATIOXS ON BONES. which forms a species of cement by which the different constit- uents are blended into a consistent mass to be spread upon the surface covering the locahty of the fracture. Its components are black pitch, resin, and Venice turpentine, blended by heat. The dressing may be applied du'ectly to the skin, or a covering of thin linen may be interposed. A putty made with powdered chalk and the white of an egg is recommended for small animals, though a mixture of sugar of lead and burnt alum with the albumen is preferred by others. Another formula is spirits of camphoi', Goulard's extract and albumen. Another recommendation is to saturate the oakum and bandages with an adhesive solution formed with gum arable, dextrine, flour paste, or starch. This is advised particularly for small animals. Dextrine mixed, while warm, with burnt alum and alcohol cools and sohdifies into a stony consistenc}', and is preferable to plaster of Paris, which is less friable and has less solidity, besides being heavier and reqvuring constant additions as it becomes older. Starch and plaster of Paris form another good compoimd. In applying the dressing the leg is usually padded with a cushion of oakum, thick and soft enough to equalize the irregu- larities of the surface and to form a bedding for the protection of the skin from chafing. Over this the splints are placed. The material for these is, variously, pasteboard, thin wood, bark, laths, gutta percha, strips of thin metal, as tin or perhaps sheet iron. These should be of sufficient length not only to cover the region of the fracture, but to extend sufficiently above and below to render the immobility more complete than in the surrounding joints. The spHnts again, are covered with cloth bandages, linen preferably, soaked in a glutinous moisture. These bandages are to be carefully appHed, with a perfect condition of lightness. They are usually made to embrace the entire length of the leg, in order to avoid the possibihty of interference with the circulation of the extremity, as well as for the prevention of chafing. They should be rolled from the lower part of the leg upward, and carefully secured against loosening. In some instances suspen- sory bandages are recommended, but excepting for small animals our experience does not justify a concurrence in the recommen- dation. These permanent dressings always need careful watching in reference to then- immediate effect upon the region they cover. FRACTURES. 229 especially during the first days succeeding that of their appHca- tion. Any manifestation of pain, or any appearance of swelling- above or below, or any odor suggestive of supjouration should excite suspicion, and a thorough investigation should follow with- out delay. The removal of the dressing should be performed with great care, and especially so if time enough has elapsed since its apphcation to allow of a probability of a commencement of the healing process or the existence of any points of consoHdation. "With the original dressing properly applied in its entirety in the first instance, the entu'e extremity will have lost all chance of mobility, and the repaii'ing process may be permitted to proceed without interference. There will be no necessity and there need be no haste for removal or change except under such special con- ditions as have just been mentioned, or when there is reason to judge that solidification has become perfect, or for the comfort of the animal, or for its readaptation in consequence of the atrophy of the limb from want of use. Owners of animals are often tempted to remove a splint or bandage prematurely at the risk of producing a second fracture in consequence of the failure of the callus properly to consolidate. The method of applying the splints which we have described refers to the simple variety only. In a compound case the same rules must be observed, with the modification of leaving openings through the thickness of the dressing, opposite the wound, in order to permit the escape of pus and to secure access to the points requiring the application of treatment. Fracture of different Bones. Of the Cranial Bones. — Fractures of this variety in large animals are comparatively rare, though the records are not desti- tute of cases. AVhen they occur, it is as the result of external violence, the sufierers being usually runaways which have come in coUision with a wall or tree, or other obstruction ; or it may occur in those which in pulling upon the halter have broken it with a jerk and been thi-own backward, as might occur in rearing too violently. Under these conditions we have witnessed fractui-es of the parietal, of the frontal, and of the sphenoid bones. These fractures may be of the complete or incomplete kind, which in- deed is usually the case with those of the flat bones, and they are liable to be comjoHcated with lacerations of the skin, in conse- 230 OPERATIONS ON BONES. quence of which they are easily brought under observation. But when the fact is otherwise and the skin is intact, the diagnosis becomes difficult. The incomplete variety may be unaccompanied by any special symptoms, but in the complete kind one of the bony plates may b^ so far detached as to j^ress upon the cerebral substance with sufficient force to produce serious nervous com- phcations. "WTien the injury occurs at the base of the cranium, hemorrhage may be looked for, with paralj'tic symptoms, and when these are present the usual ter- mination is death. It may still haj)j)en, however, that the symptoms of an appa- rently very severe concussion may dis- appear, with the result of an early and complete recovery, and the surgeon vdll do well to avoid undue precipitation in venturing upon a prognosis. In frac- tures of the orbital or the zygomatic bones the danger is less pressing than with injuries otherwise located about the head. The treatment of cranial fractures is simple, though invohdng the best skill of the experienced surgeon. "When in- complete, hardly any interference is need- ed ; even plain bandaging may usually be dispensed with. In the comj)lete va- riety the danger to be combated is com- pression of the brain, and attention to this indication must not be delayed. The Fig. 254.-Apparatu8 for Frac- j^g^ns to be employed are the trephinmg ture of the Nasal Bone. ^ / ■, o of the skull over the seat of the fracture, and the elevation of the depressed bone or the removal of the por- tion which is causing the trouble. Fragments of bone in commin- uted cases, exfoliations, collections of fluid, or even protruding portions of the brain substance must be cleansed away, and a simple bandage so appUed as to facilitate the appHcation of sub- sequent dressings. /fractures of the Hones of the Face. — In respect to their origin — usually traumatic — these injuries rank with the preceding, and are commonly of the incomplete variety. They may easily be over- FRACTURES. 231 looked and may even sometimes escape recognition until the rep- arative process has been weU estabhshed and the discovery of the v\round becomes due to the prominence caused by the presence of the provisional caUus which marks its cure. When the fractiu-e is complete it will be marked by local deformity, mobiHty of the fragments, and crepitation. Nasal hemorrhage, roaring, frequent sneezing, loosening or loss of teeth, difficulty of mastication, and inflammation of the cavities of the sinuses are varying complica- tions of these accidents. The object of the treatment should be the restoration of the depressed bones as nearly as possible to their normal position, and their retention in place by protecting splints, which should cover the entire facial region (Figs. 254, 255), Fig. 255.— Apparatus for Fracture of the Bones of the Pace Applied. and special precautions should be observed to prevent the patient from disturbing the dressing by rubbing his head against sur- rounding objects, such as the staU, the manger, the rack, etc. Clots of blood in the nasal passages must be washed out, collec- tions of pus must be removed from the sinuses, and if the teeth are loosened and likely to fall out, they should be removed. If roaring is threatened, tracheotomy is indicated. Fractures of the F re-Maxillary Bone. — These are mentioned by continental authors. They are usually encountei'ed in connec- tion with fractures of the nasal bone, and may take place either in the width or length of the bone. The deformity of the upper lip, which is di'awn sideways in 232 OPEKATIONS ON BONES. this lesion, renders it easy of diagnosis. The abnormal mobility and the crei^itation, with the pain manifested by the patient when undergoing- examination, are concuri'ent symptoms. Looseness of the teeth, abundant salivation, and entu-e inability to grasp the food complete the symptomatology of these accidents. In the Fig. 256.— Fracture of the Lower Jaw. treatment, splints of gutta percha or leather are sometimes used, but they are of difficult application. Our own judgment and practice are in favor of the union of the bones by means of metallic sutures. The Loioer Jaw. — A fracture here is not an injury of infrequent occiirrence. It involves the body of the bone, at its symphysis, or back of it, and includes one or both of its branches, either more or less forward, or at the posterior part, near the temporo-max- illary articulation, at the coronoid process. Falls, blows, or other external violence, or powerful muscular contractions during the use of the speculum, may be mentioned among the causes of this lesion. The fracture of the neck and of the branches in front of the cheeks cause the lower jaw, the true dental arch, to drop without the ability to raise it again to the upper, and the result is a peculiar and characteristic physiognomy (Fig. 256.) The prehension and mastication of food become im- possible; there is an abundant escape of fetid and sometimes bloody saliva, especially if the gums have been wounded ; there is excessive mobility of the lower end of the jawbone ; and there is FRACTURES. 233 Fig. 257.— Splint for Fracture of the Lower Maxillary. crepitation, and frequently paralysis of the under lip. But al- though the aspect of an animal suffering mth a complete and often compound and comminuted fracture of the submaxilla pre- sents at times a frightful spectacle, the prognosis of the case is comparatively simple, and recovery usually only a question of time. The severity of the lesion corresponds in degree with that of the violence to which it is due, the degree of simphcity or the amoiint of compUcation, and with the situation of the wound. It is simple when at the symphysis, but becomes more serious when it affects one of the branches, to be again aggravated when both are involved. Fracture of the coronoid process becomes import- ant princij)ally as an evidence of the existence of a morbid diathe- sis, such as osteoporosis, or the like. The particular seat of the injury, with its special features, will of course determine the treatment. For a simple fracture without displacement, provided there is no laceration of the periosteum, an ordinary supporting bandage will usually be sufficient. But when there is displacement the reduction of the fracture must first be accomphshed, and for this special splints are necessary. In a fracture of the symphysis or of the branches the adjustment of the fragments by securing them with metallic sutures is the first step necessary, to be followed by the appHcation of supports, consisting of sphnts of leather or sheets of metal (Fig. 258 and 259), the entu-e 234 OPERATIONS ON BONES. Fig 25^ — ^i liiit, l(ji 1 idLture of the Branches. front of the head being then covered with bandages prepared with adhesive mixtures. During the entire course of treatment a special method of feeding becomes necessary. The inability of the patient to appreciate the situation of course necessitates a resort to an artificial mode of introducing the necessary food into his stom- ach, and it is accomplished by forcing between the commissures of the lips, in a hquid form, by means of a syringe, the milk or Another Splint foi- Fracture of the Maxillary. FRACTURES. 235 nutritive gruels selected for liis sustenance, until the consolidation is sufficiently advanced to permit the ingestion of food of a more solid consistency. The callus will usually be sufficiently hardened in two or three weeks to allow of a change of diet to mashes of cut hay and scalded grain, until the removal of the dressing re- stores him to his old habit of mastication. Fractures of vertebrm. — These are not very common, but when they do occur the bones most frequently injured are those of the back and loins. The ordinary causes of fracture are responsible here as elsewhere, such as heavy blows on the spinal column, severe falls while conveying heavy loads, and especially violent efforts in resisting the process of casting. Although occurring more or less frequently under the latter circumstances, the accident is not always attributable to carelessness or error in the management. It mav of course, sometimes result from such a cause as a badly prejDared bed, or the accidental presence of a hard body concealed in the straw, or to a heavy fall when the movements of the patient have not been sufficiently controlled by an effective apparatus and its skillful adaptation, but it is quite as likely to be caused by the violent resistance and the consequent powerful muscular contrac- tion by the frightened patient. The sim- ple fact of the overarching of the vertebral column, with excessive pressure against it from the intestinal mass, owing to the spasmodic action of the abdominal mus- cles, may account for it, and so also may the struggles of the animal to escape from the restraint of the hobbles while frantic under the pain of an operation without anaesthesia. In these cases the fractui-e usually occm-s in the body or the annular part, or both, of the posterior dorsal or FiG.sfio.-Fiactureof the Body the anterior lumbar vertebra. AATien the of a Dorsal Vertebra,. ^inverse processes of the last-named bones are injured, it is probably in consequence of heavy concus- sion incident to striking the ground when cast. Diagnosis of a fracture of the body of a vertebra is not always easy, especially when quite recent, and more especially when there is no accom- panying displacement. There are certain pecuHar signs accom- panjdng the occurrence of the accident while an operation is in 236 OPERATIONS ON BONES. Fig. 261a.— Comminuted Fracture of a Dor- sal VertetoriJB at the Annular Portion. Fig. 261.— United Fracture of the Spi- nous Processes of Dorsal Vertebrae. progress which should at once excite the suspicion of the surgeon. In the midst of a -sdolent struggle the patient becomes suddenly quiet ; the movement of a sharp instrument which at first excited his resistance fails to give rise to any further evidence of sensation ; perhaps a general trembling, lasting for a few minutes, will follow, succeeded by a cold, profuse perspii'ation, particularly between the hind legs, and frequently there will be mictvmtion and defe- cation. Careful examination of the vertebral column may then detect a slight depression or irregularity in the direction of the sjiine, and there may be a diminution or loss of sensation in the i:)Osterior part of the trunk while the anterior portion continues to be as sensitive as before. In making an attemjit to get upon his feet, however, upon the removal of the hobbles, only the fore part of the body will respond to the effort, a degree of paraplegia being present, and while the head, neck, and fore -pea-i of the body will be raised, the hind quarters and hind legs will remain inert. The animal may perhajDS succeed in rising and probably may be re- FRACTURES. 237 Fig. 262.— Fracture of tho Axis in an Animal Suffering with Osteo-Porosis. moved to his stall, but the displacement of the bone will follow, converting the fracture into one of the comj^lete kind, either through the exertion of walking or by a renewed attempt to rise after another fall, before reaching his stall. By this time the paralysis is comj)lete, and the extension of the meningitis which has become estabHshed is a consummation soon reached. To say that the prognosis of fracture of the body of the vertebrae is always serious is to speak very mildly. It were better, jjerhaps, to say that occasionally a case may recover. Fractures of the transverse processes are less serious. Instead of stating the indication in this class of cases, as if assuming them to be medicable, the question naturally becomes rather a query : " Can any treatment be recommended in a fractui'e of the body of a vertebra?" The only indication in such a case, in our opinion, is to reach the true diagnosis in the shortest pos- sible time and to act accordingly. If there is displacement, and the existence of serious lesions may be inferred from the nervous symptoms, the destruction of the suffering animal appears to sug- gest itself as the one conclusion in which considerations of policy, humanity, and science at once unite. If, however, it is faMy evident that no disjDlacement exists; that pressure upon the sj^inal cord is not yet present; that the animal with a little assistance is able to rise upon his feet and to walk a short distance, it may be weU to experiment upon the case to the extent of placing the patient in the most favorable circum- stances for recovery, and allow nature to operate without further interference. This may be accomplished by securing immobility 238 OPERATIONS ON BONES. of the whole body as much as j)ossible, and especially of the sus- pected region, by placing the patient in slings, in a stall sufficiently narrow to preclude lateral motion, and covering the loins with a thick coat of agglutinative mixtui-e, and wait for developments. Fracture of the Ribs. — The different regions of the chest are not equally exjDOsed to the violence to which fractm-es of the ribs are due, and they are therefore either more common or more easily discovered during life at some points than at others. The more exposed regions are the middle and the posterior, while the front is largely covered and defended by the shoulder. A single rib may be the seat of fracture, or a number may be involved, and there may be injuries on both sides of the chest at the same time. It may take place lengthwise, in any part of the bone, though the middle, being the most exposed, is the most frequently hiu-t. In- complete fractures are usually lengthwise, involving a portion only of the thickness, or one or other of the surfaces. The complete kind may be either transverse or obhque, and are most commonly , Fig. 263.— United Transversal and Longitudinal Fractures of the Ribs. denticulated. The fracture may be comminuted, and a single bone may show one of the complete and one of the incomplete kind at different points. The extent of sm'face presented by the thoracic region, with its complete exposure at all points, explains the liabihty of the ribs to suffer from all forms of external vio- lence. In many instances fractures of these bones continue undiscov- ered, especially the incomplete variety, without displacement, though the evidences of local pain, a certain amount of swelling and a degree of distm-bance of the respiration, if noticed during the examination of a jDatient, may suggest a suspicion of their ex- istence. Abnormal mobility and crepitation are difficult of de- tection, even when present, and they are not always present. FUACTURES. 239 "Wlieu there is tlisplacemeut tlie deformity which it occasions will betray the fact, and when such an injury exists the sm-geon will, of course, become vigilant in view of jDossible and probable com- phcations of thoracic trouble, and prepare himself for an encoun- ter with a case of traumatic pleuritis or pneumonia. Fatal injur- ies of the heart are recorded. Subcutaneous emphysema is a common accompaniment of broken ribs, and we recall the death from this cause of a patient of our ovm, which had suffered a frac- ture of two ribs in the region of the withers under the cartilages of the shoulder, and of which the diagnosis was made only after the fatal ending of the case. These hurts are not often of a very serious character, though the union is never as solid and complete as in other fractures, the callus being usually imperfect and of a fibrous character, with an amphiartkrosis formation. Still, comj)Hcations occur which may impart gravity to the prognosis. Fractures with but a slight or no displacement need no reduc- tion. All that is necessary is a simple application of a blistering nature as a preventive of inflammation or for its subjugation when present, and in order to excite an exudation which will tend to aid in the support and immobHization of the parts. At times, however, a better effect is obtained by the application of a band- age placed firmly around the chest, although, while this limits the motion of the ribs, it is aj)t to render the respiration more labored. If there is displacement with much accompanying pain and evident irritation of the lungs, the fracture must be reduced with- out delay. The means of effecting this vary according to whether the displacement is outward or inward. In the first case the bone may be straightened by pressure from without, while in the second the end of the bone mvist be raised by a lever, for the in- troduction of which a small incision through the skin and inter- costal spaces wiU be necessary. When coaptation has been af- fected it must be retained by the external apphcation of adhesive mixture, with spUnts and bandages around the chest. Fractures of the hones of the pelvis wiU be considered under their separate denominations, as those of the sacrum and the as innominata, or the hip, which includes the subdivision of the iUum, the pubes, and the ischium. The Sacrum. — Fractures of this bone are rarely met with among solipeds. Among cattle, however, it is of common occur- m 240 OPERATIONS ON BON~ES. rence, being attributed not only to the usual varieties of violence, as blows and other external hxirts, but to the act of coition, and to violent eflforts in partxirition. It is generally of the transverse kind, and may be recognized by the deformity which it occasions. This is due to the dropping of the bone, with a change in its di- rection and a lower attachment of the tail, which also becomes more or less paralyzed. The natural and spontaneous rehef which usually interposes in these cases has doubtless been observed by the extensive cattle breeders of the "West, and their practice anti example fully establishes the inutility of interference. Still, cases may occur in which reduction may be indicated, and it then be- comes a matter of no difficulty. It is effected by the introduction of a round, smooth piece of wood into the rectum as far as the frag- ment of the bone, and using it as a lever, resting it upon another as a fulcrum placed under it outside. The bone having been thus returned maybe kept in place by the ordinary external means in use. 77ie Os Intiominata. — Fractures of the iHum maybe observed either at the angle of the hip or at the neck of the bone ; those of the pubes may take place at the symphysis, or in the body of the bone ; those of the ischitmi on the floor of the bone, or at its pos- terior external angle. Or. again, the fracture may involve all three of these constituent parts of the hip bone by having its situ- ation in the articular cavity — the acetabulvmi by which it joins the femur or thigh bone. Some of these fractures are easily recognized, while others are diflicult to identify. The ordinary- deformity which characterizes a fracture of the external angle of the ilivun. its dropping and the diminution of that side of the hip in width, unite in indicating the existence of the condition expressed by the term "hipped." But an incomplete fractxure. or one that is complete without displace- ment, or even one with dispLacement, often demands the closest scrutiny for its discovery. The lameness may be well marked, and an animal may show but Httle appearance of it while walking, but upon being urged into a trot wiU manifest it more and more, until presentlv he will cease to use the crippled limb altogether, and perform his traveling entirely on three legs. The acute character of the lameness wiU vary in degree as the seat of the lesion ap- proximates the acetabulum. In walking, the motion at the hip is veri- limited, and the leg is draggeil, while at rest it is relieved from bearing its share in sustaining the body. An inteUigeut i 4 4 « 241 ^J^7 ^%^^ Fig. 264.— Fractnres of tii^ Ossa Innomiiiata : 1. at the external angle ; 2, at tlie internal angle; 3. at the necfc of the ilium; 4, at the body of the pubis: 4ret'e?i^io?i of the hemorrhage. It consists simply in twisting or ligating the arterial vessels which have been divided. If the means used for the temporary hemostasis prevent the operator from discovering its source, the ligatures can be slightly relaxed until it is betrayed by the oozing of the blood. The various methods of permanent hemostasis have already been considered, and need no further description. In the application of a dressing to the wound of amputation, the requu-ements are few, but they are imj)erative, and they are sufficient, assuring the best results by theii' simphcity and solid- ity. The soft tissues and the skin must be brought together, over the extremity of the bone, and kept together by the aj)plica- tion of a continued suture, lea\Tng a place of drainage for the suppuration and the sloughing of the ligatures which occlude the blood vessels, and the extremities of these must be gathered to- gether at the most dependent part of the wound. This is com- pleted and protected by the application of an antiseptic dressing consisting of pads of oakum, absorbent cotton, or threads of tourbe, kept in place by rollers, and supported by an outside AMPUTATIONS. envelope of coarse cloth. The wound may cicatrize by first or by second intention, according to the severity of the original injury, as well as to the amount of attention bestowed upon the antisep- tic apphcations which may have been employed. Fig. 289.— Wooden Leg after Amputation. CompHcations are not uncommon after amputations, though they do not materially differ from those which are encountered in other serious operations. Among those which may be mentioned are: 1st. (Secondary hemorrhage, as the result of carelessness in the application of the ligatures, which can be overcome, however, by immediate or lateral compression, or by the renewal of the lig- ature. 2d. Abscesses, of various dimensions, resulting from the presence of the ligatures into the wound, or possibly of necrosis of the bone. These collections are to be treated in the usual way, as are also undermining of the skin by suppiu'ative collections, phlehitis, purulent infection and gangrene, all of these being con- ditions having the same indications as in other forms of traumatic lesions. There are, however, some complications which belong specially to the sequelae of this operation, such as may result from an im- proper section of the bone, which might end in the formation of a conical stump, a condition which, like that of strangidation of the stump, can only be relieved by a new amputation, with a bet- 274 OPERATIONS ON BONES. ter section of the bone, and more careful attention to the subse- quent dressing. JV^ecrosis of the amj^utated bone may also com- jjhcate the process of cicatrization, accompanied by more or less pain and diffused suppuration, which cannot be reheved until the necrotic bone has sloughed away. Amputations in the contiguity of the bones are, besides, likely to be complicated with synovial Jistulas, which may be of an ar- ticular or tendinous nature. The ordinary forms of treatment in similar cases will be sufficient for these. These general rules regvilate amputations of every kind, though the various steps of the operation may have somewhat varied, ac- cording to circumstances. But whether it be in the continuity or contiguity of a bone, or whatever may be the bone involved ; whether the scapulo-humeral joint, the fetlock or the digital re- gion ; or even to remove supplementary digits ; they are of equal applicability, and the general modus operandi remains the same. Even in the operation of amjnitation of the vnngs we find but little room for modification or change. In operating iipon the wings of birds, with the j)rincij)al object of destroying their power of flight, it may frequently be accom- plished by simply cutting off the extremity of the wing, at the carpal articulation, with the scissors, and cauterizing the wound with perchloride of iron or nitrate of silver. Another method is to pull out the feathers from the inner side of the wing, as far as the elbow joint, the skin being then incised with a bistoury somewhat below the joint, and dissected and reversed upward, the bones being then divided with the bone forceps. The wound should be carefully washed or sponged with cold water, to check the bleeding, and the skin drawn over the stump, secm-ed by interrupted sutures. The bird requires no special attention, and the wound heals in a few days. Amputation of Hokns. The amputation of horns is an operation the description of which dates back to 1790. It is indicated in cases of fractures, or of vicious growths which might embarrass the motions and prevent the usefulness of the animal, and also to pro\dde against the mu- tual injui-ies which cattle are liable to inflict upon one another. It is also indicated in cases of suppurative collections in the si- nuses, and for the removal of parasites from those cavities. It has AMPUTATIONS. 275 of late not only assumed a place among the operations of fashion, but has found favor from its alleged tendency to improve the quantity and quality of milk, and of the flesh yielded by animals subjected to it. It is in relation to this hypothesis that Gourdon considers it as "a great progress in the raising of horned cattle, and which, on account of the benefits that may be derived from it, is perfectly justifiable." The operation is comparatively a sim- ple one, but nevertheless involves special considerations, varying according to the sj^ecies of the animal. 1st. In Bovines. — If only the free extremity of the organ is to be cut off, it is done with the saw carried rapidly through the horny structure, the animal, of course, being proj)erly secured. But occasionally, especially in cases of fracture, the section is to be made near the base, or the middle of the horn, and soft and sensitive tissu.es are also involved. The amputation must then be made below the fracture with a sharp saw, appHed perpendicularly to the long axis of the horn, and completed as rapidly as possible. The operation will be accomj^anied by some hemorrhage, but not sufficient, usually, to require the ai)j)hcation of severe hemo- statics. The woimd is dressed with pads of absorbent cotton, or of carbolized or antiseptic oakum, retained by compresses or the Maltese cross bandage. Possible collections of pus must be watched for, and the sinuses should be carefully cleaned by injec- tions. The dressings are renewed as often as the indications require, and continued until the granulations have closed the cavities of the sinuses, and the suppuration has almost entirely subsided. The appHcation of a permanent dressing in the form of a pitch plaster is recommended by Gourdon. It need not be removed, like the ordinary dressing, and under some circumstances is of great advantage. Among the probable accidents attendant upon this operation, there are four which require mention : (a) Hemorrhages, more or less serious, always occur after the section of the horn, and of its bony support. Usually, it is sufl&ciently arrested by the dressing alone, but there are times when the appUcation of the actual cautery becomes necessaiy to subdue it. (b) Inflmnmation of the mucous tnemhrane of the sinuses may also foUow. In its ordinary manifestation it is not serious, and is 270 OPERATIONS OX BONES. likely to terminate either by resolution or even suppuration, though in a few cases it may be followed by gangrene. (c) Gangrene, which generally manifests itself toward the eighth or tenth day, ordinarily ends in death, and is often accom- panied by an attack of ophthalmia more or less violent. (d) Incomplete cicatrization of the stump, occurring principally in cases in which the wound has been neglected, and suffered to remain too long unj^rotected by a dressing, and when the mucous membrane of the horn has become the seat of chronic inflamma- tion. A central fistula usually results, accompanied by an abun- dant suppuration, which is apt to prove exceedingly intractable to treatment. 2d. In many you7ig ruminants this operation is performed on calves two or three months old, and consists in removing the rudi- mentary horns. For this Charlier has invented a peculiar tre- phine kind of cu'cular gouge, which is used as follows : The aui- FiG. 290.— Charlier's Method of Amputation of Horns in a Calf. 1st Step. mal being thrown and held by two assistants, the hair is cut short around the base of the horns, and the trephine ajDjilied over the horns in such a manner as to divide the skin and subjacent tissues down to the frontal bone where they are isolated by a cii'cular in- <'ision. Then by a downward and horizontal twist of the trephine the di%dded structures are gouged out and the secreting matrix of AMPUTATIONS. 277 Fig. 291.— Charlier'a Method of Amputation of Ilorns in a Calf. 2d Step. the horn removed. The hemorrhage is controlled with a com- pressive bandage or other hemostatic, and antiseptic dressing applied. The wound generally heals rapidly and without compli- cations. Amputation of the Tail. For some unexplainable reason the term "docking" has been apphed to this operation, which is simply the removal of some of the vertebrae composing the caudal aj)pendix. It is one of the most peculiar among the operations of fashion, although, of course, under some special conditions incident to all animals, it is also sometimes performed as an operation of genuine beneficent surgery. This may be the case, for example, when the tail is abnor- mally so long and hea\ry as to interfere with the usefulness and comfort of the animal, or when, it becomes the seat of disease and becomes affected with caries or necrosis, or fistulous tracts, or af- fections of the skin. In some instances, also, this curtailing oper- ation does constitute a true surgico-therapeutical means of obtain- ing a local bleeding. Docking, which is of English origin, is now performed all over the world, and has given rise to a great deal of controversy upon the question of its propriety. "Whether it is an act of inexcusable cruelty or not, it is not at present our province to decide, but from a surgical point of view we feel that it is due to truth to say that we are satisfied that a gx^eat deal of what has been said in opposition to the operation results, from the various and, too often, bimgling 'ZiQ OPEKATIONS ON BONES. and cruel metliods wliich have characterized the details of the amputation. We believe that some of these methods may be so modified as to relieve the operation of its apparent character of cruelty. We refer now especially to the means which have been and are employed for the arrest of the hemorrhage which is likely to follow the section of the blood vessels of the region. The tail has for its bony support a series of the caudal verte- brae— from fifteen to eighteen — varying in number and diminish- ing in size from the sacrum to the end of the organ, and imited by a thick inter-vertebral ligament, and attached to them are the caudal muscles in pairs, three on each side, the siqyerlors or ele- vators, the inferiors or depressors, and the laterals or inclinators. Beside these, there is also the ischio-caudal muscle, which extends from the ischiatic ligament upward and backward to terminate on the sides of the first caudal vertebrae. Between each of the lateral and inferior caudal muscles runs the lateral caudal, and on the median line between the inferior muscles the median caudal ar- tery, all running to the end of the tail, and likely, when divided, to cause a more or less troublesome hemorrhage. All these or- gans are surrounded by the caudal aponeurosis, from the deep surface of which proceed bands which form a special sheath for each muscle, and is ultimately vmited by its external face to the thick skin which surrounds the region. This skin on the upper and on each lateral face of the tail is covered with long, thick, coarse hair, while the inferior face is hairless, smooth and com- paratively thin. Fig. 292.— Tail Cutters. AMPUTATIONS. 279 Docking properly includes three steps : 1st, the preparation of the tail ; 2d, the amputation ; and 3d, the arrest of the hemor- rhage. (There is, however, a mode of operation in which the last two steps can be merged into one.) The animal is kept in the upright position, and well secured. 1st Stq). Preparation of the Tail. — This is first well washed and combed, and ought to be cleaned with an antiseptic solution. The place where the amputation is to be performed should be marked by clipping the hair from it in a circle, and above this the hair should be secured either by being braided, or simply tied tightly in a mass with a string around the tail. Some practition- ers apply a cord Ugature or an elastic bandage above the place to prevent the hemorrhage. 2d Step. The Amputation. — This is accomplished by several methods. The oldest mode was by using a simple hatchet as the instrument with which the tail, properly prepared and laid over a wooden block, was severed by a heavy blow on the " instrument." (Fig. 292). 280 OPERATIONS ON BONES. At a later period, special knives called tail cutters, were in- troduced. These were pecidiar large shears, differing more or less in general form and in that of their cutting edges, but which were used in the same manner, and are stiU in common use by many practitioners. The manner of using them is very simple. The tail, prepared as before mentioned, and held horizontally by an assist- ant, is so placed in a hollow formed in the edge of the shears as to insure a perpendicular stroke, and the division is made by closing the blades with a single quick and forcible motion. Other instru- ments were invented to work by springs. Fig. 296.— Spring Tail Cutter. Some practitioners, instead of dividing the entire thickness of the organ, prefer to do so by disarticulating the vertebrae with a bistoury, first making flaps on each side of the skin in order to find the joint. 3d Ste}). — To stop the Hemorrhage. — The moment the tail is amputated three streams of blood spring from the stump, with more or less force, according to the position of the member, unless a ligature or an elastic bandage has been previously apj^Hed. In Fig. 297.— Tail Cautery. AMPUTATIONS. 281 either case attempts may be made to ligate or to employ torsion of the arteries, but the hemostatic generally employed is the actual cautery. The tail-cautery, heated to nearly a white heat, is firmly held upon the truncated tail for a few seconds until it has stopped the hemorrhage. To assist this process and obtain the formation of a thicker scab, certain com- bustible substances are some- times placed upon the wound before the cautery is apphed, to increase the heat by their igni- tion. A ring of hair or a little pulverized resin may be employed for this purpose. We have before noted that in this measure of hemostasia there is much that is repulsive and coarse, and that it is not at all in har- mony with the spirit of modern scientific surgery, and we have long felt a conviction that a great improvement is possible in the manipvdation of such a case. We have, therefore, made the matter one of careful experimentation, and the conclusion we have reached is that the following course of procedure will meet all the indica- tions and fulfil all the purposes contemplated, and at the same time avoid the comphcations Ukely to occur, and obviate the objections of the sensitive and the timid, besides securing results entirely satisfactory to all the parties concerned. First, to render the operation painless, we inject cocaine at two or three points in the circumference of the tail skin. Then, around the tail, and above the ring made by clipping the hair, as before mentioned, to mark the place of amjDutation, we place a narrow elastic band at a tension merely sufficient to stop the hemorrhage. Having waited for the full effect of the anesthetic, and accurately identified the center of the articulation between two of the vertebrae through which we intend to amputate, with a strong and sharp bistoury we make rapidly a circular incision of the skin entirely around the tail, and, if possible, divide the causcle with a single stroke through the intervertebral ligament. With a little care and practice the amputation may be completed in a few seconds, and there remains at the end of the tail but a smooth, perfectly blood- less stump. We cover the fresh surface with a dressing powder, antiseptic, caustic or astringent as indicated, and leave the patient eating his oats as he had been doing during the operation, unaware 282 OPERATIONS ON BONES. of the mutilation to which he has been subjected. We leave the elastic band in place for from twenty-four to thirty-six hours, pos- sibly loosening it once dming that time, or tightening it, if any oozing of blood is discovered, and removing it entirely as soon as it becomes safe to do so. The stump generally needs no special care, except in cases of possible complications which may follow the operation. The am- putation of the tail by flaps is also performed by some veterinarians with great success, this mode leaving a wound which generally heals very rapidly and without the ordinary possibility of comj^Ucation. Among these are, first, hemorrhage. The occurrence of this is an evidence that the hemostasia has been imperfect, proba- bly the cauterization has not been sufficiently thorough; or the torsion of the arteries has been insufficient ; or the Hgature has been loosely tied. This accident requires a repetition of the man- ipvdation, and perhaps another cauterization or torsion or ligature. With the apphcation of our elastic band this can scarcely ever oc- cur. If it does, another turn of the band will complete the work. Bad aspect of the Stump. — The amputation of the tail by sec- tion through the continuity of the bone, as commonly happens when the tail-cutters have been used, leaves in the center of the wound a projecting portion of a vertebrae, which is usually bm-nt by the cautery, when this has been used. As the resiilt of this, and surrounding the mortified bone, large granulations rapidly appear, overlapping the circiilar edges of the wound, and char- acterized by an abundant discharge. The necrotic bone must then be amputated and the granulations heavily cauterized with caustics of the potential kind ; the saturated solution of chloride of zinc making an excellent prescription for the purpose required. To obviate this complication the operator will do well, when any portions of vertebras have been left in the stiimp, to remove the fragments with the bone forceps rather than to wait for their re- moval by the natural process of necrosis. We have never encoun- tered these compiications when using the elastic band, being careful to amputate at the articulation of the vertabrse. The powdered di'essings we have used have always kept the granulations under control. Multiple Abscesses. — We have met these once, as the result of the presence of a very thick scab, which prevented the escape of the underljdng suppuration. TREPHINING. 283 Gangrene and Tetanus have also been recorded as sequelae of this operation. The rules we have given apply without change to the amputa- tion of the tan in smaller animals, as sheep, dogs and cats. TREPHINING. The operation of trephining or trepanning consists in boring into or through a bony or other hard structure, in order to form an aperture for surgical purposes. Although the cranium is usually the seat of the opening, it may be made ia any part of the body where the indications demand it. The application of the trephine or of terehration, as it is called when it is performed at the base of the horns of cattle, dates back to antiquity, having a record antedating the time of Hippocrates, and yet it was not until toward the year 1749 that it in fact entered the domain of veterinary surgery. About that time Lafosse, Sr., performed it to oj^en the frontal and maxillary sinuses in the treatment of glanders and other diseases mistaken for it. It was afterwards recommended by Greave and Haubner as the proper treatment for the reHef of purulent collections in the sinuses of the head, and it has been recommended by many others for parasitic affections of the cranial cavity, as cases of coenurus cerebraHs. Trephining is undoubtedly indicated in many pathological conditions, and in fact ought to be more frequently practiced by the veterinarian of to-day. Much has been lost, no doubt, by its neglect and disuse. Its value is most fully demonstrated in cases where it becomes necessary to remedy the effects of mechan- ical lesions taking the form of bloody or purulent gatherings within the cranium, like those which may result from the pressure of fragments of fractured bones upon the brain. Fractures of the cranial bones resulting in this manner are not common with our domestic animals, but when they do occur they are always of a serious nature, and too often are beyond remedy. In a case of remediable character the removal of the pressure ujDon the men- inges by trephining and cleansing the wound from the matters which produce and continue it, whether bony fragments or bloody extravasations, is the treatment indicated before any other. Yet as experience has many times jn^oved that the brain is able to sus- tain a very considerable amount of 2:»ressure without betraying 284 OPERATIONS OX BONES. any signs of inconvenience, the indication of trepliining only becomes absolute when serious nervous manifestations are ex- hibited. In simple contusions, or even with complete fractiu-e of the bone, trephining is not indicated unless brain lesions are unmistakably present. It is indicated in solipeds in cases of chronic discharges pi'o- ceeding from suppurative collection in the sinuses, characterized by a yellowish, grumous, and often offensive, running at the nose, usually from but one side, and not uncommonly accompanied by a deformity of the face, caused by a bulging of the bones, and associated with it a dullness on percussion over their surface. Jessen & Unterburger have also recommended it in cases of suppuration in the cavities of the nasal turbinated bones. In the treatment of chronic catarrhal inflammation of the horns or of the portions of the frontal sinuses which extend into the appendix of the head, in ruminants, it has given excellent results. It is also indicated for the removal of foreign bodies, either of a pathological nature or the product of wounds, entering the cranium from the outside. It is available for the removal of polyi^i or any kind of neoplasm, of migrating dental cysts, of odontomPB, or as one of the first steps in the operation for the removal of diseased teeth from their alveolar cavity; in all these cases it is the first indication. It is also of common apj^lication in extracting parasites, the coenurus especially, from the cranial cav- ity of small ruminants, when their location has been first j)Ositively ascertained. In some severe cases of diseased withers accom- panied with abundant suppuration, which may filtrate under the internal surface of the scapulfe, and accumvdate between that bone and the thorax, it has been claimed that, performed upon the scapula, it would f m-nish an eligible means of reaching the bottom of the collection, and providing suitable drainage and consequent relief. Trephining the wall of the foot in special cases of laminitis, to assist the escape of the effused blood from between the lamincB has also been tried, but with what results we are not informed. It has even been performed in the treatment of immo- bility, but so far as we have learned, has never been followed by satisfactory results. It is also referred to in connection with the cranial inoculation of rabies, as j^erformed by Pasteur. The special instrument employed in the operation is the TKEPHINING. 285 trejyhine, or trepan, in various modified forms. There are also others which may be considered as accessory, viz., scissors, bis- touries, forcejis, bone-scrapers and elevators. The brace and bit trephine is the orio-inal instrument which has been more or less modified, and which, while it is capable of more rapid execution, is probably less controllable than the ordin- FiG. ■,TO.— Bichat'8 Trephine. Fig. 293.-01d-Fa8hioned Trephine. Fig. 300.— Single-Handed Trephine. 286 OPEKATIONS ON BONES. Fig. 301.— Operation of Trephining. Modus Operandi. ary trephine (Fig. 300), and therefore not so safe. The single- handed trephine is also to be preferred from the fact that the former requires both hands to manage it, while the latter can be manipulated with a single hand. They are both what might be properly denominated true circular saws, if judged by the result of their appUcation, which is the removal of a cii-cular portion of the bony structiu'e, and a corresponding round ojDening, through which other surgical indications can be fulfilled. A simple gimlet has often taken the place of the regular instru- ment, but such an appliance can be considered as possessing little more than the character of a mere exploring needle, from the impossibility of making an opening with it of sufficient dimen- sions to be available for any other practical use. TREPHINING. 287 The hone-scrapers, or elevators, whicli are sometimes employed as accessory, are used for preserving the periosteal covering of the bones; for removing the rough edges of the opening; or in ^^P Fig. 302.— Bone Scrapers and Elevators. raising the bony fragments vi^hich have been crushed in, or may be pressing against the cerebral substances. An important step before entering uj^on the operation, is to determine the points which are to be avoided. Generally speak- ing, any part of the head or of the body can be oj)erated upon, so long as there is a bony sui-f ace that can be readily exposed without danger of injuring other important organs. But, upon the head, the angles of bones and the tl-acts of the cranial sutui-es ought to be avoided. In the more common apphcations of the operation upon the head (Figs. 303, 304), one of four princij^al j^oints is gen- erally selected, by which to effect an entrance into the cavities of the sinuses. The points marked h, near the lower borders of the frontal bone, will open the frontal sinuses : the point c, upon the surface of the nasal bones, communicate with the sujDerior part of the nasal canities in the upper portion of the turbinated bone; the points e, upon the zygomatic bone, will enter the superior, and /', upon the great maxillary bone, will penetrate the lower maxillary sinus. Besides these specific regions upon which to apply the 288 OPERATIONS ON BONES. Fig. 303. Parts of the Head where Trephining : Pig. 304. Performed. instrument, there are conditions where, the bone being less sub- cutaneous, the operation is less easily performed. Such is the case as to the lateral faces of the parietal bone, where it will be necessary to penetrate through where the crotaphite muscle is. This, however, makes a compUcation of little importance. Again, there are indications, such as in cases of chronic coryza, with sup- pvu^ation of the sinuses, where a double trephining becomes neces- sary, one to enter the frontal, and the other the superior maxillary sinus. Figure 305, which is borrowed from Peuch & Toussaint, shows the exact location where the trephining can be made. A, entering into the frontal; B, the upper, and C, the lower max- illary sinuses. The modus operandi of this operation is very simple. Unless the animal is very restless, and cannot be controlled by the ordi- nary means of restraint, or by local anesthesia, and must there- fore be cast, or unless the trephining is merely the first step of an operation to remove foreign bodies or growths from the sinuses, or to apply special action upon a displaced bone, as in a fracture, we prefer to operate in the standing posture, and in such cases have found the use of cocaine of great advantage. In any case the skin is first di\^ded by either a V, or a T, or a TKEPHINING. 289 Fig. 305.— Common Points of Selection for Trephining. semi-lunar incision. We prefer the first as being least liable to be followed by a blemish. The periosteum is divided in the same form, if its division has not ah'eady followed that of the skin. The flap thus formed in two structures is then carefully raised from the attachment to the external surface of the bone, and held aside by an assistant, with either a blunt tenaculum or forceps. The instrument is then implanted upon the centre of the exfiosed bony surface, and by the rotatory or semi-rotatory motion imparted to it, gradually separates a circular disk of the bone. The pressure necessary to make the instrument seize or bite on the bone may at first be considerable, but as the trephine penetrates, the force" must be carefully relaxed in order to avoid the hazard of injuring the j^arts beneath by the sudden yielding of the bone and plunging of the instrument into the parts beneath, accompanied by the bony disk, as it separates from its last attach- ments, perhaps passing beyond reach, and costing no Uttle touble and danger before it can be discovered and removed. It is not judicious to penetrate through the bone at once. As the operator feels that he has nearly reached the last turn, the 290 OPERATIONS ON BONES. safe plan will be to j^artly sej^arate the disk with a partial, obhque turn of the trephine, and to complete the separation with the elevator. Sometimes this segment will be retained in the crown of the instrument, or, again, it will be only jiartially loosened. In that case, securing it with a pair of bull-dog forceps, its excision can be made complete with the bistoury, by dividing the mucous membrane of the sinus which may hold it. If the edges of the opening in the bone are not perfectly smooth, their asperities should be removed with the bone scrapers or bone knives. The indications following the perforation of the bone vary according to the case. If it is a fracture, with pushing in of the bone, the fragments, or the bone debris, must be removed by being raised with the bone elevator, cutting from within outward. If a removal of a parasite of the cranial cavity is to be effected, its membranous envelopes may be carefviUy twisted around the jaws of the forceps, and thus removed in a single mass. In cleansing out a purulent collection in the sinus, it must be injected and washed with the proper medicated solution. If, on the contrary, the removal of a foreign body is necessary, as a polypus, or an odontoma, or the extraction of a molar tooth by gouging, it may become necessary to enlarge the opening. This is done either by chipping off the edges with the bone forceps, or by making another opening with the trephine, adjoining the first, and merging them together by properly trimming and shaping them. The dressings required after trephining vary according to cir- cumstances. If the trephining has been but a preliminary step to a subsequent manipulation, such as the raising of a fragment of fractm-ed bone, or for the removal of foreign bodies, the wound, after beino- thoroughly and antiseptically washed, can be closed by bringing the edges of the integument together by sutures, and covering the surface with a pad of oakum, kept in place by a fig- ure 8 roller, around the head, or by one of the frontal, single or double, already described. If, however, the operation has been performed in a locality where there would be difficulty in retain- ing such a dressing, the application of agglutinating preparations or plasters will effect the object. When the frontal and maxillary sinuses have been opened, and it becomes necessary to wash out their cavities by injections thrown into them, the trephined opening must be prevented from closing by the introduction of a tent of oakum and a kind of soft cork, PEKIOSTOTOMY. 291 which may be kept in pLace by securing it to the halter of the l^atient, to prevent it from falling into the sinus. The cicatrization of the wound made by the trephining in- strument springs from the rapid development of granualations which soon fill up the opening. These granulations soon undergo the various changes which take place in the j^rocess of calcification and ossification, and the loss of bony substance is soon completely rej^aired. In a few instances, however, the seat of the ojDeration, after a few days, assumes a most unfavorable aspect, becoming swollen and ofiensive, and betraying the characteristic necrotic odor. In many instances the seat of the necrosis is found to be the edge of the opening, and is due to the imperfect appHcation of the tre- phine, and the destruction of thej^eriosteum. Care must then be taken to remove all the loose necrotic fragments. To allow them to remain imbedded in the granulations and under the skin, wiU be to incur the certain hazard of the development of abscesses and the formation of fistulous tracts, which will refuse to heal until the last particle of diseased bone has been exfoHated and removed. PERIOSTOTOIVrY. Periostotomy is an operation which consists in the subcutaneous division of the periosteum, on the surface of bony growths. It may be for the purpose of stimulating their resolution, or it may be to relieve the pain arising from the tension of the inelastic membrane as it is pressed upon by a tumor of the bone growing under it. The operation was originally performed by Professor Sewell of the Royal Veterinary College in 1846, and was at first considered to be one of the neatest and most scientific among the methods practiced for the rehef of the lameness due to exostoses. It was considered by Sewell himself to be far sufierior to any other means then in use, counter irritations, firing, and the rest. But although earnestly supported by the authority of its inventor, periostotomy has not sustained its claims by exhibiting all the results which were promised for it, and experience has shown that it is in many instances not only a useless, but even a dangerous operation. Several special instruments are necessary in its per- formance. These are a peculiar roxoel scissors (Fig. 306) to incise the skin, for which, however, a special bistoury (Pig. 307) is 292 OPERATIONS ON BONES. Fig. 306.— Scissors. 307.— Bistoury. 308.— Periostome. 309.— Seton Needles. sometimes substituted; a periostome (Fig. 308), a kind of blunt bistoury, narrow and curved; and two flat needles (Fig. 309), short and curved flatwise, one of which is blunt, and used to di- vide the connective tissue, the other being sharp and to be used as a seton needle to pass a tape into the subcutaneous incision, if it is judged necessary. These needles may either be inserted into a handle, or used free. The operation is a simple one to perform. The animal being cast and properly secured, an incision is made with the rowell scissors or the bistoury, at the most dependent parts of the bony growth, large enough to allow the introduction of the blunt curved needle. This being pushed slowly under the skin, separates it from its attachments, and ui^on being gradually withdrawn, the periostome is passed into the tract thus formed, directly over the bony tumor. Turning the sharp edge of the periostome on the exostosis, and pressing it over the periosteum, this is divided by subcutaneous strokes down to the most superficial layer of the exostosis, which may be incised by the instrument. When the tumor is of long standing, a seton may be intro- duced by pushing into the tract, from which the periostome has been removed, the curved needle which carries the tape, and it is brought out by an opening made at the highest part of the tumor. SeweU claims that after twenty-four hours the parts become the seat of a large swelling, and more or less inflammation may take place, but after twelve days the animal is ready to resume his work, the swelling ha\Tng gradually subsided, and the lameness RESECTION OF BONES. 293 passing off, sometimes tlie enlargement having disappeared. Our own observation, however, differs from that of Sewell and agrees with that of Reynal, as we have seen cases where excessive inflam- mation has followed the operation, accompanied by the persistent development of large indurated swellings, intractable to any other form of treatment, and giving rise to permanent lameness. This operation, although highly recommended by English practitioners, especially in the treatment of splints, is not, however, held in the same estimation by Continental veterinarians. RESECTION OF BONES. The resection of a bone is the removal of a portion of its sub- stance, for the connection of a deviation from its normal position, or other deformity, or in cases of fracture, or necrosis, or other incurable disease. It is to a bone what excision is to the soft tissues. It has been known for a long time, but it is within only a comparatively recent period that it has found admission into veterinary surgery, and even now it is but seldon practiced. It is pi-acticable on all parts of the skeleton, but there are some special conditions in which it is more e>idently indicated than in others, such as cases of necrosis in the vertebrae, giving rise to obstinate fistulous withers, and in the treatment of some exostoses ; or again in that of the comphcated wounds accompanying frac- tures. Fig. 310.— Various Forms of Saws. 294 OPEKATIONS ON BONES. Fig. 312.— Bone Forceps. Fig. 313.— Gouge. Fig. 313«.— ChiseL (I ^9 Fig. 3136.— Mallet. The instruments necessaiy are quite numerous. Saws of different forms, including the chain saw, the bone forceps, or shears, the gouge, the chisels, and the mallets are all brought into requisition at times. Before making a resection the diseased bone must be thoroughly exposed by a free and long incision, giving ample room to the surgeon for the free use of the instru- ments. If the bone is akeady exposed, great care should be taken to protect the soft tissues, the muscles, the blood vessels and the nerves, from being accidentally wounded, by covering them with compresses, cloths, or other substances. RESECTION OF BONES. 295 The manipulations will of course vary, according to the bone which is to be incised. AVhen one of the long bones is to be re- sected in its long axis, either in part or in whole, the periosteum must be kept as nearly intact as possible ; as the jjrinciple regen- erator of the osseous tissue, its removal would necessarily interfere with the cicatrizing process. It must be very careftdly separated from the bone, and isolated, to the whole extent of the segment to be removed. This done, the bone can be readily cut off, with either the chain saw or the plain instrument. The resection of bones in theii' articular extremities seldom occurs in our practice ; it sometimes becomes necessary in diseases of the vertebrae, in fis- tulous withers, and occasionally in caries of the ribs. In the first case, that of the diseased vertebrae, the excision is commonly made with the bone forceps and chisels, or even with the gouge. The principal point to observe in these instances is to avoid injury of the ligamentum nuchoe as much as possible, and to save all the periosteum that can be preserved. The resection of ribs is accomplished with difiiculty, on account of the proximity of the pleura which lines their internal surface. To avoid woimding this important organ the rib is exposed by a longitudinal or crucial incision, and after isolating the intercostal muscles from their attachments, the pleura can be pushed away from the bone with the blunt end of a scalpel, and with the chain saw introduced carefully between the bone and the pleura, the resection can be accomplished by dividing the bone from within outwards. The hemorrhage which arises from the intercostal artery can be stopped by plugging. The wound is dressed by a protective antiseptic bandage applied round the chest. The general indications, after the resection of bones, are to care- fully watch the progress of the wound and watch for the possibility of the formation of fistulous tracts, which may result from the extension of the necrosis, which may not have been entirely re- moved, or may result from the removal of the periosteum. These, however, may often be prevented by so regulating the process of granulation, as to prevent the accumulation of pus in the wounds, and if necessary, by applying caustics or resorting to any other of the means recommended to fulfil the existing indications. CHAPTEK VII. OPERATIONS ON MUSCLES AND THEIR ANNEXES. CAUDAL IHYOTOMY. This operation, more commonly known under the name of pricking, is exclusively performed on equiaes, and is designed to diminish the power of contraction of certain of the muscles of the tail. However it originated, it has been perpetuated by a class of horse fanciers who have, to a certain extent, made it a dictum of fashion, and by whom it has been supposed to improve the symmetry of the animals upon which it is inflicted But it has lost, in oirr day, much of the estimation in which it was once held, and whUe at first, before its prestige had been weakened, all kinds of horses, indifferently, became victims to the bad taste and thoughtless cruelty of the custom, either the external form of our horses and the mode of attachment of their tails have been improved by more skillful methods of breeding, or they have in- stinctively learned the regulation style of carrying their caudal extremities. Whatever may be the cause, the fact is beyond dispute that the indications for the operation have considerably diminished. But though the effect of the division of the inferior caudal muscles is in fact, with some animals, to cause them to carry their tails in lines more graceful and more horizontal than before, it is still necessary, in order to accomplish a successful result, that the tail should be properly attached to the body as a con- genital arrangement, or well set up on the sacrum. A horse with an obHque sacrum, with the tail set low and close to the ischial tuberosities, can never be a good subject for the operation, or made to serve as a favorable example of the beautifying effect of pricking. But with all this, there is sometimes a condition which (look- ing not to the welfare of the horse, but solely to the conveniences CAUDAL MYOTOMY. 297 of bis master), renders caudal myotomy an operation of necessity. This occurs with those animals which have contracted the annoy- ing habit, when driven in harness, of switching their tails over the reins and, in effect, grasping and holding them so tightly that it is only with difficulty that they can be extricated — often placing the driver in a position of imminent peril by making it impossible to control their movements at a moment when perhaps a disas- trous collision or other dangerous encounter may impend. There is also another condition which relieves caudal my otomy from the imputation of relying for its justification exclusively on the plea of being in the fashion, though it involves only the sordid argument of a money consideration. This condition is found ill the case of the animal which carries its tail sidewise or with a lateral curvature — a deformity which may in many instances considerably diminish his market value. In other words, if the contra-indication of the operation is the fact of bad conformation of the animal and a low insertion of the tail, the indications, leav- ing aside the question of good appearance, no matter if the tail is attached low or high, are when the horse has the habit of taking hold of the reins by switching it over them, and again when the tail is carried crookedly sideways. We proceed to consider the operation under all the requirements. Caudal Myotomy Proper^ or Pricking, means the division of the two inferior sacro-caudal muscles, for the purpose of dimin- ishing their contractile j)ower. It is performed in several ways, most of which consist not only in the division of the muscles, but in the removal of a portion of the muscular substance. There is, however, one method of which we have failed to dis- cover any mention by European authors, and which we have for years practiced in the United States, where it has been in vogue for a period of more than forty years. This mode of ojDeration Ave shall consider in another place as the " American method.'''' A glance at plate 314 will show the peculiar anatomical position of the muscles, blood vessels, and nerves of the region to be oper- ated upon. Peuch and Toussaint refer to six modes of operations, but we think the matter can be judiciously simphfied by reducing the number by at least one-half. We shall therefore adopt a sim- pler classification, and describe the operation as it is performed by, ^r.s#, the transversal incision; second, the longitudinal; and third, the transversal and longfitudinal in combination. 298 OPEBATIONS ON MUSCLES AND THEIR ANNEXES. Fig. 314.— Anatomy of the Perineal, Anal and Caudal Regions. 1 1.— The skin. 2.— Portion of the aponeurotic sheath of the coo(>ygeal muscles. 3 3.— Inferior sacro coccygeal muscles. 4 4.— Lateral sacro coccygeal muscles. 5 5.— Is- chio coccygeal muscles. 6.— Suspensory ligament of the anus. 7 7.— Lateral caudal arteries. 8.— Deep caudal vein, satellite ot the median artery. 9.— ^Median caudal artery. 10 10.— Inferior caudal nerves. 11.— Lymphatic glands. 12 12.— Superficial caudal veins. 12'— One of the superficial caudal veins. 13.— Portion of the perineal aponeurosis. 14 14.— Semi-membranosus muscle. 15.— Sphincter ani. 16 16.— Ischio cavernous muscle. 17 17.— Bulbo cavernous muscle. 18 18.— Suspensoi-y ligaments ot thei)fniB. 19 19.— Bulbous or internal pudic arteries. 20.— Im-ision of the urethral canal lor urethrotomy. 21.— Anus. CAUDAL MYOTOMY. 299 The patient must be kept, as much as possible, in the stantliug position, with a twitch on his nose, and his hind legs hobbled, or secured with the hipj)o-lasso ; or if he is of a very excitable and restless disposition, the stocks should be brought into requisition. The decubital position is, in our opinion, unnecessary, and un- doubtedly a very inconvenient one for the surgeon, and not at all contributive to the performance of a neat operation. We have often used cocaine when pricking horses, and it has in many in- stances produced all the excellent effects of general anesthesia; and we prefer it, therefore, to the inhalations of chloroform which some recommend. 1st. Operation by Transverse Incisions. — The instruments required in this mode are a histouri a serpette, an instrument re- sembling that known as histouri cache, of our obstetric cases; Fig. 315.— Bistoury for Caudal Myotomy. a sharp convex bistoury, and a bull-dog forceps, or a pointed tenaculum. The animal being secured in position, an assistant, placed on one side of the croup of the patient and facing the operator, raises the tail perpendicularly and well on the middle of the back of the patient, in order to render the mus- cles tense and cause them to project well under the fine, soft sMn which covers that region. The operator, directly facing the posterior parts of the animal, then firmly grasps the tail with his left hand and steadies it, while holding the blade of the histouri a serpette between the right thumb and index finger, close to its sharp part, and plunges the instrument through the skin and the entire thickness of the muscle, beginning on its inside border, or slightly on one side of the median line, and carrying Fig. 315a.— How to Hold the Bistoury and Make the Incision. 300 OPERATIONS OX MUSCLES AND THEIK ANNEXES. the incision outward, right across the entire width of the muscle. The incision must rvm through the entire thickness of the organ and ovight to be made by a single stroke of the instrument. The first incision is to be made about three fingers width from the base of the tan ; the second from one inch and a half to two inches back of it, and the third, if not considered unnecessary, at the same distance from the second. Owing to the taj^ering form of the tail, the incisions should become shorter as they approach the end of that member. When all the incisions are made on the right side, the oj)erator, if ambidexter, changes hands and re- verses his mode of manipulation, proceeding otherwise in the same manner as before, being careful that all the incisions are made directly in line with one another, entirely across the muscle. These first three incisions constitute the first step of the operation. If the division of the muscle has been made through its entire thickness, the portions of tissue be- tween the incisions will slightly protrude, and these are to be seized with the bull-dog forceps, and drawn over to one side, while they are care- fully dissected away with the convex bistoury, placed flatwise, under the muscle, with the sharp edge turned up- ward, and separating entirely the two portions of muscles included Fig 316 —Trans- between the incisions. The amount versa! Incisions in of muscular tissue thus removed Caudal Myotomy. ^^ measui'e from thi-ee to four inches ia length. The number of the incisions varies. At first one was considered sufficient, but the number was gradually increased to five, while at present com- mon agreement has fixed the rule at three. 2. The Operation by Longitudinal Incisions. — This is comparatively an old mode of operating, which, havuig been once abandoned, was revived by Delafond, in 1833, when it was again reinstated in general practice. It requires for its perform, fig. 3i6«.— Cau- ance only a stronnf, convex bistoury. The animal ^^^ Myotomy by ., . "^ _ °' -^ _ , Longitudinal In- being secured m the usual position, and the tail cisions. CAUDAL MYOTOMY. 301 kept as in the other methods, the operator makes on the middle of one of the projecting- muscles a longitudinal incision, three or four inches long, dividing at one stroke the skin and the fascia underneath. From the muscle thus exposed, a j^ortion is dissect- ed, and by i:»assing the bistoury under it, close to the vertebrse, it is removed b}^ cutting- it transversely at both extremities of the cutaneous incision. The removal of the muscle is made first on one, then on the other side of the median line. 3d. Operations by Mixed Incisions. — This was devised by Vatel, who made two transversal incisions on each side of the tail, from thi-ee to foiu' inches apart, and uniting those of the same side by a longitudinal incision, made in the direction of each in- ferior caudal muscle, and then dissecting a portion of each organ with the aid of a bistoury, or a pair of scissors, securing a hold at one end with a pair of forceps, or a j^ointed tenaculum. The method patronized by Brog- niez, and recommended by Belgian veterinarians, requires two special in- struments: the caudal dermatome, which is used for the division of the skin, and the caudal myotome for that of the muscles. The operation is . minutely described by Director Degives, and includes the following stejDS : Two or three incisions are made on the prominent part of the muscle, parallel to its long axis, the first about two fingers' width from the base of the tail, a space of about half an inch being left between each in- cision. These incisions are made with the dermatome, pressed perpendicularly over the tissues to be divided. The two lower incisions are first made, then the two middle ones, and the two upper ones last. By this process the skin and subcutaneous fascia are divided. The myotome is then introduced under the muscle, from within outward, and after twisting it around the organ, di- vides it by turning the instrument so as to bring its sharp edge against the muscular tissue. Thus divided, the muscles protrude through the incision, and are then excised in the usual way. Fig. 317.— Operation ny Mixed In- cisions (Vatel's method) 302 OPERATIONS ON MUSCLES AND THEIR ANNEXES. Fig. 318.— Caudal Der- matome. Pig. 319.— Cau- dal Myotome. Fig. 320.— Brogniez's Mode of Operation. The American^ or Subcutaneous Method. — This requires but a single instrument, viz.: a strong, straight tenotomy knife. The operator, ha\'ing the animal in the usual position, with the tail under proper control, and holding his knife flat full in the hand, plunges it flatwise through the skin, with the sharp edge turned downward, from without inward, measuring carefully to intro- duce it at about the sej)aration of the lateral and inferior caudal muscles, and pushing it as nearly as possible between the mass of the muscle and the vertebrae. When the instrument has pene- trated to near the median line, the sharp edge of the instrument is, by a twist of the hand, turned perpendicularly in the direction of the muscle, and by a careful sawing motion, the division of its fibers is accomplished. This is easily detected by a peculiar crack- ing sound, which ceases as soon as the entire thickness of the muscle is divided. The edge of the instrument can then readily be felt under the skin. The cutting must be carefully done in order to avoid the division of the entu-e thickness of the skin. A second and third division must follow, the number being equal on each side. There is also another subcutaneous mode, practiced by Ger- CAUDAL MYOTOMY. 303 man veterinarians, but which is claimed by Hering to be uncertain as to its results. In this operation both a straight and a curved myotome are used. With the straight knife a small incision is made, parallel to the axis of the tail and close to the haii', and the curved myotome is then introduced between the skin and the muscle. A turn of the instrument brings its edge against the muscle, and by the usual sawing motion, the organ is divided from within outwai'd, the blunt end of the myotome sHding upon the vertebrae. Neither of these subcutaneous methods include the removal of any portion of muscle. When the operation is finished, the animal may be relieved and the tail released without any apprehension of serious hemorrhage, although by reason of the unavoidable division of the lateral caudal arteries, a certain amount will necessarily take place. But this is not of a serious nature, and, as a rule, needs no special attention ; we have seen the blood which had flowed quite freely while the tail was hanging pendant, cease almost immediately when the animal was returned to his stall, and the tail placed in the position to be described on another page. But in case of an unusually abundant hemorrhage, a simple compressible bandage may be applied, to be left on until the bleeding is controlled. The treatment appropriate for wounds resulting from incision and removal of portions of muscular substance, is that which is common to all suiDpurating wounds, cleanliness being the most important item. AVhile such attentions are naturally re quired for animals subjected to any of the various methods of operation, the subcutaneous mode can claim an imj^ortant advantage in the fact that the heahng process is almost always by first intention, and the tail demands no subsequent nursing. Whatever may have been the method of operation which the animal has undergone, it will be subsequently necessary to place the tail in some given elevated position, and retain it in position for a term ranging from two to possibly four weeks, or until the wounds are cicatrized. Various devices are in use for keeping the tail in an elevated position, the simplest and probably the best of which is that of the pulleys. The proof is simple ; either a single pulley is placed in the middle of the ceiling, or two are used, one on each side of the stall, and in either case about on a level with the loins of the animal. The tail is kept in the perpendicular 304 OPERATIONS ON MUSCLES AND THEIR ANNEXES. Fig. 321.— Simple Methodto Keep the Tail Elevated. position by a cord passing through the pulley, one end being se- cured to the tail and the other to a weight sufficiently heavy to effect the purpose (Fig. 323). A httle art is necessary in attaching the cord to the tail. The hair should be nicely braided and a loop formed, and then a small wooden pin run through the braid will effectually prevent the cord from becoming detached. This plan Fig. 322.— Brognlez'B Apparatus to Elevate the Tail. CAUDAL MYOTOMY. 30^ Fig. 323.— Elevating the Tail with Pulleys. also has the advantage of equalizing the strain on the hair. In respect to the amount of weight to be employed in this process, much caution must be exercised in order to avoid excess. An error here might cause the loosening and loss of the hair, with the troublesome consequences of greatly interfering with the final result at the cost also of much suffering to the horse. The cord should run freely through the pulley and be of sufficient strength to allow the animal to lie down if disposed to do so. It will be a prudent precaution to accustom the animal to the use of the j)ul- leys by placing them on him for a few hours daily for a short pe- riod in anticipation of the operation. It will be necessaiy — as we before remarked — for the horse, after that, to remain in the pul- leys not less than two, and possibly three or four weeks, although after a short time he may be relieved for the pvirjDOse of taking proper exercise. The Bartlet's apparatus recommended by G. Fleming may also give very good results (Fig. 324). Caudal myotomy is an operation, which, though simple in it- self, may be followed hj numerous and, at times, severe compli- cations. Out of one hundred and forty-one animals operated upon by Hering, four died from either gangrene, severe petechial fever or suppurative infection. Among the most common acci- dents met with are the following : 306 OPEKATIOXS ON MUSCLES AND THEIR ANNEXES. Fig. 324.— Bartlet's Apparatus, Separate and in Position. 1st. Hemorrhage^ which is not generally serious, taking j^lace mostly when the tail is loosened and allowed to hang down, and ceasing as soon as it is again placed in an elevated position. It is but seldom that it becomes necessary to interfere for the jDur- pose of arresting it, which is easily effected by the ordinary means, as pressure or the ajDplication of hemostatics. 2d. Gangrene is one of the most dangerous sequelae of the operation, whether resulting from excessive traction on the tail by the heavy weights, a di-essing too tightly applied, or excessive inflammation, or, according to Hering, to the completed section of all the arteries supplying the tail "When becoming gangren- ous, the wounds assume a brown or blackish appearance, the sup- puration becomes sanious, with a rejoulsive, sui generis odor, the tail is swollen and flabby, and the oedema surrounding is cold and puffy. The gangrenous process generally begins toward the end of the tail and progresses raj)idly, endangei'ing in time the life of the patient. It is often only by the most energetic measures that it can be controlled, such as the free use of antiseptics, scarifica- tion, cauterization, or even amputation. 3d. 'Wounds of the Vertehrm and of their lAgaynents. — These injuries, not so serious in their character, are usually produced by the contact of the knife during the operation, causing a scraping of the bone and wounding of the periosteum or the ligaments which unite the vertebrse. Another injury is a re- sulting necrosis caused by the formation of a fistula, from which a thin sanious pus is discharged, and which forms a wound which refuses to cicatrize. Though Zundel affirms that this compHca- tion is most common after the subcutaneous operation, long experience with this process fails to justify our agreement with CAUDAL MYOTOMY. 307 this assertion. "WTieu disease of the bones exists, the indication is to promote the exfoHation of the necrosed parts by free open- ings, antiseptic di-essings, and, if necessary, caustic injections. Anchylosis of the vertebrae is a common sequel of this complica- tion. 4th. Abscesses. — These suppurative collections are not uncom- mon, especially in animals having peculiar idiosyncrasies, as in cases of strangles. They may extend to the root of the tail, around the anus, or any part of the hind legs even to the rectal region. They require treatment similar to that of all analgous gatherings. 5th. Anal Fistulce. — This accident occurs when the first in- cision is made so near to the anus that it enables the pus, when it forms, to filtrate between the skin and the rectum into the pel- ^dc ca\T.ty, and is a condition which can be reheved only b}" giving free exit to the collected suppuration. 6th. Tetanus. — This termination can, in many instances, be avoided by antiseptic measures during and after the operation. 7th. l^he introduction of air into the veins is also mentioned by Loiset and Brogniez, but in our opinion there is no more reason to expect its occurrence in this than in any other operation. 8th. Exaggerated Elevation of the Tail. — This is one of the most common of all the sequelae met with. In this case the tail, instead of being carried horizontally and hanging gracefully, is, on the contrary, either elevated vertically, or even laid back on the croup. This is not j)recisely due to imj)roper manipulations during the operation, but is rather the result of the apphcation of too hea\y a weight and an excessive amount of traction while the animal is in pulleys. The most effectual way of avoiding this un- pleasant incident is to watch closely the progress of the cicatri- zation by taking the patient out for exercise and watching the manner in which he carries his tail, and then increasing or di- minishing the weight on the pulley, and shortening or lengthen- ing the period of its use. Operation for Abnormal Deviation of the Tail. — This is in- dicated where there is a lateral curvature of the tail, and the animal carries it sidewise, whether it be a congenital habit or occurs as one of the complications of jjricking ; and also when he cai-ries it in an excessively elevated position. In these cases myotomy is performed, according to the requirements, either on 308 OPERATIONS ON :\IUSCLES AND THEIK ANNEXES. the lateral caudal muscle on the side to which the tail is carried, or upon one or both of the superior sacro-caudal muscles, the elevators of the tail. As a rule, one incision only is necessary, and it must be done subcutaneously, and in the subsequent treat- ment, instead c f placing- the animal in pulleys, the tail must be tied up to the surcingle on the side opposite to that of the opera- tion ; or it may be allowed to hang down free. An experience on our part of many years, has rendered us skeptical as to the success of lateral caudal myotomy, a careful dissection of the tails of animals affected with this deformity having- proved the existence of an abnormality in the formation and development of the caudal vertebrae which has been either the cause or effect of the trouble. Operations jDerformed upon animals of this class have not been usually followed by a satisfactory result. CEUEAL MYOTASE— CRURAL MYOTOI^IY. This affection is peculiar to bovines, and is a species of dis- location, or displacement of the long vastus muscle — the external ischio-tihial. It is a lesion which forms a very serious impediment to the act of locomotion, by its disabling- effect upon the movements of the hind leg-. The nature of crural myotase will be understood by those who are f amihar with the anatomy of the region in cattle. With them, the bicej)s femoris covers, in its normal position, the whole of the coxo- femoral joint, in such a manner that its anterior border {a b), Fig. 325, is situated in front of the joint. This border, from the articulation to its lower end, forms a kind of tendon, (c) closely connected with the aponeurosis of the fascia lata, (f) whose divided layers surround the muscle, adhering intimately to its two faces, the deep and the superficial. Passing over the trochanter of the femur, with the assistance of a large mucous biirsa, the biceps is quite thin, and is kept in position by an aponeurosis (c) which partially covers the gluteus externus, and is united to the fascia lata. "^Tien this aponeurosis is lacerated at a point on a level with the hip joiat, while the leg is carried backward, in excessive ex- tension, it is possible that the trochanter, thus carried forward, may become engaged in the laceration, the biceps itself being- hooked, as it were, behind the trochanter, and prevented from re- CEUKAL MYOTOMY. 309 Pig. 325.— The Biceps Femoris in Cattle. Normal Position. Fig. 326.— The same over the Trochanter. turning in its normal direction. This accident lias been noticed and mentioned in the remotest ages. It may result from both predisposing and occasional causes. Among the former may be reckoned the conformation of the animal, as when, for example, the croup is short, flat and narrow, the hip joint not prominent, and the trochanter high. Among the predisposing causes may also be included that of leanness, as when the animal is thin and in poor condition, and the cellular tissue deficient. The combina- tion of these causes renders it easy for the muscle to slip over the trochanter, now relatively prominent, and it is thus that the dis- location occurs. Occasional causes also call for mention. These include all mischances likely to bring about the excessive extension of the leg, such as falls, missteps, slipping, jumping, kicking, blows, etc., any of which may thus affect the limb and jDroduce the lesion under consideration. And withal, it may take place without any ^isible, direct and efificient agency beyond the circumstance of the excessively lean condition of the animal, and even if the difficulty is remedied, and the displacement is reduced, while the same state of things continues, there is a constant liability to a return of the difficultv. 310 OPERATIONS ON MUSCLES AND THEIK ANNEXES. The symptoms characteristic of this lesiou are readily identi- fied. Principally, there is great difficulty in flexing the hip joint. The diseased leg is dragged on the ground, carried outward and backward and the animal resting it on the ground by the point of the hoof only. It very much resembles the position of a limb of a horse suffering with a dislocated patella. The anterior border of the muscle, hooked by the trochanter, forms a longitudinal projection, resembling a stretched cord, which becomes more and more mai'ked when examined nearer the coxo-femoral joint. It can be made more prominent by raising the opposite leg, when it will be found extending obliquely downward from the joint to the patella. As the trochanter is no longer coyered by the muscle, this bony eminence becomes directly subcutaneous, and may be readily recognized, holding posteriorly the displaced muscle, which forms a kind of tvimor behind it. These symptoms, being rarely associated with inflammatory phenomena, are not always easy to detect. There are cases where the lameness, and the carrjdng of the leg outward and backward, are the only aj)parent symptoms. The lameness, however, is characteristic, and may be temporary or intermittent, being more severe when the animal is traveling up-hill than when descending, but remaining the same on both soft or hard ground ; and it sometimes happens that while the animal is in the act of descend- ing, the muscle will suddenly return to its place with a claj^ping sound, and the lameness subside, though only to return again as soon as the slightest effort is required of the animal, and his hind leg is again carried backward more forcibly than usual. This peculiar intermittent character is sometimes the cause of an error of diagnosis w^hich confounds this affection with the dislocation of the patella, but the exjDloration of the stifle will always serve to establish the differential diagnosis. This accident is more or less serious in its consequences, and is particularly detrimental to the usefulness of working animals. It may sometimes, however, subside spontaneously or by simple rest, and especially if the condition of the animal is improved by good feeding with fat-producing fodder. Sometimes the displace- ment is comphcated by a laceration of the mucous bursa with the formation of a hygroma of warm, painful, oedematous swellings, indicating the rupture of the aj^oneurosis or the inflammation of the cellular tissue. CRUKAL MYOTOMY. 311 Generally the dislocation is unilateral, but in other cases it may occur in both legs. This last condition is always of a serious natui-e, and seldom responsive to treatment. The displacement of the biceps femoris seldom recovers naturally, although where in- comi^lete and intermittent, it may be benefitted by long rest, or when, as we have before remarked, it is due to the excessive lean- ness of the patient, in which case a hberal fattening diet will prove the best remedy, by removing the cause of its appearance. Local, external topical treatment by blisters, plasters, setons, etc., are of no avail. The section of the muscle or the operation of crural myotomy, is the indication. The modus operandi is not uniform, although the final object is the same in all. Oiu- opinion in respect to the best way of operating is in favor of that by the subcutaneous section. This is performed below the trochanter, and yet as near to it as possible, where the excessive tension of the hooked muscle can readily be felt. This consists simj)ly in making a small incision through the skin, by which to introduce a blunt bistoury, which is inserted under the muscle, with a director or a finger for a guide, and when at a proper depth tiu'ned to bring the sharp edge towards the aponeurosis, and cutting it from within outward, carefully avoiding the section of the skin. Fig. 327.— Gouze's Bistoury. The bistoury invented by N. Gouze answers the purpose very well. There is no after-treatment required beyond the ordinary care re- quired for all wounds. Simple as the operation of crural myotomy is, some compHca- tions may accompany it. Hemorrhage is not uncommon, usually subsiding without inter- ference, but sometimes requiring the application of hemostatics. Inter-Muscular Abscesses. — Diffused Suppuration. — These are the result of improper manipulations during the operation, such as lacerations of the cellular tissue by introducing the fingers too frequently into the wound, or dividing the muscle in several places. Ganyrene. — Though but rarely met with, this should be re- membered among the possible contingencies. It may occur as the 312 OPEKATIOXS ON MUSCLES AND THEIR ANNEXES. result of the presence of clots of blood or other mortified tissues in the wound, and is indicated by the bad apj)earance of the parts, the pecuhar oedematous sweUiug, first warm and painful, but sub- sequently becoming cool and painless. This condition requires promjDt and efficient treatment, both external and internal. In /Solipeds. — We once had occasion to resort to crural myotomy for the reHef of a case of pseudo-dislocation of the patella of several months' standing. The division was made towards the lower por- tion of the muscle, and was followed by satisfactory results, though not immediately. OPEKATIONS UPON FIBBOUS TISSUES. Tenotomy. In the terminology of surgery, tenotomy means the sectiofi of tendons — an operation which contemplates the con-ection of de- formities, from whatever cause they may proceed ; the relief of pressure upon exostoses, and the prevention of the complete execu- tion of a normal function, as that of flj^ing in birds. Our atten- tion wiU, accordingly, be directed to the study of the five varieties oi plantar, carpal, antibrachial and tarsal tenotomy, with that of the icings of birds. Plantar Tenotomy. This operation is the proper remedy for the deformity known as hmickling, or the malposition which arises from the exaggerated flexion of the fetlock joint, and consists in the subcutaneous section of the tendons of the flexor of the phalanges. In this affection of knuclding, which is mostly peculiar to sohpeds, there is lameness more or less marked, with a hard and painful enlargem.ent of the tendons, and a consequent interference with the act of locomotion, caused by an incomplete flexion of the articulations. The fetlock is carried forward, and contact with the ground is effected with the toe alone. Instances of spontaneous ciu-e or abatement are exceedingly rare. On the contrary, it has a tendency to aggravation, the swell- ing increasing, and the deformity becoming by degrees more and more developed, until at length the anterior face of the wall of the foot rests on the ground, and the case assumes all the well estab- 0PEKATIOX8 UPON FIBROUS TISSUES. 313 lished characters of a recognized club-foot. lu a majority of cases the disease is localized in the tendon of the deep flexor of the phalanges, but it often extends to the superficial tendon as well, or may involve the tarsal or carpal baud, or the suspensory ligament. This deformity of knuckling may exist in three different degrees : either the cannon bone and the phalanges meet in an almost ver- tical hue, as in the case of the animal stra'ujht or xiprifjht on his paster )is, which is the first degree; or the bones meet to form an angle opening backward, the phalanges being somewhat obhque ill that du-ection, instead of forward, as in the normal state, and the animal still resting on the entire plantar surface of the foot, which is the second degree ; while in the third degree these conditions are stni more exaggerated, the animal traveling altogether on his toe and exhibiting a case of the perfect talipes. This last conformation, which exists principally in the hind legs, is specially due to the retraction of the deep flexor, while in the other degrees it is the superficial flexor which is diseased. Lesion of the suspensory ligament may coexist in either case. The condition of the tendons, from which this deformity arises, is not the only question to take into consideration when the pro- priety of the operation is to be determined. The causes which have produced it must not be overlooked. For example, while ia the hind legs the accident has usually a traumatic cause, such as a sprain, violent over-exertion, lacerations, or contusion of tendons ; when the fore legs are affected it is most commonly as the accom- paniment of some lesion in other parts of the leg, as of the foot or the digital region proper, such as bad feet, na\dciilar disease, contraction of the heels, corns, quarter and toe-cracks, quittors, deep punctui-ed wounds, and very commonly ringbones, or other exostoses. Taking aU these various causes into consideration, with their specific natures, and the extent of the lesions which accompany them, we are justified in belie\dng vnih. Gourd on, that plantar tenotomy is indicated with fair chance of success, when the knuck- ling results from traumatism, and the perforans tendon is alone diseased ; and even when both tendons are affected, good results are still not improbable ; but that it is contra-indicated whenever complications exist which are likely to prevent the leg from re- turning to its natural position, as when the disease is of long standing ; when thei-e are alterations of the articular surfaces ; 314 OPEEATIONS ON MUSCLES AND THEIR ANNEXES. anchylosis of the fetlock ; exostoses ; adhesions between the ten- dons and the bones ; large engorgements of the tendinous struc- ture ; or chronic dilatation of the synovial bursse sm-rounding the region of the fetlock. Remediable cases would seem, from this, to constitute rather a small minority of the whole number. The fibrous tissues acted upon in plantar tenotomy, are the tendons of the flexors of the phalanges, in that part of their length which is situated back of the cannon bone, between the carpal or tarsal sheath and the fetlock. The superficial tendon reaching the fetlock forms a ring through which the deep flexor passes, a cir- cumstance from which has been devised the manner of perforatus and perforans, by which they are known. Fig. 328.— Median section at tbe infe- rior row of the carpus— of the metacar- pus and suspensory ligament. 1. Os magnum. 2. Posterior common ligament of the carpus. 3. Band to the perforans. 4. Suspensory ligament. 5. Its superficial layer. 6. The deep. 7. Principal metacarpal bone. The superficial tendon is covered by the fibrous expansion of the two carpal and metacarpo-phalangeal sheaths in the fore, and by the tarsal and metatarso-phalangeal in the hind leg. The deep flexor toward the middle of the cannon receives a strong, fibrous band coming from the posterior ligament of the carpus or tarsus. Below and between the two small metacarpal or metatarsal bones is the suspensory ligament, a strong band, thin suj)eriorly at its origin, and bifid inferiorly. Between the suspensory ligament and the cannon bone, there is an interosseous vein and the two inter- osseous arteries ; on the side of the tendons, the internal and ex- ternal collateral veins, with, in the fore leg, the principal artery OPERATIONS UPON FIBROUS TISSUES. 315 collateral of the cannon, and the internal plantar nerve as its satellite on the inside, and the external plantar nerve on the out- side of the leg; while on the posterior leg the princijyal artery of the cannon, which is the collateral metatarsal, is situated on the outside of the bone, and comes in relation with the tendons only in the lower part of the metatarsus. In the anterior legs, the carpal bursa, hned with its synovial sac, extends downward on the flexor tendons as far as below the superior third of the metacarpal region ; the synovial vaginal sac of the sesamoid sheath runs upward along the tendons, as far as the lower extremities of the small metacarpal bones. It is at about the center of the middle third of the cannon that the operation can be performed without fear of injuring either of these synovial sacs. In the hind legs the tarsal sheath extends as far as the upper part of the middle thii'd of the metatarsal region, and the sesamoid sac being the same as in the anterior leg, a little larger space is left for the operation. Modus Operandi. — To perform plantar tenotomy, the animal must be thrown. Some practitioners operate with the horse on his feet, but this position is dangerous, although by the use of cocaine, much of the risk attending it may be obviated. The animal is thrown on either side, according to the leg upon which the operation is to be performed. If on the fore leg, it must be on the side of the leg to be operated on in order to expose the inside of the limb ; if on the hind leg, the animal should be thrown in such a manner as to make the leg upon which the operation is to take place the upper one. The arrangement, according to Gourdon, makes the operation feasible both on the inside of the fore, and the outside of the hind leg. Several modes of proceeding have been practiced. The old method is by a large lateral incision, in which the tendon is ex- posed, divided either with a bistoury, or by being raised from the wound and then divided. But this style of procedure necessitates the formation of large wounds, and is Hable to severe and trouble- some complications, which the modern or subcutaneous method ob^^ates. In performing the subcutaneous division, two instruments are necessary. These are the straight and curved tenotomes. The blade of the former is narrow, straight, thin and pointed ; that of 316 OPERATIONS ON MUSCLES AND THEIR ANNEXES. Fig. 329.- Straight Tenotomy Knife. Fig. 330.— Curved Tenotomy Knife. the latter narrow, curved and blunt, and sharp on its concave edge. The ammal being prepared, a puncture of the skin is made over the tendinous region (carefully avoiding the synovial sacs, as men- tioned above), by introducing the straight tenotome perpendicu- larly between the tendons, until the point of the instrument is felt on the opposite side of the leg. A slight sawing motion of the instrument then cuts through the connective tissue which unites them, and permits the introduction of the cui'ved tenotome into the tract made by the straight instrument, and the latter is slowly withdrawn. At this point the leg is carried into excessive exten- sion by the assistants, by means of ropes secured resiDectively, one about the knee, and one about the foot, and pulling that of the knee backward and that of the foot forward. The fetlock being thus stretched to its utmost, the oj)erator, with the edge of the curved tenotome turned toward the deep flexor, makes a slight sawing motion with the instrument, and cuts through the fibrous structure from behind and forward, a peculiar crackling sound in- dicating when the sectionis accomplished. The retracted extrem- ities of the tendons can now be felt with a wide interval between them, and the straightening, more or less, of the fetlock gives fur- ther proof that the operation is completed. This is the method in simple tenotomy. Some operators have suggested the introduction of the instrument between the sus- pensory ligaments aijd the perf orans in preference to the mode we have described, in which case the section of the tendon must be made from before backward. It is, however, a complicated pro- cess, and one which is not without danger of injuring tissues which ought to be left intact. The mode of ojDerating known as the Bernard method is based on this principle. The double tenotomy, though considered at first as a severe OPEKATIOXS UPON FIBEOTJS TISSUES. 317 operation, does not involve as many objections as at first thought, but, on the contrary, has often been followed by very satisfactory resiilts. It is, therefore, a justifiable operation when the defor- mity of the fetlock is quite extensive. In fact, it is unavoidable when both tendons are united, or when the deviation in the di- rection of the bony levers is caused equally by the common con- traction of both. In performing this double tenotomy, the divis- ion of the deep flexor being made by the manipulations already described, the curved tenotome being still retained in the wound between the tendons, the oj^erator simply reverses its position in order to bring the cutting edge in contact with the superficial tendon, and completes the operation precisely as already described. In this division of the tendon great caution must be observed, in order to avoid making a complete transverse section of the skin. Double tenotomy is also performed in some cases by introducing the tenotome between the sus23ensory ligament and the tendons, and dividing them by a section made at once through both from before backward. In some peculiar cases, besides the division of the two tendons, that of the suspensory ligament has also been included, sometimes in connection with the tenotomy, and sometimes independently. In this case, the place selected difl^ers from that which is indicated for the simj)le or double oj^eration. It is. indeed, toward the lower extremity near the bifurcation, and toward the lower third of the cannon, where it is more readily reached. The straight tenotome is first introduced, flatwise on either the internal or external face of the leg, between the ligament and the deep flexor of the pha- langes, carefully avoiding the blood vessels and nerves, and the curved instrument is inserted with its cutting edge toward the ligament, the section being niade by cutting from behind forward. The instrument must not be introduced between the bone and the hgament, nor must the section be made from before back- ward ; such a course not only endangering the nerves and blood vessels, but also involving the risk of breaking the blade of the tenotome at the bottom of the wound. "Whatever mode may have been followed, and however many tendons may have been divided, or whatever force may have been appHed to the rope by the assistants who made the traction, it is an exceedingly rare result to obtain a perfect straightening of the leg, most especially when the disease has been of long continu- 318 OPERATIONS ON MUSCLES AND THEIR ANNEXES. ance, and chronic adhesions may exist. A short walking exercise following the operation may facilitate the straightening of the leg, and in any event can have no injurious effect. But even with this, it is sometimes several days before any well-marked improvement can be discerned. There are cases, indeed, when ten or fifteen days may pass without noticeable change, but if it fails to appear after such a lapse of time, the case may be considered hopeless. There are practitioners, however, among whom are Didot, Delward and Hering, who object to this exercise, and hold that the natural and spontaneous straightening of the fetlock can be greatly assisted by proper shoeing, as, for exam- Fig. 332.— Mov- ple, by wearing a shoe with a ^'^i" Toe-Cork. Fig. 331. — Shoe with Pro- long toe, such as are used in cases of club- longed Toe. for ciub-Foot. f^^^^ ^^ ^„^:^^ ^^, having pecuUar movable toe-corks by which the effect of the bearing of the shoe is in- creased. The ordinary long-toed shoe represented in Fig. 333 is often worn with advantage. Long-Toe Shoe. Complete rest after the operation will benefit the patient in the most essential manner by diminishing the causes of pain and favor- ing the cicatrization, and possibly preventing an exaggerated ex- tension at the fetlock. It is only after from twenty to twenty-five days that moderate exercise may be allowed, and not less than six OPERATIONS UPON FIBROUS TISSUES. 319 weeks should elapse before the ordinary labor of the patient can be resumed. The resulting wound needs no special dressing, and by being thoroughly sterihzed by antiseptic manipulations, the jmrts will heal without trouble. The suggestions of poultices, fomentations, counter iriitation, blisters and firiag of old-time surgery must be sti-ictly ignored. If, however, all the measures recommended for the straighten- ing of the leg should fail, and, on the contrary, a tendency to an Pig. 334. Fig. 335. Figs. 33t, 335, 336.— "Various Apparatus Recommended after Tenotomy. excessive extension of the fetlock should be manifested, the apj)li- cation of some of the various kinds of aj^paratus designed for the correction of these defects may be experimentally tried, with a 320 OPERATIONS ON MUSCLES AND THEIR ANNEXES. possibility of good results. According to their peculiar working arrangements, slowly increased extension might be maintained' or the leg might be- steadily retained in a given position, or with the power of regu- lated motion, the result being an important and permanent imjjrovement in the value and comfort of the animal. The accidents which may be apprehend- ed in connection with plantar tenotomy are hemorrhage and loounds of nerves, or of the skin, or of the synovial sacs ; an exag- geration of the extension, and a return of the original deformity. To these Peuch and Toussaint add gangrene. (a) Hemorrhage, both arterial or vein- FiG. 336. Q^^g -Q^^ ^iiis may be avoided by careful attention to the rules laid down for the operation, and if it should occur, hemostatis by pressure must be resorted to, and the band- age can be safely removed, or at least the jDressure diminished, in from twelve to twenty-four hours. (b) Wounds of JVerves. — These cannot very well be avoided, and while they are manifested by severe struggles of the animal at the moment of their occurrence, they involve no dangei' other than those pertaining to similar injuries in other regions, \dz.: the temj)orary suspension of the sensorial functions. (c) Wounds of the Skin. — These are among the comparatively severe complications, and when they occur, they destroy all the advantages which properly accompany the operation as a subcu- taneous process. They are likely to complicate the operation with fungoid growths uj)on the stumps of the tendons, abundant sujv pui-ation, ugly cicatrices, etc., and should therefore be specially guarded against. (d) Wounds of the Tendinous JBursm. — These may be attrib- uted to an improper selection of the place where the punctui-e should be made, and may be recognized by the flow of synovial fluid from the wound. Suppurative synovitis may then complicate the case with fatal effect. The treatment they require is that directed for oj)en synovial tumors. Local applications, rest, pres ■ sure, counter irritation, blisters and firing are the indications. OPERATIONS UPON FIBROUS TISSUES. 321 (e) Exaggeration of the Extension. — This may take place ^hen artificial means to produce sudden extension are too power- ful, or when the %iolent efforts of the animal have caused a ten- dency in the parts to give way suddenly. The apparatus before referred to must be here brought into requisition. (/) Return of the Original Deformity. — This results from the retraction of the new tissue formed between the stumps of the divided tendon. It occurs as a consequence of returning the animal to his work at too early a date, and when the newly formed tissvie has not yet become sufficiently matured and sohdified to sustain the strain to which it had been subjected. Best, cold water bathing in a running stream, vesicating applications and firing have been recommended as remedies, and even a second section of the tendon may be suggested, though with but a doubt- ful prospect of good results. Carpal Tenotomy. This defines the section of the tendons of the external and oblique flexor muscles of the metacarpus. They are inserted on the trapezium bone of the carpus, and their retraction occasions the deformity known as sprung knees, a condition brought on by excessive and exhaustive labor, though there is a class of pa- tients in which the lesion may be ascribed to a congenital taint, and it is principally for the benefit of this class of patients that the operation is indicated and usually performed. It is principally favored and utilized in Germany, where it was originated hj Dieterichs, though afterwards adopted and practiced by Prud- homme, Lafosse, Miguel, Brogniez, Hering, Gourdon and others. The operation can be performed on either tendon singly, or on both ; but according to Hering, the division of the external mus- cle is generally sirfficient. The anatomy of the region should be described before passing to a detail of the steps by which the section of the tendon is ef- fected. The external flexor is situated on the postei-ior external part of the forearm, and terminates by the branches, one of which, the funicular, is anterior, and passing in the groove of the external face of the trapezium, becomes attached to the hand of the exter- nal rudimentary metacarpal bone ; while the other posterior, wide and short, goes to the supero and posterior circumference of the same bone, in connection with the middle flexor, to which it is 322 OPERATIONS ON MUSCLES AND THEIR ANNEXES. united. The section must be made above tlie bifurcation of the tendon, to avoid the artery which passes under it, though it is quite deeply situated, and besides, there is no danger of injuring the synovial sac of the carpal arch. The obhque flexor is situated back and inside of this, and has its tendon single, terminated on the trapezium, with the posterior tendon of the external flexor. The section must be made before the union of the two tendons, in order to avoid injury to the carpal arch. The animal is thrown, and the knee extended with two ropes, one above and one below the knee, and drawn in opposite direc- tions. The same instruments are used for carpal as for plantar tenotomy. The incision of the skin is made about two inches above the knee with the straight tenotome, immediately in front of the tendon, which is easily felt under the skin, and is raised with the fingers ; the curved tenotome is inserted between the skin and the tendon, from before backward, and the section made as in the plantar operation. Gourdon suggests the introduction of the knives under the tendon instead of between that and the skin. By this mode the di\ision is made from within outward, while in the other way it is made from without inward. The external flexor being thus divided, the section of the middle flexor is made a little below ; the puncture of the straight tenotome is made between the two tendons, and the cui'ved tenotome inserted as before, between the skin and the tendon from before backward, or preferably, from without inward, and when its blunt end is felt on the posterior border of the muscle, the section is made from without inward, with the usual motion of the knife. Only a simple dressing is required, but the animal must be kept at rest for at least a month. The modus operandi to which we give the preference over that which we have just narrated, and which we have described in our work on lameness, is very simple. The animal being thrown, on the side opposite to that of the operation, and the knee extended as usual, the operator, who is in front of the knee, feels for the space between the two muscles, where they are about to unite, and this being found, a straight tenotome is introduced through the skin from before backward, about two inches above the super- ior border of the trapezium, and under the thickness of the middle flexor, and when the point of the instrument is felt on the OPERATIONS UPON FIBROUS TISSUES. 323 other border of the muscle, in front, the curved tenotome is in- serted and the straight one withdrawn, and the tendon divided from within outward ; the straight tenotome is then re-introduced through the same opening, between the muscles, and carried from behind forward on the posterior border of the external flexor, imder its thickness, tmtil the point of the instrument is felt on the anterior border, when the curved tenotome is again re-insert- ed, and the division of the tendons performed as before. The wound of this ojseration is simple, heals readily, and is Hable to no complications or accidents. Of course the operator must ex- ercise due caution, when dividing the tendons from within out- ward, to avoid making a complete section through the skin. Anti-Brachial Tenotomy. This operation has been recommended for the relief resijec- tively of sprung knees and knuckled fetlocks, but by reason of the numerous and almost constant failures by which it was character- ized, has been discredited, and banished from the domain of our surgery. It consisted in the section of the tendinous band which from the lower extremity of the coraco-radialis extends downward to mingle with the fibres of the anti-brachial aponeurosis, in pass- ing a httle below and in front of the elbow joint. Brogniez, who recommended the operation, performed it by making a longitudinal incision of the skin over the course of the tendon, which is readily felt under the skin, and passing the point of a convex bistoury over the aponeurosis and the band, dividing it from without inward. Tarsal Tenotomies. Two modes of operation are practised uj)on some of the tendons surrounding the hock joints, one upon the cunean branch of the flexor metatarsi muscle, the other upon the tendons of the lateral extensor of the phalanges. They are known distinctively as the cunean and the jyeroneo-phalangeal tenotomy. («. ) Cunean Tenotomy. — The flexor metatarsi, one of the muscles of the anterior tibial region, is composed of two por- tions, one muscular, the other tendinous. The tendinous portion is situated between the muscular portion and the anterior extensor of the f)halanges, and is attached above to the inferior extremity of the femur, between the external condyle and the external 324 OPERATIONS ON MUSCLES AND THEIR ANNEXES. border of tlie trochlea of that bone, and passes in the groove situated between the anterior and external tuberosity of the superior extremity of the tibia, do^vTiward to the hock, where it rests on the anterior face of that joint and is attached by two branches, one to the cuboid, on the outside of the hock, the other to the superior extremity of the principal metatarsal bone. The muscular portion, which rests on the external face of the tibia, from the upper part of which it takes its origin, terminates in- feriorly by a tendon which passes through a ring of the tendinous portion, and becomes more superficial, and then divides into two branches, a large one, which goes to the superior part of the princii^al metatarsal bone, in uniting with that of the tendinous portion, and another, smaller, which bends inward, to terminate at the small cuneiform bone. This branch is chosen as the seat of operation. The operation recommended by Abildgaard and Viborg, was indicated by Hertwig, and at a later period performed by Lafosse, Hering, Mantel, Grad, Bugniet and Dieckerhoff. It is very com- monly performed on this continent, and, like many other operations at the time of their first introduction, has been both used and probably abused to such an ex- tent that it has not yet received the credit to which it is fairly entitled. It is indicated for the relief of the pres- sure which this branch makes upon the distended periosteum of the enlarged tar- sal exostoses known as s^^avins, and when the exostosis is, strictly speaking, the only lesion in the hock, it will prove essen- tially beneficial. But if, with the new growth of bony deposits, the joint itself Fig. 337.— cunean Branch of the should be involved, and some of the ar- Flexor Metatarsi. ^.^^^^^^. ^gg^ggg gj^Q^^j^j ^^ present, the result, so far as the removal of pain and lameness is concerned, is not always certain. Although more or less satisfactory at times, in many instances it entirely fails. The difficulty of positively diagnosing the condition of the articular surfaces justifies the surgeon in operating, when the tense condition of the tendon, its pressure upon the exostosis, and the irritation of the synovial sac OPEKATIONS UPON FIBROUS TISSUES. 325 "which aids its raovements, which it produces, poiut with certainty to the cause of the lameness. The instruments necessary are scissors, a straight and a con- vex bistoury, a dissecting forceps, a curved director, and pei-haps a curved tenotomy knife. The animal is cast on the side of the leg to be operated upon, the upper leg carried forward and secured on the upper forearm, and the hair cUpped over the tract of the tendon, which can be readily identified by an oblique groove generally found running on the upper portion of the bony enlargement. An incision about two and a half inches long is made with the convex bis- toury, either j)arallel to the tendon, or slightly obhque, and right Fig. 338.— Tarsal Tenotomy. Cunean Tendon Exposed. Fig. 339.— Tarsal Tenotomy. Tbe Tendon Raised. across its direction. This incision is generally accompanied by a somewhat troublesome capillary hemorrhage, which ought to be controlled before proceeding furthei\ The tendon may then be felt through its bursa, which is raised with the dissecting forceps and opened, when the tendon is readily exposed. The curved director is then inserted under the tendon, which is easily raised from its tract, and by guidiug the tenotome along its groove the section is made by a single stroke. Some practitioners complete the operation by amputating a portion of the tendon. This is unnecessary, and complicates the operation by subjecting the parts to the necessity of a repairing 326 OPERATIONS ON MUSCLES AND THEIR ANNEXES. process, which is not needed for the result of the operation, and exposes the animal to a complication of inflammation of the synovial bursae which ought to be avoided. To obviate these dangers, Dieckerhoff is of the opinion that the division of the bursa is all that is required, and states that he has often secured good results, from that alone, without the section of the tendon. Besides this mode of operating, which may be called the 02)en incision, there is another procedure by subcutaneous division, which is also recommended by some, but the difficulty of discover- ing the tendon in its bony groove, and in reaching it properly, and the possible complication of subsequent inflammation of the bursse, will probably secure the preference for the method by open incis- ion. The operation is completed by closing the wound with a stitch of suture, and protecting it with antiseptic dressings. The results of the operation are sometimes immediate, though in some cases not apparent for a few days, but if after the lapse of two or three weeks the lameness has not either disappeared or greatly abated, it may be safely concluded that it is attributable to some cause other than the pressure of the tendon. {b.) Peroneo- Phalangeal Tenotomy. — Though the true pathology of the peculiar afi'ection of the hock joint known as springhalt, and the cause that excites the spasmodic action characterizing it, are far from being satisfactorily known, it has been observed that in animals thus afiected the tendons of the ex- tensors of the foot in front of the hock have a tense or rigid character, which renders them unusually prominent ; and it is this symptom which suggested to Brocar, a Belgian veterinarian, the division of the tendon of the lateral extensor of the phalanges, or peroneo-phalangeal muscle, as a means of cure. Brocar, Brogniez, and Delwart performed it, and have recorded their success in numerous cases. The lateral extensor of the phalanges terminates inferiorly by a round tendon, which passes into the groove situated on the out- side of the lower extremity of the tibia, in a sheath formed at the expense of the superficial external ligament of the tibio- tarsal joint. In this sheath it bends forward and downward to join the tendon of the anterior extensor toward the middle of the metatar- sus, which it crosses downward, forward and inward. The operation is of the simplest nature, and may be j)erformed with great facility. The animal being cast, and the section com- OPERATIONS UPON FIBROUS TISSUES. 327 pleted tlirough a small incision made over the tendon, a little be- low the hock, and near its junction with the principal extensor, about one inch of the tendon is removed. Sometimes the action of si^ringhalt ceases at once, when the animal is allowed to rise to his feet. Other cases require a few days for the completion of the cure. The simple operation has proved satisfactory in our hands in two cases. Tenotomy in Birds. The operation is performed in this instance with the object of preventing- the animals from flying, and consists in the section of the tendons of the extensor muscles of the carpus and phalanges. The bird is held by an assistant, with its wing extended, and a few feathers are pulled out from each side of the carpal joint, as well as in front of the radius, to expose the skin, through which the extensor tendons, two in number, are readily seen. A small incision being made through the skin, the tendon is raised with forceps, and a portion of it amputated, the operation being re- peated on the other side of the wing upon the extensor tendons of the digits, between the radius and the cubitus. The treatment is applied to both wings ; it is without hemorrhage, and the wounds heal in two or three days. CHAPTER Vni. OPERATIONS ON THE DIGESTIVE APPARATUS. ON THE TEETH. The office fulfilled by tlie dental system in the preliminary preparation of the ingesta, and the first step in the process of di- gestion, is necessarily one of the utmost imj^ortance. Of course, therefore, any diseased conditions which may interfere with its efficient action, especially with the herbivorous animals, become matters of deep interest to the veterinary practitioner. All facts and circumstances concur to establish and substantiate the claims of that branch of veterinary science which refers to the care of the teeth as a very important specialty, and we shall, there- fore, so estimate and so elucidate the subject of vetermary dentis- try, so successfully studied and so largely developed in recent years by American veterinarians. The diseases of the teeth to which our domestic animals are subject may be due to various pathological conditions. The den- tal arches formed by their arrangement in the jaw may be the seat of congenital deformity ; the teeth may possess abnormal qualities in respect to their number, their shape and their direc- tion ; or, again, in the condition of their grinding siirfaces, and there may also be special diseases of the elementary substances of the tooth itself.* The abnormahty which exists in relation to the number of the teeth is of not vincommon occurrence in horses, in which animal we sometimes discover the j)resence of supplementary molars, resulting either from the persistence of a temj)orary tooth which has failed to be shed at the proper time, or may be due to an excess of de- velopment in the evolution of a dental foUicle, as we may observe in the formation of the v;olf tooth. In relation to the shape of the dental arches, there are cases » We take pleasure in recommending, in connection with this subject, the excellent little work on Horses' Teeth, written by Mr. William H. Clarke. OPERATIONS ON THE TEETH. 329 where, instead of presenting the regular and correct natural lines, the upper and lower molar arches so far disagree as to render theu' perfect coaptation impossible, and render the execution of their function to a great extent impracticable. The direction or implantation of the teeth is, at times, so far irregular and abnor- mal as to change the frictional surfaces in such a manner as to remove the wear and abrasion from the crown to the surface of the organ. In relation to the disposition of their rubbing sur- faces, it is well known that' on account of the difference existing in the consistency and power of resistance, two of their elements, the enamel and the dentine, their frictional surfaces become rough, irregular and sharp; and, as they sometimes assume excessive dimensions, they may give rise to serious phenomena, especially when they have theu' seat in a part of the dental arch where no resistance can be offered to their development, as when the cor- responding tooth of the opposite jaws becomes diseased or absent. The special diseases of the elementary constituents of the teeth exist in the depth of their substance, and consist in caries or ul- ceration of the tooth, the affection involving the dental pulp itself, with other diseases pertaining to the alveolo-dental rnembrarie, all of them being accompanied by a series of well understood symjD- toms, severely distinctive in their character, and which in the ma- jority of cases call for the assistance of the veterinary dentist in order to reheve the suffering animal from the distress in which his human master knows but too well how to sympathize. The symptoms pertaining to the various conditions above al- luded to may be either common, or general, or special. Among the general symptoms, the first to be observed is a change in the style of performing the function of mastication, proportional to the sensitiveness occasioned by the dental lesion. Thus it is ob- served that although the animal seizes his food with the same avidity as if his teeth were in good order, the motion of his jaws, the chewing of the food, are slowly and carefully performed, the lateral movements of the lower jaw occurring in a hesitating man- ner, and often made on one side of the mouth only. In eating hay, the mouthful of the food is never triturated as it ought to be, and before the process of mastication is completed the animal drops it out of its mouth in the shape of a flattened bolus, satu- rated with saliva, to seize it again and make a new attempt at mastication, perhaps twisting his jaw in different directions in his 330 OPERATIONS ON THE DIGESTIVE APPARATUS. endeavor to accomplisli tlie act without pain. The attempt seems, however, to be vain ; again the mouth is opened and the same flattened bolus is dropped in the manger, and this continues untH the poor animal, suffering and hungry, is seen standing before a rack full of hay for which he both longs and fears to touch. The suffering horse will sometimes swallow his oats imjjerfectly mas- ticated, but the partial chewing is performed slowly and with dif- ficulty, his manner indicating the jDain it costs him ; dipping his nose in the manger, chewing on the grain for a long time, and impregnating it with saHva before he swallows it. Soft food, bran and mashes, cooked roots, scalded grains, and the like, are the only aliments that can, without difficulty with this imperfect de- gree of mastication, enter into the phaiynx. Animals suffering with diseases of the dental apparatus are often affected with coHcs. At first they may be slight and inter- mittent, but they soon become more severe and more frequent. They may last for several days, and may be marked by the pecu- liarity that during their continuance defecation may still continue, though irregular as to time, and the movements scanty in amount, the foeces besides being in small and adherent lumps, and more or less coated. In other cases they are soft, and the animal has a tendency to be washy, and more or less to scour, but in either case the droppings are more or less loaded with unmasticated food. All these symptoms are manifestations resulting from an imperfect digestion. It is easy to understand that if this condition continues for any length of time the entire economy will suffer from it. The animal looses flesh ; his coat becomes dull, dry and staring ; his force and ardor diminish ; he sweats easily, and all his other func- tions exhibit evidences of the weak condition of an organism de- prived of the nutrition and strength which foUow the ingestion of food thoroughly masticated and well digested. Having recognized these symptoms, which, if not seen by the surgeon, should be brought to his attention through the history of the patient; when intelhgently stated, the diagnosis may be considered established. But it becomes positive only after an examination of the mouth, by which the special symjotoms per- taining to each alteration are elicited. The inspection of the mouth, which may be kept oj)en by the use of the various sjDeculums, or by merely pulling the tongue OPERATIONS ON THE TEETH. 331 sidewise out of the way, will, in a great majority of cases, easily lead to the detection of the cause which interferes with masti- cation. Fu^st of all, when the mouth is opened, a peculiar symptom wiU be observed, consisting in a change in the salivary secretion. This will be increased more or less, and as the saliva will escape freely, a pecuhar acid odor will be noticed j)roceeding from it, and on looking for the cause of this trouble, if it be one or other of the iri'egularities already mentioned, such as the projection of one of the teeth, the vicious incHnation of their crowns, the sharp edges, etc., critical inspection will soon reveal them. The teeth ■will be found to be soiled with greenish food-detritus on the side where the difficulty exists, and on that same side the animal will be found to have stored the surplus food which he has accumu- lated between his teeth and the cheek. If, however, in consequence of being situated so far back in the mouth that the eye fails to detect the condition of the part, he can complete his examination with his hands. "With due prac- tice in this mode of investigation, one may become sufficiently expert in the manipulation of the mouth to dispense entirely with the aid of the speculum ; though of course there will be cases when in order to establish a thorough diagnosis of the exact and positive condition of the part, this instrument cannot be dispensed with. There are also conditions where the examination cannot be carried out in the standing position, even with the assistance of means of restraint, and the animal must be thrown down, and even, says Bouley, " placed under the effects of ether. In this condi- tion, the jaws are readily kept open and immobile, the tongue is free from contraction, and the hands and fingers can be carried over the entire length of the dental arches without the slighest danger to the operator." Manual exploration removes all doubt about the diagnosis, since the surgeon may, by skillfully j)racticing the taxis, recognize all the UTegularities present, whether the vicious direction of the dental surfaces, the uneven wearing of the teeth, the cavities which may exist in their thickness, or the condition of their im- plantation with that of the alveolar cavity, etc. When the mucous membrane has been excoriated by the sharp projections of the teeth, when the gums are highly inflamed, and the jawbones have been bruised, and are necrosed and suppurating; 332 OPERATIONS ON THE DIGESTIVE APPARATUS. when the saHva which flows from the mouth is abundant, gluey and foetid in odor ; when the mouth is hot, the mucous membrane injected, and in the regions where this diffused inflammation has started, lesions are aj^parent corresponding to the cause that pro- duced them, such as deep cuts on the internal face of the cheeks, which have been torn by the asperities of the teeth ; when there is swelling and redness of the gum at the point where it is inflamed ; when there is enlargement of the bone, with a grajdsh hue at the point where it is exposed and in process of sloughing ; or again if these fistulas penetrating the spongy tissues of the maxillary bone — all this becomes evident under the careful and accurate manip- ulation of the instructed fingers. Besides the exhibition of the general symptoms belonging to all diseases of the dental apparatus, caries of these organs is characterized b}' some special characters belonging to them ex- clusively. Principal among these is the peculiar foetor of the in- terior of the mouth and of the saliva flowing from it, which is sui generis. There is also the escape from the mouth of this saliva in excessive quantity and in long, slobbering masses. Then there is the existence on one of the faces of the carious tooth, and principally on the crown, of a blackish sj)ot, or of a hole, or of a large excavation, penetrating the substance of the tooth at a vary- ing depth, according to the extent of the disease and the duration of its existence — the Aaolent pain experienced by the animal when the percussion is applied on the tooth, or its cavity exploi-ed with the instrument — the swollen condition of the gum surrounding the diseased tooth ; its red color ; its want of adherence in some places, and the hemorrhage with the oozing of pus when pressm-e is ap- phed directly over those same places; the soUed appearance of the dental surfaces on the side of the diseased tooth, caused by particles of food remaining adherent to their anfractuosities, and filling up the cavity of the carious tooth, or forcing themselves between the tooth and the gum, and spreading, diffusing the most repulsive odor — these all belong to a carious condition of one or more of the teeth. But if in addition to this the caries is of long standing, and has advanced towards the root of the tooth, the or- dinary complications pertaining to its development in the maxil- lary bone at the alveola take place, and that point becomes the seat of an inflammatory swelling, manifested externally by a pain- ful enlargement, hot and oedematous, which gradually increases, OPERATIONS ON THE TEETH. 333 though at a given time it may remain stationary, hard and resist- ing. Again, as the progress of the disease continues, the hy^ier- trophied dental root, by its continued pressure outward, may destroy the external surface of the bone, and form a communica- tion between the bottom of the diseased alveola and the external l^late of the maxillary. In these cases pus, saliva and putrefied food collect or filtrate into the subcutaneous cellular tissue, and an abscess is formed which soon ulcerates and empties itself on the surface of the cheek. Once open, this abscess has no tendency to heal, but, on the contrary, maintains its fistulous form, and dis- charges through its opening a mixture of pus, saliva and food, having the very repulsive and characteristic odor already men- tioned. Exploration of this fistula with the probe will give different results according as the fistulous tract is straight or irregular. In the first instance, the j^robe will penetrate directly into the mouth, opening on one of the faces of the diseased tooth, or even j)assing into the center of its carious crown ; while in the other case it is arrested by the spongy substance of the ulcerated max- illary; or it may strike against the root of the diseased molar. At this point, changes will have taken place in the mouth, upon the surface of the teeth, on the side of the jaw where the disease exists. These changes vary, and consist either in a great obliquity of the tables of the teeth, the crowns or rubbing sur- faces being beveled in very oblique and opposite directions, or in the well marked elevation or projection of the molars correspond- ing to the diseased grinders, in the healthy jaw; a projection which is in proportion to the diminished size of the opposite carious tooth which stands much lower. The first condition is observed when the pain caused by the caries has entirely prevent- ed mastication on the diseased side, and the second, when, not- withstanding the caries, the performance of mastication has still continued. The condition then presented by the carious tooth may also vary. In some cases it may still be complete in its alveolar con- nection, though otherwise partly destroyed, and yet firmly ad- herent by its root. In others it may be broken, entirely or in fragments, merely parts of the outer surface being present; while again, some broken fragments, more or less detached, may remain in the alveolar ca\'ities. Caries of the first and second superior molars may become 334 OPERATIONS ON THE DIGESTIVE APPARATUS. complicated with lesions of the nasal cavities, when the ulcerating j)rocess has been followed by a perforation between one or other of these cavities and the mouth. This lesion is accompanied by a discharge taking place on the side of the nose corresponding to that of the diseased tooth. This discharge is of a muco- purulent character, and mixed with saliva and food, which gives it the usual foetid odor as well as a peculiar green aj^pearance. It is very different from that belonging to glanders, and is too charac- teristic to justify by its presence an error in diagnosis in that direction. If, however, the same comj)lications take j)lace in the molars, whose roots rest on the sinuses of the head, the symp- toms which are manifested are often so nearly similar in aspect to those of chronic glanders, that the commission of an error should not be considered wholly inexcusable. Carefiil examina- tion will readily bring out the differential diagnosis between the two diseases, though so different in their ensemble. When the caries of one of these last molars exists to such an extent as to transform the mucous membrane of the sinuses into a sup- j)urative surface, and to cause the development of granulations upon its surface ; or to allow the collection of pus in the cavity of the sinuses, a discharge becomes established through the nostril of the side of the diseased tooth and affected sinus. This dis- charge is white, grumous, very abundant, and keej^s increasing, and has also an extremely foetid odor, identical with that of dental caries. The lymphatic glands of the maxillary space then become swollen, hard, though painless, and loose under the fingers. The jDlates of the zygomatic, of the superior maxillary and of the nasal become swollen, and give a dull sound on percussion. Sometimes their surfaces are so thinned out that it flexes under the pressure of the fingers, and they are then surrounded by an oedematous infiltration of subcutaneous cellular tissue. The long and minute consideration which we have thus given to the diseases of the dental apparatus has been principally devoted to the molar teeth of herbivorous animals, although many of the conditions observed in the grinders may also be found belonging to the incisors. Indeed, incisor arches may also offer abnormah- ties in the number of teeth, in theu' position, and in the direction or the length of these organs, and they may also become the seat of accidental lesions, such as fractures, luxations, or the too OPERATIONS ON THE TEETH. 335 rai^icl wearing of various jDarts of their surfaces, tliougli it seldom reaches the point of caries. The different indications which the majority of these patho- logical conditions may impose resemble so nearly those required under similar circumstances for the grinders, that it becomes un- necessary to appropriate a special chapter to their discussion, and we therefore proceed to the consideration of the general opera- tions performed upon the teeth, according to the indications which may be from time to time presented. Operative Dental Surgery. Two principal indications present themselves under this head- ing. First, the leveling of the frictional dental surfaces, for the removal of any existing asperities or sharp projections, in order to estabhsh a perfect coaptation, as well as the free movement necessary for the execution of their function of attrition. Second, the extraction of the teeth which have undergone such important alterations in their stinicture, that their conservation becomes in- compatible with the regular execution of mastication, or because of the serious compUcations they may involve. Leveling of the Dental Arches. — The original mode of operat- ing to level the molar teeth consisted in making the animal chew on the blacksmith's rasp. It is a simj)le process, easy to perform, without danger to the animal, and so well answering the purpose that even to-day the process is still in extensive use. But this modus operandi is not without its inconveniences, among other objectionable points, requiring to be repeated for several days untn perhaps the teeth have become smooth by rubbing against the rough surface of the rasp — a result not always as satisfactory as it might be. More appropriate instruments have therefore been invented, though, in point of fact, none of them are other than more or less modified rasps or files, as they are truly called. Theu' number and variety are to-day very great, and theu' quali- ties vary very much, according to the taste, the ideas, and often the dexterity of those who use them. Samples of these files are represented in Fig. 340, and according to their general construc- tion may be classified as rough and fine rasps, flat and angular, guarded, double and single on one or other of their edges. Some are simple, and formed of a single piece, while others are jointed and compound, and may be screwed or unscrewed with facility 336 OPERATIONS ON THE DIGESTIVE APPARATUS. Fig. 340.— Samples of Tooth Rasps. for use and transi^ortation ; some have the rasp fixed to a solid handle, and again, the handle in others is moveable, and may be changed as indications may present themselves. Their number in this country is about incomputable, and while many which we find registered in the patent ofiice are of real value, many others have no reason for being beyond theu' maker's whim. As we have said, the advantages which any of them may possess depend more on special conditions than on the result to be obtained, in the removal of the small, sharj) edges of the external surface of the tooth, or its lateral faces, resulting from an excessive develop- ment in the enamel. Whatever may be the file which the veterinary dentist may see fit to use, the manii^ulations required in its handhng will be in all cases the same. In referring to this, the first question which > offers is, whether the use of the speculum is necessary to enable the surgeon to file a horse's teeth? There is no doubt that in ) many instances it will be difficult, and even perhaps impossible, I to compel the patient to keej^ his mouth sufiiciently open to per- ,j mit the use of the rasp with the necessary delicacy and freedom, or prevent him from constantly biting it, or keeping his jaws closed during the oj^eration. In every instance, the play of the instru- ment wiU be sure to be interfered with by the excited jDatient. We believe that American practitioners were the first to dis- pense with the sjDCculum in these cases ; and that to Mr. House, a celebrated veterinary dentist, who died not many years ago, is due, in fact, the paternity of this specialty in veterinary surgery. Whether the mouth of the animal is held open with a sj)ecu- OPERATIONS ON THE TEETH. 337 lum, and tlie tongue drawn out and held on one side by an assist- ant, or whether the operator himself controls the tongue with one hand while working the instrument with the other, the manipula- tions must be the same, viz. : the passage to and fro of the file over the surfaces requiring to be corrected, wherever they are rough and sharp ; filing them just as the smith files the iron he is shap- ing as he holds it in the vise. We believe, however, that the rasping out ought to be done slowly, softly and without giving the animal any cause for fright or excitement. The method sometimes practiced of vising the rasp with a succession of rapid movements over the dental arches is certainly dangerous and liable to be ac- companied with accident to the patient. An irritable, struggling animal, by violent movements of the head, or in his attempts to chew on the rasj), may easily receive injuries from the rough con- tact of the instrument with the delicate structures of the mouth. After such a passage of the rasp a number of times over the teeth, the hand introduced in the mouth will at once detect the effect upon the patient. Although the use of the speculum may be advantageous in many instances, there is certainly a risk attending its use, in the possibility of bruises and lacerations which may occur at the bars when the animal, annoyed by its application, chews upon it in his endeavors to close his mouth. The work of filing when the teeth are sharp is of common in- dication, and finds its direct appUcation under the special condi- tion that the edges or asperities which are treated should not be too large or too prominent. If this should be the case, and the inefficiency of the file or rasp, however, become evident in the trial, other means remain for accomplishing the desired pui-pose. Such a contingency was not lost sight of in former years, and chisels and gouges were then employed to reduce the excessively devel- oped projections of enamel. With these instrimients the patient was either thrown or treat- ed on his feet, his mouth being opened with a speculum, with his tongue di-awn out and held on one side. The chisel was then laid against the dental projection, and an assistant striking it with a hammer, the excess of tooth was knocked off. Bouley considered this mode of operation dangerous. " The chisel might, under the impulse received by the hammer, slide in the mouth and severely injure the tongue, the cheeks, and the soft or the hard palate ; or 338 OPERATIONS ON THE DIGESTIVE APPARATUS. in animals advanced in age, the tooth might be fractured or dis- located; or again, the operator himself might be injured by the instrument, when, suddenly displaced by a movement of the ani- mal, the assistant knocks against it." It was to remedy this objection that Brogniez invented his odontritor (Fig. 341), an instrument which carries on one end a blade sharpened on both edges, and on the other is hollowed out, in order to allow the play of a rod through one-half of the length of the instrument. This rod is provided with a transversal handle, which also acts as a hammer, by which the blow is carried against the sharp edges of the tooth. When the odontritor is used, it is not necessary to use a spec- ulum to open the mouth, the holding of the tongue out of the mouth being sufficient. The operator, holding the instrument with the left hand, places the anterior sharp edge against the j^ro- jecting portion of the tooth, and holding the rod by the handle full in his right hand, moves it to and fro, striking at the j)roper points as he moves it. This operation is repeated on both jaws until all the sharper edges of the teeth have been cut off, and is completed by passing the rasp over the dental plates, as is done when the teeth are not too sharp. Several modifications have been made in the conformation of the odontritor, but that of Prange is probably the best (Fig. 342) It consists in ha%ing three blades, which may be changed at will and which vary in the form and disposition of their cutting edges. This instrument is considered superior to that of Brogniez, and is thought to work to better advantage when the elevation of the tooth is well marked. The odontritor answers perfectly for leveling the molars when the projections are not excessively developed, or do not offer too great resistance to the action of the blade. But when an entire tooth projects above the general level, the odontritor ceases to be of any advantage, and it becomes necessary to perform the resec- tion of the tooth, consisting in the removal of all that portion of it which rises above the level of the general dental surface. To Brogniez is due again the first instrument invented for the performance of this operation in the chisel odontritor (Fig. 343). This is composed of two rods, one of them having at one end, like the ordinary odontritor, a frame of sufficient dimensions to allow the entire molar to pass through it, and on the anterior border of OPERATIONS ON THE TEETH. 339 Fig. 341 — Brognioz'8 Odontritor. Fig. 342.— PrangS's Odontritor. 340 OPERATIONS ON THE DIGESTIVE APPARATUS. tliis frame a solid blade with a sharp con- cave edge turned backward. The other extremity of this rod carries a transverse prolongation, which serves to change the position of the blade when necessary, and which has on its shorter portion a hole through which the other rod is allowed to shde. This second rod has on one end a sharp blade which slides into suitable grooves made in the frame of the first, and is curved forward on its front edge. On the other extremity it carries a metal- lic mass which is used as a hammer. In using this instrument, the tooth being enclosed in the frame between the two blades, the movable rod, with its sharp edge, is pushed against the blade of the frame, and a strong blow of the hammer cuts off the tooth smoothly and evenly. The chisel invented by Gowing (Fig. 344), works somewhat on the same princi- ple as that of Brogniez. Resection of the teeth has also been per- formed with the instruments used for the same operation on bones. Saws of various form and design are also recommended, the chain saw, which we have often used, being one of these. But there are serious Fig.344— Gow- objections to this latter instrument, among which is its liabihty to become heated while in use, when it becomes unable to " bite " upon the hard dental substance, and may, moreover, break or slide. The only method of overcoming these objections, which, in fact, may occur in using any kind of saw, is by hold- ing a wet sponge against the tooth to which the instrument is apjjlied — a precaution which is not always of easy adoption, and which can scarcely be effected without more or less danger of wounding the hand which holds Fir,. 34.3.— Brogniez's Tooth Chisel. OPERATIONS ON THE TEETH. Fig. 3J5. 341 Schemer's Extractor and Molar Cutter. 342 OPEBATIONS ON THE DIGESTIVE APPABATUS. Fig. 345a.— Hamlin' 8 Molar Cutter. the sponge. But when none of these modes of operation can be readily applied, the use of the tooth-chisel becomes the order. Its apphcation is simple, and with a well-made instrument in the hands of an expert operator, quick and strong, the resection can be readily performed. The array of tooth-chisels or resectors is beyond compute in variety and number, and especially in this country where the in- stinct of mechanical invention is so universal, and the specialty of veterinary dentistry is so extensively practiced, and many different kinds can be inspected among the samples of workmanship) which decorate the show-cases of our instrument makers. Among the principal forms, we may, however, mention those which recall the names of Lafosse, Moller, Scheffers, Gowing in Euroj)e, and of Clarke, House, Liautard and Hamlin in this country (Figs. 345, S45«). Some of these instruments have theii' jaws closed, others have them open. Some work by a pecuhar thread-screw arrange- ment, others by the manual power of the operators ; and again, the blades of some are straight and others cmwed, and still others are sharp hke a concave saw. In theii- apphcation they all work upon about the same principle, and are used in the same man- ner. The mouth being opened, the tooth is seized between the jaws of the forceps, and by the pressiu^e of the screw with which some of them are armed, or by the unaided strength of the operator, the tooth is squeezed and cut off with a sudden snap, followed by the dropping out of the mouth of the amputated portion. As a rule, the sm-face left on the tooth shows but a shght roughness, which can be smoothed off with the rasp. OPERATIONS ON THE TEETH. 343 Extraction of Teeth. The extraction or removal of teeth is indicated for the reduc- tion of any excess in their number, which may interfere with mas- tication ; or when these organs are abnormal in form or direction, and obstruct the growth or usurp the jDlace of a permanent tooth ; or when they are diseased with caries, or affected with any of the pathological conditions which we have before considered ; or when they become the cause of a dental fistula. To extract the incisors of any of our domestic animals, the molars of dogs, or the caduc molars of large herbivorous animals, some of the various forms of tooth forceps that are used in human Fig. 346.— Samples of Tooth Forceps. dentistry or the different shapes of the key of Garangeot or special larger forceps, such as that of LeceUier (Fig. 348) or the enlarged Garangeot's key, as modified by Delamarre (Fig. 349), w^iU be necessary. The modus operaiuli is generally simj^le ; the tooth, still firmly attached to its alveola, or perhaj)s loose and more or 344 OPEKATIOXS ON THE DIGESTIVE APPAEATUS. Fig. 347.— Garangeot's Keys. less puslied out of its place by a succeeding growtli, is seized be- tween the jaws of the forceps, or of the Garangeot's keys, and is easily wrenched from its position by a strong pull or with a sUght twisting motion sufficient to lacerate its last adhesions. The extraction of the permanent molars of a horse is a diffi- cult and, under some circumstances, a serious operation. Their mode of implantation and insertion in the alveolar cavities ; the great length of then- roots as compared to the small dimensions of their free portion; the narrow connections which exist be- tween them, and withal, the solidity of the dental arch — all these conditions are sufficient to explain the serious character of the prognosis of this ox^eration, and the difficulties which are often encountered when the organ to be removed is the molar tooth of a horse. These difficulties, however, vary considerably under -pe- culiar conditions, such, according to Peuch & Toussaint, as " the age of the subject, the position of the tooth on one or the other jaw, and the degree of alteration of the tooth to extract." For examjole, the operation is more difficult in young animals than in adult, or older subjects, the latter requmng less effort, the root of the tooth being shorter and the adhesion to the alveola less solid. The upper are less firmly attached than the lower OPEEATIOXS ON THE TEETH. 345 ^^^^^^ Fig. 348.— Lecellier's Tooth Forceps for Molar. Fig. 349.— Garangpot's Keys, Modi by Delamarre. molars, the presence of the cavities of the sinuses, and the diminished thickness of the walls of their alveola rendering theii- 346 OPEEATIONS ON THE DIGESTIVE APPARATUS. insertion and implantation less tenacious than in the lower. The extraction of the front is less difficult than that of the posterior molars. At times, as when the teeth are partly destroyed by caries, a single effort will be suffi- cient to extract them ; but in other cases, as when the periosteum is dis- eased, and the roots adhere more intimately to the alveola, the extrac- tion becomes very difficult. And again, if the tooth having a hyper- trophied root, resists the action of the instruments through the op- position of those immediately sur- rounding it, which, though healthy, are less firmly fixed in their alveola, which are mechanically dilated by the outward pressure made upon the plates of the maxillary bone, is easy to loosen and dislocate them ; and this is a circumstance which must not be overlooked during the manipulation required for the ex- traction, in order to avoid serious disturbances of the dental appa- ratus. In the extraction of a molar, the patient must be thrown, and the head well elevated, the mouth being kept well open by means of a per- fectly safe speculum, such as that of Lecellier (Fig. 350), but we think it rather clumsy to handle. Bouley recommends the etherization of the patient. The mouth is to be thor- oughly cleansed. There are cu'cum- stances, however, in which the op- eration of castiag is . unnecessary, and, in fact, our own j)ersonal ex- perience has raised doubts in our PiG.sso-SpecuiumofLeceuier. "lii^cl as to the necessity at any OPEKATIONS OX THE TEETH. 347 Fig. 351.— Plasse Molar Extractor (full view). Fig. 352.— The eame (side view). 348 OPERATIONS ON THE DIGESTIVE APPARATUS, time of exposing- the animal to the possible accidents which mar attend this mode of restraint. We hold strongly to the expedi- ency of performing the operation in the standing position. There will necessarily be cases in which to attempt to remove a tooth with the animal standing would be simple folly and time lost, but with many operators in this country, we have in several instances succeeded in extracting a condemned molar without any other means of restraint than a twitch on the patient's lower lip or on his ear. The removal of molars is effected in two ways — by pul- hng, or by rejjulsion or gouging out. The method by extraction or emdsion, is preferable whenever it is practicable, having the advantage of causing less injury to the surroimding structures, and is objectionable, principally for the posterior teeth, which always oppose great difficulties to the operation. The oldest instrument used in this operation is the enlarged key of Garangeot, as modified by Delamarre. Its appli- cation has always seemed to us difficult, if not dangerous, and we think that it involves more or less risk of fracture of the plates of the maxillary bone, on which account we prefar the large tooth forceps, which may be found under many forms and designs. The forceps of Plasse (Fig. 351), of Wendenburg (Fig. 353), of Pill- wax (Fig. 354), of Gowing (Fig. 355), of the same inventor, as modified by Bouley (Fig. 356), those of Gunther (Fig. 358), the key-forceps of Bouley (Fig. 357), those of House, of Walters, and many others will furnish the operator a large collection from which to select. Many of these instruments are very compHcated (as that of Scheffer) ; some are clumsy and difficult to handle ; have levers, like those of Wendenburg and Pillwax; many woi'k by merely grasping the tooth and holding it by a peculiar arrangement of spring, or of thread-screw, and thus to the end of the chapter. We have for many years given the preference to the simple forceps of Gowing, leaving off the little rod which is connected with the cross-piece which carries the thread, and which is to be screwed on the handles of the instrument to hold them firmly to- gether. What we think most essential in the instrument is that its arms should be firm and so soHd as not to bend or yield when the screw is applied on them, and that the jaws of the forceps should not be too narrow nor too curved, and above all, that the instrument should not be made mmecessarily heavy, a fault which we have too often observed in some of the continental pattei-ns. OPEKATIONS ON THE TEETH. 349 (D Fig 353.— Wendenburg Forceps. Fig. 354.— Pillwax's Forceps. Fig. 355.— Gowing's Forceps. Besides the forceps which we have named there are many others, but whatever may be their plan or shape, the manner of using them includes nearly the same manipulations for all. These, in their various steps, are done about as follows : the animal be- ing properly secured, with his mouth open, and his tongue drawn 350 OPERATIONS ON THR DIGESTIVE APPARATUS. Fig. 356.— Gowing's Forceps, Modified by Bouley. out on one side, an assistant inserts the forceps into the mouth, adjusting it to the tooth to be extracted, and notifies the op- erator of the moment when he can close the jaws of the instru- ment together, which is done in various ways according to the kind of instrument in use. When the tooth is properly seized and firmly held by the forceps, the operator, using all his force, carefully and slowly oscillates the instrument from left to right, and from right to left, in order to produce the gradual dislocation of the organ, and when it is loosened from its attachments it is drawn vertically out of its cavitj by a final movement of eAoilsion. There are instruments possessing a lever attachment close to the OPEBATIONS ON THE TEETH. FlO. 357.— Bouley's Tooth Keys. jaws by which the extraction of the tooth is considerably facilitat- ed. If the animal has not been put under general anesthesia the dislocation of the tooth is very painful, and often accompanied by 352 OPERATIONS ON THE DIGESTIVE APPARATUS. ABC Pig. 358.— Gunther's Forceps. violent struggles, at the critical moment ; and if tlie tooth is not very strongly held by the forceps, it is possible that it may slij) out of the jaws of the instrument and di-op into the mouth. To avoid the possibility of its passing into the pharynx, we think it would be but a prudential measure to have an assistant keep his hand in the animal's mouth ready to secure the tooth, if necessary, before it passes beyond the soft palate. OPERATIONS ON THE TEETH. 353 ' The second mode of extracting molars, or that by repulsion or {/ouglng, is the only one possible under all the circumstances, when the prehension of a carious or diseased tooth cannot be effected by the instrument used in the first method, as, for in- stance, in cases of disease of the posterior molars when the carious tooth is so far diseased or destroyed that not enough of its sub- stance remains above the root to be reached by the forceps ; or again, when the exostosis of the root has reached such dimensions that it will not allow its exit from the alveolar cavity, whatsoever efforts may be made to overcome its resistance. This operation was first recommended by H. d'Arboval, and although it has been condemmed by some practitioners, is certainly indicated for all operations upon the molars. All the superior molars, together with the three anterior inferiors, are readily reached by their roots, in trephining the external plate of the bones in which they are implanted. The posterior inferiors are the only ones that present any serious objections, and the trouble is truly a tangible one, being nothing less than the necessity of passing through the entire thickness of the masseter muscle. The tooth demanding removal being surely identified, and the impossibility of removing it by the mouth well estabhshed, the animal is thrown on the side opposite to that which is occupied by the diseased organ, and placed under complete anesthesia. The location of the alveolar walls, upon which the operation is to be made in order to reach the root of the tooth, must be first well determined. If it is one of the last three upj)er molars, it will corres- pond to the sinuses. But the operator must not allow himself to be deceived by the presence of a fistulous opening, which, by ap- pearing on the surface of the skin to indicate the j^oint of attack, may in fact mislead him by conducting him to a point consider- ably remote from the diseased tooth. A positive and satisfactory diagnosis being settled, and the hair being clipped, a large V or cross-shaped incision is made over the spot selected for the tre- phine, and carefully avoiding the infliction of any injury to the muscles of the region, the sinuses are opened by removing two or three circular portions, at a tangent to each other, to effect the removal of a fair-sized piece of the bone. The edges or prol6nga- tions which remain are levelled off with the bone forcei:)S, which is certainly preferable to any other means ; or if the opening made in the bone is too small, it can also be enlarged by using the same 354 OPERATIONS ON THE DIGESTIVE APPARATUS. bone forceps, by nipping oflf fragments from the edges and making entrance into the sinuses of the proper dimensions. The wound and the sinuses are then thoroughly cleaned out, and the blood and the pultaceous pur;ilent collection found in theii* bottom thoroughly removed. This exposes the root of the tooth, in the form of a hard, dry, greyish mass, analagous to a piece of necrosed bone. The operator, then holding the hlunt gouge, or repoussoir in his left hand, apphes it through the sinuses against the middle of the dental root, and with a strong mallet held in his right, strikes upon it with firm and steady blows. The mou.th of the animal being held open by the speculum, an assistant with his hand upon the crown of the tooth studies the effect of each blow, and notes as it yields to the percussion, and inoves and loosens lontil it becomes detached, and faUs, hberated into his hand, secured l^y his continuous grasp from any possible danger of being swal- lowed. As a riile the tooth is pushed out of its cavity by the first blows, either entu-e or in as many portions as it may have been divided into by the carious process. But at times it becomes necessary to repeat the percussion and to use considerable force to compel it to leave the jaw. The modus operandi is about the same for any of the molars, though for the lower teeth greater force in the blows of the mal- let is generally required, in consequence of the greater thickness of the walls of the alveolar cavities in the lower maxillary bone. If it is one of the posterior lower molars which is the subject of the operation, the masseter muscle must be cut thi-ough, but the general manipulations are otherwise the same, care being required, however, to avoid injury to the glosso-facial artery, or the duct of Steno. Though apparently a severe ojDeration, this is not a dangerous one, the wounds which it involves healing rajjidly, and the great advantages which are realized by it, among which may be included the cleansing of the sinuses, and the removal of their suppurative collection, which could not be otherwise secured, amply compen- sating for the severity of the process. After the operation the wound is, of course, to be thoroughly cleansed, fragments of bone to be removed, and acidvdated gargles used to wash the mouth and the cavity of the alveola of its blood. The cicatrization of the external wound generally gives no trouble to the siu'geon, and requires no particular methods be- OPERATIONS ON THE TEETH. 355 yond those of ordinary cleanliness and proper attention to the granulating process. It is the cicatrization of the internal wound which requii-es attention, and in some cases a great deal of it. This is in order to guard against the collecting and the packing of the food in the cavity of the alveola, and thus interfering with its closing up by proper granulations. The diet of animals thus operated on must, of course, consist almost entii'ely of liquid food, as mashes of bran or of oatmeal; hay teas, flour water, milk, etc., or of cooked roots, scalded grains and the like. According to some authors, fibrinous food is dangerous only during the early days immediately following the operation, but our experience has taught us that neither solid nor semi-solid food is to be allowed to an animal which has lost a molar tooth, for a period of from three to four weeks, and during that time the alveolar cavity ought to be thoroughly cleansed out after every meal, until all possibility of danger has subsided. The vacuum left in the dental arch after the removal of a tooth is never entirely filled up, but it gradually diminishes, in conse- quence of the oblique direction which the teeth in front and behind ai'e disposed to assume, and which, though it brings them closer to each other, never brings them into actual contact. It may hap- pen that by reason of this vacant space the tooth on the opposite side of the jaw may acquire a tendency to grow to excess, and from want of wear, ultimately project above the level of the other teeth. In reference to this it wiU be but prudent to watch the condition of that particular tooth, and to be prejDared to reduce it to its proper level, if that should become necessary. In reference to accidents that may occur during operations upon the teeth, we have already mentioned the possibihty of deg- lutition of the tooth as it is drawn from its socket. In some cases reported by Eenault and Bouley fatal results have followed, caused by violent coUcs thus induced. Strong cathartics have been rec- ommended in these cases for the removal of the foreign body, but the precaution which we have already mentioned will eflfectuaUy prevent the possibihty of this accident. Bruises and excoriations of the bars, with the speculum, and hemorrhage, are accidents which also sometimes accompany these operations of extraction. The first is not usually a matter of any importance, unless necro- sis of the jaw should follow ; and as for the hemorrhage, unless it results from du'ect injury to the palatine artery, it is easily con- "ill If 356 OPERATIONS ON THE DIGESTIVE APPARATUS. trolled by pressure and packing with oakum or compressed sponges. Fractures of tlie alveola, or of the lower maxillary bone, are of a more serious character than any of the preceding injuries, the last, mentioned in a case recorded by Koerter, having necessitated the destruction of the animal. Filing Teeth. This operation has not, we beheve, as yet entered into the general practice of veterinary surgery, and, with the exception of a few veterinarians on this continent who have attemjDted it, we think that in the presence of the many difficulties which exist in reahz- ing a perfect result, similar to those obtained with the thorough work of hujnan dentistry, it will be some time before this branch of veterinary dentistry can be practiced with any great jDrosjDect of good and permanent results. Our experience in filing the teeth of our domestic animals is very limited, and on that account we will refrain from sapng more about it, referring our readers to the work of Dr. Hinebauch on " Veterinary Dental Surgery," where the subject is treated rather extensively. Canine Dentistry. Operations on the teeth of the dog are sometimes indicated under some peculiar and abnormal conditions, such as irregu- larity in number or in direction, or in cases of traumatism, such as fractures or dislocations. Their extraction is performed with tooth forcejjs, as we have already had occasion to remark. Their resection has been recommended by a French veterinarian, Mr. Bourrel, as a means of preventing rabid inoculation (Fig. 359). The operation is a very simple one, and consists in smoothing over the sharp points of the teeth with a file, though sometimes sharp nippers are used in preference. But an operation which is of daily necessity is that of clean- ing the teeth by removal of the accumulation of cement or tartar, which gathers on the external surface of the tooth, at its insertion in the alveolar cavity, where it forms a thick crust, of greenish gray color, composed of microscopic fungi. In neglected cases, the gums become irritated and ulcerated, and the tooth, partially denuded of its gum, exposes not only its free portion, but por- tions of the root also, sometimes even becoming loose and drop- ping out of the jaw. There is in these cases a free and abundant OPERATIONS ON THE TEETH. a 357 Fig. 359.— Bourrel'8 Mode of Filing Dog's Teeth. flow of saliva, of a cliaracteristic and putrid smell ; mastication becomes im^DOssible, and the animal becomes a regular martyr to the lack of attention of his dental apparatus. The formation of these concretions can be prevented in animals in the same way and with the same care that is exercised in respect to the human when teeth- washing-, brushing, etc., with some of the properly com- pounded tooth powders, will remove a slight coat of the offensive deposit, but if the accumulation is quite large, it must be scraped off with proper instruments (Fig. 360), carefully avoiding, if prac- ticable, any injury to the gums, or the loosening of the teeth. Fig. 360.— Tooth Scrapers. r^ ,\tSJ^ 356 OPEKATIONS ON THE DIGESTIVE APPARATUS. trolled by pressure and packing with oakum or compressed sponges. Fractures of the alveola, or of the lower maxUlary bone, are of a more serious character than any of the preceding injuries, the last, mentioned in a case recorded by Koerter, having necessitated the destruction of the animal. Filing Teeth. This operation has not, we beheve, as yet entered into the general practice of veterinary surgery, and, with the exception of a few veterinarians on this continent who have attempted it, we think that in the presence of the many difficulties which exist in realiz- ing a perfect result, similar to those obtained with the thorough work of hujnan dentistry, it will be some time before this branch of veterinary dentistry can be practiced with any great prospect of good and permanent results. Our experience in filing the teeth of our domestic animals is very Hmited, and on that account we will refrain from sajdng more about it, referring our readers to the work of Dr. Hinebauch on "Veterinary Dental Surgery," where the subject is treated rather extensively. Canine Dentistky. Operations on the teeth of the dog are sometimes indicated under some peculiar and abnormal conditions, such as irregu- larity in number or in direction, or in cases of traumatism, such as fractures or dislocations. Their extraction is performed with tooth forceps, as we have already had occasion to remark. Their resection has been recommended by a French veterinarian, Mr. Bourrel, as a means of preventing rabid inoculation (Fig. 359). The operation is a very simple one, and consists in smoothing over the sharp points of the teeth with a file, though sometimes sharp nippers are used in preference. But an operation which is of daily necessity is that of clean- ing the teeth by removal of the accumulatiou of cement or tartar, which gathers on the external surface of the tooth, at its insertion in the alveolar cavity, where it forms a thick crust, of greenish gray color, composed of microscopic fungi. In neglected cases, the gums become irritated and ulcerated, and the tooth, jDartially denuded of its gum, exposes not only its free portion, but por- tions of the root also, sometimes even becoming loose and drop- ping out of the jaw. There is in these cases a free and abundant OPERATIONS ON THE TONGUE. 359 tongue out of the mouth, with perhaps a drawing- of the organ to one side, or it may be pressed between the incisors and hanging more or less outside of the buccal cavity. In opening this cavity, the tongue may then be seen to be lacerated at its free portion, the laceration being transversal or longitudinal, complete or incomplete, and varjdng in dimensions, from a small portion of the organ nipped from the main body, to nearly the entire portion in front of the fraenum. If the antei'ior portion is missing, the fraenum may be seen in its normal condition, or again may be exten- sively torn, in which case the tongue is commonly hanging out of the mouth. If the laceration is complete, the part in front of the cut may have dropped outside and fallen into the bedding of the animal, or of the one next to him, both stalls being more or less spattered with blood from the hemorrhage which has accom- panied the injury. In cases of burns, the tongue pi'esents all the symptoms of glossitis, it is swollen, its epithelium readily peels oft', the saliva- tion is abundant, and the mouth heated and sore. Considered from one point of view, the prognosis of lacerated wounds of the tongue is not serious, there being but few forms of that injury which are not more or less amenable to treatment. The nature of the prognosis varies, of course, with the extent of the wound, the depth of the tissue which it involves, and the amount of substance already lost or requiring removal. A complete section is always a serious matter, especially in herbivorous animals, by which the tongue is so largely employed, and so ef- ficient, as an instrument for the prehension of food, as well as for aiding in its mastication, by keeping it in contact with the grind- ers dui'ing the process of chewing. In carnivorous animals, as in dogs, we have seen the complete sloughing of the free portion attended with such difficulty in eat- ing, that the destruction of the patient became necessary in order to avert his death by starvation. In almost all conditions of laceration of the free portion of the tongue, there is an indication of an attempt to effect the union of the divided parts, and our experience has led us to the conclusion that no one is justified in refusing to treat a wound of the tongue or abandoning such a case without at least an effort to save it, even, as in some cases, where the divided parts are held together by the smallest portion of substance. 360 operations os the digestive appakatus. Suture. It is only by suture tliat the attempt can be successfully made. Peuch, Toussaint and Zundel advise the throwing of the horse, but we prefer the standing position for the operation. The instruments necessary are strong needles for metallic sutures, and soft, pliable lead wire. We jDref er this kind of suture as being less liable to cut through the muscular structure of the organ and having less tendency to give way. Having carefully washed the surfaces of the lingual wound, we aj^ply an interrupted suture, varying the number of stitches, according to the extent of the laceration, and prefer the interrupted to the continued suture for the reason that if one stitch fails to hold, it can be easily re- placed by another. The important point is to secure a thorough hold for each stitch, or in other words, to involve a good portion of the tongue in the stitch on each edge of the wound. Wounds of the frsenum need no special treatment, but there is an indication which by its application greatly facilitates, though indu'ectly, the cicatrizing process of Villi] il ll^lil 'I'^i/ y^ ^^^ ^^° parts. It consists in placing l\\ W'il''fj'|'|"' ' Ys|/^ the tongue in a muslin suspensory, ""^ ' ^ having the shape of the free portion I 1 of the tongue, and sewed together V ^ ' ' -] ■ on a part of their circumference, leav- ''- - ^ ing an opening for the organ to enter. V- This suspensory is kept in place by ^^><3.«.^ ^^^ strings attached to the halter on Fig. 361.— Tongue Suspensory. each side of the cheeks. The use of this easily made apphance has given us great satisfaction, not only in keeping the tongue in the mouth, but also in limiting the movements of the organ, and preventing the giving way of stitches. The suspensory is to be taken off two or three times a day, and washed, or changed for another, but must be kept in place as long as this condition of the patient requu-es it. The mouth is to be kept clean by antiseptic astrin- gents and cooling gargles, by means of a syringe or an irrigator. The use of peroxide of hydrogen has given us excellent results in these cases. Nocard recommends the application of a muzzle upon the patient's nose, to prevent the prehension of fibrous food, keeping the mouth closed, and restricting the movements of OPERATIOXS ON THE TONGUE. 361 the jaws. During- the treatment the animal is to be fed with liquid or semi-liquid food, as mashes and gruels of all kinds, with teas, milk, etc. It is only when the stitches are all united that the animal can be brought by degrees to its ordinary diet. After several days the sutiu-es can be removed. Amputation, ok Glossotomy. When the sutures have failed, or when the peduncle which holds the divided portions of the tongue together is too small to permit the j^rocesses of circulation and nutrition to go on, the in- dications are to amjjutate the part of the tongue below it. This is done with the scissors ; the hemorrhage that may follow is sel- dom serious, and soon ceases spontaneously, or yields to the use of hemostatics. Sometimes, instead of direct amputation, or in order to avoid the hemorrhage, the removal of the divided portion is effected with an elastic ligature — a mode of treatment also com- monly used for the removal of lingual tumors. The ecraseur has also been recommended, on account of the absence of hemorrhage attending its use. The animal whose tongue has been amputated eats slowly and with difficulty. His prehension of hquids is also necessarily interfered with. It requires time and practice for him to acquire facility in performing the old functions with curtailed means. Adenotomy, This operation consists in the dissection and removal of such of the glands as are accessible and amenable to that method of treatment, including the lymphatic and salivary, and is described as parotidian or maxillary, as one gland or the other becomes the subject of operation. The extirjDation of these organs is indica- ted by pathological changes occurring in their structure, as in cases of chronic infiltration following a suppurative process, as seen in the lymphatic glands of the inter-maxillary space after strangles, and again when they become the seat of scirrous de- generation, or of melanotic deposits, or in cases of salivary fistula complicated with loss of substance of the excretory ducts. Parotidian adenotomy is a very delicate operation, and has, therefore, been but seldom attempted. To Leblanc, in 1822, is due the record of its first performance, and of the advantages attending it. A reference to Figures 396 and 397, which show 362 OPEKATIONS OX THE DIGESTIVE APPARATUS. both the superficial and the deej) anatomical structures of that region, will at once suggest the difficulties to be encountered in the numerous and imj)ortant blood vessels, which must be either avoided or ligatured, and the important nerves which must be saved According to Brogniez, the operation is fully justified bv its results, and possesses an undeniable claim to admission into the domain of authorized veterinary surgery. After Leblanc, it was performed by Brogniez, Vanhaelst, Delwart, Barlow and Per- civall. The Traite de Chirurgie Veterinaire furnishes the following description of the manual execution of parotid adenotomy : " The animal, being well prepared, is thrown, with the parotid region of the side on which he lies resting on a small bundle of straw, in order to render the gland, which is to be operated upon, more prominent, and the hair being clipjoed, a long incision is made in the direction of the organ, ^iz., from the antei'ior part of the base of the ear down to below the glosso-facial branch of the jugular vein. This first incision, it may be remarked, must be made more to the anterior border of the gland, which is strongly adherent to the maxillary bone, as weU as to the blood vessels and nerves j^assing that point, and, if necessary, a second incision can be made be- hind the first and perjDendicular to its lower extremity. The skui being dissected from the whole extent of the gland, the beginning of the separation of the organ is made near the facial nerve, from thence gradually working downward. The lower extremity of the gland is isolated, and after it the posterior border, to terminate by the suj)erior extremity, which surrounds the concha — in other words, without reference to the muscular layer that covers it, or to some little glandular masses which are isolated from the prin- cipal mass, nor even to its central portion situated under the fa- cial branch of the jugular vein ; the gland being thus separated is removed in its whole circumference. After ligating the blood vessels which may have been opened, the woimd is dressed and closed with quill sutures. Suppuration is soon established, the granulations raj^idly develop themselves, and the cicatrization is soon accomplished." The most serious complication usually met with is the section of the facial and sub-zygomatic nerves, which is followed by par- alysis of the face and lips on that side. Director Degives divides the operation into three steps. The first includes the incision OPERATIONS ON THE TONGUE. 363 and dissection of the sJcin. The incision is made lengthwise, from the base of the ear down to the middle of the external face of the gland, that is, as far as below the glosso-facial vein, and involving the skin and the parotido-auricularis muscle, the dissection of the skin being made a little beyond the borders and extremities of the skin. The dissection of the gland forms the second step, and must be as complete as possible. There are some parts where the gland is difficult to isolate, especially at the base of the ear, at its masseterine adhesions near the sub-zj^gomatic blood vessels and nerves, but at these points some little glandular granulations may be left. In this dissection the use of the fingers or of the duU end of the handle of a dissecting scalpel is recommended in order to avoid the blood vessels and nerves which are so intimately connected with the organ. Beginning with the ligation and section of the posterior auric- ular vein, the anterior border of the gland is isolated from above downward, carefully avoiding the sub-zygomatic blood vessels and nerves, after which the jugular vein is isolated in the whole extent of its parotid com'se, and the gland divided into two por- tions, one above, the other below the vein. The dissection of the upper portion is made from below upward, avoiding first, four ar- terial divisions, including the external carotid, the temporal trunk, the internal maxillary, and the posterior auiicular ; second, the superficial temporal and the facial nerves ; and third, the guttural pouch, which is intimately adherent to the internal face of the gland above. The smaller arterial branches that are divided are Hgated or twisted. The lower portion is then carefully dissected from above downward. The dressing of the looimd, which is the third step, is performed according to the process of Brogniez. Maxillary Adenotomy. AYe find but a single description of this operation, which is by Director Degives in his Manuel de Medecine Operatoire Veteri- naire. Kecommendiag it only as the last treatment in the re- fractory fistula of Warthon's duct, he first divides the skin and the cutaneous muscle against the inferior border of the gland, parallel to the glosso-facial vein, and makes an incision about four inches long, which brings him to the loose and abundant cellular tissue which surrounds the gland. The dissection is made -oath 364 OPERATIONS ON THE DIGESTIVE APPARATUS. the fingers by tearing the connective tissue in the middle part of the gland ; when taking hold of it at that place it can be care- fully pulled out, the division of the cellular tissue which holds it being easily detached with the fingers or a blunt instrument. The position of the woimd is such that no special dressing is indicated, suppuration having a free exit. OPERATIONS ON THE (ESOPHAGUS. The surgical affections which require interference with the oesophagus and adjacent regions are classified as follows: Bruises, wounds, lacerations, ruptures, tumors, jabot, obstruction by for- eign bodies or alimentary masses, and strictures. The various operations of direct aj^plication which are indicated in connection with these casualties are: Catheterism of the oesophagus, the taxis, the crushing of the foreign bodies, and oesophagotomy. This classification, arranged by Peuch and Toussaint, meets with our acceptance, including the operations enumerated, and in our con- sideration of the subject we shall, for the present, refer our readers for descriptions of the various forms of disease to the standard authorities upon veterinary medicine, especially includ- ing in the hst the excellent work of Professor Williams. Before entering upon a description of these operations, a re- view of the surgical anatomy of that organ will be in place. The oesophagus is a long musciilo-mucous canal, which at the third stej) of deglutition carries the food, both liquid and sohd, from the pharynx to the stomach. Stretched between these two or- gans, it successively occupies the neck down its inferior region, the entire length of the thorax, and a small portion of the abdomen. At its origin (Fig. 362), situated on the median line, it communi- cates with the pharynx by an opening above the glottis; from thence it runs obliquely downward, from before backward, be- hind the ti-achea, until about the middle of the neck, where it begins to deviate to the left, resting from thence on that side of the trachea. In this situation it enters the thorax, to resume its former position on the trachea; passes above its bifurcation and the base of the heart, running through the layers of the posterior mediastinum, which covers it, reaches the right pillar of the dia- i:»hragm, and passes through it, and entering the abdomen, has its termination on the left side of the small curvature of the stomach. OPERATIONS OK THE tESOPHAGUS. 3G5 Fig. 362,— Anatomy of the CEsophagus and Jugular Vein of the Horse. J J, jugular vein ; C, carotid artery ; O U, suh-scapulo hyoideus muscle ; D, cBSophagus ; S, sterno- maxillaris muscle ; M, mastoido-humeralis muscle. The relations of the oesophagus must then be considered accord- ing to its divisions of the cervical, thoracic and abdominal portion. At its point of origin, at the pharynx, it is situated between the larynx and the guttural pouches. In the upper half of the neck it is in relation, in front, with the trachea; behind, with the long muscle of the neck; and on the side with the car. tid and its /satellite nei-ves. Below this point, and as it deviates to the left, it is related to the left side of the trachea, upon which it rests, and on its outside, with the scalenus muscle, the carotid artery and the jugular vein. In a very few instances, instead of passing to the left of the trachea, it deviates to the right, but otherwise holds the same relations as when in its normal position. At its entrance into the thorax, the oesophagus, still on the side of the trachea, corresponds outwardly with the inferior cervical ganglion and its branches, and to the vertebral, superior cervical and dorsal arteries 366 OPERATIONS ON THE DIGESTIVE APPARATUS. and veins, whicli cross its course and further back, returning be- tween the trachea and the longus coDi, it passes over the left bron- chia and to the right of the thoracic aorta. Beyond this, placed between the folds of the posterior mediastinum, it is received into the groove of the internal face of the lungs, with the oesoph- ageal arteries and nerves. Passing through the opening of the right pillar of the diaphragm, we find it in its abdominal portion related on the right to a notch of the superior border of the Hver, and ending at the cai'diac. The structure of the oesophagus is formed of two coats ; one of external and muscular, the other of internal and mucous membrane. The external is composed of muscular fibers, spiral, red and longitudinal, striated in its anterior three quarters, and white in the posterior quarter. Anteriorly, the crico-pharyngeus furnishes it with a sort of cii'cu- lar necktie. Towards its posterior portion, the muscular coat is much thicker than in the other parts, and as it passes through the pillars of the diaphi-agm, it is more or less pressed upon. These three points must be remembered, inasmuch as they serve to ex- plain the resistance which is encountered by instruments, such as the catheter, or the probang, when introduced into its cavity. The internal coat or mucous membrane is whitish, with longi- tudinal folds, which are so developed at the cardia that they may resist the passage of the probang into the stomach. (Esophageal Catheterism is an operation consisting in the introduction of a special instru- ment, soHd or hoUow, but always flexible, into the cavity of the oesophagus, either to remove bodies that obstruct it, or to aid the exit of gases which have accumulated in the stomach. It is therefore indicated in. three principal conditions, viz.: first, tym2)anitis in ruminants ; second, in cases of oesophageal dilatation, ox jabot ; and third, to dislodge foreign bodies arrested in its canal. In cases of tyinpanitis, it is of advantage if the trouble is not too far developed, and danger of suffocation not too imminent. In cases of oesophageal jabot, due to a more or less extensive dilatatiou of the organ, in consequence of the lodgment and packing of food, it is in many instances of but very little benefit. "When foreign bodies are lodged in the oesophagus, an accident to which horses are liable, and which is very common in cattle OPERATIONS ON THE (ESOPHAGUS. 3G7 and in dogs, it is often of great advantage. The oj)eration would naturally depend very largely for its success upon the size of the foreign body, which of course is a variable cii-cunistance, and also on the condition of its external sur- face, whether rough or smooth, or having projecting points; depend- ing much likewise on the situation in the length of the canal, and whether it has become engaged in the cervical or the thoracic portion of the passage. Probangs for the throat and a speculum for the mouth are instru- ments necessary for this operation. There are various forms of pro- bangs, the designs of different in- ventors. The first, which, accord- ing to Brogniez, was invented by Monro of Edinburgh, has been more or less perfected. The pro- bang of Baujin (Figure 363) is re- versible, and may be so adjusted as to either push down or extract the ofiending substance from its place of lodgment. The instru- ment in ordinary use is designed essentially to push the obstruction thi'ough the passage. It is found in all our surgical instrument ma- kers' shops, and is made of whalebone or of rubber, separable in two parts, connected by a screw. One end (Fig. 304) has a bulb- ous enlargement, the other a blunt mass or head, made concave Fig. 363.— Baujin's Probang. Fig. 364.— Ordinary Whalebone Probang. 368 OPEEATIONS ON THE DIGESTIVE APPARATUS. on its free end, the better to act without slipping against the ob- ject with which it is to come in contact. The probang of the stomach pump forms an excellent instrument for that purpose. Dr. Peabody has constructed a simple implement of strong, thick wire, twisted together and forming a rod of sufficient length, protected by a tube of India rubber, and having one end formed into a ring or loop, to serve as a handle, while at the other ex- tremity a sponge of suitable size is secured and formed into a bulb resembling that of the ordinary probang. Degives recom- mends for use in cases of emergency an extemporized instrument, formed of a whip handle or a branch of a tree, of sufficient length, of the size of the little finger, with a bulb composed of a ball of oakum covered with cloth. This "bulb is attached to the end with strong twiue, of which a free end is left of equal length with the instrument, in order to draw out the broken fragments in case of fracture of the probang. Whatever form of probang may be used, it is always neces- sary to associate with it a speculum to keep the mouth sufficiently open and immobile. Those which are recommended and em- FlG. .365.— Brogniez's Gag. ployed in the exploration of the mouth are available for this pur- pose. But as these are not always obtainable, some ingenious and simple apparatus can be made at a moment's notice like that illus- trated in Figure 365, which, or something equivalent, ought to be mthin the scope of the inventive and constructive capacity of any weU equipped surgeon. OPERATIONS ON THE (ESOPHAGUS. 369 In ruminants the operation is performed in the standing posi- tion, "svith the head extended and elevated on the neck. In soli- peds it cannot be performed except while the animal is down, and when the head can be placed in the proper position of extension to allow the instrument to pass beyond the elbow formed by the pharynx and the oesophagus. The animal being in position, and the speculum adjusted, an assistant draws the tongue out of the mouth, and the operator, placed in front of his patient, passes the probang through the opening of the speculum, and rapidly pushes it into the mouth, resting it upon the hard palate, in order to pre- vent its being displaced laterally by the motion of the tongue. At the bottom of the mouth the jorobang meets with some Httle re- sistance at the soft palate, but the instrument soon reaches the fauces, in the phar;^Tix, and penetrates the oesophagus. At this moment possibly some resistance may be encountered, owing to the contraction of the crico-pharjmgeus muscle, but once engaged in the oesophagus the instrument readily passes the proj)er dis- tance downwards, according to the requirements of the case. If the object in view is to relieve tjanpanitis, and a true catheter, tube, or stomach pump or hollow probang has been used, the gases will find a means of exit as soon as the instrument has penetrated the stomach. If the catheterism has been performed for the displacement of foreign bodies, the resistance they offer to the pressure of the probang must be overcome by a steady, and, at times, quite a powerful pressure of the instrument, caution being always neces- sary to avoid causing laceration of the wall of the passage. ^Vhen the obstruction is even but slightly loosened, its complete dis- lodgment often follows from the mere unassisted contraction of the cesoiDhageal muscles. Caution and gentleness must not be overlooked even in the mere withdrawal of the probang. It should be practiced as a maxim, indeed, that whatever instrument may be, for any purpose, made use of, not alone in the proj)ulsion of the intruding body in these cases, the operator must never re- mit his caution and gentleness, nor lose sight of the fact of the natural Habihty to accident always accompanying surgical in- terference with the organs and tissues having theii- place in the interior regions of the animal organism, and not cognizable by the eye. Serious accidents have been recorded as resulting from a lack of care and attention in the manner of withdi-awing the in- 370 OPEBATIONS ON THE DIGESTIVE APPARATUS. strument. Lacerations of the oesophageal walls, rupture of blood vessels, perforation of the trachea, abscesses of the mediastines, pleurisy and pericarditis belong to the list of recorded casualties in this connection. To facilitate the working of the probang, in these cases, certain practitioners have recommended the adminis- tration of oil or mucilaginous drenches. The Taxis. The oesophageal catheterism which we have just considered is principally applicable to cases where the obstruction is in the thoracic portion of the passage. When it is in the cervical por- tion, instead oi pi'opulsion or intra^yulsion, it is by extraindsion., or by the course of the natural passages that the foreign body is to be removed. In this case the taxis is made to take the place of the ordinary artificial appliances, and the hands become the in- struments with which the surgeon seeks, by making forcible and methodical pressure, to move the impacted object back into the mouth. In 1820, Delafoy recommended a process which is to-day ad- mitted to be one of the best modes of reheving cattle when suf- fering with this difficulty, and many other methods have since then been devised, but most of them are merely modified plans of Delafoy's method. We shall consider them as briefly as possible. In order to raise the iinpac.t (as we shall for convenience call it) back into the pharynx, Delafoy has the animal thrown, on the right side, and administers a glass of sweet olive oil, and while an assistant steadies the oesophagus, applies with his fingers upon the impact, a retrograde motion which carries it upward, back and to the pharjnix. When it reaches that cavity, the head is raised, the jaws are opened with a speculum, and the operator, passing his hand through that instrument into the back of the mouth, seizes the impact and brings it away. Lindenberg keeps the patient on his feet instead of casting him, but otherwise ob- serves the same modus operandi. Denenbourg operates with his patient in a standing position. While an assistant holds the head, well extended, and elevated on the neck, he places himself on the right side of the animal, and with the fingers pressing be- low the impact (like Delafoy), displaces it and gives it the as- cending motion which transfers it to the pharynx, and keeps it there by pressing hard below it. Then putting an assistant in his OPERATIONS ON THE (ESOPHAGUS. 371 place lie proceeds like the others to remove the impact with the hand passed through the speculum. Schaack operates also in the standing position, the hind legs being hobbled above the hocks, the head is kept, as much as pos- sible, in a horizontal position, and a si^eculum placed in the mouth. The operator takes his place on the left side, in front of the shoulder, the right hand on one side of the neck, the left on the other. If the impact is rather low down, or near the chest, the extremities of the fingers are brought together and employed to push it upward, with careful manipulations. If it is situated higher up, near the oesophagus where it is less surroimded by muscles, the pressure is made with the fingers closed. In either case, however, when it has reached the throat, Schaack holds it there, while an assistant with his hand boldly introduced into the mouth, seizes it and draws it out of the pharynx. According to Peuch and Toussaint, Mr. G. Tisserand, in cases of jabot, operates as follows : Making a point of support on the neck with the right hand, with the left he violently shakes the part where the projection of the jabot is most prominent, and then applies alternate movements, up and down, with a lateral shaking of the enlargement until the patient voluntarily lowers his head, and as he snuffles throws out through the nostrils and the mouth, abundant mucosities, mixed with alimentary detritus. If the first manipulations fail, Tisserand advises the occasional ad- ministration of mucilaginous decoctions, or oil, or even plain water. The method of Martin is one which is also held in high esteem, and at the hazard of needless repetition and unnecessary minutiae we give it in detail. Instead of extending the head, which has a tendency to stretch the oesophagus and diminish its diameter, he keeps the head of the patient low down, at about a foot from the ground, and placing himself on the left side of the neck, he passes his right arm over the neck, in such a manner that envelop- iag the neck between both arms, his hands can join on the lower border of the neck, and both thumbs pressed in the jugular grooves, one on the right, the other on the left. It is by succes- sive pressures from behind forward, that he succeeds in pushing the impact iu the pharynx. Then comes a peculiar step of the operation : As by its presence the soft palate closes somewhat the posterior opening of the mouth, the impact cannot re-enter this cavity, and thus, while the mass is in the pharynx and resting on 372 OPKRATIONS OX THE DIGESTIVE APPARATUS. the posterior face of the vekmi palati, with both thumbs he pushes it from above downward and from behind forward; the effect of this is to depress the base of the tongue, and to enlarge the isthmixs of the throat sufficiently for the impact to pass through it, back in the mouth, and drop it to the ground. If, however, the pressure required in this step of the operation could not, for one reason or another, such as excessive thickness of the lower border of the neck, for instance, be maintained, then the impact is ex- tracted with the hand. Courioux has advised the application of a cord around the neck, below the impact to be moved upwards with it, as the dis- placement is accomplished. The object of this is to retain what- ever progress may be gained by preventing the mass from re- ceding again. It forms a substitute for the fingers in holding it in position. The extraction by the mouth of many substances arrested in the oesophagus has also been effected with instruments. Forceps long and curved, hooks and hollow sounds, having metal- lic nippers or jaws, like that of Baujin, have been recommended. That of Wegerer is probably entitled to the highest commenda- tion of all. But with all theii- ingenuity and perfection their use is not mthout danger of causing lacerations of the oesophageal walls, and they are constant^ liable to get out of order. Ceushing the Foreign Body. At times the obstruction takes place in the cervical portion of the oesophagus, and attempts to displace it, either toward the mouth or the stomach, have failed. To meet this emergency various means have been sought for, either to crush the impact, or cut it in small pieces. One suggestion for the first object is to break it with blows of a maUet, a piece of wood, or other object held by an assistant, furnishing the point of resistance. But this is obviously a dangerous process, nearly certain to produce bruises and lacerations of the soft structures, with probably sub- sequent gangrene. At best it can be available only when the im- pact is in the form of a comparatively soft mass, such as ripe fruit or the like. Professor Lafosse had in 1846 suggested subcutaneous incis- ion, and this was put in practice in 1855 by Chapard for the relief of a cow choked by a piece of a beet. A simple puncture of the OPERATIONS ON THE CKSOPHAGUS. 373 oesopliagiis was first made, with a straight tenotome, below the obstruction, then a curved tenotome was introduced through the wound, and by careful movements in the mass of impact, it was sufficiently divided to enable it to resume its usual course down- ward into the rumen. Though this mode of operation has not become established in general practice, the application of its prin- ciple has not been overlooked, and has not been without its influ- ence in simplifying the performance of the operation of oesopha- gotomy. CESOPHAGOTOMY. When the obstruction is in the cervical portion of the oesopha- gus, and, either because of its nature or of its form, cannot be displaced by any of the means we have discussed, the division of the organ itself furnishes the only escape from the consequences of the difficulty. The operation of oesophagotomy consists in the exposure of the oesojohagus and the incision of its walls. While it is usually performed for the removal of obstrvicting bodies, it is also indicated in some cases as a mode of facilitating the adminis- tration of drugs, or, under special circumstances, of food and drinks. It is of French origin, and its adoption in veterinary surgery seems to have occurred in 1782, when it was performed by Lom- pagieu Lapole to remove an orange, arrested in the inferior region of the neck. Since that epoch it has been performed on horses, cattle, dogs, and even on swine. Damoiseau, Felix, Michel and others have performed it on cattle ; Thissine, H. Bouley, Keynal, Rey, Marrel, Mauri on the horse; Peuch, Macgillivray, Williams, on dogs, and Lagrange on pigs. H. Bouley performed it to re- move a piece of corncob and^ a large molar tooth which, after ex- traction, had slipped into the CBSophagus; Baldwin extracted a large piece of a root; Rey removed a cork; Peuch took away pieces of bone from a dog. In fact, the operation has generally, if not exclusively, as is but natural, been appropriated to the relief of patients laboring under the difficulty we have been discussing. A claim has been made in its behalf as a means of rehef in lock- jaw, by facilitating the artificial feeding of the sufi'erer. But such a claim, as to any practical value which may be supposed to attach to it, cannot in, anywise possess any validity, nor be to any extent sustained when we take into consideration the history and the 374 OPERATIONS ON THE DIGESTIVE APPAEATUS. nature of tetanus and its origin, with tlie complications and con- sequences likely to accompany and to follow it. Marrel lias rec- ommended it in cases of fractures of tlie jaws; but sucli practice would truly furnish an example of the proverbial case in which the remedy is worse than the disease It has also been recom- mended for the relief of jabot, and has been, in some cases, fol- lowed by favorable results. The instruments necessary for this operation are a convex and a straight bistoury, a pair of dissecting forceps, a director, a needle and strong thread ; to these may be added a pair of scissors and two blunt tenaculums, with also large forceps to grasp the impact and extract it, close at hand. The animal must be kept in the standing position, and held under thorough control by an assist- ant, with a twitch on the lower lip or on the ear, and either fore foot raised or both fore legs hobbled. It must be taken into consideration that the cervical jDortion of the oesophagus is situated immediately behind the trachea, con- tinuing thence as far as the middle of the neck, when it deviates to the left, where it occupies the lower third of the neck ; and again, that this cervical region is surrounded by an abundance of loose connective tissue, having on each side the carotid and its nerves. It will also be observed that the lower third of the neck forms a triangular space, with above it the inferior border of the sub-scapulo-hyoideus muscle, and on the sides the sterno-maxil- laris, levator-humeri and scalenus. In this space it is in connec- tion on the inside \\dth the trachea, upon which it rests ; and on the outside with the scalenus, the carotid, the jugular and the nerves of that region — organs which are aU covered by the cuta- neous colli and the skin. The point of separation of the middle and lower third of the neck, in the left jugular groove, is the 'place of election or of ne- cessity for the operation, or where the incision of the skin must begin, a httle above and behind the jugular. If the obstruction is considerably prominent, this incision must be made directly over it. Peuch and Toussaint, in their excellent work, divide the oj)er- ation into three steps, which they thus describe : — 1st. Step. Incision of the skin and dissection of the subja- cent tissues. — Standing on the left side, the operator first deter- mining the situation of the jugular vein, clips the hair from over OPERATIONS ON THE (ESOPHAGUS. 375 the tumor, stretches the skin with the left thumb and index finger, and with the convex bistoury, extends the incision from the initial point, about four fingers' breadth do^NTi, parallel with the blood vessels. The incision divides the skin, and the cuta- neous muscle, and exposes the jugular and carotid and their nerves. The thumb of the left hand is then introduced into the incision and depresses forward the blood vessels and nerves, while the other fingers of the same hand are embracing the tracheal border of the neck. The oesophagus is thus exposed on the lateral border of the trachea, and the cellular tissue which covers the organ is then divided. By raising the upper lip of the incision with a blunt tenaculum the oesophagus may be still more exposed. 2d Step. Loosening or isolation of the oesophagus — Cutting away part of the cellular tissue, the cesophagus is seized with the thumb and index of the right hand and drawn outward. The vascvdo-nervous fasciculus are then let loose, the cesophagus is Fig. 366.— The (Esophagus Drawn Outward and liaised with the Scissors. 37G OPEKATIONS OX THE DIGESTIVE APPARATUS. di-awn out Avitli tlie left hand, tile right holding the curved scis- sors, which being jDassed from above downward, and separating the remaining portion of cellular tissue, holds the organ resting upon its blades, in readiness for the third step (Fig. 366). 3d Step, or Incision of the cjesophagus. — The operator then, supporting the scissors with the oesophagus resting upon them, in the left hand, with a straight bistoury with the edge tuimed upward, in the right, makes a large puncture in the oesophageal walls, passing through their entire thickness, and afterwards en- larging it with the aid of a director. At this point of the operation, and at each deglutition, there is usually an escape of mucosities mingled with food. "WTien the impact forms a decided projection, the incision should be made directly over the prominence. Professor Nocard has modified the operation in cases where the obstruction can be di^'ided in small pieces, by making only a correspondingly small incision. He uses both a straight and a curved tenotome, and performs the first and second steps as in the preceding methods, the third one being made as follows: "The oesophagus being exposed, isolated and placed over the scissors, the operator introduces the straight tenotome through the oesoi:)hageal membranes, the blade running parallel with the muscular fibers, into the thickness of the impact (apple, potatoe, pieces of beet, etc..) avoiding injury to the opposite surface of the canal; then sHding the curved tenotome against the straight one, and pushing it through the entire mass until it touches the op- posite wall of the oesophagus, he withdraws the straight instru- ment, and divides the impact by movements of the curved instru- ment, analogous to those made in the division of the tendons in the operation of plantar tenotomy. The blunt end of the curved tenotome protects the oesojDhagus from any enlargement of the original wound." Cagny, after exposing the oesophagus, as already described, crushes the obstruction by rejDeated gentle blows of a small mallet, as before described. He prefers this mode to that of in- cision if the impact, though hard and flat, possesses but little force of adhesion. ^\Tien the objects of the cesophagotomy have been reahzed, there is no necessity for fm'ther interference, the appli- cation of sutures being generally considered rather injurious than otherwise, and though the resulting wound is of a somewhat com- pHcated nature, its perfect cicatrization in a comparatively short GASTEOTOMY. 377 time is the general nile. The principal indication is cleanliness in the removal of the discharges, and of any mncosities or food that may escape over its surfaces. H. Bouley has experimentally proved that to obtain the cicatrization of oesophageal wounds it is essential "■to feed the animals loith food of fibrous texture, and nothing hut pure water to drink."' By respecting this indication all danger of complications is avoided. The possible accidents and complications ai*e: xoounds of the blood vessels during the first steps of the operation, but the hemoiThage that f oUows may be stopj^ed by pressure or ligature ; iedeinatous sicelling of the w^ound, suggesting the infiltration of food or pus in the surrounding cellular tissue. It may terminate in a simple abscess, or it may be the precursor of a fatal gangrenous complication: purulent infection, seiyticmmia, tetanus, are also possible sequelse of oesophagotomy, but a faithful and judicious application of antiseptic means in dressing and nursing the patients wiU. usually baffle the possible evil. GASTEOTOMY— EUMENOTOI^IY. This title, in our opinion, ought to include the puncture or in- cision of the rumen, when designed to liberate confined gases or to remove the solid contents which may have accumulated in that viscerse. In the first case it is indicated when the tympanitic condition of the first compartment of the stomach exhibits alarming symptoms and resists all ordinary remedial indications ; and in the second, when the gases of the rumen are mixed with the aHmentary mass contained in that organ and a larger opening than that made by the trocar becomes necessary, for their re- moval. In either case the left flank must be the seat of election for the operation, the rumen occupying that side of the abdomen, and situated at a point equally distant from the last rib, the angle of the ilium and the transverse process of the lumbar vertebrae. Tabourin suggests the last intercostal space as the proper place for the operation. The instruments necessary are a large trocar (Fig. 367) with a straight and a curved bistoury. The gastrotomes invented by Brogniez (Fig. 3G8) and Sajoux are too complicated. The animal must be in the standing position. Puncture of the mmen. — The operator, facing the left flank, makes an incision throuj^h the skin, about an inch and a half lonq-, 378 OPERATIONS ON THE DIGESTIVE APPARATUS. Fig. 367.— Large Trocars. with the bistoury, or with the blade of a lancet. Then placing the trocar perpendicularly upon the flank and into the cutaneous incision, presses it against the muscles, and with his right hand strikes a heavy blow on the handle of the instrument and forces it into the cavity of the rumen, jorovided the blow has been suffi- ciently heavy. The blade of the trocar is then withdrawn, the canula being left in place, and the gases allowed to escape, as in the operation of enterotomy. Incision of the rumen. — The oj^erator, using a convex bistoury, makes an incision in the middle of the left flank, beginning a httle below the point selected for the j)uncture of the rurhen, and measuring a length of from three to four inches, cuts through and divides the entire thickness of the skin, and the walls of the rumen. The hand is then introduced and employed for the re- moval of the food contained in the cavity. The further cleaning out of the rumen may be done with a large spoon. Schaack recommends the removal of only a hmited portion of the ferment- ing mass, and that the walls of the organ should not be scraped. While the puncture of the rumen does not require to be fol- lowed by any special subsequent treatment, the wound of the in- cision needs to be closed immediately after the removal of the contents of the organ. This must be attended with every anti- septic precaution, and the closing be done by means of the inter- rupted suture. The parts shovild be thoroughly cleansed. Adhe- sion may be promoted by the application of a wide band of ad- hesive plaster placed all roimd the animal, as recommended by Professor Brush of the American Veterinary College. The wound of the puncture heals rapidly, while that of the iucision requires from a week to ten days, and if properly treated, unites by the first intention, without suj)puration. The accidents which are GASTEOTOMY. 379 piQ. 368 -Brogniez's Gastrotome. t~:;Cr" J':— a«veV..e. t.e,e.to.t. generally iDroves fatal. 380 OPERATIONS OX THE DIGESTIVE APPARATUS. ENTEEOTOMT. The division or punctm-e of the intestines, or enterotomy, is an operation the object of which is to facilitate the exit of gases contained in these organs, to prevent their excessive dilatation, and to obviate certain too commonly fatal comphcations. It was mentioned at an early day by Vegetius, especially in connection with the treatment of wind cohcs, but not again spoken of imtil 1776, when Koem, Bomvinghausen, and at a later date, Barrier and Herouard obtained good results from it. Bourgelat and Chabert recommended it in the early stages of the disease, but, notwithstanding the favorable dicta of all these authorities, the operation was not fully admitted to a place in the domain of veterinary surgery until Bernard, Dieterichs, Falke, Key, Schaack, HajTie, Eckel, Blendeiss, Charlier and others, had proved by nu- merous facts that when performed under favorable circumstances it is not orJy harmless, but is capable of insuring results of the most beneficial character. Intestinal puncture is indicated in cases of tympanitis or flat- ulent cohc, due to indigestion, or to an intestinal obstruction, and must be performed whenever the accumulation of gases has resisted ordinary forms of treatment. The indication, in our opin- ion, is to operate early in the disease, as an almost positive means of avoiding the complications, or rupture of the stomach or lacera- tion of the intestines, which, if unchecked, may accompany the flatu- lent accumulation. Enterotomy is also recommended in cases of strangulated hernia, when the gases which are imprisoned in the hernial intestines j^revent its reduction. Imbert used it with ad- vantage in reducing a strangulated ventral hernia. In former days Chabert performed the operation through the rectum, and Abadie, in 1875, reported a case in which he reached the intes- tines through the vagina. But while it may be possible to ob- tain access to the dilated intestines through these channels, it is e^^dent that it is a method which must oppose more difficul- ties and involve more comphcations than the puncture through the flank. The point of selection for the operation is about the center of the space formed forward by the border of the last rib, behind by the external angle of the ihum, and above by the extremity of the ENTEKOTOMY. 381 Fig. 369.— Trocars for the Coecum. Fig. 370.— Brogniez's Enterotome. transverse processes of the lumbar vertebrae, on the right flank — since it is there that the dilatation of the intestines is most prom- inent. The puncture, if made at this stated point, penetrates the second portion of the large colon ; if it is made nearer the lumbar vertebrae, it enters the arch of the ccecum. The only instrument necessary to perform enterotomy is a trocar. The instrument used in cattle for puncture of the rumen 382 OPERATIONS ON THE DIGESTIVE APPARATUS. was formerly employed, but it is quite unnecessary and of no ad- vantage to use a canula of such dimensions merely to allow the escape of the gases. A small, round trocar is now in general use, and is in our estimation to be preferred to the ordinary flattened form of instrument (Fig. 369). The enterotome of Brogniez (Fig. 370) is too large an instrument, and its use endangers the walls of the intestines and the siuTounding blood vessels. Brogniez reports a case of injury to one of the coecal arteries by the point of this instrument. We have frequently had re- course to the trocar of the epidermic syringe used for horses, when no other instrument was conveniently at hand. The animal suffering with flatulent colics is treated while on its feet, and the pain it endures is usually of so intense a kind that no means of restraint are necessary, and it remains per- fectly indifferent to the insignificant and minor pang of the oper- ation. The principal caution to be observed, is to be on guard against the patient's suddenly falling, but if this should occiu- it need not interrupt the operation, which may be continued with- out forcing it to rise. The modus oj^erandi is very simple. The spot being acurately determined, the point of the instrument is pressed perpendicu- larly upon the skin with one hand, and di'iven by a strong, quick blow with the other upon the handle, through the skin and the in- testinal coats into the visceral cavity. The withdrawal of the rod, leaving the canula in place, completes the process, by giving vent to the gases. These escape with more or less force, as announced by a whistling sound as they pass out of the tube. The intestines must then be entered from above downward, and not as recom- mended by Hertwig, who punctures the most dependent part of the abdomen, and thus exposes his patient to serious subcutaneous infiltrations. Peuch and Toussaint suggest the propriety of making a small preparatory incision through the skin with a bistoury, pre- vious to the main punctui'e with the trocar. The escape of the gases continues for a varying time, according to the amoimt of the accumulation. The instrument should continue in the wound while the escape continues, and until the tympanitic con- dition of the intestines disappears. If the escape of gas should suddenly cease, it will be because the canula is filled with fcecal or other matters, and the trocar must be re-inserted into its PAKACENTESIS. 383 canula until the renewed escape of the gas proves that the ob- struction has been removed. If, however, they still fail to find an exit through the canula, a second puncture must be made at a short distance from the first. The wound of the puncture re- quu-es no treatment. According to Zundel, enterotomy is comparatively — in ordin- ary cases — harmless; still, however, complications more or less severe are possible, and have been observed. Hemorrhages, though of no alarming nature, have been noticed, and several cases of abscess have been recorded, either at the seat of the operation, or at the wound of the flank, and even in the groin. Peritonitis has also been encountered. Subcutaneous emphysema has been mentioned by Bouley ; but in an experience of many years, we have never seen it. Laceration of the floating colon has been reported by Schaack. As a means of prevention against these accidents we would recommend great care in the introduc- tion of the trocar through the abdominal walls, and especially a condition of thorough cleanliness, with a careful disinfection, of the instrument. PAEACENTESIS. This term, with its synonyms of puncture and tapping, is at the present time applied exclusively to the operation performed upon the abdominal waUs for the purpose of evacuating the seros- ity collected in the peritoneal cavity, as the result of dropsical ef- fusion. It consists in puncturing the abdominal walls in the man- ner practiced in enterotomy and gastrotomy. The operations are similar, while the purpose varies materially in the several cases. This operation had ah-eady been recommended by Vegetius — afterward employed by Vitet, as a last resort in ascitis. Lafosse, Jr., also speaks of it, and in more modern times we find it advo- cated by St. Cyr, Lafosse, Forster and others. Though in the majority of cases forming only a palliative treatment, it is never- theless indicated in chronic dropsy of the abdomen, when all other forms of treatment have failed to produce the resorption of the fluid, especially when its accumulation interferes with the ab- dominal and thoracic functions. In these cases of ascites it has been performed upon horses, cattle and dogs. The injection of tincture of iodine into the peritoneal cavity, after the removal of 384 OPERATIONS ON THE DIGESTIVE APPARATUS. the effusion, has been successfully added as a means of preventing- the return of the fluid. In selecting the place where the operation is to be performed, Brogniez, Degives, Peuch and Toussaint ad\ised the middle of the hnea alba, at an equal distance from the xiphoid cartilage of the sternum and the anterior border of the pubis ; Zundel, on the contrary, recommends " a puncture on the right side in ruminants, on the left in horses, on a point at an equal distance between the umbilicus and the external angle of the ilium, about on a line run- ning from the stifle towards the cartilage of the last rib." He adds, however, "to select the point where the liquid is most de- tectable and fluctuation better felt." A trocar of the size of a quiU for large animals, and an aspirator for the smaU, are the only instruments required. In operating on large animals, they are kept standing, while small animals are laid upon a table and placed slightly on their backs. Placing himself on the left side of the animal, after having selected the place where the puncture is to be made, the operator, holding the trocar Fig. 371.— Holding the Trocar in Paracenthesis. full in his hand and limiting its action by keeping his fingers a short distance from the point of the instrument, jjushes it by a rapid and firm pressure through the thickness of the abdominal waUs, until he feels that he has overcome their resistance, and that the instrument has passed into the cavity. The trocar is then withdrawn from its canula and the fluid escapes through the tube. Director Degives describes another modus operandi, which he calls subcutaneous, in which the opening of the skin does not cor- respond with the division of the deeper muscular layers, and by which the opening becomes covered by the skin. To effect this the skin is drawn a little aside, then punctured, or a large fold of the tegument is taken hold of, and the puncture made at its base. In either case, when the skin is loosened, its retraction comjjletely closes the abdominal opening. HEKNIA. 385 If tlie escape of the fluid shoiild stop or diminish, a blunt stylet can he introduced into the canula to clean it of any albu- minous or epiploic mass which may obstruct it. The operation in small animals is performed in the same manner. As the removal of the entire accumulation of the fluid is dan- gei'ous, though less so than in thoracentesis, it is better to permit a portion of it to remain. The quantity is sometimes enormous, ranging between thirty-five and ninety-six quarts. After the quantity desired has been obtained, the canula of the trocar is carefully withdrawn, and a bandage or roller of adhesive plaster placed aroimd the body of the animal. Among accidents possible in this operation, wounds of blood- vessels or of the intestines, and fatal peritonitis may be men- tioned. HERNIA. General View. In a general sense, any tumor formed by the entire or partial escape and j)rotrusion of an organ, either wholly or in part, from the restraining tension of the integuments, or from the cavity which forms its normal location, is a hernia, or in popular phrase, a rupture. The more special appHcation of the term is to the dis- placement of the abdominal viscera, but it is also employed to describe the enceplialocele, or protrusion of the brain through the cranium; the projection of the iris and \h.Q jabot, or protrusion of the oesophagal mucous membrane, through its muscular covei'ings. And again the prominence of a synovial membrane beyond its ordinary bounderies: that of a muscle through its aponeurotic envelope ; the prolapsus of the rectum ; of the vagina ; of the uterus, etc., etc., — these also receive the same designation and are recognized members of the hernia family. We shall, in the pres- ent chapter, mainly limit our consideration to the disjjlacements of the abdominal digestive organs. The rationale of the formation of a hernia becomes a matter of easy comprehension, when we take into consideration the gen- eral anatomy of the abdomen, and especially the structure of its inferior wall. The muscular layers which form the exterior wall of this large splanchnic canity are not of equal density through their whole extent, and consequently do not offer in every part an equal amount of resistance to the outward pressure of the interior 386 OPERATIONS OX THi: DIGESTIVE APPARATUS. contents. In one place muscnlo-carfcilag-inous, or bony, it is in another, musculo-aponeurotic. In some parts protected by only a single layer of muscle, as in its anterior wall ; in others the layers of muscular aponeurotic structure, or of fibrous bandages, are re- inforced by a powerful elastic band, as in the inferior portion, by the tunica abdominalis. But besides this variety in the elements Fig. 372.— Muscles of the Inferior Abdominal Region. 1, aponeurosis of the great oblique; 2, fleshy portion ol the small oblique; 3, straight of the abdomen; 3', transverse of the abdomen; 4, pre-pubic tendon; 5, inguinal ring; 6, its anterior border; 7, the posterior; 8, external commissure; 9, internal commissure; 10, posterior border of the aponeurosis of the great oblique ; 11, internal crural aponeu- rosis; 1'^, flap of the aponeurosis of the great oblique, drawn downward to show th'^^ origin of the reflex portion which forms the crural arch ; 14, remains of the umbilicus. forming the walls of the cavity, there is also to be taken into con- sideration the fact that, at certain points in the walls, natural openings exist, and that the abdominal cavity is therefore not strictly a close cavity. These passages consist of the inguino-cru- ral openings, the umbihcus and those found in the diaphragm for HERNIA. 387 the egress of certain organs out of the aljclomen, either during foetal life or after birth. The hernia, when not arising from a traumatic cause, is the result of some violent muscular effort on the part of the animal, in the course of which the viscera are made to exert a violent out- ward pressure upon the walls of the abdomen. If the pressure bears against any of the more solid portions of the wall, there will be no }delding, and the parts will remain uninjured and intact. But if the pressure becomes unduly violent, and the attack is di- rected against some one of the weaker supports, there must be a yielding, and the intestine or omentum, as the case may be, will be forced through the oj^ening which falls most nearly in line with the direction of the violence. The resistance fails, the viscera passes through the aperture, and there is a protrusion, a rup- ture, a hernia. Two elements must enter into the composition of all hernias, with the exception of eventrations. They are the sac, and the displaced organs which form its contents, and the mode of its formation may be readily comprehended by a consideration of the figures 373, 374, 375, Avhich show the progressive displacement of the peritoneum, as it is pushed through the opening of the ab- dominal walls, by pressure of the intestines, which are also gradu- ally passing through the same opening. The figures show in what manner the hernial ox peritoneal sac is formed. The sac is thus shown to be the prolongation of the perito- neum, which is displaced, moved and distended, or may have sus- tained partial laceration of its fibres. It may even happen that the rupture of that serous membrane is complete, and that it has become lodged in the cellular tissue. In such a case the lacerated peritoneum soon throws out a provisional reparatory sheath, which becomes continuous with the natural serous membrane. Whether formed by the peritoneum itself, or by a membrane of secondary formation, the sac is always composed of a middle por- tion, or body, and an opening, or ring, which constitvites a means of communication with the abdominal cavity, with a neck or canal, a narrowed portion, uniting together the body and the opening of the tumor. But Httle uniformity exists in the formation of the ring or opening of a hernia. In some instances it is round or oblong, in others it is a narrow slit, and again it exhibits a triangular outline. 388 OPEKATIONS ON THE DIGESTIVE APPARATUS. Fig. 373. Explanation.— In these three figures an idea of the mode of formation of hernias is given: aa aa aa, represent a section of the abdominal wall; o o o, the aponeurotic opening through which the peritoneum, pjij^PPPi is engaged to form the hernial sac, s; the intestine, ii ii ii, is shown entering the hernial sac gradually. In the ventral kind the aperture is wide and of varying dimen- sions, and it may, moreover, be quite wanting, or again, it may be long and cylindrical, as in inguinal rupture; while in the um> bihcal variety it is very short, and represented merely by the thickness of the edges of the hernial ring. The body or middle portion of the intestines, or that which becomes lodged in the cavity of the sac, also varies in size, direction and form, and may be considered under the four j^rincipal heads of the cylindrical. 389 Fig. 378.— Conical Hernial Sac. Fig. 379.— Pyriform Hernial Sac. Fig. 380.— Hernial Sac in Clusters, or having three contractions — /, d, b. Figs. 381, 382 ^MultilolDular Hernial Sacs. 390 OPERATIONS ON THE DIGESTIVE APPARATUS. the spheroidal, the convex, the i^yriform, to which Zundel adds the clustered and the multilobular. The relation as to dimensions between the body of the hernia and the measurement of the ring is a point of importance in re- lation to estimating the more or less serious nature of a case. It will readily be inferred that with a narrow and contracted open- ing, an obstruction may easily take place, and at an early date, and that in due time the result will be manifested in the legitimate form of a strangulation, an accident which will be accompanied with various phenomena, according to the degree of pressure and the duration of the period of formation, and all of them attended with trouble and danger. At first, as the capillary circulation becomes retarded and diffi- cult, the intestines assume a red color, which passes successivel}' through many shades, from deep red to brown or a blue-black, indicating the arrest of the blood, of which the dreaded sequel may be looked for in the appearance, a httle later, of signs of mor- tification of the parts involved. The blood then transudes through the walls of its vessels, and filtrates into the sub-serous and sub-mucous cellular tissue, thus increasing the bulk of the contents of the sac. At the same time the external sm-f ace of the protruding intestines becomes the seat of what is at first a yellowish exudation, but which becomes a bloody deposit, ready for organization if the patient hves long enough to survive the pains of the strangulation. By the eight- eenth or towards the twent^'-fourth horn-, however, signs of total gangrene make then* appearance and the hernial portion becomes flabby, cool, and insensible ; the odor becomes very offensive, and the tissues easily lacerated or torn. The fatal end is then near, being rarely deferred beyond the twenty-fourth horn-, unless im- mediate relief has been interposed. But, of course, every case does not observe this regular succes- sion of symptoms, nor reach the same final termination, and in the instances in which the interference with the cu'culation is less pronounced and the degree of pressure upon the protruding organ is lighter, probably not more than sufficient to interfere moderately with the movement of the intestinal contents, we have a modified evil to contend with in the obstruction or engorgement of the hernia, with consequences in view less discouraging to con_ template The exudation ujDon the surface of the contents of the 391 ':V!""m:i I lnjnm.il Ht-rnia. A, intestinal circumvolution. B. h,einiittci iiutioii of the intestine. D D, neck of the viKinal sac compressing the intestiiies E, internal wall of tlie vaginal sac. T, tes- ticle in the fundus of tlie vaginal sac. sac lias resulted in an adj^esion with the internal sm'face, and the hernia has taken its place in the class of the irreducible. Hernias of long standing, which have, at intervals, shown indications of obstructions, are, in the greater number of instances, in fact, ir- reducible. There are still, however, cases of simpler condition in which the viscera continue to be movable in the sac, in which fact they are due to the lubricating effect of a free serous exudation. 392 OPERATIONS ON THE DIGESTIVE APPARATUS. Aside from other distinguishing characteristics, all hernias are divisible into two classes — internal and external. Of the latter, some, as the eventration, have no containing sac, while the others, which have a serous covering, are in reahty alone entitled to be considered as the true hernias. These, usually occurring through one of the natui'al 02)eiiings, are called natural, in ojjposition to the accidental, which, like the ventral hernias and the eventration, occur through accidental and artificial oj)enings. Any of the ab- dominal viscera, with the exception of the pancreas and the kid- neys, may enter into the formation of a hernia, and as each is known by the name of the displaced organ, we are given the designations of enterocele for a hernia of the small intestines ; epi- plocele, for that of the omentum, and entero-epiplocele of both the intestines and omentum. The name of g astro-ventral is given to the ventral hernia which involves with it the stomach ; cystocele, when it is the bladder which is affected, and hysterocele when the uterus is concerned. Hernias can be, moreover, congenital or oc- casional— that is, they may exist at birth or previous to it, and also when making their appearance under special causes after birth. They may be also considered as acute when recent, or chronic, when of long standing. Their originating causes are numerous, and may be said to comprehend any which may predispose an animal to such a lesion by contributing to an increase of the pressure which the organs contained in the abdominal cavity bring to bear upon its walls, or any w^eakness in the walls, which may diminish their power of re- sistance to the pressure, as, for example, a condition of leanness arising from a sudden or recent change from a state of obesity ; blows upon the abdomen ; wounds and cicatrices of the abdomi- nal vfalls ; \'iolent, jerking efforts, such as those required in com- pulsory jumping or hauling, or in any other of the struggles to which they are too often forced, and even when under the sur- geon's hands, when, as a j^atient, the animal is cast and secured for an operation ; the rapid relaxation after contraction of the natural openings, repeated pressure, or excessive dilatation, as with staUions used for covering mai*es, may be placed among the j)redisposing causes. They have also been observed in mares, after violent efforts during parturition ; also during colics and other tympanitis. To recapitulate and partly to rej)eat The general symptoms characteristic of hernias, are compar- HERNIA. 393 atively easy to recognize, and can be reduced to two principal points, to wit — the discovery of a tumor, and appearance of an opening coexisting in the abdominal walls. These tumors and openings offer many varieties of form and character. The tumor located opposite to a natural opening, or under a breach or sepa- ration in the structure of the abdominal walls, or under a cicatrix, forms a mass, indolent, elastic, remittent, of varying size, but di- minishing or increasing under peculiar conditions, such as rest or pressure, and the standing, or the lateral or recumbent position, etc., andha\ang different forms, being located in various places. It has also, in many instances, the quality of being reducible, that is, it may be made to disappear by means of certain manipu- lations and appropriate treatment, and arrangements of position, to retui'n to their previous status when these agencies are sus- pended; or again, they will become permanently irreducible under special pathological changes already alluded to. The presence of borborygmus is also an important item among the means of form- ing a physical diagnosis of these tumors. This is detected more or less readily when the displaced organ is a portion of the in- testines. They are, however, missing when the hernia is formed by other organs, as, for instance, in case of epiplocele. Other points connected with this subject remain to be mentioned. Among these are the final symptoms, and more or less remote re- sults, which may follow the presence and working of the lesion upon the general economy and the johysiological functions at large, when the acute action has passed away. The constitutional symptoms^ or what may be so denominated, will vary, in their nature and their intensity, correspondingly with the condition of the hernia and the compUcations which may ac- company each case. Among these comphcations, four principal ones may be mentioned as taking precedence : 1st. Irreducibility. — This is more frequent in old cases than in new, and is probably due to the increase in size of the dis- placed organ to the degeneration of the tissues, or to old adhe- sions between the organ and its covering, the sac. These cases, which may be considered rather permanent than merely chronic, maintain their status, either completely or partially, unchanged. Yet they cannot, natm-ally or rationally, be held to be compatible with a sound constitution or unimpaired stamina in the animals so conditioned, and their liabihty to contract indispositions easily 394 OPERATIONS ON THE DIGESTIVE APPARATUS. has frequently been remarked. Difficulty ia tlie performance of movements requiring effort has also been noticed, with conse- quently a liability to suffer traumatic injuries from external vio- lence. To this must be added a facility in contracting: 2d. Inflammation. — Generally this occurs as the result of external injuries, but it may also occur without any apparent cause. Its seat is the sac or its contents, and it affects the serous structures alone, or assumes a phlegmonous aspect. The inflam- mation of the serous tissue is often overlooked, while that of the phlegmonous cannot pass unobserved. It may sometimes assume a very serious character, and become even more dangerous than the true strangulation. 3d. Obstructions or engorgements, common in intestinal her- nias, are due to the accumulation of alimentary or stercoraceous masses in the displaced intestines, or to gases which interfere with the reduction of the hernia. This is often complicated with strangulation, but is not in itself of a very dangerous natiu*e. 4th. Strangulation. — This condition has been alread}^ consid- ered. It is the result of excessive pressure upon the blood vessels of the displaced organ, and while under its three periods or degrees of congestion, inflammation, and gangrene, has usually a fatal termination. The general treatment of hernia has the two objects in view of the destruction or obliteration of the sac, and the reduction or closino- of the ring. If the first is not always easy to accomjDUsh the reduction of the diameter of the ring often is so. Each form of hernia demands some special directions for the realization of these two objects, and these will each receive its own share of attention as they may in turn come under our notice in further treating the various forms of hernia. Inguinal Hernia. Inguinal hernia results from the passage or presence of a portion of the intestines, or of the omentum, or of both together, in the testicular or vaginal cavity whose opening of communica- tion with the peritoneum or inguinal ring continues in its normal condition, having never closed. A brief survey of the general anatomy of the region involved will be a necessary preliminary to our discussion of the subject, which is one of interest and im- portance. HERNIA. 395 Fig. 384.— Anatomical Disposition of the Inferior Inguinal King and Testicular Sac. Explanation of Fig. 384.— A C, testicular sac, in which are shown— let, the nock situated above the letter A, and concealed in the inguinal canal ; 2d, a middle portion extending from A to E ; 3d, a fundus, B C, whore tha testicle is. D D, division of the scrotal artery. P G, inferior inguinal ring, whoso internal commissure is rounded and formed of white fibres crossing each other and attached to tho prepubic tendon. H n, fleshy portion, from tho email obliaue, and forming tho antirior and internal lip of the inguinal ring. K K, postero internal edge of the inguinal ring, formed princi- pally by an aponeurotic portion of the great oblique. L, scrotal artery. M, veins of the scrotum and of the penis. N, part of tho penis thrown bacliward. o o o, tunica abdominalis. P, muscles of the flat of th3 thigh, short adductor of the thigh. The in/fuinal canal is an infundibuliform cavity, flattened from one side to tlie other. It is situated in the groin, and 396 OPERATIONS ON THE DIGESTITE APPAKATUS. through it pass the testicular cord and the testicular blood ves- sels, in the male, and the blood vessels of the mamm?e in the female, as they emerge from the abdominal canity. Situated on one side of the preiDubic region, it observes an oblique direction, downward, backward, and from without inward, being formed posteriorly by the crural arch, and anteriorly by the fleshy portion of the small oblique muscle of the abdomen. Inferiorly it has an opening called the inferior inguinal ring, which is made through the aponeurosis of the great obhque, oval in shape, and jDossessing two %:>s, edges or pillars, united together by two commissures. The lii^s, divided into anterior and posterior, are formed by the fibres of the aponeurosis of the great oblique muscle of the abdomen, and a few of the muscular fibres of the small oblique, reinforced by some bands of the tunica abdominalis. The commissures, divided into external and internal, result from the union of the extremities of the two pillars. The superior opening of the inguinal canal is known also as the peritoneal or stiperior inguiyial ring, and is situated in front of and dii-ectly opposite the crural ring. It represents a single sht, subject to dilatation, placed also between the crural arch and the small oblique of the abdomen, and allowing on its inner border the pas- sage of the anterior pudic or posterior abdominal artery, it sur- roimds the neck, and forms the entrance of the vaginal sheath. It is open in horses, and often in bo\dnes also, and it allows a du-ect commimication between the cavity of the vaginal sac and that of the peritoneum — undoubtedly a predisj^osing condition to hernias, not to be overlooked. The testicular sac ofi^ers to our attention, from the point of view from which we now consider it, an entrance, or true infundibulum, overlapping the internal opening of the inguinal ring or canal ; a tieek situated just below that ring, a continuation of the infundibulum or entrance, and which at a short distance from its origin ofi'ers a well marked contraction in its diameter — this being the point where strangulation takes place — a middle part, containing the sj^ermatic cord; and a bottom, or true cul-de-sac, where the testicles and the ej)ididymis are lodged. The special signification of the terms which have been else- where and already employed to designate and classify the varie- ties of form and manifestation characterizing different varieties of hernia are of interest, and should not be lost sight of. They are HERNIA. 397 di\dded principally into recent or acute, and old or chronic, and we find them considered as enter ocele, epiplocele, and enter o- epiplocele, according to their contents. The name of vaginal hernia has been used to denote a case in which the intestine is directly engaged in the inguinal canal; and hernia of the ring, or hernia in the canal, describes that in which the viscera have en- tered but a short distance into the sheath. Bubonocele signifies that the intestine has entered but a very slight distance into the inguinal sheath, in opposition to the oscheocele or scrotal hernia, when the intestine falls quite down into the sac, and with the testicles themselves, occupies the bottom of the scrotum. Inguinal hernias are generally accidental, but, as some authors hold, are also sometimes congenital, having been found existing at bii-th; and in many instances they become permanent, the in- testines occupying the vaginal sac without change, as a fixity. Then, again, they may be intermittent, disappearing more or less completely, under pecuhar conditions, only to reappear under the stress of new influential causes. Of course the classification of re- ducible and irreducible, always holds. The classification of the hernia of castration, which takes place during or after that opera- tion, is considered by some to be properly one of the forms of eventration. A consideration of the anatomical disposition of the vaginal canal, and especially of its upper ring, which prasents an opening communicating with the peritoneal cavity, will explain the reason why inguinal hernias of the horse are more common in the stallion than in the gelding. It is rare in bovines, but Lafosse has seen it in sheep and in rams and although the anatomical disposition of the canal in the dog render its occurrence difiicult, Wolstein has observed it in that aninial. Cases are rare in females, but Girard, Jr., has seen it in mares, Rychner in cows, and Hering, Hertwig and Goubaux in bitches. Recent iNoirrNAL Hernia. '\i\Tien the hernia appears suddenly, in a subject not jyredis- posed to it, the first symptoms are those of abdominal pain, ap- pearing suddenly and without warning, and quite inconsistent with the general perfect health of the animal. These symptoms are at first vague in their significance, and definable merely as ex- hibitions of simple pain in the abdomen. 398 OPERATIONS ON THE DIGESTIVE APPARATUS. If iu tile stable, tlie animal becomes restless, paws with bis fore feet, gazes earnestly toward his flanks, and flexes his legs, as if to lie down, and perhaj)S accomplishes that movement, but only to resume the standing position. The skin is moist, the per- spiration apiDearing on the face, around the ears, behind the shoulders and in the groins. If he is in harness, his action is changed, he shortens his steps, stops pulling, wants to stand still, and becomes covered with abundant perspiration running over him and di'ij)ping from his bell}^ These first sjTnptoms excite suspicion as to the real cause of the trouble, but they soon assume a character which changes the suspicion into certainty. They rap- idly assvime greater severity, increasing in the ratio of the suffer- ings of the animal, which then has no more rest or intermission, and gives evidence of the most intense abdominal j)ain. He paws and stamps upon the floor more and more violently, sometimes kicking his abdomen; gazes anxiously toward his flanks; lies carefully down and rolls to and fro on his back, sometimes keeping the dorsal jjosition for a few moments, as if he could only thus find relief; then suddenly rises to his feet and rejDcats the movements, which give evidence of the torture he suffers, but more forcibly and rapidly than before. The expression of his face soon becomes characteristic. The lips are contracted, the nostrils are retracted and dilated, and the widely opened eyes ap- pear unnaturally large and prominent, rendering then* agonized expression more and more striking. The respiration becomes ac- celerated and the pulse more rapid; the perspiration streams more copiously from his body and the poor animal groans under the weight of his trouble. After a lapse of some hours, the time arrives for the occurrence of strangulation, which may be pronounced the crisis or fatal event of inguinal hernia. It is characterized by a peculiar mo- tion of the head, which is thrown up and down repeatedly (and which the French have designated by the word " encense.'") This motion, which is sometimes habitual with horses while in harness, has a pecuhar meaning when it becomes the expression of the colic of hernia. It is then performed slowly, the head being ele- vated gradually and extended upon the neck, to be suddenly dropped again as if from weakness, to be again raised and dropped during the few and brief intervals of remission of the pains, while the animal possesses the abihty to keep on his feet. HEENIA. 399 In fact, when the hernia is completed, the colics are so violent that the animal no longer lies down, but literally throws himself with violence upon the ground, having become forgetful of the natui-al instinct of conservation, and now rendered indifferent to all other pain by the overpowering force of the hernial torture. With his body covered with bruises, and bleeding from numerous superfi- cial wounds, he now becomes a p)itiable object. There are animals of particularly sensitive temperament which wUl even, like those in a rabid furor, bite themselves on their flanks and forearms in their delirious desperation. During these excessive sufferings there seem to be just two positions in which the animal can experience a comparative de- gree of comfort. They are, lying on his back, or maintaining the dog-sitting posture, on his haunches. But these movements of reprieve are of but short duration, and the pains may continue to be manifested without cessation, by tumultuous, violent, unequal struggles, which may continue twelve or fifteen hours, or even more. At last, toward from the fifteenth to the twentieth hour, all the signs of pain subside, and a great calm succeeds to the previous violent agitation. This, however, is far from being a good sign, or an indication of the termination of the disease. It is, on the contrary, a sure token that a fatal termination is close at hand, and if the patient has ceased to suffer, it is because the anesthesia of death has fallen upon the organ in which his pains originated. The parts which were so recently altogether too much alive, have died. Gangrene has attacked the imprisoned intestine, and with its apjiearance, loss of feeling has also come — and death — for death is the loss of feeling. The animal is now in a con- dition of extreme prostration. The temperature is diminished ; the perspiration is cold, the pulse is imperceptible, his face is without expression, the poor brute can scarcely maintain a stand- ing posture or move his legs when urged to stir, and when the last remnant of his strength is exhausted, after a few hours, he drops upon the earth and dies without a struggle. Death rarely delays beyond twenty-fom- hours following the strangulation. This is the extreme limit, and in the greatest number of cases it takes place within a shorter period. These manifestations (the description of which we borrow from H. Bouley), constitute the series of general symptoms of hernia, but, at the same time, they do not belong exclusively to that kind 400 OPERATIONS ON THE DIGESTIVE APPARATUS. of injury. They are those of any violent abdominal pain spring- ing from any cause, and may be met with in invaginations, volvulus, intestinal obstruction, etc. But if not possessing any positive and intrinsic significance in themselves, they assume great value in the diagnosis, when added to the series of local, ox pathognomic symp- toms which have their origin and limit in the inguinal region. Two methods are available for the location of the seat of the lesion, one being the external exploration of the inguino- scrotal parts, the other consisting in the internal rectal examin- ation of the pubic region. In a horse, and especially a stallion, suffering from cohcs, the indication to a general and immediate examination of the inguinal region, for abnormal appearances, is always present, and it will not be safe to be too easily satisfied with visual examination exclusively, to become certain that no part of the intestines is engaged in the vaginal sac. The eye may be deceived; it is the touch alone which will prevent all possibility of error. The sensation imparted to the touch at the beginning of a recent inguinal hernia is that of a thickened testi- cular cord which has lost its usual supj)leness, and whose con- stituents can no longer be determined under the pressure of the fingers. Thus thickened, the cord gives a sensation of resistency, increasing as the exploration is carried further up in the groin, while toward the bottom of the sac, the scrotal mass feels fuller than usual, the testicle becoming less movable, giving the sensa- tion of a sHghtly pufiy tumor. After several hours duration of the disease, the characters become better marked, in consequence of the increase in the size of the intestine, and the amount of exu- dation, and there is also a formation of gases above the neck of the sac, which also contributes to its increase in size. The hernial tumor has thus become changed from its original appearance, by its enlarged size, and is easily detected by the great general tension caused by the presence of the accumulating gases ; the cord is found to be tumefied in its whole length, while its renitentcy increases as it extends upward into the canal. Du-ect pressure with the fingers upon the tumor does not seem to cause great pain, probably because this local sensation is dulled by the extension of the excessive j)ains which radiate from the hernia throughout the entire abdominal system. The external characters of the inguinal tumor become more noticeable when both sides of the testicular regions are compared, the difference between the HERNIA. 401 healthy and the diseased regions being then easily ascertained. Continued spasmodic movements of the healthy testicles have been observed. In the rectal examination of the horse, the hand may be easily carried beyond the anterior border of the pubis, and the condition of the superior ojoening of the inguinal canal, and the state of the organs engaged in it thus ascertained. In the normal condition, the anterior pillar of the superior opening of the canal is easy of identification. It is in front and on each side of the pubic region, and by reason of the extensi- bihty of its muscular structure, reqmres no greater force for its separation from the posterior pillar than the introduction of two fingers into the ring. When the intestine is in the vaginal canal, after having passed through the superior openiiig, it can be felt with the hand through the walls of the rectum, its situation being generally on the inner side; and being thus recognized, it can be raised, pulled upon, and sometimes even extracted from the open- ing through which it had passed. But to be able to judge accu- rately the nature of the object which has been felt, requires in the surgeon an amount of experience in the taxis not always pos- sessed, while its absence may at times betray the explorer into serious error. Moreover, the sensations transmitted through the rectum cannot ia every case be truly interpreted, and it sometimes becomes necessary to combine the two modes of examination em- ployed simultaneously — the rectal investigation and the external, manual, testicular exj)loration. Thus, when with one hand in the rectum, pressing on the in- ternal ring, and the other pushed well into the depths of the in- guinal region, both are brought in contact, and it is discovered by the actual touch that the inguinal canal is clear, the hypothesis of strangulated hernia is at once negatived. On the other hand, if there is hernia, and the imprisoned intes- tine is encountered, the fingers of the two hands cannot jjossibly come in contact, and the next question will be one of indication, if not of prognosis. As a rule, the prognosis of recent inguinal hernia is always seri- ous. If develoj^ed without organic predisjDOsition it is necessarily a serious lesion by reason of its tendency to spontaneous stra-ngu- lation, which when unreheved means death by torture, unless the fatal event should be humanely anticipated and prevented by the 402 OPEEATIONS ON THE DIGESTIVE APPABATUS. fiat of a compassionate master. But a fatal prognosis need not be unnecessarily volunteered. Timely and vigorous measures, es- pecially emphasizing the " timely," may still prevent the strangu- lation and defer the sentence of mortahty, and the sooner, there- fore, the means of rehef are applied, the more certain will be their effect. Every minute's delay increases the force of the disease and lessens the chances of success. It is rarely the case that the lapse of fifteen hours leaves any room for confidence, though it is not yet time to abandon hope. Within that period there are many chances for saving the patient, but after the earlier periods of the attack a single hoirr's neglect may be fatal — that horn- may prove to be the turning-point of the conflict. The treatment of recent inguinal hernia assumes two forms, consisting of the taxis, and the operation of herniotomy, or the en- largement of the neck of the vaginal sheath with a cutting instru- ment. The first mode is indicated at once, or as soon as the her- nia is recognized. The reduction must be accompHshed in the shortest time possible, the danger of strangulation becoming more imminent and threatening with the lapse of every moment. The taxis may give immediate relief, and may be materially assisted by douches of cold water. In this case the taxis consists in the manipulation of the part with the hands, by pressure and otherwise, for the purpose of re- placing the protruding intestine in its proper cavity ; technically, the reduction, of the hernia. This manipulation is appUed either by simple pressure over the external surface of the diseased part, or, if practicable and necessary, by supplementing it with a proper traction appUed upon the intestine from within through the rectal walls. This manipulation may be applied by two processes, first the subcutaneous, medial or indirect^ and second, the direct taxis. 1st. The Indirect Taxis. — In the first or indii'ect method, the animal is placed in a standing position, with the hind legs secured. Then the hand and arm of the oj)erator, well oiled, are introduced into the rectum, using the right, if he is to operate on the left side, and vice versa. When in the rectal cavity, the hand is carried to the anterior border of the pubis, while with the other, jDassed in front of the patella, pressure is appHed upon the scrotal sac, and the intestine pushed toward the superior opening. The hand in the rectum then grasps the loops of the hernia, tkrough the rectal walls, and at the same time pulls them upward. Thi'ough these HEENIA. 403 manipulations the surgeon may succeed in removing the difficulty, if by that time the testicular sheath continues to be free from con- gestion. But if this ah'eady exists, and the coUcs are increasing in severity, the taxis in the standing position becomes impossible and it will be necessary to throw the animal. This done, he must be placed in the dorsal position, with his hind legs kept apart and his haunches raised as much as possible by bunches of straw. In this position, the operator must j)roceed to practice what must be described as an exceedingly delicate massage or taxis ujDon the scrotal sac, both hands being used, in such a manner as to crowd or press the intestinal mass toward the superior opening of the canal. The design of this is to stimulate the cii'culation thi'ough the capillaries, and also to free the cavity of the intestine from the semi-fluid and gaseous contents which may be present, by this means diminishing its volume and facilitating its reduction. That this must be done with the utmost caution and patience, needs hardly to be urged. And it should be persevered in for at least a period of thirty seconds before advancing to the other stei3, which consists in gradually pushing the intestine toward the opening. If the protruding loop is not too long, and the massage has succeeded in its design, and the bulk of the tumor has been sufficiently diminished, and, above aU, if the hernia has had but a short existence, it may be within the probabilities that this external taxis alone will be sufficient to reduce it. But such a result cannot be counted on with any degree of certainty, and it is then the simple dictate of wisdom to make assurance sure, if possible, by having recourse to double taxis, and attacking the danger at both its internal and external accessible points. For a single operator to undertake the performance of both branches of this compound manipulation can hardly be advised. Few men possess the necessary powers of endurance, and an acci- dent might easily compi'omise the very life of both surgeon and patient. At the least, it involves quite an unnecessary amount of effort and fatigue. All the reasons are in favor of a division of the work, by which a competent assistant will be put in charge of the rectal taxis portion of the labor, while the practitioner in chief will direct and execute all the other steps of the treatment. The successful result of the operation will be known at once by the diminution of the tumor, the disappearance of its puffy and tense condition, by the sudden sensation of yielding, felt by 404 OPERATIONS ON THE DIGESTIVE APPARATUS. the hand working in the rectum, and also by the facility with which the fingers of that hand can be introduced into the now liberated superior ring. Anesthetics have been recommended as powerful adjuncts in the apphcation of the taxis, in this class of cases. Bouley recommended their use, and Bagge, a Russian veterinarian, agrees with Bouley, in advising their administration. His pro- ceeding is thus described: The rectum being emptied, a solution of two to four grammes of chloral and sixty or seventy centi- grammes of acetate of morphia are thrown into it, while at the same time compresses of chloroform are laid on the diseased side of the inguinal region. In the course oi ten minutes there is such a relaxation of all the tissues that the reduction by rectal taxis is quite easy. The spermatic cords are then surrounded by rolls of bandages moderately tight, in order to prevent the return of the hernia. These bandages are left on for eight or ten hours. The danger of strangulation upon the testicular cords is an im- portant objection to the adoption of this process. Severe appli- cations of douches of cold water applied for one or two hours previous to the taxis have been successfully employed by Steff and Lacassin. A process known as that of Patey, from its discoverer, con- sists in the injection of oil of belladonna into the hernial sac, the action of the oil, it is claimed, producing the dilation of the pseudo-sphincter, which prevents the reduction. It causes a cer- tain flaccidity of the parts, renders the taxis much easier, and con ■ siderably facilitates the reduction. 2d. The Direct Taxis. — This procedure is of too dangerous a character to maintain a place in the domain of veterinary surgery, except under very exceptional conditions. It consists in apjDly- ing the manipulations of the taxis directly upon the intestine, previously exposed by the dissection of the testicular enveloj)es. These manipulations, which are dangerous when the intestine is distended by gases or fluids, may, however, be rendered easier by relieving the intestinal loop, through the use of a fine needle- trocar or aspirator, of the cause of its abnormal dilatation. The method of Renault, mentioned by Zundel, is also a form of direct taxis which, though it may be employed in cattle, involves a subsequent fatal peritonitis in the horse. The operation con- sists in the opening of the flank and the performance of the re- HERXIA. 405 duction by direct traction with the hand thus introduced into the abdomen. The operation of herniotomy is that which consists in the section of the neck of the vaginal ca%"ity. It is the proper opera- tion iov strangulated he7'7iia. Bouley has said: "This operation is not, as one may be inclined to think, a last resource, which is not to be used except after the taxis, under its various forms, has been appUed and failed. Far from it. We believe, on the con- trary, that in the horse, the taxis is a means of treatment which is truly indicated only in the first five or six hours of the descent of the intestine ; that even, in this first period of time, one must not use it too much nor too long, from fear of the compHcations which might arise through the rectal manipulations, and that after this limit of a few hours has elapsed, it is better to have re- coiu'se immediately to the operation, without trusting to vain hopes from the use of the taxis." The operation is comparative- ly a simple one, the dangers which were formerly apprehended having been greatly reduced by a better knowledge of the seat of the strangulation, and of the parts to be di\ided, and the ratio of mortahty is now so small — forty-two recoveries out of fifty-two operations — that hesitation is no longer justifiable. The instruments required for this operation are straight and cui'ved bistouries, scissors, an ordinary director, a herniotome (Figs. 384a, 385), or blunt, straight bistoury, and a pair of ciu'ved clamps vdth strong cords to secure their branches. The hernio- tome is a hi stoury -cache ^ which, however, since the use of general anesthesia, has been replaced by the blunt, straight bistoury, en- ables the operator to di\T.de the neck of the vaginal sheat'h in the right place with more certainty than heretofore, and to regulate more accurately the dimensions necessary to relieve the strangu- lation. The director which is best adapted for use in herniotomy is one which has a flat, lanceolated, grooved surface at one end, and which, while it guides the blade of the bistoury, contributes likewise to the protection of the intestine against the possibility of injury by the sharp edges of the bistoury. The patient to be operated on is laid upon a soft bed, anes- thised as completely as possible, and placed upon his back. The hind leg corresponding to the side where the hernia is located is freed from the hobble, secured with a roj^e, and carried outward in abduction, with the rope made fast to a fixed point near by — 406 OPERATIOXS ON THE DIGESTIVE APPARATUS. Fig. 385. Herniotomes of Colin. as a ring in the wall, a post, a tree, or other immovable object. If the opera- tion is to be performed at night, which is too often necessarily the case, the presence of additional assistants will probably be required, in order to insure an abundant amount and proper man- agement of Hght, which is indispensable in so delicate a dissection. In operating, the surgeon kneels be- hind the patient and ^ith a curved bis- toury begins by making a long incision upon the tumor, parallel with the long axis of the testicle. This incision is similar to that which is made in castration with covered testi- cles, and must involve only ' the scrotum, the dartos, and the first layers of the lamellated cellular tissue which unite this last to the tunica erythroidea. The remaining portion of this lamellae is then carefully incised, iintil the fibrous coat is exposed, and the tumor is entirely enuclea- ted from its envelojDe of cellular tissue. This done, the fibres of the tunica erythi-oidea are scraped apart with the point of the straight bistouiy, until the vaginal sac has been open- ed, which the operator dis- covers by the appearance of a stream of liquid pass- ing through. The canula- ted director is then intro- duced into the opening and HERNIA. 407 guides the bistoury, with wliich the hernial sac is now freely opened, in front and behind. This free cutting allows the escape of all the serous or sero-sanguineous fluid contained in the sac, varying in quantity according to the duration of the hernia. The contents of the hernial sac are now exposed. They consist of the testicle, pushed outward, against the commissure of the ring ; the looj) of the intestine, placed on the inner side of the spermatic cord, rarely extending as far down as the testicle, but usually reaching to the level of epididymis, and again, not un- commonly remaining in the condition of a bubonoale. But what- ever may be the dimensions of the protruding loop, the intestine is always easily recognized by the roundness of its form, the smooth- ness of its surface and its color, which may range from various shades of red to bluish black. It is also recognized by the changes which have taken place in its consistency, resulting from the bloody and serous infiltration which has taken place in its structure. The intestine should now be carefully wiped off with a soft, fine sponge, or washed with lukewarm water, in order to free it from any de- posits or adhesions of serous or bloody matter that may be present. The opening of the hernial sac should be immediately followed by the exploration of the neck with the index finger, with a view to the determination of the exact point where the strangulation exists, and to judge of its degree of tightness. This will not be found upon the superior opening of the inguinal canal, as thought by Gu-ard, D'Ai'boval, Hertwig, Hering, Lafosse, Rey, Yerrier and others, but shovild be looked for two or three centimetres below that opening, as demonstrated by Bouley ; that is, where the neck of the vaginal sac is situated. This point made out, if the hernia is very recent, and the intestine has not yet become the seat of thick- ening, a few tactical manipuMions can be apphed, the internal face of the vaginal sac having first been lubricated with sweet oil, or some mucilaginous substance, or even oil of belladonna ; and even cool irrigation has been of service. In the performance of this taxis the first step is committed to the assistant, who stretches both borders of the sheath in order to separate them in the form of a funnel, the testicle being drawn outward, in order to stretch the cord also. The operator then applies both hands upon the loop of the intestine, and with moderate and gradual pressure endeavors to push it through the neck of the vaginal sac. Eectal taxis applied at the same moment may also be of great assistance. But these 408 OPERATIONS ON THE DIGESTIVE APPARATUS. efforts must not be persevered in too long. If not successful al- most immediately, it is better to have recourse at once to the in- cision of the neck of the sac than to expose the intestine to the subsequent effect of pressures or tractions of which the termina- tion may be a fatal gangrene. The following steps are recom- mended by Bouley in making this iucision. Says this author : "One assistant takes hold, with both hands, of the edges of the incision made through the vaginal sac, stretching them into a funnel shape ; another draws the testicle outward and backward, to stretch the cord. Then the operator having explored with his finger the con- dition of the neck, introduces the blunt bistoury or the herniotome (Fig. 386) as far as the neck of the sac, taking for his guide the index finger of his right hand (Fig. 388), introduced into the neck or canulated director, and holding the instrument in such a manner that its back rests against the pulj) of the fin- ger which supports it, and its sharj) edge turned outward, corresponds to the stiffened band of the neck, to- wards the internal face of the thigh. This band will thus become stretched over the knife in such a manner that it divides itself upon the sharp edge of the instrument, with the aid per- haps of the slightest pressure made by the finger which supports it. The important point is to make a very hm- ited incision, dividing only the thick- ness of the vaginal sac and its fibrous covering, and avoiding the wounding of the cremaster, that being one of the conditions of the closing of the sheath. The division once made, the degree of dilatation of the neck is readily made out, and if the finger can be easily in- troduced into it, the reduction of the hernia becomes then an easy task. The modus o2)erancU by the use of the herniotome differs but little from the preceding. Allien this instrument 409 Holding the Bistoury upon the Grooved Director. is to be used, a careful measurement of the amount of opening to be allowed to the blade must first be made. Then, guided by the side of the index finger, and with its blade turned outward, the instrument is introduced into the sac. When it has reached the proper point where the division is to be made, the blade is brought out by pressing upon the peculiarly-contrived handle of the instru- ment, and the division of the band of the neck is completed. After the division at the point of strangulation, the taxis is to be used, both externally and by the rectum, carefully taking into consideration the condition of the intestines in the appHcatiou of the various manipulations required. Upon reduction of the hernia, obliteration of the sac is secured by the application of a clamp, curved or straight, upon its parietal layers, embracing between them the spermatic cord. In short, the final steps of the operation will be precisely those by which the operation of castration with covered testicles is completed. This methed of closing the vaginal sac is the best, the simplest and the most certain in its results. It is true that the objection that it imphes castration is a weighty one, but the mutilation which it involves is a condition of radical recovery which cannot be obtained by any other means. The attempts which are made to save the testicles, which are justifiable only in the case of very valuable animals used for breeding purposes, are nearly always followed by fatal results. Among these may be mentioned the process by which, in- stead of leaving the testicle to drop under the efi"ect of the pressure of the clamp, it is left inclosed in the vaginal sac, whose divided edges are brought together by sutures. Schmidt has attempted to push it back into the abdomen ; but such methods have been followed by fatal peritonitis. Bouley has 410 OPERATIONS ON THE DIGESTIVE APPARATUS. also advised a subcutaneous herniotomy, which was put into prac- tice afterwards by Siegen & Verrier, in which the careful puncture of the sac was made at the origin, or, preferably, at the flabelli- form insertion of the cremaster. After enlarging the opening, the index finger is introduced into the neck, carrying with it the blunt bistoury with which the structure is divided, and the reduction is completed by the taxis, the wound being closed by several points of suture. The use of antiseptics in our day obviates a large portion of the danger arising from the comphcations which may follow these modes of operation. The operation for strangulated hernia in the gelding does not differ much from that indicated for stallions, except in the man- ner of closing the wounds, the clamp, in this class of patients, being apphed upon the hernial sac, involving the skin, as is done in some cases of treatment for umbilical hernia. The treatment of the patient subsequently to the operation is generally a simple matter, the violent coUcs, -svith other manifesta- tions of the hernia, having suddenly subsided, and the patient being comparatively free from pain. He will probably give evi- dence of some sHght abdominal uneasiness, which will j)robably be due to the pressure of the clamp upon the testicular cord, but this will not be of long duration, probably requiring no other at- tention than a moderate walking exercise. The animal is then turned loose in a box stall and placed upon a diet suited to his case, and watched for future developments. The wound requires no special attention but cleanhness, and towards the fifth or sixth day, when the suppuration is estab- lished, the clamp can be removed. It is about this time that comphcations may be looked for. A fatal peritonitis, for example, may apjpear between the fifth and tenth day, when everything has seemed to be progressing favor- ably, and bid defiance to treatment, especially if the intestines were already in a gangrenous condition when the reduction was made. After ten days there need be no more fear of complica- tions, so far as the hernia is concerned, but it is not yet too late for those of castration, which may still occur. The duration of convalescence will average from twenty to twenty-five days, after which the animal can resume his work. A return of the hernia, recidlve, is a rare and almost impossible event when the reduction has been completed by castration. HERNIA. 411 During the operation certain accidents may occur, including eventr'ation, an extra vaginal hernia and injuries to the intesti7ies. At the j)resent time, eventrations are rare, by reason of the fact that the division of the superior ring itself is no longer per- formed. Yet they may occur through an accidental slip of the knife, or a tearing of the walls of the vaginal sheath during ma- nipulation for the reduction, and the accident is usually a fatal one. Of extra vaginal hernia, Bouley says: "While making the in- cision of the neck, sometimes the cremaster muscle is divided in the direction of its length ; an accident possible, especially when one uses the concealed herniotome, and when too much freedom is allowed to its blade. It is then possible that the intestines may become engaged through this incision, and appear outside of the vaginal sac, above the inguinal ring. If at this moment, by mis- aj)plied taxis, the intestines should fail to re-enter the cavity of the sac, eventration may take place. But if, on the contrary, the intestine is first carefully returned into the vaginal cavity, and then into the peritoneum, the edges of the peritoneal opening of the canal being intact, the intestines will then be prevented from making another exit." Wounds of the intestines may take place either through a misdu-ection of the bistoury during the struggles of the animal, or possibly from the nails of the operator or his assistants, and the fact of their possibility suggests a sufficient hint touching the obvious means of obviating their occurrence. The gravity of these injuries will be measured by their extent. Old Inguinal Hernia. Old, or chronic inguinal hernias, are those of which the charac- teristic condition is that owing to the state of dilatation of the vag- inal sheath, the intestine contained in it is enabled, without jeop- ardy to the life of the patient, to continue its function in the same manner as if it had remained in the open cavity of the abdomen. The vaginal sac has in this case become a kind of large diverticu- lum of such dimensions as to allow, without interference, the work and motion of the intestinal tract, lodged within it, to go on in a natural way. These hernias are divided into continued, or perma- nent and i?iterniittent — a division elsewhere alluded to — but they may also be distinguished as sinqyle and complicated. 412 OPEKATIOKS ON THE DIGESTIVE APPAKATUS. Among the varieties belonging to the latter category may be named: the laceration of the superior opening of the testicular sheath; the collection of serosity in the sac (hydrocele); the sar- comatous transformation of the testicle where the hernia exists (sarcocele); the adhesion of the intestines to the walls of the sac (u-reducible hernia) ; with obstruction and strangulation. Although their causes belong to the Hst which we have already considered, there is still a sort of latent difference observable in the effects to which they severally give rise, as evidenced by the slowness and tardiness of their matmity. They often appear, also, as a sort of relapse or reactionary sequelae (recicUve of the French) of acute hernia improperly reduced, or as a consequence of the ab- noi-maUy dilated condition of the upper ring, while this constitutes a predisposing cause. But this same condition of dilatation may be congenital, and in animals wdth a jiredisiDOsing conformation chronic hernia of the intermittent kind is of easy occurrence. Whatever may be their mode of formation, however, they are gen- erally of long standing, and readily diagnosticated by their positive and familiar characters. Chi'onic hernias are generally of larger dimensions than the acute, and when exclusively vaginal, filling the cavity of the scro- tum and forming a true oscheocele. If the laceration of the supe- rior opening of the canal has allowed the formation of a sac and of an adjunct tumor, in front and outside of the cord, the hernial tu- mor will then consist of two lobes, the smaller situated in the depth of the groin, under the ventral walls, and the larger occupying the scrotal sac. These hernial tumors are usually formed by the small intestines and the floating colon, in exceptional cases, by the pelvic curva- ture of the colon as well. They vary also in volume as well as in consistency, from an obvious cause ; enlarging after meals, to con- tract again when the abdomen is empty ; and again, giving various impressions under the hand, according as their contents are gas- eous, liquid or soUd. In the first condition, when the intestines are empty and the animal is at rest, the tumor is soft, supple, elas- tic and more or less reducible, but when the animal is in action it increases in bulk, and becomes more tense and elastic, and less easy of reduction. There is therefore a condition of intermittency in their character, which is due to the pecuHar conditions in which the animal may be placed. The form of these tumors corresponds HERNIA. 413 to that of the testicular sac in which they are contained, the in- guinal oscheocele being pyriform, with its contracted portion resting in the groin. Vermicular movements of the intestines and borborygmus are symptoms easily detected in large hernias. The tumor of a chronic hernia is painless, or nearly so. Rectal examination furnishes evident indications of the possibility, and of the presence of the hernia by the degree of the dilatation of the ring and the size of the organ engaged in it. In such a case, the dila- tation may be so great, even notwithstanding the presence of the intestines, that the hands, placed respectively, one in the rectum and the other in the inguinal region, can be brought in such near proximity as to touch each other. All these symptoms, taken to- gether, or even isolated, are sufficiently characteristic to establish a positive diagnosis of simple chronic hernia. The serous exudation which necessarily exists in chronic hernia, may, when it is excessive, render the natm-e of a hernial tumor more obscure, and give it the appearance of a case of true hydrocele, the serous sac in these cases being so full as to render it impossible to discover, either by sight or feeling, the presence, of the intestines contained in it, even the elastic resistance of its walls being undetectable. But here a rectal exploration will help to solve the question ; and, again, by placing the animal in the dorsal position, the gravitation of the liquid into the abdomen will readily reveal the truth by leaving the intestine alone in the sac. Great caution is necessary in these doubtful cases, in which a misdirected stroke of the bistoury, thoughtlessly or accidently made, might prove certainly fatal, by incising the intestinal knuckle, which it really is, instead of simply opening the mere serous sac which it was supposed to be. The formation of a sarcocele may also render the diagnosis difficult. In these cases the testicle, considerably tumefied, rough on its surface, and hard and painful, is felt at the bottom of the sac, and thus conceals the character of the hernia. Still, with sarcocele hernia coexistent, the scrotal tumor acquires an appearance and proportions differ- ent from those of its uncomplicated state. In this last case, the testicle constitutes the principal mass, and the elongated cord, stretched by the weight of the oi'gan, can be easily traced with the fingers quite up into the groin. If, on the contrary, both hernia 414 OPERATIONS ON THE DIGESTIVE APPARATUS. and sarcocele are present, the testicle is bosselated and hyper- trophied, and the cord which suj^ports it is surrounded by the protruding intestines, which form on the outside an elongated mass, of a consistency either puffy or perfectly elastic, according to the period of digestion. Intelligent rectal exjDloration will always reveal the presence of the intestine through the ring. When chronic inguinal hernia becomes comjolicated with acute inflammation of the displaced organ, the scrotal tumor becomes warm, painful, evenly tense and remittent, and assumes nearly all the characters of a phlegmonous tumor, that a strong tempta- tion is offered to oj^en it with the bistouiy. But, if this is con- templated, it should be preceded by a rectal examination, carefully made, as the only means of avoiding a possible error of diagnosis whose consequences would be fatal. If the inflammation con- tinues to be localized, the intestine contracts adhesions with the walls of the sac, and the hernia becomes irreducible; but if, on the contrary, the phenomena of inflammation extend to the peri- toneum, an acute perit07iitis is estabUshed, and the patient suc- cumbs in a few days. The obstruction or engorgement, which is a possible complica- tion of chronic inguinal hernias, consists in the distension of the intestinal loop by the lodgment of alimentary masses of varying bulk Avhich accumulate, and for the time being, occlude the intes- tinal tract. This complication may be recognized by the in- creased volume of the tumor, its greater weight, and the sensa- tion of a softish and puffy mass contained in it. It is often, how- ever, but a temporary trouble, the coHcs which attend it yielding easily to appropriate treatment, and the removal of faeces from the rectum by back-raking being often sufficient in itself to afford relief. But in exeeptional cases, treatment fails ; the obstruction becomes persistent ; the faeces accumulate in the protruding in- testines ; the tumor is increased in bulk, and at length a period arrives when such a disproportion between the volume of the dis- tended intestine and the capacity of the opening through which it has passed is established, that all the conditions necessary for strangulation are fulfilled. This soon takes place and becomes evident by the exhibition of symptoms akin to those pertaining to its analogue of the recent or acute variety. There is, how- ever, a difference between the two forms in respect to the impor- tant matter of theu' comparative amenability to treatment, inas- HERNIA. 415 much as while strangulation in the acute cases is only relieved with great difficulty, w^ithout resorting to the ojieration of herni- otomy, it is not uncommon in those of a chronic character, also strangulated, to succeed by a careful exercise of the taxis, in dis- placing the alimentary mass which causes the obstruction, and thus forms one of the contributing conditions of the strangula- tion. It is only in case of failure in this endeavor that herniot- omy becomes admissible. A chronic inguinal hernia is always a serious ailment, though not necessai'ily incompatible with the life and health, and even partial usefulness of the horse. It must, however, constitute a blemish which cannot fail largely to depreciate his commercial value, since it must always be liable to interfere with the efficient performance of his accustomed labor, besides keeping him in a state of greater or less exposure to complications and tendencies which are a constant source and menace of danger to the valetu- dinarian animal. Operations for the relief of hernia are always attended with a certain gravity, even when they are of the simplest character of which they are capable, and if compHcations exist the danger must necessarily be intensified and aggravated, even to the ex- tent of jeopardizing the life of the patient. In the excellent work of Peuch & Toussaint, speaking of the applications of treat- ment, they remark : " In animals less than fifteen months of age suifering with hernia, the expectant method is the proper indica- tion, since the lesion may disaj)pear as the animal gets older and develops. Inguinal hernias of small size must be left alone, not interfering, while in that condition, with the work of the animal. The operation in chronic inguinal hernias, comphcated with lacer- ation of the supei'ior oj^ening of the inguinal canal, and conse- quently with ventral hernia, is contra-indicated by the imminent danger of the occurrence of eventration during the operation, or when the clamp is removed. "WTien, however, the hernial tumor has assumed such enormous dimensions, that, like the udder of a cow, it hangs doT\ai to the hocks, there is no more contra-indica- tion, the animal being then useless - and yet some slight chances of success still remain. Hernias complicated with hydrocele, sar- cocele or obstruction, are cases calUng for operation, and when the point of strangulation has been reached, the indication of immediate and urgent interference is imperative." 416 OPEKATIONS ON THE DIGESTIVE APPARATUS. To this we may add, with Bouley, that the operation is also indicated when the hernia is exclusively vaginal and of stifficient proportion to interfere with the locomotion of the patient. It is also indicated as a means of preventing its further development. The operation for chronic inguinal hernia identifies itself with that of castration with the use of the clamp, and by the process known as covered testicles, as it is by this alone that the accom- plishment of the ultimate purpose in the reduction of the hernia and release of the strangulation can be obtained. The instru- ments required are those needed in castration. The clamp, how- ever, requires to be of increased length and dimensions, and straight and Curved Clamp. curved, in order to adapt itself to the parts. A broad cloth, such as a bed sheet, may prove useful to receive and protect the intes- tines in case they should protrude too extensively. The animal is placed in the decubital position on his back, with the leg of the affected side maintained in abduction. Anes- thetics are generally used, especially when there are fears of com- plications, while, in fact, they ought never to be omitted. The operator then, with the convex bistoury, makes carefully, on the inferior border of the hernial sac, an antero-posterior incision, parallel to the median raphe of the scrotal region, cutting through the skin, the dartos and the first layer of the cellular tissue under- neath. He then with his hands tears the adhesions which exist between the dartos and the tunica erythroidea, in order to enucle- ate the hernial tumor in its entirety. This step is easily effected when the cellular tissue, which covers the fibrous coat, is not in- durated, but if that should be the case when adhesions exist, the HERNIA. 417 dissection should be carefully made with the knife until the ad- hesions are completely divided and the fibrous coat fully exposed. The reduction must then be attempted without opening the sac, and in the absence of any adhesions this is effected without diffi- culty, the inguinal opening being so large that, through the force of mere gravitation, the dorsal position in which the animal is placed is often sufficient in itself to cause the return of the intes- tines into the abdominal cavity, even the testicle and the hernial sac often following it in its inward movement. If the reduction does not take place in this manner, or in con- sequence of the position of the animal, the taxis, both scrotal and rectal, is then indicated to be performed in the same manner as for acute hernia. Difficulties in effecting this reduction may arise from three causes — either, first, the bulk of the mass repre- sented by the protruding intestines ; or second, its obstruction ; or third, the adhesions which it may have contracted with the walls of the sac or with the spermatic cord. To obviate the first difficulty, while the manipulations of the taxis, scrotal and rectal are simultaneously continued, it will be weU to relieve the position of the animal, and instead of keep- ing him lying absolutely on his back, to allow him to turn shghtly, and to rest on the side opposite the hernia. In this way the mass will not be so heavy to manipulate, and wiU be in a better position to follow the dependent dii-ection in which it must be pushed by the scrotal taxis, while at the same time, by the rectal manipulation, it can be more easily unfolded and drawn from the cavity in which it was imprisoned. But if, notwithstand- ing aU these precautions, this diffictdty in the reduction cannot be overcome, the indication of opening the sac still remains. The incision of the sac is performed as in cases of recent hernia, the bed-sheet already mentioned being held in readiness to receive the intestinal mass as it will be exposed. Then the animal being completely under the influence of ether, and in the dorsal position, an assistant grasps the edges of the sac and stretches them apart, funnel-wise, using both hands alternately, gradually pushes the intestines towards the hernial opening, an assistant at the same time slowly unfolding the mass and permit- ting it to slide into the abdominal ca\dty. Rectal taxis may largely assist in this step of the operation. If the redviction is rendered impossible by the interposition of 418 OPERATIONS ON THE DIGESTIVE APPARATUS. obstructions, the first indication will be to evacuate the intestines by a methodical pressure which will displace the alimentary mass and return it toward the abdomen. The puncture made with the aspirator has proved very beneficial in these compHcations. The adhesions require the most careful dissection, especially when they are short, and when both the visceral and parietal layers of peritoneum are closely imited. The separation must be done by a succession of short, limited incisions, at the expense of the thickness of the parietal layer. A\Tien strangulation of chronic hernia occurs, it is due not to want of room at the hernial ring, but to the enlarged bulk of the protruding organ, which constitutes the obstruction. Conse- quently the indication for herniotomy is not present. On the contrary, as serious eventration is always to be feared, the only indication is the removal of the obstruction as akeady indicated. "SMien the reduction has been completed, the occlusion of the vaginal sac is to be obtained by the application of the clamp, ajDplied as high up as possible, as in cases of strangulated acute hernia. In cases of inguinal, complicated with ventral hernia, attempts at reduction may be made by placing a long clamp over the cov- erings of the latter, invohing with them the hernial sac and its cutaneous envelope, as practiced in some cases of the umbilical form. "We need but briefly to refer to certain different modes of treat- ment of the various forms of hernia by the use of bandages, rec- ommended by Petard, Grau, Klinger and Marlot, together with the application of sutures upon the edges of the inguinal canal, patronized by Hertwig and Dieterichs, to say that none of these, any more than some others, borrowed from human surgery, can give more satisfactory results, or be employed with greater safety, and effect a radical cure better than the use of the clamp and the castration by the process of the covered testicle. Inguinal Hernia in Geldings. Although inguinal hernia in the gelding is certainly less com- mon than in the staUion, it is not, therefore, of impossible occur- rence. But from the fact of its rare appearance it is far more likely to be overlooked, and therefore neglected, with similar fatal HERNIA. 419 results to those iu the stallion, when it reaches the stage of strangulation. From the fact that, as the result of castration, the superior opening of the testicular sheath is more or less closed, it becomes a matter of rational inference, that hernia in a gelding is not of posterior occurrence to castration, but that its existence is due to a congenital disposition, and that by the operation of gelding they have been reduced to their smallest proportions, in relation to the dimensions of the intra-vaginal sac, to the dimensions, in fact, of a bubonocele, which continues imobserved in consequence of the smallness of its size, and the depth of its location. These hernias are detected outwardly by a physical symptom, to wit, the existence in the inguinal region, on either side of the penis, and above the cicatrix of castration, of a tumor about the size of an egg, soft, depressible, altogether painless, sometimes elastic and at times puffy. It varies much in size, diminishing with rest and quiet, and increasing with effort and active move- ment. It may, in fact, under the first condition, entirely disap- pear, to return as soon as the animal is put to work. In a word, it has the true character of being intermittent. Aside from these symptoms, rectal exploration fui-nishes positive data of its exist- ence, by the abnormal dilatation of the ring, easily detected, and by the pressure of the intestines lodged in it. This hernia is also susceptible of strangulation, and is then ac- companied by violent abdominal pains, which must not be ignored as to then- possible diagnosis and significance. The indication for careful examination in that direction must, indeed, never be overlooked in cases of violent coUcs in geldings. If these colics are due to strangulated hernias, the presence of a round, tense, resistant and painful tumor will be detected in either of the in- guinal regions, and, according to Bouley, more commonly on the left than on the right side. The strangulation in this class of hernia is generally ii-reducible, and becomes rapidly fatal ; if not reheved immediately, it is not reheved at all. The first indication of treatment is the reduction of the hernia by simple, external taxis, or by combining with it the rectal taxis. The reduction will be followed by the disappearance of all the symptoms, and the animal will be apparently well, until a second attack takes place. After the reduction, steps must be taken to prevent its return, by an operation similar to one of those used in 420 OPERATIONS ON THE DIGESTIVE APPARATUS. umbilical hernia, to obtain the reduction and retention of the in- testine, by the appUcation of a proper clamp upon the sac cov- ered by the scrotal skin. The treatment of the gelding for strangulated hernia does not differ from that of the stallion. Ordinarily, the taxis is sufficient to reduce such complicated hernia, but in case of failure in obtain- ing rapid success one must be careful not to carry on the manipu- lations so long as to encounter the risk of lacerating or tearing the tissues. The wiser and safer plan will then be to have recourse to the operation of herniotomy, an operation which should be performed with the greatest care in separating and dividing the existing cicatricial adhesions of castration. The clamp is after- wards placed ui^on the hernial sac, with its cutaneous covering, requiring a longer time to slough, and constituting a means of retention most favorable to the success of the oj)eration. Ckukal Hernia, or merocele, is that form of rupture in which the abdominal organs make their escape through the crural ring. It is a rare affection among our domestic animals, but has been seen by La- fosse, Jr., in the horse, by Girard, Jr., in the dog, by Dandrieu in cows, and by Hertwig in horses, donkeys and dogs. It is said to be more frequent in males than females. It results from violent muscular efforts, and especially from the slipping apart of the legs when already separated or straddling in abduction. It is char- acterized by a somewhat well defined tumor, of moderate size, situated behind the inguinal ring, towards the middle of the flat part of the thigh. When the rupture is recent, the animal is some- what stiff in his gait, especially on the affected side, and carries his leg in abduction. There is also a degree of lameness. Accord- ing to Hertwig, the tumor is easily reduced, and not very painful. In a few cases it may be complicated with strang-ulation. The organs which have been found in the sac have been portions of the small intestines ; the omentum, a*s reported by Hertwig, and the bladder, in one cow, according to Dandrieu. The progiiosis in cases which receive early attention, is not serious. The treatment consists in reducing the rupture, and afterwards closing the passage through which it occurred. This is effected by making an incision through the skin over the tumor, and closing HERNIA. 421 the ring with a few stitches upon Poupart's Hgament and the small adductor of the leg. A good bhster rubbed over the enlargement completes the treatment. According to Zundel, three weeks of subsequent rest are required to assure recovery. Pekineal Heknia. This is a very rare lesion and, as Zundel describes it, is the pas- sage of the peritoneum and viscera through the vascuio-aponeur- otic floor of the bottom of the pelvis. It is, however, reported to be common in dogs, in which animal it is situated between the ischium, the sacrum, the anus and the urethra, and is often mistaken for an abscess. It is more frequently formed by the bladder than by the intestines. Pancreatic Hernia. This hernia was first observed by Prinz, and afterwards noticed by Husson, Koell, and others. It is caused by the strangulation of the jejunum and the anterior part of the ileum through the hiatus of Winslow, the orifice above the right angle of the pan- creas, and of the vena cava, in front of the right kidney. It is accompanied by symptoms of intestinal congestion, and cannot be reached by any form of treatment, if indeed it can be accurately diagnosed during life. Pelvic, or Internal. Hernia of Oxen. This form of hernia is pi'incipally described by Zundel, from whom we extract the following : " It is the strangulation of a loop of intestines, which has pushed through the ruptured peritoneum, from before backward, between the testicular cord and the lateral wall of the pelvis, the rupture of the peritoneum having resolved during some of the manipulations of castration from excessive stretching of the cord, as in the operation by tearing. It is, there- fore, exclusively a lesion of the ox, and cannot affect the bull. It is quite common in Germany, and has been met with in England, Mecklenburg and Alsace. It was first described by Oesterten, in 1811, followed by Anker in 1824, and later by Zundel, Ostertag and Tues. It is comparatively often seen, and in many cases over- looked. The first intimation of the presence of the disease appears in the onset of symptoms of a violent attack of colic. The animal becomes anxious and restless, Hes down hastily and rises again 422 OPERATIONS ON THE DIGESTIVE APPARATUS. suddenly; turns about, moves to and fro, lashes with, his tail, and, in a word, betrays all the usual signs of intense suffering, and it becomes difficult, if not dangerous, to approach him in order to make a proper examination. The temperature of the body is ele- vated, there is some perspiration, the nose is hot, though still moist ; both respiration and circulation are accelerated. The ani- mal refuses food or drink, rumination is suspended, and though defecation has not ceased, the faeces are hard, blackish and coated. In from six to twelve hours, this state of febrile excitement subsides, and the animal becomes dull and quiet, gazing towards its flanks, the ears dropping, the hind leg corresponding to the side of the hernia is extended backward, and at the same time the lumbar region is relaxed downward. If the animal is lying down he may remain quiet for a while, with his hind leg still extended, but will presently spring to his feet with his back arched as before, at the lumbar region, but which drops again and straightens im- mediately. When he walks it is with a stiff action, principally towards the diseased side ; the extremities are cool, the pulse is small and insensible, respiration is accelerated ; constipation at length becomes complete with mucous and bloody passages, per- haps accompanied with flatulence, but micturition is still easy. Two or three days later there are other changes. The period of calm terminates, and is succeeded by a season of alternating agitation and repose — action and reaction of the fluctuating in- flammatory process. The animal now and then utters grunts of pain, his pulse be- comes smaller, and is at length imperceptible, and all the un- favorable manifestations are exaggerated. Either gangrene has supervened, or, as some would judge, enteritis, and all the symjv toms point towards the more fatal termination. It is only by rectal examination that the diagnosis can be- posi- tively established, and when this has been carefully and success- fully made, he will have discovered what may be thus described : a puffy mass, indefinite as to size, situated usually nearer the sacrum than the pubis, on the side of which, generally the right, a portion of the intestines has sHpped under the testicvdar cord — this being the definition of a crural hernia. It may be a simple protrusion of the intestine, and again, this maybe twisted around the spermatic cord, a condition particularly likely to terminate in strangulation. HERNIA. 423 This lesion may continue as long as nine days, four to five being the average duration, and it may terminate by spontaneous reduction, but the trustful surgeon who too confidently and too often expects to find that Nature has dispensed with his aid in this kindly way, is doomed to encounter many disappointments. Or it may end in gangrene or enteritis. The fact that the disease, if not interfered with, may terminate fatally in so brief a period as five days, of course renders the prognosis quite a serious one, unless the nature of the ailment has had an early identification and measures have been taken to avert the danger. The gravity of the prospect is, of course, in- creased when the complication with strangulation or enteritis, as before mentioned, enters into the case. The treatment, as in other cases, consists in the reduction of the hernia. With a small proportion of patients this may be effected by the simple act of causing the animal to walk down a steep decHvity — a sort of spontaneous, or semi-spontaneous cure, from which, although founded on anatomical principles, too much must not be confidently expected. We copy from Zundel his de- scription of other and more scientific methods : («) Reduction by Simple Taxis. — The animal is placed on an incHned plane, with his hind-quarters raised, and an assistant on one side of him ready, at a given moment, to press on the loins. The operator, with his hand in the rectum, searches for the in- testinal loop, and when he has found it, holding it in the bottom of his hand, he feels for the opening under the spermatic cord, which he dilates with his fingers, and now, while the assistant presses hard on the loins, as just mentioned, the intestine may be readily felt moving downward and forward under the cord, to resume its normal position. -Although simple, and, in the ma- jority of cases, successful, this mode has the defect of leaving the animal exposed to a return of the hernia. {h) Reduction by Laceration of the Cord through the Rectmyi. — This method is recommended by Metzger, Eisele, Schenck, Gierer and Ostertag. It consists in tearing away the adhesions formed by the stump of the cord after castration, and loosening it from the inguinal ring. It is, however, difficult to do, and not without danger. The hand being introduced into the rectum, and the opening found, the fingers are closed in the form of a wedge, and with a sHght movement of rotation pushed through 424 OPERATIONS ON THE DIGESTIVE APPAEATUS. the opening, and tlie cord thus separated from its adhesions. After a "while, the pressure, which was quite firm at first, dimin- ishes, and the intestine gradually returns to its position. This mode is slow in its steps, but it is successful in its results, even in cases of obstruction and of strangulation. ^Tien it faOs, it is because of the strength of the adhesions between the cord and the abdominal walls, or the inguinal canal. (c) Division of the Stricture through the Rectum. — To per- form this operation, invented by Schmidt, a trocar about sixty- five centimeters (some thirty-five inches) long is necessary. This trocar has its j)oint attached with a screw, in order to permit its removal and the substitution of a blunt bistoury. "With the left hand in the rectum, a fold of that intestine is secured a little be- hind the point of stricture, and the trocar pushed through it. The stylet of the instrument being then withdrawn, leading the canula in place, the jDoint of the trocar for the bistoury is then inserted, while the hand, still in the rectum, leaves the rectal fold loose, feels for the spermatic cord, raises it and guides the bis- toury against it, which with comparative ease completes the di- vision of the stricture. {d) Division of the Stricture after Incision of the Flank. — Through an incision made in the middle of the right flank, the hand is introduced and grasps the spermatic cord, which is then divided with a bistomy cache, oi', which is better, with the inside edge of a hook kejjt sharp, similar to the hook used in some cases —Sharp Hook for the Section of the Testicular Cord. of distokia. The hernia being reduced, and the wound in the flank brought together with sutures, a circular bandage is apphed around the abdomen. "With the reduction of the hernia, what- ever may have been the means of accomplishing it, the symptoms subside, and the treatment is completed by the administration of laxatives or sedatives, rectal injections, etc., as the indications may require. 425 Umbilical Heenia. Umbilical hernia is the protrusion through the non-obliter- ated umbilical ring of either the omentum or the small intestine, or both. It is also known as an exomphalus or omplialocele. It receives the name of enteromphalus or epijjloin^yhalus when formed by the displacement of the intestines, or that of the omentum separately, and when both of those organs are implicated it be- comes an entero-epip>lomphalus. UmbiUcal hernia is quite com- mon in horses and dogs, not less so in bovines, and has been no- ticed in swine and sheep. It is most common in young animals, especially soon after birth, is at times congenital, and may be long continued, even to adult age, or for eight, ten or twelve years. Umbilical hernias are either congenital or accidental. The former are formed during foetal life and continue at birth, al- though, according to some authors, they are, strictly, not so much congenital as accidental, and are, in fact, the result of the pulling and stretching of the umbilical cord during the act of de- livery. However this may be, they do usually, in fact, make their appearance during the second and third months following birth, when through the persistency of the oj^ening, and the imperfec- tion of the umbilical cicatrix, the intestines are enabled to pro- trade through the ring, and subsequently to firevent its closing by their presence. But again, while the cicatrix is weak, the ac- tive exercise and forcible movements of the young animal while at play may cause the rupture ; and still, again, the protrusion may be caused by intestinal derangements. Indeed, all traumatic causes, such as contusions, blows, and any violent efforts taking place during the period of consolidation of the closing cicatricial tissue, may become an originating cause of this lesion. Animals of low and lymphatic constitution are much predisposed to this trouble, especially such as feeble colts, born of mares badly cared for and insufficiently fed during gestation. Heredity fills a large place among the predisposing causes in low-conditioned mares with feeble organizations, and suffering with similar trouble when young, dams of this class naturally bringing forth foals of defective stam- ina, liable to perpetuate the same constitutional tendencies. The symptoms of umbilical hernia are generally exclusively local. It is characterized by a semi-globular or pyriform tumor situated on the median line of the abdomen at the umbihcal ring, 426 OPEEATIONS ON THE DIGESTIVE APPARATUS. and varyiBg in dimensions from the size of a lien's egg to that of a child's head — dimensions which may vary according to the con- dition of vacuity or fullness of the intestine ; the position of the animal, whether standing or l}ang, or according to the length of time it may have existed. The consistency of the tumor is very variable. It may be soft, easily depressed by the finger ; elastic, when distended with gases ; or soft and puify when containing alimentary matter — these changes being accounted for by the na- ture of the organ. An enteromphalus will give the sensation of an elastic mass, while the epij^lomphalus will form a puffy swell- ing. This species of hernia is almost always painless, and exhib- its as one of its pecuHar and constant symptoms the character of being reducible. In the generality of cases, it can be made to disappear temporarily by the taxis and by forcing the protruding portion back into the abdomen, but only to reappear at once as soon as the pressure is withdrawn, especially if the animal is on his feet. On being thus reduced, the opening of the ring can readily be detected, and the fingers may be freely introduced through its diameter and its form and dimensions ascertained shewing it to be sometimes elliptic, sometimes circular, and some- times irregular, the originating cause of the hernia itself deter- mining the difference. Besides these more common symptoms of umbilical hernia, there are others which can be detected by more careful examina- tion. For instance, on appljdng the hand over the tumor, the ver- micular motions of the intestines may be recognized, and by feel- ing in the hernial sac, the presence of faecal masses may be discov- ered ; and it may be possible by auscultation even to detect the presence of borborygmus through the displaced intestines, and even to observe its true nature, by reason of the transparency of the sac and its envelopes. These are the most ordinary symp- toms of an exomphalus, although it is subject to complications, and the symptomology will vary accordingly. There are cases, but they are rare, in which the hernia be- comes irreducible. The most serious of these are such as are found to have become so in consequence of the formation of ad- hesions between the protruding organ and the hernial sac — a very infrequent occurrence. The most common cause will be the pres- ence of undigested masses of food accumulated in the intestines, such as hard balls of faeces or sand. HERNIA. 427 Inflammation of umbilical hernia may follow blows or bruises, though such a result from these accidents is not a common one, and its occurrence will naturally be accompanied with changes in the appearance of the tumor, such as the usual phenomena attending inflammatory action, as increase of temperature, ten- derness or pain, cedema, etc., which may even at times so com- bine their effects as to render the hernia irreducible. Engorge- ments and strangulations, however, are very rare comphcations of this form of hernia, a fact easily understood when it is con- sidered that the neck of the hernial sac is formed by the umbihcal ring itself. An exomphalus is usually an affection of httle gravity, and often disappears spontaneously, or if it persists after the period of weaning, is easily radically cured when the animal grows and develops. Yet even if undisturbed and unchanged, they persist in remaining, their existence is not incompatible with j)erfect health and full ability to labor, however they may reduce the com- mercial value of the animal. They are less injurious to young animals than to adults, and less dangerous when small than when assuming large dimensions. When simple, they are easily amen- able to treatment, but if compHcated they become dangerous, es- pecially so when the capacity of the ring is so disproportioned to the dimensions of the protruding intestines that strangiilation be- comes an accident of easy occurrence. Reducible hernia is at- tended with but little hazard, while the danger arising from the possible formation of adhesions in cases which have passed into the irreducible class becomes a matter of very serious import. If it is an admitted fact that animals suffering with umbilical hernia do often recover spontaneously, the recovery being a normal incident of the natural development of the animal, due to changes of position in the abdominal contents, not to specify other effi- cient causes ; then the question of immediate or early interfer- ence undoubtedly receives and justifies a negative answer. Our own testimony is that we know of cases where patient waiting, even for a period of twelve months, has been rewarded by the radical disappearance of the hernia. But the objections to such long waiting are of a tangible and serious nature, and surgical interference becomes imperative and indispensable. The persons are few who are able or willing to nurse an idle horse for a year for the sake of saving him from the pain of an operation. 428 OPERATIONS ON THE DIGESTIVE APPARATUS. The object of all treatment is, of course, the reduction and re- tention of the hernia, but the means of doing so are various. They are mainly included under four heads. The first method is by bandages / the second, by external or topical applications / the third, by surgical operations for the co7istriction of the tumor; and the fourth, such special treatment as may be required to meet complications. 1st. Bandages. — The bandage of retention is essentially a belt buckled around the body, by w^hich a pad is kept over the oj)en- ing of the umbilicus to prevent the escape of the abdominal con- tents, and temporarily perform their office in the subcutaneous hernial sac. It is designed to aid in the mechanical closing of the umbilical opening until that takes place by the process of physio- logical change in the sac and its borders. The forms of bandage in use are many and various, among which Peuch and Toussaint name four princij^al kinds. A most import- ant requisite in all of them is that while they possess the sohdity and fixity necessary to retain the reduced hernia in j)lace, they shall cause the minimum amount of discomfort to the patient. The bandage of Marlot, according to Zundel, is the one which best fulfills the three conditions of solidity, fixity and elasticity. It consists of a kind of padded saddle, with straj)s at its four corners, buckling on two belts, the anterior or p>ectoral, which sur- rounds the chest like a girth, and the posterior or ventral, which presses the retaining pad against the umbilicy. This pad is a wide hair cushion of a moderate thickness, kejDt in place and pre- vented from slipping back by a longitudinal girth connecting the pectoral and the ventral belts. The bandage of Massicra is much recommended in Italy. This also is a small saddle with two wide girths passing under the thorax, and pressing against the sternum and the ei^igastric re- gion, with a steel band corresponding at its posterior extremity with the umbilical ring, forming a plate padded with a hair cushion. The apparatus of Strauss, used in Germany, is made somewhat on the same principle, but is reinforced by a kind of breeches which prevents it from slipping backward. The length of time necessary for a patient to wear a bandage will vary with the dimensions of the hernia — from one to three months, according to Lafosse, being required to obtain a radical cm-e. Marlot claims that an average of thirty-two days is all that HEENIA. 429 is necessary. The bandages must be applied only after the perfect reduction of the hernia, and the most accurate adaptation of the pad to the umbilical opening. These appliances are of difficult adjustment and are unavoidably uncomfortable to the animal from their liability to chafe and excoriate the skin. They, therefore, constitute a mode of treatment which must necessarily be attended with uncertainty, and, therefore, as justifying only a careful and modified recommendation. Still, it has in the hands of many prac- titioners given very satisfactory results. 2d. Local Applications. — The treatment by irritating local med- ication aims to produce in the tissues surrounding the hernial sac an inflammation which will end in a serous infiltration which will crowd away the protruding organ, prevent its return into the open- ing, and subsequently facilitate the obHteration of both the sac and the ring. This result is obtained by the use of certain chem- ical agents, which applied on the hernial tumor tend to produce various degrees of inflammation, from simple rubefaction to com- plete escharification of tissues. In former times sulphuric acid was recommended, and as late as 1833, Hertwig employed it in appli- cations made dviring two or three days. Blisters and their con- geners have had their day. Astringents have also been recom- mended, as also caustics, principally in the form of oratments, as that of chromate of potash, in the proportion of one part in eight, as recommended by Foelen — these also have had their advocates. But of all these, nitric acid, applied externally, is the one which has proved most satisfactory and least dangerous. The treatment consists ia applying acid upon the tumor of the exomphalus, in sufficient quantity to produce an escharotic effect, and afterwards promote the sloughing of the cutaneous sac. The mode is thus described : After positive diagnosis of the nature and character of the tumor, the animal being kept in the standing posture, the hairs cut short, the acid is applied over the entire sur- face of the sac, by rubbing it in with a brush, or a small ball of oakum secured at the end of a stick, and dipped into the acid — which should register 34" to 36° Baume — first passing it circularly over the base of the examphalus to define the place where its action is required, and then including the entii'e surface. A sufficient quantity of the caustic must be applied, and with enough energy to produce the disorganization of the skin in its entire thickness, and positively produce its mortification. Experience has proved 430 OPEEATIONS ON THE DIGESTIVE APPARATUS. that the deeper the action of the caustic, the more successful the operation is Hkely to be. It is said that nearly one ounce of the acid is required for a tumor as large as a man's fist, and that the friction should be continued from three to five minutes. The duration of the friction and the quantity of the acid to be used must, however, be guaged by the dimensions of the tumor, and also with careful consideration of the thickness of the skin. Dayot, to whom is due the positive and i^ractical introduction of this mode of treatment, proposes to apply the acid in instalments, and recom- mends that the apphcation be repeated once or twice an hour, according to the thickness of the skin, .until the desired effect is assured. The result of our own experience is a conviction that as a rule only a single apphcation is necessary. Nitric cauterization produces a yellow eschar, which ordinarily remains for a long time, soft, supple, and unctuous to the touch, but the epidermis of which is easily lacerated. In some cases the formation of the eschar is followed by a large swelling of the cauterized parts and the sur- rounding tissues. Sometimes it makes its appearance immediately following the operation, but more commonly it appears at a later period, gradually increasing during the first hours following the cautery, although again, in other cases, this swelling is altogether absent. The oedema is the direct effect of the action of the caustic upon the subcutaneous cellular tissue, which becomes infiltrated ; and in this condition apphes a uniform pressure in all directions upon the peritoneal hernial sac, crowding back into the abdominal cavity the displaced intestines and preventing their return by the kind of retentive bandage which is formed by the engorgement which takes place around the sac. In the days following, after reaching the maximum develojD- ment, the oedema gradually diminishes by resorption, becoming at the same time somewhat harder, the portions of cauterized skin which is in its center meanwhile gradually drying, and becoming transformed into a dry, hard plate. In place of the hernia there now remains a fibrous mass of new formation, which gradually diminishes and is soon more or less resorbed. In the meantime, while these phenomena are taking place, the process of the separation of the eschar has begun and progressed, and on the eighth day, on the boundary between the dead and the living structures, a fissui'e shows itself, and minute granulations appear. The sej)aration goes on slowly, from the HEKNIA. 431 circumference to the center, leaving, when complete, a rose surface, granulating evenlj^, small fibrous formations sometimes appearing in its center. This wound heals rapidly, leaving a contracted cicatrix, which assists in keeping the hernia in its place, while the indurated skin, which for some time remains adherent to the stni fibrous, abdominal, subcutaneous tissue, contributes to the com- plete obhteration of the ring. After a month the cure is radical, and in place of the hernia, there remains only a hairless cicatrix, often without pigment. Though this treatment is simple, and has, by the results it has shown, justified the credit it enjoys among those who have had experience and knowledge of its working, it must not be at once accepted as infaUible, or unattended with danger. Cases are on record which negative such a claim. For instance, too sevei^e a cauterization may be followed by the entire sloughing of some portion of the abdominal walls, followed by a large eventration ; and peritonitis, tetanus and intestinal fistulse are comphcations which have sometimes disappointed hopes which seemed to be well founded. Animals to which this treatment has been applied must be carefully watched for some time during the period following the cauterization. They must be especially prevented from indulging the tendency they often betray — to bite, or scratch with their feet or legs, the irritated, cauterized siirface. A cradle or aprons hanging in front of their hind legs, or even bandages may prove effectual to prevent this suicidal habit. The topical remedies we have mentioned before, might in strictness be considered as coming under the head of external treatment, since they have all been applied to the surface of the skin. There is, howevor another mode of application which is subcutaneous, and which is represented by the method of Dr. Luton, and employed in the treatment of the same ailment in children. It consists in injecting subcutaneously, at each cardinal points of the hernial sac, a few di'ops of a saturated solution of chlorides of sodium (kitchen salt). We have had but one oppor- tunity to try the value of this treatment, which we improved by injecting ten drops of this solution at each point of a hernial tumor. We produced an enormous swelling, followed after several weeks by resorption and complete disappearance of the hernia. According to Peuch and Toussaint, our friend M. Cagny has 432 OPERATIONS ON THE DIGESTIVE APPARATUS. made the same experiment, but failed to obtain a successful result. 3d. Surgical Operations for the Constriction of the Tumor. — Modes of surgical treatment are numerous, usually having in view the destruction of the hernial sac, by the process of mortification, so controlled and directed as to bring about the necessary work of adhesion between the walls of the sac, above the line where the mortification begins, with the formation of a secondary cicatriza- tion between the edges of the skin, where the mortified sac has dropped off. Before casting the animal, without which the operation cannot be performed, the surgeon must satisfy himself that the hernia is reducible, and that there is no adhesion, and should carefully measure the dimensions of the sac in order to know accurately where the constriction must be applied. The animal must be placed weU on his back, with his hind quarters elevated — a posi- tion which is sometimes sufficient alone to enable the hernia to reduce itself. If that fails to occm-, the sac can be evacuated by the taxis. It is then to be well stretched, and the application of the means of constriction proceeded with. These means are many, but may be considered under the three heads of the ligature, the clamp and the suture — all of which are occasionally combined in use, as the ligature with the suture, or the suture with the clamp. («) The Ligature. — This old mode of operation consists in the appHcation — the hernia having been reduced — of a strong cord, firmly tied at the base of the hernial pouch. The modus operandi is very simple. The hernia being already reduced, either by the taxis or by the power of gravitation, as before mentioned, and the horse in the right position, on his back, the sac is raised from the abdomen, and a strong Hgature, firmly tightened, is appHed at its base, a strong fishing line forming the best of ligature for this purpose. The degree of tightness of the ligature must be such that the mortification of the sac will be a gradual process, and that it does not slip from the waUs of the sac, on account of the progress of the inflammatory swelling. Still this constriction must not be permitted to become so ex- treme as to produce too rapid a sloughing of the skin, with the possible result of a calamitous eventration. In order to prevent the displacement of the ligature, some HERNIA. ^'^3 practitioners recommend the introduction of two small wooden pins just under it, either parallel or crossing each other, through the base of the sac. If the hernia is very large, instead of employing tliis mode of simple Hgature, en masse, the operator may use two ligatures. By pushing through the middle of the sac, close to the abdomen, a dog seton-needle, carrying a doubled cord, and converting it into two parts in cutting it from the needle, each length will serve to embrace half of the tumor, in the manner practiced in the pro- cess of removing large, hard tumors by ligature. Legoff has rec- ommended the use of several ligatures dipped into ammonia, placed one above the other upon the whole length of the sac, from its bottom to its base, tightening them more and more as they ap- proach the abdomen. By this process he combined constriction with cauterization. This mode of treating umbilical hernia is a simple and easy one, but yet it is not very frequently practiced. The uncertainty of its results, the possibility of the sloughing of the skin at too early a period, with the danger of eventration, as well as that of injuring the intestines with the wooden pins or the needle, have all combined to impair its credit and discourage its use among care- ful operators. (b) Clamp. — In this process, which dispenses with the caustic, after the reduction of the hernia, the skin is stretched and pressed between the branches of a wooden clamp or of a specially adapted forceps. The clamp is a simj)le imj)lement, and may be made with a curve, in which case its convexity is made to adapt itself to that of the abdomen. When ax)phed, it is pressed close to the abdom- inal walls, and its branches brought together with nippers adhoc, and secured with a strong cord, as in the process of castration. The clamp is left on from nine to fifteen days. In many cases, the displacement of the instrument is prevented by using the wooden or metaUic pins passed through the skin below it, the ends of the latter being bent over to keep them in place. This operation possesses some great advantages, but ofi^ers also some special dangers, among which is the instinctive tendency of the patient to get rid of the irritating appliance by tearing it ofif. Another objection to the clamp is found in the danger of caus- ing troublesome excoriations of the sheath by the friction which it necessarily occasions. Benkert and Brogniez have advocated 434 OPEKATIONS ON THE DIGESTIVE APPARATUS. the use of metallic clamps, but an important objection is found in their weight. Borhauer had the branches of the wooden clamp perforated in several places for the introduction of the pins which held it in place. Bordonnat has invented a special form of me- tallic clamp or rather forceps, with sharp points on the inner bor- PiG. 391.— Clamp of Bordonnat. der of one of its branches about one-half or three-quarters of an inch ajjart, and in the other a corresj^onding number of holes into which the points are designed to fit when the instrument is closed. Each branch has a prolongation at each end, which on one carries a vertical projection cut with a screw-thread, while in the other there are holes corresponding with the projections, and there are nuts to fit the screws. "When the instrument is appHed, and the projections passed through the holes, the nuts not only hold it in place, but are adapted to fix the pressure at any desired point, or change it at pleasure. The umbilical forcej)s of Marlot is made of two small wooden plates, slightly curved lengthwise, and brought together by means of gooves in their dove-tailed extremi- ties, through which screws are fastened. This instrviment, like the metallic clamps, is objectionable principally on account of its weight, and is generally less practical than the ordinary clamp. (c) Sutures. — These are of various kinds, all agreeing, how- ever, that the stitches upon which they rely shall be so close and tight that the circulation will be so efi'ectually cut off in every part of the hernial sac that mortification cannot fail to follow. The Quilled Suture. — This consists in placing the sac between two small rods of hard wood or metal, and tying them before and behind with strong cord twisted and rolled around their extremi- ties, and also by passing here and there in their length sutures of double the strength of those which are appHed in cases of ordi- nary quilled suture. Acting somewhat by pressure, this mode much resembles the treatment by the clamp, but is httle used at present, notwithstanding some small advantages which it may be thought to possess. HEENIA. 435 Twisted ^Sutures. — This consists in applying upon the hernial sac several stitches of strong cord in order to keep the reduced hernia in statu quo. It is sometimes used in dogs, but is uncer- tain and dangerous. Suture of Delavigne. — This is another dangerous mode of operation, no longer in practice because of the hazard of injury to the intestines. It consists in ai^plying a strong double suture at the base of the sac in the following manner : With a small needle, like that used by harness makers in sewing leather, a thread is I^assed through and through on both sides of the flat, cutaneous surface from right to left, or vice versa, then carried back the re- verse way at a small distance from the first puncture, and the sutures firmly tied. This is repeated until the entire sac is in- cluded and the sutures have gone beyond the umbilicus. From fifteen to twenty days are said to be sufficient to effect a radical cure. Method of Mangot. — To make a closing suture on the hernial sac, without danger to the intestine, Mangot has recommended the use of a perforated plate of lead, by which to aid in the reten- tion of the intestines in place and accurately define the line ujJon which the sutures are to be applied. The plate is made to cor- respond in dimensions with the opening of the umbilical ring, but somewhat longer and wider. Besides the longitudinal slit in its center, it also has an eye at each corner for the attachment of strings to secure it in place by tying them over the back. The hernia being reduced, and the plate put in place by pushing the skin of the sac through its longitudinal opening, the operator ap- phes a continued suture over and on the outside of the plate to keep it in position, with the flap of sewed skin hanging below it, the entire apparatus being securely attached to the abdominal walls by two pins running through the sac at the extremities of the suture. During the first days there is much inflammation. About the third or fifth day the pins are removed and the skin below the su- ture excised, leaving the plate to be retained only by the strings which pass over the back. These are sufficient, however, to keep it in place, and its removal will not be necessary until inflamma- tion is well estabUshed all around them. A simple dressing, held in place by a bandage, will help the cicatrization, which is said to take place in from seven to eight days. 43G OPERATIONS ON THE DIGESTIVE APPARATUS. Method of Hannon. — The modus operandi here indicated does not vary from that of Mangot, except in being modified by the use of the quilled su- ture, as before described, instead of employing the transversal pins of Man- got. Method of Mignon. — This is a com- plex mode, consisting of a combination of the ligature, the clamp and the sutiu'e. Like Mangot, he passes the skin through a plate of lead, attaches perforated clamps on the fjrotruding sac below it, and pass- es the stitches or sutures through the jDerforations in the clamps. Method of Benard. — This is strictly speaking, the application of the crossed suture, a stitch exactly resembling that of harness and shoemakers in their re- spective trades. In making it, a pecuhar forceps is used, which is appHed like a clamp, and serves not only to keep the sac closed and secured, but also to pre- vent the return of the intestines into its cavity, and to assist in guiding the two needles with which the suture is made. Its branches are at one end articulated together, and also at the other in order to fit into handles. It is twenty-two cen- timeters in length, without including the handles ; two centimeters in height, and one and a half in thickness. The branch- es are brought together tightly by a spe- cial screw arrangement near the handles, and each has a number of holes, placed regularly, one centimeter apart, and uni- ted by a groove. Two sti-ong straight needles and strong waxed thread are re- quired. In operating, the hernia being first reduced, the skin is well stretched fig. 392.- 0 0 -Nippers of Benard. 437 between the branches of the forceps, then these are tightened by the screw management of the handles, and next the instrument is committed to the care of an assistant. The crossed suture is then made by the simultaneous passage of the needles through the holes in the branches of the instrument. The directions to insert the needles simultaneously must not be overlooked. If disregarded, the penalty liable to follow will be the tearing of the waxed thread with the points of the instrument, and also a tang- ling of the thread. This method gives a stronger ligature than Mangot's, but it lacks the support furnished by the metallic plate. Method of Marlot. — The methods of Benard and Mangot are here combined. A pecuHar thin forceps is used having dotted grooves on its outer surface to indicate where the stitches are to Fig. 393.— Plate and Nippers of Marlow. be placed. When the suture is finished and the forceps removed a plate of zinc like that of Mangot is appUed, as a means of reten- tion, the zinc plate being thought to be an improvement upon that of lead, on account of its ad^-pting itself better to the parts. Method of Chedhomme. — The animal in this method is kept on his feet, properly secured, and a plate of lead applied, as in the process of Mangot. The hernial sac, folded in two on its longitu- dinal axis is then passed through the opening of the plate, the operator making the least possible traction until the remaining por- tion of the umbihcal cord, which is still quite large, is firmly held between the thumb and the index finger of the right hand. Then a stronger traction is made upon the sac, at the same time moving it in various directions, while with the left hand the plate is strongly pressed towards the abdominal walls. Then with the intestines entirely replaced, the operator grasps the sac with the 438 OPERATIONS ON THE DIGESTIVE APPARATUS. left hand, and with the right, introduces a strong needle which is pushed through and through at each extremity of the sac, and an elastic hgature passed three or four times aroiind its base. Towards the tenth day the slough is completed, and only a small wound remains, which cicatrizes rapidly. Direct Suture of the umbilical ring. — Director Degive recom- mends for the treatment of umbilical hernia in young dogs, the direct interrupted sutures of the ring, the number of stitches varying with its dimensions. After bringing the threads together the wound is left open until they have safely eliminated themselves. We have employed this mode of operation for many years in the hospital of the American Veterinary College, using antiseptic pre- cautions, and with the best results. Making a longitudinal line on the median Hne of the sac, and having carefully pushed back the intestines, the edges of the ring are sewed together with two or three stitches of cat gut ligature. The parts were then thor- oughly washed with a solution of bichloride of mercury, and the edges of the skin brought together with silk sutures and a com- pressing bandage appHed for the protection of the wound from the patient's own teeth. Complete cicatrization follows in a few days. Whatever may be the original mode of treatment the secondary effects are about the same in each case. They consist of ii'ritation of the parts, more or less marked, and betrayed by the patients by varying degrees of restlessness, and possibly, in some cases, by abdominal pain or cohcs. After a few hours the swelling of the j)art begins. A diffused oedema takes place above the point of comj)ression, and the hernial sac is shghtly swollen and warm and becomes covered with little phlyctenoids, indicating a commencing necrosis. Perhaps a little fever is manifested and there is great thirst. By the third day the swelling is quite large, and in males it may involve the sheath. The sac then becomes cooler, the fever subsides, the appetite re- turns, and the animal which has instinctively kept his feet, rests himself by lying down. On the fourth or fifth day the skin of the sac is insensible, cold and flabby, and the sloughing process between the Hving and the dead skin has begun. Little by little this pro- cess becomes more active, and the separation becomes more and more marked, the secretion around its opening a purulent character, and from the sixth to the tenth day the complete sloughing will have taken place. The wound that remains is now granulating. HEKNIA. 439 Its lengtli exceeds its widtli, and it is somewhat depressed in its center It progresses rapidly towards cicatrization, only a small scar remaining, and this is readily concealed by the growth of the surrounding hair. {d) Operation in Cases of Complications. — If the hernia is irreducible and there is strangulation, the enlargement of the ring must be carefully made with a curved, blunt bistoury, having a short, guarded sharp edge. When the reduction is prevented by adhesions, the operation necessary for their division will demand the exercise of the utmost skill and caution to avoid injury of the peritoneum, and there should especially be no neglect or parsi- mony in respect to the employment of antiseptic precautions. In fact, it would in many instances be wiser to leave the animal to the resources of nature than to undertake an operation of so much dehcacy and importance, and which involves so many serious con- sequences, without amj)ly providing every resource of skill and knowledge, and anticipating every contingency of accident or dan- ger. In some cases, when the strangulation has been due to the formation of gases in the protruding intestine, we have used the aspirator for theii" removal, and then have met with no difficulty in reducing them by the taxis. This is a means, however, which is also recommended in the treatment of strangulated inguinal hernia, and is discussed in the chapter appropriated to operations in that region. Diaphragmatic Hernia. A diaphragmatic hernia, or diaphragmatocele, is formed by the displacement of one of the abdominal organs, and its intrusion into the pleural cavities, through a laceration of the diaphragm. It is necessarily an accidental opening, through which such a dis- placement takes place. One case is on record, and only one, where the hernia passed through a normal opening, viz., the oeso- phageal. The causes which give rise to ruptures of this kind may be classilied under three heads : first, external violence ; second, pow- erful contraction of the expiratory muscles while making a violent effort ; and third, the exertion of force and pressure upon the dia- phragm by the organs, situated on its posterior face. {a) External Violence. — Foremost in this category are blows or contusions on the posterior costal region, such as may be made 1 1 J V 438 ()I'KKATU)N.S ■ KSVK AI'PARATUS. left band, and with the right, introdu<3 a strong needle which is pushed through aud through at eac extremity of the sac, and an elastic hgature passed thi-ee or iar times around its base. Towards the tenth day the slough is >mpleted, and only a small wound remains, which cicatrizes rapid . Direct ^Hture of the lanhUical rin — Director Degive recom- mends for the treatment of umbilical lemia in young dogs, the direct iuteiTupted sutures of the rii , the number of stitches varying with its dimensions. ^Vfter br ging the threads together the wound is left open until they have k ely eliminated themselves. Wo have emi)loyod this mode of oper ion for many years in the hospital of the American Yeterinarj' Ctlege, using antiseptic pre- cautions, and with the best results. laking a longituilinal line on the metban hue of the sac, and havig carefully pushed back the intestines, the edges of the ring ai- sewed together with two or three stitches of cat gut hgature. be parts were then thor- oughly washed with a solution of bich ride of mercury, and the edges of the skin brought together wit silk sutures and a com- pressing bandage applied for the proteeon of the wound from the patient's onnti teeth. Complete cicatriziion follows in a few days. Wliatever may be the original mode ( treatment the secondari' effects are about the siuue in ejich case. They consist of irritation of the parts, more or less marked, aud b^rayed by the patients by vjuying degrees of restlessness, and i^sibly, in some cases, by abdomiujil pain or cohcs. After a few hom-s the swelling of thtpart begins. A diffused oedema tixkes place above the point of coipression, and the hernial sac is slightly swollen and warm and btomes covered ^^-ith littlr phlyctenoids, indicating a commencing xerosis. P( fever is mimifested and there is great tirst. Bi the sweUiug is quite hu'ge, and in males may The sac then becomes cooler, the fever ibsic\ tiu-ns, jmd the animal which has instindveli himself by lying down. On the fom-th ofi| sac is insensible, cold and flabby, juid the i the Hviug jiud the dead skin lias begun, cess becomes more active, and the sepi more marked, the secretion ai'ound its ( ixnd from the sixth to the tenth day have taken place. The wound tha*^^ ' I ^1 4 4 •t ^^rr-^Wr/V-v yj-A A ^'n < m -t^ Its lengtli exceeds its wid , and it is some-wiiat. center It progresses rapi y towards dcat scar remaining, and tliis is 3adily concealed by tie ; surrounding hair. (d) Operation hi Case.- of Complication's. — If me «■»- irreducible and there is sb agulation, theenlargoMBKC^rrr: must be carefully made w h a ciuTed, blunt iBaaarv.„MBL. short, guarded shai-p edge When the redudimi i- tjtmhml adhesions, the operation icessary for their diriaiai. •wikmam^ the exercise of the utmost kill and caution to peritoneum, and there shild especially be no mony in respect to the emlojonent of antiseptic- fact, it would in many iutinces be \viser to leave the resom'ces of natui-e thi to imdertake an dehcacy and importance, ud which involves so sequences, without ampl; pro\dding every r« knowledge, and anticiiDatig' every contLngtr ' ger. In some cases, whe:the strangulatioi. formation of gases in theproti-uding intent aspirator for their remove and then have in reducing them by the ixis. This is a i; is also recommended in le treatment of - hernia, and is discussed i the chapter appropruiu in that region. DiAI RAQMATIC HeRNIA . ] A diaphragmatic hem, orj displacement of into the - agmatoneU, . orgaij 1 440 OPERATIONS ON THE DIGESTIVE APPAEATUS. by the shafts of vehicles with either the blunt or broken ends. The laceration of the diaphragm may occur either with or without involving the fracture of the ribs. Several cases of this kind have been seen and recorded by Professor Barrier. (b) The Powerful Contractions of the Expiratory Muscles during Yiolent Muscular Efforts. — It may result from the vio- lent and concentrated action of the abdominal muscles, compress- ing powerfully the intestinal mass, and crowding it against the diaphi-agm, until it destroys its continuity at one or more points, sufficiently to admit of the passage of the abdominal organ into the thoracic cavity. Durand has seen it in a six-months-old colt ; Didry and Fabey have reported cases where the hernia took place during violent efforts in hauling a load, and Franconi met with a case of a similar character to the one referred to in which the rup- ture opened into the oesophagus. Schild has seen it associated with the efforts of parturition. (c) Yiolent Action and Pressure upon the Diaphragm by the Organs Situated on its Posterior Face. — The obliquity, forward and downward, of the inferior plane of the abdomen, is shared forward upon the posterior face of the diaphragm by the organs related to it, as the Hver, the stomach and the anterior cm^vatures of the large colon. These are bulky organs, and their united weight being very considerable, the pressure it exerts upon the diaphragm, under any extra impulse would tend directly and nat- urally to the disruption of the weaker muscular fibres of the midriff, and these yielding, the hernia would immediately become developed, and thus we have the generation of this kind of hernia. A sudden fall might easily bring this to pass, in a second or two of time. Bouley has recorded a case in which this accident oc- cured in an animal cast for a surgical operation. Pilton has seen it take place in an animal falling down while butting against a slope of ground. Diaphragmatic hernias, like others, are either acute or chronic ; or convertibly, recent and free, or of old standing, with adhesions. The distinctions of hepatocele, splenocele, stomachocele and entero- cele are of but Httle importance, none of these differences being discoverable in the living animal. The symptoms of acute hernia of the diaphragm differ, accord- ing to the extent of the laceration of the muscle, and the size of the displaced abdominal mass. There are cases in which the in- HERNIA. 443 able. It is always serious. Some kill immediately, while with others there may be a resj)ite of several hours or days, and with those which are chronic, there may be no apparent impairment of life or health. But whatever may be the character or the aspect of a given case, and however the prognosis may vary, it must never be forgotten that diajjhragmatic hernia has this invariable character, that its effect is always to interfere with the respiration ; that the horse is at the best permanently afifected with heaves, is unable to perform any active or laborious service where strong lungs are needed, and is always more or less Hable to engorgement and strangulation. Diaphragmatic hernias are incurable, their sit- uation, in the deepest interior of the anatomy, rendering it impos- sible to api^ly any means of direct therapeutic treatment. They cannot be reduced, and even if that were practicable, they could not be secured and retained ^V^ situ. Attempts have been recom- mended by Bouley to reduce them by making an incision through the flank and replacing the protruding organ in its projDer posi- tion by the taxis with the hand in the abdominal cavity. Whether in our days of perfect antiseptics such an operation could be suc- cessfully performed on the horse is a question not yet solved. The experiment might be attempted with better chances of success in cattle. In any case the operation will be justifiable only as a last resource, and when the life of the suffering animal is abso- lutely in jeopardy, in fact, as a final alternative, a dernier resort. Ventral Hernia. This term includes all hernial tumors produced by the pro- trusion of one or several of the abdominal organs through an ac- cidental opening in the muscular and fibrous walls of the abdomen, under the skin, which remains intact. The opening through which this kind of rupture takes place is always accidental, unlike those which pass through the natural channels, as the umbilical or in- guinal, but still, in common with them, has a peritoneal lining. Ventral hernias are of quite common occurrence, principally however, in large animals, while in small quadrupeds they occur less frequently, and they may take place in any part of the abdo- men. They are known by distinctive names, corresponding with those of the protruding organ, as gastrocele, hepatocele., enterocele and epiploocele, etc. They usually originate as direct causes in blows or contusion 444 OPERATIONS ON THE DIGESTIVE APPAKATUS. ^4= Fig. 394.— Vential Utrn a. upon the abdominal walls, made by blunt bodies, which, lacking force to pierce through the elastic skin, are jet sufficient to lace- rate the interior abdominal walls. An example of this occurs in a thrust from the shaft of a vehicle, or its broken end, in case of a faU, or of kicks or horning among cattle in the field. In colts they are more commonly found in the lower wall of the abdomen, the animal frequently inflicting them upon itself by attempting too high a jump over a picket fence, and failing to clear it properly. Serres says that in cattle they may follow a severe distension of the abdomen under the influence of tympanitis, abdominal dropsy, or gestation. The character of a case of ventral hernia wiU vary in respect to its being acute and recent, or chronic and old. Indeed, the lapse of but a few hours will materially change its character from one to the other. If seen immediately after the infliction of the HERNIA. 445 injury, it is in the form of a round, soft, elastic tumor, well- defined in its outlines, and easily reducible. But if not examined until after a season of delay, the definite configuration disappears, and it is changed into an inflammatory swelHng, oedematous, warm and painful to pressiire — in fact ha^dng the aspect of a warm ab- scess. In the recent cases, the edges of the torn abdominal walls may be identified through the thickness of the skin, but the sur- geon will vainly try to make out this condition if the inflamma- tory process following the lesion has become established, and the serosity and the blood have become sufficiently infiltrated into the cellular tissue to make the change described. After a few days, if the hernia is not situated too low in the abdomen, the swelling moves downward toward a more dependent spot, and gradually abating disappears in about two weeks. Upon reaching this point, the hernial tumor is once more recognized, constituting, as it does, the exclusive manifestation of the displacement of the in- testinal mass, and its presence outside of its natural cavity. It is recognized by its changing conditions — elastic when the intestine is empty ; soft and pufiy during digestion ; by its state of tension, increasing with effort, and by being painless, depressible and re- ducible. "When reduced, the edges of the opening are easily made out, but it is not uncommonly found, upon the subsidence of the inflammatory process, that, during the continuance of that state, adhesions of the protruding organ with the walls of the sac have formed, and the hernia has become irreducible. In their dimensions, ventral hernias vary considerably. They may measure from the size of a large nut to that of a man's head, or even exceed that. Zundel reports a case where the rumen had penetrated into the sac, which hung almost to the ground, and had produced a dis- placement of the mammse, crowding them in a mass toward the right side of the abdomen. Although the diagnosis of ventral hernia is not difficult, it is still not impossible to mistake a recent case for certain other affec- tions of the abdominal walls, such as tumors of bacterian anthrax, or those of a bloody nature, or with phlegmonous or oedematous growths. The reducibility and elasticity of the tumor, the bor- borygmus, and the presence of the opening through the abdomi- nal walls, are intelhgible signs by which to recognize the ventral hernia. Aspiration of the tumor may sometimes be performed, and rectal examination will also be of great assistance provided 446 OPERATIONS ON THE DIGESTIVE APPARATUS. the injury is not beyond the reach of exploration with the hand. Certain complications are not uncommon in ventral hernia. Besides irreducihUity already mentioned, excessive infiammation has sometimes been followed by traumatic peritonitis. Lacera- tions of the disj^laced organs have proved fatal. Internal hemor- rhages, fistulas and consecutive eventration have also been record- ed. Strangulation is not unknown, though it is comparatively rare. But with all these possibilities, it is not a rare circumstance to meet with animals affected with ventral hernia, even of large di- mensions, which have reached a good age with all the appearance of perfect health. From data like these upon which to found a judgment, it ought not to be difficult to deduce a prognosis which should never be far wrong. But, although compatible with the life, health and utilization of the animal, such a lesion must neces- sarily detract more or less from its commercial value. Under any circumstances, it is a blemish. The least dangerous of this class of ruptures are those which are situated on an elevated point of the abdomen. Recent and uncompHcated, they are amenable to treatment more or less, according to their extent ; if old or chronic, the chances of success are reduced ; if strangulated, they are generally fatal. Usually, a ventral hernia, to be curable, must be treated when it is recent, and before sufficient time has elapsed for the intestines to become, as it were, accommodated to their new position, and especially before the cicatrization of the borders of the lacerated openings has taken place. Eecent and free from compHcations, all that is required is their reduction and retention in their proper place. When reduced, whether by rectal taxis or by external pres- sure, the parts are covered with a mixture of pitch and Venice turpentine melted together, upon which is spread oakum cut in small, short threads, which is to be covered with a second appli- cation of the j)itch, after which a sheet of pasteboard, itself also impregnated with the pitch mixture, is placed over the oj^ening. The whole is then covered and held in place by a broad bandage carefully roUed around the abdomen. Leather is sometimes used in Heu of the pasteboard. This bandage, when applied uj^on male bovines, requires to be carefully adapted in order to avoid any possible interference with the penis, and its freedom of motion in the act of micturition. The complications of swelling or bloody HEENIA. 447 extravasations must not prevent the immediate application of the bandage. in cases of chronic hernia, compression is no longer sufficient. Jannet recommends the use of clamps as in umbihcal hernia, and reports having reheved a case vrhere the tumor was as large as a child's head. Leblanc advises the quilled suture, and Schwane- feld cm-ed by this mode a hernia twice as large as the head of a man. Hertwig speaks favorably of the application of Delavigne's method in exomphalus. Going, Lafosse and Hertwig have ob- tained success with nitric acid injections, and Krantz and Schutt with blisters. Peyon, Dandrieu, Terrien and Obich have had good results with the direct suture of the ventral walls in bovines, and even sohpeds. Bouley objects to the suture of the edges of the opening, and also to injections into the evacuated sac of irri- tating substances, to excite inflammation and produce the adhe- sion of its walls. We have ourselves experimented several times with the subcutaneous injections, but every attempt has resulted in failure. According to Peuch & Toussaint, if old ventral her- nias are to be treated, the best plan is to have recourse to bandag- ing, as employed in the treatment of exomphalus. EVENTEATIONS. An eventration may be deflned as a compound hernia, and it constitutes an accident of the first degree of severity, consisting in the formation of a hernia, of indefinite dimensions, taking place through an opening involving the entire thickness of the abdomi- nal walls, the skin included, in such a manner that some portion of the abdominal ^iscera, but most commonly the intestines or the omentum, become directly exposed. Ordinarily they are due to some traumatic lesion, such as a thrust from or a fall upon a sharp body, or they may be produced by stab wounds, or punctures with a fork or a knife ; or again, by kicks inflicted by other animals, or horn-blows, when cattle are crowded into too contracted a space and struggle for more room, or quarrel when herded in pastures. And they quite commonly end the career of the wretched victims of barbarity which are compelled to assist in the bloody and cruel sport of the Spanish buU fight. They are also observed at times following severe surgical manipulations, as in castration, during the operation for strangulated inguinal hernia, after the efforts of 448 OPEKATIONS ON THE DIGESTIVE APPARATUS. distokia. They may also form one of the complications of some of the forms of the treatment of umbilical hernia. In the smaller animals, such as dogs, they may be produced by a severe bite by a larger animal. The pathognomonic symptom of an eventration may be con- sidered the protrusion of a portion of the abdominal contents through its lacerated walls. If the opening through which this takes place is small, the viscera will appear as a small round tumor, which presently becomes transformed into a large mass of intes- tinal circumvolution, which itself varies in dimensions, according to the extent of the laceration. As the exposed intestines begin to protrude, they for a period retain their physiological appear- ance and normal color, but they undergo rapid changes, becoming progressively darker, blueish and then black, and grow cool to the touch. The viscera as they protrude from the abdomen may be quite intact, but they often are injured, bruised or torn, the con- ditions varying according to the peculiar circumstances attending the accident. And not only is this so, but the sequel of the case must be especially considered, since an eventration which possible- might be susceptible of cure, if carefully tended from the first, may become so aggravated and exaggerated as to preclude aU possibility of remedy, as when the wounded creature, frantic with pain, from colics and otherwise, in rearing and struggling, forces his entrails more and more out of their place, and tears and tram- ples them upon the earth until they become a mere mass of crushed and bruised viscera, ground into the earth. And yet, colics are not always present in eventrations, even in horses whose irritable temper, combined with the condition of the injured parts, would naturally tend to render their occurrence quite inevitable. The prognosis of their injuries varies according to the species of the animal, and also under the special condition and circum- stances of each case, as judged by itself. In horses, it is, in the majority of cases, a fatal accident. The sensitiveness of the animal to impressions upon the nerves, and the delicate susceptibHity of the peritoneum account for this. In ruminants they are less serious, and certainly still less so in carnivorous animals, where sometimes the whole intestinal mass may be seen hanging through the laceration, and with extensive co-existing inflammation, with- out the occuiTeuce of a fatal termination. Swine are also very sensitive to this kind of injury, though the EVENTRATIONS. 449 prognosis may vary with them, according to the condition of the lesion, being more or less favorable according as the bulk of the protruding viscera is less or greater. The chances of recovery will also vary in the ratio of the degree of the exposure of the vis- ceral organs to the atmospheric air, or to the severity of any traumatic accidents they may have encountered. The indications of treatment suggested in these cases is obvious. The first is always, when practicable, reduction. To return the intestine to the situation designed by nature for its occupancy is the first step to take. If it has not been seriously wounded, and is in a state of cleanliness, and has escaped contact with the earth and other soils and stains, simple washing may be attended to at once. But if, on the contrary, it is bruised, soiled and inflamed, it must be carefully cleansed with warm water, before being re- turned to its position. This reduction must be carefully per- formed by the taxis, and if the opening of the abdomen is too small to allow this to be accomplished with facility, it will be good prac- tice-to enlarge the opening with the knife, rather than to hazard the too free manipulation of the tender parts which will form the dangerous alternative which may become the exciting causes of consecutive inflammatory, and perhaps gangrenous sequelae. If instead of the intestines the eventration allows the exit of the omentum, this also must be cleaned and washed, if necessary, and returned, though in some instances it may be torn or cut off after ligating its large blood vessels, or better yet, ligating the whole mass with animal ligature. The second step of the Operation con- sists in appl;y'ing means of restraint to retain the returned organ and prevent a second exit. The quilled suture is at this juncture the means which always first suggests itself to the surgeon's mind. The clamps have their advocates, but Zundel prefers the metaUic interrupted sutures. The entire application is to be supported, reenforced and protected by a wide bandage, similar to some of those recommended in umbilical hernia. LAPAEOTOMY. This operation, which consists in the opening of the abdominal cavity through the loins or flanks, is one which, considering the general indication for which it is performed in human surgery, has found but little appHcation and occupies but a small place in 450 OPEKATIONS ON THE DIGESTIVE APPARATUS. veterinary practice. According to Director Degives, who furnishes the only description of the operation to which we have been able to obtain access, the indication for laparotomy occurs in cases of intestinal invagination, internal hernia and intestinal strangulation and for the removal of foreign bodies from the abdominal cavity or the intestinal tract. Once a celebrated surgeon of New York had decided to prac- tice it upon one of his valuable dogs, which was suffering with impaction caused by the lodgement of a mass of hair in the intes- tines, which we fortunately succeeded in softening and removing by internal treatment. The indications for the operation are im- perative as soon as a fatal result becomes imminent and certain. The instruments necessary are a convex bistouiy and suture needles. Dr. Degives briefly describes the operation as follows: '^ jPosi- tion and Kestraint of the animal standing up, or in stocks, or resting against a wall or its equivalent. If the animal is restless let him be thrown down on the side opposite to that of the opera- tion, which is divided into three steps. First Step, opening of the Jiank. — The abdominal opening must be in the upper part of the flank, upon a line between the hip and the last rib. This opening may be made in two ways : 1st, or Simple Method. — It consists in making an incision through the various anatomical layers, in the same direction, in order to form a simple vertical wound, large enough to admit the hand. The parts ha\-ing been shaved, the division of the skin, the abdominal muscles and the peritoneum is made successively with the convex bistoury. The incision of the deep layers alone j)re- sents any difficvdty, and this requires some attention, the hemor- rhage being sometimes troublesome ; but when the peritoneum is exposed, the incision is increased, from without inward, with either a blunt bistoury or the straight bistoury controlled by a grooved dii'ector, an assistant protecting the intestines from the contact of the instrument. 2d, or N'eio Method, by Gotnplex Incision. — In this each mus- cle is divided in the direction of its own proper fibres. Thus, the first is a transverse, cutaneous incision ; second, three muscu- lar divisions, running in directions more or less opposed to each other ; the first, obliquely downward and backward ; the second, obliquely forward and downward, and the third transversal and parallel to that of the skin. These incisions are very easily made. LAPAROTOMY. 451 little more being necessary than a simple laceration of the intesti- nal tissue with the fingers — there is little or no hemorrhage. The opening thus made admits the hand into the abdomen, and when it is removed the fibres of each muscle having a tendency to come together spontaneously, the opening is more or less effectually closed. Seco7id step. — This varies, to correspond with the object of the operation ; 1st, whether the extraction of a foreign body in the abdomen or intestines, or 2d, the reduction of an invagination or of an internal hernia (diaphragmatic, mesenteric, epiploic, or pan- creatic), and, 3d, the displacement or removal of a tumor involving the intestines. In the reduction of an internal hernia, it may be necessary either to puU or to push upon the displaced organ. In some cases the hernial ring must be enlarged, and if that cannot be done with the fingers, the bistoury must be used. The reduction of an intes- tinal invagination is obtained by the combined action of a slight traction on the invaginated part and a steady external j)i'essure upon the enlargement formed by it in the portion of the intestines in which it is enfolded. "WTien the swelling of the organs or the presence of abnormal adhesions prevent the reduction, the traction must be increased and in ojiposite directions — the invaginated por- tion in one, the enfolded portion in the opposite. If a stone, a calculus, or any foreign body is to be extracted, the intestine is to be incised at some distance from the insertion of the mesentery, on its lateral face, between the two curvatures. On the removal of the body the intestinal suture is to be applied. Third step, Closing the Parietal Wound. — AMien the complex incision has been made, a strong cutaneous suture is all that is re- quired. When the division has been a simple one, the edges of the muscular wound are brought together by ordinary interrupted sutures, and the skin is afterward sewed up. The drainage at the lower part of the wound is always advantageous." As enteritis and peritonitis are common sequelse of this opera- tion much care and watchfulness devolve on the surgeon in direct- ing the regimen and nursing of the patient in order to prevent the possibility of their access from becoming a certainty. CHAPTER IX. OPERATIONS ON THE RESPIRATORY APPARATUS. ON THE GUTTURAL POUCHES— HYOVERTEBROTOMY. This term fails to meet the approval of Zundel, who has pro- posed that of Ilyosjyondylotomy as a substitute, in order the better to indicate the puncture of the sac of the guttural pouches which it signifies. The former name, however, has been generally ac- cepted, and while its etymology would point to the operation by which the punctiu'e referred to is made between the hyoid bone and the atlas, it is still used to mean generally, the puncture of the pouches, at whatever point it may be made. These guttural pouches, which exist exclusively in the sohpeds, and are two in number, are situated between the cranium, the pharvTix and the atlas, resting upon each otlaer on the median Hne, each one, by an expansion of the miicous membrane of the Eustachian tubes, forming a sac and filling the triangular space situated jiosterior to the phar^Tix and extending to the larynx. The mucous membrane which forms them is easily stretched, and the cavity may thus become greatly distended by the accumulation of pus, and when this is the case, the pouch extends below the larynx and the lower extremity of that organ. Thus situated in the parotid region, these two sacs sustain important relations to other points, varying according to -the position, whether of extension or flexion, of the head uj^on the neck, and are covered by seven separate tissues, as represented in theu' order from without inward, by 1st, the skin ; 2d, a layer of subcutaneous connective tissue, more or less abundant ; 3d, a thin expansion of cutaneous muscle with the parotido-auricularis muscle ; 4th, the parotid gland, whose internal face is moulded upon the muscles and blood vessels un- derneath ; 5th, the following muscles in the order as named from above downward, viz., the small oblique of the head — the stylo- hyoideus, which fills the space left between the anterior border of HYOVEETEBROTOMY- 453 Fig. 395.— Antero-Posterior Section of the Head, showing the Mouth, Fances, and Nasal Cavities. 1, genio-glossuB muscle; 2, genio-hyoideus muscle; 3, the velum palati; 4, pharyn- geal cavity; 5, CBsophagus; 6, guttural pouches; 7, pharyngeal opening of the Eustach- ian tube; 8, laryngeal cavity; 9, lateral ventricle of the iarynx; 10, trachea; 11, ethmoi- dal turbinated; 12, maxillary turbinated; 13, ethmoidal volutes; 14, cerebral compart- ment of the cranian cavity; 15, cerebellar compartment of the same; 16, falx cerebri; 17, tentorium cerebelli; 18, superior lip; 19, inferior lip. the styloid process of the occiiDital bone and the superior border of the long branch of the hyoid, through which the puncture is made in order to enter the guttural pouches, and back of this the stylo-hyoideus and the superior border of the digastricus ; then, 6th, on the deepest layer, the guttural pouches are found supe- riorly, resting intimately on the internal f^e of the stylo-hyoideus muscle, inferiorly closely cemented with the posterior face of the pharynx and posteriorly with the superior extremity of the long muscle of the neck ; and 7th, the numerous and important blood vessels and nerves belonging to the parotid region. 454 OPERATIONS ON THE KESPIEATORY APPARATUS. Fig. 397.— Parotid Kegion— Superficial Layer. PP, parotid gland; Mpa, parotido-auricular muscle; 3, transveral artery of the face; 4, maxillo-muscular vein; 7, jugular vein; 8, glosso-facial vein; 9. transversal vein of the face; 10, maxillo-muscular vein; 12, posterior auricular vein; 13, facial nerve; 15, auricular branch of the 2d cervical pair. The arteries are tlie three divisions of the primitive carotid ; 1st, the occipital, which, by its mastoid branch, runs over the ex- ternal surface of the styloid process of the occipital bone ; 2d, the internal carotid, which runs upward through the thickness of the fold of the mucous membrane which forms the guttural sacs ; 3d, the external carotid, with its parotid branches, the maxillo-mus- cuiar, the posterior auricular, the superficial temporal trunk and the internal maxillary The veins, which are numerous, empty H YO VERT EBKO TOHY. 455 Fig. 397.— Parotid Region— Middle Layer. P, parotid gland; D, digastricus muscle; Sh, oocipito, or stylo-hyoideus, muscle ; Sm, sterno-maxillaris muscle; P, thyroid gland; n, posterior border of the great branch of the hyoid bone; 1, primitive carotid artery; 2, external carotid artery; 3, transversal artery of the face; 4, maxillo-muscular artery; 5, posterior auricular artery; 6, thyro-laryngeal artery; 7, jugular vein; 8, gloaso-facial vein; 9, transversal vein of the face; 10, maxillo-muscular vein; 11, anterior auricular vein; 12, posterior auricular vein; 13, facial nerves; 14, anterior auricular nerve. into the jugular or its different branches. The principal nerves of the parotid region are the facial, the pneumogastric, the spinal, the superior cervical ganglion of the sympathetic, the great hypo- glossus and the glosso-pharyngeal. These nerves, with the exception of the facial, are situated on the external face of the pouches below the long branch of the hyoid bone and the stylo-hyoideus. 456 OPERATIONS ON THE RESPIRATORY APPARATUS. This rapid summary of the anatomy of the parotid region ^^i]l sufficiently indicate the dangers which the surgeon is likely to encounter at successive steps of the operation, and especially if he duly considers the location of the occipito-hyoideus, which must be reached before the puncture can be made, and again, the j^ecu- liar course followed by the posterior auricular artery as it emerges from the parotid to reach its destination. Hyovertebrotomy is indicated in all cases of repletion of the guttiu'al pouches resulting from a purulent collection and main- tained by a process of chronic inflammation. It is princiiDaily when horses have become Hable to be attacked vnth. strangles that these purulent collections are formed. They are marked by an increase of size in the pouches, gradually augmenting with the continued formation of the pus, and interfering more and more with deglutition and respiration, sometimes assuming such pro- portions as even to threaten suffocation. Attacks of pharyngitis or laryngitis, or catarrh of the anterior chambers of the resjoira- tory apparatus and nasal cavities, or sinuses, are at times noticed in connection with this affection. To revert to the anatomical arrangement of the parts : The guttural pouches, opening into the cavity of the pharynx by a narrow sHt, are situated on the lateral surface, and thus allow any collection of pus they may contain to flow wdthout interruption into the pharynx,and hence into the other nasal ca\'ities. We have here an explanation of the fact that a discharge from the nose in any one of a variety of affections, such as sujipuration of the guttural pouches, pharyngitis, laryngitis, catarrh, and also the dis- charo-e of glanders, may all possess different characteristics, and each exhibit a different aspect, and therefore demand a different diagnosis and require different treatment. The discharge from the guttural j^ouches is whitish, glairy, more or less mixed with mucosities, inodorous, non-adhesive to the wing of the nose, and intermittent, being marked dm-ing mastication or deo-lutition, and especially while swallowing liquids — in all form- ino- an assemblage of characteristics which should be sufficient to distinguish the affection from all others. There is, besides this, a negative point, in the absence of chancres, which with the distinct nature and peculiarity of the discharge, and the characters so typical of the maxillary lymphatic glands in that disease, will largely aid in determining the difference between the two affections. HYOVERTEBKOTOMY. 457 In respect to glanders, moreover, the bad odor, the thick, gru- mous nasal discharge, and the soreness and dullness on percussion of certain parts of the face, will in many cases serve to identify and distinguish a pathological condition of the sinuses very dif- ferent from that of the disease we are considering. Gohier and Vatel also refer to guttural tympanitis, or dilatation of the pouches by air, as a featm-e of their -disordered condition. The amount of pus collected in the pouches varies in different cases to such an extent that from only a trifling degree of dilatation it may be suf- ficiently extensive to produce a sensible projection of the sac below the parotid. This dilation furnishes a guide for the determination of the proper point at which to make the puncture, whether in the upper, in the middle, or in the lower part of the pouches. The uj)per operation is hyovertebrotomy proper. Besides these three modes of operation, Gunther has proposed a fourth method which consists in penetrating the pouches through the nasal cavities. Upper operation — Hyovertebrotomy p)roper. — As described by Chabert and Fromage de Feugre, this is one of the finest and most delicate operations of veterinary surgery. Extremely so when per- formed on horses whose pouches are healthy and normal in size, it loses a great deal of its apparent difficulty when these are full of pus with prominent and well developed walls. The nerves and blood vessels which surround them are then easily pushed aside from their position, and the lobules of the parotid are more or less separated. The instruments required for this operation are: a pair of scissors, a convex and a straight bistoury, a dissecting forceps, an Fig. 398.— Curved Trocar, or Hyovertebrotome. S probe, or preferably, the curved trocar, the hyovertebrotome (Fig. 398), and a piece of tape. Artery forceps and ligatures ought to be always within reach. Bouley, Zundel and others recommend that the animal should be kept in the standing position with simply a twitch on the lip, 458 OPERATIONS ON THE RESPIRATORY APPARATUS. but our experience has taught us that the recumbent position is the safest, especially if there are plenty of assistants at hand, with instructions to keep the head of the animal steady, and in a mode- rate state of extension on the neck. The operation is divided into three steps ; 1st, The incision of the skin and dissection of the parotid ; 2d, The jyuncture of the pouch through the occipito-hyoideus muscle ; and 3d, The estab- lishment of the counter-opening. Before considering these three steps, it will be well to answer sundry important questions put by Lecoq in the first good de- scription of the operation, made in 1841. 'Where shall the puncttire he made ? The anatomical disposition, which we have already examined, suggests as an answer to this query, that the occipito-hyoideus inuscle is the proper place for the puncture. Its inner side is lined with the mucous membrane of the pouches, and as has al- ready been remarked, when this is distended by fluid and becomes tense and resisting, it is in a much better condition for the pass- age of the knife through its thickness than when flabby and soft, and therefore movable and shifting, as if endeavoring to evade the knife. At any other point the pouches are so surrounded by im- portant blood vessels and nerves that the operation is precluded by the ganger which would be incurred by attempting it. Where must the first incision he made to reach the occipito- hyoideus muscle? It would be easy to reach the muscle by a division of the paro- tid gland, bvit this would involve the formation of a fistula, and a wound difiicult to heal, to avoid which the gland must be raised out of the way. This should be done by raising the posterior bor- der, where it is loose and free from blood vessels or nerves of importance, in j)reference to doing so by disturbing the anterior border or superior extremity, where the posterior auricular artery, the facial nerve and the sub-zygomatic artery are situated. The superior extremity of the incision must begin near the inferior border of the tendon common to the splenius and small com- plexus muscles, a little in front of the transverse border of the atlas, and extend downward for a space of two or three inches. Upon v}hat point of the muscle must the puncture he made? The answer to this is — upon the central portion of the muscle. The introduction of the bistouiy into the superior part of the HYOVERTEBROTOMY. 459 muscle will involve possible danger to the posterior auricular ar- tery, and the risk of the division of the facial nerve. In rohat direction must the sharp edge of the bistoury be turned? The reply to this is the jyohU of minhmmi danger from irregu- lar motions of the instrument, caused by the struggling of the patient ; and this result is most likely to be accomplished by carry- ing the bistoury towards the tuberosity of the hyoid bone, and consequently in the direction of the patient's nose. With the instrument turned towards the ear, there would be j)0ssible dan- ger of dividing the posterior auricular artery, the facial nerve or, perhaps, the internal carotid. In carrying it tow^ard the atlas, the internal carotid, and the nerves surroimding it, would be the endangered j^arts, if any. If directed do\\'nward, toward the larynx, a division of the great hy- poglossus, and possibly of the external carotid, might be possible. What must be the direction of the instrument ? If the bistoury is pushed through the occipito-hyoideus muscle, and in a direction perpendicular to it, there will be great danger, at a certain depth, of reaching and penetrating through the in- ternal carotid artery ; but if an obHque direction be given to the instrument, not only is this danger avoided, but no accident be- yond some slight muscular injury, of no importance, need be ap- prehended. Where is the cotinter-openi?ig to be made? The right place will be the most dependent part of the pouches, and the instrument used must be either the S probe or the trocar, as will be hereafter described. These preliminary points being understood, we shall the more intelligently follow the description of the three steps of the opera- tion, which we now proceed to give. 1st. The Incision of the Skin and Dissection of the Posterior Border of the Parotid. — This incision is made a little in front of the transverse process of the atlas. It includes the skin and some subcutaneous aj)oneurotic fibres, and extends to the posterior bor- der of the parotid, which is at this point exposed. With the straight bistom-y and dissecting forceps, the parotid border is dissected, and under it the aponeurosis of the levator-humeri is divided. The finger is then pushed between the aponeurosis and the small oblique muscle of the head, in order to reach the occipito- 460 OPERATIONS ON THE RESPIRATORY APPARATUS. hyoideus, whicli is readily identified by feeling for the styloid pro- cess of the occipital bone and the superior border of the long branch of the hyoid. Some little hemorrhage and some strug- gling of the patient may follow this incision, caused by the divis- ion of the auricular vein and nerve, but the consequences will not be serious. 2d. Puncture of the Pouch through the Muscle. — The central point of the muscle being identified, the operator, with a straight bistoury held in the manner of a writing-pen, introduces it under the parotid, obliquely, from above downward, and from behind forward, and thus divides the muscle through and through, and penetrates the pouch. If the puncture proves to be sufficiently large, the index finger is introduced into the opening for explora- tion, and, if necessary, for its further dilatation. If the collection of pus is not very abundant, and the mucous membrane lining the sac not greatly distended, it will be important to have a very sharp-pointed instrument, which will make its work of incision sure, instead of merely pushing the membrane away from the internal face of the muscle — an accident which might lead to serious results. But again, when the collection is abundant and the pouches much distended, the use of the bistoury may prove unnecessary, the puncture being then readily made by pushing the index finger through both the muscle and the mucous membi'ane of the pouch. 3d. Making a Counter-Opening. — The S probe, or curved tro- car (Fig. 398), is introduced through the opening made, and is pushed down to the bottom of the pouch, where the mucous mem- brane is easily torn ; it is then carefully directed toward a point a little below the glosso-facial branch of the jugular, back of the thick border of the maxillary bone, and pushing against it with sufficient force, the instrument forms a prominent point under the skin. If the S probe is used, an incision is made with the bistoury through the skin, and the instrument is exposed. If the curved trocar, it is by a strong pushing movement j^assed thi-ough the skin and brought outside. Whatever instrument may be used, a piece of tape or kind of seton is introduced from the lower through the upper opening, and the continued escape of pus thus facihtated and ensured. The extremities of this piece of tape are secured together by tying them with the knot used with the or- dinary seton. HYOVERTEBROTOMT?. 461 The attention reqmred by the patients after the operation is of the simplest kind, consisting in keeping the wounded surface thoroughly clean and keeping up the flow of the pus. This will at first make its escape through the upper opening, but will soon find its way through the lower one, and so long as it is discharg- ing the opening must not be allowed to close, nor must the seton be moved. Puncture in the Middle and the Lower Regions of the Parotid. — These modes of operation are so nearly identical that, with H. Bouley, we think they may with propriety be jointly con- sidered. In these cases but Httle attention to the anatomy of the part is required. The growth of the purulent collection distends the pouches, displaces the blood vessels and nerves, separates them more or less from the parotid, and becomes more superficial, and, in fact, may idcerate through the skin and empty itself spontane- ously. But this process is a very slow, tedious and painful one, and subjects the patient to such a degree of suffering, that it be- comes a duty imperative to interpose the resources of surgery for its relief. The puncture in this case should be made as early as possible, and at the fluctuating point, as with an ordinary abscess. It is made with the bistoury, or, what would be better, with the oHvary actual cautery, by which the prevention of hemorrhage will be as- sured. The opening thus made and cauterized, wOl, moreover, have less tendency to close too rapidly, besides which the modify- ing effects of the cauterization will have a highly advantageous in- fluence upon the healing process. The opening of the pouch at its lower extremity has been recommended when the purulent collection is small, or when con- cretions of inspissated pus are supposed to exist in the ca\'ities. It is done by first dissecting the wide and thin lower portion of the parotido-auricularis, then of the base of the parotid, under which the distended pouch is seen and punctured. We remember a case where the collection in both cavities was such that we had no difficulty in opening them on each side of the neck, about on a level with the thjToid glands, the lower operation with emphasis ! Puncture Through the Eustachian Tubes. — Gunther has in- vented a tube, rounded at one extremity, a sort of hollow bougie. 462 OPERATIONS ON THE KESPIEATORY APPARATUS. which he introduces into the guttural pouches by passing it through the nasal cavities and the Eustachian tubes. Although in performing this operation the animal is thrown down, it is very difficult to accomplish, and requires to be preceded by the operation of tracheotomy. It also requires to be repeated several times, by reason of the hability of the collection to return. The mode of operation is a matter of no importance, since the solutions of continuity resulting from it seldom assumes a form more serious than that of an ordinary simple wound, and requir- ing no special directions as to treatment. Even ordinary de- tergent washes are scarcely necessary. LAEYNGOTOMY— AKYTENECTOMY. The history of surgical interference at the larynx, to relieve the pecuhar difficidty of respiration known as roaring, depending upon j)ai"alysis of the laryngeal muscles, dates as far back as 1845, when Professor Gunther, of Hanover, attempted, in succession, the resection of the vocal cords, the removal of the vocal cord of the paralyzed side of the larynx, the partial excision of the arytenoid cartilage, the entire extirpation of that cartilage, the removal of the vocal cord and of the corresponding laryngeal ventricule, and finally the fixation of the arytenoid, by an anchylosis at its artic- xdation with the thyroid cartilage. The resiilts obtained by Gun- ther were more or less successful. These experiments were repeated by Gerlach, H. Bouley, Stockfelth and Bassi, but subsequently repudiated and ignored. But in later years Professor Moller, of Berlin, and George Flem- ing, of London, have turned their attention to the subject, with the suggestion of various new modes of operating, which have yielded resTilts more or less encouraging. The matter has been followed up by other veterinarians in various parts of the world, and re- cently especially by Professor Cadiot, and the successes which have been recorded, though not always perfect, seem to justify the prosecution of further inquiries and new trials for the relief of a disease which has thus far bafEed the skill of vetei-inarians, and consigned manj^ a valuable animal to the hands of the knacker. The operation of Professor Moller, also recommended by Pro- fessor Cadiot, as at present practiced, is the excision of the para- lyzed cartilage. That of George Fleming is the removal of the LARYNGOTOMY ARYTENECTOMY, 463 cartilage and the vocal cord. "We shall describe the Fleming and Cadiot modes as we find them recorded in their own works, " Roaring in Horses," by the former, and " The Surgical Treat- ment of Chronic Roaring," by the latter. The Fleming Method. — The special instruments necessary are small ordinary forceps; scalpels; bvdl-dog forceps; tracheal Fig. 399 —Tracheal Tampon Canula. tampon ; a canula, formed of a long tracheotomy tube, with ah india rubber bag surrounding its middle. This bag is inflated by means of an india-rubber air-pump, after the insertion of the tube into the trachea, and is useful in preventing the flow of blood into the bronchii during the horse's getting up after the operation, and for half an hour subsequently. Other instruments required are a razor-shaped knife, with which to excise the cartilage ; a bent knife with which to remove the muscles from the outside of the arytenoid cartilage ; a hook to seize and raise the lower end of Fig. 402.— Hook to Secure the Cartilage. 464 OPERATIONS ON THE RESPIRATORY APPARATUS. Fig. 406.— Electric Lamp. the cartilage ; a special forceps with toothed ends, to seize the body of the cartilage ; cui'ved scissors to cut through the mucous membrane ; two retractors to keep the trachea opened during the operation ; and an electric lamp to illuminate the interior of the lar;yTix. Fleming describes the operation as follows: "The horse should be well fed for a day or two preceding the operation, but have little or no food or drink for some hours before its actual performance. In the case of thoroughbred horses, a dose of four ounces of tincture of opium in a pint of water, half an hour be- fore operating, is a,dvisable. The hair must be removed closely from around the upper part of the trachea and larjnix, before the LAKYNGOTOMY AKYTENECTOMY. 465 animal is cast, and he is thi'own in the usual manner, on a good bed of straw or moss or litter. The chloroform bag is put on, and when the requii-ed state of narcosis is induced, the animal is placed on his back, and maintained there by sacks filled with straw, placed close under each side of the body. The neck and head are ex tended in a Une with the body, the head placed on the vertex and kept steady by an assistant. The operator places himself in a kneeling position, on the off, or right side of the body, if right handed, beside the neck, with his back to the shoulder and face toward the head." The operation is divided into three stages : First Stage. — " With a scalpel, an incision of from four to six inches in length is made through the skin, the middle line of the larynx and trachea, opposite the posterior border of the lower jaw, extending from the body of the thyroid cartilage to the second or third tracheal ring. This exjjoses the subscai:)ulo-hyoid, sterno- hyoid and sterno-thyroid muscles, which are incised to the same extent, and as close as possible to their line of junction {rax)he) in the middle, the section being then carried through to the larynx and trachea. There is a variable amount of hemorrhage now to contend with, which, if only oozing, may be checked by sponging it dry until the blood has ceased to flow ; and if it comes from twigs of arteries or veins, they may be seized, and twisted, or ligated." Second Stage. — "The middle crico-thyroid ligament, cricoid car- tilage, and one, two or three tracheal rings are cut through, in a straight line, exj^osing the interior of the larynx and trachea. If blood vessels are cut, they should be taken up. A retractor is applied to the sides, and these being pulled gently apart by an assistant, there is amj^le space in which to manii^ulate. The con- vex lower border of the arytenoid on each side can now be seen, and if the respiration is deep, that which is next the operator (the right), will be observed to move actively from the side toward the middle ; while if the roaring is due to paralysis of the left dilator muscle, there is no movement in the opposite cartilage. "WTien the breathing is very tranquil, which is often the case, the right carti- lage moves almost imperceptibly, and it becomes necessary to as- certain whether the left one is really immovable. This can be done by passing the finger, or a long probe, up toward the epi- glottis, when the act of swallowing will be excited, during which 466 OPEEATIONS ON* THE RESPIP.ATORT APPARATTS. the right arytenoid cartilage is energetically jerked into le mid- dle of the ca^-ity ; but the left one is either motionlef i ir only feebly stirs, depending upon the degree of the wasting clhe con- strictor muscles on that side. " If any blood lodges in the trachea, it can be reioved by large or small (handled) sponges, which may be passt to the operator by an assistant who receives and washes them. As the horse is now breathing through the wound, the chlorofrm bag may be removed. "It is always ad\-isable to examine the interior of It hmnx carefully, in order to ascertain its exact condition, as thei ?aay l)e something more in the case than an immovable cartilage, or this piirpose the electric huu]^ '>- invMlnnhl. M Fig. 407.— Left Side Section of Larynx, chowlng the Parts excised In ttao tf'iTatioa for Roaring. " The left arytenoid cartilage may be excised by conumcing at the lower convex border, or at the upper part, where j :iieet8 the right cartilage (Fig. 407). If the latter method is .sected, then a cut with a razor-shaped knife is made through the nicous t ' * f 4 4 J 4 A 4 •> LARYNGOTOMT ARYTENECTOMY. 467 meibrane, into the arytenoid ligament and aijtenoid muscle, as clce to the margin of the cartUage as possible, beginning between th cartilage of Santorini, downward and then upward and the vwl process at the insertion of the vocal cord (Fig. 407). The hok is inserted in the vocal process, which is raised, and the veal cord is separated from the cartilage by the scissors ; then tb muscles on the outside of the cartilage are cut with the bent kiio, or, what is better, pushed from its sui'face as close as possi- bi The hook is removed, and the body of the cartilage seized vrh the rachet forceps. The mucous membrane connecting the : :i]age with the vocal pouch is divided, with, the curved scissors, I ing as close to the cartilage as possible, to save the membrane. •The arytenoid cartilage is now free, except at its articulsr- rm M-ith the cricoid, and it may either be disarticulated or cut trough with the scalpel at this point, care being taken to leave I ) loose portions or shreds. The cartilage being now only retained ' the soft parts at the upper portion (or base of the aiytenoid crtilage), these are cut through, close to it, with the scissors, when :s altogether detached. ' Care must be taken to avoid wounding the other cartilages, ' 'he pharyngeal mucous membrane, and to spare that membrane 1 |>roximity to the aiwtenoid cartilage as much as possible, remov- 1'^ only that which covers its surface and the cartilage of • atorini. •' The vocal cord is now removed close to its attachment to the lyroid cartilage, in front and at its fixed border (Fig. 407). This ,n be done with the scissors, a finger being passed to the bottom the ventricle to facilitate the excision ; or the cord may be awn from the side by inserting a hook in it, to allow plenty of Dom for the scissors. " If the hemorrhage is troublesome, which it seldom is, the lood can be mopped out of the trachea with the sponges. It nuot pass down that tube, owing to the position of the neck. necessary, the electric lamp may be employed to ascertain how :e operation has been performed, or even during it performance ; at after a little experience this is unnecessary." Third Stage. — "The trachea being completel}^ freed from lood, and the tampon canula introduced, the bag being inflated fter it has been properly placed into the trachea by means of the u--pump, the canula is secured in position by a tape around the 466 OPEEATIONS ON THE KESPIKATOEY APPARATUS. the right arytenoid cartilage is energetically jerked into the mid- dle of the cavity ; but the left one is either motionless or only feebly stirs, dejjending iipon the degree of the wasting of the con- strictor muscles on that side. " If any blood lodges in the trachea, it can be removed by large or small (handled) sponges, which may be passed to the operator by an assistant who receives and washes them. As the horse is now breathing through the wound, the chloroform bag may be removed. "It is always advisable to examine the interior of the larynx carefully, in order to ascertain its exact condition, as there may be something more in the case than an immovable cartilage. For this purpose the electric lamp is invaluable. Fig. 407.— Left Side Section of Larynx, showing the Parts excised in the OperatloB for Eoaring. '* The left arytenoid cartilage may be excised by commencing at the lower convex border, or at the ujoper part, where it meets the right cartilage (Fig. 407). If the latter method is selected, then a cut with a razor-shaped knife is made through the mucoua LARYNGOTOMY ARYTENECTOMY. 469 Fig. 411.— Hooked Forceps. peculiar curved needle, shown in Figure 418, straight, long and ordinary curved scissors, bistouries, dissecting forceps, artery nip- pers, loose and fixed sponges, thread, cotton, pheniated or iodo- formed gauze, and antiseptic solutions. The preparation of the animal is similar to that in Fleming's method. First Stage. — Incision of the Skin and Muscles covering the Larynx. — The incision must be made on the median line, and ex- tend from the body of the thyroid to the second or third tracheal ring. This is done with the convex bistoury, first dividing the skin in its whole length, when the edges separating show the raphe of the sterno-hyoid and omoplat-hyoideus muscles. The muscular layer can then be divided exactly ujDon the median line. The division of the prelaryngeal connective tissue closes the first stage. The hemorrhage is always hght and easily controlled. Second Stage. — Incision of the Larnyx and of the First Two Mings of the Trachea, Introduction and Fixation of the Can- tda. — The incision may be made by a single stroke of the knife, dividing the crico-thyroid, and with it, successively, the cricoid and the crico-tracheal ligaments, and the first rings of the trachea. But by this mode of operation, the vocal cords may be injured, and to avoid this, the bistoury held perfectly vertical, with the edge turned backward, is inserted through the crico-thy- roid Hgament, immediately in front of the cricoid cartilage, and this is divided with the crico-tracheal ligament, as well as the first ring of the trachea. The edges of the laryngo-tracheal incision are then opened with the spreaders, or the spring tenaculum, and the division of the thyro-cricoid ligament is completed, from be- hind forward, and from within outward. As by the act of inspi- ration the vocal cords move more or less outward, this movement should be carefolly watched while making the incision of the crico-thyroid membranes to save them from injury. The canula- tampon is then introduced, and when in place, is moderately in- flated by an assistant, the operator measuring the degree of dila- 470 OPEEATIONS ON THE RESPIRATORY APPARATUS. tation with his fingers in the superior part of the trachea. When it is sufficiently expanded, a ligature is applied upon the India rubber tube, and this is cut off. Though the tampon is inflated, Fig. 412.— Arytenectomy. The second step is over. The crico-thyroid ligament, cri- coid cartilage, crico-tracheal ligament and the two first tracheal rings are divided. The canula and the tenaculum are in place— tc. Cricoid Cartilage. IE, First King of the Trachea. the canula has a tendency to slip in the lar\Tix, and for the pre- vention of this accident should be secured by bands or strings tied backward over the neck. Third /Stage. — Ablation of the Arytenoid Cartilage. — The ablation of the cartilage is effected by several stej)s : {a) Incision of the Mucons Membrane along the Superior and Posterior Borders of the Cartilage. — With a blunt bistomy and a slight pressui-e, an incision is made in the mucous mem- brane along the side of the superior and posterior borders of the LAEYNGOTOMY AEYTENECTOMY. 471 ai'vtenoid (see Fig. 413), the instrument being then carried into the larynx on the median line, from before backward to the cri- coid, and thence from within outward and from below upward, as far as the insertion of the vocal cord. To save the mucous mem- 1.1 \ v„. y Fig. 413.— Sd Step, a, Incision of tlio Mucou.s ^Jonibiviuo aioug the Superior and Pos- terior Borders of the Arytenoid. brane, the incision may be made at some distance from the bor- ders of the cartilage, but the division of the membrane must be complete. {b) Section of the Vocal Cord ; Dissect io?i of the Cartilage on its Inferior and Anterior Borders and External Face. — With long, sharp, sti-aight scissors, the vocal cord is excised at its in- sertion upon the arytenoid (see Fig. 414). The cartilage is then, by small nips of the scissors, made from behind forward, dis- sected in dividing the mucous membrane along its inferior bor- der, and the muscular fibres of the crico-arytenoid and thyro-ary- tenoid, inserted on its external face (Fig. 415); the mucous mem- brane, which covers the anterior border, being divided from above J3BiS3»PS «r 3BE a^KBacJwas: ^ggs.xsrrs. "nr- WTTTTtJ- i < - - L HEl£. gnr :g i— :._ r __r : _i , : , -- .-^: Tfrm :iEe -f^Ti?-Tf!a ^a-^ if :f^tf -rH^-TfaiTig. T[tt337£ ■ite -grTtf re 315 jtirri -anju T~TP*T TTe^ -^^-rktrcc^ ^ ^siacsEEsZ V^jtri "Ht^ SiTs^ IT :ai^ Jii'at-rtF^ii^rrn'ff Trn^-f'^. jl j±EiiiiEr:n2se«? -aa^s- pace ±rnn.:ae nmt- .^r^caumiijit triiU -iw I i I f ' %v f < » < « € / # I ^risL ^ a^iT-nT ar as JXL. SL. 472 OPEBATIONS ON THE RESPIRATORY APPARATUS. Fig. 414.— 3d Stn-). b, Section of the Vocal Cord. downward with the scissors. To facilitate this part of the oper- ation, the cartilage must be firmly held with either the hooked or the bull-dog forceps, and carried toward the median line, when the inferior border and the external face are dissected, and drawn backward and upward when the dissection goes on, on the ante- rior border. The only important or jiarticular caution needed here, is to hold the point of the scissors always m contact with the cartilage, to keep close to it, to save the mucous membrane, and to avoid the larjTigeal ventricle as well as the tissues loosened from the external face of the cartilage. Toward the end of this thu'd step, when the cartilage is separated from the fibres of the thyro-arytenoid muscle, a hemorrhage takes place from the divid- ed laryngeal branch of the thyroid artery (Fig. 416). This must be controlled by torsion or artery nippers. (c) Section of the Cartilage near its Articulation with the LARYNGOTOMY ARYTENECTOMY. 475 FiG. 417.— Sd Step, d. Excision of the Cartilage with the Curved Scissors. together with two or three interrupted catgut sutiu-es, made with «, special needle (Fig. 418). Three of these are generally re- quired (Fig. 419). After cleansing the larynx of the blood, it is di'essed with wad- ding or iodoformed gauze. The edges of the external wound are brought together by two interrupted sutures, one upon the mus- cular coat, the other on the skin, the latter being so placed as to prevent the displacement of the canula. The care of the wound, aside from the matters of cleanhness and the application of antiseptic measures, varies according to the two modes of operation. But they agree in advising the early removal of the canula at a period not later than the day following that of the operation. Careful diet is indicated, but Fleming advises strict fasting from both food and water for two or three days, while Cadiot per- mits the animal to have his ordinary diet without interruption. 476 OPERATIONS ON THE RESPIRATORY APPARATUS. Pig. i\8.—Uth Step. How to Apply the Sutures. There is no serious febrile reaction, and after three or four weeks the cicatrization is complete. The result of the operation cannot be fully ascertained until about three months after the operation, when the animal can be tested. The application of the sutures constitutes an improvement, we believe, on Fleming's oj)erations for assisting the cicatrization of the laryngeal wound, which, however, can be more easily watched if the external sutures recommended by Cadiot are dispensed with. Excessive granulations, when detected, must be cauterized with chloride of zinc or nitrate of silver. Among the accidents and complications that may follow ary- tenectomy, and which are mentioned by Fleming and Cadiot, are wounds of the mucous membrane and of the arytenoid left in the larynx, incomplete deglution of the dressing, pneumonia from [■RACHEOTOMY. 477 Fig. 419.— The Sutures are in Place ; three are necessary. foreign bodies, excessive granulations of the cicatrix, pyemia, tetanus, besides those which result from the division of the carti- laginous structure, such as deformity of the tracheal rings, and the contraction of the tracheal diameter. TRACHEOTOIVIT. This term represents an operation consisting in making a methodic opening of varying dimensions, in the cervical position of the trachea, in order to provide a free channel for the atmos- pheric ail' into therespu'atory tract. Its ultimate object is either the removal of foreign bodies, or of the abnormal growth from the larynx, or to facilitate the passage of the air necessary to respira- tion. Its subjects are principally the large domestic animals, more especially the horse, and it has also been employed with advantage on ruminants, and often successfully on dogs. 478 OPERATIONS ON THE RESPIEATOKY APPARATUS. The importance of the operation, with its utility, is readily demonstrated by studying the e£fect of its performance, and esti- mating the relief which immediately follows, in some special cases of ailment or accidents, complicated with the danger of immi- nently impending suffocation. It is performed in the middle of the inferior border of the neck, in that portion where the trachea 'ii|;^y; Pig. 520.— Tracheal Region. T, Trachea; A A, Sterno-Hyoideus and Thyroideus Mus- clee; S H, Sub-Scapulo-Hyoideus ; if M, Sterno-Maxillaris ; J, Jugular Vein. being most subcutaneous, can be readily felt, in the lozenge formed by the diverging branches of the stemo-maxillaiy muscles below, and the two converging sub-scapulo hyoideus above. The trachea is here merely covered by the subcutaneous band of the sterno-hyciaeus and sterno-thyroideus, and tLe whole is wrapped TRACHEOTOMY. 479 by the thin expansion of the cutaneous colli. In this middle third of the neck, the cartilaginous rings of the trachea, with the liga- ments between which unite them, are readily identified. The indications of tracheotomy, which are quite numerous, are enumerated by Zundel, under five principal heads : 1st, when an obstacle exists which interferes with the free access of air to the lung, as in case of contraction or obstruction of any portion of the air passages, including all the diseases of the upper part of the respiratory tract, and acting directly, such as acute larj-ngitis, oedema of the glottis, and polypi or paralysis of the larynx ; or to- gether with those which act indirectly, as strangles, pm-ulent col- lections in the guttural pouches, anasarca and pui-pura hemon-ha- gica ; 2d, when foreign bodies have become lodged in the fauces or the larynx, in order to facilitate their extraction, either du-ectly, by means of special forceps, or indirectly, by pushing them back into the mouth to enable the surgeon to grasp them with his hand ; 3d, to remove tumors, polypi, cysts or cancerous growths ; 4th, in cases of fractures of the bones of the face, of the cartilages of the larjTix, or of the trachea ; and 5th, again, when the trachea has become the seat of any specific lesions, such as tracheocele ; caries of the tracheal cartilages, or of deformities, such as may result from frac- tures, ossifications and contractions. The operation is, however, contra-indicated when the cause or object which impedes respiration occupies a point so low in the passage as to be beyond reach by the tracheotomy tube ; or when the difficulty in breathing and the danger of suifocation are due to a diseased condition, either of the lungs or of the heart. The instruments required for the operation are : a pair of curved scissors, a convex and a pointed bistoury, a sharp-pointed tenaculum, a bull-dog forceps, two blunt tenaculums and a trach eotomy tube. Some special instruments for the division and am- putation of the trachea have been invented, but the tracheotomes as they are called, do not generally serve as good a purpose as the ordinary instruments already named. Tracheotomy tubes are of various forms and devices. Some are of very simple construction, and others are more or less com. phcated. The ordinary tube consists of a bent and curved can- ula, made of various diameters, more or less cylindrical, and secured on a square plate, nearly flat, or with a curve in order to adapt it to the convexity of the neck, and with an eyelet or 480 OPERATIONS ON THE KESPIEATORY APPARATUS. Fig. 421.— Ordinary Tracheotomy Tube, front and back view. slit at each corner, for the attachment of bands or straps. These tubes are generally made of silver or nickel-plated metal, though gutta percha is the material sometimes used, its lack of solidity, however, rendering the instruments composed of it uncertain and dangerous. Besides this ordinary tube, there is a long catalogue of others, among which we have those invented by Dieterichs, Gowing, Spooner, Vachette, Pradat, Brogniez, Leblanc, Kenault, Peuch, Imlin, Trasbot, and these do not exhaust the list. But among all this host of instruments of this class there is probably none w^hich fulfils its purjDose better than that of Director Degives, somewhat modified by Professor Peuch (Fig. 430), which, by its simplicity, and especially from the fact of its being a self-holder, has proved itself to be the most convenient of all for general prac- tice. "When once inserted and adjusted, this tube may be left in place without danger of removal or dropping of itself, while the or- dinary tube, which requires to be secured by strings tied over the neck, can never be as safe as the self-retaining instruments, which hold themselves. There are two methods of performing the operation, one of which may be called the classical, and the other the immediate method. In the former, two adjoining tracheal rings are divided, and re- moved, in part or totally ; in the latter, a longitudinal incision is made through the rings without loss of substance (Fig. 433). In TRACHEOTOMY. 481 Fig, 422.— Tube of Dieterichs; posterior view. Fig. 423.— Qowing's Tracheotomy Tube. Fig. 424.— Spooner'B Traclieotomy Tube. either case the animal is, if possible, kept on his feet, with the head elevated by a twitch apphed on the lower lip. It may sometimes be necessary to place him in stocks ; to hobble his fore legs, or perhaps only to raise one of the fore feet. In some instances the patient is unable to stand, and, in fact, is already down when the surgeon is called, and this is probably one of the only conditions when the longitudinal incision is fully justified. Classical Method. — This includes three steps, the object of ■482 OPERATIONS ON THE RESPIRATOKY APPARATUS. Fig. 425.— Vachette's Tube. Fig. 426. -Tube of Pradat, Fig. 427.— Tube of Brogniez. the first being the the exposure of the trachea ; of the second, to open it by removing a circular portion of the organ ; and the third by the introduction of the tube into the aperture prepared for it. TKACHEOTOMY. 483 Fig. 430.— Tube of Peuch. The operator stands facing the animal, slightly on the right. Grasping the trachea (the hair having been closely cHpped), he fixes and stretches the skin with the left thumb and fore finger, at about the middle of the tracheal region, and incises it with a sin- gle stroke of the convex bistoury, cutting through the skin and the cutaneous muscle. The incision is about three inches in length, and exposes the sterno-hyoideus and thyroideus muscles. These must be carefully isolated from the face of the trachea by 484 OPERATIONS ON THE EESPIKATORY APPARATUS. Fio. 433.— Trachea, open for the introduction of the Tube. TKACHEOTOMY. 485 tlie dissection of the cellular tissue which confines them, and drawn apart by means of two blunt tenaculums, leaving a gaping wound through which to reach the trachea, which is thus exposed, and in readiness for the second step of the process. Second Step. — In the second step portions of the two cartilages which have been selected, are held by the pointed tenactdum, passed through the connecting ligament, are excised, and a circular open- ing established by the removal of a semilunar segment from each ring. It is necessary at this point to be certain that the isolated valve is securely held, to guard against the force of suction, by which it may be liable to be drawn into the trachea as the new breathing place is suddenly opened. lliird Step. — This consists in the insertion of the tube into the apertiu'e prepared for it, and is the simplest and easiest part of the procedure. The only difficulty likely to occur is from the neglect or error of the operator in measuring the dimensions of the opening, and securing a perfect coaptation between that and the tube. If the opening proves to be too narrow, it must, of coui'se, be enlarged, with the caution before mentioned against losing any detached portions by the suction of the trachea. The bull-dog forceps is of value here. If the tube is of the self-hold- ing kind, its introduction completes the operation ; but if the or- dinary tube before described is used, the t}Txig over the neck of the tapes attached to the flat plate becomes the final manipulation. If no tube is at hand, the wound must be held apart with tapes applied upon its edges, and tied over the neck. Immediate Operation by Longitudinal Incision. — This is done with the sharp straight bistoury, passing it at once through all the tissues, penetrating the trachea between two cartilages, and making a vertical incision of two or three rings. This mode, as we have said, is principally justifiable in case of emergency when suffocation is imminent, and no time can be lost in proour- ing the instruments necessary for the classical operation. There is still another mode of operating, credited to Kris- haber, which, from the location where it is performed, is better known as sub-cricoidean tracheotomy, and which consists in mak- ing the opening through the crico-tracheal ligament, which unites the cricoid cartilage to the first tracheal ring. It includes three steps, comprising the incision of the skin and dissection of the underl^dng muscles, the incision of the ligament, and the inser 486 OPERATIONS ON THE RESPIRATORY APPARATUS. tion of the tube. This mode of operating is simple and of easy- performance, especially in the absence of any swelling of the re- gion. It prevents perichondi'itis, and is not followed by changes in the diameter of the trachea. It has, besides, the advantage of allowing the tube to be, to a great extent, concealed, and thus removes one of the principal objections urged against the operation in cases of chronic roaring, for which it might well be recommended. The subsequent measures vary somewhat, depending upon whether the operation has been performed as only a temporary expedient, or as a permanent means of rehef for the difficulty in breathing. In the first case, it is not neisessary to remove the tube before the acute symptoms, which have required its intro- duction, have subsided, which is a condition which generally does not continue more than two or three days. If, however, during that time the canula of the tube should become closed by the dis- charge or other pathological secretions, it must be removed, cleansed and rej)laced, to be left until its use becomes unneces- sary, which will be readily discovered by the restored regularity of the respiration when the tube is removed or its canula becomes occluded. If the tube is to be worn permanently, careful attention should be paid to its proper fit and adjustment, and its daily removal and thorough cleansing shoiild never be overlooked. It should be ascertained that the instrument fits properly, being held with sufficient firmness in the opening, and making a safe and moder- ate pressure on the soft tissues around. "When the instrument has been worn for a (variable) time, the ojDening of the trachea has a tendency to contract, and becomes smaller by reason of the development of the granulation of the edges of the wound. In this case it may become necessaiy to enlarge the opening, by the excision of the granulations, sufficiently to allow of the ready re- introduction of the tube. When it becomes desirable to close the wound, the removal of the tube, and the application of an ordi- nary dressing, protecting it only by a pad of antisej)tic oakum, kept in place by a few turns of bandage around the neck, is all that is necessary. Usually, after two or three weeks the cicatrix is complete. The oi^eration of tracheotomy may be accompanied or followed by various accidents : TEACHEOTOMY. 487 ITemorrhage is rare, the small amount of bleeding wliicli occurs proceeding from the division of some of the arterioles, branches of the carotid, passing between the cartilages over the sui-face of the inter-cartilaginous Hgament. It ceases spontane- ously, and never requu-es any special attention. Emphysema of the neck may take place when the cellular tis- sue is very loose and the edges of the skin overlap the tracheal in- cision. It generally subsides without interference, or by moder- ate, regvdated pressure. Tracheocele. — Renault so denominates certain growths which appear on the tracheal mucous membrane, as the result of the ir- ritation produced by the friction of the branches of the tube which come in contact with it. He claims to have noticed their appear- ance six weeks after the removal of the instrument. The nature of the tumor varies much. They may be purulent, but they are more commonly fibrous and of slow growth; and may sometimes take the character of ossification of the cartUages. If these ob- structions appear above the seat of the operation, the trouble is easily remedied by the reintroduction of the tube, but if, how- ever, they are found below that point, it is a more serious com- plication, since it requires a second operation at a point below that of the first. The ohstruction of the trachea by plastic exudation above and below the seat of the operation, or its contraction, caused by the overlapping of the divided ends of the rings which may have been incised, may also be met with, and can only, as in the former case, be overcome by a second operation. We personally remember a case in which the formation of a post-tracheal abscess, which had produced extensive contraction in the calibre of the trachea, proved fatal through the impossibility of the introduction of a tube after a second operation. The patient had been treated sev- eral weeks previously for an attack of strangles, which had re- quired an operation, and some six weeks after his recovery was brought back suffering with a severe attack of roaring. As he entered our hospital he fell to the ground, and the second opera- tion was rapidly performed by a longitudinal incision, but the tubes we had at hand were all too large, and in a few moments the animal died. At the post-mortem a large abscess was found behind the trachea, just opposite the seat of the first operation, and the pus in collecting had so compressed and deformed the 4bb OPERATIONS ON THE KESPIEATORY APPARATUS. trachea that the index finger could scarcely be inserted into the passage. THOKACENTESIS. The usual intention of this operation is the removal from the thoracic cavity of suppurative matter {empyema) or blood or se- rous fluid, by puncturing the walls of the chest. It is indicated in hydrothorax and in some traumatisms of the chest, and when- ever there is a large collection of bloody or other fluid in the thorax; in all cases, in fact, where the ordinary forms of treatment have failed to relieve the patient thus affected. Although extensively performed in human surgery, w^here the advantages and facilities of operating are so many and so manifest, it has naturally proved less beneficial to veterinary patients. And still, though probably in the majority of the cases in which it has been employed the rehef which has followed it has been of only a temporary charao- ' ter, and served only to prolong briefly the life of the animal sub- jected to it, some few cases are on record in which it has given very excellent results. The researches of St. Cyr have, moreover, demonstrated that the operation is perfectly harmless, contrary to the opinion formerly held, and that a large proportion of its fail- ures to effect recovery are due to the fact that its application had been too long postponed to justify a reasonable expectation of success ; when, in fact, it had been deferred imtil the accumula- tion of fluid had already become too abundant, and the pleural membranes had already assumed the condition of a tendency to pyogeny. On this point, Peuch and Toussaint remark that if the punc- ture is made when only the lower thii'd of the cavity is full, and if after the evacuation of the hquid a diluted solution of tincture of iodine is injected into the pleural sac, as is done in human surgery, perhaps more satisfactory residts might be realized. Our own -view, however, is that the disposition of the pleura and of the ca\dties, which they form, would scarcely justify the in- jection. The instruments required are a straight or convex bistomy, and a small trocar, straight or slightly curved. Keul has invented a paracento-injector trocar (Fig. 434), which is used for both the puncture and the subsequent injection of the medical compounds. The use of the aspirator (Dieulafoy) is also recommended. THORACENTESIS. 489 Fig. 434.— Trocar paracento-injecteur de Keul. According to St. Cyr, the proper place for the puncture is between the seventh and eighth sternal ribs, a little above the spur vein, this jDoint permitting the removal of a larger quantity of fluid than any other, with the advantage also of offering a wider space between the ribs, and a dimin- ished thickness in the muscular sub- stance. Unless there are special rea- sons to the contrary, the puncture is made on the right side ; if operating on the left is indicated, care must be taken to avoid injuiing the heart. For this reason the puncture is made between the eighth and ninth ribs, with the point of the in- strument turned backward. The puncture is made with the patient on his feet, and he rarely needs any apparatus of restraint, though it will always be judicious to apply a twitch on his lip. St. Cyr describes the operation as follows : " The operator makes an incision with the bistoury, about one inch long, near the anterior border of the eighth rib or of the ninth, if he is on the left side, dividing the skin and superficial muscular layers until he reaches the internal intercostal muscle, which he leaves intact. In piercing the cavity, he holds the trocar with the right hand, guarding against its entering the chest too deeply by keep- ing his fingers sufficiently near the point to gauge and control its depth through the remaining undivided muscle. What remains then is to withdraw the rod from the trocar, and keep the latter in place while the fluid escapes. Any albumino-fibroid clots, which may enter the canula and obstruct the flow of the liqiiid, may be dislodged by introducing a blunt stylet into the tube. When the canula is withdrawn after the escape of a sufficient amount of fluid, the wound is closed with a single pin suture. The trocar of Mr. Keul is inserted (Figure 434) in the usual manner, with the nut E closed, and after removing the desired 490 OPEBATIONS ON THE KESPIEATOKY APPARATUS. quantity of fluid, the nut F is closed and E is opened. In the funnel D, the diluted tincture of iodine is j)oured and carried into the chest as slowly as the operator thinks proper, where it mixes with the remaiaing portion of the fluid. "When the injection re- turns in the instrument to a level with the little piece of glass C, the nut E is closed, and the instrument removed, thus guarding- entirely against the introduction of air into the chest. In resi^ect to the quantity of fluid that can be safely removed at once, there are varying opinions. Some practitioners hold that the cavity ought to be entirely emj)tied, or, at least, so far as the location of the punctiu'e allows, while others favor the method of discharging the contents by installments. According to St. Cjr, who has exj^erimented very extensively in this matter, the removal of a small quantity is followed by a negative result, the fluid forming again in a very short time ; while, on the other hand, if the entire accumulation is taken away at one time, amounting, perhaj)s, to forty or fifty quarts, it must be at the hazard of encountering, as supervening disorders, syncope, rupture of the j^ulmonary vesicles, congestions, or splenic or hep- atic hemorrhages, with an ultimate fatal termination. The question thus remains unsolved, and if recoveries have been recorded by Lafosse, Jr., Strauss, Massot, Bar and others, failures have followed the operation in the hands of Gohier, Pilger, Bassi, Dieterichs, Prudhomme, St. Cyr, etc. Pelle and Sewell have obtained recoveries when removing all the fluid at once. Our own experience has been negative in the cases in which we have observed both conditions — that of partial, and, as weU, that of the entire removal of the fluid. Supplementing the operation with medicinal injections of some sort has been recommended. Hertwig has used astringent solutions ; Leblanc, Bouley and Prudhomme have favored the use of tincture of iodine, and the following prescriptions, used in human surgery, are recommended by Peuch and Toussaint : Weak Solution — 3 — Tinct. of iodine, 10 parts; iodide of potass., 1 part ; distilled water, 100 parts. This is first used, but, if it fails, the following is injected : Strong Solution — 5 — Tinct. of iodine, 30 parts; iodide of potass., 4 parts ; distilled water, 100 parts. The general treatment recommended for those foi'ms of dis- eases in which these hqoid accumulations originate, must be per- THORACENTESIS. 491 severed in after the thoracentesis, inchiding the counter-irrita- tions, diuretics, tonics, stimulants, alteratives, etc. The operation is performed on the dog also in the same man- ner as on the horse, but either with smaller trocars, or, what is better, with some one of the aspirators recently invented. With this animal the results are more satisfactory on account of the simplicity and unilateral development of the pleuritic effusion. CHAPTER X. OPERATIONS ON THE CIRCULATORY SYSTEM. BLEEDING— VENESECTION. The term bleeding, or venesection, signifies the opening of certain veins for the escape of a portion of the blood, for a ther- apeutical, or experimental pm-pose. If it is designed to reduce the volume of the circulation, it is known as general, and is per- formed upon some one of the larger blood vessels ; if practiced to remove blood only from a given region, it becomes local, and in that case the smaller vessels are divided. A better division is that which is based on the nature of the vessel which is opened, and thus it is phlehotomy, if a vein is opened; arteriotomy, if an artery ; and capillary, or arterio-j^hlebotomy , when the opera- tion is practiced upon the capillary system. There has been much discussion upon the question of the utility of blood-letting, and strong advocates and earnest opj)0- nents, who have argued its benefits and denied its usefulness, and, in fact, ascribed evil results to its practice, whether the depletion affects the general circulation or a limited region. But upon this we shall not enter. Those who maintain its practice consider it to be indicated when it is desirable to reduce the activity of the circulation, or, on the contrary, to stimulate it in parts where, from different causes, it has been temporarily suspended, and to stimulate absorption, or to relieve the organism of foreign ele- ments. It is, however, contra-indicated in aU eruj)tive fevers, in anaemic patients, and in those suffering with typhoid diseases. The old fashion of " taking blood" as a projohylactic measure, or at a certain season of the year, is simply the result of an ignor- ant delusion. The quantity of blood that can be removed must vary, of course, with the size, the nature and the condition of the animal. PHLEBOTOMY. 493 Gourdon recommends the following- scale as representing the aver- age bleeding, proper, for the animals named : The horse, between 4 and 5 pounds ; large ruminants, 5 to 6 pounds ; pig, 1 to 1^ pounds ; sheep, 6 to 9 ounces ; dog, 3 to 6 ounces. PHLEBOTOIilY. Fhlebotomy, or the opening of veins, is the mode universally adopted for general bleeding, and is generally performed upon superficial veins. The instruments necessary are fleams, lancets, scissors, bleed- ing-sticks, pins, pin-holders, graduated jars or vases, and a piece of silk, and, for small animals, bandages. The fleam, made in various forms, resembles a small lancet, and is secured on a steel support received into a metaUic, horn or gutta-percha handle. Ordinarily, two or three lancets of different Fig. 435.— Ordinary Fleam, with three blades. sizes have one common handle, upon which they are so mounted as to be used singly with facility. Some of them, of German make, or of English invention, or of a Belgian pattern, act with a spring, like the phlebotome of Brogniez. The hleedlnrj -stick is simply a stick of hard and hea^y wood, a foot or more in length, with which to drive the fleam into the vein. 494 OPERATIONS ON THE CIRCULATORY SYSTEM. Fig. 436. Fig. 437. Figs. 436, 437, 438.— German and English Spring Fleams. riG. 439.— Fleam of Brogniez. FIG. 440.— Bleeding Stick. PHLEBOTOMY. 495 The graduated vase is to receive the blood, and at the same time measure its flow. In ordinary practice a pail is substituted. The 2^ms must be long- and strong. The pin-holder is used to assist in the introduction of the pin Avhen the suture is made and the bleeding terminated. Sponges and cold water should be accessible. Modus Opekandi. Position of the Animal. — The standing position is the one generally preserved. The animal is held well in hand by an as- sistant, and if he appears to be excited and unwilhng to stand quietly, and soothing treatment has no effect, a twitch is placed on his nose, or a cap on his head. The operation consists of three steps: 1st. Preparation of the Plood Vessel : This consists in a];)j)ly^g' sufficient pres- sure upon it to temporarily interrupt the circulation and cause it to become more prominent under the skin. This is done with the fingers, and some- times AVith a ligature, when the loca- tion of the vessel permits it. In some blooded and thin-skinned animals, a little brisk exercise is sufficient to stim- ulate the circulation and render the veins prominent. 2d. 02)ening of the Vessel. — This is done with the fleam, the lancet or the bislomy. The fleam is more com- monly used for large animals. Held as in figure 441, it is brought opposite the vessel, parallel to its course, and per- fectly perpendicular to it, and at such a distance from the skin as to apjjrox- imate very nearly, but without forming an actual contact with it. When in this position the fleam is made to pen- etrate the vessel by a smart blow with the bleeding-stick on the back of the Fig. 441.— Manner of Holding the Fleam. blade; some practitioners, instead of 496 OPERATIONS ON THE CIRCULATORY SYSTEM. striking with the stick, apply the blow with their hands, hut with cattle, the stick is indispensable. The moment the blow has been appHed properly, the stream of blood escapes freely; when the blow has been too Hght, and the skin only divided, with but a scanty or no escape of the blood, it is called a v:/dte . bleed- ing ; and slahhery when the opening is not large enough for the escape of a full stream, or when the openings of the vein and of the skin are not in apposition, which will be the case if the fleam, instead of being held perfectly perpendicular to the skin, has been held obhquely. The opening of the blood vessel with the spring fleam is performed in the same manner, except that the lancet receives its impulse from the spring instead of the stick. The puncture with the lancet or bistoury should be made with a single stroke of the instrument. In large and superficial veins, the spring lancet is as easily and safely managed as the fleam. 3d. Closing the Blood Vessels and jStojyjnng the Floio. — "When a sufficient quantity of blood has been drawn, and the j)res- sure upon the vein, which has been continued during the flow, is gradually relaxed, the stream ceases, more or less completely. To terminate it entirely, a simple stitch of pin sutm-e is api^lied. It is to be prefeiTcd to all other means, such as pressm-e, bandaging or adhesive plasters. The suture is made by grasj)ing the two edges of the skin with the thumb and index finger of one hand, and sHghtly raising them, then transfixing them with a long pin through their middle, with either the hand or the pin-holder, in- cluding a fair amount of skin, and comjDleting it by a special knot, made with silk or a loop of the long hair of the mane or tail of the animal. In aj^plpng this suture, the skin must not be pulled away from the body too far, nor the knot tied excessively tight. To keep the wound clean and prevent Fig. 442.— Suture after the animal from rubbing off the dressings is aU mg. ^^^ ^^ necessary, for a few hours, after the operation. The wound heals by first intention, and the suture and the pin can be safely removed after twenty-fom' hours. Phlebotomy in Solipeds.. Four of the principal superficial veins are selected for this operation in soHpeds ; the jugular, the cephalic, the subcutaneous thoracic and the internal saphena. PHLEBOTOMY. 497 Phlebotomy at the Jugular. This vein is usually selected on accoimt of its size, its situation, and the facility with which it can be opened, and the wound of the skin closed. It is, however, contra-indicated when the vessel is in any degree diseased, or when the animal is suffering with itching skin diseases. Formed by the superficial temporal trunk and the internal maxillary vein, the jugular descends through the parotid gland to- ward its inferior extremity, receiving several collateral veins, and reaches the groove of the lower part of the neck, which from its presence is called the jugular groove^ until it reaches the lower extremity of the neck, when it enters the chest.' In its course in the groove it accompanies more or less closely the carotid artery, Fig. 443.— Anatomy of the Jugular Vein and (Esophagus in the Horse. J J, Jugular vein; C, carotid artery; O 11, omo-hyoideus muscle; D, oesophagus; S, sterno-maxillariB muscle; M, mastoido-humeralis muscle. 498 OPEEATIONS ON THE CIKCULATOKY SYSTEM. but in the middle third of its length becomes separated from it bj the flat ribbon-like structure of the sub-scapulo or omo-hyoideus, whose fibres pass obliquely between the two blood vessels, from below upward. It is, therefore, in the middle third of the neck that the bleeding at the jugular must be made, in order to avoid wounding the carotid artery. Besides the general rules already stated, this special bleeding requires peculiar measures. (a) Position of the Animal. — He must be kept well in hand, with the head somewhat elevated, and must be prevented from seeing the various movements of the operator, by covering his head with the cap or mask, or by having the eye, on the side of the operator, covered with the hand of an assistant. {b) The fleam is generally employed, the size of the blade vary- ing according to the thickness of the skin and the condition of the blood vessels. The left jugular is generally selected, unless contra- indicated for some special reasons. (c) Preparation of the J^ein. — The application of artificial pressure for the dilatation of the vein is not only unnecessary in solipeds, but has in some cases proved dangerous. In this step of the operation the hand is to be preferred as safer and more reli- able than any ligature or bandage can possibly be. The compression is made with the fingers of the hand which holds the fleam, applying it in the jugular groove, below the point where the incision is to be made. The projection of the vein may be made more distinct by moistening the hair over the spot to be punctured, with a wet sponge. The improper habit to which some practitioners are addicted, of doing this with their saliva, by spitting upon the neck is to be severely condemned. If the bleed- ing takes place on the left side, the pressure must be made with the left hand, the operator turning his back toward the hind parts of the animal. If it takes place on the right side, the pressure is made with the fingers of the right hand. (d) 02yening of the Vein. — Placed as we have described, at the side of the neck of the patient, his back turned toward his hind parts, and pressing with the fingers of his left hand which holds the fleam, as before stated, the operator grasps the bleeding- stick, and striking upon the fleam, opens the vein, and the blood escapes in a good, full stream. Maintaining the pressure on the vein throughout the flowing of the blood, he lays aside the stick PHLEBOTOMY. 499 and the fleam, and attends to tlie flow of the blood into the grad- uated jar, or the pail provided to receive it. (e) Keeping the Stream. — As we have said, the pressure upon the blood vessel must be sustained from the beginning to the end of the operation. Eeheviug it but for a moment is an error, likely to be followed by the introduction of air through the wound into the vein. Not only must it be kept up continuously, but it must be steady. The habit which largely prevails of moving the fljigers or the vase up and down along the vein while the pressure is applied, and with the idea of stimulating the flow of the blood, is most dangerous. If the blood does not escape freely, though the operation has been properly performed, an increased circulation may be stimulated by making the animal move his jaws, or shak- ing the bit in his mouth, or placing the bleeding-stick or a finger of the assistant, into the mouth over the bars, and quietly moving them. (/) "When the bleeding is to be stopped, the operator applies one of his fingers over the wound of the skin and gradually re- moves the pressure made below it. When this has been done, he proceeds to the apphcatiou of the suture, always introducing the pin with the head turned uj^ward, irrespective of the side on which the operation has been performed. {g) Subsequent Care. — This is the same as in other cases, but we may add that an animal that has been bled at the jugular is unfit to work for three days, in order to give time for the wotmd to heal completely. Phlebotomy at the Cephaxic Vein. The cephaUc is one of the terminal branches of the median subcutaneous vein, and runs upward and forward to pass toward the lower extremity of the coraco-radialis, where it crosses the tendinous band which this muscle sends to the anterior extensor of the metacarpus, running in the space which separates the sterno- humerahs muscle from the levator-humeri, and emptying into the jugular, a little in front of the confluent of those two veins. In this coiu'se, the most accessible portion is that which rests on the inferior extremity of the levator-humeri. The fibrous band of the coraco-radialis is the guide indicating its position, viz., a little in- side the forearm, on a level with the anterior and oblique fold which separates the arm from the forearm. 500 OPERATIONS ON THE CIRCULATORY SYSTEM. Fig. 444.— Anatomy of the Cephalic Vein, m, Median subcutaneous vein; b, basilic ■vein; c, cephalic vein; d, inferior extremity of the coraco-radialis; t, aponeurotic band extending from the coraco-radialis to the anterior extensor of the metacarpus; s, ster- no-humeralis; h. mastoido-humeralis; «, space between these two muscles; /, humeral vein. On account of the presence of the other terminal branches of the main vein, from which the cephahc rises, viz., the basihc, pres- sure upon the cephahc does not allow of its dilatation. To obtain this, the animal must be exercised for some time, and when brought to stand still, to raise the opposite leg, or to carry the leg to be bled forward. As the vein is easily displaced from its position, it is hardly PHLEBOTOMY. 501 safe to attempt to open it witli the lancet. The fleam is always preferable. If the bleeding is from the left vein, the instrument is held with the right hand, the operator is placed against the shoulder, fleam having its blade turned downward, the fingers resting against the chest, and with a blow of the stick the vein is opened. This bleeding is often accompanied by the formation of a hematoma over the course of the vessel, due to the fact that very often the fleam has opened the vein through and through. This, however, is not a matter of any serious consequence. Phlebotomy on the Subcutaneous Thoeaoic. This vein rims on the side of the thorax, on a level with the stemo-trochineus muscle, and is readily discovered toward the sixth or seventh rib. To render it more conspicuous, a bandage can be api)Hed around the chest, as suggested by Chabert, or by carrying the leg of the side to be bled forward, and by rubbing hard the tract of the vein, or even by simple pressure with the fingers. The operation can be performed either by a simple puncture with a lancet, or with a fleam, held parallel with the course of the ves- sel, and between two ribs, to avoid breaking the instrument against one of the bones. The bleeding is stopped in the usual way. It is not unfrequently followed by the formation of a thrombus, which generally disappears by pressure, or astringent local appli- cations, and often by spontaneous absorj)tion. Phlebotomy at the Internal Saphena. The comparatively large size of this vein, and its superficial position, both explain and justify the fact that next to the jugular, it is the one most commonly selected for the operation. Fortius reason phlebotomy is indicated here, when it is contra-indicated upon the vein of the neck. The saphena is formed by two branches, and in its course crosses slightly the direction of the tibia in running upward on the surface of the tibial aponeurosis, arri\dng at the flat of the thigh, formed by the short adductor of the leg, and then dips in the space left between this muscle and the long adductor, where it empties into the femoral. In this course the vein is superficial, covered only by a thin skin, from which it is separated by a thin ajjoneurotic layer. It is at a point where the vein i^asses over the 502 OPERATIONS ON THE OIKCULATOKY SYSTEM. Fig. 445.— Anatomy of the Internal Saphena Vein, s, internal saphena vein; e, its anterior root; t, its posterior root; /, femoral vein; g, deep inguinal lymphatic glands; c, short adductor of the leg; I, long adductor of the leg; a, subcutaneous aponeurotic layer; r, fascia lata. flat of the thigh that it must be oi^ened. If the operation is per- formed with the fleam, the higher the better ; if with the lancet, it can be done as the vein passes over the tibia, where it is more accessible. In oj)erating, the leg opjoosite the one to be bled is held uj) and backward by a strong assistant, in the posture of the black- smith about putting on a shoe. PHLEBOTOMY. 503 If tlie lancet is used, the operator, placing himself on that side also, bends down, and, looking from under the abdomen of the horse, brings the instmment close to the vein, opening it by a rapid stroke, and enlarging the orifice by a slight incising motion of the instrument. If the fleam is used, the operator assumes the same position, and applies it precisely as has been described in the cases akeady considered. Operating on the right side he holds the fleam with the right hand and strikes with the bleeding-stick in the left, and vice versa. This position of the operator is awkward, and not without danger, exposing him to the chances of a blow with the stifle of the leg which is held by the assistant. To avoid this, Peuch and Toussaint suggest that the assistant, instead of holding the leg backward, should carry it forward, and that the operator should place himself behind the animal. It is also claimed that in that position the vein is more easily exposed. The operation is per- formed in the same way, except that the instrument is held with the right hand if one operates on the left leg, and with the left hand if the bleeding is done on the right leg. The flow of the blood in this bleeding is generally slabbery, and the introduction of the pin of the suture quite painful, and means of restraint are, therefore, often necessary before the ani- mal will submit to the application of the suture. Phlebotomy on Other Supekficial Veins. Others, besides the veins which have been described, are also subject to phlebotomy, but its performance is more with some local object in view than that of a general bleeding. All are performed with the lancet, the region (Fig. 446) where they occur being at the transversal of the face, a ; the angular of the eye (b) ; the facial or glossofacial, d ; the sxqnrficial nasal, (c) ; the posterior auricular (e) ; the deep lingual; the inferior caudal, and the median sxibcutaneons of i\\.e forearm. If required by their size and position a pinned suture is applied after the bleeding, but in several instances pressure alone is sufiicient. Phlebotomy in Large Ruminants. The operation is confined to two principal veins of the large ruminants. These are the jugular and subcutaneous abdominal. 504 OPERATIONS ON THE CIRCULATORY SYSTEM. c Fig. 446. PHLEBOTOlVrY ON THE JuGULAE. It is performed in the same manner essentially as in the soli- peds, and with the same instruments. But as cattle are less sub- missive to the preparations which precede the operation, means of restraint must be used with them, and they must be tied to a tree or a post. The jugular of cattle has thicker walls than that of sohpeds, its diameter is much greater, and it is separated from the carotid in its whole length by a thicker layer of muscle. For these reasons a larger fleam becomes necessary. To dilate the vein a strong ligature is applied tightly on the neck, the j)res- sure of the fingers never being sufficient to furnish the necessary force. To open the vein the blow of the stick must be heavier, and w^hen properly given is followed, as in soUpeds, by a strong stream of blood, which rapidly ceases when the hgature is loosened or removed. It is not always necessary to apply a pinned suture, but it is always safer and more prudent to do so, though the in- troduction of the pin is rendered difiicult by the toughness and thickness of the skin. The value of the pin-holder is demon- strated in this case. The thrombus which so often follows this operation is not serious, and, in fact, its formation is stimulated by some practi- tioners. Phlebotomy at the Subcutaneous Abdominal. This vein is of enormous volume, extending from the udder to the xyjohoid cartilage of the sternum, at the side of the abdomen, PHLEBOTOMY. SO.": •to terminate in the internal thoracic vein. It is, therefore, easily recognized, and particularly so in milch cows, and it is, therefore, unnecessary to use the ligature or any other means to swell its dimensions, the pressiu'e of the fingers being more than sufficient. A fleam of medium dimension is preferable to the lancet in this case. The animal is firmly held by the head, and to prevent his kicking, is pulled forward by its tail passed between its hind legs. In opening the vein the operator places himself forward of the shovdder, his back turned toward the head of the animal, holding the fleam with the hand corresponding to the side of the animal against which he is placed. The bleeding is stopped with a pin, or, what is better, a bandage, to prevent the formation of a thrombus. Phlebotomy on Small Animals. Bleeding is seldom performed on sheep. When it is indicated it is performed on the /acial, the jugular, the cephalic, or the ex- ternal saphena. The vessel is opened with the lancet, the wool, Fig. 447.— Position of the Facial Vein in Sheep. if necessary, having been clipped off from the place of pimcture, and the wound is closed with a pin suture. In svnne two sets of veins are eligible for the operation, the posterior auricular, as it runs at the internal face of the ears, and the external saphena, where it passes along the tendo Achilles. The lancet is used upon both. The first stops bleeding without help ; the second is closed with the pin suture. In clogs, ihe jugular is sometimes opened. This vein, from its position, requires the application of a string around the neck to swell the vessel. The puncture is made with a small fleam or a lancet, and the wound closed with a pin. The external saphena 506 OPERATIONS ON THE CIRCULATORY SYSTEM. being quite large is cliosen in preference to the internal, wluch is very small. The place of selection is the superior part of the vem, when it nearly reaches the posterior border of the leg. A bandage is applied to stop the hemorrhage. The cephalic might be opened as it passes toward the interior third of the humerus, the wound being closed by a stitch of twisted suture. ACCIDENTS OF BLOOD-LETTING. The operation of blood-letting may be followed by several complications, some being of little importance, while others may be sufficiently serious to compromise the life of the patient. Among them may be named : The white and the slabbery bleed- ing ; wounds of surrounding non- vascular organs ; the thrombus ; inflammation of the vein, or j)hlebitis ; wound of the carotid, and the introduction of air into the veins. Others, such as the lesions of nerves, syncope, etc., are seldom, if ever, encountered in veter- inary practice. 1st — White and Slabbery Bleeding. It is a question whether these, properly speaking, should be classed among the true sequelae of blood-letting. We already alluded to them when describing the various methods of perform- ing phlebotomy. They are often the result of the disposition of the parts, the vein being deficient in size, or more deeply situated than natural, and thus imbedded in the loose suiTOunding cellular tissue ; or, perhaps, the cause is an imguarded movement of the animal ; and it is often known to be the imperfect manipulation of the surgeon in stiiking the fleam too lightly, or not vertically, and so failing to bring the openings of the skin and the vein into exact coaptation. These accidents are, however, of an unimportant character, and are easily obviated by exercising more care and deliberation. 2d — Wounds of Surrounding Non- vascular Organs. (a) Wounds of the Trachea. — The improper action of the surgeon is generally chargeable with this accident. He may have erred in using too large an instrument, or the error may have con- sisted in making excessive j^ressure when ligating the neck with the cord used to eff'ect the distension of the jugular. It is a rare ACCIDENTS OF BLOOD-LETTING. 507 accident, but may be easily recognized by tlie flow of blood wliicli escapes through the nostrils, and possibly by the changes which may affect the respiration by threatenings of strangUng, suffoca- tion, etc. In this serious case the hgation of the blood vessel is the only means of stopping the hemorrhage. (b) Wounds of the Caudal Muscles. — This is comparatively a common accident with cattle, but is seldom attended with symp- toms of a serious character. The principal danger consists in the possibility of the formation of fistulous tracts, more or less re- bellious to treatment, as besides the muscles, the tendons, and even the bones may have been injured by the instrument. 3d — Thkombus, This is understood to be a bloody tumor, or hematoma, which is formed around the opening of the veiu by the accumulation of the blood ia the surrounding cellular tissue. It appears when the opening of the vein does not accurately correspond with that of the skin, or when the iucision of the tegument is too small to allow a free flow of the blood through it. It often appears when the animal is allowed to rub himself after the operation, or when the opening of the vein has involved a section of one of the valves. Some veins, as the saphena, the cubital, and the subcutaneous thoracic, are more exposed to thrombus than others, even when the operation has been well performed and completed. At these veins, they are generally not serious, and are readily subdued by simple treatment, if they do not spontaneously disappear. But the thrombus, which is sometimes encountered at the jug- ular, is of a more serious character, and is not unfrequently com- plicated with phlebitis. The symptoms of this lesion are essentially local, and the symptoms and the disease are, in efiect, one, consisting of a tumor of uncertain, dimensions, according to the quantity of blood col- lected vmder the skin. In the beginning it is roiind, well circum- scribed, soft, and slightly elastic to the touch, but the swelling soon becomes hard, perhaps oedematous, or somewhat diffused, when it has been caused by rubbing on the part of the animal. The simplest cases gradually disappear after two or three days. But at other times they are not so tractable, and serious trouble may ensue, the tumor becoming stationary, or perhaps increas- ing in size, and then changing its character. It becomes warm 508 OPERATIONS ON THE CIEGULATOKY SYSTEM. and painful, assumes aspects of a phlegmonous nature, and per- haps becomes complicated with hemorrhages. It is not yet too late to look for resolution, but if it does not soon take place, and if the symptoms increase, and the swelling extends, the veiu is changed into a hard, large cord, and a case of phlebitis is estab- lished. Absorption and resolution are now the two most favorable ter- minations of thrombus, but they are of unusual occurrence, except when the tumor is of small size, and j)romptly attended to. Suppuration is the more common event, and if this continues to be superficial, recovery may be looked for without obHteration of the vein. JPhlebltis, which commonly accompanies a deep suppiirative thrombus, is always a serious termination. Abscess of the throm- bus, however, may assume various modifications, and may pass to a chronic condition, or that of induration, or one of still more serious nature, that of gangrene. When it has become developed, the animal must be immedi- ately secured to prevent him from rubbing the parts, and as early as possible the treatment should be directed to the limitation of its development and the promotion of its absorption. Local ap- 23lications of cold water ; astringent compresses, moistened with vinegar or lead solutions ; povJtices of clay, of soot, or of chalk, mixed with vinegar, will very often be sufiicient to control or re- move the growth. Sometimes, however, the absorption will be more effectually stimulated by frictions with cantharidis oint- ment, and in a week or ten days the thrombus will have entirely disappeared. The Girard ointment, of Venice turpentine and bichloride of mercury, is sometimes also very effective. If the tumor assumes the nature of an abcess, and this re- mains superficial, it may be opened with the bistoury, or the actual cautery, and should hemorrhages occur they must be principally controlled by pressure. 4th — Phlebitis. The first effect of the inflammation of veins is the coagulation of the blood and the formation of a clot in a given length of the vascular canal, adherent more or less to the walls of the vessel, the residt being the partial or perhaps comi:)lete obliteration of the vein, and hence a certain disarrangement of the cii'ciilation, which ACCIDENTS OF BLOOD-LETTING. 509 may be supplemented by the anastomotic action of collateral ves- sels above and below the occluded portion. Or, again, the circula- tion may be entirely obstructed, and, as a consequence of the in- flammatory changes, adhesions follow, between the clot and the venous wall, the clot being resorbed, and the obliterated vein transformed into a fibrous cord. So long as the inflammation is limited to the internal wall of the vessel, phlebitis is known as adhesive ; but if it extends to the external or even to the middle structure, and becomes suppurative^ it is so distinguished. Either of these forms of the disease may be changed by a third modifica- tion to that of hemorrhagic phlebitis. These three forms or diver- sities of the disease have been established by Peuch and Tous- saint, whose views touching the treatment of the affection we also reproduce, referring our readers for the pathological history of the lesion to the various works relating to it. 1st. Adhesive Phlebitis. — At the beginning of the disease, the animal must be placed under such conditions as wiU tend most favorably to influence the process of organization between the clot and the venous walls, and to prevent the estabHshmeut of suppuration. To effect this object, the enforcement of a state of immobility in the patient is most essential. His head must be firmly secured on both sides, and his mastication made as easy as possible, by suitably regulating the consistency of his diet, in order to diminish the force of the circulation, and so far obviate the danger of the displacement of the clot and possible resulting hemorrhage. The diseased parts should be treated by local ap- pHcations, among which lotions of lead water, with continued cold water irrigations, will give excellent results. But ointments of any kind should be avoided, especially in warm weather, from their liabiUty to become rancid and irritant, and to stimulate the patient to rub himself. The use of cooling applications must be perse- vered in, in preference to the frictions with vesicatories, which, especially in nervous animals with tender skin, might be liable to encoiu'age the suppurative process. In tougher-skinned animals, and those of a lymphatic temperament, in which the inflammation has a tendency to become chi-onic, resolvents, blistering, liquid liniments, and alteratives are indicated, and of these, and first in order, must be named cauterization with the red iron. The conical cautery is applied on closed, fine points, and arranged quintuply, every second point being deep, while the others are 510 OPERATIONS ON THE CIRCULATORY SYSTEM. only superficial. By this peculiar mode of firing the absorption becomes greatly stimulated, and the resorption of the tumor very rapid. Cauterization, however, if beneficial in chronic, is not so in acute cases, having in the latter a tendency to be followed by sup- puration, 2d. Snppuratwe Phlebitis. — For this form of this serious af- fection several modes of treatment are pro2:)osed. {a) Expectant Treatment. — This is the plan by which the j)hy- sician or surgeon, administering palliatives only, trusts to the vis conservatrix for cure, watching meanwhile the development of the disease, and waiting for and expecting the guidance of nature in respect to his own interference. (J) Simple Incision. — This is the simplest of surgical inter- ferences, and means nothing more than the opening of the abscess, the enlargement of the fistulous tract, and the formation of an exit for the pus and coagulated blood which it contains. This is done with an ordinary bistoiuy, guided by a probe or grooved director. (c) Injections. — The fistulous tract which exists on the phle- bitic tumor is washed with a detersive injection of solutions of tincture of iodine, or perchloride of iron ; or of corrosive subli- mate, from 5Uff to TTsVff. These are intended not only to remove any remaining clots softened by the suppuration, but also to stimulate the granulations and the cicatrization. {d) Enlargement of the Fistula and Introduction of a Seton. — An S probe is introduced into the fistula, and when it has reached the upper part of the swelling formed by the vein, close to the obturating clot (which must not be disturbed), an incision is made over its blunt end to enable it to pass out through the skin. The fistulous tract is then enlarged with the straight bis- toury from below upward to a small extent, and between the two openings a small seton is passed by means of the probe, and se- cured in place by knotting the ends. The movement of the seton by drawing it to and fro, effects the removal of such portions of the clot as may remain in the wound. {e) Enlargement of the Intra Venous Fistxda in its Whole length. — This consists in opening the tract from its commence- ment to its superior cul de sac, as far as the adhesion between the clot and the vein extends, the incision sometimes reaching below the ojDening made by the fleam. Thus exposed, the tract ACCIDENTS OF BLOOD-LETTING. 511 is washed out with the tincture of iodine or perchloride of iron solution, or even destroyed with the actual cautery. The last two forms of treatment, however, are dangerous, from their liability to occasion consecutive hemorrhages. 3d Ilemorrhagie Phlebitis. — The most serious incident of phlebitis, proceeding, as it does, from both the adhesive and the sujjpui-ative forms, is the more or less abundant hemorrhage, which, resulting from any of the various causes which have been mentioned, may interfere with the cicatrization or obliteration of the venous wound. Three modes of treatment are j^racticed for their suppression. These are the twisted and the quilled sutiu'e, and the ligation of the vein. {a) The Twisted Sutiire. — This consists in the combination of several (two or three) long pin sutures, placed upon the wound made by the fleam, and including a larger portion of the skin at the sides than the single pin suture of an ordinary bleeding. Sometunes wooden pins are substituted for those formed of me- talHc material, and when the sutures are completed, the wound is strengthened by a coating of some strong, adhesive mixture. Some practitioners, however, prefer to this the application of a severe blistering friction, which, by the pressure of the swelling which it produces upon the internal circumjacent parts, secures practically all the effects to be obtained by a compressive bandage. (b) Quilled Sutures. — These are applied on each side of the wound, securing a good hold by placing them at some distance from the edges, and embracing tightly between them a thick por- tion of the skin. This point is important, for the reason that this portion of skin is destined to be sacrificed by being left to slough off, and this must not take place until the obhteration of the wound is entii-ely completed. (c) Ligature of the Vehi. — The success of this operation, to be assured, requires the selection of a healthy portion of the vein on which to place the Hgature, even if it become necessary to look for it among the original roots of the jugular, viz., the facial and the glosso-facial. In performing it, the animal must be seciu:ed in the recumbent position. A single incision is made through the skin, the whole extent of the obliterated vein, jiarallel to its axis, and the vessel exposed and sej^arated from the surrounding tissues. The separation, which requires skillful and cautious manij)ulations, can be effected by means of either a dii-ector or a long probe. It 512 OPERATIONS ON THE CIRCULATORY SYSTEM. will be no more than a wise precaution to apply a second ligature below the clot, to prevent the possibility of the escape of suppura- tive matter into the general cu'culation. The material of the ligature may be either ordhiary linen cord or silk. Our own pref- erence is for sterilized catgut. The resulting wound is treated in the manner proper for all similar wounds, and in from twenty to twenty- five days complete recovery may generally be looked for 4th. Wound of the Carotid. — This compHcation of phlebotomy at the jugular is not of common occurrence, but is easily possible. It may become one of the consequences of using a fleam unneces- sarily large, and out of proportion with the dimensions of the vein and the thickness of this skin ; or it may be caused by the exhibi- tion of needless violence, in striking too heavy a blow with the bleeding- stick. Nor are these the only causes to which wounds of the carotid may be referred. An abnormal anatomical disposition of the artery, either permanent or temjsorary, may cause it to re- ceive the wound designed for its neighbor the jugular. The symptoms pertaining to this accident are very character- istic. The color and volume of the blood, and the rapidity of the per saltum flow of the stream are sufficient evidences of the arterial and non-venous source of the hemorrhage. Concurrently with this, a swelling takes place around the edges of the wound, increasing with greater or less rapidity, and nearly resembling the ordinary thi'ombus of venous extravasation, though dififering from it by the rapidity of its formation. This false aneurism is now subcutaneous, and has a tendency to extend itself downward toward the lower part of the neck, and has, indeed, been found extending as far as the entrance to the chest. This accident is generally one of a serious nature, not alone in itself, but often because of the specific manipulations which it necessitates in order to overcome it. There are, however, several fatal cases on record. The indications of treatment may be either quite simple, or, at times, of serious import. If the puncture of the artery is but a small one, and the flow not abundant, one or two strong pin sutures may be sufficient to control it, esjjecially if associated with it steady and firm pressure is estabUshed du-ectly upon the com-se of the vessel, either by compressive bandages, or, what is better, with the fingers firmly pressing in the jugular groove. If, however, the wound is large, and accompanied by a ACCIDENTS OF BLOOD-LETTING. 513 correspondingly profuse hemon-liage, it becomes necessary to have recourse to the direct appHcations of a Hgature. A description of this operation will be made the subject of our chapter on hemostasia. 5th. Introduction of Air into the Veins. — This is one of the most remarkable of the accidents attending the operation of phle- botomy. The phenomenon has been observed as early as the seven- teenth century, but it was not until 1806 that it was observed and recorded as belonging to the category of casualties connected with the familiar act of blood-letting in an animal. The first author to put the occurrence on record in this connection was Verrier, who reported a case in 1806, and he was soon followed by others with accounts of their experience with the same lesion and operation in human practice. There are two principal causes to which this accident can be attributed. One of these may be an unnecessarily large aperture in the vein, but more commonly it follows improper manipulations on the part of the surgeon, particiilarly the irregular pressure made upon the vein during the flow, by many practitioners, who have formed the habit of rubbing the vessel along its length, under the erroneous idea that by this movement they accelerate the bleeding. Again, and perhaps principally, the casualty may be the result of neglecting to close the wound of the skin with the finger below the point from which the current proceeds, before the pressure iipon the vessel is stoj^ped. The occurrence is made known by a peculiar gurgling sound, which is made more evident by auscultation of the heart. In the meantime, the animal is attacked by shiverings; the respiration becomes accelerated ; there is a rapid heaving of the flanks ; the body becomes covered with perspiration ; the action of the heart is quickened; the countenance becomes anxious; the animal is seized with convulsions ; falls down and dies, unless by the con- tinuance of the flow through the open vein the air may be carried out through the same channel by which it entered, or unless the quantity has been very minute. As the result of our own study, tested by many experiments, we have become strongly inclined to believe that the quantity of air necessary to produce death must be very large, more, in fact, than a careful operator would allow to enter without attempting to j^revent it. The possibHity of the occurrence of this accident may easily 514 OPERATIONS ON THE CIRCULATORY SYSTEM. be obviated, seeing that it merely requii'es careful attention to the execution of the few details which constitute the act of vene- section. But when it has taken j^lace, the simplest and most ob- vious thing to do is, if possible, to remove the air from the vessel in which it has intruded. The means of effecting this consists ia reopening the closed vein, and permitting the blood to resume its flow. The loss of three or four pounds of blood additional is usually sufficient to insure the escape of all the air. Gourdon recommends, in addition, showering with cold water, stimulating frictions, and even, if the case seems to require it, artificial respiration. ARTERIOTOMY. Bleeding from an artery is so termed to distinguish it from phlebotomy. It is not commonly used in practice, being princi- pally resoi-ted to as a means of local depletion, and is performed only on some of the most suj^erficial of the vessels. In fact, there are but three of these eligible by their position to the operation. These are the transveral of the face, the 2)oste7'ior auricnlar, and the middle caudal. The 7nodus operandi differs but httle from that of phlebot- omy, except that there is usually no need of the apphcation of ar- tificial means to swell then- bulk or increase then* rotundit}', their position, and theu' distinct and characteristic pulsation, so readily detected, sufficiently revealing their location and course. In open- ing arteries the fleam is seldom used, the lancet or a pointed bis- toury being a much more eligible instrument. The incision of the vessel is made across its course instead of longitudinally, as ia phlebotomy, and the flow of blood must be arrested by means of pressure with compresses or bandages. (a) Bleeding at the Transve?-sal of the Face. — Though the position of this artery is nearly correspondent in all animals, it is principally with soUpeds that it is chosen for blood-letting. It is situated below the temporo-maxillary articulation, and crossing the direction of the fibres of the masseter muscle, where it is cov- ered only by a fine skin, it is opened at the same level with the place where phlebotomy is usually performed. Some operators prefer casting the animal, others the standing position. The appearance of the vessel is that of a small, round pulsa- ting cord, and, as before stated, it is incised, not as the veins and ARTEEIOTOMY. 515 opened, but in the direction of its axis. The stream differs from that which flows from a vein, and instead of issuing with a regu- lar flow, escapes per saltiim, or by alternating leaps, synchronous with the action of the heart. It also differs from that of the veins in color, being of a lighter and brighter red. As the apjplication of a pin suture will scarcely be sufficient to perfectly suppress the flow, pressure must be resorted to, either by direct apphcation over the posterior border of the maxillary bone, or over the place where the artery passes, or by covering the incision with a pad of oakum, retained by means of a circular bandage passing by sev- eral tm-ns over the upper part of the head. The animal should be tied up for several days after the bleeding, or until the closing of the artery is fully assured. {b) Bleeding at the Posterior Auricular. — Though the trans- versal of the face can be opened in large ruminants, as well as in horses, arteriotomy in those animals is more commonly performed upon the posterior auricular, where it is attended by aU the con- ditions of size and position required to serve the convenience of the surgeon. In cattle, upon which it has been practiced for both its general and local effects, it has been, recommended in diseases of the brain, and for affections of the eyes and other parts of the head. The posterior auricular runs under the j^arotid gland from the base of the concha upward on its external face, near its supe- PlG. 448.— Anatomy of the Posterior Auricular Artery in Cattle. 516 OPERATIONS ON THE CIRCULATOKY SYSTEM. rior border, where it loses itself. It is most superficial toward the base of the cartilage as it issues from under the posterior cer- vico-aui'icular muscle. The oiDeration is comparatively simple. The animal being firmly held or tied to a post or a tree, hard friction is api^Hed to the ear to stimulate the circulation and render the artery more promi- nent. The concha is held by the left hand, with the index finger in front and the thumb behind the artery, the incision is made by piercing the vessel with the lancet held perpendicularly to the concha, the artery being cut directly across, and the incision en- larged by a downward movement of the instrument. This is fol- lowed by the appearance of a few drops of arterial blood, but which soon stops unless the flow is assisted, which is done by the operator, without releasing the ear, by striking light blows or taj^s with a small stick along the course of the artery between the in- cision and the animal's head. This last step is indispensable to obtain a good, free flow, ^)er saltum, of course. This whipping process is continued imtU the stream becomes abundant, but may be susjoended when it reaches that point, to be renewed again, however, if the hemorrhage diminishes. Artificial means to close the incision are not usually required, the flow generally ceasing spontaneously, but when that fails to occur a pin suture or a bandage at the base of the concha, or finally the Hgation of the artery, if necessary, will efi'ect the object. The animal must be kept confined for some time, to prevent him from rubbing the wound or shaking his head too violently. In surlne, this artery is so easily reached that it is often se- lected in preference to other blood vessels which may be more or less imbedded in the fat of the animal. The knowledge of its position is very important, as it is very small and difficult to find. Running vertically between the temporo-maxillary joint, it reaches the base of the concha, and passes by the side of its convex sur- face towards its point. It must be opened at the lower third of the cartilage, where it presents its largest dimensions. The artery must be cut transversely with the lancet. The bleeding ceases spontaneously, or, if necessary, may be treated in the manner in- dicated for cattle. (Fig. 449.) (c) Bleeding at the Median Caudal. — In cattle this artery is quite large and very superficial. It runs along the inferior face of the tail, being covered at the base of that organ by the inferior CAPILLAKY BLEEDING. 517 Fig. 449.— Anatomy of the Posterior Auricular Artery in Swine. caudal muscles, then becoming superficial and readily accessible to the end of the member. In opening it, it is pierced by the lancet in the longitudinal axis of the vessel, the tail being kept elevated. Ordinarily, however, not only is the artery cut directly across, but the skin or surrounding muscular fibres are included. The incision must be made on a level with the superior third of the tail ; higher up the operation may be complicated with abscess, disease of the vertebrse, sloughing of the tail, etc. If it becomes necessary to stimulate the flow of blood the same "whipping" process may be employed that was recommended in bleeding from the posterior aui'icular. A bandage may be appHed round the tail to stop the hemorrhage, though it is not commonly needed. A few practitioners prefer to operate with the fleam. CAPILLAEY BLEEDING. The consideration of the operation which consists in the de- pletion of the minute extreme vessels naturally and logically fol- lows that which treats of a kinth-ed procedure with the veins and arteries. The intention of the treatment instituted for all is the same, and their curative efi^ects are adapted to similar ailments. These are principally local, and may be divided into two classes, to wit : those which have been in a great measure discarded from general practice, and those which still retain their place in the domain of veterinary surgery. The former includes bleeding at the palate, the coronet, and the foot, and the latter comprehends 518 OPERATIONS ON THE CIRCULATOKY SYSTEM. the punctures, tlie scarifications, the veiitouses, or cupping, and the leeching, of regular current practice. (a) Punctures and Scarifications. — These are methods of producing small suj)erficial wovmds through the skin and the sub- cutaneous cellular tissue, to obtain the effect of a local bleeding, or the escape of any other fluid contained in the subcutaneous substance. They are indicated against local swellings and serious effusions, or oedema of the cellular tissue. They can be apphed ujDon any part of the body, and though they take effect in the escaj)e of but small quantities of fluid, their action may be stimu- lated by additional local appHcations, such as warm poultices, warm water fomentations, or diy, stimulating frictions. Punctiu'es, however, are principally effective when employed to overcome cedematous sweUings of the extremities, and of the genital organs, while scarifications are prescribed with better ad- vantage to obtain the resolution of cold or chi'onic swellings, or to control the Inflammatory process in cases in which the tissues are largely swollen and threatened with gangrene. Both the bistoury and the lancet, and, in rare instances, the fleam, are used in fulfilling these indications. In making punctm-es the skin and cellular tissue are pricked or pierced to the depth required, with the bistomy or lancet, by rapid thrusts distributed over the entu'e sui'face of the swelling, and when the fleam is used it is manipulated precisely as when used in bleeding, though, of course, with qmck repetitions. (5) Scarifications may be defined as rather small incisions, made with a convex bistoury, with which the skin is cut from without inward, in parallel series, but which, in some instances, when an increased effect is desired, are doubled by a second series crossing the first at an angle. (c) Cupping. — This mode of obtaining capillary bleeding is very seldom employed in veterinary practice. The cups are, how- ever, indicated in subcutaneous inflammations, accompanied w^ith sweUings, and resulting from blows, contusions, kicks, and other and similar traumatic causes, and are often preferable to blisters. They are recommended in arthritis, ostitis, and even in internal phlegmasia. They render valuable aid in emptying some forms of abscesses, and are credited with the possession of power. to arrest or prevent the absorjition of virus introduced into wounds or deposited on then- surface. CAPILLARY BLEEDING. 519 There are two modes of cupping, the dry and the scarified, or •wet. The dry cup consists in the simple appUcation of the in- strument upon the skin to produce a sweUing, accompanied with more or less injection of the capillary vessels, and a local irrita- tion, which generally rapidly subsides. The operation of scarified cupping consists, first, in applying the instrument to produce the swelling, and when the tumefac- tion is sufficient following it with the scarificator. In completing the first step, which is the same as for the dry cuppings, several means are used. The skin being prejjared by clipping or shaving off the hair, a small glass globe, filled with heated air, is placed over the spot selected for the operation. A small ball of wadding or oakum, either dry or moistened with an inflammable liquid, is placed in the glass and lighted, and as it begins to burn the glass is pressed upon the skin. To avoid burning the skin, pumping, or vacuum-cups, have been devised, some of which are provided with scarificating blades. These are, however, too complicated for our general practice. When the effect of the cupping is com- pleted, the red and tumefied skin, which is exposed as the glass is removed, is scarified with instruments ad hoc, as the lancet or the bistoury, and the cup is immediately reapphed over the same spot. The blood then escapes freely from the incisions, and con- tinues to flow until the cup is filled and removed. {d) Leeches are not as frequently used in veterinary surgery as they might be with profit. They are well adapted to small animals, such as dogs, whose fine and vasciilar skin yields readily to theii- appHcation. For applying them the skin is first smeared with a little milk, sugai', or blood, and the leech, placed in a small glass, or cup, or clean pill-bok, is brought in contact with the skin by reversing the cup or box upon the chosen place. Usually it attaches itself at once, and remains until it becomes gorged Avith blood, when it voluntarily releases its hold. Sometimes, however, it is better to place them upon a thick compress, moistened with tepid water, and to apply this over the skin. In appl;ving them on the leg it is a good plan to cover them with a cloth, secured with a string tied about the leg above and below, formiog a sort of bag. When the animal fails to drop off, after being thoroughly gorged, a sprinkle of salt speedily causes him to release his hold. The succeeding hemorrhage will ordinarily cease after a short )20 OPEKATIOXS OX THE CrRCULATOET STSTEXI. time without aiJ. but if it is desii-able to continue it. the parts may be fomented with wai-m water, or covered with a wai-m poultice, (t) Jjhtdhig at the JPalate. — Bleeding in this region of the mouth is done by a division of the capillai-y network which rests between the mucous membrane and the fibrous coat which liaes the bones forming the palate. The bones rejDresented by the inferior face of the palatine pro- cess of the great maxillary bone, and the posterior face of the short j)rocess of the anterior maxillai-y, ai'e covered with a fibrous coat, which extends over their whole sui-face and the cartilage that fills up the incisive sHt. On each side of the palate i-un the palato-labial ai*teries, which, forward, form an arch, and anastomose together, and give rise to a single branch, which enters the in- cisive canal formed by the internal face of the two small maxillaiies. The veius, which are veiy numerous, foi*m a lai-ge network which fills the space left between these two large ai'teries. The whole is covered by the mucous membrane, which is white, rosy, thick, adherent to the fibrous coat, and showing a number of mgse, about twenty, curved forwai'd and diminishing posteriorly in size and prominence. Anteriorly they are very lai'ge. by reason of the presence of a certain amount of ceUulai- tissue, which di- minishes by degrees, from before backward. The anastomosis of the ai-teries takes place about on a level with the thii'd rugae of the palatine sui'face, and it is, therefore, posterior to this that the bleeding must be per- formed to avoid wounding the arteiy. The instrument required is the simple bistoury, or the one rep- resented in figure 451. The operator, facing the animal, and hold- ing the tongue with the left hand, draws it out of the mouth on the right side, and with the edge of the knife turned backward, makes a small incision from before backward, in the middle of the palate between the fourth and fifth rugse. There is no danger of wounding the arteries if the incision is made at the proper place and on the median line. 'When that is the case, the hemon-hage, continuing for a variable length of time, subsides by degrees. Fig. 450.— CirciOation of tlie Palate, mn. Pala- tine mucous membrane «, grooves of tlie palate; a, palato-labial artery. CAPILLAKY BLEEDING. 521 Fig. 451.— Lancet to Bleed at the Palate. If, on tlie contrary, an artery has been cliyided and the flow of blood becomes sufficiently abundant and continuous to become alarming, it becomes necessary to employ hemostatic means. These may be a small sponge comj)ressed or moistened with cold water or an astringent solution ; or, if necessary, a pad of oakum can be aj)plied and secured with a bandage passed through the mouth and around the maxillary bone, and tied on the face. It can also be accomphshed by means of a peculiar bit, represented in Fig. 452. This bit has a small board in its middle, and on each side of the bar two straps, one to act as the check-piece of a bridle, the other being passed over the nose where they are buckled to- gether more or less tightly. The board of the bar is padded, and p,^^ 452. -Apparatus to Apply Pressure is apphed directly over the place *« "'^'"p *^® Bleeding at the Palate, of the incision. The pressure should be continued for several hours. This operation was first recommended in cases of stomatitis, in the pecuhar form known by the unmeaning name of kanjKis, but is resorted to for a much better pm-pose in apoplectic conges- tion of the head. (/) Bleeding at the Coronet. — In the " Dictionary of Veteiin- ary Medicine and Surgery," Bouley says : " There exists on each side of the coronet, a rich superficial venous plexus resting on the cartilaginous plates of tha foot, formed at this point by the union of numerous veins of the digital region. These veins are united by large communicating vessels, nmning on the anterior and posterior faces of the second phalanx. Nothing is easier than to open one of these vessels by plunging the point of a bistoury through the skin ; the puncture being followed by an abimdant flow of blood, and, if it is repeated, a large bleeding, quite as abundant as that obtained by the opening of another large vein, 522 OrER.\T10Xi« OX THK CTKOri-VT«"tKY SYSTEM. can be gaiueil. But it is not a matter of indifference wbetlier the pmiotiu-e is made in fivnt or behind, or upon tlie sides of tlie re- gion. It must never be made on tlie sides, because of tlie danger of iujui'iug the cartilj^e, sevenvl Ciiises of cai'tila^iuous quittor having been known whicli were attributable to no other cause than bleeiling on the side of the coronet. In front the opersitiou is less dangerous, j\lthough a wound of the tendon of the smterior exten- sion of the phaliuiges is possible. It is safer to bleed on the pos- terior pai't of the coronet, where no djinger can be looked for. This bleeding has been principiillv recommended jis a local opei'ation in cases of acute laiuinitis. (f/) JSh'f I >»j.i. niii .^ I t-i.^ . u. i:-\ ■'%- % 524 OPERATIONS ON THE CIRCULATORY SYSTEM. operations of considerable magnitude, the means of subduing it should always, especially in cases of that class, be included among the customary instruments and appliances of the working surgeon. The flow may proceed from any of the blood vessels, the arteries, however, from the nature of then- functions and the force of their action, requiriag more frequently and more particularly the appli- cation of precautionary and remedial measures. Temporary or Preventive Hemostasia. This becomes necessary as an occasional expedient, when the presence of the blood is likely to become an obstacle to the opera- tion, and the preventive means may be appHed either before or during its performance. Included under this general head is the circular compression, or ligation en masse, when the situation and the form of the region render it practicable. The effect of this being the flattening or collapse of the vessels, and the temporary closure of their calibre, one of the necessary conditions of its suc- cessful application, especially with the superficial vessels, is that they should be situated near enough to some structure sufiiciently hard and solid to fm-nish an unyielding 2)oiiit appui to the com- pressing agent. If, from the jDOsition of the artery, no such point of resistance can be made available among the surrounding parts, resistance can be established by a double pressure made in op- posite directions, in such a manner that the compressing powers can furnish mutual support, each to the other. By this plan com- pression can be effected in four different ways. 1st. JBy Digital Pressure. — A^Tien this can be applied and proves sufficient, it is the simplest and the best mode. While it serves to obstruct the cu'culation, its action is limited to the ves- sel which alone needs it, and the tissues are not contused by the pressure; it can, moreover, be suspended or renewed at will, and can be managed by an assistant who may be placed in a position in which interference with the oi:)erator can be entirely obviated, and, indeed, can sometimes be performed by the surgeon himself. It is obtained by pressing the vessel with the tips of the fingers placed either vertically upon the vessel itself, or along its course ; and only such a moderate degree of force need be employed as will prove sufficient to close the calibre of the vessel, without fatiguing the hand by uimecessary pressure. ^^^^fjOOBtfji 5 -• ' -<■ 1 -*^ .i ^ ^ - AA.6^ SUKGICAL HE-J.STASIA. 527 1st. liefrige rants. — The ageia included in this class act almost exclusively by depriving tb parts upon which they are apphed of their heat, and in produiug a certain excitation ujDon the vaso-motor nerves, followed by toxic contraction of the mus- cular fibres of the vessels, and th.iUmuiution, or sometimes the complete arrest, of the bloody flo'. Their action is principally efficacious on vessels of small cahto, such as the capillai-ies. Cold water, snow, cracked ice, ad the very volatile Mquids, as ether, chloroform, and freezing m::nrcs, fill an important place in this category. In veteriuarj- sui'-vs . cold water, being the sim- plest, the most accessible and abudant, and the easiest to apply, heads the hst. It is used in the )nu of douches, baths, lotions and injections, or by means of ci.ijircs.ses, pads, or cushions of oakum laid upon the seat of heu'rilnige. The saline mixtures, and the snow or cracked ice, ar« lactd in cloths, bags or blad- ders, but their action must be imiLi d in order to obviate the possibihty of congelation and mcojlication of the tissues, quite a possible result of excessive refrigration. Refrigerants are generally coBdered as forming the least ef- fective of hemostatics, but their fr^lity of ajiphcation has brought them into common use. They ro priucip.dly indicated against external capillars' bleeding, or ttt which escapes from a small vessel, but would generally proi insufficient against a hemor- rhage from a large vessel. The luay, however, prove advanta- geous against some internal heiorrhages, which, though they may be controllable by other dir<«. means, yet can be reached by the water without difficulty or dai^er, and act directly or by con- tinuity in producing the ntct s> ,- contraction- In this manner, injections into the nasal ca%iti* or the uterus, or rectum are often efficacious in arresting a heiorrhagic flow suddenly occur- ring. But in any case, refrigerats should be apphed with care, and their efl"ect watched. If thf are allowed to remain too long in place, or the temperature be )o low, they may induce an in- flammatory reaction and local gngrene, or produce other dan- gerous general eflects upon the itemal economy. On the other hand, if imperfectly apphed, an A\-ithout a sufficient degree of cold, their action, already weak, nil become a mere useless nega- tion, if not worse. Between the.- two extremes there is a middle course, which the competent 6u?eon will be able to obsene by exercising his discretion, and an ppeal to his own experience. *' » 526 OPEKATIONS ON THE CIRCULATORY SYSTEM. consists of a roller of India rubber, to be so aj)plied around the seat of the operation as to cause the blood to recede toward the center of the body, its return being prevented by firmly placing- a ligature just above the point of incision. The pressure pro- duced by this band can be regulated by means of a toiu-niquet, or a piece of elastic tubing, or an ordinary string that may be twisted with a stick. This mode of compression is adapted to cases of amputation of the limbs and of the tail, or the removal of tumors. Permanent, or Definite Hemostasia. The arrest of hemorrhage may become necessary at any step of an operation, Lut it is ordinarily when it has been completed that the indication must be fiilfiUed. It is true that in many in- stances, even after extensive lesions, the hemorrhage will cease spontaneously, but it is equally true that at other times special interference becomes a necessity. If the hemorrhage is capillary, the surgeon may safely overlook it, and leave it to subside under the influence of the retractihty of the tissues ; but if it is of ve- nous origin, it cannot be safely left to spontaneous action. Still, usually it is only when one of the larger veins is the seat of the bleeding that danger becomes imminent, as with those situated near the center of the cu'ctdatory system ; but serious accidents are seldom to be feared. If the vein is cut across, moderate pres- sure upon the orifice will generally insure the formation of a clot which will constitute a sufficient plug, or if the vera is opened longitudinally by a lateral incision, pressure at the point of the wound, though not strong enough wholly to stop the circulation within the vessel, may still be sufficient to assure the rapid obliter- ation of the wound. But when large veins or arteries are oj^ened, or even when the capillary hemorrhage is usually abundant, more complicated means of hemostasia must be resorted to, and not only applied carefully and securely, but also with celerity. The means of obtaining permanent hemostasia are of two kinds — one taking effect through ihe physico-chemical action of special agents, the other including those which are known as surgical means proper. Physico-Chemical Hemostatics. Among these must be considered the refrigerants, absorbents^ astringents or stgj^tics, and 2>otential and actual cauterization. SURGICAL HEMOSTASIA. 529 face it forms, with the blood, a blackish magma, and a resisting, strongly-adherent clot in the cavity of the vessel. 4th. Potential Caustics. — The chemical astringents have gen- erally the same mode of action. Upon being placed in contact with the tissues they enter into combination with their elements and form a coagulum, and it is the presence of this clot which produces the hemostatic effect. They are but little used, how- ever, in veterinary practice. The nitrate of silver, some of the mineral acids, as sulphuric, nitric, or arsenious, or bichloride of merciuy, are the potential caustics which are occasionally used, though it should always be with great caution, in view of the possible danger of producing an excessive effect. 5th. Actual CauteHzatioti. — Cauterization with the hot iron is the oldest and principal hemostatic in use in the surgical treat- ment of the domestic animals, and in many instances may be made to supersede all the chemical agents we have considered, more especially in cases of capillary hemorrhage. It is applied with the iron heated to a white heat, and laid upon the bleeding sur- face, where it immediately creates a thick, impermeable eschar, adherent to the wound, and offering an insurmoimtable barrier to the escape of the blood. To obtain all the effect desired the wound must be thoroughly free from all extraneous substances, liquid or solid, that nothing may interfere with the rapid formation of the eschar. The blood should be well soaked out, a plug of oakum firmly pressed uj)on the wound, and the iron pressed perpendicularly upon the tissues ; this rai)idly forms the eschar. The application of the cautery must be continued for a few seconds only, on account of its ha- bility, while cooling off, to adhere to the tissues and to the eschar, with the consequent risk of reopening the wound and renewing the hemorrhage upon attempting its removal. It is better if the eschar is not sufficiently thick, after a first application, to renew it a second, or even a third time, always taking the same precau- tions; and being careful to avoid contact with sound tissues. In this operation it is essential that the temperature of the cautery should be at its maximum. Half-heated, or cooled off by the blood, not only is the apphcation more painful, but the effects are incomplete and the hemoiThage is likely to return. If the blood escapes too freely, or coagulates too slowly, the eschar not forming, it may sometimes become necessary to carbonize the 530 OPERATIONS ON THE CIKCULATORY SYSTEM. bleeding svirface by means of some combustible substance which will furnish more solid materials for the protective scar. A loop of hair, or some pulverized rosin, placed upon the wound, and burnt with the cautery, often fulfills the requu'ements. For hem- orrhage from parts below the surface, the edges of the wound must be separated before the cautery is introduced, to prevent its coohng before reaching the proper point of application. When the eschar is well formed and estabhshed it should be left without interference to complete the process of sloughing. The thermo-cautery, with which the required heat can be re- tained at a uniform degree, is one of the best instruments for the application of this mode of hemostasia, there being no need of removing it until an eschar of sufficient thickness has been ob- tained. Surgical Hemostatics. Among the numerous surgical means of obtaining both per- manent and definitive hemostasis, there are three which principally merit our attention : compressioti, ligature and torsion. (A) Compression. — We have already referred to this method while considering the subject of temporary hemostasia. There are cases in which it acts as an excellent mode of permanently controlling hemorrhage, whether proceeding from arterial, venous or capillary sources, and equally whether from a large surface or from a deep cavity, where the origin of the hemorrhage cannot be distinctly located. Still, for arterial hemorrhages it is only effica- cious for vessels of small or medium size, or when the wounds are of small dimensions. There are secondary circumstances which determine the designations of certain variations of pressure. One is the situation of the vessel, relatively to that of the bleeding orifice, when the pressure, to be effective, must therefore be direct or lateral, and with the latter, either mediate or immediate. Some- times, again, it is applied at a distance from the bleeding point, and in an indirect manner, and involves an alternative between l^higging and direct compression. It is aj^plied to the wound itself when the vessel has been cut directly across. It is usually effected by covering or fiUing the wound with a dressing of balls of oakum applied directly upon the bleeding orifice, and covering these with pads, increasing in dimensions as they become more superficial. The whole apparatus is submitted to pressure SURGICAL HEMOSTASIA. 531 by approximating the edges of the wound, as much as possible, by means of interrupted, pin, or a quill sutui'e ; or sometimes a circular bandage of dry or compressed sponge, cut into small pieces, may be used in the same manner as the oakum with ex- cellent effect, especially when the hemorrhage is abundant, or ligation become impracticable. The objection to the mode of compression, generally speaking, is its liability to become loosened in consequence of the softened and yielding condition of the surrounding tissues. For this rea- son the mode of applying the force directly is not often practiced, or, at least, is adopted only when the hemorrhages are small and controllable by slight pressure, or in case of the section of an in- comj^ressible artery, like that of a bone. In order to increase the effect of direct pressure the surgeon sometimes has recourse to the joint use of some of the physico- chemical hemostatics before mentioned. ( a ) Immediate Lateral Compression. — This is practiced against hemorrhages due to lateral wounds of blood vessels, and is applied directly upon the opening in the vessel. The method of its application does not differ from that of direct compression, and it is Hable to the same objections in its irritating effect upon the surface of the wound and consequent interference with cica- trization, and the danger of a renewal of the bleeding. More- over, if the vessel is without a solid resting-place, and there is no sufficient resisting point, hemorrhage is not arrested. But again, in a contrary condition, it may be followed by gangrene or the obUteration of the vessel, and if the wound is of such a form that this last accident cannot be avoided it is better to have immediate recourse to the ligature. It remains, then, that this mode of hem- ostasia is only ad\dsable when the wound is small and the artery small and superficial, or in such a position that it cannot be ligated. Immediate lateral compression, however, can be made with great benefit with the finger upon the wound, pressing with the necessary force to prevent the escape of the blood, without clos- ing the cahbre of the vessel. The finger is kept in position for one or two hours, with an occasional insi)ection to discover whether the hemorrhage has ceased, and when it is I'emoved there remains but a simple wound, easy to dress. This mode of compression has the advantage of obviating the accidents that may occur from excessive external pressure main- 532 OPEEATIOXS ON THE CIRCULATOKY SYSTEM. tained by ligatures and dressings, such as the division of the skin and the possibihty of gangi-ene. The vakie of this measure of digital compression may be estimated by the fact of its successful application to a vessel of the dimensions of the carotid artery in a case of a wound by pricking. (b) Jlediate Lateral Compression. — The compression here is applied outside of the solution of continuity, in such a manner as to leave a certain thickness of the tissues betvpeen the injvu'ed ves- sel and the compressing apparatus. It may take effect either directly upon the wound itself, or elsewhere along the course of the vessel. It can be effectively made only upon superficial ves- sels, principally arteries which, like those of the extremities, lie upon or near enough to resisting surfaces to furnish a means of support to the pressure. The manner in which temporary and permanent hemostasia can be obtained is the same, excepting that the cords, bandages and tourniquet are replaced by graded com- presses, supported by rollers or appropriate bandages, which are continued only dui'ing the existing necessity. The objection to this hemostatic method, and which it shares with all the other processes of compression, is, that when a large vessel is to be compressed, and a certain amoimt of force becomes necessary, other tissues, with other vessels, veins and nerves alike, must participate in the same pressure, and, as a consequence, dis- turbances of varying degrees of sevei'ity will occm- in parts situ- ated beyond the comijressed surface, proportioned to the duration of their exposure to the acting cause. Hence the indication, in applying the apparatus, to begin at the peripheric portion of the region, to cany it toward the center, in passing over the wound akeady protected and covered by the balls, pads or compresses, which constitute the true means of compression. The principal objections to this process of hemostasia can be obviated by leaving on the apparatus only for the minimum time necessary to obtain the cicatrization of the wound of the vessel, which will, of course, vary according to circumstances, and will be especially influenced by the consideration whether the cahbre of the vessel is to be preserved or obliterated. If the vessel be a small one, the wound of small dimensions, and the continuity of the channel is to be preserved, a few hours will be sufficient ; or, if otherwise, it is to be obliterated, one or two days will be required, or even. at times one or two weeks. SURGICAL HEMOSTASIA. 533 (e) Plugging. — This mode of compression is chosen as a per- manent hemostatic to arrest hemorrhages which occur upon the surface of natural cavities, or upon wounds where the injured vessel cannot be reached. This is done with balls, or pledgets of oakum or sponge, carried with a forceps to the bottom of the caxdties, or with sachets, arranged in the manner of the tampon, impregnated with an astringent solution or a cold mixture, the whole being kej)t in place by the dressing which closes the cavity. It is used in cases of epistaxis and hemorrhages from the uterus, or those following castration. But with all its advantages it is an uncertain mode, and oj)poses but a shght obstacle to the hemor- rhage ; besides which it irritates, by the pressure of the plugging material on the parts with which it is in contact, where it acts in the manner of a foreign body, which in fact it is, giving rise to some pain, and perhaps stimulating muscular contractions, and thus exciting the hemorrhage anew. However, these objections are not of sufficient weight to contra-indicate its employment as a ready and efficacious means of hemostasia, or to prevent it from being wisely appreciated and largely employed by the surgeon. (B) — Ligature. — The Ugature is the typical and obvious means of hemostasia — the hemostat jOrtr excellence — perfect in its sim- pHcity, though consisting simply in tying a' circular thread or cord around the wounded vessel with sufficient tension to close its channel, suppress the cu'culation, and convert the tube into a cord. It can be applied either on the cut extremity of an artery, or upon its continuity. It is seldom appHed upon veins, however, from its HabUity to induce phlebitis, but still, it is resorted to in wounds of large veins, or when the hemorrhage cannot be con- trolled by other means. As with compression, ligature may be irmnedlate or mediate^ and may also be divided into temporary and permanent — temr- porary, when its continuance depends upon some contingency — permanent^ when it is to remain until it is eHminated by suppura- tion, or becomes organized and absorbed, as when the ligating thread is composed of some special animal fibre — which is the kind most commonly used. The instruments required for this operation are : tenaculum, aneurism needle, Hgature materials, ordinary dissecting or bull- dog forceps, scalpel or bistoury, and the grooved director. 534 OPERATIONS ON THE CIKCULATORY SYSTEM. The kind of forceps used are known as artery forceps, and are of numerous varieties. Fig. 457.— Cooper Needles, or Tenaculum. The tenaculum, or aneurism needle, is a kind of blunt tenacu- lum with an eye at its end, and is used to seize or secure the vessels. The suture materials are linen thread, silk, animal Hgatures, such as catgut or tendinous fibrilla, and sometimes very fine me- tallic wire. Ordinary linen thread and silk, well waxed, are most commonly used in veterinary practice. (a) Immediate Ligature. — This is the surest of hemostatic means. It is applied principally upon large arteries surrounded ordy by their cellular sheaths, and a difference is made in applying SURGICAL HEMOSTASIA. 535 it between vessels wliicli are perfectly intact and those whicli have been partially cut through or otherwise injured. The Immediate Ugating of an artery entirely divided includes but two steps : the prehension of the artery and the adjustment of the hgature. When drawn out of its position with the proper forceps the artery must be carefully examined for possible adhesions, and especially any nervous threads which may be attached to its sur- face— all of which must be dissected. In j)lacing the ligature many operators carry the thread, form- ing a loop, with the forceps, and on seizing the artery and seeing that it is clear from the surrounding tissues, they slip the loop down over the instrument upon the vessel, to be tied by an assist- ant. The apparent simplicity of this movement is deceptive ; too often the loop of the ligatm-e adheres to the wound, the ends roll over themselves and one another, the Ugature cannot be properly placed over the vessel, and the knot is tied over the forceps before the thread has reached the artery. To avoid this it is better, when the vessel has been weU secured and isolated, to have the assistant apply the ligature by its middle upon the jaws of the forceps, be- hind the hand of the surgeon holding them, in order to be free iii his movements. Then making first a simple knot, without twist- ing the thread, and tying it close to the forceps, he then, with the Fig. 458.— Applying the Ligature. thumbs, pushes the thread further along the artery, and ties it by pressing the thumbs together with sufficient firmness to rupture the internal membrane of the vessel. If the wound be deep, in- stead of the thumbs both indexes are used to cany the thread along the artery and tie it. The forceps is then removed and OPERATIONS ON THE CIKCULATORY SYSTEM, Fig. 460.— Improperly-made Knot. a second straight knot is made (Fig. 459), The knot represented in Fig. 460 is improperly made and liable to become loosened. The extremities of the thread are left of a sufficient length to allow their being turned toward the most dependent part of the wound. If they are cut too short they are liable to become loose in the tissues, and be covered or concealed by the granulations and become the center of a suppurative gathering. Ligatures intended to remain in the tissues, must be made of animal material. The wound of an artery always involves the application of a ligature on both extremities of the course, the central and the peripheric. Where the artery cannot easily be raised or dissected from the tissues into which it is retracted, the pointed tenaculum can be used to draw it out of its position ; this instrument is more suita- ble for small than large vessels, the coat of which it is liable to tear. In the immediate ligating of an intact artery, and without a solution of continuity, the vessel is exposed by means of an in- cision, either parallel or sometimes oblique, and at others perpen- dicular to the artery, according to its situation and the nature of the subjacent tissues, carefully noting any projections of the bones, muscles, or tendons which can be made available as points de repere; observing, indeed, all the anatomical connections exist- ing between the different structures. When the artery has been nearly reached, in order to avoid injuring it, it should be separated by dissection with the forceps and the bistoury from the tissues covering it, or by introducing a blunt, grooved director under them, as a guide, and dividing them with the knife. The sheath of the vessel is also carefully divided and separated from the ves- sel itself, which is then carefully isolated from its vein or surround- ing adhesion, and the blunt-eyed tenaculum, or the aneurism SUKGICAL HEMOSTASIA. 537 needle passed under it. Sometimes this is easily done, but in other cases the density of the connective tissue surrovmding the artery is too great to allow the needle to pass readily under it, in which case the obstacle can be removed by scraping it away with the finger-nail, which will obviate the application of extra trac- tion upon the vessel. The ligature can then be adjusted around the vessel by means of the tenaculum, and the operation completed as usual. (b) Jlediate Ligature. — This operation comprises including in the ligature of the vessel a certain portion of the surrounding tissue — a portion which should be as small as possible. It is done with a curved needle and a Hgatui'e of single or double waxed thread or silk. The needle is introduced into the thickness of the tissues, at a small distance from the artery, and passed around it with the ligature, which should be firmly tied in the usual way. The ligature is quite painful in consequence of the pressure it makes upon the nervous fibres which accompany the artery, and it is less safe than the immediate operation, exposing the vessel, dur- ing its performance to the risk of wounds from the needle, and requiring, besides, a stronger traction upon the ligature and the knot, from the increased bulk of tissues involved ; and there is, again, great uncertainty as to securing a sufficient division of the internal and middle coats of the artery. For these reasons it is less adapted to large than to small arteries. The effects produced by the application of a ligature are not wholly mechanical. It is also followed by certain pecuHar changes in the condition of the vessel, and by specific inflammatory phe- nomena which result in the permanent obhteration of the tubular character of the artery. When an artery is tied with the ligature the internal and mid- dle coats of the vessel are also divided by the compressing thread, and by their retraction above and below it they form a double cone, the apices of which rest on the ligated spot, the external coat resisting and arresting the flow of the blood. A clot is then formed, and the ii-ritation produced by the pressure of the ligature stimulating the proliferation of the cellular elements of the walls of the vessel, adhesions are soon established between them and the coagulated blood, and the termination is the solidification of the former tube. 538 OPERATIONS ON THE CIRCTTLATORY SYSTEM. Tlie presence of the Kgature and its effect on the surroundings of the blood vessel give rise to a process of elimination, by which, after a certain time, the hgating thread is expelled, carrying with it the vascular stump situated beyond the Hgature. At the same time, and while these phenomena are taking place outwardly, the clot, adhering more and more to the vasctdar surfaces, soon be- comes the seat of pecuhar absorbent changes, and gradually dimin- ishing in size, at length disajopears. As the resorj)tion of the clot takes place the walls of the ves- sel contract until at length the caHber of the artery becomes en- tii'ely obliterated, and the former tubular canal is transformed into a fibrous cord, extending from the point of the ligature to the nearest collateral vessel. This obliterating process of the arterial canal may, however, be defeated by the interference of too active an inflammation, pro- ducing the premature sloughing of the ligature, or by the exist- ence in too close proximity to the point of ligation of a collateral arterial branch. In both cases hemorrhages may follow ; in the first, because the adhesion of the clot is imjoerfect, and in the second, because no clot has been formed. (C) Torsion. — This hemostatic j^rocess has been known from an early date, but was not methodically described until about forty or fifty years ago, by Amussat, who recommended it in preference to the method of ligation. But daily experience has demonstrated its inferiority, and j)roved it to be a less powerful hemostatic meas- ure than that of the hgature, and, moreover, that it is only avail- able for hemorrhages occurring in small vessels. There are several ways of aj^plying torsion. Among the principal is that recognized by Amussat. It requires four forceps, two ordinary anatomical, another whose branches are terminated by smooth cylindrical jaws, and the fourth the artery-ttiyisting force2)s. The artery is held with one of the ordinary forceps ; with the other the tissues surrounding it are separated from it ; then the twisting forceps grasp the artery at its extremity in place of the one first used, keei^ing it out of the wound, and when thus secured the instrument with the smooth transverse jaws is applied above it, close to the tissues, and firmly pressed upon the coats of the artery. In this position, the twisting forceps is given a rotary motion upon its axis, as if the vessel were to be rolled over its extremities, and is twisted upon itself by seven or eight SURGICAL HEMOSTASIA. 539 Fig. 461.— Artery Forceps for Torsion. turns. The smooth-jaw forceps is then removed, and the stump of the artery is released and pushed into the tissues, unless the torsion has been sufficiently severe to produce the laceration and retraction of the vessel. As the result of these manipulations the two internal coats of the torn artery retract upon themselves and the external coat is elongated and rolled upon itself — all in such a manner that the clot is arrested by the retracted internal mem- 540 OPERATIONS ON THE CIRCULATORY SYSTEM. branes, as well as by the support contributed by the pseudo-plug- ging, which results from the twisting of the external coat. This process is a comphcated one, but it has been modified in, several ways. In one process only two ordinary artery forceps are used ; one applied at some distance from the end of the artery, transversely to its axis, and the other holding the vessel by its end in continuity to its length. Keeping the first tight on the vessel, the torsion is made by ten or twelve complete rotations of the second. Another still simpler mode consists in grasping the mouth of the bleeding vessel, and giving it a number of rotations with a strong artery forceps, the artery being thus twisted without tear- ing or entirely dividing it. Nothwithstanding all these modifica- tions, torsion is not applicable to large arteries, and cannot super- sede the ligature. It is slower in performance ; it is more painful ; it requires a greater isolation of the vessel ; and the possibility of untwisting, and with it, secondary hemorrhage, is always to ba feared. CHAPTER XI. OPERATIONS ON THE NERVOUS SYSTEM. PLANTAR NEUROTOMY. Altliough the word neurotomy, when correctly defined, means, in a general sense, the dissection of nerves, it has In surgery an- other signification, and is applied indifierently to describe the di- vision, the resection or the amputation of a nerve, according to the special manipulations of a given case. In veterinary surgery, it is held to be strictly appUcable to the operation which consists in the dissection and removal of a portion of a nerve, and as the present chapter proposes to treat princiiDally of affections of the foot, it is simply correct to employ the term i^lantar as a prefix to the title, as we have done. The design of the operation is the destruction of the susceptibility of the region or organ imphcated in the treatment, and to subdue the pain, if not permanently, at least for a period of time sufficient to restore a working animal to his ability to labor, which, without such a relieving operation, would have been lost to usefulness and comfort. This curious and important operation has a comparatively recent history. It is of English origin, two British surgeons claiming priority in its performance. These rival contestants are Moorcrof t and Sewell, who put it in practice, the former in India, and the latter in England, at about the same time. After its in- troduction, it was frequently performed by EugHsh veterinarians, among whose names occur those of Goodwyn, Coleman, Percivall, Sj)Ooner and others. Its introduction on the continent was in France, and is credi- ted to Gu'ard, Jr., who described it in 1824, and from that date it continued to be a subject of experiment at the hands of many veterinarians. We say ex])eri)iuut, because it was only after a 542 OPERATIONS ON THE NEEVOUS SYSTEM. long series of trials, and as the result of much discussion of its merit and value, that it secured an affirmative verdict from the magnates of veterinary practice, and became an estabUshed posi- tion in our science. Yet the objections which it encountered in Europe have not to this day been wholly eradicated, and on this side of the Atlantic there are few practitioners who still decHne to give it their confidence and adopt it in their practice. The opposition which it has encountered is founded principally upon the failures, the accidents and the unfortunate sequelae, which were not rarely met with during the period immediately following its original introduction. These objections we now proceed to consider. Stumbling has been mentioned as one of the first e£fects of the loss of the tactile function of the foot, by the destruction of its sensibility. The animal which has lost the sohdity and the certainty of his gait, will only after a long time become accus- tomed to the proper use of the comparatively inert mass repre- sented by so indispensable a part of his organization as his foot, so complicated in its arrangements and adaptations, and so per- fect a portion of his anatomical structure before the extirpation of its nervous sense. And yet, while this condition of stumb- ling must be fvilly appreciated by those whose anatomical knowl- edge enables them to take into full and careful consideration the physiology of the part, and who have verified the objection from their own observation, there are also veterinarians of large practice and long experience who have operated in numerous cases, even upon animals used for fast work, where the muscular effort is of a comparatively violent character, who have met with the accident only in very rare and strictly exceptional cases. It must rationally be inferred that an unskilled operation of such a character would leave the patient in a condition of which an awk- ward and stumbhng gait would be but a natural and inevitable sign. But it would also be in the course of a natural and healthy reaction for a horse to educate himself rapidly to the situation, and acquire a new certainty of movement and confidence in the use of his feet, which would soon restore him to his former abil- ity to labor. The casting off of the hoof, as a compUcation or termination of the operation in neurotomized horses, is one necessarily of a fatal character. This fataUty has, in some instances, followed the PLANTAK NEUROTOMY. 543 operation within a period of from one to two months, but on the other hand its occurrence has been deferred in other animals for jears. Evidently, these varying results must be considered as the effect of different and quite disconnected causes. The truth is, indeed, that in the first instance it is due to a gangrenous dis- organization of the tissues within the foot, and in the second, in- stead of being the result of insufficient vitality, or arising from lack of nutrition of the parts, it is more probably the consequence of the unregulated force of the concussion when the foot strikes the earth — unregulated because of the loss of the discriminating instinct formerly exercised, but now lost with the missing nerve- oonsciousness which once controlled all the movements of the limb. It could scarcely happen that such a condition of things should fail, after years of continuance, to encounter some susceptible temper in which to exhibit its baleful influence. A reason which must not be oveiiooked in relation to the cast- ing off of the hoof is the fact that in the neurotomized animal the essential symptoms of the first development of any lesions which might give rise to it, are missing. The first of these symp- toms is the pain which is normally manifested by the lameness, and for that reason it is that the care and attention required by the foot of a neurotomized horse are at once so important and so commonly overlooked and omitted. But without ignoring the possibility of this accident, the question is presented, whether it is of such common occurrence that its frequency constitutes a cogent reason for abolishing the operation. Our answer to this, founded on the showing of the record, must be given in the negative. To quote but one among many authorities — Professor Nocard says that out of more than one thousand operations, he has never met with that accident. For ourselves, in a practice of many years, with a number of neurot- omy cases which we can count by the hundreds, we also have never encountered it. In the only case we have seen, other causes existed in the form of suppurative corns, which were overlooked, and which were, moreover, comphcated with gangrene of the vel- vety and podophyllous tissues. The Softening of the Perforans Tendon and its subsequent rupture, is also a very severe sequelae of neurotomy. This may take place almost immediately after the operation, or it may be postponed until after a few months, when the animal has resumed long series of triu merit and value, i magnates of vetei : tion in our scienci Euroi)e have not t side of the Atlaut i to give it their c< opposition which the failures, the , were not rarely n i ' its originiil iiitri consider. the loss of the ; its sensibility. certainty of L tomed to the sented by s(» complicni edge enabL the physic' iroBPL then -4 ^-^ PLAXTAE NEUROIMV. 545 V in tliis allegation, from the hmn fact that in a majority IS its early reciUTenceis mainly iie to imperfect methods or a.-lallful performance of the opeition, and cannot, for that ii, bo considered a prof)er incidit of the case, but simply i lent, which may be obviated 7 care and precaution, and \Ang the transaction, must be?Uminated from the argu- ■ibably the most important anduost nearly vahd objection ' t the suppression of the nervou influence has more or less " upon the nutrition of the digit; region. Notw-ithstanding I » nervations of Braael, the questii of the direct influence of .i^^itcil nerves upon the nutritic of that region is a poiat . 1 ;.s not yet been thoroughly ccqirehended by om- physiol- For this region this objectio. and the points involved in f, n- further study, and it is ne.iy certain that when it has il this the end will be the remral of the reproach brought t neurotomy of interfeiing wit the vegetative Ufe of the ■i] region. Having thus examined the objectiis which have been ui'ged nust neurotomy, a consideration ojthc advantages claimed for A ill come next in order of mentioi Lea^•ing out of view the . .iUirts to which the operation, iicommon with every human 1 endeavor, whether in great miters or small, is from the ..Liition of things, hable, we proctd to the facts which demon- [lic usefulness and value of th treatment, with a descrip- f the various modes of procedin practiced by different sur- The facts of the direct and &ccessful results which be- ^ iuestion have been secured, areo numerous and so patent, ■ they so far counter-balance all ossible accidents, that no iceivable array of abortive cases, reported truly and with- ^ prejudice, can imijaii' their force ud significance. It would ■ impossible to reach even a proxiiate estimate of the value ved and the loss prevented by the ostoration of unnumbered t^iess and sufi"eriQg animals to comf t and usefvdness. And these are what might be call the positive or direct ad- .ii cages of neui'otomy. But besides lese, there are other advan- _,^d in the secondary effects of the peration, of which the im- .auce cannot be ignored, especiallnvhen they are commended ir attention by such authority as lat of Professor Nocard, of it, when he says : " In several c^es I have noticed a great 544 OPEKATIONS ON THE NERVOUS SYSTEM. Lis work. It has, indeed, been charged to undue haste, in com- pelling- the animal to labor without allowing suificient time for the healing process to be completed, and it is also alleged that it is a consequence of the performance of the operation on both sides of the leg at once. It is both a possible theory and a plausible argu- ment that the failure of the tendon is the result of the shocks in- flicted upon it while in a condition of disease and unconsciousness, and this may explain the possibihty of the accident without any reference to the circumstance of putting the animal to work. But this falls far short of proAing that the neurotomy exercised any 2)otent agency in bringing on the softening and rupture. And as to the effect of performing the double simultaneous operation, our oj)inion will be readily inferred from the fact which we here state, that out of the large number of neurotomy cases which have passed through our hands, we have seen but a single case of softening and ruptiu'e of the perforans tendon, and that was associated with a fracture at the os pedis. The horse had been operated on upon both feet, and on both sides at once, for navicular disease of old standing, and on the thu'd day following he was found in his box standing on both fetlocks. He was destroyed and it was found that the tendons of the perforans had given away in both feet, with a fracture of the navicular bone and os pedis on one foot, and of the OS pedis alone at the semi-lunar crest on the other. It is our constant habit to operate on both sides, and with this sole excep- tion, we have never met with softening of the tendons. Springhalt. — Beugnot and Renner report cases in which the performance of the operation on the hind feet was followed by the appearance of springhalt. In addition to the points we have been discussing, other alleged objections exist, which may claim superior force and value, but there are none among them of sufficient weight, in view of the many benefits realized from the operation, to justify its repu- diation and abandonment. .Among these may be mentioned the theory that the foot de- prived of its sensibihty by neurotomy is more exposed to the se- quelae of pricks, contused wounds, corns, etc., from the circum- stance that there is no betrayal or visible manifestation of the lameness which is usually indicative of lesions of that organ. It is further objected that in many instances the lameness Khows, sooner or later, a tendency to relapse. But there is httle PLANTAR NEUROTOMY. 547 tlie imdiscovered disease, it will, at least, relieve the lameness, if not in all, yet still in a large majority of the cases. In contraction of the heels, or in feet subject to chronic corns, as result of their conformation, and in some cases of chronic laminitis, where there is either no alteration of structure, or very little, as well as in keraphylocele, here also neurotomy is bene- ficial. But it is principally in navicular disease that its advan- tages are best illustrated. And next to these, as best adapted to prove and exemj)hfy its benefits, must be classed ringbones and sidebones, the characteristic exostoses of the digital region. Excellent results have followed it when performed for the rehef of the lameness which often supervenes upon severe injuries, or operations about the foot, such as fractures of the phalanges, crush- ing of hoof, or any of the sometimes violent acts of surgical inter- ference necessitated by the diseases of that region. The question has even been discussed of the probability of obtaining beneficial results in tetanus, following traumatic lesions of the foot ; especially in punctured wounds. A glance at the counter-indications of neurotomy will furnish a plausible explanation of the objections alleged against it in its earlier history. In the fact that the complications now recognized as thus related to it were then miknown, and consequently un- recognized, and the operation performed notwithstanding, we at once discovered a sufficient reason for the failures and bad results of the treatment, and the consequent' odium into which it naturally fell. It was not yet adequately comprehended — it was misapplied — it was, perhaps, unskilfully performed — it failed. A very logical formula; but it ought not to have been denounced. Neurotomy is indicated in navicular disease, and for some in the very iucipiency of the attack, all other modes of treatment being only palliative and temporary, and when it has advanced to its chronic stage an operation will be of Httle advantage, or wholly unsuccessful, if at this period the bone has become extensively diseased, and the tendon reduced to the condition of a mere mem- braneous pellicle. It is also contra-indicated in all forms of acute inflammation of the foot ; in badly formed feet, such as the flat or pumiced of chronic laminitis ; and, again, when the lameness origi- nates ia a very large exostosis or other bony disease likely to be- come a mechanical obstruction to the movements of the articula- tion, or to the play of tendons, or to produce anchylosis. , To 548 OPERATIONS ON THE NERVOUS SYSTEM. resume, it may be said with Bouley, " one must not ask from neu- rotomy more than it can grant, by applying it to cases where the lameness must necessarily persist, even after the removal of pain, in the diseased parts." One important practical point in the performance of the opera- tion is the determination of the place where it is to be performed. A reference to the anatomical disposition of these plantar nerves vsdll aid us here. In the forelegs both the external and inter- nal plantar nerves form branches about equal in size, running on each side of the leg, with an identical disposition. Each of these nervous branches is situated along the tendon of the perforans Fig. 462.— Plantar Nerves in Digital Region. P, plantar nerve; A, original of the digital nerves; BBB, cartilaginous branch; C C C, cutaneous branch; D, digital artery, with the nerve back of it; E E, ramifications of the cartilaginous and cutaneous branch ; F F, bulbous branches ; G, Transverse branches back of the fetlock joint: V, digital vein. PLANTAR NEUROTOMY. 549 muscles, then, at a point a little above the fetlock, they ramify and divide into three branches, or digital nerves proper ; one prin- cipal, posterior or continuation of the main trunk, running toward Fig. 463.— Plantar Nerve on the Posterior Face of the Phalanges. P. plantar nerve; A, origin of the plantar nerve above the sosamoids; B, cartilagi- nous branch; C, cutaneous branch; D, digital artery; II, branch to the cartilaginous bulbs— sometimes absent; I, branch of the plantar cushion ; K, transversal coronary branch; M, podophyllous ramification; O, pre-plantar nerve; Q. branch to the patilobe eminence: R, arterial branches; V, vein which is sometimes found running bacii of the plantar nerve. the middle part of the lateral cartilage of the foot, under which it passes ; a second, anterior, smaller than the posterior, which is divided toward the middle of the first phalanx, into several branches, ramifying in the tendon and other parts of the anterior region of the foot ; and a thii-d, or middle branch, which goes to the coronary band and podophyllous tissue. The consideration of the relation held by these plantar and digital branches to the blood vessels constitutes an important practical point in the opera- tion. Ai'tery, vein and nerve descend on both sides of the fet- lock, in such a manner that the vein is situated in front, the artery 550 OPERATIONS ON THE NERVOUS SYSTEM. in the middle, and the nerve behind — the veia being on a plane somewhat more superficial than the artery, which is a little deej)er. Consequently the operation may be performed at any one of four points, and on either side of the leg. These are, first, above the fetlock, on the plantar nerve proper ; second, below the fetlock, on the posterior branch ; third, below the fetlock, also on the anterior branch ; and fourth, according to Nocard, above the fetlock, on the anterior branch. The first or second of these locations is more often selected for the operation^ and forms either the high or loio process. For each of these operations there is a point of selection. In the high process this is immediately above the fetlock, where the nerve is most superficial and most easily exposed, on the outside border, and a little in front of the perforans tendon. In the low method it is below the fetlock, in the middle of that part of the coronet region where a depression is felt between the tendon and the first phalanx. The question of preference between the high and low opera- tions has been made the subject of much discussion, and it re- mains still unsolved. With many the high operation is that which yields the best results; others hold that the object especially con- templated in any given case must determine the point as the oc- casion presents itself. It is only just to say, however, that the ma- jority of practitioners prefer the high operation ; not only because it is easier to perform, but also because it is more likely to be successful. Personally, we believe that the high operation, with some few exceptional cases, is that which will prove almost generally beneficial. The instruments necessary are, a pair of scissors, a convex bistoiuy or scalpel (we prefer the latter), a narrow, straight bis- toury, two dissecting forceps, a pair of blunt tenaculums, with an elastic band (Fig. 464), an aneurism tenaculum (Fig. 465), needles, thread and sponges. Those who are familiar with the operation highly commend a new instrument, the neurotome (Fig. 466), which has been invented to take the place of the straight bistoury. Neurotomy is a simple operation, but a very paiaful one, and it is necessary, therefore, to have the animal well secured from the commencement of his struggles, which may endanger both himself PLANTAR NEUROTOMY. 551 Fig. 464.— Blunt Tenaculum, witli Elastic Band. Fig. 465.— Blunt Tenaculum, Fig. 466.— Eight and Left Neurotomes. and the surgeon and his attendants. We fully agree with the admitted rule that animals undergoing surgical operations should be thrown and properly secured. We, with other practitioners, however, have succeeded so well in obtaining complete local an- esthesia by the use of cocaine, that it has enabled us to perform the operation in the standing position. We, nevertheless, can scarcely see the necessity for general anesthesia when, as we be- heve, the intense pain which occm's the moment of the division of the nerve can be mitigated by careful local anesthesia after the nerve is exposed, should the operator think it necessary. A careful consideration of the various methods recommended for securing an animal, when cast for operation, has induced us to adoj)t the following as the simplest, the safest and the easiest to apply and control: The animal is thrown upon the side of the leg which is to be operated upon, and, both legs being bound together above the knee with a few twists of a flat rope in the form of a figure 8, the leg to be treated is removed from the hobble and drawn 552 OPERATIONS ON THE NERVOUS SYSTEM. forward with a rope attached to the foot. In this manner the inside of the leg is first treated, after which the animal is turned over and the process repeated on the outside. If the operation is to be performed on both legs, the patient may be thrown on either side indifferent^, and his legs secured as before described. The under leg is then first released and dealt with on the inside ; then rebound to the hobble and the upper leg liberated, and the process repeated on the outside. The horse is then turned over, and the inside of the second leg oj^erated upon is neurotomized and returned to its hobble ; and finally, the uj^per leg, which was on the under side at the beginning, is operated on uj^on the outside. Our mode of operating may differ somewhat from those prac- ticed by others, but the general plan is the same. The patient, having always been prepared by local treatment of his fetlocks, which have been soaked and firmly bandaged for twenty-four hours, is cast and secured, as before stated, the hair is closely clipped with the scissors, and the parts thoroughly washed with an antiseptic solution (bichloride of mercury). Having carefully felt for the location of the nerve, which, in many cases, can be discovered by feeling the pulsations of the artery, an incision is made through the skin with, if possible, one stroke of the convex bistoury, measuring from an inch to an inch and a half in length. It is an advantage to have the incision slightly obHque to the direction of the nerve. Then, with a f orcej)s in one hand, and the handle of a bistoury or scaljpel in the other, the cellular tissue is lacerated from the edges of the incision, in order to allow the aj)plication of the two blunt rubbered tetiaculums, which, when in position, hold open the wound; or sometimes threads are used instead, being passed through the edges of the wound and tied on the opposite side of the leg. If the incision has been made in the proper place, after sj)onging away the trifling hemorrhage w^hich obscures the wound, the nerve may be seen at the bottom, or it may be found surrounded with more or less condensed cellular tissue, and the next move is its dissection. With a dissecting forceps in each hand, we firmly grasp the con- nective tissue with one, while with the other we tear it away immediately over the nerve, removing it by two or three small portions at a time until the nerve is exposed, lying more or less closely to the artery. Then, with a gentle two-and-fro movement, we isolate the nerve from its attachments with the cellular PLANTAK NEUROTOMY. 553 structure, and when it is loosened, a fact easily recognized by an apparent shrinking in its length, it is ready for the division. At times we pass under it the blunt aneurism tenaculum, carry- ing a thread with which to secure it, and when secured, passing the pointed bistoury under it, we divide it with a single upward stroke of the instrument. In other instances, instead of the ten- aculum and thread, we use the neurotome, which, having a curved, blunt end, enables us at once to isolate the nerve, and with a simple motion of the sharp edge to divide it from below upward. Upon making the section the lower end of the nerve is secured with forceps, drawn out of the wound, separated from its adhe- sions by scraping it with the bistoury, and when a portion about an inch or an inch and a half in length has been dissected, and the resection is completed, either with the neurotomy knife or the bistoui-y, the wound is to be cleansed with antiseptic washes. The edges are in a very few instances secured by a stitch of suture, but we often prefer a simple antiseptic dressing and a bandage. There is, of com^se, no doubt that animals will often struggle during the operation, and especially at the moment when the Uga- ture is tightened upon the nerve, or when the nerve is divided, but the pain in either case is so transient that while we appreciate the value of anesthesia, we cannot recommend, in ordinary prac- tice, general etherization or chloroformization. If it is necessary to have recoiu'se, as some do, to the tourniquet, or of any other means, to control a possible hemorrhage, a large experience in the practice of this operation has failed to show us a single case where such practice would have been of advantage. The various details of the operation are substantially the same, both for the high and the low process. It must be borne in mind, however, when operating below the fetlock, that the nerve is often concealed by a little fibrous band, which a careless operator might mistake for the Herve itself. There is probably no special attention required as supple- mental to the operation. The wound heals more or less rapidly by first or second intention, and, as a rule, after two or three weeks there are no signs of the occurrence excepting a simple linear cicatrix remaining. Of the accidents which may be en- countered during the operation, hemorrhage is the most import- ant. Generally this is referrible to an error on the part of the 554 OPERATIONS ON THE NERVOUS SYSTEM. operator in dividing the artery or tlie vein, and usually it is not dangerous, though it may still prove very troublesome. If the artery is divided the ligature must be apphed on the truncated ends ; if the vein, pressure will be sufficient. The last important point involved in a case of neurotomy is the length of time required by a neurotomized animal to recuper- ate before he can safely return to his work. It is undeniable that to a too hasty return of the patient to his accustomed labor most of the objections and alleged complications of the operation may be traced, and for this reason the answer to the question how long a rest shall follow the operation must be as long as circum- stances vyill 2>eTmit. Zundel, Gourdon, Fleming, and others, make a month the minimum period within w^hich no considerable exertion should be undergone ; we would sometimes be still more liberal in allotting the length of the vacation. CHAPTER Xn. OPERATIONS ON THE GENITO-URINARY APPARATUS. CATHETERISM OF THE URETHRA. The object of this operation is the exploration of the interior of the bladder, and consists in the introduction of a catheter, species of canula, or through the urethral canal into that organ, for the purpose of ascertaining and removing its contents. Al- though the urethra of the male has great length, with an acute curve at the ischial arch, the operation is not a difficult one. It is described as the partial and the complete, according to the dis- tance to which the instrument is inserted into the canal, being partial when the catheter is pushed in the urethra only as far as the pelvic portion of the passage, but complete when it is carried completely into the bladder. The operation is employed in animals of both sexes, and is indicated in cases of retention of urine, due either to the pressure of calculi, or to the spasmodic contractions of the bladder, which accompany some cases of colic ; or, again, when in attacks of paraplegia the animal is unable to micturate naturally. It also constitutes one of the first steps of the operation in urethrotomy, in cystotomy, and in lithotrity. We shall consider the operations separately as performed in males and in females. In Males. — The catheter used in veterinary practice for male solipeds is composed of a tube of wire, twisted in close spirals, and covered with a species of thin oil-cloth, making the outer sur- face perfectly smooth, and forming a perfect canula. It is fur- nished with a stylet made of flexible rush broom, or whalebone, which can be readily withdrawn from the cavity of the instru- ment. Metallic catheters, invented first by Brogniez, and improved on the plan of those used in human medicine, may also be ob- 556 OPERATIONS ON THE GENITO-UEINARY APPARATUS. Fig. 467.— Catheter. tained, but they are not in as general use as the simpler and cheaper kind above described. India-rubber instruments, more or less pliable, constructed on the same general plan, are also made. In solipeds, urethral catheterism can be performed either when the animal is standing or in the recumbent position. In the first case he is kept quiet by the application of a twitch on one lij) and of the hobbles on his hind legs. This done, the first step is to secure control of the penis by drawing it out of the sheath, which must first have been thoroughly cleaned and washed to remove all the sebaceous secretion which by its greasy consistency renders this step of the operation quite a difiiciilt one, many animals resisting the attempt to accomplish this with all their force. But by obtaining and retaining a firm hold of the penis above the glans, and drawing upon it slowly, firmly and steadily, the resist- ance of the animal may be at length overcome, and the organ brought into full view. The operator then, guided by the little protrusion of the urethral canal, in the middle and a little toward the lower border of the glans, carefully introduces the instru- ment, which should be freely lubricated with oil or vaseline, pushes it slowly toward the ischial arch. When the instrimient CATHETEEISM OF THE UEETHKA. 557 reaches the ischial space the stylet must be withdrawn in order to avoid the diiS&culty of bending the catheter over the curve formed at that point in the urethra. At this moment a gentle but firm and. steady pressure upon the end of the instrument (easily felt at the ischial arch), made by an assistant bending it forward, will, with a little careful pushing, effect its entrance into the bladder. This will, of course, become known at once by the cessation of the resistance, and by the escape of the urine which may be con- tained in the bladder. The removal of the institmient is effected by simply drawing it carefully from the passage. Sometimes simple pressure over the- ischial arch is insufficient, and the bending of the instrument into the proper direction is to be made through the rectum, and hence the indication of ha\dng that organ well emptied before j^roceeding to the oi^eration. The indication of great caution in this operation is suggested by a consideration of the fact that (if the canal should chance to be of unusually narrow diameter or its walls softened by disease) there is sometimes danger of forming false passages, by punctur- ing the mucous membrane, and forcing the catheter into the erectile tissue which surrounds the urethra. This is an incident which, however, can be avoided by removing the stylet from the canula before its introduction into the urethra, the canula itself being terminated by a j^erforated oval bulb, perfectly smooth, and thus incapable of inflicting injury. In Catheterizing Females, a small catheter may be and is sometimes used, but as a rule, the metallic instrument is prefer- able, the conditions of the method, the shortness of the passage CT Fig. 468.— Female Catheter. and its comparatively large diameter, with the facility with which it can be entered, rendering the metallic on all accoimts more ehgible than the composition or the rubber tube. The instrument, being lubricated with oil or vaseline, the oper- ator, opening the vulva with the left hand, introduces his right, holding the instrument, into the vagina, and carries it forward to the meatus urinarius, which he can feel at about six or seven 558 OPERATIONS ON THE GENITO-UEINARY APPARATUS. inches in front of the vulva. WhUe thus holding- the instrument, he feels, with the middle finger of his right hand, for the mucous valvular fold which covers the meatus, pushes the finger under it, and then, bringing the bulb end of the catheter to the opening of the urethra, inserts it into the bladder. The accidents that may arise from carelessness, or otherwise, in the catheterism of males, are not met with when treating females. UKETHKOTOMY. Incisions of the urethral canal are made for various purposes. The removal of foreign bodies, usually calculi ; the restoration of the suspended power of micturition when is has been caused by the closure of the passage ; the estabhshment of an artificial urethral opening ; and the penetration of the cavity of the bladder when necessary for surgical j)urposes — these are among the reasons for which this important canal is incised by the surgeon. It is principally performed on males, the dimensions, aside from its shortness, of the urethra in females being, as a rule, ample, and the organ sufficiently dilatable for the removal of calcuh, or other objects, without invohing the necessity of an operation. Among the males, the ox is the animal which most frequently re- quii-es it, by reason of the peculiar Hability of this animal to suffer from a constitutional tendency to the formation of calcuH and the fact that these accretions are often arrested in the urethra, in consequence of a peculiar double curvature, or S formation, in the penis. With horses, it is in some districts quite a common operation. In these animals, however, the calculi, though of rare formation, are larger and are more generally retained, either in the bladder or in the first portion of the urethra. In smaller animals, calculi are also quite common and troublesome, esj)ecially in dogs, on account of the presence of the bony formation in the structure of the penis. In the horse, the principal operation is performed in the peri- neal region, or the part extending on the median hne from the anus to the scrotum, bounded above and on each side by the ischial tuberosities, and below by the flat of the thighs. The skin of the perineum is very fine and thin, and is hairless URETHROTOMY. 559 ' I ifJitf J k Fig. 469.— Anatomy of the Perineal, Anal and Caudal Regions. 1 1.— The skin. 2.— Portion of the aponeurotic sheath of the coccygeal muscles. S 3.— Inferior eacro-coccygeal muscles. 4 4.— Lateral sacro-coccygeal muscles. 5 5.— Is- chio-coccygeal muscles. 6.— Suspensory ligament of the anus. 7 7.— Lateral caudal arteries. 8.— Deep caudal vein, satellite of the median artery. 9.— Median caudal artery. 10 10.— Inferior caudal nerves, li. -Lymphatic glands. 12 13.— Superficial caudal veins. 12'.— One of the superficial caudal veins. 13.— Portion of the perineal aponeurosis. 14 14.— Semi-membranosus muscle. 15.— Sphincter ani. Kj 16.— Ischio cavernous muscle. 17 17.— Bulbo cavernous muscle. 18 18.— Suspensory ligaments of the penis. 19 19.— Bulbous or internal pubic arteries. 20.— luciaiou of the urethral canal for urethrotomy. 21.— Anus. 560 OPERATIONS ON THE GENITO-tJRINAKY APPARATUS. below the anus, but downwai'd and on the sides, is is covered with short hau\ Below the skin are foimd the two principal layers of aponeurotic covering, divided into the superficial and the deep. The former, of fibro-elastic texture, is the continuation of the dar- tos, and covers the perineal region, thinning down as it nears the anus, to disappear at the sphincter ani. Its most superficial fibres give attachment to a subcutaneous muscular fasiculus, which from the spHneter ani runs downward to lose itself about three inches below. The latter j)lane, or deep aponeurosis is formed of white inextensible fibrous tissues. Intimately adherent by its external face to the superficial layer, it covers and unites with the accelerator urinae, and the ischio-cavernous muscles, as well as with the suspensor and retractor ligaments of the penis. It then passes between the ischio-cavernous and the semi-membranosus, to attach itself above on the ischial tuberosity and become lost downward on the thighs. Some of its fibres directly surround the fixed portion of penis, and join the aponeurosis common to all the muscles of the flat of the thigh. The sus23ensor and retractor of the penis form, in the upper perineal region, that is, from the anus to the ischial arch, an ex- pansion of sufficient width to form a true anatomical layer. Below this they represent bands about half an inch wide, situated on the median line, and covering the accelerator muscle. They are formed of white muscular fibres. The blood-vessels and nerves of this region, with the other parts pertaining to the anatomy of the urethra, have already been considered. The pecuUarity that belongs to the penis of ruminants must not be overlooked, when the question of urethrotomy in these animals is under discussion. Their penis is very long and thin, and is surrounded in the perineal region by a complete aponeurotic sheath, and on a level with the pubis it has two curvatures, which give to the organ the form of an S. On a level with the second curvature it gives attachment to the suspensory ligaments. The free portion of the organ is elongated, strongly fihform, and covered by a fine, rosy mucous membrane. The peculiarities possessed by the penis of the horse do not exist in cattle. The operation of urethrotomy is classified and designated with reference to the part of the urethra, which is to be divided, and this is of course determined by the location of the body to be re- moved, making the designations principally regional; and it is UEETHROTOIMT. 561 therefore said tliat the operation can be performed in three ways, though three places would be the more accurate phrase. Thus we have first, the incision at the point of the penis, or preiyutial urethrotomy y second, the division in the scrotal region, or scrotal urethrotomy ; and third, the incision below the anus, or ischial urethrotomy. Preputial Ueetheotomy. In horses and dogs the urethra becomes more or less con- tracted toward the full extremity of the penis, and calculi are therefore apt to become arrested in that locality ; in other cases, masses of sebaceous matter will collect in the navicular fossa. In sheep, saline concretions are found, either in the prepuce or in the urethra. All these conditions involve a contingency of surgical interference. To remove them in the horse and in dogs, a trans- verse incision is made with a bistoury over the spot where the presence of the foreign body is detected, and it is readily disposed of. If the erratic substance is in the urethra, an incision is made through its membranes and it is removed in entirety, or sometimes after having been reduced to fragments by means of a probe or of a curator. In sheep, the simple amputation is recommended by some. The wound made in these cases heals without trouble. Scrotal Urethrotomy. Scrotal urethrotomy ean be performed either on the front or behind the testicles. In cattle it is ordinarily posteriorly that the calculus is lodged, more commonly in the second than in the first curvature, and hence the indication for selecting this place for the operation. Yet there are practitioners who j)refer the anterior sec- tion, because the penis being more superficial at that place, there is less cellular and adipose tissue to be divided before exposing it. In either case, the animal is thrown, with the hind leg carx'ied forward and secured as for castration. If the operation is to be performed behind the testicular mass, an incision is made on the median Une, measuring about three inches in length, the cellular tissue divided with the knife or the finger and the penis drawn out through the incision. The calculus is extracted through a longitudinal incision. The canal should then be examined with a probe or bougie, to ascertain whether any more ofi'ending bodies are present, and if so, they are of course also removed. The 5G2 OPERATIONS ON THE GENITO-UEINAKY APPARATUS. wound may be either closed by sutures, or, preferably, left without interference, to obviate the possible danger of the formation of future scrotal abscesses. In the pre-scrotal oj)eration, the hair is first clipped short, and an incision made through a transverse fold of the skin, to expose the penis. The concluding steps are the same as those in the former case. It is, however, always advisable, when the animal is secured, and before dividing the tissues, to insert the hand into the pre- puce to draw out the organ. By thus straightening it and remov- ing the S curvature, it is possible, and sometimes occurs, that calculi are displaced and extracted without the necessity of resort- ing to the knife. The urinary fistixlas which are among the sequelae of scrotal urethrotomy, are of two or three weeks' duration, seldom continu- ing longer. Care must be taken to protect the skin from the irritation produced by the dripping of the urine through the wound. Ischial Urethrotomy. This is the most common of the three operations, and is appli- cable to all males. It is performed without casting, with the animal hobbled on both hind legs and a twitch on his lip. (Fig. 470.) The decubi- tal position is seldom required. The free use of cocaine has enabled us to operate without any means of restraint, not only in horses, but in camels, which are very awkward and uneasy animals at the best, and esjoeciaUy when in the hands and under the knife of the surgeon. The insertion of a catheter has been recom- mended by many, to serve as a guide to the dissection of the urethra, while others prefer the artificial dilatation of the canal by the injection of water. In some cases, however, neither of these expedients is necessary. The presence of the calculus and the dilatation of the urethra above it, by the confined urine, greatly assists in the location and puncture of the canal. The incision must be made on the main line, on a level with the ischiatic arch. The structures to be divided are first, the skin, then the subcutaneous cellular tissue, the aponeurotic layers, and the accelator urinae; which being completed, a straight puncture can be made in the urethra between the two suspen- sory ligaments. The incision is then extended upward or down- URETHROTOMY. 563 Fig. 470.— Secure for Ischial Urethrotomy. ward, as may be required, with the bistoury, guided by the grooved director, a blunt bistoury being sometimes chosen from the motive of prudence, in order to avoid possible injury to the surrounding blood vessels. In our experience we have secured very satisfactory results by adopting the method recommended by Boiiley, of making one comprehensive pimcture, which penetrates the canal without any preUminary dissection of the incumbent parts, especially when a catheter has been placed in the ui'ethra for the guidance of the knife. The hemorrhage, which generally accompanies this mode of operation is of no great importance, often subsiding of itself, and seldom requmng external hemostatic appHcations. "NVe believe it to be the better coiirse, when the object in view has been realized, to leave the wound to itself, without interfering with the healing process by seeking to facilitate it by the appHca- tion of sutures. It gradually granulates and closes without any special care beyond the observance of cleanHness and the neces- sary measures to prevent irritation of the skin from the contact of the urine as it "leaks " through the wound. When the urethra has been opened, in whatever region of the penis the offending foreign body may be lodged, it is readily 564 OPEEATIOXS ON THE GENITO-UKINARY APPARATUS. 15 I'tt Straight. Curved. Figs. 471, 472.— Forceps to remove Foreign Bodies from the Bladder. extracted witli straight or curve forceps. These can also be em- ployed to secm-e those of comparatively small size that may be foimd in the bladder, and answer very well Hkewise for those masses of a sedimentary nature that are commonly seen in mares. There may sometime be some peculiar pathological conditions which render it necessary to prevent the closing of the woimd in cases of ischial urethrotomy, and when the formation of a perma- nent artifical opening should, perhap, be attempted. The entu-e closing of the urethra, in its anterior portion, re- URETHROTOMY. 565 suiting from some siDecial trauma^ tism woiild be such a case ; or again, when the formation of calcuH has become an estabUshed constitutional habit, and the results of this perver- sion of the nutritive and assimilative function are always present and con- tinually renewed. In view of this amfortunate state of things, and to prevent the closing of the woxmd, Troeber recommends the use of a pecuhar tube, which, when intro- duced into the urethra can be per- manently retained in place for an indefinite length of time (Fig. 473), We have attempted the formation of an artificial urethral opening, by Fialk-Tube of Troeber, for iscuial sewing together the mucous mem- Urethrotomy in Bovines. brane of the canal and the skin, but the results of the experiment were of the most transient character. CYSTOTOIHY. Improperly knowTi also as lithotomy, is an operation which consists in the incision of the neck of the bladder to remove cal- culi of dimensions too great for removal intact through the urethra. This operation has no longer a place in our surgery, and, in fact, there is no existing reason for its performance. If a calculus is of small or of medium size the neck of the bladder can always be sufficiently dilated to permit its passage, and if it should be of greater dimensions, and rendered impossible of ex- traction by its size, the operation of Hthotrity is always available, and in experienced hands as nearly certain and safe as can reason- ably be expected. LITHOTEITY. This term designates the operation of crushing, or piercing, or drilling stones in the bladder, in order to reduce them to frag- ments, preparatory to then- removal by means of forceps or cur- ates, or by washing them out of the bladder with water. It mostly corresponds with, or rather, includes the Uthotomy of 666 OrEUA'l'IONS ON THE OENITO-UiaNAltY AITAKATUS. K 1 I Fl(». 471.— T.ltliotrltor of OiilUon. V I lunnan Kur^ory. It wan por- foriucd for tlio firwt tiiuo l)y H. Bouloy iu 1858, with the aHHiHtaiico of ji pr.'Uititioiior of humau Hurgcry, Dr. Guil- lou. HorHOH are moro Hpecially tlio Hubjocts of this opera- tion in caHCB wlien the cal- culi are too bulky and too bard to be broken and re- moved with the forceps alone. In ruminants, on the contrary, vesical calculi, though more common, and more numerous in single animals, are generally of 8uf1[ici(>utly small size to permit the relief of the pa- tient by the Bimi>lo opera- tion of urethrotomy. The instrumenis neces- sary for this operation are the lithotritor, or liffum- triptor, with also tht> asily o\>\\- % ^ I » t-«JL» V^^^A-^^V. U-. \ ■m TA4tr^ *U(. ^l^-HHM v> 566 OPEKATIONS ON THE GENITO-URINARY APPARATUS. Fig. 474.— Lithotritor of Guillon. human surgery. It was per- formed for the first time by H. Bouley in 1858, with the ' assistance of a practitioner of human surgery, Dr. Guil- lon. Horses are more specially the subjects of this opera^ tion in cases when the cal- culi are too bulky and too hard to be broken and re- moved with the forceps alone. In ruminants, on the contrary, vesical calculi, though more common, and more numerous in single animals, are generally of sufficiently small size to permit the relief of the pa- tient by the simple opera- tion of m-ethrotomy. The instruments neces- sary for this operation are the lithotritor, or lithon- trijytor, with also the crush- ing forceps. The lithotri- tor of GuiUon (Fig. 474), or the crushing forceps of Bouley (Fig. 475), are those generally used. We are con- vinced by our experience of these instruments that the ^. principal, and probably the only objection that apphes to them lies agamst their mechanical construction. We consider them to be too clumsy, too large and too heavy; objections, howevei", which are ver-y easily ob\d- LITHOTKITY. 569 witli the bivalve speculum, a stream of water is then thrown into the bladder, either with the syringe or the tube of the irrigator. The water ought to be tepid and antiseptic ; and a hand intro- duced into the rectum and manipulating the bh^dder, will facHi- tate the repulsion of the larger fragments, and the washing out of the smaller. The general attention required in all cases of serious operations will be necessary after the performance of lithotrity. In respect to any special dressing, they are the same as those in- dicated in simple urethrotomy. Serious, however, as this operation is, it is comparatively free from dangerous sequelae. Hemorrhages of easy control have been met, TU'iaary abscesses, with infiltration, have occurred, serious wounds of the urethra, of the rectum and of the bladder may also happen, but they are of rare occurrence, and can be avoided by careful manipulation through all the steps of the operation. AMPUTATION OF THE PENIS. This operation is indicated in the horse when the penis becomes the seat of warty growths; of epithelial, papillomatous, or can- cerous degenerations ; of fractture ; of paraphymosis, or of paraly- sis. Warty growths are usually found covering more or less the free part of the penis ; or its free extremity; or the glans penis; and are also sometimes met with on the inside of the sheath, their presence being accompanied with an ofifensive and very irritating sebaceous discharge, becoming at times so painful as to interfere with micturition. They resist the severest forms of treatment, and it is not unusvial for theDQi to develop into forms of a more alarming nature, notably those of chancroid degeneration, of which, in fact, these epithilial growths are but the seminal origin. In other cases the erectile tissue of the glans penis becomes the seat of idceration, extending in depth, spreading in such a manner over the penis that the free portion of the organ becomes a mere mass of bleeding surface, of irregular asjject, macerating in the pus which abimdantly forms, and which escapes with its pecuUarity of bloody saniousity, with the most repulsive odor and irritating effect, rendering the act of micturition most painful and difficult. In many instances the animal so dreads to bring his j^enis out of the sheath that he urinates within the ca\aty formed by the folds of the skin, adding another soui-ce of irritation to that ak-eady 570 OPERATIONS ON THE GENITO -URINARY APPARATUS. existing. And if the penis is still allowed to pass out of the sheath, the inictm'ition is made with a crooked stream, which in- stead of escaping forward is, on the contrary, discharged back- ward. In such a case no treatment will reheve the difficulty but the removal of the entire diseased structirre. In fractures of the penis ; in many conditions of paraphymosis ; or in those of paralysis, the organ hangs suspended outside of the sheath, and cannot be restored to its cavity. If pushed back it soon returns to its abnormal condition, and even if retained by artificial means, will continue in place only while the means are continued to enforce it, becoming displaced agaia whenever the restraining agency ceases to operate. This serves to render the animal useless, in consequence of its appearance being so repul- sive as to preclude his employment in public view. Of course the only radical cure for such an ailment is the knife or its equivalent. The operation usually consists in the removal of the free por- tion of the penis, the necessity for going beyond this seldom occurring, yet in order to reach the diseased part it is sometimes necessary to divide the sheath along the median line. The general anatomy of the organ, as far as it relates to the operation, is very simple. The penis it formed by the corpus Pig. 477.— Penis in Normal Condition. cavernosum, a long, erectile structure, flattened from side to side, and grooved on its inferior border for the reception of the corj)us spongiosum urethi'se. Terminated inferiorly by a blunt point, this corpus cavernosum dips into the erectile tissue of the urethra- After passing out of the pehic cavity, by the ischial arch, the spongious portion of this canal, is received into the groove of the corpus cavernosum, at the anterior part, and also extends beyond it. The mucous membrane is covered externally by the tissue AMPUTATION OF THE PENIS. 571 which gives to this part of the urethra its name, and this erectile tissue terminates anteriorly in an enlargement, more or less developed, forming the head of the penis, or the glans penis. The urethra proper protrudes a little below the center of the head of the penis, and shows in a cavity undei-neath, the lurethral fossa, more or less filled with a sebaceous secretion. The blood vessels which ramify in these erectile structures are the two dor- sal arteries of the penis, anterior and posterior, and the veins, which form large branches, running also upon the dorsal border of the organ. Zundel very wisely insists upon two principal conditions (to which we shall again refer) to reahze in the operation, ^Vs^ to manage to leave a free means of exit for the luine, by cutting away less of the urethra than that of the cavernous body, and seco7id, to avoid the hemorrhage, which is especially liable to take place in horses, on account of the abundant circulation in the erectile tissues. The animal if to be placed in the recumbent position, as in the operation for castration, that is, on the left side ; or it may prove advantageous to place him on his back. Five modes of operation are described by different writers on the subject — 1st, the ligature; 2d, cauterization; 3d, excision; 4th, by scraping; and 5th, by crushing. As an adjunct to the various instruments which these different operations may require, metalHc catheters are also necessary. The Ligature. — The catheter being introduced into the urethra, beyond the point where the amputation is to be made, a strong ligature is apjDhed at that point and tightened sufficiently, if j)os- sible, to strangulate the portion of the penis which is to be removed. After from twenty-four to forty-eight hours, the external layers of the tissues will have become mortified, even to a certain depth in the penis, and a new ligature is then appHed, and strongly tied like the first one. The deeper layers of the penis are also, after a day or two longer, so mortified that they continue attached to the tissues above the ligature only by a small jiarticle, which can be divided with the knife. The catheter may then be removed or it may be allowed to remaia in place a few days longer. No special subsequent treatment is required. If, after a few days, micturation seems to become difficult, the urethral opening may be enlarged by the introduction of a bougie 572 OPERATIONS ON THE GENITO-UEINAKY APPARATUS. or a catlieter, or again enlarged by an incision with the bistoury. Instead of the ordinary string, an elastic ligatm-e may be sub- stituted with the advantage of maintaining an uninterrupted pres- sure upon the tissues up to the moment when mortification is established in the part to be amputated. Cauterization. — No catheter is required with this plan. Two ligatures are applied, one anterior, by which the penis is kept out of its sheath, and one posterior, acting as a hemostatic, placed above the point where the division is to be made. The operator then with a flat and sharp cautery, heated to white heat, makes a complete section of the penis. But, says Zundel, " as the urethra is especially dehcate and sensitive, it is better, in order to avoid its retraction, to separate it from the cavernous body about half an inch in front of the place where the section is made." A hollow bougie of india rubber inserted into the urethra will also prevent its contraction. Professor Nocard has recommended the use of the galvano- cautery, to obtain an easier division of the tissues, a more perfect hemostatis and to shorten the duration of the operation. Excision. — After introducing a metallic catheter, a rapid sec- tion of the organ is made by a single stroke of the knife. Again, says Zundel, " when the lu-ethra is reached, it must be dissected a little forward, toward the glans penis, and caused to protrude about half an inch beyond the point cauterized." Scraping of the perns. — This method, which was put in prac- tice in 1829 by Moiroud and Delafond, consists in scraping the penis with a bistoury, in such a way that the remaining portion of the organ forms a cone, with its apex formed by the urethra. A catheter may be introduced into the canal previous to the opera- tion and left in place for awhUe ; or again, it may, if thought proper, be entirely dispensed mth. This mode precludes the danger of hemorrhage. Crushing. — By operating with the ecraseur, the amputation is perfected without danger of hemorrhage. The chain of the instrument is applied at the point of amputation, and by slow and gradual action, cuts through the tissues until the diseased part drops off. The danger attending this method is that the chain may break during the process, in consequence of the resistance of the cavernous tissue. This accident has certainly been encoun- tered by many practitioners, and we have oui'selves witnessed it AMPUTATION OF THE PENIS.. 573 in two instances. On one occasion it was found necessary to re- place the chain twice, and to complete the amputation with the knife. Eeynal has modified the crushing- operation by making the action of the ecraseur slower. He has invented a small instru- ment (ecraseur) which is left in place for two or three days, being- tightened every day, or several times a day, until the mortification is complete, and the diseased penis sloughs off. In this method, a metallic catheter is placed in the urethra ; in the other the catheter is not required. In reflecting upon the various modes of operation we have thus described, and noting especially the two very important, and indeed, essential requirements referred to by Zundel, in respect to the matters of micturition and hemorrhage, we are struck with the fact that in none of those methods are these obvious require- ments comj)lied with, or if they are, it is in a manner so faintly implied, and so indefinite and unsatisfactory as to be scarcely intelligible, and certainly to leave no distinct impression on the mind, of the importance of the points referred to. In every case the danger of possible subsequent interference with micturition is threatened, whether the catheter is used during or after the operation, or even, we fear, if left in the passage " at least two months," as recommended by Peuch and Toussaint. We can remember cases of our own which, with even a longer retention of the catheter, were followed by failure. We have attempted the formation of an artificial urethral opening below the ischial arch, and with no better result. We are tempted to believe that the hemorrhage is less danger- ous than many think, and we beheve it could be controlled by ordinary pressure, or by plugging the sheath afterward, or by still other means of hemostasia. Taking all this into consideration, we cannot but think strange of it, that the process used in human surgery, which we find merely mentioned in some European works, but which we believe has been performed by Gerlach, and which we ourselves adopted more than fifteen years ago, should be practically ignored or rejected by writers as well as practitioners. We have practiced it during the period mentioned without having encountered the sHghtest comj)lication or troublesome sequelae. We refer to it as the only safe, and as, therefore, the best mode 574 OPERATIONS ON THE GENITO-UEINAEY APPARATUS. of operation for the amputation of the penis. It differs from any that have been previously recommended, and is as follows : The animal being prepared for the operation in the ordinary way, the penis is secured with a ligature at its end and drawn out of the sheath, and another ligature tightly appUed on the upper part of the organ. An incision of the skin covering the penis is made entirely around the organ and down to the cavern- ous body, with the precaution of drawing the skin slightly back- ward, so that when the amputation is completed, and the skin allowed to return to its position, it will slightly overlap the stump of the penis. We divide the cavernous body, carefully avoiding injury to the urethra, and when this organ is reached it is dissected from its groove forward into the cavernous body (Figure 4:77a) for a Fig. 477a.— Amputated Penis, with the Urethra Protruding. length extending between one and one-half to two inches, when the division across the urethral canal completes the amj)utation. The removal of the diseased tissue being thus made, we have before us the stump of the cavernous body, almost dry, the hemori'hage being prevented by the upper Ugatm-e, which moreover, secures a good hold and good view of the mutilated organ. The urethra is then slit on its inferior border on the median raphe and both flajDS turned upward and brought in contact by interrupted sutm-es with the skin which has been so divided as to overlaj) the stump (Fig. 477/^). These sutures are made close to each other, of strong silk or catgut. The result is that the stump of the penis carries at its lower margin a sHt of from one to one and one-half inches in length, which, after allowing for all shrinkage of cicatricial tissue, will always be sufficient to permit thorough micturition. AMPUTATION OF THE PENIS. 575 Fig. 4776,— Stump of Amputated Penis, with Stitches uniting Urethra and Skin. The sewing done and the upper ligature removed, the penis re- tracts within the sheath, and the animal is allowed to rise. "We have been performing this operation for fifteen years, and have never yet met with the slightest complication or disappoint- ment. In dogs the amputation of the penis is indicated for about the same diseased processes as in the horse. The amputation, however, does not include only the soft tissues, but also the bone of the penis, which is divided with nippers or a saw. The division of the cav- ernous body is done with the ligature or the ecraseur. Strictures of the urethra are of common occurrence after this operation, and can be overcome only by the repeated introduction of the catheter, or the enlargement of the urethral opening with the knife. CHAPTER Xm. OPERATIONS ON THE FOOT. ANATOMY. In our domestic animals we call tlie foot tlie extremity of the leg, and even only the extremity of the digit, for, considered in a zoological point of view, the foot extends from the carpus or tar- sus to the last phalanx, inclusive. The foot of the horse forms an extremely imj)ortant study on account of the numerous diseases to which that member is sub- ject, and also of the value of the motor powers required from the horse ; the old horsemen expressed this importance by the aphor- ism, "no foot, no horse." This truth finds daily its sad appHcations in the premature ruin of large numbers of horses rendered useless because of the defects in their feet. All the quahties of a horse are, indeed, considerably diminished and can even be entu-ely destroyed, by the bad conformation or accidental alterations of these essential organs. The study of the foot of the horse has been the object of many voluminous works, such as those of Gir- ard, Bouley, Bracy, Clark, Anker, Leisering & Hartman, Lafosse, Gourdon, Reynal, Defays, and many others, to which we refer for the more complete description of the organization of the foot. The organ is composed of two orders of parts, some internal, organized and sensitive ; the other external, formed of a horny, organic substance, the hoof, but entirely void of the property of vital sensitiveness. The internal parts are bones, three in number, the second and third phalanges, and the small sesamoid, which form by their reunion the articulation of the foot ; special liga- ments, which maintain the connections of these bones ; tendons, which fiU the trij)le office of agents of transmission of motion, articvilar ligaments and organs of support of the weight of the body ; a fibro-cartilaginous apparatus, superadded to the third phalanx, and which completes, so to sjjeak, jDOsteriorly, and increases the surface by which it rests on the hoof and transmits ANATOMY OF THE FOOT. 577 Fig. 478. -Longitudinal Section of the Digital Region teched to the oa coroniB. I. -Insertion of plantar K.— bpongy structure of 08 suffraginis. L, ~ H.— Porforatus tendon at- aponeurosis to the semi-lunar crest. to the ground the pressure which it receives. These are the lat- eral cartUages audthe plantar cushion; arteries, veins, lymphatics and nerves, remarkable for their number, development and dispo- sition; and at last, a ligamentous, sub-horny membrane, or kera- 578 OPERATIONS ON THE FOOT. Fig. 479.— Plantar Nerves in Digital Eegion. P.— Plantar nerve. A.— Origin of the digital nerves. B B.— Cartilaginous branch. C C— Cutaneous branch. D —Digital artery. G.— Transverse branches back of the fet- lock joint. I.— Nerve of the plantar cushion. L.— Lateral band of the plantar cushion, v.— Digital vein. togenous apparatus, forming a continuation of the skin, which surrounds the parts of the foot like a stocking, and upon which the foot rests, as a shoe on the human foot. In this apparatus are found: 1st, the coronary band, which forms a rounded projection at the separation of the skin and hoof, and which serves as a matrix to the perioj)le and the wall ; at its surface are seen numer- ous villosities or papillse ; 2d, the podophyllous or laminated tissue which is spread upon the anterior face of the third phalanx, and is remarkable by the sheet of j)arallel laminse which it presents at its surface, separated by deep furrows in which are received the analogous laminpe of the internal face of the wall (Figure 481) ; ANATOMY OF THE FOOT. 579 Fig. 480.— Arteries of the Digital Region. AAA.— Digital artery. B.— Transversal branch in front of fetlock ioint C— Per- pendicular artery of Percival. D.— Its ascending branch. E.— The descending branch. F.— Branch to form the superficial coronary circle. G.— Posterior transverse branches. K.— Artery of the plantar cushion. P.— Circumflex artery. CO.— Ascending terminal branches of the digital artery. 3d, the velvety tissue or villous tunic which covers the plantar cushion at the interior face of the foot, and is the secreting organ of the sole and frog, its surface covered with villosities similar to those of the coronary band, and like them, of various sizes, are lodged in the porosities of the internal face of the sole and frog. The external parts of the foot are four in number : the wall. 580 OPERATIONS ON THE FOOT. A A I Fig. 481.— Portion of the KeratogenouB Apparatus. A.— The skin. B B.— Coronary baud. R.— Its villosities. P.— Podophyllous tissue. 6/ ? Fig. 482.— Section of the Hoof. 1.— Periople. 2.— Cutigeral cavity. 3.— Keraphillous tissue. 4.— Wall. 5.— Contin- uation of the periople with the frog. 6.— The sole. 7.— Union of the sole and wall. 8.— Frog stay. the sole, tlie frog and the periople (Fig. 482). These form, together, a homy box, the nail, or hoof, which is adapted exactly by its internal cavity to the external contour of the sub-horny membrane, contracting with it an intimate union by a reciprocal reception, and thus completing the structure of the foot, fui*nish- ing to the sensitive parts an apparatus, thick, hard, resisting and at the same time elastic, which makes one with them, and protects them against violence from the substances with which the foot, from the nature of its function, must necessarily come in contact. ANATOMY OF THE FOOT. 581 The horny substance which constitutes the hoof has a fibrous aspect ; it is hollowed all over by cylindrical canals, whose superior extremities, widened into a funnel shape, cover the papillse of the matrix of the hoof, either at the coronary band or velvety tissue, while the inferior open in the wall upon the plantar border, in the sole and frog, at the external or inferior face. These canals are rectilinear, except those of the frog, which are flexuous ; their diameter varies from 0, 02 to 0, 2 or 04"'°- These tubes are not only hollowed in the horny substance ; they have also proper walls, of very great thickness, formed of numerous concentrical layers, received into each other. These are lamelljB of pavimentous epithelium, which constitute the horny tissue ; in the walls of the horny tubes, they are grouped flatwise around their inferior canals, and stratified from within outward, so as to form successive and concentrical layers; in the intertubular horn, these lamellae are not stratified in a direction parallel to that of the tubes, but at right angles with it. Ai'ound the tubes, the lamellae have an oblique intermediate direction. A granular opaque substance fills up the space lying between the horuy tubes and the papillae. The hoof, which is a part of the epidermis, develops similarly, that is, by the constant formation of cells in the layer which cor- responds to the mucous malpighian body, at the expense of the plasma thrown off by the numerous blood-vessels of the keratoge- nous membrane. The velvety tissue is the starting point of the elements of the sole and frog ; the jDerioplic band is the organ secreting the periople ; and the coronary band proper, the matrix of the waU. Upon these different parts, the ej^ithelial cells multi- ply and flatten into lameUte, in the direction of the surface of the keratogenous membrane, as they spread from it. The wall then grows from its superior to the inferior border, and the other parts of the wall from their internal to their external face. The villosi- ties of the coronary band and of the velvety tissue are the organs around which accumulate the epithelial cells ; their presence defines, consequently, the tubular structure of the horn. The laminse, ui the physiological state, do not co-operate in a sensible manner with the formation of the wall ; the keraphyllous laminae form themselves at the coronary band, at the origin of the podophyllous ; they descend with the wall, gliding at the surface of the layer of cells which separates them from the laminated tissue, a movement of descent which is facihtated, however, by the 582 OPEEATIONS ON THE FOOT. multiplication in the same direction of the said cells. When the podophyllous tissue is inflamed, whether exposed or not, its latent activity soon manifests itself. It gives rise to a great quantity of hard horn, hollowed, as seen by Gourdon, with tubes, and oblique in a du-ection backward. These tubes, more irregular than those of the normal wall, are disposed in a parallel series ; they are in form round, villo-papillfe, which have developed on the face border of the laminae. In these cases of production of horn by the action of the podophyUous tissue alone, ojie never sees, between the sensitive laminse, distinctly formed horny laminse in the middle of the other cells, as it is observed in the wall proceeding from the coronary band. The horn which rises on the surface of the podophyllous, immediately after the removal of the piece of the wall, is not a permanent one ; it must be replaced by the horn of the coronary band. This change is complete, microscopical examination proving that the wall which descends from the coronary band, provided with keraphyllous laminse, engages itself under the temporary wall, and slides by the action already described over the surface of the soft cells of the laminated tissue. As soon as this tissue, modified by inflammation, is covered over by the permanent wall, its papillae become atrophied, and its action returns to the limited boundaries of physiological condition. — {Chauveau.) The foot is an organ of support and an apparatus of elasticity; it is through it that the whole animal machine maintains its rela- tions with the groimd, and that it adapts itself in its various move- ments, so to speak, to its roughness. It is this that, as a last spring, distributes and modifies the force of all the movements of the horny mass of the body, whose columns, the legs, may be considered as the resultant. Intermediate with the body and the ground, the foot transmits all the actions of weight reaching it, and also between the body and the sensorium, toward which all sensations resulting from its contact with surrounding external substance return, the foot then becoming at the same time an organ of feeling. To adapt it to this triple formation, nature has given to it three properties, in appearance incompatible with each other, which has, however, harmonized, viz.: first, a very great external hardness, due to its horny envelope ; second, a certain amount of flexibility, the combined result of the physical properties of its cortical envelope and of its mechanical disposition of its different ANATOMY OF THE FOOT. 583 parts, and thii'dly, a higlily developed sensibility resulting from the high organization of its tegumentary membrane. — Bouley. DISEASES AND DEFECTUOSITIES OF THE FOOT IN SOLIPEDS. Of all the domestic quadrupeds, the horse is the most exposed to diseases of the foot, which are more or less frequent in him according to the work he is subjected to, the places he lives in, and the nature of the ground upon which he travels. As rare as are those accidents ia farm horses, so common are they among horses in cities, of heavy draught, and also army horses ; in all, in fact which travel continually on hard, j^aved and stony roads, and especially in large cities, where all those injuries can but be the result of their constant work on stone pavements, always so rough and shppery. If to these conditions are added the very numerous accidents resulting from bad shoeing, so badly carried on, one will be less stu'prised to see the foot becoming deformed and altered in different ways, deteriorated, and preserving with difficulty, and for a short time, its state of integrity, and becoming the seat of numerous affections. We shall distinguish the diseases proper and the vices of conformation of the foot. The former are generally sufficiently serious to merit special description. Among them some are su- perficial, as the false quarters, uncomplicated cracks, or solution of continuity, thrushes, canker; others of deeper interest, specially those of the keratogenous apparatus, such as laminitis, with its complications and sequelae, keraphylocele, seedy toe, and sep)aration of the wall, which may extend as far as entire sloughing of the hoof ; accidents then due to the suppuration accompanying several diseases of the foot. Some maladies are specially the effects of wounds, of contusions such as overreaching, quittor, bruised sole, bruised heels, corns, punctured wounds; others are results of shoeing, pricked, tight shoe, burned sole; others are deep alto- gether, such as bionions, navicular disease, and, lastly, fracture of the OS 2)edis, or of the navicidar bone. VICES OF CONFORMATION. Among the vices of conformation some are serious, as contrac- tion of the heels, flat foot, pumiced foot, club foot, crooked foot, rammy foot, and, lastly, the /c»o« with bad horn. 584 OPERATIONS OK THE FOOT. (a) Flat foot (Germ. Platfuss). — By tliis is understood the foot in wliicli the sole, instead of having the natural concavity, is, on the contrary, flat, and by its whole surface about on a level with the border of the wall and the base of the frog ; ordinarily this is accompanied with low heels, more or less contraction, and a well-marked oblique direction of the wall. Flat foot is generally observed only on front feet, and is very common in lymphatic animals or of low breed, raised in low and damp soils ; it may be congenital. Large feet, badly shod or used up by very heavy work, are predisposed to it. It is claimed that the weakening of the sole by too repeated and deep paring of the sole will ultimately bring it on ; it is said that abuse of poultices may produce it ; it follows excess of the hollowing of the shoe by the upper surface, which, pushing the wall outward, obliges the sole to drop lower than its normal level. The horse with flat foot rests on all parts of the sole at once ; there is no elasticity of the arch of the sole, and percussions take place on it entirely. The actions of the animal are heavy, espe- cially as it is commonly seen when the feet are large. When the foot is somewhat tender, the animal lames easily, especially if the shoeing is bad, or if the animal rests on the sole or is obHged to trot on rough or stony roads, which render the percussion very painful. There arises some irritation, which keeps on increasing, and produces several accidents, such as bruised sole, corns, pumiced feet. The horse which has flat feet often has weak walls, and as the nails of the shoe become loose, this is often cast. By shoeing one may remedy this bad condition of the foot. For this, the foot must be pared flatways, the sole spared, the wall relieved only of what is broken oif ; the frog must be left alone, the heels also ; a shoe somewhat wide in the web, protecting, therefore, the sole more than an ordinary shoe does. It will be adjusted so as to rest on the border of the wall only, and not on the sole ; still, care will be taken not to hollow it too much or to excess. Sometimes a thick shoe only is necessary, without in- creased width. Soles of gutta-percha or felt are also used, as we will see when speaking of the pumiced foot. (b) Pumiced foot (Germ. Vollfuss). — Thus is called the foot whose sole projects beyond the level of the wall, and presents a convex surface, extending beyond the plantar bordei-, upon which ANATOMY OF THE FOOT. 585 the horse rests. It is the exaggeration of the flat foot. In the pumiced foot the wall has a great obliquity, sometimes even assuming a nearly horizontal direction. The horse is never born with such feet; this is a malformation, accidental, or resulting from various causes. One of the most common is lack of care of the foot, of necessary caution, for instance, in paring, or shoeing in such a way as to bring the rest of the foot on the cii'cumference of the under part in such a way that the sole does not touch the ground, and ceases to be pressed by it. Too much concavity of the shoe may bring on this result, by resting only on a too narrow part of the inferior border of the foot ; and by opposition, not enough concavity will compress the tissues, irritate them, and produce the same alteration. Feet become pumiced by laminitis, but this is compHcated with seedy toe. Nevei', then, is the foot pumiced in its whole extent ; its deformity stops always at the limit of the inferior border of the bars ; beyond them, behind, on each side are seen the excavations of the lateral lacunse of the frog, so much deeper that heels are higher. The hoof does not preserve its circular shape. It atro- phies on the side, and presents at the toe an excess of thickness in the wall; the heels assume a greater development. This deformity is very serious, and disables the horse easily ; rest takes place only upon the sole and frog ; after laminitis, upon the sole and heels ; it is always very painful. Work upon hard ground and pavement is next to impossible. After laminitis, one sees, during walking, that the foot rests upon the heels, and then by a motion from backward to forward. An animal with pum- iced feet has a tendency to f,orge and interfere; the slightest bruise of the sole gives rise to serious compHcations. One often observes wounds, suppurations, etc. The indications are analogous to those of the flat foot; the sole ought to be si>ared as well as the frog, the walls only ought to be slightly trimmed ; the shoe must be made so as to carry the rest upon the border of the wall and protect the sole. When the foot is not pumiced to excess, one must use a broad web shoe, sufficiently concave to allow the sole to rest in it ; but it must not be too excessive, as then the base of the rest would not be very firm. A sheet of gutta-percha, or felt, with tar and oakum, may be placed between the shoe and the foot. (c) Club foot (Germ. Bockhuf). — This is the foot in which the 586 OPERATIONS ON THE FOOT. "wall is straightened more or less perj^endicularly, or even obliquely backward, so that the superior border of the wall is more forward than the inferior. The superior levers participate always in this vicious direction, which constantly brings back the rest of the foot toward the anterior jDart of the wall, and, according to its degree, makes the animal walk more or less on the toe, even some- time obliging him to rest on the anterior face of the hoof ; the heels are raised from the ground, and the fetlock, instead of being open forward, seems to be turned backward. This deformity, which exists especially in the hind legs, is very common, and is even natural in mules, and supposes, with its presence, high heels, which throw the rest on the toe, which is always very thick. It may also exist with low heels, especially when due to ovei'work or other accidental cause. Horses which, like mules, are club-footed only by a peculiar condition of the parts, walk with firmness, and even pull better and work better in hilly countries. If they are unfit for the saddle, it is because their reactions are hard, and that they tire the rider. It is not so with those which are club-footed from hard work ; they continually stumble, are subject to knuck- ling, to interfering, or even to falling ; and for these reasons do they always require a mode of shoeing which would give them the missing solidity, and render their walk more steady. This cir- cumstance indicates the necessity of sparing the toe, and throwing the weight back on the heels, which, however, must not be pared off too much. The best shoe for such feet must be short, thin at the heels, with a thick toe, slightly raised upward, and prolonged beyond the level of the border of the wall ; small heels to the shoe are often advantageous, as giving an opportunity for rest and relief. The shoe with truncated branches of Lafosse (slipper), which is a short shoe, not extending beyond the quarters, and leaving the heels free, is sometimes used. This shoe is very thick at the toe, and very thin at the heels. It is unnecessary to say that club foot is often cured by tenotomy, or by treatment of the tendinous retraction. id) Crooked foot. — We call by this name the foot whose sides are not of the same height ; it may be crooked outward or inward. This deformity may result from a vice of du^ection of the x-egions above ; ordinarily, however, only from a deviation of the phalan- geal one. Sometimes it is due to bad shoeing, to bad paring of the feet ; sometimes it f oUows imequal wearing of the foot, it being ANATOMY OF THE FOOT. 587 without shoe. Colts which have never been shod, and are walking- for a long time on hard and rough ground, often present this con- dition. The horse with crooked feet inward, specially if the deviation is much marked at the toe, is exposed to cut himself with the internal heel of the shoe — to bruise himself ; the horse with crooked feet outward cuts himself with the inner toe. Besides these, lameness, from lacerations of articular ligaments, may often follow. This is relieved, especially in young animals, by lowering the side of the wall which is the highest, and sparing the other ; the proper shoe for this condition must be thicker in the branch cor- responding to the lower side of the foot. The shoe ought to be changed quite often, in proportion to the existing difference in the height. If the foot is very crooked, it is difficult to straighten it by having a greater thickness of the shoe ; it would make this too heavy. Sometimes it is better to use nails with large-sized heads on the lower side of the hoof ; and in these cases one might put on corks at the heels, external or internal, as required. (e) Mammy foot. — This is a defectuosity of the foot, always accidental, in which the surface of the wall offers more or less numerous circles, above each other and running from one quarter or heel to that of the other side. These roughnesses, arrranged in rows, rise always from the coronary band, and form as many elevations gradually descending and disappearing toward the in- ferior border of the wall. They are so much more serious that they are deep, and sometimes are accompanied with lameness, especially when in great number, close to each other, and when the foot is narrow and long. These circles are sometimes seque- lae of laminitis, and accompany seedy toe ; the rings are then in the middle of the toe, which is more or less roughened, like an oyster shell, and they disappear only when the primitive alteration is removed. When they are small, not numerous, and grow down without being replaced by new ones, this favorable disposition of the wall must by stimulated by all the means which may stimulate and keep up the suppleness, by Hght bhsters over the coronet. A light shoeing, often changed, is the best in those cases. Circles which reappear continually are due to an intimate and continued alteration, and are in company with other defectuosities, such as contraction, pumiced foot, etc. {/) Foot with had hoof. — A hoof may be too soft or too dry. 588 OPERATIONS ON THE FOOT. When too soft, too greasy, it contains too much dampness and is lacking resistance. Horses which have this weak hoof, as said Laf osse, have the foot tender and unfit for long walks on hard and stony ground ; they are, besides, much exposed to lose their shoes, because the hoof breaks up at the nail-holes. This fault is quite common in large feet, frequently seen in Northern lymphatic ani- mals, especially in those which come from marshy districts ; if, then, those horses are submitted to stabulation, their hoof becomes dry to excess, which gives rise to narrow and contracted feet. The lower part of the foot must be pared with care, as it has but httle thickness ; the application of the warm shoe while fitting must be as short as possible. An ordinary thin and light shoe must be used ; the naUs will be as light and thin as possible, and ham- mered in carefully. Too dry hoof is liable to break, because it has lost its physio- logical suppleness ; this brittleness is often met in animals whose feet have been much in water and afterward are placed on dry ground ; it seems as if the water had dissolved the adhesion of the horny cells. The same condition follows the excessive use of poultices and also of strong grease in shape of ointments. It is wise to grease, but previously the old crust must be removed. Hoof ointments of wax, turpentine or tar are better. The foot is called dc'rohe (broken) when by the use of a thick nail it is more or less broken at the edges of the wall. These feet lose the shoe easily ; animals then go on bare feet, and then it becomes very difiicult to pvit other shoes on. It is necessary in these cases to punch nail holes on the shoe corresponding with parts where the hoof is sound. In paring, all the pieces of broken horn are removed, or at least as much as can safely be done. Nails are secured as high as possible ; shoes must be changed as often as possible, and the hoof is to be kept supple by unctuous api^lica- tions. When the breaks of the horn are too large, softened gutta- percha, or a mixture of gutta-percha three parts, with one of gum ammoniac, melted together, can be used to fill the anfractuosities, all grease having been first removed by a wash with ether ; the putty hardens, and the shoe can be tacked on solidly. Nails can even be punched through the gutta-percha. ANATOMY OF THE FOOT. 589 Instruments. The sm-gery of the foot requires special instruments for the operations which influence action upon the hoof, as also for those which are to be performed upon the tissues of the foot proper. Besides those which are commonly required in ordinary sur- gery, such as curved scissors, probes, bistouries and forceps, others are needed of special forms and for special purposes; among those most commonly used are the different sage knives and di-awing knives. Sage knives are lanceolated blades secured to handles, and are either double or right or left. The blade, which is curved upon its long axis, may be sharp on both edges, as in the double, Fig. 485. Pig. 484. SAGE KNIVES. (Fig. 483) or on only one or other edge, when it is known as a right (Fig. 484) or left (Fig. 485) sage knife, being thus adapted to use by either the right or the left hand. Drawing knives, which are made somewhat like those used by blacksmiths in the ordinary method of paring the foot, yet differ from those in being straighter in their attachment to the handle, and also on being curved on their long axis, being also sharp on both edges. The groove of the instrument is made to vary in 590 OPERATIONS ON THE FOOT. wicltli, and thus can be used as the different steps of the operation may require (Fig. 486). Sometimes the drawing- knife resembles more that of the blacksmith, as being sharp on one edge only (Fig. 487), and in this case the groove of the blade is generally much narrower than in the others. Some special operations require peculiar forms of drawing knives ; for instance, those which are Fig. 487. Figs. DRAWING KNIVES. made with a blade perfectly straight and narrow, very slightly sharp on the edges, but having a very narrow groove at the ex- tremity (Fig. 488). These are used principally in the scraping of diseased bone-structure, in deep punctured wounds of the foot, and in cartilaginous quittor, when small sections of cartilage are to be removed from the lateral border of the os pedis, which could not othewise be accomplished. Other instruments are also required, the description of which will be given as we refer to the different diseases where they find their applications. General Operations. Bemoval of the sole (Germ. Absohlen). — This is an operation by which the sole of the foot is removed by severing it from the living tissues underneath. In times gone by this operation was extensively performed, being considered indispensable as soon as the slightest lesion under the sole existed. It was alleged that ANATOMY OF THE FOOT. 591 tmless this was done the suppui'ation would be likely to spread uuderneath tlie horn. In our days it is rarely performed, as it is considered that it presents but little advantage, so far, at least, as it involves the removal of the entire organ. Sometimes, however, portions of it have to be taken off, as in some special diseased con- dition of the foot, such as in punctured woimd, pricking by the blacksmith, burnt sole, etc., the modus operandi of which will be considered when treating of these diseases. Removal of portion of the xoall. — A few morbid conditions of Bome parts of the foot requii-e in their treatment the removal of a portion of the wall, in order that the escape of pus, the removal of diseased tissue, or the sloughing of necrossed cartiliginous or bony structure, as in complicated cases of suppurative corns, of quarter-crack or in cartilaginous quittor. A similar operation is sometimes required in cases of toe-crack, complicated with disease of the OS pedis. These will be further considered when ti^eatiag of these special subjects. Dressings. As nearly every operation of the foot requu'es a mode of dress- ing peculiar to the manipulations which have been necessary, we shall, when speaking of the different diseases, where parts of the walls have been removed, iaclude also a description of the pecidiar dressing they require. There is one, however, which is thought much of in veterinary surgery, and of which we will ha*"e to say more when speaking of punctm-ed wounds of the foot. This is the dressing with plates, which serve to retain the plantar surface, the balls and pads of oakum, which are placed to protect the wound. The aj^plication of these plates is far suj^erior to the leather sole, because of its easy removal when the parts are being examiaed, and of their easy replacement ; thus allowing the sui-geon to change the dressing whenever he sees fit, without being obHged to remove the shoe. DISEASES. Canker of the Foot. (Germ., Strahlkrebs, Hufkrebs). — Under this somewhat un- scientific,* though accepted name, is designated a peculiar disease * Cra/paud of the French. 592 OPERATIONS ON THE FOOT. of the feet of solipeds, seated in the secreting tissues of the horny box, always beginning at the frog, and characterized by alteration of the homy secretion. Names of a more scientific meaning have frequently been proposed, such as gnawing ulcer (Bourgelat), schirrus or cancerous carcinoma of the frog, carcinoma of the reticular tissue of the foot (Vatel), darter of t?ie plantar cushion, chronic podoj)arencJiyder7nitis (Mercier), and epithelioma of the frog (Fuchs). None of these has ever been accepted, and the old hipj)iatric name has been retained. History. — It is conceded that the old veterinaiians were ac- quainted with canker, and Vegetius evidently speaks of it, but not until the time of Solleysel do we find a descriiDtion somewhat comj)lete of the disease and its treatment ; Garsault, La Gueri- niere, Weyrother and others spoke of it, and have expressed various opinions as to its etiology, and especially as to its treat- ment. So little progress was discernible in the writings of Bour- gelat, Chabert, Huzard and Gii'ard, on that very question, and so many false ideas were admitted, that Chabert in despair has called canker the opprobrium of veterinary medicine. It is but recently that serious research as to the natm'e of the disease have thrown some hght on the question, and estab- lished the important fact that its seat is not in the disorganized horn, but in the secreting organs, and that there is an alteration in the products of this secretion ; that it is consequently to these that remedies must be appHed. We might refer to the writings of Jeannie, Crepin, Hurtrel d'Ai-boval, Prevost, Mercier, Plasse, Percivall, Dietrichs, Eichbaum, Wells, H. Bouley, KejTial, Haubner, Fuchs, Eey, Megnin, etc., each of whom has furnished his contingent, while still the inti- mate nature of the disease remains but imperfectly known, and there is but little certainty either in the treatment or its resiilts. Let us observe, however, that in our day canker has become comparatively a rare disease, especially in cities, which, doubtless, is because of the cleanliness of the streets. In the begimiing of this century, canker and grease — closely related diseases — were frequent in Paris; then horses were obHged to travel through deep gutters of mud, while to-day these affections are excejitional occurrences (H. Bouley). The same thing has been observed by Percival in England. When hygienic precautions were not as weU understood as they are to-day, in establishments employ- DISEASES. 593 mg large numbers of horses, when the stables of mail and stage coaches, and even those of military garrisons, were small, ill-venti- lated and dirty, among horses standing in filth and soiled manure, these afiections were relatively common ; with hygienic improve- ments, they have almost disapj)eared. In the army, canker was the cause of considerable annual loss, almost as serious as those from glanders ; to-day it is rare and almost unknown. Improvements in the different breeds of horses, either by bet- ter choice of reproducers, or by changes in the mode of feeding, resulting from the progress of agricultural processes, the suppres- sion of common pastures, etc., have contributed to render the disease less common. Synqitoms. — It is seldom that the symptoms of canker can be observed from the start ; slow in its progress, and not surexciting the sensibHity of the parts, the disease may progress without manifesting any ill effects, and consequently escape notice by the owner or groom, nothing appearing to call his attention to the affected foot. Thus, in a majority of cases canker is only dis- covered after it has been in existence for a considerable period, and when serious alterations have already taken place. It is often at the shoeing shop, when the shoes are changed, that in the laminse is observed a moisture more or less abundant, giving rise to softening and raising of the hoof. The disease sometimes attacks only one foot, often several feet at a time ; at times when one foot is cured, another becomes affected, and the disease thus appears traveling alternately from one foot to another. Usually the disease begins with the inflamation of the kerato- genous membrane which covers, the median lacunae of the plantar cushion ; the hoof covering this is softened, raised by a serOus moisture, and once loose, is not renewed, the tissue producing it having lost its function of secreting the horny substance, and now secreting a serous element, which becomes the caseous matter of which we shall speak hereafter. Sometimes the disease begins by moisture in the hollow of the coronet, by a kind of grease, a disease which we shall see to be of the same nature as canker. The is an oedematous swelling, warm, somewhat painfvil, of the phalangeal region, first serous, then be- coming opalescent, which seems to filtrate through the softened, but not yet raised, epidermis. This inflammation, spreading little by little toward the hoof, extends to the plantar keratogenous. 594 OPERATIONS ON THE FOOT. membrane, and gives rise to an exhalation of the same nature as that of the skin which produces the separation of the hoof, and the first marks of canker. Sometimes one may observe at once, a fungoid growth of ficus, formed by an hypertrophy of the tissues underneath ; this growth is more or less moist and offensive, bleeding easily, having the aspect of cauliflowers, and protruding through a break of the softened hoof, and forming a thready detritus to be subsequently studied. Commonly, the hoof is more or less loose, and under it is a caseous matter, greas}^, ordinarily of a foetid odor, easily re- moved by scraping, being non-adherent to the tissue which secretes it. If the parts are well cleaned from this, the velvety tissue of the pyramidal body of the frog, appears to be covered with a smooth membrane of a slight whitish color ; the external layer then appears formed by a pellucid epidermic covering, show- ing through its transparency the purplish color of the capillaries underneath. The velvety tissue is diseased, but still retains its functions, which, on the contrary, are increased but perverted, and instead of secreting a horny substance which adheres to the surface of tbe keratogenous membrane, produces the caseous mat- ter already referred to. The break in the hoof frequently seems small in size. Nevertheless, the alteration of the keratogenous tissues, viz : the substitution for its normal, of a pathological se- cretion, whose product is this loose caseous matter, is far ad- vanced. There is then an extensive, though a concealed separa- tion of the hoof. One then must not allow himself to be deceived into supposing it to be a limited diseased process, by the apparent external integrity of the horny box. The characteristic of canker is its tendency to sj^read, like can- cerous affections. Once manifested in any part of the sub-horny tissues, the special changes which characterize the disease seldom remain circumscribed; on the contrary, they generally extend from that part as a centre, throughout the whole circumference, and little by little, attack slowly but continuously the whole ex- tent of the secreting apparatus, and thus loosen the entire horny box — starting from the median lacunse, or the glomes of the frog, it extends to the branches and the body of the plantar cushion ; then spreads at the side, in the lateral laminae, from there all roimd on the velvety tissue, then by degrees reaches the inferior ex- tremity of the podophyllous laminte and going upward, reaches DISEASES. 595 the coronary band, the h\st point, where, in extreme cases, the hoof preserves its adhesions with the tissues which form it. In this condition the disease process progresses more slowly than be- tween the sole and the velvety tissue, and then it seems to remain stationary ; otherwise the dropping of the hoof would be possible. We have seen that often at the beginning, but especially as the disease progresses, there are growths called fici, found principally round the laminae, the frog and the sole. These are of whitish color, opal, var^-ing in size and in shape ; they constitute an irregular mass, formed of those fici pressed together ; some of these growths have a wide basis, others are somewhat peduncu- lated ; sometimes they are single, tubercular, slightly elevated ; at other times elongated bodies, true fibrous bundles. The fici are nothing more than the normal villosities of the keratogenous tissue which have become tumefied and hypertrophied, and are found principally where, in the normal state, the villosities of the velvety tissue are themselves more numerous and more developed. "Where these vegetations are confluent, as upon the sharp edge of the bone, they are separated from each other by a kind of deep sinu- ous grooves, filled with the caseous matter secreted by the diseased keratogenous structure. These growths bleed easily and grow rapidly again when excised. Those most developed, and which seemed to form a homogeneous mass, constitute, however, an aggregate of smaller vegetations united in a certain part of their extent, and continued at their bases. Besides the vegetation of the living tissues, the jjlantar sur- face of the foot presents, in old cankers, isolated fasciculi of soHd homy substance, of thready appearance, soft, analogous in their form to coarse brushes whose hairs are glued together. These isolated, still adherent, brushes are seen spreading toward the sole ; they correspond with j^arts of the velvety tissue which have maintained their soundness in the midst of the diseased surface, and there continue to secrete healthy hoof. These horny growths are ordinarily multiple, and are of various shaj^es, often twisted, and give to the plantar surface a peculiar asj)ect, so much so, that then* brushy masses sometimes retain the mud of the streets and are filled at their bases with a black and fcetid substance of an ugly appearance. ^Tien canker has amved at a very advanced period, it is char- acterized by the deformity of the whole horny box, whose length 596 OPERATIONS ON THE FOOT. and width is considerably increased. The last of these conditions is a sure sign that the disease has spread under the wall of the quarters and of the heels, and has produced the complete separa- tion of the bars from above and below. When percussed, the hoof at the heels gives a duU sound. The excessive length is only an indirect consequence of the disease, and is due to the fact that, so as to keep the animal at work, the walls are spared as much as possible by the blacksmith, so as to avoid the contact of the protruding parts with the ground. Physiological signs are almost entu'ely absent in canker. It is a curious fact that the sensibihty which is generally highly in- creased in all affections of the foot, even in chronic diseases, re- mains always so obscure in canker that animals may be used for a long time without lameness, though the sub-horny tissues have become quite unprotected over a large surface. Complications. — Very frequently, canker is complicated by a disease of the skin, analogous to it, known as grease ; a disease which, if not entirely of the same nature, as admitted by Plasse, Megnin, etc., is closely related to it. It is often through this that canker begins, and very often the two diseases exist together in the same animal, one sometimes following the other, just as canker of one foot follows that of another. Among the complications of canker, as generally admitted, are some injui'ies of the plantar cushion : inflammation and necrosis of cartileges, ligaments or tendons, and even caries of the os pedis and anchylosis, which are sometimes observed ; however, a close examination of the facts allows us to say that these accidents do not arise under the simple influence of the disease alone, but that they are due to the improper use of sharp instruments, of the actual cautery, and especially of potential caustics. As La Gueri- niere said, the deep lesions of tendons and of the os pedis, which are observed in severe cankers, have no other cause than the action of too powerful dessicatives. Duration, march, termination. — Canker is an essentially chronic disease, and may be of long continuance, even lasting for years. Still, under this heading there are many variations, whose cause it is difficult to find. There are horses whose disorganization of the hoof is complete after two or three months. There are others where the disease remains stationary for more than a year. We have seen it remaining limited to one lacuna for months, and all DISEASES. 597 at once assume a rapid evolution of disorganization. We have noticed this principally after the use of sharp instruments. Generally, animals affected with canker feed well, and for a long time retain a good condition ; toward the end, however, they lose flesh and exhibit symptoms of sejjticohemia, especially if affected with grease. We do not admit that, as advanced by some, canker can give rise to such virulent diseases as glanders and farcy. Diagnosis. — At the beginning, canker may be confounded with thrushes, and many veterinarians have considered this as the first stage of canker. There is, however, a great difference be- tween the two : first, as to the anatomo-pathological point of view, inasmuch as the pultaceous, foetid secretion is less abund- ant ; that the loosening of the hoof is less, and that there are no fici; and again, especially in the point of view of the treatment, where single cases of cleansing, with or without dessicatives, easily control it, while canker remains rebellious to them. Prognosis. — The prognosis varies. Where the animal is young, well fed, and the disease is not too old, it is favorable. Yet it remains uncertain, as often the most benign form may last long and remain rebellious to all treatment. The severity and the extent of the internal lesions cannot be estimated by the altera- tions or deformities of the hoof, as these appearances are often deceptive. Canker, though considered incurable for a long time, is not absolutely so — far from it ; with rational treatment, prop- erly carried on, it is curable in the majority of cases. There are cases, however, not very rare, where relapses and useless attempts have discouraged the owner ^s well as the veterinarian, and where it has been more advantageous to destroy the animal rather than to submit him to a long, tiresome, and always expensive treat- ment. Pathological Anatomy and Nature of the Disease. — It has always been considered that a morbid condition susceptible of producing disorders so severe as those produced by canker, must necessarily be a deep affection, essential and important to the organic structure, and depending on a complete transformation in its texture. And, indeed, it is the impression which predominated from the time of SoUeysel down to the foundation of veterinary schools and which still exists with Girard, who considers canker as a gnawing ulcer which changes and alters the tissues it invades, 598 OPERATIONS ON THE FOOT. and even with Vatel and Hurtrel d' Arboval, who looks upon canker as the carcinoma of the reticular structure of the foot. It is but recently that these ideas have been abandoned. Du- puy, in 1827, considered canker as a hy^Dertrophy of the fibres of the hoof, admitting at the same time the disintegrations and softening of those same fibres occasioned by an ammoniacal sap- onization produced by an altered secretion. In 1841, Mercier expressed the opinion that canker is nothing more than a chronic inflammation of the reticular tissue of the foot, characterized by diseased secretions of this apparatus. It is now known that there is in canker no essential alterations of the sub-horny tissues ; no radical change of their substance, and no deposit of heteromorphous molecules in theu* structure. This last mentioned fact was well observed by Kobin, who in his microscopical remarks constantly observed the absence of the characterizing elements of canker. Hertwig and Haubner, who have made researches in the same direction, arrived at the same result and have noticed the absence of any cancerous cells in canker. This opinion is, however, doubted by GHsberg and Fuchs, who look ujDon canker as an epithelioma, though they bring no sufl&cient evidence to establish it. Except vegetal parasitism, of which we will speak hereafter, and which makes of canker a true dartre, an herpetic disease, as demonstrated by Megnin, there is only in canker a chronic in- flammatory condition of the sub-horny tissues which is mani- fested by a perversion in their secretion, and is complicated by a morbid hyj^ertroj^hy of the villous processes by which their sur- face is normally covered. Eobin has seen in the fici, papillae made thicker and more brittle by the plastic infiltration which moistens them; he has observed besides, that at the points where the secre- tion is good, it is so active, that instead of drjdng in sheaths, to scale off afterward in transverse pieces, as normally occurs in the frog and sole, the epithelial cells grow lengthwise, as those which form the walls of the foot. Hence these long, horned, twisted threads (epithelioma?) which are seen rising from the sole of long affected cankerous feet. It has sometimes been admitted that fici had deep roots in the tissues, and even in the plantar aponeurosis, which is an eiTor ; injections and macerations ha\ang shown that there are no essen- tial changes in the anatomical structiu'es of these parts, and that DISEASES. 599 what have been considered as the roots of fici were only cellular tissues, which has become indurated under chronic inflammation (Bouley). Fici are only fasciculi of villosities whose vascular net- work is no longer retained by the thick horny box which encloses them and which is infiltrated with plastic material. Boioley has already admitted that canker could not be better classified than among skin diseases, with and after dartroid affec- tions, and thus gave reason to Huzard senior; Plass also found that canker had the greatest analogy with grease, and that in it the nutrition of the horn underwent the same alteration with nu- trition of hairs in the second affection. Megnin, in 1864, observed, in operating upon fresh pieces taken from the hving animal, and from one which had not received any treatment, that in canker there is constantly a cryptogam, as in favus, and that canker is a parasitic affection. Examining the caseous product of the abnormal secretion which characterizes canker, Megnin found in it a large quantity of very animated vibrios, swimming in a liquid having in suspension nu- merous epidermic cells more or less advanced in dissolution ; he found besides rounded corpuscles, which he recognized as the spores of the cryptogam, and from which the vibrios escaped at the matuiity of the granulations there contained. In examining the fici, he has recognized them to be an aggregate of hypertrophied villosites, at the base of which were found in the mass obtained by a slight scraping epidermic cells or parts of cells enclosed in a net-work of inter-crossed, ramified threads, aj)pearing to rise from certain centers marked by an agglomeration of spores, forming in their whole a yellow spot. In the water of the microscopic prep- arations, one finds also several of these isolated threads, epithelial cells, globules of lymph, of blood and finally spores ; very rarely vibrios ; of tener micrococci. These threads are nothing more than the parasites, the myceHum product of the vegetation of the spores ; those contained in the serosity, swell, break up, and the granulations which escape from them become for some time the vibrios, or as we prefer to call them, pseudo-vibrios ; as soon as the brownian motion, which for some time animates the granula- tions, ceases, the cells which have proceeded from them (the micro- cooci) gather together in chains and form the characteristic threads of the myceHum. This parasite of canker has been named by Megnin the kera- GOO OPEKATIONS ON THE FOOT. phyton or parasitic plant of the horn, by analogy with the tricho- phyton, the parasite of the hair. We consider this name very apj)ropriate and prefer it to the name of odium batracosis, parasite of the canker, which Mr. Megnin has also proposed. Etiology. — The causes of canker are yet but little known ; there is one, however, which cannot be ignored, and which, if it does not produce the disease, assists materially in its develop- ment and is indisjDcnsable to its existence. We refer to the con- dition of damj)ness. It is that influence of dampness which explains why the disease is so very common in the marshy lands of Poitou ; in the pastures of Holland, and in general in low grounds ; and why it is more frequent in northern than in southern coun- tries. Canker is incomparably more frequent in rainy seasons than in those where dryness predominates. We have already seen in the history of the disease that it is since the streets and the stables of administration are kept more free from damj)ness that canker has become less common. Sometimes the action of direct irritating causes has been admitted, and then the canker has been attributed to irritating muds and the excrementitial liqu.ids of stables ; their contact often giving rise upon the skin, upon the glomes of the frog, to an ery- thematous inflammation, soon followed by a serous flow, which ex- tends to the sub-horny structures and gives rise to an exudation in the laminse of the frog. This cause produces the rotten frog (thrushes) but not canker. We beheve that this cause has princi- pally been admitted by veterinarians who look upon thrushes as the first stages of canker, but this is not so, and for canker to develop itself under similar conditions, others are necessary, which are as yet unknown. Canker has also been attributed to narrow and contracted feet, so common in horses of meridional climates, and in which the sole is very concave, with the frog and pyramidal body shrunk in. Often in the laminse of these feet a sero-purulent moisture is dis- covered, more or less offensive, which is a rotten frog, but not canker, and but seldom followed by it. To produce canker a simple irritation of the sub-horny struct- ure is not sufficient. There must be a special cause, proper to canker, stimulating alone the characteristic changes of the cause. This cause we find in the cryptogam which characterizes canker, propagates it, and which has no power of spontaneous existence. DISEASES. 'GOl As with other parasitic diseases, canker is communicable by contagion ; although the examples are quite rare they cannot be doubted. Hutrel, d'Arboval, Plass, Blind and Megnin have ob- served them, and in all the cases dampness has contributed to the propogation of the cryptogam. The lymphatic constitution in an animal is eminently propi- tious to the development of canker, as it is observed to be, in fact, for all parasitic diseases. It is known by daily observation of facts that horses whose sldn is thick, with the hahy system well developed, the feet flat, with thick frogs, are more often affected with canker than animals of a nervous constitution. It is more particularly observed in horses with much white at their extremities, with stockings and white feet, and in those where there is a tendency to albinism. An unknown diathesis has also been considered as causing a predisposing constitutional organic condition, but this has not been justified by observation. It may happen that canker cured or dried on one foot, may attack another foot, perhaps a third, and then a fourth, to re-appear in the first ; this chai'acter of the disease has often been mentioned as proof of this diathesic condi- tion ; but it may also be explained by its contagious character. The disease remains too much localized to be constitutional, as generally in diathesic diseases we have critical eruptions upon different organs or different tissues. Treatment. — From the preceding remarks, it is evident that in feet affected with canker, the keratogenous ajjparatus of the foot has undergone no essential alteration in its structure, that its thickness and density have only increased by consequence of the infiltration and organization in its net-work of the plastic products of inflammation. And, again, the secreting function of this appa- ratus, far from being arrested, is on the contrary, more active ; but the products it gives instead of being concrescible, remain difflu- ent ; hence the impossibility for the hoof to be restored in the regions where this alteration of secretion exists and remains. These important facts, says M. Bouley, must take the lead in the chapter of the therapeutics of canker, because they teach the practitioner that the object to effect, in the treatment of this dis- ease, is not to radically destroy the diseased tissues, as has been too often done and recommended, but to return to them their physical and physiological properties by the application on their 602 OPERATIOXS ON THE FOOT. surface, of modifying agents which influence the nutritive and secreting functions of their tissues without interfering with their structiu-e. To reach this point, the most varied pharmaceutical agents have been recommended, the most successful being those which at the same time had parasiticide properties. We, however, find it difficult to give the preference to any of them ; and we have now more faith in the modus faeiendl, to the skill of the operator, to the continued use of dressings properly applied, than to such or such agent ; all of those which have been recommended if methodically appUed, can cure canker, and it will be wise to em- ploy them alternatively ; when one fails at first it is prudent to try another ; canker is a disease so often rebellious to treatment, especially when confined to the lacunae of the frog, that too many remedies cannot be used. The first indication is to remove the excess of the horn of the waU, the length of which, we have said, is often very great; then prepare a convenient shoe for the dressings. This shoe nec- essarily varies, as canker is exclusively locaHzed to the plantar surface of the foot or extends to the podophyllous laminae. Gen- erally an ordinary shoe is used, more or less covered (wide) and so hoUowed as to aUow the free application of plates by which the dressing is kept in place. "When the condition of the disease requires the removal of large pieces of horn, a truncated slipper is used, proportioned in cutting to the extent of the parts of the wall upon which it is to be applied. There are circumstances even when shoes cannot be used, so much does the disease extend under the waU. It is then necessary to use a shoe without nails, or boots, secured to the coronet by means of straps. In all cases the rule is to take care that the dressings remain fixed in the most exact manner, and that through them a methodic, steady, but not excessive pressure is constantly appHed over the diseased parts. The first step of the operation passed, the next consists in the removal with proper instruments of aU the loose portions of the horn, either at the plantar surface, at the quarter, or at the heels. One must avoid, in this ojoeration, the excision of soft parts ; but the important indication is to follow the disease where- ever it exists, and to leave no part of the horn which may have been detached by morbid exudations. Better cut the healthy structures, and have them bleed, than to neglect to completely expose a diseased part. This done, the horn is to be thinned as DISEASES. 603 much as possible, upon the circumference of the diseased spots, in order to give a supjDleness which would ease the swelling of the uncovered parts. Upon the exposure of the disease where it exists, the fici exist- ing on the surface and edges of the velvety tissues are to be removed with the scissors or sharp sage knife ; at the same time the parts of horn which may have remained are to be cut off, avoiding, however, the healthy tissue beneath, which still retains its normal character. When the canker is very extensive, so that the wall is loose on each quarter, or on all its circumference, it is of advantage to pro- ceed in the required operations at different times. This done, the shoe can be put on ; after which the diseased surface and surrounding horn are to be covered with a thick layer of the medicamentous preparation. If this is in form of a paste, as is often the case, it is sjoread over with a spatula. If in powder, it is thrown over it carefully. If liquid, balls of oakum are soaked with it and placed on, the whole being then kept in place by pads and plates. The important point is that the dressing should be so appHed as to be easily changed, that an exact, regular and sufficiently strong pressure be kept on. No better means can be used for this than the divided plates already referred to. In canker the dressing must be renewed every day, and even twice daily at the beginning of the treatment. This is an essential condition of success, whatever may be the therapeutical agent employed ; and this is not a simple difficulty in practice where the patient is not always of easy access. Moreover, this dressing is somewhat complicated, and can only be skillfully made by the vet- erinarian himself. It often occurs that upon the removal of the first dressing, (the second day) one finds the tissues already covered by a layer of hardened horn, adherent to the surfaces. One must then, with the finger, a spatula, or a di-y pad of oakum, rub it off where it is found loose and movable and, if necessary, renew the application of the dressing. The same must be done at the other dressings, carefully watching if this new horn thus formed by the influence of the medication, is not separable from the parts underneath by the different morbid secretions of the disease. One must then carefixlly scrape off all that is not adherent, and thin the edges, and the projections of all the horn which retains its soundness; 604 OPEEATIONS ON THE FOOT. the caseous substance being also removed ; the same compressive dressing to be put on again. The modification in the horny secretion, and the formation of a layer of hardened and adherent horn, are especially great in the parts where podophyllous and velvety tissues exist ; but are very slow, and surrounded with difficulties in the median and lateral lacunse of the frog. After ten days of treatment, one may have brought about a normal secretion on the whole circumference of the sole, on the inferior face of the os pedis, and on the prominent parts of the pyramidal body. But in the lacunse the alteration remains isolated, and resists treatment-; and it often happens that, if neglected, it may again sj)read and the disease reach its former extent. It is then the case, when the disease is limited to the lacunse, to add to the ingredient already in use and which is kept api^lied upon the restored parts, another stronger and more active agent, sometimes simply absorbent; here again it becomes diffi- cult for us to advise the practitioner, the number of recommended drugs being very large and the result depending less on their nature than in the intelligent and persisting manner with which it is apphed. When caustics are used, it must be done with great care, to Umit their action only to the thickness of the keratogen- ous tissue, and not to carry it to the destruction of the bone, or still worse, of the plantar aponeurosis. Let us glance at the drugs which have proved most successful in the treatment of canker : First we have the different pyrogen- ous preparations, especially wood tar, recommended by Bracy, Clark, Eeynal and Bouley, and which give astonishing results. Gas tar, oil of cade, petroleum and soot have also been used, but with less advantage ; creosote and phenic acid have often shown them- selves very useful, by penetrating easier to the base of the villosities where the parasite resides and thus acting more regularly ; phenic acid proved very useful with Krause, Gerlach and Zundel. After these the best recommended preparations are the salts of iron. Hertwig seems to be well pleased with the powder of sul- phate, and Ai-nold recommends the pyrohgnite of the same metal ; Megnin advises sj^ecially the perchloride, which, like phenic acid, is rather a powerful astringent than a true caustic. The jjrepar- ations of copper have also had their time, and es^Decially the aceta- tes, such as the cegyptiacum ointment (Girard, Schaack, Kainard and Key) ; the baths of sulphate of copper were employed by DISEASES. 605 Verrier, Jr., of Rouen; a solution of sulphate of copper and of zinc in water or vinegar were recommended by Delaval and Haub- ner ; Solleysel emj)loyed the j)reparations of copper, but added to them arsenic and other di'ugs ; Eichbaum preferred the powder of chloride of lime, and Eauch ordinary hme, while Aubry employed a mixture of Ume and caustic potash. Caustics were well recommended by other practitioners, but their prescriptions seem to be contraxy to the rule we have laid down in the beginning. However, one must not forget that the tissues of the foot, especially when diseased, offer an extraordinary resistance to the action of caustics ; they are, so to speak, impene- trable, and the irritation they produce remains superficial, while where those tissues are healthy such agents produce a deep cau- terization. Again, this resisting force of the indurated tissues against the actions of caustics is limited, and it is possible that one, two or three applications may apparently remain inefficacious, where a fourth or a fifth will give rise to extensive cauterization. The result is explained by the repeated u-ritating influence of the caustic agent, which, by gradually increasing the vascularity of the parts it touches, increases also the means of their absorption and imbibition. These facts must also be present to the practitioners mind, and it is by them that he will be guided in their use, rendering them at will, simply modifying, catheretic, or deep caustics. Nitric acid was used by Percivall and Delorme, the latter con- sidering it the best means in use. Sulphuric acid has also been employed, seldom alone, but mixed with agents likely to reduce its effects and render its applications more convenient. CoUignon and Renault recommend its reduction with alcohol ; Mercier mixed it with four parts of oil of tui-pentine ; Prangc with equal parts of tar, and Plass made a paste of it with burnt alum. This last remedy, very simple in its foi-mula, was applied without any dressing ; it has proved most excellent in a great number of cases, but may give rise to too deep cauterization (Bouley, Mendel). Arsenious acid was much used by old horsemen, combined with cegyptiacum, tui-pentine and other ingredients. Hoffmann prefers the arsenite of soda in solution ; he sold his secret to the Austrian government for a high price. Butter of antimony was recom- mended by Huzard Sr., Prevost, and especially Huzard ; chloride of zinc was preferred at the Lyons school. The treatment of canker by actual cauterization was indicated GOG OPERATIONS ON THE FOOT. by Solleysel, but soon abandoned by him. In applying the cau- tery upon the uncovered tissues of the hoof, we encounter the chance of producing a very severe inflammation, which spreads by degrees and gives rise to extensive slough of the hoof, as a con- sequence of the serious exudation which takes place ; the action of the cautery may then become either too mild or too vigorous. Still, it has been recommended by Prevost, of Geneva. Hurtrel d'Arboval, who also employed it, used it in the following manner: the parts being covered with a mixture of gunpowder and sulphur, a red-hot iron was applied to the spot, the powder burning sud- denly and the sulphur slowly. If the' combustion was too slow, he increased it and kept it up by the same means. "When the ojDeration is concluded the parts are transformed into a black scar, which can be easily removed by scraping, and the application and cauterization may be repeated, and so on until it appears that a sufficient amotmt of heat has penetrated the tissues to destroy the material by which canker may be regenerated. The cauterization being once properly effected, then in order to sustain irritation, the foot is covered with Burgundy pitch, or resin, melted and warm, which is allowed to cool off on the foot, when a dressing of oakum and the shoe are put on. The dressing is changed as soon as suppuration shows itself and renewed with the same ingredients in the same manner until the wound becomes healthy and granu- lating. It is only for the sake of the record that we refer to the ex- clusively surgical treatment, based upon the erroneous idea that the fici of canker are abnormal products, deejoly implanted in the tissues beneath, and where it was advised to look for the imagin- ary roots of these fici at their extreme limits. In this treatment, not only the diseased horn was removed, but the entire sole, the plantar cushion and often the plantar aponeurosis was excised. This practice, advised by Lafosse junior, was also recommended in the veterinary schools by Chabert in France, and Dieterichs in Germany. It prevailed for a long time, though experience showed that the wound resulting from such an operation was of very slow recovery, that the frog especially could not be regenerated, that there remained a central ulcer, and that it gave rise to such a mal- formation of the foot that the animal remained lame for a long time, sometimes for life. Notwithstanding these objections, ob- served by Jeaune, Girard and Eichbaum, this treatment is still DISEASES. 607 followed by a few who prefer it to the simple operations of SoUey- sel, which consists in the division of the loose pieces of horn and the excision of the fungoid projections. We have thus far only spoken of the local, without referring to the internal or constitutional treatment of canker, recommended by those who look upon the disease as constitutional. "Without believing that it can have any real curative effect, we, however, admit its usefiilness, when the disease is of old standing, and that the animal has suffered much by it. Ferruginous preparations are specially advisable, and we prefer the carbonates that are used by Delwart to the sulphates recommended by Prevost, Delaval and Hertwig, and it is well to unite them with bitters and tonic powders, Arsenious acid is prescribed internally by Delaval, Feuillette, Niederberger, Obich ; and other alteratives, such as mercury, which we would not advise. Nor can we understand how any benefit is to be dei'ived from diuretics and purgatives, and especially from the use of external emunctories, such as setons. Corns. Under this name is understood an alteration of the tissues underneath the hoof ; of the heels of the horse's foot by lesions of the li\dng parts in the movements of expansion of the hoof ; by bruises, compressions or contusions. There is then a capillary hemorrhage which extends in ecchymosis in the hoof. A corn, then, is a bruise of the living horn at the extreme end of the branches of the sole, and especially in the laminated tissue of the folds of the bars. It is a very common disease, and one to which all horses are exposed. Some have them constantly. Corns are seen mostly on the fore feet, and on the inside more commonly than on the external side. They are rare on the hind feet, because in the various gaits the weight of the body is carried more on the front legs and on the posterior part of the foot, while in the hind legs it is the front part which principally receives it. I. Divisions. — Lafosse Sr., has distinguished them into natural and accidental, while Girard considers them all as accidental. H. Bouley designates as essential those which come from other than external causes. We believe that it would be better to estabhsh the divisions on pathological and anatomical bases, and admit a 608 OPERATIONS ON THE FOOT. corn of the tvall, or laminated, that whicli has its seat in the laminse which unites the wall to the tissues underneath, viz., in the keraphyllous and podophyllous tissues of the heels and bars, and a corn of the sole, or velvety,^ that which has its seat in the velvety tissue which unites the sole to the fleshy parts. The laminated corn corresponds exactly to the " natural " of Lafosse and to the " essential " of Bpuley. It is due to lacerations in the movements of expansion of a badly-made foot. The other is due to contusions. "WTiatever may be the adopted divisions, we, with Gn-ard, and as admitted in practice, recognize in each category, the dry, the moist and- the suppurated corn. II. Etiology. — All feet are exposed, but not all predisposed to corns. They are more frequent in heavy feet, with those where the heels are high or contracted in which there is a motion of re- traction of the hoof which interferes with the displacement back- ward of the third phalanx at the time of rest, and hence the lacera- tions are easy ; besides, there is a continual pressure upon the living parts of the posterior region of the nail. Corns are fre- quently observed in excessively long feet where the hoof does not receive the moisture necessary to its elasticity ; it then losses its suppleness and fails to assist the internal motions of the parts contained within. It is seen whenever the hoof is too dry, the posterior diameter of the feet being then diminished. Corns are seen on weak feet, on which the hoof is too thin to resist the dilating effect of the internal structure, and spreads excessively. Wide and flat feet, with low heels, in which the interior surface of the branches of the sole is on a level with the plantar border of the quarters and bars, are very often affected with corns. The pres- sure of the shoe or the roughness of the ground produce these bruises through the sole. Here the conditions are unfavorable to the normal dilatations of the hoof ; the ungeal phalanx, being unsupported by the convexity of the sole, has a tendency to drop down lower, the tissues are easily lacerated and bruised in its dis- placement at the time the foot rests on the ground. The most serious causes of corns arise from the shoeing, which not only sometimes gives to the hoof a shape predisposing to that disease, but also very often is a determining cause itself of these injuries. " As long," says Hartmann, " as horses will have corns, horse-shoeing cannot pass as an art, and their too frequent pi-es- ence is an e\ddent proof of our imperfect means of protection to DISEASES. 609 the hoof." Without shoeing there would be no corns, and it is in its irrational methods that the true causes of these accidents originate. It is by the greater or less frequency of corns that one may judge of the state of that art in a country. The faults are found, 1st, in the manner in which the foot is pared, or in the shape which it receives ; 2d, in the fitting of the shoe ; 3d, in its appHcation. In paring the foot, the sole is often weakened and thinned too much ; it does not resist the pressure, and, at the time of resting the foot, all the weight of the body is thrown upon the point of union of the sole with the wall. Ordi- narily too much has been cut away from the frog, and this not resting any more on the ground, no longer resists the pressure, and the lowering of the branches of the sole is then extreme, as proved by the experiments of Leisering. The custom of cutting the corns, and of cutting the hoof at the heels, acts in a similar manner ; the posterior half of the foot is weakened, and that is the part which must carry the greatest part of the w^eight. One needs only to compare a foot from which the shoer has removed much horn at the sole, frog and bars, with one in which the hoof has been left alone for a long time. In making a vertical and tranverse section of the two in the middle of the frog, a little in front of the angles of the sole, he will see at once how weak the point of reunion of the sole with the wall has become, the means of resistance to the pressure of the weight of the body through the thii'd phalanx being thus diminished, and consequently a pre- disposition to bruises created. The shape of the shoe also contributes to corns ; an excess of concavity ; a shoe which from the last nail-hole is not flat to the heels, whose branches are too much inchned, contributes to the lateral contraction of the foot and gives rise to corns. In this case the shoe resists the play of the horny box, and by itself, through the sole, exercises a' great pressure upon the tissues underneath. Too high caulks, in preventing the resting on the frog, cause an excessive pressure on the inside of the foot, and compel it to rest on the heels and the branches of the sole, which are too much lowered. The opposite excess, when the shoe is thin at the heels, as in the Coleman shoe — which is thick at the toe and thin at the heels — produces a similar result, because in increasing the pres- sure on the heels, it gives rise to bruises of the tissues through the retrossal processes, which comes down too heavily. A very 610 OPERATIONS ON THE FOOT. wide slioe, too tliin, may also contribute to the genesis of corns, because, then, the shoe helping-, with the intensity of the reactions on the pavement or on too hard and stony roads, the shoe soon gives under the foot, and compresses the sole and tissues beneath. The manner in which the shoe is put on may also be a cause of corns ; the shoe ought to rest exclusively on the inferior border of the wall, and not touch the sole ; when it is too narrow it may be a cause of contusion or of contraction ; if too wide it prevents the natural expansion. It is upon horses long shod that the wrong apj)lication of the shoe as a cause of corns is observed. As a con- sequence of the growth of the hoof, the shoe no longer sufficiently protects the plantar border of the foot, the heels of the shoe being inward and pressing on the branches of the sole ; this is especially the case when the shoe is thinned by wearing ; it yields, and easily bruises the parts of the sole on which it rests ; high caulks, on a branch already too short, or too thin, act the more injuriously be- cause, not being concentrated on the projection of the caulk, the branch gives away sooner, and presses still more on the heels. The shoe becomes an indirect cause of corns, when hard sub- stances, as stones or dry earth, are found between its superior and inferior face on the sole, or between the frog and the internal bor- der of the branches of the shoe ; this is a secondary cause, which was formerly considered of great importance. The work of horses has a great influence, corns being very fre- quent in horses which work on pavements and stony and hard roads. They are I'are in country horses, but common in those of great cities ; a rapid gait contributes to their development on account of the great pressure on the ground. The seasons have also an influence, dry and warm weather depriving the hoof of its moisture, and by preventing its elasticity of motion, increasing the effect of pressure upon the tissues. Emigration has been considered a cause of corns. Horses coming from the north of Germany are mentioned as having been rapidly affected by them after being in large cities. But if the change too suddenly made from soft "to dry bedding is an effective cause, the mode of shoeing can also be considered as a stimulating cause. The same is true with respect to the African horses, which are generally free from the disease in their native country, but frequently suffer with them when brought to France, and submitted to a mode of shoeing so different from that of the Arabs. DISEASES. 611 III. jSi/mptonis. — The ordinary symptoms of corns are noticed in the abnormal position of the leg at rest, in the lameness and the sensibility of the region. When lame with a corn the horse carries the leg forward of the plumb line, and keeps it semi-flexed at the fetlock; he tries to relieve the painful region by resting ; sometimes he manifests his pain by pawing and moving his feet from forward backward, pushing his bed under him. The lameness is not characteristic ; it varies greatly in intensity, from a slight soreness to lameness on three legs. It is generally proportioned to the intensity of the disease. However, there are horses so accustomed to their corns that they do not go lame, while others are very much so for a trifling injury. Sometimes it is intermittent, and diminishes when the suppui'ation has made its way between hair and hoof. The sensibility of the heel — seat of a com — is discovered by an explo- ration with the blacksmith's nippers. Sometimes it is made known by pressure of the fingers, the cases varying, of course, according to the severity of the disease. There is often heat, especially at the coronet, which may be tumified, particularly so when the corn is of a compHcated suppurative character. To obtain an accurate view of the disease the foot should be well pared, and this opera- tion may be greatly facilitated by the application of povdtices for twenty-four or forty-eight hours previously. It is only by the objective examination and the pathological anatomy, so to speak, of the corn that the moist or suppiu'ative variety can be distinguished from the dry, and we shall find either a simple ecchymotic spot, or a complete disintegration of tissues. rV. Pathological Anatomy. — The lesions vary according to the severity of the disease. In dry corn, we find an infiltration of blood in the horny structure. This is blood which has transu- dated through the laminated or irritated velvety tissue from the injured blood vessels. This blood gives to the hoof various tints, more or less pronounced, not unfrequently yellowish, according to the intensity and duration of the disease. The hoof sometimes loses consistency and becomes brittle ; at others, it is hard and dry, and then resembles healthy hoof minus its coloration. If the ecchymotic spot involves the whole thickness of the horn, from its surface to its depth, it is an evidence of the continued activity of the cause. A deep mark indicates a recent injury; a superficial one is an evidence of an older corn, which disappears, 612 OPEKATIONS ON THE FOOT. and then it seldom produces lameness. Sometimes the marks are arranged in layers, the healthy horn being alternated with others which are infiltrated with blood. This is a proof of the intermit- tent character of the acting cause which has originally produced the corn. The ecchymosis, however, is not the actual seat of the corn, which is more in the velvety and especially in the laminated tissues, which are torn or bruised, the blood escaping thi-ough the sole simply by the action of the laws of gravitation. It is rarely that this lesion is looked for in the case of dry com, and it is usually ignored; but in the confirmed corn, a true alteration of the laminse of the keraphyllous tissue is observed. This is re- placed by a horny tumor, a kind of keraphyllocele, analogous to that of chronic laminitis, due to a union of the laminse under the influence of the fibro-plastic exudation resulting from the inflam- mation, which is of varying size, and presses more or less on the sub-horny tissues. In some cases, this horn breaks up little by Uttle, and gives rise to quarter crack. The ecchymotic spots of the dry corn may vary in size ; they may range from the size of a pea to that of a ten-cent coin. At other times they may occupy the entire space between the bars and the walls of the foot. In moist corn, there is not only hemorrhage, but also inflam- mation proper, with serous exudation. The hoof is colored, as in dry corn, of a brownish tint, due to the infiltration of blood which occm-ed at the start ; on searching deeper, one will discover be- tween the hoof and the living tissues beneath a separation of varying dimensions, fiUed by citrine serosity. Most frequently this separation takes place at the line of the sole with the wall, and extends under both. The horny svibstance is then more or less impregnated with this serosity, and then has a charcteristic yellow appearance and a waxy consistency. In suppurative corn, or more properly, suppurating, the in- flammation ends in sujjpuration. The pus is secreted by the vel- vety and laminated tissues. It makes room for itself by gradually separating the hoof as its formation progresses. Before long it passes between the podophyllous grooves of the bars and of the quarters, the horny are lessened from the fleshy laminse, and in its ascending progress the pus soon makes its appearance between haii-s and hoof at the quarter, at the heels, or at the glomes of the frog. It is not common for the pus to make its way through a hoof of too thick or resisting a nature, unless it has first been DISEASES. 613 siiificiently softened by poultices and thinned down with the knife. This suppuration, in the generahty of cases, brings on serious comphcatiou, by the excessive pressure to which the sub-horny tissues are then subjected. Gangrene of the velvety tissue near the branches of the sole and of the podophyllous grooves which have been lacerated in the suppuration, are very common comj)li- cations. If the pus remains long in the hoof its gangrenous re- sults may extend to the os pedis, the laternal cartilage, the j)lantar cushion, and even to the plantar aponeurosis, and give rise to necrosis or caries of the bones, or to quittor, to a more or less variable extent. This sub-horny suppuration, which may some- times be considerable, as well as the compHcations accompanying it, are detected with the probe. V. Termination and Prognosis. — Resolution is a common termination of corns. But their relapse is common also, especially in feet j)i'edisposed to them by bad conformation. A kind of chronic condition of the disease, and one which is more liable to become serious than the accidental variety, is the ordinary ter- mination in this case. The mere extent of the disease is of less importance in the diagnosis than the predisposing conditions. Generally the dry corn is less serious than the moist one, and especially less than the suppurative. CompHcated corns, princi- pally in flat, wide feet, with low heels, by reason of uncertain, j)rotracted and expensive treatment, are in general fatal, and necessitate the destruction of the patient. VI. Treatment. — The largeness of the sjjace we have consumed in considering the etiology of corns will compel us to be brief in our remarks upon the preventhie treatment. Shoeing, which is so often the cause of corns, may also be made a means of preventing them, even upon predisposed feet, if performed with intelligence and proper observation, based upon the anatomy and physiology of the foot. Generally speaking, one must not proceed rashly by changing too suddenly the mode of shoeing. We do not think that any one specified system of shoeing will with certainty pre- vent corns, but we do believe that each case demands its special study and care. Usually, a flat shoe, and which has the heels rather thin but resisting, and which rests on the wall proper, even of the diseased one, if not too painful, is to be preferred. If the shoe is for a low-heeled foot, the heels of the shoe should be thicker in order to supply their insufficient height and to ojffer 614 OPERATIONS ON THE FOOT. more resistance to the weight of the body. Sometimes the pro- tecting effect of the shoe must be completed by the use of a plate of gutta percha or leather between the foot and the shoe ; india rub- ber does not answer, as by its elasticity it interferes with the re- sistance of the shoe. It is absolutely necessary to preserve the hoof in a sufficiently supple condition, to effect which tar, hoof ointments and other greasy substances are used. Flaxseed meal, poultices of cow manure and salt water, a damp bedding, tallow in the hollows of the heels, all are very good preventives and even curative means, which a careful hostler will not neglect. Paring the feet thin, as practiced by some, is very objectionable, and is a serious obstacle to the extirj^ation of corns. The feet should be pared as little as possible, especially at the heels or in the lacunae. As for the curative treatment, there are, according to H. Bou- ley, four indications to f oUow : Fkst, remove the acting cause ; second, treat the injury it has produced; third, relieve the pres- sure upon the diseased region, until it has returned to its healthy condition; fourth, prevent the return of the injury. The first indication is easy to fulfill w^ith the accidental corn, but often nearly impossible in that due to a bad conformation of the feet. The second indication varies according to the extent of the disease. Generally it is advised to thin down the hoof at the bruised part and its surroundings, so as to relieve the pressure on congested or inflammed parts. Still, we are not in favor of too much thinning of the hoof, and except under peculiar conditions, would practice it very slightly. Even in the moist corn, we be- lieve in leaving to the hoof a certain protective thickness. The pressure can be sensibly diminished by the apphcation of chloro- formedoil, or of tincture of creosote ; they very readily penetrate the hoof, and act dkectly upon the inflamed parts. We believe that excessive paring, the "cutting out of the corns," to use the shoer's expression, is injurious, and pi'edisposes to new corns, by weakening the region and promoting a more rapid desiccation and contraction of the hoof. In all cases of dry and moist corn, one must avoid making the parts bleed, the exposiu-e of the soft tis- sues, and all unnecessary cutting. Thinning is necessary in sup- purative corn, and has to be done over the whole extent of the separation of the horn, and a wide channel of exit made for the pus on the side of the sole. It is a wise plan not to remove the DISEASES. 615 entire mass of the loosened hoof, as by this the dressing will be much facihtated. Cold baths are useful in aU cases of corns ; at other times poultices of bran or other material are preferred. Sometime^ sulphate of ii'on or of copjDer are added to the bath, especially in the moist corn. In the suppurative kind, when the suppuration is m-egular, and when complications are likely to follow, warm and slightly aromatic baths are better, and after this, a dressing with tincture of creosote, renewed the same day or the next. Later, cold iron or copper baths may be used again ; if the suppui-ation has broken out between hairs and hoofs, injections of Villates' solution, after free escape of the pus by the plantar surface, are indicated. In the comphcated suppurative corn these means are insuffi- cient. We must cut deeper, and for this the animal must be thrown. Then, when the diseased tissues are exposed by the removal of the loosened hoof, the nature of the lesion must indi- cate the requirements of the treatment. The velvety and podo- phyUous tissues, if gangrenous, must be excised as far as their diseased condition extends; carious bone is to be scraped, the fibrous and fibro-cartilaginous structures, if necrosed, are to be excised or cauterized, or sometimes left alone and watched, ac- cording to the peculiar character and extent of their lesions and the extent to which they exist. Once operated on, a dressing with plates and bands is applied, and the animal allowed to rise. It is by a pecuhar shoeing that, for some time, the painful heel must be relieved from supporting its part of the weight of the body, and protected from outside pressure. This is the "bar shoe." By the transverse bar, which imites both branches, it pre- sents a support to the frog and protects the heels. The resting of the shoe takes place equally upon the wall of the toe and of the quarters, especially the external, and it does not rest on the diseased heels which may have been first cut away. Some veter- inarians prefer the truncated, or the oblique bar shoe, or that with a bar forming an acute re-entering angle. Hartmann recommends the first ; Mayer prefers the bar shoe in which the bar heels have been thinned down, and even hollowed, to avoid as much as possi- ble the pressure on the diseased part ; this shoe has sometimes given us good results in horses with a weak frog. In many cases ordinary shoeing answers ; then the diseased hoof is pared down. 616 OPERATIONS ON THE FOOT. The branch of the shoe in this case requires a greater thickness. Whatever may be the mode of shoeing used much advantage can be obtained by the application of a sole of leather or of gutta percha. Sandckacks. Seime of the French ; Horyispalt of the Germans ; Fissura of the Italians — are fissures or solutions of continuity observed on the walls of the foot, ordinarily very narrow, which follow the direction of the horn. Principally observed on the hoof of soh- peds, it has been seen also in ruminants, but rarely, and of httle importance. I. Division. — They may exist on every part of the wall. On the median line of the nail they are called toe-crack, and then are more frequent on the hind feet. They are rarely found on the outside or inside toe (the mamelles of the French), but commonly met with on the quarter {quarter-cracks), then situated on the lateral parts of the wall, toward the heels, and more frequently on the fore feet, especially on the inside. They are sometimes oblique, relatively to the thickness of the wall. Cracks are superficial or deep, according to the thickness of the wall involved. They are complete when they extend from the coronary band down to the plantar border ; incomplete when more Hmited. In this last case, those which do not extend u.j) to the skin are the more disposed to recovery, and will grow down with the growth of the wall, while those which extend to the coronary band are more serious, being continually aggravated as the growth of the hoof progresses. According to the date of their formation, they are called recent and old. Simple cracks are those which only involve the wall ; they are coynpllcated where there is more or less serious lesion of the tissues beneath, such as inflammation of the laminte, hemor- rhage, or caries of the bone. A serious compHcation is that of keraphylocele. II. Symptoms. — Often the solution of continuity is the only one obsei'ved, and it is the special characteristic of the disease. But the fissure may be masked, either accidentally or by design. It may be concealed by the hairs, by the mud, or covered by hoof- ointment, tar, wax, or even a putty of gutta-percha. Concealed internal cracks have sometimes been discovered, such as fissures involviug the internal face of the wall, which, consequently, were DISEASES. 617 not noticed from the outside, or showing but a slight depression on the surface of the wall. These cracks are only discoverable when the foot has been well pared down. As slight as the solu- tion of continuity may be, it participates in the motion of dilata- tion of the foot, and it is better detected when the foot is raised than when it rests on the ground. This is the case when it is a toe- crack, but on the contrary, the quarter-crack is more open when the animal rests its weight on the leg, in which case, the sepa- ration of the borders of the cracks may be from two to four milli- metres, and may expose the bottom of the fissure. Ordinarily, cracks appear first at the coronet, and there is then but a shght opening, but as they become older, and grow down, they have a tendency to become deeper and more complete. When of old standing, their borders are rough and scaly, having between them an ulcerated tissue and sometimes a fungus growth, from which escapes a sanious fluid. In other cases, as of quarter-crack, the edges have a tendency to cover each other. Superficial cracks are not always attended with lameness ; it is, on the contrary, often very severe when they are deep. The pain is generally in proportion to the depth and degree of opening of the fissure, and also esjDecially to any comphcations which may exist in the tissues beneath. The lameness seems at times to be due to the injury of the deep, soft tissues, and to be caused by the motions of the horny box when they become pinched, irritated and bruised. The afi'ected animals are especially lame when the foot rests on the ground, and the lameness is greater on a hard than on a soft surface. If an animal suffering with toe-cracks is moved on descending ground^ the lameness is greater than on ascending a hill, the weight of the toe in the latter case producing less ox^ening of the edges of the solution of continuity. In quarter- cracks, the severity of the lameness is always in proportion to the rapidity of the gait; many horses which are but slightly lame on a jog, become much more so when the gait is accelerated, the dila- tion of the heels being greater, and the separation of the b rders of the crack increasing in proportion to the speed. "When there is lameness, there is naturally an increase of heat and sensibility of the foot, especially at the seat of the crack. This is often dis- covered by feeling with the hand ; old cracks are generally accom- panied by a thickening existing at a corresponding point of the hoof. A deep, but recent crack, is apt to be accompanied with 618 OPERATIONS ON THE FOOT. hemorrhage ; there is blood which sometimes exudes between the borders of the crack, and flows in abundance when the movement is rapid ; and old crack, in similar circumstances, may show pus, sometimes mixed with blood. A misstep, a sprain, may give rise to hemorrhage in cracks which are ordinai'ily dry. In toe-crack, the solution generally involves the thickness of the wall, through which it runs in a line almost parallel to the median plane of the body, while in quarter-crack it is often oblique and irregular, not exactly following the direction of the fibres, but following the thickness of the wall obliquely in such a way that the external solution of continuity is more posterior than the external. If the crack is rather old, and the foot where it exists is contracted, it is generally incurvated, one border covering the other, and some- times they seem to be moulded on each, other, so as to cover and conceal the true crack. III. Complications. — Among these we may first mention the inflammation of the recticular tissue, which is first pinched and injui-ed. This may be followed by suppuration and local gangrene. Very often the disease is followed by necrosis of the os pedis, and caries of varying dejDth. In toe-crack cases have been seen of caries of the tendon of the anterior extensor of the phalanges, and even arthritis, though rarely occuring, have been observed. In quarter-crack, one may have cartilaginous quittor and suppurative corns. As before stated, these lesions are indicated by the severity of the lameness, the presence of the blood or pus through the crack, and the extreme sensibility of the part. It is especially when, in the course of treatment, a part of the hoof has been removed, that the keratogenous apparatus has been exposed, that the abnorma- coloration of the podophyllous tissue is seen, in its swollen condi- tion and its sensibility to pressui-e, accompanied with the presence of the pus or sanious discharge, and at times the necrosis of the bone. Sometimes, also, foreign substances, as dirt or gravel, may be found introduced in the cracks, and acting as causes of irrita- tion to the sensitive tissues below. A complication, not so frequent, however, according to some authors, is that known as Keraphylocele, and which consists in an hyj)ersecretion of horn, from the coronary band on the inside of the crack. Sometimes the horny growth remains separate from the borders of the crack, and is adherent to the wall only by its base, towards the coronary band ; this is especially the case when DISEASES. 619 tlie wall has been thinned down or partly removed. In other cases it is adherent to the two borders of the crack, and this forms a natural cicatrix. This horny column, of varying length and strength, according to its age, presses upon the tissues beneath, and gives rise to severe lameness. With time there is correspond- ing atrophy of the podophyllous tissue, or even of the os pedis. This is often followed by a marked deformity of the hoof, and especially a deep fissure, parallel to the direction of the crack. The soft tissues under the keraphyllocele often in time become harder, in consequence of the disappearance of the papillae ; the hoof then is no longer adherent to the tissues beneath, and so incurable cracks are the result. A double wall or false quittor have often also been observed. Thus deformed, the foot is always subject to lameness, even if the crack is cured. Contraction or atrophy of the frog have been observed with quarter-crack. IV. Progress, duration, termination. — Ordinarily, cracks once existing become worse. From being superficial and imperfect they become deep and complete as a natural result of the ordinary motions of the foot. If rest and some hygienic attention can be given, they may recover spontaneously, and disappear by the nat- ural downward growth of the hoof. This fortunate termination, however, is principally obtained when the crack is due to acci- dental causes, without deformity of the foot. V. Prognosis. — Simple cracks, superficial and incomplete, especially arising from the plantar border, almost always recover under rational treatment, which has for its principal aim the pre- vention of increase in the size of the fissure. Cracks starting from the coronary band are always of a more serious nature, with a ten- dency to increase easily. Still they are no longer to be consid- ered incurable. Cracks in which the borders are much separated by the motion of walking ; those which are oblique ; those whose edges are incurvated inward ; those where a poi-tion of the wall, is loose ; those which bleed, and those where there is a continued irritation of the sub-horny tissues, are the most serious ; and so much so, that they may require quite serious surgical interference, and after all baffle the best skill of the operator. VI. Etiology. — The causes of cracks vary greatly, and are often multiple in a single case. Seldom the result of accident, they are most commonly the combined effect of both a predispos- ing and an extraneous cause. A frequent one among others is 620 OPEEATIONS ON THE FOOT. the relative dryness of tlie hoof, which then becomes excessively brittle. We have seen the conditions in which the hoof loses its natural flexibility, and shall here only state that alternate changes from dampness to dryness have as much influence as the drjTiess alone. Cracks are more frequent in animals working along damp than in those j^ulling in dry and stony roads. They are common in animals which after being kept in pastures are placed in good paved stables, with dry bedding. It is principally in these condi- tions we find the quarter-crack. During some seasons, while a term of dryness follows continued wet weather, the conditions are favorable to their formation, and they often assume an epizootic form. Emigration to dry cUmates is a frequent cause, by produc- ing the contraction of the ungueal structure. This last cu'cum- stance explains why cracks are more common in army horses, which are called to go on long journeys during the warm days of summer But if the European horse taken to Africa suffers less from the disease, a similar result occurs to the African horse when brought to our climate. The Arabian horse readily contracts quarter-cracks in our stables, and with our shoeing. Animals with small feet, or with hard and thick hoofs, have a natural predispo- sition, which is also found in Hungarian, Kussian or Tartar ani- mals. Feet excessively large are also easily affected with the disease, esj)ecially those which have canker or grease. Unskilful shoeing may predispose to cracks, and this is princi- l^ally the case if the wall is thinned or rasped down too much ; the same result is obtained from shoes which are too wide or too heavy, or which are kept on by too heavy nails. Feet with toes turned outward are predisposed to it, as in these the weight of the body rests more on the internal quarter, which being thinner than the external, give way the easiest. Con- tracted feet are subject to it. Quittor, suppurative corns, and some other diseases, are also predisposing causes. Among occa- sional or accidental causes may be mentioned ti'aumatism, contu- sions of the foot and blows during work. The service of heavy trucking for heavy horses exposes the hind feet to toe-crack, especially if the pulling is done in going up hill or on slippery pavements; mules' feet are very subject to it, and heavy falls in jumping and external blows are occasional causes. Heredity in cracks has been mentioned. We do not admit this, except so far as it belongs among the predisposing causes DISEASES. 621 which may be transmitted, and we should object to an animal for breeding- purposes though otherwise well-formed, if he were affected with cracked feet. VII. Treatment — Prophylaxy ought to be the principal treat- ment of cracks. It is not always easy, however, to prevent them, and it becomes important therefore, to treat them as soon as they appear. One ought at least to try to prevent them from becoming complete and deep. This form of treatment may bo called the hygienic, as it is not properly curative, and so long as the crack is not yet completely formed, the animal may be kept at work as if everything was normal. Curative treatment is that which is apj)Hed to the deep or complete disease, more or less comj)licated, and it most commonly consists in removing that portion of the wall which bruises and irritates the tissues beneath, and in equal- izing the wound. In general, there is no necessity for haste in operating, the hygienic treatment being often sufficient to obviate the need of serious oj)erations. The distinction between the hygienic and curative treatment is not, however, always definitely marked, and quite often the two modes of treatment must be combined, both the hygienic and the curative being necessary. The prophylactic treatment consists specially in the applica- tion of tonics, with the object of preventing the hoof from drying. Its normal hyrogoscopic condition must be preserved, and it must be prevented from taking up too much of the dampness of the ground upon which it travels, as well as from losing that which keeps up its flexibility. At times it must be rendered more moist and, according to the requirements of the case, recourse must be had to hoof ointments and other greasy substances, glycerine and astringent poultices. At the same time the shoeing must be care- fidly attended to ; the shoe must not be too heavy nor too wide, and should be secured by nails of a proper size. The hygienic treatment has for its first and principal indica- tions to prevent the solution of continuity from increasing, from extending through healthy structure, and especially to new hoof, as this is secreted by the coronary band. The borders of the cracks must be prevented from separating in the movements of dilatation of the foot. The normal suture of the wall not being produced by the natural process, or at least producing it only in keraphyUocele, which is likely to be as injurious as the crack it- self, the borders of the crack must be brought together artificially. v-%*. -T-J*!---— — .-t=- ififti Ai i I ft i^ji t r^ / I 622 OPERATIONS ON THE FOOT. It lias been supposed that this could be done with the putty of Defay's, a mixture of gutta-percha (2 parts) and gum ammoniac (1 part), introduced into the well-cleaned fissure, and pushed in as deeply as jiossible by a warm iron plate or a spatula. This putty is excellent for superficial cracks, but is insufficient to bring the borders together when the fissure is somewhat deep, or especially if it is irregular and sinuous. A better way, at least for toe crack, is that which consists in suturing the edges of the solution of continuity by metallic clasps, which immobilize the hoof. This mode is always preferable to circular liga*tures of wire or cord, which have the efi'ect of interfer- ing with the natural elasticity of the hoof. Clasps only fix the hoof locally, and are an old means of treatment, having been used by Sollej^sel and Garsault. It was advised to perforate the horn through and through with a small punch, and pass a wire, which was bent over the crack, or twisted together at the ends. The same authority recommends the dri\ing of a nail through both edges, and securing it tightly, as in the application of the nails of the shoe. This treatment was recently recommended by Haupt, Lafosse and Rey. The first of these professors takes an ordinary nail, with a small head, drives it through one edge of the crack, so as to come through the other at an equal distance from the point of entrance ; the nail being thus driven to the head the borders of the crack are then brought together, and the nail secured in the ordinary way. Two or three of these clasps are employed, according to the extent of the crack. Lafosse makes a groove on each side of the fissure about one centi- meter from the border, in a direction transverse to that of the fibres of the wall, which limits the passage of the nail. The nail is then introduced and secured as in the first instance. Eey makes a track for the nail first, by drilling a hole through the borders of the crack. The animal must be cast diu'ing these operations. The best kind of clasps or hooks are undoubtedly those of Vachette, which require sj^ecial instruments for their application, but give a real solidity to the means of fixing the position of the parts. The clasjDS are all prepared, made of strong wire, bent at both extremities, and slightly sharp inwardly (Fig. 489). These are secured on the foot by a special nipi^er or forceps (Fig. 490) in the notches made on the wall with a special cautery (Fig. 491) ; DISEASES. 625 cannot rest on the crack, and recommends the application of two clips on each side of the toe. In quarter cracks, it is recommended to lower the toe, to save the bars and the frog ; and when the crack is incomplete, and not accomi^anied with lameness, Defays recommends not to lower the diseased quarter, and to have the heels resting well on that branch of the shoe which shall be thick and straight. Schreb'e advises a calk on that side. If the crack is deep, with excessive lameness and deep lesions, the quarters and heels must be joared down as much as possible, and a bar to be then put on, resting on the frog, if need be. An ordinary shoe, with a thick branch, may be sometimes emploj^ed. As part of the hygienic treatment, we may consider the means recommended to increase the secretion of the coronary band. It is known that a slight irritation at that part of the foot is accom- panied with an increased secretion of hoof, which is sometimes sufficient to give rise to a new growth of healthy horn. One of the most common methods is to slightly cauterize the coronary band with the iron. This was already known by old practitioners, who employed an S cautery ; but they committed the error of biirning the hoof too deeply instead of simply cauterizing the cor- onary band. SoUeysel speaks of the cauterization of the band. Garsault mentions only the burning with three S's across the crack. Such cauterization could have no useful effect, and the deep apj)hcation of the cautery might be followed by serious com- plications. For these reasons Lafosse objected to them. In our days it is abandoned, and the coronary band only is touched by the cautery ; Castandet and Key also employ it. Chemical cauteries have also been recommended, nitric acid by Laguerriniere, and more recently by Lafosse. Putty of corrosive sublimate and ointment of oxide of mercury are also in use, but have no marked advantages. BHsters prove very beneficial, and also turpentine, as recommended by Lafosse and Key, and the oil of Cade by Maury. Defays ad^dses the putty of gutta percha, which is also used to conceal the clasps. The curative treatment is necessary w^henever any complication attends the crack. If it is recent, antiphlogistics and rest should be first tried ; cold bathing, blisters combined with hygienic treat- ment may then be sufficient. A single groove at the upper part of the crack, near the coronary band, is often sufficient, or a re- 626 OPEEATIONS ON THE FOOT. Pig. 495.— Operation of simple Toe Crack by the process of thin- ning down the wall in V-shape. moval of a V-sliaped portion of the lioof, extending more or less deeply, accord- ing to the condition of tlie crack, care being observed to avoid tlie growth of vascular granulations between the edges of the crack. There are cases where it is not necessary to remove the segments of the hoof entirely down to the soft tis- sues, but only to thin them down and to apply over it a dressing of oakum, se- cured by several turns of roller band- ages. In all cases a bar shoe must be applied to relieve the pressure on the quarter where the crack exists. This is principally recommended by Prevost, Gii"ard and others. If there are deep lesions of the sub-horny tissues, a piece of the waU must be removed, and the operation for radical cure be performed. It is an old operation, by which all diseased tissues are exposed. As little of hoof as possible is removed. In ojjerating, two grooves will be made alongside and at some distance from the solution of continuity. The wall between is removed so as to exjoose the podophyllous tissues from the coronary band down to the sole, care being taken to avoid the tearing of the structure of the coronary band, and the diseased tissues are then removed. If the podophyllous tissue, it is excised with the sage knife ; if the bone is carious, it is scraped with the drawing knife. The whole Fig. 496.— Operation for Com- plicated Toe Crack B, by removal of a piece of the toe of the wall, yl .4.— Oblique grooves limiting the size of the piece to remove. Fig. 497.— Dressing for Complicated Toe Crack. DISEASES. G27 is then dressed vip with a shoe having the toe thinned down, and extending somewhat beyond the border of the foot. The cicatrization does not take place from the coronary band alone, but also from the horny secretions of the podophyllous tis- sues. The repair is then quite rapid. The first dressing is re- moved after eight or ten days, and if everything goes on well need not be changed more than once a week. The animal is not to be put to work until the hoof has obtained a certain consistency. The operation for quarter crack is similar, except that only one groove is I'equired in front of the crack, the tissues being exposed as in the operation for the removal of the lateral cartilages of the foot. Calk. Synonyms. — Kronentritt (Ger.) — Atteinte (Fr.) — Thus is called a contusion, with or without wound, that the animal receives on the coronet, from the shoe of another foot, or from a foreign body, or by another animal walking behind or alongside him. The skin of that region is very thick, slightly extensible, not easily yielding to the imflammatory swelling ; there is commonly sloughing and mortification of tissues, accompanied with violent pain. It is frequent in animals that forge, also in very young horses or those which are weak in the lumbar region, and which interfere and cut themselves in walking. This lesion is also very common in the districts where horses are shod with high calked shoes, when the wound resulting from it is made by the internal branch of the shoe, which lacerates the skin of the coronet. Horses shod to travel on ice are commonly affected with it ; the injury being more or less serious according to the size and sharp condition of the calk. Horses ridden in ridding schools are often affected with it dur- ing the various evolutions of the haute ^eole. It is called single when the wound is slight ; concealed when the pain is great and continued, as in the case where it takes place on the tendon, near the heels or the quarters; horny when the contusion has taken place on the wall or at the coronary band ; complicated, when it is very serious and accompanied with other more severe lesions. It is always a horizontal wound or a tumor by contusion. 628 OPERATIONS ON THE FOOT. I. Symptoms. — It is ordinarily recognized by the wound or swelling which exists upon the parts. Often the horse is lame, and the affected part warm and painful ; sometimes the hairs are cut, the skin scratched or torn. There may be a slight bleeding at the seat of the wound. When the wall has received the con- tusion, the vascular network underneath may become inflammed, and then pus is formed between the teguments and the hoof, which then become separated. Sometimes even the lateral fibro- cartilage of the foot becomes irritated and swollen, and ulcerates, especially when the contusion has taken place on that part where the cartilage is ; in this case the injury may be complicated with cartilaginous quittor. In severe cases, one may i-ecognize a furuncular calk, charac- terized by the mortification and sloughing of a portion of skin at the place where the contusion took place ; it is the cutaneous quittor of old hippiatry, with formation of a core ; this is always very painful, and the inflammation generally spreads underneath the wall. Bouley calls it gangrenous when there is unlimited similar mortification of the tissues ; in this case the slough in- volves large portions of the skin. At times it may be called phleg- 'inonous, when an abscess forms itself under the skin, then the coronet is warm, thick and inflamed, and the pain is extreme. Then if an incision be made through the dermis in its entire thick- ness, an abundant bleeding takes place, generally followed by the resolution of the disease ; if there is already suppuration, it is at the same time immediately allowed to escape. II. Treatment. — If the injury is slight or recent, whether with or without wound, very cold water and the removal of the cause by taking off the shoe, are sufficient to bring on a cure. But if the contusion has been great and deep, recovery is more difficult to obtain on account of the suppuration which will follow. Then the application of poultices is indicated ; if there is formation of a core, and mortification of tissues, poultices of honey are espec- ially indicated ; in case of phlegmon, the poultice must be warm, and then incisions and counter opening must be made for the escape of f)us ; afterward dressings are made with oakum saturated with tepid wine or tincture of aloes. "When the caulking is horny, the use of emollient topics is in- sufficient ; an excellent way then is to obtain the required sJough- ing of the tissues by actual cauterization — the iron heated to white DISEASES. 629 heat ; by thus destroyiag a portion of the hoof and the soft tissues one will avoid the excessive pressure at the coronary band ; this may also be prevented by the thinning down of the wall with the sage knife ; but one must be careful not to remove too soon the portions of horn which may be detached. When the calking takes place at the heel, it is good — so as to prevent other complications — to pare the foot down, especially at the heel, to remove the divided hoof and transform the wound to a simple one which can be dressed, as already stated, or with digestive ointment secured by several turns of a roller. "WTien there are wounds of the teguments, it sometimes hap- pens, if the immediate union has not been obtained, that the por- tion of skin forming the inferior edge of the wound turns down and that the granulations protmde, tending to form a kind of fungoid growth. Chabert says that these must be cut off and dressed with oakum soaked in alcohol. Calking at the hind feet being the most severe, and those which are followed by the most serious complications, on account of the urine and droppings of the animal, which impregnate the wound, one can never be too particular in keeping them clean and dressing them well. When they end in cartilagious quittor, they must be treated as that disease usually is. As to the means of prevention, they consist in not placing the horses too close to each other in stables, fairs, etc., in not forcing them too much in their gait, in shoeing properly those which forge or interfere, and in placing or riding them in such a way as to avoid the possibility of then- wounding each other. Punctured Wound of the Foot. Synonyms. — Naglebritt (German) — Nail in the foot (English) — Clou de rue (French). — In veterinary science this designation has been given to a punctured wound, often with laceration, some- times with contusions, either at the sole or frog of the foot of the monodactyles, and produced by sharp or cutting bodies, most commonly nails, upon which the animal steps. The form of these bodies, the direction they take, the force with which they pene- trate, and the part of the sole they enter, give rise to various lesions of varying gravity as they are older or as the injured part enjoys a greater sensibility. Etiology. — Nails, stumps of nails, are most often those which 630 OPERATIONS ON THE FOOT. are picked up in the streets ; at other times it is a metaUic sub- stance elongated and sharpened ; agaiu, there are pieces of glass, or other substances, such as bones or sharp stones, which are picked up and produce the wound. It is principally in the streets of populous cities, in the yards of builders, or on the grounds where buildings are pulled down, that horses are liable to receive these injuries. In rural districts they are rare, comparatively, to what they are in cities. It is evident that horses with wide, flat, thin, softened hoofs are more exposed than those which are of different strvicture. I. Divisions. — Punctured wounds of the foot may be simple or superficial, deep or j^enetrating. One of these bodies j)iercing into the frog requires to go in deep to be serious, as above the frog (which is itself quite thick, though formed by a soft and flexible horn) is the plantar cushion, a fibrous, soft and elastic mass, which offers a great resistance. If, however, the injuring body is a very long nail, which runs per- pendicularly in through the frog at the plantar cushion, it may reach the terminal extremity of the perforans tendon, situated immediately under the plantar cushion, and penetrate the sesa- moid sheath. It is known that this sheath forms a sac of some dimensions, that it extends above and below from the inferior half of the coronary to the semi-lunar crest, and in its transverse axis extends from one retrosal process to the other ; the inferior portion of this synovial bursa covers the plantar aponeurosis in its whole extent. Sometimes, again, the puncturing body pene- trates as far as the bone ; sometimes the navicular ; at others the OS pedis, and sometimes even penetrates into the articulation. II. Symptoms. — They vary according to the seat of the lesion, its depth, the mode of action of the penetrating body, length of time it has remained in the wound, and the nature of the lesions it has made ; all conditions which may change the character of the disease from a first degree, when the animal shows no evi- dence of pain, to the extreme point, where its life is in danger, and evens ends in death, by the excessive local alterations and the sufferings accompanying it. Often the first point which assists in the diagnosis of the case is the history. The driver has seen the horse become suddenly lame, has examined the foot, and found a nail more or less deeply imbedded ; or it is the surgeon who finds the nail in its hiding- DISEASES. 631 place. The exploration of the part shows with certainty the nature of the lesion, the direction and depth of the wound, as well as the physical condition of the body which has made it, and all circum- stances which allow a positive diagnosis to be made. Quite often the nail is no longer in the foot ; sometimes it has left its mai'k — an opening which can be explored ; often this is not visible at first sight, though the wound may be even deep ; this is when the injury to the hoof has been very slight, and when the hoof has retracted on itself by its elasticity or when the open- ing is concealed by the dirt of the streets. It must be remem- bered that sometimes the penetrating body remains broken in the soft tissues after its entrance through the hoof. If the accident is recent, only a little blood may be found — Hquid or coagulated — over the wound ; later, some serosity, more or less puinilent, is observed ; the pus is white or black, sometimes mixed with syno- vial fluid ; sometimes there are granulations on the bodies of the wound which protrude over the edges, commonly called proud flesh. Such are the first objective symptoms obtained by the exploration of the parts. Ordinarily they are insufficient, for it is not always easy to probe the wound. It then becomes neces- sary at the beginning to pare off the hoof all around the wound, and sometimes to hollow it at the point of injury, without going to the sensitive structure, however. In this way the exploration and the probing of the wound are rendered much easier. The pain, expressed by the lameness, is almost always mani- fested ; it varies according to the seat of the lesion and its depth. At first the intensity of the lameness does not give the exact measure of the disease, and often one may be led into error by it; but it gives an exact value of the lesion when a few days have elapsed since the injury was received; if the pains are slight or absent, they indicate that the reparative process is going on well ; it is, on the contrary, interfered with by complications when, as time goes on, the lameness increases instead of becoming dimin- ished. Generally one can say that the injury will amount to nothing when the lameness is slight, while, orl the contrary, seri- ous complications must be always looked for when it is great and remains on long, even when the first lesion has been slight and superficial. The wound, w^hich has penetrated through the hoof only, has no symptoms, no sequeL-e ; the animal is not lame from it, or if he be the lameness is very shght, the foot resting entirely 632 OPEEATIONS ON THE FOOT. on the inferior surface ; when the resting takes place only on the toe, ordinarily the tendon is injured, possibly the synovial sheath; in cases where high inflammation exists the pain is very great, the animal walking on three legs only. The anatomical examination of the injured part teaches that the most serious punctured wound of the foot is that of the cen- tre of the foot, where the tendon, synovial sac, and where the articulations may have been injured. Forward of this the wound is less serious, even if it involves the bone. Posterior to it, it can only injure the plantar cushion. Under this condition the plantar region of the foot is divided into three zones ; one, ante- rior, from the toe to the point of the frog ; one, middle, extending from the first to the median lacunse of the frog ; and the third, anterior, covering the space left back of this to the heels. The most serious of the injuries to which the foot is liable are those caused by foreign bodies which penetrate the middle zone, that being the most complicated portion of the structure. The symptoms wiU vary, according as the wound extends to tlie plan- tar apouevirosis, or only as far as this membrane ; or lacerates the soft surrounding tissues without touching it ; or it goes beyond this and injuries the small sesamoid sheath, or even going deeper, severs the na\icvdar bone, or its ligamentous attachment to the os pedis ; or reaches the last phalangeal articulation. A wound of the plantar aponeurosis is always very painful, especially when complicated with necrosis, in which case there is no weight put on the diseased leg, and continual lancinating pains and reacting fever are soon observed. The wound is then fistulous in character, and the suppuration then flowing from it meets with difficulties in its escape, which gives rise to a state of general i nflammation, and the foot becomes hot and very painful If the necrosed scar becomes loose and sloughs off, being de- tached by suppuration, improvement soon ensues, but as the ne- crosis of the tendon has generally a tendency to spread, there is an increase in the character of the symptoms. If the wound extends to the sesamoid sheath from the start, the synovial fluid is observed escaping, first pure, but soon becoming milky and piu'ulent in aspect, if the sheath has become inflamed, and easily coagulated in yellowish clots. The pain is then very great, much more so than when the aponeurosis alone is diseased. At times, by rapid closing of the plantar wound or obstruction of the fis- DISEASES. 633 tula, a warm swelling forms itself in the back of the coronet, which raises the skin by degrees and becomes elevated, prominent at one point, and giving a feeling of fluctuation. This swelling ends in vdceration, and allows the escape sometimes of an abundant synovial, purulent discharge. The wound of the small sesamoid and of its ligament adds nothing to these series of symptoms. The probing of the tract will only determine it by the sensation of roughness which it will give ; but generally one must be carefvd in using the probe, es- pecially when the flow of synovia is absent. If the foreign body has pierced through the ligament, or has penetrated in the coffin joint, phalangeal arthritis is the consequence. The same result is likely to follow excessive inflammation of the foot and the macer- ating effect of the suppuration, in which case the tendon may soften down and give way. It may then also hajjpen that this tendon retracts by the contraction of the muscular fibres, and can then be traced U2:)ward to the back of the coronet, or of the fet- lock, according as the giving way has taken place higher or lower. "With arthritis there is a hot, painful swelling of the whole cor- onet, with diffused oedema above the fetlock and the cannon, and extending upward to the whole leg, complicating the lesion by lym- phangitis, and painful swelHng of the lymphatic glands. Then sub- cutaneous abscesses are found round the coronet, with gangrene of the tissues ; while, again there may be only an extensive fibro- plastic exudation, which ends in calcarious organization and anchy- losis. In the anterior zone the only serious lesion met with is caries of the OS pedis, characterized by great pain, continual lancination, loss of the use of the leg, and high reacting fever. There is abundant bloody and foetid suppuration, and the probe gives the sensation of the soft resistance of the bone, of its rough condition, and its partial fragility. The caries having most generally a pro- gressive march, complications of separation of the hoof, to a vary- ing extent, are often seen ; the pus arrives at the surface between hairs and hoof ; and diflused gangrenes are also often seen, which extend as well to the podophyllous as to the velvety tissues. In the posterior zone, the only serious wounds are the lateral ones, which may injure the fibro-cartilage and become comj)licated with their caries or quittor and fistula down to the lacunae of the frog, as we have seen in sujopurating corn. 634 OPERATIONS ON THE FOOT. Nails may penetrate the joosterior zone through and through,, coming out behind the coronet, withovit danger. The sub-horny suppuration may detach the frog and be the only serious compli- cation to be met with. As terminations of all these injuries we may see resolution, sup- puration, gangrene, softening of the tendons and phalangeal arth- ritis, and as sequelae, bony tumors of the coronet, and anchylosis. The most serious complications are the dropi^ing of the entire hoof, the rupture of the tendons, tendinous and cartilaginous quit- tors, for the injured hoof, and chronic laminitis for the opj)Osite one. IV. JPrognosis. — This varies according to the seat of the wound. Less serious in the posterior than in the anterior zone, it is less in the last than in the middle, where the region is so comphcated and the nature of the tissues so different. The dej^th of the wound has also some influence on the prognosis. Wounds of the plantar aponeurosis are more dangerous than those of the plantar cushion ; those of the sesamoid sheath are more so than those of the aponeurosis ; they are still more serious if the bones are affected ; the worst of all is that of the joint. The direction of the foreign body and its simple or complicated action, will also influence the prognosis. This, we have already said, can be established by the severity of the lameness. The nature of the foreign body must also be taken into consideration ; if blunt, which crushes the tissues, it is more dangerous than if sharp and jjointed. In a flat or convex foot, punctured wounds are more serious than in a well-made foot. They are less serious in heavy than in light draught horses, as the former, though they may remain lame, are still useful. The excitable condition of a patient will also alter the prognosis. Wounds of the anterior feet are more serious than those of the posterior. V. Treatment. — In all cases, the first indication is to obtain a natural cicatrization and natural repair, always more rapid and perfect than that which is gained by surgical interference. This is generally easily secured, and for this reason it is important to avoid too severe manij)ulation upon the injured foot. One must watch the progress of the disease, give the foot as much rest as possible, remove the shoe, thin down in its whole extent the plan- tar hoof, so as to avoid any pressure, and keep the foot in a cool- DISEASES. 635 mg bath — ordinary cold water, to which often is added acetate of lead, sulphate of iron, or common salt, very beneficially. Poultices, cold preferable to hot, give excellent results. By this treatment, the progress of the inflammation is checked, and very often deep and serious wounds, even those where the tendinous sheath has been injured, are easily cured. If the lameness gradually diminishes, the case rapidly gets well ; at any rate, by this treatment, the inflam- matory process is diminished, and the painful pressure of the hard- ened and thick hoof is avoided. In the winter, when cold baths are of difficult application, chloroformed or carbolized compresses may be applied round the foot. The hoof is thus softened and the pain reduced. At other times a blister is aj)plied round the coronet. If the lameness remains, or seems to increase, it is due to ten- dinous necrosis or caries, and it becomes necessary to operate. Must the surgeon then have recourse to an operation, and make a simple wound with his sharp instrument ? Or, is it still better to merely depend on natural resources, and assist them ? It is difficult to lay down any special rules. If the disease is old, if the necrosis has progressed and is. still increasing, a serious 'operation becomes necessary. If the necrosis is recent, one must be guided by external indications. Notwithstanding (Renault remarks) one should not be too hasty, as the animal must neces- sarily be laid up for several months afterward. It is often suffi- cient, in a recently punctured wound, in order to avoid complica- tions, to modify the conditions of the fibrous tissues in the whole extent of the lesion, by applying substances simply antiseptic, or still better, slightly caustic. Rey employs the cold bath, in which he dissolves a pound of sulphate of coj)per for ten or fifteen quarts of water ; by this means he has secured the speedy recovery of severe punctiu-ed wounds. For a long time, and with the same object, we have been using a mixture of equal j)arts of sulphate of coj)per and sulphate of u'on, having first hollowed the foot downward around the source of the puncture, and the sole being pared down as thin as could be borne. H. Bouley prefers the application of pulverized corrosive sub- limate ; after tracing the wound to its bottom, he fills it well with the powder. This remedy was already recommended by Solleysel, who used it in caries of the os pedis. Other practitioners prefer phenic acid, and claim for it great advantages. By the action of OPERATIONS ON THE FOOT. the caustics upon the fibrous tissues exposed to necrosis, or ab-eady in that condition, a double salutary result is obtained ; first, the transformation of the part, which is the seat of a pro- gressive gangrene, into a chemical eschar ; and, again, promoting the more active vascularization of the surrounding parts, and con- sequently their increased power of healthy reaction ; conditions twice favorable to the sloughiug of the eschar, and the process of repair following it. When the wound has reached the os pedis, and this has become carious, a portion of the sole is removed, so that the supj)uration can escape, the bone is scraped off, and a dressing of carbolized alcohol applied, kej)t on by a thin shoe or slij)per, with tin plates. When there is a fistulous wound, through which syno'sia escapes, yet not purulent, caustics are recommended. Solleysel preferred these, but blacksmiths used them so carelessly that they soon were discarded. Since, however, they have been employed again, not in powder, but as trochiscus. Eey recommends the corrosive sublimate in conic pencils, introduced to the bottom of the fis- tula ; by them he obtains an eschar, a solid clot, from the synovia, which closes up the wound and prevents the synovial flow, at the same time stimulating the granulations which close up the fistula. We have ah-eady said that these measures must be used only when the sjTiovia is not pm'ulent, as then the escape of morbid Hquids may be prevented. It is not then uncommon to see abscesses forming at the back of the coronet ; generally not so serious as is usually believed ; not as much as those which take place in front and which are due to suppuration of the articula- tion. After the running out of those abscesses, sometimes the wound of the foot assumes a better aspect, the symptoms im- prove, and the animal recovers rapidly. Injections of a very weak solution of tincture of iodine, as well as the baths of copper or iron, are then very advantageous. Hertwig advises the introduc- tion of a seton through the sesamoid sheath. This treatment is not always sufficient, especially where the lesions are deep. All the diseased structures must be then ex- posed, and they must be removed and the wound changed into a simple one, which, well di-essed, will heal without difficulty. The operation is required in proportion to the extent and nature of the lesion, and if this is recent and comparatively superficial, if a piece of the foreign body yet remains in the woimd, or if its re- DISEASES. 637 moval has resulted in the sloughing of a small piece of dead tis- sue, it may be sufficient, the foot being pared thin, as already ad- vised, to simply make an infundibuliform opening, various in size, so as to exjDose the bottom of the wound. For that pm-j)ose, the drawing knife or the sage knife is used, a hght shoe is put on, and a dressing of digestive ointment, segyjDtiacum, or simply alcoholic mixtures, are kept on by plates. At times it is advantageous to assist the process of sloughing by the use of caustics, sulphate of copper, Villate's solution, tincture of iodine, etc. If the wound is near or at the heels, the branches of the shoe are shortened and an appropriate dressing is put on. Subsequent dressings require the same care. Cicatrization goes on and the hoof soon returns to its normal condition. Sometimes the surgeon is called only when the inflammation is far advanced and suppuration already established. This peculiar condition is manifested by the swell- ing and heat of the parts, the acute pains, and often the high fever. The wound then must be at once enlarged and the pus allowed to escape, and this is the true operation for deep punctured wounds. The operation becomes more serious if there is separation, partial or total, of the sole or frog, with a more or less advanced disorganization of the tissues underneath. If there is escape of purulent synovia, extensive cuttings are to be made. In olden times, to perform the operation of the deep punc- tured wound, the entire removal of the sole was performed, with- out distinction or exception and notwithstanding the severe pain following it. In our day, a portion of separated sole or frog only is taken off. This is done by slices, and only so far as neces- sary for the other steps of the- operation. This operation is indicated when there is great pain, continu- ing without regard to what treatment has been followed. It is also when the plantar aponeurosis has assumed a greenish tint, diffused in its extent, without indication of a repairing process, with the marks of sloughing of the dead structure. The instru- ments needed are various : sage knives, single and double ; draw- ing knives of various sizes : a directory, bistoury and forceps. The animal, properly secured, and placed under ansesthetics, if too irritable (Bouley), the horny structures are removed where- ever the suppuration has separated them from the soft tissues be- neath, or the sole is only pared down thin, as well as the horny frog in its whole extent. 638 OPERATIONS ON THE FOOT. This first step of tlie operation completed, the operator intro- duces a director into the whole tract of the fistula, and with a sharp sage knife a longitudinal incision is made, following the canula of the directory as a guide, above and below the fistulous opening, and in the direction of the antero-posterior axis of the foot. This done, with the sage knife held in full hand, with one cut the surgeon, by a deep incision, removes the greatest thick- ness of the tissues all around the longitudinal cut he has just made, transforming the fistulous tract into a conical infundibu- lum, whose apex is at the bottom of the wound. If then the apo- neurosis is not yet exposed, the operator removes with the for- cej^s and bistoury whatever tissues still cover it. Then follows the excision of the aponeurosis. This is meas- ured by the extent of the necrosis. As a rule, it must reach a little beyond the diseased part, and by that operation the puru- lent synovia finds a free chance to escape. If the sesamoid is sound, it must be left alone, but if the diathrodial surface is roughened, ulcerated and on the way to desquammation, it must be scraped off with the narrow and long drawing knife. The complications of arthritis cannot be interfered with by the surgeon. It is by general antiphlogistic treatment, and by local and external api^lications that they must be treated. The operation ended, the dressing follows, and becomes one of the most important parts of the means of recovery. As light a shoe as possible is placed on the foot, a coat of hoof ointment, Venice turjoentine, or tar, is applied upon the thinned sole ; j^ads of oakum, wet with alcohol, carbolized or not, are then carefully laid on the soft jDarts. Some practitioners cover them with cegyptiacum (Mandel) ; others simply with Venice turpentine (Lafosse). The pads or balls of oakum must not be too thick or hard, as no pressure is needed. The whole dressing is retained by plates, and several circular straps of tape above the coronary band. Cold water baths are always good afterward. In the subsequent dressings one must bear in mind that the work of repair, the granulating, is more rapid in the tissues of the plantar cushion and fleshy sole than upon the bone and tendinous tissue ; and that in this case it is longer than upon bone if this has been scraped. The result of this is a wound which presents DISEASES. 639 various aspects in its progress of cicatrization. It often has a handsome granulating appearance over its entire surface, while at the bottom there may be a clot of coagulated synovia covering the surface of the sesamoid and the edges of the wound of the plantar aj^oneurosis. A free escape of synovia must always be facilitated, and often the development of the granulations has to be con- trolled. If the cicatrization proceeds weU and regiilarly, dress- ings need be changed but seldom, being satisfied with the cold bath, with copper solutions. Dressings can be made with tincture of myrrh or aloes ; some- times in the centre with tincture of iodine. At times caustics are again used, while at others, fragments of bone or of tendon have to be excised. The entu'e closing of such a woiind may sometimes take place in a month ; but often, even without comj^lications, two or three are required. Complications may easily make their appearance and interfere with the cicatrization. Sometimes j)ieces of necrosed tis- sues which remain at the bottom of the wound give rise to fistulous tracts, until they are entirely removed. In this case, twice as long a time may be necessary to a cure. The pain and intensity of the lameness after the operation do not accurately indicate the nature of the disease ; the general phlogosis, especially the synovial in- flammation, always causes a special acute pain, which for from three to six weeks may prevent the animal from resting his foot on the ground. This pain is entirely indej^endent of the process of repau-, and must not alarm the veterinarian. "While the react- ing fever is absent, and there is a good appetite and no swelling in the region of the coronet, the progress may be considered sat- isfactory. After the cicatrization of the plantar wound made during the operation, the parts may return to their physiological condition, or nearly so ; or, on the contrary, remain in an entirely abnormal condition. Often, indeed, the sesamoid sheath may become obht- ei'ated, the diarthrodial surface has lost its smoothness and there is no more sliding upon it, the tendon having become united to it. The animal then remains lame, and cannot be utilized except in walk- ing ; if coronary anchylosis, ringbones are detected, and the appli- cation of firing is indicated. Sometimes neurotomy gives excellent results. 640 OPERATIONS ON THE FOOT. CONTKACTED HeELS HoOF BoUND. Synonym: ZwangJuiff, German; Encdsleture, French; Incas- tellatura, Italian; Encatenadura, Spanish. This name has been given to a defect of the horse's foot, by which it becomes characterized by its general narrowness, more marked, however, in the posterior than the anterior part. It is especially marked by the diminution of the lateral diameter of the horny box, the deformity consisting in a greater or less contrac- tion of the heels and of the quarters. It is principally observed in the fore feet, and it is there only that it presents the characters we are about to describe. This is due to the fact that in the fore legs there is need of a certain ex- pansibility in the posterior part of the foot, which, especially during the action of locomotion, receives the weight of the body ; while the contraction of the hiad feet gives rise only to an ordinary form of lameness. Sometimes one of the anterior legs only is affected; sometimes both, and ia this latter case the alteration is usually greater in one foot than in the other. Some horses are also seen whose feet are contracted only on one, usually the inner side, while the other preserves its normal form and dh^ections. Sometimes "hoof-bound" is only a simple deformity, without lameness and without serious result. But in most cases, it consti- tutes a very serious affection, which renders many horses useless and almost without value. It is of more common occurrence than is generally admitted, and gives rise to many other affections of the foot. Cases of lameness treated as located in the shoulder, or as navicular disease, are very often nothiag but the result of com- mencing contraction of the heels. True navicular arthritis and hoof-bound are closely related. "Whether the disease of the sesa- moid sheath, arising primitively, brings on the subsequent con- traction; whether the contraction already existing gives rise to the alteration of structm-e which constitutes the disease so named, cannot always be determined. Hoof -bound was known in old times, and the oldest hippiatrics have proposed means to cure it. Eiders especially have studied it, because the disease is most com- mon in fine saddle horses, whose feet are small. It is fi-equent in Turkish and Spanish horses, and animals from the Pyrenean dis- tricts, but common horses are not exempt from it. DISEASES. 641 n. Bouley describes two forms of the disease, the true and the pretended or false contraction. In the first, the hoof is very nar- row, sometimes even concave on its lateral face, to such an extent that its antero-posterior considerably exceeds its tranverse diame- ter; while at the same time its wall is more vertical, and the heels considerably higher than normal, and the foot looks like that of a mule, of which this is recognized as the normal appearance. In the false contraction, there is merely a diminution of the transver- sal diameter of the homy box in its posterior parts, the foot being narrow and contracted at the heels only. We prefer to recognize a total contraction where the whole foot is contracted, and is smaller than its fellow, atrophied^ so to speak, consisting in a contraction of the quarter — when it is principally narrow in those quarters, the condition extending back to the heels — and a contraction of the heels when this is well marked from the quarters to the heels only. A coronary and a plantar contraction have also been designated, depending upon whether it occurs at the superior or inferior part of the foot, and there are cases where the contraction is intermediate, that is, in the middle of the foot only, while it has its normal size, both at the coronary band and at the plantar border. Siru/le and compUcated contrac- tions have also been named. It is admitted that it may be con- genital, though rare ; more often, however, it is developed by it- self, as a result of special causes. I. Symptoms. — The physiognominal aspect of the hoof-bound foot is characteristic, and it is by this that we shall begin the symj)- tomatology of the disease. When the disease is total, the com- plete general dimensions of the foot are observed to be smaller than would be required by the size of the animal affected; most frequently the hoof has an oval form, consequent upon the antero- posterior diameter exceeding the lateral, which is generally dimin- ished. In the contraction of the quarters, the narrow condition of the foot is specially marked from the centre of the quarters back to the heel. In contraction of the heels, the diminution is very marked from the centre of the quarters to the end of the heels, so that the two sides of the wall converge toward each other posteriorly in following nearly a straight line, instead of the cir- cular appearance of the normal state, and tfte heels have princi- pally lost their round appearance, and are elongated, and even pointed in appeai'ance. The wall, in the regions where the con- 642 OPERATIONS ON THE FOOT. traction is more marked, that is, behind, is either perpendicvilar to the ground, or even oblique downward and inward, in such a way that the coronary circumference is greater than the plantar, and consequently it represents an inverted truncated cone. The opposite form of contraction, that of the coronary, is seldom seen, and we may ignore it. The wall is irregularly rough and ramy, and without its shining apj)earance. The heels are gener- ally high, nearly as high as the toe, though it is not so severely altered in cases where the heels only are contracted. As a con- sequence of the contraction of the plantar border of the wall, the sole seems to become folded in the direction of its antero-posterior axis, and it shows a much greater concavity on its internal face than in the normal state. This cavity is then filled by the frog, considerably reduced in size, thus presenting an idea of the sever- ity of the contraction. Most frequently it is a thin, thready body, flattened on its sides by the closing of the bars ; its branches, thin and narrow, resembling two bands so closely resting on each other that the lacunae which separates them is no more than a narrow fissure, which will scarcely admit the introduction of the thin blade of a knife, and from the bottom of which escapes a sero- purulent, gray or blackish liquid ; the lateral lacunae being also transformed into two narrow and deep fissures, filled with the same fluid. The bars, generally high, assume a direction perpen- dicular to the ground, instead of being obUque, as in the normal state, from the centre of the foot toward its circumference. In all the regions of the foot, but especially at the wall, the horn is so dry and hard that sharp instruments cannot cut its cor- tical covering, while it is at the same time brittle, and hence nu- merous superficial fissures appear at the quarters, and the outside and inside toes, the frog itself being hollowed by fissures upon its body and branches. Sometimes it happens that the bars show deep fissures, running from above downward, to the extremity of the lateral lacunae, which are thus continued by a crack of the heel up to the skin of the coronary band. There is often a sepa- ration of the wall and the sole, the formation of what has been called a double wall, or false quarter. Quarter cracks are com- monly met with it. Corns are frequently seen in connection with it. "Whatever may be the form of the contraction, it is generally accompanied by pain, manifested by change of position while at rest and by lameness when in action. DISEASES. 643 If only on one side, the affected leg is carried forward, and thus reHeved from the too painful pressure which would take place if it remained in a vertical direction under the center of gravity. "When both feet are diseased, the horse is constantly moving and balancing himself, pointing the legs alternately, and sometimes stretching both legs forward, as in laminitis, but always ■ moving, so as to push his bedding under him and away from his- fore feet. If the pain is slight, there is only a stiff gait, and the animal hesitates and stumbles easily. But if the disease is advanced the lameness is great and the animal is very groggy in his gait. He fears to rest on his heels, which, without being a peculiar charac- teristic, is a symptom which present, however, a particularly notice- able condition. While there is hesitation in the action of resting, there is difficulty in that of the shoulder. This is principally observable when the disease affects both feet. The shoulders then seem to be fixed to the trunk, and their motion forward is very limited. The symptoms are mostly more marked when the anunal leaves the stable. It may then happen that the pain tem- porarily losing somewhat of its intensity as the horse is moved, the shoulders become more free, the Hberty of action returns, and once warmed up, the animal may offer a totally different ap- pearance from that when first leaving the stable. But as soon as they become rested, the pain returns as severely as before, if not more so, and with it the same exhibitions of symptoms. The examination of the unshod foot while it is warm, shows the extreme sensibhty of the heels. The foot being pared, gen- erally one may observe, in the region where the contraction is most marked, yellowish or reddish discolorations, evidences of the bruises in the living parts, as well as of the serous or bloody exudations which have taken place on theu- surfaces. These indi- cations are especially abundant on the level of the sole and walL If the contraction is old, there is at that point a purulent mas» which, when removed, leaves a caxity which sometimes extends npward under the quarters. It is a separation of the wall, of twa or three centimeters in dej)th. An important observation for hoof-bound, and which assists in its recognition, is the increased wear upon the shoes at the toe^ which takes place not only when animals are working, but also while idle in the stable, as the result of pointing and scraping the 644 OPEEATIOXS ON THE FOOT. stable flooi-. The horse which has both feet diseased in constantly in motion, to such an extent that his shoes are entirely worn in a few days. At times the pain is so great that it gives rise to general symp- toms ; the animal becomes anxious, loses his appetite, refuses his food, lies down most of the time, and rises only with difficulty. II. Cotnplications. — We have already seen that quarter cracks and dry cordis are common affections of contracted feet. Exos- tosis of the phalangeal region is also commonly met in such feet, especially side-bones. Knuckling, and diseases of the tendons and of their sheaths are also often caused by contractions of the feet. The rest of the foot on its whole surface is thus perverted and the tendons become retracted, painful and swollen. Navicular disease is so often met with in company with con- tracted feet, that one disease is frequently mistaken for the other. Laminitis has been said to be also one of the complications ; if so, it is at least quite rare in its occurrence. Tetanus has sometimes been observed among its associations, and Hartmann attributes the development of so-called idioj^athic cases of that disease to this condition of the feet. The emaciation of the affected leg is a complication seen also, with other forms of lameness. III. Pathological Anatomy. — We have indicated the external changes of the hoof. The tissues that have been long enclosed in the contracted foot become atrophied ; molecular changes do not take place as in the normal state ; they become changed in asjoect, composition and properties ; they become denser and more com- pact, and are no more able to fulfill, to the same extent, then," physiological functions. The plantar cushion is so completely pressed upon itself that the stratified structure of its fibrous layers can scarcely be dis- tinguished, and the presence in the interstices of the yellow fibrous substance is with difficulty observed. It forms only a homogene- ous mass, whitish in color, resisting in consistency, and lardac- eous in aspect The dilated bulbs which are above the cushion are also considerably diminished in size, and present, when cut through, a uniform white color, its composing substance being reduced to a single inelastic mass. The ungueal phalanx becomes deformed by degrees, loses its circular shape and becomes of an elongated oval form. Its lateral DISEASES. 645 faces assume a perpendicular direction ; its structure is modified ; its substance becomes more compact, and the small vascular open- ings are obliterated, while the largest are increased in size. The work of obliteration is specially observable at the patilobe emi- nences, which appear to be crushed. The lateral cartilages are also much compressed, condensed and modified in their struc- ture. The navicular bone is also compressed, the sheath and its sup- port not allowing the easy play of the tendons, and it is in this way that navicular disease may follow hoof-bound. But there is a specially noticeable modification in the keratogenous appara- tus, which, as a consequence of the arterial obliterations, fails to receive freely and actively the necessary amount of blood. The horny secretion proper to the podophyllous tissue, the white or soft horn, is reduced; the podophyllous tissue itself is atro- phied ; its lamellae are less prominent and their separations are diminished in dej^th ; the adherence of the podophyllous or kera- phyllous tissues still exists where the circulation of the blood is not interrupted, but beyond, they are easily separated and often present deep excavations toward the sole. If hoof-bound advances slowly, the same atrophy of the sub- horny tissues takes place. Then, however, it proceeds by degrees, the tissues accommodating themselves in size to the gradually diminishing dimensions of the cavity where they are contained, and there is an equal proportion between the size of the hoof and the volume of the tissues enclosed in it. These being less com- pressed, there is less pain. In this manner an excessive contrac- tion of the heels may sometim.es exist without marked lameness. IV. Prognosis. — This is the more serious as the disease is more developed. Total hoof-bound if excessively tenacious, and resists the best curative measures, though if there is only a slight contraction at the heels, it is generally amenable to judicious treatment. The duration of the disease is an important factor in the question of the success of the treatment, as the condition of the OS coronae, os pedis, navicular bone, sesamoid sheath, plantar cushion and the atrophy of the keratogenous membranes have all to be taken into consideration. The age of the diseased animal and any existing complications are, of course, circumstances which influence the prognosis in an important degree. 646 OPERATIONS ON THE FOOT. V. Etiology. — Hoof-bound, says H. Bouley, is not a simple fact, produced by a unique cause acting always in the same man- ner : it is, on tbe contrary, a very complex one, to the production of whicli a great number of causes of various character and inten- sity contribute with simultaneous or successive effects. The hygrometic condition of the horny substance is a principal feature in the etiology of the disease. It is when the hoof loses by evaporation the moisture which it should contain that it con- tracts as all organic substances do, and its flexibility returns when by sufficiently long immersion in a liquid, the moisture it has lost is recovered. Observation proves that this disease often finds the conditions of its presence in circumstances which induce dryness in the part. In such cases the foot has the property of retracting, to an extreme degree, especially toward its posterior extremity, where the frog is situated, constituted as it is of a softer and more depressible substance than -that of the wall. The same phe- nomena takes place in the living structure that is observed upon the hoofs of dead feet ; a phenomenon which cannot even be pre- vented by filHng their cavity with plaster. During life the hoof is constantly permeated by a current of fluids which penetrate it from its depth to the surface. It is the serous food that the hoof is continually absorbing by the hygroscopic properties common in living tissues, which coitnterbalance the tendency of the foot to retract upon itself and keep it in the dimensions required for the perfect reception of the parts it covers. So long as the equilib- rium is preserved between the loss of this fluid by evaporation and its renewal through the perspiration of the keratogenous apparatus, the hoof preserves its physiological form ; but if this equilibrium is destroyed by an excess of the loss, then the condi- tion occiu's for the reti-action of the hoof and the infliction upon the parts underneath of an excessive and painful pressure. This explains why, as proved by observation, lameness in general and that of contracted heels especially, is more frequent in warm than in moist seasons. Long standing in the stable is also an efficient producing cause. The feet become diy upon a constantly dry bedding, and here also the influence of inaction must be taken into account. The disease is commonly found in stabulation, but seldom when the animal is in pasture ; and when it has existed it often disappears in the latter circumstances. The alternation of dampness and dryness also influences per- DISEASES. 647 liaiDS more the genesis of the disease than dryness alone. A foot too much impregnated with dampness, which is afterward left to thfe air, becomes harder than a normal one placed in the same con- ditions. It retracts easier, also. It is probable that the water, in softening the superficial layers of the wall, also renders the evap- oration of the Hquids of its deep parts more active. In the ordi- nary condition of the foot, the evaporation is diminished by the impermeability of the external hoof, which it owes to its density ; but where this hoof is softened by maceration, its fibres, partly disintegrated by the dissolution of the glutinous substance which keeps them as a compact mass, allow the air to penetrate in their interspaces ; air which dries them to a certain depth ; hence a groportionate movement of retraction of the entire hoof upon itself. This evil effect of an excess of moisture explains how it is that poultices or other moist ajDplications which horse attendants abuse so frequently, may give rise to results entirely opjoosite to the one in view, and why the hoof becomes dry and brittle, if not contracted. These topical appHcations take off from the cortical layer of the foot its protecting varnish, and expose it to lose its water of growth. Some of the practices in shoeing contribute also to the dessi- cation of the hoof ; such is principally that which consists in rasp- ing the wall from the coronary band to the plantar border ; as also the too long continued contact of a hot shoe with the foot. Shoeing itself promotes the same result, as, protected by a shoe, the foot no longer wears normally and grows beyond nor- mal limits. The mass of hoof which, in the process of growth, has gone beyond the inferior limits of the podophyllous fissures, is no longer in contact with the li\ing parts beneath, and they cease to be impregnated by the fluids which are thus constantly allowed to evaporate. It then dries up by evaporation and become hard, and retracts upon itself in such a manner that the circumference of the foot in the lateral diameter diminishes more or less, espec- ally posteriorly, and thus forces the incurvations of the sole and of the bars (H. Bouley). If a horse remains shod for several months without having his feet trimmed and pared by the black- smith, these are seen contracting by degrees, as they increase in length, and soon assume the aspect of hoof-bound. But these are not the only effects of shoeing in the etiology of contraction. On the contrary, this practice is the most common 648 OPEKATIONS ON THE FOOT. cause of this lesion of the hoof if not practiced with the intelli- gence it requires. We have said, in speaking of corns, that they were proofs of bad shoeing. The same might be said of the con- traction. Moreover, corns generally indicate great errors in shoe- ing, while hoof-bound demonstrates the ignorance of the physiology of the hoof, which in action must enjoy the necessary elasticity to relieve the contact with the weight of the body upon the ground. No doubt the theory of Bracy Clark exaggerates the degree of elasticity in admitting a great power of dilatation of the hoof, but it is an opposite excess to deny it entirely. The dilatation of the hoof, though Umited, is evident at the heels; especially on feet which have never been shod (Merche). There is especially in the inside of the foot, in the soft and supple parts, a certain compres- sibility of the hoof, which is often overlooked, and which is inter- fered with by a too narrow or unmethodical shoeing. The external dilatation of the hoof is comparatively limited, but on the inside of the hoof there is, in the posterior pai-t of the foot (especially in the fore feet) a movement downward and out- ward of the OS pedis, for whether the normal elasticity of the hoof is necessary, either by the physical and physiological constitution or the arrangement of the constituent parts of the hoof. Quite often, then, shoeing, especially if too tight, resists the internal pressure. Even admitting that the dilatation of the heel is nor- mal, shoeing which would prevent it, would always produce, at the time of rest, a pressure uj)on the hoof which would limit the comj)ressibility of the deep, soft tissues. The frog, especially, formed of a softer horn, and placed under the plantar cushion, must receive this gradual pressure, which diminishes by degrees as the hoof becomes harder, and is reduced considerably as it reaches the external horny layers. The errors committed in shoeing, and which predispose to hoof-bound, vary. The first is in the manner in which the foot is pared ; too often the heels are lowered to excess, while the toe is allowed to remain too long ; too often, again, the bars are hollowed too deeply', thinned too much, as well as the frog. The wall then tends to retreat, as it is no longer protected behind. In reducing the height of the heels, in opening them, the tendency to contrac- tion is increased ; the thinned hoof dries up, the lowered heels lose their strength, and the bars are unable to perform their functions. DISEASES. 649 A vicious adjustment also contributes to contraction. When the shoe is so prepared that its upper face is concave, and its branches form a plane inclined from without inward, and when this face extends back to the heels, there is a circular pressure produced upon the inferior border of the wall. This is a case in which the foot has a tendency to droj), pressed in as it also is by the weight of the body as the foot rests on the ground. Another wrong practice is to place the nails too near the heels. The fixing of the shoe on the foot tends always to jDroduce con- traction, as Bracy Clark observed ; it especially prevents the wide- ening of the hoof, as remarked by Eodet and Coleman. But this effect of the nails is well marked at the heels, where they prevent the dilatation of that part of the foot. These effects of shoeing are to be observed so much the more rapidly and seriously when the hoof is thicker, denser, and of a finer structure, as it is observed in small feet. In these feet, the hoof grows more rapidly, and is on this account more ready to contract. Let us now consider that this effect of shoeing is jjer- manent, and that to the effect of a first shoeing comes to be added that of a second, of a third, and so on, and we can readily under- stand how truly the great number of contracted heels one may meet with can be attributed to erroneous shoeing. Inaction is also an important cause, as, sa^'s Turner, the horse is by natui-e destined to be always in motion ; it is a condition of its health, and it is on account of this condition that in the state of nature he is free from contracted heels. It is, on the contrary, because the domesticated horse is confined within a stall for hours and days, that his feet become contracted. We have seen colts raised without exercise, whose feet were contracted before they were shod. Contraction of the heels is often the result of other diseases of the hoof, and of other lameness. It is commonly associated with corns, navicular disease, punctured wounds of the plantar region, accompanied with long sensitiveness of the posterior parts of the foot, after-diseases of the frog, thrushes, side bones, phalangeal articular diseases; in fact, after all affections of long standing, even if they have their seat in the upper segment of the frog. Finally, heredity has been named as one of the causes. This cannot be denied as to some breeds, principally of meridional climates, as a consequence of the organization of their feet, which 650 OPEEATIONS ON THE FOOT. are usually small. The proposition lias, however, we believe, been exaggerated. This is proved by the Arabian horse, which, though accused of the vicious confirmation from heredity, has, according to Vallon, Crompton, and others, the most admirable comformation of his feet, when it has not been shod. It is broad, with good heels, neither too high nor too low, well open, well j)rominent, wide frog, the external wall being strong and well developed. In the horses of Caramania, Ajiatolia, Syria, and those of the Arabs, which are constantly in the desert, from Bagdad and Bassaro to the Gulf of Persia, the foot is handsomely made, and free from all contractions when it has been exempted from shoeing. VI. Treatment. — Prophylaxy plays an important part in the treatment of this disease. It is easier and especially more rational, to prevent than to cure it when once estabhshed. One of the first indications is to prevent the drying of the hoof, to efi"ect which baths and poultices have been commonly used — the latter formed of cow manure, of clay, etc. — or by the applica- tion of greasy substances, in order to diminish the evaporation of the water of the hoof. Some practitioners are accustomed to use tar and various hoof ointments. The number of preparations brought into use is considerable, and in respect to some of these, the secret of which has been kept by the inventors, the effects have been entirely different, and the hoof, instead of preserving its natm-al good condition, has been altered in its qualities. " It is not with ointment," says Hartman, "that the hoof injured by the blacksmith can be repaired. It is by good shoeing, and never otherwise. The workman, to excuse himself, attributes to the quality of the hoof the origin of the mischief he has done." Hoof ointment never gives to the hoof its natural polish, but many oint- ments, by becoming rancid, take off that which the blacksmith has left. The ii-ritating ingredients which compose them sometimes produce the same results. This does not mean that a reasonable application of ointment is not necessary ; but to act favorably it is essential that one coat should be carefully removed before the apphcation of another. Otherwise, the new will fail of its proper effect, and, on the contrary, the old coat, by its alteration, will give rise to a deterioration of the hoof, especially in affecting the substance which unites the horny elements, and would reduce it to fine powder. And, again, ordinarily it is only the wall which DISEASES. 651 is greased, the hoof of the sole and of the frog being left without, though they may be in equal need of it. The best hoof ointment is made of lard, a small quantity of wax or turpentine, sometimes mixed with tar. Glycerine is very useful, to give the hoof supple- ness when it has become hard ; it is applied by friction, after the foot has been well washed and dried. In the majority of cases poultices are preferable to mucilaginous baths. Greasing is necessary for horses which are much exposed to dampness, and is as good for the sole and frog, as for the wall. It is applicable, also, to feet which have to stand on dry bedding. Feet, which, on account of diseased conditions, requii-e to be fre- quently soaked or poulticed, ought also to be greased. Bedding of fine sand and of sawdust has been recommended. It is well, also, to place horses upon marshy lands. All these measures may "be advantageous if the feet are properly shod. Good shoeing is the essential prophylaxy of hoof-bound ; we must avoid all improper practices likely to promote desiccation and contraction of the foot, such as abuse of the rasp ; too long application of the heated shoe when fitting ifc to the foot ; the lowering of the heels ; the excessive paring of the frog or of the bars ; the bad fitting of the shoe ; useless calks ; too many nails in the quarter or near the heels — all these errors must be carefully avoided. The foot, moreover, must not be allowed to grow too long. The shoeing should be renewed at least monthly, even if the shoe is not worn. And lastly, the horse must not be allowed too long periods of inactivity. It has been proposed to abolish the custom of shoeing, but in the present conditions and modes of using the horse this is im- possible. The feet, deprived of their accustomed protection, would soon become painful, and only by keeping the animal in the coun- try could the feet be suffered to remain unshod. Several modes of shoeing have been invented to prevent con- tractions in feet which are predisposed to them. Some are un- doubtedly beneficial, but they must be used as an ordinary shoe- ing, and not reserved until the access of the disease. Good ordinary shoeing is often all that is required, but no doubt better and quicker resvdts will be obtained by the shoe with short branches, with the flat shoe, or with the Charlier shoe. The half shoe, the shoe loith short branches {fer a croissant), originally recommended by Cesar Fiaschi, then by Solleysel, La- 652 OrEKATIONS ON THE FOOT. Fig. 498.— Short-branched Shoe. fosse, Sr., and Crompton, is an ordinary shoe, made light, with very short branches (Figure 498), which when put on protects the toe, the mammse (outside or inside toe), and the anterior parts of the quarter in such a man- ner that the parts posterior to these remain uncovered, and rest du-ectly on the ground. Thus shod, the shoe is almost in its natural condition; it rests on the ground by its posterier part, and the heels are made to contribute to the movement of expansion of the elastic parts of the foot. This shoe, then, has real advantages, if the posterior part of the foot is yet normal, but if the heels are low and the frog atrophied, it ceases to be of service. The flat shoe, or the shoe vnth base {fer a siege), first recom- mended by Osmer, Morcroft, and more recently by Miles, Ein- siedel and Hartmann, is the style generally adopted at the pre- sent time in Saxony, and in various parts of Germany, as well as in England. In France it has found its way through the benefits observed by a few veterinarians. It is a shoe almost equal in thickness to its width, square, so to speak, but as hght as possi- ble; the internal border of the foot surface being hollowed or dished in order not to come in contact with the sole, while the part which rests on the plantar border of the wall is perfectly flat and horizontal. The heel portion is rounded, and covers mostly the heels of the foot where the borders of the shoe become per- fectly adapted to the borders of the wall, to the remotest part of the heels, and preserves the same contour until it reaches the frog. The shoe nowhere projects beyond the border of the Mall ; it is only toward the toe that it is slightly raised and has a small clip. The groove of the English shoe renders its application better than the peculiar nail holes of the French. Five or six nails are usually sufficient. This shoe allows the dilatation of the foot in G-)3 nil its limits, and while protecting the heels, does not predispose to their contraction. For its application, the j)lantar border only needs paring. That of the sole, the frog and the bars must be carefully avoided. For the shoeing of Charlier, or ^^eri-/jto»tor (Figs. 499 and 500) the part of the hoof which is most exposed is protected. It Fig. 499.— Foot prepared for Charller Shoe. Fia. 500.— Foot Shod; Charlier's Method. preserves entirely all the other parts of the plantar surface in such a way that, as in the conditions of nature, it is only by the fact of the wearing of the shoe that the excess of hoof is gradually re- moved. The foot shod by this process is provided at its inferior border with a metallic bar, often greater in thickness than in width, lodged in a groove made exclusively in the wall. This bar adapts itself in its internal circumference to the contour of the sole, which projects beyond the border of the groove, because all its thickness has been preserved as well as that of the frog and of the bars. In this way the rest of the foot receives its adjustment from the shoe itself, and by the regions of the plantar surface which it surrounds. This result does not, howevei', take place immediately, or when the foot is recently shod ; but by degrees, and as the shoe wears out, the time arrives when the horse walks both on his shoe and the sole of his foot. Owing to the general equalization of the friction any partial wear is thus diminished, 654: OPERATIONS ON THE FOOT. and the important result is secured of reducing the weight of the shoe without the necessity of too frequent renewals, experience having jDroved that for the fore-feet it is quite as durable as the ordinary shoe of twice its weight, but which from the manner in which it is applied suffers, unaided, the effects of the pressure and friction (H. Bouley). As in the action of paring the foot only the projecting portions of the wall at the inferior border are re- moved, the preserved parts of the plantar region resist the move- ment of retraction, and thus prevent its occurrence in a transverse direction. Again, as the thickness of the Charher shoe is greater than its width, it possesses a certain elasticity and adapts itself to the successive movements of the dilatation and contraction of the horny box, however lunited they may be. We may now refer to some special modes of shoeing, recom- mended as preventive of contracted heels, but which seem to us to possess inferior advantage to the preceding. "We first find the unilateral shoe of Turner, which, according to that veterinarian, reheves the foot from pressure upon the heels by placing the nail holes on the toe and the external branch only. Tui'ner recom- mends also the conservation of the frog and that of the bars, and it is probably to this that the success he has obtained by that mode of shoeing is due. Coleman recommended a shoe very thick at the toe and thin at the heels, the toe being three times as thick as the heels. This veterinarian thought that by this shoe the animal was obliged to rest on his frog ; at the same time the nails were driven in the toe principally, so as to allow the dilatation of the heels. This shoe has no real advantages, and predisposes to corns. The bar shoe is of some utility when the frog is well developed, by placing on that part the pressure of the foot, and leaving the heels free. But it often fails in contracted heels, because in aj)ply- ing it these parts require to be pared down, in order to increase the prominence of the frog, and a condition is thus produced which does not exist in contracted feet. The same may be said of the Charlier bar shoe. The objections stated and the reasons suggested are true of all the various shoes designed to adjust the frog pressure. The hinge-shoe or articulated (Figs. 501 and 502) of Bracy Clark and Vatel, and the half-shoe of Sempastous, of Peillard, also possess but a doubtful utility. Practice has not confirmed 655 Fig. 502.— Hinged Shoe. FiG. 502.— Articulated Shoe. the hopes of their inventors. They are difficult to make, easily injured, and of small solidity, and their advantages are wholly of the problematic order. Mayer has recommended a shoe whose internal border is thicker than the external, in such a way that the plane of the plantar surface of the shoe shall be incHned outward, and instead of the concavity of the ordinary shoe, where the foot is pressed when in position of rest, there is a convexity which promotes and even increases the dilatation of the foot. This mode of shoeing has for its inconvenience the exj)osure of the sole to contusions. It supposes an extensive expansion of the foot which is not natu- ral ; the horizontal plane is amply sufficient in ordinary circum- stances. We have, however, used it advantageously in j)reventing the pressure of the sole against the shoe by means of a sheet of gutta-percha. "We have used it in almost complete contraction, and we think we have noticed, with Hartmann, that the dilatation once started by a mechanical means, not too severely appUed, nature continues it, with the assistance of that style of shoe. In- stead of giving that special shape of the shoe in its entire length, it has been proposed to have it only at the branches ; each heel presenting at its internal border a thickness double, or even treble, that of the external, by which the shoe is inclined outward by its plantar and becomes horizontal by the ground face. It is flat at the toe and the quarters, and is the shoe with slippers of de la Broue (Fig. 503), of SoUeysel, and that Vatrin has used in pro- posing to have the internal half of the width of the shoe inclined (Fig. 504). It thus resembles the shoe geneU or with ears, of 656 Ml OPERATIOSS ON TUt KOOT Fig. 503. -Shoo of do la Brouo. '^ /^' Fuj SOt.-VMrtn'«ii»« \\bich wo shall si>»jik limiiftrr. Thi" sIkm- is ouly indicunl when tli»^ lu'ola arc aln-july rontnu-tod ; they have uo indicatm u i>r<> p.iylastic shooing. The Hhoo with nlipporH is iiulwd n nhoo whirh in vtao cnses mav cure contriu'tiou. "If the roMultH ()btaii)(*il bavr ot l>een very Katisfa<'tor^'." sayn Defayn, " this ilepondM ni^t u|wii le hhoe, but arises from the defective iiianner in which tho foot ^\% pored. To bo efficacious in that shoeing the heels must l>o left tune, and the sole and the barn must be well thinneil. It is true tLi in this way the foot is hi the most favorable condition for cotraotion, but the circulation is rendered ea«ier in the tissues uncmeatll, and the effects of the thinning of the biKjf are tliininishi by the resistance opposed to contraction by the inclined plain of the branches of the slipper. The same maybe said of th shoe of de BelleNille, also recommended by Solhysel. and for who8e. This is a shoe proNided on the inner border of each b*i with I I iJW4V#/.«** JJJ-J * t « -H •« ■< -«, +« ^« 's> ^ % 't I- # ■■ * < <; .,4 A a -^ « .« ■■•' " - ■• • '^H ■■■} '-t A A ' \ DISEASES. 657 an obliue, blunt, sometimes peq:)endicular clip, resting upon tlie bars, v;ich have been previously hollowed out for its reception, the des^m of which is to resist the return of the hoof which has been dated, to its former contracted condition. Euinien had spoken. f this shoe as early as 1618. It was put on, after the dilatarin of the hoof with the farrier's nippers, apphed on each Flo. 505.-Shoe with Ears. Fio. 506.-JaiTier Spreader. side c the quarter, the sole being entirely removed. In oui- days this oeration of removing the sole is considered useless, and in- stead, f the nippers of the faii-ier, dilators are used, under the nam.i.f spreaders (desencasteleui-). The oldest known form is that i Jaii'ier (Fig. 506). This is composed of two curved branoes, 11 centimetres in length, articulated at one of theii- ex- tremies like the ordinaiy compass, at which point there is a scre^of pecuhai- fonu by which the branches are closed or opened at wi, the other extremity having a strong claw projecting out- ware! These claws are apphed inside of the bars, toward the heeh which ai-e previously thinned out, and by manipulating the screi the hoof is dilated to the extent desked. The shoe is'^then used ike an ordinary one, both heels being anned with a clip on the itemal border, the chps resting on the heels of the foot, whie iiave been first opened with the draA%-ing knife. This mode of tj-itment proved successful with Lafosse and others who ex- peruented with it at the Saumm- school. Under various experi- meu^. the desencasteleur has changed its form. Thus, Lafosse has n-anged the two branches to run separately upon a transversal 656 OPERATIONS ON THE FOOT. Fig. 503.— Shoe of de la Broue. Fig. 504.— Vatrin's Shoe. whicli we shall speak hereafter. This shoe is only indicated when the heels are already contracted ; they have no indication as pro- puylastic shoeing. The shoe with slippers is indeed a shoe which in some cases may cure contraction. " If the results obtained have not been very satisfactory," says Defays, " this depends not upon the shoe, but arises from the defective manner in which the foot was pared. To be e£&cacious in that shoeing the heels must be left alone, and the sole and the bars must be well thinned. It is true that in this way the foot is in the most favorable condition for contraction, but the circulation is rendered easier in the tissues underneath, and the effects of the thinning of the hoof are diminished by the resistance opposed to contraction by the inchned planes of the branches of the slipper. The same may be said of the shoe of de Belleville, also recommended by Solleysel, and for whose appH- cations the foot has to be carefuUy pared. We feel assured of the propriety of recommending the use of the inclined plane of the branches of the shoe with the presence of a small clip on the inner borders of the heels, such as proposed by Vatrin. Attempts have been made to dilate the contracted foot and to cause its return to its normal dimensions by mechanical means. The shoe vyith ears (Fig. 505) has been devised for this pur2iose. This is a shoe pro\ided on the inner border of each heel with 659 Fig. 508.— Spreading Shoe. Fig. 50Sa.— a Better For Holland has contrived an articulated shoe in three pieces, the two lateral pieces being kept apart by double steel springs, which press upon them from the toe on their internal border, and thus effect the desired dilatation. Hatin has a simpler shoe (Fig. 509). It is a light shoe, with nail-holes dis- tant from the heels, and provided on the internal border with a small chp, upon which rests a V spring, fixed by its point upon the toe of the shoe. The branches of the spring lodge in the hollows of the sole and of the frog, and press upon the shoe, and thus pro- duce a slow dilatation. Steinhoff has also invented a shoe with springs. It has recently been proposed to obtain the dilatation by means of a strong sole of cautchouc, placed between the shoe and the foot, leaving the frog full ; very thin where it rests upon the shoe and the foot, and becoming thicker toward the inner border of the shoe, which it overlaps. First it rests in the groove of the bars, and then portrudes upon the flat of the shoe, and bears on the ground at the time of rest. This elastic mass, compressed at the moment of contact, sHghtly dilates the shoe, which is articulated, or, what is better, very nar- row at the toe, and square ; the heels, also, are thus slowly and gradually dilated. Fig 509.— Hatin's Shoe. 660 OPERATIONS ON THE FOOT. Goodwin also has invented a very ingenious, but too compli- cated shoe, comjiosed of three articulated pieces. From the center of the median piece a prolongation of iron extends to the back of the frog, and is of sufficient thickness to be perforated, the hole having a thread through which a screw is introduced, running on each side. The branches of the shoe have three nail-holes, and from the inner border of the heel rises a clip so turned as to rest on the origin of the bar. The mechanism of the shoe is easy to understand, each branch being opened by the play of the screw which passes through the prolongation of the median piece, one extremity of which rests upon this prolongation, while the other presses upon the inner border of the movable branch. The Goodwin shoe has been es- sentially improved by Foures (Fig. 510). It is a bar shoe, the bar being thicker than the rest of the shoe, and wider than the ordinary bar shoe. The bar is notched on each side, and through each notch runs a thread or vise which holds a mov- able clip, which is made to rest on the inside of the bars, and which are first properly thinned out. By a motion of the chp through the thread, the heels are slowly dilated Fig. 510.— Foures' Shoe. by degree. This shoe, however, is very expensive, difficult to make, and easily put out of order. In all these methods of dilatation the shoe has to be made of several pieces, and in this condition is found a constant cause of weakness and of rapid deterioration, for which reason they are not very practicable. It is not so vdth the system used by De- fays, Sr., by which the shoe, besides containing the essential ele- ments of the desired mechanical dilatation, is left entu'e to fulfill the functions of the ordinary shoe, as well. That which charac- terizes Defays' method, who had vised it in 1829, but which was made known only in later years, is that the shoe itself, which, by its ductihty in action, becomes the agent of the dilatation of the hoof, becomes also, by its natural tenacity, the obstacle to the return of the foot to its former contracted condition, when once it has yielded to the outward motion which it has acquired. De- DISEASES. 661 fays uses an ordinary shoe, thick and narrow, and then further narrowed at the toe, if it is to be used on a foot regularly con- tracted. When it is thus afi'ected, at five or six centimetres of the heels if the contraction exists at the quarters, at the end of each branch. This shoe carries on the inside border a strong, resisting clip, made at right angles, to rest on the internal border of the wall of the heels. The shoe is flat, grooved, like an English shoe, with nail-holes slightly turned inward ; the last nail-hole made as far as possible from the heels. It is made of the best quality of ii'on, in order to resist, when cold, the greatest amount of forced spreading by the dilator ; it is the expansive slipper of Defay's {'pantotifle expansive). The foot upon which this slijDper is to be fixed must have both heels pared evenly, the sole and the bars pared down to a spring, and the hoof round the frog, on each side, thinned down as much as can be borne. Then, the shoe, flattened and without curvature on its faces — resting, therefore, on a strictly horizontal plane — is put on the foot in such a manner that the chp of the heels rests against the internal face of the quarters. This done, the space between the two heels is measured with a compass, and then the dilator is applied (Fig. 511). This instrument represents a true vice, with jaws reversed, moving from, instead of apjDroaching each other. It is formed of two jaws which can be made to ap- proach or separate by a transverse screw put in motion by a mov- able lever. The degree of separation is regulated by, a graduated rule placed horizontally, which serves also to maintain the jaws at the same point when separated. The two jaws being introduced between the heels of the shoe, the vice being held perpendicularly to the plantar face, the screw is slowly turned until the branches are opened, say, eight or nine millimetres ; then at the point or points of the shoe which have yielded to the pressure of the in- strument, one or more blows are struck with a hammer on the outside of the branch of the shoe, to loosen the instrument, until it drops down, without disturbing the screw, a record being made of the degree of dilatation secured, upon the graduated register. After three or four days the same operation is repeated, the spread- ing being then not more than four or five milhmetres. It must be less than at the first, because at the beginning the less perfect contact between the projection of the heels of the shoe and the wall has allowed a considerable amount of dilatation without pro- 662 OPERATIONS ON THE FOOT. Fig. 511.— Def ays' Contrary Vise. ducing much result. These repeated dilatations once in four days for a month, are assisted by the apphcation of soft poultices in horses which, on account of the pain and consequent lameness, are kept in the stable. Others may be j^ut to work, and receive poultices only when at rest, or may be turned into damp fields. The shoe rarely needs changing during the treatment, which lasts about a month. This mode of opening the heels is especially practicable and of easy application, and has the advantage of allowing the use of the horse, whose foot is as well protected as with the ordinary shoe. It becomes indispensable when the dis- G63 ease has been of long continuance, and is accompanied with much lameness. It is liable to but one contra-indication, and that is when the foot is not sufficiently strong to hold it, by reason of the heels having been pared down excessively. It has been tested for a long time, not only by the Defays, Senior and Junior, but by many others. H. Bouley, in France, with Hartmann and Mayer in Germany, recommend it as an excellent curative treatment. These instruments have been modified and perfected, such as those shown in Figs. 512 and 513. Pig. 512.— Defays' Improved Vise. Fig. 513.— Mericant'B Desencasteleur. "We must again mention the simple and light desencasteleur of Jovard (Fig. 514), which is as powerful as that of Defays. It is composed exclusively of a double vice, with opposite threads, opening or closing two strong claws, which are applied upon the Fig. 514.— Jovard Desencasteleur. internal borders of the branches of the shoe ; a rod of iron is in- troduced in the holes of the head of the vice and puts the instru- ment in motion. It may be said that on general principles it is preferable to treat hoof-bound by the use of dilating shoes than to resort to the bloody operations recommended in earlier times. It is these 664 OPERATIONS ON THE FOOT. that Brognie^; recommended highly for the removal of one or two quarters of the wall, with an aj)propriate dressing. H. Bouley, however, believes that it would be wrong to discard these opera- tions entirely; he believes that there are conditions where they become necessary, and where they furnish better and quicker results than the others referred to. We cannot overlook the treatment recommended by Barthelemy, which consists in the thinning first with the rasj), then with the drawing knife, of the bars, in their whole length, depth and thick- ness; thinning them down to a spring under the pressure of the finger. This done, a layer of blister is applied on the skin of the cuti dura and upon it, in the parts corresponding where the hoof has been thinned down; the appHcation to be renewed several times, until the lameness has subsided. This operation is followed by an excess of the horny secretion and a marked enlargement of the hoof, and gives good but slow results. Gross has often oper- ated in the same manner, alternating the blister with poultices. A modus operandi which has also been very satisfactory, is the one that was recently made known by Weber, and which consists in the division of the wall at several points, by grooves extending down to the keraphyllous horn, in the direction of the fibres of the hoof. Two or three are made, on each side, between the quarters and the heels, the heels at the same time being pared down, when a bar shoe is put on which rests on the frog, or if that organ is atrophied, pressure upon it is simulated by the ad- dition of pieces of leather. Frequently, instead of paring the heels down excessively, and when the frog is atroj)hied, we prefer a slipper after having pared the sole and bars to a spring. The method of Weber is not new. It was previously known by La- gueriniere, and is mentioned by Brogniez and Hurtrel d'Arboval. With it we may slowly but surely achieve success, and there are but few feet which are not reheved or cured ; but the grooves must be renewed from above at each shoeing. SoUej'sel made lines of cauterization on each side of the heels, extending from the hair to the shoe, which, running through the hoof, softens it and renders it more tractable. We cannot at present consider the comphcations likely to be encountered, but must satisfy ourselves by remarking that in cases of false c^uarters, to avoid the painful pinching of the soft parts between the two walls, there is nothing better than to clean the 665 place of separation thoroughly with the drawing knife, and to fill the space with a putty of gutta percha. Diseases of the Feog. This part of the horse's foot is exposed to many joathological lesions. Some are merely accidental, and result from the intro- duction into its structure of nails, and other various foreign bodies, more or less sharp, which the animal picks up in walking or performing his work. We have already considered these forms of lesion in the article upon punctured wounds. The frog is often bruised, a lesion which may be followed by a comi^lication which we may be allowed to consider under the name of furuncle of the frog. But besides this, some special diseases are also ob- served, among them one already known to us under the name of canker^ and another which is more commonly known under that of thrushes. (A) Thkushes. — This afi:ection is often, but wrongly, considered as the beginning of canker, being characterized by the presence of a puriform secretion, blackened and very fretid, which collects and accumulates in the laciuise and excavations of the frog, whether in its middle or upon its sides. There is often an in- creased sensibiUty of the parts, which in some cases may give rise to very serious lameness, preventing the animal from stand- ing, and rendering the movement of walking very painful. The horn of the frog often becomes soft and thready, when the frog is called rotten., and the softness increases until it drops off by piece- meal. The causes of this affection are, first, excessive work on stony roads ; changes from excessive dryness to moisture ; the strong muds of streets, and standing in damp and dirty places, esj)ecially in urine and manure, as is often the case in badly kept stables. But there are horses whose feet are also affected with thrushes even when standing on a dry bedding ; those whose feet are con- tracted ; and again, well-bred horses with good frogs, and in which there is a constitutional tendency to that condition of the horny structiu'es. The treatment consists in avoiding aU known causes likely to give rise to this morbid condition of the frog. Sometimes the foot must be pared, and all the parts where the puriform secretion 6C6 OPERATIONS ON THE FOOT collects exposed and thoroughly cleansed. The lacunae of the frog are then to be dressed with Villate's solution, ^gyptiacum oint- ment and sometimes only with simple drying powders, a mixture of subacetate of copper, burnt alum and tannin. When the paui is excessive, glycerine, with a little Goulard's extract or per-chloride of iron, is very beneficial. Dusting with calomel powder gives also excellent results. In some cases again, excellent results are obtained by poulticing. It is certain that proper shoeing must, in many instances, be of great advantage. (B) Furuncle of the Frog. — Under this name is understood the partial necrosis of that portion of the plantar cushion which is situated above the frog proper, from a biruise of that part of the hoof. Loiset describes it under the name of plantar Jibro-chon,- drltis, connecting it with quittor, which he named, lateral Jibro- chondritis. Sym/ptoins. — There is nearly always, and especially at the out- set, a severe lameness, the greater in degree as the mortification is more extended and more deejily situated, "WTaile standing, the affected leg is carried forward, resting on the toe ; the heels are raised, and the fetlock is half flexed. In action, the rest is very slight, sometimes quite absent, and occurs on the toe only. As the disease progresses, and the necrosed spot develops itself, the animal rests his foot better, and the lameness diminishes. Upon examination of the foot early in the history of the case, a small oj)ening may ordinarily be discovered, either on the body of the frog, or in its branches, while at other times there is merely a discharge of a yellowish serous pus of a strong odor, and more abundant in quantity than wotdd be expected from the size of the wound, while surrounding it the hoof is loose and sometimes ready to drop off. If the disease is several days old a mass of dead tissues is ordinarily found partly loose, projecting through the opening of the frog, which has the aspect of a whitish body, slightly green, soft, loose and detached among the surrounding tissues. When this core (boui'billon) is not visible it may some- times be felt with the finger introduced through the wound in the frog. If there is no lesion of the frog the purulent fluid accumulates under the hoof, raising and loosening it from the velvety tissues to a varying extent. Fluctuations may be sometimes even felt under the hoof. Some- DISEASES. 667 time the j)us oozes through the lacunoe of the frog, while again it may then aj^pear at the heels, after making its way under the en- tire sole. Pathological Anatomy. — As we said at the beginning, the characteristic lesion of the frog is the gangrene of a portion of the fibrous structure of the plantar cushion, when it changes its general aj)pearance and becomes of livid yellow-greenish color, while at the same time a process of elimination takes place in the surroimding parts, and pas forms, separating the dead tissues from the healthy structure surrounding. This process of elimina- tion is more active on the surface than in the deeper parts of the plantar cushion, to which very often this core remains attached. In some serious cases the disease becomes complicated with ne- crosis of the jDlantar aponeurosis, or of the os pedis, and some- times of caries of the lateral cartilages, or cartilaginous quittor. Causes. — Furuncle of the frog always proceeds from some vio- lent injury through the horny envelope of the tissues it covers, either when the hoof has been cut through and through by a sharp instrument, or as the result of some simple bruise with- out solution of continuity, contusion, or even crushing. Any for- eign body likely to produce a punctui-ed wound of the foot may produce it. But in such cases as are accompanied by furuncle it is necessary that the wound should be more of a contused or bruised than of the punctured variety. Kough, angular stones are the most common agents of injury, being often picked up be- tween the shoe and the frog, and then, pressing more or less upon the tissues underneath, they produce the same result when they are located in laminae of the frog. A thick, voluminous frog in a foot with low heels is very much exposed to the class of injuries under discussion, equally with the frog whose horny covering has been pared too closely. Treatment. — The first indication, says H. Bouley, when one has to treat a furuncle of the frog, is to thin down as much as possible the horn of the plantar region, and especially that of the frog, of the bars and the branches of the sole, in order to avoid the painful pressure it would produce if its thickness should in- terfere with the expansion of the parts. This done, if the frog is already punctured, and there is an opening communicating Avith the cavity where the core (or boitrbillon) exists, a free incision or opening must be made through the hoof and the fibrous covering 668 OPERATIONS ON THE FOOT. of the plantar cushion, and thus the escape of the pus facilitated. If the horny frog has remained intact, a longitudinal incision must also be made in order to allow the frog to discharge, and avoid further burrowing or undermining of the hoof. It is bad practice to attempt to pull the core out with a sharp instrument. It is better to leave it rmdisturbed and wait for the natural process of elimination, which may, however, be hastened by the application of a poultice. The time requu-ed for the entire separation of the necrosed spot varies, and as it approaches, the animal begins to imj)rove in the matter of resting his foot. When it becomes en- tirely detached, the cavity which it occupied in the plantar cushion is treated as a simple wound, with turj)entine or tincture of aloes. However, a dressing supported by the shoe with plates is always advantageous, and must be frequently repeated. No great length of time is usually required for the entire healing of the parts, and the animal is soon returned to his work. In a few cases, nevertheless, the furuncle becomes compHcated with necrosis of the plantar cushion, disease of the os pedis, or of the lateral cartilages, the treatment of which must vary according to the nature and severity of the lesions. In these instances operations similar to those required in cases of deep punctiired wounds of the foot or in cartilaginous quittor are indicated. Keeaphyllocele. This name was given by Yatel to a tumor which forms on the internal surface of the wall of the horse's foot, at the expense of the keraphyllous tissue, which becomes hypertrophied. These tumors are sometimes irregularly rounded, at other elongated, but usually rounded and again flattened from side to side. They vary in size from that of a goose quill to that of the finger, and while in some cases they occujDy the whole length of the wall from the coronary band to the plantar border, in others they only begin at one-third or one-half of the height of the wall. The difference in size allows a division of keraphyllocele into complete and hiGomiylete. At different points the columns are roughened by frequent enlargements. Sometimes full and formed by a very- compact and hard tissue, they are, however, sometimes of a fis- tulous character and accompanied by a blackish discharge of an offensive odor. The lamellae of the reticular tissue which are nearest to them are generally wider and thicker than in the nor- DISEASES. 669 mal state. As the tumor increases it compresses the lamellated tissue and the corresponding surface of the os pedis, injuring the soft parts, and resting in a groove they thus form for their development. The causes vt^hich give rise to their development are more especially cracks of the walls ; though they often follow laminitis or supervene upon severe operations on the wall. Vatel claims to have observed them after injuries on the hoof resulting from the hammering of the foot while bemg shod. The symptoms are very obscure. At first the animal is but slightly sore in traveling, but the lameness increases as the tumor enlarges in size. The region surrounding the tumor is always warmer and more sensitive than is natural. In many horses the coronet presents a swelling, well marked. In some cases the dis- eased quarter is depressed, and the toe seems elongated. When a toe or quarter crack is accomjpanied with severe lameness kera- phyllocele may generally be suspected. But when none of these external signs exists it is exceedingly difficult to make a positive diagnosis of their presence, for though the swelling of the coro- net, the heat and the pain of the hoof may be present, those symptoms may belong also to other diseases of the foot. Then the only means at our disposal is to pare the foot well down, when, at the surface of the sole, the extremity of a portion of hoof ordinarily harder than the normal consistency may be detected. The treatment consists in removing the portion of the hoof corresponding to the horny tumor, as in a case of toe cracks, and treating the wound thus made in the same manner, according to the indications presented. Laminitis. Synonyms: Sehe, Versehlag, Hufentzunclmtg, German; Four- bure, Fourhature, French ; Rlfondhnento, ItaHan ; Aguadura, Spanish. By this name is understood the bloody congestions of the keratogenous apparatus of ungulated animals. The increase of the circulating fluid produces a swelling of the living tissues of the foot ; but these being enclosed in a box of so hard, resisting a material, a painful pressure results, which becomes especially common and serious in horses and other solipeds. It has also been observed in bovines, though it is then less frequent and 670 OPEEATIONS ON THE FOOT. serious. It has also been seen in sheep, in goats and in swine. It may, in fact, occur in all ungulated animals. Dogs, even, are not exempt from its attacks. The simjDle bloody congestion, more or less inflammatory, of the keratogenous apparatus of the horse, is sometimes called acute laminitis and acute founder. The disease may pass off by reso- lution, leaving no traces of its occurrence, but more commonly it becomes complicated with some lesion of more important and serious a character, as hemorrhage, suppuration, inflammatory exudation, and especially of a hypersecretion of the horny sub- stances, in which case it becomes chronic laminitis or founder; an affection which gives rise to alterations of a jDeculiar nature, and leads to certain changes in the form and character of the hoof. "We do not agree to the divisions admitted by several authors, into traumatic laminitis, rheumatismal lam,initis, and metastatic laminitis. I. Symptoms. — Laminitis, in most instances, is preceded by certain general symptoms, such as are premonitory of the inva- sions of ordinary inflammatory diseases, but of an uncertain sig- nificance. There is dullness, general insensibility, muscular tremblings, and stiffness of the loins. The respiration is accel- erated, the pulse febrile, the mucous membranes injected, the mouth dry, the f cecal discharges dry and coated, the urine scanty; and perhaps anorexia is present. Kodet, who held that laminitis is more a secondary than primitive affection, and that it is simj)ly an inflammatory angeiothenical fever which had localized itself, was obliged to acknowledge that this fever has nothing character- istic, and that it is always followed by laminitis. It is certain, however, that but a short time elapses — from several hours to one or two days — after the originating cause has become active, before the bloody congestion of the reticular tissues and the peculiar phenomena belonging to the disease become manifest. It is only when the capillary circulation of the foot has considerably increased, and when the rigidity of the structure prevents the swelling of the podophyllous tissue, that laminitis truly exists. Laminitis in the horse has the following principal symptoms : Considerable heat of the entire foot, extreme sensibility with intense pain, increasing rapidly, and obliging the animal to rest upon the sound legs, in order to relieve the affected ones; diffi- DISEASES. 671 culty and uncertainty in walking ; and sometimes a peculiar trem- bling of the muscles of the patellar face of the femur, and of those of the extensors of the fore arm, which fill the triangular space formed by the scapula and the humerus. The physiognomy always indicates intense suffering. The pulse is hard, the respi- ration increased, and the skin hot, and in places moistened by a copious perspiration. These symptoms vary with the legs which are affected, whether the disease is located in the fore or hind feet exclusively, or in all four together. As M. Bouley says, it is a peculiarity of this affection that it may remain localized in the feet of one patient, either forward or behind, ^ or may at once attack the four extremities, and that it seldom attacks the limbs on one side only, to the exclusion of the feet of the opposite side, i. e., it may be laterally biped, affecting either both the fore or both the hind feet, but not often occurring othei'wise. Some- times, however, the disease is more marked in one leg than in the other of one biped. It is generally only after some traumatic lesion, or other local influence, that laminitis occurs in one foot only. When laminitis affects the two anterior feet, the animal carries its extremities forward, and the hind feet are brought well under the centre of gravity. The standing of the animal is altered, the walking difficult and painful, and the resting of the feet on the ground is done with hesitation and fear. The feet are carried forward, because the pressure takes place on the frog and on the heels ; if it should occur as in the healthy and normal condition, upon the entire inferior circumference of the foot, there would be pressure upon all the living tissues, which are gorged with blood, tumefied and painful, and this pressure would greatly increase the suffering of the patient. It is, then, to relieve himself, and to avoid the intensity of the pain, that the animal instinctively changes its mode of resting on the ground. In placing the heels down, the weight is borne only upon a follicu.lar, fatty tissue ; from there it spreads along the side of the coronet to the fetlock, and thus upon all the other portions of the leg, and in this way the foot becomes greatly relieved during the action of resting. If, however, the fore legs only were carried forward, the effect would be equivalent to lengthening the body of the animal, and he would be unable to carry on the action of walking. To allow the fore feet to be moved, it is necessary that the body be carried 672 OPEEATIONS ON THE FOOT. forward by the hind legs and brought closer under the centre of gravity, a position which contributes also to the rehef of the animal while at rest. The more painful and diseased the feet become, the more the animal fears the impingement of the ground. Thus, so to speak, he sounds the ground before putting the foot down, and for this reason the walking becomes slow, stiff and difficult, and the noise of the contact of the foot louder than that of the healthy legs. Sometimes the animal proceeds only by a series of jumps, or a kind of rearing, while backing is especially difficult. The hoofs of the foundered feet give to the hand, when feeling them, a sensation of heat greater than that in the physiological condition ; a sensation which can be more readily detected by a comparison of the fore and hind feet simultaneously examined. The jjains in the diseased feet are rendered more manifest, also, by percussion vipon the hoof with the hammer, when each blow, however light, is followed by a motion of the animal in suddenly withdrawing his foot on account of the pain experienced. The lateral arteries of the fetlock, in the foundered legs, beat stronger than in health, and can be readily felt by the fingers. The feet cannot be raised without great effort, and when raised, the animal stands only with great difficixlty, and makes struggling attempts to relieve himself and resume its natural mode of standing on fom' legs. When laminitis affects only the fore feet, the animal will sometimes remain standing for a length of time together; he may retain this attitude for several days, without any displacement of his body ; still he is observed moving surplace, from side to side, especially on his fore legs, reheving one foot for a moment to give the same comfort immediately afterward to the other. But when, exhausted by fatigue and pain, the foundered horse lies down, it is very difficult to get him on his feet again. He continues in the decubital position, l}Tng mostly flat upon his side, the fore legs in constant motion, and soon complicates his diseased condition by the addition of bed sores upon the prominent parts of his body. The attitude of the animal is very different when the hind feet are affected; then both the anterior and posterior bipeds are brought to each other, the feet of the hind legs being carried for- ward under the abdomen, so that the rest may take place upon the heels ; and the anterior ones are carried backward, and nearer DISEASES. 073 to the centre of gTa\ity, to assist the function of the hinder ex- tremities in sustaining the weight of the body. In this case, the animal is constantly in side motion, on account of the pain he en- dures Walking is still more difficult, and seems to take place as if the animal was treading on sharp needles, as, the more the an- terior biped is engaged under the body, the more also those legs are loaded with the animal's weight, and the more difficult is theu' movement. But the anterior legs, contrary to their ordinary func- tion (not being adapted to the support of an overshare of the body) sustaining now a great part of its mass, and moreover, comj)elled to assist in the act of propulsion, necessarily and in- evitably become easily fatigued, and too often in their turn be- come likewise affected. Animals suffering with posterior laminitis are found occupying the standing position less freqviently than those whose fore feet are affected. Their unsteady equilibrium, consequent on their mode of standing, tii'es them more quickly, and compels them to lie down, and once on the ground, it is again more difficult to make them rise. They may do so readily with the fore legs, but the posterior extremities do not always respond to the call. The attitude of animals suffering with laminitis of all the four feet, is the same as of those which are affected in the fore feet only. All four feet are carried in advance of their plumb line, the anterior forward, the posterior well under the centre of gravity. Sometimes the horse has all his feet somewhat apart, in order to carry the principal part of the weight on the inner side of the foot. The standing posture being painfvil to either foot, the animal lies down most of the time. Locomotion is very difficult and staggering, and the animal can only be induced to move by severe punishment, and even that cruel resort sometimes fails to effect it. If the animal is made to walk, he does it with the great- est difficulty, by reason of the increase of his sufferings, brought on by the displacement. His legs, stiff and trembling, are raised in a convulsive manner, and brought back to the ground with the greatest hesitation, and upon the heels ; the constant motion of the lips of the animal being well characteristic of his sufferings. In the ox, laminitis is more frequent in the hind than in the fore feet. It is, however, more serious in the latter, the inner being more affected than the outer toe. The foundered ox walks with hesitation, and takes advantage of every opportunity to lie 674 OPERATIONS ON THE FOOT. down. 'WTien standing, his back is arched, the feet closed to- gether, the hind feet resting on the heels, the fore legs on the points of the toes. The fever is severe, sometimes attended with loss of appetite and of rumination. If the disease continues long, the cattle will die. The abdomen is stuck up and the animal loses flesh very rapidly, indicating a serious condition, as the dis- ease is princij)ally found in fat animals, which are obliged to make forced marches to be delivered at their markets. II. — Termination and Complications. — Well treated, laminitis is generally of short duration, and ends in three or four days by resolution. Sometimes, however, this is not accomplished until a later period, even toward the tenth day, though cases of this charac- ter are rare ; and even when resolution proceeds slowly, some lesions in the foot may be looked for, and chronic laminitis will probably result. Eesolution in acute founder is marked by the gradual disappearance of the local and general symptoms. In some sub- jects, the improvement is quite rapid from day to day, and the form of termination is known as delitescency. Laminitis ending in resolution is not usually followed by alterations in the horny box or the tissues which it covers. When the congestion which constitutes the disease terminates otherwise than by resolution, it is always followed by accidents of varying character. Some of these may have a happy termination, but, in the end, are more or less likely to be followed by a de- formity of the horny box, to which the name of chronic laminitis is given. Before entering upon this, however, let us examine the various complications which may follow acute founder, and study in succession: the hemorrhage, inflammation with exudation, suji2')uration, gangrene, consecAitive arthritis, metastasis, and, lastly, chronic laminitis. Resolution is most commonly met with in the ox. Sometimes the separation of the hoof by suppuration occurs, and chronic founder is not observed in that animal. It is seldom that seedy toe is observed. a. — Hemorrhage, or apox)lexy of the reticular tissue, is due to the rupture of the excessively distended capillaries, when the ex- travasated blood either infiltrates into the meshes of congested tissue, or spreads around it, and penetrates between the podophyl- lous and keraphyllous lamellae, filling up the spaces at the toe, the mammse and the anterior parts of the quarters, the os pedis being pushed back by the joressure of the incompressible fluid. The DISEASES. 675 pain is then very great ; tlie blood, continuing to separate the tis- sues, often oozes at the coronary band. If this last sign is absent, a groove may be made with a draw- ing-knife in the region of the toe, behind the commissure of the sole and of the wall. If we meet with a cavity, resulting from the extravasation of the blood in the podophyU-ous and keraphyl- lous space, or if blood flows out from it, the true nature of the comphcation becomes at once apparent. This mode of explora- tion is generally difficult, as the animal in pain does not readily allow his feet to be raised, and as the other foot cannot sustain the entire weight of the body, the horse easily falls down. It is sometimes necessary to throw the animal in order to make this exploration, which very often becomes necessary if we would know accurately the progress of the disease. h. — Inflammation, with fibrinous exudation, or pseudo-mem- branous formation on the surface of the podophyllous tissue. The transudated fibrine mixes with the hoof, secreted by the podo- phyllous tissue, and this matter separates that structure from the keraphyllous laminae, especially at the anterior part of the region. Again, in chronic laminitis we find this abnormal secre- tion pushing the os pedis forcibly backward and sej)arating the toe of the bone from that of the hoof, and thus producing a pain still greater and more violent than that produced by the laminitis and the hemorrhage. These pains are often so intense that they give rise to an access of furious vertigo. But pains, even when of an exaggerated degree, indicate simply the presence of the exudative form of laminitis. It is not a positive sigh ; the foot must be explored at the toe, where, in the vacuum which exists between the horny lamellae is found, more or less abundantly, a citrine serosity of a slightly reddish color. Sometimes this ser- osity oozes between the hair and the hoof, in consequence of the separation of the tissues at the coronary band, and appears in the form of a thin, reddish foam, about the band itself. c. — Suppuration between the wall and the podophyllous tis- sue is a complication more rare than the others, but which, how- ever, has been observed, especially when laminitis is traumatic. We have seen it appear under the sole and separate it entirely from the tissues underneath. In these cases, the pain is always very great, and the living structures are pressed beyond measure. Standing is impossible, and the animal continues lying down, or, 676 OPERATIOXS ON THE FOOT. under the influence of the pains, constantly moving from one leg to another, balancing himself, so to speak. There is no relief for him until the suppuration has shown itself between hair and hoof, when it oozes outward at the coronet. Relief, however, may also be obtained by making an opening at the toe with the drawing-knife. This complication often results in the entire separation and drop- ping off of the hoof. Cases have been observed when this acci- dent has taken place as early as the third day (Lafosse, Stanley). Gillmeyer has seen a new foot grow out entirely, but this requkes a long time. d, — Gangrene of the sub-horny tissues sometimes takes place, though seldom, under the influence of the excessive pressure, especially when there is sub-homy exudation. The violent pains then cease suddenly ; the resting becomes more solid ; the move- ments take j)lace without difficulty. But at the same time, the physiognomy of the patient becomes anxious and contracted; the pulse becomes small and difficult to count ; the temperature of the body diminishes ; the animal has a trembling gait ; is indifferent to any excitement ; he is prostrated, and soon he ends by sep- ticaemia. The hoof then often drops off, and the sub-horny tis- sues are seen to be of a bluish-brown color, without consistency, but with a very foetid odor. Volpi thought that laminitis was the inflammation of the articu- lation of the foot ; but this arthritis, if it exists (a fact which is rare), is not a consecutive phenomenon, but a complication. The inflammation does not remain limited to the recticular tissue ; it extends also, and consecutively, to the contiguous structure, spreads to the tendons and articular ligaments, even penetrates to the synovial capsules of the articulation of the third with the second phalanges, and may also react upon other parts of the organism. The anchylosis of the articulation of the foot with that of the coronary joint are complications somewhat frequent, as well as that of the ossification of the cartilages of the foot. e. — Metastasis has been often observed, and when accom- panied by intense fever have been noticed as complicated with serious diseases of the chest, especially of pleuro-pneumonia. At other times, it has been the intestines to which the metastasis has transferred the disease, in which case there is, in most instances, constipation of the bowels. Enteritis, however, is seldom ob- served, notwithstanding what has l^een said on the subject. This DISEASES. 677 metastasis has also been seen toward the lumbar region, and this is much more commonly believed from the fact that there is more motion at the hip than at any other joint during locomotion, and also because the back and the loins are more or less arched. In fact, laminitis has been, by some, designated as an affection of the loins ; some have looked upon it as a rheumatism of that region. All these errors have originated in the peculiar motion of the ani- mal while walking, or of its peculiar mode of resting when stand- ing still. We have also observed an attack af complete myelitis as a complication of laminitis. /. — The most common complication met with in chronic lam- initis is an affection which we might have treated as a special sub- ject had we not, upon principle, considered it as a sub-inflamma- tory state of acute founder of the foot. An attack of laminitis which has not ended by resolution in five, ten, or fifteen days at most, takes a character of persistency which, in most cases, ends in absolute incurability. To properly study chronic laminitis we must observe it when the alterations which characterize it are ac- complished. When we have completed the consideration of the pathological changes, we will examine the intermediate period, and discuss the mechanism by w-hich these alterations take ]3lace in relation to the pathological anatomy. The first thing observed is the change of form in the hoof (Fig. 515). The nail of a horse's foot easily recalls the form of a Chinese shoe (Knollhuf, of Germany). The hoof seems to have also lost its varnish and its suppleness in the • , T i. J.1" T Fig. 515.— Chronic Laminitis. pomts correspondmg to the dis- eased parts. It is, besides, brittle, and seems to have lost part of its connection with the remaining parts of the foot, and there is a change in the direction of the wall, the fibres of which, instead of being oblique to the ground, assume an almost hori- zontal direction. The foot seems as if flattened from above down- ward, and the lines which bound its surface form a well-marked obtuse angle with that of the coronary region. The anterior wall of the foot also forms a well-marked projection forward, from which results a great exaggeration of the antero-posterior diame- ter of the nail with the ti'ansverse diameter and the oval form of 678 OPERATIONS ON THE FOOT. the horny box. The external surface of the wall, instead of be- ing smooth, as in physiological conditions, presents, on the con- trary', a roughened aj^jjearance, which results from the presence of circles of ridges and circular grooves, placed one above the other and extending from one heel to the other. A remarkable peculiarity is here observed in the fact that in the anterior part of the nail the circles are quite near each other, while, on the con- irary, upon the lateral parts they are separated by much wider grooves. "When, then, at the toe, the wall has some difficulty in growing downward, on account, probably, of the internal adhes- ions between the podophyllous and keraphyllous tissues; the heels, on the contrary, grow without difficulty, and thus obtain a relative height superior, and sometimes even equal, to that of the toe. Often at the mammae and quarters of the foot contractions are seen, and longitudinal grooves running from the coronary band to the plantar surface, reminding one of the lesions usually met Avith in encastelure. Considered on the side of the inferior face, the old f ound- dered hoof offers four remark- able lesions (Fig. 516). Besides its oval form, a disposition al- together different from that of the normal state, the sole is convex in all the anterior part of the plantar region, especially at the point of the frog. There exists at that point a transversal tumor or enlargement, projecting sufficiently to exceed in height the inferior border of the wall. The solar sheet has been pushed outward by the pressure against the superior face from the contents of the horny box, and the foot is convex. This convexity never equals the entire extent of the foot, the deformity ending at the boundary of the inferior border of the bars, beyond which and backward are found the cavities of the Fig. 516.— Chronic Laminitls, last stage. also higher (Fig. 517). The center of this tumor or enlargement of the sole is often flexible under the pressure of the finger, and generally bleeds easily on the application of the sharp tools of the blacksmith. It is not rare to see the sole perforated through and through and showing the inferior border of the os pedis project- ing through the border of the bone, which then soon becomes 679 Fig. 517.— Foot affected with Chronic Laminitis. a.— Anterior extensor of the phalanges. 6.— Ordinary wall, c— Coronary band. d.—Podophyllous tissue modified, e.— Morbid horny wall. /.—Seedy toe. jr.- Displaced and deformed OS pedis, ft.— Velvety tissue. 1—Perforans tendon. 7'.— Navicular bone. A;.— Perforatus tendon. I —Plantar cushion. necrosed. This is the result of the excessive displacement of the OS pedis and of the strong pressure upon the velvety tissue against the sole-tissue, which is atrophied or even destroyed (Fig. 518). This is an ulcerating wound, somewhat semi-lunar, secreting a Fig. 518.— Chronic Laminitis, with Keraphylocele t)»U OPERATIONS ON THE FOOT. very offensive pus, with granulation and proud flesh, or even sepa- ration of the sole. Between the sole and wall the line of demarcation is no longer so well defined as in the normal state. At the toe, the mammae and the anterior part of the quarter, there is an excavation formed of softer horn of bad nature, and less identified with the true horn of the wall and of the sole. A complete vacuity is often found, a cavity around the internal face of the wall at the toe and at the mammae of varying depth and size, but always larger at the inferior than at the sujDerior end of the foot, where it gradually diminishes, and often contains a dry, granular mass, resulting from the drying of the blood, and the di'ied plastic lymjjh, mixed with small, horny, pulverized masses. This cavity is formed in front by the healthy wall and posteriorly by a new wall due to the secreted hoof thrown upon the podophyllous tissue ; this is called seedy toe. This double wall is observed especially after laminitis of the hind feet ; it is more common in the donkey and the mule ; it is also noticed in horses with small feet, as in those of Oriental breeds. The deformities of the horny box due to chronic laminitis are not in all cases identical in their character; there are degrees in them, and consequently they vary in their features, which varia- tions are due to the duration of the disease and its intensity, and also, according to H. Bouley, to the primitive form of the diseased foot. In a case of chronic founder of the fore feet, one may often notice a difference between the deformity of the left and that of the right foot. The deformities may take place at various times, and one may find a well-marked case of seedy toe while as yet the wall has j)reserved its normal oblique direction and shown rudimentary ramy appearances. Again, the wall may have under- gone changes in its direction only at the new hoof, which grows from the coronary band; there is then formed between the old wall and the coronet a cu'cular groove, sometimes called the digi- tal cavity, the deformities of the wall taking place only as it grows down. At times, also, instead of the groove, there is a ridge of horn at the coronary band, originating in the hyper-secretion of the horn, which grows also downward. And, again, there are cases where there is seedy toe and still no well-marked alteration of the shape of the wall of the sole. Chronic laminitis is always accompanied with more or less DISEASES. G81 lameness. There are cases, however, where it is missing ; for ex- ample, in seedy toe. Ordinarily, the foot is raised from the ground with a convulsive motion, as may be well observed in donkeys and mules, which animals rest their feet on the heels. This soreness diminishes with time, as the foot, assuming its new form, offers a wider space to the sub-ungulated tissues and presses less upon them, these tissues having, at the same time, become somewhat atrophied. In cases of hernia of the os pedis, the resting of the foot on the ground is ahnost impossible, the animal being afraid to bear his weight on the sole. The heat and the pain of the feet are less marked. The percussion is louder in case of seedy toe, while it is duller when the space between the wall and the recticu- lar structure is filled with hoof of new formation. This percus- sion is very painful in case of keraphylocele. Unless there are serious lesions, chronic laminitis is not accomjoanied with fever. III. Pathological Anatomy. — At the initial period of lamini- tis, when there is only simple congestion of the keratogenous ap- paratus, and especially of the podoph^ilous tissue, the sub-horny tissues are in a condition of sanguineous derangement, characterized by objective signs. "\^Tien the hoof covering them during life is removed, they are found of a dark red color, in a kind of eythema. When pressed between the fingers, their thickness is noted to be increased, and they are f oimd to be gorged with blood, an incision made through them allowing the escape of a large quantity of that fluid. If the laminitis exists for several days, the podophyllous tissue is found to be infiltrated with plastic exudations, and if there has been hemorrhage or apoj)lexy,- blood is found between both the sensitive and insensitive laminae. In other cases there is pus, and in case of gangrene, the tissues are found of a livid color. The alterations are still more serious in cases of chronic founder. ^Tien a foot, foundered for some time, is divided by the saw in its antero-posterior axis by a section of all the jDarts, the thing first noticed is a change in the connection of the os pedis with the wall. These changes, however, exist principally at the toe, and extend as far as the half of the quarters, on a level with the lateral cartilages of the foot, while further backward they are not to be observed. On the side, some laminae are always found in their normal condition, as can be seen by a section of the foot made transversely. Generally, a yellowish substance, of G82 OPERATIONS ON THE FOOT., horny appearance, but softer, fills uj) the si^ace situated between the walls and the keratogenous structure. This is the product of the exudation of the inflamed podoj:»hyHous laminae, mixed with the horny substance which they secrete normally. These laminae are themselves hypertrophied, being sometimes one and two cen- timeters in length and exceeding by four or five times their nor- mal size. The keraphyllous laminae are also hypertrophied, a condition which is evidently due, as resj)ects the podophyllous tissue, to the increase of vital activity, resulting from the inflam- matory condition of the tissue and to the infiltration by fibro- plastic exudation, resulting from the inflammation. As to the keraphyllous laminae, they rejDeat on the internal face of the wall, in an inverse manner, the disposition of the secreting laminae of the hoof between which they are formed and lodged. These, however, as they increase in extent, unite at their base in the whole of that portion which does not co-operate to theu' union with the podophyllous bands, and then forms a compact mass uniting most frequently with the internal face of the wall. Some- times this mass of yellowish hoof occupies the whole space be- tween the OS pedis and the wall, but, in some cases, it adheres only to the wall, when it forms around the keratogenous tissue, a new wall, also provided with keraphyllous laminae, and there is formed between it and the normal wall that porous, brittle mass, without homogeneity, which fills up the space, which constitutes the seedy toe. The mass thrown between the wall and the os pedis presses upon it ; the anterior face of the bone assumes a vertical direction, and the os pedis presses toward the solar arch on its anterior border at a point situated posterior to that where, in normal feet, this border rests. Notwithstanding its resting power, the wall gives to the effort of the mass interjDosed in front, the form of the foot changes, and then results the change to the oval in the contour of the foot. Under the influence of the dis- placement of the phalanx, not only the flattening and afterward the convexity of the sole and even its perforation results, but the plantar cushion is itself pressed down and crushed between the bone and the frog, which is then generally atrophied. A hoof of new formation is often developed between the sole and the infe- rior face of the phalanx, in order to prevent it from necessarily sinking. This increases the pressure upon the bone and contrib- utes to its atrophy and sometimes to its complete disintegration. DISEASES. 683 But, between the surface of tlie coronary band and the origin of the roof, whose formation is anterior to the himinitis, there may also be a new layer of hoof, more resisting than that which occupies the space between the wall and the podophyllous tissue, which is no more hoof mixed with the fibrinous exudation, but a pseudo-hoof secreted by the coronary band. The fibres of this hoof, however, instead of being rectilinear and growing down in the direction of the old wall, with the fibres of which they are continuous, are, on the contrary, sinuous and nodulated, and dis- posed to take a somewhat horizontal direction. There is often, besides the old wall, a deep horny tumor, a keraphyllocele which grows inside, attempts to replace the soft horn secreted by the podophyllous tissue, and adds to the pressure of the os pedis, by forming a new wedge, more solid and resisting, which produces a displacement of the phalanx, whose anterior face then often be- comes more than vertical. This horny secretion from the coronary band is made evident by a section of a foundered foot, when the cutigeral cavity will be found much enlarged. Guy on, Jr., Hert- wig, and Gourdon remark that the displacement of the os pedis is counterbalanced by the more rapid development of the heels and the projection of the foot forward ; and that thus the phalanx does not sui:)port the weight of the body except by its inferior border only, but preserving nevertheless, its primitive position. It is especially observed that when the foot is completely de- formed, the projection of the wall does not prevent the os pedis from remaining in its normal position. The growth of the hoof from the podophyllous tissue and the coronary band is not easily stppped. The horny masses which are formed continue to increase, and even soon end in uniting. There then remains a thick mass of deformed shape, four or five times thicker than the normal wall, but where the keraphyllous leaves are still noticed, corresponding to the podophyllous laminae, largely developed, and above all, running deeply into the wall of the hoof. The space between the wall and the anterior face of the OS pedis is filled with pus besides the secreted hoof ; the seedy toe, if it existed, disappears. Though the hoof becomes thus much more voluminous than before, the deep parts are not any more in their normal condition, but are lodged in a smaller and smaller sj^ace, and are thus in such a state of compression that they become atrophied. The bone is altered in its texture, as 684 OPEKATIONS ON THE FOOT. Fig. 519.— Changes of Structure of the Os Pedis in old cases of Chronic Laminitla. well as in its form, and becomes denser and more brittle. (Fig. 6ld). One might suppose that as the disease progresses, the os pedis would become pressed backward more and more toward the sole, in consequence of its giving way under the pressure. This, however, is not so. As the old normal walls disappear, the new horn yields to the pressure from forward, the heels rise, the os l^edis resumes its horizontal direction, and the danger of hernia of the bone diminishes, and a hypersecretion of the hoof is even noticed toward the point where the hernia would have taken place, in the middle of the pumiced sole. We have, so far, supj)Osed that chronic laminitis is always manifested by the presence, between the internal face of the wall and the podophyllous surface, of a mass of abnormal hoof. But there are cases, after hemorrhage, and especially after serous exudation, where, instead of it, a cavity is found — a seedy toe. There is also an entire separation between the os pedis and the wall. But the horny production, that of the podophj'llous tissue especially, is not sufficient iu amount to fill up the whole space, there being hoof only upon the podojDhyllous tissue. There is then a sound wall formed, separated from the old one by a vac- uum, which is often filled by a dry mass derived from the blood and serosity, mixed with the horny cells. But more frequently DISEASES. 685 the separation is limited to the height of the poclophyllous tissue, and the wall yet remains adherent to the coronary band, by its cutigeral cavity. The band then continues to produce the ex- ternal wall of the hoof, while the podophyllous produces the abnormal waU, and the seedy toe remains between the two walls. There are cases where the separation, produced by the con- gestion of laminitis, takes place to such an extent, in circumfer- ence or in height, that the hoof loses all its adhesion, except toward the heels ; and then one may see the curious fact of the new generation of an entire new nail within the old one, the for- mer being, so to speak, sequestered in the latter. rV. Differential Diagnosis. — It is possible that, notwith- standing its distinctly characterized physiognomy, laminitis, of the hind feet especially, may be mistaken for a disease of the sj)inal region. Often, when the founder is light, the hinder parts wag, as in sj)rains of the loins, but the resting of the feet on the heels, their heat and their sensibility, will soon point out the dis- tinction. In more severe cases, the hinder founder may stimu-. late paralysis, especially if the animals cannot or will not raise themselves. Here the history of the case is very useful, and the explorations of the feet will assist in making the diagnosis. "We have seen cases of laminitis behind, where the raising of the foot has been such that it might be taken for springhalt, or even for locomotor ataxy. It may be also taken for tetanus when in mild form, or yet incompletely characterized. V. I^rognosis. — Laminitis is so much more alarming and re- bellious as to treatment, as it is more extensive, more serious, and of longer existence. The most serious cases are those which are due to a constitutional predisposition, and those which follow a general alteration, or are complicated with other diseases. Chronic laminitis is especially serious from the production without separation, and in an excessive measure, of the horny substance. Seedy toe is then less serious, and that which does not extend to the coronary band is sometimes curable by the gradual growth of the hoof; the tumor of the os pedis is the most rebellious to treatment. The destruction of patients is often necessary, from then- inability to walk or to do any work, and that notwithstanding all treatment they are entirely useless. VI. Etiology. — Laminitis has been attributed to many and the most varied causes, and, among others, has now been ascribed 686 OPEKATIONS ON THE FOOT. to a traumatic origin, consisting of injuries of the foot ; and again, to internal lesions, resulting in the inflammatory process which is characteristic of the affection. The external traumatic injuries, which it is claimed are those chiefly instrumental, are, on the contrary, of very rare occurrence as causes of the disease. Our observations agree with those of H. Bouley, and if there is a traumatic causation for this disease, or, at least, one identical with it in respect to symptoms and primitive lesions, it is, nevertheless, certain that its progress is very different ; there is found with it an evident tendency to suj)- puration instead of exudation, and there is no such formation as the chronic process which is found when laminitis is due to an internal phlegmasia. It has been said in reference to the action of the heated shoe uj)on the hoof, the percussion of the blacksmith's hammer and the pressiure of the shoe and of the nails uj)on the Hving tissues, that all these causes together must, as their sure effect, make the foot tender, and stimulate in its constituting structxu'e, the con- gestion which is the initial phenomenon of founder itself. But this assumption may be successfully contested. But shoeing may produce many forms of lameness ; never laminitis. It has been said that feet of defective conformation are more commonly af- fected with founder that those which are well formed. This, however, is not so ; feet with contracted heels are no more predis- posed to it than flat feet, as claimed by Girard. Traumatic acci- dents, as blows, injuries and pressure, produced by stones, crush- ing of the feet under heavy weights or under the wheels of a truck, etc., may produce a violent congestion of the reticular tis- sue of the foot, and consequently laminitis. But this founder itself is of too active a character and more complex, perhaps with a natural tendency to suppuration, as we have already said. It must then be considered as varying from laminitis proper, or that form in which the congestion is of a more passive character, or at least internal and somewhat analagous to that which is sometimes observed in the lungs or in the intestines. It might be better described as an "astonishment" {^tonnement) of the foot, as it is sometimes called. Laminitis proper is rarely due to a unique cause, but more properly to a number of circumstances or to an assemblage of various causes by which the horse is at first somewhat indisposed DISEASES. 687 — sick in fact ; and it is only after various general symptoms that the disease localizes itself in the feet, or, as the old phraseology has it, falls in the feet. The most effective cause is too abundant and especially too substantial feeding, which produces plethora by rich blood. It is the use of other grains than oats, as wheat, barley or rye, which especially predisposes to the disease. Latin authors called it hordeatlo (from hordeum, barley), and it is mentioned by Sol- leysel, Garsault, Gaspard de Saunier, and various hippiatrics. Rodet has observed its bad effects in Egypt and in Spain, where animals were fed not only with those grains, but where they received wheat in spike. MHtenberger had observed the same effects dur- ing the war of 1812, in Poland, where the horses were fed with rye. Even in our days laminitis is seen breaking out in the years when feed is scarce and when oats have to be replaced by other grains, as is proved by the observations of Bouley, Verrier, Key, etc. Artificial varieties of fodder also predispose to founder, though less often ; even oats, when given in excess, may produce it (SoUeysel, Blind), and especially if new oats (Hertwig). The influence of seasons cannot be denied, and it is during the summer months that laminitis is more frequent, while it is rare in winter, as well as in the spring and fall. It is to the warm chmates of Spain and Egypt that Rodet attributed, in great part, the frequency of the founder observed in the army horses en- gaged in campaigning in those countries. It has been also attrib- uted to the su.dden checking of the perspiration, and cutaneous chills when the animals are sweating ; a cold bath or the drink- ing of cold water at that moment having also often been consid- ered as occasional causes. The work of the horse greatly influences the development of laminitis. It is more frequent in those which are driven at great speed than in those which work while walking, and especially in whose frame an excess of strength is required, and particularly those which labor on rough and stony ground. It is almost in- evitable if the animal is well fed, and if he is unaccustomed to that kind of work and not trained for it, and most especially if it is during warm weather. This explains why the disease was so frequent among post, diligence and coach horses, especially diu'- ing the period preceding the establishment of railroads, when the expenditure of strength exacted from these unfortunate animals 688 OPERATIONS ON THE FOOT. reached the last limits of possibility. More recently, again, dur- ing the war of 1870-71, when railroad traveling was more or less impeded, laminitis became more common among horses from which an excess of muscular effort was requu'ed. It is a frequent and ver}' serious accident among English race horses (Hering). Laminitis in oxen is due almost exclusively to the fatigue of long journeys and to repeated frictions of the unshod feet ujDon the ground. It was very common before the era of raHroads in animals brought to market. But prolonged rest and inaction also jn-edisj^ose to founder. The disease is frequent in horses making sea voyages. It is not rare to see horses become foundered when they are obliged to stand uj) during several days in consequence of injuries to the ex- tremities, or other pathological conditions, requiring them to be kept in slings. In diseases of the feet which have requii-ed pain- ful operations (toe or quarter cracks, punctiu-ed wounds of the feet, quittor, etc.) it is quite common to see an animal persevere in maintaining the standing jjosition, and too often has the leg corresponding to one first attacked become also affected, leaving both of the anterior or both of the j)osterior ultimately affected in a serious manner. It is common for laminitis to follow intestinal congestions, especially if these result from the administration of a drastic purge, as aloes for example, and this is a very serious form of the disease. Tisserand has seen laminitis of the anterior extremities following j)arturition in mares, and particularly after abortion. Gloag and Smith have observed similar facts. Hertwig says that it sometimes follows rheumatismal affections, especially the acute foi'm. A metastatic laminitis has been seen following diseases of the chest. H. Bouley does not believe in these cases, and thinks the laminitis is the effect of the quadrupedal standing position, or also the feeding with farinaceous substances in too great quantity. At times, founder accompanies malignant fevers, such as anthrax and typhoid attacks, which are always accompanied with a certain alteration of the blood * VII. Treatment. — In acute laminitis all attempts must tend to remove the congestion of the keratogenous apparatus, or at least to abate its intensity, so as to prevent or diminish the seri- ous sequelae that may too often follow. To effect this, general or 689 local bleedings have been specially recommended, with antiphlo- gistic aj)pHcations upon the congested regions. General bleeding at the jugular is especially indicated; a large bleeding of from five to ten litres, repeated if the pulse or the condition of the dis- ease indicates it. Local bleeding, often recommended, seems to us, generally speaking, to be useless ; that of the toe is of difficult performance in founder, as the feet are usually raised from the ground with difficulty, and the operation is quite painful, and may give rise to more or less serious complications. However, in serious cases it can be done while the animal is thrown down, not so much on account of the blood depletion as to prevent the pos- sibility of gangrene supervening. It is more useful in the ox, according to Lafosse, who recommends to pare the foot down to the quick and to put on the shoe again if the animal has to con- tinue its journey. The topical applications employed are varied and numerous ; the simplest and most practical is cold water, cold baths at half the leg (Fig. 520) ; take in running water, if it can be done, and if the animal stands up; walking in the water is then recom- mended, if practicable, walking increasing the venous circulation of the part. Instead of running water, ponds, marshy grounds, pools of stagnant water, or even Uquid manure may serve the same purpose. In establishments where horses are numerous, there are special tubs where the water is constantly changed. The animal may be placed in some of these, up to his fetlock, in an astringent solution. Mathew has in- vented an apparatus for continued irriga- figs. 520. tion, consisting of a reservoir of water ele vated above the body of the animal ; around each coronet is placed, in shape of a bracket, a tube of india rubber, perforated with holes opening on the hoof ; from the reservoir rvins a tube which bifur- cates and furnishes to each leg a descending division connected with the bracket (Fig. 521). The water is then allowed to run around the coronet and drip over the foot. Instead of simple water, the use of snow or broken ice has been recommended, wrapped in cloth round the hoof ; pads of oakum dipped in solu- Local Cold Douch Application. 690 OPEEATIONS ON THE FOOT. Fig. 521.— Apparatus of Mathew for Cold Water Application. tion of salt, sulphate of iron, or alum ; clay poultices mixed with vinegar have also been used. As the heat of the foot has a ten- dency to rise, the temperature of the liquid or of the topic used must be often changed in order to keep up its antiphlogistic ef- fect. Baths of sulphate of iron are especially indicated in cases of traumatism. Irritating frictions, used as derivatives, are also recommended, but their efficacy in this case is at least problematical. Irritation, when the congestion is somewhat passive, is not easy to produce. However, frictions of the hock with oil of turpentine, by the pain they produce stimulating the animal to move and not allowing him to remain in a state of almost complete immobility, may be advantageous. Blisters around the coronet are useful toward the third or fourth day, when plastic exudation or hypersecretion of the hoof are to be feared. Frog seton is recommended by English practitioners ; Gabriel says it is a sure means to prevent the separation of the nail. This seems to us unwarranted. Internally, the administration of ni- tre, cream of tartar, ammoniacal salts, sulphate of soda, are given ; drugs which are indicated by the febril state ; alkaline remedies, and principally of nitrate of potash in large doses, are administered to render the blood more fluid and increase the venous circulation. Aloes, recommended in England by Hertwig, are contra-indicated, as increasing the disease and facilitating the dropping of the foot. DISEASES. 691 It has been advised to take the shoes off. This is not only a difficult operation, on account of the sufferings of the animal, ob- liged to stand upon one leg, but it seems to us useless. Shoeing has not the effect supposed of it in the etiology. If it is well fitted it is not uncomfortable to the foot, while its removal from the foot, hy the hammering it requu'es, is always painful, and had better be avoided. It has been recommended to pare the foot, to shorten it, to thin the sole down ; but this operation seems to us in many cases superfluous. It is true that the topics will act more readily upon the living tissues underneath, but the advantages thus obtained do not compensate for the difficulty of the operation; at any rate, it cannot be done' except when the animal lies down. We shall pass silently the effect, so to speak homeopathic, that English veterinarians pretend to obtain with very warm poultices around the foot, and which have their reasons only when suppuration or gangrene is threatening. Neither shall we refer to the compression of the foot, recommended by Nanzio — a treat- ment which is much nicer in theory than in practice. In a great number of cases, the patient is considerably relieved by resting on a good bed, and this is especially necessary for severe laminitis when locomotion is very painful. However, in less serious cases, walking on soft ground, especially on grass, is an excellent treat- ment. It stimulates the circulation in parts where the blood has a tendency to accumulate, and controls the venous engorgement of the keratogenous tissue. It has been sometimes recommended to support the animal in slings to relieve him ; but as with this one would expose his patient to pulmonary complication, it is bet- ter to cast him and keep him in that forced position, being careful to turn him over from time to time. A dietetic regime, light feeding, during the first days at least, cooling drinks, rectal injections and comfortable blankets are all indicated. One must particularly watch what takes place in the foot, and for this purpose grooves made at the surface of the foot have also been recommended; but they cannot be made deep enough, as the wall is always there resisting more or less to the eccentric forces of the deep parts. If toward the third or fourth day there is no marked improve- ment, especially in traumatic founder, if even the patient becomes 692 OPERATIONS ON THE FOOT. worse, if the pulsation at the digital arteries is stronger, harder and more frequent, it becomes necessary at once to thin the sole down, and make a puncture upon the Une of demarcation of the sole and wall with the drawing knife. Often then a flow of pus or blood, more or less altered, takes place, the nature of which in- dicates the progress of the disease. If it is of a grey blackish color, it is evidence that the homy tissue only is affected ; while if white, it indicates a greater change. Hertwig advises this opera- tion always, when laminitis is of long duration. He thus pro- duces an artificial seedy toe, which is considered the mildest form of the disease. He recommends to make a deep groove upon this white line so far as there is separation of the wall from the podo- phyllous tissue, and then combines the treatment with the use of astringent baths of suljohate of copper. We have, on several oc- casions, been pleased with this treatment, combining it with the application of a blister around the coronet. It is preferable to the longitudinal grooves, or to trephining, which is sometimes recommended. There are numerous cases, however, when, notwithstanding all these rational means, the disease cannot be arrested, and when a fatally chronic laminitis ensues. This must be considered incur- able in the majority of cases. It is almost impossible to bring the foot back to its physiological condition, and, above all, to pre- vent the hypersecretion of the hoof which characterizes it. However, in case of simple seedy toe, if it is the result of hemorrhage, or even of suppuration, a cure may sometime be ob- tained. Generally, by thinning it down, the entire portion of the wall which, at the toe, the mammae and the anterior part of the quarters is superposed, to the keraphyllous hoof, without adhering to it, is removed. The keraphyllous hoof, also, is thinned down in its whole extent ; then a dressing of hoof ointment or tar is ap- plied so as to protect it from drying and to keep it supj^le. In these cases, the hoof coming down from the coronary band has sometimes united with that flowing over the podophjdloiis laminae. At other times the seedy toe is only cleaned of its contents, and is filled with medicated oakum, if there is a wound of the j)odo- phyllous tissue, or with hoof ointment and Venice turpentine, the whole being kept in place by a wide web shoe. The last treat- ment seems to us the best, only instead of hoof ointment we em- ploy gutta percha, melted with gum ammoniac, as recommended DISEASES. t)93 by Defays. For this there must be uo wound, and the ca\dty must be well cleaned of all substances, or even washed with ether to remove all greasy substances which would prevent the gutta percha from adhesion with the hoof. This course has enabled us to see deep seedy toes recover by the gradual growth of the foot. Hence, the indication to try to obtain an artificial seedy toe as early as possible, as recommended by Her twig. AVhen there is thickening of the keraphyllous horn and adhes- ion with the wall ; when, also, the toe is formed entirely by a de- formed horny mass, the case is more serious and the treatment more uncertain. It has been recommended, wrongly, we believe, to perform the operation which consists in cutting off all the pro- truding hoof — to even cut off all the accidental production. To do this the rasp and drawing-knife are used, the keraphyllous mass being thrown down as much as possible. D'Arboval has also ad- vised to make with the drawing-knife an artificial seedy toe be- tween the internal face of the wall proper, which is preserved, and the anterior face of the podophyllous apparatus, upon which a thin layer is left. This treatment has an advantage over the other of keeping the wall intact, to render easier and more solid the application of the shoe which is to protect the foot and allow the animal to resume his work. This operation, however, is only pal- liative. It, however, gives great relief, especially in the first steps of chronic laminitis. Gross has been satisfied with thinning down with the rasp the suj^erior part of the wall, below the coronet, in a width of about four centimeters, in such a way that from one heel to the other there was only a very thin coat^ which he protected with basilicon ointment. The coronet was then stimulated with a little oil of cantharides. Under this treatment, a new growth of hoof is started, not so protruding, and by paring down by degrees the hoof, a new foot was grown in a few months, less deformed and more regular. Meyer and Gunther say that they have obtained good success with this treatment, which nearly resembles that of Gohier and Dehan, except that with those the entire wall was pared down to a thin pellicle, flexible under the pressure of the finger. Silber- man advised to place around the hoof, below the coronary band, after paring it down thin, a baud of steel, two fingers wide, which could be tightened by a screw placed at the heels. In this way 694 OPERATIONS ON THE FOOT. the secretion of the coronary band was kept under control, but not that of the podophyllous tissue. Generally in these cases the suppleness of the hoof must be kept up by appropriate topics. It must be cut off when too thick, and a shoe must be applied sufficiently wide in the web to protect the anterior part of the sole as far as the point of the frog. This shoe must be quite hollow on the foot surface, so as to avoid any pressure upon the sole. It must be nailed on principally at the heels, as nails at the toe would not hold sufficiently. Between the shoe and the foot a piece of gutta percha, or felt or leather may be put on. Thus shod, a horse will still do long service, even in cities, and much more in the country. When there is a wound at the sole, with separation of the part, suppuration, caries of the os pedis, which protrudes through the sole, it is advised to have recourse to a surgical oj)eration. The contents of the abscess under the sole must be evacuated, and the sole thinned down in the entire plantar region. If the bone is carious it is scraped, the necrosed parts are removed, and a proper dressing, kept up by plates under the shoe, is jDut on. There are a few cases where, by this treatment, horses have been enabled to resume their work. Often in chronic laminitis when, notwithstanding the opera- tion and the shoeing, the horse is unable to resume his work, ac- cording to H. Bouley, the operation of neurotomy will then be beneficial. Grad is not of the same opinion. He claims that the relief is then uncertain and only temporary. Jessen and Hering say that this operation is followed very often by the sloughing of the hoof, and the animals stumble very easily. According to Braull this operation is followed by a greater growth of the hoof. If the lameness is reduced after the operation the deformity of the foot continues to increase. Navicular Disease. Synonyms. — Chronische Hufgenklahme, German; Maladie Namculaire, French. This disease, called by Loisel and H. 'S>ovl- \e^, j)odosesmnoideal synovitis (synovite podosesamoidienne) ; by Braull, chronic podotrochlitis, is an inflammation of the sesamoid sheath of the horse, that Turner and some other English veterin- arians were the first to describe, and which is mostly observed in thoroughbreds. DISEASES. 695 The disease is i^rincipally seen in the fore feet, and more com- monly in one foot alone ; sometimes, however, both legs are affected, one first, and the other following. Navicular disease of the hind feet is seldom observed. It is accompanied with lameness and deformity of the foot, and often proves rebeUious to treatment. It is followed by con- traction of the heels {encastelure) which is itself often mistaken for navicular disease. At any rate, the affections are nearly re- lated, whether the disease of the sesamoid sheath, first occurring, is followed by the contraction, or that the hoof, originally con- tracted, gives rise to the subsequent alterations of structure which constitute navicularthritis. At present we shall only con- sider the deep inflammation of the podosesamoideal articulation, occurring without primitive alteration in the form of the foot. I. Symjytoms. — These are at first obscure. The lesion is deeply situated, and is, so to speak, concealed in the hoof, which itself, is generally at first of very hmited extent. The first symp- tom which attracts attention is the lameness, which sometimes, indeed, seems to be merely a certain weakness of the affected leg. This lameness is at first intermittent and slight, but gradually in- creases. When in the stable, the animal " j)oints," that is, the dis- eased foot is carried forward of a vertical hne, and assunjes a state of general relaxation of the muscles, with the coronet straightened and the foot mostly resting on the toe. This in- complete rest of the leg, which is sometimes kept in motion for- ward and backward, becomes especially apparent if the animal is moved backward in his stall. He then sets down his foot with much hesitation, and for a short time ; the same thing also occurs when, in order to relieve the opposite leg, the animal puts all his weight on the diseased one. Still, a close examination of the foot fails to reveal any marked lesion ; no change of form appearing, no wain at the coronary band; merely a little heat toward the heels, or on the frog, where there can also be found a certain amount of low and deep sensibility, made aj^parent only by per- cussion of the hammer upon the foot, or by the pressure with the blacksmith's nippers, principally toward the heels and the frog. According to Lafosse, the frog is often found indurated, atrophied and thrushy. If exercised, the horse frequently stumbles, and sometimes falls on his knees ; he fears the pain of resting the heels on the ground, and is limited in the movements of his knee OyO OPERATIONS OX THE FOOT. and fetlock. If the heels are pared off, in such a manner that the frog- is well prominent, and the horse becomes much heated, the lameness is increased, although at first it may have been very slight. Blacksmiths may frequently obtain the same result by placing under the foot a bar shoe, which, then resting on the frog, and not the heels, greatly aggravates the lameness until it be- comes excessive. This mode of diagnosis was originally indicated by Brauell : When, after more or less exercise, the animal is left to cool off, he at once points, straightens his fetlock, and slightly flexes the knee; the leg has a trembling motion, and no rest is taken upon the heels. There are, however, according to Hertwig, cases where navicu- lar disease suddenly reaches a period where, in the stable, the animal avoids all resting on the heel ; points constantly, and hes- itates to put his foot on the ground when made to walk. It al- ways seems that there must be some traumatic lesion in the foot, as a punctured wound or a suppurating corn ; and still there is no increased heat in the hoof, and no extraordinary x^ulsation of the arteries of the foot. The disease has a tendency to increase, and the animal soon becomes very lame upon being put to work, especially on a hard road or rough ground. The heat of the foot is increased princi- pally after work, though not in proj)ortion to the lameness. The sensibility of the foot is also more manifest under the exploring pressure of the nippers. In the stable the pointing is well marked, and the trembhng of the leg gives signs of deep and per- sistent pain. It is only after several months of this suffering that the foot begins gradually to show a change of shape. It then be- comes visibly narrowed and elongated, in a manner which can readily be detected both by sight and management. There is a general atrophy of the hoof; the periople has disappeared, or scales off; the foot becomes covered with ridges, more or less marked, but better developed toward the heels ; the frog has be- become sunken and atrophied; the sole is ecchymosed, present- ing evidences of corns ; and the leg is atrophied, esj)ecially about the muscles of the shoulder. In cases where both fore feet are affected, the animal points with either foot alternately, while seeking the desired relief for each, but the rest on either is very short. The hind legs are brought under the centre of gravity, the back is arched, and the DISEASES. 697 decubitus prolonged. In stepping out of the stable, both fore feet are held stiffly, and kept close to the ground, the animal stumbles on his fetlocks, and often falls, and one might suspect him of being weak. In walking, his shoulders seem to be rigidly attached to his body, but as he warms up the legs move more freely and his actions become less limited ; but immediately on cooling off, and especially the day following one of hard work, all the symptoms reappear, with even aggravated intensity. The disease increases steadily with the lapse of time. When one, or what is more rarely the case, both hind feet are affected (Loiset has seen it occur), the animal is stiff behind; he is lame on one or both feet ; he puts his foot on the toe only ; knuckles at the fet- lock; and presently an atrophy of the muscles of the superior regions takes place. II. Progress^ Duration, Termination. — The disease gener- ally maintains a steady progress ; nevertheless it very often un- dergoes a remission, due to the hygienic conditions in which the animal is placed; to the seasons; to the state of the atmosphere, and to other causes. It may diminish in severity, and its symp- toms disapi:»ear, while in its first period, if the animals are left at rest — without shoes if possible — loose in a box, with damp bed- ding, or in a marshy field ; or in winter, during the rainy season, while the atmosphere continues in a moist condition for a long period. It is, under these circumstances, not uncommon to see feet which had become contracted quite recover their natural di- mensions. Aside from these exceptional cases of recovery, the lesion keeps on slowly destroying the tissues where it exists ; the lameness remains constant, oi* becomes intermittent for years, sometimes after the animals have become entirel}^ unfit for work There are frequent complications involving the surrounding parts ; sometimes a true arthritis, and besides the complete atro- phy of the muscles of the shoulder, the carpal ligament becomes thickened, the tendon of the perforans undergoes the same alter- ation, and ring-bones and side-bones may follow. Again, how- ever, the animal may become knuckled to such a degree that he can scarcely rest his foot on the ground at all. III. Pathological Anatomy. — As we have said, the disease has its seat in the sjTiovial capsule, formed by the small sesamoid sheath between the navicular bone and the perforans tendon, slid- ing upon it. At first may be observed a certain injection of the byo OPEKATIONS ON THE FOOT, synovia, and a darker hue in the coloration of the trochlear carti- lage with the corresp.onding face of the tendon, the synovia be- coming reddish and thick, the surrounding cellular tissue becom- ing, also, inflamed and infiltrated. At a later jDcriod, when the disease has somewhat progressed, there is a thickening of the walls of the cajjsule, which is then filled with a clear citrine ser- osity. There is then, a kind of hygroma, a chronic dropsical con- dition of the sheath. In the interior of this are also to be found fibrous bands, running from the tendon to the bone. If the dis- ease is older, erosions are found ujDon the diarthrodial surface of the navicular varying in number and in size, and the tendon is roughened on its anterior face with longitudinal fissures. At times, it becomes atrophied and thin, dry and brittle; and has been found, it is said, ruptured transversely. In many cases, the cartilage covering the bone has disappeared and the bone is ex- posed, hollowed and afi"ected with osteoporosis. The union of the bone with the tendon has also been found among the varieties of determination. IV. Diagnosis. — This disease is at first easily mistaken for some form of rheumatic affection. "Where jDain is the main symp- tom it is easily detected, but where there are no other signs of in- flammation, it is just the lack of j)roj)ortion between the intensity of the lameness and the serious sym2:)toms, such as the absence of heat ; of special sensibility ; of pulsations in the digits, which distinguishes navicular disease from other affections of the feet. The error with contracted heels is easier, as here the change of form of the foot being primitive, at once attracts the attention of the practitioner ; while this alteration in the foot is absent in navicularthritis at the outset of the disease. V. Prognosis. — Generally, it is unfavorable, as most com- monly the veterinarian is called only when the disease has already made serious progress and passed into the chronic stage ; and again, because of the difficulty of reaching the disease by reason of its peculiar location. VI. Etiology. — To j)ro23erly understand the etiology of this disease, one must bear in mind the part played by the anterior legs in the action of locomotion. Columns of suj^port more than of impulsion, it is their office to sustain the weight of the body when it is thrown forward by the extension of the hind legs. The reaction of the ground is first felt at the shoulders, through the DISEASES. 699 muscular slings which attach them to the trunk, but it is partly diminished in the scapulo-humeral joint, which closes, notwith- standing the resistance of the muscles implanted on its apex. The remaining force is transmitted to the vertical column, represented by the union of the radius, the carjDus and the metacarpus. Reach- ing the digital region, this force is there decomposed. Part of it, passing on the phalanx, loses itself and disaj^pears in front of the horny box of the foot, the other being thrown uj)on the flexor tendons, and finally upon the perforans, which distributes it to the posterior parts of the foot, and to the navicular bone. It must be observed that in this complex action of decomposition of the shock, the os sesamoid, though pushed from before backward by the OS coronse is, however, supported by the resistance of the per- forans tendon. Consequently, both the bone and the tendon are pressing upon each other, when the feet are placed on the ground, throwing the body forward by the impulse of the hinder parts, and thus press powerfully against each other. When this pressure takes place in an animal going full speed, and a good and high stepper, it may commence by becoming merely a slight confusion, but, if often repeated, the result may be some lesion upon the corresponding surface of the bone and of the tendon, or of the synovial which facilitates their move- ments. But the energy of action in the animal cannot be con- sidered the only producing cause of these lesions, as a vice of conformation in the foot, a want of elasticity in its posterior parts where the resisting power is diminished, may also produce it. The disease, then, is observed in animals whose plantar cushion, covered by a small, dry and atrophied frog, is itself badly devel- oped, from being compressed between the bars, which are more vertical, or the heels, which are more contracted; all these be- ing conditions which diminish the flexibiUty of the back of the foot. Two principal causes, then, co-operate in the genesis of navi- cular disease, and are almost always present in animals thus affected. On the one hand, it will appear among well-bred ani- mals, especially those of English breeds, those from Hanover, Mecklenburg and Normandy, which will be more affected. Loiset and Lafosse, however, have seen it in common breeds, in animals with flat feet and soft horns. Lafosse says he has seen it in mules. But besides this influence of the breed, there is the effect of what 700 OPERATIONS ON THE FOOT. we may denominate tile hygiene of the foot ; the too dry bedding, certain wrong modes of shoeing and all the predisposing causes of contracted heels. Let us add also, as a cause, the effect of changing the animals from marshy fields, where they were walk- ing on soft, damp ground, to stables with dry bedding — a cause commonly present in horses transported from northern Germany to the south. Hard work and excessive exercise are also causes of this affection — for example, jumping fences with a heavy rider, slipping in steeple-chases, racing, a sudden stop on the fore feet, especially on stony, hard, frozen or rough ground. All these are fruitful cases of navicular disease. Traumatic causes, such as punctured wounds, involving the sesamoideal sheath, are also productive causes which may origin- ate navicular disease. We do not believe in internal causes, nor admit, with Loiset, that viscei'al inilammation, sudden arrest of perspii'ation, especially of the lower part of the legs, can produce the disease. We should rather anticipate that these metastases would affect more the more important serous structure. Neither can we admit, with Lafosse, that this affection can also follow a sudden arrest of the milky secretion. VII. Treatment. — We have seen, in speaking of the termina- tions of these lesion, that in certain peculiar circumstances which may be accounted favorable to the return of the elasticity of the foot, a spontaneous recovery is possible. This leads us to the measure of the prophylactic means proper to be used; and it seems evident that by a better hygiene of the feet, by rational shoeing, sometimes educating young horses only gradually to fast work, one may in many cases avoid navicular disease. '\Vhile it is in its first stages, one may, with care and patience, sometimes reheve the patient. In this case, absolute rest is coun- ter-indicated, but on the contrary, moderate exercise, upon even and not too hard ground; or, if the lameness is great, walking exercise only, at a moderate gait. The absorption of the serosity present is made easier by a little exercise than by absolute rest. Bleeding from the toe, or the veins of the affected legs, is also, at least, superfluous, the disease becoming chronic almost at the outset. It is also a good practice to shoe the horse, and above all, to remove the shoe frequently. The best shoeing is that which allows for the natural expansion of the hoof. The Charlier shoe has proved useful, while the bar shoe, which is heavier, and DISEASES. 701 presses upon the frog, is counter-indicated. It is important to en- courage the suppleness of the hoof b}' proper ointment, especially the application of glycerine, and to have vinder the feet a bed- ding always sUghtly damj) and soft. The bedding of moist saw- dust is very convenient ; we prefer it to poultices, and even to the tepid alkaline baths mentioned by Hertwig. At times, at inter- vals of about eight days, and then during two consecutive days, a good friction with blister ointment above the coronet is advan- tageous, as well as one with Lebas' ointment. English practi- tioners prefer salines ; the better treatment would be to turn the animal to grass. Brauell advises iodine internally, and says he has found it work well. Others recommend diuretics. Setons in the shoulder or chest seems to us inexpedient. We prefer the ad- ministration of a purgative ball every eight days. Sewell and Brauell advise a seton, running from the hollow of the coronet through the plantar cushion, a little behind the tendon of the perforans, and within a short distance, therefore, of the diseased capsule, making its exit at the anterior third of the frog. This drain is to be maintained for two, three, and even four weeks ; Sewell, Brauell, Hertwig, and several other veterinarians, English especially, claiming much benefit from it. This seton is intro- duced by means of a curved frog seton-needle ; it has been used but little in France. Bruner has recently proposed the punctui-e of the sesamoideal capsrde with a trochar, introduced into the hollow of the coronet, an operation only practicable if the serous collection can be felt outward. After the puncture, he recommends an injection of iodine. Lafosse proposes after the removal of the sole, the transversal incision of the plantar cushion, with removal of a part of it, down to the tendon, following the axis of the sesamoid; then the cau- terization of the bone and its cartilage, in imitation of what is sometimes done in punctured wounds of the foot. Brauell recom- mended as a usefiil surgical operation, the section of the perforans tendon in the metacarpal region, in order to prevent friction against the sesamoid groove, and to allow an easier adhesion be- tween the tendon and the bone. But it is to be feared that this section, supposing that it proves successful, might so weaken the tendon as to render the animal unfit for fast work. If navicular disease should be accompanied with deviation of the wall, and contraction, true or false, the treatment will be that I i (^ 702 OPERATIONS ON THE FOOT. of this affection in its simple form. An operation, often recom- mended, has been that of neurotomy, upon the posterior branches of the plantar nerves, repeated at intervals of at least fifteen days, in 6rder to remove the lameness wholly, without entirely depriv- ing the foot of the sensibility of feeling. Berger, Brauell, Bou- ley. Gross, Mandel, and others, have obtained real success by it; but it is attended with serious dangers ; at any rate the benefit is not of long duration, or about one year. The animal then stumbles more readily, and is more exposed to traumatic lesions, etc., and it is probable from this cause that double neurotomy is seen to be followed by softening of the deep parts of the foot, suppuration, sloughing of the foot, while the animal has previously shown no signs of pain. Consequently, neurotomy is an operation which finds its appHcation only in peculiar and exceptional cases, and animals thus operated upon remain fit for light work only. Synonyms. — Fesselgeschvmr, German ; giarda, Italian ; gialarrs, Spanish ; javart, French. A name of unknown etymology, by which old hippiatrics desig- nate various affections of the inferior regions of the legs of the horse, donkey and mule, and even of bovines. These possess the common character of a degeneration of a portion of the tissues, that is expelled by the efi'orts of natui-e under the form of a slough {hourhillon). There is a softening of the mortified structures, and an elimination by suppuration. In several old works, these sloughs are called quittors (Javars), and this name has been ex- tended to the disease itself. This name having been preserved by use, notwithstanding the efforts of Vatel in opposition, we shall also employ it, and with Girard, recognize : 1st. The simple or cutaneous quittor, which is only the furuncle which occurs in the thickness of the dermoid structui-e nearest to the coronary band, 2d. The tendinous quit- tor, which greatly resembles the felon of man, where a portion of the sub-cutaneous cellular tissue, and of a tendon sloughs out. 3d. The sub-horny quittor, the furuncle of the cutidura of the coronary band itself, the slough involving the suj)erior portion of laminated tissue. 4th. The cartilaginous quittor, or the limited caries of the lateral fibro-cartUage of the os pedis, and Avhich old writers compounded with the horny quittor. We might join to f ':*vr«%'.,v-^vv 703 those the furuncle of the frog. We believe it useless, at present, to enter upon a general consideration of quittor, and will pro- ceed to examine the pathological phenomena presented by each variety. A. Cutaneous Quittor. — This is a simple furuncle of the coronary region of the foot, in that part of the dermis nearest to the coronary band, having, however, a sj^ecial character on account of the extraordinary thickness and inelasticity of the dermis of the region it occupies, the result being a kind of strangulation of the inflamed tissue beneath, and a very painful compression. It is through error that some authors have designated by the same name, the furuncle of the canon, of the fetlock, and of the co- ronet. The hind feet are more subject to it than the fore, and it is more frequent at the heels, at the flexure of the fetlock, though it is also observed on the sides and front of the coronet, in which case it is much more painful. Cutaneous quittor has also been observed in bovines, where, however, as we shall see as we pro- ceed, it is generally complicated with the tendinous variety, and becomes a true felon. I. Si/niptotns. — Cutaneous quittor is characterized by an in- flammatory tumor or swelling, warm, painful, and tense, of the coronary region of the foot, the color of the skin being but little changed, if it is dark, but if the skin is Hght then the redness is well marked. This swelling is accompanied with a diffused sedema, extending to the fetlock, or even to the hock. We often find angeioleucites, or rather what we call leucophlegmasiae. The lameness is generally extreme, and the animal frequently can scarcely rest on the diseased leg. The pain is sometimes so great as to induce general fever and loss of appetite, and the animal becomes dull and depressed. After acquiring certain dimensions, the tumor shows a tendency to soften at its summit, its base, however, remaining hard for a considerable time. Rising more and more, it soon ulcerates at a point from which flows a small quantity of bloody pus, followed by the appearance of the slough, {bourbillon). An abscess is now formed in the tumor, which, as it opens, carries with it a portion of the skin, sometimes limited, at others measuring from four to ten centimeters, and there is a slough formed of the subcutaneous cellular tissue which separates by the suppuration with the portion of dead skin. This comes 702 OPERATIONS ON THE FOOT. of this affection in its simple form. An operation, often recom- mended, has been that of neurotomy, upon the posterior branches of the plantar nerves, repeated at intervals of at least fifteen days, in 6rder to remove the lameness wholly, without entirely depriv- ing the foot of the sensibility of feeling. Berger, Brauell, Bou- ley, Gross, Mandel, and others, have obtained real success by it; but it is attended with serious dangers ; at any rate the benefit is not of long duration, or about one year. The animal then stumbles more readily, and is more exposed to traumatic lesions, etc., and it is probable from this cause that double neurotomy is seen to be followed by softening of the deep parts of the foot, suppuration, sloughing of the foot, while the animal has previously shown no signs of pain. Consequently, neurotomy is an operation which finds its application only in peculiar and exceptional cases, and animals thus operated upon remain fit for light work only. QUITTOR. Synonyms. — Fesselgesehwur, German ; giarda, Italian ; gialarrs, Spanish ; javart, French. A name of unknown etymology, by which old hippiatrics desig- nate various affections of the inferior regions of the legs of the horse, donkey and mule, and even of bovines. These possess the common character of a degeneration of a portion of the tissues, that is expelled by the efforts of nature under the form of a slough {bourhilloti). There is a softening of the mortified structures, and an elimination by sujopuration. In several old works, these sloughs are called quittors {javars), and this name has been ex- tended to the disease itself. This name having been preserved by use, notwithstanding the efforts of Vatel in opposition, we shall also employ it, and with Gu'ard, recognize : 1st. The simple or cutaneous quittor, which is only the furuncle which occurs in the thickness of the dermoid structm-e nearest to the coronary band. 2d. The tendinous quit- tor, which greatly resembles the felon of man, where a portion of the sub-cutaneous cellular tissue, and of a tendon sloughs out. 3d. The sub-horny quittor, the furuncle of the cutidura of the coronary band itself, the slough involving the superior portion of laminated tissue. 4th. The cartilaginous quittor, or the limited caries of the lateral fibro-cartilage of the os pedis, and which old writers compounded with the horny quittor. We might join to DISEASES. 705 ways more irritating and contains mineral substances, especially lime, alkalines, and salts, and other substances. The gutters of some industrial estabUshments have also a direct irritating action. D'Arboval has observed that the mud of places where mineral springs exist, is more irritating, as also are calcareous soils, where cutaneous quittor is more frequent than in any other. Common, large horses, notwithstanding their thick skins — or, rather on that account and on account of the haii* which covers it — are more commonly affected than private horses. Towing horses are much more exposed to the disease than those otherwise employed. IV. Treatment. — As a first direction, during the course of the treatment it is always a prudent rule not to work the animal and to keep it in the stable, the feet being kept dry on a good bedding. An internal treatment is seldom necessary to control the general symptoms ; if any is required, ordinai-y salines will generally be sufficient. It is necessary to assist the process of suppvu'ation of the abscess by emolients, warm baths, j)Oultices of flaxseed or of marshmallows, with melted lard, api^lied quite warm, or by the application of a mixture of honey and bran or flour. We have ajipUed a coating of blister ointment to the tu- mor, covered with a warm poultice ; the maturing efifect is then very rapid. It is often necessary to lance the tumor to reduce the i^ain and prevent the mortification of ' a large piece of skin. This operation is recommended by D'Ai-boval and H. Bouley, and is sj)ecially indicated when the tumor is much developed. It is then important to incise in the entire thickness of the dermis and to a sufficient length, and if necessary to make severel parallel in- cisions which will give rise to a copious flow of blood. In this Imode, the parts are relieved, the pressure of the tumefaction is reduced and the gangrene diminished, if not entirely prevented. Jt is necessary — and we insist on this point — to incise so deeply •that the tumefied skin is divided in its entire thickness. We have seen blacksmiths thus operate by the introduction of points of cauterization in the summit of the abscess ; but this mode, though facilitating the sloughing of the strangvdated part and reducing the compression, ought not to be preferred to the incision with a sharp instrument — cauterization is more painful. When gangrene exists and the abscess is open, the incision is certainly less efficacious than at the outset, but it is not for that reason useless, as it relieves the pain and prevents excessive com- 706 OPERATIONS ON THE FOOT. pression. We do not by it attempt to loosen the slough, which it is advantageous to have detaching loose itself vs^hen it holds only by its base. If the abscess, once formed, is slow to ulcerate, making a point of cauterization is a good way to stimulate the escape of the matter of the slough. This mode of opening pro- duces in the part an increase of vital action and forms a sore of benign character, which falls off by the effect of the suppuration formed underneath, and which is nearly always followed by a comj^aratively speedy recovery. To obtain this radical cure, it remains to continue the use of the ordinary means to facilitate suppuration and bring on resolution. If the wound is pal^ and covered at the bottom with large granulations, it must be dressed first with basilicon ointment and afterward with alcoholic liquids, as spirits of camphor, tincture of aloes, or simply an aromatic in- fusion; at times, baths of sulphate of iron, with a little siilphate of copper, are indicated ; or, when the wound has become red, the granulations vascular and of healthy character, a simple dressing of cegyptiacum ointment, diluted in vinegar, is enough. If proud flesh develops itself, it must be cut off. It is important to have the wound covered with a protecting dressing, which must be re- newed daily if the suppuration is very abundant, or it may some- times be left on for two days. B. Tendinous Quittok. — Synonym: Hornwurne (Germ.) — It is the nervous quittor of hippiatres, and the analogue of the felon of man. It is again a furuncle, different from the preceding, only because instead of being limited to the skin and subcutane- ous cellular tissue, there is caries of a portion of the tendons (especially the flexors), or of the ligaments of the region, and also, at times, necrosis of the bone with synovitis and arthritis. By extension, though we think, improperly, the name has also been given to the felon of the region of the cannon, while the applica- tion ought to be confined to that of the digital region, situated in the fold of the fetlock. The quittor may be suj)erficial or deep-seated when it affects only the subcutaneous cellular tissue, uniting the skin to the ten- dons, or whei'e the inflammation extends to the phalangeal sheath, and the pus accumulates into it. Differing from cutaneous quit- tor, this form, generally less common, is more frequently seen in the anterior than the posterior extremities. It may also be seen in cattle. DISEASES. 707 I. Symptoms. — The first symptom is an excessive lameness, manifesting itself even where no visible change exists in the af- fected leg. The animal evidently suffers great pain, while his actions do not aid us in locaUzing it accurately, though the foot is always examined as being the probable seat of it, the animal raising it more rapidly than the other from the groxmd, and rest- on it with much caution and hesitation. After from two to five days, a phlegmonous tumor apxaears at the coronet, above the heel. It is extremely warm, and much more painful than that in cutaneous quittor, the hoof and the skin preventing the free de- velopment of the inflammation by strangulating it. The foot almost ceases to rest on the ground, but is flexed and raised from it, feeling in the parts being very painful. The swelling of the leg extends to the fetlock, or to the cannons, and even to the knee. The animal has more or less fever, and when there is a deep quittor, he loses all his appetite, and ordinarily lies down and continues in the recumbent position. Generally, much time is required for the phlegmon to assume the character of an abscess, as the slough, being in this case no longer formed by the cellular tissue, is slower to define itself. This process of suppuration is not so well localized ; there is, on the contrary, a kind of deep abscess, which probably becomes complicated by the resistance opposed to the ulcerative inflamma- tion by the aponeurosis of the sheath and the thickness of the skin. However this may be, it is always very difficult to recog- nize the presence of one or several of these abscesses, even when they form in the subcutaneous cellular tissvie, and so much the more if the purulent gathering is deeply seated. After the opening of the abscess and exfoliation of the slough, either with or without the dropping of a portion of the skin, there does not remain the simple wound of the cutaneous quittor, but on the contrary, a persistent fistula, running down a necrosed point of the tendons or of the fibrous sheaths. At times, almost from the outset, we may observe in the fold of the coronet numer- ous little pimples, which terminate in as many deep fistulse, from which ooze a more or less thick humor, foetid, puriform and bloody. In frequent cases, the disease in unaccompanied with suppuration, and there is a swelling, more or less hard, with a gradual diminution of the j^ain and other inflammatory symptoms. A more frequent complication is the suppurative inflammation of 708 OPEKATIONS ON THE FOOT. the tendinous sheaths, or even of the digital articulations. There may also be a diffused gangrene with separation of the hoof and purulent infiltration under the horny box — periostitis, and caries of the cartilage. This is the deep tendinous quittor in the most severe form. In this last case, especially if there is an accumula- tion of pus in the tendinous sheath, the tumor is very painful, the slightest touch giving rise to the manifestation of extremely acute suffering, the hoof being constantly raised from the groxmd. The fever is violent, there is a complete anorexia, and the exercise of all functions is more or less disturbed. The compulsory resting upon the healthy legs may give rise to swelling of the hocks, and even to laminitis. In cattle, tendinous quittor becomes more painful than in the horse, and is always accompanied by a swelling which may extend to the knee. Rumination stops, and the animal endures great an- gmsh. The slough is followed by a wound of varying depth, which often exposes the diseased articular surfaces of the phalanges. If this remains too long, the pus may affect the interdigital ligament, complicate the disease, and even make it incurable. In this case, the amputation of one of the digits may sometimes be performed. II. Progress, Duration and Termination. — The duration is generally protracted ; the disease often gives rise to chronic lesions difficult to remove. This will be easily understood, if we remem- ber that the region affected is composed, between the skin and the bones, of synovial capsules, ligaments, tendons and aponeu- roses, more or less cellular tissue, and of very strong nervous ramifications. If the disease is not very deeply seated or unilat- eral, complete recovery may be looked for; but if there are chronic lesions, if the articular surfaces become affected; espe- cially if particles of bones are sloughing, if the animal recovers it will be but imperfectly, and it will usually be accompanied by anchylosis of the joint, and diffused gangrene is also a complica- tion to be looked for. in. Diagnosis. — We said at the beginning that tendinous quittor is a very obscm-e disease ; the lameness is very great, but not characteristic ; in proceeding, we referred to the acute local pains at the side of the tendinous cord of the cannon, the inflam- matory swelling, the increase of local pains, and the general reac- tive fever. rV. Prognosis. — It is a very serious disease, on account of DISEASES. 709 the possible complications and bequelae. The loss, or the deform- ity of a phalanx, which are sometimes armng the sequelae of the felon of man, are in him accidents which never give rise to serious comphcations, or are quickly forgotten, while in the horse suck complications are equivalent to the death of the animal. ^ V. J^tiology. — The causes are the same as those of a simple quittor, which is complicated with the tendinous kind; this is also observed after the subcutaneous abscesses, frequently resulting from bruises, or even from punctered wounds. It is most com- monly met with in low-bred horses, and Fisher says that it is more frequent, and less malignant, in young than in adult ani- mals ; according to this writer, it is a common manifestation of distemper. Irritating muds favor its development in the same manner in active as in simple quittor. It often appears without appreciable causes. VI. Treatment. — When tendinous quittor is superficial, it re- quires about the same treatment as the simple kind, except that, in this case, the counter openings must be made early to prevent the sloughs, migrations of the pus and the gangrene. The sur- geon must not forget that the inflammation in this affection must ordinarily terminate by suppuration, and he must bear in mind that there is a possibility of the modification of the inflamed cell- ular tissue, and that the mortified portion of that tissue must slough out, as their presence, too long continued, may be very dangerous. The general indication is to prevent, as much as pos- sible, the accumulation of the pus, an indication which will be best fulfilled by making open^ings for its escape, even before the formation of the abscess. As the tissues which surround the pus are very resisting, nature will not be able, or if so, only with great difficulty, to effect the expulsion of these matters. It is for this reason that it is necessary to assist her operations by making an opening for the escape of the pus and of the slough. Tbe opera- tion is without danger ; but if it is not jjerformed in good time, lesions will be likely to spread, the disease cease to remain a local trouble, and the life of the animal become compromised. It is also more necessary to make an opening when the puru- lent secretion is established, for in this case it is important to avoid delay and to facilitate its escape. A simjDle longitudinal in- cision, four or five centimeters long, is sufficient, when the collec- tion lies immediately under the cutaneous organ. This incision 710 OPERATIONS ON THE FOOT. must involve the whole thickness of the skin, as far as the ten- dons, and should be made in the middle of the coronet region, as near the foot as possible. It gives rise to an abimdant hemor- rhage, which relieves the part, and warm poultices and baths, to accelerate the suppuration, are then indicated. When the product of suppuration has passed in the tendinous sheath, a longitudinal opening of this part towards the most de- pendent points, is indicated. To do this, a canulated directory is introduced to guide the bistoury ; when the incision is made, the pus flows freely, and by this mode the large blood vessels and the various ligaments of the region are avoided in the operation. Notwithstanding the incision, or if the suppuration had already accumulated before it was made, the pus may also accumulate in the pouch formed by the tendinous sheath behind the tendons. It is then very difficult to prevent its collection in those deep joarts, and it may extend to the small sesamoid. It is because the pus cannot run toward the skin that it filtrates along the tendon. It is only by pressure and by injections that the indications presented can be fulfilled. After making free incisions, one may try by pres- sure to remove the pus accumulated between the tendons and their sheaths, following it by cleansing injections, which must be re- peated as often as possible. The wounds which remain after the slough, in the superficial tendinous quittor, and that which follows the opening of the simple or multiple abscesses when it is deeper, are always charac- terized by the presence of fistulas running down to some necrotic spot of the tendons or of their sheaths. For these, an injection is recommended of tincture of aloes, tincture of iodine, and some- times of Villate's solution; lately, dressings with petroleum or phenic acid have been used. Phenicated baths, those of sulphate of iron and lotions of permanganate of potash have also proved useful. At times, when the fistulas are persistent, it is necessary, after enlarging them, to have recourse to actual cauterization -with a pointed cautery introduced, while at a white heat, down to the bottom of the tract. A general dressing of the wound follows, with tincture of aloes, sometimes with egyptiacum. The di*ess- ings should be more or less frequent, according to the quantity of the pus discharged. We must dress it until the wound is entirely healed, and it must, moreover, be carefully watched for fear of another infiltration of pus, or the formation of other fistulas. DISEASES. 711 Superficial cauterization is necessary in order to remove the induration and swellings likely to follow, and to stimulate the resolution. The action of the firing may be stimulated by blister- ing, or by an alterative ointment of iodide of mercm*y, of sulphur, etc. C. SuB-HoKNY QuiTTOR. — This is the inflammation of the su- perior part of the keratogenous apparatus of the cutidura; or even of the superior parts of the sensitive lamina. This quittor is, therefore, located under the horny box, and is more like the cartilaginous kind, which old hippiatrics, and especially Solleysel and Garsault, describe with it. It generally takes place on the quarter, and more seldom at the toe, or at the mammae. Some - times it is observed at the heels, but it is then of small conse- quence. I. Sym.2ytonis. — The lameness is very great. The animal walks on three legs, and there is strong reactive fever, due to the excessive pain — this form of the disease being more painftd than the others, in consequence of the pressure of the horny structure upon the inflamed tissues. At the origin of the nail a warm and very painful tumor is found; the foot is hot and the hairs staring- on the site of the injury. If the disease has existed for some time, there is a separation of the hoof at its origin, due to a sero- purulent exudation, and under the hoof suppuration and mortifi- cation of a more or less extensive portion of the coronary band, or of the laminae will be found. The suppuration which there exudes varies, being in rare instances blackish, as it is usually found in ti'aumatic injuries of the hoof; or, again, it is white and unctuous, with the odor of decaying cheese ; while more commonly it consists of a bloody or greyish matter, mixed with pus. If the mortified portion is not deeply seated, so that the slough can take place readily, the quittor is quite simple, since as soon as it has di-opped off there is a well marked improvement. The pain then ceases almost instantaneously, and the wound at once progresses toward cicatrization. But it is not rare, even when the mortification is somewhat superficial, to find the sub-ungueal suppiu^ation extending so that the matter runs under the hoof, producing at times more or less serious fistida, or a separation of the sensitive and insensitive laminae. Girard says it has been seen to extend downward to the sole, and to separate it from the vel- vety tissue. The deep, sub-horny quittor may be complicated. 712 OPERATIONS ON THE FOOT. forward, with necrosis of the tendon of the extensor muscle; with the inflammation of the joint; with caries of the os pedis, and even to assume the cartilaginous form of the disease by its exten- sion to the cartilages of the foot. After the recovery of the sub-horny quittor, if the coronary band has been mortified in its entire depth, the foot may present permanent longitudinal fissures, or seams, or transversal grooves, presenting evidences of the existence of a cicatricial tissue when the quittor was in progress. II. Prognosis. — The gravity of this quittor dei^ends upon the depth of the disease. "When superficial and affecting only the surface of the tissue, it is easy to cure, but if deeply seated it is more serious, on account of the possibility of complications. III. Etiology. — Bruises and violent blows are the ordinary causes of sub-horny quittor. It is commonly due to overreach- ing, or to the wounds occurring when animals are wearing long caulks, as in winter. The irritating effect of frozen mud has also been admitted as a cause. IV. Treatment. — The sujjerficial quittor requires a simple treatment. Emollient baths and maturating poultices are then indicated. It is a good plan to thin the wall with the rasjD or the sage knife over the whole extent of the furuncular tumor to a height of about two fingers. A comjn-ess of chloroformed oil, while it alleviates the pain, is also indicated to soften the wall. It frequently becomes necessary to puncture the tumor, but we j)refer to cauterize it with a pointed iron, following the cauteriza- tion with a poultice of honey with Venice turpentine or camphor. Some authors recommend astringent baths, as oak bark, or of sulphate of iron. It is often the case that after some interval fol- lowing sloughing of the hoiirhillon, the wound continues to dis- charge a liquid secretion, which is an evidence that there is a ten- dency to accumulation of matter toward the lateral cartilage, or under the wall, in the laminae ; or that there is some carious spot existing. In the first, if probing horizontally, a cavity is de- tected, it is convincing evidence that a cartilaginous quittor is in com-se of development ; in the second case, the pressure and col- lection of the matter increases the inflammation of the laminse, separates the wall, and complicates the disease, necessitating the operation of the suh-ho7-ny quittor. The removal of the portion of the hoof which covers the lesion. DISEASES. 713 must, however, include more than tlie purulent center, so tnat the diseased tissues may be well exposed and the suppurative process detach them readily. This removal, always proportioned to the internal lesions, is made either lengthwise, following the direction of the horny fibres, or crosswise. In that case, it will attack only a portion of the wall toward its point of union with the skin. This latter method, it is true, requires less cutting, but it has sev- eral quite serious objections and often necessitates a second oper- ation. Even in cases where the growth of the granulations can be controlled, and where a good return of the horse is obtained, the horse only recuperates its perfect integrity by the slow growth downward of the waU. In some circumstances the operation is completed by the removal of a portion, or even of the entire mass of the sole, when it is separated from the velvety tissue. The removal of a portion of the wall must be accomplished in the manner which will be indicated for cartilaginous quittor, in carefully avoiding the injury of the coronary band and of the podophyllous tissue. The diseased tissue being exposed, all that is of bad appearance is removed, the carioiis portion being freely taken off. An ordinary' dressing of oakum with diluted alcohol, or any other drug, kept in place with a light shoe or slipper, en- tire or truncated, as the case requires, is then applied. As for all wounds of the foot, the dressing needs only to be changed when the pus accumulated under the oakum, or other peculiar conditions indicate it. It is true that changing the dress- ing is an effective means of cleansing the wound, but it has the inconvenience of also irritating it, and especially at the begin- ning may tend to infeiTupt the natural process of repair. It is of advantage, after the first dressings, to change them as infrequently as possible. In this way hemorrhages, which may always be looked for, are avoided. This is a point of the first importance. It has been proved that even in operations where a jDortion of the wall has been removed, a dressing left on for from fifteen to twenty days without removal, was followed by rapid recovery, the new hoof growing under the oakum without suppuration. It is useless to probe or wipe out the surface of the wound. On the second dressing, that is, after a few days, the parts begin to be covered with numerous white points, which are so many rudi- ments of hoof. These, which at first are soft, white, and isolated, gather together by degrees, and first unite into a thin layer, soft 714 OPERATIONS ON THE FOOT. and yellowish, which becomes hard and thick ; it is the hoof secret- ed by the laminse, which, httle by little, unites with that coming from the coronary band. Excessive granulations or proud flesh are removed in the ordinary way. D. Cartilaginous Quittor. — Hufknorpelfister (German) — {improperly called sub-horny quittor^ by Lafosse, Jr., coronary quittor of Vitet^y^^ro chrondritls of the third phalanx, by Vatei; sub-horny cartilaginous quittor of Girard ; quittor proper of Del- wart). This form of quittor is peculiar to solipeds, they being the only animals which have fibro-cartilage on the os pedis. Fig. 523.— Cartilaginous Apparatus of the Hrrse's Foot, o.— Lateral flbro cartilage. 6.— The superior border, c— Its posterior border, d.— Anterior lateral ligament, e.— Flexor tendons. /.—Extensor tendon. g.—Os pedis. A.— Retrorsal process. These fibro-cartilages (Fig. 523) are two pieces, which, with the plantar cushion, complete the os pedis and form the base of the heels, each representing a piece flattened sidewise, a parallelo- gram in shape, and extending posteriorly to the cofiin bone. Their external face is convex and pierced with foramina for the passage of veins, and slightly overlies the surface of the bone of the foot. It is separated from the skin by a very rich vascular plexus. The internal face, concave, is hollowed by vascular grooves, and covers (forward) the articulation of the foot and the cul-de-sac of the synovial sac which protrudes between the two lateral hgaments of that joint. Downward and backward it is united to the plantar cushion, either by continuity of tissue, as DISEASES. 715 near the inferior border, or by fibrous bands running from one to the other. The superior border, either convex or straight, is thin and separated from the posterior by an obtuse angle in front of which it presents a deep notch for the passage of the blood ves- sels and nerves. The inferior border is attached, forward, to the basilar and retrosal processes of the os pedis. Behind this it re- flects inward, to continue to the inferior face of the plantar cush- ion. The posterior border, obHque, backward and downward, is slightly convex and unites with the preceding. The anterior border, oblique in the same direction, is more intimately united to the anterior lateral ligament of the articulation and can be sepa- rated from it only by artificial dissection. It sends upon this ligament and upon the anterior extensor of the phalanx, a fibrous extension, which unites with that of the opposite side. In their structure, the fibro-cartilages comprehend a mixture of fibrous and cartilaginous tissue, a mixture which is far from being homogeneous and even in the various parts. The more it is examined forward and near the base, the more its substance is seen to resemble that of cartilages proper, being white, flexible, brittle, and homogeneous. Toward its posterior part it loses its character of homogenity, becomes less brittle and presents in its thickness a greater amount of fibrous texture. More posteriorly again, the fibro-cartilaginous structure is more marked. By close attention it seems to show cartilaginous nuclei, isolated, and sur- rounded with an entirely fibrous substance ; and again, at its pos- terior extremity it becomes fibro-greasy with much cellular tissue and unites with the plantar cushion. The vitality of the cartilage is in inverse ratio with its density and consequently is greater in its posterior part than toward the base and its anterior extremity. This fibro-cartilage may easily and more or less completely be- come ossified ; old horses are those which most commonly present this condition, and draught horses are more subject to it than those used to the saddle. It assumes various forms. At times it occupies the entire extent of the cartilage, and at others only at its base ; sometimes the external surface is ossified, while the internal remains in its normal structure ; then again, the ossification exists only anteriorly while the posterior is cartilaginous, and it more rarely happens that the process consists in bony lamellae, which, starting from the base, spread toward various points of its cir- cumference. 716 OPERATIONS ON THE FOOT. These fibro-cartilages are generally more developed in the an- terior than the posterior extremities. They also j)resent, in one foot, this slight difference, that the internal stands a little higher than the external. Cartilaginous quittor is a serious affection, characterized by the partial caries of one of the fibro-cartilages ; it is a partial gan- grene whose character is to slowly spread into the cartilaginous structure upon which it starts. To be treated with success, it re- quires a very regular attendance, and often an operation, which consists in the removal of the cartilage. Sometimes this opera- tion is indispensable, and its study is interesting, especially be- cause, though not as commonly performed as at the beginning of this century, it is one which requires a high degree of surgical skill for its success. I. Symptoms. — A division has been made of an acute and chronic form of this disease. Under the first name, is considered the earlier period of the affection, that in which there is inflam- mation of the cartilage and painful swelling of the part, and when the caries or necrosis of the fibro-cartilage is not yet estabhshed; or if there is a wound, when it does not yet granulate, and the suppuration, if it exists, is very slight. Chronic javart would be that in which the partial and progressive mortification of the fibro-cartilage exists ; for, as Kenault has said, it is the ordinary termination of fibro-chondritis. When free from serious compHcation, the disease is generally accompanied with but little lameness ; sometimes there is almost none, and animals can be kept at work, esj)ecially at a slow gait; but if made to trot, the horse will show lameness. It is especially when the quittor exists in the posterior parts, that the inflamma- tion and the pain are not excessive, because there is then an abundance of soft, fatty tissue. But when the caries is more for- ward, and is situated more deeply, in a point nearer the articular surface, the lesion then affects the fibrous tissues and the pain is greater. It is sometimes excessively acute. Upon the lateral part of the coronet, toward the heels or the quarters, more or less tumefaction appears, more or less painful, according to the duration of the disease, and in this case more or less indurated. In the centre there exists a granulating fistu- lous wound. There are one or several fistulfe (Figs. 524, 525, 526) whose openings show granulations, bleeding easily, their course DISEASES. 717 FIGS s'^'.'STs^^rtnagTnon.Qnlttor. Various Spots of NecrOBlB. 718 OPEKATIONS ON THE FOOT. always forward, running at times in straight lines, at others ir- regularly. The tracts frequently communicate and discharge a granular, serous and thin pus, of pale greyish color, generally odorless, or slightly sanious, containing greenish particles, which are but pieces of diseased fibro-cartilage. The pus dries up on the surface and adheres to the hoof and to the hair, and some- times irritates the surface of the skin. If one of these fistula be- come cicatrized, a fluctuating tumor soon appears, close to it, which rapidly ulcerates, and then gives rise to another fistula. If the disease is quite old, the hoof of the quarter corresponding to the necrosed cartilage, loses its perioplic band, becoming rough, ramy and cracked, and the wall is thickened, because the irritation of the coronary band has stimulated its growth. This change in the condition of the wall varies with the length of time the dis- ease has existed, and consequently, it indicates its duration quite accurately, when one remembers that the hoof grows downward about one centimeter in each month. "When cartilaginous quittor is the sequelae or complication of the suppurative corn, of a punctured wound by a nail of the shoe, or any other affection of the foot, the symptoms proper to these diseases are first observed, though the lameness is greater, and the fistulse of the quittor is evident. Often, however, this, instead of being external and on the coronet, is situated at the in- ferior part of the foot, at the internal face of the inferior border of the wall, upon the sole, and sometimes connected with the wound of some of those affections of the foot. II. Pathological Anatomy. — When one examines the cartil- age affected with the necrosis proper of quittor, he always finds lesions in proportion to the intensity and the age of the disease. It is seldom, however, that the portions of the cartilage which have undergone the green degeneration, constituting the caries, reaches more than one centimeter in extent ; they have the form of a small plate, of a green color, ordinarily elongated, and adhe- rent to the healthy parts of the cartilage by one of its extremities, that which is more forward and the deepest. Others have com- pared it to the green growth of a seed in germination. The points of the fibro-cartilage which are in immediate contact with the carious portion, have also a slightly pale greenish hue. These are already diseased ; there is already a beginning of necrosis ; in the remainder of its extent the exfoliation is separated from the DISEASES. 719 cartilage by a reddish, soft tissue, which also lines the inside of the fistulous tract. This fistula, which extends from the necrosed spot to the skin, is but the hollow tract left by the diseased proc- ess upon the cartilage, while gradually destroying its substance. Always Hned with a pseudo-mucous membrane, by a true pyro- genic apparatus, the fistula is often narrow, sinuous, irregular in its coui'se and extent, especially if the disease is of some standing. Kenault, and after him Lafosse, have mentioned a special al- teration of the fibro-cartilage which is sometimes met, and which Lafosse looks upon as a step toward recovery. It is a softening of the tissue, anatomically characterized by a loss of the consist- ency of the cartilage, resembling the case of the cellular tissue becoming indurated, or that of bones deprived of their earthly salts after soaking in weak acids ; its yellowish color is then char- acteristic. It may be noticed during life, and is recognized by a softening in the region of the cartilage, which then yields, giving easily to the pressure of the finger; besides this,, a probe intro- duced into the fistulous tract readily penetrates into the softenetl substance. But the true way to diagnosticate this change con- sists in raising the coronary band or after thinning the wall ; then one will see and may feel the true nature of the transformation. Lafosse adds that, in presence of this alteration, the removal of the cartilage is no more necessary, for then the cicatrization is readily obtained by stimulating the sloughing of the necrosed tis- sue or by removing it. With cartilaginous quittor there is always plastic infiltration of the cellular tissue surrounding the cartilage. Very often the wall of the synovial capsule of the articulation of the foot is some- what thickened, and in that case there is less risk of injuring it during the operation. — (Key.) III. Progress, Duration and Termination. — Left to itself, the caries of the fibro-cartilage may last for a long time, through difficulty in determining its true nature. Spontaneous cure, how- ever, is not impossible, as Eenault proved it, and as many practi- tioners have seen it, especially in young and healthy subjects, when the disease is mild at its outset and effects parts of the or- gans where the fibrous element predominates, as in the posterior portion of the cartilage. This fortunate result follows the slough- ing of the " bourbillon " which makes its appearance under the shape of a greenish particle. 720 OPERATIONS ON THE FOOT. But, ordinarily, the disease progresses slowly, destroying the cartilage by degrees, and the diseased process ceases only when the caries has reached the ligament of the joint, which it some- times also attacks. The tissue of the fibro-cartilages has not the force of reaction possessed by other inflamed structures, and which is so well marked in cellular tissue. A process of suppura- tion, such as rapidly eliminates the mortified structure, cannot very readily take place in it, and when by natural forces the cari- ous spot is eliminated and pushed outward, the surrounding tis- sues are most commonly already affected. These undergo the same alterations, and are eliminated in the same manner until the entire cartilage is destroyed. This process of caries by repe- tition may last a year. In its progressive stage, the disease may spread to surround- ing parts, such as the os pedis, the plantar aponeurosis, the liga- ment of the joint, or the sesamoid sheath, all of which may be- come the seat of inflammation. They are diagnosticated by the greater pain and more marked lameness, symptoms which are comparatively light in the simple necrosis of the cartilage. Finally, as a possible complication of cartilaginous quittor, one may observe an entire emaciation of the animal, an alteration of the fluids due to a putrid or purulent infection; some authors claim to have even seen glanders and farcy follow it ; this is inad- missible. IV. Diagnosis. — Cartilaginous quittor is recognized only when there is a wound from which escapes the product of the suppuration and of the necrosis. This pus has nothing charac- teristic, notwithstanding what has been said. If it is thinner than that of a simple solution of continuity of the region, or that of simple quittor ; if it is less foetid than that of bony caries, it has, however, of itself some sjiecial characters, varying according to the subject and the degree of the disease, and especially resem- bhng much that of sub-horny quittor. If the escape of the pus is slow, and it is desired to carefully examine it, a simple pad of oakum, kept by a few turns of bandages on the fistulous opening, will, when removed, give a sufficient opportunity to recognize its nature. The probing will often assist in distinguishing the cartilagin- ous from the simple or sub-horny quittor. In these last, the fis- tula is less profound, and does not reach the thickness of the DISEASES. 721 cartilage ; but, as in cartilaginous disease, the fistvila is often sin- uous, it is better to use a soft, flexible instrument, such as a fine probe made of lead. The injection of liquid may take the place of the probing ; injected in a superficial tract, it returns outward directly, while in deeper and irregular fistulae, it will penetrate more readily. The induration of the coronet, the rough and ramy appearance of the hoof of the quarter corresjDOuding to the fis- tula, indicate generally a necrosis of the fibro-cartilage ; these characters are missing in the furuncle. V. Jr*rognosis. — In consequence of the tenacity of the disease, this form of quittor is always serious ; though this gravity has, in our days, greatly diminished, on account of the means of treat- ment now in use, which were unknown some thirty years ago. Now, this affection, which was considered by all hippiatrics as al- most incurable and which more recently was treated by an opera- tion which rendered the animal unfit for work for several months, can in the majority of cases be cured in about fifteen days. The prognosis, however, varies and depends on the comj)lica- tion. "When there is caries of the ligaments, inflammation of the articulation of the foot, or of the sesamoid sheath, the extirpation of the cartilage itself, done with the greatest dexterity, is not even a warranty of recovery. It remedies only the necrosis of the cartilage, but leaves the other diseased processes to progress in such a manner that the animal remains worthless if he has not to succumb to them. The pain is, besides the other signs, one of the most important points to consider : very acute, it is generally a discouraging omen, and points to the existence of serious com- pUcations. VI. Etiology. — Heavy draught horses are more frequently af- fected, on account of their peculiar work. The most common cause is a bruise, a blow, a burn, a prick, any wound exposing the cartilage; it is most common in horses drawing trucks loaded with stones, which may drop on their feet and crush the fibro- cartilage. The same cause exists for horses working in extensive works of buildings, in the construction of railroads, and in the shops of mechanic construction. Owing to these conditions, it is also more common in large cities than in the country, and more frequent in stony and tem- porary roads than in those which are smooth and flat. Flat feet, with low heels, are more exposed than others, as well as those 722 OPERATIONS ON THE FOOT. whose lioofs are soft. Quittor is more frequent in the fore than the hind feet, the fibro-cartilages of the fore feet being more de- veloped and more flexible, and because their heels are generally lower than in the hind legs. In some, it is more common on the internal than the external quarters, while with us, it has been the contrary. It is often a comphcation of suppurative com ; of piinctured wounds of the foot, of canker, of simple and sub-horny quittor, of grease, etc., which are then the determining causes of the disease. VII. Treatment. — "VMien the disease is recent and the quittor acute, and antiphlogistic treatment may be attempted and resolu- tion looked for, baths and emollients are generally beneficial. A good blister has sometimes proved advantageous, and when it is used, hmited suppuration, with the formation of a simple slough, may take place. If necrosis is well established, it is an indication of the neces- sity of a recourse to more energetic treatment, in which case sev- eral measures are recommended, including the actual and poten- tial cautery and the removal of the cartilage. In actual cauterization, the necrosed spot is destroyed by a cautery brought to a white heat, apjplied directly ujDon it, after it has been exposed by a free incision. It is a simple treatment, and one that has been successful in cases of posterior necrosis where much fibrous tissue was diseased, and principally in young and weU-conditioned animals (Lafosse, Sr., Girard, Vatel, Mangin, Kenault). Still, this treatment not only often fails, but may even become a means of irritation of the fibro-cartilage, and cause an extension of the necrosis. (Hurtral, D'Arboval, Lafosse). In our day, this treatment is almost entirely ignored by good practition- ers, and the potential cautery more generally adopted. This had already been employed by hippiatrics. Solleysel principally recommended the use of corrosive sublimate mixed with aloes ; Girard, Barreyre and Bernard also mentioning it. English veterinarians recommended their use very strongly. (White, Blaine, Kiding, etc.). These practitioners all used the sohd caustic, either in the form of trochiscus or in powder, and if they obtained good results, it requii-ed a much longer time than that required in our day by the use of the liquid forms of caustics which are at our command. With the solid form, the action was of limited extent, and scarcely more effective than that obtained DISEASES. 723 by the actual cautery; moreover, they frequently injured the healthy structures by irritating them and increasing the inflam- mation, and thus resulting in serious complications. As we have said, Hquid caustics are largely used to arrest the spread of the caries; they modify the process of decomposition, dry up the suppuration and stimulate the tissues w^ithout injuring the healthy structures. This mode of treatment must be credited to Mariage, who in 1847 established the unfailing efficacy of re- peated injections of Villate's solution; one of sulphate of copper and sulphate of zinc, 64 grammes of each in 1 liter of vinegar, and decomposed by 125 grammes of Goulard's extract. It is really simply a solution in vinegar of acetate of copper and zinc, holding sulphate of lead in suspension. Villate himself had al- ready used his solution with success by injecting it in cartilagin- ous quittor as early as 1829, since which time Burgniet, Verrier, Sr., Collignon and others have recognized the benefit of liquid €Scharotics in the treatment of the same disease. Villate's solu- tion is not a specific, and cartilaginous quittor has been cured by the injection of tincture of sublimate with solution of nitrate of silver (Bernard), with the perchloride of iron, chloride of copper, sulphate of copper and zinc, nitrate of lead, more or less concen- trated mineral acids, and especially the Eabel water (Collignon). It is difiicult to say which is the more useful of these drugs and which has been more successful. Success has also been ob- tained with injections of tincture of iodine, phenic acid and even petroleum. It is less the nature of the drug that insures the ef- fect than the mode of using it. We ought also to say that, ad- vantageous as this mode of treatment is, it is not infallible, though Mariage and others so consider it. It is not to be preferred to the extirpation of the cartilage, an operation which proves suc- cessful when all other means have failed. To obtain a cure by the use of liquid applications it is essen- tial to make injections every day, and even several times daily. These are made with a syringe, carefuUy adapted in resjoect to size, with a small canula. The injection must be pushed well in, but must be allowed to escape freely after coming in contact with all the diseased sui-faces which it is designed to modify. To effect this, it becomes necessary, as the fistulse are sometimes very nar- row, and even irregular, to enlai'ge them, or to make counter openings. Mariage had originally insisted that these jprecautiona 724 OPERATIONS ON THE FOOT. were essential to the success of tlie treatment. H. Bouley and Viseur also strongly insisted upon the same point, viz., that of en- larging the fistula in order that the liquid should not be allowed to remain at the bottom of the fistulous tracts, by which all possi- bility of the extension of the disease from that cause might be avoided. These enlargements of the fistulse, or counter openings, close, however, very rapidly; as a remedy to which, Hivernat has suggested the introduction into the tracts of little wedges of wood pointed like pencils, for the purpose of lacerating the walls of the fistula, followed by the insertion in them of small setons, moist- ened with Villate's solution. Guerrapain introduced a fine meche of oakum, a seton in the tract, by means of a curved needle. If the fistula runs downward its bottom is under the wall, and he thins this down and makes a counter opening through the hoof thus thinned. This seton j)revents the closing of the counter opening, and enables the operator to push through the injection regularly. Other precautions are also necessary. One, especially, is rest. The animal must not be put to work. Lafosse says that these liquid caustics act with regularity and cure with certainty. A bar shoe, not pressing on the diseased quarter, is also useful. Emol- lient poultices are sometimes necessary after the injection, to diminish the irritation. Mariage also recommends them. If the fistula extends under the coronary band, or the podophyllous tis- sue, it becomes necessary to thin, or to remove altogether, the hoof of the diseased quarter. After fifteen days of this treatment, the exfoliation often takes place, and recovery follows. Often, however, twice this length of time is necessary. After the first eight days the pus becomes more abundant, white and laudable ; the tumor softens and dimin- ishes, as the pain subsides. Later, the injections penetrate with greater difficulty, which is a good sign. The injections constantly attack the germ of the disease and leave it without chance to re- form or to spread; the gangrenous structure which develops in the cartilage is changed into an inert substance; the pyogenic membrane of the fistulous tract is stimulated; the process of granulation becomes more rapid ; the wound becomes more and more healthy, and the diseased process ceases. If, however, it continues, the wound changes its character, large granulations develop themselves, and in their center the openings of the fistu- DISEASES. 725 Ions tracts, -vrhicli open on the cartilage, make their appearance. At times the woimd closes ; but, after a short interval, opens again, or another forms at another point. There is then a repetition of the same course of treatment by caustic apphcations — but gener- ally this indicates a complication, and suggests the propriety of an operation. The injections are generally successful, however, and most certainly so if the caries occupies the posterior parts of the cartilage. They may even succeed in the anterior parts, when the animal is young and of good constitution. But if the cartil- age has already become partly ossified, the caustic is irregular in its action, and the result becomes doubtful. If the caries is deep and extensive, and especially if the necrosis extends through and through to a point corresponding to the synovial capsule of the articulation of the last phalanx; or if the necrosis exists on the internal face of the cartilage, where it covers that structure, then the repeated injections of Villate's, or of any other caustic, may be followed by serious complications. An old or comj)licated caries will offer an increased resistance to the treatment by liquid caus- tics, in proportion as there is more or less difficulty in bringing them in dii'ect contact with the necrotic points. The thu-d method of treatment is that of the removal of the cartilage. This operation, first recommended by Lafosse, Sr., in 1754, was often performed by his sou, and may be considered one of the most valuable results of the application of anatomical knowledge to the practice of veterinary surgery. This operation was also performed by Bourgelat and his students, by Girard, Hurtrel, D'Arboval, and was principally studied and described by Renault. In Germany, notwithstanding the writings of Langen- bacher, Dieterichs and Hertwig, it did not meet with approval, and EngHsh veterinarians seldom, if ever, resorted to it. At pres- ent, even in France, it is seldom performed, except in case of fail- ure by the caustic injection treatment, and this is often the case where the disease is situated in the anterior part of the fibro- cartilage, where the cartilaginous tissue predominates, or where the vitality is diminished, and above all, where ossification has taken place. It is an operation of the greatest delicacy, and ac- companied with great risks on account of the proximity of the joint of the foot, and it requires an experienced operator and thorough practitioner to justify a hope of successful results. It consists in the excision, by layers, of the diseased cartilage, and 72G OPERATIONS ON THE FOOT. in avoiding injury to the coronary band, and to the podophyllous tissue, which are essential elements of the organization of the foot. It is also essential to avoid injury of the lateral ligament of the foot joint, which is close to the cartilage, and above all, of the synovial capsule of the joint, which is directly covered by the cartilage. The partial or entire extirpation of the cartilage can be performed. In the first case, only a portion of the necrosed fibro-cartilage is removed. Vatel, Sanstas, Renault, Bell and La- fosse have reported many cases of recovery by this mode of oper- ation, but it is not Ukely to be thoroughly successful, unless in circumstances as favorable as .those accomj)anying the treatment by liquid caustics. It is generally much better when the operation is decided uj^on to perform it by excising the entire structure, and removing all the carious elements. The partial removal is to-day entirely abandoned, and entire extirpation accej^ted as the true and only oj^erative procedure. The best method of performing it is that recommended by Renault and adopted in our colleges. We shall make it the subject of description with all necessary details, and with various modifications as performed by other practitioners ; we shall also offer some observations upon various other modes of performing the operation in question. The ojieration includes two principal steps : first the removal of the part, or the whole of the wall corresponding to the diseased cartilage ; and second, the extirpation of the cartilage itself. The opinions of surgeons vary as to the amount of hoof which should be removed, and the extent of horny tissue to be taken off. In respect to the length of the superior border of the portion requir- ing removal, it is generally agreed that it must extend from the anterior extremity of the cartilage backward, that is, the two pos- terior thirds of the space reaching from the toe to the heels, or one-third of the circumference at the coronary band. But opinion continues divided as to the lower border (Fig. 527). Lafosse, Sr., left it longer than the superior, and made the direction of the division of the groove corresjjond to that of the fibres of the hoof. Lafosse, Jr., accepting the idea of Solleysel and of Dieterichs, did not reach the sole with its groove, and removed only a portion of hoof parallel to the coronary band. Renault prefers crossing the fibres of the hoof with the groove, and brings the lower end of it to one-half the dimensions of the upper border, its groove running backward. Rey considers this to be running too far back and 727 Fig. 537.— Direction the Groove should take to remove the Quarter In the Operation for Cartilaginous Quitter. A £.— According to Lafosse. A C— According to Eey. A D. —According to Renault. A ^.—According to Lafosse and Dietericths. too near the heel, and recommends the groove to be so made that the lower border will have the same length as the upper, and for that reason advises that it be as nearly parallel as j)ossible with the line of the heels. Lafosse, Sr., removes too large a portion of the hoof. Lafosse, Jr., leaves a portion of hoof which not only is useless, but which interferes with certain steps of the operation, when with the double sage knife, the skin is separated from the external surface of the cartilage, and also, when this is removed ; and again, there is a separation between the severed portions of the quarters much greater than occurs in the process of Renault, which, like that of Rey, exposes the entire cartilage, and greatly facilitates the operation. It is to be understood that the foot has been prepared ; that the hair has been clipped over the skin covering the cartilage; that the sole has been pared thin, down to the blood, as well as the bar corresponding to the diseased cartilage, so that the quarter has been allowed to project below the sole, to facilitate its aver- sion. The foot has been, moreover, well prepared by two or three days of poulticing, to render the hoof easier to be cut by the in- strument, and the operation easier to j)erform, and therefore shorter in its various steps, beside placing the patient in the best condition for the endurance of so serious an oj)eration. After casting the animal upon a good bed, and fixing the feet, placing a temporary hemostasis, by the use of a strong cord, simi- lar to a tourniquet, around the coronet, a groove is made, using various-sized drawing-knives, running from the anterior angle of the lower border of the cartilage downward to the sole, following 728 OPERATIONS ON THE FOOT. tlie direction recommended by Lafosse, Sr., Eey, or Renault. This groove, made first with the widest, and finished with the narrow- est of the drawing knives, must not touch the podophyllous tissue, and still must run thi'ough the entu'e thickness of the wall, with- out producing hemorrhage. In this step of the operation, as Girard correctly observes, short cuts of the knife are always bet- ter and quicker than those made by scraping or dragging with the instrument. It is also important to come down to the soft tissue at the coronary band first, and successively downward to the inferior border of the waU, as otherwise, as the instrument is moved from above downward, with a certain amount of force, it might slip and cause a serious division or laceration of the podo- phyllous tissue. The separation is then made of the wall from the sole by another groove, extending from the end of the groove already made, on the quarter, back to the heels. This is done without difficulty, with a smaU drawing-knife, when the foot has been properly prepared. There is, however, one point which usually offers more or less resistance when the quarter is removed. It is that where the wall is continued to the bars. This resistance is sometimes so considerable that if much traction is made, the wall will break more or less in front of the heels, where it is com- paratively thin, and it may consequently become necessary to re. move, by itself, the portion which has remained attached. This little accident, however, can be avoided by ascertauiing certainly before the extraction of the wall is effected, that the continuity of the wall and bars has been cut off. This being the case, the com- plete separation of the wall from the sole is made by running the sharp edges of the double sage knife through the structure of the living tissue underneath. The resection of the quarter can then be proceeded with. For this purpose, a properly constructed lever is carefully in- troduced into the groove before mentioned, at the wall and sole of the foot. The inferior and anteiior angle of the hoof at this point being then carefully raised, an assistant grasps it with the nippers, turns it back and tears it slowly, while the surgeon, with such a motion of the lever as may be necessary, assists in the tearing off of the portion of the quarter requiring removal. If adhesions remain, interfering with this manij)ulation, they are removed by cutting with a sharp instrument. As this separation of the wall reaches about to the coronary band, the separation is very easy, DISEASES. 729 and no fear of lacerating the soft structures need be entertained. Care is necessary at this step, however, to avoid injuring the cor- onai-y band, and the podophyllous tissue ; to prevent which it will be prudent on the part of the assistant to press upon the band as the separation takes place. This being accomplished, the edges of the wound are carefully examined; any projections remaining are removed, and the blood is sponged off. The double sage knife is then carefully plunged, with the convexity turned upward (that is, toward the skin), be- tween the external surface of the cartilage and the internal face of the skin, below the border of the coronary band, and then cai^ried forward and backward, or as required, until the separation of the skin and the cartilage is completed and the external surface of the cartilage is exposed. In moving the instrument backward, it is necessary to be very cautious, especially while carrying the sharp edges downward and inward, in order to avoid injury to the cor- onary band and the skin, of which, however, there can be but little danger, when the knife is carefully held and properly directed. The succeeding step is to separate the skin from the cartilage ; it is to be carefully raised and separated from its attachments under- neath, which is sometimes a process quite difficult to accomplish, as the skin has always become more or less tumefied, and there- fore has lost much of its natural flexibility and suppleness. Some operators, in order to avoid these difficulties, and overlooking the functions of the coronary band, cut it, and remove it, with those portions of the skin which cover the cartilage. Others, more con- servative (Herting, for example) cut it only through the middle, until they reach the superior border of the cartilage, and then, raising the two flaps of the skin, accomplish the same result with less cutting. The destruction of the principal organ of the secretions of the hoof having been involved in the first method, and having now taken place, it can never be restored to a healthy condition, and the animal continues to be exposed to the frequently serious com- plications of "false quarter." By the second method, the produc- tion of a new wall is nearly always accompanied with the forma- tion of a "quarter crack." The recovery is slow in either case, and more or less deformity is likely to follow. It is, then, the better and wiser plan to separate the skin from below, and to avoid the division of the coronary bands or of the teguments. 730 OPERATIONS ON THE FOOT. The next step is the removal of the cartilage altogether. This is done with the single sage knife, held firmly in the hand, either the left or the right, always, however, that corresponding to the side of the heel to be operated upon. Taking a point of rest with the flat of the thumb upon the plantar surface of the foot, the in- strument is pushed between the skin and the cartilage, and the sharp edge turned backward, with a firm rotary motion, down- ward and forward. The detached portion of cartilage is then seized with a pair of bull-dog forcej)s, and brought outward, and the sage knife is brought forward, downward and outward, from under the cartilage. It is a good plan, in order to make more room for working, to raise the skin and coronary band with a blunt tenaculum. The operation should always be commenced at the posterior part, in order to avoid the articular synovial cap- sule, which might be opened if the removal of the cartilage was begun forward. As the operator reaches the anterior part of the cartilage, which is situated almost over this capsule, it is prudent to hold the foot in excessive extension, and thus avoid injury to the capsule. This is an important point to consider in the oper- ation. The sharp instrument being carefully handled, every por- tion of the cartilage is taken ofi", either at once, or better by layers successively, until the whole is removed. It is thus accomplished in three or four pieces. In some instances the anterior portion is cut off by a longitudinal incision, made with a straight bistoury, following the direction of the posterior face of the coronet, the object, in this case, being simply to render the operation easier. The cartilage is thus removed, great care being taken to avoid opening the capsular articular bursse. It is essentially necessary to remove the whole of the diseased tissues, in order to bring the parts into the condition of a simple wound. Still, there need be no alarm if some small portions remain, more fibrous than cartilag- inous, which, deep as they are, may protect the synovial capsules or the ligament ; and moreover, they often slough off by them- selves, with the abundant suppuration which follows. To operate with the greater facility, it is well to have two forms of sage knife, one right and one left-handed, and some of extra strength, with which to remove the larger particles of cartilage, the others being small, thin and light, being adapted to the more careful dissection necessary toward the lateral ligament, and about the synovial bm-sse of the joint. DISEASES. 731 Toward the end of the operation, the surgeon will, with the finger, carefully explore the condition of the parts, to insure him- self that the cartilage is entirely removed ; that the articular syn- ovial sac has been preserved intact; that the ligament of the joint remains -periect, and that the parts are well washed, and ready for the dressings. Although in the absence of possible complications, the operation is now finished, it may yet be followed by some serious sequelae, which we will next consider. The operation may become complicated by a variety of atten- dant and accessory cii^cumstances. Among these are, the opening of the articular capsules; the wounding of the anterior lateral ligament of the articulation ; the ossification of the fibro-cartilage ; caries of the os pedis ; and the alteration of the coronary band and of the reticular tissue. The opening of the articular capsule, either during the oper- ation, or by ulcerative process, is not so serious an accident as it was originally thought to be. Still, however, it requires some at- tention. It only becomes dangerous when the ulceration is ac- companied by serious disorganization, and especially when it is associated with purulent arthritis. (Renault, Hurtrel, D'Arboval, Bernard). It is treated by simple pressure, camphorated jiaste, a little corrosive sublimate mixed with starch, or better, with Egyptiacum ointment. llie toound of the ligaments has also been considered a very serious accident, which, according to Girard, cripples an animal permanently. But Lafosse thinks this an exaggerated notion, and claims to have witnessed the radical recovery of animals after the necrosis and sloughing of the ligament. If ossification of the cartilage is discovered during the opera- tion, the removal of all the unossified portion is first jDroceeded with, in order to prevent a recurrence of the disease. The extir- pation of the osteo-cartilaginous portion is then efi^ected, either with a small drawing-knife, or the gouge, or the bone forceps. The removal is made as far as the ossification is found to be com- plete, the operator making sure that every portion of cartilage is thoroughly destroyed. If the ossification is but partial or irregu- lar, the surgeon must be guided by the condition of the parts. When the entire cartilage has undergone ossification, its suscepti- bility to caries has ceased. When caries of the os pedis exists, the part must be destroyed 732 OPERATIONS ON THE FOOT. with the sage knife, the gouge, or the chisel, according to the existing conditions. But in this case, portions of the reticular structure require removal, of which, however, as little as possible should be destroyed. It may happen that the portion of the coronary hand covering the cartilage may be destroyed, either wholly or in part, either as an effect of the disease, or by accident during the ojoeration. In the first case, if the entire band has been destroyed, there is noth- ing to be done. But in the other case, if any portions of it re- main, care must be taken to insure their preservation, as they may supply the necessary elements for a new, healthy secretion of hoof, and the quarter may grow again, more soUd and less de- formed. If the wound of the coronary band consists merely in a simple division of limited extent, the wisest course will be to at- tempt to obtain union by immediate adhesion, or first intention, by bringing the edges of the incision together and maintaining the contact by careful dressing. "When the alteration of the re- ticidar tissue alone, is present, it is very essential to avoid the ex- cision of the injured laminae. It is, in fact, the better coui'se to avoid wholly the use of sharp instruments, and to leave to the natural process of suppuration the removal of the disorganized jDarts. Renault having observed how their removal interfered with the reparative process, has often left them undisturbed, even when their dark color and softened condition indicated the small- ness of their chance of conservation. The success of the oj^era- tion after a first dressing, has shown the wisdom of the plan of non-interference ; they were found covered with a new layer of yellowish hoof; and D'Arboval has on several occasions observed the same result. The dressing must be methodically and carefully applied. Done well, a dressing greatly assists in the recovery, while many, when badly performed, have been the cause of serious comi^lica- tions, which have greatly hindered the repau-ing process, and of- ten, indeed, rendered a disease inciu'able, which need not have been beyond remedy. In the application of the dressing", two points are important to consider : first, we must dress the subcu- taneous wound, resulting from the separation of the skin and the extraction of the fibro-cartilage ; the other, that of the sub-horny wound, produced by the removal of the portion of the quarter. Both are important, but the second requu'es the greater care, and 733 is more difficult and more important than the former ; any excess in the sanguineous circulation must be prevented, and excessive granulations must be kept under control. The dressing, then, must be somewhat compressive, without being excessively rigid, in order to ob^date possible danger of excessive inflammation ; not too loose or so soft as to allow hemori-hage, or the undue pro- liferation of granulations. It must be both supple and firm, and of an even and uniform px'essiu'e. The proper material is balls of oakum for the subcutaneous wound, and pads of the same mate- rial for the sub-horny, the first being moistened with alcohol, while the others are made dry. It is in question whether we should aim to obtain immediate adhesive union of the wound resulting from the removal of the cartilage, or in other words, whether it is good treatment to in- troduce some material of dressing between the skin and the bot- tom of the wound. Here opinions vary. Our belief is, that this union is by no means easy to secure ; and that the removal of the cartilage, more or less altered, prevents it at various points. Still, we must not raise the skin too much, and choosing a middle course between, only a small, soft ball of oakum is now placed in the deepest part of the wound, or a thin pad is placed between the two parts, sufficient to represent about the natural form of the part, being enough, however, to prevent the immediate reunion from taking place. A Hght, thin shoe having been prepared (Figure 528), adapted to assist the application of the dressing and its holding prop- erly, it is j)ut on with one of its branches cut off short on the side where the operation has been performed, while the other branch projects backward beyond the heel, to support the roUers of the bandage of the dressing. Des- plas had thought to turn up that long branch of the shoe (Fig. 529) in the shape of a hook to assist in . ^'''- 52^--Truncated Shoe for Dressing holding the dressings. This is plicated corn. 734 OPERATIONS ON THE FOOT. Fig. 529.— Desplas' Shoe for Dressing after Operation of Cartilaginous Quittor and Complicated Corns. useless. Some veterinarians leave the animal unshod, but the bandage is more likely to slij) off. The shoe must be put on while the animal is down, and before the application of the dressing. "With some practitioners, that is the moment for the removal of the tourniquet or cord, which had been appHed at the beginning of the operation in order to prevent the bleeding. This is an un- necessary precaution, and only renders the application of the dressing more difl&cult. First, balls of oakum are placed over the coronary band, then, upon the points of union of the preserved wall and of the podophyllous tissue, and then all over the wound. We must endeavor, as Renault says, to give the di'essing a cylin- drical form, or rather, according to Rey, hemispherical, after which the whole is covered with pads and rollers. These must be put on in abundance, the rollers passing over the branch of the shoe on the sound side, and running successively from above down- ward, and generally from before backward (Figs. 530, 531, 532, 533). Flat feet require sjDecial care in dressing, and the fore feet are generally more difficult to dress than the hinder. "When all is finished, the animal has to be watched for several days. Ordi- narily, after the operation, there is abundant hemorrhage, occur- ring within some fifteen minutes, and oozing through the dress- ings. This requires no special attention, and generally ceases spontaneously, or by the pressure of the dressing, or by the use of the cold bath. If the dressing seems to be too tight, and the animal shows signs of acute pain, with strong reactive fever, it is not therefore necessary to remove the dressing, but may be suffi- cient simply to loosen the bandage. The animal should be j^laced in a wide stall, or box, if possible, where he may move freely, and r35 VARIOUS STEPS IN THE APPLICATION OF THE DRESSING AFTER OPERA- TION FOR CARTILAGINOUS QUITTOR. PKt 53^ —id btPl) FiCt 5^3 Dressing ( ompleted. lie down easily ; and lie must be prevented from tearing off the dressing by the application of a neck cradle. A low diet is neces- sary for several days, in some instances mashes being the only food allowed. Still, a good appetite and lively condition are always good signs. The interval of time which should be allowed to elapse be- tween the operation and the removal of the first dressing, should be judged by the amount of pain which the animal seems to suf- fer ; by the temperature of the atmosj^here ; and by the amount of liquid discharge found oozing from the wound and moistening the dressing which covers and protects it. Generally, the dress- ings should be disturbed as late and as seldom as possible. Cir- cumstances will sometimes occur, however, which necessitate their removal earlier, as for example, the extreme heat of the weather; 736 OPERATIONS ON THE FOOT. the extremely offensive odor proceeding from the diseased parts; and a sudden and evident increase of pain in the wound, without any known cause. Under these circumstances, which, however, are of rather infrequent occurrence, it is sometimes necessary to remove the dressing as early as the third day, although at this time, as suppuration is not yet well established, the operation is quite painful, and may be accompanied by free hemorrhage. But if the weather is not excessive; or the di'essing remains di'y on the outside, and matters seem to be generally in good condition, the better course is to wait from eight to ten days, before the dressing is renewed. Indeed, numerous cases are on record when a still longer period has been allowed to elapse, and the re-dress- ing has been deferred to the extent of three weeks, or longer. In any event, great caution must be exercised in the removal of the dressings, and the surgeon should be careful to have all his ap- pliances ready in advance, in order that the wound may be ex- posed to the air for the shortest possible space of time. WTien exposed, the wound should be of a red color, with commencing granulations, and a temporary hoof, soft and whitish in appear- ance, should be visible on the podophyllous tissue. A di-essing is then applied of tincture of aloes, or a weak solution of iodine. At a later period the dressings are changed at intervals of about eight days, and an apjihcation is made of pulverized sulphate of copper, in order to facilitate the drying and hardening of the soft hoof. Baths of sulphate of iron, with a small portion of sulphate of copper are of service in promoting and hastening the cicatriza- tion. About the thirtieth or fortieth day after the extirpation of the cartilage, the animal may be put to Hght work. But three or four months, if not a longer period, must elapse, before it will be safe to task him with heavy labor. Toward the end of the assigned term he should be fitted with a bar shoe, shortened on the side where the qviittor has existed. If the dressing is skillfully appUed and proper care is exercised, the diseased foot may be sufficiently protected, and the animal made to resume his work with safety. In time, the jDortion of hoof secreted by the coronary band unites with that of the podophyllous tissue, and after a few months, no remains of the operation are visible. But if the cor- onary band has ulcerated; if the skin has been divided; if by contact of the firing iron, or application of caustics, it has been DISEASES. 737 ■destroyed; the quarter then presents irregularities, and some- times divisions, which may be of long continuance, and give rise to a lameness which may, perhaps, become permanent. This danger indicates the necessity of exercising the utmost skill and caution in operating, in order to avoid possible injuries to the coronary band. Several modifications of the ordinary mode of operation have been proposed. Some have had for their principal object, the prevention of the extraction of the hoof, with a view of thus re- turning the animals to their work at the earhest period practic- able. It is thus that Hazard, Jr., proposed to make a crucial incision upon the skin covering the fibro-cartilage ; the four flaps being so dissected as to expose it, and then removing it with the sage knife. In this process, the extirpation of the entire cartilage becomes extremely difficult without inflicting injury upon the lat- eral hgaments and the synovial capsules. Pagnier has proposed to merely thin down the quarter, to make an incision in the skin along the superior border of the car- tilage, and through this to remove the organ. But in this opera- tion, however thin the hoof may be, it always interferes with the entire extirpation of the cartilage. Bernard, following the idea of Lafosse junior, who only re- moved the superior border of the wall, proposed a mode of pro- ceeding which is principally useful in cases of separation of the hoof. Instead of removing the band of hoof parallel with the coronary bourrelet, Bernard pared it down with the drawing- knife, the sage-knife, or the rasp, in order to make it as thin as possible, while avoiding the injury to the sensitive laminae. This done, an incision is made along the coronary band, below it, de- stroying its union with the laminse. At this step of the operation, the indications are the same as in the ordinary modus operandi, except that the coronary band being covered with a certain thick- ness of hoof, is less flexible. This, however, is easily removed, as soon as it becomes softened. The remaining steps of the opera- tion are the same as in the ordinary, old way. That is to sa}', the posterior part of the cartilage being well defined, the sage-knife is used in the same manner. In this method, however, as the sage-knife works more flat-wise, there is less danger of wounding the ligaments or the synovial capsules. If any part of the car- tilage remains near these organs, some care must be used in 7db OPERATIONS ON THE FOOT. removing it, and it must be done by degrees, and in very small portions. The advantages of this process are : 1st, the avoidance of ex- tensive wounds, and of the extreme pain produced by the extirpa • tion of the quarter. 2d, to keep the foot shod, and to allow the animal to resume his work as soon as the first pain has subsided, which may occur at quite a considerable interval in advance of the perfect cicatrization of the wound. 3d, to avoid long and fre- quently-repeated dressings. In this method, however, the quarter left intact sometimes in- terferes with the operation, and the excision of the cartilage is more difficult, being only practicable, indeed, in cases where there is a separation of the wall. Maillet has modified the method of Bernard, so that, instead of thinning down the band of hoof, he only appHes the rasp upon the quarter, and thins down with it all that portion which is ex- tirpated in the process of Kenault, and availing himself also, of the drawing and sage-knives. The remaining details of the oper- ation are like those of the ordinary processes. An objection to this mode is that it can be put in practice only in cases where there is already a separation of the wall. It is objectionable from its tendency to weaken the foot too much, by interfering with the firm and solid adjustment of the shoe, as well as retarding its application to the hoof. CHAPTEK XIV. OPERATIONS UPON THE EYE AND EAR. ON THE EYE. Ophthalmology, though it has made appreciable progress in vet- erinary practice within a few years, has not yet reached a position corresponding with that which it occupies in human surgery, and probably will not for years to come, if ever. The difference in value and importance between the functions of the organ of sight in the man and in the horse is too measureless to induce or re- quire an equal amoimt of interest and study in the optical path- ology of the two animals, the haman and the eqviine. It is in- deed, a fact that many of the forms of disease which affect the eye of the horse have not yet been recognized and investigated by students of veterinary medicine. For these reasons the contents of the present chapter will be limited to those affections in which, strictly speaking, special sur- gical interference has been so imperatively needed as to compel the attention of scientific veterinarians, by considerations of both duty and interest. "We shaU consider the subject under two principal divisions, or heads, viz., operations, performed on the accessory, and those pertaining to the essential organs of the ocular apparatus. 1. — Operations Perfoemed on the Accessory Ocular Organs. On the Eyelids. — These constitute the two cutaneo or mu- cous veils, which are situated in front of the organ, and are divided into superior and inferior, uniting at their extremities to form the angles or commissures of the eye. Besides these, there is a pecu- liar apparatus situated on the internal or nasal angle, known as a third eyelid, or menbrana nictitans. This is a small cartilage, thinned out on its free border, continued on its posterior portion with the adipose cushion of the eye, and covering it in front, wiping, as it were, its corneal surface, whenever the ocular globe 740 OPEEATIONS UPON THE EYE AND EAK. is drawn back into the orbital cavity. On the internal commis- sure are found the caruncula lachrynialis, showing on the upper and lower lids the lachrymal puncta, both of which empty into the lachrymal sac, which is itself continuous with the lachrymal canal, and through the lachrymal duct empties at the lower com- missure of the nostril by the lachrymal opening. Among the surgical diseases of the eyehds must be mentioned traumatic lesions, pathological growths, defective congenital con- formations, and specific diseases of their elements. A. — Traumatic Lesions. Bruises of the eyelids are specially common in horses after kicks and blows in that region, and may also be the result of fric- tion and chafing from the harness. If the cause has been severe, oedema of the lid is the result, as well as more or less flow of tears, and, possibly, irritation of the cornea. These accidents are generally of no great severity so long as the globe of the eye re- mains intact, but if this is injured serious complications ensue. The indications of treatment are those of all similar injuries of a local character, consisting of cooling astringents, with local bleeding, which generally bring rapid rehef. B. — Solutions of Continuity. These are very common with all our animals. They are sel- dom simple, but are more commonly complicated with lacerations of the tissues, by naUs, hooks, etc., or even the teeth of other animals. Clean wounds by sharp instruments are rare, and are easier to treat than those having torn and in-egular edges. They may be superficial, and may involve the thickness of the lid alone, but they may also be deep and complicated with wounds of the globe of the eye itself. The condition of the wound in this re- spect is important to know, and should be ascertained as early as possible. The raising of the eye with the elevator palpoebrum (Fig. 534) greatly faciUtates this examination, and the animal sel- dom offers any serious resistance to it. Fig. 534.— Eyelids Elevator. SOLUTIONS OF CONTINUITY. 741 Simple lacerations of the lids commonly lieal without any treat- ment beyond mere cleanliness — a soft sponge and a little clean water. But the application of the pin or twisted suture, in con- nection with antiseptic measures will greatly promote cicatrization by the first intention. Care must be taken to confine the animal's head in such a manner as to prevent him from rubbing the wound until cicatrization is well established. C. — Defective Congenital Conformations. Under this head we shall consider the deviation of the lids, either outwardly or inwardly, from the convex lines of the cornea, with which they should be parallel. A deviation in the growth of the eyelashes, or cihse, is another annoying irregularity of the same region. The outward deviation of the eyelid is called ectro- pion; the inward, entropion. The deviation of the eyelash is known as trichiasis. 1. Ectropion. — The two principal causes of this abnormal condition are an excess of mucous membrane or deficiency of skin. Again, the ectropion depending upon paralysis of the orbic- ularis palpoebrum, is of a different nature. Ectropion occurs more frequently in the lower than in the upper lid When dejaending on a want of skin, it is generally the result of a wound or a burn, or possibly of an abscess, and is a cicatricial ectropion., in which the retraction of the cicatricial tissue has carried the lid with it. Paralytic ectropion is the result of age, and is more or less peculiar to old animals. It may also result from a diseased condi- tion of the conjunctiva, or of some of the organs of the orbital cavity. The treatment of a case of this affection should be modified by the nature of its cause. If it is due to excess in the mucous membrane, the redundancy must be reduced. If caused by want of cutaneous surface, the remedy must be applied to that surface. If a hyphertrophied, mucous membrane is the trouble, astrin- gents, caustics, and scarifications must be emjjloyed ; or even the removal of portions of the conjunctival mucous membrane, with the scissors or the bistoury. If, on the contraiy, the deformity results from the condition of the skin, hUpharoplasty or hlepha- rortapy must be resorted to. The simplest manner of operating consists in amputating a V-shape portion of the eyehd and uniting the edges with stitches. 742 OPERATIONS UPON THE EYE AND EAR. 2. Entropion. — This is a malformation in which the border of the hd is turned inward. "SMiile in an ectropion the skin is in excess, the reverse condition is discovered here, where it is defi- cient. It is often the result of ophthalmic attacks, and it may also follow a loss of substance in the conjunctiva, after ulceration, or the removal of foreign growths. According to JJeblanc and D'Ai'boval it may follow some eruptive fevers, or parasitic dis- eases. In entropion there is an increased flow of tears, abundant muco-purulent secretion, keratitis, which may become ulcerative, and loss of sight. The treatment consists in the excision of all the inverted por- tion of the deformed lid, which is accomplished by raising it from the globe with a forceps, and separating it with a single cut of the curved scissors, the protruding portion being then amputated. The hemorrhage is stopped with cooling lotions. Another mode of operating consists in cutting off only a por- tion of the skin of the lid, and unfolding it by passing the finger under the inverted border. Then a fold of skin is amputated near the free border of the lid, and the edges brought together by twisted pin suture. 3d. The deformity of trichiasis, or abnormal growth of the lashes has been observed by Leblanc in sheep, but in our domestic animals is a rare disease. Amputation of a portion of the skin ; pulling out the eyelashes, followed by cauterization, and extirpation of the free border of the lids, have all been recommended against this abnormality of cutaneous secretion. D. — Pathological Growth and Caries of the Membrana NiCTITANS. Acute inflammation of the third eyehd, either as a symptom of ophthalmia, or resulting from direct traumatism, such as blows, or the presence of foreign bodies, terminating in caries of the constituent cartilage of this delicate organ, or the formation and development of epitheUoma of the mucous membrane, are condi- tions often seen in our domestic animals, principally in horses and dogs. We have often noticed this peculiar affection, so easUy recognized by the presence at the nasal angle of the eye, of granu- lating masses of various sizes, proti'uding at their internal commis- sure of the lids, and over the surface of the cornea, accompanied DISEASES OF THE MEMBRANA NICTITANS. 743 ^th more or less suppuration, lacrymation and ectropion of the lower lid. The epithelial growths, when small, will sometimes disappear under the appHcation of caustics, or can be removed with the ligature, or by direct amputation with fine scissors. In some cases they assume very large dimensions, the mucous membrane becoming more or less ulcerated, and the cartilage itself diseased, and amputation of the entire cartilage becoming necessary. This operation is not of recent origin, having been per- formed, within our knowledge, some years ago, though entirely upon empirical grounds, in tetanic cases, from the fact that the protrusion of the membrana nictitans over the inner side of the external surface of the ocular globe, quite out of its nor- mal position, had often been noticed among the symptoms of lock-jaw. The removal of the '' hawck^'' as the operation was then called, has never, however, for the reasons which were them ac- cepted, become legitimized among the therapeutics of the scien- tific veterinarian. The removal of part, or what is more effectual, of the whole of the membrana nictitans requires three instru- ments, a speculum ocuh, a special forceps, like that of Snellen, and a pair of curved blunt scissors. The animal must be thrown, and the eye being anestheticised with cocaine, and the lids kept well apart with the speculum, the organ, with the mucous membrane which covers it, is drawn out •with the Snellen forceps, and by degrees severed in its continuity. "UTien it is loosened sufficiently to be brought entirely out of the orbital cavity, it is separated with the scissors from all its attach- ments. The adipose mass which was then slightly i)rotruding re- turns to its position and the operation is concluded. There is always a little hemorrhage accompanying the dissec- tion, which, however, is readily subdued by means of a simple compress of cold water. No special subsequent attention is neces- sary. n. — Operations on the Lachrymal Apparatus. A. — On the Caruncula A2yparatus. The caruncula lachrymalis is sometimes the seat of hypertro- phy, as commonly seen in cattle, the vague designation of Encan^ this being given to all such lesions of the caruncula lachrymalis, whatever may be their origin or nature. 744 OPEEATIONS UPON THE EYE AND EAR. It is an affection which is quite frequent in dogs, as the result of localized chronic conjunctivitis. It is characterized by a tume- faction of the organ, more or less developed, pedunculated, pro- truding in the inner commissure of the Hds, and accompanied by lachrymation, caused by the obstruction of the lachrymal punctse. "WTiUe at the outset anodynes and astringent collyria may some- times control its develoj)ment, there are many cases in which its removal by ligature or excision is indicated. Silk is recommended by Leblanc as the best material for a ligature, but elastic thread is in our judgement much to be preferred. Excision is far preferable. The operation is a simple one, con- sisting in merely severing the peduncle with a curved scissors or Fig. 535.— Bistoury for the Excision of the Encanthis. a bistoury (Fig. 535), ad hoc. The comparative abundant hemor- rhage that follows is controlled by cold water applications. The wound which remains is treated on general principles. B. — 071 the Lachrymal Ducts. The occlusion or obliteration of these little canals by foreign bodies, or as the result of inflammation of their mucous membrane, sometimes occurs in horses. Its characteristic symptom is an abundant and continual lachrymation, and it is only by careful examination of the condition of the orifices of the lachrymal punc- tae, that a correct diagnosis can be assm-ed; a thick, muco-puru- lent discharge sometimes oozing from them. Though this diffi- culty often subsides by resolution of the inflammation, or the use of washes and collyria, there are cases where surgical interfer- ence, of the nature of a true catheterism of the duct, veith joossi- bly an enlargement of its canal with the bistoury, cannot be dis- pensed with. The probe of Bowmann (Fig. 536), and the knife of Weber (Fig. 537), answer the purpose very weU. The animal is placed in the decubital position, the grooved probe introduced into the duct, and its wall divided with the knife, guided by the groove of the probe. THE LACHRYMAL APPARATUS. 745 Fig. 536.— Probe of Bowmann. FiG. 537.— Knife of Weber. C. — On the Lachrymal Canal. The obliteration of the lachrymal canal may become necessary in consequence of changes in the structure of its walls, or the pressure made upon it by the surrounding parts. In the first case, it occurs as the result of traumatic lesions, or of inflamma- tion of the mucous membrane, the exudates accompanying it, and the accumulation of thick secretions in the channel of the canal. In the second case, it is due to severe rhinitis, swelHng of the in- flamed mucous membrane of the nasal cavities, polypi, bony growth of any kind, or in cases of dental caries. The symptoms are : Lachrymation, filling up of the canal, its inflammation, and arrest of the flow of the tears through the lachrymal opening at the nose. According to Professor Leclainche, there are four modes of treatment for the relief of this trouble. 1st. Opening of the natural tract and removing the cause of the obstruction. — This is done by the catheterism of the canal by means of fine probes, or by detersive injections forced through the inferior opening in the nostrils; or, again, as practiced by Director Trasbot, by insufflation. 2d. Making an Artificial Tract. — If the point of obliteration is situated near the lower opening of the canal, an artificial open- ing can be made above it. To do this, Leblanc recommends the in- troduction of a whalebone probe through the superior lachrymal opening into the canal until the place of obstruction is reached when a counter opening is made with a fine bistoury through the walls of the canal. Two or three silk threads are then introduced into the new passage between the two openings and left in place for about twenty days. If the obhteration is in the bony portion of the canal, and cannot be overcome with the silver probe, the perforation of the lachrymal bone and an artificial fistula must be made. 746 OPERATIONS UPON THE EYE AND EAR. Neither of these operations is often followed by successful re- sults, although the perforation of the bone enables the tears still to escape in the nasal cavities. The formation of a fistula fur- nishes a channel for the flow of the tears over the lachrymal sur- face of the face. 3d. Ohliteratiofi of the Natural Tract. — The intention of this operation is to effect the entire obUteration of the duct from the lachrymal puncta and the lachrymal duct down. It is obtained by the cauterization of these parts, either alone or inclusive of the obHteration of the lachrymal sac. Tincture of iodine often pro- duces the same effect. As the result of this treatment, the flow of the tears takes place over the face. 4th. JExtirjyation of the Lachrymal Gland. — This is not re- ferred to as a practicable measure, but only because it is some- times mentioned in the way of theorizing. The situation of the gland in our domestic animals renders the operation an impossi- bihty. m. — Operations on the Essential Organs of Sight. On the Globe. — The essential organ of vision, or ocular globe, is a membranous ball, completely closed, and filled with transpar- ent fluids of different densities, and popularly known as the humors (or media) of the eye. This baU, nearly spherical, flattened from backwards in front, has its greater convexity in front, where it is closed by the cornea, a transparent expansion, thick and resisting ; the glass of the eye. Posteriorly, it is composed of three capsular, concentrical sheaths, proceeding from without inward. These are the fibrous sclerotic, the choroid and the retina (Fig. 538). In the cavity of the globe one of these membranes — the cho- roid— throws out, perpendicularly to the great axis of the organ, a septum, the iris., a kind of contractile diaphragm, perforated in its center by the 'pupil. The retina is a membrane of special nature, being an expan- sion of the optic nerve, and performs the function of receiving the impressions of light, and transmitting its impressions and images to the brain. The humors of the eye are three, considered from before back- ward, the most anterior being the aqiieous, the most jjosterior the vitreous, with the crystalline lens in the intermediate position. ON THE ESSENTIAL ORGANS OF SIGHT. 1^7 0 c d- 3- \"\1 ^ Pig. 538.— Theoretical Section of the Horse's Eye. a.— Optic nerve. 6.— Sclerotic, c— Choroid.— rf.—Ketina. «— Cornea. /.— Iris.— ^^.— Ciliary circle (or ligament) and processes given off by the choroid, though repre- sented as isolated from It, in order to indicate their limits more clearly. 1— Insertior of the ciliary processes on the crystalline lens, j.— Crystalline lens, fc— Crystalline capsule. Z.— Vitreous body, ww.— Anterior and posterior chambers, o.— Theoretical indication of the membrane of the aqueous humor. ^'P-— Tarsi. (77— Fibrous m«m- brane of the eyelids, r.— Elevator muscle of the upper eyelid, s s.— Orbicularis muscle of the eyelids. <.— Skin of the eyelids, u —Conjunctiva. ■;;.— Epidermic layer of this membrane covering the cornea, a;.— Posterior rectus muscle, jr.— Superior rectus muscle, z— Inferior rectus muscle, w -Fibrous sheath of the orbit (or orbital mem- brane). To this essential organ are added as accessories, first, a mus- ■cular apparatus, constituted by seven muscles — di posterior straight or retractor, four others, also straight, the superior, inferior, ex- ternal and internal; and two oblique, or rotators, the great and small, or external and internal oblique; second, an adipose pad; thu'd, an apparatus of lubrication, composed of the lachrymal gland and its means of conducting the tears, the product of its secretion, viz., the hygrophthahnic canals, the puncta lachrymalis, the caruncula lachrymalis, the lachrymal ducts, the lachrymal sac, and the lachrymal canal. The whole mass of this apparatus is enclosed in a conical fibrous sac, the ocidar sheath, which forms a membranous lining, as it were, to the orbital cavity, or bony box, which is anteriorly oj^en, except when closed by the eyelids. Our design in the present chapter is to confine our considera- tion entirely to such portions of surgical ophthalmology as are likely to demand the careful and practical attention of the vet- erinarian. 748 OPERATIONS UPON THE EYE AND EAK. A. — The Extraction of Foreign Bodies on the Surface OF the Globe. The presence of a foreign body between the lids and the globe of the eye is just as painful to animals as to man, and may, if allowed to remain, give rise to symptoms of irritation and inflam- mation which, unless promptly relieved, may induce severe attacks of diseases which may compromise the usefulness of the organ. Dust, insects, and small seeds of various kinds may indeed find a lodgment in the eye, and resist the efforts made for their removal, notwithstanding the excited function of the membrana nictitans, or the super-excited flood of tears stimulated by their presence. Immediate removal is the first indication. This may some- times be effected by bringing the lids together and keeping them temporarily closed until the stimulated collection of tears washes out the offending substance. If this fails, cocaine must be apfdied upon the eye, and when its full effect is obtained, careful examination must be made, if necessary, with the assistance of a loup, by everting the lids, in order to bring the entire surface of the cornea into view The irritating body may be wiped out with the finger, a piece of cloth, or a soft camel hair brush, or when the object is hard and angu- lar, as a particle of metal or stone, which has become partly im- bedded in the cornea, the forceps may be necessary. B. — Puncture, or Paracentesis of the Cornea. The object of this operation is to empty the anterior chamber of the eye of its aqueous humor, of a collection of pus, or to effect a release of a living intruder from the cavity of the eye, as, for example, the -pax&sitic ^/ilaria oculi. The operation is simple, but the use of cocaine cannot be omitted. The instruments necessary are a cataract knife, or a lanceolated bistoury (Fig. 539). It is introduced obliquely through the cornea, at a very short distance from the sclerotic, and its in- FlO. 539 —Lanceolated Bistoury. ON THE ESSENTIAL ORGANS OF SIGHT. 7-! 9 troduction of course causes the immediate evacuation of the fluid contained in the anterior chamber, and the dropping or collapsing of the cornea, which assumes a rough and shrunken appearance. In a few hours, however, it resumes its normal condition, the secretion of the humor having taken place, and the wound of the cornea being closed. Compresses of cold water, and the application of a weak solu- tion of atropine will obviate severe symptoms. C. — Staphyloma. This designation applies to a deformity or distension of the cornea, consisting in its protrusion beyond its normal and sym- metrical convexity. It varies in shape, and may be round or pointed. It is very common in dogs, especially in young ones, and if not discovered and attended to in its first stage becomes very rebellious to treatment. If overlooked and neglected ulcera- tion of the cornea and destruction of the eye is certain. Cauterization, with nitrate of silver, the ligature, and complete excision with the scissors are recommended, but the chances of success depend on the length of time it has existed and the size it has attained. D. — Cataract. The opacity of the crystalline lens, or that of its capsule, or that of the humor of Morgagni, or of these three conjointly, pro- duces loss of sight, and for its re-establishment the operation called " of the cataract " is, in some exceptional cases, attempted on horses and dogs. The object in view is the extraction of the opaque lens; its division into fragments that may be resorbed ; or its dislocation from its normal position. It is not often performed in veterinary practice, but successful attempts have been credited to Vatel, La- fosse and others, while still others, as Gohier, Brogniez, H. Le- blanc, Haubner, Hertwig and Hering have reported their results as sometimes successful and sometimes otherwise. The animal is to be placed in the deciibital position, and the dilatation of the pupil is to be obtained by the application of a solution of sulphate of atropia or extract of belladonna. Among the difficulties connected with this operation is the peculiar anatomy of the globe of the eye, which by the action of 750 OPEEATIOXS UPON THE EYE AND EAR. the posterior rectus muscle is drawn back in the orbital cavity, a displacement which not only renders the action of the instruments more difficult, but also stimulates the motion forward, over the cornea, of the membrana nictitans. The immobility of the eye is one of the first points to be secured. There are two ways of securing it, one fixing it from the front, the other from behind. It can also be fixed from the front in two ways — that of Le- blanc and that of Brogniez. Leblanc uses a tricuspid stylet (Fig. 540), which has three branches, two of which are applied on the Pig. 540.— Tricuspid Stylet of Leblanc. sclerotic at the internal angle of the eye, the third, which is mov- able, resting also on the same membrane at its inferior part. The first two keeps the membrana nictitans from the cornea, and all three, implanted into the sclerotic, keep the globe immovable. Brogniez uses a special instrument, which he calls a "diapta- tor" (Fig. 541), which is a metallic rod, having three or fom' Fig. 341.— Brogniez Diaptator. points, twisted like those of a cork-screw, which by a shght pressure, combined with a little twist of the instrument, com- pletely fixes the ocular globe. To fix the globe from behind, Hayne, Dieterichs, Prinz and Bleiweiss make an incision through the skin behind the orbital arch, and an assistant, with one of his fingers passed thi'ough it, keeps it in place by du^ect pressure. General anesthesia is always indicated. Peuch and Toussaint recommend the use of the Waldon forceps (Fig. 542) to immobil- FlG. 542.— Forceps of Waldon. ON THE ESSENTIAL ORGANS OF SIGHT. 761 ize the eye. It operates by grasping the conjunctiva on the inner angle of the organ, and keeping it motionless by a shght pres- sure. The lids are kept widely separated by means of the specu- lum ocuH already mentioned. There are three principal modes of operation besides these, which are used in human surgery, which result in the union of these priucipal methods. 1st. Method. Dislocation of the Lens. — It is intended to displace the cataract en masse from the pupHar focus, and to fix it in a dependent part of the chamber, behind the iris, where it will no longer intercept the light. It is generally performed in two ways — through a puncture of the sclerotic (Scleroticonyxis), or by puncture through the cornea (Keratonyxis). The instrument used is called Scarpa's needle (Fig. 543). This is either straight or curved. The eye being fixed, Fig. 543.— Scarpa's Needles. and the pupil dilated, the needle is introduced through the scle- rotic, on the outside, and lower part of the globe, a short distance back of the cornea (Fig. 544), pushing it in a direction first sHghtly obliquely upward, and then horizontally. The needle has thus Fig. 544.— Operation of Cataract by Displacpment of the Lens 752 OPEEATIOKS rPOK THE EYE AND EAR. penetrated between the ciliary processes and the border of the lens, and presently becomes visible to the operator, passing be- yond the internal border of the pupil. By a sHght motion up- ward and downward, the capsule is then opened and the lens depressed, first backward, then yertically, and pushed downwai-d into the lower part of the yitreous humor. A gentle rotation of the instrument then releases it from the substance of the lens, and it is returned to its horizontal position. The instrument is not withdrawn until it is ascertained that the lens is estabHshed in its new position. "When the puncture is made through the cornea the entrance into the eye takes place near the center of this membrane, and the access to the lens takes place through the opening of the pupil. In either case the wound of the globe is insignificant. 2d. Method. Extraction. — There are two principal modes of Ci^eration, one by extraction through a tiap of the cornea upward, and another by a linear incision on the side of the globe. In the operation by the fiap iqncard, the knife of Eichter, modified by Beer (Fig. 545), is introduced horizontally through Fig. 545.-Knife of Beers. the cornea, near the sclerotic border, a little aboye the horizontal diameter of the globe, with the edge turned upward, and as soon as the point of the instrument has entered the anterior chamber of the eye, it is pushed in a straight, horizontal direction, passing into the anterior chamber (Fig. 546), and when its point reaches the opposite side of the cornea, it is pushed through it in such a manner that its exit and its entrance occur at equal distances from the sclerotic border. The flap is comjDleted by pushing the instrument directly out, when the aqueous humor escapes, and the cornea collapses. The anterior waU of the crystalline coyer is then divided with the kystitome (Fig. 547). The hook of which turns backwai'd, and is made to tear the envelope by moving it from above down- ward and from within outward. The upper lid being raised with forceps, and a gentle pressure made with the finger at the lower ON THE ESSENTIAL ORGANS OF SIGHT. 753 Fig. 546.— Operation of the Cataract by Flap Upward. Fig. &47.— Kystitome. border of the cornea, the lens presently falls out through the in- cision. If it becomes engaged in the wound it can be removed with the forceps or the curette of the kystitome. Unless care is taken at this point to avoid making too great a pressure upon the eye, there is danger of the escape of the ^^[treous humor. The Uds are then brought together and a light bandage appUed, and as in other cases, the animal must be prevented from disturbing the wound by inibbing or otherwise. The linear method consists in making a straight incision on the outside border of the cornea with the knife of Graafe (Fig. 548). It is principally employed in cases of soft cataract. Fia. 548.— Knife of Graafe. 754: OPERATIONS UPON THE EYE AND EAR. E. — Amputation or Extirpation of the Eye. This operation is only indicated in cases of degeneration of the globe, and after special traumatic lesions of the organ. It is comparatively a simjDle one, and not as dangerous nor as painful as it is generally supposed to be. It can easily be performed with a simple or a blunt bistoury. Hertwig recommends a sage- knife, and we have often performed it with only a pair of curved scissors. With the lids well separated, the eye, or what may remain of it, is secured with a pointed tenaculum, or a pair of forceps, and the conjunctiva divided in all its circumference with the knife. Then passing the bistoury into the orbital cavity, close to its walls, and cutting from the inside, and thence to the inferior part, the entire mass is detached, with the exception only of being held by the cord of the optic nerve. This last attachment is then severed with the scissors. The hemorrhage which always accompanies the operation is readily subdued by pressure. Simple cleanliness is all that is required in the subsequent treatment. Doctor E. Eolland describes his modus operandi for the enu- cleation of the eye as follows: The operation requires a specu- lum oculi, a hook such as is used in the operation for strabismus, curved blunt scissors, forcej)s to fix the eye, and a pair of scissors curved on their flat for the section of the optic nerve. The lids being held apart with the speculum the operator grasps a fold of the conjunctiva, on the outside of the eye, and shts it near the border of the cornea. Then, with the scissors, the conjunctiva is eutu'ely divided round its margin, near the corneal border. The sub-con junctival cellular tissue being after- ward divided with the scissors, the muscles are brought out with the strabismus hook and divided, beginning with the external rectus. The speculum is then removed, and by pressing firmly on both Hds, the globe of the eye is pushed out of the orbital cavity. The curved scissors are passed behind the globe, and the optic nerve amputated at its i)oint of entrance into the globe. The operation ended, the orbital cavity is washed out with cold sterilized water, and is then filled with pulverized and sifted bor- acic acid. This dressing is removed daily for five or six days, and the eye protected as in Fig. 549. ON THE ESSENTIAIi ORGANS OF SIGHT. 755 Fig. 549.— How to Protect the Eye. Ocular Prothesis. The animal which has undergone the preceding operation is considerably deformed, but the difficulty is easily remedied by the insertion of an artificial eye. Artificial eyes for horses were first introduced by Schmidt in 1850. They were originally made of glass, but many varieties of material have since been used, and to-day all instrument-makers probably keep them in stock, of hard rubber and gutta-percha, etc. By the skillful use of pigments the artificial organ can now be made to so closely match its living companion as to be undis- tinguishable from that Avhich the animal has always carried (Figs. 550 and 551). But the artificial organ must not be introduced into the orbital Figs. 550, 551.— Artificial Eye— side and full view. 756 OPEEATIONS UPON THE EYE AND EAK, cavity until all granulations, suppuration and inflammatory proc- esses in and about the wound have ceased. To put the artificial eye in place the upper lid is raised and the the border of the artificial organ placed underneath it ; in the meanwhile the lower lid is drawn downward and the correspond- ing border of the eye jjushed on its internal face. The eye is in place, esjDecially if after its introduction the animal makes a few motions with his lids, all the folds of which are soon removed. To remove the eye the lower lid is drawn downward, and it is dis- lodged by passing a blunt probe under it toward its posterior face. The artificial eye will not need removal of tener than once in eight or ten days. If worn too long there might be danger, with cer- tain materials, of softening. The advantage of having an alter- nate eye will, upon reflection, become obvious. ON THE EAR. Amputation. Usually, only horses and dogs are subjected to this oj)era- tion. With the horse, the object is commonly either the correction of a deformity, or the cui'e of disease or injury. When performed upon the dog, it is principally as an opera- tion of fashion — so-called — or in compliance with some prevalent caprice relating to a supposed improvement in the appearance of the animal. Yet with these it must at times, of course, become necessary for the repair of an accident. It should be understood that the seat of the operation is in aU cases the cartilage of the concha. Amputation in Horses. — The amputation may be either partial or complete. One ear may exceed the other in size, and it may become necessary to trim down the larger for the sake of estab- lishing symmetry between the mismatched pair with the knife. Or both may be similarly misshapen, and a partial amputation of both may be, therefore, indicated, for the same aesthetic reason as that which influenced in the other case. This operation is seldom, if ever, performed at the present time. The comj)lete amputation is indicated in cases where the cartilage is affected with pathological degenerations, and especially when these exist toward its base. AMPUTATION OF THE EAR. 757 Partial amputation may be performed with, the patient in any posture, and may be considerably simplified by using Brog- Figs. 552, 553.— Brognlez Apparatus for Amputation of the Ear. Fig. 554.— Apparatus of Brog- niez in Position. niez's apparatus. This consists of a wooden model of the inside of the cartilage (Fig. 552), and of metallic en- velopes or patterns of the outside (Fig. 553) of which there should be separate ones for each ear. Both the wooden model and the metallic pattern are held in place by a systematic screw (or wood screw) like those usen by cabinet-ma- kers in gluing wooden joints together. The ap- paratus is adjusted as shown in Fig. 554, and the excision of the protruding cartilage is made with the bistoury. Amputation with the nippers of Garsault (Fig. 555), or that with the bistoury do not give equally satisfactory results. Comjilete amputation, according to Peuch and Toussaint, is best performed with the ani- mal under complete anesthesia. We have had opportunities of operating without it, but it cannot be questioned that it furnishes power- ful assistance, when it becomes necessary to keep the head in place, as in this case. ^'^- ^^a^sS^""' °' 758 OPERATIONS UPON THE EYE AND EAR. We consider the operation to be comparatively a simple one, though delicate handling is required. A convex bistoury or scalpel, dissecting and artery forceps and needles and thread are the instruments required. A circular incision is made always, if possible, by one stroke of the knife, toward the base of the cartilage, beginning at about the lower commissure of the external opening of the concha; then carefully avoiding the division of the bifurcation of the parotid gland, the insertion of the muscles attached upon the concha is divided, the posterior and anterior auricular arteries are ligated, the adhesions with the surrounding cellular tissue are lacerated with the handle of the scalpel, and the ligament which unites the concha to the annular cartilage is severed, the little prolongation of the former can then be easily followed to its end, and the con- cha be readily extirpated b}' lacerating its cellular attachments. The wound is closed with sutures, and treated in the usual way. Amputation in Dogs. — Although, as we have remarked, this is principally an operation of fashion, there are still conditions in which it is rationally indicated. It is commonly performed with scissors, curved or straight, with which the required portions of the concha are amputated by a single cut of the instrument. Instruments have been invented to insure a more certain suc- cess in the operation, and a neater finish after the wounds have Fig. 556.— Nippers to Amputate Dogs' Ears. healed. The limitation forceps, rei^resented in Figure 556, pos- sess some advantages in these resjDects. In any mode of operation, the flap of skin first excised be- comes the only true pattern by which to shape the second. The operation is generally followed by some hemorrhage, but this either subsides spontaneously, or by the application of local hemostatics, and the cicatrization proceeds without help under the scab, which after a day or two covers the edges of the wound. CHAPTER XV. DISEASES OF THE WITHERS. The withers is the region of the body which, of all others, is most exposed to lesion, the injuries to which it is subject being of every form, nature and degree of severity. From its very loca- tion it is esiDecially Hable to all kinds of external traumatisms, and is peculiarly apt to suffer from blows, bruises, bites, contusions, pressures and frictions by the harness, etc., and these giVe origin to bloody or serous tumors ; cold and warm oedemas, abscesses superficial or deep, and various wounds of the surface, with or without injuries of the subjacent tissues; and these again may be followed by necrosis of the dorso-cervical ligament, and of the apex of the dorsal vertebrae, accomjDanied with purulent filtrations, in various localities, the formation of fistulous tracts, and possibly the extenston of the diseased conditions to the ligamentum nuchse, ending with the disease of the neck, with all its unfortunate sequelae. With the consideration of such a multiphcity of pathological evils before us, an orderly and systematic arrangement of topics is especially necessary, and we shall, therefore, in our treatment of the diseases of the withers, adopt the classification of Bouley dlid Nocard. And this introduces us successively to the study of excoriations, cedemas, hemato')na, core or stickfasts, cysts, abscesses, wotinds, and the "diseased withers''^ proper, or what is generally understood as "the persisting lesion, fistulous in its character, and whose condition of formation and duration is due to the mortification of the fibrous, yellow or cartilaginous tissue of the ajjex of the spinous processes of the anterior dorsal vertebrae." Considered from an anatomical point of view, the withers form a very complex region. Its skeleton is formed by the superior spinous processes of the anterior dorsal vertebrae, and it is sur- rounded by muscles arranged in layers, intersected by fibrous 760 DISEASES OF THE WITHERS. aponeurotic bands or slieaths. The vertebrae give attachment by the cartilaginous nucleus, which is at their apex, to the pos- terior portion of the yellow, elastic cord, which is part of the funicular portion of the hgamentum nuchae, and are also united by the interspinal ligament. The muscles which rest upon the ver- tebrae form six different planes, thus divided : 1st. The skin, lined inside by cellular tissue, more condensed toward the median line than on the sides, where it is loose ; 2d. The trapezimn muscle, thin and aponeurotic inferiorly, but thicker in its upper portion, Fig. 557.— 1st and 2d Layers of the Eegion of the Withers. P.— Skin folded down, pf.— Funicular portion of the cervical ligament, to. —Cer- vical portion of the trapezium, td.— Dorsal portion of the same, ea.— Acromion spine which is muscular (Fig. 557), and lying over the external surface of the scaj)ula and its cartilage of prolongation. 3d. The rhom- boideus muscle, which is separated from the second plane on its external siu'face by a layer of loose cellular tissue (Fig. 558), and is lined in its internal face, by a yellow elastic band, inserted on the inside face of the cartilage of prolongation of the scapula. DISEASES OF THE WITHEES. 761 Fig. 558.-33 Layer of the Region of the Withers, cb. — Cartilage of the scapula, pf. — Funicular portion of the cervical ligament, rh.— Rhomboideus muscle, a.— Angularis of the scapulse. S.— Splenius. Fig. 559.— 4th Layer of the Withers, sc. — Section of the scapula and surrounding muscles, da. — Anterior small serratus. ap.— Its aponeurosis, gd.— Great serratus. pf.— Funicular portion of the cervical lig- ament, s. — Inferior attachment of the splenius. ad. — Kamiflcations of the dorsal artery, gc. — Gre&t complesus. pc— Small complexus. a. — Section of the angularis BcapulsB. 762 DISEASES OF THE WITHEKS. This band is specially liable to attacks of necrosis. 4tli. The su- perior portion of the anterior small serratus muscle, wliicb is formed by a broad aponeui'osis, attached to the superior extrem- ity of the spinous processes of the vertebrae (Fig. 559). 5th. The Pig. 560.— 5th Layer of the Withers, pi.— Lamellar portion of the cervical ligament, pf.— Funicular portion of the same, ac— Superior cervical artery, te.— Transversal spinous of the neck, bs.— Superior branch of the spinalis, bl.— Inferior branch of the same muscle, ic— Common inter- costal, ad.— Dorsal artery, gd.— Great serratus. si.— Inferior scalenus, it — Inter- transversalis muscle. anterior portion of the iUo-spmalis muscle (Fig. 560). The 6th and the deepest of these planes, resting on the faces of the long spinous processes of the vertebrJB, is formed by the trayisverse spinal muscle of the back. (Fig. 561). To these are to be added the posterior extremities of some of the muscles of the neck, covered by the internal face of the scapula, the ramification of the large blood vessels, branches of the anterior aorta, and the dorsal and superior cervical artery with the spinal nerves which are distributed in that portion of the body. If we majD all this distinctly in our minds, we shall have the material for forming an idea of the structure of the withers, and the intricate and inter- estiug arrangement and disposition of its many parts, with their relation to the ailments which attack them. This will be facilitated by an inspection of the illustration (Fig. 562), representing a transverse section of the entire region involved. The drawing exhibits the obliquity of the direction of the various muscular layers, and demonstrates the tendency of the purulent gatherings, by gravitating and collecting between them, to contribute to the DISEASES OF THE WITHERS. 763 Fig. 561.— 6th Layer of the Withers, pi.— Lamellar portion of the cervical ligament, pf.— Funicular portion, te.— Trans- verse spinalis of the necli. ac— Spinous processes of the dorsal vertebrsB. t.— Tuber- osities of the same, te.— Transverse spinalis of the bacli. ie.— Common intercostal, c— Ribs, gd.— Great serratus. it.— Inter-transversalis. i.— External intercostal mus- cle. 1. — Inter-spinalis ligament. formation of the ailment recognized as a true " diseased withers," with the habitual severity which is its characteristic. The originating causes of the diseases of the withers may be divided into the 2:>redisposlng and the occasional. Among the first are to be noted a defective anatomical conformation of the region; the kind of work performed by the animal, and the degree of care he receives. For exami:)le, when the withers are low, thick and fleshy, as in heavy draught horses, the saddle of the harness has a tendency to slij) forward and cause chafing and excoriation, an accident from which, however, animals with high, sharj? withers are by no means exempt ; for though, for the reason stated, they are less liable than those of the other conformation, the advantaga is offset by the fact that the skin is exj^osed to a more unequal pressure, especially if that j^art of the harness is not properly padded and fitted, and presses irregularly on the soft tissues, upon which it rests. 764: DISEASES OF THE WITHEBS. Fig. 562.— Transverse Section of the Eegion of the Withers, p.— Skin, fe.— Fibre elastic tissue, t.— Dorsal trapezium, r.— Rhomhoid muscle, •cp.— Cartilage of the scapula, is.— Ilio spinalis, v.— 5th dorsal vertebra, gd.— Great serratus. ss. — Sub-scapularis. s.— Scapula, se. — Antea-spinatus. sh.— Scapulo- humeral joint, pf.— Deep pectoral, pt.— Thoraciq walls. Saddle horses are for the same reason peculiarly apt to become sufferers from the lesion of which we are sj^eaking. The self- inflicted bites and the scratching and rubbing of animals suffering from parasitic affections, in their efforts to relieve themselves, may also result in placing them in the category of the predisposed. To enumerate all the occasional causes would be to make a catalogue of casualties, which would be best done by copjdng from the accident columns of the daily press, and we shall merely refer to a few of a kind which may possess some sj^ecial characters and notable features, not too obvious or common and familiar Contusions of any kind, resulting from the causes stated, or even little abrasions from the simple misfit of a blanket kept in place by a surcingle too tightly buckled — anything, in fact, which may give rise either by its immediate effect or by its continuance. DISEASES OF THE WITHERS. 765 to the slightest form of pathological change, may serve as a spark which may kindle into the most serious case of fistulous, diseased withers. (a) JSxcoriation. — This is the simplest of the lesions of the skin covering the withers, or any j)ortion of the body. It is most com- mon in summer, when it appears in the form of a red si^ot, becom- ing rapidly covered with an abundant serous exudation, which rapidly forms a yellow or brownish crust, adherent to the under- lying tissues. This is always painful, especially in summer, when it excites a violent f>ruritis, which may degenerate into a lesion of a serious nature. Excoriations, however simple, ought never to be neglected, and precautions should always be taken against them. When they do occur, local healing applications, usually simple ones, are sufficient, and should be made without delay. (b) Wann (Edema. — This is the result of the laceration of the subcutaneous cellular tissue and its subsequent inflammation. Saddle horses suffer from it, especially in summer and after long jom-neys. At such times, the skin becoming more or less adher- ent to the saddle, the motion of the animal, together with that of the skin, is communicated with every step to the subjacent cellular tissue (a sort of rubbing, to-and-fro motion) ; and this vio- lence, though slight, produces by its long continuance the natural effect of inducing an inflammatory state in the tissue. This oedema is characterized by a tumefaction of the parts, warm and pitting under pressure, more or less painful, and having a tendency to sj^read toward dependent structures. It disappears by resorp- tion in two or three days, but leaves a slight thickening of the cellular tissue, sometimes difficult to detect. This resorption takes place if the originating cause has, within a moderate period, ceased to operate ; but if, on the contrary, it has been permitted to keep up its u-ritating action, the oedema will increase, and in due time the condition will be changed to that of suj^puration, — a termination to be, if possible, by all means anticipated and pre- vented. The removal of the cause, sometimes accomplished by merely giving the patient a season of rest, is the most important item in the treatment. The resoi'j^tion of the oedema can be accelerated by means of massage, cold compresses, astringent lotions, weak stimulating frictions of an alcoholic nature, or cold irrigations. 766 DISEASES OF THE WITHERS. (,c) Hematoma, or Bloody Tumor. — This lesion is produced by a violent traumatism, such as a blow, a contusion, or a violent bite by some other animal. It develops immediately upon the oc- currence of the cause, resulting from the laceration of the super- ficial blood vessels. ' It is characterized by a swelling, vai-ying in size according to the nature of the producing cause. It is at first somewhat warm and fluctuating, then becoming puffy, and when the blood has coagulated, hard, tense and crepitating. Ordinarily it is not very warm or painful, but it becomes so after a few hours, and then there is danger of its assuming a supiDiu-ative character. Yet in other cases it may maintain that condition for two or three weeks, undergoing the process of resolution, the resorption usually becoming complete in that period. The correct diagnosis of this condition, and of any occurrent changes, some of which it is im- portant to know, can be more satisfactorily established by explor- ation. Left without interference and in the absence of irritating causes, the hematoma w^ill usually subside by spontaneous action. In their treatment, cold applications are indicated during the first days of its existence, but at a later period, when the tumefaction has be- come of a denser consistency, absorbent and stimulating local medication is indicated, such as blisters of cantharides, or of mer- curial preparations, or of the iodine compounds. These applica- tions, however, must not be too hastily resorted to, lest the exces- sive or premature stimulation should end in the formation of abscesses. Except when there is positive evidence of supj)uration, pressure by bandaging and the opening of the tumor with the bistoury are always contra-indicated. {d) Gore, or Stickfast. — This is caused by the immediate mortification of a portion of the skin, and often of the deej^er tissues. It is a hairless scab of a blackish color, having the ap- pearance of tanned leather. It is at times superficial, and has a tendency to extend to the subjacent structures. It is rigid and inflexible, and its j)ressure upon the deeper tissues tends to in- crease mortification. The tissues surrounding it are inflamed and their sensibility increased, and at a later period a j^rocess of elim- ination by suppuration takes place all around its edges. But this pus does not very readily escape, and there is always a j^ortion remaining in the bottom of the sloughing surface which becomes fistulated with the formation of collections. If the core should DISEASES OF THE WITHERS. 767 extend to the dorsal ligament or to tlie bones, the result will be necrosis and caries, and a true diseased wWier will be the conse- quence. With these conditions, lymphangitis, leucophlegmasia, and deep abscesses may be expected, and usually supervene. The sloughing of the mortified structure is always slow, espe- cially when the deeper tissues are involved, but the wound which remains after the casting off of the core is not uniform in its sub- sequent action. When it is superficial it heals quite rapidly, but recovers only with great difficulty when it is deep-seated, and in- volves fibrous, cartilaginous and bony structures. The prognosis of this lesion of the withers varies according to the thickness of the tissues which are involved ; but it also varies according to its location, those which are situated on the lateral faces of the withers being less serious than those which occur on the median line. The treatment indicated is strictly local. The first indication is to discontinue, or obviate, the irritating cause, by changing the harness, by chambering it, or, what is better, by refraining from working the animal until he has entirely recovered. The second indication is to hasten the sloughing of the mortified tis- sue, and allay the irritability which the animal betrays upon the slightest touch of the hand, or other object, upon his back. Top- ical remedies in the form of ointments, lotions or poultices, are in- dicated for this purpose. As soon as the process of sloughing begins it must be stimulated and encouraged. Warm comj)resses, antiseptic lotions, glycerine, phenial mixtures are then beneficial. The maintenance of simple moisture, by means of phenicated or creolined mixtiu-es has, in our own experience, been of great ad- vantage. If during the process of the elimination of the core the suppuration seems to be abundant with a tendency to accumulate instead of escaping, care must be taken to facilitate its removal by means of oakum, absorbing cotton, sponges or drainage tubes. Sometimes the core is of unusual size, with roots reaching deeply into the tissues beneath, but although this may be the case, no attempt should ever be made to tear them forcibly away. They must be permitted to drop away by spontaneous action. If the edges are very wide they may be trimmed off with the scissors or bistoury, but interference beyond this is never permissible. When they have entirely sloughed away there remains but a simple granulating wound, which ordinarily requires but mild forms of 768 DISEASES or the withers. treatment. The animal, however, ought not to be made to re- sume work until it is entirely healed. (e) Cyst, or Hygroma. — These terms designate a tumor which usually forms on either the middle or the lateral face of the withers, originating in the dropsical condition of a serous bursa. On whatever part of the withers it may make its appearance, the originating cause is the same, and it is the effect of friction, or of the slight but long-continued irritation produced by an ill-fitting harness, inflicted while the animal is suffering from parasitic dis- eases. In these cases the connective areolae of the bursa become the seat of an amount of secretion in excess of that which is re- moved by the act of resorption, and the accumulated hyper- secreted fluid gathers into the cavity, to form the serous cyst. When located in the median line, the hygroma constitutes a soft tumor, of varying size, from that of a pigeon's egg to that of a child's head — bilobulated, always soft, fluctuating, without heat, and painless ; even transparent, when the skin is pigmentless. It always presents the differential characters of being well defined in its outlines, and without inflammatory perij)herical infiltra- tion. When the cyst is on the side of the withers it may present some similar characters, but when it is deep, under the apone- urosis of the trapezium, or even under the rhomboideus, an ex- ploration becomes necessary to establish the differential diagnosis from abscess, as upon the true nature of the tumor depends the immediate indications of treatment. Hygroma of the withers may retain their characteristics for a long time, but many change in their nature under the influence of external irritations, bruises, contusions, improper treatment, etc. In that case the cyst is transformed into an abscess, or rather a suppurating cyst. In respect to the treatment of cystic withers, the first indica- tion is to remove the cause, and with this not only will the accu- mulation of the serosity cease, but the possibility of its trans- formation into the abscess form will be removed. When the cyst is small and of recent formation, resolvent treatment is in order, as cantharides ointment, bichloride or biniodide of mercury pomatums, etc. Actual cauterization, in lines or in points, has given satisfactory results in chronic cases. In- jections of tincture of iodine have also been recommended. Our DISEASES OF THE WTCTHERS. 769 own experience warns us that it is not without danger, from its habiUty to be followed by a severe form of diseased withers. Bouley and Nocard, in relation to this mode of treatment, say "it is better to empty the cyst with a capilliary trocar, or by the aspirator, to wash its cavit}^ with an antiseptic preparation, slightly irritating (5 per cent, solution of phenic acid), to repeat this injec- tion several times, until the liquid taken out of the cyst is per- fectly limpid, and then apply over the entire surface of the skin a thick coat of blister." The purulent cyst is treated as an abscess. {f) Abscess. — A phlegmon of the withers may rise suddenly under the influence of a severe traumatism, or become the sequel of a hematoma, or of a cyst. It appears most commonly on the superior part of the withers ; sometimes on the sides, as a tumor more or less warm and painful, first uniformly hard and tense, and afterward soft, with a fluctuating center, and surrounded b}'' an oedematous infiltration, more or less developed. If the abscess is superficial, ulceration of the skin soon takes place, followed by the escajDC of thick, white and creamy pus. If, on the contrary (and this is often the case), the abscess is deep, developing itself under the the aponeurosis of the great dorsal, or of the rhomboideus muscle, or even deeper, under the cartilage of the scapvila, or the thickness of the ilio-si^inahs, the symptoms then, however, being less defined. The tumefaction is less characteristic, the heat less marked, the fluctuation not detect- able, and the only sign which guides the surgeon is the excessive pain manifested upon the slightest ^pressure on the tumor, and from which the animal shrinks in fear. This soreness is in fact so great that in some animals it interferes with the action of the leg on the side affected. The appearance of general febrile symptoms is not uncommon at this period, with elevation of temperatui-e, increase in the circulation, anorexia, excessive thirst, etc. At this period, also, it becomes important to be certain of the diagnosis, or at least to be sure of the existence of the sui^puration, and its loca- tion must be accurately made out, in order to prevent the severe disorders that may be caused by the presence of the pus ; a prob- lem which can be only solved by repeated capillary exploring punctures, made at various points, and at given depths, according to the dimensions of the phlegmonous enlargement. The prognosis of abscess of the withers depends altogether on 770 DISEASES OF THE WITHERS. the seat it occupies. If superficial, and on the lateral faces of the region, it is not serious. If on the median line, it assumes a more severe character. If deep, it is also of a dangerous nature, unless it is simi^le or Hmited; but, on the contrary, if the quantity of the pus has continued to increase, and infiltration has taken place into the cellular tissue separating the muscular laj^ers ; or the sup- puration has penetrated under the cartilage of the scapula; it wni have assumed the most complicated form of the disease, with chances of recovery of a very doubtful character. "When the pres- ence of the pus has been detected, the immediate indication is to assist its discharge by a free incision down to the bottom of the cavity. The incision must be made on the most dependent part of the tumor ; in such manner as to prevent the collection from settling in a cul-de-sac. A means of drainage must be provided, and the tube is preferred to the tent of oakum, or even to the seton, as more sure to reach all parts of the collection, and the more thoroughly to wash out the cavity. Jf, however, the suppuration has not been detected, the appli- cation of local stimulation is indicated by means of warm com- presses, hot poultices and the like ; a constant watchfvdness being maintained, meanwhile, in order to detect the presence of the pus at the earhest moment of its formation ; when it must be immedi- ately evacuated. {9) Wounds. — Kesulting from every variety of traumatic agencies, these injuries will necessarily vary ia their extent and the nature of the tissues which are involved. They therefore extend from the most trifling hurt of the skin to the severest lacerations of the important ligamentous, cartila- ginous and bony structures contained in the region under con- sideration. With such a diversity in their form and nature there must also be a corresponding range in the character of the prog- nosis to be announced, from that of rapid spontaneous recovery, without interference, to the gravest of terminations. One of the principal indications in the treatment of woimds of the withers is to prevent as much as possible the filtration and deposit of pus through the various layers of the region, and facih- tate the cicatrization, by placing them in a state of immobihty, and according to Bouley and Nocard, the best method of secirring this suspension of movement is to apply a broad bhster all around the wound, and to repeat the appHcation after a few days. The DISEASES OF THE WITHERS. i71 pain caused by this compels the animal to abstain from all move- ment, and besides this the inflammatory swelling resulting from the bhster promotes the cicatrizing process by stimulating the proHferation of the cells of the repairing tissue. Aside from this special direction, the treatment of wounds of the withers involves no methods or indications different from those of similar hurts in other parts of the body. In most cases the surgeon must trust his experience and knowledge of general principles for guidance. (A) ''Diseased Withers'' 2^^'02Jer: Fistulous Withers.— k^ \fe have before stated, this denomination belongs to " a persisting lesion, fistulous in character, due to the mortification of the tis- sues of the withers, fibrous, yellow, cartilaginous or bony." It is necrotic in its nature, and while ii may attack but one, it may also exist in all of these organs. Whatever this condition may be, however, the necrosis is always manifested externally by an indicator, in the form of a fistula giv- ing exit to an abundant, thin pus, serous, sanious, grayish in color, adhering to the haii% and irritating and excoriating the skin upon which it flows. At first it is odorless, and nearly homogeneous, but it soon becomes foetid in odor and loaded wdth the detritus of necrotic tissues, more or less abundant, varying in thickness and in color, according to the nature of the tissue from which it is formed. One or several of these fistulous openings may exist on one or both sides of the withers leading from the same or from different necrotic centers. Their number is not limited. Several of them may be in existence at the salne time, especially when the disease has maintained its hold on the system for a period of three or four months without being checked or cured ; a state of things not infrequently witnessed. Their formation is explained by the constant accumulation of the pus in the sinuosities of the original tract, which by degrees overcomes the resistance of the surrounding structures, and es- tablishes a channel for itself by the same process as that by which the first outlet was formed. It may sometimes happen that the opening of new canals becomes the cause of the closure, or perhaps only the constriction, of the original channel, and a new exploration becomes necessary to ascertain the new routes of the fluid. In this case their direction will be best made out by the injection of liquids through their open mouths. 772 DISEASES OF THE WITHEES. The presence of one of these canals at the bottom of a wound may sometimes he detected by the appearance of large, fleshy, cone-shaped granulations, of a pm-phsh color, from which an ooz- ing of pus takes place upon the application of pressure. But in another case, the orifice of the fistula may be directly on the skin, surrounded with granvdations, protruding, soft and bleeding upon the shghtest touch, with an escape of sanious pus between them ; these granulations at a later period, flattening, as the wound contracts, until the thinned skin seems to be continu- ous with the smooth, reddish membrane which lines the internal face of the tract. It may even happen that a process of cicatriza- tion taking place around the opening will transform its external outlet into a narrow strait which opens in the bottom of a cavity formed by the skin drawn inwardly by the cicatricial retraction of the indurated peri-fistulous tissue. The direct exploration of the fistula is the best mode of ascer- taining its existence, direction, extent and depth, and also the lesion which gives rise to it. This exploration ought to be made by the taxis, since it is obvious that no instrument can communi- cate an impression such as can be obtained by the touch of the finger. By the hand, therefore, must be ascertained the course and sinuosities of the fistula, its diverticulum, the nature of the necrosed tissue, and the extent of the mortification. But this manual exploration is not always possible, either because of the deficient caliber of the passage, or of its sinuosity, or its length. Kesort must be had to the various probes and directors in use. When the necrosis occupies the apex of one or more of the spinous processes, and the fistvila is superficial, a slight incision will expose the diseased spot to ocular inspection, and the condi- tion of things may be at once fully reahzed. When the lesion is limited to the cervical ligament, the eschar or slough will have an olive-greenish color, and will be of soft, pultaceous consistency, with a pecvdiar foetid odor, from its maceration in the pus. If the necrosis has attacked the cartilages of the vertebrse, the morti- fied part assumes a yellow color, with a tint of pale green. In all cases, however, it is more or less loosened at its borders, and diflers materially from that of the healthy tissue. And while at the point of separation it is covered with a layer of granulations, highly vascular, yet the continuity of the fibres between the healthy and the diseased tissues still exists in the parts which are DISEASES OF THE WITHERS. 773 deeper and more central, where the connection is maintained by a sort of peduncle of varying size, through which the necrosis con- tinues to be propagated. If the disease is of sufficiently long standing the necrosis may involve the entire thickness of the carti- lage. In this case the spongy tissue of the vertebrae is exposed, covered with the healthy granulations, which contribute to the cic- atrization. This, however, is a rare termination, the bone, ordi- narily, becoming necrosed or carious, the necrosis being indicated by its brownish color, its dryness, its roughness and its sonority on percussion, while the caries is recognized by its friability, its red and yellowish color, the foetid suppuration which oozes from its areola and the facility with which it yields to the edge of a sharp cutting instrument. This condition of mortification may affect but a single verte- bra, but it is not uncommon to find several, or possibly aU, the spinous processes of the region affected. While the fistula may be considered as the essential physical symptom of this ailment there are other symptoms coexisting. There is accompanying it an external swelling, sometimes diffuse, sometimes compact, and more or less indurated, according to the duration of its existence ; very painful on pressure, and of which the form, direction and extent so perfectly correspond with those of the fistula, that it may be viewed as accurately representing the extent and limits of the lesion itself. This induration increases in consistency, and may with time become infiltrated with calcareous deposits, or even bony growths, attached to the spinous processes. The diagnostic and prognostical importance of this induration is very great. So long as there is no perceptible decrease in its dimensions, no apparent improvement in the external wound or modification in the nature and amount of the discharge can be of any favorable signification, and the surgeon may feel thoroughly assiu'ed that the disease continues unchanged in extent and char- acter. As it diminishes it indicates that the necrosis is also con- tracting its limits, and it becomes certain that the sloughing has taken place and the wound is once again assuming its character of original simplicity. And when the swelling disappears, and ■ the tissues have resumed their normal integrity, questions as to the depth of the fistula, or the extent of its sinuosities, and abun- dance of the discharge will cease to be of any significance. 774 DISEASES OF THE WITHEKS. In the beginning of tlie necrosis, while the parts are verj sensitive, the exaggerated sensibility is not at all in proportion to the apparent extent of the disease. The animal shrinks from the manii^ulations of the touch, and this is a symptom which should be carefully considered in its relation to the progress of the dis- ease, from the fact that in these manifestations it is passing through the same phases as those which marked the progress of the induration, running a sort of parallel with the duration of the necrosis, and diminishing as the sloughing proceeds, the interior situation being interpreted by the exterior phenomena, with some exceiDtions. For there are cases in which it diminishes, while the disease continues without change, to exhibit the same severe sj-mptoms. One effect of the abundant suppuration accom- panying diseased withers, and the febrile symptoms which accom- pany it, is a rapid loss of flesh by the suffering animal. The disease is always of long duration, and even when treated in the most rational manner. Its persistency will naturally cor- respond with the slow process of the sloughs and repairs of the tissues involved, themselves of comparatively low vitality and slow of change. But as soon as the separation of the diseased parts has taken place, however deejD the wound may have been, or whatever the number and depth of the fistulae, the cicatriza- tion proceeds rapidly, and is comjileted in a comparatively short time. The terminations, which are to be looked for, are classified by Bouley and Nocard under the following heads : 1st. Resolution. — This is very rare if the disease has been neglected, and only occurs when it has been of a circumscribed extent and seated in a region favorably situated for the elimin- ation of the mortified tissue, as when it escaj^es through large oj^enings, without lying long enough in the midst of the muscular substance to produce the effects of the long confinement of the pus in the deeply situated regions. 2d. Disease of the neck, when the necrosis has spread as far forward as the cervical joortion of the ligamentum nuchte. This forms the more common termination, and is as serious and fatal as the original disease itself. It is too often met with, especially in low-bred animals of lymphatic constitution. 3d. Death, too frequently. 4th. Putrid infection, due to purulent fermentation and the absorption of septic principles. DISEASES OF THE WITHERS. 775 5th. Purulent infection, i. e., consecutive with the caries of the Tertebrse and with the phlebitis of the veins of the region. 6th. Purulent pleurisy, resulting from the passage of the pus into the thoracic cavity through the intercostal muscles. 7th. Exhaustion, in consequence of the uncompensated loss of substance b}^ the abundant continued suppuration, and its ac- companying severe and persistent fever. Fistulous withers is always a serious disease, not only because of its progressive tendency, but also because, however intelligent and proper may be the treatment it receives, it can never be relied on to prevent the spreading of the necrosis, and assure a healthy cicatrization. The degrees of severity nevertheless vary, accord- ing to circumstances. It is less serious when the necrosis is on the median line, and the prognosis is still more favorable when it is on the posterior part of the region. "WTien situated forward it seems more tenacious, and the danger of its extending to the neck is greater. But it is principally when its seat is in the an- terior part of the withers that the prognosis becomes alarming, as there the spinous processes are less prominent, the muscles thick- er and more complicated in their arrangements, and the cartilage of the scapula nearer, all these being conditions which render the discharge of the pus more difficult and the purulent infiltrations more likely to take place, and where also counter-openings are made with more difficulty, and indeed become almost impossible if the purulent accumulations are situated on the inside of the scapula or its cartilage of prolongation. It may be said, in fact, that the most important factor in the prognosis of this disease is the distance which separates the apex of the spinous processes of the vertebrae from the superior border of the cartilage of the scapula ; the chances of recovery being in the ratio of the distance between those two points. It is thus that it becomes less grave in well-bred animals, with elevated pro- jecting withers, than in low draught horses in which that region is depressed and thick, and the projection of the dorsal processes often replaced by a deep groove, bound on each side by the pro- jection of the muscles and of the border of the scapular cartilage. The disease is also of less gravity in young animals, except when they are under the influence of distemper. The treatment required in fistulous withers includes two prin- cipal indications : 1st. To facilitate the escape of the pus and 776 DISEASES OF THE WITHERS. obviate its action upon tlie tissues with which it comes in contact and prevent its necrosing influence, and second to accelerate the ehmination of the necrosed parts. The first indication is fulfilled in enlarging the fistulas to the greatest extent possible. This is done with the straight bistoury carried in the groove of the director or of the S probe, introduced into the tract as far as possible. But when the fistula runs ob- liquely downward and inward, and has become complicated with diverticulums which run into the depths of the tissues, this en- largement of the fistula is more difficult, inasmuch as it necessi- tates too extensive a division of tissues for safety. This difficulty is obviated by establishing counter-openings at points correspond- ing with the bottom or cul-de-sac of the fistula. The situation of these counter-openings must be carefully cal- culated in order to make the drainage perfect. The instruments most suitable are the dog seton needle, a curved trocar, or prefer- ably the S probe, and a straight bistoury. The openings must be liberal to assure the best results, and they must be prevented from contracting or too rapidly closing, and so checking the pur- ulent flow either by the introduction of a tent of oakum or other permeable foreign substance, or, and it is much the better method, by the use of a drainage tube similar to the India rubber ii-riga- tion tube. This implement, besides fulfilling all the other indica- tions desired, possesses the additional advantage of facilitating the injection of fluid detergents or curatives into the fistulous tract. When the drainage has become well established irrigations must be made two or three times daily as long as may be neces- sary. The fluids best adapted as being both detergent and cura- tive in their natui*e are pure tepid water, phenicated water (five per cent, solution), or permanganate of potash solution (one to two per cent.), or again simple alcoholic water. The irrigation can be made with an ordinary syringe. Peuch and Toussaint, however, say " that when the circumstances allow it cold water in continued irrigation constitutes the best medication and that which prevents most certainly all comjDlications. On that account they cannot recommend it too strongly." While this form of treatment is usually successful in cases of lesser severity, there are many instances in which they become powerless, and other means become necessary for the removal of the necrosed part. In times gone by caustics, in both the solid DISEASES OF THE WITHERS. 777 and liquid form, were held in high repute, even in the form of actual cauterization, as recommended by Lafosse. In later times, however, the serious effects which followed their application caused them to be ignored. Preparations of lesser severity were then recommended, among which were Villate's solution; those of the sulphates of copper or of zinc, in various degrees of strength; of tincture of iodine, of spirits of turpentine, of nitrate of silver, and even of tartar emetic, and their use was followed by good results. Cantharides ointment, apphed externally over the swelling, and by injections into the fistulous tract, after being diluted with tincture of cantharides, is also recommended. When the pus has filtrated inside of the shoulder, Bouley and Nocard suggest the propriety of "attempting to lacerate with a me- tallic rod the cellular tissue of the internal face of the shoulder, so as to produce an abscess by congestion, whose opening, which must be made wide, would allow the escape of the pus, and the possible frequent cleansing of the enormous fistula thus formed. By this process one might avoid the serious accidents likely to result from the sejourn of the pus, and its fermentation from the contact of the tissues." For cases like these Lafosse recommended the trephining of the scapula — a very serious operation. It is said to have been successful with him, but it must be a difficult matter to perform it properly in such a manner that the trephine is appHed at a point on the surface exactly corresponding to the bottom of the fis- tula. When all means of so stimulating the action of the parts as to effect the arrest of the necrosis, and the sloughing of the morti- fied structure have failed, there is but one alternative left, and that is the direct amputation of the apex of the spinous ^jrocess, and the excision of the diseased portion of the ligament. But this operation, indicated by Lafosse, is possible only w^hen the disease is limited to the apex of the most prominent spinous pro- cesses. It is positively contra indicated in low and thick withers, in which the wound left after the operatio-n would be a hollow, cup-shaped depression, from which the pus would naturally gravi- tate and filtrate in all directions. The instruments necessary for this operation are : A grooved director, curved and straight bistouries, sage-knives, sharp draw- / I b DISEASES OF THE WITHERS. ing knives, bull-dog forceps, and an amputating saw ; and with- these the apj)liances usually needed in the way of hemostatics, and the necessary dressings, artery forceps, oakum, sjDonges, drainer-tubes, dog seton needles, etc. The various steps of tlie operation- are thus described by Peuch and Toussaint : "Everything being ready, the operator enlarges the fistulous tract, simple or ramified as it may be, so as to expose the ne- crosis. In making this special attention must be taken to give the incision a direction favorable to the escape of the pus. This first step of the operation is accompanied with abundant hemor- rhage, which must first of all be arrested either by ligating the divided blood vessels, or by plugging the wound with oakum moistened with a solution of perchloride of iron. The hemor- rhage stopped, and the necrosis exposed, the second step, and the important one of the operation, is jDroceeded with. To eifect this the necrosed surface is limited by a double incision, made with a sharp instrument, straight bistoury, or sage-knife. This incision involves the entu'e thickness of the cervical Ugament and the fibro- cartilage covering the apex of the spinous process and passing under this cartilage. In making this incision the operator must be careful not to injure any of the other processes if they are not diseased. This done, with the sage-knife the deepest layers of the cartilage are excised, and then, with the drawing knife, the bony tissue underneath is resected so as not to leave the smallest particle of necrosed tissue. Here, as in some cases of foot opera- tion, not only must all the diseased tissue be removed, but some of the healthy structures. The resection of the apex of the ne- crosed processes can be made with the saw instead of the draw- ing knife. But this instrument is preferable, as it is easier to manipulate and it always leaves a smooth wound." The subsequent treatment is of the routine kind. The parts are, of course, thoroughly cleansed; the hemorrhage is controlled by pressure, a drain tube is secured at the lower angle of the wound, and the edges are brought together by quilled sutiu-es. Kepeated injections of phenicated water are passed through the di-ainage tubes, and the patient is watched in order to prevent him from injuring himself by rubbing. If the season and the circum- stances permit, continued irrigation is established. Toward the fourth or fifth day the sutures are removed and the dressing changed. The granulating process is carefully DISEASES OF THE WITHERS. 779 watched, and its progress kept under control by mild caustic ap- plications, or by pressui-e, to prevent an uneven and too rapid cicatrization During the treatment the animal must be kept quiet, and even in some cases it will be prudent to hobble his fore legs in order to limit his movements and prevent the filtration of the pus under the shoulder. He is to be kept on light and nutritive diet, to compensate for the losses resulting from the abundant suppura- tion, and when the disease has disappeared, and there is only a superficial wound remaining, and no more fear of returning com- plications or relapses, the animal can be returned to his labors, but must make his adieus to the bulky collar which has weighed so heavily on his neck, and substitute for it the equally efficient and far more sightly Dutch collar, which has never yet in any way contributed to bring upon its wearer the calamity of diseased withers. DISEASES OF THE POLL. This region of the neck is the seat of lesions, frequently occur- ring, and of varying nature. They include excoriations, oedema- tous swellings, cores, cysts, bloody tumors, abscesses, bruises, wounds, etc., any of which may become complicated, and termi- nate in poll evil, or the necrosis of one of the fibrous, elastic, or bony elements which enter into the composition of that region. Li considering the anatomical structure of the portion of the neck in question we find on the to2) a mass of hair, separated from that of the superior border of the neck by a surface which has become callous by the constant frictions of the head-strap of the halter or of the bridle; the skin (Fig. 563), thick on the median line, thinner on the sides, but always loosely connected with the subjacent tissues; a thick layer of connectwe tissue, more or less infiltrated with fat, and lardaceous in low-bred horses ; the cord of the ligamentum nuchse, which is attached to the occipital bone, and more or less covered by the cervico-auricularis muscles ; on each side, and on the same level, the terminal insertion of the spleniiis muscles, and forming an elevation which is covered by the aponeurosis common to that muscle and the small complexus, which itself makes an apparatus of retention of great resistance to the organs of the region ; then another layer, composed of the large tendon of the great complexus, the small oblique muscle of 780 DISEASES OF THE POLL. Fig. 563— Section of the Neck on a Level with the Poll p.— The skin, to.— Lardaceous connective tissue on the top of cervical ligament, gc— Superior extremity of the great complexus and small oblique muscle of the head. Ic— Ligament nuchee. dp.— Posterior straight muscles of the head, lao.— Atloido- occipital ligament. Is.— Superior part of the atlas. sm.— Rachidian dura mater. m.— Spinal marrow, ta.— Adipose tissue of the rachidian canal, a. — Atlas, ph. — Pharynx, go.— Section of the great oblique muscle of the head, ao.— Section of odon- toid process of the axis, p.— Parotid gland, sm.— Sub-maxillary gland, da.— Anterior straight of the head, ce.— (Esophagus. the head, the great oblique^ and under them, the posterior straight muscles of the head; a serous sac, assisting the ghding of the cord of the Hgamentum nuchse over the atlas, which is very small in young animals, assumes larges dimensions in old subjects ; and, finally, a skeleton of the region, the atlas, the axis and the occi- pito-atloid and atloido-axoid articulations. Two large arteries are distributed throughout the locality, the occipito-muscular and the atloido-muscular. The causes in which diseases of the poll originate are numer- ous. Among them may be mentioned first, bruises, from blows given with the handle of a whij), or of a fork; contusions and continued frictions against hard substances, as the manger; the pressure and rubbing of the parts of the harness (the bridle, etc.), which pass over that region; the repeated rubbing which the ani- mal inflicts upon himself when he is afi'ected with parasitic cuta- neous disease; the blows which he receives when in tossing his head, he brings it in contact with the ceiling of his stable, when this is too low, and he has formed the habit of pulling back on the halter ; the spreading of diseases of the neck by the extension of the necrosis of the cord of the cervical ligament, all these are DISEASES OF THE POLL. 781 considered to be so many active agencies in the etiology of poll evil. In cattle it is most commonly chargeable to the pressure and frictions of the yoke. Hertwig, with other German authors, con- siders it, and particularly the sus-atloid hygroma, as the local mani- festation of a diathesic condition, such as rheumatism and dis- temper. They also admit that the true poll evil may develop itself spontaneously, and independently of all other traumatic causes. In considering the various forms which the disease may assume in this locality we shall adopt the division sanctioned by Bouley, who has thus arranged them. A — ExcoKiATioNS ; B — (Edematous Swellings; C — Cobe; D — Bloody Tumors. Diseases of the poD, in horses, exhibit too close a resemblance in their type and general history to escape notice, and the ther- apeutic indications exhibited in them are the same. And it must be borne in mind that however slight they may ajDpear to be, and whatever may be their nature, they always require immediate at- tention and careful watching, and in all cases the use of the bridle and the halter must be suspended. E.— Cyst. Cysts of the poll are divided into superficial and deej). The former, which are of uncommon occurrence, have their seat in the subcutaneous cellular tissue, and possess features in common with those which appear at the withers. The latter is an abnormal dilatation of the serous sac which facHitates the gliding of the cervical cord upon the atlas ; it is also known as the atloid hy- groma. It generally begins suddenly, and is manifested by the presence of a soft tumor, fluctuating, spherical, or bilobulated by the median pressure of the cervical ligament. It is usually pain- less, except when it is the result of acute \iolence, in which case it may be accompanied with inflammatory symptoms, which may extend to suppuration, but in such cases, which, however, are in- frequent, there is also a degree of fever corresponding in intensity with the other features of the case. The fluctuation is at first imiform, and easily detected, but at a later period, as the secre- tion becomes more abundant, and the tension of the pouch be- 782 DISEASES OF THE POLL, comes greater, and the thickening of the walls progresses, it be- comes obscure. In the stable the animal is very quiet, standing with the neck extended and the head carried downward ; he moves with difficulty, without raising the head, and avoiding all movements of the muscles of the neck, and especially of the extensors. At times the distension of the walls of the cyst may be so extreme that the capsular ligament of the occipito-atloid joint is pushed in- ward in the rachidian canal, and when this occurs nervous symp- toms appear, caused by the pressure of the rachidian bulbs. If unremedied, it assumes a chronic condition, with progres- sive distension, which may end in death by pressure upon the bulb. Purulent transformation, and poll evil proper, are also the possible terminations of the atloid hygroma; indeed, it is only in rare instances that it is known to subside by resolution or resorp- tion. In cases of doubtful diagnosis as to the formation of cystic or purulent collections, exploration will relieve the doubt, and at once settle the question of treatment. Blistering and absorbing applications, often repeated, and combined with aspiration, have often relieved the atloid hygroma. Cauterization in lines or points, both suj^erficial and deep, are also recommended. Injections of tincture of iodine have also their supporters, but they are sometimes liable to give rise to vio- lent irritation, ending in purulent collections, and perhaps necrosis possibly of the cervical ligament. F. — Abscess. This is the most frequent lesion of the poll, forming at once, when the exciting cause is sufficiently active, or when originating in the manner already described. It consists at first, of a diffused, not weU defined, swelling of the abundant cellular tissue which sej)arates the muscles of the region, to coalesce at a later period, to form a single purulent gathering, but not until it has macerated and destroyed all the intermediate tissues into which it had become infiltrated, and this destructive process advances so actively and persistently that when it reaches the surface, instead of closing up, the abscess has be- come transformed into a fistulous center, with a constant dis- charge of mortified, fibrous, elastic, or bony structure. DISEASES OF THE POLL. 783 The establishment of the svippurative process, even before any local symptoms have been manifested, is betrayed by the changed appearance of the animal. As described in the previous pages, he becomes listless and dull, standing quietly with the neck extended and the head resting on the manger; refusing to move, or if doing so, never raising his head, and by grunts and moans betraying the great pain he is suffering. If his head be raised by force he rebels against it, struggles, goes backward, strikes with his fore feet, and perhaps rears. By bringing the animal under control and restraint, as by throwing him, the abscess may be easily discovered, on one side of the neck, as a diffused swelling, tense, warm, and so excessively sensitive to the sHghtest contact, that it is with the greatest diffi- culty that an obscure and deej) fluctuation can be detected. The positive nature of this tumor must then be made out as early as possible, by repeated capillary explorations, since if discovered to be unmistakably of a suppurative nature, a free exit to the pus must be at once established, to avoid its necrotic tendency ; while if it be a cyst, there is danger in opening it, arising from its lia- bility to be followed by necrosis of the cer\ical ligament. The prognosis of this abscess will vary according to the length of time which may have elapsed between its incej^tion and its detection. The serious nature of this prognosis is explained by the fact of tho incomjjressibility of the pus and the inextensi- biUty of the aponeurosis of the splenius and complexus muscles, which resist the swelling of the inflamed tissues, and by their compression and strangulation, become the cause of gangrene. If a diagnosis of abscess is made, and it is immediately opened, the cavity may assume the character of an ordinary abscess, and close entirely ; but this is a rare termination. More ordinarily, the incar- ceration of the infiltrated pus between the muscular layers is an obstacle to its free and complete discharge, and it remains infil- trated, gathering into cul-de-sacs, and migrating irregularly be- tween the muscles. Hence the formation of so many fistulous tracts, opening at diverse points on the skin, which are generally the result of the necrosis of the ligamentum nuchse, or of the fibrous tissue of the tendons, or even of that of the atlas, or possibly of the occipital bone. All the dangers which are likely to follow the existence of an abscess at the poll, demonstrate the necessity for prompt surgi- 784 DISEASES OF THE POLL. cal interference. Whenever the presence of the pus is established the abscess must be opened, and opened very freely. This must be cai'efully done. The puncture must be made in the center of the tumor, and after the evacuation of the pus it njust be ex- tended with the bistotu-y, introduced with the aid of a grooved director, and making, of course, a counter-opening at the most dependent point. This incision should be made parallel with the cervical ligament, and must be carefully made, in order to avoid wounding the capsular ligament of the joint, or the occipito-mus- cular artery. The hemorrhage which accompanies this operation is easily controlled by pressure. Antiseptic dressings, with the use of a drainage tube constitute the after-treatment, which must be simUar to that of the same diseases at the neck and at the withers, with the difference, perhajas, that the dressings and cleanings must be oftener renewed. If no complications arise the wound will heal without diffi- culty, and the animal may be able to resume work after two or three weeks' recuperation. Poll Evil. But if, on the contrary, the animal is suffering with the per- sistent and tenacious lesion which consists in the necrosis of the yellow or white fibrous tissue of the region, or a diseased condi- tion of the surrounding bones, we are confronted with the very serious affection commonly known as poll evil. This disease originates, ordinaiily, in one of those already con- sidered, and yet it may appear sj)ontaneously, if the instigating traumatism from which it grew has been sufficiently severe or violent. And, again, it may be a sequelae or extension of a similar diseased process in the neck. Its characteristic appearance is that of a large induration, de- veloped around one or several fistulous tracts, from which escapes a thin, sanious pus, of foetid odor. Upon being explored these fistulas are found to vary in their direction, in their depth, and in the tissue on which they tenninate. Exploring with the probe, or, more certain, with the finger, a cavity is found more or less filled with pus, with granulating walls, in the bottom of which the cervical ligament is felt, isolated, roughened and more or less escharrified, or, if this chord has remained intact, it will indicate DISEASES t)F THE POLL. 785 that the seat of the lesions is the tendon common of the splenius, or of the complexu's, or, perhaps, of the oblique or j)Osterior straight muscles. At an advanced period, when the progress of the mortification has been for some time unchecked, and the bony insertions of the ligament, or of the tendons, have become affected, the surfaces of these bones also become affected and their roughened or possibly necrotic character is readily recognized by the exploring finger. It may also hai:)pGn that the capsular ligament of the joint, constantly macerated in the pus, softens and yields, and the pene- tration of the discharge into the vertebral canal soon ends the ease by the rapid development of suppurative cerebro-spinal men- ingitis. Hertwig and Lafosse have reported instances where anchylosis of the occipito-atloid joint had taken place. There is in the museum of the American Veterinary College a preparation of an anchylosis of the occipito-atloid articulation which undoubtedly is the result of a case of chronic poll evil. The prognosis of this ailment is always serious. A slight lesion may grow and develop into a case, with all its dangers. For this reason a cautious expression of opinion on the part of the surgeon is equally due to considerations of policy as to the obhgations of truth. The treatment is essentially and exclusively surgical. In the simplest cases free oj)enings and ample drainage of the wound, with plenty of washing and antiseptic attention will con- trol the trouble. In more severe cases, where the presence of the fistulous tracts is stimulated by the induration of the parts, and the con- stant movements of their walls, the external application of a strong blister and the injection into the fistulse of tincture of iodine, or of cantharides, or of solutions, more or less concen- trated, of tartar emetic, nitrate of silver, chloride of zinc, etc., will contribute to immobilize the parts and stimulate the granu- lating and healing process. The section of the cord of the ligamentum nuchae is indicated when the tension of the region becomes too rigid, and the pain inor- dinate. This alleviating measure was first instituted by Langen- Ijacher and Hertwig in Germany ; then by Lafosse and Rey in France, and it has always given excellent results. It relieves the t.i.-lf «" i m f I. 8 I :i William R. Jenkins \\- liturtj Books. CHAUVEAV. "Tlu' Coinpaiali' Aiuilouiy of the Domesticated AuimaLs." By A imuveau. New edition, translated, enlarged and nUeiy revised V>y George Fleming, F.E.C.V.S. f>v cloth with 5B5 Illustrations •••• CLAHKE. Anatoiu}-, enlarged. CLARKE. "H >rst's' Teeth," :Mreatise on their Pathology. Dentistry, o. Revised and By W, H. Clarke. 12ni -loth and I'cetli of (haii ol tln' K. Fossil Horse; 7 00 2 50 .iMMmriiii:lledieine and Edward Courtney. . S. Crown, 8vo, COURTNEY. Surgery. " By L-lolh. Th. 75 2 75 {•*)COX. "Horses: In Accident wl Disease. sketches introduced embrace varies attitudes which have been observed, such as in chojig; the disorders and accidents occurring to the stonch and intestines ; afifection of the brain ; and some spoal forms of lame- ness, etc. By J. Roalfe Cox, F. 't V.S. 8vo, cloth, fully illustrated CURTIS. "Horses, Cattle, Sheep id Swine. ' The origin, history Improvement, descriion, charactt^ris- tics. merits, objections, etc. ByGeo. W. 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"Vade Mecum of Equine Anatomy." By A. Liautard, M.D.V.S. Dean of the American Vet- erinary College. l2mo. cloth LIAUTABD. "Translation of Zundel on the Horse's Foot." Cloth 2 00 LIA UTABD. "How to TeU the Age of the Domestic Animal." By Dr. A. Liautard, M.D., V.S. Profusely illustrated. 12mo, cloth - LIAUTABD. " On the Lameness of Horses." By A. Liautard, M.D.,V.S ^ 50 i**)LIAUTABD. "Manual of Operative Veterinary Surgery " By A. Liautard, M.D., V.M., Principal and Professor of Anatomy, Surgery, Sanitary Medicine and Jurisprudence in the American Veterinary College ; Chevalier du Merite Agricole de France, Honorary Fellow of the Royal College of Veterinary Surgeons (London), etc., etc. 8vo, cloth, 786 pages and nearly ti 00 600 illustrations LONG. "Booli of the Pig." Its selection, Breeding, Feeding and Management. Bvo, cloth * 25 10 William R. Jenkins^ Veterinary Books. {**)LUPTON. "The Horse: Sound and Unsound, »» with Law relating to Sales and Warranty. By J. Irvine Lupton, F.R.C.V.S. 8vo, cloth, illustrated 1 25 L UFTON. " The Horse." As he Was, as he Is, and as he Ought to Be. By J. I. Lupton, F.R.C.V.S. Illus- trated. Crown, 8vo 140 MAGNEJR. "Art of Taming and Educating the Horse." By D. Magner. Upwards of 1,000 pages, illustrated with 900 engravings. 8vo, cloth, $5 00; sheep, $6 00 ; full morocco 7 50 MAGNER. "Yeterinary Diagrams." (1) The Struc- ture of Horses Feet (in colors). The Structure of Horses Feet (Effects of Bad Treatnaent of the Feet). Mounted and Varnished . . 2 00 (2) The Shoeing of the Horse. The Education of the Horse. Mounted and Varnished 2 00 MAYHEW. "The niustrated Horse Doctor." An accurate and detailed account of the Various Diseases to which the Equine Race is subject ; together with the latest mode of Treatment, and all the Requisite Pre- scriptions written in plain English. By E. Edward May hew, M.R.C.V.S. Illustrated. Entirely new edition, 8vo, cloth 2 75 McBBIDE. "Anatomical OutUnes of the Horse." 12mo, cloth 2 50 McCOMBIE. " Cattle and Cattle Breeders." Cloth 100 JH'FADTEAN. "Anatomy of the Horse." A Dis- section Guide. By J. M. M'Fadyean, M.R.C.V.S. This book is intended for Veterinary students, and offers to them in its 48 full-page colored plates numer- ous other engravings and excellent text, the most valuable and practical aid in the study of Veterinary Anatomy, especially in the dissecting room. 8vo, cloth 5 50 Williavi R. Jenkins' Veterinary Books. 11 M'FADYEAK. "Comparative Anatomy of the Domesticated Animals." By J. M'Fadyean. Pro- fusely illustrated, and to be issued in two parts. Part I_Osteologj', ready. Paper, $2 50; cloth 2 75 (Part II. in preparation.) MILLS, "How to Keep a Dog: in tlie City." By Wesley Mills, M.D., V.S. It tells how to choose manage, house, feed, 'educate the pup, how to keep him clean and teach him cleanliness. Paper 25 {*)MOLLER, ' ' Operative Veterinary Snrger j . " By Professor Dr. H. Moller, Berlin. Translated and edited from the 2d edition, enlarged and improved, by John A. W. Dollar. M.R.C.S. Prof. Holler's Avork presents the most recent and complete exposition of the Principles and Practice of Veterinary Surgery, and is the standard text-book on the subject throughout Germany. Many subjects ignored in previous treatises on Veterinary Surgery here receive full consideration, while the better known are presented under new and suggestive aspects. As Prof. MoUer's work represents not only his own opinions and practice, but those of the best Veterinary Surgeons of various countries, the trans- lation cannot fail to be of signal service to American and British Veterinarians and to Students of Veter- inary and Comparative Surgery. 1 vol., 8vo. 722 pages, 142 illustrations . . 5 25 MOBETON. " On Horse-breaking." i2mo, cloth.. 50 MOSSELMAJS-LIENA UX. "Veterinary Microbio- logy." By Professors Mosselman and Lienaux, Nat- ional Veterinary College, Cureghem, Belgium. Trans- lated and edited by R. R. Dinwiddle, Professor of Veterinary Science, College of Agriculture, Arkansas State University. 12mo, cloth, 342 pages 2 50 12 William R Jenkins' Veterinary Books. ONOCARD. "The Animal Tuberculoses, and their Relation to Human Tuberculosis." By Ed. Nocard, Professor of the Alfort Veterinary College. Trans- lated by H. Scurfield, M.D. Ed., Ph. Camb. Perhaps the chief interest to doctors of human medicine in Professor Nocard's book lies in the demonstration of the small part played by heredity, and the great part played by contagion in the propa- gation of bovine tuberculosis. It seems not unreason- able to suppose that the same is the case for human tuberculosis, and that, if the children of tuberculosis parents were protected from infection by cohabitation or ingestion, the importance of heredity as a cause of the disease, or even of the predisposition to it, would dwindle away into insignificance. ]2mo, cloth, 143 pages 1 00 PEGLER. "The Book of the Goat." 12mo, cloth. . . 1 75 PROCTOR. " The Management and Treatment of the Horse" in the Stable, Field and on the Road. By William Proctor. 8vo 2 40 PETERS. "A Tuberculous Herd-Test with Tuber- culin." By Austin Peters, M. R. C. V. S., Chief Inspector of Cattle for the New York State Board of Health during the winter of 1892-93. Pamphlet 25 REYNOLD. "Breeding and Management of Draught Horses." 8vo, cloth 1 40 ROBERTSON. "The Practice of Equine Medicine." A text-book especially adapted for the use of Veter- inary students and Veterinarians. By W. Robertson, Principal and Professor of Hippopathology in the Royal Veterinary College, London. 8vo. cloth, 806 i, revised edition 6 25 (**)ROBERGE. "The Foot of the Horse," or Lame- ness and all Diseases of the Feet traced to an Unbal- anced Foot Bone, prevented or cured by balancing the foot. By David Roberge. 8vo, cloth 5 00 William R. Jenkins' Veterinary Books. 13 (*) SMITH. **A Manual of Yeterinary Physiology." By Veterinary Captain F. Smith, M.E.O.V.S. Author of " A Manual of Veterinary Hygiene." Throughout this manual the object has been to con- dense the information as much as possible. The broad facts of the sciences are stated so as to render them of use to the student and practitioner. In this second edition— rewritten— Ihe whole of the Nervous System has been revised, a new chapter dealing with the Development of the Ovum has been added together with many additional facts and illustrations. About one hundred additional pages are given. Second edition, revised and enlarged, with additional illus- 3 75 trations {**) SMITH. "Manual of Yeterinary Hygiene." 2nd edition, revised . Crown, 8vo, cloth 3 25 STOHNMOUTH. "Manual of Scientific Terms." Especially referring to those in Botany, Natural History, Medical and Veterinary Science. By Rev, James Stornmouth ^ 00 {**)STItANGEWAY. 'Yeterinary Anatomy. ' New edition, revised and edited by I. Vaughn, F.L.S., M R C V S., with several hundred illustrations. 8vo, cloth.; 500 VETERINARY DIAGRAMS. Five Charts, on stout paper, as follows : No. 1. With eight colored illustrations. External Form and Elementary Anatomy of the Horse 1 25 No. 2. "The Age of the Domestic Animals." With forty-two woodcuts ''-• No. 3. " Unsoundness and Defects of the Horse." With fifty wood cuts '^^ No. 4. "The Shoeing of the Horse,Mule, and Ox." With fifty-nine wood-cuts • "^5 14 William R. Jenkins' Veterinary Books. No. 5. "The Elementary Anatomy, Points, and Butcher Joints, of the Ox." With seventeen colored illus- trations 1 25 These are printed with explanatory text. Price, per set of five 4 7) WALLEY. "Hints on the Breeding- and Rearing- of Farm Animals." 12iuo, cloth — 80 WALLET. " Four Bovine Sconrges." (Pleuro-Pneu- monla, Foot and Mouth Disease, Cattle Plague and Tubercle.) With an Appendix on the Inspection of Live Animals and Meat. Illustrated, 4to, cloth 6 40 WALLEY. "The Horse, Cow and Dog." By Dr. Thomas Walley. A poetical account of the " Troubl- ous Life of the Horse " ; " The Life of a Dairy Cow," and " The Life of a Dog " ; with an article on Animal Characteristics. 12mo, cloth 80 WALLEY. "A Practical Guide to Meat Inspection." An important work, and will be found invaluable to all Health oflQcers and Sanitarians. By Thomas Walley, M.R.C.V.S. 8vo, cloth, 47 colored illustrations. New and revised edition in press (**) WILLIAMS. "Principles and Practice of Veter- inary Medicine." New author's edition, entirely revised and illustrated with numerous plain and color- ed plates. By W. Williams, M.R.C.V.S.Svo., cloth. 6 00 (**)WILL1AMS. "Principles and Practice of Veter- inary Surg-ery." New author's edition, entirely revised and illustrated with numerous plain and colored plates. By W. Williams, M.R.C.V.S. 8vo, cloth 6 00 ZUNDEL. "The Horse's Foot and Its Diseases." By A. Ziindel, Principal Veterinarian of Alsace Lorraine. Translated by Dr. A. Liautard, V.S. 12mo, cloth illustrated 2 00 ZUILL. "Typhoid Feyev; or Contagious Influenza in the Horse." By Prof. W. L. Zulll, M.D.,D.V.S. Pamphlet , 25 Williaia a. Jenkins' Veterinary Booka. VETERINARY JOURNALS. Veterinary Journal and Annals of Comparative Patliology. Edited by Prof. William Williams, (Monthly), per annum, $5 00 Current numbers 0 50 Tlie Journal of Comparative Pathology and Tlierapeutics. Edited by J. M'Fadyean, M.B., B Sc, F.R.S.E. (English.) (Quarterly), per annum 3 00 Current number 75 American Yetprinary Review. Edited by Prof. A. Liautard, M.D., V.M., with the assistance of Prof. W. Coates, M.D., D.V.S., Prof. Roscoe E. Bell, D.V.S. and others. Per annum 3 00 Current number 25 The Journal of Comparative Medicine and Veterinary Archives. Edittid by Eush Shippen Huidekoper, Veterinarian (Alforl), W. Horace Hoskins, D.V.S., and H. D. Gill, V.S. Per annum 3 00 Current number 30 Webster Family Librany of Veterinary fvledicine Cummings School of Veterinary fvledicine at Tutts University 200 Westboro Road North Grafton, MA 01536 Mwl^. i* A « i,i iAJJA i i -v. '^tf 9 WVf^t^^ :'^'%^ ^-"'■r'x". # H l§ ^1. 'I -1 ^'i ^ # ■■^'' ,vy f«.mj